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Controlling as a function of Nursing Management
Control is the management function in which performance is measured and corrective
action is taken to ensure the accomplishment of organizational goals. Control includescoordination of numerous activities : decision making related to planning and organizing
activities and information from directing and evaluating each workers performance.
Control is also viewed as being concerned with records, reports, organizational progress
toward aims, and effective use of resources. Controll uses evaluation and regulation;
controlling is identical to evaluation. oontz and !eihrich defined controlling as the
measurement and correction of the performance in order to make sure that enterprise
ob"ectives and the plans devised to attain them are accomplished.
#$stem %heor$
&eedback and ad"usment comprise the control element of nursing management. 'utput is
described or defined in terms of the patient in the patient care model and is measured b$
(ualit$ indicators and outcomes. )n case management, these indicators are predicted and
met on a timed basis. *ischarge planning will take note of them. !hen the outcomes or
indicators fall short, the information is fed back to the clinical nurses who make
ad"ustments in the case management plan and the process controlled b$ the critical path.+oth the patient and nurse are s$stem inputs, whereas throughput consists of nursing
actions related to patient outcomes and managerial actions related to setting goals for
nurses behavior. ualit$ management is the process b$ which the nursing product or
process is measured and action prescribed to correct deficiencies.
#imilarl$, s$stems theor$ can be applied to perfomance evaluation of the registered nurse
as output. )nput is still the patient and the nurse, with throughput the managerial actions
related to goals for nurse behavior. - performance results contract between clinical nurse
and nurse manager spells out agreedon perfomance goals or results. !hen the$ are not
being met, the nurse manager discusses the deficienc$ with the clinical nurse and the$agree on corrective actions. )n tan open s$stem the process is continuous.
-n effective control s$stem has standards, measuring tools, and a surveilance process
culminating in corrective action. - (ualit$ control program for measuring patient care
will have these same components.
Controlling is the second ph$sical act of administration, the fist ph$sical act being
directing. )t is the founthand final elements of the administrative composite process
/-C01, planning and organizing being the conceptual acts. -ll functions of management
planning, organizing, directing, and controllingoccur simultane ousl$. )nputs would
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include resources other than the clinical nurse, such as supplies, e(uipment, and plant,
plus all of the direct and indirect cost elements, used in achieving the outputs.
Control as Management %ools
)n the process of measuring the degree of which predetermined goals are achieved and of
appl$ing necessar$ corrective actions to to improve performance, policies and procedures
are used as standard. -lso, observations, (uestion, patient charts, patients, and health care
team members serve as sources of data. Corrective actions can be corroborative,
disciplinar$, or education. in the process of feedback a positive e2perience will stimulate
motivation and contribute to the growth of emplo$es.
Controls are management tools for improving performance. -mong the controls are rules
that are needed to let people know what is e2pected of them and how functions are to be
coordinated. Communication as information is essential to control. #elfcontrol is
essensial to managerial control because it is the highest from the control. #elfcontrol
includer being uptodate in knowledge, giving clear orders, being fle2ible, under
standing reason for behavior, helping others improve, increasing problemsolving skills,
standing calm under pressure, and planning ahead. 3mplo$es should be told the pacts in
language that the$ understand and words that have the intended meaning. 3ffective
nursing managers set limits and make them known to their emplo$es. %hen, when the line
is crossed, the appropriate disciplinar$ action can be taken. %he latter is achieved b$corrective action that is consistentl$ applied after check in the facts.
Controls can be separated into two elements, mechanical and sosiological. %here are three
stages of control, the firts two being the mechanical elements and the third the
sociological element.
4. - predetermined definition of standards for level of performance
5. Measurement of current performance against the standards
6. Corrective action when indicated
Nurse managers will avoid the unintended conse(uence of control, that is,
noncompliance. +ecause control can be perceived as a threat from unwanted power and
authorit$, it can trigger defense mechanism such as aggression and repression. 7emin
advocated the following approaches to control b$ Mc8regor: time, a high degree of
mutual trust, a high degree of mutual support, open and authentic communication, clear
understanding of ob"ective, respect for differences, utilization of member resources, and a
supportive environment. %hese approaches will lead to conflict resolution, changed
believes and attitudes, genuine innovation, genuine commitment, strenghned
management, and prevention of unintended conse(uences of control.
