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NURSING MANAGEMENT PROCESS
PREPARED BY: AILYN B.PINEDA, RN
NURSING MANAGEMENT
Is the process of working through staff members to
be able to provide comprehensive care to the patient This includes planning, organizing, directing and controlling The task of the nurse manager is to plan, organize, direct and control available financial, material, and human resources in order to provide effective, economic care to groups of patients
NURSING MANAGEMENT PROCESS
NURSING MANAGEMENT PROCESS
Purpose of the Nursing Management Process
To achieve scientifically – based, holistic,
individualized care for the patient
To achieve the opportunity to work collaboratively
with patients and others
To achieve continuity of care
Characteristics of the Nursing Management Process
Systematic Dynamic Interpersonal Goal Directed Universally Applicable
PLANNING
MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS
PLANNING
Is deciding in advance what to do, how to do a
particular task, when to do it, and who is to do it.
Is predetermining a course of action in order to
arrive at a desired results. It is the continuous process of assessing, establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known
COMPONENTS OF PLANNING
PLANNING: PREDETERMINED ACTION
WHAT TO DO: -nursing activities
HOW TO DO IT: -technique, principles
WHO IS TO DO IT: -professional, nonprofessional
Nursing management -planning PRINCIPLES OF PLANNING
1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives of the organization. 2. Planning is a continuous process. 3. Planning should be pervasive within the entire organization covering the various departments, services and the various levels of management to provide maximal cooperation and harmony. 4. Planning utilizes all available resources. 5. Planning must be precise in its scope and nature. 6. Planning should be time bounded. 7. Projected plans must be documented for proper dissemination to all concerned for implementation and implementation as to the extent of its achievement.
PLANNING
It leads to success in the achievements of goals and
objectives It provides meaning to work It provides for the effective use of available personnel and facilities It helps nurses cope with crises and problems calmly and efficiently It is cost effective It is based on past and future activities It reduces the element of change It is necessary for effective control
Characteristics of a GOOD PLAN
It should have a clearly worded objectives, including
results and methods for evaluation Be guided by policies and/or procedures affecting the planned action Indicate priorities Develop actions that are flexible and realistic in terms of available personnel, equipment, facilities and time Develop a logical sequence of activities Select the most practical methods for achieving each objective
PLANNING
TYPES OF PLANNING:
1. STRATEGIC OR LONG-RANGE PLANNING “what are the right things to do” - usually extending 3 to 5 years into the future. 2. OPERATIONAL OR SHORT-RANGE PLANNING “how does one do things right” - deals with day to day maintenance activities. 3. CONTINUOUS OR ROLLING PLANS - similar to operating plans, involves mapping out the day-to-day activities.
ELEMENTS OF PLANNING
Forecasting or Estimate the future Set Objectives/Goals and Determine Results Desired Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time Frame Prepare the Budget and Allocation of Resources Establish Policies Procedures and Standards
Elements of Planning -Forecast or Estimate the FutureForecasting is looking into the future Refers to estimation of time series, cross sectional or
longitudinal data In making forecast, the planner should consider 3 things:
Agency Community affected Goals of care
Forecast must be supported by facts, reasonable
estimates and accurate reflection of policies and plans
Elements of Planning
Set Objectives/Goals and Determine Results Desired
GOALS are broad statements of intent derived from
the purposes of the organization
Is a desired aim or condition toward which one is willing to work Individual goals- are personal goals; based on one’s desired in life Group goals- may refer also to organizational goals although on a smaller scale Organizational goals- management goals of an organization that are established to justify its existence
Short term goals and long term goals
Objectives
The objectives of the Nursing Department is congruent to its
vision as well as to the 11 key areas of responsibilities to nursing practice: To observe ethical principles and standards that govern nursing practice. (ethico-moral-legal responsibilities) To establish well coordinated referral system for the continuity of patient’s/ client’s care. (communication) To assure the application of acceptable performance of functions, duties, and responsibilities of every position in the nursing department. (safe & quality nursing care, management of resources) To encourage its nursing personnel to participate in nursing research for improving nursing care. ( research) To utilize media for information campaign to intensify health education program. (health education)
Nursing management - ELEMENTS OF PLANNINGMISSION OR PURPOSE
- The mission statement outlines the agency’s reason for existing ( whether hospital or health care), who the target clients are ( the poor, the needy, the middle or upper class), and what services will be provided ( in-patient, out-patient, emergency). - reason for the existence of the organization (Nursing service exist to promote and maintain health)
Vision
The Board of Nursing under the guidance of
the Almighty, with its unquestionable integrity and commitment, envisions itself to be the ultimate authority in regulating the nursing profession in the Philippines and to lead nursing development to its highest level of excellence.
Mission
The BON shall unwaveringly pursue the advancement
of nursing development in the country by: 1. providing leadership, information, options, scenarios and lobby efforts to targeted decision makers and stakeholders 2. ensuring adherence to professional, ethical and legal standards as mandated by existing regulatory laws 3. unifying the nursing sector through good governance 4. fostering linkages with the domestic and international stakeholders
Nursing management - ELEMENTS OF PLANNINGPHILOSOPHY
- Philosophy is the sense of purpose of the organization and the reason behind its structure and goals. - Philosophy states the beliefs that influence nursing practice and beliefs about health care.
POLICIES
Policies in general, they are guidelines to help in the safe and efficient achievement of organizational objectives
PROCEDURES
Procedures are specific directions form implementing written policies
Nursing management - ELEMENTS OF PLANNING• Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time Frame Strategy is the techniques, methods, or procedure by which the overall plan of the higher management achieve desired objectives. Programs are activities put together to facilitate attainment of some desired goals.
Nursing management PLANNING
Time Management is a technique for allocation of
one’s time through the setting of goals, assigning priorities, identifying and eliminating time wastes and use of managerial techniques to reach goal s efficiently
Nursing management PLANNING
Principles of Time Management 2) Planning for contingencies-planning anticipates the
problem that will arise from actions without thought 3) Listing of task-task to be accomplished should be done in sequence which are prioritized according to importance 4) Inventory 5) Sequencing 6) Setting and keeping deadlines- and adhering to deadline is an excellent exercise in self discipline 7) Deciding on how time will be spent
Nursing management PLANNING
Time Saving Techniques, Devices and Methods to Better Use of Time
3. Conduct an inventory of your activities. 4. Set goals and objectives and write them down. 5. With the use of calendars, executive planners, logs or journals, write what
you expect to accomplish yearly, monthly, weekly or daily. 6. Break down large projects into smaller parts. 7. Devote a few minutes at the beginning of each day for planning. 8. Organize your work space so it is functional. 9. Close your door when you need to concentrate. 10.Learn to delegate. 11. In a meeting, define the purpose clearly before starting. 12. Take or return phone calls during specified time. 13. Develop effective decision-making skills. 14. Take rest breaks and make good use of your spare time.
Nursing management PLANNING
Multitasking
Trying to get more things done in less time Examples: answering phone calls while driving, sending emails while in the meeting
Nursing management PLANNING
DEVELOPING AND SCHEDULING PROGRAMS
Programs are predetermined, developed and targeted within a time frame to reach the set goals and objectives.
