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Nursing Management: Planning Strategies

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10 views20 pages

Nursing Management: Planning Strategies

Uploaded by

chriscas011204
Copyright
© All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Module 2.

1
Nursing Management Function
[Link]
planning-phase

1. PLANNING

Planning as a basic function of management is a principal duty of all managers. It is a


systematic process and requires knowledgeable activity based on sound managerial theory.
Being the first element of management defined by Fayol, planning is making a plan of action to
provide for the foreseeable future. This plan of action must have unity, continuity, flexibility, and
precision.

Planning is a continuous process, beginning with the setting of goals and objectives and then
laying out a plan of action for accomplishing them, putting them into play, reviewing the process
and the outcomes, providing feedback to personnel, and modifying plans as needed. As
planning is put into action, the management functions of organizing, leading, and evaluating are
implemented, making all management functions interdependent.

Planning is a thinking or mental process of decision making and forecasting. It is future oriented
and ensures desirable probable outcomes. Likewise, it involves determining objectives and
strategies, programs, procedures, and rules to accomplish the objectives. In nursing, planning
helps to ensure that clients or patients will receive the nursing services they want and need and
that these services are delivered by satisfied nursing workers.

Planning should be based on objectives that should be framed in terms of making a product or
providing a service for the community. Simplification and standardization are basic to sound
planning procedures. The product or service should be of the right pattern. Planning provides
information to coordinate work effectively and accurately. A good plan should be based on an
objective, be simple, have standards, be flexible, be balanced, and use available resources first.

Planning improves with experience, gives sequence in activity, and protects a business against
undesirable changes. Fayol's concept was that planning facilitates wise use of resources and
selection of the best approaches to achieving objectives. Planning facilitates the art of handling
people. It requires moral courage, since it can fail. Effective planning requires continuity of
tenure. Good planning is a sign of competence.

TYPES OF PLANNING

1. Strategic Planning

Drucker defines strategic planning as "a continuous, systematic process of making risk-
taking decisions today with the greatest possible knowledge of their effects on the future;
organizing efforts necessary to carry out these decisions and evaluating results of these
decisions against expected outcome through reliable feedback mechanisms." Nursing
administrators can increase effectiveness through strategic planning, which can promote
professional nursing practice and the long-range goals of the organization and the division of
nursing.

Strategic planning in nursing is concerned with what nursing should be doing. Its purpose is to
improve allocation of scarce resources, including time and money, and to manage the agency
for performance. Strategic planning provides strategic forecasting from one year up to more
than twenty years. It should involve top nurse managers and representatives of all levels of
nursing management and practice. It will include analysis of such factors as projected
technological advances, the internal and external environments, the nursing and health-care
market and industry, the economics of nursing and health care, availability of human and
material resources, and judgments of top management.

In today's world, the strategic planning process is used to acquire and develop new health-care
services and product lines, including new nursing services and products. Strategic planning is
also used to remove outdated services and products. Both activities present moral and ethical
dilemmas for the managers and practitioners of nursing. Strategic planning can foster better
goals, better corporate values, and better communication about corporate direction. It can lead
to changes in operating management and organization. Strategic planning can produce better
management strategy and analysis and can forecast and mute external threats.

Odiorne recommends the following process for crafting a strategic plan:

1. Identify the major problems of your organization, determining where you are headed and
where you want to be. This is "gap analysis," a technique to examine markets, products,
customers, employees, finances, technology, and community relations. Cabinets or task forces
from each area may be helpful in doing gap analysis and identifying major problems.

2. Examine outside influences that relate to the key problems of your organization. Focus on the
few major issues.

3. List the critical issues: those that affect the entire organization, have long-term impact, and
are based on irrefutable evidence rather than media hype.

4. Rank the critical issues according to their importance to your organization and plan
accordingly: "must do" and "to do" and "important but not urgent." Then divide them into
"success producers" and "failure preventers.''

5. Decide the critical issues to all organization managers.

6. Include time in the budget.

Strategic plans should be developed from the bottom up, the front line where business occurs.
The written plan should be shared with everyone, should not be slavishly followed, as it will be
constantly affected by change, and should be modified every year.

How Strategic Planning Can Be Used to Improve Nursing Management

§ To provide accountability and monitoring of performance; to tie merit to performance.

§ To set up more formal planning programs and require divisional and unit planning.

§ To integrate strategic plans with operational and financial plans.

§ To improve knowledge of and training in strategic planning.

§ To increase top management involvement and commitment.

§ To improve focus on competition, market segments, and external factors.

§ To improve communication from top administration and nursing management.

