Professional Documents
Culture Documents
Reading 4.1 Marquis, B. 2003, Leadership Roles and Management Functions in Nursing, Lippincott Williams & Wilkins, A Wolter Kluwer Company, pp. 7-10.
The management process is similar in many ways to the nursing process. Both processes are cyclic, and many different functions may occur simultaneously. Suppose that a nurse-manager spent part of the day working on the budget (planning), met with the staff about changing the patient care management delivery system from primary care to team nursing (organizing), altered the staffing policy to include 12-hour shifts (staffing), held a meeting to resolve, a conflict between nurses and physicians (directing), and gave an employee a job performance evaluation (controlling). Not only would he nurse-manager be performing all phases of the management process, but each function has a planning implementing, and controlling phase. Just as nursing practice requires that all nursing care has a plan and an evaluation, so too does each function of management.
Reading 4.2 Clark, C. 2009, Creative Nursing Leadership and Management, Jones and Bartlett Publishers, LLC., USA., pp. 32-35.
PART
Reading 5.1 Tomey, A. 2000. Guide to Nursing Management and Leadership, Elsevier Science (Singapore) PTE LTD, pp. 175-177
Reading 5.2 Swanshurg, R.C. and Swansburg R.J. 1999. Introductory Management and Leadership for Nurses. 2nd ed. Massachusetts, Jones & Bartlett Publishers. pp. 73-86.
Characteristics of Planning
What is the nature of planning? What is so distinctive about it that requires a nurse to have the knowledge and skills requisite to engage in planning? In an environment of changing technology; mounting costs, and multiple activities, a need exists for professional nurses to plan. The forecasting of events and the laying out of a system of activities or actions for accomplishing the work of nursing and of the organization are perquisites to success. Koontz and Weihrich define planning as selecting missions and objectives and the actions to achieve them; [planning] requires decision making, that is, choosing future courses of action form among alternatives. They viewed planning as an elementary function of management. In planning, the nurse would avoid leaving events to chance; she or he would apply an intellectual process to consciously determining the course of action to take in accomplishing work. Donovan stated that the planning process must be deliberate and analytic to produce carefully detailed programs of action that will achieve objectives. The nurse manager plans effectively to create an environment in which nursing personnel will provide the nursing care desired and needed by clients. In such an environment, clinical nurses will make decisions about the form or modality of practice, and nurse managers will work with nursing personnel to establish and meet their personal objectives while meeting the objectives of the organization.
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According to Hodgetts, planning forces a firm to forecast the environment, gives direction in the form of objectives, provides the basis for teamwork, and helps management to learn to live with ambiguity. It should be comprehensive, with professional nurses carefully determining objectives and making detailed plans to accomplish them. All managers and representative clinical nurses should provide input into strategic planning, and every unit should have a strategic plan. Planning involves the collection, analysis, and organization of many kinds of data (the how) that will be used to determine both the nursing care needs of patients and the management plans that will provide the resources and processes to meet those needs. The following are some of the kinds of data that will need to be collected and analyzed for planning purposes: 1.) 2.) 3.) 4.) 5.) 6.) 7.) 8.) Daily average patient census. Bed capacity and percentage of occupancy. Average length of stay. Number of births. Number of operations. Trends in patient populations. Trends in technology. Environmental analysis.
Reading 5.3 Swanshurg, R.C. and Swansburg R.J. 1999. Introductory Management and Leadership for Nurses. 2nd ed. Massachusetts, Jones & Bartlett Publishers. pp. 73-86.
Reading 5.4 Simms, L., Price, S., and Ervin, N. 2000. Professional Practice of Nursing Administration. 3rd ed. Delmar Publishers. pp. 198-206.
Both controllable and noncontrollable expenses are projected. The manager determines the number of personnel needed and the level of skills required of each. Wage levels and quality of materials used are other controllable expenses. Indirect expenses, such a rent, lighting, and depreciation of equipment, are noncontrollable. The noncontrollable expenses and the probability of rises in the material prices of labor cost during the budgetary period demand that an operating budget include some cushion funds to provide for changes beyond the agencys control. The operating budget deals primarily with salaries, supplies, and contractual services. Nonfinancial factors, such as time, materials, and space can be translated into dollar values. Work hours, nurse-patient interaction hours, units of materials, equipment hours, and floor space also can be assigned dollar values.
