Nurs|ng Management

rocess and Iunct|ons

8SN IV
1he managemenL process ls unlversal lL ls used ln one's
personal llfe as well as one's professlonal llfe Cne applles lL Lo
managemenL of oneself a paLlenL a group of paLlenLs or a group of
workers knowledge of Lhls process assures nurses of smooLh
funcLlonlng of Lhelr unlLs ln aLLalnlng Lhelr goal of quallLy care
Lhrough Lhe [udlclous use of avallable human and maLerlal resources
wlLhln a speclfled Llme
Management ls geLLlng Lhe rlghL Lhlngs done aL Lhe rlghL Llme
Nurs|ng Management a relaLlonshlp of lnpuLs and ouLpuLs ln whlch
Lhe workers physlcal resources and Lechnology are emerged Lo brlng
abouL Lhe organlzaLlonal goals for dellvery of quallLy nurslng care
Management rocess and Iunct|ons
NPUT OUTPUT
HUMAN
RESOURCES
Medical
Nursing
Allied Health
Patient / Client
Significant Others
PHYSCAL AND
TECHNOLOGCAL
RESOURCES
Building
Grounds
Supplies
Equipment
Realization of
goals
Delivery of
quality patient
care
Schemat|c D|agram of Nurs|ng Management
Management rocess
conslsL of achlevlng
organlzaLlonal
ob[ecLlves Lhrough
plannlng organlzlng
dlrecLlng and
conLrolllng human and
physlcal resources and
Lechnology
ORGANIZATION
ADMNSTRATON
MANAGEMENT
O
R
G
A
N

N
G
D

R
E
C
T

N
G
C
O
N
T
R
O
L
L

N
G
PLANNNG
Jhlle ann|ng |s the f|rst funct|on one musL recognlze LhaL lL
permeaLes lnLo oLher funcLlons whlch are dependenL on lL
Iorecast|ng est|mates the future seLLlng ob[ecLlves deLermlne
Lhe resulLs Lo be achleved developlng and schedullng program
deflne acLlvlLles needed wlLhln a seL Llme frame preparlng Lhe
budgeL allocaLes Lools and resources whlle esLabllshlng pollcles
and procedure deflne Lhe course of acLlon and sLandards
rgan|z|ng esLabllshes formal auLhorlLy lL seLs up Lhe
organlzaLlonal sLrucLure by ldenLlfylng grouplngs roles and
relaLlonshlps wlLhln Lhe agency 1hls ls deplcLed ln an organlzaLlonal
charL
!ob descrlpLlons deflne Lhe quallflcaLlons and scope of
responslblllLles relaLlonshlps and auLhorlLles of personnel SLafflng
would lnclude deLermlnlng Lhe number of sLaff needed Lhus
developlng and malnLalnlng a sLafflng paLLern recrulLlng selecLlng
orlenLlng and developlng personnel Lo accompllsh Lhe goals of Lhe
organlzaLlon
1he selecLed personnel are Lhen dlsLrlbuLed ln Lhe varlous areas
of Lhe agency as needed and sLafflng schedule are made Lo meeL Lhe
needs of cllenLs personnel and agency
D|rect|ng or ead|ng acLuaLes efforLs Lo accompllsh goals 1hls
wlll lnclude uLlllzlng varlous modallLles of nurslng care Lhrough Lhe
nurslng process updaLlng pollcles and procedure supervlslng
personnel Lo harmonlze work Lhrough Lhe nurslng process
supervlslng personnel Lo harmonlze work Lhrough adequaLe guldance
and leadershlp coordlnaLlng personnel and servlces Lo a common
goal communlcaLlng vla varlous rouLes Lo ensure common
undersLandlng developlng people by provldlng sLaff developmenL
programs and maklng sound declslons
ontro|ng assesses / regulaLes performance of workers Lo
ensure progress Loward ob[ecLlves lL uLlllzes sLandards ln measurlng
performance monlLorlng and evaluaLlng nurslng care lncludlng
uLlllzaLlon of resources ConLrols prompLly reveal devlaLlons from seL
plans and sLandards necesslLaLlng lmmedlaLe correcLlve measures
acLlons and / or dlsclpllne
I LANNING
ls predeLermlnlng a course of acLlon ln order Lo arrlve aL a deslred
resulL
ls Lhe process of esLabllshlng goals deflnlng and developlng sLraLegy
and LacLlc for acLlon
Lhlnklng ahead deLermlnlng whaL shall be done
lL dlrecLs one Lhlnklng of
WnA1 ls expecLed Lo do
Wn lL wlll be done
WnLkL lL wlll be done
nW lL wlll be done
WnLN we expecL Lo do lL
Wn ls golng Lo do lL
lL ls a conLlnuous lnLellecLual process of assessmenL esLabllshlng
goals and ob[ecLlves lmplemenLaLlon and evaluaLlon sub[ecL Lo
change as new lnformaLlon ls known knowlng whaL should be done
and deLermlnlng how Lo do lL
rgan|zat|ona ann|ng ls a conLlnuous process of assesslng
esLabllshlng goals and lmplemenLlng and evaluaLlng Lhem Lo ensure
abouL Lhe use of people resources and envlronmenL Lo help achleve
agency's goals for Lhe presenL and Lhe fuLure
A Imortance of ann|ng
-urse manager should know how Lo plan for Lhe followlng reasons
1 It eads to the ach|evement of goas and ob[ect|ves
Jorkers relaLe whaL Lhey do Lo meanlngful resulLs slnce plans
are focused on ob[ecLlves
2 It g|ves mean|ng to work
Lmployees or workers experlence greaLer saLlsfacLlon lf whaL
Lhey are dolng becomes meanlngful Lo Lhem
3 It rov|des for effect|ve use of ava|abe resources and fac||t|es
1he besL use of personnel and maLerlal resources avold wasLage
4 It hes |n co|ng w|th cr|s|s
PosplLals should provlde for dlsasLer plans 1hese allow Lhe
workers Lo funcLlon more clearly and efflclenLly when acLual crlsls
occur such as flre or emergencles caused by dlsasLer -ew ?ear or
flesLas where more people are llkely Lo geL hurL
It |s costeffect|ve
CosLs can be conLrolled Lhrough plannlng for efflclenL operaLlon
lor example pro[ecLlng Lhe number of operaLlons ln a glven day
lncludlng dally dresslng can forecasL Lhe needed supplles for a
week ln Lhe surglcal unlLs accuraLely so as Lo prevenL undersupply
or oversupply of pllferages
6 It d|scovers the need for change
Many hosplLals have found ouL LhaL lnpaLlenL hosplLal days can
greaLly be reduced by havlng laboraLory and dlagnosLlc workup ln
Lhe ouLpaLlenL deparLmenL raLher Lhan have Lhese examlnaLlons
on admlsslon Mlnor surgerles are also done aL Lhe ouLpaLlenL
deparLmenL so LhaL more hosplLal beds can now be alloLLed Lo
crlLlcally lll paLlenLs or for Lhose needlng speclallzed servlces
7 It |s based on the ast and future act|v|t|es
LvaluaLlon of programs schedules and acLlvlLles wheLher
successful or noL prevenLs and / or reduces Lhe recurrence of
problem and provldes beLLer ldeas ln modlfylng or avoldlng Lhem
It |s necessary for effect|ve contro
-urse managers evaluaLe Lhe envlronmenL or seLLlng ln whlch Lhey
work or where Lhe paLlenLs are conflned and make necessary
recommendaLlons Lo make lL more LherapeuLlc noL only for Lhe
paLlenLs buL also for Lhe workers as well
erformance of workers and evaluaLlon of servlces Lo paLlenLs
based on crlLerla seL durlng Lhe plannlng sLage would lndlcaLe
wheLher sLandards have been made and wheLher changes are
lndlcaLed
8 kes|stance to ann|ng
PIanning is something that many managers avoid.
ailure of the manager to plan may be attributed to one or
more of the following factors:
1. Managers may lack knowledge of the philosophy, goals, and
objectives and workings of the organization
2 1hey may noL undersLand Lhe slgnlflcance of plannlng process LhaL
Lhe success or fallure of Lhe work acLlvlLles relaLe dlrecLly Lo Lhe
quallLy of Lhe plan how Lhls plan ls carefully and Lhoroughly done
or how lL ls poorly done
3 1lme spenL on plannlng ofLen seems wasLed ln relaLlon Lo Lhe day
Loday dolngs of one's [ob
4 Some manager may ack conf|dence fear|ng fa|ure
Some managers prefer Lo acL on lmmedlaLe problems because Lhey
generaLe lmmedlaLe feedback
6 lannlng may brlng unwanLed change
knowlng Lhese facLors wlll help nurse manager Lo overcome
Lhem and uLlllze plannlng as baslc key Lo Lhe success of
Lhelr work
1op ManagemenL or Lhe -urslng ulrecLors Chlef -urses or
ulrecLor of -urslng and Lhelr asslsLanLs seL Lhe overa goas and
o|c|es of the organ|zat|on 1helr scope of responslblllLy ls Lhe over
a management of Lhe organlzaLlon
Mlddle ManagemenL of -urslng Supervlsors dlrecL Lhe acLlvlLles
LhaL acLually |mement the broad oerat|ng o|c|es such as sLafflng
and dellvery of servlces Lo Lhe unlLs headed by Lhe Senlor or Pead
-urses lormulaLlon of pollcles rules and regulaLlons meLhods and
procedures for personnel for lmmedlaLe level plannlng for ongolng
acLlvlLles and pro[ecLs are done ln coordlnaLlon wlLh Lhe Lop
managemenL and Lhose ln Lhe lower level
AL Lhe Lower or llrsL Level ManagemenL Lhe Pead -urses or
Senlor -urses (lncludlng Charge -urses or 1eam Leaders) do the
da|y schedues or weekly plans for Lhe admlnlsLraLlon of dlrecL
paLlenL care ln Lhelr respecLlve unlLs
. Scope of PIanning
lans can be undersLood Lhrough four ma[or aspecLs
1 ans shoud contr|bute to ob[ect|ves
lL should seek Lo achleve a conslsLenL coordlnaLed sLrucLure of
operaLlon focused on deslred ends AcLlon wlLhouL plans ofLen
resulL Lo chaos
2 ann|ng recedes a other rocess of management (organ|z|ng
d|rect|ng contro|ng)
lL supporLs easy accompllshmenL of Lhe agency's ob[ecLlves
whlch are necessary for group efforL lannlng and conLrol are as
lnseparable as Slamese Lwln
Lxample PosplLal musL be bullL on planned budgeL conLrol of
expenses and acLlvlLles musL be made oLherwlse cosL may swell
blgger Lhan Lhe approprlaLed budgeL and Lhe hosplLal may noL be
flnlshed and lLs operaLlons may noL be sLarLed as LargeLed
. Major Aspects of PIanning
3 It ervades a eves
lL pervades from hlgher Lo lower echelons and vlce versa and
horlzonLally Lhrough peer levels and / or across servlces and
members of Lhe healLh Leam
4 It shoud be eff|c|ent
lL should conLrlbuLe Lo Lhe aLLalnmenL of ob[ecLlves noL only ln
Lerms of pesos manhour unlLs of producLs buL also lnclude
values as lndlvlduals and group saLlsfacLlon lear resenLmenL and
low morale resulL ln low producLlon
A welldeveloped plan should
1 have clearly worded ob[ecLlves lncludlng resulLs and meLhods for
evaluaLlon
2 be gulded by pollcles and / or procedures affecLlng Lhe planned
acLlon
3 lndlcaLe prlorlLles
4 develop acLlons LhaL are flexlble and reallsLlc ln Lerms of avallable
personnel equlpmenL faclllLles and Llme
develop a loglcal sequence of acLlvlLles and
6 selecL Lhe mosL pracLlcal meLhods for achlevlng each ob[ecLlve
. haracteristics of a Good PIan
. Iements of PIanning
.1. orecasting
orecasting estimates the future, including the
environment in which the plan will operate. t includes who
the patients are their customs, belief, language dialect
barriers, public attitude and behavior, the acuity of their
conditions / illness, the kind of care they will receive; the
number and kind of personnel (professional and non-
professional); and the resources, equipment, facilities, and
supplies needed.
