Final Seminar on Directing in Nursing Management
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Transcript of Final Seminar on Directing in Nursing Management
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AIM:
At the end of the seminar the student will be better equipped to
perform the directing function in nursing management, by using
motivation.
Objectives:
At the end of the session the student will be able:
To understand directing as a function of nursing management.
Get an understanding of the roles and functions of various cadres in
nursing management.
To understand the characteristics/features of motivation.
To know the need of motivation of employees.
To know the steps in motivation process.
How to create & implement a strategy for motivation
To understand the model of motivation.
To get knowledge about the theories of motivation.
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To know the types of motivation.
To know about the motivational approaches.
To know about the motivational killer.
To know the importance of motivation.
To know the what is effective motivation.
To understand the techniques to build motivational climate.
To understand Role & functions of manager/administrator .
To understand the methods of motivating employees.
To know the advantages of motivation.
Understand the role of motivation in directing the employees /
subordinates.
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Directing
Introduction
Directing/Direction is a function of management performed by top level
management in order to achieve organizational goals. It is very important and
necessary function of management. Management has to undertake various
activities like, guide people, inspired and lead them as well as supervision of
their activity is required in order to achieve desired results.
Meaning and Definition
Direction consists of the process and techniques utilized in issuinginstructions and making certain that operations are carried as originally
planned.
Directing involves determining the course, giving order and instructionand providing dynamic leadershipMarshall
Activating means and moving into action- supplying simulative powerto the group- G.R Terry
Directing is the process through which a manager communicates with andinfluences other members of the organization in the pursuit of company
objectives.
Directing is said to be a process in which the managers instruct, guide andoversee the performance of the workers to achieve predetermined goals.
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Directing is said to be the heart of management process. Directing
initiates action and it is from here actual work starts. Direction is said to
be consisting of human factors. In simple words, it can be described as
providing guidance to workers is doing work. In field of management,
direction is said to be all those activities which are designed to encourage
the subordinates to work effectively and efficiently. According to Human,
Directing consists of process or technique by which instruction can be
issued and operations can be carried out as originally planned Therefore,
Directing is the function of guiding, inspiring, overseeing and instructing
people towards accomplishment of organizational goals.
The managerial function of directing is like the activities of a teacher in aclassroom. In order to teach, a teacher has to guide his students, maintain
discipline, inspire them and lead them to the desired goal. It is a very
important function in the management of any enterprise. It helps the
managers in ensuring quality performance of jobs by the employees and
achievement of organizational goals.
The Three important skills that the nurse manager must possess when they
are trying to influence the behaviour of other:-
1) Diagnose: The manager must first know the problem or the situation thatneeds direction.
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2) Adapt: - As the situation demands, the manager must try to fit themselvesinto the situation & understand it before directing others to do so.
3) Communication:- Having understood , analysised & changed theirbehaviour according to the situation the managers shall communicate to
other members to understand the situation & change their behaviour
accordingly.
Features of directing
Ongoing process: - Directing is not an intermittent function ofmanagement. It is a process of continuously guiding the behaviour of
individuals.
Not supported by rules :- Since the behaviour of an individual cannotbe predicted
through any mathematical or statistical tool, the function of directing is
purely based on possibilities of outcomes of application of behavioural
sciences & is not supported by any rules or regulations.
Directing is situational:- The force applied by the managers ininfluencing the individual behaviour changes from situation to situation.
The environment, the nature of individuals the group behaviour to
which an individual belongs, the attitude of individuals towards the
working are some of the factors that the nursing manager must keep in
mind while directing.
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Behavioural science:- Since directing deals with the human behaviour,the managers should try to study the different aspects of human
psychology to develop an understanding of how to influence this
behaviour.
Understanding of the group behaviour:- No individual can inisolation. While he is working in an organisation, he becomes the part
of the informal groups.The behaviour of a person is different as an
individual & a member of group it is therefore, essential that the
managers understand the importance & nature of group behaviour to be
able to direct effectively.
Participative in nature:- The directions issued by managers initiateaction on the part of individual to ensure greater participation of
individual in carrying out the organisational activities, they should be
made a part of the discussion & meeting where the various directive are
being discussed.
Importance of Directing
Plans remain mere plans unless they are put into action. In the absence
of direction, subordinates will have no idea as to what to do. They will probably
not be inspired to complete the job satisfactorily. Implementation of plans is,
thus, largely the concern of directing function. As a function of management,
directing is useful in many ways.
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Creation of a sound work environment:- Issuing directions in
consultation with maximum potential, willingly & enthusiastically to
contribute towards organisational goals.
Development of managers:- The managers must be personally
motivated to work in a given work environment & only thereafter should
direct others to work. The managers thus try to develop their skills &
competence to fit into a given situation & then direct others to follow.
Working of managers & others organisational members with cooperation
& harmony helps not only in prompting the skills of the members but also
enables the managers to develop themselves as potential candidates for
being promoted to higher levels of organisation structure.
Behavioural satisfaction:- As the emphasis in farming directive is on the
human behaviour & psychology, the individuals feel behaviourally
satisfied & feel personally inspired to work towards the attainment of
organisation goal.
Increase the productivity:- Personally satisfied employees contribute
towards increased output & overall efficiency of the organisation.
Achieves coordination:- Directing, described as an ongoing process
aims at continual supervision of the activities of the organisational
members. This ensures that they are working according to the planned
activities in a coordinated & an integrated manner.
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Facilitates control:- Co ordination of individuals efforts aims at
bringing the actual performance in conformity with the planned
performance. The controlling function is also thus, facilitated through
effective directing.
Facilitate growth:- An organisation where the managers direct the
individuals actions in a co ordinate & a balanced manner, is a stable &
better condition to grow & adapt itself to environment changes than the
one where direction is not effective.
Principles of direction
1) Unity of command:- One boss for one subordinate that is all directionsorders & instructions should come from only one boss, is the basic
principles that must be followed to mark direction effective. If one
subordinate receives instructions from more than one superior, there are
chances that he would not be able carry out the instructions of either of
the two.
2) Unity of direction:- One plan or related set of activities must have onlyone head. All activities related to personnel should be headed by the
personnel manager. This helps in avoiding duplication of action &
instructions, thereby economising on the use of scare resources.
3) Appropriate selection of employees:- The managers while selectingemployees must ensure that the employees are capable of adjusting
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themselves to the organisation structure & are both willing & able to
carry out the directions issued by their superior.
4) Participation: Since directing relates to influencing the behaviour ofothers, the managers should preferably follow the principle of
participation of those who have to actually carry out the directions.
5) Communication:- To make direction effective, the managers mustensure that there is a two way flow of communication between managers
& subordinates.
6) Counselling & guidance:- When the subordinate face problems incarrying out their task, the managers must provide them with necessary
counselling & guidance. This will make direction more effective as the
subordinates are free to approach their superiors for counselling.
7) Synthesis conflicting objective:- Each group of people, whether owners,managers, or labour has its own personal interest as supreme while
carrying out the organisational activities. This can lead to conflicting
interests which may hamper the overall organisational growth. Effective
directions, motivation, guidance & counselling people about the need to
consider their goals as subordinate to the overall goals shall enable the
different group of people move towards the common directions. The
conflicting objective are thus synthesized into one single plan, one
objective, one direction & one goal & that is ,to achieve the overall
organisational goals.
