Nursing Leadership

and Management

Organizing and
Staffing

Presented by:
BSN 4C 2
-ANTHEA-
O Nice
R G A NOrgan
IZ IN G!!!!
!!!
Organizing
• It is the process of establishing formal
authority.
•
• It involves setting up the organizational
structure through identification of
groupings, roles and relationships,
determining the staff needed by
developing and maintaining staffing
patterns and distributing them in
various areas as needed.
•
• It includes developing job descriptions
by defining the qualifications and
Elements of Organizational
Structure
• Setting up the Organizational
Structure
• Staffing
• Scheduling
• Developing Job Description
•
 Setting up the Organizational
Structure


 Understanding the organizational

structure as a whole facilitates the
development of roles and relationships to
enable the achievement of goals. The
organizational structure refers to the
process by which a group is formed, its
channel of authority, span of control and
lines of communication.
Departmentalization and division of work
provide orderliness in administration.
Through a breakdown of activities each
individual becomes responsible for a
specified set of activities and performs
such.
Purposes of Setting up the
Organizational Structure:
• It informs members of their
responsibilities so that they may
carry them out.
• It allows the manager and the
individual workers to concentrate
on his/her specific role and
responsibilities.
• It coordinates all organizational
activities so there is minimal
duplication of effort and conflict

• It reduces the chances of doubt and
confusion concerning
assignments.
• It avoids overlapping of functions
because it pinpoints
responsibilities.
• It shows to whom and for whom they
are responsible.

 Purposes of Setting up the
Organizational Structure
• It informs members of their
responsibilities so that they may
carry them out.
• It allows the manager and the
individual workers to concentrate
on his/her specific role and
responsibilities.
• It coordinates all organizational
activities so there is minimal
duplication of effort and conflict

 The organizational structure of
the Nursing Service should be
updated, reviewed, approved and
documented by the proper authority.
Date of last review should be
documented.
 Staffing
 The purpose of all staffing activities is
to provide each nursing unit with an
appropriate and acceptable number of
workers in each category 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. Such situation can lead
to high rates of absenteeism and staff
turn-over resulting in low morale and
dissatisfaction.
 Scheduling
 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-duty days
can be achieved and the individual
members of the nursing team will
feel that they are treated fairly. They
will also know their schedule in
advance.
 Developing Job Description
 A 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, that work is
efficiently distributed, that talents
are fully used, and morale is
 Principles of Organizing
• Unity of Command
• Scalar Principle or Hierarchy
• Homogenous Assignment or
Departmentation
• Span of Control
• Exception Principle
• Decentralization or Proper Delegation
of Authority
 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.

Scalar Principle or Hierarchy
 Authority and responsibility
should flow in clear unbroken lines
from the highest executive to the
lowest. The other term for this is
“chain of command”, usually a
military term.
 Homogenous Assignment or
Departmentation (Specialization)
 Workers performing similar
assignments are grouped together
for a common purpose.
Departmentation promotes the
specialization of activities, simplifies
the administrator’s work, and helps
maintain effective control.

 Exception Principle
 Recurring decisions should be
handled in a routine manner by
lower-level managers whereas
problems involving unusual matters
should be referred to the higher
level.
 Decentralization or Proper
Delegation of Authority
 Decentralization is the process
of conferring specified decision
making to the lower levels of the
organization. Basic top level
decisions and policies must receive
attention at the top levels. The
amount of skills and competence of
subordinates and executives
determines the success of any
program of decentralization.
 Executives should be developed
to handle situations delegated to
them. This delegation of authority is
still subject to the supervision and
control of the delegating superior.

-UMALI-
ORGANIZATIONAL
STRUCTURE
ORGANIZATIONAL REDESIGN,
RESTRUCTURING AND
REENGINEERING

Delmar LearningCopyright © 2003 Delmar Learning, a Thomson Learning com

 RESTRUCTURING
A significant modification made to the
debt operations or structure of a company. This
type of corporate action is usually made when
there are significant problems in a company,
which are causing some form of financial harm
and putting the overall business in jeopardy.
The hope is that through restructuring, a
company can eliminate financial harm and
improve the business.

