NCM 105

LEADERSHIP AND
MANAGEMENT
ORGANIZING
 ORGANIZATION signifies an
institution or functional group such
as business, government agency,
or hospital or other healthcare
agency with a formal intentional
structure of roles or positions
ORGANIZATION consists of the
structure and process which allow
the agency to enact its philosophy
and utilize its conceptual
framework to achieve its goals
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
 FOUR CHARACTERISTICS OF
ORGANIZATION

a common goal or purpose

coordination of effort
division of labor
established delegation of authority
ORGANIZING is identifying the
organizational needs from mission
statements
and objectives and from
observations of work performed,
and adapting the organizational
design and structure to meet these
needs
 Like planning,
organizing is primarily
a thinking act
 ORGANIZATIONAL
STRUCTURE
-furnishes the formal framework in
which organizing takes place
-refers to the process or way a group is
formed and its channels of authority,
span of control, and lines of
communication
 ELEMENTS OF ORGANIZATIONAL
STRUCTURE

Designing jobs
Forming departments and work units
Creating hierarchy
Forming a span of control
Coordinating and integrating activities
JOB DESIGN – so that both employer
and employee understand what is
expected and what degree of authority
each has
DEPARTMENTS AND UNITS – after
an organization has determined how to
structure various jobs, it must decide
how to arrange them into logical
departments or units
HIERARCHY – a network of reporting
relationships, a pattern of reporting
relationships throughout an
organization
SPAN OF CONTROL – defined as the
number of persons who report directly
to the manager
COORDINATING & INTEGRATING
ACTIVITIES – needs determined by the
extent to which people and groups are
interdependent or how much they must
rely on one another to get their work
done
ORGANIZATIONAL CHART is
a line of drawing that shows
how the parts of an
organization are linked
ORGANIZATIONAL CLIMATE

-a work environment that is conducive

to worker satisfaction and productivity
is a major concern in every
organization
 PURPOSE 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
 PURPOSE OF
ORGANIZATIONAL STRUCTURE

3.It coordinates all organizational

activities so there is minimal
duplication of effort or conflict
4.It reduces the chances of doubt and
confusion concerning assignments
 PURPOSE OF
ORGANIZATIONAL STRUCTURE

5.It avoids overlapping of functions

because it pinpoints responsibilities
6.It shows to whom and for whom they
are responsible
 MAJOR PRINCIPLES OF AN
ORGANIZATIONAL CHART

1.DIVISION OF WORK - each box

represents the individual or sub-unit
responsible for a given task of the
organization’s work load
2. CHAIN OF COMMAND – lines
indicate who reports to whom and
what authority
 MAJOR PRINCIPLES OF AN
ORGANIZATIONAL CHART

3.TYPE OF WORK TO BE
PERFORMED - Indicated by labels or
descriptions for the boxes
4. GROUPING OF WORK SEGMENTS
– shown by the clusters or work
groups (departments or single units)
 MAJOR PRINCIPLES OF AN
ORGANIZATIONAL CHART

5.LEVELS OF MANAGEMENT -
indicate individual and entire
management hierarchy
HIERARCHY – refers to a body of
persons or things organized or
classified in pyramidal fashion accdg
to rank, capacity or authority
PRINCIPLES OF ORGANIZING

1.THE PRINCIPLE OF CHAIN OF

COMMAND
- denotes centralized authority and
corresponding authority
this principle states that to be satisfying
to members, economically effective,
and successful in achieving their goals,
organizations are established with
hierarchical relationships within which
authority flows from top to bottom
PRINCIPLES OF ORGANIZING

2. THE PRINCIPLE OF UNITY OF

COMMAND
- states that an employee has one
supervisor/leader and one plan for a
group of activities with the same
objective
 In nursing, primary nursing and case
management support the principle of
unity of command
Although employees may interact with
many different employees in the
performance of their duties, they should
be responsible to only one superior
PRINCIPLES OF ORGANIZING
3. THE PRINCIPLE OF SPAN OF
CONTROL
- the number of workers that a
supervisor can effectively manage
should be limited, depending upon the
pace and pattern of the working area
this principle is flexible because the
more trained an employee is, the
less supervision is needed, while
those still under training need more
supervision to prevent mistakes
PRINCIPLES OF ORGANIZING
4. THE PRINCIPLE OF
SPECIALIZATION
- the concept of division of labor or the
differentiation among kinds of duties,
springs from this principle. This
principle states that each person
should perform a single leading
function
 LINE AND STAFF
RELATIONSHIPS
LINE AUTHORITY – is the authority that
entitles a supervisor to direct an
individual’s work.
is the simplest and most direct type in
which each position has general
authority over the lower positions in the
hierarchy
 ORGANIZATIONAL TYPES OF
AUTHORITES
STAFF AUTHORITY – Staff authority in
positions created to support, assist,
recommend, and generally reduces the
supervisors’ informational responsibilities
 EXECUTIVE DIRECTOR
ASSIST. EXECUTIVE
DIRECTOR

