DIRECTING Introduction Directing is getting the work done through others.

It is management of people which is the heart of the administrative process to be properly understood and practiced by a nurse manager. Directing in nursing is giving orders and directions to others to attain quality patient care. This function of a nurse manager is administrative in nature which involves two major aspects, namely: the human and technical aspects. NATURE AND CHARACTERISTICS OF DIRECTING THE NURSING SERVICES Directing is the issuance of assignments, orders and instructions that help the nursing personnel to understand what are expected of them. It also refers to supervision and guidance of every one in the organization so that they can efficiently and maximally contributes to the attainment of organizational objectives in general and the attainment of quality nursing service objectives focused on quality client care, in particular. Leadership, motivation, communication, delegation and supervision characterized the directing function of the nurse manager. DIRECTING IS RELATED TO LEADERSHIP PROCESS The nurse manager, being an administrator, affects the human relations more than anyone else in the nursing system. He or she is so involved with motivation, communication, daily off operations, and the decision-making process, being in the key position to affect the human resources in the organization. The relationship between the nurse managers and staff members should be based on mutual trust and confidence. COMMUNICATION ON MANAGEMENT Communication is viewed as a process of symbol using understanding, interaction, and reduction of uncertainty, transference and transmission of information (Bormann, 1980). It functions in the linking the individual to the environment establishing commonality, exercising power, time binding and replicating memories. At a general level, communication refers to a process of acting on information. The encouraging climate of the organization facilitates upward communication. Staff nurses should feel a responsibility for initiating upward-or lateral (sideward)-communication that is accurate and pertinent. Communication is used for varied reasons and purposes by nurse managers. Communication enhances the nurse managers capability to facilitate work, enhance motivation, provide innovations, effect optimum care, add more worker satisfaction and ensures coordination within the organization.

FLOW OF ORGANIZATION Flow of information. Communication on management maybe downward, upward, and lateral or sideward. Downward communication. This may come in forms of policies, manuals and guidelines for information and compliance of everyone in the organization. Memoranda, job descriptions, performance appraisals, and the likes are other forms of downward communication. Upward Communication. This usually comes form subordinates to top management. It is done in the form of feedback informing the administration as to the effect of the downward communication-the extent of which it has been received and acted upon. Lateral or Sideward Communication. This is being observed between employees, personnel, units or departments on similar level. It comes out in various forms like endorsements between shifts, nursing rounds, conferences, or meeting or in making referrals between service departments.

DECISION MAKING Decision making has important implications in the directing function of the nurse manager. Many authorities view decision making as the most important administrative activity since it is involved in the other process of administration such as planning, organizing, coordinating, directing, controlling, and evaluating. Decision making is generally recognized as the heart of organization and the process of administration.

CATEGORIES OF DECISIONS Personal Decisions. These are those which every staff member does in discharging duties. These duties are related to every nurses assessment of the patients needs, planning and implementing care, and evaluating of outcomes. Organizational Decisions. This relates to the operations of a unit or department or the entire system and they are of concern to all members of the aforementioned organizational groups. DECISION MAKING PROCESS AND PROBLEM SOLVING

Following are the steps that believed to be involved in every decision- making process in relation to problem solving: Recognize, define, and limit the problem; Analyze and evaluate the problem; Establish criteria or standards by which the solution will be evaluated or judged as acceptable and adequate to the need; Collect the necessary data and information; Formulate and select the preferred solutions or actions; Put into effect the selected or preferred by: Programming the solution Controlling the activities in the program Evaluating the results and the process PERSONNEL PARTICIPTION IN DECISION- MAKING Two advantages: First, the discussion provides maximum input with regard to the decision. Second, the staff members who are involved in a decision making process implement the decision better. Decisions may as well be made by the nursing personnel as there are directly with the implementation, including all other matters that are relevant to he patients health care delivery system.

MANAGEMENT CONFLICT Management conflict are usually attributed to the customary ideas about what a manager performs planning, organizing, directing or leading, and controlling compared with the traditional role of the worker doing manual labor (Myers, 1970). Nature and Causes Traditional organizations have conflicting views regarding role relationships between managers and workers. Organizational managers are the ones who have been presumed to possess the maturity, knowledge, ability, and responsibility to plan, direct and control the workers activities. Labor unions have impact in formalizing and widening the gap between the employer and the employees.

