Controlling Ariel R. Sinco, RN, MN Controlling

CONTROLLING
Ariel R. Sinco, RN, MN

CONTROLLING
Definition:
Seeing that everything is being carried out in accordance with the plan which
has been adopted, the orders which have been given, and the principles which have
been laid down. Its object is to point out mistakes in order that they may be rectified
and prevented from recurring (Henri Fayol).
CONTROLLING
Definition:
Control is checking current performance against pre-determined standards
contained in the plans, with a view to ensure adequate progress and satisfactory
performance. (EFL Breach).
CONTROLLING
Definition:
Controlling is the measurement and correction of performance in order to
make sure that nursing objectives and the plans devised to attain them are
accomplished. (Harold Koontz).
CONTROLLING
Controlling Coverage Includes:
1. Performance Appraisal
2. Progressive Discipline
3. Nursing Audit
4. Collective Bargaining
5. Nursing Documentation (Charting)
6. Nursing Informatics
Performance Appraisal
“An effective appraisal process rewards productive employees and assists the
professional growth and development of inexperienced and unproductive
individuals” (Mable H. Smith).
Definition:
 Is a control process in which nurses’ performance are evaluated against
standards.
 May also be referred to as Employee Performance Evaluation.
 It is also determined in a form of Self evaluation and Peer Evaluation.
Self Evaluation:
Requires that you try to look objectively at your own performance and
identify areas in which you are doing well and those areas in which you hope to
grow and develop..
Critical to professional growth.
Peer Evaluation:
Nurses are asked to evaluate other nurses as a contribution to their growth
and development in nursing..
Lack clear standards of measurement and may be greatly influenced by
personal biases.
Purposes:
1. Improve the functioning of the organization.
2. To foster the personal development of the employee within the
organization.
3. To provide a basis for termination of an employee from a position, should
that be necessary.
Purposes:
4. Can provide information on which to base management decisions
regarding such matters as salary increases, merit wage increases, promotion, transfer,
demotion, and termination.
5. Help assess the effectiveness of an organization’s hiring and recruiting
practices.
6. Help identify training and development needs of the employees so that
staff development programs can be structured appropriately.
Characteristics of an effective performance appraisal system:
1. Administrative support present..
Fair and productive by all who participate in it.
2. Evaluation related to job description..
For what purpose will the evaluation will be used e.g. salary, transfer,
promotions, etc.
3. Clear criteria for evaluation was used..
Well defined procedure used in relation to the negotiated contract with
the hospital administration and reliance on the job description.
Characteristics of an effective performance appraisal system:
4. Evaluators identified to employees..
All individuals employed must know who in that system is responsible
for evaluating their performance.
5. Procedures consistently applied..
Evaluator must be trained in the evaluation tool and the appraisal
interview, and must give verbal feedback, written evaluation and give opportunity for
the nurses to respond in writing.
Common Problems That Interfere with the Success of Formal Appraisal:
1. Performance appraisal programs may be viewed as demanding too much
from the supervisors.
2. Standards and ratings tend to vary widely, with some raters being tough
and others more lenient.
3. An appraiser may replace organizational standards with personal values
and standards.
4. Because of lack of communication, standards by which employees think
they are being judged are sometimes different from those their superiors actually
use.
5. Appraisal techniques tend to be used as performance panaceas and cannot
replace sound selection, placement and training programs.
6. The validity of ratings may be reduced by supervisors’ resistance to
making the ratings, due to the discomfort they feel when having to confront the
employee with negative ratings and negative feedback.
7. Ratings can boomerang when communicated to the employees, because
negative feedback fails to motivate and may cause employee to perform poorly.
8. Performance appraisal may interfere with more constructive coaching
relationship between the supervisor and the employee..
Supervisors may see the evaluation process as placing them in the role of
JUDGE.
Types of Performance Evaluation Tools:
1. Narrative or essay technique (most common)
The evaluator writes a paragraph or more (usually even more) outlining the
employees STRENGTHS, WEAKNESSES (or areas for improvement), and
POTENTIALS..
 Provides in-depth review of the employees performance and may be suitable for
