ORGANIZING

– process of coordinating the work to be done

– ongoing process that systematically reviews the use of human o material resoures 1

Involves:
● identifying the work of the organization
● dividing the labor
● developing the chain of commands
● assigning authority

In healthcare, the basis of organization are:

● Mission
● Formal Organization Structure
● Delivery systems
● Job descriptions
● Skill mix
● Staffing Patterns

ORGANIZATION
- Refers to a body of persons, methods, policies and procedures arranged in a systematic process
through the delegation
of functions and responsibilities for the accomplishment of purpose.

AUTHORITY - The right to act, empower or make decisions without approval of higher
administrators.

RESPONSIBILITY - Obligation to perform or accomplish the assigned tasks.

ACCOUNTABILITY- Taking full responsibility for the quality of work and behavior while
engaged in the practice of one's

CHARACTERISTICS OF AN ORGANIZATION CHART

1. Division of Work
- Each box represents the individual or sub-unit responsible for given task.
- reduces number of tasks that each employee must carry out
- managers can standardize the work to be done, which in turn provides greater control.
2. Chain of Command
- Lines indicate who reports to whom and by what authority.
- hierarchy of authority and responsibility within the organization.

3. Type of Work to be Performed

- Indicated by labels or descriptions for the boxes

4. Grouping of Work Segments

- Shown by clusters of group works (departments or single unit)

5. Lerels of Management
- Indicate individual and entire management hierarchy

ORGANIZING PRINCIPLES
1. Unity of Command - one direction ONLY; under the 14 principles of management (Henri Fayol) -
An employee should report to only one supervisor

2. Scalar Principle or Hierarchy - refers to a clearly defined line of authority that includes all
employees in the organization . immediately report to the higher management

3. Homogenous Assignment / Departmentalization

4. Span of Control - number of people you can directly monitor; the higher the number, the lesser
the possible control.
- How many employees a manager can effectively supervise.
- Complex organization has tall structure due to numerous departments in which authority is
centralized
- Less complex organization has flat structure; authority is decentralized with sereral managers
supervising large work groups.

5. Exception - decision to your own department; on your own

shared with the employees

6. Decentralization - proper delegation of authority; Decision-making is

STAFFING
– Process of assigning competent people to fulfill the roles designated for the organizational
structure through recruitment, selection and development, induction and orientation of the
 new staff of the goals, vision, mission, philosophy etc.

Functions of Staffing
Industrial Relations
Employee Records
Employee Welfare
Services
Working Conditions
Compensation
Training and Development
Employment

Staffing Process
● Manpower
● Recruitment
● Selection
● Orientation and Placement
● Training and Development
● Remuneration
● Performance Evaluation
● Promotion and transfer

Staffing Process
● Preparing to Recruit
● Attracting a Staff
● Recruiting and Selecting a Staff

FACTORS AFFECTING STAFFING

1. Tipe, philosophy & objectives of the hospital & nursing services.
2. The population served or the kind of patients served whether pay or charity.
3. The number of patients, severity of illness & knowledge and ability of personnel are
matched with the actual care needs or 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 and holiday off-duties.
6. Standards of care desired which should be available & clearly spelled-out. Institution may
utilize the ANSAP's (Association of Nursing Service Administrators of the Philippines)
standard of Nursing Practice.
7. Layout of various nursing units & resources available within the department such as adequate
equipment, supplies, & material.
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
organizations, formal educational development, participation in research & staff development.
10. Teaching program or extent of staff involvement in teaching activities.
11. Expected hours of work per annum of each employee, influenced by the 40-hr week law
12. Pattern of work schedule:
● 5 days/wk, 8 hrs/day; 2 days off/wk
● 4 days/wk, 10 hrs/day, 3 days off/wk
● 3 ½/2 days/ wk, 12 hrs/ day, 3 ½ days off/wk

Staffing Pattern
– plan that articulates how many and what kind of staff are needed shift or per day in unit or in
department.

2 Ways of Developing a Staffing Pattern

● Determine the # of NCH needed/patient - Generating the full time equivalents of an
employee

● Determine the N-P ratio in providing nursing care

1.0 FTE = works 5 days/week, 8 hours/ day

0.5 FTE = part time employee who works 5 days/2 weeks

Considerations in Staffing Pattern

1. Benchmarking
– Management tool for seeking out the best practice in one's industry so to improve one's
performance.
– Benchmarking can foster positive competition between healthcare facilities, encouraging
them to practice continuous improvement.

2. Regulatory Requirements (mandated by RA)

3. Skill Mix (Ex 40FTE (20 RN + 20 non RN) = 50% RN mix)

4. Staff Support (suf support in place for the operations of the units or department.)

5. Historical Information (reriew of any data on quality or staff perception regarding the
effectiveness of the previous staffing pattern)

Understanding Hospital Compliance: Regulatory Requirements for Hospitals

Hospital compliance refers to the adherence to laws, regulations, and standards set by government
agencies and accreditation bodies.

These regulations are designed to:

● Protect Patients PHI
● Ensure Safety
● Promote Ethical Practices

Hospital compliance programs provide guidelines - policies and procedures - that help to meet
these requirements.

PRINCIPLES OF PATIENT ASSIGNMENT

● Made by head nurse for each individual nurse
● Planned weekly and revised daily to ensure continuity of care
● Must be balanced among nursing staff
● Never assign same task to more than one nurse
Based on:
Nursing needs of each patient

Skill, experience, capabilities of each staff

Job description

CHALLENEGES IN PATIENT ASSIGNMENT

1. Problem of personal management
2. Shortage of trained manpower
3. Lack of adequate training
4. No involvement in planning
5. No autonomy in nursing activities
6. Inadequate number of nursing staff

METHODS OF PATIENT ASSIGNMENT

– Case method nursing or total patient care.
– Functional nursing
– Team nursing or modular nursing
– Primary nursing
– Case management or managed care
– Progressive patient care
[Link] METHOD
● The case method or total patient care method of nursing care delivery is the oldest method of
providing care to a patient.

