Organizing

 Set up organizational structure, identify groupings, roles,

relationships.
 Consist of the structure and process which allows the agency to enacts
its philosophy and utilize its conceptual framework to achieve each goal
 It refers to the body of person, methods, policies and procedures
arrange in a systematic process through the delegation of functions and
responsibilities for the accomplishment of purpose.
 Is the process of establishing formal authority
 Develop job description, define qualification and function of personnel.
 Determine staff needed, develop and maintain staffing patterns and
distribution in areas needed
 Determine what task are to be done, who is to do these, how the tasks
are to be grouped, who reports to whom and what decisions are to be
made.
 It is a form of identifying roles and relationships of each staff on order
to delineate specific tasks or functions that will carry out organizational
plan s and objectives.
 Process of identifying and grouping the work to be performed, defining
and delegating responsibility and authority and establishing
relationships for the purpose of enabling the people to work more
effectively together in accomplishing objectives.
 As a process, it refers to the building of a structure that will provide for
the separation of activities to be performed and for the arrangement of
these activities in a framework which indicates their hierarchal
importance and functional association.

Elements of Organizing
1. Setting up the organizational chart
2. Staffing
 3. Scheduling
4. Developing job descriptions

Organizing Process Includes

1. Identifying and defining basic tasks.
2. Delegation of authority and assigning responsibility
3. Establishing relationships

Organizing principles:
A. Unity of command – employees should be responsible to only one superior, to
avoid confusion, overlapping of duties and responsibilities and misunderstanding.

B. Scalar principle – [ “chain of command”] authority and responsibility should

flow in clear unbroken lines from the highest executive to the lowest, usually a
military term.

Proper definition and delegation of authority and responsibility facilitates the

accomplishment of work. So, the following must be observed:

 When responsibility for a particular job is delegated to a

subordinate, the latter should have authority over resources needed to
accomplish the task.
 When a particular function is delegated to a subordinate, the superior’s
own responsibility is in no way diminish general authority over the
lower position in the hierarchy in the accomplishment of the main
operation of the organization. Example: Unit head has direct
responsibility for the work of the unit.
 When the person is bestowed the authority for action to the person
that bestowed him such. The conscientious nurse exhibits
accountability towards her employing hospital, the patient, the
government, her profession and to God.

C. Homogeneous assignment or Departmentation – workers performing similar

assignment are group together for a common purpose . Departmentation
promotes specialization of activities, simplifies the administrators work, and helps
maintain effective control.

D. Span of Control—the number of workers that a supervisor can effectively

manage should be limited, depending upon the pace and pattern of working area.

E. Exception Principle –recurring decisions should be handled in a routine manner

by lower level managers whereas problems involving unusual matters should be
referred to the higher level.

F. Decentralization or Proper Delegation of Authority – decentralization is the

process of pushing decisions to the lower levels of the organization.

Setting up the Organizational Structure

 The organizational structure refers to the process by which a group is
formed, it channels authority, span of control and lines of
communication.
 Departmentation and division of work provide orderliness in an
administration. Through a breakdown of activities each individual
becomes responsible for a specified set of activities.
 Successful setting up of organization structure enables the organization
to achieve each purpose:

1. It informs members of their responsibilities so that they may carry

them out
2. It allows the manager and individual workers to concentrate on
his/her specific role and responsibilities
3. It coordinates all organizational activities so there is minimal
duplication of effort or conflict.
4. It reduces the chances of doubt and confusion concerning
assignment

Forms of Authority
1. Line authority – is the simplest and most direct type of organization in
which each position has general authority over the lower position in the
hierarchy.
 > is a direct supervisory authority from supervisor to subordinates. (Ex.
Clinical and administration)

o Chain of Command – unbroken line of reporting relationships

that extends through the entire organization. The line defines
the chain of command and the formal decision-making structure.

o Unity of Command – within the chain states that, each person in

the organization should take orders and reports only to one
person.

o Span of Control – refers to the number of employees that

should be placed under the direction of one leader-manager.
2. Staff Authority – authority that is based on the expertise and which
usually involves advising the line managers.

 Is purely advisory to the line structure with no authority to put

recommendations. (Ex. Training and Research)

3. Team Authority – is granted to committees or work teams involved in an

organization’s daily operations. Work teams are group of operating
employees who shared a common vision, goals and objectives.
4. Informal Organization – refers to horizontal relationships rather than
vertical. This is composed of small groups of workers with similar
interests.
5. Functional organization – is one where each unit is responsible for a
given part of the organization’s workload. There is clear delineation
of roles and responsibilities which are actually interrelated .

