신슬주 Nursing care provided in level I

○
LEADERSHIP AND hospital as well as intermediate &
partial category of supervised care
MANAGEMENT for 24 hrs or longer
By: ROUSSEL FRANCES C. GAJETE, RN • Level III (Tertiary)
○ Departmentalized hospital that
THE SETTING: THE HOSPITAL provides clinical care &
• An integral part of a social and medical management on the prevalent
organization , the function of which is to diseases in the locality as well as
provide for the population it serves, particular forms of treatment,
complete health care, both curative and surgical procedures & intensive
preventive, and whose out-patient services care.
reach out to the family in it home ○ Clinical services provided in level II
environment; as well as speciality clinical care
• It is also a center for training and research ○ With highly specialized critical
ommittee on Organization of Medical Care of the World Health Organization care provided
• Other health facilities
○ Birthing Home- maternity service on
pre-natal care, NSD, care of
• A place devoted primarily to the newborn babies
maintenance and operation of facilities for ○ Psychiatric Care Facility- health
the diagnosis, treatment and care of facility for mentally ill patients
individuals suffering from illness, disease • Acute-Chronic- medical
or deformity, or in need of obstetrical or service, nursing care,
other medical and nursing care psychopharma intervention
RA 4226: Hospital Licensure Law • Custodial- long term care
with basic human services
(food & shelter)
• Any institution, building or place with beds,
cribs or bassinets for use by patients for 24
OWNERSHIP & CONTROL
hours or longer, in the treatment of
• Government
diseases, diseased conditions, injuries,
○ operated and controlled either
deformities
partially or wholly by national,
provincial, municipal or city govt
REVISED RULES & REGULATIONS
• National : PGH, NCMH, POC
GOVERNING THE REGISTRATION,
• Regional: Batangas Regional
LICENSURE, & OPERATION OF HOSPITALS &
Hospital
OTHER HEALTH FACILITIES IN THE
• Provincial: Bulacan Integrated
PHILIPPINES
Provincial Hospital
(Administrative Order No. 2005-0029)
• City: Ospital ng Maynila
• Classification:
• Municipal: Ospital ng Tondo
○ General
• Private or Non- government
• Service for ALL types of
○ Privately owned, established and
deformity, disease, illness or
operated with funds, raised capital
injury (PGH, QMMC)
or other means by private
○ Special
individuals, associations,
• Specific clinical care and
corporations, religious
management (NKTI, Heart
organizations, firms, companies, or
Center, NCH)
joint stock corporations
• Classification (As per service capability)
• Missionary: Mary Johnston
○ Level I (Primary)
Hospital
• Provides initial care & mgt to • Organization: Urology Center
patients requiring of the Philippines Inc.
immediate treatment, as • Community: Romero
well as primary care on Community Hospital
prevalent diseases in the • Private: St. Luke’s Medical
locality Center
• Clinical services may include
general medicine, pediatrics, TRAINING AND NON-TRAINING HOSPITAL
OB & non-surgical • Training Hospital
gynecology, minor surgery. ○ With an accredited Residency
• Gen admin services &
Training Program in one or more
ancillary system (primary
specified specialty or discipline.
clinical laboratory, first level
• Non- training Hospital
radiology and pharmacy)
○ Departmentalized but has no
• Level II (Secondary)
accredited Residency Training
○ Non-departmentalized hospital
Program
that provides clinical care &
management on prevalent diseases
PLANNING
in the locality
○ Clinical services include general
medicine, pediatrics, OB-gyne,
surgery & anesthesiology
 • Defined as pre-determining a course of
action in order to arrive at a desired result
• A continuous process of assessing,
establishing goals & objectives,
implementing & evaluating them.
• Largely conceptual
• PRINCIPLES IN PLANNING
1. Always based and focused on the
vision, mission, philosophy &
clearly defined objectives
2. A continuous process
3. Pervasive w/in the entire
organization
4. Utilizes all available resources
5. Must be precise in scope and
nature. It should be realistic and
must focus on outcomes
