Organizational Communication

Definition

 Essential to the wellbeing of an organization.

 Essential for strategic planning process of any Organization

 Crucial for attainment of short and long-term organizational goal.

pivotal to the day-to-day operation of any organization, affecting patient safety and
quality care, employee satisfaction, and customer relations and satisfaction.

Communication theories

MECHANISM PERSPECTIVE

The two people become a sender and receiver

Sender encodes the message into units of spoken language that conveyed by sound
waves to the receiver.

Receiver decodes the message

Any feature not intended by the sender but inadvertently included in the message is
called noise.

PSYCHOLOGICAL PERSPECTIVE

Builds from mechanical perspective, acknowledging the sender and receiver, and the
message, but based in large part on learned behavior.

When message is receive it serve as a stimulus

This process of give and take, in which (1) a message is sent, (2) it stimulates the
receiver to respond, (3) a response is sent, which then (4) stimulates the receiver to
respond, is a learned behavior.

“As communicators, we actively choose to attend to certain stimuli, interpret them by

means of our own unique mental structures, and respond by emitting certain behaviors
capable of stimulating others”

INTERACTIONIST PERSPECTIVE

This perspective developed as a way to understand the development of self as learned

through a process of interaction within the larger society/environment. Started during
infancy The self emerges as that which makes each person unique and comprises a set
of ideas, values, and experiences, all arrived at through social interaction.

Types of Communication

Vertical Communication

Vertical communication is communication that occurs between superiors and

subordinates.

Downward communication, in which information and other types of communication are

sent by superiors to subordinates. It reflects the hierarchical structure of the
organization. Example news that will please or distress the subordinates, such as bonus
or upcoming layoffs respectively.

Upward communication occurs when employees or managers who are subordinate to

top level management send messages up through the chain of command. For example,
nursing staff members may be concerned about inadequate staffing on a unit.

If not met, the employees often feel that their input and questions are not welcomed and
complain that they do not receive satisfactory responses, which may have a negative
impact on employee satisfaction and productivity.

Horizontal Communication

Horizontal communication occurs when managers and others communicate with people
on the same level in the organizational structure. Staff nurses communicate with other
staff nurses, or nurse managers communicate with other managers.

Effective horizontal communication can facilitate coordination between departments as

well as problem solving and decision making. Horizontal communication provides a
direct, often expedient, way of solving problems and addressing issues critical to the
effective functioning of the organization.

Diagonal Communication

In diagonal communication, managers interact with managers, physicians, and groups

of people in other departments in the organization who are not on the same level in the
hierarchy. Diagonal communication serves much the same function of being an
expedient, direct route of decision making and problem solving as horizontal
communication but encompasses a wider range of people throughout the organization.
Diagonal communication allows managers to go directly to a person at a different level
in the bureaucratic structure to resolve issues. For example, a nurse executive might
work with the leadership of the medical staff to address a clinical issue.

Formal vs. Informal communication

Formal communication occurs when a nurse manager takes a unit problem to an

immediate superior. Much communication occurs informally between employ- ees who
are not formally connected within the hierarchy. For example, nurses may have lunch
with employees from the laboratory and discuss a process or procedure.

Informal communication can occur in chance encounters within the organization but
may be useful in accomplishing goals. The nurse executive may use informal
communication to clarify a formal communication, to provide or seek additional
information on an issue, or as a vehicle for negotiation and persuasion.

Grapevine

The grapevine is the informal and unsanctioned information network within every
organization. Word is spread from one person to another outside the formal
communication network. The grapevine is the spread of information without regard for
the traditional networks of communication.

Information Technology and Electric Communication

Clinical information systems allow nurses to chart at the bedside, eliminating duplicate
documentation. Wireless technology allows nurses, for example, to access patient
records, answer call lights from remote locations, and access databases for clinical
practice

Electronic Health Records

Note that immediate access to health information and data regarding patients’
diagnoses, allergies, medications, laboratory test results, etc., is useful in timely
decision making. Results management speaks to the ability of providers of care in
multiple settings to have quick access to new and past data, such as laboratory test
results, thereby increasing patient safety and quality of care.
 Business Writing and reporting Skills

Business memo is used to communicate something of immediate importance to people

within a business or organization. A memo also can be sent to people or firms that have
close or long-standing relationships, such as vendors or consultants. Like a business
letter, a memo is a permanent record of your communication.