● In this method, nurses assume total responsibility for meeting all the needs of assigned
patient during their time on duty:

● The premise of the case method is that one nurse provides total care to one patient during
her entire work period of one shift.

● This method was used in the era of Florence Nightingale when patient received total care in
the home.

● That time nurses were hired" and they lived with in the family of the patient provided 24
hours care to patient and even family.

● During an 8-12 hour shift the patient receives consistent care from one nurse. The nurse,
patient, family share mutual trust and work together toward specific goals.

● Usually the care is patient-centered, comprehensive, holistic and continuous.

CHARACTERISTICS
1. Complete care
2. Provides nurses with high autonomy and responsibility.
3. Assigning patients is simple and direct.
4. Patient theoretically receives holistic and un-fragmented care during the nurse's time on
duty.
5. It is developed and communicated through written sources, its usage remains in
contemporary practice.

ORGANIZATION OF THE CASE METHOD

Nurse Manager role:
– Consider the expense of the system before arranging the staff
– Arrange skilled and qualified nurse so that she could manage all the care of the person need
to identify the level of education and communication skills of all
– Arrange for continuing education and in service education for the personnel

Staff nurse's role:

– Provide holistic care to assigned patient during a defined work period
– Assessment and teaching the patient and family
MERITS
● Nurse can see better and attend to the total needs of the patient
● Continuity of care can be facilitated
● Client or nurse interaction and rapport can be developed
● Client may feel more secure
● Nurse's accountability for their function is built into it.
● Family friends become more known by nurse and get more involved
● Work load can be equally divided by the staff.

DEMERITS
● Many clients do not require the inherent care
● Must be modified if non-professional health workers are used
● Great disadvantage when nurse is inadequately trained
● Cost-effectiveness
● Nurse may feel overworked if most of her assigned patient care sick.
● She/he may tend to 'neglect the needs of patient when the other patients 'problem' or
'need' demands more time

2. PRIMARY NURSING CARE

● It was developed in the 1960s with the aim of placing RNs at the bedside and improving the
professional relationships among staff members.
● It supports a philosophy regarding nurse and patient relationship.
● This method is based on the concept of 'my patient-my nurse". In this nursing care delivery
system, each registered nurse is assigned to the care of group of patient for which she plans
complete 24 hours care and writes the nursing care plan.
● He or she is responsible for coordinating and implementing all the necessary nursing care
that must be aiven to the patient during the shift.
● If the nurse is not available, the associate nurse responsible for filling in for the nurse's
absence will provide hospital care to the patient based on the original plan of care made by
the nurse.
● This type of nursing care can also be used in hospice nursing, or home care nursing.
● Provides total direct care for patients.
● Requires a nursing staff made up of only Nurses.

CHARACTERISTICS
1. The Primary nurse assumes 24-hour responsibility from admission or start of treatment to
discharge or the treatment's end.
 2. During work hours, primary nurse provides total direct care for that patient.
3. When the primary nurse is not on duty, care is provided by other junior nurses.
4. An integral responsibility of the primary nurse is to establish a good
communication

ADVANTAGES
Satisfaction for both patients and nurses

The relationship between nurses and patient is intimate

Autonomy for the nurses

Nurse is the person who plans and providing complete care

She communicates with all other health team members involved in client care

Other health team members including physician tend to view her more knowledgeable and
responsible

Patient receives quality and continuity of care

Reduces the number of errors than can result from a relay of orders

Increased satisfaction both to patients and nurses

Nurse can identify patient outcome as a result of their work

DISADVANTAGES
More nurses are required for this method of care delivery and it is more expensive than
other methods.

Level of expertise and commitment may vary from nurse to nurse which may affect quality of
patient care.

Associate nurse may find it difficult to follow the plans made by another if there is
disagreement or when patient's condition changes.

It may be cost-effective especially in specialized units such as the ICU.

May create conflict between primary and associate nurses.

Stress of round the clock responsihility.

Difficulty in hiring all RN staff

Confines nurse's talent to his/her own patients.

Nurse may be isolated from colleagues

Nurses talent to a limited number of patients

 Nurses talent to a limited number of patients

Nursing care plan can be changed only with the permission of primary nurse

Creates separation anxiety in patients when nurse

Nurses should be well educated and trained in all area of patient care, most of the time
which may lack

[Link] NURSING
– It is task focused, not patient-focused.
– In this model, the tasks are divided with one nurse assuming responsibility for specific tasks.
For example, one nurse does the hygiene and dressing changes, whereas another nurse
assumes responsibility for medication administration.

Merits
1. Each person become very efficient in every task
2. It is easy to organize the work of the unit and staff.
3. The best utilization can be made of a person's aptitudes, experience and desires.
4. The organization benefits financially from this strategy because patient care can be delivered
to a large number of patients by mixing staff with a large number of unlicensed assistive
personnel.
5. Nurses become highly competent with tasks that are repeatedly assigned to them.
6. Less equipment is needed and what is available is usually better cared for when used only by
a few personnel.

