PALMR ARPH

- PROFESSIONAL ADJUSTMENT -

● Emphasis on appearance
I. PROFESSION ● Good health

● Profession: a calling in which its members profess to B. FIELDS IN NURSING

have acquired special values, knowledge, training or by
experience so that they may guide others in that special ● Public Health Nursing: emphasis on promotion of health
field. and prevention of diseases.
● Nursing profession: an occupation with a unique body of ● Private duty nursing: give comprehensive nursing care
knowledge, training or by experience so that they may on a client on a one-to-one ratio
guide others in that special field. ○ Home Health care
● Professional Nursing: the performance for a fee or salary ● Occupational Health nurse: focuses on promotion,
of professional services such as undertaking responsible protection, and supervision of workers' health within the
nursing care, the observation of symptoms, accurate context of a safe and healthy work environment.
reporting & recording, supervision of others, execution of ● Military Nursing: provides comprehensive and quality
nursing procedures and execution of legal orders. nursing care to all military authorized relatives
○ Scope of Nursing Practice: general list of ● School Health Nursing: responsible for the school's
nursing task activities in the areas of health service, health education,
■ Specific list of tasks of a nurse in and environmental health and safety.
different fields (academe, nursing ● Clinic Nursing (office nursing): must possess general
service, etc) → Job description nursing skills, must have excellent teaching and
● Professional Nurse: a person whose name and communication skills, exhibit organizational and leadership
registration/professional license number is entered in the ability, possess good assessment skills, and have good
Commission's registry book and computerized database insight in anticipating needs of patients.
as legally authorized to practice the nursing profession. ● Nursing education: career ladder in nursing education
starts with a Clinical Instructor's position up to the Dean of
A. CHARACTERISTICS OF A PROFESSION a College of Nursing.
● Institutional Nursing: involve assessment of the patient's
3A’s needs for nursing and planning for giving or providing the
care either for personal care, rehabilitation measures or
● Autonomy health instructions.
○ Practicing on your own ● Advanced Practice Nursing: requires the knowledge
○ Making your own decisions skills and supervised skills obtained through graduate
○ Independent nursing functions study in nursing, this field covers the roles of the clinical
● Authority nurse specialist.
● Accountability ● Clinical Nurse Specialist (nurse specialist, nurse
○ Answerable clinician or clinical specialist) - is an expert practitioner
○ liability within a specialized field of nursing.

3 P’s 3 BROAD AREAS IN NURSING

● Community Health Nursing
● Professionalism ○ PHN
○ Actions and words ○ SHN
○ OHN
● Patriotism
○ MN
● Personal Governance ○ CN
○ You’ll be responsible with your own action ● Nursing Education
○ Self appraisal of your own action → making sure ● Nursing Service
that your practice is aligned with proper conduct ○ Institutional nursing
●
II. PROFESSIONAL ADJUSTMENT
C. COMPREHENSIVE NURSING SPECIALTY PROGRAM

● Professional Adjustment: the preparation of a nursing

● Mandated to formulate and develop a comprehensive
student for the responsibilities of professional and social
nursing specialty program
life by the development of her capabilities in a way that
● Mandated to formulate and develop a Comprehensive
would make her fit to enter upon the practice of nursing.
Nursing Specialty Program:
○ Start of prof ad: 4th year until you become
○ BON in coordination with
adjusted to the life of being a nurse (at least a
○ APO
year)
○ DOH
● Governance: in nursing practice is shifting from the
○ Recognized Specialty Org.
traditional view that nurses are subordinate and passive
● Aim: upgrade the level of skill and competence of
employees towards having more proactive involvement of
specialty nurse clinicians in the country, such as but not
taking charge of administrative practice → decision
limited to the areas of critical care, oncology, renal and
making over professional practice.
other areas as may be determined by the Board.
○ Newly grad nurse: Nurse generalist
A. PROFESSIONAL EXPECTATIONS OF A NURSE

