NLM
WEEK 1:
management- universal process of coordinating and supervising to attain a goal
3-Fold Concepts of the scope of management
economic source- production factor, together with land and capital
system of authority- *management starts with determining actions of ranks
class and status system- based on education and knowledge
roles of manager
interpersonal- symbol, leader, liaison
informational- monitor, disseminate, spokesperson
decisional- entre[reneur/innovator, troubleshooter
theories of management
4 principles of scientific management
traditional rule of thumb- work is replaced with scientific methods, give time for
worker tasks
workers are hired, trained, and promoted based on competence and abilities
employees are entitled to financial reward/incentive for work, humans as money-
motivated economic animals
maintain good relationships between workers and managers, should be cooperative and
interdependent, work shared equally
scientific management- (father)Frederick taylor
how people work
theories do not remain static
system of work improvement
controlled observation of worker performance thru time and motion study
scientific selection of best workers for each job
training selected workers for assigned tasks
paying at differential rate
appointing most skilled to manager and planning and preparing worker tasks
appointing foremen for each work aspect
frank and Lillian Gilbreth(1st lady of management)
emphasized job simplification, work standards, and effects of incetives on work
fatigue
henry gantt
humanitarian management advocate
concerned with efficiency problems
contributed to scientific management by refining previous work over introducsing a
new topic
classical organization theories
henry fayol/father of management process school, studied manager functions,
concluded management is universal
process management-planning, organizing, coordinating, and controlling/PODC
14 principles of management
work division
authority and responsibility
discipline
unity of command
unity of direction
general over individual interest
renumeration of personnel
centralization
scalar chain
order
equity
stability of personnel tenure
initiative
esprit de corps/honor shared by members
management process
planning- determine philosophy, goals, objectives, policies, procedures, and rules
organizing- establish organizational structure to carry plans out
determining most appropriate type of care delivery
staffing- recruiting, interviewing, hiring, and orienting staff
directing- other staffing functions: motivating, delegating, communicating,
facilitating collaboration, and managing conflict
controlling- performance appraisals, fiscal accountability, quality control, legal
& ethical control
max weber- father of organizational management
developed organizational chart
3 types of authority: traditional, charismatic, rational
lyndall urwick
taylor + fayol theory = organizational theory
"span of control and unity of command"
human relation management
mary follet
pioneer of participative decisionmaking/magnagement
managers should have authority over one another
solutions without domineering over employees can be found
elton mayo
productivity of workers given special attention increases
hawthorne effect- productivity change upon knwoing one is being observed
jacob moreno
sociometry- measurements of relationship degree
behavioral science
abraham maslow
humans as wanting organisms that sasitfy needs in sequence
higher levels cannot be reached until lowers are attained
actualization
esteem
love and belonging
safety
physiological
frederick herzberd
2-factor motivational need theory
hygiene factors/dissatisfiers (external)
eg: policies, salary, work condition
motivation factors/satisfiers (internal)
eg: achievement, recognition
douglas mcgregor
managerial attitude can be correlated to employee satisfaction
theory x(authoritarian) and theory y(liberating)
Willian blake
managerial grid in terms of concern for productivity vs people
types of managers:
1.1 impoverished- low productivity and people concern
1.9 country club- high people concern, low productivity concern
5.5 organizational man- balanced
9.1 authority obedient/compliance- high productivity concern, low people concern
9.9 team- high concern for both
contemporary management
levels
top- look at overall operation (ceo, coo)
middle- coordinate different department activitites
1st level- directly responsible for service production
skills
technical- skills
human- attitude
conceptual- knowledge
summer
knowledge- evidence based
attitude- feelings and values
ability- skill, art, judgement, wisdom
leadership
-influencing group to take an action, about creating change and fulfilling mission,
motivate members
nursing leadership
-nurse influences others towards quality nursing care
manager- responsibility, position, obligated to be followed
leader- have power through influence, wider role variety, empower others, doesnt
need to be in high position, goals may not be same with organization
leadership theories
great man theory- leaders are born
trait- leaders are made
charismatic- possess charisma
