Leadership • Exercise self direction and self-control.

Foster independence.
• Someone who can influence others and who has 3. Laissez-faire
managerial authority.
• Aka permissive/ free reign/ ultraliberal
• Influencing a group toward the achievement of
• Exercises minimum control
goals.
• “let alone” – “abdicates”
• Increases productivity.
• Effective in highly motivated individual
Management
Henry Fayol
• Cooperative group directs action towards a
common goal. • Developed 14 Management Principles
• Coordinating work activities so that they are • Focuses on basic functions and tasks of
completed efficiently and effectively with and management (PODC)
through other people. • Father of Management Process Sch.
• Represent the ongoing primary activities engage Max Weber
in by managers.
• Father of Organizational Theory
Efficiency • Bureaucratic Organization Theory (Line
• Doing things right. Getting the most output from Authority)
the least amount of inputs. • A hierarchical structure adhering to strict rules.
• He saw the need for legalized, formal authority,
Effectiveness and consistent rules and regulations for
personnel in different positions.
• Doing the right things. Completing activities so
that organizational goals are attained. Henry Mintzberg
Common Leadership Goals • 3 Roles of Manager
1. Interpersonal – roles that involve people
1. Leader
and other duties that are ceremonial and
2. Followers
symbolic in nature.
3. Communicator
▪ Figurehead
4. Decision Maker
▪ Leader
Six (6) Traits ▪ Liaison
2. Informational – roles that involves
• They think longer term receiving, collecting, and disseminating
• They look outward, toward the larger org. information.
• They influence others beyond their own group ▪ Monitor
• They emphasis vision, values, and motivation ▪ Disseminator
• They are politically astute ▪ Spokesperson
• They think in terms of change and renewal 3. Decisional – roles that revolves around
making choices.
Different Leadership Styles
▪ Entrepreneur
1. Autocratic/ Directive ▪ Disturbance Handler
• aka Directive/ Bureaucratic, Centric, ▪ Resource Allocator
Theory X ▪ Negotiator
2. Democratic
Henry Gantt
• Aka Theory Y
• Radic leader • “Practice makes Perfect”
• Focuses on human aspects and builds • Concern with the problem of efficiency
effective teams
Chris Argyris

REINALYN RAMIRO//NLM 1
 • Managers should help the workers achieve self
actualization as people mature, they progress
from a passive to an active state and from
dependence to independence.
Clayton Aldelfer
• ERG Theory
o Existence Needs
o Relatedness Needs
o Growth Needs
• He organized Maslow’s needs hierarchy into 3
levels and agreed that unsatisfied needs
motivate individuals.
Mary Follett
• Importance of Coordination
Kurt Lewin
• Revive the study of group dynamics
• Change Process
o Unfreezing – Movement - Refreezing
• Jewish psychologist
Alvin Toffler
• Future Shock
o The physical and psychological distress
that arises from over-loading the
individual’s physical adaptive system
and decision-making process.
o To minimize the FS is to develop the
mechanism and techniques to guide the
direction of change and to the pressure
of change.
Aristotle
• Trait Theory (Great Man Theory)
o They are born with the capacity to
persuade, influence, and motivate
others.
o Leaders are well rounded and
simultaneously display both
instrumental and supportive leadership
behavior.
Charlotte McDaniel
• Transformational Leaders
o Leaders who provide individual
considerations, intellectual stimulation,
and possess charisma.
Bass
• Transformational Leaders
o Focus leadership
o Followers exhibit similar leadership
qualities, though of lesser degree
(Cascading effect)
o The leader is a role model uses
individualized consideration, has sense
of direction and encourages self-
management.
o The leader promotes employee
development, inspires, influence,
provides intellectual stimulation and
encourages followers to be creative.
Greenleaf
• Servant & Leadership
o Servant leaders put serving others;
including employees, customers and the
community as a number one priority
• Leader and Power
o 5 Sources of leader power:
1. Legitimate Power – the power a
leader has a result of his position
in the organization.
2. Coercive Power – the power a
leader has because of his ability
to punish or control.
3. Expert Power – expert power is
that kind of power which an
employee has due to the
knowledge and expertise that
he/ she possesses.
4. Referent Power – is power that
is a resultant of the personality
of a person.
5. Reward Power – reward power
arises out of the authority that a
person has to recognize and
reward people.
William Ouchi
• Participative
Rensis Likert
• System Approach
David McClelland
• 3 Basic Needs:
REINALYN RAMIRO//NLM 2
 o Achievement – desire to contribute, to
excel and to succeed.
o Power - high need for power want to be
in control/ have influence over others.
o Affiliation – people with high affiliation
needs desire in working in human
environment and seek out meaningful
friendship.