Reading 5.5 Tomey, A. 2004. Guide to Nursing Management and Leadership (8 th e.d). Mosby Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 233-248.
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PART
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Organizational Principles
Certain organizational principles should be observed in designing the table of organization for a nursing department and in orienting personnel to function effectively within the structure.
The Principle of Unity of Command indicates that although an employee may interact with many different individuals in the course of his work, he should be responsible to only one supervisor, whose direction can be regarded as final. The Principle of Requisite Authority indicates that when responsibility for a particular task in delegated to a subordinate, that subordinate must also be given authority over resources needed to accomplish the task. The Principle of Continuing Responsibility refers to the fact that when a superior delegates responsibility for a particular function to a subordinate, he in no way diminishes his own responsibility for that function. The Principle of Organizational Centrality refers to the fact that the greater the number of persons with whom a given worker reacts, directly, the more information he receives, and the more powerful he becomes in the total organizational structure. The Principle of Exceptions refers to a management practice followed in some organizations, in a which subordinates are expected to report only departures from normal functioning, so that managerial efforts may be limited to those processes that cannot be handled by routine control mechanisms. Organization Concepts
In analyzing the effects of formal organizational pattern on the nature of communication between workers, it is helpful to understand the concepts of role, power, status, authority, centrality, and communication. Role can be defined as the set of behaviors and attitudes expected of an individual by those with whom he interacts. It is important to note the reciprocal or reflexive aspect of role. Because ones role is defined by others expectations, the individual is strongly dependent upon those others for this aspect of personal identity. Throughout life an individual occupies a series of roles, which change with alterations in lifes circumstances. As a nursing department employee, the nurse may occupy several occupational roles at the same time. A particular head nurse is a subordinate to her supervisor, a supervisor to her own staff nurses, a peer to other head nurses, and perhaps a committee chairperson or consultant to workers in other divisions of the organization. Because different attitudes and behaviors are called for in the execution of each role, the head nurse just described must change costume many times during a typical work day, adjusting and readjusting facial expression, body language, a tone of voice, and language to meet expectations of those significant others who have defined each role.
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Reading 6.1 Gillies, D. 1989. Nursing Management A System Approach. (2 nd ed.) Saunder Company. pp. 140-150.
Reading 6.2 Swanshurg, R.C. and Swansburg R.J. 1999. Introductory Management and Leadership for Nurses. 2nd ed. Massachusetts, Jones & Bartlett Publishers. pp. 356.
Organizational theories fall into three basic categories, each of which is characterized by a prevailing school of thought. Elements of each school of thought apply to health care organizations today. Health care organizations are major industries and as such are structured on various principles of organizational theory. Organizational theories have several implications for nursing. Understanding organizational structures from historical and scientific perspectives provides a basis for effective nursing leadership and management. Nurses must be aware of the evolution of organizational theory to be able to contribute to the organization. Knowledge of the theory or theories under which a health care organization functions enables nurses within that organization to clarify their individual roles and functions.
Reading 6.3 Grant, A., and Massey, V. 1999. Nursing Leadership, Management and Research. Springhouse Corporation, Pennsylvania. pp. 10-16
D.)
Processes in Organizing
societys needs, including the needs for increased care for the elderly and the need to control resources. Autonomy will be strengthened by unbundling the hospital bill and by direct reimbursement for nursing services by third-party payers.
D.3: Culture
Organizational culture is the sum total of an organizations beliefs, norms, values, philosophies, traditions, and sacred cows. It is a social system that is a subsystem of the total organization. Organizational cultures have artifacts, perspectives, values, assumptions, symbols, language, and behaviors that have been effective in the past.
D.4: Climate
The organizational climate is the personality of an organization, the perception and feelings shared by members of the system. It can be formal, relaxed, defensive, cautious, accepting, trusting, and so on. It is employees subjective impressions or perceptions of their organization. Practicing nurses create, or at the very least, contribute to the creation of, the climate perceived by patients.
