NURSING MANAGEMENT Planning and Organization in Nursing PLANNING Planning is defined as pre-determining a course of action in order to arrive at a desired

result. It is a continuous process of assessing, establishing goals and objectives, implementing and evaluating them, and subjecting this change as new facts are known. (Venzon) IMPORTANCE OF PLANNING (Venzon) 1. Planning leads to the achievement of goals and achievements. 2. Planning gives meaning to work. 3. Planning provides for effective use of available resources and facilities. 4. Planning helps in coping with crises. 5. Planning is cost effective. 6. Planning is based on past and future activities. 7. Planning leads to realization of the need for change. 8. Planning is necessary for effective control. SCOPE OF PLANNING (Venzon) 1. Top Management (Nursing directors, chief Nurses or Directors of Nursing and their assistant) set goals and policies of an organization. 2. Middle Management (Nursing supervisors) direct their activities to actually implement the broad operating policies of the organization such as staffing and delivery of services to the units. 3. Lower of First-level Management (Head nurse or senior nurse, including charge nurse or team leaders) do the daily and weekly plans for administration of direct patient care in their respective units. CHARACTERISTICS OF A GOOD PLAN (Venzon) 1. Clearly worded objectives, including desired results and methods for evaluation. 2. Guided by policies and procedures. 3. Indicate priorities. 4. Develop actions that are flexible and realistic in availability of personnel, equipment, facilities and time. 5. Develop a logical sequence of activities. 6. Include the most practical methods for achieving each objective. ELEMENTS IN PLANNING (Venzon) 1. Forecasting 2. Setting the Vision, Mission, Philosphy, goals and objectives. 3. Time Management PLANNING FORMULA (Venzon) 1. What has been done 2. When when should the job be done 3. How will the job be done 4. Who has been doing the job 5. Why to each question, ask why 6. Can can some steps or equipments be eliminated? Organizational planning

is a special type of decision that consist of investigating the organizational environment, analyzing the organizational systems and the subsystems, clarifying the organizational mission, establishing organizational goals, assessing organizational capabilities, identifying possible course of action, evaluating the probable effectiveness of these action, selecting an appropriate course of action (Gillies, 1989) STEPS IN PLANNING THE OPERATION FOR A NURSING SERVICE ORGANIZATION: 1. First Step: obtaining agreement by nurse managers on a statement of nursing mission. a. The statement of the nursing mission will derive from the statement of institutional mission and from the managers philosophy of nursing. b. In some agencies nursing staff members as a group select a specific nursing theory or conceptual framework as a basis for nursing philosophy, mission statement and goals (for example members of the nursing department of mercy catholic Medical center in Darby, Pennsylvania, adopted the Neuman Systems Model framework for nursing practice in that institution. 2. Second Step: ideally, all staff members should participate in selecting a conceptual framework for nursing practice and enunciating a statement of philosophy. After selecting a framework and nursing philosophy have been agreed upon, managers and representatives from all nursing specialties should compose a mission statement that clarifies the nursing purpose. a. Staff members cannot identify an appropriate nursing mission without first completing a comprehensive assessment of the nursing department internal and external environment. b. A catchments area for agency clients, to identify the character of key population groups to be served by the agency, to highlight the social and lifestyle changes of the clients that will affect their needs for nursing service, and to identify strengths and weaknesses of the nursing staff that will influence their ability to need client demands. TACTICAL AND STRATEGIC PLANNING Tactical or operational planning is based on short timpe perspective. But according to Kami (1977), this is no longer appropriate, societal changes have made it impossible for administrators and managers to forecasts organizational environment for years in advance. Therefore the focus in planning should shift from long range forecasting to short term strategies that will enable managers to adjust operations to rapidly changing circumstances. Paralysis by analysis: - inability to move on incomplete and unclear signals of future trends and demands holds off planning until a detailed need survey to can be examined. Strategic Planning is formulation before hand a scheme to realize those goals while conserving scarce resources. IN CASE OF NURSING MANAGEMENT, THOSE SCARCE RESOURCES TO CONTROL HEALTH COSTS IN THE FUTURE ARE: 1. Personnel 2. Equipment 3. Supplies THE KEY ELEMENTS OF STRATEGIC PLANNING (Schermerhorn, 1984) 1. Identification of organizational mission and goals. 2. Identification of threats and opportunities in the external environment 3. Identification of internal strengths and weaknesses THE PLANNING HIERARCHY Figure 1.1 The Planning Hierarchy. The hierarchy broadens at the lower level, representing an increase in the number of planning components. In addition planning components are more specific. (Marquis, Huston, 2006) Mission and Vision The Mission Statement Is a brief statement identifying the reason that an organization exists, while its future aims.

