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Name: Maricar Mae Bandiola 1.

Nursing and Leadership Management Assignment BSN 4

Case study on the following: a. Delegation and communication problems

CASE 2 Joe Garcia has been an operating room nurse for 5 years. He was often on call on Saturday and Sunday, but he enjoyed his work and knew that he was good at it. Joe was called to come in on a busy Saturday afternoon just as his 5-year-old daughter's birthday party was about to begin. "Can you find someone else just this once?" he asked the nurse manager who called him. "I should have let you know in advance that we have an important family event today, but I just forgot. If you can't find someone else, call me back, and I'll come right in." Joe's manager was furious. "I don't have time to make a dozen calls. If you knew that you wouldn't want to come in today, you should not have accepted on-call duty. We pay you to be on-call, and I expect you to be here in 30 minutes, not one minute later, or there will be consequences." Joe decided that he no longer wanted to work in the institution. With his 5 years of operating room experience, he quickly found another position in an organization that was more supportive of its staff. 1. What style of leadership and school of management thought seemed to be preferred by Joe Garcia's manager? 2. What style of leadership and school of management were preferred by Joe? 3. Which of the listed qualities of leaders and managers did the nurse manager display? Which behaviors? Which ones did the nurse manager not display? 4. If you were Joe, what would you have done? If you were the nurse manager, what would you have done? Why? 5. Who do you think was right, Joe or the nurse manager? Why? b. Time Management CASE 8 A large health-care corporation recently purchased a small, 50-bed rural nursing home. A new director of nursing was brought in to replace the former one, who had retired after 30 years. The new director addressed the staff members at the reception held to welcome him. "My philosophy is that you cannot manage anything that you haven't measured. Everyone tells me that you have all been doing an excellent job here.With my measurement approach, we will be able to analyze everything you do and become more efficient than ever." The nursing staff members soon found out what the new director meant by his measurement approach. Every bath, episode of incontinence care, feeding of a resident, or trip off the unit had to be counted, and the amount of time each activity required had to be recorded. Nurse managers were required to review these data with staff members every week, questioning any time that was not accounted for.Time spent talking with families or consulting with other staff members was considered time wasted unless the staff member could justify the "interruption" in his or her work. No one complained openly about the change, but absenteeism rates increased rapidly. Personal day and vacation time requests soared. Staff members nearing retirement crowded the tiny personnel office, overwhelming the single staff member with their requests to "tell me how soon I can retire with full benefits." The director of nursing found that shortage of staff was becoming a serious problem and that no new applications were coming in, despite the fact that this rural area offered few good job opportunities. 1. What evidence of resistance to change can you find in this case study? 2. What kind of resistance to change did the staff members exhibit? 3. If you were a staff nurse at this facility, how do you think you would have reacted to this change in administration? 4. Why did staff members resist this change? 5. What could the director of nursing do to increase acceptance of this change? What could the nurse managers and staff nurses do? CASE 9 Julio works at a large teaching hospital in a major metropolitan area. This institution services the entire geographical region, including indigent clients, and, because of its reputation, administers care to international clients and individuals who reside in other states. Like all health-care institutions, this one has been attempting to cut costs by using more UAP. Nurses are often floated to other units. Lately, the number of indigent and foreign clients on Julio's unit has increased. The acuity of these clients has been quite high, requiring a great deal of time from the nursing staff. Julio arrived at work at 6:30 a.m., his usual time. He looked at the census board and discovered that the unit was filled, and Bed

