It aims to get the work done thoughts others.

To direct is to achieve the goals of the organization.

In nursing, it is directions to others to attain quality client care.
Douglas
defines directing as the ``issuance of assignments, orders and instructions
that permit the worker to understand what is expected of him or her, and
the guidance and overseeing of the worker so that he or she can
contribute effectively and efficiently to the attainment of organizational
objectives``.
Factors to a successful directing:
Leadership
Delegation
Motivation
Supervision
Communication
I.

LEADERSHIP

Leadership defined:
Maloney- ``an interpersonal process of influencing the activities of an individual
or a group toward goal attainment in a given situation``.
Gardner- ``the process of persuasion and example by which an individual (or
leadership team) induces a group to take action that is in accord with the leaders
purpose or the shared purposes of all. ``
Stoner- ``process of directing and influencing the task-related activities of group
members. ``
Mitton- `` leadership is the process of sustaining an initiated action. It is certainly
not a matter of pointing in a direction and just letting things happen. Leadership is a
conception of a goal and a method of achieving it; the mobilization of the means of
necessary for attainment; and the adjustment of values and environmental factors in
the light of the desired level.``

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Leadership is viewed as involving followers, and interpersonal

relationships, and as a process of influencing others.

Leadership styles:
1. Authoritarian or autocratic leadership style- represents primarily directive
behaviors. Make decision alone and lack of group support.
2. Democratic or participative leadership style- leader is describe as people
oriented, focusing on human relations, teamwork and building of an effective
work group.
3. Laissez-faire or permissive leadership style- leaders have no established goals or
policies and deliberately abstain from leading their staff.
Bases of Power
1. Reward power- is based upon a number of incentives that leader can
provide for group members and upon the degree to which the group
members value those incentives.
2. Punishment/ Coercive power- is based on the negative things that the leader
might do to individual group members or the group of a whole.
3. Information power- is based on who knows what in an organization and
the degree to which access to information can be controlled.
4. Legitimate power- stems from the group members perception that the nurse
manager has a legitimate right to make a request; this power is based on the
authority delegated to the nurse manager by virtue of her job and position
within the management of hierarchy.
5. Expert power- is based on particular knowledge and skill not possessed by the
staff. Nurse manager, by virtue of their experience and possibly advanced
education, frequently qualify as the persons who know best what to do in a
given situation.
6. Referent power- this power is based on admiration and respect for an
individual as a person. It is power that is largely a function of the leaders
personal qualities.
Theories of Leadership
1. Great Man Theory
-leaders are born, not made.

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2. Trait Theory
- To be a leader, one must have certain innate or inherited traits which
studies revealed that it can be learned and experienced.
3. Charismatic Theory- leader is someone who can inspire people to be loyal,
obedient and committed to a vision or a cause.
-

Leaders has strong personal convictions, possesses selfconfidence and perceives himself or herself as someone
who can overcome obstacles.

4. Situational Theory- type of leadership and traits required of a leader vary

depending on the situation.
5. Contingency theory- leadership style will be effective or ineffective depending
on the situation.
3 aspects of a situation that structure the leaders role:
a. Leader-member relations- represent the amount of confidence and
loyalty followers have in their leader.
b. Task structure- refers to the number of correct solutions to a given
situational dilemma.
c. Position of power- means the amount of organizational support
available to the leader.
6. Path Goal theory- leader facilitates a task by minimizing obstructions to the goals
and by rewarding followers for completing their task.
7. Life Cycle theory- Leaders assess the capacity of the followers to complete the
task assigned and provides the leadership behaviors that would best meet the
needs of the followers in a given situation.

Hersey and Blanchard suggest that a leadership style may be predicted

on the basis of the maturity of the followers.
Maturity refers to the level of security and competence the
individual feels about the task to be completed.
8. Strategy Theory- suggested by Bennis and Manus
-it was based on an extensive study on what is common to
leadership and leaders.
Four stages of ``human handling skills`` common to leaders: (Bennis and Manus)

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STRATEGY 1: Management of attention through Vision

Refers to the ability of the leader to create a focus or a clear

picture of an outcome.

STRATEGY 11: Meaning through communication

A group of leaders are able to turn their vision into images others
could understand.
Leaders have the ability to translate their ideas into symbols with
real meaning.