Reading 6.4 Swanshurg, R.C. and Swansburg R.J. 1999. Introductory Management and Leadership for Nurses. 2nd ed. Massachusetts, Jones & Bartlett Publishers. pp.359-373.
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Reading 6.5 Tomey, A. 2004. Guide to Nursing Management and Leadership (8 th e.d). Mosby Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 283-292.
F.) Staffing
Changes in assignment systems are a response to changing needs. In the 1920s the case method and private duty nursing were popular. By 1950 functional nursing was predominant in response to the shortage of nurses. During the decade team nursing was introduced to maximize
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use of the knowledge and skills or professional nurse through primary nursing. Case management became popular during the 1980s, and managed competition emerged as an economic strategy guiding health care reform during the 1990s. It stimulated partners in practice, which is an interdisciplinary team.
Case Method
In the case method each patient is assigned to nurse for total patient care while that nurse is on duty. The patient has a different nurse each shift and no guarantee of having the same nurses the next day. The patient care coordinator, with no obligation to assign nurses to the same patient, supervises and evaluates all care given on the unit. Popular during the 1920s along with private duty nursing, the case method emphasized following physicians orders (Grohar-Murray and Di Croce, 2003.)
Collaborative Practice
Collaborative practice can include interdisciplinary teams, nurse-physician interaction in joint practice, or nurse-physician collaboration in caregiving. Collaboration is cooperative and assertive. The interaction between nurses and physicians or other health care team members in collaborative practice should enable the knowledge and skills of the professions to influence the quality of patient care provided synergistically. It is important to the managed care models that proliferated during the 1990s.
Level of Staff The level of staff available greatly influences the assignment system used. When there are a few RNs and a few practical nurses, many aides are quickly oriented and used. This is an expensive and relatively dangerous mix, because aides do not have the educational background to do most of what is required or to recognize what should be reported. After the aids have done all they can, there is still much work to be done. Consequently, there is considerable downtime. This staffing mix lends itself best to functional nursing.
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F.3: Self-Scheduling
A system that is coordinated by staff nurses (Table 13-5). It is a process by which nurses and other staff collectively develop and implement work schedules, taking policies and variables affecting staffing, into consideration.
Reading 6.6 Tomey, A. 2004. Guide to Nursing Management and Leadership (8 th e.d). Mosby Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 378-402.
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Types of Power
A.) Position power: Derives from organizational sources. 1.) Reward power. The extent to which a manager can use extrinsic and intrinsic rewards to control other people. Success in accessing and utilizing rewards depends on managers skills. 2.) Coercive power. The extent to which a manager can deny desired rewards or administer punishments to control other people. Availability varies from one organization and manager to another. 3.) Legitimate power. Also known as formal hierarchical authority. The extent to which a manager can use subordinates internalized values or beliefs that the boss has a right of command to control their behavior. If legitimacy is lost, authority will not be accepted by subordinates. 4.) Process power. The control over methods of production and analysis. Places an individual in the position of: Influencing how inputs are transformed into outputs. Controlling the analytical process used to make choices. 5.) Information power. The access to and/or control of information. May complement legitimate hierarchical power. May be granted to specialists and managers in the middle of the information system. People may protect information in order to increase their power. 6.) Representative power. The formal right conferred by the firm to speak as a representative for a potentially important group composed of individuals across departments or outside the firm. Helps complex organizations deal with a variety of constituencies.
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B.) Personal power: Derives from individual sources. 1.) Expert power. The ability to control another persons behavior through the possession of knowledge, experience, or judgment that the other person needs but does not have. Is relative, not absolute. 2.) Rational persuasion. The ability to control another persons behavior by convincing the other person of the desirability of a goal and a reasonable way of achieving it. Much of a supervisors daily activity involves rational persuasion. 3.) Referent power. The ability to control anothers behavior because the person wants to identify with the power source. Can be enhanced by linking to morality and ethics and long-term vision.
Reading 6.7 Tomey, A. 2004. Guide to Nursing Management and Leadership (8 th e.d). Mosby Elsevier (Singapore) PTE LTD, Health Science Asia. pp. 110-132.
