Nursing Administration 4th Year 2023-2024 (PDF)

4th Year 2023- 2024 Prepared by: Nursing Administration Department Staff Nursing Administration book 4th year (1) Course Specification Course Specifications Programs on which the course is given: Bachelor of Science in nursing. Major or minor element of programmes. Department offering the program: Nursing Administration department Department offering the course: Nursing Administration department A. Basic Information Title: Nursing service Administration Code: ----------- Credit Hours: 6 hrs. Lecture:4 hrs / wk /15wks Tutorial:………. Practical: 24 hrs / wk /15wks Total :168hrs Course description: This Nursing Service Administration Course is designed to enable the nurse student to apply the element of the management process in various health care setting. Emphasis is placed on the development of leadership skills in the management of patient care and nursing man power. B. Professional Information 1-Overall Aims of the Course After completion of this course the student will be able to apply head nurse role in management of patient care , nursing man power in her unit and utilize leadership skills in communication and motivation of nursing personnel. Nursing Administration book 4th year (2) 2- Intended learning outcomes of the course (ILOs). a- Knowledge and Understanding. a.1 Mention the position and criteria for selection of the head nurse and scope of her role. a.2 Identify different scope of staff development programs a3. Recognize nature and type of conflicts. a.4 Identify different source of conflict. b- Intellectual Skills b.1 Discuss the role of the head nurse in the management of patients care, staff and unit. b.2. Differentiate between various methods of staff performance appraisal. b.3. Discuss stages of group development into a team. b.4. Discuss elements of decision making process. b.5. Explain different approaches of conflict management. C- Professional and practical skills C.1. Apply various skills and tools in management of nursing human resources , staffing , employment procedure and method of patient care delivery system. C.2. Plan, implement and evaluate staff training program. C.3. Examine process and mechanism used in evaluation of patient care. C.4. plan for continuity of patient care. C.5. Apply leadership styles in clinical situation. C.6. Apply steps of decision making in clinical situation. d- General and transferable skills d.1.Describe the importance and values of nursing reports and recored in the documentation of patient care. Nursing Administration book 4th year (3) List of Content Table of Content Pages Nursing service Administration department 6 The Role of the Head Nurse 9 Staffing & Scheduling 31 i. Staffing 32 ii. Scheduling 46 Methods of Organizing care assignment 56 Evaluation of patient care 70 Performance Apperasial 79 Records And Reports 105 Managerial Skills 128 I- Leadership 129 II- Decision Making 140 III- Conflict 147 Nursing Administration book 4th year (4) Nursing Service Administration Department Objectives; on successful completion of the Lecture the student will be able to: 1. Classify the nursing service department personnel in accordance of qualification and functions. 2. Differentiate between professional and nonprofessional nursing personnel. Nursing Administration book 4th year (5) Nursing Service Administration Department Introduction; Nursing service departments is the general professional service unit of the hospital to which it is delegated, through its’ director, responsibility for the organization and administration of the nursing as the director of nursing department is responsible directly to the administrator for carrying out the general policies and practices of the hospital in the conduct of the nursing department. The Nursing service department personnel: - The primary objective of the nursing service department is good nursing care, in order to achieve this objective, careful selection of nursing service personnel is important. In selection, consideration should be given to their preparation, experience, personal characteristics in order to: 1. Be qualified for the positions they hold. 2. Carry out their responsibilities effectively, efficiently and economically. Nursing Administration book 4th year (6) Classification: 1- Professional nurses; the director of nursing service, the assistant director, supervisors, and head nurses and her assistants B.S.C degree in nursing science. 2- The nonprofessional nursing personnel are staff nurses (Licensed practical nurses) nurses' aids, and ward clerks and nursing students. Nursing Administration book 4th year (7) Role of Head Nurse Nursing Administration book 4th year (8) Outlines: 1. Introduction. 2. The Nursing service department personnel: a. Professional nursing personnel. b. Non-professional nursing personnel. 7- References. Nursing Administration book 4th year (9) Head nurse role Out line: 1. Introduction. 2. Definition of the head nurse. 3. Qualification and preparation of the head nurse: -Educational qualification. -Professional qualification. -Personnel qualification. 4. Management position of the head nurse. 5. Functions of the head nurse: a- Patient care management. b- Staff management. c- Unit management. 6. Head nurse responsibilities to improve relations with departments. Nursing Administration book 4th year (10) Head nurse role Objectives; on successful completion of the Lecture the student will be able to: 1- Define head nurse. 2- Identify the different qualification for the head nurse. 3- Illustrate the head nurse management position. 4- Describe head nurse role in patient care management. 5- Demonstrate how the head nurse conducts a nursing round. 6- Observe the head nurse role in unit administration. 7- Implement prepare for doctor round. 8- Explain the head nurse role in personnel assignment. 9- Explain the head nurse role in paramedical units. 10- Assess the head nurse role in drug administration. 11- Follow the patient admission administration process. 12- Practice the head nurse role in unit administration. 13-Create a written a report about head nurse role in the unit. 14- Explain role of head nurse in staff management. 15- Demonstrate respect for nursing personnel and care takers. 16- Communicate effectively with health care team. Nursing Administration book 4th year (11) Head nurse role Introduction: The head nurse fills one of the most critical first line- managing roles in the administration of nursing services. She/he is the person in a position linking nursing management to nursing care. Definition: She/he is the person responsible for direct and indirect nursing care of patient within an organized unit of a clinical area as medical, surgical units----etc Qualification and preparation of the head nurse: 1- Educational qualification: Completion of baccalaureate program. Advanced preparation in ward or unit management, principles of supervision and teaching are preferred. 2- Professional qualification: Experience as professional nurse in which potential administration and supervisory competence has been demonstrated. Should have at least one year experience as a staff nurse. Active participation in the professional nursing organization. Nursing Administration book 4th year (12) 3- Personal qualification: - Maintain optimum physical and emotional health. - Demonstrate knowledge, skills gained from educational experience. - Provide personnel supervision and teaching. - Accept responsibility for continuous self-improvement to maintain up to date nursing knowledge and new development. Management positions of the head nurse: The head nurse positions in the hospital setting fills a first line management Top management (Director of nursing service department) Middle management (Nurse Supervisor) First line management (Head nurse) (Fig.1) Functions of the head nurse: 1- Patient care management. 2- Unit management 3- Staff management Nursing Administration book 4th year (13) I. Patient care management: In this broad functional area the following sub-function are performed by the head nurse:- 1-Assessing and analyzing patient needs and developing the plan of care to meet needs During assessment head nurse must take the following into consideration:  The patient condition and needs.  Needs of patient’s family.  The patient environment.  Observation of the work peaches.  The effects of care.  Interaction between patients and personnel.  Social climate and physical environment of the personnel.  Signs and symptoms associated with the various disorders. What good nursing consists for patient on the service these vary with the age, degree of illness, and the disorders of the patient.  Information about individual patients, including age, condition, disabilities or special problem.  Knowledge of the total program of medical cares for the individual patients and the nurse’s responsibility in relation to it in order to be able to observe the patient.  Be familiar with the nursing care plan for each patient in order to determine whether it is being followed. Nursing Administration book 4th year (14)  Each staff nurse is informed that making nursing assessment is an expectation.  Provides opportunities for staff nurses to learn through practice, gain skill in assessing patients and their nursing care requirements.  Holding staff nurses accountable for performing nursing assessment. 2. Role of head nurse in personnel assignment:  The interests and abilities of the various member of the nursing team to ensure their maximum utilization.  Patient needs and problem.  Personal qualities as same nurses relate better than others to some patients.  The amount of time necessary to give care indicated.  Determine the number of patients on the word.  Check the number of nursing personnel Available to do the task and their educational level, experiences and needs abilities and interests.  Decide on which patient. Needs the most expert care.  Determine what other tasks are necessary to give satisfactory care to patients.  Decide which method of nursing care you will employ ( case , function , team)  Check to see that the entire workload is covered with no overlapping of assignment.  Put the plan into written form. Nursing Administration book 4th year (15)  3-Setting the standards by which extent performance of the nursing functions on her unit can be measured:-  The HN set standard which are challenging but still within the ability limits of nursing personnel on other words not to high because it will frustrate them because their inability to achieve not to low as they will fail to meet patient needs. The standard should be: 1- Flexible enough to meet changing situation. 