NURSING

MANAGEMENTCONCEPTS,
PRINCIPLES AND
TECHNIQUES

NURSING MANAGEMENT- CONCEPTS, PRINCIPLES AND TECHNIQUES

INTRODUCTION
Nursing management consists of the performance of the leadership functions of governance
and decision-making within organizations employing nurses. It includes processes common to all
management like planning, organizing, staffing, directing and controlling. It is common for registered
nurses to seek additional education to earn a Master of Science in Nursing or Doctor of Nursing Practice to
prepare for leadership roles within nursing. Management positions increasingly require candidates to hold
an advanced degree in nursing.
DEFINITION - MANAGEMENT
According to R. Terry , management is defined as implementing specific functional activities that
include framing strategies of planning , systemizing the work planned, and implementing , supervising and
directing the work performance to achieve the goal by utilizing the adequate manpower and other
resources.
According to E F. L Brech , management is defined as the process to ensure that as the works get
completed , it mainly focuses on work orientation , planning and implementing the planned strategies to
achieve the management goals.
According to Stanly Vane , management is defined as the activity of determining the control over the
activity of personnel's in order to achieve the expected goals of the management.

NURSING MANAGEMENT- CONCEPTS

Nursing management is an intellectual process in which the nurse manager plans , supervises and coordinate the work of staffs, report to higher authorities and responds to the emergent situations in order to
achieve high productivity and quality patient care.
Nursing management can be viewed in terms of

Efficiency or performance
Decision making process
Personnel oriented process
Functions or activities oriented process

Efficiency or performance oriented view

This view emphasizes on relationship between efforts and result to achieve the nursing
organizational objectives that to ensure the best possible nursing care. According to this concept nursing
management can be defined as ''the art of securing maximum effort so as to secure maximum prosperity
and happiness for both nurse managers and nurses to render the best possible patient care''.
Decision oriented view
The decision theorists like Peter Drucker and Moore emphasized that decision making by the
managers pay an important role in management. even management is viewed as decision making.

According to this concept nursing management can be simply ''the process of decision - making and
control over the actions of nurses working in various positions in the hierarchy for the expressed
purpose of attaining predetermined goal of ensuring the quality of patient care''. But the scope of this
concept is narrowed because it does not specify the process in which context decision- making is
applied.
Personnel oriented view
In this concept management is looked as a process of coordinative efforts of the personnel
working in the organizations. The management is concerned with personnel management. According to
this concept the nursing management can be defined as ''the art of getting things done trough and with
nursing personnel in formally organized groups''. This concept is incomplete because it does not specify
the functions or activities involved in the process of getting things done.
Functions or activities oriented view
According to this concept nursing management can be defined as the process by which the
nurse managers forecast, plan , organize , coordinate and control the efforts of nursing
personnel to accomplish the organizational goals. This definition is the reflection of functions
or activities of a nurse manager.
Gillies D A defined nursing management as the process of working through nursing staff
members to provide care, cure and comfort to patients. nurse managers task is to plan ,
organize, direct and control the available financial, material and human resources so as to
provide the most effective care possible to groups of patients and their families.
Nursing management is performing leadership functions of governance and decision making
within organizations employing nurses.
NURSING MANAGEMENT AND NURSING PROCESS
Gillies describes nursing management as a process that supports and parallels the nursing
process that contains a progressive sequence of interrelated activities in a logical manner.
Like nursing process nursing management includes all the steps of data gathering, diagnosing ,
planning, implementation and evaluation .
Nursing management is also viewed as self- regulating and self- correcting like nursing process by
which nurse provides care , cure and comfort for the patients. in the same way in nursing
management process nurse manager works through others to achieve the goal.
Efficiency or performance

Nursing management- A general system theory approach

A system is an assemblage of things , connected so as to form a complex unity. Nursing
management is described as a series of interrelated events that include inputs of energy , material and
information ; systematic transformation of such input in to pre planned product, patient care .
System approach provides an integrated approach of managing. it also provides a framework
through which organization environment interaction can be analyzed and facilitate decision making.

Men
Money
Material
Methods

Input
Transformati
on process
Management
functions

Quality
patient
out
put

Nurses
satisfaction

Machines

NURSING MANAGEMENT MISSION STATEMENTS

A Mission Statement defines the organization's purpose and primary objectives. Its prime function is
internal to define the key measure or measures of the organizations success and its prime audience is
the leadership team and stockholders.
Mission statements are the starting points of an organisations strategic planning and goal setting process.

