Sherlyn M.

Dizon RN MAN
Clinical Instructor

Organizing

Involves the process of deciding the necessary levels of organization needed to accomplish the objectives of a nursing division, department or service and unit. It involves setting up the organizational structure through identification of groupings, roles, and relationships, determining the staff needed and maintaining staffing patterns.

Organizing

Is the process of establishing formal authority it involves setting up the organizational structure through identification of groupings, roles and relationships, determining the staff needed and maintaining staffing patterns It also involves developing job descriptions by defining the qualifications and functions of each personnel In short, its elements are: organizational structure, staffing, scheduling and job description

Organizational Structure
It

refers to the process by which a group is formed, its channels of authority, span of control and lines of communication Through organizational structure it provides departmentalization and division of work to have orderliness in administration

Organizational Structure
Now,

the creation of it should be compatible with philosophy, conceptual framework and goals of the organization Therefore, understanding of it as a whole facilitates the development of roles and relationship to enable the achievement of goals

Organizational Structures
Organizational structures are affected by the economic, political, social and technological pressures in society.

Types of Organization Classified by Nature of Authority Line Organization: is the simplest and most direct type of organization in which each position has general authority over the lower position in the hierarchy * example: Clinical and Administration 2. Informal Organization: refers to horizontal relationships rather than vertical, this is composed of small groups of workers with similar interest
1.

3.

4.

Staff Organization: is purely advisory to the line structure with no authority to put recommendation into action * example: Training and Research Functional Organization: is one where each unit is responsible for a given part of the organizations workload * there is clear delineation of roles and responsibilities which are actually interrelated * example: Ad Hoc Committees

Organizing Principles
1.

2.

Unity of Command: employees in the performance of their duties should only be responsible to only one superior (to avoid overlapping of duties and misunderstanding ) Scalar Principle: authority and responsibility should flow in clear unbroken lines from the highest executive to the lowest * proper definition and delegation of authority and responsibility facilitate the accomplishment of work

3. Homogenous Assignment or Departmentation: workers performing similar tasks are grouped together for a common purpose. * departmentation promotes specialization of activities, simplifies the administrations work and helps maintain effective control 4. Span of Control: the number of workers that a supervisor can effectively manages hould be limited depending upon the pace and pattern of the working area * example: workers highly skilled and working near each other their number may be increased; top level a ratio of 1:6 of supervisor-workers is common; while the base of the organization is 1:10 ratio

Exception Principle: recurring decisions should be handled in a routine manner by lower level managers whereas problems involving unusual matters should be referred to higher level * for the subordinates to learn how to make decisions at their own level and free the executives from such problems 6. Decentralization or Proper Delegation of Authority: it is the process of pushing decision making to the lower levels of the organization
5.

Organizational Charts

a drawing that shows how the parts of an organization are linked. It depicts the formed organizational relationships, areas of responsibility persons to whom one is accountable, and channel of communication. may be used for outlining administrative control, for policy making and planning to evaluate strengths and weaknesses of the current structure.

Organizational Charts
e.g. Line-staff relationships
Administrator

Physical therapy

Vice president for nursing

Occupational therapy

LPN

RN

CNA

Organizational Chart of a Medical Center

Medical Center Chief Medical Division Ancillary Laboratory Radiology Dental Trng. & Research Medical Record DOH Training PGMI Training Residency Training Med. Sp. Training Clinical Surgery Anesthesia EENT Orthopedic Medicine OB-Gyne Pediatrics OPD-ER Clinical Nursing Division Trng. & Research Staff Devt. Student Affiliations Research DOH Training Special Areas OR ICU-CCU CSR NICU DR Budget & Finance Disbursing Collecting Personnel Supply Internal Audit Maintenance Admin. Division Pharmacy Med. Social Service Dietary House Keeping Linen Laundry Transportation