Control was calling all night to have clients discharged or transferred to make room for several clients who had been in the emergency department since the previous evening. He also discovered that the other RN assigned to his team called in sick. His team consists of himself, two UAP, and an LPN who is shared by two teams. He has eight clients on his team: two need to be readied for surgery, including preoperative and postoperative teaching, one of whom is a 35-year-old woman scheduled for a modified radical mastectomy for the treatment of breast cancer; three are second-day postoperative clients, two of whom require extensive dressing changes, are receiving IV antibiotics, and need to be ambulated; one postoperative client who is required to remain on total bedrest, has a nasogastric tube to suction as well as a chest tube, is on total parenteral nutrition and lipids, needs a central venous catheter line dressing change, has an IV, is taking multiple IV medications, and has a Foley catheter; one client who is ready for discharge and needs discharge instruction; and one client who needs to be transferred to a subacute unit, and a report must be given to the RN of that unit. Once the latter client is transferred and the other one is discharged, the emergency department will be sending two clients to the unit for admission. 1. How should Julio organize his day? Set up an hourly schedule. 2. What type of client management approach should Julio consider in assigning staff appropriately? 3. If you were Julio, which clients and/or tasks would you assign to your staff? List all of them, and explain your rationale. 4. Using the Delegation Decision-Making Grid, make staff and client assignments. c. Conflict Management

CASE 3 Mr. Evans, 40 years old, was admitted to the medical-surgical unit from the emergency department with a diagnosis of acute abdomen. He had a 20-year history of Crohn's disease and had been on prednisone, 20 mg, every day for the past year. Three months ago he was started on the new biological agent, etanercept, 50 mg, subcutaneously every week. His last dose was 4 days ago. Because he was allowed nothing by mouth (NPO), total parenteral nutrition was started through a triple lumen central venous catheter line, and his steroids were changed to Solu-Medrol, 60 mg, by intravenous (IV) push every 6 hours. He was also receiving several IV antibiotics and medication for pain and nausea. Over the next 3 days, his condition worsened. He was in severe pain and needed more analgesics. One evening at 9 p.m., it was discovered that his central venous catheter line was out. The registered nurse notified the physician, who stated that a surgeon would come in the morning to replace it. The nurse failed to ask the physician what to do about the IV steroids, antibiotics, and fluid replacement; the client was still NPO. She also failed to ask about the etanercept. At 7 a.m., the night nurse noticed that the client had had no urinary output since 11 p.m. the night before. She failed to report this information to the day shift. The client's physician made rounds at 9 a.m. The nurse for Mr. Evans did not discuss the fact that the client had not voided since 11 p.m., did not request orders for alternative delivery of the steroids and antibiotics, and did not ask about administering the etanercept. At 5 p.m. that evening, while Mr. Evans was having a computed tomography scan, his blood pressure dropped to 70 mmHg, and because no one was in the scan room with him, he coded. He was transported to the ICU and intubated. He developed severe sepsis and acute respiratory distress syndrome. 1. List all the problems you can find with the nursing care in this case. 2. What were the nursing responsibilities in reporting information? 3. What do you think was the possible cause of the drop in Mr. Evans' blood pressure and his subsequent code? 4. If you worked in risk management, how would you discuss this situation with the nurse manager and the staff? CASE 4 Andy is assigned to care for a 14-year-old girl, Amanda, admitted with a large tumor located in the left groin area. During an assessment, Amanda shares her personal feelings with Andy. She tells him that she feels "different" from her friends. She is ashamed of her physical development because all her girlfriends have "breasts" and boyfriends. She is very flat-chested and embarrassed. Andy listens attentively to Amanda and helps her focus on some of her positive attributes and talents. A CT scan is ordered and reveals that the tumor extends to what appears to be the ovary. A gynecological surgeon is called in to evaluate the situation. An ultrasonic-guided biopsy is performed. It is discovered that the tumor is an enlarged lymph node and that the "ovary" is actually a testis. Amanda has both male and female gonads. When this information is given to Amanda's parents, they do not want her to know. They feel that she was raised as "their daughter." They ask the surgeon to remove the male gonads and leave only the female gonads. That way, "Amanda will never need to know." The surgeon refuses to do this. Andy believes that the parents should discuss the situation with Amanda as they are denying her choices. The parents are adamant about Amanda not knowing anything. Andy returns to Amanda's room, and Amanda

