L&M Midterms Theory

NCM 119- leadership and management MIDTERMS
LESSON 1.10
ORGANIZING
ORGANIZATION
- Refers to a body of persons, methods, policies & procedures arranged in systematic
process through the delegation of functions & responsibilities for the accomplishment of
purpose (L.M. Venzon, 2003).
- Refers to the process of organizing, or the way in which work is arranged & allocated
among the members of an institution so that the goals of the enterprise can be efficiently
achieved (L.M. Douglass, 1996).
ORGANIZATIONAL STRUCTURE
- It refers to the way in which a group is formed, its line of communication, and its mean
for channeling authority and making decisions.
- It clarifies the formal relationships of individuals in the various positions within the
organization.
ORGANIZATIONAL THEORY
● Max Weber
○ A German Scientist, father of Organizational Theory
○ Developed Bureaucracy Theory
○ Characteristics of the Theory:
■ Clear division of labor
■ Well defined hierarchy of authority
■ There is impersonal rules and impersonality of interpersonal relationship
■ A system of procedures for work must exist
Elements of Organizing:
1. Setting up the organizational structure
2. Staffing - the most important element
3. Scheduling
4. Developing Job Definition
Compatible With:
1. Philosophy
2. Conceptual Framework
3. Goals of the Organization
SETTING UP THE ORGANIZATIONAL STRUCTURE
6 Purposes of Setting up the Organizational Structure:
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1. It informs members of their responsibility
2. It allows individual to concentrate on his/her specific role and responsibilities
3. It coordinates all organizational activities
4. It reduces doubt and confusion concerning assignments
5. It avoids overlapping of functions because it pinpoints responsibilities
6. It shows to whom and for whom they are responsible
Organizational Structure
The process by which:
● Group is formed
● Its channel of authority
● Span of control
● Lines of communication
Classification of Organizational Structure:
1. FORMAL
● Highly planned and visible
● Provides framework for defining managerial:
○ Authority
○ Responsibility
○ Accountability
● Roles and functions are defined and arranged systematically
● Different people have different roles
● Rank and hierarchy is evident
2. INFORMAL
● Unplanned often hidden
● Generally social
● With shifting lines of authority and accountability
● Had horizontal relationships
● Composed of small groups with similar interest
Types of Organizational Structure
1. LINE ORGANIZATION
● each position has general authority over the lower position in the hierarchy
● manager delegates authority to staff associate who in turn delegate authority to
her staff
2. STAFF ORGANIZATION
● advisory to the line structure with no authority to put recommendations into action
● Handle details, locate required data
● Function through influence
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3. FUNCTIONAL ORGANIZATION
● Each unit is responsible for a given part of organization’s workload
● Has clear delineation of roles and responsibilities which are interrelated
4. AD HOC DESIGN
○ Modification of bureaucratic structure
○ Use as temporary basis to facilitate completion of project within formal line of
organization
○ A means of overcoming the inflexibility of line structure
○ Use a project team or task approach
○ Disbanded after a project is completed
5. MATRIX DESIGN
○ Focus on both product and function
■ Function- all task required to produce the product
■ Product- end result of the function
○ Has formal vertical and horizontal chain of command
6. SERVICE LINE
○ Also called Care-centered organization
○ Overall goals are determined by the larger organization, but the service line
would decide on the process to be used to achieve the goal.
7. FLAT ORGANIZATIONAL DESIGN

○ Remove hierarchical layers by flattening the chain of command and
decentralizing the organization
○ More authority and decision making can occur where work is being carried out
Organizational Concepts:
1. Authority
➢ Is defined as the official power to act. It is power given by the organization to
direct the work of others.
➢ Example: a manager may have the authority to hire, fire, or discipline others.
2. Responsibility
➢ Is a duty or an assignment. It is the implementation of a job.
➢ Example: a responsibility common to many charge nurses is establishing the
unit’s daily patient care assignment
3. Delegation
➢ Is the process of assigning duties or responsibilities along with corresponding
authority to another person. Authority must be delegated with the responsibility/
4. Accountability
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➢ Means that individuals agree to be morally responsible for the consequences of
their actions.
➢ Example: a nurse who reports a medication error is being accountable for the
responsibilities inherent in the position.
ORGANIZATIONAL CHART
● Is a line drawing that shows how the parts of an organization are linked.
● The organization chart establishes the following:
○ Formal lines of authority- the official power to act
○ Responsibility- the duty or assignment
○ Accountability- the moral responsibility
● Depict an organization’s structure
● A picture of the organization
● Defines formal relationship within the institution
Unbroken Solid Lines

● Shows relationship of lines of communication and authority
○ Solid Horizontal line- represents communication between people with similar
spheres of responsibility and power but different functions.
○ Solid Vertical lines between position denote
■ The official chain of command
■ Formal path of communication and authority
Solid Lines Indicates/depicts the following:

1. Line of authority
2. Chain of command
○ Areas of responsibility
○ Persons to whom one is accountable
3. Channels of communication
Dotted or Broken Line

● Represents staff position
● Staff members provide information and assistance to the manager but has limited
organizational authority.
Major Characteristics/Components of an Organizational Chart
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1. Division of Command
➢ Each box represents the individual or sub individual unit responsible for a given
task of the organization’s workload.
2. Chain of command
➢ The lines indicate who reports to whom and by authority
3. Type of work to be performed

➢ Indicated by labels of descriptions for the boxes
4. Grouping of work segment
➢ Shown by the clusters of work groups (departments of single units)
5. Levels of Management
➢ indicate individual and entire management hierarchy. Hierarchy refers to a body
of persons or things organized or classified in pyramidal fashion according to
rank, capacity or authority assigned to vertical levels with offices ranked in
grades, orders or classes, one above the other.
Uses of Organizational Chart:
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1. Hiring
2. Administrative control for policy-making & planning
3. Evaluate strengths & weaknesses of the structure.
4. Show relationships with other departments & agencies.
5. Orient new personnel.
Types of Organizational Charts:
1. Structural Chart
○ “shows the components of the organization and outlines their basis of
relationship”
2. Functional Chart
○ reflects functions and duties of the components of the organization and
interrelationships of functions.
3. Position Chart
○ shows the names, positions, titles or ranks of personnel which fit into the plan of
the organization.
Advantages of Organizational Chart:
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● It provides a quick visual illustration of an organizational structure.

