ADAHLIA T.

BASCO, RN, MAN

 the process of influence in which
the leader influences others
toward goal achievement
 is the effort to envision and inspire
changes
 A social transaction in which one
person influences others.
 the process of influence in which the
leader influences others toward goal
achievement
 Process of influencing the behavior or
actions of a person or group to attain
desired objectives

A dynamic, interactive process that

involves three dimensions: leader,
follower and the situation
 the one who leads,
conducts or guides the
process
 to go with or ahead of so as to
show the way; guide
“A Leader is one others
follow willingly and
voluntarily”
 Informal leader
• Does not have official sanction
to direct activities of others;
chosen by the group itself

• Usually become leaders because

of age, seniority, especial
competencies, an inviting
personality or ability to
communicate with and counsel
others
 Informal leader
• Play a valuable role if their
behavior and influence are
congruent with the goals of
the organization.
Formal or appointed

• chosen by administration, and

given official or legitimate
authority to act

Ex. The elected and appointed

officers
Argues that few people are born
to be great leaders who are well
rounded & simultaneously
instrumental & supportive

Many finds this theory

unattractive because of the
premise that leaders are born not
made, which suggests that
leadership cannot be developed
Early works in this area
maintained that traits are
inherited, but later theories
suggest that the traits can be
obtained through learning &
experience
 “Leaders are
born, not created.”
Task-Oriented
Relationship-Oriented
 Participative Leadership
 Task-Oriented
• behaviors includes planning,
scheduling, &
coordinating activities.
Relationship-Oriented
• includes being friendly &
considerate, showing trust &
confidence, expressing
appreciation & providing
recognition
Participative Leadership
• enlists associates participation in
making decisions
Used task behavior & relationship
behavior in relation to the
follower’s readiness, called
maturity to emphasize the
importance of the maturity level of
the followers, & the leader needs to
adapt leadership styles
accordingly
Predictsthe most appropriate
leadership style from the level
of maturity of the followers
derived from the expectancy
theory where people act as
they do because they expect
their behavior to produce
satisfactory results
staff associates are introduced as
a variable where in staff
associates with high need for
achievement probably will
prefer a task oriented leader,
but people with high need for
affiliation will prefer a
considerate leader
In path-goal relationship, the
leader facilitates task
accomplishment by
minimizing obstruction to the
goals (structured activity), & by
rewarding followers for
completing their task
an exchange posture that
identifies the needs of the
followers & provides reward in
exchange for expected
performance

a contract for mutual benefits

that has contingent rewards
Promotes employee development
& attend to their needs by
motivating, inspiring, &
influencing the followers

Leader serves as a role model

who provides a sense of direction
& encourages self management
described it in terms of charisma
& intellectual stimulation

transformational leaders change

the organization by realigning
the organization’s culture with
the new vision, & revision of
assumptions, values, & norms
 Obviously there is no one best
leadership style. Leaders are rarely
totally people oriented or task oriented.

 One should be aware of his own

behavior & learn to adapt.
 involves centralized decision
making, with the leader
making the decision & using
power to command & control
others
is participatory, with the
authority delegated to
others, influential by having
close and personal
relationship with the
subordinates
Is passive & permissive,
nondirective, inactive. Chaos is
most likely to develop
because members may work
independently
Legitimate power to direct others
 It is one’s capacity to influence others
Expert power – it is derived
from the knowledge & skills one
possess
Legitimate power – is derived
from the position one holds in a
group & indicates authority but
not sufficient as one’s only
source of power
Referent power – derived from
respect & trust coming from any
individual group or organization
Reward power – it comes from
the ability to recognize others for
complying
Coercive power – is based on
fear of punishment if one fails to
conform
Connection power – it comes
from coalition & interpersonal
relationship
Informationalpower – it comes
from knowledge & access to
information
TRAIT THEORY
*leaders are born with
inherited tasks
*envisioning goals, affirming
values
serving as a symbol
 Intelligence: judgment,
knowledge and fluency of speech

Personality: adaptability,
alertness, creativity,
cooperativeness, personal
integrity, self confidence,
emotional balance and control,
independence
Abilities: ability to enlist
cooperation, popularity and
prestige, sociability/interpersonal
skills, social participation, tact
and diplomacy
Leaders are born and not made

Great leaders will arise when

there is a great need

Ex. King of Spain

Successful leadership is based in
definable, learnable behavior
People are more committed to
actions
The best action of leader depends
on range of situational factors
*motivation
*capability of followers
performance of leader and
follower
attitudes, needs and
expectations
Depends on the level of the
maturity of individual
Peopleare motivated by reward
and punishment
People will follow a person who
inspires them

A person with vision and passion

Value based leadership

Leaders has certain objectives
and initiates their followers to
attain their own objectives
1. AUTHORITARIAN/AUTOCRATI C

