NCM 119 Lecture - Midterms PDF

NCM 119 – LECTURE Defined as the number of FORMING A SPAN OF Nursing Leadership and Management persons who repo...

NCM 119 – LECTURE Defined as the number of FORMING A SPAN OF Nursing Leadership and Management persons who report CONTROL By: Devee Rose Bravo BSN4B directly to the manager Needs determined by ORGANIZING the extent to which people and groups are COORDINATING AND ORGANIZING interdependent or how INTEGRATING ACTIVITIES ➔ Signifies an institution or functional group such as much they must rely on business, government agency, or hospital, or other one another to get their work done healthcare agency with a formal intentional structure of roles or positions. ORGANIZATIONAL CHART ➔ Consists of the structure and process which allow ➔ Line of drawing that shows how the parts of an the agency to enact its philosophy and utilize its organization are linked conceptual framework to achieve its goals ➔ Refers to a body of persons, methods, policies, ORGANIZATIONAL CLIMATE and procedures arranged in a systematic process ➔ A work environment that is conducive to worker through the delegation of functions and satisfaction and productivity is a major concern in responsibilities for the accomplishment of purpose every organization ➔ Is identifying the organization needs from mission statement and objectives and from observations PURPOSE OF ORGANIZATIONAL STRUCTURE of work performed, and adapting the 1. Informs members of their responsibilities so that organizational design and structure to meet these they may carry them out needs 2. It allows the manager and the individual workers ➔ Like planning, organizing is primarily a thinking act to concentrate on his or her specific role and ➔ responsibilities. FOUR CHARACTERISTICS OF ORGANIZATION 3. It coordinates all organizational activities so there ➔ Common goal or purpose is minimal duplication of effort or conflict ➔ Coordination of effort 4. It reduces the chances of doubt and confusion ➔ Division of labor concerning assignment ➔ Established delegation of authority 5. It avoids overlapping of functions because it ➔ pinpoints responsibilities ORGANIZATIONAL STRUCTURE 6. It shows to whom and for whom they are ➔ Furnishes the formal framework in which responsible organizing takes place ➔ Refers to the process or way a group is formed and MAJOR PRINCIPLES OF AN ORGANIZATIONAL CHART its channels of authority, span of control, and lines of communication Each box represents the individual or sub-unit ELEMENTS OF ORGANIZATIONAL STRUCTURE DIVISION OF WORK responsible for a given task of the organization’ work So that both employer load and employee Lines indicate who reports understand what is CHAIN OF COMMAND to whom and what JOB DESIGN expected and what authority degree of authority each TYPE OF WORK TO BE Indicated by labels or has PERFORMED description for the boxes After an organization has Shown by the clusters or GROUPING OF WORK determined how to work groups (departments SEGMENTS structure various jobs or single units) Indicate individual and DEPARTMENTS AND UNITS It must decide how to LEVELS OF MANAGEMENT entire management arrange them into hierarchy logical department or units HIERARCHY a network of reporting ➔ Refers to a body of persons or things organized or relationships, a pattern of classifies in pyramidal fashion according to rank, CREATING HIERARCHY reporting relationships throughout an capacity, or authority organization PRINCIPLES OF ORGANIZING ORGANIZATIONAL TYPES OF AUTHORITIES Denotes centralized authority STAFF AUTHORITY- and corresponding authority ➔ Staff authority in positions created to support, assist, recommend, and generally reduces the States that to be satisfying to supervisors informational responsibilities members, economically PRINCIPLE OF CHAIN effective, and successful in OF COMMAND achieving their goals, organizations, are established with hierarchical relationships within which authority flows from top to bottom States that an employee has one supervisor or leader and one plan for a group of activities with the same objective In nursing, primary nursing and case management support PRINCIPLES OF the principle of unity of ORGANIZING command TYPES OF ORGANIZATION Although employees may interact with many different employees in the Simplest and most performance of their duties, direct type of they should be responsible to organization in which only one superior LINE ORGANIZATION each position has The number of workers that a general authority over supervisor can effectively the lowest positions