Organizational Chart
o Drawing that shows how the parts of the organizations are link.

o It depicts the formal organizational relationship, areas of responsibility

and accountability and channel of communication.
o Depicts an organization’s structure.

Characteristic of an Organizational Chart:

 1. Division of Work – each box represents the individual or sub-unit responsible for
a given task of the organization workload
2. Chain of Command – line indicates who reports to whom and by what authority.
3. Type of work to be performed – indicated by levels of description for the
boxes
4. Grouping for work segments – shown by the cluster of work groups
[department or single unit]
5. Levels of management – indicates individual and entire management hierarchy

Hierarchy – refers to a body of persons or things organized or classified in pyramidal fashion

according to rank, capacity or authority assigned to vertical levels with offices ranked in grades,
orders or classes, one above the other.

Authority – is the right to act. In legal sense, authority flows down in an

organization

 make decisions without approval of higher administrator.

 Example: Board of Trustees >>>> Hospital Administrator >>>> Various
Direction of the Hospital

Accountability –means taking full responsibility for the quality of work and

and behavior while engage in the practice of profession.

Power – ability to influence another to behave in accordance of one’s wishes,

capacity to act.

Communication – transfer of information between persons

Status – rank a group bestows on a person

Organizational Structure
o Depicts and identifies role and expectations, arrangement of positions
and working relationships.

1. Dotted or Unbroken line – represents staff positions/staff authority

(advisor to the line managers).
 2. Centrality – refers to the location of a position on an organizational chart
where frequent and various types of communication occur. Determined
by organizational distance; those with small organizational distance
receive more information than those who are more peripherally located.

3. Solid Horizontal Line – represent same positions but different functions.

4. Solid Vertical Line – chain of command form authority to subordinates

(line authority)

Managerial Levels

Level Scope of Responsibility Examples

1. Generally make
decisions with the
help of ►few
guidelines or  CEO, President, V-
 Top Level Managers structure. President, Chief Nursing
2. Coordinates Officer
internal and
external
influences
1. They conduct day-
day operations
 Head Nurse, Department
Middle Level with some
Head, Unit
Managers involvement, long
Supervisor/Manager
term planning and
policy making.
1. Concerned with
specific unit
workflows.  Charge Nurse, Team
First Level Managers Leader, Primary Nurse,
2. Deals with Staff Nurse
immediate day-
day problems.

Patterns of Organizational Structure

1. Tall/Centralized Structure
  Responsible for only few subordinates so there is narrow span of control
 Because of the vertical in nature, there are many levels of communication
 Communication is difficult and messages do not get to the top.
 Workers are boss-oriented because of close contact with their supervisor.

3. Flat/Decentralized Structure
 Characterized by few levels and a broad span of control
 Communication is easy and direct

Advantages:

1. Shortens the administrative distance from the top to the lower

2. Solutions to problems are easily carried out/fast response
3. Workers developed their abilities and autonomy
Disadvantage:

 Impractical in large organization.

Types of Organizational Structure

1. Line Organization/Bureaucratic/Pyramidal
 There is clearly defined superior-subordinate relationship
and power are concentrated at the top
1. Flat/Horizontal Organization
 Decentralized type
 Applicable in small organization
 Nurses become productive and directly involved in the decision-making
skills
 Workers become satisfied
2. Functional Organization
 Each unit is responsible for a given part of the organizational workload
 Permits a specialist to aid line position within a limited and clearly
defined scope of authority
4. Ad Hoc Organization
 Basis to facilitate completion
 Modification of bureaucratic structure
5. Matrix structure
 Focus on both product and functions
 Most complex
  Has both vertical and horizontal chain of command and line of
communication

Staffing
o Process of assigning competent people to fulfill the roles designated for
the organizational structure through recruitment, selection and
development, induction and orientation of the new staff of the goals,
vision, mission, philosophy etc.
o Process of determining and providing each nursing unit with an
appropriate and acceptable number of workers in each category to
perform the nursing task required.

