Nursing Management Process and Functions

BSN IV

The management process is universal. It is used in one’s personal life as well as one’s professional life. One applies it to management of oneself, a patient, a group of patients, or a group of workers. Knowledge of this process assures nurses of smooth functioning of their units in attaining their goal of quality care through the judicious use of available human and material resources within a specified time.

Management – is getting the right things done at the right time

Nursing Management – a relationship of inputs and outputs in which the workers, physical resources and technology are emerged to bring about the organizational goals for delivery of quality nursing care

Management Process and Functions

INPUT OUTPUT

HUMAN RESOURCES

MedicalNursingAllied HealthPatient / ClientSignificant Others

PHYSICAL AND TECHNOLOGICAL RESOURCES

BuildingGroundsSuppliesEquipment

Realization of goals

Delivery of quality patient care

Schematic Diagram of Nursing Management

Management Process – consist of achieving organizational objectives through planning, organizing, directing, and controlling human and physical resources and technology

ORGANIZATION

ADMINISTRATION

MANAGEMENT

ORGANIZING

DIRECTING

CONTROLLING

PLANNING

● While planning is the first function, one must recognize that it permeates into other functions, which are dependent on it.

● Forecasting estimates the future, setting objectives, determine the results to be achieved, developing and scheduling program, define activities needed within a set time frame, preparing the budget, allocates tools and resources while establishing policies and procedure, define the course of action and standards.

● Organizing establishes formal authority. It sets up the organizational structure by identifying groupings, roles and relationships within the agency. This is depicted in an organizational chart.

● Job descriptions define the qualifications and scope of responsibilities, relationships and authorities of personnel. Staffing would include determining the number of staff needed thus developing and maintaining a staffing pattern, recruiting, selecting, orienting and developing personnel to accomplish the goals of the organization.

● The selected personnel are then distributed in the various areas of the agency as needed and staffing schedule are made to meet the needs of clients, personnel and agency.

● Directing or leading actuates efforts to accomplish goals. This will include utilizing various modalities of nursing care through the nursing process; updating policies and procedure, supervising personnel to harmonize work through the nursing process, supervising personnel to harmonize work through adequate guidance and leadership, coordinating personnel and services to a common goal, communicating via various routes to ensure common understanding, developing people by providing staff development programs and making sound decisions.

● Controlling assesses / regulates performance of workers to ensure progress toward objectives, it utilizes standards in measuring performance, monitoring and evaluating nursing care including utilization of resources. Controls promptly reveal deviations from set plans and standards necessitating immediate corrective measures, actions and / or discipline.

I. PLANNING● is pre-determining a course of action in order to arrive at a desired

result● is the process of establishing goals, defining and developing strategy

and tactic for action● thinking ahead, determining what shall be done● it directs one thinking of:

> WHAT is expected to do> WHY it will be done> WHERE it will be done> HOW it will be done> WHEN we expect to do it> WHO is going to do it

● it is a continuous intellectual process of assessment, establishing goals and objectives, implementation and evaluation subject to change as new information is known. Knowing what should be done and determining how to do it

Organizational planning – is a continuous process of assessing, establishing goals and implementing and evaluating them to ensure about the use of people, resources and environment to help achieve agency’s goals for the present and the future

A. Importance of PlanningNurse manager should know how to plan for the following reasons:

1. It leads to the achievement of goals and objectives> Workers relate what they do to meaningful results since plans are focused on objectives.

2. It gives meaning to work> Employees or workers experience greater satisfaction if what they are doing becomes meaningful to them.

3. It provides for effective use of available resources and facilities> The best use of personnel and material resources avoid wastage.

4. It helps in coping with crisis> Hospitals should provide for disaster plans. These allow the workers to function more clearly and efficiently when actual crisis occur such as fire, or emergencies caused by disaster, New Year or fiestas where more people are likely to get hurt.

5. It is cost-effective> Costs can be controlled through planning for efficient operation. For example, projecting the number of operations in a given day including daily dressing can forecast the needed supplies for a week in the surgical units accurately so as to prevent undersupply or oversupply of pilferages.

6. It discovers the need for change> Many hospitals have found out that inpatient hospital days can greatly be reduced by having laboratory and diagnostic work-up in the outpatient department rather than have these examinations on admission. Minor surgeries are also done at the outpatient department so that more hospital beds can now be allotted to critically ill patients or for those needing specialized services.

7. It is based on the past and future activities> Evaluation of programs, schedules, and activities whether successful or not, prevents and / or reduces the recurrence of problem and provides better ideas in modifying or avoiding them.

8. It is necessary for effective controlNurse managers evaluate the environment or setting in which they work or where the patients are confined and make necessary recommendations to make it more therapeutic not only for the patients but also for the workers as well.

Performance of workers and evaluation of services to patients based on criteria set during the planning stage would indicate whether standards have been made and whether changes are indicated.

B. Resistance to Planning

Planning is something that many managers avoid. Failure of the manager to plan may be attributed to one or more of the following factors:

1. Managers may lack knowledge of the philosophy, goals, and objectives and workings of the organization

2. They may not understand the significance of planning process, that the success or failure of the work activities relate directly to the quality of the plan – how this plan is carefully and thoroughly done or how it is poorly done

3. Time spent on planning often seems wasted in relation to the day-to-day doings of one’s job

4. Some manager may lack confidence, fearing failure5. Some managers prefer to act on immediate problems because they

generate immediate feedback6. Planning may bring unwanted change

Knowing these factors will help nurse manager to overcome them and utilize planning as basic key to the success of their work.

Top Management or the Nursing Directors, Chief Nurses or Director of Nursing and their assistants set the over-all goals and policies of the organization. Their scope of responsibility is the over-all management of the organization.

Middle Management of Nursing Supervisors direct the activities that actually implement the broad operating policies such as staffing and delivery of services to the units headed by the Senior or Head Nurses. Formulation of policies, rules and regulations, methods and procedures for personnel for immediate level planning for ongoing activities and projects are done in coordination with the top management and those in the lower level.

At the Lower or First Level Management, the Head Nurses or Senior Nurses (including Charge Nurses or Team Leaders) do the daily schedules, or weekly plans for the administration of direct patient care in their respective units.

C. Scope of Planning

Plans can be understood through four major aspects:1. Plans should contribute to objectives

It should seek to achieve a consistent, coordinated structure of operation focused on desired ends. Action without plans often result to chaos.

2. Planning precedes all other process of management (organizing, directing, controlling)It supports easy accomplishment of the agency’s objectives, which are necessary for group effort. Planning and control are as inseparable as Siamese twin.Example: Hospital must be built on planned budget control of expenses and activities must be made, otherwise cost may swell bigger than the appropriated budget and the hospital may not be finished and its operations may not be started as targeted.

D. Major Aspects of Planning

3. It pervades all levelsIt pervades from higher to lower echelons and vice versa and horizontally through peer levels and / or across services and members of the health team.

4. It should be efficientIt should contribute to the attainment of objectives not only in terms of pesos, man-hour, units of products but also include values as individuals and group satisfaction. Fear, resentment and low morale result in low production.

A well-developed plan should:

1. have clearly worded objectives, including results and methods for evaluation,

2. be guided by policies and / or procedures affecting the planned action,

3. indicate priorities,

4. develop actions that are flexible and realistic in terms of available personnel, equipment, facilities, and time

5. develop a logical sequence of activities, and

6. select the most practical methods for achieving each objective

E. Characteristics of a Good Plan

F. Elements of Planning

F.1. Forecasting

Forecasting estimates the future, including the environment in which the plan will operate. It includes who the patients are – their customs, belief, language dialect barriers, public attitude and behavior, the acuity of their conditions / illness, the kind of care they will receive; the number and kind of personnel (professional and non-professional); and the resources, equipment, facilities, and supplies needed.

F.2. Setting the Vision, Mission, Philosophy, Goals, and Objectives

A vision statement outlines the organization’s future role and function. It gives the agency something to strive for.

The mission statement outlines the purpose the agency is in (whether hospital or health care), who the clients are (the poor, the needy, the middle or upper class), what services are provided (inpatient, outpatient, emergency) and why it exists.

A philosophy describes vision. It is a statement of beliefs and values that directs one’s life or one’s practice. In an organization, the philosophy is the sense of purpose of the organization and the reason behind its structure and goal.

Hospitals, clinics, and health agencies thus have as their primary reason for existence, the function of providing patient / client care services. These may include diagnostic, therapeutic, preventive, health promotion, personnel education and research services. These services vary among agencies depending on the clients served, the geographical location and the basic mission of the agency.

The philosophy of nursing service dovetails with the philosophy of the agency. It is an intentionally chosen set of values or purpose that serve as the bases for determining the means to accomplish nursing objectives.

Nursing philosophy is broad and general in wording, yet directs nursing behavior, giving it a sense of purpose. Generally emphasized in the statement of the philosophy are the quality and quantity and scope of service, decision making based on factual information, appropriate delegation, achievement of organizational goals, communication vertically and horizontally, flexibility to meet changing needs of the organization, individuals, community and society in general.

Organizations and people who set goals and objectives do better than those who do not. When manager forms goals, they put them on paper, and review them periodically. It forces him / her into action to try to accomplish them. The more a person sets a goal and specifies objectives for each of the result areas he likes to achieve, the more likely he will reach these.

Goals and objectives differ in that goals are more general and cover broad area while objectives tend to be more specific. Objectives are concrete. They are action commitments through which its mission and purpose will be achieved and the philosophy or belief sustained. They are stated in terms of results to be achieved and should focus on the production of health care services to the patient. Philosophy states beliefs and values while objectives state specific and measurable goals to be accomplished.

F.3. Developing and Scheduling ProgramsPrograms are determined, developed, and targeted within

a frame to reach the goals and objectives set.

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 goals efficiently.

