NTRODUCTION TO NURSING

SERVICE MANAGEMENT
Objectives:
At the end of this chapter, the student should be able to:
ƒDefine administration/management and nursing
service administration
ƒDescribe the managerial level, role and skills
ƒExplain the importance of good management in
a health service organization
Management is as old as human kind and existed since
man has been organized in to communities. Managers
influence all phases of our modern organizations. Our
society simply could not exist as we know it today or
improve its present status without a steady stream of
managers to guide its organizations.
Definition of management

Management is the art of getting things done through

people. It is the process of reaching organizational goals
by working with and through people and other
organizational resources. It is the process of planning,
organizing, leading and controlling the work of
organization members and of using all available
organizational resources to reach stated organizational
goals. It is the process of directing, coordinating and
influencing the operation of an organization to obtain
desired result and enhance total performance.
Nursing service administration
Nursing service administration is a coordinated activity,
which provides all of the facilities necessary for the
rendering of nursing service to clients.
Nursing service administration is the system of activities
directed toward the nursing care of clients, and includes
the establishment of over-all goals and policies within
the aims of the health agency and provision of
organization, personnel, and facilities to accomplish this
goals in the most effective and economical manner
through cooperative efforts of all members of the staff,
coordinating the service with other departments of the
institution
Nursing service administration is the marshaling of
resources to accomplish a purpose.
It is both an art and a science. It is a science in the
sense that one may systematically study and analyze
the behavior of people as a collective endeavor and,
even their individual behavior in relationship to their
individual purposes and to draw generalizations from
them that are valid guides to foresight and action. It is
an art because it requires qualities of dynamic character
to make them effective in application.
Nursing service administration is the process of
planning, organizing, leading and controlling that
encompasses human, material, financial and
informational resources in an organizational
environment to achieve the predetermined objectives.
Nursing service is the process composed of the set of
interrelated social and technical functional activities
occurring within a formal organizational setting to
accomplish predetermined objectives through utilization
of human and other resources.
The primary objective of the role of nursing service
administration is the provision for continuous individual,
group and community service, including whatever is
necessary. In addressing the factors, which determine
health, and to bring them back to self-directive activity
towards their own health. The subsidiary objectives of
this role are the professional activities of administration,
including human relations, communications, teaching,
research, and personal development, designed to
further the primary objective-the optimum nursing care
of patients. In this lecture note management and
administration are used interchangeably
Types of managers, managerial skill and roles
Nursing service managers are people who appointed to
positions of authority, which enable others to perform
their work effectively, who have responsibility for
resource utilization and who are accountable for work
results and can be proud of their organizations and what
they do.
Types of managers
Traditionally classifications of managers are by level in
the organizational hierarchy; common nomenclature is:
Ö Top level–such as board of directors, Presidents and
vice presidents
Ö Middle level–such as directors of nursing,
supervisory staffs and department heads
Ö First line/front line/ or supervisory management–
such as head nurses and staffs.
Regardless of level, managers have several common
attributes; they are:
Ö Formally appointed to positions of authority
Ö Charged with directing and enabling others to do
their work effectively
Ö Responsible for utilizing resources
Ö Accountable to superiors for results
The primary differences between levels of managers are
the degree of authority and the scope of responsibility
and organizational activity at each level. For example,
top-level managers such as nursing administrators have
authority over and responsibility for the entire
organization. Middle level managers such as
department heads and heads of services have authority
over and responsibility for a specific segment, in
contrast to the organization as a whole and act as a
liaison between top-level managers and first level
managers. First line managers, who generally report to
middle level managers have authority over and are
responsible for overseeing specific work for a particular
group of works.
Managerial Skills
Managers can also be differentiated by the extent to
which they use certain skills: conceptual, human
relations and technical skills. All managers use human
relation skills because they accomplish work through
people. Human relations skills include motivation,
leadership and communication skills. The degree to
which each is used varies with the nature of the position,
scope of responsibility, work activity, and number, types
and skills of subordinates. Senior managers use
disproportionately more conceptual skills in their jobs
than do middle level or first line managers. These
include recognizing and evaluating multiple complex
issues and understanding their relationships, engaging
in planning and problem solving that profoundly affect
the health service organization, and thinking globally
about the organization and its environment. In contrast
first line managers tend to use job related technical
skills, or skills that involve specialized knowledge.
Managerial roles
All health service managers engage in planning,
organizing, staffing, directing, controlling, and decision
making to some degree. In addition, they perform other
activities related to accomplishing work and
organizational objectives that do not readily fall within
the functional classification. These roles are defined as
the behavior or activities associated with a management
position because of its authority and status. Mintzberg's
classification identifies:
Ö Interpersonal
Ö Informational and
Ö Decisional roles
Interpersonal role
The three interpersonal roles are
™Figurehead: all managers, but especially senior
managers, are figureheads because they engage
in ceremonial and symbolic activities such as
greeting visitors and making speeches at
organizational events.
™Liaison: involves formal and informal internal and
external contacts.
™Influencer: includes activities inherent in the
directing function, the purpose of which is to
motivate and lead.
Informational role
The three informational roles of a manager are
™Monitor
™Disseminator and
™Spokesperson
Decisional Roles
The four decisional roles of a manager are
™Entrepreneur
™Disturbance handler
™Resource allocator and
™Negotiator
1.3 Health care, health services and health
service organizational models
Health care: is the total societal effort, organized or not,
whether private or public, that attempts to guarantee,
