Nursing Leadership and Management

STUDENT ACTIVITY SHEET BS NURSING / FOURTH YEAR

Session # 17

LESSON TITLE: ORGANIZING (PART 1) Materials:

LEARNING OUTCOMES: Book, pen and notebook, and index card/class list
Upon completion of this lesson, the nursing student can: References:
1. Define organizing; Sullivan, E. J. (2009), Effective Leadership and
2. Describe the organizational chart; Management in Nursing (7th edition). Singapore:
3. Enumerate the elements of organizing; Pearson Education South Asia Pte Ltd.
4. Describe staffing;
5. Determine staffing needs; and,
6. Determine the appropriate staffing mix and distribution of
staff.

LESSON PREVIEW/REVIEW

Based on the previous lesson, give the approaches to budgeting:

MAIN LESSON

ORGANIZING
- The process of coordinating the work to be done within the organization.
- Ongoing process that systematically reviews the use of human and material resources.
l Involves:
ü identifying the work of the organization
ü dividing the labor
ü developing the chain of commands
ü assigning authority
l In healthcare, the basis of organization are:
ü Mission
ü Formal Organization Structure
ü Delivery systems
ü Job descriptions
ü Skill mix
ü Staffing Patterns

ORGANIZATION
- 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 .
l AUTHORITY
- The right to act, empower or make decisions without approval of higher administrators.
l RESPONSIBILITY
- Obligation to perform or accomplish the assigned tasks.
l ACCOUNTABILITY
- Taking full responsibility for the quality of work and behavior while engaged in the practice of one’s profession.

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 ELEMENTS OF ORGANIZING
n Setting up the Organizational Structure
n Staffing
n Developing Job Descriptions
n Scheduling

Setting up the Organizational Structure

ORGANIZATIONAL STRUCTURE
- Refers to the way in which a group is formed, its lines of communication, and its means of challenging authority
and making decisions.
- Describes the arrangement of the work group
- Increases organizational efficiency.

ORGANIZATION CHART
- A line drawing that shows how the parts of an organization are linked.
- Depicts the formal organizational relationships, areas of responsibilities, persons to whom one is and channels
of communication.

PURPOSES OF ORGANIZATIONAL STRUCTURE

1. It informs members of their responsibilities so that they may carry them out.
2. It allows the manager and the individual workers to concentrate on his/her specific role and responsibilities.
3. It coordinates all organization activities so there is minimal duplication of effort or conflict.
4. It reduces the chances of doubt and confusion concerning assignments.
5. It avoids overlapping of functions because it pinpoints responsibilities.
6. It shows to whom and for whom employees are responsible.

TYPES OF ORGANIZATION
n Functional Structure
n Line Organization / Formal Structure
n Informal Structure
n Staff Organization

Functional Structure
- Employees are grouped in departments by specialty, with similar tasks being performed by the same group,
similar groups operating out the same department, and similar departments reporting to the same manager.
- Tends to centralize decision making because the functions converge at the top of the organization.
- UNCOMMON in today’s rapidly changing health care environments due to its weaknesses.
1. Coordination across functions is poor as the decision making can pile up at the top and overload senior
managers
2. General management training is limited because most employees move up the organization within the
functional departments only.

Line Organization
- Oldest, simplest and most direct type of organization in which each position has general authority over the
lower positions in the hierarchy
- Line positions are displayed by a ‘solid line’
- Vertical Line of Authority / Vertical Relationship

Informal Organization
- Refers to horizontal relationships rather than vertical.
- Composed of small groups of workers with similar interests, ideas, and responsibilities.

Staff Organization
- Purely advisory to the line structure with no authority to put recommendations into action.
- Staff positions are displayed as ‘broken line’.

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*Vertical line authority – Chief Nurse to Nurse Manager to Staff
*Horizontal –Acute nurse practitioner and Nurse manager
--- they collaborate to improve efficiency and productivity of unit but NOT responsible for the work of the other

CHARACTERISTICS OF AN ORGANIZATION CHART

1. Division of Work
- Each box represents the individual or sub-unit responsible for given task.
- reduces number of tasks that each employee must carry out
- managers can standardize the work to be done, which in turn provides greater control.
2. Chain of Command
- Lines indicate who reports to whom and by what authority.
- hierarchy of authority and responsibility within the organization.
3. Type of Work to be Performed
- Indicated by labels or descriptions for the boxes
4. Grouping of Work Segments
- Shown by clusters of group works (departments or single unit)
5. Levels of Management
- Indicate individual and entire management hierarchy

ORGANIZING PRINCIPLES
1. Unity of Command - one direction ONLY; under the 14 principles of management (Henri Fayol) -- An employee
should report to only one supervisor
2. Scalar Principle or Hierarchy - refers to a clearly defined line of authority that includes all employees in the
organization --- immediately report to the higher management
3. Homogenous Assignment / Departmentalization
4. Span of Control - number of people you can directly monitor; the higher the number, the lesser the possible
control.
- How many employees a manager can effectively supervise.
- Complex organization has tall structure due to numerous departments in which authority is
centralized
- Less complex organization has flat structure; authority is decentralized with several managers
supervising large work groups.
5. Exception - decision to your own department; on your own
6. Decentralization - proper delegation of authority; Decision-making is shared with the employees

STAFFING
- The process of determining and providing the accepted numbers and mix of nursing personnel to produce a desired
level of care to meet the patient’s demand.
- There is no single or perfect method to achieve the staffing.
- Variability in patient census requires continuous fine-tuning.

