3Nursing leadership and management

ORGANIZING
Nursing Leadership and Management
Organizing is the function of

management that involves
developing an organizational
structure and allocating human
resources to ensure the
accomplishment of objectives.
The structure of the organization

is the framework within which
effort is coordinated.
Organizing is the backbone of
management.
A manager cannot do without

organizing and there can be no
management without
organization.
As a process, organization refers to

the building of a structure that will
provide for the separation of activities
to be performed, and for the
arrangement of these activities in a
framework which indicates their
hierarchical importance and
functional association.
The organizational process is a

logical process.
It is one by which the manager
brings order out of chaos, removes
conflicts between people over work
responsibility, and establishes an
environment suitable for teamwork.
The process of organization involves:

1. Identification and definition of
basic tasks such as staffing and
creation of job description
2. Delegation of authority and
assignment of responsibility for
the accomplishment of activities.
3. Establishing relationships by
providing a system of vertical and
horizontal communications
through authority relationships to
bind and coordinate the groupings
CHARACTERISTICS OF AN
ORGANIZATION
1. Division of work
 Where each box represents an
individual or sub unit
responsible for a given task.
2. Chain of command
With lines indicating who reports to
whom and by what authority.
3. Different types of work segments

>shown by clusters of work groups.
4. Different levels of management

> Indicating hierarchical
relationships.
Principles of Organizational
Design
1. Division of labor
 Promotes departmentalization
and specialization, which
results in a more efficient unit.
2. Unity of command
3. Authority and responsibility

Determines the line and staff of
authority, which delineates the
distribution of power.
4. Span of control
Determines the different levels
of control within the system, as
well as whether it is centralized or
decentralized.
5. Contingency factors
Such as environment and
technology or knowledge
technology, which deals with task
variability and problem
analyzability.
STAFFING
STAFFING
The process of assigning
competent people to fill the roles
designated for the organizational
structure through recruitment,
selection and development.
Steps in Staffing
1. Determine the number and
types of personnel needed
>This is a decision that a manager can
best reach not alone but in
consultation with the staff and co
workers.
2. Recruit personnel
>the recruitment step is an
opportunity to attract the best and
the smartest applicants to fill in
the personnel needed in the
organization.
3. Interview
>interviews should be scheduled
properly and conducted in an airy
environment that would help bring
out the best and worst in the applicant
depending on the objectives of the
interviewer.
The interviewer should always keep

sight of the qualities and experience
desired in the position to be filled up.
Both the interviewers and
interviewees should prepare in
advance for the questions and
answers that will be asked during the
interview.
4. Induct or Orient the personnel

>Orientation allows both parties to
see whether they would be able to
work with each other, understand the
organizational culture and learn the
background of the organization.
This allows both parties to back out

before any offer can be made.
5. Job offer
The applicant will be given an offer
and accepts the offer and is therefore
hired.
The selection of the employee and
placement happens when all pre-
employment requirements are
accomplished.
Staffing Pattern
A plan that articulates how many
and what kind of staff are needed
by shift and day to staff a unit or
department.
Factors affecting time

requirement of nursing care
1. Acuity of the patient’s illness
2. Degree of dependence of the
patients on the caregivers
3. Communicability of the ailment

4. Rehabilitation needs and
special treatments and procedures
The needs of the patient as

determined by the ailment
effectively determine how much
time and care the nursing
program must devote.
Patient Classification System

(PCS)
A means of categorizing patients
on the basis of certain needs that
can be clinically observed by the
nurse.
>a measurement tool used to

articulate the nursing workload
for a specific patient or group of
patients over a specific period of
time.
As a patient becomes sicker, the

acuity level rises, meaning the
patient requires more nursing
care.
Classification of Patient care

1. “self care” or minimal care
patients
>Are capable of carrying activities
of daily living (ADL)
- hygiene, meals, exercise...
2. Intermediate or moderate care

>requires some help from the
nursing staff with special
treatments or certain aspects of
personal care.
- patient with IV fluids, catheter...
3. Total care patients

>those who are bedridden and
who lack strength and mobility to
do ADLs
- On complete bed rest, immediate
post op, with contraptions...
4. Intensive care patients

>those who are critically ill and in
constant danger of death or
serious injury.
- comatose patients , bedridden...
Nursing Care Models

>the framework for nursing care
delivery in any setting.
>design that meets the particular
needs of a group of health care
givers and clients.
1. Case method or Total Patient Care

