FOUNDATIONS OF NURSING MANAGEMENT

-Luis Alfredo B. Viola RN

CONTROLLING
Also called EVALUATING
An on going function of management which occurs during planning,
organizing and directing activities
Process wherein the performance is measured and corrective action is
taken to ensure the accomplishment of organizational goal

PURPOSES OF CONTROLLING
Open opportunities for improvement
Compare performance against set standards
Provides information about how well processes and people function
Reinforce correct behavior and Implement corrective action

STEPS IN CONTROL PROCESS

Establish standards and criteria
Measure performance
Compare results with standards

EVALUATION PRINCIPLES
1. Must be based on behavioral standards of performance with the
position requirement
2. There should be enough time to observe employees behavior
3. Employee should be given a copy of the ff. Before scheduled
evaluation
Job description
Performance standards
Evaluation forms
4. Performance appraisal should include both satisfactory and
unsatisfactory results
5. Areas needing improvement must be prioritized
6. Should be scheduled and conducted at a convenient time for both
evaluator and employee
7. Should be structured in such a way that it is perceived and accepted
positively as a means of improving job performance

CHARACTERISTICS OF EVALUATION TOOL

OBJECTIVITY
RELIABILITY
SENSITIVITY
VALIDITY
TYPES OF PERFORMANCE STANDARDS
1. STRUCTURE
Focus on the management system or structure used by the
agency in the delivery of care
Includes:
Number and categories of nursing personnel
Education
Personal and professional qualities
Function
Physical facilities
Equipments
2. PROCESS STANDARDS
Decision and actions of the nurse relative to the nursing process
Includes :
Assessment
Plan of care
Nursing intervention
3. OUTCOME STANDARDS
Designed to measure the results of care provided in terms of:
Changes in health status of client served
Changes in level of their knowledge, skills and attitude
Satisfaction of those served

PERFORMANCE APPRAISAL
A control process in which employee's performance is evaluated
against standards
The most valuable tool in controlling human resources and
productivity
Reflects how well a personnel have performed during a specific period
of time

PURPOSE OF PERFORMANCE APPRAISAL

1. Determine salary and merit increases
2. Select qualified individual for promotion or transfer
3. Identify unsatisfactory employees for demotion or termination
4. Make inventories of talents within an institution
5. Determine training and developmental needs of employees
6. Improve performance of work group
7. Improve communication between supervisors and employees
8. Establish standards of supervisory performance
9. Provide recognition of employee for accomplishments
10. Inform employees where they stand
INFORMAL APPRAISAL
Consists of Incidental observations of performance while the workers is
engaged in performing nursing care
FORMAL APPRAISAL
Collecting objective facts that can demonstrate the difference between
what is expected and what was done

PERFORMANCE APPRAISAL TOOLS

ESSAY
The appraiser writes a paragraph about the workers strength,
weaknesses and potentials

CHECKLIST
A compilation of performances expected of a worker

FORCED-CHOICE COMPARISON
The evaluator is asked to choose the statement that best
describes the employee being evaluated
The evaluator is forced to choose from favorable as well as
unfavorable statement

RANKING
Evaluator ranks according to how employee fared with co-
workers

RATING SCALE
Includes a series of items representing the different tasks or
activities in job description or the absence or presence of desired
behaviors

ANECDOTAL RECORDING
Describe experience with a group or a person, or in validating
technical skills and interpersonal relationship
Anecdotal report should include:
Description of the particular occasion
Delineation of the behavior noted including:
WHO, WHAT, WHY, WHEN, WHERE AND HOW
The evaluators opinion or assessment of the incident or
behavior
QUALITY ASSURANCE
Quality The degree of excellence
Assurance Achieving sense of accomplishment and implies a
guarantee of excellence
QUALITY ASSURANCE:
Evaluation of the health care system and the provision of
healthcare services by workers.
Focuses on the care and services the patient receives than on
how well the professionals performs the duties that the position
required

