- Choose strategy

DIRECTING
 The implementation phase of the nurse BSN018 ⋆ Group
manager’s job.
 Involves carrying out of plans, working on
the objectives to achieve the broader
3. 69- Change is integrated into
Refreezing
the present behavior and is no longer
purpose and goals of the organization questioned or criticized.
unit.
 Is the issuance of orders, assignments & LEADING
instructions enables nursing personnel to  Is defined as “to guide, to go before and
understand what are expected of them. show the way”
 Nurses can maximally contribute to the  Leadership is the art of developing people.
organization’s goals and to the nursing
service objectives. Leadership Activities
 Actuates efforts to accomplish goals. 1. Actuating efforts to accomplish goals.
 It is the connecting link between 2. Supervising or overseeing work of
organizing for work and getting the job employee.
done. 3. Coordinating or unifying personnel and
 In nursing, directing is giving directions to services among others.
others to attain quality care.
Leadership Roles
 CHANGE - Any alteration in status quo. ➢ Manager - Directs, supervises, and
- Occurs when there is imbalance coordinate the efforts of their
in the forces working toward maintaining subordinates.
the current situation and the forces ➢ Administrator - Concerned with the over-
working towards disrupting it. all planning and setting up objectives,
 Status quo – the situation that exists at a developing and scheduling of programs,
particular time. budget proposals, and establishment of
 E.G. – They want to keep the status quo. policies.
➢ Supervisor - Assumes the responsibility
Type of Change of managing nursing care and services in
1. Organizational or Institutional drift - two or more nursing units.
A person is a passive participant, people ➢ Headnurse - Responsible for the
respond to forces such as personalities, management and supervision of a
aging, financing or legislation without particular unit.
realizing that change is occurring.
2. Traditional Approach - Based on the Leadership Qualities
assumption that the ideas change the ✔ A leader possesses a striking physical
world and therefore the emphasis is personality and is energetic.
placed on direct teaching. ✔ A leader possesses a sense of purpose and
3. Planned Change - Involves a problem direction
solving process with specifically identified ✔ A leader has the power of ready speech.
elements. There is a deliberate ✔ A leader is enthusiastic about the purpose
collaborative action directed toward goal of the group and is devoted to its cause.
attainment ✔ A leader has a keen insight into human
4. Passive – remaining calm and showing no nature of people.
feeling when provoked ✔ A leader display courage and persistence
even in the face of opportunity.
Phases of Change ✔ A leader is decisive.
1. Unfreezing - Forces are mobilized in the ✔ A leader is cheerful and even-tempered.
direction of producing true change and ✔ A leader show technical mastery that
helping collaborative relationships are inspire above performance in their job.
formed. ✔ A leader is intelligent, versatile, and has
2. Movement - The problem is identified, sense of humor.
alternative solutions are explored, goals ✔ A leader has a moral vision, integrity, and
and objectives are set & mobilized in idealism.
producing true change and helping
collaborative relationships are formed. DELEGATING
- Identifying the problem Delegation
- Asses environment
  The process by which a manager assigns 3. Evaluating the staff and/or taking
specific tasks to workers with necessary corrective disciplinary action.
commensurate authority to perform. 4. Responsibility for maintaining morale or
 Trains & develops staff members who opportunity to say few words of
desire greater opportunities and encouragement to the staff especially the
challenges in their work making them new ones.
more committed and satisfied in their 5. Jobs that are too technical and those that
jobs. involve trust and confidence.

