NCM NLM
Scheduling
A. Block
• Fixed until revised yearly;
monthly.
• Requests not
accommodated.
• A nursing block schedule
may look something like
o Monday - Off
o Tuesday - On
o Wednesday - Off
o Thursday - On
o Friday - On
o Saturday - Off
o Sunday – Off
• Benefits of Block Scheduling
for Nurses
o Schedule Flexibility
o Efficient Schedule
Organization
o Consistent Income
o Travel Opportunities
o Work-Life Balance
B. Unstructured
• Created weekly & fluctuates
according to staff’s needs.
C. Skeleton
• Starts with basic skeleton
staffing & fixes only a portion
of the schedule usually
weekends.
• preliminary or basic plan that
will be further fleshed.
D. Cyclical
• Sets a pattern for each staff
person’s days & days off;
shifts are rotated.
E. Master
• Cyclical repetitive schedule
covering an entire area for a
long period such as a 4-week
block.
F. Self-scheduling
• Alternative method whereby
nurse's work together to
construct their schedules.
• The practice of letting your
team members choose the
shifts they want to work — or
to trade shifts with others —
in order to create the most
optimal schedule for
themselves and their
coworkers.
Staffing Pattern
1. Benchmarking – is a management
tool for seeking out the best
practices in one’s industry so as to
improve performance (Swansburg,
1996).
2. Regulatory requirements - local
requirements will be followed as
mandated by RA 5901.
3. Skill Mix – a critical element. It is the
percentage or ratio of professional to
non – professional.
4. Staff support – it is the support in
place for the operations of the unit or
department.
a. The less support available to
the staff, the more nursing
hours have to be built in the
staffing pattern to provide
care to patients.
5. Historical information – keep intact
the effective days of doing tasks.
a. Be knowledgeable about the
presence or absence of
equipment and supplies.
• RA.4226 – Hospital licensure
• RA.5181 – Permanent residence &
reciprocity qualifications for
examinations/registration
• RA.5901 – Working hours &
compensation in agencies with 100
bed capacity.
• RA.6365 – Established a National
Policy on Population and Created
the Commission of Population
• RA.6425 – Dangerous Drug Act –
the sale, administration, delivery,
distribution and transportation of
prohibited drugs is punished by law.
• RA.6675 – Generics Act of 1988 -
this promotes, requires and ensures
the production of an adequate
supply, distribution, use an
acceptance of drugs and medicines
identified by their generic names.
Formula to Determine Staffing Patterns
Full Time Equivalent (FTE)
• This is a formula that uses nursing
care hours and annual hours of work
provided by one FULL- TIME
EQUIVALENT.
• It is a measure of the work
commitment of a full-time employee.
• A full-time employee work 5 days a
week or 40 hrs per week for 52
weeks a year
• This amounts to 2, 080 hours (40hrs
x 52 weeks) of work time (Sullivan,
2006).
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Step 1: Determine type of hospital
whether it is primary, secondary or
tertiary.
• Example: Hospital A is a 100-bed
capacity secondary level hospital
Step 2: Categorize patients according to
levels of care.
Forty – Hour Week Law
• This formula is based on the
National League of Nurses (NLN) or
RA 5901 otherwise known as Forty
Hour Week Law.

• Where:
o ABO = Average Bed • Example:
Occupancy o 100 patients X 65 % = 65
o NCH = Nursing Care Hours patients needing
o minimal care
o 100 patients X 30 % = 30
patients needing
intermediate care
o 100 patients X 5% = 5
patients needing intensive
care
Step 3: Find the NCH needed by patients
per day and get the sum.