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PART
A.) Introduction
Directing is one of the management processes that need to be fulfilled as a manager or leader. The idea of directing is when a person has to put an output or action on the plans in order to attain a goal. To fully understand the concept of directing, a textbook from Swansburg explained it in details.
Reading 7.1 Swansburg, R. C., & Swansburg, R. 2002, Chapter 17 The Directing (Leading) Process. Introduction to Management and Leadership for Nurse Managers, Jones and Bartlett Publisher, Sudbury, MA. pp. 383-384
In describing the functions of management, Fayol stated that the manager must know how to handle people and must be able to defend his or her point of view with confidence and enthusiasm. The manager learns continuously and educates people at all levels for success in their assigned tasks. Fayol stated that command occurs when the manager gets the optimum return from all employees of his (sic) unit in the interest of the whole concern. To do this, the manager must know the personnel, eliminate the incompetent, be well-versed in the blinding agreements with employees, set a good example, conduct periodic audits, confer with chief assistants to focus on unity of direction, not become mired in detail; and have as a goal, unity, energy, initiative, and loyalty among employees. Fayol defined coordination as creating harmony among all activities to facilitate the working and success of the unit. In modern management, command and coordination are labeled directing or leading
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According to Urwich, it is the purpose of command and the function of directing to see that individual interest do not interfere with the general interest. Command (directing) protects the general interest and should ensure that each unit has a competent and energetic head. Command functions to promote esprit de corps and to carefully select a staff that can be of most service. It was Urwich premise that bringing n a new blood rather than promoting from within may excite resentment. Urwick indicated the need for a grievance procedure, for common rules to be observed by all, and for regulations that allow for self-discipline. Managers should explain regulations and cut red tape. They should decarbonizes, that is, clean out rules and regulations as needed. Rowland and Rowland stated that directing initiates and maintains action toward desired objectives and is closely interrelated with leadership. These authors suggested that a managers choice of leadership style will be the major factor in exercising the directing function. Among the activities of directing are delegation, communication, training, and motivation.
Reading 7.2 Swansburg, R. C., & Swansburg, R. 2002, Introduction to Management and Leadership for Nurse Managers, Jones and Bartlett Publisher, Sudbury, MA.
Reading 7.3 Basavanthappa, BT, 2000, Chapter 6 Directing: Nursing Administration. Jaypee Brothers Medical Publisher Ltd: New Delhi. pp 109.
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Nature of Direction
Direction means giving the order to start the operation for the implementations of a policy or plan. It is the managerial effort that is applied for guiding and inspiring the working team to make better accomplishments in the organizations, so it includes the necessary guidance and instructions for carrying out the order given, and the removal of any doubts or difficulties which may arise in the course of execution or implementation. Direction is concerned with seeking fullest cooperation of the personnel for the realization of collective purpose of economic objectives of organizations and it is also concerned with fulfilling the needs of the subordinates like physiological needs, protective needs, social needs and egoistic needs.
C.) Motivation
One of the things focus on Leadership is how to keep your subordinates motivated. A manager has to study on how to keep people stay and pursue a nursing career although the salary is not enough here in the Philippines. The manager has to understand why some employees strive to achieve higher performance while some employees dont. The concept of motivation has to be included to let the student know how to stimulate extrinsic and intrinsic motivation in each individual. There has been various studies formulated by the different famous theorist. Why do people work? Why do some employees achieve high productivity whereas others are content with mediocrity or less? What can a manager do to stimulate intrinsic and extrinsic motivation? These questions are important to the manager. They elicit complex and uncertain answers. Unfortunately, there are no simple rules that a manager can follow to stimulate the staff.
Reading 7.4 Ann Marriner Tomey, 2004, Part 1 Leadership: Chapter 4 Motivation and Morale. Guide to Nursing Management and Leadership, 4th ed. Singapore: Elsevier PTE Ltd. pp. 90-97
Leadership Styles
There are a number of different approaches, or 'styles' to leadership and management that are based on different assumptions and theories. The style that individuals use will be based on a combination of their beliefs, values and preferences, as well as the organizational culture and norms which will encourage some styles and discourage others.