Reasons For Delegating SUPERVISION

• It saves time and can help develop others.  To inspect, to guide, evaluate and improve
• Delegation maximize the use of the work performance of employees through a
talents of staff associates criteria against which the quality and
• Staff’s involvement tends to increase their quantity of work production and utilization
motivation and commitment to accomplish of time and resources are made.
goals.  Involves providing guidance and direction
• It reduces managerial costs. to work in order to achieve a certain
purpose.
The 4 Rights of Delegation  The main goal is to attain quality care for
1. Task - Within the scope of the person’s each patient and to develop potentials of
practice workers for an effective and efficient
2. Person - An appropriate job description performance.
3. Communication - Clear, concise,
complete & correct Purposes :
4. Feedback - Get input, recommend ➢ Inspect, evaluate, and improve worker’s
solution and recognize the effort performance
➢ Provide suitable working conditions for the
Consideration for delegation staff
1. Culture ➢ Orient, train and guide the individual staff
member
2. Communication- Speech , dialect,
kinesics (gestures, eye movement) use of
Principles of Supervision
touch, and tone of voice.
• Focused on improving the staff’s work
rather than on upgrading self.
Reasons for Under-Delegating
• Based on predetermined individual needs
• Planned cooperatively
• Managers may think that they can do the
• Employs democratic methods
job more quickly themselves, resent
• Stimulates the staff to continuous self
interruptions.
improvement
• Lack of confidence to their staff.
• Respect the individuality of staff members
• In some cases, managers are afraid that
• Helps create a social, psychological, and
their staff will out perform them.
physical atmosphere where the staff is
free to function at his own level.
Reasons for Not Accepting Delegation
• Staff lacks self-confidence, fear failure and
Nursing Supervisory Technique
criticism.
1. Observation of workers while having her
• Lack of guidelines, standards and control
rounds.
are additional problems.
2. Spot checking of charts – nursing audit
• Duties are not clearly defined, authority
3. Asking patients about the care they
not specified and resources not readily
received.
available.
4. Looking into general condition of the unit.
• Staffs are already overworked, they do not
5. Getting feedback from co-workers or other
want to do the job if the manager receives
supervisors.
the credits.
6. Asking questions discretely to find out
problems encountered in the wards.
What cannot be delegated
7. Drawing out suggestions from the workers
1. Over-all responsibility, authority &
for improvement of their work/ work
accountability for satisfactory completion
situation.
of all activities in the unit.
2. Authority to sign one’s name is never
Supervision Tools
delegated.
 • Organizational Tools - Statistical reports
• Personnel Policies
• Communication Devices 2. DOWNWARD Communication - Superior
• Purposeful Rounds to subordinates. Aims to impart what
• Guides to Workmanship personnel need to know what they are to
- Admin. and Supervisory Manual do and why they are to do these.
- Policy Manual Example: - Policies
- Procedure Books - Rules and regulations
- Administration of medical treatment - Memorandums
- Staffing and Scheduling patterns - Handbooks
- Model Charts - Interviews
- Job Description - Job description
• Evaluation - Performance appraisal

