ORGANIZING AND STAFFING 5.
Exception Principle
Principles of Organizing
1. The Principle of Chain of Command
• States that organization shall be established
with hierarchical relationships within which
the authority flows from top to bottom.
• Communication flows through the chain of
command and tends to be one-way
downward.
• Supports mechanistic structure with
centralized authority and responsibility
2. The Principle of Unity of Command
• States that an employee has one supervisor
and there is one leader and one plan for
group activities with the same objectives.
• Each worker has one and only one boss. This
principle states that an employee should
have one and only one supervisor to whom
he or she is directly responsible. When
allocating tasks to individuals or grouping
assignments, management should ensure
that each has one boss, and only one boss,
to whom he or she directly reports.
• Formal chain of command running from top
to bottom of the organization, like military.
3. The Principle of Span of Control
• States that a person should be a supervisor
of a group he or she can effectively supervise
in terms of numbers, functions, and
geography.
• The number of people directly reporting to
any one manager represents the manager’s
span of control and determines the number
of interactions expected of him or her.
• When determining the optimal span of
control in an organization, the manager’s
abilities, the employee’s maturity, task
complexity, geographical location and level
in the organization at which work occurs
must be all considered.
4. The Principle of Specialization
• States that each person should perform a
single leading function.
• It is the degree to which organizational tasks
are divided into separate jobs. Employees
within each department perform only the
tasks related to their specialized function.
• Specializing encourages continuous
improvement in skills and the development
of improvements in methods. Specialization
is dividing labor into small, specific tasks and
assigning employees to do a single task.
Employees can work more efficiently if
they're allowed to specialize.
• It is sometimes called division of labor.
• Routine situations or recurring decisions
should be handled in a routine manner by
the lower-level managers while situations
that involve unusual matters should be
properly referred to the higher level of
managers.
• This allows the lower-level managers to build
confidence in doing decisions and at the
same time give more time for the top-
managers to perform other important tasks
at their level.
6. Decentralization (Proper Delegation of Authority)
• The process of conferring specified decision
making to the lower levels of the
organization.
• It is the downward transfer of authority from
a manager to a subordinate. Most
organizations today encourage managers to
delegate authority in order to provide
maximum flexibility in meeting customer
needs.
• Delegation leads to empowerment, in that
people have the freedom to contribute ideas
and do their jobs in the best possible ways.
This involvement can increase job
satisfaction for the individual and frequently
results in better job performance. Without
delegation, managers do all the work
themselves and underutilize their workers.
Organization Structure (Types)
1. Formal Organizational Structure
• Provides the formal framework in which the
management process takes place.
• Provide effective work system, network of
communication and functions.
2. Informal Organizational Structure
• Comprises personal and social relationships
that do not appear on the organizational
chart.
• Ex. People who take break together, works
together or takes a class together
• Not commanded by organizational structure
but comes from the follower’s natural
respect for colleagues’ knowledge and
abilities.
• Provides social control of behavior either
internal or external control.
• Has its own channel of communication -
Grapevine Communication.
• Informal organizational structure is
important to management.
3. Bureaucratic or Hierarchy Structure
• Facilitates large-scale administration by
coordinating the work of many personnel.
 • ADVANTAGE: Suited for work requiring large
numbers of moderately educated people
who perform routine tasks. Orientation easy
and orders transmitted quickly.
• DISADVANTEGE: Detrimental to healthy
personality patterns; authoritarian
leadership; if managers do not have
technical competence, they may feel
insecure and fear associates; personnel may
develop ritualistic attachment to routines,
monotony, alienation and resistance to
change.
4. Line and Staff Structure
• Develops when a simple line structure is
altered to provide support to line
authorities.
• Line function are command and control;
Staff function is separate from the chain of
command, involve specialization and are
supportive to line authorities. Staff do what
the executives are too busy to do.
• ADVANTAGE: Executive can delegate the
task.
• DISADVANTEGE: Executives can get credit
for staff recommendation; staff may
increase their influence over the executive;
executive may ignore staff
recommendations.
5. Functionalized Line and Staff Structure
• Staff have some authority over line
executives; the staff experts responsible for
a specific management function such as
staffing, staff development, or quality
improvement, has authority to command
line executives to implement staff plans.
• ADVANTAGE: Increase staff morale.
• DISADVANTAGE: When chain of command is
broken, conflict, confusion and poor
communications can result.
6. Adhocracy Organizational Structure
• Also known as organic models; newer
organizational models that are free form,
open, flexible, and fluid than are older
bureaucratic models.
• Less likely to use organizational charts since
relationships are flexible, job description is
less meaningful, required being staff by
independent, self-reliant people who have
high tolerance for ambiguity.
• Came from AD HOC Committee. - Loosely
structured project organization.
Adhocracy Organizational Structure
a. Task Forces: Used for special projects. It has a
mission, a leader and a projected completion
date, ideally short-range. Personnel are relieved
from their usual task and given a temporary
assignment usually to investigate, analyze,
research and plan.
b. Project Management: Used for large, long-range
projects where a number of project groups are
developed and administered through the various
phases of their existence.
i. Useful in one-time projects when the
task is unfamiliar and complex
ii. When considerable planning,
coordination, high-risk research and
development are involved
iii. Long lead time between planning and
production.
c. Matrix: Try to combine the advantages of
project and functional structures.
d. Collegial Management: Restricts monocratic
authority by maintaining a division and balance
of power among the top management group
through collective efforts. Directors represent
functional areas of organization.
e. Shared Governance: Accountability-based
governance system for professionals that
empowered individuals within the decision-
making system and increased nurses’ authority
and control over their nursing practice Example:
