leadership compiled edited (long) final

8/6/2019 Leadership Compiled Edited (Long) Final

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ManagementDefinition/description

Nursing management is a branch of the nursing field which focuses on managing nurses

and patient care standards. Nursing management is performing leadership functions ofgovernance and decision-making within organizations employing nurses.

It includes processes common to all management like planning, organizing, staffing,

directing and controlling.

The definition of management is taken as the process of coordinating and integrating

work activities so that they are completed efficiently and efficiently with and through other

people (Henri Fayol).

Nurse occupy nurse manager, service directors, charge nurse and director of nursing

and other places that deliver or impact patient care.

Nurse Manager: is the nurse with management responsibilities of a nursing unit. They

typically report to a service director. They have primary responsibilities for staffing, budgeting,and day-to-day operation of the unit.

Service Directors: directors have oversight of a particular service within the facility or system

(surgical services, womens services, emergency services, critical care services etc.)

The charge nurse: is the nurse usually assigned for a shift, who is responsible for the immediate

functioning of the unit and the one who is responsible making sure nursing care is delivered

safely and that all the patients on the unit are receiving adequate care. And they are typically

the frontline management in most nursing units.

The one who supervises the care of all the patients at a health care facility is the directors of

nursing, the senior management position in an organization and often holds executive titles like

chief nursing officer (CNO), chief nurse executive, or vice president of nursing. They typicallyreport to the CEO or COO.

For the manager, managers have traditionally been responsible for the control of resources

required to accomplish organizing goals. These responsibilities include budgeting, staffing, and

maintaining the functions of the organization while simultaneously balancing fiduciary

responsibility for the resource of the organization.

Henri Fayol was an industrialist of the early twentieth century. He developed fourteen

principles of management that are still taught today. The principles are the universal truths of

management that can be taught.

14 Universal Principles of management1. Division of work. This principle is the same as Adam Smith's 'division of labour' (the main

focus of Adam Smith's The Wealth of Nations lies in the concept of economic growth. Growth,

according to Smith, is rooted in the increasing division of labor. This idea relates primarily to the

specialization of the labor force, essentially the breaking down of large jobs into many tiny

components). Specialization increases output by making employees more efficient.

2. Authority. Managers must be able to give orders. Authority gives them this right. Note that

responsibility arises wherever authority is exercised.

3. Discipline. Employees must obey and respect the rules that govern the organization. Gooddiscipline is the result of effective leadership, a clear understanding between management and

workers regarding the organizations rules, and the judicious use of penalties for infractions of

the rules.

4. Unity of command. Every employee should receive orders from only one superior.

5. Unity of direction. Each group of organizational activities that have the same objective

should be directed by one manager using one plan.


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6. Subordination of individual interests to the general interest. The interests of any one

employee or group of employees should not take precedence over the interests of the

organization as a whole.

7. Remuneration. Workers must be paid a fair wage for their services.

8. Centralizations. Centralization refers to the degree to which subordinates are involved in

decision making. Whether decision making is centralized (to management) or decentralized (tosubordinates) is a question of proper proportion. The task is to find the optimum degree of

centralization for each situation.

9. Scalar chain. The line of authority from top management to the lowest ranks represents the

scalar chain. Communications should follow this chain. However, if following the chain creates

delays, cross-communications can be allowed if agreed to by all parties and superiors are kept

informed.

10. Order. People and materials should be in the right place at the right time.

11. Equity. Managers should be kind and fair to their subordinates.

12. Stability of tenure of personnel. High employee turnover is inefficient. Management should

provide orderly personnel planning and ensure that replacements are available to fill vacancies.

13. Initiative. Employees who are allowed to originate and carry out plans will exert high levels

of effort.

14. Esprit de corps. (Morale, also known as esprit de corps)

Promoting team spirit will build harmony and unity within the organization.

Theories of management

HISTORICAL THEORIES OF MANAGEMENTScientific Management Theory

(1890-1940)

At the turn of the century, the most notable organizations were large and industrialized.

Often they included ongoing, routine tasks that manufactured a variety of products. The United

States highly prized scientific and technical matters, including careful measurement and

specification of activities and results. Management tended to be the same. Frederick Taylor

developed the scientific management theory which espoused this careful specification and

measurement of all organizational tasks. Tasks were standardized as much as possible. Workers

were rewarded and punished. This approach appeared to work well for organizations with

assembly lines and other mechanistic, routinized activities.

Bureaucratic Management Theory

(1930-1950)

Max Weber embellished the scientific management theory with his bureaucratic theory.

Weber focused on dividing organizations into hierarchies, establishing strong lines of authority

and control. He suggested organizations develop comprehensive and detailed standard

operating procedures for all routinized tasks.

Human Relations Movement

(1930-today)

Eventually, unions and government regulations reacted to the rather dehumanizingeffects of these theories. More attention was given to individuals and their unique capabilities

in the organization. A major belief included that the organization would prosper if its workers

prospered as well. Human Resource departments were added to organizations. The behavioral

sciences played a strong role in helping to understand the needs of workers and how the needs

of the organization and its workers could be better aligned. Various new theories were

spawned, many based on the behavioral sciences (some had name like theory X, Y and Z).