● It provides help in organizational planning.
● It shows lines of formal authority, responsibility and accountability.
● It clarifies who supervises whom and to whom one is responsible.
● It emphasizes the important aspect of each position.
● It facilitates management development and planning.
● It is used to evaluate strengths and weaknesses of current structure.
● It provides starting points for planning organizational changes.
● It describes a channel of communication.
Organizing Principles
1. Unity of Command
➢ Responsible to only one superior
➢ One person/one boss- employee have one manager to whom they report to and
to whom they are responsible
➢ Indicate by vertical line between position on the organizational chart
2. Scalar Principle of Hierarchy

➢ Authority and responsibility should flow in clear unbroken lines from the highest
executive to the lowest.
➢ Those having the greatest decision making responsibility are located on top,
those with least responsibility at the bottom.
➢ The other term is “Chain of command”
➢ Clear, solid lines specify:
■ To whom they can delegate
■ Who can delegate to them
■ To whom they are accountable
➢ Purpose:
■ To specialize activities
■ To simplify administrator’s work
■ To help maintain effective control
3. Homogeneous Assignment or Departmentation

➢ Workers performing similar assignments are grouped together for a common
purpose
➢ Promotes the specialization of activities, simplifies the administrator’s work and
helps maintain effective control.
4. Span of control
➢ The number of workers that a supervisor can effectively manage should be
limited
➢ At the top of the structure, a 1:6 ratio of supervisor-workers is common
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➢ At the base of the organization- 1:10 ratio is common
➢ Too wide a span
■ Managers overextending themselves
■ Workers or followers receiving too little guidance or control.
➢ Too narrow a span
■ Managers are underused.
■ Workers or followers are over-controlled.
5. Exception Principle
➢ Recurring decisions should be handled in a routine manner by lower-level
managers whereas problems involving unusual matters should be referred to the
higher level.
➢ To enable subordinates to learn how to make decisions at their own level, free
executives from being bogged down by routine details that can be handled as
well by the subordinates
6. Decentralization
➢ The process of conferring specific decision making to the lower levels of the
organization.
➢ Basic top level decisions and policies must receive attention at the top levels
➢ The amount of skills and competence of subordinates and executives determines
the success of any program of decentralization.
➢ Executives should be developed to handle situations delegated to them.
Delegation of authority is still subject to the supervision and control of the
delegating superior.
➢ Distribution of necessary info about critical issued is vital to any delegation
process.
➢ An executive should have sufficient information to make a good decision.
Disadvantages of Organizational Charts

1. Charts become outdated quickly
2. Does not show informal relationships
3. Does not show duties and responsibilities
4. Poorly prepared charts might create misleading effects
Organizational Culture
● is the total of an organization’s values, language, traditions, customs, and sacred cows-
those few things present in the institution that are not open for discussion or change.
Eight Distinct Organization Culture Styles
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Culture Style Description
1. Caring Focuses on relationship and mutual trust. Work environments

are warm, collaborative and welcoming places where people
help and support one another.
2. Purpose Exemplified by idealism and altruism. Work environments are

tolerant, compassionate places where people try to do good
for the long term future of the world.
3. Learning Characterized by exploration, expansiveness and creativity.

Work environments are inventive and open-minded places
where people spark new ideas and explore alternatives.
4. Enjoyment Expressed through fun and excitement. Work

environments are light-hearted places where
people tend to do what makes them happy.
5. Results Characterized by achievement and winning. Work

environments are outcome-oriented and merit-based places
where the people aspire to achieve top performance.
6. Safety Defined by planning, caution and preparedness. Work

environments are predictable places where people are risk
conscious and think things through carefully.
7. Authority Defined by strength, decisiveness, and boldness. Work

environments are competitive places where people strive to
gain personal advantage.
8. Order Focused on respect, structure and shared norms. Work

environments are methodical places where people tend to
play by the rules and want to fit in.
LESSON 1.11
STAFFING
STAFFING
- the process of determining & providing the acceptable number & mix of nursing
personnel to produce a desired level of care to meet the patient’s demand for care.
(Venzon)
- the process of developing & maintaining staffing patterns & assigning people to fill/fit the
roles designated for the organizational structure through ((Douglass):
1. Recruitment
2. Selection (Placement)
3. Development of personnel.
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Purpose:
- To provide each nursing unit with an appropriate & acceptable number of workers in
each category to perform the nursing task required. (Venzon)
Effect of too few or improper mixture of Nursing Personnel

1. High rates of absenteeism
2. Staff turn – over
12 Factors affecting Staffing: (Venzon)

1. Type, Philosophy & objectives of the hospital & the nursing service.
2. Population served or the kind of patients served whether pay or charity.
3. Number of patients & severity of their illness – knowledge & ability of nursing personnel
are matched with the actual care needs of patients.
4. Availability & characteristics of the nursing staff, including, education, level of
preparation, mix of personnel, number & position.
5. Administrative policies such as rotation, weekends & holiday off – duties.
6. Standards of care desired which should be available & clearly spelled out.
7. Layout of the various nursing units & resources available within the department such as
adequate equipment, supplies & materials.
8. Budget including the amount allotted to salaries, fringe benefits, supplies, materials &
equipment.
9. Professional activities & priorities in non patient activities like involvement in professional
org., formal educational development, participation in research & staff development.
10. Teaching program or the extent of staff involvement in teaching activities.
11. Expected hours of work/annum of each employee – influenced by the 40 hour – week
law.
12. Patterns of work schedule:
a. Traditional 5 days/week – 8 hours/day
b. 4 days a week – 10 hours a day & 3 days off
c. 3 1⁄2 days of 12 hours/day & 3 1⁄2 days off/week
Principles of Staffing:
● Related to Unit patient care
a. Staffing levels should reflect individual & aggregate patient needs.
b. Concept of nursing hours/patient day should be questioned.
c. Functions to support quality patient care should be used when determining
staffing levels.
● Related to Staff
a. Patient needs should determine the required competencies.
b. Nurses need both nursing management support & representation @ both the
operational & executive levels.
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c. Clinical support should be readily available from experienced RN’s for less
proficient nurses.
● Related to organization
a. Organizational policy should reflect valuing employees.
b. All organizations should have documented competencies for staff.
c. Organizational policies should recognize the needs of both patients & staff.
STAFFING PROCESS
- The process of attempting to fill schedules with the available personnel while considering
their varied and diverse competencies and numerous special request .
Steps in Implementing Staffing Process:
1. Data Collection
2. Patient Classification
3. Staff Mixing
4. Scheduling
Data Collection
Objectives for assigning nursing staff to patient:

1. To match patient care needs with available resources.
2. To ensure cost-effectiveness.
3. To provide a basis for budgetary justification of needed positions.
4. To measure efficiency of care delivery.
5. To assess quality & quantity of care delivered.
6. To ensure equitable patient care assignments.
Data’s studied first:

● Patient census
● Average length of stay in hospital.
● Patient discharges & admissions as they relate to seasons, months of the year, & days
of the week .
Patient Classification (PC) by: Douglass /
Patient Care Classification System (PCCS) by: Venzon

