Management process

Planning
A basic management function involving
formulation of one or more detailed plans to
achieve optimum balance of needs or
demands with the available resources. The
planning process (1) identifies the goals or
objectives to be achieved, (2) formulates
strategies to achieve them, (3) arranges or
creates the means required, and (4)
implements, directs, and monitors all steps
in their proper sequence.
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.
Organizational Chart
Drawing that shows how the parts of the
organizations are link. It depicts the formal
organizational
relationship,
areas
of
responsibility
and
accountability
and
channel of communication. Depicts an
organizations structure.
Organizational Structure
Depicts and identifies role and expectations,
arrangement of positions and working
relationships.
Dotted or Unbroken line represents staff
positions/staff authority (advisor to the line
managers).
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.
Solid Horizontal Line represent same
positions but different functions.
Patterns of Organizational Structure
1. Tall/Centralized Structure
Responsible for only few subordinates so
there is narrow span of control. Because of

Level

Top
Level
Manager
s

Scope
of
Responsibility

1.

2.

Middle
Level
Manager
s

First
Level
Manager
s

1.

1.
2.

Generally make
decisions with
the help of few
guidelines
or
structure.
Coordinates
internal
and
external
influences

They conduct
day-day
operations with
some
involvement,
long
term
planning
and
policy making.

Concerned with
specific
unit
workflows.
Deals
with
immediate dayday problems.

Example
s

CEO,
President
,
VPresident
,
Chief
Nursing
Officer

Head
Nurse,
Departm
ent Head,
Unit
Superviso
r/Manage
r

Charge
Nurse,
Team
Leader,
Primary
Nurse,
Staff
Nurse

the vertical in nature, there are many levels

of
communication.
Communication
is
difficult and messages do not get to the top.
Workers are boss-oriented because of close
contact with their supervisor.
2. Flat/Decentralized Structure
Characterized by few levels and a broad
span of control. Communication is easy and
direct
Advantages:
-Shortens the administrative distance from
the top to the lower
-Solutions to problems are easily carried
out/fast response
-Workers developed their abilities and
autonomy
Disadvantage:
Impractical in large organization.
Types of Organizational Structure
1.Line
Organization/Bureaucratic/Pyramidal
There
is
clearly
defined
superiorsubordinate relationship
AR and power are concentrated at the top
2. Flat/Horizontal Organization
-Decentralized type
-Applicable in small organization

-Nurses become productive and directly

involved in the decision making skills
-Workers become satisfied
3. Functional Organization
Permits a specialist to aid line position
within a limited and clearly defined scope of
authority
4. Ad Hoc Organization
Modification of bureaucratic structure
5. Matrix structure
-Focus on both product and functions
-Most complex
-Has both vertical and horizontal chain of
command and line of communication.
Staffing
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
Generating the full time
equivalents of an employee
2.
Determine the nurse-patient ratio
in providing nursing care
Considerations in Staffing Pattern
1. Benchmarking
Management tool for seeking out
the best practice in ones industry so as to
improve ones performance. Process of
measuring products, practices and services
against best performing organization as a
tool for identifying desired standards of
organizational performance.
2. Regulatory Requirements mandated by
RA
3. Skill Mix percent or ratio of
professionals to non professional
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
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
Communication exchange of
thoughts or information through
speech, writing and signals

ideas,
verbal

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 people.Ex: 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
Controlling
Controlling is one of the basic functions of
managers.

It is the measurement and correction of

performance.

Its purpose is to make sure that plans

succeed.
Who Controls?
Control activities are essential parts of
the responsibilities of managers at all levels
in the organization (first-line managers,
department heads, and top management).
Basic Steps of the Control Process
The basic control process, wherever it is
found, and whatever it controls, consist of
three steps as follows:
setting control standards.

measuring performance against these

standards (monitoring).
correcting deviations from standards.
Leadership characteristics
Proactive vs. Reactive
The exceptional leader is always thinking
three steps ahead. Working to master
his/her own environment with the goal of
avoiding problems before they arise.
Flexible/Adaptable
How do you handle yourself in unexpected
or uncomfortable situations? An effective