I2 Sett|ng the V|s|on M|ss|on h|osohy Goas and
b[ect|ves
A vlslon sLaLemenL ouLllnes Lhe organlzaLlon's fuLure role and
funcLlon lL glves Lhe agency someLhlng Lo sLrlve for
1he mlsslon sLaLemenL ouLllnes Lhe purpose Lhe agency ls ln
(wheLher hosplLal or healLh care) who Lhe cllenLs are (Lhe poor
Lhe needy Lhe mlddle or upper class) whaL servlces are provlded
(lnpaLlenL ouLpaLlenL emergency) and why lL exlsLs
A phllosophy descrlbes vlslon lL ls a sLaLemenL of bellefs and
values LhaL dlrecLs one's llfe or one's pracLlce ln an organlzaLlon
Lhe phllosophy ls Lhe sense of purpose of Lhe organlzaLlon and Lhe
reason behlnd lLs sLrucLure and goal
PosplLals cllnlcs and healLh agencles Lhus have as Lhelr
prlmary reason for exlsLence Lhe funcLlon of provldlng paLlenL /
cllenL care servlces 1hese may lnclude dlagnosLlc LherapeuLlc
prevenLlve healLh promoLlon personnel educaLlon and research
servlces 1hese servlces vary among agencles dependlng on Lhe
cllenLs served Lhe geographlcal locaLlon and Lhe baslc mlsslon of
Lhe agency
1he phllosophy of nurslng servlce doveLalls wlLh Lhe
phllosophy of Lhe agency lL ls an lnLenLlonally chosen seL of values
or purpose LhaL serve as Lhe bases for deLermlnlng Lhe means Lo
accompllsh nurslng ob[ecLlves
-urslng phllosophy ls broad and general ln wordlng yeL
dlrecLs nurslng behavlor glvlng lL a sense of purpose Cenerally
emphaslzed ln Lhe sLaLemenL of Lhe phllosophy are Lhe quallLy and
quanLlLy and scope of servlce declslon maklng based on facLual
lnformaLlon approprlaLe delegaLlon achlevemenL of
organlzaLlonal goals communlcaLlon verLlcally and horlzonLally
flexlblllLy Lo meeL changlng needs of Lhe organlzaLlon lndlvlduals
communlLy and socleLy ln general
CrganlzaLlons and people who seL goals and ob[ecLlves do
beLLer Lhan Lhose who do noL Jhen manager forms goals Lhey
puL Lhem on paper and revlew Lhem perlodlcally lL forces hlm /
her lnLo acLlon Lo Lry Lo accompllsh Lhem 1he more a person seLs
a goal and speclfles ob[ecLlves for each of Lhe resulL areas he llkes
Lo achleve Lhe more llkely he wlll reach Lhese
Coals and ob[ecLlves dlffer ln LhaL goals are more general and
cover broad area whlle ob[ecLlves Lend Lo be more speclflc
Cb[ecLlves are concreLe 1hey are acLlon commlLmenLs Lhrough
whlch lLs mlsslon and purpose wlll be achleved and Lhe phllosophy
or bellef susLalned 1hey are sLaLed ln Lerms of resulLs Lo be
achleved and should focus on Lhe producLlon of healLh care
servlces Lo Lhe paLlenL hllosophy sLaLes bellefs and values whlle
ob[ecLlves sLaLe speclflc and measurable goals Lo be accompllshed
I3 Deveo|ng and Schedu|ng rograms
rograms are deLermlned developed and LargeLed wlLhln a
frame Lo reach Lhe goals and ob[ecLlves seL
1|me Management ls a Lechnlque for allocaLlon of one's Llme
Lhrough Lhe seLLlng of goals asslgnlng prlorlLles ldenLlfylng and
ellmlnaLlng Llme wasLes and use of managerlal Lechnlques Lo reach
goals efflclenLly
1|me Management r|nc|es
a lannlng anLlclpaLes Lhe problems LhaL wlll arlse from acLlons
wlLhouL LhoughL lL anLlclpaLes Lhe crlsls LhaL may occur of Lhe
resources needed Lo solve Lhe problems
b 1ask Lo be accompllshed should be done ln sequence whlch are
prlorlLlzed accordlng Lo lmporLance
c SeLLlng deadllnes ln one's work and adherlng Lo Lhem ls an excellenL
exerclse ln selfdlsclpllne
d ueferrlng posLponlng or puLLlng off declslons acLlons or acLlvlLles
can be a hablL whlch ofLenLlmes cause losL opporLunlLles and
producLlvlLy generaLlng personal or lnLerpersonal crlsls
e uelegaLlon permlLs a manager Lo Lake auLhorlLy for declslonmaklng
and Lo delegaLe Lasks Lo Lhe lowesL level posslble conslsLenL wlLh hls
[udgmenL facLs and experlence uelegaLlon frees her some Llme
LhaL can be devoLed Lo oLher Lasks
I4 rear|ng the 8udget
8udget ls Lhe annual operaLlng plan flnanclal road map" and a
flnanclal plan whlch serves as an esLlmaLe of fuLure cosLs and plan
for uLlllzaLlon of manpower maLerlal and oLher resources Lo cover
caplLal pro[ecLs ln Lhe operaLlng programs
ls a plan for fuLure acLlvlLles expressed ln operaLlonal as well
as flnanclal or moneLary Lerms
ln healLh care lnsLlLuLlon budgeL conslsL of four componenLs
a kevenue 8udget summarlzes Lhe lncome managemenL expecL Lo
generaLe durlng Lhe plannlng perlod
b Lxense 8udget descrlbes expecLed acLlvlLy ln operaLlonal and
flnanclal Lerms for a glven perlod of Llme
c a|ta 8udget ouLllnes Lhe programmed acqulslLlons
dlsposals and lmprovemenLs ln Lhe lnsLlLuLlon's physlcal capaclLy
d ash 8udget represenLs Lhe planned cash recelpLs and
dlsbursemenL as well as Lhe cash balances expecLed durlng Lhe
plannlng perlod
Nursing Budget is a plan for allocation of
resources based on preconceived needs, for a
proposed series of programs to deliver patient
care during one fiscal year
HospitaI Budget is a financial plan to meet
the future service expectations. These
expectations are derived from the best judgment
of the need of the community. Budgeting
translates these needs of manpower, equipment
and supplies so that both services are provided
with the highest level of quality with the minimum
amount of cost
1he 8udgetary rocess
1o assure an orderly and Llmely developmenL of Lhe
budgeL Lhe budgeL commlLLee musL be well deflned
1hls commlLLee can asslsL Lhe budgeL offlcer ln budgeL
preparaLlon and ln monlLorlng Lhe budgeL 1he Chlef
-urse or her asslsLanL ls usually a member of Lhe 8udgeL
CommlLLee JlLhln Lhe nurslng servlce Lhe Chlef -urse
works wlLh supervlsors and Pead -urses ln Lhe
preparaLlon for Lhe nurslng servlce
1he followlng facLors should be consldered
assurance of sLandards accordlng Lo Lhe phllosophy and
ob[ecLlves of Lhe hosplLal and Lhe dlvlslon of nurslng
pasL experlences ln Lhe unlL anLlclpaLed needs of Lhe
unlL and percenLage of Lhe unlL occupancy
1he esLlmaLlon of sLaff for each unlL should be based
on Lhe number of paLlenLs Lhe number of nurslng care
hours needed Lhe provlslon of vacaLlon slck and oLher
leaves holldays and Lhe average number of absences per
sLaff member per year and oLher prlvlleges as aLLendance
Lo conLlnulng educaLlon programs 1hese glve a vlslble
meLhod of lnLerpreLlng nurslng care needs Lo Lhe budgeL
commlLLee and Lo Lhe hosplLal admlnlsLraLlon
1he nexL sLep ls Lo ascerLaln Lhe amounL and klnd of
supplles needed for Lhe operaLlon of each nurslng unlL A
revlew of pasL expenses and consumpLlons provlde daLa
for plannlng CaplLal equlpmenL Lo be replaced ls
requesLed wlLh documenLed [usLlflcaLlon
1he Chlef -urse complles and compleLes Lhe flnal drafL and
presenLs Lhls Lo Lhe 8udgeL Cfflcer or PosplLal AdmlnlsLraLor A
carefully planned budgeL presenLaLlon wlll usually reflecL favorable
acLlon from Lhe admlnlsLraLlon
IS Lstab|sh|ng Nurs|ng Standard o|c|es and
rocedures
a Nurs|ng Standards
1he funcLlon of Lhese esLabllshed sLandard ln an evaluaLlon
process ls Lo supply professlonally deslrable norms agalnsL whlch
Lhe deparLmenL's performance can be measured Areas for
lmprovemenL are ldenLlfled and a plan of acLlon Lo correcL Lhls be
made and lmplemenLed
b Nurs|ng Serv|ce o|c|es
ollcles are broad guldellnes for Lhe managerlal declslon LhaL
are necessary ln organlzaLlonal and deparLmenLal plannlng 1hey
govern Lhe acLlon of worker and supervlsors aL all levels and are
lnLended Lo achleve predeLermlned goals 1hey serve as basls for
fuLure acLlons and declslons help Lo coordlnaLe plans conLrol
performance and lncrease conslsLency of acLlon by lncreaslng Lhe
probablllLy LhaL dlfferenL managers wlll make slmllar declslons
when lndependenLly faclng slmllar slLuaLlons
1here are Lhree general areas ln nurslng LhaL requlre pollcy
formulaLlon
| areas ln whlch confuslon abouL Lhe focus of responslblllLy mlghL
resulL ln neglecL or malperformance of an acL necessary Lo a paLlenL's
welfare
|| areas perLalnlng Lo Lhe proLecLlon of paLlenLs' and famllles' rlghLs
eg rlghL Lo prlvacy properLy rlghLs
||| areas lnvolvlng personnel managemenL and welfare
c Nurs|ng rocedures
rocedures are speclflc dlrecLlons for lmplemenLlng wrlLLen
pollcles 1wo areas where procedures are needed are
l Lhose LhaL are relaLed Lo [ob slLuaLlons such as reporLlng complalnLs
or dlsclpllnary lnsLances
ll Lhose LhaL lnvolves paLlenL care procedure LhaL lnvolve paLlenL
care should conslder Lhe safeLy of Lhe paLlenL hls comforL whlle
undergolng lL and Lhe proper care use of supplles and equlpmenL
and good workmanshlp on Lhe parL of Lhe person dolng lL
-urslng procedure manuals should be avallable ln each unlL Lo
be famlllarlzed ln Lhe nurslng unlL lL should be revlewed updaLed
and revlsed wlLh Lhe maxlmum lnvolvemenL from Lhe unlL nurslng
sLaff
G. PIanning Process
1. AnaIysis and assessment of system
ive basic considerations in an analysis
of the system as a whole:
1.1. objectives, performance measures
1.2. environment, fixed constraints
1.3. resources
1.4. activities, goals and performance of its subsystem
1.5. operation (process or action, strategies of work)
2. ormuIation of organizationaI and individuaI goaI
t helps identify the ends toward which the administrator
would like the system to move during a specific period of
time.
This stage requires that a schedule of achieving these
goals be established.
3 Assessment of resent organ|zat|ona otent|a|t|es and
caab||t|es
8eallsLlc goals and ob[ecLlves can'L be esLabllshed wlLhouL
knowlng Lhe currenL capablllLles of Lhe organlzaLlon and
speclflcally Lhose of hls own deparLmenL
1rue plannlng Lakes lnLo accounL all Lhe llmlLaLlon as well as
Lhe resources of Lhe slLuaLlons and facLors such as shorLage of
equlpmenL and personnel or lack of adequaLe funds
4 Iormuat|ng aternat|ve courses of act|on
1hls sLage conslders speclfylng means by whlch organlzaLlonal
goals and ob[ecLlves are Lo be achleved
Sett|ng of r|or|t|es on the bas|s of effect|veness and evauat|on
ln Lhls sLage Lhe consequences of Lhe varlous plans are
pro[ecLed 1hls phase ls largely concerned wlLh Lhe esLabllshmenL
of prlorlLles
6 Imementat|on
1hls phase ls concerned wlLh resources allocaLlon
commlLmenL 1hls ls Lhe acLlon and dlrecLlon sLage
7 Lvauat|on contro and surve|ance
LvaluaLlon or provlslon of measurlng Lhe ouLcome of servlce
agalnsL Lhe ob[ecLlves should be bullL lnLo every plan
Iormat of ann|ng
8ackground
Cb[ecLlves
AcLlvlLles
1lme lrame / 1argeL 1lme
8esources
ersonnel
MaLerlals
llxed AsseLs
8udgeL
osslble roblem
ConLlngency lan
II kGANI2ING
Crganlzlng ls Lhe second manager|a funct|on Pavlng
planned Lhe manager musL now organlze so LhaL personnel can
accompllsh Lhe plans wlLh efflclency and effecLlveness
Crganlzlng lnvolves esLabllshlng a formal sLrucLure LhaL provldes
Lhe coordlnaLlon of resources Lo accompllsh ob[ecLlves esLabllsh
pollcles and procedures and deLermlne poslLlon quallflcaLlons
and descrlpLlons
rgan|zat|on comprlses sLrucLure and process whlch allows Lhe
agency Lo enacL lLs phllosophy and uLlllze lLs concepLual
framework Lo achleve lLs goals
refers to a body of eoe method o|c|es and rocedures
arranged ln a sysLemaLlc process Lhrough delegaLlon of funcLlons
and responslblllLles for Lhe accompllshmenL of purpose
rgan|z|ng lL ls a process of esLabllshlng formal auLhorlLy lL
lnvolves seLLlng up Lhe organlzaLlonal sLrucLure Lhrough
ldenLlflcaLlon of grouplngs roles and relaLlonshlps deLermlnlng
Lhe sLaff needed Lhrough developlng and malnLalnlng sLafflng
paLLerns and dlsLrlbuLlng Lhem ln Lhe varlous areas as needed
and developlng [ob descrlpLlons by deflnlng Lhe quallflcaLlons and
funcLlons of personnel
rgan|zat|ona Structure refers Lo Lhe process or Lhe way a group
ls formed lncludlng lLs channels of auLhorlLy span of conLrol and
llnes of communlcaLlon
rgan|zat|ona hart lL ls a llne drawlng LhaL shows how Lhe parLs
of an organlzaLlon are llnked lL deplcLs Lhe formal organlzaLlonal
relaLlonshlps areas of responslblllLy people Lo whom one ls
accounLable and channels of communlcaLlon
A paLLern of nurslng care ls LhaL sysLem used for Lhe dellvery
of nurslng care Lo paLlenLs / cllenLs aLLerns of care vary from
hosplLal Lo hosplLal and Lhls depends on Lhe organlzaLlonal
sLrucLure adopLed by Lhe agency Lo meeL lLs prescrlbed needs
1he meLhod selecLed for asslgnmenL of nurslng sLaff Lo paLlenLs /
cllenLs dlrecLly relaLes Lo sLafflng paLLern adopLed by Lhe healLh
agency AsslgnmenLs can be sLable only when Lhere ls a sLrong
supporL sysLem of quallfled nurslng personnel Lo carry forLh Lhe
plan ln nurslng servlces nurslng asslgnmenLs may be called by
varlous Lerms as modallLles of nurslng care sysLems of nurslng
care or paLLerns of nurslng care PlsLorlcally four baslc meLhods
are used
1 ase Method means LhaL one nurse performs all servlces for
Lhe paLlenL
Advantages of the ase Method
a 1he nurse has close conLacL wlLh Lhe paLlenL
b Able Lo provlde compleLe nurslng care over a longer perlod of
Llme
c Clves greaLer opporLunlLy Lo dlrecLly assess paLlenL's progress
slnce Lhe plan of nurslng care ls complled and carrled ouL from
dayLoday by one nurse
D|sadvantages of the ase Method
a -oL admlnlsLraLlvely or economlcally feaslble
b -oL posslble when hlghly skllled funcLlons are necessary
c 1he nurse may know only a few Lypes of cases
d 1endency Lo dlsregard paLlenL as a person wlLh unlque ldenLlLy
L|nes of author|ty |n a ty|ca hos|ta w|th case nurs|ng
Instructor harge Nurse
Patients / Iients
Registered Nurse
Patients / Iients
harge Nurse
Student
PL / L PL / L
2 Iunct|ona Method of care relleves Lhe professlonal
nurse of dally Lask Lo several paLlenLs buL does noL glve all
Lhe nurslng care Lo any one paLlenL -urslng asslsLanLs may
carry ouL measures relaLlng Lo personal hyglene
observaLlons of vlLal slgns movlng paLlenLs and
admlnlsLerlng LreaLmenLs
Advantages of the Iunct|ona Method
a -urse develops experLlse or very efflclenL ln one phase
of nurslng llke admlnlsLraLlon of medlcaLlon
b Lconomy ln Llme and equlpmenL
c Confuslon ls avolded
