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10-22-24 MIDTERMS General Principles of Nursing Management Nursing Management is the active organ Nursing Management of the division of nursing, of the It is the process...

10-22-24 MIDTERMS General Principles of Nursing Management Nursing Management is the active organ Nursing Management of the division of nursing, of the It is the process of working through organization and of the society in which staff members to be able to provide it functions. comprehensive care to the patients. ○ Organizational cultures reflect This includes, planning, organizing, values & beliefs. staffing, directing, and controlling. ○ A well-managed division of nursing motivates employees to Nursing Management Processes Supports the perform satisfactorily. Nursing Process ○ Nursing Management is directing or leading. Nursing Management is efficient Nursing Process communication. Assessment, Planning, Implementation, ○ Nursing Management is Diagnosis, Evaluation controlling or evaluating. Data Gathering, Planning, Organizing Levels of Skills Management in Nursing Staffing, Directing, Controlling 1. Conceptual Skills - Refer to an Management Process individual’s skill or mental ability to coordinate a variety of interests and activities. Purposes of Nursing Management Critical thinking To achieve scientifically-based, holistic, Create a vision individualized care of the patient. 2. Interpersonal - Refertothewaysinwhich To achieve the opportunity to work individuals interact and communicate collaboratively with patients and others. with others. Uniqueflairinspeech. To achieve the continuity of care. Amount Of Empathy. Preferred Ways Of Using language the degrees to which General Principles of Nursing Management they listen ways of responding to others. Nursing Management is planning. 3. Technical Skills - Refer to the tools, Nursing Management is the effective procedures, and techniques. Need to use of time. master the job an attempt to be viewed Nursing Management is decision as a source of help – an expert. making. Meeting patient’s nursing care needs is Characteristics of a Nurse Manager the business of the nurse manager. 1. Result-oriented or outcome-oriented. Nursing Management is the formulation 2. Good problem-solving and team and achievement of social goals. building methods. Nursing Management is organizing. 3. A gatekeepers as they interpret and enforce unit and hospital policies, Nursing Management denotes a procedures, and mandates. function, social position or rank, a 4. Self-awareness and good evaluative discipline and a field of study. skills.  5. Use of a combination of leadership Measuring the performance against styles. goals and plans. Showing where deviations from Scope of Practice of a Nurse Manager standard exist. Helping to correct the deviations from 1. Excellence in the clinical practice of standards. nursing and delivery of care. 2. Organization, coordination, and control Management Process: Planning of staff, fiscal, and other resources. It is deciding in advance 3. Institutional compliance with standard 1. What to do; of care. 2. How to perform a particular task; 4. Strategic planning 3. When to perform it; and, 5. Facilitating cooperative and 4. Who is to do it. collaborative relationships with all healthcare providers to ensure effective Planning client care. A cognitive process for decision making. Based on facts and information as opposed to a manager’s preferences or wishes. Nursing Management System It must be adaptable and flexible to current N A set of policies, processes, and realities to ensure that the desired results is procedures used by an organization to achieved. ensure that it can fulfill the tasks required to achieve its objectives. Components of Planning These objectives cover many aspects of the organization’s operations. Nursing Management Process Primarily deals with the future. Entails forecasting or setting the broad outline of the work to be done. Identification of duties to be performed. Entails assignment of authority according to the line, staff or What is a Plan? relationships between individual jobs It is a living document which can be and the entire organization. changed based on the prevailing Identification of work force circumstances. requirements, recruiting, interviewing, It is a predetermined course of action selecting, hiring, promoting, appraising, intended to facilitate the and orienting staffs. accomplishment of a task, mission or Manner of delegating assignments, work. orders, and instructions to the nursing personnel. Characteristics of a Plan Heart of management process. It must involve the future. It must involve action.  It must have an organizational 4. It derives from a good nursing identification of the action which will be management information plan. undertaken either by the planner or 5. It used and modified consistently. someone designated. Indicators of Poor Planning Good Planning 1. Delivery dates are not met. Involves continuous process of 2. Machines are idle and material is assessment, establishment of goals and wasted. objectives, implementation and 3. Some nurses are overworked while evaluation of change as new facts others are underworked. become known. 4. Skilled nurse doing unskilled work. 5. Nurses are fumbling on jobs for which Poor Planning they have not been trained. Failure to set goals, make assessments 6. There is quarreling, bickering, or provide for implementation to buck-passing, and confusion. anticipate any possible change in circumstances. Types of Planning 1.Strategic Planning Characteristics of a Good Plan Usually Ask The Question 1. It is written. “whataretherightthingstodo?” 2. It defines the nursing business. Usually around 3 to 5 years, long term 3. It contains both general and specific in nature and are based on explicit objectives. assessments of the competitive strengths 4. It defines strategies. and weaknesses of the organization. 5. It supports the mission. Usually prepared in the upper levels of 6. It details the forecasted activities for a management and serve as a basis for year and longer than one year. operating plans. It calls for increasing diversity in Characteristics of a Good Plan nursing and aggressive recruitment. 1. It has been developed with inputs from clinical nurses and 2. Operational Planning line managers. Also Known As Management Planning. 2. It addresses resources such as Pertains To Activities In Specific personnel and facilities. Departments Of An organization. 3. Changes are evident. Usualquestionaskis“how does one do 4. Financial plan is included. things right?”. 5. Needs are identified and supported. It deals with techniques or tactics for 6. Priorities are included. accomplishing these things. Usuallyshorterintimeframeandusuallyin Characteristics of a Good Plan volvethe middle and lower level 1. Timetables are listed. managers. 2. It is based on current data analysis. Focuses Timetables,target quantities,and 3. It assesses both strengths and specifies the persons responsible for the weaknesses. tasks.  Differences between Strategic Planning and 3. Continuous or Rolling Planning Operational Planning Similar To Operational Planning. Involves Mapping Day-to-day activities. Usuallytaskofthestaffnursewhohastodevi seand implement the nursing care plan for the patients, adhering or modifying the plan as necessary depending on the needs and problems of the patients and the unit to where the plan is applicable. 