CONFLICT RESOLUTION Two major factors work to eliminate or resolve the gap between labor and management. One of these factors is the rise in economic status of the less privileged members of the employee group, together with rising expectations The second factor goes with an increasing awareness and acceptance by managers about the demographic pattern in organizational leadership. This concept of the job enrichment for all employees, and not just he manager is one that includes not only the planning and control functions, but the doing as well (Myers, Ibid.). Job Enrichment in Conflict Resolution A way to encourage and let more employees to think for their welfare is job enrichment. It enhances creativity, a wider range of doing or performance and more trust in the employee. Job enrichment builds better

interest, improved self-respect, and pride. Eventually, job enrichment enables every member to satisfy more his personal needs and as it happens there comes the success of agency and patient care. THE NURSE MANAGER DIRECTING THE NURSING SERVICES Being a nurse manager and a nurse manager greatly differs in meanings (semantics). A primary nurse who works with a limited number of patients utilizes the process of management as he or she provides and manages the care of the patients. A nurse manager who may have experienced that of being on the labor side of the management/ labor conflict may be able to show greater empathy for his or her employees at all job levels.

ORGANIZING THE NURSING SERVICE Organizing Organization consists of the structure and process which allow the agency to enact its philosophy and utilize its conceptual framework to achieve its goals. It refers to body persons, methods, policies and procedures arranged in a systematic process through the delegation of functions and responsibilities for the accomplishment of the purpose. Organizing is the process of establishing a formal authority. It involves setting up the organizational structure through identification of groupings, roles and relationships, determining the staff needed by developing and maintaining staffing patterns and distributing them in the various areas as needed. It includes developing job descriptions by defining the qualifications and functions of personnel. An organizational chart is a line drawing that shows how the parts of an organization are linked. It depicts the formal organizational relationships, areas of responsibilities, person to whom one is accountable and channels of communication. Elements of Organizing setting up the organizational Structure staffing Scheduling developing job descriptions Types of Organization Classified by Nature of Authority Line Organization Informal Organization Staff Organization Functional Organization Five Major Characteristics of Organizational Chart Division of Work Chain of Command Type of Work to be performed Grouping of work segments Level of management Definition of Terms Authorityis the right to act or make decisions without approval of higher administrators. It included the right to extract obedience from subordinates. In legal sense, authority flows down in an organization. Definition of Terms Line authority is the simplest and most direct type in which each position has general authority over the lower positions in the hierarchy. Staff personnel provide advice, counsel or technical support that may be accepted, altered, or rejected by the line officer. Accountabilitymeans taking full responsibility for the quality of work and behavior while engaged in the practice of the profession.

 Responsibilityis the obligation to perform the assigned task Poweris the ability to influence another to behave in accordance with ones wishes. Statusis the rank a group bestows on a person in accord with the groups estimation of the persons value and significance to group goals. Communicationis the transmission of information between persons. Organizing Principles Unity of Command Scalar principle or hierarchy Homogenous assignment or departmentation Span of Control Exception Principle Decentralization or the proper delegation of authority STAFFING Staffing is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients demand. FACTORS AFFECTING STAFFING The type, philosophy, and objectives of the hospital and the nursing service. The population served or the kind of patients served whether pay or charity. The number of patients and severity of their illness knowledge and ability of nursing personnel are matched with the actual care needs of patients. FACTORS AFFECTING STAFFING Availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel number and position. Administrative policies such as rotation, weekends and holiday off-duties. FACTORS AFFECTING STAFFING Standards of care desired which should be available and clearly spelled out. Institutions may utilize the ANSAPS Standards of Nursing Practice; PRC-ANSAPS Standards of Safe Nursing Practice and/or the hospitals themselves may formulate/develop their own standards. Layout of the various nursing units and resources available within the department such as adequate equipment, supplies and materials. FACTORS AFFECTING STAFFING Budget including the amount allotted to salaries, fringe benefits, supplies, materials, and equipment. Professional activities and priorities in nonpatient activities like involvement in professional organizations, formal educational development, participation in research and staff development.. Teaching program or the extent of staff involvement in teaching activities. FACTORS AFFECTING STAFFING Expected hours of work per annum of each employee. This is influenced by the 40-hour week law; and Patterns of work scheduletraditional 5 days per week, 8 hours per day; 4 days a week, ten hours per day and three days off; or 3 days of 12 hours per day and 3 days off per week. DISTRIBUTION OF SHIFTS Studies have shown that the morning day shift needs the most number of nursing personnel at 45 50 51 percent, for the afternoon shift 34 to 37 percent,; and for the night shift 15-18 percent. In the Philippines the distribution usually followed is 45% for the morning shift, 37% for the afternoon shift, and 18% for the night shifts. STAFFING FORMULA 1. Categorize the number of patients according to the levels of care needed. Multiply the total number of patient by the percentage of patients at each level of care (whether minimal, intermediate, intensive or highly specialized). 2. Find the total number of nursing care hours needed by the patients at each category level.