d very good meLhod ln case of shorLage of personnel
e -urses can change from one asslgnmenL Lo anoLher
wlLhouL loss of efflclency
f -ecessary durlng mealLlme M shlfL and nlghL
g 1here ls a smooLh dlvlslon of labor
D|sadvantages of the Iunct|ona Method
a aLlenL care ls fragmenLed ofLen lncoordlnaLed
b aLlenL does noL know hls parLlcular nurse
c CreaLes sense of boredom for paLlenLs and nurses
d aLlenL feels as belonglng Lo no one
e -urse doesn'L boLher abouL raLlonale of Lhe procedure Lhey do
f -urses are noL concerned wlLh paLlenLs noL asslgned Lo Lhem
RN
Medication
Nurse
RN
Treatment
Nurse
NA
Hygienic
are
IericaI
Housekeeping
Patients /
Iients
amiIy,
Visitors
harge Nurse
Patients / Iients
Lines of authority in a typicaI hospitaI with functionaI nursing
3 1eam Method of care ls paLlenL cenLered even lf several
people glve care 1he professlonal nurse dlrecLs Lhe care and may
glve some of lL 1he dlrecLlons of care make Lhe professlonal
nurse Lhe leader of Lhe nurslng Leam 1he nurse makes declslons
and musL be able Lo undersLand and communlcaLe wlLh oLhers
effecLlvely and be able Lo help Lhe Leam work ouL Lhe organlzed
plan 1he oLher Leam members may be oLher professlonal nurses
nurslng asslsLanLs or sLudenL nurses Lvery Leam member should
have some knowledge of Lhe paLlenL's condlLlon lncludlng
problems and suggesLlons
Advantages of the 1eam Method
a Sense of saLlsfacLlon on Lhe parL of Lhe nurse
b Close relaLlonshlp among Lhe members
c 8eLLer uLlllzaLlon of personnel
d CreaLer amounL of supervlslon ls provlded
e Care provlded ls comprehenslve
D|sadvantages of the 1eam Method
a Conference schedule never ends
b lnconslsLencles ln Leam work
c -oL all are quallfled Lo become Leam leader
d Large amounL of Llme ls wasLed
e 1eam leader overpowers Lhe head nurse
1eam oncet
a 1here ls lnLerchange of ldeas
b !olnL problem solvlng
c CenLered on conLlnulLy comprehenslon
Lines of authority in a typicaI hospitaI with team nursing
harge Nurse
Team Leader
Nursing Staff
Patients / Iients
Team Leader
Nursing Staff
Patients / Iients
Team Leader
Nursing Staff
Patients / Iients
4 r|mary Nurs|ng ls a way of dellverlng nurslng care by a
reglsLered nurse wlLh Lhe concepL of one paLlenL relaLlonshlp
1he 24hour responslblllLy of evaluaLlng paLlenL care ls placed on
Lhe reglsLered nurse lLs emphasls ls on Lhe professlonal cllnlcal
pracLlce ln LhaL nurse performs Lhe essenLlal role of pracLlLloner
Leacher and manager of Lhe paLlenL's care and servlces ln Lhe
hosplLal and oLher healLh care seLLlng lL lncludes Lhe followlng
characLerlsLlcs
a rofesslonal nurses are ldenLlfled as prlmary nurses who assess
Lhe paLlenL's need for care seLs care goals wrlLes a nurslng care
plan admlnlsLers care accordlng Lo LhaL plan evaluaLes Lhe
ouLcomes of care and makes Lhe necessary changes or
ad[usLmenLs as necessary Pe / she provldes predlscharge
plannlng and Leachlng
b Asslgned wlLh a relaLlvely small case load (4 paLlenLs)
c -urslng process ls used
d locus ls on Lhe oneLoone relaLlonshlp of my paLlenL my
nurse from admlsslon Lo dlscharge
e Care ls based on paLlenL's needs and paLlenL's problems
f rlmary nurse ls accounLable for asslgned paLlenLs 24 hours a
day 7 days a week
g Lmphasls ls on professlonal cllnlcal pracLlce raLher Lhan
performance of rouLlne and Lasks
Slnce Lhe prlmary nurse assumes a 24hour responslblllLy for
nurslng care secondary or assoclaLe nurses execuLes Lhe nurslng
care plan durlng Lhe afLernoon and nlghL shlfLs and durlng Lhe
days when Lhe prlmary nurse ls offduLy
1he prlmary and secondary nurses are freed from
admlnlsLraLlve and housekeeplng responslblllLles Lo maxlmlze
Lhelr Llme for paLlenL care AuLhorlLy accounLablllLy and
auLonomy resL wlLh prlmary nurse 1herefore he / she
communlcaLes dlrecLly Lo any member of Lhe healLh Leam wlLhln
Lhe hosplLal and Lhe communlLy
1he head nurse's role ln Lhls klnd of asslgnmenL shlfLs from
LaskmasLer declslon maker and coordlnaLor of paLlenL care Lo
role model consulLanL and quallLy conLrol experL for Lhe prlmary
nurse ln Lhe unlL Pe / she encourages cllnlcal declslon maklng
and ensures needed supporL ln fulfllllng paLlenL care
managemenL coordlnaLlon funcLlon
Advantages of the r|mary Nurs|ng
a rovlslon or lncreased auLonomy on Lhe parL of Lhe nurse
Lhereby lncreaslng moLlvaLlon responslblllLy and accounLablllLy
b lL assures conLlnulLy of care
c Makes avallable lncreased knowledge of paLlenL's psychologlcal
and physlcal needs
d Leads Lo lncreased rapporL and LrusL beLween Lhe nurse and
Lhe paLlenL Lhereby esLabllshlng LherapeuLlc relaLlonshlp
e lL lmproves communlcaLlon wlLh members of Lhe healLh Leam
and ellmlnaLes Lhe use of nurslng aldes ln Lhe provlslon of dlrecL
nurslng care
Physician harge Nurse
HospitaI
Resources
Primary Nurse
Patient / Iient
Associate Nurse
venings
Associate Nurse
Nights
Associate Nurse(s)
as needed
ays
Lines of authority in a typicaI hospitaI with primary care
nursing
Lements of rgan|z|ng
1he elemenLs of organlzlng are seLLlngup Lhe organlzaLlonal
sLrucLure sLafflng schedullng and developlng [ob descrlpLlon
A Sett|ngu the rgan|zat|ona Structure
1he creaLlon of an organlzaLlonal sysLem compaLlble wlLh Lhe
phllosophy concepLual framework and goals of Lhe organlzaLlon
provldes Lhe means for accompllshmenL of purpose
undersLandlng of Lhe organlzaLlonal sLrucLure as a whole
faclllLaLes Lhe developmenL of roles and relaLlonshlps enabllng
goal achlevemenL ueparLmenLallzaLlon and dlvlslon of work
provlde orderllness ln admlnlsLraLlon 1hrough a breakdown of
acLlvlLles each lndlvldual ls responslble for and performs a
speclfled seL of acLlvlLles
uroses of rgan|zat|ona Structure
1 lL enables members whaL Lhelr responslblllLles are so LhaL Lhey
may carry Lhem ouL
2 lL frees Lhe manager and Lhe lndlvldual workers Lo concenLraLe
on Lhelr respecLlve roles and responslblllLy
3 lL coordlnaLes all organlzaLlonal acLlvlLles so Lhere ls mlnlmal
dupllcaLlon of efforL or confllcL
4 lL reduces Lhe chances of doubL and confuslon concernlng
asslgnmenL
1wo 1yes of rgan|zat|ona Structure
1 lnformal CrganlzaLlonal SLrucLure
comprlses personal and soclal relaLlonshlp LhaL do noL appear
on Lhe organlzaLlonal charL
lnformal sLrucLure provldes soclal conLrol of behavlor whlch
can elLher be lnLernal or exLernal
Interna ontro lf pressure ls lnLended Lo make a
member conform Lo group expecLaLlon (ex dlrLy shoes)
Lxterna ontro an aLLempL Lo conLrol Lhe behavlor of
someone ouLslde Lhe soclal group
lL has lLs own channel of communlcaLlon whlch may
dlssemlnaLe lnformaLlon mere broadly and rapldly Lhan Lhe
formal communlcaLlon sysLem 1he besL way Lo correcL an
lnvalld rumor ls for Lhe manager Lo provlde accuraLe
lnformaLlon
lnformal organlzaLlon sLrucLure ls lmporLanL Lo managemenL
Lhus Lhe manager musL be aware of lLs exlsLence sLudy lLs
operaLlng Lechnlques prevenL anLagonlsm and use lL Lo meeL
Lhe agency's ob[ecLlves
2 lormal CrganlzaLlonal SLrucLure
lL ls Lhe offlclal arrangemenL of poslLlons or worklng
relaLlonshlp LhaL wlll coordlnaLe efforLs of workers of dlverse
lnLeresLs and ablllLles
lL descrlbes poslLlons Lasks responslblllLles and relaLlonshlps
lL provldes orderllness ln admlnlsLraLlons Lhru esLabllshmenL
of formal organlzaLlonal paLLern by deparLmenLallzaLlon and
dlvlslon of work
bases of formal organlzaLlon sLrucLure phllosophy and
ob[ecLlves of Lhe nurslng deparLmenL and goal of Lhe
lnsLlLuLlon
Act|v|t|es to romote a os|t|ve rgan|zat|ona |mate
1 uevelop Lhe organlzaLlon's mlsslon goals and ob[ecLlves wlLh
lnpuL from Lhe nurses lncludlng Lhelr personal goals
2 LsLabllsh LrusL and openness Lhrough communlcaLlon LhaL lnclude
prompL and frequenL feedback and sLlmulaLes moLlvaLlon
3 rovlde opporLunlLles for growLh and developmenL lncludlng
career developmenL and CL
4 Analyze Lhe compensaLlon sysLem for Lhe enLlre nurslng
organlzaLlon and sLrucLure Lo reward compeLence longevlLy and
producLlvlLy
romoLe selfesLeem auLonomy and selffulflllmenL lncludlng
feellngs LhaL help work experlence hlgh quallLy
6 Assess unneeded LhreaLs and punlshmenLs and ellmlnaLe Lhem
7 rovlde [ob securlLy wlLh an envlronmenL LhaL enables free
expresslon of ldeas and exchange of oplnlon wlLhouL LhreaL of
recrlmlnaLlon whlch may occur as negaLlve performance reporLs
negaLlve counsellng confronLaLlon confllcL or [ob loss
Lncourage and supporL loyalLy frlendllness and clvlc
consclousness
9 Pelp nurses Lo overcome Lhelr shorLcomlngs and develop Lhelr
sLrengLhs
10 8e a role model of performance deslred of pracLlclng nurses
rgan|zat|ona hange
change means subsLlLuLlng one Lhlng for anoLher
experlenclng a shlfL ln clrcumsLances LhaL cause
dlfferences or becomlng dlfferenL Lhen before
Iorces 1hat Infuence hange
a Lxterna Iorces are Lhose happenlngs (ouLslde Lhe
organlzaLlon) LhaL lnfluence Lhe organlzaLlon as a whole
or Lhe Lop admlnlsLraLors
Lx 1 ouat|on exos|on addlLlonal maLernlLy ward
Lx 2 eg|sat|on that restr|cts at|ent from adm|ss|on
prlmary nurslng's use of observaLlon room
Lx 3 econom|c forces Lralnlng and educaLlon
conLrlbuLe Lo Lhe cosL conLalnmenL and lmprovemenL
of quallLy care
Lx 4 a breakthrough |n research Lhls can alLer care
glven Lo cerLaln paLlenL
b Interna Iorces are Lhose LhaL orlglnaLe prlmarlly from lnslde
operaLlons or are Lhe resulL of exLernal forces
Lx 1 composlLlon of sLafflng paLLern
decrease number of 8- and lncrease number of -A
Lx 2 producLlvlLy need
14 16 - raLlo
Lx 3 quallLy of worklng llfe may need Lo be lmproved such as
sufflclenL number of quallfled nurses
sLaff developmenL program
Llme spenL by nurslng personnel wlLh nonnurslng duLles
lnsLablllLy and lnflexlblllLy of sLaff
absenLeelsm among sLaff
kes|stance to hange Iactors
1 lf Lhe person Lo be lnfluenced by a proposed change are noL glven
adequaLe lnformaLlon regardlng Lhe naLure of Lhe change
2 Jhen one feels pressured Lo make a change and wlll be
decreased when one has a say" ln Lhe naLure and dlrecLlon of
Lhe change
3 lf change ls made on personal grounds raLher Lhan on lmpersonal
requlremenLs
4 lf Lhe change lgnores exlsLlng alllances wlLhln Lhe group
lf Lhere ls relaLlve saLlsfacLlon wlLh Lhe exlsLlng sysLem
hange rocess A anned rocedure
1he process of change ls change wlLh a purpose devlsed Lo
solve problem affecLlng nurses and Lhelr work lL deals wlLh
maklng alLeraLlons by cholce and dellberaLlon raLher Lhan by
lndocLrlnaLlon coerclon naLural growLh or accldenL
1 erce|ve a need for change senslng an unresL among sLaff LhaL
Lhere ls a need for change
2 In|t|ate grou |nteract|on Lechnlque employed ls Lhrough an
lnformal dlscusslon group commlLLee or Lask force group and
general meeLlng Lo explore a slLuaLlon
21 Ident|fy externa and |nterna forces from change
22 State the robem Lhls ls Lhe crlLlcal sLep ln Lhe change
process LxLernal and lnLernal forces are examlned SLaLemenL of
Lhe problem ls formulaLed
23 Ident|fy constra|nts consLralnLs are someLhlng LhaL resLrlcL
llmlLs or regulaLe a person and acLlvlLles
24 L|st change strateg|es or posslble approaches Lo solve Lhe
problem Allow sufflclenL Llme for dlalogue Lo occur romoLe a
free open recepLlve cllmaLe Make no commenLs abouL
responses ConLlnue Lhe dlscusslon unLll all posslble soluLlons are
exhausLed
2S Seect the best change strategy or strateg|es Lhe leader
should be someone oLher Lhan Lhe P- ln Lhls slLuaLlon because
he / she ls Lhe focal polnL of Lhe problem Care musL be Laken noL
Lo lnvlLe people who are noL skllled ln Lhe arL of faclllLaLlng
Approaches Lo solvlng Lhe problem are Lhe prlorlLy and analysls ls
made wlLh regards Lo Lhe course of acLlon Laken
26 Iormuate an for |mementat|on lf prlorlLy number ls
selecLed plan on Lhe sLraLegy SelecL represenLaLlve of Lhe group
who are Lo meeL wlLh Lhe P-
27 Deveo or seect toos for evauat|on
3 lmplemenL Lhe change one sLep aL a Llme lf posslble 1he P-
musL meeL wlLh her sLaff perlodlcally Lo hear Lhelr reacLlon
4 LvaluaLe Lhe overall resulLs of Lhe change and make ad[usLmenLs
as necessary reLaln alLer or deleLe parLs or dlsconLlnue Lhe
process
Strateg|es for Affect|ng hange
JheLher worklng wlLh Lhe lndlvldual group or Lhe sysLem
Lhe P- ls sure Lo be lnvolved wlLh managemenL of change 1he
followlng are sLraLegles ln managlng change
1 Lm|r|ca kat|ona hange
based on Lhe assumpLlon LhaL people are raLlonal and behave
accordlng Lo raLlonal self lnLeresL
lL follows Lhen LhaL people are wllllng Lo adopL a change lf lL ls
[usLlfled and lf Lhe person ls shown how he / she can beneflL
from Lhe change
Lx sysLem analysls
operaLlon research
lmplemenLaLlon of research flndlngs
2 Normat|ve keeducat|ve hange
are based on Lhe assumpLlon LhaL people acL accordlngly Lo
Lhelr commlLmenL Lo socloculLural norms lnLelllgence and
raLlonal are noL denled buL also aLLlLude and values are
consldered
Lhe manager pay aLLenLlon Lo changes ln values aLLlLudes
skllls and relaLlonshlps ln addlLlon Lo provldlng lnformaLlon
Lx personnel counsellng
Lralnlng groups or small groups
3 ower oerc|ve hange
lnvolves compllance of Lhe less powerful Lo Lhe leadershlp
plans and dlrecLlons of Lhe more powerful
lnLelllgence raLlonallLy nor values and aLLlLudes are noL denled
buL Lhey acknowledge Lhe need Lo use sources of power Lo
brlng abouL change
Lx sLrlkes slLln admlnlsLraLlon declslons and rullngs
negoLlaLlons
confllcL confronLaLlon
rgan|z|ng r|nc|e
ln deslgnlng Lhe organlzaLlonal sLrucLure of Lhe nurslng
deparLmenL / servlce / dlvlslon organlzaLlonal prlnclples musL
be observed
1 Un|ty of ommand alLhough employees may lnLeracL wlLh
many dlfferenL employees ln Lhe performance of Lhelr duLles
Lhey should be responslble Lo only one superlor 1hls ls Lo avold
confuslon overlapplng of duLles and mlsundersLandlng
2 Scaar r|nc|e auLhorlLy and responslblllLy should flow ln clear
unbroken llnes from Lhe hlghesL execuLlve Lo Lhe lowesL roper
deflnlLlon and delegaLlon of auLhorlLy and responslblllLy