Time Management Principles

a. Planning anticipates the problems that will arise from actions without thought. It anticipates the crisis that may occur of the resources needed to solve the problems

b. Task to be accomplished should be done in sequence, which are prioritized according to importance

c. Setting deadlines in one’s work and adhering to them is an excellent exercise in self-discipline

d. Deferring, postponing, or putting off decisions, actions or activities can be a habit which oftentimes cause lost opportunities and productivity, generating personal or interpersonal crisis

e. Delegation permits a manager to take authority for decision-making and to delegate tasks to the lowest level possible consistent with his judgment, facts and experience. Delegation frees her some time that can be devoted to other tasks

F.4. Preparing the BudgetBudget – is the annual operating plan, financial “road map” and a

financial plan which serves as an estimate of future costs and plan for utilization of manpower, material and other resources to cover capital projects in the operating programs.

– is a plan for future activities expressed in operational as well as financial or monetary terms

In health care institution, budget consist of four components:

a. Revenue Budget – summarizes the income management expect to generate during the planning period

b. Expense Budget – describes expected activity in operational and financial terms for a given period of time

c. Capital Budget – outlines the programmed acquisitions, disposals, and improvements in the institution’s physical capacity

d. Cash Budget – represents the planned cash receipts and disbursement as well as the cash balances expected during the planning period

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

Hospital Budget – is a financial plan to meet the future service expectations. These expectations are derived from the best judgment of the need of the community. Budgeting translates these needs of manpower, equipment and supplies so that both services are provided with the highest level of quality with the minimum amount of cost

The Budgetary ProcessTo assure an orderly and timely development of

the budget, the budget committee must be well defined. This committee can assist the budget officer in budget preparation and in monitoring the budget. The Chief Nurse or her assistant is usually a member of the Budget Committee. Within the nursing service, the Chief Nurse works with supervisors and Head Nurses in the preparation for the nursing service.

The following factors should be considered: assurance of standards according to the philosophy and objectives of the hospital and the division of nursing, past experiences in the unit, anticipated needs of the unit, and percentage of the unit occupancy.

The estimation of staff for each unit should be based on the number of patients, the number of nursing care hours needed, the provision of vacation, sick and other leaves, holidays and the average number of absences per staff member per year and other privileges as attendance to continuing education programs. These give a visible method of interpreting nursing care needs to the budget committee and to the hospital administration.

The next step is to ascertain the amount and kind of supplies needed for the operation of each nursing unit. A review of past expenses and consumptions provide data for planning. Capital equipment to be replaced is requested with documented justification.

The Chief Nurse compiles and completes the final draft and presents this to the Budget Officer or Hospital Administrator. A carefully planned budget presentation will usually reflect favorable action from the administration.

F.5. Establishing Nursing Standard, Policies, and Procedures

a. Nursing StandardsThe function of these established standard in an evaluation

process is to supply professionally desirable norms against which the department’s performance can be measured. Areas for improvement are identified, and a plan of action to correct this be made and implemented.

b. Nursing Service PoliciesPolicies are broad guidelines for the managerial decision

that are necessary in organizational and departmental planning. They govern the action of worker and supervisors at all levels and are intended to achieve predetermined goals. They serve as basis for future actions and decisions, help to coordinate plans, control performance and increase consistency of action by increasing the probability that different managers will make similar decisions when independently facing similar situations.

There are three general areas in nursing that require policy formulation:i. areas in which confusion about the focus of responsibility might result in neglect or malperformance of an act necessary to a patient’s welfareii. areas pertaining to the protection of patients’ and families’ rights e.g. right to privacy, property rightsiii. areas involving personnel management and welfare

c. Nursing ProceduresProcedures are specific directions for implementing written

policies. Two areas where procedures are needed are:i. those that are related to job situations such as reporting complaints or disciplinary instancesii. those that involves patient care – procedure that involve patient care should consider the safety of the patient, his comfort while undergoing it, and the proper care, use of supplies and equipment and good workmanship on the part of the person doing it

Nursing procedure manuals should be available in each unit to be familiarized in the nursing unit. It should be reviewed, updated and revised with the maximum involvement from the unit nursing staff.

G. Planning Process1. Analysis and assessment of system

Five basic considerations in an analysis of the system as a whole:1.1. objectives, performance measures1.2. environment, fixed constraints1.3. resources1.4. activities, goals and performance of its subsystem1.5. operation (process or action, strategies of work)

2. Formulation of organizational and individual goalIt helps identify the ends toward which the

administrator would like the system to move during a specific period of time.

This stage requires that a schedule of achieving these goals be established.

3. Assessment of present organizational potentialities and capabilities

Realistic goals and objectives can’t be established without knowing the current capabilities of the organization and specifically those of his own department.

True planning takes into account all the limitation as well as the resources of the situations and factors such as shortage of equipment and personnel or lack of adequate funds.

4. Formulating alternative courses of actionThis stage considers specifying means by which

organizational goals and objectives are to be achieved.

5. Setting of priorities on the basis of effectiveness and evaluationIn this stage the consequences of the various plans are

projected. This phase is largely concerned with the establishment of priorities.

6. ImplementationThis phase is concerned with resources allocation

commitment. This is the action and direction stage.7. Evaluation control and surveillance

Evaluation or provision of measuring the outcome of service against the objectives should be built into every plan.

Format of PlanningBackgroundObjectivesActivitiesTime Frame / Target TimeResources

PersonnelMaterialsFixed Assets

BudgetPossible ProblemContingency Plan

II. ORGANIZINGOrganizing is the second managerial function. Having

planned, the manager must now organize so that personnel can accomplish the plans with efficiency and effectiveness. Organizing involves establishing a formal structure that provides the coordination of resources to accomplish objectives, establish policies and procedures, and determine position qualifications and descriptions.

Organization – comprises structure and process, which allows the agency to enact its philosophy and utilize its conceptual framework to achieve its goals – refers to a body of people, method, policies and procedures arranged in a systematic process through delegation of functions and responsibilities for the accomplishment of purpose

Organizing – it is a process of establishing formal authority. It involves setting up the organizational structure through identification of groupings, roles and relationships, determining the staff needed through developing and maintaining staffing patterns and distributing them in the various areas as needed, and developing job descriptions by defining the qualifications and functions of personnel

Organizational Structure – refers to the process or the way a group is formed including its channels of authority, span of control, and lines of communication

Organizational Chart – it is a line drawing that shows how the parts of an organization are linked. It depicts the formal organizational relationships, areas of responsibility, people to whom one is accountable, and channels of communication

A pattern of nursing care is that system used for the delivery of nursing care to patients / clients. Patterns of care vary from hospital to hospital and this depends on the organizational structure adopted by the agency to meet its prescribed needs. The method selected for assignment of nursing staff to patients / clients directly relates to staffing pattern adopted by the health agency. Assignments can be stable only when there is a strong support system of qualified nursing personnel to carry forth the plan. In nursing services, nursing assignments may be called by various terms as modalities of nursing care, systems of nursing care, or patterns of nursing care. Historically, four basic methods are used:

1. Case Method – means that one nurse performs all services for the patient.

Advantages of the Case Method:a. The nurse has close contact with the patientb. Able to provide complete nursing care over a longer period of timec. Gives greater opportunity to directly assess patient’s progress, since the plan of nursing care is complied and carried out from day-to-day by one nurse

Disadvantages of the Case Method:a. Not administratively or economically feasibleb. Not possible when highly skilled functions are necessaryc. The nurse may know only a few types of casesd. Tendency to disregard patient as a person with unique identity

Lines of authority in a typical hospital with case nursing

Instructor Charge Nurse

Patients / Clients

Registered Nurse

Patients / Clients

Charge Nurse

Student

PL / CL PL / CL

2. Functional Method of care relieves the professional nurse of daily task to several patients but does not give all the nursing care to any one patient. Nursing assistants may carry out measures relating to personal hygiene, observations of vital signs, moving patients, and administering treatments

Advantages of the Functional Method:a. Nurse develops expertise or very efficient in one phase of nursing like administration of medicationb. Economy in time and equipmentc. Confusion is avoidedd. Very good method in case of shortage of personnele. Nurses can change from one assignment to another without loss of efficiencyf. Necessary during mealtime, PM shift and nightg. There is a smooth division of labor

Disadvantages of the Functional Method:a. Patient care is fragmented often incoordinatedb. Patient does not know his particular nursec. Creates sense of boredom for patients and nursesd. Patient feels as belonging to no onee. Nurse doesn’t bother about rationale of the procedure they dof. Nurses are not concerned with patients not assigned to them

RNMedication

Nurse

RNTreatment

Nurse

NAHygienic

Care

ClericalHousekeeping

Patients /ClientsFamily,Visitors

Charge Nurse

Patients / Clients

Lines of authority in a typical hospital with functional nursing

3. Team Method of care is patient centered even if several people give care. The professional nurse directs the care and may give some of it. The directions of care make the professional nurse the leader of the nursing team. The nurse makes decisions and must be able to understand and communicate with others effectively and be able to help the team work out the organized plan. The other team members may be other professional nurses, nursing assistants, or student nurses. Every team member should have some knowledge of the patient’s condition, including problems and suggestions

Advantages of the Team Method:a. Sense of satisfaction on the part of the nurseb. Close relationship among the membersc. Better utilization of personneld. Greater amount of supervision is providede. Care provided is comprehensive

Disadvantages of the Team Method:a. Conference schedule never endsb. Inconsistencies in team workc. Not all are qualified to become team leaderd. Large amount of time is wastede. Team leader overpowers the head nurseTeam Concepta. There is interchange of ideasb. Joint problem solvingc. Centered on continuity comprehension

Lines of authority in a typical hospital with team nursing

Charge Nurse

Team Leader

Nursing Staff

Patients / Clients

Team Leader

Nursing Staff

Patients / Clients

Team Leader

Nursing Staff

Patients / Clients

4. Primary Nursing is a way of delivering nursing care by a registered nurse with the concept of one patient relationship. The 24-hour responsibility of evaluating patient care is placed on the registered nurse. Its emphasis is on the professional clinical practice in that nurse performs the essential role of practitioner, teacher, and manager of the patient’s care and services in the hospital and other health care setting. It includes the following characteristics:

a. Professional nurses are identified as primary nurses who assess the patient’s need for care, sets care goals, writes a nursing care plan, administers care according to that plan, evaluates the outcomes of care and makes the necessary changes or adjustments as necessary. He / she provides pre-discharge planning and teachingb. Assigned with a relatively small case load (4-8 patients)c. Nursing process is usedd. Focus is on the one-to-one relationship of “my patient my nurse from admission to discharge

e. Care is based on patient’s needs and patient’s problemsf. Primary nurse is accountable for assigned patients 24 hours a day, 7 days a weekg. Emphasis is on professional clinical practice rather than performance of routine and tasks

Since the primary nurse assumes a 24-hour responsibility for nursing care, secondary or associate nurses executes the nursing care plan during the afternoon and night shifts and during the days when the primary nurse is off-duty.