Paramedical Student Affiliation

Hospital Nursing Division/ Service

Medical Center Chief Chief Nurse Asst. Chief Nurse

Supervising Nurse OPD ER Senior Nurses OPD ER

Supervising Nurse Clinical Area Senior Nurses

Supervising Nurse OC - DR - CSR Senior Nurses

Supg Nurse Instr In-Service R/S Nurse Instructor

Staff Nurses
Midwives Nursing Attendants

Staff Nurses

Staff Nurses Midwives

Trainees

Nursing Attendants

Nursing Attendants

Institutional Workers

Institutional Workers

Institutional Workers

Relationship of the Nursing Division/ Service with the College of Nursing

Medical Center Chief Chief Nurse Asst. Chief Nurse Clinical Coordinators Dean of Affiliating Colleges

Supervising Nurses OPD ER Senior Nurses OPD ER

Supervising Nurses Clinical Area Senior Nurses

Supervising Nurses OC - DR - CSR Senior Nurses

Supg Nurse Instr In-Service R/S Nurse Instructor

Clinical Instructors

Staff Nurses

Staff Nurses

Staff Nurses

Trainees

Nursing& Midwifery Affiliates

Midwives Nursing
Attendants Institutional Nursing Attendants

Midwives Nursing Attendants

Workers

Institutional Workers

Institutional Workers

Nursing Division with Assistant Chief Nurses for Nurse Training and Research and for Clinical Areas
Chief of Hospital

Chief Nurse

Asst. Chief Nurse Trng & Research

Asst. Chief Nurse Clinical Service

Supervising Nurse Instructor

Supervising Nurse Spl. Services

Supervising Nurse Clinical Services

Nurse Instructors

Senior Nurses

Senior Nurses

Staff Nurse

Staff Nurses

Nursing Attendants

Nursing Attendants

Traditional Hierarchical Chart

Chief of Hospital

Chief Nurse

Supervising Nurse

Senior Nurse

Staff Nurse

Nursing Attendant

Chart using the titles of Patient Care Administrator and Coordinator

Patient Care Administrator

Patient Care Coordinator

Head Nurse

Head Nurse

Staff Nurse

Staff Nurse

Chart for Devolved Hospitals and Rural Health Units

Office of the Governor Sanitaries/ Other Special Health Institutions

City Hospital

Integrated Provincial Hospital

Rural Health Units

Community Hospitals

District Hospitals

Mrs. Juliet O. Santos President

Dra. Nathanielz
VP For Academic Program

Dra. Mylene Santos

VP for Nursing Program

Dra. Carolina Enriquez

VP for College Affairs

Mr. Don August O. Santos

VP for Finance

Ms. Liza Villacorte, RN, MAN

Dean College of Nursing

Ms. Liza Villacorte, RN, MAN

Level IV Coordinator

Mrs. Anna Virginia Sta. Ana

Level III Coordinator

Mrs. Capulong
Academic Coordinator

Auxillary Services

Student Affair Coordinator

Clinical Coordinators Lecturer / Professor

BS Nursing Students Level III & IV

Security

Library

Office Staff

Skills Lab

Maintenance

Directing
}The issuance of orders, assignments and instructions that enable the nursing personnel to understand what are expected of them.

}Actuates effort Directing to accomplish goals

} It must be complete, understandable and given in a logical order.

Leadership Theories

Trait theory

Leaders have traits that must be enhanced by experience Traits are inherited but they can be obtained through formal learning Qualities/traits of a leader
Inteligence Personality Abilities

> task oriented > relationship oriented > participative leadership

Great man theory

Leaders are born not made Great leaders will arise when there is a great need Leadership ability to lead is contingent upon situation
Leadership member relation Task structure Position power

Contingency theory

Transactional leadership

People are motivation by reward and punishment

Transformational theory

Empowerment is the key factor There is no one best leadership style One should be aware of his own behavior and learn to adapt
Behavioral theory Participative leadership Situational leadership adapt leadership styles accordingly Appropriate style in the level of maturity of the followers