STRATEGY III: Trust through positioning

Refers to the ability of the leader to inspire trust in others by

contributing to the integrity of the organization.
The leader never loses sight of why the organization exists, what it
stands for and what it can do.
It also means staging a course. The leader directs the organization
to the right direction.

STRATEGY IV: Deployment of Self through positive Self-regard

The leader leads is a very personal way.

The leader projects a positive self-image and self-respect.

New and emerging concepts of Leadership:

Leadership can be learned and cultivated.
Leaders are not necessarily charismatic.
Leadership is not limited to those who reside at the top of the organization, but
rather leadership exist at all levels of the organization.
Leadership is not so much the exercise of power but the improvement of others.
Effective leaders are not born but develop over time through knowledge and by
using the appropriate set of skills.
Interpersonal relations:
It refers to the manner in which people respond to and identify with each other
in situations of everyday living. These also means that the dynamics of how
people interact, and why they react to each other as they do.

Good interpersonal relation

The secret for successful leadership.
Foundations include respect, trust and consideration for other
people.

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Individual characteristics that leads to the development of good interpersonal relations:

a. Self-awareness- when person realizes that one of his needs is to be accepted as
he respected, loved, and appreciated.
b. Self-acceptance- the ability to accept one`s own strengths, weaknesses and
short comings. It is also the ability to accept and live with facts and to believe in
one self and worth as a human being.
c. Acceptance of others and Sensitivity of other`s needs- people must learn to live,
work and adopt to each other and to accept the fact that other people have
rights and privileges too. Respect to others, courtesy and kindness are values that
contribute to accepting others and to developing rapport and cooperation with
each other.
d. Respect for the Job- a person shows respect for his job when he is willing to
accept responsibility for his actions performs his duties to the best of his ability
and shows interest in his work. Respect for job means to grow professionally by
undergoing further training to enhance one`s skills and competencies.
II.

DELEGATION

Delegation is defined as sharing responsibility and authority with the subordinates

and holding them accountable for their performance. It is a skill that relies on trust that
the subordinates have the necessary skill and knowledge to know how to do the
assigned task.
Delegation is further defines as a process that facilitates complex organizations
to accomplish work through the coordinated and differentiated efforts of others. It is the
manager who uses the process of delegation.
Delegation is a tool that the nurse manager uses to build morale among the
staff. It involves giving assignments to subordinates and motivating them to perform
their job efficiently and effectively.
Purposes of Delegation
Delegation is a means for promoting internalized motivation and job enrichment
by giving employees a sense of being their own through the opportunity to exercise
control over their work.
The reasons for delegating include the following:

Saves time and can help develop others

Maximizes the use of the talents of staff associates

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Uses latent abilities in personnel that contribute to their growth and

development

Aspects of Delegation
The process of delegation is concerned with the results. The manager assigns
responsibility, gives authority and creates accountability within the subordinate.
Responsibility denotes obligation. It refers to what must be done to complete a
task and the obligation created by the assignment.
Both the nurse manager and the subordinator understand what activities the
latter is responsible for, the expected results and how the performance will be
evaluated.
Authority is the power to make final decisions and give commands. It is inherent
in the position. Authority like responsibility can be shared with subordinates. When a
nurse manager assigns responsibility to subordinates, authority should also be given to
enable the subordinates to carry out the responsibility.
Although authority is delegation, the manager still maintains control and may
recall the authority.
Accountability refers to liability. It is defined as the fulfillment of the formal
obligation to disclose to referent others the purposes, principles, procedures,
relationships, results, income, and expenditures for which one has authority.
Subordinates when they accept delegated responsibility are under obligation to
complete the task and use authority appropriately.
Guidelines for Effective Delegation
For the beginning manager, some guidelines are offered to help when
delegating employees:

Give a clear description of what it is you want the employee to do.

Describe the overall scope and background of the current task.
Share with employees the outcome you expect and by when.
Discuss the degree of the responsibilities and the authority that the
employee will have.
Ask the employee to summarize the main points of the task that has been
delegated.