Delmar LearningCopyright © 2003 Delmar Learning, a Thomson Learning com


REDESIGNING

– make a design of; or a systematic

planning
– to change the design of (something).
– Reorganize, Rearrange, Recast,
Reshape


Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 24

 REENGINEERING
– Is the radical redesign of an
organization's processes, especially
its business processes. Rather than
organizing a firm into functional
specialties (like production,
accounting, marketing, etc.) and
looking at the tasks that each
function performs.


Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 25

• Restructuring and reengineering
deals with the entire organization’s
structure to improve its functioning
and productivity.
• It naturally follows organizational
affiliations, mergers, consolidations,
and integrations. Downsizing or
right sizing by cutting the number
of positions is also restructuring
requiring redesign.
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 26
 The role of the Nurse Manager
through
3 R’s Involves: (Sullivan And Decker,
2001)
• Team Building 
• Coaching
• Mentoring
• Initiating change
• Reducing cost
• Improving quality of care

Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 27

 Types of Organizational
Structure
• Informal Structure
• Formal Structure
• Pun Line Organization
• Line and Staff Organization
• Functional Line and Staff
Organization
• Matrix or Free form Organization
• Adhocracy or adaptive or organic
model
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 28
 Purpose of Organizational
Structure
• The primary purpose of an
organizational structure is to
facilitate the accomplishment of
the institution’s mission.
•

Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 29

 Informal Structure


• It is based on personal relationship

rather than on respect for positional
authority. It helps member meet
personal objectives and provide
social satisfaction.


•
•
• Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 30
Formal Organization
•  The organizational structure
furnishes the formal framework in
which the management process
takes place. It should provide an
effective work system, network of
communication, and identity to
individuals and the organization
and should consequently foster job
satisfaction.

Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 31
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 32
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 33
Line and Staff Organization

• Line and Staff Organization develops

when a simple line structure is
altered to provide support line
authorities.
• The line functions are command and
control.
• The Staff functions are separate from
chain of command. Involves
specialization, and a supportive to
line authorities.
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 34
 Functions of Staff
• Do what the executives do
• Serve the line organization
• Submerge personal interest to
champion the executive’s long
range objectives.
• Manages policies and procedures

Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 35

 Functional Line and Staff
Organization
• Staff have some authority over line
executive.
• Staff expert responsible for specific
management function , such as
staffing, staff development , or
quality improvement.
• Has authority to command line
executives to implement staff
plans.

Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 36
 Matrix and Free Form
Organization
• Matrix organizational design try
combine the advantages of the
project and the functional structures.
 The functional line organization
provide support for the project line
organization. The functional manager
has the authority to determine and rate
goals, select personnel, determine pay
and promotion, make personnel, and
evaluate personnel and the project.
•
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 37
• In a matrix organization the functional
manager shares those responsibilities
with the project manager . Initially, the
functional manager may experience a
sense of loss in status, authority and
control.
•
• Therefore it is important for the
managers to be able to persuade
others by using their personal
qualities and knowledge of the
program.
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 38
Characteristics of matrix

• decision making as far down in the

organizational structure
• Most decisions are made at the
middle management level
• More decentralized with fewer levels
of decision making
• Increases the amount of contact
among individuals & its complexity
makes conflict inevitable.

Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 39

Adhocracy/ adaptive or Organic
model
• Adhocracy or organic models are
newer organizational frameworks
that are more free form, open ,
flexible and fluid than older
bureaucratic models. Boundaries
separating internal & external
relationships are more easily
penetrated.
• adhocracy comes from an ad hoc
committee.Its structures are
loosely structured project
organizations.
Chapter 9 Copyright © 2003 Delmar Learning, a Thomson Learning company 40
-VIRAY-
 ORGANIZATIONAL CHART
• Is a line drawing that shows how the
parts of an organization are linked.
It depicts the formal organizational
relationships, areas of
responsibility, persons to whom one
is accountable and channels of
communication.
•
 PURPOSES
• They can contribute to sound
organizational structures
• Show formal lines of communication
• Help employees understand their
assignments, especially in relation
to other.

