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20 September 2011
NCM 107: Nursing Management
Rey Ramirez

ORGANIZATION
What is an organization?
social entity (involves people)
goal directed
structured and coordinated activity system
linked to the external environment
open system
Why organize?
Man is a social animal
it is inherent in man (even nomads organize to
get food)
no man is an island (early man form tribes to
survive)

KEY ELEMENTS OF AN ORGANIZATION
Involves people interacting with one another

People People


People

IMPORTANCE OF ORGANIZATIONS
Resource Management

to combine resources to make the desired goals and
outcomes
4Ms/1T
Money
Machine
Manpower
Materials
Time
Produce goods and services efficiently
Facilitate innovation

Use modern manufacturing and computer-based
technology
Adapt to the influence on changing environment
Create value for owners, customers
Accommodate ongoing challenges of diversity, ethics,
career patterns; and the motivation and coordination of
people
CHARACTERISTICS OF AN ORGANIZATION
A purpose




People using Interacting
knowledge and in groups
and
techniques




Working together in
patterned relationships

5 BASIC PARTS OF AN ORGANIZATION
Top Manager
Technical Support Staff
Middle Manager
Administration Support Staff
Technical Core

Top Manager

Technical Middle Administration
Support Staff Manager Support Staff

Technical Core


ORGANIZATIONAL EVOLUTION
Evolution:
One-man operation
Father-son/assistant type
Functional organization
Functional organization plus a central headquarters
Multi-diversonal firm
Conglomerate
Tends toward increase in the ff:
complexity
size of organizations
accelerating scientific knowledge and technological
developments
government role
customer needs
new paradigms
*warranted the need for ORGANIZATIONAL THEORY

ORGANIZATIONAL THEORY
a way to see and analyze organizations more accurately
and deeply
HOW?
based on patterns and regularities in organizational
design and behavior
insights into organization functioning
SIGNIFICANCE:
makes managers more competent and more
influential (with theoretical background)
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endless people will see and understand things other
people around cannot see/understand
provide an appreciation of understanding of what is
happening in organization

PRINCIPLES OF ORGANIZATION
COMMUNICATION
formal; vertical; horizontal
UNITY OF COMMAND
line of command; one superior; vertical line
SPAN OF CONTROL
number of subordinates that a supervisor can
supervise effectively
DELEGATION OF AUTHORITY
centralized; decentralized, delegate to competent
staff responsibility; accountability
SIMILAR ASSIGNMENTS
departmentalization; specialization
UNITY OF PURPOSE
all areas work towards a single purpose to achieve
success

ORGANIZATION THAT THRIVE IN DYNAMIC
ENVIRONMENT
FLEXIBLE
Fast Speed
Empowered
Open in its communication
Innovation
Learning-oriented
DEVELOPMENT-FOCUSED
Learn
Energized
Team-oriented
Performance-based
VALUE-DRIVEN

ORGANIZATIONAL FUNCTIONS
Operations Management
Administration
Production Management
Marketing
Supplies Management
Human Resources
Sales
Research and Development
Finance
Information Technology

ORGANIZATIONAL CLIMATE
Healthy Unhealthy
- Open and free
- Seek help
- Take risks
- Challenged by job
- Frustrated
- Threatened
- Reluctant
- Excuses for shortcomings



TYPES OF ORGANIZATION
UNITARY

DIVISIONALYZED
(+) flexible
(+) quick to respond to changes
(+) innovative
(-) duplication of resources
(-) limit exchange of knowledge

CENTRALIZED
Chief
Administrative division
Investigative division
Support service division
Uniform division
DECENTRALIZED
MATRIX
(+) to combine functional and divisional
(-) have 2 bosses
(-) not easily to implement
(-) ideal for multicompanies
PROCESS-BASED ORGANIZATION


ORGANIZATIONAL CHART
ADVANTAGES
map lines of decision-making authority
helps people understand their assignments and
those of their co-workers
reveals to managers and new personnel now they fit
into the organization
contributes to sound organizational structures
shows formal lines of organizations
LIMITATIONS
shows only formal relationship
does not indicate degrees of authority
Chief Executive
Operation Marketing Finance HR
President
Division
Product X
R&D
Manufacturing
Monitoring
Finance
Division
Product Y
R&D
Manufacturing
Monitoring
Finance
Division
Product X
R&D
Manufacturing
Monitoring
Finance
Sales Order Processing
Sales Order Processing
Sales Order Processing
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may show things as they are supposed to be/used to
be rather than as they are
possibility exists of confusing authority with status