The Planning Formula 5. WHAT 6. WHEN 7. WHERE 8. HOW 9. WHO 10.WHY 11.CAN
Nursing management PLANNING
• PREPARING THE BUDGET A budget is the annual operating plan, a financial “road
map” and plan which serves as an estimate for future costs and a plan for utilization of manpower, material and other resources to cover capital projects in the operating programs. A nursing budget is a plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year. A hospital budget is a financial plan to meet future service expectations.
Factors in BUDGET planning
Type of patient, length of stay in the hospital and
acuteness of illness Size of hospital and bed occupancy Physical lay out of the hospital, size and plan of the wards, units, nurse’s station, treatment rooms, etc Personnel policies
Salaries paid to various type of nursing personnel including OT pay or shift differential Extent of VL, SL, holidays Provision for staff development programs
Grouping of patients such as those in specialized
areas
Factors in BUDGET planning
Standards of nursing care: kind and amount of care
to be given as it affects the number of hours of bedside care The method of performing nursing care whether simple or complex; the method of documentation Proportion of nursing care provided by the professional nurses and those given by nonprofessionals Amount and quality of supervision available and provided; the efficiency of job description and job classification
Factors in BUDGET planning
Method of patient assignment whether functional,
case, team or primary Amount and kind of labor-saving devices and equipments Amount of centralized service provided: sterile supply , central o2 supply, linen supply Nursing service requirements of the ancillary departments: clinics, admitting office, ER Reports required by administration whether simple or complex Affiliation of nursing students or medical students
Establishing Nursing Standards, Policies and Procedures
Nursing Standards
Standard- a practice that enjoys general recognition and conformity among professionals or an authoritative statement by which quality of practice or education can be judged Nursing Care Standard – a descriptive statement desired quality against which to evaluate nursing care Purpose of nursing standards
Improved quality of care Decrease the cost of nursing care Determine nursing negligence
Sources of nursing standards
DOH, BON, Professional Organization, Nursing Programs
Establishing Nursing Standards, Policies and Procedures
Nursing Service Policies
Policies in general are guidelines to help in safe and efficient achievement of organizational objectives There are 3 general areas in nursing which requires policy formulation. These are:
Areas in which confusion about the locus of responsibility might result in neglect or malperformance of an act necessary to a patient’s welfare Areas pertaining to the protection of patients’ and families’ rights as right to privacy and right to property Areas involving matters of personnel management and welfare
Establishing Nursing Standards, Policies and Procedures
Nursing procedures
Procedures are specific directions for implementing written policies Procedures are more specific guide to action than policy
ORGANIZING
NURSING MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS
Nursing management - ORGANIZING ORGANIZING is the process of establishing formal
authority Involves setting up the organizational structure through identification of groupings, roles and relationships Determines staff needed through developing and maintaining staffing patterns and distributes them in the various areas as needed Develops job descriptions by defining the qualifications and functions of personnel
Organizing
Organizing is one way which nursing management
coordinates the various activities of a department or a unit so that the staff can get its work done in an orderly fashion Organizing means having qualified people and the right materials, information and equipment needed to deal with contingencies
Nursing management - ORGANIZING PRINCIPLES OF ORGANIZATION: Communication: effective and open communication in all forms; thread that binds the organization together
Directions of communication:
Downward Upward Lateral/Horizontal Grapevine
Unity of Command Span of Control Delegation of authority Similar Assignments Unity of Purpose
ORGANIZATIONAL DESIGN
Organizational design is a
formal, guided process for integrating the people, information and technology of an organization.
PRINCIPLES OF ORGANIZATIONAL DESIGN
1. 2. 3. 4. 5.
Division of labor Unity of command Authority and responsibility Span of Control Contingency Factors
Nursing management - ORGANIZING ELEMENTS OF ORGANIZING 2. Organizational Structure 3. Staffing 4. Scheduling 5. Developing job descriptions
Importance of organizational structure
It enables members what their responsibilities are so
that they may carry them out It frees the manager and the individual workers to concentrate on their respective roles and responsibilities It coordinates all
Nursing management - ORGANIZING ORGANIZATIONAL STRUCTURE
The organizational structure refers to the process by which a group is formed its channel of authority, span of control and lines of communication.
positions or working relationships that will coordinate efforts of workers of diverse interest and abilities
It is the formal structure, the official arrangement of
Patterns of Organizational Structure
Tall or Centralized Structure Flat or Decentralized Structure
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 It makes use of expertise,
Disadvantage
Transpires that the most
and allows close communication between the workers. Supervisory individuals screen the communication.
skilled individuals end up doing nothing while actual tasks are done by those less capable. Communication from bottom to top is often difficult, and messages do not get to the top Workers tend to be very “boss-oriented “ because of the close contact with their supervisor.
Flat or Decentralized Structures
Refers to an organizational
structure with few or no levels of intervention between management and staff.
Flat or Decentralized Structure
Advantages Lower likelihood of Disadvantages Supervisor spend less
messages being distorted Workers develop own abilities and autonomy and able to see the organization as humanistic resulting in greater job satisfaction The principle of “shared governance” produces maximum potential for professional growth
time with each worker Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions
Nursing management - ORGANIZING Types of Organization Classified by Nature of Authority 3) Line Organization- each position has general authority
over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal) 4) Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization) 5) Staff Organization- purely advisory to the line structure with no authority to put recommendations into action. 6) Functional Organization – each unit is responsible for a given part of the organization’s workload.
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.
Nursing management - ORGANIZING • ORGANIZATIONAL CHART
- Organizational chart is a line drawing that shows how the parts of an organization are linked.
Nursing management - ORGANIZING Characteristics of an Organizational Chart 3)Division of Work 4)Chain of Command 5) Type of Work to be performed 6)Grouping of Work Segment 7) Levels of Management
Nursing management - ORGANIZING STAFFING
Staffing is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients’ demand. 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.
NURSING CARE MODALITIES
TOTAL CARE or CASE NURSING One nurse is assigned to one patient for totality of care during his or her time on duty PDN Isolation nurse Nursing student
NURSING CARE MODALITIES FUNCTIONAL Nursing Task-oriented Particular nursing function is assigned to each nurse Time saving Worker learns w/ mastery -Medication nurse -Charge nurse -Nursing attendant
Nursing Care Modalities
PRIMARY Nursing Nurse is responsible for the total care of a small group of clients from admission to discharge
Nursing Care Modalities
TEAM Nursing The team leader assigns patients & tasks according to job descriptions
PATIENT CLASSIFICATION SYSTEM
“Self care” or Minimal Care Patients 2. Intermediate or Moderate Care 3. Total Care Patients 4. Intensive Care Patients
1.
PATIENT CLASSIFICATION SYSTEM
1.