2- The HN should refuse to let her standards drop below the minimum for essential patient care. 3- Then the head nurse can check nursing personnel performance against standard that was set to ensure quality patient. Care for the types or the degree of illness that are present in the unit. 4- She also observes the patient response to all medical and nursing care. Satisfaction can be a positive symptom for the HN of the quality and effectiveness of patient care. 5- When the standard is not met, the HN should analyze the reasons for failure with her staff and plan for improvement. 4- Supervising all nursing activities related directly and indirectly to patient care: The most important sub-function of the HN is the supervision of all nursing activities. This is done through:  Daily and constant direct observation of all patients to see that their conditions are satisfactory and that all nursing care given by each member of nursing personnel is adequate and effective. Nursing Administration book 4th year (16)  She should see and talk with every patient at least once a day to see that patients are contend with the nursing and hospital routine.  Under any circumstance there will be some patients the HN must see frequently throughout the day.  Moreover, any technique the HN can utilize to stimulate the interest of the workers to maintain everything in the word.  Making quick short rounds at the beginning of the day with the night nurse in the morning and at the end of the day. In the afternoon with the evening charge nurse provides opportunity for the two together to raise question, discuss problems and make plans. Purpose of nursing rounds: When early in the morning before physicians rounds and in different times in: a. Observe the overall physical and mental condition of each patient and note progress. b. Observe the work effort of the nursing staff as a means of evaluating quality nursing care. c. A company physicians, supervisors or family. d. Observe the patient’s environment for cleanliness, orderliness completeness of equipment and presence of hazards. e. Conduct a teaching experience for students. 5- Promotion and participation in patient education and rehabilitation. Nursing Administration book 4th year (17) The HN should promote and participate in patient education. Should be start with the first contact, if he is well enough to hear. Teaching is a part of rehabilitation, which starts upon admission of the patient, during hospitalization and before discharge. II- Unit Management: The HN during her work is running her unit is involved in different administrative duties daily and whether these duties are delegated or, she is still the responsible person.In fact many these duties may be delegated. 1-Patient admission administration: a. The HN acts as courteous hostess when the patient is admitted to the unit. b. She great the new patient, and his relatives in friendly manner. c. It is preferable for the HN to use patients on name if she knows it. d. She introduces herself and the staff member who will assist in the admission of the patient. e. The first impression is important and it is lasting. f. Understands the patients and gives them the mental and moral support he is requiring. g. Treats the patients as she would like to be treated in the same situation. Nursing Administration book 4th year (18) Orientation of the new patients and his family should include: 1) Giving them information about hospital policies, regulations and facilities available. 2) Introduce the patients to ward environment. 3) Orient the patient to staff personnel. 4) In emergency admission and upon being notified the HN must be sure that the bed is prepared and any equipment that may be required. 2. Patient Discharge Administration: The HN is responsible for the preparation of the patient for his discharge from the hospital. She asks the patient if he/she would like to discuss any problem with the medical social service worker which may interfere with his recovery. If indicated, she suggests community agencies that may help the patient at home. She should continue her role as hostess through the time of the patient discharge from the hospital: (a) Inform members of the patient’s family that the patient is being discharged, and when they should arrive for him. (b) Be sure the patient has the proper clothing to be when going to home. (c) Assigns one of her staff members to assist the patient in dressing, packing and leaving the ward. (d) Talk to the patient and his family when they are leaving. (e) Give all instruction-required drugs and further appointment. Nursing Administration book 4th year (19) 3- Doctors Rounds:- A. Administration before Dr. Round: 1- The HN should see that all investigation report for the patient is available. 2- She should see that all patient’s charts are complete and organized and on order and ready. 3- She instructs:- - Nursing staff on the order of the ward for the rounds. - Should be on comfortable position and ready for rounds. - Auxiliary staff to see that the ward is neat and tidy. - The HN also should be knowledgeable about patient Condition and is up to date and received all reports and ready to discuss patient’s problems. B. Administration after Drs. Rounds: -Nursing staff to put the patient at ease in a comfortable position and continue what was performed for him. - Auxiliary staff to keep wards tidy. - Carrying out or putting into effect the changes ordered by Dr. during the round. Nursing Administration book 4th year (20) 4- Drug Administration:- The HN should: a. Check stocks of drugs she/he has in the unit against records. b. Check patient's charts regularly to obtain patient prescriptions keep accurate charts regular records of drugs given during all shift. c. Return expired dated drugs to the pharmacy. d. Give accurate and constant instruction and supervision of nurses in the keeping of drug records. e. Be sure that the nursing staff know conation, normal dosage, side effects if the drugs given to patient’s. f. Be sure that patients are given instructions. 5- Operating Room (OR) Administration:- The head nurse should: a. Check the list. b. Inform patient of day and time of operation. c. Be sure that pre-operative preparation was done for patients by the responsible nurse who is assigned to the patient. d. Check consent of patient if necessary. e. Check to see if patients chart is complete and all investigations are present. f. Give support to patients family or relative and any necessary needed information. Nursing Administration book 4th year (21) 6- Para-medical Administration: The HN is responsible to a considerable degree for the effective coordination of the efforts of all those workers who not only engage in direct patient care but also with whom who engage in indirect patient care she is responsible for establishing an atmosphere and relationship which will improve patient care by improving the joint functioning of various departments with a common goal better patient care. HN responsibilities to improve relations with departments: 1. Know the organizational structure of the hospital. 2. Acquaints staff members in the unit with the policies, routines of the departments that cooperative with the HN unit. 3. Offer help to every employee who comes to the unit to do a job. 4. Be sure that requests to other departments be done on time. 5. Keep the patient’s appointment with other departments on the schedule provided. 6. Coordinate patient's services on the unit and between all the departments in the hospital. 7-Medical department: a. Take the initiative as a HN to establish friendly relationship and mutual understanding with the hospital staff. b. Encourage mutual planning for patient care. c. Explain the nursing situation to those your wards they will be more cooperative if they know about unusual difficulties. Nursing Administration book 4th year (22) d. Ask for conference with medical staff when important problem arise. e. Reports to them any inability to carry out his orders, and explain reasons. f. Reports symptoms, reactions and result of RN accurately. g. Assist with any examinations made during round. 8- Pharmacy: - a- In ordering, the needs must be determined accurately, sufficient stock should be available to meet current needs with reserve in hand for emergencies, but don’t over – stock.  Requisition forms should be completed properly.  The stores can keep an account of issues made and stock in hand.  The accounts department can keep a record of expenditure.  Requisitions should be simple to complete and easily understate and written legible and should be sent to the pharmacy department at the appointed time. B- Dangerous drugs should be ordered with special care this responsibility is normally undertaken by the HN. 9- Maintenance department:-  The HN should learn what services the maintenance department should provide.  She/he should report any mechanical difficulty, minor fault and inform them with the location of the trouble. Nursing Administration book 4th year (23) 10- Laundry department:-  Avoid loss of linens- be careful to check clean linen returned from laundry  Protection of the linen against dirt and loss should be understood by all members of the staff.  The linen cupboard should be keep in good order with linen folded nearly until it is used and correctly stored. 11-Housekeeping department: The HN must be satisfied with standard of cleanliness as this has such an important bearing on patient care the domestic staff (housekeeping personnel) should report to the tin who is coming on or going off duty, the HN should observe and notice whether they use the approved methods handle equipment properly and carry out the work arranged for them. 12-Dietary Department:- The HN is responsible for writing requisition to the dietary department and should avoid over ordering in order to prevent waste. The request should include the number and type of diets necessary for ward. Requests are written in the proper form and on time. 13- Diagnostic and therapeutic services Department:- The HN should familiarize herself with the functions of this department. Nursing Administration book 4th year (24) The patient should be prepared correctly and nursing personnel should be instructed to do so. The medical staff is responsible to prepare the request form and be completed.  The HN should see that the forms are available and easily located. The patient should arrive at the correct time and arranged should be made for the return of the patient to the ward when the test is completed. 