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Organizng I ❃ NURSING MANAGEMENT -7 Planning , controlling - The coordination and integration of...

Organizng I ❃ NURSING MANAGEMENT -7 Planning , controlling - The coordination and integration of Directing, Discipline nursing resources by applying the management process to upholding discipline is a core activity when running accomplish nursing care and service goals and objectives an organization, although its form varies across Is the process of working through nursing staff members organizations. to provide care, cure and comfort to patients. Management can sanction employees with This can be viewed as a relationship of inputs and outputs warnings, penalties, demotions or even dismissals. in which the workers, physical resources and technology are Unity of Command merged to bring about the organizational goals for delivery an employee should receive orders from one supervisor of quality of nursing care only. Dual command generates tension, confusion and conflict, and results diluted responsibility and blurred communication. Unity of Direction a common objective for a group of activities is an essential condition to obtaining unity of action, coordination of strength and the focusing of effort. Subordination of individual interest to general reconciling general interest with that of the group or the individual is one of the greatest problems managers face and applies to the relationship between staff and supervisor as well. ❃ MANAGEMENT Too often, managers pursue personal interest rather A process by which organizational goals are met through than the common good. the application of skills and the use of resources The process of obtaining and organizing resources and of Remuneration achieving objectivesthrough other people considering both financial and non-financial factors The coordination and integration of resources through and held that employee satisfaction is dependent on planning, organizing, directing and controlling to accomplish the composition of this mix. specific institutional goals and objectives Is the process of working through nursing staff members to Centralization of control and authority provide care, cure and comfort to patients. Fayol choose the 'living organism' as metaphor for an This can be viewed as a relationship of inputs and outputs organisation when considering centralisation versus in which the workers, physical resources and technology are decentralisation. The level of centralisation is a matter of merged to bring about the organizational goals for delivery of proportion as is the division of labour. quality of nursing care Scalar Chain August 22 ,2024 the chain of supervision that connects the managing director to the lowest ranks. Fayol combined hierarchy that makes employees aware of their place and duties, with an organisation's lines of communication. Order place for everything and everything in its place. Facilities must be tidy, materials orderly stored and staff selected according to strict procedures and clear job descriptions. Fayol advocated the creation of detailed organisational charts to support this Principle. Principles Equity Division of Work in dealings between staff and managers equity is the achieving the maximum efficiency from labour through combination of justice and kindness. specialisation across all aspects of organisation Managers must constantly apply the correct balance (commercial, financial, security, accounting, managerial) between equity and discipline. rather than just technical activities. Stability of tenure Authority and Responsibility Fayol viewed personnel planning, management having the legitimate standing to give orders. development and turnover as one activity. Authority arises from two sources: official and personal. Both staff and management require suitable Experience, intelligence, integrity and leadership ability induction periods to familiarize themselves with new are indispensable complements of a manager's official work habits and situations. authority. Managers need to act knowing that authority and responsibility are positively correlated.  Initiative - Conceptual Skills Initiative is the power to conceive a plan and ensure ability to see the organization as a whole and solve its success. problems to benefit the total system. Although Fayol regarded management as the first responsible level, he made clear that the Principle Levels of Management extended to all employees through delegated Top Managers authority. direct their attention to the major issues affecting the organization. Teamwork setting goals & objectives building and maintaining staff and management morale and unity. division strategies to meet them. Fayol considered the management style of principal job is to scan the environment & make sure 'divide and rule' counter productive. The Principles can org. is meeting objectives. still be used to identify structural flaws and sources of CEO, Chief Operating Officer, etc. conflict within an organization. Middle Managers The Three Primary Approaches to the Study of translate top management's directives