Ebro, Dianne Geraldine Eslabra, Robee Ann Directing Directing is the act of issuing of orders, assignments, instructions to accomplish

h the organizations goals and objectives. It involves the process of getting the organizations work done. It entails explaining what is to be done, to and by whom, at what time, how and why the task should be done. Characteristics of Good Directions 1. Directions must be clear, concise, consistent and complete. 2. Apart from being understandable, the person giving directions must explain the rationale well and make certain that it is understood. 3. The words used in the directions indicate their importance. o The words, must, shall, and will, indicate that directions are mandatory. 4. The person giving directions must speak distinctly and slowly. 5. Avoid giving too many directions at one time; personalized directions; and Always check to make sure directions have been followed. 7 Elements of Directing 1. Delegation 2. Supervision 3. Staff Development 4. Coordination 5. Collaboration 6. Communication 7. Evaluation Delegation Delegating is the process by which a manager assigns specific tasks/duties to workers with commensurate authority to perform the job. The act of assigning to someone else a portion of the work to be done with corresponding authority, responsibility and accountability (ARA). The worker in return assumes responsibility for its satisfactory performance and is held accountable for its results. However, the ultimate responsibility and accountability rest with the Manager who delegates the task. By delegating well-defined tasks and responsibilities, the manager can be freed of valuable time that can well be spent on planning and evaluating nursing programs and activities.

Criteria of Paramount Importance in Delegation Workers job description His/her knowledge base His/her ability to carry out the task Fairness not only to the employee but to the team as a whole Principles of Delegation 1. 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. Matters That Cannot be Delegated: 1. Overall responsibility, authority, and accountability for satisfactory completion of all activities in the unit. Nurse Managers cannot be absolved of poor performance of subordinates by blaming them. 2. Authority to sign ones name is never delegated. The worker that performed the task should be the one to sign it. 3. Evaluating the staff and or taking necessary corrective or disciplinary action. 4. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff especially the new ones. Showing confidence in the workers boosts their morale and builds up their selfconfidence. 5. Jobs that are too technical and hose that involve trust and confidence. Common Delegating Errors a. Underdelegating The manager desire to do the job by himself. He has trust issues thus lacks the trust to his subordinates. Lack of confidence in his staff feeling that only he could do task better and faster. In return, subordinates may be apprehensive in accepting delegated tasks for fear and criticism, ineptitude, or incompetence. b. Overdelegating Poor management of time and insecurity on the part of the nurse manager in her ability to perform task. c. Improper delegating A manager should be able to determine the talents and capacities of his subordinates. Delegation of task and responsibilities beyond which the person cannot perform properly is improper delegation.

Supervision Process of guiding and directing the work to be done. Providing guidelines for the accomplishment of the task or activity. It entails motivating and encouraging the staff to participate in activities to meet goals and objectives and personal development and in helping the staff to do their works. Legally, therefore, supervision means personally observing a function or activity, providing leadership in the process of nursing care, delegating functions or activities while retaining accountability, evaluating and ensuring that the nursing care provided is adequate and delivered appropriately. Qualities of Good Supervision 1. Good technical, managerial and human relation skills 2. Ability to communicate well in both spoken and written language and ability to listen 3. Firmness with flexibility to adjust to the needs of the situation 4. Fairness in dealing with employees 5. Familiarity with hospital and nursing policies that affect the patient care 6. Good decision-making skills 7. Willingness to grow and develop 8. Ability to accept changes and consider them as challenges 9. Dignified and pleasing personality 10. Ability to motivate employees and provide opportunities for continuing professional growth and development 11. Advocacy for nurses and nursing. Principles of Good Supervision 1. Good supervision requires adequate planning and organization which facilitate cooperation, coordination, and synchronization of services. 2. Good supervision gives autonomy to workers depending on their competency, personality, and commitment. It fosters the ability of each worker to think and act for himself. 3. Good supervision stimulates the workers ambition to grow into effectiveness. It provides for opportunities and incentives for the staff education and continuous professional grants and development. 4. Good supervision creates an atmosphere of cordiality and trust. 5. Good supervision considers the strengths and weaknesses of employees. 6. Good supervision strives to make the unit an effective learning situation. Responsibilities of Supervisors To teach and motivate the staff, as well as facilitate their work. Delegate work responsibilities and be available for consultation. Performa assessment and evaluation of work performance and conditions.

Staff Development Staff development is a planned experience to help employees perform effectively, and to enrich their competence in practice, education, administration, and research. It is re-training them for better performance in areas of skills, knowledge, and attitude (SKA). Functions of Staff Development Maintain staff efficiency and effectiveness Create quality employees Meet the staffs needs and address their problems, such as deficiencies in knowledge, skills and attitude. Motivate them and improve their self-confidence Help prepare them for greater responsibilities. Coordination This activity links the different components of organization and leads them toward goal achievement. It creates harmony on all activities to facilitate success of work. Collaboration The manager and the health care staff together with the other members of the health care team all participate in the decision making process. Communication Communication is the transmission of information, opinions, and intensions between and among individuals. It is a process by which a message is sent, received and understood as intended. Principles of Effective Communication 1. Clear lines of communication serve as the linking process by which parts of the organization are unified toward goal achievement. 2. Simple, exact and concise messages ensure understanding of the message to be conveyed. 3. Feedback is essential to effective communication. 4. Communication thrives best in a supportive environment which encourages positive values among its personnel. 5. A managers communication skill is vital to the attainment of the goals of the organization. Barriers to effective Communication a. Physical Barriers- environmental factors; distance and noise. b. Social/ Psychological Barriers- emotions and social values of people; stress, trust, fear, and defensiveness. c. Semantics-words, figures, symbols, penmanship, interpretation of messages through sings and symbols. d. Interpretations- these are defects in communication skills of verbalizing listening, writing, reading and telephoning.

