NRG 402

LEADERSHIP AND MANAGEMENT IN NURSING / PRE-FINALS

STAFFING decentralized nursing Credential Requirements

department ● References
● Pre-employment Testing
STAFFING - PE/Medical
Examination
➢ is the process of determining and providing the acceptable
ORIENTATION & PLACEMENT
number and mix of nursing personnel to produce a desired
level of care to meet the patients’ demands
PLACEMENT ORIENTATION
PURPOSE: ➔ putting the person on ➔ provides information
➢ Provide each nursing unit with an appropriate and acceptable the job for which he is about the activities more
number of workers in each category to perform the nursing selected. It includes specific for the position
tasks required. introducing the ➔ make the employee feel
employee to his job. like a part of the team.
FACTORS AFFECTING STAFFING
Introduction: ● Employee Introduction Content:
➢ the planned, guided a) organization’s history, mission,
1. type, philosophy, objectives of the hospital and the nursing service adjustment of an and philosophy
2. the population served or kind of patients served employee to the b) Service and service areas
3. the number of patients and the severity of their illness organization and the c) Organizational Structure
4. availability and characteristics of the nursing staff work environment d) Employee’s responsibilities to the
5. administrative policies such as rotation, weekends, and holiday organization
off-duties It Seeks to: e) Organization’s responsibilities to
6. standards of care desired 1. establish favorable employee the employee
7. layout of various nursing units and resources available within the attitudes toward the f) Payroll information
department organization, unit, and g) Rules of conduct
8. Budget department h) Tour of the facility
9. Professional activities and priorities in non patient activities 2. provide the necessary i) Schedule and staffing (plus its
10. teaching program or the extent of staff involvement in teaching information and education for policies)
activities success in the position j) Benefit plans (such as insurance
11. expected hours of work per annum of each employee 3. instill a feeling of belonging and pensions)
12. patterns of work schedule and acceptance k) Safety programs
l) Staff development programs
STAFFING PROCESS PLACEMENT OF STAFF m) Promotion and transfer policies
PROPER PLACEMENT: n) Employee appraisal system
1. Recruitment & Selection a. fosters personal growth o) Workload assignments
2. Orientation & Placement b. provides a motivating climate p) Paperwork/forms used
3. Training & Development for the employee q) Specific legal requirements
4. Remuneration, Performance, Evaluation c. maximizes productivity r) Introduction to fellow employees
5. Promotion & Transfer d. organizational goals have
better chances of being met
RECRUITMENT & SELECTION
INAPPROPRIATE PLACEMENT:
RECRUITING SELECTION a. frustration
➔ the process of actively ➔ the process of choosing b. poor quality of work
seeking out or from among the c. reduced organizational
attracting applicants applicants the efficiency
for existing positions. best-qualified individual d. rapid turn-over
➔ an ongoing process in or individuals for a e. poor image for the agency
order to meet particular job or position.
demand and provide ➔ involves verifying the TRAINING AND DEVELOPMENT
an adequate supply of applicant’s qualifications,
nurses at any given checking his/her work STAFF DEVELOPMENT
time history, and deciding if a ➢ Is the process directed towards the personal and professional
good match exists growth of nurses and other personnel while they are
Manager’s Involvement in between the applicant’s employed by a healthcare agency
Recruiting Depends On qualifications and the
1. Size of company organization’s 2 Components:
2. Existence of personnel expectations 1. Education
department 2. Training
3. Presence of nurse recruiter General Considerations:
4. Use of a centralized or ● Educational and Assessing Staff Development Needs:
 ● establish competence 1. “Self-care” or Minimal Care Patients
● meet new learning needs 2. Intermediate or Moderate Care
● satisfy interests the staff may have in learning specific areas 3. Total Care Patients
4. Intensive Care Patients
PERFORMANCE EVALUATION
1. “SELF-CARE” OR MINIMAL CARE PATIENTS
● Employee appraisal (used since 1920)
- using the appraisal as a tool to promote employee ➔ capable of carrying out activities of daily living (ADL)
growth Convalescing, no longer requires intensive, moderate, or
● performance evaluation process for Staff maximum care
Performance Evaluations are to: • Require dx studies,
a) Provide employees with feedback to improve or maintain job • Minimal therapy
performance. • Awaiting elective surgery,
b) Identify areas for employee development. • Home environment temporarily makes discharge
c) Set performance standards and goals for the next review period. undesirable

