NCM 119 Midterm Nursing Management & Leadership PDF

@krabbypanty on ig NCM 119 [MIDTERM] Among these three, the most commonly used is the descriptive kind of Patient Classification System. These are subdivided into NURSING MANAGEMENT AN...

@krabbypanty on ig NCM 119 [MIDTERM] Among these three, the most commonly used is the descriptive kind of Patient Classification System. These are subdivided into NURSING MANAGEMENT AND four classifications namely: LEADERSHIP a. Minimal Care/self-care b. Moderate Care c. Maximum Care HEALTHCARE DELIVER SYSTEM d. Intensive Care → An organization that provides resources and treatments that help people when they are sick or injured, and helps CLASSIFICATIONS OF PATIENT them stay healthy through preventive care. 1. CATEGORY I: MINIMAL CARE a. convalescing patients PATIENT CARE DELIVERY SYSTEM ▪ no longer require intensive, → means “the process of delivering care to the client by ▪ moderate or maximum care combining various aspects of nursing service that will fit to ▪ still need the nurse for supervision various patient care settings to produce a common b. Patients who require diagnostic studies outcome of delivering quality care and meeting the needs c. Needs minimal therapy of clients”. d. Needs less frequent observations e. Patients who are for elective surgery NSG PROCESS IN THE DELIVERY OF NURSING CARE SERVICES → The nursing process functions as a systematic guide to 2. CATEGORY II: MODERATE CARE client-centered care with 5 sequential steps. These a. Moderately ill are assessment, diagnosis, planning, implementation, and ▪ Recovering from serious illness or operation evaluation. Assessment is the first step and involves critical ▪ Needs assistance with ambulation and thinking skills and data collection; subjective and hygiene objective. 3. CATEGORY III: MAXIMUM CARE SWOT ANALYSIS a. Patient who needs close attention throughout the → An assessment tool shift → framework for identifying and analyzing an organization's ▪ Patients who require nursing to initiate, strengths, weaknesses, opportunities, and threats. supervise, and perform most of their → Primary goal: to increase awareness of the factors that go activities or who require frequent and into making a management decision or establishing a complex medications or treatment strategy. → provide prompt data to the managers and staff 4. CATEGORY IV: INTENSIVE CARE involvement in the analysis of what is effective and less a. Patient who is acutely ill effective in clinical systems and procedures. This is in b. Patient who has a high level of nurse dependency preparation for a plan of some form that could be an audit, ▪ who requires intensive therapy and/or assessment, or quality checks. intensive nursing care ▪ with unstable conditions that require PATIENT CLASSIFICATION SYSTEM frequent evaluation and adjustment of → A way of categorizing the present patients on the basis of therapy certain care needs that can be clinically observed by the nurse. SCHEDULING / ROTATIONAL PLAN → Can serve as the basis for planning the staffing needs of The objectives of scheduling and allocation procedures are to patients. assign working days and days off to individual members of the nursing staff in order to: METHODS OF CLASSIFYING PATIENTS 1. Provide adequate patient care while avoiding 1. Descriptive method overstaffing. 2. Checklist of nursing 2. Achieve a desirable distribution of off days. 3. Tasks method 3. Treat individual members of the nursing staff fairly. 4. Patient needs method 4. Let the personnel know well in advance what their schedule is DESCRIPTIVE a. purely subjective system wherein the nurse selects which GUIDELINES IN PREPARING THE SCHEDULE OF DUTY category the patient is best suited 1. Let it represent a balance between the needs of the employee and the employer (patient care). CHECKLIST o when conflicts arise, patient care should have b. Another subjective system, wherein the patient is assigned priority. to a numerical value based on the level of activity in o For example; endemic cholera with shortage of specific categories. The numerical value is added up to give staff and one nurse is supposed to be on leave the nurse an overall rating.  @krabbypanty on ig 2. Distribute fairly the “good” and “bad” days off among all → The leader assigns patients to the team members (nurses), employees. who are accountable for the patient’s care and outcomes. 3. Make all employees adhere to the established rotation. → The nurses who are assigned then delegate tasks to the o Exceptions should be rare and granted technicians or nurse's aides, within their scope of practice o All requests and exceptions should be in writing and should specify the period of time off → Advantage: requested. o each patient receives individualized care, and 4. Advance posting of time schedules as to allow employees that every member of the team can contribute to to plan for their personal concerns. decision-making o doing so reduces absenteeism and requests for changes → disadvantage: 5. Do not make time schedules a mystery nor use them as a o the nurse is still responsible for duties being tool of control or discipline performed without performing them personally. 6. Come up with a mechanism for emergency changes to accommodate both employee and employer. PRIMARY NURSING 7. Make schedule conform with all labor laws, and hospital → is also known as relationship-based practice and this and department policies. model focuses on keeping the nurse at the bedside, 8. Provide correct members and mix of personnel, allowing actively involved in patient care. conformity, which is essential for quality care. → In this model, one primary nurse is responsible for 9. Be consistent in scheduling to enable work groups develop managing the client’s care while in the hospital, from teamwork, which contributes to quality care. admission to discharge 24 hours a day. → Ratio 1:4-6 patient Scheduling is one of the most crucial components of → An associate nurse (RN) cares for the patients using the operating the nursing service or ward. care plan designed by the primary nurse while the later It is critical to the success of any nursing service because it goes off duty ensures that the resources (human) needed to accomplish → Primary nurses have the autonomy and authority for the the task in the different modalities of the delivery of care of their clients nursing care are available when needed. Tasks of the Primary Nurse: MODALITIES OF NURSING CARE a. Conduct an interview during admission → refers to the manner in which nursing care is organized and b. Assess the health status of the patient. provided. c. Develop the nursing care plan to include health → the kind of modality to be used depends on the philosophy teachings and discharge planning. of the organization, nurse staffing, and client population. d. Implement and evaluate the plan → Types of nursing care models are: o functional nursing → Advantages: o team nursing o Patient focused rather than the task o primary nursing o there is a strong development of the patient- o total patient care nurse relationship. o Case management o trust and rapport are established. o Case method o clear nursing accountability, because there is no ambiguity about who is responsible for the FUNCTIONAL NURSING patient’s care plan. → a task-oriented approach to delivering care. → Tasks are delegated to individual