 Find the number of patients at each level by the average number of nursing care hours needed per day. Get the sum of the nursing care hours needed at the various levels. 3. Find the actual number of nursing care hours needed by the given number of patients. Multiply the total nursing care hours needed per day by the total number of days in a year. 4. Find the actual number of the working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year. 5. Find the total number of nursing personnel needed. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year. Find the number of relievers. Multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those working 48 hours per week). Add the number of relievers of the total number of nursing personnel needed. 6. Categorize the nursing personnel into professional s and nonprofessionals. Multiply the number of nursing personnel according to the ratio of professionals to nonprofessionals. 7. Distribute by shifts. PLACEMENT It is important for a manager to consider some factors when assigning employees to a position or area where these employees have very good chances for success. Proper placement fosters personal growth provides, a motivating climate for the employee, maximizes productivity and organizational goals have better chances of being met. Inappropriate placement often result in frustration, poor quality of work, reduce organizational efficiency, rapid turn-over, and poor image for the agency. SCHEDULING A schedule is a time table showing planned work days and shifts for nursing personnel. The objective in scheduling is to assign working days and days off to the nursing personnel so that adequate patient care is assured. ASSESSING A SCHEDULING SYSTEM Ability to cover the needs of the unit Quality to enhance the nursing personnels knowledge, trainings and experience Fairness to the staff Stability Flexibility TYPES OF SCHEDULING Centralized Decentralized scheduling Cyclical Schedule VARIABLES TO BE CONSIDERED IN SCHEDULING Length of scheduling period whether two or four weeks. Shift rotation. Weekends. Holiday offs. Vacation leaves. Special days (birthdays, wedding anniversary etc...) Scheduled events in the hospital, training programs, or meetings. Job categories. Continuing Professional Education Programs.

ADVANTAGES OF CYCLICAL SCHEDULES

 shifts.

It is fair to all. Favoritism is minimized as all nursing personnel get their fair share of rotation to the various It saves time as the schedule does not have to be redone every week or two. It enables the employees to plan ahead for their personal needs preventing frequent changes in schedule. Scheduled leave coverage such as vacation, holidays, and sick leaves are more stable. Productivity is improved.

