Roles

Director of Nursing
A director of nursing (DON) is a registered nurse who supervises the care of all the patients at a health care facility. The director of nursing is the senior nursing management position in an organization and often holds executive titles like Chief Nursing Officer (CNO), Chief Nurse Executive, or Vice-President of Nursing. They typically report to the CEO or COO. The American Organization of Nurse Executives is a professional association for directors of nursing. Service directors Many large healthcare organizations also have service directors. These directors have oversight of a particular service within the facility or system (surgical services, women's services, emergency services, critical care services, etc.).

Nurse manager
The nurse manager is the nurse with management responsibilities of a nursing unit. They typically report to a service director. They have primary responsibilities for staffing, budgeting, and day-to-day operations of the unit.

Charge nurse
The charge nurse is the nurse, usually assigned for a shift, who is responsible for the immediate functioning of the unit. The charge nurse is responsible for making sure nursing care is delivered safely and that all the patients on the unit are receiving adequate care. They are typically the frontline management in most nursing units. Some charge nurses are permanent members of the nursing management team and are called shift supervisors. The traditional term for a female charge nurse is a nursing sister (or just sister), and this term is still commonly used in some countries (such as the United Kingdom). Preparing the budget Nursing budget- a plan for allocation of resources basedpreconceived needs for a proposed series of programs todeliver patient care during one fiscal year Hospital budget- is a financial plan to meet future serviceexpectationsPre Requisites for budgeting Sound organizational structure with clear lines of authorityand responsibility is needed Nonmonetary statistical data- such as number admission,average length of stay, percentage of occupancy andnumber of patient days- are used for planning and control of the budgetary process

Chart of accounts are designed to be consistent with theorganization plan Management support is essential for a budgetary program Formal budgeting policies and procedures should beavailable in the budget manualApplied Economics Economic goods These are goods or services purchased by consumersfrom supplies to provide a benefit to the consumers Income Additional resources gained over time Utility It is the benefit consumers get from the purchase of goods and services Marginal Utility It is the additional utility gained by consuming onemore unit Supply It is the amount of goods or services the suppliersare willing to provide at a given price Demand It is the amount of goods or services the consumersare willing to buy at that price Elasticity of Demand It is the degree to which the demand for a good orservice decreases in response to a price increase andincreases in response to price decrease Cost Factor Cost is a money expended for all resources used Expenses Cost of providing services to patients also calledOVERHEAD

product contributes a relatively stable percentage to thetotal sales volume

Standard cost- it is develop to predict what labor andsupplies should costBudget Approaches Zero based budgeting It is a method of budgeting used to control cost Type of budget no program is take for granted andeach program must be justified each time funds arerequested Program budgeting It is a part of budget planning Items such as continuing education program,employees benefits fares, health promotion program Flexible budgeting It determines a range of volume instead an actualvolume which is much more difficult to plan Purpose of budgeting To plan the objectives, programs and activities of services and the fiscal resources need to accomplish To motivate nursing workers through analysis of actual experiences To serve as standard to evaluate the performance of nurse administrator and manger and to increaseawareness of costChange theoryReddins theory Developed a planned change model that can be used bynurses Suggested seven techniques by which change can beaccomplished1.Diagnosis- a scientific problem solving2.Mutual objectives- ensures that the goals of both groups,those instituting the change and those affected by arebrought into like3.Group emphasis- team emphasis, change is more successfulwhen supported by team4.Maximum information- important to the success of change5.Discussion of implementation6.Use of ceremony and ritual consider the culture of organization, particularly the use of rewards to reinforce thechange 7.Interpretation to any resistance to change- the process andsystems which may require revising of the group work andobjectives set for implementationLewins Theory Most widely used change theory 3 stages Unfreezing stage- development through problemawareness of a need for change

Problem is identified and diagnosed and bestsolution is selected 3 possible mechanism provides input to initialchange Individual expectations are not beingmet (lack of confirmation) Individuals feels uncomfortable aboutsome action or lack of action Former obstacles to change no longerexists (psychological safety) Moving stage- working toward change by identifyingproblem or need for change, exploring thealternatives defining goals and objectives, planninghow to accomplish and implementing the plan forchange Defreezing- the integration of the change into onespersonality and the consequent stabilization forchangeRogers Theory Modified Lewins Change theory5 phases1 . A w a r e n e s s 2 . I n t e r e s t 3 . E v a l u a t i o n 4 . T r i a l 5 . A d a p t a t i o n Havelock s Theory Expanded to 6 elements1.Build ing a r elat io nship2.Diagno sing t he pro ble m3.Acquiring the relevant resources4.Choosing t he so lut ion5.Gaining accept ance6.Stabilization and self renewalLappits theory Added seventh phase to Lewins original theory1.Diagno sing t he pro ble m2.Assessing the motivation and capacity3.Assessing the change agents motivation and resources4.Selecting progressive change objectives5.Choosing the appropriate role of the change agent6. Ma int aining t he change7.Terminating the helping relationship Types of change1. Coerc ive changes2 . E m u l a t i v e c h a n g e 3.I ndoct r inat io n chang e4.I nt er act io na l change5 . N a t u r a l c h a n g e 6.Socia lizat io n chang e7.Technocratic change8 . P l a n n e d c h a n g e Resistance to changeResistance- often based on a threat to the security of the individualChange- upsets an established pattern of behaviourCauses of Resistance to change1.Threatened self interest2 . E m b a r r a s s m e n t 3 . I n s e c u r i t y 4 . H a b i t s 5 . C o m p l a c e n c y 6.I naccur at e per cept io n7.Per ce ived lo ss o f power8. Rewards or relat io nship9.Objective disagreement10.Psychological reactions11.Low tolerance for change12.The changes going against the current change13.The system having been stable for a long timeManagement- by objectives First advocated by Peter Drucker Is a process where by the superior and subordinate mangersof an organization jointly, identify its common goals