Organizational
Concepts and
Vertical Chart
Horizontal Chart
Circular Chart
-JRO-
 LINE AND STAFF
RELATIONSHIP
•

• Line authority is the simplest and most

direct type in which each position has
general authority over the lower
positions in the hierarchy in the
accomplishments of the main operations of
the organization. The unit head has
direct responsibility for the work of a
unit.
•


• Staff personnel provides advice,

counsel or technical support
that may be accepted altered or
rejected by the line officer.
GUIDELINES IN ORGANIZING
1. Supply Market
• It is im p o rta n t th a t th e lo ca l su p p lie r
ca p a city is p ro p e rly re se a rch e d p rio r
to o rg a n izin g a b u sin e ss
 se m in a r to e n su re th a t g o o d s a n d
se rvice s a re re le va n t to th e n e e d s.


2. Invitations


• T h e in vita tio n sh o u ld in d ica te th e typ e s

o f su p p lie rs th a t w ill b e a tte n d in g th e
se m in a r.
•
3. Frequency

• D u e to lim ite d re so u rce s, a n d in

o rd e r to b e fa ir to a ll co u n trie s,
g e n e ra lly o n ly
 p a rticip a te in o n e m a jo r su p p lie r
e ve n t p e r co u n try p e r ye a r.


4 . F a cilitie s
• T h e o rg a n izin g e n tity sh o u ld e n su re
th a t th e fa cilitie s a re a va ila b le fo r
b u sin e ss
 se m in a rs:
•
5. Agenda
• T h e a g e n d a fo r th e b u sin e ss se m in a r
sh o u ld b e a g re e d
 w ith o th e r p a rticip a tin g o rg a n iza tio n s
a n d th e o rg a n izin g e n tity.


6. Individual meeting with suppliers

• A p ro g ra m sh o u ld b e p re p a re d in
a d va n ce b y th e o rg a n izin g e n tity.
E a ch su p p lie r m e e tin g
 sh o u ld b e sch e d u le d to la st fo r n o
lo n g e r th a n 1 5 m in u te s.
•
7. Expenses

• Organizing entities in developed countries

are expected to cover the travel
expenses, hotel and
 meals for all participants
•
8. Supplier fees

• A n y fe e s ch a rg e d to su p p lie rs fo r
p a rticip a tin g sh o u ld b e ke p t to a
m in im u m a n d a im to o n ly co ve r
 co sts in cu rre d .

•
9. Travel, Accommodation & other

practical information
• The organizing entity is responsible for
making the necessary accommodation
arrangements for
 participants.
-CHICO-
Staffing
Staffing
• Is the process of determining