Charismatic Leadership Participative Leadership Situational Leadership Transactional Leadership Transformational Leadership The Quiet Leader Servant Leadership
Reading 7.5 Straker, David. (2012, March 11) Leadership Style. Retrieved from http://changingminds.org/disciplines/leadership/styles/leadership_styles.htm
Reading 7.6 Ann Marriner Tomey, 2004, Part 1 Leadership: Chapter 1 Communications. Guide to Nursing Management and Leadership, 4th ed. Singapore: Elsevier PTE Ltd. pp. 4-7.
All the managers functions involve communication. The communication process involves six steps. Ideation, encoding, transmission, receiving, decoding, response. The first step, ideation, begins when the sender decides to share the content of a message with someone, senses a need to communicate, develops an idea, or selects information to share. The purpose of
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communication may be to inform, persuade, command, inquire, or entertain. Whatever the reason, the sender needs to have a goal and think clearly or the message may be garbled and meaningless.
Reading 7.7 Ann Marriner Tomey, 2004, Part 1 Leadership: Chapter 3 Decision-Making Process and Tools. Guide to Nursing Management and Leadership, 4th ed. Singapore: Elsevier PTE Ltd. pp. 56-58
G.) Delegating
Delegation is one of the most frequently overlooked responsibilities of the team leader (Muihead & Simon 1999). Delegation is a one of the skills needed for ones manager to learned and practiced. Many leaders lack confidence that her subordinates can actually do simple task. To be an effective leader, he or she knows how to manage task to meet the deadline so thus he or she needs to make use of her subordinates. The reading is an overview of what is delegation and the leaders role to the delegation process.
Reading 7.8 Daly, J., Speedy, S., Jackson, D. 2004. Nursing Leadership. Elsevier Australia: New South Wales. pp. 322-324
What then is delegation? And what is the leaders role in the process? Delegation is the simple act of providing both the authority and responsibility for performance. Another member of the team must be given the authority to conduct the performance, and the responsibility to
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ensure that it is done correctly. This means the team member who is doing the work has the right to make choices, make decisions, use discretion and personal methods The next reading discussed more on the concept of the delegation. It tackles on the reasons for delegating and the ways on effective delegation.
Reading 7.9 Swansburg, R. C., & Swansburg, R. 2002, Chapter 17 The Directing (Leading) Process. Introduction to Management and Leadership for Nurse Managers, Jones and Bartlett Publisher, Sudbury, MA. pp. 385-386
Delegating, a technique of time management, is a major element of the directing function of nursing management. It is an effective management competency by which nurse managers get the work done through their employees. One of the criticisms of new nurse managers is that they emerge from clinical nurse roles and fail to identify with their management role. Theses nurses have been rewarded for their nursing, not for their skill in leading other nurses. Delegation is part of management; it requires professional management training and development to accept the hierarchal responsibilities of delegation.
Group: An aggregate of individuals who interact and mutually influence each other. 1.) Formal Group: clusters of individuals designated by an organization to perform specified organizational tasks. 2.) Informal Group: groups that evolve from social interactions that are not defined by an organizational structure. 3.) Real/Command Group: groups that accomplish tasks in an organization and are recognized as legitimate organizational entities. 4.) Task Group: these are several individuals who work together to accomplish specific time-limited assignments. 5.) Competing Group: groups in which members compete with each other to achieve the same goal.
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6.) Committees or Task Forces: groups that deal with specific issues involving several service areas.
Team: These are real groups in which individuals must work cooperatively with each other in order to achieve some overarching goals. A small number of people with complementary skills, who are committed to a common purpose, set of performance goals, and approach for which they hold themselves mutually accountable. It has a command or line authority to perform tasks, and membership is based on the specific skills required to accomplish the tasks.
Group & Team Processes A.) Elements of a Group System 1.) Activities: observable behaviours of group members. 2.) Interactions: verbal and non-verbal exchanges of words or objects among group members. 3.) Attitudes: perception, feelings, and values held by individual group members. B.) Stages of Group Development 1.) Forming: the initial stage of group development in which individuals assemble into a well defined cluster.
