4ENVIRON-MENTAL FACTORS Leadershipis the conception of a goal and a method of achieving it; the mobilization of the means necessary for attainment; and the adjustment of values and environmental factorsGOALMETHODMEANSVALUESENVIRON-MENTAL FACTORSPhilosophyVisionMissionObjectivesManagement FunctionsPlanningOrganizingDirectingControllingResourcesMoneyToolsEquipmentsCharacter ofthe Leader &the FollowersOrganization- its purpose- structure- its valuesNature of thetasks to beperformedSocialEconomicPoliticalTo achieve this conception the Leader has to utilize* Leadership Style * Managerial Skills * Managerial Roles* Motivation * Planned Change * Conflict Management
5MANAGEMENT the art of getting things done through people to forecast and plan, to organize, command, coordinate and to control.
6MAN – still an element of management … the efficient, effective use of organizational resources through peopleMAN – still an element of managementAGE – old and young should be togetherMENT (AL) – do not stop learning
7Management:ProcessProfessionScienceArtClass of People
8Management Theories: Early Scientific Management (Taylor, )PRINCIPLES:Scientific personnel system-hired, trained and promoted based on their technical competence and abilities.Workers view how they “fit” into the org. to contribute org. productivity.Relationship bet. Managers (“functional foremen”-plan, prepare, supervise) and workers (to do work)-cooperative/interdependent-work shared equally.PRODUCTIVITY AND PROFITS ROSE DRAMATICALLY
9Bureaucracy (Weber, 1922)Organizational theory CHARACTERISTICS: (Danna, 2006)“legal-rational” authority to issue commandsFormality,low autonomy,a climate of rules,division of labor,specialization,standardized procedures,written specifications,memoranda and minutes,centralization,controls andemphasis on a high level of efficiency and production.
10Systematic MANAGEMENT (FAYOL, 1925) POCCC (command, coordination, control)GULICK (1937)-EXPANDED –POSDCORB (mnemonic)Simplified Nursing Process Management Process FunctionsAssessing PlanningPlanning Planning/Staffing/OrganizingImplementing Organizing/DirectingEvaluation Controlling
11Scenario:A nurse –manager spent part of the day working on the budget (planning) , meet with the staff about changing the patient care management delivery system from primary care to team nursing (Organizing), altered the staffing policy to include 12- hour shifts (staffing), held a meeting to resolve a conflict between nurses and physicians (directing), and gave an employee a job performance evaluation (controlling).Not only would the nurse-manager be performing all phases of the management process, but each function has a planning, implementing, and controlling phase.
13Human Relations/Participative Management (Follett, 1930-1970) Participative decision making /humanistic management-emphasizing integration of people (“human element) into a work situation rather than machines.HAWTHORNE EFFECT (MAYO, 1953)Conducted experimental study on relationship of social factors to productivity:It was found out that physical factors were decidedly not the sole determinants of productivityResults revealed that that interaction among workers and participation in informal social groups had a great impact on individual behavior and productivity.
14Theory X and Theory Y (McGregor,1960) (managerial attitudes about employees can be directly correlated with employee satisfaction)Theory X Manager- believes their employees are basically lazy, need constant supervision and direction, indifferent to organizational needs.Theory Y Manager – believes their employees enjoy their work, are self motivated, willing to work hard to meet personal and organizational goals.
15Theory Z (Ouchi, 1981) –motivate people Characteristics:Collective decision making,Long term employmentSlower but more predictable promotionsIndirect supervisionholistic concern for the workers.Soft “S” (staff, skills, Style)Hard “S” (superordinate goals, strategy, structure, sysyems)
16TQM (Total Quality Management,1986) Premises that the individual is the focal element on which production and service depend (customer-responsive environment) and that the quest for quality is an ongoing process.Identifying and doing the right things, the right way, the first time, problem- preventing planning-not inspection and reactive problem solving-lead quality outcomes.Never-ending process, everything & everyone in the organization are subject to continuous improvement efforts.No matter how good the service is, problems-approached in a preventive/proactive mode –crisis mngt. Unnecessary.Customer needs and experiences with the product are constantly evaluated.
17Empowerment of employees by providing positive feedback and reinforcing attitudes and behaviors that support quality and productivity.Quality is placed before profit, well implemented TQM program attracts more customers, increased profit margins and financially healthier organization.
18TQM Principles (Deming, 1986) Create a constancy of purpose for the improvement of products and service.Adopt a philosophy of continual learning.Focus on improving processes, not on inspection of productEnd the practice of rewarding business on price alone; instead, minimize total cost by working with a single supplier.Improve constantly every process for planning, production, and service.Institute job training and retraining.Develop the leadership in the organizationDrive out fear by encouraging employees to participate actively in the processFoster interdepartmental cooperation and break down barriers between departments.Eliminate slogans, exhortations, and targets for the workforceFocus on quality and not just quantity; eliminate quota systems if they are in placePromote teamwork rather than individual accomplishments. Eliminate the annual rating or merit systemEducate/train employees to maximize personal developmentChange all employees with carrying out the TQM package.
19PRINCIPLES OF MANAGEMENT(Robbins, 1994) DIVISION OF WORK- specialization makes employees-more efficient-more/better outputs.AUTHORITY- managers give orders, goes with responsibility.DISCIPLINE - good discipline-clear understanding between management and workers about organization’s rules, and judicious use of penalties for infractions of the rules.UNITY OF COMMAND – each employee should receive orders only from one superior.UNITY OF DIRECTION – for each group of organizational activities having the same objective, direction comes from one manager using one plan.SUBORDINATION OF INDIVIDUAL INTEREST TO THE GENERAL INTEREST- employee or group of employees’ interest should not precede over the interests of the whole organization.RENUMERATION –employee must be paid a fair wage for their services rendered.
