20 September 2011 NCM 107: Nursing Management Rey Ramirez

CHARACTERISTICS OF AN ORGANIZATION
A purpose

ORGANIZATION
What is an organization? social entity (involves people) goal directed structured and coordinated activity system linked to the external environment open system Why organize? Man is a social animal it is inherent in man (even nomads organize to get food) no man is an island (early man form tribes to survive)

KEY ELEMENTS OF AN ORGANIZATION

Involves people interacting with one another People People People

People using Interacting knowledge and in groups and techniques

Working together in patterned relationships

IMPORTANCE OF ORGANIZATIONS
Resource Management

5 BASIC PARTS OF AN ORGANIZATION

Top Manager Technical Support Staff Middle Manager Administration Support Staff Technical Core

to combine resources to make the desired goals and outcomes 4Ms/1T Money Machine Manpower Materials Time Produce goods and services efficiently Facilitate innovation

Top Manager Technical Support Staff Middle Manager Technical Core Administration Support Staff

ORGANIZATIONAL EVOLUTION

Use modern manufacturing and computer-based technology Adapt to the influence on changing environment Create value for owners, customers Accommodate ongoing challenges of diversity, ethics, career patterns; and the motivation and coordination of people

Evolution: One-man operation Father-son/assistant type Functional organization Functional organization plus a central headquarters Multi-diversonal firm Conglomerate Tends toward increase in the ff: complexity size of organizations accelerating scientific knowledge and technological developments government role customer needs new paradigms *warranted the need for ORGANIZATIONAL THEORY

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 ORGANIZATIONAL THEORY
a way to see and analyze organizations more accurately and deeply HOW? based on patterns and regularities in organizational design and behavior insights into organization functioning SIGNIFICANCE: makes managers more competent and more influential (with theoretical background) endless people will see and understand things other people around cannot see/understand provide an appreciation of understanding of what is happening in organization

ORGANIZATIONAL CLIMATE
Healthy - Open and free - Seek help - Take risks - Challenged by job Unhealthy - Frustrated - Threatened - Reluctant - Excuses for shortcomings

TYPES OF ORGANIZATION
UNITARY

PRINCIPLES OF ORGANIZATION
COMMUNICATION formal; vertical; horizontal UNITY OF COMMAND line of command; one superior; vertical line SPAN OF CONTROL number of subordinates that a supervisor can supervise effectively DELEGATION OF AUTHORITY centralized; decentralized, delegate to competent staff responsibility; accountability SIMILAR ASSIGNMENTS departmentalization; specialization UNITY OF PURPOSE all areas work towards a single purpose to achieve success DIVISIONALYZED (+) flexible (+) quick to respond to changes (+) innovative (-) duplication of resources (-) limit exchange of knowledge

ORGANIZATION THAT THRIVE IN DYNAMIC

ENVIRONMENT
FLEXIBLE Fast Speed Empowered Open in its communication Innovation Learning-oriented DEVELOPMENT-FOCUSED Learn Energized Team-oriented Performance-based VALUE-DRIVEN CENTRALIZED Chief Administrative division Investigative division Support service division Uniform division DECENTRALIZED MATRIX (+) to combine functional and divisional (-) have 2 bosses (-) not easily to implement (-) ideal for multicompanies PROCESS-BASED ORGANIZATION

ORGANIZATIONAL FUNCTIONS
Operations Management Administration Production Management Marketing Supplies Management Human Resources Sales Research and Development Finance Information Technology

ORGANIZATIONAL CHART
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ADVANTAGES map lines of decision-making authority helps people understand their assignments and those of their co-workers reveals to managers and new personnel now they fit into the organization contributes to sound organizational structures shows formal lines of organizations LIMITATIONS shows only formal relationship does not indicate degrees of authority may show things as they are supposed to be/used to be rather than as they are possibility exists of confusing authority with status

SOURCES OF POWER
COERCIVE POWER is the opposite of reward power and is based on fear of punishment if one fails to confirm CONNECTION POWER comes from formal or informal coalition and interpersonal relations and links to prestigious and influential people within and outside the organization REWARD POWER something given in recompense LEGITIMATE POWER gives the leader or manager the right to influence and the staff member an obligation to accept the influence REFERENT POWER is based on identification with a leader and what the leader symbolizes INFORMATION POWER comes from knowledge, access to information, and the sharing of information EXPERT POWER skillful, having knowledge and training

MAJOR CHARACTERISTICS THAT DIFFERENTIATE

HEALTH CARE ORGANIZATION

services offered length of direct service provision ownership financial provision teaching status geographical location accreditation and licensure status

THE NURSE MANAGER

INTRODUCTION TO MANAGEMENT
Definition of Management: deciding what to do doing through the effective use of resources coordination and integration of resources through: Planning Organizing Leading Controlling *to accomplish specific goals and objectives within an organization science and art; a process involving mix of rational leading problem solving decision-making activities intuitive judgment KEY PURPOSES OF MANAGEMENT AND LEADERSHIP: to provide direction to facilitate change to achieve results through the use of resources (effective, responsible, creative)

ROLE OF ORGANIZATION

Knowledge x Skill = Ability Attitude x Situation = Motivation Ability x Motivation = Potential Human Performance Human Performance x Resources = Organizational Productivity MAJOR FORCES INFLUENCING PERSONALITY:

3 PERSPECTIVES OF EFFECTIVENESS Individual Group Organizational CAUSES OF EFFECTIVENESS: Individual Group effectiveness effectiveness Causes: Causes: - ability - cohesiveness - skill - leadership - knowledge - structure - attitude - status - motivation - roles - stress - norms

MANAGEMENT THEORIES
DIFFERENT THEORIES: Scientific Management (F. Taylor, M. Weber) Administrative Management (H. Fayol) Human Relations (E. Mayo) Behavioral Science (A. Maslow, D. McGregor) Contemporary Management Theories (Ouchi) TRADITIONAL MANAGEMENT METHOD: mid-19th century in pre-industrial times apprenticeship cottage industries Laissez-faire economies SCIENTIFIC MANAGEMENT Taylor, Frederick Father of Scientific Management frustrated with what he called, systematic soldiering

Organizational effectiveness Causes: - environment - technologies - strategic choices - structures - processes - culture

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 Principles: traditional rule of thumb means organizing work must be replaced with scientific methods scientific personnel system must be established so workers can be hired, trained, and promoted based on technical competencies and abilities workers should be able to view how they fit into the organization and how they contribute to overall organizational Nursing Implications: Work specialization Nurse staffing Staffing needs Supervisory tasks Departmentalization BUREAUCRATIC ORGANIZATION Max Weber, a well-known German sociologist, proposed bureaucracy as organization designed the need for legalized, formal authority and consistent rules and regulations for personnel Characteristics of Bureaucracies: there must be a clear division of labor a well-defined hierarchy of authority there must be impersonal rules and impersonality of interpersonal relationships a system of procedures for dealing with work situations must exist a system of rules covering rights and duties of each position must be in place selection for employment and promotion is based on technical competence MANAGEMENT PROCESS THEORY constitutes the body of knowledge that describes how managers conduct activities to keep the organization why study? a theory provides criteria for determining what is relevant provides stable focus for undertaking what we experience enable us to communicate efficiently challenge us to keep learning about our world Henri Fayol first identified the management functions of: Planning prevoyance (think ahead) examine the future and draw up plans of action Organization to organize build with the structure, material, and human of the undertaking Command to command (to direct) maintain activity among the personnel Coordination to coordinate bind together, unify and harmonize activity and effort Control to control

see that everything occurs in conformity with policy Fayols 14 Principles Specialization/Division of Labor a principle of work allocation and specialization in order to concentrate activities to enable specialization of skills and understanding, more work focus, and efficiency
Authority with Corresponding Responsibility

managers must be able to give orders and authority gives this right if responsibilities are allocated then the post holder needs the requisite authority to carry these out including the right to require others in the area of responsibility to undertake duties delegation process the job holder is assigned to act as the agent of the high authority to whom they report allocation and permission to use the necessary resources needed (budgets, assets, staff) to carry out the responsibilities the R = A correspondence is important to understand Discipline employees must obey and respect the rules that govern the organization good discipline is the result of effective leadership discipline is essential for the smooth running Unity of Command an employee should receive instructions from one superior only even where we are involved with team and matrix structures which one involve reporting to more than one bossor being accountable to several clients Unity of Direction unity of command idea of having one head (chief executive, cabinet consensus) with agree purposes and objectives and one plan for a group of activities must be clear Subordination of Individual Interest to the General Interest Fayols line was that one employees on interests or those of one group should not prevail over the organization as a whole this would spark a lively debate about who decides that the interests of the organization as a whole are ethical dilemmas and matters of corporate risk and the behavior of individual chancers are involved here shared set of values by people in the organization a unitarianism where the reasons for organization/activities and decisions

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are in some way neutral and reasonable Renumeration of Staff price of services rendered general principle is that levels of compensation should be fair and as far as possible afford satisfaction both to the staff and the firm (in terms of its cost structures and desire for profitability surplus)
Centralization

personnel planning and ensure that replacement are available to fill vacancies Initiative at all levels of the organizational structure, zeal enthusiasm and energy enable people to have initiative respect of employee empowerment employees who are allowed to originate and carry out plans will exert high levels of effort
Espirit De Corps

process by which the act of an organization, particularly regarding planning, decision making, become concentrated within a particular location and/or group decisions are made by the top executive/ on the basis of pre-set policies difference between centralization and decentralization also called departmentalization there are: fewer ties in the organizational structure wider span of control bottom to top flow of decision making and flow of ideas Scalar Chain/Line of Authority scalar chain of command of reporting relationship from top executive to the ordinary shop operative/driver needs to be sensible, clear and understood straighten chain of command that extents unbroken from the ultimate officer to the lowest ranks communication should follow this chain this chain creates delays cross communication can be allowed if agreed Order people and materials should be in the right place at the right time organization should provide an orderly place policies, rules, instructions and activities should be understandable one of the basic problem in management is the balancing of an organization Equity Fairness and sense of justice should pervade the organization in principle Stability of Tenure time is needed for the employee to adapt to his/her work and perform it effectively stability and tenure promotes loyalty to the organization, its purposes and values high employment is efficient if turnovers cannot be prevented, management should provide orderly

Need for building and maintaining of harmony among the work force, teamwork and sand interpersonal relationships This will also build unity within the organization ACTIVITIES OF MANAGEMENT Luther Gulick expanded Fayols management functions in his introduction of the 7 activities of management PARTICIPATIVE MANAGEMENT Mary Parker Follet was one of the 1st theorist to suggest basic principles of what they would be called participative decision-making managers should have authority with rather than over employees need for collective decision-making HAWTHORNE MANAGEMENT Elton Mayo discovered when the management paid special attention to workers, productivity was likely to increase, regardless of the environmental working conditions Hawthorne effect indicated that people respond to the fact that they are being studied attempting THEORY X AND Y Douglas McGregor, reinforced these ideas by theorizing that managed vial attitudes about employees can be directly correlated with employee satisfaction Theory X lazy, needs constant supervision Theory Y self-motivated and are willing to work hard to meet personal and organizational goals EMPLOYEE PARTICIPATION Chris Argris self-esteem and independence not met to become discouraged and trouble some

MANAGERIAL ROLES
role set is specific tasks a person performs because of the position they hold roles are directed inside as well as outside the organization THREE BROAD ROLE CATEGORIES: Interpersonal roles managers assume to coordinate and interact with employees and provide direction to the organization Figurehead role: symbolizes the organization and what it is trying to achieve

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 Leader role: train, counsel, mentor and

encourage high employee performance Liaison role: link and coordinate people inside and outside the organization to help achieve goals Informational associated with the tasks needed to obtain and transmit information for management of the organization Monitor role: analyzes information from both the internal and external environment Disseminator role: manager transmits information to influence attitude and behavior of employees Spokesperson role: use of information to positively influence the way people in and out of the organization respond to it Decisional associated with the methods managers use to plan strategy and utilize resources to achieve goals Enterpreneur role: deciding upon new projects ot programs to initiate and invest Distubance handler role: assume responsibility for handling an unexpected event or crisis Resource allocator role: assign resources between functions and divisions, set budgets of lower managers Negotiator role: seeks to negotiate solutions between other manager, unions, customers or shareholders KEY MANAGEMENT COMPETENCIES: Promote personal and associated development and empowerment Encourage risk taking innovation and organizational development Demonstrate socially responsive and ethical behavior Solve problems and make decisions Engage strategic thinking Building partnership with external customers Build and utilize internal network and teams Communicate with others 3 GENERAL CATEGORIES OF MANAGERIAL SKILLS AND ABILITIES: Conceptual skills: ability to analyze and diagnose a solution and find the cause and effect Human skills: ability to understand, alter, lead and control people's behavior Technical skills: job specific knowledge required to perform a task. Common example include marketing, accounting and manufacturing all 3 skills are enhanced through formal training, reading and practice