It identifies the organizations constituency and addresses its position regarding the following: a. Ethics b. Principles c. Standards of Practice The mission statement is of highest priority in the planning hierarchy because it influences the development of the organizations philosophy, goals, objectives, policies, procedures and rules. Managers employed in county hospital have two primary goals in their planning (Marquis, Huston, 2006): 1. Provide high quality, holistic care 2. Provide learning opportunities for students (medicine, nursing, allied health course)

2. 3.

Should be realistic. Should be clearly delineated the desired end product

Organizations usually set long and short term goals for services rendered, economics use of resources including people, funds and facilities, innovations and social responsibilities.

OBJECTIVES Are similar to goals in that they motivate people to specific end and are explicit, measurable, observable or retrievable and obtainable. They are more specific than the goals because they are more specific and measurable, they identify how and when the goal is accomplished. For objectives to be measurable, they should have certain criteria. There should be specific time frame in which the objectives are to be completed and the objectives are to be stated in: a. Behavioral terms b. Objectively evaluated c. Identify positive rather than negative outcomes Policies and Procedures Policies Are plans reduced to statements or instructions that direct organizations in their decision making. Policies are statement of expectations that set boundaries from action taking and decision making. Policies direct individual behavior towards organizations mission and vision and defined broad limits and desired outcomes of commonly recurring situation. Although some policies are required by accrediting agencies, such as the Joint Commission on Accreditation of Health care Organization, may policies are specific to the individual institution, thus providing management internal means of control.

Vision Statement The future aim or function is often written as vision statement. Vision statements are future oriented while mission statements provide the foundation for organizational planning. The Organizational Philosophy Flow from the purpose of the mission statement and delineates the set of values and beliefs that guide all actions of the organization. Philosophy is the basic foundation that directs all actions of the organization. Philosophy provides the basis for developing nursing philosophies at the unit level and for nursing service as a whole. Written in conjecture with the organizational philosophy should address the following fundamental beliefs on: a. Nursing and nursing care b. Quality and quantity c. Scope of nursing service d. How nursing will meet specific goals Leader managers also must be visionary, innovative, and creative in identifying unit purposes or goals so that the philosophy not only reflects current practices, but also incorporates a view of the future. Figure 1.2 Philosophical Congruence in the planning hierarchy McNally (1980) Identified the following four characteristics that determines a true value: 1. 2. 3. 4. It must be freely chosen from amongst the alternatives only after due reflection. It must be prized and cherished. It is consciously and consistently repeated. It is positively affirmed and enacted.

Procedures Are plans that establish customary or acceptable ways of accomplishing specific task and delineate a sequence of steps required actions Procedures identify the process or steps needed to implement a policy and are generally found in the manuals at the unit level of the organization. Some text books place the development of procedure in organizing phase of the management process. Established procedure save staff time, facilitates delegation, reduce the cost, increase productivity and provide means of control. The manager also has a responsibility to review and revise the policies and procedure statements to insure currency and applicability. Example, the manager should give clearly written procedure statement regarding request for vacation or holiday time to specific staff unit. The unit manager would assess any long term change in patient census or availability of human resources and revise the policy and procedural statements accordingly. Rules RULES AND REGULATION Are plans that define specific action of non action, Generally includes as part of the policies and procedures statements, rules describe situation that allow only one choice of action. Rules are the least flexible type of planning in the planning hierarchy, there should be as few rules as possible in the organization.

Goals and Objectives GOAL May be defined as desired result toward which effort is directed, it is the aim of the philosophy. Goals much like philosophy and values change with time and require periodic reevaluation and prioritization. Global in nature; 1. should be measured and ambitious,