Management Lecture 2011

8/8/2019 Management Lecture 2011

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NURSING MANAGEMENTNURSING MANAGEMENT

PROCESSPROCESSPREPARED BY: MMSANTOS R.N.PREPARED BY: MMSANTOS R.N.

MAN.MAN.



TOPIC III. ORGANIZATIONAL ANDTOPIC III. ORGANIZATIONAL ANDMANAGEMENTMANAGEMENT

A. . Concept management A. . Concept management 1. Management 1. Management

1. Factors in management 1. Factors in management

2. Principles in management 2. Principles in management



2. Administration2. Administration a. Factorsa. Factors b. Principlesb. Principles

3. Leadership3. Leadership 4. Organization4. Organization 5. Authority5. Authority 6. Power6. Power

a. Forms of powera. Forms of power 7. Responsibility7. Responsibility 8. Divagations8. Divagations 9. Accountability9. Accountability



B. Organization in health care systemB. Organization in health care system

b.1 Organization that plan for and or regulate the primary and secondary provides ab.1 Organization that plan for and or regulate the primary and secondary provides aDOHDOH

b.2 Organization that provides health servicesb.2 Organization that provides health services a .Hospitalsa .Hospitals b. Clinicb. Clinic c. RHUc. RHU

c. Organization that provides for HCS (secondary provides)c. Organization that provides for HCS (secondary provides) a. Educational consultationa. Educational consultation

Medical SchoolMedical School Nursing schoolsNursing schools

b. Financing institutionb. Financing institution

MedicareMedicare GSIS/SSSGSIS/SSS

d. Organization that represent Primary and Secondary Providesd. Organization that represent Primary and Secondary Provides PNAPNA PMAPMA

e. Major areas and organization. Responsibilities in each of these organizationse. Major areas and organization. Responsibilities in each of these organizations



C. Management C. Management

functions/processesfunctions/processes

1. Planning1. Planning a. Definitiona. Definition b. Importance of mission, philosophy, gals and objectives to planningb. Importance of mission, philosophy, gals and objectives to planning c. Aspects of planningc. Aspects of planning d. Characteristics of a pland. Characteristics of a plan e. Movements of plane. Movements of plan f. Steps in planningf. Steps in planning g. Principle of planningg. Principle of planning h. Management by objectivesh. Management by objectives

i. Financial management i. Financial management j. Methods to plan the ward j. Methods to plan the ward k. Management by objectivesk. Management by objectives l.Financial management l.Financial management



2. . Organizing2. . Organizing

a. Definitiona. Definition

b. Organization concept b. Organization concept

c. Basic characteristicsc. Basic characteristics

d. Type of organizational structured. Type of organizational structure

e. Functions of organizational structuree. Functions of organizational structure

f. Organizational chartsf. Organizational charts

1. Hospital management service1. Hospital management service

2. RHU management service2. RHU management service

g. Principles of organizationg. Principles of organization



3. Staffing3. Staffing a. Recruitment and retentiona. Recruitment and retention b. Determinants of staffing patternsb. Determinants of staffing patterns c. Types of staffing patternc. Types of staffing pattern d. Assignment systems for staffing/d. Assignment systems for staffing/\\modalities of modalities of

patient carepatient care 1. Advantages/disadvantages1. Advantages/disadvantages 2. Team2. Team 3. Case3. Case

4. Primary4. Primary 5. Mixed5. Mixed

e. Time management e. Time management f. Conflict management f. Conflict management



4. Directing4. Directing


b.Components of directingb.Components of directing



5. Controlling5. Controlling


.b. Quality assurance.b. Quality assurance c.Performance appraisalc.Performance appraisal

d. Evolution and professional development d. Evolution and professional development



6. Reporting and recording6. Reporting and recording

a. Attributes of reportinga. Attributes of reporting

b.Principles of reportingb.Principles of reporting c.Types of report c.Types of report

d.Good reporting techniqued.Good reporting technique



7. .Budgeting7. .Budgeting

aAdvantagesaAdvantages

b.Budgeting processb.Budgeting process c.Types of budget c.Types of budget

1. Operating or revenue and expense budgets1. Operating or revenue and expense budgets

2. Capital expenditure s budgets2. Capital expenditure s budgets

3. Cash budgets3. Cash budgets 4. Labor or personal budgets4. Labor or personal budgets

5. Flexible budget 5. Flexible budget



4. Decision Making Systems4. Decision Making Systems

a. DEFNITIONa. DEFNITION

b. Decision making toolsb. Decision making tools



5. Communication Principles5. Communication Principles

a. Communication processa. Communication process

b. Communication systemsb. Communication systems c. Downwardc. Downward

d. Upwardd. Upward

e. Diagonale. Diagonal

f. Grapevinef. Grapevine



TOPIC IV. PROFESSIONALTOPIC IV. PROFESSIONALGROWTH AND DEVELOPMENTGROWTH AND DEVELOPMENT

1. In1. In--service educationservice education

2. Continuing education2. Continuing education

3. Nursing Organizations3. Nursing Organizations





Nursing managementNursing management

is performing leadership functions of governanceis performing leadership functions of governanceand decisionand decision--making within organizationsmaking within organizationsemployingemploying nursesnurses..

It includes processes common to allIt includes processes common to allmanagement like planning, organizing, staffing,management like planning, organizing, staffing,directing and controlling.directing and controlling.