4. Nursing Succession Planning Tools in Planning Identifying & Developing Potential There are many effective tools used to Future Nursing leaders who can replace assist in planning. them in case of retirement, separation The most commonly used in the from service or any inevitable healthcare setting: circumstances. This Is To Ensure Continuity Of Leadership And Services. Five-Step Process in Succession Planning SWOT Analysis Developed by Albert Humphrey at Stanford University in the 1960s and 1970s. A framework for analyzing and identifying the internal and external factors. Most effective if it is done in collaboration with the people who have created a shared purpose. SWOT Analysis healthcare highly 1. Strengths informatics skilled Internal attributes that help an Absence of nurses organization to achieve its dominant Low salary objectives. competitors Positive effect or enabler. 2. Weaknesses Internal attributes that challenge PESTLE Analysis an organization in achieving its It is used to identify and analyze the key objectives. drivers of change in the strategic or Negative effect or barrier. business environment. It allows in the assessing of the current 3. Opportunities environment and potential changes. External conditions that If the project is better than the promote achievement of competitors, it would be able to organizational objectives. response to changes more effectively. Elements that the organization could exploit at their advantage. 1. Political - It has both internal and 4. Threats. external politics. Internal politics like External conditions that team jealousies. External politics refer challenge or threaten the to those which the stakeholders do not achievement of organizational have control like employment laws and objectives. tax policies. Elements that could cause 2. Economic - Factors takes into trouble to the organization. consideration all events that affect the internal and external economic Example of SWOT Analysis environment. 3. Sociological - Factors takes into Strengths Weaknesses consideration all events that affect the market and community socially. These State-of-the-art Outdated events include cultural expectations, medical healthcare norms, population, dynamics, healthy equipment facilities consciousness, career attitudes, global Qualified Insufficient warming. nursing staff manageme Focusing on nt training 4. Technological - Factors takes into healthcare Lack of consideration all events that affect the improvement financial technology. Since technology often resources becomes outdated within a few months after it is launched. Opportunities Threats 5. Legal - Factors takes into consideration Advancement Low all legal aspects like employment, in technology retention quotas, taxation, resources, imports and Increased funds rate exports. for better Lack of  6. Environmental - Factors takes into Mission Statement consideration ecological and It is a brief statement identifying the environmental aspects that could be reason that an organization exists. either economic or social in nature. It identifies the organization’s These include temperature, monsoons, constituency. natural calamities, access by rail, air, It addresses its position regarding and road, ground conditions, ground ethics, principles, and standards of contamination, nearby water resources. practice. Example of PESTLE Analysis Philosophy Statement It flows from the purpose or mission statement It delineates the set of values and beliefs that guide all action of the organization. It is the basic foundation that directs all further planning towards that mission. Goals and Objectives Planning Hierarchy The ends toward which the organization is working. Goals are broader. Objectives is used to motivate the people to a specific end and are explicit, measurable, observable and obtainable. Policies These are plans reduced to statements or instruction that direct organizations in their decision making. Policies can be implied or expressed. Types of Policy 1. Implied Policies Vision Statement Neither written nor expressed It used to describe future goals or aims verbally. of an organization. Usually developed over time It conjures up a picture for all group and follow a precedent. members of what they want to E.g., “A hospital may have an accomplish together. implied policy that employees An organization will never be greater should be encouraged and than the vision that guides it. supported in their activity in community, regional, and  national healthcare The balance of expenditures and revenues are organizations.” projected during a specific period of time, 2. Expressed Policies usually annually. It delineates verbally or in writing. Types of Budget E.g., formal dress code, policy 1. Capital Budget for sick leave or vacation leave. Long-range budgets, usually 3 years, that involve physical Procedures changes and the purchase of These are plans that establish major capital items. customary or acceptable ways of E.g., State-of-the-art equipment accomplishing a specific task. or renovation of the physical It delineates a sequence of steps of plant. required action. 2. Operating Budget These are generally found in manuals Short-term budgets that allocate at the unit level of the organization. funds for day-to-day activities of the organization for the Rules and Regulations forthcoming fiscal These are plans that define specific The revenues are primarily from action or non- action. the patient care income. Existing rules should be enforced to keep morale from breaking down and to 3. Cash Budget allow organizational structure. Budget that accounts for the monthly expenditures and Budgeting receipts to the department It is a detailed fiscal plan for carrying and/or the organization. out the mission, values, and goals of the 4. Personnel Budget organization over a determined period of Budget that allocates expenses time. related to the personnel usually Budget describes in details how the the salary. resources such as money, time, and people will be acquired and used. Budgetary Process It is defined as critical exercise of Purposes of Budgeting in the Nursing Service allocating revenues and borrowed funds 1. Control cost. to attain the economic and social goals. 2. Establish an annual budget plan. It involves 4 processes: Planning, 3. Identify and analyze actual experience Development of the budget compared to the budget plan. Implementation and Monitoring 4. Accurate utilization report. Evaluation. Fiscal Planning It is a formal plan for managing the financial resources. Budgetary Process 4. Make others aware of the need 1. Planning for change Gathering Information Related 5. Do not proceed until the status To Goals And Objectives, quo has been disrupted and the setting priorities, conducting an need for change is perceived by environmental assessment, and the others identifying financial objectives. 2. Development of the budget Phase 2: Movement Collectingandanalyzingdatafro The change agent identifies, plans, and mpastbudgets,allocating implements appropriate strategies, amounts based on priority, and ensuring that driving forces exceed approving the operational and restraining forces. capital budgets. 1. Develop a plan. 2. Set goals and objectives. 