NURSING ADMINISTRATION

PROCESS

Prepared by:
Jaybee Claire Santuyo

ADMINISTRATION
- Refers to the group of individuals who are in
charge of creating and enforcing rules and
regulations, or those in leadership positions
who complete important task.

NURSING ADMINISTRATION
-act of managing nursing duties,
responsibilities, or rules.

Standards
Standards: Statements that describe a level
of care or nursing performance by which the
quality of nursing practice can be judged.

Standards of Nursing Administration

1. Standards of Care = statement of a
competent level of clinical nursing practice,
such as identifying problems and planning
& taking action to correct them

2. Standards of Performance = statement of

competent role activities, such as
collaboration & quality of care
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Standards of Care
Standard 1: Assessment
Standard 2: Diagnosis
Standard 3: Identification of Outcomes
Standard 4: Planning
Standard 5: Implementation
Standard 6: Evaluation
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Standards of Care
1. Assessment: Develops, maintains, & evaluates
patient/client and staff data collection systems and
processes to support the practice of nursing and
delivery of patient care.
2. Diagnosis: Develops, maintains, & evaluates an
environment that supports the professional nurse
in analysis of assessment data and in decisions to
determine relevant diagnoses
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Standards of Care (cont.)

3. Identification of Outcomes: Develops,
maintains, & evaluates information
processes that promote desired clientcentered outcomes
4. Planning: Develops, maintains, &
evaluates organizational planning systems
to facilitate the delivery of nursing
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Standards of Care (cont.)

5. Implementation: Develops, maintains, &
evaluates organizational systems that
support implementation of the plan
6. Evaluation: Evaluates the plan and its
progress in relation to the attainment of
outcomes.
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Standards of Professional Performance

Standard 1: Quality of care

Standard 2: Performance appraisal
Standard 3: Education
Standard 4: Collegiality
Standard 5: Collaboration
Standard 6: Research
Standard 7: Resource utilization
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Standards of Performance
1. Quality of Care & Administrative Practice:
Systematically evaluates the quality and
effectiveness of nursing practice & nursing
services administration
2. Performance Appraisal: Evaluates own
performance based on professional practice
standards, relevant statutes & regulations &
organization criteria
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Standards of Performance (cont.)

3. Education: Acquires & maintains current
knowledge in administrative practice
4. Collegiality: Fosters professional
environment
5. Ethics: Decisions & actions are based on
ethical principles
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Standards of Performance (cont.)

8. Collaboration: Collaborates with nursing
staff at all levels, interdisciplinary teams,
executive officers, and other stakeholders
9. Research: Supports research & integrates
it into the delivery of nursing care &
administration

10. Resource Utilization: Evaluates &

administers the resources of organized
nursing services
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Standards
met in
carrying out
DecisionMaking

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Decision-Making
Fundamental skill for all aspects
Traditional decision-making starts with
identifying problem
Management decision-making starts with
writing objectives--fixed end goals

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Decision-Making Grid
List alternatives down
the first column on left
For each write out

Financial effect
Political effect
Department effect
Time

Last column write

decision about each
alternative
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Standards
met in
carrying out
Planning

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Roles & Functions: Planning

Mission
Philosophy
Goals & objectives
Strategies to achieve goals & objectives:
programs, policies, procedures
Time management
Delegation
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Overcoming Barriers to Planning

Goals & objectives increase effectiveness

Plan is a guide & must be flexible
Include all stakeholders in planning
Plans should be simple, specific, realistic
Planned change

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Planning: Managing Change

STAGE 1-UNFREEZING
STAGE 2 - MOVEMENT
STAGE 3 - REFREEZING

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Planning:
Emotional Stages of Change
1. Equilibrium
2. Denial
3. Anger
4. Bargaining
5. Chaos

6. Depression
7. Resignation
8. Openness
9. Readiness
10. Reemergence

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Planning: Time Management

1. Prioritizes day-to-day planning to meet
short-term & long-term unit goals
2. Schedules time for planning
3. Analyzes others use of time
4. Eliminates environmental barriers
5. Handles paperwork promptly & efficiently
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Time management (cont.)

