MODULE THREE

ORGANIZATIONAL STRUCTURE, JOB DESCRIPTION, AND JOB EVALUATION

OBJECTIVES:

At the end of module three, you will be able to:

1. Differentiate between hierarchical and matrix organizational structures.

2. Make a table of organization.

3. Make a job description.

4. Describe the processes involved in job evaluation.

5. Explain each of the four (4) methods of job evaluation.

6. Describe the techniques for team building.

7. Discuss Bales method for analyzing group members interactions

8. Describe how the principles of group dynamics are used in designing work
groups.




















LESSON 1 ORGANIZATIONAL STRUCTURE


Forms of Organizational Structure

There are two common forms of organizational structures, hierarchical, and free-form. A
mixture of both is needed in nursing. The hierarchical structure is commonly called a
line structure. This is the traditional structure and is associated with the principle of
chain of command, bureaucracy, vertical control and coordination, level differentiated by
functions and authority, and downward communication. The line structure is still used in
many nursing organizations because of its advantages such as:

It is easy to orient new employees to a line organization because of the simplicity
of interpersonal relations;

It is easy to function in a line organization because responsibility and
accountability for each function are clearly defined;

It is relatively easy to manage a line organization because of the speed with
which orders can be transmitted and, generally, the acquiescence of workers to
authoritative commands;

It is well suited to execution of tasks that require large numbers of moderately-
educated workers to perform routine operations;

The emphasis in line organization on clear-cut work specialization and role
separation makes line structure more effective in relatively stable organizations in
which the pace of change is slow.


There are also disadvantages especially to the staff. These are:

The small, repetitive, cyclical performance of tasks produces monotony and
worker alienation;

Over-emphasis on specialization leads to communication difficulties among
specialists;

Structures inability to adjust rapidly to altered circumstances;

There is a tendency of bureaucratic structure to engender passivity and
dependency in staff members and to encourage autocratic behavior in managers;

There is lack of coordination and integration between divisions or sections of the
organization;

There is the tendency for limited use of available knowledge in a bureaucratic
setting due to the relative isolation of employees from other departments.


A modification of the line structure is the line and staff organization. This pattern
minimizes the disadvantages of the line organization. Here, a simple line organization is
altered by providing management specialists to support and strengthen the top
executives.

The free-form organizational structures are called matrix organizations. When project
team or task force organization is superimposed upon and built into a fully-
functionalized hierarchical organization, the result is a matrix organization. In a matrix
organization, the efforts of numerous specialists are coordinated both vertically and
horizontally (Gillies, 1994). Vertical coordination occurs through the hierarchical chain of
command, in that the efforts of several specialized department are integrated by the
executive who supervises them. Horizontal coordination takes place through direct
interactions among diverse members of the patient care team, who represent different
departments and occupational groups. The matrix structure is different from hierarchical
and the line and staff structures in that there are fewer levels of hierarchy, greater
decentralization of decision making, and less rigid adherence to formal rules and
procedures. The advantages of matrix nursing organization structure include
(Swansburg, 1993):

1. Improved communication through vertical and horizontal control and coordination
of interdisciplinary patient care teams.

2. Increased organizational adaptability and fluidity to respond to environmental
changes.

3. Increased efficiency or resource use with fewer organizational levels and
decision making closer to primary care operations.

4. Improved human resource management because of increased job satisfaction
with achievement and fulfillment, improved communication, improved
communication, improved interpersonal skills, and improved collegial
relationships.

There are also disadvantages because in matrix organization, there may be:

1. Potential conflict because of dual or multiple lines of authority, responsibility, and
accountability relationships.

2. Role ambiguity.

3. Loss of control over functional discipline due to multidisciplinary team approach.


According to Swanburg (1993), the characteristics of a matrix organization include the
following:

1. Maintenance of old-line authority structures.

2. Specialists resources obtained from functional areas.

3. Promotion of formation of new organizational units.

4. Occurrence of decision-making at the organizational level of group consensus,
the middle management level.

5. The matrix manager exercising authority over the functional manager.

6. Cooperative planning of program development and allocation of resources to
accomplish program objectives.


Organizational Charts

Organizational charts, also called schemas, are graphic representations of the
organizing process in an institution. These charts show reporting relationships and
communication channels as well as distribution of responsibilities. Line charts show
supervisor and supervised relationships from top to bottom of the nursing organization.
Staff charts show the advisory relationship of specialists or experts who are extensions
of the nurse supervisors.