Major arena of responsibilityOdrorne- a system for making organizational structure work, of bringing about vitality and personal involvement in the hierarcy bymeans of statements of what is expected from everyone involvedand measurement of what is actually achievedProcedure and process educating- the process to be used and themethods for evaluating the programs effectivenessFirst meeting The managers creates the condition for fulfilling the nurseneed including the removal of obstacles encouragement of growth and provision of guidance Set goals that are specific promote team work that aremeasurable and attainableAction Employees perform work that meets their mutual objectivesSecond meeting The meeting will provide a time for evaluation of results,review, appraisal and the setting of further goalsProblems of MBO1. Top management is not supportive- must besupportive/monitored closely2.Inconsistency exists among mangers0 can be fixed oravoided by increase3.Goals are too easy or are attainable4.Conflicts between goals and policies exists- policies shouldgive way to the goal5.Accountability is beyond the control of employees- mangeshould modify the goal; make allowance for differencedecrease accountability6.Employees have a lack of commit mentdetermine thecause, produce interaction that will increase commitment PRINCIPLES OF NURSINGMANAGEMENTMANAGEMENT

1. Directing: Delegation, Supervision, and Coordination

Nursing Leadership and Management

OVERVIEW OF THE MANAGEMENT PROCESS

Planning Organizing Staffing Directing Coordinating Controlling

Planning Organizing Staffing Directing Controlling

Directing- is seeing that individual interests do not interfere with the general interest (Urwick). -is the issuance of assignments, orders, and instructions that permit the worker to understand what it is expected of him or her, and the guidance and overseeing of the worker so that he or she can contribute effectively and efficiently to the attainment of organizational objectives (Douglass). - is also implementation, which includes supervision, makinga ssignements and giving directions, observation, evaluation, and leadership and interpersonal relationship with co-workers, and maintaining morale.

Nurse management in directing physical act of managing -interpersonal process by which nursing personnel accomplish the objectives of nursing

Directing > Delegating > > Supervision > Coordination

Delegating- getting work done through employees Is a part of management requiring professional management training and development to accept the hierarchical responsibilities of delegation

Reasons for Delegating: (Swansburg) 1. 2. 3. 4. 5. Assigning routine tasks Assigning tasks for which the nurse manager does not have time Problem solving Changes in the nurse managers own job emphasis Capability building

How to delegate successfully 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. Train and develop subordinates Plan ahead Control and coordinate the work of subordinates Visit subordinates periodically Coordinate to prevent duplication of effort Solve problems and think about new ideas. Accept delegation as desirable Know subordinates capabilities and match the task of duty to the employee Agree on performance standards Give appropriate rewards Do not take back delegated tasks

PRINCIPLES OF DELEGATION

Accountability- the act of accepting ownership for the results or lack thereof; shared in delegation Responsibility- denotes an obligation to accomplish a task Authority- the right to act/empower

y In delegation, responsibility and authority is transferred while accountability is shared y Remember: you can only delegate those tasks fro which you are responsible. If you dont have direct responsibility for the task, then you cant delegate that task. You can only suggest or assist in that task for which you have no direct responsibility. To clearly understand who is responsible, it is important to look at practice acts, standards of care, job descriptions and policy statement.