• Strong control over the group or

directive approach

• Concern with task accomplishments

2. DEMOCRATIC OR PARTICIPATIVE

• Leaders focuses on involving

subordinates in decision making

• People oriented
3. LAISSEZ – FAIRE OR PERMISSIVE

• Delegating approach

• Little or no direction is provided to

subordinates
4. MULTICRATIC

• The leader identify which style of

leadership a particular situation
requires
 Legitimate/authority – power granted by
an official position

 Referent – potential influence one has

because of the strength of relationships
between leaders and followers

 Expert – gained thru the position of special

knowledge, wisdom, sound judgment,
good decision skills, skills or ability
Informational power – exists when
an individual have information
that others must have to
accomplish particular goals

Connection power – based on

having connections or
associations with others who are
powerful
Coercive power or punishment
power – manager control the
groups through fears, threats and
sanctions

Reward power – this is achieved

through influencing others
because of one’s control over
desired resources
Understanding of the individual
strength, weaknesses and
potential

Knowledge of basic ingredients

for leadership and management

Systematic use of self to get

things done at the right time
“Leadership is the essence of
professionalism and
should be considered an essential
component of
all nurses and other professional roles”

Joyce Clifford
 Art of getting things done thru people

 Process that involves guidance,

direction of a group of people toward
organizational goals or objectives

 Process thru which the objectives of an

organization are accomplished by
utilizing human, physical and technical
resources.
 the act of planning, organizing, directing
(leading), controlling (evaluating).

 isa process by which a cooperative group

directs actions towards common goals

 isa process of coordinating and allocating

resources to
achieve organizational goal
Informationrole – monitor,
disseminator, spokesperson

Interpersonal role- figurehead,

leaders, liaison

Decisional roles – entrepreneur,

disturbance handler, resource
allocator, negotiator
FIRST LEVEL – Supervises the
operative employee

MIDDLE LEVEL – plan and

coordinate activities of the
organization.

TOP LEVEL – manages the

organization as a whole.
 Leadership Management

Motto Do the right Do things right

things
Challenge Change Continuity
Focus Purpose Structures & procedures
Time Frame Future Present
Methods Strategies Schedules
Questions Why? Who, What, When, Where
& How?
Outcomes Journeys Destinations

Evaluate Potential Performance

Human
 Purposes of Theory

1. Provide a stable focus of

understanding what we experience

2. Enable us to communicate freely

3. Challenge us to keep learning of our

world
• Scientific
• Classical
• Human Relations
• Behavioral
 “Focused on the best way to do a
task”
- Efficiency provided information on:
standards
time & motion studies
task analysis
job simplification
productivity incentives
 “FATHER OF SCIENTIFIC
MANAGEMENT”
 Used stopwatch studies & applied the
principles of:
-observation
-measurement
-scientific comparison to determine the
most efficient way to accomplish a task
 Reduced wasted effort
 Set standard for performance
 Encourage specialization
 Stressed the selection of
qualified workers who could be
developed for a particular job.
“Monistic Theory”
Pioneers in time and motion
studies

Emphasized the benefits of:

job simplification establishment of
work standards effects of the
incentives wage plan fatigue on work
performance
Firstto use motion picture films
to analyze worker’s emotions

Developed a micro chronometer

Disciple of Taylor, was concerned
w/ problems of efficiency
Refined previous work rather
than introduce new concepts
Developed a task and bonus
remuneration plan
Arguedfor:
more humanitarian approach

placed emphasis on service

rather than profit
objectives

recognize useful non-

monetary incentives
 “Deductive rather than
inductive”

-views the organization as a whole

rather than focusing solely on
production
-focused on: planning
organizing
controlling
 “Father of Management Process
School”
 Studied the functions of
managers and concluded that
management is universal

A believer in the division of

work , he argued that
specialization increases
efficiency
 Believed that workers:

should be allowed to think

implement plans be
adequately remunerated for
their services
Encourage developmentof group
harmony through equal
treatment and stability of
tenure for personnel

“a place for everything and

everything in its place.”
Division of Labor – the more
people specialize, the more
efficient they can perform
Authority – management needs to
be able to give orders so that
they can get things done.
Discipline– members in an
organization need to respect the
rules and regulation that govern
the organization
Unityof command – subordinates
should receive orders from only
one superior
Unity of direction – member of
any organization should have
only one objectives
Subordination of Individual
Interest to the Common Good –
give way for the interest of
everybody.
Remuneration – workers should
be paid
according/commensurate to the
work they perform.
 Centralization – managers should
retain the final responsibility but
should at the same time give their
subordinate enough time and
authority to do their job.
Hierarchy – the line of authority in an
organization runs in order of rank.