BF Skinner
• Operant Theory
Victor Vroom
• Expectancy Theory
o States that motivation depends on how
much people want something and their
estimates in the probability of getting it.
Douglas McGregor
• Theory “X” and Theory “Y”
o The Theory X managers assumes that
people dislike work and will avoid it;
hence, workers must be directed,
controlled, coerced, and threatened so
that organizational goals can be met.
o Theory Y the emphasis is on the goal of
the individual. Theory Y managers
assumes that workers have the self-
direction and self-control necessary for
meeting their objectives.
Frederick Herzberg
• Two-Factor Theory (Motivators/Hygiene)
• Motivating factors: satisfiers
Saul Gellerman
• Theory of Stretching
• Gellerman suggested that individuals should be
periodically “stretched” to do tasks more
difficult than they are used to doing.
Abraham Maslow
• Hierarchy of Needs
George Kelly
• Trait Theory (Leaders are Born)
Fred Fiedler
• Contingency Theory
Hershey and Blanchard
• Situational Leadership Theory
Robert House
• Path-Goal Models
Schein
• Transactional-Rewards
• Identifies the needs of followers and provides
rewards to meet those needs in exchange for
expected performance.
Frederick Taylor
• Principle of Scientific Management
o Traditional “rule of thumb” means
organizing work.
o A scientific personnel system
o Workers should be able to view how
they “fit” into the organization, how
they can contribute to the overall
organizational productivity.
• Father of Scientific Management
Frank Gillbreth
• Principles of Economic Motion
Lillian Gillbreth
• First Lady of Management
Management Process
Planning
• Thinking ahead to achieve desired goals
(VMPGO)
• It involves the process of defining goals,
establishing strategies for achieving those goals
and developing plans to integrate and
coordinate activities.
• Internal/ external planning
• 7’s/ PESTELI
Organizing
• Establish formal authority and relationships.
• Process of determining what task are to be done;
who is to do them; how the task is to be grouped;
REINALYN RAMIRO//NLM 3
 who reports to whom; and where decisions are Why do Plans Fail?
to be made.
• False assumptions
Leading/ Directing • Not knowing overall goal
• Not enough alternatives
• It involves motivating subordinates to work
• Low motivation levels
towards achieving the company’s goal.
• Inadequate delegation of authority
• It’s functions usually entail human resource
management responsibilities. 6 Elements of Planning
Controlling/ Directing 1. Forecasting
a. It helps managers look into the future
Planning and decide in advance where the agency
• It is a process that involves: would like to be and what is to be done
o Defining organizations’ goals in order to be there.
o Establishes an overall strategy to achieve b. Factors to be consider:
those goals 1. Environment
o Develop a comprehensive set of plans to 2. Types of customers/ patients
integrate and coordinate organizational 3. Public attitude and behavior
goals. 4. Number and kind in personnel
• It’s concerned with both ends (what’s to be required
done) and means (how it’s to be done) 5. Resources
2. Objective Setting
Principles of Planning a. Foundations in Formulating Objective:
1. Vision
1. Always based and focused on the VMPG
▪ Describe the future
2. Continuous process
goals or aims of the
3. Utilizes all available resources
organization.
4. Precise in its scope and nature
▪ “What do we want to
5. Shall be time-bound
accomplish together?”
6. Must be documented for proper dissemination
▪ “What recognizable
to all concerned for implementation and
condition will be in
evaluation as to the extent of its achievement
place several years from
Purposes of Planning now?”
▪ Vision is what we want
1. It gives direction to become.
2. It reduces the impact of change ▪ Is an articulation of a
3. It minimized waste and redundancy destination toward
4. It sets the standards used in controlling which organization
Strategies for Successful Planning should aim.
2. Mission
1. Start planning at the top ▪ Statement of what the
2. Keep planning organized, clear, and definite organization wants to.
3. Remember, interpersonal relationships are ▪ “What is the reason for
important existence?”
4. Keep target dates are realistic ▪ Mission is our over-all
5. Have short-and-long-range plans and goals reason for being, what
6. Don’t bypass levels of people we are doing, and what
7. Be sure objectives are clear we are going to do in
8. Gather data pursue of our vision.

REINALYN RAMIRO//NLM 4
3. Philosophy and operating their
▪ Statement of belief and respective
values that guide all departments.
actions of the 3. Developing and Scheduling Programs
organization; how to (Programming)
achieve the mission, 4. Budget Preparation
goals, and objectives. a. Budget – it is the annual operating plan,
▪ Is the sense of purpose a financial “road map”
of an organization. It b. It includes:
gives direction toward 1. Personnel needed
the attainment of set 2. Supplies
goals and objectives. 3. Instruments
4. Goals 4. Medical equipment
▪ What organization 5. Training of personnel
would like to attain/ c. A Nursing Budget – is a plan for
accomplish. allocation of resources based on pre-
▪ Goals are targets of conceive needs like programs to deliver
performance or end patient care during one fiscal year.
