ORGANIZING
AILYN BRILLO PINEDA,
RN, MAN
PROFESSOR
“ORGANIZING”
ORGANIZATION
- 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.
“ORGANIZING
Organizing determines
what task are to be
done, who is to do
these, how the task
are to be grouped,
who reports to whom,
and what decisions
are to be made.
ORGANIZING
The process involves:
1. Identification and
definition of basic task.
2. Delegation of authority
and assignment of
responsibility.
3. Establishing
relationship
CATEGORIES OF
ORGANIZATION
1. Formal
Organization
2. Informal
Organization
CATEGORIES OF
ORGANIZATION
1. Formal
Organization
- well defined,
bounded by
delegation and
relatively stable.
CATEGORIES OF
ORGANIZATION
2. Informal Organization
- refers largely to what
people do because they are
human personalities, and to
their actions in terms of
needs, emotions and
attitudes and not in terms of
procedures and regulations.
CHARACTERISTICS OF AN
ORGANIZATION
1) Division of Work
2) Chain of Command
3) Type of Work to be
performed
4) Levels of
Management
ORGANIZATIONAL
DESIGN
Organizational
design is a formal,
guided process for
integrating the
people,
information and
technology of an
organization.
PRINCIPLES OF
ORGANIZATIONAL DESIGN
1. Division of labor
2. Unity of command
3. Authority and
responsibility
4. Span of Control
5. Contingency Factors
ELEMENTS OF ORGANIZING
1. Organizational
Structure
2. Staffing
3. Scheduling
4. Developing job
descriptions
ELEMENTS OF
ORGANIZING
1. ORGANIZATIONAL
STRUCTURE
It is the formal
structure, the official
arrangement of
positions or working
relationships that will
coordinate efforts of
workers of diverse
interest and abilities.
PATTERNS OF ORGANIZATIONAL
STRUCTURE
1) Tall or
Centralized
Structures
2) Flat or
Decentralized
Structures
TALL OR CENTRALIZED
STRUCTURE
Responsible for only
a few subordinates,
so there is a narrow
span of control
Because of the
vertical nature of the
structure, there are
many levels of
communication
TALL OR CENTRALIZED
STRUCTURE
Advantage Disadvantage
It makes use of Transpires that the most
skilled individuals end up
expertise, and
doing nothing while
allows close actual tasks are done by
communication those less capable.
between the Communication from
bottom to top is often
workers. difficult, and messages
Supervisory do not get to the top
individuals screen Workers tend to be very
“boss-oriented “ because
the of the close contact with
communication. their supervisor.
Flat or Decentralized Structures
Refers to an
organizational
structure with few
or no levels of
intervention
between
management and
staff.
TYPES OF ORGANIZATIONAL
STRUCTURE
1) Line Organization/
Bureaucratic/
Pyramidal
2) Flat Organization
3) Staff Organization
4) Functional
Organization
TYPES OF ORGANIZATIONAL
STRUCTURE
1) Line Organization/
Bureaucratic/
Pyramidal
- shows that each
position has general
authority over the
lower position of the
hierarchy.
- ARA and power are
concentrated at the
top.
TYPES OF ORGANIZATIONAL
STRUCTURE
2. Flat Organization
- refers to an
organizational
structure with few
or no levels of
intervention
between
management and
staff.
TYPES OF ORGANIZATIONAL
STRUCTURE
3. Staff Organization
- purely advisory
to the line
structure with no
authority to place
recommendations
into action.
TYPES OF ORGANIZATIONAL
STRUCTURE
4. Functional
Organization
- permits a
specialist to aid
line position
within a limited
and clearly
defined scope
authority.
ORGANIZATIONAL
RELATIONSHIP
1. FORMAL
RELATIONS
2. INFORMAL
RELATIONS
ORGANIZATIONAL
RELATIONSHIP
1. FORMAL
RELATIONS
- represents by
uninterrupted lines
between units,
showing who
reports to whom.
