Planning and Organizing PDF

PLANNING He who fails to plan is planning to fail. – Winston Churchill 7. Projected plans must be documented for proper dissemination to all concerned for implementation By failing to prepare, you are preparing to fail. – Benjamin...

PLANNING He who fails to plan is planning to fail. – Winston Churchill 7. Projected plans must be documented for proper dissemination to all concerned for implementation By failing to prepare, you are preparing to fail. – Benjamin and evaluation as to the extent of their Franklin achievement. SMART – NCP – SOAPIE IMPORTANCE OF PLANNING PLAN OF ACTIVITIES vs NURSING ACTUAL ACTIVITIES 1. Planning leads to the achievement of goals and objectives. 2. Planning gives meaning to work. PLANNING 3. Planning provides for effective use of available resources and facilities. ❖ Pre-determining a course of action to arrive at a 4. Planning helps in coping with crises. desired result. 5. Planning is cost-effective. ❖ Precise in scope and nature, realistic and outcome- 6. Planning is based on past and future activities. It centered. prevents or reduces the recurrence of problems ❖ Time bound. and provides better ideas. ❖ Proper documentation of expected outcome. 7. Planning leads to the realization of the need for GOOD PLANNING change. 8. Planning provides the basis for control. ❖ It involves a continuous process of assessment, establishment of goals and objectives, CHARACTERISTICS OF PLAN and implementation of change as new facts 1. Involves the future. become known (Douglas, 1986). 2. Involves action. POOR PLANNING 3. Must have an organizational identification of the action that will be undertaken either by the planner ❖ Failure to set goals, make assessments, or or someone designated by or for her. anticipate any possible change in circumstances. CHARACTERISTICS OF A GOOD PLAN INDICATOR OF POOR PLANNING 1. Have worded objectives, including desired results 1. Deliver dates are not met. and methods for evaluation. 2. Machines are idle. 2. Be guided by policies and/ or procedures affecting 3. Materials are wasted. the planned action. 4. Some are overworked, others are underworked. 3. Indicate priorities. 5. Skilled nurses doing unskilled work. 4. Develop actions that are flexible and realistic in 6. Nurses are fumbling on jobs for which they have terms of available personnel, equipment, facilities, not been trained. and time. 7. There is quarreling, bickering, buck-passing and 5. Develop a logical sequence of activities. confusion. 6. Include the most practical methods for achieving each objective. PRINCIPLES OF PLANNING TYPES OF PLANS 1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives 1. STRATEGIC PLANS of the organization. ❖ Based on explicit assessments of the 2. Planning is a continuous process. competitive strengths and weaknesses of 3. Planning should be pervasive within the entire the organization. organization covering the various departments, ❖ Defines the direction and growth of the services, and the various levels of management to organization. provide maximal cooperation and harmony. ❖ Usually prepared by the upper-level 4. Planning utilizes all available resources. management and basis for operating 5. Planning must be precise in its scope and nature. It plans. should be realistic and focused on its expected 2. OPERATING PLANS outcomes. ❖ Activities in certain departments 6. Planning should be time-bound, i.e., with short and ❖ Deals with tactics and techniques to long-range plans. answer, “how to do things right.”  ❖ Prepared separately by sub–unit 10 years) are referred to as long-range or managers. strategic plans. 3. CONTINUOUS OR ROLLING PLANS ❖ It may be done once or twice a year in an ❖ Like operating plans. organization that changes rapidly. ❖ The task of the staff nurse is to implement ❖ At the unit level, any planning that is at the nursing care plan depending on the least 6 months in the future may be needs. considered long-range planning. ❖ Strategic planning focuses on purpose, SCOPE OF PLANNING mission, philosophy, and goals related to TOP MANAGEMENT the external organization environment. 