ORGANIZIN

G PATIENT
CARE
 TRADITIONAL MODES OF
ORGANIZING PATIENT CARE
1. Total Patient Care
2. Functional Method
3. Team and Modular Nursing
4. Primary Nursing
5. Case Management
A. Total Patient Care

• Also known as case method nursing.

• The oldest mode of organizing patient care.
• A nursing model where one nurse provides total
care to a single patient or a group
of patients during his/her shift.
Cont….total patient care

Advantages:
• This method provides nurses with high
autonomy and responsibility.
• Assigning patients are simple and direct.
• The order of responsibility and accountability
are clear.
• Theoretically, patient receives holistic and
undivided care during the nurse’s time on duty.
Cont…total patient care

DISADVANTAGES:

• The patient may received three different

approaches of care, resulting to patient’s
confusion.
• May required highly skilled personnel, hence
may cost more compared to other forms of
patient care.
• May result to unsafe care when nurses have
heavy patient load.
Cont..
B. FUNCTIONAL METHOD
• Personnel were assigned to complete certain
tasks rather than care for specific patients.
• Uses division of labor according to specific
tasks and technical aspects of the job (ex:
medication nurse)
• Evolved primarily as result of world war II and
the rapid construction of hospitals as a result of
the Hill Burton Act
Cont….functional method

ADVANTAGES:
• Economical means of providing care.
• Task are completed quickly with little
confusion regarding responsibilities.
• Allows care to be provided with minimal
number of nurses.
Cont….functional method

DISADVANTAGES:

• May lead to fragmented care and the possibility

of overlooking patient priority needs.
• May result to low job satisfaction.
• May not be too cost effective because of the
need for many coordinators.
C. Team and Modular Nursing
•  Ancillary personnel collaborate in providing
care to a group of patients under the direction
of a professional nurse.
• Nurse acts as a team leader responsible for
knowing the condition and needs of all patients
assigned to the team.
• Duties may include: assisting team members,
giving direct personal care to patients, teaching
and coordinating patient activities.
Cont…team and mod…

• A team should consist of not more than 5 people.

• Most team nursing was never practiced in its
purest form but was in combination of team and
functional structure.
MODULAR NURSING
• A mini-team consist of 2-3 members approach.
• A small team requires less communication,
allowing members better use of their time for
direct patient care activities.
• Allows members to contribute their own special
expertise or skill.
• Comprehensive care can be provided for patient
despite a relatively high proportion of ancillary
staff.
Cont…team and mod..

ADVANTAGES:
• Continuity of care is improved.
• RN more involved in planning and coordinating
care.
• Geographic closeness and efficient
communication.
Cont…team and mod…

DISADVANTAGES:
• Disadvantages are associated with improper
implementation rather than with the philosophy
itself. e.g. insufficient time for team care
planning and communication can lead to
blurred lines of responsibility, errors and
fragmented patient care.
D. PRIMARY NURSING
• Primary Nurse assumes 24-hour responsibility
for planning the care of one or more patients
from admission or the start of treatment to
discharge or the treatment’s end.
• Also known as relationship-based nursing.
• Provides total direct care for patients.
• Requires nursing staff made up of only nurses.
• Associate nurses follows the care plan
established by the primary nurse when the
primary nurse is not on duty
Cont…primary nursing

ADVANTAGES:
• Clear interdisciplinary group communication
and consistent, direct patient care by relatively
few nursing staffs allows for holistic, high-
quality patient care.
• Establish rapport with patient.
• High job satisfaction.
Cont…primary nursing

DISADVANTAGES
• More staff are needed, thus not cost-effective.
• RN must accept 24-hour responsibility.
• Nurse must be able to practice with a high
degree of responsibility and autonomy, as a
result some nurses may be uncomfortable in this
role due to lack of experience and skills
necessary for the role.
E. CASE MANAGMENT
• A collaborative process that assesses, plans,
implements, coordinates, monitors, and
evaluates options and services to meet an
individual’s health needs through
communication and available resources to
promote quality, cost-effective outcomes
(CMSA, 2006)
•  Introduced in the 1970’s by insurance
companies as a method to monitor and control
expensive health insurance claims.
Cont…CM
• Focus is on individual patients, not populations
of patient.
• Case managers handle each case individually,
identifying the most cost-effective providers,
treatments and care setting.
• Case Management Nurses can choose to
specialize in treating people with diseases like
HIV/AIDS or cancer, or you can work with
patients of certain age groups like geriatrics or
pediatrics.
Cont…CM

• Use Critical Pathways and Multidisciplinary

action plans (MAPs) to plan patient care.

