A head nurse in OB ward wants to make a new policy regarding the universal protocol in admitting a patient in all wards/department. She decided to schedule a meeting with all of the head nurses in all department. In so doing, what kind of communication will she used?
“ He who knows not and knows not he knows not: he is a fool - shun him.
He who knows not and knows he knows not: he is humble - teach him.
He who knows and knows not he knows: he is asleep - wake him.
He who knows and knows he knows: he is wise - follow him.”
Is a consequence of different perceptions in values, ideas, attitudes, beliefs, feelings and actions.
2 main types of conflict:
Competitive conflict – victory of one side and loss for the other side (Healthy competition)
Disruptive conflict - filled with fear, anger, stress (Unhealthy competition) it’s a different side of the story
Avoidance – reduce tension
Compromise/ Bargaining - both seek acceptable solution
Smoothing- appeal using conscience, self sacrifice
Withdrawing – one party is removed
Forcing/ restriction – use of coercion or force to end conflict
Negotiation – give and take
Confrontation – brought out in open and attempts to block conflict from the start
SUMMARY of CONFLICT RESOLUTION
Competing, forcing or dominating – win-lose
Avoiding, withdrawing – lose-lose
Accommodating, smoothing or obliging – lose-win
Compromise or sharing – no-win/no-lose
Collaboration or problem solving - win-win
Majority rule or competition
Win – win ________________
Lose –Win ________________
Win –Lose ________________
Lose – Lose _______________
In this conflict resolution method, a person ignores his or her own feelings about an issue in order to agree with the other side.
With this method of conflict resolution, each side gives up something as well as gets something.
DECISION MAKING PROCESS
Is the process in making a responsible course of action.
is a critical thinking process, just like in problem solving.
STEPS in decision making:
1. Identify the need for decision
2. Determine the desired goal
3. Identify the PROS and CONS
5. Evaluation of action
2 approaches in decision making
most optimistic select alternatives for all possible outcome
recruit and retain the best possible staff even though the procedure may change in the future.
most pessimistic choose the worst possible outcome
decide that complex procedure will become obsolete and stop providing any staff support or training for the procedure.
- people will respond to the fact that they are being studied
9. Human Relations Theory
- Change Process:
-Force Field Analysis
(method for listing, discussing, and evaluating the various forces for and against a proposed change)
KURT LEWIN’s THEORY
Unfreezing -breaking down of old habits, behaviors, attitudes
Changing - compliance, identification with role model, internalization
Refreezing - integrationof desirable behavior to one’s personal system
Force Field Analysis is a planning tool for predetermining and forecasting activities in an organization from an action point of view
9. Maslow’s Hierarchy of needs
10. Herzberg HYGIENE and MOTIVATIONAL factors
Abraham Maslow’s Hierarchy of Needs Canteen, Toilet and Rest day allocation Fire Exit, Tenure, Building Structure Social amelioration, Xmas Party Promotion and advancement Chance to be the Chief Nurse
Chance to be a chief nurse _________
Senior citizens ________________
Social amelioration ________________
Fire exit ________________
Critical pathway: Common Board Question
In terms of progressing up in this hierarchy, is there any possibility or circumstances that dictates to move down the hierarchy?
Critical pathway: Common Board Question
A recent “Philstar” news report gives an example of “SURVIVORS” of corporate downsizing. These people’s esteem, belonging and even security needs can quickly become unsatisfied even though they retain their jobs.
You can have very meaningful work but still, as you see your co-workers fired, worry “am I next to go?” that’s a question about your basic security needs.
Herzberg Motivational Theory + =
HYGIENE OR MOTIVATIONAL FACTOR
Good relationship to employee
Good work conditions __________
Consists of a set of procedures by which employee representatives and employer representatives negotiate to obtain a signed agreement (contract) that spells out;
Conditions of employment
that are acceptable to both parties; It’s a negotiation between parties
An arbitrator is technically defined as a person chosen by agreement of both parties to decide a dispute between them. Perhaps the most commonly used method of seeking agreement between parties whennegotiating has not been successful is through mediation and arbitration.
