Professional Documents
Culture Documents
Nursing Leadership and Management
Nursing Leadership and Management
-ANTHEA-
Organizing
It is the process of establishing formal authority. It involves setting up the organizational structure through identification of groupings, roles and relationships, determining the staff needed by developing and maintaining staffing patterns and distributing them in various areas as needed.
It includes developing job descriptions by defining the qualifications and functions of personnel.
It reduces the chances of doubt and confusion concerning assignments. It avoids overlapping of functions because it pinpoints responsibilities. It shows to whom and for whom they are responsible.
The organizational structure of the Nursing Service should be updated, reviewed, approved and documented by the proper authority. Date of last review should be documented.
Staffing
The purpose of all staffing activities is to provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required. Too few or an improper mixture of nursing personnel will adversely affect the quality and quantity of work performed. Such situation can lead to high rates of absenteeism and staff turn-over resulting in low morale and dissatisfaction.
Scheduling
The objective in scheduling is to assign working days and days off to the nursing personnel so that adequate patient care is assured. A desirable distribution of off-duty days can be achieved and the individual members of the nursing team will feel that they are treated fairly. They will also know their schedule in advance.
Principles of Organizing
Unity of Command Scalar Principle or Hierarchy Homogenous Assignment or Departmentation Span of Control Exception Principle Decentralization or Proper Delegation of Authority
Unity of Command
Although employees may interact with many different employees in the performance of their duties, they should be responsible to only one superior. This is to avoid confusion, overlapping of duties and misunderstanding.
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.
Executives should be developed to handle situations delegated to them. This delegation of authority is still subject to the supervision and control of the delegating superior.
-UMALI-
ORGANIZATIONAL STRUCTURE
ORGANIZATIONAL REDESIGN, RESTRUCTURING AND REENGINEERING
Delmar Learning
Copyright 2003 Delmar Learning, a Thomson Learning company
RESTRUCTURING
A significant modification made to the debt operations or structure of a company. This type of corporate action is usually made when there are significant problems in a company, which are causing some form of financial harm and putting the overall business in jeopardy. The hope is that through restructuring, a company can eliminate financial harm and improve the business.
Delmar Learning
Copyright 2003 Delmar Learning, a Thomson Learning company
REDESIGNING
make a design of; or a systematic planning to change the design of (something). Reorganize, Rearrange, Recast, Reshape
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REENGINEERING
Is the radical redesign of an organization's processes, especially its business processes. Rather than organizing a firm into functional specialties (like production, accounting, marketing, etc.) and looking at the tasks that each function performs.
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Restructuring and reengineering deals with the entire organizations structure to improve its functioning and productivity. It naturally follows organizational affiliations, mergers, consolidations, and integrations. Downsizing or right sizing by cutting the number of positions is also restructuring requiring redesign.
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The role of the Nurse Manager through 3 Rs Involves: (Sullivan And Decker, 2001)
Team Building Coaching Mentoring Initiating change Reducing cost Improving quality of care
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Informal Structure
It is based on personal relationship rather than on respect for positional authority. It helps member meet personal objectives and provide social satisfaction.
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Formal Organization
The organizational structure furnishes the formal framework in which the management process takes place. It should provide an effective work system, network of communication, and identity to individuals and the organization and should consequently foster job satisfaction.
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Functions of Staff
Do what the executives do Serve the line organization Submerge personal interest to champion the executives long range objectives. Manages policies and procedures
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In a matrix organization the functional manager shares those responsibilities with the project manager . Initially, the functional manager may experience a sense of loss in status, authority and control. Therefore it is important for the managers to be able to persuade others by using their personal qualities and knowledge of the program.
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Characteristics of matrix
decision making as far down in the organizational structure Most decisions are made at the middle management level More decentralized with fewer levels of decision making Increases the amount of contact among individuals & its complexity makes conflict inevitable.
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-VIRAY-
ORGANIZATIONAL CHART
Is a line drawing that shows how the parts of an organization are linked. It depicts the formal organizational relationships, areas of responsibility, persons to whom one is accountable and channels of communication.
PURPOSES
They can contribute to sound organizational structures Show formal lines of communication Help employees understand their assignments, especially in relation to other.
Vertical Chart
Horizontal Chart
Circular Chart
-JRO-
lower
positions
in
the
hierarchy
in
the
accomplishments of the main operations of the organization. The unit head has direct responsibility for the work of a unit.