§ To allow better execution of plans.

§ To be more realistic, and less rationalizing and vacillating.

§ To improve the development of nursing management strategies.

§ To improve the development and communication of nursing management goals.

§ To put less emphasis on raw numbers.

§ To anticipate the future and plan for it.

§ To develop the annual budget.

§ To focus on quality outputs that will improve nurse performance and productivity, decrease
losses, and increase return on equity.
Summary of Phases of Strategic Planning Process

PHASE 1: The Mission and the Creed

Develop statements that define the work, the aims, and the character of the division of nursing.
These include idea statements of shared values and beliefs. They are called mission (or
purpose) and creed (or philosophy) statements and relate to personnel, patients, community,
and all other potential customers.

PHASE 2: Data Collection and Analysis

Collect and analyze data about the health-care industry and nursing. Such data should include
internal forces that define the work and affect employees, clients, stockholders, and creditors;
technological advances; threats; opportunities to improve growth and productivity; external
forces, such as competition, communities, government and political issues, and legal
requirements; marketing and public relations or image; trends in the physical and social work
environments; and communication. Use simple and complex forecasting techniques, including
trend lines, group consensus, nominal group process, and a qualitative decision matrix that
uses probabilities based on conditions of certainty, risk, and uncertainty.

PHASE 3: Assess Strengths and Weaknesses

Define those factors from the data analysis that influence the management of the division of
nursing. List them as strengths or opportunities that will facilitate effectiveness and achievement
of goals and objectives or as weaknesses or threats that will impede achieving goals and
objectives. Define the current position and strength of the unit.

PHASE 4: Goals and Objectives

Write realistic and general statements of goals. Break the goals down into concrete written
statements of objectives the division of nursing intends to accomplish in the next three to five
years.

PHASE 5: Strategies

Identify untoward conditions that could develop in achieving each objective. Note administrative
actions to avoid or manage them. Use this information to modify goals and objectives, making
contingency plans for alternative actions. Define the organization needed for doing and
implementing strategic plans. It should be interactive if cross-functional activities are involved in
a matrix organization.

PHASE 6: Timetable

Develop a timetable for accomplishing each objective. Identify by geographic units as well. This
phase will produce or become part of the plans.

PHASE 7: Operational and Functional Plans

Provide guidelines or general instructions that lead the functional and operational nurse
managers to develop action plans to implement the goals and objectives. These will include
detailed actions, policies, practices, communication and feedback, controlling and evaluation
plans, budgets, timetables, and persons to be held accountable.

PHASE 8: Implementation

Put the plans to work.

PHASE 9: Evaluation

Provide for formative evaluation reports before, during, and after the operational plan is
implemented. Provide for summative evaluation that is quantified. Report actual versus
expected results. Frequently evaluate the strategic mission and plan. Provide continuous
feedback that can be used to modify and update the plan. Use people who implement the plan
to evaluate it.

2. Operational Planning

Operational management is the organization and directing of the delivery of nursing care.
It includes such planning as creating a budget, creating an effective organizational structure that
encompasses a quality monitoring process, and directing nurse leaders, an administrative staff,
and new programs.

Operational plans are everyday working management plans developed from both long-range
objectives and the strategic planning process and short range or tactical plans. In development
of operational objectives, new strategic objectives can emerge or old ones can be modified or
discarded. Strategic and tactical plans are made into operational plans and carried out at all
levels of nursing management, not just at the patient-care level.

Operational managers develop goals, objectives, strategies, and targets to set the strategic plan
in motion. They match each unit goal or objective to a strategic goal or objective. Their
objectives can be much more detailed and specific than the strategic objectives. Numerous
operational objectives can support one strategic objective.

All aspects of an operational plan are based on goals and their achievement. The individual
leadership style determines whether goal setting will be of the top-down or bottom-up variety.
Bottom-up goal setting is participatory, using guidelines from the operational manager.
Participatory goal setting is believed to increase workers' commitment and achievement.
Increased participation leads to greater group cohesiveness, which in turn fosters increased
morale, increased motivation, and increased achievement and productivity. Individuals,
including professional nurses, can ensure greater relative success in achievement of goals by
building in some slack in terms of projected resources and time. Nurses who reject goals of
participating staff should explain their reasons for rejection. Participation in goal setting does not
alone ensure success

The goal is to plan, assess progress toward goals and objectives at all levels, and provide
feedback to all levels of management. Efficiency is also a goal; all levels of management should
guard against unnecessary time spent in meetings. As organizing changes are occurring,
controlling activities are in operation and activities are being evaluated.