identifying problem areas and areas to focus further development.
2. Rating Scales (most widely used)
The tool consist of behaviors or characteristics to be rated and some type of
scale that will indicate the degree to which the person being evaluated demonstrates
such behavior..
 Example:
Identifying actual and 5 4 3 2 1
Potential health problems O VS S F P
3. Checklist (also common)
It describes the standards of performance, and the rater indicates by placing a
check mark in a column whether the employee demonstrate that behavior..
 The columns are usually titled “yes”, “no” or “not applicable”
4. Goals and Objectives (less common)
Focus on the evaluator’s observation of the employee’s performance as
measured against very specific, predetermined objectives or goals..
 During the feedback interview, the results are discussed and new goals for the
next evaluation are established.
Progressive Discipline
Definition:
It is a process by which an employee’s performance is evaluated with
feedback and increasing sanctions on unacceptable behavior..
The goal of this process is to correct employee performance and also to set a
stage for termination if that is needed..
Actions taken on this situation are often termed as DISCIPLINARY
PROCEDURES.
Steps in Progressive Discipline:
1. Counseling
Counsel the employee regarding the performance problem and expectations
for improvement. Time frame for improvement are given..
Managers must have good understanding of the strength and limitations of
their counseling skills.
2. Official Reprimand (verbal reprimand)
The second steps involves again informing the employee about the problem
behavior, identifying acceptable behavior, and officially reprimanding the employee
for the poor performance..
Most authorities now recommend that all reprimands be in writing.
3. Second Reprimand (written reprimand)
The employee must see and sign documentation that will verify that they are
aware the problem has been discussed..
Written reprimand is kept in the employee’s personal file and a copy furnished
will be given to the employee..
The employee is given the chance to submit a written response to the
reprimand.
4. Suspension
The employee will be told that he or she is not to return to work for a period
of time, for instance, 2 weeks or even more..
The suspension will help the employee see that the behaviors being exhibited
are considered serious..
Gives the employee the needed time to make some corrections.
5. Termination
The employee is then allowed to return to work. If the unacceptable behavior
has not changed after the suspension, the final step is TERMINATION..
Many people will terminate their employment voluntarily before reaching this
stage in the process.
Employee’s who believe they have been improperly treated may always seek
retribution in court.
Protect yourself from a lawsuit by:
1. Proper and adequate documentation must be collected regarding the
problems.
2. Emphasize the importance of making some type of note at the time the
incident occurs.
3. A written record of all conferences with the employee must be kept.
4. Having a third person present provides another individual to what has
occurred.
Nursing Audit
Nursing Audit
Definition:
 It is essentially an examination, a verification or accounting of
predetermined indicators.
 A detailed review and evaluation of selected clinical records by qualified
professional personnel for evaluating quality of nursing care.
 The process of collecting information from nursing reports and other
documented evidence about patient care and assessing the quality of care by the use
of quality assurance programmes.
 A method used to monitor STANDARDS.
Nursing Audit
Three Basic Forms of Nursing Audit:
1. Structure Audits.
Focus on the setting in which care takes place..
Example: physical facilities, equipments, caregivers, organization, policies,
procedures, and medical records.
Nursing Audit
2. Process Audits.
Implements indicators for measuring nursing care to determine whether
nursing standards are met. (TASK ORIENTED)
Nursing Audit
2. Process Audits.
First used by MARIA PHANEUF in 1964 and later called The Phaneuf
Audit..
PA is retrospective and is applied to measure quality nursing care received by
the client.
Nursing Audit
The Phaneuf Audit :
1. Application and execution of physicians’ legal orders.
2. Observations of symptoms and reactions.
3. Supervision of the client.
4. Supervision of those participating in care.
5. Reporting and recording.
6. Application and execution of nursing procedures and techniques.
7. Promotion of physical and emotional health by directing and teaching.
Nursing Audit
3. Outcome Audits.
Evaluate nursing performance in terms of establishing client outcome
criteria..
This type of audit are evaluated in terms of evidence..
example:
Hyperthermia---TSB---normalization of temp.
Collective Bargaining
Definition:
A process by which organized employees participate with their employers in