in manage should be limited, hierarchy depending upon the pace Refers to horizontal and pattern of the working relationship rather than area vertical. PRINCIPLE OF SPAN OF INFORMAL ORGANIZATION CONTROL This principle is flexible This is composed of because the more trained an small groups of workers employee is, the less with similar interests supervision is needed, while Purely advisory to the those still under training need line structure with no more supervision to prevent STAFF ORGANIZATION authority to put mistakes recommendations into the concept of division of action labor or differentiation among One where each unit is kinds of duties, spring, from this responsible for a given PRINCIPLE OF principle. part of the SPECIALIZATION organization’s This principle states that each workload. person should perform a FUNCTIONAL ORGANIZATION single leading function There is a clean delineation of roles and LINE AND STAFF RELATIONSHIPS responsibilities which are actually interrelated LINE AUTHORITY ➔ Is the authority that entitles a supervisor to direct HIERARCHICAL STRUCTURE an individual’s work ➔ Called line structure ➔ Simplest and most direct type in which each ➔ Traditional structure and is associated with the position has general authority over the lower principle of chain of command, bureaucracy, positions in the hierarchy vertical control and coordination, levels  differentiated by functions and authority and 9. Professional activities and priorities in non patient downward communication activities like involvement in professional organizational 10. Teaching program or the extent of staff involvement in teaching activities 11. Expected hours or work per annum of each employee 12. Patterns of work schedule – traditional 5 days or week 8 hours per day NURSING CARE HOURS PER PATIENT PER DAY ACCORDING TO CLASSIFICATION OF PATIENTS BY UNITS CASES/PATIENTS NCH/Pt/DAY PROF TO NON PROF RATION General Medicine 3.5 60:40 Medical 3.4 60:40 Surgical 3.4 60:40 DECENTRALIZATION Obstetrics 3.0 60:40 ➔ Refers to the degree to which authority within the Pediatrics 4.6 70:30 organization is delegated downward to its Pathologic Nursery 2.8 55:45 ER/ICU/RR 6.0 70:30 division, branches, services, and units CCU 6.0 80:20 ➔ Decentralization of authority includes delegation of all management components of planning, PATIENT CARE CLASSIFICATION SYSTEM organizing, leading, and controlling ➔ Method of grouping patients according to the amount and complexity of their nursing care STAFFING requirements and the nursing time and the skills ➔ Filling, and keeping filled, positions in the they require organization structure through defining workforce Patient can take a bath on his requirements, inventorying workforce, appraising, own, feed himself, feed and selecting, compensating, and training perform his ADL LEVEL I – ➔ Staffing is the use of recruitment selection, and SELF CARE OR development of personnel to assign competent Average amount of MINIMAL CARE people to the roles designed for the NCH/pt/day – 1.5 organizational structure Ratio of prof to non prof – 55:45 Patient need some assistance in FACTORS AFFECTING STAFFING bathing, feeding, or 1. The type, philosophy, and objectives of the ambulation LEVEL II hospital and the nursing service MODERATE CARE OR 2. The population served or the kind of patients Average amount of INTERMEDIATE CARE whether pay or charity NCH/pt/day – 3 3. The number of patients and severity of their illness Ratio of prof to non prof – 60:40 – knowledge and ability of nursing personnel are Patient are completely matched with the actual care needs of patients dependent upon the nursing 4. Availability and characteristics of the nursing staff, personnel LEVEL III including education, level of preparation mix of TOTAL, COMPLETE OR personnel, number and position Average amount of INTENSIVE CARE NCH/pt/day – 4.5 5. Administrative policies such as rotation, weekends, and holiday off duties Ratio of prof to non prof – 65:35 6. Standards of care desired which should be Patient need maximum care available and clearly spelled out LEVEL IV – 7. Layout of the various nursing units and resources Average amount of HIGHLY SPECIALIZED available within the department such as NCH/pt/day – 6-9 CRITICAL CARE adequate equipment supplies and materials Ratio of prof to non prof – 80-20 8. Budget including the amount allotted to salaries, fringe benefits, supplies, materials and equipment  CATEGORIES OF LEVELS OF CARE OF PATIENTS TOTAL NUMBER OF WORKING AND NON WORKING DAYS AND HOURS OF NURSING PERSONNEL PER YEAR LEVELS OF