- this is a method of grouping patients according to the amount & complexity of their
nursing care requirements & the nursing time & skill they require over a period of time.
Advantages of PC/PCCS:
1. Identify the nursing requirements of patients on the unit.
2. Facilitate the equitable distribution of nursing resources.
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3. Ensure effective & efficient delivery of high quality patient care.
4. Predicts staffing requirements for the unit.
5. Facilitate decision-making related to staffing.
6. Assess unit productivity.
4 Determinants for a Workable Patient Classification System:

1. Number of categories into which the patients should be divided.
2. Characteristics of patients in each category.
3. Type & number of care procedures that will be needed by a typical patient in each
category.
4. Time needed to perform these procedures that will be required by a typical patient in
each category.
Classification Categories (Venzon)
4 Levels of Care Characteristics NCH/pt/day Prof: Non Prof
I - Self Care or Patient can take a 1.5 55:45

Minimal Care bath on his own, feed
himself, and perform
his ADL
II - Moderate Care or Patient needs some 3 60:40

Intermediate Care assistance in bathing,
feeding or ambulating
for short period of
time
III - Total, Complete Patients are 6 65:35

or Intensive Care completely
dependent upon
nursing personnel
IV - Highly Patients need 6-9 or more 70:30 or 80:20

Specialized Critical maximum nursing
Care care
Categories or Levels of Care of Patients
Levels of Care NCH/Pt./day Prof: Non Prof.
Level I 1.50 55:45

Self Care of Minimal Care
Level II 3.0 60:40
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Moderate of Intermediate
Care
Level III 4.5 65:35

Total or Intensive Care
Level IV 6.0 - 7 or higher 70:30

Highly Specialized or 80:20
Critical Care
Continuum of Healthcare Organizations
Type of Care Purpose Organization / Unit

Providing Services
Primary Care Entry into System Ambulatory Care Centers

Health Maintenance Physician’s Clinics
Long Term Care Preferred Provider Org.
Chronic Care Nursing Centers
Treatment or Temporary Independent Provider Org
Non-incapacitating Health Maintenance Org.
Malfunction School Health Clinics
Secondary Care Prevent Disease Home Health Care

Complications Ambulatory Care
Nursing Centers
Tertiary Care Rehabilitation Home Health Care

Long-Term
Care Rehabilitation Centers
Skilled Nursing Facilities
Assisted
Living Programs
Percentage of Patients in Various Levels of Care
Type of Minimal Care Moderate Care Intensive Care Highly Spl.

Hospital Care
Primary 70 25 5 -
Hospital
Secondary 65 30 5 -
Hospital
Tertiary 30 45 15 10
Hospital
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Special Tertiary 10 25 45 20
Hospital
Nursing Care hours / patient / day according to the classification of patients by units
Cases/Patients NCH/Pt./day Prof to Non Prof Ratio
General Medicine 3.5 60:40
Medical 3.4 60:40
Surgical 3.4 60:40
Obstetrics 3.0 60:40
Pediatrics 4.6 70:30
Pathologic Nursery 2.8 55:45
ER/ICU/RR 6.0 70:30
CCU 6.0 80:20
Computing for the Number of Personnel Needed
Forty-hour Week Law (R.A 5901)

- provides employees working in hospitals with 100 bed capacity & up will work only 40
hours a week.
- This also applies to employees working in agencies with at least 1 million populations.
- Employees working with less than 100 bed capacity or in communities with less than 1
million populations will work 48 hours a week & therefore will only get 1 off duty a week.
Total Number of Working and Non-Working Days and Hours of Nursing Personnel/Year
Rights and Privileges given Working hours / week

each Personnel / Year
40 hours 48 hours
1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2
5. Special Privileges 3 3
6. Off duties as / R.A 104 52
5901
7. Continuing Education 3 3
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Program
Total Non-Working days/year 152 100

Total Working days/year 213 265
Total Working hours/year 1,704 2,120
Relievers Needed
Average number of leaves taken each year --------- 15

1. Vacation Leave---- 10
2. Sick Leave----------- 5
Holidays ------------------------------------------------------- 12
Special Privileges/ CSC MC #6 s. 1996 ----------------3
Continuing Education Program for Prof. ----------------3
Total Average Leaves -------------------------------------- 33
Formula
Divide 33 (average # of day an employee is absent/year) by the number of working days/year

that each employee serves or (whether 213 or 265)
= 0.15 /person who works 40 Hours/week.

= 0.12/person who works 48 Hours/week
Distribution by Shifts
PHILIPPINES
Morning 45%
Afternoon 37%
Night 18%
Staffing Formula
1. Categorize the # of patients according to the levels of care needed. Multiply the total # of
patients by the % of patients @ each level of care (whether minimal, intermediate,
intensive or highly specialized).
2. Find the total number of NCH needed by the patients @ each category level.
a. Find the # of patients @ level by the average # of NCH needed/day.
b. Get the sum of the NCH needed @ various levels.
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3. Find the actual # of NCH needed by the given # of patients. Multiply by the # of total
NCH needed/day by the total # of a day in a year.
4. Find the actual # of Working hours rendered by each nursing personnel/year. Multiply the
# of hours on duty/day by the actual working days/year.
5. Find the total # of nursing personnel needed.
a. Divide the total # of nursing care needed/ year by the actual # of working hours
rendered by an employee/year.
b. Find the # of relievers. Multiply the # of nursing personnel needed by 0.15 (for 40
hours/week) or 0.12 (for 48 hours/week).
c. Add the # of relievers to the # of nursing personnel needed.
6. Categorize the nursing personnel into professionals & non – professionals. Multiply the #
of nursing personnel according to the ratio of prof. to non – prof.
7. Distribute by shifts.
Factors Affecting the Staffing Process:
1. Effects of Absenteeism
- Conditions that affects the employees fulfillment & gratification towards work:
1. Individual needs
2. Work policies
3. Relationship with co – workers & supervisors
4. Compensation
5. working conditions
● Satisfied Employee – tends to be absent less often than a dissatisfied employee.