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%he following are ten characteristics of good control s$stem, controls:
4. Must reflect the nature of the activit$
5. #hould report errors prompltl$
6. #holud be forwanr looking
9. #hould point out e2ceptions at critical points
. #hould be ob"ective
. #hould be fle2ible
. #hould be understanding
4?. #hould indicate corrective action
Nursing managers will remain aware that the best wa$ to ensure the (ualit$ of nursing
services provided in the patient units is to establish philosoph$, standards of care, and
ob"ective, involve planning, further evidence that the ma"or functions of management take
place simultaneousl$. Controlling mechanisms also include accreditation procedures,
consultants, evaluation devices, rounds, reports, inspections, and nursing audits.
Nurses activate the process of control. %his function involves the use of power and should
be used b$ nurse managers to promote openness, honest$, trust, competence and even
confrontation. %his function also involves value s$stems, ethical decisionmaking, self
control, professional selfregulation, and control b$ an aggregate of professionals. %he
processes of control function is emerging as a s$stem of (ualit$ control programs. %he
dimensions of (ualit$ management programs are (ualit$ of care, including accessibilit$,
beliefs and attitudes of patients about health care, structure of health care, processes of
care, professional competence, outcomes of care, and self regulation. -udits and budgets
are the ma"or techni(ues of control.
Control functions can be differentiated among levels of managers. &or e2ample, the nurse
managers of a unit is concerned with shortrange operational activities, including dail$
and weekl$ schedules, assignments, and effective use of resources. %his nurse manager
also keeps records of absences and incidents and prepares personnel appraisals, which are
control activities sub"ect to (uick changes.
%wo measurement methods are used to assess achievement of nursing goals : task
anal$sis and (ualit$ control. )n task anal$sis, the nurse manager inspects the motions,
actions, and procedures laid out in written guidelines, schedules, rules, records, and
budgets. %ask anal$sis is a stud$ of the process of giving nursing care. )t measuresph$sical support onl$; a few tools have been developed to do task anal$sis in nursing. )n
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(ualit$ control the nurse manager is concerned with measurement of the (ualit$ and
effects of nursing care. %he -merican Nurses -ssociation /-N-1, the @oint Commission
on -ccreditation of Aealthcare 'rganizations /@C-A'1, and other organizations have
developed mechanisms or models for measuring nursing care. Man$ (ualit$ management
techni(ues are referred to as audits.
TERJEMAHAN
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Mengontrol sebagai fungsi Mana"emen eperawatan
ontrol adalah fungsi mana"emen dimana kiner"a diukur dan tindakan korektif diambil
untuk memastikan pencapaian tu"uan organisasi. 0engendalian meliputi koordinasiberbagai kegiatan: pembuatan keputusan $ang berkaitan dengan perencanaan dan
pengorganisasian kegiatan dan informasi dari mengarahkan dan mengevaluasi kiner"a
masingmasing peker"a. ontrol "uga dipandang sebagai hal $ang berkaitan dengan
catatan, laporan, kema"uan organisasi ke arah tu"uan, dan penggunaan sumber da$a secara
efektif. ontrol menggunakan evaluasi dan regulasi; pengendalian identik dengan
evaluasi. oontz dan !eihrich didefinisikan mengendalikan sebagai pengukuran dan
koreksi kiner"a dalam rangka untuk memastikan bahwa tu"uan perusahaan dan rencana
$ang dirancang untuk mencapai mereka $ang dicapai.
%eori sistem
Bmpan balik dan pen$esuaian terdiri unsur pengendalian mana"emen keperawatan.
'utput di"elaskan atau didefinisikan dalam hal pasien dalam model perawatan pasien dan
diukur dengan indikator kualitas dan hasil. *alam mana"emen kasus, indikator ini
diperkirakan dan bertemu secara waktun$a. 0erencanaan debit akan mencatat mereka.
etika hasil atau indikator "atuh pendek, informasi diumpankan kembali ke perawat klinis$ang melakukan pen$esuaian dalam rencana mana"emen kasus dan proses dikendalikan
oleh "alur kritis. edua pasien dan perawat input sistem, sedangkan throughput $ang
terdiri dari tindakan keperawatan $ang berhubungan dengan hasil pasien dan tindakan
mana"erial $ang berhubungan dengan menetapkan tu"uan untuk perilaku perawat.