CARE NCH/Pt/DAY PROF TO NON PROF RATION RIGHTS AND PRIVILEGES WORKING HOURS PER WEEK Level 1 1.5 55:45 GIVEN EACH Self or Minimal Care 40 HOURS 48 HOURS PERSONNEL PER YEAR Level II 3.0 60:40 Vacation Leave 15 15 Moderate or Sick Leave 15 15 Intermediate Care Legal Holidays 10 10 Level III 4.5 65:35 Special Holidays 2 2 Total, Complete or Special Privileges 3 3 Intensive Care Off Duties/RA 5091 104 52 Level IV 6-9 80:20 Cont. Ed. Prog 3 3 Highly Specialized TOTAL NON-WORKING 152 100 Critical Care DAYS/YEAR TOTAL WORKING 213 265 PERCENTAGE OF NURSING CARE HOURS DAYS/YEAR ➔ Also depends on the setting in which the care is TOTAL WORKING 1704 2120 being given HOURS/YEAR *Pag less than 100 = 2120 PERCENTAGE OF PATIENTS AT VARIOUS LEVELS OF CARE PER TYPE OF HOSPITAL RELIEVERS NEEDED ➔ To compute for reliever needed, the following TYPE OF MIN MOD INT HIGHLY should be considered: HOSPITAL CARE CARE CARE SPC 1. Average number of leaves taken each CARE year = 15 Primary 70 25 5 a. Vacation Leave = 10 hosp b. Sick leave = 5 Secondary 65 30 5 2. Holidays =12 Tertiary 30 45 15 10 3. Special privilege as per CSC MC#6 = 3 Special 10 25 45 20 Tertiary 4. Continuing Education program for Profl. = 33 COMPUTING FOR THE NUMBER OF PERSONNEL NEEDED 5. TOTAL AVERAGE LEAVES = 33 ➔ When computing for the number of nursing ➔ To determine the relievers needed, divide the personnel in the various nursing units of hospital, average number of days an employee is absent one should ensure that there is sufficient staff to per year by the number of working days per year cover all shifts, off duties, holidays, leaves, that each employee serves absences, and time for staff development 33/213 = 0.15/person (40 hours/wk) pag program more than 100 bed 33/265 = 0.12/ person (48 hours/wk) 40 HOUR WEEK LAW – REPUBLIC ACT 5901 ➔ Multiply the computed reliever per person by the ➔ Employees working in hospitals with 100 bed computed number of nursing personnel capacity and up will work only 40 hours a week 0.15 x ___=___ ➔ Less than 100 bed capacity will work 48 hours per 0.12 x __=___ week ➔ This will give the total number of relievers needed DISTRIBUTION BY SHIFT ➔ 45% morning shift ➔ 37% afternoon shift ➔ 18%-night shift STAFFING FORMULA 6. Categorize professional and non-professional 1. Categorize the number of patients according to personnel. the levels of care needed. Multiply the total Multiply the number of nursing personnel number of patients by the percentage of patient according to the ratio of professionals to at each level of care. non-professionals Find the number of nursing personnel needed for Ratio of prof to non-prof in a tertiary hospital: 65:35 250 patients in a tertiary hospital 190 x.65 = 124 professional nurses 250 (pts) x.30 = 75 pts needing minimal care 190 x.35 = 66 nursing attendants 250 (pts) x.45 = 112.5 pts needing moderate care 250 (pts) x.15 = 37.5 pts needing intensive care 7. Distribute by shifts: 250 (pts) x.1 = 25 pts needing highly specialize care TOTAL = 250 RN 124 nurses x.45 = 56 nurses on AM shift 124 nurses x.37 = 46 nurses on PM shift 2. Find the number of nursing care hours (NCH) 124 nurses x.18 = 22 nurses on NIGHT shift needed by patients at each level of care per day TOTAL = 124 nurses Get the sum of nursing care hours needed NA 66 nsg attendants x.45 = 30 NA on AM shift at the various of level 66 nsg attendants x.37 = 24 NA on PM shift 75pts x 1.5 (NCH needed at lvl I) = 112.5 NCH/day 66 nsg attendants x.18 = 12 NA on NIGHT shift 112.5pts x 3 (NCH needed at lvl II) = 337.5 NCH/day TOTAL = 66 nursing attendants 37.5pts x 4.5 (NCH needed at lvl III) = 168.75 NCH/day 25pts x 6 (NCH needed at lvl IV) = 150 NCH/day - It should be noted that the computation for TOTAL = 768 NCH/day personnel are only for in-patients. - Therefore, additional personnel should be hired for 3. Find the actual number of NCH needed by the those in supervisory and administrative positions given number of patients. Multiply the total nursing care hours PLACEMENT OF STAFF needed per day by the total number of ➔ Managers should consider some factors when days in a year assigning employees to a position or area where Find the total NCH needed by 250 patients per year these employees have very good chances for 768.75 x 365 (days/yr) = 280,593.75 NCH/yr success 4. Find the actual working hours rendered by each PROPER PLACEMENT FOSTERS: nursing personnel per year. ➔ Personal growth Multiply the number of hours on duty per ➔ Provides a motivating climate for the employee day by the actual working days per year ➔ Maximizes productivity