SIGNIFICANCE OF DELEGATION

Sometimes, managers must delegate routine tasks so they can be free to handle things that are more complex or require a higher level of expertise. Can be used as a tool for problem-solving Manager may delegate to someone who is competent, knowledgeable, has greater expertise or more prepared to solve a problem. Can also be used as a way to provide learning or increasing opportunities for subordinates, thus contributing to employees personal and professional development

BENEFITS OF DELEGATION I. Benefits to the manager/delegator

offers a ready replacement if the delegator has an opportunity for advancement II. Benefits to the delegatee/staff gain new skills and abilities that can facilitate upward mobility bring trust and support, thereby building self-esteem and confidence help individuals feel more appreciated and learn to appreciate the roles and responsibilities of others, increasing cooperation and enhancing teamwork Enhances job satisfaction & motivation as they are stimulated by new challenges III. Benefits to the patient

be able to devote more time to those tasks that can not be delegated can develop new skills and abilities facilitating the opportunity for career advancement

can improve the quality of care can increase patients satisfaction

STEPS OF THE DELEGATION PROCESS

Assessment of the 5Rs or 5 Rights

1. Right Task

involves careful assessment by the nurse of the patients needs, contextual setting and thorough knowledge of plan the task entails determine what can and should be delegated delegate only an aspect of your own work for which you have responsibility and authority

* these include: routine tasks, tasks for which you do not have time, tasks that have less priority, problem solving, staff building

2. Right Circumstances

includes an assessment of the patients status, the routine nature of the task to be delegated and the available resources take into account the staffing initially available to render care

Before a task is delegated, 2 questions must be addressed: i) what areas of authority or what resources must the person control to achieve the expected results ii) what are the limits, boundaries or parameters for each area of authority or resource to be used

3. Right Person > identify the qualified person best able to complete the job in terms of capacity/skill/educational level entailed by the task and time to do so. > do not ask if they are capable of completing the delegated task but validate through direct observation

4. Right Direction/Communication

implies that the nurse has conveyed essential details of the task to the delegatee that includes what it is to be done, when it is to be done, how it is to be done, guidelines for reporting back, what supervision could be expected, and what resources are available essential that the nurse delegatee verifies that the communication was received accurately and solicits any questions from the delegatee define your expectations for the delegate; convey the essential details of the task to the delegate

5. Right Supervision

- refers to monitoring and evaluating the task through nursing rounds, utilizing teaching moments to provide feedback, and intervening when the task is not being completed properly - monitoring performance provides a mechanism for feedback and control

- ensures that the delegated tasks are carried out as agreed - remain accessible to the delegate

Delegation involves 3 components: 1. communication of the task to be delegated 2. mutual agreement 3. transfer of authority

Steps in Delegation

Planning Delegation s Five W s and an H : Who, What, When, Where, Why and How

Monitoring

helps the nurse determine that the delegation is going as planned during this phase that nurse identifies problems with the delegation and can institute change

Evaluation

a continuous process that can be summed up as follow-up provides vital information about what went wrong with the process nurse provides feedback to the assistant and the assistant provides feedback to the nurse

Ineffective Delegation:

1. Underdelegation Occurs when:

The delegator fails to transfer full authority to the delegatee the delegator takes back responsibility for aspects of the task the delegator fails to equip and direct the delegatee

Causes of underdelegation i) frequently stems from the managers false assumption that delegation may be interpreted as a lack of ability on his or her part to do the job correctly

ii)

managers desire to complete the whole job himslef or herself- lack of trust in the subordinates

I need the experience. or I can do it better/faster than anyone else. iii) fear that subordinates will resent having work delegated on them Manager: They might think Im a slave driver. or I might be putting too much on their shoulders. iv) v) Manager lacks experience in the job or in delegation itself.

Other managers refuse to delegate because they have an excessive need to control or to be perfect- obsessivecompulsive; control freak

2. Overdelegation

occurs when the delegator loses control over a situation by providing the delegatee with too much authority or too much responsibility. places the delegator in a risky position, increasing the potential for liability - burdening their subordinates.

Causes of Overdelegation a) poor time management- spending most of it just trying to get organized b) insecurity in their ability to perform a task

3. Improper Delegation Includes:

Delegating at the wrong time delegating at the wrong person delegating for the wrong reason delegating tasks and responsibilities that are beyond the capability of the person to whom they are being delegated or that should be done by the manager.

Example: Delegating decision-making without providing adequate information.

4. Reverse Delegation

common form of ineffective delegation that occurs when someone with a lower rank delegates to someone with more authority. Example: Julius , a staff nurse who says to his nurse manager, Im really swamped today, can you hang Mr. Moraless chemo so I can go to lunch? Although the nurse manager could assist Julius, this is not an efficient use of his/her time. Instead the manager could help Julius organize her own time and efficiently delegate some responsibilities.

BARRIERS TO EFFECTIVE DELEGATION

A.

BARRIERS IN THE DELEGATOR - INSECURITY

Trust vs. control- trust is paramount to delegation. Trusting others means giving up some control. Approval vs. affiliation- which is more important, the need to be liked or the need to belong and be accepted? Democratic ideal vs. classical hierarchy- which is more valued, team work and empowerment, or control and the established hierarchy? Insecurity of the Delegator Unwillingness of the Delegatee Non supportive work environment

Common Fears of the Delegator

Fear of Competition or Criticism Fear of Liability Fear of Loss of Control Fear of Overburdening Others

Commonly voiced concerns about delegation: - I can do it better. - I can do it faster. - Id rather do it myself - I dont have time to delegate.

B.