3. Implementation and Monitoring 3. Identify areas of support and Analyzing variances and resistance. adjustments during the fiscal 4. Include everyone who will be period, negotiating and revising affected by the change in its the budget as necessary, planning. allocating departmental and 5. Set target dates. cash budgets. 6. Develop appropriate strategies. 4. Evaluation 7. Implement the change. Obtaining performance reports 8. Be available to support others and analyzing efficiency. and offer encouragement through the change. 9. Use strategies for overcoming Change Theory resistance to change. Evaluate Developed by Kurt Lewin in 1951. the change. The change agent must proceed before a 10. Modify the change, if necessary. planned change becomes part of the Phase 3: Refreezing system. The change agent assists in stabilizing It has three phases: Unfreezing the system change so that it becomes Movement Refreezing integrated into the status quo. Support others so that the change Phase 1: Unfreezing continues. It occurs when the change agent convinces the members of the group to Chaos Theory change or when guilt, anxiety, or Developed by Edward Lorenz in 1960s. concern can be elicited. Even small changes in conditions can 1. Gather data. drastically alter a system’s long-term 2. Accurately diagnose the behavior (butterfly effect). problem. 3. Decide if change is needed. Management Process: Organizing Organizational Chart It determines: A line drawing composed of boxes that 1. What tasks are to be done; show how the parts of an organization 2. Who is to do these; are linked. 3. How the tasks are to be It defines formal relationships within the grouped; institution. 4. Who reports to whom; and, There are two lines in the organizational 5. What decisions are to be made. chart: Organizing 1. Unbroken Solid Lines It is the backbone of management. 2. Dotted or Broken Lines It is both a function and a process. It is both a human activity and a group Organizational Chart: Unbroken Solid Lines of people. It classifies: It is a logical process. 1. Solid Horizontal Lines It represents communication Organizational Structure between people with similar It furnishes the formal framework in spheres of responsibility and which the management process takes power but different functions. place. 2. Solid Vertical Lines It should provide: It denotes official chain of 1. Effective work system command and formal path of 2. A network of communications communication and authority. 3. Identity to individuals and the organization Organizational Chart: Dotted or Broken 4. It should foster job satisfaction. Lines It represents staff position. Types of Organizational Structures It provides information and assistance to 1. Formal Structure the manager but has limited It shows relationships among employees organizational authority. and their job positions. It provides for specialization but does It describes the managerial authority, not have legitimate authority as it acts as responsibility, and accountability. an advisory capacity. It can be presented in a diagram called the Organizational Chart. Forms of Organizational Structures 2. Informal Structure 1. Tall or Centralized Structure It is based on social and personal Also known as line structure. relationships rather than on positional Responsible for only a few subordinates, authority. so there is a narrow span of control. It illustrates how employees network Because of the vertical nature of the with one another to get work done. structure, there are many levels of communication.  Advantages The supervisors themselves may lack 1. Makes use of expertise and expertise in the variety of operations and allows close communication may end up making inappropriate between workers. decisions. 2. Supervisory individuals screen the communications. Disadvantages 1. Pyramidal or Bureaucratic Structure 1. Most skilled individuals end up Each position has a general doing nothing while actual tasks authority over the lower are done by those less capable. position in the hierarchy. 2. Communication from the This is commonly found in large bottom to top is often difficult health care facility. and messages do not get to the There is clearly defined top. superior-subordinate 3. Workers tend to be relationship. “boss-oriented” because of the It is pyramid shape where all close contact with their decisions emanate from the top supervisors. down to the subordinates. Authority, responsibility, 2. Flat or Decentralized Structure accountability and power are It characterized by few levels and a concentrated at the top. broad span of control, where As one goes up the decision-making is spread among many administrative ladder, the people. workers power increases as well Communication from lower levels to as well as its authority and higher levels is easy and direct responsibilities. Advantages 2. Matrix Structure Less likelihood of messages being loss Designed to focus on both or distorted; the organization can products and function. respond to problems or new Ithasboththeverticalandthe opportunities faster. horizontal chain of command. Workers develop their own abilities and This is the most complex form autonomy and come to see the of organizational structure. organization as humanistic, resulting in It combines the best of both greater job satisfaction. worlds. Principle of “shared governance” produces maximum potential for professional growth. Matrix Structure Function is the task required to produce Disadvantages a product that is the Supervisors spend less time with each end result of the function. other.  Unit manager is responsible for a Disadvantages: service report to both functional Takes time and effort to coordinate to manager and product manager. other healthcare members. Personnel assigned to a specific project Limits communication and continuity of may become responsible to both care for the patient over time. functional manager and product Restricts job mobility and nurses are manager. limited to perform other tasks. Forms of Organizational Structures Methods of Patient Care Delivery 1.Functional Structure 1. Functional Nursing Permits a specialist to aid line position A task or activity- oriented within a limited and clearly defined system of care that concentrates scope of authority. on duties. Allow care to be provided with Nursing Modalities of Care a minimal number of nurses. These are ways where care is organized and delivered to the patients. Advantages: Traditional Methods of Patient Care It is efficient and the best system that Delivery: Total Patient Care can be used when confronted with large 1. Functional Nursing number of load and shortage of nurses. 2. Team Nursing Little confusion about roles and duties. 3. Modular Nursing Less costly and requires few nurses. 4. Primary Nursing Disadvantages: 5. Nursing Case Management Care tends to be fragmented and depersonalized. Less oriented to Methods of Patient Care Delivery individualized and holistic care. More 1. Total Patient Care oriented to task accomplishment. Nurses assume total Clients felt that they could not identify responsibility during their time who was their nurse caretaker. on duty for meeting all the needs of assigned patients. 2. Team Nursing Sometimes referred to as the A decentralized system of care. Case Method of Assignment. A nurse leads the group in Patients may be assigned as providing the needs of the cases. patients through participative Most effective among the Level effort. 