• Minimal care = 1.5 hours
• Intermediate care = 3 hours
• Intensive care = 4.5 hours
• Example:
o Minimal care = 65 x 1.5 hrs =
97.5 NCH
Distribution per shift
o Intermediate = 30 x 3 hrs =
• AM – 45% 90 NCH
• PM – 37% o Intensive care = 5x 4.5 hrs =
• Night – 18% 22.5 NCH
o TOTAL = 210 NCH / DAY
40 HOUR / WEEK Step 4: Find the Total NCH x 365 days
• For personnel working in hospitals • Example:
with 100 bed capacity or over or o 210 NCH per day x 365 days
which are located in a 1 M = 76, 650 nursing care hours
population
Step 5: Find the number of working
48 HOUR / WEEK hours per year.
• For personnel who work in agencies • Example:
with lesser bed capacity, or which o 40 hrs/week – 216 x 8 hours
are located in communities with less ▪ = 1, 728 working hrs /
than 1 M population. yr
o 48 hrs/week – 268 x 8 hours
▪ = 2, 144 working hrs /
yr
Step 6: Find the nursing personnel
needed.

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• Add nursing personnel and relievers.
• Nursing relievers:
4. Spread the wealth in distributing
overtime.
5. Know the staff members you’re
scheduling.
6. Define a skill mix for each shift and
stick to it.
7. Vary the experience levels
scheduled on each shift.
8. Evaluate the adequacy of rest
periods between shifts when
approving schedule.
9. Develop practice guidelines.
10. Monitor key performance indicator
trends in staffing and scheduling.

o 44 nsg personnel x 0.095 = 4 Communication

nsg relievers, OR • The imparting or exchanging of
o 36 nsg personnel x 0.095 = 3 information by speaking, writing, or
nsg relievers using some other medium.
• How to arrive at .095 • The successful conveying or sharing
• The average yearly absences of an of ideas and feelings.
employee total 35 days. Dividing 35
days by 365 days is 0.095. Communication in Nursing
• This includes all mandatory leaves • Is the process of exchanging
and other absences. information or feelings between:
o 44 nursing personnel + 4 o Nurses and patients
relievers o Families
= 48 nursing employees, OR o Doctors
o 36 nursing personnel + 3 o Other members of the health
relievers team
= 39 nursing employees • It is essential for:
Step 7: Categorize into professional and o Providing efficient medical
Non-professional. care
• Primary: 55:45 o Collaborating on teams
• Secondary: 60:40 o Establishing a helping-
• Tertiary: 65 :35 healing relationship
• Example:
o 48 nursing employees X .60 Effective communication
= 28.8 OR 29 professionals • Involves two distinct steps:
o 48 nursing employees X .40 o First, adequately articulating
= 19.2 OR 19 non- ideas
professionals. o Second, understanding the
Step 8: Distribute by shift – listening audience with whom
Professionals. one is communicating
• AM = 45 % (Rosenblatt & Davis, 2009).
• PM = 37 % • 7 Cs of effective communication
o Coherence
• NIGHT = 18 %
o Concreteness
• Example:
o Courtesy
o 29 X.45 = 13
o Correctness
o 29 X.37 = 11
o Clarity
o 29 X .18 = 5
o Confidence
o Conciseness
Distribute by shift – Non-professionals.
• AM = 45 %
Factors that Impact Communication
• PM = 37 % • Gender
• NIGHT = 18 % • Generation
• Example: • Culture
o 19 X .45 = 9
• Values and Perceptions
o 19 X.37 = 7
• Personal Space
o 19 X .18 = 3
• Environment
Evidence Based Nursing • Roles and Relationships
1. Decrease the use of 12-hour shifts.
2. Investigate ways to use ensure
nurses leave on time at the end of
the shift.
3. Decrease the use of overtime hours.

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Organizational Communication
• The goal of organizational
communication is to convey the
same message across the entire
system.
• Purpose: Facilitate communication
flow
• Lack of effective communication at
the organizational level can result in
conflict and poor adherence to
guidelines (Parboteeah et al., 2010;
Pavlakis et al., 2011).
Directions of Organizational
Communication
A. Downward communication
• Reflects the hierarchical nature of
the organization (e.g., the sending of
information by administrators to
nurse leaders and managers or by
nurse leaders and managers to
staff).
