Nlm Reviewer

Leadership • • •

Someone who can influence others and who has managerial authority. Influencing a group toward the achievement of goals. Increases productivity.

Management • • •

Cooperative group directs action towards a common goal. Coordinating work activities so that they are completed efficiently and effectively with and through other people. Represent the ongoing primary activities engage in by managers.

Efficiency •

Doing things right. Getting the most output from the least amount of inputs.

•

Exercise self direction and self-control. Foster independence. 3. Laissez-faire • Aka permissive/ free reign/ ultraliberal • Exercises minimum control • “let alone” – “abdicates” • Effective in highly motivated individual Henry Fayol • • •

Max Weber • • • •

Effectiveness •

Doing the right things. Completing activities so that organizational goals are attained.

Common Leadership Goals 1. 2. 3. 4.

•

Leader Followers Communicator Decision Maker

They think longer term They look outward, toward the larger org. They influence others beyond their own group They emphasis vision, values, and motivation They are politically astute They think in terms of change and renewal

Different Leadership Styles 1. Autocratic/ Directive • aka Directive/ Bureaucratic, Centric, Theory X 2. Democratic • Aka Theory Y • Radic leader • Focuses on human aspects and builds effective teams

Father of Organizational Theory Bureaucratic Organization Theory (Line Authority) A hierarchical structure adhering to strict rules. He saw the need for legalized, formal authority, and consistent rules and regulations for personnel in different positions.

Henry Mintzberg

Six (6) Traits • • • • • •

Developed 14 Management Principles Focuses on basic functions and tasks of management (PODC) Father of Management Process Sch.

3 Roles of Manager 1. Interpersonal – roles that involve people and other duties that are ceremonial and symbolic in nature. ▪ Figurehead ▪ Leader ▪ Liaison 2. Informational – roles that involves receiving, collecting, and disseminating information. ▪ Monitor ▪ Disseminator ▪ Spokesperson 3. Decisional – roles that revolves around making choices. ▪ Entrepreneur ▪ Disturbance Handler ▪ Resource Allocator ▪ Negotiator

Henry Gantt • •

“Practice makes Perfect” Concern with the problem of efficiency

Chris Argyris REINALYN RAMIRO//NLM

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Managers should help the workers achieve self actualization as people mature, they progress from a passive to an active state and from dependence to independence.

Bass •

Clayton Aldelfer •

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ERG Theory o Existence Needs o Relatedness Needs o Growth Needs He organized Maslow’s needs hierarchy into 3 levels and agreed that unsatisfied needs motivate individuals.

Mary Follett •

Importance of Coordination

Kurt Lewin • • •

Revive the study of group dynamics Change Process o Unfreezing – Movement - Refreezing Jewish psychologist

Greenleaf •

•

Alvin Toffler •

Future Shock o The physical and psychological distress that arises from over-loading the individual’s physical adaptive system and decision-making process. o To minimize the FS is to develop the mechanism and techniques to guide the direction of change and to the pressure of change.

Aristotle •

Trait Theory (Great Man Theory) o They are born with the capacity to persuade, influence, and motivate others. o Leaders are well rounded and simultaneously display both instrumental and supportive leadership behavior.

Charlotte McDaniel •

Transformational Leaders o Leaders who provide individual considerations, intellectual stimulation, and possess charisma.

Transformational Leaders o Focus leadership o Followers exhibit similar leadership qualities, though of lesser degree (Cascading effect) o The leader is a role model uses individualized consideration, has sense of direction and encourages selfmanagement. o The leader promotes employee development, inspires, influence, provides intellectual stimulation and encourages followers to be creative.

Servant & Leadership o Servant leaders put serving others; including employees, customers and the community as a number one priority Leader and Power o 5 Sources of leader power: 1. Legitimate Power – the power a leader has a result of his position in the organization. 2. Coercive Power – the power a leader has because of his ability to punish or control. 3. Expert Power – expert power is that kind of power which an employee has due to the knowledge and expertise that he/ she possesses. 4. Referent Power – is power that is a resultant of the personality of a person. 5. Reward Power – reward power arises out of the authority that a person has to recognize and reward people.

William Ouchi •

Participative

Rensis Likert •

System Approach

David McClelland •

3 Basic Needs: REINALYN RAMIRO//NLM

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o o o

Achievement – desire to contribute, to excel and to succeed. Power - high need for power want to be in control/ have influence over others. Affiliation – people with high affiliation needs desire in working in human environment and seek out meaningful friendship.