___________________________________________________________________________

NATURE OF PLANNING

The nature of planning can be highlighted by studying its characteristics. They are as follows:

(a) Planning is a mental activity. Planning is not a simple process. It is an intellectual exercise
and involves thinking and forethought on the part of the manager.

(b) Planning is goal-oriented. Every plan specifies the goals to be attained in the future and the
steps necessary to reach them. A manager cannot do any planning, unless the goals are
known.

(c) Planning is forward looking. Planning is in keeping with the adage, “look before you leap”.
Thus, planning means looking ahead. It is futuristic in nature since it is performed to accomplish
some objectives in future.

(d) Planning pervades all managerial activity. Planning is the basic function of managers at all
levels, although the nature and scope of planning will vary at each level.

(e) Planning is the primary function. Planning logically precedes the execution of all other
managerial functions, since managerial activities in organizing; staffing, directing and controlling
are designed to support the attainment of organizational goals. Thus, management is a circular
process beginning with planning and returning to planning for revision and adjustment.

(f) Planning is based on facts. Planning is a conscious determination and projection of a course
of action for the future.

PURPOSES OF PLANNING

The following are some reasons for planning:

1. Planning increases the chances of success by focusing on results, not on activities.

2. It forces analytic thinking and evaluation of alternatives, therefore improving decisions.

3. It establishes a framework for decision making that is consistent with top management
objectives.

4. It orients people to action instead of reaction.

5. It includes day-to-day and future-focused managing.

6. It helps to avoid crisis management and provides decision-making flexibility.

7. It provides a basis for managing organizational and individual performance.

8. It increases employee involvement and improves communication.

9. It is cost-effective.

Among the activities of planning that Douglass addresses are assessment by collection,
classification, analysis, interpretation, and translation of data; strategic planning; development of
standards; identification of needs and priority setting; management by objectives; and
formulation of policies, rules, regulations, methods, and procedures.

Donovan wrote that planning has several benefits, among which are satisfactory outcomes of
decisions; improved functions in emergencies; assurance of economy of time, space, and
materials; and the highest use of personnel. She included decision making, philosophies, and
objectives as key elements in planning.

[Link]
delegation/
2. ORGANIZING

 Determine what task are to be done, who is to do these, how the tasks are to be
grouped, who reports to whom and what decisions are to be made.
 It is a form of identifying roles and relationships of each staff on order to delineate
specific tasks or functions that will carry out organizational plan s and objectives.
 Process of identifying and grouping the work to be performed, defining and
delegating responsibility and authority and establishing relationships for the purpose
of enabling the people to work more effectively together in accomplishing objectives.
 As a process, it refers to the building of a structure that will provide for the separation
of activities to be performed and for the arrangement of these activities in a
framework which indicates their hierarchal importance and functional association.

Organizing Process Includes

1. Identifying and defining basic tasks.


2. Delegation of authority and assigning responsibility
3. Establishing relationships

Three Forms of Authority

1. Line authority – is a direct supervisory authority from supervisor to subordinates.


o Chain of Command – unbroken line of reporting relationships that
extends through the entire organization. The line defines the chain of
command and the formal decision making structure.
o Unity of Command – within the chin states that, each person in the
organization should take orders and reports only to one person.
o Span of Control – refers to the number of employees that should be
placed under the direction of one leader-manager.

2. Staff Authority – authority that is based on the expertise and which usually involves
advising the line managers.

3. Team Authority – is granted to committees or work teams involved in an


organization’s daily operations. Work teams are group of operating employees who
shared a common vision, goals and objectives.

Organizational Chart

o Drawing that shows how the parts of the organizations are link.
o It depicts the formal organizational relationship, areas of responsibility and
accountability and channel of communication.
o Depicts an organization’s structure.
A. Organizational Structure

o Depicts and identifies role and expectations, arrangement of positions and working
relationships.

1. Dotted or Unbroken line – represents staff positions/staff authority (advisor to the


line managers).
2. Centrality – refers to the location of a position on an organizational chart where
frequent and various types of communication occur. Determined by organizational
distance; those with small organizational distance receive more information than
those who are more peripherally located.
3. Solid Horizontal Line – represent same positions but different functions.
4. Solid Vertical Line – chain of command form authority to subordinates (line
authority)
Level Scope of Responsibility Examples
1. Generally, make
decisions with the
help of ►few
guidelines or CEO, President, V-President,
Top Level Managers structure. Chief Nursing Officer
2. Coordinates internal
and external
influences
1. They conduct day-
day operations with Head Nurse, Department
Middle Level Managers some involvement, Head, Unit
long term planning Supervisor/Manager
and policy making.
1. Concerned with
specific unit
workflows. Charge Nurse, Team Leader,
First Level Managers
2. Deals with Primary Nurse, Staff Nurse
immediate day-day
problems.