14-Social service department: a- The HN should inform her staff about the functions of the social service department. b- Maintain a friendly, cooperative attitude towards the department. c- Accept the help which the medical social service worker can give in understanding patients. d- Encourage patients to talk with the social worker. Factors involved in good unit management: The HN is the: Planner, Organizer, Motivator, Evaluator, Educator, and In many instance the implementation of most activities that occur in her unit. Nursing Administration book 4th year (25) III. Staff management: The head nurse role in staff management: - Nursing services personnel consists of registered nurses, practical nurses, student nurses, and nurses’ aides. There are wide variation in the education, experience and personality within each of these categories and among all groups. - The head nurse must be informed and concerned with these differences in order to develop the highest potential of all workers and ensure that patients receive safe effective care. The administrative responsibilities of the head nurse toward her/his staff include: 1) Staff utilization. 2) Staff supervision. 3) Staff development. 4) Staff evaluation. 1. Staff utilization. - The head nurse is responsible for all nursing functions carried out by her staff. She delegates tasks and enough responsibility and authority and she still accountable. - The staff member have greater satisfaction in her work if she/he is given responsibility for a job and permitted to carry it out in her own way provided. - The head nurse must ensure that each staff member on the unit knows the limits of his/her responsibility, to whom he/she is responsible, to whom he/she may go for counsel and who is Nursing Administration book 4th year (26) responsible to him/her and for what these limits are prepared the job descriptions. - The head nurse should be familiar with them to enable staff to ensure conformity with hospital policies. - Plans time schedules of a staff in advance and in a way that comply with good personnel practices and maintain staff morale by taking into account personal requests of the staff. - Observe conditions under which the personnel function and ensure that the surrounding environment is conductive to clear thinking and free from destructors which interfere with the achievement of goals. E.g. beginning the day on time, putting things in order, prevent interruptions. - Maintains an effective system of communication with staff (scheduled and unscheduled) to aid the functioning of the staff, build their morale and facilitate getting the work done. - Planned conferences, written reports and records, discussions, informal teaching is methods of fostering effective communication. - Development of routines for frequently performed activities is one of the most important factors in achievement of coordination, timing, and sequencing activities such as ordering of supplies, transcribing doctors' orders, giving transfer reports, assignment of new patients, contribute to saving of time for the personnel and in improving the care of the patients. Nursing Administration book 4th year (27) 2. Staff supervision: -Supervises the quality of staff work by utilizing opportunities such as (given reports, making assignments, conducting rounds, during conferences and demonstrations). - Establish a harmonious relationship with the staff by recognizing efforts and achievements, and by encouraging free exchange of opinions and ideas. - Plans supervisory methods that facilitate staff guidance motivation and stimulate staff to continuous self-improvement by providing social, psychological and physical atmosphere which allows the individual freedom to function at their own level. -Contribute in a variety of ways to the education of students and nursing staff. E.g. uses conferences, rounds and demonstration techniques to teach staff and students. - Conferring with clinical instructors to explain activities, policies and procedures related to students learning experiences to ensure coordination and accountability. - Discovers leadership skills and creative abilities among members of the nursing staff and arrange for their expression. Nursing Administration book 4th year (28) 3) Staff development: - During everyday practices the head nurse has a marked influence on the development of her staff, the quality care she expects through the example she sets by her attitudes and behavior to a large extent , also she determine the standards of care. - Setting high standards for patient care is the greatest influential factor in the growth of staff the head nurse should involve members of staff in developing these standards and in establishing objectives and criteria for their attainment. -Encourage staff to participate in planning for improvement of nursing care and applying findings of nursing practice studies is a fruitful means of bringing out staff growth and better quality of nursing care. -The extent to which the head nurse capitalizes or learning opportunities influence staff growth. She has to provide opportunities for staff professional advancement and advanced study. - Share in planning and participates in staff educational and training programs of professional personnel. 4. Staff evaluation: - Evaluate staff performance objectively and impartially by maintaining a routine system for continuous evaluation of staff performance to ensure the attainment of objectives. Nursing Administration book 4th year (29) - Encourage staff to evaluate their own work, analyze problems and decide an action to resolve problems. Self-evaluation help individual to determine progress. - Although evaluation for administrative purpose of promotion and salary increase its main focus should be on the education growth and development of staff. - Investigate any complaint or lack of cooperation between workers and help establish atmosphere on the unit. Nursing Administration book 4th year (30) Nursing Administration book 4th year (31) Objectives  Define staffing  List goal of staffing  Enumerate effect of overstaffing  List effect of understaffing  Explain the under, overstaffing and improper staff mix  Differentiate between Staffing pattern and Staffing plan Outlines  Definition of staffing  Goal of staffing  Overstaffing effect  Understaffing effect  Under, overstaffing and improper staff mix  To forecast nursing workload on a particular unit, the manager must know  Components of staffing  Staffing pattern  Staffing plan Nursing Administration book 4th year (32) Definition: -The term staffing refers to the number and composition of personnel assigned to work in a unit at a given time. -Staffing is the process of balancing the quantity of staff available with the quantity and mix of staff needed by the organization. [ The goal of staffing: To provide an adequate amount of staff of the right mixture of personnel to give proper care to patients housed in the unit at that particular time. Staffing is most often the responsibility of the nursing office. The planning of the number and type of personnel for each unit on each shift is done centrally by the director of nursing service or her assistant with consultation with the head nurses. Staff number and mix should be appropriate according to hospital needs either wise there will be understaffing or overstaffing and both of them is a problem: Overstaffing effect: Marked over staffing impaired care quality by encouraging excessive socialization among nursing personnel, which leads to relaxed practice standard and neglect of critical care measures, also it leads to boredom and interpersonal friction. Understaffing effect: Nursing Administration book 4th year (33) Serious understaffing impairs care quality, because overworked nurses lack time to perform essential protective and therapeutic measures, also it leads to workers' frustration, fatigue and disillusionment. Under, overstaffing and improper staff mix: -Diminish nurses' job satisfaction. -Cause excessive turn over with significant financial loss. -Irritation, uncertainty. -Confusion, communication problems and time waste. To forecast nursing workload on a particular unit, the manager must know: 1) How many patients will be admitted to the unit per days, month and years? 2) Whether patients will be of different types (both medical and surgical) and the number of each type to be admitted. 3) Medical diagnosis and acuity level of patient to be cared for. 4) Average length of stay for type of patient. 5) Direct and indirect care measures to be provided to each type of patient. 6) Frequency of each care measures to be performed. 7) Average time for performance of each direct and indirect care measure. Staffing is a complex function, consisting of the following sequential and interdependent steps: 1) Identifying the type and amount of nursing care to be given. 2) Determine which categorizes of nursing personnel should be used to deliver needed care. Nursing Administration book 4th year (34) 3) Predicting the number of each category of personnel that will be needed to deliver care. 4) Recruiting personnel to fill available positions. 5) Selecting and appointing personnel from available applicants. 