introduction to management in nursing

Nursing Management and Professional Concepts

Open Resources for Nursing Open RN, Chippewa Valley Technical College

Copyright Year: 2022

ISBN 13: 9781734914191

Publisher: WI Technical Colleges Open Press

Language: English

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Reviewed by Carrie Dickson, Nursing Instructor, Normandale Community College on 5/30/23

I have used this book for two semesters in a lower-division nursing leadership/ management course and plan to continue to use it. I believe this is a very comprehensive and appropriately-leveled resource for prelicensure leadership, management, or... read more

Comprehensiveness rating: 5 see less

I have used this book for two semesters in a lower-division nursing leadership/ management course and plan to continue to use it. I believe this is a very comprehensive and appropriately-leveled resource for prelicensure leadership, management, or professional concepts nursing courses. It is especially relevant for associate's degree programs and lower-division nursing courses, and it's frankly refreshing to find resources appropriate to this level. I believe upper-division courses could start with this as foundational knowledge, but may want to build on it with other OER materials, journals, etc.

Content Accuracy rating: 5

I have found the information for be very accurate and unbiased.

Relevance/Longevity rating: 5

I believe this book can remain relevant for quite some time. The book is divided into sections that make it easy to assign small sections that fit the topics needed.

Clarity rating: 5

I am grateful to find a text that is finally at an appropriate reading level for a lower-division, pre-licensure nursing course.

Consistency rating: 5

The book feels very consistent in terminology and layout throughout. In fact, I have read several books from OpenRN and they all have excellent consistency between them, making it easy to pick up another one of their books and jump right in.

Modularity rating: 5

Modularity is among the many strengths of this book and the OpenRN structure overall.

Organization/Structure/Flow rating: 5

I appreciate how the book is organized and yet how easy it is to assign readings outside of the typical organization if I so choose.

Interface rating: 5

The book and interface are incredibly easy to use.

Grammatical Errors rating: 5

I have not seen any grammatical errors in the full year plus that I have now been using this book.

Cultural Relevance rating: 5

The content here around health disparities, social determinants of health, etc. go beyond inclusivity and support effectively teaching these topics.

My students have supported the use of the book and commented on its ease of navigation and accessibility of language.

Table of Contents

• Part I. Chapter 1 - Overview of Management and Professional Issues
• Part II. Chapter 2 - Prioritization
• Part III. Chapter 3 - Delegation and Supervision
• Part IV. Chapter 4 - Leadership and Management
• Part V. Chapter 5 - Legal Implications
• Part VI. Chapter 6 - Ethical Practice
• Part VII. Chapter 7 - Collaboration Within the Interprofessional Team
• Part VIII. Chapter 8 - Health Care Economics
• Part IX. Chapter 9 - Quality and Evidence-Based Practice
• Part X. Chapter 10 - Advocacy
• Part XI. Chapter 11 - Preparation for the RN Role
• Part XII. Chapter 12 - Burnout and Self-Care
• Part XIII. Answer Keys

Ancillary Material

About the book.

This book introduces concepts related to nursing leadership and management, prioritization strategies, delegation and supervision, legal implications of nursing practice, ethical nursing practice, collaboration within the interprofessional team, health care economics, quality and evidencebased practice, advocacy, preparation for the RN role, and the avoidance of burnout with self-care. Several online, interactive learning activities are included in each chapter that encourage application of content to patientcare situations. Additionally, the Appendix includes a “suite of patients” with suggested prompts for classroom discussion to assist students in applying concepts from the book to real patient-care situations.

About the Contributors

The Open RN project is supported by a $2.5 million grant from the Department of Education to create five free, open source nursing textbooks. However, this content does not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the federal government. More information about the Open RN grant can be found at  cvtc.edu/OpenRN . The first three textbooks of the Open RN textbook series,  Nursing Pharmacology ,  Nursing Skills , and  Nursing Fundamentals , received a  Best OER Awards  from OE Global in 2020 and 2021.

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18.3 Implementing Leadership and Management into Nursing Practice

Learning objectives.

By the end of this section, you will be able to:

• Examine the nurse manager’s and leader’s role in patient care coordination
• Recognize how nurse leaders and managers delegate patient care
• Identify how nurse managers and leaders can provide support for professional development

In the multifaceted world of health care, the roles of nurse managers and leaders extend far beyond administrative duties, deeply influencing patient care and the professional growth of their teams. This module delves into several critical areas where nurse managers and leaders make a tangible impact: the coordination and delegation of patient care and the support of nursing staff as they pursue professional development. Understanding these areas is essential for ensuring that patient care is seamless, holistic, and of the highest quality.

Patient Care Coordination

Organizing a patient’s healthcare needs across providers, settings, and time is called patient care coordination and is a cornerstone of effective healthcare delivery. Care coordination ensures that patients receive comprehensive and cohesive care tailored to their individual needs. For nurse managers and leaders, this involves a proactive approach to organizing and overseeing all aspects of a patient’s care journey, from admission to discharge and beyond. It includes the strategic use of interdisciplinary referrals and the meticulous management of cases, especially for patients with complex health conditions. Effective care coordination leads to improved patient outcomes, enhanced patient satisfaction, and a reduction in unnecessary hospital readmissions (NEJM Catalyst, 2018). It demands clear communication, collaboration among healthcare professionals, and a deep understanding of each patient’s unique healthcare needs.

Life-Stage Context

Care coordination: older adults.

While care coordination is important for patients of all ages, it’s particularly important for older adults. It’s not uncommon for older patients to have multiple chronic health conditions, be prescribed one or more medications, and have more than one provider managing their care.

When acute medical needs are added to their chronic needs, such as in the case of an injurious fall or serious infection, the coordination of care can have a significant effect on outcomes. In some cases, it may even be a matter of life or death.

Older adults may also have physical and cognitive limitations that must be factored into their care planning, such as the need for transportation or caregiver assistance. For these patients, coordination of care is not just among providers but also includes allied healthcare professionals, community resources, and family members. Recent research suggests that older adults who experience better care coordination were also more satisfied with the healthcare services that they receive (Eastman et al., 2022).

Interdisciplinary Referrals

A critical component of patient care coordination , interdisciplinary referral s allow for a holistic approach to health care. When a primary care provider identifies a need beyond their expertise or resources, best practice is to refer the patient to a specialist to address specific health issues (Morris et al., 2021). For nurse managers and leaders, facilitating an interdisciplinary referral involves ensuring that it is appropriate, that the specialist has all the necessary information to provide targeted care, and that there is a seamless communication loop between all parties involved, including the patient. For example, a patient with heart failure may require a referral to a cardiologist at an advanced heart failure center. Many healthcare facilities utilize an electronic medical record (EMR) system, enabling practitioners to electronically submit interdisciplinary referrals. The nurse manager plays a role in facilitating this process for the primary care provider. This involves ensuring that the patient’s EMR is transmitted to the cardiologist, scheduling appointments as necessary, and educating the patient about the significance of the appointment with the specialist.

Case Management Duties

The role of a case manager , often fulfilled by a nurse, is integral to patient care coordination, particularly for patients with chronic illnesses or long-term conditions. Case managers assess patients’ needs, develop personalized care plans, and coordinate the various services and resources required to implement these plans. They act as advocates for the patient, navigating the healthcare system to ensure timely access to necessary treatments and interventions. Moreover, they monitor the patient’s progress and adjust care plans as needed, in consultation with other healthcare professionals and the patient themselves (Western Governors University, n.d.). For instance, a case manager working with a patient with congestive heart failure would coordinate care among cardiologists, dietitians, physical therapists, and home health services, ensuring that all aspects of the patient’s care are addressed in a cohesive and integrated manner. Nurse managers and leaders support case managers by providing the necessary resources, guidance, and leadership to ensure that comprehensive, patient-centered care is delivered efficiently and effectively.

Delegating Patient Care

As discussed in 15.4 Nursing Standards of Delegation , delegation is the act of requesting staff members to perform tasks or procedures that are outside of their normal job but within the limits of their job description (ANA, 2013). Per the National Guidelines for Nursing Delegation, staff members who can accept delegated tasks are unlicensed assistive personnel (UAP), which includes nursing assistants, patient care technicians, and other assistive personnel. Depending on the nurse’s role and position, they may also delegate or transfer patient care to other RNs (ANA-NCSBN, 2019). The delegating nurse always retains accountability, or responsibility, for the delegated task and therefore is functionally a manager of the delegatee, regardless of their actual title. So it is especially important for nurse managers and leaders to know exactly how delegation does and does not work.

Knowledge of Scope of Practice

Recall the five “rights” of delegation ( Table 18.5 ), which were also discussed in 15.4 Nursing Standards of Delegation . To ensure all these rights are upheld, nurse leaders and managers must know the scope of practice of all potential delegates and ensure all staff also understand the scope of practice of their coworkers. As discussed in 1.3 Nursing as a Profession , scope of practice refers to the defined limits and parameters within which a professional within a particular field is authorized to work, make decisions, and provide services (ANA, 2021). Nurse leaders and managers also have the task of promoting teamwork and building a supportive environment where nurses are empowered and confident in delegating appropriate tasks, and UAP are receptive to receiving tasks (Campbell et al., 2020).

Determination of Clinical Ability

The determination of clinical ability is a critical aspect of delegating patient care, requiring nurse managers to assess the skills and competencies of their team members accurately. This involves not just a general understanding of each team member’s qualifications and experience but also an ongoing evaluation of their performance and professional development. When determining clinical ability, nurse managers must consider the following:

• The complexity of the care needs of the patient and whether the staff member has demonstrated proficiency in similar tasks.
• The staff member’s current workload and the potential impact of additional responsibilities on their ability to deliver safe, quality care.
• The need for, and availability of, additional training or support to equip the staff member with the skills needed to perform the delegated task successfully.

For example, before delegating a task such as wound care for a patient with diabetes, a nurse manager would need to assess whether the UAP has the requisite knowledge of diabetes management and wound care principles and the ability to recognize and report signs of infection or other complications. This might involve reviewing the assistant’s training records, observing their performance in related tasks, or arranging for a more-experienced nurse to provide mentorship and oversight initially. By carefully assessing clinical competency, nurse managers ensure that delegation enhances patient care without compromising safety or quality.

Supporting Professional Development

Supporting professional development is a key responsibility of nurse managers and leaders, essential for nurturing the growth of nursing staff and ensuring high standards of patient care. Through professional development, nurses can enhance their knowledge, skills, and competencies, adapting to the evolving demands of health care. Effective strategies for supporting professional development include mentorship, preceptorship, engagement with professional organizations, and continuing education (CE) . By investing in the professional growth of their team, nurse managers not only improve individual nurse performance but also contribute to the advancement of the nursing profession as a whole.

Age-Related Considerations for Nurse Leadership

Age-related considerations are important in nursing leadership and management, as “generation gaps” can influence how leaders at different life stages interact with their teams, address the needs of patients across different age groups, and navigate generational differences in the workplace. Here are some key age-related considerations for nursing leadership and management, both for nurses and staff as well as patients:

• Generational diversity: Nursing leaders and managers should recognize and appreciate generational diversity within their teams. They should understand the characteristics, values, and communication styles of different generations, such as baby boomers, Generation X, millennials, and Generation Z, and be flexible in their leadership approaches.
• Mentorship and succession planning: Nursing leaders play a crucial role in mentoring and developing the next generation of nurse leaders. They should provide opportunities for younger nurses to gain leadership experience and offer guidance and support as they progress in their careers. Additionally, nursing leaders should engage in succession planning to ensure continuity of leadership and knowledge transfer as experienced nurses retire or transition out of leadership roles.
• Age-friendly care: Nursing leaders should promote age-friendly care practices that address the unique needs and preferences of patients across the life span. They should ensure that staff are trained in age-specific care protocols, such as pediatric care, adult care, and geriatric care, and that care environments are designed to accommodate the physical, cognitive, and psychosocial needs of patients of all ages.
• Work-life balance: Nursing leaders should be mindful of the work-life balance needs of nurses at different stages of their careers and life. They should facilitate flexible scheduling options, support policies for parental leave and caregiver responsibilities, and promote wellness initiatives that address the physical and emotional well-being of staff members across different age groups.
• Technology adoption and digital literacy: Nursing leaders should recognize variations in willingness to adopt technology and overall digital literacy among nurses of different ages. They should provide training and support to help older nurses adapt to new technologies and digital healthcare platforms, while also leveraging the technological skills of younger nurses to enhance workflow efficiency and patient care delivery.
• Continuing education and professional development: Nursing leaders should support lifelong learning and professional development opportunities for nurses of all ages. They should encourage staff to pursue continuing education, certification programs, and advanced degrees to stay abreast of current practices and advance their careers.
• Retirement planning and transition support: Nursing leaders should provide resources and support to nurses nearing retirement age to help them plan for the transition out of the workforce. This may include access to financial planning services, retirement seminars, and opportunities for phased retirement or mentorship roles.

By considering these age-related factors, nursing leaders and managers can create inclusive, supportive work environments that foster collaboration, innovation, and high-quality patient care across all age groups.

Mentorship plays a vital role in the professional development of nurses, offering guidance, support, and knowledge-sharing that can significantly impact a nurse’s career trajectory. A mentor is an experienced practitioner who serves as a role model, adviser, and advocate for a student or less-experienced colleague, facilitating their professional and personal growth. This relationship can help the mentee navigate the complexities of the healthcare environment, develop critical thinking and decision-making skills, and set and achieve career goals. For instance, a mentor might help a new nurse develop confidence in patient interactions, provide feedback on clinical skills, or offer advice on balancing work and continuing education. Effective mentorship creates a supportive learning environment that encourages curiosity, innovation, and excellence, enhancing the overall quality of care provided to patients (ANA, n.d.-b).

Preceptorship

Preceptorship is another key component of professional development, focusing on the practical application of nursing skills and knowledge in clinical settings. A preceptor is a licensed professional who coaches and supervises students or new nurses during their clinical rotations, providing hands-on learning opportunities, real-time feedback, and evaluation. This one-on-one relationship allows the preceptee to gain valuable clinical experience under the guidance of an experienced nurse, bridging the gap between theoretical knowledge and practice. For example, a preceptor working in a critical care unit might guide a nursing student through the process of monitoring a patient’s vital signs, interpreting data from medical equipment, and responding to emergent situations. Through preceptorship, novice nurses learn to apply their knowledge confidently and competently, preparing them for independent practice and contributing to their professional competence and growth (Baylor University, n.d.).

In nursing, preceptors differ from other guidance roles such as mentors, coaches, and supervisors. A mentor is a trusted individual who provides long-term guidance on the nurse’s career and professional development. Coaches help nurses work on specific performance improvements by asking questions that promote reflection and problem-solving. Supervisors oversee the nurse’s day-to-day work activities by ensuring adherence to policies, evaluating performance, and encouraging staff accountability.

Professional Organizations

As discussed in 1.2 Nursing Education Programs , professional nursing organization s are collective bodies formed by nurses to represent and advocate for the interests of the nursing profession. These organizations play a crucial role in supporting the development of nurse leaders and managers and provide numerous resources and opportunities for professional growth and networking.

Professional nursing organizations offer educational programs, conferences, and workshops designed for nurse leaders and managers. These events typically cover topics such as leadership development, healthcare administration, policy and advocacy, as well as the latest trends and best practices in nursing management . Nurse leaders and managers can enhance their knowledge, skills, and competencies by attending these events, particularly if they want to learn how to more effectively lead and manage their teams, drive innovation, and navigate the challenges of the healthcare industry. Examples of the benefits of being part of and active in a professional nursing network include the following:

• Networking opportunities: Nurse leaders and managers gain access to a broad network of peers and mentors through professional associations. Networking events (virtual and in person) facilitate the exchange of ideas, sharing of best practices, and collaborations between professionals that can influence policy and practice on a much larger scale.
• Continuing education and professional development: Many nursing organizations offer workshops, seminars, and conferences throughout the year that are designed to enhance nursing leadership skills. These educational opportunities help nurses stay current regarding the latest trends, innovations, and regulations in health care, and give them the knowledge they need to remain competent and competitive in their field. Many professional nursing organizations also provide specialized certifications and credentialing programs for nurse leaders and managers. Examples of these certifications are discussed in previous sections (e.g., NE-BC, NEA-BC, CNML, CENP).
• Advocacy and influence: Nurse leaders who are part of professional organizations are well positioned to become advocates for changes in healthcare policy, nursing practice, and patient care standards. Professional bodies often have the resources and political influence necessary to successfully lobby for legislative changes that can significantly affect the nursing profession and healthcare delivery systems.
• Research and resources: Access to cutting-edge research and a wealth of academic resources, including case studies, white papers, and evidence-based practice guidelines, supports nurse managers with learning about and implementing effective patient care strategies and operational improvements within their organizations.
• Leadership and volunteer opportunities: Participating in committees or holding office within these organizations gives nurse leaders the chance to develop critical management and decision-making skills. These roles provide them practical experience in leading diverse teams and projects, significantly enhancing their leadership capabilities and helping them feel more confident and at ease in leadership roles.
• Recognition and awards: Professional organizations often recognize outstanding contributions to the nursing field by giving awards and acknowledgments. This type of public recognition not only bolsters an individual’s career but also highlights the critical role that nurse leaders play in advancing health care.

Nurse leaders and managers may also choose to take on various roles within these professional organizations, such as serving on boards or committees, presenting at conferences, or contributing to research and publications. Examples of these roles may include the following:

• Committee membership: Serve on committees that focus on ethics, practice standards, education, and policy, providing strategic direction and making pivotal decisions that shape the profession.
• Mentorship programs: Lead mentorship initiatives to prepare less-experienced nurses for future leadership roles, enhancing the profession’s overall strength and sustainability.
• Policy development: Engage in policy development efforts that directly influence clinical practices and healthcare outcomes.
• Educational speaker: Serve as speakers or panelists at professional conferences, sharing knowledge and innovations that can educate and inspire other nursing professionals.