leader will adapt to new surroundings and

situations, doing his/her best to adjust.
A Good Communicator
As a leader, one must listen...a lot! You
must be willing to work to understand the
needs and desires of others. A good leader
asks many questions, considers all options,
and leads in the right direction.
Respectful
Treating others with respect will ultimately
earn respect.
Quiet Confidence
Be sure of yourself with humble intentions.
Enthusiastic
Excitement is contagious. When a leader is
motivated and excited about the cause
people will be more inclined to follow.
Open-Minded
Work to consider all options when making
decisions. A strong leader will evaluate the
input from all interested parties and work
for the betterment of the whole.
Resourceful
Utilize the resources available to you. If you
don't know the answer to something find
out by asking questions. A leader must
create access to information.
Rewarding
An exceptional leader will recognize the
efforts of others and reinforce those actions.
We all enjoy being recognized for our
actions!
Well Educated
Knowledge is power. Work to be well
educated
on
community
policies,
procedures, organizational norms, etc.
Further, your knowledge of issues and
information will only increase your success
in leading others.
Open to Change
A leader will take into account all points of
view and will be willing to change a policy,
program, cultural tradition that is out-dated,
or no longer beneficial to the group as a
whole.
Interested in Feedback
How do people feel about your leadership
skill set? How can you improve? These are
important questions that a leader needs to
constantly ask the chapter. View feedback
as a gift to improve.
Evaluative
Evaluation of events and programs is
essential for an organization/group to
improve and progress. An exceptional
leader will constantly evaluate and change
programs and policies that are not working.
Organized
Are
you
prepared
for
meetings,
presentations, events and confident that
people around you are prepared and
organized as well?
Consistent
Confidence and respect cannot be attained
without your leadership being consistent.
People must have confidence that their
opinions and thoughts will be heard and
taken into consideration.

Delegator
An exceptional leader realizes that he/she
cannot accomplish everything on his own. A
leader will know the talents and interests of
people around him/her, thus delegating
tasks accordingly.
Initiative
A leader should work to be the motivator,
an initiator. He/she must be a key element
in the planning and implementing of new
ideas, programs, policies, events, etc.
In a practical setting, there are several
applications in which a nursing professional
may use a care plan. For instance, the
licensed nurse may document only portions
of the care plan language into a patients
chart while actually performing the entire
process mentally and in practice. Others
may use software provided by the hospital
to outline the care plan. Regardless if all of
the elements of the care plan are written
out, the licensed nurse will constantly be
using this process to make decisions in his
or her mind. While care planning in school is
often a stressful and time taxing process,
students must drill this information in
nursing school with the goal of becoming as
proficient as their licensed counterparts in
the future. This means that many of the
things you now have to look up will one day
be integrated into your memory, or you will
at least be able to simply look a care plan
up and be able to apply it accurately in the
future.
Whats
the
Purpose
of
Nursing
Diagnoses?
Nursing diagnoses offer
a
way to
standardize patient care between nurses. In
our Westernized culture, healthcare was
formally focused around the physician,
nurse, and the disease. Now that holistic
care, which involves the entire person (both
mind and body), is emphasized, this in no
longer the case. Best care practice
mandates that the nursing diagnosis to be
focused around a patient, family, or
community. Therefore, care is patientcentered, rather than derived for the
nurses benefit.
Nursing Diagnoses
The nursing diagnosis, or the nursing
problem statement, is paramount to nursing
care. Using standardized terminology, the
nursing diagnosis addresses the issues that
can be resolved within the nurses scope of
practice. The nursing diagnosis or diagnoses
you chose will create the theme of your
care plan. To prioritize, use the ABCs + P
(airway, breathing, circulation, and pain).
Another way of looking at is, what will kill
the patient the fastest?
There are four major categories of nursing
diagnoses: actual, risk, wellness statement,
and health promotion. Instructors tend to