“Self care” or Minimal Care Patients capable of carrying activities of daily living (ADL) Convalescing, no longer require intensive, moderate, or maximum care Require dx studies, Minimal therapy Awaiting elective surgery, Home environment temporarily makes discharge undesirable
PATIENT CLASSIFICATION SYSTEM
2. Intermediate or Moderate Care • requires some help from the nursing staff with special treatments. • Given to moderately ill
• •
Recovering from immediate effects of a serious illness or operation May be ambulatory for short periods (needs assistance)
PATIENT CLASSIFICATION SYSTEM
3. Total Care Patients those who are bedridden and who lack strength and mobility to do average daily living. Needs close attention
Requires nurse to initiate,
supervise, and perform most of the activities Requires frequent medication
PATIENT CLASSIFICATION SYSTEM
4. Intensive Care Patients those who are critically ill and in constant danger of death or serious injury.
Acutely ill patients w/ high level of nurse dependency
Unstable condition w/c
requires frequent evaluation with adjustment of therapy
Nursing management - STAFFING STAFFING FORMULA
Requirements: STANDARD VALUE OF NURSING CARE
Cases / Patients i. Surgery ii. General Ward iii. Pediatric iv. Pathologic Nursery v. Medical vi. OB vii. ICU/ER/RR viii.CCU NCH/pt/day 3.4 3.5 4.6 2.8 3.4 3.0 6.0 6.0 Prof. to Non-Prof Ratio 60:40 60:40 70:30 55:45 60:40 60:40 70:30 80:20
Nursing management - STAFFING Distribution Per Shift
SHIFT AM PM NIGHT
PERCENTAGE 45 % 37% 18%
Nursing management - STAFFING CATEGORIES OF PATIENT
Levels of Care
Level I Self-Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care
NCH Needed /pt./ day 1.50
Prof: Non Prof 55:45
3.0 4.5 6.0 7.0 or higher
60:40 65:35 70:30 80:20
Nursing management - STAFFING PERCENTAGE OF PATIENTS IN VARIOUS
LEVELS OF CARE
Type of Hospital Primary Hospital Secondary Hospital Tertiary Hospital Special Tertiary Hospital Minimal Care 70 65 30 10 Moderate Care 25 30 45 25 Intensive Care 5 5 15 45 Highly Spl. Care 10 20
Nursing management - STAFFING TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND
HOURS OF NURSING PERSONNEL PER YEAR
Right s and Privileges Given each Personnel/Yr 1. 2. 3. 4. 5. 6. 7. Vacation Leave Sick Leave Legal Holidays Special Holidays Special Privileges Off Duties as per R.A. 5901 Continuing Education Program Working Hours per Week 40 hours 48 hours 15 15 10 2 3 104 3 152 213 1,704 15 15 10 2 3 52 3 100 265 2,120
Total Non-Working Days/Year Total Working Days/Year Total Working Hours / Year
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. CATEGORIZE PATIENT ACCDG. TO LEVEL OF CARE
250 X 30% = 250 X 45% = 250 X 15% = 250 X 10% =
75 112.5 3.5 25
minimal care moderate care intensive care highly specialized nursing care
Nursing management - STAFFING 2. FIND THE NURSING CARE HOURS (NCH) NEEDED 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) = 168.75NCH/day 25 X 6 (NCH @ Level IV) = 150 NCH/day ------------------768.75 NCH/DAY
Nursing management - STAFFING 3. FIND NCH PER YEAR
768.75 X 365 (DAYS/YEAR) = 280,593.75 NCH/YEAR
4. 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 5. FIND THE TOTAL NUMBER OF NURSING PERSONNEL
NEEDED. a. TOTAL NCH/ YEAR
= 280,593.75 = 165 WORKING HRS / YEAR 1,704
b. RELIEF x TOTAL NSG PERSONNEL 165 X 15%=25
(CONSTANT: 15% FOR 40 HRS/WK & 10% FOR 48 HRS/WK)
c. RELIEVERS + TOTAL # OF NURSING PERSONNEL NEEDED 165 + 25 = 190 TOTAL PERSONNEL NEEDED
Nursing management - STAFFING 6. DETERMINE PROF FROM NON PROF PERSONNEL e.g. tertiary hospital 190 X 65% = 124 PROFESSIONAL 190 X 35% = 68 NON PROFESSIONAL
Nursing management - STAFFING 7. DISTRIBUTE PER SHIFT
PROFESSIONAL(124) NON PROFESSIONAL(66) AM (45%) 56 30
PM (37%) NIGHT (18%)
46 22
24 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
RA 9173 nurses with Master’s degree in Nursing are easily placed in position
Nursing management - STAFFING SCHEDULING
A schedule is a timetable showing planned work days and shifts for nursing personnel.
Factors to Consider in Making a Schedule 5. Different levels of the nursing staff 6. Adequate coverage for 24 hours, 7 days a week 7. Staggered vacations and holidays 8. Weekends 9. Long stretches of consecutive working days 10.Evening and night shifts 11.Floating
Nursing management - STAFFING Assessing a Scheduling System 3. Ability to cover the needs of the shift 4. Quality to enhance the nursing personnel’s knowledge,
training and experience 5. Fairness to the staff. 6. Stability 7. Flexibility
Nursing management - STAFFING Types of Scheduling 3. Centralized Schedule 4. Decentralized Schedule 5. Cyclical Schedule
Nursing management - STAFFING SCHEDULING VARIABLES b. Length of scheduling period whether 2 or 4 weeks c. Shift rotation d. Week-ends off e. Holiday off f. Vacation leave g. Special days h. Scheduled events in the hospital , training programs, or meetings i. Job categories j. Continuing professional education (CPE) programs
Nursing management - STAFFING DEVELOPING JOB DESCRIPTION
Job Description is a statement that sets the duties and responsibilities of a specific job. Contents of a Job Description 6. Identifying Data 7. Job Summary 8. Qualification Requirements 9. Job Relationships 10.Specific and Actual Functions and Activities
Nursing management - STAFFING Uses of Job Description 2. For recruitment and selection of qualified personnel 3. To orient new employees to their jobs 4. For job placement, transfer or dismissal 5. As an aid in evaluating the performance of an employee 6. For budgetary purposes 7. For determining departmental functions and relationships to help define the organizational structure 8. For classifying levels of nursing functions according to skill levels required. 9. To identify training needs 10.As basis for staffing 11.To serve as channel of communication.
Nursing management - DIRECTING DIRECTING
Plan put into action Activities
Delegation – transferring responsibility Updating policy Utilize the policy updates Supervision Roles in Supervision
• • • • • Guides Direct Facilitates Motivates Teaches
Nursing management - DIRECTING Principles of Delegation 2. Select the right person to whom the job is to be
delegated. 3. Delegate both interesting and uninteresting tasks. 4. Provide subordinates with enough time to learn. 5. Delegate gradually. 6. Delegate in advance. 7. Consult before delegating. 8. Avoid gaps and overlaps.
Nursing management - DIRECTING What Cannot be Delegated 3. Overall responsibility, authority and accountability for
satisfactory completion of all activities in the unit. 4. Authority to sign one’s name is never delegated 5. Evaluating the staff and or taking necessary corrective or disciplinary action. 6. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff especially the new ones. 7. Jobs that are too technical and those that involve trust and confidence.
Nursing management - DIRECTING Four Rights of Delegation
1. task The right task should be within the scope of the person’s practice and consistent with the job description. 2. person The right person should have the appropriate license or certificate, job description. 3. communication The right communication should be clear, concise, complete and correct. 4. feedback The right feedback should ask for input, get the person’s recommended solution to the problem and recognize the persons effort.