PRINCIPLES UPON WHICH QUALITY ASSURANCE PROGRAM ARE

BASED
1. All health professionals should collaborate in the effort to measure and
improve care
2. Coordination is essential in planning a comprehensive QAP
3. Resource expenditure for QA activities is appropriate
4. There should be focus on critical factors
5. Quality patient care is accurately evaluated through adequate
documentation
6. The ability to achieve nursing objectives depends upon the optimal
functioning of the entire nursing process and its effective monitoring
7. Feedback to practitioners is essential to improve practice.
8. Peer pressure provides the impetus to effect prescribed changes based
on the result of assessment and needed improvements on the quality
of care
9. Reorganization in the formal organizational structure may be required
if assessment reveals the need for a different pattern of health care
10. Collection and analysis of data should be utilized to motivate
remedial action

QUALITY IMPROVEMENT PROGRAM

The umbrella program that extends the many areas for the purpose of
accountability to the consumer
A continuous, on-going measurement & evaluation process that
includes structure, process and outcome

TOTAL QUALITY MANAGEMENT (TQM)

 A way to ensure customer satisfaction by involving all employees in
the improvement of the quality of every product or service
Aims to reduce waste and cost of poor quality
It is a structured system for involving entire organization in a
continuous quality improvement process targeted to meet and exceed
customer expectations

CONTINUOUS QUALITY IMPROVEMENT (CQI)

A process of continuously improving a system by :
Gathering data or performance
Using Multi-disciplinary team to analyze the system
Collect measurements
Propose changes

PRINCIPLES OF CONTINOUS QUALITY IMPROVEMENT (CQI)

Customer focus
Identification of key processes to improve quality
Use of quality tools and statistics
Involvement of all people in problem solving

QUALITY ASSURANCE
Focuses on the care and service the patient receives than on how well
the professional performs the duties that the position requires
METHODS USED
Patient care audit
Patient care profile analysis
Peer review
Quality circles

NURSING AUDIT COMMITTEE

Composed of a representative from all levels of the nursing staff
The audit team designate a day within the week to be the audit day
The nurses do not know which unit will be audited

PATIENT CARE AUDIT

A. CONCURRENT PATIENT CARE AUDIT
Done during rounds or patient interview
One in which patient care is observed and evaluated through:
Review of patient chart while the patients are still confined in the
hospital
Observation of the staff as patient care is given
Inspection of patient or observation and/or observation of the
effects of patient care where the focus is on the patient
 B. RETROSPECTIVE PATIENT CARE AUDIT
One in which the patient care is observed and evaluated through:
A review of discharged patients chart
Questionnaires sent to or interviews conducted on
discharged patients

PEER REVIEW
Is the process by which practicing registered nurses systematically
access, monitor, and make judgments about the quality of nursing care
provided by peers as measured against professional standards of
practice.

PEER REVIEW PRINCIPLES

1. A peer is someone of the same rank.
2. Peer review is practice-focused.
3. Feedback is timely, routine, and a continuous expectation.
4. Peer review fosters a continuous learning culture of patient safety and
best practice.
5. Feedback is not anonymous.
6. Feedback incorporates the nurses developmental stage.

QUALITY CIRCLES
It is a way of capturing the creative and innovative power that lies
within the work force
A group of workers doing similar works who:
Meet regularly
Voluntarily
On normal working time
Under the leadership of the supervisor
Purpose is to:
Identify, analyze, and solve work related problem
Recommend solution to management quality circle members
should implement the solution themselves
DISCIPLINE
Rigid obedience to rules and regulations
SELF DISCIPLINE: A constructive and effective means by which
employees take personal responsibility for their own performance and
behavior

FACTORS THAT INFLUENCE SELF DISCIPLINE

 Strong commitment to the vision, philosophy, goals and objectives of
the institution
Laws that govern the practice of all professionals and the respective
Codes of Conducts
Understanding of the rules and regulation of the agency
Atmosphere of mutual trust and confidence
Pressure from peers and organization

DISCIPLINARY ACTION
Any employee charge with breach of the rules and regulation, policies,
norms of conducts should be given due process
There must be existing rules of conduct governing his behavior and a
documentation of actual violation
The charged employee must be notified in writing about the violation
and be given the right counsel

