COURSE UNIT 1 Theories of Management

• Early Management
NURSING MANAGEMENT AND LEADERSHIP
1. Frederick Taylor
“If workers can be taught the one best way to
“LEADERS CAN BE MANAGERS, BUT NOT ALL accomplish a task, productivity will increase.”
MANAGERS ARE LEADERS.” - Scientific Management Theory
- Time and Motion Studies
LEADERSHIP Taylor’s Scientific Principles
- Viewed by some as one of managements many
• “Rule of Thumb”
function
- Work can be scientifically designed to promote
greatest efficiency of time and energy
MANAGER
• Scientific selection, hiring, training and promotion
- A person who has responsibility for the activities
of workers
of other people in an organization.
- Bases should be competence and abilities
• Use of financial incentives as a reward for work
Management
accomplished
- It is a universal process
- Based on his belief that humans are “Economic
- use in business, practice of one’s profession and
animals”
even day to day personal affairs
• Workers should work and managers plan, prepare,
- The process of coordinating and supervising
and supervise
personnel and resources to accomplish
organizational goals.
2. Frank and Lilian Gilbeth
- About coping with complexity
- Emphasized job simplification and establishment of
- Does the thing right
work standards
- Guiding or taking charge
- Handling, direction, control
3. Henry Gantt
- Processing of utilizing the resources available in
- Introduced the use of the Gannt chart which shows
order to achieve the desired organizational
the relationship of the work planned or completed
goals efficiently and effectively
on one axis to the amount of time needed or used
- Men - manpower, money - capital, materials -
on the other
machine for devices, milieu – environment

Characteristics of Managers
- Has assigned position within a formal organization.
- Legitimate source of power (delegated authority)
- Specific functions, duties, and responsibilities
- Utilize resources effectively and efficiently towards
achieving organizational goals
- Directs both willing and unwilling followers
4. Henry Fayol
Three-fold Concepts of Management - Management functions
1. Economic Source – management of a firm - Planning, organization, command, coordination, and
determines to a large extent, its productivity and control
profitability - “Father of the Management Process School”
2. System of Authority – management first develops Fayol’s Administrative Principle
with top individuals determining the course of • Division of labor
action for the rank and file • Work specialization
3. Class and Status System – managers have become • Scalar chain of authority (levels of authority)
an elite group of brains and education • Responsibility accompanied by authority
• Fair and just remuneration
• Group harmony through equal treatment or “spirit
d’ corps”
• Stability of tenure of employees

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 5. Lyndall Urwick 3. Jacob Moreno
- added to these principles the following - System of pairings called Sociometry;
• Span of control - Believes that people are attracted to, repulsed by or
• Unity of command just indifferent towards each other

6. Luther Gulick (1937) Behavioral Theories

- Expanded on Fayol’s management functions 1. Abraham Maslow
- Seven Activities in Management POSDCORB - Described humans as “wanting” organisms that
(Planning, Organizing Staffing, Directing, satisfy their basic needs in a specific sequence.
Coordinating Reporting, and Budgeting) - According to Maslow, higher level needs do not
- He also believed that “management should be emerge as motivators until lower level needs are
taught in school” satisfied.
• Planning – vision, mission, philosophy, goals and
objective, policies, procedures and rules 2. Douglas Mc Gregor
• Organizing – organizational structure to carry out “Managerial attitudes can be directly correlated with
plans and the most appropriate type of patient care employee satisfaction”
delivery. Theory X
• Staffing – recruiting interviewing, hiring, and - Believes that employees are basically lazy, need
orienting staff constant supervision and direction.
• Directing – motivating, managing conflict, Theory Y
delegating, communicating, facilitating - Believes that workers enjoy their work, are self-
collaboration motivated, and are willing to work hard to meet
• Controlling – performance appraisals, fiscal personal and organizational goals
accountability, quality control, legal and ethical
control 3. Frederick Herzberg
- proposed the Two-factor Motivational Need
7. Max Weber - hygiene Factors “Dissatisfiers”
- Motivating factors “Satisfiers”
Bureaucratic Organization
- Advocated that the ideal form of organization is
4. William G. Ouchi
bureaucracy with the following
Theory Z
• Well defined hierarchy or authority
- Consensus decision making
• Division of work based on specialization of function - Fitting employees to their jobs
• Highly specified rules and regulations - Job security
- Slower promotion (horizontal movement the
3 Bases of Authority organization)
1. Traditional - Holistic concern for the workers
2. Charisma - Guarantee of lifetime employment
3. Rational and legal (K, S, A = competence)
Blake and Mouton’s Managerial Grid
Human Relations Management - Stated that there are 2 critical dimensions of
- Developed concepts of participatory and leadership (a) concern for people, and (b) concern
humanistic management for production.
- Emphasis on people rather than machines - A manger can be high on both (9,9) or low on both
(1,1); high on task, low on relationship (9,1) low on
1. Mary Parker Follet task, high on relationship (1,9)
“Managers should have authority with, rather than,
over employees.”

2. Elton Mayo and Colleagues

- Hawthorne Plant Study
“When management paid special attention to workers,
productivity will likely to increase regardless of the
working conditions”
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 Roles of a Manager
• Interpersonal – symbol of the organization, liaison
between the organizations and the outside contacts
• Informational – monitors and disseminates
information represents the subordinates to
superiors and vice versa.
• Decisional – trouble shooter, conflict negotiator

Levels of Management

Contemporary Approach
The System Approach LEADERSHIP
1. Closed System - About coping with change
- Not influenced by and do not interact with their - Does the right thing
environment. - An interpersonal skill of influencing others towards
- There is greater predictability goal achievement
2. Open System - Out front, moving forward, taking risks, challenging
- System that interacts with their environment the status quo
- Open to new ideas and improvement of the system
Characteristics:
The Contingency Approach - Often do not have delegated authority
- States that a variety of factors, both internal and - May or may not be a part of a formal organization.
external to the firm, may affect the organization’s - Emphasize interpersonal relationships
performance. - Focus on group process information gathering,
- Therefore, there is no “one best way” to manage feedback and empowering others
and organize because circumstances vary. - Directs willing followers
- Have goals that may or may not reflect the
A Management Approach that recognizes organizations organizational goals
as different, which means they face different situations
(contingencies) and require different ways of managing. Development of Leadership Training
1. Great Man Theory
Situational characteristics are called contingencies. The “Some people are born to lead whereas others are born
contingencies include to be lead.”
• Circumstances in the organization’s external 2. Charismatic Theory
environment. - Inspirational quality possessed by some people that
• The internal strengths and weaknesses of the make others feel better with their presence.
organization - Arousing strong feeling of loyalty and enthusiasm.
Skills of Manager
• Technical – proficient in performing an activity in Evolution of Leadership Theory
the correct manner with the right technique. (Skills)
• Conceptual – ability to see individual matters as
they relate to the total picture, develop creative
ways to respond to identified problems with the use
of relevant facts (Knowledge)
• Human – dealing with people and how to get along
with them (Attitude)
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 1. Traits Theories Traits required of a leader differ according to varying
“Assume that some people have certain characteristics Variables
or personality traits that make them better leaders than - Personality of the leader
others” - Performance requirements of both the leader and
follower
2. Behavioral Theories - Attitudes, expectations and needs of the leader and
- Emphasis is not on the traits the leader has but followers
rather on what he did as a leader (style)
• High task, low relationship style – is effective when
Authoritarian subordinates are low in motivation and ability
Lewin, White & Lippit’s Leadership Styles • High task, high relationship style – is effective when
- Strong control over the work group subordinates have adequate motivation but low
- Use of coercion and command ability
- Downward flow of communication • Low task, high relationship style – is effective when
- Emphasis on the difference of status subordinates have adequate ability but low
- Criticism is punitive motivation
• Low task, low relationship style – is effective when
Democratic subordinates are very high in ability and motivation
- Less control
- Use of economic and ego rewards as motivators Transformational Theory
- Directs through suggestion and guidance Interactional Leadership
- Communication flows up and down Transaction and Transformational Leadership (Burns)
- Participative decision making - Suggests that both the leaders and followers have
- Emphasis is on “we” not “I” and “you” the ability to raise each other to a higher level of
- Criticism is constructive motivation and morality

Laissez-Faire • Transactional Leader focuses on tasks and getting

- Permissive, with little or no control the work done
- Motivates by support when requested by the group • Transformational Leader focuses on vision and
or individuals empowerment
- Provides little or no direction
- Upward and downward communication between Power
members of the group - The ability to impose the will of one person or group
- Disperses decision making throughout the group to bring certain behaviors in other persons or
- Places emphasis on the group groups.
- Does not criticize
1. Reward Power – comes from the ability to reward
3. Situational and Contingency Leadership Theories others for complying
Believed that leadership style should vary according to 2. Coercive Power – based on a fear of a punishment if
the situation one fails to conform; an opposite of reward power
3. Legitimates Power – the right to the manager or
Mary Parker Follet leader to influence and the staff member on
- Conceptualized the “law of the situation” which obligation to accept that influence
dictates that a person does not take orders from 4. Referent Power – based on identification with a
another person but from the situation itself. leader and what that leader symbolizes. The leader
is admired and exerts influence because the
Fred Fiedler, 2960 followers desire to be like the leader
“No leadership style is ideal for every situation” 5. Expert Power – gained through knowledge, skills,
information, experience and competence; expertise
Paul Hersey and Kenneth Blanchard 1950-1980 gains people respect and compliance
- Predicts the most appropriates leadership style 6. Information Power – comes from knowledge,
from the level of maturity of the followers access to information, and sharing of information. It

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 is especially powerful when others need the CLASS AND STATUS SYSTEM
information - This is from sociologist’s point of view that managers
7. Connection Power – comes from formal or informal have become an elite group of brains and education.
coalitions and interpersonal relations and links to This class is based on education and knowledge.
prestigious and influential people within and Managers continue to expand their horizons in an
outside of the organization effort to attain the ultimate in life or goal.

Introduction to Nursing Management THEORIES OF MANAGEMENT

- Nursing Management is a guide for nurses who EARLY MANAGEMENT
wants to learn the concepts behind Nursing A. Scientific Management Theory (1900-1930)
Management. This will also guide nurses to - Frederick W. Taylor, the “father of scientific
organizing, staffing, scheduling directing and management’ Taylor postulated the workers could
controlling, it also deals with the application of the be taught “one best way to accomplish a task”
concepts, principles, theories and methods of productivity would increase. He called these
developing nursing leaders and managers in the principles scientific management.
hospital or any settings.
- Management is an old French term its means “the FOUR PRINCIPLES OF SCIENTIFIC MANAGEMENT:
directing”. There are many definition of 1. Traditional “Rule of Thumb” means
management is. It is a universal process. It is the organizing work must be replaced with
process of coordinating and supervising personnel scientific methods. Give allotted time to
and resources to accomplish organizational goals. workers in accomplishing their task.
Also it is to design and maintain an internal 2. Workers can be hired, trained and promoted
environment in which people working together in based on their competence and abilities.
groups. That can perform effectively and efficiently 3. Employees are entitled of receiving financial
towards the attainment of group goals. Management rewards, and incentives for worked
is being use in running a business, practice ones’ accomplished because he viewed humans as
profession, and day to day interaction. A thorough “economic animals’ motivated solely by
knowledge in management includes: time, resources money.
and workforce. 4. Maintain good interpersonal relationship
- According to Venson, (2010) management is a between the workers and managers they
process by which a cooperative group directs actions should be cooperative and interdependent
towards common goals, it involves technique by and the work should be shared equally.
which a distinguished group of people coordinates
the services of people. It also includes moral and Frank and Lilian Gilbreth
ethical standards in the selection of right ends “The First Lady of Management”
toward which managers should strive. - Use motion picture to develop work efficiency.
- “Therbligs” - 17 classification of hand movements.
There are three-fold concept to emphasize the broader - Develop Job Simplification.
scope of management, (Harbizon and Myers) - Subject of the book “Cheaper by the Dozen
ECONOMIC SOURCE
- is one of the factors of production together with Henry Gantt
land, and capital. Industrialization increases, Disciple of Frederick Taylor
management is substituted by labor and capital. - Develop Gantt Chart
Management of a firm determines to a large extent, - Advocates for a humanitarian management
its productivity and profitability.
SYSTEM OF AUTHORITY B. Classical Organization Theories
- management first develops with top individuals - Henry Fayol (1925) identified management functions
determining the course of action for the rank and file. of planning, organization, command, coordination,
The constitutional management emphasizes definite and control Luther Gulick (1937) expanded on
and consistent concern for policies and procedures in Fayol’s’ management functions he mentioned that
dealing with the working group. A line toward a they are “seven activities in management” staffing,
democratic and participative approach follows as directing. Coordinating.
employee receive higher education.
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- Reporting, and budgeting-POSDCORB. Often times warrant attention. Employee knows that they are
Managers considered this as the process of being evaluated by management.
management. He also believes that management
should be taught in school. Jacob Moreno
- developed a system of pairings called Sociometry,
Management Process believes that people are attracted to, repulsed by or
a. Planning it is determining philosophy, goals and just indifferent towards each other.
objective, policies, procedures and rules.
b. Organizing it includes establishing the D. Behavioral Science
organizational structure to carry out plans Abraham Maslow
Determining the most appropriate type of - developed the Hierarchy of Needs
patient care delivery. o Physiologic Needs
c. Staffing functions consist of recruiting o Safety and Security Needs
interviewing, hiring and orienting staff. o Love and Belonging Needs
d. Directing it includes several staffing functions o Self-Esteem Needs
such as motivating, managing conflict. o Self- Actualization
Delegating, communicating, facilitating
collaboration. Frederick Herberzg
e. Controlling functions include performance - develop taxonomy of job situation.
appraisals. Fiscal accountability, quality control, o Believes in job satisfiers/ motivation factor
legal and ethical control. and dissatisfies/ hygiene factor

Max Weber William Ouchi

“Father of Organizational Management” - develop Theory Z by comparing the Japanese
- He developed the organizational chart. According to organization to the American organization.
him there are 3 basis of authority traditional,
charismatic and rational authority. Douglas McGregor (1960)
- theorizing that managerial attitude about employees
Lyndal Urwick this could be correlated to employee’s satisfaction.
- She combined the theories of Taylor and Fayol to He labeled Theory X and theory Y. Theory X,
develop the classic Organizational Theory”, manager’s beliefs that their employee are basically
popularized the term “span of control and unity of lazy.
command.
William Blake
C. Human Relation Management (1930-1970) - develop the Managerial Grid
Mary Parker Follett (1926) Types of Managers in Managerial Grid
- one of the first theorist to suggest basic principles of - Impoverish Manager
what today would be called participative decision - Country Club Manager
making or participative management - Organizational Man Manager
- She believed that managers should have authority - Authority Obedient Manager
with one another, rather than over employees, that - Team Manager
solution could be easily be found that could satisfied
both employee without dominating each other. CONTEMPORARY MANAGEMENT

Elton Mayo and his Harvard associates

- conducted a study done at the Hawthorne Works of
the Western Electric Company near Chicago, they
found out that if workers give special attention
productivity increases, regardless of the
environmental conditions.
- This Hawthorne effect shown that people respond
that they are being studied, they felt that whatever
behavior they attempted they still continue to

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 Contemporary Approach Levels of Management
- means new, recent or current approaches in the field 1. Top Level Manager – look at the overall operation
of management. of the organization. - Coordinate internal and
- EXAMPLE: external affairs of the organization. - Makes the
• The way company was running 100 years ago is major decisions - Determines the organization’s
different from today. However, one steel mission/ vision statement, philosophy, policies and
company today might say they use procedures. - Creates goals and allocate resources.
“contemporary management” meaning they use 2. Middle Level Manager – coordinates activities of
the same type of management that other steel different department - Receives policies from the
companies use today. top-level manager. - Makes specific objectives and
programs.
Contingency Approach 3. First Level Manager – directly responsible for the
- A management approach the recognizes actual production of services. - Act as a link between
organizations as different, which means they face the higher-level managers and non-managers.
different situations (contingencies) and require
different ways of managing. Skills of a Manager according to Katz
- Assumes there is no best way to manage. 1. Technical Skill – knowledge and proficiency in
o The environment impacts the organization activities involving methods, procedures and
and managers must be flexible to the act to process.
environmental changes. 2. Human Skill – ability to work with people - Create a
o The way the organization is designed and harmonious working relationship.
control systems selected defend on the 3. Conceptual Skill – ability to see the overall picture
environment. to identify important elements in a situation and to
- Technological environments change rapidly, so must understand the relationship among the elements.
managers. And identifying pertinent factors, responding to the
big problems, and discarding irrelevant facts.
Situational characteristics are called contingencies.
- The contingencies include: Other approach according to Summer
o Circumstances in the organization’s external 1. Knowledge factors refer to ideas, concepts, or
environment. principles that can be expressed and are accepted
o The internal strengths and weaknesses of because they have logical proofs.
the organization. 2. Attitude factors relate to those beliefs, feelings, and
o The values, goals, skills, and attitudes of values that may be used on emotions and may not
managers and workers in the organization. be subjected to conscious verbalization.
o The types of tasks, resources, and 3. Ability factor skill, art, judgement, and wisdom. They
technologies the organization uses. abstract factors but they direct one’s thinking to
factors that can be developed by the individual
System Approach manager who takes time to consider them.
- A set of interrelated and interdependent parts
arranged in a manner that produces a unified whole Roles of a Manager
1. Interpersonal Role, the manager acts as:
Process Closed System A. Symbol because of the position he/she
- system that are not influence by and do not interact occupies and consists of such duties as signing of
with their environment. papers/documents required by the organization.
B. Leader, who hires, trains, encourages, fires,
Open System remunerates, and judges
- systems that interact with their environment C. Liaison Officer between outside contacts such
- The contingency perspective refutes universal as community, suppliers and the organization
principles of management by stating that a variety of
factors, both internal and external to the firm, may 2. Informational Role, the manager does;
affect the organization’s performance. A. Disseminates Information, from both external
- Therefore, there is no “one best way” to manage and and internal sources
organize because circumstances vary. B. Monitors information

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 C. Spokesperson or representative of the where and how as the use schedules to get to the
organization. He/she represents the destinations and evaluate human performance.
subordinates to superiors and the upper
management to the subordinates. Manager
- Are assigned a position by the organization.
3. Decisional Role makes him/her - Have a legitimate source of power due to delegated
A. Problem Solver/ Trouble Shooter, who authority that accompanies their position
handles unexpected situations such as - Have a specific duties and responsibilities they are
resignation of subordinates, firing or expected to carry out.
subordinates, and loss of clients - Emphasize control, decision making, decision
B. Innovator/ Entrepreneur a designer to analysis, and results.
improve projects that direct and control change - Manipulate people, the environment, money, time,
in the organization and other resources to achieve the goals of the
C. Negotiator when conflict arise organization.
- Have a greater format responsibility and
LEADERSHIP accountability for rationality and control than
- It is important to remember though that a job title leaders.
alone does not make a person leader. Only a person’s - Direct willing and unwilling subordinates.
behavior determines if he or she holds a leadership
role. Leaders
- The manager is a person who brings things about the
- Often do not have delegated authority but obtain
one who accomplishes, has the responsibility, and
power through other means, such as influence.
conducts. A leader is the person who influences and
- Have a wider variety of roles than managers.
guides direction, opinion, and course of action.
- Focus on group process, information gathering,
- There are several definitions of what leadership is:
feedback, and empowering others.
o A process of influence in which the leader
- May or may not be part of the formal hierarchy of the
influences others toward goal achievement
organization.
o The process of influencing the activities of an
- Emphasize interpersonal relationship
organized group in its efforts toward goal
- Direct willing followers
setting and goal achievement
- Have goals that may or may not reflect those of the
o Is about creating change. It involves
organization.
establishing a direction, aligning people
through empowerment, motivating and
DIFFERENT LEADERSHIP THEORIES
inspiring them toward producing useful
change and achieving the mission.
o It Is the vital ingredient that transforms a
crowd into a functioning, useful
organizations.

Nursing Leadership
- process whereby nurse influences one or more
persons to achieve a specific goal in the provision of
quality nursing care.

COMPARISON BETWEEN LEADERSHIP AND

MANAGEMENT
- Leaders need to do the right things, are challenged EARLY LEADERSHIP
by change, focus on purposes and have a future time 1. Great Man theory: (1900-1940)
frame. - Leaders are born.
- Managers do things right are challenged by - Leaders display both instrumental (technical) and
continuity and focus on structures and procedures in supportive (socially oriented) leadership behavior
a present time frame. They ask who, what, when, - Great leaders arise when situation demands it.

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 2. Trait Theory 4 criteria to determine the degree of task structure:
- Traits are inherent (before). Traits can be learned 1) goal clarity;
(now) 2) extent to which a decision can be verified
- Identified traits: energy, affection, enthusiasm, knowing who is responsible for what;
ambition, aggressiveness, decisiveness, self- 3) multiplicity of goal paths, number of solutions
assurance, self-confidence, friendliness, affection, 4) specificity of solution, number of correct
honesty, fairness, loyalty, dependability, technical answers
mastery, teaching skill.
c. Position power
3. Charismatic Theory - authority inherent in a position (use rewards and
- Leaders possess charisma (an inspirational quality punishment)
that some leaders possess that makes others feel - Note; Fiedler says that one can predict the most
better in their presence.) productive leadership styles
1. Task is structured, leader disliked, then
4. Situational Theory diplomatic
- Traits required of a leader differ according to varying 2. Task is ambiguous, leader is liked, then seek
situations (variables) cooperation
- Variables: 3. Accepting, considerate leadership style
o personality of the leader probably will be most productive.
o performance requirements of both the
leader and followers attitudes, 6. Path goal Theory
expectations and needs of the leader - People act as they do because they expect their
and followers behavior to produce satisfactory results
a. Degree of interpersonal contact possible - Structured activities were more productive and
b. Time pressures successful
c. Physical environment
d. Organizational structure 7. Situational Leadership Theory (Paul Hersey &
e. Influence of the leader outside the group Nature Kenneth Blanchard) (1950-1980)
of the organization - Predicts the most appropriate leadership style from
the level of maturity of the followers through the
5. Contingency Theory: (Fred Fiedler, 1960s) four quadrant model, a horizontal continuum
- According to Fiedler no leadership style is ideal for registers low emphasis on the accomplishment of
every situation. tasks on the left side to emphasis on task behavior on
- The interrelationship between the group’s leader the right side
and its members were most influenced by the - The vertical continuum depicts low emphasis on
manager’s ability to be a good leader. interpersonal relationships at the bottom to high
emphasis on relationships at the top
3 aspects of a situation that structure the leaders: - The lower left quadrant represents laissez -faire type
a. Leader-member relations of leadership with little concern for production or
assessed through Group Atmosphere Scale relationships

b. Task structure
- High if it’s easy to define and measure a task
- Low if it’s difficult to define a task and to measure
progress toward its completion

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 LEADERSHIP STYLES BY HERSEY & BLANCHARD - Economic and ego rewards are used to motivate.
1. DIRECTING STYLE: This is a high task, low - Emphasis is on “we” rather than I and you.
relationship style and is effective when - Criticism is constructive
subordinates are low in motivation and ability
2. COACHING STYLE: This is a high-task, high 3. Laissez-faire
relationship style and is effective when - Leaving workers without direction and supervision
subordinates have adequate motivation but low and allows them to plan
ability - Leader uninvolved, disinterested, withdrawn.
3. SUPPORTING STYLE: This is a low-task, high- - Permissive with little or no control
relationship style and is effective when - Uses upward and downward communication
subordinates have adequate ability but low between members of the group
motivation - Places emphasis on the group
4. DELEGATING STYLE: This is a low-task, low- - Does not criticize
relationship style and is effective when
subordinates are very high in ability and CONTEMPORARY LEADERSHIP
motivation. 1. Transformational Theory
- Promotes employee development
8. Transactional Theory - Attends to needs and motives of followers
- Exchange posture that identifies needs of followers - Inspires through optimism
and provides rewards to meet those needs in - Influences changes in perception
exchange for expected performances - Provides intellectual stimulation Encourages
- Leaders focuses on a day-to-day operation followers’ creativity

9. BEHAVIORAL THEORY 2. Servant Leadership

- Is a management philosophy that evaluates leaders - They are more concerned with the needs of other
according to the actions they display in the work than themselves and lead through their service. They
place. To be effective leader is to learn a certain set foster a service inclination in others that promotes
of behaviors. collaboration, teamwork, and collective activism.
- A leadership theory developed, researchers changed
from studying what traits the leader had and placed 3. Authentic leader
emphasis on what he or she did, the leadership style - A leader manager arsenal, in order to lead, leaders
of leadership. must be true to themselves and their values and act.
Authentic or congruent leadership theory differs
3 LEADERSHIP STYLES (Kurt Lewin, et al 1930) from traditional transformational leadership theory.
- His breathrough occurred when he and White (9151)
and Lippitt (1960) identified with common leadership 4. Thought leader
styles. - Applies to a person who is recognized among his or
1. Authoritarian her peers for innovative ideas and demonstrates the
- Uses positional and personal power confidence to promote those ideas
- Demanding and controlling
- Emphasis is on difference in status ( “I” and you POWER
“you”). - the ability to impose the will of one person or group
- Others are directed/ motivated with commands to bring certain behaviors in other person or groups.
- Critism is punitive
- Communications flow up & downward Reward Power
- Decision making does not involve others - it is the leader or manager’s power comes from the
ability to reward others for complying.
2. Democratic
- Allows for group governance through collaboration Coercive Power
or group efforts - based on a fear of punishment if one fails to conform
- Situation of trust and openness - an opposite of reward power
- Decision making involves others
- Less control is maintained
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 Legitimate Power
- the right of the manager or leader to influence and
the staff member an obligation to accept that
influence.