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CONTEMPORARY THEORIES OF MANAGEMENT

Contingency Theory

Basically, contingency theory asserts that when managers make a decision, they must

take into account all aspects of the current situation and act on those aspects that are key to

the situation at hand. Basically, its the approach that it depends. For example, the continuingeffort to identify the best leadership or management style might now conclude that the best

style depends on the situation. If one is leading troops in the Persian Gulf, an autocratic style is

probably best (of course, many might argue here, too). If one is leading a hospital or university,

a more participative and facilitative leadership style is probably best.

Systems Theory

Systems theory has had a significant effect on management science and understanding

organizations. First, lets look at what is a system? A system is a collection of part unified to

accomplish an overall goal. If one part of the system is removed, the nature of the system is

changed as well. For example, a pile of sand is not a system. If one removes a sand particle,

youve still got a pile of sand. However, a functioning car is a system. Remove the carburetor

and youve no longer got a working car. A system can be looked at as having inputs, processes,

outputs and outcomes. Systems share feedback among each of these four aspects of the

systems.

Lets look at an organization. Inputs would include resources such as raw materials,

money, technologies and people. These inputs go through a process where theyre planned,

organized, motivated and controlled, ultimately to meet the organizations goals. Outputs

would be products or services to a market. Outcomes would be, e.g., enhanced quality of life or

productivity for customers/clients, productivity. Feedback would be information from human

resources carrying out the process, customers/clients using the products, etc. Feedback alsocomes from the larger environment of the organization, e.g., influences from government,

society, economics, and technologies. This overall system framework applies to any system,

including subsystems (departments, programs, etc.) in the overall organization.

Systems theory may seem quite basic. Yet, decades of management training and

practices in the workplace have not followed this theory. Only recently, with tremendous

changes facing organizations and how they operate, have educators and managers come to

face this new way of looking at things. This interpretation has brought about a significant

change (or paradigm shift) in the way management studies and approaches organizations.

The effect of systems theory in management is that writers, educators, consultants, etc.

are helping managers to look at the organization from a broader perspective. Systems theory

has brought a new perspective for managers to interpret patterns and events in the workplace.

They recognize the various parts of the organization, and, in particular, the interrelations of the

parts, e.g., the coordination of central administration with its programs, engineering with

manufacturing, supervisors with workers, etc. This is a major development. In the past,

managers typically took one part and focused on that. Then they moved all attention to another

part. The problem was that an organization could, e.g., have a wonderful central administration

and wonderful set of teachers, but the departments didnt synchronize at all.

Chaos Theory

As chaotic and random as world events seem today, they seem as chaotic in

organizations, too. Yet for decades, managers have acted on the basis that organizational

events can always be controlled. A new theory (or some say science), chaos theory,

recognizes that events indeed are rarely controlled. Many chaos theorists (as do systems

theorists) refer to biological systems when explaining their theory. They suggest that systems

naturally go to more complexity, and as they do so, these systems become more volatile (or


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susceptible to cataclysmic events) and must expend more energy to maintain that complexity.

As they expend more energy, they seek more structure to maintain stability. This trend

continues until the system splits, combines with another complex system or falls apart entirely.

Sound familiar? This trend is what many see as the trend in life, in organizations and the world

in general.

Management processManagement process is a process of planning and controlling the performance or execution

of any type of activity, such as:

y a project (project management process); ory a process (process management process, sometimes referred to as the process

performance measurement and management system)

Roles that managers fulfill in an organizationThe organization's manager is responsible for carrying out its management process.

However, this is not always the case for all management processes;

for example:

y project manager- responsible for carrying out a project management processStrategic planning process

Strategic planning process

A strategic plan can be defined as the sum, total or outcome of the processes by which

an organization engages in environmental analysis, goal formation, and strategy development

with the purpose of organizational growth and renewal. Drucker (1973) defines strategic

planning as a continous, systematic process of making risk-taking decisions today with the

greatest possible knowledge of their effects on the future; organizing efforts necessary to carry

out these decisions and evaluating results of these decisions against expected outcome through

reliable feedback mechanisms. Strategic planning is ongoing and is especially needed whenever

the organization is experiencing problems or internal/external review problems.

Benefits of strategic planning

y It provides for objective consideration of strategic choices or options that are bettermatched with organizational goal and objectives.

y The outlook becomes future oriented, resources are allocated systematically and rapidchange is accommodated.

Vision/mission/philosophy/objectives/core values

Mission / Purpose

Is a formal expression of the purpose or reason for existence of the organization. It is the

declaration of its primary driving force or its vision of the manner in which it believes care

should be delivered. Mission statements provide information and inspiration that clearly and

explicitly outline the way ahead for the organization. Typically, this mission statement reflectsthe organizations values and provides the reader with an indication of the behavior and

strategic actions that can be expected from that organization.

