NCM 107A- LEADERSHIP AND MANAGEMENT

DEFINITION:

LEADERSHIP
– is a dynamic and interactive process of persuading and motivating
people to work for the achievement of the common goal.
– The process of moving a group of groups in same direction
through mostly non coercive means.

There is numerous definitions of leadership that exists:

1. Gardner (1986) – leadership is the process of persuasion and example by

whish an individual (or leadership team) induces a group to take action
that is in accord with the leader’s purposes or the shared purpose of all.

2. Holloman (1986) – leadership is the in which a person inspires a group

constituents t work together using appropriate means to achieve a
common mission and common goals. They are influenced to do this and
willingly and cooperatively with zeal and confidence and to their greatest
potential.

3. Stoner (1978) – leadership is the process of directing and influencing the

task – related activities of group members.

4. Merton (1969) – leadership is a social transaction in which one person

influences others. Persons in authority do not necessarily exert leadership.
Rather effective people in authoritative positions combine authority and
leadership assist an organization to achieve its goals.

5. Flores (1989) – provided definitions of a leadership such as:

a. Leadership – can be described as a process of influence in a
specific set of circumstances that stimulate people to strive willingly
to attain, organizational objectives, giving them the experience to
attain the common objectives and satisfaction with the type of
leadership provided.

b. Leadership – is the knacks of getting other people to fellow you and

do willingly the things you want them to do. It is the ability to
motivate subordinates ad other employees toward the achievement
of company objectives.

c. Leadership must be based on the insight into present realities.

Leaders who succeed are those who can get inside their people
and motivate them. A leader gets inside people so as to energize
them.

6. Robins – the process of empowering beliefs and teaching others to tap

their full capabilities by shifting the beliefs that has been limiting them.

7. Yukl – the process of influence in which the leader influences (inspire,

enliven, or encourage) others towards goal achievement)

Example of leader Roles:

a. teacher
b. coach
 c. counselor
d. decision maker
e. critical thinker
f. risk taker
g. advocate
h. visionary
i. evaluator
j. facilitator
k. mentor
l. role model

Nature and scope of leadership

How should a nurse lead?

A leader who aims to establish and continue to maintain productive

organization should not only be concerned with sort – ranged task achievement
but must develop an atmosphere that gives staff members personal satisfaction
and the incentive to continue work towards the ultimate organization goals.

Landborg (1986) pointed out that a leader is the one who is followed by
others willingly and voluntarily. However, evidences show that the productivity of
a work unit is affected by the kind of leadership the unit receives (Golembiewski,
1961)

Fundamental considerations for effective leadership (Merton 1969)

1. A person receiving the communication understands it.
2. The person has the resources to do what is being asked in the
communication
3. This person believes the behavior being asked is consistent with personal
interest and values.
4. This person believes it is consistent with the purposes and values of the
organization.

Major variables in leadership (Mc Gregor 1960)

1. Personality of the leader – the characteristic of a leader
2. Personality of the group – the attitudes, need and other personal
characteristics of the followers
3. Situation in which leadership is exercised – the characteristics of the
organization, such as its purpose, its structure, the nature of the task to be
performed
4. Organizational factors – the social, economic and political milieu

3 dimensions of leadership
1. The leader – must understand his people. Qualities such as sincerity,
integrity, unselfishness, sympathy, patience, kindliness ad the likes
cannot help but an assets to the leader or administrator.

Leaders can be:

a. formal leader – person in a position of authority or in a
sanctioned, assigned role with an organization that connotes
influence

b. Informal leader – individuals who demonstrates leadership role

as a member of a group, one who is affected by others and is
perceived to have influence
 Influence – instrumental part of a leadership where leaders affect other by
inspiring, enlivening and encouraging others to participate.

2. The follower – characteristic of the followers. The leaders must know

the organization realities, its own unique history, values, folkways and
unwritten rules of conduct.

3. The situation – the leader must accommodate his leadership actions

to the mandate of the situation. This implies that the personal
characteristics that enabled the administrator to be a success in one
situation may not necessarily ensure success in another. Different
styles of leaderships are needed to meet the different situations which
prevail in the profession.

THEORIES OF LEADERSHIP

1. Great Man Theory

- premise that “leader are born not made” which suggest that
leadership cannot be develop. Argues that a few people are
born with the necessary characteristics to being great.
- Leaders are well rounded and simultaneously display both
instrumental and supportive leadership behavior.

Instrumental Leadership Behavior Supportive Leadership Behavior

(Activities) (Activities)
1. planning 1. is socially oriented
2. organizing 2. allows participation and
3. controlling (the activities of consultation from subordinates
subordinates to accomplish the for decision that affect them.
organizational goal
4. obtaining and allocating resources
such as people, equipments,
materials, funds and space

People who use both instrumental and supportive leadership behavior are
considered “great men and supposedly are effective leaders in any situation.

2. Trait Theory – premise that “ leaders are made not born” was the basis
for most leadership research until the mid- 1940’s. Early work in this area
maintained that traits are inherited but later theories suggested that traits
could be obtained through learning and experience.

Traits that re related to leadership effectiveness (Swansburg, 1993)

1. Intelligence traits
a. a leader must posses knowledge, decisiveness judgment and
fluency of speech – these enables the nurse manager to relate well
and inspire subordinates to perform well.
b. Leaders need to be more intelligent that the group they lead
c. Must posses initiative and the ability to perceive and start course of
action not considered by others.
d. Must have a good communication skills since the leader needs to
understand others and speak and write clearly
 2. Personality traits
a. must possess adaptability, alertness, creativity, cooperativeness,
personal integrity, self confidence and non conformity. These
facilitates the leadership capability of a nurse manager to motivate
the people in achieving organization goals.
b. Creativity as an asset. Having an originality to think of new
solutions to problems and ideas of new ways to be productive
c. Emotional maturity with integrity a sense of purse purpose and
direction, persistence, dependability and objectivity
d. Mature leaders do what they say they will and are consistent in
their actions.
e. They often work long hours, apply themselves intensely and spread
enthusiasm to followers.

3. Ability traits
a. ability to enlist cooperation, popularity and prestige, sociability
(interpersonal skills) social participation, tact and diplomacy. These
enhances collective unity among members of the system to achieve
its goals.
b. Leaders participate in social activities. Able to socialize with all
kinds of people and adapt to various groups.
c. Being approachable, friendly, helpful – will gain the confidence and
loyalty of others in such a way that makes people willing to
cooperate.
d. Persuasion often is used by leaders to gain the consent of
followers. The leaders may make suggestions, simply supportive
date, ask penetrating questions, make compromises and request
action to persuade others.

4. Behavioral Theory
a. focus is geared not towards the leader is but how the leader
actually behaves
b. the behavioral theory of leadership underscores the significance
understanding human behavior
c. a nurse manager must understand human beings as the behavior
of people is the core of leadership and management in nursing.
People in the organization are very complex and a leaders genuine
understanding of them is invaluable in having them to work together
to achieve the purpose of the organization

Two basic leader behavior

1. Employee centered leaders – effective leadership with focus on the

human needs of subordinates

2. Job- centered leader – less effective because of their focus on schedule,

costs and efficiency resulting in a lack of attention to developing

Two dimensions of Leadership Behavior (Ohio States Studies)

1. Initiating structure – emphasis is on the work to be done, focus on the

task and the production, concerned with how work is organized and on the
achievement of goals, (planning, directing, others and establishing
deadlines and details of how work is to be done) e.g. nurse manager
provides a manual for job descriptions, personnel policies and procedures
 2. Considerations – involves activities that focus n employee and
emphasizes relating and getting along with people. Leader is concerned
with creating relationship that fosters communication and trust as a basis
for respecting other people and their potential contribution (e.g. nurse-
leaders with considerate behavior talk to co-workers, is empathetic and
show interest in them as people)

CONTINGENCY THEORY

Fiedler’s Contingency Theory - states that there are other factors in the
environment which influence outcomes as much as leadership styles; and that
leader effectiveness is contingent upon or depends upon something other than
the leader’s behavior.

This theory views the pattern of leader behavior as dependent upon the
interaction of the personality of the leader and the needs of a situation. The
needs of the situation or how favorable the situation is towards the leader
involves leader – member relationships; degree of task structure and the leader’s
position of power.

Leader – member relation – are feelings and attitudes of followers regarding

acceptance, trust and credibility of the leader. Personality is a factor but its
influence depends on the group’s perception of the leader.

Good leader member relation - followers respect, trust and have

confidence in the leader.

Poor leader – members relation – reflects distrust, lack of confidence and

respect, and dissatisfaction with the
leader by the follower.

Task structure - refers to the degree to which the work is defined with specific
procedures, explicit directions and goals; or the procedural nature of job
assignments.

High task structure – involves routine, predictable, clearly defined

work task; leader will have less power.

Low task structure – involves work that is not routine, predictable or

clearly defined like creative, artistic or
qualitative research activity; the leader will be
in a position to exert greater power.

Position power – the degree of formal authority and influence associated with
leader.

High power position – favorable for the leader

Low position power – unfavorable for the leader

Effective – task-related leader concerned with task accomplishment

Most effective – intermediate or moderate range of favorableness, human

relation leader concerned about people

SITUATIONAL THEORY – Assumes that a leader should help the followers grow
in their readiness to perform new tasks as long as they are able and willing to go.
 Situational leadership means that there is no one best leadership style
and maintains that effective leadership is matching the appropriate leadership
style to the individual’s or group’s level of task – relevant readiness (Heidenthal,
2003)

Determinants of effective leadership style:

• personality of a leader
• performance requirements of both the leader and followers
• Attitudes, needs and expectations of the leader and followers
• Degree of interpersonal contact possible
• Time pressures
• Physical environments
• Organizational structure
• The nature of the organization
• State of the organization’s development
• Influence of the leader outside the group

READINESS - an individual’s ability to motivation to perform a particular task.

Follower readiness called “ maturity” is addressed in order to select one of the
four leadership styles (Hershey and Blanchard)

1. Telling leadership – groups with low maturity, with members unable

or unwillingly participate or are unsure. ( Leader to provide direction
and close supervision)

2. Selling leadership – low to moderate maturity who are unable but

willing and confident (Leader can give clear direction and supportive
feedback to get the task done)

3. Participating Leadership – groups with moderate to high maturity

who are able but unwilling or unsure (Leader can give support and
encouragement)

4. Delegating leadership – groups with high maturity who are able and
are ready to participate and can engage in the task without direction or
support

FRAMEWORK OF SITUATIONAL LEADERSHIP

Benner’s model of novice to expert (based on Dreyfus and Dreyfus

model of skill acquisition in nursing) specified that there are tasks, competencies
and outcomes that practitioners can be expected o have acquired based on five
level of experience.
1. Novice nurse – they are those practitioners who are task oriented and
focused.

2. Advance beginners – they are nurses who are able to demonstrates

marginally acceptable performance

3. Competent nurses – they are nurses performing the same role for two
to three years who have developed the ability to view their actions as
part of the long – range goal set for their patients. Their conscious and
deliberate planning skills promote efficiency and organization.

4. Proficient nurses – they are nurses who look at situations as wholes

rather that a series of tasks. They have learned from their experiences
 the need to develop a plan of care for a patient to be guided from point
A to point B and that in typical situations a patient is expected to
manifest specific behaviors to achieve specific goals. Once those
behaviors are not exhibited within a certain period of time or time
frame, it implies that the changes should be done in the care plan.

5. Expert nurses – they are nurses whose expertise is so embedded in

their practice as they intuitively know what is happening with their
patients. Expert nurses strive for professional advancement who
eventually become clinical specialists.

• LEADERS DEVELOP FOLLOWERS OVERTIME TO INCREASE

THEIR LEVEL OF MATURIRY

PATH – GOAL THEORY (ROBERT HOUSE) – Based on expectancy theory

which holds that – “people are motivated when they believed they are able to
carry out the work and when they think their contribution will lead to the expected
outcome and that the rewards for their efforts are valued and meaningful”

Leaders work to motivate followers and influence goal accomplishments.

By using the appropriate style of leadership for the situation (directive,
supportive, participative or achievement – oriented) leaders make the path
towards the goal easier for the followers.

1. Directive style – leaders provide structure through direction and

authority with focus on getting the job done.

2. Supportive style – reaction – oriented providing encouragement,

interest and attention

3. participative style - focuses on involving followers in decision –

making

4. achievement – oriented - provides high structure and direction

through consideration behavior

TRANSFORMATIONAL LEADERSHIP – (Bennis & Nanus) – assumption –

“POWER IS THE BASIC ENERGY TO INITIATE AN SUSTAIN ACTION
TRANSLATING INTENTION INTO REALITY”

Leaders commit people to action, convert followers into leaders, and may
convert leaders into agents of changes. Competencies for dynamic and effective
transformational leadership include:

a. management of attention – leaders possess a vision or sense of outcomes

or goals which are mutually developed, are based on a sense of quality,
appeal to values and emotions and are feasible yet challenging.
b. Management of meaning – leaders inspires commitment thus, must
communicate their vision and create a culture that sustains the vision. All
elements must enhance the worth of individuals, allow creativity and appeal to
the values of nurses.
c. Management of trust – leaders whose judgment is sound and consistent and
whose decisions are based on fairness, equity and honesty are always
respected. People would much rather follow individuals they can count on,
even when they disagree with their viewpoint than people they agree with but
who shifts positions frequently.
d. Management of self – knowing one’s self and using them effectively. Nurse
leaders need to master the skills of leadership because mastery reduces
stress and burn-out. It is critical that nurse leaders recognize their lack of
management skills and then take responsibility to their own continuing
education.

Transformational theory serves to promote employee development, attends to

needs and motives of followers, inspires through optimism, influences changes in
perception, provides intellectual stimulation, and encourages follower creativity.
This use individualized consideration, provides a sense of direction, and
encourages self – management, cooperation, process – focused networking and
uses charisma as trait.

Transactional – a exchange posture that identifies needs of followers and

provides rewards to meet those needs in exchange for expected performance. It
is a contract for mutual benefits that has a contingent rewards. The leader is a
caretaker who set goals for employees, focus on a day-to-day operations, and
uses management by exception. It is a competitive, task-focused approach that
takes place in a hierarchy.

TRANSACTION TRANSFORMATIONAL
Hierarchy Networking
Competitive Cooperative
Task focus Process Focus
Exchange posture Promote employee development
Identify needs of followers Attend to needs and motives of
followers
Provide rewards to meet goals Inspire through optimism
Exchange for expected performance Influence change in perception
Contract for mutual benefits Provide intellectual stimulation
Contingent Rewards Encouragement of follower creativity
Role model
Caretaker Individualize consideration
Set goals for employees Provide sense of direction
Focus on day – to day – operation Encouragement of self-management
Management by exception
• Comparison of transactional and transformational leadership

CHARISMATIC THEORY – is base on the inspirational quality possessed by

individuals that other feel better in their by individuals that others feel better in
their presence. Charismatic leaders inspires others obtaining emotional
commitment from followers and by arousing strong feelings of loyalty and
enthusiasm. They set as an example by their behavior, communicate high
expectations to followers and express confidence in them, and arouse motives
for the group’s mission.

SERVANT LEADERSHIP – (ROBERTA GRRENLEAF) is a life and leadership in

the service of the Lord. Leaders uses their gifts from God according to the grace
given to them, share them with others generously; if they have the authority, they
should work hard, and should show acts of mercy with cheerfulness. It puts
serving first, takes a holistic approach, shares decision making and builds
community. In nursing it is selfless commitment and devotion to duty.

Defining Characteristics: Has the ability to

1. Listen on a deep level and truly understand (listening)
2. Keep an open mind and hear without judgment
3. Deal with ambiguity, paradoxes and complex issues
 4. Honesty shared critical challenges with parties and ask for their input
which is more important than personally providing solution.
5. Be clear on goals and good at pointing the direction without giving
orders
6. Be a servant, helper, and teacher first, and then a leader (stewardship)
7. Be always thinking before reacting
8. Choose work carefully so as not to damage others being led.
9. Use foresight and intuition
10. See things whole and sense relationship and connections
11. Focus on a long term management that involves slower promotions
and less direct supervision. Organizations invest in its employees and
address both home and work issues creating a path for career
development.

LEADERSHIP STYLES

THREE BASIC LEADERSHIP STYLES – Kurt Lewin (1890 – 1947)

1. Autocratic – Leaders make decision alone (centralized) with the use of

power to command and control others. They rend to be more concerned
with task accomplishment than with concern for people. Similarly, they
promote hostility and aggression or apathy and decrease initiative.

2. Democratic – Leaders participate with authority delegate to others; uses

expert power and power base afforded by having close, personal
relationships. They involve their followers in the decision making process.
They are people – oriented and focus on human relations and teamwork.
They lead to increase productivity and job satisfaction.

3. Laissez – faire – passive and permissive and abstain from leading their
staff. Leader defers decision making. They foster freedom fro everyone
and want everyone to feel good. However, this results in low productivity
and employee frustration.

Autocratic Democratic Laissez – Faire

Strong control Less control No control
Gives order Offers suggestions No directive
Does decision making Makes suggestions Abdicates decision making

Leader does planning Group does planning No Planning

Directive Participative Uninvolved
Foster dependency Foster dependence Foster Chaos

CHARACTERISTICS AND BEHAVIORS OF AN EFFECTIVE LEADER

Behaviors that include promotion of economy, decision making, and

participative management by professional leaders are known to be and should be
facilitated by effective nurse who are also called leaders. The learned behavioral
patters of the nurse managers is needed to exercise judiciously the task of
leading and having their people worked together toward a common goal – with
efficiency as leaders.

THREE DIMENTIONAL THEORY OF MANAGEMENT (William J. Reddin)

Based on adapted dimensions from Managerial Grid Theory, Contingency
Leadership Style Theory and Effectiveness Theory.

1. Separated – both task orientation and relationship are minimal

 2. Dedicated – task orientation is high and relationship orientations low.
Leaders are only dedicated to job.
3. Related – relationship orientation is high and task orientation is low.
Leaders relate primarily to their subordinates.
4. Integrated – both task and relationship behavior are high. Leaders focus
on managerial behavior combining task orientation and relationship
orientation.

EFFECTIVE LEADERSHIP STYLES AS APPLIED AFTER SITUATION

ASSESSMENTS

1. Executive leaders – integrated and more effective compared to

compromise leaders who are considered less effective integrated leaders.
2. Developer leaders – related and are believed to more effective that
missionary leaders who are less effective related leaders
3. Bureaucrat leaders – separated and more effective separated leaders
4. Benevolent autocrat leaders – dedicated and more effective than autocrat
leaders who are less effective dedicated leaders.

VALUES AND BEHAVIOR AFFECTING THE FILIPINO LEADERSHIP STYLE

1. Bahala or pagwawalang – bahala – maniefested negatively as

Pasensya and pagtitimpi – resignation to and acceptance of

failures and shortcomings
Suerte – relating everything to fate

Overdependence on authority

Resiliency or capacity to adapt to misfortune with tendency to

return to old ways and forgetting lessons of past misfortunes

Pagtitiis – to endure a hard life without complaint and with complete

resignation to such fate
Mañana habits – putting off for later what can be done now

Filipino time – propensity to be late for appointments

Ningas kugon – tendency for sudden outburst of enthusiasm at the

start of any endeavor followed by an equally
abrupt loss of interest.

“come what may” attitude – one can leave matters as they are, no
need to exert effort because the
supernatural spirits or Bathala will take
care of everything for anybody.

Mixing pleasure with work leading to failure to distinguish one from

the other

Talagang ganyan ang kapalaran – (that’s life) eats up one’s sense

of responsibility and personal accountability;
gives one false sense of self confidence to
proceed even unsoundly in the belief that
somehow one will manage to get by.

Segurista – demands demonstration of assured success

2. Person- oriented

Hiya – (shame or embarrassment) – development of the capacity

for this feeling is encouraged by the family since the threat of
experiencing it is considered an effective means of obtaining
approved behavior

Utang na loob – (obligation) feeling which develops when one has

received a favor from another; cannot be repaid by money.
Repayment is expected by the donor but in a form to be decided at
some future time by the donor

Pakikisama (going along together)

Practice of galang or respect - the result of the definition of

rights and obligation which are inherent in the structural positions of
individuals I the Filipino kinship system

Practice of using go – between (lakad system ) – arrange or

fix things for someone

Practice of bata system – (relationship between superior and

subordinate) a protégé, a favored individual, close friend, comrade
to rely in time of need

Amor – propio – (self esteem) leads to smooth interpersonal

relationship with his subordinates, fellow managers and even
competitors. The core of which is the need to be treated as a
person and not as an object.

3. high – respect and regard for women – the “Pinay power” becomes a very
evident in the Filipino organization
4. application of bureaucracy – constitute an essential part of Filipino life
because the chief function as reinterpreted is to – strengthen the traditions
norms of society through evolution of a unique synthesis of the rational
and traditional

5. Personalism – identifies leadership with benevolence; focuses not so

much on what a person does as on who he is; not so much on what the
person knows as whom he knows and who knows him; not so much on
the objective reality of things as on the way things are really actually
perceived.

6. Dangal (honor), puri (modesty), utang na loob (sense of gratitude) –

considers moral dimension of his actions, solutions, and decisions.
Senese of gratitude to the people who supported the company at the early
stage may make him / her decide to retain an employee even if his / her
skills and knowledge are no longer needed.

7. great zeal for professionalism and education – pursue masters and

doctoral degree which entail great sacrifices on them considering their
busy schedule and work.
MANAGEMENT

- the process of working with and through others to achieve

organizational objectives in a changing environment
- the process of obtaining and organizing resources and of
achieving objectives through other people
- is planning, directing, coordinating and controlling, including
leadership, giving direction, developing staff, monitoring
operations, giving rewards fairly and representing both staff
members and administration as needed.
- Is the set of interactive process through which the utilization of
resources results in the accomplishment of organizational
objectives

MANAGEMENT – a body of knowledge existing as a PROCESS, as an ART,

and a SCIENCE.

Management as a PROCESS - It is a series of systematic, sequential or

instances of overlapping steps directed toward the achievement of organization
goals and objectives

Features:
• Time dimension reflecting the dynamic nature of management
• A recognition that one major task of management is the integration
of the efforts of group or organization
• Inclusion of the phrase “purposeful group”, - includes not only goal
definition and objectives but also includes assumption that
organizational managers must work together in the direction of their
purpose.

Management as a SCIENCE – Achievement is required through the scientific

method which employs an empirical measurement of data, causal links among
phenomena, logical organization of internal structure, conclusions validated
through experimentation.

Management as an ART – Getting one done through people; problems are

adaptive to individual styles based on creativity, judgment, intuition and
experience instead of the usual systemic methods of science.

To manage is to:

FORECAST and PLAN – foresee and provide means in examining the future and
drawing up the plan of action

ORGANIZE - Build up the dual structure – material and human of the undertaking

COMMAND – bind together, unifying and harmonizing all activities and effort

CONTROL – see that everything occurs in harmony with established rule and
expressed demand.

MANAGEMENT THEORIES
 1. SCIENTIFIC MANAGEMENT – characterized and guided by the
application of scientific approaches to solve managerial problems. Area of
focus is productivity.

FREDERICK W. TAYLOR – (1856 – 1915) – Father of scientific

management; change the traditional “rule of thumb”. AN ORGANIZATION
IS A MACHINE TO BE RUN EFFICIENTLY.”

Through the use of his stop-watch studies he applied the principles

of observation, measurement, and scientific comparison to determine the
most efficient way to accomplish a task. When the most efficient way to
complete the task was determined, workers were trained to follow that
method.

FOUR PRINCIPLES
1. develop a science for each man’s work
2. select and train workers scientifically
3. accomplish work objectives through cooperation of management
and labor
4. divide responsibility more equitably between managers ad workers

Managerial outcome:
• reduced wasted efforts
• set standards for performance
• encouraged specialization
• stressed the selection of qualified workers who could be developed
for a particular job.

LILIAN GILBRETH (1879 – 1919 – the first lady of management) FRANK

GILBERTH (1868 - 1924) – pioneers time and motion studies;
emphasized the benefits of job satisfaction and establishment of work
standards, and the effects of incentives, wage plans and fatigue on work
performance.