MIDDLE MANAGER supervises a number of 1st level manager's usually in related specialties or in a given geographical area responsible for people and activities within the department supervise acts as liaison between upper and 1st level managers TOP LEVEL executive managers chief nurse executive (CNE) it is to them that middle manager reports primarily responsible for establishing organizational goals and strategic plans responsible for buffering the effects of the external environment on nurses within the organization

MANAGERIAL QUALITIES

ATTRIBUTES OF SUCCESSFUL MANAGERS: command of basic facts relevant professional knowledge self-knowledge mental agility proactive creative analytical, problem-solving and decision/judgingmaking skills continuing sensitivity of events social skills and abilities emotional resilience balance learning habits

FUNCTIONS OF MANAGEMENT

PLANNING: deciding on course of action to achieve desired

results ORGANIZING: setting up and staffing the most appropriate organization to achieve the aim LEADING: exercising leadership to motivate people to work together smoothly to the best of their ability as part of the team CONTROLLING: measuring and monitoring the progress of work in related to the plan of and taking corrective action when required

PLANNING
is a mental predisposition to do things in orderly way to think before acting and to act in the light of factors rather than guesses deciding for the best alternative among others to perform different managerial functions in order to achieve predetermined goals PURPOSE: gives direction

NURSING MANAGEMENT LEVELS

FIRST LEVEL MANAGER responsible for supervising non-managerial staff day-to-day activities of a specific unit primarily responsibility for motivating the staff to achieve the organization

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 anticipate and offset change effective use of resources give meaning to work improve program and activities basis for control compels visualization of whole CHARACTERISTICS: purposeful process not an act deliberate, rationale and objective futuristic flexible largely conceptual dimensional hierarchy in nature PRINCIPLES: objectives - specific, clear and understood facilitates action coordination and communication maybe delegated constantly improved/re-planned tentative and interim

TIME FRAME FOR PLANNING

LONG-RANGE PLANS covers many years any plan beyond 5 years INTERMEDIATE PLANS less tentative and subject to change usually covers from 1 to 5 years specially important for meddle or first line managers parallel tactical plans SHORT-RANGE PLANS covers 1 year or less generally affects managers day to day activities 2 KINDS OF SHORT-RANGE PLANS: Action Plan Reaction Plan develop to react to unforeseen circumstances

BARRIERS TO GOAL SETTING AND PLANNING AND

HOW TO OVERCOME:
BARRIERS: inappropriate goals improper reward system dynamic and complex environment reluctant to establish goals resistance to change constraints lack of resources government restrictions strong competition OVERCOMING THE BARRIERS: understand purpose of goals and plans communication and participation consistency, revision and updating effective reward system contingency planning determination of alternative course of action to be taken if intended plan of action is unexpectedly disrupted/rendered inappropriate

PLANNING HIERARCHY
Mission/Vision Vision mental image or the power of imagination to see something that is not actually visible Mission an aim to be accomplished Philosophy articulate a vision and provide a statement of beliefs and values that direct ones practice Goals the end or outcome to be accomplished Objectives something aimed at/or striven for; things done to achieve the goal Policies a governing plan for accomplishing goals and objectives Procedures chronological sequence of sets within a process Roles set of responsibilities or expected results associated with a job

PURPOSES OF GOALS

KINDS OF ORGANIZATIONAL PLANS:

STRATEGIC PLAN a generalized plan outlining decisions of resource allocation, priorities and action steps to reach strategic goals have long term focus TACTICAL PLAN plan aimed at achieving tactical goals developed to implement parts of strategic plans concern more with activity getting things done that deciding what to do have more specific and concrete focus OPERATIONAL PLAN focuses on carrying out tactical to achieve operational goals have short term focus and relatively narrow in scope

provide guidance and unified direction promote good planning and facilitate future goal setting serve as source of motivation to employees provide an effective mechanism for evaluation and control

CORPORATE PLANNING

PHASE I STRATEGIC PHASE II OPERATION PHASE III FEEDBACK AND CONTROL

PLANNING PROCESS

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STAGE 1: ANALYSIS OF OPPORTUNITIES SWOT Analysis this is formal analysis of your strengths and weaknesses, and if the opportunities and threats that you face Risk Analysis understanding pressures for change STAGE 2: IDENTIFYING THE AIM OF YOUR PLAN What do I want the future to be? What benefits do I want to give my customers? What returns do I seek? What standards am I aiming at? What values do I and my organization believe in? STAGE 3: EXPLORING OPTIONS STAGE 4: SELECTING THE BEST OPTION STAGE 5: DETAILED PLANNING STAGE 6: EVALUATION OF THE PLAN AND ITS IMPACT STAGE 7: IMPLEMENTING CHANGE STAGE 8: CLOSING PLAN

refers to those activities and steps needed to be taken for the manager to formulate a budget BUDGET WORKSHEET a tool used for/by a manager to prepare their budget VARIANCES a general term to describe the difference between a budgeted number and an actual result STEPS IN BUDGETING: Review past performances Review the organization's goals and projection Review the variance Actual preparation of budget TYPES OF BUDGET: Operating (revenue, expense) Personnel Capital Expenditure Cash Flexible NUMBERIZING PLANS BY BUDGET: developed such budget as volume and price of sales operating expenses necessary for plans expenditure for capital equipment

GANTT CHART
implemented work over a period a time-scale is given on the chart's horizontal axis and each activity is shown as a separate horizontal rectangle (bar) whose length is proportional to the time required (or taken) for the activity's completion in project planning, these charts show start and finish dates, critical and non-critical activities, slack time, and predecessor-successor relationship also called CHRONOOGRAM, invented in 1917 by Henry L. Gantt (1861-1919) PRINCIPLES OF THE GANTT CHART: measure activities by the amount of time needed to complete them represent amount of activity that should have been done in time

PLANNING CYCLE

ORGANIZING
the establishment of a formal structure of authority, through which work subdivisions are arranged, defined and coordinated for the achievement of defined objectives provide the relationships between people activities in such way as to organizational goals occurs through interactional phenomena because of hierarchal arrangement of interdependent people can be defined as: act of deploying the resources needed to achieve an identified goal including human resources organizing is critical to success for any enterprise considers whether the resources at their disposal are effectively deployed PURPOSE: best use of the organizations resources to achieve organizational goals Special phenomenon: power authority status process of delegation

STEPS IN PLANNING FUNCTIONS: Establishment of objectives Establishment of planning premises Choice of alternative course of action Formulation of derivative plans Securing Co-operation Follow-up/Aprraisal of plans

BUDGET
a planning document used by a department or organization that forecasts both receipts and expenditures a systematic programming of organizational activities based on their cost and on the amount of resources available BUDGET PROCESS

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 LEVELS OF ORGANIZING
*Organizing take place in many levels FIRST: ORGANIZE YOURSELF get control of your desktop and work area at scheduled intervals critically evaluate your daily routine at scheduled intervals avoid time-wasting people and activities inventory your inbox contents organize your day so that your daily activities will accomplish your plans do not over-schedule yourself try to avoid scheduling more than half of any day if at all possible leave time for the work that will have to be done as a result of the events that you have scheduled examine your daily routine try to avoid scheduling more than half of any day if at all possible practice the first things, first rule always do first things never do second things delegate, dont abdicate inform other who need to know delegate only those things you should avoid procrastination do the tasks you enjoy the least, first ORGANIZE YOUR DEPARTMENT TO MEET ITS GOALS AND OBJECTIVES how many layers of management you are in? If there is more than one why? is the span of control principle observed in your department? do employees understand the departments goals and objectives? are you using the most effective means of communication? do you have (or attend) too many meetings? do all meetings have a stated purpose and a written agenda? Agenda item assigned a time limit?

STEPS IN ORGANIZING PROCESS

Review plans List tasks Group tasks into jobs Group jobs Assign work Delegate authority

TERMINOLOGIES

JOB collection of tasks and responsibilities that an employee is responsible to conduct; jobs have titles FUNCTIONS large number of tasks a complex positions in the organization TASK typically defined as a unit of work ROLES set of responsibilities or expected results associated with a job

TIME MANAGEMENT
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set of skills, tools, systems work together help you get more value out of your time with the aim of improving the quality of your life TIME MANAGEMENT STRATEGIES: Action Idea Logic People time styles Time analysis Daily planning Crisis control Problem analysis Time control Time evaluation BARRIERS TO EFFECTIVE TIME MANAGEMENT: Habit Work expansion Oversuspension Underdelegation Losing sight of objectives PRINCIPLES OF TIME MANAGEMENT: Communication Planning Delegating Prioritizing goals SKILLS ASSOCIATED WITH TIME MANAGEMENT: Planning Prioritizing Goal setting Scheduling Managing your workload KINDS OF TIME: Managerial Response Discretionary TIME MANAGEMENT PROCESS: analyzing the present situation where am I now? developing relevant assumptions what conditions will most likely exist within the time span of the plan establish objectives what do I want to achieve? developing alternatives what ways might I attain objectives? making a decision implementing the decision establishing review and control TIME MANAGEMENT TECHNIQUES: personal commitment to improving deciding what not to do learning to say no recording how time is used planning use of time fire fighting vs fire prevention prime time programming blocks of time organizing the workspace memoitis essential but use only when necessary COMMON TIME WASTERS: overcommitment visitors

 telephone meetings indecision paperworks and readings lack of delegation lack of priorities MANAGE MEETINGS: start on time end on time develop agenda only those needed must be present gather information prior to meeting TECHNIQUES TO STOP PROCRASTINATION: break a large job down to smaller tasks do a start-up task take advantage of your moods consider the consequences of not doing the job consider hiring someone to do the job consider switching job with someone divide up the job to do what one likes to do make a commitment to someone/wager with someone set goals set realistic time schedule gather necessary information avoid over-commitment give yourself a reward organize the department functional product geographical process BENEFITS OF TIME MANAGEMENT: efficient success healthy OBSTACLES TO EFFECTIVE TIME MANAGEMENT: Obstacles Unclear objectives Disorganization Inability to say NO Interruptions More interruptions Periods of inactivity Too many things at once Stress and fatigue All work and no play What we can do? Recognize that obstacles exist Identify them Set goals (Specific, Measurable, Attainable, Realistic, Time bound) Prioritize (Do, Delegate, Delay, Delete) Organize Learn to say NO You can't do everything Don't undertake things you can't complete Remain consistent to your goals Use your waiting time on public transportation at doctor's office waiting for your phone

on hold when you are early correspondence letter/memos book/tapes Concentrate on the task at hand Focus on your goal Consider personal time Morning? Evening? Late night? Celebrate your success

DECISION-MAKING

is the skill to solve problems by selecting the one course of action from several possible alternatives it is a key component of time management skills DECISION MAKING PROCESS: identify the problem and analyze the situation explore the alternatives choose the most desirable alternative implement the decision evaluate the results DECISION STRATEGIES: Optimizing: greatest possible gain Satisficing: good enough solution Mixed Scanning: satisfied to remove least promising solutions than select best of remaining options Opportunistic: solution chosen by problem identifier Do Nothing: waiting for the storm to pass Eliminate Critical Limiting Factor: remove most powerful obstacle to succees PROBLEM SOLVING PRINCIPLES: rely on policy for small problem: conserve time for large, unique problems delegate recurring problems to subordinates trained to handle them seek information for problem solving from internal and external experts ensure adequate time and relaxed conditions for creative problem solving after appropriate consideration, select and implement best solution without rumination