It is common forIt is common for RNsRNs to seek additionalto seek additionaleducation to earn aeducation to earn a Master of Science in NursingMaster of Science in Nursingoror Doctorate in NursingDoctorate in Nursing to prepare for leadershipto prepare for leadershiproles within nursing.roles within nursing.

Management positions increasingly requireManagement positions increasingly require



The process of setting and achieving goalsThe process of setting and achieving goalsthrough the execution of five basicthrough the execution of five basicmanagement functions : planning,management functions : planning,organizing, staffing, directing andorganizing, staffing, directing andcontrolling that utilize human , financial,controlling that utilize human , financial,and material resources.and material resources.



Characteristics of a managerCharacteristics of a manager

Has an assigned position within the formal organizationHas an assigned position within the formal organization

Has a legitimate source of power due to the delegate sHas a legitimate source of power due to the delegate sauthority that accompanies the positions expected toauthority that accompanies the positions expected tocarry out specific functions duties and responsibilitiescarry out specific functions duties and responsibilities

Emphasizes control, decision making, decision analysis,Emphasizes control, decision making, decision analysis,and resultsand results

Manipulates people, the environment, money , time andManipulates people, the environment, money , time andother sources to achieve organizational goals.other sources to achieve organizational goals.

Has a greater formal responsibility and accountability forHas a greater formal responsibility and accountability forrationality and controlrationality and control

Direct willing and unwilling subordinatesDirect willing and unwilling subordinates



Management functionsManagement functions

1. Planning1. Planning

2. Organizing2. Organizing

3. Directing3. Directing 4. Controlling4. Controlling



Management ProcessManagement Process

Organizing

StaffingControlling

Directing

Planning



Five functions of management Five functions of management

processprocess 1.Planning encompasses determining1.Planning encompasses determining

philosophy, goals, objectives, policies,philosophy, goals, objectives, policies,procedures, and rules carrying out longprocedures, and rules carrying out longand short range projections; determiningand short range projections; determininga fiscal course of action; and managinga fiscal course of action; and managingplanned changeplanned change



2. Organizing includes establishing the2. Organizing includes establishing thestructure to carry out plans, determiningstructure to carry out plans, determiningthe most appropriate type of patient carethe most appropriate type of patient caredelivery, and grouping activities to meet delivery, and grouping activities to meet unit goals.unit goals.



3. Staffing functions consist of recruiting,3. Staffing functions consist of recruiting,interviewing, hiring and orienting staff.interviewing, hiring and orienting staff.Scheduling staff development, and oftenScheduling staff development, and oftenemployee socialization also are included asemployee socialization also are included asstaffing functionsstaffing functions



4. Directing sometimes includes several4. Directing sometimes includes severalstaffing functions. However, this phasesstaffing functions. However, this phasesfunctions usually entail human resourcefunctions usually entail human resourcemanagement responsibilities such asmanagement responsibilities such asmotivating , managing conflict, delegating,motivating , managing conflict, delegating,communicating and facilitatingcommunicating and facilitating

collaborationcollaboration



5. Controlling functions includes5. Controlling functions includesperformance appraisals, fiscalperformance appraisals, fiscalaccountability, quality control, legal andaccountability, quality control, legal andethical control, and professional andethical control, and professional andcollegial control.collegial control.



Integrating Nursing Process andIntegrating Nursing Process andManagement processManagement process

Simplified nursing processSimplified nursing process Management Process FunctionManagement Process Function

Assessing

Planning

Implementing

Evaluating

PL ANNING

PL ANNING

ST AFFING

ORGANIZING

ORGANIZING

DIRECTING

CONTROLLING







IS DECIDING IN ADVANCE WHAT TO DO,IS DECIDING IN ADVANCE WHAT TO DO,HOW TO DO IT, WHEN TO DO IT ANDHOW TO DO IT, WHEN TO DO IT ANDWHO IS TO DO IT.WHO IS TO DO IT.

IT IS A COGNITIVE PROCESS FORIT IS A COGNITIVE PROCESS FORDECISION MAKING.DECISION MAKING.

IN GENERAL, PLANNING IS ANIN GENERAL, PLANNING IS AN

INTELLECTUAL PROCESS BASED ONINTELLECTUAL PROCESS BASED ONFACTS AND INFORMATION, NOT ONFACTS AND INFORMATION, NOT ONEMOTION OR WISHES.EMOTION OR WISHES.



A PROACTIVE AND DELIBERATE PROCESS A PROACTIVE AND DELIBERATE PROCESSTHAT REQUIRES DECIDING IN ADVANCETHAT REQUIRES DECIDING IN ADVANCEWHAT TO DO, WHO IS TO DO IT,ANDWHAT TO DO, WHO IS TO DO IT,ANDHOW , WHEN AND WHERE IS TO BEHOW , WHEN AND WHERE IS TO BEDONE.DONE.



PLANNINGPLANNING

Process:Process:

Establish objectives (goals)Establish objectives (goals) Evaluate the present situation and predict Evaluate the present situation and predict

future trends and eventsfuture trends and events

Formulate a planning statement (means)Formulate a planning statement (means)

Convert the plan into an action statement Convert the plan into an action statement



PlanningPlanning

Is important on both an organizational and aIs important on both an organizational and apersonal level and may be an individual or grouppersonal level and may be an individual or groupprocess that addresses the questions of :process that addresses the questions of :

WHATWHAT WHY WHY

WHEREWHERE

WHENWHEN

HOWHOW

BY WHOMBY WHOM



REASONS FOR PLANNINGREASONS FOR PLANNING

Planning leads to success in achievement Planning leads to success in achievement of goals and objectives.of goals and objectives.