ROTATING WORK SHIFTS Rotating work shift is common in most hospitals. It is desirable that there be equal share of morning, afternoon and night shifts as prolonged night shifts may affect the heath of the personnel. Many nursing personnel would prefer the morning shift duty but this is given most frequently to senior nurses. Permanent shifts, however, give several advantages. The nursing personnel feel a sense of belonging with the other personnel in the unit and in the same shifts. They are able to adjust their family, social and recreational lives, or when day opt to continue their formal education. DEVELOPING JOB DESCRIPTIONS A job description is a statement that sets the duties and responsibilities of a specific job. It includes the needed characteristics or qualifications of the individual to perform such duties successfully. It is an important management tool to make certain that responsibilities are wisely dedicated that work is efficiently distributed, that talent are fully used, and morale s maintained. CONTENT OF A JOB DESCRIPTION Identifying data Job summary Qualification requirements Job Relationships Specific and actual functions and activities USES OF JOB DESCRIPTION For recruitment and selection of qualified personnel. To orient new employees to their jobs. For job placements, transfer or dismissal. As an aid in evaluating the performance of the employee. For budgeting purposes. USES OF JOB DESCRIPTION For determining departmental functions and relationships to help define the organizational structure For classifying levels of nursing functions according to skill levels required To identify training needs As basis for staffing To serve as channel of communication What is management? Definition and Overview Management; is the act, art, or manner of managing, or handling, controlling, direction; skill in managing; executive ability The accomplishment off an organizations goals by defining of goals, organization of works, motivation of others, staffing of the positions, the control of the labor, material and evaluate of the completed effort What is management? Distinct process consisting of planning, organizing actuating and controlling performed to determine and accomplish the objective by the use of people and resources. Management ; is getting things done through other people (1979 ,AMA) Management is working with and through other people to accomplish the objectives of both the organization and its members. Differences between the two definitions

Places greater emphasis on human being in the organization Focuses attention on the results to be accomplished, on objectives rather than just a things or activities Adds the concepts that accomplishment of the members personal objectives should be integrated with accomplishment of the organizational objectives From the definition we can say that management; Is the effective motivation of men and the efficient utilization of resources for the attainment of predetermined objective. Workers have to be motivated so that they perform the assigned to them as programmed by management. Is a technique by means of the purpose and objective of particular human group are classified and effectuated Management: Art and Science Some management authorities regard management as an art, It involves proficiency in the practical application of knowledge acquired through study, experience and observations. It also involves application of skills and techniques to achieve desirable results. Managing as practice ia an art. Management is a science It is a body of knowledge dealing with a body of facts or truths systematically arranged and showing the operation of acceptable standard of laws. Organized knowledge about management is science. The emphasis in any activity that is classed as an art is on applying skills and knowledge and accomplishing of an end through deliberate efforts. Management Process Consist of achieving organizational objectives through planning, organizing, directing, and controlling human and physical resources. Management process is self-regulating and self- correcting Importance of management in management of Nursing Care Intended to assist the nurse in the patient care unit/ward toward gaining a better understanding of factors involved in management of patient care. To solve all nursing care problems as possible when and where required. Intended to provide best services to the client. Optimum benefits for personnel Essential component of professional nursing care. Coordination of needs, new ideas, techniques , procedures and approaches Smooth functioning of units to attain their goal of quality care through judicious use of available human and material resources within specific periods Relationship between management and administration Administration is a process and gency which is responsible for determination of the aims for which an organization and its management are to strive, which establishes the broad policies under whhich they are to operate and which gives general oversight to the continuing effectiveness of te total operation in relizing the objectives Management is the process and agency which directs and guides the operations of an organization in realizing of the established aims. Three- fold concept to emphasize the broader scope of management AN ECONOMIC RESOURCE One of the factors in production together with land, labor and capital. As industrialization increases , management is substituted for labor and capital. The management resource of a firm determines to a large extent, its productivity and profitability. Management is used to extensively in industries experiencing innovation. As a system of authority Management first develops with top individuals determining the course of actions for the rank and file.

Humanitarian concepts have later developed paternalistic approaches. This is followed by constitutional management which emphasizes definite and consistent concern for policies and procedures in dealing with the working group. The trend toward a democratic and participative approach follows as employees receive higher education