PROMOTION AND TRANSFER 2. INTERMEDIATE OR MODERATE CARE

● Promotion is defined as the movement of an employee from ➔ requires some help from the nursing staff with special
one position to another position of a higher pay grade or treatments.
salary. ➔ minimal to moderately ill
● Transfer is defined as the movement of an employee from one ➔ Recovering from immediate effects of a serious illness or
position to another position at the same pay grade level or operation
similar salary. ➔ May be ambulatory for short periods (needs assistance)

Internal Mobility 3. TOTAL CARE PATIENTS

➢ Internal Mobility is necessary to match the employee’s skill
and requirements with the job's and organization's ➔ those who are bedridden and who lack the strength and
requirements continuously. mobility to do average daily living.
➔ Needs close attention
Why is there a Need for Internal Mobility: ➔ Requires nurse to initiate, supervise, and perform most of the
• Changes in job structure, job design, job grouping changes in activities
technology, mechanization etc, resulting in the encasement of job ➔ Requires frequent medication
demand.
• Expansion and diversification of production or operations
4. INTENSIVE CARE PATIENTS
• Adding different lines of auxiliary supportive activities
• Taking up geographical expansion and diversification
• Introduction of creative and innovative ideas in all the areas of ➔ Those who are critically ill and in constant danger of death or
management resulting in increased job demands serious injury. Acutely ill patients w/ high level of nurse
dependency
Need for Internal Mobility: ➔ Unstable condition w/c requires frequent evaluation with
• Changes in employee skill, knowledge, abilities, aptitude, values etc. adjustment of therapy
• Changing demands of trade unions regarding protecting the interests of
their members.
• Chancing government role in human resource development STAFFING FORMULA
• National economic and business trends and their impact on job design REQUIREMENTS:
and demands.
• Problem of maintenance of interpersonal relations and sound human A. STANDARD VALUE OF NURSING CARE
relations
CASES/PATIENTS NCH/PT/DAY PROF. TO NON-PROF
• Social and religious conditions of the employees or the region.
RATIO

Purpose of Internal Mobility:

i. Surgery 3.4 60:40
1. To improve the effectiveness of the organization ii. General Ward 3.5 60:40
2. To maximize the employee efficiency iii. Pediatric 4.6 70:30
3. To ensure discipline and iv. Pathologic Nursery 2.8 55:45
4. To adopt organizational changes v. Medical 3.4 60:40
vi. OB 3.0 60:40
PROMOTION & TRANSFER vii, ICU/ER/RR 6.0 70:30
viii. CCU 6.0 80:20
a) within a Department
b) Between Departments
c) When Initiated by the Employee B. DISTRIBUTION PER SHIFT
SHIFT PERCENTAGE
PATIENT CLASSIFICATION SYSTEM
 AM 46% CLASSIFICATION LOC
PM 37%
NIGHT 18% MINIMAL CARE 250 x 30% = 75
MODERATE CARE 250 x 45% = 112.5
INTENSIVE CARE 250 x 15% = 3.5
C. PERCENTAGE OF PATIENTS IN VARIOUS LEVELS OF CARE HIGHLY SPECIALIZED 250 x 10% = 25
NURSING CARE
TYPE OF MINIMAL MODERATE INTENSIVE HIGH
HOSPITAL CARE CARE CARE SPECIAL
CARE
2. FIND THE NURSING CARE HOURS (NCH) NEEDED
Primary 70 25 5 - PATIENT BED CAPACITY X TOTAL NCH/DAY
Hospital CLASSIFICATION NCH/PT./DAY

Secondary 65 30 5 - MINIMAL CARE 75 x 1.5 = 112.5

Hospital MODERATE CARE 112.5 x 3 = 337.5
INTENSIVE CARE 37.5 x 4.5 = 168.75
Tertiary 30 45 15 10 HIGHLY SPECIALIZED 25 x 6 = 150
Hospital NURSING CARE