>the original model of nursing care
delivery.
>the registered nurse is responsible
for all aspects of the care of one or
more patients.
 RNs work directly with the

patient, family, physician and
other health care staff in
implementing a plan of care.
 The RN gives total care within
her shift.
 The goal of this system is to have

one nurse give all care to the same
patient(s) for the entire shift.
 This model is typically used in
areas requiring a high level of
nursing expertise, such as critical
care units or post-anesthesia
recovery areas
Advantages of this model:

>the nurse can better see and attend
to the total needs of clients and the
continuity of care can be facilitated
with ease.
>client’s interaction and rapport with
the nurse are well developed, and
the client’s needs are monitored
 Both the client and his relatives

feel secure.
Disadvantage:
 RNs spend some time doing task
that could be done more effectively
by less-skilled persons.
2. Functional Nursing
>also called task nursing
>the needs of a group of patients are
broken down into tasks, which are
assigned to RNs, LPNs, nursing
aides so that the skill and licensure
of each caregiver is used to the best
advantage.
>this model is task and procedure

oriented.
>it is used when there are too many
patients in proportion to available
RN.
>nurses are assigned to selected
functions such as vital signs,
treatments, medication...
Advantages:
>nurses become skilled in
performing assigned tasks
>individual aptitude and
experience improves.
>less equipment is needed
>time is saved
>improves both productivity and
organization
Disadvantage:
>no continuity of care
>patients can not identify who
their nurse is.
3. Team nursing
>evolved from functional nursing
>a team of nursing personnel
provides total care to a group of
patients
Characteristic of team nursing

>The RN leads a large group of
nursing personnel ...LPN,
UAP(unlicensed assistive
personnel)
>this small group is centered
through participation efforts.
>the team work together to

identify, plan, implement, and
evaluate comprehensive client-
centered nursing care toward a
common goal of providing
quality nursing care.
 It is oriented towards the

decentralization of a nursing
unit and of the head nurse’s
authority.
 Comprehensive nursing care
becomes the responsibility of
the entire team.
Advantages:
>the constant group work fosters
a feeling of participation and
belongingness.
>the workload is balanced and
shared with the division of
labor
>each member of the team has the

opportunity to learn from
colleagues.
>there is also a variety in the daily
assignment
>it also helps maintain interest in
client’s well being and is cost
effective.
>the patient is able to identify

personnel due to the continuity
of care.
>barriers between the nurses and
clients can be minimized.
>everyone gets to contribute to
the care plan.
4. Primary Nursing
>decentralized decision-making by
the staff nurses is the core
principle of this model.
>responsibility, authority and
accountability for nursing care
allocated to staff nurses at the
 This model represents total

nursing care directed by a nurse on
a 24 hour basis, from the moment
of admission to discharge.
 It is accomplished through
decentralization, autonomy and
independently competent nursing
care.
Advantages:
>the nurse sees the client and family
as one system and authority,
responsibility, and accountability
(ARA) is increased.
>the nurse uses a wide range skills
knowledge and expertise and
develops creativity
>this increase trust ad satisfaction by the

clients.
>there is excellent communication
between the primary nurse and
associate nurses.
• >primary nurses are able to hold
associate nurses accountable for
implementing the nursing care as
Disadvantage:
>because of transfers to different
units, critically ill patients may
have several primary care nurses,
disrupting the continuity of care
inherent in the model
5. Case Management model

>care is directed by a case manager
focused on achievement of
outcome and appropriate time
frame and resources.
>the case manager focuses on an
entire episode of illness.
>the model is used to organize patient

care according to diagnoses or
other related groups.
>the manager does not provide direct
patient care but rather supervises
the care provided by the RNs and
other nursing personnel
6. Modular model
>RN provides direct nursing care with
assistance of aides.
>this is a modified team and primary
nursing method where RN
provides leadership, support and
instruction.
DIRECTING
>Directing is the act of issuing of

orders, assignments, and
instructions to accomplish the
organization’s goals and objectives.
>involves the process of getting the
organization’s work done.
>it entails explaining what is to be

done, to and by whom, at what
time, how and why the task should
be done.
>all directions must be consistent
with departmental policies to help
personnel perform their duties
safely and effeciently
Characteristics of Good Directions