STAFFING

provides the appropriate numbers and mix of nursing staff and nursing care hours to match the actual/projected patient care needs that will lead to the delivery of effective and efficient nursing care DETERMINING NURSING CARE HOURS Nursing Hours Per Patient Day (NHPPD) calculated by dividing the total nursing care hours by the total census (number of patient) there are no specific standards for nursing care hours, it varies from the average of 5-7 hours in the medical/surgical units; 10-24 in CCU; 2428 for new, severely burned, selected clients DETERMINING FULL-TIME EQUIVALENT (FTEs)

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 one FTE = 40 hours of work/week for 52 weeks or 2080 hours/year this is used to staff a unit 24 hours a day, 7 days a week techniques in determining FTEs hours of week for the staff for 2 weeks, average daily census and hours of care formula: ave nsg care hrs x days of staffing period x ave px census hours of week/FTE in 2 weeks data: number of hours worked/FTE in 2 weeks = 80 number of days of coverage in 2 weeks = 14 average daily census = *depends average nursing care hours (based from patient classification system) = 6.15 DETERMINING DISTRIBUTION OF STAFF patient census or average patient days (annual census/number of beds) activities workload (care demands) skills of staff training and staff development exposures occupancy rate (average patient days/number of days in a year) patient-related groups (DRGs) SCHEDULING cyclic list of nurses working in a given week, in a particular unit shows balance to work flow between nursing needs and staff available it allows efficient giving of assignments and improve staff utilization

ensure quality nursing care provided in a safe environment PATIENT CLASSIFICATION SYSTEM: Category I ambulatory; needs no assistance from health professional Category II with minimal assistance; with IV tubings; NSD minor surgery, few days post-operative Category III with moderate assistance; immediate post-operative Category IV full assistance with dependence on health professional; comatose neurological patient USES OF PCS: improve patient satisfaction by providing required time to the patient according to his/her needs enhance staff satisfaction monitor the provision of quality nursing care

PRIORITY SETTING

INVOLVES: list the things that frequently get in the way identify aspects of your work that lies in and out of your control keep a time log (set time frames) evaluate and analyze likely upcoming demands SUGGESTED PRIORITY SETTING PRACTICES: set up a written priority matrix to analyze activities that really merit higher priorities attach deadlines To Do item always allot a margin of time for interruption in your plans clarify the time needed for the interruption; decide whether you can handle it now when you become overloaded, ask for a meeting with appropriate people: explain the competing demands suggest alternatives ask for additional ideas press for a decision about re-ordering priorities and responsibilities when you take on a task, clarify scope and expectations for its completion determine where the importance of this task file in the big picture whenever delegating a task, explain set a specific task CONSIDERATIONS IN PRIORITY SETTING: ABC of the ABC Maslows Hierarchy of Needs Professional ethics/laws Institutional safety rules/regulations safety first DELEGATION it is handling of a task over to another person, usually a subordinate it is assignment of authority and responsibility to another person allows a subordinate to make decisions ensure that the delegate understands: why the work is to be done why they are expected to do

PATIENT CLASSIFICATION SYSTEM (PCS)

a scheme that groups patients according to the amount and complexity of their nursing care requirements; it serves as a tool to reassure patient needs, caregivers interventions and the skill levels, required to meet those needs developing a fair, objective, and reliable way to predict the required number and skill level of staff to meet patient needs providing appropriate staffing assignment measured by standards of care determined by the number of hours of care needed to provide quality of care to the patient PURPOSES OF PCS: determine the unit measure for: nursing time nursing hours per patient day (NHPPD) time needed to provide patient care according to hospital department standards of care and practice determine: number monitor changes in patient care needs provide data on each patient care unit to project staffing needs

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the date by which they are expected to do it the authority they have to make decision the problems they must refer back the progress or completion report they should submit how you propose to guide and monitor them the resources and help they will have to complete the work TIPS FOR DELEGATION: competent employee reasons for selecting employees explain what and why guidance and support delegate, dont abdicate inform other who need to know only those things you should

TOTAL PATIENT CARE Charge Nurse RN Patient

RN Patient

RN Patient

MODALITIES OF DELIVERING NURSING CARE

FUNCTIONAL Charge Nurse Med Nurse Treatment Nurse Bath duty Nurse (ADL)

also called Case Method one RN is responsible for all aspects of care of one or more patient Advantages Continuous, holistic, expert Total accountability Continuity of communication Disadvantages Too expensive Spends much time with tasks that can be delegated Places the RN back to the patient bed side from admission to discharge There is decentralized care RN designs, implements and evaluates patient care

Advantages The needs of a group of patient are broken down into tasks Tasks are assigned to RNs/LPNs so the skill are used to the best advantage Contribute to efficiency and effectiveness in doing assigned tasks Disadvantages Uneven continuity of care No holistic view of patient Time consuming Problem with follow-up TEAM NURSING Charge Nurse

CASE MANAGEMENT Case Manager Patient Caseload Caregiver Caregiver Caregiver

Team/Module leader RN / LPNs Patient

Team/Module leader RN / LPNs Patient

Team/Module leader RN / LPNs Patient

a team of nurse provides total patient care to a

group of patient A team of nurse to a group of patient Modular limit the team in a geographical area Advantages Allows use of less prepared nurses Coordinated care Disadvantages Requires much time for effective communication, supervision and coordination Diminished continuity of care Fragmented care of client Role confusion

a model identifying, coordinating and monitoring the implementation of services needed to achieve desired patient care outcomes with a specified period of time Advantages Reduced complications Reduced cost Increase collaborations Improved quality care Disadvantages Case manager does not give direct nursing care Treatment focused High level of coordination, supervision and communication Expensive PROGRESSIVE DISCIPLINE APPROACH Improper Behavior No Discipline Goal Warning Written Warning Supervision Termination

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 Steps in Progressive Discipline: Counsel the employee regarding the performance problem and expectations for improvement. Timeless for improvement are given Reprimand the employee for the first time if the unacceptable behavior continues. This may be oral/written, depending on policies/contacts Reprimand the employee for the second time if the unaccepted behavior continues. This must be written Suspend the employee for a given period of time if the unacceptable behavior continues Terminate employee if the unacceptable behavior continues after return from suspension Principles of Disciplinary Actions: Have a positive attitude Investigate carefully Be prompt Protect privacy Focus on the act Enforce on the act Enforce rules consistently Be flexible Advice the employee Take connective, constructive action Follow-up Principles of Disciplinary Actions: Describe the situations and review previous agreements Ask for explanation Listen and response with empathy Indicate what action you must take and why Agree on specific action Express confidence Modification of Employee Behavior: Reinforcement Shaping Punishment Extinction Components of a Disciplinary Action: Codes of conduct Authorized penalties Records of offense and corrective measures Right to appeal

function of management that gets work done through others 5 SPECIFIC CONCEPTS OF DIRECTING: Giving directions Supervising Leading Motivating Communicating REASONS WHY PEOPLE ARE DIFFICULT TO DIRECT: Fundamental disagreement Rivalry Different values Real or imagined sight Arrogant behavior or as perceived Feeling worthless Frustrated ambition Not being able to get own way Concern about impact of change Too much pressure real/ perceived

SUPERVISING
concern with training and discipline of the work force follow-up to ensure prompt execution of orders SUPERVISORS ROLE AS LINE/MIDDLE MANAGER: People management Managing managerial costs Providing technical expertise Organizing, such as planning work allocation, monitoring work process Checking quality Dealing with customers/clients Measuring operational performance SUPERVISORS ROLE IN TRAINING: Formulating training objectives Planning the training program Performing training program Evaluating effectiveness SUPERVISORS ROLE DURING ON-THE-TRAINING: preparing the trainer: setting an atmospheres of receptivity demonstrating the parts of the job; tell and show performance by the trainee; do not permit trainee to learn in error follow-up and review QUALITIES OF A SUCCESSFUL SUPERVISOR: Gives clear work orders, communicates well Praises others when deserved Is willing to take the time to listen Has confidence and self-assistance Gains the groups respect through personal honesty Fair to everyone Demands good work for everyone Gains group trust by representing their view to higher management Has appropriate technical knowledge of the work being supervised Understands the group problems Goes to bat for the group Is approachable, friendly yet retains some distance KEY POINTS TO SUPERVISORS ROLE IN TRAINING:

LEADING

the 3rd function of management ability to inspire and to influence others in order to attain the objectives FIRST ACTIVITY give directions Clear Concise Consistent Conforms to requirements should conform with the requirements of the situation tone of directions (different situation requires different emphasis)

DIRECTING
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 efficiently trained employees will produce less waste and have fewer accidents poorly trained employees have higher roles of absenteeism, tardiness and turnover wait for competently trained employees; dont rush the process key part of training is the preparation of the trainee remember the 3 basic objective of training point out what the employees know, and do not know and what they should know and do define what is considered acceptable performance real education should be directed to improve competence beyond the job now held supervisor plays a critical role in the updating of training programs and employees skills

Dissatisfies relate to pay, job security Satisfiers content with work

CONFERENCE
widely used method of training in healthcare offers participants the unusual opportunity to contribute ideas, exchange experiences and solve problem by areas of pooled judgments drawing together employees with varying skills, experiences and responsibilities in order for the group to learn from each other success of the conference is dependent on its composition and the skill of the leader SUPERVISOR AS CONFERENCE LEADER knows the topic planned for the conference fully aware of its goals EFFECTIVE CONFERENCE MANAGEMENT CHECKLIST Make certain the subject is worth a meeting Plan carefully Work out a plan of action Inspect the meeting room Know the participants Review your responsibilities Dont forget follow-up

Expectancy theory (Vroom) chance of high satisfaction rewards through effort HOW TO MOTIVATE PEOPLE? Take care Be optimistic Respect your employee Create an environment that has meaning for the employee/his work Encourage new ideas and innovations Develop your employees professionally and personality at all times Provide awards and rewards Total commitment Make efforts to retain talented and committed employees

COMMUNICATING
interactive process whereby the leader influence a group the medium by which leadership is conveyed to the group involves the what, how, why the direction is necessary transfer of information and understanding COMPONENTS OF COMMUNICATION: Message the idea to be conveyed Communication process consists of 6 steps Ideation Encoding Transmission Receiving Decoding Response Communication Climate Positive enhances the message Negative detracts from understanding the message 10 BASICS FOR GOOD COMMUNICATION: Clarify your ideas before communicating to others Consider the physical setting Consider the psychological environment Consult with others when necessary to be sure your communication is accurate Be mindful of the tome as well as the words of the message Take the opportunity to convey something to help, value or praise to the receiver Follow-up your communication Non-verbal communication should support communication Be an active listener Be assertive when expressing your view ACTIVE LISTENING Stop talking Put other person at ease Dont interrupt Empathize Paraphrase Ask open minded questions Use silence

THEORIES OF LEADERSHIP
Situational Contingency Transformation

LEADERSHIP STYLES
Autocratic Democratic Laissez-faire

MOTIVATING
set of skills manager uses to help employee to indentify own needs find ways within the organization to help satisfy them caused behavior, a psychological process that gives behavior purpose and direction THEORIES OF MOTIVATION: Need theorists (Maslow) Personality type

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 Allow reflection BLOCKS TO COMMUNICATION: Poor listening habits Time and work demands Semantics Frame of reference

CONTROLLING

a process comparing actual performance and taking corrective action if needed to achieve desired objectives PRINCIPLES OF CONTROLLING: Reflect the nature and needs of the activity Report deviations promptly Forward-looking Objective Flexible Point up exceptions at critical points Economical Understandable Lead to corrective action Reflect the organization pattern PURPOSES OF CONTROLLING: Establish standards of performance Determine tools to measure performance 7 Ms to control: Manpower Mins (time) Money Machine Method (Policies) Materials Evaluate and provide feedback of performance Improve productivity Provide quality management Institute necessary change TYPES OF CONTROL: Feedforward anticipating for the outcome or the future Concurrent continuous supervision Feedback PRINCIPLES OF SUPERVISING CONTROL: Preventive control Management by exception Strategic control point

CONTROL PROCESS

Step 1: Establish performance standards Step 2: Measure actual performance Step 3: Compare measured performance Step 4: take corrective action

CHARACTERISTICS OF EFFECTIVE CONTROL

Properly designed Prevent problems it was designed to detect Set appropriate standards Specify solutions Accurate and timely

