CHAPTER 8: ORGANIZING

Formal structure
is done after planning the task to provide for the coordination of resources to accomplish the objectives of the group

the manager then becomes the organizer

Organization
one step of nursing management backbone of management a function and a framework, a process and a structure, a human activity and the group of people

IDENTIFICATION AND DEFINITION OF BASIC TASK

staffing and creation of job description

DELEGATION
authority and assignments of responsibility for the accomplishment of activities

ESTABLISHING RELATIONSHIPS
providing a system of vertical and horizontal communications through authority relationships to bind and coordinate the groupings

FORMAL ORGANIZATION
system of well definably jobs, bounded by delegation and relatively stable governed by principles crystallized by TAYLOR, FAYOL, and GANTT among others

 refers to what people do because they are human personalities , and to their actions in terms of needs, emotions, and attitudes and not in terms of procedure and regulations people work together because of their likes and dislikes people in this group cross formal barriers

INFORMAL ORGANIZATION
CHARACTERISTICS OF AN ORGANIZATION Division of Work Chain of Command Type of Work Segment Levels of Management

ORGANIZATIONAL DESIGN
process used to improve the probability that an organization will be successful it is also use to match the purpose with the operations undertaken and to improve collective efforts of members to ensure success it is guided by an external facilitator whose role is to assure a systematic process and to encourage creative thinking

HIERARCHICAL SYSTEMS
the triumvirate of authority, responsibility and accountability are arranged in a hierarchy, which which is often known as bureaucracy

REASONS FOR ORGANIZING

The best way for an organized group to succeed The end result of effective organizational design

PRINCIPLES OF ORGANIZATIONAL DESIGN

Division of Labor Unity of Command Authority and Responsibility Span of Control Contingency Factors

ORGANIZATIONAL STRUCTURE
is a process within a group is formed including its ARA(Authority, responsibility and accountability), span of control and lines of communication formal structure, official arrangement of position, formal system of task (Swansburg:1996)

Task of a Manager
Encourage employees to work and develop supportive work attitudes Allows people to cooperate and work together efficiently and effectively.

Pattern of Organization
Tall/Centralized a. responsibility for few, so there is a narrow span of control b. vertical nature so there are many levels of communications

Advantage
a. makes used of expertise and allows close communication between workers b. supervisory individual screen the communication

Disadvantage
most skilled individual end up doing nothing communication from bottom to top is often difficult and message do not get to the top BOSS ORIENTED because of the close contact with their supervisor

Flat/Decentralized few levels and broad span of control, decision making is spread among people communication from lower to higher level is easy and direct

Advantage
a)lower change of message is being lost or distorted and organization can respond to problem faster
b)worker developed their own ability and autonomy ;organization is humanistic resulting greater job satisfaction c) shared governance produced maximum professional growth

Disadvantage

supervisor spends less time with each worker

supervisor may lack expertise which may come up to inappropriate decision making

LINE/BUREAUCRATIC/PYRAMIDAL ORGANIZATION
each position has general authority over the lower position found in large health care facilities clearly defined superior-subordinate relationship Traditional=pyramid shaped where all decisions emanate from the top down to the subordinates ARAP(power)= concentrated at the top

FLAT ORGANIZATION
decentralized, flattened and fewer levels of position lined for less complex org., several managers supervising large work groups horizontal organization, few or no level of intervention between management and staff feedback immediately reported; minimizes poor feedback only applicable in smaller organization; pingpong ball communication

Disadvantage

requires painstaking of building of personal relationship between and among workers can be easily destroyed by negative feedback

STAFF ORGANIZATION

purely advisory, no authority to place recommendation into action

FUNCTIONAL ORGANIZATION
permits specialist to aid line position within a limited and clearly defined scope of authority

AD HOC ORGANIZATION
modification of bureaucratic structure temporary basis to facilitate completion means overcoming inflexibility of line structure

MATRIX ORGANIZATION
focus on both product and function has vertical and horizontal chain of command most complex org structure