begins asking all types of questions regarding the tests and the treatments. In answering, Andy hesitates, and Amanda picks up on this, demanding that he tell her the truth. 1. How should Andy respond? 2. What are the ethical principles in conflict? 3. What are the long-term effects of Andy's decision? 2. Universal Principles of management Specialisation/Division Of Labour This principle is the same as Adam Smith's 'division of labour'. Specialisation increases output by making employees more efficient.A principle of work allocation and specialisation in order to concentrate activities to enable specialisation of skills and understandings, more work focus and efficiency. Authority With Corresponding Responsibility Managers must be able to give orders. Authority gives them this right. Note that responsibility arises wherever authority is exercised. If responsibilities are allocated then the post holder needs the requisite authority to carry these out including the right to require others in the area of responsibility to undertake duties. A manager should never be given authority without responsibility-and also should never be given responsibility without the associated authority to get the work done. Discipline The generalisation about discipline is that discipline is essential for the smooth running of a business and without it - standards, consistency of action, adherence to rules and values - no enterprise could prosper.Employees must obey and respect the rules that govern the organisation. Good discipline is the result of effective leadership, a clear understanding between management and workers regarding the organisation's rules, and the judicious use of penalties for infractions of the rules. Unity Of Command The idea is that an employee should receive instructions from one superior only. This generalisation still holds - even where we are involved with team and matrix structures which involve reporting to more than one boss - or being accountable to several clients. The basic concern is that tensions and dilemmas arise where we report to two or more bosses. One boss may want X, the other Y and the subordinate is caught between the devil and the deep blue sea. Unity Of Direction Each group of organisational activities that have the same objective should be directed by one manager using one plan.The unity of command idea of having one head (chief executive) with agreed purposes and objectives and one plan for a group of activities is clear. Subordination Of Individual Interest To The General Interest Fayol's line was that one employee's interests or those of one group should not prevail over the organisation as a whole. This would spark a lively debate about who decides that the interests of the organisation as a whole are. The interests of any one employee or group of employees should not take precedence over the interests of the organisation. Remuneration Of Staff " The Price Of Services Rendered". The general principle is that levels of compensation should be "fair" and as far as possible afford satisfaction both to the staff and the firm (in terms of its cost structures and desire for profitability/surplus). Centralisation Centralisation refers to the degree to which subordinates are involved in decision making. Whether decision making is centralised (to management) or decentralised (to subordinates) is a question of proper proportion. The task is to find the optimum degree of centralisation for each situation. Scalar Chain/Line Of Authority The scalar chain of command of reporting relationships from top executive to the ordinary shop operative or driver needs to be sensible, clear and understood.The line of authority from top management to the lowest ranks represents the scalar chain. Communications should follow this chain. However, if following the chain creates delays, cross-communications can be allowed if agreed to by all parties and superiors are kept informed. Order People and materials should be in the right place at the right time.The level of generalisation becomes difficult with this principle. Basically an organisation "should" provide an orderly place for each individual member - who needs to see how their role fits into the organisation and be confident, able to predict the organisations behaviour towards them. Thus policies, rules, instructions and

actions should be understandable and understood. Orderliness implies steady evolutionary movement rather than wild, anxiety provoking, unpredictable movement. Equity Equity, fairness and a sense of justice "should"pervade the organisation - in principle and practice.Managers should be kind and fair to their subordinates. Stability Of Tenure High employee turnover is inefficient. Management should provide orderly personnel planning and ensure that replacements are available to fill vacancies.Time is needed for the employee to adapt to his/her work and perform it effectively. Stability of tenure promotes loyalty to the organisation, its purposes and values. Initiative Employees who are allowed to originate and carry out plans will exert high levels of effort.At all levels of the organisational structure, zeal, enthusiasm and energy are enabled by people having the scope for personal initiative. Esprit De Corps Here Fayol emphasises the need for building and maintaining of harmony among the work force , team work and sound interpersonal relationships.Promoting team spirit will build harmony and unity within the organisation. 3. Organizational Structure The typically hierarchical arrangement of lines of authority, communications, rights and duties of an organization. Organizational structure determines how the roles, power and responsibilities are assigned, controlled, and coordinated, and how information flows between the different levels of management. Read more: 4. Major functions of Management a. Planning is the process of creating the business vision, mission and objectives and how it will be accomplished. When planning, one has to view the organization such as its mission, goals, and techniques as such what things they want to accomplish at the end. b. Organizing is arranging the internal structure of the organization. This is where you can divide, coordinate and control the task and information within the organization. The managers distribute the authority to do some jobholders. c. Staffing is when you designate the qualified people in the position that you want them to be in the business. First you recruit the people you want to hire for your company. After hiring there goes the training for your employees. Then evaluate them if they can pass or not. The last step would be to compensate the specific task or activities that is included in the function. When it is about the family business, staffing means the unpaid and paid positions held by family members including the owner or operators. d. Leading is when you influence the people's behavior through proper leadership, group dynamics, communication, motivations and discipline. It aims to assign the behaviors of all the personnel to accomplish the mission of the organization and objectives while helping them to accomplish their own career objectives. e. Controlling is the last process of creating performance standards based on the firm's objectives, measuring and reporting actual performance and comparing the two.