for use by Management lower-level management & first-level employees. Management as a Functional Process critical in providing information for upper-level Management as an Enactment of Roles management's problem-solving. Management as the Utilization of Certain Skills department heads, division managers, deans, plant managers, sales managers. Management as a Functional Process Mission Functions Lower-Level Managers → activities directly associated with accomplishing an implement the directives and plans of middle or organization's mission. upper management. → Planning, Organizing, Leading, Controlling the entry level of management. supervisors, team leaders, foremen Creative Problem Solving → The core function of management. ! Management Functions by Level More planning by upper-level managers. → The process of practicing ongoing environmental Organizing about the same at all levels. analysis, recognizing & identifying a problem, making Leading & Controlling are performed more at lower assumptions about the decision environment, generating levels. creative alternatives, deciding, implementing & controlling Problem solving at all levels. for results. varies by situation & by industry. → Other Functions → Communicating, Representing, Staffing, Negotiating, Management Skills by Level Coordinating, & Supervising Top levels use conceptual skills more, lower levels least. All levels use human skills about equally. Management as the Enactment of Roles Lower levels use technical skills more, top levels least. Mintzberg's Managerial Roles ~ Interpersonal Relationships The Managerial Environment Often ceremonial, but critical. External figurehead, leader, liaison memorize Four principal external forces economic/ competitive T & Information Processing e technological monitor, disseminator, spokesperson communicating - political-legal P most important aspect societal S & Decision Making entrepreneur Internal disturbance handler Factors affecting decisions resource allocator negotiator P people O organization's rules, policies & procedures Use information to make decisions that solve problems. Management as the Utilization of Certain Skills Ms management systems structure - Technical Skills - ability to use tools, techniques, S strategy and specialized knowledge. R resources accountant, engineer, secretary S Human Skills - ability to work effectively in The manager must be able to balance the needs & interpersonal relationships. requirements of both internal & external environments. build trust & cooperation as they motivate, influence, or lead. 72 memor -  August 30,2024 STRATEGIC PLANNING usually strategic and long range planning is PLANNING ANSWERS the following Questions: undertaken by the top level. What action is necessary? Why? Elements of Planning decide in advance Where will it takes place? Forecasting looking - a future Why? Setting of Vision, mission, Philosophy, Goals and When will it takes place? Objectives Why? Who will do it? Why? Vision How will it be done? Why? -Should answer the basic question" what do we want to become?" - Provides the foundation for developing a Scope of Planning S 1. O comprehensive mission statement.. Strategic Planning - Top Level Management- more Critical, Broad in scope Intermediate Planning- Middle Level Mission Management - Formulation of policies, rules, regulations, An enduring statement of purpose that methods and procedures distinguishes one organization from other similar Operational Planning - Lower/First enterprises Management Level- Scheduling of daily and weekly plans A declaration of an organization's "reason for being" in the unit Some times called a creed statement, a statement of purpose, statement of beliefs, a statement of Why Planning is necessary ? business principles, or a statement "defining our Run things efficiently business" It gives meaning to work It helps in coping with crisis It helps one discover the need for change When based on the past and future helps reduce the element of change Why Planning fails? Planners are unskilled Planners act on incorrect or incomplete information Support and commitment are lacking Unanticipated events occur Planners are rigid Planners fail to overcome resistance to change Characteristics of Good Plan It should be based on clearly-defined objectives It should be simple It should provide for the proper analysis and classification of actions It should be flexible It should be balanced It should exhaust all available resources before creating new resources, applying the principle of simplicity. TYPES OF PLANNING Directional Planning D Administrative Planning A REASONS FOR DEVELOPING A MISSION Operational Planning M emorize O STATEMENT Strategic planning S I. To ensure unanimity of purpose within the organization. DIRECTIONAL PLANNING - 2. To provide a basis, or standards, for allocating - it is often called policy planning and is concerned with the organizational resources broad general direction of the programme. 