NCM119: NURSING LEADERSHIP AND MANAGEMENT

Study Guide 6: The Nursing Management Process: Planning

Topic Outline
1.1 Planning Defined
1.2 Types of Plans
1.3 Reasons for Planning
1.4 Elements of Planning
1.5 Budgeting
1.6 Models of Planning

Learning Objectives
• After studying this unit, you will be able to:
• Define planning, project planning, operational planning, and strategic planning.
• Describe the elements of the strategic planning process
• Compare good from poor planning
• Describe the elements and scope of planning
• Discuss the different models of planning

Introduction
The environmental challenges of providing health care in the 21st century require more
sophisticated problem-solving solutions. With shrinking resources and increasing demands in the
work place, it is imperative that planning become a major element in any manager’s job
description. It is easy to lose sight of the big picture when we are so busy focusing on the small
one.
In our daily nursing routines, we sometimes fail to understand overriding nursing
administration goals and objectives. We become so consumed with our shift’s activities that we
cannot see beyond them. As a result, we are not always prepared to deal with situations that
arise, and we fail to anticipate situations that may have benefited from advance thought and
planning.

The Nursing Management Process

• Planning
• Organizing
• Directing
• Controlling
PLANNING
Deciding in advance
1. What to do
2. How to do a particular task
3. When to do it
4. Who is to do it
Good planning
 • Good planning involves
• Continuous process of assessment
• Establishment of goals and objectives
• Implementation
• Evaluation of change
Poor Planning
• Delivery dates are not met
• Machines are idle, materials are wasted
• Nurses are overworked/underworked
• Skilled nurses doing unskilled work
• Nurses are fumbling on jobs for which they are not trained
• Quarreling, bickering, buck passing, and confusion

PLAN
• It is a predetermined course of action intended to facilitate the accomplishment of a task,
work, or mission
• A living document that can be changed based on the prevailing circumstances.

CHARACTERISTICS OF A PLAN
• It must involve the FUTURE
• It must involve ACTION
• It must have an ORGANIZATIONAL IDENTIFICATION of the action which shall be
undertaken either by the planner or someone designated by or for her

Organizational Identification
The degree to which employees define themselves as a member of the organization and to what
extent they experience a sense of oneness with it, it’s values, brand, methods etc.

TYPES OF PLANS

A. STRATEGIC PLANS
• The sum total or outcome of the process by which an organization engages in work
analysis, goal setting, and strategy formulation for the purpose or organizational growth
and development
• “What are the right things to do?”
• Usually around 3 – 5 years long
• Based on explicit assessments of the competitive strengths and weakness of the
organization
• Prepared in the upper levels of management
• Serve as basis for operational plans (e.g., increase diversity in nursing, aggressive
recruitment)
Steps in Strategic Planning
1. Assess the environment
2. SWOT Analysis (Strength, Weaknesses, Opportunities, Threats)
3. Assessment of the Community as Stakeholders
4. Other Methods of Assessment
• Focus group interaction
• Surveys and questionnaires
• Advisory boards
• Review of literature and similar programs
• Review of best practices

B. OPERATIONAL PLANS
• Usually pertains to activities in specific departments of an organization
• “How does one do things right?”
• Deals with the tactics or techniques for accomplishing things
• Prepared separately by managers of functional sub-units of an organization
• Focuses on timetables, target quantities, and the specific persons responsible for the
tasks

C. CONTINUOUS/ROLLING PLANS
• Involves mapping out day-to-day activities
• Example: The staff nurse devises and implements NCP for the patients, altering and
modifying as necessary depending on needs and problems of the patient

Reasons for Planning

1. It leads to success in the achievement of goals and objectives
• Brings about behavior that leads to desired actions and outcomes
• Makes performance of tasks more meaningful
• Helps the nurse relate to what they are doing and their professional growth
2. It provides for effective use of available personnel
3. It helps nurses cope with crises and problems calmly and efficiently
4. It reduces element of change
• Studying of success and failure can give a better idea of what to do in the future
• Discover the need for change and innovation, trends and practices to meet expectations
• Points out opportunities for new and different services
5. Overall, it is necessary for effective control

Resistance to Planning
1. Lack of knowledge of philosophy, goals, and operations of the organization
2. Lack of understanding of significance of planning
3. Lack of proper appreciation of time spent for planning
4. Lack of confidence and fear of failure
5. Lack of openness to change that planning may entail
 6. Lack of willingness to engage in new activities that planning produces
7. Exigencies of the situation, prefers to act on immediate problems that give immediate
feedback

Elements of Planning
1. Forecasting or estimating the future
2. Setting goals and objectives
3. Developing strategies and setting the time frame
4. Preparing the budget and allocation of resources
5. Establishing policies, procedures, and standards

Forecasting or Estimating the future

• Looking into the future
• Weighing the unknown values on the situation and using them as basis for and educated
guess about the future
• Prediction – an estimation of time series, cross sectional or longitudinal data