MAJOR CHARACTERISTICS THAT
DIFFERENTIATE HEALTH CARE
ORGANIZATION
services offered
length of direct service provision
ownership
financial provision
teaching status
geographical location
accreditation and licensure status

ROLE OF ORGANIZATION
Knowledge x Skill = Ability
Attitude x Situation = Motivation
Ability x Motivation = Potential Human Performance
Human Performance x Resources = Organizational
Productivity
MAJOR FORCES INFLUENCING PERSONALITY:

3 PERSPECTIVES OF EFFECTIVENESS
Individual
Group
Organizational
CAUSES OF EFFECTIVENESS:
Individual
effectiveness
Group
effectiveness
Organizational
effectiveness
Causes:
- ability
- skill
- knowledge
- attitude
- motivation
- stress
Causes:
- cohesiveness
- leadership
- structure
- status
- roles
- norms
Causes:
- environment
- technologies
- strategic
choices
- structures
- processes
- culture

SOURCES OF POWER
COERCIVE POWER is the opposite of reward power and
is based on fear of punishment if one fails to confirm
CONNECTION POWER comes from formal or informal
coalition and interpersonal relations and links to
prestigious and influential people within and outside the
organization
REWARD POWER something given in recompense
LEGITIMATE POWER gives the leader or manager the
right to influence and the staff member an obligation to
accept the influence
REFERENT POWER is based on identification with a
leader and what the leader symbolizes
INFORMATION POWER comes from knowledge, access
to information, and the sharing of information
EXPERT POWER skillful, having knowledge and training

THE NURSE MANAGER
INTRODUCTION TO MANAGEMENT
Definition of Management:
deciding what to do
doing through the effective use of resources
coordination and integration of resources through:
Planning
Organizing
Leading
Controlling
*to accomplish specific goals and objectives
within an organization
science and art; a process involving
mix of rational
leading
problem solving
decision-making activities
intuitive judgment
KEY PURPOSES OF MANAGEMENT AND LEADERSHIP:
to provide direction
to facilitate change
to achieve results through the use of resources
(effective, responsible, creative)

MANAGEMENT THEORIES
DIFFERENT THEORIES:
Scientific Management (F. Taylor, M. Weber)
Administrative Management (H. Fayol)
Human Relations (E. Mayo)
Behavioral Science (A. Maslow, D. McGregor)
Contemporary Management Theories (Ouchi)
TRADITIONAL MANAGEMENT METHOD:
mid-19
th
century in pre-industrial times
apprenticeship
cottage industries
Laissez-faire economies
SCIENTIFIC MANAGEMENT
Taylor, Frederick
Father of Scientific Management
frustrated with what he called, systematic
soldiering
Principles:
traditional rule of thumb means organizing
work must be replaced with scientific methods
scientific personnel system must be established
so workers can be hired, trained, and promoted
based on technical competencies and abilities
workers should be able to view how they fit
into the organization and how they contribute to
overall organizational
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Nursing Implications:
Work specialization
Nurse staffing
Staffing needs
Supervisory tasks
Departmentalization
BUREAUCRATIC ORGANIZATION
Max Weber, a well-known German sociologist,
proposed bureaucracy as organization designed
the need for legalized, formal authority and
consistent rules and regulations for personnel
Characteristics of Bureaucracies:
there must be a clear division of labor
a well-defined hierarchy of authority
there must be impersonal rules and
impersonality of interpersonal relationships
a system of procedures for dealing with work
situations must exist
a system of rules covering rights and duties of
each position must be in place
selection for employment and promotion is
based on technical competence
MANAGEMENT PROCESS THEORY
constitutes the body of knowledge that describes
how managers conduct activities to keep the
organization
why study?
a theory provides criteria for determining what
is relevant
provides stable focus for undertaking what
we experience
enable us to communicate efficiently
challenge us to keep learning about our
world
Henri Fayol first identified the management
functions of:
Planning
prevoyance (think ahead)
examine the future and draw up plans of
action
Organization
to organize
build with the structure, material, and
human of the undertaking
Command
to command (to direct)
maintain activity among the personnel
Coordination
to coordinate
bind together, unify and harmonize activity
and effort
Control
to control
see that everything occurs in conformity
with policy
Fayols 14 Principles
Specialization/Division of Labor
a principle of work allocation and
specialization in order to concentrate
activities to enable specialization of skills
and understanding, more work focus, and
efficiency