3. To establish a general tone or organizational climate. ADMINISTRATIVE PLANNING 4.To serve as a focal point for individuals to identify - it is concerned with the overall implementation of the with the organization's purpose and directions, and to policies developed and with the mobilization and deter those who cannot from participating further in coordination of the personnel and material available. the organization's activity. 5.To facilitate the translation of objectives into a work OPERATIONAL PLANNING structure involving the assignment of tasks to - it is concerned with the actual delivery of the service to responsible elements within the organization. the community. 6. To specify organizational purposes and the -Short-range planning that deals with day-to-day translation of these purposes into objectives in such maintenance activities. a way that cost, time and performance parameters can be assessed and controlled.  August 30,2024 IMPORTANCE OF BUDGET Importance of Mission Statements It is needed for planning for future course of action and Effective vehicles for communicating with important to have a control over all activities in the organization internal and external stakeholders It facilitates coordinating operation of various Provide unity of directions departments and sections for realizing organizational Promote a sense of shared expectations objectives Consolidate values over time and across individuals and It serves as a guide for action in the organization interests groups Project a sense of worth 4 Components of Budget Affirm the company's commitment to a responsible action - Revenue Budget RE - Expense Budget - CHARACTERISTICS OF A MISSION STATEMENT Capital Budget - A declaration of attitude Cash Budget A costumer Orientation !! memorize A declaration of Social Policy Revenue Budget Summarizes the income which management expects to COMPONENTS OF A MISSION STATEMENT generate during the planning period. 2 Costumer Revenue Budget is a budget which pays for the cost of - Who are the firm's costumers? Product P salaries, premises, services and other running costs. / M Expense Budget -What are the firm's major products or services? ↑ Market T Describes the expected activity in operational and - Geographically, where does the firm compete? financial terms for a given period of time ~ Technology -Is the form technologically current? Capital Budget Concerns for survival, growth and profitability Outlines the programmed acquisitions, disposals and - Is the form committed to growth and financial soundness improvements in an institution's physical capacity Philosophy -What are the basic beliefs, values, aspirations, and ethical Cash Budget priorities of the firm? Represents the planned cash receipts and disbursement Self-concept as well as the cash balances expected during the planning -What is the firm's distinctive competence or major period competitive advantage? Concern for public image Factors in Budget Planning - Is the firm responsive to social, community, and Type of patient, length of stay, acuity of illness environmental concerns? Size of the hospital and its bed capacity Concern for employees Physical layout of the hospital - Are employees a valuable asset of the firm? Personnel policies: > Salaries including overtime pay or shift differential GOALS - they are the "WHAT" > Extent of vacation and sick leaves, holidays and they are long-term results we want to achieve > Provision for staff development programs including they are the potential results instructional staff that will move the organization closer to its vision and mission The grouping of patients such as those in specialized areas eg ICU o Shared vision allows ordinary people to do Standards of nursing care e.g kind and amount of care to EXTRAORDINARY THINGS be given as it affects the number of hours of bedside care The method of performing nursing care whether simple or GUIDELINES IN WRITING OBJECTIVES: complex Usually starts with the word "to" be followed by an The method of documentation action verb The proportion of nursing care provided by professional It specifies a single key result to be accomplished nurses and those given by non-professionals It is consistent with basic organizational policies and The amount and quality of supervision available and procedures provided It is realistic and attainable The efficiency of job description and job classification It is agreed upon by both superiors and subordinates The method of patient assignment, whether functional, case, team or primary The amount and kind of labor-saving devices and equipment, enter communication systems BUDGET PLANNING The amount of centralized service provided: sterile supply, central oxygen service, linen supply; BUDGET - is a concrete precise picture of the total The nursing service requirements of the ancillary operation of an enterprise in monetary terms departments: clinics, admitting office, emergency room; Budgeting - It is the planning of income and expenditures Reports required by administration whether simple or * It presents an opportunity for evaluation of programme complex; and and policies thereby identifying obsolete or unnecessary Affiliation of nursing students or medical students eg activities and giving a call for