Unit 3 Nursing Management: Directing PDF

Prepared by: Mheden M. Supremo, RN September 2024 v Delegation vMotivation vScientific Decision Making vConflict Management vChange Management vTime Management vSupervision Ø Directing refers to the manner of delegating assignments, orders and instructions to the nursing personnel where the latter...

Prepared by: Mheden M. Supremo, RN September 2024 v Delegation vMotivation vScientific Decision Making vConflict Management vChange Management vTime Management vSupervision Ø Directing refers to the manner of delegating assignments, orders and instructions to the nursing personnel where the latter is made aware of the work expected of him/her. Ø The directing function of management is the process of motivating, communicating, instructing, leading, and supervising employees in order to ensure that they are working towards the accomplishment of organizational goals. I. Supervision involves providing guidance and direction to the work in order to achieve a certain purpose; 2. In the Nursing Service, the main goal of supervision is to attain quality care for each patient and to develop the potentials of workers for an effective and efficient performance. 3. A good understanding of administration, clinical competence, and democratic management are essential in supervision. Instead of giving commands, the supervisor should persuade the worker. 1. Good supervision is focused on improving the staff's work rather than on upgrading himself/herself. 2. Good supervision is based on predetermined individual needs. 3. Good supervision is planned cooperatively. 4. Good supervision employs democratic methods. 5. Good supervision stimulates the staffto continuous self-improvement. 6. Good supervision respects the individuality of the staff member. 7. Good supervision helps create a social, psychological, and physical atmosphere where the individual is free to function at her own level. 1. Organizational chart 2. Personnel policies 3. Communication devices 4. Purposeful rounds 5. Guides to workmanship, such as: 5.1 Administrative and supervisory manual 5.2 Policy books (personnel, inter-department, laboratory, dietary and safety) 5.3 Procedure books (general and special) 5.4 Instruction for Kardexuse, administration ofmedical treatment in case of accident 5.5 Schedule of professional and nonprofessional personnel including rotation hours and duties 5.6 Model charts 5.7 Job descriptions 6. Evaluation 2 things to be considered when making a decision: A. the end to be accomplished B. the means to be used to accomplish this end 3 fields /occasions where Organizational decisions originate : a) Authoritative communication from superiors; b) Cases referred by subordinates for decisions; c) Cases originating from the initiative of the supervisor or administrator. 1. Occasions for decisions are frequently furnished with instructions from superior authority. These decisions relate to the interpretations, application, and distribution of instructions. Ex. determining the ratio of nursing personnel based on allocated budget. 2. The cases referred by subordinates for decision arise from the incapacity of subordinates, uncertainty ofinstruction, or conflict of orders. Ex. conflicts or solving relationship problems ofthe Nursing Service with other service departments. 3. The occasions for decision that arise on the initiative of the administrator are the most important test of his/her capacity. This needs the administrator's specific justification for his/her decision. Ex. nursing administrator determines the institution's quality of nursing care. § To entrust responsibility and authority to others and to create accountability for its results. § Delegation is a processs of entrusting because the supervisor/administrator shares work and decisions with others which he/she would otherwise carry alone. 1. Responsibility entails an obligation to fulfill the work assigned to a certain position. 2. People will not perform the work unless they can make decisions related to it. The person given more authority to make the most of his/her own decisions. Authority is the sum of the powers and rights assigned to a position. 3. Accountability is the process of establishing an obligation to perform the work and to make a decision within set limits. 1. A clear-cut outline of duties, responsibilities and relationships should be established. 2. Authority should be delegated within specially defined limits to avoid stepping on others' rights. 3. Define objectives and suitable measures for determining performance. 4. Delegated responsibility must be accompanied with the corresponding authority. 