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● Beneficiaries of the program are obliged to serve in any Framework (PQF) for national relevance for global
hospital for a period of at least 2 years of continuous comparability and competitiveness.
service
○ If funded by the government B. MATRIX OF CPD
● The Nursing Specialty Certification Program was
previously created on the basis of RA 7164, through FORMAL LEARNING
Resolution No. 14 of the BON on February 18, 1999, and
created a Nursing Certification Council under it to oversee ● Formal Learning: refers to educational arrangements
the administration of new programs by the Specialty such as curricular qualifications and teaching learning
Certification Boards. requirements that take place in Higher Educational
● Specialty Certification is defined in 3 perspectives Institutions (HEls).
○ As a process ○ Doctoral Degree
○ As a mechanism ○ Masteral Degree
○ As an act ○ Post-graduate Diploma/ Certificate /
● 3 Levels subject to Certification ○ Diplomate / Fellowship Program
○ Level 1 - Nurse Clinician I
○ Level II - Nurse Clinician Il NON-FORMAL LEARNING
○ Level III - Clinical Nurse Specialist
● NON-FORMAL LEARNING: refers to learning that has
D. EXTRA-PROFESSIONAL ACTIVITIES IN NURSING been acquired in addition or alternatively to formal
learning, which may be structured and made more flexible
● Membership in an accredited professional organization according to educational and training arrangements.
○ National League of Government Nurses ○ Self-directed learning: includes CPD activities
○ Association of Nursing Service Administrators of such as professional activity and volunteer
the Philippines engagement.
○ Association of Deans of Colleges of Nursing in ○ OTHER SELF-DIRECTED LEARNING
the Philippines ACTIVITIES: refer to CPD programs that
○ Military Nurses Association of the Philippines contribute to the learning of professionals that
○ Occupational Health Nurses Association of the are not included above.
Philippines
○ Private Duty Nurses Association of the UNDER PROFESSIONAL ACTIVITIES
Philippines
○ Operating Room Nurses Association of the
● Conference
Philippines
● Seminar/workshop/colloquium
○ Psychiatric Nursing Specialists Foundation of
● In-service training
the Philippines
● Webinar
○ Catholic Nurses Guild of the Philippines
● Tutorial
○ Philippine Nurses Association
● Study tour/plant visit
■ Overall APO
● Exhibit
● Nurse’s Week Celebration: Proclamation No. 539 dated
● Poster presentation
October 17, 1958 by the then President of the Philippines
● Program/module development
designated the last week of October of every year as the
● Publication invention
Nurses' Week.
● Consultancy, and recognition/award/title.
●
III. CONTINUING PROFESSIONAL DEVELOPMENT
INFORMAL LEARNING

● RA 10912 CPD of 2016 Resolution 2019-1146

● INFORMAL LEARNING — refers to learning that occurs
● 15 units
in daily life assessed, through the recognition, validation
● Revised guidelines on the continuing professional
and accreditation proçesses, and which can contribute to
development for all registered and licensed professional
a qualification
○ Government
A. EXTRA-PROFESSIONAL ACTIVITIES IN NURSING ○ Business / Private
○ Academe
● Continuously improve the quality of the country's reservoir ○ Civil Society
of registered professionals by updating them on the latest
scientific / technological / ethical and other applicable
trends in the local and global practice of the professions. 1. SEMINAR / WORKSHOPS
○ Update:
■ Scientific ● Participant
■ Technological ● Resource Speaker
■ Ethical ● Panelist/Reactor
● Provide support to lifelong learning in the enhancement ● Facilitator/Moderator
of competencies of Filipino professionals towards delivery
of quality and ethical services both locally and globally. 2. POST GRADUATE / SPECIALTY TRAINING
○ Lifelong learning: all learning activities
undertaken throughout life for the development ● Master's Degree
of competencies and qualifications. ● Doctoral Degree
● Deliver quality continuing professional development (CPD) ● Residency /Externship / SpecialtySubspecialtylty
activities aligned with the Philippine Qualifications

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 ○ Community Health Nursing
● Fellowship
TERM OF OFFICE
3. SELF-DIRECTED AND/OR LIFELONG LEARNING

● 3 years
● Training Module
● 3 years reappointment
● Technical Paper / Professional Journal Article
● Total of 6 years
Research / Innovative Programs / Creative Projects
● Doctrine of holdover: allowed to continue to hold office
● Book / Monograph
until replaced
● Article
● *Ad interim appointment: appointment in the meantime
● Professional Journal Editor
in the absence of a regular incumbent
● Peer Reviewer
● Inventions
POWERS AND DUTIES OF THE BOARD
● Short-term Post graduate / In Service Training Study
Tour / Visits
● Professional Chair QUASI-JUDICIAL