1. Directions must be clear, concise,
consistent and complete.
2. The person giving directions must
explain the rationale well and
make certain that it is
understood.
3. The words used in the directions

indicate their importance.
>”must”, “shall” and “will” indicate
that the directions are mandatory.
>”may” denotes the action is
recommended
 “should” places the directive

somewhere between mandatory
and recommended action.
4. The person giving directions must
speak distinctly and slowly.
>direction must come across as requests
not commands, using specific tone and
set of words
 Give directions in logical manner

and prioritize the tasks directed to
be done by importance and time.
5. It is important to:
a. Avoid too many directions at one
time
b. Personalize directions
c. Always check to make sure
directions have been followed.
Tools in Directing
1. Nursing Care Plan
2. Policies
3. Standards operating
procedures
4. Rules and regulations
Elements of Directing
1. Delegation
2. Supervision
3. Staff development
4. Coordination
5. Collaboration
6. Communication
7. Evaluation
DELEGATION
 The act of assigning to someone
else a portion of the work to be
done with corresponding
authority, responsibility and
accountability.
What cannot be delegated

a. overall ARA
b. Final evaluation of staff
performance
c. correcting and disciplining staff
>delegated tasks must be based on

policies, job description and
capabilities of workers.
Why managers do not want to

delegate
a. Mistakes in delegation can be
costly
b. Failure to delegate wisely increases
management costs and contributes
to personnel dissatisfaction
c. Fear on the part of the director,

of her own ability to delegate.
d. Fear of losing control of the
staff.
e. Fear of failing to get others do
the work
f. Fear of criticism
The manager who enjoys the

personal satisfaction gained
from doing the work herself
will likewise not be inclined to
delegate the work.
Common delegation errors

a. Underdelegating
- This stems from the manager’s false
assumption that delegation may be
interpreted as the lack of ability on
his part to do the job correctly or
completely.
- The manager has trust issues

and thus lacks the trust in his
subordinates
- He is insecure that he fears that
subordinates will resent the
work delegated to them
- Underdelegating also occurs

when the manager lacks
experience in the job. Thus,
there is the excessive need to
control and be perfect.
b. Overdelagating
- It unnecessarily burdens the
subordinates with tasks that are
either inconsequential or
irrelevant to the delivery of the
goal.
- The culprit is usually poor

management of time and
insecurity on the part of the
nurse manager in his ability to
perform tasks.
c. Improper delegating
- A manager should be able to
determine the talents and
capacities of his subordinates.
- Delegation of tasks and

responsibilities beyond which
the person cannot perform
properly is improper
delegation.
The Delegation Process

1. Define the task
 Routine tasks
 Tasks for which you do not have
time
 Tasks that have moved down in
priority.
2. Decide whom to delegate

 Match the task to the individual
 Analyze individual’s skill levels and
abilities to evaluate their capacity
to perform the various tasks.
 Determine availability.
3. Determine the task

 Provide for enough time to
describe the task and your
expectations and to entertain
questions
 Describe the
task...what/when/where/how
 clearly describe the expected

outcome and the timeline for
completion.
 Establish how closely the
assignment will be supervised
 Identify any constraints for

completing the tasks or any
conditions that could change.
4. Reach agreement
- Once you have outlined your
expectations, you must be sure
that the delegate accept
responsibility and authority for
the task.
Delegation is an agreement that is

entered into voluntarily...
5. Monitor performance and

provide feedback
 Monitoring performance
provides a mechanism for
feedback and control that
ensures that the delegated tasks
are carried out as agreed.

3Nursing leadership and management

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

3Nursing leadership and management

Uploaded by

Copyright:

Available Formats

ORGANIZING

Nursing Leadership and Management

Organizing is the function of

The structure of the organization

A manager cannot do without

As a process, organization refers to

The organizational process is a

The process of organization involves:

3. Different types of work segments

4. Different levels of management

3. Authority and responsibility

The interviewer should always keep

4. Induct or Orient the personnel

This allows both parties to back out

Factors affecting time

3. Communicability of the ailment

The needs of the patient as

Patient Classification System

>a measurement tool used to

As a patient becomes sicker, the

Classification of Patient care

2. Intermediate or moderate care

3. Total care patients

4. Intensive care patients

Nursing Care Models

1. Case method or Total Patient Care

 RNs work directly with the

 The goal of this system is to have

Advantages of this model:

 Both the client and his relatives

>this model is task and procedure

Characteristic of team nursing

>the team work together to

 It is oriented towards the

>each member of the team has the

>the patient is able to identify

 This model represents total

>this increase trust ad satisfaction by the

5. Case Management model

>the model is used to organize patient

>Directing is the act of issuing of

>it entails explaining what is to be

Characteristics of Good Directions

3. The words used in the directions

 “should” places the directive

 Give directions in logical manner

What cannot be delegated

>delegated tasks must be based on

Why managers do not want to

c. Fear on the part of the director,

The manager who enjoys the

Common delegation errors

- The manager has trust issues

- Underdelegating also occurs

- The culprit is usually poor

- Delegation of tasks and

The Delegation Process

2. Decide whom to delegate

3. Determine the task

 clearly describe the expected

 Identify any constraints for

Delegation is an agreement that is

5. Monitor performance and

You might also like