Mana"emen mutu adalah proses dimana produk keperawatan atau proses diukur dan
tindakan diresepkan untuk memperbaiki kekurangan.
*emikian pula, teori sistem dapat diterapkan untuk kiner"a evaluasi perawat terdaftar
sebagai output. Masukan masih pasien dan perawat, dengan throughput tindakan
mana"erial $ang berhubungan dengan tu"uan untuk perilaku perawat. #ebuah hasil kiner"akontrak antara perawat klinis dan mana"er perawat merinci tu"uan kiner"a $ang
disepakation atau hasil. etika mereka tidak terpenuhi, mana"er perawat membahas
kekurangan dengan perawat klinis dan mereka setu"u pada tindakan korektif. *alam
sistem terbuka tan proses kontinu.
#ebuah sistem kontrol $ang efektif memiliki standar, alat ukur, dan proses surveilance
$ang berpuncak pada tindakan korektif. #ebuah program pengendalian mutu untuk
mengukur perawatan pasien akan memiliki komponenkomponen $ang sama.
0engendalian adalah tindakan fisik kedua administrasi, tin"u tindakan fisik $angmengarahkan. )ni adalah elemen akhir founthand dari proses komposit administrasi
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/-C01, perencanaan dan pengorganisasian men"adi tindakan konseptual. #emua fungsi
mana"emen perencanaan, pengorganisasian, pengarahan, dan pengendalianmenerus
ter"adi simultan. )nput akan mencakup sumber selain perawat klinis, seperti perlengkapan,
peralatan, dan pabrik, ditambah semua elemen bia$a langsung dan tidak langsung, $ang
digunakan dalam mencapai output.
ontrol sebagai Management %ools
*alam proses mengukur dera"at $ang tu"uan $ang telah ditentukan tercapai dan
menerapkan tindakan perbaikan $ang diperlukan untuk meningkatkan kiner"a, kebi"akan
dan prosedur $ang digunakan sebagai standar. @uga, pengamatan, pertan$aan, grafik
pasien, pasien, dan anggota tim kesehatan berfungsi sebagai sumber data. %indakankorektif dapat n$ata, disiplin, atau pendidikan. dalam proses umpan balik pengalaman
positif akan merangsang motivasi dan kontribusi pada pertumbuhan emplo$es.
ontrol adalah alat mana"emen untuk meningkatkan kiner"a. *i antara kontrol aturan
$ang diperlukan untuk membiarkan orang tahu apa $ang diharapkan dari mereka dan
bagaimana fungsi harus dikoordinasikan. omunikasi informasi sangat penting untuk
mengontrol. ontrol diri adalah essensial mana"erial kendali karena itu adalah tertinggi
dari kontrol. 0engendalian diri ikutsertakan $ang uptodate di pengetahuan, memberikan
perintah $ang "elas, men"adi fleksibel, di bawahberdiri alasan untuk perilaku, membantu
orang lain meningkatkan, meningkatkan kemampuan memecahkan masalah, berdiritenang di bawah tekanan, dan perencanaan ke depan. %enaga er"a harus diberitahu pakta
dalam bahasa $ang mereka mengerti dan katakata $ang memiliki arti $ang diinginkan.
Mana"er keperawatan $ang efektif menetapkan batas dan membuat mereka dikenal
emplo$es mereka. emudian, ketika garis disilangkan, tindakan disipliner $ang tepat
dapat diambil. ang terakhir ini dicapai dengan tindakan korektif $ang diterapkan secara
konsisten setelah checkin faktafakta.
ontrol dapat dipisahkan men"adi dua unsur, mekanik dan sosiologi. -da tiga tahap
kontrol, menggoda dua men"adi elemen mekanik dan ketiga unsur sosiologis.