Tasks: Define the purpose of the group. Determine the goals. 2.) Storming: group members develop roles and relationships, in which competition and conflicts may arise. Tasks: Roles and functions are assigned to the members. Acknowledge and solve the conflicts that arise.
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3.) Norming: group members define goals and rules of behaviour. Tasks: Determine the acceptable and unacceptable behaviours and attitudes. Develop group cohesiveness. Explain standards or performance. Facilitate relationship building. 4.) Performing: group members agree on basic purposes and activities, and carry out the work. Tasks: Improve cooperation and the setting aside of emotions. Provide feedback towards the work being done. Reinforce interpersonal skills among the group. 5.) Adjourning: final stage of group development in which a group dissolves after achieving its objectives. Tasks: Prepare the group for dissolution. Facilitate closure through celebration of success. 6.) Re-forming: the group resembles after a major change in the environment or in the goals of the group that requires the group to refocus on the activities. Tasks: Explain new direction and instructions. Provide guidance in the process of re-forming.
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PART
A. Introduction
As the last part of the management process, controlling is one of those elements that need to be harness among leaders or managers. This is to set the movement of the body of the organization in one direction. Controlling was defined by Urwick as seeing that everything is being carried out in accordance with the plan which has been adopted, the orders which have been given, and the principles which have been laid down. In the reading selected by Swansburg about controlling, discusses further about controlling with its principles being followed, the description of the controlling process, the usage of controlling as a function of the nursing management.
Reading 8.1 Swansburg, R. C., & Swansburg, R. 1996, Chapter 23 Controlling or Evaluating. Management and Leadership for Nurse Managers, Jones and Bartlett Publisher, Sudbury, MA. pp. 551-552
The final element of management defined by Fayol was control, which he defined as: Verifying whether everything occurs in conformity with the plan adopted, the instructions issued, and principles established. It has for its object to point out weaknesses and error in order to rectify them and prevent recurrence.
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Controlling or evaluation was defined by Urwick as seeing that everything is being carried out in accordance with the plan which has been adopted, the orders which have been given, and the principles which have been laid down.
B. Control Processes
In the control process, one should know the steps getting it done. The control process is easy to blurt out or memorize but the application is a little rough for it needs persuasion, assertiveness and dedication to keep the group intact and keep them motivated in getting the goal. The reading discusses the 3 basic control processes based on management by Lorenzana.
Reading 8.2 Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling. Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City, Philippines. pp. 70
C. Types of Control
As a nurse manager, one should know the different types of control that are often practiced in some organizations. This will be able to expound the idea on what type of control should be appropriate with this kind of group of people in the organization. This is also a good basis for assessment by managers in order for the manager to create a contingency plan. The reading explains briefly and precisely the types of control that are used by different agencies.
Reading 8.3 Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling. Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City, Philippines. pp. 70-71
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Reading 8.4 Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling. Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City, Philippines. pp. 71- 72
In one of the page of Swansburgs text book, he had mentioned also a ten characteristics of a good control system.
Reading 8.5 Swansburg, Russel C. 1996. Chapter 23 Controlling or Evaluating. Management and Leadership for Nurse Managers.2nd ed. Jones and Bartlett Publishers Canada: Ontario. pp. 553.
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Reading 8.6 Lorenzana, Carlos C. 1993 . Part II: The Management Functions. Chapter 7 Controlling. Management: Theory and Practice. Rex Printing Company, Inc. : Quezon City, Philippines. pp. 72- 74.
F. Quality Management
As part of the controlling process, one should keep track on the quality of each output. For nurses, we care about the care we are giving our patients, for as simple as workers at a factory, it goes with the same process of quality in each end product. Quality management does not aim to assure 'good quality' by the more general definition, but rather to ensure that an organization or product is consistent. The reading discusses the introduction, facet and principles of quality management. This will help you as a student an idea on the quality management and how it is important in the controlling process.
Reading 8.7 Sukhija, Raman. 2009. Quality Management: An Excellence Model. Global India Publications Pvt Ltd: New Delhi. pp.1-13
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