Special 10 25 45 20 TOTAL: 768.75 NCH/day

Tertiary
Hospital
3. FIND NCH PER YEAR
TOTAL NCH/DAY X DAYS/YEAR = NCH PER YEAR
D. CATEGORIES OF PATIENT (768.75 X 365 (DAYS/YEAR) = 280,593.75 NCH/YEAR)
LEVELS OF CARE NCH NEEDED/PT./DAY PROF:NON-PROF
4. FIND ACTUAL WORKING HOURS NEEDED BY EACH NURSING
Level I (Self Care or 1.50 55:45 PERSONNEL / YEAR
Minimal Care) HRS/DAY X WORKING DAY/YEAR = WORKING HRS/YEAR
8 (hrs/day) X 213 (WORKING DAY/YEAR)= 1,704 WORKING HRS/YEAR
Level II (Moderate or 3.0 60:40
Intermediate Care) 5. FIND THE TOTAL NUMBER OF NURSING PERSONNEL NEEDED
a. TOTAL NCH/ YEAR (280,593.75*) ÷ WORKING HRS / YEAR (1,704*) =
Level III (Total or 4.5 65:35
165 RELIEVERS
Intensive Care)

Level IV (Highly 6.0 70:30 b. RELIEF x CONSTANT % =NSG PERSONNEL

Specialized or Critical 7.0 or higher 80:20 165 X 15% = 25
Care (CONSTANT: 15% FOR 40 HRS/WK & 10% FOR 48 HRS/WK)

c. RELIEVERS + NSG PERSONNEL= TOTAL NSG PERSONNEL NEEDED

E. TOTAL NUMBER OF WORKING AND NON-WORKING DAYS AND
165 + 25 = 190 TOTAL PERSONNEL NEEDED
HOURS OF NURSING PERSONNEL PER YEAR
RIGHTS AND PRIVILEGES GIVEN EACH WORKING HOURS PER WEEK 6. DETERMINE PROF FROM NON-PROF PERSONNEL
PERSONNEL/YEAR TOTAL PERSONNEL X PROF/NONPROF RATIO = TOTAL PROF OR NONPROF
40 HOURS 48 HOURS PERSONNEL
● 190 X 65% = 124 PROFESSIONAL
1. Vacation Leave 15 15
● 190 X 35% = 68 NON PROFESSIONAL
2. Sick Leave 15 15
3. Legal Holidays 10 10
4. Special Holidays 2 2 7. DISTRIBUTE PER SHIFT
5. Special Privileges 3 3
6. Off Duties as per R.A 5901 104 52 SHIFT PROF NON-PROF
7. Continuing Education Program 3 3
AM (45%) 56 30
Total non-working days/year 152 100 PM (37%) 46 24
Total working days/year 213 265 NOC (18%) 22 12
Total working hours/year 1,704 2,120
RA 5901 = 40H WK LAW TOTAL: 124 66