members of the team. → Disadvantage: → Division of labor is observed o there are no always enough registered nurses → The team members are focused on their specific task(s) available for every patient to have a primary nurse. instead of the total patient. TOTAL PATIENT CARE → Advantage: → Total patient care or patient-focused care is a model where o Task can be done in a shorter amount of time the registered nurse takes on total responsibility for planning and delivering care to the patient for the assigned → Disadvantage: time period. o Fragmented care o Nurses’ accountability & responsibility decreases CASE MANAGEMENT → It is a care delivery model that incorporates concepts of TEAM NURSING (SPORTS - TEAM NURSES) continuity and efficiency in addressing both long and → an approach where the team is led by a team leader short-term physical needs, psychological and social needs (usually a registered nurse) who is knowledgeable about of clients. the patients and in charge of evaluating the patient’s care → The primary goals are promoting self-care, upgrading the plans. quality of life and using resources efficiently.  @krabbypanty on ig → Case managers (nurses) coordinate the care of a group of TIME WASTERS AND SAVERS clients, monitor the implementation of interdisciplinary Time Wasters care plans, and maintain communication with third-party External Sources: payers and referral sources. → Interruptions by phone → The nurse follows the client through the entire stay in the → Doing work that could be delegated health care system and back into the community. (Black → Doing unnecessary paper works and Hawks, 2008) Internal Sources: CASE METHOD → Lack of objectives → It is the oldest patient care delivery method. → Failure to establish priorities → In this method, one professional nurse assumes total → Inability to make decisions responsibility for providing complete care for one or more → Inability to organize work & delegate patients (1-6) while she is on duty. → Procrastination → This method is used frequently in intensive care units and in teaching nursing students. TIME SAVERS → Learning to set priorities and objectives and organize TIME MANAGEMENT/MANAGING TIME work. → Time management is a misnomer (misleading). No one → Allowing co-workers to perform duties listed in the job manages time. What is managed is how time is Used. description or teaching them. → As a precious commodity, time must be used wisely and → Avoiding wasted motions – learning to be dexterous efficiently. (skillful) → Once time is lost or passed, it cannot be recalled → Avoiding procrastination → Time is a major source that should be managed well. → Using computer, tape recorder, etc, whenever possible. → Using the wastebasket PRINCIPLES OF TIME MANAGEMENT 1. Effective communication facilitates time management. → Correct information and clear messages minimize or irradicate errors that can lead to wasted time and useless expenditure of energy. 2. The ability to plan effectively is essential to the effective use of time. → Planning charts the course of action in order of importance. → Every minute spent in planning saves time in the execution of activities. → The basic issue in “time-saving” planning is that optimal results occur with the least amount of effort. 3. Procrastination prevents others from doing their work. → Planning properly makes the manager manages the 5 S IN A WORKPLACE time wisely and efficiently. → provide a methodology for organizing, cleaning, developing, and sustaining a productive work 4. Delegation environment. → Ensures that the work of the the organization is completed on schedule. 1. Sort (or Seiri) → The most efficient and effective use of time occurs → classify through all materials to find the most useful when the the manager manages and the professional items, keep them and remove what is not needed staff do the operative work 2. Set in Order (or Seiton) Efficiency → ensure that each item is properly organized and → refers to doing the task Right (doing more with less) assigned a location. Effectively 3. Shine (or Seiso) → refers to doing the right Task correctly (the quality → proactive efforts to keep the workplace clean and that the resources (eg. time) are delivered orderly. → A result-oriented manager executes the plan of the 4. Standardize (or Seiketsu) organization through the appropriate use of → set up a set standard for your organization and your delegation processes.  @krabbypanty on ig → You take the first three S’s and create rules to govern TIME EVALUATION how tasks are done. These standards could include → Do this periodically to assess the use of time charts, lists, schedules, etc. The ability to organize and use time effectively is the 5. Sustain (or Shitsuke) “hallmark of good management”. → The nurse manager must adopt new practices and perform audits to maintain discipline. TIME MANAGEMENT STRATEGIES NURSING MANAGEMENT FUNCTIONS → Are approaches to preserve, conserve, structure, and use Planning time to meet goals Organizing Leading / Directing Time Management Strategies. Controlling ✓ Time analysis. ✓ Daily planning PLANNING ✓ Crisis control → The forecasting of events, making decisions, setting goals, ✓ Problem analysis setting priorities, developing policies, and setting ✓ Task analysis standards. ✓ Time control ✓ Time evaluation → According to Rowland and Rowland (1992), planning directs our thinking toward: TIME ANALYSIS o What activity do we expect to do? → this is a personal diary in of all activities in 15 minutes ▪ Why it will be done? blocks are recorded for a week. ▪ Where it will be done? → This log becomes the basis of analysis. ▪ When do we expect to do it? → It reflects apparently where time is spent, wasted and ▪ How it will be done? properly used. ▪ Who is going to do it? DAILY PLANNING TYPES OF PLANNING → planning should be in time frames (timelines) with the 1. STRATEGIC PLANNING manager’s responsibility. ✓ a process in which an org’s leaders define their vision → Done daily, weekly, and Monthly bases. for the future and identify their org’s goals and → review plans for the evening preceding to ensure the objectives. completeness of the activities ✓ The process includes establishing the sequence in which those goals should be realized so the org can CRISIS CONTROL reach its stated vision. → Refers to the communication and delegation of a new plan reorganized around priorities to manage an unexpected Main Purpose: and untoward event. ✓ Necessary to determine the direction of your → Inform at once the people involved with the details of the organization problem. ✓ It focuses your efforts and ensures that everyone in the nursing service works towards a common goal PROBLEM ANALYSIS ✓ Also helps you agree with actions that will contribute → Distinguish crisis, urgent situation, and important event. to the growth and improvement of the nursing service They need different responses. 5 steps in Strategic Planning ▪ Crisis - requires major reorganization of priorities. 