• Effective case managers should have 3-5 years of

direct care experience, preferably within the
specialty area in which they case manage. (Smith
2003)
Cont…CM

Qualities of Case Manager

1. Extremely Bright.
2. Well-developed interpersonal skills.
3. Able to multitask.
4. Strong foundation in utilization review.
5. Understands payer-patient specifics and hospital
reimbursement mechanisms.
Disease Management
• One role increasing assumed by Case Managers is
coordinating disease management programs.
• Also known as population-based health care and
continuous health care improvement.
• Includes early detection and early intervention as
well as comprehensive tracking of patient
outcomes.
• The difference of DM in Case Management is
that the focus is on “covered lives” or
populations of patients, rather than on the
individual patient.
Cont…DM
GOAL: Serve the optimal number of covered lives required to
reach operational and economic efficiency.

• Common Features:
1. Focus is on prevention as well as early disease detection and
intervention.
2. Population-based.
3. Employs multi-disciplinary health care team, including
specialists .
4. Use standardized clinical guidelines – clinical pathways
reflecting best practice research to guide providers.
5. Use integrated data management systems.
6. Frequently employs professional nurses in the role of case
manager or program coordinator.
 5 Components of Determining the Model of
Nursing Care Delivery (Reno et. Al 2005)

A. Conversion of manual systems into automated

ones.
B. Differentiated levels of nursing practice.
C. Increased knowledge base of nursing
practitioners.
D. Development of flexibility and nimbleness.
E. Attraction of nursing candidates from a more
diverse pool of professionals.
 STAFFING,
SCHEDULING
and
RECRUITMENT
RECRUITMENT 
•  Recruitment procedures include the process and
the methods by which vacancies are notified, post
are advertised, applications are handled and
screened, interviews are conducted and
appointments are made.
Sources of recruitment:
A. Internal sources: 
• Internal sources include present employees,
employee referrals, former employee and former
applicants.

B. External sources:
• Sources external to an organization are
advertisements, college/university/institute
placement services, walk-ins and writer-ins,
consultants
C.  Advertisements: 
• These constitute a popular method of seeking
recruits as many recruiters; prefer
advertisements because of their wide reach.
• For highly specialized recruits, advertisements
may be placed in professional journals.
Newspaper is the most common medium.
• Advertisement must contain the following
information: •
• The job content ( primary tasks and
responsibilities)
• A realistic description of working conditions •
the location of the job
• The compensation, including the fringe
benefits
• Job specifications
• To whom one applies.
Staffing
• Is the process of determining and providing the
acceptable number and mix of nursing personnel
to produce a desired level of care to meet the
patient’s demand.
• Process of assigning competent people to fulfill
the roles designated for the organizational
structure through recruitment, selection and
development, induction and orientation of the
new staff of the goals, vision, mission,
philosophy etc.
Purpose:

• To provide each nursing unit with an

appropriate and acceptable number of workers
in each category to perform the nursing tasks
required
FACTORS AFFECTING STAFFING
1. The type, philosophy and objectives of the
hospital and the nursing service .

2. The 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,
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 clearly spelled out.
 Patient Care Classification System
• It is a method of grouping patients according to
the amount and complexity of their nursing
care requirements and the nursing time and
skill they require.
• Purpose:
• 1. Serve in determining the amount of nursing
care required, generally within 24 hours.
• 2. to determine the category of nursing
personnel who should provide that care.
 Classification Categories
• Level I- Self Care or Minimal Care
• Can take a bath on his own.
• Feed himself
• Perform his own ADL.
• For discharge patient, non-emergency, newly
admitted don’t exhibit unusual s/s, requires
little treatment and observation
• Level II- Moderate Care or Intermediate Care 

• Need some assistance in bathing, feeding,

ambulating for short period.
• Extreme s/s of illness must have subsided or
have not yet appeared
• May have slight emotional needs.
• Patient with v/s taking ordered 3x/shift; with
IVF/BT; are semi- conscious and exhibiting
some psychosocial or social problems.
• Patient who have periodic treatments and/or
observations and /instructions.
• Level III- Total, Complete or Intensive Care
• Patient are completely dependent upon the
nursing personnel.
• They are provided complete bath, are fed, may or
may not be unconscious, with marked emotional
needs.
• Patient with v/s monitoring more than 3x/shift,
maybe on continuous oxygen therapy, with chest
or abdominal tubes.
• Patients who require close observation at least
every 30 minutes for impending hemorrhage, with
hypo or hypertension and/ or cardiac arrhythmia
• Level IV- Highly Specialized Critical Care
• Need maximum level of nursing care with a
ratio of 80 professionals to 20 non-
professionals.
• Needs continuous treatment and observation.
• Patients with many medications, IV piggy
backs.
• Patients with v/s monitoring every 15-30
minutes; hourly output.
• Patients with significant changes in doctor’s
orders.
Categories of Level of Care of Patients: Nursing
Care Hours/Pt/Day & Ratio of Prof-Non Prof

Levels of Care NCH needed per pt/day Ratio of Prof to Non-Prof

Level I 1.5 H 55:45

Level II 3.0 H 60:40

Level III 4.5 H 65:35

Level IV 6 to 7H or higher 70:30

80:20
• Distribution by Shifts
•Morning or day shift 45 to 51 percent.
•Afternoon shift 34 to 37 percent.
•Night shift 15 to 18 percent.

