NCM119 Nursing Leadership & Management Lecture

MIDTERM NOTES

NURSING LEADERSHIP & Staffing functions consist of identifying work force

MANAGEMENT requirements, recruiting, interviewing, selecting, hiring,
promoting, appraising, and orienting staffs that tasks are
accomplished effectively and efficiently. It also involves
NURSING defines the Nursing Services as "The part of the
filling and keeping filled, the positions in the organization
total health organization which aims to satisfy the major
structure. Scheduling, staff development, employee
objective of the Nursing Services, and that is - prevention
socialization, and team building are also often included as
of disease and promotion of health. (WHO)
staffing functions.
The Nursing Service constitutes the formidable backbone
of the healthcare system both in numbers and its span of
Directing is the manner of delegating assignments, orders
influence across the hospital spectrum. In almost all health
and instructions to the nursing personnel. It is the heart of
care settings, the nursing group is composed of about 40%
management process. The elements of directing include
to 50% of the total workforce.
supervision, delegation, communication, teamwork and
collaboration, problem solving and decision making,
As the largest health care workforce in the clinical setting,
motivation, bench marking. conflict management and
the Nursing Service has a critical role in the provision of
change management.
highest level of patient safety and quality
care because they are at the forefront of patient care. The
Controlling is measuring performance against goals
group is challenged to be creative and innovative in
and plans, showing where deviations from standard exist
meeting the dimensions of quality: safe,
and helping to correct deviations from standards.
effective, efficient, equitable. timely, and patient-centered
Controlling functions include performance appraisals, fiscal
care.
accountability, quality control, and professional and
collegial control.
What it takes to become a Nurse Manager
Five Major Basic Management
Planning is designed for the nurse administrators who are
1. Planning
seeking more effective means of improving current and
2. Organizing
future performance. It offers principles of planning
3. Staffing
and decision making guides in nursing practice.
4. Directing
It deals with those aspects of planning that directly
5. Controlling
affects the nurse administrators on a personal as well as
organizational level.
Planning is the first management function that primarily
deals with the future. It entails forecasting or setting the
It is the first management process defined by Fayol as
broad outline of the work to be done. It directs our
making a plan of action to provide for the
thinking toward what we expect to do, why it will be done,
foreseeable future. It is a continuous process, beginning
where it will be done, when we expect to do it, how it will
with the setting of goals and objectives and then laying out
be done, and who is going to do it.
a plan of action for accomplishing them, putting them into
play, reviewing the process and the outcomes, providing
Organizing involves the identification of duties to be
feedback to personnel, and modifying the plan as needed.
performed, a grouping of these duties to indicate division
(Roussel, 2006).
of labor. It also entails assignment of authority according
to the line, staff or functional relationships that will exist
Importance of Planning
between individual jobs and total organizational units.