5. Every supervisor is held completely accountable for the methods and results of the work assigned to him/her. 1. Describe the tasks/projects procedures to be done. 2. Relay the description of the task, etc. 3. Establish checkpoints. a. Policies/standards b. Allocate resources c. Time frame d. Rounds 4. Establish dialogue before, during, and after, for feedback on: a. Clarification b. Attitude/feelings of the staff delegated with the task c. Judgment of delegation 1. Provide clear and specific instructions. Make sure that the responsibilities are clear. 2. Give authority commensurate to responsibility. 3. Keep subordinates informed. 4. Show you have confidence in your subordinates. 5. Be loyal. Points to remember in delegation 1. Authority to sign your name is never delegated. 2. Let the person who actually did the work sign it. 3. The opportunity to say a few words to new employees is never delegated. Ø Motivation describes the factors that initiate and direct behavior. Ø Motivated employees are more likely to be productive than are nonmotivated workers. 1. Content Theories Ø Emphasize individual needs or the rewards that may satisfy those needs. 2 Types: a. Instinct theories characterized instincts as inherited or innate tendencies that predisposed individuals to behave in certain ways. b. Need theories supported the concept that motives were learned behaviors. 2. Process Theories Ø Emphasize how the motivation process works to direct an individual’s effort into performance. a. Reinforcement theory, (Skinner, 1953) Ø also known as behavior modification, views motivation as learning. Behavior is learned through a process called operant conditioning, in which a behavior becomes associated with a particular consequence. Consequences may be positive, as with praise or recognition, or negative. Punishment- common technique use as egative reinforcers to inhibit an undesired behavior. Extinction is another technique used to eliminate negative behavior. By removing a positive reinforcer, undesired behavior is extinguished. b. Expectancy theory (Vroom, 1964) Ø emphasizes the role of rewards and their relationship to the performance of desired behaviors. Expectancy theory regards people as reacting deliberately and actively to their environment. c. Equity theory (Adams, 1963, 1965) Ø suggests that a person perceives that one’s contribution to the job is rewarded in the same proportion that another person’s contribution is rewarded. Job contributions include such things as ability, education, experience, and effort, whereas rewards includ job satisfaction, pay, prestige, and any other outcomes an employee regards as valuable. d. Goal-setting theory (Locke, 1968) Ø suggests that it is not therewards or outcomes of task performance per se that cause a person to expend effort, but rather the goal itself. § Change is the process of making something different from what it was. § Organizational change is essential for adaptation; creative change is mandatory for growth (Heath & Heath, 2010). § The process begins with the present state, is disrupted, moves through a transition period, and ultimately comes to a desired state. Once the desired state has been reached, however, the process begins again. 1. Assessment a.Identify the problem or opportunity. b. Collect necessary data and information. c. Select and analyze data. 2. Planning a. Develop a plan for change, including time frame and resources. 3. Implementation a. Identify supporters or opposers. b. Build a coalition of supporters. c. Help people prepare for change. d. Prepare to handle resistance. d. Provide a feedback mechanism to keep everyone informed of the progress of change. 4. Evaluation a. Evaluate effectiveness of the change and, if successful, stabilize the change. 1. Power-coercive strategies Ø Are based on the application of power by legitimate authority, economic sanctions, or political clout. Ø Useful when a consensus is unlikely despite efforts to stimulate participation by those involved. Ø When much resistance is anticipated, time is short, and the change is critical for organizational survival, power-coercive strategies may be necessary. 2. Empirical–Rational Model Ø The power ingredient is knowledge. Ø The assumption is that people are rational and will follow their rational self-interest if that self-interest is made clear to them. Ø Often effective when little resistance to the proposed change is expected and the change is perceived as reasonable. 