20CENTRALIZATION – degree subordinates involvement in decision making CENTRALIZATION – degree subordinates involvement in decision making. Centralized (Management), or decentralized (subordinates).SCALAR CHAIN- the line of authority from top management to the lowest ranks in the organization .ORDER- people and materials are in the right place at the right time.EQUITY & Justice- fair and just treatment; no favoritism.STABILITY OF TENURE-orderly personnel planning to ensures that replacements are available to fill vacancies.INITIATIVE – whenever employees are allowed to originate and carry out plans, they are expected to exert high levels of efforts.ESPRIT DE CORPS- promotion of team spirit builds harmony and unity within the organization.Motivation of personnel – allowed to work in problem solving/decision making(Tan & Beltran, 2009).
2110 BASIC MANAGERIAL ROLES (MINTZBERG, 1975) Leadership RolesFigurehead –performance of ceremonial dutiesLeader-direct involvement to approve decisions and choose managerial teamLiaison- dealing with outside peopleInformational RolesMonitor- receipt and sending of information for control purposes.Dissemination- sharing of information, collected as monitor, with subordinate.Spokesman-speaks for his department
22Decisional RolesEntrepreneurial – involvement with constant addition or deletion of new projectsDisturbance handler- attention to problems arising out.Resource allocator- of an argument to negotiation of a labor allocation of budgets, time, and informationNegotiator- ranges from negotiating contract.
23LEVELS OF SKILLS MANAGEMENT IN NURSING CONCEPTUAL – individual’s mental ability to coordinate a variety of interests and activities. Thinks critically and able to conceptualize how things could be. VISIONARYINTERPERSONAL – individuals’ preferred ways of using language, the degrees to which they listens, and their ways on responding to others.TECHNICAL- tools, procedures, and techniques that are unique to the nurse manager’s specialized situation. Master of the job-viewed as a source of help. AN EXPERT.
24A nurse manager performs these management functions to deliver health care to patients. Nurse managers or administrators work at all levels to put into practice the concepts, principles and theories of nursing management. They manage the organizational environment to provide a climate optimal to provision of nursing care by the clinical nurses.
25Nursing administration the application of the art and science of management to the discipline of nursing.
26Nursing managementthe process by which nurse managers practice their profession.also the group of nurse managers who manage the nursing organization.
28All types of health-care organizations, including nursing homes, hospitals, home health-care agencies, ambulatory care centers, student infirmaries, and many others, need nursing management.Even the nurse working with one client and family needs management knowledge and skills to help people work together to accomplish a common goal.A primary nurse working with several clients prioritizes their care to assist time to improve health or, sometimes, peaceful death.
29Nursing Management Functions: IN nursing, management relates to performing the four basic functions (Processes): orPlanning – provides the framework forperformanceOrganizing – in order to establish orderand systematically achieve the goalsDirecting – focuses on leading the staff in themost effective manner possibleControlling – evaluates performance againstestablished standards
30P O D S C P O D S C P O D S C Universality of Management TopManagementPODSCMiddle ManagementPODSCFirst-Line ManagementAmount of Emphasis on Management FunctionP - PlanningS - StaffingO - OrganizingC - ControllingD - Directing
31P L A N N I N Gpre-determining a course of action in order to arrive at a desired result.the continuous process of assessing, establishing goals and objectives and implementing and evaluating them, which is subject to change as new facts are known.While planning is largely conceptual, its results are clearly visible.
32is a thinking or conceptual act that is frequently committed to writing – if plan is not written down, they probably won’t be implemented.is primary to all other activities or functions of managementis an important management function that helps reduce the risks of decision makingproblem solving, and effecting planned change.
33nursing managers who learns to PLAN will aim for maximum utilization of all resources – money, supplies, equipment, and personnel.
34Principles of Planning: Always based and focused on the VMP, and clearly defined objectives of the organization.Continuous process to be more effective.Pervasive within the entire organization (departments, services, level of management) to provide maximal cooperation and harmony.Utilizes available resourcesPrecise in its scope and nature, realistic and focused on expected outcome.Time –bound (short/long range plan)Projected plans-documented for proper dissemination to all concerned for implementation and evaluation as to the extent of its achievement.
35CHARACTERISTICS of PLANNING (Levey and Loomba,1984) Purposeful - analysis of both external/internal factors, objective processProcess Oriented – continuousHierarchical in nature-all members contribute to the process in their own waysFuture directed- forecasts of economic, needs and demands of patients, direction of political forcesMulti-dimensional- key dimensions: time (short range/<1 yr, medium range/<5yrs, long range/>5yrs), organizational(departmental), functional area, orientation (internal/external), scope (strategic, tactical, implementation plan)
36Importance of Planning : It leads to the achievement of goals & objectivesgives meaning to workprovides for effective use of available resources & facilitieshelps in coping with crisesis cost-effectiveis based on the past & future activitiesdiscovers the need for changenecessary for effective controlorients people to action, instead of reactionincreases the chances of success by focusing on results, not on activitiesincreases employee involvement & improves communication
37Scope of PlanningTop Management ( Nursing Directors, Chief Nurses, Directors of Nursing &their assistants)- Set the over-all goals and policies of the organization.- Scope of responsibility is the over-all management of the organization.Middle Management ( Nursing Supervisors)-Direct the activities that actually implement the broad operating policiessuch as staffing and delivery of services to the units headed by the Senioror head Nurses.- Formulation of policies, rules and regulations, methods and procedures forpersonnel for intermediate level planning for ongoing activities andprojects are done in coordination with top management and those in thelower level.Lower or first level management (Head Nurses or Senior Nurses (including Charge Nurses or team leaders)- do the daily schedules, or weekly plans for the administration of directpatient care in their respective units
39Proportions of Management skills needed at ConceptualHumanTech-nicalTopManagementConceptualHumanTechnicalMiddle ManagementCon-ceptualHumanTechnicalFirst-Line ManagementProportions of Management skills needed atDifferent levels of management
40Concerned with broad-based, long-range decisions that affect the entire organization; therefore, conceptual skill is most important at that levelTopManagementFocuses basically on her or his group,Therefore, the need for conceptual skill isat a minimumFirst-Line ManagementThe need to be able to understand andwork with people is important at all levels,but the first-line manager’s position placesa premium on human skill requirementsbecause of the great number of employeeinteractions requiredHuman Skill
414 -Types of Planner:Reactive-planning occurs after a problem exists, done in response to a crisis, lead to hasty decisions and mistakes.Inactivist- consider status quo, spend a great deal of energy preventing change and maintaining conformityPreactive-utilize technology to accelerate change, future orientedProactice/interactive-consider the past, present, and future, and attempt to plan the future of their organization rather than react to it, dynamic and adaptive to the environment
42Types of Planning: SWOT Analysis Tactical/short-term Strategic/long range-forecasts the future success of an org. by matching and aligning all its capabilities with its external opportunities (Marquis & Huston,2006).SWOT Analysis(a tool frequently used to conduct environmental assessments. STRENGTHS,WEAKNESSES,OPPORTUNITIES, THREATS)Tactical/short-termWhere is the org going? How it is going to get there?