By actively participating in these organizations, nurse leaders can enhance their professional development and contribute to the advancement of the nursing profession as a whole. Table 18.6 lists some of the major national and international nurse leadership organizations and their respective missions, highlighting the diverse resources and opportunities available to nurse leaders and managers.

Additionally, each nursing specialty has its own professional organization, such as the Academy of Medical-Surgical Nurses, the Emergency Nurses Association, and Society of Pediatric Nurses. Most states also have multiple professional organizations, in addition to a board of nursing (BON) , which oversees the practice of nursing within that state.

Continuing Education

A cornerstone of nursing practice is continuing education (CE) . By participating in ongoing educational activities, nurses remain at the forefront of medical knowledge, technological advancements, and best practices in patient care. Continuing education is essential for personal and professional growth. These activities can range from workshops, seminars, and conferences to online courses and academic programs, all designed to keep nursing professionals informed and competent in their practice.

For nurse leaders and managers, supporting and encouraging CE is crucial for fostering a culture of lifelong learning within their teams. This support can manifest in various ways, such as providing time off for staff to attend CE events, offering reimbursement for educational courses, or organizing in-house training sessions on emerging healthcare trends. For example, a nurse manager might coordinate a series of workshops on the latest evidence-based practices in wound care, enabling the nursing staff to update their skills and apply new techniques to improve patient outcomes.

Moreover, CE is not only about enhancing clinical skills but also about developing leadership, communication, and critical thinking abilities that are vital for effective nursing practice. It prepares nurses to adapt to changes in healthcare delivery, meet the challenges of modern nursing, and take on advanced roles within the healthcare system. By prioritizing CE, nurse managers and leaders ensure that their teams are not only competent but also confident and innovative, contributing to the overall excellence in healthcare services.

Cultural Context

Cultural considerations for nurse leadership.

Cultural considerations are crucial in nursing leadership and management , as they influence how health care is delivered, how teams function, and how patients experience care. Here are some key cultural considerations related to nursing leadership and management:

• Diversity, equity, and inclusion: Effective nursing leaders recognize and value diversity among their staff and patient populations. They promote a culture of inclusivity where all individuals feel respected, supported, and empowered to contribute their unique perspectives and talents.
• Cultural competence: Nursing leaders and managers should possess cultural competence—the ability to understand, communicate with, and effectively interact with people from diverse cultural backgrounds. They should be knowledgeable about diverse cultural beliefs, practices, and healthcare preferences, which will help them provide culturally sensitive care and support their staff in delivering culturally competent care.
• Language and communication: In multicultural healthcare settings, language barriers can impede effective communication between healthcare providers and patients. Nursing leaders should ensure that patients have access to interpretation services and language assistance to facilitate clear communication and understanding. They should also promote the use of plain language and nonverbal communication techniques to bridge cultural, linguistic, and health literacy divides.
• Cultural sensitivity in care delivery: Nursing leaders and managers should promote cultural sensitivity in care delivery by encouraging their staff to recognize and respect patients’ cultural beliefs, values, and preferences. This may involve adapting care practices, treatment plans, and communication styles to align with patients’ cultural norms and expectations.
• Health disparities and equity: Nursing leaders have a responsibility to address health disparities and promote health equity among diverse patient populations. They should advocate for policies and practices that reduce barriers to healthcare access and improve health outcomes for marginalized or underserved communities.
• Cross-cultural team dynamics: In multicultural healthcare teams, nursing leaders play a vital role in fostering collaboration, mutual respect, and understanding among team members from different cultural backgrounds. They should promote cultural humility—the recognition of one’s own cultural biases and the willingness to learn from others’ cultural perspectives.
• Conflict resolution and cultural sensitivity: Nursing leaders should be adept at resolving conflicts that arise due to cultural differences or misunderstandings. They should facilitate open dialogue, promote empathy and understanding, and seek mutually acceptable resolutions that respect the cultural values and dignity of all involved parties.
• Cultural competence training and education: Nursing leaders should provide ongoing training and education to their staff on cultural competence, diversity, and inclusion. This may include workshops, seminars, or online courses to enhance staff awareness, knowledge, and skills in working effectively with diverse patient populations.

By integrating these cultural considerations into nursing leadership and management practices, healthcare organizations can create a culturally responsive environment that promotes high-quality, patient-centered care and enhances the well-being of both patients and healthcare providers.

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Chapter 1 - Overview of Management and Professional Issues

1.1. overview.

This textbook discusses professional and management concepts related to the role of a registered nurse (RN) as defined by the American Nurses Association (ANA). The ANA publishes two resources that set standards and guide professional nursing practice in the United States: The  Code of Ethics for Nurses With Interpretive Statements  and  Nursing: Scope and Standards of Practice . The  Code of Ethics for Nurses With Interpretive Statements  establishes an ethical framework for nursing practice across all roles, levels, and settings and is discussed in greater detail in the “ Ethical Practice ” chapter of this book. The  Nursing: Scope and Standards of Practice  resource defines the “who, what, where, when, why, and how of nursing” and sets the standards for practice that all registered nurses are expected to perform competently.[ 1 ]

The ANA defines the “who” of nursing practice as the nurses who have been educated, titled, and maintain active licensure to practice nursing. The “what” of nursing is the recently revised ANA definition of nursing: “ Nursing  integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.”[ 2 ] Simply put, nurses treat human responses to health problems and life processes and advocate for the care of others.

Nursing practice occurs “when” there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education, anytime, anywhere. Nursing practice occurs in any environment “where” there is a health care consumer in need of care, information, or advocacy. The “why” of nursing practice is described as nursing’s response to the changing needs of society to achieve positive health care consumer outcomes in keeping with nursing’s social contract and obligation to society. The “how” of nursing practice is defined as the ways, means, methods, and manners that nurses use to practice professionally.[ 3 ] The “how” of nursing, also referred to as a nurse’s “scope and standards of practice,” is further defined by each state’s Nurse Practice Act; agency policies, procedures, and protocols; and federal regulations and ANA’s Standards of Practice.

STATE BOARDS OF NURSING AND NURSE PRACTICE ACTS

RNs must legally follow regulations set by the Nurse Practice Act by the state in which they are caring for patients with their nursing license. The  Board of Nursing  is the state-specific licensing and regulatory body that sets standards for safe nursing care and issues nursing licenses to qualified candidates based on the Nurse Practice Act. The  Nurse Practice Act  is enacted by that state’s legislature and defines the scope of nursing practice and establishes regulations for nursing practice within that state. If nurses do not follow the standards and scope of practice set forth by the Nurse Practice Act, they may be disciplined by the Board of Nursing in the form of reprimand, probation, suspension, or revocation of their nursing license. Investigations and discipline actions are reportable among states participating in the Nurse Licensure Compact (that allows nurses to practice across state lines) or when a nurse applies for licensure in a different state. The scope and standards of practice set forth in the Nurse Practice Act can also be used as evidence if a nurse is sued for malpractice.

Find your state’s Nurse Practice Act on the National Council of State Board of Nursing (NCSBN)  website . Read more about malpractice and protecting your nursing license in the “ Legal Implications ” chapter of this book. Read Wisconsin’s  Nurse Practice Act ,  Standards of Practice for Registered Nurses and Licensed Practical Nurses (Chapter N6) PDF,  and  Rules of Conduct (Chapter N7) PDF .

AGENCY POLICIES, PROCEDURES, AND PROTOCOLS

In addition to practicing according to the Nurse Practice Act in the state they are employed, nurses must also practice according to agency policies, procedures, and protocols.

A  policy  is an expected course of action set by an agency. For example, hospitals set a policy requiring a thorough skin assessment to be completed when a patient is admitted and then reassessed and documented daily.

Agencies also establish their own set of procedures. A  procedure  is the method or defined steps for completing a task. For example, each agency has specific procedural steps for inserting a urinary catheter.

A  protocol  is a detailed, written plan for performing a regimen of therapy. For example, agencies typically establish a hypoglycemia protocol that nurses can independently and quickly implement when a patient’s blood sugar falls below a specific number without first calling a provider. A hypoglycemia protocol typically includes actions such as providing orange juice and rechecking the blood sugar and then reporting the incident to the provider.

Agency-specific policies, procedures, and protocols supersede the information taught in nursing school, and nurses can be held legally liable if they don’t follow them. It is vital for nurses to review and follow current agency-specific procedures, policies, and protocols while also practicing according to that state’s nursing scope of practice. Malpractice cases have occurred when a nurse was asked by their employer to do something outside their legal scope of practice, impacting their nursing license. It is up to you to protect your nursing license and follow the Nurse Practice Act when providing patient care. If you have a concern about an agency’s policy, procedure, or protocol, follow the agency’s chain of command to report your concern.

FEDERAL REGULATIONS

Nursing practice is impacted by regulations enacted by federal agencies. Two examples of federal agencies setting standards of care are The Joint Commission and the Centers for Medicare and Medicaid Services.

The Joint Commission accredits and certifies over 20,000 health care organizations in the United States. The Joint Commission’s standards help health care organizations measure, assess, and improve performance on functions that are essential to providing safe, high-quality care. The standards are updated regularly to reflect the rapid advances in health care and address topics such as patient rights and education, infection control, medication management, and prevention of medical errors. The annual National Patient Safety Goals are also set by The Joint Commission after reviewing emerging patient safety issues.[ 4 ]

The Centers for Medicare & Medicaid Services (CMS) is an example of another federal agency that establishes regulations affecting nursing care. CMS is a part of the U.S. Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid. The CMS establishes and enforces regulations to protect patient safety in hospitals that receive Medicare and Medicaid funding. For example, one CMS regulation often referred to as “checking the rights of medication administration” requires nurses to confirm specific information several times before medication is administered to a patient.[ 5 ]

STANDARDS OF PRACTICE

The ANA defines  Standards of Professional Nursing Practice  as “authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.”[ 6 ] These standards are classified into two categories: Standards of Practice and Standards of Professional Performance.

The  ANA’s Standards of Practice  describe a competent level of nursing practice as demonstrated by the critical thinking model known as the  nursing process . The nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation and forms the foundation of the nurse’s decision-making, practice, and provision of care.[ 7 ]

Read more information about the nursing process in the “ Nursing Process ” chapter of Open RN  Nursing Fundamentals .[ 8 ]

The  ANA’s Standards of Professional Performance  “describe a competent level of behavior in the professional role, including activities related to ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, and environmental health. All registered nurses are expected to engage in professional role activities, including leadership, reflective of their education, position, and role.”[ 9 ] This book discusses content related to these professional practice standards. Each professional practice standard is defined in the following sections with information provided to related content in this book and the Open RN  Nursing Fundamentals  textbook.[ 10 ]

The ANA’s  Ethics  standard states, “The registered nurse integrates ethics in all aspects of practice.”[ 11 ]

Read about ethical nursing practice in the “ Ethical Practice ” chapter of this book.

The ANA’s  Advocacy  standard states, “The registered nurse demonstrates advocacy in all roles and settings.”[ 12 ]

Read about nurse advocacy in the “ Advocacy ” chapter of this book.

RESPECTFUL AND EQUITABLE PRACTICE

The ANA’s  Respectful and Equitable Practice  standard states, “The registered nurse practices with cultural humility and inclusiveness.”

Read about cultural humility and culturally responsive care in the “ Diverse Patients ” chapter in Open RN  Nursing Fundamentals .[ 13 ]

COMMUNICATION

The ANA’s  Communication  standard states, “The registered nurse communicates effectively in all areas of professional practice.”[ 14 ]

Read about communicating with clients and team members in the “ Communication ” chapter in Open RN  Nursing Fundamental s.[ 15 ]

Read about interprofessional communication strategies that promote patient safety in the “ Collaboration Within the Interprofessional Team ” chapter of this book.

COLLABORATION

The ANA’s  Collaboration  standard states, “The registered nurse collaborates with the health care consumer and other key stakeholders.”[ 16 ]

Read about strategies to enhance the performance of the interprofessional team and manage conflict in the “ Collaboration Within the Interprofessional Team ” chapter of this book.

The ANA’s  Leadership  standard states, “The registered nurse leads within the profession and practice setting.” [17]

Read about leadership, management, and implementing change in the “ Leadership and Management ” chapter of this book. Read about assigning, delegating, and supervising patient care in the “ Delegation and Supervision ” chapter of this book. Read about tools for prioritizing patient care and managing resources for the nursing team in the “ Prioritization ” chapter of this book.

The ANA’s  Education  standard states, “The registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking.” [18]

Read about professional development and specialty certification in the “ Preparation for the RN Role ” chapter of this book.

SCHOLARLY INQUIRY

The ANA’s  Scholarly Inquiry  standard states, “The registered nurse integrates scholarship, evidence, and research findings into practice.”[ 19 ]

Read about integrating evidence-based practice into one’s nursing practice in the “ Quality and Evidence-Based Practice ” chapter of this book.

QUALITY OF PRACTICE

The ANA’s  Quality of Practice  standard states, “The nurse contributes to quality nursing practice.”[ 20 ]

Read about improving quality patient care and participating in quality improvement initiatives in the “ Quality and Evidence-Based Practice ” chapter of this book.

PROFESSIONAL PRACTICE EVALUATION

The ANA’s  Professional Practice Evaluation  standard states, “The registered nurse evaluates one’s own and others’ nursing practice.”[ 21 ]

Read about nursing practice within the legal framework of health care, negligence, malpractice, and protecting your nursing license in the “ Legal Implications ” chapter of this book. Read about reviewing the interprofessional team’s performance, providing constructive feedback, and advocating for patient safety with assertive statements in the “ Collaboration Within the Interprofessional Team ” chapter of this book.

RESOURCE STEWARDSHIP

The ANA’s  Resource Stewardship  standard states, “The registered nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, financially responsible, and used judiciously.”[ 22 ]

Read more about health care funding, reimbursement models, budgets and staffing, and resource stewardship in the “ Health Care Economics ” chapter of this book.

ENVIRONMENTAL HEALTH

The ANA’s  Environmental Health  standard states, “The registered nurse practices in a manner that advances environmental safety and health.”[ 23 ]

Read about promoting workplace safety for nurses in the “ Safety ” chapter in Open RN  Nursing Fundamentals .[ 24 ] Read about fostering a professional environment that does not tolerate abusive behaviors in the “ Collaboration Within the Interprofessional Team ” chapter of this book. Read about addressing the impacts of social determinants of health in the “ Advocacy ” chapter of this book.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

• Cite this Page Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Management and Professional Concepts [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 1 - Overview of Management and Professional Issues.
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Nursing Management: Guide to Organizing, Staffing, Scheduling, Directing and Delegating

Effective nursing management is crucial for ensuring high-quality patient care and maintaining a harmonious work environment. This involves several key concepts, including organizing, delegation, motivation, supervision, coordination, and conflict management.

Table of Contents

Organizing process, three forms of authority, organizational chart, managerial levels, patterns of organizational structure, staffing process, staffing pattern, patient classification system, shifting patterns, elements of directing, barriers in communication, common errors in delegation, steps in effective delegating, key concepts in effective delegation, conflict resolution strategies.

Organizing is a crucial management function that ensures tasks are logically identified, assigned, and grouped. It determines who is responsible for each task, establishes clear lines of reporting, and facilitates decision-making. At its core, organizing defines roles and relationships within the organization, clarifying each staff member’s functions to execute the organizational plan effectively.

The process of organizing involves the following:

• Identifying and Defining Tasks . Determine the basic tasks that need to be accomplished.
• Delegating Authority and Assigning Responsibility . Allocate authority and assign responsibilities to appropriate individuals.
• Establishing Relationships . Create a structure that separates activities, arranges them hierarchically, and fosters efficient teamwork.

Authority within an organization can be categorized into three primary forms:

Line Authority

Line authority is the direct supervisory authority that flows from a supervisor to their subordinates. It represents the clear, direct chain of command where decisions and instructions are passed down the hierarchy. For example, a nurse manager has direct supervisory authority over a team of registered nurses (RNs) on a hospital ward. The nurse manager delegates tasks, oversees patient care , and evaluates the performance of the nursing staff, ensuring that the ward operates smoothly.

Staff Authority

Staff authority is based on expertise and typically involves providing advice and support to line managers. Staff authority does not entail direct command over other employees but focuses on specialized knowledge and guidance. For example, a clinical nurse specialist (CNS) provides expert advice to the nursing staff and line managers on best practices for patient care . Although the CNS does not have direct supervisory control, they influence decisions through their specialized knowledge in areas such as wound care , pain management , or diabetes education.

Team Authority

Granted to committees or work teams involved in daily operations, team authority empowers groups of employees who share a common vision , goals, and objectives. These teams are responsible for collaborative decision-making and achieving specific outcomes. For example, in a hospital setting, the chain of command starts with the Chief Nursing Officer (CNO) at the top, followed by nurse directors, nurse managers, charge nurses, and finally the staff nurses. This hierarchy ensures that decisions and instructions are passed down systematically and that issues can be escalated appropriately.

Additional concepts related to authority include:

• Chain of Command . This is an unbroken line of reporting relationships that extends through the entire organization, defining the formal decision-making structure and ensuring clarity in the flow of authority.
• Unity of Command . This principle states that each person in the organization should take orders from and report to only one supervisor, preventing confusion and overlapping directives.
• Span of Control . This refers to the optimal number of employees that one leader-manager can effectively supervise. A well-defined span of control ensures efficient management and communication within the organization.

An organizational chart is a visual representation that illustrates the structure of an organization. It shows how different parts of the organization are linked, highlighting formal relationships, areas of responsibility, accountability, and communication channels.

Organizational Structure

The chart clearly depicts roles and expectations, as well as the arrangement of positions and working relationships within the organization.

Lines of Authority

In an organizational chart, various lines are used to represent different types of authority and relationships within the organization:

• Dotted Line. Represents staff positions or staff authority, indicating advisory roles to line managers.
• Solid Horizontal Line. Represents positions of equal status but different functions.
• Solid Vertical Line. Indicates the chain of command, showing direct authority from supervisors to subordinates (line authority).
• Centrality. Refers to the position on the chart where frequent and diverse communication occurs. Positions with smaller organizational distance, closer to the center, receive more information compared to those located more peripherally.