Committee Structure.
Organizational Charts
The drawing that shows how the parts of the
organization are linked.
Components
1. Division of Work: Each box represents the
individual or sub-unit responsible for a given task
of the organization’s workload.
2. Chain of Command: Lines indicates who reports
to whom and by what authority.
3. Type of Work to be Performed: Indicated by
labels or description for the boxes.
4. Grouping of Work Segments: Shown by clusters
of work groups (departments or single units).
5. Levels of Management: Indicates individual and
entire management hierarchy.
Types Advantages Disadvantages
• Increase morale, • Organization may not
1. Structural
promotes be large enough to
• Reflects basic organizational components – interpersonal merit decentralization.
simplicity, clarity, symmetry, and unity. relationship • Top administrators
• Examples: FLAT VS. TALL STRUCTURE • Promotes informality may not desire
• Vertical Chart, left-to-right chart, circular and democracy, brings decentralization.
chart. decision making closer • Conflicts between
to the action. divisions.
a. Flat Structure • Determines • Increased cost – more
• Develop along horizontal dimensions accountability. managers and larger
according to the number of staff.
organizational functions that are • Problem with control
and uniform policies.
identified separately.
• Work duplication.
• Few levels of management
• ADVANTAGE: minimize distortion
through shorten line of communication; 2. Centralized Organization
large group has greater variety of skills • Concentrate power, authority and decision
and capacity to solve greater problems- making at one-point within the
high employee morale and confidence- organization.
Democratic and Personal.
Advantages Disadvantages
• DISADVANTAGE: impractical for large
• Uniformity of • Static and highly
organization- overburdened managers.
command, predictable regulated
internal environment. environment, reduce
b. Tall Structure people morale.
• Developed along vertical dimensions by
use of the scalar process to define 3. Matrix Organization
relationship between levels of • Try to combine the advantages of project
organization – Authoritarianism. and functional structures; functional line
• Most effective in situation that require organization provides support for project
rapid changes and precise coordination. line organization.
• ADVANTAGES: Narrow range of
management allows staff to evaluate Advantages Disadvantages
decision frequently - allow group • Manage dual • Dual Authority – 1 line
cohesiveness. demands. 1 project.
• DISADVANTAGES: Expensive, more • Good for complex • Complicated
levels of communication leading to works. • Maybe viewed as
• Good for uncertain confusing.
distortion, increases impersonality.
environment. • Complex structure.
• Need well-educated
2. Functional • Good for non-routine
personnel.
• Same as the structural chart but shown also technologies.
• Complex
major function of each component. • High interdependence communication.
• Position Chart (Billet Assignment Chart) between functions. • Advanced
o Show assignment of personnel by • Collaborative interpersonal
name, title, rank or grade in an management. relationship skills
existing organization or planned • Flexible efficient used needed.
organization. of scarce resources. • Role conflicts and
• Adaptive and ambiguity.
Forms of Organization • Requires frequent
innovative.
1. Decentralized Organization • Decision close to meetings.
• Time consuming.
• Degree to which decision is diffused operations.
• Improved • Special learning
throughout the organization.
required in conflict
• Factors to consider: interpersonal skills and
management and
o Top management positive attitude conflict management
interpersonal
towards decentralization. leading to relationships.
o Competent personnel achievement and job
o Larger organization satisfaction.
o Organization growth through
acquisition- geographical.
Staffing 3. The type and number of care procedures that
will be needed by a typical patient in each
Is a process of determining and providing the acceptable
category.
and necessary number and mix of nursing personnel to
4. The time needed to perform these procedures
produce a desired level of care to meet the patient’s
that will be requires by a typical patient in each
demand.
category.
Factors Affecting Staffing
Classification Categories
• The type, philosophy, and objectives of the
• Classifying patient care according to the acuity of
hospital and the nursing services
their patient’s illnesses
• The population served or the kind of patient
• Various units can develop their own ways of
being served whether pay or charity
classifying patient care
• The number of patients and severity of their
illness-knowledge and ability of nursing NCH Ratio
needed of Pro
personnel are matched with the actual care Level of Care
Patient under the
per to
needs of patients Category
patient Non-
• Availability and characteristics of the nursing per day Prof
Level I: Self- Patient about to be
staff, including education, level of preparation,
care of discharged; requires little
mix of personnel number and position 1.5 55:45
Minimal treatment/ observation
• Administrative policies such as rotation, Care and or instruction.
Patients need some
weekends, and holiday off-duties
assistance in bathing,
• Standards of care desired which should be Level II: feeding, or ambulating
available and clearly spelled out. Hospital may Moderate or for a short period of
3.0 60:40
Intermediate time; with vital signs
utilize Standard of Nursing Practice formulated
Care needed to be monitored
by government agency or the hospitals 3x per shift; semi-
themselves may formulate/ develop their own conscious
standards Level III:
Total, Patients are completely
• Layout of the various nursing units and resources Complete or dependent upon nursing 4.5 65:35
available within the department such as Intensive personnel.
adequacy of equipment, supplies, and materials Care
Level IV: Patient needs maximum
• Budget including the amount allotted to salaries, Highly level of nursing care, 6.0 to 7
70:30 or
fringe benefit, supplies, materials and Specialized doctors’ orders and care or
80:20
equipment or Critical changes per patient per higher
Care hour/day.
• Professional activities and priorities in
nonpatient activities like involvement in
professional organizations, formal educational The Hospital Nursing Services Administration Manual of
development, participation in research and staff DOH recommendation for Nursing Care Hours for
development patients in Various Units of Hospital
• Teaching program or the extent of staff Prof to Non-Prof
involvement in teaching activities Units/Cases/Patients NCH/patient/day
ratio
• Expected hours of work per annum of each General Medicine 3.5 60:40
Medical 3.4 60:40
employee. This is influenced by the 40-hour
Surgical 3.4 60:40
week law Obstetrics 3.0 60:40
• Patterns of work schedule- traditional 5 days per Pediatrics 4.6 70:30
week, 8hours per day; 4 days a week, ten hours Pathologic Nursery 2.8 55:45
ER,ICU.RR 6.0 70:30
per day and three days off; or 3 ½ days of 12 CCU 6.0 80:20
hours per day and 3 ½ days off per week

