Organizing/ Staffing

Organizing
 is the grouping of activities for the purposes of achieving
the objectives, the assignment of such groupings to
manager with authority for supervising each group, and
the defined means of coordinating appropriate activities
with other units, horizontally and vertically, that are
responsible for accomplishing organizational objectives.
 Is one way in which nursing management coordinates the
various activities of a department or a unit so that the staff
can get its work done in an orderly fashion.
 Organizing means having qualified people and the right
materials, information, and equipment needed to deal with
contingencies.
Steps in Organizing
Koontz (1986) describes six steps in organizing:
1. Establishing enterprise objectives
2. Formulating supporting objectives, policies and plans.
3. Identifying and classifying activities necessary to
accomplish the objectives of the enterprise.
4. Grouping these activities in the light of human material
resources available and the best way, under the
circumstances, of using them.
5. Delegating the head of each group the authority
necessary to perform the activities.
6. Tying together the group horizontally and vertically,
through authority relationships and information flows.
Development of Mission, Philosophy and
Objectives

Mission/ Purpose- describes what it will be

and what it should be . It describes the
constituencies to be satisfied. It is the
professional nurses manager’s
commitment to a specific definition of
purpose or mission.
Philosophy- states the beliefs that influence
nursing practice and beliefs about
healthcare and the vision of the nursing
department and how the mission and
purpose the nursing departments will be
achieved.
Objectives- are concrete and specific statements
of goals that the nurse manager of the
department of nursing plans to accomplish.
They are action commitments through which
the mission or purpose will be achieved and
the philosophy or beliefs sustained. They are
used to establish priorities. They should be
stated in terms of results to be achieved and
should focus on the production of health care
services to clients.
Development of Organizational Charts
Organizational Chart – it indicates clearly who has the
legitimate power to make decisions and who should give
and receive directions.
Characteristics of an Organization
1. Goals
Every organization has a specific purpose expressed in
terms of set of goals.
eg. Nursing service- To provide quality nursing care
To produce the highest quality care
2. People
Organizations are consists of people who work together in
a distinct way.
3. Structure- it defines and limits the behavior of
organizational members. Rules and regulations in the
structure are created in order to identify some members
as supervisors to give them authority over our
employees and to explicitly describe every member’s
job to eliminate confusion on what to be expected.
4. Cultures
It refers to the personality of the organization. It
reflective of the values, symbols and rituals, myths,
and work practices that are common to every
organizational member. It tells how each member will
behave in the organization.
5. Job
The kind of job that every employee performs plays a
very significant part in influencing behavior at work.
The features of the job itself plays an important role in
defining an employee’s work behvior and may lead
him to his job satisfaction.

6. Supervision
Every organization has its management personnel.
Creating positive work environments by the supervisor
lead to an improved performance and job satisfaction.
Factors affecting the Organizational
Structure and Productivity
1. The presence of increasing demands and
expectations from other professional groups and
departments, originating from hospital
administration and physicians to the younger
generation of employees and labor unions.
2. The emergence of a new period of stress and
transition in the nursing profession itself as leaders
work to sway legislation affecting licensure,
minimize intergroup dichotomy and fractionalization
within the profession and unified various sources of
power so that nursing communicates with stronger,
more expressive voice.
Factors affecting the Organizational
Structure and Productivity

3. The complexity of meeting numerous clinical

demands because of technological innovations
affecting patient care.
4. The ever- increasing requirements of
governmental, accrediting, educational,
institutional, insuring and related agencies.
5. The critical need for cost containment through
operational effectiveness in all areas.
Factors affecting the Organizational
Structure and Productivity

6. The decreasing efficiency of nursing’s role in the

delivery and management of patient care.
7. The seemingly more defined program toward
prevention rather than cure per se in healthcare.
8. The prevalence of movement of human rights
movement with all of its manifestations- whose
members are consumers, patients, employees, students,
union members, managers, educators, doctors, nurses,
and all other interrelated groups of people.
Organizational Types of Authorities
1. Line Authority
It is the authority that entitles a supervisor to direct an
individual’s work. It is the traditional employer-
employee authority relationship that emanates from
the top of the organization to the worker population,
following what is called the chain of command.
2. Staff Authority
It is the authority in positions created to support, assist,
recommend and generally reduces the supervisor’s
informational responsibilities.
Development of Department Policies and
Procedures
Policies- are guidelines to help in the safe and efficient
achievement of organizational objectives.
Procedures- are specific directions for implementing
written policies.
Four (4) principles in giving direct patient care
1. Safety of the patient
2. Comfort of the patient while care is made effective
3. The proper use and care of supplies and equipment
4. Good workmanship on the part of the person doing the
technique.
Suggestions in Developing Procedures