2. OPERATIONAL PLANNING OR SHORT-RANGE ❖ Chief nurse/ Executive nurse/ Nurse director PLANNING ❖ Set the overall goals and policies of the ❖ It deals with day-to-day maintenance organization. activities. ❖ It is done in conjunction with the MIDDLE MANAGEMENT preparation of the budget. ❖ Nursing supervisor ❖ Planning may also be related to the ❖ Direct activities to implement the operating policies improvement and maintenance of facilities. of the organization such as staffing. ❖ Nurse managers are most likely to be involved in this type of planning. It gives LOWER MANAGEMENT individual managers the freedom to accomplish their objectives as well as ❖ Charge nurse/ Senior nurse. those of the institution. ❖ Staff nurse ❖ Key ingredients of the operational plan, PLANNING MODES Consultation Budgetary information 1. REACTIVE PLANNING Calendar of events, maintenance ❖ Occurs after a problem exists. schedules ❖ Planning efforts are directed towards Training plans returning the organization to a previous, Facility use schedules. more comfortable state. ❖ Done in response to a crisis. WHY MANAGERS FAIL TO PLAN ❖ Can lead to hasty decisions and mistakes. ❖ Lack of knowledge of the philosophy, goals, and 2. INACTIVISM objectives. ❖ Status quo is the stable environment. ❖ Lack of understanding of the significance of ❖ Planning is focused on preventing change the planning process. and maintaining conformity. ❖ Lack of confidence in formulating plans. ❖ Changes are slow and occur incrementally. ❖ Lack of time management. 3. PREACTIVISM ❖ Future-oriented. STRATEGIES FOR SUCCESSFUL PLANNING ❖ Experience is not valued, and the future is always preferable. ❖ Start planning at the top. ❖ Technology is used to accelerate change. ❖ Keep planning organized, clear, and definite. 4. PROACTIVE/ INTERACTIVE PLANNING ❖ Don’t bypass levels or people. ❖ Past, present, and future are considered. ❖ Have short and long-range plans and goals. ❖ There is an attempt to plan the future of ❖ Know when to plan and when not to the organization rather than react to it. ❖ Keep target dates realistic. ❖ Gather data appropriately. TYPES OF ORGANIZATIONAL PLANNING ❖ Be sure objectives are clear. 1. STRATEGIC OR LONG-RANGE PLANNING PLANNING IS A FOUR-STAGE PROCESS TO ❖ If refers to determining the long-term objectives of the institution and the ❖ Establish objectives (GOALS) policies that will be used to achieve these ❖ Evaluate the present situation and predict future objectives. trends and events. ❖ Generally, complex organizational plans ❖ Formulate a planning statement (MEANS) that involve a long period (usually 3, 5, or ❖ Convert the plan into an action statement.  PLANNING It is of the highest priority because it influences the development of an ❖ Organization-level plans, such as determining organization’s philosophy, goals, organizational structure and staffing or operational objectives, policies, procedures, and rules. budgets, evolve from the mission, philosophy, and ❖ PHILOSOPHY STATEMENT goals of the organization. Flows from the mission statement and ❖ The nurse manager plans and develops specific delineates the set of values and beliefs goals and objectives for her or his area of that guide all actions of the organization. responsibility. It is the foundation that directs all further ❖ Important on both an organizational and a personal planning towards that mission. level and may be an individual or group process ❖ (NURSING) PHILOSOPHY STATEMENT that addresses the questions of what, why, where, Written in conjunction with the when, how, and by whom. organizational philosophy. ❖ Decision-making and problem-solving are inherent It should address fundamental beliefs in planning. about nursing and nursing care. ELEMENTS OF PLANNING The quality, quantity, and scope of nursing services and how nursing will specifically 1. FORECASTING meet organizational goals. 2. SETTING THE VISION, MISSION, PHILOSOPHY, ❖ GOALS GOALS, AND OBJECTIVES The desired result towards which effort is 3. DEVELOPING AND SCHEDULING PROGRAMS directed. 4. TIME MANAGEMENT It is the aim of the philosophy. 5. PREPARING THE BUDGET Should be measurable and ambitious but 6. ESTABLISHING NURSING STANDARDS, POLICIES, realistic. AND PROCEDURES ❖ OBJECTIVES Like goals but are more specific and FORECASTING measurable and identify how and when the ❖ Trying to estimate how a condition will be in the goal is to be accomplished. future. ❖ POLICIES ❖ Helps managers look into the future and decide in A statement of expectations that sets advance where the agency would like to be and boundaries for action-taking and decision- what is to be done to get there. making. ❖ It includes the environment in which the plan will It can be implied or expressed. be executed; who the client will be-their customs ❖ PROCEDURES and beliefs, language/ dialect barriers, public Plan that establishes customary or attitude and behavior, the severity of their acceptable ways of accomplishing a conditions/ illnesses, the kind of care they will specific task and delineates a sequence of receive; the number and kind of personnel required steps of required action. (professional and non-professional), and the ❖ RULES AND REGULATIONS necessary resource-equipment, facilities, and Plan that defines specific action or non- supplies. action. Describe situations that allow only one SETTING THE VISION, MISSION, PHILOSOPHY, choice of action. GOALS, AND OBJECTIVES The least flexible type of planning in the planning hierarchy. ❖ VISION STATEMENT The future aim of a function of the DEVELOPING AND SCHEDULING PROGRAMS organization. It gives the agency something to strive for. ❖ Programs are determined, developed, and targeted ❖ MISSION STATEMENT within a time frame to reach the set goals and The purpose: a brief statement identifying objectives. the reason that an organization exists. ❖ The Planning Formula: A mission statement identifies the WHAT has been done? What should be organization’s constituency and addresses done? What equipment and supplies have its position regarding ethics, principles, been used or are needed? What steps are and standards of practice. necessary in the procedure?  