The primary and secondary nurses are freed from administrative and housekeeping responsibilities to maximize their time for patient care. Authority, accountability, and autonomy rest with primary nurse. Therefore, he / she communicates directly to any member of the health team within the hospital and the community.

The head nurse’s role in this kind of assignment shifts from taskmaster, decision maker and coordinator of patient care to role model, consultant and quality control expert for the primary nurse in the unit. He / she encourages clinical decision making and ensures needed support in fulfilling patient care management coordination function.

Advantages of the Primary Nursing:a. Provision or increased autonomy on the part of the nurse thereby increasing motivation, responsibility, and accountabilityb. It assures continuity of carec. Makes available increased knowledge of patient’s psychological and physical needsd. Leads to increased rapport and trust between the nurse and the patient, thereby establishing therapeutic relationshipe. It improves communication with members of the health team and eliminates the use of nursing aides in the provision of direct nursing care

Physician Charge NurseHospital

Resources

Primary Nurse

Patient / Client

Associate NurseEvenings

Associate NurseNights

Associate Nurse(s)as needed

Days

Lines of authority in a typical hospital with primary care nursing

Elements of OrganizingThe elements of organizing are: setting-up the

organizational structure, staffing, scheduling, and developing job description.

A. Setting-up the Organizational StructureThe creation of an organizational system compatible with

the philosophy, conceptual framework, and goals of the organization provides the means for accomplishment of purpose.

Understanding of the organizational structure as a whole facilitates the development of roles and relationships enabling goal achievement. Departmentalization and division of work provide orderliness in administration. Through a breakdown of activities, each individual is responsible for and performs a specified set of activities.

Purposes of Organizational Structure

1. It enables members what their responsibilities are so that they may carry them out

2. It frees the manager and the individual workers to concentrate on their respective roles and responsibility

3. It coordinates all organizational activities so there is minimal duplication of effort or conflict

4. It reduces the chances of doubt and confusion concerning assignment

Two Types of Organizational Structure1. Informal Organizational Structure

▪ comprises personal and social relationship that do not appear on the organizational chart

▪ informal structure provides social control of behavior which can either be internal or external

Internal Control – if pressure is intended to make a member conform to group expectation (ex. dirty shoes)

External Control – an attempt to control the behavior of someone outside the social group

it has its own channel of communication, which may disseminate information mere broadly and rapidly than the formal communication system. The best way to correct an invalid rumor is for the manager to provide accurate information

informal organization structure is important to management, thus the manager must be aware of its existence, study its operating techniques, prevent antagonism, and use it to meet the agency’s objectives

2. Formal Organizational Structure it is the official arrangement of positions or working

relationship that will coordinate efforts of workers of diverse interests and abilities

it describes positions, tasks, responsibilities, and relationships it provides orderliness in administrations thru establishment

of formal organizational pattern by departmentalization and division of work

bases of formal organization structure: philosophy and objectives of the nursing department and goal of the institution

Activities to Promote a Positive Organizational Climate1. Develop the organization’s mission, goals, and objectives with

input from the nurses, including their personal goals2. Establish trust and openness through communication that include

prompt and frequent feedback and stimulates motivation3. Provide opportunities for growth and development, including

career development and CEP4. Analyze the compensation system for the entire nursing

organization and structure to reward competence, longevity, and productivity

5. Promote self-esteem, autonomy, and self-fulfillment, including feelings that help work experience high quality

6. Assess unneeded threats and punishments and eliminate them7. Provide job security with an environment that enables free

expression of ideas and exchange of opinion without threat of recrimination, which may occur as negative performance reports, negative counseling, confrontation, conflict, or job loss

8. Encourage and support loyalty, friendliness, and civic consciousness

9. Help nurses to overcome their shortcomings and develop their strengths

10. Be a role model of performance desired of practicing nurses

Organizational Change▪ change means substituting one thing for another,

experiencing a shift in circumstances that cause differences or becoming different then before

Forces That Influence Changea. External Forces – are those happenings (outside the

organization) that influence the organization as a whole or the top administratorsEx 1. population explosion – additional maternity wardEx 2. legislation that restricts patient from admission – primary nursing’s use of observation roomEx 3. economic forces – training and education contribute to the cost containment and improvement of quality careEx 4. a breakthrough in research – this can alter care given to certain patient

b. Internal Forces – are those that originate primarily from inside operations or are the result of external forcesEx 1. composition of staffing pattern

decrease number of RN and increase number of NAEx 2. productivity need

1:4 ~ 1:6 N ~ P ratioEx 3. quality of working life may need to be improved, such as:

▪ sufficient number of qualified nurses▪ staff development program▪ time spent by nursing personnel with non-nursing duties▪ instability and inflexibility of staff▪ absenteeism among staff

Resistance to Change Factors:

1. If the person to be influenced by a proposed change are not given adequate information regarding the nature of the change

2. When one feels pressured to make a change and will be decreased when one has a “say” in the nature and direction of the change

3. If change is made on personal grounds rather than on impersonal requirements

4. If the change ignores existing alliances within the group5. If there is relative satisfaction with the existing system

Change Process: A Planned Procedure

The process of change is change with a purpose devised to solve problem affecting nurses and their work. It deals with making alterations by choice and deliberation, rather than by indoctrination, coercion, natural growth or accident.

1. Perceive a need for change – sensing an unrest among staff that there is a need for change

2. Initiate group interaction – technique employed is through an informal discussion group, committee or task force group and general meeting to explore a situation2.1. Identify external and internal forces from change2.2. State the problem – this is the critical step in the change process. External and internal forces are examined. Statement of the problem is formulated2.3. Identify constraints – constraints are something that restrict limits or regulate a person and activities2.4. List change strategies or possible approaches to solve the problem. Allow sufficient time for dialogue to occur. Promote a free, open receptive climate. Make no comments about responses. Continue the discussion until all possible solutions are exhausted

2.5. Select the best change strategy or strategies – the leader should be someone other than the HN. In this situation, because he / she is the focal point of the problem. Care must be taken not to invite people who are not skilled in the art of facilitating. Approaches to solving the problem are the priority and analysis is made with regards to the course of action taken2.6. Formulate plan for implementation – if priority number is selected, plan on the strategy. Select representative of the group who are to meet with the HN2.7. Develop or select tools for evaluation

3. Implement the change one step at a time, if possible. The HN must meet with her staff periodically to hear their reaction

4. Evaluate the overall results of the change and make adjustments as necessary; retain, alter, or delete parts or discontinue the process

Strategies for Affecting Change

Whether working with the individual, group, or the system, the HN is sure to be involved with management of change. The following are strategies in managing change:

1. Empirical – Rational Change▪ based on the assumption that people are rational and behave

according to rational self interest▪ it follows then that people are willing to adopt a change if it is

justified and if the person is shown how he / she can benefit from the changeEx. system analysis

operation research implementation of research findings

2. Normative – Re-educative Change▪ are based on the assumption that people act accordingly to

their commitment to socio-cultural norms. Intelligence and rational are not denied but also attitude and values are considered

▪ the manager pay attention to changes in values, attitudes, skills, and relationships in addition to providing informationEx. personnel counseling

training groups or small groups

3. Power – Coercive Change▪ involves compliance of the less powerful to the leadership,

plans, and directions of the more powerful▪ Intelligence, rationality nor values and attitudes are not denied

but they acknowledge the need to use sources of power to bring about changeEx. strikes, sit-in, administration decisions and rulings

negotiations conflict confrontation

Organizing Principle

In designing the organizational structure of the nursing department / service / division, organizational principles must be observed:

1. Unity of Command – although employees may interact with many different employees in the performance of their duties, they should be responsible to only one superior. This is to avoid confusion, overlapping of duties, and misunderstanding

2. Scalar Principle – authority and responsibility should flow in clear unbroken lines from the highest executive to the lowest. Proper definition and delegation of authority and responsibility facilitates the accomplishment of work. In this connection, the following must be observed:a. When responsibility for a particular job is delegated to a subordinate, the latter should have authority over resources needed to accomplish the task

b. When a particular function is delegated to a subordinate, the superior’s own responsibility is in no way diminishedc. When a person is bestowed the authority for action, he is accountable for his actions to the person that bestowed him such. The conscientious nurse exhibits accountability toward her employing hospital, the patient, the government, her profession, and to God

3. Homogenous Assessment or Departmentation – workers performing similar assignments are grouped together for a common purpose. Departmentation specializes activities, simplifies the administrator’s work and maintains effective control.