 Announce or confirm a meeting or event

 Provide instructions  Provide a status report on a project
 Request feedback or recommendations
 Summarize action required after a meeting
 Clarify or change a policy or procedure
 Distribute minutes or handouts from a meeting or event
 Notify others of a problem or that a problem was resolved
 Provide a short report of an event or decision

Memo Writing

Part 1: HEADER
TO: provide the names and titles of everyone who will receive your memo
FROM: provide your complete name and title
DATE: provide the complete and accurate date – don’t forget to include the year
SUBJECT: provide a brief, yet specific description of what the memo is about

Part 2: MESSAGE
Introduction – explain the purpose
Body – addresses the information required
Conclusion – (Summary and possible recommendations)
Minutes of the meeting

Definition

Meeting minutes are notes that are recorded during a meeting. They highlight the key
issues that are discussed, motions proposed or voted on, and activities to be
undertaken. The minutes of a meeting are usually taken by a designated member of the
group. Their task is to provide an accurate record of what transpired during the meeting.

What to include in meeting minutes

 Date and time of the meeting happened

 Names of attendees, as well as absent participants
 Acceptance of, or amendments made to, the previous meeting’s minutes
 Decisions made
o Activities undertaken or agreed upon
o Next steps
o Outcomes of elections
o Motions accepted or rejected
o New proposals
o Date and time of the next meeting
Presentation of Reports

Takes place when two or more people share information about the client care
either face-to-face or by telephone.

a. Preparation and Conduct of Meeting

b. Costumer Engagement Management

Records Management

A. Data Privacy Protocols in Data Safe seeking and Release of Records

Sentinel Events

Sentinel events are patient safety events (not primarily related to the natural course of
the patient’s illness or underlying condition) that reach a patient and result in any of the
following:

 Death
 Permanent harm
 Severe temporary harm (critical, potentially life-threatening harm lasting for a
limited time with no permanent residual, but requires transfer to a higher level of
care/monitoring for a prolonged period of time, transfer to a higher level of care
for a life-threatening condition, or additional major surgery, procedure, or
treatment to resolve the condition.

An event is also considered sentinel if it is one of the following:

 Suicide of any patient receiving care, treatment, and services in a staffed around-
the-clock care setting or within 72 hours of discharge, including from the
hospital’s emergency department
 Unanticipated death of a full-term infant
 Discharge of an infant to the wrong family
 Abduction of any patient receiving care, treatment, and services
Any elopement (that is, unauthorized departure) of a patient from a staffed
around-the-clock care setting.
 Invasive procedure, including surgery, on the wrong patient, at the wrong site, or
that is the wrong (unintended) procedure
 Unintended retention of a foreign object in a patient after an invasive procedure,
including surgery
 Fire, flame, or unanticipated smoke, heat, or flashes occurring during an episode
of patient care.
Anecdotal Report

An anecdotal record is an observation that is written like a short story. They are
descriptions of incidents or events that are important to the person observing. Anecdotal
records are short, objective and as accurate as possible.

It has some significant item of conduct, a record of an episode in the life of students, a
word picture of the student in action, a word snapshot at the moment of the incident,
any narration of events in which may be significant about his personality

Purposes of anecdotal records

 To furnish the multiplicity of evidence needed for good cumulative record.

 To substitute for vague generalizations about student’s specific exact description
of   behavior.
 To stimulate teachers to look for information i.e. pertinent in helping each student
realize good self- adjustment.
 To understand individual’s basic personality pattern and his reactions in different
situations.
 The teacher is able to understand her pupil in a realistic manner.
 It provides an opportunity for healthy pupil- teacher relationship.
 It can be maintained in the areas of behavior that cannot be evaluated by other 
systematic method.
 Helps the students to improve their behavior, as it is a direct feedback of an
entire observed incident, the student can analyze his behavior better.
 Can be used by students for self-appraisal and peer assessment.
Incident Report

An incident report is an electronic or paper document that provides a detailed,

written account of the chain of events leading up to and following an unforeseen
circumstance in a health care setting.

The incident doesn’t have to have caused harm to a patient, employee, or  visitor,
but it’s classified as an “incident” because it threatens patient safety.