BARRIERS IN THE DELEGATEE:

Unwillingness

CAUSES: 1) delegatee not equipped to handle the task 2) lack of confidence 3) concern of how mistakes should be handled 4) avoids responsibility or is overdependent on others- feels overburdened 5) Fear of situation 6) Lack of positive incentives

C. BARRIERS IN THE SITUATION

1. Organizational culture Hierarchies, management styles and norms all preclude delegation. Rigid chains of command and autocratic leadership styles do not facilitate delegation and rarely provide good role models. * The norm is to do the work oneself because others are incapable or unskilled. This breeds an atmosphere of distrust and poor tolerance of mistakes. - Norm of crisis management Poorly defined job descriptions or chains of command

2. Personal qualities poor communication and interpersonal skills

- Thomas & Hume (1998)- In addition to good communication skills and respecting and treating the staff fairly, a willingness to work with the other, to be open to suggestions, to provide feedback and acknowledgement for work well done is essential. Delegates must be reliable and willing to follow instructions.

3. Resources- lack of: people to delegate to finances educational resources time

SUPERVISION

is guiding and directing the work to be done for the achievement of a purpose the process by which employees are given the needed resources to accomplish their jobs

GOAL OF SUPERVISION

To attain quality of care for each patient and to develop potentials for effective and efficient performance of workers

ESSENTIALS IN SUPERVISION

  
    

Good understanding of administration Clinical competence Democratic management

PRINCIPLES OF SUPERVISION It is focused on improvement of the work rather than on upgrading the worker. It is based on the needs of individuals which have been cooperatively determined. It is cooperatively planned. It stimulates the staff to continuous self-improvement. It helps create a social psychological and physical atmosphere in which the individual is free to function on her own top level.

GENERAL FUNCTIONS OF THE SUPERVISOR

CHARACTERISTICS OF A GOOD SUPERVISOR

    

Has positive attitude Loyal Fair Good communicator Has the ability to delegate

ROLES OF A SUPERVISOR

supervisor as a planner -providing information and estimates -allocating resources

-developing a budget -scheduling supervisor as an organizer and delegator -sets up the group, allocates resources and assigns work to achieve goals -gives another person authority and responsibilities to carry out tasks

Supervisor as a leader Supervisor as a controller -makes sure that work goes according to plan

THE NURSE SUPERVISOR vs SENIOR NURSE/ HEAD NURSE

1. CONTROLLING evaluates personnel performance utilizing the established appraisal system established by the Nursing service facilitate the gathering of information pertinent to progress of nursing care programs/plans of care, status of staff, unit equipment, facilities supplies and materials 2. UNIT MANAGEMENT Attends /coordinates /participates in staff development activities Evolve staff development activity based on: results of personnel performance appraisal manifested or expressed personnel needs. NURSE SUPERVISOR

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takes the necessary steps to ensure the maintenance of quality nursing care service through: placement of quality nursing personnel equitable staffing patterns utilization of commendations assesses the extent of personnel compliance with established cost effectiveness measures measures of effectiveness and efficiency of coordinative activities pertinent to: analyzes and utilizes resources

HEAD NURSE

ensures adequacy of facilities/equipment/supplies/materials pertinent to meeting the needs of clients and personnel through sufficiently justified budget proposals devises control mechanisms to maximize the effectiveness/efficiency of facilities material resources through: preventive maintenance systems/programs in coordinating with the engineering/plan maintenace personnel adequate personnel orientation Evaluates the performance of personnel based on the evaluation parameters established by the nursing service assures strict implementation of hospital policies/rules/regulations through adequate interpretation/orientation of personnel other members of the health team/clientele/public makes periodic reports relevant to the status of material resources/facilities assists the nurse supervisor in the formulation/consolidation of budget estimates and annual reports

METHODS OF SUPERVISION Community Setting 1. Analysis or records and reports

Actual observation of the RHM performance in the various situations as in: Clinic work, Home Visit, Conduct of Individual or group classes, Organization/implementation of community projects and activities 3. Individual/group conferences and meetings Clinical Setting 2. 1. 2. 3. 4. 5. 6. Personnel Policies Communication Devices Problem-Solving Techniques Rounds Facilities for Operation and Cooperation Staff, In-Service, and Orientation Program

Factors affecting Supervision

Factors related to the Supervisor:

1. Supervisory Skills a. Managerial skills: With honed skills, the nurse will be able to forecast, plan, organize, lead, coordinate and control her work as well as her supervisees efforts. b. Technical Competence: The nurses technical knowledge is one of her bases of authority. c. Coaching and Training: If the nurse is able to train her supervisees by using coaching as a method of teaching, among others, then the assets of the Health Unit will be enhanced d. Guidance and Counseling : The competent and respected supervisor will be able to help the midwives become mature, well-adjusted, and emotionally stable. e. Interpersonal Relations : The ability of the nurse to maintain good interpersonal relations will enable her to get along with other people and win the cooperation of her supervisees, superiors, colleagues, and the public. f. Leadership: The nurses leadership ability will facilitate the completion of the HMs work targets, achievement of the individual workers needs, and the maintenance of the teams morale and cooperation. g. Communication: Effective communication is an important ingredient of leadership. The effective supervisor keeps the HMs informed and updated of the Departments policies, objectives, and programs, administrative issuances and changes in the plans and policy directions problem h. Problem Solving and Decision Making : When faced with a problem, a nurse with competent problem-solving skills will be able to analyze and prioritize the problem, identify causes and make a sound decision.