4. Span of Control – the number of workers that a supervisor can effectively manage should be limited, depending upon the pace and pattern of the working area. If the workers are highly skilled, are working near each other, the number of workers may be increased. At the top level of the structure, a 1:6 ratio of the supervisor-workers is common, while at the base of the organization a 1:10 ratio is common

5. Exception Principle – recurring decisions should be handled in a routine manner by lower-level managers whereas problems involving unusual matters should be referred to higher levels. This will enable subordinates to learn how to make decisions at their own level

Organizational Culture

☻is the sum total of an organization’s beliefs, norms, values, philosophies, traditions, and sacred cows. It is a social system that is a subsystem of the total organization. It has artifacts, perspectives, values, assumptions, symbols, language, and behaviors that have been effective.

☻ it includes communication networks, both formal and informal. They include a status / role structure that relates to characteristics of employees and customers or clients. Such structures also relates to management style, whether authoritarian or participatory. In a health care setting, these structures promote either individually or teamwork. They relate to classes of people and could be identified through demographic surveys of both employees and patients

The basic mission of the organization is part of its culture: employment, service, learning, and research. There is a technical or operational system for getting the work done. Also, there is an administrative system of wages and salaries of hiring, firing, and promoting of report making and quality control of fringe benefits and of budgeting.

The artifacts of an organizational culture may be physical, behavioral (rituals), or verbal (language, stories, myths). Verbal artifacts result from shared values and beliefs. They include traditions, heroes, and the party line, and result in ceremonies that embody rituals. They include ceremonies to reward years of service, annual picnic, the Christmas Party, and the wearing of badges and insignia.

Perspectives are shared ideas and actions. They relate to decision-making methods. For example, social, technical, and managerial systems or subsystems will either support innovation or demand conformity.

Dress, personal appearance, social decorum, and the physical environment are all part of the organizational culture. They will require strict compliance through written or implied rules.

Values are the general principles, ideals, standards, and sins of the organization. Basic assumptions are the core of the culture. They include the beliefs groups have about themselves, others, and the world.

Culture and the Manager

When output or productivity decreases in amount or kind, managers look at the social, technical, and managerial systems that are part of the organization culture. They know that the people behave in accordance with their understanding of the organization’s norms and values. If they want to be successful, they identify these norms and values and apply their efforts in conformity with them.

The successful managers identify and accept the prevailing culture before making changes. It is more difficult to change a culture at the level of basic beliefs, values, and perspectives. It is easier to change technical and administrative systems.

Organizational Climate

☻ is the emotional state shared by members of the system. It can be formal, relaxed, defensive, cautious, accepting, trusting, and so on. It is employees’ subjective impression or perception of their organization. The employees of the major concern to the nurse managers are the practicing nurses. Practicing nurses create, or at the very least contribute to the creation of, the climate perceived by patients. The work climate set by the nurse managers determines the behavior of the practicing nurses in setting the work climate.

Practicing nurses want a climate that will give them job satisfaction. They achieve job satisfaction when they are challenged and their achievements recognized and appreciated by managers and patients. They achieve satisfaction from climate of collegiality with the managers and other health care providers in which they participate in decision-making.

Types of Formal Organizational Structure Classified by Nature of Authority

1. Line Organization☻ oldest, simplest, and most direct type in which each position

has general authority over lower positions in the hierarchy in the accomplishment of the main goals of the agency

☻ connects positions and tasks of each level with those above or below it

☻ it is the backbone of the hierarchy, staff, and functional organization merely supplement the line

☻ the line positions are related to direct achievement of organizational objectives. The manager has the right to give the order, demand, accountability, and discipline violators

2. Staff Organization ☻ is purely advisory to the line structure with no authority to place recommendations into action ☻ provides advisory functions to line supervisors and executives, offers suggestion to aid and not to criticize ☻ they handle details, locate required data and other counsel on managerial problems ☻ they function through influence for they do not have authority to accept, use, modify, or reject plans ☻ they make the line more effective, but organization can function without staff authority, staff assistant, and administrative assistant

3. Functional Organization ☻ permits a specialist to aid line positions within a limited and clearly defined scope of authority ☻ it decreases the line manager’s problem because it permits orders to flow directly to lower levels without attention to routine technical problems by the line positions

Major Forms of Organizational Structure:1. Centralized

♥ control emanates from top down♥ most common in hospital♥ emphasis is concentrated on traditional nursing

Functional arrangement is by such activities as:> transportation> food> budget control> personnel> various specialties in Nursing Service MSP

Advantages:a. It can be highly cost-effective

> The special services are grouped together which eliminates duplication of effort

b. It makes management easier> Managers have to be experts in only a

concentrated range of skills

Disadvantages:a. As the organization becomes large and more complex, the hierarchal arrangement can prove cumbersome

b. The arrangement does not readily adapt to change> Because such decisions have to be made by the higher

managers

2. Decentralized or Participatory Structure> this is a system whereby the large structure is broken down

into smaller units, and authority is delegated to those closer to the majority of workers

> the top management still retains ultimate responsibility for the operations of the various hospital departments but planning and implementation for each department is carried out by the department head who functions autonomously with authority to administer that department 24 hours a day

Advantages:As middle managers, the department head can:a. Reflect their interest and have a voice in decision makingb. Improve quality of care through 24 hours continuityc. Increase communication departmentally and interdepartmentallyd. Problem solved with greater imagination and creativity

Disadvantages:a. The initial cost in developing managers and staff training (turn over

rate under decentralization has been found to be low)b. Communication breakdown – the most serious problem that can

occur. Effective communication cannot occur with the face exchange of information among all the concerned parties

c. Problems with the role clarification can also occur. Question of who has the authority of the authority of the system is not yet well established

3. Matrix System> the benefits of centralized and decentralized control are used.

It provides for both hierarchal coordination in a separate department as well as lateral coordination across department

> it contains three unique sets of relationshipsa. Unit or department manager who heads and balance the dual line of authorityb. The matrix manager who shares workers e.g. project manager in charge of cost controlc. The staff who reports to these 2 different managers

Advantages:a. The management can apply specialized skills to solve a

problemb. Interdisciplinary cooperation is encouragedDisadvantage:a. All members must possess good interpersonal skills to receive

orders from two different bosses

Organizational Chart

Most nursing organizations have made graphic representative of the organizing process in the form of organization chart. These charts usually show reporting relationships and communication channels. Line charts show supervisor and supervisee relationships from top to bottom of the nursing organization. These are hierarchical relationship on which communication channels follow the line of authority to and through the chief nurse executive. Organizational charts are sometimes referred to as schemas.

Two Forms of Schemas or Organizational Charts1. Flat2. Pyramidal

Differentiation Flat Pyramidal

1. Number of levels Fewer More

2. Span of control Broad Narrower

3. Delegation Greater Lesser

4. Authority Decentralized Centralized

5. Accountability Greater Lesser

6. Control Less control of subordinates

More control of subordinates

7. Communication Easier Harder

Five Major Characteristics of Organizational Charts

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 and by what authority

3. Type of Work to Be Performed – this is indicated by labels or description for the boxes

4. Grouping of Work Segment – this is shown by the clusters of work groups (department or single units)

5. Levels of Management – these indicate individual and entire management hierarchy. Hierarchy refers to a body of people or thing organized or classified in pyramidal fashion according to rank, capacity or authority assigned to vertical levels with offices ranked in grades or classes, one above the other

B. StaffingIt 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 of care.

The purpose of all staffing activities is to provide each nursing unit with appropriate and acceptable number of each category of workers to perform the nursing tasks required. Too few or an improper mixture of nursing personnel will adversely affect the quality and quantity of work performed.

Factors Affecting Staffing1. Type, philosophy, and objectives of the hospital and nursing

service

2. Population served – kind of patients served whether charity or pay

3. Number of patients and acuity of their illness – knowledge and ability of the nursing personnel are matched to the actual care needs of patients

4. Availability and characteristics of the nursing staff – education, level of preparation, mix of personnel, number, and position

5. Administrative policies such as rotation, weekend, and holiday off-duties

6. Standard of care desired – should be available and clearly spelled out. Institutions may utilize the ANSAP’s Standard of Nursing Practice

7. Lay-out of the various nursing units and resources available within the department – adequate equipment, supplies, and materials should be provided

8. Budget – amount allotted for salaries, fringe benefits, supplies, materials, and equipment

9. Professional activities and priorities in non-patient activities – involvement in professional organizations, formal educational development, participation in research and staff development

10. Teaching program – extent of staff involvement to teaching activities

11. Expected hours of work per annum of each employee – this is influenced by the 40 hours a week law

12. Pattern of work schedule – traditional 5 days a week, 8 hours per day; 4 days a week, 10 hours per day and three days off; or 3 ½ days of 12 hours per day and 3 ½ days off per week

Patient Care Classification System

The patient care classification system is a method of grouping patients according to amount and complexity of their nursing care requirement, of nursing time and skill they require. This assessment can serve in determining the amount of nursing care required, generally within 24 hours, as well as the category of the nursing personnel who should provide the care.

To develop a workable patient classification system, the nurse manager must determine the following:

1. The number of categories into which the patients should be divided

2. The characteristic of patients in each category3. The type and number of care procedures that will be needed by a

typical patient in each category4. The time needed to perform procedures that will be needed by

the typical patient in each category

Classification Categories

The various units may develop their own way of classifying patient care according to the acuity of their patient’s illness.

Categories or level of care of patient, nursing care hours needed per patient per day, and ratio of professional to non-

professional

Level of Care NCH needed / pt / day

Ratio of prof. to non-prof.

Level I: self care or minimal care

1.5 55:45

Level II: moderate or intermediate

3 60:40

Level III: total or intensive care 4.5 65:35

Level IV. highly specialized 6 70:30

or critical care 7 or higher 80:20

Percentage 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.

