Leadership and Management

1. Demonstration of Leadership and Management Skills to provide Safe and Quality Nursing Care

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
 Primary Nursing
 Team Nursing
 Case Management
 Case Method
 Total Patient Care

2. Utilization of Health Resources

Health Economics - Health economists apply the theories of production, efficiency, disparities,
competition, and regulation to better inform the public and private sector on the most
efficient, or cost-effective, and equitable course of action.

3. Establishing Healthy Working Environment for Health Workers

• Collaboration - Collaboration is a working practice whereby individuals work together to a

common purpose to achieve business benefit

 Awareness - We become part of a working entity with a shared purpose

 Motivation - We drive to gain consensus in problem solving or development
 Self-synchronization - We decide as individuals when things need to happen
 Participation - We participate in collaboration and we expect others to participate
 Mediation - We negotiate and we collaborate together and find a middle point
 Reciprocity - We share and we expect sharing in return through reciprocity
 Reflection - We think and we consider alternatives
 Engagement - We proactively engage rather than wait and see

• Teamwork - It is the process of working collaboratively with a group of people in order to

achieve a goal.

4. Creating a Safe Environment of Care

CQI
 I. Head Nurse/ Senior Nurse/Nurse II:
 A professional nurse who assumes responsibility for managing the human and material
resources of a nursing unit to provide quality patient care and an environment conducive
to staff growth and satisfaction.

Functions/Roles:
A. Patient Care management- assumes responsibility for the delivery of quality patient care
for the nursing unit.
B. Management of nursing personnel- provides leadership and direction to nursing
personnel in accordance with organizational and departmental goals and objectives.
C. Management of patient Care units- maintains an environment that encourages quality
patient care and staff satisfaction.
D. Educational responsibilities- assist in staff development activities in the unit.
- Assists clinical instructors of affiliating colleges of nursing in planning,
implementing and evaluating the learning experience of the students.
- Assumes responsibility for own learning and developmental needs.
E. Acts as Supervision nurse in the absence of one and when so delegated.
F. Staffing- the process of determining and providing the acceptable number and mix of
nursing personnel to produce a desired level of care to meet the patient’s demand.

II. JOB DESCRIPTION- is a statement that sets the duties and responsibilities of a
specific job.
- are specifications of duties, conditions and requirements of a particular job
prepared through a careful job analysis. This is also known as performance
descriptions.
- Include the needed characteristics or qualifications of the individual to
perform such duties successfully.

Purposes:
- Recruitment, selection, of qualified personnel
- To orient new employees to their jobs
- Guidance and direction
- Evaluation of performance
- Job placement, transfer or dismissal
- Reduction of conflict and frustration,
- Avoidance of overlapping of duties
- Facilitating working relationships with outside bodies such as professional
associations
- Basis for staffing
- Identify training needs
- Budgeting purposes- Serving as basis for the employees’ salary range.
- Serve as channel of communication.

Contents of Job Description:

1. Identifying data- position title, department
 2. Job summary- essential features of the job that distinguish it from the others
3. Qualification requirements- educational preparation, training and experience necessary
to fill the position
4. Job relationships- source of workers
5. Specific and actual function and activities.

III. PATIENT CARE CLASSIFICATION SYSTEM:

- Method of grouping patients according to the amount and complexity of their
nursing care requirements and the nursing time and skill they require.
- Serve in determining the amount of nursing care required, generally within
24hours and the category of nursing personnel who will provide the care.
 The nurse manager or head nurse must determine the following;
1. The number of categories into which the patients should be divided
2. Characteristics of patients in each category
3. Type and number of care procedures that will be needed by a typical patient in each
category and
4. The time needed to perform the procedures that will be required by a typical patient
in each category.

Classification categories:
- Way of classifying patient care according to the acuity of their patient’s
illnesses.
 Level I – Self Care or Minimal care- patient can take a bath on his own, feed and
perform his activities of daily living. Average amount of nursing care hours
(NCH) per patient per day is 1.5. ratio of professional to non-professional
nursing personnel is 55:45.
 Level II- moderate Care or Intermediate Care- assistive in bathing, feeding or ambulating
for short periods of time.
- Have slight emotional needs, IV fluids, blood transfusion; semi-conscious and
exhibiting some psychosocial or social problems, periodic treatment.
- Average NCH per day is 3 and the ratio of professional to non-professional
personnel is 60:40.
 Level III- Total, Complete or Intensive care- completely dependent upon the nursing
personnel.
- Provide complete bath, are feed, on continuous oxygen therapy, with chest or
abdominal tubes, unconscious, marked emotional needs.
- Require close observation at least 30minutes for impending hemorrhage,
HPN or cardiac arrhythmias.
- NCHs per patient per day is 6 with a professional to non-professional ratio of
65:35.
 Level IV- Highly specialized Critical Care- need maximum nursing care with a ratio of 80
professionals to 20 non-professionals.
- Continuous treatment and observation, IV piggy backs, V/S every 15-
30minutes, hourly output.
 - NCHs per patient per day may range from 6-9 or more and the ratio of
professional to non-professionals range from 70:30 to 80:20.