Patterns of Organizational Structure

1. Tall/Centralized Structure

o Responsible for only few subordinates so there is narrow span of control


o Because of the vertical in nature, there are many levels of communication
o Communication is difficult and messages do not get to the top.
o Workers are boss-oriented because of close contact with their supervisor.

2. Flat/Decentralized Structure

o Characterized by few levels and a broad span of control


o Communication is easy and direct
Advantages:
1. Shortens the administrative distance from the top to the lower
2. Solutions to problems are easily carried out/fast response
3. Workers developed their abilities and autonomy

Disadvantage:

1. Impractical in large organization.

Types of Organizational Structure

1. Line Organization/Bureaucratic/Pyramidal

o There is clearly defined superior-subordinate relationship


o AR ►and power are concentrated at the top

2. Flat/Horizontal Organization

o Decentralized type
o Applicable in small organization
o Nurses become productive and directly involved in the decision making skills
o Workers become satisfied

3. Functional Organization

o Permits a specialist to aid line position within a limited and clearly defined scope of
authority

4. Ad Hoc Organization

o Modification of bureaucratic structure

5. Matrix structure

o Focus on both product and functions


o Most complex
o Has both vertical and horizontal chain of command and line of communication
B. Staffing

o Process of assigning competent people to fulfill the roles designated for the
organizational structure through recruitment, selection and development, induction
and orientation of the new staff of the goals, vision, mission, philosophy etc.

Staffing Process

1. Preparing to Recruit – types and number of personnel


2. Attracting a Staff – formal advertisement
3. Recruiting and Selecting a Staff – interview ►induction ►orientation ►job order
►pre-employment testing ►signing of contract
Staffing Pattern – plan that articulates how many and what kind of staff are needed/shift or per
day in ►unit or in ►department.

Two Ways of Developing a Staffing Pattern

1. Determine the # of nursing care hours needed/patient


o Generating the full time equivalents of an employee
2. Determine the nurse-patient ratio in providing nursing care

 FTE – measure of work committed of full time employee


o 1.0 FTE = works 5 days/week, 8 hours/day

o 0.5 FTE = part time employee who works 5 days/2 weeks

Considerations in Staffing Pattern

1. Benchmarking

 Management tool for seeking out the best practice in one’s industry so as to improve
one’s performance.
 Process of measuring products, practices and services against best performing
organization as atool for identifying desired standards of organizational performance.

2. Regulatory Requirements – mandated by RA

3. Skill Mix – percent or ratio of professionals to nonprofessional


Ex: 40 FTE (20 RN + 20 non-RN) = 50% RN mix

4. Staff Support – staff support in place for the operations of the units or department.

5. Historical Information – review of any data on quality or staff perception regarding the
effectiveness of the previous staffing pattern.
C. Patient Classification System

o Measuring tool used to articulate the nursing workload for specific patient or group of
patients over a specific time.
o Patient Acuity – measure of nursing workload that is generated for each patient.

Patient Care is Classified According to:

1. Self-care or minimal care patients are capable of carrying ADL, e.g., hygiene, meals
etc.
2. Intermediate or moderate care requires some help from the nursing staff with special
treatments or certain aspects of personal care, e.g., patients with IV fluids, catheter,
respirator, etc.
3. Total care patients are those who are bedridden and who lack strength and mobility
to do average daily living. Ex: patients on CBR, immediate post-op, with contraptions.
4. Intensive care patients are those who are critically ill and in constant danger of death
or serious injury. Ex: comatose, bedridden etc.

D. Scheduling

 Timetable showing planned work days and shifts for nursing personnel.

Issues to consider in scheduling staff:

1. Patient type and acuity


2. Number of patients
3. Experience of Staff
4. Support available to the staff

Shifting Variations

 Traditional Shifting Patterns


o 3 shift (8 hr shift)
o 12 hr shift
o 10 hr shift
 Weekend option
 Rotating work shift
 Self-scheduling – staff makes their own schedule
 Permanent work shift
 Floaters – “on-call”
Forty Hour Week Law – based on RA 5901

 No work, no pay
 Entitled to 2-week sick leave and off duty for 2 days
 Special Holidays – with pay

E. Modalities of Care

Types of Nursing Modalities

Michael Evans
Updated December 27, 2018

In the last century, numerous nursing modalities – also called nursing care models –
emerged to meet the ever-changing needs of patients and the health-care industry. Each
nursing professional plays a critical role in patient care and the way in which patients experience
their health care. Nursing care models vary in administration and scope. While some provide
quality care for large numbers of patients, others focus on serving the needs of individuals.
Nursing care models are fluid, allowing each hospital, clinic or private practice to devise a
method to serve patients.