PERFORMANCE APPRAISAL
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as a structured formal interaction between a subordinate and supervisor that usually takes the form of a periodic interview (annual or semi-annual) in which work performance of the subordinate is examined and discussed with a view to identifying weaknesses and strengths as well as opportunities for improvement and skill development APPRAISAL METHODS: Rating Scales offers a high degree of structure for appraisals traits relevant to appraises job are rated on a bipolar scale/points ranging from poor to excellent Advantages: Structured and standardized Same criteria, rating process for all Easy to use and understandable Disadvantages: Trait relevance Systematic disadvantages Perceptual errors Perceived meanings Rating errors Essay Method the appraiser prepares a written statement about the employee being appraised statement usually: concentrates on describing specific strengths and weaknesses in job performance suggests causes of action to remedy the identified problem areas statement maybe written and edited by the appraiser alone, or it be composed in collaboration with the appraise Advantages: Less structured and confining Permits the appraiser to examine relevant issue or attribute of performance Process is open-ended and very flexible Disadvantages: Time-consuming Difficult to administer Demanding Writing skills of appraisers can upset/distort the whole process Process is subjective Rating Scales measure employee performance by examining the extent to which predetermined work objectives have been met objectives are established jointly by the supervisor and subordinate once an objective is agreed, the employee is usually expected to self-audit to identify the skills needed to achieve the objective they are expected to monitor their own progress and development Advantages: Concentrates on actual outcomes Employees are judged according to real outcomes Direct results can be observed

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 Advocate that employees performance cannot be taken into constituent parts Disadvantages: May lead to unrealistic expectations about what can and cannot be reasonably accomplished Need for a strong reality checking skills for supervisors Tend to impose a certain rigidity Variable objectives may cause employee confusion TECHNIQUES OF PERFORMANCE APPRAISAL: Encourage discussions Constructive intervention Set performance goal Credibility of the appraiser Steps: Do background work for the performance review Clarify job description and responsibilities Clarify employee development interests and needs List specific development areas for concentration Review performance objectives and performance standards Review progress toward objectives through ongoing feedback and pre-discussions Decide on purpose (s) include giving employees answers to: What am I expected to do? How well am I going? What are my strengths and weaknesses? How can I do a better job, how can I contribute more? BENEFITS OF APPRAISAL: Motivation and satisfaction Training and development Recruitment and in direction Employee evaluation COMMON MISTAKES IN APPRAISAL: Fear factor Judgment aversion Feedback-seeking Appraiser preparation Employee participation Employee education BIAS EFFECT OF APPRAISAL: Matthew Effect suggests that no matter hard an employee strives, their past appraisal records will prejudice their future attempts to improve CHARACTERISTICS OF EFFECTIVE APPRAISAL: Specific Descriptive Certain that feedback is not self-serving Directed towards behavior that can be changed Sensitive to time Feedback is clearly understood MAINTAINING IMPROVED PERFORMANCE: Describe the improvement Explain the benefit of said improvement to you and the group Listen with empathy to employees comments

Ask the employee if there is anything you can do to further improvement If appropriate, indicate your intention to take such action Thank the employee for the improvement

ALLOCATION OF RESOURCES
Allocation decision an organization makes regarding how many of its resources will be devoted to a particular effort Resource Allocation distribution of organizational assets to meet identified organizational goals CONCERNS OF ALLOCATION: Making staffing mix decisions Meeting regulations requirements Providing care to individual who are medically indigent and have long-term care needs Providing needed patient care programs Compare values Learning to use finite resources efficiently Wise distribution of available resources Ensure cooperation of everyone PROCESS OF ALLOCATION: Identify organizational goals Identify available organizational assets/resources Define constraints on decision maker Finding appropriate resources

COST CONTROL

The monitoring of costs, recording, and analysis of the data to take corrective Cost control implies good cost management which must include: Cost Estimating Cost Accounting Project Cash flow Earned value reporting CONCEPT OF COST CONTROL: Cost control is designed To put pressure on the project manager To perform exceptionally good project So that changes will be minimized PHASES OF COST CONTROL:

*operating cycle from phase II phase V PURPOSE OF COST CONTROL: Derivation of output specifications (project objectives) Delineation of required activities (work) Coordination and communication between organizational units

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 Determination of type, amount and timing of necessary resources Recognition of high-risk elements and assessment of uncertainties Suggestion of alternative courses of action Realization of effect of resource level changes on schedule and output performance Measurement and reporting of genuine progress Identification of potential problems Basis for problem solving, decision making and corrective action Assurance of coupling between planning and control

C.Q.I. ongoing process through which care standards and practice behaviors are progressively enhanced Current research findings Practice Patient and public welfare

NURSING CARE STANDARDS

Standard The desired quantity, quality or level of performance that is established as a criterion against which worker performance will be measured PURPOSES: Guide the provision of nursing care Provide the means by which nursing personnel are evaluated in the provision care Provide the means by which to measure the end results of nursing care through patient outcomes STANDARDS OF CARE REFERS TO: Nurses conducting themselves professionally according to generally accepted reasonable practice of nursing care Conduct themselves with the degree of care, skill and knowledge that reasonably competent nurses would exhibit in any situation Practice that avoid being found negligent Exercise good judgment, education and training to the best of their ability under any circumstances SOURCES OF STANDARD OF CARE: Nursing Law Professional organizations Code of Ethics for Nurses Joint Communication Accreditation of Healthcare Organization (JCAH) Case Law and Published opinions by judges State Statutes and Administrative Codes Hospital Policies Authoritative Nursing Journals

QUALITY CONTROL
Refers to quality related activities associated with the creation of project deliverables Used to verify that deliverables are of acceptable quality and that they are complete and correct Examples: Peer review; testing process Involves performance management and maintenance Includes systematic method of ensuring conformance to a desired standard or norm QUALITY ASSURANCE (QA) Refers to the process used to create the deliverables, and can be performed by a manager, client or even a third party reviewer Examples: process checklist; project audits Process of establishing a target degree of excellence For nursing intervention and taking action to ensure that each client receives that agreed on level of care Objectives of QA: Set standard for nursing care delivery Establish as basis to evaluate this standard Components of QA program: Clear and concise written statement of purpose, philosophy, values and objectives Standards or indication for measuring quality of care Policies and procedures for using such standards in data gathering Analysis and reporting of the data gathered with isolation of problems and variances Use of the results to prioritize and correct problems and variances Monitoring of clinical and managerial performance and ongoing feedback Evaluation of the Q.A. system QUALITY IMPROVEMENT (QI) Concerned with performance development On going Involved with fixing NOW Preventing future costly mistakes Fostering breakthrough Continuous Quality Improvement (CQI): Ongoing process of monitoring structure, process and outcome indicator in order to identify signal events, significant trends and opportunities for change It integrates QA, QC, and QI DIFFERENCE BETWEEN QA AND CQI: Q.A. goals only air at maintaining care quality at a present level

LEADERSHIP

NURSING LEADERSHIP: - What is a leader?

- Who is a good leader? - What are the characteristics of a good leader? LEADERSHIP: - the process of influencing people while operating to meet organizational requirements and improving the organization through change - use of personal traits to constructively and ethically influence organizational outcome are achieved through collective efforts LEADER: a person who demonstrates and exercises influence and power (charismatic) over others MANAGEMENT: activities need to plan, organize, motivate MANAGER: person who directs team of workers DIFFERENCE BETWEEN MANAGERS AND LEADERS: MANAGER LEADER - have an assigned position - often do not have delegated

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within the formal organization - have legitimate source of power d/t delegated authority that accompanies their position - expected to carry out specific functions, duties and responsibilities - emphasize control, decision making, analysis, and result - directs people - manipulates people, the environment, money, time and other resources to achieve organizational goals - have greater formal responsibility, accountability and control than leaders - directs willing and unwilling subordinates

authority - obtains power through other means such as influence - has a wide variety of roles than managers do - focuses on group process, informing, gathering, feedback and empowering others - emphasizes interpersonal relationships - have goals that may/may not reflect those of the organization - may or may not be part of the organization - directs willing followers

Macro Management Problem solving and quality management MANAGER Director Controller Micro management Blaming Problem identifying Telling and selling Subordinates

THEORIES OF LEADERSHIP
DEVELOPMENT OF LEADERSHIP THEORY (1900-PRESENT): Management and leadership theory is dynamic What is known and believed about leadership Contributes to change overtime LEADERSHIP THEORY: Describe the nature of leaders Who are they? What are their unique accomplishments? What are the situations where leadership intervention required? THEORIES OF LEADERSHIP: Theories of Leadership (1900-1940) Great Man (1841) Thomas Carlyle Born with the necessary characteristic to be great
Trait (1940)

LEADERSHIP CONCEPTS
People ask the difference between a leader and a boss The leader works in the open, and the boss in convert. The leader leads, and the boss drives. Theodore Roosevelt 3 ESSENTIAL ROLES OF LEADERS: Define task Achieve the task Maintain effective relationships PRINCIPLES OF LEADERSHIP: Leaders are made not born It can be learned It requires certain traits No one best style or leadership PROCESS OF LEADERSHIP: Vision Mission Critical Success factors Goal Actions Steps Results! FUNCTIONS OF A LEADER: Motivator Mentors Confessors Cheerleaders Coaches Role models Sounding boards

LEADER AND MANAGER

LEADER Facilitator Coordinator Peers or followers Inspiring and integrating Coaching and challenging

C. Bird Inherited could be obtain through learning and experience Behavioral Theory (1940-1980) Leadership Style (Kurt Lewin) Authoritarian Leader dependence Strong control is maintained Motivated by coercion Communication downward I Democratic Leader Independence Less control Directed through suggestion and guidance Communication flows up and down Decision making involves others We Laissez-faire Leader Chaos No control No direction Humanistic (1960) Ability to manage people more than organization resources Social environment Theory X and Theory Y McGregor X controlled, coerced with threaten Y self-directed, self-control Theory Z (1965) W.G. Ouchi Lifetime employment

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 Slow promotion

Self-Actualization (1965)
Abraham Maslow

Contingency Approach (1960)

F.E. Fieldler Task structured Leader-maker Position power Path Goal (1971) R.J. House Minimize obstruction Situational (1950-1977) Hershey and Bianchard The follower become leader in some situation Servant Leadership (1977, 1991) Natural feeling that one wants to serve Charismatic (1994) Max Weber Inspires by obtaining emotional commitment Strong beliefs, high, self confidence Transformational (1994) Heinrich von Pierer Valuing Empowering Promoting quality Visionary (1994) P. Senge To follow vision through self confidence Empathy Ethical (1994) R. Heifets

Formal those who are officially assigned leadership responsibilities within the organization Basis for Informal Formal Comparison General Unofficial Official Major Power and Authority and concepts politics responsibility Primary Focus Person Position Source of Given by Delegated by power group management Guidelines for Norms Rules behavior Sources of Sanctions Rewards and control penalties

FACTORS OF LEADERSHIP
Situation Follower Leader Communication

HOW TO BECOME A GOOD LEADER

Know yourself and seek self improvement Be technically proficient Know your people and look for their well-being Keep your workers informed Seek responsibility and take responsibility for your actions Ensure that the tasks are understood, supervised and accomplished Develop a sense of responsibility in your workers Train a team Use the full capabilities of your organization

QUALITIES OF A LEADER (MAXWELL)

Character Charisma Commitment Communication Competency Courage Discernment Focus Positive Attitude Problem Solving Relationship Responsible Generosity Initiative Listening Passion Security Servant hood Self Discipline Teach ability Vision

MORAL ASPECT OF LEADERSHIP

Release of human potential Mutual interdependence of individual and group Maintain and review values Foster individual initiative and responsibility VALUES: Deeply held values and principles provide the road map for the way we lead and the way other people respond to us Managers are people who do things right while leaders are people who do the right thing Warren Bennis PhD KNOW the four factors of leadership (follower, leader, communication, situation) KNOW yourself KNOW human nature DO provide direction DO implement DO motivate BE a professional BE a professional who possesses good characteristics

ABC OF LEADERSHIP
Positive Attitude Self knowledge Effective Behavior Communication skills Personal Confidence Transformative practice

PHASES OF LEADERSHIP GROWTH

Phase 1 I dont know what I dont know Phase 2 I know what I dont know Phase 3 I grow and know and its starts to show Phase 4 I simply go because of what I know Ineffective 1 and 2 Effective 3 and 4