Demerits:
1. Client care may become impersonal, compartmentalized and fragmented.
2. Continuity of care may not be possible.
3. Staff may become bored and have little motivation to develop self and others.
4. The staff members are accountable for the task.
5. Client may feel insecure.
6. Only parts of the nursing care plan are known to personnel.
7. Patients get confused as so many nurses attend to them, e.g. head nurse, medicine nurse,
dressing nurse, temperature nurse, etc.

[Link] NURSING
– Team nursing is based on philasophy in which groups of professional and nonprofessional
personnel work together to identity, plan, implement and evaluate comprehensive client-
 centered care.
– In team nursing an RN leads a team composed of other RNs, LPNs or LVNs and nurse
assistants or technicians.
– The team members provide direct patient care to group of patients, under the direction of the
RN team leader in coordinated effort.
– The charge nurse delegates authority to a team leader who must be a professional nurse.
This nurse leads the eam usually of 4 to 6 members in the care of between 15 and 25
patients.
– The team leader assigns tasks, schedules care, and instructs team members in details of
care.

Advantages
1. High quality comprehensive care can be provided to the patient
2. Each member of the team is able to participate in decision making and problem solving.
3. Each team member is able to contribute his or her own special expertise or skills in caring
for the patient.
4. Improved patient satisfaction.
5. Feeling of participation and belonging are facilitated with team members.
6. Work load can be balanced and shared.
7. Division of labour allows members the opportunity to develop leadership skills.
8. There is a variety in the daily assignment.
9. Nursing care hours are usually cost effective.
10. The client is able to identify personnel who are responsible for his care.
11. Barriers between professional and non-professional workers can be minimized, the group
efforts prevail.

Disadvantages
1. Establishing a team concept takes time, effort and constancy of personne
2. Unstable staffing pattern make team nursing difficult.
3. All personnel must be client centered.
4. There is less individual responsibility and independence regarding nursing functions.
5. The team leader may not have the leadership skills required to effectively direct the team
and create a —team spirit.
6. Itis expensive because of the increased number of personnel needed.

[Link] PATIENT CARE

● It is a method in which client care areas provide various levels of care. The central theme is
beer wilization of facilities, services and personnel for the better patient care.
● Here the clients are evaluated with respect to all level (intensity) of care needed.
● As they progress towards increased self care (as they become less ethically ill or in nced of
 ●
intensive care or monitoring) they are referred to units/ wards staffed to best provide the type
of care needed.

Principal elements of PPC are

i) Intensive care or critical care: Patients who require close monitoring and intensive care
round the clock, e.g. patients with acute Ml, fatal dysarythmias.

ii) Intermediate care: Critically ill patients are shifted to intermediate care units when their
vital signs and general condition stabilizes, e.g, cardiac care ward

iii) Convalescent and Self Care: Patients are taught administration of drugs, life style
modification, exercises, ambulation, self-administration of insulin, checking pulse, blood
glucose and dietary management.

iv) Long-term care: Chronically ill, disabled and helpless patients are cared for in these
units. Nurses and other therapists help the patients and family members in coping,
ambulation, physical therapy, occupational therapy along with activities of daily living.

v) Home care: Some hospital/centers have home care services. A hospital based home care
package provides staff, equipment and supplies for care of patient at home, e.g. paralyzed
patients, post-operative, mentally retarded/spastic patient and patient on long chemotherapy.

vi) Ambulatory care: Ambulatory patients visit hospital for follow up, diagnostic, curative
rehabilitative and preventive services. These areas are outpatient departments, clinics,
diagnostic centers, day care centers etc.

Merits
1. Efficient use is made of personnel and equipment.
2. Clients are in the best place to receive the care they require.
3. Use of nursing skills and expertise are maximized.
4. Clients are moved towards self care, independence is fostered where indicated.
5. Efficient use and placement of equipment is possible.
6. Personnel have greater probability to function towards their fullest capacity.

Demerits
1. There may be discomfort to clients who are moved often.
2. Continuity care is difficult.
3. Long term nurse/client relationships are difficult to arrange.
 4. Great emphasis is placed on comprehensive, written care plan.
5. There is often times difficulty in meeting administrative need of the organization, staffing
evaluation and accreditation.

[Link] MANAGEMENT
– The case manager is assigned responsibility of following a patient's care and progress from
the diagnostic phase through hospitalization, rehabilitation and back to home care. For eg;
case manager for cardiac surgery patients assists them go through diagnostic procedures,
pre-operative preparations, surgical interventions, family counseling, post-operative care and
rehabilitation.

Responsibilities of case managers

● Assessing clients and their homes and communities.
● Coordinating and planning client care.
● Collaborating with other health professionals in the provision of care.
● Monitoring client progress and client outcomes.
● Advocating for clients moving through the services needed.
● Serving as a liaison with third-party payers in planning the client's care.

Merits
1. Case management provides a well coordinated care experience that can improve the care
outcome, decrease the length of stay, and use multiple disciplines and services efficiently.
2. Provides comprehensive care for those with complex health problems.
3. It seeks the active involvement of the patient, family and diverse health care professionals

Demerits
1. Nurses identity major obstacles in the implementation of this service, financial barriers and
lack of administrative support.
2. Expensive
3. Nurse is client focused and outcome oriented
4. Facilitates and promotes co-ordination of cost effective care
5. Nursing case management is a professionally autonomous role that requires expert clinical
knowledge and decision making skills.
6. There may be discomfort to clients who are moved often.
7. Continuity care is difficult.
8. Long term nurse/client relationships are difficult to arrange.
9. Great emphasis is placed on comprehensive, written care plan.
10. There is often times difficulty in meeting administrative need of the organization, staffing
evaluation and accreditation.
CONCLUSION
– No single nursing care model works in all settings, or even necessarily across a single
multiservice setting.
– Before selecting a model, the nurse manager must consider all the influencing factors.
– For a better care effective selection and mixing of these methods are essential.
– All the models should be evaluated periodically for its appropriateness to ensure safe and
effective nursing care.