1) Assess the org’s strategy and environment (SWOT ▪ Urgent situation - requires immediate action Analysis) ▪ Important event – requires analysis and planning 2) Identify your company’s goals and objectives (what the nursing service wants). Goals drive priority TASK ANALYSIS setting, resource allocation, capability requirements, → Evaluate the tasks performed. and budgeting activities. → In this way you can discuss which of the tasks are of low 3) Develop your strategic plan and determine value and could be eliminated, consolidated, and performance metrics (how to achieve the goal, what delegated. assessment as means of monitoring is) 4) Implement and share your plan TIME CONTROL 5) Revise and restructure as needed → At certain times, simply sit down in the office, think, or clear up pressing business.  @krabbypanty on ig How to do (7 steps) Strategic Planning: → Review it with key managers so that each knows her Step 1: environmental scan personal responsibilities for the accomplishment of Step 2: internal analysis activities. Step 3: strategic direction Step 4: develop goals and objectives 5. Review the appropriate portions of the department’s Step 5: define metrics, set timelines, and track progress operational plan also with subordinates when they are Step 6: write and publish a strategic plan being counseled. Step 7: plan for implementation and the structure 6. Plan ideas gleaned from professional publications for Main Benefit of Strategic Planning discussion. A strategic plan allows orgs to anticipate things that → Integrate research results into practice are most likely to happen and prepare accordingly PHASES OF PLANNING Purposes: 1. DETERMINING OBJECTIVES ✓ Helps clarify beliefs and values of the org → Identify nursing concerns ✓ Give direction to the org → Outline data for each concern – as the basis to ✓ Improve communication and coordination of determine procedures & courses to be followed. activities ✓ Eliminate duplication of efforts 2. COLLECTING DATA ✓ Allow adaptation to the changing environment Using existing data presents few problems. Use of the data ✓ Set realistic and attainable goals involves: → Identifying their sources 2. OPERATIONAL PLAN → Assessing the relevance, timeliness and accuracy ✓ Also known as work plan → Abstracting the data from the original sources ✓ The process of turning your strategic plan into a → Analyzing the meaning & implications of the data. detailed map that outlines exactly what action your team will take on a weekly or sometimes even daily Methods in Collecting Data: basis. a) Questionnaire ✓ Focuses on the short-term execution of strategies and b) Interview tactics to achieve the org’s strategic objectives c) Observations ✓ Shows how best to use the company’s resources to achieve those strategic objectives 3. DEVELOPING THE PLAN OF ACTION ✓ Deals with day-to-day maintenance activities In this phase, attention is given to the following: ✓ Done in conjunction with the preparation of the → Specify the goals, objectives, and policies for carrying budget. out recommendations and suggested programs. → Phasing activities (the action of dividing a large task 3. UNIT PLANNING or process into several stages. “The phasing of the ✓ Department of unit planning should be done daily, overall project”) so that the resolution of problems weekly, or long-range basis. requiring immediate actions leads to actions and measures for attaining long-range goals PRACTICAL DAY-TO-DAY ACTIONS FOR NURSES → Specify the time span for achieving specific objectives 1. At the beginning of each day, or steps in the plan → make a list of actions to be accomplished. → Providing Methods for the evaluation of progress → Cross off the actions as they are accomplished or at the end of the day. 4. EVALUATING THE PLAN → at the beginning of the next work day, carry over A plan is generally good if: actions not accomplished; either do them first or → Aligned with the objectives decide whether they really need to be done. → Indicates the procedural method for putting the plan → Do not hold tasks over from one day to the next into action. indefinitely → Can be communicated effectively → Is operational, professionally sound, and economically 2. Plan meetings ahead. feasible. → If the meeting is a nursing responsibility, prepare and → Allows alternate courses of action as changes occur & distribute a copy of the agenda in advance. opportunities for new approaches arise. 3. Identify developing problems and place them in the DECISION-MAKING appropriate portion of the division’s operational or → Means choosing options that are directed toward the management plan. resolution of organizational problems and the achievement of organizational goals. 4. Review the operational plan on a scheduled basis.  @krabbypanty on ig → Attributes of a decision maker: c. Compare alternatives o The freedom to make the decision in question → Think of the disadvantages and advantages of o The capacity and ability to make a wise decision each in terms of cost, manpower, time which requires: a. Sound judgment d. Rate the risk b. Deliberation → Rate the degree of risk of every alternative c. Objectivity d. Experience e. Select the best alternative o The will, motivation and commitment to choose → Remember: no alternative is desirable which requires: a. Volition (will) f. Get into Gear b. A conscious activity of the will to make a → Make your decision operative decision Problem-solving – the process of coming up with ways to fix TYPES OF DECISIONS something that's wrong or not working. 1. CONSIDERED DECISIONS ✓ Are of great magnitude Decision-making – the process of choosing the best option ✓ Complicated and needs considerable reflections among the ideas you've come up with thru problem-solving. ✓ Aside from the personal thoughts, this needs interactions with others since perceptions of others BUDGET will provide multiple alternatives that help to address → It is necessary for the nurse manager to be aware of the the situations financial concerns that affect the Organization and the ✓ Considered decision requires time to find alternatives Nursing Department 2. OPERATIONAL DEICISIONS → The Nurse Manager should actively participate in the ✓ Made practically every day preparation of its budget since the nursing department accounts for as much as half of the total expenditure of the 3. SWALLOW-HARD DECISIONS hospital ✓ Often, personally uncomfortable to make since they may result in discomfort or uneasiness for → BUDGETING – an allocation of scarce resources on the subordinates or others. basis of forecasted needs for proposed activities over a ✓ This affects interpersonal relationship specified period of time. 4. TEN-SECOND DECISIONS PURPOSES OF BUDGETING ✓ Made during daily operation 1. Ensure the most effective use of scarce financial and ✓ They bring operations together and keep them ready, non-financial resources alive, and running well. 2. Coordinate efforts among organizational departments ✓ The overriding factor in a ten-second decision is the 3. Establish a frame of reference for managerial pressure to make it quickly. decisions GUIDES TO MAKE THE TEN-SECOND DECISION TYPES OF BUDGETS (QUICK DECISION) INSTITUTIONAL BUDGET: 1. Manpower Budget 1) Determine 1st whether the situation really requires one ✓ Includes: wages, salaries, and compensations 2) Determine the major objective of that decision paid to permanent employees or for casual or o Determine what you are trying to accomplish before temporary workers leaping in and solving the problem. 