Nursing Management Functions/Process

PLANNING

Definition:

• A pre-determining course of action in order to arrive at a desired result.

• A continuous process of making provision of the things to be done with visible results.
• It is the continuous process of assessing, establishing goals and objectives, implementing
an evaluating them, and subjecting these to change as new facts are known.

Principles of Planning

✓ Always based and focused on the vision, mission, philosophy, and clearly defined
objectives of the org.
✓ Continuous process (proper analysis for revision/flexibility to be done to make it more
effective)
✓ Pervasive within the entire org (provide maximal cooperation & harmony)
✓ Utilize all available resources
✓ Precise in its scope & nature (realistic & focused on realistic outcomes)
✓ Time-bound (short/long range plans)
✓ Projected plans should be documented for proper dissemination (implementation/
evaluation extent of its achievement)

Importance of Planning

✓ Achievement of goals & objectives (meaningful results)

✓ Gives meaning to work (experience greater satisfaction)
✓ Effective use of available resources & facilities (best use to prevent wastage)
✓ Helps in coping with crises (disaster plans, function more clearly/effectively)
✓ Cost effective (efficient operation)
✓ Based on past & future activities: evaluation of programs, schedules, activities whether
successful or not prevents/reduces recurrence of problems & provide better ideas to
modify/avoid them.
✓ Leads to the realization of the need for change
✓ Provides basis for control (evaluate accomplishment of the set programs/ activities.
✓ Necessary for effective control (evaluate environment/setting & recommend to make
hospital conditions therapeutic)

Characteristics / Criteria of Good Planning

1. Have clearly worded objectives, including desired results and methods for evaluation

1
 2. Be guided by policies and or procedures affecting the planned action indicate priorities
3. 3. Develop actions that are flexible and realistic in terms of available personnel,
equipment, facilities and time.
4. Develop logical sequence of activities
5. Include the most practical methods for achieving each objective.

REASONS WHY MANAGERS FAIL TO PLAN EFFECTIVELY

• Lack of knowledge of the philosophy, goals & objectives of the agency
• Lack of understanding of the significance of planning process
• Do not know how to manage their time to devote to planning
• Lack confidence in formulating plans
• Fear that planning may bring about unwanted changes that they are unwilling to
undertake/unable to cope with

SCOPE OF PLANNING

➢ TOP MANAGEMENT (Nursing Directors/Chief Nurses): set the over-all

goals and policies.
o Responsibility: covers the over-all management of the nursing
service.

o MIDDLE MANAGEMENT (Nursing Supervisors): direct the activities to

implement the broad operating policies of the org., such as staffing & delivery of
services to the units.
o Responsibility: Formulation of policies, rules and regulations, methods
and procedures for intermediate level planning for on-going activities
& projects, in coordination with TLM & LLM.

o LOWER/FIRST LEVEL MANAGERS (Head Nurses or Senior Nurses including charge

nurses or team leaders)
o Responsibility: Do the daily and weekly plans for the administration of
direct patient care in their respective units.

ELEMENTS OF PLANNING
1. Forecasting
2. Setting the Organizational Vision, Mission, Philosophy, Goals, and Objectives

2
 3. Developing and Scheduling Programs
4. Budget Planning
5. Time Management
6. Establishing Nursing Standards, Policies, and Procedures

FORECASTING
o estimating the future mission, vision, objectives
o Helps managers look into the future and decide in advance where the agency would like
to be and what is to be done in order to get there.
o It includes the:
- environment in which the plan will be executed;
- who the client will be – their customs and beliefs, language/dialect barriers, public
attitude and behavior, the severity of their conditions/illnesses, the kind of care they
will receive, number and kind of personnel required (professional and non-
professional); and the
- necessary resources- equipment, facilities, and supplies

Setting the Organizational Vision, Mission, Philosophy, Goals, and Objectives

Organizational Vision, Mission, Philosophy, Goals and Values

Establishing Objectives (SMART)/Setting goals
a. Specific
b. Measurable
c. Attainable
d. Realistic
e. Time-bound

