2.

ORGANIZING

DR. CHARLIEMANE A. BULLALAYAO

DEAN, College of Allied Health Sciences
Professor
ORGANIZING
❑ Grouping of activities to achieve objectives, the
assignment of such groupings to a manager with
authority for supervising each group, and the defined
means of coordinating appropriate activities with other
units, horizontally and vertically that are responsible for
accomplishing organizational objectives
ORGANIZATION
❑ Is a form of every human association for
the attainment of a common purpose -
Serving as a facilitating agency in the
achievement of a purpose
Organizational Structure
❑ It is a process in which a group is
formed including ARA, a span of
control, and lines of communication
Categories of Organization
1. Formal Organization
❑ Is a system of well-defined jobs each with a measure of
authority and responsibility and accountability

2. Informal Organization
❑ Refers largely to what people do because they are human
personalities and do their actions in terms of needs, emotions,
and attitudes and not in terms of procedures and regulations
Patterns of Organizational Structure
I. Tall or Centralized Structures
❑ Responsible for only a few subordinates,
so there is a narrow span of control
❑ Because of the vertical nature of the
structure, there are many levels of
communication
II. Flat or Decentralized Structures
❑ It is characterized by few levels and a broad
span of control where decision making is spread
among many people
❑ Communication from lower levels to higher
levels is easy and direct
Types of Organizational Structure
1.Line Organization/Bureaucratic/Pyramidal
❑ There is a clearly defined superior-subordinate
relationship
❑ It is pyramid-shaped where all decisions
emanate from the top down to the subordinates
❑ ARA and power are centralized at the top
2. Flat Organization/Horizontal
Organization
❑It is a decentralized type
❑Used for less complex organizations, with authority
decentralized and with several managers supervising
large workgroups
❑With few or no levels of intervention between
management and staff
❑Applicable only in smaller organizations or individual
units within larger organizations
3. Functional Organization
❑ Permits a specialist to aid line
position within a limited and
clearly defined scope of authority
Organizational Relationships
1. Formal Relationships - they are represented by
uninterrupted lines between units, showing who
reports to whom
2. Informal Relationships -
represented by a broken dotted line,
where power relationships are
coordinated
 Staffing
❑ Process of assigning competent people to fill the roles
for the organizational structure through recruitment,
selection, and development
❑ Process of determining and providing the acceptable
number and mix nursing personnel to produce a
desired level of care to meet patient’s demand
PURPOSE:
❑ to provide each nursing unit with an
appropriate and acceptable number
of workers in each category to
perform the nursing task required
Factors Affecting Staffing
1. Type, philosophy, and objectives of the hospital and the nursing service
2. Population served or the kind of patients served whether pay or charity
3. The number of patients and severity of their illness, knowledge, and
ability of nursing personnel are matched with the actual care needs of
patients
4. Availability and characteristics of the nursing staff, including
education, level of preparation, a mix of personnel, number and
position
5. Administrative policies such as rotation, weekends, and holiday off-
duties
6. Standards of care desired which should be available and spelled out
Factors Affecting Staffing
7. Layout the various nursing units and resources available within the
department such as adequate equipment, supplies, and materials
8. The budget includes the amount allotted to salaries, fringe benefits,
supplies, materials, and equipment
9. Professional activities and priorities in non-patient activities like
involvement in professional organizations, formal educational
development, participation in research and staff development
10. Teaching program or the extent of staff involvement in teaching activities
11. Expected hours of work per annum of each employee. Influenced by the
40-hour week law
Factors Affecting Staffing
12.Patterns of work schedule
a. Traditional 5 days per week, 8 hours per day,
and 2 days off
b. 4 days a week, ten hours per day, and 3 days
off
c. 3 ½ days or 12 hours per day and 3 ½ days off
per week
Steps in Staffing
1. Determine the number and types of personnel
needed
❑ This is a decision that a manager can best
reach not alone but in consultation with the
staff and co-workers
❑ This can be done through interviews or daily
observations of the needs of clients
Steps in Staffing