HENRY GANTT (1861 – 1919)

§ concerned with problems of efficiency; preferred to refine
previous work rather than introducing new concepts.
§ He developed the GANTT CHART – forerunner of PERT
CHART (program evaluation and review technique)
§ Developed a task and bonus remuneration plan whereby
workers receive a guaranteed day’s wage plus a bonus
for production above the standard to stimulate higher
performance
§ Believed in humanitarian approach to management
placing emphasis on service rather than profit objectives,
recognizing useful non – monetary incentives such as job
security and encouraging staff development

2. CLASSIC ADMINISTRATION / ORGANIZATION – views the organization

as a whole rather than focusing solely on production. Managerial activities
are planning, organizing and controlling.

HENRI FAYOL (1841 – 1925) – “Father of the management Process

School”; firm believer of order who advocated “A place for everything and
everything in its place”.
14 Management Principles

1. Division of Work
Specialization of labor results in increased productivity through
reduction of job elements expected of each worker.

2. Authority and responsibility

Authority is the right to give orders and the power to extract
obedience, which is balanced by responsibility for performing
necessary functions.

3. Discipline
Obedience to agreements reached between parties in the firm must
be exercised. Good discipline results from effective leadership clear
understanding of the organization’s rules, and prudent use of
penalties for violation of these rules.

4. Unity of Command
Employees should received orders from only one superior

5. Unity of Direction
Each group of activities having the same purpose should operate
under one head and one plan

6. Subordination of individual interest to general interest

The overall objective that the group seeks to achieve takes
precedent over the objectives of the individual.

7. Remuneration of personnel
Compensation for workers should be based on a systematic
attempt to reward well-directed effort.

8. Centralization
The degree to which subordinates participate in decision making

9. Scalar chain
A graded chain of authority from top to bottom through which all
communication flow

10. Order
The material and human instruments of business must be arranged
logically. The organization must provide an orderly place for all
individuals.

11. Equity
The enforcement of established rules tempered by a sense of
kindness and justice should pervade the organization

12. Stability and tenure of personnel

Top management should implement practices which encourages
the long-term commitment of employees particularly of managers to
the firm

13. Initiative
Employees must be encouraged to think through and implement a
plan of action. The opportunity to exercise initiative is a powerful
motivator.
 14. Esprit de corps
Unity of effort through harmony of interests. Promoting teamwork
will encourage harmony within the organization.

MAX WEBER (1864 – 1920) – German sociologist known as the “Father of

organization theory”;

Competence – basis for hiring and promoting a employee and decisions

should be done in an orderly and rational way based on rules and regulations

Three basis of Authority

1. traditional authority – “rule of the king”; accepted since things have always
been that way
2. charisma –
3. rational, legal authority – person demonstrates the knowledge , skill and
ability to fulfill position; if subordinates do not believe that a person is
qualified for the position, they may not accept the person’s authority

Conditions in Weber’s bureaucratic organization

• administrator is appointed not selected
• administrator has fixed salary and do not own what they administer
• are subject to strict rules which are applied impersonally and
uniformly
• all personnel are selected for competence
• division of labor, authority and responsibility is clearly defined
• positions are organized into hierarchy

Advantages of bureaucratic management

• produces competent and responsible employees
• employees perform by uniform rules and conventions
• accountability to one authority
• social distance with supervisors and clients
• reduces favoritism; promotes impersonality
• rewards and incentives given based on technical qualifications,
seniority and achievements

Disadvantages of bureaucratic management

• “red tape” complaints heard and experienced
• Observable procedural delays
• Inevitable frustrations among employees and clients
3. HUMAN RELATIONS – Refers to integration of people into a work situation in
a way that motivates them to work productivity, cooperatively and with economic,
psychological and social satisfaction (Andes, 1989) It signifies individual worker
as the source of control, motivation and productivity (Heidenthal, 2003)

The chief concerns are individuals, group process, interpersonal relations,

leadership and communication. Instead of concentrating on the organization’s
structure, managers encourage workers to develop their potential and help them
meet their needs for recognition, accomplishment and sense of belonging.

MARY PARKER FOLLETT (1868 – 1933) – Stressed the importance of

coordinating psychological and sociological aspects of management; believes
that managers should be aware that each employee is a complex collection of
emotions, beliefs, attitudes and habits
- one of the first theorist to suggest the principle of “ participative
decision – making” or participative management”, were
workers are more satisfied if they have participation in
decisions about their work environment
- advocates that managers should study the total situation to
achieve unity because control is obtained only through
cooperation among all of the elements, people and materials

cooperation seen by roductivity

a spirit of unity Follet as

self-control the keys to democratic

way of life

* Follet’s concept of Motivation and Management

ELTON MAYO (1880 – 1949)

– Discovered that when special attention is given to workers by

management, productivity is likely to increase, regardless of
changes in the working condition.
– That informal work groups and an informal social environment
among employees which allow for group decision making have a
great influence on productivity
– Proposed that improvements be made by making the structure
less formal and by permitting more employee participation in
decision making

Hawthorne Effect – phenomena of being observed or studied, resulting in

changes in behavior

KURT LEWIN (1890 – 1947)

- Jewish psychology who advocated democratic supervision
where participants solve their own problems and to have the
opportunity to consult with leader.
- Revived the study of group dynamics; maintained that groups
have personalities
- Showed that group forces can overcome individual interests

3. BEHAVIORAL SCIENCE – Emphasizes the importance of maintaining a

positive attitude toward people, training managers, fitting supervisory
action to the situation, meeting employees, sense of achievement, and
obtaining commitment through participation in planning and decision
making.

DR. ABRAHAM MASLOW (1908 – 1970) – father of motivation

who determined that people can be best understood through study of
human needs and their influence on behavior. He developed the
hierarchy-of-need theory (motivation theory – which is based on a holistic-
dynamic theory) which explains “why people act the way they do” and how
a manager can relate to individuals as human beings.
 Because no two people are alike, needs vary in type and intensity
from one person to another. One person may desire recognition, whereas
a sense of belonging to a group may be important to someone else.

Hierarchical structure for human needs:

Physiological needs are at the base of needs system. These needs are
based on homeostasis which refers to the body’s automatic efforts to maintain a
constant, normal state of the blood stream. Human beings do not just eat they
eat selectively to maintain homeostasis. Physiological needs are he most pre-
potent or strongest of human needs when unsatisfied. Dominance of a
physiological need changes the individual’s philosophy for the future.

Human needs are organized in hierarchy of prepotency: higher ones

emerge as lower ones are satisfied. When physiological needs are satisfied, the
human beings are no longer motivated by them. However, when deprived of a
long-satisfied need, that person tolerates it better than one who has been long or
previously deprived.

Safety needs which include security, protection, dependency and stability;

freedom from anxiety, chaos, and fear; need for order, limits, structure, and law;
strength in he protector, and others are the second group in the hierarchy. Their
satisfaction influences a person’s philosophy of life and values. What threatens
the safety or nursing? Insurance, programs, job tenure, and savings account are
expression of safety needs. Today’s managers are often threatened by the new
generation of personnel who question regulations and use the law to achieve
their goals.

Once the physiological and safety needs have been satisfied, the needs
for love, affection and belongingness emerge. A society that wants to survive
and be healthy will work to satisfy these needs. Otherwise, people will be
maladjusted and will exhibit severe emotional and behavioral pathology.

The esteem needs – all people share these needs. First they desire
strength, achievement, adequacy, mastery and competence, confidences before
the world, independence and freedom. Second, they desire reputation or
prestige, status, fame and glory, dominance, recognition, attention, importance,
dignity or appreciation. A person whose self – esteem is satisfied has feelings of
self-confidence, worth, strength, capability, adequacy, usefulness, and known or
deserved respect.

Self – actualization, the top of the hierarchy is the effort of the people to
be what they can be. Nurses want to become everything that they are capable of
becoming, to achieve their potential, to be effective nurses, to be creative and to
meet personal needs.

Challenging job Self Achievement in work

Creativity actualization Advancement In organization

Supervisory recognition Ego or Job Title

 Acclaim by peers Self- esteem needs Increase in pay for
Responsibility recognized services

Companionship Social needs Professional friendship

Quality of supervision Caring, affection

Safe working conditions Security or safety needs Generally salary

Fringe benefits increases
Job security

Base salary Physiological needs Heat and air

Working conditioning
conditions
Cafeteria

• Maslow’s hierarchy of needs applied to members of an organization

FREDERICK HERZBERG (1923 – 2000)

Two-Factor-Theory or MOTIVATION-HYGIENE THEORY – states that if
people are satisfied with their job they are receiving positive feedback developing
skills and improving their performance. These are the hygiene or maintenance
factors

Motivators (Intrinsic) Hygiene Factor (Extrinsic)

Salary
Achievement Supervision
Recognition Job security
Responsibility Positive working condition
Advancement Personal life
Possibility for growth Interpersonal relation / peers
status

Although hygiene factors do not motivate, they are needed to create an

environment that encourages the workers to move on higher – level needs;
combat dissatisfaction and are useful in recruiting an adequate personnel.

MOTIVATORS HYGIENIC FACTORS

(higher – order needs) (lower-order needs)
Job content Job context
(can raise performance) (cannot motivate but can
Become source of
Dissatisfaction and
lower performance)

Achievement
Recognition
Work Itself
Responsibility
Advancement
Growth

Performance
On the Job Supervision
Company policy and
Administration
Working conditions
Interpersonal relations
Status
Job security
Salary
Personal life

• Herzberg’s two factor motivation hygiene theory

theory of motivation

DOUGLAS McGREGOR (1932) – Theory X and Theory Y (The Human Side of

the Enterprise) the style of management depends upon one’s philosophy of
human.

Assumptions:

Theory X: Manager’s emphasis is on the organizational goals

The people dislike work and will avoid it. Most people want to be directed
and to avoid responsibility they have little ambition. They desire security

Manager: Directs, controls and threatens so that organizational goals can

be met; Does he thinking and planning with little input from staff associates;
delegates little, supervises closely, and motivates workers through fear and
threats, failing to make use of their potential.

Theory Y: Manager’s emphasis is on the goal of the individual

People do not inherently dislike work and that work can be a source of
satisfaction. Workers have the self-direction and control necessary for meeting
their objectives and will respond to rewards for the accomplishments of these
goals. Under favorable conditions people seek responsibility and display
imagination, ingenuity and creativity.

Manager : Allows participation, delegates, gives general rather than close

supervision support job enlargement, and use positive incentives such as praise
and recognition.

THEORY X THEORY Y

Dislike work Work is natural

Must be directed to do work Exercise self control
Avoid responsibility Enjoy responsibility
Believe achievement is irrelevant Value achievement
Dull and non-creative With potential, imagination and
Money-reason for working creativity
 Lack desire to improve quality Want to improve quality

McGregor suggest that when people are unable to satisfy their higher level
needs, they experience personal frustrations resulting negative behavior.
Managers with a human relations orientation have made working conditions
pleasant and have provided rewards unrelated to job performance.

WILLIAM OUCHI – THEORY Z – (PARTICIPATIVE MANAGEMENT) –

Focuses on a better way of motivating people through their involvement; a
Japanese form / concept of organization

Characteristics:
1. long- term (lifetime) employment
2. slowed down rates of evaluation and promotion
3. more implicit and less formalized control system
4. wholistic concern for employee
5. cross functional rotation
6. some degree of participative consensual decision making
7. emphasis on collective responsibility

FOCUS – 4 SOFT S’s of management

1. Staff – worker
2. Skills – capabilities of the organization
3. Style – cultural style of organization or how managers achieve goals
4. Superodinate goals – guideposts (personnel)

CHRIS ARGYRIS (1932) – Focus on coexistence of personal and

organization needs and found that individuals give priority to meeting their own
needs.

Managers can make jobs more meaningful by taking advantage of

people’s talent and letting them participate in planning, goal setting and problem
solving.

RENSIS LIKERT (1903 – 1981) – PARTICIPATIVE MANAGEMENT

THEORY – believes that effective managers are highly sensitive and their staff
associates, use communication to keep the group working as a unit and foster
supportive relationships between all group members.

FOUR TYPES OF MANAGEMENT SYSTEM

Exploitative – authoritative
• manager shows little confidence in staff associates and ignores
theirs ideas (staff associates do not feel free to discuss their jobs
with their managers)
• responsibility for the organization’s goal is at the top; goals are
established through orders
• decisions are made without input from below (workers strongly
resist the organization’s goals and develop an informal organization
of their own)
• policing and punishment are used as control functions.
 Benevolent – authoritative
• Manager is condescending to staff associates (although staff
associates ideas are sometimes sought they do not feel very free to
discuss their jobs with their managers)
• Top and middle managers set goals
• Little communication is directed downward after being censored by
manager
• Decision are made at top with some delegation
• Managers are non-knowledgeable of the staff associates’ situations
(staff are occasionally consulted for problem solving)
• Goals are established through orders
• Rewards and punishments are used as control
• Presence of informal organizations resisting form one
Consultative System
• Managers has substantial confidence in staff associates (Their
ideas are usually sought, thus they feel free to discuss their work
with the manager)
• Responsibility for setting goals is fairly general
• Considerable communication – both upward and downward
accepted with some caution
• Managers are quite familiar with the problems faced by their staff
associates
• Broad policy is set at top with delegation; goals are set after
discussion
• Decision making throughout the organization
• Control functions delegated to lower levels where rewards and self
– guidance are used.
• Sometimes informal organization resists the formal goals.
Participative management
• Managers have complete confidence in their staff associates (staff
associate ideas are always sought, they feel completely free to
discuss their jobs with the manager)
• Goals are set at all levels
• Great deal of communication – upward, downward and sideways –
accurate and received with an open mind
• Managers are well informed about the problems faced by their staff
associates, and the decision-making is well integrated throughout
the organization with full involvement of staff associate Goals are
established through group of action – with little or no resistance.
• No informal organization resisting the goals of the formal
organization
• Control is widely shared through the use of self – guidance and
problem solving

PETER DRUCKER (1909) – introduced MANAGEMENT BY OBJECTIVES

He first advocated MBO as a directing element and then made famous by
George Odiorne who defined it as:

A process whereby the superior and the subordinate managers if an

organization jointly identify its goals, define each individual’s major areas of
responsibilities in terms of the results expected of him, and use these measures
as guides for operating the unit and assessing the contribution of each of its
members.
 The manager develops the framework, and the staff associate supplies
the goals which agreed on by both. The staff associate gives progress report to
the manager. Drucker maintains that it is more productive for workers to set
standards for performance, and measure results against those standards. It
determines the results that the nurse is to achieve in a given time frame.

Problems with MBO

1. Top management not supportive

2. Inconsistency among managers
3. Goals too easy or attainable
4. Conflict of goals and policies
5. Accountability beyond control of subordinates
6. Lack of commitment of subordinates

MBO should promote flexibility. It is a superb tool if the objectives are:

1. simple
2. focused on what’s important
3. genuinely created from the bottom up
4. a “living contract, not a form – driven exercise

A theory of nursing management explores the cause-and –effect relationship

between clinical nurses and their performance. It has its object of removal of
controls that create distrust, fear, and resentment and the promotion of
conditions (climate) that provide opportunities for clinical nurses to achieve
their goals.

DIRECTING

DEFINITION
- getting the work done through others
- the issuance of assignments, orders and instructions that permit the
worker to understand what is expected of him or her.
- The guidance and overseeing of the worker so that he or she can
contribute effectively and efficiently to the attainment of organization
objectives
- A supervisory function that initiates action which involves using directives,
communicating instructions, and guiding and motivating employees
- Requires building an effective work team and motivating each worker at
higher levels in a willing and enthusiastic manner
- (nursing administration) is giving orders and directions to others to attain
quality patient care.

Major Aspects:

Technical – includes those considerations as budget – preparation,

purchase and care of equipment, office management and other responsibilities

Human – focused on the management of all the people in the organization

this is the most important task because all depends upon how well it is done

Major elements of directing

• leadership
 • motivation
• communication
• delegation
• supervision

LEADERSHIP – The relationship between the manager and staff members

should be based on mutual trust and confidence where the latter expect their
leader to be technically competent. If this is not properly observed, they literally
lose confidence in their leader. If the leader cannot be trusted by the people of
the organization, climate will never be healthy and may eventually result to
organizational problems.

MOTIVATION – an internal force that incites a person to action; what motivates

one will not necessarily excite another; Managers can create a motivating climate
by being positive and enthusiastic role model. The attitude and energy level of
nurse managers directly affects attitude and productivity of their employees. The
manner in which the first line managers communicate with the employee affect
the staff attitude towards the organization for he / she has more influence over
the employees than any other level managers.

COMMUNICATION – is viewed as a process of symbol using, understanding

interaction, reduction of uncertainty, transference and transmission of
information. In organizations, it is the formal process by which the managers use
the established organizational channels to receive and relay information to
people within the organization and to relevant individuals and groups outside it.

GOAL: narrow the gap between the intended message and received the
message.
PURPOSE: TO effect change and to influence action toward the welfare of the
clinical setting.

Kinds of communication used by nurse managers:

1. interpersonal communication
o process of passing a message from one person to another; or
within a small group of people, with the intention that the message
sent will be received and understood as intended.

2. organizational communication – components include:

a. positive communication atmosphere
b. positive communication between staff nurses and their immediate
superiors
c. personal feedback on job performance

Importance of communication:
1. Nurse managers spend most of their time communicating
2. good communication motivates staff members
3. communication leads to influence and power

Channels of communication – process by which a message is sent, received and

understood and to whom will it flow
1. formal – organization chart
2. informal – grapevine

THE GRAPEVINE:
 1. A social interaction, fulfilling people’s needs for communication and
recognition
2. Based on a natural motivation to exchange information
3. Occurs at all levels in an organization in horizontal, vertical and
diagonal patters.
4. Extremely influential, shaping person’s attitudes and having the
capacity to carry information both helpful and harmful to the
organization
5. Has an unusual ability to find out even the most tightly guarded
organization secrets
6. Employees become active in the grapevine when they have fresh news
that is fresh and “hot”
7. Can become active when information is of high interest to the
individual and the messages regarding that interest are vague or
unclear
8. Source of information directly affects the strength and duration of the
grapevine
9. More of a product of a situation than of personality
Example:
• major change in the agency’s management causes fear of transfer,
dismissal, or uncertainty regarding wages and benefits
• individual members become known for some achievement, good or
bad

Methods used by nurse managers to offset the negative effect of grapevine:

1. Keep staff as well informed as possible concerning work-related issues

that have relevance to them.
2. Maintain an open communication system that encourages feedback.
3. Listen and learn from grapevine. Learn who the leaders are, how the
grapevine operates, and what information if carries. The object is to
determine what is important to nursing and staff members. Omission in
information or false messages can be identified; then strategies can be
developed to heighten areas of satisfaction and reduce anxiety, conflict
and misunderstanding.
4. Try to influence the grapevine by giving relevant information to liaison or
key people.

Barriers to effective communication:

1. Physical Barriers – environmental factors that prevent or reduce

opportunities for the communication process to occur
• physical space or distance – face to face communication offers the
best means for confirmation that the message has been received
and intended; greater distance reduces opportunity to clarify
intention.

• temperature or ventilation – extreme cold or heat may be distracting

and affect communication

• structural or equipment problems – presence or absence of walls

and equipment influences the kind of communication possible
• noise – disturbances that obscure or reduces clarity or quality of a
message
 2. Social – psychologic barriers – blocks or inhibitors in communication that
arise from the judgment, emotions and social values of people; positive
emotions indicate the process is open and receptive while negative
emotions indicate the presence of a barrier.

3. Semantics - interpretation of messages through signs and symbols;

barriers may include misinterpretation of meaning, difficulty in exercising
verbal skills poor listening habits.

FLOW OF COMMUNICATION

DOWNWARD UPWARD LATERAL (SIDEWARD)

Policies Grievance procedures Endorsements

Manuals Incident reports Nursing rounds
Guidelines Conferences
Memoranda Meetings
Job description Referrals
Performance appraisal

UPWARD
To superior

OUTWARD
HORIZONTAL
To peer members NURSES To patient, family and
Of the health team community
To workers’ family
and friend

DOWNWARD
To subordinates

• Four – dimensional flows of communication in nursing care

PRINCIPLES OF EFFECTIVE COMMUNICATION

1. Clear lines of communication serves as the linking process by which the

parts of the organizations are unified toward goal achievement.
Synchronization of effort is facilitated when proper lines of communication
are identified and utilized.
2. Simple, exact, and concise messages ensure understanding of the
message to be conveyed.
3. Feedback is essential to effective communication. Mutual interaction is
required. Listening, openness to the other person’s point of view and
being supportive provide the means to effective feedback.
 4. Communication thrives best if a supportive environment that encourages
positive values among its personnel. Communication is used to support
the vision, mission and goals of the organization and the nursing service.
5. A manager’s communication skill is vital to the attainment of the goals of
the organization.
6. Adequate and timely communication of work related issues of changes
that may affect jobs enhance compliance. People resist change if they do
not understand the reason for it.

IMPACT OF TECHNOLOGY ON ORGANIZATION COMMUNICATION

1. Determines which technical advances can and should be used at each

level of the organizational hierarchy to promote efficiency and
effectiveness of communication
2. Assesses the need for and providing training to appropriately and fully
utilize the technological communication tools that may become available
to them.
3. Aligns communication technology with organization mission
4. Finds a balance between technological communication options and need
for human touch, caring and the one-on-one, face –to – face interaction.

CONFIDENTIALITY
– protecting confidentiality and privacy of personal or patient
information has been made even more difficult as a result of
increased electronic communication.
– ethical duty to maintain confidentiality regarding sensitive
personal communication between managers and subordinates.

INDIVIDUAL ROLES IN COMMUNICATION

1. aggressor - disapproves others values and feelings

2. blocker - persist in expressing negative points
3. recognition seeker – with always focus on him / herself
4. self – confessor – uses group settings as forum for personal insecurity,
confusion, or self-depreciation
5. playboy – remains uninvolved and demonstrates cynicism or horseplay
6. dominator – attempts to control and manipulate the group
7. help-seeker – uses expression of personal insecurity, confusion or self
depreciation to manipulate sympathy for others
8. special interest pleader – cloaks personal prejudices or biases by
ostensibly speaking for others.

DELEGATING – a technique of time management requires professional

management and development to accept the hierarchical responsibilities; a
process by which manager assigns specific tasks / duties to workers with
commensurate authority to perform the job. The worker in return assumes
responsibility for its satisfactory performance and is held accountable for its
results.

DELEGATION – It is an effective management competency by which nurse

managers get work done through their employees. Nurse Managers learns to
delegate by purposefully thinking about the delegation process, by doing careful
planning for it, by gaining knowledge of clinical nurses’ capabilities, by planning
and implementing effective interpersonal communications, and by willing to take
the risk
TYPES OF DELEGATION

• Direct Delegation
§ verbal delegation regarding an activity or ask in a specific
nursing care situation

• Indirect delegation
§ an approved listing of activities or tasks that have been
established in policies and procedures of the health care
institution or facility.

PRINCIPLES OF DELEGATION

1. Select the right person to whom the job is to be delegated.

Make sure that the employee is capable of doing the job. Give the
employee accountability and authority to do the job.

2. Delegate both interesting and uninteresting tasks.

Uninteresting jobs can be used to challenge, motivate and increase

a person’s performance and commitment. Interesting jobs draw out the best
among employees and inspire them to higher achievement.

3. Provide subordinates with enough time to learn.

Expertise can be achieved through training and experience.

4. Delegate gradually

New employees may not be able to assume full responsibilities as

employees who have stayed longer on the job.

5. Delegate in advance

Specify goals and objectives to be met within a set time frame.

6. Consult before delegating

Clarification minimizes problems and promotes teamwork.

7. Avoid gaps and overlaps

A gap occurs when a job is left out with no one taking responsibility;
an overlap happens when two or more people have responsibility for the
same job, causing confusion and low morale.
FIVE RIGHTS OF DELEGATION

• Right task
• Right circumstances
• Right person
• Right direction / communication
• Right supervision

PRINCIPLE OF DELEGATION
 1. Begin with the end in mind
It is important for the manager to specify results desired for the delegation;
it is motivating to specify the importance of task.