6. Time-bounded (short & long range
plan)
7. Must be documented for proper
dissemination for implementation
and evaluation as to the extent of
their achievement
• WHY IS PLANNING IMPORTANT?
1. It leads to achievement of goals
2. It gives meaning to work
3. Provides effective use of available
resources
4. Helps in coping with crises (disaster
plans)
5. Cost effective
6. Based on past and future activities
7. Leads to realization of the need for
change
8. Provides the basis for control
(performance evaluation based on
criteria set during planning)
• MAJOR ASPECTS OF PLANNING
1. It should contribute to objectives
2. It precedes all other processes of
management. Planning & control are
inseparable!
3. It pervades all levels
4. It should be efficient (peso value, man
hours, production as well as individual
values and group satisfaction)
• CHARACTERISTICS OF A GOOD PLAN
○ Precise w/ clearly-worded objectives
○ Guided by policies, procedures
○ Indicate priorities
○ Logical sequence of activities
○ Flexible & realistic actions
○ With most practical methods for
achieving objectives
○ Pervade the whole organization
• ELEMENTS OF PLANNING
○ Forecasting: deciding in advance
where the agency would like to be &
what is to be done to get there.
✔ The environment
✔ The clients
✔ The language/ dialect barriers
✔ The public attitude
behaviour
✔ The severity of condition/
illnesses
✔ The kind of care to be
received
✔ The # or personnel required
✔ The necessary supplies
MISSION, VISION, PHILOSOPHY
• Vision- future role and function
• Mission- agency’s reason for existing
• Philosophy- a statement of beliefs and
values
○ The philosophy of the nursing
service dovetails with the
philosophy of the organization.
○ An intentionally chosen set of values
or purposes.
GOALS AND OBJECTIVES
• Objectives
✔ More specific, concrete
✔ Stated in terms of results to
be achieved
• Goals
✔ More general with a broad
area
THE PLANNING FORMULA
1. WHAT?
– What has been done?
– What should be done?
– What equipments have been used
or are needed?
– What steps are necessary in the
procedure?
– What sequence of activities was
previously used?
– What other efficient methods may
be used?
1. WHERE?
– Where is the job to be done?
– Where does an activity occur in
relation to those activities
immediately preceding or following
it?
– Where could supplies be stored,
cleaned and so forth?
2. WHEN?
– When should the job be done?
– When was it formerly done?
– When could it be done?
3. WHO?
– Who has been doing the job?
– Who else could do it?
– Is there more than one person
involved?
4. HOW?
– How will the job be done?
– How will the time & energy of the
staff be used?
– How MUCH will it cost?
– How much TIME will it require?
5. WHY?
– Why is this job, this procedure,
necessary?
– Why is this done in this way, in this
place, at this time, by this person?
6. CAN
– Can some steps or equipment be
eliminated?
– Can this activity be efficiently
combined with other operations?
– Can somebody else do it better?
&
– Can we get enough machine to
help?
– Can we get enough money?
THE 4 PLANNING MODELS
1. Reactive planning
– Occurs AFTER a problem exists
– (+) dissatisfaction with the current
situation
– Done in response to a crisis
 – May lead to hasty decisions and
mistakes
1. Inactivism
– Inactivists spend a great deal of
energy preventing change and
maintaining conformity.
– Changes occur in the organization
slowly
2. Preactivism
– Preactive planners use technology
to accelerate change & are future
oriented
– They do not value experience &
believe that the future is always
preferable
3. Interactive or proactivism
– These planners consider the past,
present & future
– Adaptation is the key requirement
– Done in anticipation of changing
needs
– Or to promote growth in an
organization
• Promotes consistency of
action
E.g. formal dress code,
policy for sick leave &
disciplinary procedures
PROCEDURES
• Establishes customary ways or acceptable
ways of accomplishing tasks (how to…)
• Delineates sequence of steps of required
action
• Generally found in manuals at the unit
level in the org as ready reference
• Manager must review and revise policies
and procedures to ensure currency &
applicability