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8) Direct supervision:- Work by their superiors shall help them in knowingdeviations in their work performance & the ways to remove them. This
will increase their interest in the work & also their confidence & loyalty
in their supervisors.
Characteristics of Directing
1. Pervasive Function - Directing is required at all levels oforganization. Every manager provides guidance and inspiration to
his subordinates.
2. Continuous Activity - Direction is a continuous activity as itcontinuous throughout the life of organization.
3. Human Factor - Directing function is related to subordinates andtherefore it is related to human factor. Since human factor is
complex and behaviour is unpredictable, direction function
becomes important.
4. Creative Activity - Direction function helps in converting plansinto performance. Without this function, people become inactive
and physical resources are meaningless.
5. Executive Function - Direction function is carried out by allmanagers and executives at all levels throughout the working of an
enterprise; a subordinate receives instructions from his superior
only.
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6. Delegate Function - Direction is supposed to be a function dealingwith human beings. Human behaviour is unpredictable by nature
and conditioning the peoples behaviour towards the goals of the
enterprise is what the executive does in this function. Therefore, it
is termed as having delicacy in it to tackle human behavior.
Elements of Direction
1. Communication2. Supervision3. Motivation4. Leadership
These are the four essential elements of directing. We shall discuss
about the nature and significance of each of these components.
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Communication
- Complex and multifaceted phenomenon. It is the process by which
verbal and non-verbal symbols are sent, received and given meaning.
Communication word has been derived from Latin word Communis
which means common, thus communication stands for sharing of an idea in
common.
Communication is an exchange of facts, ideas, opinions or emotions by
two or more persons Newman and Summer
It is a sum of all the things one person does when he wants to create
understanding in the minds of another. It is a bridge of meaning, it involve
systematic telling, listening, and understanding Haimann
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Most Common Way to Communicate
Speaking
Writing
Body Language
Visual Images
Elements of Communication
People- minimum is 2; one will act as the sender and the other the receiver.
Messagethe content or the substance of what is being communicated, could
be an idea, feeling, instruction, fact or opinion.
Channel the medium and the manner by which the message is conveyed ;
could be verbal or non-verbal.
Feedback the reaction of the receiver to the message as conveyed through a
particular channel; measures the effectiveness of the communication.
Noiseanything that distorts the message conveyed.
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Communication Process (NOTE: EXPLAIN)
The process by which a message, encoded by a sender, is transmitted through a
medium to a receiver, who encodes the message and provides feedback.
FOUR BASIC DIRECTIONS
Downward Communication
Communication which flows from the superiors to the subordinates is known
as downward communication. In an organizational structure, the superiors
utilize their abilities to attain the desired targets which mean that they may be
engaged in issuing commands, directions and policy directives to the persons
working under them. Under downward communication, the superiors anticipate
instant recital of a job thats why it is highly directive. Katz and Kahn have
identified five general purposes of superior-subordinate communication.
a. To give specific task directives about job instructionb. To give information about organization procedures and practicesc. To provide information about the rationale of the jobd. To tell subordinates about their performancee. To provide ideological-type information to facilitate the indoctrination of
goals
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Upward Communication
Travels from subordinate to superior. The most common purpose of this
communication is to provide feedback on how well things are going. It provides
also the middle level managers the opportunity to represent their subordinates to
the upper level managers.
a. Open-Door Policy -(a communication policy in which a manager,
CEO, president or supervisor leaves their office door "open" in order to
encourage openness and transparency with the employees of that company.)
b. Complaint program
Lateral Communication
Lateral communication refers to messages conversed between people on
the same hierarchical level. For example, in terms of the workplace, if two
supervisors have a discussion or two board members raise an issue this is
known as lateral communication. The most common reason for this
communication flow is to provide coordination and teamwork.
Diagonal Communication
Occurs between people who are neither in the same department nor in the
same level of management hierarchy. In this case, someone communicate either
downward or upward with someone in another functional area. In utilizing this
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flow of communication, protocol must be observed so as not to bypass the
authority of the person concerned
EFFECTIVE METHODS OF COMMUNICATION
Methods Factors to consider
Electronics these are highly effective means of quickly reaching those withwhom you are communicating
Interaction and participation are possible and often simple for allinvolved parties
Their ease of use means that they pose a possible risk ofcommunications overload
The seemingly endless possible combinations of words, images andcolor are very powerful
Meetings If used properly; meetings can build relationships and mutual trust Meetings enable instant feedback Meetings facilitate mutual understanding Reponses can often be gauged through eye contact Preparation, planning and openness are required
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Journalism In-house publications enable a wide range of msgs and editorialtechniques
It is possible to facilitate some interaction through reader lettersand contributions.
The content of most organizations journals tends to be bland,resulting in low leadership
Internal marketing This is a powerful method of selling change to the organizationsown staff
Detailed written documents and colorful posters help to explain andsimplify complex msgs
These techniques are able to elicit very strong, immediatemotivational responses
Noticeboards Can be either official information givers, or for general use byemployees
Provide a central location in which to make information accessibleto all employees.
There is no real possibility of interactive response, and employeesmay feel uninvolved.
Telephone The telephone is not suitable for lengthy or complicated discussions The lack of physical presence may lessen the speakers
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understanding of each other
BARRIERS TO EFFECTIVE COMMUNICATION
Too much information people suffers from what we call sensoryoverload
The message is poorly organizedcommunicating also involves planning Inaudible voicewhen talking in front of a crowd be sure that you have
loud and clear voice so that everybody will be able to hear what you are
saying
Mannerismsdistract attention Lack of understanding Inconsistent verbal and non-verbal communication Noise any factors that disturbs, confuses or interferes with
communication
Differing perceptions people who have different backgrounds ofknowledge and experience often perceive the same phenomenon from
different perspective
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Too many links in the communication process Symbol with different meaning a symbol that may mean something to
the sender might mean another to the receiver.
Badly expresses message The message is not clearly expressed by thesender thats why the real message is not received by the receiver.
Faulty Translation Mistranslation from other language may affect thereal meaning of a message
Language differences the words used must mean the same thing tosender and receiver
OVERCOMING BARRIERS TO COMMUNICATION
Use feedback to facilitate understanding and increase the potential forappropriate action
Repeat message in order to provide assurance that they are properlyreceived
Use multiple channels so that the accuracy of the information may beenhanced
Use simplified language that are easily understandable and whicheliminates the possibility of people getting mixed-up with meanings.
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TO ATTAIN EFFECTIVE MANAGERIAL COMMUNICATION
1. Humanizeunderstand, appreciate and elevate the importance of humansabove other concerns
2. Harmonize establish a climate of cooperation, trust, helpfulness,confidence, belongingness and openness
3. Habitualizeput into a habit such positive practices4. Institutionalize put into practice good communication habits at the
individual level until these practices are introduced to the company or
organization as standard operating procedure
5. Acclimatizeadjust, be flexible and extra tolerant6. Modernizelearn the modern ways of communicating7. Symbolizeif words will not do, use symbols8. Empathize to understand intimately the other peoples feelings
,thoughts, motives and aspirations
9. Dualizemake your communication dual10.MinimizeKeep It short!!!!
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INFORMAL COMMUNICATION IN THE ORGANIZATION
Grapevine is an informal channel of business communication. It is called so
because it stretches throughout the organization in all directions irrespective of
the authority levels.
a. Grapevine networks1. Gossip chainhappens when one person passes informal communication to
all others in the informal organization
2. Single strand each person receives information from one individual and
passes it to another
3. Probability chainpeople randomly pass information to the other members
of the organization
4. Cluster chain people pass information to other members of the informal
organization selectively
b. Grapevine activity. People tend to engage in grapevine when:
1. People lack information
2. There is insecurity in a situation
3. People have personal interest in the situation
4. They have new information
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LEADERSHIP
- Art of getting someone else to do something that you want done because
he wants to do it (Dwight D. Eisenhower)
- Process of directing the behavior of others toward the accomplishments
of objectives.