Authority with Corresponding Responsibility
managers must be able to give orders and
authority gives this right
if responsibilities are allocated then the
post holder needs the requisite authority
to carry these out including the right to
require others in the area of responsibility
to undertake duties
delegation process
the job holder is assigned to act as the
agent of the high authority to whom
they report
allocation and permission to use the
necessary resources needed (budgets,
assets, staff) to carry out the
responsibilities
the R = A correspondence is important to
understand
Discipline
employees must obey and respect the rules
that govern the organization
good discipline is the result of effective
leadership
discipline is essential for the smooth
running
Unity of Command
an employee should receive instructions
from one superior only
even where we are involved with team and
matrix structures which one involve
reporting to more than one bossor being
accountable to several clients
Unity of Direction
unity of command idea of having one head
(chief executive, cabinet consensus) with
agree purposes and objectives and one
plan for a group of activities must be clear
Subordination of Individual Interest to the
General Interest
Fayols line was that one employees on
interests or those of one group should not
prevail over the organization as a whole
this would spark a lively debate about who
decides that the interests of the
organization as a whole are
ethical dilemmas and matters of corporate
risk and the behavior of individual
chancers are involved here
shared set of values by people in the
organization
a unitarianism where the reasons for
organization/activities and decisions
are in some way neutral and
reasonable
Renumeration of Staff
price of services rendered
general principle is that levels of
compensation should be fair and as far as
possible afford satisfaction both to the
staff and the firm (in terms of its cost
structures and desire for profitability
surplus)

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Centralization
process by which the act of an
organization, particularly regarding
planning, decision making, become
concentrated within a particular location
and/or group
decisions are made by the top executive/
on the basis of pre-set policies
difference between centralization and
decentralization
also called departmentalization
there are:
fewer ties in the organizational
structure
wider span of control
bottom to top flow of decision
making and flow of ideas
Scalar Chain/Line of Authority
scalar chain of command of reporting
relationship from top executive to the
ordinary shop operative/driver needs to be
sensible, clear and understood
straighten chain of command that extents
unbroken from the ultimate officer to the
lowest ranks
communication should follow this chain
this chain creates delays
cross communication can be allowed if
agreed
Order
people and materials should be in the right
place at the right time
organization should provide an orderly
place
policies, rules, instructions and activities
should be understandable

one of the basic problem in management is
the balancing of an organization
Equity
Fairness and sense of justice should
pervade the organization in principle

Stability of Tenure
time is needed for the employee to adapt
to his/her work and perform it effectively
stability and tenure promotes loyalty to the
organization, its purposes and values
high employment is efficient
if turnovers cannot be prevented,
management should provide orderly
personnel planning and ensure that
replacement are available to fill vacancies
Initiative
at all levels of the organizational structure,
zeal enthusiasm and energy enable people
to have initiative
respect of employee empowerment
employees who are allowed to originate
and carry out plans will exert high levels of
effort


Espirit De Corps
Need for building and maintaining of
harmony among the work force, teamwork
and sand interpersonal relationships
This will also build unity within the
organization
ACTIVITIES OF MANAGEMENT
Luther Gulick expanded Fayols management
functions in his introduction of the 7 activities of
management
PARTICIPATIVE MANAGEMENT
Mary Parker Follet was one of the 1
st
theorist to
suggest basic principles of what they would be called
participative decision-making
managers should have authority with rather than
over employees
need for collective decision-making
HAWTHORNE MANAGEMENT
Elton Mayo discovered when the management paid
special attention to workers, productivity was likely
to increase, regardless of the environmental working
conditions
Hawthorne effect indicated that people respond to
the fact that they are being studied attempting
THEORY X AND Y
Douglas McGregor, reinforced these ideas by
theorizing that managed vial attitudes about
employees can be directly correlated with employee
satisfaction
Theory X lazy, needs constant supervision
Theory Y self-motivated and are willing to work
hard to meet personal and organizational goals
EMPLOYEE PARTICIPATION
Chris Argris
self-esteem and independence not met to become
discouraged and trouble some