THE PLANNING HIERARCHY

RULES
• The least flexible type in planning
• Existing rules must be enforced
• Has only one specific course of action
• Existing rules must be enforced to keep
morale from breaking down & to allow
organizational structure

DECISION MAKING
• The process of selecting one course of
action from alternatives
• Relies on the decision making process:
POLICIES 1. Identify the problem & analyze
• Derived from philosophy, goals & situation
objectives 2. Explore alternatives
• Guides general course & scope of 3. Chose MOST desirable alternative
organizational activities 4. Implement decision
• Direct individual behavior towards org 5. Evaluate results
mission • ORGANIZATIONAL MODELS IN DECISION
• Defines broad limits & desired outcomes MAKING
• 2 types of POLICIES ○ Collegial Model
1. Implied • Full participation of
• Neither written nor verbally community of peers for
• Have developed over time decision making
E.g. employees are • GROUP CONSENSUS
supported in their activity ○ Rational Model
in their professional • Based on common goals,
organizations technical competence when
1. Expressed INDIVIDUAL goals are = to
• Delineated verbally or in ORGANIZATION goals
writing
 • The best solution to achieve ** Process is repeated until a consensus is
desired outcome reached
○ Garbage Can Model • Advantages, Limitations, Unique Qualities,
• Decisions are unplanned & Overcome Limitation (ALUo)
coincidental ○ “How can we overcome the
• Implementation is incidental weakness?”
w/ no planning ○ Evaluates strengths, weaknesses &
• Outcomes occur by chance & unusual qualities
errors may repeat ** Unique qualities are preserved
○ Bureaucratic Model
• Common in healthcare CREATIVE THINKING
• Based on history, norms &
tradition (info & action)
DEVELOPCreativity BLOCKCreativity
• The hierarchal bureaucracy
dictates key players – Be open minded – Negative attitudes
○ Cybernetic Model – Have trust and acceptance – Self censorship
• 3 phases – Good humor – Inflexibility, lack of
1. Needs Assessment confidence
– Determine desired – Have inner motivation, – Misconceptions
outputs, nature of
mental ability
problem, level of goal
– Objectivity – Lack of effort
accomplishment
expected, strategy, – Tolerance for complexity – Conformity&
criteria & causal chain – Enjoyrisk, takingand ability – Reliance on
of processes & to find problems Authority
outcomes
2. Program Implementation TIME MANAGEMENT
– Determine that
program is in place & • A technique for allocating one’s time
progress according to through setting goals, assigning priorities,
time plan identifying & eliminating wasted time
3. Results Assessment • One’s personality, education & culture
– Determine that influences how he/ she manages time
program outcomes are
met & outputs justified SYMPTOMS OF TIME MISMANAGEMENT
the costs • Rushing
• Fatigue & listless hours of non- productive
CREATIVE THINKING TECHNIQUES activity
• Brainstorming • Constantly missed deadlines
○ Description of task is sent to • Insufficient time for rest/ personal
participants relationships
○ Free flow of ideas • Feeling overwhelmed with details/
○ Ideas are recorded demands
○ Permissive atmosphere with mutual • Chronic vacillation between unpleasant
respect alternatives
• Think Tanks PRINCIPLES OF TIME MANAGEMENT
○ 5-8 gather together in an exotic or 1. Plan to anticipate problems that will arise.
diff place to stimulate innovation. 2. Prioritize task & accomplish them
The relaxed atmosphere is according to importance
encouraged to stimulate divergent 3. Set own deadline & adhere to it
& unusual ideas 4. Don’t make postponing, putting off
• Collective notebook technique decisions a habit
○ A problem is identified 5. Delegate
○ Participants record thoughts and
ideas in a specific period TIME SAVING TECHNIQUES
○ Notebooks are rotated to another 1. Make an inventory of activities
person, ideas are read and 2. Set goals & objectives & write them
synthesized 3. Use calendars, planners, journals & write