situational- certain traits give rise to a leader in certain situations
contingency- not one style is for every situation
3 aspects:
leader-membership relationships, ax via group atmosphere scale: higher scores for
positive social traits
task structure:
4 criteria:
goal clarity
extent of knowledge of who is accountable
many goal paths and solutions
solution specificity, number of correct answers
position power
disliked leader- needs diplomacy
ambiguous task- needs cooperation
path goal theory
people act to produce satisfactory results
structured activities are more successful
situational leadership theory
predicts best style from follower maturity vie 4 quadrant model
horizontal- low emphasis on tasks
vertical- low emphasis on relationships
lower left- laissez faire, low task low people
directing style- high task, low people, for low motivation and ability
coaching style- high task and people, for good motivation and low ability
supporting style- low task, high people, for high ability but low motivation
delegating- low task & people, for high ability & motivation
transactional theory
work quality based on reward/punishment
leaders focus on day to day operation
behavioral
evaluate leaders on workplace actions
leaders need certain behaviors
leadership styles
authoritarian
democratic
laissez-faire
contemporary leadership
transformational theory
promotes employee development
attends to needs and motives of members
inspires via optimism
influences change
stimulates intellectually
encourages creativity
power- ability to impose will on others
reward power
coercive power
legitimate power
referent power- based on symbol of leader
expert power
information power
connection power
WEEK 2:
patient classification system/PCS
-predict patient needs, groups according to acuity of illness to estimate needed
staffing pattern
levels:
1-self or minimal care: 1.5hr/day
2-moderate/intermediate care: 3hr/day
3-total/intensive care: 4.5hr/day
4-highly specialized/critical care: 6-7 or higher hrs/day
patient care delivery system
methods
traditional
assignment
delegates work
gains cooperation
produce high quality care
improve environment stability
minimize uncertainty
improve communication skills
know roles/duties in advance
minimize level of workload
principles of personnel assignment
made by head nurse/ in charge for each nurse based on:
patient needs and time needed
ability and experience of staff
job description
planned weekly, revised daily as needed
account for all activities
consider geographical location of unit and assigned duties
balanced workload
characteristics of good assigning
definite
simple
clear
signed
written
posted in advance
process of organizing care
planning: what should be done, when, how, where, by whom, and to whom
assigning
leading
evaluating
reporting: nursing unit report/endorsement
nursing care delivery models
method for care
no single method is ideal
for care evaluation and saving money
factors for selecting model
patient population
org goals
budget
staff availability
unit objectives
traditional care models
total patient care/case method
oldest mode (1930-40)
provided in patient home
nurse cares, cooks, cleans, etc
1 to 1 holistic care, high autonomy and responsibility
good for critical care/post-anesthesia recovery
manager must weigh expenses and if patient needs RN care, or LPN/UAP care
functional nursing/task
from ww2, nurse shortages and rapid hospital construction
staff cares for multiple patients with certain tasks
manager must know care quality given, achieve patient outcomes, and improve staff's
pov on lack of independence, rotate tasks, conduct meeting frequently
fragment of care
very efficient & effective
lack holistic understanding
team nursing
1950s- correct fragmented care
ancillary personnel directed by professional nurse collaborate with care provision
to group of patients
manager has to ensure and improve competency
charge nurse act as liaison for team leaders for referrals
team leaders update ncp, delegate work, supervise, evaluate, and assist
modular nursing
2-3 member approach "care pairs"
need less comms
primary Nursing
1960s- to increase accountability
1 on one, nurse is in charge for entire hospitalization of patient
only RN, but helped by associate nurse
integrated models
practice-partnership by marie manthley 1989
rn and assistant, senior and junior
work in same schedule and group of patients
coordinate care by planning, facilitating, and evaluating interventions across care
levels
can be outside hospital
case management model
by advanced nurse practitioner
manager: involves patient family in treatment options
case manager: follow patient from diagnosis to home care, focus on certain client
groups
critical pathway
gives direction for managing care for specific patient and time
comprehensive pre-printed standard course of treatment with predictable outcomes
critical path/care map- outcomes and strategies made by collaborative practice team
need revision incase of unpredicted outcomes
differentiated practice
sorting of nursing practice roles, function, and work based on education,
experience, and competence
nurse chooses specialization, need master's degree