2. Delegate completely
The manager should be clear about whom accountability is being
assigned; for what task; when the work is to be completed; and how and
to who the results are to be reported.

3. Allow participation the delegation of assignments

When workers understand the assignments and its importance to the
organizational goals; have the knowledge and skills necessary to the job,
find the assignments consistent with their values and interest and have
input into what is delegated to them, they are more likely to willingly
accept delegated task.

4. Establish parity between authority and responsibility

Balance responsibility with authority to do the job

5. Work within the organization structure.

Delegate down through the hierarchy. Do not skip people in line authority
to get to the people closest to the situation.

6. Provide adequate support for delegated tasks

Give people what they need to do the job or explain why desired
resources are not available.

7. Focus accountability on results

Close monitoring of the process destroys the five dimensions of
empowerment: (self-efficacy, self – determination , personal control,
meaningfulness, and trust)

8. Delegate consistently
Use delegation to empower and develop others, not to get rid of
unpleasant tasks.

9. Avoid upward delegation

Ask workers to make recommendations rather than ask for advice,
respond with questions like, “What do you think we should do?”

10. Clarify consequences

Identify the impact the task has had on the organization and consumers.
Give rewards for success even if they are so simple as a thank you for a
job.

REASONS FOR DELEGATING:

1. Assigning routine task
2. Assigning tasks for which the nurse manager does have time
3. Problem solving
4. Changes in the nurse managers’ own job emphasis
5. Capability building

WHAT CANNOT BE DELEGATED:

 1. Over-all responsibility, authority and accountability for satisfactory
completion of all activities in the unit.
2. Authority to sign one’s name
3. Evaluating the staff and / or taking necessary corrective or disciplinary
action
4. Responsibility for maintaining morale or the opportunity to say a new word
of encouragement to the staff specially the new ones.
5. Jobs that are too technical and those that involve trust and confidence.

WHY NURSE MANAGERS DO NOT DELEGATE

1. lack of confidence in their staff

2. feeling that only they could do the task better and faster
3. fear of loss of control if some of the duties are delegated

WAYS FOR NURSE MANAGERS TO SUCCESSFULLY DELEGATE:

1. Train and develop subordinate
2. Plan ahead. It prevents problems
3. Control and coordinate the work subordinates but do not peer over their
shoulder
4. Follow up visiting subordinates frequently
5. Coordinate
6. Solve problems and think about new ideas
7. Accept delegation as desirable
8. Specify goals and objectives
9. Know subordinates’ capabilities and match the task or duty to the
employee
10. Agree on performance standards
11. Take an interest
12. Assess results
13. give appropriate rewards
14. Don not take back delegated tasks

BARRIERS IN DELEGATOR
1. Reference for operating oneself
2. Demand that everyone “know all the details”
3. “ I can do it better myself” fallacy
4. Lack of experience in the job or in delegating
5. Insecurity
6. Feel of being disliked
7. Refusal to allow mistakes
8. Lack of confidence in subordinates
9. Perfectionism, leading to excessive control
10. Lack of organization skill in balancing workload
11. Failure to delegate authority commensurate with responsibility
12. Uncertainty over tasks and inability to explain
13. Disinclination to develop subordinates
14. Failure to establish controls and follow – up
BARRIERS TO DELEGATE
1. Lack ox experience
2. Lack of competence
3. Avoidance of responsibility
4. Overdependence on the Boss
5. Disorganization
6. Overload of work
7. Immersion in trivia
BARRIERS IN THE SITUATION
1. One-person-show policy
2. No toleration of mistakes
3. Criticality of decisions
4. Urgency, leaving no time to explain (crisis management)
5. Confusion in responsibility and authority
6. Understaffing

LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS ASSOCIATED WITH

DELEGATION:

LEADERSHIP ROLES
1. Functions as a role model, support, and resource person in delegating
tasks to the subordinates.
2. Encourages followers to use delegation as a time management strategy
and team building tool
3. Assist followers in identifying situations appropriate for delegation
4. Communicates clearly and assertively in delegating tasks
5. Maintains patient safety as a minimum criterion in determining the most
appropriate person to carry out delegated tasks.
6. Is an informed and active participant in the development of local, state and
national guidelines for UAP scope practice.
7. Is sensitive to how cultural phenomena affect transcultural delegation

MANAGEMENT FUNCTIONS
1. Creates job description / scope of practice statements for all personnel,
that conform to national state and professional recommendations for
ensuring patient care.
2. Is knowledgeable regarding legal liabilities of subordinate supervision
3. Accurately assesses subordinates’ capabilities and motivation when
delegating
4. Delegates a level of authority necessary to complete delegated tasks
5. Develops and implement a periodic review for all delegated tasks.
6. Provides recognition or reward for the completion of delegated tasks.

COMMON DELEGATION ERRORS

1. Underdelegating
2. Overdelegating
3. Improperly delegating

SUPERVISION

It is to inspect, to guide, to evaluate and improve work performance of

employees through the criteria against which the quality and quantity of work
production and utilization of time and resources are made. The atmosphere
created by the supervisor during rounds or talks will determine to a large extent
the acceptability of the comments, criticism and / or corrections she makes
- it is the development and enabling process whereby the supervisor
ensures that work is done effectively and efficiently by the person being
supervised and at the same time keeps the person satisfied and motivated
with his work.

OBJECTIVES:
1. Identify the supervisory needs of the student
2. determine ways of meeting the needs of the workers
 3. develop the capability of the worker to solve own problems and meet own
needs by providing continuing personal guidance and professional
development
4. evaluate the performance of the worker as it becomes the basis for
providing help or guidance.

METHODS AND TOOLS FOR SUPERVISION

METHODS TOOLS
o Analysis of records and reports Record forms
o Personal data sheet of the
worker
o Client record
o Performance evaluation
o Daily Time record
o Record submitted
o Accomplishment reports
o Target Client list
o Actual Observation of worker’s Observation guide in form of:
Performance in various situations o Questionnaire
• Clinic o Checklist
• Home visit
• Conduct of individual or
group classes
• Nursing Conferences
• Organization/
implementation
of projects and activities
Individual / group conferences and Anecdotal report
meetings Critical incident report
Performance evaluation form
Minutes of meetings
Manuals / handbook
Modules / case studies
Nursing audit
Supervisory logbook

Problems in supervision
1. inadequate skills, knowledge and attitude
2. conflict between organizational and individual goals
3. work and personal situation
4. lack of motivation

SUPERVISORY TECHINQUES
1. Observation of the worker while making rounds
2. spot checking of charts through nursing audits
3. asking patient about the care they receive
4. looking into the general condition unit
5. getting feedback from co-workers or other supervisors or relatives
6. asking questions discretely to find out the problems they encounter in the
wards
7. drawing out suggestions from the workers for the improvement of their
work or work situation.

Evaluation of self- performance

Self – appraisal
- promotes dignity and self respect
- less structured approach that promotes employee acceptance of plan for
improvement and uses the manager as a coach rather than a judge
- ensures that a person is prepared for the discussion and increases the
perception of fairness
- personnel may be fearful of punishment
- rate themselves low to avoid disagreement with the boss, or evaluate
themselves high to influence the supervisor
- if used alone can provide inaccurate picture
- if not consistent with other available data, manager should confront the
differences

CONFLICT MANAGEMENT

CONFLICT – internal and external discord that results from differences in ideas,
values, or feelings between two or more people.

CAUSES OF CONFLICT

1. Defiant behavior – produces guilt feelings in the person to whom it is

directed. The nurse manager should take the position that the person who
experiences defiance is responsible for the conflict.

2. Stress – include having too little responsibility, lack of participation in

decision making, lack of managerial support, having to keep up with
increasing standard of performance and coping with rapid technological
change.

3. Space – crowded units causes stress that leads to burn out and turnover

4. Physician authority – nurses today want to be more independent to have

professional responsibility and accountability for patient care.

5. Belief, values, and goals – Incompatible perception or activities create

conflict. Personal goals frequently conflict with organizational goals within
which the nurses work

6. Other causes – change, organizational climates and leadership style, off –

the job problems, age.

TYPES OF CONFLICT
1. Intersender – arises when an individual receives conflicting messages
from two or more sources

2. Intrasender – conflicts originates in the sender who gives conflicting

instructions or expects conflicting or mutually exclusive behavioral
response.
 3. Interrole – occurs when an individual belongs to more than one group

4. Person – role – results from disaparity between internal and external role

5. Interperson – common between two people whose positions require

interaction with other people who fill various roles in the same organization
or other organizations

6. Intragroup – occurs when the group faces a new problem, when new
values are imposed on the group from outside, or when one’s extragroup
role conflict with one’s intragroup role.

7. Intergroup – Common where two have different goals and can achieve
their goals at the others expense.

8. Role ambiguity – a condition in which individuals do not know what is

expected of them.

9. Role overload – a person is simply unable to accomplish so much within a

limited time period. – quality is sacrificed; conflict remains, reemerge and
be more exaggerated

CONFLICT RESOLUTION
1. Avoiding
- creates a lose – lose situation through unassertive and uncooperative
means
- conflict not addressed properly; conflict remains, reemerge and be more
exaggerated

2. Accommodating
- cooperative but unaasertive; self – sacrificing
- by complimenting one’s opponent and accentuating points of agreement
on minor issues, but the real problem is still have to be dealt with.

3. Compromising
- willingness to yield less than accomodaters but more than competitors as
they seek expedient

4. Collaborating
- is assertive and cooperative; a win-win strategy; most effective since both
parties try to find mutually satisfying solutions.

5. Competing
- power – oriented mode; assertive but uncooperative; one is aggressive
and pursues one’s goals at the expense of the other; creates a win – lose
situation; trust creates an atmospheres conducive to successful conflict
resolution
 STRATEGIES FOR CONFLICT RESOLUTION

WIN – LOSE LOSE - LOSE WIN – WIN

Position power Compromise Consensus

Mental or physical power Bribes Problem solving
Failure to respond Arbitration Collaborating
Majority rule General Rules
Railroading
Competing

MODEL FOR MANAGING CONFLICT

1. Determine the basis of the conflict
Intrapersonal
Interpersonal
Group
Intergroup
Organizational

2. Analyze the sources of the conflict

Cultural differences
Different facts
Separate Pieces of information
Different perceptions of the event
Defining the problem differently
Divergent views of power and authority
Role conflicts
Number of organizational levels
Degree of organization levels
Degree of association
Parties dependent of others
Competition for scarce resources
Ambiguous jurisdiction
Need for consensus
Communication barriers
Separation in time and space
Accumulation of unresolved conflict

3. Consider alternative approaches to conflict management

Avoiding
Accommodating
Compromising
Collaborating
Competing

4. Choose the most appropriate approach

5. Implement the conflict management strategy

6. Evaluate the results

High

Nurse manager with a high Nurse manager who

Level of concern for people combines high regard for
and human relationship with people with deep concern
secondary concern for work for accomplishing work.
accomplishment. Uses the Uses the confronting,
smoothing, accommodating collaborative, problem
C approach. solving approach
O (Lose / Win) (Win / Win)
N
C
E
R Nurse manager who functions
adequately, balancing the
N necessity to get the job done
while maintaining morale at a
F Satisfactory level; maintains
O status quo. Uses compromise,
bargaining approach
R (Lose / Lose)

S
T
A
Nurse manager has low Nurse manager has primary
F concern for work
regard for both task and
F relationships. accomplishment in an
Shows lack of concern for authoritarian manner,
clear articulation of goals. allowing a minimal
Uses avoidance, withdrawal interference from human
and indifferent approach. relationship. Uses power /
(Lose / Lose) competition, restriction and
force
LOW ( Win / Lose)

Low High

* Leadership styles and conflict resolution

LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS ASSOCIATED

WITH CONFLICT RESOLUTION

LEADERSHIP ROLES
1. Is self – aware and conscientiously works to resolve intrapersonal conflict
2. Addresses conflicts as soon as it is perceived and before it becomes felt
or manifest
3. Seeks a win-win solution to conflict whenever feasible
4. Lessens the perceptual differences that exits between conflicting parties
and broadens the parties’ understanding about the problems.
5. Assists the subordinates in identifying alternative conflict resolutions
6. Recognizes and accepts the individual differences of staff
7. Uses assertive communication skills to increase persuasiveness and
foster open communication.
MANAGEMENT FUNCTIONS
1. Creates a work environment that minimizes the antecedent conditions for
conflict
2. Appropriately uses legitimate authority in a competing approach when a
quick or unpopular decision needs to be made.
3. When appropriate, formally facilitates conflict resolution involving
subordinates
4. Accepts mutual responsibility for reaching predetermined supraordinate
goals
5. Obtains needed unit resources through effective negotiation strategies.
6. Compromises unit needs only when the need is not critical to unit
functioning and when higher management gives up something of equal
value
7. Is adequately prepared to negotiate for unit resources, including the
advance determination of a bottom line and possible trade-offs
8. Addresses the need for closure and follow up the negotiation.

CAREER PLANNING

Career – the work one chooses as an occupation for life.

Path – an established way, course or track in which everything has moved

Career Path - is an organized or individual process for identifying specific job

opportunities with an organization and the sequential steps in education, skills
and experience building needed to attain specific career plans

Career Development
– Planning and implementation of career plans
– A critical life process involving both the individual and the
employer
– Accomplished through assessment of oneself and one’s work
environment, job analysis, education training, job research and
acquisition and work experience.

Career Plan – concerns where you are today and where you are going
tomorrow.

Career Planning
- represents individual responsibility
- include – evaluating one’s strengths and weaknesses, setting goals,
examining career opportunities, preparing for potential opportunities and
using appropriate development developmental activities
(exploration, opportunities and change)
- must be an on-going, conscious and deliberate process)

Career mapping
- is a strategic plan for one’s career
- provides direction for formal education, experience, continuing education,
professional association and networking

CHOOSING, RETAINING, RESIGNING AND DISMISSAL FROM A POSITION

Choosing a field of Nursing – people differ in their choice of a particular field of
nursing. Long and short-range goals should also be considered. Self –evaluation
is the first consideration nurses must take.

Factors to consider in self-evaluation:

1. Qualifications
o educational qualifications. (Bachelor of Science in Nursing) Deans,
Chief Nurses or Directors of Nursing (Master Degree in Nursing)

2. Years of experience and training

o Special Areas (OR, ICU, CCU and ER) requires experience in
these areas; staff nurse position may not require experience and
training.

3. Age and physical condition

o Young nurses are preferred for beginning positions
o Older nurses may feel comfortable in administrative positions.

4. Emotional stability and goals in life

o Objectives and philosophy in life determine the kind of field you
wish to get into.

Factors in selecting a field of Nursing

1. Kind of work to performed
a. Are you prepared for the job?
b. Can you work under stress?
c. Do you get along well with people?
d. Are you interested in it?
e. What kind of Skills are needed
f. Is it hazardous?

2. Availability of the work.

a. Will you choose a field of nursing that is crowded?
b. Or where there is a shortage of nursing?

3. Hours of work
a. How many hours a week do you go on duty?
b. Is your work rotated on shifts?
c. Will you be paid for extra hours of duty you perform?

4. Qualification
a. What are the requirements in terms of educational qualifications?
Experience? Training?

5. Opportunities for advancement

a. What chances do you have in being promoted after several years of
employment?
b. Will they allow you to go school if you so desire?
c. Are you allowed to attend professional meetings / seminars on
official time?

6. Method of entering
a. Do you need an examination to enter?
b. Do you need someone to recommend you?
 7. Earning
a. How much is the initial salary?
b. The maximum salary?
c. Is salary paid weekly or every fifteen days?
d. Is traditional pay given for overtime work?

8. Fringe Benefits
a. How many days of vacation and sick leaves are given? Maternity
leaves? Education leaves?

9. Other Benefits
a. Are insurances, medicare, retirement benefits provided for?
b. Can nurses participate in discussion of condition of work?

Retaining position – leads to self-satisfaction and building a career in nursing.

Suggested ways to become successful in the chosen field.

1. Have adequate knowledge and preparation for the job

Update you knowledge through reading of professional literature and
attending seminars.

2. Have a well developed personality

Cultivate pleasing personality.

3. Develop a good interpersonal relationship with co-workers by;

a. Being enthusiastic, dedicated to work and being sincere and
considerate with others.
b. Being tactful and dependable
c. Developing ability to adhere to social amenities and being socially
compatible.
d. Having self-confidence and being cheerful.
e. Offering help when needed.

4. Develop proficiency in communications

5. Being able to adjust to working conditions and to life pattern
characteristics of particular occupations and communities.
6. Keep a breath with advances in medicines, nursing and related sciences.

Causes of Failure in retaining position

1. Incompetence or lack of the required ability and knowledge for a particular
job.
2. Poor interpersonal relationship
3. Personal defects
4. Inadequate knowledge in social conduct
5. Indifference to need for professional growth.

How to turn failure into success

1. Know your weaknesses by accepting your limitations – and then
overcome them.
2. Learn how to fit and adjust to the position. (Be competent to the job – be
the best of all the time)
3. Put high values on honor, sense of gratitude, shame, emotion and
responsibility (dismissal on a job is considered family tragedy)

Resigning from a position – to seek a better position (primary reason)

1. Keep position for at least two years if position is acceptable to them.
 2. If advantage of leaving far outweighs the reason for staying, consider to
make a change.
3. If offered a better position, talk it over with the employer.
4. Observe an “open – door policy”
(Leave a friendly feeling towards superiors and co-workers. A
reference letter may be needed later or one may decide to return to the
institution of agency)
5. Give advance notice
One month – for those handling a staff nurse position
Six months – for those in or administrative positions.
6. Submit a resignation letter observing the following points:
a. Date of resignation
b. Reasons for leaving
c. Expression of gratitude for kindness and consideration given during
the period of employment.
d. Clearance for money, work and property responsibilities.
Never walk off form a position to avoid liability for breach of
contract and abandonment of duty (French leave or AWOL)

Dismissal from a position

Reasons for being dismissed include:

1. Negligence
a. Failure to use reasonable care
b. Doing of something which is a reasonably prudent person would
not do.
c. Failure to do something which a prudent person would do under
similar circumstances.
d. A departure from what an reasonable member of a community
would do in the same community.

2. Incompetence
a. Unable of incapable of doing something

3. Malpractice
a. (mala praxis) bad or unskillful practice of a physician or other
professional person, such as midwife, lawyer, etc. whereby the
health or the welfare of the patient or client is injured
b. The failure of a professional to follow accepted standards of
practice of his or her profession
c. Considered a misdemeanor since it breaks the trust which the
patient has put in the physician., and tends directly to destruction.

4. Unprofessional behavior or breach of contract

Examples of unprofessional behavior:

a. willfully betraying a professional secret
b. making sexual advancement
c. Requesting sexual favors or engaging in any other verbal conduct
or physical conduct of a sexual nature
d. Requesting sexual favors or engaging in any other verbal conduct
of a sexual nature
e. Making any false fraudulent statement, written or oral, in connection
with the practice of medicine
f. Failing to reasonably disclose and inform the patients or the
patient’s representative of the method, devise or instrumentality the
 licensee uses to treat the patients’ disease, injury, ailment or
infirmity

Breach of contract – violation of contract by failing to perform one’s

contractual obligations

• Due process of the law must be observed before nurses can be

dismissed from their work.

MEMBERSHIP IN DIFFERENT PROFESSIONAL ORGANIZATIONS

Professional organization – a group of people who share a set of professional

values and who decide to join their colleagues to affect change.

Advantages:
1. May receive information on the history of the organization, future meetings
and current activities, officers contact information and local contacts.
2. Carry out their missions and conduct activities and business

Reasons for involvement:

1. Sense of responsibility to the profession or the hope they contributing to
the greater good of the profession.
2. Desire to enhance their resume’ and marketability purposes
3. To promote their profession, have particular legislative interest or have
other social reasons.
4. Organization of choice can help improve conditions and care for their
patients.
5. To become active participants by joining committee work, running for
office or taking other leadership roles.
6. Can improve using nursing morale.

Benefits for the organization involvement:

1. Substantial discount on continuing education
2. Certifications
3. Credentialing
4. Group insurance plan for professional liability, hospitalization and disability
5. Travel service such as auto rentals, hotel stays and restaurant visit
6. Quick access to staff experts on practice and advocacy
7. Professional standards
8. Discounts on professional journal.

NURSING ORGANIZATION

I. Nursing Associations in the Philippines

A. Alumni Association – first association a nurse joins upon graduation
Objective – to provide graduates with opportunities to:
1. Keeping abreast of school activities, programs and / or
problems thus assisting the school to develop along sound
lines
2. becoming interested, well informed and active members of
their professions or of a other fields of endeavor and being
increasingly useful and helpful members of the society;
3. keeping school friendship alive. The joy of meeting school
mates and recalling meaningful experiences are precious
moments money cannot buy;
 4. Assisting individual members of the association in job
placements or in other ways deemed necessary.
5. assisting in securing endowment funds / money for a
variety of purposed such as the establishment of
scholarships and procurements of loans.
6. recognizing outstanding alumni through an achievement
program. This serves as inspiration to students and your
graduates
7. becoming a part of an organization through which their
alma mater continues to be of service to them after
graduation through cooperative programs of continuing
education; and
8. helping to interpret the program of the school to recruitable
students so that in return , only quality students can be
admitted for training.

B. Professional Associations

1. Philippine Nurses Association (PNA)

Former name – Filipino Nurses Association
Organized – October 22,1922 initiated by Mrs.Anastacia Giron Tupas
First president – Mrs. Rosario Delgado
Journal – Filipino Nurse no called “The Philippine Journal of Nursing”

Purposes:
1. to attain optimal level of professional standards
2. to work for the welfare of member nurses
3. to respond to the changing health needs of the Philippine Society
4. to establish linkages with government, national and international agencies in
the attainment of national health goals and welfare of member nurses.

2. The National League of Government Nurses (NLGN)

Former – Department of Health National League of Nurses (DHNLN)
Founder – Annie Sand (nursing consultant of DOH on Jan. 16. 2961.

Objectives:
1. to promote and maintain the highest standard of nursing In government
2. to address problems concerning nurses and nursing through participation
in formulation of all policies, guidelines, programs and laws affecting
nurses and nursing practice in the Philippines.
3. to continuously upgrade professional competence through research,
training scholarship grants both foreign and local, and dissemination of in
formation through nursing publications.
4. to collaborate with government, non-government and other allied
professional groups for the promotion of health services.
5. to foster national and international goodwill among nurses and harness all
energies towards the attainment of common goals
6. to help advance the science and art of nursing in the Philippines to meet
the needs of changing society.
7. to recognize the exemplary performance and accomplishments of
members.

Categories of membership
1. Regular – nurse who have rendered a minimum of five-year service in any
government agency
 2. Life – nurses who have been a members for at least three successive
years and have pain the required life membership fee

3. Honorary - people who have outstanding service to the cause of nurses

and nursing and elected to such membership by the board but have no
voting privileges

3. Association of Nursing Service Administrator of the Philippines Inc.

(ANSAP)
Founded – 1963 but recognized In 1973; composed of nurse
service administrators both in government and private agencies.

Objectives:
1. Provide dynamic leadership in the acquisition of knowledge and
techniques in nursing service administration.
2. uphold the highest standards of professional ethics, integrity, and
dedication to the case of nursing and nursing service administration
3. initiate programs which will elevate members to the highest level of
competence in nursing administrative practice.
4. keep abreast of latest research findings, initiate and / or conduct research
and / or disseminate results thereof for information and / or improvement
of nursing practice
5. pool resources through collaborative action with other national nursing
associations for the promotion of professional, social and economic
welfare of nursing service practitioners through legislative and or other
means
6. participate actively and stand courageously in support vital issues
affecting public welfare

Nursing Standards developed:

1. Standards of Nursing Service and Nursing Practice
2. Standards in Critical Care
3. Standards in Community Health
4. Standards in Operating Room
5. Standards in Psychiatric Nursing Practice

a.