WHEN should the job be done? When was enables one to have time for himself/ herself it formerly done? When could it be done? because of the effective use of time. WHERE is the job to be done? Where does 4. Deferring, postponing, or putting off decisions, an activity occur to those activities actions, or activities can become a habit that immediately preceding and following it? oftentimes causes lost opportunities and HOW will the job be done? What are the productivity, generating personal or interpersonal steps to be followed in doing the crises. Learning to understand why one procedure? How will the time and energy procrastinates makes him/ her aware that a plan of personnel be used? can be initiated to prevent procrastination. WHO has been doing the job? Who else 5. Delegation permits a manager to take authority for could do it? It is more than one person decision-making and to assign tasks to the lowest involved? level possible consistent with his/her judgment, WHY to each of the questions, ask why. facts, and experience. Why is this job, this procedure, this step necessary? Why is this done in this way, in PREPARING THE BUDGET this place, at this time, by this person? ❖ PREPARING THE BUDGET AND ALLOCATION OF CAN some steps or equipment be RESOURCES eliminated? Can this activity be efficiently Systematic financial translation of a plan, combined with other operators? Can and allocation of resources based on the somebody else do it better? Can we get a forecasted needs. machine to help? Can we get enough ❖ BUDGET money? A plan that uses numerical data to predict TIME MANAGEMENT the activities of an organization over some time. ❖ It is a technique for allocating one’s time through It is the annual operating plan, a financial the setting of goals, assigning priorities, “road map” and a plan that serves as an identifying, and eliminating wasted time, and using estimate of future costs and a plan for managerial techniques to reach goals efficiently. utilization of manpower, material, and ❖ Although everyone has the same number of hours other resources to cover capital projects in in a day and the same number of days in a week the operating programs. (or days in a year), some people accomplish more ❖ NURSING BUDGET than others because they make better use of their Plan for allocation of resources based on time. preconceived needs for a proposed series ❖ We often hear people say, “Work smarter, not of programs to deliver patient care. harder” to get more work done in less time. ❖ HOSPITAL BUDGET Developing a better understanding of one’s use of Financial plan to meet future service time would help reduce stress. expectations. ❖ One’s personality, education, and culture influence Manpower, equipment, supplies how he or she manages time. The way one views Provide the highest quality at a minimum time influences the degree of stress he or she will cost. feel when time is mismanaged. BUDGET PLAN PRINCIPLES OF TIME MANAGEMENT ❖ PLAN FOR FUTURE ACTIVITIES WITH 4 1. Planning anticipates the problems that will arise COMPONENTS: from actions without thought. It anticipates the 1. REVENUE BUDGET – Summarizes the income crises that may occur, or the resources needed to that management expects to generate during solve the problems. Studies have shown that the planning period. for every hour spent in effective planning, three to 2. EXPENSE BUDGET – Describes the expected four hours in the execution of the plan is saved. activity in operational and financial terms for 2. Tasks to be accomplished should be done in given a period. sequence and should be prioritized according to 3. CAPITAL BUDGET – Programmed acquisitions, importance. Failure to prioritize oftentimes results disposals, and improvements in an institution’s in spending more time on unimportant tasks. physical capacity. 3. Setting deadlines in one’s work and adhering to 4. CASH BUDGET – Planned cash receipts and them is an excellent exercise in self-discipline. It disbursements as well as the cash balances expected during the planning period.  ❖ Capital budgets plan for the purchase of buildings 6. Standards of nursing care or major equipment, which include equipment that 7. Method of performing nursing care (simple or has a long life (usually greater than 5 to 7 years), complex) is not used in daily operations, and is more 8. Method of documentation expensive than operating supplies. 9. Proportion of care given by pro and non- professionals TYPES OF BUDGETS 10. Amount and type of supervision available and 1. PERSONNEL OR MANPOWER provided. 2. OPERATING 11. Efficiency of job description and job classification 3. CAPITAL 12. Method of patient assignment 4. CONTINUOUS OR PERPETUAL 13. Amount and kind of labor-saving devices and 5. FISCAL YEAR equipment, intercommunication. 14. Amount of centralized service provided. ❖ The largest of the budget expenditures is the 15. Nursing service requirements of the ancillary workforce or personnel budget because health care departments is labor intensive. 16. Reports required by the administration. ❖ The operating budget is the second area of 17. Affiliation of nursing students and medical expenditure that involves all managers. The supplies. operating budget reflects expenses that change in response to the volume of service. ❖ Next to personnel costs, supplies are the second most significant component in the hospital budget. BENEFITS FROM BUDGETARY PROCESS 1. PLANNING ❖ Stimulates thinking in advance and anticipates future opportunities and problems. ❖ Leads to specific planning such as cost, volume, and personnel needed. ❖ Stimulates action and interaction. 2. COORDINATION ❖ Plans of one department must complement the plans of other affected departments. ❖ Encourages exchange of information. ❖ Stimulates team play or team approach. ❖ Enabling each team member to contribute to the organization. 3. COMPREHENSIVE CONTROL ❖ Evaluate the thinking of the budget contributor. ❖ The budget standards being set, comparisons between actual expenditures and budget standards. ❖ Tends to define fixed and agreed-upon goals. ❖ Cost consciousness is enhanced throughout the institution. FACTORS AFFECTING BUDGET PLANNING 1. Type of patient, length of stay, and acute of illness. 2. Size of hospital and bed capacity. 3. Physical layout of the hospital. 4. Personnel policies (salary, VL, SL, staff development) 5. Grouping of patients  ORGANIZING ORGANIZING CHAIN OF COMMAND ❖ The process of establishing formal authority, ❖ Formal line of authority and communication. involves setting up the organizational structure through: Identifications of groupings Roles and relationships Determining staff needed PROCESS OF ORGANIZING 1. Identification and definition of basic tasks 2. Delegation 3. Establishing relationships SPAN OF CONTROL CATEGORIES OF ORGANIZATION ❖ Different levels of control systems within the INFORMAL ORGANIZATION organization. ❖ People work together because of their likes and ❖ Refers to the location of the position in an dislikes. organization where frequent communication ❖ What people do because they are human occurs. personalities and their actions in terms of needs, ❖ Whether centralized or decentralized. emotions, and attitudes not in terms of procedures and regulations. TRENDS AFFECTING ORGANIZATIONAL STRUCTURES FROM TO Hierarchical management Flat organization Formal channels of Free access to information communication UNITY OF COMMAND Functional boundaries Absence of boundaries Division of labor Empowerment of ❖ Represented by a vertical solid line between employees positions on an organizational chart. Division and simplification Enrichment of work ❖ One person has one boss. of work through multiple tasks and expansion of knowledge Simple Complex ELEMENTS OF ORGANIZING ❖ ORGANIZATIONAL STRUCTURE ❖ STAFFING ❖ SCHEDULING TYPES OF WORK SEGMENTS ❖ DEVELOPING JOB DESCRIPTION ❖ Shown by a cluster of work groups. CHARACTERISTICS OF AN ORGANIZATION LEVELS OF MANAGEMENT DIVISION OF WORK ❖ Indicating hierarchical relationships. ❖ CHAIN OF COMMAND ❖ SPAN OF CONTROL ORGANIZATIONAL STRUCTURE ❖ UNITY OF COMMAND ❖ TYPES OF WORK SEGMENTS ❖ Process in which a group is formed including its ❖ LEVELS OF MANAGEMENT authority, responsibility and accountability, span of control, and lines of communication. Each box represents an individual or sub-unit responsible ❖ Formal structure is the official arrangement of for a given task. positions or working relationships to coordinate efforts.  