SETTING THE VISION, MISSION, PHILOSSOPHY, GOALS & OBJECTIVES

VISION Statement: outlines the organization’s future role and function. (give agency something
to strive for)

MISSION Statement: outlines the agency’s reason for existing (whether hospital or health care)
- Who the target clients are (the poor, the needy, the middle or upper class)
- What services will be provided (in-patient, out-patient, emergency)

3
PHILOSOPHY: describes the vision. Statement of beliefs and values that direct one’s life or one’s
practice.
✓ The sense of purpose of the org
✓ The reason behind its structure and goals
✓ Explains the beliefs that shape how the mission or purpose will be achieved.
✓ Gives direction toward the attainment of the set goals and objectives
➢ SERVICES (diagnostic, therapeutic, preventive, health promotion, personnel education,
and research services)

Nursing Philosophy (broad/general)

• Directs nursing behavior, giving it a sense of purpose
• Quality, quantity and scope of service
• Decision-making based on factual information
• Appropriate delegation of function
• Achievement of organizational goals
• Vertical & horizontal communication
• Flexibility to meet the changing needs of the organization, individual, community & society.

GOALS: more general and they cover a broad area.

OBJECTIVES: more specific, and concrete.

✓ Action commitments through which an organization’s mission & purpose will
be achieved & the philosophy or belief sustained.
✓ Stated in terms of results to be achieved & focuses on the production of health
care services to the patient
✓ State specific & measurable goals to be accomplished

Example: The Philippine Department of Health

The Department of Health shall be responsible for the formulation, implementation, and
coordination of policies and programs in the field of health. The primary function is the promotion,
preservation, or restoration of the health of the people through the provision and delivery of health
services and through the regulation and encouragement of providers of health goods and
services.

Vision – Health as a Right: Health is the basic human right. A continuous set of services must
be provided to assure the enjoyment this right to especially by the poor.

Mission – The Department of Health shall work to make the enjoyment of the right to health a
reality by
✓ Making services available;
✓ Mobilizing resources;

4
 ✓ Providing the means to better health; and arousing community awareness

Developing and Scheduling Program

- Define activities needed within a set timeframe

✓ PROGRAMS are determined, developed & targeted within a time frame to reach the set
goals & objectives. Kron has developed a planning formula which may be used for daily
duties, or for short and long-range projects:

PLANNING FORMULA by KRON

✓ WHAT - What has been done? What should be done? What equipment and supplies
have been used or are needed? What steps are necessary in the procedure? What
sequence of activities was previously used? What other efficient methods may be
used?

✓ WHEN - When should the job be done? When was it formerly done? When could it be
done?

✓ WHERE - Where is the job to be done? Where does an activity occur in relation to
those activities immediately preceding and following it? Where could supplies be
stored, cleaned, and so forth?

✓ HOW - How will the job be done? What are the steps to be followed in doing the
procedure? How will the time and energy of personnel be used? How much will it cost?
How much time will it require?

✓ WHO - Who has been doing the job? Who else could do it? Is more than one person
involved?

✓ WHY - To each of the question, ask why? Why is this job, this procedure, this step
necessary? Why is this done in this way, in this place, at this time, by this person?
One more question can be added to make the formula more helpful.

✓ CAN - Can some steps or equipment be eliminated? Can this activity efficiently be
efficiently combined with other operations? Can somebody else do it better? Can we
get a machine to help? Can we get enough money?

5
GANTT chart

PERT diagram (Performance Evaluation Review Technique)

Budget Planning/Preparation

BUDGET: the annual operating plan, a ‘road map’ and plan which serves as:
✓ An estimate of future costs
✓ Plan for utilization of manpower, material and other resources to cover capital projects in
the operating programs
✓ numerical description of expected income and planned expenditures for an organization
for a specific period of time.
✓ Allocate tools and resources
✓ A management tool used to interpret organizational objectives and plans to change
resulting activities into financial and statistical terms.
✓ Involves evaluating past and present expenditures forecasting probable income and
establishing priorities in agency activities.