4. Association of Deans of Colleges of Nursing in the Philippines.

First established – 1959 with Deans of College of Nursing as members.

Purposes:

Main purpose – To promote, elevate and maintain the standards of clinical

instruction program of nursing students and to improve nursing service facilities
of the clinical field in hospitals and public health agencies.

Other purposes:
1. to participate in the formulation of legislations affecting nursing education.
2. to make representations in discussion of problems and solutions of the
same to the Department of Health, Evaluation Committee on Accreditation
of Training and the Student Affiliation, Budget office / Congress as the
case may be
5. The Military Nurses Association of the Philippines

Officially organized – September 5, 1965 in V. Luna Hospital AFP in

Quezon City by a group of dynamic nurses and corps officers both active and
inactive and retired.

Official organ – Philippine Military Nursing Journal

Objectives:
1. to establish and maintain the highest standard of military nursing in Armed
Forces of the Philippines
2. to develop the social, cultural and educational well – being of its members
in line with current trends in nursing
3. to cultivate and maintain the spirit of camaraderie and promote the general
welfare of its members
4. to encourage active participation in the activities of both local and national
nursing organizations and to promote effective cooperation and
coordination among the military nurses and members of allied professions.
5. to publish periodicals and bulletins as sources of information and
guidance.
6. to establish a code of conduct for its members
7. to promote reciprocity between military nurses of the Philippines and those
of Allied countries
8. to undertake activities that are geared toward social action and community
development.

6. Occupational Health Nurse Association of the Philippines

formerly known as – industrial Nursing Unit of the Philippine Nurses Association

established – November 21, 1950 to promote friendship and to organize nurse in
industrial and commercial enterprises into an Industrial Nursing Unit

Objectives:
1. to contribute to the promotion of public health through the conservation
and promotion of the industrial worker’s health and that of the family
2. to keep up with modern methods and techniques of public health nursing
in general and of industrial nursing in particular in order to promote the
quality and quantity of nursing service
3. to provide expert nursing guidance for industrial health workers.
4. to attain good relationship and understanding among industrial nurses in
particular and all nurses in general.
5. to provide a medium whereby common problems of industrial nurses may
be threshed out for the benefit of all.
6. to raise insight of industrial nurses beyond the walls of their industrial
clinics so they may see their practice not only in nursing service but in the
total public health program as well
7. to gain support from agencies employing nurses

7. Philippine Association of Public Health Nursing Faculty

Organized – September 1961

Objective:
1. To standardize and broaden instructions in Public Health Nursing
2. To undertake that which will enhance professional growth
8. Private Duty Nurse Association of the Philippines
Founding officer – Mrs. Grace Oppus Villanueva

9. Operating Room Nurses Association of the Philippines

Objectives;
1. to develop standards of nursing care for all patients before, during and
after operation.
2. to provide opportunities for professional and personal growth through:
a. an exchange program within the country and with other countries
b. seminars and conferences designed to keep its members abreast
with the new techniques in operating room management and the
use of modern and sophisticated instruments and apparatus.
c. Cooperation and coordination in all its projects and activities

10. Psychiatric Nursing Specialist Foundation of the Philippines (PNSI)

Psychiatric nursing is an interpersonal process whereby the professional
nurse practitioner assist an individual, family or community to promote mental
health, to prevent or cope with experience of mental illness and suffering if
necessary, and to find meaning in these experiences.

Objectives:
1. to provide therapeutic and supportive needed to help the client and his
family in the formers relearning to live in the community
2. to help the client identify and develop his inherent potentials and latent
abilities and to utilize these in his effort toward self-reliance and success
3. to undertake research studies in the field of mental health and psychiatric
nursing
4. to offer educational programs in mental health – psychiatric nursing

11. Catholic Nurses Guild

Official organ – Catholic Nurses Guild Magazine

Purposes:
1. to promote the spiritual welfare of the nurses and to aid them in promoting
the spiritual welfare of those under their care.
2. to participate and encourage the members to strive always to advance in
professional and technical competence along the lines of scientific
progress following Christian principles
3. to study and coordinate governmental legislations affecting hospitals and
colleges of nursing, public health and to be alert to meet the problems
arising from such legislations.

12. Integrated Registered Nurses of the Philippines (IRNUP)

Integration – bringing together all individual registered nurses in the
country under one corporate body

Established – December 28, 1995 at the Lung Center of the Philippines

Purpose:
To provide a medium through which the Filipino registered nurses can
share their common interest working in a unified manner to develop the
contribution of nursing to the health of the Filipino people and to the achievement
of national health development goals.

Objectives:
 1. the provision of direction and guidance in nursing development in the
country
2. the improvement of nursing practice through education and research.
3. serving as unified voice for nurses and nursing nationality
4. the improvement of the professional, social and economic positions of
nurses
5. serving as the reference / referral center for information on nurses and
nursing for both members and the public at large
6. provision of a forum through meetings and conventions where they may
come in contact with their peers, exchange information, seek support and
form network and alliances
7. representation of nurses and nursing in any form requiring nursing input
and be the authoritative voice for nursing
8. working with heath and health-related sectors in the pursuit of achieving
health goals influencing Philippines 2000

13. International Nursing Foundation of Japan (INFJ) Scholars Association of the

Philippines.

Objective: To promote the highest professional standards of the nursing

profession and provide expertise and assistance in various settings in our
country

C. The National Allied Organizations

1. The Philippine National Red Cross (PNRC)

a. Created by R.A. 95 on March 22, 1947
b. Major services – disaster preparedness and relief service, blood
program, safety services, nursing service, Red Cross Youth and
social services

II. International Nursing and Allied Organization

1. The International Council of Nurses

Objective: To provide a medium through which national nurses

associations may share their common interests by working together to
develop the contribution of nursing to the promotion of health of the people
and the care of the sick

• official organ – International Nursing Review published 4x a year

2. International Committee of Catholic Nurses (ICCN)

Objectives:
a. To encourage in all countries the organizations and development
of Catholic professional organizations that are capable of giving
moral and spiritual support to catholic nurses (and all public health
nurses) as well as helping them perfect their techniques
b. To coordinates efforts of Catholic professional associations while
respecting their autonomy, in order to study and to represent
Christian thought in the profession in general

3. World Health Organization (WHO)

Main activities:
• assistance to countries for the improvement if health services
• for education and training in the firld of health
 • for fighting communicable diseases, coordination and stimulation of
medical research
• exchange of information on public health and worldwide reporting
of outbreaks of dangerous diseases
• programs involving malaria and smallpox eradication
• cancer and heart disease research.
• Air and water pollution
• Dangerous drugs and water supply

4. International Red Cross

Fundamental Principles of the IRC and Red Crescent Movement

1. Humanity
§ protect life and health and ensure respect for the human
being
§ promote mutual understanding, friendship, cooperation and
lasting peace amongst all people

2. Impartiality
§ makes no discriminations as to nationality, race, religious
beliefs, class or political opinions
§ endeavors to relieve the suffering of individuals, being
guided solely by their needs and to give priority to the most
urgent distress

3. Neutrality
§ not taking sides in the hostilities or engage at any time in
controversies of a political, racial, religious or ideological
nature

4. Independence
§ must maintain their autonomy so that they may be able at all
times act in accordance with the principles of the movement

5. Voluntary Service
§ is a voluntary relief movement not prompt in any manner by
desire for gain

6. Unity
§ must be open to all; must carry on its humanitarian work
throughout its territory

7. Universality
§ all societies have equal status and share equal
responsibilities and duties in helping each other

CONTINUING EDUCATION PROGRAM

Continuing Education Program

- consist of planned learning experiences beyond basic education program
- the inculcation, assimilation and acquisition of knowledge, skills and
proficiency and ethical and moral values after initial registration of a
professional, raise and enhance professional’s technical skills and
professional competence.
Objectives:
1. to provide and ensure the continuous education of a registered
professional with the latest trends in the profession brought about
by modernization and scientific and technological advancement
2. to raise and maintain the highest standard and quality of the
practice of the professions
3. to make he professional globally competitive
4. to promote the general welfare of the public

In-service education
- a planned program provided by the employing agency to its employee
- viewed as part of continuing education
- focuses on and designed to re-train people to improve their performance
and communication ability to get them started in the never-ending
continuum of education

Major goal
• improvement of professional practice
• fullest development of the nurse as a person and as contributing
members of the society

BOARD OF NURSING RESOLUTION NO. 1903.S. OF 1985 – continuing

professional education program for nurses became effective in 1988.

Formal Studies Leading to Degree Courses:

1. Baccalaureate Degree in Nursing

i. No supplemental BSN course anymore
ii. Former graduates of the three-year basic program must enroll in the
regular course under the new curriculum

2. The graduate Education in Nursing

i. Education beyond the baccalaureate degree
ii. Program leading to a master’s degree in a chosen area of study
iii. Prepares leaders in nursing who will influence the practice and study of
the profession by generating higher levels of competence and by
teaching, administering and investigating professional practice
iv. A graduate is a critical, self-directed practitioner, an effective
professional leader, and a productive contributor to the profession of
nursing

Major Purpose: Prepare nurse capable of improving nursing care through the
advancement of nursing theory and science.

3. The Doctoral Degree Program

i. Prepares nurses for various positions such as administrators of nursing
colleges, nursing specialists, consultants of nursing services, nursing
education programs or hospital services.

Nurse qualities:
• should consider their competencies, the quality of their professional
experience; the quality of their scholarship, the ability to do creative
writing that will explain, interpret and stimulate thinking and action
• must have a great deal; of drive and ability to take criticism and
resolve conflicting recommendations and still retain self-control and
an objective point of view.
Other forms of continuing education programs:

1. Seminars
The gathering of professionals and include among others –
workshops, technical lectures or subject matter meetings, non
degree training courses and scientific meetings

2. Conventions
The gathering of professionals and include among others –
conferences, symposia, assemblies for round table discussions

3. Residency
Apprenticeships training at the graduate level, which is beyond the
basic preparations for health professional conducted by duly
accredited hospitals and medical centers

4. Distance Learning
Correspondence learning which uses course manuals or accredited
learning modules which include instructional materials, or programs
which may include cassette tapes, films, computerized assisted
learning (CAL), study kits, learning aids and modules or the use of
information highway. (include clearly defined objectives, adequate
content and an evaluation content for each module.

Continuing Professional Education Units (CPEU) as pre-requisite for licensure

1988 – require all Filipino Nurses who will renew their licenses to present 60
contact hours of CPEU (20 hours / year) since license is renewed v=every 3
years

PRC Resolution no 624 of August 11, 1999, Sec 18, Article IV and Sec 19 of
Article V of PRC Resolution No. 507 S. 1997
- repealed and CPEU was no longer required for licensure.

However;

CPEU is still encouraged as ethical and moral obligations to enhance their

knowledge, attitudes and skills for competent and safe practice.

However in 2004

PRC resolution no. 2004 – 179 s. 2004 CPEU was again implemented for
registered professionals. Any excess units earned are not carried over to the next
three – year period except credit units earned for doctoral and master’s degrees.

Requirement for Inactive Nurses Returning to practice (5 consecutive years)

• one (1) month of didactic training

• three (3) months of practicum – from hospitals accredited by the
BON to conduct the said training program

Other institutions / agencies offering continuing education program

1. National professional nursing associations
a. Philippine Nurses Association
b. League of Government Nurses
c. Associations of Nursing Service Administrators of the Philippines
 2. professional organizations representing various nursing specialties
a. Critical Care Nurses Association of the Philippines
b. Psychiatric Nursing Specialist, Inc.
c. Occupational Health Nurses Association of the Philippines
d. Operating Room Nurses of the Philippines

3. Health agencies with specialties

a. Philippine Heart Center
b. Philippine Children’s Medical Center
c. Lung Center of the Philippines
d. National Kidney Institute
e. St. Luke’s Medical Center

4. employing agencies in the form of in – service training program

Objectives:
• equip new employees with the basic organizational information to
enable him / her to adapt to the new situation
• further enhance the skills of nurses to provide the quality patient
care with focus to keep updated on new concepts, knowledge and
techniques that relate to special nursing care like intensive, care
units, operating room, neonatal or pediatric units, coronary or
respiratory care.
• Prepare nurses for leadership positions who are given special
training for promotion and / or develop a ready pool of trained
nurses for supervisory positions

Some other forms of continuing education programs are the following:

1. Seminars – refers to gathering of professionals and include among others

– workshops, technical lectures or subject matter meetings, non – degree
training courses, and scientific meetings

2. Conventions – refer to the gathering of professionals and include among

others conferences, symposia or assemblies for round - table discussions

3. Residency – refers to apprenticeship training at the graduate level, which

is beyond the basic preparation for health professionals. This is conducted
by duly accredited hospitals and medical centers.

4. Distance Learning – refers to correspondence learning which uses

courses manuals or accredited learning modules – which are instructional
materials or programs that may include cassette tapes, films,
computerized assisted learning (CAL), study kits, learning aids and
modules or the use of information highway; include among others, clearly
defined objectives, adequate content and an evaluations content for each
module.

5. On-the-job training – externship training specialization at the post-

graduate level for a minimum period of four weeks.
PLANNING

Planning – is a defined as pre – determining course of action in order to arrive at

a desired result. It is the continuous process of assessing, establishing goals and
objectives, implementing and evaluating them, and subjecting these to change as
new facts are known. While planning is largely conceptual, its results are clearly
visible.

PRINCIPLES OF PLANNING

1. Planning is always based and focused on the vision, mission, philosophy, and
clearly defined objectives of the organization.
2.Planning is a continuous process. Provision for proper analysis would indicate
a revision or flexibility to be done to make it more effective.
3.Planning should be pervasive within the entire organization covering various
departments, services, and the various levels of management to provide maximal
cooperation and harmony.
4.Planning utilizes all available resources.
5.Planning must be precise in its scope and nature. It should be realistic and
focused on its expected outcomes.
6.Planning should be time – bound, i.e., with short – and long range plans.
7.Projected plans must be documented for proper dissemination to all concerned
for implementation and evaluation as to the extent of its achievement.

SCOPE OF PLANNING – means how far the manager can go in developing

plans for self and others.

G the higher the level of position the more critical the scope
G the further down the level the lesser the scope of planning
Top management or the nursing directors, chief nurses and their assistants set
the over – all goals and policies of an organization
Middle management or nursing supervisors direct the activities to actually
implement the broad operating policies of the organization such as staffing and
delivery of services to the units. The formulation of policies, rules and regulations
methods and procedures for intermediate level planning.
Lower or first level management, the head nurses or senior nurses ( including
charge nurses ) do the daily and weekly plans for the administration of direct
patient care in their respective unist.

IMPORTANCE OF PLANNING

Nurse managers should know how to plan for several reasons:

1. Planning leads to success in achieving goals and objectives

Workers relate what they do to meaningful results since plans are focused
on objectives.

2. Planning gives meaning to work

Employees or workers experience greater satisfaction if what they do
becomes meaningful to them.

3. Planning provides for effective use of available personnel and facilities

The best use of personnel and material resources prevents wastage
4. Planning helps in coping with crises. Hospitals should provide for disaster
plans. This allows the workers to function more clearly and efficiently
when actual emergencies occur such as fire, typhoons, earthquakes, or
 during New year celebrations and/or other occasions when more people
are likely to get hurt.
5. Planning is cost effective. Costs can be controlled through planning for
efficient operation. For example, projecting the number of operations in a
given day, including daily dressings, helps in determining accurately the
needed weekly supplies in the surgical units so as to prevent undersupply,
oversupply.
6. Planning is based on past and future activities. Evaluation of programs,
schedules, and activities whether successful or not, prevents and/ or
reduces the recurrence of problems and provides better ideas in modifying
or avoiding them.
7. Planning leads to the realization of the need for change. Many hospitals
have found that in – patient hospital days can greatly be reduced by
having the laboratory and diagnostic work –up in the OPD rather than
have these examinations on admission. Minor surgeries are also done at
the OPD so that more hospital beds can be allotted to critically ill patients
or for those needing specialized services.
8. Planning provides the basis for control. It becomes the basis for evaluating
the accomplishment of the set programs/activities.
9. Planning is necessary for effective control. Nurse managers evaluate the
environment or setting in which they work or the patients are confined and
make necessary recommendations to make hospital conditions more
therapeutic not only for the patients but for the workers as well.
Performance of workers and evaluation of services to patients based on
criteria set during the planning stage will indicate where the standards are
met and whether changes are indicated.

WHY MANAGERS FAIL TO PLAN EFFECTIVELY

- Lack of knowledge of the philosophy, goals and objectives of the agency
or lack of understanding of the significance of the planning process.
- They may not know how to manage their time to devote for planning.
- They may lack confidence in formulating plans or may fear that planning
may bring about unwanted changes that they are unwilling to undertake.

MAJOR ASPECTS OF PLANNING

Plans can be understood through four major aspects.

1.Planning should contribute to the objectives. It should seek to achieve a

consistent, coordinated structure of operation focused on desired ends.
2.Planning precedes all other processes of management. Without a paln there
would be nothing to organize, direct, and control. Planning and control are
inseparable.
3.Planning pervades all levels. It encompasses both higher and lower echelons
and vice versa and spreads horizontally through peer levels and/ or across
services and members of the health team.
4.Planning should be efficient. It should contribute to the attainment of objectives
not only in terms of peso value, manhours, unit production but also include
values and group satisfaction.

CHARACTERISTICS OF A GOOD PLAN

A well developed plan should:

- Be precise with clearly – worded objectives, including desired results and
methods for evaluation;
 - Be guided by policies and/ or procedures affecting the planned action;
- Indicate priorities
- Develop actions that are flexible and realistic in terms of available
personnel, equipment, facilities, and time;
- Develop a logical sequence of activities
- Include the most practical methods for achieving each objective,:and
- Pervade the whole organization,

ELEMENTS OF PLANNING

FORECASTING
- Helps the managers look into the future and the agency decide in advance
where the agency would like to be and what is to be done in order to get
there.
- It includes the environment in which the plan will be executed; who the
client will be; the kind of care they will receive; the number and kind of
personnel required, and the necessary resources – equipment, facilities
and supplies

SETTING THE VISION, MISSION, PHILOSOPHY, GOALS AND OBJECTIVES

Vision statement – outlines the organizations future role and function, it gives the
agency something to strive for.

Mission statement – outlines the agency’s reason for existing, who the target
clients are, and what services will be provided.

Philosophy – describes the vision. It is a statement of beliefs and values that

direct one’s life or one’s practice. In an organization , the philosophy is the sense
of purpose of the organization and the reason behind its structure and goals
A written statement of the philosophy explains the beliefs that shape how
the mission or purpose will be achieved. It gives direction toward the attainment
of the set goals and objectives.

Nursing philosophy maybe broad and general, yet it directs nursing

behavior, giving it a sense of purpose. Generally emphasized in the statement of
the philosophy are:
- Quality, quantity and scope of service
- Decision making based on factual information
- Appropriate delegation of function
- Achievement of organizational goals
- Vertical and horizontal communication
- Flexibility to meet the changing needs of the organization, individuals, the
community, and society in general

Goals and objectives differ in that goals are more general and they cover
a broad area. Objectives tend to be specific and are concrete. They are
action commitments through which an organization’s mission and purpose
will be achieved and the philosophy or belief sustained

Philosophy states beliefs values while objectives state specific and

measurable goals to be accomplished.

DEVELOPING AND SCHEDULING PROGRAMS

Programs are determined, developed and targeted within a time frame to

reach the set goals and objectives.
THE PLANNING FORMULA ( KRON )

- WHAT – what has been done, what should be done, what equipment and
supplies have been used or are needed?, what steps are steps are
necessary in the procedure? What sequence of activities was previously
used? what other efficient methods maybe used?
- WHEN – when should the job done? When was it formerly done? When
could it be done?
- WHERE – where is the job to be done? Where does an activity occur in
relation to those activities immediately preceding and following it? Where
could be the supplies be stored, cleaned and so forth?
- How – how will the job be done? What are the steps to be followed in
doing the procedure? How will the time and energy of personnel be used?
How much will it cost? How much time will it require?
- Who – who has been doing the job? who else could do it? Is more than
one person involved?
- Why – why is this job, this procedure, this step necessary? Why is this job,
this procedure, this step necessary? Why is this done in this way, in this
place, at this time, by this person?
- CAN – Can some steps or equipment be eliminated?

TIME MANAGEMENT
Is a technique for allocating one’s time through the setting of goals,
assigning priorities, identifying and eliminating the wasted times and using
managerial techniques to reach goals efficiently.

TIME MANAGEMENT PRINCIPLES

- Planning anticipates the problems that will arise from actions without
thought. Studies have shown that for every hour spent in effective
planning, three to four hours in the execution of the plan is saved.
- Task should be accomplished should be done in sequence and should be
prioritized according to importance.
- Setting deadlines in one’s work and adhering to them is an excellent
exercise in self discipline.
- Deferring, postponing, or putting off decisions, actions, or activities can
become a habit which oftentimes cause lost opportunities and productivity,
generating personal or interpersonal crises.
- Delegation permits a manager to take authority for decision making and to
assign tasks to the lowest level possible consistent with his/or her
judgment, facts, and experience. It frees him/her of some time that can be
devoted to other tasks.

TIME SAVING TECHNIQUES, DEVICES AND METHODS TO BETTER USE OF

TIME
- Conduct an inventory of your activities
- Set goals and objectives and write them down
- With the use of calendars, executive planners, logs or journals, write what
you expect to accomplish yearly, monthly, weekly or daily
- Break down large projects into smaller parts
- Devote a few minutes at the beginning of each day for planning
- Organize your work space so it is functional
- Close your door when you need to concentrate
- Learn to delegate
- In a meeting, define the purpose clearly before starting
- Take or return phone calls during specified time
- Develop effective decision making skills. Do not be afraid to say no
 - Take rest breaks and make good use of your spare time. Reward yourself
periodically

PREPARING THE BUDGET

Budget – annual operating plan, a financial ‘road map’ and plan which serves
as an estimate of future costs and a plan for utilization of manpower, material,
and other resources to cover capital projects in the operating programs.
Nursing Budget – plan for allocation of resources based on pre – conceived
needs for a proposed series of programs to deliver patient care during one
fiscal year.
Hospital Budget – is a financial plan to meet future service expectations.
Budgeting translates these needs to manpower, equipment and supplies so
that both services are provided at the highest level of quality at a minimum
cost.
Budget – is simply a plan for future activities expressed in operational plan as
well as financial or monetary terms. In health care institutions, this composed
of four components:
- Revenue budget – summarizes the income which management expects to
generate during the planning period
- Expense budget – describes the expected activity in operational and
financial terms for a given period of time.
- Capital budget outlines the programmed acquisitions, disposals and
improvements in an institutions physical capacity.
- Cash budget – represents the planned cash receipts and disbursements
as well as the cash balances expected during the planning period

BENEFITS DERIVED FROM THE BUDGETARY PROCESS

- Planning
Budgeting stimulates thinking in advance. It anticipates future opportunities or
problems and prepares for them.
It leads to specific planning such as the volume and type of services to be
rendered and revenue to be derived therefrom; the number and type of
personnel required; the cost, volume and type of supplies needed; their cost
and source of funds, cash collections and disbursements
Budget preparation stimulates action and interaction
-Coordination
The budgetary process has a balancing effect on the total organization, that
is, the quantity and quality of service to be given a patient should closely
equal the expected revenue
Budgeting encourages exchange of information
The budget process stimulates team play or team approach. The budget
becomes a stimulant to employee commitment and efficiency, and an
effective guide to proper utilization of resources.
- Comprehensive Control
The budgeting process gives the administration an opportunity to evaluate the
thinking of the budget contributor. The budget maybe an aid in evaluating
quality and initiative in performance
Once the budget standards are set, comparisons between actual
expenditures and budgeted standards can be made with little or no effort.
Though the budgeting process is flexible, it tends to define fixed and agreed
upon goals.
Cost consciousness is enhanced throughout the institution.

