Organizing Structuring the agency to accomplish task, setting up the organization structure, defining roles and function of every

y member of organization. ORGANIZATIONAL STRUCTURE Most often, the existing organizational structures are communicated by means of an organizational chart. This organization has a tall bureaucratic structure with many layers in the hierarchy or chain of command and a centralized formal authority in the board of trustees. It represents a formal, top-down reporting structure. EXAMPLE:

A. MATRIX STRUCTURE -designed to focus on both product and function. Function is described as all the tasks required to produce the product and the product is the end result of function. B. FLAT VERSUS TALL STRUCTURE Organizations are considered flat when there are few layers in the reporting structure. A tall organization would have many layers in the chain of command. C. DECENTRALIZED VERSUS CENTRALIZED STRUCTURE

 These two refers to the degree to which an organization has spread its lines of authority, power, and communication. STAFFING Is the process of assigning competent people to fill the roles designated for the organizational structure through recruiting, selection and development, one of the major function of a nurse manager, a management activity that requires much planning it involve deciding what types of &how many personal are needed to provide adequate & quality 24 hours aday,7days a week and 52 weeks a year the process of determining and providing the acceptance number& mix of nursing personnel to produce a desired level of care CONSIDERATIONS IN DEVELOPING A STAFFING PATTERN 1. BENCHMARKING-a management tool for seeking out the best practices in ones industry so as to improve performance. 2. SKILL MIX-the percentage of RN staff to other direct care staff, LPNs, and Unlicensed Assistive Personnel. 3. STAFF SUPPORT-the supports in place for the operations of the unit or department. 4. HISTORICAL INFORMATION-this can help go identify operational issues that would not be apparent otherwise. SELECTION OF PERSONEL 1. Recruiting it is describe as the process of selecting personnel for employment, advertising, and employee recommendation

2. screeening- screen applicant who do not fit the image of the agency, try to fit the jog to a promising applicant, try to fit the applicant to the job 3. interview- to obtain further information the applicant qualifies for the position *some interview observes that the applicant a. does the applicant show genuine interesting the job, willingness to work in assumes responsibility b. is he/she has mannered?

4. Orientation- a process of becoming familiar with a new environment &adapting well to it, a part of staff development & one of your function

5. Staff development- as a nurse manager, support the program of the institution, review the

goal &provide a budget for the activity. Nurses should engage in professional education such as attending seminar ,conference in-service training program, engage in other activities that well enhance her/his competencies as a nurse &development his/her aesthetic sense &personality. PATIENT CLASSIFICATION SYSTEM To assess how many staff are needed at any given time, it is necessary to determine what the patient needs are. A measurement tool used to articulate the nursing workload for a specific patient or group of patients over a specific period of time. Classification data can be based on the patients acuity. As a patient becomes sicker, the acuity level arises, meaning the patient requires more nursing care. As a patient acuity level decreases, the patient requires less nursing care. FACTOR SYSTEM-uses units of measure that equate to nursing time. These system attempts to capture the cognitive function of assessment, planning, intervention and evaluation of patient outcome along with a written documentation process. This is the most popular of classification system of its ability to project care needs to individual patients as well as patient group. ADVANTAGES: Data are generally readily available to managers and staff for day-today operations. DISADVANTAGES: the ongoing workload for the nurse in classifying patients every day. There are also documented problems with classification creep, whereby acuity levels rise as a result of misuse classification criteria. This system does not holistically capture the patients needs for psychosocial, environmental, and health management support. PROTOTYPE SYSTEM Allocates system nursing time to large patient groups based on an average of similar patients. This model assumes that, on average, this will reflect the nursing care required and provided. The data are the news of the hospitals in determining the cost of nursing care and negotiating contracts with payers for specific patient population. ADVANTAGES: There is reduction of work for the nurse because she is not required to classify patients daily. DISADVANTAGES: There is no ongoing measure of actual nursing work required by individual patients. There are also no ongoing data to monitor the accuracy of the preassigned nursing care requirements. SCHEDULING Is the staff responsibility of the nurse manager.