nursing competencies generally measured in:
technical skills
communication
care management/leadership
WEEK 3: EBP IN NURSING MANAGEMENT
national nursing care competency standards/nnccs
2001 from initiative of professional regulation commission-board of nursing/ PRC-
BON
created national taskforce for core competency standards development
completed in 2005
3 roles of the nurse
beginning nurse's role on client care, management & leadership, and reasearch as
well as 4 types of client
11 core competencies
Safe & quality nursing practice
Management of resources & environment
Health education
Legal responsibility
Ethico – moral responsibility
Personal & professional development
Quality improvement
Research
Record management
Communication
Collaboration & teamwork
10 key phases in NNCCS
1- work setting scenario
2- validation studies of roles and responsibilities/benchmarking
3- integrative output review from strategy validation
4- core competency consensual validation
5- conduct of public hearing
6- promulgation of revised & modified core competency standards
7- printing of revision
8- training in implementation of revisions
9- implementation of revisions
10- evaluation of revision effectiveness
patient care safety standards
- beneficence and non maleficence
key elements
leadership
institutional development: standards, practices, equipment
reporting system- ensure confidentiality in individual cases
feedback and comms
adverse event prevention and risk management
disclosure of reported serious events
professional development
patient centered care and consumer empowerment
patient safety is national priority and core agenda
ways to improve safety
culture of safety
measure safety protocol performance
optimize staff scheduling
improve patient handling
use safer medical equipment
ways to improve patient safety
knowledge and implementation of healcare policies & procedures
open comms and teamwork
reviewing medication rights
engage in creating/updating reporting system
engage in research and EBP activities
stay updated on life-saving certifications: CPR, BLS, ACLS, PALS, NALS, and other
nursing specialty certification programs
engage in hospital committees
be responsible in error and near-miss reporting
ensure better lighing and less clutter in work areas
standards of practice
ax
dx
outcome identification
planning
implementation
evaluation
ethics
education
EBP and research
quality of practice
comms
leadership
collaboration
professional practice evaluation
resource utilization
environmental health (infection precautions)
WEEK 4:
RA 9173: Philippine Nursing Act of 2002
Article I:
S1: Title: Philippine Nursing Act of 2002
Article II:
S2: Declaration of the Policy
Article III:
S3: Organization of the Board of Nursing/BON, 1 chairperson, 6 members
S4: Qualifications of chairperson & members
natural born
Philippine resident
good-standing member of accredited professional nursing organization
RN, master's in Nursing(esp chairperson), Teaching, or medical
conferred by government-recognized college/university
10 continuous years practice, last 5 in the Philippines
no moral offenses
BON representing 3 nursing areas: education, service, and community health
S5: certified BON member must immediately resign from work
S6: Chair and members have 3y term, until successor is appointed, can be re-
appointed
S7: Compensation similar to chair & other professional regulatory boards
S8: Admin supervision of the board, custodian of records, secretariat, & other
support services: Commission/PRC
S9: Powers and Duties of the board: manage nursing practice via:
conduct licensure exam
issue, suspend, or revoke registration certificates for nursing practice
monitor & enforce philippine practice standards
ensure education quality via
*Commission on Education with written BON recommendation has power to open/close
nursing colleges/education programs
conduct hearings & investigate to resolve complaints
promulgate ethical code
recognize nursing specialty organizations
prescribe, adopt issue, & promulgate: guidelines, regulations, measures, and
decisions
S10: Annual Report every end of calendar to Philippine president thru the
Commission
S11: Removal/Suspension of Board Members by President
continued neglect/incompetence
commission/toleration of licensure exam irregularities
unprofessional, immoral, or dishonorable conduct
Article IV: Examination & Registration
S12: Licensure Exam- written
S13: Qualifications for Licensure Exam-
Philippine citizen
Citizen of country permitting Filipino nursing practice w/ similar requirements
good moral, BSN
S14: Exam Scope
BON considers curriculum objectives, borad areas, & other competencies
S15: Ratings
Gen av: 75%
none below 60%
those w/ 75% av, but have one subject below 60% must retake exam, but only in
failed subjects, but need 75% to pass
S16: oath
S17: Registration Certificate /Pro License/Pro ID issued to passer upon payment
S18: Exam and Registry Fees
S19: Registration by Reciprocity
regcert/pro license can be issued w/o exam for nurses under foreign countries
given:
requirements and privileges in said country are similar
S21: Practice thru Special/Temporary Permit