2. Commitment The nurses commitment to the mission, vision, philosophy goals and objectives of the Department of Health is a facilitating factor in the performance of her job as a supervisor

3. Interpersonal Qualities of the Supervisor a. b. c. d. e. f. g. h. i. j. k. l. m. willingness to supervise and take responsibility Ability to explain thoroughly and listen actively Open-mindedness--ability to accept and withstand criticism Well-organized Calmness during emergency Persuasiveness Warmness and optimism Fairness Patience Tact and Discretion Awareness of limitations and willingness to spend time and effort to improve Sincerity Integrity and Honesty

Problems in Supervision

1. Work problems occurring in the clinical setting: a. Mistakes in the nature of the forgetting or the omitting of things to be done that should be done b. Failure to produce work according to job specifications c. Carelessness in workmanship; poor work d. The jeopardizing of safety or being accident-prone; wastefulness in terms of time, effort, material e. Beginners given to the taking of unsafe shortcuts, using equipment for purposes other than those fir which they are intended, and being time- rather than service minded in caring for patients.

2. Problems involved in the observance of policies, procedures, and other guides a. Conscious and deliberate deviation from guides b. The issuing of inadequate records and reports c. The assuming of privileges not provided in policies and the abusing of such as are provided d. Carelessness in the care and maintenance of institutional and patients property e. Over-use of time-out when on duty, for smoking, gossiping, and loafing

3. Problems that involve attitudes and appreciations a. Procrastination or utter insubordination b. The assuming of responsibility beyond the level of preparation c. The use of unprofessional language or conduct

d. Speaking disparagingly of supervisors, doctors and the hospital, with resultant confusion to the patients and to the public e. The inability or unwillingness to work together with others f. Carrying an air of condescension toward students, practical nurses, and aides; unwillingness to guide or assist them.

4. Nursing Service vs. Nursing Education Problems a. Lack of knowledge or unwillingness to make assignments so as to provide the maximum of values from the available teaching opportunities b. Failure on the part of staff nurses and head nurses to realize their responsibility for the supervision and follow up of student nurses and aides c. Inadequate orientation programs with subsequent dissatisfactions with rotations, promotions, and salary arrangements d. Failure to provide opportunity for personnel to attend and to participate in meetings and in-service programs

5. Intangible and unpredictable problems of personnel a. Illness, death, or accidents to members in the family, causing emotional, social, and economic pressures apart from work b. Unforeseen personal health problems of personnel with possible changes in capacity for work.

SUPERVISORY VISITS
-tours or excursions into areas where patients are cared for, where personnel operate, where intra- and interdepartmental communications take place, where facilities for operation in terms of equipment and supplies are discernible, for the purpose of ensuring adequate nursing care through the stimulation, promotion, and development of personnel on the job.

Purpose of Supervisory Visits 1. To ensure adequate nursing care and patient satisfaction: a. By obtaining an _expression of the desires, likes, and dislikes of a patient b. By observing his mental and physical reactions to nursing care and treatment c. By ensuring tender loving care to patients, particularly the critically ill and dying. To provide administrative satisfaction to the hospital: a. By provision and maintenance of adequate equipment and supplies. b. By ensuring proper care, use, and preservation of equipment. c. By eliciting ideas and suggestions for improved working facilities To stimulate, promote, and develop personnel on the job: a. By establishing rapport, good will, and personal interest in growth and development, and the desire to do well.

2.

3.

4.

By detecting potentialities for growth and encouraging their development By creating a sense of need and belongingness, opportunity for contribution, and a realization of joy of work and security To utilize every opportunity possible for the development of good public relations: a. By setting an example of good contacts. b. By teaching and meeting the needs of people.

b. c.

Supervisory Plans These are derived from the plans of higher levels of management. Usually, the planning information that comes from upper management is general in nature. Developing a detailed plan involves answering the following questions: What must be done? Why must it be done? Where should it be done? Who should do it? How should it be done?

COORDINATION

The act of assembling and synchronizing people and activities so that they function harmoniously in the attainment of organizational activities (Haimann, 1989) Preventive managerial function concerned with heading off conflict and misunderstanding.

COORDINATION vs COOPERATION

Cooperation merely indicates the willingness of individuals to help each other; it is the result of a voluntary attitude of a group of people. Coordination is much more inclusive, requiring more than the mere desire and willingness of the participants.