and organizational goals WH/YR =8 (hrs/day) x 213 (working days/year) = 1,704 (working hours /yr) INAPPROPRIATE PLACEMENT OFTEN RESULTS IN: ➔ Frustration 5. Find the total number of nursing personnel ➔ Poor quality of work needed. ➔ Reduced organizational efficiency a. Divide the total number of nsg care ➔ Rapid turn over needed/yr by the actual number of working ➔ Poor image for the agency hours rendered by an employee/year Total NCH/yr = 280,593.75 = 165 FACTORS TO CONSIDER IN PLACEMENT OF STAFF: ---------------------- ------------------ Working hours/year = 1,704 ➔ Past experience and training of the employee ➔ Culture of the clientele b. Find the number of relievers ➔ Decision making skills Relief x Total Nursing Personnel ➔ Communication skills = 165 x 0.15 = 25 SCHEDULING ➔ Timetable showing planned work days and shift for c. Add the number of relievers to the number of nursing person el nursing personnel needed Total Nsg Personnel needed = 165 + 25 = 190 SCHEDULING MUST FUNCTION SMOOTHLY IN TERMS OF: homes or who are employed by 1. Ability to cover the needs of the unit nurse registries 2. Quality to enhance the nursing personnel’s Application form knowledge, training, and experience ▪ should include: 3. Fairness to the staff personal history 4. Stability educational bg 5. Flexibility work experience pertinent information TYPE OF SCHEDULING ▪ used to Determine whether the One person, usually the chief nurse or applicant meets hiring her designate, assigns the nursing requirement personnel to the various units of the Furnish background CENTRALIZED hospital. SCHEDULING data useful in the selection interview This includes the shifts on duty and off duty Obtain names of Shift and off duties are arranged by references who may be DECENTRALIZED the supervising nurse or head or senior contacted for further SCHEDULING nurse of the particular unit information Covers a designated number of Collect information for weeks called the cycle length and is personnel repeated thereon. administration, such as CYCLICAL It assigns the required number of SSS, TIN SCHEDULE nursing personnel to each nursing unit 2. Selection of Nursing Personnel consistent with the unit’s patient care o responsibility for staffing an organization requirements, the staff’s preference, with nursing personnel rests with every their education, training and manager at every level experience 3. Induction and Orientation o Induction ADVANTAGES OF CYCLICAL SCHEDULE ▪ consists of those formal 1. It is fair to all. Favoritism is minimized procedures an employee follows 2. It saves time as the schedule does not have to be immediately after being hired redone every week or two o Orientation 3. It enables the employees to plan ahead for their ▪ formal process of familiarizing the personnel needs preventing frequent changes in new employee with the schedule organization and his or her place 4. Scheduled leave coverage such as vacation, in it holidays, and sick leaves are more stable 5. Productivity is improved STAFF DEVELOPMENT ➔ includes all training and education undertaken by EMPLOYMENT PROCEDURES an employer to improve the occupational and 1. Recruitment personal knowledge, skills, and attitudes of o to recruit nurses, one can fill vacancies employees from within the facility, hire graduates from schools and colleges, place STAFFING PROCESS advertisements and announcements, and use professional and private nurse EFFECTS OF ABSENTEEISM employment agencies, both national ➔ studies in the workplace have been conducted and international over the past three decades and have shown that Experienced Nurses individual needs, relationships with co-workers o nurses who have practiced for a and supervisors, working conditions, work policies number of years and have and compensation affect the extent to which an become experts in their fields individual is gratifies or fulfilled in his or her work carry more clout with recruiters Supplemental Staffing o involves the use of nurses who are available and on-call at their STAFF BURNOUT USES OF JOB DESCRIPTION ➔ burn out has been associated with three ➔ for recruitment & selection of qualified personnel composite factors: ➔ To orient new employees to their jobs a. emotional exhaustion, or feeling ➔ For job placement, transfer or dismissal overextended and worn out from work ➔ As an aid in evaluating the performance of an b. depersonalization, or lack of appropriate employee responses to the nurse’s efforts, ➔ For budgetary purposes c. a diminished sense of personal ➔ for determining departmental functions