- is one of the important parts of direction.
Leadership is the ability to secure desirable action from a group of
followers voluntarily, without the use of coercion- Alford and Beatly
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Leadership refers to the quality of the behaviour of the individual
whereby they guide people on their activities in organized efforts - Chester
Barnard
LEADING IN TIMES OF CRISIS
1. Stay calm2. Be visible3. Put people before business4. Tell the truth5. Know when to get back to business
LEADERSHIP STYLES
1. Autocratic LeadershipUnder the autocratic leadership style, all decision-making powers
are centralized in the leader, as with dictators.
Leaders do not entertain any suggestions or initiatives from subordinates.
The autocratic management has been successful as it provides strong motivation
to the manager. It permits quick decision-making, as only one person decides
for the whole group and keeps each decision to him/herself until he/she feels it
needs to be shared with the rest of the group.
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2. Participative LeadershipConsists of the leader sharing the decision-making abilities with group
members by promoting the interests of the group members and by
practicing social equality.
Consultative LeadersThis style focuses on using the skills, experiences, and ideas of
others. However, the leader or manager using this style still retains
the final decision-making power. To his or her credit, they will not
make major decisions without first getting the input from those that
will be affected.
Consensus LeadersFor leadership to occur one party must follow another party. An
exception being which requires the leader influence the followers
to aid in a common task, which would seem to eliminate the
possibility of leading people to do nothing. Which is kind of
amusing when one considers to "do nothing" is usually the decision
reached by process of consensus in the first place.
Democratic Leadersdemocratic leader A leader who maintains an egalitarian
atmosphere within the group and who is prepared to delegate
planning, decision making, and other responsibilities to followers.
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3. Free- rein LeadershipA person may be in a leadership position without providing
leadership, leaving the group to fend for itself. Subordinates are given a
free hand in deciding their own policies and methods.
4. Narcissistic leadershipThe narcissism may be healthy or destructive although there is a
continuum between the two. To critics, "narcissistic leadership
(preferably destructive) is driven by unyielding arrogance, self-
absorption, and a personal egotistic need for power and admiration.
5. Toxic leadershipA toxic leader is someone who has responsibility over a group of
people or an organization, and who abuses the leader-follower
relationship by leaving the group or organization in a worse-off condition
than when he/she first found them.
Importance of Leadership
Initiates action- Leader is a person who starts the work by
communicating the policies and plans to the subordinates from where the
work actually starts.
Motivation- He motivates the employees with economic and non-
economic rewards and thereby gets the work from the subordinates.
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Providing guidance- A leader has to not only supervise but also play a
guiding role for the subordinates. Guidance here means instructing the
subordinates the way they have to perform their work effectively and
efficiently.
Creating confidence- Confidence is an important factor which can be
achieved through expressing the work efforts to the subordinates,
explaining them clearly their role and giving them guidelines to achieve
the goals effectively. It is also important to hear the employees with
regards to their complaints and problems.
Building morale- Morale denotes willing co-operation of the employees
towards their work and getting them into confidence and winning their
trust. A leader can be a morale booster by achieving full co-operation so
that they perform with best of their abilities as they work to achieve
goals.
Builds work environment- Management is getting things done from
people. An efficient work environment helps in sound and stable growth.
Therefore, human relations should be kept into mind by a leader. He
should have personal contacts with employees and should listen to their
problems and solve them. He should treat employees on humanitarian
terms.
Co-ordination- Co-ordination can be achieved through reconciling
personal interests with organizational goals. This synchronization can be
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achieved through proper and effective co-ordination which should be
primary motive of a leader.
THEORIES OF LEADERSHIP
a. Fielders Contingency Theory- it hypothesizes that, in any given leadership situation success is
determined primarily by;
1) The degree to which the task being performed by the followers is
structured
2) The degree of position power possess by the leader
3) The type of relationship that exists between the leader and the
followers.
b. Theory X and Y Assumptionsc. Theory Z
MANAGEMENT STYLES
1. Management by crisis2. Management by exception3. Management by objectives4. Management by coaching and development
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5. Management by competitive edge6. Management by consensus7. Management by styles8. Management by walking around9. Words simplifications
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SUPERVISION AND MANAGEMENT
Supervision is defined as An art or a process by which designated individual
or group of individuals oversee the work of others and establish controls to
improve the work as well as the worker. Supervision is generally termed as an
educational process in which a person with better training or more experience
takes the responsibility of training a person with less training or less experience,
and in this educational process the leadership of the supervisor and the growth
of the supervised combine to achieve and maintain progressively the highest
level of performance of which the worker is capable. Supervision is observation
and providing feedback to ensure the quality of the program and to enable the
staff to perform to their maximum potential. Traditional approaches to
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supervision emphasized on inspecting facilities and controlling individual
performance.
OBJECTIVES OF SUPERVISION
1. To help subordinate to do their job skilfully and efficiently.
2. To develop subordinates capacity to the fullest extent.
3. To promote team work
4. To promote moral and motivation among workers.
5. To bridge the gap between personal goal and organizational goal.
PURPOSE OF SUPERVISION:
To improve the quality of work / performance.
Helping the person doing the work and develop the highest possible standard
PRINCIPLES OF SUPERVISION
1. Supervision should aim at growth in knowledge and improvement of skill of
the person.
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2. Supervision should improve the ability in thinking and adjusting to the new
situation.
3. It should help to formulate objects.
4. Good supervision stimulates their interest and effectors.
5. No undue pressure for achievement
6. Autonomy to subordinate preferred
7. Supervision should have competence
8. Supervision should have receive training
9. Decision making is encouraged
10. Free communication to required
11. No over burdening to staff
12. Good leadership by supervisor
13. Suitable climate for work
14. Give guidance
15. Supervision should encourage innovation allowing free flow of ideas and
share positive experiences of personnel
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PRINCIPLES APPLIED TO NURSING:
Supervision should be focused on the attainment of one goal, the giving of
a high quality of nursing care.
Strives to make the ward a good learning situation.
Supervision is well planned.
It should posters the ability to think and act herself.
Helps her to attain objectives stimulates interest and effort.
Encourages and challenges her to greater endeavour through adequate
approval commendation and by recognition of work well done.
To make pattern for analysis and to analyze continuously her success in
reaching the objectives.
COMMON SUPERVISORY METHODS
1.Individual
conference
2.Group
conference
3.Training
sessions
4.Review of
records
5.Evaluation
sessions
6.Direct
observation
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WHO IS SUPERVISOR?
A supervisor is a person who is primarily incharge of a section & is
responsible for both quality & quantity of production, for the efficient
performance of the equipment, & for the employees in his charge & their
efficiency, training & morale
A supervisor drives authority from the departmental head for getting work
done from the workers by using the resources of the enterprises.
