Directing and Nursing Administration.ppt

---Part I---

Activities Related to the Directing Functions

Elements of Directing

1. Delegation

1.1. Principles of Delegation

1.2. Reasons for Delegation

1.3. Management by Objectives

1.4. Effective Delegation

1.5. Nursing Care Assignment

1.6. Utilization of Policies and Procedures

---Part II---

2. Supervision of Personnel (Principles and Techniques)

3. Motivation

3.1. Theories of Motivation (Content and Process Theories)

3.2. Use of Motivation Theories to Nursing Administration

4. Coordination of Services

5. Communication

5.1. Principles of Effective Communication5.2. Lines of Communications

---Part III---

6. Staff Development

7. Decision-making

8. Benchmarking (Standards of Evaluating the Directing Function)

9. Conflict Management

9.1. Characteristics of Conflict 9.2. Assessing Conflict9.3. Sources/Causes and Types of Conflict9.4. Conflict Management – What to Consider9.5. Techniques/Skills for Managing Conflicts

●Definitions of Directing●

Directing is known as the act of issuing of orders, assignments, and instructions to accomplish the organization’s goals and

objectives. It involves the process of getting the organization’s work done. It entails explaining what it is to be done, to and by whom, at what time, how and

why the task should be done.

Directing is a function of management often performed by top level management in order to

achieve organizational goals. It is a very important and necessary function of management. Directing consists of the processes and techniques utilized in

issuing instructions and making certain that operations are carried as originally planned.


Directing involves determining the course, giving order and instruction and providing

dynamic leadership. (Marshall)


●Activities Related to the Directing Functions●

-telling people what is to be done and explaining how to do it-issuing instructions and orders to subordinates-inspiring them to contribute towards the achievement of objectives-supervising their activities-providing leadership and motivation

●Delegation●

-the act of assigning to someone else a portion of the work to be

done with corresponding authority, responsibility and

accountability

-a skill to be learned and mastered beginning with learning what cannot be

delegated and what will be delegated to whom

History

The next day Moses took his seat to serve as judge for the people, and they stood around him from

morning till evening. When his father-in-law saw all

that Moses was doing for the people, he said, “What is this you are doing for the people? Why do you alone sit as judge, while all these people stand around you

from morning till evening?”

History

Moses answered him, “Because the people come to me to seek

God’s will. Whenever they have a dispute, it is

brought to me, and I decide between the

parties and inform them of God’s decrees and

instructions.”

History

“The thing that you do is not good. Both you and these people who are

with you will surely wear yourselves out. For this

thing is too much for you; you are not able to perform it by yourself”

(Exodus 18:17, 18)

History

“If you do this thing, and God so commands you, then you will be able to

endure, and all this people will also go to their place in peace.”

●Reasons for Delegation●

For the nurse manager

1. To free up time for planning and organizing.

2. To help the nurse manager learn how to properly and effectively manage and develop employees.

3. To keep the nurse manager from ‘spreading him/herself too thin’.

4. Delegation encourages open communication and trust.

5. It can show the nurse manager a better way of handling people and resources.

For the subordinates

6. Delegation motivates and builds morale.

7. Delegation encourages and stimulates creativity and initiative.

8. Delegation helps develop the skills of subordinates

9. Delegation allows the subordinates to contribute significantly to team success.

For the organization

10. Delegation benefits the team, the department, and the organization.

●Principles of Delegation●

Principle of Result Expected

Suggests that:

-every nurse manager before delegating the powers to the subordinate should be able to

clearly define the goals as well as results expected from them

-goals and targets should be completely and clearly defined and the standards of

performance should also be notified clearly

Principle of Parity of Authority and Responsibility

-the nurse manager should keep a balance between authority and

responsibility - both of them should go hand in hand

- if a subordinate is given a responsibility to perform a task, at the same time he should be given enough independence and power to carry out

that task effectively

Principle of absolute responsibility

-responsibility is fixed; authority can be delegated but responsibility

cannot-the nurse manager is always responsible to his superior for

carrying out his task by delegating the powers

-every nurse manager is responsible for the act of his/her

subordinate and is also accountable to his/her superior

Principle of

Authority level

-suggests that a nurse manager should exercise his authority within the jurisdiction / framework given

-before a nurse manager takes any important decision, he should make sure that he has the

authority to do so

-emphasizes the degree of authority and the level up to which it has to be maintained

●Delegation: Additional Information●

What cannot be delegated?

• Overall ARA• Final evaluation of staff

performance • Correcting and disciplining

staff• Activities which the nurse

to whom the task is delegated does not want to do because it is unpleasant

Delegated tasks must be based on

• Policies• Job Description

• Capabilities of Workers

Why Managers do not want to delegate?

• Mistakes in delegation can be costly.