Decentralization

Decentralization refers to the degree to which authority within an organization is
delegated downward to its divisions, branches, services, and units. Decentralization of
authority includes delegation of all the management components of planning,
organizaing, leading, and controlling. Flat organizational structures are characteristic of
decentralized management. Because of the participatory management characteristic of
decentralization, many management titles and positions are either eliminated or
decreased.


The Informal Organization

Every formal organization has an informal one. The informal organization can pose a
problem in an institution as it can create conflicting loyalties restricted productivity,
resistance to change, and management plans. On the positive side, the informal
organization, meets the employees needs for relationships, friendships, for sharing
interests, hobbies, experiences, and feelings. It meets their need to belong. The
informal organization can also help serve the goals of the formal organization. It should
not be controlled but instead, the wise manager should exercise tolerance and
understanding.


Informal organization should be encouraged and nurtured especially if they:

1. Provide a sense of belonging, security, and recognition to employees.

2. Provide methods for friendly and open discussions of concerns.

3. Maintain feelings of personal integrity, self-respect, and independent choice.

4. Provide an informal and accurate communication link.

5. Provide opportunities for social interaction.

6. Provide a source of practical information for managerial decision making,

7. Are sources of future leaders.


Steps in Analyzing Organizational Structure

There are six steps in analyzing the organizational structure of a division of nursing.
Analyzing organizational structures are used when there is a major organizational
problem, such as friction among departments heads over authority, staffing problems,
and so forth.

1. Compile a list of the key activities determined by the mission and objectives of
patient care. It must be remembered that when there are changes in the
institutions mission, philosophy, objectives, the organizational structure should
be reviewed and analyzed. Once the list is completed, it is analyzed and grouped
according to similarities or kinds of contribution they make, such as:

Results-producing activities related to direct patient care, such as the
nursing process.

Support activities, which may include audit, advice, and teaching.

Hygiene and housekeeping activities.

Top management activities, including managing people, marketing,
innovation, audits.

2. Based on the work functions to be performed, decide on the units of the
organization. Decide which kinds of decisions will be required and who will make
them. All decisions should be placed at the lowest kevel and as close to the
operational scene as possible.

3. Decide which units or components will be joined and which will be separated.
Join activities that make the same kind of contribution.

4. Decide on the size and shape of the units or components.

5. Decide on appropriate placement and relationships of different units or
components . this will require relations analysis.

6. Draw or diagram the design and put it in operation. This will result in an
organizational chart or schema.
















JOB ANALYSIS, JOB EVALUATION, JOB DESCRIPTIONS
Job Descriptions. A job description provides a definition of the responsibility and
authority involved with each position. It is also a contract that includes the jobs function
obligations and tells the person to whom the worker is responsible ( Swanburg, 1993) It is
written report normally prepared by a job analyst outlining duties, responsibilities, and condition
of the assignment.
A job description is a description of a job and not of a person who happens to hold the
job. Job descriptions are based on the functional needs of the agency. ( Tomey, 1992)
The purpose of writing a job description, in addition to recording data for a job evaluating
are too:
a) Facilitate wage and salary administration
b) Provide a basis for manpower planning
c) And assist with recruitment, selection , placement, orientation, and evaluation of
employees
d) Clarify relationships between jobs to avoid overlaps and gaps in responsibility
e) Help employees analyze their duties so that they will have a better understanding
their jobs
f) Establish lines of promotion within the department ( Swanburg,1993)

Format. Each job description should include the following information: job title, job
code, summary statement of job purpose, function, and span of responsibility, listing
of principles and subsidiary duties, and personal requirement or specifications for
employees.

Job description should be written in a standardized outline. To eliminate confusion
among workers and managers, each job should be referred to only one title. For
example, if the nurse educator, the education specialist and staff development
instructor titles refer to the same position in an institution, only one of these titles
should be consistently used. The ideal title brief and descriptive of a job. For
example, head nurse, ICU.