decisions about their rates of pay, hours of work, and other term and conditions of
employment.
Definition:
A process through which the representatives of the employers and employees
meet at reasonable times, confer in good faith about wages, hours, and other matters
and put into writing any agreements reached.
Definition:
Is the means by which professional nurses can influence hospital nursing
care delivery system and labor-management relations through a united voice.
Definition:
Is a process whereby the management and union discuss and decide terms
and conditions of employment which will govern the conduct of their relationships
during the duration of the agreement (NEGOTIATION).
To be successful in negotiation:
Both union and panels should negotiate in good faith, trust and confidence
with understanding and cooperation rather than resort in the employment of tactics
or threats that will delay or obstruct peaceful negotiation.
Factors affecting climate for proper negotiations:
1. The attitude, thinking, and policy of the company’s top management as
well as of the union officers.
2. The attitude, thinking, experience, and knowledge of the persons, both
union and management, doing the negotiations.
3. The conditions of labor supply and demand as well as the support of the
members to the union.
4. Knowledge of the customary practices, in the type of business to which the
establishment belongs.
5. The market conditions of the company’s products and services and their
profitability.
6. The economic and other basic conditions prevailing at the time of
negotiations and the expected economic conditions of the country.
Strikes: Definition
Concerted work stoppages, slowdowns, mass leaves, sit-downs, attempts to
damage, destroy or sabotage plant equipments and facilities and similar activities.
Strikes:
1. Unfair labor practice strike
The management has allegedly committed or is doing an act inimical to
the interest of the union and its members.
2. Economic strike
Does not meet the Socio-economic demands of the union such as:
higher wages, overtime benefits, etc.
Strikes:
3. Recognition strike
Strike to force the employer to recognize and deal with the union. Arises
when the union is new which the employer refuse to recognize it.
4. Jurisdictional strike
When two or more unions collide as they secure the membership of and
representation for employees in a specific type of jurisdiction.
Strikes:
5. Sit-down strike
When the employees refuse to work but remain in the premises of the
firm.
6. Slow-down strike
This is a form of work stoppage in which employees deliberately reduce
their individual production.
Strikes:
7. Sympathy strike
employees strikes in support of another.
8. Wildcat strike (illegal strike, boycott or secondary strike)
This is a strike declared suddenly, quickly, unauthorized by the union.
Lockout: Definition
Comprises shutdowns or suspension or cessation of business operations in
the course or as a result of a deadlock in collective bargaining negotiations or labor
dispute.
Picketing: Definition
An act of strikers patrolling back and forth, carrying posters, signs, and
placards in front of the company’s premises under strike.
Advantages:
 Equalization of power..
Decentralization of power among administrators and staff associates because of
the staff associates strength in numbers
 Viable grievance procedures
 Equitable distribution of work
 Professionalism is promoted
 Nurses gains control over practice.
Disadvantages:
 Adversary relationship..
Adversary relationships may develop on both parties.
 Strikes may not be prevented..
Strikes may stemmed from economic and socio-economic causes. Strike to
enforce demands for higher wages, overtime premiums, differential pay, shorter
working hours, wage adjustments, and better working conditions.
Disadvantages:
 Leadership may be difficult to obtain..
Because professional nurses have little experience in positions of authority.
Women tend to view employment as JOB instead of a career, minimizing interest in
leadership positions.
 Unprofessional behavior.
 Interference with management.
Nursing Documentation
CHARTING
Nursing Progress Notes
Definition:
 Progress notes are usually narrative descriptions of patient’s progress toward
goal achievement.
 This includes assessment of the client’s mental and physical condition, client
activities, nursing interventions and client responses, visits by other members of the
health team, and treatments performed by physicians that affect nursing care.
Methods:
1. Chronological Narrative Charting
It is a traditional charting format.
Events and patients responses are written in chronological order.
EXAMPLE:
Methods:
2. SOAP Charting
SOAP is an acronym for Subjective Data, Objective Data, Assessment, and
Plan.
SOAPIER is used by some institutions where I represents intervention, E for
evaluation, and R for revision.