Types of Staffing
1. Case method - IN - 1P for & his then different next day
2. Functional nursing - Beneficial if less RN than NA
3. Team nursing - Match the pts needs = 3 skills and knowledge
4. Modular/District nursing- team +primary
5. Primary nursing - 4 to 6P for 24 hrs
6. Case management - Psych
7. Collaborative
8. Managed care - financial, insurance, provider org, integrated care org.

Patient Classification System

– Measuring tool used to articulate the nursing workload for specific patient or group of
patients over a specific time.
– Patient Acuity System

Patient Care is Classified According to:

LEVEL I - Self Care or Minimal Care

LEVEL II - Moderate Care or Intermediate Care

LEVEL III - Total, Complete or Intensive Care

LEVEL IV - Highly Specialized Critical Care

LEVEL I
– Patient can take a bath on his own, feed himself, and perform his ADI.s,
– Patients about to be discharged, those in non-emergency, newly admitted, don't exhibit
unusual s/sx & requires little treatment.
– NCH: 1.5
– Ratio: 55:45 (Professional: Non-Professional)
LEVEL II
– Patients need some assistance in bathing, feeding & ambulating
– Ereme symptoms may have subsided, haven't yet appeared
– May have slight emotional needs, with V/S ordered up to 3x/shift, IVF or BT, are semi-
conscious
– Require periodic treatment
– NCH: 3
– Ratio: 60:40

LEVEL III
– Patients are completely dependent upon the staff
– Provided with complete bath, fed, may or may not be unconscious, may be on continuous 02
therapy, with chest or abdominal tubes
– Require close observation at least 30 minutes
– 2 NCH: 4.5
– 2 Ratio: 65:35

LEVEL IV
– Patients need maximum nursing care
– Patient needs continuous treatment, with many medications, IV piggy backs, V/S every 15 to
30 minutes, hourly
– output, with significant changes in doctor's order
– 2 NCH: 6 *NCH can go to 9
– 2 Ratio: 70:30 *Ratio can go to 80:20

SCHEDULING
– Timetable showing planned work days and shifts for nursing personnel.

Issues to consider in scheduling staff:

● Patient type and acuity
● Number of patients
● Experience of Staff
● Support available to the staff

Shifting Variations
1. Traditional Shifting Patterns
 ● 3 shift (8-hr shift)
● 12-hr shitt
● 10-hr shift
2. Weekend option (Part 2 Baylor)
3. Rotating work shift
4. Self-scheduling
5. Permanent work shift
6. Floaters - "on-call'"
7. Block/Cyclical work shift
8. Variable work shift

Types of hospital
Level 1 - basic services like isolation facilities, maternity, dental clinics and basic laboratory
and x-ray facilities (Community Health Centers)

Level 2 - specialty services in addition to the level 1 services (District Hospital)

Level 3 - specialized and sub-specialized services, including teaching and training

programs (EVMC, St. Arnold Medical Mission, INC.)

Forty Hour Week Law

– Based on R.A. 5901
– No work, no pay
– 2-wk sick leave and off duty for 2 days
– Special Holidays - with pay

CIVIL SERVICE COMMISSION

– As per Memorandum Circular No. 6 Series of 1996
– 3-day special privilege to government employees, which may be spent for:
1. Birthday / Wedding
2. / Anniversary
3. r Funeral / Relocation
4. Enrolment / Graduation
5. Hospitalization
6. Accident Leaves

TABLE 2: Categories / Levels of Care of Patients, NCH needed/pt/day & Ratio of Professional to
Non- Professonal

Levels of Care NCH/Patient/Day Pro to Non-Pro

 Ratio
LEVEL / 1.5 55:45
LEVEL /I 3.0 60:40
LEVEL III 4•5 65:35
LEVEL IV 6 70:30

TABLE 3: Percentage of Patients at Various Levels of Care per Type of Hospital

Type of Minimal Care Moderate Intensive Highly

Hospital Care Care Specialized
Care
Primary 70% 25% 5% -
Secondary 65% 30% 5% -
Tertiary 30% 45% 15% 10%
Special 10% 25% 45% 20%
Tertiary

TABLE 4: Total # of Working & Non-Working Days & Hrs of Nursing Personnel Per Year

Rights & Privileges 40 hrs/wk 48 hrs/wk

Given/Yr
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 per RA 104 52
5901
 7. Continuing 3 3
Education Program
Total Non-Working 152 100
Days/Yr
Total Working Days/Yr 213 265

● Standard: 365 days per year

● Standard reference
For the relievers:
33 days average number of days an employee is absent/yr
213 total number of working days/yr (40hrs)
0.15 per person who works 40 hrs/wk
33/265 = 0. 12per person who works 48 hrs/wk

SHIFT DISTRIBUTIONS
AM SHIFT - 45%
PM SHIFT - 37%
NIGHT SHIFT - 18%
* Whether it would be nurses or nursing attendants

DIRECTING
– 4th stage of management process
– Coordinating or activating
"In this doing phase of mgt, managers direct/lead work of subordinates

"- Process of getting the organization's work done.

"- The issuance of orders, assignments, and instructions that enable the nursing personnel to
understand what is expected of them.

