Nursing Management

in the Local Public

Health System
Aligato Bajarias - Banzon Daaca Hortezano Odal Palmez Parantar Sajulga Sinogaya Villamero - Tinoy

MANAGEMENT
(Rakich, Longest & Donovan) - It is a set of

interactive processes through which the

utilization of resources results in the
accomplishment of organization objectives

(Kast & Rosenzweig) - is the primary force within

an organization that coordinates the activities of

the subsystems and relates them to its
environments

LEVELS OF MANAGEMENT
Top managers: Responsible for overall

operations.

Middle managers: coordinate nursing activities

of several units.

First line managers: (supervisors, or head

nurses.) directly responsible for the actual

production of nursing services.

MANAGEMENT FUNCTIONS
MANAGEMENT PROCESS :
Planning
Organizing
Staffing
Directing
Controlling

PLANNING
Includes defining goals and objectives;
Developing policies and procedures;
Determining resource allocation;
Developing evaluation methods.
Budgets are used in planning.

ORGANIZING
The personnel can implement the plans with

efficiency and effectiveness;

Includes identifying the management structure to

accomplish work;

Determining communication processes;

and coordinating people, time and work.

STAFFING
Recruiting, selecting, orienting developing

personnel to accomplish the goals of the

organization.
Determining assignment systems , case method,

functional, team, primary nursing.

Schedules to meet the needs of the clients,

personnel, and institution.

LEADING (or directing)

(Direct personnel and activities to accomplish the

goals of the organization)

Motivating and leading personnel .
Knowledge of ones leadership style .
To get work done by others .
Tasks require good communication skills and

assertive behavior

CONTROLLING
Ensures progress toward objectives according to

plan and involves setting standards, measuring

performance against those standards

Analyzes results to evaluate a accomplishments

and includes evaluating employee performance;

Analyzing financial activities;

Monitoring quality of care.

SUPERVISORS POSSESS FOUR

TYPES OF SKILLS
1. Technical skills: Involve methods, procedures,

techniques & knowledge of work being

performed.
2. Human relations skills: ability to motivate and

lead others and to manage conflict.

3. Administrative skills: ability to perform the

planning, organizing and controlling functions

4. Decision-making/problem solving skills:

ability to critically analyze information and

problems and make appropriate decisions.

RESPONSIBILITIES OF THE
DIFFERENT LEVELS OF MANAGEMENT
1. Setting objectives

8. Establishing procedures

2. Planning strategy

9. Providing facilities

3. Setting goal-short-

10.Providing capital

term objective
4. Developing company
philosophy
5. Setting policies-the
plan
6. Planning the
organization
7. Providing personnel

11.Setting performance
standards
12.Initiating management
programs
13.Developing management
informations systems
14.Activating people

MANAGEMENT IN PUBLIC
HEALTH
Public health in the Philippines setting

Is a unique undertaking given the different macro

and micro contexts of the local public health
organization
Government policies
Programs of the national government
National an local health budgets
Geography
Political dynamics
Local culture

THE LOCAL PUBLIC HEALTH

ORGANIZATION
Health Department - serving as the governing

agency, a department in the local government

unit
LGU (Local Government units)and the local

leaders providing services to communities and

individuals
RHU (Rural Health Units) exist in every

municipality to improve access to healthcare

PHN (Public Health Nurses) and Midwives are

assigned to the different health centers

STANDARD HEALTH SERVICES

HEALTH CENTERS PROVIDE:
Immunization
Prenatal and postnatal care
Consultations
Laboratory and diagnostic examinations
Emergency medical care
Treatment of common illnesses
Referral to hospitals

PHN AS A MANAGER AND

SUPERVISOR
PLANNING
Nurses participate in planning for the whole local health

organization.
A component of the organizations plan is a nursing unit

plan.
PHNs are exposed to, and participate in different types of

plans:
Strategic plan
Operational plan
Program plan
Nursing care plan

PHN AS A MANAGER AND

SUPERVISOR
STRATEGIC PLAN
Long-range plan which contains an organizational

vision and mission, guiding principles, broad

strategic objectives, and specific tactics projects or
activities for achieving the broad objectives.
PHNs participate in reviewing the organizations

strengths, weakness, opportunities and threats

(SWOT)

PHN AS A MANAGER AND

SUPERVISOR
OPERATIONAL PLAN

Short-range plan that generally deals with the routine activities of

the organization

Addresses the requirements for delivering health services on a

daily basis

It may include training of health center staff, income generation,

purchase of instruments and equipment, introduction of a new
system in queuing of clients, how to improve intra-office intrasectorial and intersectoral collaboration, participation in the
training of affiliating nursing students

PHN AS A MANAGER AND

SUPERVISOR
Plans should be realistic and should be acceptable to

the decision-makers-the local council and the mayor

Preparing a budget for the health centers
Manual of personal policies, standards and procedures

should contain all pertinent laws (such as: Magna Carta

of Public Health Workers and Code of conduct and
Ethical Standards)

PHN AS A MANAGER AND

SUPERVISOR
ORGANIZING
Prior

to RA 7160 (Local Government Code),

the

organizational structure of health departments or units

was standard
In assessing an existing organizational structure, nurses

should be familiar with some of the principles of

organization

PRINCIPLES OF ORGANIZATION
DIVISION OF WORK:
1. Division of work or specialization alone can give

maximum productivity and efficiency.