BF Skinner •

Operant Theory

Victor Vroom •

Expectancy Theory o States that motivation depends on how much people want something and their estimates in the probability of getting it.

Douglas McGregor •

Theory “X” and Theory “Y” o The Theory X managers assumes that people dislike work and will avoid it; hence, workers must be directed, controlled, coerced, and threatened so that organizational goals can be met. o Theory Y the emphasis is on the goal of the individual. Theory Y managers assumes that workers have the selfdirection and self-control necessary for meeting their objectives.

Frederick Herzberg • •

Two-Factor Theory (Motivators/Hygiene) Motivating factors: satisfiers

Saul Gellerman • •

Theory of Stretching Gellerman suggested that individuals should be periodically “stretched” to do tasks more difficult than they are used to doing.

Fred Fiedler •

Hershey and Blanchard •

Hierarchy of Needs

George Kelly •

Trait Theory (Leaders are Born)

Situational Leadership Theory

Robert House •

Path-Goal Models

Schein • •

Transactional-Rewards Identifies the needs of followers and provides rewards to meet those needs in exchange for expected performance.

Frederick Taylor •

•

Principle of Scientific Management o Traditional “rule of thumb” means organizing work. o A scientific personnel system o Workers should be able to view how they “fit” into the organization, how they can contribute to the overall organizational productivity. Father of Scientific Management

Frank Gillbreth •

Principles of Economic Motion

Lillian Gillbreth •

First Lady of Management

Management Process Planning • •

Abraham Maslow •

Contingency Theory

• •

Thinking ahead to achieve desired goals (VMPGO) It involves the process of defining goals, establishing strategies for achieving those goals and developing plans to integrate and coordinate activities. Internal/ external planning 7’s/ PESTELI

Organizing • •

Establish formal authority and relationships. Process of determining what task are to be done; who is to do them; how the task is to be grouped; REINALYN RAMIRO//NLM

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who reports to whom; and where decisions are to be made. Leading/ Directing • •

It involves motivating subordinates to work towards achieving the company’s goal. It’s functions usually entail human resource management responsibilities.

Controlling/ Directing Planning •

•

It is a process that involves: o Defining organizations’ goals o Establishes an overall strategy to achieve those goals o Develop a comprehensive set of plans to integrate and coordinate organizational goals. It’s concerned with both ends (what’s to be done) and means (how it’s to be done)

Principles of Planning 1. 2. 3. 4. 5. 6.

Always based and focused on the VMPG Continuous process Utilizes all available resources Precise in its scope and nature Shall be time-bound Must be documented for proper dissemination to all concerned for implementation and evaluation as to the extent of its achievement

Purposes of Planning 1. 2. 3. 4.

It gives direction It reduces the impact of change It minimized waste and redundancy It sets the standards used in controlling

Strategies for Successful Planning 1. Start planning at the top 2. Keep planning organized, clear, and definite 3. Remember, interpersonal relationships are important 4. Keep target dates are realistic 5. Have short-and-long-range plans and goals 6. Don’t bypass levels of people 7. Be sure objectives are clear 8. Gather data

Why do Plans Fail? • • • • •

False assumptions Not knowing overall goal Not enough alternatives Low motivation levels Inadequate delegation of authority

6 Elements of Planning 1. Forecasting a. It helps managers look into the future and decide in advance where the agency would like to be and what is to be done in order to be there. b. Factors to be consider: 1. Environment 2. Types of customers/ patients 3. Public attitude and behavior 4. Number and kind in personnel required 5. Resources 2. Objective Setting a. Foundations in Formulating Objective: 1. Vision ▪ Describe the future goals or aims of the organization. ▪ “What do we want to accomplish together?” ▪ “What recognizable condition will be in place several years from now?” ▪ Vision is what we want to become. ▪ Is an articulation of a destination toward which organization should aim. 2. Mission ▪ Statement of what the organization wants to. ▪ “What is the reason for existence?” ▪ Mission is our over-all reason for being, what we are doing, and what we are going to do in pursue of our vision.