MANAGERIAL ROLES
role set is specific tasks a person performs because of the
position they hold
roles are directed inside as well as outside the
organization
THREE BROAD ROLE CATEGORIES:
Interpersonal
roles managers assume to coordinate and
interact with employees and provide direction to
the organization
Figurehead role: symbolizes the
organization and what it is trying to
achieve
Leader role: train, counsel, mentor and
encourage high employee performance
Liaison role: link and coordinate people
inside and outside the organization to help
achieve goals
Informational
associated with the tasks needed to obtain and
transmit information for management of the
organization
Monitor role: analyzes information from
both the internal and external environment
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Disseminator role: manager transmits
information to influence attitude and
behavior of employees
Spokesperson role: use of information to
positively influence the way people in and
out of the organization respond to it
Decisional
associated with the methods managers use to
plan strategy and utilize resources to achieve
goals
Enterpreneur role: deciding upon new
projects ot programs to initiate and invest
Distubance handler role: assume
responsibility for handling an unexpected
event or crisis
Resource allocator role: assign resources
between functions and divisions, set
budgets of lower managers
Negotiator role: seeks to negotiate
solutions between other manager, unions,
customers or shareholders
KEY MANAGEMENT COMPETENCIES:
Promote personal and associated development and
empowerment
Encourage risk taking innovation and organizational
development
Demonstrate socially responsive and ethical behavior
Solve problems and make decisions
Engage strategic thinking
Building partnership with external customers
Build and utilize internal network and teams
Communicate with others
3 GENERAL CATEGORIES OF MANAGERIAL SKILLS AND
ABILITIES:
Conceptual skills: ability to analyze and diagnose a
solution and find the cause and effect
Human skills: ability to understand, alter, lead and
control people's behavior
Technical skills: job specific knowledge required to
perform a task. Common example include marketing,
accounting and manufacturing
all 3 skills are enhanced through formal training,
reading and practice

NURSING MANAGEMENT LEVELS
FIRST LEVEL MANAGER
responsible for supervising non-managerial staff
day-to-day activities of a specific unit
primarily responsibility for motivating the staff to
achieve the organization
MIDDLE MANAGER
supervises a number of 1
st
level manager's usually in
related specialties or in a given geographical area
responsible for people and activities within the
department supervise
acts as liaison between upper and 1
st
level managers
TOP LEVEL
executive managers
chief nurse executive (CNE)
it is to them that middle manager reports
primarily responsible for establishing organizational
goals and strategic plans
responsible for buffering the effects of the external
environment on nurses within the organization


MANAGERIAL QUALITIES
ATTRIBUTES OF SUCCESSFUL MANAGERS:
command of basic facts
relevant professional knowledge
self-knowledge
mental agility
proactive
creative
analytical, problem-solving and decision/judging-
making skills
continuing sensitivity of events
social skills and abilities
emotional resilience
balance learning habits

FUNCTIONS OF MANAGEMENT
PLANNING: deciding on course of action to achieve desired
results
ORGANIZING: setting up and staffing the most appropriate
organization to achieve the aim
LEADING: exercising leadership to motivate people to work
together smoothly to the best of their ability as part of the
team
CONTROLLING: measuring and monitoring the progress of
work in related to the plan of and taking corrective action
when required

PLANNING
is a mental predisposition to do things in orderly way to think
before acting and to act in the light of factors rather than
guesses
deciding for the best alternative among others to perform
different managerial functions in order to achieve
predetermined goals
PURPOSE:
gives direction
anticipate and offset change
effective use of resources
give meaning to work
improve program and activities
basis for control
compels visualization of whole
CHARACTERISTICS:
purposeful
process not an act
deliberate, rationale and objective
futuristic
flexible
largely conceptual
Top
Middle
1st line
Managers
Non-Management
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dimensional
hierarchy in nature
PRINCIPLES:
objectives - specific, clear and understood
facilitates action
coordination and communication
maybe delegated
constantly improved/re-planned
tentative and interim

PLANNING HIERARCHY
Mission/Vision
Vision mental image or the power of imagination to
see something that is not actually visible
Mission an aim to be accomplished
Philosophy
articulate a vision and provide a statement of beliefs
and values that direct ones practice
Goals
the end or outcome to be accomplished
Objectives
something aimed at/or striven for; things done to
achieve the goal
Policies
a governing plan for accomplishing goals and
objectives
Procedures
chronological sequence of sets within a process
Roles
set of responsibilities or expected results associated
with a job