● ● Conduct hearings and investigations to resolve

IV. RA 9173 complaints against nurse practitioners for unethical and
“Philippine Nursing Act of 2002” unprofessional conduct and violations of this act
● Issue, suspend, revoke or reissue, reinstate certificate of
● Provide nursing care through the utilization of the registration for the practice of nursing.
nursing process. ● Issue Subpoena duces tecum: you shall bring with you
○ ADPIE (documents/records)
○ NCP ● Subpoena ad testificandum: testify
● Establish linkages with community resources and
coordination with the health team.
Certificate of Registration: BON
○ Referral
License: PRC
○ Collaboration
● Provide health education to individuals, families, and
communities. QUASI-LEGISLATIVE
● Teach, guide, supervise students in nursing education
programs ● Prescribe, adopt, issue, and promulgate guidelines,
● Undertake nursing and health human resource regulations, measures, and necessary for the
development training and research improvement of the nursing practice.
○ BON resolutions
A. COMPOSITION OF THE BOARD ● Keyword: Legislative → rules, laws

● Chairperson QUASI-EXECUTIVE
● 6 members
● Nominated by: APO ● Executive: ipatupad
● Recommended by: PRC ● Conduct the licensure examination
● Appointed by: President ○ Prepare the test question
● Basis in choosing BON: ○ Score and rate the examination papers
○ Integrity ● Monitor and enforce quality standards of nursing
○ Merit practice in the Philippines
○ Fitness ● Ensure quality nursing education by examining the
facilities of those seeking permission to open nursing
QUALIFICATIONS courses.
○ Responsibility to open and close a nursing
● Natural born citizen and resident of the Philippines school: CHED
○ Born of Filipino Mothers ● Promulgate a Code of Ethics in coordination and
● RN and holder of Master's degree in nursing, education or consultation with the APO of nurses.
other allied medical profession, provided, that: ● Recognize nursing specialty organizations in
○ (1) Majority of the Members of the Board shall coordination with the APO.
be a holder of Master's Degree in nursing ● Removal or Suspension of Board Members
○ (2) Chairperson shall be a holder of a Master's ○ Continued neglect of duty or incompetence
Degree in Nursing ○ Commission or toleration of irregularities in the
● 10 years continuous practice, the last 5 years shall be in licensure examination
the Philippines ○ Unprofessional, immoral, or dishonorable
● Member of APO conduct.
● Not have been convicted of any offenses involving moral
turpitude B. LICENSURE EXAMINATION

MEMBERSHIP OF THE BOARD ● Qualifications:

○ Citizen of the Philippines
● Membership of the Board shall represent the 3 Areas of ○ A person of good moral character
Nursing ○ Holder of a Bachelor’s Degree in Nursing
○ Nursing Education ● Requirements:
○ Nursing Service ○ TOR