• In the Philippines the distribution usually

followed is:
• 45% for the morning shift
• 37% for the afternoon shift
• 18% for the night shifts
 Computing for the number of nursing
personnel needed
• Should ensure that there is sufficient staff to cover all
shifts, off-duties, holidays, leaves, absences, and time
for staff development programs.

• The Forty-Hour Week Law (Republic Act 5901)- for

100 bed capacity and up
• Granting of the 3-day special privilege to govt.
employees by the Civil Service Commission as per
Memorandum Circular No. 6 series of 1996
(birthdays, weddings, anniversaries, funerals
(mourning), relocation, enrollment or graduation
leave, hospitalization, and accident leave.
Staffing Formula
• To illustrate: Find the number of nursing according to
levels of care needed.

1. Categorize the patients according to levels of care

needed
250 pts x 0.30 = 75 pts needing minimal care
250 pts x 0.45 = 112.5 pts needing moderate care
250 pts x 0.15 = 37.5 pts needed intensive care
250 pts x 0.01 = 25 pts need highly specialized
__________

250 nursing care

2. Find the number of nursing care hours (NCH)
needed by patients at each level of care per day.

75 pts x 1.5 (NCH needed at Level I) = 112.5 MCH/day

112.5 pts x 3 (NCH needed at Level II) = 337.5 NCH/day
37.5 pts x 4.5 (NCH needed at Level II) = 168.75 NCH/day
25 pts x 6 (NCH needed at Level IV) = 150 NCH/day
______
Total 768.75 NCH/day 
3. Find the total NCH needed by 250 patients per
year.

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

4. Find the actual working hours rendered by each

nursing personnel per year.

8 (hrs/day) x 213 (working days/year) = 1,704

(working hours/year) 
5. Find the total number of nursing personnel needed

a. Total NCH per year = 280,593.75 = 165

Working hrs/year 1,704
b. Relief x total nsg. Personnel = 165 x 0.15 = 25

c. Total nursing personnel needed 165 + 25 = 190

• 6. Categorize to professional and non-professional
personnel ratio of prof to non-prof in a tertiary
hospital is 65:35

190 x .65 = 134 professional nurses

190 x .35 = 66 nursing attendants

7. Distribute by shifts 

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
Total 124 nurses

66 nsg attendants x .45 = 30 nsg. attendants on AM shift

66 nsg attendants x .37 = 24 nsg attendants on PM shift
66 nsg attendents x .18 = 12 nursing attendants on NOC
Total = 66 nursing attendants
SCHEDULING
• Implementation of staffing pattern by assigning
personnel to work specific hours and days in a
specific unit or area.

• Make a schedule in a weekly or monthly basis

and do cycle system with the staff under the area
assigned for fairness and flexibility.
Centralized Scheduling
• The schedule done by the upper manager for all
nurses in all departments manually or by
computer.
Decentralized Scheduling
• When managers are given authority and assume
responsibility, they can staff their own units
through decentralized scheduling.
Self scheduling
• A system that is coordinated by staff nurses.
• Staff may negotiate before and after work and
during break and lunchtime.
• Alternating or rotating work shifts
• It may take 2-3 days to 2 weeks for a person to
adjust to a different sleep-wake cycle.

• Permanent shift
• Relieve nurses from stress and health related
problems associated with alternating and
rotating shifts.
• Block, or cyclical, scheduling 
• Uses the same schedule repeatedly.
• The schedule repeat itself every 6 weeks.
• Eight hour shift in a five day workweek
• 5-day, 40-hours workweek
• Ten hour shift in four day workweek
• The main problem was fatigue. The long
weekends and off were attractions. There is
time to finish work, peak work loads can be
covered, and there is decreased overtime and
decreased costs.
• Twelve-hour shift in seven day workweek
• The better use of personnel lower staffing
requirements; this consequently lowers the cost
per patient day.
Any Questions?
REFERENCES
• Finkler, S.A., & Kovner, C.T. (2000). Financial management for
nurse managers and executives (2nd ed.). Philadelphia, PA:
Saunders.
• Henderson, E. (2003). Budgeting: Part one. Nursing Management,
10(1), 33- 37.
• Henderson, E. (2003). Budgeting: Part two. Nursing Management,
10(2), 32- 36.
• Lehmann-Spitzer, R. (1994). Nursing management desk reference
concepts, skills and strategies. Philadelphia: Saunders.
• https://nurseslabs.com/nursing-management-guide-to-organizing-
staffing-scheduling-directing-delegation/#staffing_process