FACTORS IN BUDGET PLANNING

- The type of patient, length of stay in the hospital, and the acuteness of
illness
- The size of the hospital and its bed occupancy
 - The physical layout of the hospital, the size and plan of the ward or units,
the Nurses’ Station, treatment rooms etc
- Personal policies
*salaries paid to various type of nursing personnel, including pay for
overtime or shift differential
*the extent of vacation and sick leaves, holidays, and
*provision for staff development programs including instructional staff
- The grouping of patients such as those in specialized areas
- Standards of nursing care e.g. the kind and amount to be given as it
affects the number of hours of bedside care
- The method of performing nursing care whether simple or complex
- The method of documentation
- The proportion of nursing care provided by professional nurses and those
given by non professionals
- The amount and quality of supervision available and provided
- The efficiency of job description and job classification
- The method of patient assignment, whether functional, case, team or
primary
- The amount and kind of labor saving devices and equipment;
intercommunication systems
- The amount of centralized service provided; sterile supply, central oxygen
service, linen supply
- The nursing service requirements of the ancillary departments; clinics,
admitting office, emergency rooms
- Reports required by administration whether simple or complex, and
- Affiliation of nursing students or medical students e.g., inexperienced
students need more equipments and supplies

THE BUDGETARY PROCESS

- The budget committee must be well defined – assist the budget officer in
budget preparation and in monitoring the budget. The chief nurse or
his/her assistant is usually a member of the committee. The chief nurse
works with supervisors and head nurses. Participation of nursing
personnel in budget preparation and control leads to cost consciousness,
awareness of activities, and increased cost effectiveness.
- Past operations must be analyzed and the overall master staffing plan
must be reviewed.
- In budget preparation, several factors should be considered; assurance of
standards according to the philosophy and objectives of the hospital; past
experiences in the unit and the percentage of unit occupancy
- The estimation of staff for each unit should be based on:
• The number of patients
• The number of nursing care hours needed
• The provision of vacation, sick and other leaves, holidays and the
average number of absences per staff member per year
• Attendance in continuing education programs

- New activities/programs such as new patient services, staff development

programs or changes in hospital services that affect the required nursing
services
- Ascertain the amount and kind of supplies needed for the operation of
each nursing unit. Requests for the replacement of capital equipment must
be supported with documented justification.
- The Chief Nurse compiles and completes the final draft of the budget and
presents this to the Budget Officer or Hospital Administrator.
COMPONENTS OF BUDGET

Cash Budget – forecasts the amount of money received, consists of beginning

cash balance, estimates of the receipts and disbursements, and the estimated
balance for a given period corresponding to that of the operating and capital
budgets. It is prepared by estimating the amount of money to be collected from
patients and allocating it to cash disbursements required to meet obligations
promptly as they come
Operating Budget – deals primarily with salaries, supplies, contractual services,
employee benefits, laundry service, drugs and pharmaceuticals, in – service
education, travels to professional meetings, books, periodicals. Composed of the
revenue and the expense budget
Capital Expenditure – consist of accumulated data for fixed assets that are
expected to be acquired during the budgeted period. These include estimated
costs and sources of funds for expected replacements, improvements and
additions to fixed assets. The combination of individual reports provides
information about anticipated procurements, priorities and timing as well as the
feasibility of acquisition.

KINDS OF PLANNING

STRATEGIC PLANNING

G long-range planning usually extending 3 to 5 years into the

future which examines an organization’s purpose, mission
philosophy and goals in the context of its external environment;
G it organizes efforts necessary to carry out decision and
evaluating results of these decisions against expected outcome
through reliable feedback mechanism.

BASIC FEATURES

G a clear statement of the organization’s mission

G the identification of the agency’s external constituencies or
stakeholders and the determination of their assessment of the
agency’s purpose and operations
G the delineation of the agency’s strategic goals and objectives,
typically in a 3 to 5 year plan.
G the development of strategies to achieve the goals.

PURPOSE

G gives direction to the organization

G improves efficiency
G weeds out poor or underused programs
G eliminates duplication of efforts
G concentrates resources on important services
G improves communication and coordination of activities
G provides a mind – expanding opportunity
G allows adaptation to the changing world
G sets realistic and attainable yet challenging goals.
G help ensure goal achievement.

PHASES OF STRATEGIC PLAN

The focus of strategic plan is usually on the entire organization. Major
activities include:
 1. STRATEGIC ANALYSIS
G also known as the Situational Analysis
G includes the conduct of some sort of scan, or review of the
organization’s environment
G planners also consider the various strength, weakness
opportunities and threats regarding the organization
G SWOT is the acronym for this activity.

G external assessment looks at opportunities and threats

G internal assessment checks for strengths and weaknesses

Strengths & Weaknesses Opportunities Threats

Management development Nurse and physician Shortage of nurses
Qualifications of staff Recruitment Decrease in patient
Abundance or scarcity of Referral patterns Satisfaction
staff New programs Decrease in insured
Medical staff expertise New markets patients
Financial situation Population growth Increase in accounts
Marketing efforts Improved technology receivable
Marked share New facilities Decrease in demand for
Facilities services
Location Competition
Quality of services Regulations
Litigations
Legislative changes
Unionization
Loss of accreditation

2. SETTING STRATEGIC DIRECTION – Planners usually identify or update

strategic philosophy which include identification and update of the mission, vision
and or values statements of the organization. (elements in planning)

3. ACTION PLANNING – the process of laying out how the strategic goals will be
accomplished carefully. Objectives or specified results are often included in
action planning, with each strategic goal. Reaching a strategic goal typically
involves the accomplishment of a set of goals along the way such that an
objective is still a goal, but n a small scale.

OPERATIONAL PLAN

G it is the process of assuring that specific projects are carried out

effectively and efficiently.
G it specifies and activities and procedures that will be used to
achieve then and sets timetable for their achievement.
G it also tells who the persons are for each and every activity and
procedures
G it is also called management plan
G short range planning that deals with day to day maintenance
activities; involves; involves a period of 1 hour to 3 years and
are usually less complex; may be done annually, bi-monthly,
weekly, daily or even hourly.
ESTABLISHING NURSING STANDARDS POLICIES AND PROCEDURES

Established standards in an evaluation process provide professionally

desirable norms against which the department’s performance can be measured.
Areas for improvement are identified, and a plan of action to correct this is made
and implemented

E.g. structure, criteria and standards

STRUCTURE: Organization of Nursing Service

There is an organized Nursing Service / Department which is directed by a

qualified nurse administrator

CRITERION: Philosophy and goals

The nursing service has a written set of philosophy and goals that reflects
the standards prescribed by the nursing profession and provides direction
towards the development of programs to improve the delivery of nursing care. It
shall consider, among other that such philosophy and goals are congruent with
the service goals of the institution.

Standards Philosophy and Objectives – the philosophy shall be based on

the belief that the client is an integral whole and that he is a unique individual
with needs that can be met through the nursing interventions.

The philosophy shall reflect collective views of the nursing personnel and
the clientele served.

The goals and objectives shall reflect the philosophy of the nursing service

The primary goals shall be the provision of the prescribed quality and
quantity of nursing care.

Statements – shall be widely disseminated and interpreted to the extent

possible
- shall be reviewed and revised as necessary

STANDARDS – A predetermined level of excellence that serves as a guide for

practice. Organizational standards outline levels of acceptable practice within the
institution.

Characteristics of standards

G Predetermined
G Established by an authority
G Communicated to and accepted by the people affected by them
G Objective, measurable and achievable

STANDARD OF CARE- the degree of care, expertise and judgement used by

reasonable and prudent nurse under similar circumstances, established by
expert testimony in nursing malpractice cases.

POLICIES – are broad guidelines for the managerial decisions that are
necessary in organizational and departmental planning.
 - govern the action of workers and supervisors at all levels and are
intended to achieve pre – determined goals.
- serve as basis for the future actions and decisions, help coordinate
plans, control performance and increase consistency of action by
increasing the probability that different managers will make similar
decisions when independency facing similar situations

THREE GENERAL AREAS IN NURSING THAT REQUIRE POLICY

FORMULATION

1. areas in which confusion about the locus of responsibility might result in

neglect or malperformance of an act necessary to a patient’s welfare.
2. areas pertaining to the protection of patients and families rights (right to
privacy, property rights)
3. areas involving personnel management and welfare

CHARACTERISTICS OF GOOD POLICIES

1. written and understandable and known by those who will be affected by them.
2. comprehensive in scope, stable, flexible, so that they can be applied to
different conditions that are not diverse that they require different sets of policies.
3. consistent to prevent uncertainty, feelings of bias, preferential treatment and
unfairness
4. realistic and should prescribe limits
5. allow for discretion and interpretation by those responsible for it.

The Nursing Policy Manual

G is an effective for orienting new employees

G a reference when unexpected problems arise
G a basis for developing administrative procedures
G a firm basis for discussion when differences occur
§ A periodic review of policies is necessary to evaluate their
effectiveness and workability
§ Problems in their implementation are discussed including
verification as to whether these are being followed.
§ Should changes be necessary all personnel should be
informed.

Examples of Nursing Service Policies

1. Accident – care, reporting, precautions to prevent occurrence
2. Admissions – receiving, consent, notifying doctor, care of patients
3. Autopsies – obtaining informed consent
4. Breakage – classification, responsibility
5. Bulletin boards – location, posting of information
6. Committees – types, membership, functions
7. Complaints – how handled, action taken
8. Consent – informed consent taken by whom, from who, shared decision –
making with patient and family and / or significant others together with members
of the health team.
9. Death – notification, care and identification, care of personal belongings, death
certificates.
10. Discharge – time, clearances, discharge planning, accompaniment of patient.
11. Doctor’s order – written, verbal by telephone
12. Equipments and supplies – list of expendable and non expendable items,
are, lending, requesting, repairing
13. Fire regulations – drills, prevention
14. Nursing care

a. administration and preparations of – oral medications, IV infusions,

blood transfusion.
b. charting – forms used, of various colors of ink, format considering
legal implications.
c. daily assignment – by whom, where and when
d. emergency drug supply – contents, responsibility, location
e. kardex – use, sample form
f. medication – card system, responsibility, checking, dosages, errors:
reporting, corrections
g. property of patients – responsibility, placement
h. private duty nurses – engaging, obligations to hospital, supervision,
evaluation, remuneration
i. reasonable and due care – definition, explanation, legal implications
j. referrals – within and outside of agency
k. safety devices – siderails, restraints

15. Reports – forms, responsibility

16. Reporting on or off duty – information given when leaving unit
17. Meetings – frequency, purpose, types, membership, minutes

Interdepartmental policies

1. Admissions – type of patient, time, reservations, identifications of patient,

signing of consent.
2. Transfers – request, departments to be notified
3. Discharges – notification, against medical discharge, conduction, clearance
4. Blood blank – how obtained, checking information (type, cross – match),
reactions replacement.
5. Cashier – safekeeping of valuables, clearances
6. Dietary – requisition (diet list, new diets, therapeutic), discharge planning with
nutritionists
7. Laboratory – requests (routine, emergency) record keeping
8. Personnel department – request for additional personnel, interview (pre
employment, exit) record keeping, counseling, grievances, health and welfare,
training, personnel policies, general orientation, record – keeping
9. Pharmacy – ordering of drugs, narcotics and barbiturates regulations,
inspections of stock drugs and solutions in the units, safety procedures.
10. Social service – referrals from various department
11.X – ray – request, preparation of patient (details of the procedure) transporting
of patients.

NURSING PROCEDURES

Procedures are specific directions for implementing written policies

Two areas where procedures are needed

1. Those related to job situations

G Reporting complaints
G Disciplinary instances

2. Those involving patient care

G Safety of the patient
G Comfort while undergoing it
G Proper care
G Use of supplies and equipment
 G Good workmanship on the part of the person doing it

Nursing procedure manuals

G can be effective tool in ensuring that a procedure will be done
according to the agency’s protocol.
G should be available in each unit to familiarize nurse with the
common nursing procedures utilized in that unit
G should be complete, up to date, and properly indexed to
facilitate easy referral
G usually have general format – (definition, purpose, materials
needed, proper requisitioning of supplies, proper disposal of
used equipment, any pertinent information or precaution to take,
legal implications, expected responsibilities of the nurse and the
patient, and proper documentation when such is completed.
G review, updated and / or revised with maximum involvement of
the unit’s nursing staff

DECISION MAKING
G Recognized as the heart of organization and the process of
administration
G a process of scientific problem solving that encompasses
change, conflict, group, dynamics and communication
G a core aspect of management wherein every action by the
leader of group springs from a decision
G the process of selecting course of actions from alternatives

CATEGORIES OF DECISIONS
Personal decision – are those every staff member does in discharging
duties (nurse’s assessment of patient’s needs, planning and implementing care,
and evaluating of outcomes.)

Organizational decisions – relate to the operations of the unit or

department of the entire system and they are concern to all members of the
organizational groups.

PROBLEM SOLVING
G a skills that can be learned by observing others
G can foster good decision – making
G can involve the making of several decisions

STEPS IN DECISION MAKING PROCESS AND PROBLEM SOLVING

1. Recognize, define and limit the problem

2. Analyze and evaluate the problem
3. Establish criteria or standards by which the solution will be evaluated or judged
as acceptable and adequate to the need.
4. Collect the necessary data and information
5. Formulate and select the preferred solutions or actions. Test them in advance
6. Put into effect the selected or preferred solution by:

ETHICAL PRINCIPLES IN DECISION MAKING

AUTONOMY
- personal freedom, freedom of choice, responsibility for one’s choice
(recognized by informed consent and progressive discipline)
BENEFICENCE
- action that the action one takes should be in an effort to promote
good
- can support providing extensive, painful treatments to increase
quantify and quality of life or allowing a person to die without life
support.
- can be used to promote employees positive attributes instead of
their shortcoming

FIDELITY
- keeping one’s commitments and promises ( promises that cannot
be kept should not be made)

JUSTICE
- treating people equally and fairly
( e.g pay raises should reflect performance and time of service)

NONMALIFICENCE
- if you cannot do good at least do no harm
(nurses may need to remember that even pain and suffering can bring
about good for the patient when they are performing painful
procedures for the patient’s benefit)

(performance appraisals should emphasize the employee’s good

qualities and give positive direction for improved performance instead
of destroying self – esteem)

PATERNALISM

- allows one to make decisions for another, limits freedom of choice

(considered an undesirable practice)

RESPECT FOR OTHERS (highest principle)

- incorporates all of the principles; acknowledges the rights of people

to make their own decisions and to live by their decisions.

UTILITY
- What is best for the common good outweighs what is best for the
individual

VERACITY
- people should tell the truth
(telling patients and staff the truth so they can make well informed
decisions)

PERSONAL PARTICIPATION IN DEVISION MAKING

It should be consensus that all affected by a decision should take part in
its deliberating. Advantages include:

1. The discussion provides maximum input with regard to the decision. Nursing
personnel are able to provide a larger number of possible ways of looking at a
problem, more suggestions for a solution, and a greater number of criticisms of
every proposed plan. It is a great possibility that vital information or the best idea
for solving the problem could arise from unexpected sources.
2. The staff members who are involved in a decision making process implement
that decision better.

SHARING – in nursing services, it is the giving the concerned nursing staff

members on opportunity to discuss the issue and express their personal
convictions and concerns.

DEMOCRATIC ADMINISTRATION – believed to be as before decisions are

made, a decision vote of those concerned has to be considered.

INTEGRATING LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS IN

DECISION MAKING

1. Recognizes the appropriate people to include in decision – making and to

use a decision making style suitable for the decision situation.
2. Develops a systematic, scientific approach to problem solving that begins
with a fixed goal and ends with an evaluation step.
3. Is aware of the areas of vulnerability that hinder successful decision –
making and will expend his or her efforts to avoid the pitfalls of faulty logic
and data gathering.
4. Is cognizant that the very act of deciding and evaluating decisions
increases his / her expertise in decision making

DOCUMENTATION

Documentation
- anything printed or written that is relied on as a record of proof for
authorization.
- should be pertinent and concise, and should be reflective of the
patient’s status.
- should provide nursing interventions and the patient’s responses
noted interventions applied and responses noted as well.

Records – a valuable source of data used by all members of the health team for
the following purposes

PURPOSES OF THE RECORDS

1. Communication – facilitates patient’s progress and condition, the measure to
maintain continuity of care, and serve as a reference point for further
assessment.
2. Legal evidence of care – serves as description of what happened to the
patient. Nursing care given no matter how excellent is, if not documented, under
the law care is not rendered.
3. Education – used by students of medicine, nursing and other paramedical
students for educational purposes.
4. Financial billing – hospitalization bills of pay patients are based in the patient’s
chart.
5. Evaluation of quality of care rendered – degree to which quality assurances or
quality improvement standards are being met.
6. Research and Statistical Information – used to supply statistical data relation
to frequency of disorders, complications, use of specific medical and nursing
therapies, death and recoveries.

NURSING DOCUMENTATION FORMS

1. Nursing Health History and Assessment Worksheet – completed by the nurse
upon admission.
2. Graphic flow sheets – forms used to record specific measurements or
observations on a repeated basis.
2. Medicine and treatment records – contains all medications and treatments
given on a repeated basis.
3. Nursing kardex – flip over card kept in portable index file at the nurses station
4. Discharge summary – a special progress report that helps ensure that a
client’s discharge results in desirable planning.
5. Nurses Progress Notes – narrative descriptions of patient’s progressive
towards goal achievement.
6. Chronological Narrative Charting – traditional charting format.
7. SOAP charting / SOAPIER

GUIDELINES FOR GOOD DOCUMENTATION

1. factual
2. accurate
3. confidential
4. complete
5. current
6. organized
7. ethical

HOW TO DOCUMENT CORRECTLY

1. Chart everything that other nurses and physicians need to know to assess the
patient’s / client’s needs
2. Be specific, avoid general and vague expressions
3. Document any nursing action take in response to the problem
4. Describe the patient/ client’s response
5. Document all safeguards used
6. Document that an incident report was completed
7. Document each observation, leaving no gaps; gaps may imply neglect
8. Document procedures after they are completed, not before
9. Record on every line. Do not leave empty space. sign every entry.
10. Chart on omission as a new entry; never backdate or add to previous entries
11. Never attempt to erase or cover an error, follow prescribed procedure for
correction
12. Never document for someone else
PRECAUTIONS TO OBSERVE IN DOCUMENTATION
1. Only the nurse who performed the nursing intervention makes the entry and
signs it.
2. Charting made by nursing students should be countersigned by their clinical
instructors.
3. Chart all important information before going on a break or when leaving the
unit.

SETTING THE EVALUATION PARAMETERS

Appropriateness of the planned program and activities, i.e., the extent to which
such has been directed to the identified problems that have been prioritized’
The adequacy of the program or the degree to which the program will be able to
meet the identified problems.
The effectiveness of the program or the extent to which the pre-established
objectives will be attained as the result of the activities implemented
The efficiency of the program which includes the relationship of the cost of
resources, both human and material, and the attainment of the objectives.
Problems encountered or the identification of the problems that maybe
encountered and the development of alternative measures to prevent or minimize
these.

ORGANIZING

PRINCIPLES OF ORGANIZING

CHAIN OF COMMAND (scalar principle) – to be satisfying to the members

economically effective and successful in achieving their goals, organizations are
bottom. (also referred to as scalar principle)

UNITY OF COMMAND
- an employee has one supervisor and there is one leader and one
plan for a group of activities with the same objectives.

SPAN OF CONTROL - a person should be a supervisor of a group that he or

she can effectively supervise in terms of numbers, functions, ad geography

HOMOGENOUS ORGANIZATION OR DEPARTMENTATION – workers

performing similar assignments are grouped together for a common purpose. It
promotes the specialization of activities, simplifies the administrator’s work, and
helps maintain effective control

EXCEPTION – recurring decisions should be handled in a routine manner by

lower level managers whereas problems involving unusual matters should be
referred to the highest level.

DECENTRALIZATION OR PROPER DELEGATION OF AUTHORITY – it is the

process of conferring specified decision making to the lower levels of the
organization. Basic top levels decisions and policies must receive attention at the
top levels. The amount of skills and competence of subordinates and executives
determines the success of any programs of decentralization. Executives should
be developed to handle situation delegated to them. This delegation of authority
is still subject to the supervision and control of the delegating superior.

ELEMENTS OF ORGANIZING

Setting up the organizational structure

- process by which the group is formed, its channels of authority,
span of control and lines of communication
- should be up dated, reviewed, approved and documented by the
proper authority

Date of last review should be documented

PURPOSE
G it informs members of their responsibilities so they may carry
them out
G it allows managers and the individual workers to concentrate on
his / her specific role and responsibilities
G it coordinates all organizational so there is minimal duplication
of effort of conflict
G it reduces the changes of doubt and confusion concerning
assignment
 G it avoids overlapping of functions because it pinpoints
responsibilities
G it shows to whom and for whom they are responsible

ORGANIZATION

G a system of interrelated resources, including environment,

materials, supplies and behavior of the people, that performs a
task which has been differentiated into severe distinct sub –
system, each subsystem has been performing a part of the task,
and the effort of each being integrated to achieve effective
performance of the total system.

Types of organization classified by nature of authority

1. Line organization
G oldest, simplest and most direct type of organization in which
each position has a general authority over the lower positions in
the hierarchy
G the authority that entitles a supervisor to direct an individual’s
work
G is the traditional employer – employee authority relationship that
emanates from the top of organization to the worker population,
following what is called the chain of command.
G command relationship is depicted by a solid line on
organizational chart
G related to the direct achievement of organizational objectives

Example : clinical and administration

2. Informal organization – refers to horizontal relationship rather that vertical

composed of small groups of workers with similar interests.

3. Staff organization
G purely advisory to the line structure with no authority to put
recommendations into action
G the authority in positions created to support line – authority
relationships are advisory or service oriented
G depicted by a dashed line on an organizational chart.
G handles details, locate required data and offer counsel or
managerial position
G two major categories – personal (assistant and general staff)
and specialist advisory, service, control and functional)

Example: Training and research

4. Functional organization – one where each unit is responsible for a given part
of the organization’s work load with clear delineation of roles and responsibilities
which are actually interrelated.
E.g. All standing and Ad Hoc Committees

IMPROVING LINE – STAFF RELATIONSHIPS

G Participation of both in determining objectives and plans and
their implementation
 G each must be briefed on the roles and functions of the other
team members.
G the line of responsibility, accountability, and authority should be
clearly established and publicized.
G both must interact with open, communication

ORGANIZATIONAL CHART – a drawing that shows how the parts in the

organization are linked. It depicts the formal organizational relationships, areas of
responsibility, person to whom one is accountable, and channels of
communication

ADVANTAGE DISADVANTAGE
1. Contribute to sound organizational 1. Becomes obsolete quickly
structure 2. Shows only formal relationships
2. Map lines of decision making 3. Shows no formal communication
authority 4. Shows how things are supposed to
3. Shows formal lines of not how they are
communication 5. May confuse authority and status.
4. Show how people fit into the
organization
5. Helps employees understand their
assignment

Components of an organizational chart

1. Division of work – each box represents the individual or sub – unit responsible
for a given task of the organization work load
2. Chain of command – lines indicate who reports to whom by what authority
3. Type of work to be performed – indicated by labels or descriptions for the
boxes
4. Groupings of work segments – shown by the clusters of work groups
(departments or single units)
5. Levels of management – indicate individual and entire management hierarchy

A hierarchy – refers to a body of persons or things organized or classified

in pyramidal fashion according to rank, capacity or authority assigned to vertical
levels with offices rank in grades, orders or classes one above.

FLAT VS TALL

FLAT TALL
Have few layers in the operating Developed along vertical dimensions
structure by use of the scalar process to define
Short administrative distance between relationship between levels in an
to and bottom levels organization.
Direct, simple and with fast More of authoritarian style which is
communications most effective in situations requiring
Large groups with variety of skills and rapid changes and precise coordination
capable of solving greater variety of Allows evaluation of decisions
problems frequently
Interaction facilities group
cohesiveness
Reduces understanding between
higher and lower levels and increase
impersonality

BEREAUCRATIC – commonly called line structures or line organizations

 - authority and responsibility are clearly defined leading to efficiency
and simplicity of relationships

AD HOC (Adhocacy) – modification of the bureaucratic structure and sometimes

used on a temporary basis of facilitate completion of a project within a formal line
organization.