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 ● Ensures alignment of nursing unit/department and critical enabler for governance and framework for decision-
financial plans making.
● with the strategic plan. Thus, increases the
probability of achieving the organizational goals,
vision, and 2.Perform environmental scanning
● mission. ENVIRONMENTAL SCANNING is a process that
● Establishes a framework for decision making systematically surveys and interprets relevant data to
consistent with top management objectives. identify internal strengths and weaknesses, and external
● Forces analytic thinking and evaluations of opportunities and threats. Assessment of the internal
alternatives, thereby improving decision-making. environment may include occupancy rate, population
● Ensures safe quality care through awareness of trends, length of patient stay, patient acuity, quality
individual responsibility and accountability. patient care, staff attrition and retention rate, service
utilization, process efficiency, information system and
TYPES PLANNING financial resources. The external environmental factors
1. Strategic Planning is a broad continuous systematic may include statutory and regulatory laws, healthcare
process that emphasizes assessment of the organizational trends, accreditation, technology advancement, industry
environment both internally and externally such as competition, economic, political and market factors.
economic, political, social, and technological factors. It is
management tool that helps organizations set long-term 3. Collect and analyze data
goals, a risk-taking decision with knowledge of their effects Data collection is the process of gathering and measuring
in the future, and evaluating the outcomes through reliable information on targeted variables in an established
feedback mechanism. It focuses on performance systematic operation. On the other hand, analysis of data
improvement and utilizes strategies to accomplish the is the process of systematically applying statistical
organization's desired outcomes. and logical techniques to describe, illustrate, and evaluate
gathered data. Nursing data may include patient census,
2. Operational Planning is a detailed work plan or written cases, mortality and morbidity rates, and acuity of care;
blueprint in which the objectives of a nursing staff retention and attrition; nursing sensitive quality
unit/department are put into measurable actions. It indicators such as hospital acquired pressure ulcer and
provides a clear picture of how a team, infections Catheter Associated Urinary Tract Infection
nursing unit or department will contribute to the (CAUTI), Central Line Associated Blood Stream Infection
achievement of the organization's strategic goals. It (CLABSI), Ventilator - Associated Pneumonia (VAP), and
is also known as a management plan. Some categorical medication error and fall rates.
areas for objectives are: patient satisfaction, patient safety,
internal process, staffing, training and education, research, 4. Set specific objectives Setting specific objectives is a
and financial. process of identifying something that the nurse manager
would like to accomplish in a given period of time. It is
3. Nursing Succession Planning Is a strategy for written in a clear and concise manner and it must
identifying and developing potential future nursing leaders be specific, measurable, attainable, realistic, and time
who can replace them in case of retirement, separation bounded. Example of nursing unit specific objective is to
from service or any inevitable circumstances to ensure reduce the medication error rate by 5% at the end of the
continuity of leadership and services. year.

STEPS IN STRATEGIC PLANNING 5. Determine programs and activities

Programs and activities are the implementation or
1.Know the strategic direction-goals-It is important to execution phase of the
know the strategic direction of the organization for it is a management plan. They are the means by which
organizational goals and objectives are achieved. Examples

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of programs are related to: total quality management, perceived risks inherent in a particular undertaking, even
patient safety, patient satisfaction, infection prevention before any damage or disaster takes place.
and control, training, education and research, and nurse
certification. 12. Monitor and evaluate the results
Monitoring and evaluation is a process of tracking the
6. Set key performance indicators progress and accomplishment based on the set goals and
Performance indicator is any metric or data used to objectives. It utilizes tools to measure the actual
measure the achievement of the performance based on the established indicators Examples
organizational performance. It is based on standards of monitoring tools are: Safety Checklist. Competency
determined through evidence-based research literature or Analysis, IPCR, DPCR, Nursing Audit, Performance Budget
consensus of experts when evidence is unavailable. It is a Utilization, and Gantt Chart. The color-coded reporting is
measurable value that demonstrates how effectively an utilized to monitor the progress of the management plan
organization is achieving its key objectives. such as a) green - on progress, b) yellow - delayed, c) red
no progress/major issues identified
7. Identify the person responsible
Person responsible or known as a project/program 13. Develop a communication plan
champion is a team leader who provides psychological, Communication plan is a policy-driven approach to provide
moral, physical supports and resources to the members for constituents with information about the plan, which
the execution of the assigned specific program. The tasks contains the specific programs and activities.
should match with the abilities of the identified person Communication plan is crucial to program success. It
responsible. formally defines who should be given
specific information, when that information should be
8. Set the time frame delivered. what communication channels will be used, and
Time frame is a set period of time to accomplish the to whom the communication should be delivered or
program or project and other related activities. It includes cascaded
specific month and date in a year.
14. Disseminate the approved plan
9. Forecast the budget Budget It is the process of cascading the approved management
is a detailed financial plan for carrying out the programs plan usually through memoranda and unit/department
and activities the nurse manager wants to accomplish for a meetings.
certain period of time.
Steps in Planning the Nursing Service
10. Identify the risks A. Forecast - describes the ultimate conditions or
Risk identification is a process of determining the projections that provide the general incentive and
undesirable events such as threat of damage, injury and direction to planning. It anticipates the environment
liability loss, and evaluating its impact that could or setting where the plan will be operationalized.
potentially prevent the program of the organization from B. Define the philosophy and objectives of the Nursing
achieving its objectives. It aims to mitigate the risks and Service The statement of objectives, mission or
limit their impact through risk management program. philosophy provides the basis for the nursing service
existence. It explains the system of belief and values that
11. Create a mitigation plan determine the way by which the purpose should be
Mitigation plan is the process of developing options and achieved.
actions to enhance opportunities and reduce threats to C. Identify and develop strategies, programs/projects
organizational goals. The purpose of mitigation plan is to activities. Set the time frame. Prepare the budget
curtail the effects of possible threats or hazards if not D. Establishing Nursing Service Standards, Policies
totally eliminate the adverse impacts of the known or and Procedures

