University of Bohol College of Nursing

ORGANIZATION
MANAGEMENT FUNCTION
 DISCLAIMER

► This presentation is intended for educational purposes only and do not replace
independent professional judgment. Information herein presented are taken
from the following resources:
Leadership and Management in Nursing, A Transformative and Reflective
Patient Care 1st Edition by Tan & Beltran
Marquis, B. L., Huston, C. J. (2015). Leadership roles and management
functions in nursing: theory and application, 9th ed.

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 Definition

►It is the process of identifying and grouping the work to

be performed, defining and delegating responsibility and
authority, and establishing relationships for the purpose of
enabling the people to work most effectively together in
accomplishing objectives.

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 Organization as a Process

1. Identification and definition of basic task.

2. Delegation
3. Establishing relationships

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 Organization as a Structure

1. Objectives and plans

2. Centers of authority
3. Environment within which it is to function
4. Quality of available manpower to run it.

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 Categories

► 1. Formal Organization – a system of well-defined jobs, each with a

measure of authority and responsibility and accountability.
► 2. Informal Organization – refers largely to what people do because
they are human personalities and to their actions in terms of needs,
emotions and attitudes and not in terms of procedures and
regulations.

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 ORGANIZATIONAL THEORY

Characteristics of Bureaucracy by Weber:

1. There must be a clear division of labor
2. A well-defined hierarchy of authority must exist in which superiors are separated from
subordinates
3. There must be impersonal rules and impersonality of interpersonal relationships.
4. A system of procedures for dealing with work situations (i.e., regular activities to get a job done)
must exist.
5. A system of rules covering the rights and duties of each position must be in place.
6. Selection for employment and promotion is based on technical competence.

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 Characteristics

►Division of work
►Chain of command
►Types of work segments
►Levels of management

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 MANAGERIAL LEVELS

► Top-level managers look at the organization as a whole,

coordinating internal and external influences, and generally
make decisions with few guidelines or structures.
► Middle-level managers coordinate the efforts of lower levels of
the hierarchy and are the conduit between lower and top-level
managers.
► First-level managers are concerned with their specific unit’s
workflow.

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 Organizational Design

► A process used to improve the probability that an organization will be

successful. It is a formal, guided process for integrating the people,
information and technology of an organization.
► It is used to match the purposes with the operations undertaken and
improve collective efforts of members to ensure success
► It is guided by external facilitators whose role is to assure a systematic
process and to encourage creative thinking.

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 Principles of Organizational Design

1. Division of labor
2. Unity of Command
3. Authority and responsibility
4. Span of control
5. Contingency Factors

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 Organizational Structure

►It is a formal structure, the official arrangement of

positions or working relationships that will coordinate
efforts of workers or diverse interest and abilities.

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 Patterns of Organizational Structure

►Tall or Centralized Structure

►Flat or Decentralized

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 Types of Organizational Structure

► Line organization/Bureaucratic/Pyramidal
► Flat organization
► Staff organization
► Functional organization
► Ad Hoc organization
► Matrix Organization
► Shared Governance organization
► Lateral organization
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 Organizational Relationships

►Formal – represented by uninterrupted lines between

units, showing who reports to whom
►Informal – represented by a broken line or dotted line
where power relationships are coordinated.

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 Organizational Culture

►The personality of the organization comprised of the

assumptions, values, norms and tangible signs of the
corporation, as well as its attitudes, feelings, beliefs, norms
and customs.
►Is a system of symbols and interactions unique to each
organization. It is the ways of thinking, behaving, and
believing that members of a unit have in common.

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 Staffing

►Process of assigning competent people to fill the roles

designated for the organizational structure through
recruitment, selection and development.
►Apart from recruitment, selection and hiring, this also
includes induction and orientation of the new staff.

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 Predicting Staffing Needs

► Accurately predicting staffing needs is a crucial management

skill because it enables the manager to avoid staffing crises.
► Managers should know the source of their nursing pool, the
number of students enrolled in local nursing schools, the usual
length of employment of newly hired staff, peak staff
resignation periods, and times when the patient census is
highest.

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 Steps in Staffing

►1. Determine the number and types of personnel needed

►2. Recruit personnel
►3. Interview
►4. Induct or Orient the Personnel (indoctrination)
►5. Job Offer

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 Job Description

► Specifications of duties, conditions and requirements of a particular

job prepared through careful job analysis.
► Includes:
1. Job title
2. Job relationships
3. Performance descriptions

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 Terminologies

► Recruitment is the process of actively seeking out or attracting applicants

for existing positions and should be an ongoing process.
► An interview may be defined as a verbal interaction between individuals
for a particular purpose.
► Selection is the process of choosing from among applicants the best
qualified individual or individuals for a particular job or position.