Nursing management - DIRECTING • Aspects of Delegation
1. Responsibility – denotes obligation 2. Authority – the power to make final decisions and give commands. 3. Accountability – refers to liability
Nursing management - DIRECTING COMMUNICATION
Communication is the transmission of information, opinions, and intentions between among individuals. Purpose of communication 1. facilitates work 2. increases motivation 3. effects change 4. optimizes patient care 5. increases workers’ satisfaction 6. facilitates coordination
Nursing management - DIRECTING Types of Communication
1. Verbal Communication 2. Written Communication 3. Non-verbal Communication e. Personal appearance f. Intonation of the voice g. Facial expression h. Posture and gait i. Touch
Nursing management - DIRECTING Lines of Communication
UPWARD
to superior
HORIZONTAL
to peers and members of the Health Team
NURSES
OUTWARD
to patient, family and community to workers’ family and friends
DOWNWARD to subordinates
Nursing management - DIRECTING DECISION MAKING
Decision is a course of action that is consciously chosen from available alternatives for the purpose of achieving a desired result.
5 Steps in Decision Making 1. definition of the problem “ why the problem occur” 2. analysis of the problem “getting to the cause of the problem” 3. development of an alternative solution “search for and analysis of alternatives and their possible consequences” 4. selection of the solution weighing of facts and exploring alternative solutions 5. implementation and follow-up
Nursing management - DIRECTING Major Management Functions in Implementing
Decisions 1. Planning which entails consideration and selection of realistic objectives, policies and procedures. 2. Organizing which means helping personnel understand the decision and the procedures necessary for implementing the decision. 3. Staffing or the selection of the right person/s to carry out the decision 4. Controlling the environment and the group to prevent adverse effects.
Nursing management - DIRECTING Art of Decision Making: 2. Not making decision that others should make, to
preserve morale and authority; 3. Not deciding on problems that are not pertinent to matters at hand to prevent waste of time and energy; 4. Not deciding prematurely to prevent prujudice 5. Not making ineffective decisions to avoid losing the respectability of the decision maker.
Nursing management - DIRECTING CONFLICT MANAGEMENT
CONFLICTS – clash, fight, battle or struggle; it may be constructive or destructive Basis of the Conflict 1. Intrapersonal 2. Interpersonal 3. Group 4. Intergroup 5. Organizational
Nursing management - DIRECTING
Sources of the Conflict Cultural differences Different facts Separate pieces of information Different perception of the event Defining the problem differently Divergent views of power and authority Role conflicts Number of organizational levels Degree of association Parties dependent on others Competition for scarce resources Ambiguous jurisdictions Need for consensus Communication barriers Separation in time and space Accumulation of unresolved conflit
Nursing management - DIRECTING Types of Conflict
1. Intrasender - conflict originates in the sender who gives conflicting instructions. 2. Intersender - conflict arises when an individual receives conflicting messages from two or more sources. 3. Interrole - conflict can occur when an individual belongs to more than one group. 4. Person-role - conflict is the result of disparity between internal and external roles.
Nursing management - DIRECTING 5. Interperson - conflict is common among people whose positions require interaction with other persons who fill various roles in the same organization or other organizations. 6. Intragroup - conflict occurs when the group faces a new problem. 7. Intergroup - conflict is common where 2 groups have different goals and can achieve their goals only at the others’ expense. 8. Role Ambiguity - a condition in which individuals do not know what is expected on them. 9. Role Overload - the person is simply unable to accomplish so much within a limited time period.
Nursing management - DIRECTING Conflict Resolution
1. Avoidance - used by groups who do not want to do something that may interfere with their relationship 2. Accommodation - self-sacrifice 3. Collaboration - inspires mutual attention to the problem and utilizes the talents of all parties 4. Compromise - in this method, accommodation and adjustment lead to workable situations rather than to the best solution.
Nursing management - DIRECTING 5. Competition - it is an assertive position that fosters conflict resolution on the part of the subordinate. 6. Smoothing - disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence. 7. Withdrawing - one party is resolved thereby making it possible to resolve the issue. 8. Forcing - yields an immediate end to the conflict but leaves the cause of the conflict unresolved.
Nursing management - DIRECTING Rules on Mediating a Conflict Between Two or More
Parties: 1. Establish clear guidelines and make them known to all. 2. Do not postpone indefinitely. 3. Create an environment that makes people comfortable to make suggestions. 4. Keep two-way communication. 5. Stress a peaceful resolution rather than confrontation. 6. Emphasize shared interests. 7. Follow-up on the progress of the plan.
Nursing management - DIRECTING • Staff Development
Staff development is geared ultimately to organizational development.
• Orientation
Orientation is a planned and guided activities of an employee in the organization, the work environment , and in his job.
Nursing management - CONTROLLING CONTROLLING
Controlling or evaluating is an on-going function of management which occurs during planning, organizing, and directing activities. The controlling process opens opportunities for improvement and comparing performance against set standard.
Nursing management - CONTROLLING Reasons For Conducting Evaluation 2. Evaluation ensures that quality nursing care is provided. 3. It allows for the setting of sensible objectives and ensures
compliance with them. 4. It provides standards for establishing comparisons. 5. It promotes visibility and a means for employees to monitor their own performance. 6. It highlights problems related to quality care and determines the areas that require priority attention. 7. It provides an indication of the costs of poor quality. 8. It justifies the use resources. 9. It provides feedback for improvement.
Nursing management - CONTROLLING Principles of Evaluation. 2. The evaluation must be based on the behavioral standards of performance 3. 4. 5.
6. 7. 8.
which the position requires. The evaluation should have enough time to observe employee’s behavior. The employee should be given a copy of the job description, performance standards, and evaluation conference. The employee’s performance appraisal should include both satisfactory and unsatisfactory results with specific behavioral instances to exemplify these evaluative comments. Areas needing improvement must be prioritized to help the worker upgrade his/her performance. The evaluation conference should be scheduled and conducted at a convenient time for the rater and the employee. The evaluation report and conference should be structured in such a way that is perceived and accepted positively as a means of improving job description.
Nursing management - CONTROLLING Characteristics of an Evaluation Tool 2. Should be objective 3. Should be reliable 4. Should be sensitive
Nursing management - CONTROLLING PERFORMANCE APPRAISAL
Performance appraisal is a control process in which employee’s performance is evaluated against standards.
Purposes of Performance Appraisal 5. Determine salary standards and merit increases. 6. Select qualified individuals for promotion or transfer. 7. Identify unsatisfactory employees for demotion or
termination 8. Make inventories of talents within the institution. 9. Determine training and development needs of employee.
Nursing management - CONTROLLING 6. Improve the performance of work groups by examining, improving, correcting interrelationship between members 7. Improve communication between supervisors and employees and reach an understanding on the objectives of the job 8. Establish standards of supervisory performance. 9. Discover the aspirations of employees and reconcile these with the goals of the institution 10. Provide employee recognition 11. Inform employees where they stand.
Nursing management - CONTROLLING Methods of Measuring Performance 2. Essay 3. Checklist 4. Ranking 5. Rating Scales 6. Forced-choice Comparison 7. Anecdotal Recording
Nursing management - CONTROLLING -
PREPARED BY: AILYN B.PINEDA, RN
NURSING MANAGEMENT
Is the process of working through staff members to
be able to provide comprehensive care to the patient This includes planning, organizing, directing and controlling The task of the nurse manager is to plan, organize, direct and control available financial, material, and human resources in order to provide effective, economic care to groups of patients
NURSING MANAGEMENT PROCESS
NURSING MANAGEMENT PROCESS
Purpose of the Nursing Management Process
To achieve scientifically – based, holistic,
individualized care for the patient
To achieve the opportunity to work collaboratively
with patients and others
To achieve continuity of care
Characteristics of the Nursing Management Process
Systematic Dynamic Interpersonal Goal Directed Universally Applicable
PLANNING
MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS
PLANNING
Is deciding in advance what to do, how to do a
particular task, when to do it, and who is to do it.