faclllLaLes Lhe accompllshmenL of work ln Lhls connecLlon Lhe
followlng musL be observed
a Jhen responslblllLy for a parLlcular [ob ls delegaLed Lo a
subordlnaLe Lhe laLLer should have auLhorlLy over resources
needed Lo accompllsh Lhe Lask
b Jhen a parLlcular funcLlon ls delegaLed Lo a subordlnaLe Lhe
superlor's own responslblllLy ls ln no way dlmlnlshed
c Jhen a person ls besLowed Lhe auLhorlLy for acLlon he ls
accounLable for hls acLlons Lo Lhe person LhaL besLowed hlm
such 1he consclenLlous nurse exhlblLs accounLablllLy Loward her
employlng hosplLal Lhe paLlenL Lhe governmenL her professlon
and Lo Cod
3 nomogenous Assessment or Deartmentat|on workers
performlng slmllar asslgnmenLs are grouped LogeLher for a
common purpose ueparLmenLaLlon speclallzes acLlvlLles
slmpllfles Lhe admlnlsLraLor's work and malnLalns effecLlve
conLrol
4 San of ontro Lhe number of workers LhaL a supervlsor can
effecLlvely manage should be llmlLed dependlng upon Lhe pace
and paLLern of Lhe worklng area lf Lhe workers are hlghly skllled
are worklng near each oLher Lhe number of workers may be
lncreased AL Lhe Lop level of Lhe sLrucLure a 16 raLlo of Lhe
supervlsorworkers ls common whlle aL Lhe base of Lhe
organlzaLlon a 110 raLlo ls common
Lxcet|on r|nc|e recurrlng declslons should be handled ln a
rouLlne manner by lowerlevel managers whereas problems
lnvolvlng unusual maLLers should be referred Lo hlgher levels
1hls wlll enable subordlnaLes Lo learn how Lo make declslons aL
Lhelr own level
rgan|zat|ona uture
ls Lhe sum LoLal of an organlzaLlon's bellefs norms
values phllosophles LradlLlons and sacred cows lL
ls a soclal sysLem LhaL ls a subsysLem of Lhe LoLal
organlzaLlon lL has arLlfacLs perspecLlves values
assumpLlons symbols language and behavlors
LhaL have been effecLlve
lL lncludes communlcaLlon neLworks boLh formal
and lnformal 1hey lnclude a sLaLus / role sLrucLure
LhaL relaLes Lo characLerlsLlcs of employees and
cusLomers or cllenLs Such sLrucLures also relaLes Lo
managemenL sLyle wheLher auLhorlLarlan or
parLlclpaLory ln a healLh care seLLlng Lhese
sLrucLures promoLe elLher lndlvldually or
Leamwork 1hey relaLe Lo classes of people and
could be ldenLlfled Lhrough demographlc surveys of
boLh employees and paLlenLs
1he baslc mlsslon of Lhe organlzaLlon ls parL of lLs culLure
employmenL servlce learnlng and research 1here ls a Lechnlcal
or operaLlonal sysLem for geLLlng Lhe work done Also Lhere ls an
admlnlsLraLlve sysLem of wages and salarles of hlrlng flrlng and
promoLlng of reporL maklng and quallLy conLrol of frlnge beneflLs
and of budgeLlng
1he arLlfacLs of an organlzaLlonal culLure may be physlcal
behavloral (rlLuals) or verbal (language sLorles myLhs) verbal
arLlfacLs resulL from shared values and bellefs 1hey lnclude
LradlLlons heroes and Lhe parLy llne and resulL ln ceremonles
LhaL embody rlLuals 1hey lnclude ceremonles Lo reward years of
servlce annual plcnlc Lhe ChrlsLmas arLy and Lhe wearlng of
badges and lnslgnla
erspecLlves are shared ldeas and acLlons 1hey relaLe Lo
declslonmaklng meLhods lor example soclal Lechnlcal and
managerlal sysLems or subsysLems wlll elLher supporL lnnovaLlon
or demand conformlLy
uress personal appearance soclal decorum and Lhe
physlcal envlronmenL are all parL of Lhe organlzaLlonal culLure
1hey wlll requlre sLrlcL compllance Lhrough wrlLLen or lmplled
rules
values are Lhe general prlnclples ldeals sLandards and slns
of Lhe organlzaLlon 8aslc assumpLlons are Lhe core of Lhe culLure
1hey lnclude Lhe bellefs groups have abouL Lhemselves oLhers
and Lhe world
uture and the Manager
Jhen ouLpuL or producLlvlLy decreases ln amounL or klnd
managers look aL Lhe soclal Lechnlcal and managerlal sysLems
LhaL are parL of Lhe organlzaLlon culLure 1hey know LhaL Lhe
people behave ln accordance wlLh Lhelr undersLandlng of Lhe
organlzaLlon's norms and values lf Lhey wanL Lo be successful
Lhey ldenLlfy Lhese norms and values and apply Lhelr efforLs ln
conformlLy wlLh Lhem
1he successful managers ldenLlfy and accepL Lhe prevalllng
culLure before maklng changes lL ls more dlfflculL Lo change a
culLure aL Lhe level of baslc bellefs values and perspecLlves lL ls
easler Lo change Lechnlcal and admlnlsLraLlve sysLems
rgan|zat|ona |mate
ls Lhe emoLlonal sLaLe shared by members of Lhe sysLem lL can
be formal relaxed defenslve cauLlous accepLlng LrusLlng and
so on lL ls employees' sub[ecLlve lmpresslon or percepLlon of
Lhelr organlzaLlon 1he employees of Lhe ma[or concern Lo Lhe
nurse managers are Lhe pracLlclng nurses racLlclng nurses
creaLe or aL Lhe very leasL conLrlbuLe Lo Lhe creaLlon of Lhe
cllmaLe percelved by paLlenLs 1he work cllmaLe seL by Lhe nurse
managers deLermlnes Lhe behavlor of Lhe pracLlclng nurses ln
seLLlng Lhe work cllmaLe
racLlclng nurses wanL a cllmaLe LhaL wlll glve Lhem [ob
saLlsfacLlon 1hey achleve [ob saLlsfacLlon when Lhey are
challenged and Lhelr achlevemenLs recognlzed and appreclaLed
by managers and paLlenLs 1hey achleve saLlsfacLlon from cllmaLe
of colleglallLy wlLh Lhe managers and oLher healLh care provlders
ln whlch Lhey parLlclpaLe ln declslonmaklng
1yes of Iorma rgan|zat|ona Structure ass|f|ed by Nature of
Author|ty
1 L|ne rgan|zat|on
oldesL slmplesL and mosL dlrecL Lype ln whlch each poslLlon
has general auLhorlLy over lower poslLlons ln Lhe hlerarchy ln
Lhe accompllshmenL of Lhe maln goals of Lhe agency
connecLs poslLlons and Lasks of each level wlLh Lhose above
or below lL
lL ls Lhe backbone of Lhe hlerarchy sLaff and funcLlonal
organlzaLlon merely supplemenL Lhe llne
Lhe llne poslLlons are relaLed Lo dlrecL achlevemenL of
organlzaLlonal ob[ecLlves 1he manager has Lhe rlghL Lo glve
Lhe order demand accounLablllLy and dlsclpllne vlolaLors
2 Staff rgan|zat|on
ls purely advlsory Lo Lhe llne sLrucLure wlLh no auLhorlLy Lo
place recommendaLlons lnLo acLlon
provldes advlsory funcLlons Lo llne supervlsors and
execuLlves offers suggesLlon Lo ald and noL Lo crlLlclze
Lhey handle deLalls locaLe requlred daLa and oLher counsel
on managerlal problems
Lhey funcLlon Lhrough lnfluence for Lhey do noL have
auLhorlLy Lo accepL use modlfy or re[ecL plans
Lhey make Lhe llne more effecLlve buL organlzaLlon can
funcLlon wlLhouL sLaff auLhorlLy sLaff asslsLanL and
admlnlsLraLlve asslsLanL
3 Iunct|ona rgan|zat|on
permlLs a speclallsL Lo ald llne poslLlons wlLhln a llmlLed and
clearly deflned scope of auLhorlLy
lL decreases Lhe llne manager's problem because lL permlLs
orders Lo flow dlrecLly Lo lower levels wlLhouL aLLenLlon Lo
rouLlne Lechnlcal problems by Lhe llne poslLlons
Ma[or Iorms of rgan|zat|ona Structure
1 entra|zed
conLrol emanaLes from Lop down
mosL common ln hosplLal
emphasls ls concenLraLed on LradlLlonal nurslng
luncLlonal arrangemenL ls by such acLlvlLles as
LransporLaLlon
food
budgeL conLrol
personnel
varlous speclalLles ln -urslng Servlce MS
Advantages
a lL can be hlghly cosLeffecLlve
1he speclal servlces are grouped LogeLher whlch
ellmlnaLes dupllcaLlon of efforL
b lL makes managemenL easler
Managers have Lo be experLs ln only a
concenLraLed range of skllls
D|sadvantages
a As Lhe organlzaLlon becomes large and more complex Lhe
hlerarchal arrangemenL can prove cumbersome
b 1he arrangemenL does noL readlly adapL Lo change
8ecause such declslons have Lo be made by Lhe hlgher
managers
2 Decentra|zed or art|c|atory Structure
Lhls ls a sysLem whereby Lhe large sLrucLure ls broken down
lnLo smaller unlLs and auLhorlLy ls delegaLed Lo Lhose closer Lo
Lhe ma[orlLy of workers
Lhe Lop managemenL sLlll reLalns ulLlmaLe responslblllLy for Lhe
operaLlons of Lhe varlous hosplLal deparLmenLs buL plannlng
and lmplemenLaLlon for each deparLmenL ls carrled ouL by Lhe
deparLmenL head who funcLlons auLonomously wlLh auLhorlLy
Lo admlnlsLer LhaL deparLmenL 24 hours a day
Advantages
As mlddle managers Lhe deparLmenL head can
a 8eflecL Lhelr lnLeresL and have a volce ln declslon maklng
b lmprove quallLy of care Lhrough 24 hours conLlnulLy
c lncrease communlcaLlon deparLmenLally and lnLerdeparLmenLally
d roblem solved wlLh greaLer lmaglnaLlon and creaLlvlLy
D|sadvantages
a 1he lnlLlal cosL ln developlng managers and sLaff Lralnlng (Lurn over
raLe under decenLrallzaLlon has been found Lo be low)
b ommun|cat|on breakdown Lhe mosL serlous problem LhaL can
occur LffecLlve communlcaLlon cannoL occur wlLh Lhe face exchange
of lnformaLlon among all Lhe concerned parLles
c roblems wlLh Lhe role clarlflcaLlon can also occur CuesLlon of who
has Lhe auLhorlLy of Lhe auLhorlLy of Lhe sysLem ls noL yeL well
esLabllshed
3 Matr|x System
Lhe beneflLs of cenLrallzed and decenLrallzed conLrol are used
lL provldes for boLh hlerarchal coordlnaLlon ln a separaLe
deparLmenL as well as laLeral coordlnaLlon across deparLmenL
lL conLalns Lhree unlque seLs of relaLlonshlps
a unlL or deparLmenL manager who heads and balance Lhe
dual llne of auLhorlLy
b 1he maLrlx manager who shares workers eg pro[ecL
manager ln charge of cosL conLrol
c 1he sLaff who reporLs Lo Lhese 2 dlfferenL managers
Advantages
a 1he managemenL can apply speclallzed skllls Lo solve a
problem
b lnLerdlsclpllnary cooperaLlon ls encouraged
D|sadvantage
a All members musL possess good lnLerpersonal skllls Lo recelve
orders from Lwo dlfferenL bosses
rgan|zat|ona hart
MosL nurslng organlzaLlons have made graphlc
represenLaLlve of Lhe organlzlng process ln Lhe form of
organlzaLlon charL 1hese charLs usually show reporLlng
relaLlonshlps and communlcaLlon channels Llne charLs show
supervlsor and supervlsee relaLlonshlps from Lop Lo boLLom of
Lhe nurslng organlzaLlon 1hese are hlerarchlcal relaLlonshlp on
whlch communlcaLlon channels follow Lhe llne of auLhorlLy Lo
and Lhrough Lhe chlef nurse execuLlve CrganlzaLlonal charLs
are someLlmes referred Lo as schemas
1wo Iorms of Schemas or rgan|zat|ona harts
1 llaL
2 yramldal
ifferentiation Iat PyramidaI
1. Number of levels ewer More
2. Span of control Broad Narrower
3. Delegation Greater Lesser
4. Authority Decentralized Centralized
5. Accountability Greater Lesser
6. Control Less control of
subordinates
More control of
subordinates
7. Communication Easier Harder
I|ve Ma[or haracter|st|cs of rgan|zat|ona harts
1 D|v|s|on of Work each box represenLs an lndlvldual or subunlL
responslble for a glven Lask of Lhe organlzaLlon's workload
2 ha|n of ommand llnes lndlcaLe who reporLs Lo whom and by
whaL auLhorlLy
3 1ye of Work to 8e erformed Lhls ls lndlcaLed by labels or
descrlpLlon for Lhe boxes
4 Grou|ng of Work Segment Lhls ls shown by Lhe clusLers of
work groups (deparLmenL or slngle unlLs)
Leves of Management Lhese lndlcaLe lndlvldual and enLlre
managemenL hlerarchy Plerarchy refers Lo a body of people or
Lhlng organlzed or classlfled ln pyramldal fashlon accordlng Lo
rank capaclLy or auLhorlLy asslgned Lo verLlcal levels wlLh offlces
ranked ln grades or classes one above Lhe oLher
8 Staff|ng
lL ls Lhe process of deLermlnlng and provldlng Lhe accepLable
number and mlx of nurslng personnel Lo produce a deslred level
of care Lo meeL Lhe paLlenLs' demand of care
1he purpose of all sLafflng acLlvlLles ls Lo provlde each
nurslng unlL wlLh approprlaLe and accepLable number of each
caLegory of workers Lo perform Lhe nurslng Lasks requlred 1oo
few or an lmproper mlxLure of nurslng personnel wlll adversely
affecL Lhe quallLy and quanLlLy of work performed
Iactors Affect|ng Staff|ng
1 1ype phllosophy and ob[ecLlves of Lhe hosplLal and nurslng
servlce
2 ouat|on served klnd of paLlenLs served wheLher charlLy or
pay
3 Number of at|ents and acu|ty of the|r |ness knowledge and
ablllLy of Lhe nurslng personnel are maLched Lo Lhe acLual care
needs of paLlenLs
4 Ava|ab||ty and character|st|cs of the nurs|ng staff educaLlon
level of preparaLlon mlx of personnel number and poslLlon
AdmlnlsLraLlve pollcles such as roLaLlon weekend and hollday
offduLles
6 Standard of care des|red should be avallable and clearly spelled
ouL lnsLlLuLlons may uLlllze Lhe A-SA's SLandard of -urslng
racLlce
7 Layout of the var|ous nurs|ng un|ts and resources ava|abe
w|th|n the deartment adequaLe equlpmenL supplles and
maLerlals should be provlded
8udget amounL alloLLed for salarles frlnge beneflLs supplles
maLerlals and equlpmenL
9 rofess|ona act|v|t|es and r|or|t|es |n nonat|ent act|v|t|es
lnvolvemenL ln professlonal organlzaLlons formal educaLlonal
developmenL parLlclpaLlon ln research and sLaff developmenL
10 1each|ng rogram exLenL of sLaff lnvolvemenL Lo Leachlng
acLlvlLles
11 Lxected hours of work er annum of each emoyee Lhls ls
lnfluenced by Lhe 40 hours a week law
12 attern of work schedue LradlLlonal days a week hours
per day 4 days a week 10 hours per day and Lhree days off or 3
Z days of 12 hours per day and 3 Z days off per week
at|ent are ass|f|cat|on System
1he paLlenL care classlflcaLlon sysLem ls a meLhod of
grouplng paLlenLs accordlng Lo amounL and complexlLy of Lhelr
nurslng care requlremenL of nurslng Llme and sklll Lhey requlre
1hls assessmenL can serve ln deLermlnlng Lhe amounL of nurslng
care requlred generally wlLhln 24 hours as well as Lhe caLegory
of Lhe nurslng personnel who should provlde Lhe care
1o develop a workable paLlenL classlflcaLlon sysLem Lhe
nurse manager musL deLermlne Lhe followlng
1 1he number of caLegorles lnLo whlch Lhe paLlenLs should be
dlvlded
2 1he characLerlsLlc of paLlenLs ln each caLegory
3 1he Lype and number of care procedures LhaL wlll be needed by a
Lyplcal paLlenL ln each caLegory
4 1he Llme needed Lo perform procedures LhaL wlll be needed by
Lhe Lyplcal paLlenL ln each caLegory
ass|f|cat|on ategor|es
1he varlous unlLs may develop Lhelr own way of classlfylng
paLlenL care accordlng Lo Lhe aculLy of Lhelr paLlenL's lllness
ategor|es or eve of care of at|ent nurs|ng care hours needed
er at|ent er day and rat|o of rofess|ona to non
rofess|ona
LeveI of are NH needed
/ pt / day
Ratio of prof.
to non-prof.