5. a.

Types of Leadership Authocratic The autocratic leader makes all the decisions without input from staff. The expectation is that the staff will follow the directive without question. This leader tends to: Think about the work itself rather than the worker Be rigid Believe that there is only one best way to get the job done Be comfortable giving direction for completing tasks and making all decisions on the unit This type of management is best used in an emergency or crisis situation where the leader gives a directive and expects immediate reaction from staff without question. The nurse in this situation must assign tasks to the appropriate staff and continue to make decisions until the matter is resolved. For example, if the fire alarm is activated, this leader will

direct staff to move all residents behind the fire doors, close resident doors, remove all objects from hallway, take a head count, and ensure other staff are safe and have completed their appropriate duties. For non-emergency, everyday decisions, this style may be frustrating to the staff because they have no input in the job they do. When the staff does not feel their contributions are of value, they will be less productive. In addition, this style will usually result in passive resistance from the staff, requiring the leader to provide continual pressure and direction to get the job done. b. Democratic Democratic leaders allow all members of the team to have input in decision making and problem solving. There are two approaches in this style of leadership: formal and informal. The formal approach is based on clearly written goals and identifying the tasks involved to meet these goals. All members of the team are involved in this process and tasks are distributed to all members to achieve the goal. The leaders responsibility is to coordinate the pr ocess, monitor the progress, and evaluate the results, while making necessary changes in the plan as needed. An example of a formal style approach is a resident care plan meeting. One drawback of this method is that it is time consuming. In the informal approach, decisions are made on the spot, but still allow for input of all staff. The leader gathers the staff together to discuss a problem, and they brainstorm to\ agree on the solution. In this approach, since the decision is made on the spot, there may be some staff unavailable for the discussion. Due to the possibility of staff not being present, it is important to have a way to communicate the problem, required tasks, and goals to all team members. The leader still has the responsibility to monitor the progress and evaluate the outcome. Whether using the formal or informal approach, the end results are that a problem is identified and that the tasks are agreed upon from team member input to meet the goal. Laissez-faire Laissez-faire leaders allow workers the opportunity to plan, perform, and\ evaluate their own work in any manner. This approach is based on the theory that a happy worker is more productive. This type of leader will often not assume responsibility, leaving workers without direction, supervision, or coordination of work. This style lets the staff make independent decisions and have autonomy. Even though this style may be relaxed, the leader is still responsible for the activities on the unit. Laissez-faire leadership is best used with motivated and skilled people who have confidence in their abilities and are capable in making decisions. Multicratic Multicratic leaders compromise between autocratic and democratic leadership. This leader has the best attributes of both leadership styles. This style empowers workers and encourages self-confidence. All employees are allowed to share ideas and contribute to reaching the goal. There are no secrets or information kept from the workers with this style. Control and power are spread throughout the group.