FORMAL AND INFORMAL LEADERS

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PROFESSIONAL AND PERSONAL DEVELOPMENT

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ETHICO-MORAL ASPECTS OF NURSING PRACTICE

ETHOS: meaning MORAL DUTY, the practical science of the morality of human conduct MORALS: specific behaviors to accomplish ethical practices HEALTH ETHICS: division of ethics that relate to human health; also termed as the ethics for the health profession PROFESSIONAL ETHICS: obligations of professional to the general public BIOETHICS: moral issues in the field of health

NURSING ETHICS
(Venzon, et. Al) the interrelatedness of all principles of right conduct as they apply to nursing profession (Johnson) examination of all ethical and bioethical issues from the prospective of nursing PURPOSES OF NURSING ETHICS: it directs and teaches the professional nurse how they should act and how it should be it pertains to the manner of acting and the means to do a certain act in the right way IMPORTANCE OF BIOETHICS: Every health care provider is a moral agent The health care provider must make his decisions responsibility through correct moral reasoning and well grounded judgment

PROFESSIONAL CODE

Body of information that nurses confer or consult in making decisions 2 TYPES: Code of Ethics consists of declarations of faith and ideas, which the profession upholds and the members conform and follow Code of Conduct consists of a paradigm of moral action or a framework of behavior, it is of guideline professional behavior

LAW

A system of principles and practices by which people who live in a society deal with their disputes and problems, seeking to solve or settle without resort to force Serve as a guide to conduct The sum total of rules and regulations by which society is governed; rule of conduct pronounced by controlling authorities Rules of conduct, established and enforced by authority, which prohibit extremes in behavior so that one can live without fear for one self or ones property CLASSIFICATION OF LAW (in general): Divine Law authority GOD Human Law authored by man Public Law applies generally to people of state enacting it Criminal Law treats of the nature, extent and degree of every crime

International Law regulates the intercourse of nations Political Law - defines the organization and operation of the government organs of the state and regulates relation between state and individual that compose it Private Law relates to private matters that do not concern public at large and administered between citizen and citizen Civil Law has double purpose of organizing the family and regulating property Commercial Law relates to the rights of property and the relations of persons engaged in commerce Remedial Law- prescribes method of enforcing rights obtaining redress of their invasion LEGAL RIGHT That which a man entitled to have or to do, or to receive from others within the limits prescribed by law That right to which the states gives sanction A claim which can be enforced by legal means against persons or the community whose duty is respect it PURPOSES OF STUDYING ETHICO-LEGAL AND LEGISLATIVE ISSUES: Serves as guide in the performance of nursing functions and responsibilities addressed by the law Reflect certain concepts of the law in the day to day functions and tasks Prevent/resolve conflict that may affect basic societal and individual rights Appreciate nursings overall mission, its limits and constraints Analyze impact of law/legislative issue on nursing ESSENTIAL SOURCES OF LAW: Constitution Statutes/legislation Regulations issued by executive branch of government Case decisions/judicial opinions Presidential decrees Letters if instructions TYPES OF LAW: Tort legal wrong committed against a person or property, e.g. assault, battery Unintentional negligent acts Intentional presence of interest to harm another person Liability obligation incurred or might incurred due to actions or failure to act Personal individual person is liable for his/her actions Vicarious negligence is assumed due to association with negligent person Corporate the organization is responsible for wrongful conduct of its subordinate

LEGAL ISSUES OF NURSING

PATIENT CARE ISSUES:

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 Patients rights Invasion of privacy Confidentiality Informed consent Sexual Harassment Occupational safety MANAGEMENT ISSUES: Delegation and supervision Staffing Job reassignment (floating) Policies and procedures Incompetent practice Sexual Harassment Occupational safety SCOPE OF NURSING: Provide nursing care utilizing nursing process Establish linkages with community resources and coordination with health team Promote Health education Teach, guide and supervise students in nursing education programs Undertake nursing and health human resource development, training and research

Future inheritance in case expressly authorized by law All services which are not contrary to law, morals, good customs, public order and public policy CAUSE OF CONTRACT: Consideration of the contract that is the inducement to it or the motive price, or impelling influence which induces a contracting party to enter into the contract Contract to be valid must have sufficient cause or consideration

WILL
An act whereby a person is permitted the formalities prescribed by law to control to a certain degree the disposition of his estate to take effect after his death Making of a will is a strictly personal act No one can lawfully substitute his intention and will Mere mechanical work writing the testators work may be done by a third person TESTATORY CAPACITIES: Ability to comprehend the nature of the transaction in which the testator is engaged at the time To recollect the property to be disposed of and the persons who would naturally be supported to have claims upon the testator To comprehend the manner in which the instrument will distribute his property among the objects of his bounty Testator must be of sound mind at time of execution HOLOGRAPHIC WILL: With entirely written, dated, and singed by hand of the testator himself Subject to no form and need not be witnessed The disposition of the testator written below his signature must be dated and signed by him for validity DISALLOWANCE OF WILL: If will was not executed and attested in accordance with formalities required by law If testator at time of execution of will was in sense or otherwise mentally incapable of making a will If testator executed will through force or under duress or influence of fear/threats If will was procured through undue and improper pressure and influence by the beneficiary or some other persons for the benefit of beneficiary Of the signature of the testator was procured by fraud or trick If testator acted by mistake or did not intend at the time he affixed his signature to the will that instrument he signed should be his will

CONTRACT
An agreement which creates an obligation Agreement upon sufficient consideration to do or not to do a particular thing Meeting of minds of mind between 2 persons/parties whereby one birds himself with respect to the other, to give something or to render some services (Civil Code) TYPES: Express Agreement is formal and stated either verbally or in writing Terms of agreement are declared by the parties in writing or verbally at the time it is entered into Implied Agreement is presumed or inferred from the acts of the parties May also arise from mere consent VALIDITY OF CONTRACT: Must be binding on both contracting parties Contracting parties may established such stipulations, clauses terms and conditions deemed convenient provided not contrary to law, morals, good customs, public order or public policy Obligations arising from contracts have the force of law between the contracting parties and should complied in good faith STATUTORY REQUISITES OF A CONTRACT (ESSENTIAL REQUISITES WITHOUT THERE CAN BE NO CONTRACT): Consent of the contracting parties Object certain which is the subject matter of the contract Cause of established obligation OBJECT/SUBJECT MATTER OF A CONTRACT: All things which are not outside the commerce of men, including future things All rights which are not in transmissible

NURSES AND CRIMINAL LIABILITY

Nurse may incur criminal liability Performing an act offensive against persons or property Committing a felony Acts or omissions punishable by law committed by: Deceit (dolo) performed with deliberate intent freedom intelligence elements essential in a criminal

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 (Culpa) - wrongful act results from imprudence, negligence, lack of foresight/ lack of still CONSPIRACY: Exists when two or more persons come to an agreement concerning the commission of a felony and decide to commit it CLASSIFICATION OF PERSONS CRIMINALLY LIABLE: Principal Those who take a direct part in execution of the act of Those who take directly force/induce others to commit it Those who cooperate in the commission of the offense of another act which the crime Accomplices Persons not being principles by direct participation inducement or cooperation through another act essential to the consummation of the crime cooperate in the execution of the offense by previous or simultaneous acts Known also as accessory before the act Accessories Those who having knowledge of the commission of the crime and without having participated therein either as principal or accomplice, take part subsequent to its commission in any of the following manners: By profiting themselves or assisting the offenders to profit by the effects of the crime By concealing or destroying the body of the crime, or the effects or instruments thereof, in order to prevent its discovery By harboring, concealing or assisting in the escape of the principal of the crime CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY: Justifying Circumstances circumstances surrounding the commission of a crime may be justified by: Act in defense of oneself of his rights Act in fulfillment of a duty under order of a superior Exempting Circumstances imbecile, under 9 y/o, under 15 y/o, merely an accident without intention, under compulsion of an irresistible force, uncontrollable fear, prevented by lawful or insuperable cause Mitigating Circumstances does not constitute justification but in fairness and mercy may be considered extending or reducing the degree of moral capability Aggravating Circumstances increase the criminal liability of the offender or make his guilt more severe these includes taking advantage, committed with insult to public authority and abuse, committed in consideration of a reward, causing intentional damage Alternative Circumstances
Fault

those which must be taken into consideration as

aggravating or mitigating according to the nature and effect of the crime and other conditions attending its commission; these are usually relationship of intoxication to the degree of instruction

LEGAL DOCTRINES
FORCE MAJEURE an irresistible or superior force it is a fact or accident which human prudence can neither foresee nor prevent extraordinary circumstances cause the act which is independent of the actor HOLD-OVER DOCTRINE the principle under which a public officer is permitted to continue in possession of an office and to continue to exercise the functions of the office after the end of his lawful term JUS SOLIS the principle that the nationality of a person is determined by the law of the place of his birth RES IPSA LOQUITOR the thing speaks for itself under this doctrine the defendant is presumed to be negligent where the instrumentality causing anothers injury was in the defendants control and where the accident was one which ordinarily does not happen in the absence of someones RESPONDENT SUPERIOR Let the superior answer, let the principal answer for the acts of his agent Under the legal maxim, the principal or master is answerable for the acts of his agent or servant DOCTRINE OF NEGLIGENT CONDUCT the nurse is liable for negligent conduct DOCTRINE FOR DAMNUM ABSQUE INJURIA although there was damage, there was no legal injury

INFORMED CONSENT

Related to the principle of autonomy and respect for person Any procedure to be done on a person may only be administered with his free and informed consent Gives valid permission for others to act in certain specific ways ELEMENTS OF INFORMED CONSENT: Knowledge Information disclosure by the health care provider, truth of the proposed action, its nature, probable benefits, possible risks, and alternative options comprehensive subject Consent Subject competence (decisions based on the reasons) Subject freedom (able to choose and act without undue pressure of time, emotional upset,

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confusion, persuasion, threat, deception, manipulation, fear) LEGAL DOCTRINES OF NURSING PRACTICE: Malfeasance, Misfeasance, and Nonfeasance Performance of action not to be done, improper performance of an action, omission of an action ought to be done Doctrine of Informed consent The right to information and decide voluntarily Doctors order rule It is legally safe to follow doctors order Good Samaritan Law A nurse or any persons with proper knowledge and skill may render first aid or treatment at the scene of an emergency and who does so within the standard of care, acting in good faith, is relieved of the consequences of the act Negligence Refers to the commission or omission of an act, pursuant to a duty, that a reasonable prudent person in the similar circumstance would or would not do and the acting or the non-acting of which is the proximate cause of injury to another person or his property Elements of Professional Negligence: Existence of a duty on the part of the person charged to use due care under circumstances Failure to meet the standard of due care The foreseeability of harm resulting from failure to meet the standard The fact that the breach of this standard resulted in Malpractice Improper or unskillful care of patient by a nurse, also may be considered as stepping beyond ones authority with serious consequences negligence or carelessness of professional personnel negligent act committed in the course of professional performance

PRC BOARD OF NURSING

PD 223 created the professional regulations commission and prescribed its power and functions June 23, 1973 Composition Chairman and members representing 3 areas of nursing (NE, NS, CHN) QUALIFICATIONS: Natural born citizen, permanent resident of the Philippines Masters in Nursing, education or allied medical profession At least 10 years of continuous practice of profession, last 5 years in the Philippines Member of good standing of the accredited professional organization of nurses Good moral character POWERS AND DUTIES OF THE BOARD OF NURSING: Conduct licensure exam Issue, suspend or revoke Monitor and enforce quality standards of nursing practice Ensure quality nursing education Conduct hearings/ investigations Promulgate Code of Ethics in coordination with accredited professional organization Recognize nursing specialty organization Prescribe, adopt, issue and promulgate guidelines and decisions for improvement of nursing practice and advancement of profession QUALITIES OF NURSING EXAMINES: Filipino citizens BSN graduate from an accredited college/university good moral character REGISTRATION OF RECIPROCITY: professional license issued without examination to nurses registered under foreign laws Requirements: Licensure in said country substantially the same as prescribed by Philippine Nursing Act Laws of said state/country grant same privileges to registered nurses of the Philippines in sane basis as their citizens From Foreign countries (Licensed nurses granted special/temporary permit): Internationally well-known specialists or outstanding experts in any filed of nursing who renders service for free or not free Those on a medical mission whose services shall be free in a particular hospital, center/clinic Those employed as exchange professors in specially of nursing by school/colleges of nursing Note: Permit maybe issued by the BON subject to approval of the commission and upon payment of prescribed fee. Permit effective only for duration of the project, medical, Revocation or Suspension of Professional License and Certificate of Registration: Criminal offense involving moral turpitude (unprofessional and unethical conduct) Gross impotence/ serious ignorance