Referent Power
- is based on identification with a leader and what that
leader symbolizes. The leader is admired and exerts
influence because the followers desire to be like the
leader.

Expert Power
- gained through knowledge, skills, information,
experience and competence. Their expertise gains
people respect and compliance.

Information Power
- comes from knowledge, access to information, and
the sharing of information. It is especially powerful
when others need the information.

Connection Power
- comes from formal or informal coalitions and
interpersonal relations and links to prestigious and
influential people within and outside of the
organization.

TERMINOLOGIES
Effectiveness extent wo which desired outcomes are
attained through use of intervention.

Efficiency the relationship between monetary value of

resources expanded and monetary value of results
achieved. Achieving the best results with least cost.

Management the process of getting work done

through others

Manager one who carries out predetermined policies,

rules and regulations with official sanction or act.

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 COURSE UNIT 2
PATIENT HEALTH CARE DELIVERY SYSTEM
Nursing Process in the Delivery of Nursing Care
Service

- Patient classification systems (PCS), also known as

workload management, or patient acuity tools,
were developed in 1960s.
- A PCS group patients according to specific
characteristics that measure acuity of illness in an
effort to determine both the number and mix of the
staff needed to adequately care for those patients.
Below is a sample classification system.

- Nursing process is defined as a systematic, rational 1. Self-care / Minimal care

method of planning and providing individualized - Include patients who are recovering and normally
nursing care. requires only diagnostic studies, minimal therapy,
- It is utilized to identify a client’s health status and less frequent observations, and daily care for minor
actual or potential health care problems or needs, to conditions and are awaiting elective surgery
establish plans to meet the identified needs, and to
deliver specific nursing interventions to meet those 2. Moderate care
needs. - Include moderately ill or under the recovery stage
- It is cyclical and its components follow a logical from a serious illness or operation. They require
sequence, but more than one component may be nursing supervision or assistance that is related to
involved at one time. ambulating and caring for their own hygiene
- At the end of the first cycle, care may be terminated
if goals are achieved, or the cycle may continue with 3. Intensive care
reassessment, or the plan of care may be modified - patient needs close attention and complete care all
(Berman, Synder, & Frandsen, 2016). through the shift. The nurses initiate, supervise and
perform most of the patient’s activities.
Patient Classification System
- A patient classification system (PCS) predicts patient 4. Critical Care
needs and requirements for nursing care. - Patients are acutely ill and high level of nurse
- A system grouping patients based in acuity of illness dependency is required because of the unstable
and complexity of nursing activities necessary to condition of the patient. Frequent evaluation,
care for the patients observation, monitoring and adjustment of therapy
- Typically, patient acuity data are collected every shift is required. Patient in these levels include those in
by nursing staff and are analyzed to project nursing critical conditions or in life-or-death situations.
staff needs for the next shift.
- The advantage of using a PCS is that it is an objective
approach to determine staffing needs (proper mix
and number) based on patient care needs: a sicker
patient requires more nursing care and therefore
would have a higher acuity level. However, there are
numerous issues regarding use of PCSs, including lack
of standardization, lack of credibility among nurse
leaders and managers, and no consideration of
patient flow (Hertel, 2012).
- Workload management, or patient acuity tool

13
 Patient classification systems are institution-specific and must be modified to reflect the unique staff and patient
population of each health-care organization. Other variables within the system have an impact on nursing care hours
(NCH) and are usually not possible to transfer a PCS from one facility to another.

14
 Modalities of Care different approaches to care, often resulting in
- There are five most well-known means of organizing confusion for the patient.
nursing care for patient care delivery. These are the - To ensure quality of care delivered, highly skilled
functional nursing, team and modular nursing, personnel is required and may cost more than some
primary nursing, and case management. other forms of patient care.
- Each of these basic types has undergone many - Opponents of this method argue that some tasks
modifications, often resulting in new terminology. performed by the primary caregiver could be
- An example is the primary nursing which was once accomplished by someone with less training and
called case method nursing and is now frequently therefore at a lower cost.
referred to as professional practice model. - The greatest disadvantage of this method occurs
- Team nursing is sometimes called partners in care or when the nurse is inadequately prepared or too
patient service partners, and case managers assume inexperienced to provide total care to the patient.
different titles depending on the setting in which
they provide care.

1. Case Method Nursing or Total Patient Care

- Nurses assume total responsibility during their time
on duty for meeting all the needs of assigned
patients.
- Patients may be assigned as cases

Case Method Illustration

2. Functional Nursing
- Personnel were assigned to complete certain tasks
rather than care for specific patients
- May lead to fragmented care and the possibility of
overlooking patient priority needs and may result in
low job satisfaction.

Functional Nursing Illustration

- Total patient care is the oldest mode of organizing
patient care. With total patient care, nurses assume
total responsibility during their time on duty for
meeting all the needs of assigned patients.
- Total patient care nursing is sometimes referred to
as the case method of assignment because patients
may be assigned as cases, much like the way private
duty nursing was historically carried out.
- This method of assignment is still widely used in
hospitals and home health agencies. Nurses are
provided with high autonomy and responsibility.
- Assigning patients is simple and direct and does not
require the planning that other methods of patient
care delivery require. The lines of responsibility and
accountability are clear. - The functional method of delivering nursing care
- The patient receives holistic and unfragmented care evolved primarily as a result of World War II and the
during the nurse’s time of duty. rapid construction of hospitals as a result of the Hill
- Because the nurse practices with high autonomy, Burton Act. Because nurses were in great demand
care regimen may be modified. Therefore, if there overseas and at home, a nursing shortage
are three shifts, the patient could receive three
15
 developed and ancillary personnel were needed to - In team nursing, ancillary personnel collaborate in
assist in patient care. providing care to a group of patients under the
- Relatively unskilled workers were trained to do direction of a professional nurse.
simple tasks and gained proficiency by repetition. - As the team leader, the nurse is responsible for
- Personnel were assigned to complete certain tasks knowing the condition and needs of all the patients
rather than care for specific patients. assigned to the team and for planning individual
- Examples of functional nursing tasks were checking care.
blood pressures, administering medications, - The team leader’s duties vary depending on the
changing linens, and bathing patients. patient’s needs and the workload. These duties may
- RNs became managers of care rather than direct include assisting team members, giving direct
care providers, and “care through others” became personal care to patients, and coordinating patient
the phrase used to refer to this method of nursing activities.
care. - Extensive team communication is required so that
- This functional form of organizing patient care comprehensive care can be provided for patients
continued even after the war ended. despite a relatively high proportion of ancillary staff.
- Most health-care organizations continue to employ This communication occurs informally between the
health-care workers of many educational team leader and the individual team members and
backgrounds and skill levels. formally through regular team planning
- Functional nursing may lead to fragmented care and conferences.
the possibility of overlooking patient priority needs - A team should consist of not more than five people
and may result in low job satisfaction. It may also not or it will revert to more functional lines of
be cost-effective due to the need for many organization.
coordinators. - Team nursing is usually associated with democratic
leadership as group members are given as much
3. Team Nursing (Partners in Care or patient Service autonomy as possible when performing assigned
Partners) tasks, although the team shares responsibility and
- Ancillary personnel collaboration in providing care accountability collectively.
to a group of patients under the direction of a - Disadvantages are associated with improper
professional nurse implementation rather than with the philosophy
- The nurse-leader determines the condition and itself.
needs of all the patients assigned to the team and - Frequently, team care planning and communication
plans for individual care is faced with insufficient time and can lead to
- Duties vary based on the patient’s needs and the blurred lines of responsibility, errors, and
workload and may include assisting team members, fragmented care.
giving direct personal care t patients, and - For team nursing to be effective, the team leader
coordinating patient activities. must be an excellent practitioner and have good
communication, organizational management, and
Team Nursing Illustration leadership skills.

16
 4. Modular Nursing 5. Primary Nursing (Professional practice Model)
- Uses a mini-team (two or three members with at - Relationship-based nursing; uses some of the
least one member being an RN), with members of the concepts of total patient care as the RN also
modular nursing team sometimes being called care provides bedside care.
pairs. - The primary nurse assumes 24-hour responsibility
- Patient care units are typically divided into modules for planning the care of one or more patients from
or districts, and assignments are based on the admission or the start of treatment to discharge or
geographical location of patients. the treatment’s end
- During work hours, the primary nurse provides total
Modular Nursing Illustration direct care for that patient. When the primary nurse
is not on duty, associate nurse, who follow the care
plan established by the primary nurse, provide care.

Primary Nursing Illustration

- Team nursing, as originally designed, has undergone

much modification in the last 30 years. Most team
nursing was never practiced in its purest form but
was instead a combination of team and functional
structure. Attempts to refine and improve team
nursing have resulted in many models including - Primary nursing, also known as relationship-based
modular nursing. nursing, was developed in the late 1960s, uses some
- Modular nursing uses a mini-team (two or three of the concepts of total patient care and brings the
members with at least one member being an RN), RN back to the bedside to provide clinical care.
with members of the modular nursing team - In inpatient primary nursing, the primary nurse
sometimes being called care pairs. In modular assumes 24-hour responsibility for planning the care
nursing, patient care units are typically divided into of one or more patients from admission or the start
modules or districts, and assignments are based on of treatment to discharge or the treatment’s end.
the geographical location of patients. - During work hours, the primary nurse provides total
- Keeping the team small in modular nursing and direct care for that patient. When the primary nurse
attempting to assign personnel to the same team as is not on duty, associate nurses, who follow the care
often as possible should allow the professional plan established by the primary nurse, provide care.
nurse more time for planning and coordinating team - Although originally designed for use in hospitals,
members. In addition, a small team requires less primary nursing can also be applied in home health
communication, allowing members better use of nursing, hospice nursing, and other health-care
their time for direct patient care activities. delivery systems.
- An integral responsibility off the primary nurse is to
establish clear communication among the patient,
MODIFIED MODULAR NURSING ASSIGNMENTS - RN
the physician, the associate nurses, and other team
members.
- Feedback is sought from others in coordinating the
patient’s care.
- The combination of clear interdisciplinary group
communication and consistent, direct patient care by
relatively few nursing staff allows for holistic, high-
quality patient care.
- In these models of care, job satisfaction is high and
nurses often feel challenged and rewarded.
17
- Disadvantages to this method lie primarily in facilitation, and advocacy for options and services to
improper implementation. meet an individual’s health needs through
- An inadequately prepared or incompetent primary communication and available resources to promote
nurse may be incapable of coordinating a quality cost-effective outcomes”.
multidisciplinary team or identifying complex patient - In case management, nurses address each patient
needs and condition changes. individually, identifying the most cost-effective
- Many nurses may be uncomfortable in this role or providers, treatments, and care setting possible. In
initially lack the experience and skills necessary for addition, the case manager helps patients access
the role. community resources, helps patients learn about
their medication regimen and treatment plan, and
ensures that they have recommended tests and
procedures.
- Case managers often manage care using critical
pathways and multidisciplinary action plans (MAPS)
to plan patient care.
- The care MAP is a combination of a critical pathway
and a nursing care plan. It also indicates times when
nursing interventions should occur.
- All health-care providers follow the care MAP to
facilitate expected outcomes. If a patient deviates
from the normal plan, a variance is indicated.
- A variance is anything that occurs to alter the
CASE MANAGEMENT patient’s progress through the normal critical path.
- Collaborative process of assessment, planning, - Because the role expectations and scope of
facilitation, and advocacy for options and services to knowledge required to be case manager are
meet an individual’s health needs though extensive, some experts have argued that this role
communication and available resources to promote should be reserved for the advance practice nurse or
quality cost-effective outcomes. (Case management RN with advanced training, although this is not
Society of America CMSA, 2008-2016) as usually the case in the practice setting today.
- Nurses address each patient individually, identifying - In fact, board certification as a case manager is
the most cost-effective providers, treatments, and available to any individual with a professional license
care setting possible. In addition, the case manager such as an RN, licensed clinical social worker, or
helps patients access community resources, helps pharmacist, and with completed supervised field
patients learn their medication regimen and experience in case management.
treatment plan, and ensures that they have
recommended tests and procedures. Contemporary Models of Organizing Patient Care
- Contemporary models of care, also called innovative
models are the newest approaches to organizing
patient care to foster patient safety and quality
outcomes. These include the Professional Nursing
Practice Model, the Differentiated Nursing Practice
Model, the Clinical Nurse Leader Model, the Synergy
Model for Patient Care, Transforming Care at the
Bedside, and the Patient- and Family-Centered Care
Model.

Professional Nursing Practice Model

- This provides a “framework for guiding and aligning
clinical practice, education, administration, and
research in order to achieve positive patient and
nurse staff outcomes” (Lineweaver, 2013).
- Case management is defined by the Case
- This model is identified as a core feature of Magnet
Management Society of America (CMSA, 2008-2016)
hospitals (Neisner & Raymond), 2002) because
as a collaborative process of assessment, planning,
18
 Magnet hospitals typically have higher RN-to-patient clinical unit, or system are matched with the nurse’s
ratios, and many of these hospitals are moving to all- competencies.
RN staffs. - This model fosters effective communication and
- In this model, TNs have greater autonomy and collaboration in achieving optimal, realistic patient
control over practice, and there are higher rates of and family goals.
patient satisfaction, lower rates of nurse burnout, - Although the model was originally developed for
and safer work environments. critical care units, it has been used in a variety of
- This model supports the RN’s control over the clinical settings.
delivery of nursing care as well as effective inter - This model includes eight patient characteristics
professional and intra professional communication. (resiliency, vulnerability, stability, complexity,
resource availability, participation in care,
Differentiated Nursing Practice Model participation in decision making, and predictability,
- Care in this model is differentiated based in the level and eight nursing characteristics or competencies
of education, competence, and clinical expertise of derived from patient’s needs (clinical judgment,
RNs advocacy and moral agency, caring practices,
- With associate degree function as technical nurses collaboration, systems thinking, response to
and provide the majority of bedside care diversity, facilitation to learning, and clinical inquiry).
- Baccalaureate-prepared nurse function in
collaborating and facilitating patient care from Transforming Care at The Bedside
admission through discharge - The goal of this model is to empower nurses and
- Advanced practice nurses’ function within the broad other healthcare team members to redesign work
healthcare system and provide care across all processes to improve the quality of patient care and
settings throughout wellness and death. decrease turnover.
- Nurses must be clinically competent and flexible in - Five themes comprise the TCAB model of care:
providing nursing care, and they must value the transformational leadership, safe and reliable care,
differing roles. vitality and teamwork, patient-centered care, and
- Differentiated nursing practice recognizes that all value-added care processes.
nurses, regardless of education, are needed to
provide high-quality, comprehensive care to all Patient- And Family-Centered Care Model
patients in all settings - This model places an emphasis on collaborating and
planning care with patients (and their families) of all
Clinical Nurse Leader Model ages, at all levels of care, and in all healthcare
- This was developed with the goal to improve the settings (Conway, 2006).
quality of patient care across the continuum and as a - In the patient-focused care, the RN is the coordinator
way to engage highly skilled clinicians in outcome- and planner of care who brings as many care services
based practice and quality improvement. to the patient as possible; in patient- and family-
- The CNL has responsibilities including designing, centered care, the patient has control over his or her
implementing, and evaluating patient care by care, and all health-care decisions are made with the
coordinating, delegating, and supervising the care RN as a collaborator in his or her care.
provided by an inter professional team.
- The nurse in this role is the leader in the healthcare FORMAL AND INFORMAL ORGANIZATIONAL
delivery system and is not in an administrative or STRUCTURE
managerial role The CNL is a provider and - According to Fayol (1949), an organization is created
coordinator of care and fosters inter professional and when the number of workers is large enough to
intra professional communication. require a supervisor.
- Organizations are essential because thru
Synergy Model for Patient Care organizations, collective effort is more effective than
- The American Association of Critical-Care Nurses individual effort.
developed this model with the core concepts that - As stated by Venzon (2016), it pertains to the body of
needs of patients and families influence and drive the persons, methods, policies and procedures arranged
competencies of nurses and that synergy occurs in a systematic process through the delegation of
when the needs and characteristics of the patient, functions and responsibilities for the
accomplishment of purpose.

19
- Every organization has a formal and an informal Organizing
structure. - is the process of establishing formal authority and
- In formal structure, managerial authority, involves setting up the organizational structure
responsibility, and accountability is clearly defined. through identification of groupings, roles and
- Roles and functions are outlined, people have relationships, determining the staff needed by
specific task to perform, and rank and hierarchy are developing and maintaining staffing patterns and
apparent. Informal structure, according to Education distributing them in the various areas as needed. It
Portal (2003-2013), is the channel “that fills in the includes developing job descriptions by defining the
gaps with connections and relationships that qualifications and functions of personnel.
illustrate how employees network with one another
to get the work done.” Organizational Chart
- As supported by Schatz (2013) informal structures - is a line drawing that shows how the parts of an
are typically centered on camaraderie and often organization are linked. It depicts the formal
produce direct response from individuals, saving organizational relationships, areas of responsibility,
people’s time and effort. persons to whom one is accountable and channels or
- Informal structure is also useful when the formal organization.
structure becomes non-effective.
- The communication network used in informal TERMINOLOGIES
structure is known as grapevine. This is considered to Patient classification systems - also known as
be the heart of the informal organization as these are workload management or patient acuity tools
communications that occur in the break room, down
the halls, during the carpool, and in between work Case method nursing or total patient care nursing –
that allows relationships of informal groups to oldest form of patient care organization and is still
develop. widely used today
- Also, social media sites and electronic
communication such as e-mail and text messages are Functional nursing – the modality of care that requires
also used to facilitate communication among the completion of specific tasks by different nursing
members. Because of the fast transfer of messages, personnel
grapevine communication often becomes a source
for rumor or gossip (Murray, 2017). Team nursing – typically uses a nurse-leader who
coordinates team members of varying educational
ORGANIZATIONAL THEORY AND BUREAUCRACY preparation and skill sets in the care of a group of
- Max Weber is known as the father of organizational patients
theory. According to him, bureaucracy is an
institutional method for applying general rules to Modular nursing – uses mini-teams, typically an RN
specific cases, making the actions of management and unlicensed health-care workers, to provide care to
fair and predictable. a small group of patients, usually centralized
geographically
Other characteristics of bureaucracy are the following:
• There must be a clear division of labor. Primary care nursing – one health-care provider
• A well-defined hierarchy of authority must exist (typically the RN) has a 24-hour responsibility for care
which separates the superiors from planning and coordination
subordinates. There must be remuneration for
work, recognition of authority, allotment of Case management – a collaborative process that
privileges and conferring of promotion. assesses, plans, implements, coordinates, monitors,
• There must be impersonal rules and and evaluates opinions and services to meet an
impersonality of interpersonal relationships. individual’s health needs through communication and
• A system of procedures for dealings with work the use of available resources to promote quality and
situations must exist. cost-effective outcomes
• A system of rules covering the rights and duties
of each position must be in place. Accountability – taking full responsibility for the
quality of work and behavior while engaged in the
• Selection for employment and promotion is
presence of the profession.
based on technical competence.
20
Authority – the right to act or make decisions without
approval of higher administrators. It includes the right
to extract obedience from subordinates. In
government hospitals, flow of authority is from the
Chief of Hospital down to the Heads of the various
Divisions such as the Administrative Officer, the Chief
of the Nursing Division, and the Chief of Clinics.

Communication – the transmission of information

between persons.

Power – the ability to influence another to behave in

accordance with one’s wishes.

Relationships within Nursing Services – can be

depicted through the organizational chart.
a. Line relationship those that exists between
the superior and subordinated immediately
and directly responsible to him/her.
Ex: Chief Nurse to Supervising Nurse, Head
Nurse to all nursing staff.
b. Lateral relationship those that exists between
position in various divisions and sections of an
undertaking where no direct authority is
involve.
Ex: Senior Nurse and Physician, Staff Nurse
and Clinical Pharmacist.
c. Functional relationship those that arise when
duties are divided on a functional basis like
when an individual exercises authority on a
particular subject by special skill or
knowledge.
Ex: Chief Nurse with Administrative Officer,
Staff Nurse with Clinical Nurse Instructor.
d. Staff personnel provides advice, counsel, or
technical support that may be accepted,
altered, or rejected by the line officer.

Responsibility – the obligation to perform the

assigned tasks.

Status – the rank a group bestows on a person in

accord with the group’s estimation of the person’s
value and significance to group goals. The status of the
Nursing Director or Chief Nurse is equal to that of the
Administrative Officer and Chief of Clinics.