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 ○ Certificate of Live Birth 5. The patient has the right to every consideration of his
○ Marriage Contract for female applicants privacy concerning his own medical care program.
○ 4 passport size colored pic with name tag white a. Violation → invasion of privacy
background i. Use of px’s name/likeness for profit
○ Community Tax Certificate/ Valid ID ii. Unreasonable intrusion without need
● Other requirements: for nursing care
○ RLE record iii. Public disclosure of private facts
○ Cases iv. Putting the client in false light
○ Interview for Second Courser b. Defamation of character - maligning the
○ Certificate of Undertaking character of the character (with malice)
● Scope of Examination i. Slander: oral
○ Shall take into consideration the objectives of ii. Liber: written/ caught on record
the nursing curriculum, the broad areas of 6. The patient has the right to expect that all
nursing and other related disciplines and communications and records pertaining to his care should
competencies. be treated as confidential by the hospital, except in cases
○ Nursing Practice 1,2,3,4, and 5 such as suspected public health hazards where reporting
is permitted or required by law.
C. PROHIBITIONS IN THE PRACTICE OF NURSING a. Confidentiality: not allowed to divulge
information
● Without a COR (Certificate of Registration) / PL b. Legalities of confidentiality:
(Professional License) / STP (Special Temporary Permit) i. Patient’s consent
● Who uses as his/her own the COR / PL / STP of another ii. If the information is shared with the
suspended or revoked COR / PL expired or canceled STP members of the healthcare team
● Gives any false evidence to the Board in order to obtain a iii. Medico-legal case
COR/PL/STP iv. Communicable disease
● Falsely poses or advertises as a RN v. Threat to life
● Appends BSN/RN to his/her name without having been 7. The patient has the right to review the records
conferred said degree pertaining to his medical care and to have information
● Assists the Illegal practice of a person who is not lawfully explained or interpreted as necessary except when
qualified to practice nursing restricted by law.
8. The patient has the right to expect that a hospital will
make reasonable responses to the request of a patient for
NOTE: PROHIBITION → UNREGISTERED V.S REVOCATION & appropriate and medically indicated care and services.
SUSPENSION → REGISTERED The hospital must provide evaluation, service, and/or
● referral as indicated by urgency of the case. When
V. PATIENT’S BILL OF RIGHTS medically appropriate and legally permissible, or when a
patient has so requested, may be transferred to another
facility. The patient must also have the benefit of complete
● Has no legal basis
information and explanation concerning the need for, risk,
○ Still a pending bill → in the Philippines
benefits, and alternatives to such transfer.
○ Bill “Magna carta of patient’s rights”
a. Informed consent - invasive procedure
1. The patient has the right to considerate and respectful
9. The patient has the right to ask and be informed of the
care
existence of business relationships among the hospital,
2. The patient has the right to and is encouraged to
educational institutions, other health care providers, or
obtain from physicians and other direct caregivers
players that may influence the patient's treatment and
relevant, current, and understandable information
care.
concerning diagnosis, treatment, and prognosis.
10. The patient has the right to consent to or decline to
a. Relatives? No, not unless they have patient’s
participate in proposed research studies or human
consent
experimentation affecting his care and treatment or
3. The patient has the right to make decisions about the
requiring direct patient involvement, and to have those
plan of care prior to and during the course of treatment
studies fully explained prior to consent. A client who
and to refuse a recommended treatment or plan of care to
declines to participate in research, is entitled to the most
the extent permitted by law and hospital policy and to be
effective care that the hospital can otherwise provide.
informed of the medical consequences of this action. In
11. The patient has the right to expect reasonable continuity of
case of such refusal, the patient is entitled to other
care when appropriate and to be informed by physicians
appropriate care and services the hospital provides or
and other caregivers of available and realistic patient care
transfer to another hospital.
options when hospital care is no longer appropriate.
a. Right to refuse
b. Which of the ff rights is inviolable?
i. Right to refuse treatment A. RESTRAINTS
ii. Right to confidentiality
iii. Right to privacy ● Physical/chemical means of limiting one’s movement
4. The patient has the right to have an advance directive
concerning treatment or designating a surrogate decision PURPOSE
maker with the expectation that the hospital will honor the
intent of that directive to the extent permitted by law and ● Protect the patient from physically harming himself
hospital policy. ○ Self-extubation
a. Self-determination law - autonomy ● To protect the nurse and family members
b. Advanced directives: type of care the patient ○ Violent patients
wants to receive should he become ● To allow assessment to uncooperative patients
incapacitated ○ Common in pedia patients
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 ● To perform medically needed procedure
Privileged communication: all the information that you acquired
○ Common in pedia and intoxicated
throughout the course of the patient’s treatment or hospitalization
(alcohol/drugs) patients
● To prevent elopement Seal of secrecy: will forever remain unless removed by the
○ homicidal/suicidal patient
● Once the patient revealed an information, the doctor
NURSING CONSIDERATIONS can already reveal the information as well