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3. Philosophy ▪ Statement of belief and values that guide all actions of the organization; how to achieve the mission, goals, and objectives. ▪ Is the sense of purpose of an organization. It gives direction toward the attainment of set goals and objectives. 4. Goals ▪ What organization would like to attain/ accomplish. ▪ Goals are targets of performance or end results relating to long term endeavor. 5. Objectives ▪ Things to be done to achieve goal. ▪ It is a result oriented and must be SMART. ▪ Advantages of Clearly Stated Objectives: a. More effective planning. b. Better organizational effect. c. Basis for direction and motivation. d. Better control. 6. Standards ▪ Is the yard stick against which the performance of the organization and or the people in the organization and or the people in the organization will be measured. 7. Policies ▪ Are guidelines for managerial decisions necessary to guide the personnel in planning

and operating their respective departments. Scheduling Programs

3. Developing and (Programming) 4. Budget Preparation a. Budget – it is the annual operating plan, a financial “road map” b. It includes: 1. Personnel needed 2. Supplies 3. Instruments 4. Medical equipment 5. Training of personnel c. A Nursing Budget – is a plan for allocation of resources based on preconceive needs like programs to deliver patient care during one fiscal year. d. Budgeting – the work a manager performs to achieve an objective within a specific period of time. e. Purposes of Budget: 1. It helps managers set realistic objectives. 2. Ensures that resources are obtained in order to meet important objectives. 3. Establishes standards measurable goal to strive for it. f. Types of Budget in Health Care Institution: 1. Revenue Budget ▪ Summarizes the income which management expects to generate during the planning period. ▪ Income as estimated. 2. Expense Budget ▪ Describe the expected activity in operation and financial terms for a given period of time. ▪ Expenses as estimate. 3. Hospital Budget ▪ Outlines the programmed acquisitions, disposals and improvements in an

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institution’s physical capacity. ▪ Capital intensive facility. 4. Cash Budget ▪ Represents the planned cash receipts and disbursements as well as the cash balances expected during the planning period. ▪ Expected cash receipt and disbursement in day to day operation of the institute. 5. Personal Budget ▪ Determine recruitment, hiring, and firing of personnel. ▪ Include staff development. 6. Time Management ▪ Is a technique for allocating one’s time through the setting of goals, assigning priorities, identifying and eliminating wasted time and using managerial techniques to reach goals efficiently. 5. Establishing Nursing Standards, Policies, and Procedures a. Nursing Standards – some institutions develop their own standards of nursing practice; however, they are in reference to the Standards of Nursing Practice and Nursing Service Administration formulated by a joint committee of ANSAP and the PNA. b. Nursing Procedures – are specific directions for implementing written policies. c. 2 Areas to be Considered: 1. Those that are related to job situations such as reporting complaints or disciplinary instances. 2. Those involving patient care safety of the patient, his comfort

while undergoing the procedure, proper care, used supplies and equipment, and good workmanship of the person doing it. 6. Setting Educational Parameters a. Appropriateness of the planned program and activities. b. The adequacy of the program of the degree to which the program will be able to meet the identified problem. c. The effectiveness of the program or the extent to obtain the pre-established objectives will be attained because of the objectives implemented. d. The efficiency of the program which includes the relationship of the cost of resources, both human and material, and the attainment of the objectives. e. Problems encountered are identified and alternative measure to prevent. 4 Types of Planning

1. Breadth Strategic Planning • • •

Strategic plans give you “the big picture” Usually participated by Top Management; Middle Management inputs are solicited; but the 1st level managers are more involve (unit heads) Involve a long-range plan usually 3 to 7 years.

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•

• •

Forecast the future success of an organization by matching and aligning an organizations capability with its internal and external capabilities. Examines an organizations’ purpose, mission, philosophy, and goals in the context of its external environment. Effective Tools to Effective Strategic Planning: 1. SWOT Analysis – also known as TOWS (Albert Humprey). Identify and defined the desired end stage or objective. ▪ Internal Environment SW – pertains to organizational analysis. (7S: Style, Structure, Strategy, System, Skills, Staff, Shared belief) • Strength – are internal attributes that helps an organization to achieve its objectives. • Weakness – are internal attributes that challenge an organization in achieving its objectives. ▪ External Environment OT – pertains to environmental analysis (PESTELI: Political Factors, Economic Influence, Social Trends, Technological Innovations, Ecological Factors, Legislative Regulations, Industry Analysis). Factors outside the organization. • Opportunities – are external conditions that promote achievement of organizational objectives. • Threats – are external conditions that challenges or threaten the achievement of organizational objectives.