It brings about behaviors that lead toIt brings about behaviors that lead todesired actions and outcomes.desired actions and outcomes.

Employees can see that result of theirEmployees can see that result of theirlabor.labor.




Planning gives meaning to work.Planning gives meaning to work.

Knowing that objectives help theKnowing that objectives help the

employees relate what they are going toemployees relate what they are going tomeaningful outcome and leads to greatermeaningful outcome and leads to greateremployee satisfaction,employee satisfaction,




Planning provides for effective use of Planning provides for effective use of available personnel and facilities.available personnel and facilities.

Available resources are used to the Available resources are used to themaximum.maximum.

Planning helps in coping with crisis. PlansPlanning helps in coping with crisis. Plansanticipate emergencies; they allow theanticipate emergencies; they allow theworker to function more calmly andworker to function more calmly andefficiently when an actual crisis occurs.efficiently when an actual crisis occurs.




Planning is cost effective. Some costs canPlanning is cost effective. Some costs canbe contained through planning of nursesbe contained through planning of nursesneeded operation.needed operation.

Example: projecting the number of Example: projecting the number of courses needed to care for a groupcourses needed to care for a grouppatients or ordering enough supplies for apatients or ordering enough supplies for a

unit.unit.




Planning based on the past and futurePlanning based on the past and futurehelps reduce the element of change.helps reduce the element of change.Studying what has been successful orStudying what has been successful orunsuccessful can give the manager aunsuccessful can give the manager abetter idea of what to do in the future.better idea of what to do in the future.




By planning, one discover the need forBy planning, one discover the need forchange.change.

Planning can point out opportunities orPlanning can point out opportunities ordifferent services.different services.




Planning is necessary for effective control.Planning is necessary for effective control.Managers can evaluate the environment,Managers can evaluate the environment,resources and employees effectivenessresources and employees effectivenesswhen the expected is known.when the expected is known.



RESISTANCE TO PLANNINGRESISTANCE TO PLANNING

Failure to plan may be attributed to the followingFailure to plan may be attributed to the followingfactors:factors:

Managers may lack knowledge of theManagers may lack knowledge of thephilosophy, goals and working of thephilosophy, goals and working of theorganizationorganization

Managers may not understand the significanceManagers may not understand the significanceof planning, that success or failure of workof planning, that success or failure of workactivities relate directly to the quality of the planactivities relate directly to the quality of the plan



RESISTANCE TO PLANNINGRESISTANCE TO PLANNING

Time spent on planning often seems wasted inTime spent on planning often seems wasted inrelation to the day to day doing of ones jobrelation to the day to day doing of ones job

Some managers may lack confidence, fearingSome managers may lack confidence, fearingfailure.failure.

Some managers prefer to act to immediateSome managers prefer to act to immediateproblems because they generate immediateproblems because they generate immediatefeedbackfeedback

Planning may bring unwanted change.Planning may bring unwanted change.

Reluctance may exist because implementation of Reluctance may exist because implementation of plans may require new activities that theplans may require new activities that theindividual in unwilling to engage in.individual in unwilling to engage in.



SCOPE OF PLANNINGSCOPE OF PLANNING

1. Forecast or estimate the future1. Forecast or estimate the future

It describes the ultimate condition or projections that It describes the ultimate condition or projections that provide general incentive and direction to planningprovide general incentive and direction to planning

Should consider the:Should consider the: A. agency A. agency

B. CommunityB. Community

C. goals of careC. goals of care

Forecast must be supported by facts, reasonable estimates andForecast must be supported by facts, reasonable estimates and

accurate reflection of policies and plansaccurate reflection of policies and plans



2. setting objectives/goals2. setting objectives/goals determinedetermineresults desiredresults desired

GOALSGOALS-- ARE STATEMENT OF INTENT ARE STATEMENT OF INTENTDERIVED FROM THE PURPOSES OF THEDERIVED FROM THE PURPOSES OF THEORGANIZATION AND THEY ARE STATEDORGANIZATION AND THEY ARE STATEDBROADLY AND IN GENERAL TERMSBROADLY AND IN GENERAL TERMS

OBJECTIVESOBJECTIVES-- SPECIFIC BEHAVIOR OR TASK SPECIFIC BEHAVIOR OR TASK SET FOR ACCOMPLISHMENT OF A GOALSET FOR ACCOMPLISHMENT OF A GOAL



3. Develop and schedule strategies, programs / projects /3. Develop and schedule strategies, programs / projects /activities.activities.

Set the time frame.Set the time frame.

StrategiesStrategies are overall plans of the higherare overall plans of the highermanagement system to achieve objectives.management system to achieve objectives.

ProgramsPrograms are series of activities that functionare series of activities that functiontogether to facilitate attainment of some desiredtogether to facilitate attainment of some desiredgoalsgoals

Example: staff development programs, outreachExample: staff development programs, outreachprograms, discharge teaching program.programs, discharge teaching program.