• providing the acceptable number

•
• mix of nursing personnel to produce
a desired level of care to meet
the patients demand.
•
Factors affecting
staffing:
• the type, philosophy, and objectives of
the hospital and the nursing service;
•
• the population served or the kind of
patients served whether pay or
charity;
•
• the number of patients and severity of
their illness-knowledge and ability of
nursing personnel are matched with
the actual care needs of patients;
•
Factors affecting staffing
con’t
• availability and characteristics of the
nursing staff, including education,
level of preparation, mix of
personnel, number and position;
•
• administrative policies such as
rotation, weekends and holiday off-
duties;
•
Factors affecting staffing
con’t
• standards of care desired which
should be available and clearly
spelled out. institution may utilize
the ANSAP’s standard of nursing
practice; PRC-ANSAP’s standards of
safe nursing practice and/ or the
hospitals themselves may
formulate/develop their own
standards;
•
Factors affecting staffing
con’t
• availability and characteristics of the
nursing staff, including education,
level of preparation, mix of
personnel, number and position;
•
• administrative policies such as
rotation, weekends and holiday off-
duties;
•
Factors affecting staffing
con’t
• expected hours of work per annum of
each employee. this is influenced
by the 40-hour week law; and
• patterns of work schedule-traditional
5 days per week, 8 hours per day; 4
days a week, ten hours per day and
three days off; or 3 ½ days of 12
hours per day and 3 ½ days off per
week.
•
Factors affecting staffing
con’t
• layout of the various nursing units
and resources available within the
department such as adequate
equipment, supplies, and materials;
• budget including the amount allotted
to salaries, fringe benefits,
supplies, materials, and equipment;
•
Factors affecting staffing
con’t
• professional activities and priorities
in nonpatient activities like
involvement in professional
organizations, formal educational
development, participation in
research and staff development;
• teaching program or the extent of
staff involvement in teaching
activities;
•
Factors affecting staffing
con’t
• expected hours of work per annum of
each employee. this is influenced
by the 40-hour week law; and
• patterns of work schedule-traditional
5 days per week, 8 hours per day; 4
days a week, ten hours per day and
three days off; or 3 ½ days of 12
hours per day and 3 ½ days off per
week.
•
Selection of personnel
• Recruitment and Retention
• Screening of potential staff
• Interview
• Orientation
Selection of personnel
• Recruitment and Retention


––The
“if aacquisition
man proceedsof qualified people
confidently in
in the
any agency ofis his
direction critical
dreamsfor andthe
establishment
endeavors ,tomaintenance and he
live the life growth
has
of the organizational. Therefore
imagined,
active he will meet
recruitment with success
is important , and
unexpected
the attraction of in qualified
commonapplicants
hours”
is------henry
the first david
stepThoreau
in selection of
 personnel.
Selection of personnel
• Recruitment and Retention

Modes for active
recruitment
• employee recommendations and
word of mouth
•
• advertisement in local newspaper,
nursing organization bulletins, and
nursing journal
•
• recruitment literature, such as fliers
and newsletter  Recruitment and
Retention
Modes for active
recruitment con’t
• Posters
•
• career days
•
• job fairs
•
• contract with schools graduating
classes
 Recruitment and
Retention
Modes for active
recruitment con’t
• placement service
•
• open houses
•
• nursing conventions 
•
• Recruiters should know nursing
qualifications and the needs of the
institution.  Recruitment and
Retention
•
Major sources of
personnel
• persons seeking their first jobs
• dissatisfied employees
• unemployed individuals


üThese classifications are important

for all categories indicate types of
information the nursing manager
should obtain and they influence
the selection process.  Recruitment and
Retention
•
Selection of personnel
• Recruitment and Retention
• Screening of potential staff
• Interview
• Orientation
Selection of personnel


• Screening of potential staff

– investment in well-qualified nurses
can produce a high rate of return
and errors
– whether they be failure to hire a
promising nurse or hiring someone
who fails to achieve the
organizations expectations
– can be expensive mistaken.

 There are three underlying
philosophy the screening
 process:
1. The manager should screen out
applicants who do not fit the
agency’s image.
2. The manager should try to fit the

job to a promising applicant.

3. Usually the manager should try to

fit applicant to the job.

•  Screening of potential staff
 Application forms and
resumes
• Data in the personal history
educational background, work
experience, and other pertinent
information­­­can be used to the
following:


– determine whether the applicant

meets minimal hiring requirements,
such as minimal educational level or
minimal job experience
 Screening of potential staff

 Application forms and
resumes con’t
– furnish background data useful in
planning the selection interview
– obtain names of references who may
be contracted for additional
information about the applicant’s
work experience and general
character
– Collect information for personnel
administration, that is, social
security number, number of
dependents, and 
so forth.
Screening of potential staff

Selection of personnel
• Recruitment and Retention
• Screening of potential staff
• Interview- A preemployment interview to
• p re d ict jo b su cce ss sh o u ld b e
Orientation
co n d u cte d w ith th e m o st q u a lifie d
a p p lica n ts.
Selection of personnel
• Recruitment and Retention
• Screening of potential staff
• Interview
• Orientation
Purposes of the
interview
• to obtain information
• to give information
• to determine if the applicant meets
the requirements for the position
•

