WINTERTemplate

ORGANIZING

^nursing management functions^

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02• Process of determining the activities to be to be performed, arranging these activities to administrative units, as well as assigning managerial authority and responsibilities to people employed in the organization.

• affects organization and delivery of health service

• backbone of management

Definition

03Importance of Organizing

• Focus on, and facilitate the attaining of, attaining of objectives

• Arrangement of positions and jobs within the hierarchy.

• Define responsibilities and line of authority line of authority of all levels.

• Creating relationships that will minimize friction.

04Steps in Organizing

• t

05Elements of Organizing

• Centralization and decentralization

• Delegation of authority

• Span of control (supervision)

• Division of service

• Departmentation

061. CENTRALIZATION AND DECENTRALIZATION

I.e., the level at which most of the decisions are made within the organization.

07Centralization

08Decentralization

Advantages• Raise morale and promote

interpersonal relationships.• Relieve from the daily administration.• Bring decision-making close to action. • Develop Second-line managers• Promote employee’s enthusiasm and

coordination• Facilitate actions by lower-level

managers. • Improves coordination, especially for

services.

Disadvantages• Top-level administration may feel it

would decrease their status.• Managers may not permit full and

maximum utilization of highly qualified personnel.

• Increased costs. It requires more managers and large staff.

• It may lead to overlapping and duplication of effort.

• It may lead to lack of uniformity and lowering of standards in decision-making.

• Emergency decision may not be possible.

092. DELEGATION OF AUTHORITY

Delegation• Process of assigning work from a top organizational level to a

lower one or from one superior to subordinate, and giving that person the authority to accomplish them.

• A downward flow of authority from HIGHER level in the organization to LOWER level.

10The delegation process

• Allocation of duties.• Delegation of authority.• Assignment of responsibility.• Creation of Creation of accountability.

Accountability: subordinates must be held answerable to their carried out duties

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12Barriers to successful delegation

• Lack of superior’s ability to direct the subordinates.

• Lack of confidence in subordinate.

• Absence of control.

13Major causes of managers’ refusal to delegate

• Tendency to do things do things personally.

• Desire to dominate the knowledge, information, information, and/or skills.

• Unwillingness to accept risks of wrongs.

14Reasons for subordinates’ avoidance of accepting delegation

• Decision-making is a hard mental work, and people seek ways of avoiding it.

• Fear of criticism for mistakes.

• Lack of necessary information and resources to do a good job.

• Overload of work.

• Positive incentives may be inadequate.

15Authority

The right to take final decisions, to act or to command action of others.

It moves in a It moves in a downward direction.

16Types of authority

• Ultimate authority

• Legal authority

• Technical authority

• Operational authority

17Responsibility

• The obligation involved when one accepts an assignment.

• It cannot be delegated, it may be continued or it may be or it may be terminated with the accomplishment of a single action.

18Types of organizational relationships

• The line relation - presents levels of hierarchy, superior -subordinate relationships, and provides the framework for the organization. it is showed by a solid line in the organizational chart line

• Staff relation - has no command, personnel have only the right to advise, assist, support those in line authority in the performance of their duties, showed by a dotted line in the organizational chart.

19Line & Staff Relationships

203. SPAN OF CONTROL

• Number of subordinates that can be adequately supervised by one supervisor.

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20Dimensions of span of control

Narrow span of control

The manager supervises a small number of workers

21Narrow span of control

Advantages:• Close supervision.• Close control.• Fast communication between subordinates and superiors.

Disadvantages:• Superiors tend to get too involved in subordinates’ work.• Many levels of management.• High costs due to many levels.

22Wide span of control

Wide span of control

The manager supervises a large number of workers

23Wide span of control

Advantages:• Superiors are forced to delegate.• Clear policies must be made. • Subordinates must be carefully selected.

Disadvantages:• Tendency of overload superiors to take most or all decisions.• Danger of superior’s loss of control.• Requires exceptional quality of managers.

24Tall versus Flat Organizations

25Factors determining the span of control

• The competence of both the supervisor and the subordinate.

• The degree of interaction between the units between the units or personnel being supervised.

• Other duties of the top manager. Lower–level managers have a wider range of span than top top-level manager.

• The similarity or dissimilarity of activities being supervised.

26Factors determining the span of control

• The incidence of new problems in the unit.

• Availability of plans of work, policies and standardized procedures.

• The degree of physical distribution.

• The nature of work (stability, complexity, etc).

274. DIVISION OF SERVICE

Dividing large activities to be distributed among several people.

Advantage:• Allow an employee to master a task with a maximum skill, a

minimum time and effort.