2 Types of Directing
● Written - memorandum
● Verbal

ELEMENTS OF DIRECTING
1. Delegation
2. Supervision
3. Communication
4. Coordination
5. Staff Development
6. Decision Making

LEADERSHIP SKILLS (DECISION MAKING)

– Complex, cognitive process of choosing a part. course of action

Critical elements
● Define objectives clearly
● Gather data carefully
● Generate many alternatives
● Think logically
● Choose & act decisively

Individual variations
● Values
● Life experience
● Individual preference
● Individual ways of thinking & decision-making

WHAT IS POWER?
Power - is defined as the capacity to act or the strength and potency to accomplish something.

– "enables us to accomplish goals (Hersey, Blanchard, & Johnson, 2007).;

ability to influence
– "Authority to guide, support, and motivate the healthcare team toward achieving safe,
effective, and compassionate patient care.

Types of Power
1. Reward power - offering rewards and incentives
2. Coercive power - applying negative consequences
3. Legitimate - by virtue of their official position
4. Expert - based on expertise
5. Referent - personal traits ( charisma, integrity and empathy)
6. Informational - access to & sharing of info
7. Self-power - inner strength, confidence, self awareness.

STRATEGIES FOR BUILDING PERSONAL

POWER BASE
 – Maintain personal energy
– Present powerful image to others
– Learn language & symbols of org.
– Learn how to use org.'s priorities
– Increase prof K&S
– Maintain broad vision
– Use experts & seek counsel
– Be flexible
– Develop visibility & voice in org.
– Learn to toot own horn
– Maintain sense of humor
– Empower others

DELEGATION
– is the process by which responsibility and authority for performing a task (function, activity,
or decision) is transferred to another individual who accepts that authority and responsibility.

DIFFERENTIATING DELEGATION FROM ASSIGNMENT

– Delegation involves transfer of responsibility and authority.
Effective delegation benefits the delegator, the delegate, and the organization.

– In assignment no transfer of authority occurs.

– Assignments are a bureaucratic function that reflect job descriptions and patient or
organizational needs.

BENEFITS OF DELEGATION
BENEFITS TO THE NURSE
– If the nurse can delegate some tasks to Unlicensed Assistive Personnel (UAPs), more time
can be devoted to those tasks that cannot be delegated, especially complex patient care.
– "Thus, patient care is enhanced, the nurse's job satisfaction increases, and retention is
improved.
– The delegate gains new skills and abilities that can facilitate upward mobility. In addition,
delegation can foster trust and support, thereby building self-esteem and confidence.
– Morale improves;
– a sense of pride and belonging develops, as well as a greater awareness of responsibility.
– Individuals feel more appreciated and learn to appreciate the roles and responsibilities of
others, increasing cooperation and enhancing teamwork.

THE DELEGATION PROCESS

1. Define the task.
Delegate only an aspect of your own work for which you have responsibility and authority.
These include:
 ● Routine tasks
● Tasks for which you do not have time
● Tasks that have moved down in priority

2. Decide on delegate.
Match the task to the individual. Analyze individuals' skill levels and abilities to evaluate their
capability to perform the various tasks.
Determine characteristics that might prevent them from accepting responsibility for the task.

3. Describe the task using "|" statements, such as "I would like..." and appropriate nonverbal
behaviors- open body language, face-to-face positioning, and eye contact.
" Decide whether written reports are necessary or if brief oral reports are sufficient. If written
reports are required, indicate whether tables, charts, or other graphics are necessary.

4. Reach agreement. Once you have outlined your expectations, you must be sure that the delegate
agrees to accept responsibility and authority for the task.

5. Monitor performance and provide feedback.

"provides a mechanism for feedback and control that ensures that the delegated tasks are carried
out as agreed.

ACCEPTING DELEGATION
– "understand what is being asked of you.
– Acknowledge
– If you do not have the skills, you must inform the delegator. However, it does not mean you
cannot accept the responsibility.
– See whether the person is willing to train or otherwise equip you to accomplish the task. If
not, then you need to refuse the offer.
– Accepting delegation means that you accept full responsibility for the outcome and its
benefits or liabilities

PRINCIPLES OF DELEGATION
Rights of Delegation
1. the right task
2. the right circumstance
3. the right person
4. the right direction/communication
5. the right supervision.
PRINCIPLES OF DELEGATION
" Four guidelines for effective delegation by Koloroutis
(2004, p. 136)
● Delegation requires RNs to make decisions based on patient needs, complexity of the
work, competency of the individual accepting the delegation, and the time that the work is
done.
● Delegation requires that timely information regarding the individual patient be shared,
defines specific expectations, clarifies any adaptation of the work in the context of the
individual patient situation, and provides needed guidance and support by the RN.
● Ultimate accountability for process and outcomes of care - even those he or she has
delegated - is retained by the RN.
● RNs make assignments and the care provider accepts responsibility, authority, and
accountability for the work assigned.

SPECIFIC ACCOUNTABILITIES OF RNS, OTHER HCPS, AND EMPLOYERS/HC FACILITIES

- RNs (delegators) are accountable to:
a) their regulatory body, and employers for the competent performance of nsg services they
provide.
b) have a sound rationale for a decision to delegate.
c) assess whether the outcome of a delegated task/function will be reasonably predictable.
d) decide whether to delegate a task or only a specific component of a task.
e) determine that the HCP (delegatee) has the necessary ability and knowledge to perform the task/
function safely and competently.
f) know the educational preparation and competencies of other HCPs involved in client care.
g) provide the necessary communication, support and supervision for a delegated task/ function to
a delegatee.
h) evaluate whether a delegated task was completed in a satisfactory manner.
i) document a decision to delegate, with rationale and outcomes.
j) ensure that the facility/organization has adequate resources to support a decision to delegate and
to support the healthcare providers involved (e.g., policies, educational preparation).