Management as class and status system Managers have become an elite group of brains and education. Entrance to this class is based on education and knowledge. The new managers continue to expand their horizons in the effort to attain the ultimate in life. ROLES OF MANAGERS INTERPERSONAL ROLES As symbol because of the position he/she occupies and consist of duties as signing papers As a leader who hires, trains, encourages, fires, remunerates, and judges As a liaison between outside contracts such as community, supplier and rhe organization INFORMATIONAL ROLE A manager who monitors information Disseminates information from both external and internal resources As spokesperson or representative of the organization. She/he represents the subordinates to superiors and the upper management to the subordinates Decisional role Makes her/him an entrepreneur or innovator, problem discoverer, a designer to improve projects that direct and control change in the organization. A trouble-shooter who handles unexpective situations such as resignation of subordinates, firing of subordinates, and looses of clients As negotiator when conflicts arise. Planning It permeates into other functions which are dependent on it. By forecasting one can estimate the future By setting objectives the results to be achieved can be determined. By developing and scheduling programs, the activities needed can be defined. By preparing budget, tools and resources can be allocated while establishing polies and procedures that will define the course of action and standards. \Organizing Establishes formal authority. It set up the organizational structure by identifying groupings, roles and relationships within the agency. Job descriptions define the qualifications and scope of responsibilities, relationships and authorities of personnel. Staffing includes determining the staff needed, thus developing and maintaining staffing pattern. The process covers recruiting, selecting, orienting and developing personnel to accomplish the goals of the organization. The selected personnel are then destributed in various areas of the agency where they are qualified to belong Staffing schedules are made to meet the needs of clients, personnel and agency. Directing Actuates efforts to accomplishment of goals. This includes utilization of various modalities of nursing care through the nursing process; updating policies and procedures Supervising of personnel to harmonize work through adequate guidance and leadership. Coordinating personnel and service toward a common goal Communicating via various routes to ensure common understanding. Developing people by providing staff development programs Making sound decisions.

Controlling Leads to assessment and regulation of performance of workers. To ensure the attainment of objectives. Certain standards are utilzed to measure performance. Monitor and evaluate nursing care including utilization of resources. Controls promptly reveals deviations from set plans and standards necessitating immediate corrective measures, actions and/or discipline. You should remember There are three major activities in the cyclic management process Planning Controlling Evaluation and feedback A. Strategic planning 1. Setting goals Operational planning Designing the organization in the best way to achieve the goals and objectives 3. Assigning responsibilities 4. Allocating resources 5. Designing organizational controls( timetables and measures of the organizations performance as a whole) 11. Controlling A. management control ( ensuring efficient and effective use of resources) 1. Developing individual standards Designing project controls (such as work plans and milestone charts) Motivating Reviewing progress Solving problems Coaching and counseling Performance appraisal OPERATIONAL CONTROL (ensuring that specific tasks are carried out efficiently and effectively ) Scheduling Establishing procedures 111. EVALUATION AND FEEEDBACK TO THE NEXT CYCLE You should remember Once we have the goals set through strategic planning, we define objectives, assign responsibilities, and set up organizational controls for each budget cycle. We the enter into day-to-day process of ensuring that we meet our objectives , This is controlling, The type of control with which we are nost concerned with human resource. In controlling, we develop individual standards of performance with our subordinates, set up specific project controls, motivate our employees to fulfill their responsibilities, monitor and review progress, solve problems along the way, coach and counsel when necessary, and finally, appraise individual performance, At the end of the cycle we evaluate how well we did in achieving our objectives and prepare to begin the cycle again. Know the basics There are 3 major activites; planning, controlling and during evaluation cycle and feedback. The circle represents the cyclic nature of the process; in others words, these are the activities or steps an organization should go through continuously usually moving through one cycle during a budget or other designated period. The two major kinds of planning are strategic planning and operational planning.

The major outcome of strategic planning is the setting of goals for the organization .The key steps in operational planning are defining objectives and assigning responsibilities. When we assign responsibilities, we essentially break down our objectives and hand out responsibility for those pieces to various units or individuals. When the assigned responsibilities are fulfilled and added up , they should equal the successful accomplishment of our objectives. Know the basic Controlling enables us to make sure on a day-to-day use basis that our objectives will be met. The two basic types of control are management control (ensuring efficient and effective use of resources) and operation control ( the detailed scheduling and procedures that become routine functions) Standards of performance are conditions that should exist when responsibilities are carried out well. Standards of performance are developed for each responsibility assigned. It follows that standards of performance successfully added together will equal the achievement of the assigned responsibility. All achieved responsibilities added together will equal the accomplishment of the objective. The major components of the system for managing for results are defining objectives, assigning responsibilities, developing standards of performance, and appraising performance