1. Functional Nursing Model

The functional nursing method is a decades-old, traditional form of patient care. The model
relies on a hierarchy of nurses who perform different tasks depending upon their level of
education, training and experience.

The team leader, a registered nurse (RN), collaborates with physicians to determine the needs
of a patient. The head nurse then delegates tasks to nurses under her supervision. For
example, she might assign another registered nurse to administer treatments, while a licensed
practical nurse (LPN) monitors blood pressure and a nurse's aide assists the patient with an
exercise regime.

Functional nursing applies an assembly-line method of patient care, which can offer economic
advantages for the hospital because it maximizes each team member’s skill set. This nursing
model works well in periods of high demand, such as wartime or during epidemics. However,
functional nursing does not provide the holistic care that many patients need, because the
nurses focus on their individual tasks rather than the overall condition or progress of the patient.

2. Team Nursing Model

Developed in the 1950s, the team nursing model is similar to the functional nursing method, but
provides care on a larger scale. The team nursing model assigns an RN as the group leader
who delegates tasks to a team of medical professionals who care for multiple patients.

Teams contain at least two nurses, typically with different experience, education and skill levels.
An RN team member might dispense medications, while an LPN monitors patient blood
pressure. The team might also include a nurse’s aide, who carries out tasks such as bathing
and dressing the same group of patients.

Surveys of nurses have yielded high marks for the team nursing model. Inexperienced nurses
appreciate the opportunity to work with and learn from their experienced colleagues. Likewise,
experienced nurses report that they feel more supported in their duties under a team nursing
model. The team nursing approach also benefits medical facilities by enabling inexperienced
nurses to learn more quickly, giving them increased value as employee assets. The method
also promotes and improves communication among team members, which can result in
improved patient care.
Team nursing relies on team leader RNs with good management and leadership skills. Patient
needs can impact the success of the team nursing method. Designed to provide care for
numerous patients, the team nursing model does not offer appropriate coverage for patients
who need constant care and attention.

3. Primary Nursing Model

The primary nursing model assigns patients to a primary RN, who takes responsibility for their
care throughout the hospital stay. By following a patient’s progress, the RN can provide a more
holistic level of care, while offering the patient the comfort of having a primary caregiver among
the nursing staff.

The primary nursing method developed in the 1970s and quickly gained popularity. It addressed
the shortcomings of older models such as functional and team nursing, which left gaps in patient
care because of task-oriented approaches. Primary nursing has proven particularly successful
in meeting the needs of patients with complex medical conditions. For example, a patient with
diabetes might have heart problems, tissue damage and dietary restrictions, which require the
type of comprehensive care a primary nurse can provide. Patients respond well to the primary
nursing model, because it provides them with a knowledgeable medical contact and a sense of
continuous care. Generally, nurses appreciate the feeling of autonomy primary nursing offers,
while enabling them to provide patients with a high level of care.

Flexible work schedules, which allow nurses to work three consecutive days of 12-hour shifts,
followed by four days off, create a disadvantage to the primary nursing model, particularly for
patients who require long-term hospitals stays.

The primary nursing model has remained relatively unchanged since its conception. Most
studies indicate that it provides a higher level of job satisfaction for nurses and is popular among
patients. However, results have largely offered anecdotal evidence and lack hard data about
how primary nursing’s quality of care compares with models such as team and functional
nursing.

4. Total Patient Care Model

Total patient care is the grandfather of nursing models. It requires a patient to receive all nursing
care from one nurse. In today’s medical industry, total patient care can only be applied in certain
types of situations, including critical care and home health care.

In the total patient care model, the attending nurse typically provides care for the patient from
the beginning to the end of his medical care episode. For example, a nurse might provide a few
weeks of around-the-clock, in-home care for an elderly patient who has broken a hip. The
patient might deal with more than one nurse due to work schedules, but he does not receive
care from multiple nurses during a work shift. Total patient care requires nurses to assume all
care for their patients. They must closely monitor the patient’s condition and communicate
closely with the patient’s physicians.

Typically, patients respond favorably to total patient care, because their nurses attend quickly to
their needs. In many cases, the patient and nurse develop a friendship, which makes the
experience less stressful and more meaningful for the patient.