PATTERNS OF ORGANIZATIONAL STRUCTURE TYPES OF ORGANIZATIONAL STRUCTURE TALL OR CENTRALIZED STRUCTURE LINE ORGANIZATION/ BUREAUCRATIC/ PYRAMIDAL ❖ Responsibility for only a few subordinates, there is a narrow span of control. ❖ Each position has general authority over the lower ❖ There is a vertical nature of the structure, there are position in the hierarchy. many levels of communication. ❖ Clearly defined superior. Subordinate relationship ❖ Top-down authority. ADVANTAGES ❖ Makes use of expertise and allows close FLAT ORGANIZATION communication between workers. ❖ Flattened scalar chain and fewer levels of position. ❖ Supervisory individuals screen the communication. ❖ Use for less complex organizations with authority DISADVANTAGES decentralized. ❖ Also known as horizontal organization. ❖ Often, most skilled individuals end up doing nothing, and tasks are done by less capable members. ❖ Communication from bottom to top is often difficult. ❖ “Boss-Oriented” FLAT OR DECENTRALIZED STRUCTURE ❖ Few levels and a broad span of control CULTURE OF INDIVIDUALS ❖ Decision-making is spread among many people. ❖ Includes the individual's VALUES, ATTITUDES, ❖ Communication from lower levels to higher levels PERCEPTIONS, INTERPERSONAL NEEDS, ROLES, is easy and direct. and COGNITIVE STYLES. VALUES ❖ Represents personal convictions about what is right, good, or desirable. ❖ Help individuals to decide which mode of conduct ADVANTAGES is preferable to others. ❖ Respond to problems or new opportunities faster. ATTITUDE ❖ Workers develop their abilities and autonomy ❖ Mental state of readiness that is organized through resulting in greater job satisfaction. experience and event-specific influences on a ❖ The principle of shared governance produces person's response to people, objects, and professional growth. situations. DISADVANTAGES PERCEPTIONS ❖ Supervisors spend less time with each other. ❖ Psychological process that makes sense out of ❖ Supervisors may lack expertise in a variety of what the individual sees, hears, smells, tastes, or operations and may end up making inappropriate feels. decisions.  ❖ Previous experiences and personal value systems ❖ Climate, on the other hand, is often defined as the affect perception. recurring patterns of behavior, attitudes, and ❖ There are differences in people’s ability to process feelings that characterize life in the organization data, to remember facts, and to explore alternatives (Isaksen & Ekvall, 2007). Although culture and which results in different perceptions. climate are related, climate often proves easier to assess and change. INTERPERSONAL NEEDS POSITIVE ASPECTS OF AN ORGANIZATIONAL ❖ Influenced by one’s basic needs about relationships CULTURE with others. ❖ People need to be people and tend to seek ❖ GUIDES DECISION-MAKING compatible relationships with others in social ❖ PROVIDES IDENTITY FOR MEMBERS situations. ❖ AMPLIFIES COMMITMENT ❖ GUIDES EMPLOYEE BEHAVIOR PERSONALITY ❖ PROVIDES JUSTIFICATION FOR ACTIONS ❖ Stable set of characteristics, temperaments, and STRENGTH OF AN ORGANIZATIONAL CULTURE tendencies. ❖ A strong culture could help an organization adapt ROLES to the environment. ❖ ROLES THEORY: Collection of concepts, definitions, ❖ A strong culture can also be an anchor around the and hypotheses that predict how actors will neck of change. perform under certain circumstances. ❖ ROLE: Acts of behaviors expected of a person who VISIBLE SIGNS OF STRONG ORGANIZATION occupies a given social position. CULTURE ORGANIZATIONAL CULTURE ❖ Stories ❖ Heroes ❖ A set of values or beliefs, underlying assumptions, ❖ Rituals expectations, and definitions that characterize an ❖ Ceremonies organization and its members. ❖ Symbols ❖ It is a potential predictor of organizational ❖ Myths performance. THE NEED TO MANAGE ORGANIZATIONAL CULTURE ❖ Organizational Culture has a powerful effect on the performance and long-term effectiveness of organizations. ❖ It impacts individuals within the organization in the areas of employee morale, commitment, productivity, physical health, and emotional well- being. ❖ It is different from an organizational climate which ❖ It is imperative to measure key dimensions of is focused on explicit and temporary attitudes, culture and to develop a strategy for changing it. feelings, and perceptions of individuals; organizational culture is more enduring and MEASURING ORGANIZATIONAL CULTURE deeper. THROUGH COMPETING VALUES ORGANIZATIONAL CLIMATE ❖ CAMERON AND QUINN (1999, 2006) Introduced the competing values framework for assessing and profiling dominant cultures of the organization by identifying the underlying cultural dynamics of the organization.  COMPETING VALUES FRAMEWORK PURPOSE: To provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required. FACTORS AFFECTING STAFFING 1. The type, philosophy, and objectives of the hospital and the nursing service. 2. The population served or the kind of patients served whether pay or charity. 3. The number of patients and severity of their illness- knowledge and the ability of nursing personnel are matched with the actual care needs of patients. 4. Availability and characteristics of the nursing staff, including education, level of preparation, a mix of personnel, number, and position. 