DECISION MAKING Decision making is choosing options that are directed toward the resolution of organizational problems and the achievement of organizational goals. The nurse manager is a decision maker and therefore plays a vital role in achieving the goals and objectives of the organization. ATTRIBUTES OF A DECISION MAKER The freedom to make decision in question The capacity and ability to make a wise decision (Doing so requires sound judgment, deliberation, objectivity, and experience) The will, motivation and commitment to choose. (This attribute requires volition, a conscious activity of the will to make a decision.) TYPES OF DECISIONS Considered Decisions are usually those of great magnitude that is, they tend to be completed and call for considerable reflection. They requires interaction with others, because the perceptions and ideas of other people often provide multiple alternatives that help in approaching the problem situation

A CONSIDERED DECISION REQUIRES TIME Time to find alternatives To seek other opinions To get dissent To determine implementation problems. Incorporating these elements in a decision-making situation leads to appropriate decisions that can be implemented with minimum probability of success Operational Decisions Are those we make practically everyday. Some of these decisions, in fact, may be made at approximately the same time each day, and they may prevent problems as well as solve them. Swallow- Hard Decisions Are those that are often personally uncomfortable to make because they may result in discomfort or uneasiness for subordinates or others

These can be generally classified as decisions impacting interpersonal relationship that is, decisions affecting relationships among people in an organization. It is the kind of decision that is necessary- the kind that managers are paid to make.

Ten-Second Decisions Are those we make during daily operation, They are the decisions that bring operation together, keep it ready, alive, and running well. The overriding factor in a ten-second decision is the pressure to make it quickly. STEPS IN TEN-SECOND DECISIONS Determine first whether the situation really requires one. Determine the major objective of that decision. Before leaping in and solving the problem determine first what you are trying to accomplish. Determine what alternatives are available. Once you have considered alternatives, the last question concerns implications. That is, what could go wrong in the future if you pursue A given course of action?

DECISION MAKING PROCESS Analyze and Identify the situation . Clarify first the situation youre trying to resolve. Before making a decision, take into consideration the circumstances. Find out whats wrong and why its wrong before you proceed. Develop alternatives. In every decision-making circumstance, there are at least two possible actions, e.g. either taking action or not. In most cases ,there are more. Compare alternatives. There are few cases where you are lucky enough to have one alternative that represents the likelihood of 100 % satisfaction. Usually each alternative has the advantages and disadvantages. When decision. If js crucial, take time to write out the advasntages and of each alternatives. Rate the risk. One of the differences between decision making and problem solving is that a proper solution to a problem is sure fire. If it is indeed the right solution, youve practically sure of getting the results desired.

STEPS Select the best alternative. If the previous steps have been done carefully, it is possible that the most likely alternative becomes selfevident. No alternative is desirable. The risk involved in all alternatives, for example, may properly persuade you not take any action, because no move you think of at time promises to be successful. Merge two or more alternatives The resources factor may swing your decision. Alternative A may have more advantages than alternative B Get into gear. After you have made a decision, make it operative. FACTORS AFFECTIING DECISION MAKING INTERNAL FACTORS 1. Decision makers physical and emotional state 2. Personal characteristics 3. Cultural, social, and philosophical background, 4. Interest, knowledge, and attitudes EXTERNAL FACTORS Environmental conditions and values Values are determined by ones cultural, social, and philosophical background. Certain personality factors such as self esteem and self confidence affect whether one is willing to take risks in solving problems or making decisions.