To ensure the details are as accurate as possible, incident reports should be

completed within 24 hours by whomever witnessed the incident.
Purpose of an Incident Report

Incident reports are used to communicate important safety information to hospital

administrators and keep them updated on aspects of patient care for the following
purposes:

1. Risk management. Incident report data is used to identify and eliminate

potential risks necessary to prevent future mistakes. For example, if an incident
report review finds that most medical errors occur during shift changes, risk
management teams may suggest that nursing staff develop standardized
turnover protocols to avoid future errors.

2. Quality assurance, is all about patient safety, customer satisfaction, and

improving healthcare quality. Quality control groups comb through incident
reports to look for indicators that suggest a patient received high-quality, patient-
centered care at a reasonable price.

3. Educational tools. Incident reports form of great training tools because of innate

ability to learn from their mistakes — or the mistakes of others. Healthcare teams
often use resolved incident reports as educational tools to prevent similar
occurrences.

Kardex

The Kardex is used as a reference throughout the shift and during change-of-
shift reports.

 Provides a concise method of organizing a recording data of the client, making

information readily accessible to all members of the healthcare team.
 Tears of cards usually kept in portable file.
 It is a way to ensure continue witty of care from one shift to another and from one
day to the next.
 It is a tool for change of shift report. But endorsement is not simply reciting
content of Kardex. Health care needs of the client is still primary basis for
endorsement.

a. Client data (e.g. name, age admission date, allergy)

b. Medical diagnoses and nursing diagnoses
c. Medical orders, list of medications
d. Activities, diagnoses and nursing diagnostic tests, or specific data on the
patient.
Entries usually written in pencil. This implies the Kardex is for planning and
communication purpose only.
Patient’s Chart / Records

A legal document that describe all aspects of a patients care, including

medications administered, services provided and procedures performed.

201 File

A file containing the employees personal records which are submitted to the
organization for profiling.

STAFFING IN THE NURSING SERVICE

Staffing is the most crucial, complex, and time-consuming management function of a

nurse manager at every level of the healthcare organization because the quality of the
Nursing personnel and their performance will determine the degree by which the goals
of the Nursing Service are achieved. Although the goal of Nursing is focused primarily
on providing a competent Nursing workforce to achieve the best patient clinical
outcomes at reasonable cost, the healthcare environment has been becoming
increasingly complex.

Rowland (2004) defined staffing as 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 for care."

Safety of the patient shall be the fundamental principle to guide staffing. It is also mostly
relevant in the compliance of minimum requirements for the hospital licensure to ensure
quality and safe delivery of care to patients.

Importance of Staffing
  Recruits’ competent personnel for various clinical areas based on patient's needs.
 Allocates job tasks properly among the nursing personnel according to their
qualifications, and specializations.
 Provides the numbers and mix of nursing staff needed per nursing unit.
 Ensures adequate and equitable manpower for efficient and effective delivery of
nursing care.
 Optimizes the utilization of nursing human resource at the least manpower cost but
high on quality nursing care.
 Retains, develops, and places the right nursing staff in the right job positions.

The principles of staffing are adapted from the American Nurses Association as cited by
Yoder-Wise (2011).

1. Patient Care Unit Related

 Appropriate staffing levels for a patient care unit must reflect analysis of individual
and aggregate patient needs.
 There is a critical need to either retire or seriously question the usefulness of the
concept of nursing hours per patient day.
 Unit functions necessary to support delivery of quality patient care must also be
considered in determining staffing levels.

2. Staff Related

 The specific needs of various patients’ population should determine the

appropriate clinical competencies required of the nurse practicing in that area.
 Registered nurses must have nursing management support and
representation at both the operational level and the executive level.

 Clinical support from experienced registered nurses should be readily available to

those registered nurses with less proficiency.

3. Institution/Organization Related
  Organizational policy should reflect an organizational climate that values
registered nurses and other employees are strategic assets and exhibit a true
commitment to filling budgeted positions in a timely manner.
 All institutions should have documented competencies for nursing staff including
agency or supplemental traveling registered nurse for those activities that they
have been authorized to perform.
 Organizational policies should recognize the myriad needs of both patient and
nursing staff.