● Doctor’s order D. CONSENT

○ Receive telephone only during EMERGENCY
■ The doctor should countersign within ● General admissions consent
24 hrs ○ Includes:
■ Restraint: as much as possible ■ Parenteral medications
countersign within or less than 8 hrs ■ NGT
● Informed consent → relative ■ IFC
● Never use as a form of discipline ● Informed consent : explanation of a procedure
● Maximum time limitation for restraint → 24 hrs ○ Risk
○ Primary behavioral problems (adults): 4 hrs ○ Benefits
○ 9-17 yrs old: 2 hrs ○ Complications
○ < 9 yrs old: 1 hr ○ Alternatives
● Remove the restraint every 2 hrs within 10- 30 mins for ○ Nurse: Witness → verifying that the physician
feeding, movement, and elimination. thoroughly informs the patient of the said
procedure, risks, benefits, complications, and
B. ADVANCED DIRECTIVES alternatives.
■ Doctor - get/give
● Advanced directives: type of care the patient wants to ■ Nurse - secure
receive should he become incapacitated ● Consent for operation - patient is signifying
○ Assault - threats to do bodily harm
DURABLE POWER OF ATTORNEY ○ Battery - unconsented touching of the person,
including his belongings even his clothes
● Health care proxy ●
● Person that you are assigning in your behalf VI. PNA CODE OF ETHICS
● Up to what extent
● The Nurse is Practicing her Profession for the People,
LIVING WILL Society, and Co-worker
● Nurses and People
● Organ donation ○ Values, customs, and spiritual beliefs held by
○ Patient individuals are to be respected.
○ Spouse ○ The nurse holds in strict confidence personal
○ parents/children information acquired in the process of giving
○ Siblings nursing care.
○ Nearest relative ● Nurse and Practice
○ Physician - given that he has exhaust all efforts ○ The nurse is accountable for his/her own
to find the relatives within 24 hrs nursing practice. Responsible for his/her own
● DNR personal and professional growth and
● No to Blood transfusion development
■ Seminars & Training
○ The nurse maintains or modifies standards of
Are we allowed to become a witness in LIVING WILL? No practice within the reality of any given situation.
● Because we can affect their decisions
Quality care is her/his goal.
Are we allowed to become a witness in LAST WILL AND ○ The nurse is the advocate of the patient, takes
TESTAMENT? Yes appropriate steps to safeguard the patient's
rights and privileges.
○ The nurse is aware that her nursing actions
C. CHART
have professional, ethical, moral, and legal
dimensions.
● A legal document admissible in court ○ The nurse observes personal and professional
● Owned by the hospital decorum at all times.
● Can the patient use the chart as part of his defense? YES ● ​Nurses and co-workers
○ Through a court order → Subpoena duces ○ The nurse maintains collaborative working
tecum relationship with her/his co-workers and other
○ Only the pages needed → brought by the members of the health team.
medical librarian ○ The nurse recognizes her/his capabilities and
● Presenting the chart by the Doctor/hospital as an evidence limitations in accepting responsibilities and
with patient’s consent those of her/his coworkers when delegating
○ Exhibit responsibilities to them.
○ Civil case - confidentiality is binding (consent is ● Nurses, society and environment
needed) ○ The preservation of life, respect for human
○ Criminal case - no confidentiality rights, and promotion of a healthy environment
shall be the commitment of the RN.
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 ○
The establishment of linkages with public in UTILITARIANISM
promoting local, national and international
efforts to meet the health and social needs of ● Vews a good act that brings the least harm and most good
the people to people
● Nurses and Profession ● Mass triage
○ The nurse must be a member of the APO.
Inherent in this responsibility is to support and STEWARDSHIP
uphold its constitution and by-laws.
○ The nurse helps to determine and implement ● Taking care of one another
desirable standards of nursing practice and ● In vitro, Genetic engineering, Artificial Family Planning,
nursing education. Cosmetic surgery
○ She/he participates actively in the development
and growth of the nursing profession. VERACITY
○ Contribution to the improvement of the
socioeconomic conditions and general welfare
● Truth telling
of nurses through appropriate legislation
● Give informed consent - veracity
● Signing consent - autonomy
● Legal Responsibilities
● Spiritual Responsibilities B. JURISPRUDENCE
● Ethico-Moral Responsibilities
● All criminal have civil responsibility, but not all civil have
VII. ETHICO-MORAL RESPONSIBILITIES criminal responsibility

● Ethics: system or guiding principle of proper conduct CIVIL

○ Standards of proper conduct
○ Dictated upon the society where you belong ● Contract
● Morals: the application of ethics ● Tort
○ The human conduct of ethics ○ Intentional
■ Assault & Battery
A. PRINCIPLES ■ Defamation of character
■ False imprisonment
○ Unintentional
JUSTICE
■ Negligence
■ Malpractice
● Treat all person equally as person regardless of age, sex,
status in life, and education
CRIMINAL
● Used when there is more than one person

● Felony: act of omission punishable by law not only

RESPECT
committed by deceit but also by fault
○ There is deceit when the acts committed is with
● Treat all person as person regardless of age, sex, status in
deliberate intent:
life, and education
■ Freedom
● Used interchangeably with justice
■ Intelligence
● Giving choices

BENEFICENCE

● Doing good
● Acts of kindness, goodness, or charity

NON-MALEFICENCE

● Avoiding/preventing harm
● Actions may compromise/hurt the client, but you have to
do it