HRD DIRECTOR OF DIRECTOR OF

OPERATIONS PURCHASING

Unit 1 MANAGER Unit 2 MANAGER

OPERATIONS
OPERATIONS Purchasing

HUMAN
RESOURCES
 TYPES OF ORGANIZATION

LINE ORGANIZATION
INFORMAL ORGANIZATION
STAFF ORGANIZATION
FUNCTIONAL ORGANIZATION
LINE ORGANIZATION – is the
simplest and most direct type of
organization in which each
position has general authority
over the lower positions in the
hierarchy
INFORMAL ORGANIZATION –
refers to horizontal relationships
rather than vertical. This is
composed of small groups of
workers with similar interests
STAFF ORGANIZATION – is
purely advisory to the line
structure with no authority to put
recommendations into action
FUNCTIONAL ORGANIZATION
– is one where each unit is
responsible for a given part of the
organization’s workload. There is
clean delineation of roles and
responsibilities which are actually
interrelated
HIERARCHICHAL STRUCTURE is
commonly called LINE STRUCTURE
 this is the traditional structure and is
associated with the principle of chain
of command, bureaucracy, vertical
control and coordination, levels
differentiated by functions and
authority, and downward
communication
 HOSPITAL DIRECTOR

CHIEF NURSE

ASSISTANT CHIEF NURSE

NURSE SUPERVISOR

SENIOR STAFF NURSE

STAFF NURSE

Traditional Hierarchal structure

 DECENTRALIZATION
 refers to the degree to which
authority within the organization is
delegated downward to its divisions,
branches, services, and units
  DECENTRALIZATION of
AUTHORITY includes delegation of
all management components of
planning, organizing, leading, and
controlling
 STAFFING
 filling, and keeping filled, positions
in the organization structure through
defining workforce requirements,
inventorying workforce, appraising,
selecting, compensating, and training
 STAFFING
 Staffing is the use of recruitment,
selection, and development of
personnel to assign competent
people to the roles designed for the
organizational structure
 FACTORS AFFECTING STAFFING
1.The type, philosophy, and objectives
of the hospital and the nursing service
2.The population served or the kind of
patients served whether pay or charity
3.The number of patients and severity
of their illness – knowledge and ability
of nursing personnel are matched with
the actual care needs of patients
 FACTORS AFFECTING STAFFING
4.Availability and characteristics of the
nursing staff, including education,
level of preparation, mix of personnel,
number and position
5.Administrative policies such as
rotation, weekends and holiday off-
duties
 FACTORS AFFECTING STAFFING
6.Standards of care desired which
should be available and clearly
spelled out
7.Layout of the various nursing units
and resources available within the
department such as adequate
equipment, supplies and materials
 FACTORS AFFECTING STAFFING
8.Budget including the amount allotted
to salaries, fringe benefits, supplies,
materials, and equipment
9.Professional activities and priorities in
nonpatient activities like involvement
in professional organizations
 FACTORS AFFECTING STAFFING
10.Teaching program or the extent of
staff involvement in teaching activities
11.Expected hours of work per annum
of each employee
12.Patterns of work schedule –
traditional 5days/wk, 8 hours per
day….
 NURSING CARE HOURS PER PATIENT PER
DAY ACCORDING TO CLASSIFICATION OF
PATIENTS BY UNITS

CASES/PATIENTS NCH/Pt/day Prof to Non

Prof Ratio

General Medicine 3.5 60:40

Medical 3.4 60:40
Surgical 3.4 60:40
Obstetrics 3.0 60:40
Pediatrics 4.6 70:30
Pathologic Nursery 2.8 55:45
 NURSING CARE HOURS PER PATIENT PER
DAY ACCORDING TO CLASSIFICATION OF
PATIENTS BY UNITS