21
 COURSE UNIT 3 GOALS AND OBJECTIVES OF THE PROJECT
This goal blended well with the goal of the ILO project to
EVIDENCED-BASED PRACTICES IN NURSING improve Nursing Education and practice through the
MANAGEMENT dissemination of materials and training of nurses.
Specifically, the project aims to:
National Nursing Core Competency Standards (NNCCS) 1. Establish the team and system for
- The development of the NNCCS for nursing practice implementing the project,
started in 2001 through the initiative of the 2. Develop and implement the training design
Professional Regulation Commission - Board of and materials aligned with the revised
Nursing (PRC-BON) which created a National Task NNCCS competencies,
Force for Core Competency Standards Development. 3. Pilot the training course in Luzon, Visayas
- The project was completed in 2005 after a series of and Mindanao,
workshops, consultations and discussions among 4. Recommend strategies to address
representatives of nursing practice, nursing sustainability concerns.
education and community health nursing
- In the foreword of the 2012 NNCCS, Professional SIGNIFICANCE OF THE 2012 NNCCS
Regulation Commission Chair T.R. Manzala stated: Serve as a guide for the development of the following:
“Out of this lengthy process emerged the Revised 1. Basic Nursing Education Program in the
Nursing Core Competency Standards, emphasizing Philippines through the CHED
the three roles of the nurse: Beginning Nurses’ Role 2. Competency-Based test framework as the basis
on Client Care, Beginning Nurses’ Role on for the development of course syllabi and test
Management and Leadership and Beginning Nurses’ questions for "entry level" nursing practitioner
Role in Research as well as four types of clients of the in the PNLE
nurse. 3. Standards of the Philippine Professional Nursing
- With the promulgation of the 2012 NNCCS, the Practice in various settings in the Philippines
succeeding stage is its implementation and 4. National Career Progression Program for
evaluation in both nursing education and nursing nursing practice in the Philippines
service in all settings. 5. Related evaluation tools in various practice
- This will be a collaborative activity of all partners of settings in the Philippines
the PRC-BON. This collaboration materialized when
the Commission on Higher Education (CHED) 10 KEY PHASES:
obtained a grant from the International Labour • Phase 1 – Work Setting scenario
Organization (ILO). This project entitled “Nursing • Phase 2 – Validation studies of roles and
Core Competencies for Master Trainers in Nursing responsibilities/Benchmarking
Education and Practice” is the initial step in the • Phase 3 – Integrative review of outputs from
implementation of the 2012 NNCCS the validation strategies
• Phase 4 – Core competency consensual
validation
• Phase 5 – Conduct of public hearing
• Phase 6 – Promulgation of the revised and
modified core competency standards.
• Phase 7 – Printing of the revised and modified
core competency standards.
• Phase 8 – Training in the implementation of the
revised core competency standards. Phase 9 –
Implementation of the revised core competency
standards.
• Phase 10 – Evaluation of effectiveness of the
revised core competency standards.

22
 Revised Nursing Core Competency Standards COMPETENCY STANDARDS OF NURSING PRACTICE IN
emphasized the three roles of the nurse: THE PHILIPPINES
1. Beginning Nurses' Role on Client Care (Philippine Nurse Licensure Examination 2007)
2. Beginning Nurses' Role on Management and 1. Safe and Quality Nursing Care
Leadership 2. Management of Resources and Environment
3. Beginning Nurses' Role in Research 3. Health Education
4. Legal Responsibility
BEGINNING NURSE'S ROLE ON CLIENT CARE 5. Ethico-Moral Responsibility
1. Practices in accordance with legal principles and 6. Personal and Professional Development
the code of ethics in making personal and 7. Quality Improvement
professional judgment. 8. Research
2. Utilizes the nursing process in the 9. Record Management
interdisciplinary care of clients that empowers 10. Communication
the clients and promotes safe quality care. 11. Collaboration And Teamwork
3. Maintains complete and up to date recording
and reporting system. Philippine Professional Nursing Practice Standards
4. Establishes collaborative relationship with (PPNPS)
colleagues and other members of the team to PR PR-BON Res. NO. 22 S. 2017
enhance nursing and other health care services. - The primary purpose of nursing standards is to
5. Promotes professional and personal growth and promote, guide and direct professional nursing
development. practice
- It will be used by the following:
BEGINNING NURSE'S ROLE ON MANAGEMENT AND o Individual professional
LEADERSHIP o Employers
1. Demonstrates management and leadership o Nursing administration leaders
skills to provide safe and quality care. o PR-BON
2. Demonstrates accountability for safe nursing
practice. PPNPS
3. Demonstrates management and leadership A. Value-Based Nursing Practice Standards
skills to deliver health programs and services - Used in clinical decision-making process
effectively to specific client groups in the A1. Care of clients
community settings A2. Ethical-Moral-Legal Practice.
4. Manages a community/village-based health A3. Personal and professional values
facility /component of a health program or a B. Knowledge-Based Nursing Practice Standards.
nursing service. - Consistent application of a scientific body of
5. Demonstrates ability to lead and supervise knowledge and skills
nursing support staff. B1. Research
6. Utilizes appropriate mechanisms for B2. Evidence-based nursing practice
networking, linkage building and referrals. B3. Continual Quality improvement

BEGINNING NURSE'S ROLE ON RESEARCH C. Outcome-Oriented Professional Relationships

1. Engages in nursing or health related research C1. Communication
with or under the Supervision of an experienced C2. Collaboration and Teamwork
researcher. C3. Transcultural Nursing care
2. Evaluates research study/report utilizing
guidelines in the conduct of a written research D. Leadership and Governance Standards
critique. D1. Personal and professional Development
3. Applies the research process in improving client D2. Personal Responsibility and Accountability
care in partnership with a quality improvement D3. Positive Practice environment
/quality assurance/nursing audit team. D4. Social responsibility
D5. Resource management

23
 Patient Care Safety Standards ▪ formulate standards of what is
- Aims to prevent harm to patients, their families and expected from health providers
friends, health care professionals, contractual service ▪ communicates; provide training;
workers, volunteers, and the many other individuals ▪ enforce the standards that comes
whose activities bring them into an environment. with the policies and
- making appropriate care available ▪ give the patients a voice through a
- Nurses, as the largest group of healthcare service feedback system or a patient
providers in the nation, are vital members of this satisfaction survey
team. Keeping patients safe: Transforming the Work 3. Reporting System
Environment of Nurses made it explicit that nurses o The National Patient Safety Committee shall
are the healthcare service professional most likely to develop and institutionalize a pro-active
intercept errors and prevent harm to patients. reporting and learning system that requires
- Given the role that nurses play in care and quality its leadership to encourage reporting of
improvement, it is important for nurses to know events
what proven techniques and interventions they can 4. Feedback and Communication
use to enhance patient and organizational outcomes. Performance Feedback and Benchmarking
- The Department of Health, through the Health Mechanism
Facility Development Bureau, in collaboration with o communicate leadership responses
active partners from both the public and private o to the reports shall be established
sectors. o to demonstrate commitment
- Safety in healthcare organizations aims to prevent o to patient safety and ensure continuous
harm to patients, their families and friends, improvement
healthcare professionals, contract of service 5. Adverse Event Prevention and Risk
workers, volunteers, and the many other individuals Management
whose activities bring them into an environment. o Risk reduction strategies through patient
- Safety is one aspect of quality where quality includes risk assessment
not only avoiding, preventable harm, but also making o Patient feedback survey, health technology
appropriate care available providing effective assessment, and safety assessment code
services to those who could benefit from them and 6. Disclosure of Reported Serious Events
not providing ineffective or harmful services. o The reporting system ensures
confidentiality of individual cases.
KEY ELEMENTS OF PATIENT SAFETY o The events can be made available to the
1. Leadership public through
o Leadership and political commitment are ▪ disclosure of results of
essential at the health facility level where investigation,
patient safety becomes an integral ▪ summary reports or annual reports
component of quality care that summarize
o The Leadership shall address strategic ▪ events and actions taken
priorities for institutional development. 7. Professional Development
o Its culture and infrastructure, engage its o Training and supervision of the healthcare
various stakeholders, communicate and staff to improve their decision and clinical
build awareness. judgments is imperative
2. Institutional Development o Instill standard norms of behavior of
o Approaches to institutionalize patient safety courtesy, promptness and efficiency among
and quality in the health facilities will have patients. the healthcare workers and
to consider the following: improve the quality of service given to
▪ financial and human resources patients
▪ facility and equipment 8. Patient Centered care and Empowerment of
management; Consumers
▪ strengthen management o Patients must be at all centers of patient
responsibility, safety initiatives and must be partners in all
▪ authority and competency; aspects of the process.

24
 o Patient centered care and patient safety is a - Reporting incidents and learning from them is critical
national priority and a core agenda to implementing staff safety.
▪ to improve quality care in all - For example unintentional exposure to aggressive
health substances is taken less seriously than needle stick
▪ to protect patients, form faulty injuries
system
3. OPTIMIZE STAFF SCHEDULING
Importance of Safety in Health Care - Hospital management faces many challenges – two
5. Improve patient satisfaction and clinical outcomes. of the most areas, finding enough qualified people to
6. Ensure accuracy of patient's identification. fill their teams.
7. Enhance the effectiveness of communication - When hospital teams are understaffed, employees
among healthcare personnel. are overworked, and the risk of safety incidents
8. Improve the safety of using medications. increase.
9. Reduce the risk of healthcare associated infections - While management needs to control labor costs for
10. Reduce the risk of harm resulting from injuries. hospitals to remain profitable, there needs to be a
11. Improve staff productivity and retention rate. balance between minimizing cost and maximizing
12. Increase awareness of occupational health and staff safety.
environmental control like ergonomically-designed
workplace. 4. IMPROVE PATIENT HANDLING
13. Workers must be trained on prevention practices - Moving and handling patients can be one of the most
and be educated about the benefits of adopting physically demanding aspects of healthcare
good practices and work methods. professions.
14. A strong ergonomics integration prevents injuries - Dependency of patients on nursing staff (2) increases
and increases productivity. and equipment gest more complex, patient-handling
methods form the past might not be as effective
5 Ways to Improve Staff Safety in Healthcare today.
- Working in the healthcare profession is one of the
most rewarding careers you can choose, but working 5. USE SAFER MEDICAL EQUIPMENTS
in healthcare also puts your own health at risk. - Medical device is quickly improving, and recent
- Aside from the physical demands of crowded innovations, eliminate health risks that plagued staff
hospitals and the stress that comes with long shifts and patients in the past.
and treating serious ailments, working with sick • Improving Infection Control
patients puts you at risk for the same illnesses that • Helping prevent needlestick injuries
brought them to the hospital. • Reducing medication errors (by reducing
stopcock manipulations)
1. PROMOTE A CULTURE OF SAFETY • Increasing protection against exposure to blood
- Company culture heavily influences the general and drugs
attitude of a working environment. • Minimizing disconnections, air embolism and
- Hospitals that place a big emphasis on staff safety are misconnections
more likely to prevent incidents because safety is
aligned with professionalism in the workplace. Nursing Actions to Improve Patient Safety
1. Knowledge and implementation about
2. MEASURE THE PERFORMANCE OF SAFETY healthcare policies and procedures.
PROTOCOLS 2. Open communication and teamwork among all
- One of the fundamental practices that make other healthcare providers.
hospitals as effective as they are is the use of record 3. Review the medication rights before giving the
keeping. medications
- Nurses and Doctors are bombarded with information 4. Engage in creating and updating reporting
and urgent tasks throughout the day without system to avoid a blaming culture
checklist, scheduled, and other methods of 5. Involve in research and evidence-based
monitoring task, it would be nearly impossible to activities for better decision making
keep track of everything.

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 6. Be updated on all life-saving certification like STANDARD 3. OUTCOMES IDENTIFICATION
CPR, BLS, ACLS, PALS, NALS and other Nursing The registered nurse identifies expected outcomes for a
Specialty Certification Programs. plan individualized to the healthcare consumer or the
7. Engage in hospital committees to make the situation.
healthcare system safe, effective and patient-
centered. STANDARD 4. PLANNING
8. Be responsible in reporting all errors and near The registered nurse develops a plan that prescribes
misses not only for the patient to prevent strategies and alternatives to attain expected outcomes.
sentinel and adverse events to happen again.
9. Ensure better lighting and less clutter in the STANDARD 5. IMPLEMENTATION
work areas The registered nurse implements the identified plan.

Standards of Professional Nursing Practice (American STANDARD 5A. COORDINATION OF CARE

Nurses Association, 2015) - The registered nurse coordinates care delivery.
- The Standards of Professional Nursing Practice
content consists of the Standards of Practice and the STANDARD 5B. HEALTH TEACHING AND HEALTH
Standards of Professional Performance. PROMOTION
- The registered nurse employs strategies to promote
Standards of Practice
health and a safe environment.
- The Standards of Practice describe a competent level
of nursing care as demonstrated by the critical
thinking model known as the nursing process. STANDARD 5C. CONSULTATION
- The nursing process includes the components of - The graduate-level prepared specialty nurse or
assessment, diagnosis, outcomes identification, advanced practice registered nurse provides
planning, implementation, and evaluation. consultation to influence the identified plan,
- Accordingly, the nursing process encompasses enhance the abilities of others, and effect change.
significant actions taken by registered nurses and
forms the foundation of the nurse’s decision-making. STANDARD 5D. PRESCRIPTIVE AUTHORITY AND
TREATMENT
- The advanced practice registered nurse uses
prescriptive authority, procedures, referrals,
treatments, and therapies in accordance with state
and federal laws and regulations.

STANDARD 6. EVALUATION
- The registered nurse evaluates progress toward
attainment of outcomes

STANDARD 7. ETHICS
The registered nurse practices ethically.

STANDARD 8. EDUCATION
The registered nurse attains knowledge and competence
that reflects current nursing practice.

STANDARD 9. EVIDENCE-BASED PRACTICE AND

STANDARD 1. ASSESSMENT RESEARCH
The registered nurse collects comprehensive data
The registered nurse integrates evidence and research
pertinent to the healthcare consumer’s health and/or the
findings into practice.
situation.
STANDARD 10. QUALITY OF PRACTICE
STANDARD 2. DIAGNOSIS The registered nurse contributes to quality nursing
The registered nurse analyzes the assessment data to practice.
determine the diagnoses or the issues.
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 STANDARD 11. COMMUNICATION Safety avoiding injuries to patients from the care that
The registered nurse communicates effectively in all is intended to help them.
areas of practice.
Timely reducing waiting time and sometimes harmful
STANDARD 12. LEADERSHIP delay for both those who receive and those who give
The registered nurse demonstrates leadership in the care.
professional practice setting and the profession.

STANDARD 13. COLLABORATION

The registered nurse collaborates with healthcare
consumer, family, and others in the conduct of nursing
practice.

STANDARD 14. PROFESSIONAL PRACTICE EVALUATION

The registered nurse evaluates her or his own nursing
practice in relation to professional practice standards
and guidelines, relevant statutes, rules, and regulations.

STANDARD 15. RESOURCE UTILIZATION

The registered nurse utilizes appropriate resources to
plan and provide nursing services that are safe, effective,
and financially responsible.

STANDARD 16. ENVIRONMENTAL HEALTH

The registered nurse practices in an environmentally safe
and healthy manner.

TERMINOLOGIES
Effective providing services based on scientific
knowledge to all who could benefit and refraining
from providing services to those not likely to benefit.

Efficient avoiding waste, including waste of

equipment, supplies ideas and energy

Equitable providing care that does not vary in quality

because of personal characteristics such as gender,
geographic location and socio-economic status (IOM,
2001).

Patient-Centered providing care that is respectful of

and responsive to patient preferences, needs, values
and ensuring that patient values guide all clinical
decisions.

Patient Safety is defined as “the prevention of harm of

patients through the prevention, avoidance of risk,
adverse outcomes, or injuries stemming from the
process of healthcare. It is the degree to which the risk
of an intervention and risk in the care environment are
reduced for a patient and other people, including
healthcare providers.

27
 COURSE UNIT 4 NOW, THEREFORE, the Board hereby resolved, as it now
resolves, to promulgate the hereunder Code of Ethics for
Ethico-Legal and Moral Considerations in Registered Nurses:
Nursing Leadership & Management
Code of Ethics Article I:
Preamble
SECTION 1. Health is a fundamental right of every
individual. The Filipino registered nurse, believing in the
worth and dignity of each human being, recognizes the
primary responsibility to preserve health at all costs. This
responsibility encompasses promotion of health,
prevention of illness, alleviation of suffering, and
restoration of health. However, when the foregoing are
not possible, assistance towards a peaceful death shall be
his/her obligation.

SECTION 2. To assume this responsibility, registered

nurses have to gain knowledge and understanding of
man's cultural, social, spiritual, physiological,
CODE OF ETHICS FOR REGISTERED NURSES (BOARD OF psychological, and ecological aspects of illness, utilizing
NURSING) the therapeutic process. Cultural diversity and political
- approved July 14, 2004 thru Board Resolution No. and socio-economic status are inherent factors to
220, Series of 2004 effective nursing care.
- succinct statement of the ethical obligations and
duties of every individual who enters the nursing SECTION 3. The desire for the respect and confidence of
profession. clientele, colleagues, co-workers, and the members of
the community provides the incentive to attain and
CODE OF ETHICS FOR NURSES maintain the highest possible degree of ethical conduct.
WHEREAS, the Board of Nursing (BON) has the power to
promulgate a Code of Ethics for Registered Nurses in Code of Ethics Article II:
coordination and consultation with the accredited Registered Nurses and People
professional organization (Sec. 9, (g), Art III of (Republic SECTION 4.
Act) No. 9173, known as Ethical Principles
the “Philippine Nursing Act of 2002); 1. Values, customs, and spiritual beliefs held by
individuals shall be respected.
WHEREAS, in the formulation of the Code of Ethics for 2. Individual freedom to make rational and
Registered Nurses, the Code of Good Governance for the unconstrained decisions shall be respected.
Professions in the Philippines was utilized as the principal 3. Personal information acquired in the process of
basis thereof: All the principles under the said Code were giving nursing care shall be held in strict
adopted and integrated into the Code of Ethics as they confidence.
apply to the nursing profession;
SECTION 5.
WHEREAS, the promulgation of the said Code as a set of Guidelines to be observed:
guidelines, regulations or measures shall be subject to REGISTERED Nurses must
approval by the Commission (Sec. 9, Art. II of R.A. No. a. consider the individuality and totality of
9173); and patients when they administer care.
b. respect the spiritual beliefs and practices of
WHEREAS, the Board, after consultation on October 23, patients regarding diet and treatment.
2003 at Iloilo City with the accredited professional c. uphold the rights of individuals.
organization of registered nurses, the Philippine Nurses d. take into consideration the culture and values
Association, Inc. (PNA), and other affiliate organizations of patients in providing nursing care. However,
of Registered Nurses, decided to adopt a new Code of in the event of conflicts, their welfare and
Ethics under the afore-mentioned new law; safety must take precedence.

28
 Code of Ethics Article III: SECTION 9.
Registered Nurses and Practice Guidelines to be observed:
SECTION 6. REGISTERED Nurses must
Ethical Principles a. respect the "Patients' Bill of Rights" in the
1. Human life is inviolable. delivery of nursing care.
2. Quality and excellence in the care of the b. provides the patients or their families with all
patients are the goals of nursing practice. pertinent information except those which may
3. Accurate documentation of actions and be deemed harmful to their well-being.
outcomes of delivered care is the hallmark of c. upholds the patients' rights when conflict arises
nursing accountability regarding management of their care.
SECTION 7.
SECTION 11.
Guidelines to be observed:
Guidelines to be observed:
REGISTERED Nurses must
REGISTERED Nurses must:
a. Know the definition and scope of nursing
a. perform their professional duties in conformity
practice which are in the provisions of R. A. No.
with existing laws, rules regulations measures,
9173, known as the "Philippine Nursing Act of
and generally accepted principles of moral
2002" and Board Res. No. 425, Series of 2003, the
conduct and proper decorum.
"Rules and Regulations Implementing the
b. not allow themselves to be used in
Philippine Nursing Act. of 2002", (the IRR).
advertisement that should demean the image of
b. Be aware of their duties and responsibilities in
the profession (i.e. indecent exposure, violation
the practice of their profession as defined in the
of dress code, seductive behavior, etc.).
"Philippine Nursing Act of 2002" and the IRR.
c. decline any gift, favor or hospitality which might
c. Acquire and develop the necessary competence
be interpreted as capitalizing on patients.
in knowledge, skills, and attitudes to effectively
d. not demand and receive any commission, fee or
render appropriate nursing services through
emolument for recommending or referring a
varied learning situations.
patient to a physician, a co-nurse or another
d. If they are administrators, be responsible in
health care worker; not to pay any commission,
providing favorable environment for the growth
fee or other compensations to the one referring
and developments of Registered Nurses in their
or recommending a patient to them for nursing
charge.
care.
e. Be cognizant that professional programs for
e. avoid any abuse of the privilege relationship
specialty certification by the BON are accredited
which exists with patients and of the privilege
through the Nursing Specialty Certification
access allowed to their property, residence or
Council (NSCC).
workplace
f. Sees to it that quality nursing care and practice
meet the optimum standard of safe nursing Code of Ethics Article IV:
practice. Registered Nurses and Co-workers
g. Ensure that modification of practice shall SECTION 12.
consider the principles of safe nursing practice. Ethical Principles
h. If in position of authority in a work environment, 1. The Registered Nurse is in solidarity with other
be normally and legally responsible for devising members of the healthcare team in working for
a system of minimizing occurrences of ineffective the patient's best interest.
and unlawful nursing practice. 2. The Registered Nurse maintains collegial and
i. Ensure that patients' records shall be available collaborative working relationship with
only if they are to be issued to those who are colleagues and other health care providers.
professionally and directly involved in their care
and when they are required by law SECTION 13.
Guidelines to be observed:
SECTION 8. REGISTERED Nurses must
Ethical Principle a. maintains their professional role/identity while
4. Registered Nurses are the advocates of the working with other members of the health
patients: they shall take appropriate steps to team.
safeguard their rights and privileges.
29
 b. conform with group activities as those of a health Code of Ethics Article VI:
team should be based on acceptable, ethico- Registered Nurses and The Profession
legal standards. SECTION 16.
c. contributes to the professional growth and Ethical Principles:
development of other members of the health 1. Maintenance of loyalty to the nursing
team. profession and preservation of its integrity are
d. actively participates in professional ideal.
organizations. 2. Compliance with the by-laws of the accredited
e. not act in any manner prejudicial to other professional organization (PNA), and other
professions. professional organizations of which the
f. honor and safeguard the reputation and dignity Registered Nurse is a member is a lofty duty.
of the members of nursing and other 3. Commitment to continual learning and active
professions; refrain from making unfair and participation in the development and growth of
unwarranted comments or criticisms on their the profession is commendable.
competence, conduct, and procedures; or not do 4. Contribution to the improvement of the socio-
anything that will bring discredit to a colleague economic conditions and general welfare of
and to any member of other professions. nurses through appropriate legislation is a
g. respect the rights of their co-workers. practice and a visionary mission.

Code of Ethics Article V: SECTION 17.

Registered Nurses, Society, And Environment Guidelines to be observed:
SECTION 14. Registered Nurses must
Ethical Principles a. be members of the Accredited Professional
1. The preservation of life, respect for human Organization (PNA).
rights, and promotion of healthy environment b. strictly adheres to the nursing standards.
shall be a commitment of a Registered Nurse. c. participates actively in the growth and
2. The establishment of linkages with the public in development of the nursing profession
promoting local, national, and international d. strives to secure equitable socio-economic and
efforts to meet health and social needs of the work conditions in nursing through appropriate
people as a contributing member of society is a legislation and other means.
noble concern of a Registered Nurse. e. assert for the implementation of labor and work
standards
SECTION 15.
Guidelines to be observed: Code of Ethics ARTICLE VII:
REGISTERED Nurses must ADMINISTRATIVE PENALITIES, REPEALING CLAUSE, &
a. be conscious of their obligations as citizens and, EFFECTIVITY
as such, be involved in community concerns. SECTION 18.
b. be equipped with knowledge of health - The Certificate of Registration of Registered Nurse
resources within the community, and take an shall either be revoked or suspended for violation of
active role in primary health care. any provisions of this Code pursuant to
c. actively participate in programs, projects, and o Sec. 23 (f), Art. IV of R. A. No. 9173 and...
activities that respond to the problems of o Sec. 23 (f), Rule III of Board Res. No. 425,
society. Series of 2003, the IRR.
d. lead their lives in conformity with the principles
of right conduct and proper decorum e. project Suspension or Revocation of License
an image that will uplift the nursing profession Suspension
at all times - the nurse is not allowed temporarily to practice
e. project an image that will uplift the nursing nursing until final judgment of her case is resolved;
profession at all times. license is not confiscate
Revocation
- license to practice is confiscated either temporarily
or permanently.