KINDS OF ORGANIZATIONAL PLANS:
STRATEGIC PLAN
a generalized plan outlining decisions of resource
allocation, priorities and action steps to reach
strategic goals
have long term focus
TACTICAL PLAN
plan aimed at achieving tactical goals
developed to implement parts of strategic plans
concern more with activity getting things done that
deciding what to do
have more specific and concrete focus
OPERATIONAL PLAN
focuses on carrying out tactical to achieve
operational goals
have short term focus and relatively narrow in scope

TIME FRAME FOR PLANNING
LONG-RANGE PLANS
covers many years
any plan beyond 5 years
INTERMEDIATE PLANS
less tentative and subject to change
usually covers from 1 to 5 years
specially important for meddle or first line managers
parallel tactical plans
SHORT-RANGE PLANS
covers 1 year or less
generally affects managers day to day activities
2 KINDS OF SHORT-RANGE PLANS:
Action Plan
Reaction Plan develop to react to unforeseen
circumstances

BARRIERS TO GOAL SETTING AND PLANNING
AND HOW TO OVERCOME:
BARRIERS:
inappropriate goals
improper reward system
dynamic and complex environment
reluctant to establish goals
resistance to change
constraints
lack of resources
government restrictions
strong competition
OVERCOMING THE BARRIERS:
understand purpose of goals and plans
communication and participation
consistency, revision and updating
effective reward system
contingency planning determination of alternative
course of action to be taken if intended plan of
action is unexpectedly disrupted/rendered
inappropriate
PURPOSES OF GOALS
provide guidance and unified direction
promote good planning and facilitate future goal setting
serve as source of motivation to employees
provide an effective mechanism for evaluation and
control

CORPORATE PLANNING
PHASE I STRATEGIC
PHASE II OPERATION
PHASE III FEEDBACK AND CONTROL

PLANNING PROCESS

STAGE 1: ANALYSIS OF OPPORTUNITIES
SWOT Analysis this is formal analysis of your
strengths and weaknesses, and if the opportunities
and threats that you face
Risk Analysis understanding pressures for change
STAGE 2: IDENTIFYING THE AIM OF YOUR PLAN
What do I want the future to be?
What benefits do I want to give my customers?
What returns do I seek?
What standards am I aiming at?
What values do I and my organization believe in?

How?
Now Where?
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STAGE 3: EXPLORING OPTIONS
STAGE 4: SELECTING THE BEST OPTION
STAGE 5: DETAILED PLANNING
STAGE 6: EVALUATION OF THE PLAN AND ITS IMPACT
STAGE 7: IMPLEMENTING CHANGE
STAGE 8: CLOSING PLAN

PLANNING CYCLE

STEPS IN PLANNING FUNCTIONS:
Establishment of objectives
Establishment of planning premises
Choice of alternative course of action
Formulation of derivative plans
Securing Co-operation
Follow-up/Aprraisal of plans

BUDGET
a planning document used by a department or
organization that forecasts both receipts and
expenditures
a systematic programming of organizational activities
based on their cost and on the amount of resources
available
BUDGET PROCESS
refers to those activities and steps needed to be
taken for the manager to formulate a budget
BUDGET WORKSHEET
a tool used for/by a manager to prepare their budget
VARIANCES
a general term to describe the difference between a
budgeted number and an actual result
STEPS IN BUDGETING:
Review past performances
Review the organization's goals and projection
Review the variance
Actual preparation of budget
TYPES OF BUDGET:
Operating (revenue, expense)
Personnel
Capital Expenditure
Cash
Flexible
NUMBERIZING PLANS BY BUDGET:
developed such budget as volume and price of sales
operating expenses necessary for plans
expenditure for capital equipment
GANTT CHART
implemented work over a period
a time-scale is given on the chart's horizontal axis and
each activity is shown as a separate horizontal rectangle
(bar) whose length is proportional to the time required (or
taken) for the activity's completion
in project planning, these charts show start and finish
dates, critical and non-critical activities, slack time, and
predecessor-successor relationship
also called CHRONOOGRAM, invented in 1917 by Henry L.
Gantt (1861-1919)
PRINCIPLES OF THE GANTT CHART:
measure activities by the amount of time needed to
complete them
represent amount of activity that should have been
done in time

ORGANIZING
the establishment of a formal structure of authority, through
which work subdivisions are arranged, defined and
coordinated for the achievement of defined objectives
provide the relationships between people activities in such
way as to organizational goals
occurs through interactional phenomena because of hierarchal
arrangement of interdependent people
can be defined as:
act of deploying the resources needed to achieve an
identified goal including human resources
organizing is critical to success for any enterprise
considers whether the resources at their disposal are
effectively deployed
PURPOSE: best use of the organizations resources to achieve
organizational goals
Special phenomenon:
power
authority
status
process of delegation

