Nursing Management: Guide to

Organizing, Staffing,
Scheduling, Directing &
Delegation
Organizing

Determine what task are to be done, who is to do these, how the tasks
are to be grouped, who reports to whom and what decisions are to be
made.
It is a form of identifying roles and relationships of each staff on order to
delineate specific tasks or functions that will carry out organizational plan s
and objectives.
Process of identifying and grouping the work to be performed, defining
and delegating responsibility and authority and establishing relationships
for the purpose of enabling the people to work more effectively together in
accomplishing objectives.
As a process, it 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 hierarchal importance
and functional association.

Organizing Process Includes

1.

Identifying and defining basic tasks.

2.

Delegation of authority and assigning responsibility

3.

Establishing relationships

Three Forms of Authority

1.

Line authority is a direct supervisory authority from supervisor to

subordinates.
o
Chain of Command unbroken line of reporting relationships
that extends through the entire organization. The line defines the chain

2.

of command and the formal decision making structure.

Unity of Command within the chin states that, each person in

the organization should take orders and reports only to one person.
Span of Control refers to the number of employees that
should be placed under the direction of one leader-manager.
Staff Authority authority that is based on the expertise and which

usually involves advising the line managers.

3.
Team Authority is granted to committees or work teams involved in
an organizations daily operations. Work teams are group of operating
employees who shared a common vision, goals and objectives.

Organizational Chart
o
o
o

Drawing that shows how the parts of the organizations are link.
It depicts the formal organizational relationship, areas of responsibility
and accountability and channel of communication.
Depicts an organizations structure.

Organizational Structure
o

1.

Depicts and identifies role and expectations, arrangement of positions

and working relationships.
Dotted or Unbroken line represents staff positions/staff authority

(advisor to the line managers).

2.
Centrality refers to the location of a position on an organizational
chart where frequent and various types of communication occur.

Determined by organizational distance; those with small organizational

distance receive more information than those who are more peripherally
located.
3.
Solid Horizontal Line represent same positions but different
functions.
4.
Solid Vertical Line chain of command form authority to subordinates
(line authority)

Managerial Levels
Level
Top Level Managers

Scope of Responsibility
1.

Generally make
decisions with the help of
few guidelines or

Examples
CEO, President, V-President,
Chief Nursing Officer

structure.
2.

Coordinates internal
and external influences

Middle Level

1.

They conduct day-day

operations with some

Managers

involvement, long term

planning and policy

Head Nurse, Department

Head, Unit
Supervisor/Manager

making.
First Level Managers

1.

Concerned with
specific unit workflows.

2.

Deals with immediate

day-day problems.

Charge Nurse, Team Leader,

Primary Nurse, Staff Nurse

Patterns of Organizational Structure

1. Tall/Centralized Structure
o
o
o
o

Responsible for only few subordinates so there is narrow span of

control
Because of the vertical in nature, there are many levels of
communication
Communication is difficult and messages do not get to the top.
Workers are boss-oriented because of close contact with their
supervisor.

2. Flat/Decentralized Structure
o
o

Characterized by few levels and a broad span of control

Communication is easy and direct

Advantages:
1.

Shortens the administrative distance from the top to the lower

2.

Solutions to problems are easily carried out/fast response

3.

Workers developed their abilities and autonomy

Disadvantage:
1.

Impractical in large organization.

Types of Organizational Structure

1. Line Organization/Bureaucratic/Pyramidal
o
o

There is clearly defined superior-subordinate relationship

AR and power are concentrated at the top

2. Flat/Horizontal Organization
o
o
o
o

Decentralized type
Applicable in small organization
Nurses become productive and directly involved in the decision making
skills
Workers become satisfied

3. Functional Organization
o

Permits a specialist to aid line position within a limited and clearly

defined scope of authority

4. Ad Hoc Organization
o

Modification of bureaucratic structure

5. Matrix structure
o
o
o

Focus on both product and functions

Most complex
Has both vertical and horizontal chain of command and line of
communication

Staffing
o

Process of assigning competent people to fulfill the roles designated for

the organizational structure through recruitment, selection and
development, induction and orientation of the new staff of the goals,
vision, mission, philosophy etc.

Staffing Process
1.

Preparing to Recruit types and number of personnel

2.

Attracting a Staff formal advertisement

3.

Recruiting and Selecting a Staff interview induction orientation

job order pre-employment testing signing of contract

Staffing Pattern plan that articulates how many and what kind of staff are
needed/shift or per day in unit or in department.

Two Ways of Developing a Staffing Pattern

1.

Determine the # of nursing care hours needed/patient

Generating the full time equivalents of an employee

2.

Determine the nurse-patient ratio in providing nursing care

FTE measure of work committed of full time employee

1.0 FTE = works 5 days/week, 8 hours/day
0.5 FTE = part time employee who works 5 days/2 weeks

o
o

Considerations in Staffing Pattern

1. Benchmarking

Management tool for seeking out the best practice in ones industry so
as to improve ones performance.
Process of measuring products, practices and services against best
performing organization as atool for identifying desired standards of
organizational performance.

2. Regulatory Requirements mandated by RA

3. Skill Mix percent or ratio of professionals to non professional
Ex: 40 FTE (20 RN + 20 non RN) = 50% RN mix
4. Staff Support staff support in place for the operations of the units or
department.