4 patients. Effective across all levels of care (level 1, 2, 3, and 4 Advantages: patients). Focuses on the entire episode of illness. Emphasizes achievement of outcome. Advantages: Incorporates manage care. Motivates full participation among team members towards quality and safe care. Maximizes staff capabilities.  Sets goals and priorities for patient care. Disadvantages: Centralizes of information through the Confines nurses’ competencies to a use of Kardex. limited number of patients. Disadvantages: Problems may occur of the other nurse Does many tasks for a limited number of changes the care plan without discussing patients instead of a single task for a the reasons with the primary nurse. large number of patients. Wide variation in its operationalization Increase likelihood of committing and implementation. errors. Takes time to coordinate Cost-containment pressure. delegated work. Total accountability may create burn out. 3. Modular Nursing Poorly prepared nurse may feel Uses a mini-team. threatened by primary nursing. Has 2 or 3 members with at least 1 nurse as a member. 5. Nursing Case Management Typically divided into modules A collaborative process of or districts assessment, planning, Assignments are based on the facilitation, and advocacy for geographical location of the options and services by the case patients. manager to meet an individual’s health needs. 4. Primary Nursing Nurse address each patient Primary nurse assumes 24- hour individually, identifying the responsibility. most cost-effective providers, Planning the care of one or treatments, and care settings more patients from admission to possible. discharge. Also known as When the primary nurse is not “Second-Generation Primary on duty, the associate nurses Nursing”, “Outcomes follow the care plan established Management”, or “Clinical by the primary nurse. Resource Management” Advantages: Advantages: Provides for increased autonomy on the Entire episode of illness is the focus. part of the nurse, thus, increasing Achievement of outcomes is motivation, responsibility, and emphasized. accountability. Care is coordinated by a case manager. Assures more continuity of care as a Healthcare team meetings are held. primary nurse gives or directs care Interdisciplinary approach is used. through hospitalization. Disadvantages: Leads to increased rapport and trust Coordination requires effort. between the nurse and the patient. It is the ways of thinking, behaving, and Improves communication of information believing that members to the physician. of a unit have in common.  This must be learned and adopted by driven, personal, promotive, and newcomers before they can be accepted relaxed. into the agency. The leader is a catalyst, Culture is learned, shared, and cultivator, empowerer, inspirer, transmitted. promoter, and steward. This requires the interpersonal and communication skills of a Management Process: Staffing leader. It is the process of determining and It is important to support a providing the acceptable number and “nurse-friendly” culture where nurses mix of nursing personnel to produce a can function effectively and efficiently. desired level of care to meet the patients demand. Types of Culture Most crucial, complex, and 1. Control Culture time-consuming. Authoritative, cautious, conservative, and definitive. Factors Affecting Staffing The leader is firm, impersonal, I. Patient Factors tough minded, realistic, 1. Census fluctuations systematic, task-driven, 2. Patient acuity objective, and prescriptive. 3. Levels of care or degree of dependence 2. Collaborative Culture 4. Patient age group Adaptive, collegial, democratic, 5. Special treatment and procedure first among equals, informal, 6. Communicability participative, personal, 7. Rehabilitation needs relational, supportive, and 8. Patient and family care demands and trusting. expectations The leader functions as a coach, II. Staff Factors integrator, team builder, and 1. Number of nursing staff available trust builder. 2. Ratio of professional to non-professional 3. Competence Culture 3. Number of leaves Assertive, challenging, 4. Turn-over rate persuasive, efficient, 5. Absenteeism rate emotionless, formal, 6. Proficiency rate impersonal, intense, objective, 7. Span of supervision rational, and task- driven. The leader is an assertive, III. Nursing Service Factors visionary standard setter who 1. Nursing care modality in use recruits the most competent 2. Patient care classification system people and then stretches them. 3. Patterns of work schedule 4. Training and staff development 4. Cultivation Culture programs Attentive, emotional, enabling, 5. Research activities humanistic, nurturing, people- IV. Organizational Factors positions and should be an ongoing 1. Type of hospital process. 2. Services offered Types: 3. Work time policy 1. Planned - Arise from changes in 4. Administrative policy on rotation, an organization and recruitment weekend and holiday duty policy. 5. Presence of support services 1. Anticipated - Studying trends in 6. Nursing unit architectural design the internal and external 7. Availability of resources organization. 8. Technology anticipated 2. Unexpected - Arise due to 9. Projected units of services accidents, transfer or illness. 10. Budget limitations Recruitment Process Steps in Staffing 1. Planning 1. Determine the number and types of 2. Strategy development personnel needed to fulfill the 3. Searching philosophy, meet fiscal planning 4. Screening responsibilities, and carry out the chosen 5. Evaluation and control patient care delivery system selected by the organization. Selection 2. Recruit, interview, select, and assign Process of choosing from among personnel based on established job applicants, the best qualified applicants. description performance standards. Involves verifying: 3. Use organizational resources for 1. Applicant’s qualifications; induction and orientation. Ascertain that 2. Checking his work history; and, each employee is adequately socialized 3. Deciding if a good match exists between to the applicant’s qualifications and the 4. organization values and unit norms. organization’s expectations. 5. Use creative and flexible scheduling based on patient care needs to increase Selection Process productivity and retention. 1. Preliminary interview 2. Selection of test Staffing Procedures 3. Employment interview 1. Recruitment 4. Reference and background checks 2. Selection 5. Selection decision 3. Placement 6. Physical examinations 4. Indoctrination 7. Job offer 5. Training and Development 8. Contract of employment 6. Promotion Selection Process Recruitment Interview is a verbal interaction between Process of actively seeking out or individual for a particular purpose. attracting applicants for existing Types of Interview: 1. Formal  2. Informal Training and Development 3. Structured Process of enhancing the skills, 4. In-depth capabilities, and knowledge of 5. Group employees for doing a particular job. 6. Panel Molds the thinking of the employees. Leads to quality performance of Placement employees. Process of assigning a specific job to a It is continuous and never ending in selected candidate or assignment of nature. specific task and responsibility. Proper placement: Promotion 1. Fosters personal growth; Assignment of individual to a job of 2. Provides a motivating climate higher rank. for the employee; Maximizes Advancement of an employee from one productivity; and, position to another with an increase in 3. Increases the probability that duties and responsibilities. organizational goals will be met. Usually associate with increase in salary. Indoctrination Types: Planned, guided adjustment of an 1. Up or Out employee to the organization and the - Either earn a promotion or seek work environment. employment It has two Phases: 2. Dry promotion 1. Induction - Compensation is adjusted keep 2. Orientation pace with cost of living. 