Areas to Consider for Delegation

There are five areas to consider for delegation, as follows:

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1. Routine tasks
Screening mail, preliminary interviewing of the job applicants, handling
minor scheduling. Problems-activities like these may be parceled out to
subordinates when youre not inclined to do them yourself. For example
the nurse manager delegates to a subordinate the preparation of
assignment and schedule of non-nursing personnel.
2. Tasks for which you dont have time
Theres another group of activities not necessarily routinary, but of
comparatively low priority. When you have time for these, prefer to do
them yourself. But when more urgent matters occupy your attentions,
these may be passed along to a capable subordinate. For example, the
nurse manager delegates to a subordinate to represent her in meeting
when she is not able to attend.
3. Problem Solving
Some executives properly turn over a problem situation to a subordinate.
This is usually of low or medium propriety area; and actually there are may
be one (or more) of your subordinates with a particular knowledge or skill
in the area that qualifies him or her to take on the task. In addition, he or
she will be motivated to give it special attention, since it will represent a
challenge. To exemplify this area, the nurse manager may delegate to a
subordinate who has training and experience in conducting research, the
task of find out why there is too much infection on post-operative wounds
of patients in the surgical ward.
4. Change in your own Job Emphasis
For the average executive, job content changes over the years, slowly in
some cases, rapidly in others. As executives become aware of these
changes in emphasis, they understand that new elements in their activity
require more of their time. To make the time, the executive must, as
practical matter, delegate old aspects of his or her responsibility to
subordinates. A nurse manager delegates the task preparing the yearly
budget for the unit, a task she has been doing for a long time.
Relinquishing the responsibility will give her more time for other challenging
tasks.
5. Capability Building

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Delegation may be used to increase the capability of the individual

subordinates. Properly managed, delegation becomes the means by
which you train and develop the skills of the subordinates. A nurse
manager assigns subordinates to act as team leader in the unit.
Areas NOT to be Delegated
There are some responsibilities that may not be delegated, such as the following:

The power of discipline. This is the backbone of executive authority.

Responsibility for maintaining morale. You may call upon others to help
carry out assignments that will improve morale. t\you cannot ask
anybody else to maintain it.
Overall control. No matter how extensive are delegations, ultimate
responsibility for final performance rests on your shoulders.
The hot potato. Dont ever mistake a mistake of passing one along just
to take yourself off the spot.

Barriers to Delegation
Often times, managers are reluctant to delegate. Some of the reasons are as
follows:

I can do it better myself fallacy

It has been found that nursing personnel with high standards of
performance are naturally are tempted to perform any activity that they
can do better themselves. A nurse manager must reconcile turning over
the task to someone whose performance will be good enough. The
comparison is not between the quality of work, but the BENEFITS to the
total attention to planning and supervision which is only the manager is in
the position to perform. Only after the manager accepts the idea that the
job requires getting most things done through other people will be the
manager be able to make full use of delegation.

Lack of ability to direct:

The manager must be able to communicate to the staff, often in
advance, what is to be done. This means that the manager must think
ahead and visualized the work situation; formulates objectives and
general plan of action; communicate both to the assistants. In essence,
the manager must identify and communicate the essential features of the
long range plans. All too often administrative personnel have not
cultivated this ability to direct.

Absence of controls that warn of impending difficulties

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Care must be taken that the control system does not undermine the very
essence of delegation. The nurse manager cannot completely delegate
responsibility unless the manager has confidence in the controls.

Aversion to taking a risk

The manager may be handicapped by temperamental aversion to taking
risk. The greater the number of subordinates and the higher the degree of
delegation, the more likely it is that sooner or later there will be trouble.
The manager who delegates takes a calculated risk. Over the period of
time the manager may expect that the gains from delegation will far
offset the troubles that arise.

III.