Integrative leadership model

Charismatic theory

Charm and grace are needed to attract followers Inspires others by obtaining emotional commitment from followers and by arousing feelings of loyalty and commitment

Leadership Styles

Autocratic Democratic Laissez faire Multicratic/situational

Sources of Power

Expert Legitimate Referent Reward Coercive Connection informational

ELEMENTS OF DIRECTING
%DELEGATION %UTILIZATION %SUPERVISION %COORDINATION %COMMUNICATION %STAFF DEVELOPMENT

%DECISION MAKING

DELEGATION
Process by which a manager assigns specific tasks/duties to workers with commensurate authority to perform the job.
2 important criteria in delegation

Ability of the workers to carry out the task Fairness not only to the employee but to the team as a whole

Reasons for Delegation

1. Saves time and help develop others 2. maximizes the use of talents of staff associates 3. uses talents abilities in personal that contribute to their growth and development

*Three Aspects of Delegation

1. Responsibility what must be done and denotes obligation 2. Authority- power to make final decisions and give commands 3. Accountability- denotes liability and answerability to work performed

MATTERS THAT CANNOT BE DELEGATED Overall responsibility, authority and accountability for satisfactory completion of all activities in the unit Authority to sign one s name is never

delegated

Evaluating the staff and or taking necessary corrective or disciplinary action

Jobs that are too technical and those that involve trust and confidence

UTILIZATION
Utilization of NURSING SERVICE Policies and Procedures

*Policies, procedures, rules and regulations are the standing plans of an organization. *Nursing service exist for standardization and as source of guidance for the nursing staff. *Policies promote consistency of action and stability. They speed up decision-making. They conserve time by setting standards.

Establishing Nursing Standards, Policies, and Procedures

Nursing Standards functions of established standards in an evaluation process are top supply professionally desirable norms against which the departments performance can be measured.

Nursing Policies are broad guidelines for the managerial decisions that are necessary in organizational and departmental planning.

*Uniformity of standards promotes fairness and prevents conflicts. *Current and written procedure manuals should be available to all nursing personnel. *Uniformity of standards promote fairness and prevents conflicts.

Policies are usually written and made available as manuals and used by the personnel Procedure manual outlines a standard technique or method in performing duties. It serves as a guide for action == Procedure Manual- outlines a standard technique or method in performing duties. It serves as a guide for action.

SUPERVISION
to supervise means to inspect, to guide, evaluate, and improved work performance of employees through in certain against which the quality and quantity of work production and utilization of time and resources.

SUPERVISORY TECHNIQUES Includes:

observation of the worker while making her rounds spot checking of chart thru nursing audits asking the patient about the care they receive looking into the general condition of the units getting feedback from co-workers or other supervisor or relatives asking question discretely

Unites personnel and services toward a common objective. Synchronization of activities among the various services and departments enhances collaborative efforts resulting in efficient, smooth and harmonious flow of work.

Coordination with the medical service. Coordination with the administrative office. Coordination with the laboratory service. Coordination with the radiology service Coordination with the pharmacy service Coordination with the dietary service Coordination with the medical social service Coordination with the medical records service Coordination with the community agencies, other institutions and civic organizations.

Nurse carry out written prescriptions of medication and treatments. Nurses, being involved in the plan of care, must have knowledge on the patients diagnosis, actual conditions and the medical plan of care. Feedback on the patients condition, response to medications and treatments must be referred to physicians-in-charge so as to provide immediate action or modification appropriately. Meetings and conferences must be held regularly to address problems and come up with satisfactory solutions.

Pertains to both human and material. Nurses participate in budget planning for staffing, adequate facilities and material resources. The Head Nurse makes requisitions for supplies, linen and equipment to Administrative Service.

Nurses should direct Medical technologists to where the patient is located and provide necessary assistance. Patients needing special preparation should be reminded by the Nursing Personnel. Nurse files the results of Laboratory Examination.