6. Breaks down large tasks into smaller
achievable ones.
7. Uses technology for documentation &
communication
8. Discriminates between inadequate staffing
& inadequate time

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Planning: Examples of Specific Strategies

Use last 30-60 minutes of day to plan next
& clean desk
Plan what you will do in each 30-60 minute
block
Number tasks in order of priority
Start with most difficult priority task &
work for set time
Plan communication with staff
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Standards
met in
carrying out
Organizing

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Roles & Functions:

Organizing Delivery of Nursing Care

Organizational structure
Authority & power in organizations
Nursing systems
Organizing client care
Committees
Nursing informatics
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Organizing: Management Functions

1. Understand agencys structure & personal
responsibility & authority within it
2. Informs staff of unit organizational chart
3. Maintains & clarifies unity of command as
possible
4. Follows subordinate complaints upward
5. Establishes proper span of control
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Organizing: Management Functions

6. Knowledgeable about agency culture
7. Uses informal organization to meet agency
goals
8. Uses committee structure for quality &
quantity of work

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Organizing: Decision-Making
Centralized: Few managers at the top
Decentralized: At the lowest level possible

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Organizing: Assessing Culture

1. How does the organization view physical
environment?
2. What is the organizations social
environment?
3. How supportive is the organization
4. What is the organizational power structure?
5. How does the organization view safety?
6. What is communication environment?
7. What are organization taboos & heroes?
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Organizing: Span of Control

The appropriate number depends on the
organization, the maturity of the
subordinates, and the type of work to be
done. An inappropriate span of control can
result in inefficiency.
(p. 161, Marquis & Huston, 2000)

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Organizing: Committees
Groups who want to work on a project
Manager must give parameters--A clear
assignment with deadlines
Written agendas & chairperson
Large enough to do task; small enough to
talk
Discourage group think
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Organizing: Patient Care

Case Method OR
Total Patient Care Structure

RN Manager
delegates to

Charge Nurse
for each shift
RN

RN

RN

Patients Patients Patients

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Organizing: Patient Care

Functional Nursing Organizaton
Charge RN
Type title here
Medication RN

Treatment RN
Type title here

Nursing Assistants
Type title here

Clerical &
Housekeeping

Patients

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Organizing: Patient Care

Team Nursing Organization
Charge RN
each shift
RN staff
Type title here

RN staff
Type title here

RN, LVN,
RN, LVN,
Nursing Assistant Nursing assistant

Patients

Patients
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Organizing: Patient Care

Primary Nursing
1 RN plans & manages care for the patient in
collaboration with Associate RNs
Interfaces with MD, Charge RN, & resources

Case Management
All RNs use resources to expedite health; OR
A special nurses monitors & facilitates use of
resources in the agency for many patients in
collaboration with their nurses
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Organizing: Informatics
Data recording & retrieval used to
Manage care
Monitor care

Computer/technology
RNs must be educated

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Standards
met in
carrying out
Staffing

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Roles & Functions: Staffing

1. Personnel
2. Fiscal planning/budgeting
3. Staffing & scheduling
4. Staff Development

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Staffing: Management Functions

1. Ensures adequate, skilled workforce to meet
agency goals
2. Shares recruitment responsibility
3. Interviews with proper techniques
4. Develops selection criteria
5. Places based on agency needs & employee
strengths
6. Interprets employee handbook
7. Participates in employee orientation.
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Staffing: Personnel
Recruiting: Actively seeking out and hiring
those who can best do job
Interviewing:
Based on specific job criteria
Best predictor of future performance is past
performance
Give person clear information about job
Try to contradict your first impressions
More than 1 interviewer is ideal
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Staffing: Structured Interview

Motivation
Physical
Education
Work experience
Present work
Previous work
Personal characteristics & goals
Anticipated contributions to this agency
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Staffing: Orientation & Socialization

Orientation --> Competence --> Quality
Socialization
Introduce to others & their roles
Coach as take on role responsibilities
Recognize current skills & knowledge & build
on these

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Staffing: Scheduling
Scheduling should
Meet agency need
Be fair to all

Policies should include, for example

Lateness, absence, illness, emergencies
Vacations & regular time off; Special requests
Expectations for working in other areas of the
agency
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Staffing: Scheduling & Budgeting

NCH/PPD = Nursing hours in 24 hour period
Patient census
Acuity of patients calculated to adjust RNs

Cost controlled
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Staffing: Staff Development

Interface with educators
Own role in orientation & motivation
Preceptor program
Identification of clinical & teaching expertise
Education of preceptor
Adjustment in assignments of preceptor & new
staff
Competence checklists
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Standards
met in
carrying out
Directing

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Roles & Functions: Directing

1. Use authority to provide reward system
2. Use positive feedback as reward
3. Unit goals that integrate agency & employee
needs
4. Environment that
Reduces job dissatisfiers
Focuses on employee motivators

5. Maintain tension for productivity along with job

satisfaction
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Roles & Functions: Directing (cont.)