licensed nurses from foreign states if:
well-known specialist/outstanding expert in special branch
on medical mission with free serices in certain hospital/center/clinic
employed by schools/colleges of nursing as exchange professors in branch/specialty
*special/temp permit only valid for project/mission/employment duration
S22: Non-registration & Non-Issuance of regcert/pro license/ special/temp permit
convicted of immoral/dishonorable act
declared by court to be unsound of mind
S23: Revocation & Suspension of regcert/pro license/ special/temp permit
unprofessional/unethical conduct
gross incompetence/serious ignorance
malpractice/negligence
fraud/deceit in obtaining regcert/pro license/ special/temp permit
violation of 9173, Code of Ethics, technical standards, BON and Commission
policies, conditions of temporary/special permit
*regcert/pro license suspension wont exceed 4y
S24: Re-issuance of revoked certificates & Lost certificate replacement
after 4 years from revocation, BON can return license for:
equity & justice reasons
revocation cause is gone/corrected
upon payment
Article V: Nursing Education
S25: Nursing Education program: give sound general & professional foundation for
nursing practice
S26: Inactive nurse returning to practice requirements
1 month didactic training & 3 months practicum for 5y-inactive
S27: Faculty qualifications
RN in philippines
1y specialized practice
good-standing member of accredited nursing organization
master's in nursing, teaching, other medical science
college dean: need all aforementioned, and 5 years nursing experience
Article VI: Practice
S28: scope of nursing
provide care via nursing process
special training needed for suturing perineal tear
establish community resource links 7 coordinate w/ health team
give health education
teach & supervise students in nursing education programs in giving: nursing care in
hospitals & clinics, consultations
undertake: nursing & health human resource development training & research,
including advance nursing practice development
observe ethics code
continual learning submitted & approved by board
*inapplicable for nursing students performing under qualified faculty supervision
S29: Qualification of Nursing Service Admins
one occupying supervisory/managerial positions need:
Rn in Philippines
2y experience in nursing service administration
BSN w/ at least 9units in graduate management & admin courses
good-standing member of accredited nursing organization
chief nurse/director of nursing service also need:
5y experience in supervisory/managerial nursing position
MSN
*military hospital chief nurses w/ MSN and completion of General Staff Course are
priortized
5 years to qualify
Article VII: Health Human Resources Production, Utilization & Development
S30: Studies for Nursing Manpower Needs, Production, Utilization and Development
S31: Comprehensive Nursing Specialty Program
S32: Salary- publlic health institution nurse salary is min. grade 15 in acc with
RA6758: Compensation & Classification Act of 1989 Sec10
S33: Funding for the Comprehensive Nursing Specialty Program
S34: Incentives and Benefits
Article VIII: Penal and Misc Provisions
S35: prohibitions in practice
50-100K fine/1-6y imprisonment for:
any person practicing nursing
in terms of: regcert/pro license/special/temp permit
no cert
uses another
uses invalid
gives false evidence to BON
fakes being licensed nurse
uses name appendages(RN, MSN) without degree
RN abetting/assisting unlicensed
any person/chief executive officer of judicial entity undertaking serivce ed
programs/conducts review classes for local & foreign exams w/o BON and Commission
permit
any person/employer violating minimum pay/benefits
any person/chief executive officer of a judicial entity violating RA9173
Article IX: Final provisions
Other Laws Affecting Nursing Profession & Practice
RA- by congress
RA 6675: Generic drug act of 1988
generic name- identification of drugs w/ scientific & internationally recognized
active ingredient
Brand name- from manufacturer
Essential drug list- prepared by DOH acc to philippine health conditions and
international criteria
RA 9165: Comprehensive Dangerous Drug Act of 2002, repeal RA6425
- prohibits any business practice with prohibited drugs
RA 6425: Dangerous Drug Act
S2- code for doctors who can prescribe narcotics
RA 7877: Anti-Sexual Harrassment Law
RA 7610: Anti-Child Abuse
RA 7658: An Act Prohibiting the Employment of Children below 15y
RA 9262: Anti Violence Against Women & their children
RA 8172: Salt Iodization law
RA 3573: An Act Providing for the prevention and Suppression of Dangerous
Communicable Diseases
RA 7432: Senior Citizen
RA 8423: Established traditional and alternative care
RA 8344: penalize refusal of hospitals & med clinics to give proper initial
treatment for emergencies
RA 7305: Magna Carta of Public Health Workers
prohibit: discrimination, under/overstaffing, undue process
give: normal work hours, OT pay, night shift diff, salary scale, payment in legal
tender, hazard allowance, right to self-organization
RA 8749: Clean air act 1999
