THE NURSING MANAGEMENT PROCESS

Objectives
To identify the four major steps in nursing management process To understand the relevance of planning To identify the kinds of plans and its characteristics. To discuss the importance of budgeting and allocation of resources To discuss decision making and its concepts

FOUR STEPS
PLANNING ORGANIZING DIRECTING CONTROLLING

PLANNING

What is planning?
It is deciding in ADVANCE:
What to do (Nursing Activities) How to do a particular task (Techniques/Procedures, Principles) When to do it (Time frame) Who will perform it (Assigned person to perform the task)

What is planning?
It is a cognitive process for decision making based on facts and information. It must be adaptable and flexible to the current situation to achieve desired result.

GOOD PLANNING
Involves: Continuous process of assessment Establishment of goals & objectives, implementation and evaluation of change as new facts become known (Douglas, 1986)

POOR PLANNING
Indicators, (McLarney, 1964): Delivery dates not met Machines are idle. Materials wasted. Some nurses are overworked, others underworked. Skilled nurses doing unskilled work Confusion and unhealthy working relationship between colleagues.

PLANS
It is a living document that can be changed based on prevailing circumstances. It is a predetermined course of action intended to facilitate the accomplishment of a task work or mission.

CHARACTERISTICS OF A PLAN
A well-developed plan must: Involve the FUTURE; Involve ACTIONS; Have an ORGANIZATIONAL IDENTIFICATION of the action.

TYPES OF PLANS
1. Strategic Plans 2. Operating Plans 3. Continuous or Rolling Plans

STRATEGIC PLANS
What are the right things to be done? Long-term in nature 3-5 years Based on explicit assessments of the strengths and weaknesses of the org. Defines direction & growth of the organization

OPERATING PLANS
How does one do things right? Pertains to activities in specific depts. Generally short term in time frame (1 year) Involves the middle & lower level managers

ROLLING PLANS
Similar to operating plans Focus on day-today activities Ex. A staff nurse who creates and implements the NCP and continuously modifying as needed.

PLANNING
Reasons for Planning Resistance to Planning How to overcome resistance to planning. Models of planning

Reasons for Planning

1. It leads to success in the achievement of goals and objectives. 2. It provides for the effective use of available personnel and facilities. 3. It helps nurses cope with crises and problems calmly and efficiently

4. It reduces the element of change.

5. Overall, it is necessary for effective control.

Resistance to Planning
Many nurse-managers avoid planning because they lack: Knowledge of the philosophy, goals and operations of the organization;

Understanding of the significance of planning, that success or failure of work activities relate directly to the quality of a plan; Proper appreciation of use of time for planning; they erroneously perceive that time spent on planning would be better spent on addressing day-to-day concerns;

Resistance to Planning
Confidence and fear of failure; Openness to change that they believe planning may entail; Willingness to engage in new activities that planning produces; and Insights into the exigencies of the situation, they prefer to act on immediate problems that give them immediate feedback.

How to overcome resistance???

Nurse-managers should be willing to be open-minded about planning and change.

To avoid resistance:
Forecast or estimate the future Set objectives/goals and determine results desired Develop and schedule strategies, programs/projects/activities, and set time frame Prepare budget and allocation of resources

Establish procedures and standards

I. Forecast or Estimate the Future

Looking into the future It must be supported by facts, reasonable estimates and accurate reflection of policies and plans Three things should be considered:
The agency The community affected The goals of care

II. Set Goals/Objectives and Determine Desired Results

GOALS broad statements of intent derived from the purposes of the organization OBJECTIVES specific behaviors or tasks set for the accomplishment of a goal.

III. Develop & Schedule Strategies, Programs; Set Time Frame

STRATEGY techniques, methods, or procedures by which the overall plan of the higher management achieve desired objectives.

PROGRAMS activities put together to facilitate attainment of some desired goals, (Staff development programs, outreach programs, discharge teaching programs, etc.)

Principles of Time Management

Planning for contingencies. Listing of tasks. Inventory or looking at tasks done and not done. Sequencing or prioritizing. Setting and Keeping deadlines. Set time targets. Delegate

Prepare for a Short Quiz

Tools in Project Management

A. Gantt Chart
It was created by Henry Gantt Shows task and schedule information It is both a management tool and a communication tool.

Gantt Chart Sample

B. Performance Evaluation and Review Technique (PERT)

A network system model for planning and control It involves identifying key activities, sequences them in a flow diagram and assigning a specific duration for each phase of work. It involves extensive research and development.

PERT Sample

C. Critical Path Method (CPM)

It can calculate time and cost estimates for each activity Used to create estimates using either normal or crash operations. A tool used to analyze a project and determine duration, based on identification of a critical path through an activity network.