● Dissatisfied Employee – may often be absent & may experience stress that disrupts co
– workers.
2. Staff Burn-out
Characteristics:
a. Associated with 3 composite factors:
- Emotional exhaustion or feeling overextended & worn – out from work.
- Depersonalization or a lack of appropriate responses to the nurse’s
efforts.
- Diminished sense of personal accomplishment.
b. Associated with work – related factors:

- Workload
- hours worked each week
- team size
- amount of patient contact
- Characterized by:
● Apathy
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● Alienation
● job dissatisfaction
● depersonalization of patients
STAFFING SCHEDULES OR STAFF SCHEDULING
SCHEDULING
- a timetable showing planned work days & shifts for nursing personnel.
Objective:
- to assign working days & days – off to the nursing personnel so that adequate patient
care is assured.
Advantages of Scheduling:
1. A desirable distribution of off-duty days can be achieved.
2. Individual members of the nursing team will feel that they are treated fairly.
3. Schedule of duty will also be known in advance.
Factors to be considered in making schedules (Venzon)

1. Different levels of the nursing staff
2. Adequate coverage for 24 hours – 7 days a week
3. Staggered vacations & holidays
4. Weekends
5. Long stretches of consecutive working days
6. Evening & night shifts
7. Floating
Disadvantages of Scheduling:
1. Nurse may feel insecure.
2. Disruption in the unity of work may occur.
Recommendations:
1. Cross Training
2. Orientation to Complementary Units
Assessing a Scheduling System
Scheduling may vary from agency to agency, but the scheduling system must function
smoothly in terms of:
1. Ability to cover the needs of the unit
2. Quality to enhance the Nursing Personnel’s knowledge, training & experience
3. Fairness to the staff
4. Stability
5. Flexibility
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Types of Scheduling:
1. Centralized Schedule
2. Decentralized Schedule
3. Cyclical Schedule
Staffing System Advantages Disadvantages
Centralized ● Conserves time. ● Denies nurse

● Scheduler is familiar managers the right to
with the overall make staffing
situation. decisions.
● Easier to handle the ● Minimal opportunity
need for help with for personal contact
qualified personnel in with staff.
times of illness, ● Limited knowledge of
absence, or worker’s abilities,
emergency. interests & needs.
● Less frequent ● Limited knowledge of
requests for special nursing care needs in
privileges. the separate
● Compatible with departments & units
● computerization. of nursing.
Decentralized ● Nurse manager is ● May be time

accountable for consuming.
staffing decisions. ● Sometimes results in
● Scheduling is based insufficient numbers
on knowledge of of qualified personnel
personnel & necessary to meet
patient/client needs. unforeseen needs.
● Greater control of ● Increased number of
activities; can requests for special
rearrange schedule privileges.
quickly as needed.
● Fresh ideas
generated for
improvement of the
system.
4 Methods of Staffing Patterns
Method Description Advantages Disadvantages
Conventional Centralized- ● Pattern can If there is too much

decentralized be altered. Decentralization,
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- combination is ● Nurse cohesiveness & order

the oldest & manager can will be lost.
most use the “float
common. concept” to
- Nurse his or her
manager advantage.
makes up ● The precise
particular unit; measurement
it is then of nursing
incorporated hours needed
& centralized per patient
in master plan population is
in nursing measurable
office. with this
pattern.
Cyclic The staffing pattern ● Pattern A constant, sufficient

repeats itself every 4 provides for number of the
– 6, 7 – 12 weeks float appropriate mix of
personnel to personnel is required
fortify staff
when need
arises.
● Good & bad
hours are
distributed
fairly among
all staff.
● No favoritism
is shown.
● Each person
knows his her
pattern & can
plan ahead.
● Once a cyclic
pattern is
established,
laypersons
can work with
it.
Forty Hours; Forty hours a week is ● The large time Fatigue is possible,
4 days worked in 4 days, block off set resulting in poorer
followed by a block of the possibility quality of care.
off – duty time. of fatigue. Studies in other
● Staff may disciplines have
have more shown an increase in
weekends off. accidents & a lack of
● Overlapping overall productivity.
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may provide
for better
coverage @
meal time.
Seven days off, A 10- hour day is ● Nurses are ● Pattern may
7 on worked for 7 days, paid for 8 be too hard
followed by 7 days hours with no on personnel
off. vacation or physically.
holidays ● Staff may
allowed. desire
Given 70 holidays &
hours of sick vacation time.
leave.
● Better
continuity of
care is
achieved
because the
same staff
may cover
almost an
entire
hospitalization
of a patient.
● There is
better
communicatio
n with
physicians &
other staff.
● In-service
program is
strengthened.
Developing Job Description

- A job description is a statement that sets the duties and responsibilities of a specific job.
- It includes the needed characteristics of qualifications to perform the duties successfully.
- It is an important management tool to make certain that responsibilities are:
● wisely delegated
● work is efficiently distributed
● talents are fully used
● morale is maintained
Contents of Job Description

1. Identifying data
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2. Job Summary
3. Qualification Requirement
4. Job Relationships
5. Specific and Actual Functions an Activities
Uses of Job Description

1. For recruitment and selection of a qualified personnel
2. To orient new employees to their jobs
3. for job placement, transfer and dismissal
4. As an aid in evaluating the performance of an employee
5. for budgetary purposes
6. For determining departmental functions and relationships to help define the
organizational structure.
7. For classifying levels of nursing functions according to skill levels required.
8. To identify training needs.
9. As basis for staffing
10. To serve as channel of communication.
Lesson 1.12
LEADING/DIRECTING
Leadership
● Is a process influencing a group to set and achieve goals.
● It is the use of one’s skills to influence others to perform the best of their ability toward
goal achievement.
● Leadership is present in any group of people regardless of age or setting.
Leader
● Someone who influences others to accomplish specific goals using interpersonal skills.
He/she derives their power from followers.
● One who take risks attempt to achieve shared goals, and inspire others to action
(Marquis & Huston)
Manager
● An individual employed by an organization who is responsible for efficiently,
accomplishing the goals of the organization.
FORMULA ON BECOMING EFFECTIVE LEADER AND MANAGER

1. Understanding of individual strengths, weaknesses and potential.
2. Knowledge of basic ingredients for leader and manager.
3. Learning from other people and experiences.
4. Systematic use of self to get the right things done at the right time = EFFECTIVE
LEADER AND MANAGER
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FUNCTIONS:
LEADER MANAGER
● Creates connection among an ● Coordinates and integrate resources

organization members using the functions:
● Achieve consensus within the group a. Planning
about its goal b. Organizing
● Supply necessary information that c. Supervising
helps provide direction and d. Staffing
clarification. e. Evaluating
● Maintain group satisfaction cohesion, f. Negotiating
and performance g. Representing
● Focus on:
a. Communicating *Interpersonal skill is important, but a
b. Motivating manager also has the authority, responsibility,
c. Initiating power defined by the organization.
d. Facilitating
e. integrating
10 FATAL LEADERSHIP FLAWS

(Zenger & Folkman, 2009)
1. Lack of energy and enthusiasm

2. Acceptance of their own mediocre performance
3. Lack of clear vision & direction
4. Having poor judgment
5. Not collaborating
6. Not walking the talk
7. Resisting new ideas
8. Not learning from mistakes
9. A lack of interpersonal skills
10. Failing to develop others
LEADERSHIP TRAITS MOST RESPECTED & VALUED BY MILLENIALS