They focus attention and assure that internal and external stakeholders understand what the organization is
attempting to accomplish.
Dimensions of Mission statements:
According to Bart, the strongest organizational impact occurs when mission statements contain 7
essential dimensions.

Key values and beliefs

Distinctive competence
Desired competitive position
Competitive strategy
Compelling goal/vision
Specific customers served and products or services offered
Concern for satisfying multiple stakeholders
The mission statement of an; organization describes the purpose for which that organization exists.
Mission statements provide information and inspiration that clearly and explicitly outline the way
ahead for the organization. They provide vision.
Individuals want productive and meaningful lives .therefore, the purpose of the organization and of
each of its units should be defined a teamwork approach should be properly trained: and all
individuals within the organization should be treated with respect.
Organizational purpose moves and guides the organization toward a perceived goal.
Many writers indicate that the purpose or mission statement should be created from mission
statement should be properly trained and all individual s within the organization should be treated
with respect.
Organizational purpose moves and guides the organization toward a perceived goal.
The mission or purpose statement incorporates the culture of the organization, including strong
leadership, rules and regulations, achievement of goals, and the notion that people are more
important than work.

Employees who participate in developing the vision statement believe in their own abilities and are more
committed to the organization.
The mental exercise of creating one is more meaningful than the contents of the statement itself.
Vision, values, mission or purpose statements are meaningful only to the creators.

Employees who participate in developing the vision statement believe in their own abilities and are
more committed to the organization than employees who do not participate.
The vision statement is shared companywide so that employees may live the vision. It is updated to
keep pace with technology and trends..
Vision values, mission, or purpose statements are meaningful only to the creators.
Translated for the community, these statements place value on the way nurses care for people.

It follows that ethnic populations are considered in developing vision and values statements for
nursing entities. Nursing education teaches the meaning of values such as tolerance and
compromise.
Examples of values are informality, creativity, honesty, quality, courtesy, and caring,Philosophy
and Cost effectiveness

In management or administration of any enterprises for organization, the quality, quantity, timing and cost
of the necessary to reach the objective of the enterprises are interrelated factor which must be given
constant attention.
Execution and control of work plan: One of the greatest possible contributors to wastage of our precious
recourses, whether at the local or national level, is the failure of those at any level of administration, and at
all stages in the management of the activity, to base all decision on verifiable facts.
Delegation of responsibility and authority: The delegation of responsibility and authority is an important
aspect of successful administration, to place the responsibility for decision at the lowest possible
organizational level in order to attain decision as speedily as possible.
Human relation and good morale:
Since the function of administration is to attain an established objective through the management of
people, administration if deeply concerned with human relation. Good morale of the staff is essential to the
success of any organization.
Effective communication:
Effective communication are essential for all aspect of effective administration .staff must be adequately
and correctly informed about plan, methods ,schedules, problems events and progress.
Flexibility:
Administrators must be completely flexible to meet the changing needs of the situation.

LEVELS OF NURSING MANAGEMENT

Levels of nursing management are classified in to three categories on the basis of hierarchy,
their position and relative responsibilities. These are
Top level
Middle level
Operative level
Top level
This include chief nursing officer/ nursing superintendent / matrons in the hospitals.
They are the source of authority and it establishes goals, policies and objectives for the nursing
service.

Mainly involved in planning and coordinating functions.

They are accountable for the nursing services for which they are serving.
They issue instructions to the lower levels .
They control all the activities of the hospital nursing services.

Middle level
This includes heads of nursing units in the hospital and are at supervisory levels, designated as
ward sisters or sister grade 1.
They are responsible for the top management for the functioning of their departments.
They make duty plans to the nursing personnel of lower or operational level and devide work to
them.
They evaluate the performance of operative level nurses and co- ordinate with other
departments to ensure best quality patient care.
They arrange necessary equipments for the operative level nurses and provide necessary
working and therapeutic environment.
They maintain good human relations and communicate problems to the higher level
management.
Operative level
This level comprise of nurses at the operational levels designated as staff nurse or sister grade
II.
They are responsible for patient care.
Also known as the 1st line management and are responsible for patient care.
They plan and take the decision for care of their assigned patients.
They carry out the instructions given by their superiors and team members in patient care.

