• Management is a process to achieve organizational goals.
• Nursing management is the process of getting nursing staff to provide care to patients.
• The nurse manager plans, organizes, directs, and controls financial, material, and human resources in order to provide the most effective care possible to groups of patients and their families.
PLANNING
Planning is the determination of what needs to be done. Its essential elements are
• objectives,
• strategic planning,
• budget, and
• setting priorities.
Objectives
• Objectives are the specific measurable statements that flow from the philosophy and mission of the institution that identify what needs to be achieved by the nursing unit.
• When the statement refers to the institution, it is called a goal.
Strategic Planning
• Strategic planning refers to the long-range planning by a health care organization; it provides the direction that the organization will go in over the next 3–5 years.
• It is based on the values, philosophy, and mission of the health care organization and the vision of its leaders.
Budget
• Budget is the allocation of resources on the basis of forecasted needs.
• It is a numerical expression of expected revenues and expenditures of the nursing service department.
• The objective for making a budget is to ensure the attainment of desired goals in the most cost-effective manner.
• There are two types of budgets: operating budget and capital budget. The operating budget includes manpower resources, supplies, minor equipment, overhead expenses, salaries, and benefits while the capital budget includes items of considerable expense, such as major pieces of
equipment.
Setting Priorities
The nurse leader determines the importance of activities and establishes the order in which the activities will be carried out. Setting priorities involves decision making.
ORGANIZING
Organization involves determination of how the planning is to be accomplished, how the parts are to be arranged into a functioning whole, and how the activities are to be coordinated to achieve a goal. Hence it is a means to an end, not an end in itself. Its essential elements are
• organizational structure
• position/job descriptions
• team building
• staffing
Organizational Structure
The formal organizational structure is the official arrangement of positions (organizational chart) and should be based upon goals of the institution and philosophy and objectives of the department. The informal organizational structure is the unofficial personal relationship among workers, which influences their
working effectiveness.
Organizational principles
• Unity of Command—an employee should be responsible to only one supervisor.
• Requisite Authority—when responsibility is delegated to a subordinate, the subordinate must also be given authority over the resources needed to accomplish the task.
• Continuing Responsibility—when a superior delegates responsibility to a subordinate, it does not diminish the superior’s responsibility for the function.
• Organizational Centrality—an individual has more information available when she/he interacts directly with more individuals in the organization and becomes more powerful.
Position/Job Description
• Position/job description is a formal written document that describes the principal duties and scope of responsibilities for a particular position.
• It facilitates wage and salary administration, manpower planning, and assists with recruitment, selection, placement, orientation, and evaluation of employees.
Team Building
• Team building focuses on both task and relationship aspects of a group’s functioning and is intended to increase efficiency and productivity.
• Team building involves data gathering about the team and its functioning, diagnosing strengths and areas needing development, and addressing team problems.
• Successful teams reflect open and effective communications, members that are committed to the team, clearly identified roles and responsibilities of the members, and trust and collegiality.
LEADING
Leading is the process of getting the organization’s work done. Its essential elements are
• leadership,
• supervision,
• decision making,
• shared governance,
• change agent,
• managing conflict,
• power—authority, and
• time management.
Leadership
• Leadership is the ability to influence other people. A nurse leader can inspire the nursing staff to work together to accomplish the nursing unit’s goals.
• Formal leadership is when the nurse has legitimate authority as defined by the health care organization.
• Informal leadership is when a staff member exercises leadership without the management role.
• Present-day theories of leadership evolve from the principles of quantum mechanics and reflect a fusion of the earlier theories of leadership: trait, behavior, and contingency theories.
• Six perspectives of quantum leadership are charismatic, transactional, transformational, connective, shared, and servant leadership.
Supervision
• Supervision refers to the guidance, oversight, and evaluation of a member of the nursing team to whom the nurse leader has delegated an activity. It is an opportunity for the nurse to encourage the development of team members.
• Effective supervision utilizes the skills of communication, human relations, and teaching.
• Supervision is a mutual effort on the part of the individual being supervised and the person supervising.