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 FACTORS AFFECTING STAFFING
1. Type, philosophy & objectives of the hospital & nursing services.
2. The population served or the kind of patients served whether pay or charity.
3. The number of patients, severity of illness & knowledge and ability of personnel are matched with the actual care
needs or patients.
4. Availability & characteristics of the nursing staff including education, level of preparation, mix of personnel,
number & position.
5. Administrative policies such as rotation, weekends and holiday off-duties.
6. Standards of care desired which should be available & clearly spelled-out. Institution may utilize the ANSAP’s
(Association of Nursing Service Administrators of the Philippines) standard of Nursing Practice.
7. Layout of various nursing units & resources available within the department such as adequate equipment,
supplies, & material.
8. Budget including the amount allotted to salaries, fringe benefits, supplies, materials & equipment.
9. Professional activities & priorities in non-patient activities like involvement in professional organizations, formal
educational development, participation in research & staff development.
10. Teaching program or extent of staff involvement in teaching activities.
11. Expected hours of work per annum of each employee, influenced by the 40-hr week law.
12. Pattern of work schedule:
ü 5 days/wk, 8 hrs/day, 2 days off/wk
ü 4 days/wk, 10 hrs/day, 3 days off/wk
ü 3 ½ days/ wk, 12 hrs/ day, 3 ½ days off/wk

PATIENT CARE CLASSIFICATION SYSTEM

- Sometimes referred to as PATIENT ACUITY SYSTEMS
- Method of grouping patients according to the amount and complexity of their nursing care requirements and the
nursing time and skill they require.
- To be most effective, patient classification data are collected midpoint for every shift by the unit nursing staff and
analyzed before the next shift to ensure appropriate number and mix nursing staff.
- Use patient needs to determine workload requirements and staffing needs objectively.
- Ideally, this system would accurately predict the number and skill level of nurses needed for the next shift
- Reality, much can go amiss due to:
1. Nurses call in sick
2. Nurses schedule may not have the skill set necessary for a new admission (ex: patient condition may change)

TABLE 1: NCH/ Patient/ Day

*according to classification of patients by units.
*NCH – Nursing Care Hours

CLASSIFICATION CATEGORIES:
n LEVEL I – Self Care or Minimal Care
n LEVEL II – Moderate Care or Intermediate Care
n LEVEL III – Total, Complete or Intensive Care
n LEVEL IV – Highly Specialized Critical Care

LEVEL I
- Patient can take a bath on his own, feed himself, and perform his ADLs.
- Patients about to be discharged, those in non-emergency, newly admitted, don’t exhibit unusual s/sx & requires little
treatment.
² NCH: 1.5
² Ratio: 55:45 (Professional: Non-Professional)

LEVEL II
- Patients need some assistance in bathing, feeding & ambulating
- Extreme symptoms may have subsided, haven’t yet appeared
- May have slight emotional needs, with V/S ordered up to 3x/shift, IVF or BT, are semi-conscious
- Require periodic treatment
² NCH: 3
² Ratio: 60:40

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 LEVEL III
- Patients are completely dependent upon the staff
- Provided with complete bath, fed, may or may not be unconscious, may be on continuous O2 therapy, with chest or
abdominal tubes
- Require close observation at least 30 minutes
² NCH: 4.5
² Ratio: 65:35

LEVEL IV
- Patients need maximum nursing care
- Patient needs continuous treatment, with many medications, IV piggy backs, V/S every 15 to 30 minutes, hourly
output, with significant changes in doctor’s order
² NCH: 6 *NCH can go to 9
² Ratio: 70:30 *Ratio can go to 80:20

FORTY HOUR WEEK LAW

- Provides that employees working in hospitals with 100-bed capacity and up will work only 40 hours a week.
- This also applies to employees working in agencies with at least one million population.
- RA 5901 - an act prescribing 40 hrs a week of labor for government and private hospitals or clinic personnel

CIVIL SERVICE COMMISSION

- As per Memorandum Circular No. 6 Series of 1996
- 3-day special privilege to government employees, which may be spent for:
ü Birthday
ü Wedding
ü Anniversary
ü Funeral
ü Relocation
ü Enrolment / Graduation
ü Hospitalization
ü Accident Leaves

TABLE 2: Categories / Levels of Care of Patients, NCH needed/pt/day & Ratio of Professional to Non-
Professonal

