Supervision and Management [PDF]

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Contents INTRODUCTION SupervisionDefinition Objectives Nature and scope of supervision Purposes Principles Salient Features of supervision Common supervisory methods Principles applied to nursing Supervisor Qualities of a good supervisor Functions of a supervisor Steps in supervision Types of supervision Methods of supervision Tools of supervision Techniques & process of supervision Factors of effective supervision Problems of Supervision Responsibilities of the nursing supervisor JOURNAL ARTICLE CONCLUSION BIBLIOGRAPHY



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SUPERVISION AND MANAGEMENT INTRODUCTION 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. DEFINITION: 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 refers to the direct and immediate guidance and control of subordinates in the performance of their work. Supervision is guiding and directing efforts of employees and other resources to accomplish stated work outputs. – George.R.Terry and Stephen G Franklin 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 supervision emphasized on inspecting facilities and controlling individual performance. OBJECTIVES OF SUPERVISION The main aim of supervision is to inspect, evaluate and improve workers' performance. The objectives of the supervision are as follows: 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 1. Supervision should aim at growth in knowledge and improvement of skill of the person. 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 is 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.



Nature and Scope Supervision The nature and scope of supervision varies with the kind of the work to be supervised ,the type of the people to be supervised, the extent of the supervisor's responsibility and the level of supervision. Thus supervision of production in factories is different from the supervision of nurses' work in the hospital, or supervision of the office work. Supervision is the art of overseeing, watching and directing with authority, the work and behaviour of others. It is essentially an educative process in which the leader/manager takes responsibility for helping his/her subordinates to develop themselves and become more competent in their jobs. The supervision was earlier conceived as inspecting and finding fault with others. It is different from inspection, which is more or less concerned with finding of faults. An inspector finds good or bad points which may result into praise or punishment of the worker without any liability on the part of the inspector who is not at all affected. In supervision the concept is quite different, where the supervisor cannot escape the responsibility of poor performance by the supervise. In other words, supervision is much more than inspection. It is a continuous process in which atmosphere of cordiality, mutual trust, respect and linking is essential for the creation of positive relationship between the supervise and supervisor. The modern concept of supervision is to guide and help the subordinates in their work by way of training, checking, individual counselling and guidance. Supervising also includes inspecting another's work, evaluating her or his performance, and approving or correcting performance. Supervision creates anxiety for overseer and overseen. So the purpose of supervision is to inspect, evaluate and improve workers' performance. Therefore, criteria needed for judging the quality of work processes and outcomes



Supervision is the name given to the activities that contribute to the achievement of the goals of the plan prepared by the administrator. As stated earlier, it is a function of the organisation, which operates in an organisational structure. Sometimes it is difficult to draw a distinction between administration and supervision. The best way to distinguish between them is that according to their purposes. ff the purpose is to improve instruction then the activity may be termed as supervision. Whereas, the purpose of activity is primarily concerned with areas other than improving instruction, then the activity could be termed as administration. (J E marks, Emery Stoops, Joyce King-Stoops 1978). The supervision was earlier conceived as inspecting and fault finding with subordinates. The modern concept of supervision is to guide, and help the subordinates in their work by way of training, demonstration, checking, individual counselling and guidance. Supervision is an ongoing process invariably interwoven with motivation, performance appraisal as, staff development and leadership. Supervision includes inspecting the anothers work, evaluating her or his performance, and approving or correcting performance, supervision creates anxiety for seen and overseen. The effectiveness of workers depends largely on the supervision they reserve. In otherwords, quality of work is directly related to the degree of supervision. High degree of supervision improves the quality of work, poor supervision leads to poor work. Good supervision is facilitative, because knowledgeable overseen inspects work in progress and can remedy inadequate performance before serious consequences develop. PRINCIPLES OF SUPERVISION 1. Supervision should not overburden any individual or group. 2. Supervision should not exert undue pressure, causing unreasonable pressure for achievement, results in low performance and low confidence in the supervisor. 3. Supervision should be general and not close. 4. Supervision should be professionally and technically competent for his/her success in career. 5. Supervision calls for good planning and organisation, which ensures good planning, organising and co-ordination. 6. Supervision is a process of co-operation and co-ordination. 7. Supervision needs to understand the problems and situations. 8. Supervision should create suitable climate for productive work. 9. Supervisors should communicate with workers freely for their effective supervision, i.e. good communication is essential for supervisor. 5



10.



Supervisors should have the capacity to influence downwards depends on capacity to influence upwards.



11.



Supervision should give autonomy to workers depending upon personalities, expertise, capabilities, knowledge, competence, experience and characteristics.