Is predetermining a course of action in order to
arrive at a desired results. It is the continuous process of assessing, establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known
COMPONENTS OF PLANNING
PLANNING: PREDETERMINED ACTION
WHAT TO DO: -nursing activities
HOW TO DO IT: -technique, principles
WHO IS TO DO IT: -professional, nonprofessional
Nursing management -planning PRINCIPLES OF PLANNING
1. Planning is always based and focused on the vision, mission, philosophy, and clearly defined objectives of the organization. 2. Planning is a continuous process. 3. Planning should be pervasive within the entire organization covering the various departments, services and the various levels of management to provide maximal cooperation and harmony. 4. Planning utilizes all available resources. 5. Planning must be precise in its scope and nature. 6. Planning should be time bounded. 7. Projected plans must be documented for proper dissemination to all concerned for implementation and implementation as to the extent of its achievement.
PLANNING
It leads to success in the achievements of goals and
objectives It provides meaning to work It provides for the effective use of available personnel and facilities It helps nurses cope with crises and problems calmly and efficiently It is cost effective It is based on past and future activities It reduces the element of change It is necessary for effective control
Characteristics of a GOOD PLAN
It should have a clearly worded objectives, including
results and methods for evaluation Be guided by policies and/or procedures affecting the planned action Indicate priorities Develop actions that are flexible and realistic in terms of available personnel, equipment, facilities and time Develop a logical sequence of activities Select the most practical methods for achieving each objective
PLANNING
TYPES OF PLANNING:
1. STRATEGIC OR LONG-RANGE PLANNING “what are the right things to do” - usually extending 3 to 5 years into the future. 2. OPERATIONAL OR SHORT-RANGE PLANNING “how does one do things right” - deals with day to day maintenance activities. 3. CONTINUOUS OR ROLLING PLANS - similar to operating plans, involves mapping out the day-to-day activities.
ELEMENTS OF PLANNING
Forecasting or Estimate the future Set Objectives/Goals and Determine Results Desired Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time Frame Prepare the Budget and Allocation of Resources Establish Policies Procedures and Standards
Elements of Planning -Forecast or Estimate the FutureForecasting is looking into the future Refers to estimation of time series, cross sectional or
longitudinal data In making forecast, the planner should consider 3 things:
Agency Community affected Goals of care
Forecast must be supported by facts, reasonable
estimates and accurate reflection of policies and plans
Elements of Planning
Set Objectives/Goals and Determine Results Desired
GOALS are broad statements of intent derived from
the purposes of the organization
Is a desired aim or condition toward which one is willing to work Individual goals- are personal goals; based on one’s desired in life Group goals- may refer also to organizational goals although on a smaller scale Organizational goals- management goals of an organization that are established to justify its existence
Short term goals and long term goals
Objectives
The objectives of the Nursing Department is congruent to its
vision as well as to the 11 key areas of responsibilities to nursing practice: To observe ethical principles and standards that govern nursing practice. (ethico-moral-legal responsibilities) To establish well coordinated referral system for the continuity of patient’s/ client’s care. (communication) To assure the application of acceptable performance of functions, duties, and responsibilities of every position in the nursing department. (safe & quality nursing care, management of resources) To encourage its nursing personnel to participate in nursing research for improving nursing care. ( research) To utilize media for information campaign to intensify health education program. (health education)
Nursing management - ELEMENTS OF PLANNINGMISSION OR PURPOSE
- The mission statement outlines the agency’s reason for existing ( whether hospital or health care), who the target clients are ( the poor, the needy, the middle or upper class), and what services will be provided ( in-patient, out-patient, emergency). - reason for the existence of the organization (Nursing service exist to promote and maintain health)
Vision
The Board of Nursing under the guidance of
the Almighty, with its unquestionable integrity and commitment, envisions itself to be the ultimate authority in regulating the nursing profession in the Philippines and to lead nursing development to its highest level of excellence.
Mission
The BON shall unwaveringly pursue the advancement
of nursing development in the country by: 1. providing leadership, information, options, scenarios and lobby efforts to targeted decision makers and stakeholders 2. ensuring adherence to professional, ethical and legal standards as mandated by existing regulatory laws 3. unifying the nursing sector through good governance 4. fostering linkages with the domestic and international stakeholders
Nursing management - ELEMENTS OF PLANNINGPHILOSOPHY
- Philosophy is the sense of purpose of the organization and the reason behind its structure and goals. - Philosophy states the beliefs that influence nursing practice and beliefs about health care.
POLICIES
Policies in general, they are guidelines to help in the safe and efficient achievement of organizational objectives
PROCEDURES
Procedures are specific directions form implementing written policies
Nursing management - ELEMENTS OF PLANNING• Develop and Schedule Strategies,
Programs/Projects/Activities; Set the Time Frame Strategy is the techniques, methods, or procedure by which the overall plan of the higher management achieve desired objectives. Programs are activities put together to facilitate attainment of some desired goals.
Nursing management PLANNING
Time Management is a technique for allocation of
one’s time through the setting of goals, assigning priorities, identifying and eliminating time wastes and use of managerial techniques to reach goal s efficiently
Nursing management PLANNING
Principles of Time Management 2) Planning for contingencies-planning anticipates the
problem that will arise from actions without thought 3) Listing of task-task to be accomplished should be done in sequence which are prioritized according to importance 4) Inventory 5) Sequencing 6) Setting and keeping deadlines- and adhering to deadline is an excellent exercise in self discipline 7) Deciding on how time will be spent
Nursing management PLANNING
Time Saving Techniques, Devices and Methods to Better Use of Time
3. Conduct an inventory of your activities. 4. Set goals and objectives and write them down. 5. With the use of calendars, executive planners, logs or journals, write what
you expect to accomplish yearly, monthly, weekly or daily. 6. Break down large projects into smaller parts. 7. Devote a few minutes at the beginning of each day for planning. 8. Organize your work space so it is functional. 9. Close your door when you need to concentrate. 10.Learn to delegate. 11. In a meeting, define the purpose clearly before starting. 12. Take or return phone calls during specified time. 13. Develop effective decision-making skills. 14. Take rest breaks and make good use of your spare time.
Nursing management PLANNING
Multitasking
Trying to get more things done in less time Examples: answering phone calls while driving, sending emails while in the meeting
Nursing management PLANNING
DEVELOPING AND SCHEDULING PROGRAMS
Programs are predetermined, developed and targeted within a time frame to reach the set goals and objectives.
The Planning Formula 5. WHAT 6. WHEN 7. WHERE 8. HOW 9. WHO 10.WHY 11.CAN
Nursing management PLANNING
• PREPARING THE BUDGET A budget is the annual operating plan, a financial “road
map” and plan which serves as an estimate for future costs and a plan for utilization of manpower, material and other resources to cover capital projects in the operating programs. A nursing budget is a plan for allocation of resources based on preconceived needs for a proposed series of programs to deliver patient care during one fiscal year. A hospital budget is a financial plan to meet future service expectations.