In an organization, managerial roles are divided into different levels, each with distinct responsibilities and scope of influence:

• Top-Level Managers . Make strategic decisions with minimal guidelines or structure. Coordinate both internal and external influences. Examples include: CEO, President, Vice President, Chief Nursing Officer
• Middle-Level Managers. Oversee day-to-day operations while also engaging in long-term planning and policy-making. Examples include: Head Nurse, Department Head, Unit Supervisor/Manager
• First-Level Managers. Focus on specific unit workflows and address immediate, day-to-day issues. Examples: charge Nurse, Team Leader, Primary Nurse, Staff Nurse

Organizational structures define how tasks, responsibilities, and authority are distributed within an organization. Different structures cater to various organizational needs and scales, each with distinct characteristics and implications for communication and management. These may include:

Tall or Centralized Structure

Tall or centralized structures are characterized by a narrow span of control, where supervisors are responsible for only a few subordinates. Due to its vertical nature, this structure involves many levels of communication. Communication can be difficult, and messages often fail to reach the top effectively. Workers tend to be boss-oriented due to close supervision.

Flat or Decentralized Structure

Flat or decentralized structures feature few levels and a broad span of control, making communication easy and direct. This structure shortens the administrative distance between top and lower levels, facilitates fast problem-solving and response, and encourages workers to develop their abilities and autonomy. However, it is impractical for large organizations.

Types of Organizational Structure

Organizational structures can vary significantly, each designed to meet specific operational needs and management styles. Understanding the different types helps in selecting the most appropriate structure for a given organization.

• Line Organization/Bureaucratic/Pyramidal . In a line organization, there is a clearly defined superior-subordinate relationship. Authority and power are concentrated at the top.
• Flat/Horizontal Organization . A decentralized type, flat organizations are applicable in small organizations. Nurses become more productive and directly involved in decision-making processes, leading to greater worker satisfaction.
• Functional Organization . This structure allows specialists to assist line positions within a limited and clearly defined scope of authority.
• Ad Hoc Organization . An ad hoc organization is a modification of the bureaucratic structure, often created for specific projects or purposes.
• Matrix Structure . The matrix structure focuses on both products and functions, making it the most complex type. It incorporates both vertical and horizontal chains of command and lines of communication.

Staffing is the process of assigning competent individuals to fulfill the roles designated within an organizational structure. This involves recruitment, selection, development, induction, and orientation of new staff to align with the organization’s goals, vision, mission, and philosophy.

Staffing involves a systematic approach to ensuring the organization has the right number and type of personnel to achieve its goals. The following steps outline the key stages in the staffing process:

• Preparing to Recruit . This initial step involves determining the types and number of personnel required to meet the organization’s needs.
• Attracting Staff . Formal advertisements and outreach efforts are used to attract potential candidates.
• Recruiting and Selecting Staff . This phase includes conducting interviews, induction, orientation, job orders, pre-employment testing, and signing contracts to onboard new employees.

Developing an effective staffing pattern is essential for ensuring that an organization has the right number of staff with the appropriate skills to meet its needs. There are two primary methods for creating a staffing pattern:

Determining Nursing Care Hours

This method involves calculating the number of nursing care hours required per patient. For example, if each patient needs an average of 6 hours of nursing care per day and the unit has 20 patients, the total nursing care hours needed per day would be 120 hours. This helps in determining the number of nurses required per shift to meet patient care needs effectively.

Calculating Full-Time Equivalents (FTEs)

This approach measures the work commitment of full-time employees. For instance, 1.0 FTE represents a full-time employee who works 5 days a week, 8 hours a day, totaling 40 hours a week. Conversely, 0.5 FTE corresponds to a part-time employee working 5 days every 2 weeks, totaling 20 hours a week.

Considerations in Staffing Pattern

When developing a staffing pattern, several key factors must be taken into account to ensure optimal organizational performance and compliance with regulations. The following considerations are essential:

• Benchmarking. This management tool is used to seek out the best practices within the healthcare industry to improve performance. For instance, a hospital might compare its nurse-to-patient ratio with top-performing hospitals. By measuring their staffing practices and patient outcomes against these benchmarks, the hospital can identify areas for improvement and set realistic targets for nurse staffing levels.
• Regulatory Requirements. Staffing patterns must adhere to mandated regulations, such as those outlined in relevant legislative acts. For example, the laws regarding safe staffing in certain regions mandates specific nurse-to-patient ratios that must be maintained to ensure patient safety and care quality.
• Skill Mix. The skill mix refers to the percentage or ratio of professionals to non-professionals within the staff. For example, in a hospital unit with 40 full-time equivalents (FTEs), if there are 20 registered nurses (RNs) and 20 nursing assistants, the RN mix is 50%. This ratio ensures a balanced team with the necessary expertise and support staff, allowing RNs to focus on complex patient care tasks while nursing assistants handle more routine duties.
• Staff Support. Adequate staff support must be in place for the operations of units or departments. For example, a nursing unit might need administrative staff to handle scheduling, clerical tasks, and patient records . This support allows nurses to dedicate more time to patient care rather than administrative duties.
• Historical Information. Reviewing historical data on quality and staff perceptions regarding the effectiveness of previous staffing patterns is crucial. For example, a hospital may analyze past staffing patterns during peak flu seasons to determine the optimal number of nurses required to maintain patient care standards. This historical review helps in planning and adjusting staffing levels to meet future demands more effectively.

The term Patient Classification Systems refers to measurement systems in nursing that reflect actual patient care needs for staffing purposes. These systems, also known as Acuity Systems, are used to articulate the nursing workload for specific patients or groups of patients over a defined period. While “Acuity” typically denotes the unidimensional severity of illness in a medical context, the nursing community prefers the broader term “Patient Classification” to encompass the bio-psycho-social-spiritual aspects of patient care. For this discussion, the term Patient Classification/Acuity System is used.

Patient Care Classification

Patients are classified into different categories based on their care needs:

• Self-Care or Minimal Care . These patients are capable of performing activities of daily living (ADLs) independently, such as hygiene and meals. They require minimal assistance from the nursing staff.
• Intermediate or Moderate Care . Patients in this category require some assistance from the nursing staff for special treatments or specific aspects of personal care. Examples include patients with IV fluids , catheters, or on respirators.
• Total Care . These patients are bedridden and lack the strength or mobility to perform ADLs. They require comprehensive nursing care. Examples include patients on complete bed rest (CBR), those in the immediate post-operative phase, or those with significant mobility restrictions.
• Intensive Care : Intensive care patients are critically ill and in constant danger of death or serious injury . They require continuous monitoring and specialized nursing care. Examples include comatose patients or those with life-threatening conditions who are bedridden.

By classifying patients according to their care needs, the Patient Classification System ensures that nursing resources are appropriately allocated, enhancing patient care and optimizing the nursing workload.

Scheduling is the process of creating a timetable that outlines the planned workdays and shifts for nursing personnel. Effective scheduling takes into account several key factors to ensure that staffing meets patient care needs and maintains staff well-being. Several key factors must be considered to create an optimal schedule that meets both patient needs and staff preferences. The following are some issues to consider in scheduling staff:

• Patient Type and Acuity . Different patients require varying levels of care, significantly impacting how staff is allocated. For example, intensive care unit (ICU) patients need constant monitoring and specialized care, requiring more experienced nurses compared to patients in a general ward.
• Number of Patients . The total patient count directly influences the number of staff needed. A higher patient load requires more nursing staff to ensure each patient receives adequate attention and care. For instance, during peak flu season, a hospital might need to increase its nursing staff to handle the influx of patients.
• Experience of Staff . The skill and experience levels of the staff should match the complexity of patient care required. For example, a novice nurse might handle basic patient care tasks, while a more experienced nurse might be assigned to complex cases or critical care units.
• Support Available to the Staff . The availability of support personnel, such as nursing assistants and administrative staff, affects how nursing duties are distributed. For example, having sufficient administrative support can allow nurses to focus more on patient care rather than paperwork.
• Shifting Variations . Different shift patterns are utilized to meet both patient care needs and staff preferences. These variations can help in maintaining a balanced and effective workforce.

To meet the diverse needs of patients and preferences of nursing staff, various traditional shifting patterns are utilized. Each pattern offers unique benefits and challenges, helping to ensure continuous and effective patient care.

• 3 Shift (8-hour shift) . Commonly used to provide 24-hour care, this pattern divides the day into three 8-hour shifts. For instance, one nurse might work from 7 AM to 3 PM, another from 3 PM to 11 PM, and a third from 11 PM to 7 AM.
• 12-hour Shift . This pattern involves longer shifts with fewer workdays, often preferred by nurses who enjoy having more consecutive days off. A nurse might work from 7 AM to 7 PM, providing continuity of care for patients but also requiring adequate rest between shifts to prevent burnout .
• 10-hour Shift . Less common but offers a balance between 8 and 12-hour shifts. This pattern might involve a nurse working from 7 AM to 5 PM, allowing for extended care periods without the intensity of a 12-hour shift.
• Weekend Option . Staff works primarily on weekends, which can be ideal for nurses who prefer or need weekdays off. This option helps in ensuring adequate coverage during weekends when patient admissions might fluctuate.
• Rotating Work Shift . Shifts rotate between day, evening, and night, allowing all staff to experience different times of day. This can help in maintaining a fair distribution of shifts but requires careful management to avoid disruption to staff routines and circadian rhythms.
• Self-Scheduling . Staff members create their own schedules, promoting autonomy and job satisfaction. For example, a nurse might choose to work three consecutive days followed by four days off, allowing flexibility in managing personal commitments.
• Permanent Work Shift . Staff work consistent shifts without rotation, providing stability and predictability. For instance, a nurse might always work the night shift , ensuring they can plan their personal life around a steady work schedule.
• Floaters . Staff who are “on-call” to fill in as needed. Floaters provide critical support during unexpected absences or increased patient loads, ensuring that the unit remains adequately staffed at all times.

Directing is the act of issuing orders, assignments, and instructions to achieve organizational goals and objectives. It involves guiding and supervising staff to ensure effective performance.

The following are the elements of directing:

• Communication . The exchange of ideas, thoughts, or information through verbal speech, writing, and signals.
• Delegation . Assigning responsibility and authority to subordinates.
• Motivation . Encouraging staff to achieve high performance and job satisfaction.
• Coordination :.Harmonizing efforts to ensure efficient operations.
• Evaluation . Assessing performance to provide feedback and improve outcomes.

The following are the common barriers of communication:

• Physical Barriers : Environmental factors that hinder communication, such as distance and noise.
• Social and Psychological Barriers : Judgments, emotions, and social values that obstruct communication, such as stress, trust issues, fear , and defensiveness. These include the internal climate (values, feelings, temperament, and stress levels) and external climate (weather, timing, temperature, and lack of message validation).
• Semantics : Misunderstandings arising from words, figures, symbols, penmanship, and the interpretation of messages through signs and symbols.
• Interpretations : Defects in communication skills, including verbalizing, listening, writing, reading, and using telephony

Delegation involves assigning a portion of work to someone else, along with the corresponding authority, responsibility, and accountability. According to the American Nurses Association (ANA), it is the transfer of responsibilities, but not of accountability, for the performance of a task from one person to another. Much of a manager’s work is accomplished by transferring responsibilities to subordinates.

Managers often delegate routine tasks to free themselves for more complex problems requiring higher levels of expertise. Additionally, delegation is beneficial when someone else is better prepared or has greater expertise in solving specific problems. However, some managers hesitate to delegate due to a lack of trust in others, fear of mistakes, fear of criticism, or doubt about their own ability to delegate effectively. Here are the three common errors involved in delegation:

Under Delegation

Managers may underdelegate due to the false assumption that delegation might be seen as a lack of ability to do the job correctly. For example, a charge nurse might feel that only they can correctly handle patient assessments and may avoid delegating these tasks to other nurses, leading to unnecessary workload and burnout .

Over Delegation

This occurs when subordinates become overburdened, leading to dissatisfaction and low productivity. For instance, a nurse manager who delegates too many tasks to a single nurse, such as patient care duties, administrative tasks, and training responsibilities, can cause that nurse to become overwhelmed and reduce their effectiveness and morale.

Improper Delegation

Delegating tasks to the wrong person, at the wrong time, or tasks beyond the subordinate’s capability can lead to inefficiencies and errors. For example, assigning a newly graduated nurse to handle a critical care patient without adequate supervision can lead to mistakes and compromise patient safety .

Effective delegation involves a systematic approach to ensure tasks are appropriately assigned and executed. Here are the steps to achieve effective delegation:

• Plan Ahead . Anticipate future needs and identify tasks that can be delegated. For instance, a nurse manager can plan to delegate routine check-ups during busy shifts.
• Identify Necessary Skills and Levels . Determine the skills and experience required for the tasks. For example, wound care should be delegated to a nurse with specialized training.
• Select the Most Capable Personnel . Choose individuals who are best suited for the tasks. A senior RN may be chosen to oversee the orientation of new nurses.
• Communicate Goals Clearly . Ensure that the delegate understands the objectives and expectations. For instance, clearly explain the expected outcomes of a patient discharge process.
• Empower the Delegate . Provide the necessary authority and resources for the task. Ensure that the nurse has access to all needed supplies and information.
• Set Deadlines and Monitor Progress . Establish timelines and check in regularly to ensure progress. For example, set a deadline for completing patient assessments and follow up to track progress.
• Model the Role and Provide Guidance . Demonstrate how to perform the task and offer support as needed. Show a nurse how to use new medical equipment and be available for questions.
• Evaluate Performance . Assess the delegate’s performance and provide feedback for improvement. After delegating a task, review the outcomes and discuss areas for improvement.

Effective nursing management and delegation involves several key concepts that ensure high-quality patient care and efficient team operations. Here are three essential concepts:

Motivation influences our choices and drives the direction, intensity, and persistence of our behavior. In nursing, motivation can come from personal fulfillment, professional recognition, and the desire to provide excellent patient care. For example, nurses might be motivated by positive patient outcomes or career advancement opportunities.

Supervision

Supervision entails guiding and directing work, motivating staff, and encouraging participation in activities that meet organizational goals while fostering personal development. Effective supervision in nursing includes regular check-ins, feedback, and professional growth opportunities. For instance, nurse managers might hold weekly meetings to discuss challenges, celebrate successes, and provide training on new protocols.

Coordination

Coordination involves arranging activities to create harmony and facilitate success. In nursing, effective coordination ensures team members work together efficiently to provide optimal patient care. This includes coordinating schedules, assigning tasks based on expertise, and ensuring clear communication.

Conflict Management

Conflict arises from internal and external discord due to differences in ideas, values, or feelings between two or more people. It often stems from economic and professional value differences and can significantly impact workplace harmony and productivity. Conflict can either be competitive or disruptive:

• Competitive Conflict. This occurs when two or more groups vie for the same goal, but only one can attain it. Management typically sets these goals, leading to a competitive environment where each group strives to outperform the others.
• Disruptive Conflict. This type of conflict happens in environments filled with anger, fear, and stress. There are no mutually acceptable rules, and each party’s goal is to eliminate the opponent. This destructive form of conflict can severely hinder cooperation and productivity.

Effective conflict management involves employing various strategies to address and resolve conflicts constructively in the nursing field. Here are some common approaches:

• Use of Dominance and Suppression . This win-lose strategy involves one party imposing their will on the other, often leading to anger and resentment. For example, a head nurse might unilaterally decide on a new scheduling system without consulting the staff, leading to dissatisfaction and resistance.
• Smoothing Behavior. This strategy involves persuading the opponent diplomatically to maintain harmony and avoid confrontation. For example, a nurse manager might smooth over a conflict between two nurses by diplomatically discussing their concerns and finding a temporary compromise to ease tensions.
• Avoidance Behavior. Both parties are aware of the conflict but choose not to acknowledge or resolve it. For example, two nurses who have a personal disagreement might avoid discussing it, which can lead to unresolved issues affecting teamwork and patient care.
• Majority Rule. This approach relies on a unanimous decision-making process. For instance, when deciding on a new policy, the nursing team might vote on the options, with the majority’s decision being implemented.
• Compromising. This consensus strategy involves each side agreeing to solutions that partially satisfy both parties, aiming for a middle ground. For example, a nurse manager might compromise on shift preferences to balance the needs of the staff and the unit.
• Interactive Problem-Solving. A constructive process where the parties involved recognize the conflict, assist each other, and openly work together to solve the problems. For example, a nursing team might hold a meeting to discuss and collaboratively find solutions to recurring staffing issues.
• Win-Win Strategy. This strategy focuses on goals and attempts to meet the needs of both parties, fostering cooperation and mutual satisfaction. For example, a head nurse and a staff nurse might work together to develop a new patient care protocol that improves efficiency and meets both management and frontline needs.
• Lose-Lose Strategy. In this approach, neither side wins, often leading to a situation where both parties are dissatisfied. For example, if a nurse manager enforces a policy change that neither the administration nor the nursing staff fully support, it may result in widespread dissatisfaction.
• Confrontation. Considered the most effective means of resolving conflict, confrontation involves addressing the issue openly with knowledge and reason, seeking a solution through direct communication. For example, a nurse manager might directly address a conflict between two staff members by facilitating a mediated discussion to resolve their differences.
• Negotiation. This “give and take” process involves both sides making concessions to reach an agreement that satisfies both parties to some extent. For instance, during a staff meeting, nurses and management might negotiate shift schedules to balance personal preferences and unit needs.

Effective nursing management integrates crucial concepts to create a well-functioning healthcare environment . By organizing tasks and defining roles, clarity and efficiency are ensured. Delegation allows managers to focus on complex issues while empowering staff. Motivation, supervision, and coordination are vital for maintaining high performance and smooth operations. Conflict management strategies, including competitive and disruptive conflict resolution, ensure disputes are handled constructively, fostering a positive work atmosphere. By applying these principles, nursing managers can create a supportive and efficient workplace, leading to improved patient outcomes and higher staff satisfaction.