results relating to long d. Budgeting – the work a manager
term endeavor. performs to achieve an objective within
5. Objectives a specific period of time.
▪ Things to be done to e. Purposes of Budget:
achieve goal. 1. It helps managers set realistic
▪ It is a result oriented objectives.
and must be SMART. 2. Ensures that resources are
▪ Advantages of Clearly obtained in order to meet
Stated Objectives: important objectives.
a. More effective 3. Establishes standards
planning. measurable goal to strive for it.
b. Better f. Types of Budget in Health Care
organizational Institution:
effect. 1. Revenue Budget
c. Basis for ▪ Summarizes the income
direction and which management
motivation. expects to generate
d. Better control. during the planning
6. Standards period.
▪ Is the yard stick against ▪ Income as estimated.
which the performance 2. Expense Budget
of the organization and ▪ Describe the expected
or the people in the activity in operation and
organization and or the financial terms for a
people in the given period of time.
organization will be ▪ Expenses as estimate.
measured. 3. Hospital Budget
7. Policies ▪ Outlines the
▪ Are guidelines for programmed
managerial decisions acquisitions, disposals
necessary to guide the and improvements in an
personnel in planning

REINALYN RAMIRO//NLM 5
 institution’s physical while undergoing the
capacity. procedure, proper care, used
▪ Capital intensive facility. supplies and equipment, and
4. Cash Budget good workmanship of the
▪ Represents the planned person doing it.
cash receipts and 6. Setting Educational Parameters
disbursements as well a. Appropriateness of the planned
as the cash balances program and activities.
expected during the b. The adequacy of the program of the
planning period. degree to which the program will be able
▪ Expected cash receipt to meet the identified problem.
and disbursement in day c. The effectiveness of the program or the
to day operation of the extent to obtain the pre-established
institute. objectives will be attained because of
5. Personal Budget the objectives implemented.
▪ Determine recruitment, d. The efficiency of the program which
hiring, and firing of includes the relationship of the cost of
personnel. resources, both human and material,
▪ Include staff and the attainment of the objectives.
development. e. Problems encountered are identified
6. Time Management and alternative measure to prevent.
▪ Is a technique for
allocating one’s time 4 Types of Planning
through the setting of
goals, assigning
priorities, identifying
and eliminating wasted
time and using
managerial techniques
to reach goals
efficiently.
5. Establishing Nursing Standards, Policies, and
Procedures
a. Nursing Standards – some institutions
develop their own standards of nursing
practice; however, they are in reference
to the Standards of Nursing Practice and
Nursing Service Administration
formulated by a joint committee of
ANSAP and the PNA.
b. Nursing Procedures – are specific
1. Breadth
directions for implementing written
policies. Strategic Planning
c. 2 Areas to be Considered:
1. Those that are related to job • Strategic plans give you “the big picture”
situations such as reporting • Usually participated by Top Management;
complaints or disciplinary Middle Management inputs are solicited; but the
instances. 1st level managers are more involve (unit heads)
2. Those involving patient care • Involve a long-range plan usually 3 to 7 years.
safety of the patient, his comfort

REINALYN RAMIRO//NLM 6
• Forecast the future success of an organization by
matching and aligning an organizations
capability with its internal and external
capabilities.
• Examines an organizations’ purpose, mission,
philosophy, and goals in the context of its
external environment.
• Effective Tools to Effective Strategic Planning:
1. SWOT Analysis – also known as TOWS
(Albert Humprey). Identify and defined
the desired end stage or objective.
▪ Internal Environment SW –
pertains to organizational
analysis. (7S: Style, Structure,
Strategy, System, Skills, Staff,
Shared belief)
• Strength – are internal
attributes that helps an
organization to achieve
its objectives.
• Weakness – are internal
attributes that
challenge an
organization in
achieving its objectives.
▪ External Environment OT –
pertains to environmental
analysis (PESTELI: Political
Factors, Economic Influence,
Social Trends, Technological
Innovations, Ecological Factors,
Legislative Regulations, Industry
Analysis). Factors outside the
organization.
• Opportunities – are
external conditions that
promote achievement
of organizational
objectives.
• Threats – are external
conditions that
challenges or threaten
the achievement of
organizational
objectives.
2. The Time Frame of Planning
a. Short Term
• Covers a period from one day or less to
six months, with the time increment
usually weekly.