Patient Care Classification System Percentage of Nursing Care Hours

It is a method of grouping patient’s according to the Percentage of Patients in Various Levels of Care
amount and complexity of their nursing care Highly
Type of Minimal Moderate Intensive
requirements and the nursing time and skill they require. Specialized
Hospital Care Care Care
Care
To develop a workable patient classification system, the Primary 70 25 5 -
Secondary 65 30 5 -
nurse manager must determine the following: Tertiary 30 45 15 10
Special
1. The number of categories into which the tertiary 10 25 45 20
patients should be divided. hospital
2. The characteristics of patient in each category.
RA 5901 • Team leaders assigns team members to
patient by matching patient needs with
• Forty-Hour Week Law - Provides that employees
staffs’ knowledge and skills.
working in hospitals with 100-bed capacity and
• Centralizes information through the use of
up will work only 40 hours a week. This also
Kardex.
applies to employees working in agencies with at
• Members reports to team leader, who
least one million population.
reports to the patient care coordinator.
Total number of Working and non-working days and hours of • Nursing conference- is the main feature of
nursing personnel per year
team nursing.
Rights and Privilege Given each Working Hours per Week
Personnel per Year 40 hours 48 hours • Team leader is responsible for planning and
Vacation leave 15 15 conducting team conference, which should
Sick leave 15 15 be limited in time and scope.
Legal holidays 10 10
Special holidays 2 2
Special privileges 3 3 4. Modular Nursing - (District nursing) It is a
Off-duties as per RA 5901 104 52 modification of team and primary nursing, uses
Continuing Education Program 3 3 smaller teams for patients who are grouped
Total non-working days per
year
152 100 geographically.
Total working days per year 213 265 • It uses smaller teams for patients who are
Total working hours per year 1,704 2,120 grouped geographically.
• Each RN, assisted by paraprofessionals,
Assignment System for Staffing delivers as much care as possible to a group
of patients.
1. Case Method - Assigning each patient to a nurse for • The RN plans the care, delivers as much of it
total patient care. as possible and directs the paraprofessionals
• A number of patients are assigned to a nurse for the more technical aspects of care
for total nursing care while the nurse is on • The RN’s role is closer to that of a
duty. coordinator and information processor than
• Patient may have a different nurse each shift that of the charge nurse.
and no guarantee of having same nurse next • It decreases the sense of isolation and
day. unrealistic expectations often associated
• The case method emphasized following with primary nursing.
physicians, order.
5. Primary Nursing - RN who gives total patient care to
2. Functional Nursing – Hierarchical division of labor. four to six patients.
• Hierarchical structure predominates. • The primary nurse remains responsible for
• Medication nurse, treatment nurse, and the care of those patients 24 hours a day
bedside nurse are all products of this system throughout the patient’s hospitalization.
• Emphasizes efficiency, division of labor and • Associate nurse cares for the patient by
rigid controls. using the care plan developed by the primary
• Efficient system that is the least costly and nurse, while the primary nurse id on off-duty
requires few RNs. • The associated nurse is expected to contact
• Care tends to be fragmented. the primary nurse regarding changes in the
• RNs keep busy with managerial and non- care plan.
nursing duties and nursing aides deliver the • The number of patient assigned to one nurse
majority of patient care. varies to the length of hospitalization,
complexity of care, number of medical and
3. Team Nursing - It is based on the philosophy that paramedical personnel involved with the
supports the achievement of goals through group patient’s care, availability of support system,
effort. and the shift worked.
• Uses the knowledge and skills of • The primary nurse does the admission
professional nurses and to supervise the interview and develops the care plan,
increasing numbers of auxiliary nursing staff. including teaching and discharge plan, which
• Is based on the philosophy that supports the is being shared to associates.
achievement of goals through group action. • Success of this type seems to depend on the
• The team is led by a professional nurse who quality of nursing staff and administrative
plans, interprets, coordinates, supervises support.
and evaluates the nursing care.
6. Case Management - It focuses on the entire episode Scheduling Method
of illness, including all settings in which the patient
Pros Cons
receives care.
• Coordinated by • Increases
staff nurses amount of
7. Managed Care - Comprehensive health care system
• Saves mangers time staff
services through established networks of hospitals, spends on
scheduling time
physicians and other health care providers to give • Helps develop scheduling
population wide access to economical, high- quality accountability
care. • Increased
Staffing Schedules perception of
autonomy
To determine the staffing policy, try considering the • Increased job
Self-
following questions: satisfaction
scheduling
• Improved team