Types of Communication 1. Verbal communication- It involves spoken words; the speaker must be able to speak slowly, enunciating the words clearly. 2. Written communication- written in words that are clearly understood by the reader; ambiguous terms should be avoided to prevent misunderstanding. 3. Non-verbal communication- transmission of message without the use of words; people oftentimes unconsciously use facial expressions, gestures, touch, body language, or vocal tones. a. Personal appearance- the appearance of a person gives the general impression of his/her personality and self-concept. b. Intonation of the voice- the intonation of the nurses voice should be soft and gentle; should not be irritating to the ear. c. Facial expression- a friendly smile establishes immediate rapport with the client and invites trust and confidence in the nurse. d. Posture and gait- the nurse posture and gait indicate his/her physical wellness, emotions, and attitude towards his/her clients. e. Touch- is a way of caring; a gentle touch conveys a caring person; rough touch indicates insensitivity to the patients and unresponsiveness to their needs. Lines of Communication 1. Downward communication Traditional line of communication is from superior to subordinate which may pass through various levels of management. It includes policies, rules and regulations, memoranda, handbooks, interviews, job descriptions, and performance appraisal. Communication aims to impart what the personnel need to know, what they are to do and why they are to do these. 2. Upward communication Emanates from subordinates and goes upward (to superior). This is usually in the form of feedback to show the extent to which downward communication has been received, accepted, and implemented. Subordinates may not have the ability to express their thoughts or may be too shy to express them. Eg: Discussions between subordinates and superiors, grievance procedures, written reports, incident reports, and statistical reports. 3. Horizontal communication/Lateral communication Flows between peers, personnel or departments on the same level. It is used most frequently in the form of endorsement, between shifts, nursing rounds, journal meeting and conferences, or referrals between departments or services. 4. Outward communication Deals with information that flows from caregivers to the patients, their families, relatives, visitors, and the community.

Clear explanation of policies, rules and regulations promote good public relations; patients should understand the nature of their illness, the medical, and prescribed nursing care plans of care so that they could participate in the decision making.
UPWARD To Superior

HORIZONTAL To peers and members of the health team

NURSES

OUTWARD To patient, family, and community To workers family and friends

DOWNWARD To subordinates

Evaluation
A desired result of any employee behavior is effective job performance. An important role of the manager is to determine performance in advance and state desired outcome of what has been done.

Purposes of Evaluation Provide constructive feedback; Determine progress and worthiness of individual nurse for greater responsibilities; and Serve as basis for promotion and increase in salary or other similar rewards.

It is meant to: Recognize and further develop strengths; Minimize weakness; Provide security for patients, personnel, agency and the community; and Develop a fair employment practice and performance appraisal process that is in accordance with the law.

Different Types of Evaluation a. Outcome or product evaluation- which takes note of the response of patients after nursing care is done. b. Process evaluation- nursing actions are examined, to determine if the client goals have been met or have not been met. c. Structure evaluation- the goal is to obtain feedback on the systems such as financial and material resources, nursing personnel, policies and procedures.

Nursing Care Assignment

Four Basic Methods of Assigning Nursing Care: 1. Functional Nursing This kind of modality is task-oriented in which a particular nursing function is assigned to each worker. It is best system that can be used when there are many patients and professional nurses are few. It is suitable only for short-term use. Advantages: It allows most work to be accomplished in the shortest time possible. Workers learn to work fast. Because the tasks are repetitive they gain skill faster in that particular task. Greater control over work activities and it is aimed at conservation of workers and cost.

Disadvantages: Fragmentation of nursing care and therefore holistic care is not achieved. Nurses accountability and responsibility are diminished. Patients cannot identify who their real nurse is. Nurse-patient relationship is not fully developed. Evaluation of nursing care is poor and outcomes are rarely documented. It is difficult to find a specific person who can answer the patients or relatives questions.

2. Total Care or Case Nursing One nurse is assigned to one patient for the delivery of total care. The nurse plans, coordinates, implements, evaluates, and documents the nursing care he/she has given during his/her shift. The one-on-one pattern is a common assignment for private duty nurses, for nurses in special care units such as the critical care units or those in isolation, and for nursing students. The nurse is accountable for his/her own actions. He/she provides holistic care to his /her patient, who in turn can relate well with his/her. However, this method works best when there are plenty of nurses and patients are few. 3. Team Nursing Is a decentralized system of care in which a qualified professional nurse leads a group of nursing personnel in providing for nursing needs of a group of patients/clients through a participative effort. The team leader assigns patients and tasks to team members according to job descriptions. However, if not fully implemented, team nursing can lead to fragmentation of care.

4. Primary Nursing As a form of assigning responsibilities for patient care, is an extension of the principle of decentralization of authority. Each registered nurse is responsible for the total care of a small group of patients from admission to discharge.

 The primary nurse asses the patients needs for care, set care goals, writes a nursing care plan , administers care according to that plan, evaluates the outcomes of care, and make necessary changes or adjustments as necessary. He/she provides pre-discharge planning and teaching.

Other nursing Assignments

Modular Method Modification of team and primary nursing. It differs from team nursing in that registered nurse provides direct nursing care with assistance of aides. The professional nurse provides leadership, support, and instructions to the non-professional nursing personnel.

Case Management A system of patient care delivery that focuses on the achievement of outcomes within effective and appropriate time frames and resources. It focuses on an entire episode of illness, crossing all setting in which the patient receives care. He/she is responsible for the assessment of patient and family, establishes the nursing diagnosis, develops, the nursing care plan, delegates nursing care to associates, activates interventions, coordinates and collaborates with interdisciplinary team, and evaluates outcomes of care.