3) Determine the alternatives after determining the 2. Capital Expenditure Workers objectives ✓ requires long-range planning 4) Establish the implications. Think of what could go wrong in ✓ Includes purchase of land, equipment, the future if you pursue a given course of action renovations, buildings DECISION-MAKING PROCESS 3. Operational Budget ✓ Includes purchase of minor equipment, repairs, a. Analyze and identify the situation supplies, or overhead expenditures (insurance, → Clarify 1st the situation and consider the rent, utilities and others) circumstances. → Find out what’s wrong and why it’s wrong b. Develop alternatives → Taking action or not and more  @krabbypanty on ig BUDGETING PROCESS ❖ Any organization needs to create, execute, and realize organizational goals. Preliminaries to Budgeting ❖ To make this happen, the functions of management must 1. Review the financial performance during the prior work together. budgeting time frame (month, year) 2. Formulate a new budget PHASE 1 – PLANNING ORGANIZING a. Set short- and long-term goals → The grouping of activities for the purpose of: b. Form a budget committee o Achieving objectives, c. Prioritize objectives o Assigning the groups to a manager with authority d. Analyze past performance to supervise, e. Predict future costs and revenues o defining means of coordinating appropriate f. Develop budget guidelines activities with other units, horizontally and vertically, that are responsible for accomplishing PHASE 2 – PREPARATION organizational objectives a. Translate objectives into projected costs and revenues b. Write justifications for all requested expenses → organizing the nurse manager to determine: c. Eliminate lowered priority objectives as necessary o what tasks are to be done, d. Present proposed budget o who is to do the task, o how the tasks are to be grouped, PHASE 3 – MODIFICATIONS AND APPROVAL o who reports to whom, and a. Prepare preliminary master budget from all o what decisions are to be made department requests b. Compare projected costs with estimated revenues → a form of identifying the roles and relationships of each c. Eliminate lowest priority items until budget is staff in order to delineate (carry out) specific tasks or balanced functions that will carry out organizational plans and d. Approve final master budget objectives. e. Communicate final budget to all departments Essentials in Planning and Organizing: PHASE 4 – MONITORING a. Vision and Mission Statement a. Prepare monthly summaries of the departmental b. Philosophy and objectives expenses c. Policies and procedures b. Investigate any variance above 5% d. Job description c. Readjust budget and/or improve performance as necessary ORGANIZING PROCESS d. Continue to monitor on monthly basis 1. Identifying and defining basic tasks. → Process of identifying and grouping the work to be performed HEALTH CARE 2. Delegation of authority and assigning responsibility Philippines to hire unlicensed nurses as shortages bite → Process of defining and delegating responsibility The DOH recently announced plans to hire thousands of and authority. unlicensed nurses to fill vacancies in government hospitals. DOH said that nurses who had failed the board exam but 3. 3. Establishing relationships scored between 70% and 74.9% on the test would be eligible for temporary licenses. → This refers to the building of a structure DOH Secretary Teodoro Herbosa (arrangement) that will provide for the separation of activities to be performed and Addressing the Burnout and Shortage of Nurses in the Philippines. indicate their hierarchal importance and Rowalt Alibudbud, MD functional association. burnout among Filipino nurses lead to resignations, change of profession, and migration to other countries. THREE FORMS OF AUTHORITY shortage of local nurses poses a significant threat to the A. LINE AUTHORITY Philippine healthcare system. → a direct supervisory authority from supervisor to While mental health programs and interventions may help subordinates. address burnout, structural factors affecting burnout, such as low salaries, delayed benefits, understaffing, overworked conditions, and job insecurity, must be addressed. 1) Chain of Command – this refers to the unbroken line of It is necessary to mobilize existing resources, such as hiring reporting relationships that extends through the entire nurses to permanent government positions, and improve organization. policies to address burnout among Filipino nurses. ✓ The line defines the chain of command and the formal decision-making structure.  @krabbypanty on ig 2. Coordinates internal and 2) Unity of Command – it refers to the guideline that each external influences person in the organization should take orders and report Middle Level 1. They conduct day-day Head Nurse, only to one person. Managers operations with some Department involvement, long term Head, Unit - planning and policy making. Supervisor/ 1) Span of Control – refers to the number of employees that Manager should be placed under the direction of one leader- First Level 1. Concerned with specific Charge Nurse, manager. Managers unit workflows. Team Leader, Primary Nurse, B. STAFF AUTHORITY 2. Deals with immediate day- Staff Nurse → authority that is based on expertise and which day problems. usually involves advising the line managers. PATTERNS OF ORGANIZATIONAL STRUCTURE C. TEAM AUTHORITY 1. TALL / CENTRALIZED STRUCTURE → is granted to committees or work teams involved ✓ Responsible for only a few subordinates so there is a in an organization’s daily operations. narrow span of control o Work teams are groups of operating ✓ Because of the vertical in nature, there are many employees who share a common vision, levels of communication goals, and objectives. ✓ Communication is difficult and messages do not get to the top. ORGANIZATIONAL CHART ✓ Workers are boss-oriented because of close contact → Drawing/diagram that shows how the parts of the with their supervisor. organizations are linked. → It shows the formal organizational relationship, areas of 2. FLAT / DECENTRALIZED STRUCTURE responsibility and accountability, and channel of ✓ Characterized by few levels and a broad span of communication. control → Illustrates the organization’s structure. ✓ Communication is easy and direct Advantages: ✓ Shortens the administrative distance from the top to the lower ✓ Solutions to problems are easily carried out/fast response ✓ Workers developed their abilities and autonomy Disadvantage: ✓ Impractical in large organizations. TYPES OF ORGANIZATIONAL STRUCTURE 1. LINE ORGANIZATION/ BUREAUCRATIC/ PYRADIMAL ORGANIZATIONAL STRUCTURE → There is a clearly defined superior-subordinate → To make unity of command in the organization possible relationship each employee is joined into the network of the → AR and power are concentrated at the top organization. → Pyramidal command structure. → Each employee must receive information from the → very organized with a high degree of formality in the centrality of the organization no matter where the way it operates. employee is in the organization, whether the employee is → Organizational charts generally exist for every near the centrality or peripherally located. department, and decisions are made through an → In the organizational chart lines symbolize communication, organized process relationship command, and authority → Solid Horizontal Line o represents the same positions but different functions. → Solid Vertical Line o the chain of command form authority to subordinates (line authority) MANAGERIAL LEVELS Level Scope of Responsibility Examples Top Level 1. Generally make decisions