LeveI I: seIf care or minimaI
care
1.5 55:45
LeveI II: moderate or
intermediate
3 60:40
LeveI III: totaI or intensive care 4.5 65:35
LeveI IV. highIy speciaIized 6 70:30
or criticaI care 7 or higher 80:20
ercentage of Nurs|ng are nours
1he percenLage of nurslng care hours aL each level of care
also depends on Lhe seLLlng ln whlch Lhe care ls belng glven
ercentage of at|ents at Var|ous Leves of are er 1ye of
nos|ta
Type of HospitaI MinimaI
are
Moderate
are
Intensive
are
HighIy Sp.
are
Primary HospitaI 70 25 5 -
Secondary
HospitaI
65 30 5 -
Tertiary HospitaI 30 45 15 10
SpeciaI Tertiary
HospitaI
10 25 45 20
omut|ng for the Number of Nurs|ng ersonne
Jhen compuLlng for Lhe number of nurslng personnel ln Lhe
varlous nurslng unlLs of Lhe hosplLals one should ensure LhaL Lhere
should be sufflclenL sLaff Lo cover all shlfLs offduLles holldays
leave absences and Llme for sLaff developmenL programs
1he lorLyPour Jeek law 8epubllc AcL 901 provldes LhaL
employees worklng ln hosplLals wlLh 100bed capaclLy and up wlll
work only 40 hours a week 1hls also applles Lo employees worklng
ln agencles wlLh aL leasL one mllllon populaLlon 1hese employees
worklng ln agencles locaLed ln communlLles wlLh less Lhan one
mllllon wlll work forLyelghL hours a week and Lherefore wlll geL
only one offduLy a week
1ota Number of Work|ng and Nonwork|ng Days and nours of
Nurs|ng ersonne er ear
Rights and PriviIeges Given ach
PersonneI / Year
Working Hrs / Week
40 Hrs 48 Hrs
1. Vacation Leave 15 15
2. Sick Leave 15 15
3. LegaI HoIidays 10 10
4. SpeciaI HoIidays 2 2
5. SpeciaI PriviIeges 3 3
6. ontinuing ducation Program for
ProfessionaIs
3 3
7. Off-duties as per RA 5901 104 52
TotaI Non-working ays / Year 152 100
TotaI Working ays / Year 213 265
TotaI Working Hours / Year 1,704 2,120
ke|evers Needed
1o compuLe for rellevers needed Lhe followlng should be
consldered
a Average number of leaves Laken each year1
a1 vacaLlon Leave10
a2 Slck leave
b Polldays12
c ConLlnulng LducaLlon3
d Speclal rlvlleges as per CSC MC #6 serles 19963
1ota Average Leave 33 days
lL wlll be noLed Lherefore LhaL alLhough an employee ls
enLlLled Lo 1 days slck leave and 1 days vacaLlon leave 12
holldays 3 days for conLlnulng educaLlon plus 3 days of speclal
prlvlleges or 4 days LoLal he / she geLs only an average of 33
days leave per year
1o deLermlne Lhe rellevers needed dlvlde 33 (Lhe average
number of days an employee ls absenL per year) by Lhe number
of worklng days per year each employee serves (wheLher 213 or
26) 1hls wlll be 01 per person who works 40 hours per week
and 012 per person for Lhose worklng 4 hours per week
MulLlply Lhe compuLed rellever per person by Lhe compuLed
number of nurslng personnel 1hls wlll glve Lhe LoLal number of
rellevers needed
D|str|but|on by Sh|fts
SLudles have shown LhaL Lhe mornlng or day shlfL needs Lhe
mosL number of nurslng personnel (4 1) for Lhe
afLernoon shlfLs (34 37) and for Lhe nlghL shlfLs (1
1) ln Lhe hlllpplnes Lhe dlsLrlbuLlon usually followed ls 4
for Lhe mornlng shlfL 37 for Lhe afLernoon shlfL and 1 for
Lhe nlghL shlfL
Staff|ng Iormua
1o compuLe for Lhe sLaff needed ln Lhe lnpaLlenL unlLs of Lhe
hosplLal Lhe followlng sLeps are consldered
1 ategor|ze the number of at|ents accord|ng to the eve of care
needed
a MulLlply Lhe LoLal number of paLlenLs by Lhe percenL of
paLlenLs aL each level of care (wheLher mlnlmal lnLermedlaLe
lnLenslve or hlghly speclallzed)
2 I|nd the tota number of nurs|ng care hours needed by the
at|ents at each categor|zed eve
a -umber of paLlenLs aL each level by Lhe average number of
nurslng care hours needed per day
b CeL Lhe sum of Lhe nurslng care hours needed aL Lhe varlous
level
3 I|nd the actua number of nurs|ng care hours needed by these
g|ven number of at|ents
a MulLlply Lhe LoLal number of nurslng care hours needed per
day by Lhe LoLal number of days ln a year
4 I|nd the actua number of work|ng hours rendered by each
nurs|ng ersonne er year
a MulLlply Lhe number of hours on duLy per day by Lhe acLual
worklng days per year
I|nd the tota number of nurs|ng ersonne needed
a ulvlde Lhe LoLal number of nurslng care needed per year by Lhe
acLual number of worklng hours rendered by an employee per
year
b llnd Lhe number of rellevers mulLlply Lhe number of nurslng
personnel needed by 01 (for Lhose worklng 40 hours per week)
or by 012 (for Lhose worklng 4 hours per week)
c Add Lhe number of rellevers Lo Lhe number of nurslng
personnel needed
6 ategor|ze |nto rofess|onas and nonrofess|onas
a MulLlply Lhe number of nurslng personnel accordlng Lo Lhe
number of professlonals Lo nonprofesslonals
7 D|str|bute by sh|fts
1o lllusLraLe llnd Lhe number of nurslng personnel needed for a
100bed capaclLy LerLlary hosplLal
1 CaLegorlze Lhe paLlenLs accordlng Lo level of care needed
100 paLlenLs x 030 30 paLlenLs needlng m|n|ma care
100 paLlenLs x 04S 4S paLlenLs needlng moderate ]
|ntermed|ate
care
100 paLlenLs x 01S 1S paLlenLs needlng |ntens|ve care
100 paLlenLs x 010 10 paLlenLs needlng h|ghy
sec|a|zed
care
__________________________________________________
1ota No of at|ents 100
2 llnd Lhe number of nurslng care hours needed (-CP) by Lhe
paLlenL aL each level of care
30 paLlenLs x 1S (m|n|ma care) 4S Nn needed ] day
4S paLlenLs x 30 (moderate care) 13S Nn needed ] day
1S paLlenLs x 4S (|ntens|ve care) 68 Nn needed ] day
10 paLlenLs x 60 (h|ghy s care) 60 Nn needed ] day
__________________________________________________
1ota Nn needed er day 308
3 llnd Lhe LoLal number of -CP needed by 100 paLlenLs per
year
308 Nn ] day x 36S days ] year 112420 Nn ] year
4 llnd Lhe acLual worklng hours rendered by each nurslng
personnel per year
8 hrs ] day x 213 work|ng days ] yr 1704 work|ng hrs ] yr
llnd Lhe LoLal number of nurslng personnel needed
a 112420 Nn ] year 66 nurs|ng ersonne
1704 work|ng hrs ] yr
b 66 x 01S 10 re|evers
c 66 + 10 76 tota nurs|ng ersonne needed
6 CaLegorlze Lo professlonal and nonprofesslonal personnel Slnce
Lhls ls a LerLlary hosplLal Lhe raLlo of professlonal Lo non
professlonal ls 63
76 x 06S 49 rofess|ona nurses
76 x 03S 27 nurs|ng attendants (nonrofess|ona
nurses)
7 ulsLrlbuLe by shlfLs
49 nurses x 04S 22 rofess|ona nurses on morn|ng
sh|ft
49 nurses x 037 18 rofess|ona nurses on M sh|ft
49 nurses x 018 9 rofess|ona nurses on n|ght sh|ft
27 nurs|ng attendants x 04S 12 nurs|ng attendants on
morn|ng sh|ft
27 nurs|ng attendants x 037 10 nurs|ng attendants on
M sh|ft
27 nurs|ng attendants x 018 S nurs|ng attendants on
n|ght sh|ft
lL should be noLed LhaL Lhe above personnel are only for
lnpaLlenL 1herefore addlLlonal personnel shall be hlred for Lhose
supervlsory and admlnlsLraLlve poslLlons and Lhose ln speclal
unlLs such as CperaLlng 8ooms Lhe uellvery 8ooms Lmergency
8ooms and CuLpaLlenL ueparLmenLs AlLhough roomedln bables
ln Lhe moLher's unlL are noL lncluded ln Lhe paLlenL census Lhey
are glven servlce such as baLhlng changlng of dlaper and Lhe
llke AddlLlonal sLaff should be provlded for Lhe bables
PosplLals now are also cenLers of wellness 1herefore
addlLlonal personnel shall be needed for healLh educaLlon classes
boLh Lhe lnpaLlenL and ouLpaLlenL unlLs
Schedu|ng
ls a LlmeLable showlng planned work days and shlfLs
for nurslng personnel
1he ob[ecLlve ln schedullng ls Lo asslgn worklng
days and daysoff Lo Lhe nurslng personnel so LhaL
adequaLe paLlenL care ls assured a deslrable
dlsLrlbuLlon of offduLles ls achleved Lhe lndlvldual
members of Lhe nurslng are LreaLed falrly and LhaL
Lhey know ln advance whaL Lhelr schedules are
Iactors ons|dered |n Mak|ng Schedues
1 D|fferent eves of the nurs|ng staff an adequaLe
mlx of nurses and nurslng aLLendanL should be
observed so LhaL Lhey only assume duLles Lhey are
legally responslble for accordlng Lo Lhelr poslLlon
educaLlon Lralnlng and experlence
2 Adequate coverage for 24 hours seven days a week afLernoon
and nlghL shlfL's requlremenLs for sLaff are usually lower Lhan ln
Lhe mornlng shlfL Also SaLurdays and Sundays Lend Lo have
lower requlremenLs slnce Lhere are lesser medlcal rounds fewer
medlcal orders and lower paLlenL census
3 Staggered vacat|ons and ho|days slnce everybody can en[oy
Lhe hollday off on exacLly Lhe same day LhaL Lhey occur
schedules for holldays are sLaggered aL leasL once a monLh
vacaLlon ls llkewlse sLaggered Lo ensure adequaLe coverage aL all
Llmes Jeekends are scheduled ln such a way LhaL everyone geLs
a falr share of aL leasL one weekend off a monLh
4 Long stretches of consecut|ve work|ng days Lhls should be
avolded as much as posslble because lL mlghL affecL Lhe healLh of
Lhe nurslng personnel AfLernoon and nlghL shlfLs are more
dlfflculL Lhan Lhe day shlfLs 1he nurslng personnel should geL
Lhelr falr share of Lhese shlfLs lncludlng Lhe rellef" duLy for Lhe
Lhree shlfL perlods
Lven|ng and n|ght sh|fts and foat|ng Lhere are some problems
LhaL occur ln Lhe schedules 8usy unlLs may requlre addlLlonal
help unscheduled absences may occur and suddenly a sLaff may
be pulled ouL from her regular area of asslgnmenL Lo cover for
anoLher unlL 1he nurse may feel lnsecure ln Lhe area where she
ls asked Lo help or relleve ulsrupLlon ln Lhe unlLy of work groups
may occur and Lhls may cause [ob dlssaLlsfacLlon and hlgh
Lurnover raLes 1hls ls especlally Lrue lf Lhe nurse does noL have
Lhe necessary sklll and knowledge LhaL Lhe unlL may requlre
ln order Lo mlnlmlze problems as a resulL of emergency
asslgnmenL crossLralnlng and / or orlenLaLlon Lo complemenLary
unlLs ls advlsed uurlng orlenLaLlon Lo Lhe -urslng Servlce new
nurses are Lold of Lhe posslblllLy LhaL Lhey may be asked Lo
relleve ln areas of Lhe hosplLal oLher Lhan Lhelr regular
asslgnmenLs Lmphasls however ls glven Lo Lhe facL LhaL cross
Lralnlng enhance Lhelr skllls and capablllLles aslde from meeLlng
Lhe needs of Lhe servlce
Assess|ng Schedu|ng System
Jhlle schedullng may vary from agency Lo agency Lhe
schedullng sysLem musL funcLlon smooLhly ln Lerms of
1 AblllLy Lo cover Lhe needs of Lhe unlL A mlnlmum requlred
number of sLaff Lo meeL Lhe nurslng needs of Lhe paLlenLs on Lhe
unlLs aL all shlfLs
2 CuallLy Lo enhance Lhe nurslng personnel's knowledge Lralnlng
and experlence Jhlle belng permanenLly asslgned Lo one unlL
enhances skllls ln carlng for a parLlcular klnd of paLlenL (wheLher
obsLeLrlcal medlcal surglcal or pedlaLrlcs) many nurses who
have fuLure plans of golng lnLo Leachlng or speclallzaLlon or even
worklng abroad would prefer Lo experlence belng asslgned Lo
varlous unlLs flrsL before seLLllng down Lo a parLlcular unlL of Lhelr
cholce
3 lalrness Lo Lhe sLaff All nurslng personnel should geL a falr share
of weekends hollday offs roLaLlon paLLerns for Lhe whole year
lncludlng asslgnmenL Lo dlfflculL" or llghL" or undeslrable"
unlLs or shlfLs
4 SLablllLy 1he nurslng personnel should llke Lo know ln advance
Lhelr schedule of asslgnmenL so LhaL Lhelr personal schedules
(wheLher home soclal and clvlc responslblllLles) are ln harmony
wlLh each oLher
llexlblllLy llexlblllLy means Lhe ablllLy Lo handle changes broughL
abouL by emergency leaves scheduled or unscheduled leaves of
absence
1yes of Schedu|ng
1here are several Lypes of schedullng whlch are
1 entra|zed Schedues one person usually Lhe Chlef -urse or
her deslgnaLe asslgns Lhe nurslng personnel Lo Lhe varlous unlLs
of Lhe hosplLal 1hls lncludes Lhe shlfLs of duLy and offduLles
2 Decentra|zed Schedues one person usually Lhe Chlef -urse or
her deslgnaLe asslgns Lhe nurslng personnel Lo Lhe varlous
nurslng unlLs 1he shlfL and offduLles are arranged by Lhe
Supervlslng -urse or Pead or Senlor -urse of Lhe parLlcular unlLs
3 yc|ca Schedues Lhe cycllcal schedule covers deslgnaLed
number of weeks called Lhe cycle lengLh and ls repeaLed Lhereon
lL asslgns Lhe requlred number of nurslng personnel Lo each
nurslng unlL conslsLenL wlLh Lhe unlL's paLlenL care requlremenLs
Lhe sLaff preference Lhelr educaLlon Lralnlng and experlence
1he followlng schedullng varlables should be consldered
a LengLh of schedullng perlod wheLher 2 Lo 4 weeks
b ShlfL roLaLlon
c Jeekends off
d Polldays off
e vacaLlon leaves
f Speclal days (blrLhdays weddlng annlversary eLc)
g Scheduled evenLs ln Lhe hosplLal (Lralnlng programs meeLlngs
eLc)
h !ob caLegorles
l ConLlnulng rofesslonal LducaLlon (CL) programs