The summary statement in the job description should be written in such a way as
differentiate the job from all others in the department. It should be written in such a way as
differentiate the job from all others in the department. It should indicate reporting relationship
to other jobs. The summary statement of a nurse educator position in the surgical units might
required plans, executes and evaluates educational programs for the staff nurses in the three
surgical units. Serves as educational and clinical resource person to the head nurse

JOB CHARACTERISTICS PERSONAL CHARACTERISTICS
Job Duties Knowledge
Job Responsibilities Skill
Job Contact Personal attributes



Job specification are the enumeration of necessary and desirable personal qualities
that an applicant should posses in order to execute the job satisfactory. They include needed
knowledge, skills, attitudes, temperament and experience. According to Gillies ( 1994), a good
rule thumb to follow in writing a job description is to explain the jobs duties, responsibilities
and conditions in enough detail, with such specificity that an uninformed outsider would have
no difficulty in visualizing the job tasks or understanding the purpose and significance of the
job activities.

Job Evaluation. Job evaluation is needed in creating a sound wage salary and career
ladder systems. In order to ensure fair salary structure for the department of nursing, the nurse
manager must be able to evaluate and cost out various nursing jobs according to the
methods used by the personnel and financial experts. Jobs evaluation requires job analysis and
job description.

Job evaluation can be defined as systematical method of appraising the work of each
job in relation to all other jobs in organization ( Belcher, in Gillies, 1994). The purpose of job
evaluation is to determine the relative worth of each job as a basis for equitable pay
differentials. The objective of job evaluation is to identify those job factors or conditions that
place one job higher than another in a value hierarchy and to measure the number and degree
of these factors present in these job.

The first step in job evaluation is job analysis. Job analysis is the process of
investigating each job from two standpoints a). the duties and responsibilities associated with
each job and b). the skills and personal attributes required to perform the job satisfactorily.
Thought job analysis, the manager can determine what the worker does in a particular job, how
does it, why he does it a he does, and how much skill is required to do it Following is an
illustration of a bipartite approach to job analysis (Gillies, 1994 page 138):









Figure 4 Bipartite Approach to Job Analysis.

The following aspect are studied in analyzing any job: a) procedure to be executed, b)
equipment to be used, c) subject matter to be dealt with, d) problems to be handled, e) scope
and responsibility associated with the job, f) amount of discretions allowed in making
decisions, standards of job performance, g) magnitude of workload, h) number and type of
supervisory and reporting relationship, i) length of training period required, j) working
condition and hazards, k) and promotional opportunities associated with successful job
performance.

Methods of Job Evaluation: There are four methods by which job evaluation is carried out.
These are:
a) Ranking
b) Job Classification
c) Factor Comparison, and
d) Point System
Job ranking is the simplest and the least precise. Ranking consists of arranging jobs in hierarchy
of complexity from highest to lowest. It does not reveal the degree of difference in value of
between jobs at various points in the hierarchy. The advantage of the ranking method is its ease
and speed of use. In job classification, the number of job grades and decided, each job grade is
defined, and appropriate pay range is assigned for each job grade. The description of each job
grade should indicate the general type of work and the level of responsibility involved. Grade
descriptions should be sufficiently detailed and precise to ensure that similar jobs will be
grouped together and that groups of job will be differentiated according to the number and level
of compensable factors present A bench mark job should be identified to typify each job grade.
To qualify as bench mark job, a position must be: numerically important as far as the total work
force is concerned; must be fairly stable in job content over a long period of time; must be well
known to the managers, line workers, personnel experts, and job analyst who constitute the Job
Evaluation Committee, must be possible to describe clearly and concisely, must be representative
of wide range of jobs. An appropriate monetary value is assigned for each benchmark job on the
basis of prevailing market rate. Job classification method is favored by many managers because
it differentiates between jobs and because it is easy for both employees and managers to
comprehend.
A grade classification system for hospital personnel might group nursing jobs in the
following manner: (Gillies, 1994 p145)
Grade 16: High level administrative activities, with a large measure of discretionary
power in planning, budgeting, directing, and controlling the activities of a large work force of
diverse levels and types of workers several geographical locations (Masters level preparation:
Director of Nursing)
Grade 15: Experienced practitioner and midlevel manager, with responsibility for
planning, organizing, staffing, supervising, coordinating, and monitoring the work force of an
entire nursing specialty division. (Master level of preparation: Divisional Director)
Grade 14: Highly skilled subject specialist with department-wide responsibility for care
planning, problem solving, research, and patient and staff teaching, with advisory rather than
command responsibilities towards other staff members. (Masters level of preparation: Clinical
Specialist)
Grade 13: Skilled practitioner and first level manager with total responsibility for day-to-
day planning, direction, evaluation of the efforts of a primary work group on a single patient unit
with direct supervisor responsibility for a staff of 25 to 30 employees. (Bachelors degree: Head
nurse)
Grade 12: Professional care giver with considerable responsibility for independent
decision making relative to the adaptation of hospital routines and procedures to the care of
specific patients, but little responsibility for the direction of other health workers. (Bachelors
degree: Staff nurse)
Grade 11: Highly skilled technical care giver with some responsibility for programmed decision
making with the limits of well-defined protocols. No responsibility for the direction of other
workers. (Diploma state: Nurse)
Grade 10: Low level technical specialist with narrowly defined responsibility for
caregiving under direct supervision of a professional worker. (Practical Nurse)
Grade 9: Ancillary worker with responsibility for carrying out orders for the unskilled
specs of nursing care. (Nursing Aide)