provide, and finance the promotion of health, prevention
of diseases, and restoration of health and rehabilitation.
Health service: is the delivery of health care
Health service organizations: Deliveries of health
services to clients occur in a variety of organizational
settings. Health service organizations can be classified
by ownership, profit motive, whether the client is
admitted. Historically, hospitals and nursing facilities
have been the most common and dominant health
service organizations engaged in delivery of health
services.
The Benefit of good Management in Health
Service organizations
™
High lights priority areas
™Adopts the service to the needs of a changing
situation
™Makes use of the most limited resources
™Improves the standard and quality of services
™Maintain high staff morale
PHILOSOPHY OF NURSING
SERVICE MANAGEMENT
Objectives:
At the end of this chapter, the student should be able to:
ƒDefine mission, philosophy and goals
ƒExplain the relationship of mission, philosophy
and goals
ƒDiscuss the importance of mission, philosophy
and goals of an organization for nursing service
administration
Mission
A mission statement is a broad general goal of an
organization that describes its purpose in the
community. The mission statement of a small
community hospital may indicate that its purpose is to
serve the health care needs of the immediate
community and provide care for commonly occurring
illnesses. A large university hospital may have a mission
statement that encompasses research, teaching and
care for complex problems. These two organizations will
establish different priorities for spending, choose
different technologies as essential to their missions, and
structure their staff in different ways. These mission
statements provide the overall umbrella under which all
functions of the organization take place.
In addition to or even in place of a mission statement a
general statement of philosophy
may be used. When both are present, they should
agree. The philosophy is typically longer and more
detailed.
Organizational Philosophy and philosophy of
Nursing Service Administration
Organizational Philosophy is its explicit and implied view
of itself and what it is. Generally it is expressed in
mission statements. The philosophy is directly linked to
and rooted in the organizations cultural beliefs and
values. Philosophy depicts the desired nature of the
relationships between health service organizations and
its customers, employees and external constituents. It is
a set of beliefs that determines how organizational
purposes are achieved and that serves as the
foundation for agency objectives, policies and
procedures.
Nurses have the right to know the beliefs about nursing
care, nursing practice and nursing management held by
the collective group, which they are a part of the nursing
department. A statement of philosophy is a valuable
management tool. Nurses should be given a copy
before they join the staff so that they can judge whether
their personal philosophy is sufficiently in agreement
with the organizational philosophy to enable them to
become a contributing member of the department.
Philosophy statements are relatively enduring
documents because stated beliefs are usually
expressions of firm commitment to the best that can be
achieved and are derived from the broad goals of the
agency.
A useful philosophy has a timeless quality because
basic premises change only under unusual conditions.
Nevertheless, philosophy statements need to be
reviewed periodically. If a review by all members of the
department reveals that the statement still reflects the
guiding beliefs of the collective group, there is no need
to revise the document. If scrutiny indicates that the
statement is not consistent with current agency goals or
philosophy or is not effective in directing the actions of
the department, then the statement should be rewritten
to assure that it meets the criteria of compatibility,
attainability, intelligibility, acceptability, measurability and
accountability. When developing or reevaluating a
philosophy, the manager should consider theory,
education, practice, research, and nursing's role in the
total organization.
Goals
Goals are the broad statements of overall intent of an
organization or individual. They are usually stated in
general terms. The purpose of writing goals is to identify
where you are going and to enable you to evaluate
when you have arrived there. A meaningful stated goal
is one that succeeds in communicating the intent of
those generating the goal. It should be stated in such a
way that it will be understood clearly by others. As a
nurse in a health care institution, you need to be aware
of the existence of several levels of goals: the
institutional level, the nursing department level and the
nursing unit level. The goal levels all need to relate to
the health needs of the community, because these are
the focus of health care.
Institutional Goals
Based on the community’s health needs, the institution
forms goals and objectives. An institution that focuses
thinking on goals for the future and activities that will
move the organization toward these goals is referred to
as a proactive institution. The managers of such
institutions spend a great deal of time, money and
energy on identifying possible future events and on
preparing the institution to deal with them. Institutions
that do not have specific or future oriented goals are
reactive institutions. They spend their time reacting to
events, that is, “putting out fires” rather than “preventing
them.” A reactive facility would wait until such
emergencies occurred and then would handle them as a
crisis rather than as an anticipated event.
Nursing Department Goals
The goals of the institution definitely affect those of
nursing service, which must support and complement
institutional goals. In an institution with an overall goal of
developing a mental health program, a nursing
department goal may include developing nurses in
psychiatry
The astute manager of a nursing department must also
be proactive about the national issues facing nursing,
community needs for nursing, and the needs within the
institution itself. This manager would formulate goals to
help the nursing department meet the challenges of care
in the future, because the ultimate nursing department
goal is quality client care.
Nursing Unit Goals
It is important that each employee understand the
institutional and nursing department goals, because the
group or unit goals develop from them. Each nurse
should be able to contribute to the formation of unit
goals in terms of philosophy of care, quality of care, and
development of nursing expertise.
Helping to formulate the goals for your unit is important,
because these goals can also represent your individual
goals. Unit goals develop from the group as a whole and
often include individual goals in the process.
Development and implementation of goals must be
meaningful to the group if they are to be successful. The
member of the group must feel that they are the
originators of the unit goals and objectives
Organizational Climate
The climate of an organization refers to the prevailing
feelings and values experienced by individuals. The
feeling of thrust, belonging, esteem and loyalty are part
of the climate. Values for competence and
accomplishment are also part of the climate. The climate
is bases on the official policies and procedures of the
organization, and the feedback provided within the
organization