1. Own and live the company values
2. Communicate openly and early
3. Inspire people to reach higher
4. Own their mistakes
5. Recognize big wins, small wins and hardwork
6. TRUST people
7. Make the RIGHT decision, not the popular decision
8. Add VALUE to their teams, helping them to succeed
9. Have the courage to GENUINE and VISIBLE
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10. TAKE CARE of people
FOUR LEADERSHIP DOMAINS

1. STRATEGIC THINKING: effective leaders keep everyone focused on a long-term future.
2. INFLUENCE: effective leaders can sell ideas, develop political support, and get people
to rally behind a project or an initiative.
3. RELATIONSHIP BUILDING: effective leaders are able to unite a group of disparate
individuals into a team that works toward a common goal.
4. EXECUTION: effective leaders know how to get things done by translating plans into
action.
ASSESSING YOUR STRENGTHS-BASED LEADERSHIP SKILLS (Ambler, 2015)

1. Do you have a good understanding of your personal strengths and weaknesses?
2. What are your top 3 strengths and are you using them on a daily basis?
3. Are you deliberately investing on your strengths?
4. Are you building a team that compensates for your weaknesses?
5. Do you select team members for their leadership strengths as opposed to their
knowledge and technical expertise
6. Are you developing your team members’ strengths?
7. What is the level of trust between you and your team?
8. Does your team feel that you care for them on a personal level?
9. Does your team know what to expect from you?
10. Is your team inspired by a positive future?
FIVE LEVELS OF LEADERSHIP (Jim Collins, 2001)
LEVEL 1: Highly Capable Individual

LEVEL 2: Contributing team member
LEVEL 3: Competent Manager
LEVEL 4: Effective Leader
LEVEL 5: GREAT LEADER
Servant Leadership
● Developed by Greenleaf (1977)
● Put serving others including employees, customers, and the community, as the number
ONE priority.
“VALUES are the pillars that uphold the entire structure of servant leadership. Honesty, Truth,
Compassion, and Acceptance are some of the intrinsic core values shared by servant leaders”
(Eswaran, 2018)
DEFINING QUALITIES OF SERVANT LEADERS (Marquis & Huston)

1. The ability to listen on a deep level and to truly understand.
2. The ability to keep an open mind and hear without judgment.
23
3. The ability to deal with ambiguity, paradoxes, and complex issues.
4. The belief that honestly sharing critical challenges with all parties and asking for their
input is more important than personally providing solutions.
5. Being clear on goals and good at pointing the direction toward goal achievement without
giving orders.
6. The ability to be a servant, helper and teacher first than a leader.
7. Always thinking before reacting.
8. Choosing words carefully so as not to damage those being led.
9. The ability to use foresight and intuition.
10. Seeing things whole and sensing relationships and connections.
Direction
● The connecting link between organizing for work and work accomplishment.
● Must be complete, understandable, & given in a logical order.
Too many directions given at 1 time

➔ Results in confusion & poor performance.
Written Directions
● Prevents misunderstandings.
*GIving directions in a COURTEOUS MANNER encourages cooperation, interest, & better

performance in their jobs.
3 ELEMENTS THAT HELPS MAINTAIN QUALITY OF WORK:

1. Clear directions
2. Follow-up
3. Supervision
Direction
● It is the issuance of (A,O,I) Assignments, Orders and Instructions that permit the worker
to understand what is expected of him or her.
● It also involves guidance and supervision.
● Process of applying the management plans to accomplish nursing objectives.
● It is the connecting link between organizing for work and work accomplishment.
● When giving directions, it should be within the scope of his/her job description.
DIRECTING FUNCTION:
1. Interpersonal Relationship
2. Communication
Leadership and management take effect through:

1. Communication
2. Delegation
24
3. Training
4. Motivation
In directing… there are certain STANDARDS that are being followed.
Standards
● Are the basis for directing and controlling.
● They provide direction for performance.
● E.g.
○ Procedure and policy manual
○ Job descriptions
○ NCP’s, Nsg care conferences, patient care conferences.
It is inherent in the acceptance of a management position that the person develop and use
leadership abilities:
1. Identification of personal training needs of individuals & establishment of a program to
meet them.
2. Establishment of a system of performance appraisal to identify personal competencies
and assignment & promotion based on competency.
3. Development of trust & subsequent delegation of responsibility and authority for decision
making.
2 PRECONDITIONS FOR SUCCESS IN DIRECTION-GIVING
1. Acquire the ability to direct

➢ The ability to direct is the demonstrated capacity to achieve organizational goals
both effectively and efficiently through the work of others.
➢ “Do I acquire the necessary abilities through theory and practice?”
➢ Integrating theory into practice leads to effective & useful direction giving.
➢ THEORY
■ Helps one systematically analyze & draw conclusions about the
significance of the management & directing process.
➢ WORK EXPERIENCES
■ Put the newly acquired theories into practice.
➢ IMPLICATION
■ There should be a personal meaningful integration of theory & practice- a
manager, especially a new one, must recognize that learning is a process
and takes time.
25
2. Acquire the art of time management
➢ Poor time management is one type of stressor that can diminish enthusiasm.
➢ Managers frequently state that time is their scarcest and most valuable
commodity.
■ Time always moves quickly & often leads to short-circuiting of important
issues or activities.
➢ List overall responsibilities
➢ Reduce overall task to specifics- “detailed plans”
THE TIME WASTERS

1. Technology
2. Socializing
3. Paperwork overload
4. A poor filing system
5. Interruptions
BASIC STEPS TO TIME MANAGEMENT
1. Allow time for planning and establishing priorities.

2. Complete the highest priority tasks whenever possible and finish one task before
beginning another.
3. Reprioritize based on the remaining tasks and on new information that may have been
received.
TIME MANAGEMENT TIPS FOR COLLEGE STUDENTS

1. List everything that must be done (school, work, tasks that must be completed)
2. Create a life schedule (use a time schedule/ time management tool if that is helpful)
3. Be flexible but realistic about how much you can accomplish in a day (typically not more
than 8-10 hrs of dedicated time)
4. Allow time for planning to avoid repetitions.
5. Avoid procrastination and distraction. Study in environments where you are most
productive.
6. Exercise to clear your head in between study sessions.
7. Constantly review and reassess your schedule to see if changes are needed or new
priorities have emerged.
Example of a “to do” list of a nurse manager
TIME MANAGEMENT:
MUST DO IMPORTANT TO DO NICE TO DO BUT NOT