prefer new students to use the first two. Of

course, an actual problem takes precedence
of a risk, but sometimes the risk is so
severe that you may chose it over the
actual. For instance,
suppose that a patient is in the hospital for
a broken leg. The patient is experiencing
pain (actual diagnosis) and is being
administered penicillin for prophylaxis of
infection. The patient states that he has
never taken penicillin before and you know
that many people are allergic. Therefore, he
is at risk for a hypersensitivity reaction. This
has the potential of impacting his airway if
it were to manifest in anaphylaxis. In this
case, both diagnoses could be considered
priorities of nursing care. (And also sounds
like the setting of a test question that many
of us would miss).
Priority Interventions
After the nursing diagnosis is established,
the priority nursing intervention addresses
the most important solution to the specific
issue the client is experiencing. In the
example of the patient with the broken leg,
the priority interventions would include
administer pain medication as ordered for
the pain diagnosis. For the risk diagnosis,
the interventions would include monitoring
for signs of an allergic response, such as
erythema, pruritus, and wheezing and to
maintain
emergency
resuscitative
equipment at the bedside.
If you chose medication administration as
an intervention, be sure to include the
phrase, as ordered, or from the standing
order in your writing. This clarifies to your
instructor that you are not proposing to
prescribe the drug. In the beginning of
nursing school, students often have to
clarify the obvious in their care plans.
Evaluation
The evaluation portion provides for this by
providing the nurse with an opportunity to
analyze the success of the intervention.
From an individual patient perspective, this
is determined by assessing the patient
following
the
intervention,
preferably
through use of objective measurements. For
example, consider a patient with a medical
diagnosis of heart failure. Following the
assessment, you analyzed the data you
collected to determine that the nursing
diagnosis is fluid overload. The priority
intervention you develop is to administer
diuretics from the standing order. A few
hours later, you reassess the patient and
discover the urine output has increased and
the oxygen saturation is up several
percentage points. From the outcome, you
have evaluated the intervention and
determined that it was successful.
Classical Management Theory

Definition of management: Management

takes
place
within
a
structured
organisational setting with prescribed roles.
It is directed towards the achievement of
aims and objectives through influencing the
efforts of others.
Classical management theory
-Emphasis on structure
-Prescriptive about 'what is good for the
firm'
-Practical
manager
(except
Weber,
sociologist)
Advantages
Fayol was the first person to actually give a
definition of management which is generally
familiar today namely 'forecast and plan, to
organise, to command, to co-ordinate and
to control'.
Fayol also gave much of the basic
terminology and concepts, which would be
elaborated upon by future researchers, such
as division of labour, scalar chain, unity of
command and centralization.
Disadvantages
Fayol was describing the structure of formal
organizations.
Absence of attention to issues such as
individual
versus
general
interest,
remuneration and equity suggest that Fayol
saw the employer as paternalistic and by
definition working in the employee's
interest.
Fayol does mention the issues relating to
the sensitivity of a patients needs, such as
initiative and 'esprit de corps', he saw them
as issues in the context of rational
organisational structure and not in terms of
adapting structures and changing people's
behaviour to achieve the best fit between
the organisation and its customers.
F W Taylor - (1856 - 1915), USA- The
Scientific Management School
Taylorism involved breaking down the
components
of
manual
tasks
in
manufacturing environments, timing each
movement ('time and motion' studies) so
that there could be a proven best way to
perform each task. Thus employees could
be trained to be 'first class' within their job.
This type of management was particularly
relevant to performance drives e.g 'Action
On' projects.
This was a rigid system where every task
became discrete and specialized. It is fair to
suggest that this is unlikely to be of value to
the NHS with the Modernisation agenda
suggesting that we should have a flexible
workforce.
For the managers, scientific management
required them to:

-develop a science for each operation to

replace opinion and rule of thumb
-determine accurately from the science the
correct time and methods for each job (time
and motion studies)
-set up a suitable organisation to take all
responsibility from the workers except that
of the actual job performance
-select and train the workers (in the manner
described above)
-accept
that
management
itself
be
governed by the science deployed for each
operation and surrender its arbitrary powers
over the workers, i.e. cooperate with them.
Therefore, in summary, while the scientific
management technique has been employed
to increase productivity and efficiency both
in private and public services, it has also
had the disadvantages of ignoring many of
the human aspects of employment. This led
to the creation of boring repetitive jobs with
the introduction of systems for tight control
and the alienation of shop floor employees
from their managers.
Max Weber (1864 - 1924), Germany
Bureaucracy in this context is the
organisational form of certain dominant
characteristics such as a hierarchy of
authority and a system of rules.
Through analyses of organisations Weber
identified three basic types of legitimate
authority: Traditional, Charismatic, RationalLegal.
Authority has to be distinguished from
power in this discussion. Power is a
unilateral thing - it enables a person to force
another to behave in a certain way, whether
by means of strength or by rewards.
Authority, on the other hand, implies
acceptance of the rules by those over whom
it is to be exercised within limits agreeable
to the subordinates that Weber refers to in
discussing legitimate authority.
Weber presented three types of legitimate
authority:
Traditional authority: where acceptance of
those in authority arose from tradition and
custom.
Charismatic authority: where acceptance
arises from loyalty to, and confidence in,
the personal qualities of the ruler.
Rational-legal authority: where acceptance
arises out of the office, or position, of the
person in authority as bounded by the rules
and procedures of the organization.
It is the rational-legal authority form that
exists in most organisations today and this
is the form to which Weber ascribed the
term 'bureaucracy'.
The main features of bureaucracy according
to Weber were:

-a continuous organisation or functions

bounded by rules
-that individuals functioned within the limits
of the specialisation of the work, the degree
of authority allocated and the rules
governing the exercise of authority
-a hierarchical structure of offices
-appointment to offices made on the
grounds of technical competence only
-the separation of officials from the
ownership of the organisation
-the authority was vested in the official
positions and not in the personalities that
held these posts. Rules, decisions and
actions were formulated and recorded in
writing.
Advantages
Appointment, promotion and authority were
dependent on technical competence and
reinforced by written rules and procedures
of promoting those most able to manage
rather than those favoured to manage. We
take a lot of this for granted in the UK today.
Anything else is regarded as nepotism and
corruption.
The adoption of bureaucratic type of
management systems allow organisations
to grow into large complex organised
systems
that
are
focused
towards
formalised explicit goals.
It cannot be stated strongly enough that the
Weber theory has the advantage of being
used as a 'gold standard' on which to
compare and develop other modern
theories.
Disadvantages
Subsequent analysis by other researchers
have identified many disadvantages:
Tendency for organisations to become
procedure dominated rather than goal
dominated.
Rigid procedures and rules are demotivating
for the subordinates that work in the
organizations.
Exercise of control based on knowledge as
advocated by Weber has led to the growth
of 'experts' whose opinions and attitudes
may frequently clash with those of the more
generalised managers and supervisors.
Human Relations Theories
Elton Mayo: Hawthorns studies
Where Classical theorists were concerned
with
structure
and
mechanics
of
organisations, the theorists of human
relations were, understandably, concerned
with the human factors.

The foci of human relations theory is on

motivation,
group
motivation
and
leadership.
At the centre of these foci are assumptions
about relationship between employer and
employee. Best summarised by Schein
(1965) or Elton Mayo
-they were academic, social scientists
-their emphasis was on human behaviour
within organisations
-they stated that people's needs are
decisive
factors
in
achieving
an
organisation's effectiveness
-they were descriptive and attempted to be
predictive of behaviour in organisations
A 'motive' = a need or driving force within a
person.
The process of motivation involves choosing
between alternative forms of action in order
to achieve some desired end or goal
McGregor (Theory X and Theory Y)
Managers were perceived by McGregor,
whose theories are still often quoted, to
make two noticeably different sets of
assumptions about their employees.
Advantages
Identifies two main types of individual for
managers to consider and how to motivate.
Disadvantages
Only presents two extremes of managerial
behaviour.
Theory
X (essentially
'scientific' mgt)

Theory Y

Lazy

Like working

Avoid
responsibility

Accept/seek
responsibility

Therefore need
control/coercio
n

Need space
to develop
imagination/i
ngenuity

Schein type:
'rational
economic man'

Schein type:
'selfactualising
man'

assessment

diagnosis

inference

plannin
g

Subjective:
mainit ang
pakiramdam
ko as
verbalized by
the patient.

Hyperther
mia
related to
dehydratio
n

Infectious agents

After 4
hours of
nursing
interven
tion, the
patient
will
maintai
n core
temper
ature
within
normal
range.

Objective:
Flushed
skin,
warm to
touch
Restless
ness
V/s
taken as
follows:

Monocytes
Pyrogenic
cytokines
Elevated
thermoregulatory
set point
Increased heat
conservation(vasoc
onstriction
behaviour
changes)increased
heat
production(involunt
ary muscular
contractions)
fever

interventio
n
Independe
nt
-monitor
heart rate
and
rhythm.

-record all
sources of
fluid loss
such as
urine,
vomiting
and
diarrhea.
-promote
surface
cooling by
means of
tepid
sponge
bath.
-wrap
extremitie
s with
cotton
blankets
-provide
suppleme
ntal
oxygen

rationale

Evaluatio
n

dysrhythmi
as and ecg
changes are
common
due to
electrolyte
imbalance
and
dehydration
and direct
effect of
hypertherm
ia on blood
and cardiac
tissues

After
4hrs of
nursing
interventi
ons. The
patient
was able
to
maintain
core
temperat
ure
within
normal
range.

-to monitor
or
potentiates
fluid and
electrolyte
loses.
-to
decrease
temperatur
e by means
through
evaporation
and
conduction.
-to
minimize
shivering.
-to offset
increased
oxygen
demands
and
consumptio
n.