a. What is the best organization for staffing- spirit
centralized or decentralized to clinical areas or • Improved morale
nursing unit? • Decreased
b. Who is responsible for the original scheduling or absenteeism
daily adjustment? • Reduced
c. Where are nursing hours posted and an accurate turnover
copy kept? • Effective for
d. For what period will schedules be prepared- recruitment and
1,2,4 or 6 weeks retention
e. How far in advance will personnel know their • Can rotate team • Rotate among
work schedule? shifts
f. Will there be shift rotation? how often? • Increases
g. What day starts a calendar week- Sunday or Rotating stress
Work • Affects health
Monday?
Shifts • Affects quality
h. Will there be 2 days off each week, how often are
of works
weekends off guaranteed
groups
i. Will days off be split or consecutive?
• High turnover
j. What are the maximum and minimum work
• Can participate • Most people
spans? in social activities want day shift
k. How many holidays and vacation days are • Job satisfaction • New
allowed? • Commitment to graduates
l. How will holiday time off be determined? the organization predominantly
m. Is there a policy for trading days off? • Fewer health staff evening
n. What is the emergency request policy? problems and nights
Permanent • Less tardiness • Difficulty
Shifts • Less evaluating
Pros Cons absenteeism evening and
• Fairness • Lack of • Less turnover night staff
Centralized • Cost individualized • Nurses may
containment treatment not appreciate
• Managers • Unfair the workload
have authority treatment or problems of
• Staff ger • Schedule used other shifts
personalized to punish and
attention reward
• Staffing is • Time-
easier consuming for
Decentralized • Staffing is less managers
complicated • Less efficient
use of
resources
• Cost
containment
is more
difficult
Directing
• Sometimes labelled as command and
coordination.
• Coordination - Defined as creating a harmony
among all activities to facilitate the work and
success of the unit- Fayol
• Directing protect the general interest and
ensures that each unit has a competent and
energetic head – Urwick.
• Directing initiates and maintains action towards
desired objectives and is closely interrelated
with leadership- Rowland and Rowland.
• The managers choice of style in leadership will
be a major factor in directing.
• The physical act of the nursing management.
• A process of applying the management plan to
accomplish nursing objectives.
Major Elements of Directing
The following elements are embodied in the supervision
of nursing personnel:
1. Motivation
• It is a concept used to describe the external
conditions that stimulate certain behavior
and intrinsic response that demonstrate the
behavior.
o Motives - Often described as needs,
wants, or drive
• It is measured by observable and recorded
behavior.
• Motivation is the reflection of management
style.
Theories of Motivation
• Content theories (Exogenous Theory) - Focus on
factors or needs within a person that energize,
directs, sustain, and stop behavior.
o Maslow's theory of Needs
• Process theories (Endogenous Theory) - Deals
with process or mediating variables such as
expectancies and attitudes “that are amenable
to modification only indirectly in response to
variation in one or mere exogenous variables,”
Four Endogenous Theories
1. Arousal-Activation Theory - Focuses on the
internal processes that mediates the effects of
conditions of work on performance.
2. Expectancy-Valence Theory - Which focuses on
people’s expectations that their efforts will
result in good performance and on valued
outcomes.
3. Equity Theory - Focuses on fair treatment; inputs
from the employee will result in equal inputs
from the employer.
4. Intention-Goal Theory - Focuses on the
performance as determined by commitment to
goals.
2. Leadership
3. Communication
4. Delegating
• A major element of directing.
• Sometimes called the time management
technique.
• An effective management competency by
which nurse managers get the work done
through their employees.
• Although task is delegated, the ultimate
responsibility and accountability rest with
the manager who delegate the task.
• Two factor important in delegation:
o Ability of worker to carry out the
task.
o Fairness not only to the employee
but to the team as a whole.
Principles of Delegation
• Section of right people for the task
• Delegate both interesting and uninteresting
tasks
• Provide subordinates with enough time to
learn
• Delegate gradually
• Delegate in advance
• Consult before delegating
• Avoid gaps and overlaps
Matters that Cannot be Delegated:
1. Overall responsibility, authority, and
accountability for the satisfaction of all activities
in the unit.
2. Authority to sign one’s name is never delegated
3. Evaluating the staff and/or taking necessary
corrective or disciplinary action.
4. Responsibility for maintaining morale or the
opportunity to say a few words of
encouragement to the staff especially the new
ones.
5. Jobs that are too technical and those t5hat
involves trust and confidence.
Controlling
• A process that open opportunities for
improvement and comparing performance
against standards.
• A process that includes assessing and regulating
performance in accordance with the plans that
have adopted, operating procedure issued, and
principles and rules established.
• Evaluating
Reasons for Evaluating