12. Supervision should encourage innovation allowing free flow of ideas and share positive experiences of personnel. 13. Supervision should ensure staff development, i.e. it should focus on continued and sustained staff growth and development. 14. Supervisors are always accountable for the performance of their subordinates under his/her sign of control. 15.



Supervision should be a teaching-learning process, in which it should help workers improve, develop and reinforce knowledge and skills according to their individual learning need.



16. Supervisors are required to help the workers develop the right attitude, i.e. by adapting positive and supportive attitude rather an attitude of inspection. 17. Supervision should provide necessary counselling, guidance and training to staff. 18. Supervisors are responsible for checking and guidance. 19. Supervision should encourage deserved staff and decision making. 20. Supervision should provide good leadership. The good leadership is a part of good supervision.



SAILENT FEATURES OF SUPERVISION i.



Supervision is done at all levels of management Each level of management is in direct contact with their subordinates and oversees their work performance.Top management supervises the work of middle management which inturn supervises the work of lower management.



ii.



Supervision is most pronounced at the lowest level of management Although managers at all levels are generally engaged in overseeing the work of their subordinates,the lowest-level managers have their primary duty the supervision of workers in basic operation.



iii.



Supervision aims at guiding subordinates in their work performance To guide subordinates in their work performance, the act of supervision involves: 6



a. preparing work schedules,assigning work and work facilities to employees b. issuing orders and instructions for observing work procedures and maintaining smooth workflow. c. inspiring subordinates for better and higher performance through creating a team spirit. d. controlling work output by comparing actual performance with work targets and removing the gap between the two,if any. COMMON SUPERVISORY METHODS 1.Individual conference 2.Group conference 3.Training sessions 4.Review of records 5.Evaluation sessions 6.Direct observation 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.



WHO IS SUPERVISOR?



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• 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: The qualities of a supervisor derived from the personality characteristics and professional competence, will include: • Trained person • Understand the training background and ability of the supervised. • Good knowledge, the local practice • Good in health, skills in T.G & have pleasing manner • Good listener. • Supervisor should have leads examplenory life • Creative enthusiasm • Just impartial human, tolerant and tactful • Helpful  Forcefulness, integrity and firmness. • Full awareness of the job and the rules and regulation. • Full awareness of existing situations. • Intelligence and willingness to grow. • Good power of judgement, impartial understanding of others', emotions, attitudes and feelings and quickness in recognizing achievements of subordinates. • Ability to delegate duties and responsibilities; the right job to right person. • Continuous guidance, cooperation and coordination. • Sympathetic attitude and good listening. • Willingness to adopt new policies and accept changes if necessary. • Maintain good health, possess self-confidence, self control, enthusiasm for work and human interests, human relations. • Ability to communicate information skilfully and tactfully, maintain two-way communications • Ability to work with others and establish a climate of rapport. • Ability to inspire and take immediate action. • Update professional knowledge of the activities, techniques and procedures. • Objectivity, impartiality, approachability,fair discipline, loyalty and fairness in dealing. • Trustworthy and trust others and respect members. • Command respect from members and support member's ideas. • Has originality and initiativeness. • Humble and willing to accept his mistakes. 8



• • • •



Has good command of the language the members speak. Has vast experience in dealing with problems. Concern for other individuals and group. Impartial, humane, tactful, tolerant.



SUPERVISION CONSIST OF Leadership Motivation Communication Evaluation FUNCTIONS OF SUPERVISOR: A. Administrative B. Educative C. Communicative D. Evaluative 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. 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:   Supervisor is supposed to carryout performance appraisal of all the staff this include identify the cause of difficulty.   Providing C E and guidance. 9



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         



Planning the work Issuing orders: The high point of supervision Providing guidance & leadership Motivation Preserving records Controlling output – performance of the worker Liaison between management & workers Grievance handling Industrial safety



STEPS IN SUPERVISION: When supervision is needed the suprvisor 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 according to plan. 1. Definition of the job refers to that supervisor should know his position clearly whether he/she is in line or staff position. The line position is administrative character and the staff position is advisory and consultative. Usually the definition of job requires an understanding of the general and specific objectives of his job, and extent and limits of authority inherent in his/her position and the supervisor also should be aware of problems and needs of the community as well as qualifications, qualities and problems of the personnel.



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2.



Selection and organisation of activities refers to the activities chosen should be compatible with the objectives of the supervision and also should be based on the available facilities and personnel relating to service (nursing) and improvement in the service, which is expected by the agency and the community.



3.



Anticipating difficulties according to the type of job, i.e. service problem, administrative difficulties, personal factor (e.g. resource to change, poor relation) and other related problems.