Group Work and Team Building
Groups. A group can be defined as an entity consisting of several individuals having
collective perception of their unity and a tendency to act in a united manner toward the
environment. All group objectives are two types: 1) achievement of some specific group goal
and 2) maintenance of strengthening of the group itself. (Cartwright in Gilles, 1994 p150)
Group Communication. In all work groups such as committees, project team conference
groups, workshop and seminar groups, the work of the group is accomplished through
communication of ideas and opinions among members. However, communication within a group
is different from a simple one-to-one interchange because of the greater number of person
involved. As the size of discussion group increases as for example, from six to twelve, the degree
of consensus achieved through discussion decreases markedly especially when time is limited.
Furthermore, the larger the group, the more skill is required from the leader to assist the group to
achieve consensus.
Aside from the number of persons involved, there are other factors that influence
communication within a group. According to McDougall (I GIllies, 1994 p152), group syntality
or togetherness is another factor that makes group communication different from individual
communications. Group syntality develops from the strong pressures exerted toward uniformity
of behavior and attitude among group members. These pressures for togetherness are of such
magnitude as to cause some members to discredit their own perceptions and judgment in order to
move toward majority opinion when faced with a conflict situation.
Reasons for joining the group is another factor that influence communication
within group. An individual may join a group because she admires certain people in the group
and wants to be with them, or an individual may join a group because she sees membership in
the group as means toward a desired end. Not only are some members attracted to a group
because of liking for certain group members, but once assimilated into group, new member also
tend to act a (agree with) those group members whom they especially admire. Social power of
group members also influences communication within a group. Social power can be defined as
the ability to impel others to act in a certain manner. Differences in social powerange status
among group members affect both the number and type of communications initiated by each.
Leadership styles influence communication within group. Communication within
a group with a democratic leader will be different from a group with either an autocratic leader
or odd whose leadership is laissez faire.
Another factor that controls communication among group member is the
configuration of the communication network. A communication network is the system of
communication channels within a group that determines the direction of message flow among
members. The table of organization creates a formal communication network. An informal
communication network can also be created within a group as when one habitually takes the
same seating position relative to each other, in a circular arrangement.
Group Interaction. Bales and Slater developed a method for analyzing the interaction of
group member by which communication act may be classified into one of 12 categories:
1. Shows solidarity, raises anothers status, gives help or reward;
2. Shows tension release, jokes, laughs, shows satisfaction;
3. Agrees, shows passive acceptance, understands, concurs, complies
4. Gives suggestions, directions, implying autonomy of other
5. Gives opinions, evaluations, analysis, expresses feeling or wish;
6. Gives orientation, information, repetition, confirmation;
7. Asks for orientation, information, repetition, confirmation;
8. Asks for opinion, evaluation, analysis, expression of feeling;
9. Asks for suggestions, direction, possible ways of action;
10. Disagrees, shows passive rejection. Formality, withholds help;
11. Shows tension, asks for help, withdraws from field;
12. Shows antagonism, deflates others status, defends or asserts self.
Behavior in categories 4,5 and 6 are considered problem-solving behavior accounts for about
half of all communication acts. Categories 1,2 and 3 are positive reactions, while categories
10,11 and 12 are negative reactions.
Group Dynamics. In designing work groups, the manager should:
1. Apply the principles of group dynamics appointing individuals to group
membership, chairing work groups, and serving as group members in an
appointed or a voluntary capacity.
2. Weigh the effect of group size against the need for representation of certain
groups, since consensus is difficult to achieve in group with more than 10 to
12 members.
3. Consider the probable effect of each candidates position in the formal
communication network on the number and type of her communications
within the group.
4. Consider the possible effect of various seating arrangement on establishment
of chance related communication networks and should alter positions when
necessary to improve message flow through the group.
5. Classify communications according to the method of Bales and Slater into
task-oriented or group-oriented behaviors when serving as group leader.
6. Practice those task-oriented and group-oriented messages with which she is
still at ease.
Team Building. Team building activities involves identifying work group
problems, identifying solutions and developing action plans, implementing the plans, and
evaluating and monitoring the outcomes.
Teams are working groups. To be considered a team, a group must have some stability of
membership and common purpose. The members work interdependently; they function as
interrelated parts of the whole team. A group whose member work independently of each other
with little communications, coordination, or shared responsibility, are not working as a team.
Teams can be classified according to composition, purpose, leadership, and function.
(Tappen, 1996)
As for comparison, some teams are made up of people in only profession, as for example,
the medical team. Others are made up of people at different levels within a particular profession,
such as the nursing team which consists of registered nurses, midwives, nursing, and assistants.
The interdisciplinary team is made up of people from different professions, such as the
physicians, nurses, social workers, physical therapists, nutritionists, a psychologist, and patient
educator.
The purpose of the team is often reflected in its name. For example there are surgeon
teams, intravenous teams, primary care teams, cardiac care teams, and code team.
A team can have a leader who is designated, emergent, or situational. One or more
leaders can exist at any one time in a team. The designated leader is one who has been
deliberately chosen either by the team or by an administrator who has some authority over the
team. The emergent leader is one who evolves from the group by acting as the leader
consistently enough to become an actual leader of the team. Emergent leaders often arise when
the designated leader is weak or when the team has no designated leader. The situational leader
emerges from group in response to a particular situation or need.
Teams can also be categorized according to the way in which they function. Teams can
be classified according to their stage of development (forming, storming, morning, performing or
adjourning), or degree of maturity. Another classification of function closely related to the style
of leadership concerns the way members of the team relate to each other. This may be collegial
or hierarchical. When the relationships are collegial, every member is accorded equal worth as an
individual and recognition is based n their contribution to the team. In contrast, hierarchical
relationships are based on each team members status and position.
Steps in Team Building. Effective teas do not just happen. Team building requires
specific knowledge and skill. The following are the steps in the team building as suggested by
Tappen (1996):
1. Select team members. In selecting team members, the following are to be
considered: (a) ability to contribute to both the task and the relationship
aspects of team functioning; (b) there should be an appropriate mix of people
and skills in a team; (c) stability of membership to maintain the team.
2. Set goals, There is a need to clearly define the purpose of the team.
3. Define roles. Role clarification is essential to smooth team function. If roles
are vague and ambiguous, conflict may arise, especially if the team is
interdisciplinary the roles should be consistent with the defined goals and
roles.
4. Develop team identity and cohesiveness. Cohesion is needed to develop
commitment to the goals of the team and the willingness of team members to
engage in the sharing and support function of the team. Identity and
cohesiveness can be done by: (a) defining to the members the purpose and
functions of the team (b) the new team needs to stake out its territory, which
established team holds and often expands its territory, which is not only
geographic but also functional and psychological; (c) cohesiveness is also
develop by increasing the number of links among team members. Holding
regular meetings increases theses connections. (d) Esprit de Corps is a shared
spirit, a feeling of enthusiasm that characterizes the team as a whole. This has
something to do with the leaders own enthusiasm and energy, it is also
developed when members need are met.
5. Guide decision making. The different ways in which decisions are made by a
group include default, authority, minority vote, consensus and unanimous
consent. Decision by default is the result of a groups failure to reach a
decision. Silence or lack of response from the team is taken to mean consent.
Decision made by a minority are those made by a small number of people on
the team, usually a dominant subgroup. When decisions are railroaded this
way, it is often presented by the rest of the group. Majority made by talking a
poll of the entire team are acceptable to most people. Decisions made by
consensus are those in which the team are acceptable to most people. It seeks
to gain every members agreement on the issue. Unanimous consent is a
decision that reflects genuine agreement of every team member on an issue.
6. Influence group norms. Norms are those unwritten rules that prescribe
acceptable behavior in the group. Once a norm is established within a group, it
can be difficult to change. Norms that support creativity and flexibility and
resistance would affect the team responds to a new assignment. Norms
supporting open communication over suppression of feelings and
disagreements affect the way conflicts are handled.
7. Encourage open communication. Open communication is essential to the
development effective working relationships within the team and with outside
groups.
8. Manage conflicts. As a general rule, conflict is neither to be avoided nor
stimulated. Too much conflict or unresolved conflict reduce the teams
effectiveness and eventually immobilize the team. On the other hand,
suppressed conflict continues to grow underground and is more difficult to
resolve when it eventually surfaces.