6) Arranging available nursing personnel into desired configuration, by unit and shift. Components of staffing: 1. The staffing pattern It indicates the number and mix of personnel that should be on duty per each unit per shift, per day. 1. The staffing plan It determines the number of personnel that must be hired to deliver on that staffing pattern. A. The staffing pattern: Is a relatively permanent document based on the daily average requirements for patient care in each unit. It is reviewed at least yearly for modifications required by changes in patient population, care trends or other factors. A staffing pattern for a single patient care unit may be as follows: Category of personnel Days Evenings Nights Head nurse 1 - - Prof. nurse 4 2 1 Non prof. nurse 2 1 1 (practical or assistant Nursing aide 2 2 2 Nursing Administration book 4th year (35) Methods of Determining the Staffing Pattern: a. The traditional system: -The old system of determining the staff number and mix was based on the number of beds per unit (one nurse per 4-6 beds) or on the average census per unit (one nurse per 4 patients). -These calculations ignored the fact that one group of patients might need far more care than another group of the same number. -In addition, this system shows only the number of hours worked during a day without differentiation between patients or between the various shifts of duty. -Also, it does not reflect either the particular needs of patients or the level of care needed. -The hours worked include direct nursing care activities and administrative and other activities. -The distribution of nurses is based on the administrator's opinion of the proportion of care that is needed on each shift. Example: Days 45% of the staff Evenings 35% of the staff Nights 20% of the staff  Since this system does not reflect either the particular needs of patients or the nursing tasks to be performed, it is considered useless in providing quality care accepted as a standard. b. The new system (Patient classification and task quantification): This new system for determining staffing relies on data concerning patient needs and the tasks to be performed during a shift and not a day as in the old system. Nursing Administration book 4th year (36) The staffing pattern is developed through: 1. A patient classification system that focuses on patient needs. Patients are grouped according to the acuity of their illness and the degree of their dependency on nursing time into care categories: - Intensive care group - Intermediate care group - Self-care group  The number of nursing hours required per patient in each category per shift is calculated and converted into an index. 2. A task qualification system that focuses on the nursing tasks to be performed. Each direct care activity, as well as indirect care activities (administrative, dietary, messenger...) is timed and assigned to a given level of worker and by cumulative count of tasks per level, a ratio of staff mix can be established and an index is developed. 3. Using the indices for determining staffing pattern for each unit for each shift is established.  The patient classification system and the task quantification system aims to relate patients' needs and nursing tasks to staffing and therefore prove to be more advantageous than the old system. Types of staffing patterns: a. Basic and supplementary staff: Since both methods used to determine the staffing patterns are based on average care requirements, the basic (permanent) staff for each unit will need supplementary staff when demands for care exceed the capabilities of the basic staff. Nursing Administration book 4th year (37) Methods for use of supplementary staff: Borrowing method: -This is a common method of borrowing staff from units that have the most to help those who have too little. -The problem with this method is that the staff often resents being transferred from unit to unit and the H.N. never admits that she has more nurses. Float staff: -This is a better method for managing the increased staffing needs. A pool of nurses who are permanent workers but do not belong to any Special unit are used to fill in for increase in patient care activities or absence among the unit staff. -This method helps in day to day variations in work volume. Some nurses like this type of assignment and the chance to work with different types of patients. On-call staff: Usually on-call staff is filled with regular employees who receive extra pay for being on call whether or not they are called. This method is useful in OR, ICU and other special care units. b. Variable staffing pattern: It is an alternate to permanent staffing pattern. This method is based on the assumptions regarding the average needs of patients but the pattern is determined daily based upon present needs of patients on each unit. The information on patient needs is calculated once or twice a day and is analyzed to give the number and mix of staff needed on Nursing Administration book 4th year (38) each unit and each shift. Thus, the pattern on each unit may change daily. In this method the staff of the entire hospital is centrally distributed each shift. Usually, the calculations are done by the computer based on data collected from the patient classification and task quantification techniques.  Although this is a very effective method for staffing, it creates dissatisfaction among staff due to frequent change of unit and patients. Nursing Administration book 4th year (39) Criteria for patient classification system according to nursing care requirements Item Self-care Partial care Immediate care Intensive care Type A patient who requires A patient who requires A patient who requires A patient who requires only minimal amount an average amount of above average amount maximum nursing care of nursing care nursing care of nursing care Criteria 1. Ambulant 1. only partially 1. confined to bed or 1. confined to bed, 2. Bed made when un confined to bed chair, requires some requires to be lifted or occupied 2. requires bed made lifting moved 3. Capable of all other unoccupied 2. requires bed made, 2. requires bed made, services 3. No assistance either occupied or either occupied or 4. Requires minimal required with washing unoccupied unoccupied. medication or 4. requires frequent 3. requires to be 3. requires to be treatment medications and / or washed or assisted washed and/or dressed 5. requires minimal treatment and/or dressed 4. requires frequent observation 5. requires moderate 4. requires frequent medication and any of 6. no assistance observation medication and any of the following required in toilet 6. up for toilet purpose the following treatments: IV therapy, Nursing Administration book 4th year (40) 7. feed self 7. can feed self treatments: IV therapy, blood transfusion, 8. no assistance 8. may acquire blood transfusion, oxygen therapy, required in bathing assistance in bathing oxygen therapy, suction, drainage, suction, drainage, monitoring of vital monitoring of vital signs signs 5. requires continues 5. require frequent observation observation 6. requires bed pan or 6. requires bed pan patient is incontinent 7. can feed self with or 7. requires feeding without assistance 8. requires bathing in 8. requires bathing in bed and assistance bed and all personal with personal services services Average nursing 2.8 nursing hours 4.3 nursing hours 5.8 nursing hours 6.8 nursing hours hours needed/ 24 hours Nursing Administration book 4th year (41) Factors affecting staffing pattern determination: Staffing judgment often is a mixture of scientific knowledge plus knowledge of what works best in a given situation. Yet, there are many factors that may affect staffing determinations. These include: 1)Nursing organization factors: a. Patient care objectives b. Determined levels of patient care. c. Nursing unit functions. d. Assignment systems. e. Services to staff_(in-service training). 2) Patient factors: a. Variety of patient conditions. b. Acuity and general health status. c. Length of stay. d. Patient number, fluctuation in number. e. Age groups. f. Care expectations. 3 Staff factors: a. Job description of the division. b. Educational level of staff. c. Experience level of staff. d. Staff mix available in the community. e. Staff number available. 4) Health organization factors: a. Budget available. b. Personnel policies especially regarding work time. c. Support services within the organization. d. Number of bed/units. e. Architecture layout of the unit. Nursing Administration book 4th year (42) B. The staffing plan: Is a mathematical calculation of how nurses of what category (professional or non-professional) must be hired in order to deliver the required care on a yearly basis. Methods for calculating the staffing plan: a. Divide the number of days in a year by the number of days actually worked per nurse per year to derive the number of staff required to fill one position for the year. Then calculate the total number of staff needed to fill the different positions for each category for the whole hospital. Example: calculating the number of persons needed to be hired to fill a single professional nurse position on a day shift on a given patient care unit: 1. Calculate the actual number of days worked by a professional nurse/year (52 weeks). a. Number of days off (2/w) = 104 days b. Number of days (vacation) = 20 days c. Number of days ill (hosp. policy) = 10 days d. Number of days (holiday) = 10 days 144 days Actual working days/prof, nurse/year = 364-144 = 220 days 2. Number of nurses needed to fill one position of professional nurse = 364/220 = 1.65 workers, i.e. you will need 1.65 professional nurses to fill one position. Nursing Administration book 4th year (43) 3. Calculate the total number needed/year for hospital to fill in the professional nurse's position = total number of professional nurses needed for staffing patterns for all units 31.65. b. Using the care hours: Hospitals using the patient care hours for developing their staffing pattern, calculate the staffing plan as follows: 1. Calculate patient care hours/ unit/ shift. 2. Calculate the total number of nursing hours required per year. 3. Calculate the number of staff required to deliver those hours. 4. Calculate the number of positions required to deliver that staff.  The final staffing plan should present who work consistently each week of the year. The main difficulty is in coordinating the rotation of employees among the various units and shifts. Thus, the staffing plan should be based on the scheduling plan to ensure that an equal distribution of staff is achieved.  Some hospitals, however, use part time workers to fill in the number of staff needed for coverage of days off and holidays. Other hospitals employ permanent evening and night staff to overcome the problem of rotating staff through the various shifts of duty.  A system of shift differential is established to compensate for hours worked in the evening or night (30% more salary), the same compensation applies to work during holidays. Nursing Administration book 4th year (44) Objectives  Define scheduling  List objective of scheduling  Enumerate principles of scheduling  Differentiate between systems of scheduling  Differentiate between scheduling pattern  Differentiate between scheduling types Outlines  Introduction  Definition  Objectives Of Scheduling  Principles Of Scheduling  Systems Of Scheduling 1- Centralized 2- De Centralized 3- Staff Self scheduling  Types Of Scheduling  Block Scheduling  Cyclic Scheduling  Computerized Scheduling  Scheduling Patterns of Working hours. - Straight Shift - The 10 hours Shift - The 12 hours Shift - Irregular hours Scheduling pattern  Role of manager in Scheduling Nursing Administration book 4th year (45) Introduction Time scheduling is an important function in the human resource management, where the worker are assigned specific days and specific hours of work. Also, scheduling is a central measure of staffing function and the appropriate time scheduling is prerequisite for successful nursing operation. Pattern of working and non-working hours direct affect employee productivity and work satisfaction. Definition 1- It means the distribution Of hours to be worked by each person during each 24 hours , seven days a week i.e. assigning personnel specific days and specific hours Of work. 2- It is the ongoing implementation of the staffing pattern by assigning individual personnel to work specific hours and days and in a specific unit or area. Objectives of time scheduling: 1. To ensure patient care without over staffing. 