Directing and Controlling Lecture Notes

- Choose strategy

DIRECTING

 The implementation phase of the nurse manager’s job.  Involves carrying out of plans, working on the objectives to achieve the broader purpose and goals of the organization unit.  Is the issuance of orders, assignments & instructions enables nursing personnel to understand what are expected of them.  Nurses can maximally contribute to the organization’s goals and to the nursing service objectives.  Actuates efforts to accomplish goals.  It is the connecting link between organizing for work and getting the job done.  In nursing, directing is giving directions to others to attain quality care.

 CHANGE - Any alteration in status quo.

- Occurs when there is imbalance in the forces working toward maintaining the current situation and the forces working towards disrupting it.  Status quo – the situation that exists at a particular time.  E.G. – They want to keep the status quo. Type of Change 1. Organizational or Institutional drift A person is a passive participant, people respond to forces such as personalities, aging, financing or legislation without realizing that change is occurring. 2. Traditional Approach - Based on the assumption that the ideas change the world and therefore the emphasis is placed on direct teaching. 3. Planned Change - Involves a problem solving process with specifically identified elements. There is a deliberate collaborative action directed toward goal attainment 4. Passive – remaining calm and showing no feeling when provoked Phases of Change 1. Unfreezing - Forces are mobilized in the direction of producing true change and helping collaborative relationships are formed. 2. Movement - The problem is identified, alternative solutions are explored, goals and objectives are set & mobilized in producing true change and helping collaborative relationships are formed. - Identifying the problem - Asses environment

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BSN018 ⋆ Group Refreezing 69- Change is integrated into the present behavior and is no longer questioned or criticized.

LEADING  Is defined as “to guide, to go before and show the way”  Leadership is the art of developing people. Leadership Activities 1. Actuating efforts to accomplish goals. 2. Supervising or overseeing work of employee. 3. Coordinating or unifying personnel and services among others. Leadership Roles ➢ Manager - Directs, supervises, and coordinate the efforts of their subordinates. ➢ Administrator - Concerned with the overall planning and setting up objectives, developing and scheduling of programs, budget proposals, and establishment of policies. ➢ Supervisor - Assumes the responsibility of managing nursing care and services in two or more nursing units. ➢ Headnurse - Responsible for the management and supervision of a particular unit. Leadership Qualities ✔ A leader possesses a striking physical personality and is energetic. ✔ A leader possesses a sense of purpose and direction ✔ A leader has the power of ready speech. ✔ A leader is enthusiastic about the purpose of the group and is devoted to its cause. ✔ A leader has a keen insight into human nature of people. ✔ A leader display courage and persistence even in the face of opportunity. ✔ A leader is decisive. ✔ A leader is cheerful and even-tempered. ✔ A leader show technical mastery that inspire above performance in their job. ✔ A leader is intelligent, versatile, and has sense of humor. ✔ A leader has a moral vision, integrity, and idealism. DELEGATING Delegation

 The process by which a manager assigns specific tasks to workers with commensurate authority to perform.  Trains & develops staff members who desire greater opportunities and challenges in their work making them more committed and satisfied in their jobs. Reasons For Delegating • It saves time and can help develop others. • Delegation maximize the use of the talents of staff associates • Staff’s involvement tends to increase their motivation and commitment to accomplish goals. • It reduces managerial costs. The 4 Rights of Delegation 1. Task - Within the scope of the person’s practice 2. Person - An appropriate job description 3. Communication - Clear, concise, complete & correct 4. Feedback - Get input, recommend solution and recognize the effort Consideration for delegation 1. Culture 2. Communication- Speech , dialect, kinesics (gestures, eye movement) use of touch, and tone of voice. Reasons for Under-Delegating • • •

Managers may think that they can do the job more quickly themselves, resent interruptions. Lack of confidence to their staff. In some cases, managers are afraid that their staff will out perform them.

Reasons for Not Accepting Delegation • Staff lacks self-confidence, fear failure and criticism. • Lack of guidelines, standards and control are additional problems. • Duties are not clearly defined, authority not specified and resources not readily available. • Staffs are already overworked, they do not want to do the job if the manager receives the credits. What cannot be delegated 1. Over-all responsibility, authority & accountability for satisfactory completion of all activities in the unit. 2. Authority to sign one’s name is never delegated.

