- 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
BSN018 ⋆ Group
3. 69- Change is integrated into
Refreezing
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 over-
all 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
 • 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 four-
way 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 inter-
departmental relationships should be
established
and made available to all.
• Channels of Communication should be
followed
CONFLICT
  A clash between two hostile and opposing
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 authority-
obedience approach. Enforce the rule of
discipline. “Win-Lose Situation”
➢ SMOOTHING – disagreements are
ignored so that surface harmony is
maintained in a state of peaceful co-
existence. Appropriate in solving minor
problems but issues also remain
unresolved and may later resurface. “Win-
Lose 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 itself-
challenges ,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
○ 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
or more about the worker’s strengths,
weaknesses and potentials.
2. Checklist - Is a compilation of all nursing
performances expected of a worker.
3. Ranking - The evaluator ranks the
employees according to how he or she
fared with co-workers with respect to
certain aspects of performance.
4. 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.
5. Forced-Choice Comparison - The
evaluator is asked to choose the
statement that best describes the nurse
being evaluated.
6. 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

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.