1.RECRUIT PERSONNEL
❑ Process of enlisting personnel
for employment
a.Advertising
- The most common method of informing the public of vacant positions
- Local newspapers, professional publications, bulletins, newspapers, radio,
or television – offer the employer a broader field for selecting personnel

b. Word of Mouth – a very effective method however it may lead to the hiring of
friends and relatives a practice that may foster favoritism and nepotism

c. Employee Recommendation – nurses who are already employed in the

institution recruiting personnel may recommend fellow nurses when they
have previously worked within the past and who they know are competent
and reliable
2.SCREENING
*During the process, the applicants
submit their biographical data (resume)
that include information on personal
history, educational background, and
work experiences
3. INTERVIEW
✓All interviewers must be ready with the background of the
prospective employee
✓Resumes or curriculum vitae with pictures of the faces of the
applicants usually help in identifying the interviews
✓Should be scheduled and properly conducted in an airy
environment that would help bring out the best and the worst
in the applicant depending on the objectives of the
interviewer
✓PURPOSE: To obtain further information and to
determine if the applicant qualifies for the position

✓WHAT TO OBSERVE DURING THE INTERVIEW?

Does the applicant show genuine interest in the
job, willingness to work and assume
responsibilities?
4.ORIENT THE
PERSONNEL
✓ ORIENTATION –
the process of
becoming familiar
with a new
environment and
adapting well to it
✓Newly hired personnel are oriented during the first few days of
employment – well-designed orientation program would
include:
a. Tour to the physical facilities
b. Introduction to co-workers
c. Description of the organizational structure of the
institution
d. Information on the philosophy, goals, policies, and
standards of the institution
e. Functions of the members of the health team
5.JOB OFFER
✓ If the applicant accepts
the offer, therefore he is
hired

✓ Before any signing of a

contract, pre-employment
testing and physical
examination must be done
Staffing Pattern
❑ Is a plan that articulates how many
and what kind of staff are needed
by shift and day to staff a unit or a
department
Considerations in the development of a Staffing Pattern

1. Benchmarking – a
management tool for
seeking out the best
practices in one’s
industry to improve
performance.
Considerations in the development of a Staffing Pattern

2. Regulatory
Requirements – the
local requirements
will be followed as
mandated by RA
5901
3. Skill Mix – it is the percentage or ratio of professionals to non-
professionals

4. Staff support – it is the support in place for the operations of the unit
or department

5. Historical Information – keep intact the effective ways of doing the

task and be knowledgeable about the presence or absence of equipment
and supplies
Patient Classification System – a measurement tool used to
articulate the nursing workload for a specific patient or group of
patients over a specific period

1. SELF-CARE OR MINIMAL CARE

PATIENTS
❑ capable of carrying activities of daily
living - The patient can take a bath on his
own, feed himself. Feed and can perform
his activities of daily living
❑Falling under this category are patients
about to be discharged, those in non-
emergency, those newly admitted, who do
not exhibit unusual symptoms, and
requires little treatment/observation and
or instructions
2. INTERMEDIATE OR MODERATE CARE
❑ Requires some help from the nursing staff with
special treatments or certain aspects of personal
care - They require some assistance in bathing,
feeding, or ambulating for short periods
❑ Extreme symptoms of their illness must have
subsided or have not yet appeared
❑ Patients may have slight emotional needs,
with vital signs ordered up to 3 times per
shift, intravenous fluid or blood transfusion
❑ They are semi-conscious and exhibiting
some psychosocial or social problems;
periodic treatments and or observations and
instructions
3.TOTAL CARE PATIENTS
❑ Are usually those who are bedridden and
who lack strength and mobility to do
average daily living - Patients are
completely dependent upon the nursing
personnel
❑ They are provided complete bed bath, are fed, may or may
not be unconscious with marked emotional needs with
vital signs more than 3 times per shift, maybe on
continuous oxygen therapy and with chest or abdominal
tubes