Coordination is more important than cooperation. Coordination is a conscious effort to tie the activities together.

THE NEED FOR COORDINATION

A high degree of coordination is likely to be beneficial for work that is non routine and unpredictable, for work in which factors in environment are changing, and for work in which task interdependence is high.

ROLE OF A COORDINATOR A coordinator should be aware of who is doing what and what the outcome should be and has the responsibility to make sure the specific and interrelated tasks are accomplished.

THREE APPROACHES TO EFFECTIVE COORDINATION IN MANAGEMENT

Basic Management Techniques Increasing Coordination Potential Reducing the Need for Coordination

APPROACHES TO EFFECTIVE COORDINATION:

1. BASIC MANAGEMENT TECHNIQUES

 Managerial Hierarchy  Rules and Procedures  Plans and Goals

2. INCREASING COORDINATION POTENTIAL

 Vertical Information System

- the means by which data are transmitted up and down the levels of the organization

 Lateral Relationships
- permit the information to be exchanged and decisions to be made at the level where the needed information actually exists.

3. REDUCING THE NEED FOR COORDINATION

 Creating Slack Resources

Providing slack (additional) resources gives units leeway in meeting each others requirements.

 Creating Independent Units

Units that can perform all the necessary aspects of a task internally.

DIMENSIONS of COORDINATION

1. VERTICAL COORDINATION

Between the different levels of an organization Achieved by delegating authority, assigning duties, and supervising and controlling

Effective vertical coordination is better achieved by performing the managerial functions wisely instead of relying on the weight of formal authority.

2. HORIZONTAL COORDINATION

Exists between persons and departments on the same organizational levels Achieved by a policy and procedure stating that when necessary, departments must interact, cooperate and adjust their activities to achieve coordination.

3. DIAGONAL COORDINATION

Cuts across the organizational arrangements, ignoring positions and levels. Easier to achieve in smaller organizations

TYPES OF COORDINATION:
A. Intraorganizational Coordination Coordination is interwoven with other elements of organization.

Planning Nurses should be involved in planning or hospital layouts. Includes a plan for necessary budget of the units, including supplies and equipment.

Organizing Delegating, accountability and evaluation are necessary in the synchronization of nursing personnels work in the different units so that each one becomes part of a whole.

B. Coordination with other Institutions Comprehensive care to patients oftentimes necessitates coordination with civic groups or institutions outside the hospital. This includes community agencies that relate to the total care of the patient.

BARRIERS TO EFFECTIVE COORDINATION 1. Growth of an organization 2. Specialization 1. Human nature

CONFLICT MANAGEMENT

Conflict is generally defined as the internal or external discord that results from difference in ideas, values, or feelings between two or more people.

I. History of Conflict Management A. Early 20th Century Views th B. Mid-20 Century Views C. Interactionist theories of the 1970s

II. Categories of Conflict A. Intrapersonal Conflict the internal struggle to clarify contradictory values or wants B. Interpersonal Conflict happens between two or more people with differing values, goals, and beliefs C. Intergroup Conflict occurs between two or more groups of people, departments, or organizations

III. A. B. C. D. E.

Conflict Process Stage 1 Latent Conflict Stage 2 - Perceived Conflict Stage 3 Felt Conflict Stage 4 Manifest Conflict Stage 5 Conflict Aftermath

IV. A. B. C. D. E.

Conflict Management Strategies Compromising each party gives up something it wants Competing approach one party pursues what it wants at the expense of the others Cooperating approach one party sacrifices and allows the other party to win Accommodating approach collecting I-owe-yous Smoothing used to get someone to cooperate with another party, focus on agreements rather than differences F. Avoiding parties aware of conflict and choose not to acknowledge or attempt to solve it G. Collaborating assertive means that result to win-win situation

V. A. B. C. D. E. F.

Strategies on Managing Unit Conflict Urging Confrontation Third-party Consultation Behavior change Responsibility Charting Structure Change Soothing One Party

VI.

Negotiation

DELEGATION AS A MANAGEMENT FUNCTION FUNCTIONS OF ADMINISTRATION Introduction

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Management is creative problem solving. Management is a generic function that includes similar basic tasks in every discipline and in every society. Management and administration sometimes appear to be synonymous, but they are not synonymous terms.

Definition
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Management may be defined as the art of securing maximum results with a minimum of effort so as to secure maximum prosperity and happiness for both employer and employee and give the public the best possible service (John Mee, 1963)

Functions of management are:

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Planning Oorganizing Directing Coordinating and Controlling Reporting and Recording Budgeting

Planning Planning means to decide in advance what is to be done. It charts a course of actions for the future. It is an intellectual process and it aims to achieve a coordinated and consistent set of operations aimed at desired objectives. Essentials of good planning
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Yields reasonable organizational objectives and develops alternative approaches to meet these objectives. Helps to eliminate or reduce the future uncertainty

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and chance. Helps to gain economical operations. Lays the foundation for organizing. Facilitates co-ordination. Helps to facilitate control. Dictates those activities to which employers are directed.