Levels of nursing management in hospitals

Top level
Chef nursing officer/
Nursing
superintendent/
Matrons
Middle level
ward sisters/ sister
grade I

Operational levels
Staff nurse/ sister grade
II

PRINCIPLES OF MANAGEMENT IN NURSING

Management principles in nursing are statement of fundamental truth related to nursing field. The
principles of nursing management was derived from principles of administration by Henry Fayol. This
principles serve as guidelines for decision and actions of nurse managers working at any level in defferent
settings. This describe the key management discuss why some roles are considered to be more important or
less important at different levels in the organizational hierarchy.
The principles are,
Division of work
This is otherwise called principle of specialization. This implies that any employee should be assigned
only one type of work so as to bring about specialization in every activity. Specialization will help in
creating specific personal and professional development among the nurses and will increase their
efficiency. This principle is applicable to nurses working at operational, supervisory as well as managerial
level.
Authority and responsibility
Authority means right to give order by a superior to her subordinates; responsibility means the
obligation for performance. This principle suggest that there must be parity between authority and
responsibility. They are co-existent and go together and are two sides of the same coin.
Discipline
Discipline is essential for the smooth functioning of all organizations. Discipline refers to
getting obedience to the rules and regulation of the organization.
proper conduct in relation to others
respect to authority or superior.

Unity of command
Every subordinate must receive orders and instructions and be accountable to one and only to
one superior. This will improve the performance of employee , otherwise there will be overlapping of
orders and will create confusion and conflict. Dual command generate tension confusion, and conflict
result in diluted responsibility and blurred communication.
Unity of command also make it easier to fix responsibility for mistakes and there will be
harmonious relationship between the superior and the subordinates.
Unity of direction
This means that one head should give the direction. All the activities of a work unit or group
should be directed towards the same goal. There should be one plan of action for them. There will be
the focus of efforts and co-ordination of strength.
Subordination of individual interest to general interest
The management must put aside the personal considerations and put organizational objectives
first. Interest of the goal of the organization should be supreme over the personal interests of
individual. The subordinates can show the general interest through collective bargaining.
Remuneration
The employee must be just and fair to everyone so that each employee gets motivated to work.
There should be compensation for services by considering both financial and non financial factors
mix.
Centralization
It means the extent to which authority is centralized or decentralized. Centralization lays the
concentration of decision making authority at the top management. Dispersal of authority with
lower levels is called decentralization. There should be proper balance. The amount of power rested
with the central management depends on organization size.
Scalar chain of command or hierarchy
Scalar chain is the chain of superiors ranging from top management to the lowest rank. The
principle suggest that there should be a clear chain of authority from top to bottom linking all
managers at all levels. it recognizes the necessity of formal authority in the organization.
Order
Social order ensures that there should be a place for everything and everyone. Material order
ensures safety and efficiency in the workplace. Facilities must be tidy , materials orderly stored and
systematically arranged as per the need of the department and staff selected according to strict
procedures and clear job descriptions.
Equity
Equity means fair and impartial treatment. Employees must be treated with kindness and justice
must be enacted to ensure a smooth working environment. Managers must constantly apply the
correct balance between equity and discipline.

stability of tenure
The job of employee should not be too short and they should not be rotated from positions
frequently. An employee cannot render worthwhile service if she is removed before she used to he
work assigned to her.
Initiative
Subordinates should be given an opportunity to take some initiative in developing and initiating
the plans as it can become a source of strength for organization. Employees are likely to take
greater interest in the functioning of the organization.
Esprite de Corps (Union is strength)
This means sense of belonging, team spirit , the spirit of loyalty, devotion and co-operation
which unites the members of the group. Manager need to ensure and develop morale in the work
place. Team spirit helps to develop an atmosphere of mutual trust and understanding. The two
enemies for Espirit de corps are divide and rule and abuse of written communication by the
superior.
FUNCTIONS OF NURSING MANAGEMENT
Its management has its own administrative and managerial functions. According to Luther
Gullick the functions management are explained by the acronym POSDCORB.
o Planning
o Organizing
o Staffing
o Directing
o Coordinating
o Reporting
o Budgeting
Planning
Planning is one of the basic and prime functions of management. It involves selecting objectives,
policies, strategies programmes for the nursing service. Input and resources are also needed. The objectives
are set, policies are made, strategies are determined and time scheduling is done. It is a decision making
process that involves deciding n advance what to do, how to do, who is going to do and how the results are
to be evaluated.