1. Induction Phase Application Form Educate the new employee A way to collect demographic about the organization, information of the applicants. employment, and personnel Usually created by the employer. policies and procedures. 2. Orientation Phase It contains: Activities are more specific for 1. Personal information the position. 2. Educational qualifications Purpose: To make the employee 3. Work experience feel like a part of the team. Help 4. Salary to reduce burnout among new 5. Personality items employees. 6. Reference checks Help the new employees become independent more Biodata quickly in their new roles. Also known as biographical data. Essentially a resume plus physical attributes, such has height, weight, hair, skin, eye color, and a photo.  Organizational Structure and Resume Staffing Standards for It includes a work and salary history, Government Hospitals-CY 2013 educational history, and job objective. Edition). Curriculum Vitae Ratio-Based Staffing List of one's professional and educational history and tends to focus on one area of expertise. It is commonly used by authors, researchers, speakers, professors, and other experts in a particular field. Job Description - A statement setting forth: 2. Acuity-Based Staffing 1. The duties and responsibilities Reflects the severity of the of a specific job; and, physical and psychological 2. The characteristics of the status or illness of the patient. individual needed to perform The intensity attribute of acuity the job successfully. indicates the nursing care needs - It contains the basic job-related data. and the corresponding workload 1. Job title required. 2. Position classification Number of hours with 3. Salary grade associated costs. 4. Job summary Total time and staff mix of 5. Job duties and responsibilities nursing personnel consumed by 6. Reporting relationship an individual patient during the 7. Nature of supervision episode of care. 8. Equipment, machines, and tools to be used Acuity-Based Staffing 9. Working environment 10. Qualifications Staffing Methods 1. Ratio-Based Staffing Reflects the number of nurses assigned to care for certain number of patients as a 1. Benchmarking state-mandated regulatory - It is the management tool for requirement for a seeking out the best practices in nurse-to-patient assignment. one’s industry so as to improve Department of Health mandated performance. (Swansbury, nursing staffing ratios for 1996). government hospitals (Revised 2. Budget-Based Staffing  - Nurses are allocated according There are also benefits that have to be to nursing care per hour per enjoyed by each personnel regardless of patient per day. the working hours per week. The least is the granting of the 3-day special privilege to government employees by the Civil Service Budget Based Staffing Commission as per Memorandum Circular No. 6 series of 1996: 1. Birthdays 2. Weddings 3. Anniversaries 4. Funerals (Mourning) 5. Relocation 6. Enrollment or graduation leave, and etc. Total Number of Working days, Non- Working days and Working Hours of Nursing Personnel per Year Staffing Methods 1. Statutory and Regulatory Requirements As mandated by RA 5901 (The 40 Hour a Week Law). Employees working in a 100 bed capacity and up will work only 40 hours a week. Employees working in agencies Patient Care Classification System with at least one million Primarily developed to objectively population will work only 40 determine workload requirements and hours a week. staffing needs. Employees working in agencies It is a means of categorizing patients on with less than 100 bed capacity the basis of certain needs that can be or in agencies located in clinically observed by the nurse. communities with less than one It indicates how many actual hours of million population will work 48 nursing care the patient needs during a hours a week and therefore will particular shift. get one off-duty a week. It uses the Nursing Care Hours (NCH) per Patient per Day. Statutory and Regulatory Requirements Nursing Care Hours (NCH) per Patient per Day Classification of Patient Care by Levels of A standard measure that quantifies the Care, NCH, and Ratio nursing time available to each patient by available staff. Simply means the amount of time nurses spend with each patient per day. Formula: NCH = Total of hours worked in 24 hours/Total patient census in a day Nursing Care Hours (NCH) per Patient per Day Example: There are 12 staff nurses Classification of Patient Care by Levels of working 8 hours with a total patient Care according to Type of Hospital census of 40. NCH = 12 staff nurses x 8 hours/40 patients NCH = 96 worked hours/40 patients NCH = 2.4 Patient Care Classification System 1. Classification of Patient by Units, Classification by Levels of Care Nursing Care Hours per Patient per Day, 1. Level 1 (Self-Care or Minimal Care) and Ratio of Professionals to They are capable of Non-Professionals carrying-out activities of daily 2. Classification of Patients by Levels of living (ADL), hygiene, meals, Care, Nursing Care Hours per Patient exercises etc. per Day, and Ratio of Professionals to Patient who enters the hospital Non- Professionals for diagnostic work-ups (e.g., 3. Classification of Patients by Levels of blood test, x-ray, or other Care according to Type of Hospital with non-invasive tests) Percentage of Patients at Various Levels AverageNCH/patient/dayis1.5. of Care Ratio of professional non-professional personnel is Classification of Patient Care by Units, NCH, 55:45. and Ratio 2. Level 2 (Moderate Care or Intermediate Care They require some help from the nursing staff with special treatments or certain aspects of personal care. PatientwithIVfluidstherapy,cath eter,chest physiotherapy. AverageNCH/patient/day is 3.0.  Ratio Of Professional To Ratio of professionals to Non-professional personnel is non-professionals is 65:35 60:40. 1. Categorize the number of patients 3. Level 3 (Total Care, Complete Care, or according to the levels of care needed. Intensive Care) Multiply the total number of patients by They are usually bedridden who the percentage of patients at each level lack strength or mobility and of care (whether minimal, intermediate, need nursing assistance to do intensive, or highly specialize). average daily living. 