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Nursing Service Standards created by the various academic medical center/training specialty
professional organizations and governmental hospital.
agencies concerned with quality health care can be ● Threats are external conditions that challenge or
of immense values to the nursing administrator by threaten the achievement of organizational
serving as a framework for departmental evaluations. objectives. These are the elements that could
Standards are desired quantity, quality or level of cause trouble to nursing department/organization.
performance that is established as a criterion which Examples are: low retention rate, lack of highly
worker performance will be measured. skilled nurses, low salary, and statutory laws
affecting the nursing practice.
Policies are broad guidelines for the managerial
decisions that are necessary in organizational and
departmental planning. Procedures are series of
steps followed in a regular definite order to perform a
given activity, the how of the activity.

Tools in Planning
1. SWOT Analysis
2. PESTEL or PESTLE Analysis
3. BALANCED Score Card
4. STEEPLE ANALYSIS

SWOT Analysis an acronym for Strengths,

Weaknesses, Opportunities, and Threats. It is a
framework for analyzing and identifying the
internal and external factors that can have an
impact on the achievement of the organizational
goals and objectives.
● Strengths are internal attributes that are likely to
B. Pestel or Pestle Analysis It is a tool that is used to
have a positive effect or enabler in the
identify and analyze the key drivers of change in the
achievement of the organizational objectives.
strategic or business environment. The tool allows in the
Examples are: extraordinary reputation on health
assessing of the current environment and potential
care services, clinical expertise of staff, high-
changes.
performing team, and supportive leadership.
● Weaknesses are internal attributes that are likely
Political. These events include all political events like
to have a negative effect or barrier in the
employment laws, tax policies, trade restrictions, trade
achievement of the organization objectives. These
reforms, environmental regulations. political stability,
are areas that need improvement and may include:
tariffs, etc.
poor patient care, understaffing, lack of quality
Economic. This factor takes into consideration all events
procedures, and vague organizational direction -
that affect the internal and external economic
goals.
environment.
● Opportunities are external conditions that
promote achievement of organizational objectives.
These are the elements that the nursing
department/organization could exploit at their
advantage. Examples are: absence of dominant
competitors, advancement in technology,

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 can be helpful when planning the strategic positioning
which is more advance as it deals with macro-
environmental external factors.
S-Social Income distribution, Demographic changes Labor/
Social Mobility, Lifestyle Changes, Fashion Changes
T-Technological New invention and development, Rate of
technology transfer, Life cycle
E - Economic Economic growth, Unemployment policy,
Inflation, interest rates and other monetary policies
Consumer confidence
Sociological. The sociological factors take into E - Environmental / Ecological Environmental regulation
consideration all events that affect the market and P- Political Government organization / attitude Political
community Stability / Instability
socially. L - Legal Tax policies Employment
Technological. This factor takes into consideration all laws Safety regulations, Competition regulations
events that affect technology. It also includes all barriers E - Ethical Values Moral Values
to entry in certain markets and changes to financial
decisions.
Environmental. This factor takes into consideration
ecological and environmental aspects that could be either
economic or social in nature.
Legal. This factor takes into consideration all legal aspects
like employment. quotas, taxation, resources, imports and
exports.