Order – materials and people should

be at the right time and at the right
place.
 Equity – people in the organization
should be treated with equity and
justice
 Stability of Staff – the greater the
turn-over rate, the less workers are
efficient
 Initiative – subordinate should be
given the freedom to do their
work/conceive plans even though
some mistakes occur
 Espirit de Corps – good relationship
must be maintain in the organization.
“Father of Organizational
Theory”
Conceptualized bureaucracy w/
emphasis on rules instead of
individuals and competency
over favoritism as the most
efficient basis of organization
Conceptualized a structure of
authority that would facilitate
the accomplishment of the
organizational objectives
1. Traditional Authority

1. Charisma

2. Rational/Legal Authority
 “Stresses the Social
Environment”

-focused on the effect

individuals have on the
success or failure of an
organization
Studied the functions of
executives while he was a
manager for the New Jersey bell
telephone system

He defined the manager’s

responsibilities
1. Defining Objectives

2. Acquiring Resources

3. Coordinating Activities
Stressing the importance of
cooperation b/w management
and labor, he noted that the
degree of cooperation
depends on the non-financial
inducement
Stressed the role of informal
organization for

• aiding communication
• meeting individual’s needs
• maintaining cohesiveness
“Mother of Modern
Management”
Stressed the importance of
coordinating the psychological
and sociological aspect of
management

Perceived
the organization as a
social system and
management as social
process
She considered subordination
“offensive”
Distinguishedbetween power w/
others and power over others
and indicated that legitimate
power is produced by a circular
behavior whereby superior and
subordinates mutually
influence one another.
The law of the situation dictates
that a person does not take
orders from another person
but from the situation
Author of “The Hawthorne
Studies”
Though criticized for poor
research methods, the
“Hawthorne Studies”
stimulated considerable interest
in human problems on the job

“lighting had little effect on

production”
Work norms obviously had more
influence than wage incentive
Study of “Group Dynamics”
 maintained that groups have
personalities of their own;
composite of the member’s
personalities

advocated democratic supervision

Identified the three types of
leaders

• Autocrat

• Democrat

• Laissez-Faire
Developed “Sociometry” to
analyze group behavior
Claimed that people are either:
attracted to
repulsed by
indifferent towards others

Developed the sociogram to

chart pairings of preferences for
others
Contributed to:
• psychodrama (individual therapy)
• sociodrama ( related to social and
cultural roles)
• and role playing techniques for the
analysis of interpersonal relations
emphasizes the use of scientific
procedures to study the
psychological, sociological,
and anthropological aspects
of human behavior in
organization
“Hierarchy of Needs
Theory”
Initiatedthe Human Behavioral
School in 1943

He outlined a hierarchical structure

for human needs classified into five
categories:
1. Physiological
2. Safety
3. Belonging
4. Esteem
5. Self-actualization
“Once needs are met,
newer and more mature
ones must emerge”
Factors in the job can raise the
level of performance and meet
the higher order needs
• Job-content (factors in the job) ex:
achievement, recognition, growth =
motivators
• Job-context (surrounding
environmental factors) ex: supervision,
company policy, working conditions =
hygiene factors
“Theory X and Y”
Developed the managerial
implications of Maslow’s Theory

Notes that ones style of

management is dependent on
one’s philosophy of humans
Theory X – manager’s emphasis
on the goal of the organization

• People dislike & will avoid work

• Workers must be directed, controlled,

coerced, threatened
Theory Y – emphasis is on the
goal of the individual

• People do not inherently dislike work

• Work can be a source of satisfaction

• Workers have self direction, self-

control, responds to rewards for the
accomplishment of goals
“Theory Z”
Published Theory Z: How
American Business Can Meet
the Japanese Challenge in
1981
 Japanese organization

• “lifetime employment”
• Slow evaluation & promotion
• Non-specialized career paths
• Implicit control mechanisms
• Collective decision-making &
responsibility
• Holistic concern
US organization

• Short-term employment
• Rapid evaluation & promotion
• Specialized career paths
• Explicit control mechanisms
• Individual decision-making
• Individual responsibility
• Segmented concern
Gave a more extensive
discussion of the Art of
Japanese Management:
Application for American
Executives in 1981.
Explain that organization in the
US tend to savor strategy,
structure, and systems,
whereas the Japanese
organization focus on staff,
skills, style, and
superordinate goals
Theory of Management is based on his work at the University
of Michigan’s Institute for Social Research
He identified 3 types of variables
in organization
Includes:

• Leadership behavior

• Organizational structure

• Policies

• Controls
These are:

• Perceptions

• Attitudes

• motivations
Includes:

• Measures of profits

• Costs

• Productivity
“Managers may act in ways
harmful to the organization
because they evaluate end
results to the exclusion of
intervening variables.”
 B E
(1,9) (9,9)

C
(5,5)

A D
(1,1) (9,1)

Vertical – concern for people Horizontal – concern fro

production
Behavioral Science
Robert Blake (1918) & Jane Mouton (1930)

Maintained that there are 2 critical dimensions of leadership

1. Concern for people

2. Concern for production

They depicted these on a 9 x 9 or 81 square managerial grid.