Organizing
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Once the objectives have been established through planning, management concern must turn to developing an organization that is capable of carrying them out. The management function of organizing can be defined as ,relating people and things to each other in such a way that they are all combined and interrelated into a unit capable of being directed toward the organizational objectives. Work activities required for the organizational performance are separated through o Horizontal differentiation (i.e.. Dividing the organization into operational units for more effective and efficient performance.) o Vertical differentiation (i.e.. Establishes the hierarchy and the number of levels in the organization

The formal organization depends on two basic principles: a) Responsibility: responsibility n an organization is divided among available personnel by grouping the functions that are similar in objectives and content. This should be done in a manner that avoids overlaps and gaps as much as possible. Responsibility may be continuing or it may be terminated by the accomplishment of a single action. b) Authority: when responsibility is given to a person, he must also be given the authority to make commitments, use resources and take the actions necessary to carry out his responsibilities. Staffing
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Staffing is the selection, training, motivating and retaining of a personnel in the organization. Before selection we have to make analysis of the particular

job, which is required in the organization., then comes the selection of the personnel. It involves manpower planning to have the right person in the right place and avoid square peg in the round hole. Manpower planning involves the following steps.

1. Scrutiny of present personnel strength. 2. Anticipation of manpower needs. 3. Investigation of turnover of personnel. 4. Planning job requirements and job descriptions. Directing
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Directing means the issuance of orders, assignments and instructions that permit the subordinate to understand what is expected of him, and the guidance and overseeing of the subordinate so that he can contribute effectively and efficiently to the attainment of organizational objectives. Directing includes the following activities
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Giving orders Making supervision Leading Motivating Communicating

Giving orders: the central task in directing is giving orders. The order is the technical means through which a subordinate understands what is to be done. To facilitate this there are certain characteristics of good orders which manager should be aware of:
y

The order should be clear, concise and consistent to give sufficient information to ensure understanding Order should be based on obvious demands of a particular situation, it seems logical to the subordinates and not just an arbitrary whim of the manager. The tone of the order is very important. The manner in which the manager delivers the order has a great deal to do with its

acceptance by the subordinate. Whenever possible, the reason for the order should be given. A subordinate will accept an order more readily if he understands the need for it. y In some instances the manager uses delegation of authority instead of issuance of orders for avoiding too many specific orders. Supervision:
y

Supervision is the activity of the management that is concerned with the training and discipline of the work force. It includes follow up to assure the prompt and proper execution of orders. Supervision is the art of overseeing, watching and directing with authority, the work and behaviour of other.
y

Leading:

Leadership is the ability to inspire and influence others to contribute to the attainment of the objectives. Successful leadership is the result of interaction between the leader and his subordinates in a particular organizational situation. There are number of styles of leadership that have been identified such as autocratic, democratic participative leadership. The continuum of leadership styles, ranges from the completely authoritarian situation with no subordinate participation to a maximum degree of democratic leadership, enabling the subordinate to participate in all phases of the decision making process.
y

Motivating:

Motivation refers to the way in which the needs (urges, aspirations, desires) control, direct or explain the behaviour of human beings. The manager must motivate, or cause, the employee to follow directives.
y

Communicating:

Communication is the passing of information and

understanding from a sender to receiver. Communication is vital to the directing function of the management, one way to visualise this importance is to view the manager on one side of a barrier and the work group on the other. Communication is the means the manager has of reaching through the barrier to attain work group activity. Coordinating
y

It is the act of synchronising people and activities so that they function smoothly in the attainment of organization objectives. Coordination is more important in the health services organization, because functionally they are departmentalized. Different kinds of organization require different amount of coordination. Basic approaches to coordination:
y

Corrective co ordinations are those coordinative activities that rectify the present error or correct a dysfunction in the organization. Preventive coordination comprises those coordinative activities that are aimed at preventing the occurrence of anticipated problems of coordination, or at least minimizing the impact of these problems. Regulatory coordination comprises those coordinative activities that are aimed at the maintenance of existing structural and functional arrangements in the organizations. Promotive coordination has those coordinative activities that are aimed at attempting to improve the articulation of the parts of the organization, or to improve the existing organizational arrangements without regard for specific problems.

Controlling
y

Controlling can be defined as the regulation of activities in accordance with the requirements of plans. Steps of control: o The control function, whether it is applied to

cash, medical care, employee morale or anything else, involves four steps. 1. Establishments of standards. 2. Measuring performance 3. Comparing the actual results with the standards. 4. Correcting deviations from standards. Reporting and recording Reports are oral or written exchanges of information shared between caregivers or workers in a number of ways. A report summarizes the services of the person, personnel and of the agency. Reports are written usually daily, weekly, monthly or yearly. Purposes of reporting:
y y y y y

To show the kind and amount of services rendered over a specified period. To illustrate progress in reaching goals. As an aid in studying health conditions. As an aid in planning. To interpret services to the public and to the other interested agencies.