10. Pinoy Management Theory
- Tomas Andres
Styles of Pinoy Mgt:
1. Mgt by Kayod (Realism Mgt)
- workers with commitment and desires to complete task
2. Mgt by Libro (Idealism Mgt)
- “gut-feeling” or flushes of intuitions
-meticulous thinker and decision maker
-good planner, organizer, scheduler
3. Mgt by Suyod (Contingency Mgt)
- combination of Libro and Kayod
4. Mgt by Lusot (Opportunism Mgt)
- workers are carefree, time conscious, and loves to be bribed
Attributes of an effective manager:
1. V ision to plan for the future of the organization
2. I ncreased trust
3. S ound communication
4. I ncreased decision making ability
5. O rganizational skills
6. N eutral (ability to balance)
Nursing management process:
1. P lanning
2. O rganizing
3. S taffing
4. D irecting
5. C ontrolling
- forecasting of events (future)
- decisions are made
- goals and objectives (SMART) are set and prioritized
- policies and standards are developed
“ FAILURE TO PLAN IS ACTUALLY PLANNING TO FAIL”
How The most critical management activity, involves carefully evaluating the situation, setting goals, establishing priorities, and identifying necessary resources. PLAN What When Where Who Why Can
Different types of planning:
1.long range or strategic planning
-extends from 3-5 years into the future
2. short range or operational planning
-deals with day to day maintenance activities.
Purposes of Planning:
D -irects the organization
I -mproves efficiency
R -esources are maximized
E -stablish reference for managerial decisions
C -ost effective measures are identified
T -otal enhancement of communication and coordination
-planning and controlling resources that affect the organization
-involves examining resources, anticipating costs and predicting gains and shortfalls.
Types of Budget
1. Capital Expenditure Budget
--intended for purchase of major equipments and properties
2. Zero-based Budget
-budget with justification of allocated expenses in comparison with old one to determine profit or loss
3. INCREMENTAL BUDGET
uses past budget as starting point
BUDGETS MAY BE INCREMENTAL OR ZERO BASED
Zero-based budgeting may produce a more precise estimate of costs
takes much longer and frequently much longer and frequently
A reduction in budget may result.
Incremental budgeting uses the prior year’s budget as starting point and adds more costs based on projections .
Simple and Easy to Accomplish
Generally more accepted by staff.
Incremental P 1 Million + Budget 2007 Proposed Budget 2008 Additional Projected Expeditures For the Year Budget 2008
Zero Based P 1 Million + Php O.OO Budget 2007 Proposed Budget 2008 Estimated Expenditures For the Year Budget 2008 Back to Zero
Types of Budget
3. Personnel/ Manpower Budget
-budget intended for the employees salaries and fringe benefits
4. Operational Budget
-budget intended for the purchase of everyday supplies
Types of Budget
5. Fixed-ceiling Budget
-financial plan with the uppermost spending limit determined by the organization
6. Open-ended Budget
-budget with no specific amount
Types of Budget
7. Sunset Budget
-self-destructing budget that terminates at a specific period of time
8. Contingency Budget
-emergency budget, if not used can be part of savings
Five step process:
D efinition of problem – what and why
A nalysis - objective
D evelop alternative solution
S election of solution - weighing
I mplementation and follow up
-structuring the agency to accomplish the tasks necessary to meet the agency goals.
-is a statement of belief that influences nursing practice
-describes and reflects an organizations core value and what the organization wants to achieve
-provides an image of the desired future.
GOAL- specific statements of what the organization wants to achieve but broader than objectives
OBJECTIVE- aim derived from goals
* Must be compatible with philosophy and goals of the organization.
TYPES OF ORGANIZATIONAL STRUCTURE
– line structure or staff organization
- general authority over the lower positions in the heirarchy.
- Advantage: authority and responsibility are clearly defined
FORMS OF ORGANIZATIONAL STRUCTURE Centralized Vs. Decentralized
Unity of Command
Responsible for 1 superior
Scalar Principle or Chain of Command
Responsibility should flow from top to bottom
Span of Control
which refers to the number of employees supervised by a manager.
-refers to the required number and mix of nursing personnel in a nursing unit
Main purpose of Staffing:
-to provide safe, quality care.