LEVELS OF ORGANIZING
*Organizing take place in many levels
FIRST: ORGANIZE YOURSELF
get control of your desktop and work area at
scheduled intervals
critically evaluate your daily routine at scheduled
intervals
avoid time-wasting people and activities
inventory your inbox contents
organize your day so that your daily activities will
accomplish your plans
do not over-schedule yourself
try to avoid scheduling more than half of any
day if at all possible
leave time for the work that will have to be done
as a result of the events that you have scheduled
examine your daily routine
try to avoid scheduling more than half of any day if at
all possible
practice the first things, first rule
always do first things
never do second things
Analysis of opportunities
Identify aim
Explore options
Select best option
Detailed planning
Plan evaluation
Plan implementation
Closure of plan
Feedback
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delegate, dont abdicate
inform other who need to know
delegate only those things you should
avoid procrastination
do the tasks you enjoy the least, first
ORGANIZE YOUR DEPARTMENT TO MEET ITS GOALS AND
OBJECTIVES
how many layers of management you are in? If there
is more than one why?
is the span of control principle observed in your
department?
do employees understand the departments goals
and objectives?
are you using the most effective means of
communication?
do you have (or attend) too many meetings?
do all meetings have a stated purpose and a written
agenda? Agenda item assigned a time limit?

STEPS IN ORGANIZING PROCESS
Review plans
List tasks
Group tasks into jobs
Group jobs
Assign work
Delegate authority

TERMINOLOGIES
JOB collection of tasks and responsibilities that an
employee is responsible to conduct; jobs have titles
FUNCTIONS large number of tasks a complex positions
in the organization
TASK typically defined as a unit of work
ROLES set of responsibilities or expected results
associated with a job

TIME MANAGEMENT
set of skills, tools, systems
work together
help you get more value out of your time
with the aim of improving the quality of your life
TIME MANAGEMENT STRATEGIES:
Action
Idea
Logic
People time styles
Time analysis
Daily planning
Crisis control
Problem analysis
Time control
Time evaluation
BARRIERS TO EFFECTIVE TIME MANAGEMENT:
Habit
Work expansion
Oversuspension
Underdelegation
Losing sight of objectives
PRINCIPLES OF TIME MANAGEMENT:
Communication
Planning
Delegating
Prioritizing goals
SKILLS ASSOCIATED WITH TIME MANAGEMENT:
Planning
Prioritizing
Goal setting
Scheduling
Managing your workload
KINDS OF TIME:
Managerial
Response
Discretionary
TIME MANAGEMENT PROCESS:
analyzing the present situation
where am I now?
developing relevant assumptions
what conditions will most likely exist within the
time span of the plan
establish objectives
what do I want to achieve?
developing alternatives
what ways might I attain objectives?
making a decision
implementing the decision
establishing review and control
TIME MANAGEMENT TECHNIQUES:
personal commitment to improving
deciding what not to do
learning to say no
recording how time is used
planning use of time
fire fighting vs fire prevention
prime time
programming blocks of time
organizing the workspace
memoitis essential but use only when necessary
COMMON TIME WASTERS:
overcommitment
visitors
telephone
meetings
indecision
paperworks and readings
lack of delegation
lack of priorities
MANAGE MEETINGS:
start on time
end on time
develop agenda
only those needed must be present
gather information prior to meeting
TECHNIQUES TO STOP PROCRASTINATION:
break a large job down to smaller tasks
do a start-up task
take advantage of your moods
consider the consequences of not doing the job
consider hiring someone to do the job
consider switching job with someone
divide up the job to do what one likes to do
make a commitment to someone/wager with
someone
set goals
set realistic time schedule
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gather necessary information
avoid over-commitment
give yourself a reward
organize the department
functional
product
geographical
process
BENEFITS OF TIME MANAGEMENT:
efficient
success
healthy
OBSTACLES TO EFFECTIVE TIME MANAGEMENT:
Obstacles
Unclear objectives
Disorganization
Inability to say NO
Interruptions
More interruptions
Periods of inactivity
Too many things at once
Stress and fatigue
All work and no play
What we can do?
Recognize that obstacles exist
Identify them
Set goals (Specific, Measurable, Attainable,
Realistic, Time bound)
Prioritize (Do, Delegate, Delay, Delete)
Organize
Learn to say NO
You can't do everything
Don't undertake things you can't complete
Remain consistent to your goals
Use your waiting time
on public transportation
at doctor's office
waiting for your phone
on hold
when you are early
correspondence
letter/memos
book/tapes
Concentrate on the task at hand
Focus on your goal
Consider personal time
Morning?
Evening?
Late night?
Celebrate your success

