OVERVIEW OF THE NURSING MANAGEMENT PROCESS

Changes in the Health Care Delivery System

** The Philippine Nursing Law of 2002, R.A. 9173 focuses on 3 changes in the
effort to improve the people’s health:

1.HOSPITAL or INSTITUTIONAL CARE  emphasis shifted to community

health delivery

2. PHYSICAL CARE  efforts are now directed toward holistic approach to

care of individuals, families and communities

3. RECIPIENTS OF CARE  patients, individuals, families and communities

are now active participants in health care efforts.

∞ The management process is universal. Knowledge of this process assures

nurses of smooth functioning of their units in attaining their goal of quality care
through the judicious use of available human and materials resources within a
specified time∞
THREE MAJOR AREAS OF RESPONSIBILITY BY THE NURSE MANAGER:

Patient Care Management Operational Management Human Resource

Management
Assess Problems & Needs Budgeting Teaching

Problem Identification Controlling Expenses Counseling

Planning of Care Staffing Facilitating
Teaching Providing Supplies Rounds
Treatments Scheduling Conferences
Medications Communicating Inservice programs
continuing education
Clinical Conferences & Coordinating Bulletin Boards
evaluating results
Planning Journals
Evaluating performance Career mobility
Meetings, Auditing & Peer review
Committees
Research
DEVELOPING FUTURE MANAGERS:
¤ MANAGEMENT SKILLS ¤

1. HUMAN RELATIONSHIP SKILLS

- Pertains to dealing with people and how to “get along” with them.
(ability to work with and for people, to communicate with others and to understand other’s
needs).

2. TECHNICAL SKILLS
- The proficiency in performing an activity in the correct manner with the right technique.
(ability to use the tools, equipments, procedures and techniques of a specialized field)

3. CONCEPTUAL SKILLS
- ability to see individual matters as they relate to the total picture and to develop creative
ways of identifying pertinent factors, responding to the big problems, and discarding
irrelevant facts
.
4. POLITICAL SKILLS
Ones ability to enhance one’s power, build a power base and establish
the “right” connections.

5. DIAGNOSTIC and ANALYTICAL SKILLS

Ability to identify and evaluate problem and analyze decision made.

** ALL managers must have these types of skills, but the mix of skills a
manager requires varies with his / her rank in the hierarchy
 KNOWLEDGE , ATTITUDE AND ABILITY FACTORS:
1. KNOWLEDGE FACTOR
- refers to ideas, concepts, or principles that can be expressed and are accepted
because they have logical proofs.

2. ATTITUDE FACTORS
- relate to those beliefs, feelings and values that may be based on emotions and may not
be subjected to conscious verbalization.
Include:
 Interest in one’s work
 confidence in one’s mental competence
 desire to accept responsibility
 respect for the dignity of one’s associates
 desire for creative contribution

3. ABILITY FACTORS
- are abstract factors but they direct one’s thinking to factors that can be
developed by individual manager who takes time to consider them.
Include:
 skill
 art
 judgement
 wisdom.
ACADEMIC REQUIREMENTS FOR NURSING SERVICE ADMINISTRATORS IN
THE PHIL.
1. Chief Nurses or Nursing Service Directors of Hospital with 100 bed capacity
are required to have Master’s of Arts in Nursing (MAN) with a major in
Nursing Administration.

2. Supervising Nurses - at least 9 units in graduate

studies in nursing.
 CONCEPTUAL FRAMEWORK OF THE NURSING MANAGEMENT PROCESS

Establish
Policies, Set up organizational
Prepare procedures Structure identity Determine
Develop & budget Establish groupings roles Staff needed
schedule Allocate definite relationships Develop & maintain
programs, resource course of staffing patterns
define activities action and Distribute in areas as
methods needed
Set objectives needed & set
time frame
Determine Organizing
Results desired Establishing Develop job
Planning
formal descriptions, define
Thinking ahead Materials-Methods qualifications and
Making Future authority
Forecast Manager functcins of personnel
Projections to
Estimate Future
Achieve desired
Results

Specify criteria and

GOAL Delegate Nursing care
Controlling Directing assignments
Standards
Utilize performance Actuating efforts
Assessing/ Moments of time
standards to accomplish Utilize, revise, update
Regulating Money-Men-Machines goals policies & procedures
Performances