2. The Time Frame of Planning a. Short Term • Covers a period from one day or less to six months, with the time increment usually weekly. • This is tied into the daily or weekly scheduling process and involves adjusting eliminate the variance between planned output and actual output. b. Long Range/ Intermediate • Monthly or quarterly plans for the next 6-18 months. • Here the capacity may be varied by such alternatives as hiring, lay off, new tools, minor equipment purchase, and subcontracting. 3. Specificity: Directional VS. Specific a. Specific Plans • Have clearly defined objectives and leave no room for misinterpretation. • There is no ambiguity, no problem with understanding. • “What, when, where, how much, and by whom” (process-focus) b. Directional Plans • They are flexible plan that set out general guidelines. • They provide focus but do not lock managers in specific objectives or count of action. • It is an outcome-focus. 4. According to Frequency of Use: Single Use VS. Standing a. Single Use • A one-time plan that is specifically designed to meet the needs of a unique situation. • Essentially one-time use plans having a specific goal or objective. b. Standing Plan • Ongoing plans that provide guidance for activities performed repeatedly. • These plans must be updated regularly. • They are ongoing operations.

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Organizing • • • •

•

It involves establishing a formal structure that provides the best possible coordination/ use of resources to accomplish unit objectives. We look at how the structure of an organization facilities or impedes communication, flexibility, productivity, and job satisfaction. Examines the role of authority and power in organizations and how power may be used to meet individual, unit and organizational goals. It involves setting up the organizational structure by identifying: groups, roles and relationships; determining the staff needed and distributing them in the various areas as needed. It includes the development of job descriptions by defining the qualifications and functions of personnel.

Organization • •

The structure or framework derived from grouping people together so that they can work effectively towards a goal. Consist of the structure and process which allow the agency to enact its philosophy and utilize its conceptual framework to achieve its goals.

Basic Step to Effective Organizing 1. Make a list of all the things that need to be done. 2. Identify the most important thing/ tasks to be attended with a given time frame. 3. Review your calendar and the schedules according to priorities 4. Make provisions possible activities/ schedules.

•

4. Create specialized departments, sections by groupings related jobs together. 5. Establish the relationship between the various jobs of groupings. Principles of Organizing 1. Unity of Command •

2. Divide the task into activities that can be performed by one person or group. • •

Each person or group has a set of activities to perform, called JOB. Label each job position to describe its main function.

3. Formulate the job description and job specification: • •

Job Objective -purpose of the job Job Summary – main functions

An employee has one superior and one plan for a group of activities with the same objective, to avoid confusion, overlapping of duties and understanding.

2. Scalar Principle or Hierarchy • • •

Principle of Chain of Command Authority and responsibility should flow in clear unbroken lines from the highest executive to the lowest. Authority flows from top to bottom. Usually a military team.

3. Departmentalization/ Homogeneous Assignment • • •

Principles of Specialization Grouping of workers performing assignment for a common purpose. Departmentalization: promotes specialization of activities.

similar the

4. Span of Control •

The Organizing Process 1. Review the output of the planning process: VMGPO, Key Results Areas

Work Relationship – to whom the position is reporting number of subordinates; positions being supervises coordinating functions.

The number of workers that a supervisor can effectively manage/ supervised upon the pace and pattern of the working area.

5. Exception Principle • •

Recurring decisions shall be handled in a routine manner by lower-level manager. To enable subordinates to learn how to make decisions at their own level and free the executives from being bogged down by routine details.

6. Decentralization • •

Proper delegation of authority. Is conferring specified decision making to the lower levels of the organization. REINALYN RAMIRO//NLM

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7. Centralization •

All report to one.

• •

Elements of Organization 1. Setting the organizational structure 2. Staffing 3. Scheduling

The Organizational Structure •

4. Developing job descriptions Concepts of Organization

•

1. Status • •

Rank given to a person. The rank that a reference group confer based on the assessment of individual worth and significance of the group.

2. Accountability •

Taking full responsibility for the quality of work and behavior while engage in the practice of the profession.

3. Responsibility •

Is the obligation to perform the assigned task.

4. Authority •

• •

The persons right to make decisions and make actions without approval from higher administration plus the right to extract obedience from others. Top level position carries high level of responsibility and authority. 2 Types: o Line Authority – is the authority that entitled supervisor to direct an individual work. o Staff Authority – is the authority in position created to support, assist, recommend, and generally reduces the supervisor’s information responsibilities.