• This is tied into the daily or weekly
scheduling process and involves
adjusting eliminate the variance
between planned output and actual
output.
b. Long Range/ Intermediate
• Monthly or quarterly plans for the next
6-18 months.
• Here the capacity may be varied by such
alternatives as hiring, lay off, new tools,
minor equipment purchase, and
subcontracting.
3. Specificity: Directional VS. Specific
a. Specific Plans
• Have clearly defined objectives and
leave no room for misinterpretation.
• There is no ambiguity, no problem with
understanding.
• “What, when, where, how much, and
by whom” (process-focus)
b. Directional Plans
• They are flexible plan that set out
general guidelines.
• They provide focus but do not lock
managers in specific objectives or count
of action.
• It is an outcome-focus.
4. According to Frequency of Use: Single Use VS.
Standing
a. Single Use
• A one-time plan that is specifically
designed to meet the needs of a unique
situation.
• Essentially one-time use plans having a
specific goal or objective.
b. Standing Plan
• Ongoing plans that provide guidance for
activities performed repeatedly.
• These plans must be updated regularly.
• They are ongoing operations.
REINALYN RAMIRO//NLM 7
Organizing
• It involves establishing a formal structure that
provides the best possible coordination/ use of
resources to accomplish unit objectives.
• We look at how the structure of an organization
facilities or impedes communication, flexibility,
productivity, and job satisfaction.
• Examines the role of authority and power in
organizations and how power may be used to
meet individual, unit and organizational goals.
• It involves setting up the organizational structure
by identifying: groups, roles and relationships;
determining the staff needed and distributing
them in the various areas as needed.
• It includes the development of job descriptions
by defining the qualifications and functions of
personnel.
Organization
• The structure or framework derived from
grouping people together so that they can work
effectively towards a goal.
• Consist of the structure and process which allow
the agency to enact its philosophy and utilize its
conceptual framework to achieve its goals.
Basic Step to Effective Organizing
1. Make a list of all the things that need to be done.
2. Identify the most important thing/ tasks to be
attended with a given time frame.
3. Review your calendar and the schedules according to
priorities
4. Make provisions possible activities/ schedules.
The Organizing Process
1. Review the output of the planning process: VMGPO,
Key Results Areas
2. Divide the task into activities that can be performed by
one person or group.
• Each person or group has a set of activities to
perform, called JOB.
• Label each job position to describe its main
function.
3. Formulate the job description and job specification:
• Job Objective -purpose of the job
• Job Summary – main functions
• Work Relationship – to whom the position is
reporting number of subordinates; positions
being supervises coordinating functions.
4. Create specialized departments, sections by groupings
related jobs together.
5. Establish the relationship between the various jobs of
groupings.
Principles of Organizing
1. Unity of Command
• An employee has one superior and one plan for
a group of activities with the same objective, to
avoid confusion, overlapping of duties and
understanding.
2. Scalar Principle or Hierarchy
• Principle of Chain of Command
• Authority and responsibility should flow in clear
unbroken lines from the highest executive to the
lowest.
• Authority flows from top to bottom. Usually a
military team.
3. Departmentalization/ Homogeneous Assignment
• Principles of Specialization
• Grouping of workers performing similar
assignment for a common purpose.
• Departmentalization: promotes the
specialization of activities.
4. Span of Control
• The number of workers that a supervisor can
effectively manage/ supervised upon the pace
and pattern of the working area.
5. Exception Principle
• Recurring decisions shall be handled in a routine
manner by lower-level manager.
• To enable subordinates to learn how to make
decisions at their own level and free the
executives from being bogged down by routine
details.
6. Decentralization
• Proper delegation of authority.
• Is conferring specified decision making to the
lower levels of the organization.
REINALYN RAMIRO//NLM 8
7. Centralization • Referent Power – ability to inspire such admiral
to others that they wish to identify themselves.
• All report to one.
• Expert Power – ability to convince others that
Elements of Organization possess a high degree of K&S in some are of
specialization
1. Setting the organizational structure
The Organizational Structure
2. Staffing
• Refers to the process, by which a group if
3. Scheduling formed, its channels of authority and decision
4. Developing job descriptions making, span of control and lines of
communication/
Concepts of Organization • The organizational structure should be updated,
reviewed, approved and documented by the
1. Status
proper authority.
• Rank given to a person.
Purpose of Organizational Structure
• The rank that a reference group confer based on
the assessment of individual worth and 1. It informs members of their responsibilities to be
significance of the group. carried out.
2. Accountability 2. It allows the manager and the individual worker to
concentrate on its specific role and responsibilities.
• Taking full responsibility for the quality of work
and behavior while engage in the practice of the 3. It coordinates all organizational activities so there is
profession. minimal duplication of effort or conflict.