Motivating the Individual Employee. The five basic needs that can be used by the
manager as motivators are the following according to Kafka (Tappen, p309)
(a) Economic security
(b) Control or the ability of the employee to influence the situation
(c) Recognition or attention or visibility
(d) Personal self-worth
(e) Belonging
A different approach to motivation is based on an analysis of the goals that are set and
responses to the degree to which they are met. (Evans, Tappen, p305). In the first stage,
employee faces a new task and accepts a goal that has been set by the manager, by the employee
or by both. Accepting the goal has several effects. It directs attention to the task, mobilizes and
sustains efforts and stimulates thinking about ways to meet the goal. A difficult goal is generally
thought to increase motivation unless it is considered unrealistic or impossible to achieve. The
effort to reach the goal occurs in the second performance stage of the cycle. At the third stage
both employee and the manager evaluate the degree to which the original goal was met
measuring it in terms of degrees of success or failure. In fourth stage, the reasons for success or
failure are analyzed. These include the amount of effort put into meeting the goal, the difficulty
level of the task, the employees skill level and how much luck was involved in achieving
success. In the fifth stage, the employees satisfaction and feelings of effectiveness comes as a
result of effort, ability and luck. At this point the cycle is complete and the employee faces new
goal, the cycle begins all over again but this time it may be with increased satisfaction, self-
confidence and motivation or with the same or less motivation depending on the results of the
previous experience.



