DIRECTING AND CONTROLLING

Directing
 issuance of orders, assignments, and instructions that enable the nursing personnel to understand what are
expected of them.
 includes supervision and guidance so that in doing their jobs well, nurses can maximally contribute to the
organization’s goals in general and to the objectives of nursing service in particular
Importance
1. Establish direction in carrying out desired action
2. Influence nursing personnel to follow the direction
3. Initiate actions
4. Integrate efforts
5. Become a means of motivation
6. Provide stability
7. Enable employee to cope with the changes
8. Help in efficient utilization of resources
Purpose
1. Obtain the optimum return from all staff in the interest of the institution
2. Bring personal and professional growth of employees
3. Bridge the gap of directing
4. Create a direct link between the nurse managers and the nursing personnel through effective communication
5. Maintain standards of services cooperatively to develop coordination to avoid overlapping
6. Assist in the problem solving of the matters concerning personnel
7. Assess continuously the services given personnel performance
Principles
Harmony of objective Employees work well when they feel that their physiological and psychological needs are met.
Unity of command Dual subordination brings d/o and chaos, undermines authority and leads
instability.
Appropriate direction techniques Motivation such as pay, incentives, awards, status, promotion, etc., can increase job
satisfaction, productivity and quality/excellence of work.
Use of informal organization Special attention should be given to the informal organization to strengthen the formal
organization.
Managerial communication Direct and personal contact or feedback makes supervision effective and motivating.
Appropriate leadership style Nurse managers to influence their subordinates must provide good leadership.
Follow through follow up Nurse managers must monitor as to what extent the policies framed and issued directions
have been enforced.
Characteristics
 Initiates action
 Giving directions and instructions the nurse managers get the work started in the organization
 Continuous process
 Nurse managers continuously take steps to ensure that orders and instructions are carried out properly.
 Takes place at every level
 Directing is a pervasive function of all manager at all levels in all units perform it.
 Flows from top to bottom
 Nurse managers direct their immediate subordinates and take directions from their immediate superiors.
 Performance-oriented
 Directing function helps converting plans to performance.
 Human level
 the talents and skills of the subordinates, which can be used for succession planning.
Purposes of Delegation
1. Provide appropriate distribution of tasks for safe and quality nursing care
2. Promote individual responsibility and accountability
3. Allow the nurse to perform more complex patient care and other related services
4. Reduce workload to prevent burn out
5. Enhance the knowledge and skills of nursing personnel and other health care workers
6. Promote cost containment and effectiveness for the health care facility.
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.
Elements of Delegation
1. Responsibility
2. Authority
3. Accountability
 Rights of Delegation
1. Right task
2. Right circumstances
3. Right person
4. Right direction and communication
5. Right supervision and evaluation
Steps in Delegation
 Prepare
 Assign
 Confirm understanding and commitment
 Monitor accomplishment against the assigned tasks
 Ensure accountability
Pointers to Proper delegation of work
 Provide clear and specific instructions
 Give authority commensurate to responsibility
 Keep subordinates informed
 Show you have confidence in your subordinates
 Be loyal
Ways for nurse Mangers to Delegate Successfully:
 Train and develop subordinates
 Plan ahead, it prevents problems
 Control and coordinate the work of subordinate
 Visit subordinates periodically
 Coordinate to prevent duplication of effort
 Specify goals and objectives
 Solves problems
 Know subordinates’ capabilities and match the task or duty to the employees.
 Agree on performance standards
 Take an interest
 Do not take back delegated task
What Cannot Be Delegated
There are matters that cannot be delegated. Among these are:
1. Overall responsibility, authority, and accountability for satisfactory completion of all activities in the unit.
2. Authority to assign 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 involve trust and confidence.
Why Nurse Managers Do Not Delegate
There are some reasons why nurse managers fail to delegate.
 Lack of confidence in their staff, feeling that only they could do the task better and faster, or fear of loss of control
if some of their duties are delegated. Subordinates may be apprehensive in accepting delegated task for fear of
criticism, ineptitude, or incompetence.
 Insecurities may be avoided if there is open communication among the staff. Warm and cordial relationships
where everyone is free to ask questions or seek clarifications regarding of delegated task which to them may be too
difficult to understand.
Utilizing / Revising / Updating Nursing Service Policies and Procedures
 Policies, procedures, rules, and regulations are the standing plans of an organization. Nursing service exists for
standardization and as a source of guidance for the nursing staff.
 Policies promote consistency of action and stability. It speeds up decision making. It helps conserve time by
setting standards. Uniformity of standards promotes fairness and prevents conflicts. Policies as usually written
and ma de their periodic review and revision necessary.
 Current and written procedure manuals should be available to all nursing personnel. A procedure manual outlines
a standard technique or method in performing duties. It serves as guide for action. It contains detailed plans for
nursing skills and includes steps in proper sequence.
 A manual is used by employees to review a procedure which is not familiar to them or which they have not done
for some time. It is used to teach new employees or orient them to procedures that are commonly done in the
institution but which the employees may not familiar with. The manual of procedures on patient care should
inform, teach, and reduce the chances or errors.
 Policies, procedures are updated by a committee of professional nurses.