REPUBLIC ACT NO. 9173

Philippine Nursing Act of 2002 (Changes in the new law): Section 4 members of the board of examiners Section 23 suspension of license not to exceed 4 years Section 26 requirements for inactive nurse returnees Section 28 scope of nursing practice, emphasizes code of ethics, safe practice, APO-NPA Section 32 salary scale Section 34 funding for comprehensive nursing specialty program by PCSO Section 35 incentive and benefits non-cash in nature standard nurse-patient ratio

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 Malpractice/negligence Guilty of fraud, deceit or false statements to

obtain certification of registration

Violation of Nursing Act, Code of Ethics for

Nurses, technical standards of nursing practice

Practicing professional

TERMINOLOGIES
REVOCATION recall of a power or authority that was conferred of Elimination of the professional statue of a professional nurse CANCELLATION to annul or to render void/invalid SUSPENSION forced temporary withdrawal from the practice of nursing. Stop temporarily privilege CRIMINAL OFFENSE violation of law with malicious intent or with intent to injure others MORAL TURPTITUDE an act contrary to the accepted and customary rule of right and duty between man and his fellow men or society in general IMMORAL CONDUCT personal behavior contrary to good morals or inconsistent with the rules and principles of morality behavior harmful to public welfare according to standards of the community DISHONORABLE CONDUCT personal behavior that is disreputable, discreditable, disgraceful, shameful or scandalous personal conduct which stains persons character or lessens his reputation UNPROFESSIONAL CONDUCT behavior that is unbecoming a member of a profession in good standing behavior violates rules or ethical code of the profession

PHILIPPINE NURSING ACT OF 2002

ARTICLE I TITLE Section 1. Title. This Act shall be known as the "Philippine Nursing Act of 2002." ARTICLE II DECLARATION OF POLICY Section 2. Declaration of Policy. It is hereby declared the policy of the State to assume responsibility for the protection and improvement of the nursing profession by instituting measures that will result in relevant nursing education, humane working conditions, better career prospects and a dignified existence for our nurses. The State hereby guarantees the delivery of quality basic health services through an adequate nursing personnel system throughout the country. ARTICLE III ORGANIZATION OF THE BOARD OF NURSING

Section 3. There shall be created a Professional Regulatory Board of Nursing, hereinafter referred to as the Board, to be composed of a Chairperson and six (6) members. They shall be appointed by the president of the Republic of the Philippines from among two (2) recommendees, Per vacancy, of the Professional Regulation Commission, hereinafter referred to as the Commission, chosen and ranked from a list of three (3) nominees, per vacancy, of the accredited professional organization of nurses in the Philippines who possess the qualifications prescribed in Section 4 of this Act. Section 4. Qualifications of the Chairperson and Members of the Board. The Chairperson and Members of the Board shall, at the time of their appointment, possess the following qualifications:; Be a natural born citizen and resident of the Philippines Be a member of good standing of the accredited professional organization of nurses Be a registered nurse and holder of a master's degree in nursing, education or other allied medical profession conferred by a college or university duly recognized by the Government: Provided, That the majority of the members of the Board shall be holders of a master's degree in nursing: Provided, further, That the Chairperson shall be a holder of a master's degree in nursing; Have at least ten (10) years of continuous practice of the profession prior to appointment: Provided, however, That the last five (5) years of which shallbe in the Philippines; and Not have been convicted of any offense involving moral turpitude; Provided, That the membership to the Board shall represent the three (3) areas of nursing, namely: nursing education, nursing service and community health nursing. Section 5. Requirements Upon Qualification as Member of the Board of Nursing. Any person appointed as Chairperson or Member of the Board shall immediately resign from any teaching position in any school, college, university or institution offering Bachelor of Science in Nursing and/or review program for the local nursing board examinations or in any office or employment in the government or any subdivision, agency or instrumentality thereof, including government-owned or controlled corporations or their subsidiaries as well as these employed in the private sector. He/she shall not have any pecuniary interest in or administrative supervision over any institution offering Bachelor of Science in Nursing including review classes.

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 Section 6. Term of Office.

The Chairperson and Members of the Board shall

hold office for a term of three (3) years and until their successors shall have been appointed and qualified: Provided, That the Chairperson and members of the Board may be reappointed for another term. Any vacancy in the Board occurring within the term of a Member shall be filled for the unexpired portion of the term only. Each Member of the Board shall take the proper oath of office prior to the performance of his/her duties. The incumbent Chairperson and Members of the Board shall continue to serve for the remainder of their term under Republic Act No. 7164 until their replacements have been appointed by the President and shall have been duly qualified. Section 7. Compensation of the Board Members. The Chairperson and Members of the Board shall receive compensation and allowances comparable to the compensation and allowances received by the Chairperson and members of other professional regulatory boards. Section 8. Administrative Supervision of the Board, Custodian of its Records Secretariat and Support Services. The Board shall be under the administrative supervision of the Commission. All records of the Board, including applications for examinations, administrative and other investigative cases conducted by the Board shall be under the custody of the Commission. The Commission shall designate the Secretary of the Board and shall provide the secretariat and other support services to implement the provisions of this Act. Section 9. Powers and Duties of the Board. The Board shall supervise and regulate the practice of the nursing profession and shall have the following powers, duties and functions: Conduct the licensure examination for nurses Issue, suspend or revoke certificates of registration for the practice of nursing Monitor and enforce quality standards of nursing practice in the Philippines and exercise the powers necessary to ensure the maintenance of efficient, ethical and technical, moral and professional standards in the practice of nursing taking into account the health needs of the nation Ensure quality nursing education by examining the prescribed facilities of universities or colleges of nursing or departments of nursing education and those seeking permission to open nursing courses to ensure that standards of nursing education are properly complied with and maintained at all times. The authority to open and close colleges of nursing and/or nursing education programs shall be vested on the Commission on Higher Education

upon the written recommendation of the Board Conduct hearings and investigations to resolve complaints against nurse practitioners for unethical and unprofessional conduct and violations of this Act, or its rules and regulations and in connection therewith, issue subpoena ad testificandum (writ of summons to testify orally) but it includes clauses to bring in hand books, papers, etc. for the court). And subpoena duces tecum( "bring with you under penalty of punishment") is a court summons to appear and produce tangible evidence for use at a hearing or trial) to secure the appearance of respondents and witnesses and the production of documents and punish with contempt persons obstructing, impeding and/or otherwise interfering with the conduct of such proceedings, upon application with the court Promulgate a Code of Ethics in coordination and consultation with the accredited professional organization of nurses within one (1) year from the effectivity of this Act Recognize nursing specialty organizations in coordination with the accredited professional organization

REPUBLIC ACTS
REPUBLIC ACTS RA 6675 RA 9165 RA 953 RA 9262 RA 7610 RA 7658 RA 6809 RA 8172 RA 3573 RA 7305 RA 8749 RA 6713 RA 8344 RA 7160 RA 2644 RA 2382 RA 9710 RA 7600 RA 7432 RA 9257 RA 9994 RA 8423 TITLE Generic Drugs Act of 1988 Comprehensive Dangerous Drug Act of 2002 Narcotic Drug Act Antiviolence against Women and their Children Act Anti-child abuse Act prohibiting employment of children below 15 y/o Emancipation Law Salt Iodization Providing Prevention and Supression of dangerous communicable diseases Magna Carta for Public Health Workers Phil. Clean Air Act of 1999 Code of Conduct and Ethical Standards for Public Officials and employees Act penalizing refusal of hospital/medical clinic to administer emergency treatment Local Govt Code Phil Midwifery Act Practice of Medicine by Nurses Magna Carta for Women Rooming in and breast feeding Act of 1992 Senior Citizens Act of 1992 Senior citizens Act of 2004 Expanded Senior citizens Act of 2010 Establishment of traditional and alternative

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RA 877 RA 4704 RA 7305 RA 8981 RA 9262 RA 9439 BON Resolution #220 BON Resolution # 112 CHED Memo Order # 30 EO 496 HB 4110 HB 5043 HB 13

health care Philippine Nursing Law 1953 Philippine Nursing Law 1966 The Magna Carta of Public Health Workers The PRC Modernization Act of 2000 Anti Violence Against Women & Children Act 2004 Hospital Detention Bill 2007 The Code of Ethics for the Registered Nurse Competency Standards for Nursing Practice 2003 (11 Competencies) Updated Policies and Standards for Nursing Education Procedures/criteria for Selection of Nominees for Vacant Positions in the PRC Reproductive Health Bill The Philippine Reproductive Health Bill and Population Development Act of 2008 Providing for the Safety and Protection of the Unborn Child and for other Purposes (R. Goilez) The New Anti-Abortion Act of 2010 (A.S. Bagatsing) Protection of the Unborn Child Act of 2010 (JP Enrile) Mental Health Patients Bill of Rights Child and Youth Welfare Code Immediate registration of birth w/in 30 days Compulsory Basic Immunization Sanitation Code of the Philippines Administrative Order related to EINC Bill of Rights

PERSONAL/PROFESSIONAL
STAFF DEVELOPMENT
The provision of creative and consistent high-quality education to adult learners who practice nursing in an environment of rapid advances in technology, budget constraints, and sophisticated performance improvement techniques It is based on a philosophy of ADULT EDUCATION that utilizes teaching-learning principles and concepts that apply to people who have a combination of responsibilities (such as in the including family, financial obligations, employment commitment, and identified areas of interest or specialization) Nurses who are adult learners combines many of these traditional adult responsibilities with the demands of increasingly complex societal and health care provider roles AIM OF STAFF DEVELOPMENT PROGRAMS: to educate the whole person towards building competencies for performing various roles in life (Malcolm Knowles, 1978) ROLE OF MOTIVATION IN STAFF DEVELOPMENT: Motivation is the energy that causes adults to strive toward competence that are important STAFF DEVELOPMENT PROCESS: Focuses on developing nursing skills and knowledge within a comprehensive program that includes: Orientation Introduces employees to new situations and includes content related to philosophies, goals, policies, procedures, personnel, benefits, role expectations, and physical facilities Orientation is essential every time there is change in the roles responsibilities of a nurse In-service Education Provides learning experiences in the work setting for the purpose of: Refining basic skills Developing new skills and knowledgerelated to job performance These learning experiences are aimed at only one competency or knowledge area and are usually narrow in scope and conducted in a short period of time Continuing Education Program are planned and organized around learning experiences in a variety of settings that are intended to build on the educational and experiential bases of the nurse it offers nurses new approaches to health care delivery and enhance practice, education, administration, research, and theory development Example includes workshops, conferences, self-learning modules and seminars Job-related Counseling

HB 3667 SB 2497 SB 1695 PD 603 PD 651 PD 996 PD 856 Phil constitution Art. 3 Sec 1 AO 2007-0026

Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternal and Newborn Care Services AO 2008 0029 Implementing Health Reforms for the Rapid Reduction of Maternal and Neonatal Mortality AO 2009 0025 Adopting New Policies and Protocol on Essential Newborn Care AO 2010-0036 The Aquino Health Agenda: Achieving Universal Health Care for All Filipinos WHO GUIDELINES: Baby Friendly Health Initiatives: Revised, Updated and Expanded for Integrated Care : Section 4 Hospital Self-appraisal and Monitoring (January 2006) Pregnancy, Childbirth, Postpartum and Newborn Care: A Guide for Essential Practice (Integrated Management of Pregnancy and Childbirth, 2006) WHO Recommendations for the Prevention of Postpartum Hemorrhage, 2006 Newborn Care until the First Week of Life Clinical Practice Pocket Guide, 2009 Philhealth Circular No. 011-2011 New Philhealth Care rates for Selected Medical Cases and Surgical Procedures and the No Balance Billing Policy