4. Establishment of criteria for evaluation Evaluation refers to determining as to what extent the programme has met problems or objectives according to plan. This can be done by objective measurement, subjective comparison of service indices and opinion or judgement of the staff, supervisor TYPES OF SUPERVISION: (1) Direct supervision – Face to face talk with worker Points to be considered: - Do not loose temper - Use democratic approach and avoid autographic - Give workers chance to reply - Do not talk too much and too fast - Be human in behavior - Do not give instructions – haphazard way. (2) Indirect supervision: With the help of record and reports of the worker and through written instructions. This includes: - Ensuring – carrying out allotted work - Analysis of monthly progress – input efforts and achievement - Analyzing amount of work allotted - Support and guidance.



METHODS OF SUPERVISION: (1) Technical vs. creative supervision 11



(2) Co-operative vs. authoritarian (3) Scientific vs. institutive (4) Task oriented vs. employee oriented I. Technical – These are basic supervisory skills and which need to be trained – group discussion and conference For example: techniques of service study, record construction, time study etc. Creative – provides 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. Cooperative – full 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 supervision – Relies 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



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Rating scales



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Nurses reports



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Nursing rounds



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Job descriptions



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Personnel policies



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Staff educations



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Problem solving approach 12



TECHNIQUES OF SUPERVISION  A technique is a way of doing something. Techniques vary with the personality 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 democratic psychological principles which takes account the nurse‘s individuality. Techniques of Supervision includes: 1. Group conference 2. Individual conference 3. Anectotal records 4. Initial conference 5. Control of early experience 6. Assistance with bedside care 7. Reassurance 8. Supervision of nursing procedure 9. Conferences-Individual,groups 10. Incidental teaching • Example as a method of teaching • Answering and asking questions • Demonstrationof desirable performance • Positive suggestions • Making an opportunity for observation of unusual symptoms.



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. 2. Study of document 3. Identification of priorities 13



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. 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. • Counselling and guidance regarding career development and professional growth FACTORS OF EFFECTIVE SUPERVISION 1. Human relations skills and abilities 2. Technical and Managerial knowledge 3. Leadership position 4. Improved upward relations 5. Relief from non-supervisory duties 14



6. General and lose supervision 7.Nature of the supervision 8.Group cohesiveness 9.Proper understanding about subordinates 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, counselling, 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 good quality of supervisors, the supervisor‘s should be regularly allowed to present their views and suggestions to top executive in regard to the personnel and their works performance. 5. Relief from non-supervisory duties To make the supervisory duties purposeful, supervisors are to be relieved of many routine activities that divert their attention from the real job. Such as submission of numerous reports,training of subordinates etc. 6. Nature of supervision: General and close supervision According to some experience, the general and close 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. 7.Group cohesiveness Group cohesiveness is characterised by the degree of attraction that each member has for the group or the stick togetherness of the group. Group with high cohesiveness produce better results because each member of the group work towards the attainment of common goals. An effective supervisor attempts for group cohesiveness by infusing confidence and trust in employees. 15



8.Proper understanding about subordinates Effective supervision demands that the superior must understand his subordinates and try to satisfy their genuine needs for promotion, recognition, and work-centred benefits.



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. 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 16



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 can rental, uniform allowance, security of the staff within the community, need for supplies and equipment, duplication of services provided by another organization. Responsibilities of the Nursing Supervisor Since supervisor usually will be the middle level manager, has got upward downward responsibilities. The upward responsibilities will include: •



Identify the activities of the authorities community setting (district health).



and



either institutional setting (hospital) or



• Make arrangement to carry out identified activity. • Always keep in touch with the higher authorities what is being done or doing. • Suggest measures to improve efficiency of health personnel or nursing personnel and efficacy of performance. • Act as a liaison between higher authorities and subordinates (nursing staff) interpreting the requirements of the authorities. • Timely refer matters to immediate officers in hierarchy which are required to draw their attention to deal with. The downward responsibilities will include: Assist in selecting, orienting and training new staff and students. Teach them to demonstrate concern decorum, manners, tact, courtesy, in their day-today dealings. Help them effectively ,humanly communicate with their clientele and all others concerned. 



Build good interpersonal relationships among workers.



• Assign duties and responsibilities to right nurses to perform right job at right time. • Help nurses perform their job effectively,when needed. • .Arrange for their leave, day off and rotation plans. • Appraise the nurses performance for guidance. • Help the nurses adjust to situations when needed. 17



•



Assist the nurses to take pride in their work, urging them to do their best with dedication, human concern and sense of involvement.