STEPS FOR COMPUTING THE STAFF NEEDED IN THE

IN-PATIENT UNIT OF THE HOSPITAL SCHEDULING
1. CATEGORIZE PATIENT ACCORDING. TO LEVEL OF CARE A schedule is a timetable showing planned work days and shifts for
nursing personnel.
PATIENT TYPE OF HOSPITAL X TOTAL
FACTORS TO CONSIDER IN MAKING A SCHEDULE
1. Different levels of the nursing staff DIRECTING
2. Adequate coverage for 24 hours, 7 days a week
3. Staggered vacations and holidays ➢
the function of guiding, inspiring, overseeing, and instructing
4. Weekends people toward the accomplishment of organizational goals
5. Long stretches of consecutive working days ➢ is the “doing” phase of management, requiring the leadership
and management skills necessary to accomplish the goals of
6. Evening and night shifts
the organization
7. Floating
- Managers direct & support work of their
subordinates
ASSESSING A SCHEDULING SYSTEM COMPONENTS
1. Ability to cover the needs of shift 1. LEADERSHIP & SUPERVISION
2. Quality to enhance the nursing personnel’s knowledge, training and 2. MOTIVATION
experience 3. COMMUNICATION
3. Fairness to the staff. 4. MANAGING CONFLICT / NEGOTIATING
4. Stability 5. COLLECTIVE BARGAINING
5. Flexibility
1. LEADERSHIP & SUPERVISION
TYPES OF SCHEDULING
1. Centralized Schedule ROLES IN SUPERVISION:
2. Decentralized Schedule • Guides
3. Cyclical Schedule • Direct
• Facilitates
• Motivates
SCHEDULING VARIABLES
• Teaches
1. Length of scheduling period whether 2 or 4 weeks
2. Shift rotation
INFLUENCE
3. Week-ends off - the capacity to have an effect on the character, development,
4. Holiday off or behavior of someone or something, or the effect itself.
5. Vacation leave
6. Special days POWER
7. Scheduled events in the hospital , training programs, or meetings - The ability to influence other people despite their resistance
8. Job categories and may be actual or potential, intended or unintended
9. Continuing professional education (CPE) programs ● Positional
- power awarded or granted to a person
JOB DESCRIPTION
● Personal
Job description is a statement that sets the duties and responsibilities of a - power derived from followers
specific job.
TYPES OF POWER:
CONTENTS OF A JOB DESCRIPTION 1. REWARD
1. Identifying Data - is obtained by the ability to grant favors or reward others with
2. Job Summary whatever they value
3. Qualification Requirements 2. COERCIVE or PUNISHMENT
4. Job Relationships - based on fear of punishment
3. LEGITIMATE
5. Specific and Actual Functions and Activities
- position power
4. EXPERT
USES OF JOB DESCRIPTION
- gained through knowledge, expertise, or experience
1. For recruitment and selection of qualified personnel 5. REFERENT / CHARISMATIC
2. To orient new employees to their jobs - Power that a person has because others identify with that
3. For job placement, transfer or dismissal leader or with what that leader symbolizes
4. As an aid in evaluating the performance of an employee - Personal charisma
5. For budgetary purposes ➢ charisma is a more personal type of power
6. For determining departmental functions and relationships to help 6. INFORMATIONAL
define the organizational structure - obtained when people have information that others must
7. For classifying levels of nursing functions according to skill levels have to accomplish their goals
required.
8. To identify training needs TYPE SOURCE
9. As basis for staffing 1. REFERENT ➔ Association with others
10. To serve as a channel of communication. 2. LEGITIMATE ➔ Position
3. COERCIVE ➔ Fear
4. REWARD ➔ Ability to grant favors
DIRECTING
5. EXPERT ➔ Knowledge and skills
6. CHARISMATIC ➔ Personal
7. INFORMATIONAL ➔ The need for information
If authority is the right to command, then, “Why do workers sometimes 5. MCLELLAND
not follow orders?” 6. GELLERMAN
➢ people in power are prone to dismiss or, at the very least, 7. MCGREGOR
misunderstand the viewpoints of those who lack authority
➢ Gap that sometimes exists between a position of authority MOTIVATING CLIMATE
and a subordinate ➢ organizational climates or attitudes that directly influence
Narrow Authority-Power Gap worker morale and motivation
➔ more power subordinates perceive a manager to have, the • Incentives & rewards
smaller the gap • Generational Differences and Motivation
Wide Authority-Power Gap • The Relationship Between the Employee and Supervisor
➔ if subordinates perceive a manager to have lesser power
➔ Organizational chaos 3. COMMUNICATION
➔ Decreased productivity
➢ communication impacts all management activities and cuts
2. MOTIVATION across all phases of the management process
➢ The nurse-leader needs to communicates
- is the force within the individual that influences or directs ● must have excellent interpersonal communication
behavior. skills
- involves the action people take to satisfy unmet needs. It is ➢ Organizational communication is even more complex than
the willingness to put effort into achieving a goal or reward to interpersonal or group communication
decrease the tension caused by the need. • more communication channels
• more individuals to communicate with
TYPES OF MOTIVATION: • more information to transmit
● INTRINSIC • new technologies
- Comes from within the person ➢ communication as “the exchange of thoughts, messages, or
● EXTRINSIC information, by speech, signals, writing, or behavior.”
- Comes from outside the individual
TWO LEVELS:
INTRINSIC EXTRINSIC ➢ Verbal
- Comes from within - Comes from outside the ➢ Nonverbal
the individual individual
- Often influenced by - Rewards and INTERNAL
family unit and reinforcements are given - includes the values, feelings, temperament, and stress levels
cultural values to encourage certain of the sender and the receiver
behaviors and/or levels of
Achievement EXTERNAL
- external factors such as the weather, temperature, timing,
➢ Leaders can create an environment that maximizes the status, power, authority, and the organizational climate itself
development of human potential
➢ Leader-manager must identify components and strengthen
them in hopes of maximizing motivation

MOTIVATION
➔ Human beings have needs that motivate them.
➔ The leader focuses on the needs and wants of individual
workers and uses motivational strategies appropriate for each
person and situation.
➔ Leaders often face tremendous challenges in accurately
identifying individual and collective motivators.