12 thoughts on “Nursing Management: Guide to Organizing, Staffing, Scheduling, Directing and Delegating”

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1.1 Overview

This textbook discusses professional and management concepts related to the role of a registered nurse (RN) as defined by the American Nurses Association (ANA). The ANA publishes two resources that set standards and guide professional nursing practice in the United States: The Code of Ethics for Nurses With Interpretive Statements and Nursing: Scope and Standards of Practice . The Code of Ethics for Nurses With Interpretive Statements establishes an ethical framework for nursing practice across all roles, levels, and settings and is discussed in greater detail in the “ Ethical Practice ” chapter of this book. The Nursing: Scope and Standards of Practice resource defines the “who, what, where, when, why, and how of nursing” and sets the standards for practice that all registered nurses are expected to perform competently. [1]

The ANA defines the “who” of nursing practice as the nurses who have been educated, titled, and maintain active licensure to practice nursing. The “what” of nursing is the recently revised ANA definition of nursing: “ Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.” [2] Simply put, nurses treat human responses to health problems and life processes and advocate for the care of others.

Nursing practice occurs “when” there is a need for nursing knowledge, wisdom, caring, leadership, practice, or education, anytime, anywhere. Nursing practice occurs in any environment “where” there is a health care consumer in need of care, information, or advocacy. The “why” of nursing practice is described as nursing’s response to the changing needs of society to achieve positive health care consumer outcomes in keeping with nursing’s social contract and obligation to society. The “how” of nursing practice is defined as the ways, means, methods, and manners that nurses use to practice professionally. [3] The “how” of nursing, also referred to as a nurse’s “scope and standards of practice,” is further defined by each state’s Nurse Practice Act; agency policies, procedures, and protocols; and federal regulations and ANA’s Standards of Practice.

State Boards of Nursing and Nurse Practice Acts

RNs must legally follow regulations set by the Nurse Practice Act by the state in which they are caring for clients with their nursing license. The Board of Nursing is the state-specific licensing and regulatory body that sets standards for safe nursing care and issues nursing licenses to qualified candidates based on the Nurse Practice Act. The Nurse Practice Act is enacted by that state’s legislature and defines the scope of nursing practice and establishes regulations for nursing practice within that state. If nurses do not follow the standards and scope of practice set forth by the Nurse Practice Act, they may be disciplined by the Board of Nursing in the form of reprimand, probation, suspension, or revocation of their nursing license. Investigations and discipline actions are reportable among states participating in the Nurse Licensure Compact (that allows nurses to practice across state lines) or when a nurse applies for licensure in a different state. The scope and standards of practice set forth in the Nurse Practice Act can also be used as evidence if a nurse is sued for malpractice.

Find your state’s Nurse Practice Act on the National Council of State Board of Nursing (NCSBN) website .

Read more about malpractice and protecting your nursing license in the “ Legal Implications ” chapter of this book.

Read Wisconsin’s Nurse Practice Act , Standards of Practice for Registered Nurses and Licensed Practical Nurses (Chapter N6) PDF,  and Rules of Conduct (Chapter N7) PDF .

Agency Policies, Procedures, and Protocols

In addition to practicing according to the Nurse Practice Act in the state they are employed, nurses must also practice according to agency policies, procedures, and protocols.

A policy is an expected course of action set by an agency. For example, hospitals set a policy requiring a thorough skin assessment to be completed when a client is admitted and then reassessed and documented daily.

Agencies also establish their own set of procedures. A procedure is the method or defined steps for completing a task. For example, each agency has specific procedural steps for inserting a urinary catheter.

A protocol is a detailed, written plan for performing a regimen of therapy. For example, agencies typically establish a hypoglycemia protocol that nurses can independently and quickly implement when a client’s blood sugar falls below a specific number without first calling a provider. A hypoglycemia protocol typically includes actions such as providing orange juice and rechecking the blood sugar and then reporting the incident to the provider.

Agency-specific policies, procedures, and protocols supersede the information taught in nursing school, and nurses can be held legally liable if they don’t follow them. It is vital for nurses to review and follow current agency-specific procedures, policies, and protocols while also practicing according to that state’s nursing scope of practice. Malpractice cases have occurred when a nurse was asked by their employer to do something outside their legal scope of practice, impacting their nursing license. It is up to you to protect your nursing license and follow the Nurse Practice Act when providing client care. If you have a concern about an agency’s policy, procedure, or protocol, follow the agency’s chain of command to report your concern.

Federal Regulations

Nursing practice is impacted by regulations enacted by federal agencies. Two examples of federal agencies setting standards of care are The Joint Commission and the Centers for Medicare and Medicaid Services.

The Joint Commission accredits and certifies over 20,000 health care organizations in the United States. The Joint Commission’s standards help health care organizations measure, assess, and improve performance on functions that are essential to providing safe, high-quality care. The standards are updated regularly to reflect the rapid advances in health care and address topics such as client rights and education, infection control, medication management, and prevention of medical errors. The annual National Patient Safety Goals are also set by The Joint Commission after reviewing emerging client safety issues. [4]  

The Centers for Medicare & Medicaid Services (CMS) is an example of another federal agency that establishes regulations affecting nursing care. CMS is a part of the U.S. Department of Health and Human Services (HHS) that administers the Medicare program and works in partnership with state governments to administer Medicaid. The CMS establishes and enforces regulations to protect client safety in hospitals that receive Medicare and Medicaid funding. For example, one CMS regulation often referred to as “checking the rights of medication administration” requires nurses to confirm specific information several times before medication is administered to a client. [5]

Standards of Practice

The ANA defines Standards of Professional Nursing Practice as “authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.” [6] These standards are classified into two categories: Standards of Practice and Standards of Professional Performance.

The ANA’s Standards of Practice describe a competent level of nursing practice as demonstrated by the critical thinking model known as the nursing process . The nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation and forms the foundation of the nurse’s decision-making, practice, and provision of care. [7]

Read more information about the nursing process in the “ Nursing Process ” chapter of Open RN Nursing Fundamentals, 2e . [8]

The ANA’s Standards of Professional Performance “describe a competent level of behavior in the professional role, including activities related to ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, and environmental health. All registered nurses are expected to engage in professional role activities, including leadership, reflective of their education, position, and role.” [9] This book discusses content related to these professional practice standards. Each professional practice standard is defined in the following sections with information provided to related content in this book and the Open RN Nursing Fundamentals, 2e textbook. [10]

The ANA’s Ethics standard states, “The registered nurse integrates ethics in all aspects of practice.” [11]

Read about ethical nursing practice in the “ Ethical Practice ” chapter of this book.

The ANA’s Advocacy standard states, “The registered nurse demonstrates advocacy in all roles and settings.” [12]

Read about nurse advocacy in the “ Advocacy ” chapter of this book.

Respectful and Equitable Practice

The ANA’s Respectful and Equitable Practice standard states, “The registered nurse practices with cultural humility and inclusiveness.”

Read about cultural humility and culturally responsive care in the “ Diverse Patients ” chapter in Open RN Nursing Fundamentals, 2e . [13]

Communication

The ANA’s Communication standard states, “The registered nurse communicates effectively in all areas of professional practice.” [14]

Read about communicating with clients and team members in the “ Communication ” chapter in Open RN Nursing Fundamentals, 2e . [15]

Read about interprofessional communication strategies that promote client safety in the “ Collaboration Within the Interprofessional Team ” chapter of this book.

Collaboration

The ANA’s Collaboration standard states, “The registered nurse collaborates with the health care consumer and other key stakeholders.” [16]

Read about strategies to enhance the performance of the interprofessional team and manage conflict in the “ Collaboration Within the Interprofessional Team ” chapter of this book.

The ANA’s Leadership standard states, “The registered nurse leads within the profession and practice setting.” [17]

Read about leadership, management, and implementing change in the “ Leadership and Management ” chapter of this book.

Read about assigning, delegating, and supervising client care in the “ Delegation and Supervision ” chapter of this book.

Read about tools for prioritizing client care and managing resources for the nursing team in the “ Prioritization ” chapter of this book.

The ANA’s Education standard states, “The registered nurse seeks knowledge and competence that reflects current nursing practice and promotes futuristic thinking.” [18]

Read about professional development and specialty certification in the “ Preparation for the RN Role ” chapter of this book.

Scholarly Inquiry

The ANA’s Scholarly Inquiry standard states, “The registered nurse integrates scholarship, evidence, and research findings into practice.” [19]

Read about integrating evidence-based practice into one’s nursing practice in the “ Quality and Evidence-Based Practice ” chapter of this book.

Quality of Practice

The ANA’s Quality of Practice standard states, “The nurse contributes to quality nursing practice.” [20]

Read about improving quality care and participating in quality improvement initiatives in the “ Quality and Evidence-Based Practice ” chapter of this book.

Professional Practice Evaluation

The ANA’s Professional Practice Evaluation standard states, “The registered nurse evaluates one’s own and others’ nursing practice.” [21]

Read about nursing practice within the legal framework of health care, negligence, malpractice, and protecting your nursing license in the “ Legal Implications ” chapter of this book.

Read about reviewing the interprofessional team’s performance, providing constructive feedback, and advocating for client safety with assertive statements in the “ Collaboration Within the Interprofessional Team ” chapter of this book.

Resource Stewardship

The ANA’s Resource Stewardship standard states, “The registered nurse utilizes appropriate resources to plan, provide, and sustain evidence-based nursing services that are safe, effective, financially responsible, and used judiciously.” [22]

Read more about health care funding, reimbursement models, budgets and staffing, and resource stewardship in the “ Health Care Economics ” chapter of this book.

Environmental Health

The ANA’s Environmental Health standard states, “The registered nurse practices in a manner that advances environmental safety and health.” [23]

Read about promoting workplace safety for nurses in the “ Safety ” chapter in Open RN Nursing Fundamentals, 2e. [24]

Read about fostering a professional environment that does not tolerate abusive behaviors in the “ Collaboration Within the Interprofessional Team ” chapter of this book.

Read about addressing the impacts of social determinants of health in the “ Advocacy ” chapter of this book.

• American Nurses Association. (2021). Nursing: Scope and standards of practice (4th ed.). American Nurses Association. ↵
• The Joint Commission. https://www.jointcommission.org ↵
• Centers for Medicare and Medicaid Services. https://www.cms.gov/ ↵
• Nursing Fundamentals, 2e by Chippewa Valley Technical College is licensed under CC BY 4.0 ↵

“Nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. Nursing is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities, and populations in recognition of the connection of all humanity.”

The state-specific licensing and regulatory body that sets standards for safe nursing care and issues nursing licenses to qualified candidates, based on the Nurse Practice Act.

Law enacted by a state’s legislature that defines the scope of nursing practice and establishes regulations for nursing practice within that state.

An expected course of action set by an agency.

An official way of completing a task.

A detailed, written plan for performing a regimen of therapy.

Authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.

Standards describing a competent level of nursing practice as demonstrated by the critical thinking model known as the nursing process. The nursing process includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation.

Includes the components of assessment, diagnosis, outcomes identification, planning, implementation, and evaluation.

Standards describing a competent level of behavior in the professional nursing role, including activities related to ethics, advocacy, respectful and equitable practice, communication, collaboration, leadership, education, scholarly inquiry, quality of practice, professional practice evaluation, resource stewardship, and environmental health.

Nursing Management and Professional Concepts 2e Copyright © by Chippewa Valley Technical College is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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The new nurse manager survival guide, part II

Cathcart, Eloise Balasco MSN, RN, FAAN

Eloise Balasco Cathcart is a clinical associate professor and the director of the graduate program in nursing administration at New York University's Rory Meyers College of Nursing in New York, N.Y.

Acknowledgments: The author would like to acknowledge her students Alexa Bichenough, Kathryn Bunt, Sam Campbell, Jessica Parra, Sarah Gerber, and Nik Zuyev and the contributions of Dr. Patricia Benner.

The author has disclosed no financial relationships related to this article.

Leading in a time of crisis

We created this series to offer new nurse managers basic tenets of leadership to help them succeed in this pivotal organizational role. Little did we imagine the chaos and disruption that were in store for all of us as the coronavirus pandemic has changed life as we know it. Hospitals have been reconfigured for the sole purpose of creating maximum capacity for infected patients. Elective surgeries and routine procedures have been canceled; ORs and postanesthesia care units have been turned into patient care units to provide ventilator support with anesthesia machines when there are no more ICU beds.

New protocols are being created and implemented in real time as physicians and nurses learn what to do and when to do it as they go. Clinicians are required to make immediate choices about how to best care for huge numbers of very sick patients who appear in EDs with breathtaking rapidity, and the ethics of allocating scarce resources when the pace is fast and actions need to be decisive have their own emotional toll. 1 Rigid hierarchies and siloed fiefdoms that have characterized hospitals are rapidly breaking down as new models of teamwork take hold. This energy pulsating in hospitals is in sharp contrast to the eerily empty streets outside silenced by shelter-in-place orders. 2

No nurse manager practicing today has experienced anything like the coronavirus pandemic; this will be a formative event for all nurses as we move into an unknown future. None of us has managed this degree of chaos, complexity, and uncertainty before so, in a sense, we're all new nurse managers trying to find our way. Here are some things to think about that may be helpful to you as you navigate this new reality.

Embrace your leadership role, even if you're uncertain about what to do

This time of crisis highlights the importance of the crucial organizational role you have as a nurse manager. You're the linchpin that holds a COVID-19 unit together, ensuring that patients get the best possible care. You're also the connector between patients and senior hospital leaders. It may be necessary for you to assume responsibility that you don't feel quite ready to take on. But rather than succumbing to fears and self-doubt, you may find yourself propelled by your core conviction that COVID-19 patients deserve excellent nursing care and you can help make that happen.

Know who your clinical and administrative resources are before you begin each day and never hesitate to ask for help in any situation when you need it. Asking questions to gather more information or clarify issues will give you the reassurance to proceed with your decision or find a new course of action. Remember that you have proven clinical skills and good judgment, so trust yourself when you must make an immediate call. If you're uncertain, think about a leader you want to emulate and imagine how he or she would act in this situation. Practice being like that leader because this is an important way we all learn how to shape our own leadership practice.

As a new or experienced nurse manager, you may find yourself on your own reconfigured unit or in a new physical location with your own staff or new staff members whom you don't know, some or all of whom are learning to care for ventilated ICU patients in real time. Take time to meet new nurses individually; be sure they know who you are and that you're there to support them. Connecting them to a more experienced nurse who can be an immediate resource may alleviate some of their anxiety and foster trust in you and their colleagues that will help them feel safe.

It's important to be visible and available to engage in patient care so that you can assess how individual members of your team are coping and see for yourself the demands and new challenges presented by caring for COVID-19 patients. Remember to do things that focus on staff wellness. Since wearing a mask all day is a barrier to drinking and eating, have water and healthy snacks readily available and remind staff members to stay hydrated and maintain their energy levels. Be sure individuals are taking regular breaks.

You may be asked to open a new COVID-19 unit on short notice. Your organization may have a special team to handle the logistics of doing this or you may need to reach out to several other hospital departments and coordinate their individual efforts. Although others are doing the actual work of setting up the unit, as the nurse manager you'll still need to be sure the unit is safe and ready for patients and staff. Are the beds configured in the best possible way? How many staff members do you need to provide care? What's the appropriate skill mix of nurses and patient care technicians? Is there someone to answer phones and be a central point of communication for you and the staff? Remember that some staff members will undoubtedly become ill or test positive for the virus and need to be out for long periods of time. How will you replace them?

If possible, negative pressure air flow or high-efficiency particulate air filters should be installed in patient rooms. You'll want to be sure there are sufficient levels of supplies for patients and enough personal protective equipment for staff members so they're safe, but shortages may likely occur. Try to preempt problems by working closely with supply chain managers to procure what your team needs and tap into the resourcefulness of nurses to preserve existing equipment. The pharmacy department will need to supply the unit with medication dispensing equipment and you'll need to be sure that all staff have access to it. What kind of documentation is required during this time of crisis? Are there enough computers to facilitate communication and documentation?

There will be many other details that need your attention, and some you'll surely forget until the need arises. Don't hesitate to reach out to a more experienced nurse manager colleague or your director for help in mobilizing other hospital departments. Remember that these are extraordinary times—no one has done this before and we're all learning.

Now, more than ever, your comportment is your most important management tool

Nurses are experiencing fears about physical and psychological safety at a very basic level while at the same time demonstrating acts of true heroism and unbounded compassion. One CNO described staff members as being “fearless, scared, exhausted, numbed, tearful, displaying every emotion possible,” so you as the nurse manager will find yourself coping with a whirlwind of human responses. Nurses are facing patient assignments that were unfathomable weeks ago as new blueprints to organize patient care are now created in real time, often with unfamiliar coworkers. Scarce resources necessitate the need for immediate gut-wrenching ethical decisions about who gets what kind of care.

For nurses to safely practice in this chaotic environment and meet these unrelenting demands, it's most important for you as the nurse manager to stay calm and focused. 3 Many nurses are grieving for a world that's irrevocably changed and feeling unsafe because they don't know what's to come. 4 Nurses who practice in non-ICU areas feel trepidation at the thought of providing care to four or more ventilated patients. Those who aren't yet reassigned may be anxious as they wait to hear where they'll be needed or may feel guilty about not being on the frontline of care.

One of the most important priorities you can establish for yourself is to be visible and stay connected to staff. As you strive to meet individuals where they are emotionally, it's okay to relax your boundaries a bit so you can connect with your staff on a very real and human level. This is a time to give people more room to express their feelings. For some people, the stress may be overwhelming, and their behavior will be distracting and disruptive. It may be necessary to listen, acknowledge the individual's feelings, and redirect behaviors to ones that support the team.

Express a vision for the day and acknowledge short-term wins

In your start-of-shift huddle, remind staff members that today's goal is to get patients and themselves safely through the day. People can keep going if they know where they're headed and why, so it's important to reiterate what we as nurses believe, what we're there for, and what matters most. 5 Honor the courage and persistence of clinical nurses who've chosen to walk toward this crisis rather than walk away. In your communications, focus on facts, not opinions or hunches. Your unit may feel very intense and somber; there's lots of difficult news, but denying reality makes people assume you're out of touch. (See The devastating effects of COVID-19 on patients and staff .)