Organizing
Organizing means developing a system. It is the process of developing physical resources,
informational resources and human resources as per plan. various activities like identify work activities ,
preparing job descriptions and job responsibilities , assigning and identifying job roles and developing
rationale to organize those activities. According to Allen organization involves identification and grouping
the activities to be performed and dividing them among the individuals and creating authority and
responsibility relationship among them for the accomplishment of organizational objectives.

Staffing
It involves making the organizational structure through proper and effective selection, appraisal and
development of nursing personnel. This process includes setting recruitment procedures, selecting
personnel, deploying them in proper positions organizing orientation and other skill training programme
and appraising them.
Directing and Leading
This is concerned with inspiring and encouraging staff and creating understanding among them.
Supervision, communication exhibiting leadership and motivating the staff are important ingredients for
getting the maximum output and to achieve the organizational objectives. According to Koontz and
Donnell, direction embraces those activities which are related to guiding and supervising subordinates.
Controlling
This is also called system measurement which is the process of measuring and correcting the
performance of the activities of staff as per expected performance. For this standards are determined ,
actual performance is measured , comparing the actual performance with standards of performance and
taking the appropriate corrective action.
Co-ordination
Co-ordination is the essence of management and is considered as one of the managerial functions and
is a deliberate effort of the manager to achieve the organizational goals.. It is important to synchronize and
unifies the individual staff efforts for better action to achieve organizational objectives through formal and
informal relations. Management seek co-ordination through planning , organizing, staffing , directing and
controlling.
Planning

Organizing

Coordinati
on

Directing

Controlling

Staffing

MANAGEMENT TECHNIQUES
Management techniques can be classified in different ways. M. J Clay has based his classification on
the following eight objectives which various management techniques attempt to achieve.
1. Detection : To find out what is happening or discover something.
Technique- Input -output analysis, attitude survey, production study.
2. Evaluation : To measure or to estimate the value of an item.

3.
4.
5.
6.
7.
8.

Technique- Job evaluation, work measurement, performance appraisal, cost-benefit analysis.

Improving performance
Technique: Management by objective
Optimising performance
Technique : Linear programming, Operational research
Specification of a desired value of situation or action
Techniques : Layout planning of offices and plants
Control
Technique : Cost control, credit control, labour control, production conrol and budget control
Communication
Technique : Visual aid, Report writing, Management information
Demonstration
Technique : Programmed learning, job instruction, Training.

MANAGEMENT BY OBJECTIVES(MBO)
Management by objectives (MBO) is a process whereby superiors & subordinates jointly identify
the common objectives ,set the results that should be achieved by subordinates, asses the contribution of
each individual, and integrate individuals with the organization so as to make best use of organizational
resources.
DEFINITION

A process whereby the superior & subordinate managers of an organization jointly identify
its common goals, define each individual's major areas of responsibility in terms of the
results expected of him, and use these measures as guides for operating the unit and
assessing the contribution of each of its members.
( George S. Odiorne, 1965).
A comprehensive managerial system that integrates many key managerial activities in a
systematic manner, consciously directed towards the effective & efficient achievement of
organizational objectives. (Haro ld Ko o ntz )

Objectives of MBO:
1.
2.
3.
4.
5.
6.
7.
8.

1. To measure and judge performance

To relate individual performance to organizational goals
To clarify both the job to be done and the expectations of accomplishment
To foster the increasing competence & growth of these subordinates
To enhance communication between superior and subordinates
To serve as a basis for judgments about salary and promotion
To stimulate the subordinates motivation and
To serve as a device for organizational control and integration.

Characteristics of MBO
1. MBO is an approach & philosophy to management & not merely a technique.

2. On the other hand, MBO is likely to affect every management technique. MBO employs
several technique but it is not merely the sum total of these techniques. It is a way of
thinking about management.
3. MBO is bound to have some relationship with every management technique. Certain
degree of overlapping is there. In fact often MBO provides the stimulus for the
introduction of new techniques of management & enhances the relevance & utility of the
existing ones.
4. The basic emphasis of MBO is an objectives.MBO is also concerned with determining
what these results & resources should be. This MBO tries to match objectives &
resources.
5. The MBO is characterized by the participation concerned managers in objective setting,
the performance reviews, and his performance.
6. Periodic review of performance is an important feature of MBO.
7. Objectives in MBO provide guidelines for appropriate systems procedures.