PURPOSE OF BUDGET
o To ensure the effective use of all resources in achieving agency policies/goals.
o To prevent the outgo or cost from exceeding the expected outcome

ADVANTAGES
1. Means to cost control
2. Better and more careful planning
3. Guide for operation
4. Departmental & self-evaluation
5. Source of information and hospital policy review
6. Financial accounting for nursing service department

➢ NURSING BUDGET: a plan for allocation of resources based on preconceived needs for
a proposed series of programs to deliver patient care during one fiscal year.

➢ HOSPITAL BUDGET: a financial plan to meet future service expectations derived from
the best judgment of the needs of the community.

6
 - translates these needs to manpower, equipment & supplies so that both services are
provided at the highest level of quality at a minimum cost.

TYPES OF BUDGET

1. OPERATING EXPENSE BUDGET: includes services to be provided and goods the unit
expects to consume or use during the budget period. E.g. salaries, fringe benefits, cost
of supplies, minor equipment, repairs, overhead expense.

2. CAPITAL EXPENDITURE/ CAPITAL EXPENSE BUDGET: includes costs of major

equipment or physical changes in the building requiring large amount of money. E.g.
major repairs of buildings, physical changes renovations, cost of lands /purchases of lands
& buildings, major equipment with considerable expense & long life

3. MANPOWER BUDGET: wages and salaries paid to regular institutional employees and
fees paid to outside registries through whom the institutions contracts for temporary
worker.

Budget Planning:

BUDGET: a plan for future activities expressed in operational as well as financial or

monetary terms.

FOUR COMPONENTS

1. REVENUE BUDGET: summarizes the income which management expects to generate

during the planning period.
2. EXPENSE BUDGET: describes the expected activity in operational & financial terms for
a given period of time.
3. CAPITAL BUDGET: outlines the programmed acquisitions, disposals & improvements in
an institution’s capacity.
4. CASH BUDGET: represents the planned cash receipts and disbursements as well as the
cash balances expected during the planning period.

Components of an Institutional Budget

1. Capital Expenditure
2. Personnel Budget

7
 3. Operating Budget

Capital Expenditure

- A large capital outlay for buildings or equipment that commits the institution to a
particular path for some time in the future
- Includes physical changes such as replacement or expansion, major equipment and
inventories.

Personnel Budget
- Estimates the cost of direct labor necessary to meet the agency’s objectives.
- Determines recruitment, hiring, assignment, lay off and discharge of personnel.

Operating budget

- Input-output analysis of expected revenues and expenses

- Includes personnel salaries, employees benefits and insurance, medical-surgical
supplies, office supplies, rent, heat, light, housekeeping, laundry service, drugs,
pharmaceuticals, repairs, maintenance, in-service trainings, books etc.

Types of Budgets

1. Fixed-ceiling – Uppermost spending limit is fixed by the organization before subordinate

managers are asked to develop budget proposals for their individual units.
2. Open-ended – operating manager presents a single cost estimate for what she
considers the optimal activity level, without indicating how that plan should be scaled
down if less funding is available.
3. Flexible - can be adjusted or manipulated, consists of several financial plans, each for
a different level of activity of different operating conditions
4. Sunset – designed to “self-destruct” within a prescribed period to ensure cessation of
the funded program by a predetermined date.
5. Zero-based - expenses have to be justified to determine profit or loss, forces managers
to set priorities and justify resources, based on previous year’s expenditure
6. Contingency – can be used in case of emergency; if not used, can be part of savings.
7. Performance - based on functions, such as direct nursing care, supervision, in-service
education, quality control, nursing audit, procedure revision and development, nursing
research, etc.

8
 MODELS OF NURSING

A. Basic Planning - A simple, goal-oriented approach to planning used to achieve short-

term objectives with minimal complexity. Ideal for individuals or groups with limited
resources or experience.

Key Features/Importance:

✓ Focuses on clear, actionable goals.

✓ Encourages prioritization and organization of tasks.
✓ Builds a foundation for more advanced planning methods.
✓ Suitable for quick decision-making or initial attempts at planning.