5. Power • • •

Ability to influence others to behave accord into one’s wishes. Reward Power – ability to provide reward. Coercive Power – apply punishment.

Referent Power – ability to inspire such admiral to others that they wish to identify themselves. Expert Power – ability to convince others that possess a high degree of K&S in some are of specialization

Refers to the process, by which a group if formed, its channels of authority and decision making, span of control and lines of communication/ The organizational structure should be updated, reviewed, approved and documented by the proper authority.

Purpose of Organizational Structure 1. It informs members of their responsibilities to be carried out. 2. It allows the manager and the individual worker to concentrate on its specific role and responsibilities. 3. It coordinates all organizational activities so there is minimal duplication of effort or conflict. Setting Up the Organizational Structure: 1. Identify the group and the work to be done (effectively accomplished by people) 2. Provides the framework for the formal distribution, delegation of authority and responsibility. Types of Organizational Structure 1. Formal (line) Organizational Structure • • •

•

Also called bureaucratic organization design, hierarchic structure or line organization. It defines managerial authority, responsibility and accountability. Is the simplest and most direct type of organization in which each position has general authority over the lower positions of the hierarchy. It is a chain of command or manager-staff associate or a leader-follower relationship.

**The command relationship is a direct line between the manager and staff-associate and is depicted by a solid line on organizational chart.

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Line (Solid/ Vertical) – reporting relationship. Solid Vertical – denote the official chain of command, formal path of communication and authority. Solid Horizontal – represents communication between people with similar sphere of responsibility and power but with different function. 2. Informal Organizational Structure •

• •

It is a structure that fills in he gaps with connections and relationships that illustrates how employees’ network with one another to get work done. Refers to horizontal relationship rather than vertical. This is composed of small groups of workers with similar interest.

3. Flat Organizational Designs/ Horizontal •

•

There continuous to be line authority/, but because the organizational structure is flattened, more authority and decision making can occur where the work is being carried out. Decentralized organization.

Five Major Characteristics of an Organizational Chart: 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 indicate 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 the cluster of work groups (department or single unit) 5. Levels of Management • Indicates individual and entire management hierarchy (ranking) Decision Making within the Organizational Hierarchy • • •

4. 5. Functional Organization • • •

Dual reporting relationships Has command authority over line employee. There is clear delineation of roles and responsibilities which are interrelated.

Tall Organizational Structures – usually tend to be more expensive requiring more managers. Flat Organizational Structure – leads to higher levels of employee morale and productivity. 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.

The decision making is scalar chain of command. In centralized decision-making top of the hierarchy makes the decision. In decentralized decision-making, there is diffuse decision-making, thus allows problems to be solved at the level at which the problem occurred.

Organizational Structures of Devolved Hospitals •

Legal Basis o Local Government Code of 1991. LGU’s enjoys full autonomy in the exercise of their economic enterprises, subject to the limitations provided in the code and other applicable laws. o Section 18 DOH Rules and Regulations Implementing the LGU Code of 1991 the (DOH Rules) assigns the Local Government Units the management and operation, among others of provincial, district, municipal and city hospitals. o Funding of the hospitals shall come from the share of the province or city. o The LGU shall continue to govern, manager and finance the devolve hospital directly.

Table of Organization • •

Tall VS. Flat Communication VS. Authority REINALYN RAMIRO//NLM

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Basic Level of Management 1. Top Managers • They are responsible for the overall direction and operations of an organization. 2. Middle Managers • They receive broad, overall strategies and policies from the top manager and translate them into specific goals and plans for the first line managers to implement. 3. First Line Manager

• • •

It involves planning for hiring and deploying qualified human resources to meet the needs of a group of patients. It is a tool to determine the appropriate ratio of healthcare personnel to perform their respective task for the benefit of the client. The workforce must reflect appropriate balance of high skilled, competent professional and support workers. Managers should be alert to the gender, culture, ethnicity, age, and language diversity in the communities served by the organization and should seek recruit a staff that is both sensitive and responsive to that diversity.