SUPERVISION
The word “supervision” comes from the word “supervide” which means “to oversee or view directly.”

Supervision is providing guidelines for the accomplishment of a task or activity with initial direction and
periodic inspection of the actual accomplishment of the task or activity.
It appraises not only the quantity and quality of work performed, but also the time within which the work is
accomplished, the proper and economic utilization of resources,
the amount of assistance needed by the worker, and the need for staff development or continuing education
programs.

The nurse who delegates is responsible for the acts of the subordinate and may incur liability if found negligent in the
process of delegating and supervising. This is under the doctrine of I respondeat superior which mean “let the
superior answer for the acts of the subordinate.”
Qualities of Good Supervision
Good supervision requires
 Good technical, managerial and human relation skills;
 Ability to communicate well in both spoken and written language and ability tom listen;
 Firmness with flexibility to adjust to the needs of the situation;
 Fairness in dealing with employees;
 Familiarity with hospital and nursing policies that affect patient care;
 Good decision-making skills;
 Willingness to grow and develop;
 Ability to accept changes and consider them as challenges;
 Dignified and pleasing personality;
 Ability to motivate employees and provide opportunities for continuing professional growth and development;
and Advocacy for nurses and nursing.
Principles of Good Supervision
 Good supervision requires adequate planning and organization which facilitate cooperation, coordination,
and synchronization of services.
 Good supervision gives autonomy to workers depending on their competency, personality, and
commitment.
 Good supervision stimulates the worker’s ambition to grow into effectiveness.
 Good supervision creates an atmosphere of cordiality and trust.
 Good supervision considers the strengths and weaknesses of employees.
 Good supervision strives to make the unit an effective learning situation.
 Good supervision considers equal distribution of work considering age, physical condition, and
competence
Techniques in Supervision
1. observation of the worker while making the rounds;
2. spot checking of chats through nursing audits; asking the patients about the care they receive;
3. looking into the general condition of the units;
4. getting feedback from co-workers or other supervisors or relatives
5. asking question discretely to find out the problems they encounter in the wards; or
6. drawing out suggestions from the workers for improvement of their work or work situation.
Given in a soft, courteous manner, these will be taken willingly and accepted as a challenge to improve
performance. Give harshly, especially in public, it builds up resentment, ill-will, and poor quality of work.