He issues instructions to the workers, directs their activities & reports to the
department head on the performance of his section.
QUALITIES OF A GOOD SUPERVISOR:
Trained person
Understand the training background and ability of the supervised.
Good knowledge, the local practice
Good in health, skills in T.G & PR/t have pleasing manner.
Good listener.
Supervisor should have leads examplenory life
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Creative enthusiasm
Just impartial human, tolerant and tactful
Helpful
Good power of judgment.
Functions of Supervision:
A. Administrative:
Assignment of the work loads of individual and groups according to the level
of physical and mental competence (or) preparing the duty roaster.
Identify the needs for supplies and equipment and providing materials and
supplies to facilitate the staff performance.
Identify the problem and helps to solve.
A. Administrative B.Education
C. Communication D. Evaluative
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B. Educative:
Orientation
Teaching subordinates
Plan and conduct in service education program
Ensuring staff developments
C. Communicative
The supervision act as a communicator between the staff and authorities and
other health team members.
She facilitates communication
She should encourage free communication among persons between worker
and community representatives and members of health team.
D. Evaluative:
include identify the cause of difficulty.
.
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OTHER FUNCTIONS ARE:
Co-ordinates there of subordinates and agents and promote team worker.
Promote social contact with in the team to bring staff together and increases
group cohesiveness.
Develops mutual confidence
Raises level of motivation
Develops good IPR
Maintains R & R
Establish control over the subordinates
AS A MANAGER SUPERVISOR HAS TO PERFORM THE
FOLLOWING FUNCTIONS
performance of the worker
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STEPS IN SUPERVISION: When supervision is needed the supr has to make
plan for supervision by using certain steps to follow.
1. Defining of the job to be done
2. Selection and organization of supervisor activities based on available
resources.
3. Anticipation of difficulties
4. Establishment of criterion for evaluation determining what extent the
programme has met problem / objectives acc to plan.
Types of supervision:
(1) Direct supervisionFace to face talk with worker
Points to be considered:
- Do not loose temper
- Use democratic approach and avoid autographic
- Give workers chance to reply
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- Do not talk too much and too fast
- Be human in behavior
- Do not give instructionshaphazard way
(2) Indirect supervision: With the help of record and reports of the worker and
through written instructions. This includes:
- Ensuringcarrying out allotted work
- Analysis of monthly progressinput efforts and achievement
- Analyzing amount of work allotted
- Support and guidance.
Methods of supervision:
(1) Technical vs. creative supervision
(2) Co-operative vs. authoritarian
(3) Scientific vs. institutive
(4) Task oriented vs. employee oriented
I. TechnicalThese are basic supervisory skills and which need to be trained
group discussion and conference
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For example: techniques of service study, record construction, time study etc.
Creativeprovides maximum adaptation to the situ Ex. Instead of orientation
period of two week for each new staff member, a variable plan in both contents
and time according to the needs of each individual should formulated.
II. Cooperativefull participation of each member of the group in planning,
action and decision.
Authorization: supervision responsibility centers entirely on the supervisor,
with the staff following his / her orders.
Both are needed all to situation.
III. Scientific supervisionRelies on objective study and measurement than
personal judgment / opinion.
Intitutive supervision :It needs to maintain IPR
IV. Task oriented supervision emphasize the task more than performer.
Employee oriented: Supervisors are more concerned about worker staff their
needs and welfare than assigned tasks.
TOOLS FOR SUPERVISION
Checklist Rating scales Nurses reports
Nursing rounds
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Job descriptions Personnel policies Staff educations Problem solving approach
TECHNIQUES OF SUPERVISION
A technique is a way of doing something. Techniques vary with thepersonality and ability of the individuals who are being supervised, the
activities that are being performed under supervision and the immediate
circumstances.
Any technique used for supervision must be based on sound democraticpsychological principles which takes account the nurses individuality.
THE PROCESS OF SUPERVISION:
Stage 1: Preparation for supervision
1. A supervisor should focus on specific issue.
- Efficacy of service provided to the
- Relevant problems
- Efficacy problem utilization management of limited resources.
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2. Study of document
3. Identification of priorities
4. Preparation of a supervision schedule
Stage 2: supervision
Use tools: - Job description
- Task description
- Weekly time table
- Check list / rating for each work
As a supervisor the following duties has to be performed.
Establish contact
Review the objectives, targets and norms
Review job descriptions
Note actual / potential conflict
Observe the actual performance.
Observe the individual nursing staff carries out his/her tasks.
Identify the gaps & needs for follow up action based on feed back data
attained through the observation.
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Stage 3: Follow up of supervision
Unless actions to follow-up the gaps and needs identified during stage are taken,
supervision remains incomplete. Each supervisor must prepare a report on the
observations made during supervision. The follow-up action may include:
Organizing in-service training programmes/continuing education programmes
for the nursing personnel.
Reorganization of time table / work plan/ duty roaster.
Initiating changes in logistic support or supply system.
Initiating actions for organizing staff welfare activities.
Counseling and guidance regarding career development and professional
growth
THE EFFECTIVENESS OF SUPERVISION DEPENDS ON:
1. Human relations skill
2. Technical and Managerial knowledge
3. Leadership position
4. Improved upward relations
5. Relief from non-supervisory duties
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6. General and lose supervision
1. Human relations skill:
Supervision is mainly concerned with instructing, guiding and inspiring human
beings towards greater performance. For purpose of direction, the supervisor
has to rely on leadership, counseling, communication and other determinants of
human relations
2. Technical and Managerial knowledge:
Guidance implies a complete understanding of all work problems, for which
supervisor should have good knowledge about technical aspect of job and also
the managerial aspect
3. Leadership position
The authority of supervisor must be made commensurate with their duty so as to
make the job of supervision a satisfying, rewarding and challenging one
4. Improved upward relations
To ensure god quality of supervisors, the supervisors should be regularly
allowed to present their views and suggestions to top executive in regard to the
personnel and their works performance.
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5. Relief from non-supervisory duties
To make the supervisory duties purposeful, the supervisors are to be relieved of
many routine activities that divert their attention from the real job.
6. General and lose supervision
According to some experience, the general and loose supervision is more
productive than close supervision. Here the leader must allow freedom and
initiative to his followers for pursuing a common course of action.
PROBLEMS OF SUPERVISION
PROBLEMS IN NURSING SERVICE:
There are no perfect nursing service programs/situations without any problems
1. Shortage of nursing personnel.
2. Individual differences among personnel in interests, capacities and abilities.
3. Lack of information, insight and understanding of changes and developments
in the interest of the continuance and improvement of nursing.
4. Lack of clearly defined assignments, multiple responsibility and lack of
planning on the part of those to whom personnel is responsible
5. Outdated policies, procedures and guides to workmanship which cause them
to be disregarded and unused.
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6. Inadequate, unsafe, and defective equipment.
7. Ill health in the part of personnel
8. Undesirable personnel characteristics with special attention to attitudes.
COMMON PROBLEMS IN COMMUNITY HEALTH NURSING
SUPERVISION:
1. Problems inherent to budgeting, planning and timing.
2. Personnel problems including problems of poor performance.
3. Grievances
4. Lack of financial resources.
5. Lack administrative support
6. Staff members who are inflexible and resist any type of change
7. Assignment to projects other than those committed to perform
8. Lack of political support
9. . Staff members who do not accept or support the program goals.