DECISION-MAKING
is the skill to solve problems by selecting the one course
of action from several possible alternatives
it is a key component of time management skills
DECISION MAKING PROCESS:
identify the problem and analyze the situation
explore the alternatives
choose the most desirable alternative
implement the decision
evaluate the results

DECISION STRATEGIES:
Optimizing: greatest possible gain
Satisficing: good enough solution
Mixed Scanning: satisfied to remove least promising
solutions than select best of remaining options
Opportunistic: solution chosen by problem identifier
Do Nothing: waiting for the storm to pass
Eliminate Critical Limiting Factor: remove most
powerful obstacle to succees
PROBLEM SOLVING PRINCIPLES:
rely on policy for small problem: conserve time for
large, unique problems
delegate recurring problems to subordinates trained
to handle them
seek information for problem solving from internal
and external experts
ensure adequate time and relaxed conditions for
creative problem solving
after appropriate consideration, select and
implement best solution without rumination

STAFFING
provides the appropriate numbers and mix of nursing
staff and nursing care hours
to match the actual/projected patient care needs
that will lead to the delivery of effective and efficient
nursing care
DETERMINING NURSING CARE HOURS
Nursing Hours Per Patient Day (NHPPD)
calculated by dividing the total nursing care
hours by the total census (number of patient)
there are no specific standards for nursing care
hours, it varies from the average of 5-7 hours in
the medical/surgical units; 10-24 in CCU; 2428
for new, severely burned, selected clients
DETERMINING FULL-TIME EQUIVALENT (FTEs)
one FTE = 40 hours of work/week for 52 weeks or
2080 hours/year
this is used to staff a unit 24 hours a day, 7 days a
week
techniques in determining FTEs
hours of week for the staff for 2 weeks, average
daily census and hours of care
formula:
ave nsg care hrs x days of staffing period x ave px census
hours of week/FTE in 2 weeks

data:
number of hours worked/FTE in 2
weeks = 80
number of days of coverage in 2 weeks
= 14
average daily census = *depends
average nursing care hours (based from
patient classification system) = 6.15
DETERMINING DISTRIBUTION OF STAFF
patient census or average patient days (annual
census/number of beds)
activities
workload (care demands)
skills of staff
training and staff development exposures
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occupancy rate (average patient days/number of
days in a year)
patient-related groups (DRGs)
SCHEDULING
cyclic list of nurses working in a given week, in a
particular unit
shows balance to work flow between nursing needs
and staff available
it allows efficient giving of assignments and improve
staff utilization

PATIENT CLASSIFICATION SYSTEM (PCS)
a scheme that groups patients according to the amount
and complexity of their nursing care requirements; it
serves as a tool to reassure patient needs, caregivers
interventions and the skill levels, required to meet those
needs
developing a fair, objective, and reliable way to predict
the required number and skill level of staff
to meet patient needs
providing appropriate staffing assignment
measured by standards of care
determined by the number of hours of care needed
to provide quality of care to the patient
PURPOSES OF PCS:
determine the unit measure for:
nursing time
nursing hours per patient day (NHPPD)
time needed to provide patient care
according to hospital department
standards of care and practice
determine:
number
monitor changes in patient care needs
provide data on each patient care unit to project
staffing needs
ensure quality nursing care provided in a safe
environment
PATIENT CLASSIFICATION SYSTEM:
Category I ambulatory; needs no assistance from
health professional
Category II with minimal assistance; with IV
tubings; NSD minor surgery, few days post-operative
Category III with moderate assistance; immediate
post-operative
Category IV full assistance with dependence on
health professional; comatose neurological patient
USES OF PCS:
improve patient satisfaction by providing required
time to the patient according to his/her needs
enhance staff satisfaction
monitor the provision of quality nursing care

PRIORITY SETTING
INVOLVES:
list the things that frequently get in the way
identify aspects of your work that lies in and out of
your control
keep a time log (set time frames)
evaluate and analyze likely upcoming demands

