Nursing Management

Functions

ORGANIZING
Intended Learning Outcomes:
• Explain the concept of organization, categories,
characteristics, designs, principles and structures.
• Analyze the different categories of organizations and its
implications to leadership and management.
• Design an organizational chart specific to the area of
assignment.
• Discuss organizational or staff culture and patterns in relation
to patient care classification.
• Explain the meaning of job description and employee
discipline in relation to organizational goals.
Organization
- is the form of every human association for the
attainment of a common purpose (Mooney,
1939).
- an act of putting into systematic relationships
those elements and activities essential to the
satisfaction of the purpose.
- a form of identifying roles and relationships of
each staff in order to delineate specific tasks or
functions that will carry out organizational plans
and objectives.
- the process of identifying and grouping the work
to be performed, defining and delegating
responsibility and authority, and establishing
relationships for the purpose of enabling the
people to work most effectively together in
accomplishing objectives (Allen, 2008).
The process involves:
1. Identification and definition of basic tasks of
individuals at work such as staffing and creation of
job descriptions;
2. Delegation of authority and assignment of
responsibility to each member of the team for the
accomplishment of activities;
3. Establishing relationships of people by
providing a system of vertical and horizontal
communications through hierarchical relationships
to bind and coordinate all the activities to be done.
Characteristics of an Organization
1. Division of work where each box represents an
individual or sub- unit responsible for a given task.
2. Chain of command with lines indicating who
reports to whom and by what authority.
3. Types of work segments, shown by clusters of
work groups differentiated from one another.
4. Levels of management indicating hierarchical
relationships.
Principles of Organizational Design
These principles on which sound organizational
design is founded are the following.
1. Division of labor promotes departmentalization
and specialization, which results in a more efficient
performance of a unit.
2. Unity of command, whether it follows a line of
command or vests it in one superior ensures a unity
of vision.
3. Authority and responsibility determine the line
and staff authority, which delineates the
distribution of power.
4. Span of control determines the extent of control
in each level, area or unit within the system, as well
as whether it is centralized or decentralized.
5. Contingency factors the environment and
technology or knowledge of team members, which
deals with task variability and problem analyzability.
ORGANIZATIONAL STRUCTURE
• a process in which a group is formed including its
authority, responsibility and accountability (ARA),
span of control and lines of communication.
• It is a formal structure, the official arrangement of
positions or working relationships that will
coordinate efforts of workers of diverse interest
and abilities.
Patterns of Organizational Structure
• Tall or Centralized Structure
― are characterized by a narrow span of control, where
supervisors are responsible for only a few
subordinates.
― due to its vertical nature, this structure involves many
levels of communication.
― Communication can be difficult, and messages often
fail to reach the top effectively.
― Workers tend to be boss-oriented due to close
supervision.
• Flat or Decentralized Structure
― feature few levels and a broad span of control,
decision-making is spread among many people,
making communication easy and direct.
― this structure shortens the administrative distance
between top and lower levels,
― facilitates fast problem-solving and response,
― encourages workers to develop their abilities and
autonomy.
Types of Organizational Structure

• Line Organization/Bureaucratic/Pyramidal.
In a line organization, there is a clearly defined
superior-subordinate relationship. Authority and
power are concentrated at the top.
• Flat/Horizontal Organization. A decentralized
type, flat organizations are applicable in small
organizations. Nurses become more productive
and directly involved in decision-
making processes, leading to greater worker
satisfaction.
• Functional Organization. This structure allows
specialists to assist line positions within a limited
and clearly defined scope of authority.
• Ad Hoc Organization. is a modification of the
bureaucratic structure, often created for specific
projects or purposes.
• Matrix Structure. focuses on both products and
functions, making it the most complex type. It
incorporates both vertical and horizontal chains of
command and lines of communication.
Organizational Culture
• The personality of the organization comprised of the
assumptions, values, norms and tangible signs of the
corporation
• Different types of organizational culture:
• The tough-guy macho culture
• The work hard/pay hard culture
• The bet your company culture
• The process culture
STAFFING Why staffing is
• Process of assigning importance?
competent people to 1. Getting qualified and skilled people
fill the roles designated into the team.
for the organizational 2. Roles become clearer and the
structure through workload works become lesser.
recruitment, selection 3. There is an improvement in the
and development morale and job satisfaction.
4. It helps the organization diversify its
talent profile and hence aids with
company growth.
STEPS IN STAFFING
1. Determine the number and types of personnel
needed (manpower planning)
2. Recruit personnel
3. Interview
4. Induct or orient personnel
5. Job offer
STAFFING PATTERN
─ is a plan that articulates how many and what kind
of staff are needed by shift and day to staff a unit
or department.
1. Determining Nursing Care Hours required per
patient - For example, if each patient needs an average of
6 hours of nursing care per day and the unit has 20
patients, the total nursing care hours needed per day
would be 120 hours.
2. Calculating Full time Equivalents (FTEs) - For
instance, 1.0 FTE represents a full-time employee who
works 5 days a week, 8 hours a day, totaling 40 hours a
week. Conversely, 0.5 FTE corresponds to a part-time
employee working 5 days every 2 weeks, totaling 20 hours
a week.
Considerations in Staffing Pattern
1. Benchmarking – is used to seek out the best practices
within the healthcare industry to improve performance.