DELEGATING TO THIRD-PARTIES
– On occasion, registered nurses may be required to teach S.O.s how to perform a nursing task/
function.
In such situations, the registered nurse would be accountable to:
a) assess that the family member or third-party has the ability to perform the task/function safely
and competently.
b) competently provide the teaching based on evidence-based knowledge.
c) assess the effectiveness of the teaching, and communicate available resources to family
members or third-parties.

Communication is "the exchange of thoughts, messages, or information, by speech, signals,

writing, or behavior."
Two levels:
1. Verbal
2. nonverbal.

COMMUNICATION
MODES
1. Written
● Know what you want to say before writing
● Put people into writing
● Use action words
● Write plainly
● Use as few words as possible
● Use simple, direct sentences
● Give reader direction
● Arrange material logically
● Use paragraphs for lead
● Connect thoughts
● Be clear
● Express thoughts in similar ways

NON-VERBAL VERBAL
• Space - Reflect
• Environment • Repeat assertive msg
• Appearance - Point out implicit
• Eye contact assumptions
• Posture - Restate msg w/ assertion
- Gesture Question
Facial expression
Timing
Vocal Cues
CLIMATES OF COMMUNICATION
INTERNAL CLIMATE
- Includes internal factors such as the
values, feelings,
temperament, and stress levels of the sender and the receiver

EXTERNAL CLIMATE
- Includes external factors such as the weather,
temperature, timing, status, power, authority, and the organizational climate
itself

CHANNELS OF COMMUNNICATION
1. Upward communication- the manager is a subordinate to higher management.
2. Downward communication- the manager relays information to subordinates.
3. Horizontal communication- managers interact with others on the same hierarchical level as
themselves who are managing different segments of the organization.
4. Diagonal communication- the manager interacts with personnel and managers of other
departments and groups who are not on the same level of the organizational hierarchy.
5. Grapevine communication- flows quickly and haphazardly among people at all hierarchical
levels and usually involves three or four people at a time.

COMMUNICATION SKILLS
1. Assertive communication allows people to express themselves in direct, honest, and
appropriate ways that do not infringe on another person's rights.

2. Passive communication occurs when a person suffers in silence although he or she may feel
strongly about the issue.

3. Aggressive communication is generally direct, threatening, and condescending.

4. Passive-aggressive communication is an aggressive message presented passively. This

person feigns withdrawal in an effort to manipulate the situation.

COMMUNICATION TOOLS
S
SITUATION
Introduce yourself and the patient and briefly state the issue that you want to discuss
Describe the background or context
B
BACKGROUND
(patient's diagnosis, admission date, medical diagnosis, and treatment to date)

A
ASSESSMENT
Summarize the patient's condition and state what you think the problem is
Identify any new treatments or changes

R
RECOMMENDATION
ordered and provide opinions or recommendations for further action

LISTENING SKILLS
● The leader who actively listens gives genuine time and attention to the sender, focusing on
verbal and nonverbal communication.
● The leader must continually work to improve listening skills by giving time and attention to
the message sender.

GREETING - Offer greetings and establish positive environment

RESPECTFUL LISTENING- Listen without interrupting and pause to allow others to think

REVIEW - Summarize message to make sure it was heard accurately

RECOMMEND OR REQUEST MORE INFORMATION- Seek additional information as necessary

REWARD- Recognize that a collaborative exchange has occurred by offering thanks

MOTIVATION THEORIES
● Maslow's Hierarchy of Needs
● Skinner's Operant Conditioning & Behavior Modification
● Herzberg's Motivation-Hygiene Theory
● Vroom's Expectancy Model
● McClelland's Three Basic Needs in Motivation
● Achievement, Affiliation & Power
● Gellerman's Humanistic Motivational Theory
 ● Stretching & participation; managers tend to "overmanage"
● McGregor's Theory X & Theory Y

TIME MANAGEMENT
– Making optimal use of time
● 3 basic steps
1. Allow time for planning & establish priorities
2. Complete highest priority and finish one at a time
3. Reprioritize based on remaining task & new info received

5 Priority-setting Traps
– Whatever hits first
– Path of least resistance
– Squeaky wheel
– Managing by default
– Waiting for inspiration

CONFLICT MANAGEMENT
Too little conflict - Organizational stasis
Too much conflict - Reduced effectiveness w/ immobilization of employees

CONFLICT MANAGEMENT
Categories
1. Intrapersonal - within
2. Interpersonal - 2 or more individuals
3. Intergroup - 2 or more groups

Process (based book for definition)

● Latent
● Perceived
● Felt
● Manifest

Look for meaning in the book

1. Compromising (Negotiating)
2. Competing (Forcing)
3. Smoothing (Accommodating)
4. "Avoiding (Withdrawing)
5. Collaborating (Problem-Solving/Integrating) - WIN-WIN APPROACH
NEGOTIATION - collaboration/competition
Before
– Be prepared mentally by having done homework
– Determine starting point, trade-offs, & bottom line
– Look for agendas, both own and that of the party

During
– Maintain composure
– Role model good communication skills, assertiveness & flexibility
– Avoid using destructive techniques but be ready to counter

After
– Restate what has been agreed upon, verbal and written
– Recognize & thank all participants

CONTROLLING
– An on going function of management which occurs during planning, organizing and
directing activities.
– Process wherein the performance is measured and corrective action is taken to ensure the
accomplishment of organizational goal.
– Open opportunities for improvement
– Compare performance against set standard
– Provides information about how well processes and people function

Steps in Control Process

1. Establish standards and criteria
2. Measure performance
3. Compare results with standards
4. Match with standards?
– YES - do nothing to improve
– NO- take corrective action

PRINCIPLES OF BUDGETING IN NURSING ADMINISTRATION

DEFINITION
● A forecast of the resources required to deliver the services offered by the organization.
● A budget is a financial plan that includes estimated expenses as well as income for a period
 ●
of time.
● A nursing budget is a systematic plan that is informed best estimate by nurse administrators
of nursing revenues and expenses. It projects how revenues will meet expenses and projects
a return on equity or profit.