CEO, President, Managers with the help of few V-President, guidelines or structure. Chief Nursing Officer  @krabbypanty on ig 2. FLAT/HORIZONTAL ORGANIZATION → Decentralized type → Applicable in small organization → Nurses become productive and directly involved in the decision-making skills → Workers become satisfied → Few levels of management between the workforce and the highest level of managers → absence of middle managers → Middle manager roles are shared by the top manager and the workforce although workers report directly to 5. MATRIX STRUCTURE the top manager → Focus on both product and functions → Greater autonomy and authority of the worker in → Most complex terms of decision-making → Has both vertical and horizontal chain of command → Has few levels of management between the and line of communication workforce and the highest-level managers. The → A combination of two or more types of organizational absence of the middle managers places more structures. It is a way of arranging the business so as authority, such as decision-making functions, at the to make a set up reporting relationships as a grid, or a worker level. matrix, rather than in the traditional hierarchy. → In a flat organizational structure, there are few levels of management. Thus workers will report directly to higher-level managers. This means that the role of middle-manager is shared between the workers and the higher-level managers. It generally means greater autonomy and authority for the worker. It can also be more efficient for the org to not have various levels of bureaucracy. This structure can serve to motivate employees who are more autonomous. → Flat structure generally employs collaborative work teams as a method of employee oversight. STAFFING → One of the major functions of a nurse manager → Involves deciding what type of and how many personnel are needed to provide adequate and quality patient or client care 24 hrs a day, 7 days a week, and 52 weeks a year. → Process of assigning competent people to fulfill the roles 3. FUNCTIONAL ORGANIZATION designated for the organizational structure through: → Permits a specialist to aid line position within a limited o recruitment, and clearly defined scope of authority. o selection and → A functional organizational structure is a business o development, structure that groups employees by specialty, skill, or o induction and related roles. It is based on levels of hierarchy that o orientation of the new staff of the goals, vision, include different departments, under the direction of mission, philosophy etc. designated leaders. STAFFING PROCESS → Preparing to Recruit – types and number of personnel → Attracting a Staff – formal advertisement → Recruiting and Selecting a Staff – interview ► induction ► orientation → ► job order ► pre-employment testing ► signing of contract STAFF DEVELOPMENT 4. AD HOC ORGANIZATION → Seminar-workshops Modification of bureaucratic structure → In-service training programs → An ad hoc activity or organization is not planned in → Reading professional publications advance but is done or formed only because a → Conferences particular situation has made it necessary → Engaging in other activities → Most teams in hospital medicine are ad hoc, meaning that the teams vary in participants. Ad hoc teams can be found in academic teaching hospitals where team members change across shifts and rotations.  @krabbypanty on ig SYSTEMS OF ASSIGNMENT (NURSING CARE MODALITIES) 4. STAFF SUPPORT 1. CASE METHOD → staff support in place for the operations of the units ✓ each patient is assigned to a nurse for total patient or department care including medicines and treatment. 5. HISTORICAL INFORMATION 2. FUNCTIONAL METHOD → review of any data on quality or staff perception ✓ Nurses are assigned to perform specific tasks based regarding the effectiveness of the previous staffing on the employee’s education and experience pattern 3. TEAM METHOD PATTERN CLASSIFICATION SYSTEM ✓ Grouping of personnel as a team to give total care to ✓ Measuring tool used to articulate the nursing workload for a selected group of patients a specific patient or group of patients over a specific time. ✓ Patient Acuity – a measure of nursing the workload that is 4. PRIMARY METHOD generated for each patient. ✓ The primary nurse is given the full responsibility of planning, implementing, and evaluating the nurse’s PATIENT CARE IS CLASSIFIED ACCORDING TO: care for 4 or 5 patients Category I – Self-care or minimal care ✓ The primary nurse plans 24-hour continuity in nursing 4. patients are capable of carrying ADL, e.g., hygiene, meals care utilizing a written nursing care plan, etc. communicates with other members of the health team, and plans for the discharge of his or her patients Category II – Intermediate or moderate care 5. Requires some help from the nursing staff with special 5. MODULAR METHOD treatments or certain aspects of personal care, e.g., ✓ A combination of primary and team nursing where the patients with IV fluids, catheter, respirator, etc. nurse is assisted by non-nursing members to take care of 8-12 patients Category III – Total or maximum care 6. patients are those who are bedridden and who lack Staffing Pattern – plan that articulates how many and what strength and mobility to do average daily living. Ex: kind of staff are needed/shift or per day in ►unit or in patients on CBR, immediate post-op, with contraptions. ►department. Category IV – Intensive care TWO WAYS OF DEVELOPING A STAFFING PATTERN 7. patients are those who are critically ill and in constant Determine the # of nursing care hours needed/patient danger of death or serious injury. Ex: comatose, bedridden ✓ Generating the full-time equivalents of an employee etc. Determine the nurse-patient ratio in providing nursing care SCHEDULING FTE (full-time employee) – a measure of work committed by a → Timetable showing planned work days and shifts for full-time employee nursing personnel. → FTE = works 5 days/week, 8 hours/day → Issues to consider in scheduling staff: → 0.5 FTE = part-time employee who works 5 days/2 o Patient type and acuity weeks o Number of patients o Experience of Staff CONSIDERATIONS IN STAFFING PATTERN o Support available to the staff 1. BENCHMARKING → Management tool for seeking out the best practices in PURPOSE: one’s industry so as to improve one’s performance. o Provide adequate patient care while avoiding overstaffing → Process of measuring products, practices, and o Achieve a desirable distribution of off days. services against best-performing organization as a o Treat individual members of the nursing staff fairly. tool for identifying desired standards of organizational o Let the personnel know well in advance what their performance. schedules are 2. REGULATORY REQUIREMENTS – MANDATED BY RA GUIDELINES IN SCHEDULING → In the Philippines, the nurse-to-patient ratio typically 1. Consider the balance between the needs of the employee stands at 1:20 but can escalate to 1:50, far exceeding and the employer (patient care) the 1:12 standard set by the Philippine Department of 2. Distribute fairly the good and bad days off among Health (Tamayo et al., 2022; Villanueva, 2023). Aug employees 13, 2023 3. Make all employees adhere to the established rotation. 