10. Conflict within the nursing unit itself.
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11. Inability to proceed (for many reasons) because the timing is wrong
12. Inability to hire qualified personnel.
13. .Changes in program priorities.
14. Other issues can include anything from car rental, uniform allowance,
security of the staff within the community, need for supplies and equipment,
duplication of services provided by another organization.
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MOTIVATION
INTRODUCTION Motivation is an action that stimulates an individual to take
a course of action, which will result in an attainment of goals, or satisfaction of
certain material or psychological needs of the individual.
Motivation is a powerful tool in the hands of leaders. It can persuade convince
and propel people to act.
DEFINITION:-
Motivation is defined as Motivation is an inner impulse or an internal
force that initiates and directs the individual to act in a certain manner to satisfy
a need.
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Motivating force is a need that comes from within an individual, e.g. to make a
living, gain status and respect or to remove a source of frustration (Review of
Maslows Hierarchy of Needs). Motivation refers to the way in which urges,
drives, desires, aspirations, striving or needs direct, control or explain the
behavior of human beings. -Dalton E. McFurland
NEED FOR MOTIVATION:-
The nurse manager must realize that nurses have different personalities, work
habits, and what motivates one nurse may not motivate others. Meanwhile,
some nurses are skilled, confident, and capable of self-direction and seem to
motivate themselves, while other nurses lack self-confidence; they do their jobs
poorly and have little motivation.
The nurse manager is responsible to motivate the second group and to improve
their performance. Researchers have revealed that job performance is the result
of the interaction of two variables; the ability to perform the task and the
amount of motivation.
Job Performance = Ability + Motivation. Job dissatisfaction:
Job dissatisfaction contributes to higher turnover rates and decreased
productivity and considerable time and money are required to recruit and select
a replacement for someone who leaves the organization, it also takes time to
socialize new employee to the organizational culture, which is expensive time,
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beside that, other employees will need to carry more load to cover the needs,
and at last the kind of interruptions that results from the loss of this employee.
For all those reasons the manager should be concerned about job satisfaction of
employee, and to do that there is a need to look at the different theories.
TYPES OF MOTIVATORS
1) Intrinsic motivation: Refers to motivation that comes from within the
person, driving him or her to be productive. It is related to a persons level of
inspiration. The motivation comes from the pleasure one gets from the task
itself or from the sense of satisfaction in completing or even working on the task
rather than from external rewards.
2) Extrinsic motivation: It refers to motivation that comes from outside an
individual, i.e. enhanced by the work environment or external rewards such as
money or grades. The rewards provide a satisfaction and pleasure that the task
itself may not provide. An extrinsically motivated person will work on a task
even when they have little interest in it because of the anticipated satisfaction
they will get from the reward. e.g.- reward for a student would obtain good
grade on an assignment or in the class.
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TYPES OF MOTIVATION
1) Achievement motivation
It is the drive to peruse and attain goals. An individual with achievement
motivation wishes to achieve objectives and advance up the ladder of success.
Hence, accomplishment is important for his/her own sake and not for the
rewards that accompany it.
2) Affiliation motivation
It is a drive to relate to people on a social basis. Individuals with affiliation
motivation perform work better when they are complimented for their
favourable attitude and co-operation.
3) Competence motivation
It is the drive to be good at something, allowing the individual to perform high
quality work. Competence/skill motivated individuals seek job mastery, take
pride in developing and in using their problem solving skills and strive to be
creative when confronted with obstacles. They learn from their experiences.
4) Power motivation
It is the drive to influence people and change situations. Power motivated
people wish to create an impact on their organisation and are willing to take
risks.
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5) Attitude motivation
Attitude motivation is how people think and feel. It is their self-confidence,
their belief in themselves and their attitude to life. It is how they feel about the
future and how they react to the past.
6) Incentive motivation
It is where the people are motivated through external rewards. Here, a person or
team reaps a reward from an activity. It is the type of rewards that drive people
to work harder.
7) Fear motivation
Fear motivation coercions a person to act against will. It is instantaneous and
gets the job done more quickly. Fear motivation is helpful in the short run.
Methods of motivating employees / Motivational factors:
There are different methods which can be used for motivating employees .There
can also be treated as motivational factors/ forces/stimulators. They include
monetary & non monetary factors.
Monetary factors:
1) Salaries/wages: Money happens to be the most important motivationfactor. While determining salaries, management must give to employees
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security of income along with ability to lead respectable life. Salary
should be revised periodically to meet the cost of living.
2) Bonus: Under the bonus payment Act,1965 a company has to declarebonus whenever it earns profit. Bonus adds to annual income of the
employees & it becomes monetary incentive.
3) Incentives: When employees are paid over & above their salary, anadditional payment in recognition of better work, it is called incentive.
When incentive payment is offered, employees work hard to earn more &
they remain motivated.
4) Allowances: Management providers to employees both statutory & nonstatutory types of allowances such as medical allowance, educational
allowance, house rent allowance, recreation allowance, education
allowance & so on .These allowance act as motivators.
5) Special incentives : There are certain monetary incentives offered only todeserving employees e.g. performance bonus, attendance etc. It has a
positive impact on others because they also work hard to earn these
special incentives.
NonMonetary factors:
1) Job Security & job enrichment: Job security is useful the motivation ofemployees. Such security keeps the employee away from the tension of
becoming unemployed. Job enrichment provides an opportunity for
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greater recognition & advancement, job enrichment refers to redesign of
jobs.
2) Fair treatment to employees: Employer should give attention to theneeds, difficulties & grievance of employees. Small work groups &
effective communication are useful for solving the problems of workers.
Employees must be given decent treatment. They will be co- operative
only when they are treated with sympathy & love, affection & dignity.
Employees should also be given help in personal matters.
3) Recognition of good work: Recognition of good work at an appropriatetime gives encouragement to the employees to show better performance
in future. As an appreciation of good work, prizes rewards, promotions
etc. should be given.
4) Encouragement to self-development & career development :Employees should be given varied training facilities self- development &
also provides opportunities for career development. Every employee has a
desire to grow, develop & rise higher. This desire should be exploited
fully for motivating employees. For this, training as well as management
development programme should be introduced.
5) Delegation of authority: Due to delegation of authority, a subordinateemployee fells that superior has faith in him & also in his ability to use
authority in a proper manner. Employees get mental satisfaction when
authority is given to them. They take interest & indicative in work & try
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to prove that they are competent to work at the higher levels. Thus
delegation of authority becomes a motivating factor.
6) Congenial working condition: It is a non-functional incentive formotivation. Employees should be given various facilities & conveniences
at the work place. The work environment should be pleasant, safe &
reasonably comfortable. This creates desire to work efficiently.
7) Helpful attitude of management: The helpful attitude towards itsemployees creates a sense of affinity for the organisation. Fair treatment
to workers. Cordial industrial relations also motivate employees. Thus
,enlightened & pro-employee attitude of management acts as a motivating
factor.
8) Fair opportunity of promotion: Fair opportunity of promotion to alleligible workers is one more method useful for motivating employees.
They take interest in the work as they feel that they will be rewarded in
the form of promotions. Training facility should be provided to
employees in order to make them eligible for promotion.