5. Historical Information review of any data on quality or staff perception

regarding the effectiveness of the previous staffing pattern

Patient Classification System

o
o

Measuring tool used to articulate the nursing workload for specific

patient or group of patients over a specific time.
Patient Acuity measure of nursing workload that is generated for
each patient.

Patient Care is Classified According to:

1.

Self care or minimal care patients are capable of carrying ADL, e.g.,
hygiene, meals etc.

2.

Intermediate or moderate care requires some help from the nursing

staff with special treatments or certain aspects of personal care, e.g.,
patients with IV fluids, catheter, respirator, etc.

3.

Total care patients are those who are bedridden and who lack strength
and mobility to do average daily living. Ex: patients on CBR, immediate
post-op, with contraptions.

4.

Intensive care patients are those who are critically ill and in constant
danger of death or serious injury. Ex: comatose, bedridden etc.

Scheduling

Timetable showing planned work days and shifts for nursing personnel.

Issues to consider in scheduling staff:

1.

Patient type and acuity

2.

Number of patients

3.

Experience of Staff

4.

Support available to the staff

Shifting Variations

o
o
o

Traditional Shifting Patterns

3 shift (8 hr shift)
12 hr shift
10 hr shift
Weekend option
Rotating work shift
Self-scheduling staff makes their own schedule
Permanent work shift
Floaters on-call

Forty Hour Week Law based on RA5901

No work, no pay
Entitled to 2-week sick leave and off duty for 2 days
Special Holidays with pay

Directing

Act of issuing of orders, assignments, instructions, to accomplish

organizational goals and objectives.
Delegation entails responsibility
Assignments no responsibility

Elements of Directing
1.

Communication

2.

Delegation

3.

Motivation

4.

Coordination

5.

Evaluation

Communication exchange of ideas, thoughts or information through verbal

speech, writing and signals

Barriers in Communication
1. Physical Barriers

Environmental factors that prevent or reduce the opportunities for

communication. Ex: Distance and Noise

2. Social and Psychological Barriers

Blocks or inhibitors of communication that rise from the judgment,

emotions, social values of people.Ex: stress, trust, fear, defensiveness
Internal climate (values, feelings, temperament and stress levels) and
external climate (weather, timing, temperature, lack of validation to the
message).

3. Semantics

Words, figures, symbols,penmanship and interpretation of the message

through signs and symbols.

4. Interpretations

Defects in communication skills by verbalizing, listening, writing,

reading and telephony

Delegation

Act of assigning to someone else a portion of the work to be done with

corresponding authority, responsibility and accountability (ARA).
According to ANA, it is the trabsfer of responsibilities for the
performance of the task from one person to another

Much of the work of manager is accomplished by transferring the

responsibilities to subordinates

Good Reasons for Delegation

1.

Manager delegate routine task so that they are free to handle problems
that are more complex or require higher level of expertise

2.

Delegate routine task if someone else is better prepared or has greater

expertise or knowledge in solving the problems

Managers who do not delegate

Does not trust

Fear of mistake
Fear of criticism
Fear of own ability to delegate

Common Errors in Delegation

Underdelegating systems from the managers false assumptions

that delegation maybe interpreted as a lack of ability on his part to do the
job correctly and competently. Reasons are:
o
Managers believe that they can do the work faster and better
o
Managers believe that the responsibility may be rejected if
delegated
Overdelegating subordinates become overburdened which may lead
to dissatisfaction and low productivity. Reasons are:
o
Managers who are lazy
o
Manager who are overburdened and exhausted
Improper Delegation delegating at the wrong person, time, tasks
and beyond the capability of the subordinates.

Steps in Effective Delegating

1.

Plan ahead

2.

Identify necessary skills and levels

3.

Select most capable personnel

4.

Communicate goal clearly

5.

Empower the delegate

6.

Set deadlines and monitor progress

7.

Model the role and provide guidance

8.

Evaluate performance

Motivation whatever influences our choices and creates direction,

intensity, and persistence in our behavior.
Supervision guiding and directing the work to be done. It entails
motivating and encouraging the staff to participate in the activities to meet
the goals and objectives for personal development in making the work
better.
Coordination arranging in proper order. It creates harmony in all
activities to facilitate success of work

Conflict Management

Conflict internal and external discord that results in from differences

in ideas, values or feelings between 2 or more people. It arises because of
differences in economic and professional values.

Two Main Types

1.

Competitive Conflict 2 or more group the same goal and only one
group can attain them
o

2.

Management: Set Goals

Disruptive Conflict takes place in environment filled with anger, fear

and stress. There is no mutually acceptable set of rules and the goal of
each party is the elimination of each opponent.

Conflict Resolution Strategies

1.

Use of dominance and Suppression

o
o

2.

Win lose strategy

Loses feels angry
Restriction autocratic coercive style that uses indirect and obstructive

expression of conflict.
3.
Smoothing Behavior persuades the opponent in a diplomatic way
4.

Avoidance Behavior 2 parties are aware of the conflict but choose

not to acknowledge or attempt to resolve it.

5.
Majority rule unanimous decision
6.

Compromising consensus strategy where each side agrees

solutions
7.
Interactive Problem Solving constructive process in which the
parties involve recognized that conflict, assist and openly try to solve the
problems
8.
Win-Win Strategy focuses on goals and attempts to meet the needs
of both parties.
9.
Lose-Lose Strategy neither side wins
10.

Confrontation most effective means of resolving the conflict.

Resolves through knowledge and reason brought out in an open.

11. Negotiation give and take