Steps in process of MBO

1. Setting of Organizational Purpose & Objectives
2. Identify the Key Result Areas(KRAs)
3. Establishment of the objectives of the supervision
4. Recommending objectives for the subordinates by the superiors.
5. Setting subordinates objectives
6. Periodic review of the performance of the subordinates.
7. Review of the performance by the superiors.
8. Final review of performance by the superiors.
9. Performance appraisal by superiors.
10. Providing feedback to the top level.
Steps of MBO
1. Setting Goals

Top managers formulate the overall organizational goals

Middle managers work with first line managers to set goals
This strengths organizations overall goals and commitment.

2. Planning
During action planning, managers decide in the who, what, whom, and how detail needed to
achieve each objective.

3 .Implementing plans
1. To control their performance managers must be allowed to implement plans in their own
way.
2. Element of self control
4 . Reviewing performance

Managers review the performance of the people by supervisor

Evaluate the plans to achieve individual & group goals
Discuss how can these obstacles be removed.

Benefits of MBO
1. Better management of organization
i. Clarity of objectives
ii. Role clarity
iii. Periodic feedback of performance.
iv. Participation by managers in the management process
v. Realization that there is always scope for improvement of performance in every situation.
2. Clarity in organizational action
3. Personnel satisfaction

4. Basis for organizational change.

Limitations of MBO
1.
2.
3.
4.
5.
6.

Time and cost

Failure to teach MBO philosophy
Problems in objective setting
Emphasis on short- term objectives
Inflexibility
Frustration

Pre requisites for installing MBO program

1.
2.
3.
4.
5.
6.

Purpose of MBO
Top management support
Training for MBO
Participation
Feedback for self direction & self control
Other factors:i. Implementing MBO at lower levels
ii.MBO & Salary Decision
iii. Conflicting objectives.

NURSE MANAGER IN THE HEALTH CARE DELIVERY SYSTEM

Nursing is a professional career and that forms part of a very competitive industry. As a nurse manager
one's duties and responsibilities require much skill and professionalism, this is achieved by dedication ,
hard work and passion for career.
Qualities of a nurse manager

Professional knowledge
Good physical health
Commanding power
Ability to understand
Ability to judge situation
Will power
Willingness to accept responsibility
Experience and enthusiasm

ROLES OF A NURSE MANAGER

The general roles of a nurse manager include,

Creating team work and co-ordination among members of the group

Providing leadership and motivation to individuals

Maintaining a dynamic equilibrium between organization and its ever-changing environment
Being responsible for the creation, survival and growth of organizations
Improving standards through effective utilization of human and material resources
Monitoring duties and responsibilities in accordance with the organization's vision and
statement
Building of team leadership
Decision making within the organizations
Participation as a member of research committee
Setting goals and objectives for nursing services
development and implementation of policies and procedures
Support and promotion of staff development and continuing education of staff .

Specific role of a nurse manager include

Preparing objectives: Develop plans and objectives for the designated work area
Patient assignment : Conduct assessment of a patient's need and initiate nursing care plan
Delegation of duty : Assign the staff their duties to ensure smooth functioning t achieve
goals
Supervision : Direct and control the general nursing provided by the staff nurses
Coordinate activities : Schedule work assignment, set priorities and direct the work of
subordinate employees
Programme evaluation: Evaluate the nursing programs and nursing care plans
Evaluation of performance : Verify and evaluate the nurses performance through review of
completed work assignments and work techniques.
Record and report keeping: Maintain records, prepare reports .
Coordination: Coordinate the community nursing activities with those of social work staff
to ensure continuity of care
Auditing: Evaluate and document patient's progress
Public relations : serve as a liaison between staff and higher authority
Adviser: Serve as an adviser to other disciplines
Budgeting: assess needs for personnel, supplies equipment and physical facilities.
Staff development: Identify staff development and training needs and ensure that the staff
nurses gets required training. organize educational activities for the development of staff
nurses.
CONCLUSION

To achieve the most without wasting the resources in experimentation there is need for devising
and introducing techinques that bring maximum results with limited resources. MOTTO: The Right
technique ,at the right place,at the right time, at the right cost, by the right methods.
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