9) Labour participation in management: Labour participation is useful forthe motivation of employees. Workers get higher status & better scope for
expressing their views through such participation. Even the formation of
quality circles or joint management council is useful for motivating
employees.
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10) Designation & status: When an employee is provided with abetter designation, it adds to his status. Employees are proud to reveal
their attractive & high-sounding designations.
Characteristics/Features of motivation:-
1) Psychological process: Motivation is a psychological process usefulencouraging employees to take more interest & initiative in the work
assigned. It relates to human relations.
2) Initiative by manager: The initiative for motivation is to be taken by themanager by offering guidance & also by other methods like appreciation
of good work or offering incentives.
3) Continuous activity: It is a continuous & circular process. Subordinatesneed motivation in a continuous manner as their needs & expectations
change from time to time. A manager has to study the needs of the
worker & use the technique of motivation accordingly. The process of
motivation must be made a regular & continuous one.
4) Goal- oriented & action- oriented:- Motivation diverts humanbehaviour towards certain goals. Attainment of organisational &
individual goals depends on the motivational plans.
5) Broad concept:- motivation is a comprehensive concept &cover needs,human relations & satisfaction of employees. For employee motivation
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monetary & other incentives need to be offered. Job satisfaction is one
need of subordinates & is useful for motivation.
6) Essence of management process:- Motivation is an essential function ofa manager. He has to motivate his subordinates for achieving
organisational objectives. Motivated force is an asset of business unit.
Motivation employees bring success, stability & prosperity to a business
unit.
7) Beneficial to employees & management:- Motivation offers benefits toemployees & organisation. It avoids clashes & encourages cooperative
outlook among employees. Motivation leads to cordial labour-
management relations. It provides more profit to management & better
welfare to employees.
8) Varied measures available for motivation: For motivation variousmonetary & non monetary incentives can be offered to employees by the
management. Attractive wages, welfare facilities, job security & fair
treatment are some measures of motivating employees.
Importance of motivation of employees:-
Nature of motivation
Unending process: human wants keep changing & increasing.
A psychological concept: deals with the human mind.
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Whole individual is motivated: as it is based on psychology of the
individual.
Motivation may be financial or non-financial: Financial includes
increasing wages, allowance, bonus, etc.
Motivation can be positive or negative: positive motivation means use of
incentives - financial or non-financial. E.g. of positive motivation:
confirmation, pay rise, praise etc. Negative motivation means
emphasizing penalties. It is based on force of fear. Eg. demotion,
termination.
Motivation is goal-oriented behaviour.
Motivation is an internal feeling of an individual. It cant be observed
directly; we can observe an individuals action and interpret his behaviour
in terms of underlying motives. This leaves a wide margin of error. Our
interpretation may not reveal the individuals true behaviour.
Motivation is a continuous process that produces goal directed behaviour.
The individual tries to find alternatives to satisfy his needs.
Motivation is a complex process. Individual may differ in their
motivation even though they are performing the same type of job. For
example, if two men are engaged in cutting stones for constructing a
temple, one may be motivated by the amount of wages he gets and the
other by the satisfaction he gets by performing the job.
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COMPONENTS OF MOTIVATION
Motivation comprises of three main components:
We start off by deciding what we want, which is our direction as we know
where we want to go and what we have to achieve. Then we make an effort
towards our goal. We start to do things and we continue our making the efforts
for some time and give it everything that we have. Now comes the part where
we have to be persistent with our efforts and keep doing them.
SOURCES OF MOTIVATION
1) Internal or push forces:
-esteem
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2) External or pull forces:
a. Characteristics of the job
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b. Characteristics of the work situation
REQUISITES TO MOTIVATE
We have to be Motivated to MotivateMotivation requires a goalMotivation once established, does not last if not repeatedMotivation requires RecognitionParticipation has motivating effectSeeing ourselves progressing Motivates usChallenge only motivates if you can winEverybody has a motivational fuse i.e. everybody can be motivatedGroup belonging motivates .
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In the initiation, a person starts feeling lacknesses. There is an arousal of need
so urgent, that the bearer has to venture in search to satisfy it. This leads to
creation of tension, which urges the person to forget everything else and cater to
the aroused need first. This tension also creates drives and attitudes regarding
the type of satisfaction that is desired. This leads a person to venture into the
search of information. This ultimately leads to evaluation of alternatives where
the best alternative is chosen. After choosing the alternative, an action is taken.
Because of the performance of the activity satisfaction is achieved which than
relieves the tension in the individual.
CREATING A MOTIVATING CLIMATE
As the organization has an impact on intrinsic and extrinsic motivation, it is
important to examine organizational climates or attitudes that influence workers
morale and motivation. Employees want achievement, recognition and
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feedback, the opportunity to assume responsibility, a chance for advancement,
fairness, good leadership, job security and acceptance and adequate monetary
compensation. All these create a motivating climate and lead to satisfaction in
the work place. e.g. nurses who experience satisfaction stay where they are,
contributing to organizations retention.
STRATEGIES TO CREATE A MOTIVATING CLIMATE
1. Have a clear expectation for workers and communicate effectively.
2. Be fair and consistent when dealing with all employees.
3. Be a firm decision maker.
4. Develop a team work/team spirit.
5. Integrate the staffs needs and wants with the organizations interest and
purpose.
6. Know the uniqueness of each employee.
7. Remove traditional blocks between the employee and the work to be done.
8. Provide opportunities for growth.
9. Encourage participation in decision-making.
10. Give recognition and credit.
11. Be certain that employees understand the reason behind decisions and
actions.
12. Reward desirable behaviour.
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13. Allow employees exercise individual judgement as much as possible.
14. Create a trustful and helping relation with employees.
15. Let employees exercise as much control as possible over their work
environment.
Leadership Roles and Management Function Associated With Creating A
Motivating Work Climate:- Leadership Roles:
1. Recognize each worker as unique individual who is motivated by different
things.
2. Identifies the individuals and collective value system of the unit and
implements a reward system that is consistent with those values.
3. Listen attentively to individual and collective work values and attitudes to
identify unmet collective needs that can cause dissatisfaction
4. Encourage workers to stretch themselves in an effort to promote self
growth and self actualization.
5. Maintains a positive and enthusiastic image as a role model to subordinates in
the clinical setting
6. Encourage mentoring, sponsorship and coaching with subordinates.
7. Develop time and energy to create an environment that is supportive and
encouraging to the discouraging individual.
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8. Develop a unit philosophy that recognizes the unique worth of each employee
and promote reward systems that make each employee feel like a winner.
9. Demonstrates through actions and words a belief in subordinates that they
desire to meet organizational goals.
10. Is self- aware regarding own enthusiasm for work and takes steps to
motivate self as necessary.
MEASURES TAKEN BY THE NURSE MANAGER TO FACILITATE
NURSES MOTIVATION: - The nurse manager while managing the nursing
unit will have to choose a combination of the following measures to facilitate
nurses motivation.
1) Act as a Role model (Set a good example):-
a) Set high standards in the units.
b) Maintain a positive attitude towards the work and staff.
c) Be optimistic; in other words, be aware of how difficult the job is and how it
can be done.
d) Ask for help when in need.
e) Admit mistakes.
2) Develop and maintain Good Personal Relations:-
a) Use two-way communication.
b) Be friendly, not to criticize staff in front of others and be fair.
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c) Keep a sense of humor and avoid getting angry.
d) Try to understand nurses attitudes, likes, dislike their experience, previous
training, problems in their work and needs.