The vertical axis represents the managers concern for
people, & the horizontal axis represents concern for
production. The 5 basic styles are to each corner & in the
middle
lack of concern for both people &
production
thoughtful & friendly but lack
concern for production
represents a moderate concern for
both people & production but not at
the same time
efficiency in operation but lacks
concern for human element
the optimal managerial style. These
managers integrate their concern for
people & production
Accdg to Robert Katz

 Technical skills – knowledge and

proficiency in activities involving
methods, procedures and process. It
also involves working w/ tools and
specific techniques to achieve the
desire result.
 Human skills – the ability to
work w/ people. It is the creation
of work environment in w/c
people feel secure and free to
express their opinion.
Conceptual skills – the ability
to see the over-all pictures to
identify important elements in a
situation and to understand the
relationship among the elements
Summer emphasized

• Knowledge factors

• Attitude factors

• Ability factors
INTERPERSONAL ROLE

• Symbol

• Leader

• Liaison
INFORMATIONAL ROLE

• Monitors Information

• Disseminates Information

• Spokesperson or Representative
DECISIONAL ROLE

• Entrepreneur or Innovator

• Troubleshooter

• Negotiator
 Forecasting or setting the broad outline
of work to be done

-Why it will be done?

-What action is necessary?
-Where it will be done?
-When it will be done?
-Who will do it?
-How it will be done?
Strategicplanning based on
mission of the institution
 Supervisors
- formulate policies, rules and regulations,
methods and procedures
-coordinates nursing activities
-translate strategies and procedures into
specific objectives and program
 Head nurses
- schedule daily and weekly plans for the
administration of patient care for his or
her unit
- directly responsible for the actual
production of nursing services
 Based on clearly defined objectives
 It should be simple
 It should provide for the proper analysis and
classification of action
 It should be flexible
 It should be balance
 It should make use of all available resources
 Increases the chance of success by focusing
on results not activities
 Forces analytic thinking and evaluation of
alternatives
 Establish a framework for decision making
 Orient people to action than reaction
 Includes day to day and future focused
managers
 Helps avoid crisis management and provide
decision making flexibility

 Provide a basis for managing organizational

and individual performance

 Increases employee involvement and

improves communication

 Cost effective
1. Develop the purpose or mission
statement, goals, objectives,
philosophy

• Mission – purpose of existence and

reason behind organizational
structure

• Philosophy – statements of shared

values and beliefs
• Goals – statement of intent derived
from the purposes of the organization,
usually stated broadly and generally

• Objectives – specific aims, purposes

or targets that will have to be
accomplished
2. Collect and analyze data -
external and internal forces

3. Assess for the strength

(opportunities that will facilitate
effectiveness and achievement of
goals and weaknesses (threats
that will impede achieving goals
and objectives)
4. Write realistic and general
statements of goal

5. Identify strategies to achieve

specified goals

6. Develop a timetable for

accomplishing each objectives

7. Provides guideline for developing

operational and functional plans
8. Put plans to work/implement

9. Provide for formative

evaluation reports before, during
and after the plan is
implemented
Budget

• operational management plan related

to income and expenses for division of
time; allocated resources necessary for
future expenditures
Sound organizational structure
with clear line of authority and
responsibility

Managerial support

Formal policies and procedures

must be reflected in the
budgetary manual
 To plan the objective, programs,
activities of the nursing service
and finance to accomplish them.

To motivate nursing workers

through analysis of actual
experience.

To serve as standards.

 Capital

 Operational

 Personnel or manpower

 Flexible

 Cash flow

 Fixed ceiling
 Fixed
cost - not related to volume and
remain constant.
 Variablecost - related to volume and
varies according to different factors.
 Direct
cost - related to providing
product service.
 Indirect
cost - incurred in support of
providing products service.
 COST AWARENESS

 COST FAIRS

 COSTMONITORING – focuses on how

much will be spent, where, when, and
why.

 COST MANAGEMENT – what can be

done to manage cost
 COSTINCENTIVES – motivation and
rewards

 COST AVOIDANCE – not buying

supplies, technology or services not
necessary needed.

 COSTREDUCTION – spending less for

goods or services

 COST CONTROL – effective use of

available resources through careful
planning, forecasting, reporting and
monitoring.
1. Determine productivity goal

2. Forecast workload

3. Budget patient care hours

4. Budget patient care hours and

staffing

5. Plan for nonproductive hours

6. Chart productive time

7. Estimate the cost of supplies and

services

8. Anticipate capital expense

Grouping of activities, providing
assignments, supervising,
defining means of coordinating
activities to accomplish goals and
objectives
To sustain the philosophy,
achieve the mission and vision
and objectives of the organization

Show the part each person shall

work in the organization
Divisionof work in which each
boxes represent an individual
responsible for a given part of the
organization’s workload

Chain of command, with lines

indicating who reports to whom
and why what authority
 Thetype of work performed, indicated
by the labels or description for each
boxes

 Thegrouping of work segments shown

by the cluster of work groups

 The level of management, which

indicate individual and entire
management hierarchy
People

Purpose

structure
Informal
– consists of the personal
and social relationship of the
members in the organization