Set Goals and Objectives and Determine Desired Results

• Goals – broad statements of intent derived from the purpose of the organization
• Objectives – specific behaviors or tasks set for the accomplishment of a goal

Develop and Schedule Strategies, Programs, Projects and Activities and Set the Time Frame
• Strategy – the techniques, methods, or procedures by which the overall plan and its
objectives are achieved
• Programs – activities put together to facilitate attainment of desired goals (e.g., staff
development programs, outreach programs)

Time Management
• Time is the manager’s single most important resource
• It is finite, so the manager should allocate it as efficiently as possible
• This can be done by setting goals, assigning priorities, and identifying and avoiding time
wasters
• Good time management is about efficiency and determining the most effective means of
fulfilling a task
Efficiency - the ability to accomplish something with the least amount of wasted time, money,
and effort or competency in performance.
Effectiveness - the degree to which something is successful in producing a desired result

When time is mismanaged:

• Worked is rushed
• Service is substandard
• Deadlines are missed
• Bad choices are made
 • Employees suffer fatigue
• Personal lives and relationships suffer

Good Time Management Habits

• Planning for contingencies
• Listing of tasks
• Inventory
• Sequencing
• Setting and keeping deadlines
• Deciding on how time will be spent
• Delegating

Multitasking - the observable performance of two or more tasks simultaneously (e.g., talking to
a patient and preparing medication)
Task switching - the management of multiple tasks in which there is switching between tasks
that are progressing in parallel.

Time management in nursing helps nurses organize and prioritize patient care, internal
administrative tasks, educational responsibilities and personal obligations.

Although nursing is a demanding profession, nurses who develop techniques to better manage
their time can achieve balance in the face of time limitations.

Effective management of time helps get more work done, produces a higher work quality, and
provides fewer missed deadlines. Additionally, there is a better sense of self-control, improved
self-image, and decreased stress with good time organization.

Project Planning
Project planning entails planning for a project. Project planning involves a one-time effort. Most
unit managers will involve their staff in project planning. This type of planning requires that one:
■ Identify the problem that the project will ultimately address.
■ Name the project. Selecting a name for the project is important. Choose a name that will
help members quickly identify your project. Once a project has been created, the name cannot
be changed.
■ Determine the project goals. Setting goals and measurable objectives will guide you through
the completion of the project.
■ Specify tasks for each member. Determine the size of the project team, and then distribute
the necessary tasks.
■ Identify resources needed. It is essential to list the resources needed for all team members to
be able to plan and monitor the project.
■ Indicate timelines for completion. To keep all members aware of the progress of the project,
it is advantageous to display a chart or timeline that provides the status of each activity and its
completion.
■ Implement the project. Once you have gathered all the data and know which group of nurses
to target, your team will determine by whom and where the project will be implemented.
■ Evaluate the project. It is important to assess the progress of the project so that evaluation
becomes a natural step in the process. Evaluation of the project should always go back to the
objectives. Were the objectives accomplished?

Tools in Project Management

Gantt Chart

Gantt charts show task and schedule information. It allows the manager to assess how long a
project should take, determine the resources needed, and lay out the order in which tasks need
to be carried out. Gantt charts help the manager monitor the project’s progress and stay on track.
Gantt charts help the manager plan out the tasks. It allows the manager to assess how long a
project should take, determine the resources needed, and lay out the order in which tasks need
to be carried out. Gantt charts help the manager monitor the project’s progress and stay on track.
Gantt charts help the manager plan out the tasks.

Critical Path Method

The critical path method (CPM) is another tool that helps managers prepare a schedule and plan
resources. During the management of a project, the CPM allows a manager to monitor
achievement of project goals and take remedial action if the project is not going well. The CPM
consists of diagrams that depict the activities and the time line required. CPMs can calculate time
and cost for each activity when they are significant factors because both can be estimated from
past experiences

Program Evaluation and Review Technique

The program evaluation and review technique (PERT) calculates a realistic timeframe by using
the shortest possible time each activity will take, the most likely length of time, and the longest
time it might take. Managers can input these figures into PERT to calculate the time to use for
each project stage.

Prepare the Budget and Allocation of Resources

Budgeting – a systematic financial translation of a plan, the allocation of scarce resources on the
basis of forecasted needs for proposed activities over a specified period of time. It is a tool for
planning, monitoring and controlling cost and meeting expenses.

A nursing budget allocates resources and nursing programs to deliver patient care during a fiscal
year.

A hospital budget is designed to meet future service expectations, to provide quality care at
minimum cost.
A budget plan for health care institutions, which is simply a plan for future activities, generally
consists of four components:
• A revenue budget summarizing the income, management expects to generate during the
planning period.
• An expense budget describing expected activity in operational financial terms for a given
period of time
• A capital budget which outlines the programmed acquisitions, disposals, and
improvements in the institution’s physical capacity
• A cash budget, consisting of money received, cash receipts and disbursement expected
during the planning period

Approaches in Budgeting
1. Centralized Budget – developed and controlled by the
comptroller/administration/director of nursing with little or no consultation with lower
managers
2. Decentralized Budget – includes the middle level managers in the planning and budgeting
process with authority, responsibility, and accountability placed on the practitioner level

Components of Total Institutional Budget

1. Manpower Budget
Consists of the wages and salaries of the regular employees and the fees paid to outside registries
through which the institution contracts short term employee
2. Capital Expenditure
Involves the large expense of purchasing lands, buildings, and major equipment meant for long
time use
3. Operational Budget
This includes the cost of supplies, minor equipment repair, and maintenance as well as other
overhead expenses.