3. Evaluating the staff and/or taking necessary corrective disciplinary action. 4. Responsibility for maintaining morale or opportunity to say few words of encouragement to the staff especially the new ones. 5. Jobs that are too technical and those that involve trust and confidence. SUPERVISION  To inspect, to guide, evaluate and improve work performance of employees through a criteria against which the quality and quantity of work production and utilization of time and resources are made.  Involves providing guidance and direction to work in order to achieve a certain purpose.  The main goal is to attain quality care for each patient and to develop potentials of workers for an effective and efficient performance. Purposes : ➢ Inspect, evaluate, and improve worker’s performance ➢ Provide suitable working conditions for the staff ➢ Orient, train and guide the individual staff member Principles of Supervision • Focused on improving the staff’s work rather than on upgrading self. • Based on predetermined individual needs • Planned cooperatively • Employs democratic methods • Stimulates the staff to continuous self improvement • Respect the individuality of staff members • Helps create a social, psychological, and physical atmosphere where the staff is free to function at his own level. Nursing Supervisory Technique 1. Observation of workers while having her rounds. 2. Spot checking of charts – nursing audit 3. Asking patients about the care they received. 4. Looking into general condition of the unit. 5. Getting feedback from co-workers or other supervisors. 6. Asking questions discretely to find out problems encountered in the wards. 7. Drawing out suggestions from the workers for improvement of their work/ work situation. Supervision Tools

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Organizational Tools Personnel Policies Communication Devices Purposeful Rounds Guides to Workmanship - Admin. and Supervisory Manual - Policy Manual - Procedure Books - Administration of medical treatment - Staffing and Scheduling patterns - Model Charts - Job Description Evaluation

PARTICIPATORY MANAGEMENT  The nurses are given increasing authority to manage themselves.  There is increased accountability of the employee through self supervision.  Outcome: high morale, teamwork, and participation.  It increases individual and organizational capabilities to learn, adapt and develop toward higher levels of excellence. Decision Making  Is a course of action that is consciously chosen from available alternatives for the purpose of achieving a desired result.  Involve a choice utilizing mental processes at the conscious level and is aimed at facilitating a defined objective. COMMUNICATION  Transmission of information, opinions and intentions between and among individuals.  Facilitates work, increase motivation, effect change, optimize care, increase worker satisfaction and facilitate coordination.  Binds the organization to ensure common understanding. LINES OF COMMUNICATION  Communication is described as a two way process, yet in an organization, it is a fourway process.

1. UPWARD Communication – Emanates from subordinates and goes upward. Form of feedback to slow the extent to which downward communication has been received, accepted and implemented. Example: - Discussion between subordinate and superior - Grievances procedures - Written reports - Incident reports

- Statistical reports

2. DOWNWARD Communication - Superior to subordinates. Aims to impart what personnel need to know what they are to do and why they are to do these. Example: - Policies - Rules and regulations - Memorandums - Handbooks - Interviews - Job description - Performance appraisal

3. HORIZONTAL Communication - Flows between peer, personnel or department on the same level Example: - Endorsement - Nursing rounds - Journal meetings and conferences - Referrals between departments or service

4. OUTWARD Communication - Deals with information that flows from caregivers to patients, families, relatives, visitors and community. Patient should understand the nature of their illness, medical and nursing care plan so that they could participate in decisions. COORDINATION  Synchronization of activities among the various services and departments enhances collaboration of efforts resulting in efficient, smooth and harmonious flow of work.  Unites personnel and services toward a common objective.  Prevents overlapping of functions, promotes good working relationships and work schedules are accomplished as targeted.  Enhances communication process necessary to unite, facilitate and synthesize resources. Pointers for Effective Coordination • Responsibilities should be clearly defined and understood by all. • Policies, guidelines and SOPs on interdepartmental relationships should be established and made available to all. • Channels of Communication should be followed CONFLICT

 A clash between two hostile and opposing 

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parties. A warning to managers that something is wrong and need solution through problem solving and clarification of objectives, establishment of norms and determination of group boundaries. Conflict that is managed instead of being ignored or suppressed can be used effectively (can stimulate competition, identify differences within the institution). Unresolved conflict is debilitating and oftentimes frustrating - productivity declines and the possibility of mistakes occur.

Conflict Management Sources of Conflict  Personality Clashes  Status Differences  Scarcity of Resources  Goal Differences  Unworkable Organizational structure  Unacceptable Leadership Style

 Ambiguity – a word or phrase that is ambiguous has more than one meaning CONFLICT MANAGEMENT Types of Conflict 1. Based on Hierarchical Relationship a. Vertical – difference in opinion between superior and subordinates which is caused by inadequacy of communication, opposing interests, and lack of shared attitudes. b. Horizontal or line-staff conflict Arises as a common struggle between department and services wherein the degree of interdependent and collaboration determines success in achieving share goals and objectives.