AdvanLages of Cycllcal Schedule
1 lL ls falr Lo all lavorlLlsm ls mlnlmlzed as all nurslng personnel
geLs Lhelr falr share of roLaLlon Lo Lhe varlous shlfLs
2 lL saves Llme as Lhe schedule does noL have Lo be redone every
week or Lwo
3 lL enables Lhe employees Lo plan ahead of Lhelr personal needs
prevenLlng frequenL changes ln schedule
4 Schedule leave coverage such as vacaLlon holldays and slck
leaves are more sLable
roducLlvlLy ls lmproved
D Deveo|ng Iob Descr|t|on
A [ob descrlpLlon ls a sLaLemenL LhaL seLs Lhe duLles and
responslblllLles of a speclflc [ob lL lncludes Lhe needed
characLerlsLlcs or quallflcaLlons of Lhe lndlvldual Lo perform such
duLles successfully lL ls an lmporLanL managemenL Lool Lo make
cerLaln LhaL responslblllLles are wlsely delegaLed work efflclenLly
dlsLrlbuLed LalenLs fully used and morale malnLalned
ontents of Iob Descr|t|on
1 Ident|fy|ng Data
os|t|on 1|te Staff Nurse
Deartment Nurs|ng
Suerv|sor's 1|te nead ] Sen|or Nurse
2 Iob Summary 1hls wlll lnclude Lhe essenLlal feaLure of Lhe [ob
LhaL dlsLlngulshes lL from Lhe oLhers
3 ua|f|cat|on kequ|rements LducaLlon preparaLlon Lralnlng and
experlence necessary Lo flll Lhe poslLlon
4 Iob keat|onsh|s source of workers
Sec|f|c and Actua Iunct|ons and Act|v|t|es
Uses of Iob Descr|t|on
1 lor recrulLmenL and selecLlon of quallfled personnel
2 1o orlenL new employees Lo Lhelr [ob
3 lor [ob placemenL Lransfer or dlsmlssal
4 As an ald ln evaluaLlng Lhe performance of an employee
Cb[ecLlve evaluaLlon beneflLs boLh Lhe employer and employee
lor budgeLary purposes Salarles are equaLed wlLh Lhe level of
responslblllLles and skllls deflned ln Lhe [ob descrlpLlon and Lhus
become Lhe basls for lmprovemenL and / or furLher acLlon
6 lor deLermlnlng deparLmenL funcLlons and relaLlonshlps Lo help
deflne Lhe organlzaLlonal sLrucLure Cne of Lhe organlzlng
prlnclples ls grouplng employees performlng slmllar funcLlon Lo
avold dupllcaLlon or overlapplng of funcLlons and lmproves
workflow
7 lor classlfylng levels of nurslng funcLlons accordlng Lo sklll levels
requlred 1hls enables nurslng admlnlsLraLors Lo deLermlne
wheLher a reallgnmenL of responslblllLles ls lndlcaLed
1o ldenLlfy Lralnlng needs
9 As basls for sLafflng
10 1o serve as channel of communlcaLlon
III DIkL1ING
AfLer Lhe manager has planned organlzed and sLaffed he /
she musL dlrecL personnel and acLlvlLles Lo accompllsh Lhe goals
of Lhe organlzaLlon knowledge of one's leadershlp sLyle
managerlal phllosophy sources of power and auLhorlLy and
pollLlcal sLraLegles are lmporLanL 1o geL Lhe work done by oLhers
Lhe manager musL deal wlLh confllcL and moLlvaLe and dlsclpllne
sLaff all of Lhese Lasks requlre good communlcaLlon sklll and
asserLlve behavlor
D|rect|on lL ls Lhe lssulng of asslgnmenLs orders and lnsLrucLlons
LhaL permlLs Lhe worker Lo know whaL ls expecLed of hlm / her
and Lhe guldance and overseelng of Lhe worker so LhaL he / she
can conLrlbuLe effecLlvely Lo Lhe aLLalnmenL of organlzaLlonal
ob[ecLlves
lL acLuaLes efforLs Lo accompllsh goals
uroses of D|rect|ng
1 1o achleve ob[ecLlves ln Lhe manner lL was planned and organlzed
2 1o accompllsh asslgnmenL glven by Lhe managemenL
3 1o regulaLe Lhe acLlvlLles
4 1o conLrlbuLe effecLlvely and efflclenLly Lo Lhe aLLalnmenL of Lhe
organlzaLlon
Lements of D|rect|ng
A Deegat|on
ls Lhe process by whlch a manager asslgns speclflc Lasks / duLles Lo
workers wlLh commensuraLe auLhorlLy Lo perform Lhe [ob
ls a means of allocaLlng and decenLrallzlng auLhorlLy lmposlng
responslblllLy and accounLablllLy and asslgnlng Lasks down Lo Lhe
lowesLposslble level aL whlch Lhere ls sufflclenL compeLence and
lnformaLlon for effecLlve declslon maklng on Lask performance
A1 8as|c oncet of Deegat|on
kesons|b||ty obllgaLlon Lo do whaL ls asked
Author|ty Lhe rlghL Lo declde and command
Accountab||ty responslble / answerable for one's acLlons
A2 Stes to 8etter Deegat|on
1 1h|nk before you deegate
arL of plannlng Lo delegaLe ls deLermlnlng whaL Lo accompllsh
and how well you expecL each person Lo do ?ou musL declde
speclflcally whaL you can and cannoL delegaLe
Matters that cannot be deegated
a Cverall responslblllLy auLhorlLy and accounLablllLy for
saLlsfacLory compleLlon of all acLlvlLles ln Lhe unlL -urse
managemenL cannoL be absolved wlLh poor performance of
subordlnaLes by blamlng Lhem
b AuLhorlLy Lo slgn one's name ls never delegaLed Lhe worker
LhaL performed Lhe Lask should be Lhe one Lo slgn lL
c LvaluaLlng Lhe sLaff and / or Laklng necessary correcLlve or
dlsclpllnary acLlon
d 8esponslblllLy of malnLalnlng morale or Lhe opporLunlLy Lo say
a few words of encouragemenL of Lhe sLaff especlally Lhe new
ones Showlng confldence ln Lhe workers boosL Lhelr morale and
bulld up Lhelr self confldence
e 1oo Lechnlcal [obs and Lhose LhaL lnvolved LrusL and confldence
2 an and organ|ze unt| act|v|t|es are |n og|ca order
ueclde whaL ls mosL lmporLanL and Lherefore whaL musL be done
flrsL 1hen arrange Lhe resL of Lhe work ln order of lmporLance
and avallable Llme
3 Determ|ne why you are deegat|ng certa|n act|on act|v|t|es to
a art|cuar erson
erhaps Lhe lndlvldual needs Lo acqulre knowledge and skllls or
has asked for cerLaln asslgnmenLs
keasons why managers fa| or refuse to deegate
a Lack of confldence ln Lhelr sLaff
b 1hey feel LhaL Lhey can do Lhe Lask beLLer and fasLer
c 1hey are Loo busy and enough Llme ls needed Lo Leach
d 1hey resenL necessary lnLerrupLlon Lo explaln
e 1hey fear of loslng conLrol lf some of Lhelr duLles are delegaLed
4 8e speclflc when you delegaLe
LeL people know exacLly whaL Lhey are responslble for very ofLen
lnformaLlon should be ouL ln wrlLlng use feedback Lo ensure each
person undersLand whaL ls Lo be done
ulrecLlon musL be compleLe undersLandable
Speak dlsLlncLly and slowly
Avold glvlng Loo many dlrecLlon aL one Llme
1he wordlngs of dlrecLlon lndlcaLes lLs lmporLance
8e w||ng to accet the r|sks and accountab||ty for the
act|ons of others
lndlvlduals are obllgaLed Lo carry ouL Lhe delegaLed Lasks and are
accounLable for Lhelr own performance she ls accounLable Lo her
supervlsors noL only for her own acLlons buL also Lhe flnal resulL
of all Lhe servlces rendered by lndlvldual sLaff members
6 kee |nformed after you deegate
CeL perlodlc reporLs buL also examlne resulLs of Lhe work boLh
ln Lhe progress and upon compleLlon Jhen someLhlng ls wrong
dlscuss lL wlLh Lhe person and lf Lhe work ls done well you musL
glve recommendaLlon
8 Suerv|s|on
ls a process of geLLlng Lhe work done Lhrough oLhers whlch ls
done properly on Llme and wlLhln Lhe budgeL
Supervlslon ls
JhaL Jhen Jho Pow Jhy
lannlng Sklllfully
ulrecLlng SafeLy
Culdlng CorrecLly
1eachlng aLlenLly so LhaL every CompeLenLly
Cbservlng ConLlnuously Lvery 1acLfully worker can Accordlng Lo
Lncouraglng worker lalrly do hls / her hls / her
CorrecLlng work and capablllLy
CommenLlng glve any care llmlLaLlon
LvaluaLlng of work
1he purposes of supervlslon are Lo lnspecL Lo gulde evaluaLe
and lmprove work performance of employees Lhrough a crlLerla
agalnsL whlch Lhe quallLy of work producLlon and uLlllzaLlon of Llme
and resources are made
-urse manager provldes guldance and dlrecLlon Lo workers Lo
achleve Lhe goals and ob[ecLlves of Lhe lnsLlLuLlon and LhaL of Lhe
nurslng unlL
1he aLmosphere creaLed by Lhe supervlslon as he / she
makes hls / her rounds or Lalks Lo Lhe sLaff wlll deLermlne Lo a
large exLenL Lhe accepLablllLy of Lhe commenLs crlLlclsm and / or
correcLlons he / she makes
Clven a sofL courLeous manner Lhese wlll be Laken wllllngly
and be accepLed as a challenge Lo lmprove performance Clven a
harshly especlally ln publlc bullds up resenLmenL lllwlll and
poor quallLy of work
Lmphasls of supervlslon ls geLLlng Lhe work done accordlng
Lo deflnlLe pollcles and procedures
1yes of Suerv|s|on
1 Autocrat|c Suerv|s|on
supervlsor plans all Lhe work
makes all Lhe declslon
lssues commands Lo workers who are Lo obey wlLhouL
quesLlon
regards lndlvldual as machlne and noL as human belng
more on dlrecLlon and lnspecLlon
2 Democrat|c Suerv|s|on
emphasls ls lnsLead of geLLlng Lhe work done ls now placed on
helplng Lhe lndlvldual Lo do Lhe work beLLer
Lhere ls a greaLer degree of freedom whereln workers are
glven a volce ln seLLlng up work goals and plannlng meLhod for
reachlng Lhem
Leachlng and helplng people develop new skllls and greaLer
undersLandlng of Lhelr [ob
Suerv|sor's chaenge ls Lo creaLe a cllmaLe ln whlch
sponLaneous Leamwork ls posslble and harmonlze Lhe goals of
Lhe lndlvldual wlLh Lhose of Lhe group
Importance of Supervision:
1. t is concerned with people as well as the work area,
working condition, and work itself
> supervision must try to provide as much as possible
suitable working condition not only physical surroundings
but also good atmosphere in which the staff works
(environment where people work should give them a feeling
of freedom and the desire to do the best they can)
2 lL ls also concerned wlLh Lhe plannlng execuLlon and evaluaLlon
of work
Lhe sLaff should also have Lhe parL ln Lhls plannlng and help Lo
perform and evaluaLe Lhelr own work
3 CrlenLaLlon Lralnlng and guldance of lndlvldual accordlng Lo Lhelr
needs are dlrecLed Loward uLlllzaLlon of Lhelr capablllLles and Lhe
developmenL of new skllls
Supervlsor should be acqualnLed wlLh every lndlvldual and
musL be able Lo sLlmulaLe each lndlvldual Lhe deslre for self
lmprovemenL lf Lhe person recognlzes hls / her needs for
lmprovemenL Lhe leader musL supply Lhe necessary help and
lnsLrucLlon aL Lhe same Llme gulde Lhe worker ln acqulslLlon of
accepLable aLLlLude and lnLeresLs and good worklng hablLs
oord|nat|on
CoordlnaLlon unlLes personal and servlces Lo a
common ob[ecLlve SynchronlzaLlon of acLlvlLles
wlLh Lhe varlous servlces and deparLmenLs enhances
collaboraLlve efforLs resulLlng ln efflclenL smooLh and
harmonlous work flow CoordlnaLlon also prevenLs
overlapplng of funcLlons enhances good worklng relaLlonshlps
and work schedules are flnlshed on Llme
AL Lhe unlL level supervlslng nurse coordlnaLe Lhelr work
wlLh oLher deparLmenLs servlces or unlLs uLlllzlng clearly deflned
pollcles sLandard operaLlng procedures and guldellnes Lhrough
proper channel of communlcaLlon
1yes of oord|nat|on
1 Intradeartmenta coordlnaLlon ls usually wlLhln Lhe
deparLmenL
2 Interdeartmenta coordlnaLlon beLween one deparLmenL Lo
anoLher
21 CoordlnaLlon wlLh Medlcal Servlces
All nurses should know Lhe medlcal sLaff ln Lhelr respecLlve
unlLs Lhelr servlces and scheduled Llme of medlcal rounds Cn
Lhe oLher hand nurse should know Lhe paLlenLs ln Lhe unlL
Lhelr dlagnosls acLual condlLlons medlcal plan or care and
LreaLmenLs so LhaL Lhey can parLlclpaLe lnLelllgenLly ln plannlng
Lhe care of each lndlvldual paLlenL
1oo ofLen nurses [usL become lmplemenLers of care" 1hey
do noL acLlvely lnvolve Lhemselves ln plannlng Lhe care of
paLlenLs 1hey musL remember LhaL ln carrylng ouL wrlLLen
prescrlpLlons of medlcaLlons and LreaLmenLs Lhey musL exerclse
reasonable [udgmenL and care Lo avold errors or
mlslnLerpreLaLlons
22 CoordlnaLlon wlLh AdmlnlsLraLlve Servlce
perLalns Lo resources boLh human and maLerlal AL Lhe unlL
level nurses parLlclpaLe ln budgeLlng plannlng for
sLafflng adequaLe faclllLles and maLerlal resources
repalrs and malnLenance of equlpmenLs are made ln
approprlaLe forms
Use of ogbook daLe and equlpmenL should pass Lhru
Lhe admlnlsLraLlon servlces
oversLocklng of supplles should be avolded Lo prevenL
wasLage
23 CoordlnaLlon wlLh Lhe LaboraLory Servlce
8equesL for laboraLory examlnaLlons should be
glven speclflc lnsLrucLlon relevanL Lo Lhe examlnaLlon
Lo be done such as fasLlng blood sugar
LaboraLory resulLs are properly fllled wlLh laLesL
exam on Lop for easy references
2.4. oordination with the RadioIogy
Service
Request for x-ray examination are
likewise forwarded to x-ray services for
proper scheduling and specific instruction
if needed.
2.5. oordination with Pharmacy
Service
Policies regarding procurement
of drugs are formulated jointly by the
administrative, medical and nursing
services with the pharmacy.
There are some hospitals that clinical pharmacist in
their units are manned by clinical pharmacist. They prepare
medicines prescribed by the physician and these are
administered by the nurse in the unit.