C. Balanced Scorecard
Balanced Scorecard is a planning tool used in collecting and
analyzing the data from four organizational perspectives:
customer/stakeholder, internal process, learning and
growth, and financial. This aims to develop
objectives, measures or key performance indicators,
targets or thresholds, and initiatives. TOOLS IN PROJECT MANAGEMENT:
1. Gantt Chart show task and schedule information. The
Balanced Scorecard tasks are numbered and listed vertically. A bar shows the
The balanced scorecard (BSC) is a strategic planning and starting date and projected completion date of each task.
management system that Color or shading is sometimes used to show
organizations use to: how much of each task has been completed. It is both a
✓ Communicate what they are trying to accomplish. management tool and a communications tool.
✓ Align the day-to-day work that everyone is doing with 2. Performance Evaluation and Review Technique (PERT)
strategy. The PERT or the Performance Evaluation and Review
✓ Prioritize projects, products, and services. Technique is a network system model for planning and
✓ Measure and monitor progress towards strategic control which involves identifying key activities, sequences
targets. them in a flow diagram and assigning a specific duration
for each phase of work.
C. STEEPLE Analysis This is a strategic planning tool which 3. Critical Path Method or CPM
The Critical Path Method (PM)
can calculate time and cost estimates for each activity. This

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method is used to create a cost estimate using either ✓ 4. A cash budget, consisting of money received, cash
"normal" or "crash" operating conditions.Normal operating receipts and disbursement expected during the planning
conditions are those involving the least cost, while crash period.
operating conditions have much less available time than
under normal conditions. TWO KINDS OF BUDGET:
1. OPERATING BUDGET
Budgeting for the Nursing Service accounts for the revenues and expenses associated with
Budgeting for the Nursing Service is a day to day activities within the nursing unit/ department /
detailed financial plan that estimates the revenues and organization for the forthcoming fiscal year. The revenues
expenditures for a period of time in order to deliver the are primarily from the patient care income based on the
patient services, It is a plan for allocation of resources volume and mixed of patients, rates, discounts, and
based uh preconceived needs for the proposed reimbursements from the third party payers.
programs, projects, and activities of the nursing
unit/department aligned with the organizational goals. 2. CAPITAL BUDGET
Purposes of Budgeting the Nursing Service reflects expenses related to the purchase
✓ Control cost of major capital items such as state of the art
✓ Establish annual budget plan equipment and creation of new services
✓ Identify and analyze actual experience compared that necessitates either construction or
to the budget plan renovation of physical plant.
✓ Accurate utilization report
Approaches in Budgeting
Budgeting is defined as a systematic The two basic approaches in budgeting are the
financial translation of a plan, the allocation of scarce centralized and the decentralized approaches to
resources on the basis of forecasted needs for proposed budgets.
activities over a specified period of time. 1. Centralized Budget - Centralized budgeting is
● A nursing budget allocates resources and nursing developed and imposed by the comptroller,
programs to deliver patient care during a fiscal administrator and/or director of nursing with
year. little to no consultation with lower level
● A hospital budget is designed to meet future managers.
service expectations, to provide quality care at 2. Decentralized Budget Decentralized
minimum cost. budgeting, has the middle level manager
● A budget plan for health care institutions, which is involved in the planning and budgeting
simply a plan for future activities, process with ARA (authority, responsibility and
accountability) placed on the practitioner
A budget plan four components: level.
✓ 1. A revenue budget summarizing the income,
management expects to generate during the planning Components of Total Institutional Budget The
period. components of total institutional budget are:
✓ 2. An expense, budget describing expected activity in 1. Manpower Budget - This consists of the wages
operational financial terms for a and salaries of the regular employees and the
given period of time. fees paid to outside registries through which the
✓ 3. A capital budget which outlines the programmed institution contracts short-term employees.
acquisitions, disposals and improvements in the 2. Capital Expenditure Budget This involves the
institution's physical large expense of purchasing of lands, buildings,
capacity. and major equipment meant for long-term use.
3. Operational Budget - This includes the cost of
supplies minor equipment repair and