6. Theories of Leadership Early Leadership Theories a. Trait Theories If you have ever heard the statement that leaders are born, not made, then you have heard someone expressing the fundamental belief underlying a trait theory of leadership. Trait theories assume that a person must have a certain innate abilities, personality traits, or other characteristics in order to be a leader. If true, it would mean that some people are naturally better than others. b. Great Man Theory According to the Great man theory of leadership tremendous influence of some well known people has actually determined or changed the course of history. Some believe that these people possessed characteristics that made them great leaders. Such important historical figures, such as Caesar, Alexander the great, Hitler, and Gandhi have been studied to find the characteristics that made these men leaders of their time. c. Individual Characteristics- Many studies have focused on ascertaining which individual physical or personality traits are associated with leadership. Despite the fact that no single trait has been discovered in all leaders, some popular beliefs remain and influence selection of individuals' positions, because they seem stronger and more dominating. A tall person can be physically imposing and can literally look down on other people. Behavioral Theories The behavioral theories, sometimes called the functional theories of leadership, still focus on the leader. The primary difference between the trait and behavioral theories is that the behavioral theories are concerned with what a leader does

rather than who the leader is. They are still limited primarily to the leader element in a leadership situation, but they are far more action oriented and do consider the co-actors. Authoritarian-Democratic-and Laissez-Faire styles. The classic research done by Lewin, Lippitt, and White (White, Lippitt, 1960) on the interaction between leaders and group members indicated that the behavior of the leader could substantially influence the climate and outcomes of the group. The leaders behaviors were divided into three distinct patterns called leadership styles: authoritarian, democratic, and laissez-faire. These styles can be thought of as a continuum from a highly controlling and directive type of leadership to a very passive, inactive style. Authoritarian The authoritarian leader maintains strong control over people in the group. This control may be benevolent and considerate (Paternalistic leadership) or it may be dictatorial, with the complete disregard for the needs and feelings of group members. Authoritarian leaders give orders and expect group members to obey these orders. Directions are given as commands, not suggestions. Criticism is more common from the authoritarian leader than from the other types, although not necessarily a constant occurrence. Mostly authoritarian leaders are also quite punitive. The leader alone, not by the group, does decision making. Some will try to make decisions congruent with the group's goals. The less benevolent leaders will make decisions that are directly opposed to the group's needs or goals. The authoritarian leader clearly dominates the group, making the status of the leader separate from, and higher than, the status of group members. This reduces the degree of trust and openness between leader and group members, particularly if the leader tends to be punitive as well. Authoritarian leadership is particularly suitable in an emergency situation when clear directions are the highest priority. It is also appropriate when the entire focus is on getting the job done or in large group when it is difficult to share decision making for some reason. It is often referred to today as a directive or controlling style of leadership. In contrast, democratic leadership is based on the following principles: Every group member should participate in decision-making. Freedom of belief and action is allowed within reasonable bounds that are set by society and by the group. Each individual is responsible for himself or herself and for the welfare of he group. There should be concern and consideration for each group member as a unique individual. Democratic Democratic leadership is much more participative and far less controlling than authoritarian leadership. It is not passive, however. The democratic leader actively stimulates and guides the group toward fulfillment of the principles listed and toward achievement of the group's goals. Rather than issuing commands, democratic leader offer information, ask stimulating questions, and make suggestions to guide the work of the group. They are catalysts rather than controllers, more likely to say "we" rather than" I" and "you" when talking about the group. They set limits, enforce rules, and encourage productivity. Criticism is constructive rather than punitive. Control is shared with group members who are expected to participate to the best of their abilities and experience. The democratic style demands a strong faith in the ability of group members to solve problems and to ultimately make wise choices when setting group goals and deciding how to accomplish these goals. Most studies indicate that democratic leadership is not as efficient as authoritarian leadership. While the work done by a democratic group is more creative and the group is more self-motivated, the democratic style is also more burdensome. First, it takes more time to ensure that everyone in the group has participated in making decision, and this can be very frustrating to people who want to get a job done as fast as possible. Second, disagreements are more likely to arise and must be resolved, which can also require much effort. Democratic leadership is particularly appropriate for groups of people who will work together for an extended time, when interpersonal relationships can substantially affect the work of the group. It is often called supportive or participative leadership today. There are variations in the degree to which decision-making is shared with the group, with styles midway between democratic and autocratic. For example, a leader may encourage in put from group members and consider their views but make the final decision. Laissez Faire The laissez faire leader is generally inactive, passive, and non-directive. The laissez- faire leader leaves virtually all of the control and decision making to the group and provides little or no direction, guidance, or encouragement. Laissez faire leaders offer very little to the group: few commands, questions, suggestions, or criticism. They are very permissive, set almost no limits, and allow almost any behavior.