250 patients x 0.10= 75 patients Patients on complete bed rest, needing minimal care immediate post-operative with 250 patients x 0.30 = 112.5 contraptions. patients needing moderate care AverageNCH/patient/day is 4.5 250 patients x 0.45 = 37.5 to 6.0. patients needing intensive care Ratioofprofessionaltonon-profes 250 patients x 0.15 = 25 patients sional personnel is 65:35. needing highly specialize care TOTAL = 250 patients 4. Level 4 (Highly Specialized Care or Critical Care) - Find the total number of nursing care They are critically-ill and in hours needed by the patient’s at each constant danger of death or category level. serious injury like comatose A. Find the number of patients at patients. each level by the average Patients need continuous number of nursing care hours treatment and observation with per day. many medications on titration, B. Get the sum of the nursing care intravenous piggybacks, vital hours at the various level. signs every 15 to 30 minutes, and hourly output. Therearesignificantchangesindo ctor’sordersthatneedto carry-out. AverageNCH/patient/dayis6.0to 9.0ormore. Ratio of professionals to non-professional personnel 1. Find the actual number of the nursing care ranges from 70:30 to 80:20. hours needed by the given number of patients. Multiply the total nursing care hours needed per Staffing Formula day by the total number of days in a year. Steps to illustrate on how to calculate 768.75 NCH/day x 365 (days/year) = the number of staff needed in the 280,593.75 NCH/year in-patient areas of the hospital. Example used is a staffing requirement 2. Find the actual number of working hours for a 250-bed capacity tertiary hospital. rendered by each nursing personnel per year. Multiply by the number of hours on duty per day A. Distribute by shifts for the by the actual working days per year. Professionals. 8 (hours/day) x 213 (working days/year) = 1,704 (working hours/year) 3. Find the total number of nursing personnel needed. A. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year. B. Find the number of relievers. Multiply B. Distribute by shifts for the Non- the number of nursing personnel needed Professionals. by 0.15 for those working 40 hours/week or by 0.12 for those working 48 hours/week. C. Add the number of relievers with the number of nursing personnel needed. Scheduling A timetable showing planned work days and shifts for nursing personnel. 1. Categorize the nursing personnel into The objective in scheduling is to assign professionals and non-professionals. working days and days off to the nursing Multiply the number of nursing personnel so that adequate patient care personnel according to the ratio of is assured. professionals to non-professionals. Ratio A desirable distribution of “off days” of professionals to non-professionals is can be achieved and the individual 65:35. members of the nursing team will feel Total Nursing Personnel Needed that they are treated fairly. x 0.65 Ratio = Professionals Nursing staff will know their schedule in Total Nursing Personnel Needed advance. x 0.35 Ratio = Fundamentally, scheduling system can Non-Professionals be categorized into; 190 x 0.65 = 123.5 = 124 190x 0.35 = 66.5 = 66  1. Centralized Staffing The power and authority for 3. Self-Scheduling staffing decisions occur An approach in which the nursing centrally personnel sign up for their preferred for the entire hospital. shifts using staffing and scheduling Commonly, the staffing and policy and guidelines. scheduling office of the Nursing Associated with increased perception of Service. autonomy, improved professionalism, The chief nurse or his designate increased job satisfaction, more plans the coverage for all the cooperative atmosphere, improved team nursing units. spirit, improved morale, decreased 2. Decentralized Staffing absenteeism, reduced turnover, and The power and authority for shortened scheduling time. staffing decisions are methodically dispersed to Rotation Work Shifts first-line managers of each It desirable that there must be equal nursing unit. share of morning, afternoon, and night The shift and off duties are shifts. arranged by the supervising As prolonged night shifts may affect the nurse, head nurse or senior health of the personnel. nurse of the particular unit. Many personnel would prefer the morning shift duty but his given most Scheduling Approaches frequently to first-line managers. 1. Block Scheduling Permanent shifts would make feel a The work schedule for nursing sense of belonging among the nursing units is planned in block of personnel with the other personnel in the weeks, often 1 to 4 weeks at a unit and in the same shifts. time. It has flexibility because the Management Process: Directing next block of time need not A key managerial function. necessarily follow the pattern of It involves the process of getting the the preceding or the following organizations work done. week. It entails explaining: ○ What to be done?To and by 2. Cyclical Scheduling whom? At what time? How and An improvement of the block why? schedule in which it has a cyclical repetitive work pattern Directing of 4 weeks. The heart of the management process It is known as “team rotation” that involves: because the nursing team is 1. Giving instructions scheduled as a unit. 2. Guiding This method is used in the team 3. Overseeing nursing modality of care. 4. Counselling  5. Motivating 2. Must be understandable, the person 6. Leading the staff giving the direction must explain the rationale and make certain that it is Characteristics of Directing understood. 1. Initiates Action 3. The words used in the direction indicate By giving directions and their importance like should, must, shall, instructions the nurse managers will and may. get the work started in the 4. The person giving the direction should organization. speak distinctly and slowly. 2. Continuous Process 5. Directions in logical manner and Nurse managers continuously prioritized tasks. Give them one at a takes steps to ensure that orders time. and instructions are carried-out properly. Elements of Directing 3. Flows from Top to Bottom 1. Supervision Nurse managers direct their 2. Problem Solving and Decision Making immediate subordinates and 3. Delegation take directions from their 4. Communication immediate superiors. 5. Collaboration and Coordination 4. Takes Place at Every Level 6. Motivation Directing is a pervasive function for all managers at all levels in Supervision all units perform it. An essential part of management. It takes place wherever It helps to put plans into action towards superior-subordinate relation the accomplishment of goals. exists. It is providing guidelines for the 5. Performance-Oriented accomplishment of a task or activity. Directing function helps in converting plans into Purposes of Supervision performance. 1. To ensure the worker is clear about It initiates action in people and roles and responsibilities. makes physical resources 2. To ensure the worker meets the meaningful. agency’s objectives. 6. Emphasized Human Element 3. To ensure quality of service to clients. Since human behavior is 4. To assist professional development. complex and unpredictable 5. To reduce stress. directing function involves 6. To ensure the worker is given the studying workers’ behavior and resources to do their job. motivating them to work with their best ability. Methods of Supervision 1. Direct Supervision Characteristics of Good Direction The supervisor is physically 1. It must be clear, concise, consistent and present in the workplace. complete.  He takes principal responsibility Authoritarian Supervision - Centers its and accountability for the action responsibility entirely on the supervision taken by the supervisee. with the staff following the orders. He observes the supervisee in providing clinical care Bases for Nursing Supervision according to the supervised 1. Patient’s records and reports practice plan. 2. Patient’s history sheets E.g., assessment and/or 3. Treatment records, results of treatment of individual patients. investigation, and diagnostic procedures 4. Round books and procedure manuals 2. Direct Supervision 5. Medicine ledger book, dangerous The supervisor is physically drug record and registers present in the workplace. 