Good mission statement, express the organizations vision and values, evoking passion

in the employees. Good mission statements delineate the organizations uniqueness.


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Effective nurse leaders make sure that employees see, feel, and think the mission by

following it themselves. They expect and accept resistance.

Vision

An image of the future organization seeks to create. It is not an abstract tool, but a practical

tool offering goals to be accomplished in terms that can ultimately be assessed.It is a mentalprediction of the fulfillment of the organizations success. A vision statement is sometimes

considered more strategic than a mission statement.

Core Values

Are concepts of perceived worth or importance; examples of informality, creativity, honesty,

quality, courtesy, and caring. Values are the moral rationale for business. Agreement on values

provide a mechanism for built-in quality; adherence to values makes organizations successful.

Philosophy

It typically embedded in the mission statement. It is, in essence, a value statement of the

principles and beliefs that direct the organizations behavior. Statement of philosophy sets out

values, concepts, and beliefs that pertain to nursing administration and nursing practice within

the organization. It states their beliefs as to how the mission or purpose will be achieved, giving

directions toward this end. Statement of philosophy are abstract and contain value statement

about human being as clients or patients and as workers, about work that will be performed by

nursing workers for clients or patients, about self-care, about nursing as a profession about

education as it pertains to competence of nursing workers, and about the setting or community

in which nursing services are provided.

Goals and objectives

The goal is the end result desired, the reason for a particular behavior. Purpose is to set out

clearly what direction your work should take and what specific accomplishments (outcomes)are expected given period of time. Serve as a guide to the planning of your work and later as a

guide to evaluating your work. Objectives are used to establish priorities and are fundamental

strategy of nursing. These are concrete statements that became the standards against which

performance can be measured.

Standards of nursing practice

y Standards of practice (standards of care) are guidelines used to determine what a nurseshould or should not do.

y Standards-defined as a benchmark of achievement which is based on a desired level ofexcellence

y Standards of care (SOCs) measure the degree of excellence in nursing care and describea competent level of nursing care.

A standard is a model of established practice that is commonly accepted as correct. The

care provided by nurses is guided by standards of care. Standards of care were developed and

implemented to define the quality of care provided. They are the basis for nursing care and

draw on the latest scientific data from nursing literature. Clinical, administrative and academic

experts have contributed to the development of standards of nursing practice.

All standards of practice provide a guide to the knowledge, skills, judgment and attitudes

that are needed to practice safely. The standards are based on the premise that the registered

nurse is responsible for and accountable to the individual patient for the quality of nursing care

he or she receives. SOCs provide a means of determining the quality of care which an individual

receives regardless of whether intervention is provided solely by a registered nurse or by a

registered nurse in conjunction with other licensed or unlicensed personnel.


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The standards of practice shall:

1.Be considered as the baseline for quality nursing care

2.Be developed in relation to the law governing nursing practice

3.Apply to the registered nurse practicing in any setting

4.Govern the practice of the licensee at all levels of practice

Nursing standards are important because they:

1.Outline what the profession expects of its members

2.Promote, guide, and direct professional nursing practice important for self-assessment

and evaluation of practicing nurses

3.Aid in developing a better understanding and response for the various and

complementary roles that nurses have

ANA Standards of professional performance

StandardsD

efinition Measurement criteriaI: Quality of

practice

The registered nurse

systematically enhances the

quality and effectiveness of

nursing practice

1. Demonstrates quality by documenting

the application of the nursing process in a

responsible, accountable and ethical

manner.

2.Uses quality improvement activities to

initiate changes in nursing practice and

health care delivery system

3.Uses creativity and innovation to improve

nursing care delivery

4. Incorporates new knowledge to initiate

changes in nursing practice if desired

outcomes are not achieved.

5. Participates in quality improvement

activities.

II: Education The nurse attains knowledge and

competency that reflects current

nursing practice

1. Participates in ongoing educational

activities related to clinical knowledge and

professional issues.

2.Demonstrates commitment to life long

learning

3.Seeks experiences to maintain clinical

skills4.Seeks knowledge and skills appropriate to

the practice setting

5. Maintains professional records that

provide evidence of competency and

lifelong learning.

III: Professional

practice

evaluation

The nurse evaluates ones own

nursing practice in relation to

professional practice standards

and guide line, relevant statutes,rules and regulations.