In home health care settings, a patient might face a disadvantage if he needs medical care the
nurse cannot readily provide. For example, if an in-home patient suddenly develops a breathing
problem, the nurse cannot quickly summon a respiratory therapist. Many nurses enjoy the
autonomy that total patient care offers them. However, focusing effort on one patient at a time
can lead to burnout.

5. Case Management
Case management focuses on the administrative issues of health care, rather than the actual
delivery of health care. An RN case manager evaluates a patient’s care to determine her
healthcare costs and the likelihood that the insurer will provide coverage. Case managers follow
the progression of a patient’s care to determine the likely discharge date and her care needs
after discharge.

The case management model stems from the complexity of third-party health-care payers and
the rising costs of health care. A case manager serves as an intermediary between the patient
and third-party payers, which may include insurance companies, Medicare or Medicaid. They
also ensure that third party payers will reimburse the health-care facilities for services.

Case managers often deal with 12 to 28 patients per day. In the past, they reviewed patient
charts and communicated with third party payers every three to seven days. But in today’s
digital age, case managers communicate daily with attending doctors, nurses and third-party
payers.

Effective case management benefits everyone involved. The case manager communicates with
the patient to inform her about approvals or denials from her healthcare provider. Likewise, the
case manager can help prevent health-care facilities from losing money because of unexpected
coverage denials.

Case managers must stay abreast of every aspect of the patient’s care, from diagnostic tests to
surgery schedules and from outpatient therapies to home health-care requirements. For
example, a case manager must keep track of the number of days a patient’s insurance
company will pay for inpatient care. If a patient experiences a discharge delay due to a
rescheduled surgery, the case manager must communicate with the third-party payer and
coordinate new surgery and discharge dates with health-care staff. A case manager must work
closely with the patients to assess the effectiveness of treatments and help devise self-care
plans for after discharge.
3. DIRECTING

 Act of issuing of orders, assignments, instructions, to accomplish organizational goals


and objectives.
 Delegation – entails responsibility
 Assignments – no responsibility

Elements of Directing

1. Communication
2. Delegation
3. Motivation
4. Coordination
5. Evaluation

3.1 Communication – exchange of ideas, thoughts or information through verbal


speech, writing and signals

Barriers in Communication

1. Physical Barriers
Environmental factors that prevent or reduce the opportunities for
communication. Ex: Distance and Noise

2. . Social and Psychological Barriers

 Blocks or inhibitors of communication that rise from the judgment, emotions,


social values of [Link]: stress, trust, fear, defensiveness
 Internal climate (values, feelings, temperament and stress levels) and external
climate (weather, timing, temperature, lack of validation to the message).
3. Semantics

 Words, figures, symbols,penmanship and interpretation of the message


through signs and symbols.

4. Interpretations

 Defects in communication skills by verbalizing, listening, writing, reading and


telephony

3.2 Delegation

 Act of assigning to someone else a portion of the work to be done with corresponding
authority, responsibility and accountability (ARA).
 According to ANA, it is the transfers of responsibilities for the performance of the task
from one person to another
 Much of the work of manager is accomplished by transferring the responsibilities to
subordinates

Good Reasons for Delegation

1. Manager delegate routine task so that they are free to handle problems that are more
complex or require higher level of expertise
2. Delegate routine task if someone else is better prepared or has greater expertise or
knowledge in solving the problems

Managers who do not delegate

 Does not trust


 Fear of mistake
 Fear of criticism
 Fear of own ability to delegate

Common Errors in Delegation

 Underdelegating – systems from the manager’s false assumptions that delegation


maybe interpreted as a lack of ability on his part to do the job correctly and
competently. Reasons are:
o Managers believe that they can do the work faster and better
o Managers believe that the responsibility may be rejected if delegated.

 Overdelegating – subordinates become overburdened which may lead to


dissatisfaction and low productivity. Reasons are:
o Managers who are lazy
o Manager who are overburdened and exhausted
 Improper Delegation – delegating at the wrong person, time, tasks and beyond the
capability of the subordinates.

Steps in Effective Delegating

1. Plan ahead
2. Identify necessary skills and levels
3. Select most capable personnel
4. Communicate goal clearly
5. Empower the delegate
6. Set deadlines and monitor progress
7. Model the role and provide guidance
8. Evaluate performance

3.3 Motivation – whatever influences our choices and creates direction, intensity, and
persistence in our behavior.

3.4 Supervision – guiding and directing the work to be done. It entails motivating and
encouraging the staff to participate in the activities to meet the goals and objectives for
personal development in making the work better.