Staying focused on the present and acknowledging the small wins that come from a team working together to do their best can help bolster staff morale. Share instances when patients are extubated or discharged from the hospital to help staff remember that there are patients who survive. When things go wrong, and they will, let go of judgment as you ask, “How could we have done better?” Talk with your staff about how we're all learning to do this together; there are no established rules or protocols to guide the way.

Keep the voice of the clinical nurse in the conversation

The practice itself is always the best teacher, and good leaders look to nurses engaged in direct patient care for answers in challenging situations. The best way to understand the coronavirus pandemic isn't by listening to newscasts or briefings but by tuning in to the distress on the frontlines. 7 Intentionally creating opportunities for nurses to speak about their experiences will validate the value and worth of the incredible work they're doing and lessen the tremendous burden they carry. Collecting exemplars of best practice will allow us to reimagine how we should model care going forward if there's a second wave or when these days are behind us. Just as many nurses caring for COVID-19 patients are reconnecting to the values, ethics, and passion that brought them into the profession, this pandemic may be an opportunity for nurses to use the same passion to own their practice in new ways.

Some nurses may choose to share their experiences with the public in newspaper op-ed pieces or on social media. You can help nurses learn to do this responsibly by teaching them to express themselves in ways where their message can be heard and the focus is on the goals, challenges, and outcomes of their work.

How can I possibly do this?

The extra emotional challenges and health risks to nurse managers during this time can be daunting. There's no way to sugarcoat that truth. One new nurse manager described it this way, “Each day as I enter the hospital, I take a deep breath, not knowing what I'm going to encounter during that workday. It's a feeling that brings initial trepidation, but through mindfulness I've channeled that energy into grit and determination. It's easy to get caught up in the frenzy and become unfocused in the chaos, but one thing I've learned is to take the day 1 hour at a time. When I feel overwhelmed, I remind myself why I went into the profession. I wanted to make a difference, help others, and provide purpose.”

Give yourself permission to feel the wide range of emotions you have and recognize that we all cope differently. Control what you can and practice letting go of those things that are beyond your control. Hard as it may be to do, this is the time to practice healthful behaviors in terms of eating, sleeping, regularly exercising, and using whichever mind-focusing activity helps you relax. Cut down on how often you engage in venues where fear feeds on itself, such as social media, cable news, and frenzied conversations with friends and coworkers. This isn't to say you should bury your head in the sand but do your best to distinguish between people who are speculating and those who have sound information. Seek out positive, high-quality connections with others, even if they're virtual. These practices may help you build the calm and positivity that you want to pass along to your staff and colleagues. 8

Being optimistic about the future and at the same time being realistic is important. As you think about how to build on the good that comes from this time of extraordinary challenge and sadness, ask yourself how you've learned to focus your mind, control your stress, excel under pressure, work through fear, build courage, and adapt to adversity. Knowing these things about yourself can help you develop the spiritual and ethical resilience that will form you into a great leader who can transport people emotionally and sometimes literally from this place into a post COVID-19 world of healthcare. 9 In many ways, this crisis is a key leadership moment and, in fact, may be your finest hour. 10

The devastating effects of COVID-19 on patients and staff

Patients with COVID-19 often present a confounding clinical picture of seemingly improving over days and then worsening precipitously, requiring emergency intubation and complex treatment for the ensuing organ failure. Clinical instincts honed by observing patterns in disease pace and trajectory suddenly seem insufficient and unreliable. 2 Dr Adam Brenner, who oversees the ICU at Mount Sinai Brooklyn, recently wrote in the New York Intelligencer Diary of a Hospital blog, “There are so many theories about what this is and the best way to manage it, and it just suggests to me that nobody really knows.” 6 Clinicians find themselves launching new practices without guarantees of success and despite their best efforts, many patients will die, often in rapid succession. The unrelenting death toll of both young and old patients is traumatic for clinicians who've given their all to help patients survive. Many are overwhelmed and struggling to hold on to shreds of hope.

Nurses have spoken movingly about the weight of being the only person present with patients as they're dying, and the dilemmas created by deciding whether and how to allow family to be with patients at the moment of death. One nurse said, “It's heartbreaking to know that you're that person's everything. The weight of trying to fill the shoes of the people who can't be there is really heavy.” Always at the back of every clinician's mind is the danger of contracting the virus or bringing it home to their family. Many have chosen to isolate from family members, denying themselves the comfort and support that comes from meaningful connection. Physicians and nurses have become more dependent on and responsible to each other as the work family becomes a source of psychological protection and emotional support.

Managing staff members who are incessantly working long hours day after day under intense conditions to preserve life is something most of us have never done. You'll need to muster courage and perseverance you didn't know you had to do it. Your presence, support, and compassion and your willingness to lift the burden of care, even temporarily, will be what matters to staff members navigating untested waters and doing the very hard clinical and emotional work that's required of them. Helping nurses appreciate the value of care when cure isn't possible may help give meaning to the incredible work they're doing, even when death is the outcome. Pointing out the simple and specific ways in which a patient's dignity and humanity were protected in the midst of chaos may sustain the team. One New York City ED team have adopted the practice of honoring dying patients by stopping for 10 seconds, bowing their heads, stating the patient's name, and asking for silence. Some staff members may need real-time emotional support and you can help by making mental health professionals, clergy, and grief counselors available to them.

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Introduction to Nursing Management and Leadership

This course presents exploration of more complex leadership principles in the role of the RN as a manager of healthcare teams, organizations, financial resources, information technology, human resources, and oneself as a member of the healthcare profession. Concepts presented include application of knowledge, judgment, critical-thinking skills, and professional values within a legal and ethical framework. This course focuses on the students’ development of clinical judgment; leadership skills; knowledge of the rules and principles for delegation of nursing tasks; Involvement of clients in decision making and a plan of care; Participation in quality improvement processes to measure client outcomes and identify hazards and errors using case studies.

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

Introduction

This is an open educational resource with CC-BY licensing. It has been developed specifically for pre-licensure nursing students preparing to graduate and take the NCLEX-RN to obtain their nursing license. It is a remixed version of the Nursing Management and Professional Concepts OER and the content has been updated based on the Texas State University St. David’s School of Nursing nursing curriculum Leadership and Management of Nursing Care course (NURS 4351), the 2019 NCLEX-RN Test Plan, [1] and the Texas Nurse Practice Act. [2]

This book introduces concepts related to nursing leadership and management, prioritization strategies, delegation and supervision, legal implications of nursing practice, ethical nursing practice, collaboration within the interprofessional team, health care economics, quality and evidence-based practice, advocacy, preparation for the RN role, and the avoidance of burnout with self-care. Several online, interactive learning activities are included in each chapter that encourage application of content to patient care situations.

The e-book is free and can be viewed online or downloaded as a PDF or other formats for offline use. Affordable print versions are also published in collaboration with XanEdu and are available on Amazon and in college bookstores.

The following video provides a quick overview of how to navigate the online version.

• NCSBN. (n.d.). 2019 NCLEX-RN test plan. https://www.ncsbn.org/2019_RN_TestPlan-English.htm ↵
• Texas State Legislature. (2021).Texas Board of Nursing. https://www.bon.texas.gov/laws_and_rules_nursing_practice_act.asp ↵

Leadership and Management of Nursing Care Copyright © 2022 by Kim Belcik and Open Resources for Nursing is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