Monitor and Supervise,

evaluate nursing Harmonize goals
care / services Develop Coordinate thru guidance
Performance
Utilize various people Unite
Appraisal
methods Decide Provide Personnel
Assess, interpret, Make staff And
correct
Judgment development Services
Apply discipline
 HOSPITAL – An integral part of a social and medical organization, the function of
which is to provide for the population it serves, complete health care, both
curative, preventive and whose out-patient services reach out to the family in its
home environment: it is also a center for the training of health workers and bio-
social research. (Expert committee on Organization of Medical Care of the WHO)
It is a place devoted primarily to the maintenance and operation facilities
for the diagnosis, treatment and care of individuals suffering from illness, disease
or deformity, or in need of obstetrical or other medical and nursing care. (Hospital
Licensure Law, R.A. 4226)
Any institution, building or place where there are beds, cribs, or
bassinets for 24 hour use or longer by patients in the treatment of diseases,
diseased condition, injuries, deformities, and all institutions such as those for
convalescence, sanitorial care, infirmaries, nurseries, dispensaries and such other
names by which they may be designated.
A. CLINICAL
1. GENERAL HOSPITALS
 Provides services for all kinds of illnesses, diseases, injuries and
deformities.

Philippine General
Hospital
(Taft Avenue, Metro
Manila)

2. SPECIAL HOSPITALS
Provide services for one particular kind of illness or disease or health and
medical care

National Kidney and

Transplant Institute
(East Avenue, Diliman,
Quezon City)
B. OWNERSHIP AND CONTROL:

1. GOVERNMENT HOSPITAL– operated and controlled either partially or

wholly by the national, provincial, municipal, or city
government or other political subdivision, board or
other agency.

2.PRIVATE OR NON- GOVERNMENTAL HOSPITALS – are privately owned,

established and operated with funds, raised capital or
other means by private individuals, associates,
corporation, religious organizations, firms, companies, or
joint stocks corporations.
C. TRAINING AND NON-TRAINING
1.TRAINING
A departmentalized hospital with accredited residency training program in
one or more specified specialty or discipline

2. NON-TRAINING
> A hospital which may be departmentalized but without an accredited
residency training program in one or more specialty disciplines

HOSPITAL CATEGORIES
According to Service capabilities they offer:
LEVEL I
 Municipal and medicare hospitals that have facilities and capabilities for
first contact emergency or initial care and management of patient requiring
immediate treatment as well as primary care on prevalent diseases in the
locality.
 Clinical Services:
1. general medicine
2. Pediatrics
3. Obstetrics
4. non – surgical gynecology
5. Minor surgery
 May provide anciliary services ( primary clinical laboratory, 1st level radiology
and pharmacy)
 Provide nursing care for patients who require minimal category of supervised
care for 24 hours or longer.

LEVEL 2
 Non- departmentalized hospital that provide clinical care and management
on the prevalent diseases in the locality requiring hospitalization.
 It has expertise of trained specialists. (hospitals with 50 beds up to 100 beds
capacity)
 Clinical Services:
1. general medicine
2. pediatrics
3. obstetrics and gynecology
4. surgery and anesthesia
 Administrative and Ancillary Services (secondary clinical laboratory, first level
radiology, and pharmacy)
 Nursing care provided in Level 1 Hospital, intermediate, moderate and partial
category of supervised care for 24 hours or longer.
HOSPITAL CATEGORIES

3. LEVEL 3

 Specialized centers, regional hospitals, medical centers, provincial or

general hospitals. They have capabilities for providing medical care to
cases requiring sophisticated diagnostic and therapeutic equipment and
expertise of trained specialists and the sub-specialists.

 Clinical Services: 1. Services provided by level 2 hospital

2. specialty clinical care

 Nursing Care provided in level 3 hospital as well as

continuous and highly specialized critical care
4. SPECIAL TERTIARY LEVEL
> Composed of special tertiary centers in particular which are fully equipped
with sophisticated diagnostic and therapeutic facilities for specific medical
problem area.
DEFINITION:
Planning is pre-determining a course of action in order to arrive at a desired result. It
is a continuous process of assessing, establishing goals and objectives, implementing
and evaluating which is subject to change as new facts are known.

It is forecasting of events, making decisions, setting goals, priorities, developing

policies and setting standards.