- means to overcome the inflexibility of line structure

- uses a project team or task approach and are usually disbanded
after a project is completed

DUAL
- separates technical and administrative responsibilities
- has one hierarchy in which technical professionals.
- provides a set of titles and job descriptions for each hierarchy.

PYRAMID
- people are ranked according to their function an the amount of
authority that they have
- the smallest number of people with greatest
- also ranked according to the amount of status and salary paid.

MATRIX – designed to focus on both product (e.g. satisfactory outcome of a

client’s problem) and function (all task required to produce the product)

HEAD NURSE PROJECT DIRECTOR

NURSING STAFF

CENTRALIZED VS DECENTRALIZED

CENTRALIZED DECENTRALIZED
- power and authority are concentrated - power and authority are shifted from
in relatively few persons or positions the hands of a few persons at the top
- have many levels of department each of the organizational structure to
one highly specialized and subject to subordinate hierarchal level.
rigid rules and procedures - promotes independence,
- with its rigid rules procedures span of responsibility and quicker decision
control are short and employees and making at all levels of an organization
managers are in close contact - this wide span of control means that
- it generates a tall, pyramid – shaped employees and managers have less
organizational chart depicting the contact with each other
multileveled hierarchy of management - generates a flat or matrix
and individual manager’s short span of organizational chart which depicts
control fewer management levels and wider
- the many levels of a typical span of control
centralized structure may cause - has fewer hierarchal levels and tend
communication problems within the to have better communication among
organization. levels
- leaders and managers tend to - leaders and managers tend to
function in an autocratic management function democratically
style demanding rigid adherence to
rules and procedures

IMPORTANCE OF THE ORGANIZATIONAL CHART

G Used from outlining administrative control, for policy making and

planning
G to evaluate strength and weakness of the current structure
G for showing relationships with other departments and agencies
G more effective means of communicating the agency’s
organizational structure

DEFINITION OF TERMS

ROLE – the set of behaviors and attitudes expected of an individual by those with
who he interacts

POWER - is the ability to influence another to behave in accordance with one’s

whishes. One measure of the among of power the organization accords to
individual nurses or the nursing group as a whole is the amount of participation
allowed to them in decision making process.

STATUS – the rank of group confers on an individual in accord with their

estimation of their work and significance. The degree of status accorded in
particular job is closely related to its distance from the top of the organizational
hierarchy, the amount of skill called for in performing the job, the degree of
special training or education required for the position, the level of responsibility
and autonomy expected in job performance and the salary accorded to the
position.

AUTHORITY - is the right act. It flows down in an organization. It is sactioned

power to direct or influence the behavior of another. it is never absolute or
unlimited.

CENTRALITY – refers to the fact that certain position are also located in the
organizational structure that they involve the incumbent in frequent
communications.

ACCOUNTABILITY – means taking full responsibility for the quality of work and
behavior while engaged in the practice of the profession.

RESPONSIBILITY – is the obligation to perform the assigned tasks.

COMMUNICATION – is the transmission of information between persins.

STAFFING

The process of determining and providing the acceptable member and mix
of nursing personnel to produce the desired of care to satisfy the patient’s
demand for care
STAFFING
3 MAIN COMPONENTS

G planning – encompasses determination of the # of nursing

personnel needed over a along term period.
G scheduling – entails assigning nursing staff for specific time
periods by shifts based on patient care needs
G allocation – involves staffing assignments or readjustments on a
holiday or shift basis

FACTORS AFFECTING STAFFING

1. the type, philosophy and objectives of the hospital and the nursing service
2. the population served or the kind of patients served whether pay or charity
3. the number of patients and severity of their illness knowledge and ability of
nursing personnel are matched with the actual care needs of patients
4. availability and characteristics of the nursing staff, including education, level of
preparations, mix of personnel, number of position.
5. administrative policies such as rotation, weekends and holiday off – duties
6. standards of care desired which should be available and clearly spelled out.
G ANSAP’s Standard of Nursing Practice
G PRC- ANSAP’s Standards of Safe Nursing Practice
G Hospital’s own developed standards

7. layout of the various nursing units and resources available within the
department such as adequate equipment, supplies and materials
8. budget including the amount allotted to salaries, fringe benefit, supplies,
materials and equipments.
9. professional activities and priorities in non patient activities like involvement in
professional organizations, formal educational development, participation in
research and staff development
10. teaching program or the extent of staff involvement in teaching activities
11. expected hours of work per annum of each employee, influence by the 40
hour week law.
12. patters of work schedule

G traditional 5 days per week, 8 hours/ day

G 4 days / week, 10 hours / day and three days off
G 3 ½ days of 12 hours / day and 3 ½ days off week

STAFFING FORMULA:

Average census x Nursing Hours x 1.4 1.14

7.5

WHERE:
1.4 = 1.4 work weeks of 5 days to cover a 7 – day week
1.14 = built in holidays, sick leave, annual leave
7.5 productive hours on an 8 – hour shift

Other comprehensive formula (Hospital Nursing Service Administrative Manual ,

DOH)

1. Categorize the # of patients according to the levels of care needed

Total # of patients X % of patients at each level of care (either minimal,

intermediate, intensive or highly specialized)
250 (pts) x 30 = 75 pts. needing minimal care
250 (pts) x 45 = 112.5 pts needing moderate care
250 (pts) x .15 = 37.5 pts needing intensive care
250 (pts) .01 = 25 pts needing highly specialized care
____________________
250 patients

2. Find the total # of nursing care hours needed by the patients / day at each
categorized level

a. # of patients at each level X the average number of nursing care hours /

day
b. get the sum of the nursing care hours needed at the various levels

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

112.5 pts x 3 (NCH needed at level II = 3337.5 NCH / day
37.5 pts x 4.5 (NCH needed at level III) = 168.75 NCH/day
25 pts x 6 (NCH needed at level IV) = 150 NCH / day
______________________
total 768.75 NCH /day

3. Find the actual # of nursing care hours needed by these given number of
patients (per year)

a. Total nursing care hours needed per day X the total number of days (365) in a
year

768.75 x 365 (days/year) = 280593.75 NCH / year)

4. Find the actual # of working hours rendered by each nursing personnel per
year

a. # of hours on duty / day X the actual working days / year

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

5. Find the total # of nursing personnel needed

a. Total # of NCH by the given# of patients / year = 280.593.75 = 165

Actual # of working hours /employee/year 1,794

b. Find the # of relievers

# of nursing personnel needed x 0.15 (for those working 40 hours / week)
# of nursing personnel needed x 0.12 (for those working 48 hours / week)

165 total nursing personnel x 0.15 relief = 25

b. Add the # of relievers to the # of needed nursing personnel

6.Categorize to professional and non – professional personnel. Ratio of

professionals to non – professionals in a tertiary hospitals is 65:35
190 x .65 = 124 professional nurses
190 x .35 = 66 nursing attendants
7.Distribute by shifts.

124 nurses x.45 = 56 nurses on AM shift

124 nurses x .37 = 46 nurses on PM shift
124 nurses x.18 = 22 nurses on night shift
Total 124 nurses

66 nursing attendants x.45 = 30 Nursing Attendants on AM shift

66 nursing attendants x.37 = 24 Nursing Attendants on PM shift
66 nursing attendants x.18 = 12 Nursing Attendants night shift
Total 66 Nursing Attendants

PLACEMENT - proper placements fosters personal growth, provides a

motivating climate for the employee, maximizes productivity and organizational
goals have better chances of being met.
Inappropriate placement often results in:
- Frustration
- Poor quality of work
- Reduced organizational efficiency
- Rapid turn – over
- Poor image of the agency

SCHEDULING – timetable showing planned workdays and shifts for nursing

personnel. The objective is to assign working days and days off to the nursing
personnel so that adequate patient care is assured. A desirable distribution of off
duty days can be achieved and the individual members of the nursing team will
feel that they are treated fairly. They will also know their schedule in advance.

ASSESSING A SCHEDULING SYSTEM

Scheduling system must function smoothly in terms of
- Ability to cover the needs of the unit – a minimum required number
of staff must meet the nursing needs of the patients in the units at
all shifts;
- Quality to enhance the nursing personnel’s knowledge, training and
experience – while permanent assignment to one unit enhances
skills in caring for a particular kind of patients, many nurses who
have future plans of going into teaching, or specialization or even
working abroad, would prefer to experience being assigned to
various units before settling down to a particular unit of their choice;
- Fairness to the staff – all nursing personnel should get a fair share
of weekends, holiday offs, rotation patterns for the whole year
including assignment to ‘difficult’ or ‘light’ or ‘undesirable’ units or
shifts;
- Stability – the nursing personnel would like to know in advance their
schedule of assignment so that their personal schedules are in
harmony with each other; and
- Flexibility – it is the ability to handle changes brought about by
emergency leaves, scheduled or unscheduled leaves of absence.

TYPES OF SCHEDULING
1. Centralized - Chief nurse or her designate who usually does the assignment of
the nursing personnel to the various areas.

2. Decentralized
- Chief nurse or her designate usually does the assignment of the nursing
personnel to the various nursing areas. Arrangement of the shifts on duty and off
duties are done by the supervising Nurse or head or senior nurse of the particular
units or areas.

3. Cyclic
- established basic pattern for a certain number of weeks and is repeated

4. Self – scheduling
- system that is coordinated by staff nurses and other staff where they
collectively develop and implement work schedules, taking policies and variables
affecting staffing considerations

5. Alternating or rotating work shifts

- frequency of alternating between days and evenings, or days and nights
or rotating through all shifts.

6. Permanent shifts
- assignments to preferred shift may have to be done on a seniority –
priority basis

7. Variable staffing
- uses patient needs to determine the number of mix of the staff

TYPES OF PATIENT ASSIGNMENT

1. Case method
- nurse is assigned to a patient for total patient care; one on one scheme
and is common for nurses on private duty, special care units and for nursing
student for educational purposes
- a patient is able to relate well with the nurse who is tasked to
provide him with holistic cure.

2. Primary method
- nurse personally does the assessment of the patient’s health status or
needs for care, develops and administers the nursing care plan which includes
health teaching and pre – discharge planning and evaluates the outcomes or
care for adjustments as needed; care for 4-6 patients on a 24 hours basis
throughout the hospitalization period.
- patients are provided with continuous care in his nursing modality
even when the primary nurse is off duty since secondary or associate nurses
assume the responsibility of executing the nursing care plan during the afternoon
and night shifts

3. Functional method
- nurses and other care givers perform specific tasks in the delivery of
nursing care. Everyone is responsible to the head nurse or senior nurse as she
provides for the overall direction of the nursing personnel. One registered nurse
may be tasked to give all medication.

4. Team method
- professional, technical and ancillary personnel are grouped as a team to
provide total care to a selected group of patients. Team leader assigns,
coordinates supervises and ensures that full coopeation and participation of her
co workers are observed in the planning and delivery of care to the patients.
- This aims to provide patient centered care through identification of
the patient’s care needs, observed through nursing diagnosis and implementing
of planned care

5. Case management
- nurse directs care provision for the patient as it focuses on an entire
episode of illness and delegates nursing care to her associates. Nurturing
relationship between the case manager and physician; primary nurses, public
health nurses, interdisciplinary nurse is important.
- Done prior to admission and spans to about two or three week
after discharge.

CRITERIA FOR STAFF SCHEDULING

1. The policies, standards, and practices of the employing agency on use of

professional and paraprofessional nursing personnel.

2. Appropriate ratio or balance between professional and paraprofessional or

support staff.

3. Continuity of services (for the promotion of quality of care, nurses must care
for the same patients/ clients over time and work with the same nursing
personnel.

4. Approved master staffing budget with effective and economical assignment of

personnel through avoidance of maldistribution and overstaffing

5. Satisfaction of staff members in their work.

6. Consideration of vacations and other scheduled time off, which needs to be

planned well in advance to provide year and round distribution.

7. Allowance for adjustment in case of illness, emergencies, or changes in care

needs.

8. Staff members informed of their work schedules at least 2 weeks in advance of

implementation

9. Protection of the rights of individuals against discriminatory action because of

sex, ethnic differences, or religious beliefs.

Patient Care Classification system – a method of grouping patients according to

the amount and complexity of their nursing care requirements and the nursing
time and skill they require. Requirements include:

G the number of categories into which the patients should be

divided
G the characteristics of patients in each category
G the type and number of care procedures that will be needed by
a typical patient in each category
G the time needed to perform these procedures that will be
required by a typical patient in each category

Classification categories
 - Level I – self care or minimal care
§ patient can take a bath on his own, feed himself and perform
his ADL
§ patients include: those to be discharges, non emergency
newly admitted, do not exhibit unusual symptoms and
requires little treatment / observation and / or instruction

- Ratio: professional to non professional – 55:45

- average amount of nursing care / patient – 1.5
- Level II – Moderate care or Intermediate Care
§ patients need some assistance in bathing, feeding, or
ambulating for short periods of time
§ extreme symptoms of their illness must have subsided or
have not appeared
§ patient with slight emotional needs, with V/S ordered up to
3x / shift, IV fluids or Blood Transfusion
§ semi – conscious and exhibiting some psychological or
social problems
§ periodic treatments and / or observations and / or
instructions
§ average nursing care hour / patient day
§ ratio or professional to non professional personnel – 60:40

- Level III – Total, Complete or Intensive Care

§ patients care completely dependent upon nursing personnel
§ provided with complete bat, are fed, may or may not be
unconscious with marked emotional needs, with V/S more
than 3x / shift
§ may be on continuous oxygen therapy with chest or
abdominal tubes
§ requires close observation at least every 30 minutes for
impending hemorrhage, with hype or hypertension and / or
cardia arrhythmia
§ average nursing care hour / patient / day
§ ratio of professional to non professional personnel

- Level IV – Highly Specialized Critical Care

§ patients need maximum nursing care
§ need continuous treatment and observation, with many
medications , IV piggy backs
§ V/S every 15 – 30 minutes, hourly output
§ Doctor’s order changes every 6-9 hours patient/day

Levels of Care Nursing Care Hour Ratio of professional to

Needed per patient per non professional
day
Level I – Self care or 1.50 55:45
minimal care

Level II – Moderate or 3.0 60:40

Intermediate care

Level III – Total or 4.5 65:35

intensive Care

Level IV – Highly 6.0 70:30

Specialized or Critical 80:20
Care

G Categories or levels of care of patients – nursing care hours

needed / patients / day and Ratio of professional to non
professional

LEADERSHIP ROLES AND MANAGEMENT FUNCTIONS ASSOCIATED WITH

STAFFING AND SCHEDULING

LEADERSHIP ROLES

1. Identifies creative and flexible staffing methods to meet the needs of

patients, staff and organization
2. Is knowledgeable regarding contemporary methods of scheduling and
staffing
3. Assumes a responsibility towards staffing that builds trust and
encourages a team approach
4. Periodically examines the unit standard of productivity to determine if
changes are needed
5. Is alert to extraneous factors that have an impact on staffing
6. Is ethically accountable to patients and employees for adequate and
safe staffing
7. Plans for staffing shortages so patient care goals will be met

MANAGEMENT FUNCTIONS

1. Provides adequate staffing to meet patient care needs according to the

philosophy of the organization

2. Uses organizational goals and patient classification tools to minimize

understaffing and overstaffing as patient census and acuity fluctuate

3. Schedules staff in a fiscally responsible manner

4. Develops fair and uniform scheduling policies and communicates these clearly
to all staff

5. Ascertain that scheduling policies are not in violation of local and national labor
laws, organizational policies, or union contracts

6. Assumes accountability for quality and fiscal control of staffing

7. Evaluates scheduling and staffing procedure and policies on a regular basis

DEVELOPING JOB DESCRIPTION

A job description is a statement that sets the duties and responsibilities of

a specific job. It is an important management tool to make certain that
responsibilities are wisely delegated, that work is efficiently distributed, that
talents are fully used, and morale is maintained.

CONTENTS OF JOB DESCRIPTION

 Identifying data
Position Title: Staff Nurse
Department: Nursing
Supervisor’s Title: Head/Senior Nurse
Job Summary
This includes the essential features of the job that distinguish it
from the others.
Qualification Requirements
Educational preparation, training and experience necessary to fill
the position.
Job Relationships
Source of workers
Specific and Actual Functions and Activities

USES OF JOB DESCRIPTION

- For recruitment and selection of qualified personnel;
- To orient new employees to their jobs
- For job placement, transfer or dismissal
- As an aid in evaluating the performance of an employee
- For budgeting purposes – salaries are equated with the level of
responsibilities and skills defined in the job description and thus
become the basis for position justification and budgetary
preparations
- For determining departmental functions and relationships to help
define the organizational structure. One of the organizing principles
is grouping employees performing similar functions to avoid
duplication or overlapping of functions and to improve workflow;
- For classifying levels of nursing functions according to skill levels
required
- To identify training needs
- As basis for staffing, and
- To serve as a channel of communication
 CAREER PLANNING

Career – the work one chooses as an occupation for life.

Path – an established way, course or track in which everything moves or has

moved.

Career path – is an organized or individual process for identifying specific job

opportunities with an organization and sequential steps in education, skills and
experience building needed to attain specific career plans.

Career development – planning and implementation of career plans.

- a critical life process involving both the individual and the employer
- accomplished through assessment of oneself and one\s work
environment, job analysis, education, training, job research, and
acquisition and work experience.

Career plan – concerns where you are today and where you are going
tomorrow.

Career planning – represents individual responsibility

- includes – evaluating one’s strength and weakness, setting goals,
examining career opportunities, preparing for potential opportunities and
using appropriate development activities (exploration, opportunities and
change)
- must be on-going, conscious and deliberate process

Career mapping – is a strategic plan for one’s career

- Provides direction for formal education, experience, continuing education,
professional associations and networking.

CHOSSING, RETAINING, RESIGNING AND DISMISSAL FROM A POSITION

Choosing a field of nursing – people differ in their choice of a particular field of
nursing. Long and short-range goals should be considered. Self-evaluation is the
first consideration nurses must take.

Factor to consider in self-evaluation:

1. Qualifications
- Educational qualifications. (Bachelor of Science in Nursing) Deans, Chief
nurses of Director of Nursing (Master Degree in Nursing)

2. Years of experience and training

- Special Areas (OR, ICU, CCU and ER) requires experience in these
areas; staff nurse position may not require experience and training.

3. Age and physical condition

- young nurses are preferred for beginning positions
- older nurses may feel comfortable in administrative positions

4. Emotional stability and goals in life.

- objectives and philosophy in life determine the kind of field you wish to
get into.

Factors in selecting a field trip of Nursing

 1. Kind of work to be performed
• Are you prepared for the job?
• Can you work under stress?
• Do you get along well with people?
• Are you interested in?
• What kinds of skills are needed?
• Is it hazardous?

2. Availability of the work

• Will you choose a field of nursing that is crowded?
• Or where there is a shortage of workers?

3. Hours of work
• How many hours a day or week do you go on duty?
• Is your work rotated on shifts?
• Will you be paid for extra hours of duty you will perform?

4. Qualifications
• What are the requirements in terms of educational qualifications?
• Experience? Training

5. Opportunities for advancement

• What chances do you have in being promoted after several years of
employment?
• Will they allow you to go to school if you so desire?
• Are you allowed to attend professional meeting/seminars on official
time?
6. Method of entering
• Do you need an examination to enter?
• Do you need someone to recommend you?

7. Earning
• How much is the initial salary?
• The maximum salary?
• Is salary paid weekly or every fifteen days?
• Is traditional pay given for overtime work.

8. Fringe benefits
• How many days of vacation and sick leaves are given? Maternity leaves?
• Education leaves?

9. Other benefits
• Are insurances, Medicare, and retirement benefits provided for?
• Can nurse participate in discussion of condition of work?

Retaining a position – leads to self-satisfaction and building a career in nursing

Suggested ways to become successful in the chosen field:

1. Have adequate knowledge and preparation for the job.
Update your knowledge through reading of professional literature
and attending seminar.
 2. Have a wee-developed personality
Cultivate a pleasing personality
3. Develop a good interpersonal relationship with co-workers by;
a. Being enthusiastic, dedicated to work and being sincere and
considerate with others
b. Being tactful and dependable.
c. Developing ability to adhere to social amenities and being socially
compatible
d. Having self-confidence and being cheerful.
e. Offering help when needed.
4. Develop proficiency in communications.
5. Being able to adjust to working conditions and to life pattern
characteristics of particular occupations and communities
6. Keep a breath with advances in medicines, nursing and related sciences.

Causes of failure retaining position

1. Incompetence or lack of the required ability and knowledge for a particular
job
2. Poor interpersonal relationship
3. Personal defects
4. Inadequate knowledge in social conduct
5. Indifference to need for professional growth

How to turn failure into success

1. Know your weaknesses by accepting your limitations and then overcome
them
2. Learn how to fit and adjust to the position (Be competent to the job – be
the best all of the time)
3. Put high values on honor, sense of gratitude, shame, emotion and
responsibility (dismissal on a job is considered a family tragedy)

Beginning from apposition – To seek a better position (primary reason)

1. Keep position for at least two years if position is acceptable to them.
2. If advantage of leaving far outweighs the reason for staying, consider to
make a change
3. If offered a better position, talk it over with the employer
4. Observe an “open-door policy” (Leave a friendly feeling towards superiors
and co-workers. A reference letter may be needed later or one may decide
to return to the institution or agency)
5. Give advance notice
One month – for those handling a staff nurse position
Six months – for those in teaching or administrative positions
6. Submit a resignation letter observing the following points:
1. Date of resignation
2. Reason for leaving
3. Expression of gratitude for kindness and consideration given
during the period of employment
4. Clearance for money, work and property responsibilities
Never walk off from a position to avoid liability for breach of
contract or abandonment of duty (French leave or AWOL)

Dismissal from a position

 Reasons for being dismissed include:
1. Negligence – failure to use reasonable care
- Doing of something which a reasonably prudent person
would not do
- Failure to do something which a prudent person would do
under similar circumstances
- A departure from what an ordinary reasonable member of a
community would do in the same community
2. Incompetence – unable or incapable of doing something

3. Malpractice – (mala praxis) bad or unskillful practice of a physician or

other professional person such as a midwife, lawyer, etc. whereby the
health or welfare of the patient or client is injured
- The failure of a professional to follow the accepted
standards of practice of his or her profession
- Considered a misdemeanor since at breaks the trust which
the patient has pit in the physician and tends directly in
destruction
4. Unprofessional behavior or breach of contract
Example of unprofessional behavior
1. Willfully betraying a professional secret
2. Making a sexual advancement
3. Requesting sexual favors or engaging in any other verbal conduct
or physical conduct of a sexual nature
4. Making any false or fraudulent statement, written or oral in
connection with the practice of medicine
5. Failing to reasonably disclose and inform the patient or the patient’s
representative of the method, device or instrumentality the license
uses to treat the patient’s disease, injury, ailment or infirmity

Breach of contract – violation of a contract by failing to perform one’s

contractual obligations

Due process of the law must be observed before nurses can be dismissed from
their work.