These measures will help in understanding nurses behavior. Understanding is
the first step toward motivating nurses. Trust comes with understanding and it
develops slowly based on the respect and acceptance of the manager.
Motivation is based on understanding and trust.
Some guidelines for developing trust:-
a) Apply rules equally and consistently.
b) Avoid favoring some nurses over others, be fair.
c) Share informationshow respect for ideas and opinions and confidentiality.
d) Be supportive at all times.
3) Post Each Nurse where she can work best:-
The nurse is more likely to succeed and be motivated if her/his interests and
skills are considered in the assignment. Success is the best motivator.
4) Use a participative style:-
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Participation and sharing information will motivate nurses since they feel they
are taking part in decisions. Motivation requires more than physical
involvement in a job. It also demands mental and emotional involvement.
5) Guide, encourage and support continuously:-
Guidance means helping nurses in planning, evaluating their work and in
solving work and personal problems.. Encouragement means helping and
reassuring nurses regardless of the type of problems. Develop a supportive
environment by reducing physical stresses associated with the job. Support
means removing obstructions and providing nurses with satisfying work
environment which include personnel and facilities and suitable learning
materials needed to do their job.
Reward Good work:-
a) Give recognition for successful achievement of the job. Praise frequently and
informally. It can be in front of other staff.
b) Reward includes: Pay increase, promotion, training for advancement to a
higher level within a job.
c) Thank you is a type of reward that helps to increase self-confidence.
6) Build team work (Team spirit)
a) Schedule regular meetings.
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b) Make nurses feel that their job is important to the success of the team.
c) Integrate the needs and wants of the staff nurses with those of the nursing
unit.
d) Think of nurses in the unit as a group and do what is best for them.
7) Provide continuing education:-
Nurses enjoy learning new knowledge and skills or updating the existing
knowledge and skills or taking new responsibilities through continuing
education.
SYMPTOMS OF MOTIVATED NURSES:-
1. Show interest, enthusiasm and have a positive attitude.
2. Believe their work is important and work hard.
3. Work well with their supervisors and others.
4. Take part willingly in planning, implementing and evaluating their work.
5. Show responsible behaviour.
Strive to find the best way to produce optimal job performance.
THEORIES OF MOTIVATION The word motivation theory is concerned
with the processes that describe why and how the human behaviour is activated
and directed. It is considered as one of the most important areas of study in the
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field of organizational behaviour. There are two different categories of
motivation theories- the content theories and the process theories.
A) Content theories of motivation
This is also called as the Need theory. It mainly focuses on the internal factors
that energize and direct human behaviour. Some of the need theories are-
1) Abraham Maslow (1943)
Maslows theory included 5 basic needs in his theory, namely the- The
physiological needs, Safety and security needs, Love needs, self-esteem needs
and self-actualization needs. Maslow suggested that human needs are ordered in
a hierarchy from simplex to complex. Higher level needs do not emerge as
motivators until lower needs are satisfied and a satisfied need no longer
motivates behaviour.
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Physiological needs: Food, water, warmth, shelter, sleep, medicine and
education, etc. Once the physiological needs are met, the next level becomes
predominant.
Safety and security needs: These are the needs to be free of physical
danger and of the fear of losing a job, property, food or shelter. It also includes
protection against any emotional harm.
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Social needs: Since people are social beings, they need to belong and be
accepted by others. People try to satisfy their need for affection, acceptance and
friendship. After the lower needs are well satisfied, affiliation or acceptance will
emerge as dominant and the person strives for meaningful social relationship.
Esteem needs: According to Maslow, once people begin to satisfy their
need to belong, they tend to want to be held in esteem both by themselves and
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by others. This kind of need produces such satisfaction as power, prestige status
and self-confidence.
Need for self-actualization: Maslow regards this as the highest need in his
hierarchy. It is the drive to become what one is capable of becoming; it includes
growth, achieving ones potential and self-fulfilment. It is to maximize ones
potential and to accomplish something.
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2) Alderfer ERG theory
ERG theory is similar to Maslows hierarchy of needs. The existence (E) needs
are equivalent to physiological and safety needs; relatedness (R) needs to
belongingness, social and love needs. The growth (G) needs to self-esteem and
self actualization- personal achievement and self-actualization. The major
conclusions of this theory are:
satisfied than the desire to satisfy a lower need
intensifies.
satisfaction of the lower-level needs. This phenomenon is known as frustration-
regression process
3) Frederick Herzberg Two Factor need theory (1966)
Herzberg felt that job satisfaction and dissatisfaction exists on dual scales.
Workers are motivated by two types of needs/factors-
intrinsic/motivation factors
(satisfiers): challenging aspects of the work, achievement, added responsibility,
opportunities for growth and opportunities for advancement
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extrinsic/hygiene factors
(dissatisfiers): salary, status, working conditions, quality of supervision, job
security and agency policies.
According to Herzberg, the hygiene factors must be maintained in quantity and
quality to prevent dissatisfaction. They become dissatisfiers when not equitably
administered, causing low performance and negative attitudes. The motivation
factors create opportunities for high satisfaction, high motivation and high
performance. Absence of motivation factors causes a lack of job satisfaction.
4) David McClelland(1961)
David McClelland has developed a theory on three types of motivating needs:
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People with high need for power are inclined towards influence and control.
They like to be at the center and are good orators. They are demanding in
nature, forceful in manners and ambitious in life. They can be motivated to
perform if they are given key positions or power positions. In the second
category are the people who are social in nature. They try to affiliate themselves
with individuals and groups. They are driven by love and faith. They like to
build a friendly environment around themselves. Social recognition and
affiliation with others provides them motivation. People in the third category are
driven by the challenge of success and the fear of failure. Their need for
achievement is moderate and they set for themselves moderately difficult tasks.
They are analytical in nature and take calculated risks. Such people are
motivated to perform when they see atleast some chances of success.
McClelland observed that with the advancement in hierarchy the need for power
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and achievement increased rather than Affiliation. He also observed that people
who were at the top, later ceased to be motivated by this drives.
5) McGregors Theory X and Theory Y
Douglas McGregor proposed two different motivational theories- theory X and
theory Y. He states that people inside the organization can be managed in two
ways. The first is basically negative, which falls under the category X and the
other is positive, which falls under the category Y.
Assumptions of theory X:
er possible, will attempt
to avoid it.
threatened with punishment to achieve goals.
issued.
s place a greater importance on security over all other factors
and display little ambition.
Assumptions of theory Y:
-control and self-direction and if they are committed to
those goals.
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imagination, ingenuity and creativity in solving the problems of the
organization.
power
is only partly used.
On analysis of the assumptions it can be detected that theory X assumes that
lower-order needs dominate individuals and theory Y assumes that higher-order
needs dominate individuals. An organization that is run on Theory X lines tends
to be authoritarian in nature- power to enforce obedience and the right to
command. In contrast Theory Y organizations can be described as
participative, where the aims of the organization and of the individuals in it
are integrated; individuals can achieve their own goals best by directing their
efforts towards the success of the organization
B) Process theories of motivation
Process theories of motivation provide an opportunity to understand thought
processes that influence behaviour. The major process theories are- Vrooms
expectancy theory, goal-setting theory and reinforcement theory.