30
 Re-Issuance of Revoked Certificate communities in any health care setting. It includes,
Upon proper application and payment of required fees: but is not limited to, nursing care during conception,
1. After the expiration of the maximum period of 4 labor, delivery, infancy, childhood, toddler, pre-
years from the date of revocation school, school age, adolescence, adulthood, and old
2. When the cause for revocation has disappeared, age.
cured or corrected
IT SHALL BE THE DUTY OF THE NURSE TO:
THE INTERNATIONAL COUNCIL OF NURSES (ICN) CODE 1. Provide nursing care through the utilization of
OF ETHICS FOR NURSES the nursing process in the following:
- first adopted by the International Council of Nurses a. Traditional and innovative approaches
(ICN) in 1953. b. Therapeutic use of self
- latest revision completed in 2012 c. Executing health care techniques and
- has four principal elements that outline the procedures
standards of ethical conduct. d. Essential primary health care
e. Comfort measures
1. NURSES AND PEOPLE f. Health teachings
- Nurse’s primary professional responsibility is to g. Administer written prescription for
people requiring nursing care. treatment and therapies (oral, topical and
parenteral medications
2. NURSES AND PRACTICE h. do Internal examination during labor (in the
- Nurses carries personal responsibility and absence of prenatal bleeding) and delivery
accountability for nursing practice i. Suturing of perineal laceration (requires
- Maintaining competence by continual learning. special training)

3. NURSES AND THE PROFESSION Special Considerations

- The nurse assumes the major role in: determining A. Medical Orders - execution is a dependent function
and implementing acceptable standards of - written orders are legal orders
- clinical nursing practice, management, research and - must be clear, specific, and legible
education.
The nurse is active in: B. Telephone Orders - should be limited only
1. Developing a core of research-based - in cases of extreme emergency and,
professional knowledge. - when there is no doctor around
2. Developing and sustaining a core of professional
values. How does the nurse protect herself?
- Nurse reads back the order to the doctor
4. NURSES AND CO-WORKERS - Nurse writes the name of the physician who made
- The nurse sustains a collaborative and respectful the order per his/her own and note the time when
relationship with co-workers in nursing and other the order was made
fields. - Such order should be signed by the physician on his
- The nurse takes appropriate action to safeguard visit within 24 hours
individuals, families, and communities when their If problem/s arise, refer back to the ordering physician
health is endangered by a co-worker or any other
person. 2. Establish linkages with community resources
- The nurse takes appropriate action to support and and coordinate with the health team
guide co-workers to advance ethical conduct. 3. Provide health education to individuals, families
and communities
PROFESSIONAL NURSING 4. a) Teach, guide and supervise students in
ART. VI SEC. 28 of RA 9173 (THE PHILIPPINE NURSING nursing education
ACT OF 2002) b) Administration of nursing services in varied
- A person shall be deemed to be practicing nursing settings,
within the meaning of this Act when he/she singly or c) undertake consultation services,
in collaboration with another, initiates and performs
nursing services to individuals, families, and

31
 d.) engage in such activities that require the b. be of sound mind
utilization of knowledge and decision-making c. not be under the influence of
skills of a registered nurse, and intoxicating drugs, or fear of bodily
harm;
5. Undertake nursing and health human resource d. not be suffering from physical disability
development training and research towards the such as those who are mentally
development of advancements in nursing incompetent.
practice e. literate

*The abovementioned shall not apply to nursing Kinds of Contracts

students. 1. Formal Contract
*The nurse is also duty bound to observe the Code of - Refers to an agreement among parties involved and
Ethics for Nurses and to uphold the Standards of Nursing is required to be in writing by some special laws.
Practice. - Examples are marriage contracts, mortgages, and
*The nurse is also required to maintain competence deeds of sale or work contracts.
through continuing professional education provided by
2. Informal Contract
an accredited professional organization or any
- is one which is concluded as the result of a written
recognized professional nursing organization; provided
document or correspondence where the law does
that the program and activity for the continuing
not require the same to be written, or as the result
professional education shall be submitted to and
of oral and spoken discussion between the parties or
approved by the Board.
conduct between the parties, evidence and intention
to contract.
CONTRACTS
- A contract is a meeting of minds between two 3. Voidable Contract
persons whereby one binds himself, with respect to - An agreement which is enforceable by law at the
the other, to give something or to render some option of one or more of the parties thereto, but not
service. at the option of the other or others, is a voidable
- A contract is a promise or a set of promises which the contract.
law recognizes as a duty and when that duty is not - A contract is voidable when one of the parties to the
performed, the law provides a remedy contract has not exercised his free consent. One of
- When a nurse enters into a contract with an the essential elements of a formation of a contract
employer, it is usually an agreement to be paid a for example, free consent, is absent.
certain amount of money and be provided certain - All voidable contracts are those which are induced by
benefits in exchange for such services. coercion fraud or misrepresentation. The person
whose consent is not freely given may avoid a
Requisites of a Contract contract. It therefore continues to be valid till the
1. Two or more persons must participate. party whose consent is caused by coercion, undue
2. Consent influence, fraud or misrepresentation choose to
3. The object/subject matter of the contract such avoid the contract within a reasonable time. Contract
as: then is not binding on the other party.
a. all things which are not outside the
commerce of man 4. Void Contract
b. all rights which are not in transmissible - Contract which ceases to be enforceable by law
c. future inheritance in cases expressly becomes void, when it ceases to be enforceable. - A
authorized by law void contract is a nullity from its inception. No rights
d. all services which are not contrary to accrue there under.
law, morals, good customs, public order, - A contract may also be originally valid when entered
and public policy. into but subsequently due to change in the
4. The cause of obligation is established (time, - events or circumstances, it may become void. It
price, and subject matter). should be noted that there cannot be a void contract
5. Contracting parties must have the legal capacity because when the contract is void, it is no contract at
to enter into a contract. all. The right expression therefore is void agreement
a. be of legal age (18 y.o. and above) and not void contract

32
 5. Unenforceable Contract 10. Quasi-Contract
- A contract which cannot be enforced is a valid - Certain relations resemble those created by a
contract in law, but is incapable of proof, and contract. Certain obligations which are not contracts
therefore cannot be enforced in the Court of Law in fact but are so in the contemplation of law.
- Ex. Private duty nurse who begs off from contract
6. Executed Contract due to a better work opportunity must find her
- Where both the parties have performed their replacement
obligation, it is an executed contract. Even when one
party to the contract has performed his share of the 11. Contingent Contract
obligation, the contract is executed through to the - A contingent is one in which a promise is conditional
other party is still under an outstanding obligation to and the contract shall be performed only on the
perform his part of the promise. happening of some future uncertain event

7. Executory Contract INEXISTENT CONTRACT

- Here neither party to the contract has performed his The following contracts are void or inexistent from the
share of the obligation, for example, both the parties beginning.
have yet to perform their promises, the contract is • Those whose cause, object or purpose are
executory. contrary to law, morals, good customs, public
- In an executed contract one party has already order or public policy.
performed his part of the agreement while the other • Those whose cause or object did not exist from
party has to perform his par. the time of transaction.
- In an executory contract both the parties have to • Those whose object is outside the commerce of
perform their mutual promises and the fact that they man.
have to perform their parts of the contract does not • Those which contemplate an impossible service.
affect the validity of the contract. • Those were the intention of the parties relative
to the principal object cannot be as certain
8. Express Contract • Those expressly prohibited or declared void by
- When the terms of a contract are reduced in writing law.
or are agreed upon by spoken words at the time of • Those which are absolutely simulated or
its formation, the contract is express. fictitious.
- An example of this is usually found in formal
contracts wherein the kind of services offered, VOIDABLE CONTRACTS
salary, date and time of effectivity including fringe The following contracts are voidable or annullable, even
benefits, if any, are specified. though there may have been no damage to the
- If a private duty nurse is asked by a physician to go contracting parties.
on special duty for his patient and the patient himself • Those contracts wherein one of the parties is
and his relatives do not object to the service, it is incapable of giving consent to a contract.
implied that the private duty nurse will be paid under • Those whose consent is vitiated by mistake,
the doctrine of facio ut des which means ”I do that Violence, intimidation, undue influence or fraud.
you may give.”
ILLEGAL CONTRACTS
9. Implied Contract - Contracts obtained through use of fraud (deception
- The terms of a contract are inferred from the conduct and trickery,) undue (unlawful) influence or duress
or dealing between the parties. When the proposal (coercion) in securing such, and those that are
or acceptance of any promise is made otherwise than expressly prohibited by law are illegal:
in words, the promise is said to be implied.
- Such an implied promise leads to an implied contract. 1. Those that are made in protection of the law. If a
- Example: A boards a bus. It is implied from his nurse proceeds or administer intravenous
conduct that A has entered onto an implied promise injection without special training and according
to purchase a ticket. to protocol established, she/ he violates RA
9173, the Philippine Nursing Act of 2002. If a
nurse sutures a laceration

33
 2. Consent obtained by fraud. If a nurse obtained ADVANTAGES OF WRITTEN CONTRACTS
the consent of a patient or the family to be given Many nurses fear written contracts. The following are the
services, through misrepresentation that she/he advantages of written contracts over oral ones.
is licensed although she/he is not, such a • A written contract is certain. It avoids the
contract is illegal. Ex. misrepresentation that uncertainty of human memory.
she/he is licensed although she/he is not • It can specify a definite time within which it is
3. Those obtained under duress. Duress means binding so as to protect both sides against
actual or threat of violence or imprisonment in sudden changes without notice. It also fixes a
order to obtain consent. A nurse may be forced time limit after which conditions are no longer
to sign a contract under threat of dismissal. binding but may be opened for discussion.
4. Those obtained under undue influence. If a nurse • It sets a standard and relieves an individual
who has been taking care of an elderly patient professional person from haggling over
uses her close relationship to acquire high salary compensation. It is more likely to be open and
or other options as property, such contract is well-known so that the use of written contracts
invalid as it is illegal. tends to establish minimum standards for
5. Those obtained through material professional practitioners and to protect them
misrepresentation. Aside from fraud, material against discrimination in compensation.
misrepresentation may permit a person to avoid • It is definite and can be definite on many details
or cancel a contract. Suppose a midwife applied which may otherwise stimulate favoritism or
as nurse in an agency and was soon found not to caprice even among professionals, such as hours
be a registered nurse, the contract that she of work, vacation allowances, holiday privileges,
signed becomes illegal because she misled the health and insurance provisions.
employer that she is a nurse. • It can provide a definite procedure in case of
complaints about substandard work, so that the
BREACH OF CONTRACT employer has a clear course and the professional
- Is failure to perform an agreement, whether nurse has protection against arbitrary action.
expressed or implied, without cause. • It creates a minimum of certainty and security for
The following constitute breach of contract for nursing the professional employee so that he/she is free
services (examples): to concentrate on his/her work without concern
o prevention of performance for the details which the written contract has
o failure to perform because of inconvenience or settled.
difficulty; failure of cooperation in performance • Definite commitments stipulated in a contract
o abandonment of duty (i.e., leaving unconscious are hours of work and salary, length of time of
patients, contract, days of off duty, details of duties and
o going off-duty without endorsement, loafing responsibilities including the course to be taken
while on duty) in case of non- fulfilment of the terms of contract
o substitution of performance
o failure to use due care. WILL
- a legal declaration of person's intentions upon death
LEGAL EXCUSES IN REFUSING, NEGLECTING OR FAILURE - called a testamentary document because it takes
TO PERFORM A CONTRACT effect after the death of its maker
• discovery of material misrepresentation made - It is an act whereby a person is permitted with the
and relied upon; formalities prescribed by law, to control to a certain
• where performance would be illegal; where degree the deposition of his estate, to take effect
performance is made impossible by reason of after his death.
illness; 1. Holographic Will
• where performance is made impossible by death - entirely written, dated, and signed by the hand of the
of patient or nurse; testator himself.
• where performance is made for other reasons; - In the probate of a holographic will, it is necessary
and that there is at least one witness who knows the
• where contract is insufficient. handwriting and signature of the testator and
explicitly declares that the will and the signature are
in the handwriting of the testator.
34
 2. Oral Will, Nuncupative Wills, Deathbed Wills THE NURSE'S OBLIGATIONS IN THE EXECUTION OF A
- spoken/oral, rather than written and usually made WILL
before at least 2 witnesses. - note the soundness of the patient's mind (that
- Restrictions to the oral will are that such will be made he/she understood the act of making a will)
during the person's last illness, that it be done in the - there was freedom from fraud or undue influence
place in which he died, that he asked one more (he/she was not induced to make someone the
witnesses to the will, that the will be put in writing beneficiary of the will)
within a given number of days, and that it be offered - that the patient was above 18 years of age.
to probate within a specified time - should note that the will was signed by the testator,
Related Terms that the witnesses were all present at the same time
o Testator/Testatrix and signed the will in the presence of the testator.
o Probate
o Testate GIFTS
o Administrator - Another way disposing property, aside from
o Intestate executing a will is by gifts
• The gift must consist personal property
3. Nuncupative Will or Noncupation • There must be intention to make the gifts
• An Oral Will that have at least two witnesses and • There must be indication transfer of control over
meets specific statutory guidelines. such property
• Restrictions to the oral will are that such will be • There must acceptance by recipient
made during the person’s last illness, that it be - Gifts made by a person because anticipation of death
done in the place in which he died, that he asked or belief in approaching death are called gifts causa
one more witnesses to the will, that the will be mortis or donation causa mortis.
put in writing within a given number of days, and
that it be offered to: probate within a specified LEGAL PROCEDURE AND TRIAL
time. - In a trial, the judicial procedure is to ascertain facts
by hearing evidence, determine which facts are
TESTAMENTARY CAPACITY AND INTENT relevant, apply the appropriate principle of law, and
Essentials of a will to meet legal requirements: pass judgment.
1. The testator must have the expressed intention
of making a will. COMMENCEMENT OF THE ACTION
2. 18 years old and above. - to determine what kind of legal action to take.
3. of sound mind and must be free from undue - ex. Negligence. breach of contract.
influence.
4. The testator shall name the person who will be STATUTES OF LIMITATION
in charge of carrying out the provisions of the Complaint must be filed within a specific time or the right
will. (Administrator) to complain may be lost forever.
5. Properties must be disposed of in accordance - Witnesses become less reliable after passage of time
with legal requirements. - negligence or malpractice vary from two (2) to three
6. The will must be signed by the testator, attested, (3) years
and signed by at least three witnesses in his - In criminal cases, statutes of limitation vary from two
presence and of one another. (2) to six (6) years except in cases where murder is
7. Every will must be acknowledged before a notary committed in which there is no time limit.
public by the testator and witnesses.
8. Witnesses to the wills shall be of sound mind, 18 PLEADING
years of age or more, not blind, deaf or dumb, - The defendant is informed about a complaint that he
and able to read and write. had committed a crime. Where it is determined
9. A married woman may make a will without the whether there is prima facie evidence or probable
consent of her husband and without the cause to charge someone... could either plead guilty
authority of the court. or not guilty

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 PRE-TRIAL PROCEDURES - Only in an extreme emergency and when no other
- Informal discussion between the judge and attorney resident or intern is available should a nurse receive
to eliminate matters not in dispute, agree on issues, telephone orders.
and settle procedural matters relating to the trial. - The nurse should read back such an order to the
Cases are often settled at this point physician to make certain the order has been
correctly received and written on the patients' chart.
TRIAL - Such order should be signed by the physician on
- At the trial, facts of the case are determined, the his/her next visit within 24 hours. The nurse should
principles of law relating to those facts are applied sign the name of the physician on her own and note
and a conclusion as to liability is reached. The judge the time the order was received. Should any problem
determines the facts and applies the law. arise, the order should be referred back to the
ordering physician. It is safer that when a telephone
WITNESS order is given, another resident physician or intern in
The necessity of testimony by any person in a legal the same service receive it since the latter can
proceeding is determined by the attorneys for the discuss with the former the actual condition of the
parties. patient.
Subpoena
- a court summons is served directing a witness to CONSENT TO MEDICAL AND SURGICAL PROCEDURES
appear and give testimony on the date and time Consent
ordered. - is defined as a “free and rational act that
presupposes knowledge of the thing to which
Subpoena Duces Tecum consent is being given by a person who is legally
- is served to a witness requiring him to bring records, capable of giving consent.”
papers, and the like which may be in his possession - The consent signed by the patient or his authorized
and which may help clarify the matter in issue. representative/legal guardian upon admission is for
- She should testify only on what she knows based on the initial diagnosis and treatment.
facts. This is called testimony of facts.
Nature of Consent
- Consent is an authorization, by a patient or person
Testimony of Opinion
authorized by law to give the consent on the
- given by expert witnesses who is qualified to testify
patient’s behalf, that changes touching, for
based on special knowledge, skill, experience, and
example, from non-consensual to consensual.
training; has the privilege against self-incrimination.
Informed Consent
Dying Declarations or Ante-Mortem Statements - Haytand Hayt state that “it is an established
- are considered hearsay evidence except when made principle of law that every human being of adult
by a victim of a crime years and sound mind has the right to determine
what shall be done with his own body.
APPEALS Essential Elements:
- An appellate court reviews the case, and when the - The diagnosis and explanation of the condition
case is decided by it, the final judgment results and - A fair explanation of the procedures to be done and
the matter is ended. used and the consequences of
- A description of alternative treatments or
EXECUTION OF JUDGMENT procedures
- Generally, lawsuits against hospitals or physicians - A description of the benefits to be expected
and nurses involve recovery of money damages. The - Material rights if any
defendant is compelled to execute the judgment. - The prognosis, if the recommended care, procedure,
Failure to obey will be regarded as contempt of court is refused
and will result in fine or imprisonment.
- Doctors should limit telephone orders to extreme Proof of consent
emergency situations where there is no alternative. A written consent should be signed to show that the
The use of a telephone in a non-emergency as a procedure is the one consented to and that the person
substitute for the physician himself can lead to understands the nature of the procedure, the risks
serious errors and may border on malpractice. involved and the possible consequences.

36
 Who Must Consent? Representing the law, the scope of nursing practice
- Patient is the one who gives the consent in his own to protect the public welfare.
behalf. - Nurses are also increasingly being subjected to
- Parent/legal guardian for incompetent (minors or malpractice lawsuits. When nurses become
mentally ill) or physically unable and is not an defendants in legal actions, Other nurse serve as
emergency case expert witnesses both for the defense (representing
- Emancipated minor the practitioner) and the prosecution (representing
the plaintiff).
Consent of Minors - Expert witnesses testify to the standard of care
- Parents or someone standing in their behalf, Parental required of the health care provider and whether it
consent is not needed, however, if the minor is was met. For these reasons, professional nurses need
married or otherwise emancipated. basic knowledge of the legal aspects of nursing.
- Responsibility and Accountability for the practice of
Consent of Mentally Ill Professional Nursing Professional nurses undertake
- A mentally incompetent person cannot legally sign; to practice their profession, they are held
consent must be taken from the parents or legal responsible and accountable for the quality of
guardian. performance of their duties.
- Once they are employed in any institution, or
Emergency Situation hospital are directly responsible to their immediate
- No consent is necessary because inaction at such supervisors. Private duty nurses, being independent
time may cause greater injury. practitioners, are held to a standard of conduct that
is expected of reasonably prudent nurses.
Refusal to Consent - A standard is the desired and achievable level of
- A patient who is mentally and legally competent has performance against which actual practice is
the right to refuse the touching of his body or to compared.
submit to a medical or surgical procedure no matter - Standards serve as benchmark against which to plan,
how necessary, nor the imminent danger to his life to implement and assess quality of services and to
or health if he fails to submit to treatment. show that nursing is accountable to society, to
consumers of nursing services and to governments as
Consent for Sterilization well as to the profession of nursing and individual
- The husband and the wife must consent to the members, Venson, (2016).
procedure if the operation is primarily to accomplish
sterilization. PROFESSIONAL NEGLIGENCE AND MALPRACTICE
Standard
CHARTING DONE BY NURSING STUDENTS - Desired and achievable level of performance against
- Clinical instructor countersigns the charting of a which actual practice is compared.
nursing students - Serves as benchmark against which to plan, to
- Attests that he/she has personal knowledge of implement and assess quality of services
information and that such is accurate and authentic
Intentional Wrongs
- Anyone who countersigns without verification
- Tortious acts that a nurse may be held liable which
commits herself to possible legal risks.
arise in performance of her duties

RELATED TERMS Professional Negligence

- Responsibility - omission or commission of an act, that a reasonably
- Accountability prudent person in similar circumstances would or
- Liability would not do and the action or inaction is the
proximate cause of injury to another person or his
Criminal Liabilities and Legal Responsibilities of a Nurse property
- As Nurses starts to practice their profession, Nurses - If a person charged with negligence shows that she
liability has increased. Assuming authority, meets or even surpasses this standard, then there is
responsibility, accountability for their professional no negligence or carelessness. But if the defendant’s
practice, professional nurses increasingly are being action fails to meet the standard, then there has
subjected to scrutiny by Boards of Nursing been negligence.

37
 Elements of Professional Negligence DOCTRINE Of RES IPSA LOQUITUR “the thing speaks for
- Existence of a duty itself”
- Failure to meet the standard of due care - The injury could not have happened if someone was
- Foreseeability of harm not negligent that no further proof is required.
- Injury to the plaintiff - Example: forceps left inside the abdominal cavity
after a TAHBSO procedure
Examples of Negligence
- Failure to report observations to attending MALPRACTICE
physicians - Improper or unskillful care of the patient by a nurse;
- Failure to exercise the degree of diligence which the also denotes stepping beyond one’s authority with
circumstances of the particular case demands serious consequences
- Mistaken identity - Wrong medicine, wrong - Term of negligence of professional personnel
concentration, wrong route, wrong dose (Professional Negligence)
- Defects in the equipment such as stretchers and - Used properly only when it refers to a negligent act
wheelchairs may lead to falls thus injuring the committed in the course of professional
patients performance
- Administration of medicine w/o a doctor's - Example: Giving of Anesthesia by a nurse or
prescription prescribing medicines.
- Errors due to family assistance
DOCTRINE OF FORCE MAJEURE
Civil Code, Article 19 - An Irresistible force, one that is unforeseen or
- One shall act with justice, give every man his due, inevitable.
observe honesty and good faith. Civil Code, - Under the Civil Code of the Philippines, no person
shall be responsible for those events which cannot be
Article 20 foreseen, or which, though foreseen, are inevitable,
- Those who, in the performance of their obligations except in cases expressly specified by law.
through negligence cause any injury to another, are - Ex. floods, fire, earthquakes and accidents fall under
liable for damages. this doctrine and nurses fail to render service during
this circumstance are not held negligent.
3 conditions required to establish a defendant's
negligence DOCTRINE OF RESPONDEAT SUPERIOR
- Injury was of such nature that it would not normally - “Let the master answer for the acts of the
occur unless there was a negligent act on the part of subordinate.”
someone - The liability is expanded to include the master as well
- Injury was caused by an agency w/in control of the as the employee and not a shift of liability from the
defendant subordinate to the master.
- Plaintiff himself did not engage in any manner that - Example: The hospital will be held liable, if, in an
would tend to bring about the injury effort to cut down on expenses if decides to hire
under board nurses or midwives in place of
Example professional nurses, and these persons prove to be
- A patient came in walking to the out-patient clinic for incompetent.
injection. Upon administering the injection to his - The surgeon will be held responsible in case a
buttocks, the patient experienced extreme pain. His laparotomy pack is left in a patient’s abdomen.
leg felt weak and he was subsequently paralyzed. His - Note: Private duty nurses, however, are considered
sciatic nerve was injured. independent contractors. They are liable for their
- The presence of sponges in the patient’s abdomen own negligent actions.
after an operation.
- Fracture on a newly-delivered baby born by breech INCOMPETENCE
presentation. - Lack of ability, or legal qualifications and being unfit
to discharge the required duty. It is a ground for the
revocation and suspension of her certificate of
registration.