Formal – describes the positions,

responsibilities and those
occupying the positions and their
relationships among them
Hierarchic or bureaucratic model

Adaptive or organic model

1. Freeform
2. Collegial
3. Project management
4. Task force
5. Matrix
 Diagrammatic representation of
the organizational structure
Types according to depiction

1. Positional – position is indicated

2. Functional – duties and

responsibilities

3. Structural – agency is shown

 Isthe simplest and most direct type of
organization in which position has
general authority over the lower
position in the hierarchy.
DIRECTOR

CHIEF NURSE

SN SN SN
 ADVANTAGES  DISADVANTAGES

1. Maintain 1. Neglects special

simplicity. planning

2. Makes clear 2. Overworks key

division of people
authority.
3. Depends upon
3. Encourage retention of a few
speedy action key people
Is one where each unit is
responsible for a given part of
the organization’s workload.
There is a clear delineation of
roles and responsibilities which
are actually interrelated
 ADVANTAGES  DISADVANTAGE
S
1. Relieves line
executive of 1. Makes relationship
routine specialized more complex
decision
2. Provides 2. Makes limits of
frameworks for authority of each
applying expert specialist a difficult
knowledge coordination
3. Teach toward
3. Relieves press of centralization of
need for large organization.
number of well-
rounded personnel
 Ispurely advisory to the line structure
w/ no authority to put
recommendations into action.

DIRECTOR

TRAINING OFFICER

CHIEF NURSE

SN SN SN
 ADVANTAGES  DISADVANTAGES

1. Enables specialist 1. Continues in

to give expert organization even if
advise its function are not
clear
2. Frees the line 2. Reduces expert
executive of power to place
detailed analysis recommendation
into action
3. Affords young
specialist a mass 3. Tends towards
centralization of
training the organization
 Depicts the Chief Executive at the top
with line of authority flowing down the
hierarchy.
DIRECTOR

CN

SN SN SN

NA NA NA
 Depicts
the manager at the top w/ a
wide span of control
CN

SN SN SN SN SN

NA NA NA NA NA
 shows
outward flows of
communication from center
SN

CN

SN SN
 Is the process of determining
and providing the acceptable
number and mix of nursing
personnel to produce a
desired level of care to meet
the patient’s demand.
 The Hospital Nursing Service
Administration Manual of the Department
of Health has recommended the following
nursing care hours (NCH) for patients in
the various nursing units of the hospital.
 CASES NCH/Pt/day Prof. to Nonprof
ratio

1. General 3.5 60:40

Medicine

2. Medical 3.4 60:40

3. Surgical 3.4 60:40

4. Obstetrics 3.0 60:40

5. Pediatrics 4.6 70:30

6. Pathologic 2.8 55:45

Nursery
7. ER/ICU/RR 6.0 70:30

8. CCU 6.0 80:20

…quantify the quality of nursing
care by matching patients’ needs
to numbers and kinds of nursing
personnel using time as the unit of
measure.
A nurse manager must determine the
following:

 Number of categories in which the pt should be

divided

 Characteristics of pts per category

 Type & number of care procedures that will be

needed by a pt per category

 Time needed to perform these procedures that will

be required
 Levels of care NCH/pt/ day Ration prof to non-
prof

L1 self care or 1.5 55:45

minimal care

L2 moderate or 3.0 60:40

intermediate

L3 total or intensive 4.5 65:35

care

L4 highly specialized 6.0 70:30

or critical care 7 or higher 80:20
Percentage of Nursing Care Hours

 
Period of NCH at each levels of care
depends on the setting in which the
care is being given.
Level I- SELF CARE or MINIMAL CARE

- patient can take a bath on his own, feed

himself and perform his ADL.

- patient about to discharge, those non-

emergency, newly admitted do not exhibit
unusual symptoms, and requires little
tx/observation or instruction.

- 1.5 NCH/ 55:45 ration prof and non prof

- patients under this level need some assistance
- extreme symptoms of their illness must have
subside or have not yet appeared.
- slight emotional needs, w/ V/S ordered up to
3x/shift, intravenous fluid or blood transfusion, are
semiconscious and exhibiting some psychological
or social problems; periodic tx, observation &
instructions
- 3 NCH / 60:40 ration prof & non-prof
- patients in this category are completely
dependent upon the nursing personnel.
- they are with marked emotional needs, w/ V/S
more than 3x/shift, may be on continuous O2
therapy, w/ chest or abdominal tubes.
- require close observation at least 30 mins for
impending hemorrhage, w/ or w/o hypo or
hypertension & cardiac arrhythmia.
- 6 NCH / 65:35 Ration prof & non-prof
- Need maximum nursing care.

- patients need continuous tx &

observation; w/ many medication, IV
piggy banks; V/S q 15-30 mins; hourly
output.