and accomplishment relationships to help define the organizational ➔ Researchers has began to investigate variables structure that reduce or buffer burnout ➔ For classifying levels of nursing functions according ➔ “PERSONAL HARDINESS” to skill levels required o Three personality characteristics ➔ To identify training needs determine hardiness: ➔ As basis for staffing ▪ Commitment, involves a strong sense of JOB SPECIFICATION dedication to self and ➔ Are the enumeration of necessary and desirable others personal qualities that an applicant should ▪ Control, possess in order to execute the job satisfactorily means that a nurse can JOB EVALUATION influence the course of ➔ needed in creating a sound wage salary and events in his or her life career ladder systems ▪ Challenge ➔ requires job analysis and job description career offers ➔ defined as systematic method of appraising the opportunities to use work of each job in relation to all other jobs in one’s abilities, energies organization and resources or provides an opportunity DIRECTING to attempt what one ➔ issuance of orders, assignments, and instructions believes he or she can that enable that nursing personnel to understand accomplish what are expected to them JOB DESCRIPTION ➔ in NURSING: ➔ statement that sets the duties and responsibilities ➔ explaining what it is to be done to whom at what of a specific job time, how and why ➔ also a contract that includes the job’s functions ➔ Directing is the process of applying management and obligations and tells the person to whom the plans to accomplish nursing objectives worker is responsible ➔ Must be complete, understandable, and given in ➔ are being discussed with the nursing personnel to a logical order enable them to see the extent to which their jobs contribute to patient care, their place in the CHARACTERISTICS OF GOOD DIRECTION nursing team and the hospital as a whole ➔ Clear, concise, consistent, and complete ➔ Understandable and well explained rationale and CONTENTS OF JOB DESCRIPTION make certain that it is understood ➔ IDENTIFYING DATA ➔ The words used indicate its importance o Position Title: Staff Nurse ➔ Speak distinctly and slowly request not command o Department: Nursing o Supervisor’s Title: Head/Senior Nurse DIRECTING ACTIVITIES OF NURSE MANAGERS/SUPERVISORS ➔ JOB SUMMARY ➔ Formulating objectives for care that are realistic o this includes the essential features of the for the health agency, patient, client, and nursing job that distinguish it from the others personnel ➔ QUALIFICATION REQUIREMENTS ➔ Giving priority to the needs of the patients/clients o educational preparation, training and assigned to the nursing staff experience necessary to fill the position ➔ Provide for coordination and efficiency among ➔ JOB RELATIONSHIPS departments that provide support services ➔ SPECIFIC AND ACTUAL FUNCTIONS AND ACTIVITIES ➔ Identify responsibility for all activities  ➔ Providing safe, continuous care d.Responsibility for maintaining morale or the ➔ Considering the need of variety of task and opportunity to say a few words of personnel development encouragement to the staff especially the ➔ Providing for the leader’s availability to staff new ones members for assistance, teaching, counsel and e. jobs that are too technical and those that evaluation involve trust and confidence ➔ Trusting members to follow through their ➔ Why nurse managers do not delegate? assignments 1. Lack of confidence and trust in their staff ➔ Interpreting protocol for responding to incidental 2. The belief that “I can di it better myself” request 3. They fear loss of control if some of their ➔ Explaining procedure to be followed in duties are delegated emergency 4. Time involved in explaining the task ➔ Giving clear, concise, formal and informal 5. Fear of competition direction 6. Reluctance to take the risks involved in ➔ Using management control process that assess depending on others the quality of care given and evaluates individual 7. Fear of loss of power and group performance given by nursing ➔ Overcoming Barriers in Delegation personnel a. Managers should recognize what prevents them from delegating and what motivates WORK ASSIGNMENTS workers to respond favorably to challenging ➔ One of the fundamental managerial functions work FACTORS TO CONSIDER IN GIVING ASSIGNMENTS NURSING CARE ASSIGNMENT 1. Abilities of the employee ➔ Sometimes called Modalities of Nursing care, 2. Fairness of the assignment Systems of Nursing Care, or Patterns of Nursing 3. Efficiency of the employee Care 4. Continuity 5. Staff preferences