(Rowland and Rowland 1992) Described it as future-oriented. It is the process whereby

management bridges the time span between where it is at present and where it wants to
become at some point in the future

Planning is the most fundamental activity of the management process. All other
management functions are dependent on planning.

It directs our attention towards:

•What activity we expect to do
•Why it will be done
•Where it will be done
•When we expect to do it
•How it will be done
•Who is going to do it
IMPORTANCE OF PLANNING:
1.It leads to the Achievement of goals and objectives
= workers relate what they do to meaningful results since plans are focus on
objectives

2. It gives meaning to work

= employees or workers experience greater satisfaction if what they do become
meaningful to them

3. It provides for effective use of available resources and facilities

= the best use of personnel and material resources prevent wastage

4. It helps in coping with crisis

= Hospital should provide for disaster plans. This allow workers to function more
clearly and effectively when actual emergencies occur such as typhoons,
earthquakes, or during New years celebration or other occasions where more people
are likely to get hurt

5. It is cost effective
= cost effective measures are identified
= cost can be controlled through planning for efficient operation.
Ex: Projecting the number of operations in a given day, including daily dressings
helps in determining accurately the needed supplies in the surgical units so as to
prevent undersupply or over supply.
6. It is based on the past and future activities
= evaluation of programs, schedules and activities whether successful or not,
prevent and or reduces the recurrence of problems and provides better ideas in
modifying or avoiding them.

7. It discovers the need for change

= Many hospitals have found out that in patient hospital days can greatly be
reduced by having the lab and diagnostic work up in the OPD.
= Minor surgeries are also done at the OPD so more hospital bed can be allotted
to critically ill patients and those needing services.

8. It is necessary for effective control

= Nurse managers evaluate the environment or setting in which they work where
patients are confined and make necessary recommendation to make hospital
condition more therapeutic not only for the patients but for the workers as well.
= Performance of workers and patient care services are also evaluated based on
the criteria set during the planning stage to indicate whether standards have been
followed and whether charges are indicated.
1. STRATEGIC OR LONG-RANGE PLANNING

 Refers to determining the long term objective of the institution and the policies
that will be used to achieve these objectives
 It is usually done in the executive level of management.
 It is future oriented. Extended 3-5 years in the future
 The main output of strategic planning is to set the goals for the organization
 A SITUATIONAL ANALYSIS be done first before making the strategic plan:
SWOT analysis is the tool to be used.
 Before making a plan, identify the Strengths, Weaknesses, Opportunities and
Threats of the organization.

STRENGTHS AND WEAKNESSES INCLUDES

• Expertise of nursing and medical personnel staff
• Qualifications
• Over and under staff
• Financial status
• Quality of patient care
• Abundance or scarcity of medical equipment or supplies.
THREATS
•Competition
•Decrease in patient load
•Shortage of nurses and other personnel
•Low patient’s satisfaction
•Increase of charges
•Legal threats

OPPORTUNITIES
•Improve or new facilities
•Recruitment of medical and nursing personnel
•Referrals
•New health care programs

2. OPERATIONAL or SHORT RANGE PLANNING

> Deals with the day to day maintenance activities. It is done in conjunction with
the preparation of the budget. It would also relate to the improvement and
maintenance of facilities. Nurse managers are involved in this type of planning.
3. UNIT PLANNING
Planning for a department or unit done on a daily, weekly or long range basis
= A daily planning related to the care done on patient
a. Taking health history
b. Assessing his health status
c. Formulating the nursing diagnosis
d. Implementing the care plan

SCOPE OF PLANNING
A.TOP MANAGEMENT (Nursing Director)
Set over all goals and policies of the organization
Scope of responsibility is the over all management of the organization

B. MIDDLE MANAGEMENT (Nursing supervisors)

Directs the activities to actually implement the broad operating policies of the
organization – staffing and delivery of services to the units.

C. LOW or FIRST LEVEL MANAGEMENT (head nurses, senior nurses, charge

nurse, or team leader)
> Daily schedule or weekly plans for the administration of direct patient care in
their respective units.
WHY MANAGERS FAIL TO PLAN EFFECTIVELY?
1.Lack of knowledge of philosophy, goals and objectives of the agency
2.Lack understanding of the significance of the planning process
3.Doesn’t know how to manage their time to devote for planning
4.Lack confidence in formulating plans or fear the planning may bring about
unwanted changes that they are unwilling to do or are unable to cope with.