4. *efinisi $ang telah ditentukan standar untuk tingkat kiner"a
5. 0engukuran kiner"a saat melawan standar
6. %indakan korektif ketika ditun"ukkan
Mana"er perawat akan menghindari konsekuensi $ang tidak diinginkan dari kontrol, $aitu,
ketidakpatuhan. arena kontrol dapat dianggap sebagai ancaman dari kekuasaan $ang
tidak diinginkan dan wewenang, hal itu dapat memicu mekanisme pertahanan seperti
agresi dan penindasan. 7emin mengan"urkan pendekatan berikut untuk mengontrol oleh
Mc8regor: waktu, tingkat tinggi saling perca$a, tingkat tinggi saling mendukung,
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komunikasi $ang terbuka dan otentik, pemahaman $ang "elas tentang tu"uan,
menghormati perbedaan, pemanfaatan sumber da$a anggota, dan lingkungan $ang
mendukung. 0endekatan ini akan men$ebabkan resolusi konflik, berubah perca$a dan
sikap, inovasi asli, komitmen $ang tulus, mana"emen strenghned, dan pencegahan
konsekuensi $ang tidak diinginkan dari kontrol.
+erikut ini adalah sepuluh karakteristik sistem kontrol $ang baik, kontrol:
4. Aarus mencerminkan sifat kegiatan
5. Aarus melaporkan kesalahan prompltl$
6. sholud men"adi forwanr mencari
9. Aarus menun"ukkan pengecualian pada titiktitik kritis
. Aarus ob$ektif
. Aarus fleksibel
. Aarus pemahaman
4?. Aarus menun"ukkan tindakan korektif
Mana"er keperawatan akan tetap sadar bahwa cara terbaik untuk memastikan kualitas
pela$anan keperawatan $ang diberikan dalam unit pasien adalah untuk membangun
filosofi, standar perawatan, dan ob$ektif, melibatkan perencanaan, bukti lebih lan"ut
bahwa fungsi utama dari mana"emen ter"adi secara simultan. Mekanisme pengendalian ini
"uga mencakup prosedur akreditasi, konsultan, perangkat evaluasi, putaran, laporan,
inspeksi, dan audit keperawatan.
0erawat mengaktifkan proses kontrol. &ungsi ini melibatkan penggunaan kekuasaan dan
harus digunakan oleh mana"er perawat untuk mempromosikan keterbukaan, ke"u"uran,
keperca$aan, kompetensi dan bahkan konfrontasi. &ungsi ini "uga melibatkan sistem nilai,etika pengambilan keputusan, pengendalian diri, pengaturan diri profesional, dan kontrol
oleh agregat profesional. 0roses fungsi kontrol $ang muncul sebagai sistem program
kendali mutu. *imensi program mana"emen mutu adalah kualitas pela$anan, termasuk
aksesibilitas, ke$akinan dan sikap pasien tentang perawatan kesehatan, struktur pela$anan
kesehatan, proses perawatan, kompetensi profesional, hasil perawatan, dan regulasi diri.
-udit dan anggaran adalah teknik utama dari kontrol.
&ungsi kontrol dapat dibedakan antara tingkat mana"er. #ebagai contoh, mana"er perawat
dari unit $ang bersangkutan dengan kegiatan operasional "arak pendek, termasuk harian
dan "adwal mingguan, tugas, dan penggunaan sumber da$a secara efektif. Mana"er
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perawat ini "uga men$impan catatan absensi dan insiden dan mempersiapkan penilaian
personil, $ang kegiatan pengendalian tunduk pada perubahan $ang cepat.
*ua metode pengukuran $ang digunakan untuk menilai pencapaian tu"uan keperawatan:
analisis tugas dan kontrol kualitas. *alam analisis tugas, mana"er perawat memeriksa
gerakan, tindakan dan prosedur ditata secara tertulis pedoman, "adwal, aturan, catatan,
dan anggaran. -nalisis tugas adalah studi tentang proses pemberian asuhan keperawatan.
Mengukur dukungan fisik sa"a; beberapa alat telah dikembangkan untuk melakukan
analisis tugas dalam keperawatan. *alam kontrol kualitas mana"er perawat berkaitan
dengan pengukuran kualitas dan efek dari asuhan keperawatan. -merican Nurses
-ssociation /-N-1, omisi +ersama -kreditasi esehatan 'rganisasi /@C-A'1, dan
organisasi lainn$a telah mengembangkan mekanisme atau model untuk mengukur asuhan
keperawatan. +an$ak teknik mana"emen mutu $ang disebut sebagai audit