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TABLE 3: Percentage of Patients at Various Levels of Care per Type of Hospital

TABLE 4: Total # of Working & Non-Working Days & Hrs of Nursing Personnel Per Year

* Standard: 365 days per year

* Standard reference
For the relievers:
33 days average number of days an employee is absent/yr
213 total number of working days/yr (40hrs)

0.15 per person who works 40 hrs/wk

33 ⁄265 = 0.12per person who works 48 hrs/wk

SHIFT DISTRIBUTIONS
n AM SHIFT – 45%
n PM SHIFT – 37%
n NIGHT SHIFT – 18%
* Whether it would be nurses or nursing attendants

STAFFING COMPUTATION
PROBLEM: Find the number of nursing personnel needed for 250 patients in a tertiary hospital.

1. Categorize the patients according to the levels of care needed. Refer to table 3

250 x .30 = 75 pts needing minimal care

250 x .45 = 112.5 pts needing moderate care
250 x .15 = 37.5 pts needing intensive care
250 x .10 = 25 pts needing highly specialized care

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 2. Find the number of Nursing Care Hours (NCH) needed by the patients at each level of care per day. Refer to table
2.
75 x 1.5 (NCH at Level I)= 112.5 NCH/day
112.5 x 3 (NCH at Level II)= 337.5 NCH/day
37.5 x 4.5 (NCH at Level III)= 168.75 NCH/day
25 x 6 (NCH at Level IV)= 150 NCH/day

TOTAL = 768.75 NCH/day

3. Find the total NCH needed by 250 patients.

768.75 NCH/day x 365 days/year = 280,593.75 NCH/yr

4. Find the actual working hours rendered by each nursing personnel per year.

8 hrs/day x 213 working days/year

= 1,704 working hours /yr

5. Find the total number of nursing personnel needed.

a. Total NCH per year

Working hrs/year

280,593.75 NCH/yr
1,704 = 165 nursing personnel

b. Relief x Nursing Personnel

0.15 (constant for 40 hrs) x 165 = 25 relievers

c. Total Nursing Personnel needed

165 nursing personnel + 25 relievers = 190

6. Categorize to professional and non-professional personnel. Ratio of pro to non-pro in a tertiary hospital is ______.

65:35 (Refer to table 2)

190 x .65 = 123.5

190 x .35 = 66.5

7. Distribute the shifts. (Refer to shifts distribution)

a. NURSES = 123.5
123.5 nurses x .45 (AM shift) = 56
123.5 nurses x .37 (PM shift) = 46
123.5nurses x .18 (NIGHT shift) = 22
TOTAL: 124

b. NURSING ATTENDANTS = 66.5

66.5 NA x .45 (AM shift) = 30
66.5 NA x .37 (PM shift) = 25
66.5 NA x .18 (NIGHT shift) = 12
TOTAL: 67

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CHECK FOR UNDERSTANDING
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.
You are given 20 minutes for this activity:

Multiple Choice

PROBLEM: Find the number of nursing personnel needed for 150 patients in a secondary hospital.

1. How many patients needs minimal care?

a. 45
b. 97.5
c. 105
d. 15
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

2. How many patients needs moderate care?

a. 45
b. 97.5
c. 105
d. 15
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

3. How many patients needs intensive care?

a. 22.5
b. 67.5
c. 7.5
d. 15
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

4. Patients on level 1 care needs how much NCH?

a. 67.5
b. 146.25
c. 157.5
d. 22.5
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_______________________________________________________________________________________________

5. Patients on level 2 of care needs how much NCH?

a. 135
b. 292.5
c. 315
d. 45

ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

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6. Patients on level 3 of care needs how much NCH?
a. 101.25
b. 303.75
c. 33.75
d. 67.5
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

7. What is the total number of NCH per year for 150 patients?
a. 168,356.25
b. 283,331.25
c. 49,275
d. 114,975
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. How many nursing personnel are needed?

a. 99
b. 166
c. 29
d. 67
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

9. How many relievers are needed?

a. 15
b. 25
c. 4
d. 10
ANSWER: ________
RATIO:___________________________________________________________________________________________
________________________________________________________________________________________________
________________________________________________________________________________________________

10. How many TOTAL Nursing personnel are needed?

a. 114
b. 191
c. 33
d. 77
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
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4. ANSWER: ________
RATIO:_______________________________________________________________________________________
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5. ANSWER: ________
RATIO:_______________________________________________________________________________________
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6. ANSWER: ________
RATIO:_______________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
10. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

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LESSON WRAP-UP (10 minutes)
You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

AL Strategy: CAT 3-2-1

This activity is to evaluate what your learned after the discussion and the activity.

Three things you learned:

1. __________________________________________________________________________________________
2. __________________________________________________________________________________________
3. __________________________________________________________________________________________
Two things that you’d like to learn more about:
1. __________________________________________________________________________________________
2. __________________________________________________________________________________________
One question you still have:
1. ___________________________________________________________________________________________

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