MAJOR ASPECTS OF PLANNING

*Plans can be understood through the four major aspects.

1.PLANS SHOULD CONTRIBUTE TO OBJECTIVES

It should seek to achieve a consistent, coordinated structure of operations
focused on desired ends. Actions without plans often result to chaos.

2. PLANNING PRECEEDS ALL OTHER PROCESSES OF MANAGEMENT

(Organizing, Directing, Controlling)
It supports easy accomplishment of the agency’s objectives that are necessary
for group effort

3. IT PERVADES ALL LEVELS

> It encompasses both higher to lower echelon and vice versa and spread
horizontally through peer levels and/or across services and members of the health
team
 4. IT SHOULD BE EFFICIENT
It should contribute to the attainment of objectives not only in terms of peso
value, man-hours, units of products but also include individual values and group
satisfaction. Fear, resentment and low morale results in low production.

A. FORECASTING
 It estimates the future, including the environment in which the plan will operate

IT INCLUDES:
• Who the patients will be
• Their customs and belief
• Language and dialect barriers
• Severity of their condition or illness
• Kind of care they will receive
• The number and kind of personnel required (professional and non-professional)
• The resource-equipment, facilities, supplies needed
B. SETTING THE VISION, MISSION, PHILISOPHY, GOALS AND OBJECTIVES
Results to be achieved can be determined

VISION – provides an image of the desired future

VISION STATEMENT – outlines the organization’s future role and function.

It gives the agency something to strive for.
It outlines the agency’s reason for existing.
Example:
“ The medical center envisions itself to become a Center of excellence providing
holistic approach to health care services. As a center of wellness, the services
provided shall enable the people to improve their health and increase control over it”

MISSION – describes and reflects an organization’s core value

MISSION STATEMENT – outlines the purpose the agency is in

•Whether a hospital or health care facility
•Who the target client’s are (the poor, the needy, the middle or upper class)
•What services are provided (in-patient, out-patient, emergency)
Example:
“ The medical center, as a public, tertiary hospital is maintained as the people’s
partner and improved to provide accessible, quality, cost effective, preventive,
promotive, curative, rehabilitative health care services to the general public,
especially the destitute. The institution is also committed to medical, nursing and
allied health education, training and research”

PHILOSOPHY – describes the vision. It is a statement of beliefs and values

that direct one’s life or one’s practice.
- it is the sense of purpose of the organization and the reason
behind it’s structure and goals.
- It explains the beliefs that determine how the mission or
purpose is achieved; it gives direction towards the
attainment of the set of goals and objectives.
GOALS AND OBJECTIVES
•Goals are more general and cover a broad area while objective tend to be more
specific and are concrete

-Goals are broad statements of overall intent of an organization or individual

-Objectives are concrete specific statements of the goals that the nurse manager
seek to accomplish
-They are actions commitments through which its mission or purpose is achieved
and the philosophy or belief sustained. They are stated in terms of results to be
achieved and should focus on the production of health care services to the
patients. Objectives state specific and measurable goals to be accomplish.

C. DEVELOPING AND SCHEDULING PROGRAMS

= By developing and scheduling programs, the activities needed within a set time
can be defined.
= Programs are determined, developed and targeted within a time frame to reach
the goals and objectives set.
PLANNING FORMULA (by KRON)

1. WHAT – What should be done? What has been done? What equipment and
supplies have been used or are needed? What steps are necessary in the
procedures? What sequence of activities was previously used? What more
efficient methods may be used.

2. WHEN – When should the job be done? When was it formerly done? When
could it be done?

3. WHERE – Where is the job to be done? Where does an activity occur in

relation to those activities immediately preceding and following it? Where could
supplies be stored and cleaned and so forth?

4. HOW – How will the job be done? What are the steps to be followed in doing
the procedure? How will the time and energy of personnel be used? How much it
will cost? How much time will it require?

5. WHO – Who has been doing the job? Who else could do it? Is more than one
person involved?
 6. WHY – To each of the question, ask why? Why are this job, this procedure,
and this step necessary? Why is this done in this way, in this place, at this time,
by this person?

7. CAN – Can some steps or equipments be eliminated? Can this activity be

efficiently combined with other operations? Can somebody else do it better?
Can we get a machine to help? Can we get enough money?