MOTIVATIONAL THEORIES

- Traditional management philosophy premised that high CHANNELS OF COMMUNICATION

productivity means greater monetary incentives for the
worker, and workers are viewed as being motivated primarily ● Upward
by economic factors. - from subordinate to superior
- shift from traditional management philosophy to a greater ● Downward
focus on the human element and worker satisfaction as - from superior to subordinate
factors in productivity ● Horizontal
- from peer to peer
1. MASLOW ● Diagonal
2. SKINNER - between individuals at differing hierarchy levels
3. HERZBERG and job classifications
4. VROOM ● Grapevine
 - informal, haphazard, and random, usually involving 4. Passive-Aggressive
small groups - an aggressive message presented in a passive way
- involves limited verbal exchange (often with
COMMUNICATION MODES incongruent nonverbal behavior) by a person who
feels strongly about a situation
WRITTEN
- Written messages (memos, reports, e-mail, and texting) allow LISTENING SKILLS
for documentation.
FACE-TO-FACE - most people hear or actually retain only a small amount of
- Oral communication is rapid but may result in fewer people the information given to them
receiving the information - communication failure is a common root cause of medical
TELEPHONE error
- Rapid & responsive, but does not allow the receipt of
nonverbal messages How to become a better listener:
NONVERBAL 1. Be aware of how own experiences, values, attitudes, and biases affect
- includes facial expression, body movements, and gestures and how message is receive and perceive
is commonly referred to as body language 2. Must overcome the information and communication overload inherent
in the middle management role
ELEMENTS OF NONVERBAL COMMUNICATION 3. Must continually work to improve listening skills by giving time and
attention to the message sender
SPACE
- The degree of space we require depends on who we are GRRRR AS A TOOL
talking to as well as the situation we are in. To some distance
may imply a lack of trust or warmth Greeting - offer greetings and establish a positive environment
ENVIRONMENT Respectful listening - listen without interrupting and pause to allow
- The area where communication takes place is an important others to think
part of the communication process Review - summarize message to make sure it was heard accurately
APPEARANCE Recommend or request more information - seek additional information
- Much is communicated by our clothing, hairstyle, use of as necessary
cosmetics, and attractiveness Reward - recognize that a collaborative exchange has occurred by
EYE CONTACT offering thanks
- invites interaction and emotional connection. Can signal to
your listeners that you are not interested in them and that IMPACT OF TECHNOLOGY ON CONTEMPORARY ORGANIZATIONAL
you are not engaged in the conversation COMMUNICATION:
POSTURE ● Internet
- Posture and the way that you control the other parts of your ● Hospital Information System
body are also extremely important as part of nonverbal ● Wireless, LAN
communication ● Social Media & Organizational Communication
GESTURES
- appropriate gestures takes on added emphasis
DELEGATION
FACIAL EXPRESSION & TIMING
- Effective communication requires a facial expression that • Getting work done through others
agrees with your message. • Giving someone else the authority to complete a task or action on your
VOCAL EXPRESSION behalf, (Huston, 2009).
- Vocal clues such as tone, volume, and inflection add to the • A “transfer or hand-off to a competent individual, the authority to
message being transmitted perform a task/activity in a specific setting/situation” (Winstead, 2013).
• is a skill that must be taught and practiced for proficiency
VERBAL COMMUNICATION SKILLS • an essential element of the directing phase
• synonymous with productivity
“All communication is either assertive or passive”
REASONS FOR DELEGATING:
1. Assertive 1. Managers delegate routine tasks so they are free to handle
- allows people to express themselves in direct,
problems that are more complex
honest, and appropriate ways
