Directing

AILYN BRILLO PINEDA, RN

DIRECTINGThe act of issuing orders, assignments, instructions to accomplish the organization’s goals and objectives.It entails explaining what is to be done, to and by whom, at what time, how and why.

TOOLS IN DIRECTING

Nursing Care PlanPoliciesStandardsStandard Operating ProcedureRules and Regulation

ELEMENTS IN DIRECTING

1. Delegation2. Supervision3. Staff Development4. Coordination5. Collaboration6. Communication7. Evaluation

1. Delegation

Getting work done through others.

Directing the performance of one or more people to accomplish organizational goals.

Delegation Provides learning or ‘stretching’ opportunities for subordinates.

Increases power.

Cannot delegate total responsibility.

Do not delegate responsibility without authority.

Delegate to the right person, at the right time, and for the right reason.

Say no when you must.

Reward subordinates for jobs well done.

Don’t just delegate boring jobs.

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Principles of Delegation1. Select the right person to whom the job is to be

delegated.2. Delegate both interesting and uninteresting tasks.3. Provide subordinates with enough time to learn.4. Delegate gradually.5. Delegate in advance.6. Consult before delegating.7. Avoid gaps and overlaps.

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• Aspects of Delegation1. Responsibility – denotes obligation2. Authority – the power to make final decisions and give commands.3. Accountability – refers to liability

Sometimes managers must delegate routine tasks so they are free to handle problems that are more complex or require a higher level of expertise.

Managers may delegate work if someone else is better prepared or has greater expertise or knowledge about how to solve a problem.

For nurses, delegation is not an option, but a necessity.

Delegation is a managerial tool for subordinate accomplishment and enrichment.

Causes of UnderdelegatingFear that delegation may be interpreted as a lack of ability to do the job completely or correctly.A desire to complete the whole job himself or herself.Fear that subordinates will resent delegated work.Lack of experience in the job or with delegation; or the need to control or be perfect.Enjoyment of the work.

Causes of Overdelegating

Poor managers of time who spend too much time trying to get organized.

Insecurity in the ability to perform a task.

Causes of Improperly Delegating

Wrong time, to the wrong person, or for the wrong reason.Beyond the capability of the person or something the manager should do.Decision making without providing adequate information.

Clear Communication + Delegation

Define the task clearly.

Delineate end results,

time frame, standards.

Delegate the objective,

not the procedure.

If the delegator requires a higher quality than “satisficing,” this must be made clear at the time of the delegation. Not everything that is delegated needs to be handled in a maximizing mode.

Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task, but should also validate this perception by direct observation.

Monitoring delegated tasks keeps the delegated task before the subordinate and the manager, so that both share accountability for its completion.

“Never tell people how to do things. Tell them what you want to achieve,

and they will surprise you withtheir ingenuity.”

George Patton, 1944

Delegation as Function of Professional Nursing

RNs at all levels are increasingly expected to make assignments and supervise the work of different levels of employees.Supervisor + delegator — are RNs prepared?

Resistance is a common response by subordinates to delegation.

2. SUPERVISION

The process of guiding and directing the work to be done.

PRINCIPLES OF GOOD SUPERVISION

1. Focused on the improvement of work rather than upgrading the worker.

2. It is based on line of authority, organizational philosophy, vision, mission, job description, policies and standards, the needs of the individual.

3. Focus on the 3 areas of skill: conceptual, technical and interpersonal

4. It is cooperatively planned, and accepts both challenge and change.

5. Uses democratic process.6. THE ULTIMATE GOAL OF GOOD

SUPERVISION IS TO PROVIDE SAFE, EFFECTIVE , QUALITY CARE.

RESPONSIBILITIES OF SUPERVISORS

Teach and motivate the staffDelegate work responsibilitiesPerform ax and evaluation of work performance and condition.Attend consultation.

3. STAFF DEVELOPMENT

Staff development is a planned experience to help employees perform effectively , and to enrich their competence in practice, education, administration and research.

FUNCTION OF STAFF DEVELOPMENT

To maintain staff efficiency and effectivenessTo create quality employeesTo meet the staff’s needs and address their problemsTo motivate them and improve their self-confidenceTo help prepare them for greater responsibilities

4. COORDINATION

Coordination links he different components of an organization and leads them toward goal achievement.

5. COLLABORATION

Collaboration is working together in the decision making process.

6. COMMUNICATION

Communication is the process by which a message is sent, received and understood as intended.

Communication

The complex exchange of thoughts, ideas, or information on at least two levels: verbal and nonverbal. (Chitty, 2001)

Channels of Communication

UpwardAllows employee input

Staff satisfaction high

Supervisor passes up

Outward To patient, family and

community

Downward

Traditional

Primarily directive

Satisfaction less for subordinate

Employee handbook, reports, job descriptions

Horizontal

To peers and members of the health team.

