Nursing ManagementNursing Management

Time ManagementTime Management DelegationDelegation Conflict ManagementConflict Management Change ImplementationChange Implementation

Managerial functionsManagerial functions

PlanningPlanning OrganizingOrganizing DirectingDirecting ControllingControlling Decision makingDecision making

PlanningPlanning Determining objectives and identifying Determining objectives and identifying

methods that lead to achievement of those methods that lead to achievement of those objectivesobjectives

OrganizingOrganizing Using resources (human and material) to Using resources (human and material) to

achieve pre-determined outcomesachieve pre-determined outcomes

DirectingDirecting Guiding and motivating others to meet the Guiding and motivating others to meet the

expected objectivesexpected objectives

ControllingControlling Using performance standards as criteria for Using performance standards as criteria for

measuring success, and taking corrective measuring success, and taking corrective action, if necessary to see that others comply action, if necessary to see that others comply with performance standardswith performance standards

Decision makingDecision making Identifying a problem and deciding which Identifying a problem and deciding which

alternative can best achieve the objectivesalternative can best achieve the objectives

Howlett Hierarchy of work motivatorsHowlett Hierarchy of work motivators

Level 1: salary, benefits, working conditions, Level 1: salary, benefits, working conditions, supervision, supervision, policies of agencypolicies of agency

Level 2: safety in the workplace, job securityLevel 2: safety in the workplace, job security Level 3: affiliation, interpersonal relationshipsLevel 3: affiliation, interpersonal relationships Level 4: recognition, growth, responsibilityLevel 4: recognition, growth, responsibility Level 5: achievement, advancementLevel 5: achievement, advancement

Work MotivatorsWork Motivators contribute to leadership contribute to leadership

AchievementAdvancement

RecognitionGrowth - Responsibility

Nature of the job

AffiliationInterpersonal relationships

Safety in the workplaceJob security

Salary, benefits, working conditions,Supervision, policies of agency

PowerPower

Types of powerTypes of power Reward Reward – ability to provide incentives– ability to provide incentives CoerciveCoercive – ability to punish – ability to punish ReferentReferent – charisma; others want to be around me – charisma; others want to be around me ExpertExpert – excellent knowledge and skills – excellent knowledge and skills LegitimateLegitimate – “positional” – based on position in – “positional” – based on position in

organizationorganization PersonalPersonal – positive self-esteem – “take charge” – positive self-esteem – “take charge” InformationalInformational – based on type and amt of information – based on type and amt of information

people can accesspeople can access

Principles of powerPrinciples of power

The degree of power experienced by a person is The degree of power experienced by a person is dynamic.dynamic.

Power is rarely discussed openly within health care Power is rarely discussed openly within health care organizations.organizations.

Power is an expendable source.Power is an expendable source. Power requires commitment to goals.Power requires commitment to goals. Power occurs in degrees, from minimal to extreme.Power occurs in degrees, from minimal to extreme.

Responsibility vs accountabilityResponsibility vs accountability

Responsibility – the specific accountability or Responsibility – the specific accountability or liability associated with the performance of liability associated with the performance of duties of a particular roleduties of a particular role

Accountability – Answerable to oneself and Accountability – Answerable to oneself and others for actions others for actions

Developing a power Developing a power basebase

Expanded practice roles have increased Expanded practice roles have increased nursing’s power.nursing’s power.

Knowledge, competence, caring, and affiliation Knowledge, competence, caring, and affiliation (mentorship, preceptorship, networking) are (mentorship, preceptorship, networking) are avenues for nurses to achieve power.avenues for nurses to achieve power.

NetworkingNetworking

Building connections with othersBuilding connections with others Encourages sharing of information and Encourages sharing of information and

creates a synergistic effect for all involvedcreates a synergistic effect for all involved Friendships, co-worker alliances, and Friendships, co-worker alliances, and

professional organizations are sources of professional organizations are sources of networking.networking.

EmpowermentEmpowerment

Empowerment is enabling others to do for Empowerment is enabling others to do for themselves.themselves.

Supportive, caring environment and open Supportive, caring environment and open communication fosters empowerment.communication fosters empowerment.

Mutual goal setting and decision-making helps Mutual goal setting and decision-making helps to establish empowerment.to establish empowerment.

A common purpose is essential for A common purpose is essential for empowerment to flourish.empowerment to flourish.

Empowerment of clientsEmpowerment of clients

Client teaching is used by nurses to empower Client teaching is used by nurses to empower clients.clients.

Another mechanism for nurses to empower Another mechanism for nurses to empower clients is advocacy.clients is advocacy.

Empowerment of Empowerment of nursesnurses

Share power and resources with others.Share power and resources with others. Admit when a mistake is made as it Admit when a mistake is made as it

demonstrates honesty.demonstrates honesty. Avoid power struggles.Avoid power struggles. Use persuasion.Use persuasion. Use accurate information in decision making.Use accurate information in decision making.

Politics of NursingPolitics of Nursing

Organizational politics determines who has the Organizational politics determines who has the power, who controls the resources, who is power, who controls the resources, who is rewarded, and who makes the decisions.rewarded, and who makes the decisions.

Nurses need to be involved not only in Nurses need to be involved not only in organizational politics, but also in politics that organizational politics, but also in politics that affect society at large.affect society at large.