Decision Making
• The decision-making process involves a series of steps that the nurse manager goes through to make a logical, well-informed, rational choice.
• Decision making always involves evaluating several possible solutions and making a choice.
Shared Governance
• Shared governance is based on a philosophy that nursing practice is best determined by nurses.
• It involves a network of nurses making nursing practice decisions in a decentralized environment.
• The outcome is that nurses participate in an accountable forum to control their own practice.
• Such forums can be in the form of councils or advisory boards.
Change Agent
• Change is a continual unfolding process.
• This process begins with the present state, moves through a transition state, and comes to the desired state. Having once arrived at the desired state, the process starts again.
• Change agent is the individual who helps to achieve the results during the dynamic process.
• Planned change has four steps: designing the change, planning the implementation, implementing the change, and integrating the change. Choosing change strategies depends on the amount of resistance anticipated and the degree of power the change agent has over the situation.
• Resistance to change occurs for a variety of reasons and comes from three major sources: technical concerns— concern about the change being a good idea, psychosocial needs—Maslow’s hierarchy of needs, and threats to a person’s position and power.
Managing Conflict
• Conflict management begins with a decision of “if and when” to intervene.
• It deals with conflict of issues, not personalities.
• Participants are responsible for working toward solutions and an open and full discussion of the problem is required.
Strategies
• Maintain equity in each party’s presentation of their information.
• Establish an environment where positive as well as negative feelings can be expressed.
• Engage in active listening of all parties.
• Restate key themes and encourage both parties to provide feedback.
• Develop alternative solutions and a plan to carry them out. Follow up on the plan.
• Provide positive feedback.
• Never blame.
Power—Authority
• Power is the ability to influence other people even when there is resistance on the part of the other person.
• There are four types of power: authority—the power granted to a nurse or a group of nurses by virtue of position; reward—the promise (by the nurse manager) of money, goods, services, recognition, or other benefits; expertise—the special knowledge an individual (nurse) is believed to have; coercion—-the threat (by the nurse manager) of physical, economic, or psychological pain or harm.
Time Management
• In time management, what is really being managed is not time but how time is being used.
• An important aspect of time management is establishing one’s own goals and time frames.
• There are seven principles of time management: goal setting, time analysis, priority determination, daily planning, delegation, interruption control, and evaluation.
• Assignment sheets that reflect the patient care assignments for each staff member as well as staff member’s individual worksheets are tools to assist one in organizing time.
CONTROL
Control is the process of establishing standards of performance, measuring performance, and evaluating performance and providing feedback.
Information Systems
• Information systems are complex automated systems that are integrated through networked computers to process data.
• The common information systems are management information system, hospital information system, and nursing information system.
• Automated systems offer efficient organization, management, and storage and retrieval of information.
Total Quality Management
• Total quality management is the framework for the nurse manager to manage both costs and quality of patient care.
• It is a management philosophy that emphasizes a commitment to excellence.
• Total quality management is the umbrella philosophy that supports the process of continuous quality improvement.
• Continuous quality improvement is the process that systematically determines ways to improve patient care.
• Joint Commission on the Accreditation of Healthcare Organizations (The Joint Commission) provides standards that help health care institutions focus on the quality improvement efforts.
• Components of quality management are developing a comprehensive plan, setting standards and benchmarks, carrying out performance appraisals, and focusing on intradisciplinary and interdisciplinary assessment and improvement.
Performance Appraisal
• Performance appraisal is the formal evaluation of an employee by a nurse manager.
• The employee’s behavior is evaluated against a standard that identifies what the employee is expected to perform.
• The position description is the basis for the performance behaviors.
• The main reason for conducting a performance appraisal is to provide constructive feedback to the employee.
• Performance appraisals are frequently used in the decisions for salary increases and promotions. Appraisals need to be in writing, done once a year, and shared with the employee. Employees should have the opportunity to respond and have an avenue for appeal.The manager needs to have adequate opportunity to observe the employee and should keep anecdotal notes as well as the staff nurse’s self-assessment.
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