Factors Affecting Staffing

There are factors affecting staffing that should be considered in determining the number
and mix of nursing personnel. These are as follows but not limited to:

1. Patient factors

 census fluctuations
 patient acuity
 level of care /degree of dependence
 patient age group
 special treatment and procedure
 communicability
 rehabilitation needs
 patient and family care demands/expectations

2. Staff factors

 number of nursing staff available

 ratio of professional to non-professional
 number of leaves
 turn-over rate
 absenteeism rate
  proficiency level
 span of supervision

3. Nursing Service factors

 nursing care modality in use

 type of services/patient classification system
 patterns of work schedule
 training and staff development programs
 research activities

4. Healthcare organization factors

 type of hospital
 services offered/population served
 work time policy
 administrative policy on weekend and holiday duty
 presence of support services
 nursing unit architectural design
 availability of resources like equipment. materials and supplies
 technology anticipated
 projected units of services
 budget limitations

Patient Care Classification System

The Patient Care Classification System is primarily developed to objectively

determine workload requirements and staffing needs. It is a means of categorizing
patients on the basis of certain needs that can be clinically observed by the nurse. It
aims to respond to the constant variation in the care needs of patients. It is essential to
staffing the nursing unit of hospitals for it quantifies the quality of nursing care. The

patient then can be assigned to an acuity or complexity category that will indicate how
many actual hours of nursing care the patient needs during a particular shift.
The Nursing Care Hours Per Patient Day (NCHPPD) is defined as a standard
measure that quantifies the nursing time available to each patient by available staff. It
simply means the amount of time nurses spend with each patient per day. It is
calculated by dividing the total number of productive hours worked by nurses with direct
patient care responsibilities with the total cencus or number of patients in a day or
month.

The formula is:

NCHPPD = total number of hours worked in 24 hours

Total patients census in a day

Ex. =12 nurses x 8 hours x 3 shifts

40 patients

= 96 worked hours

40 patients

= 2.4 NCHPPD

The various nursing units may develop their own ways of classifying patient care
according to the acuity of their patient’s illness. The figures below are example of
patient care classification with nursing care hours/patients/day and ratio of professionals
(clinical nurses) and-professionals (assistive nursing personnel).
Classification of patient care by units, nursing care hours/patients/pay and ratio to RN
and non-professional staff needed.

Nursing Care Ratio of RN to non-

Patients Care Units
hours/patient/day professional staff

General medicine 3.5 60:40

Medical 3.4 60:40

Surgical 3.4 60:40

Obstetrics 3.0 60:40

Pediatrics 4.6 70:30

PICU/NICU 6.0 70:30

ER/SICU/PACU 6.0 70:30

MICU/CCU 6.0 70:30

Classification of patients by levels of care, nursing care hours/patients/day and

ratio of RN to non-professionals needed

Nursing Care Ratio of RN to non-

Level of Care
Hours/Patients/Day professional staff

Level 1 self-care or
1.5 55:45
minimal care

Level 2 moderate or
3.0 60:40
Intermediate Care

Level 3 Total Care or

4.5 65:35
Intensive Care

Level 4 highly Specialized 70:30

6.0
or Critical Care Or 80:20
Level 1-Self Care or Minimal Care. Under this category, the patient is capable of
carrying out daily activities as long as the nurse provides the necessary materials and
supplies. A patient who enters the hospital for diagnostic work-up that includes
numerous laboratories. X-ray and other non- invasive tests, is often self-care patient for

the duration of his work-up. Example, the average amount of nursing care hours per
patient per day is 1.50 while the ratio of professional to non-profession.al nursing

personnel are 55:45.

Level II- Moderate Care or Intermediate Care. Under this category. the patient can feed,
bathe. toilet and dress himself without help, but requires some assistance from the
nursing staff for special treatments or certain aspects of personal care i.e. A partial care
patient might require wound debridement or dressing, catheterization, colostomy
irrigation, intravenous fluid therapy, intramuscular or subcutaneous

injection or chest physiotherapy. Example, the average nursing care hours per patient
per day is 3.0 and the ratio of professional to non - professional personnel is 60:40.

Level III - Total, Complete or Intensive Care. Under this category, a bedridden patient
who lacks the strength or mobility, needs nursing assistance or all of the patient's daily
activities, such as feeding bathing. dressing, moving, positioning, eliminating, comfort
seeking, and injury avoidance. Example, the average nursing care per hours per per
patient is 6.0 with a professional to non-professional ratio 65:35.