MEMBERSHIP IN DIFFERENT PROFESSIONAL ORGANIZATIONS

Professional Organization – a group of people who share a set of professional

values and who decide to join their colleagues to affect change

Advantages
1. May receive information on the history of the organization, future
meetings and current activities, officer contact information, and local
contacts.
2. Carry out their missions and conduct activities and business

Reasons for involvement:

1. Sense of responsibility on the profession or the hope they are
contributing to the greater good of the profession
2. Desire to enhance their resume and marketability purposes
 3. To promote their profession, have particular legislative interest or have
other social reasons
4. Organization of choice can help improve conditions and care for their
patients
5. To become active participants by joining committee work, running for
office or taking other leadership roles.
6. Can improve nursing morale

Benefits from the organizational involvement:

1. Substantial discounts on continuing education
2. Certifications
3. Credentialing
4. Group insurance plan for professional liability, hospitalization and
disability
5. Travel service, such as auto rentals, hotel stays and restaurant visit
6. Quick access to staff experts on practice and advocacy
7. Professional standards
8. Discounts on professional journal

NURSING ORGANIZATIONS
A. Nursing Associations in the Philippines
A. Alumni Association – first association a nurse joins upon graduation
Objective: To provide graduates with opportunities to:
1. keeping abreast of school activities, programs and/or problems thus
assisting the school to develop along sound lines
2. becoming interested, well-informed and active members of their
professions or of other fields of endeavor and being increasingly
useful and helpful members of the society;
3. Keeping school friendships alive. The joy of meeting school mates
and recalling meaningful experiences are precious moments money
cannot buy;
4. Assisting individual members of the association in job replacement
or in other ways deemed necessary
5. Assisting in securing endowment finds/money for a variety of
purposes such as the establishment of scholarship and
procurement of loans
6. Recognizing outstanding alumni through an achievement award
program. This serves as inspiration to students and young
graduates
7. Becoming part of an organization through which their alma mater
continues to be of service to them after graduation through
cooperative programs of continuing education; and
8. Helping to interpret the program of the school to recruitable
students so that in return, only quality students can be admitted for
training.

B. Professional Associations
1. Philippine Nurses Association (PNA)
Former name – Filipino Nurses Association
Organized – October 22, 1922 initiated by Mrs. Anastacia
Giron Tupas
First president – Mrs. Rosario Delgado
Journal – Filipino Nurse now called “The Philippine Journal
of Nursing “

Purposes
1. to attain optimal level of professional standards
 2. to work for the welfare of member nurses
3. to respond to the changing health needs of the Philippine
society
4. to establish linkages with government, national and international
agencies in the attainment of national health goals and welfare
of member nurses

2. The National League of Government Nurses (NLGN)

Formerly – Department of Health National League of Nurses
(DHNLN)
Founder – Annie Sand (nursing consultant of the DOH on
January 16, 1961

Objectives:
1. to promote and maintain the highest standards of nursing in
government
2. to address problems concerning nurses and nursing through
participation in formulation of all policies, guidelines, programs
and laws affecting nurses and nursing practices in the
Philippines
3. to continuously upgrade the professional competence through
research, training, scholarship grants both foreign and local, and
dissemination of information through nursing publications
4. to collaborate with government, non-government and other
allied professional groups for the promotion of health services
5. to foster national and international goodwill among nurses and
harness all energies towards the attainment of common goals
6. to help advance the science and art of nursing in the Philippines
to meet the needs of a changing society
7. to recognize the exemplary performance and accomplishments
of members

Categories of membership
1. Regular – Nurses who have rendered a minimum of five-year service in
any government agency
2. Life – nurses who have been members for at least three successive
years and have paid the required life membership fee
3. Honorary – people who have outstanding service to the cause of nurses
and nursing, and elected to such membership by the board but have so
voting privileges

3. Association of Nursing Service Administration of the Philippines, Inc.

(ANSAP)
Founder – 1963 but recognized in 1973; composed of nurse
service administrators both in government and private
agencies

Objectives:
1. provide dynamic leadership in the acquisition of knowledge and
techniques in nursing service administration
2. upload the highest standards of professional ethics, integrity,
and dedication to the cause of nursing service administration
3. initiate programs which will elevate members to the highest level
of competence in nursing administrative practice
4. keep abreast of latest research findings, initiate and/or research
and/or disseminate results thereof for information and/or
improvement of nursing practice
 5. pool resources through collaborative action with other national
nursing associations for the promotion of professional, social,
and economic welfare of nursing service practitioners through
legislative and/or other means
6. participate actively and stand courageously in support of vital
issues affecting public welfare

Nursing Standards developed:

1. Standards of Nursing Service and Nursing Practice
2. Standards In Critical Care
3. Standards in Community Health
4. Standards in Operating Room
5. Standards in Psychiatric Nursing Practice

4. Association of Deans of Colleges of Nursing in the Philippines

First established – 1959 with Deans of Colleges of Nursing
as Members

Purposes:
Main purpose – To promote, elevate and maintain the
standards of clinical instruction program of nursing students and to
improve nursing service facilities of the clinical field in hospitals and
public health agencies.
Other purposes:
1. to participate in the formation of legislations affecting
nursing education
2. to make representations in discussions of problems and
solutions of the same to the Department of Health,
Evaluation Committee on Accreditation Training and the
Student Affiliation, Budget Office/Congress, as the case
may be.

5. The Military Nurses Association of the Philippines

Officially organized – September 5, 1965 in V. Luna Hospital
AFP in Quezon city by a group of dynamic nurses and corps
officers both active and inactive and retired
Official organ – Philippine Military Nursing Journal

Objectives:
1. to establish and maintain the highest standard of military
nursing in the Armed Forces of the Philippines
2. to develop the social, cultural, and educational well-being
of its members in line with the current trends in nursing
3. to cultivate and maintain the spirit of camaraderie and
promote the general welfare of its members
4. to encourage active participation in the activities of both
local and national nursing organizations and to promote
effective cooperation and coordination among military
nurses and members of allied professions
5. to publish periodicals and bulletins as sources of
information and guidance
6. to establish a code of conduct for its members
7. to promote reciprocity between military nurses of the
Philippines and those allied countries
8. to undertake activities that are geared toward social
action and community development
6. Occupational Health Nurse Association of the Philippines
Formerly known as – Industrial Nursing Unit of the Philippine
Nurses Association
Established – November 21, 1950 to promote friendship and
to organize nurse into an Industrial Nursing Unit.

Objectives:
1. to contribute to the promotion of public health through the
conservation and promotion of the Industrial worker’s
health and that of the family
2. to keep up with modern methods and techniques of
public health nursing general and of industrial nursing in
particular in order to promote the quality and quantity of
nursing service
3. to provide expert nursing guidance for industrial health
workers
4. to attain good relationship and understanding among
industrial nurses in particular and all nurses in general
5. to provide a medium whereby common problems of
industrial nurses may be threshed out for the benefit of all
6. to raise the insight of industrial nurses beyond the walls
of their industrial clinics so they mat see their practice not
only in the nursing service but in the total public health
program as well
7. to gain support from agencies employing nurses

7. Philippine Association of Public Health Nursing Faculty

Organized – September 1961
Objectives:
1. to standardize and broaden instruction in Public Health
Nursing
2. to undertake that which will enhance professional growth

8. Private Duty Nurses Association of the Philippines

Founding officer – Mrs. Grace Oppus Villanueva

9. Operating Room Nurses Association of the Philippines

Objectives:
1. to develop standards of nursing care for all patients
before, during, and after operation
2. to provide opportunities for professional and personal
growth through:
a. an exchange program, within the country and with other
countries
b. seminars and conferences designed to keep its
members abreast with the new techniques in operating
room management and the use of modern and
sophisticated instruments and apparatus
c. cooperation and coordination in all its projects and
activities

10. Psychiatric Nursing Specialists Foundation of the philippines

Psychiatric nursing is an interpersonal process whereby the
professional nurse practitioner assists an individual, family or
community to promote mental health to prevent or cope with the
 experience of mental illness and suffering if necessary, and to find
meaning in these experiences.
Objectives:
1. to provide therapeutic and supportive needed to help the
client and his family in the former’s relearning to live in the
community
2. to help the client identify and develop his inherent
potentials and latent abilities and to utilize these in his
effort toward self-reliance and success
3. to undertake research studies in the field of mental health
and psychiatric nursing
4. to offer educational programs in mental health-psychiatric
nursing

11. Catholic Nurses Guild

Official organ – Catholic Nurses Guild Magazine
Purposes:
1. to promote the spiritual welfare of the nurses and to aid
them in promoting the spiritual welfare of those under their
care
2. to participate and encourage the members to strive always
to advance in professional and technical competence along
the lines of scientific progress following Christian principles
3. to study and coordinate governmental legislations affecting
hospitals and colleges of nursing, public health and to be
alert to meet the problems arising from such legislations

12. Integrated Registered Nurses of the Philippines (IRNUP)

Integration – bringing together all individual registered
nurses in the country under one corporate body
Established – December 28, 1995 at the Lung Center of the
Philippines
Purposes:
To provide a medium through which the Filipino registered
nurses can share their common interest working in a unified
manner to develop the contribution of nursing to the health
development goals.
Objectives:
1. the provision of direction and guidance in nursing
development in the country
2. the improvement of nursing practice through education and
research
3. serving as a unified voice for nurses and nursing nationality
4. the improvement of the professional, social, and economic
positions of nurses
5. serving as the reference/referral center for information on
nurses and nursing for both members and the public at
large
6. provision of a forum through meetings and conventions
where they may come in contact with their peers,
exchange information, seek support and form network
alliances
7. representation of nurses and nursing in any forum requiring
nursing input and be the authoritative voice for nursing
 8. working with health and health-related sectors in the
pursuit of achieving health goals influencing Philippines
20000

13. International Nursing Foundation of Japan (INFJ) Scholars Association

of the Philippines
Objective: To promote the highest professional standards
of the nursing profession and provide expertise and
assistance in various settings in our country
The National Allied Organizations
1. The Philippine National Red Cross (PNRC)
• Created by R.A. 95 on March 22, 1947
• Major services – disaster preparedness and relief service,
blood program, safety services, nursing service, Red Cross
Youth and social services

International Nursing and Allied Organization

1. The International Council of Nurses
Objective: To provide a medium through which the national
nurses associations may share their common interest by working
together to develop the contribution of nursing to the promotion of
health of the people and the care of the sick
• Official organ – International Nursing Review published 4x
a year

2. International Committee of Catholic Nurses (ICCN)

Objectives:
1. to encourage in all countries the organizations that are capable
of giving moral and spiritual support to Catholic nurses (and
public health nurses) as well as helping them perfect their
techniques
2. to coordinate efforts of Catholic professional associations while
respecting their autonomy, in order to study and to represent
Christian thought in the profession in general

3. World Health Organization (WHO)

Main Activities:
1. assistance to countries for the improvement of health services
2. for education and training in the field of health
3. for fighting communicable disease, coordination and stimulation
of medical research
4. exchange of information on public health and worldwide
reporting of outbreaks of dangerous diseases
5. programs involving malaria and smallpox eradication
6. cancer and heart disease research
7. air and water pollution
8. dangerous drugs and water supply

4. International Red Cross

Fundamental Principles of the IRC and the Red Crescent Movement
1. Humanity – protect life and health and ensure respect for the
human being
- promote mutual understanding, friendship, cooperation
and lasting peace amongst all people
2. Impartiality – makes no discrimination as to nationality, race,
religious belief, class or political opinions
 - endeavors to relieve the sufferings of the individual,
being guided solely by their needs, and to give priority
to the most urgent distress
3. Neutrality – not taking sides in hostilities or engage at any time
in controversies of a political, racial, religious or ideological
nature
4. Independence – must maintain their autonomy so that they may
be able at all times to act in accordance with the principles of
the movement
5. Voluntary service – is a voluntary relief movement not prompted
in any manner by desire for gain
6. Unity – must be open to all; must carry on its humanitarian work
throughout its territory
7. Universality – all societies have equal status and share equal
status and share equal responsibilities and duties in helping
each other

CONTINUING EDUCATION PROGRAM

Continuing education program
- consists of planned learning experiences beyond the basic education
program
- the inculcation, assimilation, and acquisition of knowledge, skills,
proficiency and ethical and moral values after the initial resignation of
professional, raise and enhance the professional’s technical skills and
professional competence.
Objectives:
1. to provide and ensure the continuous education of a registered
professional with the latest trends in profession brought about by
modernization and scientific and technological advancement.
2. to raise and maintain the highest standard and quality of the practice of
the professions
3. to make the professional globally competitive
4. to promote the general welfare of the public
In-service education
- a planned program provided by the employing agency to its employee
- viewed as part of continuing education
- focuses on and designed to re-train people to improve their performance
and communication ability to get them started in the never ending
continuum of education.
Major goal
• improvement of professional practice
• fullest development of the nurse as a person and as a contributing
member of the society.

Board of Nursing Revolution No. 1903.s. of 1985 – continuing professional

education program for nurses became effective in 1988

Format Studies Leading to Degree Courses

1. Baccalaureate Degree in Nursing
- no supplemental BSN course anymore
- former graduates of the three-year basic program must enroll in the
regular BSN course under the new curriculum

2. The Graduate Education in Nursing

 - Education beyond the baccalaureate degree
- Program leading to a meter’s degree in a chosen area of study
- Prepares leaders in nursing who will influence the practice and stdy
of the profession by generating higher levels of competence and
teaching, administering professional practice
- A graduate is a critical contributor to the profession of nursing.
Major purpose: Prepare nurses capable of improving nursing care through the
advancement of nursing theory and science.

1. The Doctoral Degree Program

- Prepares nurses for various positions such as administers of
nursing colleges, nursing specialists, consultants nursing services,
nursing education programs or hospital services.

Nurses qualities:
• Should consider their competencies, the quality of their professional
experience, the quality of their scholarship the ability to do creative
writing that will explain, interpret and stimulate thinking and action
• Must have a great deal; of drive and ability to take criticism and
resolve conflicting recommendations and stills retain self-control and
an objective point of view.

Other form of continuing education programs:

1. Seminars – the gathering of professionals and include among other –
workshops, technical lectures or subject-matter meetings, non-degree
training courses, and scientific meeting.
2. Conventions – the gathering of professionals and include among others
conferences, symposia or assemblies for round-table discussions
3. Residency – apprenticeship training at graduate level, which is beyond the
basic preparation for health professional conducted by duty accredited
hospitals and medical centers.
4. Distance learning – correspondence learning which uses courses manuals
or accredited learning may include instructional materials, or programs
which may include cassette tapes, films, computerized assisted learning
(CAL), study kits, learning aids and modules or the use of information
highway, (include clearly defined objectives, adequate content, and
evaluation content for each module.

Continuing Professional Education Units (CPEU) as pre-requisite for licensure

1988 – required all Filipino nurses who will renew their licenses to present 60
contact hours or CPEU (20 hours/year) since license is renewed every 3 years

PRC Resolution No. 99.624 of August 11, 1999, Sec. 18, Article IV and Sec. 19
of Article V of PRC Resolution No. 507 S. 1997
- repealed and CPEU was no longer required for licensure
HOWEVER
CPEU is still encouraged as an ethical and oral obligation to enhance their
knowledge, attitudes and skills for competent and safe practice

HOWEVER IN 2004
PRC Resolution No. 2004 – 179 s. of 2004 CPEU was again implemented for
registered professionals. Any excess units earned are not carried over to the next
three year-period except credit units earned for doctoral and master’s degrees.

Requirement for inactive Nurses Returning to Practice (5 consecutive years)

• one (1) month of didactic training
 • three (3) months of practicum – from hospitals accredited by the BON to
conduct the said training program.

Other institution/agencies offering continuing education program

1. national professional nursing association
- Philippine Nurses Association
- League Government Nurses
- Associations of Nursing Service Administrators of the Philippines

2. professional organizations representing various nursing specialties

- Critical Care Nurses Association of the Philippines
- Psychiatric Nursing Specialists, Inc.
- Occupational Health Nurses Association of the Philippines
- Operating Room Nurses of the Philippines

3. Health agencies with specialties

- Philippine Heart Center
- Philippines Children’s Medical Center
- Lung Center of the Philippines
- National Kidney Institute
- St. Luke’s Medical Center

4. employing agencies in the form of in-service training program

Objectives:

1. equip the new employees with the basic organizational information to

enable him/her to adapt tot the new situation
2. further enhance the skills of nurses to provide quality patient care with
focus to keep updated on new concepts, knowledge and techniques that
relate to special nursing care like intensive care units, operating room,
neonatal or pediatric units, coronary or respiratory care.
3. prepare nurses for leadership positions who are given special raining for
promotion and/or develop a ready pool of trained nurses for supervisor
positions

Some other forms of continuing education programs are the following:

1. Seminars – refer to the gathering of professionals and include among
others – workshops, technical lectures or subject-matter meetings, non-
degree training courses, and scientific meetings
2. Conventions – refer to the gathering of professionals and include among
others conferences, symposia or assemblies for round-table discussions
3. Residency – refers to apprenticeship training at the graduate level, which
is beyond the basic preparation for health professionals. This is conducted
by duty accredited hospitals and medical centers.
4. Distance learning – refers to correspondence learning which uses course
manuals or accreted learning modules – which are instructional material or
programs that may include aids and modules or the use of information
highway: include among others, clearly defined objectives, adequate
content and evaluation content for each module.
5. On-the-job-training – Externship training specialization at the post-
graduate level for a minimum period of four weeks.

CONTROLLING
DEFINITION
- seeing everything is being carried out in accordance with the plan
which has been adopted, the orders which has been given, and the
principles which have been laid down
- verifying whether everything occurs in conformity with the plan
adopted, the instruction issued, and the principles established
- an on-going function of management occurring during planning,
organizing and directing activities
- the sum of the findings of the means in use to determine whether the
goal is being achieved [includes decision making related to planning
and organizing activities, and information from directing and evaluating
of each worker’s performance; records, reports, organizational
progress towards aims, and effective use of resources]
- the measurement and correction of the performance in order to make
sure that the enterprise objectives and the plans devised to attain them
are accomplished

PRINCIPLES OF CONTROLLING (Urwick)

• Principle of Uniformity – ensures that control is related to the
organizational structure
• Principle of Comparison – ensures that controls are stated in terms of the
standards of performance required
• Principle of Exception – provides summaries that identify exceptions to the
standards

PRINCIPLES OF CONTROL (Sullivan & Decker)

• Principle of “setting the fox to watch the henhouse”
- requires their employees to supply their superiors with the needed
information. Precautions should be observed as they tend to be
subjective and are not easy to detect or measure.

• Principle of “measured behavior” driving out “unmeasured behavior”

- giving of feedback to an employee focused on specific and
unmeasurable aspect of the job tends to drive out unmeasured
behavior that is not rewarded

• Principle of “paradox of control”

- any attempts of an individual to control others may impose on them
new requirements. Counter measures may be observed by the
controlee by avoiding the control, modifying the information or
looking for substitute for the desired action.

Controlling as a management function focuses on BETTER RESULTS.

FUNCTIONS OF CONTROLLING
1. It involves setting standards for evaluation purposes at carefully
selected strategic control points.
2. It aims to check and make reports on performance compared with
standards;
3. It seeks to take corrective action as indicated and if condition warrant
4. It measures performance results periodically against plans through the
appraisal of departmental and unit results against objectives and
observe performance reviews by comparing individual reports with the
criteria for satisfactory performance and specific objectives
5. It includes results interpretation which allows the modification and
expansion of existing plans to achieve revised objective
 6. Its feedback aspect necessitates the rise of a suitable performance
evaluation procedure so that people may know ho they are doing
thereby enabling them to plan the desirable changes for the future

CONTROLLING PROCESS
1. Establish standards for elements of management in terms of expected
and measurable outcomes. These are the yardsticks by which
achievements of objectives are measured.
2. Apply the standards by collecting data and measuring the activities of
nursing management, comparing standards with actual care.
3. Make any improvements deemed necessary from the feedback.
4. Keep the process continuous for all areas including:
§ Management of the nursing division and each subunit
§ Performance of personnel
§ Nursing process/product

Formula: Ss + Ss + F + C = I

Standard set plus Standards applied plus Feedback plus Correction will yield
IMPROVEMENT

ESTABLISHMENT OF STANDARDS FOR MEASURING PERFORMANCE

Standards – desirable set of conditions and performance necessary to ensure

the quality of nursing care services which are acceptable to those instrumental to
or responsible for setting and maintaining them.

THREE TYPES OF PERFORMANCE STANDARDS

1. Structure – those that focus on the structure or management system

used by the agency to deliver care.

E.q. Number and categories of nursing personnel including

education Personal and professional qualities and proficiencies
including functions Physical facilities and equipments

2. Process standards – decisions and action of the nurse relative to the

nursing process which necessary to provide good nursing care
assessment plan of care nursing intervention

3. Outcome standards – designed to measure the results of care provided

in terms of changes in the health status of clients served.,
changes in the level of their knowledge, skills and attitudes
and satisfaction of those served including the members of the
nursing and health team
METHODS FOR MEASURING NURSING CARE
1. task analysis – actions and procedures such as written guides,
schedules, rules, records and budgets are inspected
- uses tools as time studies and checklist
2. quality control – activities and techniques employed to achieve and
maintain the quality of product, service or process.
- not only involves monitoring activity but is also
concerned with finding and eliminating causes of
problems so that requirements of the customer are
actually met
 - level of nursing care provided and its effects on the
clients are assessed.

CATEGORIES OF CONTROL
• perfect control – complete assurance that actual accomplishment
proceeds according to plan is never possible because of the likely
occurrence of unforeseen events.
• good control – an informal person could be reasonably confident that
major unpleasant incidents will occur.

“Out of control” – refers to a high probability of forthcoming poor

performance, despite a reasonable operating plan.

CHARACTERISTICS OF COOD CONTROL

1. Future-oriented – goal is to have to unpleasant surprises in the future. The

past serves as a guide of future.
2. Multidimensional – good control be established over activity with multiple
objectives unless performance on all significant dimensions has been
considered. Example: control of nursing services cannot be considered
good unless all the major dimension, including quality, efficiency, and
asset management are well controlled
3. The assessment of whether good performance assurance has been
achieved is difficult and subjective.
4. Better control is not always economically feasible, the control tools are
costly and should be implemented only if the expected benefits exceed the
costs.

EVALUATION PRINCIPLES

1. The evaluation must be based on the behavioral standards of

performance which he position requires. The goals and objectives are
clearly presented to the employee performance evaluation is based on
these.
2. In evaluating performance, there should be enough time to observe
employee’s behavior. Usual and consistent behavior should be evaluated
rather than those isolated or typical actuations.
3. The employee should be given a copy of the job description, performance
standards and evaluation form before the scheduled evaluation
conference.
4. The employee’s performance appraisal should include both satisfactory
and unsatisfactory results with specific behavioral instances to exemplify
these evaluative comments.
5. Areas needing improvement must be prioritized to help the worker
upgrade his/her performance
6. The evaluation conference should be scheduled and conducted at a
convenient time for the rater and the employee under evaluation, in a
pleasant surrounding and with ample time for discussion.
7. The evaluation report and conference should be structured in such a way
that it is perceived and accepted positively as a mean of improving job
performance.

Characteristics of an Evaluation Tool

1. Objective- evaluation must be free from bias

2. Reliable- accuracy or precision of the tool such that it will produce the
same results if administered twice.
 3. Sensitive- instrument can measure fire lines of differences among the
criteria being measured.
(validity) – relevancy of the measurement of the performance of the
employees

PERFORMANCE APPRAISAL

- A periodic formal evaluation of how well personal have performed their

duties during a specific period.
- Is a control process in evaluating how well the nursing personnel have
performed during a specific period of time. In nursing serving personnel
performance is evaluated against standards

PURPOSE OF PERFOMANCE APPRAISAL

1. To determine job competence
2. To enhance staff development and motivate personnel toward higher
achievement
3. To discover the employee’s aspirations and to recognize accomplishments
4. To improve communications between managers and staff associates and
to reach an understanding about the objectives of the job and agency
5. To improve performance by examining and encouraging better
relationships
6. To aid the manager’s coaching and counseling
7. To determine training and development needs of nurses
8. To make inventories of talent within the organization and reassess
assignments
9. To select qualified nurses for advancement and salary increases
10. To identify unsatisfactory employees

PERFORMANCE APPRAISAL METHODS

1. Checklist method or forced choice method- know as the Preference
Checklist Method or descriptive Scale which provides a number of traits or
factors and their corresponding definitions shown on the left-hand column
of the form. These are the quality of work, quantity of work, job attitude,
judgment, reliability, and punctuality
2. Narrative Essay- Provides detailed feedback to employees about their
work performance. A rater tasked to describe the nurse’s (employee)
strengths, weaknesses and potentials, including suggestions for
improvements in specific areas of work
3. Graphic Rating Scale- uses a chart or graph that contains a list of traits
to be observed when rating the nurse job performance
4. Anecdotal Record/critical incidents- validate the technical skills as well
as the interpersonal relationships of the nurses. Employees are able to
obtain meaningful feedbacks so that they are afforded the chance to
received changes needed for their improvement in their job
5. Forced distribution method- employs a five point (superior, above
average, average, below average and poor) job performance scale in
rating employees who perform similar job. Two criteria used to rate
employees – job performance and promotional capability.
6. Paired comparison method- the evaluator determines which of the two
employees in each pair is superior in terms of the trait being considered
and underlines his name.
7. Ranking or rank order method- ranks employees based on how he/she
fared with co-workers with regards to performance or qualifications

Performance maybe formal and informal:

Formal performance appraisal- done regularly and methodologically by
gathering facts objectively that could show the difference between what was
expected and what was done. All mentioned methods are used.