❑ They require close observation at least every 30 minutes

for impending hemorrhage, with hypo or hypertension and
or cardiac arrhythmia
4.Intensive Care Patients
❑ Are those who are critically ill and in constant
danger of death or serious injury
❑ Patients need continuous treatment and
observations
❑ With many medications, IV piggybacks, vital signs
every 15-30 minutes, hourly output measurement -
There are significant changes in doctor’s orders
Nursing Care Models
1. The Case Method or Total
Patient Care Patients –
this is used for
assignments in ICUs where
there is a one-on-one
relationship between the
nurse and the client. It is
also used for educational
purposes for nursing
students.
2. The Functional Method/Task
Nursing
the emphasis of this
system is to get tasks and
procedures done. It is
based on the concept of
division of labor where
nurses and other
caregivers are assigned to
do specific tasks on
several patients
3.Team Nursing –
employs both
professional nurses
(leadership skills) and
non-professionals
(technically proficient)
providing total
nursing care to a
specific client
4. Primary Nursing Method
❑ the primary nurse who is a RN is responsible
to give TPC to 4-6 patients/24 hours a day
❑ primary nurses have the autonomy and
authority for the care of their clients
❑ BASED ON RESEARCH: Patients have fewer
complications and a shorter hospitalization
when cared for by a primary nurse
 Steps in the Computation of the number of staff
needed in a certain hospital

To illustrate:
Find the number of
nursing personnel needed for
250 patients in a tertiary hospital
1. Categorize the number of patients according to the levels of care needed.
Multiply the total number of patients by the percentage of patients at
each level of care (whether minimal, intermediate, intensive, or highly
specialized).

Percentage of Patients in Various Level of Care per type of hospital

Type of Hospital Minimal Care Moderate Care Intensive Care Highly
Specialized
Care
Primary Hospital 70 25 5 -
Secondary 65 30 5 -
Hospital
Tertiary Hospital 30 45 15 10
Special Tertiary 10 25 45 20
Hospital
Minimal care patients
250 patients x .30 = 75.00

Moderate care patients

250 patients x .45 = 112.50

Intensive care patients

250 patients x .15 = 37.50

Highly specialized nursing care

250 patients x .10 = 25.00
250 patients
2. Find the total number of nursing care hours needed
by the patients at each category level.

Find the number of patients at each level by the

average number of nursing care hours needed per day
Get the sum of the nursing care hours needed at the
various levels
Categories or levels of care of patients, nursing
care hours needed per patient per day and ratio
of professional to non-professionals
Levels of Care NCH needed/patient/day Ratio of Prof. to Non-Prof.
Level 1 1.50 55:45
Self Care or Minimal Care
Level 2 3.0 60:40
Moderate or Intermediate
Care
Level 3 4.5 65:35
Total or Intensive Care
Level 4 6.0 70:30
Highly Specialized or Critical 7 or higher 80:20
Care
NCH needed at Level 1
75 x 1.50 NCH/patient/day 112.50 NCH/day
NCH needed at Level 2
112.5 x 3.0 NCH/patient/day 337.50 NCH/day
NCH needed at Level 3
37.50 x 4.5 NCH/patient/day 168.75 NCH/day
NCH needed at Level 4
25 x 6 NCH/patient/day 150.00 NCH/day
768.75 NCH/day
3. Find the actual number of nursing care hours needed
by the given number of patients. Multiply the total
nursing care hours needed per day by the total
number of days in a year.

TOTAL NCH NEEDED x days in a year

768.75 x 365 (days/year) = 280,593.75NCH/year

4. Find the actual number of
working hours rendered by each
nursing personnel per year.
Multiply the number of hours on
duty per day by the actual
working days per year.
TOTAL NUMBER OF WORKING AND NON WORKING DAYS
AND HOURS OF NURSING PERSONNEL PER YEAR
Rights and Privileges given Working hours per week
each personnel per year 40 hours 48 hours
Vacation Leave 15 15
Sick leave 15 15
Legal Holidays 10 10
Special Holidays 2 2
Special Privileges 3 3
Off duties 104 52
Continuing Education 3 3
Total Non-working Days per Year 152 100
Total working Days per Year 213 265
Total Working Hours per Year 1704 2,120
 Inclusion of CSC MC #6 s. 1996
1. Paternity Leave
2. Funeral/Mourning Leave
3. Graduation Leave
4. Enrollment Leave
5. Wedding/Anniversary Leave
6. Birthday Leave
7. Hospitalization Leave
8. Accident Leave
9. Relocation Leave
8 (hours/day) x 213 working days/year) =

1,704 working hours/year

5. Find the total number of nursing personnel needed.
a. Divide the total number of nursing care needed per
year by the actual number of working hours
rendered by an employee per year

TOTAL NCH/YEAR = 280,593.75

WORKING HOURS/YEAR 1,704

164.67 = 165
b. Find the number of relievers. Multiply the number of
nursing personnel needed by 0.15 (for those working 40
hours per week) or by 0.12 (for those working 48 hours
per week).