PURPOSE
● To plan the objectives, programs and activities of nursing services and the fiscal resources to
accomplish them.
● To motivate nurse managers and nursing workers
through analysis of actual experiences.
● To evaluate the performance of nurse administrators and managers and increase awareness
of the costs.
IMPORTANCE OF BUDGET
– An essential management tool
– Budget tells you how much money you need to carry out your activities
– Budget enables to monitor income and expenditure.
– The budget is basis for financial accountability and transparency.

BUDGETING PROCESS
- “HOW NURSE EXECUTIVE CAN PREPARE A NURSING DIVISION BUDGET”

BUDGETING PROCESS
● STEP 1: Review past performance
● STEP 2: Review the organizations goals and projections
● STEP 3 : Review of variences with high levels
● STEP 4: Actual preparation of the budget
STEP 1: Review past performance
● Prior financial records.
● Present activities of the nursing division
● Activities that the division plans to institute during the projected financial period.
● Activities the division plans to delete during the projected financial period.

STEP 2: Review the organizations goals and projections

● Items in the major budgetary report that affect the nursing department should be determined

STEP 3: Review of variances with high levels

● Proposed Departmental Goals, Variances, their causes, Proposed corrective actions.
● And then, the new budgeting process can begin

STEP 4: Actual preparation of the budget

● a bridge/ worksheet is essential - is "a tool used by managers to prepare their budget"
Information about:
– Historic information with aid budget.
– Actual numbers with comments explaining the variances.
– Revenue and costs.

CAPITAL BUDGET
– Fund needed for the capital items for the growth
– New supplies and facilities and the replacement of worn out equipment, machinery and
furniture.
– The decision on capital budgeting is primarily is based on:
1. Needs of patients and existing alternatives
2. Effects of additional equipment on income and expenditure
3. Availability of funds

OPERATING BUDGET
– It provides an overview of an agency's functions by projecting the planned operations usually
for the upcoming year.
– The nurse manager might includes personnel salaries, employee benefits, insurance,
medical-surgical supplies, office supplies, rent, heat, light and house keeping
CASH BUDGET
– Cash budget are planned to make adequate funds available as needed and to use any extra
funds profitably.
– The ensure that the agency has enough, but not too much, cash on hand during the
budgetary period.
– cash inflow and outflow
– summary of all cash flows

PERSONNEL BUDGET
– Estimates the cost of direct labor necessary to meet the nursing needs of the estimated
patient population. It includes recruitment, hiring, assignment, lay off and discharge of
personnel.
– The current staffing patterns, number of unfilled positions and last year's report can provide
a base.

BUDGETING APPROACHES
INCREMENTAL
– Budget for the coming year is projected
– Requires little budget expertise from the part of the manager.
Advantages:
● Simple to prepare and understand
● Consistent basis
● Better coordination between budgets
Disadvantages:
● Totally ignore the impact of changes
● No incentive in development and innovation
● Encourages spending up to the budget

This approach is not recommended as it fails to take into account changing circumstances.

ZERO-BASED BUDGETING
– Assumes the base for projecting next year's budget is zero.
– Managers are required to justify all activities and programs as if they initiated for the first
time.
– Every proposed expenditure must be justified with:
● current environment
● fit with organizational objectives
Since all the costs are required to be justified, it seems inappropriate to use ZBB for the whole
budgeting process. One way of overcoming this drawback is to use this method selectively.

ADVANTAGES:
– Efficient allocation of resources
– Drives managers to find cost reduction methods
– Identifies and eliminates wasteful activities
DISADVANTAGES:
– Very complex O Time and manpower consuming
– Necessary to train employees, especially managers
– In a relatively large corporation, the amount of information might be too excessive to go
through all. Compressing the information might take out critical details
– Can result in internal conflicts between departments over budget allocation.

FLEXIBLE BUDGETING
– are budgets that adjust automatically over the course of the year depending on the variables
such as the volumes, labor cost and capital expenditures.
– automatically calculates what expenses should be given the volume what is occurring thus
the costs can be allocated on a volume basis.
ADVANTAGES:
1. Adjustment for Predictions
2. Adapting Change
3. Control and Evaluation
DISADVANTAGES:
1. Continuous Monitoring
2. Lack of Information
3. Complexity

PERFORMANCE BUDGETING
– Focuses on the activities of a cost center such as indirect care, direct care and quality
monitoring. Each activity has objectives with specific financial resources; performance
budgeting focuses on what is expected to be accomplished.
– Performance budgeting is an improvement over flexible budgeting because it ties
performance to consumption of financial resources.
STEPS OF PERFORMANCE BUDGETING:
1. Define the performance activities or areas of accomplishment for the cost center.
2. Identify the line-item operating budget for the cost center being evaluated.
 3. Define how much of the resources presented by each line item are to be devoted to each
performance areas.
4. Choose measures of performance for each performance area, budget an amount of work
for each area and determine the budgeted cost-per-unit of work based on these measures.