1.Engage in self evaluation on a regular

basis

2.Seeks constructive feedback regarding

ones own practice3.Takes action to achieve goals identified

during the evaluation process

4.Participates in systematic peer review as

appropriate

5.Practice reflects knowledge of current

practice standards, laws and regulations


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6.Provides age appropriate care in culturally

and ethnically sensitive manner

IV: Collegiality The nurse interacts with and

contribute to the professional

development of peers and other

health care providers ascolleagues

1.Shares knowledge and skills with peers

and colleagues

2.Provides peers with feedback regarding

their practice3.Interacts with peers and colleagues

4.To enhance ones own professional

nursing practice

5.Maintains compassionate and caring

relationships with peers and colleagues

6.Contributes to an environment that is

conductive to clinical education nursing

students as appropriate

7.Contributes to a supportive and healthy

work environmentV: Collaboration The nurse collaborates with

patient, family, and others in the

conduct of nursing practice

1.Communicates with the patient,

significant others, and health care providers

regarding patient care and nursings role in

the provision of care

2.Collaborates with patient, family and

others health care providers in the

formulation of overall goals and the plan of

care and in the decisions related to care

and delivery of services

3.Partners with others to effect change and

generate positive outcomes

4.Document referrals, including provisions

for continuity of care, as needed

VI: Ethics The nurse integrates ethical

provisions in all areas of practice

1.Practice is guided by code of ethics for

nurses with interpretive statement

2.Maintains therapeutic and professional

patient-nurse relationship

3. Delivers care in the manner of that

preserves patient autonomy, dignity, and

rights.

4.Seeks available resourced in formulatingethical decisions

5.Reports illegal, incompetent or impaired

practice

6. Maintain patient confidentiality within

legal and regulatory parameters.

VII: Research The nurse integrates research

findings in practice

1.Utilize best available evidence including

research findings to guide practice

decisions

2.Participates in research activities as

appropriate to the nurses education andposition such as the following:

3.Identifying clinical problems suitable for

nursing research

VIII: Resource

utilization

The nurse considers factors

related to safety effectiveness,

cost, and impact on practice in

1.Evaluates factors related to safety,

effectiveness, availability and cost when

practice options would result in the same


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the planning and delivery of

nursing services.

expected patient outcome

2.Assists the patient and family in

identifying and securing appropriate and

available services to address health related

needs

3.Assigns or delegate tasks based on theneeds and condition of the patient, the

potential for harm, the stability of the

patients condition, the complexity of the

task, and the predictability of the outcome

4.Assists the patient and family in becoming

informed consumers about the cost ,risks,

and benefits of treatment and care

IX: Leadership The nurse provides leadership in

the professional practice setting

and the profession

1. Engages on team work.

2. Works to create and maintain healthy

work environments.3. Teach others to succeed through

mentoring.

4. Exhibits creativity and flexibility during

change.

5. Directs coordination of care across

settings and care givers.

6. Demonstrates energy, excitement and a

passion for quality work.

Nursing Standards of Care pertain to professional nursing activities that are

demonstrated by the nurse through the nursing process. These involve assessment, diagnosis,

outcome identification, planning implementation, and evaluation. The nursing process is the

foundation of clinical decision making and encompasses all significant action taken by nurses in

providing care to all consumers. While Nursing Standards of Professional Performance

describe the roles of all professional nurses, there are many other responsibilities that are

hallmarks of professional nursing. These nurses should be self-directed and purposeful in

seeking necessary knowledge and skills to enhance career goals.

Management functionsManagers exist in every business. In fact, managers do the same types of tasks in all

businesses. Whether a person manages a hair salon or a factory, the managers job consists of

similar tasks. Planning, organizing, leading and controlling all serve an important part in

achieving managements vision. Each component is important and one cannot function well

without the others.

The position that managers provide in planning, organizing, leading and controlling is an

essential responsibility in any business. A manager must organize these functions in order to

reach company goals and maintain a competitive advantage. Putting these plans into action

requires forming groups as underlings must be directed to complete the plan, and the plan's

development must be directed by control. In order for these practices to succeed in an

operational manner, an understanding must be reached concerning the basics in which these

practices are in relationship to the business structure. (Bateman, Snell, 2007).


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PlanningIt is the managerial function of selecting priorities, results, and methods to achieve

results. It is setting the direction for a system and then guiding the system to follow the

direction. It is also determining the long- and short-term objectives. Steiner described planning

as the conscious determination of courses of action to achieve preconceived objectives.

Planning can be detailed, specific and rigid, or it can be broad, general, and flexible. Planning is

deciding in advance what is to be done and when, by whom, and how it is to be done.

There are two types of planning:

a. Strategic Planning. More broad-ranged, this approach means determining theoverall purposes and directions of the organization. This is often focused on mission,

vision and major goal identification.

b. Tactical Planning. More short-ranged, this type means determining the specificdetails of implementing broader goals. Examples are project planning, staffing

planning, and marketing plans.

Planning is a process that is heavily dependent on the decision-making process. Part of

planning is choosing among a certain number of alternatives. Thus in nursing, the manager

often must balance the needs of clients, staff, administrators, and physicians. Since resources

are limited, planning involves an analysis of how to best proceed under the given constraints.

Typical planning phases include the following:

- Identify the mission- Conduct an environmental scan- Analyze the situation- Establish goals- Identify strategies to reach goals- Set objectives to achieve goals- Assign responsibilities and timeless- Write a planning document- Celebrate success and completion

Planning is a function that assumes stability and the ability to predict and project intothe future. Yet the current environment is turbulent, making planning difficult. Learning and

adapting are important abilities in a changeable environment. Interactive planning has been

suggested as an approach to planning in complex situations and changing environments.