5. Administrative policies such as rotation, weekends, TYPES OF CULTURES and holidays off-duties. THE CLAN CULTURE 6. Standards of care desired which should be available and spelled out. ❖ A very friendly place to work where people share a 7. Layout of the various nursing units and resources lot of themselves. It is like an extended family available within the department such as adequate where shared values and goals, cohesion, equipment, supplies, and materials. participativeness, individuality, and a sense of we- 8. Budget including the amount allotted to salaries, ness exist. fringe benefits, supplies, materials, and equipment. ❖ An organization that concentrates on internal 9. Professional activities and priorities in non-patient maintenance with flexibility, concern for people, activities like involvement in professional and sensitivity for customers. organizations, formal educational development, participation in research, and staff development. THE HIERARCHY CULTURE 10. Teaching program or the extent of staff ❖ A very formalized structured place to work. involvement in teaching activities. Procedures govern what people do. 11. Expected hours of work per annum of each ❖ An organization that focuses on internal employee. This is influenced by the 40-hour week maintenance with a need for stability and control. law. ❖ Center on maintaining efficient, reliable, fast, 12. Patterns of work schedule traditional 5 days per smooth-flowing production. week, 8 hours per day; 4 days a week, 10 hours per day and 3 days off; or 3 ½ days of 12 hours THE ADHOCRACY CULTURE per day and 3 ½ days off per week, ❖ A dynamic entrepreneurial, and creative place to NURSING CARE HOURS PER PATIENT PER DAY work. People stick their necks out and take risks. ACCORDING TO CLASSIFICATIONS OF ❖ An organization that concentrates on external PATIENTS BY UNITS positioning with a high degree of flexibility and individuality. CASES/ NCH/PT/DAY PRO-NON ❖ Characterized by a dynamic, entrepreneurial, and PATIENTS PRO RATIO creative workplace. GEN MED. 3.5 60:40 MEDICAL 3.4 60:40 THE MARKET CULTURE SURGICAL 3.4 60:40 OBSTETRICS 3.0 60:40 ❖ A results-oriented organization whose major PEDIATRICS 4.6 70:30 concern is getting the job done. People are PATHO 2.8 55:45 competitive and goal-oriented. NURSERY ❖ An organization that focuses on external ER/ICU/RR 6.0 70:30 maintenance with a need for stability and control. CCU 6.0 80:20 ❖ Core values are competitiveness and productivity. STAFFING PATIENT CARE CLASSIFICATION SYSTEM ❖ Process of determining and providing It is a method of grouping patients according to the amount an acceptable number and mix of personnel to and complexity of their nursing care requirements and the produce a desired level of care. nursing time and skill they require. PURPOSE: with chest or abdominal tubes. 1. Serve in determining the amount of nursing care ❖ They require close required, generally within 24 hours. observation at 2. Determine the category of nursing personnel who least every 30 should provide that care. minutes for impending CLASSIFICATION CATEGORIES hemorrhage, with hypo or LEVELS OF CARE DESCRIPTION hypertension and/ ❖ Can take a bath or cardiac on his own, feed arrhythmia. himself, perform ❖ Need maximum his own ADL. level of nursing ❖ For discharge pt, care with a ratio LEVEL I – MINIMAL non-emergency, of 80 CARE newly admitted professionals to don’t exhibit 20 non- unusual s/s. professionals. ❖ Requires little ❖ Needs continuous treatment and LEVEL IV – HIGHLY treatment and observation. CRITICAL observation. ❖ Need some ❖ With many assistance in medications, IV bathing, feeding, piggyback; v/s and ambulating monitoring every for a short period. 15-30 minutes; ❖ Extreme s/s of hourly output. illness must have ❖ There are subsided or have significant not yet appeared. changes in ❖ May have slight doctor’s orders. LEVEL II – emotional needs. INTERMEDIATE CARE ❖ V/S taking ordered 3x/ shift; LEVELS OF NCH/PT/DAY PRO-NON with IVF/ BT; are CARE PRO RATIO semi-conscious LEVEL I – 1.50 55:45 and exhibiting MINIMAL CARE some LEVEL II – 3.0 60:40 psychosocial or INTERMEDIATE social problems. ❖ Periodic CARE treatments and/ LEVEL III – 4.5 65:35 or observations INTENSIVE and instructions. CARE ❖ Patients are LEVEL IV – 6.0 or higher 80:20 completely HIGHLY dependent upon CRITICAL the nursing personnel. ❖ They are provided PERCENTAGE OF PATIENTS IN VARIOUS LEVELS complete baths, OF CARE are fed, may or TYPE OF MINIMAL MODERATE INTENSIVE HIGHLY LEVEL III – may not be HOSPITAL CARE CARE CARE CRITICAL INTENSIVE CARE unconscious, with PRIMARY 70 25 5 - marked emotional HOSPITAL needs; with v/s SECONDARY 65 30 5 - monitoring more HOSPITAL TERTIARY 30 45 15 10 than 3x/ shift. HOSPITAL ❖ Maybe on SPECIAL 10 25 45 20 continuous TERTIARY oxygen therapy, REPUBLIC ACT 5901 (FORTY-HOUR WEEK LAW) STAFFING FORMULA ❖ Employees working in 100-bed capacity and up Find the number of nursing personnel for a 250-bed will only work forty hours