Type of plans:Type of plans: (according to time frame)(according to time frame)

Long term plansLong term plans 33 5 years or more5 years or more

Short term plansShort term plans 6 months to one year6 months to one year



4. Prepare the budget 4. Prepare the budget--allocate resourcesallocate resources

BUDGETBUDGET

ALLOCATION OF SCARCE RESOURCES ON THE ALLOCATION OF SCARCE RESOURCES ON THE

BASIS OF FORECASTED NEEDS FOR PROPOSEDBASIS OF FORECASTED NEEDS FOR PROPOSED ACTIVIIES OVERA SPECIFIED PERIOD OF TIME ACTIVIIES OVERA SPECIFIED PERIOD OF TIME

A TOOL PLANNING, MONITORING AND A TOOL PLANNING, MONITORING ANDCONTROLING COST OR A SYSTMATIC PLAN FORCONTROLING COST OR A SYSTMATIC PLAN FOR

MEETING EXPENSES.MEETING EXPENSES.



Type of plans:Type of plans: (according to time frame)(according to time frame)

Long term plansLong term plans 33 5 years or more5 years or more

Short term plansShort term plans 6 months to one year6 months to one year



PLANNING CAN BE:PLANNING CAN BE:

A. Contingent A. Contingent

B. StrategicB. Strategic



CONTINGENT PLANNINGCONTINGENT PLANNING

The manager identifies and manages the manyThe manager identifies and manages the manyproblems that interfere with getting work done.problems that interfere with getting work done.

It may be reactive, in response to a crisis, orIt may be reactive, in response to a crisis, or

proactive, in anticipation of problems or inproactive, in anticipation of problems or inresponse to opportunities.response to opportunities.

Short range .operational planning is done inShort range .operational planning is done inconjunction with budgeting, usually a fewconjunction with budgeting, usually a few

months before the new fiscal year. It developsmonths before the new fiscal year. It developsthe departmental maintenance and improvement the departmental maintenance and improvement goals for the coming year.goals for the coming year.





IMPORTANCE OF PLANNINGIMPORTANCE OF PLANNING

1. Planning leads to the achievement of goals and1. Planning leads to the achievement of goals andobjectivesobjectives

2. Planning gives meaning to work2. Planning gives meaning to work

3. Planning provides for effective use of available3. Planning provides for effective use of available

resources and facilitiesresources and facilities 4. Planning helps in coping with crises4. Planning helps in coping with crises



IMPORTANCE OF PLANNINGIMPORTANCE OF PLANNING

5. Planning is cost effective5. Planning is cost effective

6. Planning is based on past and future6. Planning is based on past and future

activities.activities. 7. It prevents or reduces the recurrence of 7. It prevents or reduces the recurrence of

problems and provides better ideasproblems and provides better ideas

8. Planning leads to the realization of the8. Planning leads to the realization of theneed for changeneed for change

9. Planning provides the basis for control9. Planning provides the basis for control



ORGANIZINGORGANIZING

Is the process of coordinating the work to beIs the process of coordinating the work to bedone.done.

Formally, it involves identifying the work of theFormally, it involves identifying the work of theorganization, dividing the labor, developing theorganization, dividing the labor, developing the

chain of command, and assigning authority.chain of command, and assigning authority. It is an ongoing process that systematicallyIt is an ongoing process that systematically

reviews the use of human and materialreviews the use of human and materialresources.resources.

In health care, the mission, formalIn health care, the mission, formalorganizational structure, delivery systems, joborganizational structure, delivery systems, jobdescription, skill mix, and staffing patterns formdescription, skill mix, and staffing patterns formthe basis for the organization.the basis for the organization.



DIRECTINGDIRECTING

Is the process of getting the organizationsIs the process of getting the organizationswork done.work done.

Power, authority, and leadership style arePower, authority, and leadership style areintimately related to a managers ability tointimately related to a managers ability todirect.direct.

Communication abilities, motivationalCommunication abilities, motivational

techniques and delegation skills also aretechniques and delegation skills also areimportant.important.



CONTROLLINGCONTROLLING

Involves comparing actual results withInvolves comparing actual results withprojected results.projected results.

This includes establishing standards of This includes establishing standards of peformance,determining the means to bepeformance,determining the means to beused in measuring performance,used in measuring performance,evaluating performance and providingevaluating performance and providing

feedback.feedback.



The efficient manager constantly attempts toThe efficient manager constantly attempts toimprove productivity by incorporating techniquesimprove productivity by incorporating techniquesof quality management, evaluating outcomesof quality management, evaluating outcomesand performance and instituting change asand performance and instituting change as

necessary.necessary. Today managers share many of the controlToday managers share many of the control

functions with the staff. In organizing using afunctions with the staff. In organizing using aformal quality improvement process, such asformal quality improvement process, such ascontinuous quality improvement , staff continuous quality improvement , staff participate in and lead the teams. Someparticipate in and lead the teams. Someorganizations use peer review to control qualityorganizations use peer review to control qualityof care.of care.



Planning, organizing, directing andPlanning, organizing, directing andcontrolling reflects a systematic , proactivecontrolling reflects a systematic , proactiveapproach to management . This approachapproach to management . This approachis used widely in all types of organizations,is used widely in all types of organizations,health care included. Timmereck (200)health care included. Timmereck (200)founded that health care managers usesfounded that health care managers uses

these classic functions extensively.these classic functions extensively.



Mintzbergss Behavioral descriptionMintzbergss Behavioral description

Believed that much of a managers activityBelieved that much of a managers activityinvolves human relations, a premise that isinvolves human relations, a premise that is

supported by the contemporary leadershipsupported by the contemporary leadershiptheories discussed previously.theories discussed previously.

Mintzberg also believed managers were moreMintzberg also believed managers were morereactive than proactive.reactive than proactive.