REASONS FOR CONDUCTING EVALUATION

● Ensures that quality services is provided
● Allow for setting of sensible objectives and ensures compliance
● Provides standards for establishing comparisons
● Promotes visibility and means for employees to monitor own performance
● Highlights problem related to quality care and determines areas that require priority
attention
● Provides an indication of the cost of poor quality
● Justifies the use of resources
● Provides feedback for improvement

EVALUATION PRINCIPLES
1. Must be based on behavioral standards of performance with the position requirement
2. There should be enough time to observe employee's behavior
3. Employee should be given a copy of the ff. Before scheduled evaluation
– Job description
– Performance standards
– Evaluation forms
4. Performance appraisal should include both satisfactory and unsatisfactory results
5. Areas needing improvement must be prioritized
6. Should be scheduled and conducted at a convenient time for both evaluator and employee
7. Should be structured in such a way that it is perceived and accepted positively as a means of
improving job performance

CHARACTERISTICS OF EVALUATION TOOL

● OBJECTIVE
– Free from bias
● RELIABLE
– Accurate and precise that it will produce the same results if administered twice

● SENSITIVE
– Instrument can measure fine lines of differences among criteria being measured

● VALID
TYPES OF PERFORMANCE STANDARDS
1. STRUCTURE
– Focus on the management system or structure used by the agency in the delivery of care
Includes:
● Number and categories of nursing personnel
● Education
● Personal and professional qualities
● Function
● Physical facilities
● Equipments

2. PROCESS STANDARDS
– Decision and actions of the nurse relative to the nursing process
INCLUDES :
● Assessment
● Plan of care
● Nursing intervention

3. OUTCOME STANDARDS
– Designed to measure the results og care provided in terms of:
● Changes in health status of client served
● Changes in level of their knowledge, skills and attitude
● Satisfaction of those served

PERFORMANCE APPRAISAL
– A control process in which employee's performance is evaluated against standards

– The most valuable tool in controlling human resources and productivity

– Reflects how well personnel have performed during a specific period of time

PURPOSE OF PERFORMANCE APPRAISAL

– [Link] performance of work group
 – 7. Improve communication between supervisors and employees
– 8. Establish standards of supervisory performance
– 9. Provide recognition of employee for accomplishments
– 10. Inform employees "where they stand'

METHODS OF MEASURING PERFORMANCE

1. ESSAY- The appraiser writes a paragraph about the workers strength, weaknesses and
potentials

2. CHECKLIST - A compilation of performances expected of a worker

3. RANKING - Evaluator ranks according to how employee fared with co-workers

4. RATING SCALE- Includes a series of items representing the different tasks or activities in job
description or the absence or presence of desired behaviors

5. FORCED-CHOICE COMPARISON
– The evaluator is asked to choose the statement that best describes the employee being
evaluated
– The evaluator is forced to choose from favorable as well as unfavorable statement

6. ANECDOTAL RECORDING
– Describe experience with a group or a person, or in validating technical skills and
interpersonal relationship
– Anecdotal report should include:
1. Description of the particular occasion
2. Delineation of the behavior noted including:
WHO, WHAT, WHY, WHEN, WHERE AND HOE
3. The evaluator's opinion or assessment of the incident or behavior

QUALITY ASSURANCE
● Assurance → achieving sense of accomplishment and implies a guarantee of excellence
● Quality → the degree of excellence

QUALITY ASSURANCE:
– A process of evaluation that is applied to the health care services b health workers
– Focuses on the care and services the patient receives than on how well the professionals
performs the duties that the position required
PRINCIPLES UPON WHICH QUALITY ASSURANCE PROGRAM ARE BASED
1. All health professionals should collaborate in the effort to measure and improve care
2. Coordination is essential in planning a comprehensive QAP
3. Resource expenditure for QA activities is appropriate
4. There should be focus on critical factors
5. Quality patient care is accurately evaluated through adequate documentation
6. The ability to achieve nursing objectives depends upon the optimal functioning of the entire
nursing process and its effective monitoring
7. Feedback to practitioners is essential to improve practice.
8. Peer pressure provides the impetus to effect prescribed changes based on the result of
assessment and needed improvements on the quality of care
9. Reorganization in the formal organizational structure may be required if assessment reveals
the need for a different pattern of health care
10. Collection and analysis of data should be utilized to motivate remedial action

QUALITY IMPROVEMENT PROGRAM

● The umbrella program that extends the many areas for the purpose of accountability to the
consumer
● A continuous, on-going measurement & evaluation process that includes structure, process
and outcome

TOTAL QUALITY MANAGEMENT (TQM)

● A way to ensure customer satisfaction by involving all employees in the improvement of the
quality of every product or service
● Aims to reduce waste and cost of poor quality
● It is a structured system for involving entire organization in a continuous quality
improvement process targeted to meet and exceed customer expectations

CONTINIOUS QUALITY IMPROVEMENT (CQI)

● A process of continuously improving a system by :
1. gathering data or performance
2. Using Multi-disciplinary team to analyze the system
3. Collect measurements
4. Propose changes

PRINCIPLES OF CONTINOUS QUALITY IMPROVEMENT (CQI)

 1. Customer focus
2. Identification of key processes to improve quality
3. Use of quality tools and statistics
4. Involvement of all people in problem solving

QUALITY ASSURANCE
● Focuses on the care and service the patient receives than on how well the professional
performs the duties that the position requires
METHODS USED
● Patient care audit
● Patient care profile analysis
● Peer review
● Quality circle

NURSING AUDIT COMMITTEE

– Composed of a representative from all levels of the nursing staff
– The audit team designate a day within the week to be the audit day
– The nurses do not know which unit will be audited