ORGANIZATIONAL
RELATIONSHIP
2. INFORMAL
RELATIONS
- represented
by a broken or
dotted line,
where power
relationships
are
coordinated.
ELEMENTS OF
ORGANIZING
2. Staffing
Needs
STAFFING
The process of
assigning competent
people to fill the roles
designated for the
organizational
structure through
recruitment, selection
and development.
- STAFFING -
FACTORS AFFECTING TIME
REQUIREMENT OF NURSING CARE
• Patient’s acuteness of illness
• Degree of dependence
• Communicability of ailment
Steps in Staffing
• Determine the
Number and Types
of Personnel Needed
• Recruitment
• Interview
• Induct or Orient the
Personnel in
Organization
• Job Offer
Centralized Staffing
Staffing decisions for all units
are made by a central office
or computer.
Tends to be fairer to
employees, because policies
are implemented more
consistently and impartially.
Frees manager to complete
other functions.
Most cost effective, because
it maximizes use of human
resources organization-wide.
Decentralized Staffing
Staffing is done at unit level, frequently
by unit manager.
Allows person who knows the individual
unit the best to make staffing decisions
for that unit.
Allows staff to take requests directly to
their own manager, which gives them
increased autonomy and flexibility.
Increases the risk that employee
requests may be treated unequally or
inconsistently.
Time-consuming for unit manager.
Organizational Staffing
Policies
Need policies that
address:
1. Sick leave
2. Vacations
3. Holidays
4. Call-offs for low
census
5. On-call pay
6. Tardiness and
absenteeism
Examples of Staffing
Standards
Inpatient units: NCH/PPD
Surgery: minutes per case
Emergency departments:
total visits
Labor and delivery:
number of births
Home health agencies:
visits per month
The Relationship between
Staffing and Quality of Care
Staffing mix
Staffing
ratios
Numbers of
staff
PATIENT CLASSIFICATION
SYSTEM
1. “Self care” or
Minimal Care
Patients
2. Intermediate or
Moderate Care
3. Total Care Patients
4. Intensive Care
Patients
PATIENT CLASSIFICATION
SYSTEM
1. “Self care” or
Minimal Care
Patients
- capable of carrying
activities of daily
living (ADL)
PATIENT CLASSIFICATION
SYSTEM
2. Intermediate or
Moderate Care
- requires some help
from the nursing
staff with special
treatments.
PATIENT CLASSIFICATION
SYSTEM
3. Total Care Patients
- those who are
bedridden and who
lack strength and
mobility to do
activities of daily
living.
PATIENT CLASSIFICATION
SYSTEM
4. Intensive Care
Patients
- those who are
critically ill and in
constant danger of
death or serious
injury.
The five primary means of organizing nursing care
for patient care delivery are:
1. Total patient care
2. Functional nursing
3. Team and modular
nursing
4. Primary nursing
5. Case management
Choosing the most appropriate
organizational mode to deliver patient
care for each unit or organization
depends on the skill and expertise of the
staff, the availability of registered
professional nurses, the economic
resources of the organization, the acuity
of the patients, and the complexity of
the tasks to be completed.
Total Patient Care or
Case Method Nursing
Oldest mode of
organizing patient
care.
Nurses assume total
responsibility for
meeting the needs of
all assigned patients
during their time on
duty.
Functional Nursing
Evolved as a result of
World War II.
Uses relatively
unskilled workers who
have been trained to
complete certain
tasks.
Care is assigned by
task rather than by
patient.
Team Nursing
Ancillary personnel
collaborate in providing
care to a group of
patients under the
direction of a
professional nurse.
Requires extensive
team communication
and regular team
planning conferences.
Modular Nursing
Modification of team and
primary nursing.
Like team nursing, but
uses a smaller team.
Pairs professional nurse
with ancillary staff to
deliver care to groups of
patients.
Used frequently during the
1980s and 1990s.
Primary Care Nursing
As originally designed, it
requires an all-RN nursing staff.