Types of Institutional Budget

1. Open Ended budget
Characterized by as single cost estimate for each program in the proposed unit. There is no
specified amount on the budget
2 Fixed Ceiling Budget
The uppermost spending limit is set by the top executive who then asks the managers to develop
budget proposals for individual units
3. Flexible Budget
Contains several financial plans for each level of activity or for different operating conditions. Top
management can select the budget or shift the spending level upwards or downwards, whichever
is best for optimum productivity. The budget can be adjusted or manipulated
4. Performance Budget
Based in the functions involved in the operation budgeted. In a nursing care management setting,
this may refer to direct nursing care, supervision, and quality control etc.
5. Program budget
Costs are computed for a program as a whole or the entire program itself rather than for
individual activities or functions
6. Zero-Based Budget
Justifies in detail the cost of all programs, both old and new, in every annual budget preparation
7. Sunset Budget
Designed to “self-destruct” within a prescribed period to ensure cessation if the funded program
at a predetermined date

Benefits of Budgeting
1. Planning
Budgeting stimulates thinking in advance. It leads to specific planning such as the type and
volume of services, personnel, equipment, and supplies required as well as corresponding costs.
2. Coordination
Budgeting encourages coordination among the different persons involved in the process and has
a balancing effect on the organization. It encourages continuous exchange of information up and
down the organizational ladder and stimulates team approach.
3. Comprehensive Control
In assessing whether a budget is realistic or not, an administrator needs to evaluate the quality
of performance and is able to set standards and compare them with actual expenditures and
revenue. The manage is able to define fixed and preexisting goals through cost consciousness

Factors in Budget Planning

1. Patient
Needs of the patient as determined by his condition, length of stay, and severity of illness.
2. Hospital or Health Care Facility
Availability of facilities and resources/supplies including bed occupancy and capacity, physical
layout, size of wards/units
3. Personnel
Salaries and benefits, provisions for staff development like trainings and seminars
4. Standards of Nursing Care and Supervision
Cost of training ang maintaining personnel, equipment needed b based on the volume of patients
and the nature of their needs
5. Establish Policies, Procedures, and Standards
Policies – standing plans used repeatedly. Guides or rules that governs action in all levels in the
organization
Procedures – a more specific guide to action where each step is listed in the process
Standards – the minimal level of achievement acceptable to meet the set objectives

Models of Planning
1. Basic Strategic Planning
✓ Planning is carried outby the top-level management, who identifies:
• Purpose or mission statement
• Goals to be accomplished to fulfill the mission statement
 • Specific approaches/strategies needed to achieve goals
• Specific action plans to implement each strategy
• Consistent monitoring and updating of the plan
2. Issue-based or Goal-based Planning
✓ Consists of:
• External/internal assessment to identify SWOT
• Strategic analysis to identify and prioritize major issues or goals
• Designing major strategies/programs to address issues and achieve goals
• Designing or updating organization’s vision, mission, and values
• Establishment of action plans based on objectives, resource needs, roles, and
responsibilities for implementation
• Documentation of issues, goals, strategies/programs
• Development of yearly operational plan
• Development and implementation of budget
• Monitoring/reviewing/evaluating/updating the Strategic Plan
3. Alignment Model
✓ Geared toward ensuring that the organization’s resources are aligned with its mission and
vision to ensure effective operation.
✓ Useful for organizations that need to fine tune their operating strategies
4. Scenario Planning
✓ Involves identifying possible scenarios or situations that the organization may face. This
model is useful in identifying strategic issues and goals and can be used to find concrete
solutions to problems
5. Organic or Self-Organizing Planning
✓ Requires repeated reference to common cultural values within the organization
6. Functional Planning
✓ Deals with the actual activities of the organization, internal/administrative matters, as
well as work, cost, and resources
✓ Works in the context of an overall plan and has to weigh between competing priorities
from other programs and internal initiatives for organizational advancement
7. Cross-Sectional Planning
✓ Focuses on managing the external effects on outputs of a function
✓ Brings together the activities of various functional group in support of a single project
8. Operational Planning
✓ Defines how one will implement the action agreed upon and monitor these plans, what
the needs are, how to use resources, how to deal with risks, and how to ensure
sustainability

REFERENCES
Patronis Jones, Rebecca A. Nursing Leadership and Management Theories, Processes and
Practice. 2007.
Marquis, Bessie L., and Carol J. Huston. “Leadership Roles and Management Functions in
Nursing.” Theory and Application, 2017.