ROLE OF MANAGERSROLE OF MANAGERS

Interpersonal RoleInterpersonal Role

Informational RoleInformational Role

Decisional RoleDecisional Role



Interpersonal RoleInterpersonal Role

1. Figurehead1. Figurehead Reflects the ceremonial performance of duties, suchReflects the ceremonial performance of duties, such

as welcoming new employees at orientation oras welcoming new employees at orientation orattending social events.attending social events.

2. Leader2. Leader The manager defines work environment of the organizationThe manager defines work environment of the organization

and is responsible fo the work of associatesand is responsible fo the work of associates--motivating ,motivating ,training, and disciplining as needed.training, and disciplining as needed.

The manager, as a leader , is responsible to see that theThe manager, as a leader , is responsible to see that theorganizations goals are accomplished efficiently.organizations goals are accomplished efficiently.

3. Liaison deals with expanding the managers information3. Liaison deals with expanding the managers informationsources and networks outside the organization. Nationalsources and networks outside the organization. Nationalconferences, local coalitions and professional meetings areconferences, local coalitions and professional meetings arevaluable resources for obtaining information and expandingvaluable resources for obtaining information and expandingnetworks.networks.




Monitor, the manager informally seeksMonitor, the manager informally seeksinformation about the organizationinformation about the organizationthrough internal networks, gossip, andthrough internal networks, gossip, and

observations.observations.




Tours of the organization, as well asTours of the organization, as well asformal ad informal meetings, allow theformal ad informal meetings, allow themanager to find out how the organizationmanager to find out how the organization

is functioning and what might be neededis functioning and what might be neededto improve it.to improve it.




Dissemination role either shareDissemination role either shareinformation between work units or shareinformation between work units or shareinformation from outside the organization.information from outside the organization.






Attending community meetings, offering Attending community meetings, offeringcontinuing education and participating incontinuing education and participating inprofessional organizations are examples of professional organizations are examples of

ways in which the manager serves as aways in which the manager serves as aspokesperson.spokesperson.



Decisional RolesDecisional Roles

Entrepreneur constantly seeks ways toEntrepreneur constantly seeks ways tosolve problems and make improvements insolve problems and make improvements inthe organization.the organization.

Reorganizing supplies, redesigning staff Reorganizing supplies, redesigning staff assignments, or creating new roles areassignments, or creating new roles areexamples.examples.




Disturbance handler responds toDisturbance handler responds tounforeseen circumstances, such asunforeseen circumstances, such asreplacement of staff for sick call,replacement of staff for sick call,

nosocomial outbreaks, or missingnosocomial outbreaks, or missingequipment.equipment.




Resource allocator managers scheduleResource allocator managers scheduletheir own time, assign staff, and managetheir own time, assign staff, and managefinancial resourcesfinancial resources

Negotiator deals with outside forcesNegotiator deals with outside forcesmediating resources and decisions such asmediating resources and decisions such asresolving collective bargaining disputes orresolving collective bargaining disputes or

helping decide on major capitol purchases.helping decide on major capitol purchases.



Fundamental skills of a managerFundamental skills of a manager

Technical skillsTechnical skills

PROFICIENCY IN PERFORMING AN ACTIVTIY PROFICIENCY IN PERFORMING AN ACTIVTIY IN THE CORECT MANNER WITH THE RIGHTIN THE CORECT MANNER WITH THE RIGHT

TECHNIQUETECHNIQUE



Human relation skillsHuman relation skills

Dealing with people and how to get along withDealing with people and how to get along withthemthem







Manager conceives the frameManager conceives the frame

Purpose of the jobPurpose of the job

Work neededWork needed

How it should be doneHow it should be done



Managing involves:Managing involves:

Communicating and controlling at theCommunicating and controlling at theinformationinformation

Leading and linking at the people levelLeading and linking at the people level

Doing at the action levelDoing at the action level



Communicating and controllingCommunicating and controlling

communicating Involves receiving andcommunicating Involves receiving andsharing information with otherssharing information with others

Controlling is using information to manageControlling is using information to managethe work othersthe work others



leadingleading

Involves encouraging and enabling othersInvolves encouraging and enabling others--individually , as a team or as an entireindividually , as a team or as an entireorganiztionorganiztion--to take effective actionto take effective action



linkinglinking

Is establishing networks outside the unit Is establishing networks outside the unit in order to relay needs and exchangein order to relay needs and exchangeinfluenceinfluence

33rdrd l l f k d t tl l f k d t t



33rdrd level of work and most concretelevel of work and most concretelevellevel

Managing action by doingManaging action by doing

DOINGDOING-- includes taking supervisoryincludes taking supervisoryactionsactions-- directing change, handlingdirecting change, handlingdisturbances, and negotiating with otherdisturbances, and negotiating with otherdepartments.departments.