6. Nursing care plans (NCP) or Nurse’s He takes principal responsibility notes (FDAR) and accountability for the action 7. Call books taken by the supervisee. 8. Admission and discharge registers He observes the supervisee in 9. Death registers providing clinical care according to the supervised practice plan. Bases for Nursing Supervision E.g., assessment and/or 1. Incident reports treatment of individual patients. 2. Requisition registers for drugs and supplies 3. Infection prevention and control Types of Supervision accomplishment reports Technical Supervision - Uses some of 4. Non-conformance and corrective the basic supervisory skills which need action reports to be trained (i.e., group conferences and 5. Patient safety checklists and group discussions. accomplishment reports Creative Supervision - Provides 6. Other available clinical records maximum adaptation of the situation 7. RA 9173 (Nursing Law) such as orientation. 8. RA 6713 (Code of Ethics of Public Scientific Supervision - Relies on Official and Employees) objective study and measurement that personal judgment or opinion Problem Solving and Decision Making Intuitive Supervision - Needs to 1. Problem Solving maintain interpersonal relationship. The An individual or collaborative supervision needs a sensitive and process composed of two intuitive reaction to the emotional needs different skills. of another person. To analyze a situation accurately Cooperative Supervision - Means full and to make a good decision participation of each member of the based on that analysis. group in planning action and decisions.  2. Decision-Making 5. What lies outside the The process of making action problem is not the from choices, decisions, problem to be faced or information, alternative solved. resolutions. alternative making by identifying a gathering and 2. Analysis of the Problem assessing Means Getting To The Cause Of It involves a choice utilizing The Problem. mental processes at the It produces an explanation that conscious level and is aimed at can be verified because the facilitating a defined objective. event or cause has already taken place. Five Steps of Decision-Making Process Heshouldbeopen-mindedandflex 1. Definition of the Problem ible. What should be done or avoided The entire decision-making is not what is being done or process should be objective to prevented. arrive at the best solution. How To Correct This Deviation After the problem has been Is A Problem. identified, the Nurse Supervisor The decision maker set the stage or Head Nurse proceeds to for decision making. Pre- investigate, gather data, and determined objectives provide evaluate the results. the focus for the decision. He should be careful not to let He or she should gather all his prejudices or biases color the relevant data so as to recognize evaluation of the facts. the real problem. A lot of questions should be 3. Development of Alternative Solutions considered: This step focuses on the search for and analysis of alternatives 1. Does the problem occur and their possible consequences. in all units or only in Sufficient information enables one specific unit? the decision maker to arrive at 2. Does it involve all rational decisions. personnel or only Factors to be considered in certain personnel? evaluating alternative solutions: When does the problem 1. Time occur and how often? 2. Available resources 3. What is the content of 3. Labor the problem? 4. Cost of tools and 4. Only after the real cause equipment to be used has been identified can 5. Moral and the legal the question of “why implications the problem occurs” be answered.  The problem should be shared Implementation and Follow-up with the subordinates to gather 1. Planning additional ideas, information Entails consideration and and suggestions. selection of realistic objectives, The deciding authority can policies, and procedures. make decisions that may or may 2. Organizing not reflect his/her subordinates Helping personnel understand opinions. the decision and procedures It is reasonable to share the necessary for implementing the problems with the subordinates decision. because the share the same 3. Staffing organizational goals. Selection of the right persons to Together they can evaluate carry out the decision. alternatives and attempt to reach 4. Controlling an agreement or consensus in a Control the environment and the solution. group to prevent the adverse effects. 4. Selection of a Solution A follow-up appraisal through Facts have been weighed and alternative observation, feedback and solutions have been explored, ranking of reports are necessary to find out preferences is important. if the problem has been The Supervising Nurse or Head Nurse resolved. chooses the best course to follow This provides information for considering the advice from others, future decisions. experience, and most importantly the If solution proves to be logical reasoning. unsatisfactory, the whole He narrows down his choice to two or process of decision making is three alternatives, repeated and the entire problem while weighing the advantages and is reviewed. disadvantages of each. Choose the best solutions that offers a Conflict Management better chance of success. Conflict is a natural, inevitable Decisions may mean a compromise or condition in an organization and often is combination of two possible solutions. a prerequisite to change in people and organization. 5. Implementation and Follow-up Conflicts occur on several levels The Major Management Functions categorized as follows: Implementing A Decision include 1. Intrapersonal planning, organizing, staffing, and 2. Interpersonal controlling. 3. Intragroup 4. Intergroup Intrapersonal Conflict Sources of Conflict It occurs within the individual. 1. Differences in knowledge, skills, values, It involves an internal struggle to clarify interests, scarcity of resources. contradictory values or wants. 2. Intergroup rivalry for rewards. 3. Role-ambiguity. Interpersonal Conflict 4. Unworkable organizational structure. It happens between two or more people 5. Shift in organizational power base and with differing values, goals, and beliefs. organizational climate. May be closely linked with bullying, 6. Unacceptable leadership style. incivility, and mobbing. When bullying, incivility, and mobbing Types of Conflict occur in the workplace, this is known as 1. Competitive Conflict “workplace violence”. It occurs when two or more groups attempts the same goals Types of Interpersonal Conflict and only one group can attain 1. Bullying them. A repeated, offensive, abusive, It is defined by the victory for intimidating, or insulting one side and a loss for other. behaviors. The process by which such Abuse of power, or unfair conflict is resolved by sanctions that make recipients determined by a set of rules. feel humiliated, vulnerable, or threatened. 2. Disruptive Conflict Thus, creating stress and This takes place in an undermining their self- environment filled with fear, confidence. anger and stress. 