AUTONOMY

● Able to make decision free from any external constraints

FIDELITY

● Promise keeping
● Abiding to your duty

DOUBLE EFFECT

● For every act there is always a good and evil effect

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 - LEADERSHIP AND MANAGEMENT -
○ Participates in all activities related to overall
I. LEADERSHIP AND MANAGEMENT management
● SUPERVISORY
● Leadership: Process of Influencing a group of persons ○ Authority to hire, transfer, suspend, promote,
towards a common goal assign, discipline, and terminate employees
● A leader:is an individual (or, rarely, a set of individuals) ● ASSERTIVENESS
who significantly affects the thoughts, feelings, and/or ○ Key tasks for an assertive style of management:
behaviors of a significant number of individuals towards a ○ Communicating clearly and consistently
common purpose or goal (Howard Gardner). ○ Knowing yourself
● Management: proper and effective allocation of resources ■ Know when to talk and who to talk to
● A manager… Is someone who controls resources and ○ Taking responsibility
expenditures, have formal authority to interpret and ■ You know when to say “I am sorry”
enforce policy. ○ Proactively managing conflict and confrontation
○ Avoiding defensiveness
○ Recognizing faults and being honest
Leadership is just an idea ○ Setting reasonable limits
Position in an institution: MANAGER
○ Recognizing that change is good and cannot be
avoided
II. LEADERSHIP ○ Dispersing in an emotional situation until rational
discussion can occur
A. LEADERSHIP STYLES
○ Saying “No” without being aggressive or feeling
guilty
● Autocratic - authoritarian, directive
○ “I decide” B. CHARACTERISTICS OF A MANAGER
○ Full control
○ During crisis/emergency ● Result or outcome oriented
● Democratic - participative, consultative ● Problem server
○ Less control ● Interpreter and enforcer of unit and hospital policy
○ Consult ● Uses a combination of leadership styles
○ Policy making/Issuance of assignment
○ “We decide” C. CHARACTERISTICS OF AN EFFECTIVE LEADER
● Laissez-faire - permissive, ultra-liberal, non-directive
○ “You decide” ● Has vision of the future
○ No control ● Has influence to gain cooperation
○ With highly motivated people ● Has power to exert actions resulting to changes in
● Bureaucratic - traditional attitudes
○ “By the book” ○ Reward power - based on incentives
○ Always follows the rules and regulations ○ Coercive power - based on punishment
● Charismatic - strong feelings of commitment ○ Legitimate power - granted by position

😟
○ Have many loyalists ○ Expert power - based on knowledge, skill,
○ Often always fail abilities
■ “High hopes” of people ○ Referent power - based on charisma,
○ Good for short-term admiration and respect
● Transactional - provides incentives to promote loyalty and ○ Information power - based on charisma,
performance admiration and respect
○ Always with exchange process
D. QUALITIES/SKILLS/COMPETENCIES OF A LEADER
● Transformational - fosters creativity and is a risk-taker
○ Risk-takers
● Delegation (ARA)
● Connective - promotes collaboration and teamwork
○ Authority
○ Responsibility
III. MANAGEMENT
○ Accountability
A. ROLES OF NURSE MANAGER ● Critical-thinking
○ Looking beyond
● Conflict management ● Communication Patterns/behavior of a leader
○ Goal: To reach a solution that meet everyone's ○ Aggressive type - loud
needs ○ Passive type - shy
● Decision Maker/ Supervisor ○ Assertive
○ Prioritizing Cases ● Motivation
○ Result-Oriented ○ 3 Landmarks in the field of Motivation
● Client Advocate ■ Achievement - the need to excel
● Manager and Coordinator ■ Power - the need to make others
● Communicator behave in a way they would not
● ADVOCACY behave otherwise
○ To plead in behalf of another ■ Affiliation - the desire for friendly and
○ Develops budget close relationship
○ Asks nurse executive for a specific program or ● Decision making
change ○ Decision making process
■ Identify the situation
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 ■ Identify participants ● Maintaining a clean, safe, and efficient environment
■ Gather pertinent facts ● Housekeeping, transporting, and record keeping
■ Generate alternative solutions ○ Bedmaking
■ Predict outcomes ● Stocking and maintaining supplies
■ Select the best alternative
■ Get into gear WHAT CANNOT BE DELEGATED?
● Ethics
○ Beneficence Any part of NCP
○ Non-maleficence
○ Justice ● Initial nursing assessment
○ Autonomy ● Determination of nursing diagnoses
○ Veracity ● Establishment of nursing care goals
● Conflict management ● Development of nursing plan of care
○ STRATEGIES FOR CONFLICT ● Evaluation of patient's progress
MANAGEMENT ● Health counseling or teaching
■ Win-Lose Strategies: competing, ● Activities that require specialized nursing knowledge, skill,
● Compromising or judgment
■ Lose-Win Strategy: accommodating
■ Lose-Lose Strategy: avoidance or RULES OF DELEGATION
Withdrawal
● Smoothing or suppressing ● Delegate activities for stable patients with predictable
■ Win-Win Strategy: collaborating outcomes
● Confrontation ○ Normal, stable, non critical → YOU DELEGATE
○ Abnormal, unstable, uncritical → STAY WITH
TYPES OF CONFLICT RN
● Delegate activities that involve standard, unchanging
● Intrapersonal procedures
● Interpersonal ● Do not delegate the functions of assessment, evaluation,
● Intragroup nursing judgment and teaching.
● Organizational
This is the responsibility of the reasonable and prudent nurse and
she can't give this responsibility to someone else.
E. DELEGATION