3. Normative–Reeducative Strategies Ø Rest on the assumption that people act in accordance with social norms and values. Ø People’s roles and relationships, perceptual orientations, attitudes, and feelings will influence their acceptance of change. Ø The power ingredient is the skill in interpersonal relationships and collaboration. Ø Adequate time or when group consensus is fundamental to successful adoption of Ø the change, be effective in reducing resistance and stimulating personal and organizational creativity. Ø The drawback is the time required for group participation and conflict resolution. Reasons of Resistance (Yukl, 2009; Hellriegel, Jackson, & Slocum, 2007): 1. lack of trust, 2. vested interest in the status quo, 3. fear of failure, loss of status or income, 4. misunderstanding, and 5. belief that change is unnecessary or that it will not improve the situation Rogers (2003) identified six responses to change: Innovators love change and thrive on it. Less radical, early adopters are still receptive to change. The early majority prefer the status quo, but eventually accept the change. The late majority are resistive, accepting change after most others have. Laggards dislike change and are openly antagonistic. Rejecters actively oppose and may even sabotage change. Conflict is defined as the consequence of real or perceived differences in mutually exclusive goals, values, ideas, attitudes, beliefs, feelings, or actions. (a) within one individual (intrapersonal conflict), (b) between two or more individuals (interpersonal conflict), (c) within one group (intragroup conflict), or (d) between two or more groups (intergroup conflict). Conflict is dynamic. It can be positive or negative, healthy or dysfunctional. 1. Competitive Conflict Ø Competition occurs when two or more groups attempt the same goals and only one group can attain those goals. Ø A victory for one side and a loss for the other side. The process by which the conflict is resolved is determined by a set of rules. Ø The emphasis is on winning, not the defeat or reduction of the opponent. Ø When one side has clearly won, competition is terminated. 2. Disruptive conflict Ø Does not follow any mutually acceptable set of rules and does not emphasize winning. Ø The parties involved are engaged in activities to reduce, defeat, or eliminate the opponent. Ø This type of conflict takes place in an environment charged with fear, anger, and stress. 1. Confrontation Ø is considered the most effective means for resolving conflicts. Ø This is a problem-oriented technique in which the conflict is brought out into the open and attempts are made to resolve it through knowledge and reason. Ø The goal of this technique is to achieve win–win solutions. Ø Facts should be used to identify the problem. The desired outcome should be explicit. 2. Negotiation Ø Involves give-and-take on various issues among the parties. Ø Its purpose is achieve agreement even though consensus will never be reached. Therefore, the best solution is not often achieved. Ø Negotiation often becomes a structured, formal procedure. Ø Negotiation skills are important in arriving at an agreeable solution between any two parties. 3. Collaboration Ø Iimplies mutual attention to the problem, in which the talents of all parties are used. Ø The focus is on solving the problem, not defeating the opponent. The goal is to satisfy both parties’ concerns. Ø Collaboration is useful in situations in which the goals of both parties are too important to be compromised. 4. Compromise Ø is used to divide the rewards between both parties. Neither gets what she or he wants. Ø Compromise can serve as a backup to resolve conflict when collaboration is ineffective. Ø It is sometimes the only choice when opponents of equal power are in conflict over two or more mutually exclusive goals. Ø Compromising is also expedient when a solution is needed rapidly. 5. Competing Ø is an all-out effort to win, regardless of the cost. Ø Competing may be needed in situations involving unpopular or critical decisions. Ø Competing is also used in situations in which time does not allow for more cooperative techniques. 6. Accommodating Ø is an unassertive, cooperative tactic used when individuals neglect their own concerns in favor of others’ concerns. Ø Accommodating frequently is used to preserve harmony when one person has a vested interest in an issue that is unimportant to the other party. 7.Avoiding Ø the participants never acknowledge that a conflict exists. Ø Avoidance often used in highly cohesive groups. 8. Withdrawal Ø removes at least one party, thereby making it impossible to resolve the situation. Ø The issue remains unresolved, and feelings about the issue may resurface inappropriately. Ø If the conflict escalates into a dangerous situation, avoiding and withdrawing are appropriate strategies. 9.Smoothing Ø is accomplished by complimenting one’s opponent, downplaying differences, and focusing on minor areas of agreement, as though little disagreement existed. Ø Smoothing may be appropriate in dealing with minor problems, but in response to major problems, it produces the same results as withdrawing. 10. Forcing Ø is a method that yields an immediate end to the conflict but leaves the cause of the conflict unresolved. Ø Forcing may be appropriate in life-or-death situations but is otherwise inappropriate. 