165 x 0.15
25
c. Add the number of relievers to the
number of nursing personnel needed.

Personnel Needed = 165

Relievers Needed = 25
190
6. Categorize the nursing personnel needed into professionals
and non-professionals. Multiply the number of nursing
personnel according to the ratio of professionals to non-
professionals
190 x .65 =
124 professional nurses
190 x .35 =
66 nursing attendants
7. Distribute by shifts.

Philippines
Range Average Mean
Morning Shift 45-51% 45%
Afternoon Shift 34-37% 37%
Night Shift 15-18% 18%
124 nurses x .45 = 56 nurses on AM Shift
124 nurses x .37 = 46 nurses on PM Shift
124 nurses x .18 = 22 nurses on Night Shift
= 124 nurses
66 NA x .45 = 30 NA on AM Shift
66 NA x .37 = 24 NA on PM Shift
66 NA x .18 = 12 NA on Night Shift
= 66 Nursing Attendants
Schedule

❑ Timetable showing planned work days and

shifts of nursing personnel

❑ OBJECTIVE OF SCHEDULING:
assigning working days and days off to the
nursing personnel so that adequate
patient care is assured
 SUN MON TUE WED THU FRI SAT
AM OFF 7-3 7-3 7-3 OFF 7-3 7-3
PM 7-3 OFF 3-11 3-11 3-11 OFF 3-11
REL 3-11 3-11 11-7 OFF OFF 3-11 11-7
NITE 11-7 11-7 OFF 11-7 11-7 11-7 OFF
FLO 7-3
Factors to consider in making Schedules
1.Different levels of the nursing staff
2.Adequate coverage for 24 hours, seven days a
week
3.Staggered vacations and holidays
4.Weekends
5.Long stretches of consecutive working days
6.Evening and night shifts
7.Floating
Assessing a Scheduling System
1. Ability to cover the needs of the unit – a minimum required
number of staff must meet the nursing needs of the patients in
the units at all shifts

2. Quality to enhance the nursing personnel’s knowledge,

training, and experience – while permanent assignment to one
unit enhances skills in caring for a particular kind of patient

3. Fairness to the staff – all nursing personnel should get a fair

share of weekends, holiday offs, rotation patterns for the whole
year including assignments to “difficult” or “light” or “Undesirable”
units or shifts
4.Stability – the nursing personnel would like to
know in advance their schedule of the assignment
so that their schedules are in harmony with each
other

5.Flexibility – means the ability to handle changes

brought about by emergency leaves, schedules, or
unscheduled leaves of absence
Types of Scheduling

1. Centralized Schedule
2. Decentralized Schedule
3. Self-Scheduling
The following scheduling variables should be
considered:
1.Length of scheduling period whether 2 or 4 weeks
2.Shift rotation
3.Weekends off
4.Holiday offs
5.Vacation leaves
6.Special days
7.Scheduled events in the hospital, training programs, or
meetings
8.Job categories
9.CPE programs
Job Descriptions/Performance Description

❑ They are specifications of duties, conditions, and

requirements of a particular job prepared through a
careful job analysis
❑ Statement that sets the duties and responsibilities
of a specific job
❑ Includes the needed characteristics or
qualifications of the individual to perform such
duties successfully
Components of Job Description

1. Job Title – the position and the

necessary qualifications
a. Position Title
b. Department
c. Supervisor’s Title
d. Qualification Requirement
2.Job Relationships – such as the degree
of supervision imposed on the worker

3.Performance Description – which is a

catalog of the responsibilities of the
worker; specific and actual functions and
activities