Continuation: Avoid Resistance to Planning

4. Prepare the Budget and Allocation of Resources

What is budgeting?
A systematic financial translation of plan The allocation of scarce resources on the basis of forecasted needs for proposed activities over a specified period of time. It is a tool for planning, monitoring and controlling cost and meeting expenses.

What is a Nursing Budget?

Allocates resources for nursing programs and activities to deliver patient care during a fiscal year.

What is a Hospital Budget?

Is designed to meet future service expectations and to provide quality patient care at a minimum cost.

Four Components of a Budget Plan

For Health Care Institutions: 1. Revenue Budget 2. Expense Budget 3. Capital Budget 4. Cash Budget

Revenue Budget
Is summarizing the income the management expects to generate during the planning period.

Expense Budget
Describes expected activity in operational financial terms for a given period of time.

Capital Budget
Outlines the programmed acquisitions, disposals and improvement in the institutions physical capacity.

Cash Budget
Consists of money received, cah receipts and disbursement expected during the planning period.

Types of Budgeting
CENTRALIZED developed and imposed by the administrator and/or director of nursing with little to no consultation with lower managers.

DECENTRALIZED has the middle level manager involved in the planning and budgeting process with

Components of Total Institutional Budget

Manpower Budget wages and salaries of the regular
employees and fees paid to outside registries through which the institution contracts short-term employees.

Capital Expenditure Budget large expense of

purchasing of lands, buildings, and major equipment meant for long-term use. equipment repair and maintenance as well as other overhead expenses.

Operating Budget includes the cost of supplies, minor

Types of Institutional Budget

Open-ended Budget Fixed Ceiling Budget Flexible Budget Performance Budget Program Budget Zero-based Budget Sunset Budget

Factors in Budget Planning

1. Patient
Nature of needs Type of care needed and to be given Method of patient assignment Severity of the illness

Factors in Budget Planning

2. Hospital or Health Care Facility
Available facilities and resources (ex. Bed occupancy and capacity, nurse stations, treatment rooms, equipment, and supplies)

3. Personnel
Salaries of personnel, leave benefits, staff development programs

Factors in Budget Planning

4. Standard of Nursing Care and Supervision
Nurse managers determine the following:
Labor-saving devices and equipment necessary Affiliation of nursing students or medical students to the system Documentation of nursing care method employed Costs of training and maintaining of personnel and acquisition of equipment.

Continuation: Avoid Resistance to Planning

5. Establish Policies Procedures and Standards

Policies and Procedures

POLICIES Standing plans used repeatedly; Guides or basic rules that govern action at all levels in the organization; Stem from the goals of the organization Ex. Personnel policy PROCEDURES More specific guide to action; STANDARDS Indicate the minimal level of achievement acceptable to meet the set objectives

DECISION MAKING
Definition Kinds of Decision Making Decision Making Models Tools in Decision Making

DECISION MAKING
A process of identifying and choosing a particular course of action from among several possible choices. This process is influenced by the values and preferences of the decision maker (Sullivan, 2006)

Kinds of Decisions
1. Whether Decisions 2. Which Decisions 3. Contingent Decisions

Decision Making Models

1. Win-win
Mutual willingness in the group to come-up with solutions that are acceptable to all. Based on everyones preferred solution Negotiate solutions that are acceptable to all

Decision Making Models

2. Win-Lose
Some interests are advanced at the expense of others.

3. Disagreement and Collaboration

Decisions resulting from high quality decisions, creative decisions, understood decisions, and accepted and owned decision. These are made when conflicts and disagreements arise.

Decision Making Models

4. Solution Shaping focused on how to modify or amend
an unpopular proposed solution rather than attempt to pressure people into changing their minds about the solution.

Tools in Decision Making

Probability Theory
Devised to address the presence of risk or uncertainty in a decision making situation by looking for predictable patterns on historical data;

In cases of limited historical precedent, it becomes hard to apply the theory and the risk remains unchecked.

Decision Trees Model

More graphic in nature; Enables the planner to visualize alternative courses of action taking into account all factors involved like risks, information needs and outcomes for a problem over time.

Queuing Theory
Problems are addressed one after another A powerful tool in hospitals particularly in the ER department, OPD, clinics, etc. The three queuing disciplines:
1. First In First Out (FIFO) 2. Last In First Out (LIFO) 3. Processor Sharing (PS)

Linear Programming
This method uses matrix algebra or linear mathematical equations to determine the best way to use limited resources to achieve maximal results (Marquis and Huston, 2006).