Records and reports must be functional, accurate, complete, current organized and confidential. Budgeting
y

Budgeting, though primarily recognized as a device for controlling, becomes a major part of the planning process in any organization. It is expressed in financial terms and based on expected income and expenditure. Budget is the heart of administrative management. It served as a powerful tool of coordination and negatively an effective device of eliminating duplicating and wastage.

Features of budget:
y

Should be flexible.

y y

y y

Should be synthesis of past, present and future. Should be product of joint venture & cooperation of executives/ department heads at different levels of management. It should be in the form of statistical standard laid down in specific numerical terms. It should have support of top management throughout the period of its planning and supplementation

COORDINATION AS A MANAGEMENT FUNCTION

Introduction
y y

Coo rdinat io n is co ns idered as an esse nt ia l e le me nt o f ad min ist rat io n. Coo rdinat io n is t he int egrat io n, s ync hro nisat io n o r o rderly pat t ern o f gro up effo rt s in t he inst it ut io n to wards t he acco mp lis hme nt o f co mmo n o bje ct ives. The co ncept o f co -o rdinat io n is much broader than that of coo perat io n.

De fin it io n
y

"Co -o rdinat io n is t he orderly s ync hro niz at io n o f e ffo rt s to pro vide t he pro per amo unt , t iming , and d ire ct ing e xecut io n resu lt ing in har mo nio us a nd and u nified act io ns to a st at ed o bject ive " "Co -o rdinat io n is t he int egrat io n of several parts into an orderly who le to achie ve t he purpo se o f undertaking" "Co -o rdinat io n is t he int egrat ing process in an orderly pattern of gro up effo rt s in a n o rganizat io n to ward t he acco mp lis hme nt o f a co mmo n o bje ct ive"

Importance of co-ordination

Creative force
y

gro up effo rt s when co o rdinat ed creat e a resu lt great er t han t he su m tot al o f t he ind iv idua l a nd iso lat ed.

Unity of direction
y

co -ordinat io n e nsure s unit y if d irect io n by wa y o f secur ing spo nt aneo us co lla bo rat io n o n t he part o f d iffere nt depart me nt s.

High employee morale

y

co -ordinat io n e nha nc es t he genera l le ve l o f e mp lo yee mo ra le a nd pro vides sat is fa ct io n

Diverse and specialised activities

y

Tot al act ivit ies o f an o rganisat io n are divided int o severa l u nit s a nd subu nit s o n t he bas is o f e it her pro duct spec ia lis at io n.

To avoid personal rivalries and prejudice

y

hu ma n o rganisat io n g ive r ise in co urse o f t ime to t he deve lo p me nt o f perso na lit y po lit ic s a mo ng members.

To avoid conflict of interests

y

Subo rdinat io n o f ind iv idua l int ere st to general int erest o ft en happen in o rganizat io ns. There is ne ed fo r coo rdinat io n to avo id co nflict s or o ver lapp ing in t he wo rk o f e mp lo yee s o r unit s o r as o rganisat io n.

Techniques of co-ordination

y y y y y y

Co mmu nicat io n Orderly plans Supervis io n Leadership Depart me nt at io n D irect co nt act

Types of co-ordination
y y

Int erna l co -ordinat io n Ext erna l co -ordinat io n.

Hindrances to co-ordination 1. Uncert aint y o f t he fut ure, as to t he be ha vio ur o f t he ind iv idua l a nd t he peo ple. 2. Lack o f k no w ledge, exper ie nce, w isdo m a nd c haract er amo ng leader s and t he ir co nfused a nd co nflict ing idea s and o bject ive s. 3. Lack o f ad min ist rat io n sk ill a nd technique. 4. Vast nu mber o f var ia ble s invo lved and t he inco mp let eness o f hu ma n kno w ledge, part icu lar ly w it h rega rd to me n a nd life. 5. Lack of orderly methods coo rdinat io n.. 6. S ize a nd co mp le xit y, perso na lit y and po lit ic a l fact o rs. 7. Lack o f leaders w it h w isdo m a nd kno w ledge pert a ining t o public ad min ist rat io n 8. Acc e lerat ed expans io n o f public ad min ist rat io n o f int ernat io na l d ime ns io n. Coordination Applied to Nursing Management
y

Hea lt h care s yst e m co ns ist s o f d iffere nt cat ego ries o f hea lt h perso nne l w hic h requ ires int e ns e coo rdinat io n to funct io n it e ffect ive ly.

Nurs ing ser vice is o ft en t he large st gro up o f he a lt h perso nne l w it h w ide range o f fu nct io ns and sk ills. Effect ive co ordinat io n o f nurs ing servic es a nd pat ie nt care will lea d to pat ie nt sat is fact io n, bett er qua lit y o f ser vice a nd pat ie nt o ut co me s.