44Elements of Planning: Forecasting - estimates the future, including the environment inwhich the plan will operate.- It includes who the patients are – their customs,beliefs, language/dialect barriers, publicattitude and behavior, the acuity of theirconditions/illnesses, the kind of care they willreceive; the number and kind of personnel(professional and non-professional); and theresources-equipment, facilities, supplies needed
45Nursing Standards, Policies and Procedures 1. Nursing Standards – this can supply professionally desirable normsagainst which the department’s performance can be measured.Areas for improvement are identified, and a plan of action to correctthis be made and implemented.2. Nursing Service Policies – are broad guidelines for the managerialdecisions that are necessary in organizational and departmentalplanning.- they govern the action of workers and supervisors at all levels andare intended to achieve pre-determined goals.- they serve as basis for future actions and decisions, help coordinateplans, control performance, and increase consistency of action byincreasing the probability that different managers will make similardecisions when independently facing similar situations.
46Three General Areas in Nursing that requires POLICY formulation areas in which confusion about the locus of responsibility might result in neglect or mal performance of an act necessary to a patient’s welfare,areas pertaining to the protection of patients and families’ rights e.g right to privacy, property rights,areas involving personnel management and welfare
47Characteristics of Good Policies 1. written and understandable and known by those who will be affected by them.2. comprehensive in scope, stable, flexible so they can be applied to different conditions that are not so diverse that they require different set of policies.3. consistent to prevent uncertainty, feelings of bias, preferential treatment and fairness.4. realistic and prescribe limits5. should allow for discretion and interpretation by those responsible for it.Example of Nursing Service Policies1. Admissions – Receiving, consent, notifying doctor, care of patients2. Doctor’s Orders – written, verbal, telephone3. Reporting On or Off-Duty – Information given in leaving unit
481) related to job situations such as 3. Nursing Proceduresare specific directions for implementing written policies.Two areas where procedures are needed:1) related to job situations such asreporting complaints or disciplinaryinstances,2) involves patient care
49C. Development & Scheduling Program- programs are determined, developed and targeted within a time frame to reach the goals and objectives set.D. Preparing the Budgetis a plan for allocation of resources based om preconceived needs for a proposed series of programs to deliver patient care.
50Components of Budget Cash Budget – estimating the amount of money received form patients and allocating itto cash disbursement required to meetobligations promptly as they come.Operating Budget – salaries, supplies, drugs &pharmaceuticals, etc…Capital Expenditure Budget – consists of accumulateddata for fixed assets that are expected to be acquiredduring the budgeted period
51Time Management – is a technique for Time and Planning:Time Management – is a technique forallocation of one’s time through thesetting of goals, assigning priorities,identifying and eliminating time wastesand use of managerialtechniques to reach goals efficiently.
52Barriers to Planning: No specified goals and objectives. Not flexible planNo communication, coordination and involvement of people.Not SMARTEROverplan and underplanNo final evaluation at the end of the plan
53THE URGENT VS. THE IMPORTANT URGENT BUTUNIMPORTANTBTHE 80/20 LEADERURGENT & IMPORTANTCTHE CRISIS LEADERNON-URGENT &ATHE SHUFFLERNON-URGENTBUT IMPORTANTDTHE PLANNERURGENT - NON-URGENTUNIMPORTANT --- IMPORTANT
54Hospital A: “ Our mission is to ensure the highest CRITICAL THINKING- Examine these two mission statements and then respond to the questions that follow.Hospital A: “ Our mission is to ensure the highest
55ORGANIZINGthe grouping of activities for the purpose of achieving objectives.it shows the part each person will play in the general social pattern as well as the responsibilities, relationships and standards of performance.
56Theories:Classical (1890s) –components (organizational structure, specialization of labor, chain of command, span of control); flat organizational structure.Neoclassical (Humanistic,1930s) –employees are given satisfactory working conditions and opportunities to socialize with other employees .IMPROVE JOB SATISFACTION/MORE MOTIVATEDSystems Theory – org. viewed as a whole mix of intertwined elements: input (employees, pts materials, money, equipment), throughputs (work), output (product )Chaos Theory - change is inevitable, employees must learn to adapt and excel to remain employable.Contingency Theory- org. structure match the working of the environment, flexible, varies based on the needs of the org. and the leader.