SHARED GOVERNANCE ORGANIZATION

most radical and idealistic which was developed in 1980s-alternative to traditional pyramidal/ centralized structure

LATERAL ORGANIZATION
coordination and collaboration between and among nursing staff and Hospital staff

ORGANIZATIONAL RELATIONSHIPS

FORMAL RELATIONSHIP INFORMAL

ORGANIZATIONAL CULTURE
personality of organization provides reason to be satisfied or not less tangible and difficult to measure

CORPORATE CULTURE can be looked at as a system, in which inputs includes feedback from the group

THE TOUGH- GUY MACHO CULTURE WORKHARD/PAYHARD BET YOUR COMPANY CULTURE THE PROCESS

STAFFING

allows predictable pattern process ofassigning competent people to fill the rules designated for the organizational structure process of providing acceptable number of nursing personnel

STEPS IN STAFFING
1. DETERMINE THE TYPE AND NUMBER OF PERSONNEL -can best reach out not alone but with consultation to co-worker -done through interview 2. RECRUIT PERSONNEL -done through advertisement; the recruitment step is an opportunity to attract the brightest and the best 3. INTERVIEW -must be ready with background -airy environment 4. INDUCT OR ORIENT THE PERSONNEL -see whether they would be able to work -allows to back out before any offer is made 5. JOB OFFER -when the personnel will be given an offer

STAFFING PATTERN
1) 2) 3) 4) 5) BENCH MAKING REGULATORY REQUIREMENT SKILL MIX STAFF SUPPORT HISTORICAL INFORMATION

FACTORS AFFECTING TIME REQUIREMENT OF NURSING CARE

1) acuity of the patients illness 2) degree of dependence of the patient on the caregivers 3) communicability of the ailment 4) rehabilitation needs and special treatments and procedure

PATIENT CARE IS CLASSIFIED ACCORDING TO:

1. Self-care/minimal-ADL Capable 2. Intermediate/moderate some help 3. Total Care Patient-bedridden/lack of strength 4. Intensive CP-critically ill and in constant danger

1. Case Method/Total Patient Care

Oldest develop rapport nurse is responsible for all aspect of the care one or more patients registered nurse work directly with the clients complete care model which includes treatment, medications and NCP its goal is to have one nurse give all care to the same patient for the entire shift.

Advantages
Can better see and attend to the total needs of client Care can be facilitated with ease Interaction and rapport are well-developed Needs are monitored carefully.

Disadvantage:

RN spend some time doing task that could be done more cost effectively by less skilled person

2.Functional Method(Cheapest)
Also called task nursing. A response to a national nursing shortage in 1940s Task and procedure-oriented Used when there are too many clients.

Advantages:
nurses who are oriented this way become skilled in performing assigned tasks individual aptitude and experience improves: less equipment is needed time is saved task-oriented approach improves both productivity and organization

3. Team Nursing
Evolved from functional nursing RN leads a large group of many people Small group is centered through participation efforts Personnel work together to identify, plan, implement nursing care Oriented towards the decentralization and Head Nurse authority Comprehensive Nursing care becomes the responsibility of the entire team

Advantages
Constant group work fosters participation and belongingness Balance workload and shared with the division of labor Each member of the team has opportunity to learn from colleagues Has variety in the daily assignment Helps maintain interest in clients well- being and is cost effective Patient is able to identify personnel Minimized barriers Everyone contributes to nursing care.

4. Primary Nursing Method ( Triple A Nurse)

Designed to place the RN back at the patients bedside Core principle is decentralize decision-making 24-houe basis from admission to discharge with A.R.A. Accomplished through decentralization.