• Help them develop value system that would be beneficial to clients at all levels. • Develop spirit of dedication, teamwork, cooperation among the workers. • Take suitable steps to maintain high standard of performance at all levels. Supervision in Field Setting The following are the activities of supervision in the community health setting. i. Home visiting: Home visiting along with the staff is one of the best ways in supervision. The purpose of visit is to help and guide the staff. The frequency of visit will depend on the need of the individual, or the request from individual or the amount of time available for visiting. During home visiting the supervisor is expected to make observations on: • The approach to the family, • The action taken by the nurse to meet the problem, • Standing orders are observed adequately, • The response of the health teaching did previously, • The plan made with the family about further course of action, • The nursing technique followed, and • Whether all aspects of the health problem dealt or not. ii. Clinic visiting: Supervisor is also expected to visit the clinic, where she/he has to make observations on: • Clinic set-up, • Sterilisation of equipments, • Nursing procedures being carried out, • Clinic records, • Health teaching being carried out, and • Supply, storage and maintenance of drugs and supplies. iii. Visit to school and community: Supervisor is also expected to visit school and related community organization, for: 18



• Helping in identifying needs/problems of the people. • Assistance in planning the program, • Guidance to implement the plan by providing supplies and materials • Checking the records maintained by them, • Conducting individual and group conferences ,and • Appraising the efficient and effective service rendered duly. In arrangement, individual conference and counselling is to help to understand and rectify the individuals problems in confidence; maintaining rapport; providing guidance and counselling. iv. Record review: The routine record review may be done when common errors are committed by the staff repeatedly, which help in guidance and counselling for increasing efficiency and improvement of their performance. The record scrutiny may includes the type of cases and service being rendered, the medical and nursing services; the contact of the services, routine demonstration, teaching procedures, family needs to the consideration of socioeconomic factors, cooperation with other agencies.



CONCLUSION



Supervision means overseeing the employees at work. It has been defined as the authoritative direction of the work of one's subordinates. It is a necessary concomitant of their hierarchical organisation in which each level of subordinate to the one immediately above it and subject to its, orders. Workers at the intermediate levels of the organisation supervise as well as are supervised. They supervise the work of those immediately below them and their own work is subjected to the supervision of their superior officers. At the lower level of the organisation, however supervision occurs in its pure form over the first line workers who in their turn supervise on one else's work. . It is a continuous process in which atmosphere of cordiality, mutual trust, respect and linking is essential for the creation of positive relationship between the supervise and supervisor. The modern concept of supervision is to guide and help the subordinates in their work by way of training, checking, individual counselling and guidance.



JOURNAL ARTICLE The effectiveness of clinical supervision in nursing: an evidenced based literature review AUSTRALIAN JOURNAL OF ADVANCED NURSING Volume 25 Number 3



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Authors Scott Brunero RN, DipApSc, BHSc, M.Nurs (Nurse Practitioner)Clinical Nurse Consultant, Liaison Mental Health Nursing, Prince of Wales Hospital, Nursing Education Research Unit (NERU), Edmund Blackett Building, Sydney, New South Wales, Australia. Jane Stein-Parbury RN, MEd, PhD, FRCNA Professor of Mental Health Nursing, South Eastern Sydney and Illawarra Area Health Service and University of Technology, Sydney, New South Wales, Australia.



Objective Clinical supervision (CS) is attracting attention in the Australian nursing context with efforts underway to embed CS into mental health settings and to extend it to the general nursing population. The purpose of this paper is to review the available evidence regarding the effectiveness of CS in nursing practice in order to inform these efforts. Method Relevant literature was located by first accessing research articles in peer-reviewed publications that related to CS and nursing. A total of 32 articles were retrieved. In selecting articles for review, the following criteria were then applied: the article reported an evaluation of the effectiveness of CS; the participants in the study included qualified nurses (not students or generic health care workers); the approach to CS was clearly described; and, the method of data collection and analysis, either quantitative and/or qualitative, was explained in detail. Results Of the 32 studies identified in the literature 22 studies met the inclusion criteria. One feature that differentiated the studies was research method, for example, pre-post design; and, articles were initially grouped by method. The reported outcomes of the studies were then categorised according to Proctor’s three functions of CS. The results of the studies demonstrated that all three functions, restorative, normative and formative, were evident. The restorative function was noted slightly more frequently than the other two functions. Conclusions : There is research evidence to suggest that CS provides peer support and stress relief for nurses (restorative function) as well a means of promoting professional accountability (normative function) and skill and knowledge development (formative function).



BIBILIOGRAPHY 1. Jogindra Vati. Principles and practice of Nursing Administration(2013) .Jaypee publications. 2. Anoop.N, Chetan Kumar, M.R, Deepak.K , A Text book on Nursing Management,2011. 3.Basvanthappa BT, Nursing Administration, 2nd edition,Jaypee publications.



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