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
those patients.
Case Management
Nursing
Collaborative process that assesses, plans,
implements, coordinates, monitors, and
evaluates options and services to meet an
individual’s health needs through
communication and available resources to
promote quality, cost-effective outcomes.
(Powell, 2000)
Coordinates care throughout an episode of
illness.
Focus is on individual clients, not
populations of clients.
Six Core Functions of
Case Management
1. Assessment
2. Planning
3. Linking
4. Monitoring
5. Advocacy
6. Outreach
Goals of Case
Management
Decreased hospital readmission
Decreased length of stay
Adherence to therapeutic regime
Achievement of desired outcomes
Decreased resource use
Improved quality of life
Improved functional status
Increased patient satisfaction
Decreased symptom management
Nursing management
- STAFFING/ SCHEDULING -
STAFFING FORMULA
Requirements:
STANDARD NCH/pt/day
Cases / Patients
VALUE OF NURSING
Prof. to Non-Prof
Ratio
CARE
i. Surgery 3.4 60:40
ii. General Ward 3.5 60:40
iii. Pediatric 4.6 70:30
iv. Pathologic 2.8 55:45
Nursery 3.4 60:40
v. Medical 3.0 60:40
vi. OB 6.0 70:30
[Link]/ER/RR 6.0 80:20
[Link]
Nursing management
- STAFFING -
Distribution Per Shift
SHIFT PERCENTAGE
AM 45 %
PM 37%
NIGHT 18%
CATEGORIES OF PATIENT
Levels of Care NCH Needed /pt./ Prof: Non Prof
day
Level I 1.50 55:45
Self-Care or
Minimal
Care
Level II
Moderate or 3.0 60:40
Intermediate Care
Level III 4.5 65:35
Total or Intensive
Care
Level IV
Highly 6.0 70:30
Specialized 7.0 or higher 80:20
or Critical Care
Nursing management
- STAFFING -
PERCENTAGE OF PATIENTS IN
VARIOUS LEVELS OF CARE
Type of Hospital Minimal Moderate Intensive Highly
Care Care Care Spl. Care
Primary Hospital 70 25 5 -
Secondary
Hospital 65 30 5 -
Tertiary Hospital 30 45 15 10
Special Tertiary 10 25 45 20
Hospital
TOTAL NUMBER OF WORKING AND
NON-WORKING DAYS AND HOURS OF
NURSING PERSONNEL PER YEAR
Right s and Privileges Working Hours per Week
Given each Personnel/Yr 40 hours 48 hours
1. Vacation Leave 15 15
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2
5. Special Privileges 3 3
6. Off Duties as per R.A. 104 52
5901
7. Continuing Education 3 3
Program
Total Non-Working Days/Year 152 100
Total Working Days/Year 213 265
Total Working Hours / Year 1,704 2,120
RA 5901 = 40H WK LAW
Nursing management
- STAFFING-
Steps for Computing the Staff
Needed in the in-patient Unit of
the Hospital
COMPUTATION:
CASE: 250 BED CAPACITY TERTIARY
HOSPITAL. HOW MANY STAFF NURSES
DO WE NEED?
1. Determine type of hospital.
Nursing management
- STAFFING-
2. CATEGORIZE PATIENT ACCDG. TO LEVEL
OF CARE
250 X 30% = 75 minimal care
250 X 45% = 112.5 moderate care
250 X 15% = 37.5 intensive care
250 X 10% = 25 highly specialized
nursing care
Nursing management
- STAFFING -
3. FIND THE NURSING CARE HOURS (NCH)
NEEDED by PATIENT BY DAY AND GET THE
SUM.