Skills necessary for managersSkills necessary for managers

Basic nursing skillsBasic nursing skills Time management techniquesTime management techniques Use of resources for learningUse of resources for learning Power of positive self-talk and thinkingPower of positive self-talk and thinking Rules for assertivenessRules for assertiveness Communication skillsCommunication skills Legal and ethical aspects of health careLegal and ethical aspects of health care Problem solving and critical thinkingProblem solving and critical thinking Stress managementStress management Participation in clinical evaluationParticipation in clinical evaluation

Care delivery modelsCare delivery models Case method Case method – total care nursing – total care nursing Functional method Functional method – task-oriented – efficiency and – task-oriented – efficiency and

division of labor – may overlook holistic viewdivision of labor – may overlook holistic view Team method Team method – capabilities of each member used – capabilities of each member used

effectivelyeffectively Primary care method Primary care method – RN individualizes care and accepts – RN individualizes care and accepts

accountability for total client care – facilitates continuity; accountability for total client care – facilitates continuity; expensiveexpensive

Case management Case management – Focuses on cost-effective, quality – Focuses on cost-effective, quality care – case manager keeps an eye on timely discharge and care – case manager keeps an eye on timely discharge and continuity of care in the community continuity of care in the community

Time managementTime management Share time management strategies Share time management strategies

with one classmate – try something with one classmate – try something new!new!

Functions of LPN managersFunctions of LPN managers

Maintain safe environmentMaintain safe environment Discipline and counselingDiscipline and counseling Assuring cost-effective careAssuring cost-effective care -Diverse nursing team-Diverse nursing team -Staff education and resource person-Staff education and resource person -Interdisciplinary team-Interdisciplinary team -Motivation of team members -Motivation of team members

(see daily work assignment)(see daily work assignment)

Charge nurse dutiesCharge nurse duties

Assignments/delegation to LPN’s and Assignments/delegation to LPN’s and assistive personnel assistive personnel

Communication/shift reportsCommunication/shift reports Patient assessmentsPatient assessments Determining accuracy of client Determining accuracy of client

ordersorders

Legal Aspects of DelegationLegal Aspects of Delegation The LPN charge nurse assists in the The LPN charge nurse assists in the

supervision of nursing assistants and shares supervision of nursing assistants and shares accountability with the RN for their actions.accountability with the RN for their actions.

Know your practice act!!! Know your practice act!!!

(National Council of State Boards of Nursing)(National Council of State Boards of Nursing)

NCSBN web site: NCSBN web site: www.ncsbn.orgwww.ncsbn.org (delegation) (delegation)

5 R’s of Delegation 5 R’s of Delegation Right taskRight task Right personRight person Right circumstanceRight circumstance Right communication/directionRight communication/direction Right supervisionRight supervision

Right taskRight task Laws in your stateLaws in your state Policy in your institutionPolicy in your institution Needs of your residentsNeeds of your residents Training of nursing assistantsTraining of nursing assistants

Right personRight person should …

be able to:Communicate effectively,Collect basic subjective and objective dataPerform noncomplex activities safelySeek guidance (Hill, 276)

Right CircumstanceRight Circumstance

Setting and patient situation MUST be Setting and patient situation MUST be considered when delegatingconsidered when delegating

Right direction/communication

It is not only what you say but how you say it!!!

Communication must be specific, objective, clear-cut terms. Realistic, measurable, and time referenced.

Right Supervision, Feedback, and EvaluationRight Supervision, Feedback, and Evaluation

There needs to beThere needs to be Appropriate monitoring, intervention, and Appropriate monitoring, intervention, and

evaluation of the nursing assistantevaluation of the nursing assistant How closely do you monitor the nursing How closely do you monitor the nursing

assistant?assistant? Are you giving appropriate feedback?Are you giving appropriate feedback? Are you available if needed?Are you available if needed? Are tasks being completed on time and correctly?Are tasks being completed on time and correctly? If necessary, interveneIf necessary, intervene

Do I or don’t I?

Delegation decision-making tree

Iowa Board of Nursing Delegation Grid (click here to visit)

Applying problem solving as an LPN leaderApplying problem solving as an LPN leader

Identify the real issue and solve it!Identify the real issue and solve it! Collect dataCollect data Define problemDefine problem Identify GoalIdentify Goal Develop interventionsDevelop interventions EvaluateEvaluate

Team buildingTeam building

As charge nurse, you are in charge of creating As charge nurse, you are in charge of creating the climate of the work environment that will the climate of the work environment that will motivate staff. motivate staff.

How are you going to accomplish this? (See How are you going to accomplish this? (See Work Motivators PyramidWork Motivators Pyramid))

Behaviors that encourage teambuildingBehaviors that encourage teambuilding

Use “us” and “we” Use “us” and “we” languagelanguage

Encourage politeness, Encourage politeness, cooperation, trustcooperation, trust

Honest feedbackHonest feedback Ask of ideasAsk of ideas

Create positive Create positive environmentenvironment

Rewards for positive Rewards for positive reinforcement of reinforcement of behaviorsbehaviors

Treat members of your Treat members of your team as you would like team as you would like to be treatedto be treated

Stress ManagementStress Management

Display the ability to cope with stress as it Display the ability to cope with stress as it affects you.affects you.

Create a work environment with decreased Create a work environment with decreased stress levelsstress levels

Guide and support nursing assistants when Guide and support nursing assistants when they experience stress.they experience stress.