VITALLY IMPORTANT
26
1. Plan or oversee daily Oversee daily activities Greet new personnel director
schedules for staff
2. Determine needed Visit patients/clients/families Meet representatives of

changes in staffing volunteer services
3. Orient new PM unit Conduct two performance Call a staff member who is
manager evaluations home on leave.
4. Attend unit manager’s Investigate excessive Have lunch with staff

meeting disappearance of supplies
Example of a “to do” list of a staff nurse.
TIME MANAGEMENT:
MUST DO IMPORTANT TO DO NICE TO DO BUT NOT

VITALLY IMPORTANT
1. Received assignment Supervise team members Assist physicians on routine

rounds
2. Count narcotics Make self-available for Teach staff about new

assistance as possible medication/procedure
3. Review patient Take breaks when Restocks shelves with

records schedule/report to nurse who supplies
is covering
4. Make patient rounds Cover for other team leaders Clean the medication room
as scheduled
5. Give treatments Talk with other family

members/significant others
12 DIRECTING FUNCTIONS OF THE NURSE MANAGER
1. Formulating objectives for care that are realistic for the health agency, patient and
nursing personnel.
2. Giving first priority to the needs of the patients/clients assigned to the nursing staff.
3. Providing for coordination and efficiency among departments.
4. Identifying responsibility for all activities.
5. Providing for safe and continuous care.
6. Considering the need for variety in task assignment.
7. Providing for the leaders availability
8. Trusting members to follow through with their assignments
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9. Interpreting protocol for responding to incidental requests.
10. Explaining procedures to be followed during emergencies.
11. Giving clear, concise, formal and informal directions.
12. Using a management control process that assesses the quality of care given.
Factors to consider in Direction Giving
The elements of Directing-Delegation
DELEGATION
● Defined as sharing responsibility and authority with subordinates and holding them
accountable for their performance.
● It is a skill that relies on trust that the subordinates have the necessary skills and
knowledge to know how to do the assigned tasks.
● it is a tool that the nurse managers uses to build morale among
● the staff which involves:
○ giving assignments to subordinates
○ motivating them to perform their job efficiently and effectively.
● Is a major element of the directing function of the nursing management competency by
which nurse managers get the work done through their employees.
PURPOSES OF DELEGATION:
1. Saves time and can help develop others.
2. Maximizes the use of the talents of staff associates.
3. Uses latent abilities in personnel that contribute to their growth and development.
FIVE RIGHTS OF DELEGATION

1. RIGHT TASK
2. RIGHT CIRCUMSTANCES
28
3. RIGHT PERSON
4. RIGHT DIRECTION/COMMUNICATION
5. RIGHT LEVEL OF SUPERVISION
7 Principles of Delegation:
1. Select the right person to whom the job is to be delegated.
○ Make sure that the employee is capable of doing the job.
○ Give the employee the accountability & authority to do the job.
2. Delegate both interesting & uninteresting tasks.
○ Uninteresting jobs – can be used to challenge, motivate & increase a person’s
performance & commitment.
○ Interesting jobs – draw out the best among employees and inspire them to higher
achievement.
3. Provide subordinates with enough time to learn.
○ Expertise can be achieved through training & experience.
4. Delegate gradually.
○ New employees may not be able to assume full responsibilities as employees
who have stayed longer on the job.
5. Delegate in advance.
○ Specify goals & objectives to be met within a set time frame.
○ Describe the specific results expected out of the activities to be performed.
6. Consult before delegating.
○ Clarification minimizes problems & promotes teamwork.
7. Avoid gaps & overlaps.
○ Gap – occurs when a job is left out with no one taking responsibility.
○ Overlap – happens when 2 or more people have responsibility for the same job,
causing confusion & low morale.
14 WAYS ON HOW TO DELEGATE SUCCESSFULLY

1. Train and develop subordinates
2. Plan ahead
3. Control and coordinate the work of subordinates
4. Visit subordinates periodically, spot problems of morale, disagreement & grievances.
5. Coordinate to prevent duplication of effort
6. Solve problems and think about new ideas.
7. Accept delegation as desirable
8. Specify goals and objectives
9. Know subordinates capabilities & match the tasks or duty to employee
10. Agree on performance standards
11. Take interest
12. Give appropriate rewards
13. Do not take back delegated tasks.
Aspects of Delegation
The process of delegation is concerned with results.
29
The manager assigns:
1. Responsibility
2. Gives authority
3. Creates accountability within the subordinates
Guidelines for effective Delegation:

1. Give a clear description
2. Share the outcome with the employee
3. Discuss the degree of responsibility and authority
4. Ask the employee to summarize the main points of the task
5. Reason for delegating
5 reasons for delegating

1. Assigning routine task
2. Assigning tasks for which the nurse manager does not have time
3. Problem solving
4. Changes in nurse managers own job emphasis
5. Capability building
When Not To Delegate:

1. Do not delegate the power to discipline
2. Do not delegate responsibility for maintaining morale.
3. Do not delegate overall control
4. A “Hot potato” jobs that are too technical.
5. Do not delegate duties involving a trust or confidence.
Behavioral Objectives that can help the team leader provide coordination & efficiency of
service
1. Determine the number & characteristics of patients/clients assigned to the nursing team
2. Assess priority of care for all patients/clients
3. Review available staff and consider their roles, competencies, and preferences.
4. Assign patients/clients who require the most skilled attention to the most qualified staff
members.
5. Double assign a patient/client or groups of patients if assistance with care is anticipated.
6. Note coverage for breaks.
Barriers to Delegation (Reasons why managers do not delegate as much as they should)
1. The Belief that “I can do it better myself”.
2. Lack of confidence and trust in others.
3. Low self-confidence; insecurity
4. Time involved in explaining the task
5. Vague job description
6. Fear of competition
7. Reluctance to take the risks involved in depending on others
30
8. Lack of control that provides an early warning of problems with delegated duties.
9. Fear of loss of power.
Overcoming Barriers to Delegation

1. “Behavior of people is the key to productivity” – human relations approach management.
2. Recognize what prevents them from delegating - as they should and what motivates
workers to respond favorably to challenging work.
3. Open communication – to avoid insecurities.
4. Warm & cordial relationship – every one should be free to ask questions, seek
clarifications regarding a delegated task which to them may be too difficult to
understand.
CULTURAL PHENOMENA TO CONSIDER WHEN DELEGATING TO A TRANSCULTURAL