FOUR BASIC METHODS: 6. Learning opportunities for staff members 1. FUNCTIONAL NURSING ➔ is a tasked oriented in which a particular nursing ELEMENTS OF DIRECTING function is assigned to each worker ➔ This method divides the work to be done with 1.DELEGATION each person being responsible to the head or ➔ process by which a manager assigns specific senior nurse tasks/duties to workers with commensurate authority to perform the job ➔ Reasons: a. Assigning routine tasks b. Assigning tasks for which the nurse manager does not have time c. Problem solving d. Changes un nurse manager’s own job e. Capability building f. Delegate in advance g. Consult before delegating h. Avoid gaps and overlaps ➔ What cannot be delegated? a. overall responsibility, for maintaining morale or opportunity to say a few words of encouragement to the staff especially the new ones b. Authority to sign one's name is never delegated c. Evaluating the staff and/or taking necessary corrective or disciplinary action 2. CASE METHOD 2. Ability to communicate well in both spoken ➔ is the assignment of one nurse to the total care of and written language, ability to listen one or more patients/clients 3. Firmness with flexibility to adjust to the needs ➔ The assigned nurse is responsible for providing all of situations the nursing care that is needed 4. Fairness in dealing with employees ➔ A private duty nurse uses the case method 5. Familiarity with hospital and nursing policies ➔ In this nursing modality, the nurse is accountable that affect patient care for his or her own actions 6. Good decision-making skills ➔ The nurse provides holistic care to her patient 7. Willingness to grow and develop 8. Ability to accept changes and consider them as challenges 9. Dignified and pleasing personality 10. Ability to motivate employees and provide opportunities for professional growth 11. Advocacy for nurses and nursing ➔ Techniques in Supervision 1. Observation of the worker while making the rounds 2. Spot checking of chart through nursing audits 3. Asking the patients about the care they 3. TEAM NURSING receive ➔ is the delivery of nursing care by a designated 4. Looking into the general condition of the units group of staff members including both 5. Getting feedback from co-workers or other professional nurses and ancillary staff supervisors or relatives ➔ the team leader assigns patients and tasks to 6. Asking questions discretely to find out the team members according to job descriptions problems they encounter ➔ team leader is responsible for coordinating the ➔ Leading total care of a group of patient o Defined as “to guide, to go before, and show the way” 3.COMMUNICATION ➔ Transmission of information, opinions, and intentions between and among individuals ➔ Basic Principles for Successful Communication 1. Successful communication involves a sender, a receiver and a medium 2. Successful communication occurs when a message is received 3. Successful managers achieve successful communication ➔ Importance of the Communication Process 1. Good communication motivates staff 4.PRIMARY NURSING members ➔ every patient has a designated primary nurse 2. Communication leads to influence and who is responsible for planning the care and power ensuring that the plan is implemented around the clock, seven days a week ➔ from admission to discharge 2.SUPERVISION ➔ The word ''SUPERVISE'' comes from the word ''SUPERVIDE'' which means "to oversee or view directly" ➔ The result of supervision is the attainment of a service that is both EFFICIENT and EFFECTIVE ➔ Qualities of Good Supervision 1. Good, technical, managerial, and human relation skills ➔ Principles of Effective Communication 4. COORDINATION o Clear lines of communication serve as ➔ United personnel and services toward a common the linking process by which parts of the objective organization are unified toward goal ➔ It prevents overlapping functions, promotes good achievement working relationship o Simple, exact, and concise messages o Coordination with Administrative Service ensure understanding of the message to o Coordination with the Laboratory Service be conveyed o Coordination with Radiology Service o Feedback is essential to effective o Coordination with the Pharmacy Service communication o Coordination with the Dietary Service o Communication thrives best in a supportive environment which CONFLICT MANAGEMENT encourages positive values among its ➔ Conflict Means a clash between hostile or personnel opposing parties or ideas o A manager's communication skill is ➔ Conflicts between employees grow