Staffing Functions of the Managers •

• •

• • • • • • • • •

Staffing •

Factors Affecting Staffing

In staffing, the leader – manager: 1. Recruits 2. Selects 3. Places 4. Indoctrinates/ orients and 5. Promotes personnel development 6. Demotes 7. Fires Accomplish the goals of the organization. Purposes: o To provide each nursing unit with an appropriate and acceptable number of workers in each category to perform the nursing tasks required. o To give quality and quantity of work performed o To correct high risk of absenteeism and staff turn-over resulting to low morale and dissatisfaction.

• • •

The type, philosophy, and objective of the hospital and nursing service. The population served whether pay or charity. The number of patients and the severity of their illness. Availability and characteristic of nursing personnel. Administrative policies. Standards of care. Lay-out the various nursing units and resources available. Budget. Professional activities and priorities in nonpatient activities. Teaching program/ staff development in teaching activities. Expected hours of work per annum of each employee. This is influence by the 40-hour week law. Pattern of work schedule: o Traditional 5 days/week; 8 hours per day. o 4 days/week, 10 hours per day & 3 days off. o 3 ½ days/ 12 hours per day & 3 ½ days off per week.

Generational Considerations for Staffing 1. Silent Generation/ Veteran • 1925 to 1942 • 5% workforce • As silent generation, they tend to support the status quos rather than to protest or push for rapid change. • More risk averse, highly respectful of authority, supportive hierarchy and disciplined. • Work values are traditional, often recognize for their loyalty to employers. 2. Baby Boomer/ Boom • 40% • 1943 to 1960 • “Workaholic” • Still display traditional work values. • Tend to be materialistic, thus willing to work long ours of their job to go ahead (promotions) REINALYN RAMIRO//NLM

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•

Caring for family members, volunteer their time for a cause. 3. Generation X • “Generation Xers” • 1961 to 1980 • They lack the interest of lifetime employment at one place. • Value greater work for hour flexibility and opportunities for time off. • Less economically driven. 4. Generation Y • “Millennial” • “Digital Natives” • 1981 to 2000 • Represents the first cohort of truly global citizens. • Known for their optimism, selfconfidence, relationship orientation, volunteer mindedness and social consciousness. • Highly sophisticated in their use of technology. • Tend to change job more frequently. Staff Strategies (Staffing Crisis) A. Float Staffing • Accept nurses on contractual basis who could float to different units. B. Flexible Staffing Time Schedule • Staggered shifting to augment staffing at peak hours. • 7-3/ 8-4/ 9-6/ 10-7 • Pay for overtime. C. Borderless Pattern • Equalize manpower distribution by “pull out” system. • Hire nurses as staff nurses of the institution, not by the unit where they will be assigned. D. Mandatory Overtime • Employees forced to work additional shifts, often under threat of patient abandonment. Key Terms •

Average Daily Census (ADC) – average number of patients cared for per day for the reporting period.

• • • • • •

• • • • • • • • • •

Average Length of Stay (ALOS) – average number of days that a patient remained in an occupied bed. Block Schedule – using the same schedule repeatedly. Centralized Schedule – scheduling done in one location. Decentralized Schedule – scheduling done in a local area. Full Time Equivalent – equal to the equivalent of a full-time employee. Nursing Hours per Patient (NHPP) – total paid hours for nursing personnel for specific time period divided by the number patient’s day in the same period. Patient Acuity – measure of nursing work load that is generated for each patient. Permanent Shift – personnel works the same hour permanent. Rotating Work Shift – alternating work hours among days, event, and night shift. Self-scheduling – staff coordinating their own work schedule. Staffing Pattern – plan that articulates how many and what kind of staff are needed by shift and day to shift a unit or department. Staffing Ratio – number of nursing staff per patient. Staffing Schedule – work schedule for personnel. Variable Staffing – determining the number and mix of staff base on patients’ needs. Variance Reports – noting differences in budgeted or planned staffing and cost. Staffing Plan (Staffing Matrix) – has different elements needed in the scheduling and staffing system.

Factors in Determining Staffing Needs 1. Acuity of Patients Illness • Level of care • Communicability • Degree of dependence • Rehabilitation needs 2. Special Treatment and Procedures 3. Type of Hospital 4. Ratio of Professional to Non-Professional Nursing Personnel 5. Turn-over of Patients and Nursing Personnel 6. Hospital Policy REINALYN RAMIRO//NLM

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▪

7. Budget 8. Available equipment/ material/ supply (5M) 9. Population served.

Provides that employees working in hospital with 100 capacity and up will only work for 40 hours a week. 2. Forty-eight Hours ▪ For those working on agencies located in communities with less than one million population and in hospitals with less than 100 bed capacity. 3. Memorandum Circular No. 6, series of 1996 ▪ Indicating other privileges granting a 3-day special privilege to government employees by the Civil Service Commission.