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 Terminologies

► Indoctrination refers to the planned, guided adjustment of an employee

to the organization and the work environment.
► The induction process includes all activities that educate the new
employee about the organization and employment and personnel
policies and procedures.
► Induction provides the employee with general information about the
organization, whereas orientation activities are more specific for the
position

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 Staffing and Scheduling as Unit Manager’s
Responsibility

► The requirement for night, evening, weekend, and holiday work that is
frequently necessary in health-care organizations can be stressful and
frustrating.
► Managers should do what they can to see that employees feel they have some
control over scheduling, shift options, and staffing policies

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 Common Staffing and Scheduling Options

► 10- or 12-hour shifts

► Premium pay for weekend work (Agency or Travel Nurses)
► Part-time staffing pool for weekend shifts and holidays.
► Cyclical staffing, which allows long-term knowledge of future work
schedules because a set staffing pattern is repeated every few weeks.
► Job sharing

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 Common Staffing and Scheduling Options

► Allowing nurses to exchange hours of work among themselves

► Flextime is a system that allows employees to select the time schedules that best meet
their personal needs while still meeting work responsibilities.
► Use of supplemental staffing from outside registries and float pools
► Staff self-scheduling allows nurses in a unit to work together to construct their own
schedules rather than have schedules created by management.
► Shift bidding, which allows nurses to bid for shifts rather than requiring mandatory
overtime

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 STAFFING PATTERN

► Is a plan that articulates how many and what kind of staff are needed by shift
and day to staff a unit or department.
► Considerations is developing staffing patterns:
1. Benchmarking
2. Regulatory Requirements (RA 5901) – staffing mandates
3. Skill mix
4. Staff Support
5. Historical information
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 Factors affecting time requirement for nursing
care

►1. Acuity of the patient’s illness

►2. Degree of dependence of the patients on caregivers
►3. Communicability of the ailment
►4. Rehabilitation needs and special treatments and
procedures

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 Formula to determine staffing patterns

1. Full time Equivalents (FTE) – it measures the work commitment of a full time
employee. (5 days a week, 40 hours a week for 52 weeks in a year)

X = Total Nursing Care Hours x days in a year

Total annual hours per one FTE

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2. Forty Hour Week Law (RA 5901)

Average Bed Occupancy x Nursing Care hours = Total No. of personnel in 24

No. of Working Hours hours

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 40 hour week law

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

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

Area Ration
Surgery 60:40
Gen. Ward 60:40
OB 60:40
Pedia 70:30
Nursery 55:45
ICU 80:20

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 Rights/Privileges of Working hours Per week
Personnel
40 hours 48 hours

c. Distribution per Shift Vacation leave 15 15

Shifts: Sick leave 15 15

AM =45% holidays 12 12
continuing 3 3
PM =37%
Off duties 104 52
NOC = 18%
Total non working 149 97
days/year
Total working 216 268
days/year
TOTAL 1,728 2,144
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 d. 40 hour / week – for personnel working in hospitals with 100 bed
capacity or over or which is located in a 1 million population

e. 48 hour / week – personnel who work in agencies with lesser bed

capacity or which are located in communities with less than 1 million
population

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 GUIDELINES for determining the Nursing
personnel need

► Determine type of hospital (primary, secondary or tertiary)

e.g : Hospital A is a 100 bed capacity secondary level hospital

► Categorize patients according to levels of care

category primary secondary tertiary

Minimal care 70% 65% 35%

100 pts x 65% = 65 pts needing minimal care
Intermediate care 25% 30% 45% 100 pts x 30% = 30 pts needing intermediate care
100 pts x 5% = 5 pts needing intensive care
Intensive care 5% 5% 20%

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 ► Find the NCH needed by patients per day and get the SUM
Minimal Care = 1.5 hours Minimal care = 65 x 1.5 hrs = 97.5 NCH
Intermediate care = 30 x 3 hrs = 90 NCH
Intermediate Care = 3 hours Intensive care = 5 x 4.5 hrs = 22.5 NCH
TOTAL: 210 NCH/day
Intensive Care = 4.5 hours
► Find the Total NCH x 365 days (210 NCH per day x 365 days = 76, 650 NCH in a year)

► Find the number of working hours per year (refer to table 40 wk Law)
40 hrs/wk = 215 x 8 hours = 1,728 working hours/yr

48 hrs/wk = 268 x 8 hours = 2,144 working hours/yr

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► Find the Nursing personnel needed.

Number of needed personnel = NCH per year 76, 650 NCH/yr = 44 nursing personnel
1,728 wrk hrs/yr (40 h /wk)
Working hours per year
Number of relievers needed = No. of personnel x 0.095 44 nursing personnel x 0.095 =
4 nursing relievers

► Add nursing personnel and relievers

44 nursing personnel + 4 relievers =
48 nursing employees

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 ► Categorize into professional and non-professional
Primary = 55.45 48 x .60 = 26 (professionals)
48 x . 40 = 18 (non-professionals)
Secondary = 60:40
Tertiary = 65:35
► Distribute by shifts.
AM = 45% Professionals: Non-Professionals:
26 x .45 = 12 (AM) 18 x .45 = 8 (AM)
PM = 37% 26 x .37 = 10 (PM) 18 x .37 = 7 (PM)
26 x .18 = 5 (NOC) 18 x .18 = 3 (NOC)
NOC = 18%

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 Patient Classification System

► Is the measurement tool used to articulate the nursing workload for a

specific patient or group of patients over a specific period of time.
► PCSs are institution specific and must be modified to reflect the unique
staff and patient population of each health-care organization.
1. Self care or minimal care patients
2. Intermediate or moderate care
3. Total care patients
4. Intensive care patients

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 Nursing Care Models

►Is the framework of nursing care delivery in any setting that

meets the particular needs of a group of health care givers
and clients.