57Organizational Characteristics Organization at WorkPeople/JobCultureGoalsSupervision/Structure
58Organizing Principles 1. Unity of Command – responsible to only one superior.2. Scalar principle – authority & responsibility should flow in clear unbroken lines from the highest to the lowest executive.3. Homogenous Assignment or Departmentation - workers performingsimilar assignment are grouped together for a common purpose.4.Span of Control- the # of workers that a supervisor can effectively manage should be limited depending upon the pace & pattern of the working area5. Exception Principle -recurring decisions should be handled in a routine manner by a lower-level manager. Unusual matters/problem should be referred to higher levels.6. Decentralization or Proper Delegation of Authority
59Organizational Structure process or way a group is formed, its channels of authority, span of control and lines of communicationmechanism through which work is arranged & distributed among the members of the organization so that the goals can be logically achieved.Organizational Chart – a line drawing that shows how theparts of an organization are linked.
60It establishes the following: Organizational Chart- outlines the formal working relationships and the way people interact within the given structure. Displays the decision making authority w/in the org., illustrating who has the power to make and enforce decisions for the org.It establishes the following:Formal lines of authority - the official power to act.Responsibility – the duty or assignmentAccountability – the moral responsibility
61Characteristics of Organizational Chart Division of Work – each box represents an individual or sub-unit responsible for a given task of the organization’s workload.2. Chain of Command – lines indicate who reports to whom & by what authority.Type of work to be Performed - indicated labels or descriptions for the boxes.4.Grouping of work segment- shown by the clusters of workgroups5.The level of Management, which indicate individual & entire management hierarchy, regardless of where an individual appears on the chart.
62Figure:Organizational Chart of Nursing Division With Assistant Chief Nurses for Nursing Training and Research and for Clinical Areas
64Figure: An Organizational Structure Showing the Relationship of the Nursing Service / Division with the College of Nursing
65Institutional Workers Medical CenterChiefChief NurseDean of AffiliatingCollegesAss. Chief NurseClinicalCoordinatorsSupervising NursesSupervising Nurse InsClinicalInstructorsSenior NursesNurse InstructorsStaff NursesTraineesNsg. & MidwiferyAffiliatesMidwivesNursing AttendantsInstitutional Workers
66Types of Organizational Structure 1. Hierarchical / line organization- oldest and simplest formassociated with the principle of chain of command, bureaucracy, vertical control and coordination, levels differentiated by function & authority & downward communications- has authority for direct supervision of employees2. Staff organization-assists the line in accomplishing the primary objectives of the unit- provides advice and counsel- includes clerical, personnel, budgeting & finance, staff development, research & specialized clinical consulting
673. Free –Form/ Matrix - super imposes a horizontal program over the traditional vertical hierarchy. personnel from functional depts. are assigned to a specific program or project & become responsible to 2 bosses – a program manager & the functional dept. head. - actually an interdisciplinary team of core & extended members - e.g. “task force”, “ad hoc committee” - the expert is the authority that leads the team 4. Flat/horizontal - few or no levels of intervention between management and staff
68Difference between flat and pyramidal structure. CATEGORYFLATPYRAMIDALNo. of LevelsFewerMoreSpan of ControlBroadNarrowDelegationGreaterLesserAuthorityDecentralizedCentralizedControl over SubordinatesTypeModernTraditional
69Patient Classification System (PCS) method of grouping patients according to the amount and complexity of their nursing care requirements, of nursing time & skill they require.serves in determining the amount of nursing care required, generally within 24 hours, as well as the category of nursing personnel who should provide that care.
70Purposes for classifying patients: For/ to 1. staffing. Perceived patient needs can be matched with available nursing resources 2. program costing & formulation of the nursing budget 3. tracking changes in patient care needs 4. determine values for the productivity equation: output divided by input. 5. determine quality
71Orem’s Self-Care Theory Self Care Capabilities DeficitNursing SystemsIntenseWorkforthePatientIntenseWorkfortheNurseNURSEPATIENTPartiallyCompensatoryEducative /SupportiveWhollyCompensatory71
72Types of Patient Classification Systems: Descriptive – narrative descriptive ofvarious degrees of care required by aparticular patientA.1 Checklist – lists down patientproblems according to patient acuity.A1.1. Self-careA.1.2 Minimal careA.1.3 Moderate CareA.1.4 Extensive care A.1.5 Intensive care
73A.2 Time-based – lists patient needs according to level of acuity and ascribe the amount of nurse-time needed to meet the needs A.2.1 Minimal A.2.2 Partial A.2.3 Acute A.2.4 Complex The number of categories in a patient classification may range from 3 to 4, which is the most popular, to 5 or 6. These classes relate to the acuity of illness and care requirements, such as minimal, moderate, or intensive care.
74Other factors affecting the classification system would relate to the patient’s capability to meet his physical needs to ambulate, bathe, feed himself, instructional needs including emotional support.Patient care classifications have been developed primarily for medical, surgical, pediatrics, and obstetrical patients in acute care facilities.
75Classification Categories Level I – Self Care or Minimal Care– Patient can bathe, feed and perform ADL.Level II – Moderate Care or Intermediate Care– Patient needs some assistance in ADL,ambulating up and about for short periodsof time,Level III – Total, Complete or Intensive Care– Patients are completely dependent uponthe nursing personnel.
76Level IV – Highly Specialized Critical Care - - Patients maximum nursing care, they needcontinuous treatment, observation, manymedications, IV piggy backs, vital signs q 15-30 mins. hourly output;- significant changes in doctor’s orders morethan care hours / patient /day may rangefrom 6-9 or more.
77Ratio of Prof. to Non-Prof Levels of CareNCH NeededPer Patient/ DayRatio of Prof. to Non-ProfLevel ISelf Care orMinimal CareLevel IIModerate orIntermediate CareLevel IIITotal or Intensive CareLevel IVHighly Specializedor Critical Care1.534.567 or higher55:4560:4065:3570:3080:20
78Percentage of Nursing Care Hours The percentage of nursing care hours at each level of care also depends on the setting in which the care is being given.
