ORGANIZING (NCM 105 Nursing Leadership &

Management

Nhelia B. Perez RN MSNNortheastern College

College of NursingSantiago City, Philippines

ORGANIZING

• Organization consists of the structure and process which allow the agency to enact its philosophy and utilize its conceptual framework to achieve its goals.

• Also refers to a body of persons, methods, policies and procedures arranged in a systematic process through the delegation of functions and responsibilities for the accomplishment of purpose.

Elements of Organizing

• Setting up the organizational structure

… refers to the process to which an organization/group is formed, its channels of authority, span of control and lines of communication.

Purposes

• Informs members of their responsibilities so that they may carry them out.

• Allows the manager and the individual workers to concentrate on his / specific role and responsibilities.

• Coordinates all organization activities so there is minimal duplication of effort or conflict.

• Reduces the chances of doubt and confusion concerning assignments.

• Avoids overlapping of function because it pinpoints responsibilities.

• Shows to whom and for whom they are responsible.

Types of organization classified by Nature of Authority.

• Line organization

…simplest and most direct type of organization in which each position has general authority over the lower position in the hierarchy.

ex. Clinical and Administration

• Informal Organization

… refers to horizontal relationships rather than vertical.

… composed of small groups of workers with similar interests.

• Staff Organization

… purely advisory to the line structure with no authority to put recommendations in action.

… Ex. Training and Research

• Functional Organization

… one where each unit is responsible for the given part of the organization’s workload.

… there is a clear delineation of roles and responsibilities which are actually interrelated.

Ex. All Standing and Ad Hoc Committees

Five Major Characteristics of an Organizational Chart

• Division of Work

• Chain of Command

• Type of Work

• Grouping of Work Segments

• Levels of Management

Definition of Terms

• Authority – right to act or make decisions without approval of higher administration.

• Line and Staff Relationships

Line authority is the simplest and most direct type in which each position has general authority over the lower positions in the hierarchy in the accomplishment of main operations of the organization.

Staff personnel provides advice, counsel or technical support

that may be accepted, altered or rejected by the line officer.

• Accountability - taking full responsibility for the quality of work and behavior while engaged in the practice of the profession.

• Responsibility – the obligation to perform the assigned task.

• Power – ability to influence another to behave in accordance with one’s wishes.

• Status – rank a group bestows on a person in accord with the group’s estimation of the person’s value and significance to group goals.

• Communication - the transmission of information between persons.

Organizing Principles

• Unity of Command

• Scalar Principle or Hierarchy

• Homogenous assignment or departmentation

• Span of Control

• Exception Principle

• Decentralization or Proper Delegation of Authority

Kinds of Organization Structure

• Traditional Hierarchical Structure

• Organization Structure for Devolved Hospitals

Staffing

• 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.

Factors Affecting Staffing

• The type, philosophy, and objectives of the hospital and the nursing service;

• The population served and the kind of patient served, whether pay or charity;

• The number of patients and severity of their illness – knowledge and ability of nursing personnel are matched with the actual needs of patients;

• Availability and characteristics of the nursing staff, including education, level of preparation, mix of personnel, number and positions.

• Administrative policies such as rotation, weekends and holiday-off-duties.

• Standards of care desired which should be available and clearly spelled out.

• Layout of the various nursing units and resources available within the department such as adequate equipment, supplies, and materials;

• Budget including the amount allotted to salaries, fringe benefits, supplies, materials and equipment.

• Professional activities and priorities in non-patient activities like involvement in professional organizations, formal educational development, participation in research and staff development.

• Teaching program or the extent of staff involvement in teaching activities.

• Expected hours of work per annum of each employee. This is influenced by the 40=hour week law; and

• Patterns of work schedule – traditional 5 days per week, 8 hours per day; 4 days a week, ten hours per day and three days off; or 3 ½ days of 12 hours per day and 3 ½ days-off per week.

PATIENT CARE CLASSIFICATION SYSTEM• A method of grouping patients

according to the amount of complexity of their nursing care requirements and the nursing time and skill they require.