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• Administration (Flow Chart 1.1)
• Basic Definition Needs to be Expanded
• Difference between Administration and Management
• Characteristics of Management
• Management as a Discipline
• Management as a Body of Individuals
• Management as a Process
• Management as a Profession
• Management as a Financial Resource
• Management as a Human Process
• Some of the Other Concepts of Management
• Is it a SCIENCE or an ART?
• Management is a Science as Well as an Art
• LEVELS OF MANAGEMENT
• Production Management
• Marketing Management
• Finance and Accounting Management
• Personnel Management
• Controlling
• Coordination
• Interpersonal Roles
• Informational Roles
• Decisional Roles
• Functions and Role of Nursing Managers
• Globalization
• Workforce Diversity
• Entrepreneurship
• Managing in an e-Business World
• Knowledge Management and Learning Organizations
• Quality Management
• Technical Skills
• Human Skills
• Conceptual Skills
• Design Skill
• Basic Principles and Theories of Management by FW Taylor
• Division of Work
• Authority and Responsibility
• Unity of Command
• Unity of Direction
• Subordination of Individual to General Interest
• Remuneration
• Centralization
• Scalar Chain
• Stability of Tenure
• Esprit de Corps
• Deming’s 14 Principles of Management
• Scientific Management
• General Administrative Theorists
• Quantitative Approach to Management
• Organizational Behavior
• The Systems Approach
• The Contingency Approach
• Hertzberg’s Two Factor Theory of Management
• Douglas MCGregor (1906–1964)
• Abraham H Maslow (1908–1970)
• Factors within Human
• Factors within Employee
• Frederick W Taylor (1856–1915)
• Gantt HenryIGantt (1861–1910)
• Emerson (1853–1936)
• Charles Babbage (1792–1871)
• Follett Theory (1868–1933)
• Lewin Theory (1890-1947)
• Douglas McGregors Theory (1932)
• Factors Measured by Likert Scale
• PRINCIPLES OF ADMINISTRATION APPLICABLE TO ALL ORGANIZATION BY LYNDAL URWICK
• Responsibilities
• General Duties (or) Roles of Nursing Manager in Hospital
• INTRODUCTION OF PLANNING
• MEANING OF PLANNING
• DEFINITION OF PLANNING
• CHARACTERISTICS OF GOOD PLANNING
• Comprehensive Financial Planning
• General Philosophy of Planning
• Primacy of Planning
• Planning a Process
• Examples of Planning
• Future Orientation
• Information Base
• Rationality
• Formal and Informal Nature
• Intellectual Process
• Pragmatic, Action Oriented
• Decision Making
• PURPOSE (OR) MISSION OF PLANNING
• IMPORTANCE OF PLANNING
• Establishing Objectives
• Establishment of Planning Process
• Determining Alternative Courses
• Evaluation of Alternatives
• Selecting a Course of Action
• Formulating Derivative Plans
• Establishing Sequence of Activities
• Feedback (or) Follow-up Action
• Steps in Planning Process
• Barriers of Effective Planning
• TYPES OF PLANNING
• Seven Principles of Planning Process
• Advantages of Planning
• Disadvantages of Planning
• Operation Plan Include Analysis and Discussions of
• Operation Plan Should Contain
• Importance of Operational Plan (Flow Chart 2.2)
• ORGANIZATION
• INTRODUCTION OF ORGANIZATION
• DEFINITION OF ORGANIZATION
• Organization as a Structure
• Organization as a Process
• NATURE/CHARACTERISTICS OF ORGANIZATION
• IMPORTANCE OF ORGANIZATION
• Span of Control
• Party Authority and Responsibility
• Unity of Objectives
• Scalar Principles
• Flexibility
• Leadership Facilitation
• EFFECTIVENESS OF NURSING ORGANIZATION
• The following are the sequential steps of staffing responsibilities
• Meaning of Staffing
• PHILOSOPHY OF STAFFING IN NURSING
• OBJECTIVES OF STAFFING IN NURSING PROFESSION
• NEEDS AND IMPORTANCE OF STAFFING
• Manpower Planning
• Job Analysis
• Recruitment
• Selection and Placement
• Training and Development
• Performance Appraisal
• Compensation
• Promotion and Transfer
• STAFFING FORMULAS
• Teaching Staff
• External Teachers
• Non-teaching Staffs
• Normal Position of Nursing Staff in the Hospital
• Staffing Studies
• Patient Classification Systems
• Advantages and Disadvantages of Various Scheduling Methods of Staffing in the Hospital
• Advantages and Disadvantages of Variable Staffs Duties Timing in the Hospitals in India
• HUMAN RESOURCE MANAGEMENT
• INTRODUCTION
• DEFINITION OF HUMAN RESOURCE MANAGEMENT
• CHARACTERISTICS OF HUMAN RESOURCES
• OBJECTIVES OF HUMAN RESOURCE MANAGEMENT
• SCOPE OF HUMAN RESOURCE MANAGEMENT
• Corporate Significance
• Professional Significance
• Social Significance
• National Significance
• Managerial Functions
• Operative Function
• RECRUITMENT
• INTRODUCTION OF RECRUITMENT
• DEFINITION OF RECRUITMENT
• Internal Sources of Recruitment
• External Sources of Recruitment
• PROCESS OF RECRUITMENT
• METHODS OF RECRUITMENT
• INTRODUCTION OF SELECTION
• Development of Employees
• Difference Between Selection and Recruitment of Employees
• RETAINING OF EMPLOYEES
• SUPERANNUATION (RETIREMENT PLAN)
• Advantages of promotion policy
• INTRODUCTION OF BUDGETING
• MEANING OF BUDGET
• PURPOSE OF BUDGETING
• IMPORTANCE OF BUDGET
• Advantages of Budgeting
• Disadvantages of Budgeting
• OBJECTIVES AND FUNCTIONS OF BUDGETING
• PROCESS OF BUDGETING
• PRINCIPLES OF BUDGETING
• INTRODUCTION OF DIRECTION
• DEFINITION OF DIRECTION
• ELEMENTS OF DIRECTION
• NEEDS OF DIRECTION
• CHARACTERISTICS OF GOOD DIRECTION
• IMPORTANCE OF DIRECTION
• PRINCIPLES OF DIRECTION
• Nature and Features of Direction
• Advantages of Direction
• Disadvantages of Direction
• COORDINATING AND CONTROLLING
• MEANING OF CONTROLLING
• End function
• Forward Looking
• Exercised at all levels
• Identified with Individuals
• No Curtailment of Rights
• Managerial Statistics
• Special Reports
• Breakeven Points
• Internal Audit
• Cost Accounting
• Personal Observation
• Need Oriented
• Detecting Deviation
• Defining Exceptions
• Objective oriented
• Simple and Easy
• Role of Leadership in Quality Control
• Role of Management in Quality control
• Meaning of Coordination
• Definition of Coordination
• Nature of Coordination
• Characteristics of Good Coordination
• PURPOSE OF COORDINATION
• IMPORTANCE OF COORDINATION
• PRINCIPLES OF COORDINATION
• MATERIAL MANAGEMENT
• INTRODUCTION OF MATERIAL MANAGEMENT
• Components of Material Management
• Objectives of Materials Management
• Acquisition of Required Items can be done by Following Methods
• Method of purchase
• Different types of Cost
• Method of Analysis
• Primary Objectives
• Secondary Objectives
• FUNCTIONS OF MATERIAL MANAGEMENT
• Basic principles of material management
• PROGRAM EVALUATION REVIEW TECHNIQUE (PERT)
• MEANING OF PERT
• Techniques and Procedures to Assist Project Managers
• PERT and Applicability
• Critical Path Method
• Purpose of Using PERT
• Steps in PERT
• Elements of PERT
• GANTT CHARTS
• PURPOSE OF GANTT CHARTS
• Advantages and Disadvantages of Gantt Chart
• BENCH MARKING
• INTRODUCTION OF BENCH MARKING
• Collection of Information
• Analysis of Data
• Implementation
• NURSING AUDIT
• Purposes of Nursing Audit
• Method to Develop Criteria
• Training for auditors should include the following
• Steps to Problem Solving Process in Planning Care
• Outcome Audit
• Process Audit
• Structure Audit
• Advantages of Nursing Audit
• Disadvantages of the Nursing Audit
• Hospital Design
• Public Hospitals
• Voluntary Hospitals
• Private Nursing Hospitals (or) Homes
• Corporate Hospitals
• Classification According to the Objectives
• Classification According to Size
• Classification According to management
• Patient Care Units
• Natural Disasters
• Man Made Disaster (Unintentional)
• Man Made Disaster (Intentional)
• Disaster Management
• Principles of Emergency Management
• Aim of Disaster Plans
• Disaster Management Committee
• Disaster Control Room
• Rapid Response Team
• Information and Communication
• Disaster Beds
• Logistic Support Systems
• Training and Drills:
• Elements of Disaster Plan
• Fields that are under this Definition Include
• Phases and Professional Activities
• Preparedness
• Structural Mitigation
• Non-structural Mitigation
• Airport Emergency Preparedness Exercise
• As a Profession
• International Association of Emergency Managers
• Red Cross/Red Crescent
• European Union
• International Recovery Platform
• Terminology
• Assess the Community
• Community Disaster Planning
• Implement Disaster Plans
• Evaluate Effectiveness of Disaster Plan
• Relation of Human Resource Objectives with Activities or Functions
• Channels of Recruitment
• Step 1: Preliminary Reception
• Step 2: Employment Test
• Step 3: Selection Interview
• Step 4: References and Background Checks
• Step 5: Medical Evaluation
• Step 6: Supervisory Interview
• Step 7: Realistic Job Previews
• Step 8: Hiring Decision
• Purpose of Orientation
• Content of Orientation Programs
• Responsibility for Orientation
• Orientation Follows-up
• Topics Often Covered in Employee Orientation Programs
• Objectives of Compensation Administration
• Phase I: Job analysis: (Identify and study job)
• Phase II: Job Evaluation (Internal Equity)
• Phase III: Wage and Salary Surveys (External Equity)
• Phase IV: Pricing Jobs (Matching Internal and External Work)
• RETENTION OF EMPOLYEE
• TEN WAYS TO RETAIN A GREAT EMPLOYEE
• PATIENT CLASSIFICATION AND NURSE STAFFING SYSTEM
• Level I: Minimal Nursing Care
• Level II: Partial Nursing Care
• Level III: Full Nursing Care
• Level IV: Complex Nursing Care
• Level IV: Complex ICU Care
• TIME REQUIRED EACH LEVEL OF CARE
• Employee Mix
• Distribution Per Shift
• Need for Staff Development
• Principles Involved in Staff Development
• Staff Development Philosophy
• Staff Development Model for Goal Achievement of the Health Care Agency, the Nurse and Nursing Profession
• Educational Component Includes
• Socioeconomic Component
• Components of Staff Development
• FACTORS INFLUENCING STAFF DEVELOPMENT PROGRAMS
• FUNCTIONS OF STAFF DEVELOPMENT PERSONNEL
• PROGRAMS FOR STAFF DEVELOPMENT
• OTHER ACTIVITIES OF STAFF DEVELOPMENT
• Inservice Education
• Aim of Inservice Education
• Concepts of Inservice Education (Flow Chart 3.1)
• Characteristics
• FACTORS INFLUENCING INSERVICE EDUCATION
• APPROACHES TO INSERVICE EDUCATION
• CONTINUING EDUCATION
• Philosophy of Continuing Education
• Planning for Continuing Education
• The Planning Formula
• Steps in The Planning Process
• ROLES: He/She:
• Meaning of Budget
• BUDGET FOR NURSING UNIT
• STEPS IN PREPARING A SUCCESSFUL BUDGET PROPOSAL
• Material Management Integrates all Materials Functions
• Material Planning
• Aim of Material Management Planning
• Purpose of Material Management Planning
• Basic Principles of Material Management Planning
• Elements of Material Management Planning
• Objectives of Procurement System
• Procurement Cycle
• Points to Remember while Purchasing
• Procurement Steps
• Inventory Control
• Objectives of Inventory Control
• ABC Analysis
• FSN Analysis
• Ved Analysis
• HML Analysis
• ABC and VED Analysis (Matrix Module: Criticality Vs Cost)
• DELEGATION AND DISCIPLINE
• Principles of Delegation
• The Five Rights of Delegation
• Right Supervision/Evaluation
• Ways or Steps for Nurse Managers to Successfully Delegate
• Barriers in the Delegator
• Barriers in the Delegate
• Barriers in the Situation
• Benefits for the Delegating Nurse
• Benefits for Team Members
• Benefits for the Organization
• Definition of Supervision
• Objectives of Supervision
• Factors of Effective Supervision
• Human Relations Skills
• Technical and Managerial Knowledge
• Leadership Position
• Improved Upward Relation
• Relief from Non-supervisory Duties
• General and Loose Supervision
• Functions of Supervision
• Principles of Supervision
• Qualities of a Good Supervisor
• Others Qualities
• Styles of Supervision
• Types of Supervision
• Method of Supervision
• Techniques of Supervision
• Tools for Supervision
• Implement Standards, Policies, Procedures and Practices
• Characteristics of Standard
• Purposes of Standards
• Major Objectives of Publishing, Circulating and Enforcing Nursing Care Standards are to:
• Sources of Nursing Care Standards
• Classification of Standards
• Legal Significance of Standards
• To Recover Losses from a Charge of Malpractice, a Patient Must Prove that
• Aims and Objectives of Discipline
• Types of Discipline
• Essential in Disciplinary Action
• Disadvantages of Suspension
• Components of a Disciplinary Action Program
• Approaches of Discipline
• The Five Pillars of Self-Discipline
• Constructive Vs Destructive Discipline
• Dealing with Disciplinary Problems
• Disciplinary Proceedings Enquiry in Management
• General Civil Services Rules
• Causes of Disciplinary Proceedings
• Stages of Disciplinary Proceeding Enquiry
• CONTROLLING/EVALUATION
• CHARACTERISTICS OF CONTROLLING
• Relationship between Planning and Controlling
• NURSING ROUNDS
• PURPOSES OF NURSING ROUNDS
• Methods of Conducting Nursing Rounds
• Requirements
• Guidelines to Write Nursing Protocols
• QUALITY ASSURANCE
• CONCEPT OF QUALITY ASSURANCE
• Credentialing
• Accreditation
• Certification
• Peer Review
• Standard as a Device for Quality Assurance
• Audit as a Tool for Quality Assurance
• System Model
• ANA Quality Assurance Model
• Donabedian Model (1985)(Flow chart 3.2)
• Quality Health Outcome Model (Flow chart 3.3)
• Plan, Do, and Study, Act Cycle
• Step 1: Setting Standards
• Step 2: Assign Responsibility to Individual or Committee
• Step 3: Delineate Scope of Care
• Step 4: Identify Important Aspects of care
• Step 5: Determining Criteria
• Step 6: Data Collection
• Step 7: Evaluating Performance
• Step 8: Problem Identification
• Step 9: Problem solution (Flow Chart 3.2)
• Step 10: Monitoring and Feedback
• FACTORS AFFECTING QUALITY ASSURANCE IN NURSING CARE
• Objectives of Performance appraisal
• Ranking Method
• Forced Distribution Method
• Critical Incident Techniques
• Checklists and Weighted Checklists
• Unique Features and Advantages of Mbo
• The 360 Degree Performance Appraisal (Flow Chart 3.6)
• Performance Appraisal Process
• RECORDING AND REPORTING
• Purposes of Records
• Principles of Record Writing
• Benefits of Maintaining of Records
• Types of Records
• In Hospital
• In Community Setting
• Related to Nursing Education
• Purposes of Reports
• Types of Reports
• Reports Used in Hospital Settings
• NURSE’S RESPONSIBILITY FOR RECORD KEEPING AND REPORTING
• Organizational Design
• Purpose of Organization
• Objectives of Organization
• Principles of Organization
• Organization Specifies the Following
• Purpose of Organizational Structure
• Characteristics of line Organization Structure
• Personnel staff’s personnel management responsibilities
• Line and staff Organization Structure
• Organizational Effectiveness
• Classical Organization Theory
• Taylor’s Scientific Management Approach
• Weber’s Bureaucratic Approach
• Administrative Theory
• Principles of the Neoclassical Approach
• Modern Theories
• Choosing the Span
• Disadvantages
• Differences between Narrow Span and Wide Span
• Factors Influencing the Span of Supervision
• Importance of Communication
• Purposes of Communication
• Predictive Principles in Communication
• Intrapersonal Communication
• Interpersonal Communication
• Public or Group Communication
• Factors Influencing Communication
• Communication Process Model
• Organizational Communication
• Channels of Communication
• Media of Communication (Flow Chart 4.4):
• Barriers to Communication
• Management of Communication
• Nurse’s role in Communication
• Managing Action
• Ingredients of Leadership
• Definition of Leader
• Qualities of Good Leaders
• Interpersonal Skills
• Communication Skills
• Organizational Consciousness
• Creativity Skills
• Achieving Results
• Intelligent
• Fair minded
• Brief Mover
• Desire to serve others
• Empowering people
• Develop themselves
• Functions of Leader
• Types of Leaders
• There are Five Ways for the Leader to Act Assertively
• Accountability
• Factors Influencing Dynamic Leaders in Nursing
• Definition of Motivation
• Achievement Motivation
• Affiliation Motivation
• Competence Motivation
• Power Motivation
• Attitude Motivation
• Incentive Motivation
• Fear Motivation
• THEORIES OF MOTIVATION
• Definitions of Group
• Definition of Group Dynamics
• Essential Qualities of a Group
• Ability to Act in Unitary Manner
• Classification of Group
• Permanent Formal Groups
• Transference
• Group Functions
• Functions of Group Norms
• Selected Group Techniques
• Focus Group
• Group Dynamics
• Importance of Group Dynamics
• Techniques for Managing Group Dynamics
• Task groups
• Work Related Social Support
• Managerial Application of Group Dynamics Theory
• Factors Affecting Group Dynamics
• Significance of Group and Group Dynamics in Nursing
• Professional intimacy
• Differences Between Professional and Personal Relationships
• Understanding Interpersonal Relationship
• Warning Signals of Nurse Behavior
• Introduction
• Purpose of Interpersonal Relations
• Principles of Interpersonal Relations
• Type of Interpersonal Relations
• Task of Preinteraction Phases
• Tasks of Introductory (or) Orientation Phases
• Tasks of Working Phase
• Termination Phase
• Barriers of Interpersonal Relationship
• Factors Related to Interpersonal Relationship
• Techniques of Interpersonal Relationship in Positive Way
• Negative Way Approach
• Aims of Human Relation
• Nature of Human Relation
• Importance of Human Relation
• Human Relations in Context of Nursing
• Definition: As per WT Parry
• Public Relation by Include
• A Good PRO as Need
• Need for Public Relation:
• Functions of PRO/Executive
• Methods and Technique of Public Relation
• Public and Publication
• Radio and Television
• Film and Exhibition
• Advertising
• Public Speaking
• Research Opinion Survey
• Essentials of Public Relation
• Meaning of Conflict
• Definition of Conflict
• Philosophical and Historical Background of Conflict Management
• Characteristics of Conflict
• Types of Conflict
• Other Types
• Sources of Conflict
• Stages of Conflict
• Sublimation
• Vigorous physical activity
• Identification
• Rationalization
• Reaction formation
• Flight into fantasy
• Displacement
• Strategies for Conflict Resolution
• Resolving Interpersonal Conflict
• Negotiation
• Collaboration
• Team Approach
• Prevention of Conflict
• Definition of In-Service Education
• History of In-Service Education
• Objectives of In-Service Education
• Factors Affecting In-Service Education
• Centralized In-Service Training
• Decentralized In-Service Education
• Combined (or) Coordinated In-Service Training
• Measures to Improve Effectiveness
• Principles of In-Service Education
• Organization of In-Service Education
• METHODS OF IMPARTING IN-SERVICE EDUCATION
• Need for Continuing Education
• It has Certain Steps
• Scope of In-Service Education
• Definition of Evaluation
• Educational Program Evaluation
• Purpose of Evaluation
• Objectives of Evaluation
• Process of Evaluation
• Application of Principles of Evaluation
• Aims of Educational Program Evaluation
• Purpose and Benefits of Program Evaluation
• The Factors Influence the Adult Learning Process
• General Principles of Adult Learning
• Principles to be Followed During Learning Situation by Adults
• Adults Learn Best
• Use of Teaching Methods for Adult Learning
• Methods of Using Evaluating Staff Educational Program (or) In-Service Education
• Using Test for Evaluation of Staff Development Programs
• Techniques of In-Service Education
• Preparation of Report for In-Service Education
• Functions of Indian Nursing Council
• Post Basic BSc Nursing
• Start MSc Course
• PhD Nursing in India
• IGNOU; The People’s University
• Eligibility
• Philosophy of Nursing program
• Objectives of Nursing Program
• Regulatory Bodies in Nursing Profession
• Aims of Accreditation
• Functions of Accreditation
• Importance of Accreditation in Nursing
• Accreditation Process
• Purpose of Accreditation
• Criteria for Accreditation
• Process of Registration of School or College
• Application form
• Academic Committees for College/School of Nursing
• Minimum Standard Requirements
• Physical Facilities
• Clinical Facilities
• For School of nursing with 60 students (i.e. an annual intake of 20 students)
• Recruitment and Selection of Students
• Definition of Recruitment
• Wither and Davis
• Definition of Selection
• Admission Policies
• Other Points
• I. Selection Committee
• II Selection Policies
• III. Application Forms
• IV. Registration
• V. Orientation
• VI. Development of Master Plan
• VII. Parent Teacher Association (PTA)
• Faculty and Staff
• During Recruitment Administrator Utilize Appropriate Resources for Locating Potential Faculty
• Faculty Selection
• Job Description
• Objectives of Performance Appraisal
• Process of Performance Appraisal
• Methods of Performance Appraisal (Flow Chart 6.1)
• Advantages of Performance Appraisal
• Limitations of Performance Appraisal
• I. Promotion
• II Increments
• III Incentives
• IV Transfer
• VI In-service Education
• VII Continuing Education
• Purpose for Developing Faculty Competence
• Methods Used for Faculty Competence Development
• Role of Administrator to Develop Faculty Competence
• In-service Education
• Continuing Education
• Barriers to Faculty Development
• Curriculum Planning
• Criteria to Plan, Develop, and Implement Curricula
• Curriculum Foundation
• Definition of Curriculum Implementation
• The Teacher
• The Learners
• Resource Materials and Facilities
• Interest Groups
• The School Environment
• Culture and Ideology
• Instructional Supervision
• Definitions of Curriculum Evaluation
• Bureaucratic Evaluation
• Autocratic Evaluation
• Democratic Evaluation
• Norm-Referenced Evaluation
• Criterion-Referenced Evaluation
• Self-Evaluation
• Focuses of Evaluation
• Curriculum Objectives
• Curriculum Content and Methodology
• Curriculum Outcomes
• Formative Evaluation
• Summative Evaluation
• Evaluation Methods and Tools
• The Following Records and Reports to be Maintain School/College of Nursing
• Academic Performance of Each Class
• Faculty Records
• Nursing as a Profession
• Criteria of Profession
• Characteristics of a Profession
• International Code of Ethics in Nursing
• Characteristics of Professional Nurse
• Philosophy of Nursing
• Aim of ANM Nursing Program
• Role and Functions of Nurse
• Extended Role of a Nurse
• Expanded Role of the Nurse
• Role of Regulatory Bodies
• Major Objectives
• Organization and Administration
• The Governing Body
• Activities of ICN
• Functions of WHO
• Nursing in WHO
• Functions of INC
• Role of State Government
• Functions of TNAI
• Student Nurses Association
• Definition of Education
• Nursing Education
• Aims of Nursing Education
• Purpose of Nursing Education
• Evolution of Nursing Education in World
• Evolution of Nursing Education in India
• Trends in Nursing Education
• Basic Courses
• Nursing Education Future Trends
• Professional Issues in Nursing
• Issues in Nursing Education
• Issues of Nursing Research
• Issues of Nursing Administrator
• Definition of Profession
• Definition of Standards, Nursing Standards
• Purpose of Publishing, Circulating and Enforcing Nursing Care Standards
• Characteristics of Standards
• Sources of Nursing Standards
• Principles of Standards
• Types of Standards
• Definition of Law
• Sources of Law
• Functions of Law
• Principles of Law
• Types of Law (Flow Chart 7.1)
• Criminal law
• Who is a Consumer?
• Reliefs Under the Consumer Protection act
• Rights of Consumers as Patients
• Where to File a Complaint
• Framework of Human Rights
• Consumerism and Health Care Rights
• Right to Self-determination
• Right to the Whole Truth
• Right to Privacy
• Right to equal access to health care
• Consumer Protection Agencies
• Implications in Nursing
• National council of State Boards of Nursing as a Consumer Protection Organization
• Nursing Program (School) Approval
• Information Exchange
• Rights of the Consumer
• Responsible Person for File a Complaint
• Procedure to File a Complaint
• Implementation of the Act
• Problems of Consumer Protection Act
• Application of Consumer Protection Act to Doctors
• Definition of Continuing Education
• Methods of Obtaining Continuing Educations in Nursing and its Advantages and disadvantages
• Lifelong Learning Continuing Education Nursing Profession
• Continuing Nursing Education in Educational Institution
• Continuing Community Healthcare Education
• Continuing Education for Nurses
• Accredited Continuing Education Online Courses
• System Essentials
• Purpose of Nursing Continuing Education
• Licensing and Certification
• Continuing Education Units
• Considerations
• Record Keeping
• Career Opportunities in Nursing Profession
• Licensed Practical Nursing
• Associate’s Degree/Registered Nurse
• Bachelor’s Degree with a Major in Nursing/Registered Nurse
• Master’s Degree/Advanced Practice Registered Nurse and Doctoral Degree (PhD and DNP)
• Nursing Homes
• Home-health
• Public Health
• Occupational Health or Industrial Nurses
• Leadership Positions
• Teaching positions at Hospitals and Colleges and Universities
• BSc (Nursing), PBBSc (N)
• MSc (Nursing)
• Factors Influencing Changing in Nursing Profession
• Introduction and Definition of Collective Bargaining
• Meaning of Collective Bargaining
• Nature of Collective Bargaining
• Essential Prerequisites of Collective Bargaining
• Characteristics of Collective Bargaining
• Function of Collective Bargaining
• Comprises of Five Core Steps
• Nurse Manager’s Role in Collective Bargaining
• Major issues leading to union and collective bargaining are the following
• National Nursing Organizations in India
• Nurse Practitioner Journals
• Free Nursing Oriented e-Journals (Open Access)
• List of Journals Commonly used in Nursing Education Institution
• There are Various Types of Journals Including
• Aims of Journals
• Guidelines for Material Being Submitted Publication to Nursing Journals
• Special Articles/Research Report
• Author’s Information
• Typing and Margin
• Figure Legends
• Participation of Nursing Research and Practice in Nurses
• Nursing Research and Clinical Nursing
• EVALUATION OF TEACHING BY THE TEACHERS
• EVALUATION PROFORMA FOR STUDENT-TEACHER
• MENTAL HEALTH NURSING PRACTICAL EVALUATION FORMAT III YEAR BASIC BSC NURSING
• PRACTICAL EXPERIENCE IN NURSING ADMINISTRATION AND MANAGEMENT
• Purpose of the Experiment
• Methods of Study
• In Realtion to School Administration
• Purpose of the Experience
• PROFORMA FOR PROGRAM EVALUATION
• PROFORMA OF COURSE EVALUATION
• TEACHER EVALUATION BY STUDENT
• ANNEXURE II: CUMULATIVE RECORD FOR BSc NURSING PROGRAM
• ANNEXURE III: HEALTH RECORD
• ANNEXURE IV: COLLEGE OF NURSING
• ANNEXURE V: FACULTY PERSONAL RECORD
• On completion of the course, the ANM/FHW will be able to:
• The nurse on completion of this course will be able to:
• On completion of the four year BSc Nursing program the graduate will be able to:
• On completion of BSc Nursing (Post-Basic) degree program the graduates will be able to:
• On completion of the two year MSc Nursing program, the postgraduate will be able to:
• Competencies for Post Basic Diploma in Oncology nursing
• Post Basic Diploma in Nurse Practitioner in Midwifery
• Post Basic Diploma in Neonatal Nursing
• Post Basic Diploma in Psychiatric/Mental Health Nursing
• Post Basic Diploma in Emergency and Disaster Nursing
• Post Basic Diploma in Critical Care Nursing
• Post Basic Diploma in Cardiothoracic Nursing
• Post Basic Diploma in Orthopedic and Rehabilitation Nursing
• Post Basic Diploma in Neuro Science Nursing
• Post Basic Diploma in Operation Room Nursing
• ANNEXURE VII: COLLEGE OF NURSING
• ANNEXURE VIII: REVIEW QUESTION PAPERS FOR NURSING MANAGEMENT IN SERVICE AND EDUCATION
• : Bibliography

Chapter Notes

Introduction to management in nursing chapter 1.