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- Ex. A nursing assistant giving IV medication to the ADVOCACY
patient. - Helping others grow and self-actualize by informing
them of their rights and ascertaining that they have
LIABILITY FOR WORK OF NURSE TRAINEES AND NURSE the right information on which to base their
VOLUNTEERS decisions.
- Nurses are responsible and accountable for their The Code of Ethics for Registered Nurses, Sec. 8 and Sec.
practice, nurse volunteers should exercise utmost 9 Guidelines to be Observed:
caution, critical thinking and independent judgment 1. Registered nurses are the advocates of the
to prevent incurring liabilities which may be hard to patients.
get out of. 2. Nurses should be able to advocate for
themselves and the profession.
LIABILITY OF NURSES FOR THE WORK OF NURSING
AIDES MEDICAL ORDERS, DRUGS, AND MEDICATIONS RA 6675
- Nurses should not delegate their functions to nursing - Only validly registered medical, dental and veterinary
aides since the Philippine nursing act specifies the practitioners, whether in private institutions,
scope of nursing practice of professional nurses. corporations or in the government, are authorized to
- Nurses are enjoined to supervise their subordinates prescribe drugs.
and see to it that they perform only those which they - Requires that the drug be written in their generic
have been taught to do and those which they are names.
capable of doing. - Only when these orders are legal writing and bear
- Nursing aids are responsible for their actions the doctor’s signature thus the nurse has the legal
- Nurses should not delegate their functions to nursing right to follow them.
aides. - The nurse must not execute an order if she is
- Nursing aides perform selected nursing activities reasonably certain it will result in harm to the
under the direct supervision of nurses. patient.

LIABILITY FOR THE WORK OF NURSING STUDENTS PHARMACY ACTRA 5921

- RA 9173 – nursing students do not perform All prescriptions must contain the following information:
professional nursing duties. - Name of the prescriber
- Nursing students should be under supervision of - Office address
their clinical instructors. - Professional registration number
- In order that the errors committed by nursing - Professional tax receipt number
students will be avoided or minimized, the following - Patient’s/client’s name, age, sex
measures should be taken: - Date of prescription.
- Nursing students should always be under supervision
of their clinical instructors. INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS•
• They should be given assignments that are their Philippine Nursing Act of 1991 Section 28
level of training experience and competency. - in the administration of intravenous injections,
• They should be advised to seek guidance if they special training shall be required according to
are performing a procedure for the first time. protocol established”.
• They should be oriented to the policies where - Basis of nurse’s legal right to give IV injection.
they are assigned. - Board of nursing resolution no. 8 states that any
• Their performance should be assessed registered nurse without such training and who
frequently to determine their strengths and administers IV injections to patients should be held
weaknesses. liable, either criminally or administratively or both.

Legal Defense in Negligence SCOPE OF DUTIES AND RESPONSIBILITIES IN

- When Nurses know and attain the standard of care INTRAVENOUS THERAPY
giving service and that they have documented the 1. Interpretation of the doctor’s orders for
care they give. intravenous therapy
- If the patient’s careless conduct contributes to his 2. Performance of venipuncture, insertion of
own injury. needles, cannulas except TPN and cut down

39
 3. Preparation, administration, monitoring and CRIMES AFFECTING NURSING PRACTICE/ REGISTERED
termination of intravenous solution such as NURSES
additives, intravenous medications, and TORT
intravenous push - A tort is a legal wrong, committed against a person
4. Administration of blood/blood products as or property independent of a contract which renders
ordered by physicians the person who commits it liable for damages in a
5. Recognition of solution and medicine civil action.
incompatibilities Examples
6. Maintenance and replacement of sites, tubing’s, a. Assault
dressings in accordance with established - Imminent threat of a harmful or offensive bodily
procedures contact.
7. Establishment of flow rate of solutions, - Verbal threat
medicines, blood and blood components - Ex: A nurse threatens a geriatric patient when he
8. Utilization of thorough knowledge and proficient will take his medications
technical ability in the use/care, maintenance,
and evaluation of intravenous equipment b. Battery
9. Nursing management of TPN, outpatient
- Intentional, unconsented touching of another person
intravenous care
- Ex. When the patient refuses the IM injection of
10. Maintenance of established infection control
medication but the nurses give it anyway, he can be
and aseptic nursing interventions
charged with battery
11. Maintenance of appropriate documentation
associated with the preparation, administration
and termination of all forms of intravenous the c. False Imprisonment or Illegal Detention
therapy. - Unjustifiable detention of a person without legal
warrant within boundaries fixed by the defendant by
TELEPHONE ORDERS an act or violation of duty intended to result in such
- Only in an extreme emergency and when no other confinement.
resident or intern is available should a nurse receive - Ex. Patient insists on leaving the hospital, probable
telephone orders. consequences of their action explained by the doctor
- The nurse should read back such an order to the or medical staff, he is still allowed to go home against
physician to make certain the order has been medical advice In order not to be charged with false
correctly written. imprisonment
- Such an order should be signed by the physician on - However, if patient has a communicable disease,
his next visit within 24 hours. hospital cannot be charged with false imprisonment
in order to protect the public.
MEDICAL RECORDS
● Supplies rich material for medical and nursing research d. Invasion of Right to Privacy and Breach of
● Serves as a legal protection for the hospital, doctor, Confidentiality
and nurse by reflecting the disease or condition - The right to be left alone, right to be free of
of the patient and his management. unwanted publicity and exposure to public view
● “if it was not charted, it was not observed or done”. - Privacy relates to a person or identity.
● Nurses are expected to record fully, accurately, legibly - Example: curtains are used during bed bath
and promptly their observations from procedure to provide privacy of the patient
admission to the time of the patient’s discharge. - Confidentiality relates to data or information about
● Nurses are legally and ethically bound to protect the an individual.
patient’s chart from unauthorized persons. - Example: patient’s charts are not shared with nurses
who have not have direct involvement in the care of
CHARTING DONE BY STUDENT NURSES the patient.
- When a nurse or clinical instructor counter signs the e. Defamation
charting of the nursing student, he/she has personal - Character assassination, be it written or spoken
knowledge of information and that such is accurate
and authentic. Anyone who countersigns without Slander
verification commits herself to possible legal risks. - oral or spoken defamation
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 Libel Felony
- written defamation (cartoon characters, words • Public offense for which a convicted person is
written or essay). There must be a third person who liable to be sentenced to death or to be
hears or reads the comment. imprisoned in a penitentiary or prison
• A felony Is committed with deceit and fault.
There must be a third person who hears or reads the • Deceit exists when the act is performed with
comment. deliberate intent and there is fault when the
wrongful acts result from imprudence,
CRIMES, MISDEMEANORS, AND FELONIES negligence, or lack of skill or foresight.
Crime
• Defined as an act committed or omitted in Criminal Negligence may be classified into:
violation of the law • Reckless Imprudence when a person does an act
• It has 2 elements: (1) criminal act and (2) evil or or fails to do it voluntarily but without malice,
criminal intent. from which material damage results
immediately.
Conspiracy to commit a crime • Simple Imprudence the person or nurse did not
• Conspiracy to commit a crime exists when 2 or use precaution and the damage was not
more persons agree to commit a crime or felony immediate or the impending danger was not
and decide to do it. They can be classified as: evident or manifested immediately.
Principal
• Has committed a direct part in the execution of Criminal Intent
the act. • State of mind of a person at the time of the
• He/she directly force or induce others to commit criminal act is committed. The person is aware
the act. that the act is unlawful but commits it anyway.
• Considered as the mastermind of the crime: Deliberate intent includes two elements without
principal by inducement. which can be no crime. These are freedom and
intelligence.
Accomplices • However, when the person offers evidence of
• Cooperates in the execution of the offense by insanity, necessity, compulsion or accident or
previous or simultaneous act and has knowledge infancy, the court will decide if he is not guilty of
of the criminal intention of the principal the criminal offense.

Accessory Classified according to the degree of the acts of

• Have knowledge of the commission of the crime execution
• Take part subsequent to its commission by a. Consummated
profiting themselves or assisting the offender to • When all the elements necessary for its
profit from the effects of the crime execution and accomplishment are present.
• Provides exit strategy • Ex. The nurse wanted to commit euthanasia and
had given an overdose of morphine that leads to
Criminal Actions patient’s death
• Deals with acts or offenses against public
welfare. These vary from minor offenses and b. Frustrated
misdemeanors to felonies. • When the offender performs all the acts or
execution which will produce the felony as a
Misdemeanor consequence but which nevertheless, do not
• Is a general name for a criminal offense which produce it by reason of causes independent of
does not in law amount to felony the will of the perpetrator.
• Punishment is usually fine or imprisonment in • Ex. Nurse was hired to give poison to a geriatric
term of less than one year patient by a relative for inheritance. However,
the patient was revived after the poison was
given.

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 c. Attempted b. There is reasonable necessity for the means
• When the offender commences the commission employed by the person defending
of the same directly by overt (open or manifest) himself/herself to prevent such aggression
acts due to unforeseen circumstances there was c. There is lack of sufficient provocation on the part
no complete execution to produce the desired of the person defending himself.
felony. - When he/she acts in defense of the person or the
• Ex. Respiratory Physiotherapist planned to rights of his/her spouse, ascendants,
poison a geriatric patient with an overdose of descendants, or legitimate or natural or adopted
inhaled anesthetic but due to lack of available brothers or sisters, or relatives
supply, the patient was only kept drowsy and not - When he/she acts in defense of the person or
comatose or dead. rights of a stranger provided that the first
circumstances and second requisites mentioned
Felonies classified according to the degree of in the first circumstance and that the person
punishment defending is not included by revenge,
a. Grave felonies resentment or other evil motives
Those to which the law attaches the capital punishment - When any person who, in order to avoid an evil
(death) or penalties which in any of their periods are or injury, does not an act which causes damage
afflictive imprisonment ranging from 6 years and 1 day to to another provided that the evil sought to be
life imprisonment or fine not exceeding php6,000.00. avoided actually exists, the injury feared is
greater that done to avoid it and there is no other
b. Less Grave felonies practical and less harmful means to prevent it.
Law punishes with penalties which in their maximum - Fulfillment of a duty or lawful exercise of right or
period are correctional. Imprisonment from one month office,
and one day to six years Fine not exceeding php6,000.00 Ex: police officers shooting a drug addict to
defend oneself from getting shot back.
c. Light felonies
Those infractions of law for the commission of which the 2. Exempting Circumstances
penalty of arresto menor Imprisonment for one day to 3o The following persons may be exempted from the crime
days or a Fine not exceeding php200.00. Light felonies they have committed:
are punishable only when they have been consummated, • Imbecile or insane person, unless the latter has
with the exception of those committed against a person acted during a lucid interval.
or property. • Person less than 9 years’ old
• Person over 9 years of age and under fifteen
Criminal Liability unless he/she acted with discernment
• Nurse may incur criminal liability or subject • Any person while performing a lawful act with
herself to criminal prosecution either by due care he/she causes merely an accident
committing a felony or by performing an act without fault or intention or causing it
which would be an offense against person or • Any person under compulsion of an irresistible
property. Ignorance of the law is not an excuse force
for failure to comply therewith. • Any person who acts under the impulse of an
uncontrollable fear of an equal or greater injury
• Violators of the criminal law cannot escape
• Any person who fails to perform an act required
punishment on the ground of ignorance of the
by law when prevented by some lawful or
law.
insuperable cause.
CIRCUMSTANCES AFFECTING CRIMINAL LIABILITY
3. Mitigating Circumstances
1. Justifying Circumstances - Those which do not constitute justification or excuse
- a person may not incur criminal liability under the of the offense in question, but which in fairness and
following circumstances: mercy, may be considered as extenuating degree of
- When he/she acts in defense of his/her person or moral culpability.
rights provided that: - The following are some of the circumstances
a. There is an unlawful aggression on the part of the considered by law to be mitigating and Lessen the
offended or injured party; criminal liability of the offenders.

42
 • When the offender has no intention to commit 5. Alternative Circumstances
so grave a wrong as the one committed • Taken into consideration as aggravating or
• When the offender is under eighteen years of mitigating according to the nature and effects of
age or over seventy years old. the crime and other conditions attending to its
• When sufficient provocation or threat on the commission
part of the offended party immediately precedes • Relationship is aggravating in physical injuries
the act inflicted by a descendant upon as ascendant.
• Act is committed in the immediate vindication of • It is mitigating when an accused aided his/her
grave offense to the one committing the felony, brother in the fight against the offended party
his/her spouse, ascendants, legitimate, natural • Intoxication of the offender as mitigating when
or adopted brothers or sisters, or relative by the offender committed the felony in a state of
affinity within the same degree. intoxication.
• Offender voluntarily surrenders himself to a • When intoxication is habitual or intentional, it
person in authority or authority can be an aggravating circumstance.
• Defender is deaf and dumb, blind or otherwise • Illiteracy is mitigating if there is lack of sufficient
suffering from some physical defects which does intelligence and knowledge of the full
restricts his/her means of actions, defense Or significance of one’s act.
communication with fellow beings. • Lack of education is not mitigating in: rape, force
• Suffering from such illness as would diminish the abduction, arson, treason, crimes against
exercise of his/her will power without, depriving chastity like seduction and acts of lasciviousness
him/her consciousness of his/her acts and acts committed in merciless or heinous
Note: Lack of education is not mitigating in: manner.
a. Rape
b. Forcible abduction MORAL TURPITUDE
c. Arson - act of baseness, vileness or depravity in social or
d. Treason public duties which a man owes to his fellow man or
e. In crimes against chastity like seduction and acts to society in general. It is contrary to the accepted and
of lasciviousness customary right and duty between men.
f. Those acts committed in a merciless or heinous
manner MURDER
- unlawful killing of a human being with intent to kill.
4. Aggravating Circumstances - Ex. Euthanasia and abortion HOMICIDE killing of a
- Attending the commission of crime and which human being by another. It may be committed
increase the criminal liability of the offender or without criminal intent by any person who kills
make his guilt or more severe. another other than his father, mother, child or
- The following are Some of the circumstances that ascendants or descents, spouse without any of the
consider the law as aggravating circumstances attendant the crime of murder being
• When the offender takes advantage of his public present.
position.
• Crime is committed in place of worship ABORTION
• Act is committed with evident premeditation or - expulsion of a product of conception before the age
after an unlawful entry of viability. In law, any person with the intention of
• Act committed with abuse or confidence or prematurely ending a pregnancy willfully or
obvious ungratefulness unlawfully does any act to cause the same is guilty of
• When the crime committed in consideration of a procuring abortion.
price, reward, or promise
• Crime is committed on occasion of a INFANTICIDE
conflagration, shipwreck, earthquake, epidemic - killing of child less than 3 days of age. The mother who
or other calamity or misfortune commits this crime shall suffer penalty of
• When craft, fraud or disguise was employed imprisonment ranging from 2 years, four months and
• When the wrong done in the commission of the one day to 6 years.
crime is deliberate augmented by causing other
wrongs not necessary for its commission.

43
 PARRICIDE 9. Consult your superior for problems that may be
- crime committed when one kills his/her father, too big for you to handle.
mother or child whether legitimate or illegitimate, 10. Verify orders that are not clear to you or those
his/her ascendants or descendants or his spouse. A that seem to be erroneous.
person convicted shall be imposed of penalty for life 11. The doctors should be informed about the
imprisonment (reclusion perpetua) to death. patient's conditions.
12. Keep in mind the values and necessity of keeping
ROBBERY accurate and adequate records13. Patients are
- crime against person or property of taking personal entitled to an informed consent
property of another person. Ex. Nurse takes patient’s
cash or jewelry while patient is sleeping.

CONTROLLED SUBSTANCES RA 6425 (Dangerous Drugs

Act of 1972)
- covers administration and regulation of manufacture,
distribution and dispensing of controlled drugs.
Authorized persons to prescribe or dispense these
drugs require to register and have special license for
this purpose. Controlled drugs are kept in locked
cabinets and are documented and counted every
shift.

SIMULATION OF BIRTH, SUBSTITUTION OF ONE CHILD

FOR ANOTHER OR ABANDONMENT OF LEGITIMATE
CHILD
o Simulation of birth
- one who enters in a birth certificate a birth that
did not occur. It is a crime against the civil status
of a person.
o Substitution of one child
- for another or concealing or abandoning any
legitimate child with intent to cause such a child
his/her civil status shall be punishable for
simulation by birth, prison mayor and a fine not
exceeding one thousand pesos.

Things to remember in order to avoid criminal liability

1. Be very familiar with the Philippine nursing law.
2. Beware of laws that affecting nursing practice
3. At the start of employment, get a copy of your
job description, the agency’s rules, regulations
and policies.
4. Upgrade your skills and competence
5. Accept only such responsibility that is within the
scope of your employment and your job
description.
6. Do not delegate your responsibilities to others.
7. Determine whether your subordinates are
competent in the work you are assigning them.
8. Develop good interpersonal relationships with
your co-workers, whether they be your
supervisors, peers or subordinates.

44
 COURSE UNIT 5 Peplau's Theory of Interpersonal Relations
Hildegard Peplau defined nursing as an "interpersonal,
ORGANIZATIONAL COMMUNICATION therapeutic process that takes place when professionals,
specifically educated to be nurses, engage in therapeutic
Models and Theories of Communication relationships with people who are in need of health
Transmission Model of Communication services." She cited that nurse-patient relationships must
describes communication as a linear, one-way process in pass through three phases in order to be successful:
which a sender intentionally transmits a message to a (a) orientation phase,
receiver (Ellis & McClintock, 1990). (b) identification,
(c) exploitation, and
(d) resolution.

Orientation Phase
- Starts with the definitions of the problem.
- The nurse's assessment of the patient's health
and situation is vital in this phase.

Interaction Model of Communication

describes communication as a process in which
participants alternate positions as sender and receiver
and generate meaning by sending messages and
receiving feedback within physical and psychological
contexts (Schramm, 1997). Identification Phase
- Includes the selection of the appropriate
assistance by a professional.
- The development of a nursing care plan is
performed in this phase.
Exploitation Phase
- Utilizes professional assistance for problem-
solving alternatives.
- This phase is the implementation of the nursing
care plan.
Resolution Phase
- This is the termination of the professional
relationship after the patient's needs have been
Transactional Model of Communication
met through the collaboration of patient and
describes communication as an exchange of messages,
nurse. This is the evaluation of the nursing
but also create relationships, form intercultural alliances,
process.
shape our self-co engage with others in dialogue to
create communities. Barriers to Communication Among HealthCare
Providers and Health- Care Recipients
1. Low Health Literacy
- individuals who lack the skills necessary to
acquire and use healthcare information are less
likely to manage their chronic conditions and/or
medication regimens effectively. For this reason,
they utilize healthcare facilities more frequently
and have higher mortality rates.

45
 2. Cultural Diversity • Opening, context, and task (includes the
- Culture affects communication in how the purpose of the memo, the context and problem,
content is conveyed, emphasized, and and the specific assignment or task): one fourth
understood of the memo
• Summary, discussion segment (the details that
3. Cultural Competence support your ideas or plan): one half of the
- This affects the way/y healthcare providers memo
interact with each other and with the • Closing segment, necessary attachments (the
populations they service. To practice, cultural action that you want your reader to take and a
competence, healthcare professionals need to notation about.
recognize and relate how culture is reflected in
each other and in the individuals with whom they In addition, because writing is a learned skill that
interfere. improves with practice, Writing Help Central, suggests
the following in writing professional correspondence:
4. Interprofessional Communication Education of - Keep your message short and concise. Less than
Healthcare Providers. once page is
- Challenges may also occur when communicating - always preferred. Use bullets to highlight key
with professionals in other disciplines and may points.
include use of concepts and terminology - Use the first paragraph to express the context or
common to once specific discipline but not well purpose of the memo and to introduce the
understood by members of other professions. problem. In the next paragraphs, address what
These may affect another professional's has been done or needs to be done to address
understanding of the meaning or value of the the problem at hand.
situation. - Add a conclusion to summarize the memo, to
clarify what the reader is expected to do, and to
Written Communication with in the Organization address any attachments.
- Although many forms of communication take - Focus on the recipient's needs. Make sure that
place in organizations, written communication is your communication addresses the recipient's
the most used in large organizations. The written expectations and what he or she needs to know.
communication issued by the manager reflects - Use simple language so that the message is clear.
greatly on both the manager and the Keep paragraphs to less than three or four
organization. Therefore, the manager must be sentences.
able to write clearly and professionally and to - Review the message and revise as needed.
use understandable language. Always reread the written communication
before sending it. Look for areas that might be
Memo Writing misunderstood. Pay attention to tone.
- The written communication used most by - Use spelling and grammar checks to be sure that
managers in their daily work life is the memo. the communication looks professional.
Perkins and Brizee (2013) suggest that business Remember that your document is a direct
memos have a two fold purpose: reflection of you, and even the most important
o They bring attention to problems and message will likely be ignored if the
o They solve problems. communication is perceived as unprofessional.
- Hence, it is essential to choose the recipient of a
memo prudently and to ensure that everyone Meeting Minutes
intended to receive it. - Meeting minutes are notes or records, usually
taken by the secretary that contains the details
Business Memos of what transpired in a meeting, the issues that
- according to Perkins and Brizee (2013) suggest that were discussed, motions proposed, and any
business memos should be composed of the votes taken. If a member did not attend a
following components: corporate meeting, they can gefer to the
• Header (includes the to, from, date, and subject meeting notes to find out any important
lines): one eighth of the memo information they have missed.