- 6-9 NCH / 70:30 to 80:20

 Type of Minimal Moderate Intensive Highly Spl.
hospital care care care care

Primary 70 25 5 -

Secondary 65 30 5 -

Tertiary 30 45 15 10

Special T. 10 25 45 20
When computing for the nursing personnel, one should
ensure that there is sufficient staff to cover:
1. All shifts

2. Off-duties
3. Holidays
4. Leaves
5. Absences
6. Time for Staff Development
Rights & privileges given Working Working
each personnel/year hr/wk hr/wk
48 hrs 40 hrs

1. Vacation leave 15 15
2. Sick leave 15 15
3. Legal holidays 10 10
4. Special holidays 2 2
5. Special privileges 3 3
6. Off duties/ R.A. 5901 104 52

7. Continuing Education Program 3 3

Total Non-working days/year 152 100

Total Working days/ year 213 265

Total Working hours/ year 1,704 2,120

1. Ave. number of leaves taken each year---- 15
• Vacation Leave --------------------------------10
• Sick Leave--------------------------------------- 5
2. Holidays ---------------------------------------------- 12
3. Special Privileges --------------------------------- 3
4. Continuing Education Program for
Professionals ------------------------------------- 3
Total Average Leaves 33
33 (ave # of days an employee is
absent)
213 or 265
(# of working days/year that each
employee serves)

= 0.15 (15%) for persons who work

40hrs/wk

= 0.12 (12%) for persons who work

48hrs/wk
 Morning shift = 45 – 51% (0.45 –
0.51)
 Afternoon shift=34 – 47% (0.34 – 0.47)
 Night shift = 15 – 18% (0.15 – 0.18)

***Note: In the Philippines, the

distribution usually followed is 45%
(0.45) for the morning shift, 37% (0.37)
for the afternoon shift and 18% (0.18)
for the night shift.
1. Categorize the patients according to
levels of care. Multiply the total # of
patients by the % of patients at each
level of care.

Ex. Find the # of nursing personnel needed for

250 bed capacity in a tertiary hospital

250 (pts) x .30 = 75 pts need L1

250 (pts) x .45 = 112.5 pts need L2

250 (pts) x .15 = 37.5 pts need L3

250 (pts) x .10 = 25 pts need L4

2. Find the # of nursing care hrs (NCH)
needed by patients at each level of
care/ day.

75 pts x 1.5 (NCH at L1) =112.5 NCH/day

112.5 pts x 3 (NCH at L2) =337.5 NCH/day
37.5 pts x 4.5 (NCH at L3)=168.75 NCH/day
25 pts x 6 (NCH at L3) =150 NCH/day
Total = 768.75 NCH/day
3. Find the total NCH needed by given number of
patients or bed capacity/year.

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

4. Find the actual number of working hours

rendered by each nursing personnel/year.

8 (hrs/day) x 213 (working days/year)=

1,704 (working hrs/year)

5. Find the total # of nursing personnel needed.

(immediate, reliever, total personnel)
a. Total NCH/year = 280,593.75 = 165
working hrs/yr 1,704

b. Relief x total immediate nsg personnel

165 x 0.15 = 25

c. Total nsg. Personnel needed

165 + 25 = 190
6. Categorize the nursing personnel into
professional and non-professional.

190 x .65 = 124 professional nurses

190 x .35 = 66 nursing attendants
190 nursing personnel

7. Distribute by shift

124 x .45 = 56 nurses on AM shift

124 x .37 = 46 nurses on PM shift
124 x .18 = 22 nurses on Night shift
124 nurses
66 x .45 = 30 nsg attendants on AM shift
66 x .37 = 24 nsg attendants on PM shift
66 x .18 = 12 nsg attendants on Night shift
66 nursing attendants
 It is a timetable showing planned
work days and shift for nursing
personnel.

Scheduling is to assign working

days and days off to the nursing
personnel so that adequate
patient care is assured.
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
…sets a basic time pattern
that is repeated in cycles.
…include systems of scheduling
personnel such as 10-hour and 12-
hour shifts, weekend alternative, team
rotation, and flexible hours.
…is a method of scheduling in
which the nurse manager
determines the needs per day and
shift and the nursing staff
schedule themselves to meet
these needs.
…is a system of measuring worker
output and is commonly defined
as outputs divided by inputs.
…are contract workers hired from a
staffing agency for a period of
time that may be for one to
several days or weeks.
Temporary workers are not
employees of the health care
agency where they work.
 Oversees staffing activities through
human resource management that
includes use of a patient
classification system and provision
of qualified nursing personnel in
adequate numbers to meet patient
care needs.
 Uses input from employees to
develop and implement a staffing
philosophy and staffing policies that
inspire personnel to work to their
maximum level of productivity.
Basic to planning for staffing of a division of
nursing is the fact that qualified nursing
personnel must be provided in sufficient
numbers to ensure adequate, safe nursing care
for all patients 24 hours a day, 7 days a week,
52 weeks a year.