1. Analyze each motion or step for efficiency, safety,

comfort and therapeutic effectiveness for the patient.
2. List each action in the order of performance. Place
necessary precaution as notes either beneath each
step or in a separate column.
3. Word directions clearly and concisely, making them
easy to understand.
4. Include complete directions for the preparation of the
patient and equipment and for necessary care and
follow-up of the patient after a procedure is
completed. Include also observations concerning the
response of the patient and record those observations.
Nursing Department Policy Manual

- It contains pertinent information about the organization

and functions of the department, policies and
procedures, and directives that may be used as a guide
for the nurse manager in implementing the policies.
 It is a tool for orienting staff or new employees and a
reference guide when problems or conflicts arise.

Suggestions in writing Policies and organizing them

into a Manual
1. Use concise, simple language, keep it easy to
understand and next to impossible to misunderstand.
2. Remember that policies are guides for making
decisions about what to do, so keep them realistic and
truly reflective of the objectives of the department.
3. Organize the manual as simply as possible, so it will be
easy to use. Give thought to indexing, to dating entries,
and to the need for keeping the manual up-to-date.
Provide for incorporating policy changes into the
manual.
4. Plan for periodic review of policies, and set up a
timetable for such review.
5. In reviewing, evaluating effectiveness and workability;
review experiences of personnel in carrying out the
policies, and verify that policies are being followed.
6. Be objective about changes. Don’t let policies become
sacred.
7. When charges are made, inform all personnel.
Development of Job Description
Job Description
 are guides for the nurse manager in delegating and assigning of
duties.
 a written account of the organizational relationships, responsibilities,
specific duties and working conditions of particular job.
 details the qualifications such as education, experience, and skills
required for appointment and a resume of duties delegated to the
position by top management.
In developing job description, a job evaluation should first be
conducted.
Job Evaluation
 Is the systematic method of appraising the work of each job in
relation to all other jobs in the organization.
 The first step in job evaluation is Job Analysis
Job Analysis
- Is the process of investigating each job from two
standpoints:
a. Duties and responsibilities associated with the job
b. The skills and personal attributes required to perform
the job satisfactorily.
After the job has been analyzed, the job description can
now be written. It should be written in a standard form
describing the principal duties and scope of
responsibility of the worker. A simple and direct
narrative style is preferred.
Staffing
 Is the process of determining and providing the acceptable
number and mix of nursing personnel to produce a desired level
of care and to meet the patient’s demand for care.
 The staffing process involves the selection of qualified and
competent personnel, a system of assignment and staffing
schedules.

Selection of Personnel
Steps:
1. Recruitment
2. Screening
3. Interview
4. Orientation
1. Recruitment

 The process of enlisting personnel for employment.

 Methods of recruitment: advertising, word of mouth,
employee recommendation.
2. Screening
Three (3) philosophies to observe during screening
process:
a. Screen out applicants who do not fit the image of the
agency.
b. Try to fit the job to a promising applicant
c. Usually, try to fit the applicants to the job.
- The applicant usually submits a biographical data
(personal history, educational hx, work experience)
3. Interview- to obtain further information about the
applicant, to give information, and to determine if the
applicant qualifies for the position.
 Some: series of test- aptitude test, personality and
psychomotor test.
4. Orientation- to assist and introduce the nurse to her new
job. It is a process of becoming familiar with a new
environment and adopting well to it. This reduces anxiety
and misunderstandings.
- A well-designed orientation program would include:
a tour of the physical facilities, introduction to co-
workers, description of the org. structure, information on
the philosophy, goals, policies and standards of the
institution & functions of the members of the health team
Patient Classification System