6. Clear communication of expectations
7. Communicates sincere respect, concern, trust, &
sense of belonging to subordinates
8. Assigns work appropriate to employee
competence
9. Identifies what motivates subordinates, and
develops motivational strategies to meet these.

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Directing: Communications
1. Understand & use agency formal communication
network
2. Uses appropriate communication mode for
distribution of information
3. Prepares appropriate written communication
4. Consults/coordinates with others who have
overlapping functions
5. Differentiates between information &
communication and recognizes need for both.
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Directing: Communications
6. Protects subordinate confidentiality
7. Prepares self & staff for use of technology
8. Uses group dynamics knowledge to achieve
agency goals

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Directing: Delegation
1. Creates & follows specific job descriptions that
conform to national/professional standard of care
2. Understands legal liabilities of management
3. Delegates based on abilities/limits of staff
4. Delegates authority appropriately to achieve goals
5. Maintains periodic review of delegated task
6. Recognition & rewards for task completion

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Directing: Managing Conflict

1. Anticipates & minimizes sources of conflict on
unit
2. Uses authority when quick, unpopular decision
must be made
3. Facilitates conflict resolution between employees
4. Accepts mutual responsibilities for reaching goals
5. Effectively negotiates for needed resources
6. Compromises unit needs only on the noncritical
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Directing: Labor Issues

1. Uses union contract appropriately
2. Administers policies fairly
3. Works cooperatively with administration &
personnel when dealing with unions
4. Understands laws relating to managers work
5. Safe work environment
6. Alert for discrimination
7. Ensures licensing requirements met
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Standards
met in
carrying out
Control

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Roles & Functions: Controlling

1. In collaboration with others, establishes clear-cut
measurable standards of care & determines the
most appropriate method for measure [whether]
those standards have been met.
2. Selects & uses process, outcome & structure
audits as quality control
3. Gathers data from appropriate sources
4. Determines discrepancies between performance &
standards & determine why
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Roles & Functions: Controlling

5. Uses quality findings for performance review,
rewards, & development of employees
6. Educates self about state & accrediting regulations
that define quality
7. Participates in benchmarking efforts and best
practices initiatives.

mefh 8/01

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Controlling: Quality
STEPS
1. Identify standards & expected outcomes
2. What information would objectively measure
these standards/outcomes?
3. Determine how & where to collect the information
4. Gather information
5. Compare information to standards/outcomes
6. Make a judgment about quality
7. Share information & take corrective action prn
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Controlling: Quality
Audits
1. Structure
2. Process

3. Outcomes
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Controlling: Quality
Total Quality Improvement (TQI or QI or
QAI or CQI) is a different philosophy
Identifying doing the right things, the right
way, the first time, and problem-prevention
planning--NOT inspection and problemsolving--lead to quality outcomes

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Controlling: Performance Appraisal

1. Uses formal, established system of appraisal
2. Gathers fair & objective data
3. Uses to determine staff education & training needs
4. Based on written standards that have been
communicated
5. Documents process
6. Follows up on deficiencies
7. Conducts appraisal in way that promotes positive
outcome
8. Provides continuous feedback to employees.
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Example
Part of an oncology nurse performance evaluation
tool for Professional Performance Standard 3:
Education The oncology nurse acquires and
maintains current knowledge in oncology nursing
practice.
Rating scale used:
1. Performance below standards
2. Performance meets standard
3. Performance exceeds standard
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Professional Performance Standard 3:

Education: The oncology nurse acquires and
maintains current knowledge in oncology
nursing practice.
Criteria:
Rating
1 2 3
1. Participates in ongoing
educational activities (including
inservices, continuing education,
formal education, and
experientatil learning) to expand
oncology knowledge of
professional issues
2. Seeks experiences to develop
& maintain clinical skills
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Promoting Professionalism

Professional standards
Professional relationships & commitment
Patient advocate
Staff education & career planning

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