• Reverse Brainstorming expectations (yearly, monthly, weekly,
○ Break down ideas into smaller parts daily)
○ Analyze and focus on a particular 4. Break down large projects into small parts
5. Start the day with planning
problem
6. Organize work place
○ Done verbally
7. Close your door when you need to
• The Delphi Technique
concentrate
○ Decision making w/o meeting face
8. Delegate
to face
9. Take/ return calls during a specified time
○ Problem is identified, questionnaires
10. Develop effective decision making skills-
are used, Qs are anonymously learn to say NO
returned & compiled 11. Take rest breaks & reward yourself
○ Each member is sent a copy of the periodically
result 12. In meetings, define purpose clearly before
starting
 CASH BUDGETS
BUDGET • Planned to make adequate funds available
• A plan for allocation of resources & a as needed
control for ensuring that results comply • Ensures that agency has enough cash on
with the plans hand during the budgetary period
• Quantitative terms • Money available for immediate use
• Usually prepared for each organizational
unit & for each function w/in unit TYPES OF BUDGETS
• Helps coordinate efforts of the agency by
determining: REVENUE CAPITAL
○ What resources will be used by BUDGET EXPENDITUR
whom, when, & for what purpose INCOME the E BUDGET
health care Long-term major
BUDGETARY LEADERSHIP & MANAGEMENT institution investments,
• Inspire proactive fiscal planning expects to acquisitions,
• Determine resources needed EXPENSE improvements
• Guide visioning of justification for
resources
BUDGET
Expected CASH
• Negotiate for needed resources
• Analyze expenses activity in BUDGET
• Anticipate, recognize & creatively deal with operational & Money available
budgetary problems financial terms for immediate
• Create a financially savvy work FACTORSfor a
INgiven
BUDGET PLANNINGuse
environment 1. period of time
The type of patient, length of stay &
• Help groups find innovative ways to be acuteness of illness
more cost effective 2. Size of hospital & bed occupancy
3. Physical layout of hospital, size & plan of
TYPES OF BUDGET ward & units (nurse’s station etc)
• Operating / Revenue & Expense 4. Personnel policies
• Personnel Budget a. Salaries paid
• Capital Expenditure Budget b. Vacation leaves & holidays
• Cash Budget c. Staff development
• Flexible Budget
5. Patient grouping
(e.g. special units, charity ward)
6. Standards of nursing care
(e.g. amount of care to # of hours of
bedside care)
7. Method of performing nursing care
(e.g. simple / complex)
8. Method of documentation
OPERATING/ REVENUE & EXPENSE BUDGET: 9. Proportion of care
• An overview of an agency’s functions by (prof RN: Non-Prof)
projecting the planned operations, 10. Amount & quality of supervision available
usually for the upcoming year & provided
• Factors included: 11. Efficiency of job description & classification
○ Personnel salaries, employee 12. Method of patient assignment
benefits, insurance, medical- (e.g. functional, case, team or primary)
surgical supplies, office supplies , 13. Amount of labor saving devices &
rent, light, housekeeping, laundry equipment; communication systems
service, drugs & pharma, repairs & 14. Amount of centralized service provided
maintenance, legal fees etc. (Central oxygen supply, linen supply)
15. Nursing service requirements of ancillary
PERSONNEL BUDGET departments
• Estimates the cost of direct labor (Clinics, admitting office, ER)
necessary to meet the agency’s objectives 16. Reports required by admin
• Determines recruitment, hiring, 17. Affiliation of nursing students/ medical
assignment, lay-off & discharge of students
personnel
• May be affected by personnel policies such COST CONTAINMENT
as: • GOAL- Keep costs within acceptable limits
○ Salary related to position for volume, inflation & other parameters
○ # of days allowed for leave • Involves cost awareness, monitoring,
○ Overtime costs management, & incentives to:

CAPITAL EXPENDITURE BUDGET

• Related to long range planning
• Includes physical changes such as
replacement or expansion of the facility, • Cost Awareness- what costs are, process
major equipment & inventories available for containing them, how they
• Usually major investments which take can be managed, & by whom
time to recover the costs
 • Cost Monitoring- how much will be spent,
where, when and why. Identifies, reports &
monitors costs
• Cost Management- What can be done by
whom
• Cost avoidance- not least expensive &
most effective supplies should be
identified
• Cost reduction- spending less for goods
& services.
e.g. Safety programs to reduce work
absenteeism & sick time, volume buying,
conservation of supplies, careful handling
of equipment & inventory control.
SETTING UP THE ORGANIZATIONAL
STRUCTURE
• Organizational chart
○ A line drawing that shows how parts
of an organization are linked
○ Depicts formal & organizational
relationships, areas of responsibility,
persons to whom one is accountable
& channels of communication

APPROACHES TO BUDGET DEVELOPMENT

• Open-ended budget: managers are
given no explicit guidelines regarding
budget amounts and are allowed to submit
whatever amounts they consider
necessary to run the department.
• Fixed-ceiling budget: is constrained by
the amount that is specifically stated
for each department
• Performance based budgeting (PBB):
use statements of missions, goals &
objectives to explain why the money is
being spent.
• A way to allocate resources to
achieve specific objectives based on
program goals and measured
results.
• The elements are:
1. Result: the final outcome
2. Strategy: ways to achieve
final outcome
3. Activity/outputs: what is
actually done to achieve final
outcome.
• Zero based budgeting (ZBB):
– All expenses must be justified for
each new period.
– Starts from "zero base" & every
function within an organization is
analyzed for its needs & costs.
– Budgets are then built around what
is needed for the upcoming period,
regardless of whether the budget is
higher or lower than the previous
one
THE MANAGEMENT PROCESS
• Organizing
○ Establishing formal authority.
○ It involves
1. Setting up the organizational
structure
2. Determining the staff needed
3. Developing job descriptions
ELEMENTS OF ORGANIZING
1. Organizational structure
2. Staffing
3. Scheduling
4. Developing job descriptions
ORGANIZATIONAL STRUCTURE
• PURPOSES:
1. Informs members of their
responsibilities
2. Allows manager & worker to
concentrate o specific roles &
responsibilities
3. Coordinates all organizational
activities to lessen duplication of
effort
4. Reduces overlapping of functions
because it pinpoints responsibilities
5. Shows whom and for whom they are
responsible
TYPES OF ORGANIZATION BY NATURE OF
AUTHORITY
• Informal organization- horizontal
relationships; small group of workers with
similar interests
• Line organization- simplest & most direct;
Each position has general authority over
lower positions in the hierarchy
• Staff organization- purely advisory to the
line structure with NO authority to put
recommendations into action
• Functional organization- each unit is
responsible for a given part of the
organization’s workload. There is clear
delineation of roles and responsibilities
that are interrelated

5 CHARACTERISTICS OF AN
ORGANIZATIONAL CHART
1. Division of work
2. Chain of command
3. Type of work to be performed
4. Grouping of work segments
 5. Levels of management
TYPICAL ORGANIZATIONAL CHART
1. Administrative Division
• Headed by Administrative Officer
• Human & material resources
2. Nursing Division
• Headed by Chief Nurse/ Director of
Nursing
Services
• Caring aspect
3. Medical Division
• Headed by Chief of Professional
Service/Chief of Clinics
• All units that pertain to diagnosis &
cure
NURSING SERVICE/ DIVISION
• Delineates responsibilities & duties of each
category & level of the nursing personnel
• Identifies line, staff & functional
relationships within Nursing
Service/Division
• LARGEST group of hospital employees
tasked with responsibility of:
○ Setting standards for safe nursing
practice
○ Providing quality care to patients
○ Coordinating services with various
divisions/ departments/ services in
the hospital & community
• Administered by Chief Nurse
○ Who is directly responsible to the
Chief of Hospital/ Medical Center
Chief
○ Assisted
by Asst. Chief
Nurse
• Staff Nurse
○ Provides direct patient care
○ Assisted
by nursing
attendants
• Head Nurse/ Senior Nurse
○ Management of nursing unit
ORGANIZATIONAL CHART: NURSING SERVICE
DIVISION
ORGANIZATIONAL CHART: TRAINING
HOSPITAL
With an affiliated college of nursing / school of
midwifery
• Solid lines depict direct relationships
• Broken lines show coordinated
relationships
• FIGURE 4, PAGE 54
• Chief Nurse:
○ directly responsible to the chief of
hospital
○ With assistant chief nurse with
supervising nurses for:
Clinical areas
Training and research
TRADITIONAL HIERARCHICAL STRUCTURE
Chief nurse
Directly under chief of hospital
With supervising nurses with 2 or more units
Senior nurse is in charge of a nursing unit
Staff nurses and NA report directly to Senior/head
nurse
FOR DEVOLVED HOSPITALS
MANAGEMENT LEVELS
• Top Level Managers
○ Looks at the org as a whole
○ Coordinate internal & external
influences
○ Determine org philosophy, policy,
goals, resource allocation
○ Examples
 Chief Operating Officer
 Chief Executive Officer
 Director of nursing/ chief
nurse
• Middle-level managers
○ Coordinates efforts of lower levels of
the hierarchy
○ Channel bet lower & top level
managers
○ Carries out day to day operations
○ Examples:
 Nurse supervisors, nurse-
managers, head nurse
 Management Levels
• First level managers
○ Concerned with specific unit’s
workflow
 ○ Immediate problems in the unit’s
daily operations
○ Examples: RECRUITMENT
 Charge nurse, primary care The process of actively seeking out or attracting
nurse, team leader applicants for existing positions