2. To know well in advance what individual schedules. 3. To achieve distribution of days off. 4. To treat fairly individual members. 5. To maximize the use of nursing staff power and to optimize the use of professional expertise. 6. To satisfy personnel both as to work hours and as to perceive sense of equity. Nursing Administration book 4th year (46) 7. To consider the unique needs of the staff as well as the patient. 8. To define responsibility of personnel Principles of Scheduling 1. It should be planned to meet needs of each time period ( by knowing the busiest days and hours). It must balance the needs of patients and personnel. 2. There must be an equitable distribution of the desirable as well the undesirable hours of duty. 3. An employee must be assured that his assigned time on duty will not fluctuate unless an extreme emergency arises, and only with his permission. 4. All staff members should be assigned similar duty hours as much as possible, and days off should be equitable for all personnel. 5. Scheduling policies must be identified at the time of employment 6. There should be no accumulation of days off. 7. There should be a professional nurse on duty at all times during the 24- hour period 8. Special requests should be granted if reasonable 9. Changes in the time schedule should be kept to a minimum 10. There should be an overlapping of each shift to provide time for shift reports. 11. There should be a day apart between head nurse and assistant head nurse days off. 12. The head nurse is rarely off duty on Saturday , which is the beginning of the week 13. A day off is given before and after a night shift 14. The head nurse has to be sure that the unit is adequately staffed when inexperienced Nursing Administration book 4th year (47) 15. The plan should enable the staff to meet the objectives, standards, and policies of the organization. 16. The plan should provide for flexibility in meeting changing needs of personnel (sick leaves, vacations, holidays). Scheduling Policies 1. Time covered by each schedules. 6. Length of meal time, break time. 2. Dates for posting schedules. 7. Number of sequential work days and off. 3. Day beginning the work week. 8. Frequency of shift rotation. 4. Number of work hours per week. 9. Number of weekends of per month. 5. Beginning or ending time for shifts 10.Number of paid holiday per year. Systems Of Scheduling :- 1-Centralized scheduling ( Central staffing Pattern ) This System or pattern is mostly used in the very large hospitals. One person in the nursing administration Office plans coverage For all nursing units (assistant matron, supervisor or a centralized staffing secretory). The person concerned has the responsibility for Scheduling all personnel for all shifts in all units. Advantages: 1- Fairness to employee through consistent, objective and impartial application of policies and opportunities for cost containment through better use of resources, i. e Performed without personal bias. 2- Central control of staffing Nursing Administration book 4th year (48) 3- Balanced distribution of nurses among different units. 4- Minimal overstaffing or understaffing. 5- Save professional nursing time i.e. relieve the head nurses from time consuming duties ( a non-nurse can easily learn the necessary nursing implications for scheduling ). 6- Easier to make adjustment among different units for reasons such as, absence of nurses or changes in patient care needs. 7- The scheduler, who does this as a full – time job or as a major responsibility, will become skilled in coping with the intricacies of scheduling. 8- It allows for coordination over the entire division. 9- The scheduler will be in an ideal position to judge how to fill gaps if it becomes necessary to pull personnel because of staff illness or change in Patient work load 10- It is likely to develop efficient systems to deal with personal requests for exceptions or schedule alternations. 11- Provides an overall picture of the staffing situation. 12- Eliminates the personal contacts that develop between a head nurse and her personnel as it relates to employee work schedules. Disadvantages:- 1- The lack of personal relations with staff may make the scheduler insensitive to pressing needs for schedule alterations. 2- Weak personal contact between the unit staff members and their head nurses. 3- It the central scheduler is not skilled in interpersonal relationships, the schedules are likely to become a focus for employee discontent. 4- The person in charge of scheduling knows very little about the personnel for whom she does the schedule. Nursing Administration book 4th year (49) 5- In case that staffing is developed by a secretary its validity and Feasibility must be evaluated by someone in the nursing office. 6- There is depersonalization that influences the employee satisfaction. Decentralized Scheduling :- Are planned at the unit level , usually by the head nurse or the unit manager. Advantages:- 1. The head nurse know her staff intimately , she is in better position to meet their individual scheduling needs. 2. Because the head nurse know her patients' needs , she can respond to them in her scheduling with a sensitivity that someone in the a central office cannot have. 3. When there are differences concerning desired work days , the head nurse can get staff members together for negotiation and problem resolution 4. Personnel feel that they get more personalized attention. 5. The head nurse feel more in control of her unit activities. 6. Improving satisfaction for staff Disadvantages:- 1- The staff may try to manipulate the head nurse. they may ask for special favors, she may be afraid not to grant them , especially if the relationship between the head nurse and the staff members is one of close friend ship. 2- Staff members may try get the head nurse to put their needs above the needs of patients. 3- Some staff members may receive individualized treatment at the expense of others. Nursing Administration book 4th year (50) 4- Work schedule can be used as a punishment – reward system by the head nurse. 5- Scheduling , which is very time consuming takes the head nurse a way from other duties. 6- Using of resources less frequently and consequently make cost containment more difficult. 7- There is likely to be more reworking of the schedule because workers are likely to ask for more schedule modifications from the head nurse than from central scheduler. Staff self – scheduling:- Self-scheduling process has the potential to promote staff autonomy and increase staff accountability in addition team communication, problem solving skills and negotiation skills can be enhanced through the self- scheduling process. Successful self-scheduling is achieving when each individual's personal schedule is balances with the unit's patient care needs. Nursing Administration Book 4th year (65) Advantages: 1. Empowering nursing staff and increasing their control to balance their personal and professional lives. 2. Increasing flexibility of nursing schedule 3. Enhancing the communication and interaction in the work environment to stimulate cooperative community building B. Types of Scheduling Working Hours : 1- Block scheduling : Means that the work schedule for a unit is planned in a " block" of weeks , i.e., days to be worked by staff are blocked together. Nursing Administration book 4th year (51) Block scheduling is done for 4-8 weeks at a time. it can be calculated easily and has flexibility in that the next block of time not necessarily need to follow the pattern of the proceeding block. This type of scheduling does not provide for maximum level of care seven days a week. Example of block time scheduling : X : days worked O: days off in the week Nurse Days Su Sa W M M su su su th th th th sa sa sa m m w w w F F t t f t f t A X x O o x x x x x x o o x x o o x x x x x o o x x x X x B X x X x o o x x x x x x o o x x x o o x x x x o o x X x C O o X x x x x o o x x x x x o o x x x x x o o x x x X x 2- Cyclical Scheduling:- Is an improvement on block scheduling in that it has repetitive work pattern assigned to personnel. A fixed cycle of usually ( 4 to 6) weeks is repeated. The employee may have a different schedule for each of the weeks contained in the cycle, but the pattern repeats without change. This type of scheduling is desirable to many nurses since they can calculate even month in advance when they will be on – duty and off. This type also provide for coverage of professional nurses and allow each employee to have at least one full weekend off every 4 weeks cycle and it never has the nurse working more than five consecutive days. This type is developed once per staffing pattern.Also there are never less than 2RNs on duty ,there are never more than 2 persons [RN and LPN considered together] off on the same day. Nursing Administration book 4th year (52) There is never a day without at least one LPN on duty. Because it repeats without change, the only schedules that need attention are those in which exception occur, as in a week containing a holiday. Example of cyclic Schedule D: day shift E : evening shift N: night shift.. : off duty (2) (3) (4) week (1) day sa su M T W th F sa su M T W th F sa su M T W th f sa su m t w Th F D D D D D D. D D D D D D. D D D D D D. D D D D D D. change.... N N N N... E E E.. D D N N N N... E E E.. D D 1.......... D D.. N N N... E E E E D D.. N N N... E E E E 2.......... E E E.. D D N N N N... E E E.. D D N N N N... 3............. E E E E D D.. N N N... E E E E D D.. N N N 4.......... Computerized scheduling This type enables the user to devise a plan which considers more variables than schedules done by individuals. Computerized scheduling allows for maintaining the patterns to be used and the choice of employee and the planning of holidays, days off and vacation. All data necessary for time planning are fed to the computer