ACCEPTING A PERSONNEL
Recruitment- use of ads, job fairs, literatures
Screening- reviewing of credentials
Interviewing- method of selecting employees
Selection- selecting the personnel based on his/ her qualifications
Placement- confirmation of applicant’s acceptance in writing
Indoctrination- induction, orientation, socialization of employees
Determinants of Staffing:
1. Number of personnel
2. Mix of personnel
3. Number of patients
4. Type of patient care delivery system
5. Classification of patients
Table 1. Categories or levels of care of patients, nursing care hours needed per patient per day and ratio of professionals to non-professionals. Levels of Care Nursing care hours per patient per day Ratio of Prof. to Non-prof Level Self Care or Minimal Care 1.50 5:45 Level II Moderate or Intermediate Care 3.0 60:40 Level III Total or Intensive Care 4.5 65:35 Level IV Highly Specialized or Critical Care 6 or 7.0 70:30 or 80:20
Table 2. Percentage of patients at various levels of care per type of Hospital PERCENTAGE OF PATIENTS IN VARIOUS LEVELS OF CARE Type of Hospital Minimal Care Moderate Care Intensive Care Highly Specialized Care Primary Hospital 70% 25% 5% 0 Secondary Hospital 65% 30% 5% 0 Tertiary Hospital 30% 45% 15% 10% Special Tertiary Hospital 10% 25% 45% 20%
Table 3 Total number of working and non-working days and hours of nursing personnel per year. Rights and Privileges given each personnel per year 40 hours/week 48 hours/week 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 as per R.A. 5901 104 52 7. Continuing Professional Education 3 3 TOTAL NON-WORKING DAYS PER YEAR 152 100 TOTAL WORKING DAYS PER YEAR 213 265 TOTAL WORKING HOURS PER YEAR 1,704 2,120
S - strengths
W - weakness
O - opportunities
T - threats
Types of Staffing:
1. Centralized staffing - chief nurse
-assignment of personnel is made by the nurse manager at the organizational level.
2. Decentralized staffing - head nurse
-allocation of nursing personnel at the unit level.
3. Cyclical Staffing – covers a designated number of weeks called the cycle length and is repeated thereon.
8 hours/day; 5 days/week (40 hours/week)
10 hours/day; 4 days/week (40 hours/week)
Composed of 2 shifts
Mon-Fri: traditional, weekends: 12-hour shift
Methods of Patient Care Delivery
1. Case Method/Total Patient Care
-a nurse is responsible for all the care required for a particular patient
-usually used in critical care units
2. Functional Nursing
- a nurse performs specific tasks and procedures according to schedule
3. Team Nursing
- based on group approach
- staff members work as a team
- use of non- nursing members of health care team
- utilize smaller teams for patients grouped geographically
5. Primary Nursing
- involves comprehensive care of patients
- the primary nurse has a 24-hour responsibility for the assigned patients.
-Total patient care to 4-6 patients
PATIENT CARE CLASSIFICATION
Level 1. Self care or minimal care
Ex: for discharge
no unusual symptoms
Level 2. Moderate care
Needs assistance in ambulating, dressing, hygiene or feeding
Level 3. Total/ Maximum care
Complex treatment and medications
Needs closer supervision
Level 4. Intensive care
Highly dependent to the nurse
Requires intensive nursing care
needs continuous treatment and observation for unstable condition
- Is the issuance of assignment, orders and instructions that permit the worker to understand what is expected of him or her
- guidance and overseeing (supervision) of the worker so that he or she can contribute effectively and efficiently to the attainment of organizational goals.
Getting work done by directing the performance of other people to achieve the goals of the organization
Frequent mistakes in Delegating:
Rights in delegation:
-refers to overseeing, guiding, and facilitating the activities of others.
Different Purposes of Supervision
1. I nspect, evaluate and improve worker’s performance
2. P rovide suitable working conditions for the staff
3. O rient, train, and guide the individual staff member
-process of checking to make sure that things are done as intended.
-a process by which managers attempt to see that actual activities conform to planned activities.
Checklist – collection of all nursing performances expected of a worker
Forced Choice Comparison– the evaluator is asked to choose the statement that best describes the evaluated nurse.
Essay – The appraiser writes a paragraph or more about the strengths, weakness and potential
Rating Scale – A rating scale includes a series of items representing the different task.
Anecdotal Recording- describes the nurse’s experience with a group or a person.
Patient Care Audits – a review of the patient charts while the patients are still confined in the hospital, observation of the staff as patient care is given and inspection of patients and/or observation of the effects of patient care
Peer Review – Audits may be done by peers
Utilization of Results – Nursing staff in the unit is given a feedback on the results of the quality assurance study
Quality Circles – nurses who have homogenous work meet regularly to solve work-related problems
Predetermined level of excellence
Evaluates performance based on set standards
The nurse manager can select the best example of a nurse’s performance and apply that example as a standard to improve performance and this is known as “benchmarking”.