TEAM
● COMMUNICATION: Especially dialect, volume, use of touch and eye contact
● SPACE: Interpersonal space differ between cultures
● SOCIAL ORGANIZATION: Family unit of primary importance in some cultures
● TIME: Cultures tend to be past, present, or future-oriented
● ENVIRONMENTAL CONTROL: Cultures often have either internal or external locus of
control
● BIOLOGICAL VARIATIONS: Susceptibility to diseases and physiologic differences
So... in delegation one must remember these:
T - TAUGHT – have the individual been taught of the skills, treatment, service
E - EVALUATE – just because they have been taught how to do something, it does not mean
they are competent to do it.
L - LICENSE – does the individual have or need a license to do the task? is it within the scope
of practice?
L - LISTS - what list of standards of care are written regarding the tasks based on the agency
policy?
REMEMBER: THE DELEGATOR DELEGATE THE TASK BUT NOT THE RESPONSIBILITY
One cannot be a Good Leader and a Delegator if she/he does not know how to communicate
with the other team members
COMMUNICATION PROCESS
● It is a cyclic process whereby message is passed from the sender to receiver and back
again with the hope that the exchanged information is correctly understood.
● It is described as the practical art of persuasion, including rhetoric public speaking.
31
● Face to face communication is the best way to confirm that the intended message has
been received.
The Communication Process
Types of Communication
1. Interpersonal communication
○ The process of exchanging information and meaning either between two people
or in a small groups of people.
2. Organizational communication
○ The process whereby manager use established communication system to
receive and relay information to people within the organization and to relevant
individuals and groups outside the organization.
Importance of Communication Process

1. To effect a change and influence action towards the welfare of clinical setting
2. It is the key process that enables the Middle-management nurse to serve as a role
model of exemplary patient care, to direct staff, to challenge peers to produce, and to
support higher management.
Barriers to Effective Communication

1. Physical Barrier
○ are environmental factors that prevent or reduce opportunities for the
communication process.
2. Social-psychologic Barriers
○ are blocks or inhibitors in communication that arise from the judgments,
emotions, and social values of people.
3. Semantic Barriers
○ interpretation of messages through signs and symbols
How to improve a Nurse manager’s verbal communication skills:
32
1. Clarify ideas before speaking
2. Consider the physical and human setting
3. Use tone of voice and choice of language that makes the desired impact
4. Speak clearly and to the point, using as little time necessary for the communication to be
effective
5. Repeat key concepts of the message
6. Restate difficult messages
7. Recycle ideas wherever feedback indicates they are weak or misunderstood
8. Use synonyms for the key words in an attempt to clarify.
Listening
● is “Tuning –in” or giving heed to (pay attention) something.
● Eugene Raudsepp, Ph.D., believes that most people develop poor listening habits.
● Such poor listening habits can cause misunderstandings on a busy nursing unit.
Raudsepp offers 7 Fundamental Listening Skills

1. Take time to listen
2. Teach self to concentrate
3. Do not interrupt
4. Listen to what a person is saying, not how she or he is saying
5. Suspend judgment
6. Listen between the lines
7. Listen with the eyes
Cross- cultural communication

● occurs when a person from one culture understands a message that is sent from a
person of another culture.
● process includes having respect, empathy, & tolerance for and non- judgmental attitudes
toward people with different behaviors, values & attitudes.
33
The Principles for Effective Nursing Conferences:

1. Adequate preparation by the leader for all conferences expedites fulfillment of
expectations for the conferences.
2. Relieving caregivers of responsibility while conference is in session allows members to
proceed without interruptions.
3. Prior announcements of time, place, purpose & duration of conference to all concerned
promote assembly to a group well prepared & ready to focus attention on purpose of the
conference.
Nursing conferences as to purpose:

1. Direction- giving conference
2. Patient- centered conference
3. Content conference
4. General problem conference
5. Reporting conference
6. Periodic care review conference
Assignments
● are written delegation of duties in the care of a group of patients by trained employees
assigned to the unit based on:
a. Knowledge and skills
b. Job description
c. Interest
d. Patients nursing needs
Characteristics of a Good Assignment:
34
1. It is related to the previous experience of the worker.
2. It is definite and clearly understood.
3. The words are clearly written.
4. It is given in such a way that workers are guided in their learning activities.
5. Difficulties are minimized
6. It emphasizes essentials & recognizes individual indifferences
7. There should be a feeling of cooperation between the HN & workers.
8. Needs, capacities & experiences of all workers must be considered.
Basic Principles of all Patient assignments:

1. The basic assignment must be made by the senior nurse.
2. Assignment must be planned from week to week rather than by day to day.
3. The senior nurse must know the capability of each worker & the type of work the latter is
expected to do.
4. The senior nurse must know the nursing needs of each patient & the appropriate time
required to care for him.
General rule for making assignments:

1. Develop specifically worded written policies and job descriptions.
2. Prepare assignments carefully –know what is to be done and who is best for the job,
varied assignments – more interested –more productive.
3. Organize assignments according to time & location.
4. Post delegated duties and daily assignments where staff can easily refer to them.
5. Only one person should be responsible for making the assignment especially in team
nursing.
6. Two people should not be assigned to exactly the same task – if 2 people were assigned
, one should be made responsible and the other to help.
7. Equal division of work is not always fair or efficient – estimate time needed to complete
task and difficulty of assigned to work, provide help or additional instruction when
necessary.
8. Help the staff understand their assignments and importance of each tasks.
STRESS - all responses to that wear and tear
STRESSORS
- all things that create “wear and Tear” on the body.
- are any perceived oppression on an individual group or organization.
Example:
Pressure
Strain
Distress
Hardships
35
Burdens
Stress in an Organization
1. Task Demands- making fast life threatening decisions.
2. Role demands – position in the organization.
3. Physical demands- job setting.
4. Interpersonal – relationships within an organization, leadership styles of managers.
CHANGE
● Is substituting one thing for another experiencing a shift in circumstances that cause
differences, or becoming different than before.
● Is inevitable and can be positive or negative
● Forces that can influence change can be external or internal.
The change process involves several steps:

1. Perceiving a need for change
2. Having group interaction
3. Implementing the plan for change one step at a time.
4. Making a cyclic evaluation of the overall results of the change and making necessary
adjustments.
Change agent
● can be a member of an organization. The nurse manager is the one to institute official
changes in a unit or department which are often a result of suggestions made by the
staff members.
Forces that influence change:

A. External Forces:
a. Changes may occur such as:
i. hospital resizing
ii. employee buy out
iii. early retirements
iv. Termination
v. continued substitution by RN’s by lesser trained & lower paid healthcare
worker
vi. increasing economic pressure on hospitals & physicians to discharge
patients early & possible limits on the numbers & types of treatment given
to certain patients.
b. Healthcare reform do not address such issues as fair opportunities for advanced
nursing practice.
c. Aids confront nurses with epidemic proportions.
d. Nurses should be engaged in designing new ways of organizing structuring
nursing care delivery.
36
B. Internal Forces:
a. The composition of staffing patterns, reduction in the number of RN’s & an
increase in the number of LPN/ LVN’s & nursing assistant.
b. Increase productivity
c. Quality of life may need to be improved.
CONFLICT
● is a disagreement among two or more individual groups, or organizations.
● it is present when an inner or outer struggle occurs regarding ideas, feelings or actions.
THE CONFLICT PROCESS