 Interview
vOne of the main purpose is to learn
about the prospective employee.
v
vThe interview answers questions,
explains policies and procedures, and
helps acquaint the applicant with the
position.
v
vFinally, the interviewer must predict
whether the applicants overall
performance will be satisfactory.
 Interview
•
Selection of personnel
• Recruitment and Retention
• Screening of potential staff
• Interview
• Orientation
- Induction is the first2 o 3
d a ys o f o rie n ta tio n . It ca n
be done by p e rso n n e l
d e p a rtm e n t e m p lo ye e s fo r a ll
n e w e m p lo ye e s.
It includes a history of
the …
• organization
• the vision
• purpose
• structure
• working hours
• holiday time
• Vacation
• sick time
• paydays  Orientation
• Orientation is important, and the
manager who does not take the time
to assist a new employee is making a
serious mistake.
 

• Because of the information overload,

induction and further orientation
should be conducted over time. a
checklist for orientation that indicates
the content, time frame, and who is
Orientation
responsible to teach it can be helpful.
-CRISTINA-
 Staff development
• Goes beyond orientation
• It is a continuing liberal education of
the whole to develop her potential
fully
• It deals with aesthetic senses, as well
as technical and professional
education
• It is also related to retention, raises,
advancement to other positions or
termination
 Preceptor ships
• Used to help recruit, retain, orient, and
develop staff.
• Is responsible for the quality of patient
care and facilities the students
learning.
• They are liaison between students and
the agency
• They help students learn skills and
learn how to organize their work.
• A work shop to prepare preceptors is
desirable.

 Preceptor ships
Purposes


• Gives agency personnel an

opportunity to evaluate students
and determine if they are suitable
candidate’s employment.
•
 Mentorship
• Should provide an opportunity to share
information review works, provide
feedback, explore issues, plan
strategies and solve problems.
• Preceptors are role model who may
become mentors’.
• Is a confident who personalizes role
modeling and serve as a sounding
board for decisions.
• Are resource people who support the
development of the younger person
through influences and promotion.

 Mentorship
Purposes


• Gives their times, energy and

materials support teach, guide,
assist, counsel and inspire younger
nurses.

 Phases of the mentoring
process
• Invitation
• Questioning
• Transitional

 Career mapping
• Is a strategic plan for ones career
• It provides direction for formal
education, experience, continuing
education, professional association
and network ship

 Career mapping
Purposes


• Nurses need to assess their own values

and define success for themselves
• Job security , sense of accomplishment
and opportunities for professional
advancement are often considered
important
• Other issues to considered are work
hours, salary, benefits retirements
plans, organizational and
geographical climate and location

 Careers typically progress
through stages:
• Exploration (ages 15 to 22 yrs)
• Early career(22 to 38 yrs)
• Middle career (38 to 55 yrs)
• Later career (55 to 70 yrs)
-JENA-
 ASSIGNMENT SYSTEM FOR
STAFFING:
• Changes in assignment systems are
a response to changing needs.


– shortage of nurses
– manage competition
– care to patient through primary
nursing

 System Used in Staffing
• Case Method
– Each patient is assigned to a nurse for
total patient care while that nurse is
on duty.
–
• Functional Nursing
– Hierarchical structure predominant
– Efficient system that is least costly
and requires few RNs

• Team Nursing
– Group or Team action
– Led by a professional or
Technical Nurse who: 
• Plan
• Interprets
• Coordinates
• Supervise
• Evaluates
– Team member is encourage to
make suggestion and ideas
• Primary Nursing
– Patient should be the focus of
professional nurses instead of task
– The RN remains responsible for the
care of the patient 24 hrs per day
throughout the patient
hospitalization

• Modular or District Nursing
– Modification of Team and primary
nursing
– Uses smaller team who are grouped
geographically