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maintenance as well as other overhead function. Thus, there is a division of tasks and
expenses. responsibilities based on the specialty of the individual or
groups.

ORGANIZING 5. The Principle of Continuing Responsibility. When a

manager delegates a function to a subordinate, the
Organizing is the process of identifying and grouping the manager's responsibility for that function is in no way
work to be performed, defining and delegating diminished.
responsibility and authority and establishing relationships
for the purpose of enabling people to work most 6. The Principle of Organizational Centrality. Nursing
effectively together in accomplishing the objectives It personnel interact with the greatest number of other
follows planning as a second phase of the management healthcare workers, receive the greatest amount of work-
process. related information and become most powerful in
organizational structure.
ORGANIZING PRINCIPLES
1. The Principle of Chain of Command. Organizations are 7. The Exception Principle. Subordinates should report
established with only unusual from normal functioning, so that managers
hierarchical relationships, with authority that flows from can limit their attention to events that are unresponsive to
top to bottom. This supports a centralized authority that routine control mechanisms.
aligns authority and responsibility. Communication flows
through the chain of command that tends to one way- 8. The Principle of Esprit d' Corps. It means teamwork and
downward. In modern nursing organization, the chain of implies that in unity there is strength.
command is flat. Communication flows freely in all
directions, with authority and responsibility Types of Organizational Structures
delegated to the lowest operational level. Formal Structure
This structure shows the relationships among employees
2. The Principle of Unity of Command. An employee has and their job positions. It describes the tasks,
one supervisor. There is one leader and one plan for a responsibilities and relationships. This can be presented in
group of activities with the same objective. However, this a diagram called the organizational chart.
is modified by an emerging organizational theory where Informal Structure
nurses and others are frequently engaged in matrix This is based on social and personal relationships rather
organizations in which they answer for more than one than on positional authority. It helps members achieve
supervisor. their personal and social needs.

3. The Principle of Requisite Authority. When Forms of Organizational Structure

responsibility for a particular task is delegated to a 1. Hierarchical (tall, centralized, bureaucratic)
subordinate, the latter must also be given authority over This is commonly called line structure. It is a formal
resources needed for task accomplishment. He/she is structure where authority and responsibility are clearly
accountable for the quality of his/her work. defined leading to simplicity of relationships. It is
associated with the principles of command, vertical control
4. The Principle of Span of Control. This states that a and coordination levels, and downward communications.
person should be a supervisor of a group that he/she can 2. Decentralized (flat, horizontal, participatory)
effectively manage in terms of numbers, functions, and The authority is shifted downwards to
location. In the past, the managers had a limited span of its divisions, services, and units. The decision-making can
control, with few staff. Recently, the span of control has occur where the work is being carried out, thereby
increased to cover more nursing units and departments professionals who do the job can participate in managing
with large numbers of employees. The Principle of
Specialization. Each person should perform a single leading