Factors in BUDGET planning
Type of patient, length of stay in the hospital and
acuteness of illness Size of hospital and bed occupancy Physical lay out of the hospital, size and plan of the wards, units, nurse’s station, treatment rooms, etc Personnel policies
Salaries paid to various type of nursing personnel including OT pay or shift differential Extent of VL, SL, holidays Provision for staff development programs
Grouping of patients such as those in specialized
areas
Factors in BUDGET planning
Standards of nursing care: kind and amount of care
to be given as it affects the number of hours of bedside care The method of performing nursing care whether simple or complex; the method of documentation Proportion of nursing care provided by the professional nurses and those given by nonprofessionals Amount and quality of supervision available and provided; the efficiency of job description and job classification
Factors in BUDGET planning
Method of patient assignment whether functional,
case, team or primary Amount and kind of labor-saving devices and equipments Amount of centralized service provided: sterile supply , central o2 supply, linen supply Nursing service requirements of the ancillary departments: clinics, admitting office, ER Reports required by administration whether simple or complex Affiliation of nursing students or medical students
Establishing Nursing Standards, Policies and Procedures
Nursing Standards
Standard- a practice that enjoys general recognition and conformity among professionals or an authoritative statement by which quality of practice or education can be judged Nursing Care Standard – a descriptive statement desired quality against which to evaluate nursing care Purpose of nursing standards
Improved quality of care Decrease the cost of nursing care Determine nursing negligence
Sources of nursing standards
DOH, BON, Professional Organization, Nursing Programs
Establishing Nursing Standards, Policies and Procedures
Nursing Service Policies
Policies in general are guidelines to help in safe and efficient achievement of organizational objectives There are 3 general areas in nursing which requires policy formulation. These are:
Areas in which confusion about the locus of responsibility might result in neglect or malperformance of an act necessary to a patient’s welfare Areas pertaining to the protection of patients’ and families’ rights as right to privacy and right to property Areas involving matters of personnel management and welfare
Establishing Nursing Standards, Policies and Procedures
Nursing procedures
Procedures are specific directions for implementing written policies Procedures are more specific guide to action than policy
ORGANIZING
NURSING MANAGEMENT FUNCTION NURSING MANAGEMENT PROCESS
Nursing management - ORGANIZING ORGANIZING is the process of establishing formal
authority Involves setting up the organizational structure through identification of groupings, roles and relationships Determines staff needed through developing and maintaining staffing patterns and distributes them in the various areas as needed Develops job descriptions by defining the qualifications and functions of personnel
Organizing
Organizing is one way which nursing management
coordinates the various activities of a department or a unit so that the staff can get its work done in an orderly fashion Organizing means having qualified people and the right materials, information and equipment needed to deal with contingencies
Nursing management - ORGANIZING PRINCIPLES OF ORGANIZATION: Communication: effective and open communication in all forms; thread that binds the organization together
Directions of communication:
Downward Upward Lateral/Horizontal Grapevine
Unity of Command Span of Control Delegation of authority Similar Assignments Unity of Purpose
ORGANIZATIONAL DESIGN
Organizational design is a
formal, guided process for integrating the people, information and technology of an organization.
PRINCIPLES OF ORGANIZATIONAL DESIGN
1. 2. 3. 4. 5.
Division of labor Unity of command Authority and responsibility Span of Control Contingency Factors
Nursing management - ORGANIZING ELEMENTS OF ORGANIZING 2. Organizational Structure 3. Staffing 4. Scheduling 5. Developing job descriptions
Importance of organizational structure
It enables members what their responsibilities are so
that they may carry them out It frees the manager and the individual workers to concentrate on their respective roles and responsibilities It coordinates all
Nursing management - ORGANIZING ORGANIZATIONAL STRUCTURE
The organizational structure refers to the process by which a group is formed its channel of authority, span of control and lines of communication.
positions or working relationships that will coordinate efforts of workers of diverse interest and abilities
It is the formal structure, the official arrangement of
Patterns of Organizational Structure
Tall or Centralized Structure Flat or Decentralized Structure
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 It makes use of expertise,
Disadvantage
Transpires that the most
and allows close communication between the workers. Supervisory individuals screen the communication.
skilled individuals end up doing nothing while actual tasks are done by those less capable. Communication from bottom to top is often difficult, and messages do not get to the top Workers tend to be very “boss-oriented “ because of the close contact with their supervisor.
Flat or Decentralized Structures
Refers to an organizational
structure with few or no levels of intervention between management and staff.
Flat or Decentralized Structure
Advantages Lower likelihood of Disadvantages Supervisor spend less
messages being distorted Workers develop own abilities and autonomy and able to see the organization as humanistic resulting in greater job satisfaction The principle of “shared governance” produces maximum potential for professional growth
time with each worker Supervisors may lack expertise in the variety of operations and may end up making inappropriate decisions
Nursing management - ORGANIZING Types of Organization Classified by Nature of Authority 3) Line Organization- each position has general authority
over the lower positions in the hierarchy. (also known as Bureaucratic/Pyramidal) 4) Informal Organization- refers to horizontal relationship rather than vertical.(Flat or horizontal organization) 5) Staff Organization- purely advisory to the line structure with no authority to put recommendations into action. 6) Functional Organization – each unit is responsible for a given part of the organization’s workload.
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.
Nursing management - ORGANIZING • ORGANIZATIONAL CHART
- Organizational chart is a line drawing that shows how the parts of an organization are linked.
Nursing management - ORGANIZING Characteristics of an Organizational Chart 3)Division of Work 4)Chain of Command 5) Type of Work to be performed 6)Grouping of Work Segment 7) Levels of Management
Nursing management - ORGANIZING STAFFING
Staffing is the process of determining and providing the acceptable number and mix of nursing personnel to produce a desired level of care to meet the patients’ demand. 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.
NURSING CARE MODALITIES
TOTAL CARE or CASE NURSING One nurse is assigned to one patient for totality of care during his or her time on duty PDN Isolation nurse Nursing student
NURSING CARE MODALITIES FUNCTIONAL Nursing Task-oriented Particular nursing function is assigned to each nurse Time saving Worker learns w/ mastery -Medication nurse -Charge nurse -Nursing attendant
Nursing Care Modalities
PRIMARY Nursing Nurse is responsible for the total care of a small group of clients from admission to discharge
Nursing Care Modalities
TEAM Nursing The team leader assigns patients & tasks according to job descriptions
PATIENT CLASSIFICATION SYSTEM
“Self care” or Minimal Care Patients 2. Intermediate or Moderate Care 3. Total Care Patients 4. Intensive Care Patients
1.
PATIENT CLASSIFICATION SYSTEM
1.