QUALIFICATION POINT SYSTEM FOR JOB GRADING
Numerical values are assigned to qualifications to establish consistent compensation bases for
all levels of positions in the nursing department. Once point values have been assigned to
various job factors, they can be added to determine a grade. The grades for various job can be
ranked, and job-to-job comparisons can provide a basis for determining pay.
Qualifications
Education
Less than a high school diploma
10
High school diploma 20
High school diploma plus a special training course
30
Associate degree or three years in work-study program and
40
passage of accrediting examinations
Baccalaureate degree and passage of accrediting examinations
50
Masters degree in area of specially needed for the position
60
Doctorate in area of specially appropriate for the position
70
Mental Skills
Work is simple and repetitive and is performed according to instructions
10
Work involves a variety of duties that are performed according to procedures
20
but requires alertness to identify needed changes
Work involves a variety of complicated duties and some independent
30
actions in adapting procedures to specific situations
Work involves planning, organizing, implementing, and evaluating
40
actions related to patient care
Work involves development of policies and procedures, organization of functions,
50
development of staffing patterns, and budget preparations.
Manual Skills
Work involves the normal manual skills, such as lifting, pushing, folding, writing,
filing 10
Work involves above normal manual skills, such as accurate measurements,
40
administration of medications and treatments, manipulation
of instruments, typing, bookkeeping
Work involves considerable manual skill, such as administering complex
treatments 50
and manipulation of complex equipment.