Staff personnel provides advice, counsel or technical support that may be accepted altered or rejected by the line officer.
GUIDELINES IN ORGANIZING
1. Supply Market It is important that the local supplier capacity is properly researched prior to organizing a business seminar to ensure that goods and services are relevant to the needs. 2. Invitations The invitation should indicate the types of suppliers that will be attending the seminar.
3. Frequency Due to limited resources, and in order to be fair to all countries, generally only participate in one major supplier event per country per year. 4. Facilities The organizing entity should ensure that the facilities are available for business seminars:
5. Agenda The agenda for the business seminar should be agreed with other participating organizations and the organizing entity. 6. Individual meeting with suppliers A program should be prepared in advance by the organizing entity. Each supplier meeting should be scheduled to last for no longer than 15 minutes.
7. Expenses
Organizing entities in developed countries are expected to cover the travel expenses, hotel and meals for all participants
8. Supplier fees Any fees charged to suppliers for participating should be kept to a minimum and aim to only cover costs incurred.
-CHICO-
Staffing
Staffing
Is the process of determining providing the acceptable number mix of nursing personnel to produce a desired level of care to meet the patients demand.
Selection of personnel
Recruitment and Retention Screening of potential staff Interview Orientation
Selection of personnel
Recruitment and Retention
if a acquisition man proceeds confidently in the of The of qualified people in direction any agency hiscritical dreams to live the life he and has is forand the endeavors establishment, maintenance imagined, willorganizational. meet with success unexpected in growth ofhe the Therefore active common hours ------henry david Thoreau recruitment is important, and the attraction of qualified applicants is the first step in selection of personnel.
Selection of personnel
Recruitment and Retention
Recruiters should know nursing qualifications and the needs of the institution.
Recruitment and Retention
Selection of personnel
Recruitment and Retention Screening of potential staff Interview Orientation
Selection of personnel
Screening of potential staff
investment in well-qualified nurses can produce a high rate of return and errors whether they be failure to hire a promising nurse or hiring someone who fails to achieve the organizations expectations can be expensive mistaken.
Selection of personnel
Recruitment and Retention Screening of potential staff Interview - A preemployment interview to predict job success should be conducted with the most Orientation
qualified applicants.
Selection of personnel
Recruitment and Retention Screening of potential staff Interview Orientation
Interview
One of the main purpose is to learn about the prospective employee. The interview answers questions, explains policies and procedures, and helps acquaint the applicant with the position. Finally, the interviewer must predict whether the applicants overall performance will be satisfactory.
Interview
Selection of personnel
Recruitment and Retention Screening of potential staff Interview Orientation - Induction is the first 2 o 3 days of
orientation. It can be done by personnel department employees for all new employees.
Orientation is important, and the manager who does not take the time to assist a new employee is making a serious mistake.
Because of the information overload, induction and further orientation should be conducted over time. a checklist for orientation that indicates the content, time frame, and who is responsible to teach it can be helpful.
Orientation
-CRISTINA-
Staff development
Goes beyond orientation It is a continuing liberal education of the whole to develop her potential fully It deals with aesthetic senses, as well as technical and professional education It is also related to retention, raises, advancement to other positions or termination
Preceptor ships
Used to help recruit, retain, orient, and develop staff. Is responsible for the quality of patient care and facilities the students learning. They are liaison between students and the agency They help students learn skills and learn how to organize their work. A work shop to prepare preceptors is desirable.
Preceptor ships
Purposes Gives agency personnel an opportunity to evaluate students and determine if they are suitable candidates employment.
Mentorship
Should provide an opportunity to share information review works, provide feedback, explore issues, plan strategies and solve problems. Preceptors are role model who may become mentors. Is a confident who personalizes role modeling and serve as a sounding board for decisions. Are resource people who support the development of the younger person through influences and promotion.
Mentorship
Purposes Gives their times, energy and materials support teach, guide, assist, counsel and inspire younger nurses.