• Managed Care
– Focused from acute care to promotion
of health and disease management
of chronic and terminal care

• Case Management
– Focused on chronic long term
outpatient
– (Psychiatry and social work)

• Collaborative Practice
– Interdisciplinary team
– Nurse-physician interaction in
practice or nurse-physician
collaboration on care giving

Advantages and Disadvantages
of Assignment System

SYSTEM Advantage Disadvantag

s es
Case Total patient Different nurse,
Method care different shifts,
different days
SYSTEM Advantage Disadvantage
s s
Functiona Efficiency Nurses do
l Nursing managerial work
Nurses’ aides do
patient care
Time needed to
coordinate
delegated work.
Team Team effort Time needed to
nursing Frees patient care coordinate
coordinator to delegated work
manage the unit
Nursing care
conferences help
problem solve and
develop staff
Nursing care plan
Modular Useful where Paraprofessiona
nursing there are few ls do technical
RNs aspects of care
RNs plan care
Primary RNs give total patient Confines nurse’s
Nursing care talents to a limited
Primary nurse has 24- number of patients
hour responsibility Associates nurse may
Associate nurse works change care plan
with patient while the without discussing
primary nurse is off with primary nurse
duty
Accountability in
place
Continuity of care is
facilitated
Reduces number of
errors from relay of
orders
Fewer patient
complaints
Shorter
hospitalization
Managed Incorporates Questionable
Care case management continuity of
Can be used care
with any
nursing care
deliver system
Standard
critical paths
Increases
efficiency
Reduces costs
Case Focuses on entire Effort to coordinate
episode of illness
Management Emphasizes
achievement of
outcomes
Care is coordinated
by a case manager
Second-generation
primary nursing
Critical paths
Variation analysis
Intershift reports
Health care team
meeting
Interdisciplinary
-ANJIING-
Staffing Schedule
for Productivity
 Definition
SCHEDULING


• is the process of deciding how to

commit resources between a variety
of possible tasks. Time can be
specified or floating as part of a
sequence of events.
TYPES OF SCHEDULING:


• Centralized Schedule- one person,

usually the chief nurse or her
designate, assigns the nursing
personnel to the various units of
the hospital. This includes the
shifts on duty and off-duty.
•
• Decentralized Schedule- the shift and off
duties are arranged by the supervising
nurse or head or senior nurse of the
particular unit.
•
• Self Schedule- it is a system that is
coordinated by staff nurses. It is a
process by which nurses and other staff
collectively develop and implement work
schedules, taking policies and variables
affecting into consideration.
-KAT-
 Patient Care
Classification System
• Is a method of grouping patients
according to the amount and
complexity of their nursing care
requirements and the 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
nursing personnel who should
provide that care.
 LEVEL I
 - Self Care or Minimal -


• Patient can take a bath his own, feed

himself, feed and perform his
activities of daily living.
•
 LEVEL II

 - Moderate Care or Intermediate

Care -
•
• Patients under this level need some
assistance in bathing, feeding, or
ambulating for short periods of
time.
•
 LEVEL III
- Total, Complete or intensive Care
-
•
• Patient under this category are
completely dependent upon the
nursing personnel.
•
 LEVEL IV
- Highly Specialized Critical Care -
•
• Patients need maximum nursing care
with ratio of 80 professionals to 20
non-professionals.
1.
-BABY-
Republic Act 5901 – The Fourty – Hour Week
Law

Ø Provides that employees working in

the hospitals with 100 bed capacity
and up will work only 40 hours a
week.
Ø
Ø Employees working in agencies with
less than 100 bed capacity or in
agencies located in communities
with less than one million
populations will work 48 hours a
week and therefore will get only
 Civil Service Commission as per
Memorandum Circular No.6, series of 1996

Ø Granting of the three-day special

privilege to government
employees.
Ø
Ø Which may be spent for Birthdays,
weddings, anniversaries, funerals
(mourning), relocation, enrolment
or graduation leave, hospitalization,
and accident leaves.
Rights and Privileges given Working hours per week40 Working hours per week
each personnel per year hours 48 hours