per week. capacity: ❖ Employees working in less than 100-bed capacity or community agencies will work forty-eight hours 1. Categorize pts according to levels of care needed. per week. 250 (pts) x.30 = 75 pts (MINIMAL CARE) 250 (pts) x.45 = 112.5 pts (MODERATE CARE) WORKING AND NON-WORKING DAYS 250 (pts) x.15 = 37.5 pts (INTENSIVE CARE) 250 (pts) x.1 = 25 pts (HIGHLY CRITICAL) R&P/ 40 HOURS 48 HOURS TOTAL: 250 pts PERSONNEL/YR VACATION LEAVE 15 15 2. Find the number of NCH needed by a patient at SICK LEAVE 15 15 each level/ day. LEGAL HOLIDAYS 10 10 75 x 1.5 (NCH NEEDED AT LEVEL I) = 112.5 NCH/day SPECIAL HOLIDAYS 2 2 112.5 x 3 (NCH NEEDED AT LEVEL II) = 337.5 NCH/day SPECIAL PRIVILEGES 3 3 37.5 x 4.5 (NCH NEEDED AT LEVEL III) = 168.75 OFF DUTIES (RA 104 52 NCH/day 5901) 25 x 6 (NCH NEEDED AT LEVEL IV) = 150 NCH/day CONTINUING 3 3 TOTAL: 768. 75 NCH/day EDUCATION PROGRAM 3. Find the total NCH needed by 250 pts/year. NON-WORKING 152 100 768.75 x 365 (days/year) = 280,593.75 NCH/year DAYS/ YEAR WORKING DAYS/ 213 265 4. Find actual working hours rendered/ personnel/ YEAR year. WORKING HOURS/ 1,704 2,120 8 (hours/day) x 213 (working days/year) = 1,704 YEAR working hours/year 5. Find the total number of nursing personnel needed. RELIEVERS NEEDED a. Total NCH/year = 280,593.75 = 165 ❖ Divided the average number of days an employee Working hours/year 1,704 is absent per year by the number of working days. b. Relief x Total nsg personnel a. 33/213 = 0.15 165 x 0.15 = 25 b. 33/265 = 0.12 c. Total nsg personnel needed. ❖ Computed RELIVER PER PERSON x NUMBER OF 165 + 25 = 190 NURSING PERSONNEL = RELIEVERS NEEDED 6. Categorize pro and non-pro (65:35) ratio in tertiary CIVIL SERVICE COMMISSION AS PER hospitals. MEMORANDUM CIRCULAR NO. 6 SERIES OF 190 x.65 = 124 professional nurses 1996 190 x.35 = 66 nursing attendants 3 DAYS SPECIAL PRIVILEGE: 7. Distribute by shift (nurses) ❖ Birthday 124 x.45 = 56 (am) ❖ Wedding 124 x.37 = 46 (pm) ❖ Anniversaries 124 x.18 = 22 (night) ❖ Relocation TOTAL: 124 ❖ Graduation ❖ Hospitalization Distribute by shift (N.A) ❖ Funeral 66 x.45 = 30 (am) ❖ Accident 66 x.37 = 24 (pm) 66 x.18 = 12 (night) DISTRIBUTION PER SHIFT TOTAL: 66 ❖ MORNING SHIFT – 45-51% EXERCISES ❖ AFTERNOON SHIFT – 34-37% ❖ NIGHT SHIFT – 15-18% Find the number of nursing personnel for a 300-bed capacity: 1. 300 (pts) x.30 = 90 pts (MINIMAL CARE) 300 (pts) x.45 = 135 pts (MODERATE CARE)  300 (pts) x.15 = 45 pts (INTENSIVE CARE) SCHEDULING 300 (pts) x.10 = 30 pts (HIGHLY CRITICAL) TOTAL: 300 ❖ Timetable showing planned worked days and shifts. TYPES OF SCHEDULING 2. 90 x 1.5 (NCH NEEDED AT LEVEL I) = 135 NCH/day 135 x 3 (NCH NEEDED AT LEVEL II) = 405 NCH/day 1. CENTRALIZED SCHEDULE 45 x 4.5 (NCH NEEDED AT LEVEL III) = 202.5 NCH/day 2. DECENTRALIZED SCHEDULE 30 x 6 (NCH NEEDED AT LEVEL IV) = 180 NCH/day 3. CYCLICAL SCHEDULE TOTAL: 922.5 NCH/day ADVANTAGES OF CYCLICAL SCHEDULE 3. 922.5 x 365 (days/year) = 336.712.5 NCH/day ❖ Fair 4. 8 (hours/day) x 213 (working days/year) = 1,704 ❖ Saves time. working hours/year ❖ Enables employees to plan. ❖ Covers leave and vacation. 5. Find the total number of nursing personnel needed. ❖ Productivity is improved. a. Total NCH/year = 336,712.5 = 198 Working hours/year 1,704 ASSESSING A SCHEDULING SYSTEM b. Relief x Total nsg personnel 1. Ability to cover the needs of the unit. 198 x 0.15 = 29.7 = 30 2. Quality to enhance the nursing personnel’s c. Total nsg personnel needed. knowledge, training, and experience. 198 + 30 = 228 3. FAIRNESS TO THE STAFF – a fair share of weekends, holiday offs, and rotation patterns for 6. 228 x.65 = 148 professional nurses the whole year including assignments to 228 x.35 = 80 nursing attendants “DIFFICULT” or “LIGHT” or “UNDESIRABLE” units or shifts. 7. 148 x.45 = 67 (am) 4. STABILITY – The schedule must be harmonized with 148 x.37 = 55 (pm) the family or social activities of the nurse staff. 148 x.18 = 26.64 or 26 (night) 5. FLEXIBILITY – Ability to handle changes brought by TOTAL: 148 emergency leaves. 80 x.45 = 36 (am) SCHEDULING SYSTEM 80 x.37 = 29.6 or 30 (pm) 80 x.18 = 14.4 (night) Make a schedule on a weekly or monthly basis and do TOTAL: 80 a cycle system with the staff under the area assigned for fairness and flexibility. STAFFING PATTERN PERSONNEL S M T W T F S 7/3 Head X X BENCHMARKING Nurse/Senior Nurse ❖ Seeking out the best practices in one’s industry to Staff Nurse X X improve performance. Nsg. Att. X X 3/11 Staff X X REGULATORY REQUIREMENTS Nurse Nsg. Att. X X ❖ Requirements as mandated by law. 11/7 Staff X X Nurse SKILL MIX Nsg. Att X X Gen. Rel. 3/11 3/11 11/7 X X 3/11 11/7 3/11; 11/7 ❖ Ratio of professional and non-professional. S. Nurse N. Att. 3/11 11/7 X 7/3 3/11 11/7 X STAFF SUPPORT ❖ Systematic process to implement. MODALITIES OF CARE HISTORICAL INFORMATION ❖ Organizing patient care is a critical role for nursing ❖ Knowledge about the presence or absence of leaders and managers, whether in a hospital, a equipment. skilled nursing facility, home care, or other healthcare settings. ❖ The primary goal when organizing patient care is delivering safe and quality nursing care using available resources effectively.  