Staffing Process

1. Preparing to Recruit – types and number of personnel

2. Attracting a Staff – formal advertisement
3. Recruiting and Selecting a Staff – interview ►induction ►orientation ►job
order ►pre-employment testing ►signing of contract

Staffing Pattern – plan that articulates how many and what kind of staff are
needed/shift or per day in ►unit or in department

Factors Affecting Staffing:

1. Type, philosophy and objectives of the hospital and the nursing service
2. Population served or the kind of patient served whether pay or service
3. The number of patient and severity of their illness – knowledge and
availability of nursing personnel are matched with the actual care needs for
patient
 4. Availability and characteristic of the nursing staff, including education, level
of preparation, mix of personnel, number and position.
5. Administrative policies such as rotations, weekends and holiday off duties
6. Standards of care desired which should be available and clearly spelled out.
Example: may utilized ANSAP Standards of Nursing Practice.
7. Lay out of various nursing units and resources available within the
department such as adequate equipment supplies and materials
8. Budget including the amount of allotted amount of salaries, fringe benefits,
supplies, materials and equipment.
9. Professional activities and priorities in non-patient activities like involvement
in professional organization, formal educational development, participation
in research and staff development
10.Expected hours of work per annum of each employee, influence by 40
hours / week law.
11.Patterns of work schedule – traditional 5 days per week, 8 hours per day,

Two Ways of Developing a Staffing Pattern

1. Determine the # of nursing care hours needed/patient

o Generating the full-time equivalents of an employee
2. Determine the nurse-patient ratio in providing nursing care

 FTE – measure of work committed of full-time employee

o 1.0 FTE = works 5 days/week, 8 hours/day
o 0.5 FTE = part time employee who works 5 days/2 weeks

Considerations in Staffing Pattern

1. Benchmarking

 Management tool for seeking out the best practice in one’s industry so as
to improve one’s performance.
 Process of measuring products, practices and services against best
performing organization as a tool for identifying desired standards of
organizational performance.
2.Regulatory Requirements – mandated by RA
3. Skill Mix – percent or ratio of professionals to non-professional
Ex: 40 FTE (20 RN + 20 non RN) = 50% RN mix
4. Staff Support – staff support in place for the operations of the units or
department.
5. Historical Information – review of any data on quality or staff perception
regarding the effectiveness of the previous staffing pattern

Patient Classification System

 Is a method of grouping patients according to the amount and

complexity of their nursing care requirements and the nursing time and
skill they require.
 To develop a workable patient classification system the nurse manager
must determine the following:
1. The number of categories into which the patient should be divided.
2. The characteristic of patient in each category
3. The type and number of care procedure that will be needed by a
typical patient in each category
4. The time needed to perform these procedures that will be required by
a typical patient in each category

Patient Care is Classified According to:

1. Self care or minimal care patients are capable of carrying ADL, e.g.,
hygiene, meals etc. Falling under this category are about to be discharge,
those in non-emergency, do not exhibit unusual symptomsand requires
little treatment observation and instruction.
2. Intermediate or moderate care requires some help from the nursing staff
with special treatments or certain aspects of personal care, e.g., patients
with IV fluids, catheter, respirator, etc.
3. Total care patients are those who are bedridden and who lack strength
and mobility to do average daily living. Ex: patients on CBR, immediate
post-op, with contraptions.
 4. Intensive care patients are those who are critically ill and in constant
danger of death or serious injury. Ex: comatose, bedridden etc.

Modalities of Care
1. Total Patient Care/ Case Method = the nurse is responsible for the total
care of their patient during her tour of duty.
 The oldest mode of organizing patient care
 Is referred as the case method
 This methods provide nurses with high autonomy and responsibility
 Still widely used in the hospital and home health agencies.
 The patient receives holistic and unfragmented care during nurse’s time
duty.
 Requires highly skilled personnel
 Cost more than some other forms of patient care
 Disadvantage: when the nurse is inadequately trained or prepared to
provide total care to the patient and very costly.
 Relationship based on trust is developed between the RN’s and the
patient’ family
2. Functional Nursing = task oriented method wherein a particular nursing
function is assigned to each staff member. The medication nurse, treatment
nurse and bedside nurse are all products of this system. For efficiency,
nursing was essentially divided into tasks, a model that proved very
beneficial when staffing was poor. The key idea was for nurses to be
assigned to task, not into patients.

Advantage:

 A very efficient way to delivery care

 Could accomplish a lot of tasks in a small amount of time
 Staff members do only what they are capable of doing
 Least costly as fewer nurses are required
 Most economical means of providing care

Disadvantages:

 Care of patients become fragmented and depersonalized for the

possibility of overlooking priority patient needs , workers feel
unchallenged and underestimated in their roles.
  Patients do not have one identifiable nurse
 Very narrow scope of practice
 Leads to patient nurse dissatisfaction/ low job satisfaction
 Focus only on their own efforts, with less interest in overall results.