out of vital to the attainment of the goals of the different perceptions about what is occurring in organization the work situation o Adequate and timely communication of work-related issues or changes that may SOURCES OF CONFLICT affect jobs enhance compliance ➔ Competition, domination and provocation ➔ Flow of Information ➔ Differences in knowledge, skills, values, interests’ o Downward Communication scarcity of resources intergroup rivalry for rewards ▪ may come in forms of policies, manuals, and guidelines for THREE LEVELS OF INTERNATIONAL CONFLICT information and compliance of everyone in the organization experienced when confronted with o Upward Communication two ▪ Usually comes from subordinates or more incompatible demands to top management INTRAPERSONAL it may also occur when a nurse is ▪ It is done in form of feedback CONFLICT unable to reconcile a need for informing administration professional autonomy and an ▪ Example: grievance procedure, obligation to conform to the rules of incident or situational reports organization and other forms of written r. Occur between two or more o Lateral/Sideward Communication INTERPERSONAL people when one person perceives CONFLICT or values a situation differently than ▪ Being observed between the other employees, personnel, units, or Occurs between two or more department on similar level INTERGROUP groups, and may result from CONFLICT o Outward Communication competition among departments ▪ Deals with information that flows from the caregivers to the COMMON APPROACHES TO CONFLICT RESOLUTION patients, their families, caregivers to the pt relatives visitors & Is “winner take all” attempt at community COMPETITION complete dominance resulting in a win-lose situation is the opposite of competition and results in a lose-win situation ACCOMODATION occurs when one person gives in & yields to the other Lose lose situation Occurs when one side avoids the AVOIDANCE problem, uncooperative, denies that a problem exists, or withdraws from situation involves negotiation, tradeoffs, COMPROMISE swapping. Each person gets  something else up in the process, 5. Highlights problems related to quality care and resulting in a WIN -LOSE I WIN-LOSE determined the areas that require priority SITUATION for the two sides attention occurs when each party meets the 6. Provides an indication of the costs of poor quality problem head on with equal 7. Provides feedback for improvement concern for both the issues and COLLABORATION maintenance of a working relationship. CHARACTERISTICS OF AN EVALUATION TOOL ➔ Should be objective This results in a WIN-WIN SITUATION ➔ Reliable ➔ Sensitive PROCEDURES FOR CONFLICT RESOLUTION 1. Identify the root problem and clarify issues METHODS OF EVALUATION surrounding values, purposes, goals ANECDOTAL NOTES These are objective descriptions 2. Encourage a free exchange of ideas, feelings, of behavior recorded on plain and attitudes, and cultivate an atmosphere of paper or form trust CHECKLISTS Assess the presence or absence 3. Search for alternative ways to resolve the problem of desired characteristics or behavior 4. Ask for help from outside sources as needed 5. Set up a means for evaluation of possible solutions Very useful in evaluating nursing 6. Keep interacting until all parties agree to a skills solution RATING SCALES Includes a series of items representing the different tasks in CONTROLLING the nurses’ job description ➔ Refers to the process of evaluating, measuring, Numerical rating scale usually and feedback function includes numbers against which ➔ Fayol defined control as: a list of behaviors is evaluated a. Verifying whether everything occurs in conformity with the plan adopted, the 5 – Excellent instructions issued and principles 4 – Very satisfactory established 3 – average 2 – minimally satisfactory 1 - unsatisfactory A GOOD CONTROL SYSTEM CAN BE DESCRIBED AS: RANKING Evaluator ranks the employees 1. must reflect the nature of the activity according to how he or she 2. should report errors promptly fared with co-workers with 3. should be forward-looking respect to certain aspects of 4. should point out exceptions at critical points performance or qualifications 5. should be flexible PEER REVIEW Process whereby a group of practicing registered nurses 6. objective evaluate the quality of another 7. reflect the organizational pattern registered nurse’s professional 8. economical performance 9. understandable 10. indicate corrective action Purpose is to provide the individual with feedback from PERFORMANCE APPRAISAL those who are best acquainted