• Downward communication includes
directives to employees,
expectations for employees, and
performance feedback (Phillips,
2007; Sullivan, 2012).
B. Lateral communication
• Is the sharing of information among
nurse leaders and managers or
other staff at the same level.
• Examples of lateral communication
are coordination between:
o Units and services
o Information sharing
o Problem solving
o Conflict management
(Phillips, 2007)
C. Diagnonal Communication
• Communication with others in the
organization who are not on the
same level in the hierarchy.
• This occurs, for example, when a
nurse leader and manager
communicate with the chief financial
officer or the medical director
(Phillips, 2007).
D. Upward communication
• Is the sending of information up the
hierarchal chain (e.g., staff to the
nurse manager or leader, or nurse
leader and manager to higher- level
managers and administrators).
• Common instances of upward
communication:
o Requests for resources
o Sharing ideas or suggestions
for improvement
o Employee grievances
(Phillips, 2007; Sullivan,
2012).
SBAR (Situation, Background,
Assessment, Recommendation) Tool
• Is a verbal or written communication
tool that helps provide essential,
concise information, usually during
crucial situations. In some cases,
SBAR can even replace an
executive summary in a formal
report because it provides focused
and concise information.
• S – Situation
o A concise statement of the
problem
o Example: The patient has
been hospitalized with an
upper respiratory infection.
Respiration are labored and
have increased to 28 breaths
per minute within the past 30
minutes. Usual interventions
are ineffective.
• B – Background
o Pertinent and brief
information related to the
situation.
o Example: He had her left hip
replaced yesterday. He
started complaining of chest
pain about three hours ago.
His pulse is 155, blood
pressure 134 over 57, is
restless and short of breath.
• A – Assessment
o Is a technique that helps
communicate essential and
concise information
especially in critical situations
between members of the
health care team about a
patients’ condition.
o Can improve safety,
teamwork, and accuracy in
health care settings.
o Example: Diagnostic X-rays
reveal hip fracture, physical
examination shows bruising
on thigh, skin intact. Patient
reports mild pain, morphine
administered at 01:00 by ER
staff.
• R – Recommendation
o Action
requested/recommended —
what you want.
o Example: Physician
consultation with surgeon
scheduled for this morning.
Continue monitoring for pain,
follow-up with surgeon
regarding next steps.
Handover Communication
• Is a term that isn't new to the
healthcare profession. It implies that
there's a sharing or transfer of
information and knowledge along
with authority and responsibility
among healthcare providers.
• It refers to the ability for the
subscriber to have an active session
in progress (e.g., voice call)
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• Importance - Improve patient care
outcomes, prevent adverse events
during care and reduce
readmissions to hospital after
discharge.
Bedside Handover
• Bedside handover is a strategy to
improve communication accuracy
during handovers so nurses can
share information between them,
involve patients in nursing care, and
improve patient's environment
safety.
Charting
• Is the process of documenting the
patient’s information, condition,
progress and care.
• This serves as a permanent record
for the patient and the health care
team, as legal evidence in case of
complaints or malpractice claims.
FDAR (Focus, Data, Action and
Response).
• Each category represents the
following information.
• Focus charting assists nurses on
documenting patient records by
providing a systematic template for
each patient and their specific
concerns and strengths to be the
focus of care.
Evidence Based Practices in Nursing
Management
Nursing Standards
• Nursing standards as guide to the
knowledge, skills, judgement and
attitudes that are needed to practice
safely. They reflect a desired and
achievable level of performance
against which actual performance
can be compared.
• RN Association of British Columbia
and the College of Nurses of Ontario
Types of Nursing Standards
• Standards are used to monitor and
measure performance of nursing
care services. These services are
then compared and evaluated
against the standards through
records, reports and observations.
1. Structure Standards
• Standards that focus on the
structure or management system
used by an agency to organize and
deliver nursing care, including the
number and categories of nursing
personnel who provide that care.