¤ It is a technique for allocation of one’s time through setting of goals, assigning

priorities, identifying and eliminating time wastes and use of managerial techniques
to reach goals efficiently.

“Work smarter, not harder” to get more work done in less time
FACTORS THAT INFLUENCE TIME MANAGEMENT:
1.One’s personality
2.Education
3.Culture
= these factors influence how one manage time

SYMPTOMS OF TIME MANAGEMENT

1.Rushing
2.Fatigue and listlessness with hours of non-productive activity
3.Constant missed deadlines
4.Insufficient time for rest and personal relationship
5.Feeling overwhelmed by details and demands among others

INTERNALLY GENERATED TIME WASTER

1.Procrastination and indecision (Postponing and deferring)
2. Lack of self discipline
3.Inability to say “NO”
4.Inability to delegate
5.To act without thinking
6.To jump from task to task without finishing any of them
PRINCIPLES OF TIME MANAGEMENT
1.Planning anticipates the problems that will arise from action without thought
∞ It anticipates the crises that may occur or the resources needed to solve
the problems

2. Prioritize tasks to be accomplished

∞ Tasks to be accomplished should be done in sequence or in order and should
be prioritized according to importance. Failure to prioritize oftentimes result in
spending more time on unimportant tasks.

3. Set deadlines to one’s work and adhere to them

∞ This is an excellent exercise in self – discipline. It enables one to have time for
himself/herself because of effective use of time.

4. Procrastination
∞ Deferring, postponing, or putting off decisions, actions or activities can become
a habit which oftentimes cause lost opportunities and productivity, generating
personal or interpersonal crisis.

5. Delegation permits a manager to take authority for decision making and judgment,
facts and experience
∞ delegation frees manager of some time that can be devoted to other tasks
1. Conduct and inventory of your activities
 Log in activities for one day to determine how much time is spent on each activity.
 Identify time problems, examine your old habits that get in the way of using your
time well

2. Set goals and objectives and write them down

3. With the use of calendars, executive planners, logs or journals, write what you
expect to accomplish yearly, monthly, weekly, or daily.
4. Breakdown large projects into smaller parts. Do first thing first and concentrate on
one thing at a time. Get all the data you need to avoid breaks in your work.
5. Devote a few minutes at the beginning of each day for planning. At the end of each
day, account for the task that you have accomplished. Prepare a list of what is to
be done the following day.
6. Organize your work space so it is functional. Sort paperwork on your table
according to priority.
7. Close your door when you need to concentrate. Agree on a period of quiet office
time. Avoid having an “open-door” policy during the entire workday.
8. Learn to delegate.
9.In a meeting, define the purpose clearly before starting. Distribute the agenda in
advance and control interruptions during the meeting. Conduct the meeting
according to time schedule.

10. Take or return phone calls during specified time. Maintain a telephone log so
you can return calls at one time in possible. Outline your basic points and move
immediately into the business of the call.

11.Develop effective decision making skills. Don’t be afraid to say “NO”.

12. Take a rest breaks and make good use of your spare time. Reward yourself
periodically.
DEFINITION OF TERMS:

Budget – is an annual operating plan, a financial “road map” and a financial plan
which serves as an estimate of the future cost and a plan for utilization
of manpower, material and other resources to cover capital projects in
the operating programs.

NURSING BUDGET
-Is a plan for allocation of resources based on preconceived needs, for a proposed
series of programs to deliver patient care during one fiscal year

HOSPITAL BUDGET
-Is a financial plan to meet future service expectations. These expectations are
derived from the best judgment needs of the community.

BUDGETING - is allocating of scarce resources on the forecasted needs for the

proposed activities over a specified period of term.
BUDGETING INVOLVES:
•Examining resources
•Anticipating cost
•Predicting gains and shortfalls

2 COMMON APPROACHES TO BUDGETING:

•Incremental budgeting
- Develop annually based on the previous year’s expenses

•Zero base budgeting

- Each year, the budget begins at zero

1. CASH BUDGET
 Forecast an estimate of the amount of money being received. It consists of the
beginning cash balance, estimates of the receipts and disbursement, an the
estimated balance for a given period corresponding to that of the operating
and capital budget.
2. OPERATING BUDGET
Deals primarily with salaries, supplies, contractual services, employee benefits,
laundry services, drugs and pharmaceuticals in-service education, travel to
professional meetings, books, periodicals, professional magazines, repairs and
maintenance among others. (revenue and expense budget)

3. CAPITAL EXPENDITURE BUDGET

Consists of accumulated data for fix assets that are expected to be acquired
during the budgeted period: of estimated cost and sources of funds for expected
replacement, improvement and additions to fixed assets.
Requires long range planning. Includes purchases of equipments and buildings.