Patient Care Classification System •

•

•

A method of grouping patients according to the amount and complexity of their nursing care requirements, the nursing time and skill the require. The assessment can serve in determining the amount of nursing care required, within 24 H, as well as the category or nursing personnel to provide the care. Basis for planning staffing needs.

Classification Categories 1. Self Care or Minimal Care (1.5) (55:45) • Patient can do his activities of daily living. • Patient about to be discharge, nonemergency, newly admitted but not exhibit unusual symptom. • Teaching routines for simple procedures on discharge. • Convalescing patients. 2. Moderate Care to Intermediate Care (3) (60:45) • Patients needs some assistance in bathing, feeding, or ambulating for a short period of time. • VS 3x/shift, 1 hr. continuous monitoring. 3. Total, Complete, or Intensive Care (4.5-6) (65:45) • Patient is completely dependent upon the nursing personnel, patient may or may not be unconscious, they require close observation every 30 minutes for impending problem. 4. Highly Specialized Critical Care (6-9) (70:80) • Patient continuous treatment and observation, with many medication, VS q 15-30 minutes, hourly output with many significant changes in doctors’ orders. • One on one observation. Considerations when Computing for the Number of Nursing Personnel •

Consider the rights and privileges given to each personnel per year. 1. Forty-Hour week law (RA 5901)

Total Number of Working and Non-Working Days and Hours of Nursing Personnel per Year RIGHTS AND PRIVILEGES GIVEN EACH PERSONNEL PER YEAR 1. Vacation Leave 2. Sick Leave 3.Legal Holidays 4. Special Holidays 5. Special Privileges 6. Off-Duties as per R.A. 5901

WORKING HOURS PER WEEK 40 48 HOURS HOURS 15 15 15 15 10 10 2 2 3 3 104 52

Total Non-Working Days per Year Total Working Days per Year Total Working Hours per Year

-----152

-----100

213 1704

265 2120

Percentage of Nursing Care Hours Percentage of Patients in Various Levels of Care Type of Hospital

Minima l Care

Moderat e Care

Intensiv e Care

Primary Hospital Secondar y Hospital Tertiary Hospital

70

25

5

Highl y Spl. Care -

65

30

5

-

30

45

15

10

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Special Tertiary Hospital

10

25

45

▪

20

o Relievers Needed Consider the ff: 1. Average number of leaves taken each year a. Vacation Leave b. Sick Leave 2. Holidays 3. Special Privileges as per CSC MC #6s 1996 4. Continuing Education Program for Professionals TOTAL AVERAGE LEAVES

o

15 10 5 12 3

o

3 33

To Determine the Relievers Needed: • • •

Divide 33 (the average number of days an employee is absent/ year or total average year) 213 working days/ year that employee had serve (40H/week = 0.12) Multiply by the computed Nursing Personnel

o

Staffing Formula •

Find the number of nursing personnel needed for 250 patients in a tertiary hospital. o Categorize the patients according to levels of care needed. ▪ 250 pts. X .30 = 75 (patients needing minimal care. ▪ 250 pts. X .45 = 112. 5 (patients needing moderate care. ▪ 250 pts. X .15 = 37.5 (patients need intensive care) ▪ 250 pts. X .1 = 25 (patients need highly specialized nursing care.) ▪ Total: 250 o Find the NCH needed by patients at each level of care per day. ▪ 75 pts x 1.5 (NCH needed at level 1) = 112.5 NCH/day. ▪ 112 pts. X 3 (NCH needed at level 2) = 337.5 NCH/day ▪ 37.5 pts. X 4.5 (NCH needed at level 3) = 168.75 NCH/day