3. Team Nursing =most commonly used model and is still in used today. It was
developed in the 1950”s in order to ameliorate the fragmentation that was
inherent in the functional model. The goal of team nursing is for a team to
work democratically. In the ideal team, an RN is assigned as a team leader for
a group of patients. The team leaders has a core of staff reporting to her,
and together they work to disseminate their activities. The team member
possessing the skill needed by the individual patients assigned to their
patient, but the team leader has accountability for all of the care. Team
conferences occur in which the expertise of every staff member is used to
plan the care
Advantages:
 Each member’s capabilities are maximized to job satisfaction should be
high
 Patients have one nurse(the team leader) with immediate access to other
health providers

Disadvantages:

 Requires a team spirit and commitment to succeed, RN may be the team

leader one day and a team member the next, thus continuity of care may
suffer.
 Care is still fragmented with only 8 or 12 hours accountability.

4. Primary Nursing =the hallmark of this modality is that one nurse cares for
one group of patients within 24 hour accountability for planning their care. In
other
words, the primary nurse cares for her primary patients every time she
works and for as long as the patient remains on her unit. This is
decentralized delivery model: more responsibility and authority is placed
with each staff nurse.
Advantages:
 Increased satisfaction for patients and nurse
 More professional system: RN plans and communicates with all health
care members. RN are seen as more knowledgeable and responsible
  RN’s are more satisfied because they continue to learn as part on the in-
depth care they are required to deliver to their patient.

Disadvantage:

 Only confines a nurse’s talents to a limited number of patient’s, so other

patients cannot benefit if the RN is competitive
 Can be intimidating for RN;s who are less skilled and knowledgeable

5. 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)
 It is a collaborative process that assess, plans, implements, coordinates,
monitors, and evaluates options and services to meet an individual
health care needs through communication and available resources to
promote quality, cost-effective outcomes.
 Is also a client- centered model of care that uses critical pathways and
multidisciplinary action plan to help plan patient care.

Scheduling
 Timetable showing planned work days and shifts for nursing personnel.
 Objective in scheduling is to assigned working days and days off to the
nursing personnel so that adequate patient care is assured
 Is a desirable distribution of the nursing team will feel that they are
treated fairly.
 They will also know their schedule in advance

Issues to consider in scheduling staff:

1. Patient type and acuity

2. Number of patients
3. Experience of Staff
4. Support available to the staff

Factors considered in making schedule

1. The different levels of the nursing staff

2. Adequate coverage for 24 hours, seven days a week
3. Staggered vacation leaves and holidays
4. Weekends
5. Longest stretches of consecutive working days
6. Evening and night shifts
7. Floating

Assessing a schedule system

1. Ability to cover the needs of the unit = a minimum required number of

staff must meet the nursing needs of the patient in the units at all shift
2. Quality to enhance the nursing personnel’s knowledge, training and
experience – while permanent assignment to one unit enhances skills in
caring for a particular kind of patient (medical, surgical,pedia,ob-gyne)
many nurses who have future plans of giving into teaching or
specialization or even working abroad, would prefer to experience being
assigned to various units before settling down to a particular unit of their
choice.
3. Fairness to the staff = all nursing personnel should get a fair share of
weekends, holiday off, rotation patterns for the whole year including
assignment to difficult or light or undesirable units or shifts.
4. Stability =nursing personnel would like to know in advance of their
schedule of assignment so that their personal schedule are in harmony
with each other
5. Flexibility = means the ability to handle changes brought about by
emergency leaves, scheduled or unscheduled leave of absences(sick
leaves, death of members)

Types of Scheduling
1. Centralized schedule = one person, usually the chief nurse or her
designate assigns the nursing personnel to various units of the hospital.
This includes the shift and off duties.
2. Decentralize schedule = the shift and off duties are arrange by the
supervising nurse or head/ senior nurse of the unit.
3. Cyclical schedule = covers a designated number of weeks called the cycle
length and is repeated thereon. It assigns the required number of nursing
personnel to each nursing units patient care requirements, the staff
preference, their educational training and experience.

Advantage of cyclical scheduling:

1. It is fair to all, favouritism is minimize as all nursing personnel gets their

fair share of rotation to various shift.
2. It saves time as the schedule does not have to be redone every week or
two
3. It enables the employees to plan ahead for their personal needs
preventing frequent changes in schedules
4. Schedule leave coverage such as vacation, holidays and sick leave are
more stable
5. Productivity is improve

Rotating Work Shift

Schedule Variables:

1. Length of scheduling period( 2 or 4 weeks)

2. Shift rotation
3. Weekends off
4. Holidays off
5. Vacation leaves
6. Special days (birthdays, wedding, etc...)
7. Schedule events in hospital training, programs or meetings.
8. Job categories
9. Continuing professional education program, seminars

Shifting Variations
  Traditional Shifting Patterns
o 3 shift (8 hr shift)

o 12 hr shift
o 10 hr shift
 Weekend option
 Rotating work shift
 Self-scheduling – staff makes their own schedule
 Permanent work shift
 Floaters – “on-call”