OrganizingAlthough planning is the key to effective management, the organizational

structure furnishes the formal framework in which the management process takes

place. The organizational structure should provide an effective work system, a

network of communications, and identity to individuals and the organization and

should consequently foster job satisfaction.

ORGANIZING

- Organizing follows planning as the second phase of the management process. Inthe organizing phase, relationships are defined, procedures are outlined,


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equipment is readied, and tasks are assigned. It also involves establishing a

formal structure that provides the best possible coordination or use of resources

to accomplish unit objectives.

TWO TYPES OF ORGANIZATIONAL RELATIONSHIP1. FORMAL RELATIONS

Formal structure, through departmentalization and work division,

provides a framework for defining managerial authority, responsibility and

accountability.

2. INFORMAL RELATIONSInformal structure is generally social, with blurred or shifting lines of

authority and accountability

ORGANIZATIONAL PRINCIPLES

1. Chain of Command- states that the organization are established with hierarchical

relationships, with which authority flows from top to bottom in order to

satisfying to members , economically effective, and successful in achieving

goals.

- It is a formal line of authority and communication within the

organization and the structure.Demonstrates who formally reports to whom

within the organization.

2. Unity of Command

- states that an employee has one supervisor and that there is one leader

and one plan for a group of activities with the same objective.

- The concept of unity of command is that each person on the

organization chart has one manager or one boss.

3. Span of Control

- states that a person should be a supervisor of a group that he or she caneffectively manage in terms of numbers, functions, and geography.

- Span of control means the number of individuals a person is responsible

for managing .A wide span of control indicates that many people are

reporting to a manager, and a narrow span of control indicates that only

a few people are reporting to the manager.

ORGANIZATIONAL STRUCTURE refers to the way in which a group is formed, its

lines of communication, and its means for channeling authority and makingdecisions. It clarifies the formal relationships of individuals in the various

positions within the organization

IMPORTANCE OF ORGANIZATIONAL STRUCTURE

y It enables members what their responsibilities


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y It frees the manager and the individual workers to concentrate on theirrespective roles and responsibilities

y It coordinates all organization activities so there is minimal duplication ofeffort or conflict.

yAvoids overlapping of function because it pinpoints responsibilities.

y Shows to whom and for whom they are responsibleFORMS OF ORGANIZATIONAL STRUCTURE

1. Tall or centralized

-responsible for only a few subordinates, so there is a narrow span of

control

-because of the vertical nature of the structure, there are many levels of

communication

2. Flat or Decentralized

- refers to an organizational structure with few or no levels of

intervention between management and staff

ORGANIZATIONAL CHART

Organizational chart is a line drawing that shows how the parts of an

organization are linked.

The organization chart establishes the following:

Formal lines of authoritythe official power to act

Responsibilitythe duty or assignment

Accountabilitythe moral responsibility

y Authority is defined as the official power to act. It is power given by the organization todirect the work of others. A manager may have the authority to hire, fire, or discipline

others.

y A responsibility is a duty or an assignment. It is the implementation of a job. Forexample, a responsibility common to many charge nurses is establishing the units daily

patient care assignment

y Accountability means that individuals agree to be morally responsible for theconsequences of their actions. A nurse who reports a medication error is being

accountable for the responsibilities inherent in the position.

Staffing (selection, orientation, job description)

Staffing is one of the most important issues in the delivery of health care. It is widely recognized

that there is a crisis in nursing.

1. Staffing PhilosophyStaffing is one of the major problems in any nursing organization, whether that

organization is a hospital, nursing home, home health care agency, ambulatory care agency,

or another type of facility. Components of staffing process as a control system include a


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staffing study, a master staffing plan, a scheduling plan, and a nursing management

information system.

2. Staffing StudyA staffing study should gather data about internal and external environmental

factors affecting the staffing requirements of an organization.

Four techniques drawn from engineering to measure the work of nurses, all of

which involve the concept of time required for performance:

a. Time study and task frequencyb. Work samplingc. Continuous samplingd. Self reporting

Staffing requires much planning on the part of the nurse administrator. Data must be

collected and analyzed. These data include facts about the following:

- The product, that is, the needs of patient care.- Diagnostic and therapeutic procedures performed by physicians and nurses.- The knowledge elements of professional nursing translated into the skills of taking a

medical history, performing an assessment, providing a nursing diagnosis andprescription, applying care, evaluating, keeping records, communicating, and taking

all other actions related to primary health care of patients.

3. Staffing ActivitiesNumerous staffing activities have been identified:

a. One person ultimately responsible for each activity should be identified.b. The category and position of the person who should be responsible for each activity

should be identified.

c. The activity should be specified as requiring nursing or non-nursing personnel.d. The review should be performed for the day, evening, night, weekend, and holiday

shifts.

y Orientation PlanThe orientation plan offered to new employees can impact both recruitment

and retention; orientation is a time when a sense of belonging can beinstilled. A main purpose of orientation is to help the nursing worker adjust;

it should be planned program overseen by the education department or a

unit based clinical coordinator, with a one-on-one preceptor.