MOTIVATION

One of your most important task as a nurse manager in directing or leading is

motivating subordinates in the work setting. It is commonly assumed that an employees
motivation is related to individuals productivity, job, satisfaction and job turnover.
Motivation is defined as a leadership function aimed to arouse, excite or
influence another person to behave in some role or perform some action the person
would not ordinarily do. It also refers to some inner drive, impulse or intention that
causes one to act or believe in a certain way, or to seek a particular goal.
Motivation is the effect of persuasive communication between a leader and a
follower.
Theories of Motivation
Maslows Theory Of Human Motivation
The human being is motivated by a number of basic needs. It is the unsatisfied
needs which have the greatest influence in the behavior .once a need had been
gratified it has little effect on motivation. A want that is satisfied is no longer a want. The
first two needs are basic needs, the other three are growth needs.
1. Survival (Physiological) Needs
Represent our needs for foods, clothing, shelter, and other things which
are essential to our existence. So long as these needs go unsatisfied, the
individual is little concerned with other needs and his effort will be
directed toward satisfaction in this area.
2. Security (Safety) needs

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Once the individuals survival are satisfied to at least a minimum degree,

his dominant needs security needs. His efforts are directed towards
satisfaction in this area. Security needs include physical safety, job tenure,
insurance, pensions, and so on.
3. Social (Love, Affection, Belonging) needs
When the individual has minimum satisfaction of his survival and security
needs, belongingness needs become more important to him. These are
the needs for love, acceptance, and approval by others his family ,
friends, those with whom he works.
4. Status ( Esteem, Self-worth) needs
The individual whose survival, security, and belongingness needs are
satisfied in at least a minimum fashion then becomes concerned with
esteem needs the needs for recognition and status.
5. Self- actualizing (Self- fulfillment) needs
If the survival, security, belongingness and esteem needs are all satisfied
to at least a minimum degree, the individuals dominant need becomes
self- fulfillment. This need is the individuals desire to become his best self,
to realize his capabilities to the fullest, to know that he is making his
greatest contribution to humanity.
Herzbergs Theory Of Job Satisfaction
Frederick Herzberg proposed a two-factor motivational need theory. He claimed
that workers are motivated by two types of needs;

Hygiene factors or needs are associated with working conditions such as pay,
quality of supervision, job security and agency policy.

Motivation factors or needs are associated with work itself- challenges added
responsibility, opportunities for personal growth and opportunities for
advancement.

According to Herzberg, lack f hygiene factors causes job dissatisfaction and

absence of motivation factors causes lack of job dissatisfaction.
Motivating Staff
One of the most important part of your job as a nurse manager is to motivate the
staff, which is not always easy to do. However, with much effort and a positive attitude
that the job can be done, effective motivation will be carried out.

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There are number of ways to increase staff motivation :

1. Manage change properly
One tool that the nurse manager can use to influence the
performance of the staff and provide job satisfaction is to properly
manage change. You, as a nurse manager, can do this of you adhere to
the following key rules in introducing change:

Implement change only for a good reason there are good

reasons that are applicatble to a wide varirty of situations.
- Change in order to solve some problmens
- Change to make work procedures more efficient so that
time will not be wasted.
- Change to reduce unnecessary work load.

Introduce change gradually. You should not try to change

everything all at once. Introduce change in only one or two areas
at first and then gradually build upon the success of that first effort
as a means to develop the trust and cooperation of the staff.

Plan. You should plan carefully the change and the strategy for
introducing it. There is a likelihood that the change will be
accepted and will be successful. Changes that are implemented
hurriedly will likely to create problems for the staff and the nurse
manager.

2. Assign undesirable jobs on rotation basis.

Usually, the best employee gets to do the bad jobs because you
are assured that it will be done properly. However, it may give the
impression that the rewards of high performance is doing disagreeable
tasks.
Undesirable jobs should be rotated among the staff. If the same
people get to do the job because they do well, a feeling of inequity will
prevail; however, if the task is rotated, inequity is less likely to happen. It is
best that the nurse manager provide some incentive to the employee for
the completing undesirable tasks. Examples of undesirable tasks are nonnursing jobs.
3. Job redesign.
The purpose of this is to create jobs that provide a high degree of internal
work motivation, high quality of work performance, high satisfaction with
the work, and low absenteeism and turnover.

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The usual methods of changing a job to increase self-esteem ,

achievement and self- actualization are job rotation, job enlargement
and job enrichment.
Job rotation can be used to increase motivation
(temporarily) for an employee whose job is considered
unchangeable and thus is deemed monotonous, boring
and without challenge. To deicers job monotony the worker
id relieved of his usual tasks for a while and is rotated
through a salaries of other tasks, which provide opportunities
to develop other skills.