Percentage of Patients at Various Levels of Care Per Type of Hospital

Type of Hospital Minimal Care

Moderate Care

Intensive Care

Highly Sp. Care

Primary Hospital 70 25 5 -

Secondary Hospital

65 30 5 -

Tertiary Hospital 30 45 15 10

Special Tertiary Hospital

10 25 45 20

Computing for the Number of Nursing Personnel

When computing for the number of nursing personnel in the various nursing units of the hospitals, one should ensure that there should be sufficient staff to cover all shifts, off-duties, holidays, leave, absences, and time for staff development programs.

The Forty-Hour Week law, Republic Act 5901, provides that employees working in hospitals with 100-bed capacity and up will work only 40 hours a week. This also applies to employees working in agencies with at least one million population. These employees working in agencies located in communities with less than one million will work forty-eight hours a week and therefore will get only one off-duty a week.

Total Number of Working and Non-working Days and Hours of Nursing Personnel Per Year

Rights and Privileges Given Each Personnel / Year

Working Hrs / Week

40 Hrs 48 Hrs

1. Vacation Leave 15 15

2. Sick Leave 15 15

3. Legal Holidays 10 10

4. Special Holidays 2 2

5. Special Privileges 3 3

6. Continuing Education Program for Professionals

3 3

7. Off-duties as per RA 5901 104 52

Total Non-working Days / Year 152 100

Total Working Days / Year 213 265

Total Working Hours / Year 1,704 2,120

Relievers Needed

To compute for relievers needed, the following should be considered:

a. Average number of leaves taken each year……………15a.1. Vacation Leave……………………………..10a.2. Sick leave…………………………………….5

b. Holidays…………………………………………………….12c. Continuing Education……………………………………....3d. Special Privileges as per CSC MC #6 series 1996……..3

Total Average Leave 33 days

It will be noted therefore that although an employee is entitled to 15 days sick leave and 15 days vacation leave, 12 holidays, 3 days for continuing education, plus 3 days of special privileges or 48 days total, he / she gets only an average of 33 days leave per year.

To determine the relievers needed, divide 33 (the average number of days an employee is absent per year) by the number of working days per year each employee serves (whether 213 or 265). This will be 0.15 per person who works 40 hours per week and 0.12 per person for those working 48 hours per week.

Multiply the computed reliever per person by the computed number of nursing personnel. This will give the total number of relievers needed.

Distribution by Shifts

Studies have shown that the morning or day shift needs the most number of nursing personnel (45% ~ 51%), for the afternoon shifts (34% ~ 37%), and for the night shifts (15% ~ 18%). In the Philippines, the distribution usually followed is 45% for the morning shift, 37% for the afternoon shift, and 18% for the night shift.

Staffing FormulaTo compute for the staff needed in the inpatient units of the hospital, the following steps are considered:

1. Categorize the number of patients according to the level of care neededa. Multiply the total number of patients by the percent of patients at each level of care (whether minimal, intermediate, intensive, or highly specialized)

2. Find the total number of nursing care hours needed by the patients at each categorized levela. Number of patients at each level by the average number of nursing care hours needed per dayb. Get the sum of the nursing care hours needed at the various level

3. Find the actual number of nursing care hours needed by these given number of patientsa. Multiply the total number of nursing care hours needed per day by the total number of days in a year

4. Find the actual number of working hours rendered by each nursing personnel per yeara. Multiply the number of hours on duty per day by the actual working days per year

5. Find the total number of nursing personnel neededa. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per yearb. Find the number of relievers – multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for those working 48 hours per week)c. Add the number of relievers to the number of nursing personnel needed

6. Categorize into professionals and non-professionalsa. Multiply the number of nursing personnel according to the number of professionals to non-professionals

7. Distribute by shifts

To illustrate: Find the number of nursing personnel needed for a 100-bed capacity tertiary hospital

1. Categorize the patients according to level of care needed

100 patients x 0.30 = 30 patients needing minimal care 100 patients x 0.45 = 45 patients needing moderate /

intermediate care

100 patients x 0.15 = 15 patients needing intensive care 100 patients x 0.10 = 10 patients needing highly

specialized care

__________________________________________________ Total No. of Patients =100

2. Find the number of nursing care hours needed (NCH) by the patient at each level of care

30 patients x 1.5 (minimal care) = 45 NCH needed / day45 patients x 3.0 (moderate care) = 135 NCH needed / day15 patients x 4.5 (intensive care) = 68 NCH needed / day10 patients x 6.0 (highly sp. care) = 60 NCH needed / day

__________________________________________________ Total NCH needed per day = 308

3. Find the total number of NCH needed by 100 patients per year

308 NCH / day x 365 days / year = 112,420 NCH / year

4. Find the actual working hours rendered by each nursingpersonnel per year

8 hrs / day x 213 working days / yr = 1,704 working hrs / yr

5. Find the total number of nursing personnel needed

a. 112,420 NCH / year = 66 nursing personnel 1,704 working hrs / yr

b. 66 x 0.15 = 10 relievers

c. 66 + 10 = 76 total nursing personnel needed

6. Categorize to professional and non-professional personnel. Since this is a tertiary hospital, the ratio of professional to non-professional is 65:35

76 x 0.65 = 49 professional nurses76 x 0.35 = 27 nursing attendants (non-professional

nurses)

7. Distribute by shifts

49 nurses x 0.45 = 22 professional nurses on morning shift

49 nurses x 0.37 = 18 professional nurses on PM shift49 nurses x 0.18 = 9 professional nurses on night shift

27 nursing attendants x 0.45 = 12 nursing attendants on morning shift

27 nursing attendants x 0.37 = 10 nursing attendants on PM shift

27 nursing attendants x 0.18 = 5 nursing attendants on night shift

It should be noted that the above personnel are only for Inpatient. Therefore, additional personnel shall be hired for those supervisory and administrative positions and those in special units such as Operating Rooms, the Delivery Rooms, Emergency Rooms, and Outpatient Departments. Although roomed-in babies in the mother’s unit are not included in the patient census, they are given service such as bathing, changing of diaper, and the like. Additional staff should be provided for the babies.

Hospitals now are also centers of wellness. Therefore, additional personnel shall be needed for health education classes both the inpatient and outpatient units.

C. Scheduling♥ is a timetable showing planned work days and shifts

for nursing personnel

The objective in scheduling is to assign working days and days-off to the nursing personnel so that adequate patient care is assured, a desirable distribution of off-duties is achieved, the individual members of the nursing are treated fairly and that they know in advance what their schedules are.

Factors Considered in Making Schedules1. Different levels of the nursing staff – an adequate

mix of nurses and nursing attendant should be observed so that they only assume duties they are legally responsible for, according to their position, education, training, and experience

2. Adequate coverage for 24 hours, seven days a week – afternoon and night shift’s requirements for staff are usually lower than in the morning shift. Also, Saturdays and Sundays tend to have lower requirements since there are lesser medical rounds, fewer medical orders, and lower patient census

3. Staggered vacations and holidays – since everybody can enjoy the holiday off on exactly the same day that they occur, schedules for holidays are staggered at least once a month. Vacation is likewise staggered to ensure adequate coverage at all times. Weekends are scheduled in such a way that everyone gets a fair share of at least one weekend off a month

4. Long stretches of consecutive working days – this should 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. The nursing personnel should get their fair share of these shifts including the “relief” duty for the three shift periods

5. Evening and night shifts and floating – there are some 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. The nurse may feel insecure in the area where she is asked to help or relieve. Disruption in the unity of work groups may occur and this may cause job dissatisfaction and high turnover rates. This is especially true if the nurse does not have the necessary skill and knowledge that the unit may require

In order to minimize problems as a result of emergency assignment, cross-training and / or orientation to complementary units is advised. During orientation to the Nursing Service, new nurses are told of the possibility that they may be asked to relieve in areas of the hospital other than their regular assignments. Emphasis however is given to the fact that cross-training enhance their skills and capabilities aside from meeting the needs of the service.

Assessing Scheduling System

While scheduling may vary from agency to agency, the scheduling system must function smoothly in terms of:

1. Ability to cover the needs of the unit. A minimum required number of staff to meet the nursing needs of the patients on the units at all shifts

2. Quality to enhance the nursing personnel’s knowledge, training, and experience. While being permanently assigned to one unit enhances skills in caring for a particular kind of patient (whether obstetrical, medical, surgical, or pediatrics) many nurses who have future plans of going into teaching or specialization or even working abroad, would prefer to experience being assigned to various units first before settling down to a particular unit of their choice

3. Fairness to the staff. All nursing personnel should get a fair share of weekends, holiday offs, rotation patterns for the whole year including assignment to “difficult” or “light” or “undesirable” units or shifts

4. Stability. The nursing personnel should like to know in advance their schedule of assignment so that their personal schedules (whether home, social, and civic responsibilities) are in harmony with each other

5. Flexibility. Flexibility means the ability to handle changes brought about by emergency leaves, scheduled or unscheduled leaves of absence

Types of Scheduling

There are several types of scheduling which are:1. Centralized Schedules – one person, usually the Chief Nurse or

her designate, assigns the nursing personnel to the various units of the hospital. This includes the shifts of duty and off-duties

2. Decentralized Schedules – one person, usually the Chief Nurse or her designate, assigns the nursing personnel to the various nursing units. The shift and off-duties are arranged by the Supervising Nurse or Head or Senior Nurse of the particular units

3. Cyclical Schedules – the cyclical schedule covers designated number of weeks called the cycle length and is repeated thereon. It assigns the required number of nursing personnel to each nursing unit consistent with the unit’s patient care requirements, the staff preference, their education, training, and experience

The following scheduling variables should be considered:

a. Length of scheduling period whether 2 to 4 weeksb. Shift rotationc. Weekends offd. Holidays offe. Vacation leavesf. Special days (birthdays, wedding anniversary, etc.)g. Scheduled events in the hospital (training programs, meetings,

etc.)h. Job categoriesi. Continuing Professional Education (CPE) programs

Advantages of Cyclical Schedule:1. It is fair to all. Favoritism is minimized as all nursing personnel gets

their fair share of rotation to the various shifts2. It saves time as the schedule does not have to be redone every

week or two3. It enables the employees to plan ahead of their personal needs

preventing frequent changes in schedule4. Schedule leave coverage such as vacation, holidays, and sick

leaves are more stable5. Productivity is improved

D. Developing Job DescriptionA job description is a statement that sets the duties and

responsibilities of a specific job. It includes the needed characteristics or qualifications of the individual to perform such duties successfully. It is an important management tool to make certain that responsibilities are wisely delegated, work efficiently distributed, talents fully used, and morale maintained.

