NURSING MANAGEMENT: ORGANIZING

Determine what task are to be done, who is to do these, how the tasks are to be grouped, who reports to whom and what decisions are to be made. It is a form of identifying roles and relationships of each staff on order to delineate specific tasks or functions that will carry out organizational plan s and objectives. Process of identifying and grouping the work to be performed, defining and delegating responsibility and authority and establishing relationships for the purpose of enabling the people to work more effectively together in accomplishing objectives. As a process, it refers to the building of a structure that will provide for the separation of activities to be performed and for the arrangement of these activities in a framework which indicates their hierarchal importance and functional association.

ELEMENTS OF ORGANIZING

1. 2. 3. 4.

Organizational Structure Developing job descriptions Staffing Scheduling

ORGANIZING PROCESS INCLUDES: 1. Identifying and defining basic tasks. 2. Delegation of authority and assigning responsibility 3. Establishing relationships IMPORTANCE OF ORGANIZATIONAL STRUCTURE 1. 2. 3. 4. 5. It enables members what their responsibilities It frees the manager and the individual workers to concentrate on their respective roles and responsibilities It Coordinates all organization activities so there is minimal duplication of effort or conflict. Avoids overlapping of function because it pinpoints responsibilities. Shows to whom and for whom they are responsible

ORGANIZATIONAL RELATIONSHIP 1. FORMAL RELATIONS Formal structure, through departmentalization and work division, provides a framework for defining managerial authority, responsibility and accountability. 2. INFORMAL RELATIONS Informal structure is generally social, with blurred or shifting lines of authority and accountability. The organization chart establishes the following: Formal lines of authoritythe official power to act Responsibilitythe duty or assignment Accountabilitythe moral responsibility Authority is defined as the official power to act. It is power given by the organization to direct the work of others. A manager may have the authority to hire, fire, or discipline others.

A responsibility is a duty or an assignment. It is the implementation of a job. For example, a responsibility common to many charge nurses is establishing the units daily patient care assignment Accountability means that individuals agree to be morally responsible for the consequences of their actions. A nurse who reports a medication error is being accountable for the responsibilities inherent in the position . THREE FORMS OF AUTHORITY: 1. Line authority is a direct supervisory authority from supervisor to subordinates. 1.1 Chain of Command unbroken line of reporting relationships that extends through the entire organization. The line defines the chain of command and the formal decision making structure. 1.2 Unity of Command within the chin states that, each person in the organization should take orders and reports only to one person. 1.3 Span of Control refers to the number of employees that should be placed under the direction of one leadermanager. 2 Staff Authority authority that is based on the expertise and which usually involves advising the line managers. 3 Team Authority is granted to committees or work teams involved in an organizations daily operations. Work teams are group of operating employees who shared a common vision, goals and objectives. ORGANIZATIONAL CHART Drawing that shows how the parts of the organizations are link. It depicts the formal organizational relationship, areas of responsibility and accountability and channel of communication. Depicts an organizations structure.

ORGANIZATIONAL STRUCTURE - Depicts and identifies role and expectations, arrangement of positions and working relationships. 1. Dotted or Unbroken line represents staff positions/staff authority (advisor to the line managers). 2. Centrality refers to the location of a position on an organizational chart where frequent and various types of communication occur. Determined by organizational distance; those with small organizational distance receive more information than those who are more peripherally located. 3. Solid Horizontal Line represent same positions but different functions. 4. Solid Vertical Line chain of command form authority to subordinates (line authority)

MANAGERIAL LEVELS Level Top Level Managers Scope of Responsibility 1. Generally make decisions with the help of few guidelines or structure. 2. Coordinates internal and external influences Middle Level Managers 1. They conduct day-day operations with some involvement, long term planning and policy making. Head Nurse, Department Head, Unit Supervisor/Manager Examples CEO, President, V-President, Chief Nursing Officer

First Level Managers

1. Concerned with specific unit workflows. 2. Deals with immediate dayday problems.

Charge Nurse, Team Leader, Primary Nurse, Staff Nurse

PATTERNS OF ORGANIZATIONAL STRUCTURE 1. Tall/Centralized Structure Responsible for only few subordinates so there is narrow span of control Because of the vertical in nature, there are many levels of communication Communication is difficult and messages do not get to the top. Workers are boss-oriented because of close contact with their supervisor.