RA 6173: Code of Conduct & Ethical Standards for Public Officials & Employees
RA 7160: Local Gov Code
RA 2644: Midwifery Act
RA 2382: Practice of medicine by nurse
RA7600: Rooming in & Breastfeeding act of 2002
RA 7164: Philippine Nursing act of 1991
RA 1080: Civil Service Eligibility for borad & bar passers
RA 2328: Philippine Medical act
RA 1612: Privilege Tax Law: pro tax payment
RA 5181: Permanent Residence and Reciprocity
RA 1082: Rural health units
RA 4073: Liberalizes Leprosy treatment
RA 1054: Free emergency medical treatment for employees & laborers
RA 4226: Hospital Licensure Act
RA 5901: 40 hours/week for nurses in with 100-bed capacity
RA 3573: Reporting of Communicable Diseases
RA 6111: Medicare Act
RA 6758: Salary Standardization Law
RA 7277: Magna Carta of Disabled Persons
RA 7624:Drug Education Law
RA 6972: Day Care Center for every barangay
RA 7170: Organ Donation
RA 0349: Legalized use of human organs for scientific purposes
RA 9505: Cheaper medicines Act
RA 0877: Philippine Nursing Law 1953
RA 8991: PRC modernization Act of 2000
RA 9439: Hospital Detention Law
RA 8187: granting 7 days paternity leave
RA 8171: Prevention & Control of Diabetes Mellitus Act
Public Act 2808- The first True Nursing Law
Presidential decrees/PD
PD 603: Child and Youth Welfare code
highlight nurse roles:
birth registration, child health, freedom of expression, child's right to life,
basic health service
parental rights and duties:
authority, joint, granparents, eldest sibling, nearest next of kin, court-appointed
guardian
PD 651: register births in 30 days
PD 996: compulsory basic immunization for all below 8yrs
PD 856: code of sanitation
PD 825: Garbage disposal act
PD 418: family code- promote responsible parenthood & planning
PD 626: Employee Compensation & State Insurance Fund
PD 807: Civil Service law- recruitment & selection of employees in government
service
PD 44: labor code of the philippines
provide for rights & privileges of private sector employees
cacation/sick leave, nsd-10%, OT pay
rights of women, and to self-organization
PD 223: Professional Regulation Commission/PRC
creation of BON
can recommend nominees for BON
PD 143: Woman and Child Labor Law- no child below 14 shall be employed)
PD 069: Four children for tax exemption
PD 541: Practice of profession in the Philippines by former professionals
PD 048: Four children for maternity privilege
PD 965: Family Planning and Responsible Parenthood
PD 1519: Medicare Benefits for all government employees
PD 1636: Compulsory membership to SSS of self-employed persons
EXECUTIVE ORDER: from executive branch
EO 51: Milk Code
EO 209: Family Code
EO 203: List of Regular Holidays and Special days
EO 180: Guidelines on the right to organize of Government Employees
EO 857: Compulsory Dollar Remittance Law
EO 174: National Drug Policy (availability, affordability or safe, effective,
quality drugs)
Board Resolutions
No. 633 series of 1984: ICN Code of Ethics
No. 1955 s. 1989: PNA Code of Ethics
No. 1930s. 1985: CPE for Nurses
No. 187 s. 1991: Renewal of Professional license
No. 217s. 1992: Delisting of delinquent professionals
Letters of Instructions
LOI 949: Legal Basis of Primary Health Care
LOI 100: Preference given to members of accredited professional organization for
employment and seminars
2016-2022 Health Agenda: All for Health, Towards Health for All
Goals:
financial protection
better health outcomes
responsiveness
equitable & inclusive
transparent & accountable
efficient resource use
high quality service
milestones:
devolution
generics use
milk code
philhealth
DOH resources to promote local health system development
government hospital's fiscal autonomy
good governance programs
UHC funding
Health outcome inequities
2000/y mothers die from pregnancy complications
children born to poorest are 3x more likely to die before 5y compared to richer
families
3 in 10 children are stunted
1.5 million families go into poverty from health expenses yearly
filipinos forego/delay care due to fees
Php 4000/month healthcare expenses considered catastrophic for single income
families
Poor quality seen in public health institutions
long wait times
limited provider choices
unhygienic restrooms, lack amenities
privacy & confidentiality not valued
poor record-keeping
overcrowding & care underprovision
All for Health Towards Health for All
Values: equity, equality, accountability, sustainability, resilience
3 guarantees:
1. all life stages & triple burden of disease
2. service delivered by networks that are:
fully functional
compliant w/ guidelines
24/7 availability, even in disaster
gatekeep
close to the people
telemedicine-enhanced
3. Universal health insurance: philhealth
strategy: ACHIEVER
A- advance quality, health promotion, & primary care
C- cover all filipinos against health-related financial risk
H- harness strategic HRH(human resources for health) development
I- invest in ehealth & data for decision-making
E- enforce standards, accountability, and transparency
V- value all clients, patients, especially the unfortunate
E- elicit multi-sectoral & multi-stakeholder support for health
*omeprazole/buscopan for stomachache, if ineffective: NSAIDs