Responsibility for resources
Personnel
Supervises no one 10
Supervises fewer than 10 people
20
Directs up to 25 people
30
Directs up to 50 people
40
Directs up to 100 people
50
Directs more than 100 people 60
Finances
No responsibility for the budget
10
Responsible for budget up to $10,000
20
Responsible for budget up to $25,000
30
Responsible for budget up to $100,000
40
Responsible for budget over $100,000
50
Effort
Mental
Requires little thinking or judgment 10
Requires some alertness while performing repetitions tasks according to
directions 20
Requires mental effort for problem solving
30
Requires considerable mental effort for decision making and problem solving
40
Requires continuous mental effort for dealing with the most difficult situations
50

Physical
Light work requiring little physical effort; usually needed
10
Light physical work, use of light materials; frequently seated
20
Sustained physical activity; seldom seated
30
Considerable physical effort, continuous activity, lifting
40

Working conditions
Good working conditions: light, ventilation, freedom from
10
disagreeable elements such as dirt, heat, wetness, ordors, noise
Average working conditions with occasional exposure to
20
disagreeable elements and danger
Fair working conditions with frequent exposure to disagreeable elements and
danger 30
Poor working conditions with continuous exposure to
40
disagreeable elements and danger

Figure 6: Sample Job Descriptions
Clinical Nurse (CN1)
The clinical nurse I supports the philosophy of primary nursing by planning and
coordinating nursing care for a group of patients within his/her district. It is the CN Is
responsibility to direct auziliary personnel for full implementation of the plan of care. The CN I
supports the management of the unit and uses resources persons and or materials when the need
arises. He/She has the satisfactorily mastered the basic skills requires to work on the assigned
unit. The CN Is scope of nursing practice is focused on his/her assigned group of patients and
does not extend into administrative aspects of the unit at large.

CLINICAL NURSE IV (CN IV) INIT CLINICIAN
The CN IV is an advance clinical nurse who supports the practice of primary nursing on
the unit, as well as hospital-wide. He/She is recognized within the specific area, as well as
thoughout the hospital, as being proficient in the delivery of complicated nursing care. The CN
IV has mastered the many facets of nursing care required at the CN II and CN III levels. This
qualification is validated through the acquisition of national certification in the appropriate
specialty area.
The CN IV coordinates and directs emergency situations, seeks out learning opportunities
for the unit staff and serves as a resource for all aspects of nursing care delivery.
The CN IV collaborates closely with physicians on the unit for the implementation of the
plan of care.
This may be facilitated through assessing special equipment needs, as well as planning
multidisciplinary programs.
The CN IV works closely with the nurse manager in planning unit goals and objectives
and unit specific orientation programs, as well as assisting with the staff performance
evaluations.
The CN IV acts a liaison between his/her unit and the Department of Nursing Education
and Patient Education.

Figure 7
STRATEGIES FOR MAXIMIZING ACCOUNTABILITY
The success of a strategy to maximize accountability is dependent on the intent and the
roughness with which it is used as well as the involvement of people at all levels.
Some approaches are suggested below:
Hold an open presentation and discussion of the nurse managers requirements for
successful goal accomplishment at any given point in time including a review of external
forces and internal problems shown by past performance.
Discuss a broad analysis of changes in performance required to meet the demands of
reality.
Conduct an analysis of how everyone in the department can contribute best to the
organization effort-carried out face-to-face at all levels.
Request statements from each patient unit of the goals and standards to which it commits
itself. This includes an analysis of the help the unit feels is needed to accomplish its
goals, such as information feedback, staff resources, policy or procedure changes, and
equipment and staffing needs.


Answer the following and submit your typewritten answers/reactions to your professor
1. Observe a health care organization. Make an analysis of it in terms of
a) Structure
b) Organizational schema
c) Strengths and weaknesses
d) Presence/absence of informal organizations
2. Write your own job description based on your present responsibilities and tasks. Compare
it with the official job description for the position you are now occupying. If there is no
development one, based on what you think it should be for the position. Use the
suggested format.
3. Describe the processes involved in job evaluation. Compare these with how job
evaluation is done in you institution.
4. Describe the steps in team building. Compare with how team building is fostered in your
place of work.