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the organization. This is the primary characteristic of this 1. Division of Work: Each box represents an individual or
structure. sub-unit responsible for a given task of the organization's
3. Matrix work load, i.e., Hospital Operations and Patient Support
This is designed to focus on both the product and function. Services, Medical Services, Nursing Services, and Finance
Function is the task required to produce a product that is Services.
the end result of the function. The manager of a unit 2. Chain of Command: It is reflected in the organizational
responsible for a service reports both to a functional and structure with a solid line, or known as a line of authority.
product manager. Personnel assigned to a specific project It indicates who reports to whom - the chain that can be
may become responsible to two bosses the product flat (in decentralized organizations) or tall (in centralized
manager and the functional department organizations)
head. 3. Type of Work to be Performed: It is indicated by label or
4. Hybrid description for the boxes like for examples: Patient Care
A term applied to organizational structures that operate Services, Ancillary Services, Training and Education
with characteristics of different types of structures. Department, and Research and Quality Improvement
Department.
4. The Groupings of Work Segments or Homogenous
Forms of Organizational Structure Assignments: These are shown by clusters of work groups
1. Hierarchical (tall, centralized, bureaucratic) like for examples: Operating Room and Post Anesthesia
This is commonly called line structure. Care Unit, Labor Room and Delivery Room Unit, Intensive
It is a formal structure where authority and responsibility Care and Coronary Care Unit, and Medical and Surgical
are clearly defined leading to simplicity of relationships. It Unit
is associated with the principles of command, vertical 5. The Levels of Management: This indicates the individual
control and coordination levels, and downward and entire management hierarchy regardless of where the
communications. individual appears on the organizational chart. Hierarchy
refers to a body of persons or things organized or classified
2. Decentralized (flat, horizontal, participatory) in a pyramidal fashion according to rank, capacity of
The authority is shifted downwards to its divisions, authority assigned to vertical levels with officers ranked in
services, and units. The decision-making can occur where grades, orders or classes, one above the other.
the work is being carried out, thereby professionals who Examples: Top management, Middle management, Front-
do the job can participate in managing the organization. line management
This is the primary characteristic of this structure.
An ORGANIZATIONAL CHART is a line drawing composed
3. Matrix of boxes that show how the parts of an organization are
This is designed to focus on both the product and function. linked. It depicts formal organizational relationships, areas
Function is the task required to produce a product that is of responsibility, persons to whom one is accountable for
the end result of the function. The manager of a unit and channels of communication
responsible for a service reports both to a functional and There are two (2) lines in the organizational chart.
product manager. Personnel assigned to a specific project ✓ Unbroken Solid Lines-The unbroken solid lines are
may become responsible to two bosses the product classified into two. The solid horizontal lines represent
manager and the functional department head. communication between people with similar spheres of
responsibility and power but different functions. The solid
4. Hybrid vertical lines between positions denote the official chain of
A term applied to organizational structures that operate command and formal path of communication and
with characteristics of different types of structures. authority. Those having the greater decision -making
authority are at the top; those with the least are at the
Characteristics of an Organizational Structure bottom.
An organizational structure has five (5) characteristics:

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✓ Dotted or Broken Lines-This represents staff position. A motivated and empowered human capital, efficient and
staff member provides information and assistance to the judicious use of resources and resulting to enhanced
manager but has limited organizational authority. customer services and satisfaction.
It also provides for specialization but does not have
legitimate authority as it acts in an advisory capacity. Organizational culture is a system of symbols of
interactions unique to each organization. It is the ways of
Relationships Within Nursing Service thinking, behaving, and believing that members of a unit
The relationships within the Nursing Services can be have in common. It is the management function to build
depicted through the organizational chart. These are a constructive culture in the workplace. This requires the
known as: interpersonal and communication skills of a leader. It is
✓ Line Relationship - those that exist between the important to support a "nurse-friendly» culture where
superior and subordinates who are immediately and nurses can function effectively and efficiently. The leader
directly responsible to him/her. Examples: Chief Nurse to must take an active role to ensure this.
Supervising Nurse, to Head Nurse to all nursing personnel.
✓ Lateral Relationship - those that exist between positions
in various divisions and sections of an undertaking where
no direct authority is involved. Examples: Senior Nurse
with
Physician, Staff Nurse and Clinical Pharmacist.
staffing
✓ Functional Relationship -those that arise when duties
are divided on a functional basis like when an individual STAFFING is the most crucial, complex, and time
exercises authority on a particular subject by special skill or consuming management function of a nurse manager at
knowledge. Examples: Chief Nurse with Administrative every level of the healthcare organization because the
Officer, Staff Nurse with Clinical Nurse Instructor. quality of the Nursing personnel and their performance will
✓ Staff Relationship - is when the individual is not vested determine the degree by which the goals of the Nursing
with, but is acting "for and in behalf" of the person on Service are achieved. Although the goal of Nursing is
which the authority lies. The individual function is one of focused primarily on providing a competent Nursing
transmission and interpretation coupled with the duty of workforce to achieve the best patient clinical outcomes at
ascertaining that the orders given are carried out reasonable cost, the healthcare environment has been
becoming increasingly complex.
Kinds of Organizational Chart
Basically, there are three (3) kinds of organizational charts. Classification of Patients by Levels of Care, Nursing Care
These are: Hours/ Patient/Day and Ratio of Professionals to Non-
✓ Structural Chart shows the various components of the professionals Needed
organization and outlines the basic interrelationships.
✓ Functional Chart reflects the functions and duties of the
components of the organization and indicates the
interrelationships of these functions. Within the boxes is
the function statement, which should be clear, inclusive
and written in the present tense.
Level I - Self Care or Minimal Care. Under this category, the
✓ Position Chart specifies the names, positions and titles
patient is capable of carrying out daily activities as long as
or ranks of the personnel, which fit into the organizational
the nurse provides the necessary materials and supplies.
structure. It identifies channels of communication, levels of
Example, the average amount of nursing care hours per
accountability and areas of responsibility.
patient per day is 1.50 while the ratio of professional to
non-professional nursing personnel is 55:45.
Organizational Effectiveness (OE) is doing the right things
towards realization of organizational goals through highly

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Level II - Moderate Care or Intermediate Care. Under this
category, the patient can feed, bathe, toilet and dress ✓ In (Level 2) hospitals, it is assumed that 65 percent of
himself without help, but requires some assistance from the patients need minimal care, 30 percent needs
the nursing staff for special treatment or certain aspects of moderate care, and 5 percent needs intensive care.
personal care i.e. Example, the average nursing care hours
per patient per day is 3.0 and the ratio of professional to ✓ In (Level 3) hospitals, 30 percent of the patients need
non - professional personnel is 60:40. minimal care, 45 percent needs moderate care, 15 percent
needs intensive care, and 10 percent needs highly
Level IIl - Total, Complete or Intensive Care. Under this specialized care. For special tertiary hospitals, it is assumed
category, a bedridden patient who lacks the strength or that 10 percent of the patients need minimal care, 25
mobility, needs nursing assistance for all of the patient's percent needs moderate care, 45 percent needs intensive
daily activities, such as feeding, bathing, dressing, moving, care, and 20 percent needs highly specialized care.
positioning, eliminating, comfort seeking, and injury
avoidance. Example, the average nursing care hours per
patient per day is 6.0 with a professional to non-
professional ratio of 65:35.
Level IV - Highly Specialized Critical Care. Under this
category, an acute or critically ill patient who is in constant
danger of death or serious injury would require critical
care. Patients need continuous assessment and treatment
because of many IV medications on titration, vital signs
every 15-30 minutes and hourly output measurements.
Frequently, there are also significant changes in doctor's
orders that need to carry out. Example, the average
nursing care hours per patient per day is 7.0 or more, and
the ratio of professional to non-professional ranges from
70:30 to 80:20.

Classification of Patients by Levels of Care according to

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

✓ (Level 1) hospitals, it is assumed that about 70 percent

of their patients need minimal care, 25 percent needs
moderate care. Patients needing intensive care are given
emergency treatment and when their condition becomes
stable or when immediate treatment is necessary and the
hospital has no facilities for this, the patient is transferred
to a secondary (Level 2) or tertiary (Level 3) hospital.

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