Vacation leave 15 15
Sick leave 15 15
Legal holidays 10 10
Specials holidays 2 2
Special privileges 3 3
Off – duties as per R.A. 5901 104 52

Continuing education 3 3
program

Total non-working days per 152 100

year

Total working holidays per 213 265

year

Total working hours per year 1,704 2,120

SCHEDULED METHOD PROS CONS

SELF-SCHEDULING - coordinating by staff nurses -increases amount of time staff spends

-saves manager scheduling time on scheduling
-helps develop accountability
-increases perception of autonomy
-increased job satisfaction
-improved team spirit
-improved morale
-decreased absenteeism
-reduced turnover
-effective for recruitment and retention

ROTATING WORK SHIFTS -can rotate teams -rotate among shifts

-increased stress
-affect health
-affect quality of work
Disrupt development of works group
-high turnover
PERMANENT SHIFTS -can participate in social activities-job
satisfaction-commitment to the
organization-few health problem-less
tardiness-less absenteeism-less
turnover
-most people want day shift-new
graduates predominantly staff evening
and nights-difficulty evaluating evening
and night shift-nurses may not
appreciate the workload or problems of
other shift

BLOCK, OR CYCLICAL SCHEDULING -same schedule repeatedly-nurses not -rigidity

so exhausted-sick time reduced-
personnel know schedule in social
events-decreased time spend on
scheduling-staff treated fairly-helps
establish stable work groups-decreased
floating-promotes continuity of care

VARIABLES STAFFING -use census to determine number and

mix of staff-little need to call in
unscheduled staff
 ALTERNATING OR ROTATING WORK SHIFTS

Ø The frequency of alternating between days and

evening, or days and nights, or rotating through
all three shifts may vary among institutions.
Some nurses may work all three shifts within 7
days.
Ø
Ø Alternating and rotating work shift create stress
for staff nurses, environmental cues, such as:
sunrise and sunset, fluctuate in a predictable
cycle.

Ø Instrument s that designate hours, minute, and seconds
correspond to the natural daily cycle and allow
knowledge of one’s location in that cycle.


Ø The ability of the body function to adjust varies

considerably among individuals; it takes 2 to 3 days to 2
weeks for a person to adjust to a different sleep-awake
cycle.

•
 PERMANENT SHIFTS
Ø Permanent shifts relieve nurses from
stress and health-related problem
associated with alternating and
rotating shift.
Ø When nurses are able to choose the
shift that best suits their personal
life, they can participate in social
activities, even when they require
regular attendance.
Ø In studies conducted with MONTREAL
NURSES, those working permanent
shifts had higher average on
psychological scales such as:
mental health, job satisfaction,
social involvement, and
commitment to the organization.
 BLOCK OR CYCLICAL
SCHEDULING
Ø Uses the same schedule repeatedly.
With a 6-day forward rotation,
personnel are scheduled to work6
successive days followed by at
least 2 days off. The scheduled
repeats it every 6 weeks.
Ø Personnel can be scheduled with
every other weekend off and 1 day
during the week so that there are
more than 4 consecutive days of
are not exhausted by working too
many consecutive days, sick leave
can be reduced.
•
TEN – HOURS PER DAY, FOUR-DAY
WORK PER WEEK
• A cyclical scheduled allowed at least
14 hours off between shifts and a
4-day weekend every 6 weeks for
those who rotated.
• The work week began on Sunday and
the weekend was Saturday and
Sundays for all shifts.
Variables staffing PROS CONS

8 hours Traditional

10 hours Time to complete work, Longer workday,

Long weekends, Fatigue,
Extra days off, Overlap,
Decreased overtime, Difficult to find substitute
Cover peak workloads,
Decreased costs