PRINCIPLES OF DISCIPLINARY ACTION

Investigate carefully
Be prompt
Protect privacy
Focus on the act
Enforces rules consistently

COMPONENTS OF DISCIPLINARY ACTION PROGRAM

Code of conduct
Employees must be informed of the nature and meaning of codes
of conduct
Must understand that the rules are reasonable and directly
related to efficient, effective operation of the agency
Authorized penalties
Records of offenses
Right of appeal

DISCIPLINARY ACTION
Should be progressive in nature
CONSELLING AND ORAL WARNING
Best given in private and in an informal atmosphere
Employee is given fair chance to air his side
Relevant facts are analyzed and evaluated against past
performance
 COUNSELLING
Employee is counseled regarding:
Expectations of improved behavior/performance
Ways of correcting the problem
Warning that a repetition of the same offense may warrant
disciplinary action
The employee must commit to correct the behavior
He should be informed of any follow-up action that may be taken
WRITTEN WARNING
The second step in disciplinary action
Preceded by an interview similar to oral warning
Employee is told after the interview that he will be given a
written warning
WRITTEN WARNING:
Statement of the problem
Identification of the rule that was violated
Consequence of the continued deviant behavior
Employees commitment to take corrective action
Any follow-up action to be taken
SUSPENSION
It is given after an evidence of oral and written warning.
Temporary withdrawal from duties

DISMISSAL
Invoked only when all other disciplinary efforts have failed
Disciplinary Committee should be very sure that the cause for
dismissal conforms with the criteria of a major discipline
violations as contained in the policy manual
Review is done by higher management

COMMON DISCIPLINARY CASES

Pilferage of supplies
Theft
Insubordination
Abandonment of patient
Discourtesy to patient
Alcohol use while on duty

DATA GATHERING
Main purpose is to establish a Data Base.
Data collection and management aims to:
Maximize efficiency of staff and resources
Ensure the collection of accurate and reliable data
 Focus on careful management of data once they have been
collected

Scientific Research Process

Gather Data Analyze DataDraw Conclusions

Develop Study Design
State Hypothesis

Nursing Process

Assessment Diagnosis Planning Implementation Evaluation

Nursing Management Process

Data Gathering Planning Organizing Leading Controlling

SOURCES OF DATA
Study single nurse
Analysis of medical wards
Study of nursing department as a whole
Survey of individual health agency
Global view of health industry

VALUES AND BELIEFS

Before: A generation ago, hospitals were concerned primarily with the
quality of service rendered to clients and institutional goals
concentrated to provide care to patients and families.
Now: Financial pressures have caused health agencies to be
increasingly concerned with cost of operations, so current health goals
indicate that greater productivity and cost effectiveness are as
important as improvement in the quality of care.

DATA COLLECTION METHOD

Survey Reports
Records
 Research

DATA GATHERING:
Agency Purpose
(Mission, Vision)
Agency Programs
(Agencys contributions to community welfare.)
Agency Clients
(Socioeconomic Level, Racial Mixture, National
background, Age and Sex Distribution)
Agency Employees
(Staffing-Staff Development, Salary Fringe Benefits,
Role Portrayal)
Agency Problems
(Previous and Existing Problems)
Agency Assets
(Specialty)
Agency Future

References:
Nursing Management Towards Quality Care 4th Edition:
Lydia M. Venzon, RN, MAN, Ph.D, FPCHA
Jennifer M.V. Nagtalon, BSN, RN

Leadership and Management in Nursing 1st Edition

Crestita B. Tan, RN, RM, MAN, Ph.D
Eden I. Beltran RN, MAN

SHIELD Reviewer Module 5th Edition

Stephen Jo T. Bonilla, RN, MD, DPBS, FPSGS, FPCS
Mark Joseph A. Asuncion, BAPA, RN, MSN, MAN

Nursing Management: A Systems Approach 2nd Edition

Dee Ann Gillies, RN, MAN, Ed,D.

Sleep well tonight.

Dream of a better future.
Then get up and make that happen.