o

25 pts. X 6 (NCH needed at level 4) = 150 NCH/day ▪ Total: 768.75 NCH/day Find the total NCH needed by 250 patients per year. ▪ 768.75 x 365 (days/year) = 280, 593.75 NCH/year Find the actual working hours rendered by each nursing personnel/year ▪ 8 (hrs/day) x 213 (working days/year) = 1704 (working hours/year) Find the total number of nursing personnel needed ▪ Total NCH per year divided by working hr./year = 280, 593.75/1704 = 165 ▪ Relief x Total Nursing Personnel = 165 x 0.15 =24.75 or 25. ▪ Total Nursing Personnel Needed = 190. Categorize to professional and nonprofessional personnel. Ratio of professional to no-professional in a tertiary hospital is 65:35. ▪ 190 x .65 = 124 professional nurses. ▪ 190 x .35 = 66 nursing attendants. Distribute by shift. ▪ 124 nurses x .45 = 56 RN on AM shift ▪ 124 nurses x .37 = 46 RN on PM shift ▪ 124 nurses x .18 = 22 RN on N shift ▪ Total: 124 Nurses ▪ 66 Na x .45 = 30 NA on AM shift ▪ 66 NA x .37 = 24 NA on PM shift ▪ 66 NA x .18 = 12 NA on N shift ▪ Total: 66 Nursing Attendants

Nursing Care Delivery System • •

Also called Nursing Care Modalities; Patterns of Nursing Care; Methods of Assignment A system for delivery of care that delineates’ the nurse’s authority and accountability for clinical decision making and outcomes.

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It is integrated with the professional practice model and promotes continuous, consistent, efficient, and accountability nursing care. Professional Practice Model o A schematic description of a theory, phenomenon, or system that depicts how nurses’ practice, collaborate, communicate, and develop professionally to provide the highest quality care for those serve by the organization. Functional Method (Task Oriented) • 1950 • License and unlicensed staff member perform specific task for a large group of patients. • Hard to pinpoint responsibility, specially errors in patient care. • Care is assigned by task rather than by patient. Team Nursing (1950) • Skill mix in small group with a team leader. • Plan of care in which group of nursing personnel are lead by a qualified nurse to plan, direct and evaluate the delivery of care to a group of patient. • Modified functional nursing. • It includes the patient in the planning process. Primary Nursing (1960-1970) • RN primary nurse assumes 24 hour responsibility for planning the care of one or more patients from the start of treatment to discharge. • During work hours, the primary nurse provides direct care for her patient. Care Method (1920) • Total Patient Care/ Private duty Nursing • Oldest type • Oldest mode of organizing patient care • A nurse assumes total responsibility for meeting the needs of all assigned patients during the entire work period. • The assignment of one nurse to one patient/ client for the provision of total care.

Scheduling • • •

Is a function of implementing the staffing plan by assigning unit personnel to work specific hours and days of the week. A schedule is a plan showing when an individual or group activity or accomplishments will be started and or completed. Timetable showing planned work days and shifts for nursing personnel.

Objectives in Scheduling • • • •

To assign working days and days off to the nursing personnel so that adequate patient care is assumed. To achieve a desirable distribution of OFF duties. Nursing staff know in advance what their schedules are. To have a fair treatment of staff.

Factors to be Considered in Making Schedules • • • • • • • • • •

Adequate mix of nursing personnel be observed. Adequate coverage for 24 hours, seven days a week. Schedule for VL and H are planned in advance. Continuity of service. Long stretches of consecutive working days. Staff members are informed of their schedule at least two weeks in advance. Allowances for adjustment in case of illness emergency or changes in care needs. Fairness to staff. Stability Flexibility

Schedule Principles • • • • •

Schedule shall be posted at least 2weeks in advance of implementation. Establish written policies on request for offs, vacation leave and others. Schedule should conform with all the labor law and hospital policies. Provide good staffing mix. Ensure teamwork among the staff.

Contents of Job Description 1. Identifying Data • Position Title: Staff Nurse • Department: Nursing REINALYN RAMIRO//NLM

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• Supervisor’s Title: Head/ Senior Nurse Job Summary • Special features to distinguish it from others. Qualification Requirement • Educational preparation, training, experience. Job Relationships. • Source of workers Specific and Actual Functions and Activities

Uses of Job Description 1. For recruitment and selection of qualified personnel. 2. To orient new employees to their job. 3. For job placement, transfer and dismissal. 4. And aid in evaluating the performance of the employee. 5. For budgetary purposes. 6. For determining departmental functions and relationships to help define the organizational structure. 7. For classifying levels of nursing function according to skills levels required. 8. To identify training need. 9. As basis for staffing. 10. To serve as channel of communication.

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