● Under directing (PODC) Q&A:

● Authority
○ Authority is power, power is authority Which of the following is the advocacy role of the nurse
○ Power to delegate tasks - power to command manager?
a. Defending clients rights
● Responsibility
b. Safeguarding patients rights and privileges
○ An obligation c. Developing a new plan
● Accountability d. Protecting client’s rights
○ Liability
○ Answerable RATIONALE: if you are a nurse manager you are defending the
PRINCIPLES OF DELEGATION rights of your staff nurses, NOT PATIENTS - because you don’t
have direct contact with patients
● The transfer of responsibility for the performance of an The nurse immediately and correctly stabilized the injury.
activity from one individual to another while retaining This nurse has sense of:
accountability for the outcome. a. Advocacy
b. Accountability
ANA’S DELEGATION STANDARD c. Assertiveness
d. Critical thinking

● When delegating, the RN will consider: Nurses working in the 35 bed Female medical unit were noted to
○ Assessment of the patient condition implement new and innovative client care activities long before
■ Do not delegate if the patient is other units in the hospital. Which of the following leadership
UNSTABLE characteristics exhibited by the nurse manager best describes
○ Capabilities of the nursing and assistive staff this strength?
a. Communication skills
(SKILLS)
b. Vision and passion
○ Complexity of the task to be delegated c. Knowledge skills
■ Measure the abilities based from the d. Interpersonal abilities
initial task → easy tasks first
○ Amount of clinical supervision needed When the head nurse in your ward plots and approves your work
■ Minimal supervision schedules and direct your work, she is demonstrating:
○ Staff workload
a. Delegation
b. Authority
WHAT CAN BE DELEGATED? c. Accountability
d. Responsibility
● Feeding, drinking, positioning, ambulating, grooming,
toileting, dressing, and socializing The following tasks can be safely delegated by a nurse to a
non-nurse health worker EXCEPT:
● Collecting, reporting, and documenting data related to
these activities
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 ○ Operating budget: expenses for daily
a. Irrigation of a nasogastric tube
operations
b. Take vital signs
c. Change IV infusions ■ Rent, electricity, advertisement,
d. Transfer a client from bed to chair permits, maintenance, etc
○ Personnel/labor budget:
In conflict management, the win-win approach occurs when: ■ Things to consider:
● Types of nx care (patterns
a. There are two conflicts and parties agree to win each of nx care/ system of nx
one
care assignment/ modalities
b. Each party gives in on 50% of disagreements making
up to conflict of nx care) (Primary,
c. Both parties involved are committed to solving the functional, team)
conflict ● Patient categories/ levels
d. The conflict is settled out of court so the legal system of patient care/acuity of
and parties win patient care/ complexity of
patient care (Minimal,
When one person allows the conflict to be resolved at his or her
own expense, this is referred to in conflict management as: moderate, maximal,
a. Losing intensive)
b. The win-lose approach ○ Cash Budget: petty cash
c. Winning while losing
d. The lose-win approach ORGANIZATION

F. MANAGEMENT PROCESS ● Organization: group of people working together to

PODC achieve a desired goal
PLANNING ● Organizational Structure: is the bony skeleton of the
organization
● The most basic and essential activity of management ● Organizational Chart: visual representation of the chain
● The primary management functions that decide in of authority, division of work, levels of management, and
advance what needs to be done for the day, month, or functional communication pattern from chief executive to
years ahead? each member of the organization
○ Authority is signified by a LINE:
TYPES OF PLANNING ■ Direct link - who reports to whom
■ Dotted/broken line: staff authority
● Strategic plan: long-term (e.g for secretary, offices -
○ >5 years coordinating relationship)
○ Plan for the life of the organization ○ Management level:
● Operational plan: short-term ■ Top
○ Yearly plan ■ Middle
○ Plan for daily operations, and is usually done ■ Low
annually ■ Chief nurse (Top level in nursing
● Contingency plan: a plan for a specific problem service; middle level - whole
● Project: plan for the professional growth institution)
○ Communication pattern:
PLANNING HIERARCHY ■ Downward - Memos, announcement
■ Upward - employee input
● Vision: mental image of the future ■ Lateral - shared within the same level
● Mission: reason of your existence of management (endorsement)
● Philosophy: statement of your values and beliefs ■ Diagonal - informal (chismis -
○ Ad astra per aspera - to the stars through grapevine; unreliable)
difficulties ■ Circular: shared information (shared
● Goal to all)
● Objectives ● Span of Control: refers to the breadth and responsibility
● Policies: standards that specifically deal with conduct for directing the action of others within the organization
● Procedures: specific directions for implementing written ○ Too many subordinates - undersupervision
policies ○ Few subordinates - Oversupervision
○ 8 to 12 - average 10
BUDGETING ● Policy Manual: tool for orienting staff or new employees
and a reference guide when problems or conflicts arise
● Job descriptions: written account of the organizational
● is a planning document used by a department or
relationships, responsibilities, specific duties and working
organization that forecasts both revenues and expenses
conditions of a particular job
● Types of Budget:
○ Title: RN, MAN
○ Capital expenditure budget: it takes time to
○ Position: Supervisor
recover the cost
○ Duties and responsibilities
■ Long-range planning
○ Organizational relationship: Reporting to the
■ > 5, 10, or 20 years to recover the
Chief nurse
cost
■ E.g major investments (buildings,
equipments) STAFFING
■ Return of Investment