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 Case Method or Total Patient Care

►Nurses assume total responsibility during their time on

duty for meeting all the needs of assigned patients.
►The goal of this system is to have one nurse give all care
to the same patients for the entire shift.

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University of Bohol College of Nursing
 Advantages & Disadvantages

► Advantages:
1. Continuity of holistic, unfragmented care
2. Needs are closely monitored, rapport is established, security of family
3. Provide nurses with high autonomy and responsibility
► Disadvantages:
1. The patient could receive different approaches to care in every shift, leading to confusion
2. This requires highly skilled personnel thus may cost more
3. Some tasks can be done more cost effectively by less skilled person.

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 Functional Method

► Also called Task Nursing, developed in response to a national

nursing shortage.
► The needs of the group of patients are broken down into tasks,
which are assigned to RNs, LPNs or nursing aides so that the skill
and licensure of each caregiver is used to the best advantage.
► RNs become managers of care rather than direct care providers

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University of Bohol College of Nursing
 Advantages and Disadvantages

► Advantages:
1. Nurses become skilled in performing assigned tasks
2. Less equipment needed, more economical to administrators
3. Time is saved, efficiency – task is completed quickly
4. Task oriented approach improves both productivity and organization.
Disadvantages:
5. Cannot establish rapport, patients cannot identify their nurse
6. Low job satisfaction – (under-stimulated in their roles)
7. Fragmented care and overlooked priority needs
8. Employees are focused only on their own efforts, with less interest in over all results

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 Team or Modular Nursing

► A team of nursing personnel provides total patient care to a group

of patients.
► Ancillary personnel collaborate in providing care to a group of
patients under the direction of a professional nurse.
► Through extensive team communication, comprehensive care can
be provided for patients despite a high proportion of ancillary staff.

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University of Bohol College of Nursing
 Advantages and Disadvantages

► Advantage:
1. Democratic Leadership
2. Members contribute their own expertise or skills leading to high job satisfaction
Disadvantages:
3. Improper implementation
4. Insufficient time for team care planning and communication leading to blurred line of
responsibilities, errors and fragmented care.

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 Primary Nursing

► Bedside nursing care, relationship based nursing

► This requires a nursing staff made up of only RNs
► The nurse assumes 24 hour responsibility for planning the care of one or more patients from
admission to discharge. During working hours, he/she provides total direct care for that
patient
► When the primary nurse is not on duty, associate nurses, who follow the care plan
established by the primary nurse, provide care.

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University of Bohol College of Nursing
 Advantages and disadvantages

Advantages:
1. ARA is increased.
2. Nurse uses a wide range of skills knowledge and expertise and develops creativity.
3. Combination of clear interdisciplinary group communication and consistent direct patient care by relatively few
nursing staff allows for holistic high-quality patient care
4. High job satisfaction
Disadvantages:
5. Disruption of continuity of care if transferred to different units.
6. Improper implementation
7. Incompetent or inadequately prepared primary nurse

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 Case Management Method

► Collaborative process that assesses, plans, implements, coordinates, monitors and evaluates
options and services to meet an individual’s health needs through communication and available
resources to promote quality, cost-effective outcomes.
► Its focus is on individual patients, not populations of patients.
► Care is directed by the case manager, focused on an entire episode of illness and not unit
based.
► Used to organize patient care according to diagnoses or other related groups.

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University of Bohol College of Nursing
 Advantages and Disadvantages

Advantages:
1. Additional work efficiency
2. Established solid working relationships with staff
Disadvantages:
3. Needs extensive training for advance practice nurse
4. Qualification of Case Manager

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 Other methods

► Progressive Client Care

► Managed Care methods
► Practice Partnership methods
► Modular methods

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 Employee Discipline

► Process of generating employee compliance to institutional rules and regulations.

► This must be properly communicated to employees by management.
► It should be done privately, promptly and consistently
► It should be progressive in nature
► It should be preceded with counseling
► It should be instituted with extreme caution

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 Disciplinary Problems

STEPS TO ADDRESS THESE PROBLEMS

► Coaching - is a day to day process of helping employees improve their

performance
► Confrontation - communication technique used to address specific issues such as
violations
► Disciplinary conference – uses combination of directive and non-directive technique in
order to minimize stress during interview

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 STEPS TO PROGRESSIVE DISCIPLINE

► Counseling
► Verbal Reprimand
► Written Reprimand
► Short Suspension
► Longer Suspension
► Dismissal

1986 Bill of Rights –”No person shall be deprived of life, liberty or property without due
process of law.”

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 TOOLS FOR TERMINATING A STAFF

► Inform the human resources department and administration beforehand

► State the offending behavior and the reason for termination
► Explain the termination process
► Remain calm
► Arrange employee to be escorted out
► Report back to the human resources department and administration

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 Accurate definition and quantification of the work of
nursing is critical to the identification of appropriate
nursing resource requirements.

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