3.5 Coordination – arranging in proper order. It creates harmony in all activities to facilitate
success of work
4. Controlling

Controlling Function of Management


What is Controlling?

Controlling consists of verifying whether everything occurs in conformities with the plans
adopted, instructions issued and principles established. Controlling ensures that there is
effective and efficient utilization of organizational resources so as to achieve the planned goals.
Controlling measures, the deviation of actual performance from the standard performance,
discovers the causes of such deviations and helps in taking corrective actions

According to Brech, “Controlling is a systematic exercise which is called as a process of


checking actual performance against the standards or plans with a view to ensure adequate
progress and also recording such experience as is gained as a contribution to possible future
needs.”

According to Donnell, “Just as a navigator continually takes reading to ensure whether he is


relative to a planned action, so should a business manager continually take reading to assure
himself that his enterprise is on right course.”

Controlling has got two basic purposes

1. It facilitates co-ordination
2. It helps in planning

Features of Controlling Function

Following are the characteristics of controlling function of management-

1. Controlling is an end function- A function which comes once the performances are
made in conformities with plans.
2. Controlling is a pervasive function- which means it is performed by managers at all
levels and in all type of concerns.
3. Controlling is forward looking- because effective control is not possible without past
being controlled. Controlling always look to future so that follow-up can be made
whenever required.
4. Controlling is a dynamic process- since controlling requires taking reviewal methods,
changes have to be made wherever possible.
5. Controlling is related with planning- Planning and Controlling are two inseperable
functions of management. Without planning, controlling is a meaningless exercise and
without controlling, planning is useless. Planning presupposes controlling and controlling
succeeds planning.

Process of Controlling
Controlling as a management function involves following steps:

Establishment of standards- Standards are the plans or the targets which have to be
achieved in the course of business function. They can also be called as the criterions for judging
the performance. Standards generally are classified into two-

Measurable or tangible - Those standards which can be measured and expressed are called
as measurable standards. They can be in form of cost, output, expenditure, time, profit, etc.

Non-measurable or intangible- There are standards which cannot be measured monetarily.


For example- performance of a manager, deviation of workers, their attitudes towards a
concern. These are called as intangible standards.

Controlling becomes easy through establishment of these standards because controlling is


exercised on the basis of these standards.

Measurement of performance- The second major step in controlling is to measure the


performance. Finding out deviations becomes easy through measuring the actual performance.
Performance levels are sometimes easy to measure and sometimes difficult. Measurement of
tangible standards is easy as it can be expressed in units, cost, money terms, etc. Quantitative
measurement becomes difficult when performance of manager has to be measured.
Performance of a manager cannot be measured in quantities. It can be measured only by-

Attitude of the workers,

Their morale to work,

The development in the attitudes regarding the physical environment, and

Their communication with the superiors.

It is also sometimes done through various reports like weekly, monthly, quarterly, yearly reports.

Comparison of actual and standard performance-

Comparison of actual performance with the planned targets is very important. Deviation
can be defined as the gap between actual performance and the planned targets. The manager
has to find out two things here- extent of deviation and cause of deviation. Extent of deviation
means that the manager has to find out whether the deviation is positive or negative or whether
the actual performance is in conformity with the planned performance. The managers have to
exercise control by exception. He has to find out those deviations which are critical and
important for business. Minor deviations have to be ignored. Major deviations like replacement
of machinery, appointment of workers, quality of raw material, rate of profits, etc. should be
looked upon consciously. Therefore it is said, “ If a manager controls everything, he ends up
controlling nothing.” For example, if stationery charges increase by a minor 5 to 10%, it can be
called as a minor deviation. On the other hand, if monthly production decreases continuously, it
is called as major deviation.

Once the deviation is identified, a manager has to think about various cause which has led to
deviation. The causes can be-

Erroneous planning,
Co-ordination loosens,
Implementation of plans is defective, and
Supervision and communication is ineffective, etc.
Taking remedial actions- Once the causes and extent of deviations are known, the manager
has to detect those errors and take remedial measures for it. There are two alternatives here-

Taking corrective measures for deviations which have occurred; and


After taking the corrective measures, if the actual performance is not in conformity with plans,
the manager can revise the targets. It is here the controlling process comes to an end. Follow
up is an important step because it is only through taking corrective measures, a manager can
exercise controlling.
Relationship between planning and controlling
Planning and controlling are two separate fuctions of management, yet they are closely related.
The scope of activities if both are overlapping to each other. Without the basis of planning,
controlling activities becomes baseless and without controlling, planning becomes a
meaningless exercise. In absense of controlling, no purpose can be served by. Therefore,
planning and controlling reinforce each other. According to Billy Goetz, " Relationship between
the two can be summarized in the following points

1. Planning preceeds controlling and controlling succeeds planning.


2. Planning and controlling are inseperable functions of management.
3. Activities are put on rails by planning and they are kept at right place through controlling.
4. The process of planning and controlling works on Systems Approach which is as
follows :

Planning → Results → Corrective Action

5. Planning and controlling are integral parts of an organization as both are important for
smooth running of an enterprise.
6. Planning and controlling reinforce each other. Each drives the other function of
management.