SUGGESTED PRIORITY SETTING PRACTICES:
set up a written priority matrix to analyze activities
that really merit higher priorities
attach deadlines To Do item
always allot a margin of time for interruption in your
plans
clarify the time needed for the interruption; decide
whether you can handle it now
when you become overloaded, ask for a meeting
with appropriate people:
explain the competing demands
suggest alternatives
ask for additional ideas
press for a decision about re-ordering priorities
and responsibilities
when you take on a task, clarify scope and
expectations for its completion
determine where the importance of this task file in
the big picture
whenever delegating a task, explain
set a specific task
CONSIDERATIONS IN PRIORITY SETTING:
ABC of the ABC
Maslows Hierarchy of Needs
Professional ethics/laws
Institutional safety rules/regulations
safety first
DELEGATION
it is handling of a task over to another person,
usually a subordinate
it is assignment of authority and responsibility to
another person
allows a subordinate to make decisions
ensure that the delegate understands:
why the work is to be done
why they are expected to do
the date by which they are expected to do it
the authority they have to make decision
the problems they must refer back
the progress or completion report they should
submit
how you propose to guide and monitor them
the resources and help they will have to
complete the work
TIPS FOR DELEGATION:
competent employee
reasons for selecting employees
explain what and why
guidance and support
delegate, dont abdicate
inform other who need to know
only those things you should

MODALITIES OF DELIVERING NURSING CARE
FUNCTIONAL







Charge
Nurse
Med
Nurse
Treatment
Nurse
Bath duty
Nurse
(ADL)
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Advantages
The needs of a group of patient are broken
down into tasks
Tasks are assigned to RNs/LPNs so the skill are
used to the best advantage
Contribute to efficiency and effectiveness in
doing assigned tasks
Disadvantages
Uneven continuity of care
No holistic view of patient
Time consuming
Problem with follow-up
TEAM NURSING










a team of nurse provides total patient care to a
group of patient
A team of nurse to a group of patient
Modular limit the team in a geographical area
Advantages
Allows use of less prepared nurses
Coordinated care
Disadvantages
Requires much time for effective
communication, supervision and coordination
Diminished continuity of care
Fragmented care of client
Role confusion
TOTAL PATIENT CARE







also called Case Method
one RN is responsible for all aspects of care of one or
more patient
Advantages
Continuous, holistic, expert
Total accountability
Continuity of communication
Disadvantages
Too expensive
Spends much time with tasks that can be
delegated
Places the RN back to the patient bed side from
admission to discharge
There is decentralized care
RN designs, implements and evaluates patient
care



CASE MANAGEMENT







a model identifying, coordinating and monitoring the
implementation of services needed to achieve
desired patient care outcomes with a specified
period of time
Advantages
Reduced complications
Reduced cost
Increase collaborations
Improved quality care
Disadvantages
Case manager does not give direct nursing care
Treatment focused
High level of coordination, supervision and
communication
Expensive
PROGRESSIVE DISCIPLINE APPROACH


No Discipline


Goal Warning

Written Warning

Supervision



Steps in Progressive Discipline:
Counsel the employee regarding the
performance problem and expectations for
improvement. Timeless for improvement are
given
Reprimand the employee for the first time if the
unacceptable behavior continues. This may be
oral/written, depending on policies/contacts
Reprimand the employee for the second time if
the unaccepted behavior continues. This must be
written
Suspend the employee for a given period of time
if the unacceptable behavior continues
Terminate employee if the unacceptable
behavior continues after return from suspension
Principles of Disciplinary Actions:
Have a positive attitude
Investigate carefully
Be prompt
Protect privacy
Focus on the act
Enforce on the act
Enforce rules consistently
Be flexible
Advice the employee
Take connective, constructive action
Charge Nurse
Patient
Team/Module
leader
Team/Module
leader
Patient Patient
Charge Nurse
RN
RN RN
RN / LPNs RN / LPNs

RN / LPNs

Team/Module
leader
Patient
Patient Patient
Patient Caseload
Caregiver
Case Manager
Caregiver Caregiver
Improper Behavior
Termination
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//carengreyes
Follow-up
Principles of Disciplinary Actions:
Describe the situations and review previous
agreements
Ask for explanation
Listen and response with empathy
Indicate what action you must take and why
Agree on specific action
Express confidence
Modification of Employee Behavior:
Reinforcement
Shaping
Punishment
Extinction

Components of a Disciplinary Action:
Codes of conduct
Authorized penalties
Records of offense and corrective measures
Right to appeal