4. Staffing Policies


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Staffing policies are best derived through consultation with clinical nurses.

Written staffing policies should be readily available for at least the following areas:

o Vacations, holidays, and sick leaveo Emergency leaveo Weekend shifts: number worked, days considered as weekendo Shift rotationo Overtimeo Part-time and temporary personnelo Use of float personnelo Schedule changeso Use of educational timeo Requests of personnel and managemento The work week

5. Staffing ModulesMany different approaches to nurse staffing and scheduling are being explored in an

effort to satisfy the needs of employees and meet workload demands for patient care.

Staffing and scheduling are reasons for both turnover and job retention.

y Cyclic SchedulingIt is one way of staffing to meet the requirements of equitable

distribution of hours of work and time off. A basic time pattern for a certain

number of weeks is established and then repeated in cycles. Team rotation is a

method of cyclic staffing in which a nursing team is scheduled as a unit. It is used

in the team nursing modality.

y Self SchedulingIt is an activity that may make a staff happier, more cohesive, and more

committed. It should be planned carefully on a unit basis with a written policy in

place as a guideline. Planning may use either a self-directed work team or a

quality circle technique approach. It meets personal goals such as family, social

life, education, child care, and commuting.

A flexible role: resource acuity nurse

Cross-Training

Cross-training of nursing personnel can improve flexible scheduling. Nurses can be

prepared through cross-training function effectively in more than one area of expertise. To

prevent errors and increase job satisfaction during cross-training, nurses assigned to units and

in pools require complete orientation and ongoing staff development.


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Temporary Workers

Nurses have been doing work as temporary agency employees for several decades.

They have turned staffing agencies because they wanted control over their personal and

professional. The number of temporary jobs, professional and nonprofessional, has increased

annually and is now in the millions. In many instances temporary employment has caused

workers to experience downward mobility. The lesson for nursing personnel is to gain a

reputation for competence in more than one clinical area or in more than one of the areas of

clinical practice and management.

Strategic Staffing

It analyzes units staffing needs, based on long-term objectives for the unit and

organization, to find combination of permanent and temporary employees with the best skills

to meet these needs. Temporary staffing may protect the jobs of permanent or cone employees

when the temporary employee is used to cover a vacancy while the position or job is analyzed.

Travel Nursing

A step beyond the nurses who work for local agencies, travel nursing is an increasingly

popular career choice. The mobility of society at large has increased the willingness of nursing

workers to relocate for weeks- or months-long assignments.

Transfer Fair

In an effort to minimize the negative repercussions of downsizing, one hospital used atransfer fair to place staff quickly and fairly. The key participants were as follows:

-Managers with vacancies-Recruitment staff with a list of vacancies-Employee relations staff to answer personnel policy questions-Staff affected by downsizing

Patient classification system

Patient Care Classification Systems

- Method of grouping patients according to the amout and complexity of their nursingcare requirements and the nursing time and skill they require.

- Classification data can be used to predict the amount of nursing time needed based onthe patients acuity.

Patient acuity- The measure of nursing workload that is generated for each patient.

Two Different Types of Classification Systems:

Factor System- Units of measure that equate to nursing time.


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-These systems attempt to capture the cognitive functions of

assessment, planning, intervention, and evaluation of the patient outcomes along with

written documentation processes.

- This is the most popular type of classification system because of its

ability to project care needs for individual patients as well as patient groups.

Advantage:

Data are generally readily available to managers and staff for day-to-day operations.

These systems provide information against which one can justify changes in staffing

requirements.

Disadvantage:

Ongoing workload for the nurse in classifying patients everyday. These systems do not

holistically capture the patients needs for psychosocial, environmental, health

management support. And finally, these systems calculate nursing time needed based

on a typical nurse.

Prototype System- Allocates nursing time to large patient groups based on an average

of similar patients.

-The data are then used by hospitals in determining the cost of

nursing care and negotiating contracts with payers for specific patient populations.

Advantage:

Reduction of work for the nurse because she is not required to classify patients daily.

Disadvantage:

No ongoing measure of the actual nursing work required by individual patients.

SchedulingScheduling- Timetable showing planned work days and shifts for nursing personnel.

Factors Considered in Making Schedules

Adequate coverage for 24 hours- Adequate mix nurses and nursing attendants should be

observed so they only assume duties that they are legally responsible for according to their

positions, education, training, and experience.

Seven days a week

Staggered vacations and holidays- Vacations, whether forced or requested, are likewise

straggered to ensure adequate coverage at all times.

Weekends- Are scheduled in such a way that everyone gets a fair share of atleast one week-

end off a month.

Long stretches of consecutive working days- Should be avoided as much as possible because it

might affect the health of the nursing personnel.

Evening and night shifts- More difficult than day shifts

Floating

Assessing a Schedule System

1. Ability to cover the needs of the unit- A minimum required number of staff must meetthe nursing needs of the patients in the units at all shifts.