Each staffing plan must be tailored to the

needs of the agency and cannot be
determined with a simple worker-patient
ratio or formula.
 Classification categories
• Factor
• Prototype

 Guidelines
 Average care time for a patient in each
category
 Method for calculating required staffing,
personnel mix, and required nursing care
hours
 10-hour shift

 12-hour shift

 Weekend alternative

 Flex time

 Others
 Is commonly defined as output /
input

Percent productivity
= required staff hours / provided
staff hours x 100
…include recruitment, hiring,
assignment, scheduling, calculating
turnover, preparing payroll, developing
and administering policies, and related
activities.
involves tasks like interviewing,
hiring, coaching, retention of
state and performance
evaluation/appraisal
are persons employed in an
agency or department
 the process of enlisting personnel for
employment; the process of hiring
 the process of choosing or selecting
candidates according to their qualifications
to the job; the process of elimination
capacity to retain employees
once they are hired
 Employee recommendation
 Word of mouth
 Advertisement
 Flyers
 Newsletter
 Bulletin
 Posters
 Career Days
 Job Fairs
 Placement
 Philosophies in the screening
process:

 The manager should screen out applicants

who do not fit the agency’s image.

The manager should try to fit the job to a

promising applicant.
Usually the manager should try to fit the
applicant to the job.
 Application Forms and Resumes

• Determine whether the applicant meets

minimal hiring requirements.

• Furnish background data useful in planning

the selection interview.

• Obtain names of references who may be

contacted for additional information about
the applicant’s work experience and general
character.

• Collect information for personnel

administration (SSN, # of dependents etc.).
 Letter of Reference

 Interview

• face to face contact between the job

seeker and a person with full authority to
fill the position under discussion.

• The purpose of the interview is to obtain

information, to give information, and to
determine if the applicant meets the
requirements for the position.
 PURPOSES

1. For staffing

2. Program costing and formulating budget

3. Track changes in patient care methods

4. Determine values for productivity equation

5. Determine quality
 Issuance of assignments, orders
and instructions that permits the
worker what is expected of the to
achieve organizational goals and
objectives
…is getting the work done through
employees.
Is the process by which a
manager assigns specific
task/duties to workers with
commensurate authority to
perform the task.

The worker in return assumes

responsibility & is held
accountable for its result.
1. Ability of the worker to carry out
the task.

2. Fairness not only to the

employee but to the team as a
whole.
 Select the right person

 Delegate both interesting & uninteresting

task

 Provide staff with enough time to learn

 Delegate gradually

 Delegate in advance

 Consult before delegating

 Avoid gaps & overlaps

 Nursing Care
Assignments/
Modalities of Nursing
Care or System/Pattern
of Nursing Care
Primary

• Extension of principle of
decentralization

• Nursing process driven

• Primary nurses and associate nurses

• 24-hour coverage

• Greater patient and staff satisfaction

 Advantages

1) patient & family are able to develop trusting

relationship with RN
2) there is defined accountability &
responsibility
3) there is holistic/continuity of care.
 
 Disadvantages

1) high cost because there is a higher RN skill

2) proximity of patient assignment
3) overlapping of staff functions
4) nurse patient ratio must be realistic
 Case Method

• 1:1 nurse/patient ration

• Examples include private duty, ICU,

Community Health Nurse

• Similar to Primary, however, no Associate

RN

• The nurse is responsible for the total care

of the patient for the shift she’s working
 Advantages

1)consistency of one individual caring for the

patient for the whole shift;
2) more opportunity to observe & monitor the
patient.

 Disadvantages

1) the nurse may not have the same patient

the next day
2) it does not serve the purpose of
decentralization.
Functional Nursing

• divides the work to be done & every

member is responsible for his actions

• best system that can be used if there

are many patient & professional nurses
are few
 Advantages of functional nursing
are that :

1) work is done fast

2) workers learn to work fast

3) they gain skill faster in that particular

task.
 Disadvantages include:

1) fragmentation of nursing care therefore holistic care is not

achieved;

2) patient cannot identify who their “real nurse” is;

3) nurse-patient relationship is not fully developed;

4) evaluation of nursing care is poor & outcomes are rarely

documented, and

5) it is hard to find a specific person to answer the relative’s

questions.
  Joint Practice (Team Nursing /
Modular Nursing )

• More than modality

• Involves nurses and physicians collaborating

as colleagues

• Agreed upon protocols to manage care in

primary settings

• Modular nursing is a kind of team nursing

that divides the area into modules of
patient, with each module cared by a team
of nurses.
 Advantage
1) work is shared with others

 Disadvantages

1) patient receives fragmented, depersonalized care

2) communication is complex

3) accountability & responsibility is shared which can

cause confusion

4) these factors affects RN’s dissatisfaction.