• (e.g., A team leader is responsible
for no more than 20 patients, with no
fewer than 3 team members to
provide care).
2. Process Standards
• Standards that refer to actual
nursing care procedures or those
activities engaged in by nurses to
administer care.
3. Outcme Standards
• These are standards that are
designed for measuring the results
of nursing care.
• Other means of monitoring and
measuring include Conflict
Management, Budgeting and
Discipline.
Challenges in Nursing Profession
• Complexity of globalization
• Dynamics of information technology
• Demographic changes
• Health care reforms
• Increasing demaands for quality
nursing care from consumers
Key Areas of Responsibilitiy
1. Ethico-moral responsibility
2. Legal responsibility
3. Communication
4. Safe quality care
5. Health education
6. Collaboration and teamwork
7. Record management
8. Management of resources and
environment
9. Research
10. Quality improvement
2021 Standards of Professional
Performance
• Ethics - The registered nurse
integrates ethics in all aspects of
practice.
• Advocacy - The registered nurse
demonstrates advocacy in all roles
and settings.
• Respectful and Equitable Practice
- The registered nurse practices with
cultural humility and inclusiveness.
• Communication - The registered
nurse communicates effectively in all
areas of professional practice.
• Collaboration - The registered
nurse collaborates with the health
care consumer and other key
stakeholders.
• Leadership - The registered nurse
leads within the profession and
practice setting.
• Education - The registered nurse
seeks knowledge and competence
that reflects current nursing practice
and promotes futuristic thinking.
• Scholarly Inquiry - The registered
nurse integrates scholarship,
evidence, and research findings into
practice.
• Quality of Practice - The registered
nurse contributes to quality nursing
practice.
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 NCM NLM
• Professional Practice Evaluation -
The registered nurse evaluates
one’s own and others’ nursing
practice.
• Resource Stewardship - The
registered nurse utilizes appropriate
resources to plan, provide, and
sustain evidence-based nursing
services that are safe, effective,
financially responsible, and
judiciously used.
• Environmental Health - The
registered nurse practices in a
manner that advances
environmental safety and health.
Dimensions are built around the core
need for health care to be:
• Safe
• Effective
• Patient-centered
• Timely
• Efficient
• Equitable
What can Nurse Leaders do to facilitate
Quality Improvement & promote Patient
Safety?
• Improve performance
• Engage others
• Rpomote a “just culture”
• Manage risks
• Measure and monitor performance
• Apply for accreditation
• Adhere to IPSG’s
National Nursing Care Competency
Standards
• Board of Nursing Resolution no. 112
Series 0f 2005, adopted and
promulgated the Core Competency
Standards of Nursing Practice in the
Philippines.
• Utilized effectively in:
o Nursing education
o Nursing licensure
examination
o Nursing service
Revisiting Project
• Created in 2009 by PRBON
• A joint collaboration of CHED and
BON (Task Force on Nursing Core
Competencies).
• Goal - etermining the relevance of
the current nursing core
competencies to expected roles of
the nurse and to its current and
future work setting.
• 2009 Revisiting Project Process:
o Work setting scenario
analysis
o Benchmarking with nursing
core competencies of other
countries
o Validation studies of 3 roles
and responsibilities
o Integrative review of outputs
from validation strategies,
presentations of validation
analysis
o Core competency
consensual validation
NNCCS Nurse’s Role
• Beginning nurse’s role on client care
• Beginning nurse’s role on
manangment and leadership
• Beginning nurse’s role on research
PRBON
• Article III, section 9 (c) of Republic
Act No. 9173 Philippine Nursing Act
of 2002
• Is empowered to monitor and
enforce quality standards of nursing
practice in the Philippines.
• They exercise the powers necessary
to ensure the maintenance of
efficient, ethical and technical, moral
and professional standards in the
practice of nursing taking into
account the health needs of the
nation.