PARTICIPATORY MANAGEMENT 3. HORIZONTAL Communication - Flows

 The nurses are given increasing authority between peer, personnel or department
to manage themselves. on the same level
 There is increased accountability of the Example:
employee through self supervision. - Endorsement
 Outcome: high morale, teamwork, and - Nursing rounds
participation. - Journal meetings and conferences
 It increases individual and organizational - Referrals between departments or
capabilities to learn, adapt and develop service
toward higher levels of excellence.
4. OUTWARD Communication - Deals with
Decision Making information that flows from caregivers to
 Is a course of action that is consciously patients, families, relatives, visitors and
chosen from available alternatives for the community. Patient should understand the
purpose of achieving a desired result. nature of their illness, medical and nursing
 Involve a choice utilizing mental processes care plan so that they could participate in
at the conscious level and is aimed at decisions.
facilitating a defined objective.
COORDINATION
COMMUNICATION  Synchronization of activities among the
 Transmission of information, opinions and various services and departments
intentions between and among enhances collaboration of efforts resulting
individuals. in efficient, smooth and harmonious flow
 Facilitates work, increase motivation, of work.
effect change, optimize care, increase  Unites personnel and services toward a
worker satisfaction and facilitate common objective.
coordination.  Prevents overlapping of functions,
 Binds the organization to ensure common promotes good working relationships and
understanding. work schedules are accomplished as
targeted.
LINES OF COMMUNICATION  Enhances communication process
 Communication is described as a two way necessary to unite, facilitate and
process, yet in an organization, it is a four- synthesize resources.
way process.
Pointers for Effective Coordination
1. UPWARD Communication – Emanates • Responsibilities should be clearly defined
from subordinates and goes upward. Form and
of feedback to slow the extent to which understood by all.
downward communication has been • Policies, guidelines and SOPs on inter-
received, accepted and implemented. departmental relationships should be
Example: established
- Discussion between subordinate and and made available to all.
superior • Channels of Communication should be
- Grievances procedures followed
- Written reports
- Incident reports CONFLICT
  A clash between two hostile and opposing c. Intragroup – is manifested in feelings
parties. of unfairness over distribution of
 A warning to managers that something is assignments, off duties and holidays
wrong and need solution through problem among the staff.
solving and clarification of objectives, Strategies for Conflict Management
establishment of norms and determination 1. WIN-LOSE – includes the use of position
of group boundaries. power, mental physical power, failure to
 Conflict that is managed instead of being respond, majority rule, rail-roading,
ignored or competing.
 suppressed can be used effectively (can 2. LOSE-LOSE – includes compromise,
stimulate competition, identify differences bribes for accomplishing disagreeable
within the institution). tasks arbitration by neutral third party.
 Unresolved conflict is debilitating and 3. WIN-WIN – it focus on goals and
oftentimes frustrating emphasis consensus an integrative
- productivity declines and the possibility approaches to decision making. Focus on
of mistakes occur. the problem not with the person, or the
collection of facts, on the acceptance of
Conflict Management useful aspects ofconflicts and the
Sources of Conflict accordance of self oriented behavior.
 Personality Clashes
 Status Differences CONFLICT RESOLUTION
 Scarcity of Resources ➢ AVOIDANCE – commonly used by group
 Goal Differences who do not want to do something that
 Unworkable Organizational structure may interfere with their relationship.
 Unacceptable Leadership Style Neutrality is maintained at all times.
Appropriate to reduce tension and gain
 Ambiguity – a word or phrase that is composure. “Lose-Lose Situation”
ambiguous has more than one meaning ➢ ACCOMODATION – means self practice.
The person neglects his own needs to
CONFLICT MANAGEMENT meet the goals of the other party. Used to
Types of Conflict preserve harmony and gain social credits
1. Based on Hierarchical Relationship that can be used later. “Win-Lose
a. Vertical – difference in opinion Situation”
between superior and subordinates * Composure – the ability to stay calm
which is caused by inadequacy of ➢ COLLABORATION – inspires mutual
communication, opposing interests, attention to the problem and utilizes the
and lack of shared attitudes. talents of all parties. Focuses on problem
b. Horizontal or line-staff conflict - solving to find mutually satisfying
Arises as a common struggle between solutions Most effective method of conflict
department and services wherein the resolution. “Win-Win Situation”
degree of interdependent and ➢ COMPROMISE – both parties seek
collaboration determines success in expedient, acceptable answers for short
achieving share goals and objectives. periods when goals are only moderately
important and the parties have equivalent
1. Based on Behavioral Standpoint - It is power. “Lose-Lose Situation”
a perceived condition that exists between ➢ COMPETITION – the supervisor or nurse
two parties, when one or more parties manager exerts power at the
perceive goal incompatibility and some subordinate’s expense. Expressed through
opportunity for interfering with goal suppression of conflict through authority-
achievement of the other. obedience approach. Enforce the rule of
discipline. “Win-Lose Situation”
2. Based on Process Standpoint ➢ SMOOTHING – disagreements are
a. Intrapersonal – occurs within one ignored so that surface harmony is
individual when confronted with two or maintained in a state of peaceful co-
more incompatible demands or values. existence. Appropriate in solving minor
ex. Ethical issues problems but issues also remain
b. Interpersonal – also known as unresolved and may later resurface. “Win-
“horizontal violence” or “bullying” Lose Situation”
happens bet. 2 or more people with ➢ WITHDRAWING – one party is removed
different beliefs and attitudes. thereby making it possible to resolve the
 issue. It produces the same result as ○ Job enlargement
smoothing. ○ Job enrichment
➢ FORCING – yields an immediate end to
the conflict but leaves the cause on the 1. Provide Productive Climate & High
conflict unresolved. Appropriate in life and Morale
death situations but otherwise - Climates are clusters of employee
inappropriate. perception of an organization’s events,
practices & procedures.
Motivation - Morale implies “good spirit”
 Defined as the desire to do the job. cohesiveness or a group cooperation.
 “The Inner Drive”, impulse or intention
that causes one to act or believe in certain 2. Staff Development
way, or seek particular goal. - Nurses are given opportunities to attend
conferences or seminars conducted by