Variables Affecting Organizational Communication

Spatial distance

Different subgroups or subcultures

Differing authority and work structures

Organizations in a constant state of flux

Gender is also a significant factor in organizational communication because men and women communicate and use language differently.

Organizational Communication Strategies

Understand the structure of the organization.Realize that communication is not a one-way channel.Keep communication clear, concise, and simple.Sender should seek feedback regarding accuracy.Use multiple communication methods.Don’t overwhelm with unnecessary information.

The CommunicationProcess

Internal ClimateValuesFeelingsTemperamentStress levels of sender and receiver

External Climate

Weather conditions

Temperature

Timing

Organizational climate

Status, power, and authority as barriers to manager-subordinate communication

Communication Modes

Written communication

Verbal communication

Nonverbal communication

Grapevine Communication

Flows haphazardly between people at all levels of the hierarchy and usually involves 3-4 people at a time.Subject to error and distortion because of the speed at which it passes.Sender has little formal accountability for the accuracy of the message.

Telephone Communication

Rapid.Allows receiver to clarify message at time it is received.Does not, however, allow the receipt of nonverbal messages for either the sender or the receiver.

Listening

The average person spends 70% of his or her time listening, but only 1/3 of all messages are retained.

Good listening skills are as important as good verbal skills to the manager.

Good listening skills take ongoing effort.

Non-Verbal Communication

Ralph Waldo Emerson stated, “What you are speaks so loudly I cannot hear what you say.” (Rocchiccioli & Tilbury, 1998, p. 147)

Non-Verbal Communication Cues

Space

Environment

Outward appearance

Eye contact

Body posture

Gestures

Facial expression

Timing

Interpersonal CommunicationOther interpersonal communication skills

Nonverbal communication

Assertive communication

Listening skills

Assertive Communication

A way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person’s rights.

Passive Communication

Occurs when a person suffers in silence, although he or she may feel strongly about the issue.

Nonassertive.

Aggressive Communication

Expressing oneself in a direct and often hostile manner that infringes on another person’s rights.

Generally oriented to “winning at all costs.”

Passive-Aggressive Communication

An aggressive message presented in a passive way.

Limited verbal behavior with incongruent nonverbal behavior.

Virtual Communication

Electronic mailFaxTeleconferencesPagersInternetCD-ROMNetworked systems

Stages of Group Work

Forming Storming Norming Performing

Stages of Group Work

Forming Storming Norming Performing

Confidentiality

Confidentiality is expected regarding sensitive personal communications between managers and subordinates.

All patient records require confidentiality.

BARRIERS TO EFFECTIVE COMMUNICATION

Physical BarriersSocial/Psychological BarriersSemanticsInterpretation

7. EVALUATION

Outcome of what has been done based on job performance.

PURPOSE OF EVALUATIONProvide constructive feedbackDetermine progress and worthiness of individual nurse for greater responsibilitiesServe as a basis for promotion and increase in salary or other similar rewards.

Managing Conflict

conflict The internal or external discord that occurs as a result of differences in ideas, values, or beliefs of two or more people.

Conflict is about...Conflict is about... P Personerson

about reactions on a personal, emotional level

personal style - self-assessments

identifying the styles of others

Common Reactions to Conflict

Anger Hostility Avoidance Hurt

Personal StylesPersonal Styles

Are you right or left-brained?

Are you a Theory X or Theory Y?

Are you someone who… ?

Testing your ‘style’...

Identifying the styles of others…

the “Crazymakers” ...

Conflict is about...Conflict is about... Place Place The environment in your workplace The culture of your workplace The culture of your department Organizations are ‘messy’, complex and

contradictory things Using metaphor to understand your workplace

Conflict is about...Conflict is about... Process Process

Common approaches to conflict resolution Reframing the conflict Disarming ‘tools’ Capitalizing on your style

The Pareto Principle or 80/20 Principle

80% of the conflicts in your life are probably with 20% of the people in your life, and20% of those conflicts are causing 80% of the negative consequences in your life, soBecause you can’t resolve all the conflicts, you have to pick the ones that matter. Concentrate on the 20% that are causing 80% of your problems.

Categories of Conflict

Interpersonal

Intrapersonal

Intergroup

Intragroup

Interpersonal Conflict

Also known as horizontalviolence or bullying.

Conflict Resolution Outcomes

Win–Win

Win–Lose

Lose–Lose

Winning and losing are goals for games, not for conflicts.

The optimal goal in resolving conflict is creating a win–win solution for all involved.