1. LATENT CONFLICT – implies the existence of antecedent conditions such as short
staffing and rapid change.
2. PERCEIVED CONFLICT – is intellectualized and often involves issues and roles.
3. FELT CONFLICT – occurs when the conflict becomes emotionalized. Also referred as
AFFECTIVE CONFLICT.
4. MANIFEST CONFLICT – also called OVERT CONFLICT. The action is taken.
5. CONFLICT RESOLUTION/MANAGEMENT
6. CONFLICT AFTERMATH
Types of Conflict
1. Intrapersonal
○ conflict within an individual
○ confronted with 2 or more compatible demands.
Common Conflicts:
a. uncertainty about a work expectations as a result of insufficient & unclear
information.
b. when the nurse is confronted with an ethical issue & is torn between loyalty to
personal convictions & loyalty to the organization.
c. Role conflict – spouse and parents
d. work overload
2. Conflict between health organization

○ issues that pertains to competition for buildings, types of facilities, funding, and
business.
3. Conflict within health organizations
○ interpersonal and inter-group.
4. Conflict in a multi-cultural environment
○ nurse manager must not assume that everyone has a similar behavior, beliefs, &
values.
This cultural mix resulted in several areas of conflict:
37
1. Different interpretations of role expectation among foreign nurses graduates, patients,
families & nursing administrations.
2. Multidisciplinary team conflicts.
3. Lack of a caring attitude in foreign nurses as perceived by the patients.
4. American nurses feeling isolated because of their minority status.
5. Lack of attention to conflicts by nurse management.
6. Misunderstanding as a result of language differences.
7. Foreign nurses demonstrating paternalistic relationship with physicians.
8. A more functional approach to care delivery.
9. Differing values in the areas of grief's, death, & dying.
10. Differing views concerning documentation practices.
How to Resolve a Hidden Conflict (Nursing Department)

1. To improve communication & to promote harmony among culturally diverse staff,
families, & patients.
2. To increase awareness of diverse cultures & their impact on the healthcare delivery
system.
3. To clarify values that affect attitudes toward workplace behavior & healthcare delivery.
4. To identify common concepts held by the healthcare professionals.
5. Conflict as a result of sexual harassment in the workplace.
Equal Opportunity Commission

Guidelines define sexual harassment as:
“Unwelcome verbal or Physical conduct of a sexual nature that interferes with an individual’s
work performance by creating an intimidating, hostile, or offensive working environment”.
Frequent complaints made by victims:

1. Sexual teasing or sexually explicit jokes.
2. Sexual suggestive looks or gestures.
3. Repeated requests for dates or meetings outside work.
4. Actual touching, fondling, or pinching
5. Physical cornering “trapping” or leaning over a worker.
- highly prevalent in the hospital workplace
- staff nurses reported being harassed by:
a. Patients
b. Physicians
c. Co-workers
What are the essential criteria for identifying Sexual Harassment?

- it is one sided, unsolicited, unwelcome, repetitive & clearly not under the victim’s control.
Approaches to use when confronting a sexual harasser:

1. Be very assertive & confront the issue.
38
2. Listen to the sexual harasser’s response.
3. Make your position clear., and imply legal action.
4. Observe the sexual harasser’s behavior.
5. File a written report of the incidents with your immediate supervisor.
6. If such a situation occurs again, confront the behavior immediately.
Consequences of Conflict:
1. Issues are recognized & brought out in the open.
2. There is a rise in group cohesion and performance.
3. Poor performance
4. Constructive or destructive results
5. There may be a rise of leaders.
Methods used to resolve conflicts:

1. Competition and power
2. Smoothing
3. Avoidance
4. Compromise
5. Collaboration
Conflict Resolution
● Beneficial
● Can lead to better ways of getting things done.
● Resists change- tension will continue, will split the party/ group
39

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NCM 119- leadership and management MIDTERMS

SETTING UP THE ORGANIZATIONAL STRUCTURE

6 Purposes of Setting up the Organizational Structure:

Classification of Organizational Structure:

Types of Organizational Structure

7. FLAT ORGANIZATIONAL DESIGN

Unbroken Solid Lines

Solid Lines Indicates/depicts the following:

Dotted or Broken Line

Major Characteristics/Components of an Organizational Chart

3. Type of work to be performed

Uses of Organizational Chart:

Types of Organizational Charts:

Advantages of Organizational Chart:

● It provides a quick visual illustration of an organizational structure.

2. Scalar Principle of Hierarchy

3. Homogeneous Assignment or Departmentation

Disadvantages of Organizational Charts

Eight Distinct Organization Culture Styles

Culture Style Description

1. Caring Focuses on relationship and mutual trust. Work environments

2. Purpose Exemplified by idealism and altruism. Work environments are

3. Learning Characterized by exploration, expansiveness and creativity.

4. Enjoyment Expressed through fun and excitement. Work

5. Results Characterized by achievement and winning. Work

6. Safety Defined by planning, caution and preparedness. Work

7. Authority Defined by strength, decisiveness, and boldness. Work

8. Order Focused on respect, structure and shared norms. Work

Effect of too few or improper mixture of Nursing Personnel

12 Factors affecting Staffing: (Venzon)

Steps in Implementing Staffing Process:

Objectives for assigning nursing staff to patient:

Data’s studied first:

Patient Classification (PC) by: Douglass /

Patient Care Classification System (PCCS) by: Venzon

4 Determinants for a Workable Patient Classification System:

Classification Categories (Venzon)

4 Levels of Care Characteristics NCH/pt/day Prof: Non Prof

I - Self Care or Patient can take a 1.5 55:45

II - Moderate Care or Patient needs some 3 60:40

III - Total, Complete Patients are 6 65:35

IV - Highly Patients need 6-9 or more 70:30 or 80:20

Categories or Levels of Care of Patients

Levels of Care NCH/Pt./day Prof: Non Prof.

Level I 1.50 55:45

Level II 3.0 60:40

Level III 4.5 65:35

Level IV 6.0 - 7 or higher 70:30

Continuum of Healthcare Organizations

Type of Care Purpose Organization / Unit

Primary Care Entry into System Ambulatory Care Centers

Secondary Care Prevent Disease Home Health Care

Tertiary Care Rehabilitation Home Health Care

Percentage of Patients in Various Levels of Care

Type of Minimal Care Moderate Care Intensive Care Highly Spl.

Cases/Patients NCH/Pt./day Prof to Non Prof Ratio

General Medicine 3.5 60:40

Medical 3.4 60:40

Surgical 3.4 60:40

Obstetrics 3.0 60:40

Pediatrics 4.6 70:30

Pathologic Nursery 2.8 55:45