1. Ensures that quality care is provided.

2. Allows for the setting of sensible objectives and
ensures compliance with them.
3. Provides standards for establishing comparisons
4. Promotes visibility and a means for employees to
monitor their own performance.
5. Highlights problems related to quality care and
determined the areas that requires priority
attention.
6. Provides an indication of the costs of poor
quality.
7. Justifies the use of resources.
8. Provides feedback for improvement.

Principles of Evaluation

1. Must be based on the behavioral standards of

performance which the position requires.
2. There should be enough time to observe
employee’s behavior.
3. Employees should be given a copy of the job
description, performance standards, and
evaluation form before the scheduled
conference.
4. Performance appraisal should both include the
satisfactory and unsatisfactory results with
specific behavioral instances to exemplify this
evaluative comment.
5. Areas needing improvement must be prioritized
to help the worker upgrade his performance.
6. Evaluation conference should be scheduled and
conducted at a convenient time for the rater and
the employee under evaluation.
7. Evaluation report and conference must be
structured in such a way that it is perceived and
accepted positively as a means of improving job
performance.

Basic Component of Control Process

1. Establishment of standards, objectives, and

methods for measuring performance.
2. Measurement of actual performance.
3. Comparison of results of performance with
standards and objectives and identifying
strengths and weakness that needs
improvement.
4. Action to reinforce strength or successes.
5. Implementation of corrective action as
necessary.