8. request may be granted but it should be made in writing 3. SKILL MIX 4. Advance posting of time schedules so as to allow personal → percent or ratio of professionals to non-professional lives if desired. Ex: 40 FTE (20 RN + 20 non RN) = 50% RN mix 5. Do not make a time schedule to control or discipline  @krabbypanty on ig 6. Come up with a mechanism for emergency changes to a. hours on duty per day X actual working days per accommodate both employees and employer. year. 7. Make the schedule conform with all labor laws, and hospital and department policies. 5. Find the total number of nursing personnel needed. 8. Provide correct numbers and mix of personnel, allowing a. divide the total number of nursing hours needed continuity, which is essential for quality care. by the given number of patients per year by the 9. Be consistent in scheduling to enable work groups to actual number of working hours rendered per develop teamwork, which contributes to quality care. year. b. find the relief. Multiply the number of nursing SHIFTING VARIATIONS personnel needed by.095. ✓ Traditional Shifting Patterns c. add the number of relievers to the number of o 3 shifts (8 hr shift) needed nursing personnel. o 12 hr shift o 10 hr shift 6. Categorize into professional and non-professional ✓ Weekend option a. multiply the number of nursing personnel according ✓ Rotating work shift to ratio of professional and non-professional ✓ Self-scheduling – staff make their own schedule ✓ Permanent work shift 7. Distribute shifts ✓ Floaters – “on-call” DIRECTING Forty-Hour Week Law – based on RA 5901 → one of the functions of the nurse manager to get the work No work, no pay done through others. Entitled to 2-week sick leave and off duty for 2 days → The nurse manager directs personnel and activities to Special Holidays – with pay achieve the organization's goals. → In nursing, directing means giving directions to others to → With at least a night differential of 10% of the employee's attain quality client care. regular wage for each hour worked between 10:00 PM and → (Douglas 1998): issuance of assignments, orders, and 6:00 AM. instructions that permit the worker to understand what is → If an employee works during both regular and night shifts, expected of them and the the night differential pay should be computed based on → guidance and overseeing of the workers so that they can the actual hours worked during the night shift contribute effectively and efficiently to the attainment of the organizational objectives. STAFFING FORMULA → Studies have shown that the morning shift needs the most The success of directing is dependent on several factors or its number of nursing personnel, that is 45%, the afternoon elements: shift needs 37% and the night shift only about 18% ✓ Leadership → Reason: more nursing care is given during the morning ✓ Delegation and afternoon shifts than during the night shift. ✓ Supervision ✓ Motivation The procedure for computing the number of staff needed in ✓ Communication the in-patient areas of the hospital is as follows: 1. Categorize the number of patients according to the level LEADERSHIP (MITTON) of care needed by hospital classification. → the process of sustaining an initiated action a. Total number of patients X percent at each level → Not a matter of pointing in a direction and just letting of care things happen → Is a conception of a goal or method of achieving 2. Find the total number of nursing hours needed by patients → Mobilization of the means necessary for attainment per day at each categorized level. → Adjustment of values and environmental factors in the a. number of patients at each level average nursing light of the desired level. hours needed per day → Involving followers; building Interpersonal relationship; b. get the sum of the nursing hours in the various influencing others levels. BASES OF POWER 3. Find the total number of nursing hours needed by the → When confronted with a situation, a leader can exercise patients per year. power and influence to persuade others to perform to the a. total number of nursing hours needed per day X best of their abilities. 365 days of the year → Power is the capacity to ensure the outcomes one wishes and to prevent those (outcomes) one does not wish. 4. Find the actual number of working hours rendered by each nursing personnel each year.  @krabbypanty on ig o REWARD POWER ✓ Both the manager and subordinate understand the ✓ Based upon the number of incentives that the leader responsibilities, the expected results, how the can provide for group members and upon the degree performance is done and it will be evaluated. to which the group members value those incentives. ✓ Based on the leader’s formal responsibilities like AUTHORITY influence on determining the salary or vacation time ✓ The power to make decisions and give command for the staff ✓ Refers to what must be done to complete a task and the obligation created by the assignment o PUNISHMENT OR COERCIVE POWER ✓ Both the manager and subordinate understand the ✓ Is based on the negative things that the leader might responsibilities, the expected results, how the do to individual group members or the group as a performance is done and how it will be evaluated. whole ✓ Note: Although authority is delegated, the manager ✓ Example: formal reprimand, recommendation for still maintains control and may recall the authority firing or the salary be docked ACCOUNTABILITY o INFORMATION POWER ✓ Refers to liability ✓ based on “who knows what” in an organization and ✓ It is the fulfillment of the formal obligation to disclose the degree to which access to information can be to referent others (stakeholders) the purposes, controlled principles, procedures, relationships, results, income, and expenditures for which one has the authority o LEGITIMATE POWER GUIDELINES FOR EFFECTIVE DELEGATION ✓ Stems from the group members’ perception that the 1. Give a clear description of what it is you want the staff to nurse manager has a legitimate right to make a do. request o Describe the overall scope and background of the ✓ Based on the authority delegated to the nurse current task manager by virtue of his job and position w/n the 2. Share with the staff the outcome you expect and by when organization 3. Discuss the degree of responsibilities and authority that the staff will have o EXPERT POWER 4. Ask the staff to summarize the main points of the task that ✓ Is based on particular knowledge and skills not has been delegated possessed by the staff AREAS TO CONSIDER FOR DELEGATION o REFERENT POWER 1. Routine Task ✓ Based on admiration and respect for an individual as 9. example, scheduling of non-nursing personnel a person 2. Task for which you do not have time 10. especially if there are urgent matters ELEMENTS OF DIRECTING 3. Problem Solving DELEGATION 11. the problem is of medium or low priority → Act of assigning to someone else a portion of the work to 12. delegated to staff with expertise be done with corresponding authority, responsibility, and 4. Change in your own job emphasis accountability (ANA). o relinquishing the responsibility will give the → According to ANA, it is the transfer of responsibilities for manager more time for the challenging tasks the performance of the task from one person to another. 