Contents of Job Description:1. Identifying Data: Position Title: Staff Nurse Department: Nursing Supervisor’s Title: Head / Senior Nurse

2. Job Summary: This will include the essential feature of the job that distinguishes it from the others

3. Qualification Requirements: Education preparation, training, and experience necessary to fill the position

4. Job Relationships – source of workers5. Specific and Actual Functions and Activities

Uses of Job Description:

1. For recruitment and selection of qualified personnel2. To orient new employees to their job3. For job placement, transfer, or dismissal

4. As an aid in evaluating the performance of an employee. Objective evaluation benefits both the employer and employee

5. For budgetary purposes. Salaries are equated with the level of responsibilities and skills defined in the job description and thus become the basis for improvement and / or further action

6. For determining department functions and relationships to help define the organizational structure. One of the organizing principles is grouping employees performing similar function to avoid duplication or overlapping of functions and improves workflow

7. For classifying levels of nursing functions according to skill levels required. This enables nursing administrators to determine whether a realignment of responsibilities is indicated

8. To identify training needs9. As basis for staffing10. To serve as channel of communication

III. DIRECTINGAfter the manager has planned, organized, and staffed,

he / she must direct personnel and activities to accomplish the goals of the organization. Knowledge of one’s leadership style, managerial philosophy, sources of power and authority, and political strategies are important. To get the work done by others, the manager must deal with conflict and motivate and discipline staff: all of these tasks require good communication skill and assertive behavior.

Direction – it is the issuing of assignments, orders, and instructions, that permits the worker to know what is expected of him / her, and the guidance and overseeing of the worker so that he / she can contribute effectively to the attainment of organizational objectives – it actuates efforts to accomplish goals

Purposes of Directing:1. To achieve objectives in the manner it was planned and organized2. To accomplish assignment given by the management3. To regulate the activities4. To contribute effectively and efficiently to the attainment of the

organization

Elements of Directing:A. Delegation● is the process by which a manager assigns specific tasks / duties to

workers with commensurate authority to perform the job

● is a means of allocating and decentralizing authority, imposing responsibility and accountability and assigning tasks down to the lowestpossible level at which there is sufficient competence and information for effective decision making on task performance

A.1. Basic Concept of DelegationResponsibility – obligation to do what is askedAuthority – the right to decide and commandAccountability – responsible / answerable for one’s actions

A.2. Steps to Better Delegation:1. Think before you delegatePart of planning to delegate is determining what to accomplish and how well you expect each person to do. You must decide specifically what you can and cannot delegate.

Matters that cannot be delegated:a. Overall responsibility, authority, and accountability for satisfactory completion of all activities in the unit. Nurse management cannot be absolved with poor performance of subordinates by blaming themb. Authority to sign one’s name is never delegated – the worker that performed the task should be the one to sign it

c. Evaluating the staff and / or taking necessary corrective or disciplinary actiond. Responsibility of maintaining morale or the opportunity to say a few words of encouragement of the staff especially the new ones. Showing confidence in the workers boost their morale and build up their self confidencee. Too technical jobs and those that involved trust and confidence

2. Plan and organize until activities are in logical orderDecide what is most important and therefore what must be done first. Then arrange the rest of the work in order of importance and available time.

3. Determine why you are delegating certain action activities to a particular personPerhaps the individual needs to acquire knowledge and skills or has asked for certain assignments.

Reasons why managers fail or refuse to delegate:a. Lack of confidence in their staffb. They feel that they can do the task better and fasterc. They are too busy and enough time is needed to teachd. They resent necessary interruption to explaine. They fear of losing control if some of their duties are delegated

4. Be specific when you delegateLet people know exactly what they are responsible for very often, information should be out in writing, use feedback to ensure each person understand what is to be done.> Direction must be complete, understandable> Speak distinctly and slowly> Avoid giving too many direction at one time> The wordings of direction indicates its importance

5. Be willing to accept the risks and accountability for the actions of othersIndividuals are obligated to carry out the delegated tasks and are accountable for their own performance, she is accountable to her supervisors not only for her own actions but also the final result of all the services rendered by individual staff members.

6. Keep informed after you delegateGet periodic reports, but also examine results of the work, both in the progress and upon completion. When something is wrong, discuss it with the person and if the work is done well, you must give recommendation.

B. Supervision> is a process of getting the work done through others which is

done properly, on time, and within the budget

Supervision is…What When Who How WhyPlanning SkillfullyDirecting SafetyGuiding CorrectlyTeaching Patiently so that every CompetentlyObserving Continuously Every Tactfully worker can According toEncouraging worker Fairly do his / her his / herCorrecting work and capabilityCommenting give any care & limitationEvaluating of work

The purposes of supervision are to inspect, to guide, evaluate, and improve work performance of employees through a criteria against which the quality of work production and utilization of time and resources are made.

Nurse manager provides guidance and direction to workers to achieve the goals and objectives of the institution and that of the nursing unit.

The atmosphere created by the supervision as he / she makes his / her rounds or talks to the staff will determine to a large extent the acceptability of the comments, criticism and / or corrections he / she makes.

Given a soft, courteous manner, these will be taken willingly and be accepted as a challenge to improve performance. Given a harshly, especially in public, builds up resentment, ill-will, and poor quality of work.

Emphasis of supervision is getting the work done according to definite policies and procedures.

Types of Supervision:1. Autocratic Supervision

> supervisor plans all the work> makes all the decision> issues commands to workers who are to obey without question> regards individual as machine and not as human being> more on direction and inspection

2. Democratic Supervision> emphasis is instead of getting the work done, is now placed on

helping the individual to do the work better> there is a greater degree of freedom wherein workers are given

a voice in setting up work goals and planning method for reaching them

> teaching and helping people develop new skills and greater understanding of their job

Supervisor’s challenge – is to create a climate in which spontaneous teamwork is possible and harmonize the goals of the individual with those of the group

Importance of Supervision:

1. It is concerned with people as well as the work area, working condition, and work itself> supervision must try to provide as much as possible suitable working condition not only physical surroundings but also good atmosphere in which the staff works (environment where people work should give them a feeling of freedom and the desire to do the best they can)

2. It is also concerned with the planning, execution, and evaluation of work> the staff should also have the part in this planning and help to

perform and evaluate their own work

3. Orientation, training, and guidance of individual according to their needs are directed toward utilization of their capabilities and the development of new skills

Supervisor should be acquainted with every individual and must be able to stimulate each individual the desire for self improvement. If the person recognizes his / her needs for improvement, the leader must supply the necessary help and instruction at the same time guide the worker in acquisition of acceptable attitude and interests and good working habits.

C. Coordination

Coordination unites personal and services to a common objective. Synchronization 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.

At the unit level, supervising nurse coordinate their work with other departments, services or units utilizing clearly defined policies, standard operating procedures, and guidelines through proper channel of communication.

Types of Coordination:1. Intradepartmental – coordination is usually within the

department2. Interdepartmental – coordination between one department to

another 2.1. Coordination with Medical Services

All nurses should know the medical staff in their respective units, their services, and scheduled time of medical rounds. On the other hand, nurse should know the patients in the unit, their diagnosis, actual conditions, medical plan or care, and treatments so that they can participate intelligently in planning the care of each individual patient.

Too often, nurses just become “implementers of care”. They do not actively involve themselves in planning the care of patients. They must remember that in carrying out written prescriptions of medications and treatments, they must exercise reasonable judgment and care to avoid errors or misinterpretations.

2.2. Coordination with Administrative Service> pertains to resources both human and material. At the unit

level, nurses participate in budgeting planning for staffing, adequate facilities, and material resources

> repairs and maintenance of equipments are made in appropriate formsUse of logbook – date and equipment should pass thru the administration services

> overstocking of supplies should be avoided to prevent wastage

2.3. Coordination with the Laboratory Service Request for laboratory examinations should be given specific instruction relevant to the examination to be done such as fasting blood sugar. Laboratory results are properly filled with latest exam on top for easy references.

2.4. Coordination with the Radiology Service

Request for x-ray examination are likewise forwarded to x-ray services for proper scheduling and specific instruction if needed.

2.5. Coordination with Pharmacy Service

Policies regarding procurement of drugs are formulated jointly by the administrative, medical and nursing services with the pharmacy.

There are some hospitals that clinical pharmacist in their units are manned by clinical pharmacist. They prepare medicines prescribed by the physician and these are administered by the nurse in the unit.

2.6. Coordination with the Dietary ServicesThe head nurse is responsible for forwarding the diet list

of the patients in the unit, taking into consideration prescribed, special diets, patients’ idiosyncrasies for food allergies, food preferences, and religious restrictions.

2.7. Coordination with the Medical Social Service>Nurse’s coordination with the medical social services

through referral of patient with psycho-social-economic problems

h. Coordination with Medical Records ServicesNurses are responsible for accurate documentation and

completeness of patient’s chart including their safety and confidentiality.