She must ensure that the schedule places the appropriate staff on each day and shift for safe, effective patient care. OBJECTIVES OF SCHEDULING To assign working days and days off to individual members of the nursing staff in order to : 1. Provide adequate patient care while avoiding over staffing. 2. Treat individual members of the nursing staff fairly. 3. Achieve a desirable distribution of off days. TYPES OF SCHEDULING 1. Centralized scheduling 2. Decentralized Scheduling 3. Self-Scheduling MODALITIES OF CARE To ensure that nursing care is provided to patients, the work must be organized. A care delivery model organizes the work of caring for patients. A. CASE METHOD Oldest method of providing care to a patient. The premise is that one nurse provides total care for one patient during the entire work period. Used in Florence nightingales era when patient received total care at home. Care includes meeting the needs of the whole family like cooking TOTAL PATIENT CARE- modern day version of the case method. Nurse is responsible for the total care of her patient assignment for the shift she is working.

ADVANTAGES - Consistency of individuals in giving patient care for the entire shift. - enables the patient, nurse and family to develop a trusting relationship. -nurse has more opportunity to observe and monitor progress of the patient. DISADVANTAGES -the nurse may not have the same patients from day to day and therefore look at the patient on a shift by shift basis rather than on a continuum of care. utilize a high level of nursing hours to deliver care expensive

B. PRIMARY NURSING A care delivery model that clearly delineates the responsibility and accountability of the RN and designates the RN as the primary provider of care to patients. Primary nursing is a form of the case model that consist of four element; 1. Allocation and acceptance of individual responsibility for the decision making to one individual 2. Assignments of daily care by the case method 3. Direct person to person communications 4. And one person operationally responsible for the quality of care administered to patients on a unit 24 hours a day, 7 days a week. ADVANTAGES Patient and families are able to develop a trusting relationship with the nurse. There is a holistic approach to care which facilitates continuity of care rather than a shift to shift focus. DISADVANTAGES -High cost because there is a higher RN skill mix. The person making out the assignment s needs to b knowledgeable about the all about the patients and staffs to ensure appropriate matching of nurse to patient. -with no geographical boundaries within the unit, nursing staff may be required to travel long distances at the unit level to care for the primary patient. - Nurse-patient ratios must be realistic to ensure there is enough nursing time available to meet the patient care needs. C. TEAM NURSING Was developed after the World War II in an effort to utilize trained workers and to ease the shortage of nurses that most hospitals were experiencing. a care delivery model that assigns staff to teams that then are responsible for a group of patients. A unit maybe divided into two teams each team is lead by a registered nurse. The team leader supervises and coordinates all the care provided by those on his team. ADVANTAGES AND DISADVANTAGES RN is able to get work done through others but patients often received fragmented depersonalized care. Communication in this model is complex. There is shared responsibility and accountability which can cause confusion and lack of accountability. -

D. MODULAR NURSING A delivery system is a kind of team nursing that divided as geographic space into modules of patient, with each module cared for by a team of staff led by an RN. RN is responsible for the overall care of the patient in her module. E. FUNCTIONAL NURSING Popular during world war II when there was significant shortage of nurses in the United States. Divides the nursing work into functional units that are then assigned to one of the team members. Ach care provider has specific duties or tasks they are responsible for. Decision making is usually at the level of the head nurse or the charge nurse. ADVANTAGE -care can be delivered to a large number of patients. Utilizes other types of health care workers when there is shortage of RNs. DISADVANTAGE Patients are likely to have care delivered to them in one shift by several staff members. To a patient care, care may feel disjointed. And patient become the sum of the tasks of care they require rather than an integrated whole.

Pines City Colleges Magsaysay Avenue, Baguio City COLLEGE OF NURSING

ORGANIZING
Submitted to: Mrs Buna Racal

Submitted by: Group 4

BSN 4-2