2. If someone else is better prepared or has greater expertise or
- expressed clearly and firmly by using “I”
statements as well as direct eye contact and a calm knowledge
voice 3. employees’ personal and professional development
2. Passive PRINCIPLES
- occurs when a person suffers in silence although ❖ Select the right person to whom the job is to be delegated.
he or she may feel strongly about the issue ❖ Delegate both interesting and uninteresting tasks.
3. Aggressive ❖ Provide subordinates with enough time to learn.
- generally direct, threatening, and condescending STRATEGIES FOR SUCCESSFUL DELEGATION
- communication style typically creates enemies, 1. Plan ahead
and leads to unstable relationships
 2. Identify necessary skill and education levels to complete the 4. CONFLICT MANAGEMENT
delegated task • the internal or external discord that results from differences in ideas,
3. Select capable personnel values, or feelings between two or more people.
4. Communicate goals clearlY • differences in economic and professional values
5. Empower the delegate • competition among professionals.
6. Set deadlines & monitor progress ❖ Conflict is neither good nor bad, and it can produce growth or
7. Monitor the role & provide guidance destruction, depending on how it is managed, (Marquis).
8. Evaluate performance CATEGORIES OF CONFLICT
9. Reward accomplishment 1. INTERGROUP
WHAT CANNOT BE DELEGATED 2. INTRAPERSONAL
● Overall responsibility, authority and accountability for 3. INTERPERSONAL
satisfactory completion of all activities in the unit. ● BULLYING
● Authority to sign one’s name is never delegated ➔ repeated, offensive, abusive,
● Evaluating the staff and or taking necessary corrective or intimidating, or insulting behaviors;
disciplinary action. abuse of power; or unfair sanctions
FIVE RIGHTS that make recipients feel humiliated,
1. RIGHT TASK vulnerable, or threatened, thus
➔ should be within the scope of the person’s practice creating stress and undermining their
and consistent with the job description. self confidence.
2. RIGHT PERSON ● INCIVILITY
➔ Right person is delegating the right task to the ➔ behavior that lacks authentic respect
right person to be performed on the right person for others that requires time, presence,
➔ should have the appropriate license or certificate, willingness to engage in genuine
job description. discourse and intention to seek
3. RIGHT CIRCUMSTANCE common ground
➔ Appropriate patient setting, available resources, ● MOBBING
and other relevant factors considered ➔ when employees “gang up” on an
4. RIGHT DIRECTION/COMMUNICATION individual.
➔ Clear, concise description of the task, including its 5 STAGES OF CONFLICT
objective, limits, and expectations. 1. Latent conflict
5. RIGHT LEVEL OF SUPERVISION 2. Perceived conflict
➔ Appropriate monitoring, evaluation, intervention, 3. Felt conflict
as needed, and feedback 4. Manifest or Overt conflict
ASPECTS / ELEMENTS OF DELEGATION 5. Conflict aftermath
● RESPONSIBILITY COMMON CONFLICT RESOLUTION STRATEGIES
➔ denotes obligation. 1. COMPROMISING
● AUTHORITY ➔ each party gives up something it wants
➔ the power to make final decisions and give 2. COMPETING
commands. ➔ when one party pursues what it wants at the
● ACCOUNTABILITY expense of the others
➔ refers to liability 3. COOPERATING / ACCOMMODATING
COMMON DELEGATING ERRORS ➔ the opposite of competing. In the cooperating
1. UNDERDELEGATING approach, one party sacrifices his or her beliefs
➔ False assumptions that delegating is a lack of and allows the other party to win
ability of a manager to do the job correctly or 4. SMOOTHING
completely ➔ used to manage a conflict situation.
➔ lack of trust in the subordinates ➔ occurs when one party in a conflict attempts to
➔ often feel as though they must give up control pacify the other party or to focus on agreements
➔ Some novice managers find it difficult to assume rather than differences
the manager role 5. AVOIDING
➔ fail to anticipate the help they will need ➔ parties involved are aware of a conflict but choose
➔ not enough time to explain or teach. not to acknowledge it or attempt to resolve it