CHARACTERISTICS OF AN EFFECTIVE DECISION MAKERS Courage Willingness to take risks, Self-awareness, Energy Creativity Sensitivity Flexibility TIPS FOR PROBLEM SOLVIING SOLVING AND DECISION MAKING Seek additional information from other sources even if it doesnt support the preferred action. Learn how other people approach problem situations. Talk to colleagues and superiors who you believe are effective problem solvers and decision makers. Observe these positive role models in action. Read journal articles and relevant sections of textbooks to increase your knowledge base. Risk using new approaches through problem resolution through experimentation. PRIMARY STEPS OF DECISION MAKING Define the Problem, issue, or situation ( problem identification is influenced by information available, by the values, attitudes and experiences of the decision makers and by time.) Assessment is done continuously throughout dynamic process. Information gathered should be valid. Accurate relevant to the issue and timely. ANALYZE DATA Data are analyzed to further refine the problem statement and identify possible solutions or options. It is important to differentiate a problem from a symptoms of a problem. By distinguishing the problem from the symptoms of the problem , a more appropriate solution can be identified and implemented. DEVELOP SOLUTIONS The goal of generating options is to identify as many choices as possible Being flexible, open-minded, and creative is critical to being able to consider a range of possible options. SELECT SOLUTION The decision maker should the objectively weigh each option according to its possible risks and consequences, as well as positive outcomes that may be derived. Criteria for evaluation might include variables such as cost, cost-effectives, time, and legal or ethical considerations. The options should be ranked in the order in which they are likely to result in the desired goals and objectives The solution selected should be the one that is most feasible and satisfactory and have the least undesirable consequences. IMPLEMENT The implementation phase should include a contingency plan to deal with negative consequences, shold they appear. In essence, the decision maker should be prepared to institute plan B should need arise. EVALUATE It is important to establish early in the process how evaluation and monitoring will take place, who will be responsible for it, and when it will take place.

In collaboration with nursing staff, the manager would determine when follow-up surveys should be distributed, who will be responsible for their distribution, collection, and analysis, and how the findings will be communicated to appropriate personnel.

Preparing the Budget A BUDGET A BUDGET is the annual operating plan, a financial road map and plan which serve as an estimate of future costs and a plan for utilization of manpower material and other resources to cover capital projects in the operating programs. A NURSING BUDGET is a plan for allocation of resources based on preconceived needs for proposed series of programs to deliver patient care during one fiscal year.

Hospital Budget Hospital budget is a financial plan to meet future serve expectations. These expectations are derived from the best judgment of needs manpower, equipment and supplies so that both services are provided as the highest level of quality at a minimum cost. A budget A budget is simply a plan for future activities expressed in operational as well as financial or monetary terms. In health care institutions, this consists of four components A revenue budget An expense budget A cash budget A capital budget REVENUE BUDGET Summarizes the income which management expects to generate during the planning. EXPENSE BUDGET-describes the expected activity in operational and financial terms for a given period of time. CAPITAL BUDGET Capital budget outlines the programmed acquisitions, disposals and improvements in an institutions physical capacity Cash budget represents the planned cash receipts and disbursements as well as the cash balances expected during the planning period.

BENEFITS DERIVED FROM THE BUDGETARY PROCESS (Categorized under the major functions of planning, coordination and control) 1. PLANNING A. Budgeting stimulates thinking in advance. It anticipates future opportunities or problems and prepares for them. B. It leads to specific planning such as the volume and type of services to be rendered and revenue to be derived therefrom; the number and type of personnel required; the cost; volume and type of supplies needed; their cost of fixed assets when needed; cast collectons and disbursement. Benefits C. Budget preparation stimulates action and interaction. While the mechanical budgeting process gives empirical information , additional benefits result from the organizational thinking process that is generated and the worthwhile interrelationships that develop. COORDINATION A. The budgetary process has a balancing effect on the total organization, that is, the quantity and quality of service to be given a patient should closely equal the expected revenue. If monthly trends are defined, gains and losses can be detected. Since hospital departments are interrelated, future plans of one department must complement the plans of other affected departments. B. Budgeting encourages exchange of information. Ideas are traded thus fostering interest in and understanding of the budgetary process. C. The budget process stimulates team approach. By enabling reach team member to contribute to organizational planning as well as to see the results of good team play, the budget becomes a stimulant to employee commitment and efficiency, and an effective guide to proper utilization of resources. COMPREHENSIVE CONTROL A. The budgeting process gives the administration an opportunity to evaluate the thinking of the budget contributor. Is the budget planning realistic? Are the standards too high or low? The budget may be an aid in evaluating quality and initiative in performance. B. Once the budget standards are set comparisons between actual expenditures and budgeted standards can be made with little or no effort. C. Though the budgeting process is flexible, it tends to define fixed and agreed upon goals. Goal setting enables the administration to prevent persistent efforts of individuals or groups to seek out only their own goals which is often tend to break the hospital organizational apart. D. Cost consciousness is enhanced throughout the institution FACTORS IN BUDGET PLANNING 1. The type of patient (medical, surgical, maternity, pediatric, communicable disease, chronically ill), length of stay in the hospital and the acuteness of the illness. 2, The size of the hospital and its bed occupancy. 3. The physical layout of the hospital, the size and plan of wards or units, the nurses station, treatment rooms. Etc. 4. Personnel policies Salaries paid to various types of nursing personnel including pay for overtime or shift differential. The extend of vacation and sick leaves, holidays and Provision for staff development programs including instructional staff. 5. The grouping of patients such as those in specialized areas e.g. intensive care units 6. Standards of nursing care e.g. Te kind and amount of care to be given as it affects the number of hours of bedside care. 7. The method of performing nursing care whether simple or complex. 8. The method of documentation