Requirements • The number of categories into

which the patients should be divided;

• The characteristics of patients in each category;

• The type and number of care procedures that will be needed by a typical patient in each category; and

• The time needed to perform these procedures that will be required by a typical patient in each category.

Classification Categories

• Level I – Self Care or Minimal Care

Average amt of NCH/pt/day = 1.5

Ratio of Prof to NonProf = 55:45

• Level II – Moderate Care or Intermediate Care

Average NCH/pt/day = 3

Ration or Prof to NonProf = 60:$0

• Level III – Total, Complete or Intensive Care

Average NCH/pt/day = 6

Ratio of Prof to NonProf = 65:35

• Level IV – Highly Specialized Critical Care

Average NCH/pt/day = 6-9 hours

Ratio of Prof to NonProf = 70:30 or 80:30

Percentage of Nursing Care Hours

Type of Hospital

Minimal Care

Moderate Care

Intensive Care

Highly Spcl Care

Primary Hosp 70 25 5 -

Secondary Hosp

65 30 5 -

Tertiary Hosp 30 45 15 10

Spcl tertiary Hosp

10 25 45 20

Computing for the number of Nursing Personnel Needed• Consider sufficient staff to cover all

shifts, off-duties, holidays, leaves, absences and time for staff development programs.

• R.A. 5901 – Forty-Hour Week Law

Relievers Needed

Distribution by Shifts

• 45% AM shift, 37 % PM and 18 % night

Staffing Formula

• Categorize the patients according to the level of care needed. Multiply the total number of patients by the percentage of patients at each level of care.

• Find the total number of nursing care hours needed by patients at each category level.

• Find the number of patients at each level by the average number of nursing care hours needed per day.

• Get the sum of the nursing care hours needed at the various levels

• 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.

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

• Find the total number of nursing personnel needed.a. Divide the total number of nursing care needed per year by the actual number of working hours rendered by an employee per year.b. Find the number of relievers. Multiply the number of nursing personnel needed by 0.15 (for those working 40 hours per week) or by 0.12 (for hose working 48 hours per week).c. Add the number of relievers to the number of nursing personnel needed.

• Categorize the nursing personnel into professionals and non-professionals. Multiply the number of nursing personnel according to the ratio of professionals to non-professionals.

• Distribute by shift.

Placement

• Advantages

– Fosters personal growth

– Provides motivating climate for the employee

– Maximizes productivity

– Organizational goals have better chances of being met.

• Results of Inappropriate placement–Frustration–Poor quality of work–Reduced organizational

efficiency–Rapid turn-over–Poor image of the agency

Factors to consider

• Inherent in the employee

• Past experience and training

• Culture of the clientele

• Decision-making skills

• Communication skills

Advantages of proper placement• Adapt faster

• Feet are lighter

• A lot happier

• Felt confident when supervised

Scheduling

• A timetable showing planned work days and shifts for nursing personnel.

Factors considered in Making Schedules• Different levels of the nursing staff;

• Adequate coverage for 24 hours, seven days a week;

• Staggered vacations and holidays;

• Weekends and long stretches of consecutive working days;

• Evening and night shifts; and

• Floating.

Assessing a scheduling system• Ability to cover the needs of the

unit.

• Quality to enhance the nursing personnel’s knowledge, training and experience.

• Fairness to the staff

• Stability

• Flexibility

Types of Scheduling

• Centralized Schedule

• Decentralized Schedule

• Cyclical Schedule

Advantages of Cyclical Schedule• It is fair to all

• It saves time

• Enables the employee to plan ahead for their personal needs

• Scheduled leave are more stable

• Productivity is improved.

Rotating Work Shifts

• Common in most hospitals.

Developing Job descriptions

• Contents– Identifying data– Job summary– Qualification requirements– Job relationships– Specific and actual functions and

activities

Uses of Job Description

• For recruitment and selection of qualified applicants

• To orient new employees to their jobs

• For job placement, transfer or dismissal

• As an aid in evaluating the performance of an employee

• For budgetary purposes;• For determining departmental

functions and relationships to help define the organizational structure;

• For classifying levels of nursing functions according to skill levels required;

• To identify training needs;• As basis for staffing; and• To serve as channel of

communication.