79Percentage of Patients in Various Levels of Care Types of HospitalMinimalCareModerateIntensiveHighlySpecialize CarePrimary HospitalSecondary HospitalTertiary HospitalSpecial TertiaryHospital706530102545515-20
80The Forty-Hour Week Law, Republic Act 5901, provides that employees working in 100bed capacity and up will work only 40 hoursa week.This also applies to employees working inagencies with at least one million population.Employees working in agencies located incommunities with less than one million popu-lation,will work 48 hours/week and thereforewill get only one off-duty a week
812. Staffing the acceptable # & mix of personnel to – the process of determining & providingthe acceptable # & mix of personnel toproduce a desired level of care to meetpatient’s demand for care.
82Types of StaffingCentralized– done by the nursing directorwho develops a master plan fornursing personnel; an impersonalapproach
832.Decentralized – the managers of individual nursing units have more control over the budget, resources, and process.3. Mixed or Preference Scheduling – Flexible can be combined with self scheduling.
84Methods of Staffing Pattern Conventional – centralized- decentralized combination; oldest and most common2. Cyclical – staffing pattern repeats itself every 4 – 6 wks or wks, etc.2.a 40 hrs/4 days – 40 hrs a wk isworked in 4 days, followed by ablock of off duty time2.b Seven days off, 7 on – a 10 hr day isworked for 7 days, followed by 7 daysoff
85Criteria for staffing patterns depends on: 1 Criteria for staffing patterns depends on: 1. Existing organizational structure & Standards 2. Availability of job descriptions or performance responsibilities which spell out precise job content, including duties, activities to be performed, responsibilities & results expected from the various roles by the organization.
86Staffing Study Scheduling Plan Budgeting Plan Position Control Plan NursingManagementInformation SystemMasterStaffingPlanningSchedulingPlanBudgetingPlanPositionControl PlanComponents of the Staffing ProcessSOURCE: Reprinted from Topics in Health Care Financing. Vol. 6, No. 4, p. 15
87work days and shift for nursing personnel 3. Scheduling– a timetable showing plannedwork days and shift for nursingpersonnel
88Types of Scheduling: Centralized – Chief Nurse or designate do assigns the personnel to the hospital units Decentralized – Chief Nurse or designate assigns personnel but supervising Nurse/ Head or Senior arranged the shift and off duties Cyclical – Covers designated number of wks. (cycle length) - it assigns required number of nursing personnel to each nursing unit consistent with the unit’s patient care requirements, the staff preference, then, education, training and experience.
89The following scheduling variables should be considered: a The following scheduling variables should be considered: a. Length of scheduling period whether 2 or 4 weeks b. Shift rotation c. Week-ends off d. Holiday offs e. Vacation leaves f. Special days ( birthdays, wedding anniversaries, etc.) g. Scheduled events in the hospital training programs, meetings, etc. h. Job categories i. Continuing Professional Education (CPE) programs
90Advantages of Cyclical Schedule 1. It is fair to all 2 Advantages of Cyclical Schedule 1. It is fair to all 2. It saves time as the schedule does not have to be redone every week or two 3. It enables the employees to plan ahead for their personal needs preventing frequent changes in the schedule. 4. Scheduled leave coverage such as vacation, holidays and sick leaves are more stable 5. Productivity is improved
91Factors Considered in Making Schedules a. the different levels of the nursing staff - adequate mix of nurses and nursing attendants should be observed so that they only assume duties they are legally responsible for, according to their positions, education, training and experiences. b. adequate coverage for 24 hours, seven days a week c. staggered vacations and holidays - not everybody can enjoy the holiday off on exactly the same day that these occur; schedules for holidays are staggered at least once a month - Vacations (whether forced or requested) are likewise staggered to ensure adequate coverage at all times.
92d. weekends – Weekends are scheduled in such a way that everyone gets a fair share of at least one week-end off a month.Saturdays and Sundays tend to have lower requirements since there are lesser medical rounds, fewer medical orders and lower patient census.e. long stretches of consecutive working days are to be avoided as much as possible because it might affect the health of the nursing personnel.Afternoon and night shifts are more difficult than the day shifts.Nursing personnel should get their fair share of these thingsincluding The ‘relief ’ duty for the three shifts periods.f. evening and night shifts requirements for staff are usually lowerthan in the morning shiftg. floating
93Some problems that occur in the schedules: * busy units may require additional help* unscheduled absences may occur and suddenly a staff may be pulled out from her regular area of assignment to cover for another unit.- in order to minimize problems as a result of emergency assignments cross training and/ or orientation to complementary units is advised.
94Modalities of Patient Care Primary nursing - total care of an individual is the responsibility of one nurse.2. Team nursing – a group of nurses work together to fulfill the full functions of professional nurse, to be led by one nurse3. Case method/total Patient Care – provides one-to-one RN-to client ratio & constant care for a specified period of time.4. Functional Method/Task nursing– the oldest nursing practice modality- task oriented method: 1 nurse for giving medicines- no one is responsible for total care of any patient- it accomplishes the most work in the shortest amount of time.5. Modular Nursing –RN provides direct nursing care with assistance of aides.
95Developing Job Description – a statement that sets the duties andresponsibilities of a specific job.
96CONTENTS: (Uses) Identifying Data: Position Title: Department: Supervisor’s Title:Job Summary-essential features of the job that distinguish it from the others.Qualification RequirementsJob Relationship – source of workersSpecific and Actual Functions and Activities
97DIRECTING- the issuance of orders, assignments and instructions that enables the nursing personnel to understand what are expected of them.