Forty Hour Week Law – based on RA5901

 No work, no pay
 Entitled to 2-week sick leave and off duty for 2 days
 Special Holidays – with pay

Directing
 Act of issuing of orders, assignments, instructions, to accomplish
organizational goals and objectives.
 Delegation – entails responsibility
 Assignments – no responsibility

Elements of Directing

1. Communication
2. Delegation
3. Motivation
 4. Coordination
5. Evaluation

Communication – exchange of ideas, thoughts or information through verbal

speech, writing and signals

Barriers in Communication
1. Physical Barrier

 Environmental factors that prevent or reduce the opportunities for

communication. Ex: Distance and Noise
2. Social and Psychological Barrier

 Blocks or inhibitors of communication that rise from the judgment, emotions,

social values of people: Example: stress, trust, fear, defensiveness

 Internal climate (values, feelings, temperament and stress levels) and external
climate (weather, timing, temperature, lack of validation to the message).
3. Semantics

. Words, figures, symbols, penmanship and interpretation of the message

through signs and symbols.

4. Interpretations

 Defects in communication skills by verbalizing, listening, writing, reading and

telephony

 Blocks or inhibitors of communication that rise from the judgment, emotions,

social values of people. Ex : stress, trust, fear, defensiveness

 Internal climate (values, feelings, temperament and stress levels) and external
climate (weather, timing, temperature, lack of validation to the message).
Delegation
 Act of assigning to someone else a portion of the work to be done with
corresponding authority, responsibility and accountability (ARA).
 According to ANA, it is the transfer of responsibilities for the performance
of the task from one person to another
 Much of the work of manager is accomplished by transferring the
responsibilities to subordinates

Good Reasons for Delegation

1. Manager delegate routine task so that they are free to handle problems
that are more complex or require higher level of expertise
2. Delegate routine task if someone else is better prepared or has greater
expertise or knowledge in solving the problems

Managers who do not delegate

 Does not trust
 Fear of mistake
 Fear of criticism
 Fear of own ability to delegate

Common Errors in Delegation

  Underdelegating – systems from the manager’s false assumptions that

delegation maybe interpreted as a lack of ability on his part to do the job
correctly and competently. Reasons are:

o Managers believe that they can do the work faster and better

o Managers believe that the responsibility may be rejected if delegated

 Overdelegating – subordinates become overburdened which may lead to
dissatisfaction and low productivity. Reasons are:
 o Managers who are lazy

o Manager who are overburdened and exhausted

 Improper Delegation – delegating at the wrong person, time, tasks and beyond
the capability of the subordinates.

Steps in Effective Delegating

1. Plan ahead
2. Identify necessary skills and levels

3. Select most capable personnel

4. Communicate goal clearly

5. Empower the delegate

6. Set deadlines and monitor progress

7. Model the role and provide guidance

8. Evaluate performance

Motivation – whatever influences our choices and creates direction, intensity,

and persistence in our behavior.

Supervision – guiding and directing the work to be done. It entails motivating

and encouraging the staff to participate in the activities to meet the goals and
objectives for personal development in making the work better.

Coordination – arranging in proper order. It creates harmony in all activities

to facilitate success of work

Conflict Management

 Conflict – internal and external discord that results in from differences in ideas,
values or feelings between 2 or more people. It arises because of differences in
economic and professional values.

Two Main Types

1. Competitive Conflict – 2 or more group the same goal and only one group can
attain them
 o Management: Set Goals
2. Disruptive Conflict – takes place in environment filled with anger, fear and
stress. There is no mutually acceptable set of rules and the goal of each party is
the elimination of each opponent.

Conflict Resolution Strategies

1. Use of dominance and Suppression

o Win lose strategy

o Loses feels angry

2. Restriction – autocratic coercive style that uses indirect and obstructive
expression of conflict.

3. Smoothing Behavior – persuades the opponent in a diplomatic way

4. Avoidance Behavior – 2 parties are aware of the conflict but choose not to
acknowledge or attempt to resolve it.

5. Majority rule – unanimous decision

6. Compromising – consensus strategy where each side agrees solutions

7. Interactive Problem Solving – constructive process in which the parties involve

recognized that conflict, assist and openly try to solve the problems

8. Win-Win Strategy – focuses on goals and attempts to meet the needs of both
parties.

9. Lose-Lose Strategy – neither side wins

10. Confrontation – most effective means of resolving the conflict. Resolves through
knowledge and reason brought out in an open.

11. Negotiation – “give and take