2. Regulatory Requirements - Staffing patterns must

adhere to mandated regulations, such as those outlined in
relevant legislative acts such as RA 5901 (An Act
Prescribing Forty Hours a Week of Labor for
Government and Private Hospitals or Clinic Personnel)
3. Skill Mix - refers to the percentage or ratio of
professionals to non-professionals within the staff. ensures
a balanced team with the necessary expertise and support
staff, allowing RNs to focus on complex patient tasks while
nursing assistants handle more routine duties.

4. Staff Support. This support allows nurses to dedicate

more time to patient care rather than administrative
duties.
5. Historical Information. Reviewing historical data on
quality and staff perceptions regarding the effectiveness
of previous staffing patterns is crucial. This historical
review helps in planning and adjusting staffing levels to
meet future demands more effectively.
Patient Classification System
─ measurement systems in nursing that reflect actual patient
care needs for staffing purposes.

Patient Care Classification

1. Self-Care or Minimal Care. These patients are
capable of performing activities of daily living (ADLs)
independently, such as hygiene and meals.
2. Intermediate or Moderate Care. Patients in this
category require some assistance from the nursing staff
for special treatments or specific aspects of personal care.
(IV Fluids, catheters, or on respirators)
3. Total Care. These patients are bed ridden and lack the
strength or mobility to perform ADLs.
significant mobility restrictions.
4. Intensive Care: Critically ill and in constant danger of
death or serious injury.
NURSING CARE MODELS
─ is the framework for nursing care delivery in any setting, or
design that meets the particular needs of a group of health
care givers and clients.
1. The Case Method or Total Patient Care. this is actually the
original model of nursing care delivery, in which a registered
nurse is responsible for all aspects of care of one or more
patients.
Advantage Disadvantage

• The nurse can better see and • RNs spend some time doing
attend to the total needs of tasks that could be done more
clients and the continuity of care cost-effectively by less-skilled
can be facilitated with ease. persons.
• The client's interaction and
rapport with the nurse are well-
developed, and the client's needs
are monitored carefully, with the
result that both the client and his
or her relatives feel secure.
2. The Functional Method. This method is task and
procedure oriented. It is used when there are too many
patients in proportion to available RN. The RN learns to
work fast because activities are repetitious, and her technical
skills amplified.
The advantages of Functional Method are:
a. Nurses who are oriented this way become skilled in performing
assigned tasks;
b. Individual aptitude and experience improves;
c. Less equipment is needed;
d. Time is saved; and
e. Task-oriented approach improves both productivity and
organization.