3. Responsibility Setting Up the Organizational Structure:
• Is the obligation to perform the assigned task. 1. Identify the group and the work to be done (effectively
accomplished by people)
4. Authority
2. Provides the framework for the formal distribution,
• The persons right to make decisions and make delegation of authority and responsibility.
actions without approval from higher
administration plus the right to extract Types of Organizational Structure
obedience from others.
1. Formal (line) Organizational Structure
• Top level position carries high level of
responsibility and authority. • Also called bureaucratic organization design,
• 2 Types: hierarchic structure or line organization.
o Line Authority – is the authority that • It defines managerial authority, responsibility
entitled supervisor to direct an and accountability.
individual work. • Is the simplest and most direct type of
o Staff Authority – is the authority in organization in which each position has general
position created to support, assist, authority over the lower positions of the
recommend, and generally reduces the hierarchy.
supervisor’s information • It is a chain of command or manager-staff
responsibilities. associate or a leader-follower relationship.
5. Power **The command relationship is a direct line between the
manager and staff-associate and is depicted by a solid
• Ability to influence others to behave accord into
line on organizational chart.
one’s wishes.
• Reward Power – ability to provide reward.
• Coercive Power – apply punishment.
REINALYN RAMIRO//NLM 9
Line (Solid/ Vertical) – reporting relationship.
Solid Vertical – denote the official chain of command,
formal path of communication and authority.
Solid Horizontal – represents communication between
people with similar sphere of responsibility and power
but with different function.
2. Informal Organizational Structure
• It is a structure that fills in he gaps with
connections and relationships that illustrates
how employees’ network with one another to
get work done.
• Refers to horizontal relationship rather than
vertical.
• This is composed of small groups of workers with
similar interest.
3. Flat Organizational Designs/ Horizontal
• There continuous to be line authority/, but
because the organizational structure is flattened,
more authority and decision making can occur
where the work is being carried out.
• Decentralized organization.
4.
5. Functional Organization
• Dual reporting relationships
• Has command authority over line employee.
• There is clear delineation of roles and
responsibilities which are interrelated.
Tall Organizational Structures – usually tend to be more
expensive requiring more managers.
Flat Organizational Structure – leads to higher levels of
employee morale and productivity.
Organizational Chart
• Is a line drawing that shows how the parts of an
organization are linked.
• It depicts the formal organizational
relationships, areas of responsibility, persons to
whom one is accountable and channels of
communication.
Table of Organization
• Tall VS. Flat
• Communication VS. Authority
Five Major Characteristics of an Organizational Chart:
1. Division of Work
• Each box represents the individual or
sub-unit responsible for a given task of
the organization’s workload.
2. Chain of Command
• Lines indicate who reports to whom and
by what authority.
3. Type of Work to be Performed
• Indicated by labels or description for the
boxes.
4. Grouping of Work Segments
• Shown by the cluster of work groups
(department or single unit)
5. Levels of Management
• Indicates individual and entire
management hierarchy (ranking)
Decision Making within the Organizational Hierarchy
• The decision making is scalar chain of command.
• In centralized decision-making top of the
hierarchy makes the decision.
• In decentralized decision-making, there is
diffuse decision-making, thus allows problems to
be solved at the level at which the problem
occurred.
Organizational Structures of Devolved Hospitals
• Legal Basis
o Local Government Code of 1991. LGU’s
enjoys full autonomy in the exercise of
their economic enterprises, subject to
the limitations provided in the code and
other applicable laws.
o Section 18 DOH Rules and Regulations
Implementing the LGU Code of 1991 the
(DOH Rules) assigns the Local
Government Units the management and
operation, among others of provincial,
district, municipal and city hospitals.
o Funding of the hospitals shall come from
the share of the province or city.
o The LGU shall continue to govern,
manager and finance the devolve
hospital directly.
REINALYN RAMIRO//NLM 10
Basic Level of Management
1. Top Managers
• They are responsible for the overall
direction and operations of an
organization.
2. Middle Managers
• They receive broad, overall strategies
and policies from the top manager and
translate them into specific goals and
plans for the first line managers to
implement.
3. First Line Manager
Staffing
• It involves planning for hiring and deploying
qualified human resources to meet the needs of
a group of patients.
• It is a tool to determine the appropriate ratio of
healthcare personnel to perform their respective
task for the benefit of the client.
• The workforce must reflect appropriate balance
of high skilled, competent professional and
support workers.
• Managers should be alert to the gender, culture,
ethnicity, age, and language diversity in the
communities served by the organization and
should seek recruit a staff that is both sensitive
and responsive to that diversity.