26 oord|nat|on w|th the D|etary Serv|ces
1he head nurse ls responslble for forwardlng Lhe dleL llsL of
Lhe paLlenLs ln Lhe unlL Laklng lnLo conslderaLlon
prescrlbed speclal dleLs paLlenLs' ldlosyncrasles for food
allergles food preferences and rellglous
resLrlcLlons
27 oord|nat|on w|th the Med|ca Soc|a Serv|ce
-urse's coordlnaLlon wlLh Lhe medlcal soclal servlces
Lhrough referral of paLlenL wlLh psychosoclaleconomlc
problems
h oord|nat|on w|th Med|ca kecords Serv|ces
-urses are responslble for accuraLe documenLaLlon and
compleLeness of paLlenL's charL lncludlng Lhelr safeLy and
confldenLlallLy
3 Lxtra|nstaat|on
CoordlnaLlon ls from hosplLal Lo anoLher agency aLlenLs are
ofLen referred Lo Lhe healLh cenLer nearesL Lhelr resldence upon
dlscharge from Lhe hosplLal for follow up
D ommun|cat|on
ls Lhe process whereby a message ls passed from sender Lo
recelver wlLh Lhe hope LhaL Lhe lnformaLlon exchange wlll be
undersLood as Lhe sender lnLended
Lements of ommun|cat|on
1 Sender
2 Message
3 kece|ver
lf one of Lhese Lhree elemenLs ls mlsslng no communlcaLlon can
Lake place
hannes of ommun|cat|on
CommunlcaLlon channels used by Lhe manager may be
upward Lhe manager ls a subordlnaLe Lo a hlgher managemenL
-eeds and wanLs are communlcaLed upward Lo Lhe nexL level ln
Lhe hlerarchy
uownward Lhe manager relays lnformaLlon Lo subordlnaLes
1hls ls a LradlLlonal form of communlcaLlon ln organlzaLlons and
helps coordlnaLe acLlvlLles ln varlous levels of Lhe hlerarchy
PorlzonLal managers lnLeracL wlLh oLhers on Lhe same
hlerarchlcal level as Lhemselves who are managlng dlfferenL
segmenLs of Lhe organlzaLlon
ulagonal Lhe manager lnLeracLs wlLh personnel and managers
of oLher deparLmenLs and groups such as physlclans who are noL
on Lhe same level of Lhe organlzaLlonal hlerarchy AlLhough Lhese
people have no formal auLhorlLy over Lhe manager Lhls
communlcaLlon ls vlLal Lo Lhe organlzaLlon's funcLlonlng ulagonal
communlcaLlon Lends Lo be less formal Lhan oLher Lypes of
communlcaLlon
Crapevlne Lhe mosL lnformal communlcaLlon neLwork
CommunlcaLlon flows haphazardly beLween people aL all
hlerarchlcal levels and usually lnvolves Lhree or four people aL a
Llme Crapevlne communlcaLlon ls sub[ecL Lo error and dlsLorLlon
because of Lhe speed aL whlch lL passes and because Lhe sender
has llLLle formal accounLablllLy for Lhe message
Interersona ommun|cat|on |n a Mut|cutura Workace
8ecause lL ls lmposslble for Lhe lndlvldual manager Lo
communlcaLe face Lo face wlLh each member ln a large
organlzaLlon managers musL develop oLher lnLerpersonal
communlcaLlon skllls 1hese skllls lnclude nonverbal
communlcaLlon verbal communlcaLlon and llsLenlng skllls
1he followlng ls a parLlal llsL of nonverbal clues LhaL can
occur wlLh or wlLhouL verbal communlcaLlon
Space
LnvlronmenL
Appearance
Lye ConLacL
osLure
CesLures
laclal Lxpresslon
1lmlng
vocal Clues such as Lone volume and lnflecLlon
VerbaI ommunication SkiIIs
Highly developed verbal communication skills are
critical for the leader / manager. One of the most important
verbal communication skills is the art of assertive
communication. Assertive behavior is a way of
communicating that allows people to express themselves in
direct, honest, and appropriate ways that do not infringe on
another person's rights.
k|ghts and kesons|b||t|es of the Assert|ve erson
k|ghts kesons|b||t|es
1o speak up 1o llsLen
1o Lake 1o glve
1o have problems 1o flnd soluLlons
1o be comforLed 1o comforL oLhers
1o work 1o do your besL
1o make mlsLakes 1o correcL your mlsLakes
1o laugh 1o make oLhers happy
1o have frlends 1o be a frlend
1o crlLlclze 1o pralse
1o have your efforLs rewarded 1o reward oLhers' efforLs
1o be lndependenL 1o be dependable
1o cry 1o dry Lears
1o be loved 1o love oLhers
IV N1kLLING
ls an ongolng funcLlon of managemenL occurrlng durlng plannlng
organlzlng and dlrecLlng acLlvlLles
lL ls assesslng / regulaLlng performance ln accordance wlLh Lhe
plans LhaL have been adopLed Lhe lnsLrucLlons lssued and Lhe
prlnclples esLabllshed
ls Lhe process by whlch managers assures LhaL Lhe acLual
expendlLures and acLlvlLles conform Lo plan
1he conLrolllng process plays an lmporLanL role ln ldenLlfylng
opporLunlLles for lmprovemenL comparlng performance agalnsL
seL sLandard provldlng lnformaLlon abouL how well processes
and people are dolng so LhaL Lhey can be moLlvaLed Lo perform
beLLer ln Lhe fuLure
keasons for onduct|ng Lvauat|on
1here are some reasons why evaluaLlon ls needed and why lL
plays an lmporLanL role ln quallLy and producLlvlLy lmprovemenL
1 Lnsure quallLy nurslng care ls provlded
2 SeL senslble ob[ecLlves and comply wlLh Lhem
3 rovldes sLandards for esLabllshlng comparlsons
4 rovldes vlslblllLy and a means for employees Lo monlLor Lhelr
own performance
PlghllghLs quallLy problems and deLermlne Lhe areas LhaL requlre
prlorlLy aLLenLlon
6 Clves an lndlcaLlon of Lhe cosLs of poor quallLy
7 !usLlfles Lhe use of resources
rovldes feedback for lmprovemenLs
Lvauat|on r|nc|es
ln order Lhe employees are evaluaLed accuraLely and falrly
cerLaln prlnclples musL be observed
1 1he evaluaLlon musL be based on Lhe behavlorally orlenLed
performance sLandard of Lhe poslLlon occupled
Lhe employee ls presenLed as ob[ecLlves Lo sLrlve for and
achleve Lherefore performance musL be based on Lhese
2 ln evaluaLlng performance adequaLe samples and represenLaLlve
samples of Lhe employee's behavlor should be observed
usual and conslsLed behavlor should be evaluaLed lnsLead of
an lsolaLed or a Lyplcal behavlor
3 A copy of Lhe [ob descrlpLlon performance sLandards and
evaluaLlon form are glven Lo Lhe employee before Lhe scheduled
evaluaLlon conference for revlew so LhaL dlscusslon by Lhe raLer
and Lhe raLe wlll be from Lhe same frame of reference
4 uocumenLaLlon of an employee's performance appralsal should
lnclude boLh saLlsfacLory and Lhose needlng lmprovemenL wlLh
speclflc behavloral lnsLances Lo clarlfy Lhese evaluaLlve commenLs
rlorlLlze areas needlng lmprovemenL as Lhe worker aLLempLs Lo
upgrade hls / her performance
6 Schedule and conducL Lhe evaluaLlon conference aL a Llme
convenlenL for boLh Lhe raLer and Lhe raLee ln pleasanL
surroundlng wlLh ample Llme for dlscusslon of Lhe evaluaLlon
7 1he evaluaLlon reporL and conference should be sLrucLured LhaL lL
can be percelved and accepLed as a means of lmprovlng [ob
performance
haracter|st|cs of an Lvauat|ve 1oo
1 It shoud be ob[ect|ve
Cb[ecLlvlLy means LhaL Lhe evaluaLlon Lool ls free from blas
2 It shoud be re|abe
rellablllLy refers Lo Lhe accuracy or preclslon of Lhe Lool LhaL lf
admlnlsLered Lwlce lL wlll produce Lhe same resulLs
3 It shoud be va|d
valldlLy refers Lo Lhe relevancy of Lhe measuremenL Lo Lhe
performance of Lhe employee
4 It shoud be sens|t|ve
senslLlvlLy means Lhe ablllLy of Lhe measured flne llne
dlfferences among Lhe crlLerla belng measured
8as|c omonents of ontro rocess
1he conLrol process may be dlvlded lnLo Lhe followlng baslc
componenLs
1
sL
LsLabllshlng SLandards for Measurlng erformance
sLandards are deslrable seLs of condlLlons and performance
essenLlal ln ensurlng Lhe quallLy of nurslng care servlces whlch
are accepLable Lo Lhose lnsLrumenLal responslblllLles ln seLLlng /
malnLalnlng Lhem
3 1yes of Standards
1 Structure refers Lo Lhe baslc supporL componenLs of nurslng
are Lhose LhaL focus on Lhe sLrucLure or managemenL sysLem
used by Lhe agency Lo dellver care whlch lncludes Lhe number
and caLegorles of nurslng personnel Lhelr educaLlon personal
and professlonal quallLles and proflclencles Lhelr funcLlons and
physlcal faclllLles and equlpmenL
2 rocess Standards refers Lo Lhe deslred effecLs as speclfled
cllnlcal manlfesLaLlons moblllLy levels paLlenL knowledge or self
care skllls
refers Lo declslons and acLlons of Lhe nurse relaLlve Lo Lhe
nurslng process whlch are necessary Lo provlde good nurslng
care 1hese lnclude assessmenL plan of care and nurslng
lnLervenLlon
3 utcome Standards
are deslgned Lo measure Lhe resulLs of care provlded ln Lerms
of changes ln Lhe healLh sLaLus of cllenLs served changes ln Lhe
level of Lhelr knowledge skllls and aLLlLudes and saLlsfacLlon of
Lhose served lncludlng Lhe members of Lhe nurslng / healLh Leam
2
nd
LsLabllshlng Cb[ecLlves and MeLhods for Measurlng
erformance
measurable crlLerla and ob[ecLlves speclflc Lo glvlng nurslng care
musL be developed Lo evaluaLe process and ouLcome
esLabllshmenL of ob[ecLlves provldes clear dlrecLlon and
communlcaLlon of expecLed level of achlevemenL
Lhere should be full commlLmenL ln Lhe form of a performance
conLracL
Lhe greaLer Lhe parLlclpaLlon of Lhe employee Lhe greaLer Lhe
moLlvaLlon achleved agreed upon performance ob[ecLlves
Lherefore should be parLlclpaLlvely developed be challenglng buL
aLLalnable be clear of sLaLemenLs or performance expecLaLlon
and lle wlLhln Lhe lndlvldual's scope of conLrol
Most ommony Used Methods for Measur|ng Nurs|ng are
1 1ask Anays|s
acLlons and procedures such as wrlLLen guldes schedules
rules records and budgeLs are lnspecLed
are used Lo deLermlned lssues how long lL Lakes a nurse Lo
perform a procedure and how many members are needed
for a speclflc number of paLlenL
1oos Used
11 1lme SLudles
12 CheckllsLs
2 ua|ty ontro
ls essenLlally Lhe acLlvlLles and Lechnlques employed Lo
achleve and malnLaln Lhe quallLy of a producL servlce or
processes
concelved and assessmenL of Lhe level of nurslng care
provlded and lLs effecLs on Lhe paLlenL Lhrough process and
ouLcome
lL lncludes monlLorlng acLlvlLy buL lL ls also concerned wlLh
flndlng and ellmlnaLlng causes of quallLy problems so LhaL
Lhe requlremenLs of Lhe cusLomer are conLlnuously meL
level of nurslng care provlded ls assessed ln quallLy conLrol
effecLs of Lhe nurslng care on Lhe paLlenL
Iocus
21 paLlenL / cllenL / famlly saLlsfacLlon of nurslng care
22 faclllLles and cllmaLe
23 meLhods used Lo dellver nurslng care
24 ouLcome of nurslng care
3
rd
Measur|ng Actua erformance
measuremenL of performance ls an ongolng repeLlLlve process wlLh
Lhe acLual frequency dependenL on Lhe Lype of acLlvlLy belng
measured
Lxample nurslng care of paLlenL ls monlLored conLlnuously
formal performance appralsal done only Lwlce a year
measuremenLs may be scheduled ln advance or may be done aL
perlodlc buL unannounced lnLervals or may occur aL random
1he purpose of measuremenL should be clarlfled and Lhe sLaff
should be lnformed on Lhe Lasks and levels LhaL need aLLenLlon
4
th
omar|ng kesuts of erformance w|th Standards and
b[ect|ves
ls one of Lhe easlesL sLeps ln Lhe conLrol process
lf performance maLches Lhe sLandards and ob[ecLlves managers are
assured LhaL Lhe needs of paLlenLs are belng meL
lf performance ls conLrary Lo sLandards and ob[ecLlves seL Lhen
necessary acLlons are needed
S
th
ke|nforc|ng Strengths or Successes and 1ak|ng orrect|ve
Act|ons as Necessary
poslLlve feedback sLlmulaLes moLlvaLlon conslsLenLly hlgh
performance and growLh of Lhe employee CorrecLlve acLlons are
applled Lo lmprove performance
kesons|b||ty of nead ] Sen|or Nurse
8elng Lhe flrsL llne supervlsor he's / she's ln besL poslLlon Lo
know wheLher Lhelr sLaff nurses are performlng saLlsfacLorlly ln
Lhelr work 1helr lnfluence can be dramaLlcally ln promoLlng
quallLy care Lo paLlenLs
1 1hey have Lhe responslblllLy Lo lnsLrucL subordlnaLes ln Lhe
approprlaLe meLhods and procedures ln provldlng nurslng care
2 lnform Lhem of Lhe llkely causes of errors or defecLs and Lhe
prevenLlve measures necessary
3 lnlLlaLe and faclllLaLe any sLeps necessary Lo lmprove meLhods
equlpmenLs maLerlals and condlLlons ln Lhe work area for whlch
Lhey are responslble
4 uraw aLLenLlon Lo exlsLlng or poLenLlal quallLy problems and
reporL all errors and defecLs wasLe
SuggesL ways ln whlch rlsks or error or quallLy problems may be
reduced
6 AsslsL ln Lralnlng new sLaff parLlcularly by seLLlng as good
examples
erformance Ara|sa
ls a conLrol process ln whlch employees' performance are
evaluaLed agalnsL sLandards lL ls Lhe mosL valuable Lool ln
conLrolllng human resources and producLlvlLy lL evaluaLes how
well Lhe nurslng personnel have performed durlng a speclflc
perlod of Llme
uroses of erformance Ara|sa
are used Lo
1 ueLermlne salary sLandards and Lo merlL lncreases
2 SelecL quallfled lndlvlduals for promoLlon or Lransfer
3 ldenLlfy unsaLlsfacLory employees for demoLlon or LermlnaLlon
4 Make lnvenLorles of wlLhln Lhe lnsLlLuLlon
ueLermlne Lralnlng and developmenLal needs of Lhe employees
6 lmprove Lhe performance of work groups by examlnlng
lmprovlng and correcLlng lnLerrelaLlonshlp beLween members
7 lmprove communlcaLlon beLween supervlsor and employee and
Lo reach an undersLandlng on Lhe ob[ecLlves of Lhe [ob
LsLabllsh sLandards of supervlsory performance
9 ulscover Lhe asplraLlons of employees and Lo reconclle Lhls wlLh
Lhe goals of Lhe lnsLlLuLlon
10 rovlde employee recognlLlon" for accompllshmenLs
11 lnform employees where Lhey sLand"
Methods of Measur|ng erformance
1hese may be done Lhrough
1 Informa Ara|sa wh|ch cons|sts of
11 lncldenLal observaLlon of work performance whlle engaged ln
performlng nurslng care
12 responses made by workers durlng conferences
13 noLlng Lhe lnLeracLlon of workers wlLh cllenLs Lhelr famllles
vlslLors and coworkers
2 Iorma Ara|sa
ls accompllshed regularly and meLhodlcally by collecLlng ob[ecLlve