STAFFING DOH- Hospital Nursing Service Admin

• The process of determining & providing the Manual
acceptable number & mix of nursing CASES/ PT NCH/ PT PROF:NONPROF
personnel to produce a desired level of PerDay
1. General Medicine 3.5 60:40
care to meet the patient’s demand.
2. Medical 3.4 60:40
• PURPOSE: To be able to provide each 3. Surgical 3.4 60:40
nursing unit with an appropriate & 4. Obstetrics 3.0 60:40
acceptable number of workers in each 5. Pediatrics 4.6 70:30
category to perform the nursing staff 6. PathologicNursing 2.8 55:45
7. ER/ICU/RR 6.0 70:30
required

FACTORS AFFECTING STAFFING To compute for the # of nursing personnel for 24

1. Type, philosophy & objectives of the hours:
hospital & nursing service
2. Population served/ kind of patients served Average Bed Occupancy (ABO) x Nursing Care
(pay or charity) Hours (NCH)
3. # of patients & severity of illness + Number of working hours
knowledge & ability of nursing personnel (based on RA 5901)
4. Availability & characteristics of nursing DISTRIBU TIO N BY SHIFTS
staff
M o rn in g 45 to 51 % (45% )
– Education, level of preparation, mix
A f te rn o o n 34 to 37% (37% )
of personnel, # & position
5. Admin policies (rotation, weekends, holiday N igh t 15 to 18 % (18% )
off duties)
6. Standards of care desired (refer to ANSAP’s
Standards of Safe Nursing Practice or
hospital’s own) PATIENT CLASSIFICATION SYSTEM
7. Layout of various nursing units & resources • A method of grouping patients according to
available w/in the dept such as adequate amount & complexity of nursing
equipment, supplies & materials requirements & nursing time & skill they
8. Budget (salaries, benefits, materials, require
supplies ) • Nurse Manager must determine:
9. Professional activities & priorities ○ # of categories into w/c patient
(professional organizations, formal should be divided
education development, participation in ○ Characteristics of patients per
research & development) category
10. Teaching program / extent of staff’s ○ Type & number of care procedures
involvement in teaching activities that will be needed by a typical
11. Expected hours of work per annum of each patient in each category
employee (40 week law) ○ Time needed to perform these
12. Patterns of work schedule procedures that will be required by
– Traditional 5 days/week;8 hours/ each patient category
day
– 4 days/week; 10 hours/day; 3 days PATIENT CLASSIFICATION
off • Level I- Self Care or Minimal Care:
– 3 ½ days; 12 hours/day; 3 ½ days ○ Pt can take bath, feed himself,
off perform ADLs
○ For discharge, non-emergency, little
treatment/ observation/ instruction
 • Level II- Moderate Care or Determ ining the Relieve rs 40 48
Intermediate Care
V acatio n / Si ck Le ave 15 15
○ Pt needs some assistance in ADLs
for short periods of time Le gal H o lid ays 10 10
○ Extreme symptoms have subsided Sp e cial H o lid yas 2 2
or have not yet appeared Sp e cial P rivile d ge s 3 3
○ Pt has slight emotional needs, VS x
Co n tin u in g Ed u catio n P ro 3g. 3
3 / shift, with IVF or BT, semi-
conscious, with psychosocial TO TA L 33 33
problems; periodic treatments % Relieve rs neede d 33 / 213 0.15
= 33 / 2650.12
=
• Level III- Total, complete or intensive
care
○ Pts are completely dependent, may
or not be unconscious, with marked
emotional needs, VS 3x / shift,
requires close observation at least SCHEDULING
every 30 minutes for impending • A timetable showing planned work days
hemorrhage, with and shifts for nursing personnel
hypo/hypertension &/ cardiac • PURPOSE: to assign work days and days off
arrhythmia so adequate patient care is assured
• Level IV- Highly Specialized Critical • Off duty days must be equitably distributed
Care and schedule must be known in advance
○ Pt needs maximum nursing care
○ Pt need continuous treatment & obs TYPES OF SCHEDULING
○ With ++ meds, IV piggybacks, VS q 1. Centralized schedule:
15-30 minutes, with significant ○ One person (usually chief nurse)
changes in doctor’s orders, assigns the nursing personnel to the
various units of the hospital
PATIENT CATEGORIES/NURSING CARE ○ This includes shifts on duty/ off duty
HOURS & RATIO OF PROFESSIONALS TO 2. Decentralized Schedule:
NON-PROFESSIONALS ○ Shift/ off duties are arranged by
Supervising Nurse or Head /
LEVELSOFCARE NCH/ PATIENT/ DAY PROF: NON-PROF
Senior Nurse of a particular unit
LEVELI
Self-care or 1.5 5:45
3. Cyclical Schedule
Minimal Care ○ Covers a number of weeks called
LEVELII cycle length w/c is repeated. It
Moderate or 3.o 60;40 assigns the required number of
Intermediate Care nursing personnel to each nursing
LEVELIII
unit consistent to pt’s unit care
Total or 4.5 65;35
Intensive Care
requirements, staff’s preference,
LEVELIV education, training and experience
Highly Specialized 6 70;30
or Critical Care 7 or higher 80;20 CYCLICAL SCHEDULE
• Variables to consider:
○ Length of scheduling period (2-
4wks)
○ Shift rotation
○ Week-ends off
P e rce n tage o f P a tien ts in V ario u s Lev els o f Care
○ Holidays off
Type of Ho spital M in im al CareM o de rate Care
In te n sive Care
H ighly Spe cialize d ○ Vacation leaves
P ri m ary H o sp i ta l 70 25 5 - ○ Special days
Se co n d ary H o sp it al65 30 5 - ○ Scheduled events in the hospital
Te rtiary H o sp i tal 30 45 15 10
○ Job categories
Sp e cia l 3' H o sp i ta l10 25 45 20
○ CPE programs