Common questions

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The primary nursing model offers holistic care by assigning a primary RN to each patient, fostering continuity and accountability throughout a patient’s hospital stay. Patients benefit from having a single knowledgeable caregiver, improving trust and care satisfaction . However, it may be challenging for patients requiring long-term care due to rotating work schedules that disrupt continuity . The functional nursing model focuses on task-oriented care, which maximizes efficiency and resource use, particularly during high demand periods, but tends to neglect individualized patient needs . This model may not address the holistic care necessary for patient recovery and satisfaction .

A potential drawback of case management in nursing is the focus on administrative issues rather than direct patient care, which can lead to communication gaps between patients and third-party payers. Case managers may prioritize cost assessment and authorization over personalized care, potentially causing delays in treatment approvals or misunderstandings about patient needs or coverage limits . This miscommunication can result in dissatisfaction and disruption in care continuity for patients .

Planning is a fundamental managerial function because it serves as the starting point for all other management activities. It involves decision-making and forecasting, setting the framework for organizing, staffing, directing, and controlling functions, making them interdependent . Effective planning ensures that objectives are clear, resources are wisely used, and future challenges are anticipated, thereby aligning all managerial functions to work cohesively towards achieving organizational goals .

Traditional shift patterns, like 8-hour shifts, provide stability but may not accommodate personal preferences as well as rotating shifts, which can offer more flexibility but disrupt work-life balance due to varying schedules . Rotating shifts can lead to inconsistent patient care continuity, impacting care quality. However, they allow healthcare facilities to meet staffing needs more flexibly, maximizing coverage and potentially reducing errors due to fatigue from longer, static shifts . Effective scheduling requires balancing these factors to ensure both nurse satisfaction and optimal patient care outcomes .

Including diverse levels of nursing management and practice in strategic planning can enhance the effectiveness of these plans by incorporating a wide range of perspectives and experiences. This inclusivity ensures that strategic goals align with both management objectives and practical realities encountered by frontline staff, promoting professional practice and improving communication. It also helps in creating a more comprehensive plan that addresses the needs and challenges at all organizational levels, fostering a supportive environment for performance improvement .

Evaluating formative results is important as it allows for the adjustment and refinement of the operational plan during its execution, ensuring that it remains effective and aligned with the desired outcomes. Summative evaluation quantifies the final results, comparing them against expected outcomes to assess the overall success and areas for improvement . This dual approach provides comprehensive insights that help optimize the operational processes, enhance decision-making, and inform future planning efforts .

The total patient care model can lead to nurse burnout due to its intensive and singular focus on one patient at a time, which requires constant attention and energy . However, in home healthcare settings, this model is advantageous because it allows for personalized, detailed care that meets the complex needs of patients, potentially strengthening nurse-patient relationships and enhancing patient experience through continuity of care .

Participatory goal setting contributes to increased worker commitment and productivity through greater group cohesiveness and morale. By involving nurses in the goal-setting process, they feel a sense of ownership and are consequently more motivated to achieve these goals. This method fosters a supportive environment where communication and collaborative effort are prioritized, leading to enhanced achievement and productivity .

Flexibility in nursing planning allows adaptation to unforeseen changes and ensures plans can be modified as needed without disrupting the overall goals. Standardization, on the other hand, provides a clear, consistent approach that helps streamline processes, improves coordination, and maintains quality across nursing services . Together, these principles ensure that patient care is both adaptable and reliable, meeting community needs effectively while utilizing available resources efficiently, which is crucial in the dynamic healthcare environment .

Strategic planning in nursing administration enhances resource allocation by prioritizing resource utilization to align with long-term goals, ensuring that both time and money are used efficiently to manage nursing and healthcare performance . The process should include strategic forecasting, an analysis of projected technological advances, internal and external environments, and the healthcare market and industry . This comprehensive approach allows for adjustments and improvements in line with evolving needs and challenges in the healthcare environment .

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