NNCCS 10 Key Phases
1. Phase I – Work setting scenario
analysis
2. Phase II – Validation studies of roles
and responsibilities/ Benchmarking
3. Phase III – Integrative review of
outputs from the validation
strategies.
4. Phase IV – Consensual Validation of
Core Competency Standards
5. Phase V– Conduct of Public hearing
6. Phase VI – Promulgation of the
Revised and Modified Core
Competency Standards
7. Phase VII – Printing of the Revised
and Modified core competency
Standards (2012 NNCCS)
8. Phase VIII – Training in the
implementation of the 2012 National
Nursing Core Competency
Standards
9. Phase IX – Implementation of the
2012 National Nursing Core
Competency Standards
10. Phase X – Evaluation of the
effectiveness of the 2012 National
Nursing Core Competency
Standards
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For The Beginning Nurses' Role on
Client Care, there are 5 responsibilities:
Philippine Professional Nursing Practice
Standards
• Article III, Sec 4 (H) RA 7164 Phil
Nursing Act of 1991
o Provides power to PRBON
which includes the power
to promulgate or adopt
measures as may be
necessary for the
improvement of the nursing
practice and for the
advancement of the
profession.
o September 1994 - PRBON
had a meeting with PNA
nursing leaders, ASAP and
Other National nursing
organizations and groups.
o September 1998 - PRBON
Resolution No. 82 was
issued - which adopted and
promulgated the Standards.
• Philippine Professional Nursing
Practice Standards (PPNPS)
o PPNPS are authoritative
statements of the duties that
all registered nurses,
regardless of role, population
or specialty are expected to
perform competency. (ANA
2010)
o ANA further states that the
standards can change as the
dynamics of professional
nursing evolve and the
specific clinical
circumstances or conditions
might affect the application of
the standards at any given
time.
• Philippine Nursing Act of 2002 RA
9173
o The primary purpose of the
standards is to promote,
guide, and direct professional
nursing practice.
o Standards will be useful to
the following:
▪ Professional nurse
▪ Employers
▪ Rnusing education
leaders
▪ Public
▪ PRBON
• National Policy on Patient Safety
(Administrative Order 2008-0023)
• Obiectives:
o To establish a
comprehensive patient safety
program in all levels of the
health care delivery system
through effective
governance.
o To develop the critical
capacity of the health care
workers in the health facilities
for the implementation of
standards, guidelines,
systems, training programs,
relative to patient safety.
o To sustain and continuously
improve mechanisms that
nurtures a culture of safety
through appropriate
strategies.
Patient Care Safety Standards
• Patient Safety Program
o The implementation of the
Patient Safety Program for all
facilities shall be anchored
on both DOH licensing and
PHIC accreditation
standards.
The key priority areas in patient safety
include but not limited to:
• Proper patient identification
• Assurnce of blood safety
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• Safe clinical and surgical procedures
• Provision and maintinance of safe
quality drugs and technology
• Strengthening of infection control
standards
• Maintinance of the environemnt care
standards
• Energy and waste manangment
standards
Standards of Nursing Practice
The Joint Commission
• Was formerly the joint commission
on accreditation of healthcare
organizations (JCAHO) and previous
to that the joint commission on
accreditation of hospitals (JCAH).
• Non-profit Organization in the
healthcare industry
• Founded in 1951
• Headquarters in Illinois, USA
• Mission Worldwide
o Helping to improve the
quality of patient care;
assisting international health
care organizations, public
health agencies, health
ministries, and others in
evaluating, improving, and
demonstrating the quality of
patient care; and enhancing
patient safety in more than
60 countries.
• The purpose of The Joint
Commission's National Patient
Safety Goals (NPSGs) is to promote
specific improvements in patient
safety.
• The NPSGs highlight problematic
areas in health care and describe
evidence and expert-based solutions
to these problems.