 A means of categorizing present patients on the basis of

certain care needs that can be clinically observed by the
nurse.
 This serves as a basis for planning the staffing needs of
patients.
Categories of Patient Classification System
Category 1- Minimal Care
- given to patients who are convalescing and who no longer
require intensive, moderate or maximum care. These patients
still may need supervision by a nurse in the course of a day,
even if only at infrequent intervals.
eg. those who require diagnostic test, minimal therapy,
awaiting elective surgery
Category II- Moderate Care
- given to patients who are moderately ill or are recovering
from the immediate effects of a serious illness and/ or an
operation.
eg. Patients requiring some assistance related to ambulating
and caring of there own hygiene
Categories of Patient Classification
System
Category III- Maximum Care
- given to patients who need close attention throughout
the shift, that is, complete care for patients who require
nursing to initiate, supervise, and perform most of their
activities or who require frequent and complex
medication or treatment.
Category IV- Intensive Care
- Given to acutely ill patients who have a high level of
nurse dependency, including those requiring intensive
therapy and/ or intensive nursing care and whose
unstable condition requires frequent evaluation with
adjustment of therapy.
Staffing Formula
Example:
Find the number of nursing personnel needed for 100 patients in a secondary
hospital.
1. Categorize patients according to levels of care.
100 patients X 0.65= 65 patients needing minimal care
100 patients X 0.30= 30 patients needing moderate care
100 patients X 0.05= 5 patients needing intensive care
2. Find the number of nursing care hours (NCH) needed per day at Level
I,II,III
Given: Level 1- Minimal care: 1.5 NCH needed per patient/ day
Level II- Moderate care: 3.0
Level III- Intensive care : 4.5
Level I- 65 X 1.5= 97.5 NCH needed by 65 patients
Level II- 30 X 3 = 90 NCH needed by 30 patients
Level III- 5 X 4.5 = 22.5 NCH needed by 5 patients
210 NCH
3. Find the actual number of NCH needed by 100 patients per year
210 X 365= 76,650 total NCH needed by 100 patients/ year

4. Find the number of personnel needed.

a. 76,650 NCH per year
1,729 ( working hours per year for 216 working days at 40 hours per
week)
= 44 nursing personnel
b. 44 X 0.95/ 10= 4.18 or 4 nursing personnel as relievers
Note: Total average of absences of an employee is 35 days per year. This

includes vacation, sick leaves and holidays

Therefore, 35/ 365 days= 0.95 relief needed
c. 44 + 4 = 48 total nursing personnel needed
5. Categorize into professional and non- professional
44 X .60 = 26 nurses
44 X .40 = 17 nursing attendants
6. Distribute by shifts
Nurses Nursing Attendants
26 X 0.45 = 12 nurses 17 X 0.45 = 8 nursing attendants
26 X 0.37= 10 nurses 17 X 0.37 = 6 nursing attendants
26 X 0.18 = 4 nurses 17 X 0.18 = 3 nursing attendants

Note: 45% morning shift

37% afternoon shift
18% night shift
Compute

Compute for the number of staff for

350 bed capacity tertiary hospital, with 500
patients
Scheduling
 are to assign working days and days off to individual
members of the nursing staff in order to:

-provide adequate patient care while avoiding overstaffing

-achieve a desirable distribution of off days
-treat individual members of the nursing staff fairly
let the personnel know in advance what their schedules
are
Guidelines to observe in preparing the schedule

1. Let it represent a balance between the needs of the

employee and the employer. When conflicts arise, patient
care should have priority.
2. Distribute fairly the “good” and “ bad” days off among all
employees.
3. Make all employees adhere to the established rotation.
Exceptions should be rare and granted only if the
employee is requesting two weekdays off (working every
weekend). All requests and exceptions should be in writing
and should specify the period of time off requested.
4. Advance posting of time schedules so as to allow
employees plan for their personal lives. Doing so reduces
absenteeism and requests for changes.
5. Do not make time schedules a mystery nor use them as a
tool of control or discipline.
6. Come up with a mechanism for emergency changes to
accommodate both employee and employer.
7. Make schedule conform with all labor laws, and hospital
and department policies.
8. Provide correct numbers and mix of personnel, allowing
continuity, which is essential for quality care.
9. Be consistent in scheduling to enable work groups
develop team work, which contributes to quality care.
Types of Scheduling
1. Centralized Scheduling
- is based on a master staffing pattern that is carried out
by one person who plans and coordinates the schedule
of the nurses.
2. Decentralized Scheduling
- allows the nurse manager to staff his or her own unit.
3. Self- Scheduling
- the staff nurse in the unit collectively decide and
implement the monthly work schedule. Given the
criteria for adequate unit staffing for each 24-hour
period by the head nurse, each staff nurse chooses which
day and shift he or she will work.