facLs LhaL can demonsLraLe Lhe dlfference beLween whaL was
expecLed and whaL was done
21 Lssay
Lhe appralser wrlLes a paragraph or more coverlng Lhe
worker's sLrengLhs weaknesses and poLenLlals
ln mosL slLuaLlons parLlcularly Lhe managerlal poslLlons
essay appralsals carry slgnlflcanL welghL on Lhe
presumpLlon LhaL an honesL sLaLemenL from someone who
knows Lhe person well ls fully valld
lLs drawback ls ln lLs varlablllLy ln lengLh and conLenL and ls
more dlfflculL Lo compare because lL Louches on dlfferenL
aspecLs of a worker's performance
lL may also concenLraLe on Lhose areas of performance
whlch Lhe supervlslon enLerLalns sLrong feellngs
22 heck|sts
conLalns compllaLlon of all nurslng performance expecLed
of a worker
1he appralser's Lask ls Lo place a checkmark ln Lhe
approprlaLe column wheLher Lhe worker does or does
noL show Lhe deslred behavlor
a qulck glance aL Lhe compleLed forms would reveal Lhe
overall quallLy of Lhe nurses' performance
23 kank|ng
ln slmple ranklng Lhe evaluaLor ranks Lhe employees
accordlng Lo how he / she Lalked wlLh coworkers wlLh
respecL Lo cerLaln aspecLs of performance or quallflcaLlons
Lxample -urse A may rank lowesL ln educaLlonal
requlremenLs for Lhe nexL hlgher poslLlon among Lhe
flve candldaLes for promoLlon buL may rank flrsL ln
cllnlcal proflclency whlle -urse 8 may rank flrsL ln
educaLlonal quallflcaLlons buL rank Lhlrd ln cllnlcal
proflclency
24 kat|ng Scaes
lL lncludes a serles of lLems represenLlng Lhe dlfferenL Lasks
or acLlvlLles ln Lhe nurse's [ob descrlpLlon or Lhe absence or
presence of deslred behavlor and Lhe exLenL Lo whlch Lhese
are possessed
Lxamples
241 Cn a scale of 0 lndlcaLe Lhe degree of Lhe
nurse's sklll ln assesslng Lhe paLlenL's condlLlon
where each of Lhe correspondlng number means
LxcellenL
4 very SaLlsfacLory
3 ModeraLely SaLlsfacLory or Average
2 Mlnlmally SaLlsfacLory
1 unsaLlsfacLory
242 A descrlpLlve graphlc raLlng scale may be used Lo
descrlbe puncLuallLy ln reporLlng for duLy such as
1 CfLen Llmes laLe
2 SomeLlmes laLe
3 Always reporLs on Llme
2 Iorced ho|ce omar|son
Lhe evaluaLor ls asked Lo choose from Lhe sLaLemenLs LhaL
besL descrlbe Lhe nurse belng evaluaLed 1he lLems are so
grouped LhaL Lhe evaluaLor ls forced Lo choose from
favorable as well as unfavorable sLaLemenLs and Lo
counLerparL Lhe Lendency Lowards lenlency of some
evaluaLors
Lxample SelecL from Lhe followlng sLaLemenLs whlch
wlll besL descrlbe Lhe nurse belng evaluaLed and Lhe
leasL LhaL descrlbes hlm / her
1 respecLs Lhe ldeas of oLhers
2 communlcaLlon ablllLy llmlLed
3 evenLempered
4 capable of endurlng long hours of hard work
Lends Lo be loner
26 Anecdota kecord|ng
descrlbes Lhe nurse's experlence wlLh a group or a person or
ln valldaLlng Lechnlcal skllls and lnLerpersonal relaLlonshlp
lL should lnclude
261 descrlpLlon of Lhe parLlcular occaslon
262 dellneaLlon of Lhe behavlor noLed lncludlng who
whaL why when where and how
263 evaluaLor's oplnlon or esLlmaLe of Lhe lncldenL or
behavlor
1he descrlpLlve noLes are organlzed Lo geL lmpresslons of Lhe
overall behavlor ln a glven perlod of Llme CauLlon should Lherefore
be Laken agalnsL Lendency noL Lo glve Lhe negaLlve behavlor more
ofLen Lhan Lhe poslLlve behavlor
Lxample Mlss A was on her way Lo lunch She passed by a cllenL who
was reachlng for hls food Lray buL was havlng a hard Llme as Lhls was
placed on hls lefL slde Pls rlghL hand has an lv llne Mlss A sLopped
poslLloned Lhe food Lray comforLably and asslsLed Lhe paLlenL Lo eaL
alLhough she herself was laLe for lunch Mlss A acLed ln a
commendable manner
ua|ty Assurance
problem solvlng process LhaL sysLemaLlcally assesses Lhe quallLy
of care and correcLs any defecL LhaL ls observed
ls Lhe esLlmaLlon of Lhe degree of excellence paLlenL healLh
ouLcomes and ln acLlvlLy and oLher resource ouLcomes
(Jllllam Some) ls Lhe measuremenL of Lhe acLual level wlLh
servlce provlded plus Lhe efforLs Lo modlfy when necessary Lhe
provlslon
urose of ua|ty Assurance
Lo assure Lhe consumer of a speclfled degree of excellence
Lhrough conLlnuous measuremenL and evaluaLlon
urose of ua|ty Assurance rogram |n Nurs|ng
ls Lo measure and lmprove Lhe quallLy of nurslng dellvered ln Lhe
agency
ua|ty ls Lhe degree of excellence
Assurance formal guaranLee of a degree of excellence
ua|ty Assurance assures paLlenLs of an accepLable sLandard
of care LhaL wlll be provlded Lo Lhem
1o rov|de qua|ty serv|ce Lhe workers musL accepL responslblllLy
LhaL Lhey have Lo do Lhe rlghL [ob rlghL Lhe flrsL Llme and everyLlme
1hey have Lo accepL LhaL quallLy ls everyone's responslblllLy
CuallLy Assurance descrlbes all aLLlLudes relaLed Lo esLabllshlng
malnLalnlng and assurlng hlgh quallLy care for paLlenLs whlch
lncludes assessmenL of paLlenL care and correcLlon of ldenLlfled
problems
Lfflclency ls concerned wlLh Lhe percenLage resources acLually
used over Lhe resources planned Lo be used
erformance Lvauat|on focuses on Lhe worker
lL asks quesLlon how well Lhe worker ls saLlsfylng Lhe requlremenLs
of Lhelr [ob wlLhln Lhe organlzaLlon
ua|ty Assurance focuses on Lhe care and Lhe servlce Lhe paLlenL
recelved raLher Lhan how well Lhe professlonal ls performlng Lhe
duLles LhaL Lhe poslLlon requlres
aLlenL ls Lhe besL someLlmes Lhe only [udge of lnLerpersonal
aspecLs of care (Lxample empaLhy and communlcaLlon)
at|ent Sat|sfact|on ls an essenLlal goal of healLh care and
Lherefore a parL of quallLy of care
Methods of ua|ty Assurance
1 at|ent are Aud|ts
11 oncurrent en hart or 8ened|cter
ls one ln whlch paLlenL care ls observed and evaluaLed
a revlew of Lhe paLlenLs' charLs whlle Lhe paLlenLs are sLlll
conflned ln Lhe hosplLal
observaLlon of Lhe sLaff as paLlenL care ls glven
lnspecLlon of paLlenL and / or observaLlon of Lhe effecLs of
paLlenL care where Lhe focus ls on Lhe paLlenL (done durlng
rounds or paLlenL lnLervlew)
12 ketrosect|ve Aud|ts haneuf or osed hart
ls one ln whlch paLlenL care ls evaluaLed Lhrough
121 a revlew of dlscharged paLlenL's charLs
122 quesLlonnalre senL Lo or lnLervlews conducLed
on dlscharged paLlenLs
2 eer kev|ew
eers (employees of Lhe same professlon ranks and seLLlng) may
do paLlenL care audlLs evaluaLlng anoLher's [ob performance
agalnsL accepLed sLandards
3 ua|ty |rces
ls one of Lhe mosL publlclzed approaches Lo quallLy lnLroduced by
!apanese
a group of workers dolng slmllar work meeLs regularly volunLarlly
ln normal worklng Llme under Lhe leadershlp of Lhelr supervlsor Lo
ldenLlfy analyze and solve workrelaLed problems and so
recommended soluLlons Lo managemenL where posslble quallLy
clrcle members should lmplemenL Lhe soluLlons Lhemselves
Nurs|ng Aud|t omm|ttee
ls creaLed composed of a represenLaLlve from all levels of Lhe
nurslng sLaff
1 Member of Lhe Lralnlng sLaff
2 Supervlslng nurse
3 Pead / Senlor nurse
4 SLaff -urse
ln smaller hosplLals
Chlef -urse may be a member of Lhe commlLLee
AsslsLanL
1he audlL Leam usually deslgnaLes a day wlLhln Lhe week Lo
be Lhe audlL day Powever Lhe nurses do noL know whlch unlL
wlll be audlLed 1hls way Lhe acLlvlLles ln Lhe unlLs are noL
dellberaLely changed because Lhey know Lhey are belng
observed 1he audlL Leam uLlllzes Lhe developed process or
ouLcome crlLerla LhaL evaluaLe nurslng care 1he sLaff nurse or
Lhe senlor nurse parLlclpaLe durlng Lhe audlL and are shown Lhe
flndlngs boLh Lhe sLrong and weak polnLs 1hey slgn Lhe audlL
form Lo conflrm Lhe auLhenLlclLy of Lhe flndlngs of Lhe audlL Leam
Ut||zat|on of kesuts
Lhe nurslng sLaff ln Lhe unlL ls glven a feedback on Lhe resulLs
of Lhe quallLy assurance sLudy 1hls may be oral or wrlLLen and
ls dlrecLed Lo Lhe sLaff who admlnlsLer Lhe care or Lhelr
lmmedlaLe supervlsors
oslLlve feedback relnforces deslrable performance ConslsLenL
poslLlve flndlngs deserve a commendaLlon from Lhe nurslng servlce
-egaLlve feedback should LacLfully be conveyed lnLo a face Lo
face slLuaLlon so LhaL clarlflcaLlons can be made on Lhe assessmenL
made -egaLlve flndlngs have lmpllcaLlons for revlew of exlsLlng
sLandards ln Lhe unlL for closer supervlslon for deslgnlng sysLem Lo
remedy ldenLlfled problems and sLaff developmenL
ontro of kesources
arL of Lhe conLrol process ls Lhe perlodlc revlew of Lhe
uLlllzaLlon of maLerlals and supplles ln Lhe varlous nurslng unlLs
ConsumpLlon of supplles and maLerlals should be proporLlonaLe
Lo Lhe number of paLlenL Lo be served be Lhese ln Lhe form of
dresslng LreaLmenL done ln[ecLlon glven eLc
8equlslLlon of / or sLocklng a large number of supplles and
maLerlals should be avolded Lo prevenL pllferage (sLeal) mlsuse or
spollage A large order ls merlLed (deserve) when Lhere ls a large
demand
1he head / senlor nurse musL know Lhe average dally usage
and Lhe Llme requlred Lo recelve supplles from Lhe Llme Lhese
were requlslLloned
Crderlng Lhe correcL maLerlals and checklng lnvenLory levels
prevenL sLocklng lLems LhaL are noL frequenLly used
All equlpmenL's uLlllzaLlon reporL ls made lncludlng
frequency of breakdown
1hls wlll help evaluaLe Lhe quallLy of equlpmenL purchased
Lhe way lL ls handled used and operaLed
revenLlve malnLenance requlres regular lnspecLlon of
equlpmenL Lo prevenL breakdown and / or Lo deLecL needed
repalrs
MonLhly llnen lnvenLory ls done Lo deLermlne Lhe adequacy
of llnen lssued and uLlllzed ln Lhe varlous unlLs Measures should
be lnsLlLuLed Lo prevenL losses
Absences due Lo leaves wheLher scheduled or noL should be
analyzed as Lhese may have lmpllcaLlons for sLafflng rovlslons
for rellevers should be lncluded ln Lhe sLafflng paLLern Lo
malnLaln quallLy servlce
D|sc||ne
arL of Lhe conLrolllng process ln managemenL ls dlsclpllne
ln Lhe pasL dlsclpllne connoLes rlgld obedlence Lo rules and
regulaLlons Lhe vlolaLlon wlll resulL Lo poslLlve acLlons
1oday dlsclpllne ls regarded as a consLrucLlve and effecLlve
means by whlch employees Lake personal responslblllLy for Lhelr
own performance and behavlor 1hls ls Lermed as selfdlsclpllne
Iactors 1hat Infuence SefD|sc||ne Are
1 A strong comm|tment to the v|s|on h|osohy goas and
ob[ect|ve
a sLrong commlLmenL resulLs ln obsesslon and Leamwork whlch ln
Lurn encourages greaLer conformlLy Lo expecLed norms of
conducL wlLhln Lhe organlzaLlon
2 Laws that governs the ract|ce of a rofess|onas and the|r
resect|ve odes of onduct
among governmenL employees Lhe CS 8ules and 8egulaLlons as
per u 07 and Lhe Code of ConducL for ubllc Cfflclals 8A
6713 are also Lo be complled wlLh
3 Understand|ng the rues and reguat|ons of the agency
all employees are orlenLed Lo Lhe rules regulaLlons and pollcles
of Lhe agency Some organlzaLlons glve Lhelr employees a
handbook conLalnlng Lhese and Lhe posslble sancLlons for Lhelr
lnfracLlons
4 An atmoshere of mutua trust and conf|dence
selfdlsclpllne Lhrlves besL ln an aLmosphere of LrusL and
confldence beLween superlors and subordlnaLes
Lhe subordlnaLes wlll consulL Lhelr superlors wlLh Lhelr problems
wlLhouL fears
Lhe superlors LrusL Lhelr subordlnaLes wlll do Lhelr besL
performlng Lhelr [ob wlLhouL belng snoopervlsed"
D|sc||nary Act|on
any employee charged for break of Lhe rules and regulaLlons pollcles
norms of conducL shall be glven Lhe correspondlng due process
Lhere musL be exlsLlng rules of conducL governlng hls / her behavlor
and an acLual vlolaLlon of such rule 1he employee charged musL be
noLlfled ln wrlLlng abouL Lhe vlolaLlon Pe ls glven Lhe rlghL Lo be
counseled
D|sc||nary act|on shoud be rogress|ve |n nature such as
1 ounse|ng and ra Warn|ng
counsellng and oral warnlng ls besL glven ln prlvaLe and ln an
lnformal aLmosphere
employee ls glven a falr chance Lo alr hls slde 1he relevanL
facLs are analyzed and evaluaLed agalnsL hls pasL performance
Pe ls Lhen counseled regardlng expecLaLlons of lmproved
behavlor / performance ways of correcLlng Lhe problem and a
warnlng LhaL a repeLlLlon of Lhe same offense may warranL
furLher dlsclpllnary acLlon 1he employee commlLs Lo correcL
Lhe behavlor
he ls lnformed of any followup acLlon LhaL may be Laken
2 Wr|tten Warn|ng
ls Lhe second sLep ln dlsclpllnary acLlon
lL ls preceded by an lnLervlew slmllar Lo oral warnlng
he ls Lold afLer Lhe lnLervlew LhaL he wlll be glven a wrlLLen
warnlng Lhls lncludes
a statement of the robem
b |dent|f|cat|on of the rue wh|ch was v|oated
c consequences of cont|nued dev|ant behav|or
the emoyee's comm|tment to take correct|ve
act|on and any foowu act|on to be taken
3. Suspension
Suspension over minor violation is given after an
evidence of oral and written warnings.
Although a violation is a major infarction, suspension,
rather than dismissal is applied when management tools
that the employee can still be rehabilitated. Accurate
documentation of oral and written warnings including
suspension if done is necessary evidence of due process.
4 D|sm|ssa
1hls penalLy ls lnvoked only when all oLher dlsclpllnary
efforLs have falled 1he ulsclpllnary CommlLLee should be very
sure LhaL Lhe cause for dlsmlssal conforms wlLh Lhe crlLerla of a
ma[or dlsclpllne vlolaLlon as conLalned ln Lhe pollcy manual and
for Lhe governmenL employees Lhose conLalned ln Lhe Clvll
Servlce 8ules and 8egulaLlons and Lhe Code of ConducL
a revlew ls acLually done by hlgher managemenL
ln Lhe case of governmenL employees Lhls ls furLher
revlewed by Lhen respecLlve deparLmenL and flnal afflrmaLlon ls
done by Lhe Clvll Servlce Commlsslon