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 Involves promoting the professional growth of employees by assisting them to deliver their best job performance It may include counseling related to promotion possibilities and assistance in obtaining formal training in a specialized field PHILOSOPHY OF STAFF DEVELOPMENT: it must reflect the vision-mission and philosophy of the organization of which it is a part It needs to address the following: How learning takes place Teaching methods Employees responsibility for their own learning Organizational responsibility for providing staff development Clients right to health care MODELS OF STAFF DEVELOPMENT PROGRAM: Centralized Model An agency with a wide staff development department Composed of nursing and non-nursing multi departmental educators All departments collaborate in determining and planning the job needs of their staff Decentralized Model An in-service program managed by the nursing department It addresses the specific needs of the department that are solely nursing concerns Concerns may include the use and scheduling of classrooms, potential duplication of efforts and the cost of providing multiply small programs RESOURCES NEEDED FOR STAFF DEVELOPMENT: Personnel Nursing service administrators are responsible for staff development to promote quality client care The following are among their responsibilities: Providing financial and human resources Establishing policies for staff development Providing release time, finances, or both for staff to attend continuing education offerings Motivating employees to assume responsibility for their own professional development Providing mechanisms to identified staff growth needs Evaluating the effects of staff participation in continuing education offering on quality of client care Advisory Committees An advisory committee identify needs and resources and for planning programs. Member of the committee represent all fields of practice in the health care agencies CONSIDERATION IN DESIGNING A STAFF DEVELOPMENT PROGRAM: Needs Assessment Target population Development time Cost

Financial and human resources Analysis time Anonymity Objectivity Teaching Methods To maximize learning, staff should be aware of three important aspects involved in teaching adult learners: Collaboration between teacher and student is essential for active learning to occur Critical thinking may be seen as a basic principle of adult education Self-directed learning has an important place in the educational activities of adults Evaluation Evaluation is essential to provide staff with information to improve programs or determine whether training programs should be done continued Adult learners should have a sense of progress toward their goals and should be involved in evaluating their learning When measuring learning, a before and after approach should be used so that learning can be related to the training programs TECHNIQUES TO EVALUATE LEARNING: Observation of skills or behavior. Observation guides need to be developed and observers need to be told specifically what they should be scrutinizing Paper-and-pencil methods, such as true-false, multiple-choice, or fill-in-the blank tests Unobtrusive measures, e.g. chart reviews, audits, wear of textbook pages, or numbers of staff using self-directed learning modules PROGRAM EVALUATION: The content, process, and method of a program should be evaluated: What the participants liked or disliked about the program Whether the faculty and speakers were prepared Whether objectives were met How well the program was organized Whether the facilities were adequate Suggestion for improvement Suggestion for future programs TRANSITIONING TO ROLE OF SKILLED CLINICIAN: Embedded within the transition from school to work is the process of becoming a SKILLED CLINICIAN Dr. Patricia Benner studied the process of new nurse skill acquisition and critical thinking and concluded that NEW GRADUATESs perceptions of complex clinical situations were significantly different from those of nurses with more experience and skill STAGES OF SKILL ACQUISITION: Novice Applies theory learned in school Translates lessons into real-life patient care environment Learns the rule and rule-based reasoning Begins the use of intuition related to patient care

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successfully adjusting to numerous experiences with real patient care settings, the novice progresses to the advanced beginner stage Advanced Beginner Begins to discern among situational elements of clinical decision making Knows the rules that govern care in a situation but begins to understand how and when the rules can be applied based upon the patients condition, desire, and needs Feels overwhelmed by the effort required to notice all relevant elements and to remember and increasing number of more complicated rules. Competent Begins to understand and adopt a hierarchical perspective, i.e., to categorize the rules according to relevance and set priorities; Determines which elements in a situation are deemed to be important in creating nursing care plans Recognizes that decisions made has specific outcomes, and becomes emotionally involved in the outcome Proficient Performs interventions with concern and full involvement Has initiative and able to prioritize task at hand Performs required procedures with proficiency speed, and confidence Actions become easier and less stressful Expert Able to handle complex and unique situation Develops the ability to discriminate and choose one priority over another that requires maturity and practice Learns and gains experience in the new specialty Joins organizations where he/she can meet his/her professional goal FIELDS OF SPECIALIZATION: Institutional nursing (Staff Nursing) In-service Education Public Health Nursing Occupational Health/Industrial Nursing School Health Clinical Nurse Private Duty Nursing Military Nursing Advanced Practice Nursing Independent Nurse Practitioner Legal Nursing Consultant Nurse Informatician Nursing Education Flight Cruise Nursing

After

First Wave Early 1900s Filipinos served as plantation workers of farmlands in Hawaii, Guam, and other US territories Second Wave 1950s Filipino nurses, doctors, engineers, teachers and other professionals by thousands hurdled to the US Mainland and European continent Third Wave 1980s when petrodollar countries in the Middle East required construction workers Fourth Wave 1990s the verge of the feminization of migration high for women to serve as house helps, entertainers, teachers, nannies, caregivers, etc CAUSES OF MIGRATION: Economic Employment to a better job (Financial/ Professional growth)
Employees of:

MIGRATION

The movement of persons from one country or locality to another A group of people migrating together (especially in some given time period) WAVES OF MIGRATION:

Transnational corporations International NGOs Diplomatic Corps expatriates Non-economic Missionary work Education Retirement migration (migration from rich countries to lower-cost countries with better climate) Persecution Asylum Personal Based on relationships Marriage Reunion with family ACCULTURATION The process whereby the attitudes and or behaviors of people from one culture are modified as a result of contract with a different culture It implies a mutual influence in which elements of two cultures mingle and merge Deals broadly with changes in cultural attitudes between two distinct cultures Focus on the group rather than the individual and on how minority or immigrant groups relate to the dominant or host society Ethnic identity as an aspect of acculturation is concern with individuals and how they relate to their own group as a subgroup of the larger society Two Distinct Models of Acculturation: Linear Model a strong ethnic identity is not possible among those who become involved in the mainstream society and that acculturation is inevitably accompanied by a weakening of ethnic identity Two-dimensional Model Suggests that both the relationship with the traditional or ethnic culture and the relationship with the new or dominant culture play important roles in the process

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 Acculturation Process (JW Berry): Assimilation Movement toward the dominant culture Integration Synthesis of the two cultures Rejection Reaffirmation of the traditional culture, or marginalization (alienation from both cultures) Measures of Acculturation: All of the scales used to measure acculturation include: SECOND-LANGUAGE PROFICIENCY because being able to communicate in the language of the host culture is a prerequisite to learning about it PATTERNS of language use, friendship choices, food, music or movie preference, cultural awareness, ethnic pride, place of bitch, and contact with ones homeland PERCENTAGE of ones lifetime spent in the host country Ones age at the time of immigration (have been shown to correlate with more extensive and detailed measures of acculturation and are therefore good indicators of an individuals level of acculturation when more detailed information is unavailable) AGING POPULATION: Demography International UN (2000) 590 million, and by 2025 to over 1.1 billion, that is an increase of 224 percent since 1975 Constitute 13.7 percent of the worlds population National The total population of the Philippines stand at 73,130,885 The elderly population is equal to 4,280,364 or 5.8 percent of our population Issues on the Aging Population Security in old age Occurrence of abuse committed Health status Policies and legislative for welfare Economic impact of aging Complementary Therapy They go along with the medical care they receive from their health care provider They are used alongside the more standard medical care you receive (e.g. herbal teas with acupuncture) They dont fit into the mainstream of Western medicine and health care Common Complimentary Therapies: Physical (body) therapies Yoga

Massage Acupuncture Relaxation techniques such as meditation and visualization Herbal medicine (organic plants) MEDICAL TOURISM Medical Tourism Philippines Welcomes tourists from all over the world to visit the Philippines for medical and leisure needs The most common procedure are cosmetic and plastic surgery dermatology, weight loss surgery, ophthalmology and dentistry

PERSONAL DEVELOPMENT
is our conscious self-improvement and self-transience it is the aspiration to realize our higher self

NURSING AS A CALLING is nursing just a good career where job prospects are good? or Is nursing more than a job; its a calling. Calling Deep desire to devote oneself to serving people according to the high values of the task or profession Direct invitation or commissioning from God for a specific task or assignment that God wants us to do NURSING AS A VOCATION Nursing is Doing good deeds People-oriented Character building NURSING PROFESSION nursing is a profession focused on assisting individuals, families, and communities in attaining, maintaining, and recovering optimal health and functioning Profession is a calling wherein each member profess to have acquired the knowledge, skills, and attitude necessary to guide others in that special field PERSONAL DEVELOPMENT TIPS: identify own strengths, weaknesses, limitations determine personal and professional goals pursue continuing education support activities related to nursing and health issues adopt a positive attitude towards change and criticism CAREER PLANNING career choices are life choices, take them seriously, do it right Jobs paid occupation; something you do regularly for pay Career is a long-term of life time job, a profession you choose to spent the rest, or most, of your time in Career Planning to plan what job you would like to do for most, or rest of your life; is a lifelong process and it includes: choosing an occupation

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getting a job growing in your job possibly changing careers and eventually retiring Career Planning Process: Knowing Yourself Do self-assessment: Interests Values Roles Skills/aptitudes Preferred environment Developmental needs Your realities Exploring your Options Know which occupations interest you Research the labor market Research on the institutions you wish to work for When you have narrowed down your options, you get specific information by: Networking Part time work Internships Volunteer opportunities Written materials Informational interviews Making Decision/Match Try to identify possible occupations Evaluate these occupations Explore alternatives Choose both a short term and a long term option Moving on/Action Work towards goal by: Investigating sources of additional training and education, if needed Develop a job search strategy Write a good resume Gather information about the company Learn to compose effective cover letters Prepare for job interviews Learn to adopt to change NURSING CAREER Getting started Wrong idea: just to get the first job Correct idea: find the job that fits you and that is a good first step on the path to a lifelong career in nursing FOCUS: long-term career goals and the avenue by which they can be reached SWOT: An in-depth look at what will make you truly happy in your work, use it for initial assessment of the job market Strengths Relevant work experience Advanced education Additional product knowledge Good communication and people skills Computer skills Self-managed learning skills

Flexibility
Weaknesses

Poor communication and people skills Inflexibility Lack of interest in further training Difficulty adapting to change Inability to see health care as a business Opportunities Expanding markets in health care New applications of technology New products and diversification Increasing at risk populations Threats Increased competition among health care facilities Changes in government regulation Beginning the Search Be psychologically self-employed Your career belongs to you, not your employer Security and advancement on the job are up to you Security may be elusive, but opportunities for nurses are growing every day Learn for employability Take personal responsibility for your career success Learn for your current position but also for your next position Technical, people skills, work in teams and make presentations Plan for your financial future Ask yourself, How can I spend less, earn more, and manage better? Decisions based on financial matters makes one feel trapped and note secured Develop multiple options Moving up is only one option Be aware of emerging trends in nursing, adjacent fields, lateral moves, projects Build a safety net Networking is extremely important Join professional organizations Take time to build long term nursing relationships Interview Questions: What is your philosophy of nursing? Relate it to the position you are seeking What is your greatest weakness? Strengths? Start with weakness (make it sound like a desirable characteristic); state the obvious (e.g. lack of experience) End with a positive note (Strengths) Where do you see yourself in 5 years? Do not employers think that you will use position as a brief stop on the path to another job Answers should reflect the career plan in tune with the organizations needs (get history of position.. investigate how long staff stays) What are your educational goals? Be honest and specific