2. Both technical and managerial activities can be

performed in the best manner only through division of

labor and specialization.
3. A group or team of service providers (physician, nurse,

midwife and others) are assigned to a specific program,

service or unit.
4. In small health centers, division of work is based on

position(profession)

PRINCIPLES OF ORGANIZATION
COORDINATION:
Conscious activity of assembling and synchronizing

differentiated work efforts so that they function

harmoniously in the attainment of organization objectives.
Many nurses are designated as coordinators of health

programs like:
EPI
NATIONAL TB PROGRM
HEALTHY LIFESTYLE
LEPROSY CONTROL PROGRAM
REPRODUCDTIVE HEALTH AND FAMILY PLANNING PORGRAM
IMCI

PRINCIPLES OF ORGANIZATION
UNITY OF COMMAND:
In order to avoid any possible confusion and

conflict, each member of an organization must

receive orders and instructions only from one
superior (boss).

PRINCIPLES OF ORGANIZATION
AUTHORITY AND RESPONSIBILITY:

Authority means a superiors right to command and exact

obedience from his/her subordinates.

If a PHN is given responsibility as an EPI coordinator she

should also be granted corresponding authority

PRINCIPLES OF ORGANIZATION
SPAN OF CONTROL:

The number of subordinates reporting directly to a

superior.

If a PHN is given responsibility as an EPI coordinator she

should also be granted corresponding authority

PHN is the direct supervisor of midwives, determined by:

Level of training or competence of subordinates
Degree of geographical dispersion
Level of difficulty or complexity of the supervisees
work

NURSING IN THE ORGANIZATIONAL

STRUCTURE
STAFFING
The concern in staffing is to have an adequate number of

nurses, midwives and barangay health workers for the total

population
There should be a contingency plan in times of greater

need such as disasters

Major problem of LGUs is inadequacy of health personnel

which is mostly due to inadequate health budget

Nurses should properly and adequately document their

activities so that their proposal for increased staffing will

be considered seriously

NURSING IN THE ORGANIZATIONAL

STRUCTURE
LEADERSHIP

PHN leads the midwives so that they could deliver health

services and meet the targets for their respective barangays

The challenge for PHNs is how to influence their subordinates

to pursue the goals of the organization, specifically for them
to:
1. Behave respectfully towards their clients
2. Provide quality service
3. Meet program an/or service targets
4. Observe cost containment measures
5. Observe organizational values such as honesty,

cooperation, and punctuality

NURSING IN THE ORGANIZATIONAL

STRUCTURE
COMMUNICATION
Nurse

managers
communicate
to
their
subordinates about a number of things: policies,
standards, procedures and the work that need to
be done

Nurses also communicate upwards-to inform,

give feedback and to influence

Nurse managers also communicate with their

peers from other offices

NURSING IN THE ORGANIZATIONAL

STRUCTURE
DELEGATION
PHNs should delegate to save time, develop

others for their future roles and responsibilities

If a midwife can do a task very well, then the

nurse should delegate

NURSING IN THE ORGANIZATIONAL

STRUCTURE
CONTROLLING :
Important in improving service delivery because

they serve as reminders if there are deviations from

targets and standards
4 Components of the control process:
1. Plan, instructions, principles and standards
2. Observation, measurement and comparing what is

with what should be

3. Identification of weaknesses, problems, or errors
4. Correcting rectifying or doing something about them

NURSING IN THE ORGANIZATIONAL

STRUCTURE
CONTROLLING:
Controls that could be introduced into the public

health unit, some of which are:

1. Statistical

reports, records eg inventory of

medicines, FP Supplies), audit, Gantt-chart or
schedule activities, client feedback

Evaluation of personnel:
The evaluation of the performance of government

employee is mandatory
The performance appraisal of PHNs should focus

on their duties and responsibilities

NURSING IN THE ORGANIZATIONAL

STRUCTURE
QUALITY ASSURANCE (QA)

An important management activity to honor the health

facilitys commitment to provide quality care to its clients

1.

Structure Standards define the rules under

service must be delivered

which

2.

Process Standards define how the rules under which

service must be delivered. These cover thee health care
facility

3.

Process Standards define n the other hand, define how

nursing care is provided

4.

Outcome standards - define both the desired results to be

achieved and the undesirable results to be avoided

NURSING IN THE ORGANIZATIONAL

STRUCTURE
SENTRONG SIGLA MOVEMENT
Certification recognition program which develops

and promotes standards for health facilities Joint

effort bet.:
DOH provides technical and financial assistance

packages for health care

LGUs direct implementers of health programs &

prime developers of health centers and hospitals

making services accessible to every Filipino

NURSING IN THE ORGANIZATIONAL

STRUCTURE
NURSING AUDIT
It is a method of evaluating the quality of care given

to client through the systematic review of client

records
It is a process, not an outcome evaluation
If

the process of delivering care/service is in

accordance with established standards, then there
must be quality(outcome)