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WINTER ORGANIZING

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^nursing management functions^

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Definition
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

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Importance of Organizing

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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.

Steps in Organizing
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Elements of Organizing
Centralization and decentralization Delegation of authority Span of control (supervision) Division of service Departmentation

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1. CENTRALIZATION AND DECENTRALIZATION

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

Centralization concentration of decision-making and action at and action at high-level management

Decentralization Consistent delegation of authority to the lower levels where the work is performed

Centralization

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Decentralization Advantages
Raise morale and promote interpersonal relationships. Relieve from the daily administration. Bring decision-making close to action. Develop Second-line managers Promote employees enthusiasm and coordination Facilitate actions by lower-level managers. Improves coordination, especially for services.

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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 decisionmaking. Emergency decision may not be possible.

2. DELEGATION OF AUTHORITY

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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.

The delegation process


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

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

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Barriers to successful delegation

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Lack of superiors ability to direct the subordinates. Lack of confidence in subordinate. Absence of control.

Major causes of managers refusal to delegate


Tendency to do things do things personally.

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Desire to dominate the knowledge, information, information, and/or skills. Unwillingness to accept risks of wrongs.

Reasons for subordinates avoidance of accepting delegation

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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.

Authority

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

It moves in a It moves in a downward direction.

Types of authority

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Ultimate authority Legal authority Technical authority Operational authority

Responsibility

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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.

Types of organizational relationships

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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.

Line & Staff Relationships

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3. SPAN OF CONTROL

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

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Dimensions of span of control


Narrow span of control

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The manager supervises a small number of workers

Narrow span of control

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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.

Wide span of control


Wide span of control

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The manager supervises a large number of workers

Wide span of control


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

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

Tall versus Flat Organizations

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Factors determining the span of control

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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. Lowerlevel managers have a wider range of span than top top-level manager. The similarity or dissimilarity of activities being supervised.

Factors 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).

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4. DIVISION OF SERVICE

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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.

5. DEPARTMENTATION
Types of Departmentation: by services by time by degree of acuteness of illness by function by location by patient

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Development of Job Description

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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 employees salaray range

Job Descriptions include:

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

1. CENTRALIZATION AND DECENTRALIZATION

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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 areasintensive care unit (ICU) and postanesthetic care unit (PACU)

TOTAL PATIENT CARECONTD


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

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

Registered Nurse
8-hour shift

Registered Nurse
8-hour shift

Registered Nurse
8-hour shift

Patient Care
The registered nurse plans, organizes, and performs all care

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 areaoperating room

FUNCTIONAL NURSINGCONTD

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

Disadvantages
Care may be fragmented y Patient may be confused with many care providers y Caregivers feel unchallenged
y

Nurse Manager

LPN/LVN
PO Meds Treatments

RN
Assessments Care Plans

Nurse Aide
Vital signs Hygiene

Nurse Aide
Hygiene Stocking

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 areasmost inpatient and outpatient areas

TEAM NURSINGCONTD

Advantages
High-quality, comprehensive care with a high proportion of ancillary staff y Team members participate in decision making and contribute their own expertise
y

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

Nurse Manager

RN Team Leader RN LPNs/LVNs Nursing Assistants

RN Team Leader RN LPNs/LVNs Nursing 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 areashospice, home health, and long-term care settings

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

Disadvantages
Primary nurse must be able to practice with a high degree of responsibility and autonomy y RN must accept 24-hour responsibility y More RNs needed; not cost-effective
y

Primary Nurse
Physician and other members of the health care team

24-hour responsibility for planning, directing & evaluating patient care

Associate Nurses Provide care when primary nurse is off duty

Patient

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)CONTD


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

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