DELIVERING NURSING CARE ❖ A team of nursing personnel provides total patient care to a group of patients. ❖ The core business of a healthcare organization is ❖ In some instances, a team may be assigned a providing nursing care to patients. certain number of patients; in others, the assigned ❖ The purpose of a nursing care delivery system is to patients may be grouped by diagnoses or provider provide a structure that enables nurses to deliver services. nursing care to a specified group of patients. ❖ The size of the team varies according to ❖ The delivery of care includes assessing care needs, the physical layout of the unit, patient acuity, and formulating a plan of care, implementing the plan, nursing skill mix. and evaluating the patient’s responses to interventions. TRADITIONAL MODELS OF CARE FUNCTIONAL NURSING ❖ Also called task nursing, began in hospitals in the mid-1940s in response to a national nursing shortage. ❖ A particular nursing function is assigned to each staff member. TOTAL PATIENT CARE ❖ The medication nurse, treatment nurse, and bedside nurse are all products of this system. ❖ The original model of nursing care delivery was ❖ For efficiency, nursing was essentially divided into total patient care. tasks, a model that proved very beneficial when ❖ Also called case method, in which a registered staffing was poor. nurse was responsible for all aspects of the care of ❖ The key idea was for nurses to be assigned to tasks, one or more patients. not to patients. ❖ During the 1920s, total patient care was the typical nursing care delivery system. ❖ In total patient care, RNs work directly with the patient, family, physician, and other healthcare staff in implementing a plan of care. ❖ The goal of this delivery system is to have one nurse give all care to the same patient(s) for the entire shift. ❖ Total patient care delivery systems are typically used in areas requiring a high level of nursing expertise. ADVANTAGES ❖ A very efficient way to deliver care. ❖ Could accomplish a lot of tasks in a small amount of time. ❖ Staff members do only what they can do. ❖ Least costly as fewer RNs are required. DISADVANTAGES PRIMARY NURSING ❖ Care of patients becomes fragmented and ❖ Conceptualized by Marie Manthey and depersonalized. implemented during the late 1960s after two ❖ Patients do not have one identifiable nurse. decades of team nursing, primary nursing was ❖ Very narrow scope of practice for RNs designed to place the registered nurse back at the ❖ Leads to patient and nurse dissatisfaction. patient’s bedside. TEAM NURSING ❖ Decentralized decision-making by staff nurses is the core principle of primary nursing, with ❖ Evolved from functional nursing and has remained responsibility and authority for nursing care popular since the middle to late 1940s. allocated to staff nurses at the bedside.  ❖ Primary nursing recognized that nursing was a USES OF THE JOB DESCRIPTION knowledge-based professional practice, not just a task-focused activity. 1. For recruitment and selection. 2. To orient new employees. 3. Job placement, transfer, and dismissal. 4. For evaluation of performance. 5. Budget purposes. 6. Determine departmental function and relationship. 7. For classifying levels of nursing functions. 8. To identify training needs. 9. Basis for staffing. 10. Serve as a channel of communication. ❖ In primary nursing, the RN maintains a patient load of primary patients. A primary nurse designs implements and is accountable for the nursing care of patients in the patient load for the duration of the patient’s stay on the unit. ❖ Actual care is given by the primary nurse and/or associate nurses (other RNs). JOB DESCRIPTION ❖ It is a written statement, found in policy manuals that describe the duties and functions of the various jobs within the organization. ❖ Statement that sets duties and responsibilities of a specific job. ❖ They outline the scope of authority, responsibility, and accountability involved in each position. ❖ Important management tool to make certain that responsibilities are wisely delegated. CONTENTS OF THE JOB DESCRIPTION 1. Identifying data ❖ Position title. ❖ Department. ❖ Supervisor’s title 2. Job summary 3. Qualifications requirement 4. Job relationships 5. Specific and actual functions and activities. JOB ANALYSIS MATRIX WHAT THE WORKER DOES HOW THE WORKER DOES IT Duties Methods Tasks Tools Responsibilities Techniques WORKER QUALIFICATIONS WHY THE WORKER DOES IT Skills Products Knowledge Services Abilities Physical Demands