12 HOURS Lower staffing requirements,Lower cost Overtime,Exhaustion increases at end

per patient day,Increased knowledge of of workweek,Tension increased at the
patients,Get new admission settled,Not end of workweek,Increased in minor
so rushed,Better continuity of accident,Increased medication
care,Team development is errors,Home and social life suffer the
possible,Less daily to do week worked.
staffing,Reduced travel time,Less
personal expenses for gas, meals,
babysitting
-JOSEPH-
Determination of Number
of Nursing Personnel
Importance:


• So that there should have sufficient

staff to cover all shifts, off-duties,
holidays, leaves, absences, and
time for staff development
program.
•
 Steps in
Computing Number
of Nursing
Personnel
 Sample Problem
• Find the number of nursing personnel
needed for 250 patients in tertiary
hospital.
•
h .. Pa n u b h e e yu n ?? Toxic ya ta ??
 Illustration:
Step 1


 Categorize the patients according to the

levels of care needed.
 Multiply the total number of patients by
the percentage of patients at each
level of care.
 2 5 0 (p t x . = 75 min GIVEN
. care
 s) 30 = 112 . 5
2 5 0 (p t x . m o d . ca re
s) 45
2 5 0 (p t x .
s) 15
ca re

= 37 . 5 int.

= 2 5 h . sp cl.
 Step 2
 Find the # of Pts at each level by the
average number of nursing care hour
needed per day.

 Get the sum of the NCH/day needed at the
various
75pts x 1.levels.
5 (NCH@L1
=75) min 112.5NCH/day
= . care
 112.5pts x 3 = 112.= 5 337.5
37.5pts
(NCH@L2) mod.care NCH/day
25pts x 4.5 = 37.5=int168
. .75
(NCH@L3) care NCH/day
x Tota
6 (NCH@L4 150NCH
=) 25 h=. spcl . /day
l care 768 . 75NCH / day
 Step 3
 Find the actual number of nursing care hours
needed by the given number of patients.


 Multiply the total nursing care hours needed per

day by the total number of days in a year.




 x 365 days/year
 280,593.75 NCH/year



7 6 8 .7 5 N C H /
SAVE
d ay

 ?
Step 4
 Find the actual number of working hours rendered
by each nursing personnel per year.


 Multiply the number of hours on duty per day by

the actual working days per year.


Working hrs / yr Total NCH / yr
 8 (hrs/day)
x
213 (working
days/year)
1,704 working

SAVE
hours/year 280 , 593SAVE
. 75 NCH / year

 Step 5
 Divide the total # of NCH/yr by the actual # of
working hrs rendered by an employee/yr.
 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).
 Add the number of relievers to the number of
nursing personnel needed.
• Total NCH/yr =2 8 0 , 5 9 3 . 7 1 6 5
 Working hrs/yr5 =
1 ,
• Relief x Total Nsg Personnel =7 0 4
x 0 .1 5 2
• Total Nursing Personnel needed =+ 159 0
1 , 704 working hours / year
SAVE 280 ,=
593SAVE
. 75 NCH / year
 Step 6
 Categorize the nursing personnel into
professionals and non-professionals.

 Multiply the # of nsg personnel according to the
ratio of professionals to non-professionals

x .6 5 1 2 4 p ro fe ssio n a l
1 9 0x= . 3 5 n6 u6 rse
n usrsin g
= a tte n d a n ts
190
 Step 7
 Distribute by shifts.

 Professional
124 nurses x . = 56 nurses on AM
124 nurses 4
shift
5 = 46 nurses on PM
124 nurses
shift
x . = 22 nurses on night
total 124
nurses 3 shift
7
x .
6 6 n u rsin g 1 1 2 4 p ro fe ssio n a l
 Step 7
 Distribute by shifts.

 Non-Professional
66 Nsg attendantx . = 30 Nsg attendant on AM
66 Nsg attendant4 sh ift
66 Nsg attendant =
5 24 Nsg attendant on PM
x . sh ift
to ta l 6 6 N sg a tte n d a n t
3= 1 2 Nsg attendant on night
7 sh ift
x .
1
8
6 6 n u rsin g 1 2 4 p ro fe ssio n a l
Tapos na!