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 RN, MAN, other trainings Foreign language, computers Indicate school Describe your leadership style. How effectively you work with others Give examples of how you have implemented your leadership in the past What can you contribute to this position? Review SWOT and job description Be specific in relating your contributions to the position What are your salary requirements? You may be asked minimum salary range Investigate employers salary range for this position beforehand Be honest with your expectations, but make it clear you are willing to negotiate What if questions Competency-based reviews Be concise Focus on hospitals philosophy and goals If you dont know the answer, tell them how you will go about getting the answer (You are a new graduate, you are not expected that you know everything) Personal Questions: How would you describe yourself? Repeat what is in resume/cover letter How would your peers interview Say only strengths What would make you happy with this position Discuss needs related to your work environment Do you enjoy self-direction, flexible hours, and strong leadership support? cite specifics related to your ideal work environment Describe your ideal work environment; Describe hobbies, community activities, and recreation Brevity is important This is just used to gauge communication and interpersonal skills You May Ask: What is this positions key responsibility What kind of person are you looking for What are the challenges of the position Why is this position open To whom would I report directly Why did the previous person leave this position What is the salary for this position What are the opportunities for advancement What kind of opportunities are there for continuing education CAREER MAPPING Career maps contain detailed information to facilitate choices based on individuals talent and organizational needs. Thus, they enable HR organizations and employees separately or together to choose development paths that build intersections between career aspirations and the needs of the business

jobs come and go but people who are the best at what they do and who have achieve the highest recognition for their skills and knowledge in their profession are treasured forever. Career Maps: Like a GPS in your care Display alternative routes to build mastery in the core professions Mastery is being the best you can be Those who achieve mastery of their profession or trades are leaders, mentors, and innovators The knowledge, skills, and ability that mastery requires is enduring and guides both simple dayto-day decisions as well as complex challenges Other Desirable Skills: Oral and written communication Ability to assume responsibility Interpersonal skill Proficiency/technical competence Teamwork ability Willingness to work hard Leadership abilities Motivation, flexibility, initiative Critical thinking and analytical skills Computer knowledge Problem solving/decision making Where to look for jobs: Public employment agencies Private employment agencies HR departments Information from friends/relatives Newspapers, professional journals College and university career centers Career and job fairs Internet websites Other professionals (networking)

CORE-COMPETENCY STANDARDS
SIGNIFICANCE OF THE CORE COMPETENCY STANDARDS: The core competency standards will serve as a unifying framework for nursing education, regulation and practice Guide in developing curriculum in nursing framework in developing test syllabus for entrants into the nursing profession Tool for performance, evaluation among nurses Basis for advance practice and specialization Framework for developing a training curriculum for nurses Protect the public from incompetent practitioners Yardstick for unethical ad unprofessional practice for nursing CORE COMPETENCIES FOR THE ENTRY-LEVEL: 11 core competencies areas for nursing practice that were identified which include the following: Safe and quality nursing care Management of resources and environment Health education Legal responsibility Ethico-moral responsibility Personal and professional development

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 Quality improvement Research Record management Communication Collaboration and team work APPLICATION OF CORE COMPETENCY IN NURSING PRACTICE:: Assessment of the individual patient needs for nursing: Establishes rapport and trust with the patient, family and significant others Welcomes the patient, family and significant others on admission Greets patient by name, introduces self and co-staff Communicates in a friendly, polite and tactful manner Encourages verbalization of needs and feelings through attentive listening Convey availability and willingness to help by attending to needs at the soonest time possible Obtains a nursing history and does an initial and physical examination Applies the general principles of and follows a logical sequence in history taking and physical examination Recognizes normal and abnormal findings from common laboratory and diagnostic examination results Compares results from a standard listing of normal values/results of common laboratory and diagnostic examinations Defines health needs and problems from data gathered Identifies the significant findings from the nursing history , physical examination and laboratory/diagnostic test results Document all relevant information pertinent to patient care: Document all relevant information pertinent to patient care: Records where appropriate (kardex, flow sheets and/or nurses notes) assessments results, treatments and medications, nursing and other health care interventions, and other pertinent information Writes simply comprehensively and legibly Reports/endorses as appropriate Files reports relevant to patient care, where appropriate (report book/ communication book/others) Submits summary of endorsements of assigned patients to chare nurse or Nurse IV for inclusion in the endorsement report Records the disposition of dangerous drugs/narcotics Records in the disposition sheet the name, of the patient, ward and bed number. Amount given, date and time administered, name and dangerous drug license number (S2) of the prescribing

physician name and administering nurse

signature

of

SAFE AND QUALITY NURSING CARE

Demonstrate knowledge base on the health/ illness status of individual/groups Indentifies the health needs of the patients/groups Explains the health status of the patient/groups Provides sound decision making in the care of individuals/groups Identifies the problem Gathers data related to the problem Analyzes the data gathered Selects appropriate action Monitors the progress of the action taken Promotes safety and comfort of patients Performs age specific safety measures in all aspects of patient care Performs safe specific comfort measures in all aspects of patient care Sets priorities in nursing care based on patients needs Identifies the priority needs of the patients Analyzes the needs of patients Determines appropriate nursing care to be provided Ensures continuity of care Refers identified problem to appropriate individuals/ agencies Establishes means of providing continuous patient care Administers medications and other health therapeutics Conforms to the ten(10) golden rules of medication, administration in health therapeutics Utilizes nursing process framework for nursing. Performs comprehensive and systematic nursing assessment Obtains consent Complete appropriate assessment forms Performs effective assessment techniques Obtains comprehensive client information Maintains privacy and confidentiality Indentifies health needs Formulates a plan of care in collaboration with patients and other members of the health team Includes patient and his family in care planning States expected outcomes of nursing interventions Develops comprehensive patient care plan Accomplishes patient centered discharge plan Implements planned nursing care to achieve identified outcomes Explains intervention to patients and his family before carrying them out Implements nursing intervention that is safe and comfortable Acts according to clients health condition and needs Performs nursing activities effectively and in a timely manner Evaluates progress toward expected outcomes Monitors effectiveness of nursing interventions Revises care plan when necessary Respond to the urgency of the patients condition Identifies sudden changes in the patients health conditions Implements immediate and appropriate intervention

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 MANAGEMENT OF RESOURCES AND ENVIRONMENT

Organizes workload to facilitate patient care Identifies tasks or activities that need to be accomplished Plans the performance of tasks or activities based on priorities Finishes work assignment on time Utilizes resources to support patient care Determines the resources needed to deliver patient care Controls the use of supplies and equipment Ensures functioning of resources Checks proper functioning of equipment Refers malfunctioning equipment to appropriate unit Delegate functions to other members of the health team Determines tasks and procedures that can be safely assigned to other member of the team Verifies the competencies of the staff prior to delegating tasks Maintains a safe environment Observes proper disposal of waste Adheres to policies, procedures and protocols on prevention and control of infection Defines to follow in case of fire, earthquake and other emergency situation

LEGAL RESPONSIBILITY
Core Competency 1: Adheres to practices in accordance with the nursing and other relevant legislation including contracts, informed consent Fulfills legal requirements in nursing practice Holds current professional license Acts in accordance with the terms of contract of employment and other rules and recommendation Complies with required continuing professional education Confirms information given by the doctor for informed cont Secures waiver of responsibility for refusal to undergo treatment of procedure Checks the completeness of informed consent and other legal forms Core Competency 2: Adheres to organizational policies and procedures, local and national Articulates the vision, mission of the institution where one belongs Behaves in accordance with establish norms of conduct of the institution/organization Shows membership of the accredited professional organization and a professional organization releveant Core Competency 3: Documents care rendered to patients: Utilizes appropriate patient care records and reports Accomplishes accurate documentation in all matters concerning patient care in accordance to the standards of nursing practice

HEALTH EDUCATION
Assess the learning needs of the patient and family Obtains learning information through interview, observation and validation Defines relevant information Completes assessment records appropriately Identifies priority needs Develops health education plan based on assessed and anticipated needs Considers nature of learner in relation to: social, cultural, political, economic, educational and religious factors Develops materials for health education Involves the patient, family, significant others and other resources Formulates a comprehensive health education plan with the following components: objectives, content, time allotment, teaching-learning resources and evaluation parameters Provides for feedback to finalize the plan Implements the health educational plan Provides for a conductive learning situation in terms of time and place Considers client and familys preparedness Utilizes appropriate strategies Provides reassuring presents through active listening, touch, facial expression and gestures Monitors client and familys responses to health education Evaluates the outcome of health education Utilizes evaluation parameters Documents outcome Revises health education plan when necessary

ETHICO-MORAL RESPONSIBILITY
Respects the rights of individual/groups Renders nursing care consistent with the patients bill of rights Accepts responsibility and accountability for own decision and actions Meets nursing accountability requirements as embodied in the job description Justifies basis for nursing actions and judgment Projects an positive image of the profession Adhered to the national and international code of ethics for nurses Recites the code of ethics for nurses and abides by its provision Reports unethical and immoral incidents to proper authorities

PERSONAL AND PROFESSIONAL DEVELOPMENT

Identifies own learning needs Verbalizes strengths, weaknesses limitations Determines personal and professional goals and aspiration Pursues continuing education Attends formal and non-formal education Earns required continuing education units Get involve in professional organization and civic activities

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 Participates actively in professional, social, civic and religious activities Maintains membership to professional organizations Support activities related to nursing and health issues Projects a professional image of the nurse Demonstrate good manners and right conduct at all times Dresses appropriately Demonstrates congruence of words and actions Behaves appropriately at all times Possesses positive attitude towards change and criticism Listens to suggestions and recommendations Tries new strategies or approaches Adopts to changes willingly Performs functions according to professional standards Assess own performance against standards of practice Sets attainable objectives to enhance nursing knowledge and skills Explains current nursing practices when situations call for it

QUALITY IMPROVEMENT
Gather data using different methodologies Able to identify researchable problems regarding patient care and community health Identify appropriate methods of research for a particular patient/community problem Combines quantitative and qualitative nursing design thru simple explanation on the phenomena observed Analyzes data gathered Recommends actions for implementation Based on the analysis of the data gathered, recommends practical solutions appropriate for the problem Disseminates results of research findings Able to talk about the results of findings to colleagues/ patients/family and to others Endeavors to publish research Submits research findings to own agencies and others as appropriate

RECORDS MANAGEMENT
Maintains accurate and updated documentation of patent care Completes updated documentation of patient care Records outcome of patient care Utilizes a record system ex. Kardex of Hospital Information System Observes legal imperatives in record keeping Observes confidentiality and privacy of the patients records Maintains an organize system of filing and keeping patients records in a designated area Refrains from releasing records and other information without proper authority

QUALITY IMPROVEMENT

Gathers data for quality improvement Demonstrate knowledge of method appropriate for the clinical problems identified Detects variation in the vital signs of the patient day to day Reports necessary elements at the bedside to improve patients stay in the hospital solicits feedback from patient and significant others regarding care rendered Participates in nursing adults and rounds Contributes relevant information about patients condition as well as units condition and patient current reactions Shared with the team current information regarding particular patients condition Speaks for the patient what is relevant to his condition Documents and records all nursing care and actions Performs daily check up of patients records/condition Completes patients records Actively contributes relevant information of patient during rounds thru readings and sharing with others Identifies and reports variances Documents observed variance regarding patient care and submits to appropriate group within 24 hours Identifies actual and potential variance to patent care Submits reports to appropriate groups within 24hours Recommends solutions to identified problems Gives appropriate suggestions on corrective and preventive measures Communicates and discusses with appropriate groups Gives an objective and accurate report on what was observed rather that an interpretation of the event

COMMUNICATION
Establishes rapport with patient Creates all TRUST and CONFIDENCE Greets client in an open and respectful manner Asks client about themselves Tells client about choices depending on clients needs Helps client make an informed choice Explains fully how to choose options Returns visits for future consultation Listen actively to clients queries and requests Spends time with the client to facilitate conversation that allows client to express concerns Identifies verbal and non-verbal cues Interprets and validates clients body language and facial expression (IEC materials) Utilizes formal and informal channels Interprets and validates clients body language and facial expression (IEC materials) Responds to needs of individuals, family group and community Provides reassurance through therapeutic, touch, warmth and comforting words of encouragement Readily smiles

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Uses appropriate information technology to facilitate communication Utilizes telephone, cell phone email and internet for disease information Identifies a significant other so that follow up care can be obtained Provides holding or emergency numbers for services

COLLABORATION AND TEAMWORK

Establishes collaborative relationship with colleagues and other members of the health team Contributes to decision making regarding clients needs and concerns Participates actively in patient care management including audit Recommends appropriate intervention to improve patient care Respect the role of other members of the health team Maintains good interpersonal relationship with clients, colleagues, and other members of the health team Collaborates plan of care with other members of the health team Refers clients to allied health team partners Acts as liaison/advocate of the client Prepares accurate documentation for efficient communication of services

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