2. Quality to enhance the nursing personnels knowledge, training and experience- Whilepermanent assignment to one unit enhances skills in caring for a particular kind of

patient (whether obstetrical, medical, surgical or pediatrics), many nurses who have

future plans of going into teaching, or specialization or even working abroad, would


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prefer to experience being assigned to various units before settling down to a

particular unit of their choice;

3. Fairness to the staff- All nursing personnel should get a fair share of weekends, holidayoffs, rotation patterns for the whole year including assignment to difficult or light

or undesirable units of shifts;

4. Stability- The nursing personnel would like to know in advance their schedule ofassignment so that their personal schedules (whether at home, social, and civic

responsibilities) are in harmony with each other; and

5. Flexibility- Flexibility means the ability to handle changes brought about by emergencyleaves, scheduled or unscheduled leaves of absence.

Scheduling System

Advantages Disadvantages

Centralized

Staffing decisions are made bypersonnel in a central office

or staffing center

Policies tend to be

employed more consistentlyand impartially

Frees the middle- level

manager to complete other

management functions

More cost efficient use of

resources

Does not provide much

flexibilityIt does not account for a

workers desires or special

needs

Managers may be less

responsive to personnel

budget control

Decentralized

Unit manager is responsible

for scheduling

Unit manager understands

the needs of the unit and staff

society

Increased likelihood of

sound staffing decisionsStaff feels more in control of

their work environment

Increased autonomy and

flexibility

Risk that employees will be

treated unequally or

inconsistently

Time consuming

Difficulty in ensuring highquality staffing decisions

throughout the organization

Flextime

System that allows employees

to select the time schedules

that best meet their personal

needs while still meeting work

responsibilities

Creates greater employee

choices

Difficult for the manager to

coordinate; could easily result

to understaffing or

overstaffing

Self- Scheduling

Allows nurses in a unit to

work together to construct

their own schedules

Offers nurses greater

control and worker

participation

Saves management time

Improves morale and

professionalism

Depends on the

management skills

Manager needs patience

and perseverance throughout

the implementation

It is not easy to implement

Modalities of care

This refers to the manner in which nursing care is organized and provided. It depends on

the philosophy of the organization, nurse staffing and client population.

Nursing modalities are ways care is organized and delivered to patients. They

have to do with arranging staff members and assigning patients. Care delivery methods

take into account the total number of patients and tasks needed to be accomplished as


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well as how many nurses are needed. Most importantly, they are concerned with

meeting patient's needs and continuity of care. "The purpose of any delivery system is

to provide high quality care, efficiently and effectively," according to Kaiser Permanente

Institute for Health Policy.

Case method

It is the oldest patient care delivery method. In this method one professional nurse

assumes total responsibility of providing complete care for one or more patients (1-6) while she

is on duty. This method is used frequently in intensive care units and in teaching nursing

students.

In case method, the nurse cares for one patient whom the nurse cares for exclusively.

The Case Method evolved into what we now call private duty nursing. It was the first type of

nursing care delivery system.

In Total Patient Care, the nurse is responsible for the total care of the patient during the

nurses working shift. The RN is responsible for several patients.

Advantages:

Consistency in carrying out the nursing care plan Patient needs are quickly met as high number of RN hours are spent on the patient Relationship based on trust is developed between the RN and the patients familyDisadvantage:

It can be very costly

Primary nursingIs a model of care delivery and a model of organizing care to achieve high-quality care

outcomes. The goal is for each clients care to be comprehensive and coordinated, from

admission to discharge. Each client is assigned an RN as the primary nurse, and that nurse

always provides care for that client when he or she is working.

Advantages are: the client has the same nurse; the clients psychosocial needs can be meet;

communication with the physician is improved; and the nurse feels autonomous.

Disadvantages are: the increased cost in hiring a large RN staff; and possible role confusionbetween primary and associate nurse. (Black and Hawks, 2001)

The hallmark of this modality is that one nurse cares for one group of patients with a 24-hour

accountability for planning their care. In other words, a Primary Nurse (PN) cares for her

primary patients every time she works and for as long as the patient remains on her unit. An

Associate Nurse cares for the patient in the PNs absence and follows the PNs

individualized plan of care. This is a decentralized delivery model: more responsibility and

authority is placed with each staff nurse.

Advantages: Increased satisfaction for patients and nurses More professional system: RN plans and communicates with all healthcare members. RNs

are seen as more knowledgeable and responsible.

RNs more satisfied because they continue to learn as as part of the in-depth care they arerequired to deliver to their patient


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Disadvantage:

Only confines a nurses talents to a limited number of patients, so other patients cannotbenefit if the RN is competitive

Can be intimidating for RNs who are less skilled and knowledgeable

Team nursingWas developed in the 1950s in an effort to decrease the problems associated with the

functional model of nursing care. Many people felt that, despite a continued shortage of

professional nursing staff, a patient care delivery model had to be developed that reduced the

fragmented care that accompanies functional nursing.