1. Based on Behavioral Standpoint - It is a perceived condition that exists between two parties, when one or more parties perceive goal incompatibility and some opportunity for interfering with goal achievement of the other. 2. Based on Process Standpoint a. Intrapersonal – occurs within one individual when confronted with two or more incompatible demands or values. ex. Ethical issues b. Interpersonal – also known as “horizontal violence” or “bullying” happens bet. 2 or more people with different beliefs and attitudes.

c. Intragroup – is manifested in feelings of unfairness over distribution of assignments, off duties and holidays among the staff. Strategies for Conflict Management 1. WIN-LOSE – includes the use of position power, mental physical power, failure to respond, majority rule, rail-roading, competing. 2. LOSE-LOSE – includes compromise, bribes for accomplishing disagreeable tasks arbitration by neutral third party. 3. WIN-WIN – it focus on goals and emphasis consensus an integrative approaches to decision making. Focus on the problem not with the person, or the collection of facts, on the acceptance of useful aspects ofconflicts and the accordance of self oriented behavior. CONFLICT RESOLUTION ➢ AVOIDANCE – commonly used by group who do not want to do something that may interfere with their relationship. Neutrality is maintained at all times. Appropriate to reduce tension and gain composure. “Lose-Lose Situation” ➢ ACCOMODATION – means self practice. The person neglects his own needs to meet the goals of the other party. Used to preserve harmony and gain social credits that can be used later. “Win-Lose Situation” * Composure – the ability to stay calm ➢ COLLABORATION – inspires mutual attention to the problem and utilizes the talents of all parties. Focuses on problem solving to find mutually satisfying solutions Most effective method of conflict resolution. “Win-Win Situation” ➢ COMPROMISE – both parties seek expedient, acceptable answers for short periods when goals are only moderately important and the parties have equivalent power. “Lose-Lose Situation” ➢ COMPETITION – the supervisor or nurse manager exerts power at the subordinate’s expense. Expressed through suppression of conflict through authorityobedience approach. Enforce the rule of discipline. “Win-Lose Situation” ➢ SMOOTHING – disagreements are ignored so that surface harmony is maintained in a state of peaceful coexistence. Appropriate in solving minor problems but issues also remain unresolved and may later resurface. “WinLose Situation” ➢ WITHDRAWING – one party is removed thereby making it possible to resolve the

issue. It produces the same result as smoothing. ➢ FORCING – yields an immediate end to the conflict but leaves the cause on the conflict unresolved. Appropriate in life and death situations but otherwise inappropriate. Motivation  Defined as the desire to do the job.  “The Inner Drive”, impulse or intention that causes one to act or believe in certain way, or seek particular goal. What factors motivate people? 1. THE NEED HIERACHY APPPROACH Maslow’s hierarchy of needs 1. physiological, 2. security, 3. belongingness, 4. esteem, and 5. self-actualization

1. HERZBERG’S - Theory of Job Satisfaction a. Hygiene Factor – are associated with working conditions such as pay, quality of supervision, job security and agency policies. b. Motivation Factor – are associated with the work itselfchallenges ,added responsibility, opportunities for personal growth and advancement. Ways to Increase Staff Motivation 1. Manage change properly - Implement change only for good reasons a. Change in order to solve problems. b. Change to make work procedures more efficient so that time will not be wasted. c. Change to reduce unnecessary workload.

1. Assign “Undesirable Jobs” on a rotation basis - Usually the best employee gets to do the “bad” jobs because you are assured that it will be done properly. However, it may give impression that the rewards of high performance is doing disagreeable tasks. 2. Job Redesign - Purpose: to create jobs that provide a high degree of internal work motivation, high quality of work performance, high satisfaction with the work, and low absenteeism & turnover. - Methods of changing job are: ○ Job rotation

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Job enlargement Job enrichment

1. Provide Productive Climate & High Morale - Climates are clusters of employee perception of an organization’s events, practices & procedures. - Morale implies “good spirit” cohesiveness or a group cooperation. 2. Staff Development - Nurses are given opportunities to attend conferences or seminars conducted by other agencies or associations, or to go back to formal schooling such as graduate schools.

CONTROLLING

 or Evaluation  is an ongoing function of management which occurs during planning, organizing and directing activities.  It includes assessing and regulating performance in accordance with the plans that have been adopted, the instructions issued, and the principles established.