Level IV - Highly Specialized Critical Care. Under this category, an acute or critically ill
patient who is in constant danger of death or serious injury would require critical care.

Measurements. Frequently, there are also significant changes in doctor's orders that
need to carry out. Example, the average nursing care hours per patient per day 1s 7.0
or more, and the ratio of professional to non-professional ranges from 70:30 to 80:20.
Moreover, the percentage of nursing hours to be given by professional nurses and by
non-professional nursing personnel may depend on the patient's condition in the
hospital setting in which the care is being given. The table below is an example of
patient classification according to type of hospital.

Table. Classification of Patients by Levels of Care according to Type of Hospital with

Percentage of Patients at Various Levels of Care Levels of Care

Level of Care

Type of Minimal Moderate Intensive Highly

Hospital
Care Specialized
Care

Primary 70 25 5 -

Secondary 65 30 5 -

Tertiary 30 45 15 10

Special 10 25 25 20
Tertiary

The table shows that for primary (Level 1) hospitals. it is assumed that about 70 percent
of their patients need minimal care 25 percent needs moderate care. Patients needing
intensive care are given emergency treatment and when their condition becomes stable
or when immediate treatment is necessary and the hospital has no facilities for this, the
patient is transferred to a secondary (Level 2) or tertiary (Level 3) hospital.
ln (level 2) hospitals, it is assumed that 65 percent or the patients need minimal care, 30
percent needs moderate care, and 5 percent needs intensive care.

In (Level 3) hospitals, 30 percent of the patients need minimal care, 45 percent needs
moderate care, 15 percent needs intensive care and 10 percent needs highly
specialized care. For special tertiary hospital it is assumed that 10 percent of the
patients need minimal care, 25 percent needs moderate care, intensive care and 45
percent needs highly specialized care, and 20 percent highly specialized care.

Staffing Methods

Basically, there are three metho ds of staffing to determine the number of personnel
needed. These are:

 Ratio-Based Staffing reflects the number of nurses assigned to care for a certain
number of patients as a state-mandated regulatory requirement for a nurse-to-
patient assignment. The figures below are the Department of Health-mandated
nursing staffing ratios for government hospitals (Revised Organizational
Structure and Staffing Standards for Government Hospitals, CY 2013 Edition)

Table. Nursing Staffing Standards for Gov’t Hospitals

Unit Staff Distribution

Ward 1 ward senior (Nurse III): 50 staff nurses

1 senior nurse (Nurse II): 15 staff nurses

1 staff nurse (Nurse 1): 12 beds/patients/shift

 1 nursing attendant : 24 beds/shift

Unit Nurse to Staff Ratio

1 Ward Supervisor (Nurse III): 30 staff nurses

Critical
1 Senior Nurse (Nurse II): 15 staff nurses
Care
1 Nursing Attendant: 15 beds/shift

 Acuity-Based Staffing reflects the severity of the physical and psychological

status or illness of the patient. The intensity attribute of acuity indicates the
nursing care needs and the corresponding workload required. Moreover, the
nursing intensity is the number of nursing hours with associated costs and total
time and staff mix of nursing personnel consumed by an individual patient during
the episode of care. Table 5.2 is an example of acuity-based staffing method.

 Budget-Based Staffing means that nurses are allocated according to nursing

care hours/patient/day. Tables 5.1 and 5.3 are examples of budget-based
staffing method.

 WISN-The Workload Indicators of Staffing Need (WISN) method is a human

Resource management tool. It provides health managers a systematic way to
make staffing decisions in order to manage their valuable human resources well.

Calculating for the number of nursing personnel needed

These following provisions are the basis of the computation:

  The number of working hours and of duties in the country is largely dependent on
a 40 hour per week law otherwise known as RA 5901. This law specifies that
personal working and agencies with a population of 1 million and a hospital with
100 bed capacity and over are entitled to work 40 hours per week. On the other
hand, nursing personnel who worked in agencies with a population of less that 1
million will have to render forty-eight working hours a week, therefore getting only
one day off a week.
 3 days special privilege to government employees for birthdays, weddings,
anniversaries, funerals, relocation, enrollment or graduation leave, hospital and
accident leave.
 Study suggests nursing personnel gets only an average of that 33 out of 48 leave.
Moreover, 45% morning shifts need the most number of nursing personnel than
37% for afternoon and 18% for night.