Job enlargement is used to motivate workers when it is

recognized that worker boredom and dissatisfaction result
from overspecialization and consequent shortening of the
job activity cycle. To decrease boredom the specialists job
is enlarged to include some of the activities of other
specialists and to require broader skill development and
longer cycle time.

Job enrichment the job is redesigned to decentralize

decision making to the individual worker. This heightens
employee initiative, stimulates new skill development, and
forces acceptance of greater responsibility.

4. Provide productive climate and high morale.

Climates are clusters of employee perceptions of an organizations
events, practices and procedures; when taken together, these
perceptions are useful in characterizing the organization or subunit.
IV.

SUPERVISION

involves overseeing the activities of other

consists of inspecting the work of another, either approving or correcting the
adequacy of performance
ensures that the major goal of nursing, which is quality of care is achieved
encourages the development of the potentials of the workers for effective and
efficient performance
Purposes:

concerned with people, the work area, working conditions and the work
itself.

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Supervision is carried out to:

inspect, evaluate, and improve worker performance

provide suitable working condition
orient, train and guide the individual staff member

Principles of Supervision:
Good supervision:
1) Focused on improvement of the work rather than on upgrading the
worker.
2) Based on the needs of individuals that have been cooperatively
determined.
3) Cooperatively planned.
4) Employs democratic methods.
5) Stimulates the staff to improve continuously.
6) Respects the individuality of the staff member.
7) Helps create a social, psychological and physical atmosphere in which
the individual is free to function on his or her own top level.
V.

COMMUNICATION

Ability to communicate effectively both in written and spoken language

Essential tool that is use while performing the various functions of management
Communication Process

Communication is defined as the transfer of information and

understanding from one person to another.
The communication process involves six steps:
1) Ideation
Begins when the sender decides to share the content of the
message with someone, senses a need to communicate,
develops an idea, or selects information to share.
2) Encoding
Involves putting meaning into symbolic forms: speaking,
writing or nonverbal behavior.
Ones personal, cultural, and professional biases affect the
goals and encoding process.
3) Transmission

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actual expression of the message.

must overcome interference such as garbled speech,
unintelligible use of words, noise and other disturbances.

4) Receiving
receivers senses of seeing and hearing are activated as the
transmitted message is received.
People tend to have:
selective attention
o hear only the messages of interest to them
selective perception
o hear the parts of the message that conform with
what to hear
This selectivity causes incomplete and distorted
interpretation of the communication.
5) Decoding
Decoding of the message by the receiver is the critical fifth
step.
receiver defines words and interprets gestures during the
transmission of speech.
The communication process is dependent on the
receivers understanding of the information.
6) Response or feedback
final step
important for the manager or sender to know the message
has been received and accurately interpreted.
Communication Systems
a) The chain system
fast and accurate for simple problems
the middle person in the chain emerges as the leader, and the
leadership position is stable.
Unfortunately, morale is low and so is flexibility for problem solving.
b) The wheel and Y-systems
both provide fast, and accurate problem solving
the leader emerges at the location of highest centrality, which if the
fork of the Y and the hub of the wheel.

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The coordinator, who is centrally located, is generally satisfied, but the

peripheral members are less satisfied than members in less efficient
systems.
The wheel is an efficient, effective communication structure for simple
problems.

c) The circular structure

slow and inaccurate
structure does not influence the emergence of a leader.
Because no one can communicate with everyone, there is no
coordinator.
However, morale is high, and there is considerable flexibility for
problem solving.
d) The all-channel system
Best for completing complicated and unpredictable tasks.
Lines of Communication
The traditional lines of communication is from the top executive down
through the levels of management.
Four Types of Communication Lines
Downward Communication

Primarily directive and helps coordinate the activities of different levels

of the hierarchy by telling staff associates what to do and by providing
the information needed by staff associates to relate their efforts to the
organizations goals.
Written communication consists of the following:
1) Memoranda or memos
convey information between individuals or groups
2) Directives
administrative orders which initiate action or give instruction
in an emergency.
used to control policy of operation and to coordinate
hospital services.