9. The proportion of nursing care provided by professional nurse and those given by noonprofessionals 10. The amount and quality of supervision available and provided. 11. The efficiency of job description and job classification 12. The method of patient assignment, whether functional; case, team or primary. 13. The amount and kind of labor-saving devises and equipment intercommunication system. 14. The amount of centralized service provided; sterile supply, central oxygen service, linen supply. 15.The nursing service requirements of the auxiliary departments, clinics, admitting office, ER 16. Reports required by administration whether simple or complex and Affiliation of nursing students or medical students e.g. inexperienced students need more equipment and supplies.

THE BUDGETARY PROCESS The budget committee must be well defined. This committee can assist the budget officer in budget preparation and in monitoring the budget. The chief nurse his/her assistant is usually a member of he budget committee. Within the nursing service the chief nurse works with the supervisors and head nurses in preparing the budget for the nursing service. Participation of nursing personnel in budget preparation and control leads to cost consciousness, awareness of he activities, and increased cost-effectiveness. Past operations must be analyzed and overall master staffing plan must be reviewed . Each supervising nurse works with head nurses to determine the staff requirement for each unit. Any new activities/programs should be considered such as new patient services. Staff development programs or changes in hospital services that affect the required nursing services. The next step to ascertain the amount and kind of supplies needed for the operation of each nursing unit. A review of the fast expenses and consumption provides data for planning. Request of capital equipment for the replacement of capital equipment must be supported with documented justification. The Chief Nurse compiles and completes the draft of the budget and presents this to the Budget Officer or Hospital Administrator. A careful planned budget presentation usually reflects favorable action from the administration. COMPONENTS OF BUDGET The budgetary control program consists of three major budgets; Operating budget Cash budget Capital expenditure budget These may be supplemented by other financial plans, estimates and forecasts. The nursing division is directly concerned with the operating budget and capital expenditures, it is helpful to know what cash budget means. CASH BUDGET Forecasts the amount of money received. It consists of the beginning cash balance estimates of the receipts and disbursement , and the estimated balance for a given period corresponding to that of operating and capitals. The cast budget is prepared by estimating the amount of money to be collected from patients and allocating it to cash disbursements required to meet obligations promptly as they come. OPERATING BUDGET Deals primarily with salaries, supplies, contractual services, employee benefits, laundry services drugs and pharmaceuticals, in-service education, travels to professional meetings, books, periodicals, professional magazines, and maintenance, among others. The operating budget is composed of the revenue and expense budget. THE CAPITAL EXPENDITURES BUDGET Consists of accumulated data for fixed assets that are expected to be acquired during the budgeted period.

These include estimated costs and sources of funds for expected replacements, improvements and additions to fixed assets. The cost of estimated requirements together with the anticipated dates of acquisition should be made in an organized manner for each areas of responsibility. The combination of individual reports provides information about anticipated procurements, priorities and timing as well as the feasibility of acquisition.