Career mapping
Is a strategic plan for ones career It provides direction for formal education, experience, continuing education, professional association and network ship
Career mapping
Purposes Nurses need to assess their own values and define success for themselves Job security , sense of accomplishment and opportunities for professional advancement are often considered important Other issues to considered are work hours, salary, benefits retirements plans, organizational and geographical climate and location
-JENA-
Functional Nursing
Hierarchical structure predominant Efficient system that is least costly and requires few RNs
Team Nursing Group or Team action Led by a professional or Technical Nurse who: Plan Interprets Coordinates Supervise Evaluates Team member is encourage to make suggestion and ideas
Primary Nursing
Patient should be the focus of professional nurses instead of task The RN remains responsible for the care of the patient 24 hrs per day throughout the patient hospitalization
Managed Care
Focused from acute care to promotion of health and disease management of chronic and terminal care
Case Management
Focused on chronic long term outpatient (Psychiatry and social work)
Collaborative Practice
Interdisciplinary team Nurse-physician interaction in practice or nursephysician collaboration on care giving
Method care
SYSTEM
Advantages Disadvantages
Nurses do managerial
work Nurses aides do
Functional Efficiency
Nursing
Team
nursing Frees
the unit
Nursing
conferences
care
help
problem
solve
and
where Paraprofessionals
technical
aspects of care
Primary Nursing RNs give total patient care Confines nurses talents to
limited
number
of
Shorter hospitalization
Standard critical
paths
Increases
efficiency Reduces costs
Case Management
Focuses on entire episode of illness Emphasizes achievement of outcomes Care is coordinated by a case manager Second-generation primary nursing Critical paths Variation analysis Intershift reports Health care team meeting Interdisciplinary
Effort to coordinate
-ANJIING-
Definition
SCHEDULING is the process of deciding how to commit resources between a variety of possible tasks. Time can be specified or floating as part of a sequence of events.
TYPES OF SCHEDULING: Centralized Schedule- one person, usually the chief nurse or her designate, assigns the nursing personnel to the various units of the hospital. This includes the shifts on duty and off-duty.
Decentralized Schedule- the shift and off duties are arranged by the supervising nurse or head or senior nurse of the particular unit.
Self Schedule- it is a system that is coordinated by staff nurses. It is a process by which nurses and other staff collectively develop and implement work schedules, taking policies and variables affecting into consideration.
-KAT-
LEVEL I
- Self Care or Minimal Patient can take a bath his own, feed himself, feed and perform his activities of daily living.
LEVEL II
- Moderate Care or Intermediate Care Patients under this level need some assistance in bathing, feeding, or ambulating for short periods of time.
LEVEL III
- Total, Complete or intensive Care Patient under this category are completely dependent upon the nursing personnel.
LEVEL IV
- Highly Specialized Critical Care Patients need maximum nursing care with ratio of 80 professionals to 20 nonprofessionals.
-BABY-
Provides that employees working in the hospitals with 100 bed capacity and up will work only 40 hours a week.
Employees working in agencies with less than 100 bed capacity or in agencies located in communities with less than one million populations will work 48 hours a week and therefore will get only one off- duty a week.
Granting of the three-day special privilege to government employees. Which may be spent for Birthdays, weddings, anniversaries, funerals (mourning), relocation, enrolment or graduation leave, hospitalization, and accident leaves.
Vacation leave Sick leave Legal holidays Specials holidays Special privileges Off duties as per R.A. 5901 Continuing education program
15 15 10 2 3 104 3
15 15 10 2 3 52 3
152
213 1,704
100
265 2,120
PROS - coordinating by staff nurses -saves manager scheduling time -helps develop accountability -increases perception of autonomy -increased job satisfaction -improved team spirit -improved morale -decreased absenteeism -reduced turnover -effective for recruitment and retention
-rotate among shifts -increased stress -affect health -affect quality of work Disrupt development of works group -high turnover
PERMANENT SHIFTS
-can participate in social activities-job satisfaction-commitment to the organization-few health problem-less tardiness-less absenteeism-less turnover
-most people want day shift-new graduates predominantly staff evening and nights-difficulty evaluating evening and night shiftnurses may not appreciate the workload or problems of other shift
-same schedule repeatedly-nurses not so exhausted-sick time reducedpersonnel know schedule in social events-decreased time spend on scheduling-staff treated fairly-helps establish stable work groupsdecreased floating-promotes continuity of care
-rigidity
VARIABLES STAFFING
-use census to determine number and mix of staff-little need to call in unscheduled staff
ALTERNATING OR ROTATING WORK SHIFTS The frequency of alternating between days and evening, or days and nights, or rotating through all three shifts may vary among institutions. Some nurses may work all three shifts within 7 days.