46
 - If a member did not attend a corporate meeting, • Business from previous meeting – Summary
they can refer to the meeting notes to find out of the business that was discussed in the
any important information they have missed. previous meeting
• New business – Summary of each agenda
Purpose of Meeting Minutes item discussed at the current meeting.
- Meeting minutes are used to capture important This should include a description of the action, rational
details in a meeting. Boards will often refer to behind the decision, and major arguments for or against
meeting minutes to make future decisions about the action
how to move forward with decisions or new • Additions to the agenda – Any additional
projects. motions that were not listed on the next
meeting agenda
• Agenda for the next meeting – Topics to be
Steps on How to record Meeting Minutes discussed at the next meeting
1. Plan and outline. • Adjournment – Time the meeting ended and
- The secretary or whoever will be recording the date and time of the next meeting
minutes should meet will the chairperson before
the meeting begins to decide on an agenda for Reports in Nursing
the meeting to keep meeting minutes organized • According to Venzon, reports are oral, taped or
and easy to record. written exchanges of information between
nurses and/pr members of the health team.
2. Record taking at the meeting. Take detailed These include change-of-shift reports, telephone
notes for each agenda item which indude: orders and reports, and transfer reports.
o Decision made
o Actions taken or agreed to be taken Change-of-Shift Reports
o Next steps moving forward - This is a system of communication aimed at
o Voting outcomes including who made transferring essential information and holistic care
the motion and how each member voted for patients.
o Any motions that were rejected - Its purpose is to provide continuity of patient care
o Items to be held over for 24 hours. It may be given orally, by audio tape
o New business recording, or at the bedside during nursing rounds.
o The date and time of the next meeting - Oral reports are initially given at the nurses’ station
or conference room with nurses from both shifts
*Ask for clarification if necessary, to ensure that the attending.
notes are accurate.
A. Oral Report
3. Writing the minutes. Using the detailed notes, - Prior to the nursing rounds, a pre-conference is
the recorder will then write the final draft of the made at the nurses' station or conference room. Any
meeting minutes. The recorder should do this as information that may alarm the patient and/or
soon as possible. Many corporations use a his/her family is reported out of hearing.
standard template that includes the following - The report is given in a low voice to prevent others
information: from hearing. Change-of-shift reports should be
• Opening – Meeting title, location, time, and done quickly and efficiently.
date
• Present members – Include full names and B. Audio-tape Report
titles - This is made by the outgoing nurse and is relayed by
• Absent members – Include full names and the incoming nurse.
titles - The disadvantage of this report is that immediate
• Approval of the agenda – Should indicate if answers cannot be provided if any problems arise
the agenda was approved and distributed unlike in oral reports or those made during nursing
• Approval of the previous minutes – Should rounds which can permit immediate feedback when
indicate of the previous minutes were needed.
approves and distributed

47
 C. Nursing rounds Pre-Meeting Work
- These are made at the patient's bedside. The - Determine the specific purpose(s) for the
patient's care plan is discussed. This enables the meeting (What do you want to accomplish in the
patient and his family to participate in the meeting?).
discussion, pose questions or seek clarifications. - Create a list of meeting topics, such as “revisions
- At the same time, the nurse can perform an to nursing handbook” or “new admission policy.”
additional and needed assessment, evaluate the Create a fact sheet related to each topic to
patient’s progress and determine the interventions distribute with the agenda.
that best meet his/her needs. - Determine the meeting attendees. They are
individuals, groups, or department
Telephone Reports representatives with valuable insight or who are
- "Information given through telephone should be affected by decisions made during the meeting.
accurately transcribed by the receiving nurse in - Determine the date, time, and location for the
written form especially if this pertains to meeting, and invite attendees. To maximize
medications, or if significant events or changes in meeting attendance, ask attendees what date
a client's condition have occurred. and time would work with their schedules.
- There are legal risks in telephone orders. These - Create the meeting agenda. It should contain the
may be misunderstood or misinterpreted by the following components:
receiving nurse. They may sound unclear o Title of the group meeting
because of some trouble in the telephone line. o Date, time, and location of the meeting
- Most importantly, the signature of the ordering o Purpose(s) for the meeting in sentence
physician is not affixed in the order and may be form
denied in case errors exist or when court o Agenda items, time allotted for each
litigations arise. item, and person responsible for
- The order must be signed by the ordering reporting on each item.
physician once he/she returns to the hospital. - Send the meeting agenda out at least 1 week
- Nurses should only receive telephone orders in before the meeting so that attendees come
extreme emergency and when no other resident prepared. Send a meeting reminder 2 days
or medical intern is available. before the meeting.

Transfer Reports During the Meeting

- Patients may be transferred from one unit to 1. Ensure that the participants' comfort needs are
another as their condition or case warrants it, in met by arranging the seating in an oval or circular
such case of a patient from the medical ward shape and preferably around a table.
diagnosed to have bleeding peptic ulcer. The 2. Ask for volunteers to fulfill the following roles.
patient may be transferred to the surgical o Leader
department for further management after o Timekeeper
proper referral and assessment of a surgeon. o Recorder
- A patient may also be transferred to another 3. The leader guides the meeting by:
agency after proper referral and coordination. • Processing one agenda at a time.
The receiving unit is usually advised beforehand • Allowing the timekeeper to do his or her
about the transfer so that the unit or bed job to keep the meeting on track.
including special equipment if needed will be • Debriefing the end of the meeting by
arranged. asking these questions: "What went well
- The transfer report accompanies the patient and with the meeting?" and "What can we
contains information that the receiving nurse improve upon for the next meeting?"
needs to know for continuity of care. These questions should be used at the
end of each meeting to improve
Preparation and Conduct of Meetings subsequent meetings.
- As discussed by Cherry & Jacobs (2014), the
following steps must be undertaken to manage
effective meetings.

48
Patient Satisfaction and Customer Service Provider
• To be in this competitive environment, nurses
are expected to keep patient satisfaction and
customer service, which includes safety and
quality care, as the leading motivator of all plans
and activities (Cherry & Jacobs, 2014).
• Customers can be categorized as external and
internal, depending on their relationship to the
organization.

External Customers
• are not employed by the organization and
include patients and families, in addition to
physicians and others who serve as referral
sources for new patients.

Internal Customers
• are employed by the organization and may
include patient care staff members, staff
members of other departments (laboratory,
dietary), administrators, social workers,
dietitians, and therapists.

49
 COURSE UNIT 6 - To protect the interests of staff, students and
other stakeholders
RECORDS MANAGEMENT - Help to address complaints or legal processes.
- Records management (RM) is the supervision
- To support patient choice and control over
and administration of digital or paper records,
treatment and services.
regardless of format.
- To support day to day business of the health
- It is a systematic and effective control of records
care delivery.
(both paper and electronic).
- To support evidenced based practice.
- It aims to ensure that records are accurate and
- To assist clinical and other types of audits.
reliable, can be retrieved speedily and efficiently,
- To support sound administrative and
and efficiently, and are kept for no longer than
managerial decision making.
necessary.
- To support improvement in clinical
- It is crucial to all organizations. Unless records
effectiveness through research.
are managed efficiently it is possible to conduct
business, to account for what happened in the
BENEFITS OF RECORD MANAGEMENT
past, or to make decisions are kept for no longer
- Saves time by ensuring that records can be
than necessary.
found easily and quickly.
- Save space by preventing records from being
Records management activities include:
kept longer than necessary.
- Creation
- Saves money by reducing storage costs and
- Receipt
maintenance costs.
- Maintenance
- Improves efficiently by ensuring records are
- Use and disposal of records
readily accessible legally.
- Improves compliance by keeping records in line
Documentation may exist in:
with legal and regularly requirements.
- Contracts
- Keeps records under control by preserving data
- Memos paper files electronic files
and preventing accumulation control of referral
- Reports
material.
- Emails
- Improves the quality of information, providing
- Videos
staff with access to accurate and reliable quality
- Instant message logs or database records.
records security
- Increases the security of confidential records
What is the concept?
continuity.
• Information is "data, ideas, thoughts, or
- Support business continuity and risk
memories irrespective of medium." management
• Documents are any "recorded information or - Records are managed efficiently and can be
objects that can be treated as individual units easily assessed and used
• Records are "information created, received, and - Records are stored as cost effectively as
maintained as evidence and information by an possible and when no longer required they are
organization or person, in pursuance of legal disposed of in a timely and efficient manner.
obligations or in the transaction of business." - Complies with requirements concerning records
Archives are those records that have been and records management practices to ensure
selected for permanent preservation because of compliance with institution
their administrative, informational, legal and - Records of longer term value are identified and
historical value as evidence of official business. protected for historical and other research

IMPORTANT OF RECORD MANAGEMENT Classification of Records

- To provide evidence of actions and decisions Active Record
- To support accountability and transparency - a record that is regularly referenced or required
- To comply with legal and regulatory obligations, for current use.
including employment, contract and financial Inactive Record
law as well as the data protection act and - a record that is still needed by an organization
freedom of information act but not for current operations.

50
 Electronic Record Nurses' responsibility for record keeping and recording
- a record recorded or formatted only a computer - Keep under safe custody of nurse
can process. - No individual sheet should be separated
- Not accessible to patient and visitors
RECORD - Strangers is not permitted to read records
- It is a permanent written communication that - Records are not handed over to the legal
documents information relevant to a client's advisors without written permission of the
health care management. administration
- A record is a clinical, scientific, administrative - Handed carefully, not destroyed
and legal document relating to the nursing care - Identified with bio-data of the patients such as
given to the individual family and community. name, age, admission number, diagnosis, etc.
- Never sent outside the hospital without the
Sample of Records
written administrative permission
- Administrative records of
Grants/Contracts Nursing Administrator’s Responsibility
- Bid documents 1 - Protection from loss
- Blueprint of facilities - Safeguarding its concerns
- Consent forms-adult-minor - Completeness
- Endowment Fund Records - Responsibility for nurse notes
- Equipment inventory reports - Admission record
- General ledgers - Scientific value of the nurse notes
- Meeting minutes - Record of order carried out
- Payroll folder
- Contracts-purchase lease rental, and etc. Individual Staff Record
- A separate set of record is needed for staff,
Records in the Nursing Office and Unit
giving details of their sickness and absences.
- Administrative records: organogram, job
description, procedure manual
- Personnel records: personal files, records
- Patient records send to medical center
chief/medical director
- Leave record, duty roster, minutes of the
meeting, budget etc.
- Miscellaneous: circular log book, formats, etc.
Ward Records
Principles of Record Writing
- Deducting or increase in beds.
- Nurses should develop their own method of
- Change in medical staff and non-nursing
expression and form in record writing
personnel for the ward.
- Records should be written with clearly and
- The introduction and patient of support.
appropriately
- Records should contain facts based on
Characteristic of a Good Record and Reporting
observation conversation and action
- Accuracy
- Select relevant facts and the recording should
- Consciousness
be neat, complete and uniform
- Thoroughness
- Records should be written immediately after an
- Up to date
interview
- Organization
- Records are confidential documents.
- Confidentiality
- Objectivity
Seeking and Release of Records
1. Sentinel events Purposes of Record
2. Anecdotal - Supply data that are essential for programmed
3. Incident report planning and evaluation
4. Kardex - Provide the practitioner with data required for
5. Patients chart/records the application of professional services for the
6.201 file improvement of family health
51
- Used as tools of communication between health Managing Records
workers the family and other development
personnel
- Shows the health problem in the family and
other factors that affect health
- Indicates plan for future
- Provides baseline data to estimate the long
term changes related to services

Administrative Purpose of Clinical Records

- Legal documents
- Research or statistics rates
- Audit and nursing audit
- Quality of care
- Continuity of care
- Informative purposes
- Teaching purposes of students
- Diagnostic purposes

Importance of Records in Hospital What is the records lifecycle

(For individual and Family) CREATE/RECEIVE
- Serve the history of the client starts when records are either received from an
- Assist in the continuity of cares external source or created internally. The objectives of
- Evidence to support if legal issues arise this initial stage are:
- Assess health needs: research and teaching - Create complete and accurate records that
provide evidence of the organization's functions,
For the Doctor activities, decisions, transactions, procedures,
- Serve the guide for diagnosis, treatment, follow etc.
up and evaluation - Identify and apply an appropriate security
- Indicate progress and continuity of care classification
- Self-evaluation of medical practice - Distinguish between records and non-record
- Protect doctor in legal issues copies or working documents, to be able to
- Used for teaching and research appropriately segregate them in the filing system
- Place the record in an organizational
For the Nurses classification scheme (or file plan) either in paper
- Document nursing service rendered (e.g. in a filing cabinet or a binder) or in electronic
- Planning and evaluation of service for future version (e.g. on a shared drive or in a system) to
improvement ensure that it's preserved within its context.
- Guide for professional growth
- Communication tool between nurse and other ACTIVE PHASE
staff involved in the care It means that they are often used, shared between
- Indicate plan for future colleague retrieved to support day-to-day business and
referred to.
For Authorities
- Identify and apply an appropriate security
- Statistical Information
classification
- Administrative control
- Distinguish between records and non-record
- Future reference
copies or working documents, to be able to
- Evaluation of care in terms of quality, quantity appropriately segregate them in the filing system
and adequacy
- Place the record in an organizational
- Help supervisor to evaluate service
classification scheme (or file plan) either in paper
- Guide staff and students
(e.g. in a filing cabinet or in a binder)
- Legal evidence of service rendered by each
or in electronic version (e.g. on a shared drive or
employee
in a system) to ensure that it's preserved within
- Provide justification of expenditure of funds
its context
52
 - Preserve the integrity of the record, which
means ensuring that it has not been altered after
completion
- Maintain its usability which means making it
available for all colleagues who need an access to
the record to do their job
- Facilitate identification and preservation of
records with permanent retention

INACTIVE PHASE
During this stage, we should free up space in our
offices to new records, but we need to ensure keeping
inactive records handy. The objectives of this stage
are:
- Identify the records that are not required to be
stored in the primary office space (paper) or
systems/shared drives (electronic)
- Organize and list them
- Transfer them to the local Records Center (for
field missions the local Records Center within
mission area; for HQ offices the ARMS Records
Center)
- Retrieve only those records that are needed
from time to time

DISPOSITION PHASE
The objectives of this stage are:
- Identify records with archival value (permanent
retention), list them, organize them
- Identify records due for disposal/destruction,
list them, gather necessary approvals for the
destruction and proceed with an
environmentally friendly destruction process

53
 SEMINAR ORGANIZATION IMPACT OF THE LOOMING NURSING SHORTAGE
• As baby boomers age the demand for health
IMPLEMENTING SELF CARE FOR NURSES care services arrows
- More and more research and data about the
physical and mental strain of nursing have come NURSES GETTING INVOLVED THROUGH ADVOCACY
out. This should. prompt health care leaders to AND ACTION
take the initiative to acknowledge and treat this • The Code of Ethics for Nurses states that
issue about nurses providing for their self care Advocacy is also a nurse's responsibility. And as
in a profession that is gradually taking is toll on the biggest group of health care providers
their physical and mental health locally and internationally, nurses have a
significant opportunity to express a voice in the
INCREASED SPECIALIZATION & CAREER PATH OPTIONS future of health care and the health of the
• Psychiatry, obstetrics, gerontology is steadily nation.
growing.
• Enables nurses to develop expertise in the area NURSES NEEDING TO BE TECHNOLOGICALLY SAVVY
in which he or she is providing care. • Every day new health care technologies enter
• Opens the door to opportunities for career the market. Nurses are required to adapt to
advancement. these technologies in order to improve patient
• Patients are assured of high level of knowledge care.
and competence in a specific area of care. • Technology is introduced to reduce
administration time, increase accuracy all
EXPANDING ENTREPRENEURSHIP OPPORTUNITIES keeping clinician satisfaction and the patient
• Nurses to set up their own businesses experience in mind.
• For nurses who value independence and
autonomy, entrepreneurship may be a good fit. NURSES MOVING IN TO THE COMMUNITY
OUTPATIENT SETTING
CONTINUED GROWTH OF TELEHEALTH • Shift of health care from inpatient to outpatient
• Patients gain access to doctors and nurses settings.
through video and phone - consults, remote • Greater impact in attaining the goal of helping
monitoring, and other electronic people to get healthy and stay healthy
communication.
• Serves as opportunity for health promotion SIX BIGGEST PROBLEM FACING NURSING TODAY
wellness checks, and patient care. 1. STAFF SHORTAGES
• Fewer nurses means a more hectic workload for
INCREASING NEED FOR DOCTORAL EDUCATION the nurses that are on the wards.
• In the United States, the number of nurses 2. MEETING PATIENT EXPECTATIONS
enrolling in doctoral education programs is • Because of the shortage in manpower, nurses
growing, specifically for the Doctor of Nursing often feel that they do not come up with
Practice (DNP) because of the shortage of patients' high level of expectations.
doctors 3. LONG WORKING HOURS
• In the Philippines. the future of nursing may • Because of the shortage in staff, there are
eventually include mandate to have more hospitals that opt for the 12hour shift instead of
doctoral degree nurses but they are mostly in the 8 hour shift
the field of education 4. WORKPLACE VIOLENCE
• Being overfatigued, overstressed and
FURTHERING NURSING EDUCATION ONLINE overworked tend to take its toll on the weary
• Online classes in the post graduate programs nurses. which at times may result to conflicts.
are now being offered by some universities. Pre- 5. WORKPLACE HAZARDS
covid, it was an option, but with the pandemic it • The workplace can put the nurses' physical and
is now the trend…..>>>> mental health at risk.
• gave rise to an increasing need for nurse 6. PERSONAL HEALTH
educators.

54
 SEMINAR CONCEPTUALIZATION 4. BUSINESS/COST RESTRICTIONS
- Will it work within time and budget constraints
BRAINSTORMING given.
1. HAVE A CHALLENGE READY
- This will trigger creativity.) A. PRELIMINARIES
2. FOCUS ON QUANTITY 1. PURPOSE AND GOALS OF EVENT
- Come up with lots of ideas for more choices and 2. TITLE OF EVENT
a better likelihood of choosing a good one. 3. TARGET AUDIENCE(Undergraduates, Graduates,
- Critically reflecting ideas during brainstorming Residents)
should not be done; collect them and move on. 4. DATE & LOCATION (Choose primary date and an
3. DON'T CRITICIZE alternate)
- Slows down the idea generation process. 5. START AND END TIME
- Encourage teammates to participate 6. NUMBER OF PARTICIPANTS & COST
- Avoid negative criticisms. 7. PROGRAM (SPEAKER)
8. ROOM SET UP (Chairs, Tables, Stage, Podium)
4. APPRECIATE THE UNCOMMON 9. EQUIPMENT (Audio, Lighling, ofe)
- Entertain ideas that are seemingly unworkable 10. FOOD (Breakfast, Lunch, Dinner)
or are unusual 11. RELEVANT (Co-Curricular Learning Outcomes)
- Some even serve as stepping stones to even
better ideas. B. DEVELOP A REALISTIC BUDGET
5. COMBINE AND IMPROVE
- Building upon one another's ideas is natural and C. OBTAIN NECESSARY APPROVALS FOR:
normal during brainstorming, and helps you to EVENT REGISTRATION
generate more ideas • Includes event approval from key persons and
6. TRY DIFFERENT METHODS venue reservation
- While brainstorming can be very effective, • Corporate Sponsorship.
different methods can be added into a INVITING A GUEST SPEAKER
brainstorming session and possibly become - Follow the institutional guidelines in the choice
even more creative of a speaker. (If there are any)
7. PLAYFUL ENVIRONMENT
- Help your ideas to move more quickly, and CORPORATE SPONSORSHIP
facilitate inspiration
8. PUT THEM ON THE WALL EXTERNAL SPONSORSHIP
- Visualizing your ideas on a wall or a large space - Seek approval for sponsorship from any external
that is visible to visible to all participants helps source.
to get everyone *on the same page" and
thinking actively.
9. BREAK
- Don't go for too long. Brainstorming can be
physically exhausting, so make sure to give
yourself a break during long sessions.

EDITING AND REFINEMENT

1. TECHNICAL FEASIBILITY
- Check whether the ideas works on the platform
to be used and with the technology available.

2. MARKET OPPORTUNITY
- Think about why people would attend a planned
event based in your idea

3. GOAL CONSIDERATION
- Whether it fits well with the set goals
55
 COURSE UNIT 7 I. PRECEPTORSHIP MODEL
- A preceptor is teacher or instructor with special
INTRA-DISCIPLINARY, INTERDISCIPLINARY training and he care provide practical training to
AND MULTI-DISCIPLINARY AND WORK an intern or staff.
COLLABORATION - The best preceptor like to teach and they will
volunteer for the role rather than wait to be
Collaboration assign
- The roots of the word collaboration, namely co-,
and elaborate, combine in Latin to mean “work Responsibilities of the Preceptee's
to together.” - Provide an orientation for the students
- The collaborative process involves a synthesis of - Review agency guideline with students,
different perspective to better understand especially those that will impact the student
complex problems. experience directly
- Is a process by which members of various - Help students feel a sense of belonging in the
disciplines (or agencies) share their expertise to agency
accomplishing a common goal - Provide opportunities for the student to
- “Collaboration is the most formal inter participate in important agency functions such
organizational relationship involving shared as meetings, outreach events, etc. as
authority and responsibility for planning, appropriate.
implementation, and evaluation of a joint effort, - Be aware of the student's learning goals so that
Marquis and Huston, (2017) can be help structure experiences that will help
- Collaboration defined as a joint communication the student meet goals.
and decision-making process with the goal of - Give honest, constructive feedback to the
satisfying the health care needs of a target student and faculty supervisor as needed.
population. NNCCS, (2012). - Meet with student at frequent, regular intervals
- Mattessich, Murray and Monsey (2001), define to provide feedback, evaluate progress and
collaboration as’... a mutually beneficial and resolve problems
well- defined relationship entered into by two or - Remember what may see basic or easy for the
more organizations to achieve common goal. preceptor may not be basic or simply to the
student
EFFECTS OF COLLABORATION
- Improved patient outcomes II. MENTORSHIP MODEL
- Reduced length of stay - Mentoring is A developmental relationship in
- Cost savings which a more experienced person helps a less
- Increased nursing job satisfaction and retention experience person...
- Improved teamwork
The Value of Mentoring: Mentoring provides
TYPES OF COLLABORATION - Retention by means of personal relationship
• Interdisciplinary - Staff development and career guidance
• Multidisciplinary - Job satisfaction, and a healthy workplace
• Tran disciplinary environment
• Inter professional collaboration
Roles of Mentors
MODELS OF COLLABORATION - Teacher (educational expertise)
• Preceptor-ship model - Guider
• Mentorship model - Counselor (practical expertise)
• Lecturer practitioner model - Advisor
• Research joint appointment
MENTORS VS PRECEPTORS
• Clinical school of nursing model
Mentors
• Collaborative clinical education model
- Older than Learner
- Possesses wisdom and experience
- Career networking

56
- Facilitator III. LECTURER PRACTITIONER MODEL
- Guide - Each clinical placement gave to have named
- Advisor lecturer / practitioner or clinical educator who
- Role model will assist in the organization, facilitation and
- Chosen supervision of the clinical learning experience
- May have no formal preparation throughout the entire programs.
- Share Life, education, work experience
- Type of relationship” close, personal friendship Role of Lecturer Practitioner
- Not an evaluator - Promote active discussion within the clinical
- Occurs over time setting to encourage understanding
- No termination date - Work with clinical staff to identify alternative
- Sought out by mentee means to gain relevant experience
- Teaches networking - Play an active role in overall assessment to help
- Shares personal experiences student achieves the required learning outcome
- Experiences are personal
- Mentoring relationship may be personal, IV. Research Joint Appointments
academic, orwork-related. - Is a formalized agreement between two
institutions where an individual holds a position
Preceptors in each institution and carries out specific and
- Willing to teach and learn skills defined responsibilities
- Expertise - The goal of this approach is to use the
- Competent practitioner implementation of research findings as a basis
- Teaching and support for improving critical thinking and clinical
- Orientation and Socialization decision-making of nurses
- Role Model - A formal agreement exists within the two
- Selected organizations regarding specific responsibilities
- Assigned to learner and the percentage of time allocated between
- Prepared for role each salary and Benefits are shared between the
- Competent practitioner two organizations
- Support needed from peers, educators,
manager V. CLINICAL SCHOOL OF NURSING MODEL
- Functional not intimate relationship - The concept of a Clinical School of Nursing is one
- May evaluate that Encompasses the highest level of academic
- Has set time limit and clinical nursing research and education.
- Termination date - The development of the Clinical School offers
- Assigned benefits to both hospital and university.
- Formalized orientation - It brings academic staff to the hospital, with
- Assists in fine tuning skills opportunities for exchange of ideas with clinical
- Offers suggestions nurses with increased opportunities for clinical
- Work-related focus nursing research.
- It has a fundamental importance and close link
MENTOR VS PRECEPTOR LEARNER OUTCOMES between the theory and practice of nursing at all
Mentors levels
- Self-actualization
- Guide to established own place in the VI. COLLABORATIVE CLINICAL EDUCATION MODEL
profession - In an effort to improve the quality of new
- Enhanced problem- solving graduate transition, Epworth Hospital and
- Personal satisfaction in sharing knowledge Deakin University ran a collaborative project
(2003) founded by the National Safety and
Preceptors
Quality Council to improve the support base for
- Bridge theory to practice gap.
new graduates while managing the quality of
- Achievement of planned learning outcomes
patient are delivery.
- Skills and knowledge
- Anxiety reduction
57
 - The collaborative clinical Education Epworth Stage 2 Storming
Deakin (CCED) model developed to facilitate: - Leader tries to persuade the team and may use
o Clinical learning “salesman” ad “nice guy” styles often struggling
o Promote clinical scholarship and to be a socio—emotional leader. Team
o Build nurse workforce capability members may demonstrate resistance. Despite
persistence of scapegoating among team
members, new roles that help reduce tension
may emerge.