What factors motivate people? other agencies or associations, or to go
1. THE NEED HIERACHY APPPROACH back to formal schooling such as graduate
Maslow’s hierarchy of needs schools.
1. physiological,
2. security,
3. belongingness,
4. esteem, and
CONTROLLING
 or Evaluation
5. self-actualization  is an ongoing function of management
which occurs during planning, organizing
1. HERZBERG’S - Theory of Job Satisfaction and directing activities.
a. Hygiene Factor – are associated  It includes assessing and regulating
with working conditions such as performance in accordance with the plans
pay, quality of supervision, job that have been adopted, the instructions
security and agency policies. issued, and the principles established.
b. Motivation Factor – are
associated with the work itself- Reasons for Conducting Evaluation
challenges ,added responsibility, 1. Evaluation ensures the quality nursing
opportunities for personal growth care is provided.
and advancement. 2. It allows for the setting of sensible
objectives and ensures compliance with
Ways to Increase Staff Motivation them.
1. Manage change properly 3. It provides standards for establishing
- Implement change only for good reasons comparisons.
a. Change in order to solve problems. 4. It promotes visibility and a means for
b. Change to make work procedures employees to monitor their own
more efficient so that time will not performance.
be wasted. 5. It highlights problems related to quality
c. Change to reduce unnecessary care and determines the areas that
workload. require priority attention.
6. It provides an indication of the costs of
1. Assign “Undesirable Jobs” on a poor quality.
rotation basis 7. It justifies the use of resources.
- Usually the best employee gets to do the 8. It provides feedback for improvement.
“bad” jobs because you are assured that it
will be done properly. However, it may Evaluation Principle
give impression that the rewards of high 1. Evaluation must be based on the
performance is doing disagreeable tasks. behavioral standards of performance
which the position requires.
2. Job Redesign 2. In evaluating performance, there should
- Purpose: to create jobs that provide a be enough time to observe employee
high degree of internal work motivation, behavior.
high quality of work performance, high 3. The employee should be given a copy of
satisfaction with the work, and low the job description, performance
absenteeism & turnover. standards and evaluation form before the
- Methods of changing job are: evaluation conference.
○ Job rotation
 4. The employees’ performance appraisal 1. Essay - The appraiser writes a paragraph
should include both satisfactory and or more about the worker’s strengths,
unsatisfactory result with specific weaknesses and potentials.
behavioral instances to exemplify these 2. Checklist - Is a compilation of all nursing
evaluative comments. performances expected of a worker.
5. Area needing improvement must be 3. Ranking - The evaluator ranks the
prioritized. employees according to how he or she
6. The evaluating conference should be fared with co-workers with respect to
scheduled and conducted in a convenient certain aspects of performance.
time. 4. Rating Scales - Includes a series of items
7. The evaluation report and conference representing the different task or activities
should be structured in such a way that it in the nurse’s job description or the
is perceived and accepted positively as a absence or presence of desired behaviors
means of improving job performance. and the extent to which these are
possessed.
Basic Components of the Control Process 5. Forced-Choice Comparison - The
1. Establishment of Standards for measuring evaluator is asked to choose the
performance statement that best describes the nurse
2. Measurement of actual performance being evaluated.
3. Comparison of results of performance 6. Anecdotal Reporting - Describes the
with standards and objective and nurse experience with a group or a
identifying strengths and areas for person, or in validating technical skills and
correction and improvement interpersonal relationship.
4. Action to reinforce strength and success
5. Implementation of corrective action as Quality Assurance
necessary  is the estimation of the degree of
excellence in patient health outcomes and
Performance Appraisal in activity and other resources outcomes.
 is a process in which employee’s  QUALITY (The degree of excellence) +
performance is evaluated against ASSURANCE (Formal guarantee of a
standards. degree of excellence)
Purpose:
1. Determine salary standards and merit Quality Assurance Methods
increase. 1. Nursing Audit Committee
2. Select qualified individual for promotion or 2. Patient Care Audit
3. Peer Review
transfer. 4. Quality Circles
3. Identify unsatisfactory employees for 5. Utilization of Results
demotion or termination.
4. Make inventories of talent within the
institution.
5. Determine training and developmental Control of Resources
needs of employees. 1. Periodic review of utilization of materials
6. Improve the performance of work groups and supplies
by examining, improving, correcting 2. Requisitions
interrelationship. 3. Inventory
7. Improve communication between 4. Utilization Report
supervisors and employees and reach an 5. Regular inspection
understanding on the objective of the job.
8. Establish standards of supervisory Discipline
performance.  is regarded as a constructive and effective
means by which employees take personal
9. Discover the aspirations of employees and
responsibility for their own performance
reconcile these with the goals of the
and behavior.
institution.
10. Provide “employees recognition” for Factors that Influence Discipline
accomplishments. 1. A strong commitment to the vision,
11. Inform employees “where they stand”. philosophy, goals and objectives of the
institution.
Methods of Measuring Performance
 2. Laws that govern the practice of all
professional and their respective Codes of
Conduct.
3. Understanding the rules and regulations of
the agency.
4. An atmosphere of mutual trust and
confidence.
5. Pressure from peers and organization.

Disciplinary Approaches
1. A set of disciplinary rules
2. Disciplinary committee
3. Orientation program
4. Continuous communication

 Problem Solving - Effective supervision

aids supervisors in analyzing the work
problem of their subordinate.
 DISCIPLINARY ACTION - Any employee
charged for breach of the rules and
regulations, policies, norms of conduct
shall be given due process.
 COUNSELING AND ORAL WARNING -
Are best given in private and in an informal
atmosphere. The employee is given a fair
chance to air his side.
 WRITTEN WARNING - It is preceded by an
interview similar to the oral warning. The
employee must be told after the interview
that he will be given a written warning.
 SUSPENSION - Is given after an evidence
of oral and written warning. Is applied
when the management feels that the
employee can still be rehabilitated.
 DISMISSAL - Is invoked when all other
disciplinary efforts have failed. The cause
of dismissal should conform within the
policy manual or the Civil Service Rules.