“Self care” or Minimal Care Patients capable of carrying activities of daily living (ADL) Convalescing, no longer require intensive, moderate, or maximum care Require dx studies, Minimal therapy Awaiting elective surgery, Home environment temporarily makes discharge undesirable
PATIENT CLASSIFICATION SYSTEM
2. Intermediate or Moderate Care • requires some help from the nursing staff with special treatments. • Given to moderately ill
• •
Recovering from immediate effects of a serious illness or operation May be ambulatory for short periods (needs assistance)
PATIENT CLASSIFICATION SYSTEM
3. Total Care Patients those who are bedridden and who lack strength and mobility to do average daily living. Needs close attention
Requires nurse to initiate,
supervise, and perform most of the activities Requires frequent medication
PATIENT CLASSIFICATION SYSTEM
4. Intensive Care Patients those who are critically ill and in constant danger of death or serious injury.
Acutely ill patients w/ high level of nurse dependency
Unstable condition w/c
requires frequent evaluation with adjustment of therapy
Nursing management - STAFFING STAFFING FORMULA
Requirements: STANDARD VALUE OF NURSING CARE
Cases / Patients i. Surgery ii. General Ward iii. Pediatric iv. Pathologic Nursery v. Medical vi. OB vii. ICU/ER/RR viii.CCU NCH/pt/day 3.4 3.5 4.6 2.8 3.4 3.0 6.0 6.0 Prof. to Non-Prof Ratio 60:40 60:40 70:30 55:45 60:40 60:40 70:30 80:20
Nursing management - STAFFING Distribution Per Shift
SHIFT AM PM NIGHT
PERCENTAGE 45 % 37% 18%
Nursing management - STAFFING CATEGORIES OF PATIENT
Levels of Care
Level I Self-Care or Minimal Care Level II Moderate or Intermediate Care Level III Total or Intensive Care Level IV Highly Specialized or Critical Care
NCH Needed /pt./ day 1.50
Prof: Non Prof 55:45
3.0 4.5 6.0 7.0 or higher
60:40 65:35 70:30 80:20
Nursing management - STAFFING PERCENTAGE OF PATIENTS IN VARIOUS
LEVELS OF CARE
Type of Hospital Primary Hospital Secondary Hospital Tertiary Hospital Special Tertiary Hospital Minimal Care 70 65 30 10 Moderate Care 25 30 45 25 Intensive Care 5 5 15 45 Highly Spl. Care 10 20
Nursing management - STAFFING TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND
HOURS OF NURSING PERSONNEL PER YEAR
Right s and Privileges Given each Personnel/Yr 1. 2. 3. 4. 5. 6. 7. Vacation Leave Sick Leave Legal Holidays Special Holidays Special Privileges Off Duties as per R.A. 5901 Continuing Education Program Working Hours per Week 40 hours 48 hours 15 15 10 2 3 104 3 152 213 1,704 15 15 10 2 3 52 3 100 265 2,120
Total Non-Working Days/Year Total Working Days/Year Total Working Hours / Year
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. CATEGORIZE PATIENT ACCDG. TO LEVEL OF CARE
250 X 30% = 250 X 45% = 250 X 15% = 250 X 10% =
75 112.5 3.5 25
minimal care moderate care intensive care highly specialized nursing care
Nursing management - STAFFING 2. FIND THE NURSING CARE HOURS (NCH) NEEDED 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) = 168.75NCH/day 25 X 6 (NCH @ Level IV) = 150 NCH/day ------------------768.75 NCH/DAY
Nursing management - STAFFING 3. FIND NCH PER YEAR
768.75 X 365 (DAYS/YEAR) = 280,593.75 NCH/YEAR
4. 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 5. FIND THE TOTAL NUMBER OF NURSING PERSONNEL
NEEDED. a. TOTAL NCH/ YEAR
= 280,593.75 = 165 WORKING HRS / YEAR 1,704
b. RELIEF x TOTAL NSG PERSONNEL 165 X 15%=25
(CONSTANT: 15% FOR 40 HRS/WK & 10% FOR 48 HRS/WK)
c. RELIEVERS + TOTAL # OF NURSING PERSONNEL NEEDED 165 + 25 = 190 TOTAL PERSONNEL NEEDED
Nursing management - STAFFING 6. DETERMINE PROF FROM NON PROF PERSONNEL e.g. tertiary hospital 190 X 65% = 124 PROFESSIONAL 190 X 35% = 68 NON PROFESSIONAL
Nursing management - STAFFING 7. DISTRIBUTE PER SHIFT
PROFESSIONAL(124) NON PROFESSIONAL(66) AM (45%) 56 30
PM (37%) NIGHT (18%)
46 22
24 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
RA 9173 nurses with Master’s degree in Nursing are easily placed in position
Nursing management - STAFFING SCHEDULING
A schedule is a timetable showing planned work days and shifts for nursing personnel.
Factors to Consider in Making a Schedule 5. Different levels of the nursing staff 6. Adequate coverage for 24 hours, 7 days a week 7. Staggered vacations and holidays 8. Weekends 9. Long stretches of consecutive working days 10.Evening and night shifts 11.Floating
Nursing management - STAFFING Assessing a Scheduling System 3. Ability to cover the needs of the shift 4. Quality to enhance the nursing personnel’s knowledge,
training and experience 5. Fairness to the staff. 6. Stability 7. Flexibility
Nursing management - STAFFING Types of Scheduling 3. Centralized Schedule 4. Decentralized Schedule 5. Cyclical Schedule
Nursing management - STAFFING SCHEDULING VARIABLES b. Length of scheduling period whether 2 or 4 weeks c. Shift rotation d. Week-ends off e. Holiday off f. Vacation leave g. Special days h. Scheduled events in the hospital , training programs, or meetings i. Job categories j. Continuing professional education (CPE) programs
Nursing management - STAFFING DEVELOPING JOB DESCRIPTION
Job Description is a statement that sets the duties and responsibilities of a specific job. Contents of a Job Description 6. Identifying Data 7. Job Summary 8. Qualification Requirements 9. Job Relationships 10.Specific and Actual Functions and Activities
Nursing management - STAFFING Uses of Job Description 2. For recruitment and selection of qualified personnel 3. To orient new employees to their jobs 4. For job placement, transfer or dismissal 5. As an aid in evaluating the performance of an employee 6. For budgetary purposes 7. For determining departmental functions and relationships to help define the organizational structure 8. For classifying levels of nursing functions according to skill levels required. 9. To identify training needs 10.As basis for staffing 11.To serve as channel of communication.
Nursing management - DIRECTING DIRECTING
Plan put into action Activities
Delegation – transferring responsibility Updating policy Utilize the policy updates Supervision Roles in Supervision
• • • • • Guides Direct Facilitates Motivates Teaches
Nursing management - DIRECTING Principles of Delegation 2. Select the right person to whom the job is to be
delegated. 3. Delegate both interesting and uninteresting tasks. 4. Provide subordinates with enough time to learn. 5. Delegate gradually. 6. Delegate in advance. 7. Consult before delegating. 8. Avoid gaps and overlaps.
Nursing management - DIRECTING What Cannot be Delegated 3. Overall responsibility, authority and accountability for
satisfactory completion of all activities in the unit. 4. Authority to sign one’s name is never delegated 5. Evaluating the staff and or taking necessary corrective or disciplinary action. 6. Responsibility for maintaining morale or the opportunity to say a few words of encouragement to the staff especially the new ones. 7. Jobs that are too technical and those that involve trust and confidence.
Nursing management - DIRECTING Four Rights of Delegation
1. task The right task should be within the scope of the person’s practice and consistent with the job description. 2. person The right person should have the appropriate license or certificate, job description. 3. communication The right communication should be clear, concise, complete and correct. 4. feedback The right feedback should ask for input, get the person’s recommended solution to the problem and recognize the persons effort.