L di g d li ki g l i dL di g d li ki g l i d



Leading and linking people in orderLeading and linking people in orderto encourage people to take actionto encourage people to take action

LeadingLeading involves encouraging andinvolves encouraging andenabling othersenabling others--individually, as a team orindividually, as a team oras an entire organizationas an entire organization

Linking isLinking is establishing networks outsideestablishing networks outsidethe unit in order to relay needs andthe unit in order to relay needs andexchange influenceexchange influence



managing action by doingmanaging action by doing

DOING INCLUDES TAKING SUPERVISORY DOING INCLUDES TAKING SUPERVISORY ACTIONS ACTIONS--DIRECTING, HANDLING,DIRECTING, HANDLING,DISTURBANCES AND NEGOTIATING WITHDISTURBANCES AND NEGOTIATING WITH

OTHER DEPARTMENTSOTHER DEPARTMENTS



NURSE MANAGERS IN PRACTICENURSE MANAGERS IN PRACTICE

First line manager may also be titled asFirst line manager may also be titled asunit managerunit manager

Middle manager as department managerMiddle manager as department manager

Top level nursing administrator could beTop level nursing administrator could benamed executive manager, chief nursingnamed executive manager, chief nursingofficer, or vice president of patient careofficer, or vice president of patient care



Clinical titles might include professionalClinical titles might include professionalpractice leaders who are clinical specialist practice leaders who are clinical specialist or nurse practitioners, regardless of theiror nurse practitioners, regardless of their

titles, all nurse managers must hold atitles, all nurse managers must hold acertain competencies.certain competencies.



NURSE MANAGERS COMPETENCIESNURSE MANAGERS COMPETENCIES

The American Organization of NurseThe American Organization of NurseExecutives (AONE) identified five areas of Executives (AONE) identified five areas of competency :competency :

Skilled communicators and RelationshipSkilled communicators and Relationshipbuildersbuilders

Have a knowledge of the health careHave a knowledge of the health careenvironment environment

Exhibit leadership skillsExhibit leadership skills Display professionalismDisplay professionalism

Demonstrate business skillsDemonstrate business skills



NURSE MANAGER COMPETENCIESNURSE MANAGER COMPETENCIES

STAFF NURSESTAFF NURSE

FIRST LEVEL MANAGEMENTFIRST LEVEL MANAGEMENT

CHARGE NURSECHARGE NURSE CLINICAL NURSE LEADERCLINICAL NURSE LEADER



STAFF NURSESTAFF NURSE

The staff nurse supervises LPNs , otherThe staff nurse supervises LPNs , otherprofessionals and assistive personnel and so isprofessionals and assistive personnel and so isalso a manager who needs ,management andalso a manager who needs ,management and

leadership skills. Communication , delegationleadership skills. Communication , delegationand motivation skills are indispensable.and motivation skills are indispensable.

In some organization, shared governance hasIn some organization, shared governance hasbeen implemented and traditional management been implemented and traditional management

are allocated to the work team.are allocated to the work team.



First level management First level management

Is responsible for supervising the work of nonmanagerialIs responsible for supervising the work of nonmanagerialpersonnel and the day to day activities of a specific workpersonnel and the day to day activities of a specific workunit or unitsunit or units

With primary responsibility for motivating the staff toiWith primary responsibility for motivating the staff toi

achieve the organizations goal, the first level managerachieve the organizations goal, the first level managerrepresents staff to upper administration and vice versa.represents staff to upper administration and vice versa.

Nurse manager s have 4 hour accountability for theNurse manager s have 4 hour accountability for themanagement of a unit or area within a health caremanagement of a unit or area within a health careorganization.organization.

In the hospital setting , the first level manager is usuallyIn the hospital setting , the first level manager is usuallythe head nurse, nurse manager or an assistant.the head nurse, nurse manager or an assistant.

In other hospital they call it as coordinatorIn other hospital they call it as coordinator



Charge NurseCharge Nurse

Is an expanded staff nurse role with increasedIs an expanded staff nurse role with increasedresponsibilityresponsibility

The charge nurse functions as a liaison to the nurseThe charge nurse functions as a liaison to the nursemanager, assisting in shift by shift coordination andmanager, assisting in shift by shift coordination andpromotion of quality patient care as well as efficient usepromotion of quality patient care as well as efficient use

of resources.of resources. The charge nurse often troubleshoots problems andThe charge nurse often troubleshoots problems and

assists other staff members in decision making.assists other staff members in decision making. Role modeling, mentoring and educating are additionalRole modeling, mentoring and educating are additional

roles that the charge nurse often assumes.roles that the charge nurse often assumes.

The charge nurse usually has extensive experience,The charge nurse usually has extensive experience,skills, and knowledge in clinical practice and is familiarskills, and knowledge in clinical practice and is familiarwith the organizations standards and practice.with the organizations standards and practice.



The responsibilities are confined to aThe responsibilities are confined to aspecific shift or task, whereas the first specific shift or task, whereas the first level manager has a 24 hour responsibilitylevel manager has a 24 hour responsibility

and accountability for all unit activities.and accountability for all unit activities.She has limited authority; the chargeShe has limited authority; the chargenurse functions as an agent of thenurse functions as an agent of the

manager and is accountable to themanager and is accountable to themanager for any actions taken or decisionmanager for any actions taken or decisionmade.made.



Although often involved in planning and organizing the Although often involved in planning and organizing thework to be done , the charge nurse has a limited scopework to be done , the charge nurse has a limited scopeof responsibility, usually restricted tot e unit for a specificof responsibility, usually restricted tot e unit for a specifictime period.time period.

The charge nurse is often key to a unit's successfulThe charge nurse is often key to a unit's successfulfunctioning.functioning.

A charge nurse usually has considerable influence with A charge nurse usually has considerable influence withthe staff and may actually have more informal powerthe staff and may actually have more informal powerthan the manager.than the manager.

Therefore the charge nurse is an important leader andTherefore the charge nurse is an important leader andcan benefit by developing the skills considered necessarycan benefit by developing the skills considered necessary

for a manager.for a manager.