Total number of working days, non-working days and working hours of nursing
personnel per year.

Rights/ Privileges Given Working hours/week

each personnel
40 hours 48 hours

1. Days of vacation 15 15

2. Days of sick leave 15 15

3. Legal holidays 10 10

4. Special holidays 2 2

5. Days for continuing 3 3

education
6. Special privileges 3 3
education
7. Off duties R.A 5901 104 52

8. Expanded maternity 105

leave (RA 11210)
 9. Paternity Leave 14

Total non-working days 152 100

Total working days/ year 213 265

Total working hours/year 1,704 2,120

Staffing formula

Hereunder are the formula and steps to illustrate on how to calculate the number of staff
needed in the in-patient areas of the hospital. Example used is a staffing requirement
for a 300-bed capacity tertiary hospital.

1. Categorized the number of patients according to the levels of care needed

multiply the total number of patients by the percentage of patents at each level of
care (minimal, moderate, intensive and highly specialized).

300 (patients) x .30 = 90 patients needing minimal care

300 (patients) x .45 =135 patients needing moderate care

300 (patients) x .15 = 45 patients needing intensive care

300 (patients) x .10 = 30 patients needing highly specialized nursing care

Total 300 patients

2. Find the total number of nursing care hours needed bu the patients at each
category level.
 Find the number of patients at each level by the average number of nursing
hours needed per day.
  Get the sum of the nursing care hours needed at the various level.

90 pts x 1.5 (NCH needed at level I) = 135 NCH/ day

135 pts x 3 (NCH needed at level II) = 405 NCH/ day
45 pts x 4.5 (NCH needed at level III) = 202.5 NCH/ day
50 pts x 6 (NCH needed at level) = 180 NCH/ day
Total 923 NCH/day

3. Find the actual number of nursing care hours needed by the given number of
patients. Multiply the total nursing care hours needed per day by the total number
of days in a year.

923 X 365 (days/year) = 336. 895 NCH/ year

4. Find the actual number of working hours rendered by each nursing personnel per
year. multiple the number of hours on duty per day by the actual working days
per year.

8 hours/ day x 213 (working days/year) = 1.704 working hours/ year

5. Find the total number of nursing care personnel needed.

 Divide the total number of nursing care needed per year by the actual number of
working hours rendered by an employee per year.
 Find the number of relievers.
198 x .15 = 29.7
198 + 30 = 228

Add the number of relievers to the number of nursing personnel needed.

Total NCH/year = 36,895 = 197.7 or 198 nursing personnel

Working hours/year 1,704

 Total nursing personnel x .15 = number of relievers

= 198 x .15 = 30 relievers

6. Categorize the nursing personnel into professionals and on-professionals.

Multiply the number of nursing personnel according to the ratio of professionals
to non-professionals.

228 x .65 = 148.2 or 148 professional nurses

228 x.35 = 79.8 or 80 non-professionals

7. Distribute by shifts.

Professional

Morning 148 X .45 = 66.6

Afternoon 148 X .37 = 54.76

Night 148 X .18 = 26

Non-professional

Morning 80 X .45 = 36

Afternoon 80 X .37 = 30

Night 80 X .18 = 14
Supplemental guidelines for staffing standards pattern per hospital category can be
found in the "Revised Organizational Structure and Staffing Standards for Government
Hospitals, CY 2013 Edition.

Shift Options

It is important for Nursing Administrators and staff nurses to be aware of the various
options 1n work schedules. as well as the advantages and disadvantages of each. The
staff nurse will then be able to select the scheduling pattern best suited to meet the
nurse's need. The Nurse Administrators will be able to select the scheduling patten

best suited to meet the staffing needs of their floor or unit (See Appendix H. DOH
memorandum Circular No. 2016-0032)

Eight-Hour Shifts. Planning staffing for employees on the eight-hour shift includes
arranging for staffing for three-shifts (3) days, evenings and nights. The day shift begins
at 7 am and ends at 3:30 pm, the evening shift begins at 3 pm and ends at 11:30 pm,
and the night shift begins at 11 pm and ends at 7:30 am. Full time employees on the 8-
hour shifts work five (5) days a week for a total of 40 hours per week. Staff may work
permanent days, evening, or nights, or they may rotate to different shifts.