Participatory Management
1. Decentralization and participatory management have changed to role of Supervision Nurses.
2. They learn to delegate authority to Head Nurses, their responsibility for unit management decreases.
3. The climate of supervision changes.
4. The nurses are given increasing.
5. The nurses are given increasing authority to manage themselves. Rather than direct the work force, the
Supervising Nurse assumes the role of mentor, role model and facilitator.
6. Some hospitals have changed the position of Supervising Nurse into Clinical Coordinator or Clinical
Managers.
7. In participatory management there are mutual trust and support There is increased accountability of the
Head Nurse and of employees through self-supervision. High morale and team work result in increased
effectiveness and productivity and increased commitment and recognized of contribution. Participation
increases individual and organizational capacities to learn, adapt, and develop toward higher levels of
excellence, Venson, (2016).
8. There are some disadvantages of participatory management. Among these are difficulty in changing the
perception of employees about the previous authoritarian management, occasional failure, and difficulty in
fixing responsibilities. Nurses can be more actively involved in participatory management through job
enrichment, involvement in critical decisions that affect them, and by providing liberal training and opening of
career opportunities, Venzon, (2016).

Coordination unites personnel and services toward a common objective. Synchronization of activities among the
various services and departments enhances collaborative efforts resulting inefficient, smooth and harmonious flow of
work.
Supervising Nurses and Head/ Senior services coordinate their work with other departments services or units by
conveying clearly define policies, standards operating procedures, policies, and guidelines using the proper channels of
communication.
Importance of Coordination
 Ensure unity of direction
 Create stronger workforce
 Enhance employee morale and provides satisfaction
 Facilitates diverse and specialized activities
 Promote effective patient care management for general interest
 Establish positive work environment
Types of Coordination
External-Coordination with the outside parties with whom the organization has the business connections like
government supplies, customers, etc.
Internal-Coordination among the employees of the same department or section.
Horizontal-Coordination that takes place between different departments.
Vertical-Coordination that exists between departments where the department heads are asked to coordinate the work
of the employees.
Coordination with Hospital Services
 C/ Medical Professional Services
 Nurses should know the Medical Staff in their respective units, and their services and scheduled time of medical
rounds.
 C/Administrative Service- pertains to both human and material resources.
 Coordination with Laboratory ServiceRequest for laboratory examinations are forwarded to the laboratory unit.
 C/the Radiology Service -Request for x-ray examination
 C/ Pharmacy Service-Policies/ Dietary Service
 C/Medical social Service Nurses C/ Medical Social Service by referring patients with psycho-social problems.
 C/ Medical Records Service-Nurses are responsible for the accurate documentation and completeness of the
patient’s charts, including their safety and confidentiality.
 C w/ Community Agencies, other Institutions, and Civic Organization Networking or linkages with community
agencies, civic organizations, or other institutions are often necessary for continuity of patient care.

Motivation
 influenced by complex set of social, professional and economic factor. Human beings are motivated by different
goals, ambitions, and aspirations. Health worker will be motivated and express job satisfaction if they feel that
they are effective at their jobs and performing well.
 amount and quality of work accomplished by the manager directly reflect their motivation and that of their
subordinates. They teach and empower their workers and apply knowledge, skills and techniques of motivational
theories to achieve individual goals.
Importance of Motivation
1. Put human resources into action- It is through motivation that the human resources can be utilized by making
full use of it.
2. Improves level of efficiency of employees- For getting best of his work performance, the gap between ability and
willingness has to be filled which helps in improving the level of performance of subordinates. This result into:
 Increase productivity
 Reducing cost of operations and
 Improving overall efficiency
3. Leads to achievement of organizational goals:
1. There is best possible utilization of resources
2. There is a co-operative work environment
3. The employees are goal directed and they act in a purpose manner
4. Goals can be achieved if co-ordination and co-operation takes place simultaneously which can be effectively
done through motivation.
4. Builds friendly relationship- Motivation is an important factor which brings employees satisfaction This could
initiate the following things:
1. Monetary and non-monetary incentives
2. Promotion opportunities for employees
3. Disincentives for inefficient employees.
Leads to stability of work force- very important from the point of view of reputation and goodwill of a concern, DOH
Manual, (2016).