5. Capacity building. → Much of the work of a manager is accomplished by transferring the responsibilities to subordinates AREAS NOT TO BE DELEGATED 1. The power to discipline PURPOSE OF DELEGATION o Power to discipline is the backbone of executive → To promote internalized motivation and enrichment authority 2. Responsibility for maintaining morale (self-confidence; REASONS FOR DELEGATING self-esteem of the staff) → Saves time and can help develop others 3. Overall Control → Maximizes the use of talents of staff associates o no matter how extensive the delegation, ultimate → Uses latent (hidden) abilities in personnel that contribute responsibility for final performance rests on the to their growth and development manager’s shoulder 4. 4. The “hot potato” ASPECTS OF DELEGATION o do not ever make the mistake of passing one RESPONSIBILITY along just to take yourself off the spot. ✓ Denotes obligation ✓ Refers to what must be done to complete a task and the obligation created by the assignment  @krabbypanty on ig BARRIERS FOR DELEGATION the activities to meet the goals and objectives for 1. “I can do it better fallacy” personal development in making the work better. 2. Lack of the ability to direct guides to direct: COORDINATION ✓ think ahead and visualize the work ✓ arranging in proper order. It creates harmony in all ✓ Formulate objectives and general plans of action activities to facilitate the success of work ✓ Communicate 3. Absence of controls that warn of impending difficulties ELEMENTS OF DIRECTING o absence of confidence (fear of outcomes) SUPERVISION 4. Aversion to taking a risk → Involves overseeing the activities of others o Manager may be handicapped by a → Consists of inspecting the work of another and temperamental aversion (distaste) to taking the approving or correcting the adequacy of performance risk → Concerned with people → Concerned with the work area Managers who do not delegate → Concerned with the working conditions and the work ✓ Does not trust itself ✓ Fear of mistake ✓ Fear of criticism Purpose of Supervision ✓ Fear of own ability to delegate ✓ Inspect, evaluate, and improve worker performance ✓ Provide suitable working conditions for the staff COMMON ERRORS IN DELEGATION ✓ Orient, train, and guide the individual staff member UNDERDELEGATING 13. systems from the manager’s false assumptions that PRINCIPLES OF GOOD SUPERVISON delegation maybe interpreted as a lack of ability on his Good supervision: part to do the job correctly and competently. ✓ Focused on the improvement of the work rather than on 14. Reasons are: upgrading the worker o Managers believe that they can do the work ✓ Is based on the needs of individuals that have been faster and better cooperatively determined o Managers believe that the responsibility may be o it employs techniques that provide for self-study rejected if delegated by staff members, as a starting point in their growth and development OVERDELEGATING ✓ Is cooperatively planned → subordinates become overburdened which may lead to o objectives, methods of supervision and criteria dissatisfaction and low productivity. for judging success in the attainment of goals are → Reasons are: established o Managers who are lazy ✓ Employs democratic methods o Managers who are overburdened and exhausted ✓ Stimulate the staff to improve continuously. o arouse interest and enthusiasm IMPROPER DELEGATION ✓ Respect the individuality of the staff. → delegating to the wrong person, time, tasks, and beyond o accept idiosyncrasies (peculiarities) the capability of the subordinates. ✓ Help create a social, psychological, and physical atmosphere in which the individual is free to function on STEPS IN EFFECTIVE DELEGATING his or her own top level 1. Plan ahead 2. Identify necessary skills and levels COMMUNICATION 3. Select the most capable personnel → exchange of ideas, thoughts or information through 4. Communicate goal clearly verbal speech, writing and signals. Its aim is the 5. Empower the delegate understanding of information from one person to 6. Set deadlines and monitor progress another 7. Model the role and provide guidance 8. Evaluate performance 6 STEPS OF COMMUNICATION PROCESS FACTORS INFLUENCING EFFECTIVE DELEGATING ideation → encoding → transmission → receiving → decoding MOTIVATION → response → encoding → transmission → receiving → ✓ whatever influences our choices and creates decoding → response direction, intensity, and persistence in our behavior. 1. Ideation SUPERVISION ✓ sender decides to communicate the developed idea ✓ guiding and directing the work to be done. It entails motivating and encouraging the staff to participate in  @krabbypanty on ig 2. Encoding TWO TYPES OF CONFLICT ✓ putting meaning to symbolic forms: speaking, writing, COMPETITIVE CONFLICT non-verbal behavior Influence by: culture, → 2 or more groups with the same goal and only one professional biases group can attain them → Management: Set Goals 3. Transmission ✓ actual expression of the message DISRUPTIVE CONFLICT ✓ Factors that affect: garbled (distorted) speech, → takes place in an environment filled with anger, fear, unintelligible use of words, noise and, and other and stress. There is no mutually acceptable set of disturbances rules and the goal of each party is the elimination of each opponent. 4. Receiving ✓ receiver senses the communication (seeing or hearing CONFLICT RESOLUTION STRATEGIES or reading) 1) Use of dominance and Suppression ✓ Factors influencing the interpretation of the message: - Win-lose strategy o Receiver selective attention (hear only what - Loser feels angry is interesting) o Receiver perception (hear only what they 2) Restriction want to hear) - autocratic coercive style that uses indirect and obstructive expression of conflict. 5. Decoding of the message by the receiver ✓ receiver defines words and interprets gestures during 3) Smoothing Behavior the transmission - persuades the opponent in a diplomatic way o The communication process is dependent on the receiver’s understanding of the 4) Avoidance Behavior communication - 2 parties are aware of the conflict but choose not to acknowledge or attempt to resolve it. 6. Response to the feedback ✓ know if the message has been received and 5) Majority rule understood successfully - unanimous decision BARRIER IN COMMUNICATION 6) Compromising 1. Physical Barriers - consensus strategy where each side agrees on → Environmental factors that prevent or reduce the solutions opportunities for communication. Ex: Distance and Noise 7) Interactive Problem Solving - constructive process in which the parties involved 2. Social and Psychological Barriers recognize that there is a conflict, that need their → Blocks or inhibitors of communication that arise from assistance and openly try to solve the problems the judgment, emotions, and social values of people. → Ex: stress, trust, fear, defensiveness 8) Win-Win Strategy → Internal climate (values, feelings, temperament and - focuses on goals and attempts to meet the needs of stress levels) and external climate (weather, timing, both parties. temperature, lack of validation to the message). 9) Lose-Lose Strategy 3. Semantics - neither side wins → Words, figures, symbols, penmanship, and interpretation of the message through signs and 10) Confrontation symbols. - the most effective means of resolving the conflict. Resolves through knowledge and reason brought out 4. Interpretations in the open. → flaws in communication skills by verbalizing, listening, writing, reading and telephony 11) Negotiation - “Give and take” CONFLICT MANAGEMENT Conflict – internal and external discord that results in from CONTROLLING differences in ideas, values or feelings between 2 or more → a management function in which performance is people. It arises because of differences in economic and measured and corrective action is taken to ensure the professional values. accomplishment of organizational goals.  @krabbypanty on ig → a policing operation in management and the nurse The responsibilities and expectations of the nurse are manager seeks to create a positive climate so that the embodied in these standards process of control is accepted as a part of routine activity. → It is a forward-looking process, thus the manager SET OF STANDARDS BY ANA anticipates deviations and seeks to prevent them These standards have universal application. 1. Standard I PRINCIPLES OF CONTROL - The division of nursing has a philosophy and structure ✓ Controlling aims to verify whether the activities and that ensure the delivery of high-quality nursing care performances of the employees are in conformity with the and provide means for resolving nursing practice plans of the organization, principles, and practices. issues throughout the health organization ✓ Whatever method the nurse manager uses for evaluation, 2. Standard II it is best that the nurse manager observes principles to be - The division of nursing is administered by a qualified effective. nurse executive who is a member of the corporate administration 1. Principle of “setting the fox to watch the henhouse” ✓ In this situation, individuals themselves provide 3. Standard III their superiors with the information that will be - Policies and practices of the division for equality and used to evaluate their performances. continuity of nursing services that recognize cultural, ✓ The nurse manager should be cautious when this economic, and social differences among patients of type of self-reported data is used for evaluation the health care organization. because self-reported data are subjective and not easily detectable or measurable. 4. Standard IV - The division of nursing ensures that the nursing 2. Principle of “measured behavior” drives out process is used to design and to provide nursing care “unmeasured behavior” to meet the individual needs of patients/clients in the ✓ Focusing on specific and measurable aspects of context of their families. the job in giving feedback to an individual may drive out unmeasured” (and unrewarded) 5. Standard V behavior. - The division of nursing provides an environment that ensures the effectiveness of nursing practice. 3. Principle of “paradox of control” ✓ In attempting to control others, an individual may 6. Standard VI impose new requirements on them. Doing so - The division of nursing ensures the development of leads to countermeasures by the controlee, educational programs to support the delivery of high- either to avoid this control, to modify the quality nursing care. information, or even to seek a substitute for the desired action. 7. Standard VII - The division of nursing initiates, utilizes, and CONTROLLING PROCESS participates in research studies or projects for the COMPONENTS: (reference when evaluating the performance) improvement of patient care. 1. Setting standards and objectives as part of the planning phase of management PERFORMANCE APPRAISAL ✓ It is a control process in which employees’ performances 2. Evaluating the difference between actual results and are evaluated against standards hoped-for results. This process involves the use of the ✓ The tool is valuable for the nurse manager to use in knowledge and judgment of professional nurses controlling human resources and productivity 3. Reporting the final results of the evaluation, including the PURPOSES OF PERFORMANCE APPRAISAL probable reasons for deficiencies, if any, and making 1. basis on which administrative decisions are made for recommendations for changes. salary increases, promotion decisions, transfers, demotions and termination 4. Planning for and implementing corrective measures to 2. Stimulates individual growth and development remedy the deficiencies 3. Evaluates the performance of the employee 4. Basis for the decision to take disciplinary actions. CONTROL MEASURES 5. Influences or stimulates motivation. These are used when implementing the controlling function. 6. Basis for hiring after a probationary period. ANA developed seven sets of standards for organized 7. Identifies training needs for staff development nursing services to serve as a general guide to provide 8. Serves to evaluate and improve the manager’s own a framework for nurse managers. performance  @krabbypanty on ig GUIDELINES ON APPRAISING PERFORMANCE APPROACHES TO APPRAISAL AIM: minimize conflicts and prevent problems that may arise 1. Analysis vs. Appraisal in the future. ✓ This approach defines or determines the strengths 1. The appraisal should be in writing and carried out at potentials and weaknesses of the staff. least once a year. ✓ The focus is on the future rather than the past. ✓ Realistic goals must be established and find effective 2. The performance appraisal information should be means to attain them shared with the employee who should have the opportunity to respond to writing. 2. Management by Objectives ✓ The staff is to establish short-term performance goals 3.. There should be a mechanism by which an employee for himself. can appeal the results of the performance appraisal ✓ The supervisor helps the person relate his self- appraisal and “targets’, and plans for the ensuing 4. The supervisor should have adequate opportunities period to the realities of the organization. to observe the employee’s job performance. 3. Evaluation by Subordinates 5. Notes (critical incidents) on the employee’s ✓ This is more constructive rather a one-sided performance should be kept during the entire evaluation. evaluation period. These notes should be shared with the employee during the course of the evaluation 6. The evaluators should be trained on how to carry out the performance appraisal process. 7. The performance appraisal process should be behaviorally based (focusing on what the person did) rather than trait-based (focusing on personality characteristics such as initiative, attitude, etc) PERFORMANCE APPRAISAL PROCESS 1. PLANNING FOR THE INTERVIEW ✓ Supervisors need to prepare for the evaluation interview. ✓ A record of the observations and previous evaluation of the performance of the employee should be reached. ✓ The supervisor sets the time, date, and place in consultation with the employee to be interviewed. 2. INTERVIEW ✓ The purpose of the interview is for the supervisor to evaluate the individual staff member and not to discuss with anyone or talk about anything else. ✓ During the interview, the supervisor reviews the performance of the employee. ✓ He or she conveys his/her judgment about the performance, provides guidance and support, challenges the employee to set new goals 3. UTILIZATION OF OUTCOMES ✓ Utilizing interview results is an ongoing process. ✓ Careful attention must be given to the use of results if they are to be of optimal value. ✓ Rushing blindly into action in the excitement of new insights and opportunities can lead to bad decisions. ✓ Time is needed to consider alternative courses of action. ✓ All planning for and active participation in evaluation will have no long-range effects if results remain in the personnel office file.