Advantages of the 8-hour shift rotation include:

 The traditional work day is 8 hours. Therefore, the staff does not have to adjust to
an extended workday.
 Staff may have the option of selecting from three (3) shifts.
Table. Personnel Staffing Schedule: Eight-Hour Shift

1ST WEEK 2ND WEEK 3RD WEEK 4TH WEEK

No.
NAME SMTWTFS SMTWTFS SMTWTFS SMTWTFS

A-1 X X X X X X X X
B-1 X X X X X X X X

NOTE: For hospitals following the regulation of the DOLE, they are advised to

consider DOLE D.O. # 182 Section 4 "Hours of Work" for item Letter A

Section 4. Hours of Work - The normal hours of work of health personnel shall

not exceed eight (8) hours a day. (Refer to MC No. 3, s. 2016, Office of the Pres. Phil.)

Health personnel in cities and municipalities with a population of at least one million
(1,000,000.00) or in hospitals and clinics with a bed capacity of at least one hundred
(100) shall hold regular work hours for eight (8) hours a day, for five (5) days a week,
exclusive of time for meals, except where the exigencies of the service require that such
personnel work for six (6) days or forty-eight (48) hours in which case, they shall be
entitled to an additional compensation of at least thirty percent (30 %) of their regular
wage for work on the sixth day.

Scheduling

It is a perennial concern of nurse managers, especially nowadays, wherein the nursing

workforce is affected by generational differences, new lifestyles, technological skills,
family lives, and the integration of work life to personal life. Although satisfying each
individual nursing personnel is not feasible. a fair and balanced work schedule can be
created while meeting the needs of patients and complying with the organizational
policy, rules and regulations.
Scheduling is defined by Huber (2013) as the process of determining a set of number
and type of staff for a future time period by assigning individual personnel to work
specific hours, days or shifts and in a specific unit or area over a specified period of
time. Also, according to Rowland (2011), it is a process of allocating the available
nursing staff to the days of the week based on the estimated patient care requirements
and hospital regulations personnel. It is a timetable showing planned workdays and
shifts for nursing personnel. Thus, it provides nursing personnel a clear plan of their
work schedule in a specific week in a month.

Scheduling Systems

Fundamentally, scheduling system can be categorized into:

Centralized Staffing is a system wherein the power and authority for staffing decisions
occur centrally for the entire hospital, commonly the staffing and scheduling office of the
nursing service department. Usually under this system a person in the nursing
administration office plans the coverage for all nursing unit. A master staffing pattern is
developed for all the nursing units and staffing is based on pre-established standard.

Decentralized Staffing is a system wherein the power and authority for staffing
decisions are methodically dispersed to first-line nurse managers of each nursing unit.

Scheduling Approaches

Block Scheduling is an approach in which the work schedule for nursing units is
planned in block of weeks, regularly 1 to 4 weeks at a time. It has flexibility because the
next block of time need not necessarily follow the pattern of the preceding/following
week.
Cyclical Scheduling is an improvement of the block schedule in which it has a cyclical
repetitive work pattern of 4 weeks. It is known as "team rotation" because the nursing
team is scheduled as a unit. This method is used in the team nursing modality of care.

Self-Scheduling is an approach in which the nursing personnel sign up for their

preferred shifts using staffing and scheduling policy and guidelines.

Developing Staffing and Scheduling Policies

The Nursing Service Department must have developed staffing and scheduling policies
reviewed and updated periodically. These written policies aim to provide a fair and
consistent work schedule among nursing personnel. Once a person is work satisfied, it
has a positive impact on patient clinical outcomes and staff satisfaction and retention.