their discontinuance inexperienced students need more equipment and supplies  August 30,2024 PROCEDURES Supply a more specific guide to action than policy does POLICIES AND PROCEDURES They help achieve high degree of regularity by enumerating the chronological sequence of steps Are means to accomplishing goals and objectives Either be intra or interdepartmental It explains how goals will be achieved Morale are increased when personnel feels that they are treated equally Policies also serve as a means by which authority can be delegated I M E Polices can be: - Implied :: Expressed: Oral Written g P P E Emergence of Policies R Originated/Internal Applied O or Imposed or External = A Characteristics of a Good Policies September 6 ,2024 I. Policies should be written and understandable and known by those who will be affected by them Financial and Legal 2. Should be comprehensive in scope, stable, flexible, so that they can be applied to different conditions that are not so Aspect in Nursing divers that they require different sets of policies 3. Must be consistent Overview Financial Aspect 4. Realistic and describe limits Resources, such as personnel, supplies and equipment 5. Allow discretion and interpretation by those responsible are critical to accomplishing the goals and objectives in a for it health care delivery organization. The two major functions that are important are budgeting and resource allocation. 3 General Areas in Nursing that Require Policy Nursing managers are involved in all aspect of resource Formulation management. Successful resource management is I. Areas in which confusion about the locus of responsibility supportive of a fiscally strong organization and quality care. allocateda might result in neglect or malpertormance of an act i budget necessary to a patient's welfare, 2. Areas pertaining to the protection of patients and families' rights memorie Fiscal Planning Is the formal plan for managing the financial resources. 3. Areas involving personnel management and welfare The balance of expenditures and revenues are projected during a specific period of time, usually annually. Examples of Nursing Service Policies Allocation of projected expenses is also part of the Accidents Consent etc. budget Admissions Discharge Autopsies Death Fiscal Planning Breakage Doctor's Order It also include the goals and objectives which is critical Bulletin Boards Equipment and supplies to the development of a realistic budget, as well as the Committees Nursing Care monitoring of the budgetary expenses through control Complaints Reports procedures. Meetings Types of Budgets Capital Expenditure- Long range budgets that involve Example of Interdepartmental Policies physical chages. Admission Operating Budgets - short ter budgets that allocate Transfer funds day-to-day activities of the organization. Cash or the Cash advance supplieseierachines Discharges use Blood Bank Personnel - budget that allocates expenses related to term pesonnel. Cashier short Dietary Lab Classification of Costs Pharmacy Fixed - a cost that does not change with volume. Social Service Variable - a cost that changes based on volume. X-ray Direct - costs that can be identified for a specific service or product. Indirect - costs that cannot linked r associated with any specific service or product. Steps in Budgeting using the Nursing Process A D P I E Step 1 Assessment - Gathering information related to the goals and objectives - setting priorities - conducting an environment - Identifying financial objectives Step 3 Planning - Allocating amounts based on priority - Approving the operational and capital budgets Step 4 Implementation - To carry out the plan - Spending allocating amounts based on priority - Monitoring the budget as necessary - Allocating departmental and cash budgets Step 5 Evaluation - Obtaining performance reports and analyzing efficiency. Sample of Evaluation ORGANIZING Balanced scorecard - comprised of a range of indicators used to measure prganizational peformance the indicators are "balanced" o ensure evaluation is Elements of Organizing based on both finanacial and non financial performance Setting up of Organizational Structure Staffing Steps in Developing Scorecard Performance Scheduling Measures: Developing Job Descriptions Identify Service Objectives Consider measures for the objectives Organizing Consider the set of measures ill ensure sufficient Is the process of establishing formal authority assessment of progress towards the achievement of the It involves setting up the organizational structure objectives ey erformance indicator). It includes developing job descriptions by defining develop reporting formats. the qualifications and functions of the personnel Key Indicator to achieve a Balanced scorecard Organizational Structure Evaluation Refers to the process by which a group is formed, Patient/ Client its channels of authority, span of control and Staff communication Organization Financial Process Example: Patient/Client Complaints, satisfaction, Incidents (icludes falls, medication errors), Infection rate, waiting time, Access The Staff absenteeism (SL), incidents, Total hour of work, Education hours, satisfaction  A. Total Patient Care Nursing or Case Method Nursing 19th Century - total patient care for the wealthy and middle class was provided in the patients home which includes cooking and house cleaning and other activities in addition to traditional nursing care. Also referred as case method since patients were assigned as cases. ADVANTAGES DISADVANTAGES Oldest mode of Patient receive three organizing patient care different approaches to Line of responsibility is care which can result into clear conflict Provides nurses with Nurse can be high autonomy inadequately prepared to Types of Organizational Structure deliver patient care Line Organization Nurses assume total Ad Hoc Design responsibility in meeting Matrix Structure all the needs of the patient Flat Design Line Organization Bureaucratic Organizational Design Found frequently in large health care organization Ad Hoc Design Modification of the bureaucratic structure Use on a temporary basis to facilitate completion of a problem. Matrix Structure Is designed to focus on both product and function Function - is described as all the task required to produce the product Product - is the end result of the function B. Functional Nursing Flat Designs During World War II - Rapid construction of nurses. - Increase in demand for nurses which result into nurse Are an effort to remove hierarchical layers by flattening shortage. the chain of command - Unskilled workers were trained to assist in simple patient care task. Five Characteristics of Organizational Chart Registered Nurses became mangers rather than direct 1. Division of Work care providers. 2. Chain of command 3- Type of work to be performed ADVANTAGES DISADVANTAGES 4. Grouping of work segments Economical Fragmented care 5.Levels of Management Task are completed Overlook patient priority quickly needs Organizing Principles Allow care to be Low job satisfaction Unity of Command provided with minimal "Mutes" the nursing Scalar Principles Registered nurses process Span of Control Exception Principle Decentralization or Proper Delegation of Authority ORGANIZING PATIENT CARE Choosing the most appropriate organizational mode to deliver patient care for each unit or organization depends on the skill and expertise of the staff I, the availability of registered nurses, the economic resources of the organization. Modes of Organizing Patient Care etc 19th cent cleaning /housekeeping. A. Total Patient Care - , world was Il B. Functional Nursing Fragmented Dung - 19th cent Care Nursing- , leder Total Patient C. Team and Modular Nursing may team. Wor nurse + pt ( - World Functional Nursing During - D. Primary Nursing one - one us of on E. Case Management cont health improvement - or Modular Nursing Year Primary Nursing  ✅ ✅ ❌ C. Team or Modular Nursing Developed to decrease problem associated with functional nursing. Ancillary personnel collaborate in providing care to a group of patients under the direction of professional nurse. Teal leader's duties vary depending on the patient's needs and workload. ADVANTAGES DISADVANTAGES Comprehensive care Requires regular team can be provided planning Democratic leadership Requires more number of Shared responsibility personnel and Team leader should know E. Disease Management accountability each member's abilities Also known as management -based health care and Allows members to Need for excellent continuous health improvement. contribute own communication skills and A comprehensive, integrated approach to the care special expertise great discipline and high cost, chronic illness Recognizing the Improper implementation individual worth Blurred lines of Other Features: results to high job responsibility Focus on prevention as well as early disease satisfaction Fragmented nursing detection and intervention. care Target population groups rather than individual. Employ a multidisciplinary healthcare team, including specialists. Use standardized clinical guidelines-clinical pathways reflecting best Practice research to guide providers. Use integrated data management systems to track patient progress across care settings and allows continuous ongoing improvement. Frequent employ professional nurses in the role of case manger or program coordinator. Selecting the Optimum Mode of Organizing Patient Care Is the method of patient delivery care delivery providing the level of care stated in the organizational D. Primary Nursing philosophy? Also known as relationship-based nursing Does the method hinder or facilitate organizational One-to-one relationship between a nurse and a patient goals? with responsibility for planning and managing care clearly Is it cost-effective? established. Does it satisfy patients and their families? In the absence of the primary nurse, associate nurse follow the care plan established. Will it provide some degree of fulfillment and role satisfaction to nursing personnel? Does the system allow implementation of nursing ADVANTAGES DISADVANTAGES process? Job Satisfaction is high Nurse assumes 24 hour Does the system promote and support