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^nursing management functions^
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Definition
Process of determining the activities to be to be performed, arranging these activities to administrative units, as well as assigning managerial authority and responsibilities to people employed in the organization. affects organization and delivery of health service backbone of management
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Importance of Organizing
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Focus on, and facilitate the attaining of, attaining of objectives Arrangement of positions and jobs within the hierarchy. Define responsibilities and line of authority line of authority of all levels. Creating relationships that will minimize friction.
Steps in Organizing
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Elements of Organizing
Centralization and decentralization Delegation of authority Span of control (supervision) Division of service Departmentation
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I.e., the level at which most of the decisions are made within the organization.
Decentralization Consistent delegation of authority to the lower levels where the work is performed
Centralization
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Decentralization Advantages
Raise morale and promote interpersonal relationships. Relieve from the daily administration. Bring decision-making close to action. Develop Second-line managers Promote employees enthusiasm and coordination Facilitate actions by lower-level managers. Improves coordination, especially for services.
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Disadvantages
Top-level administration may feel it would decrease their status. Managers may not permit full and maximum utilization of highly qualified personnel. Increased costs. It requires more managers and large staff. It may lead to overlapping and duplication of effort. It may lead to lack of uniformity and lowering of standards in decisionmaking. Emergency decision may not be possible.
2. DELEGATION OF AUTHORITY
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Delegation Process of assigning work from a top organizational level to a lower one or from one superior to subordinate, and giving that person the authority to accomplish them. A downward flow of authority from HIGHER level in the organization to LOWER level.
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Lack of superiors ability to direct the subordinates. Lack of confidence in subordinate. Absence of control.
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Desire to dominate the knowledge, information, information, and/or skills. Unwillingness to accept risks of wrongs.
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Decision-making is a hard mental work, and people seek ways of avoiding it. Fear of criticism for mistakes. Lack of necessary information and resources to do a good job. Overload of work. Positive incentives may be inadequate.
Authority
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Types of authority
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Responsibility
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It cannot be delegated, it may be continued or it may be or it may be terminated with the accomplishment of a single action.
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The line relation - presents levels of hierarchy, superior subordinate relationships, and provides the framework for the organization. it is showed by a solid line in the organizational chart line Staff relation - has no command, personnel have only the right to advise, assist, support those in line authority in the performance of their duties, showed by a dotted line in the organizational chart.
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3. SPAN OF CONTROL
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Advantages: Close supervision. Close control. Fast communication between subordinates and superiors. Disadvantages: Superiors tend to get too involved in subordinates work. Many levels of management. High costs due to many levels.
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Disadvantages: Tendency of overload superiors to take most or all decisions. Danger of superiors loss of control. Requires exceptional quality of managers.
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The competence of both the supervisor and the subordinate. The degree of interaction between the units between the units or personnel being supervised. Other duties of the top manager. Lowerlevel managers have a wider range of span than top top-level manager. The similarity or dissimilarity of activities being supervised.
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4. DIVISION OF SERVICE
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Dividing large activities to be distributed among several people. Advantage: Allow an employee to master a task with a maximum skill, a minimum time and effort. Disadvantages: Creates many different, narrow jobs, which effective managerial coordination. Human problems have been created from division of service, fatigue and stress, and which lead to less quantity and quality of work, increased absenteeism and higher turnover.
5. DEPARTMENTATION
Types of Departmentation: by services by time by degree of acuteness of illness by function by location by patient
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Job Descriptions are specifications of duties, conditions and reqts of a particular job prepared through a careful job analysis; also called performance descriptions PURPOSES: Recruitment Placement and transfer Guidance and direction Evaluation of performance Reduction of conflict & frustration Avoidance of overlapping of duties Facilitating working relationships w outside bodies such as professional associations Serving as basis for the employees salaray range
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Job title position and necessary qualifications Job relationships such as degree of supervision Performance description a catalogue of the resposibilities of worker
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Advantages
High degree of autonomy y Lines of responsibility and accountability are clear y Patient receives holistic, unfragmented care
y
Disadvantages
Each RN may have a different approach to care y Not cost-effective y Lack of RN availability
y
Registered Nurse
8-hour shift
Registered Nurse
8-hour shift
Registered Nurse
8-hour shift
Patient Care
The registered nurse plans, organizes, and performs all care
FUNCTIONAL NURSING
Staff members assigned to complete specific tasks for a group of patients Evolved during World War II as a result of a nursing shortage Unskilled workers trained to perform routine, simple tasks Common use areaoperating room
FUNCTIONAL NURSINGCONTD
Advantages
Care is provided economically and efficiently y Minimum number of RNs required y Tasks are completed quickly
y
Disadvantages
Care may be fragmented y Patient may be confused with many care providers y Caregivers feel unchallenged
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Nurse Manager
LPN/LVN
PO Meds Treatments
RN
Assessments Care Plans
Nurse Aide
Vital signs Hygiene
Nurse Aide
Hygiene Stocking
TEAM NURSING
RN as team leader coordinates care for a group of patients Evolved in the 1950s to improve patient satisfaction Goal was to reduce fragmented care Common use areasmost inpatient and outpatient areas
TEAM NURSINGCONTD
Advantages
High-quality, comprehensive care with a high proportion of ancillary staff y Team members participate in decision making and contribute their own expertise
y
Disadvantages
Continuity suffers if daily team assignments vary y Team leader must have good leadership skills y Insufficient time for planning and communication
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Nurse Manager
PRIMARY NURSING
RN primary nurse assumes 24-hour responsibility for planning, directing, and evaluating care Evolved in the 1970s to improve RN autonomy Common use areashospice, home health, and long-term care settings
PRIMARY NURSINGCONTD
Advantages
High-quality, holistic patient care y Establish rapport with patient y RN feels challenged and rewarded
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Disadvantages
Primary nurse must be able to practice with a high degree of responsibility and autonomy y RN must accept 24-hour responsibility y More RNs needed; not cost-effective
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Primary Nurse
Physician and other members of the health care team
Patient
Advantages
More cost-effective than primary nursing y RN can encourage training and growth of partner
y
Disadvantages
RN may have difficulty delegating to partner y Consistent partnerships difficult to maintain due to varied schedules
y