with the requirements & demand ➔ a periodic formal evaluation of how well the nurse of that particular position has performed her duties on a specific period ➔ Observations are made by one or more peers, REASONS FOR CONDUCTING EVALUATION compared with previously set standards, and then 1. Evaluation ensures that quality nursing care is shared with the person being reviewed provided ➔ The reviewer should avoid making judgements 2. It allows for the setting of sensible objectives and based on a personal standard or feelings ensures compliance with them 3. It provides standards for establishing comparisons 4. Promotes visibility and a means for employees to monitor own performance EVALUATING MARGINAL STAFF TYPES OF COUNSELING ➔ Easy to evaluate a highly motivated and competent employee but having to evaluate a Happens when counselor listens to marginal employee is not easy for any manager the employees problems, decide DIRECTIVE to confront the employee with his or her how to solve it and tell the employee what to do shortcomings Client centered STEPS IN RESOLVING POOR PERFORMANCE Counselor listens and encourages ➔ Observe and objectively document the problem the employee to explain her NON-DIRECTIVE ➔ Counsel the employee problems, identify alternatives, a. Both positive and negative feedback explore the ramifications of each should be given to the employee option, and determine the most appropriate solution ➔ Plan for resolution of the problem Compromise between directive and non-directive. PERFORMANCE APPRAISAL ➔ Term generally used to describe the formal COOPERATIVE It is a cooperative effort by the evaluation of an employee by the manager or counselor and the employee supervisor and more recently by peers as well through and exchange of ideas to help solve the problem Can be used to minimize the QUALITY ASSURANCE OUTPLACEMENT emotional & professional pain of ➔ Process of evaluation that is applied to the health being terminated from a job care system and the provision of health care services by health workers DISCIPLINE ➔ Assurance ➔ The nurse manager must be well versed with the a. Achieving a sense of accomplishment organization’s rules and regulations to use and implies a guarantee of excellence discipline in managing or preventing conflict ➔ Quality ➔ It is the last resort in correcting undesirable a. Degree of excellence and assurance employee behavior means formal guarantee of a degree of excellence RULES IN INSTITUTING EMPLOYEE DISCIPLINE 1. Discipline should be progressive QUALITY OF CARE 2. The punishment should fit the offense, be ➔ Degree to which health services for individuals reasonable, and increase in severity for violation and population increase the likelihood of desired of the same rule health outcomes and are consistent with the 3. Assistance should be used in administering current professional knowledge discipline 4. Tact should be used in administering discipline TOTAL QUALITY MANAGEMENT 5. The best approach for each employee should be ➔ Way to ensure customer satisfaction by involving determined all employees in the improvement of the quality of 6. The individual should be confronted and not the every product or service group 7. Discipline should be clear and specific DEALING WITH PROBLEM EMPLOYEES 8. It should be objective, sticking to facts ➔ Includes: 9. Should be firm sticking to the decision. a. Substance abusers b. Angry or withdrawn employees PRINCIPLES OF DISCIPLINARY ACTION c. Excessive tardiness of absenteeism 1. The manager should have a positive attitude in d. Quarrelsome preventing or correcting undesirable behavior e. Performance below par 2. Investigate carefully 3. Be prompt EMPLOYEE COUNSELING 4. Protect privacy ➔ Counseling helps improve employee’s mental 5. When disciplining, focus on the act that is health, by enhancing understanding, self-control, unacceptable rather than on employee self-confidence and ability to work effectively 6. Enforce rules consistently 7. Be flexible – imposing penalty 8. Advise the employee  9. Take corrective constructive action and Follow up STEPS IN TERMINATING EMPLOYEES 1. Oral warning 2. Written warning with corrective interviews if the employee has not improved 3. Suspension 4. Dismissal UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS o Beneficence - helping to better the conditions of other (do what is good) o Nonmaleficence-avoiding or preventing injury to others do no harm) o Fidelity- Loyalty o Veracity- telling the truth o Justice- equal treatment o Autonomy- freedom to choose and #plements one's decision.