Steps:

1. Define the goal (e.g., complete a nursing project or assignment).

2. Break the goal into smaller, manageable tasks.
3. Allocate time and resources to each task.
4. Monitor progress and adjust if needed.

Example for Student Nurses: Planning a group presentation on patient safety. Tasks might
include dividing topics among members, scheduling research sessions, and practicing the
presentation.

B. Issue-Based Planning - A problem-focused planning approach that identifies and

addresses specific challenges or issues within a team or organization.

Key Features/Importance:

✓ Promotes problem-solving and critical thinking.

✓ Helps manage crises or resolve conflicts.
✓ Encourages collaborative efforts to find solutions.
✓ Focuses resources on the most urgent issues.

Steps:

1. Identify the problem (e.g., lack of preparation for clinical skills).

2. Analyze the causes and impacts of the issue.
3. Develop specific strategies to address the problem.
4. Implement solutions and evaluate the outcome.

Example for Student Nurses: Addressing poor handwashing compliance during clinical
rotations by organizing a peer-led workshop on infection control practices.

C. Alignment Model - A planning approach that ensures goals, actions, and resources are
aligned with the mission and vision of a group or organization.

9
Key Features/Importance:

✓ Promotes coherence between goals and activities.

✓ Enhances teamwork and efficiency.
✓ Ensures alignment with institutional values and expectations.
✓ Reduces duplication of efforts or misdirected resources.

Steps:

1. Identify the group's or institution's mission (e.g., providing patient-centered care).

2. Assess current practices for alignment with the mission.
3. Develop plans to address gaps or inconsistencies.
4. Implement the plan and monitor progress.

Example for Student Nurses: Aligning a clinical rotation schedule with the nursing curriculum’s
objectives to ensure students practice relevant skills like medication administration and wound
care.

D. Scenario Planning - A forward-thinking planning method that prepares for various

potential future events or challenges by exploring uncertainties.

Key Features/Importance:

✓ Encourages adaptability and preparedness.

✓ Helps anticipate risks and develop contingency plans.
✓ Promotes creative and strategic thinking.
✓ Suitable for high-stakes or unpredictable situations.

Steps:

1. Identify uncertainties (e.g., unexpected clinical emergencies).

2. Develop different scenarios (e.g., equipment shortage, patient emergencies).
3. Plan responses or actions for each scenario.
4. Test and refine the scenarios through simulation or practice.

Example for Student Nurses: Developing contingency plans for a simulated mass casualty
event in a nursing lab, preparing responses for varying levels of patient severity.

E. Organic Planning - A flexible and collaborative approach to planning that evolves

naturally based on feedback and active participation from all stakeholders.

Key Features/Importance:

✓ Encourages inclusivity and teamwork.

✓ Adaptable to changes or unexpected developments.
✓ Builds a sense of ownership among participants.
✓ Suitable for group-based tasks or community-oriented projects.

10
Steps:

1. Engage participants (e.g., classmates, instructors) to identify goals.

2. Develop initial plans collaboratively.
3. Allow the plan to evolve as feedback is incorporated.
4. Monitor and adjust as needed.

Example for Student Nurses: Collaborating with peers and instructors to design a community
health education program on proper nutrition, modifying the approach based on community
feedback.

F. Functional Planning - A focused approach to planning that targets specific functions or

roles within a team or organization.

Key Features/Importance:

✓ Breaks down complex projects into manageable components.

✓ Enhances clarity and accountability.
✓ Aligns departmental or individual efforts with broader goals.
✓ Encourages efficiency and specialization.

Steps:

1. Define the function’s objectives (e.g., improving clinical documentation).

2. Develop detailed strategies to achieve these objectives.
3. Allocate resources and responsibilities within the function or group.
4. Monitor progress and make improvements.

Example for Student Nurses: The head of a student clinical group assigning roles like patient
interviewing, vital sign monitoring, and charting to ensure all required tasks are completed
efficiently. --- These planning models help student nurses effectively organize their academic,
clinical, and community tasks, fostering critical thinking, teamwork, and problem-solving skills
essential for their future professional roles.

11