ROTATING WORK SHIFTS

Rights and priviledges given
Each Personnel per year
Total Working Days Per Year
• There should be EQUAL sharing of
WorkingHours per Week morning, afternoon and night shifts
40 48 • Too frequent changing in shifts results to
213 265 stress, difficulty sleeping and waking up,
different meal hours, disruption in social
and family life
• Morning shifts = senior nurses

JOB DESCRIPTIONS
• A statement that sets the duties and
responsibilities of a specific job.
• Needed characteristics or qualifications of
the individual to perform such duties
successfully.
 • An IMPORTANT management tool that
would ensure that responsibilities are
wisely delegated, work is efficiently
distributed, talents are fully used & morale
is maintained
• Contents:
○ Identifying data
 Position Title: Staff Nurse
 Department: Nursing
 Supervisor’s Title: Head/
Senior Nurse
○ Job Summary
 Essential features of the job
that distinguish it from others
○ Specific and Actual Functions and
responsibilities
○ Job relationships
 Source of Workers
○ Qualification Requirements:
 Educational Preparation,
training & experience
necessary to fill the position
• Uses of a Job Description
○ For recruitment & selection
○ To orient new employees
○ For job placement, transfer &
dismissal
○ Aid in evaluating performance
○ For budgetary purposes
○ For determining departmental
functions relationships
○ For classifying levels of nursing
functions
○ To identify training needs
○ As basis for staffing
○ To serve as channel of
communication

THE MANAGEMENT PROCESS

• Directing or Leading:
○ Actuating efforts to accomplish
goals.
○ It involves:
1. Decision making
2. Developing people
3. Communicating
4. Coordinating
5. Supervising
6. Utilizing, revising, & updating
policies
7. Delegating
8. Conflict management
• Controlling:
○ Assessing & regulating
performances. It involves:
1. Specifying criteria and
standards
2. Monitoring and evaluating
3. Performance appraisal
4. Total quality management