Nursing management - DIRECTING • Aspects of Delegation
1. Responsibility – denotes obligation 2. Authority – the power to make final decisions and give commands. 3. Accountability – refers to liability
Nursing management - DIRECTING COMMUNICATION
Communication is the transmission of information, opinions, and intentions between among individuals. Purpose of communication 1. facilitates work 2. increases motivation 3. effects change 4. optimizes patient care 5. increases workers’ satisfaction 6. facilitates coordination
Nursing management - DIRECTING Types of Communication
1. Verbal Communication 2. Written Communication 3. Non-verbal Communication e. Personal appearance f. Intonation of the voice g. Facial expression h. Posture and gait i. Touch
Nursing management - DIRECTING Lines of Communication
UPWARD
to superior
HORIZONTAL
to peers and members of the Health Team
NURSES
OUTWARD
to patient, family and community to workers’ family and friends
DOWNWARD to subordinates
Nursing management - DIRECTING DECISION MAKING
Decision is a course of action that is consciously chosen from available alternatives for the purpose of achieving a desired result.
5 Steps in Decision Making 1. definition of the problem “ why the problem occur” 2. analysis of the problem “getting to the cause of the problem” 3. development of an alternative solution “search for and analysis of alternatives and their possible consequences” 4. selection of the solution weighing of facts and exploring alternative solutions 5. implementation and follow-up
Nursing management - DIRECTING Major Management Functions in Implementing
Decisions 1. Planning which entails consideration and selection of realistic objectives, policies and procedures. 2. Organizing which means helping personnel understand the decision and the procedures necessary for implementing the decision. 3. Staffing or the selection of the right person/s to carry out the decision 4. Controlling the environment and the group to prevent adverse effects.
Nursing management - DIRECTING Art of Decision Making: 2. Not making decision that others should make, to
preserve morale and authority; 3. Not deciding on problems that are not pertinent to matters at hand to prevent waste of time and energy; 4. Not deciding prematurely to prevent prujudice 5. Not making ineffective decisions to avoid losing the respectability of the decision maker.
Nursing management - DIRECTING CONFLICT MANAGEMENT
CONFLICTS – clash, fight, battle or struggle; it may be constructive or destructive Basis of the Conflict 1. Intrapersonal 2. Interpersonal 3. Group 4. Intergroup 5. Organizational
Nursing management - DIRECTING
Sources of the Conflict Cultural differences Different facts Separate pieces of information Different perception of the event Defining the problem differently Divergent views of power and authority Role conflicts Number of organizational levels Degree of association Parties dependent on others Competition for scarce resources Ambiguous jurisdictions Need for consensus Communication barriers Separation in time and space Accumulation of unresolved conflit
Nursing management - DIRECTING Types of Conflict
1. Intrasender - conflict originates in the sender who gives conflicting instructions. 2. Intersender - conflict arises when an individual receives conflicting messages from two or more sources. 3. Interrole - conflict can occur when an individual belongs to more than one group. 4. Person-role - conflict is the result of disparity between internal and external roles.
Nursing management - DIRECTING 5. Interperson - conflict is common among people whose positions require interaction with other persons who fill various roles in the same organization or other organizations. 6. Intragroup - conflict occurs when the group faces a new problem. 7. Intergroup - conflict is common where 2 groups have different goals and can achieve their goals only at the others’ expense. 8. Role Ambiguity - a condition in which individuals do not know what is expected on them. 9. Role Overload - the person is simply unable to accomplish so much within a limited time period.
Nursing management - DIRECTING Conflict Resolution
1. Avoidance - used by groups who do not want to do something that may interfere with their relationship 2. Accommodation - self-sacrifice 3. Collaboration - inspires mutual attention to the problem and utilizes the talents of all parties 4. Compromise - in this method, accommodation and adjustment lead to workable situations rather than to the best solution.
Nursing management - DIRECTING 5. Competition - it is an assertive position that fosters conflict resolution on the part of the subordinate. 6. Smoothing - disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence. 7. Withdrawing - one party is resolved thereby making it possible to resolve the issue. 8. Forcing - yields an immediate end to the conflict but leaves the cause of the conflict unresolved.
Nursing management - DIRECTING Rules on Mediating a Conflict Between Two or More
Parties: 1. Establish clear guidelines and make them known to all. 2. Do not postpone indefinitely. 3. Create an environment that makes people comfortable to make suggestions. 4. Keep two-way communication. 5. Stress a peaceful resolution rather than confrontation. 6. Emphasize shared interests. 7. Follow-up on the progress of the plan.
Nursing management - DIRECTING • Staff Development
Staff development is geared ultimately to organizational development.
• Orientation
Orientation is a planned and guided activities of an employee in the organization, the work environment , and in his job.
Nursing management - CONTROLLING CONTROLLING
Controlling or evaluating is an on-going function of management which occurs during planning, organizing, and directing activities. The controlling process opens opportunities for improvement and comparing performance against set standard.
Nursing management - CONTROLLING Reasons For Conducting Evaluation 2. Evaluation ensures that quality nursing care is provided. 3. It allows for the setting of sensible objectives and ensures
compliance with them. 4. It provides standards for establishing comparisons. 5. It promotes visibility and a means for employees to monitor their own performance. 6. It highlights problems related to quality care and determines the areas that require priority attention. 7. It provides an indication of the costs of poor quality. 8. It justifies the use resources. 9. It provides feedback for improvement.
Nursing management - CONTROLLING Principles of Evaluation. 2. The evaluation must be based on the behavioral standards of performance 3. 4. 5.
6. 7. 8.
which the position requires. The evaluation should have enough time to observe employee’s behavior. The employee should be given a copy of the job description, performance standards, and evaluation conference. The employee’s performance appraisal should include both satisfactory and unsatisfactory results with specific behavioral instances to exemplify these evaluative comments. Areas needing improvement must be prioritized to help the worker upgrade his/her performance. The evaluation conference should be scheduled and conducted at a convenient time for the rater and the employee. The evaluation report and conference should be structured in such a way that is perceived and accepted positively as a means of improving job description.
Nursing management - CONTROLLING Characteristics of an Evaluation Tool 2. Should be objective 3. Should be reliable 4. Should be sensitive
Nursing management - CONTROLLING PERFORMANCE APPRAISAL
Performance appraisal is a control process in which employee’s performance is evaluated against standards.
Purposes of Performance Appraisal 5. Determine salary standards and merit increases. 6. Select qualified individuals for promotion or transfer. 7. Identify unsatisfactory employees for demotion or
termination 8. Make inventories of talents within the institution. 9. Determine training and development needs of employee.
Nursing management - CONTROLLING 6. Improve the performance of work groups by examining, improving, correcting interrelationship between members 7. Improve communication between supervisors and employees and reach an understanding on the objectives of the job 8. Establish standards of supervisory performance. 9. Discover the aspirations of employees and reconcile these with the goals of the institution 10. Provide employee recognition 11. Inform employees where they stand.
Nursing management - CONTROLLING Methods of Measuring Performance 2. Essay 3. Checklist 4. Ranking 5. Rating Scales 6. Forced-choice Comparison 7. Anecdotal Recording
Nursing management - CONTROLLING -