Clinical Nurse LeaderClinical Nurse Leader

The CNL is not a leader per se, but The CNL is not a leader per se, but instead is a lateral integrator of careinstead is a lateral integrator of careresponsible for a specified group of clientsresponsible for a specified group of clients

within a microsystem of the health carewithin a microsystem of the health caresetting.setting.

The CNL role is designed to respond moreThe CNL role is designed to respond moreeffectively to challenges in today's rapidlyeffectively to challenges in today's rapidly

changing, complex technologicalchanging, complex technologicalenvironment.environment.



The CNL designs, implements, andThe CNL designs, implements, andevaluates client care by coordinating,evaluates client care by coordinating,delegating and supervising the caredelegating and supervising the care

provided by the health care team,provided by the health care team,including licensed nurses, technicians andincluding licensed nurses, technicians andother health professionals.other health professionals.

AONE FIVE AREAS ofAONE FIVE AREAS of



AONE FIVE AREAS of AONE FIVE AREAS of COMPETENCIESCOMPETENCIES

COMMUNICATION AND RELATIONSHIPCOMMUNICATION AND RELATIONSHIPBUILDING COMPETENCIES:BUILDING COMPETENCIES:

Effective communicationEffective communication

Relationship management Relationship management Influence of BehaviorsInfluence of Behaviors

Ability to work with diversity Ability to work with diversity

Share decision makingShare decision making

Community involvement Community involvement Medical staff relationshipsMedical staff relationships

Academic relationship Academic relationship



KNOWLEDGE IN THE HEALTH CARE ENVIRONMENT:KNOWLEDGE IN THE HEALTH CARE ENVIRONMENT: Clinical practice knowledgeClinical practice knowledge

Patient care delivery models and work design knowledgePatient care delivery models and work design knowledge

Health care economics knowledgeHealth care economics knowledge

Heath care policyHeath care policy Understanding of governanceUnderstanding of governance

Understanding of evidence based practiceUnderstanding of evidence based practice

Outcome measurement Outcome measurement

Knowledge of and dedication to patient safetyKnowledge of and dedication to patient safety

Understanding of utilization management Understanding of utilization management Knowledge of quality improvement and metricsKnowledge of quality improvement and metrics

Knowledge of risk management Knowledge of risk management



LEADERSHIP SKILLSLEADERSHIP SKILLS

Foundational thinking skillsFoundational thinking skills

Personal journey disciplinePersonal journey discipline

The ability to use systems thinkingThe ability to use systems thinking

Succession planningSuccession planning

Change management Change management



PROFESSIONALISMPROFESSIONALISM

Personal and professional accountabilityPersonal and professional accountability

Career planningCareer planning

EthicsEthics

Evidenced based clinical management practiceEvidenced based clinical management practice

Advocacy for the clinical enterprise and for Advocacy for the clinical enterprise and for

nursing practicenursing practice Active memebership in professional Active memebership in professional

organizationorganization



BUSINESS SKILLS:BUSINESS SKILLS:

Understanding of health care financingUnderstanding of health care financing

Human resource management andHuman resource management and

development development

Strategic Management Strategic Management

MarketingMarketing

Information management and technologyInformation management and technology





WHY CHANGE?WHY CHANGE?

Leading change is an art., never needed more inLeading change is an art., never needed more inthe rapidly evolving system of health care.the rapidly evolving system of health care.

Organizational change is essential forOrganizational change is essential for

adaptation; creative change is mandatory foradaptation; creative change is mandatory forgrowth.growth.

This climate for change produces newThis climate for change produces newopportunities for nurses.opportunities for nurses.

Nurses are rethinking the way health care isNurses are rethinking the way health care isorganized and delivered.organized and delivered.



Change is necessary for growth, althoughChange is necessary for growth, althoughit often produces anxiety and fear.it often produces anxiety and fear.

Even when planned, it can be threateningEven when planned, it can be threateningand a source of conflict and a source of conflict



CHANGECHANGE

IS THE PROCESS OF MAKING SOMETHING DIFFERENTIS THE PROCESS OF MAKING SOMETHING DIFFERENTFROM WHAT IT WAS.FROM WHAT IT WAS.

There is a sense of loss of the unfamiliar; the status quo.There is a sense of loss of the unfamiliar; the status quo.

This is particularly true when change is unplanned orThis is particularly true when change is unplanned or

beyond human control.beyond human control. Even when change is expected and valued, a grief Even when change is expected and valued, a grief

reaction still may occur.reaction still may occur.

Those who initiative and manage change oftenThose who initiative and manage change oftenencounter resistance form those experiencing uneaseencounter resistance form those experiencing unease

and possibly symptoms of anxiety and grief.and possibly symptoms of anxiety and grief.



Change is a continually unfolding processChange is a continually unfolding processrather than an either/event.rather than an either/event.

The process begins with the present stae,The process begins with the present stae,is disrupted, moves through a transitionis disrupted, moves through a transitionperiod, and ultimately comes to a desiredperiod, and ultimately comes to a desiredstate. Once the desired state has beenstate. Once the desired state has been

reached, however; the process beginsreached, however; the process beginsagain.again.

S S G GS S G G



THE NURSE AS CHANGE AGENTTHE NURSE AS CHANGE AGENT

Is one who works to bring about aIs one who works to bring about achange.change.

A change agent an be a role model for A change agent an be a role model for

others by touting the positive outcomes of others by touting the positive outcomes of changechange--improved patient care.improved patient care.