 Case Management

• Clinical system with accountability for

individual or group through continuum
of care

• Negotiating

• Procuring

• Coordination of services and resources

 RESPONSIBILITIES IN DIRECTING

1. Promotive “improve systems”

2. Preventive “anticipate problems &

difficulties”

3. Corrective “institute measures to

correct problems”

4. Regulatory “preserve existing

assignments”
 Change – purposeful, designed
effort to bring about
improvements in a system, with
the assistance of change agent
REDDINS THEORY – suggested seven
techniques by which change can be
accomplished

1. Diagnosis

2. Mutual setting of objectives

3. Group emphasis
4. Maximum information

5. Discussion of implementation

6. Use of economy and ritual

7. Resistance interpretation
LEWIN’S THEORY
 Unfreezingstage – the nurse is
motivated by the need to create
change
 Movingstage – the nurse will gather
information
 Refreezingstage – changes are
integrated and stabilized as part of
the value system
ROGERS’ THEORY

1. awareness

2. interest

3. evaluation

4. trial

5. adoption
 Forces that make or propels one to act
in a certain way.

 Individual’ desire and responses to

events which prompts extraordinary
effort to attain goal and enthusiasm
 EXTRINSIC MOTIVATION – anticipated
rewards or avoidance of negative
consequences in the performance of action

 INTRINSIC – satisfaction derived from the

action itself

 TRANSCENDENTAL – recognition of the

usefulness of action to some other person
CONTENT THEORY – motivation factors
or needs within a person

1. Maslow’s Needs Theory

2. Alderfer’s theory – (Existence,

Relatedness, Growth) ERG
3. Herzberg’s Theory – two factor
theory

a. Disatisfiers or hygienic – (extrinsic)

salary, job security, working
condition, relationships

b. Satisfiers or non hygienic – (intrinsic)

achievement, recognition, reward,
advancement, work itself
4. McClelland theory – affiliation, achievement
and power

5. Monistic/scientific theory – salary as the

best motivating factor
PROCESS THEORY

1. Arousal theory – focuses on internal

process that mediate the effect of
work performance

2. Expectancy theory – focuses on

people’s expectation that their efforts
will result in good performance and
valued results

3. Equity theory – focuses on fair

treatment
 A systematic, sequential process
of choosing among alternatives &
putting those choices into action
 STEPS
1. Identify problem

2. Prioritize problem

3. Gather and analyze situation related

to problem

4. Evaluating all alternatives

5. Select an alternative for

implementation
 The process by which managers
attempt to measure if actual activities
conform to planned activities

A process wherein the performance is

measured and corrective action is
taken to ensure the accomplishment
of organization goal
Establish standards and criteria
Measure performance
Compare results with standards

Match with standards?

YES – do nothing or improve
NO - take corrective action
 Process of evaluating employee’s
performance against standards

 To determine job competence

 Enhance staff development and

motivate employee

 discover employee’s aspirations and

recognize accomplishments
 Improve communication

 Aid
managers in counseling and
coaching

 Determine training and dev. needs of

staff

 Inventories of talent

 Legal purposes
 Anecdotal records – objective description of behavior

 Rating scale

 Ranking

 Self appraisal/self rating

 Peer review

 Paired comparison

 Forced - choice
 Subordinates

 Team evaluation – multiple raters/

 Behavior – anchored – list specific

description of good, average and good
performance/

 Essayevaluation – describe strength

and weaknesses of employee

 Critical
incident – describe effective
and effective behavior of employee
 Subordinateshave not been
motivated to want to change

 People are unable to make change

 Subordinates
become resentful and
anxious when merit system is applied
 Halo error – allowing one trait to
influence the evaluation of others or
rating of all traits on the basis of first
impression

 Horn error – the evaluator is

hypercritical

 Contrast error – managers rate the

nurse opposite the way they perceive
themselves
 Leniency of error
 Central tendency error

 Racial bias

 System design and operating problems

– focuses on the method (system) and
process (operating) of evaluation

 Overgeneralization

 Recency of Events error

 Systematic
process to improve
outcomes based on customers’ needs
 Doing the right thing

-meeting the needs of the

customer
-building quality performance into
the work process
-employ scientific approach to
assessment and problem solving
Process of establishing a
standards of excellence of
intervention and taking steps to
ensure that each patient receives
the expected level of care

Fulfillment of social contract

between society and professions
 Presence of all elements/characteristics
specified in the standards.

FRAMEWORK OF QA

1. Structure – instrumentalities in the

delivery of care (personnel, supplies etc)

2. Process – how the service was delivered

3. Outcome – results expected of the service

 Official
examination of: nursing
records, physical facilities, personnel
involved in patient care

 Tool
to analyze and evaluate nurses’
bedside records and physical facilities

 Serves as a means of improving

nursing care by revealing existing
deficiencies
 Yardstick
for gauging the quality
and quantity of service

 Describes the quality of service

 Ex.
Nurses are professional in
dealing with clients
 Measures the quality of care or standards

Standard:
Nurses are professional in dealing with
clients

Criteria :
greets them with corresponding smiles
always attend to their needs
Thank
You!