Generational Considerations for Staffing
Staffing Functions of the Managers
• In staffing, the leader – manager:
1. Recruits
2. Selects
3. Places
4. Indoctrinates/ orients and
5. Promotes personnel development
6. Demotes
7. Fires
• Accomplish the goals of the organization.
• Purposes:
o To provide each nursing unit with an
appropriate and acceptable number of
workers in each category to perform the
nursing tasks required.
o To give quality and quantity of work
performed
o To correct high risk of absenteeism and
staff turn-over resulting to low morale
and dissatisfaction.
Factors Affecting Staffing
• The type, philosophy, and objective of the
hospital and nursing service.
• The population served whether pay or charity.
• The number of patients and the severity of their
illness.
• Availability and characteristic of nursing
personnel.
• Administrative policies.
• Standards of care.
• Lay-out the various nursing units and resources
available.
• Budget.
• Professional activities and priorities in non-
patient activities.
• Teaching program/ staff development in
teaching activities.
• Expected hours of work per annum of each
employee. This is influence by the 40-hour week
law.
• Pattern of work schedule:
o Traditional 5 days/week; 8 hours per
day.
o 4 days/week, 10 hours per day & 3 days
off.
o 3 ½ days/ 12 hours per day & 3 ½ days
off per week.
1. Silent Generation/ Veteran
• 1925 to 1942
• 5% workforce
• As silent generation, they tend to
support the status quos rather than to
protest or push for rapid change.
• More risk averse, highly respectful of
authority, supportive hierarchy and
disciplined.
• Work values are traditional, often
recognize for their loyalty to employers.
2. Baby Boomer/ Boom
• 40%
• 1943 to 1960
• “Workaholic”
• Still display traditional work values.
• Tend to be materialistic, thus willing to
work long ours of their job to go ahead
(promotions)
REINALYN RAMIRO//NLM 11
 •Caring for family members, volunteer
their time for a cause.
3. Generation X
• “Generation Xers”
• 1961 to 1980
• They lack the interest of lifetime
employment at one place.
• Value greater work for hour flexibility
and opportunities for time off.
• Less economically driven.
4. Generation Y
• “Millennial”
• “Digital Natives”
• 1981 to 2000
• Represents the first cohort of truly
global citizens.
• Known for their optimism, self-
confidence, relationship orientation,
volunteer mindedness and social
consciousness.
• Highly sophisticated in their use of
technology.
• Tend to change job more frequently.
Staff Strategies (Staffing Crisis)
A. Float Staffing
• Accept nurses on contractual basis who
could float to different units.
B. Flexible Staffing Time Schedule
• Staggered shifting to augment staffing at
peak hours.
• 7-3/ 8-4/ 9-6/ 10-7
• Pay for overtime.
C. Borderless Pattern
• Equalize manpower distribution by “pull
out” system.
• Hire nurses as staff nurses of the
institution, not by the unit where they
will be assigned.
D. Mandatory Overtime
• Employees forced to work additional
shifts, often under threat of patient
abandonment.
Key Terms
• Average Daily Census (ADC) – average number
of patients cared for per day for the reporting
period.
• Average Length of Stay (ALOS) – average
number of days that a patient remained in an
occupied bed.
• Block Schedule – using the same schedule
repeatedly.
• Centralized Schedule – scheduling done in one
location.
• Decentralized Schedule – scheduling done in a
local area.
• Full Time Equivalent – equal to the equivalent of
a full-time employee.
• Nursing Hours per Patient (NHPP) – total paid
hours for nursing personnel for specific time
period divided by the number patient’s day in
the same period.
• Patient Acuity – measure of nursing work load
that is generated for each patient.
• Permanent Shift – personnel works the same
hour permanent.
• Rotating Work Shift – alternating work hours
among days, event, and night shift.
• Self-scheduling – staff coordinating their own
work schedule.
• Staffing Pattern – plan that articulates how
many and what kind of staff are needed by shift
and day to shift a unit or department.
• Staffing Ratio – number of nursing staff per
patient.
• Staffing Schedule – work schedule for personnel.
• Variable Staffing – determining the number and
mix of staff base on patients’ needs.
• Variance Reports – noting differences in
budgeted or planned staffing and cost.
• Staffing Plan (Staffing Matrix) – has different
elements needed in the scheduling and staffing
system.
Factors in Determining Staffing Needs
1. Acuity of Patients Illness
• Level of care
• Communicability
• Degree of dependence
• Rehabilitation needs
2. Special Treatment and Procedures
3. Type of Hospital
4. Ratio of Professional to Non-Professional
Nursing Personnel
5. Turn-over of Patients and Nursing Personnel
6. Hospital Policy
REINALYN RAMIRO//NLM 12
 7. Budget ▪Provides that employees
8. Available equipment/ material/ supply (5M) working in hospital with 100
9. Population served. capacity and up will only work
for 40 hours a week.