• Failure to delegate wisely increases management costs and contributes to personnel

dissatisfaction.• Fear on the part of the director,

of her own ability to delegate.• Fear of losing control of the

staff.• Fear of failing to get others do

the work.• Fear of criticism.

Common Delegation ErrorsUnderdelegating

• manager’s false assumption: delegation may be interpreted as the lack of ability on his or her part to do

the job correctly or completely

• nurse manager manifests his desire to do the job by himself due to fear that

subordinates will resent the work delegated to them

• occurs when the nurse manager lacks experience in the job

Overdelegating

• unnecessarily burdens the subordinates with tasks that are

either inconsequential or irrelevant to the delivery of the goal; culprit is usually poor management of time and insecurity on the part of the nurse manager in her inability to

perform tasks

Common Delegation Errors

Improper delegating

• delegation of tasks and responsibilities beyond

which the person cannot perform

properly

Common Delegation Errors

●Management by Objectives●

Management by Objectives works if you first think through your

objectives. Ninety percent of the time you

haven’t. (Drucker)

A process whereby the superior and subordinate managers of an

organization jointly identify its common goals, define each individual’s major areas of responsibility in terms of the results expected of him and use these measures as guides for operating the unit and assessing the contribution of

each of its members. (George Odiorne)


MBO is a system for making organizational structures work, of

bringing about vitality and personal involvement in the hierarchy by means of

statements of what is expected from everyone involved and measurement of

what is actually achieved. It stresses ability and achievement rather than

personality. (Odiorne)


• allows the individual nurse to contribute to the common goal of the enterprise

• nurse managers focus on the business goals

• MBO promotes high standards, focusing on the job and not on the manager

• Nurse managers know what to expect of employees

• Just like their nurse managers, nursing staff should know for what they will be

held accountable.


• spells out the results expected of the clinical nursing unit itself and

in relation to other units

• emphasizes teamwork and team results

• includes short and long-term objectives as well as tangible and

intangible objectives


• allows people to control their own performance and measure

themselves

• nurse managers will assume that clinical nurses want to be

responsible, want to contribute, want to achieve, and have the strength and desire to do so.


Planning Phase Performance Review Phase Feedback Phase

Key Activities and Participants

Identify and define key organizational

goals (nurse manager)

Identify and define key departmental

goals that stem from overall goals

(nurse manager)

Identify and define performance

measures or operational goals for

employees (nurse manager)

Formulate and propose goals for a

specific job (subordinate)

Participate in management conferences

(nurse manager and subordinates)

Achieve joint agreement on individual

objectives and individual performance

(nurse manager and subordinates)

Set-up timetable for periodic meetings

for performance review. (nurse

manager and subordinates)

Continue to participate in periodic

management conferences. (nurse


Adjust and refine objectives based on

feedback, new constraints, and new

inputs. (nurse manager and

subordinates)

Eliminate inappropriate goals. (nurse


Readjust timetable as needed. (nurse


Maintain ongoing comparison of

proposed time-table and actual

performance through use of control

monitoring devices, such as visible

control charts. (nurse manager and

subordinates)

Review overall organizational and

departmental goals for the next

planning period, such as the next fiscal

year. (nurse manager)

●Effective Delegation●

Effective ways of delegation for nurse managers

• Train and develop subordinates.

• Plan ahead.

• Control and coordinate the work of subordinates but do not peer over their shoulders.

• Follow-up by visiting subordinates frequently.

• Coordinate to prevent duplication of effort.

• Solve problems and think about new ideas.

• Accept delegation as desirable.

• Specify goals and objectives.

• Know subordinates capabilities and match the task or duty to the employee.

• Agree on performance standards.

• Take an interest in employees.

• Assess results.

• Give appropriate rewards.

• Do not take back delegated tasks.

●Effective Delegation●

●NURSING CARE ASSIGNMENT ●

●Nursing Care Assignment●

Nursing Care Assignment is the allocation of clients or client care responsibilities or

interventions that are within the nurse’s scope of practice and/or scope of employment. It

describes the distribution of work that each staff member is to accomplish (NCSBN, 2005).

It is a dynamic process in which decisions are evaluated and adjusted as the

healthcare team works together to meet the changing needs of clients. Nurses determine assignments according to:

•the client’s condition (complexity, variability and acuity)

•the scope of practice of the health provider’s profession

•the individual scope/competence of the individual performing the intervention

•the scope of employment/agency policy

•context of practice

• When client care or a client intervention is assigned to an RN or LPN, they may perform the assignment

autonomously as they are accountable for their own decisions and actions.

• When client care or a client intervention is assigned to a UCP, the UCP is accountable to implement the

assigned care or task safely and competently within their scope of practice/employment.