3. Extra-installationCoordination is from hospital to another agency. Patients

are often referred to the health center nearest their residence upon discharge from the hospital for follow up.

D. Communication

Is the process whereby a message is passed from sender to receiver with the hope that the information exchange will be understood as the sender intended.

Elements of Communication1. Sender2. Message3. Receiver

If one of these three elements is missing, no communication can take place

Channels of CommunicationCommunication channels used by the manager may be: Upward – the manager is a subordinate to a higher management .

Needs and wants are communicated upward to the next level in the hierarchy

Downward – the manager relays information to subordinates. This is a traditional form of communication in organizations and helps coordinate activities in various levels of the hierarchy

Horizontal – managers interact with others on the same hierarchical level as themselves who are managing different segments of the organization

Diagonal – the manager interacts with personnel and managers of other departments and groups, such as physicians, who are not on the same level of the organizational hierarchy. Although these people have no formal authority over the manager, this communication is vital to the organization’s functioning. Diagonal communication tends to be less formal than other types of communication.

Grapevine – the most informal communication network. Communication flows haphazardly between people at all hierarchical levels and usually involves three or four people at a time. Grapevine communication is subject to error and distortion because of the speed at which it passes and because the sender has little formal accountability for the message

Interpersonal Communication in a Multicultural Workplace

Because it is impossible for the individual manager to communicate face to face with each member in a large organization, managers must develop other interpersonal communication skills. These skills include nonverbal communication, verbal communication, and listening skills.

The following is a partial list of nonverbal clues that can occur with or without verbal communication: Space Environment Appearance Eye Contact Posture Gestures Facial Expression Timing Vocal Clues such as tone, volume, and inflection

Verbal Communication SkillsHighly developed verbal communication skills are

critical for the leader / manager. One of the most important verbal communication skills is the art of assertive communication. Assertive behavior is a way of communicating that allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another person’s rights.

Rights and Responsibilities of the Assertive Person

Rights ResponsibilitiesTo speak up To listenTo take To giveTo have problems To find solutionsTo be comforted To comfort othersTo work To do your bestTo make mistakes To correct your mistakesTo laugh To make others happyTo have friends To be a friendTo criticize To praiseTo have your efforts rewarded To reward others’ effortsTo be independent To be dependableTo cry To dry tearsTo be loved To love others

IV. CONTROLLING

> is an ongoing function of management occurring during planning, organizing, and directing activities

> it is assessing / regulating performance in accordance with the plans that have been adopted, the instructions issued, and the principles established

> is the process by which managers assures that the actual expenditures and activities conform to plan

The controlling process plays an important role in identifying opportunities for improvement, comparing performance against set standard, providing information about how well processes and people are doing so that they can be motivated to perform better in the future.

Reasons for Conducting Evaluation

There are some reasons why evaluation is needed and why it plays an important role in quality and productivity improvement

1. Ensure quality nursing care is provided2. Set sensible objectives and comply with them3. Provides standards for establishing comparisons4. Provides visibility and a means for employees to monitor their

own performance5. Highlights quality problems and determine the areas that require

priority attention6. Gives an indication of the costs of poor quality7. Justifies the use of resources8. Provides feedback for improvements

Evaluation Principles

In order the employees are evaluated accurately and fairly, certain principles must be observed.

1. The evaluation must be based on the behaviorally oriented performance standard of the position occupied> the employee is presented as objectives to strive for and

achieve, therefore performance must be based on these2. In evaluating performance, adequate samples and representative

samples of the employee’s behavior should be observed> usual and consisted behavior should be evaluated instead of an

isolated or a typical behavior3. A copy of the job description, performance standards and

evaluation form are given to the employee before the scheduled evaluation conference for review so that discussion by the rater and the rate will be from the same frame of reference

4. Documentation of an employee’s performance appraisal should include both satisfactory and those needing improvement with specific behavioral instances to clarify these evaluative comments

5. Prioritize areas needing improvement as the worker attempts to upgrade his / her performance

6. Schedule and conduct the evaluation conference at a time convenient for both the rater and the ratee, in pleasant surrounding with ample time for discussion of the evaluation

7. The evaluation report and conference should be structured that it can be perceived and accepted as a means of improving job performance

Characteristics of an Evaluative Tool

1. It should be objective> Objectivity means that the evaluation tool is free from bias

2. It should be reliable> reliability refers to the accuracy or precision of the tool that if

administered twice, it will produce the same results

3. It should be valid> validity refers to the relevancy of the measurement to the

performance of the employee

4. It should be sensitive> sensitivity means the ability of the measured fine line

differences among the criteria being measured

Basic Components of Control ProcessThe control process may be divided into the following basic components:

1st. Establishing Standards for Measuring Performance> standards are desirable sets of conditions and performance

essential in ensuring the quality of nursing care services which are acceptable to those instrumental responsibilities in setting / maintaining them

3 Types of Standards

1. Structure – refers to the basic support components of nursing – are those that focus on the structure or management system used by the agency to deliver care which includes the number and categories of nursing personnel, their education, personal and professional qualities and proficiencies, their functions and physical facilities and equipment

2. Process Standards – refers to the desired effects as specified clinical manifestations, mobility levels, patient knowledge or self care skills – refers to decisions and actions of the nurse relative to the nursing process which are necessary to provide good nursing care. These include assessment, plan of care, and nursing intervention

3. Outcome Standards – are designed to measure the results of care provided in terms of changes in the health status of clients served; changes in the level of their knowledge, skills and attitudes; and satisfaction of those served including the members of the nursing / health team

2nd. Establishing Objectives and Methods for Measuring Performance> measurable criteria and objectives specific to giving nursing care

must be developed to evaluate process and outcome> establishment of objectives provides clear direction and

communication of expected level of achievement> there should be full commitment in the form of a performance

contract> the greater the participation of the employee, the greater the

motivation achieved agreed upon performance objectives; therefore should be participatively developed, be challenging but attainable, be clear of statements or performance expectation and lie within the individual’s scope of control

Most Commonly Used Methods for Measuring Nursing Care

1. Task Analysis> actions and procedures such as written guides, schedules,

rules, records, and budgets are inspected> are used to determined issues: how long it takes a nurse to

perform a procedure and how many members are needed for a specific number of patientTools Used:1.1. Time Studies1.2. Checklists

2. Quality Control> is essentially the activities and techniques employed to

achieve and maintain the quality of a product service or processes

> conceived and assessment of the level of nursing care provided and its effects on the patient through process and outcome

> it includes monitoring activity but it is also concerned with finding and eliminating causes of quality problems so that the requirements of the customer are continuously met

> level of nursing care provided is assessed in quality control> effects of the nursing care on the patient

Focus:2.1. patient / client / family satisfaction of nursing care2.2. facilities and climate2.3. methods used to deliver nursing care2.4. outcome of nursing care

3rd. Measuring Actual Performance> measurement of performance is an on-going repetitive process with

the actual frequency dependent on the type of activity being measuredExample: nursing care of patient is monitored continuouslyformal performance appraisal – done only twice a year

> measurements may be scheduled in advance or may be done at periodic but unannounced intervals or may occur at random

> The purpose of measurement should be clarified and the staff should be informed on the tasks and levels that need attention

4th. Comparing Results of Performance with Standards and Objectives

> is one of the easiest steps in the control process> if performance matches the standards and objectives, managers are

assured that the needs of patients are being met> if performance is contrary to standards and objectives set, then

necessary actions are needed

5th. Reinforcing Strengths or Successes and Taking Corrective Actions as Necessary

> positive feedback stimulates motivation, consistently high performance, and growth of the employee. Corrective actions are applied to improve performance

Responsibility of Head / Senior NurseBeing the first line supervisor, he’s / she’s in best position

to know whether their staff nurses are performing satisfactorily in their work. Their influence can be dramatically in promoting quality care to patients.

1. They have the responsibility to instruct subordinates in the appropriate methods and procedures in providing nursing care

2. Inform them of the likely causes of errors or defects and the preventive measures necessary

3. Initiate and facilitate any steps necessary to improve methods, equipments, materials, and conditions in the work area for which they are responsible

4. Draw attention to existing or potential quality problems and report all errors and defects waste

5. Suggest ways in which risks or error or quality problems may be reduced

6. Assist in training new staff particularly by setting as good examples

Performance Appraisal> is a control process in which employees’ performance are

evaluated against standards. It is the most valuable tool in controlling human resources and productivity. It evaluates how well the nursing personnel have performed during a specific period of time

Purposes of Performance Appraisalare used to:

1. Determine salary standards and to merit increases2. Select qualified individuals for promotion or transfer

3. Identify unsatisfactory employees for demotion or termination4. Make inventories of within the institution5. Determine training and developmental needs of the employees6. Improve the performance of work groups by examining,

improving, and correcting interrelationship between members7. Improve communication between supervisor and employee and

to reach an understanding on the objectives of the job8. Establish standards of supervisory performance9. Discover the aspirations of employees and to reconcile this with

the goals of the institution10. Provide “employee recognition” for accomplishments11. Inform employees “where they stand”

Methods of Measuring PerformanceThese may be done through:

1. Informal Appraisal which consists of:1.1. incidental observation of work performance while engaged in performing nursing care1.2. responses made by workers during conferences1.3. noting the interaction of workers with clients, their families, visitors, and co-workers

2. Formal Appraisal● is accomplished regularly and methodically by collecting objective

facts that can demonstrate the difference between what was expected and what was done2.1. Essay

● the appraiser writes a paragraph or more covering the worker’s strengths, weaknesses, and potentials

● in most situations, particularly the managerial positions, essay appraisals carry significant weight on the presumption that an honest statement from someone who knows the person well is fully valid

● its drawback is in its variability in length and content and is more difficult to compare because it touches on different aspects of a worker’s performance

● It may also concentrate on those areas of performance which the supervision entertains strong feelings

2.2. Checklists● contains compilation of all nursing performance expected

of a worker The appraiser’s task is to place a checkmark in the appropriate column whether the worker does or does not show the desired behavior

● a quick glance at the completed forms would reveal the overall quality of the nurses’ performance

2.3. Ranking● in simple ranking, the evaluator ranks the employees

according to how he / she talked with co-workers with respect to certain aspects of performance or qualifications

Example: Nurse A may rank lowest in educational requirements for the next higher position among the five candidates for promotion but may rank first in clinical proficiency while Nurse B may rank first in educational qualifications but rank third in clinical proficiency.