98Element: A. Delegating - getting the work done through subordinates – assigning specific tasks/duties to workerswith commensurate authority to perform thejob
99What Cannot Be Delegated: Overall responsibility, authority, accountabilityAuthority to sign one’s name is never delegatedEvaluating the Staff/or taking necessarycorrective/ disciplinary actionResponsibility for maintaining morale/encouragement of staffToo technical jobs and those that involves trustand confidence
100NURSING CARE ASSIGNMENT (sometimes called NURSING CARE ASSIGNMENT (sometimes called.. ) Modalities of Nursing Care, Systems of Nursing Care, Patterns of Nursing Care
1011. Functional Nursing– Task oriented- best system that can be usedwhen there are many patients andfew professional nurses.
102Patients Lines of Authority: Head / Senior Nurse R.N. Medication R.N. TreatmentNsg. AttendantHygienic CareHousekeeperLinen AttendantPatients
103Total Care / Care Nursing – 1 nurse: 1 patient (private duty nursing)- the nurse is accountable for her ownactions- this works best when there are plentyof nurses and patients are few- nurses may not be familiar withpatients in other areas
104Head / Senior NurseStaff NursePatientTotal Care / Care Nursing
105Team Nursing – decentralized system giving care through participative effort assigning patients and task according to job descriptionleader has the responsibility for coordinating the total care of a group of patient (Team Conference – the heart of team nursing)if not fully implemented, it can lead to fragmentation of carein this method only team leader has significant responsibility and authority & care may resemble functional method if the leader does not keep members informed
107Primary Nursing– a form assigning patient care responsibilitiesis an extension of the principle ofdecentralization.Each RN is responsible for the total care of asmall group of patient from admission todischarge.nurse assumes 24 hours responsibility for nursing careSecondary or associate nurses executes the nursing care plan during afternoon and night shifts or day when the primary nurse is off-duty.
108Secondary/ Ass. Nurse PM Secondary/ Ass. Nurse Nite Secondary/ Ass. PhysicianHead NurseHospital and Community ResourcesPrimary NursePatient/ ClientSecondary/ Ass. Nurse PMSecondary/ Ass.Nurse NiteSecondary/ Ass.Nurse ReliefLines of Authority in Primary Nursing
109Modular Method - Modification of team and primary nursing- RN provide direct nursing care withassistance of aidesCase Management – responsible forassessment of patient and family
110B. Utilizing / Revising/ Updating Nursing Service Policies andProcedures
111C. Supervision – to inspect, guide, evaluate, improve work performance of employeesLeading – actuating efforts to accomplish goals;supervision or overseeing work ofemployees; and coordinating or unifyingpersonnel and services among others.Managers at different levels of institutional hierarchy are referred to in different terms: Management Levels in Nursing
113D. Communication - the transmission of information, opinions, and intentionsbetween and among individuals.- It binds the organization together toensure common under-standingPurposes: * facilitate work * increasemotivation * effect change * optimizecare * increase worker satisfaction andfacilitate coordination
114Lines of Communication a. Downward – from superior to the subordinate which may pass through various levels. e.g. policies, rules and regulations, memos, handbooks, interviews, job descriptions, and performance appraisal b. Upward – emanates from subordinates to superior, usually in the form of feedback and does not flow as easily as downward communication. e.g. discussions between subordinates and superiors, grievance procedures written reports, incident reports and statistical reports.
115c. Horizontal – or lateral – flows from between peers, personnel or departments on the same level. e.g. endorsements, between shifts, nursing rounds, journal meetings and conferences, or referrals between departments or services d. Outward – deals with information that flows from the care-givers to the patients, his family, relative, visitors and the community. e.g. information about the nature of their illness, medical and nursing plans of care
116Communication can be enhanced by carefully choosing the words or information you wish to convey, by creating an environment that promotes its acceptance, by avoiding preconceived opinions and biases about a person, by listening to and understanding the other person’s point of view and by being open and supportive. Most people learn to communicate through example. Nurse managers should promote a responsive communication climate in their units.
117E. Coordinationsynchronization of activities with the various services and departments enhances collaborative efforts resulting in efficient, smooth and harmonious work flow.coordination also prevents overlapping of functions, enhances good working relationships and work schedules are finished on time.
118e.g Coordination with the Medical Service, Administrative Service, Laboratory Service (Nothing by Mouth After Midnight For Fasting Blood Sugar in AM ), Radiology Service ( For Chole-GI Series in AM! Pls. withhold Breakfast Until Aft Exam), Pharmacy Service, Dietary Service, Medical Records, Community Agencies, Other Institutions and Civic Organization
119F. Staff Development- to improve performance of employee OrientationIn-service educationContinuing educationOrganization development
120Decision Making - A decision is a course of action that is consciously chosen from available alternatives for purpose of achieving a desired result. Most people rise to the top of their chosen careers share a common characteristics: they are decisive. They make decisions and are not afraid to take risks.
121Five Steps in Decision Making Definition of the Problem Analysis of the ProblemDevelopment of an Alternative solutionSelection of the solutionImplementation and follow-upIf the solution is proved to be unsatisfactory, the whole process of decision making is repeated and the entire problem is reviewed.
122Decision Making Stages: IntelligenceDesignChoicee.g SWOT ANALYSIS:S – Strength, W – Weakness,O – Opportunities, T – Threat
123H. MotivatingMOTIVATIONIs a skill in aligning employee and organizational interest so that behavior results in achievement of employee wants simultaneously with attainment of organizational objectives.Many managers claim that motivating employees is their most difficult daily task. Managers must stimulate workers to release their energies constructively toward the accomplishment of assigned tasks.
124Common practical problems encountered by managers include the following: Employees often differ in their needs.Managers often don’t, or may not accurately perceive, what employees wantManagers have limited flexibility in offering economic rewards.The reward that may prove to be most motivating for some people are often difficult to use.Motivation is a function of understanding needs, tensions, wants, incentives, and a perception ofthe environment.