Stage 3 Norming
- coalitions of member’s exercise leadership
based on previously demonstrated competence.
Members have evolved into colleagues who
were able to defer to each other’s relevant
experience.

Stage 4 Performing
- Authority is exercise by coalition of colleagues.
Team members exemplify interdependence.

Tools for Facilitating Health Care Team Work

There are three (3) broad sets of informal roles:
1. TASK ROLES
necessary for accomplishing the team’s task. These roles
are as follows:
- Initiating/energizing
- Information/opinion giving
- Information/opinion seeking
- Reality testing/clarifying
- Coordinating
- Orienting
- Procedural Technician

2. MAINTENANCE ROLES
which help the team function as a team. Maintenance
roles are:
- Harmonizing
- Gatekeeping
- Encouraging
- Following
- Climatizing
DEVELOPMENT OF TEAM WORK AND COLLABORATION
Stages of Team Development
3. INDIVIDUAL ROLES
Stage 1 Forming
in which a team member attempts to satisfy individual
- the leader may seek control over the team and
rather than team goals. A team is most productive when
exemplify styles such as “tyrant”,
all three (3) sets are managed simultaneous. Individual
“superwoman”, “party host”, or “reluctant
roles are:
candidate”, Members are also characterized by
- Blocking/Aggressing
dependency-seeking behaviors and will most
- Out of field
likely rely on the group leader. They may also
- Digressing
take on the roles of “scapegoat” and “helper’.
- Recognition seeking (Sullivan and Decker, 2009

58
 NURSE’S ROLE IN ESTABLISHING COLLABORATIVE - Context of understanding
RELATIONSHIP IN THE DELIVERY OF HEALTH CARE - Interpersonal needs
PROGRAMS AND SERVICES - Establishing personal identity
A. Maintains good interpersonal relationships intra-
agency and inter-agency. II. Interpersonal relationship for nurses
B. Respects the role of other team members. - Building a positive functional multidisciplinary
C. Acts as a liaison/advocate of the client during decision team
making by the inter-professional team. Interpersonal - Improving intra-and/or inter-team
Relationship Defined: communication, coordination and cooperation
- Building mutual understanding and cooperation
The term Interpersonal Relationships refers to reciprocal - Improved decision making and problem
social and emotional interactions between two or more
persons in an environment and who share common III. Interpersonal relationship for patients
interests and goals. - Developing a sense of security and comfort
- Fostering trust and cooperation
NURSE INTERPERSONAL RELATIONSHIP - Facilitating communication
• Doctor - Nurse relationship - Improving socialization
• Nurse – Patient relationship - Developing and maintaining positive feelings
• Nurse – Nurse relationship
TYPES OF INTERPERSONAL RELATIONSHIP
Dynamics of Interpersonal Relationship I. FRIENDSHIP
I. DYAD - Theories of friendship emphasize the concept as
- A Dyad consists of two interacting people a freely chosen association where individuals
- It is the simplest of the three interpersonal develop a common ground of thinking and
dynamics behaving when they enter into the relationship
- One Person relays a message and the other listen by including mutual love, trust respect and
- It is none of the most unstable interpersonal unconditional acceptance for each other.
dynamic. The interaction ends when one
constituent of the dyad refuses to listen or share II. LOVE
his or her message - A in formalized intimate relationship
- It is also one of the most intimate interpersonal characterized by passion, intimacy, trust and
dynamic as the focus of listening and respect is called love.
communication is centered on only one person - Individuals in a romantic relationship are deeply
attached to each other and share a special bond
II. TRIAD
- A triad consists or three interaction people. III. PLATONIC
- The members engage in the relay and reception - A relationship between two individuals without
of thoughts and ideas. feelings of sexual desire for each other is called
- It is more stable than the dyad as the third a platonic relationship.
members may act as a mediator when there is - In such a relationship, a man and a woman are
conflict between the other two. just friends and do not mix love with friendship.

III. GROUP IV. FAMILY

- A group consist of more than three members - Family communication patterns established
and is a collection of triads and dyads. roles and identify and enable personal and
- It is the most stable form of interpersonal social growth of individuals.
relationship - Family relationships can get distorted if there is
an unresolved conflict between member since
PURPOSES OF INTERPERSONAL RELATIONSHIP other family members have significant
I. Interpersonal relationship for an individual emotional difficulties but fails to bring them out
- Personal growth and development unless the physician or nurse enquires
- Source of enjoyment
- Sense of security
59
 V. PROFESSIONAL 4. Friendly Stranger Relationship
- Individual working for the same organization are - Is characterized by a formal exchange of
said to share a professional relationship and are information and a somewhat neutral feeling
called colleagues. tone.
- Colleagues may or may not like each other
5. Hostile / Adversarial Relationship
TYPES OF RELATIONSHIP AMONG HEALTH - Are marked by anger, verbal abuse, real or
PROFESSIONALS implied threats, or resignation
A. COMPLEMENTARY RELATIONSHIP
- One person is dominant and the other is
submission
- Control is not divided equally between the two
participants
- Relationship are stable and predictable also
inhibit creativity and independent thinking
o Physician
o Nurse

B. SYMMETRICAL RELATIONSHIP
- Control is more evenly distributed between the
two participants
- Free to express their opinions
- Power struggles occurs when participants
complete to acquire or give up control
o Both Dominant
o Both Submissive

C. PARALLEL RELATIONSHIP
- Control moves back and forth between the two
participants
- Participant take turns holding and giving
control, depending on the circumstances, rather
than competing for control
- Effective and flexible communication
o Nurse / Physician

5 TYPES OF NURSE-PHYSICIAN RELATIONSHIP

1. Collegial Relationships
- Characterized by equal trust, power, and respect
are illustrated by the following excerpt

2. Collaborative Relationship
- Marked by mutual trust, power, respect

3. Student – Teacher Relationship

- Either the physician or the nurse can be the
teacher.
- Physicians who teach are identified as having a
lot of knowledge and “always willing to explain
or teach

60
 COURSE UNIT 8 8. It increases employee involvement and
improves communication.
NURSING MANAGEMENT FUNCTIONS 9. It is cost effective.
THE MANAGEMENT PROCESS
IMPORTANCE OF PLANNING
PLANNING
1. Leads to achievement of goals and objectives.
- defined as pre determining course of action in
2. Gives meaning to work.
order to arrive at a desired result.
3. Provides for effective use of available resources
- the most basic and essential activity of
and facilities.
management functions that decide in advance
4. Helps in coping with crisis.
what needs to be done for the day, month, or
5. Cost - effective
years ahead.
6. Based on facts and future activities
- Defined as deciding in advance what to do; who
7. 7.Leads to realization of the need for change
is to do it; and how, when and where it is to be
8. Planning improves communication and team
done.
collaboration through people involvement in
planning activities.
Henri Fayol (1841-1925)
9. Provides basis for control.
- The first element of management defined by
10. Necessary for effective control.
Henry Fayol is planning in which he defines as
making a plan of action to provide foreseeable
PRINCIPLES OF PLANNING
future.
1. Planning is always based & focused on the
- According to him that plan must have unity,
vision mission, philosophy, and clearly
continuity, flexibility, and precision. The plan
2. defined objectives of organization.
should be included annual and 1o year forecasts,
3. Planning is a continuous process
taking advantage of input of others. Planning
4. Planning should be pervasive.
improves experience, gives sequence in activity,
5. Planning utilizes all available resources
and protects business against undesirable
6. Must be precise in its scope & nature
changes. Planning facilitates the art of handling
7. Should be time bound
people.
8. Projected plan must be documented
- Planning is designed for the nurse administrators
who are seeking more effective means of
SCOPE OF PLANNING
improving current and future performance. It
Top Management
offers principles of planning and decision-making
- set the overall goals and policies of an
guides in nursing practice. It deals with those
organization
aspects of planning that directly affects the nurse
administrators on a personal as well as
Middle Management
organizational level.
- direct the activities to actually implement the
broad operating policies of the organization
PURPOSE OF PLANNING
such as staffing delivery service to the units.
1. Planning increases the chances of success.
2. It forces analytic thinking and evaluation of
Lower or First level Management
alternatives
- do the daily or weekly plans for the
3. It establishes a framework for decision making
administration or direct patient care in their
that is consistent with top Management
respective unit.
objectives.
4. It orients people to action instead or reaction.
MAJOR ASPECTS OF PLANNING
5. It includes day-to-day and future-focus
1. Planning should contribute to objectives.
managing.
2. Precedes all other processed of management.
6. It helps to crisis management and provides
3. Planning pervades all level
decision-making flexibility.
4. Planning should be efficient
7. It provides a basis of for managing
organizational and individual and individual
performance.

61
 CHARACTERISTICS OF A GOOD PLAN MODES OF PLANNING
• Have clearly worded objectives 1. Reactive Planning – occurs after problem exist.
• Guided by policies and procedures Problems are dealt with separately w/o
• Indicate priorities integration with the whole organization.
• Develop action that are flexible and realistic 2. Inactivism – seek status quo and they spend
• Develop logical sequence of activities their energy preventing change and maintaining
• Include practical methods for achieving conformity.
objectives 3. Preactivism – utilize energy to accelerate
• Pervade whole organization change and are future oriented.
4. Interactive or Proactive – consider the past,
BASIS IN PLANNING THE NURSING SERVICE present and the future and attempt to plan the
A. Forecasting future of their organization rather than react to
- it helps managers look into the future, including it.
the environment in which the plan will be
executed. TYPES OF PLANNING
- The hospital, this includes the type of hospital Strategic Planning
served (level 1, level 2, level 3, or level 4); the - Is a broad continuous systematic process that
kind of service it offers (general or special) its emphasizes assessment of the organizational
philosophy mission and goals and categories of environment both internally and externally such
their budget (national or local). as economic, political, social, and technological
- The community it serves, this includes the kind of factors.
people served their needs, expectations, literacy - It is a management tool that helps organizations
rate, economic levels, employment rates, set long-term goals, a risk-taking decision with
demographic statistics, cultural values, values knowledge of their effects in the future, and
and services available in the community. evaluating the outcomes through reliable
- The goals of care, vary according to the needs of feedback mechanism.
the community, agency, trends in technology - It focuses on performance improvement and
and in changing needs of the community, agency, utilizes strategies to accomplish the
trends in technology and in changing concepts of organization’s desired outcomes
the nurses’ roles and functions. - Strategic planning forecasts the future success of
an organization by matching and aligning an
B. Setting the Vision, Mission, Philosophy, organization’s capabilities with its external
Goals and Objectives opportunities. An organization could develop a
• Mission – statement outlines the agency’s strategic plan for dealing with the nursing
reason for existing, who the target clients are shortage, preparing succession managers in the
and the services will be provided. organization, developing a marketing plan,
• Vision – statement outlines the organization’s redesigning workload, developing partnership,
future role and function. It gives the agency or simply planning for organizational success.
something to strive for.
SWOT Analysis
• Philosophy – is a statement of beliefs and values
- One effective tool that can assist in strategic
that direct one’s life or one’s practice.
planning is SWOT analysis (identification of
• Goals – are broad statements or objective that is
strengths, weakness, opportunities, and threats)
expected to be achieved.
is one of the most commonly used in health care
• Objectives – are the action commitments
organizations. SWOT analysis is also known as
through which an organization’s mission and
TOWS analysis was developed by Albert
purpose will be achieved and philosophy or
Humphrey at Stanford University in the 1960s
belief sustained.
and 1970s.
- The first step in SWOT analysis is to define the
C. Developing and Scheduling programs
desired end state or objective. After the desired
PLANNING FORMULA
objective defined, the SWOT are discovered and
o Who? What? Where? When? Why?
listed. Decision makers must then decide if the
How?
objective can be achieved in view of the SWOTs.

62
 If the decision is no, a different objective is 5-year Development Plan
selected and the process repeats. With the
results of your analysis the following should be
included:
1) working out what you hope to achieve,
2) being objective,
3) incorporating the findings into the action plan,
and 40 revisiting your findings on a regular basis.
Operational Planning
- Perform correctly, SWOT allows strategic - Is a detailed work plan or written blueprint in
planners to identify those issues most likely to which the objectives of a nursing
impact a particular organization or situation in unit/department are put into measurable
the future and then to develop an appropriate actions?
plan of action - It is known as a management plan.
- Some categorical areas for objectives are:
patient satisfaction, patient safety, internal
process, staffing, training and education,
research, and financial.
- It includes the what (task to be undertaken), who
(person responsible), when (timeline for task
completion), and how much (amount of financial
resource to carry out the task).

Operational Plan

Difference between the strategic planning and

operational planning.
Strategic Planning as Management Process Basic of Strategic Operational
1. Clearly define the purpose of the organization. Comparison Planning Planning
2. Establish realistic goals and objectives consistent Scope General plan Specific plan
with the mission of the organization. Time Frame 3-5 years 1 year
3. Identify the organization’s external
Focus Goal Setting Detailed
constituencies or stakeholders and then
process Information
determine their assessment of the organization’s
Goal/Objective Broad Specific
purposes and operations.
Responsibility Top Middle & Line
4. Clearly communicate the goals and objectives to
Management Management
the organization’s constituents.
Approach Downward Upward
5. Develop a sense of ownership of the plan.
6. Develop strategies to achieve the goals.
D. Establishing Nursing Standards, Policies,
7. Ensure that the most effective use is made of the
and Procedures
organization’s resources.
8. Provide a mechanism for informed change as - Nursing Standards Institutions develop their own
standards of nursing practice, the standard of
needed.
Nursing Practice and Nursing Service
9. Provide a mechanism for informed change as
Administration formulated by the Association of
needed.
10. Build a consensus about where the organization the Nursing Service Administrators of the
Philippines and revised 2008.
is going.
- The established standards in an evaluation
provides professional desirable norms against
which department’s performance can be
63
 measured. Areas of improvement are identified Movement
and a plan of action to correct is made and - change agent must identifies, plans, and
implemented. implements appropriate strategies, ensuring
driving forces exceed restraining forces.
- NURSING STANDARDS, the philosophy shall be
based on the belief that the client is integral
Refreezing
whole and that he is a unique individual with
- during this phase the change agent assists in
needs that can be met through nursing
stabilizing the system change so that it becomes
interventions.
integrated into the status quo. For this to occur,
the change agent must be supportive and
- NURSING SERVICE POLICIES are plans reduced to
reinforce the individual adaptive behavior efforts
statements or instructions that direct
of those affected by the change, (Marquis and
organizations in their decision making. It direct
Houston, 2017).
individual behavior toward the organization’s
mission and define broad limits and desired
BUDGET
outcomes of commonly recurring situations
- Annual operating plan
while leaving some discretion and initiative to
- Financial “road map” and plan
those who must carry out that policy.
- Estimate of future costs
- Plan for utilization of capital in the operating
- POLICIES may also be implied or expressed.
programs
Implied policies neither written nor expressed
- A financial plan that includes estimated expenses
verbally, have usually developed overtime and
as well as income for a period of time,
follow a precedent.
- While expressed policies are delineated verbally
NURSING BUDGET
or inwriting. Most organizations have many
- is a plan for allocation of resources based on
written policies that are readily available to all
preconceived needs for a proposed series of
people and promote consistency of action.
programs to deliver patient care during one fiscal
year.
- PROCEDURES are plans that establish customary
or acceptable ways of accomplishing a specific
HOSPITAL BUDGET
task, and delineate a sequence of steps that
- is a financial plan to meet future service
required action. Procedures identify the process
expectations. Budgeting translate these needs to
or steps needed to implement a policy and are
manpower, equipment and supplies so that both
generally found in manuals at the unit level of
services are provided at the highest level of
the organizations, (Marquis and Huston, 2017).
quality at a minimum cost.
- Guidelines outlining the scope and standards of
practice for specialty practice areas.
TYPES OF BUDGET
PERSONNEL BUDGET
- In the mid-20th century Kurt Lewin (1951)
- It is the type of budget affected by personnel
developed change theory, identified 3 phases in
policies such as salary related to position and
which the change agent must proceed before a
number of days allowed for educational and
planned change becomes part of the system:
personal leave.
o Unfreezing
o Movement OPERATING OR REVENUE AND EXPENSE BUDGETS
o refreezing. - This includes the daily revenues and expenses
to operate the health care institution
Unfreezing - It deals primarily with salaries, supplies, and
- this occurs when the change- agent convinces contractual services.
members of the group. To change or when guilt,
CAPITAL EXPENDITURE BUDGETS
anxiety, or concern can be elicited. Change agent
- Related to long range planning
needs to have made a thorough and accurate
- Include physical changes such as replacement,
assessment of the extent of and interest in
or expansion of the plant, major equipment and
change, for them to become effective as change
inventories
agent.
64
 CASH BUDGET Phase 3 Approval and Execution
- Plan to make adequate funds available as needed 1. Summarized the proposed nursing service
and to use an extra fund profitably. budget plan and let the authorize finance budget
committee to review and approve the budget.
FLEXIBLE BUDGET 2. Make a budget plan ready for improvement in
- budgets that adjust automatically over the order to calibrate any errands to the General
course of the year depending on variables such Appropriations Act (GGA).
as volume of labor costs and capital 3. Cascade the proposed budget plan accordingly to
expenditures. all nursing unit staff and department.

PURPOSE OF BUDGETING Phase 4 Monitoring and Reporting

1. A forecast of income and expenditure 1. Observe the proper delivery or implementation
2. A tool for decision making, to provide financial of the budget plan.
framework 2. Make an analysis between the proposed budget
3. Measured the financial report and its statistical and the actual performance.
data. 3. Clarify and justify the results to determine the
significant trends
IMPORTANCE OF BUDGET 4. Ready to make an adjustment based on the
- To control the over spending of the Nursing required needs.
services. Budgeting helps you control the 5. Present the financial report according to
spending beyond the means in related to nursing hospital policy.
activities.
- To monitor income and expenses of the Nursing PRE-REQUISITES FOR BUDGETING
services. Budgeting helps you keep on track of 1. Sound organizational structure with clear lines of
the income and expenditures of the Nursing authority and responsibility is needed.
services. 2. Non monetary statistical data – such as number
- Rationalization of the financial transparency and of admission, average length of stay, percentage
accountability of the Nursing services. Budgeting of occupancy and number of patient days – are
gives you a precise report summary of the used for planning and control of the budgetary
financial responsibilities. process.
3. Chart of accounts are designed to be consistent
BUDGETING PROCESS with the organizational plan.
Phase 1 Gathering Data 4. Managerial support is essential for a budgetary
- Study the overall past performance based on program.
proposed goal. 5. Formal budgeting policies and procedures should
- Gather environmental information be available in the budget manual.
- Regulates the overall expenses and revenues
from the past reports to present based on FACTORS IN BUDGET PLANNING
proposed budget. 1. Type of patient and the length of stay in the
hospital.
Phase 2 Planning 2. Bed capacity and hospital size
1. Create a Budget Committee 3. Physical plant of the hospital, design and the
2. Set Objectives based on strategic goals size of the wards/unit and other treatment
3. Establish a program or project for future goals rooms.
4. Formulate a budget guideline to synchronize 4. Personnel policies.
with financial linkages 5. Grouping of patients
5. Settle an Operating and Capital Budget 6. Standard of Nursing Care
6. Manage a budget hearing 7. Method of performing nursing care
7. Prioritize your budget based on necessity 8. Method of documentation
8. Conclude your proposed budget plan 9. Proportion of nursing care providers
(professional / non-professional)
10. Amount and quality of supervision available and
provided

65
11. Competencies of job description and TIME MANAGEMENT
qualification - It is a technique for allocating one’s time through
12. Method of patient assignment the setting of goals, assigning priorities, and
13. Amount and kind of labor-saving devices and identifying and eleminating wasted time, and
equipment using managerial techniques to reach goals
14. Amount of centralized service provided efficiently.
15. Nursing service requirement ancillary
departments …..One of the strategies in managing the time is
16. Reports required by administration learn to prioritize duties, managing and
17. Affiliation of nursing students or medical controlling crisis, reducing stress and balancing
students work and personal time, (Marquis and
Houston,2017).
BUDGETING METHODS
• INCREMENTAL BUDGETING – simplest method …nothing is particularly hard if you divide it into
for budgeting. Since the budget for the next small jobs.
coming year may be projected, the programs - Henry Ford
and services were not prioritized.
• ZERO-BASED BUDGETING – the method does …things which matter most must never be at
not automatically claim to be funded. A set the mercy of things that matter least.
funding priority is the main purpose of this - Johann Wolfgang von Goethe
method.
• FLEXIBLE BUDGETING – this method calculates Time Management Principles
what the expenses should be specified in the a. Planning anticipates the problem that arise from
program actions without thought.
• PERFORMANCE BUDGETING – emphasizes the b. Tasks to be accomplished should be done in
outcomes and results instead of activities and sequence and should be prioritized
outputs. c. Setting deadlines in one’s work and adhering to
them is an excellent exercise in self-discipline.
FACTORS IN DETERMINING BUDGETARY d. Deferring, postponing, or putting off decisions,
REQUIREMENT actions, or activities can become a habit which
- Asses the appropriate provision in the current oftentimes causes lost opportunities and
General Appropriation Act. productivity, generating personal or interpersonal
- Associate the sources of funds (General, crises.
national, city, municipal…) e. Delegation permits a manager to take priority for
- Evaluate the current appropriations and actual decision making and to assign tasks to the lowest
expenditures for the current year. possible consistent with his/her judgement, facts,
- Analyze the projected changes in other and experience, (Venson, 2016).
department that will affect the nursing service
budget. TIME-SAVING TECHNIQUES, DEVICES, AND METHODS
- Consider the required expenditures, supplies, TO BETTER USE OF TIME
equipment and material, repair and replacement 1. Conduct an inventory of your activities
for the next coming year. 2. Set goals and objectives and write them down.
- Projects the estimated personnel salaries and 3. With the use of calendars, executive planners,
benefits including their unusual leaves. logs or journals, write what you expect to
- Assess the cost of Human Resource accomplish yearly, monthly, weekly or daily.
Development and Research Programs. 4. Break down large projects into smaller parts.
- Render this information into peso and submit the 5. Devote a few minutes to concentrate on one
official forms to the Medical Center Chief for thing at a time.
approval and inclusion in the general budget. 6. Organize your work space so it is functional.
7. Close your door when you need to concentrate.
8. Learn to delegate.
9. In a meeting, define the purpose clearly before
starting.