Nurse forward requests for x-ray services. Nurse makes proper notation for allergies for patients receiving radio-opaque dyes.

Policies regarding procurement of drugs are formulated jointly by the: Administrative, Medical and Nursing Services, and the Pharmacy. Pharmacy should also provide all Nursing units with an established Hospital Drug Formulary about the efficient and effective administration of drugs through UDDS. Consumption is properly noted and a report is given to the pharmacy. A reasonable prudent nurse exercises skills in judgement and care

Dietary Service assumes full responsibility in the preparation of the patients diet and in distributing them to the patients. Patients preferences or religious restrictions are considered and noted as well as foods in season.

Nurses coordinate with the Medical Social Service by referring patients with psycho-socio-economic problems. Nurses should welcome civic volunteers in the unit, and introduce them to the patients and provide assistance when needed.

Nurses are responsible for accurate documentation and completeness of patients charts including their safety and confidentiality. Nursing audits ensure quality of documentation.

Retrospective Audit performed on discharged patients charts. Concurrent Nursing Audit done on the chart of patients still confined in the hospital.

Referrals from one institution to another are necessary for continuing of care.

Discharged patients referred to nearest health center for proper follow-up care. Hospitals without necessary diagnostic are referred to hospitals with complete facilities.

COMMUNICATION

It is defined as the transfer of information and understanding from one person to another. the exchange of thoughts, feelings, and other information. The nurse-client relationship depends on effective communication. Communication Process: Five Major Components

Sender Message Channel Receiver Feedback

Basic Elements of the Communication Process

Sender sources of information and initiator of the communication process. Message the content of the communication. Encoding translating the message into words gestures, facial expression and other symbols Transmitting the channel used to communicate a message

Decoding the receiver perceives and interprets the senders message into information that has meaning Action the behavior taken by the receiver as a result by the message sent, the process of doing or performing something Feedback senders and receivers exchange information and clarify the meanings of message of the message sent

Flow of Information

1. Downward Communication flows from top management levels to the lower levels in the organizations hierarchy. E.g. memos, job descriptions, performance appraisal. 2. Upward Communication from staff and lower and middle management level in the organizational hierarchy.

3. Horizontal or Lateral Communication communication that flows between functional units, connects people on the same level. E.g. Endorsements between shifts, nursing rounds, conferences or meetings between service departments.

Barriers to effective Communication

Physical Barrier environmental factors that prevent or reduce opportunities for the communication process to occur. -> Noise Social Psychological Barriers blocks in communication that arise from the judgments, emotions and social values of people. Semantics E.g. misinterpretation of meaning, inability to speak effectively, poor listening habits.

STAFF DEVELOPMENT

It is continuing liberal education of the whole person to develop her potential fully It deals with aesthetic senses, something that beautify as well as technical and professional education and may include orientation preceptorships, mentorships, skills check lists, internships, in service education/training, courses, conferences, seminars, journal or book clubs, programmed learning and independent study and preceptor courses.

CONFLICT MANAGEMENT
CONFLICT
a clash between two opposing and often times, hostile parties

Sources of Conflict Factors that provokes conflict are failure to provide assistance or complete information on patient care.

Varying perceptions of working situations can be caused by different work responsibilities.

Unstable staffing and work schedules

Cont...
Highly differentiated work positions or role change Disagreements on policies and procedures

Competition for scarce resources

TYPES OF CONFLICT
Accdg. to hierarchical position: Vertical Conflict-Difference in opinions between superiors and subordinates

Caused By: Inadequacy in communication Opposing interests Lack of shared perceptions and attitudes

Horizontal or Line and Staff Conflict

Arises as a common struggle or strife between departments or services wherein the degree of interdependence and collaboration determines the success in achieving shared goals and objectives.

Conflict can also be viewed from behavioral and process standpoint. Behavioral Standpoint
It is a perceived condition that exists between two parties, when one or more parties perceive goal incompatibility and some opportunity for interfering with goal achievement of the other.