Methods:
2. SOAP Charting
SUBJECTIVE DATA:
This information is gathered from the patient which includes his perceptions
and experiences of the problem.
OBJECTIVE DATA:
The nurse observes or measures this information using senses such as: physical
findings, observations, lab results, etc.
Methods:
2. SOAP Charting
ASSESSMENT:
Subjective and objective data are interpreted and a conclusion is made.
PLAN:
The plan of care designed to resolve the stated problem.
Methods:
2. SOAP Charting
INTERVENTION:
Any action by a nurse that implements the nursing care plan.
EVALUATION:
This is the component of nursing process that determines the extent to which
the client’s goal are met.
Methods:
2. SOAP Charting
REVISION:
The nurse reassess the success of the plan.
If the plan proves unsuccessful, a new plan is needed and reinstituted.
EXAMPLE:

TIPS to keep in mind when charting:
1. Keep in mind that juries rely heavily on nurse’s charting.
If you chart properly, your chances of winning a lawsuit are better.
Remember the proper method is to draw a line through improper or incorrect
charting and place the word “error” immediately after the entry with your initials.
2. Follow these rules for charting.
 Chart everything including observations,
 nursing actions,
 patient’s response to therapy and treatment,
 any unusual incidents or omitted treatments
 safety precautions you took to protect the patient
 your attempts to reach the doctor
 any reservations you have about a doctor’s orders
 the date and time of each entry
 the patient’s name and identification number off the chart
 your signature on each entry (when in doubt chart everything)
 leaving blanks or omitting documentation could have disastrous results in a
lawsuit
3. Do not chart subjective opinions, just facts- document only what you
observe with all your senses.
Subjective opinions leave the nurse open to questions about his or her credibility
and consistency in charting.
4. Be accurate.
Being inaccurate diminishes the strength of your case.
5. Do not obliterate an entry.
The obliteration of any entry will only provide more ammunition for the plaintiff
attorney.
6. Chart as you go.
Use your best judgment and if worse comes to worse set up a sheet that has a slot
for vital signs and quick entries for any change in the patient’s condition.
7. If you observe changes in the patient, do not just chart them, but also
notify the physician.
The nurse exposes him or herself to litigation when a physician is not alerted to
changes.
8. If you make a mistake in charting-correct it after the last entry you made-
not where you should have made it in the first place.
A plaintiff attorney will use this as another way to establish that a “cover up”
was taking place.
9. If you are asked to chart for someone else don’t do it.
But if you are unable to refuse, include the name of the person you are charting
for.
10. Above all, do not try to cover up a mistake.
Once you have the reputation of covering up errors the level of trust that is
needed in the health care profession is undermined and your reputation as a professional
may be irreversibly damaged.
Nursing Informatics
Computers & Information Mgt.
Nursing Informatics:
Definition:
 Informatics (comes from the French word informatique which means
computer science)..
 Informatics is defined as computer science + information science in
conjunction to nursing profession..
 It denotes an application of computer science and information science to the
management and processing of data, information, and knowledge in Nursing.
Nursing Informatics:
Definition:
 The use of computer technology to support nursing, including clinical
practice, administration, education, and research (Hebda).
 The development and evaluation of applications, tools, processes, and
structures which assist nurses with the management of data in taking care of
patients or supporting the practice of nursing (ANA).
 a combination of computer science, information science and nursing science
designed to assist in the management and processing of nursing data, information
and knowledge to support the practice of nursing and the delivery of nursing care
(Graves J.)
The framework for nursing informatics relies on the central concepts of data,
information and knowledge:
 Data is defined as discrete entities that are described objectively without
interpretation.
 Information as data that is interpreted, organized or structured.
 Knowledge as information that has been synthesized so that
interrelationships are identified and formalized..
Resulting in decisions that guide nursing practice.
Example:
 Data: 140 systolic
 Information: 50 year-old male, day 3 of hospitalization, BP 140/70,
Hypertensive.
 Knowledge: Pt. demographics, record of BP readings, circulation system:
anatomy & physiology, pharmacokinetics of ordered medication.
Application to Nursing:
Nursing Informatics can be applied to all areas of nursing practice, which
include; clinical practice, administration, education, and research.
A. Nursing Practice
1. Work lists to remind staff of planned nursing interventions..
Nursing procedure guidelines.
2. Computer generated client documentation.
Pt’s Chart (Pt information sheet, nurse’s notes, medication sheet, etc).
A. Nursing Practice
3. Electronic Medical Record (EMR) and Computer-Based Patient Record
(CPR)..
Record Section.
4. Monitoring devices that record vital signs and other measurements
directly into the client record (electronic medical record)..
ECG, Ultrasound, Blood Chem., etc.
A. Nursing Practice
5. Computer - generated nursing care plans and critical pathways..
Electronic Nursing Care Plan.
6. Automatic billing for supplies or procedures with nursing documentation
Billing Section, CSR, Pharmacy.
A. Nursing Practice
7. Reminders and prompts that appear during documentation to ensure
comprehensive charting.
Endorsement Sheet & KARDEX.