75 X 1.5(NCH @ Level I) = 112.5 NCH/day
112.5 X 3(NCH @ Level II) = 337.5 NCH/day
37.5 X 4.5(NCH @ Level III)= 168.75 NCH/day
25 X 6 (NCH @ Level IV)= 150 NCH/day
-------------------
768.75 NCH/DAY
Nursing management
- STAFFING -
4. FIND NCH PER YEAR
768.75 X 365 (DAYS/YEAR) = 280,593.75NCH/YEAR
5. FIND ACTUAL WORKING HOURS
NEEDED BY EACH NURSING
PERSONNEL / YEAR
8 ( hrs/day ) X 213 (WORKING DAY/YEAR)=
1,704 ( working hrs/year )
Nursing management
- STAFFING -
6. FIND THE TOTAL NUMBER OF NURSING PERSONNEL
NEEDED.
a. TOTAL NCH/ YEAR = 280,593.75 = 165
WORKING HRS / YEAR 1,704
b. TOTAL NSG PERSONNEL X RELIEVER
165 X 15%=25
(CONSTANT: 15% FOR 40 HRS/WK & 15
% FOR 48 HRS/WK)
c. RELIEVERS + TOTAL # OF NURSING PERSONNEL
NEEDED
165 + 25 = 190 TOTAL PERSONNEL NEEDED
Nursing management
- STAFFING -
7. DETERMINE PROF FROM NON
PROF PERSONNEL
tertiary hospital
190 X 65% = 124
PROFESSIONAL
190 X 35% = 66 NON
PROFESSIONAL
Nursing management
- STAFFING -
8. DISTRIBUTE PER SHIFT
PRO (124) NONPRO (66)
AM (45%) 56 30
PM (37%) 46 24
NIGHT (18%) 22 12
Nursing management
- STAFFING -
Placement of Staff
proper placement:
a. fosters personal growth
b. provides a motivating climate for the
employee
c. maximizes productivity
d. organizational goals have better
chances of being met
inappropriate placement:
a. frustration
b. poor quality of work
c. reduced organizational efficiency
d. rapid turn-over
e. poor image for the agency
R A 9173 nurses with Master’s degree in Nursing are easily placed in position
ELEMENTS IN
ORGANIZATION
4. SCHEDULING
A schedule is a timetable showing
planned work days and shifts for
nursing personnel.
Factors to Consider in Making a Schedule
1. Different levels of the nursing staff
2. Adequate coverage for 24 hours, 7 days a
week
3. Staggered vacations and holidays
4. Weekends
5. Long stretches of consecutive working
days
6. Evening and night shifts
7. Floating
Nursing management
- SCHEDULING -
Assessing a Scheduling System
1. Ability to cover the needs of
the shift
2. Quality to enhance the nursing
personnel’s knowledge, training
and experience
3. Fairness to the staff.
4. Stability
5. Flexibility
Nursing management
- SCHEDULING -
Types of Scheduling
1. Centralized
Schedule
2. Decentralized
Schedule
Nursing management
- STAFFING -
SCHEDULING VARIABLES
a. Length of scheduling period
whether 2 or 4 weeks
b. Shift rotation
c. Week-ends off
d. Holiday off
e. Vacation leave
f. Special days
g. Scheduled events in the hospital
, training programs, or meetings
h. Job categories
i. Continuing professional
education (CPE) programs
Nursing management
- JOB DESCRIPTION -
4. DEVELOPING JOB
DESCRIPTION
- Job Description is a
statement that sets the
duties, condition and
requirements of a specific
job.
- PERFORMANCE
DESCRIPTION
Nursing management
- JOB DESCRIPTION -
Contents of a Job
Description
1. Identifying Data
2. Job Summary
3. Qualification
Requirements
4. Job Relationships
5. Specific and Actual
Functions and Activities
Nursing management
- JOB DESCRIPTION -
Uses of Job Description
1. For recruitment and selection of
qualified personnel
2. To orient new employees to their jobs
3. For job placement, transfer or dismissal
4. As an aid in evaluating the performance
of an employee
5. For budgetary purposes
6. For determining departmental functions
and relationships to help define the
organizational structure
7. For classifying levels of nursing
functions according to skill levels
required.
8. To identify training needs
9. As basis for staffing
10. To serve as channel of communication.