Process Standpoint
Conflict can be defined as what occurs when real or perceived conflict exist in goals, values, ideas, attitudes, beliefs, feelings or action of two or more parties.

It can be:
Intrapersonal (Individual) Interpersonal (between two or more individuals) Intragroup (within one group) Intergroup (between two or more groups)

CONFLICT RESOLUTION
Common approaches to the management of conflict Avoidance Accommodation Compromise Collaboration Competition Smoothing withdrawing Forcing

AVOIDANCE Commonly used by the groups who do not want to do something that may interfere with their relationship

ACCOMODATION Self-sacrifice The person neglects his own needs to meet the goals of other party

COMPROMISE Both parties seek expedient, acceptable answers for short periods when the goals are only moderately important an d the parties have equivalent powers.

COLLABORATION Inspires mutual attention to the problem and utilizes the talents of all parties.

COMPETITION Supervisor or nurse manager exerts power at the subordinate expense.

SMOOTHING Disagreements are ignored so that surface harmony is maintained in a state of peaceful co-existence.

WITHDRAWING One party is removed thereby making it possible to resolve the issue.

FORCING Method that yields an immediate end to the conflict but leaves the cause of the conflict unresolved.

BASIC ROLES ON MEDIATING A CONFLICT BETWEEN TWO OR MORE PARTIES Establish clear guidelines and make them known to all. Do not postpone indefinitely. Create an environment that makes people comfortable to make suggestion. Keep a two-way communication. Stress a peaceful resolution rather than confrontation Emphasize a shared interest Follow-up on the progress of the plan.

Decide / Decision Making

*The process of selecting one course of action from alternatives s a continuing responsibility of nurse managers. Behavior exhibited in making a selection and implementing a course of action from alternatives. * A systematic, sequential process of choosing among alternatives and putting the choice into action.

Decision - Making

A complex, cognitive process often defined as choosing a particular course of action It a process of selecting one course of action from an alternatives Considered to be as a continuing responsibility of a nurse managers Hospital agencies have various ways on implementing decision-making process

Decisions Making Process

Identify the problem and analyze the situation Explore the alternatives Choose the most desirable alternative Implement the decisions Evaluate the results

Organizational Models for Decision Making

Rational Model

* based on the premises of common goals, technical competence, and sequential process to achieve goals * deliberate action to select the best solution to achieve the desired outcome * advantage, it helps unify associates with the goals of the agency * disadvantage, unrealistic expectations of how people function, large amount of time for process sing and narrow thought processes

Political Model * built on the premises of a win-win situation, diversity of interest, dispersion of power, and available forums for people with multiple, conflicting values protecting their own selfinterest. * changes are based on negotiations rather than causal links and are unpredictable * advantages, can promote creative solutions with majority support * disadvantages, decisions may be limited to the statesmen's narrow views.

Collegial Model
* involves full participation of a community of peers for decision making. * based on the premises of group consensus, mutual respect and adequate time * common in the academic community * there are shared responsibilities for organizational goals based on the professional background and interest of the participants * decision tend to support general welfare

Bureaucratic Model
* is common in health care * based on the premises of historical norms and operating routines * this model does not recognize informal channels of communication and ignores political struggles for power * alternative solutions generated may be limited and depend on the historical success of the agency and the corporate memory * past inefficient operation may be perpetuated.

Garbage Can Model * based on the premise of pure accident * decisions are unplanned and coincidental based on multiple diffuse values * basically there is no planning done * the outcomes occurs by chance and may repeat errors * key players may be associates that perceive an opportunity and contribute to the organization

Cybernetic Model * has 3 phases: . Need Assessment determining the desired outputs for the program, nature of problem, level of goal accomplishments and the like . Program Implementation determining that the program is in place and progressing according to the time plan . Result Assessment includes determination that the program outcomes were met and that the program outputs justified the costs.

Thank you!!!

8/10/2013

78