B. Nursing Administration
1. Automated staff scheduling..
Electronic Scheduling based on Rotation Plan.
2. E-mail for improved communication..
Sending and receiving information through internet.
3. Cost analysis and finding trends for budget purposes..
Budget allocations on all departments.
• 4. Quality assurance and outcomes analysis..
Utilization of certain programs in any computing needs.
C. Nursing Education
1. Computerized record-keeping
Grades, Schedules, Accomplishments, etc.
2. Computerized-assisted instruction
Use of powerpoint presentations.
3. Interactive video technology
Film showing.
C. Nursing Education
4. Distance Learning-Web based courses and degree programs
Degree programs acquired through internet.
5. Presentation software for preparing slides and handouts - PowerPoint and
MS Word
B. Nursing Research
1. Computerized literature searching on web sources.
Web sources on related literature.
2. The adoption of standardized language related to nursing terms..
NANDA, etc.
3. The ability to find trends in aggregate data..
• Data derived from large population groups-Statistical Software, SPSS.
Benefits of Computer Automation in Health Care: Electronic Medical Record
or EMR
1. Improved access to the medical record..
The EMR can be accessed from several different locations simultaneously, as
well as by different levels of providers.
2. Decreased redundancy of data entry..
For example, allergies and vital signs need only be entered once.
or EMR
2. Decreased time spent in documentation.
Automation allows direct entry from monitoring equipment, as well as point-of-
care data entry.
3. Increased time for client care.
More time is available for client care because less time is required for
documentation and transcription of physician orders.
or EMR
4. Facilitation of data collection for research.
Electronically stored client records provide quick access to clinical data for a
large number of clients.
5. Improved communication and decreased potential for error.
Improved legibility of clinician documentation and orders is seen with
computerized information systems.
….and most of all.
Creation of a lifetime clinical record facilitated by information systems.

Controlling Ariel R. Sinco, RN, MN Controlling

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CONTROLLING

Ariel R. Sinco, RN, MN

Nursing Progress Notes

Nursing Progress Notes

Computers & Information Mgt.

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