Advantages
The nurse sees the client and family as one system and ARA is increased. N. uses a wide range of skills, knowledge and expertise and develops creativity Increased trust and satisfaction by the client. Excellent communication bet. The primary nurse and associate nurses Primary nurse are able to hold associate nurses, accountable for implementing the nursing care as prescribes

Disadvantages:
because of transfers to different units, critically ill patients may have several primary care nurses, disrupting the continuity of care inherent in the model

5. Progressive Client care

different areas or units provide various level of care clients are evaluated with respect to the level or intensity of care need there is increased reliant of behavior

6. Manage Care Method

Involves unit based care that is organized to achieve specific patient outcomes with in her stay in the unit

7.Practice Partnership
an RN and an assistant agree to be practice partners an efficient way of using a mixture of skills and professional and nonprofessional staff with differing levels of expertise crate synergistic energy >Compared to team nursing practice partnerships offer more continuity of care and accountability for patient care >Compared to primary nursing partnerships are less expensive for the org. and more satisfying personally for the partners

2 Main Disadvantages it tends to decrease the ratio of professional nurses to non-professional staff there is the potential for the junior member of the team to assume more responsibility than may be appropriate

8. Case Management Method

model for identifying, coordinating and monitoring the implementation of services with in a specified period of time Care is directed by a case manager focused on achievement of outcome and appropriate time frame and resources episode based rather than unit based used to organized patient care according to diagnoses or other related groups manager does not provide direct care but rather supervises the care provider

9. Modular Method
the RN provides direct care with assistance of aides modified team and primary nursing method where RN provides leadership, support and Instruction

FORMULA TO DETERMINE STAFFING PATTERNS

1. Full Time Equivalent (FTE) a formula that uses nursing care hours and annual hours of work measure of work commitment (full time employee works 5 days a week or 40 hours per week for 52 weeks a year; this amounts 2080hours of work time)

2. Forty- Hour Week Law Natl League of Nurses (NLN) or R.A. 5901 otherwise known as the FORTY-HOUR WEEK LAW

Where, ABO= average bed occuoancy NCH=nursing care hours a) Standard value of NCH

Area Surgery General Ward Pediatrics Mixed M/S

NCH 3.4 3.5

Area Nursery Medical

NCH 2.8 3.4

4.6
3.4

OB

3.0

b) Percentage of Professional and Non Professional (In Ratio) Area Surgery Gen. Ward OB Ratio 60:40 60:40 60:40 Area Pediatrics Nursery ICU Ratio 70:30 55:45 80:20

d) c) Distribution per Shift Shifts:

40 hour per week

A.M. = 45% P.M. = 37% Night = 18%

-for personnel working in hospitals with 100 bed capacity or over or which are located in a 1M population e) 48 hour/Week

-for personnel who work on agencies with lesser bed capacity or which are located In communities with less than 1m population

JOB DESCRIPTIONS: 1. Job Title- the position and necessary qualifications 2. Job relationships- the degree of supervision imposed on the worker 3. Performance Description- a catalogue of the responsibilities of the worker Employee Discipline- the process of generating employee compliance to institutional rules and regulations

Principles of Discipline
1. Should be done privately, promptly and consistently 2. Should be Progressive in nature 3. In the work environment especially it should be preceded with counseling 4. Disciplinary procedures should be instituted with extreme caution

Steps in Addressing Disciplinary Problems

1. Coaching 2. Confrontation 3. Disciplinary Conference

Steps of Progressive Discipline

-adherence to principle of due process

Different measures: 1. Counseling 2. Verbal Reprimand 3. Written Reprimand 4. Short Suspension 5. Longer Suspension 6. Discharge

1986 BILL OF RIGHTS -No person shall be deprived of life, liberty or property without due [process of law
TOOLS FOR TERMINATING STAFF

1. 2. 3. 4. 5. 6.

Inform the human resources department and administration beforehand State the offending behavior and the reason of termination Explain the termination process Remain calm Arrange for employee to be escorted out Report back to human resources department and administration

CORE COMPETENCY STANDARDS OF NURSING PRACTICE IN THE PHILIPPINES (April 2001)

1. Safety and quality nursing care 2. Mgt of resources and environment 3. Health education 4. Legal responsibility 5. Ethico moral responsibility 6. Personal and professional devt 7. Quality improvement 8. Research 9. Records mgt 10.Communication 11.Collaboration and teamwork