Patient Care Classification System 2. Forty-eight Hours
• A method of grouping patients according to the ▪ For those working on agencies
amount and complexity of their nursing care located in communities with less
requirements, the nursing time and skill the than one million population and
require. in hospitals with less than 100
• The assessment can serve in determining the bed capacity.
amount of nursing care required, within 24 H, as 3. Memorandum Circular No. 6, series of
well as the category or nursing personnel to 1996
provide the care. ▪ Indicating other privileges
• Basis for planning staffing needs. granting a 3-day special privilege
to government employees by
Classification Categories the Civil Service Commission.
1. Self Care or Minimal Care (1.5) (55:45) Total Number of Working and Non-Working Days and
• Patient can do his activities of daily Hours of Nursing Personnel per Year
living.
• Patient about to be discharge, non- RIGHTS AND PRIVILEGES WORKING HOURS
emergency, newly admitted but not GIVEN EACH PERSONNEL PER WEEK
exhibit unusual symptom. PER YEAR 40 48
• Teaching routines for simple procedures HOURS HOURS
on discharge. 1. Vacation Leave 15 15
• Convalescing patients. 2. Sick Leave 15 15
2. Moderate Care to Intermediate Care (3) (60:45) 3.Legal Holidays 10 10
• Patients needs some assistance in 4. Special Holidays 2 2
bathing, feeding, or ambulating for a 5. Special Privileges 3 3
short period of time. 6. Off-Duties as per R.A. 104 52
• VS 3x/shift, 1 hr. continuous monitoring. 5901
3. Total, Complete, or Intensive Care (4.5-6) ------ ------
(65:45) Total Non-Working Days per 152 100
• Patient is completely dependent upon Year
the nursing personnel, patient may or Total Working Days per Year 213 265
may not be unconscious, they require Total Working Hours per 1704 2120
close observation every 30 minutes for Year
impending problem.
4. Highly Specialized Critical Care (6-9) (70:80)
Percentage of Nursing Care Hours
• Patient continuous treatment and
observation, with many medication, VS q Percentage of Patients in Various Levels of Care
15-30 minutes, hourly output with many Type of Minima Moderat Intensiv Highl
significant changes in doctors’ orders. Hospital l Care e Care e Care y Spl.
• One on one observation. Care
Considerations when Computing for the Number of Primary 70 25 5 -
Nursing Personnel Hospital
Secondar 65 30 5 -
• Consider the rights and privileges given to each y Hospital
personnel per year. Tertiary 30 45 15 10
1. Forty-Hour week law (RA 5901) Hospital

REINALYN RAMIRO//NLM 13
 Special 10 25 45 20 ▪ 25 pts. X 6 (NCH needed at level
Tertiary 4) = 150 NCH/day
Hospital ▪ Total: 768.75 NCH/day
o Find the total NCH needed by 250
patients per year.
Relievers Needed ▪ 768.75 x 365 (days/year) = 280,
Consider the ff: 593.75 NCH/year
1. Average number of leaves taken 15 o Find the actual working hours rendered
each year by each nursing personnel/year
a. Vacation Leave 10 ▪ 8 (hrs/day) x 213 (working
b. Sick Leave 5 days/year) = 1704 (working
hours/year)
2. Holidays 12
o Find the total number of nursing
3. Special Privileges as per CSC MC 3
personnel needed
#6s 1996
▪ Total NCH per year divided by
4. Continuing Education Program for 3
working hr./year = 280,
Professionals
593.75/1704 = 165
TOTAL AVERAGE LEAVES 33
▪ Relief x Total Nursing Personnel
= 165 x 0.15 =24.75 or 25.
To Determine the Relievers Needed: ▪ Total Nursing Personnel Needed
= 190.
• Divide 33 (the average number of days an o Categorize to professional and non-
employee is absent/ year or total average year) professional personnel. Ratio of
• 213 working days/ year that employee had serve professional to no-professional in a
(40H/week = 0.12) tertiary hospital is 65:35.
• Multiply by the computed Nursing Personnel ▪ 190 x .65 = 124 professional
nurses.