the Nurse able to follow responsibility profession of nursing as both independent and progress of patients Required degree of interdependent? Combination of clear responsibility and autonomy Does the method facilitate adequate communication interdisciplinary group Inadequately prepared in the healthcare team? communication primary nurse may be Nurses develops skills incapable of coordinating and they challenged and Multidisciplinary team or rewarded. identifying patient needs. STAFFING Uncomfortable for those who lack skills and Is the process of determining and providing the experience. acceptable number and mix of nursing personnel to Requires registered nurses produce a desired level of care to meet the patient's only. demand  Factors Affecting Staffing Philosophy, and objective of the hospital and Nursing service; Kind of patient served; Number of patient and severity of illness Availability and characteristics of the nursing staff Standards of care desired Layout of the nursing unit and adequacy of materials or equipment Budget Professional activities and priorities in nonpatient activities Teaching program Expected hours of work per annum of each employee Patterns of work schedule To determine the reliever needed: 33 (average the personnel is absent/year) divided by the # of working days per year each employee serves 33/213 = 0.15 (40 hrs per week work) 33/265= 0.12 (48 hrs per week work) Distribution by Shift Determining Workable Patient Classification System 45% AM Pt. Classification System- is a method of grouping 37% PM patients according to the amount and complexity of their 18% Night nursing care requirements and the nursing time and skill they require STAFFING FORMULA Nurse Manager must determine the following: 1. Categorize the number of patients according to care 1.The number of categories into which the patients should needed. Multiply the total number of patients by the be divided percentage of patients at each level of care. 2. The Characteristics of patients in each category 2. Find the total number of nursing care hours needed 3.The type and number of care procedures that will be by patients at each category level. needed by a typical patient in each category; and 3. Find the total NCH needed by the given number of 4.The time needed to perform these procedures that will be patients. Multiply the total nursing care hours needed required by a typical patient in each category per day by the total number of days in a year. 4. Find the actual number of working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year. 5. Find the total number of nursing personnel needed a. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year b.Find the # of relievers. Multiply # of Nursing Personnel needed by 0.15 (40 hrs) or by 0.12 (48 hrs per wk) c. Add the number of relievers to the number of nursing personnel needed  DEVELOPING A JOB DESCRIPTION Content: 1. Identifying data: 2. Job Summary 3.Qualification Requirement 4. Job relationship USES OF JOB DESCRIPTION 1. For Recruitment purposes 2. To orient new employees to their jobs 3. For job placement, transfer or dismissal 4.As an aid in evaluating the performance of an employee DIRECTING Is the issuance of orders, assignments and instructions that enables the nursing personnel to understand what are expected of them Elements of Directing Delegation Constant ? Nursing Care Assignment/Modalities Supervision Leadership Motivation Communication Coordination Staff Development Decision Making Conflict Management Delegation Is the process by which a manager assigns specific task/duties to workers with commensurate authority to perform the job. Principles of Delegation Select the right person to whom the job is to be delegated Delegate both interesting and non interesting job Provide subordinate with enough time to learn Delegate gradually Delegate in advance Consult before delegating Avoid gaps and overlaps What can not be delegated 1. Overall responsibility, authority, and accountability 2. Authority to sign one's name in never delegated !! 3. Evaluating the staff and/taking necessary corrective or disciplinary action 4. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff esp. new ones FACTORS CONSIDERED IN MAKING SCHEDULES 5.Jobs that are too technical and that involves trust and Different Levels of Nursing staff confidence Adequate coverage for 24 hrs, seven days a wk Staggered vacations and holidays Nursing Care Assignments/Modalities Weekends, Choosing the most appropriate organizational mode Long stretches of consecutive working days to deliver patient care for each unit or organization Evening and night shift depends on the skill and expertise of the staff, the Floating availability of registered nurses, the economic resources of the organization. ASSESSING A SCHEDULING SYSTEM 1. Ability to cover the needs of the unit SUPERVISION 2. Quality to enhance the Nursing Personnel's Knowledge, training "supervive" - to oversee and experience 3.Fairness to the staff It is the active process of directing, guiding, and 4. Stability influencing the outcome of a person's performance of an activity