Some laissez faire leaders are quite supportive of individual group members and will provide information or suggestions when asked. The more extreme laissez faire leader, however, will turn such a request back to the group. When the laissez faire style becomes extreme, no leadership exists at all. In a laissez faire group, members act independently of each other, disinterest will set up, activity becomes chaotic and the frustration level rises. The goals are unclear and procedures are confusing or absent altogether. In most situations, however, laissez faire leadership is unproductive, inefficient, and unsatisfactory. Laissez-faire leadership is often called permissive or non -directive leadership today. Situational Theories a. Contingency Theory (Fred Fiedler) In the contingency model, three situational variables are used to predict the favorability of a situation for the leader: the leader's interpersonal relations with group members, the leaders' legitimate power, and the task structure. Variables affecting Leadership Effectiveness Leader-member relations - the personal relationships between the leader and the members of the group. (The better the relationships, the more favorable the situation). Degree of task structure - how specifically the job can be defined so that everyone knows exactly what to do. (The more structured the task, the more favorable the situation). Position Power - the leaders place within the organization and the amount of authority and power given to the leader. Position power may be strong or weak; it does not reflect the strength of t he individual leaders personality; rather it measures the leaders status in the organization. (The greater the position power, the more favorable the situation). According to the contingency model, a nurse manager should modify situations based on group relations, personal power, and task structure to improve staff productivity. A nurse manager who uses the contingency model must have a thorough understanding of her/his relationship with staff members, her/his power and status within the organization, and the nature of the group task. Path -Goal Theory (Robert House) Robert House's Path Theory, introduced in 1971, is concerned with motivation and productivity. According to this theory, the motivational function of management is to help employees see the relationship between personal and organizational goals, clarify the "paths" to accomplishing these goals, remove obstacles to goal achievement, and reward employees for the work accomplished. Contemporary Leader-Manager Theories Theories X and Y (Douglas McGregor) In his 1960 book, the Human side of Enterprise, McGregor (1960) compared two different sets of beliefs about human nature, describing how these led to two very different approaches to leadership and management. The first, more conventional approach, he called Theory X, and the second, more humanistic, approach was termed as Theory Y. Theory X is based on a common view of human nature: the ordinary Person is lazy, unmotivated, irresponsible, and not too intelligent and prefers to be directed rather than act independently. Most people do not really like to work and do not care about such things as meeting the organization's goals. They will work only as hard as they must to keep their jobs, and they avoid taking on additional responsibility. Without specific rules and the threat of punishment, most workers would come in late and produce careless work. Based on this view of people, leaders must direct and control people in order to ensure that the work is done properly. Detailed rules and regulations need to be developed and strictly enforced. People need to be told exactly what to do, and how to do it. Close observations is necessary to catch mistakes, to make sure people keep working, and to be sure that rules, such as taking only 30 minutes for lunch, are obeyed. Motivation is supplied by a system of rewards and punishments. Those who do not obey the rules are reprimanded, fined or fired. Those who do obey the rules are rewarded with continued employment, time off and pay rises. According to theory Y, the behavior described in theory X is not inherent in human nature but a result of management emphasis on control, direction, reward, and punishment. The passivity, lack of motivation, and avoidance of responsibility



