CHAPTER I

PRELIMINARY

1.1 Background
Nursing management is briefly interpreted as the process of implementing nursing
services through the efforts of nursing staff to provide nursing care, treatment, and security to
patients or families and the community.
Nursing management is a process carried out in accordance with an open system
approach. Therefore keperawtan management consists of several components by each
component interacting. In general, a system is characterized by five components, namely
input, process, output, control, and feedback mechanisms.
The health aspect is the range of nursing outcomes oriented to several dimensions of
service to individuals, families, and communities through efforts to prevent, maintain,
improve and restore. The environmental aspect is the area of authority and nursing
responsibility both as long as the patient is in the service institution or preparation before
returning home.

1.2 Problem Formulation

1.3 Purpose

CHAPTER II

DISCUSSION

2.1 Management
2.1.1 Understanding of Management
Management is the art of planning science, organizing the preparation, direction and
supervision to achieve the stated goals (Manulang 2004).
2.1.2 Management function
Management functions are the basic elements that will always exist and are inherent in
the management process that will be used as a reference by managers in carrying out
activities to achieve goals. 3 part management function, namely:
a. Planning ( planning )
Planning is thinking about what will be done with the resources that are owned.
Planning is done to determine the overall objectives of the company and the best way to
meet those objectives. Managers evaluate various alternative plans before taking action
and then see if the chosen plan is suitable and can be used to meet company objectives.
Planning is the most important process of all management functions because without
planning, other functions cannot work.
Planning is a process of thought and careful determination of things that will be
done in the future in order to achieve the objectives that have been set (Siagian, 1990).
 1. Planning goals :
a) Give direction to the organization.
b) Determining realistic goals.
c) Ensure the achievement of goals.
d) Increase efficiency.
e) Dispose of programs that are not useful.
f) Avoid duplication of efforts or programs.
g) Concentrate services that are urgent.
h) Increase coordination and communication activities.
i) Enables adaptation to changes in the work environment.

2. Principles of planning :
a) Clear purpose.
b) Obviously the results will be achieved.
c) Simple.
d) Based on applicable policies and procedures.
e) Priority.
f) Active involvement.
g) Effective and efficient.
h) Flexible.
i) Continuous.
j) Clarity of evaluation methods.

3. Planning includes activities :

a) Data collection: Data about patients, staff / staff, leadership, equipment, and nursing
services.
b) Environmental analysis: Using a SWOT analysis (Strength, Weaknes,
Opportunities, Threath).
c) Organizing data: Choosing data that supports and inhibits.
d) Making plans: Determine objectives / means to be achieved, description of
activities, procedures, target time, person in charge, goals, costs, equipment,
methods.

b. Organizing
Organizing is done with the aim of dividing a large activity into smaller activities.
Organizing makes it easier for managers to supervise and determine the people needed to
carry out the tasks that have been divided up. Organizing can be done by determining
what tasks must be done, who should do it, how the tasks are grouped, who is responsible
for the task, and at what level the decision must be taken.
Organizing is the overall grouping of people, tools, tasks, authorities and
responsibilities in such a way as to create an organization that can be mobilized as a unit
in order to achieve the stated goals.
1. Organizing principle :
a) Chain of command ( Chain of Command).
b) Unity of Command Chain .
 c) Spain of Control.
d) Specialization.

2. Three important aspects of organizing include :

a) The pattern of structure means that the process of interaction relationships is
developed effectively.
b) Application of each activity which is a framework within the organization.
c) The organizational work structure includes groups of activities that have the same
pattern of relationships between appropriate activities and fostering effective ways
of communication between nurses.

3. Organizing activities:
a) Develop job descriptions
b) Develop procedures.
c) Develop workforce and official work schedules.

4. Organizational structure :
a) Hierarchial Structure / line structute.
b) Adhocracy.
c) Matrix (free Form Structure)

5. Organizational uses :
a) A detailed description of all the work that must be done to achieve the goal.
b) Division of workload in accordance with the ability of individuals or groups.
c) Organize the working mechanism between each group member for relationships and
organizations.
c. Directing
Direction is an action to make all group members try to achieve goals in accordance
with managerial and business planning. Steering is an effort to move the activities of staff
to achieve the goals set. Douglas (1984) defines directors as a delivery of messages and
instructions that causes staff to understand what is expected so that it can help
organizational goals efficiently and effectively.
Direction contains important elements, namely :
1. Time management consisting of personal organization activities, organizing work and
delegation.
2. Good communication used is clear communication
3. Conflict management is the ability to deal with conflicts both with superiors and peers

d. Control ( controling )
Control is the process of checking and tracking deviations from the planned
direction which is a continuous activity and made based on evaluation at the time the
activity is running.