Reasons for Conducting Evaluation 1. Evaluation ensures the quality nursing care is provided. 2. It allows for the setting of sensible objectives and ensures compliance with them. 3. It provides standards for establishing comparisons. 4. It promotes visibility and a means for employees to monitor their own performance. 5. It highlights problems related to quality care and determines the areas that require priority attention. 6. It provides an indication of the costs of poor quality. 7. It justifies the use of resources. 8. It provides feedback for improvement. Evaluation Principle 1. Evaluation must be based on the behavioral standards of performance which the position requires. 2. In evaluating performance, there should be enough time to observe employee behavior. 3. The employee should be given a copy of the job description, performance standards and evaluation form before the evaluation conference.

4. The employees’ performance appraisal should include both satisfactory and unsatisfactory result with specific behavioral instances to exemplify these evaluative comments. 5. Area needing improvement must be prioritized. 6. The evaluating conference should be scheduled and conducted in a convenient time. 7. The evaluation report and conference should be structured in such a way that it is perceived and accepted positively as a means of improving job performance. Basic Components of the Control Process 1. Establishment of Standards for measuring performance 2. Measurement of actual performance 3. Comparison of results of performance with standards and objective and identifying strengths and areas for correction and improvement 4. Action to reinforce strength and success 5. Implementation of corrective action as necessary Performance Appraisal  is a process in which employee’s performance is evaluated against standards. Purpose: 1. Determine salary standards and merit increase. 2. Select qualified individual for promotion or transfer. 3. Identify unsatisfactory employees for demotion or termination. 4. Make inventories of talent within the institution. 5. Determine training and developmental needs of employees. 6. Improve the performance of work groups by examining, improving, correcting interrelationship. 7. Improve communication between supervisors and employees and reach an understanding on the objective of the job. 8. Establish standards of supervisory performance. 9. Discover the aspirations of employees and reconcile these with the goals of the institution. 10. Provide “employees recognition” for accomplishments. 11. Inform employees “where they stand”. Methods of Measuring Performance

1. Essay - The appraiser writes a paragraph 2. 3.

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or more about the worker’s strengths, weaknesses and potentials. Checklist - Is a compilation of all nursing performances expected of a worker. Ranking - The evaluator ranks the employees according to how he or she fared with co-workers with respect to certain aspects of performance. Rating Scales - Includes a series of items representing the different task or activities in the nurse’s job description or the absence or presence of desired behaviors and the extent to which these are possessed. Forced-Choice Comparison The evaluator is asked to choose the statement that best describes the nurse being evaluated. Anecdotal Reporting - Describes the nurse experience with a group or a person, or in validating technical skills and interpersonal relationship.

Quality Assurance  is the estimation of the degree of excellence in patient health outcomes and in activity and other resources outcomes.  QUALITY (The degree of excellence) + ASSURANCE (Formal guarantee of a degree of excellence) Quality Assurance Methods 1. Nursing Audit Committee 2. Patient Care Audit 3. Peer Review 4. Quality Circles 5. Utilization of Results

Control of Resources 1. Periodic review of utilization of materials and supplies 2. Requisitions 3. Inventory 4. Utilization Report 5. Regular inspection Discipline  is regarded as a constructive and effective means by which employees take personal responsibility for their own performance and behavior. Factors that Influence Discipline 1. A strong commitment to the vision, philosophy, goals and objectives of the institution.

2. Laws that govern the practice of all professional and their respective Codes of Conduct. 3. Understanding the rules and regulations of the agency. 4. An atmosphere of mutual trust and confidence. 5. Pressure from peers and organization. Disciplinary Approaches 1. A set of disciplinary rules 2. Disciplinary committee 3. Orientation program 4. Continuous communication

 Problem Solving - Effective supervision 

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aids supervisors in analyzing the work problem of their subordinate. DISCIPLINARY ACTION - Any employee charged for breach of the rules and regulations, policies, norms of conduct shall be given due process. COUNSELING AND ORAL WARNING Are best given in private and in an informal atmosphere. The employee is given a fair chance to air his side. WRITTEN WARNING - It is preceded by an interview similar to the oral warning. The employee must be told after the interview that he will be given a written warning. SUSPENSION - Is given after an evidence of oral and written warning. Is applied when the management feels that the employee can still be rehabilitated. DISMISSAL - Is invoked when all other disciplinary efforts have failed. The cause of dismissal should conform within the policy manual or the Civil Service Rules.