CASES/PATIENTS NCH/Pt/day Prof to Non

Prof Ratio

ER/ICU/RR 6.0 70:30

CCU 6.0 80:20
 PATIENT CARE
CLASSIFICATION SYSTEM

-is a method of grouping patients

according to the amount and
complexity of their nursing care
requirements and the nursing time and
skill they require
CLASSIFICATION CATEGORIES
LEVEL I – SELF CARE OR MINIMAL
CARE - patient can take a bath on his
own, feed himself, feed and perform his
ADL
Average amount of NCH/pt/day – 1.5
Ratio of Prof to Non-Prof – 55:45
CLASSIFICATION CATEGORIES
LEVEL II – MODERATE CARE OR
INTERMEDIATE CARE - patient need
some assistance in bathing, feeding, or
ambulation
Average amount of NCH/pt/day – 3
Ratio of Prof to Non-Prof – 60:40
CLASSIFICATION CATEGORIES
LEVEL III – TOTAL, COMPLETE OR
INTENSIVE CARE - patient are
completely dependent upon the nursing
personnel
Average amount of NCH/pt/day – 6
Ratio of Prof to Non-Prof – 65:35
CLASSIFICATION CATEGORIES
LEVEL IV – HIGHLY SPECIALIZED
CRITICAL CARE - patient need
maximum nursing care
Average amount of NCH/pt/day – 6-9
Ratio of Prof to Non-Prof – 80:20
 CATEGORIES OF LEVELS OF CARE OF
PATIENTS

LEVELS OF CARE NCH/Pt/day Prof to Non

Prof Ratio

LEVEL I 1.5 55:45

Self Care or
Minimal Care
LEVEL II 3.0 60:40
Moderate or
Intermediate Care
 CATEGORIES OF LEVELS OF CARE OF
PATIENTS

LEVELS OF CARE NCH/Pt/day Prof to Non

Prof Ratio

LEVEL III 4.5 65:35

Total or
Intensive Care
LEVEL IV 6-9 70:30
Highly Specialized or 80:20
Critical Care
 PERCENTAGE OF NURSING
CARE HOURS

-also depends on the setting in which

the care is being given
 PERCENTAGE OF PATIENTS AT VARIOUS
LEVELS OF CARE PER TYPE OF HOSPITAL

TYPE OF MIN. MOD. INT. HIGHLY

HOSPITAL CARE CARE CARE SPC.CARE

Primary Hosp. 70 25 5
Secondary 65 30 5
Tertiary Hosp. 30 45 15 10
Special Tertiary 10 25 45 20
COMPUTING FOR THE NUMBER OF
PERSONNEL NEEDED

-when computing for the number of

nursing personnel in the various nursing
units of the hospitals, one should ensure
that there is sufficient staff to cover all
shifts, off duties, holidays, leaves,
absences, and time for staff
development program
 40-HOUR WEEK LAW
(REPUBLIC ACT 5901) –
employees working in hospitals with
100-bed capacity and up will work only
40 hours a week

-less than 100-bed capacity will

work 48 hours per week
TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS
OF NURSING PERSONNEL PER YEAR

RIGHTS AND PRIVILEGES WORKING HOURS PER WK

GIVEN EACH PERSONNEL
PER YEAR 40 HOURS 48 HOURS

VACATION LEAVE 15 15
SICK LEAVE 15 15
LEGAL HOLIDAYS 10 10
SPECIAL HOLIDAYS 2 2
SPECIAL PRIVILEGES 3 3
OFF DUTIES/RA5901 104 52
CONT. ED. PROG. 3 3
TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND HOURS
OF NURSING PERSONNEL PER YEAR

RIGHTS AND PRIVILEGES WORKING HOURS PER WK

GIVEN EACH PERSONNEL
PER YEAR 40 HOURS 48 HOURS

TOTAL NON-WORKING
DAYS/YEAR 152
100
TOTAL WORKING
DAYS/YEAR 213 265
TOTAL WORKING
HOURS/YEAR 1704 2120
RELIEVERS NEEDED
To compute for relievers needed, the ff should
be considered:
1. Average number of leaves taken each year… 15
a.Vacation leave …………….10
b. Sick leave …………………. 5
2. Holidays …………………………………. 12
3. Special Privileges as per CSC MC#6 ….… 3
4. Continuing Education Prog. for Profl. ….… 3

Total Average Leaves 33

 To determine the relievers needed,
divide the average number of days an
employee is absent per year by the
number of working days per year that
each employee serves
33 / 213 = 0.15/person (40 hours/wk)
33 / 265 = 0.12/person (48 hours/wk)
Multiply the computed reliever per
person by the computed number of
nursing personnel.

