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Work Load Management

Definition - What does Workload Management mean?

Workload management is a process for determining the proper workload
distributions in order to provide optimal performance for applications and
It provides the organization with the capacity to control or micromanage
where each work request is run in order to maximize workload throughput
and enhance performance by making sure that no single processing node is
overtaxed while others are underutilized.

Q: What is the relationship between efficiency, effectiveness and

productivity and what is the path that can be followed to bring about

Efficiency is determined by the amount of time, money, and energy i.e.

resources that are necessary to obtain certain results. In order to meet our
daily production quota, we commit a specific machine that uses up energy,
make operators and maintenance personnel available, and provide raw
materials. For example, if we are able to meet our daily production with less
energy and fewer operators, we have operated more efficiently.
Effectiveness is determined by comparing what a process or installation can
produce with what they actually produce; therefore, effectiveness does not
tell anything about the efficiency the amount of resources that have to be
committed to obtain that output. If we are successful in manufacturing more
good product in the same time period, effectiveness will increase. A valuable
discussion could be whether good product should be seen as Good product
with customer demand to prevent over-production.
Productivity is determined by looking at the production obtained
(effectiveness) versus the invested effort in order to achieve the result
(efficiency); in other words, if we can achieve more with less effort,
productivity increases.

Models of Nursing care delievery:

This system emerged in 1930s in USA

Individual care givers are assigned to specific tasks rather
than being assigned to certain patients or clients . It is based on
a division of labour similar to an assembly line
This model is also referred to as task method . Functional
nursing evolved during the depression when RNs went from
being private practitioners to becoming employees for the job
Once world war II was broke out resulted in severe
shortage of nurses in US. Many nurses entered the military to
care for the soldiers. To accommodate this shortage, hospitals
increased their usage of auxiliary personel.
Functional nursing is a method of providing patient care by
which each licensed and unlicensed staff members perform
specific tasks for a large group of patients. For example RN may
administer all intravenous medications one LPN /LVN may give
treatments another LPN /LVN may give all oral medications , One
assistant may do all hygienic tasks, and another assistant may
take all vital signs. The nurse become expert in the particular
task she is performing.
A charge nurse co-ordinates care and assignments and
may ultimately be the only person familiar with all the needs of
any individual patient.
The key idea was nurses to be assigned for tasks not to
the patient

Functional method of nursing care delivery (Leadership-A.Bernhard



treatments, intravenous hgienic
oral med vital signs
admissions meds supplies

unit of 30

Important points:-

In 1930s when few registered nurses and only some practical

nurses available , much patient care was given by nursing
RNs were keep busy with managerial and non-nursing duties
and nurses aids eliver the majority of patient care
The functional method of delivering nursing care evolved as a
result of world war II as the lack of graduate , registered
nurses became critical
Auxiliary personnel were used to assist in patient care
Unskilled workers were trained and assigning persons to
complete certain tasks ,Eg; checking BP, changes linen,
patients etc
As a whole the nurses were assigned for certain tasks, not to
Person can become particularly skilled in performing
assigned tasks
The best utilization of personnel can be done
Less equipment is needed
Saves time
Potential for development of technical skills is amplified
There is a sense of productivity for the task oriented nurse

It is easy to organize the work of the unit and staff
Task oriented and time saving
Reduced work load to the registered nurses.

o Client care become impersonal
o Diminishing continuity of care
o Staff may become bored and have little motivation to
develop self and others.
o Work may become monotonous
o Less accountability for the nurse
o Lack of professional development
o Client may tend to feel insecure and inconvenient
o Only parts of the nursing care plan are known to personal
Where the model is commonly used;
In certain hospital wards, nursing homes,nurse
consultants, operating rooms.
Nurse managers role:-
The nurse manager must be sensitive to the quality of
patient care delivered and the institutions
budgetary constraints
Achieving patient outcome is her responsibility
Improve the staffs perception of their lack of independence
Rotate assignments among staff , to alleviate boredom with
Conduct staff meeting frequently to encourage staff staff
to communicate about patient care And unit functions.
Staff nurses role:-
o They are skilled at the task which is assigned
o Complete the task in an efficient and economical manner

Team nursing is the delivery of nursing care by a
designated groupof staff members including both professional
nurses and non-professional staff .