1. Controlling Principle :
 a) Principle of Unifomity: Formed from beginning to end
b) Principle of Comparison: Compares planned with achieved
c) Principle of Exception: not as perfect as planning, but there is feedback for
improvement

2. Controlling is done through activities:

a) Evaluate planning implementation

b) Preconperence, overan, post conperence
c) Nursing round
d) Evaluate productivity based on chat chat that has been made
e) Evaluation and peer review programs

3. Controlling Type:

a) Input control
b) Control process
c) Output control

4. Controlling is done on

a) Patient
 The first mental and social physical needs
 Treatment, examination and treatment
 Environment

b) Workforce
 Appearance and attitude
 Nursing care services and work systems
 Work performance
c) Tools and medicines
 Use
 Recording and reporting
 Inventory

2.2 Nursing Management

2.2.1 Definition of Nursing Management

Nursing management is briefly interpreted as the process of implementing nursing

services through nursing staff efforts to provide nursing care, treatment, and security to
patients or families and the community (Gillies, 1985).

Nursing management has an operational management scope to plan, organize, and

mobilize employees to provide nursing services as well as possible to patients through
nursing care management.
 Initial nursing management emphasized the centralization of authority and
responsibility, now becoming decentralized through delegation of authority and
responsibility by focusing on coordination, integration and supporting activities.

In addition, there has been a fundamental change in nursing management and repressive
resource users leading to the utilization of proactive resources, emphasizing the guarantee
of collaborative activities and openness in every activity to achieve goals. (Agus Kuntoro,
2010)

2.2.2 Concept of Nursing Management

The basic concept in nursing management is participatory management based on the
nursing paradigm, namely: human, environment, nursing and health
 Humans, in participatory management are individuals, families or communities who are
given nursing services through the implementation of organized, directed, coordinated
and integrated nursing tasks within the specified control range.
 Nurses or nursing are nursing staff both top, middle and lower managerial levels, and
nursing executives who are in the communication range to work together to provide
nursing services according to nursing standards.
 The health aspect is the range of nursing outcomes oriented to several dimensions of
service to individuals, families, and communities through efforts to prevent, maintain,
improve and restore.
 The environmental aspect is the area of authority and nursing responsibility both as long
as the patient is in the service institution or preparation before returning home.

2.2.3 Philosophy of Nursing Management

The philosophy in nursing management is the belief held by the nursing team that aims to
provide quality nursing care services through the division of labor, coordination and
evaluation.
2.2.4 Purpose of Nursing Management

The Purpose of nursing management are generally determined by the field of nursing
including:

1. Improve and maintain the quality of hospital services.

2. Increasing public acceptance of the nursing profession by educating nurses to have a
professional attitude and take responsibility for work.
3. Improve relationships with patients, families and communities.
4. Improve the implementation of general activities in an effort to maintain patient comfort.
5. Improve communication between staff.
6. Increase the productivity and quality of nursing staff.
2.2.5 Nursing Management Scope
a.Operational / Service Management
 Planning
 Organization
 Staffing
 Directing
 Controling

b. Nursing Care Management

 Assessment
 Planning
 Implementation
 Evaluation
2.2.6 Component of Nursing Management

Nursing management consists of several interacting components. In general, a system

is characterized by 5 elements, namely input, process, output, control and feedback
mechanisms.

 Inputs in the nursing management process include information, personnel, equipment

and facilities.
 The process is generally a group of managers and the highest level of nursing managers
until implementing nursing who have the task and authority to carry out planning,
organizing, directing and supervising the implementation of nursing services.
 Other elements in the systems approach are outputs that are generally seen and results
or quality of administration nursing care and development and research activities to
follow up on results or outputs.
 Control in nursing management processes can be done through proportional budgeting,
evaluation of nurse's work performance, making procedures that are in accordance with
standards and accreditation.
 In addition, a feedback mechanism is needed to harmonize the results and improve
future activities. Feedback mechanisms can be done through financial reports, nursing
audits, and quality control surveys, as well as the appearance of nurses' work.\

2.2.7 The Basic Princple of Nursing Management

Nursing management can be carried out correctly. Therefore, it is necessary to pay attention
to the following basic principles:

a. Nursing management based on planning

Planning is the main thing in a series of management functions and activities. The
planning and management process phase does not only consist of determining nursing
 needs on various client conditions, but also consists of making goals, allocating budgets,
identifying employee needs, and establishing the desired organizational structure.

Planning is a thought or concept - a concept of action that is generally written and

is an important function in reducing risk in decision making, problem solving, and
effects and changes. During the planning process, what can be done by the head of
nursing is analyzing and reviewing the system, regulating organizational strategies and
determining long and short term goals, assessing organizational resources, identifying
existing capabilities, and specific activities and priorities. Planning in management
encourages a nursing leader to analyze the activities and structures needed in his
organization.

b. Nursing management is carried out through effective use of time.