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3) Manuals of Operation
written procedures and techniques or standard operating
procedures of each unit or department
should always be on file for ready reference
4) Record and Reports
Written information based on facts and observations
Upward Communication

Provides a means for motivating and satisfying personnel by allowing

employee input.
The manager summarizes information and passes it upward the next
level for use in decision making.
That level then summarizes its action and transmits information to the
next level up to the top management.
Lateral/ Horizontal Communication

Between departments or personnel on the same level of the hierarchy

and is most frequently used to coordinate activities.
Diagonal Communication

occurs between individuals or departments that are not on the same level
of the hierarchy.
Informal and is used frequently between staff groups and line functions.

Blocks to Communication
Some of the common reasons for blocks to communication are:
Listening Skills
give full attention to the person speaking
listen carefully with your mind
maintaining eye contact
Psychological Blocks
an intense response to a communicated message very likely will
produce a temporary block to the rest of the message.

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 Emotions are powerful forces that may interfere with reason and
must be recognized and respected before constructive
communication may continue.
Environmental Distractions
Refer to sudden, distracting noises that occur when
communication is taking place, like engaging in a serious
discussion.
Semantic Barriers
study of words
leader should try to be aware of the choice of words or phrases
used in conveying a message to avoid misinterpretation or sending
the wrong message to group.
Principles of Effective Communication

1) Information giving is not communication

Communication requires participants to share mutual interaction

2) Responsibility for clarity resides with the sender

Communicate your ideas clearly to staff.
This responsibility resides in you and not in the staff.

3) Simple and exact language should be used.

Words used in both written and spoken communication should be precise
, simple and easily understand.
4) Feedback should be encouraged.
Feedback has been defined by Wang and Hawkins (1980), as the
process of adjusting future actions based on information about past
performance.
The best way to be sure the ones message has been interpreted
accurately is to obtain a feedback.
A common source of misunderstanding is the lack of feedback.
5) The sender must have credibility.
The personal and professional credibility of the information giver has
shown to be more important in affecting the desired outcome than the
content.

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Some of the characteristics of a credible professional are trustworthiness,

reliability, and competence.
The rule , Say what you mean and mean what you say, aptly describes
a credible professional.

6) Acknowledgement of others is essential.

Acknowledgment is encouraged if the employment atmosphere is one of
cooperation and individual contributions are viewed as complementary.

7) Directing channels of communication are best.

A face-to-face communication is preferable to written or phone
communication.

RECORDS AND REPORTS

contain data or information that may be used for decision- making,

recommendations or as a basis for the management of the unit and
patient care.

The following are some points that you as a nurse manager should observe regarding
record keeping.
1.
2.
3.
4.
5.
6.

7.
8.
9.

Records should be accurate, adequate, and up-to-date.

Records should be clear, brief and concise.
Records should be provide relevant facts for evaluation and study.
Records and reports may be temporary or permanent. Policies should be
provided for its disposition.
Record forms that are used for recording purposes must be maintained at
all times.
Confidential records and reports should be safeguarded. The word
confidential should be either be stamped or written preferably in red
ink.
Dry, sturdy storage for records must be provided.
Records should be file chronologically and by subjects to facilitate
accessibility and effective use of data.
A properly trained responsible person should be assigned in keeping
records and reports.
Records are also necessary for purposes of
reimbursement of insurance and for research.

Reports are prepared accounts of important activities of the nursing

service within a particular period. Types of reports include following:

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1. Nursing office reports such as:

a) Monthly reports on the number of nursing personnel , new
appointment, resignations, transfer, retirement, leaves of
absences, accomplishments, activities, trainings and
researches]
b) Bi-annual and annual reports that include performance
evaluation of nursing personnel, problems and issues
affecting nursing service and recommendations for the
resolution of problems.

2. Nursing unit reports

prepared by the senior or staff nurses
They include accomplishments in patient care, unusual occurrences in the
unit and adequacy of supplies and equipment.
Points to consider in making reports :
a. Reports, either written or oral, must ne up-to-date , clear and
concise.
b. Channels of communication should be properly observed.
c. Reports should be factual and may include recommendations
for actions.
d. Reports should be accomplished in forms adopted by the
hospital.
e. Verbal reports made in emergency situations should be
confirmed in writing and duly signed by the person making
such.

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