Types of Nursing Care Assignment

A nurse determines the most appropriate care provider to be ‘assigned’ to a particular client

and is accountable for that decision. When clients are ‘assigned’ to a particular nurse or

unregulated care provider, the accountability for the client care resides with the individual

assigned to the client.

A nurse determines the most appropriate care provider to ‘be assigned’ to perform a specific

intervention for one or more client(s).

Nursing care assignment to unregulated care providers

Assignment is appropriate when the assigned task falls within the UCP role description and training.

The nurse manager is responsible and accountable for developing job/role descriptions that clearly

outline the tasks that can be assigned to a UCP in an organization. UCPs may be assigned clients in

collaboration with an RN or LPN or assigned specific interventions for one or more clients.

Prior to assigning a client or an intervention, consideration should be given to the individual

competencies of the UCP.

If the task is within the role description but the UCP has not yet performed the task, the nurse

manager would need to consider the appropriateness of the assignment. The UCP may

have had past training in tasks but if the task is not included in the UCP role description, the task could

not be assigned to the UCP. Regardless of the assignment, the nurse assigning the task to the UCP is always responsible and accountable for providing appropriate supervision and feedback to the UCP.

●Utilization of Policies and Procedures●

Policies and Procedures

• Licensed nurses (Registered Nurse/Licensed Practical Nurse) within the scope of their practice are responsible for all nursing care that a patient receives under their direction. Determining the nursing needs of a patient, the plan of nursing actions, implementation of the plan, and evaluation of the plan are essential components of nursing practice. Unlicensed personnel may be used to complement the licensed nurse in the performance of nursing functions, but such personnel cannot be used as a substitute for the licensed nurse.

• Delegation by Registered Nurses and Licensed Practical Nurses must fall within their

respective scope of practice. Delegation must occur within the framework of the job

description of the delegate, organizational policies and organizational procedures.

As per R.A. 9173 (Nursing Act of 2002)

Liabilities of nurses for the work of nursing aides

• Nurses should not delegate their functions to nursing aides since the Philippine nursing act

specifies the scope of nursing practice of professional nurses.

• Nurses are enjoined to supervise their subordinates and see to it that they perform only those which they been taught to do and those which they are capable of doing.

• Nursing aides are responsible for their actions. Nurses should not delegate their functions to nursing aides. Nursing aides perform selected nursing activities under the direct supervision of nurses.

Liability for the work of nursing students

• Nursing students should not perform professional nursing duties. In order for the errors committed by nursing students to be

avoided or minimized, they should always be under supervision of their clinical instructors.

• They should be given assignments that are their level of training experience and

competency.

• They should be advised to seek guidance if they are performing a procedure for the first time.

• They should be oriented to the policies where they are assigned.

• Their performance should be assessed frequently to determine their strength and weaknesses.

Five Rights of Delegation

• Right Task. One that is delegable for a specific patient.• Right Circumstances. Appropriate patient setting,

available resources, and other relevant factors considered.

• Right Person. Right person is delegating the right task to the right person to be performed on the right person.

• Right Direction/Communication. Clear, concise description of the task, including its objective, limits and expectations.

• Right Supervision. Appropriate monitoring, evaluation, intervention, as needed, and feedback.

Online Sources:

http://www.slideshare.net/pragati_jain/directing-as-management-function

http://www.managementstudyguide.com/principles_of_delegation.htm

http://www.americannursetoday.com/from-our-readersdelegation-for-nursing-managers-increasing-the-odds-of-success-2/

http://currentnursing.com/nursing_management/delegation.html

http://www.urbanministry.org/wiki/delegation-reasons-and-rules

http://www.ncsu.edu/project/parkprgrd/PSTrainingModules/delegating/del13frame.htm

http://www.bakercommunications.com/archive/apr13/management04013.html

References:

Kozier, Barbara. Fundamentals of Nursing: Concepts, Process and Practice, 2007.

Roussel, Linda, et. al. Management and Leadership for Nurse Administrators, 2006.

Rowland, Howard, et al. Nursing Administration Handbook. Retrieved from: http://books.google.com.ph/books?id=zR6bRKsUp_0C&pg=PA32&lpg=PA32&dq=nursing+management+by+roland+howard+directing&source=bl&ots=AVzYOS2Y_5&sig=3YCE9g4lt2Fo2Gw4CzRTjUmZ2os&hl=en&sa=X&ei=qbVkVJPQJePQmAWsk4LoCA&ved=0CCoQ6AEwAw#v=onepage&q=nursing%20management%20by%20roland%20howard%20directing&f=false

College of Registered Nurses of Nova Scotia, Assignment and Delegation Guidelines for Registered Nurses and Licensed Practical Nurses (2012). Retrieved from: http://www.clpnns.ca/sites/default/files/Assignment%20and%20Delegation%20Guidelines.pdf

Leadership & Management

Directing and Nursing Administration.ppt