2. Flat/Decentralized Structure Characterized by few levels and a broad span of control Communication is easy and direct

Advantages: 1. Shortens the administrative distance from the top to the lower 2. Solutions to problems are easily carried out/fast response 3. Workers developed their abilities and autonomy Disadvantage: 1. Impractical in large organization. TYPES OF ORGANIZATIONAL STRUCTURE 1. Line Organization/Bureaucratic/Pyramidal There is clearly defined superior-subordinate relationship AR and power are concentrated at the top

2. Flat/Horizontal Organization Decentralized type Applicable in small organization Nurses become productive and directly involved in the decision making skills Workers become satisfied

3. Functional Organization Permits a specialist to aid line position within a limited and clearly defined scope of authority

4. Ad Hoc Organization Modification of bureaucratic structure

5. Matrix structure

Focus on both product and functions Most complex Has both vertical and horizontal chain of command and line of communication

II. STAFFING - Process of assigning competent people to fulfill the roles designated for the organizational structure through recruitment, selection and development, induction and orientation of the new staff of the goals, vision, mission, philosophy etc. STAFFING PROCESS 1. Preparing to Recruit types and number of personnel 2. Attracting a Staff formal advertisement 3. Recruiting and Selecting a Staff interview induction orientation job order pre-employment testing signing of contract Staffing Pattern plan that articulates how many and what kind of staff are needed/shift or per day in unit or in department. TWO WAYS OF DEVELOPING A STAFFING PATTERN 1. Determine the # of nursing care hours needed/patient 1.1 Generating the full time equivalents of an employee 2. Determine the nurse-patient ratio in providing nursing care FTE measure of work committed of full time employee o o 1.0 FTE = works 5 days/week, 8 hours/day 0.5 FTE = part time employee who works 5 days/2 weeks.

CONSIDERATIONS IN STAFFING PATTERN 1. Benchmarking Management tool for seeking out the best practice in ones industry so as to improve ones performance. Process of measuring products, practices and services against best performing organization as atool for identifying desired standards of organizational performance.

2. Regulatory Requirements mandated by RA 3. Skill Mix percent or ratio of professionals to non professional Ex: 40 FTE (20 RN + 20 non RN) = 50% RN mix 4. Staff Support staff support in place for the operations of the units or department. 5. Historical Information review of any data on quality or staff perception regarding the effectiveness of the previous staffing pattern

PATIENT CLASSIFICATION SYSTEM Measuring tool used to articulate the nursing workload for specific patient or group of patients over aspecific time. Patient Acuity measure of nursing workload that is generated for each patient. PATIENT CARE IS CLASSIFIED ACCORDING TO: 1. Self care or minimal care patients are capable of carrying ADL, e.g., hygiene, meals etc.

2. Intermediate or moderate care requires some help from the nursing staff with special treatments or certain aspects of personal care, e.g., patients with IV fluids, catheter, respirator, etc. 3. Total care patients are those who are bedridden and who lack strength and mobility to do average daily living. Ex: patients on CBR, immediate post-op, with contraptions. 4. Intensive care patients are those who are critically ill and in constant danger of death or serious injury. Ex: comatose, bedridden etc. III. SCHEDULING - Timetable showing planned work days and shifts for nursing personnel.

ISSUES TO CONSIDER IN SCHEDULING STAFF: 1. Patient type and acuity 2. Number of patients 3. Experience of Staff 4. Support available to the staff

SHIFTING VARIATIONS Traditional Shifting Patterns shift (8 hr shift) 12 hr shift 10 hr shift Weekend option Rotating work shift Self-scheduling staff makes their own schedule Permanent work shift Floaters on-call

Forty Hour Week Law based on RA5901 No work, no pay Entitled to 2-week sick leave and off duty for 2 days Special Holidays with pay