1) Reinforcement theory
B.F. Skinners theory (1969) suggests that an employees work motivation is
controlled by conditions in the external environment, that is, by designing the
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environment properly, individuals can be motivated. Instead of considering
internal factors like impressions, feelings, attitudes and other cognitive
behaviour, individuals are directed by what happens in the environment external
to them. Skinner states that work environment should be made suitable to the
individuals and that punishment actually leads to frustration and de- motivation.
Hence, the only way to motivate is to keep on making positive changes in the
external environment of the organization. Positive behaviour should be
reinforced or rewarded as this increase the strength of a response or induces its
repetition. Reinforcers tend to weaken over time and new ones have to be
developed. Negative reinforcement occurs when desired behaviour occurs to
avoid negative consequences of punishment. Punishment creates negative
attitude and can increase costs.
Expectancy theory of Vroom
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This theory postulates that most behaviours are voluntarily controlled by a
person and are therefore motivated. It focuses on peoples effort-performance
expectancy, or a persons belief that a chance exists for a certain effort to lead to
a particular level of performance. This theory states that motivation depends on
three variables-
Attractiveness: the person sees the outcome as desirable.
Performance-reward linkage: the person perceives that a desired outcome
will result from a certain degree of performance.
Effort-performance: the person believes that a certain amount of effort will
lead to performance.
3) J. Stacy Adams Equity theory
Third process theory and focuses on fair treatment. Persons believe that they are
being treated with equity when the ratio of their efforts to rewards equals those
of others. Equity can be achieved or restored by changing outputs, attitudes, the
reference person, inputs or outputs of the reference person or the situation.
People have a tendency to use subjective judgment to balance the outcomes and
inputs in the relationship for comparisons between different individuals.
Accordingly,
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4) Jeremy Benthams The Carrot and the Stick Approach
English philosopher, Jeremy Bentham ideas developed his ideas in the early
years of the Industrial Revolution, around 1800. Benthams view was that all
people are self-interested and are motivated by the desire to avoid pain and find
pleasure. Any worker will work only if the reward is big enough, or the
punishment sufficiently unpleasant. With this view, the carrot and stick
approach was built into the philosophies of the age. This metaphor relates to
the use of rewards and penalties in order to induce desired behaviour. It came
from the old story that to make a donkey move, one must put a carrot in front of
him or dab him with a stick from behind. Despite all the research on the theories
of motivation, reward and punishment are still considered strong motivators. In
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almost all theories of motivation, the inducements of some kind of carrot are
recognized. Often this is money in the form of pay or bonuses. Even though
money is not the only motivating force, it has been and will continue to be an
important one. The trouble with the money carrot approach is that too often
everyone gets a carrot, regardless of performance through such practices as
salary increase and promotion by seniority, automatic merit increases, and
executive bonuses not based on individual manager performance.
The stick, in the form of fearfear of loss of job, loss of income, reduction of
bonus, demotion, or some other penalty has been and continues to be a strong
motivator. It often gives rise to defensive or retaliatory behaviour, such as union
organization, poor-quality work, executive indifferences, and failure of a
manager to take any risks in decision-making or even dishonesty. However, fear
of penalty cannot be overlooked. Whether managers are first-level supervisors
or chief executives, the power of their position to give or with hold rewards or
impose penalties of various kinds gives them an ability to control, to a very
great extent, the economic and social well-being of their subordinates .
5) Goal-setting theory of Edwin Locke :-
This theory is based on goals as determinants of behaviour. The theory states
that when the goals to be achieved are set at a higher standard than, employees
are motivated to perform better and put in maximum effort. The more specific
the goals, the better the results produced. The goals must be achievable, and
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their difficulty level must be increased only to the ceiling to which the person
will commit. Goal clarity and accurate feedback increases security. It revolves
around the concept of Self-efficacy i.e. individuals belief that he or she is
capable of performing a hard task.
6) Arousal/ Cognitive Evaluation theory:-
Focuses on internal processes that mediate the effects of conditions of work on
performance. This theory states, a shift from external rewards to internal
rewards results into motivation. It believes that even after the stoppage of
external stimulus, internal stimulus survives. It relates to the pay structure in the
organization. Instead of treating external factors like pay, incentives, promotion
etc and internal factors like interests, drives, responsibility etc, separately, they
should be treated as contemporary to each other. The cognition is to be such that
even when external motivators are not there the internal motivation continues.
7) Attitude theory
Focuses on favorable attitudes of job satisfaction and job involvement leading
to high performance.
8) Attrition/self-efficacy theory
Focuses on explanations for events or behaviour. Perceptions of self efficacy
and self esteem affect performance.
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Motivational theories for Better Nursing Management
The needs of an individual are important motivators. These make the person
work with enthusiasm & interest. The significant individual needs are: * Need
for Power: Which results in a strong desire to influence staff, stimulate them to
work, making them achieve positions of leadership e.g. making the nursing
supervisor wholly responsible to take care of whole ward. The need for
achievement results in a desire to do something better or more efficiently than
others. People with a high need of achievement have an intense desire for
success & equally intense fear of failure. They want to be challenged, prefer to
assume personal responsibility to get work done and like to work for long hours.
Training and orientation (refresher) course increase this need. All the staff
working in a particular area should be given equal chance to attend the refresher
courses related to that particular area.
* Need for affiliation: - Some people derive pleasure from being loved and tend
to avoid the pain of being rejected by social group. They enjoy social
relationships, intimacy, empathise and help others in trouble. There is close
intimacy when a staff nurse is allowed to plan and decide patient care along
with ward supervisor. In order to satisfy the employees, a manger can also use
Maslow's Motivation Theory in these ways:
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* Improving physical working conditions to satisfy needs e.g. grilled door and
escorts to secure the nursing staff at night, providing rest rooms for lunch and
dinner.
* Increasing the level of training, development and skill in order to meet the self
esteem needs e.g. uniform, leave facilities, vacation to nursing students. If these
facilities are inadequate it harms their self esteem.
* Having congenial social group and peer group interaction to fulfill affiliation
needs.
* Placing the person in position which match their self concept to fulfill the self
actualization need. Job Design Job design is another motivator to satisfy, signify
and give value to employees encouraging them to perform well. Koul Jyoti
conducted a study on job satisfaction of 126 staff nurses of different hospitals in
J&K State and showed that only 8% were highly satisfied. Maximum
satisfaction was found for the work itself and with the competency of
supervision. The areas of best satisfaction were concerned with material
rewards and individual agency. The older age group and experienced persons
were found more satisfied. Work Environment There are many conditions in the
environment which could possibly effect the motivation of staff. It is seen by
Behaviour Modification Theorist that employees perform positively if
environment is favourable which is made by pay/ reward policies, democratic
leadership style, peer group interaction etc. To effect the performance of
employees, their input (e.g. efforts, training, experience, skill, education,
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seniority) should be equitable to their output e.g. pay, rights, benefits, job-
status, status symbol's (vacation, clothing, satisfactory superior). The employees
feel inequity if unrewarded or if given undesirable placement. The employees
always respond to the environment & these responses influence their behaviour.
A nursing Manager can accomplish this by using following motivational
techniques.
* Positive Reinforcement: Annual reward for better performance in the form of
money, recognition, praise, promotion etc. Give reward to the most clean and
best patient care ward on Annual days.
* Avoidance Learning: Some staff nurses improve their behaviour in order to
av