0.15 x _______ = ________

0.12 x _______ = ________
This will give the total number of
relievers needed
DISTRIBUTION BY SHIFTS

45% - MORNING SHIFT

37% - AFTERNOOIN SHIFT
18% - NIGHT SHIFT
 STAFFING FORMULA
1. Categorize the number of patients
according to the levels of care needed.
Multiply the total number of patients by
the percentage of patients at each level
of care
 FIND THE NUMBER OF NURSING
PERSONNEL NEEDED FOR 250
PATIENTS IN A TERTIARY HOSPITAL
25O (pts) x .30 = 75 pts needing minimal care
25O (pts) x .45 = 112.5 pts needing moderate
care
25O (pts) x .15 = 37.5 pts need intensive care
25O (pts) x .1 = 25 pts need highly
specialized care
250
 STAFFING FORMULA
2.Find the number of nursing care
hours (NCH) needed by patients at
each level of care per day.
Get the sum of the nursing care hours
needed at the various levels
75pts x 1.5(NCH needed at level I) = 112.5 NCH/day
112.5pts x 3(NCH needed at level II) = 337.5 NCH/day
37.5pts x 4.5(NCH needed at level III)=168.75 NCH/day
25pts x 6(NCH needed at level IV) = 150. NCH/day

TOTAL 768 NCH/day

 STAFFING FORMULA
3.Find the actual number of nursing
care hours (NCH) needed by the
given number of patients. Multiply
the total nursing care hours needed
per day by the total number of days in
a year.
Find the total NCH needed by 250 patients
per year.

768.75 x 365 (days/yr) = 280,593.75 NCH/yr

 STAFFING FORMULA
4. Find the actual working hours
rendered by each nursing personnel
per year. Multiply the number of
hours on duty per day by the actual
working days per year
8 (hrs/day) x 213 (working days/year) =
1,704 (working hours /yr)
 STAFFING FORMULA
5. Find the total number of nursing
personnel needed.
a.Divide the total number of nsg care needed/yr
by the actual number of working hours
rendered by an employee/year
b.Find the number of relievers
c.Add the number of relievers to the number of
nursing personnel needed
Find the total number of nursing personnel
needed.
a.Total NCH/yr = 280,593.75 = 165
Working hours/year = 1,704
b.Relief x Total Nsg Personnel =

165 x 0.15 = 25
c. Total Nsg Personnel needed =

165 + 25 = 190
 STAFFING FORMULA
6. Categorize to professional and non-
professional personnel. Multiply
the number of nursing personnel
according to the ratio of professionals
to non-professionals
 Ratio of prof to non-prof in a
tertiary hospital: 65:35

190 x .65 = 124 professional nurses

190 x .35 = 66 nursing attendants
 STAFFING FORMULA
7. Distribute by shifts.
124 nurses x .45 = 56 nurses on AM shift
124 nurses x .37 = 46 nurses on PM shift
124 nurses x .18 = 22 nurses on NIGHT shift
124 nurses

66 nsg attendants x .45 = 30 NA on AM shift

66 nsg attendants x .37 = 24 NA on PM shift
66 nsg attendants x .18 = 12 NA on NIGHT shift
66 nursing attendants
Find the number of nursing
personnel needed for a 90
patients in a secondary
hospital
 It should be noted that the
computation for personnel are only for
in-patients.
Therefore additional personnel should
be hired for those in supervisory and
administrative positions
 PLACEMENT OF STAFF
-managers should consider some
factors when assigning employees to a
position or area where these
employees have very good chances for
success
Proper placement fosters:
-Personal growth
-Provides a motivating climate for the
employee
-Maximizes productivity and
organizational goals
Inappropriate placement often results in:
-Frustration
-Poor quality of work
-Reduced organizational efficiency
-Rapid turn over
-Poor image for the agency
Factors to consider in placement
of staff:
1.Past experience and training of the
employee
2.Culture of the clientele
3.Decision-making skills
4.Communication skills
 SCHEDULING