125Reporting Evaluation Criteria: DeliveryOrganization, systematic and logical presentation of report =1,2Clarity of voice, grooming and poise.=1,2ContentCorrectness of processing and interpretation of data =1,2Clear presentation=1,2Conciseness of presentation =1,2Appropriate data presented =1,2,3Audio-visual aidsUse of audio-visual aids to facilitate presentation=1,2Mastery and TactAbility to answer relevant questions=1,2Attitude towards criticism and suggestion=1,2,3
126CONTROLLING/EVALUATING the process by which managers attempt to see that actual activities conform to planned activitiesperformance is measured & corrective action is taken to ensure the accomplishment of organizational goals
127Basic Components: 1. Establishing standards, objectives and methods for measuring performance 2. measuring actual performance 3. Comparing results of performance with standards & objectives & identifying strengths &areas for correction 4. Acting to reinforce strengths or successes & taking corrective action as necessary
128Nature & Purpose 1. Establishes trust and commitment to the system by all personnel through the use of an effective communication system 2. Clarifies organization & individual objectives 3. Presents uniform & fair standards with precise definitions of each standard, goal & objective 4. Compares expectancy with performance
129Control Mechanics 1. Standards of Care Yardsticks for gauging the quality and quantity of services.Established criteria of performance, planning goals, strategic plans, physical or quantitative measurements of products, units of service, labor hours, speed, cost, capital, revenue, program and intangible standards.An acknowledged measure of comparison for quantitative or qualitative value, criterion or norm, a standard rule or test on which a judgment or decision can be based.
1302. Total Quality Management (TQM) – a way of ensuring customer satisfaction through the involvement of all employees in learning how to reliably produce and deliver quality goods and services.“way” means .. it’s a processcustomer satisfactioninvolvement of all employeesquality goods and services
131- a work ethic involving everyone in the organization - a work ethic involving everyone in the organization. The client is the focus.Primary Goal: To improve internal and external customer satisfaction through quality control.Components of TQM:1. Quality Planning2. Quality Teams3. Quality in Daily Work ( or operations)
1321. Customer Satisfaction Principles of TQM1. Customer Satisfaction2. Management by Facts (“speaking with facts”)3. Respect for People4. P-D-C-A (Plan-Do-Check-Act)The real meaning of Quality is TOTAL QUALITY which means:integrity of function and compositiondoing “right things right”
133Wrong Things Right Ordered The Quality GridRight Things WrongOrdered the right equipment but installed incorrectlyRight Things RightOrdered the right equipmentand installed correctlyWrong Things WrongOrdered the wrong equipment and installed incorrectlyWrong Things Right OrderedOrdered the wrong equipment but installed correctly
1342.1 Elements: 2.1.1 Decentralization 2.1.2 Participatory management – makingdecisions at lower levels in the organizationalhierarchy2.1.3 Matrix management – free-formorganizational structures.2.1.4 Management by Objectives (MBO) - everyperson or group in a work setting has aspecific, attainable and measurable objectivesthat are in harmony with those of theorganization.2.1.5 Statistical analyses2.1.6 Team building
1352.1.7 Quality circles – participatory management technique that uses statistical analysis of activities that uses statistical analysis of activities to maintain quality products Theory Z (consensual decision- making) – the leadership style is a democratic one which includes decentralization, participatory management, employee involvement and an emphasis on quality of life.
1362.2 Quality assurance – defines performance measurements and compares actual processes and outcomes to clinical and satisfaction indicators. 2.3 Quality control – involves performance management and maintenance and includes systematic methods of ensuring conformity to a desired standard or norm. 2.4 Quality improvement – concerned with performance development and is ongoing. Involved with fixing now, preventing
1373. Nursing Audit – an examination, a verification or an accounting of predetermined indicators.The three basic forms are:3.1 Structure audit – focuses on the setting in which care takes place: physical facilities, equipment, caregivers, organization, policies, procedures and medical records are measured by means of checklist.
1383.2 Process audit – implements indicators for measuring nursing care to determine whether nursing standards are met. Generally task-oriented 3.3 Outcome audit – evaluates nursing performance in terms of establishing client outcome criteria: may either be concurrent or retrospective
139Control Techniques1. Nursing rounds – cover issues like patient care, nursing practice and unit management 2. Nursing operating instructions – policies which become standards for evaluation as well as controlling techniques
1403. Ganti charts – depict a series of events essential to the completion of a project or program 4. Critical control points and milestones – specific points in a master evaluation plan at which the nurse judges whether the objectives are being met, qualitatively and quantitatively.
1415. Program Evaluation and Review Technique (PERT) – uses a network of activities, each of which is represented as a step on a chart. Includes time measurement, an estimated budget and calculation of the critical path (the sequence of events that would take the longest time to finish)6. Benchmarking – technique whereby an organization seeks out the best practice in its industry so as to improve its performance.It is a standard or point of reference, in measuring or judging quality, values and cost.
142Change ProcessPurposeful, designed effort to bring about improvement in a system with the assistance of a change agent.