2. Incivility There is no mutually acceptable A behavior that lacks authentic set of rules and the goal of each respect for other that requires party is elimination of its time, presence, willingness to opponent. engage in genuine discourse. Intention To Seek Common Conflict Handling Intentions Ground. According to Thomas (1976), conflict 3. Mobbing has two dimensions: It Occurs When Employees Assertiveness (satisfying one’s own “gang-up”on an individual. concern) Cooperativeness (attempting to satisfy Intergroup Conflict another’s concerns) It occurs between two or more groups of Each representing an individual’s people, department, or organizations. intention with respect to a conflict E.g., two political affiliations with situation. widely differing or contradictory beliefs. Conflict Resolution Strategies Disagreements are ignored so that 1. Avoiding surface harmony is maintained in a state 2. Withholding or Withdrawing of peaceful co-existence. 3. Smoothing Over or Re-assuring This accomplished by complimenting 4. Accommodating one’s opponent, downplaying 5. Forcing differences, and focusing on minor areas 6. Competing of agreement, as if little disagreements 7. Compromising exist. 8. Confronting This method maybe appropriate in 9. Collaborating solving minor problems but issues also 10. Collective Bargaining remain and solved and later resurface. It uses verbal communication to defuse Avoiding strong emotions. Commonly used by groups who do not want to do something Accommodating that may interfere with their It means self-sacrifice. relationships. “Kill the enemy with kindness” is the Neutrality is maintained at all costs. related phrase. The participants never acknowledge The person neglects his own needs to that a conflict arises. meet the goals of the other party. The individual’s posture is “If I do not It is appropriate when the person is acknowledge there is a problem then wrong, when the opponent is more there is no problem”. powerful, or when the issue is more It is sometimes reflected in the phrases important to someone else. “leave well enough alone”. It is use to preserve harmony and Unassertive and uncooperative and social credits that can be used later. creates “lose-lose” situations. It focuses on points of agreement and on minor problems although the real Withholding or Withdrawing problem still exist and has to be attended It means that one party is removed to. thereby making it possible Cooperative but unassertive and to resolve the issue. creates “lose-win” situations. He withdraws from the situation. However, this strategy does give Forcing individuals a chance to calm down or to A method that yields an immediate end avoid a confrontation. to the conflict but It produces the same results as leaves the cause of the conflict smoothing. unresolved. It is a dominance move and an Smoothing Over or Re-assuring arbitrary way to manage conflict. “Everything will be okay” by As superior can issue orders but the maintaining surface harmony. subordinate will lack commitment to the Parties do not withdraw but simply demanded action. attempt to make everyone feel good.  An issue may be forced by putting it to Individual speak for themselves but in a majority-rule vote. a way that decreases defensiveness. “Let’s vote on it” as the hallmark It allows another person to hear the phrase. message. It is appropriate in life and death It is a staple of conflict management situations but is otherwise inappropriate. but requires courage. “I” messages are used while “You” Competing messages are avoided. It is sometimes reflected in the phrase “Might makes right”. Collaborating The Supervisor or Nurse Manager An assertive and cooperative strategy exerts power at the in which the parties It is expressed through suppression of work together to find a mutually conflict through authority and obedience satisfying solution. approach. It is useful in situations where the This enforces the rule of discipline. goals are too important to be It is an assertive position that fosters compromised. conflict resolution on Problems are identified, alternatives the part of the subordinate. are explored, and threats are considered Applying for a job is a form of until disagreements are resolved. competition. It is involved with the phrase “two Assertive but uncooperative and heads are better than one”. creates “win-lose” situations. Generally, this the most effective method of conflict resolution. Compromising Assertive and cooperative and creates It is called “Splitting the difference”. “win-win” situations. Both parties seek expedient, acceptable answers for short periods when the goals Collective Bargaining are only moderately important and the It involves activities occurring between parties have equivalent powers. organized labor and In this method, accommodation and management that concern employee adjustment lead to workable situations relations. rather than to the best solutions. Management that is perceived to be Because both parties feel that they deaf to the workers’ needs provides a sacrifice something, they are only fertile ground for union organizers. partially satisfied and a lose-lose Unions thrive in a climate that atmosphere results. perceives the organizational philosophy Assertive and cooperative and creates to be insensitive to the worker. ”lose-lose” situations. Negotiating Confronting Each party gives up something and the It is called assertive problem solving. emphasis is on It is focused on the issues. accommodating differences between the parties.  The very least for which a person will their cooperation in resolving the settle is often referred conflict. to as the “bottom line”. It is psychological and verbal. Delegation The effective negotiator always A major element of the directing appears calm and self- assured. function of nursing management. Mediation It is an act assigning to someone A conflict-resolution process in which a else a portion of the work to be neutral person: Facilitates done with corresponding communication, Development of authority, responsibility and understanding, Generation of options for accountability (ARA). creative dispute resolution It is also a skill to be learned and mastered beginning with Basic Rules of Mediating Conflict learning what can not be 1. Established clear guidelines and make delegated and what will be them known to all. delegated and to whom. 2. Do not postpone indefinitely. Select a An assignment is a task done time that is best for all parties. without an authority, while 3. Create an environment that makes delegation is a task with ARA. people comfortable and make suggestions. Energize them and promote Purposes of Delegation creative thinking leading to better 1. Provides appropriate solutions and strengthening of distribution of tasks for safe and relationships. quality nursing care. 4. Keep a two-way communication. 2. Promotes individual Encourage a full expression of positive responsibility and and negative feelings with an accepting accountability. atmosphere. Allow open and complete 3. Allows the nurse to perform discussion of the problem of each of the more complex patient care and participants. Maintain equity in the other related services. duration of each party’s presentation. 4. Reduces workload to prevent 5. Stress a peaceful resolution rather than burn out. confrontation. Build a bridge of 5. Enhances the knowledge and understanding. Focus on issues and not skills of nursing personnel and on personality. Protect each other’s other healthcare workers. self-respect. 6. Promotes cost containment and 6. Emphasize shared interests. Examined effectiveness for the healthcare all solutions and select