This method of nursing care was introduced in early
1950s . It was designed by
Several elements are considered necessary;
1. Team leader is the delegated authority to make assignments for
team members and guide the work of the team. The leader of the
team should be a registered nurse, not a practical nurse
2. The leader is expected to use a democratic or participative style in
interactions with team members.
3. The team is responsible for the total care given to an assigned group
of patients or clients.
4. Communication among team members is essential to its success,
and includes written patient care assignments , nursing care plans,
reports to and from the team leader, team conferences in which
patient care problems and team concerns are discussed, and
frequent informal feedback among team members.
Team nursing was created at the end of World War II to
make the best use of the limited nursing staff available
and alleviate the problems created by the functional
method . As more workers with minimum on the- job
training were hired in the healthcare field, it became
necessary to reorganize the delivery of care . It was also
hoped that the use of team nursing would increase both
staff and patient satisfaction and improve the quality of
In team nursing , a team leader is responsible
for coordinating the group of licensed and unlicensed
personnel to provide patient care to a small group of
patients. The team leader is a highly skilled leader ,
manager , and practitioner who assigns each member
specific responsibilities according to role , licensure ,
education, ability, and the complexity of the care
The members of the team report directly to the
team leader , who then reports to the charge nurse or
init manager . There are several teams per unit , and
patient assignments are made by each team leader .
Communication is enhanced through the use of written
patient assignments , the development of nursing care
plans, and the use of regularly scheduled team
conferences to discuss patient status and formulate
revision to the plan of care.

Model of a team nursing:(nursing leadership and management-Tappen , page





Important points

After the 2nd world war RN were still scarce , although the
number of auxiliary personal had increased.
It was introduced during the 1950s
To improve nursing service by giving the knowledge and
skill of professional nurses , and supervise the work of
auxiliary nurses . the result was an improvement in patient
and self satisfaction.
Auxiliary personal collaborate in providing care to a group
of patients under the direction of a professional nurse.
Based on the philosophy that supports the achievement of
goals through group actions

Team is lead by a professional or technical nurse who plans
, interprets, co-ordinates , supervise and evaluates the
nursing care
Responsibilities of team leader:-
Team leader assign team members to patients by matching
patients needs and staff knowledge and skill.
Knowing condition and needs of all assigned patients
Duty vary according to work load, I,e assisting the
members and giving direct care to patients.
Planning and conducting the conference.
Improved patient satisfaction
Cost effectiveness for the agency
Care is less fragmented because of the increased
communication and extensive co-ordination
efforts of team leader
Allows comprehensive , holistic nursing care when
the team function best.
Good interpersonal relationships among staffs
and with the patients
Satisfaction to the patient and the nurses

Continuity of care is not given
Changing team membership makes it difficult for the
team leader to assign the patient.
Team nursing requires a great deal of co-operation
communication from all staff members
The large number of people attending the same
patient is causing some discomfort to the patient.

Primary Nursing:

o Satisfaction for both patients and nurses

The relationship between nurses and patient is intimate
Autonomy for the nurses
Nurse is the person who is planning and providing complete care

She communicates with all other health team members involved in
client care
Other health team members including physician tend to view her more
knowledgable and responsible
Patient receives quality and continuity of care
Reduces the number of errors than can result from a relay of orders
Increased satisfaction both to patients and nurses
Nurse can identify patient outcome as a result of their work
Nurse may be isolated from colleagues
Nurses talent to a limited number of patients
Nursing care plan can be changed only with the permission of primary
Creates separation anxiety in patients when nurse
Nurses should be well educated and trained in all area of patient care ,
most of the time which may lack

Case management is considered as the newest type of nursing care
delivery system developed in 1985 as an outgrowth of primary care ,
nursing case management is a model used to co-ordinate the care ,
maintain quality, and contain cost while focusing on the outcomes of
Nursing case management is a collaborative activity that
focuses on comprehensive assessment and intervention and holistic
care planning with appropriate referrals to meet the health care needs
of the patient and family.
The success of nursing case management models has been
demonstrated in all health care settings including acute, sub-acute or
ambulatory settings long term care facilities , in health insurance
companies and in community.
Model of nurse case management:- nursing
leadership and management-Tappen , page 252)

Nursing administration

Medical Pediatric OB nurse Trauma nurse

nurse nurse case case
case case manager manager
manage managerpts 10
All medical Pediatric All Ob
pts patients All trauma pts
Role of nurse case manager:-

Delivers client focused and outcome oriented care

Cost effective care through integration of clinical services in combination
with financial services
Serves as an advocate for patient and family
More patient and nurse satisfaction is achieved through
intensive care
They attend to a specific high risk population
Patient receives high standard care
Nurse is highly qualified and skilled in the particular area,
More satisfaction to the patient
Increased professional standards can be developed by the
Sometimes discomfort to clients
Continuity care is difficult
Long time nurse patient relationships are difficult to arrange
Time consuming
No proper attachment between nurses and patients
Factors influencing nursing care delivery system:-
Availability of adequate staff in wards or units
Patient census
Extend of staff deficiency
Organizational policies regarding its practice
Patients preferences for care
Availability of skilled staff
Opportunities for continuing and inservice education to the
Budget of the organization
Socio economical condition of the patient
The organizations mission
Patient and community needs

No single nursing care model works in all settings, or even necessarily
across a single multiservice settings. Before selecting a model nurse
manager must consider all the influencing facors.For a better care effective

selection and mixing of these methods are essential. All the models should
be evaluated periodically for its appropriateness to ensure safe and
effective nursing care.