A SCHEDULE is a timetable showing

planned work days and shifts for
nursing personnel
Scheduling must function smoothly in
terms of:
1.Ability to cover the needs of the unit
2.Quality to enhance the nursing
personnel’s knowledge, training, and
experience
3.Fairness to the staff
4.Stability
5.Flexibility
 TYPES OF SCHEDULING
1.CENTRALIZED SCHEDULE – one
person, usually the Chief Nurse or her
designate, assigns the nursing
personnel to the various units of the
hospital. This includes the shifts on
duty and off-duty
 TYPES OF SCHEDULING
2. DECENTRALIZED SCHEDULE –
the shift and off-duties are arranged
by the Supervising Nurse or Head or
Senior Nurse of the particular unit
 TYPES OF SCHEDULING
3. CYCLICAL SCHEDULE – covers a
designated number of weeks called
the cycle length and is repeated
thereon.
It assigns the required number of nursing
personnel to each nursing unit
consistent with the unit’s patient care
requirements, the staff’s preference,
their education, training and experience
 ADVANTAGES OF CYCLICAL
SCHEDULE
1. It is fair to all. Favoritism is
minimized
2.It saves time as the schedule does
not have to be redone every week or
two
ADVANTAGES OF CYCLICAL SCHEDULE
3. It enables the employees to plan
ahead for their personnel needs
preventing frequent changes in
schedule
4. Scheduled leave coverage such as
vacation, holidays, and sick leaves
are more stable
5. Productivity is improved
 EMPLOYMENT PROCEDURES
1.RECRUITMENT - to recruit nurses,
one can fill vacancies from within the
facility, hire graduates from schools and
colleges, place advertisements and
announcements, and use professional
and private nurse employment
agencies, both national and
international
 EMPLOYMENT PROCEDURES
EXPERIENCED NURSES - nurses who
have practiced for a number of years
and have become experts in their
fields carry more clout with recruiters
 EMPLOYMENT PROCEDURES
SUPPLEMENTAL STAFFING -
involves the use of nurses who are
available and on-call at their homes or
who are employed by nurse registries
APPLICATION FORM should include:
-personal history
-educational background
-work experience
-and other pertinent information
APPLICATION FORM is used to:
-Determine whether the applicant meets
hiring requirement
-Furnish background data useful in the
selection interview
-Obtain names of references who may be
contacted for further information
-Collect information for personnel
administration, such as SSS, TIN
 EMPLOYMENT PROCEDURES
2.SELECTION OF NURSING
PERSONNEL - responsibility for
staffing an organization with nursing
personnel rests with every manager at
every level
 EMPLOYMENT PROCEDURES
3. INDUCTION AND ORIENTATION -
INDUCTION consists of those formal procedures
an employee follows immediately after being
hired
ORIENTATION is the formal process of
familiarizing the new employee with the
organization and his or her place in it
 STAFF DEVELOPMENT
includes all training and education
undertaken by an employer to improve
the occupational and personal
knowledge, skills, and attitudes of
employees
 STAFFING PROCESS
EFFECTS OF ABSENTEEISM –
studies in the workplace have been
conducted over the past three decades
and have shown that individual needs,
relationships with co-workers and
supervisors, working conditions, work
policies and compensation affect the
extent to which an individual is gratifies
or fulfilled in his or her work
 STAFFING PROCESS
STAFF BURNOUT - burn out has been
associated with three composite factors:
a.emotional exhaustion, or feeling
overextended and worn out from work
b.depersonalization, or lack of appropriate
responses to the nurse’s efforts,
c.a diminished sense of personal
accomplishment
Researchers has began to investigate
variables that reduce or buffer burnout.
“PERSONAL HARDINESS”
Three personality characteristics
determine hardiness:
Commitment, Control, Challenge
COMMITMENT – involves a strong sense
of dedication to self and others
CONTROL – having control means that a
nurse can influence the course of events
in his or her life
CHALLENGE – a challenging career
offers opportunities to use one’s abilities,
energies and resources or provides an
opportunity to attempt what one believes
he or she can accomplish
 JOB DESCRIPTION
 is a statement that sets the
duties and responsibilities of a
specific job
 JOB DESCRIPTION is also a
contract that includes the job’s
functions and obligations and tells the
person to whom the worker is
responsible
 CONTENTS OF JOB
DESCRIPTION

IDENTIFYING DATA
Position Title: Staff Nurse
Department: Nursing
Supervisor’s Title: Head/Senior
Nurse
 CONTENTS OF JOB
DESCRIPTION
JOB SUMMARY – this includes the
essential features of the job that
distinguish it from the others
QUALIFICATION REQUIREMENTS
– educational preparation, training and
experience necessary to fill the
position
 CONTENTS OF JOB
DESCRIPTION
Job Relationships – source of
workers
Specific and Actual Functions and
Activities
 USES OF JOB DESCRIPTION
 for recruitment and selection of
qualified personnel
To orient new employees to their jobs
For job placement, transfer or
dismissal
As an aid in evaluating the
performance of an employee
For budgetary purposes
JOB SPECIFICATION – are the
enumeration of necessary and
desirable personal qualities that an
applicant should possess in order to
execute the job satisfactorily
 USES OF JOB DESCRIPTION
 for determining departmental
functions and relationships to help
define the organizational structure
For classifying levels of nursing
functions according to skill levels
required
To identify training needs
As basis for staffing
 JOB DESCRIPTION are being
discussed with the nursing personnel to
enable them to see the extent to which
their jobs contribute to patient care,
their place in the nursing team and the
hospital as a whole
 JOB EVALUATION
JOB EVALUATION is needed in
creating a sound wage salary and
career ladder systems

-it requires job analysis and job

description
JOB EVALUATION is defined as
systematic method of appraising the
work of each job in relation to all other
jobs in organization