Nursing managers value time will be able to plan well programmed and carried out
activities in accordance with the time set. The success of a nursing leader depends on
effective use of time. In nursing, management is very much influenced by the ability of
nursing leaders. In this context, a leader must be able to utilize the available time
effectively. This is needed to be able to achieve high productivity in the organizational
order.
c. Nursing management involves decision making.
Various situations and problems that occur in the management of nursing activities
require decision making will affect the process or the course of activities to be carried
out. The decision making process will greatly influence communication skills and
managers.
d. Nursing management must be organized.
Organizing is carried out according to the needs of the organization to achieve the
objectives There are 4 organizational structures, namely unit, department, top or
executive level and operational level. The organizing principle includes the devision of
work, coordination, command unity, staff and line relations, responsibility and authority
that are in line with the range of supervision. In nursing, organizing can be carried out
by functional and assignment, allocation of patient care groups / nursing teams, and
primary nursing services (Gillies, 1985).
e. Nursing management uses effective communication.
Communication is an important part and effectiveness of management.
Communication that can be done effectively can reduce misunderstandings, and will
provide feelings, views and understanding among employees in an organizational order.
f. Control is an element of nursing management.
Control in the management is carried out to direct the management activities as
planned. In addition, the control carried out in the activities carried out does not occur
much error which has a negative effect on the client and parties related to management.
Control includes an assessment of the implementation of a planner that has been made,
 giving instructions, establishing principles through standard setting, and comparing
performance with standards and correcting deficiencies. (Agus Kuntoro, 2010)

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Role and Function of Nursing Management.

As well as the general management approach, the role and function of nursing management
consists of planning, organizing, staffing, directing, and controlling

Planning.
In the planning process, determining the mission, vision, goals, policies, procedures, and
regulations in the nursing service, then making estimates of short-term and long-term projections
and determining the amount of costs and regulating changes in plans

Organizing.
Includes several activities including setting organizational structure, determining the model of
nursing assignments according to the circumstances of the client and workforce, grouping
activities to achieve the objectives of the unit, working in a predetermined organizational
structure and understanding and using appropriate powers and authorities.
Staffing.
Includes activities related to staffing including recruitment, interviews, orienting staff,
scheduling and socializing new employees and staff development.

Directing.
Includes giving motivation, supervision, overcoming the existence of conflict, delegation, ways
of communicating and facilitation for collaboration ..

Controlling.
Includes the implementation of staff performance appraisal, financial accountability, quality
control, control of legal and ethical aspects and control of professionalism in nursing care

Principles Underlying Nursing Management.

General management principles according to Fayol consist of:
Division of working (division of labor).
Authority and responsibility (authority and responsibility).
Dicipline (discipline).
Unity of command.
Unity of direction.
Subordination of individual to generate interent (individual interests are subject to public
interest).
Renumeration of personal.
Decentralization (decentralization).
Scala of hierarchy.
Order (involvement)
Stability of tunnure personal (employee job stability).
Equity.
Initiative (initiative)
Esprit de corps (Loyalty of the corps).
As well as general management principles, the principles underlying nursing management are:
Nursing management should be based on planning, because through the planning function the
leader / manager of nursing can reduce the risk of ineffective and inefficient decision making and
problem solving.
Nursing management is carried out through effective use of time. Nursing managers / managers
who value time will arrange well-programmed plans and carry out activities according to
predetermined time and planning
Nursing management will involve decision making. Various situations and problems that occur in
the management of nursing activities require appropriate decision making at various managerial
levels.
Meeting the needs of patient nursing care is the focus of attention of the manager / manager of
nursing by considering what the patient sees, thinks, believes and wants. Patient satisfaction is
the main point of nursing goals.
Nursing management must be organized. Organizing is carried out according to the needs of the
service organization to achieve the goals.
Direction is an element of nursing management activities which includes the process of
delegation, supervision, coordination and control of the implementation of the plan.
A good nursing division motivates employees to show good performance.
Nursing management uses effective communication. Effective communication will reduce
misunderstandings and provide equal views, direction and understanding among employees.
Staff development is important to be carried out as an effort to prepare implementing nurses to
occupy higher positions or efforts by nursing managers to increase employee knowledge.
Control is an element of nursing management which includes an assessment of the
implementation of a plan that has been made, giving instructions and setting principles through
standard setting, comparing performance with standards and correcting deficiencies found.

Based on the principles above, the administrators and nursing managers should work together in
planning and organizing and other management functions to achieve the goals that have been
previously set

Cover
Nursing management is the process of implementing nursing services through the efforts of
nursing staff to provide nursing care, treatment and assistance to patients, and the task of nursing
managers is to plan, organize, lead and control existing financial, material, and human resources
to provide nursing services as effectively possible for each group of patients and their families.
By knowing the processes, roles, management functions of nursing services and the underlying
principles, the application of nursing management by nursing service managers is in accordance
with what is expected to be able to optimize the quality of nursing services received by the
community as consumers.