2.4. Rating Scales it includes a series of items representing the different tasks

or activities in the nurse’s job description or the absence or presence of desired behavior and the extent to which these are possessed Examples: 2.4.1. On a scale of 0-5, indicate the degree of the

nurse’s skill in assessing the patient’s condition where each of the corresponding number means:

5 – Excellent 4 – Very Satisfactory 3 – Moderately Satisfactory or Average

2 – Minimally Satisfactory 1 – Unsatisfactory

2.4.2. A descriptive graphic rating scale may be used to describe punctuality in reporting for duty, such as: 1 – Often times late 2 – Sometimes late 3 – Always reports on time

2.5. Forced Choice Comparison● the evaluator is asked to choose from the statements that

best describe the nurse being evaluated. The items are so grouped that the evaluator is forced to choose from favorable as well as unfavorable statements and to counterpart the tendency towards leniency of some evaluators

Example: Select from the following statements which will best describe the nurse being evaluated and the least that describes him / her 1. respects the ideas of others 2. communication ability limited 3. even-tempered 4. capable of enduring long hours of hard work 5. tends to be loner

2.6. Anecdotal Recording● describes the nurse’s experience with a group or a person or in

validating technical skills and interpersonal relationship● it should include:

2.6.1. description of the particular occasion 2.6.2. delineation of the behavior noted including who, what, why, when, where, and how 2.6.3. evaluator’s opinion or estimate of the incident or behavior

The descriptive notes are organized to get impressions of the overall behavior in a given period of time. Caution should therefore be taken against tendency not to give the negative behavior more often than the positive behavior.Example: Miss A was on her way to lunch. She passed by a client who was reaching for his food tray but was having a hard time as this was placed on his left side. His right hand has an IV line. Miss A stopped, positioned the food tray comfortably and assisted the patient to eat although she herself was late for lunch. Miss A acted in a commendable manner.

Quality Assurance problem solving process that systematically assesses the quality

of care and corrects any defect that is observed is the estimation of the degree of excellence patient health

outcomes and in activity and other resource outcomes (William Some) is the measurement of the actual level with

service provided plus the efforts to modify when necessary the provision

Purpose of Quality Assurance to assure the consumer of a specified degree of excellence

through continuous measurement and evaluation

Purpose of Quality Assurance Program in Nursing is to measure and improve the quality of nursing delivered in the

agencyQuality – is the degree of excellenceAssurance – formal guarantee of a degree of excellenceQuality Assurance – assures patients of an acceptable standard of care that will be provided to them

To provide quality service – the workers must accept responsibility that they have to do the right job, right the first time and everytime. They have to accept that quality is everyone’s responsibility

Quality Assurance describes all attitudes related to establishing, maintaining, and assuring high quality care for patients which includes assessment of patient care and correction of identified problems.

Efficiency is concerned with the percentage resources actually used over the resources planned to be used.Performance Evaluation – focuses on the worker – it asks question how well the worker is satisfying the requirements of their job within the organizationQuality Assurance – focuses on the care and the service the patient received, rather than how well the professional is performing the duties that the position requiresPatient is the best, sometimes the only judge of interpersonal aspects of care. (Example: empathy and communication)Patient Satisfaction – is an essential goal of health care and therefore a part of quality of care

Methods of Quality Assurance

1. Patient Care Audits1.1. Concurrent, Open Chart or Benedicter

● is one in which patient care is observed and evaluated● a review of the patients’ charts while the patients are still

confined in the hospital● observation of the staff as patient care is given● inspection of patient and / or observation of the effects of

patient care where the focus is on the patient (done during rounds or patient interview)

1.2. Retrospective Audits, Phaneuf or Closed Chart● is one in which patient care is evaluated through:

1.2.1. a review of discharged patient’s charts 1.2.2. questionnaire sent to or interviews conducted on discharged patients

2. Peer ReviewPeers (employees of the same profession, ranks, and setting) may do patient care audits evaluating another’s job performance against accepted standards.

3. Quality Circles● is one of the most publicized approaches to quality introduced by

Japanese● a group of workers doing similar work meets regularly, voluntarily, in

normal working time, under the leadership of their supervisor; to identify, analyze and solve work-related problems and so recommended solutions to management where possible quality, circle members should implement the solutions themselves

Nursing Audit Committee● is created composed of a representative from all levels of the

nursing staff1. Member of the training staff2. Supervising nurse3. Head / Senior nurse4. Staff Nurse

In smaller hospitals:Chief Nurse may be a member of the committeeAssistant

The audit team usually designates a day within the week to be the audit day. However, the nurses do not know which unit will be audited. This way, the activities in the units are not deliberately changed because they know they are being observed. The audit team utilizes the developed process or outcome criteria that evaluate nursing care. The staff nurse or the senior nurse participate during the audit and are shown the findings both the strong and weak points. They sign the audit form to confirm the authenticity of the findings of the audit team.

Utilization of Results● the nursing staff in the unit is given a feedback on the results

of the quality assurance study. This may be oral or written and is directed to the staff who administer the care or their immediate supervisors

Positive feedback reinforces desirable performance. Consistent positive findings deserve a commendation from the nursing service.

Negative feedback should tactfully be conveyed into a face to face situation so that clarifications can be made on the assessment made. Negative findings have implications for review of existing standards in the unit for closer supervision for designing system to remedy identified problems and staff development.

Control of ResourcesPart of the control process is the periodic review of the

utilization of materials and supplies in the various nursing units.Consumption of supplies and materials should be

proportionate to the number of patient to be served be these in the form of dressing, treatment done, injection given, etc.

Requisition of / or stocking a large number of supplies and materials should be avoided to prevent pilferage (steal), misuse or spoilage. A large order is merited (deserve) when there is a large demand.

The head / senior nurse must know the average daily usage and the time required to receive supplies from the time these were requisitioned.

Ordering the correct materials and checking inventory levels prevent stocking items that are not frequently used.

All equipment’s utilization report is made including frequency of breakdown.

This will help evaluate the quality of equipment purchased, the way it is handled, used, and operated.

Preventive maintenance requires regular inspection of equipment to prevent breakdown and / or to detect needed repairs.

Monthly linen inventory is done to determine the adequacy of linen issued and utilized in the various units. Measures should be instituted to prevent losses.

Absences due to leaves whether scheduled or not, should be analyzed as these may have implications for staffing. Provisions for relievers should be included in the staffing pattern to maintain quality service.

Discipline

Part of the controlling process in management is discipline. In the past, discipline connotes rigid obedience to rules and regulations, the violation will result to positive actions.

Today, discipline is regarded as a constructive and effective means by which employees take personal responsibility for their own performance and behavior. This is termed as self-discipline.

Factors That Influence Self-Discipline Are:

1. A strong commitment to the vision, philosophy, goals, and objective

● a strong commitment results in obsession and teamwork which in turn encourages greater conformity to expected norms of conduct within the organization

2. Laws that governs the practice of all professionals and their respective Codes of Conduct

● among government employees, the CS Rules and Regulations as per P.D. 807 and the Code of Conduct for Public Officials R.A. 6713 are also to be complied with

3. Understanding the rules and regulations of the agency● all employees are oriented to the rules, regulations, and policies of

the agency. Some organizations give their employees a handbook containing these and the possible sanctions for their infractions

4. An atmosphere of mutual trust and confidence● self-discipline thrives best in an atmosphere of trust and

confidence between superiors and subordinates● the subordinates will consult their superiors with their problems

without fears● the superiors trust their subordinates will do their best performing

their job without being “snoopervised”

Disciplinary Action● any employee charged for break of the rules and regulations, policies,

norms of conduct shall be given the corresponding due process● there must be existing rules of conduct governing his / her behavior

and an actual violation of such rule. The employee charged must be notified in writing about the violation. He is given the right to be counseledDisciplinary action should be progressive in nature, such as:1. Counseling and Oral Warning

● counseling and oral warning is best given in private and in an informal atmosphere

● employee is given a fair chance to air his side. The relevant facts are analyzed and evaluated against his past performance. He is then counseled regarding expectations of improved behavior / performance, ways of correcting the problem and a warning that a repetition of the same offense may warrant further disciplinary action. The employee commits to correct the behavior

● he is informed of any follow-up action that may be taken

2. Written Warning● is the second step in disciplinary action● it is preceded by an interview similar to oral warning● he is told after the interview that he will be given a written

warning, this includes:a. statement of the problemb. identification of the rule which was violatedc. consequences of continued deviant behavior the employee’s commitment to take corrective action and any follow-up action to be taken

3. SuspensionSuspension over minor violation is given after an

evidence of oral and written warnings.Although a violation is a major infarction, suspension,

rather than dismissal is applied when management tools that the employee can still be rehabilitated. Accurate documentation of oral and written warnings including suspension if done is necessary evidence of due process.

4. Dismissal

This penalty is invoked only when all other disciplinary efforts have failed. The Disciplinary Committee should be very sure that the cause for dismissal conforms with the criteria of a major discipline violation as contained in the policy manual and for the government employees those contained in the Civil Service Rules and Regulations and the Code of Conduct.

● a review is actually done by higher management

In the case of government employees, this is further reviewed by then respective department and final affirmation is done by the Civil Service Commission.