Alternating and rotating work shift create stress for staff nurses, environmental cues, such as: sunrise and sunset, fluctuate in a predictable cycle.
Instrument s that designate hours, minute, and seconds correspond to the natural daily cycle and allow knowledge of ones location in that cycle. The ability of the body function to adjust varies considerably among individuals; it takes 2 to 3 days to 2 weeks for a person to adjust to a different sleep-awake cycle.
PERMANENT SHIFTS
Permanent shifts relieve nurses from stress and health-related problem associated with alternating and rotating shift. When nurses are able to choose the shift that best suits their personal life, they can participate in social activities, even when they require regular attendance.
In studies conducted with MONTREAL NURSES, those working permanent shifts had higher average on psychological scales such as: mental health, job satisfaction, social involvement, and commitment to the organization.
Personnel can be scheduled with every other weekend off and 1 day during the week so that there are more than 4 consecutive days of are not exhausted by working too many consecutive days, sick leave can be reduced.
Variables staffing
PROS
CONS
8 hours 10 hours
Traditional Time to complete work, Long weekends, Extra days off, Decreased overtime, Cover peak workloads, Decreased costs Longer workday, Fatigue, Overlap, Difficult to find substitute
12 HOURS
Lower staffing requirements,Lower cost per patient day,Increased knowledge of patients,Get new admission settled,Not so rushed,Better continuity of care,Team development is possible,Less daily to do staffing,Reduced travel time,Less personal expenses for gas, meals, babysitting
Overtime,Exhaustion increases at end of workweek,Tension increased at the end of workweek,Increased in minor accident,Increased medication errors,Home and social life suffer the week worked.
-JOSEPH-
Sample Problem
Find the number of nursing personnel needed for 250 patients in tertiary hospital.
Illustration:
Step 1 Categorize the patients according to the levels of care needed. Multiply the total number of patients by the percentage of patients at each level of care.
care GIVEN 250(pts) x .30 =75 min. 250(pts) x .45 = 112.5 mod.care 250(pts) x .15 = 37.5 int. care 250(pts) x .10 = 25 h. spcl. care 250
Step 2 Find the # of Pts at each level by the average number of nursing care hour needed per day. Get the sum of the NCH/day needed at the various levels.
75pts x 1.5 (NCH@L1) = 112.5NCH/day =75 min. care 112.5pts x 3 (NCH@L2) 337.5 NCH/day = 112.5=mod.care 37.5pts x 4.5 (NCH@L3) = 168.75 = 37.5 int. care NCH/day 25pts x 6 (NCH@L4) 150NCH/day = 25 h. = spcl. care Total 768.75NCH/day
Step 3
Find the actual number of nursing care hours needed by the given number of patients. Multiply the total nursing care hours needed per day by the total number of days in a year.
Step 4
Find the actual number of working hours rendered by each nursing personnel per year. Multiply the number of hours on duty per day by the actual working days per year.
Working hrs/yr
Total NCH/yr
Step 5
Divide the total # of NCH/yr by the actual # of working hrs rendered by an employee/yr. Find the number of relievers: - Multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those working 48 hours per week). Add the number of relievers to the number of nursing personnel needed.
Total NCH/yr = 280,593.75 = 165 1,704 Working hrs/yr Relief x Total Nsg Personnel = x 0.15 = 25 Total Nursing Personnel needed + = 190
1,704 working hours/year SAVE 280,593.75 NCH/year SAVE
Step 6
Categorize the nursing personnel into professionals and nonprofessionals. Multiply the # of nsg personnel according to the ratio of professionals to non-professionals
Step 7
Distribute by shifts.
Professional 124 nurses x .45 = 56 nurses on AM shift 124 nurses x .37 = 46 nurses on PM shift 124 nurses x . 18 = 22 nurses on night shift total 124 nurses
66 nursing attendants
Step 7
Distribute by shifts.
Non-Professional
66 Nsg attendant x .45 = 30 Nsg attendant on AM shift 66 Nsg attendant x .37 = 24 Nsg attendant on PM shift 66 Nsg attendant x .18 = 12 Nsg attendant on night shift total 66 Nsg attendant
66 nursing attendants
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