66
 10. Take or return phone calls during specified time. - Understanding the organizational structure as a
Develop effective decision-making skills. Do no whole facilitates the development of roles and
afraid to say “no”. relationships to enable the achievement by
11. Take rest breaks and make good use of your goals.
spare time
SETTING UP THE ORGANIZATION STRUCTURE MAY
Three Steps to Time Management ACHIEVE IT’S PURPOSE:
a. Allow time to planning and establish priorities. - 1. It informs members of their responsibilities so
b. Complete the highest task whenever possible and that they may carry them out
finish one task before beginning another. - 2. it allows members and the individual workers
c. Reprioritize based on the remaining tasks and on to concentrate on his/her specific role and
new information that may have been received. responsibilities
- 3. it coordinates all organizational activities so
ORGANIZING there is minimal duplication of effort or conflicts.
ORGANIZATIONAL THEORY AND BUREAUCRACY - 4. it reduces the chances of doubt and confusion
- Max Weber is known as the father of increasing assignments.
organizational theory. According to him, - 5. Avoids overlapping of functions because it
bureaucracy is an institutional method for pinpoints responsibilities.
applying general rules to specific cases, making - 6. Shows to whom and for whom they are
the actions of management fair and predictable. responsible.
- Other individuals that the nurse may need to be
Characteristics of bureaucracy are the following: accountable to include the immediate
- There must be a clear division of labor. supervisor, the patient and family, central
- A well-defined hierarchy of authority must exist administration, and the physician because all of
which separates the superiors from them participate in the nurse’s work.
subordinates.
- There must be impersonal rules and TYPES OF ORGANIZATION CLASSIFIED BY NATURE OF
impersonality of interpersonal relationships. AUTHORITY
- A system of procedures for dealings with work Line Organization
situations must exist. - the simplest and most direct type of organization
- A system of rules covering the rights and duties in which position has general authority over the
of each position must be in place. lower positions in the hierarchy
- Selection for employment and promotion is - Line of authority flows from top to bottom
based on technical competence.
Informal Organization (Flat/ Horizontal)
ORGANIZING - refers to horizontal relationships rather than
- is the process of establishing formal authority. It vertical. This is composed of small groups of
involves setting up the organizational structure workers with similar interest.
through identification of groupings, roles and
relationships, determining staffing patterns and Staff Organization
distributing in the various areas as needed. - is purely advisory to the structure with no
authority to put recommendations into action.
ELEMENTS OF ORGANIZING
- The elements of organizing include setting up the ORGANIZATION
organizational structure, staffing, scheduling, - consists of the structure and process which allow
and developing job descriptions. the agency to enact its philosophy and utilize its
conceptual framework to achieve its goals. It
SETTING UP THE ORGANIZATIONAL STRUCTURE refers to a body or persons, methods, policies
- The creation of an organizational system and procedures arranged in a systematic process
compatible with the philosophy, conceptual through the delegation of function and
framework, and goals of the organization responsibilities
provides the means for the accomplishment of
an organization’s purpose.
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 Functional Organization 3. Type of Work to be Performed
- is one where unit is responsible for a given part - indicated by labels or descriptions for the boxes
of the organization with workload. 4. Grouping of work Segments
- Ex: All Standing and Ad Hoc Committees - shown by the clusters of work groups
(departments or single units).
ORGANIZATIONAL CHART 5. Levels of Management
- is a line drawing that shows how the parts of an - indicate individual and entire management
organization are linked. It depicts the formal hierarchy.
organizational relationships, areas of
responsibility, persons to whom one is KINDS OF ORGANIZATIONAL CHART
accountable and channels of communications - Structural chart shows the various components
of the organization and outlines the basic
interrelationships.
There are two lines in the organizational chart
- a. Unbroken Solid lines are classified into two: - Functional chart reflects the functions and
The solid horizontal lines represent duties of the components of the organization
communication between people with similar and indicates the interrelationships of these
sphere of responsibility and power but different function.
functions.
- The solid vertical lines between positions denote
the official chain of command and formal path of
communication and authority

- b. Dotted or broken lines -represents staff

position. Staff member provides information and
assistance to the manager but has limited
organizational authority.
- It also provides for specialization but does not
have legitimate authority as it acts in an advisory
capacity. - Position chart specifies the names, positions,
and titles or ranks of the personnel.

ORGANIZING PRINCIPLES
1. UNITY OF COMMAND
- employee should be responsible to only one
CHARACTERISTICS OF AN ORGANIZATIONAL CHART superior.
1. Division of Workbox
- represents the individual or sub-unit responsible 2. Scalar Principle/ Hierarchy / Chain of Command
for a given task of the organizations work load - authority and responsibility should flow in clear
2. Chain of Command unbroken lines from highest executive to the
- lines indicate who reports to whom and by what lowest.
authority

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 The following must be observed: ORGANIZATION OF THE NURSING SERVICE/DIVISION:
- when the job was given to a subordinate, he/she - The nursing service as an organization
is responsible over resources needed to constitutes the single largest group of hospital
accomplish the task. employees responsible of setting standards for
- though a particular function is being given to a safe nursing practice, providing quality care to
subordinate, the responsibility of the superior is the patients, and coordinating its services with
not being diminish. the various divisions/departments/services in
- when the subordinate was given responsibility , the hospital and community
he is accountable for his own actions to his/her - The Nursing service/division is administered by
superior. the Chief Nurse. under her. In specialty hospital
such as:
3. Homogenous assignment or Departmentalization
o Lung Center of the Philippines
- grouping together of employees with similar
o National Kidney Transplant Institute
assignments.
o Philippines Children’s Medical Center =
4. Span of control the heads of the Nursing Department are
- the number of workers that a supervisor can Called Department Managers. They still
effectively manage should be limited, depending have a Chief Nurse under them.
upon the pace and pattern of the working area. o PGH -Asst. Director for nursing
5. Exception Principle
- recurring decisions should be handled in a THE CHIEF NURSE
routine manner by lower level managers - Is directly responsible to the chief of the hospital
whereas problems involving unusual matters or medical center chief.
should be referred to the higher level. - Assisted by an assistant chief nurse.

6. Decentralization or Proper Delegation of Authority SUPERVISING NURSE

- is the process of pushing decision making to the - In charge of two or more nursing units.
lower levels of the organization.
7. The Principle of Requisite Authority. HEAD NURSE OF SENIOR NURSE
- When a particular task is delegated to a - Responsible for the management of a nursing
subordinate, the latter must also be given unit.
authority over resources needed for task
accomplishment. STAFF NURSE
- Provides direct patient care and are assisted by
8. The Principle of Organizational Centrality. nursing attendants
- Nursing personnel interact with the greatest
number of other healthcare workers, receive the NURSING ATTENDANTS
greatest amount of workrelated information and - Performs simple, routine tasks for which they
become most powerful in organizational have been trained.
structure.
9. The Principle of Esprit d’ Corps.
- This means teamwork and implies that in unity, FORMS OF ORGANIZATIONAL STRUCTURE
there is strength. 1.Traditional Hierarchical Structure (tall, centralized,
bureaucratic)
- This is commonly called line structure. Authority
and responsibility are clearly defined leading to
simplicity of relationships. This is associated with
the principles of command, vertical control and
coordination levels, and downward
communications.

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 MERITS OF LINE ORGANIZATION
- 1. Simplest
- 2. Unity of Command
- 3. Better discipline
- 4. Fixed responsibility
- 5. Flexibility
- 6. Prompt decision

ORGANIZATIONAL CHART OF A NURSING SERVICE

SHOWING SEVERAL LAYERS OF POSITIONS BETWEEN
CHIEF NURSE AND NURSING STAFF.

ORGANIZATIONAL CHART USING THE TITLES OF PATIENT

CARE ADMINISTRATOR AND COORDINATOR

2. Decentralized (flat, horizontal, participatory)

- The authority is shifted downwards to its
divisions, services, and units. The decision
making can occur where the work is being carried
out, thereby professionals who do the job can
participate in managing the organization.

3. Matrix
- This is designed to focus on both the product and
function. The manager of the unit responsible for
a service report both to a functional and product
manager.

4. Hybrid
- A term applied to organizational structure that
operate with characteristics of different types of
structures.

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 COURSE UNIT 9 PATIENT CARE CLASSIFICATION SYSTEM
- Is primary developed to determine workloads
STAFFING requirements and staffing needs. It is
- process of determining and providing the
categorizing patients on the basis of certain
acceptable number and mix of nursing personnel
needs that can be clinically observe by the nurse.
to produce a desired level of care to meet
It is a method of grouping patients according to
patient’s demand.
the amount and complexity of their nursing care
requirements and nursing time and skill they
FACTORS AFFECTING STAFFING
require.
1. Patient Factors
- Census fluctuations
Nursing care hours per patient per day according to
- Patient acuity
classification of patients by units
- Level of care/degree of dependence
- Patient age group
- Special treatment and procedure
- Communicability
- Rehabilitation
- Patient and family care demands/expectations

2. Staff Factors
- Number of nursing staff available PATIENT CARE CLASSIFICATION SYSTEM
- Ratio of professional to non-professional Level I
- Number of leaves - Patients that can do self care or minimal care
- Turn-over rate - Non-emergency
- Span of supervision - Requires little treatment
- NCH 1.5 hours/day
3. Nursing service factors - P:NP Ratio: 55:45
- Nursing care modality in use
- Type of services/patient classification system Level II
- Patterns of work schedule - Moderate or intermediate care
- Training and staff development programs - Requires periodic assessment and treatment
- Research activities - NCH is 3hours/day
- P:NP ratio: 60:40
4. Health care organization factors
- Type of hospital Level III
- Services offered/population served - Total, Complete or Intensive Care
- Work time policy - Completely dependent on the personnel for care
- Administrative policy on weekend and holiday - NCH is 6hours/day
duty - P:NP ratio: 65:35 P
- Presence of support services
- Nursing unit architectural design Level IV
- Availability of resources like equipment, - Highly specialized Critical Care
materials and supplies - Requires the maximum nursing care
- Technology anticipated - Continuous assessment, treatment and
- Projected units of services evaluation
- Budget limitations - NCH 6-9hours/day
- P:NP ratio is 70:30 to 80:20

REPUBLIC ACT 5901

Forty Hour Week Law
- Hospital employees working in = or > 100 bed
capacity will work 40 hrs/week
- If it is < 100 bed capacity 48hrs/week

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 Number of working and non-working days and hours number of patients according to the level of
of nursing personnel per year percentage of patients at each level of care.
(whether minimal, intermediate, intensive or
highly specialized)

PERCENTAGE OF PATIENTS IN VARIOUS LEVELS OF

CARE

Relievers Needs
Compute for relievers needed, the following should be
considered:
1. Average numbers of leaves taken each year----------- 15
a. Vacation Leave------------------------------------------------10 1. Categorize the Patients According to levels of care
b. Sick Leave--------------------------------------------------------5 needed.
2. Holidays---------------------------------------------------------12 Ex: Personnel needs for
3. Special Privileges as per CSC MC #6s. 1996--------------3 - 250 patients in a tertiary hosp.
4. Continuing Education Program for Professionals-------3 - 250(pts) x .30 = 75 patients needing minimal care
Total Averages Leaves------------------------------------------33 - 250(pts) x .45 = 112.5 patients needing moderate
care
To determine the relievers needed, divide 33 (the - 250(pts) x .15 = 37.5 patients need intensive care
average number of days an employee is absent per year) - 250(pts) x .01 = 25 patients need highly
by the number of working days per year that each specialized nursing care for 250
employee serves (whether 213 or 265).
2. Find the total number of Nursing care hours needed
This will be 0.15 per person who works 40 hours per week by the patients at each category level.
and 0.12 per person for those working 48 hours per - a. Find the number of patients at each level by
week. the average number of nursing care hours
needed per day
Multiply the computed reliever per person by the - b. Get the sum of the nursing care hours needed
computed number of nursing personnel. This will give the at the various levels.
total number of relievers needed.
Categories or levels of care of patients, nursing care
DISTRIBUTION BY SHIFTS hours needed for patient per day and ratio of
Morning shift (6-2) professionals to non-professionals
- Needs 45-51% of nursing personnel

Afternoon shift (2-10)

- 34-37%

Night Shift (10-6)

- 15-18%

STAFFING COMPUTATION FORMULA

Staffing Formula - 75 pts x 1.5 (NCH needed at level I) = 112.5
- To compute for the staff needed in the In-Patient NCH/day
unit of the hospital the following steps are - 112.5 pts x 3 (NCH needed at level II) =337.5
considered: NCH/day
- Categorize the number of the patients according - 37.5 pts x 4.5 (NCH needed at level III) =168.75
to the levels of care needed. Multiply the total NCH/day
72
 - 25 pts x 6 (NCH needed at level IV) = 150 - An adequate mix of nurses and nursing
NCH/day attendants
- Total 768.75NCH/day - education, training and experiences.
- Afternoon and night shift requirements for the
3. Find the total NCH needed by 250 patients per year staff are usually lower than in the morning shift.
- 768.75 x 365 (days/year) =280,593.75 NCH /year - lower staff requirements on Saturdays and
Sundays since there are lesser medical rounds,
4.Find the actual working hours rendered by each fewer medical orders and lower patient census.
nursing personnel per year - schedules for holidays are staggered at least
- 8 (hours/day) x 213 (working days/year) = 1,704 once a month. Vacations, whether forced or
(working hours /year) requested,
- Long stretched of consecutive working days
5. Find the total number of nursing personnel needed. - Busy units may require additional help.
a. Total NCH per year = 280,593.75 - Unscheduled absences may require a staff to be
- 1704 pulled out from her regular area
- = 165 working hrs/year - Job dissatisfaction and high turnovers rates.

b. Relief x total Nursing Personnel = 165 x .15 = 25 ASSESSING A SCHEDULING SYSTEM

Scheduling may vary from agency to agency, but the
c. Total Nursing Personnel needed 165+25= 190 scheduling system must function smoothly in terms of:

6. Categorize according to professional and non- 1. Ability to cover the needs of the unit a minimum
professional personnel. Ratio professional to non- required number of staff must meet the nursing needs of
professional in a tertiary hospital is 65:35 the patients in the units at all shifts:
- 190 x .65 = 124 professional nurses
- 190 x .35 = 66 nursing attendants 2. Quality to enhance the nursing personnel’s knowledge,
training and experience While permanent assignment to
7. Distribute by shifts one unit enhances skills in caring for a particular kind of
- 124 Nurses x. 45 = 56 nurses on AM shift patient (whether obstetrical, medical, surgical or
- 124 nurses x .37 = 46nurses on PM shift pediatrics), many nurses who have future plans of going
- 124 nurses x .18 = 22 nurses on night shift into teaching, or specialization or even working abroad,
- Total 124 nurses would prefer to experience being assigned to various
units before settling down to a particular unit of their
- 66 Nsg attendant x .45 = 30 Nsg attendants on choice:
AM shift
- 66 Nsg attendants x .37 = 24 Nsg attendants on 3. Fairness to the staff All nursing personnel should get a
PM shift fair share of weekends, holidays offs, rotation patterns
- 66 Nsg attendant x .18 = 12 Nsg attendants on for the whole year including assignment to “difficult” or
night shift “light” or “undesirable” units or shifts:

SCHEDULING 4. Stability The nursing personnel would like to know in

- A schedule is a timetable showing planned work advance their schedule of assignment so that their
days and shifts for nursing personnel. personal schedules (whether at home, social and civic
- The objective in scheduling is to assign working responsibilities are in harmony with each other: and
days and days-off to the nursing personnel so
that adequate patient care is assured. 5. Flexibility the ability to handle changes brought about
by emergency leaves, scheduled or unscheduled leaves
FACTORS CONSIDERED IN MAKING SCHEDULES of absences.
- different levels of the nursing staff: adequate
coverage for 24 hours, seven days a week:
- staggered vacations and holidays: weekends:
- long stretches of consecutive working days:
evening and night shifts: and floating.

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 TYPES OF SCHEDULING
1. Centralized Schedule
- One person, usually the Chief Nurse or her
designate, assigned the nursing personnel to the
various units of the hospital. This includes the
shifts on duty and off-duty.

2. Decentralized Schedule
- shift and off-duties are arranged by the
Supervising Nurse or Head or Senior Nurse of the
particular unit.

3. Cyclical Schedule
- covers a designated number of weeks called the
cycle length and is repeated thereon. It assigns
the required number of nursing personnel to
each nursing unit consistent with the unit’s
patient care requirements, the staff’s
preference, their education, training and
experience.

The following scheduling variables should be

considered:
a. length of scheduling period whether 2 or 4 weeks;
b. shift rotation;
c. week-ends off;
d. holidays offs;
e. vacation leave;
f. special days (birthdays, wedding anniversary, etc);
g. scheduled events in the hospital, training programs,
or meetings;
h. job categories;
i. tardiness and;
j. continuing professional education (CPE) programs.

ADVANTAGES OF CYCLICAL SCHEDULE

- It is fair to all. Favoritism is minimized as all
nursing personnel get their fair share of rotation
to the various shifts.
- It saves time as the schedule does not have to be
redone every week or two.
- It enables the employees to plan ahead for their
personal needs preventing frequent changes in
schedule.
- Scheduled leave coverage such as vacation,
holidays and sick leaves are more stable.
- Productivity is improved.

74
 COURSE UNIT 10 ACTION RESEARCH
- In the health Care settings, the leadership,
APPLICATION OF RESEARCH IN NURSING interpersonal, and management skills needed to
LEADERSHIP AND MANAGEMENT manage such change effectively within multi-
RESEARCH professional in a variety of health care settings. It
RESEARCH provides unique use of action research as a
- helps nurses determine effective best practices model for planning and implementing change at
and improve patient care. the patient-service interface.
- helps nursing respond to changes and challenges
in the healthcare environment, individual, Example of Action Research that can be applied with
family, patient and group populations and Nursing leadership and Management.
government regulations.
Work-based learning: a leadership development
Nursing research is: example from an action research study of shared
- systematic inquiry designed to develop governance implementation
knowledge about issues of importance to nurses,
including nursing practice, nursing education, Tracey Williamson
and nursing administration.
Polit and Beck (2006) Affiliations expand, PMID: 16238690 DOI:
10.1111/j.1365-2934.2005.00576.x
- In this complex world of 21st century, the role of
nurse continuously evolved significantly. Abstract Aim:
- An empowering action research study was
- Though each role carries different undertaken to evaluate and strengthen the
responsibilities, the primary goal of a implementation of shared governance. One aim
professional nurse remains the same: to be the was to identify factors that acted as aids or
client's advocate and provide optimal care on the barriers to effective decision-making by clinical
basis of evidence obtained through research. leaders. As a work-based learning approach,
action research was expected to lead to
PATIENT SATISFACTIONS integration of learning into practice by
- is an important and commonly used indicator for researcher and participants alike.
measuring the quality in health care.
- affects clinical outcomes, patient retention, and Background:
medical malpractice claims. - Shared governance replaces traditional
- It affects the timely, efficient, and patient hierarchies and requires and develops clinical
centered delivery of quality health care. leaders. Strategies are needed to maximize
learning from introduction of such initiatives at
Researches helps improve client satisfaction. the individual, group and organizational level.
- Researchers demonstrated that there are
differences in satisfaction levels among different Methods:
genders. - Participant-observations and interviews were
- To explore further the reasons for these undertaken with shared governance council
differences, a research made it separated to members from one model in north-west
compare the specific causal links between the England.
two gender samples and to draw broader
inference from the results. Results:
- Some findings provide support for the - Leadership skills and knowledge and shared
application of CS study to derive customer governance practices were significantly
knowledge, which also reveals some interesting enhanced. Preparation for council roles was
suggestions for future research. considered inadequate. Increased structured
time for reflection and action planning was
indicated.

75
Conclusions: 6. Design the study.
- Implementation of shared governance has a. Choose a research design (cross-
succeeded in developing leadership capacity. sectional, cohort, or correlation, for
Evaluation findings have led to improvements in example).
the overall shared governance model. Action b. Determine setting, sample size,
research has been found to have great utility at recruitment strategy, randomization (if
optimizing work-based learning. Nurse appropriate), instruments, data analysis,
Managers need to develop their coaching and and procedures.
facilitating skills and recognize there is no "quick c. Ensure protection of human subjects
fix" for developing clinical leaders. Implications (submit plan for institutional review
include the need to support learners in board approval).
identifying and implementing changes arising 7. Collaborate with stakeholders at the setting to
from work-based learning activities, the minimize disruptions and obtain support.
significant resource implications and the need to 8. Carry out the study.
optimize the organizational climate if work- 9. Analyze the results.
based learning approaches to leadership and 10. Relate the findings to plans for a future study.
management development are to succeed. a. Do results suggest it is worthwhile to
pursue the study as planned?
FEASIBILITY b. Do results provide data suggesting it
- can provide such data and this can validate study would be important to modify aspects of
procedures or identify procedures in need of this study to improve the anticipated
revision. larger study?
c. Do results provide the data needed to
Step-by-Step Guide to Feasibility Research propose a larger study as planned?
1. Identify a problem and/or a question. 11. Disseminate your findings.
2. Review the literature.
3. Identify gaps in our knowledge. JOURNAL SHARING AND REACTION ON SHARED
4. Refine the general question, formulating a GOVERNANCE
specific research question(s). Reflective journaling
5. Consider your reasons for conducting - is a term that refers to documenting your ideas,
preliminary research and determine the form it personal thoughts and experience through
should take. writing.
a. If you want to evaluate the feasibility of - a valued tool for teaching nursing students and
carrying out the planned protocols and for documentation, support, and generation of
interventions of an anticipated larger nursing knowledge among experienced nurses.
study with randomization of - a comfortable medium for nurses to be more
participants, conduct a randomized pilot open about their journey and experience.
study. - can also be a great way to map a nurse’s progress
b. If you want to evaluate the feasibility of and achievements in his or her nursing/clinical
using all or part of an intervention—and, education as well as in their career.
possibly, other processes—in a proposed
larger study, but without randomizing SHARED RESPONSIBILITY FOR IMPLEMENTING
participants, conduct a nonrandomized EVIDENCE-BASED PRACTICE
pilot study. - Evidence-based practice (EBP) is the process of
c. If you want to evaluate aspects of data collecting, processing, and implementing
collection, data management, the research findings to improve clinical practice, the
adequacy of resources to carry out a work environment, or patient outcomes.
study, or other processes to be - According to the American Nurses Association
undertaken in an anticipated future trial (ANA), nursing interventions should be practical,
(excluding the specific intervention and methodical decisions based on EBP research
exact protocol) with a small sample, studies. Utilizing the EBP approach to nursing
conduct a feasibility study that is not a practice helps us provide the highest quality and
pilot study. most cost-efficient patient care possible.

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 - When evaluating EBP nursing research studies, Key Concerns of Upper and Midlevel Managers and
focus on these four criteria: Trainers in Needs Assessment
o Validity
o Reliability
o Relevance
o Outcome
- Facilitating EBP is a shared responsibility of the
professional nurse, the organization, leader-
managers and the education or staff
development department.

Training Needs Analysis

- is a process in which the company identifies
training and development needs of its
employees so that they can do their job
Three key steps involved in training needs analysis to
effectively. It involves a complete analysis of
ensure your business is making the most of the process:
training needs required of various levels of the
- Decide On Skill Sets
organization.
- Evaluate The Skills Of Staff
- It is a process which helps the organization
- Highlight The Skills Gap
review the state of their training. Its importance
is to helps them to determine all the training
needs to be completed in a certain period to
allow their team to complete their job as
effectively as possible.
- The purpose of training needs analysis is to
identify performance requirements and the
knowledge, skills, and abilities needed by an
agency’s workforce to achieve the requirements.
An effective training needs assessment will help
direct resources to areas of greatest demand.

Three Levels of Training Needs Analysis

Training Needs Analysis at 3 Levels:
Organizational Analysis
- TNA at the organizational level. Ex: SWOT
Analysis

Task Analysis
- Tasks to be performed on the job are analyzed;
Knowledge, Skills, and Abilities needed to do
those tasks are also analyzed

Individual Analysis
- Who needs to be trained and what training is
needed

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