Disadvantages:• Creates many different, narrow jobs, which effective

managerial coordination.• Human problems have been created from division of service,

fatigue and stress, and which lead to less quantity and quality of work, increased absenteeism and higher turnover.

285. DEPARTMENTATION

Types of Departmentation:• by services• by time• by degree of acuteness of illness• by function• by location• by patient

29Development of Job Description

• Job Descriptions are specifications of duties, conditions and reqts of a particular job prepared through a careful job analysis; also called performance descriptions

PURPOSES:• Recruitment• Placement and transfer• Guidance and direction• Evaluation of performance• Reduction of conflict & frustration• Avoidance of overlapping of duties• Facilitating working relationships w outside bodies such as

professional associations• Serving as basis for the employee’s salaray range

30Job Descriptions include:

• Job title – position and necessary qualifications• Job relationships – such as degree of supervision• Performance description – a catalogue of the resposibilities of

worker

311. CENTRALIZATION AND DECENTRALIZATION

NURSING CARE DELIVERY MODELS

Detail assignments, responsibility, and authority to accomplish patient care

Determine who is going to perform what tasks, who is responsible, and who makes decisions

Match number and type of caregivers to patient care needs

CLASSIC NURSING CARE MODELS

Total patient care Functional nursing Team nursing Primary nursing Variations have been adopted to improve care

TOTAL PATIENT CARE

Nurse is responsible for planning, organizing, and performing all care

Oldest method of organizing patient care Typically performed by nursing students Common use areas—intensive care unit (ICU)

and postanesthetic care unit (PACU)

TOTAL PATIENT CARE—CONT’D

Advantages High degree of autonomy Lines of responsibility and accountability are clear Patient receives holistic, unfragmented care

Disadvantages Each RN may have a different approach to care Not cost-effective Lack of RN availability

Patient CareThe registered nurse plans, organizes, and performs all care

Registered Nurse

8-hour shift

Registered Nurse

8-hour shift

Registered Nurse

8-hour shift

Total Patient Care (Case Method) Delivery

FUNCTIONAL NURSING

Staff members assigned to complete specific tasks for a group of patients

Evolved during World War II as a result of a nursing shortage

Unskilled workers trained to perform routine, simple tasks

Common use area—operating room

FUNCTIONAL NURSING—CONT’D

Advantages Care is provided economically and efficiently Minimum number of RNs required Tasks are completed quickly

Disadvantages Care may be fragmented Patient may be confused with many care

providers Caregivers feel unchallenged

Nurse Manager

LPN/LVNPO Meds

Treatments

RNAssessmentsCare Plans

Nurse AideVital signsHygiene

Nurse AideHygieneStocking

Assigned Patient Group

Functional Nursing Care Delivery Model

TEAM NURSING

RN as team leader coordinates care for a group of patients

Evolved in the 1950s to improve patient satisfaction

Goal was to reduce fragmented care Common use areas—most inpatient and

outpatient areas

TEAM NURSING—CONT’D

Advantages High-quality, comprehensive care with a high

proportion of ancillary staff Team members participate in decision making and

contribute their own expertise Disadvantages

Continuity suffers if daily team assignments vary Team leader must have good leadership skills Insufficient time for planning and communication

Nurse Manager

RN Team LeaderRN

LPNs/LVNsNursing Assistants

RN Team LeaderRN

LPNs/LVNsNursing Assistants

Assigned Patient Group Assigned Patient Group

Team Nursing Model

PRIMARY NURSING

RN “primary nurse” assumes 24-hour responsibility for planning, directing, and evaluating care

Evolved in the 1970s to improve RN autonomy

Common use areas—hospice, home health, and long-term care settings

PRIMARY NURSING—CONT’D

Advantages High-quality, holistic patient care Establish rapport with patient RN feels challenged and rewarded

Disadvantages Primary nurse must be able to practice with a high

degree of responsibility and autonomy RN must accept 24-hour responsibility More RNs needed; not cost-effective

Primary Nurse 24-hour responsibility for

planning, directing & evaluating patient care

Patient

Associate Nurses

Provide care when primary

nurse is off duty

Physician and other members

of the health care team

Primary Nursing Model

PARTNERSHIP MODEL (CO-PRIMARY NURSING)

RN is partnered with an licensed practical nurse/licensed vocational nurse (LPN/LVN) or nursing assistant to work together consistently

Modification of primary nursing to make more efficient use of the RN

PARTNERSHIP MODEL (CO-PRIMARY NURSING)—CONT’D

Advantages More cost-effective than primary nursing RN can encourage training and growth of partner

Disadvantages RN may have difficulty delegating to partner Consistent partnerships difficult to maintain due to

varied schedules