and a program for scheduling is designed based on the fed data. The computerized scheduling is more Nursing Administration book 4th year (53) effective than the other types, it saves the nurse's time spent working out schedules and it reduces interpersonal conflicts between staff and supervisors created by changes made in scheduling Scheduling patterns of working hours : 1- Straight shift : This is a traditional pattern that uses 8 hours shifts for time planning for the[ 24 hours] period. The pattern may be as such : 7 AM To 3: 30 PM 3 PM to 11 : 30 PM 11 PM to 7 : 30 AM This pattern allows each employee to work 8 hours a day five days a week. This is mostly a block hour system and thus allows for under utilization ( poor) of staff on weekends. It cannot meet patient care needs seven days a week. 2-The 10 hours shift : This pattern allows staff to work 10 hours a day for 4 days a week and three days off. This is a 6 week cyclical Pattern that has advantage over the 8 hours/ day. shifts developed for the 10 hours day are : 7 AM to 5:30 PM. 1 PM to 11: 30 PM. 9 PM to 7 : 30 AM. The 10 hours shifts has the disadvantage of not falling evenly into a 24 hours day , but it can be planned so that the overlaps occur in peak ( heavy) work hours. This pattern is very effective in staffing ICU. Nurses are satisfied they can give comprehensive continuous care can get a longer week end and an extra day off. 3- The 12 hours shift : Nursing Administration book 4th year (54) This pattern consists of working 12 hours a day with 2 days off prior to a change of shift. The shift hours are usually 7 AM to 7: 30 PM and 7 PM to 7: 30 AM This pattern was introduced due to inadequate staffing , but it proved to be appropriate in ICU and modified ICU. It strengthens the relationship between the nurse, the doctors, and the patient and time is saved in personnel shift change over 4- Irregular hours scheduling pattern : Nurses work a number of hours each week and the hours of work may vary depending on patient care requirements or service demands. Nurses may work 10 hours, 12 hours or other irregular length shift. This system is implemented for the services of highly trained clinical nurse specialist or for nurses in service training or supervision programs. It can be useful in increasing productivity but it is often costly because it ends up increasing the number of required staff. Role Of Manager :- There are several steps in determining employees on –and off- duty time After analyzing the unit's work flow. 1. The manager must determine hours of maximum and minimum work load so as to decide hours of peak and least need for employees in each category 2. Using positions budgeted and filled, the manager Should determine a pattern of on- off duty hours that will provide the desired number of each day. 3. The manager should plan each employee's work hours for 4-to- 8 week's so as to group avail 'able staff into desired configuration's Nursing Administration book 4th year (55) (taking into consideration employee's position categories and clinical abilities). 4. The manager should check the completed schedule for errors , such as names omitted , requested, and approved holidays or vacations not provided, in adequate numbers of personnel during peak work periods, and improper mix of personnel for specific hours of the day. 5. The manager should review schedules and scheduling policies regularly to Identify staffing problems that require changes in the master schedule. Objectives:  Define patient care assignment  List 3 purpose of patient care assignment  Enumerate 4 principles underlining all patients' care  List 3 Characteristics of good assignment  Differentiate between Methods of organizing patient care assignment Outlines 1. Introduction. 2. Definition of patient care assignment. 3. Purpose of patient care assignment 4. Principles underlining all patients' care. Nursing Administration book 4th year (56) 5. Characteristics of good assignment. 6. Methods of organizing patient assignment: A) Traditional methods. B) Alternative methods. Nursing Administration book 4th year (57) Introduction: Effective management makes the organization function, and the nursing manager has a responsibility of nursing care delivery systems that demonstrate ways of organizing nursing’s work. Within these systems there are advantages and disadvantages for quality of care, use of resources, and staff growth. First and middle level managers have greatest influence on the organizing phase of the management process at the unit level, the unit manager determines how best to plan activities so organizational goals are met effectively and efficiently, this involving using resources wisely and coordinating activities with other departments. Definition of patient care assignment:  Assignment refers to a written delegation of duties in the care of a group of patients by trained employers assigned to the unit, based on their knowledge, skills, and job description and patient's nursing needs. Purposes of assignment 1. Delegate the work to be done to the nursing personnel employed in the unit based on the administrative policies, lines of authority and job description. 2. Suggest the appropriate method for delivering nursing care with maximum efficiency and minimum, effort. 3. Gain the cooperation of workers in the acceptance of the work to be done. Nursing Administration book 4th year (58) Principles underlying all patients’ care: 1. Made by the first line manager (head nurse or nurse in charge). 2. Based on nursing needs of each patient and approximate time required to care for him 3. Planned from week to week rather than from day to day to assure continuity of care. 4. The capabilities of staff, skill level and their experience are considered. 5. Take into account all indirect and unit activities. 6. Geographical location of the unit. 7. Each task must be the responsibility of one nurse. Characteristics of a good assignment: 1. It is definite and clearly understood. 2. It is related to the previous experiences.of the workers. 3. It should be written. 4. It should be interesting for the workers. 5. It should be given in such a way that workers are guided in their activities and difficulties are minimized. 6. It should emphasize essentials and recognize individual differences. Nursing Administration book 4th year (59) Methods of organizing patient assignment: Ι -The Traditional Methods: Modes of organizing patient care, There are four primary means for organizing nursing care for patient care delivery:- 1- Total patient care 2- Functional method. 3- Team method (partner in care) 4- Primary nursing (professional practice 5- Modular method 1-Total patient care nursing (case method nursing):- It is the oldest method used in which the nurses assume total responsibilities for meeting all the needs of assigned patient during their time on duty, it is mainly used for The wealthy and middle classes families but the hospital at that time was used primarily by the poor and very acutely ill patients. The method of assignment: In this method the nurse assume total responsibility for meeting all the needs of assigned patient during their time on duty, it’s mainly used for the wealthy and middle Classes. The advantages of this method: 1. Widely used in both hospital and home care. 2. Provides nurses with high autonomy and responsibility 3. Direct and simple patient assignment method. 4. Clear line of responsibility and accountability. 5. Holistic and UN fragmented care per shift. Nursing Administration book 4th year (60) Disadvantages of this method: 1. Patient receives three shifts care leads to confusion. 2. Require high skilled personnel to maintain quality of care. 3. Cost more than other method. 4. This method opponents argue that some tasks performed by the other professional nurse and others complete next shift. 2- Functional method:- It is evolved primary as a result of the 2nd world war and the rapid constriction of hospitals because nurses were in great demand overseas and at home, nursing shortage developed and ancillary personnel were needed to assist in patient care, these relatively unskilled workers were trained to do simple tasks and again proficiency by repetition such butting patient, changing linens, this form of organizing patient care was through to be temporary, but it is still used in much health care organization. The component of this method:  The head nurse: Responsible for the direction and supervision of the staff, ''reports" to the next shift of nurses who would care for the patients.  Registered professional nurses: Responsible for administering medication to all unit patients, another changing dressings and administering ordered treatments (such as postural drainage or warm Compresses) for all patients.  Technical nurses: Responsible for taking vital signs and recording intake and output for all patients in the unit, while another might is giving baths to all bedridden patients. Nursing Administration book 4th year (61)  Nurse aides: Responsible for making beds for all ambulatory patients and assisting mobility-impaired patients to move in bed or walk in the hall.  Unit clerk: Responsible for answering telephone, delivering messages, recording admissions and discharges, etc. The advantages of this method: 1. Economical means of providing care. 2. Efficient as tasks are completed quickly and little confusion regarding responsibilities. 3. Minimal numbers of registered nurse. The disadvantages 1- Fragmented care and the possibility of overlooking primarily patient need. 2- Working feels unchallenged and underestimated in their role. 3- Low job satisfaction. 4- Mutes the nursing process as the nurse who are trained as clinical become managers of patient care. 5- Employees often focus only on their Owen efforts with less interest in over results. 3- Team nursing:- This method was developed in 1950s to decrease the functional methods problems In team method ,ancillary personnel collaborates in providing care to a professional nurse , the team should not consists of more Than 5 nurses. Nursing Administration book 4th year (62) Process of implementing the team method: One registered nurse in the team is appointed by the head nurse to serve as a team leader. The team members commonly consist of at least one professional nurse, one technical nurse, nursing students and nursing aides. All team members may receive reports about their patients' care needs from the team leader or team member on previous shift. The team leader usually assigns the professional nurse to care for more ill patients, to ensure informed observation and skilled interventions for the most seriously ill patients. Often, the team leader assigns technical nurse to bath feed, move and change dressings for patients. Aides are assigned to make beds, assist ambulatory patient with bathing and grooming, test urine and perform simple care procedures. The team leader usually administers medicines and monitors potential fluid therapy for all patients assigned to the team. Without team planning and communication team nursing may become in reality just a variation of functional method. The advantages of this method:- 1- Comprehensive care provided. 