are symptoms of poor leadership and indicate that people's needs for belonging, recognition, and self-actualization have not been met. Theory Y proposes that the work itself can be motivating and rewarding. People can become enthusiastic about their work and will support the team or organization's goals when these goals also meet their need. They can be trusted to put forth adequate effort and to complete their work without constant supervision if they are committed to these goals. Under the right conditions, the ordinary person can be imaginative, creative, and productive. Theory Y leaders need to remove obstacles, provide guidance and encourage growth. The extensive external controls of theory X are not necessary because people can exert self-control and self-direction under theory Y leadership. d. Theory Z (Ouchi) /participative approach to management Ouchi (1981) expanded and enlarged on theory Y and the democratic approach to leadership to create what he calls theory Z. Like theory Y, Theory Z has a humanistic viewpoint and focuses on developing better ways to motivate people, assuming that this will lead to increased satisfaction and productivity. Theory Z was developed in part from a study of successful Japanese organizations. It was adapted to the American culture, which is different in some ways but similar in its productivity goals and advanced technology. Elements of theory Z include collective decision-making, long-term employment, slower but more predictable promotions, indirect supervision, and a holistic concern for employees.

7. Types of budget Types of budget: There are three types of expenditures that the unit manager is directly involved in, those are personnel, operating, and capital budgets. 1. Personnel budget: The largest portion of the budget expenditures is personnel budget; because healthcare is labor intensive (not machines intensive). The personnel budget includes actual worked time (Productive time), and time the organization pays the employee for not-working time (Non-productive time). Non-productive time includes the cost of benefits, new employee orientation, employee turnover, sick and holiday time, and education time. 2. Operating budget: It includes such daily expenses as the cost of electricity, repairs and maintenance, and medical/surgical supplies (as syringes, cathetersetc). 3. Capital budget: Capital budgets plan for the purchase of buildings or major equipment (of long-life equal or greater than 5 to 7 years) which is not used in daily operations, and is more expensive than operating supplies. Examples of capital budget include: renovation of a major wing in the hospital, purchasing equipment as call-light system, hospital bedsetc.


Modalities of nursing care This refers to the manner in which nursing care is organized and provided. It depends on the philosophy of the organization, nurse staffing and client population.( Functional Nursing It is a system of care that concentrates on duties. It can be seen as an assembly line of care. The RN coordinates care for an entire unit or team. Other nurses are assigned to pass medications and perform treatments. Personnel with less training are assigned to provide more basic care such as bed bath and bed making. It began during the World War II when the demand for client care outstripped the supply of nurses. (Black and Hawks, 2008) Primary Nursing It is a model of care delivery that emerged during the 1980s to meet the increasing complex needs of clients. The goal is for each clients care to be comprehensive and coordinated, from the admission to discharge. Each client is assigned to a primary nurse, who is a RN, and that the nurse provides care for that client when he or she is working. Advantages are: the client has the same nurse, the clients psychosocial needs can be met, communication with the physician has improved and the nurse feels autonomous. (Black and Hawks, 2008) Team Nursing

In team nursing, the RN works with one or more health care personnel to provide care for four or more clients. Advantages are that an RN is usually head of the team and generally knows the clients. In addition, the team leader can provide guidance to new or inexperienced nurses and other staff. (Black and Hawks, 2008) Case management It is a care delivery model that incorporates concepts of continuity and efficiency in addressing both long and short-term physical needs, psychological and social needs of clients. The primary goals are promoting self-care, upgrading the quality of life and using resources efficiently. Case managers are nurses who coordinate care of a group of clients, monitor the implementation of interdisciplinary care plans, and maintain communication with third party payers and referral sources. The nurse follows the client through the entire stay in the health care system and back into the community. (Black and Hawks, 2008) Case method It is the oldest patient care delivery method. In this method one professional nurse assumes total responsibility of providing complete care for one or more patients (1-6) while she is on duty. This method is used frequently in intensive care units and in teaching nursing students. ( ) Total Patient care Is the oldest of the care delivery system. One nurse is assigned to one client and provides all care. The one-to-one pattern is common in critical care, with student nurses, and with private duty nurses. The advantage is that the client needs to work with only one nurse and that one nurse can focus on meeting all the biopsychosocial1 needs of the client and the family. (Black and Hawks, 2001)