Staffing Formula
▪ 190 x .35 = 66 nursing
• Find the number of nursing personnel needed attendants.
for 250 patients in a tertiary hospital. o Distribute by shift.
o Categorize the patients according to ▪ 124 nurses x .45 = 56 RN on AM
levels of care needed. shift
▪ 250 pts. X .30 = 75 (patients ▪ 124 nurses x .37 = 46 RN on PM
needing minimal care. shift
▪ 250 pts. X .45 = 112. 5 (patients ▪ 124 nurses x .18 = 22 RN on N
needing moderate care. shift
▪ 250 pts. X .15 = 37.5 (patients ▪ Total: 124 Nurses
need intensive care) ▪ 66 Na x .45 = 30 NA on AM shift
▪ 250 pts. X .1 = 25 (patients need ▪ 66 NA x .37 = 24 NA on PM shift
highly specialized nursing care.) ▪ 66 NA x .18 = 12 NA on N shift
▪ Total: 250 ▪ Total: 66 Nursing Attendants
o Find the NCH needed by patients at each
Nursing Care Delivery System
level of care per day.
▪ 75 pts x 1.5 (NCH needed at level • Also called Nursing Care Modalities; Patterns of
1) = 112.5 NCH/day. Nursing Care; Methods of Assignment
▪ 112 pts. X 3 (NCH needed at • A system for delivery of care that delineates’ the
level 2) = 337.5 NCH/day nurse’s authority and accountability for clinical
▪ 37.5 pts. X 4.5 (NCH needed at decision making and outcomes.
level 3) = 168.75 NCH/day

REINALYN RAMIRO//NLM 14
• It is integrated with the professional practice
model and promotes continuous, consistent,
efficient, and accountability nursing care.
• Professional Practice Model
o A schematic description of a theory,
phenomenon, or system that depicts
how nurses’ practice, collaborate,
communicate, and develop
professionally to provide the highest
quality care for those serve by the
organization.
1. Functional Method (Task Oriented)
• 1950
• License and unlicensed staff member
perform specific task for a large group of
patients.
• Hard to pinpoint responsibility, specially
errors in patient care.
• Care is assigned by task rather than by
patient.
2. Team Nursing (1950)
• Skill mix in small group with a team
leader.
• Plan of care in which group of nursing
personnel are lead by a qualified nurse
to plan, direct and evaluate the delivery
of care to a group of patient.
• Modified functional nursing.
• It includes the patient in the planning
process.
3. Primary Nursing (1960-1970)
• RN primary nurse assumes 24 hour
responsibility for planning the care of
one or more patients from the start of
treatment to discharge.
• During work hours, the primary nurse
provides direct care for her patient.
4. Care Method (1920)
• Total Patient Care/ Private duty Nursing
• Oldest type
• Oldest mode of organizing patient care
• A nurse assumes total responsibility for
meeting the needs of all assigned
patients during the entire work period.
• The assignment of one nurse to one
patient/ client for the provision of total
care.
Scheduling
• Is a function of implementing the staffing plan by
assigning unit personnel to work specific hours
and days of the week.
• A schedule is a plan showing when an individual
or group activity or accomplishments will be
started and or completed.
• Timetable showing planned work days and shifts
for nursing personnel.
Objectives in Scheduling
• To assign working days and days off to the
nursing personnel so that adequate patient care
is assumed.
• To achieve a desirable distribution of OFF duties.
• Nursing staff know in advance what their
schedules are.
• To have a fair treatment of staff.
Factors to be Considered in Making Schedules
• Adequate mix of nursing personnel be observed.
• Adequate coverage for 24 hours, seven days a
week.
• Schedule for VL and H are planned in advance.
• Continuity of service.
• Long stretches of consecutive working days.
• Staff members are informed of their schedule at
least two weeks in advance.
• Allowances for adjustment in case of illness
emergency or changes in care needs.
• Fairness to staff.
• Stability
• Flexibility
Schedule Principles
• Schedule shall be posted at least 2weeks in
advance of implementation.
• Establish written policies on request for offs,
vacation leave and others.
• Schedule should conform with all the labor law
and hospital policies.
• Provide good staffing mix.
• Ensure teamwork among the staff.
Contents of Job Description
1. Identifying Data
• Position Title: Staff Nurse
• Department: Nursing
REINALYN RAMIRO//NLM 15
 • Supervisor’s Title: Head/ Senior Nurse
2. Job Summary
• Special features to distinguish it from
others.
3. Qualification Requirement
• Educational preparation, training,
experience.
4. Job Relationships.
• Source of workers
5. Specific and Actual Functions and Activities
Uses of Job Description
1. For recruitment and selection of qualified
personnel.
2. To orient new employees to their job.
3. For job placement, transfer and dismissal.
4. And aid in evaluating the performance of the
employee.
5. For budgetary purposes.
6. For determining departmental functions and
relationships to help define the organizational
structure.
7. For classifying levels of nursing function
according to skills levels required.
8. To identify training need.
9. As basis for staffing.
10. To serve as channel of communication.

REINALYN RAMIRO//NLM 16