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 ● Staffing: is the management activity that provides for and/or operation. Needs assistance related to ambulation
appropriate and adequate personnel to fulfill the and care
organization's objective ● Category III. MAXIMUM CARE - close attention
○ Traditional 8 hrs/ day = 40 hrs/week throughout the shift
○ 12 hrs shift ● Category IV. INTENSIVE CARE - acutely ill patients - high
○ 7 days straight/7 days off degree to nurse dependency
○ Baylor plan
■ Some will work from M-F for 8 hrs
Q&A:
■ Some will work every weekends for
The drawing that depicts how the parts of an organization are
12 hrs linked, shows the formal organizational relationship, areas of
○ Flexible hours or part-time work responsibility, to whom one person is accountable and the
○ Combination plan: combination of part-time and channels of communication is so to be:
full time a. Organizational Chart
○ Per diem nurses b. Organizational Structure
○ Float-float policy: no specific assignment c. Span of control
d. Chain of Command
● Staffing Pattern
○ Decentralized - Supervisor makes staffing As a head nurse of the unit, which of the following sources should
○ Centralized - Chief nurse makes staffing take into consideration when making effective assignments for
○ Self-scheduling the next shift?
○ Alternating or rotating work shifts
■ Equal share of am, pm, night, and a. Seniority preferences
b. Recent performance evaluation
weekend offs
c. Personality traits
○ Permanent shifts d. Client classification data
■ Permanent AM - Senior nurses (head
nurses) RATIONALE: option b is not correct, because it is only used for
○ Block or cyclical evaluation of staff as a basis whether to promote/retain/terminate
■ Equal share of am, pm, night, and them. The sources to take into consideration when making
weekend offs - cycle lengths (every 2 effective assignments should be based on the acuity of care of
the patients, therefore option d is the correct answer.
weeks or 3 weeks)
Which of the following best describes primary nursing?
TYPES OF ORGANIZATIONAL STRUCTURE
a. Is a form of assigning a nurse to lead a team registered
● Tall/ Centralized/ Vertical/ Hierarchical/ Old/ Traditional nurse in care of patient from admission to discharge
● Flat/ Horizontal/ Decentralized/ Modern b. A nurse is responsible in doing certain tasks for the
patient
● Concentric
c. A registered nurse is responsible for the 24 hour
care of a group of patients from admission to
SYSTEMS OF NURSING CARE DELIVERY Discharge
d. Registered nurse provides care for the patient with
● Case method/ Total care: 1:1 assistant of nursing aides
The one on one pattern of nursing care common in private duty
○ ICU, student nurses, private duty
nurses, ICU nurses and nursing students is called:
○ Expensive
● Functional method: task is divided a. Case method Nursing
○ Used in times of shortage of nurses b. Primary Nursing
○ More on task accomplishment → patient care is c. Team Nursing
not prioritized d. Functional Nursing
● Team method: patient is divided
○ Taking care of the patients within the day
○ RNs and NAs
● Primary Nursing: one nurse is taking care of 4-6 patients
within the day from admission to discharge
○ Continuity of nursing care
● Modular: combination of team and primary
○ 2-3 team will be assigned to 8-12 patients
○ Patients assigned to you today, will still be
assigned to you tomorrow
○ RNs only
● Case management/Case manager: follow-up on the
patient before admission and even after discharge
○ Per case (e.g. Dengue cases)
● Collaborative practice: collaboration with other members
of the healthcare team
● Managed care: health card
○ Sometimes services are rendered to you
depending on the coverage of your HMO

PATIENT CLASSIFICATION

● Category 1. MINIMAL CARE - convalescing patients

● Category II. MODERATE CARE - moderately
ill/recovering from immediate effects of a serious illness
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