Staffing and scheduling policies should include the identified list of items that Marquis
and Huston (2009) identified. These are as follows but not limited to:

 Name of person responsible for the staffing schedule and the authority of that
individual if it is other than the employee's immediate supervisor
 Type and length of staffing cycle used
 Rotation policies, if shirt rotation applies
 Day of week schedule begins
 Weekend off policy
 Policy for change days off
 Procedures for days off request
 Procedure for vacation time request
 Procedure for holiday time request
 Emergency request policy
 Procedure for resolving conflicts on request for days off, holiday or requested time
off
 Time and location of scheduling posting
 Tardiness policy
 Absenteeism policy
 Low census procedures
 Rotating to other units policy
  Policies and procedure on requesting transfer to other units
 Mandatory overtime policy

Master rotation plan is an overall plan which shows rotation of all nursing personnel to
various clinical and specialty areas in a given year. however, in hospitals where there
are specialty areas, nurses with special trainings or certification can be assigned only in
areas related to their trainings for safety of the patients.

Master Staffing Pattern is the number, and types or categories of staff assigned to the
particular units and departments of a hospital or other health care facility. Staffing
patterns vary with the unit, department, and shift and with the patient acuity levels.

This helps the Chief Nurse to visualize the equitable distribution of nursing personnel
among the various units. It serves as a guide in planning vacation coverage, as a time
table for replacement of personnel, as a support for budgeting request, as an aid in
forecasting future needs. Daily and weekly time sheets and monthly summary reports of
nursing coverage are accompanying tools.

Assignment

An assignment refers to assigning nurses to specific groups of patients. It is based on

their specific knowledge and skills, job description, interest, and patient's nursing needs.
The Chief Nurse or his/her assistant is usually responsible for assigning nursing
personnel in the unit. The Senior Nurse gives the daily and specific assignments. Such
should be signed by the Supervising Nurse in charge of the specific ward. Assignments
must be made to safeguard patients and make sure they receive adequate and quality
nursing care.
Characteristics of a good assignment

A good assignment should be:

 Related to the previous work experience and capacities of the worker.

 Definite and clearly understood and concise.
 Able to guide the workers in their learning activities
 Able to minimize difficulties.
 Considerate to individual differences.

Basic Principles Underlying Patient Assignments

 The basic assignment must be made by the Senior Nuo

 Assignments must be planned on a day-to-day basis.
 The senior Nurse must know the nursing needs of each patient’s appropriate time
required to care for him/her.
 The senior nurse must know the capability if each worker and the type work the
latter is expected to do, He/she must also be familiar with the worker's working
habits, such as the worker's speed, thoroughness and organization of work.

The routines of the ward, such as the time when dressing are changed, the time doctors
do their rounds and examine patients: and many other factors, such as modalities of
care must also be considered.

Assignment Techniques

Assigning patient care to a member of the nursing team is a responsibility that a

conscientious Senior Nurse takes seriously. The first requirement is to make a careful
analysis of the needs of each patient. Recent studies and publications that can help the
Senior Nurse to sharpen and improve his/her skills in the understanding of the patient
and his needs are available.

The Senior Nurse must make an assessment of the abilities and capabilities of each
member and delegate the work consistent with the needs of the patients based on the
patient care classification system and the workers. A standard form of patient
assignment should be accomplished by the senior nurse/charge nurse and posted in the
bulletin board provided.
Job Description

Job Description is a statement setting forth the duties and responsibilities of a specific
job and the characteristics of the individual needed to perform it successfully. Job
description is usually developed by conducting a job analysis that includes examining
the necessary knowledge and skills to perform delegated, work efficiently distributed,
talents fully used, and morale maintained .

Contents of Job Description

A job description contains the basic job-related data, which are as follows but not

limited to:

 Job title
 Position classification
 Salary gade
 Job summary
 Job duties and responsibilities
 Reporting relationship
 Nature of supervision
 Equipment, machines and tools to be used
 Working environment
 Hazards and risks
 Qualifications such as:
o Educational requirement
o Professional license, if applicable
o Training and technical skills necessary
o Work experience
o Philippine Qualification Framework (Republic Act No.10968, An Act
Institutionalizing the Philippines Qualifications Framework (POF).

Purposes of Job Description

 Serves as a basis for recruitment, selection, and job placement of qualified individuals.
 Determines and classifies departmental functions and relationships to facilitate in the
structuring of the nursing service organogram.
 Prevents overlapping of duties and responsibilities that might led to work conflict and
unproductivity.
 Used as a reference in the performance appraisal of nursing personnel.
 Determines the staff training needs for their personal and professional growth and
development.
 Utilized in making up the budget for salary requirement justification.