11.Resistance Ø can be positive or negative. Ø It may mean a resistance to change or disobedience, or it may be an effective approach to handling power differences, especially verbal abuse. Filley (1975) identified three basic strategies for dealing with conflict according to the outcome: 1. Win–Lose strategy Ø one party exerts dominance, usually by power of authority, and the other party submits and loses. Ex. Forcing, competing, and negotiating 2. Lose–Lose strategy Ø neither side wins. The settlement reached is unsatisfactory to both sides. Ex. Avoiding, withdrawing, smoothing, and compromising 3. Win–Win strategy Ø focuses on goals and attempt to meet the needs of both parties. Ø Two specific win–win strategies are consensus and integrative decision making. Ø The consensus decision is often superior to even the best individual one. True consensus occurs when the problem is fully explored, the needs and goals of the involved parties are understood, and a solution that meets these needs is agreed upon. Ø Integrative decision making focuses on the means of solving a problem rather than the ends. Ø is a constructive process in which the parties jointly identify the problem and their needs. Ø The group works toward a common goal in an atmosphere that encourages the free exchange of ideas and feelings. Mediation Ø is a form of ADR that involves a third-party mediator to help settle disputes. Ø Mediation agreements can satisfy all parties, cost less and take less time than legal remedies, and lead to improved interprofessional relationships “Time management is a misnomer. No one manages time: What is managed is how time is used.” A time waster prevents a person from accomplishing the job or achieving the goal. Common time wasters include: 1. Interruptions, such as phone calls, text messages, and drop-in visitors 2. Meetings, both scheduled and unscheduled 3. Lack of clear-cut goals, objectives, and priorities 4. Lack of daily and/or weekly plans 5. Lack of personal organization and self-discipline 6. Lack of knowledge about how one spends one’s time 7. Failure to delegate or working on routine tasks 8. Ineffective communication 9. Waiting for others and thus not using transition time effectively 10. Inability to say no A. Time Analysis Ø The first step is to analyze how time is being used. The second is to determine whether time use is ppropriate to your role. a. Time logs are useful in analyzing the actual time spent on various activities. Review your log for what activities are essential and what can be delegated or eliminated. b. planner or appointment calendar B. The Manager’s Time Ø A significant difficulty in moving from a staff nurse position to a leadership position is the need to develop different time-management and organizational skills. Ø When nurses move to a leadership position, they are responsible for defining how time will be spent. Learning to focus on setting goals, determining priorities, and evaluating time use is an important part of the analysis. 1. Determining Priorities 2. Daily Planning and Scheduling ex. To-do list 3. Grouping Activities and Minimizing Routine Work ex. making use of waiting time 4. Personal Organization and Self-Discipline ex. able to say “No” 1. Phone Calls, Voice Mail, Text Messages How to handle: 1.Minimize socializing and small talk. 2. Plan calls. 3. Set a time for calls. 4. State the reason for the call and ask for preferred call times. Ø Voice mail is an excellent way to send and receive messages when a real-time interaction is not essential. Ø Long messages or sensitive information is better conveyed one-on-one. 2. E-Mail Ø Turn off your e-mail alert and set specific times of day to check your in-box. Ø Discourage people who forward you unwanted messages. Set your e-mail filter to direct these messages to your spam folder or tell the sender that you cannot receive personal messages at work (Merritt, 2009). Ø Direct messages only to the people involved (e.g., committee members) and copy others (e.g., the department chair). 3. Drop-In Visitors Ø Open doors are open invitations for interruption. Ø Stand and remain standing. Ø Control interruptions through the way you arrange your office furniture. Ø Encouraging people to make appointments to deal with routine matters 4. Paperwork a. Plan and schedule paperwork. b. Plan and schedule paperwork. c. Send every communication electronically. d. Analyze paperwork frequently. e. Do not be a paper shuffler.  Do not meet simply because you always meet on Monday morning. If no meeting is needed, cancel it. Invite only key people to initial meetings. Others can be sent the minutes or invited to fu- ture meetings. Establish the meeting’s goal and outcomes expected at the outset. Send information before the meeting so time is not spent reading it. Set a time limit for all meetings. Routine meetings should last no more than one hour. If more time is needed, schedule another meeting. Determine the agenda and keep to the topic. Follow-up with actions assigned.  The key to using time- management techniques is to respect one’s own time as well as that of others.