The nurse , as an integral part of theThe nurse , as an integral part of thesystem, is key to stimulating the need forsystem, is key to stimulating the need forchange and crucial for the success of change and crucial for the success of planned change.planned change.

THE CHANGE PROCESSTHE CHANGE PROCESS



THE CHANGE PROCESSTHE CHANGE PROCESS

Assessment Assessment

Emphasis is placed n the assessment phase of Emphasis is placed n the assessment phase of change for two reasonschange for two reasons

Without data collection and analysis,plannedWithout data collection and analysis,plannedchange will not proceed past the wouldnt it be achange will not proceed past the wouldnt it be agood idea if stage.good idea if stage.

STEPS IN THE CHANGE PROCESSSTEPS IN THE CHANGE PROCESS




1. Identify the problem or opportunity1. Identify the problem or opportunity

2. Collect necessary data and information2. Collect necessary data and information

3. Select and analyze data3. Select and analyze data

4. Develop a plan for change , including4. Develop a plan for change , includingtime frame and resourcestime frame and resources

5. Identify the supporters or opposers5. Identify the supporters or opposers





6. Build a coalition of supporters6. Build a coalition of supporters

7. Help people prepare for change7. Help people prepare for change

8. Prepare to handle resistance8. Prepare to handle resistance

9. Provide a feedback mechanism to keep9. Provide a feedback mechanism to keepeveryone informed of the progress of everyone informed of the progress of changechange

10. Evaluate effectiveness of the change10. Evaluate effectiveness of the changeand , if successful , stabilize the changeand , if successful , stabilize the change

IDENTIFY THE Problem or theIDENTIFY THE Problem or the



IDENTIFY THE Problem or theIDENTIFY THE Problem or theOpportunityOpportunity

START BY ASKING THE RIGHT QUESTIONS,START BY ASKING THE RIGHT QUESTIONS,SUCH AS:SUCH AS: Where are we now? What is the unique about us?Where are we now? What is the unique about us?

What should our business be?What should our business be?

What can we do that is different from and better thanWhat can we do that is different from and better thanwhat our competitors do?what our competitors do?

What is the driving stimulus in our organization?What What is the driving stimulus in our organization?What determines how we make our final decisions?determines how we make our final decisions?

What prevents us from moving in the direction weWhat prevents us from moving in the direction wewish to go?wish to go?

What kind of change is required?What kind of change is required?

C ll t D tC ll t D t



Collect DataCollect Data

Once the problem or opportunity has beenOnce the problem or opportunity has beenclearly defined, the change agent collectsclearly defined, the change agent collectsdata external and internal to the system.data external and internal to the system.

This step is crucial to the eventual successThis step is crucial to the eventual successof the planned change.of the planned change.

All driving and restraining forces are All driving and restraining forces areidentified so the driving forces can beidentified so the driving forces can be

emphasized and the restraining forcesemphasized and the restraining forcesreduced.reduced.

A l th D tA l th D t



Analyze the Data Analyze the Data

The kinds, amounts and sources of dataThe kinds, amounts and sources of datacollected are important, but they arecollected are important, but they areuseless unless they are analyzed.useless unless they are analyzed.

The change agent should focus moreThe change agent should focus moreenergy on analyzing and summarizing theenergy on analyzing and summarizing thedata than on just collecting it.data than on just collecting it.

The point is to flush out resistance identifyThe point is to flush out resistance identifyareas of consensus, and build a case forareas of consensus, and build a case forwhoever option is selected.whoever option is selected.

Pl iPl i



PlanningPlanning

Planning the who, how, and when of thePlanning the who, how, and when of thechange is a key step.change is a key step.

What will be the target system for theWhat will be the target system for the

change?change?

Members from this system should beMembers from this system should beactive participants in the planning stage.active participants in the planning stage.

The more involved they are at this point,The more involved they are at this point,the less resistance there will be later.the less resistance there will be later.

I l t tiI l t ti



ImplementationImplementation

Methods to Change IndividualsMethods to Change Individuals

Methods to change groupsMethods to change groups

E l tiE l ti



EvaluationEvaluation

Evaluate effectivenessEvaluate effectiveness

Stabilize the changeStabilize the change

Change St ategiesChange St ategies



Change StrategiesChange Strategies

Power Coercive StrategiesPower Coercive Strategies

Based on application of power by legitimateBased on application of power by legitimateauthority , economic sanctions, or politicalauthority , economic sanctions, or political

clout of the change agent clout of the change agent Assumes that people are set in their ways and Assumes that people are set in their ways and

will change only when rewarded for thewill change only when rewarded for thechange or are forced by some other powerchange or are forced by some other power

coercive methodcoercive method

RationalRational empirical strategiesempirical strategies



RationalRational--empirical strategiesempirical strategies

Give current research as evidence toGive current research as evidence tosupport change. Humans are rationalsupport change. Humans are rationalbeings who will change documenting thebeings who will change documenting the

need for change.need for change.

NormativeNormative rere educative strategieseducative strategies



NormativeNormative--rere--educative strategieseducative strategies

Use group norms to socialize and influenceUse group norms to socialize and influencepeople so change will occur. Humans arepeople so change will occur. Humans aresocial animals, easily influenced by otherssocial animals, easily influenced by others

than by factsthan by facts Does not require change agent to have aDoes not require change agent to have a

legitimate power base. Power is gained bylegitimate power base. Power is gained by

skill in interpersonal relationship.skill in interpersonal relationship.

Documents

Management Lecture 2011