Often, in this approach, patients can not identify who their nurse
is
3. Team Nursing. In team nursing which evolved from
functional nursing, a group of nursing personnel provides total
patient care to a group of patients.
a. The RN leads a group of many health workers,
including students.
b. This group is centered through participation efforts.
c. The personnel work together to identify, plan,
implement and evaluate comprehensive client-centered
nursing care toward a common goal of providing
quality client care.
d. It is oriented towards the decentralization of a nursing
unit and of the Head Nurse's authority.
e. Comprehensive nursing care with authority,
responsibility and accountability becomes the
responsibility of the entire team.
Advantages of Team Nursing:
a. The constant group work fosters a feeling of participation
and belonging.
b. The workload is balanced and shared with the division of
labor for each team member.
c. Each member of the team has the opportunity to learn
from other team members or team colleagues.
d. There is also a variety in the daily assignment.
e. It also helps maintain interest in client's well being and
is cost effective.
f. The patient is able to identify who their nurses are due
to the continuity of care.
g. Barriers between nurses and clients can be minimized
since care is well coordinated.
h. Everyone gets to contribute to the care plan.
Scheduling
• process of creating a timetable that outlines the planned workdays and
shifts for nursing personnel.
Issues to Consider in Scheduling Staff
• Patient Type and Acuity. Different patients require varying levels of
care, significantly impacting how staff is allocated.
• Number of Patients. The total patient count directly influences the
number of staff needed. A higher patient load requires more nursing
staff to ensure each patient receives adequate attention and care.
Issues to Consider in Scheduling Staff
• Experience of Staff. The skill and experience levels of the staff
should match the complexity of patient care required.
• Support Available to the Staff. The availability of support
personnel, such as nursing assistants and administrative staff, affects
how nursing duties are distributed.
• Shifting Variations. Different shift patterns are utilized to meet both
patient care needs and staff preferences. These variations can help in
maintaining a balanced and effective workforce.
Shifting Patterns
1. 3 Shift (8-hour shift). Commonly used to provide 24-hour care, this
pattern divides the day into three 8-hour shifts.
2. 12-hour Shift. This pattern involves longer shifts with fewer
workdays, often preferred by nurses who enjoy having more
consecutive days off.
3. 10-hour Shift. Less common but offers a balance between 8 and 12-
hour shifts.
4. Weekend Option. Staff works primarily on weekends, which can be
ideal for nurses who prefer or need weekdays off.
5. Rotating Work Shift. Shifts rotate between day, evening, and night,
allowing all staff to experience different times of day.
Shifting Patterns
6. Self-Scheduling. Staff members create their own schedules,
promoting autonomy and job satisfaction.
7. Permanent Work Shift. Staff work consistent shifts without
rotation, providing stability and predictability.
8. Floaters. Staff who are “on-call” to fill in as needed. Floaters
provide critical support during unexpected absences or increased
patient loads, ensuring that the unit remains adequately staffed at all
times.
JOB DESCRIPTIONS
• Specifications of duties, conditions, and requirements
of a particular job prepared through a careful job
analysis.
• Also called as performance descriptions
• Used primarily for the purpose of:
• Recruitment
• Placement and transfer
• Guidance and direction
• Evaluation of performance
• Reduction of conflict and frustration
• Avoidance of overlapping of duties
• Facilitation working relationships with outside bodies
• Serves as basis for salary range
Contents of Job Descriptions
1. Job Title – position and necessary
qualification
2. Job relationships – degree of
supervision, line and staff responsibilities
and reporting mechanisms imposed on the
worker
3. Performance or Job Description –
catalogue of the assigned tasks and
responsibilities of the worker
EMPLOYEE DESCIPLINE
• Process of generating employee compliance to the institutional rules and
regulations.

Purposes of Employee Discipline

1. Creates order and smooth transition during shifts and breaks.
2. Helps nursed to perform their tasks better
3. Provides direction for delinquent employees

Employees discipline policies must be communicated to the

stakeholders.
Principles of Discipline
1. Discipline should be done
privately, promptly and
consistently Steps to Address Discipline
2. It should be progressive in Problems
nature 1. Coaching
3. It should be preceded with 2. Confrontation
counseling 3. Disciplinary conference
4. Disciplinary procedures should
be instituted with extreme
caution
 Tools/Techniques for Terminating Staff
1. Inform the HRD and the administration
Steps of Progressive beforehand
Discipline 2. State the offending behavior and the reason
for termination
1. Counseling 3. Explain the proposed termination process
2. Verbal reprimand 4. Termination must have the approval
3. Written reprimand of higher authorities
4. Short suspension 5. Arrange the employee to be escorted
5. Longer suspension out
6. Report back to the HRD and
6. Discharge/dismissal
administration