• • Definition of Management
• • Concept of Management
• • Nature of Management
• • Levels of Management
• • Scope of Management (or) Functional Areas of Management
• • Functions of Management
• • Functions of Managers
• • Current Trends and Issues of Management
• • Skills of Managers
• • Principles and Theories of Management
• • Motivational Theories of Management
• • Modern Management Theories
• • Principles of Administration Applicable to all Organization by Lyndal Urwick
• • Role of Nurse as a Manager

• As managers, people carry out the managerial functions of planning, organization, staffing, leading and controlling.
• Management applies to any kind of organization.
• It applies to managers at all organizational levels.
• The aim of all managers are the same to create a surplus.
• Managing is concerned with productivity that implies effectiveness and efficiency.
• Management is a problem-solving process of effectively achieving organizational objectives through the efficient use of scarce resources in a changing environment. — Kreither
• Management is a process by which the elements of a group are integrated, coordinated and utilized so as to effectively and efficiently achieve organizational objectives. —Howard M Carlisle
• Management is a conceptual, theoretical and analytical purpose as that process by which managers create, direct, maintain and operate organization through systematic, coordinated, cooperative human effort. —Marfarland
• Management is to make planning, organizing, commanding, coordinating and controlling for organization. —Henry Fayo
• Management is working with human, financial and physical resources to achieve organizational goals by performing planning, organizing, coordinating and controlling to the functions of institution. —Meggerison and Mosby
• Management is the responsibility and functions of manager. —Louis Allen
• Management is the art of directing and insipiring people. —J D Mooney and AC Raileys
• Management is defined as getting the right activities done in term as per plan by competent and qualified persons with the right amount of other resources such as money, machines, materials, etc.
• Management is the art of getting things done through and with people informally organized groups. —Harold Koontz
• Management is the art and science of decision making and leadership. —DJ Clough
• Management is a social process entailing responsibility for the effective (or) efficient planning and regulation of the operation of an enterprise. —EFL Brech
• Management is a multipurpose organ that manages a business and managers, managers are manages workers and work. —Peter F Drucker
• Management is the coordination of all resources through the process of planning, organizing, directing and controlling in order to attain stated goals. —Henry L Sisk
• Management is the process and agency which directs and guides the operation of an organization in realizing established aims. —Otead
• Management is principally the task of planning, coordinating, motivating and controlling the efforts of others toward a specific objective. —James Linde

• Management is a goal directed activity. There is always a definite objective of management and managers help in achieving that objective successfully.
• Management is concerned with arranging group activity in a coordinated manner, the manager alone cannot achieve the objectives. He has to take help from others. He has to see that different employees perform their activities in such a manner that there is no conflict, that work is performed in an orderly manner and completed at the right time. Besides, different activities should support each other. This is called coordination.
• Management is an economic activity. It aims at securing maximum results with minimum of effort and cost. Managers use various methods to reduce wastes and increase the efficiency of work.
• Management is a creative activity. Managers have to get workdone in different types of situations with the help of people having different types of skills.
• Managers are involved in decision making that is, choosing between alternative courses of action at all stages of management. Managers have to make a number of decisions to manage the activities properly. For example, a factory manager aims at increasing the profits through increased production and sales. Then he/she will first have to take steps to increase the level of production and then try to sell the goods produced. To increase production there may be a few alternatives, e.g. increase in working hours, installing another machine, hiring more workers, improvement in the methods of work and so on. He/she has to choose the most suitable alternative to achieve his/her objective.
• A discipline
• A body of individuals
• A profession
• A human process
• A financial resource.
• Ordinarily the word ‘discipline’ is understood to mean orderly behavior in day-to-day life. This word also means an independent branch of knowledge.
• Management is also recognized as a discipline in the same sense. Like other disciplines, it also consists of certain principles, theories and methods.
• The body of knowledge in management has been developed on the basis of thinking of experts and practitioners in the field of management.
• For instance, Henry Fayol and FW Taylor have suggested various principles of management to make management more systematic and scientific in practice.
• Taylor’s principles of scientific management suggest that instead of traditional methods, managers should adopt scientific methods for the solution of business problems.
• Henry Fayol has given fourteen principles of management. It as a discipline will be more scientific as knowledge of management expands and there is systematic thinking on management.
• As managers perform their functions jointly in a group, they are often collectively known as ‘Management’.
• The success of a business depends upon the efficiency of not one but more than one manager.
• They have to work as a team so that the objectives of the business as a whole may be fully achieved. Hence, it is proper that the word ‘management’ should not be related to any single manager but to the team of managers.
• To run any business successfully, the group of managers must work with a team spirit. Also there are certain levels of management divided on the basis of the nature of duties and responsibilities.
• The managers at different levels should work in cooperation to make sure that their joint efforts lead to the best possible result.
• Management is also ‘process’ in the sense that the work of a manager is performed by taking different steps in proper sequence.
• Planning must be done first of all before carrying out any activity. This is the first stage in the management process.
• This stage should be followed by deciding on the manner in which the work is to be arranged and distributed among the people. This is known as organizing.
• The next step should consist of selecting the right type of persons for the jobs to be preformed it is staffing.
• Directing which comprises arranging for the supervision of work.
• The last stage is to check that the actual work is in accordance with plans. This is known as controlling.
• In business activities use men, materials, machines and money to produce goods and services. The value of goods and services produce is greater than the value of resources used. Thus planning, organizing, staffing, etc. are steps taken by management which really mean a transformation process whereby material resources are converted into valuable goods and services.
• In the company form of organization, it is not possible for all the shareholders to take part in the management of the company.
• The management of company is entrusted to the elected representatives of the shareholders called the directors.
• These directors appoint managers to mange the day-to-day activities. Thus, there is a separation between ownership and management.
• Managers of a company should, therefore, possess expert knowledge and skill in management which can be acquired through education and training. Managers of other types of organizations are also expected to possess expert knowledge.
• They are expected to observe some principles in the conduct of business affairs.
• They are also expected to take care of the responsibilities of the company toward the society.
• 5 They should not do anything which is unethical and illegal, e.g. avoiding payment of taxes, earning profits through improper means, etc.
• There is a systematized body of knowledge.
• Specialized knowledge is acquired through education and training.
• Service is considered to be more important than earning profits.
• Those engaged in the occupation observe certain standards in the conduct of affairs. (These standards are embodied in ‘Code of Conduct’, which differ from profession to profession).
• There should be an association of the persons in the profession to regulate their occupational behavior.
• Management is a vital role of production of product.
• Management to establishes the organization and improve the productivity.
• The management is midpoint around the workers, to maintain the interpersonal relationship through that encourage to improve the productivity.
• Management as concentrate to coordinates various factors of production and to ensure growth of industries by labor, money and material, etc.
• Based on managers efficient the production will be improve, so manager will be get training and way of development of organization.
• A manager should act as a leader and to achieves the goal of organization.
• A manager should be delegate authority effectively.
• A manager should take decisions at all levels and any situation.
• A sound management as need effective motivation and democratic leadership qualities.
• A manager must have inter, intra, extra relationship to people and workers.
• Workers should not have fear of punishment threat of unemployment, fines and penalties if it is there the product will be affecting.
• Management participation, achievement of objectives and delegation of authority to helpful to getting successful activity and product.
• Non managerial work
• Managerial work.
• A manager is a person who works through other people (subordinates), and “brings together” their efforts to accomplish goals.
• It involved nonhuman resources, such as money and materials, are also involved.
• Management is the process of managing, a collection of managers, or an area of study.
• primary definition of management is the process of achieving goals through the efforts of others.
• Management is necessary in any organization that seeks to accomplish objectives.
• In the absence of effective management an organization becomes a collection of individuals, each going in his or her own direction with no unifying guidance toward organizational goals.
• The efficient managers are the most important ingredient in a firm's ability to reach the organization goals, the poor management is the basic cause of business failures. Because a manager must work through others to accomplish goals, how those “others” view management is important to a manager's effectiveness.
• An essential activity
• An executive activity
• An essential situation
• An intangible asset
• A social process
• A disciplinary action
• 6 A purposeful activity
• A good relationship
• A common to all
• A universal process.
• We have discussed the various interpretations of the term ‘Management’.
• When a manager performs his/her functions or takes decisions, the systematized body of knowledge helps him/her to apply one or more principles or methods in the course of his/her activities.
• Adoption of principles and methods already known to him/her during his/her education and training may be regarded as the application of science in management.
• A manager may not find it useful to apply the known methods and principles. He/she may have to understand the nature of the situation and of the problem and then acts or takes a decision after careful thinking of the nature of the situation.
• He/she has to apply his/her skill and judgment rather than simply use the methods and principles known to him. In this sense, management may be regarded as an art.
• Managers sometimes may apply methods and principles in their day-do-day activities as well as use their mind and skill where necessary. Therefore, management may be regarded as both a science as well as an art.
• The managers perform different types of duties and they are jointly perform the various functions.
• Some managers decide about the objectives.
• Some managers perform functions to achieve these objectives in different departments, like production, sales, etc.
• Some of the managers are concerned with the supervision of day-to-day activities of workers.
• Top-Level Management
• Middle-Level Management
• Lower-Level Management
• It includes Board of Directors and the Chief Executive. The chief executive may have the designation of Chairman, Managing Director, President, or General Manager.
• This level determines the objectives of the business as a whole and lays down policies to achieve these objectives (making of policy means providing guidelines for actions and decision).
• The top management also exercises an overall control over the organization.
• It includes heads of various departments, e.g. head of the production, head of the sales, etc. and other departmental managers.
• Sometimes senior departmental heads are included in the top management team.
• The objectives of the business as a whole are translated into departmental objectives for the middle-level management.
• The middle-level management acts as a mediator between top level-management and lower-level management (Supervisor).
• The heads of the various departments then issue instructions to subordinates so as to achieve these objectives.
• The middle-level managers are particularly concerned with the activities of their respective departments.
• It consists of foremen and supervisors.
• The functions of supervisory are the worker, is assigned to works, and then these people see that the work is carried out properly and at the right time.
• These three levels of management taken together form the ‘hierarchy of management’. It indicates the ranks and positions of managers in the hierarchy. It shows that the middle-level management is subordinate to the top-level and 7 that the lower level is subordinate to the middle-level management. At the top of the organization, there is usually one person.
• Production management
• Marketing management
• Financial management
• Personnel management
• Plant layout and location: This area deals with designing of plant layout, decide about the plant location for various products and providing various plant utilities.
• Production planning: Managers have to plan about various production policies and production methods.
• Material management: This area deals with purchase, storage, issue and control of the material required for production department.
• Research and development: This area deals with research and developmental activities of manufacturing department. Refinement in existing product line or develop a new product are the major activities.
• Quality control: Quality control department works for production of quality product by doing various tests which ensure the customer satisfaction.
• Advertising: This area deals with advertising of product, introducing new product in market by various means and encourage the customer to buy the products.
• Sales management: Sales management deals with fixation of prices, actual transfer of products to the customer after fulfilling certain formalities and after sales services.
• Market research: It involves in collection of data related to product demand and performance by research and analysis of market.
• Financial accounting: It relates to record keeping of various financial transactions, their classifications and preparation of financial statements to show the financial position of the organization.
• Management accounting: It deals with analysis and interpretation of financial record so that management can take certain decisions on investment plans, return to investors and dividend policy.
• Taxation: This area deals with various direct and indirect taxes which organization has to pay.
• Costing: Costing deals with recording of costs, their classifications, analysis and cost control.
• Personnel planning: This deals with preparation inventory of available manpower and actual requirement of workers in organization.
• Recruitment and selection: This deals with hiring and employing human being for various positions as required.
• 8 Training and development: Training and development deals with process of making the employees more efficient and effective by arranging training programs. It helps in making team of competent employees which work for growth of organization.
• Wage administration: It deals with job evaluation, merit rating of jobs and making wage and incentive policy for employees.
• Industrial relation: It deals with maintenance of overall employee relation, providing good working conditions and welfare services to employees.
• Managerial work consists of performing the functions of management.
• The analysis of management is facilitated by a useful and clear organization of knowledge. As a first order of knowledge classification, we have used the eight functions of managers.
• Controlling and coordination
• what is to be done
• when it is to be done
• how it is to be done
• why it is to be done.
• It emphasizes the fact that if one knows where he is going, he is more likely to get there.
• problem-solving
• decision-making.
• Whenever there is a problem, the manager should know what alternatives are there to solve it. Out of the alternative courses of action, he has to choose the most suitable one. This process of making choice is known as decision making.
• what should be done
• how it should be done
• who will do it
• where it will be done
• when it should be done
• The essential part of the planning consists of setting goals and programs of activities.
• After planning have been established the management has to organize the activities.
• The managers determine the priority of activities, necessary to achieve the objectives and how these activities should be divided among the departments and employees.
• The management must be organize the human resources and physical resources.
• The performance of any activity requires different type of work, e.g. the manager of a surgical instrument factory decides to produce 1 lakh instrument/week.
• This is his goal or objectives. Now to achieve this, he has to divide the activities and operations into certain departments.
• The production work is given to the production department.
• Finance department is assigned the work of arranging funds.
• Personnel department is to procure people with required skills.
• The sales department is to take care of sales.
• The organizing function of management involves creating departments and defining the duties and responsibilities of people in different positions within each department.
• Staffing is concerned with employing people for the various activities to be performed. An organization is meaningless without people.
• 9 The objectives of staffing is to ensure that right type of people have been recruited for different positions.
• Staffing includes the function of recruitment, selection, training, promotion of personnel to fill both managerial positions in a company and placement of employees.
• Assume that we have developed plans, created an organization structure, and staffed it.
• It now must be stimulated to action through the management function of directing.
• Directing means encouraging subordinates to work toward achieving company objectives. It synonyms by known as leading, guiding, motivating, or actuating.
• The directing function of management includes guiding the subordinates, supervising their performance, communicating information and motivating.
• A manager should be a good leader.
• The following basic concepts related to the directing function: – Participation – Communication – Motivation – Leadership
• Manager should be able to instruct and guide his subordinates in the work assigned to them.
• He should keep a watch on the performance of his subordinates and help them out whenever they come across any difficulty.
• The communication system, i.e. exchange of information should take place in clearly understandable words and without delay.
• Information should flow from managers to workers and from workers to managers at the right time.
• Managers should also understand the needs of subordinates and accordingly inspire them in their work.
• This function of management consists of the steps taken to ensure that the performance of work is in accordance with the plans.
• Controlling means measuring the actual performance with the planned one. If differences are noticed, corrective steps are taken which may include revision of plans, improvement in the division of work and providing better guidance.
• Coordination is important to note that all the activities should contribute to the achievement of the objectives of the business as a whole.
• The heads of different departments should not treat each other as competitors but should work as organs of one body.
• As the proper functioning of every organ of a human body is important for a healthy body, the work of every department is important for the organization
• Managers should therefore see that everybody in the organization understands its objectives and works in cooperation with others to achieve these objectives. This function of management is called coordination.
• It consists of harmonizing group effort so as to achieve common objectives/goals of organization.
• Nominal head
• Connection activities.
• Representative activities.
• Entrepreneur
• Disturbance handler
• 10 Resource allocator
• Negotiator.
• The management is a dynamic process. the elements of management process are known as functions of management.
• In this process as utilized in nursing profession to prevent illness, promote health and curative care.
• This functions of management as firstly classified Henrry Fayol such as planning, organizing, commanding, controlling and coordinating.
• RC Davis identified planning, organizing, and coordinating, as part of control.
• It is developed by luther Gullick.
• It indicate to do being of the functions of the executives.
• The functions (or) responsibilities of the chief executive (or) administrator stands.
• The manager has to guide, motivator, lead communicator with his subordinates (or) workers.
• Ernest Dale has in addition mentioned innovation and representation.
• Innovation is involved to creative thinking designed for changes and improvement of managerial functions. It is involved as a function of planning, budgeting is also a sub function of planning.