2. OVERDELEGATING 6. COLLABORATING
➔ poor managers of time, spending most of it just ➔ an assertive and cooperative means of conflict
trying to get organized resolution that results in a win–win solution.
➔ feel insecure in their ability to perform a task. CONFLICT RESOLUTION BETWEEN MEMBERS IN THE WORKPLACE
3. IMPROPER DELEGATING ● Confrontation
➔ delegating at the wrong time, to the wrong ● Third-party consultation
person, or for the wrong reason ● Behavior change
➔ delegating tasks and responsibilities that are ● Responsibility charting
beyond the capability of the person ● Structure change
 ● Soothing one party
PERFORMANCE APPRAISAL
NEGOTIATION
• frequently resembles compromise when it is used as a conflict ➢ The primary purpose is to give constructive feedback.
resolution strategy ➢ serve as developmental tools
• each party gives up something, and the emphasis is on accommodating
differences between the parties PERFORMANCE APPRAISAL TOOLS:
❖ Although negotiation implies winning and losing for both 1. TRAIT RATING SCALES
parties, there is no rule that each party must lose and win the - a method of rating a person against a set
same amount. standard, which may be the job description,
❖ The focus in negotiation should be to create a win–win desired behaviors, or personal traits.
situation 2. JOB DIMENSION SCALES
- This tool requires that a rating scale be
5. COLLECTIVE BARGAINING
constructed for each job classification
• Collective bargaining involves activities occurring between organized
- rating factors are taken from the context of the
labor and management that concern employee relations. written job description
• such activities include the negotiation of formal labor agreements and 3. BEHAVIORALLY ANCHORED RATING SCALES
day-to-day interactions between unions and management - requires that a separate rating form be
❖ it is true that unions and collective bargaining are very much developed for each job classification
a part of many nurses’ lived experiences - grounded in desired behaviors can be used to
EMPLOYEE MOTIVATION TO JOIN OR REJECT UNIONS improve performance and keep employees
focused on the vision and mission of the
REASONS WHY NURSES JOIN UNIONS organization
1. Increase the power of the individual 4. CHECKLISTS
2. To increase their input into organizational decision-making - weighted scale, forced checklist, and simple
3. To eliminate discrimination and favoritism checklist are some of the types under this tool
4. Because of a social need to be accepted 5. ESSAYS
5. Because they are required to do so as part of employment - AKA: free-form review
6. Because they believe it will improve patient outcomes and - Appraiser describes in narrative form an
quality of care employee’s strengths and areas where
REASONS WHY NURSES DO NOT WANT TO JOIN UNIONS improvement or growth is needed.
1. A belief that unions promote the welfare state and oppose 6. SELF-APPRAISALS
the system of free enterprise - Employees are being asked to submit written
summaries or portfolios of their work-related
2. A need to demonstrate individualism and promote social
accomplishments and productivity as part of the
status
self-appraisal process
3. A belief that professionals should not unionize 7. MANAGEMENT BY OBJECTIVES
4. An identification with management’s viewpoint - an excellent tool for determining an individual
5. Fear of employer reprisal employee’s progress
6. Fear of lost income associated with a strike or walkout - seldom used in health care
8. PEER REVIEW
CONTROLLING - peers carry out monitoring and assessing work
performance
9. THE 360-DEGREE EVALUATION
CONTROLLING - adaptation of peer review, and a new addition
to performance appraisal tools
- Involved comparing actual results with projected results. - includes an assessment by all individuals within
- performance is measured against predetermined standards the sphere of influence of the individual being
- Controlling or evaluating is an on-going function of appraised
management that occurs during planning, organizing, and
directing activities. PRINCIPLES OF EVALUATION:

REASONS FOR CONDUCTING EVALUATION: ● The evaluation must be based on the behavioral standards
of performance which the position requires.
1. ensures that quality nursing care is provided. ● The evaluation should have enough time to observe the
2. It allows for the setting of sensible objectives and ensures employee's behavior.
compliance with them. ● The employee should be given a copy of the job
3. It provides standards for establishing comparisons. description, performance standards, and evaluation
4. It promotes visibility and is a means for employees to monitor their conference
own performance ● The employee’s performance appraisal should include both
5. It highlights problems related to quality care and determines the satisfactory and unsatisfactory results with specific
areas that require priority attention. behavioral instances to exemplify these evaluative
6. It provides an indication of the costs of poor quality. comments.
7. It justifies the use of resources. ● Areas needing improvement must be prioritized to help the
8. It provides feedback for improvement. worker upgrade his/her performance.
 ● The evaluation conference should be scheduled and QUALITY IMPROVEMENT MODELS
conducted at a convenient time for the rater and the Over the past several decades, the American health-care system has
employee moved from a quality assurance (QA) model to one focused on quality
● The evaluation report and conference should be structured improvement (QI)
in such a way that is perceived and accepted positively as a TWO MODELS
means of improving job description. 1. Total Quality Management (TQM)
2. Toyota Production System (TPS)
TOTAL QUALITY MANAGEMENT (TQM)
QUALITY CONTROL ● referred to as continuous quality improvement (CQI)
• a specific type of controlling ● Developed by Dr. W. Edward Deming
• refers to activities that are used to evaluate, monitor, or regulate ● one of the hallmarks of Japanese management systems
services rendered to consumers ● It assumes that production and service focus on the individual
COMPONENTS FOR EFFECTIVE QA and that quality can always be better.
1. needs to be supported by top-level administration ● identifying and doing the right things, the right way, the first
2. sincere commitment by the institution, as evidenced by fiscal time, and problem-prevention planning—not inspection and
and human resource support reactive problem-solving—lead to quality outcomes.
3. Process of quality control must be ongoing TOYOTA PRODUCTION SYSTEM (TPS)
WHO SHOULD BE INVOLVED IN QUALITY CONTROL ● It is a production system built on the complete elimination of
● Quality control requires evaluating the performance of all waste and focused on the pursuit of the most efficient
members of the multidisciplinary team. production method possible
● Patients should also be actively involved in the determination ● “Toyota members seek to continually improve their standard
of an organization’s quality of care. processes and procedures in order to ensure maximum
STEPS IN QUALITY CONTROL PROCESS quality, improve efficiency and eliminate waste.
1. Establish control criteria ● This is known as kaizen and is applied to every sphere of the
2. Identify info relevant to criteria company’s activities”
3. Determine ways to collect information ● Health-care organizations that use TPS would have caregivers
4. Collect & analyze information not only attempt to directly solve problems at the time they
5. Compare collected info with established criteria occur, but it would also have them determine the root cause
6. Make judgment about quality of the problem, so that the likelihood of the problem
7. Provide information and, if necessary, take corrective action recurring would be minimized.
regarding findings 14 QUALITY MANAGEMENT PRINCIPLES
8. Reevaluation 1. Create a constancy of purpose for the improvement of
AUDITS products and service.
➢ Measurement tools 2. Adopt a philosophy of continual improvement.
➢ is a systematic and official examination of a record, process, 3. Focus on improving processes, not on inspection of products.
structure, environment, or account to evaluate performance. 4. End the practice of awarding business on price alone; instead,
➢ Auditing can occur retrospectively, concurrently, or minimize total cost by working with a single supplier.
prospectively. 5. Constantly improve every process for planning, production,
● RETROSPECTIVE AUDITS and service.
➔ performed after the patient receives the service 6. Institute job training and retraining.
● CONCURRENT AUDITS 7. Develop the leadership in the organization.
➔ performed while the patient is receiving the 8. Drive out fear by encouraging employees to participate
service actively in the process.
● PROSPECTIVE AUDITS 9. Foster interdepartmental cooperation and break down
➔ attempt to identify how future performance will be barriers between departments.
affected by current interventions 10. Eliminate slogans, exhortations, and targets for the workforce.
FREQUENTLY USED AUDITS IN QUALITY CONTROL 11. Focus on quality and not just quantity; eliminate quota
● OUTCOME AUDIT systems if they are in place.
➔ can be defined as the end result of care 12. Promote teamwork rather than individual accomplishments.
➔ determine what results, if any, occurred as a result Eliminate the annual rating or merit system.
of specific nursing interventions for patients 13. Educate/train employees to maximize personal development.
● PROCESS AUDIT 14. Charge all employees with carrying out the TQM package.
➔ measure how nursing care is provided
➔ assumes a connection between the process and
the quality of care
● STRUCTURE AUDIT
➔ assume that a relationship exists between quality
care and appropriate structure
➔ includes resource inputs such as the environment
in which healthcare is delivered