143Theories of Change1. Lewin’s Theory – change happens in these stages:1.a Unfreezing- felt need for change1.b Moving – gathers information forchange & implementing the change1.c Refreezing – change are integrated &stabilized as part of the system
1453. Reddin’s Theory:7 techniques change can beaccomplished:3.a Diagnosis3.b Mutual setting of objectives 3.c Group emphasis3.d Maximum information3.e Discussion of implementation3.f Use of ceremony and ritual3.g Resistance interpretation
1464. Havelock’s theory: 6 phases 4. a Building a relationship 4 4. Havelock’s theory: 6 phases 4.a Building a relationship 4.b Diagnosing the problem 4.c Acquiring the relevant Resources 4.d Choosing the solution 4.e Gaining acceptance 4.f Stabilization and self-renewal
1475. Spradley’s Model: 8 phases 5. 1 Recognize the symptoms 5 5. Spradley’s Model: 8 phases 5.1 Recognize the symptoms 5.2 Diagnose the problem 5.3 Analyze alternative solutions 5.4 Select the change 5.5 Plan the change 5.6 Implement the change 5.7 Evaluate the change 5.8 Stabilize the change
148Three possible situations that may occur before change happens RestrainingforceDrivingforceDynamic Equilibrium‘Status Quo’Desired ChangeUndesired ChangeDECISION MAKING‘Deciding to Change’UNFREEZING‘Desiring to Change‘Felt Need’MOVING‘ImplementingThe Change’REFREEZING‘Stabilizing theChange
1491. Lack of conflict is a sign of a healthy group True or False1. Lack of conflict is a sign of a healthy groupFalse2. A conflict exists whenever incompatibleactivities exist.True
1503. Conflicts are usually destructive to a group False4. Conflicts that are not openly expressed and constructively resolved will be expressed indirectly and persist.True
1515. Conflicts can and should be avoided whenever possible True6. It is not possible to teach people how to deal with conflicts effectively.False
1527. Ignoring conflicts usually causes them to dissipate and go away False8. Conflicts are valuable and evennecessary to a groupTrue
153Not Usually True 9. Conflicts are destructive to relationships 10. Conflicts help you understand whatyou are like as a personTrue
15411. A conflict uses up energy and thus decreases a group’s ability to work effectively Not Usually
156Types of Conflict1. Conflict within individual / intrapersonal – occurs when the leader is confronted with two or more incompatible demands2. Conflict between organizations – restricted to issues pertaining to competition
1573. Conflict with health organizations/ interpersonal & intergroup – maybe due to: 3.1 difference between Management &staff3.2 need to share resources3.3 interdependence of work activities inthe organization3.4 differences in values & goals amongdepartments & personnel regardingdelivery of nursing care
158Sources of Conflicts:Conflicting PerceptionsIndividuals disagree because they perceiveevents differentlyDiffering IdeasIndividuals have ideas that clash(e.g. women ordination)Conflicting ValuesIndividuals embrace different set of valuesthat influence their perceptions and judgment(e.g. competency, spirituality)
159Aggressive BehaviorIndividuals assert their rights whileknowingly or unknowingly deny other’stheirs. ‘the nail that sticks out is nailed down’Personality ClashesPersonality traits of people create frictionCommunication Problems (can be verydisastrous) Semantic, noise, lack of clarification
161Approaches to Conflict Resolution 1. Competition and Power – if the nurse’s primary concern is work accomplishment, with little regard for staff relationships 2. Smoothing – a more diplomatic method; the nurse has high concern for relationships & a secondary concern for work accomplishment
162“If we don’t talk about the problem, 3.Avoidance– low regard for both relationships & work accomplishment; nurse does not take a position regarding the conflict.“If we don’t talk about the problem,it will go away.”.
1634. Compromise – each side makes concessions 4. Compromise – each side makes concessions. Is moderately assertive & cooperative but produces a lose-lose situation because each side gives up something in order to gain something. This is a weak resolution method
1645. Collaboration– a constructive process in which theparties involved recognize that conflictexist, confront the issue and openly tryto solve the problem that has arisenbetween them. The outcome isintegrative problem solving
1651. Avoidance (Rabbits – flee away) I lose, You Lose! 4 Suggestions1. Avoidance (Rabbits – flee away)I lose, You Lose!2. Competition ( Bull - confronts )I Win, You Lose!3. Adaptation ( Camellon – highly adapts)I Lose, You Win!4. Cooperation ( Bee ) - I Win, You Win!* There is no standardized conflict resolution but it depends upon the situation
166Functions of Management PLANNINGORGANIZINGDIRECTINGCONTROLLING / EVALUATING
167PLANNING Elements of Planning a. Forecasting b. Setting the Vision, Mission,Philosophy, Goals & Objectivesc. Development & Scheduling Program
168Elements of Planningd. Preparing the Budget e. Establishing Nursing Standards, Policies and Procedures
169ORGANIZINGElements of Organizing 1. Setting up the Organizational Structure 2. Staffing 3. Scheduling 4. Developing Job Description
170Characteristics of Organizational Chart 1. Division of Work – each box represents an individual or sub-unit responsible for a given task of the organization’s workload 2. Chain of Command – lines indicate who reports to whom & by what authority 3. Type of work to be Performed – indicated labels or descriptions for the boxes
171Characteristics of Organizational Chart 4. Grouping of Work Segment – shown bythe clusters of work groups5. The level of Management, whichindicate individual & entiremanagement hierarchy, regardless ofwhere an individual appears on thechart.
172Organizing Principles 1. Unity of Command – responsible to only one Superior 2. Scalar principle – authority & responsibility should flow in clear unbroken lines from the highest to the lowest executive. 3. Homogenous Assignment or Departmentation - workers performing similar assignment are grouped together for a common purpose
1734. Span of Control – the # of workers that a supervisor can effectively manage should belimited depending upon the pace & pattern ofthe working area5. Exception Principle – recurring decisionsshould be handled in a routine manner by alower-level manager. Unusualmatters/problem should be referred to higherlevels.
174Systems of Nursing Care, DIRECTINGElement:A. DelegatingModalities of Nursing Care,Systems of Nursing Care,Patterns of Nursing Care
175Modalities of Nursing Care 1. Functional Nursing2. Total Care / Care Nursing3. Team Nursing Team Nursing4. Primary Nursing5. Modular Method6. Case Management
176Elements of DirectingB. Utilizing / Revising/ Updating Nursing Service Policies and Procedures C. Supervision D. Communication
177Elements of DirectingE. Coordination F. Staff Development G. Decision Making H. Motivating
178CONTROLLING/EVALUATING Control Mechanics1. Standards of Care2. Total Quality Management (TQM3. Nursing Audit