Defined Team nursing

>Team nursing is based on philosophy in which groups of professional and non-professionalpersonnel work together to identify, plan, implement and evaluate comprehensive client-

centered care.

>Team nursing was designed to accommodate several categories of personnel in meeting the

comprehensive nursing needs of a group of clients.

Objective of team nursing

The objective of team nursing is to give the best possible quality of patient care.

Line of organizational team nursing

A clear line of organization structure is needed for team nursing to provide a mechanism for

horizontal and vertical communication, and an organized pattern is employed

Functioning of team nursing

Two important points of functioning are:

> The head nurse must know at all times the condition of the patients and the plan for their

care and must be assured that assignments and workmanship contribute to quality nursing

> The team leader must have freedom to use her initiative and the opportunity to nurse,

supervise, and teach unencumbered by the responsibility for administrative detail.

There are 4 channels of communicating in team nursing

1. Reports2. Work or assignment conference3. Patient care conference4. Written nursing care plan

What are the advantages and disadvantage of a team nursing?

Advantages

1. High quality comprehensive care can be provided despite a relatively high proportion of

ancillary staff.2. Each member of the team is able to participate in decision making and problem solving.

3. Each team member is able to contribute his or her own special expertise or skills in caring for

the patient.

4. Improved patient satisfaction.

5. Organizational decision making occurring at the lower level.


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Disadvantages

1. Establishing a team concept takes time, effort and constancy of personnel. Merely assigning

people to a group does not make them a group or team.

2. Unstable staffing pattern make team nursing difficult.

3. All personnel must be client centered.4. There is less individual responsibility and independence regarding nursing functions.

5. The team leader may not have the leadership skills required to effectively direct the team

and create a team spirit.

6. Insufficient time for care planning and communication may lead to unclear goals.

Modular nursing

> is a mini-team (two or three members) approach. >a member of modular team is called care pair. What are the advantages and disadvantage of a team nursing? Advantages 1. Continuity of care is improved when staff members are consistently assigned

to the same module

2. The RN as team leader is able to be more involved in planning andcoordinating care.

Disadvantages 1. Costs may be increased to stock each module with the necessary patient care

supplies.

2. Long corridors, common in many hospitals, are not conducive to modularnursing.

Functional nursing

It is a task-oriented method wherein a particular nursing function is assigned to eachstaff member. The medication nurse, treatment nurse and bedside nurse are all products of this

system. For efficiency, nursing was essentially divided into tasks, a model that proved very

beneficial when staffing was poor. The key idea was for nurses to be assigned to tasks, not to

patients.

Advantages:

A very efficient way to delivery care. Could accomplish a lot of tasks in a small amount of time Staff members do only what they are capable of doing Care is provided economically and efficiently Minimum number of RNs required, so it is efficient when there is a shortage in the staff or

there is limited number of professional nurses

Useful in emergency situations.Disadvantages:

Care of patients become fragmented and depersonalized Patients do not have one identifiable nurse Very narrow scope of practice for RNs


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Leads to patient and nurse dissatisfaction

Emerged during 1950s, due to shortage of nurses. This method focuses on getting the

greatest amount of tasks in the least time. In this method, the nursing care is divided into tasks

and each staff member is assigning to perform one or two tasks for all patients in the unitaccording to the level of skill required for performance as follows:

Registered professional nurses:

Responsible for administering medication to all unit patients, another for changing dressings

and administering ordered treatments (such as postural drainage or warm compresses) for all

patients.

Technical nurses:

Responsible for taking vital signs and recording intake and output for all patients in the unit,

while another might be giving baths to all bedridden patients.

Nurse aides:

Responsible for making beds for all ambulatory patients and assisting mobility, impaired

patients to move in bed or walk in the hall.

Unit clerk:

Responsible for answering telephone, delivering messages, recording admissions and

discharges.

Modified nursing/total patient care

This is the oldest of the care delivery system. One nurse is assigned to one client and

provides all care. The one-to-one pattern is common in critical care, with student nurses, and

with private duty nurses. The advantage is that the client needs to work with only one nurse

and that one nurse can focus on meeting all the biopsychosocial1 needs of the client and the

family.

References:

Nursing Leadership and Management, second edition, Patricia Kelly pg. 234-235

Nursing Leadership and Management author: Patricia Kelly pg. 234-235

Nursing Leadership and Management concepts and practice 2nd edition, Ruth M. Tappen pg.

58,141.

Nursing Management and Leadership. 4th edition. Linda Roussel with Russell C. swansburg and

Richard J. Swansburg. Pg. 216-222, 231-232, 225-230Leadership and Care Management, 3rd edition, Diane L Huber.

Bessie L. Marquis and Carol J. Huston, Leadership Roles and Management Functions in Nursing

http://www.hgexperts.com/article.asp?id=6237

http://www.freeonlineresearchpapers.com/functions-management

http://currentnursing.com/nursing_management/nursing_standards.html

Wikipedia.com.ph

leadership compiled edited (long) final

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