Levels of Care NCH Needed Per Ratio of Prof. to

patient per Day Non-Prof
Level I – Self Care or Minimal care 1.50 55:45
Level II- moderate Care or 3.0 60:40
Intermediate Care
Level III- Total, Complete or Intensive 4.5 65:35
care
Level IV- 6.0 70:30
Highly specialized or Critical Care 7 or higher 80:20

IV. TO DETERMINE STAFFING PATTERNS:

1. Full Time equivalent (FTE)- uses nursing care hours and annual hours of work
provided by one full-time equivalent.
- Measures of the work commitment of a full time employee works 5days a
week or 40hours/week for 52 weeks a year. This amounts to 2,080hours of
work time.
- Total Nursing care hours x days in a year
Total annual hours per one FTE

2. Forty-hour Week Law- based on the National league of Nurses (NLN) or R.A. 5901
otherwise known as the Forty-hour Week Law.
- ABO x NCH = Total number of personnel in 24hours
No. of Working hours

Where: ABO- Average Bed Capacity; NCH- Nursing Care Hours

a. Standard Value for NCH:

Area NCH Area NCH

Surgery 3.4 Nursery 2.8
General Ward 3.5 Medical 3.4
Pediatrics 4.6 OB 3.0
Mixed M/S 3.4

b. Percentage (%) of professional and Non-Professional (in ratio)

Area Ratio Area Ratio

Surgery 60:40 Pediatrics 70:30
General Ward 60:40 Nursery 55: 45
OB 60:40 ICU 80:20

c. Distribution per shift:

 Morning or day shift = 45- 51%
Afternoon shift = 34-37%
Night Shift = 15- 18%

R.A. 5901 Forty Hour Week

Rights/Privileges given to each personnel Working hours per week
40hours 48hours
Vacation Leave 15 15
Sick Leave 15 15
Holidays (Legal & Special 12 12
Continuing Education program 3 3
Off duties R.A 5901 104 52
Total non-working days/year 149 97
Total Working Days 216 268
Total working hours/year 1,728 2,144

d. 40hour/week – for personnel working in hospitals with 100 bed capacity or over or
which are located in a 1million population.
e. 48hour/week – for personnel who work in agencies with lesser bed capacity or
which are located in communities with less than 1million population

V. GUIDELINES FOR DETERMINING THE NURSING PERSONNEL NEEDED; (Tan

and Venzon, 2009)
1. Determine type of hospital whether it is primary, secondary, tertiary or special tertiary
hospital.
Illustration:
 Hospital A is a 250 bed capacity tertiary level hospital. Find the number of
nursing personnel needed for 250patients in a tertiary hospital.

2. Categorize patients according to levels of care

Percentage of patients in Various levels of Care

Type of Hospital Minimal Moderate Intensive Highly Spl.
Care care Care Care
Primary hospital 70 25 5 -
Secondary hospital 65 30 5 -
Tertiary hospital 30 45 15 10
Special tertiary 10 25 45 20
hospital

250 x .30 = 75 patients needing minimal care

250 x .45 = 112.5 patients needing moderate care
250 x .15 = 37.5patients needing special care
250 x .10 = 25 patients need highly specialized nursing care
 Total: 250 patients

3. Find the number of nursing care hours (NCH) needed by patients at each level of care per
day.
75 patients x 1.5 (NCH needed at Level 1) = 112.5 NCH/day
112.5 patients x 3 (NCH needed at Level II) = 337.5 NCH/day
37.5 patients x 4.5 (NCH needed at Level III) = 168.75 NCH/day
25 patients x 6 (NCH needed at level IV) = 150 NCH/day
Total. = 768.75 NCH/day

4. Find the total NCH needed by 250patients per year (365days)

768.75 NCH/day x 365days/year = 280, 593.75 NCH/year.

5. Find the number of working hours per year.

 40hours/ week – 216 x 8 hours = 1728 working hours per year

 48hours/week – 2144 working hours per year

6. Find the total number of nursing personnel needed.

a. Total NCH/year = 280,593.75 = 162
Working hrs/year 1728
b. No. of Relievers needed= No. of personnel x 0.095
c. Total Nursing personnel needed – 162 + 15 = 177

Note: The average yearly absence of an employee total 35days. Dividing 35days by
365days is 0.095. This includes mandatory leaves and other absences.

7. Categorize to professional and non-professional personnel. Ratio of professionals to non-

professionals in a tertiary hospital is 65:35.
a. 177 x .65 = 115 professional nurses
b. 177 x .35 = 62 nursing attendants

8. Distribute by shifts:
Nurses:
a. 115 x .45 = 52 nurses- AM shift
b. 115 x .37 = 42 nurses –PM shift
c. 115 x .18 = 21 nurses –Night shift
Total 115 nurses

Nursing attendants:
a. 62 x .45 = 28 –AM shift
b. 62 x .37 = 23 – PM shift
c. 62 x .18 = 11- Night shift
Total: 62 Nursing attendants