Common Conflict Resolution Strategies

Avoiding

Compromising

Competing

Accommodating

Smoothing

Collaborating

Avoiding

Parties are aware of a conflict but choose not to acknowledge it or attempt to resolve it.

Compromising

Each party gives up something it wants.

CompetingOne party pursues what it wants regardless of the cost to others.

AccommodatingOne party sacrifices his or her beliefs and wants to allow the other party to win.

Smoothing

An individual attempts to reduce the emotional component of the conflict.

CollaboratingAn assertive and cooperative means of conflict resolution whereby all parties set aside their original goals and work together to establish a supraordinate or common priority goal.

Helpful Tips in Conflict Resolution

Focus on the causes of the disagreement and not on personalities.Try to arrive at solutions acceptable to everyone concerned.Get all the information possible. Differentiate between facts and opinions.

Helpful Tips in Conflict Resolution (cont.)

Listen carefully and don’t prejudge.Don’t belabor how the conflict occurred. Instead, concentrate on what should be done to keep it from recurring.Concentrate on understanding and not on agreement.

Three Difficult Personality Types We ALL Have Conflicts With

Sherman Tanks: The Attackers

Snipers: The Potshot Artists

Clams: The Maddening Ones

NegotiationFrequently resembles compromise when used as a conflict negotiation strategy.Emphasis is on accommodating differences between the parties.Each party must consider trade-offs and their bottom line to negotiate successfully.

Negotiating Strategies

Use factual statements.

Listen and keep an open mind.

Discuss issues and not personalities.

Start tough.

Handle the unexpected wisely.

Deal with the unexpected.

Negotiating Strategies (CONT.)

Be honest.Be pleasant and don’t show anger.Don’t give up the ship too early.Try not to use your bottom line.Take a break if necessary.

Negotiation Closure and Follow-Up

End on a friendly note.Restate final decision.Hide astonishment at your success.Make the other party feel that they also won.Follow up with a memo.

Types of Alternative Dispute Resolution (ADR)

Mediation Fact-finding Arbitration Ombudsperson

Seeking Consensus

Always an appropriate goal in resolving conflicts and in negotiation.All parties support, or at least do not oppose, an agreement.Greatest challenge in consensus building is time.

Conclusion

Conflict is inevitable in any organization, but if successfully managed, it can produce high-quality, creative solutions that lead to motivation and progress. The goal, then, should be to create a work environment that uses conflict constructively as a conduit for growth, innovation, and productivity.

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CONTROLLING

Controlling or evaluating is an on-going function of management which occurs during planning, organizing, and directing activities.

The controlling process opens opportunities for improvement and comparing performance against set standard.

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Reasons For Conducting Evaluation1. Evaluation ensures that quality nursing care is

provided.2. It allows for the setting of sensible objectives and

ensures compliance with them.3. It provides standards for establishing comparisons.4. It promotes visibility and a means for employees to

monitor their own performance.5. It highlights problems related to quality care and

determines the areas that require priority attention.6. It provides an indication of the costs of poor quality.7. It justifies the use resources.8. It provides feedback for improvement.

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Principles of Evaluation.1. The evaluation must be based on the behavioral standards of

performance which the position requires.2. The evaluation should have enough time to observe employee’s

behavior.3. The employee should be given a copy of the job description,

performance standards, and evaluation conference.4. The employee’s performance appraisal should include both satisfactory

and unsatisfactory results with specific behavioral instances to exemplify these evaluative comments.

5. Areas needing improvement must be prioritized to help the worker upgrade his/her performance.

6. The evaluation conference should be scheduled and conducted at a convenient time for the rater and the employee.

7. The evaluation report and conference should be structured in such a way that is perceived and accepted positively as a means of improving job description.

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Characteristics of an Evaluation Tool

1. Should be objective

2. Should be reliable

3. Should be sensitive

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PERFORMANCE APPRAISAL

Performance appraisal is a control process in which employee’s performance is evaluated against standards.

What Are the

Purposes

of a

Performance

Appraisal?

Purposes of Performance Appraisal

1. Determine salary standards and merit increases.

2. Select qualified individuals for promotion or transfer.

3. Identify unsatisfactory employees for demotion or termination

4. Make inventories of talents within the institution.

5. Determine training and development needs of employee.

Nursing management- CONTROLLING -6. Improve the performance of work groups by

examining, improving, correcting interrelationship between members

7. Improve communication between supervisors and employees and reach an understanding on the objectives of the job

8. Establish standards of supervisory performance.

9. Discover the aspirations of employees and reconcile these with the goals of the institution

10. Provide employee recognition11. Inform employees where they stand.

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Methods of Measuring Performance1. Essay2. Checklist3. Ranking4. Rating Scales5. Forced-choice Comparison6. Anecdotal Recording