2- Good communication. 3- Use in the regular team planning conference. 4- Autonomy for team members. 5- -Democratic leadership style is used. 6- Workers contribute in care by their Owen social expertise or skills. 7- High job satisfaction. Disadvantages of this method: 1. Collective accountability and responsibility. 2. Need for believing in team work concept. Nursing Administration book 4th year (63) 3. Need good judgment from the leader regarding the team member's skills 4. 4-fargmented care 5. Need for expert leader in communication skills, organizational management and leadership skills. 4- Primary nursing:- Developed in 1970s, uses some of the concepts of total patient care and brings the registered nurse in bed side nurse care. It consists of nursing staff comprised totally of registered nurses, who assume 24hrs responsibility for planning of care from admission to discharge or the end of the treatments. During the shift primary nurse provides total care to the patient when she is not duty, associated nurses follow the plan of care established by the primary nurse. Basic concepts in primary nursing: Patient assessment by a primary nurse, who plans the care to be given by secondary or associate nurse when the primary nurse is off duty. The 24 hours responsibility for care is put into practice through the primary nurse's written directive on KARDEX and other communication assignment. Complete communication of care given in the nursing staff daily reporting method. Discharge planning including teaching, family involvement and appropriate references. Process for implementing primary nursing method:  The head nurse: a). Assigns primary nurse to patient by matching the skills of the nurse to the needs of the patients. Nursing Administration book 4th year (64) b). Ensure proper scheduling for all shifts so that if primary nurse is off the unit an associate is available for care. c) Guides, counsels and evaluates care given to the patient. d.) Head nurses may also assign themselves to patients either as a primary nurse or associate nurse.  Professional staff nurse:  Primary nurse: Plans, implements and evaluates the nursing care regimens of a specific number of patients. She is responsible for the care of the patient admitted to the nursing unit until he/she is discharged. The Care load varies with the acuity of the patient's condition, and should not exceed six patients at any one time.  Associate nurse: Carries out the nursing care planned by the primary nurse when she is not on duty.  Technical nurse: May assist the primary or associate nurses in giving the care  Nurse aides: Their activities refocus away from direct contact with the patient and can be utilized as messengers and transporters.  Ward clerk: Responsible for the non-nursing functions of administrative duties. The advantages of this method: 1- Combination of clear interdisciplinary group communication allow for holistic high quality patient care. 2- High job satisfaction 3- Decrease errors in commission and omission 4- Decrease length of hospital stay 5- Decrease Cost per patient per day Nursing Administration book 4th year (65) 6- Increases Comprehensive and continuity of care. 7- Increases Patient's satisfaction. 8- Increases Patient's participation in care. Disadvantages:  High cost because there is a higher RN skill mix.  Nurse -to- patient ratio must be realistic to ensure there is enough time available to meet patient care needs.  An integral responsibility on primary nurse is to establish clear communication among all health team  Although the primary nurses who make the plan the feedback is sought from others  Responsibility and autonomy required of primary nurse. 5. Modular nursing: Modular nursing assignment is used when the nursing staff includes technical and nurse aides, as' well as professional workers. Although two or three are assigned to each module, the greatest responsibility for the care of assigned patients falls on the professional nurse. The professional nurse is also responsible for guiding and teaching non-professional nurse. Modular nursing is similar to team nursing because professional and non-professional employees cooperate in caring for patients under the leadership of a professional nurse. Module nursing is similar to primary nursing because each pair or trio of nursing personnel are responsible for the care of the patients in their caseload from admission to discharge, following discharge and during subsequent admissions to the agency. Nursing Administration book 4th year (66) As with primary nursing, the worker pair or trio arrange or another pair or trio to care for their assigned patients on alternate shifts and days off. Π-The alternative method: 1- Case manager:- It is defined as" a collaborative process that assesses, plans, implement, coordinate, monitors and evaluates Options and services to meet an individuals' health need through communication and available resources to promotes quality, cost effective outcomes". The focus is on individual client, case managers handle each case individually, and identifying the most cost effective providers. The case manager is an individual assigned responsibility for this process. The case manager may follow the patient form the diagnostic phase through hospitalization, rehabilitation and back to home care. Case manager has responsibility and authority for planning, implementing, coordinating and evaluating care for the patient. Throughout the period of illness, regardless of the patient's movement among various units and services (such as emergency room, surgical unit, recovery unit, etc.), The case manager ensures that plans are made in advance for the next needed step. Through this, the manager assists with decision-making and helps to ensure that the patient receives care that will achieve the most positive outcomes in the most efficient manner. How to implement: Registered nurses are the group of health care professionals who most often act as case managers. During hospitalization, the case manager follows the patient's progress, helps to coordinate various, services Nursing Administration book 4th year (67) needed, and discharge planning that shortens hospitalization. After discharge, the case manager continues to follow the patient's progress to ensure that desired outcomes are being attained. Case mangers employed by hospitals follow a patient from the time admission is planned through the time of discharge. This case manager might plan the admitting process to ensure that all preadmission work-ups are completed and that the patient is being admitted at the appropriate time to facilitate follow-up through on problems.. Nursing Administration book 4th year (68) Planning Continuity Of Care Nursing Administration book 4th year (69) Evaluation of Patient Care Nursing Administration book 4th year (70) Evaluation of Patient Care Objectives  Define quality, quality control, and quality of care  Differentiate between quality assurance and improvement  Differentiate between standards and criteria  Explain evaluation process  Discuss the nursing audit  List purpose of nursing audit Outlines  Definition of terms  Benefits of Quality Assurance (QA) / Quality Improvement (QI) Program in Nursing  The evaluation process:  Mechanism for Evaluation of Patient Care  The nursing audit  The purpose of a nursing audit:  The audit may be concurrent or retrospective:  Importance of the audit to nurses: Nursing Administration book 4th year (71) The evaluation process is utilized in nursing as part of the larger process of quality assurance; which begins with evaluation and proceeds according to the results of the evaluation. This is often followed by the change process or corrective action if care does not meet established criteria of quality. Definition of terms: 1. Quality: is the process of determining the degree to which patient care services increase the probability of desired outcomes and reduce the probability of undesired outcome. 2. Quality of care: health care services that are free from deficiencies and meet consumer needs, based on expectations of prices or cost. 3. Quality control: is the process which involves determining the extent to which a service matches some.specified quality standards. 4. Quality assurance: is the process of measuring the actual level of the service provided against the degree and defined standards and take positive action to modify services when necessary. 5. Continuous Quality Improvement (C.Q.I): is the process of monitoring structure, process and outcome indicators in order to identify signal events that will guide health care professionals in Nursing Administration book 4th year (72) preventing patient care problems arid improving already satisfactory patient services. 6. Standard: is a descriptive professional statement of desired or agreed level of performance against which the quality of care (structure, process and outcome) can be judged. It must be observable, achievable and measurable. 7. A criterion (criteria): predetermined measurable elements that will indicate if the standard is met and to what degree it is met. 8. A clinical indicator: is a quantitative measure that can be used as a guide to monitor and evaluate the quality of important patient care activities. Benefits of Quality Assurance (QA) / Quality Improvement (QI) Program in Nursing 1. Identifies weak areas in the structure, process and outcomes of nursing that must be changed. 2. Provides quantitative measures that will indicate the level of care provided. 3. Justifies staffing requirements or staffing change. 4. Provides effective indicators for staff education needs. 5. Provides feedback about deficiency in the care that needs corrective action. 6. Provides data for research and documents for legal aspects. 