International Patient Safety Goals
(IPSGs)
Joint Commission International
• Established in 1998 as a
division of Joint
Commission
Resources, inc. (JCR), a
not-for-profit, private affiliate
of the Joint Commission.
• The goals were adapted
from the JCAHO's
National Patient Safety
Goals.
• Compliance with IPSG
has been monitore
JCI accredited hospitals in
the Philippines:
• The Medical City
• St. Luke's Medical
Center
• Makati Medical Center
Questions
• How do you Identify your patients
correctly?
• How do you make sure it is the
right Patient?
• What will you do in case the
patient doesn’t have ID with him
• What are the common IPSG 1
Violations nurses do in the
Philippine Practice Setting
Hospital or Community?
Goals
Identify Patient Correctly
• The Goal is two fold: First,
to reliably identify the
individual as a person for
whom the service is
intended. Second, to
match the service or
treatment to that individual.
• Identifiers:
o Patient’s Medical
Record
o Patient’s Identification
Band
o Electronic Medical
Record
o Patient’s Registration
Card
Improve Effective Communication
A. Verbal Orders are reserved for
Urgent/ Emergent situation
ONLY.
B. Read back procedure for the
receipt of Laboratory or
Radiology Results.
C. Develop and implement process
for Handover communication
Improve the Safety of High-Alert
Medication
• High- Alert Medications – are
medications that bear a
heightened risk of causing
significant patient harm when
they are used in error.
• LASA/ Look-Alike and Sound-
Alike Medication – are
medications whose names or
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packages, sound or look similar
to other drug names or packages.
o ✓ Independent Double
Checking
o ✓ Rights of Medication
Administration
o ✓ HAMS stored in High
Alert Bins with
standardized
Medication Label.
• Controlled Substances and
Narcotics, Concentrated
Electrolytes
o ✓ Kept in locked
Cupboard
o ✓ High Alert Label
Ensure Correct-Site, Correct-
Procedure, Correct-Patient Surgery
• Wrong site, wrong procedure,
wrong patient surgery errors are
the result of ineffective or
inadequate communication
between members of the surgical
team, lack of patient involvement
in site marking, and lack of
procedures for verifying the
operative site.
o ✓ The essential Process
found in the Universal
Protocol are:
o ✓ Marking the surgical
site
o ✓ A pre-operative
verification process
o ✓ Time-out that is held
immediately before the
start of a procedure.
• Time-out — is the full
verification that is performed
immediately prior to the
induction of anesthesia or the
start of an invasive procedure
when the entire care team
actively and verbally confirms:
o Patient’s identity
o Procedure to be
performed
o Correct procedure side
or site
o Necessary imaging,
equipments, implants,
or special requirements
are present.
• It is also applicable for invasive
and other proceures performed
outside the OR
Reduce the Risk of Health Care
Associated Infection
• ✓ Implement evidence-based
Hand Hygiene guidelines to
reduce the risk of HAIs.
• ✓ Follow WHO Guidelines of
Hand Hygiene in Health care
2009
• ✓ Alcohol Based Hand Rub
• ✓ Hand Washing with Soap
and Water
Reduce the Risk of Patient Harm
Resulting from Fall
JCI Requirements:
• The Hospital must implement a
process for assessing all in
• patients and those outpatients
whose condition, diagnosis,
situation (such as arriving by
ambulance, patient transfers
from wheelchairs or location
such as PT dept. ) identifies
them as High Risk for Falls.
• The Hospital must implement a
process for the Initial and
ongoing assessment,
reassessment, and intervention
of inpatients and outpatients
identified as at risk for falls
based on documented criteria.
• Measures are implemented to
reduce fall risks for those
identified Patients, Situations,
and Locations assessed to be at
risk.
• Nursing Staff Responsibilities on
Fall Prevention:
o ✓ Assess
o ✓ Identify risk
o ✓ Environmental
check
o ✓ Footwear
o ✓ Education
o ✓ NCPs
Noelle Lessette Jacintha Fabila, SN