FACTORS IN BUDGET PLANNING

1.Type of patient, length of stay in the hospital and the acuteness of the illness.
2.Size of the hospital and its bed occupancy.
3.Physical layout of the hospital, the size and plan of the wards and units, the
Nurse’s station, treatment rooms, etc.
4.Personal policies
a.Salaries paid to various types of nursing personnel, including pay for overtime or
shift differential.
b.Extent of vacation, sick leaves and holidays.
c. Provision of staff development programs including instructional staff

5. Grouping of patients such as those in specialized areas as intensive care units

6. Standards of nursing care: The kind and amount of care to be given as it affect
the number of hours of bedside care.
7. Method of performing nursing care whether simple or complex; method of
documentation.
8. Proportion of nursing care provided by professional nurses and those given by
non-professional.
9. Amount and quality of supervision available and provided; the efficiency of job
classification.
10. Method of patient assignment whether functional, case, team, or primary.
11. Amount and kind of labor-saving devices and equipment, intercommunication
systems.
12. The amount of centralized service provided: sterile supply, central oxygen
service, linen supply.
13. The nursing service requirements of the ancillary departments: clinics, admitting
office, emergency rooms.
14. Reports required by administration whether simple or complex
15. Affiliation of nursing students or medical students: inexperienced students need
more equipment and supplies.
» Will define the course of action
» A good reference of Nursing standard was developed by the joint nursing
committee of the ANSAP – was first printed in 1981
» The function of these established standards in an evaluation process is to:
a. Supply professionally desirable norms against which the department’s
performance can be measured.
b. Areas of improvement are identified
c. A plan of action to correct is be made and implemented.

NURSING SERVICE POLICIES

☻Policies are broad guidelines for the managerial decisions that are necessary in
organizational and departmental planning. They govern the action of workers and
supervisors at all levels and are intended to achieve pre-determined goals.
a. Areas in which confusion about the locus of responsibility might result in neglect
malperformance of an act necessary to a patient’s welfare.
b. Areas pertaining to the protection of patient’s and families’ rights (e.g. right to
privacy, property rights)
c. Areas involving personnel management and welfare

CHARACTERISTICS OF A GOOD POLICY

*A good policy should be*

1. Written and understandable and known by those who will be affected by them.
2. Comprehensive in scope, stable, flexible, so they can be applied to different
conditions that are not so diverse that they require different set of policies.
3. Consistent to prevent uncertainty, feelings of bias, preferential treatment and
unfairness.
4. Realistic and prescribe limits
5. Allow for discretion and interpretation by those responsible for it.
♥ Effective tool for orienting new employees, a reference when unexpected
problems arise, a basis for developing administrative procedures and a firm basis
for discussion when differences occur.

♥ Periodic review of policies are needed to evaluate their effectively and workability.
If there’s a problem in their implementation, it should be discussed and verified as
to whether these are being followed and should changes be necessary, all
personnel should be informed.

EXAMPLES OF NURSING SERVICES POLICIES:

1.Accidents – Care, reporting, precaution to prevent

2.Admission – receiving, consent, notifying doctor, care of patient
3.Autopsies – Obtaining informed consent
4.Breakages – Classification, responsibility, reporting
5.Bulletin board – Location, posting of information
6.Complaints – How handled, action taken
♥ Developed in keeping with overall hospital policies, thus ensuring unity and
harmonious relationship among departments.

EXAMPLES:
1.Admission – Type of patients, time, reservation, identification of patient, signing
consent
2.Transfer – request, departments to be notified
3.Discharges – Notifications, against medical advise, conduction, clearances.

♥ Procedures are specific directions for implementing written policies. Areas where
procedures are needed – related to job situation and those involve patient care.

♥ Nursing procedure manual should be available in each unit to familiarize nurses of

the common nursing procedures utilized in the nursing unit.