• 11 Globalization
• Work force diversity
• Managing in an e-business world
• Knowledge management and learning organizations
• Quality management
• Organizational operations are no longer limited by national borders.
• Manager’s deals throughout the world must deal with new opportunities and challenges inherent in the globalization of business.
• In c ases of corporate the lying, misrepresentations, and financial manipulations have been widespread in recent years.
• Most of the managers continue to be have in a highly ethical manner; abuses suggest a need to “upgrade” ethical standards.
• Ethics education is increasingly emphasized in college curricula today.
• Organizations are taking a more active role in creating and using codes of ethics, ethics training programs, and ethical hiring procedures.
• It is heterogeneous in terms of gender, race, ethnicity, age, and other characteristics that reflect differences.
• The group of people by addressing different lifestyles, family needs, and work styles is a major challenge for managers.
• It is the process whereby an individual or group of individuals use organized efforts to pursue opportunities to create value and grow by fulfilling wants and needs through innovation and uniqueness, no matter what resources the entrepreneur currently has.
• The pursuit of opportunities
• It will continue to be important to societies around the world.
• Change is occurring at an unprecedented rate.
• The organization must become a learning organization because it has developed the capacity to continuously learn, adapt, and change.
• Knowledge management involves cultivating a learning culture where organizational members systematically gather knowledge and share it with others in the organization so as to achieve better performance.
• It is a philosophy of management that is driven by continual improvement and response to customer needs and expectations.
• The objective of quality management is to create an organization committed to continuous improvement in work.
• Frederick Winson Taylor (1856–1915) was an American mechanical chief engineer.
• FW Taylor suggested a new approach to management early in the twentieth century.
• Development of a true science of management replacing the old rule of thumb method, which would enable managers among other things, to determine the best method of performing each task;
• Scientific selection of workers so that each worker could be assigned the task for which he is best suited;
• Scientific training and development of workers so as to achieve the highest level of efficiency;
• Close cooperation between management and labor to ensure that work is carried out in accordance with the scientific principles which are developed.
• Define the problems of today and the future
• Allocate resources for long-term planning
• Allocate resources for research and education
• Constantly improve design of product and service
• Quality costs less not more
• Superstitious learning
• The call for major change
• Stop looking at your competitor and look at your customer instead
• Quality does not come from inspection
• Mass inspection is unreliable, costly, and ineffective Inspectors fail to agree with each other
• Inspection should be used to collect data for process control
• Price alone has no meaning, Change focus from lowest initial cost to lowest total cost Work toward a single source and long-term relationship
• Establish a mutual confidence and aid between purchaser and vendor
• Quality starts with the intent of management Teamwork in design is fundamental
• Forever, continue to reduce waste and continue to improve putting out fires is not improvement of the process
• Management must provide the setting where workers can be successful
• Management must remove the inhibitors to good work. Management needs an appreciation of variation. This is management’s new role
• Management by objectives (MBOs) Work standards Meet specifications Zero defects Appraisal of performance
• Replace with leadership. Leaders must: Remove barriers to pride of workmanship Know the work they supervise Know the difference between special and common cause of variation
• The fear of knowledge
• Performance appraisals
• Management by fear or numbers
• “Break barriers among staff areas”: Know your internal suppliers and customers. Promote team work
• They are directed at the wrong group
• They generate frustration and resentment
• Use posters that explain what management is doing to improve the work environment
• They impede quality
• They reduce production
• A person’s job becomes meeting a quota
• Performance appraisal systems
• Production rates
• Financial management systems
• Allow people to take pride in their workmanship
• Commitment to lifelong employment
• Overtime and education
• Work with higher education of needs
• Develop team building skills in children
• Struggle over the fourteen points
• Take pride in the new philosophy
• Include the critical mass of people in the change
• Learn and use the Shewhart cycle
• It is defined as the use of the scientific method to determine the “one best way” for a job to be done.
• The most important contributor in this field was Frederick W Taylor who is known as the “father” of scientific management.
• Scientific management theory also known as traditional organizational theory (or) classical theory.
• The worker and management motivation are to increase production.
• In the principles of scientific management 1911, Taylor formulated that the primary goal of any organization should be increase production and decrease wasted human effort, this could be achieved if management found the “one right way” to do things and trained workers accordingly.
• After that Taylor redesigned both the job and tools needed to eliminate the misuse of time and effort. This concept of assembly line eras industrial revolution.
• Using time and motion studies
• Hiring best qualified workers
• Designing incentive systems based on output.
• Max Weber, a well known German sociologist developed similar ideas and expanded up on Taylor’s concept.
• Weber (1958) saw the need for legalized, formal authority and consistent rules and regulations for personnel in different positions he proposed bureaucracy as an organizational design.
• 15 Weber’s work and bureaucratic organizational design is still evident today in many health care institutions.
• This group of writers, who focused on the entire organization, developed more general theories of what managers do and what constitutes good management practice.
• Henri Fayol and Max Weber were the two most prominent proponents of the general administrative approach. Fayol focused on activities common to all managers. He described the practice of management as distinct from other typical business functions.
• Unity of command
• Unity of direction
• Subordination of individual interest to group interest
• Scalar chain
• Espirit de corps.
• Max Weber was a German sociologist who developed a theory of authority structures and described organizational activity based on authority relations.
• He described the ideal form of organization as a bureaucracy marked by division of labor, a clearly defined hierarchy, detailed rules and regulations, and impersonal relationships.
• Some current management concepts and theories can be traced to the work of the general administrative theorists.
• The functional view of a manager’s job relates to Henri Fayol’s concept of management.
• Weber’s bureaucratic characteristics are evident in many of today’s large organizations—even in highly flexible organizations that employ talented professionals.
• Some bureaucratic mechanisms are necessary in highly innovative organizations to ensure that resources are used efficiently and effectively.
• The quantitative approach to management, sometimes known as operations research or management science, uses quantitative techniques to improve decision making.
• This approach includes applications of statistics, optimization models, information models, and computer simulations.
• The quantitative approach originated during World War II as mathematical and statistical solutions to military problems were developed for wartime use.
• The relevance of quantitative approach today is that it has contributed most directly to managerial decision making, particularly in planning and controlling.
• The availability of sophisticated computer software programs has made the use of quantitative techniques more feasible for managers.
• The field of study concerned with the actions (behaviors) of people at work is organizational behavior.
• Organizational behavior (OB) research has contributed much of what we know about human resources management and contemporary views of motivation, leadership, trust, teamwork, and conflict management.
• The early advocates of OB approach were Robert Owen, Hugo Munster berg, Mary Parker Follett, and Chester Barnard.
• Their ideas served as the foundation for employee selection procedures, motivation programs, work teams, and organization-environment management techniques.
• The Hawthorne Studies were the most important contribution to the development of organizational behavior. This series of experiments conducted from 1924 to the early 1930s at Western Electric Company’s Hawthorne Works in Cicero, Illinois, were initially devised as a scientific management experiment to assess the impact of changes in various physical environment variables on employee productivity.
• 16 Harvard professor Elton Mayo and his associates joined the study as consultants, other experiments were included to look at redesigning jobs, make changes in workday and workweek length, introduce rest periods, and introduce individual versus group wage plans.
• In the present day context behavioral approach assists managers in designing jobs that motivate workers, in working with employee teams, and in facilitating the flow of communication within organizations. The behavioral approach provides the foundation for current theories of motivation, leadership, and group behavior and development.
• During the 1960s researchers began to analyze organizations from a systems perspective based on the physical sciences. A system is a set of interrelated and interdependent parts arranged in a manner that produces a unified whole. The two basic types of systems are open and closed. A closed system is not influenced by and does not interact with its environment. An open system interacts with its environment.
• Using the systems approach, managers envision an organization as a body with many interdependent parts, each of which is important to the well-being of the organization as a whole. Managers coordinate the work activities of the various parts of the organization, realizing that decisions and actions taken in one organizational area will affect other areas.
• The systems approach recognizes that organizations are not self-contained; they rely on and are affected by factors in their external environment.
• The contingency approach recognizes that different organizations require different ways of managing. The contingency approach to management is a view that the organization recognizes and responds to situational variables as they arise.
• It can be described as the behavioral approach.
• It is recognition of the extreme importance of individual performance of manager at any situation.
• The manager power and control a situation and degree of uncertainty in any given situation.
• It is developed on 1959, based on realization that works motivation and job satisfaction. These two dimensions are influence the productivity of an employee.
• He is finding that good working condition, adequate salary, good human relation, good physical facilities, quality of supervision and get job satisfaction to the employees, these are comes under hygienic factors.
• Recognition of workdone status, opportunities for growth, challenging task play an important role in creating work motivation of employees these are comes under the motivation factor. Many authors interpreted that all the motivation factors are described by Hertzberg. Do not give equal amount of satisfaction to all employees.
• He believes there are two basic kinds of manager.
• Theory X, it has a negative view of employees, they had lazy, untrustworthy and incapable of thinking responsibility while the other type of manager.
• Theory Y, the employees are trustworthy and capable of thiking responsibility having high levels of motivation.
• McGregor and major theorist associated with the human relations school of management.
• Receiving his doctorate in psychology, Abraham Maslow was the first psychologist to develop a theory of motivation based upon a consideration of human needs.
• Physiological needs: The need for food, drink, shelter and relief from pain.
• 17 Safety and security: The need for freedom from threat, that is, the security from threatening events or surroundings.
• Belongingness, social and love: The need for friendship affiliation interaction and love
• Self-esteem: The need for self-esteem and for esteem from others.
• Self-actualization: The need for fulfill oneself by making maximum use of abilities skills and potential.
• Salary, air-conditioning, company criteria.
• Increase salary, pension plan, hospital and medical plan, etc.
• Employee centred supervision personal and professional friends, office, parties, and social gathering compatible work group.
• Jop title, complement office, furnishing merit, salary increase.
• Development of opportunities, opportunities to use skills.
• Gantt Henry I Gantt (1861–1910)
• He trained his workers to follow the time to complete the task given. The most productive workers were hired even when they were paid an incentive or wage.
• Labor costs per unit were reduced as a result.
• Responsibilities of management were separated from the functions of the workers.
• Developed systematic approach to determine the most efficient means of production.
• He considered management function is to plan.
• Working conditions and methods to be standardized to maximize the production.
• It was the management’s responsibility to select and train the workers rather than allow them to choose their own jobs and train by themselves.
• He introduced an incentive plan to pay the workers according to the rate of production to minimize workers dissent and reduce resistance to improved methods.
• Increased production and produce higher profits.
• Reduced wasted efforts
• Set standards of performance
• Encouraged specialization and stressed on the selection of qualified workers who could be developed for a particular job.
• He was concerned with problems related to efficiency. He contributed to scientific management by refining the previous work of Taylor than introducing new concepts.
• He studied the amount of work planned or completed on one axis to the time needed or taken to complete a task on the other axis.
• He also developed a task and bonus remuneration plan whereby workers received a guaranteed day’s wages plus a bonus for production above the standard to stimulate higher performance.
• He recommended to select workers scientifically and provided with detailed instructions for their tasks.
• 18 He argued for a more humanitarian approach by management, placing emphasis on service rather than profit objectives.
• He recognized useful non-monetary incentives such as job security and encouraging staff development.
• It is essential “competent counsel”.
• Changes should be evaluated, management should not ignore “commensense” by assuming that big necessarily better.
• Interpersonal relations and to system in management.
• Goals and ideas should be clear and well-defined as the primary objective is to produce the best product as quickly as possible at minimal expense.
• Management can strengthen discipline or adherence to the rules by justice, or equal enforcement on all records, including adequate, reliable and immediate information about the expenses of equipment and personnel should be available as a basis for decisions.
• Dispatching or production scheduling is recommended.
• Standardized schedules, conditions, and written instructions should be there to facilitate performance.
• Efficiency rewards—should be given for successful completion of tasks.
• Emerson moved further beyond scientific management to classic organizational theory.
• Division and assignment of work on the basis of skill.
• To determining the feasibility of replacing manual operations with automatic machinery.
• The human relations theory is started on 1940s. it is focused on the effect that the individuals success or failure of an organization.
• The management theory and classic organization have concentration on physical environment fail to analyze the human element.
• It is concentrating on the organizations structure, managers encourage workers to develop their potentials and help them meet their needs for recognition, accomplishment, sense of belonging
• Follett stressed the importance of coordinating the psychological and sociological aspects of management in 1920s.
• She perceived the organization is a social system and management as a social process.
• Indicated that legitimate power is produced by a circular behavior where by superiors and subordinates mutually influence one another.
• The law of the situation dictates that a person does not take orders from another person but from the situation.
• He is focused on “group dynamics”.
• He maintained that groups of personalities of their own and composites of the members personalities.
• He showed that group forces can overcome individual interests.
• In this theory, scientific procedures are use to the study of psychological, sociological, anthropological aspects of human behavior in organization.
• In this theory, a positive attitude is maintaining toward people, training managers, fitting, supervisory action to the situation, to meet needs of the employees, promoting sense of achievement to the employees and obtaining commitment through participation in planning and decision making.
• The manager’s emphasis is on the goal of organization.
• The theory assumes that people dislike work and avoid it.
• Workers must be directed
• Threatened.
• Most people want to be directed and to avoid responsibilities because they have little ambition.
• They desire security.
• Will do the thinking and planning with little input from staff associates.
• They will delegate little, supervise closely.
• Motivate workers through fear and threats
• Failing to make use of the workers potentials.
• People do not inherently dislike the work and that work can be a source of satisfaction.
• Workers have the self direction and self control necessary for meeting their objectives.
• Will respond to the rewards for the accomplishment of those goals.
• Will allow participation
• They will delegate
• Give general supervision than close supervision
• Support job enlargement
• Use positive incentives such as praise and recognition.
• People seek responsibility and display imagination, unity and creativity.
• According to theory Y human potentials are only partially used.
• The casual variable includes leadership behavior.
• The intervening variables are perceptions, attitudes and motivations.
• The end results variables are measures of profits, costs and productivity.
• Communication
• Decision making process
• Goal setting
• Staff development.
• He associates the first system with the least effective in performance.
• Managers show less confidence in staff associates and ignore their ideas.
• Consequently staff associates do not feel free to discuss their jobs with their managers.
• Staff associates ideas are sometimes sought, but they do not feel free to discuss their jobs with the manager.
• Top and middle management are responsible for setting goals.
• There is minimal communication. Mostly downward and received with suspicion.
• Decisions are made at the top with some delegation.
• The manager has substantial confidence in staff associates and their ideas are usually sought.
• They fell free to discuss their job with the manager, fairly and generally to set the objective.
• It has limited accuracy and accepted with some caution.
• Policy to be formulated at the top level management.
• They will be taken decisions making throughout organization. it will be control, functions are delegated to lower level management.
• It will be used for reward and self guidance.
• The informal groups had resistance in the organization.
• Principle of objective: In all organization must be an expression of a purpose.
• Principle of correspondence: Authorities and responsibilities are interrelated.
• Principle of responsibility: The higher authority and responsibility is to assign the work to the subordinates.
• Scalar principle
• Principle of span control
• Principle of specialization: The workers should assign and performance to the single function.
• Principle of coordination
• Principle of definition: Clearly explained authority and responsibility to the activity and position to the every duty.
• The nurse act as a manager, he/she has to do the work performance in a hospital.
• The nurse manager plays an essential role in health care. She sets the tone of any healthcare system.
• The manager is the backbone of the organization.
• The quality of patient care, as well as staff recruitment and retention success, rests with this key role.
• Over the time it will be the strength of the nurse manager.
• The nurse managers are given the opportunity to acquire the operational, financial, and management skills essential to their success and the success of their organization.
• For information about the director of nursing (DON) position at a long-term care facility.
• The director of nursing is the senior nursing management position in an organization and often holds executive titles like Chief Nursing Officer (CNO), Chief Nurse Executive, or Vice-President of Nursing.
• They typically report to the CEO or COO.
• The Organization of Nurse Executives is a professional association for directors of nursing.
• Many large healthcare organizations also have service directors.
• These directors have oversight of a particular service within the facility or system (surgical services, women’s services, emergency services, critical care services, etc.).
• The nurse manager is the nurse with management responsibilities of a nursing unit. They typically report to a service director.
• They have primary responsibilities for staffing, budgeting, and day-to-day operations of the unit.
• The charge nurse is the nurse, usually assigned for a shift, who is responsible for the immediate functioning of the unit.
• The charge nurse is responsible for making sure nursing care is delivered safely and that all the patients in the unit are receiving adequate care.
• They are typically the frontline management in most nursing units. Some charge nurses are permanent members of the nursing management team and are called shift supervisors.
• The traditional term for a female charge nurse is a nursing sister (or just sister), and this term is still commonly used in some countries (such as the United Kingdom).
• They interpret and communicate policies and procedures that the agency or facility puts in place to establish areas of responsibility and assignments among departments and staffs.
• They are also responsible for developing budget estimates and handle other information pertaining to financial concerns and requirements. They approve and monitor expenditures and purchases to ensure that the budget guidelines are complied to.
• They are responsible in the staff maintenance. They assign nurses to particular cases andoversee the patient care to ensure that it remains at a high standard.
• They are also involved in creating treatment plans for patients and to coordinate the efforts of the medical team. This is to keep everyone up-to-date of the progress in the medical care and condition of the patient.
• A nurse manager is called as a nursing superintendent, he/she is controlled all the function of the nursing units like head nurse, ward in charge nurse, duty nurses at various department in the hospital.
• For example, he/she is responsible for administrative function of medical intensive care unit.
• He/she is responsible for providing quality care for patients, maintain cost-effectiveness in the unit, during the working time to be maintain safety measures of patient care in the unit.
• He/she has to recruit qualified professional nurses.
• He /she has to take immediate and healthy decision making to solve the problem.
• To monitor daily practice activities of nurse and monitor patient outcomes at the time of hospital.
• The first activities or function of a nurse manager is to ensure patient outcomes in the unit.
• He/she has to get good name from the patient and higher authority.
• To monitor and support for beloved staffs.
• He/she acts as an advocate for patients and his/her families.
• He/she has to good knowledge about clinical practice and administration.
• He/she has to good communication skill from people.
• He/she must have commending and negotiating ability during working time.
• He/she could be in sense of humor and a sound fiscal strategies of the working.
• Nursing superintend is belongs to middle management. He/she must serve direct care to the patient and to supervise the workers and hospitals. He/she maintain the reports about the function of working people and functions of hospital.
• When top level management to take decision about organization at the time as a nursing manager is to represent about merits and demerits of the decisions.
• Nurse Managers are responsible for planning, organizing, and directing health services in their department to ensure that the goals and objectives are performed consistently and that the services provided to the patients are of the highest quality and standard.
• They select, mentor, motivate, and direct the development and evaluation of the staff nurses. They are responsible for establishing and keeping track of quality improvement indicators and other information that concerns the patient care and services.
• They ensure that resources are available in order to provide high quality service and the on-time performance that is consistent with the facility's standards. At times, they devise educational programs that are health related for the facility's non-professional and professional staff.
• They participate, consult and collaborate with other units and healthcare providers in developing long-term plans for health care programs.
• Assign the work to the staff nurse.
• Improve coordinate to the staff nurses and activities to working places.
• Organize the working priority and supervising, directing, the subordinate employees.
• To identify the nurse performance through the evaluation tool.
• To plan to conduct in-service education and training to the work staff nurses to develop the staff development program.
• She maintains the records and reports related to the workers and work to get feedback to nurses and from patients.
• He/she will be supervise the general nursing care to provide by nurses and workers.
• He/she will be develop plan and objective for working places.
• To identify the needs of patients and to improve the nursing care at the situation.
• He/she make evaluates to the nursing programs and nursing care.
• Asses the needs in the hospital like equipments, physical facilities, budget, supplies and personals.