7. Promotes cost containment. The evaluation process: To conduct an evaluation of patient care, the nurse leader uses a four-step evaluation process: Nursing Administration book 4th year (73) (1) Establishing standards and criteria: In order for quality to be measured within health care, standards and criteria of achievement need to be established. Structure, process and outcome or any combination of these is the common approach to evaluation. Structure approach Process approach Outcome approach Focuses on the delivery Focuses on the nursing Focuses on the results of system by which nursing activities performed by care (outcome) administered care is implemented. nursing personnel to the patient (patient particularly nursing tasks welfare). It includes evaluation of: It includes evaluation of: It includes - Physical environment & - Assessment techniques & - Recovery rate. building. procedures. - Mortality rate. - Policies, procedures, roles - Methods of delivering - Patient's satisfaction. & regulations. nursing care. - Patient's behavior. - Job description. - Methods of patient - Patient's knowledge. - Staff number and mix, education. - Patient's self-care. orientation and in-service - Methods of documenting. schedules. - The competence of staff - Equipment. carrying out nursing care - Ancillary & paramedical services Structure Process Outcome Resources Action Results What you need What has to be done Outcomes Nursing Administration book 4th year (74) Example for evaluating patient care: A problem concerning staff safety. Staff, both nursing and non- nursing have received an injury from disposed, used sharps. Standard statement: All sharps will be disposed of without injury to members of staff. In order to meet this standard, there are some essential structure, process and outcome criteria: Structure criteria:  Policy for sharps disposal.  Staff have knowledge of this policy.  Sharps safe box, polythene bag and label. Process criteria: The nurse places all used sharps in the sharps safe box immediately. The container is closed when it is three-quarters full. The container is placed in a polythene bag and labeled for incineration. Outcome criteria:  All sharps are successfully incinerated.  No injuries to staff from sharps reported. (2) Collecting data: The collecting instrument may be: a. Rating scale. b. Checklist. c. Anecdotal record. Nursing Administration book 4th year (75) Sources of data: - Direct data that can be collected- by observing the actual performance being evaluated. - Indirect data that can be collected by assessing the product or the outcome of the event from written records that document the event. (3) Compare and make judgment: Comparing the data collected with the established criteria and making a value judgment about it, to determine if the criteria are met and the extent to which each criteria is met. (4) Corrective action and follow-up: Is based on the results of the previous step to ensure good quality of patient care services. Mechanism for Evaluation of Patient Care The nursing audit: It is a method for evaluating the quality of nursing care through appraisal of the nursing process or outcome of care as it is reflected in the patient care records. Nursing audit is a comparison of care given (as shown on the record) with the standard of care (as set up acceptable by the Individual institution). O.R. Nursing audit is the examination of a patient's records to determine the degree to which nursing care was satisfactory according to the prescribed standards and to collect data as a base for corrective action. Nursing Administration book 4th year (76) The purpose of a nursing audit: 1. To examine nursing care that has been given to clients and verifies that acceptable standards are being met. 2. Auditing a patient's chart not only indicates what ought to be included, but also that the care given is documented. 3. To improve the quality of care and the need to prove that quality care was delivered. 4. Demonstrating the value and benefits of nursing services. The audit may be concurrent or retrospective: 1. Concurrent audit: Evaluates the care conducted during patient hospitalization; it examines the care being given by reviewing what is recorded and supplemented by observation, using: a. Open chart audit: which is the review of the patient's charts and records against present criteria. As the patient is still receiving care, this process gives staff immediate feedback. b. Patient interview or observation: which involves talking to the patient about certain aspects of care, conducting a bedside audit or observing the patient's behavior to present criteria. c. Peer review: occurs when practicing nurses determine the standards and criteria that indicate the quality and evaluate performance against it. "Nurses evaluate each other." d. Staff interview or observation: which involves talking to and observing nursing behaviors related to present criteria. e. Groups conference: which involves the patient and family in a joint discussion with staff about the care being received. This leads to problems being discussed and improved plans being agreed upon. Nursing Administration book 4th year (77) 2. Retrospective audit: Conducted after patient is discharged and involves examining a large number of records or cases, using: a. Closed chart audit: It is a method used to evaluate/monitor the quality of the care provided as it is reflected on patient's records to identify strengths and deficits of care. b. Post care patient interview: which is carried out after patient is discharged. It involves inviting the patient and family members to meet to discuss their experiences. c. Post care patient questionnaire (Patient satisfaction) : which is completed by the patient on discharge or after returning home about the aspects of care provided. d. Post care staff conference: whic involves the professionals that cared for the patient. The process involves a review of records, charts and care plans. Importance of the audit to nurses: - Increases nurses' awareness of the importance and value of nursing care. - Provides nurses with guidelines for developing discharge plans. - Attaches significance to documentation and this reinforces the concept of individual accountability. -Increases learning about patient care problems. -Stimulates nurses interest in clinical nursing research. Nursing Administration book 4th year (78) Performance Appraisal Nursing Administration book 4th year (79) Objectives  Define performance appraisal & performance program  List goal of performance appraisal  Enumerate purpose of performance appraisal  Motion Principles of an effective performance appraisal  List components to be evaluated  List characteristics of good evaluation tool  Enumerate types of performance appraisal  Differentiate Methods for Appraising Staff performance  List problems in performance appraisal  Mention leadership roles  Enumerate management role Outlines  Introduction  Definition  Goal of performance appraisal  Purpose of performance appraisal  Principles of an effective performance appraisal  Components to be evaluated 1-Traits and personal characteristics 2-Results 3-Behavioral criteria 4-Combining different types of criteria Nursing Administration book 4th year (80)  Characteristics of good evaluation tool  Types of performance appraisal  Methods for Appraising Staff performance o I -Rating Methods o II- Comparative Methods o III-Written Methods o IV-Special Appraisal Methods  Management by objectives :( MBO)  Peer review  Principles of appraisal interview  Conduct an appraisal interview  a-Before the interview  b-During the interview  c-After the interview  Problems in performance appraisal  Leadership roles  Management roles Nursing Administration book 4th year (81) Introduction Employee performance is the product of three underlying factors: ability, motivation, and environment. A defect in any of the three will impair performance.(Brucks,1985) Performance appraisal refers to:  It's a systematic, interpersonal, continuous process of evaluating, staff performance using a predetermined guide or form. It starts from the time the person is employed and ends, with his or her termination or retirement.  Is the process of interaction, written documentation, formal interview, and follow up that occurs between managers and their employees in order to give feedback, make decisions, and cover fair employment practice law. Is a periodic formal evaluation of how well the nurse has performed her duties during a specified period of time.  Performance appraisal program: is the process in use in an organization by which the performance appraisal system is implemented. It is the means of redefining and improving work performance.  Performance appraisal system: is an integral function of an organization to monitor employee performance.  performance appraisal system, In order to be effective, must be : 1-Suited to the philosophy, goals, and objectives of an organization. 2-Understood by all personnel. 3-Enacted and operationalized by qualified managers and staff. Nursing Administration book 4th year (82) Goal of performance appraisal: The goal of the evaluation process should be to improve employee performance and satisfaction rather than to threaten or punish the employee for performance inadequacy. Purpose of performance appraisal  To identify an individual current level of job performance.  To identify employee strengths and weakness.  To enable employees to improve their performance (by telling an unsatisfactory worker which aspects of her/his performance need improvement)  Helping a satisfactory worker to further enhance performance.  To provide basis for rewarding employees in relation to their contribution to organization goals.  To motivate employees.  To determine salary standard.  To select qualified employees for promotion or transfer.  To identify unsatisfactory employees for demotion or termination  To identify unrecognized talent and ability.  Locating the best individual for a special assignment.  Improving communication with a disillusioned or dissatisfied worker  To provide the employees with recognition for accomplishment.  Providing the institution with information regarding the effectiveness of its recruiting and hiring process.  To maintain safe competent care.  To meet organizational goals.  To foster professional development.  To develop ideas for clinical nursing research.  To encourage career goal planning Nursing Administration book 4th year (83) Principles of an effective performance appraisal: o Certain principles or guidelines or characteristic must be followed to evaluate a subordinates job performance accurately and fairly. o The a

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