Informal performance appraisal – consist of incidental observation of work

performance while engaged in performing nursing care, worker’s responses
during conferences and worker’s interactions with clients, their families, visitors,
co-workers

INTERGRATING LEADERSHIP ROLES AND MANAGERIAL FUNCTIONS IN

CONDUCTING PERFORMANCCE APPRAISAL

LEADERSHIP ROLES
1. Is self-aware regarding his/her own biases and prejudices
2. Uses a day-to-day coaching techniques to improve work performance and
reduce anxiety of performance appraisal

MANAGEMENT FUNCTIONS
1. Uses a formalized system of appraisal and gather data about employee
performance in a systematic manner, using many sources.
2. Attempt to be as objective as possible, using established standards for the
appraisal

QUALITY ASSURANCE

Quality = degree of excellence Assurance= formal guarantee of a degree of

excellence

Purpose – To measure and improve the quality of nursing delivered in the

agency

Quality assurance is the estimation of the degree of excellence in patient health

outcomes and in activity and other resource outcomes. It focuses on the care
and service the patient receives than on how well the professional performs the
duties that the position requires.
It is the measurement of the actual level of service proved plus the efforts to
modify when the provision of these services in light of the results o such
measurement (Williamson)

Principles Underlying Quality Assurance Efforts

1. All health professionals should collaborate in the effort to measure and
improve care.
2. Coordination is essential in planning a comprehensive quality assurance
program.
3. Resource expenditure for quality assurance activities is appropriate.
4. These should be focus on critical factors such as functions and activities
that promise the yield the greatest health and financial benefit to reveal
significant findings.
5. Quality patient care is accurately evaluated through the adequate
documentation.
6. The ability to achieve nursing objectives depends upon the optimal
functioning of the entire nursing process and its effective monitoring.
7. Feedback to practitioners is essential to improve practice. It perpetuates
good performance and replaces unsatisfactory interventions with more
effective methods.
 8. Peer pressure provides the impetus to effect prescribed changes based
on the results of assessments and needed improvements on the quality of
care.
9. Reorganization in the formal organizational structure may be required if
assessments reveals the need for a different pattern of health care.
10. Collection and analysis of data should be utilized to motivate remedial
action.

NURSING AUDIT

AUDIT - Is a systematic and official examination of a record, process, structure,

environment, or account to evaluate performance; as used in healthcare
organization, it provides managers with a means of applying the control process
to determine the quality of services rendered. It can be:

• Retrospective- performed after the client receives the service

• Concurrent- performed while the patient is receiving the service
• Prospective- attempt to identify how future performance will be affected
current interventions

NURSING AUDIT AS DEFINED

- Is the examination of a patient’s record to determine the degree to
which nursing care was satisfactory according to prescribed standards
and to collect data as a base for corrective action
- As a part of quality assurance program, it is both evaluating and
planning functions of nursing management
- With the standards of the organization, the nursing department, the
professional, government and/or nongovernmental, and the accrediting
group.

Composition of the Nursing Audit Team.

1. Training staff member
2. Supervising nurse
3. Head nurse or senior nurse
4. Staff nurse
5. Chief nurse or her assistant (in smaller hospitals)

NURSNING AUDIT PROGRAMS (Donabedian Model)

1. OUTCOME AUDIT
- The end result of care, or how’s the patients health status changed as
a result of an intervention
- Aims to identify patients outcomes that are unsatisfactory and is
therefore intended to determine the patterns of using care that
happens to be responsible.
- Determines what results, if any, occurred as a result of specific nursing
interventions for clients; it assumes that the outcome accurately
demonstrate the quality of care that was provided.
- Florence Nightingale used mortality and morbidity statistics as
outcome audit to publicize the poor quality of care during the Crimean
War
- At present, outcome research is needed to determine whether
managed care processes, restructuring, and other new clinical
practices are producing the desired cost savings without compromising
the quality of patient care.

2. PROCESS AUDIT
 - Aims to have a deeper probe of problems that are already know or
considered as problems in nursing care process.
- Are used to measure the process of care or how the care was carried
out and assume that a relationship exists between the process used by
the nurse and the quality of care provided; tends to be task-oriented
and focus on whether practice standards are being fulfilled.
- E.g. may be used to establish whether fetal heart tones and blood
pressures were checked according to an established policy; could be
used to determine in newborn teaching had been carried out during the
first postpartum visit.
- Phaneuf audit (as a process audit) is retrospective being applied to
measure the quality of nursing care received by the patient after a
cycle of care has been completed and the patient is discharged.

3. STRUCTURE AUDIT
- Assumes that the relationship exists between quality care and
appropriate structure. It includes resource inputs such as the
environment in which healthcare is delivered, elements that exists prior
to and separate from the interaction between the client and the
healthcare worker
- May include physical facilities, equipments, caregivers, organization,
policies procedure and medical records
- E.g. staffing ratios – to ensure that adequate resources are available to
meet changing patient needs
TOTAL QUALITY MANAGEMENT
OR
CONTINUOUS QUALITY IMPROVEMENT
(DR. W. EDWARD DEMING)
PREMISE – individual is the focal element on which production and service
depend, (must be customer-responsive environment) and that the quest for a
quality is an on-going process.
Identifying and doing problem-prevention quality
the right things, the right + planning = outcome
way, the first time

PHILOSOPHY – THERE IS ALWAYS A ROOM FOR IMPROVEMENT

COMPONENTS
1. A never-ending process
2. Empowerment

FOUNDATIONS OF TQM
1. Focus on the customer
2. Continuous improvement
3. Improve the quality of everything the organization does
4. Measure accurately
5. Involve employees

PRINCIPLES

1. Create constancy of purpose for the improvement of products and

services.
2. Adopt a philosophy of continual improvement.
3. Focus on improving process, not on inspection of product.
4. End the practice of awarding business on the price alone, instead,
minimize the total cost by working with a single supplier
 5. Constantly improve every process for planning, production, and service.
6. Institute job training and retraining.
7. Develop the leadership in the organization.
8. Drive out fear by encouraging employees to participate actively in the
process
9. Foster interdepartmental cooperation, and break down barriers between
departments.
10. Eliminate slogans, exhortations and targets for the workface.
11. Focus on quality and not just quantity; eliminate quota systems if they are
in place.
12. Promote teamwork rather than individual accomplishment. Eliminate the
annual rating or merit system.
13. Educate/train employees to maximize personal development.
14. Charge all employees with crying out the total quality management
package.

PROFESSIONAL NURSING IN THE PHILIPPINES

IS NURSING A PROFESSION?
Perhaps you have heard many people say that nursing is a vocation,
while some
say that it is a profession.
Nursing as a profession
—an occupation or calling requiring advanced training training and
experience in some specific or specialized body of knowledge which
provides service to society in that special field.
Nursing is an occupation
—requiring a unique body of knowledge and skills and which serves society.

CRITERIA OF A PROFESSION
Following are the criteria of profession according to William Shepard;
1. A professional must satisfy an indespensable social needs.
2. It must demand adequate pre—professional and cultural training.
3. It must demand the possesion of a body of specialized and systematized
training.
4. It must give evidence of needed skills which the public does not posses; that
is, skills which are partly inherent and partly acquired.
5. It must have developed a scientific technique which is the result of tested
experience.

6. It must require the exercise of discretion and judgement as to time and manner
of the performance of duty.
7. It must have a group of consciousness designed to extent scientific knowledge
and tecnical language.
8. It must have sufficient self impelling power to retain its members throughout
life.
9. It must recognize its obligations to society.

Flexner and other authors herein cited, describe the qualities of a profession as
follows:

1. A profession applies its body off knowledge in practical services that are vital to
human welfare.
2. It constanly enlarges the body of knowledge it uses and subsequently imposes
 on its members a lifelong obligation to remain current in order to “do no harm.”
3. A profession functions autonomously.
4.It utilizes in its practice a well defined and well--organized body of knowledge
that is intellectual in nature and describes its phenomena concern.
5. A profession has a clear standard of educational preparation for entry into
practice.
6. A profession is distinguished by the presence of specific culture, norms and
other values that are common among its members.

DEFINITION OF A PROFESSIONAL NURSE

Professional Nurse
—is a person who has completed a basic nursing education program and
is liscened in his/her country or state to practice professional nursing.

MEANING OF PROFESSIONAL NURSING

The Philippine Nursing Act of 1991 (R.A. 7164) has been repealed by the
Philippine Nursing Act of 2002 (R.A. 9173).

ARTICLE VI
NURSING PRACTICE

SEC. 28. SCOPE OF NURSING

A person shall be deemed to be practicing nursing within the meaning of
this act when she/he singly or in collaboration with another, initiates and perform
nursing services to individual , families and communities in any health care
setting. It includes but is not limited to, nursing care during conception, labor,
delivery, infancy, childhood, toddler, pre—school, school age, adolescence
adulthood and old age.

(a) Provide nursing care through utilization of the nursing process.

(b) Establish linkages with community resources and coordination with the health
team

(c) Provide health education to individual families and communities.

(d) Teach, guide and supervise student in nursing education program including
the
administration of nursing services in varied settings such as hospitals and
clinis.
(e) Undertake nursing and health human resource development training and
research which shall include, but not limited to, the development of advanced
nursing practice.

Provided, That this section shall not apply to nursing students who perform
nursing functions under the direct supervision of qualified faculty: Provided
further, That in the practice of nursing in all settings, the nurse is duty—bound to
observe the Code of Ethics for nurses and uphold the standards of safe nursing
practice. Provided, finally, That the program and activity for the continuing
professional education shall be submitted to and approved by the Board.

QUALIFICATIONS AND ABILITIES OF A PROFESSIONAL NURSE

A professional nurse must possess qualifications and abilities.
A. Professional Preparation
For his/her professional preparation a nurse must
1. have a liscene to practice nursing in the country
2. have a Bachelor of Science degree in Nursing
 3. be physically and mentally fit

B. Personal Qualities and Professional Proficiences

The personal qualities and professional proficiences of a nurse include
1. interest and willingness to work and learn with individuals in a variety of
setting
2. a warn personality and concern for people
3. resourcefulness and creativity as well—balanced emotional condition
4. capacity and ability to to work cooperatively with others
5. iniative to improve self and services
6. competence in performing workthrough the use of nursing process
7.skill in decision—making , communicating and relating with otthers and
being reseach oriented
8. active participation in issues confronting nurses and nursing.

BASIC EDUCATIONAL PROGRAM IN NURSING

Until 1983—there was only one basic educational program in nursing

—the four year collegiate degree program leading to Bachelor of
Science in Nursing.
-- the three—year hospital—based program leading to Graduate in
Nursing was phased out.
-–revision of this program continues as seen fit by the Council of the

Deans, Philippines Colleges of Nursing, the Department of Education

,
andnursing practitioner.
-- Colleges may also add courses that will enrich their curriculum.
Effective School Year 1998—1999—the curriculum for the common two –year
Associate in Health Science Education was enforced.

THE BSN CURRICULUM

The four—year Bachelor of Science in Nursing Program offers a competency based
community oriented curriculum to educate future nurse practitioners to
assume their roles and reesponsibilities in the Philippine Healtth Care
System. It aims to prepare nurses for entry level positions in any health care
setting in the country.
Overall, the BSN program intends to produce professional nurse who
demonstrates the following behavior:
1. caring behavior (compassionate, committed competent)
2. ability to practice legal , ethico—moral , social responsibilities/
accountabilities
3. critical and creative thinking
4. skill in practicing S—K—A and values for thr promotion of health
prevention of illness, restoration of health, alleviation of suffering;
assisting the client to face death with dignity and in peace .

Nursing student must have graduated from a college of nursing which has been properly
accredited to offer nursing course.

LISCENE TO PRACTICE NURSING

LICENSE
—is a legal document given by the government that permits a person to
offer to the public his/her skills and knowledge in particular jurisdiction,
where such practice would otherwise unlawful without license.
--the appropriate athority to administer, implement and enforce the
regulatory policies of government with respect to regulationand licensing of
the various professions and occupations under its jurisdicton is the
Professional Regulation Commission (PRC).

Need for Licensure

1. The primary purpose of registration is to protect the health of the people by
establishing minimum standardswhich qualified practitioners must meet.
2.Licensure discourages certain person who may tempted to
misrepresentthemselves as nurses
3.The most important tool for legal controland enforcement of nursing practice.
4.It is also used to gather statistical data about nurses and nursing in the country.

REGISTRATION
—is the recording of names of persons who have qualified under the law to
practice their respective professions.

Nurses names are recorded in a registry or registration book which contains:

1. full name of registrant
2. number and date of registration
3. age, sex and place of birth
4.place of business
5. post office address
6. name of school, college or universityfrom which he/she graduated or which
he/she studied
7.date of such graduation or term of study, together with the time spent in the
study of the profession
8.all other degrees granted to him or her from other institutions of learning.
A certificate of registration is issued by the PRC to show such qualification.

PHILIPPINE NURSING ACT of 2002, R.A. 9173, Sections 12 and 20

—state that license to practice nursing shall be issued to those who pass the
licensure examination or by reciprocity.
RECIPROCITY—means mutuality in the grant and enjoyment of privileges between
persons or nations.

--based on the principle of “do ut des” which means that for a country to
expect a favor from another , it should be willing to give a corresponding favor.

REGISTRATION BY RECIPROCITY
—a certificate of registration/professional license maybe issued without
examination to nurses registered under the laws of a foreign state or country.
--provided that the requirement for registration or licensing of nurses in said
country are substantially the same as those prescribed under this Act.
--applicants for registrations as nurses by reciprocity shall present to the
Board of Nursing a properly completed application on the prescribed form,
together with their respective certificates of registration as a nurse granted by
their state or country.
In addition, the following shall be attached:
1. a certification from the Commision on Immigration and Deportation stating that
they have been a residents of the Philippines for atleast three years prior to
registration.
2.a copy of the law or petition thereof showing reciprocal practicewith the
Philippines
3. a copy of their officially approved Bachelor of Science in Nursing curriculum

SECTION 21. PRACTICE THROUGH SPECIAL/TEMPORARY PERMIT

A special/temporary permit maybe issued by the Board to the following
persons
subject to the approval of the Commission and upon payment of prescribed fees.

1. Licensed nurses from foreign country/states with well known specialist or

outstanding
experts in any branch or specialty in nursing.
2. Licensed nurses from foreign countries/states on medical mission
3. Licensed nurses from foreign countries/ states employed by shool /colleges as
exchange professor in a branch on specialty of nursing.

REGISTRATION BY EXAMINATION
A. EXAMINATION AND REGISTRATION
SEC. 12 Licensure Examination—all apllicants for registration as a nurse are
required to
pass a wrtten examination which shall be given by the Board in such places and
dates as
maybe designated by the Commision.
--such examinations must be in accordance with and fully compliant
with
R.A. No. 8981

SEC. 13 QUALIFICATION FOR ADMISSION TO THE

LICENSUREEXAMINATION
An applicant must, at the the time of filing his/her application, establish to
the
satisfaction of the Board

1. Is a citizen of the Philippines, or a citizen or subject of a country which permits

Filipino
nurses to practice within its territorial limits.
2.Is of good moral character
3. Is a holder of Bachelors Degree in Nursing from a college or university

B. REQUIREMENTS FOR EXAMINATION

The following document are requiredof each applicant:
1. Original transcript of Record with Special Order fro the DECS unless he/she is
graduate of a Level II accredited nursing program.
2.For state colleges and universities, original TOR with date of graduation
3. Record of actual RLE experiences for the entire BSN program duly signed by
the Chief
Nurse of hospital Dean of the nursing school and the clinical instructor
4.Actual number of operating room scrubs and deliveries assisted signe by the
Chief
 Nurse, Dean, and Clinical instructor
5.Where applicable:
a. Birth Certificate
b. Marriage Contract
c. Alien Certificate of Naturalization
d.Clearance showing dismissal of case from the Court or Prosecutors
Office
Note: The application form , together with the requirements should be filed at
the PRC ten(10) days prior to the first day of examination.

C. FEES
Applicants for licensure and registration shall pay the prescribed fees set
by the
Commission

D. SCOPE OF EXAMINATION
SEC. 14. The scope of examination for the practice of nursing shall be
determined by
the Board.
MAY 1994—intgrated comprehensive nursing licensure examination has been
designed.
--to better measure the level of competence or proficiency rather
than

compartmentalized subject area of examination.

--the examinationsshall be divided into four parts organized around

four

major goals in nursing: promotive, preventive, curative and

rehabilitative.

E. CITIZENSHIP REQUIREMENTS
SECTION 1
1. Those who are citizens of the Philippines at the time of adoptionof this
Constitution.
2. Those who elect Philippine citizenship pursuant to the provisions of the
Constitution
of 1935.
Jus sanguinis doctrine
—the nationality of a person is determined by the law of his descent or
parentage; the child follows the citizenship of his father.

Jus soli doctrine

—the nationality of a person is determined by the law of the place of his
birth.
--the child born in a foreign country whatever maybe the citizenship of the
father,
is citizen of that country.

Naturalization
 —the act of adopting a foreigner and giving himthe privileges of a native
citizen.

F. RATING OF THE NURSING LICENSURE

SEC. 15 RATINGS
1. must obtain a general average of seventy—five percent (75%) with a rating not
below
sixty percent (60) in any subject.
2. An examinee who obtain 75% or higher but gets a rating below 60% in any
subject
must take the Examination again but on the subjects where he/she is rated
below
60%
3. An examinee must obtain atleast 75% in the subject or subjects repeated .

RECONSIDERATION OF RATINGS
Reconsideration of ratings maybe entertained only on:
a. grounds of mechanical, clerical or clear errors
b. malfeasance in the rating of papers

The request should be filed with the Commision within 90 days from the date of
official
release of the examination results.

OATH—TAKING OF NURSES
1.All successful candidates in the examinations shall be required to take
an oath.
2. The schedule of mass oath—taking is within 15 days upon the release
of the
results of the Licensure exam which is included in the press release by
the PRC.
3. The mass oath—taking is assissted by the accredited professional
organization
4. During oath—taking the nurses are inducted as new membersof their
professional organization.

RENEWAL OF THE NURSE LICENSE

3 years—every registered nurse shall renew his/her license with the PRC on the
form prescribed and pay the prescribed fee.

PRC RESOLUTION NUMBER 2004—179 SERIES OF 2002

—entiled “Standardized Guidelines and Procedures for the
Implementation of
the Continuing Professional Education for Professionals.
--requires that the total CPE credits for registered professionals with a
Baccalaureate Degre shall be sixty credits for 3 years.

REVOCATION OR SUSPENSION OF CERTIFICATES OF REGISTRATION

1. for any of the causes mentioned in section 22 of R.A. 9173
2.for unprofessional or unethical conduct
3. for gross incompetence or serious ignorance
4.for malpractice or negligencein the practice of nursing
5. for the use of fraud, deciet or false statements in obtaining the certificate of
registration
6. violation of this Act, implementing the rules and regulations, Codes of Ethics
for
Nurses
7.practicing his/her profession during his/her suspension
The suspension of the certificate/ professional license shall be for a period not
exceeding four years.

RE—ISSUANCE OF REVOKED CERTIFICATE

SEC. 24 Re—issuance of revoked Certificate and Replacement of Lost
Certificate--
After the expiration of a minimum of 4 years from the date of revocation of
certificate.
A new certificate of registration/ professional license to replace a
certificate that
has been lost, destroyed or mutilated maybe issued subject to the rules of the
Board.

SUSPENSION— a nurse is not allowed to practice temporarily until the final

judgement
against him i rendendered.

--the license is not confiscated.

REVOCATION
—the license to practice is confiscated either temporarily or permanently.
DUE PROCESS OF LAW
—is defined as a “law which hears before it condemns”
--the fundamental requirement of due process of law is an opportunity
for hearing and defense.
--no person shall be deprived of life, liberty or property without due
process of
law nor shall any person be denied equal protection of the laws.

FUNDAMENTAL REQUIREMENTS OF DUE PROCESS

ARTICLE III SECTION 14 of the New Constitution stating that “no person shall
be held to
answer for a Criminal offense without due process of law.

1.the accused is presumed innocent until the contrary is proved

2.the right to free accessto the courts and adequate legal assisstance
3. the rigth to remain silent and to have competent and independent legal
counsel
4. the right to bail and protection
5. the right to presumption of innocence until the contrary is proved
6. the right to be heard by himself /herself and coubsel

7.the right to be informed of the nature or the cause of accusation against him
8.the right to have speedy, impartial public trial
9. the right against self—incrimination
10. the right against the use of force, violence, threat, intimidation or other means
which vitiates free will
11. the right against cruel and unsual punishment
12. the right against excessive fines
13. the right against double jeopardy

THE LICENSING BOARD

PRC—the power to regulate the established profession in the Philippines and to
examine the applicantto practice as created by PRESIDENTIAL DECREE
223.
--the regulatory power with respect to the nursing profession is conferred
upon THE
PROFESSIONAL REGULATORY BOARD OF NURSING.

ORGANIZATION AND COMPOSITION

REPUBLIC ACT 9173—provides for the creation of a Professional Regulatory
Board of Nursing
SEC 4. COMPOSITION OF THE BOARD
The Board created under SEC 3, Article III of the Nursing Act shall
be composed of:
Chairperson and six members representing the three ares of nursing

1. nursing education
2. nursing service
3. community health nursing
Members of the Board are appointed by the President of the Philippines
and confirmed by the Commission on Appointments.
Members of the Board of Nursing maybe appointed by:
1. REGULAR APPOINTMENT
—the PNA certifies for appointment to the Nursing Board of the PRC
--12 candidates who possess required qualifications
2. AD INTERIM APPOINTMENT—board meember is appointed in the meantime
to fill in
vacancy or perform the duties of an office during the absence of regular
incumbent
--no definite term of appointment
3. DOCTRINE OF HOLD—OVER
—a member of the nursing board is permitted to continue to exercise
the functions of the office after the end of his/her lawful term until replaced

QUALIFICATIONS OF THE MEMBERS TO THE NURSING BOARD

The Chairperson and Members of the Board shall, at the time of their
appointment,
possess the
following qualification
a. a natural born citizen and resident of the Philippines

b. a member of good standing of the accredited professional organizationof

nurses
c. a registered nurse and holder of a master’s degree in nursing
d. must have atleast ten (10) years of continous practice of the profession prior to
appointmen (the last five years shall be in the Philippines)
e. must not have been convicted of any offense involving moral turpitude
f. membership to the Board shall represent the three areas of nursing

TERM OF OFFICE—the Chairperson and Members shall hold officefor a period

of three
years
 a. no Chairperson and Member shall be appointed or reappointed for more
then 2
terms
b. appointment to vacancy that occurs before the expiration of the term of
office
c. shall take the proper oath of office prior to the performance of his/her
duties

COMPENSATION OF BOARD MEMBERS

—Chairperson and Member of the Board recieve compensation and
allowance
received to the other professional regulatory boards
quantum meruit—principle means “as much as they deserve”

POWERS, FUNCTIONS AND RESPONSIBILITIES OF VARIOUS BOARD

(AS PER R.A. 8981 –THE MODERNIZATION ACT OF 2000)

1. To regulate the practice of the profession in accordance with the provisions of

their
respective professional regulatory law
2.to monitor the conditions affecting the practiceof the profession or occupation
under
respective jurisdictions.
3.to hear and investigate cases arising from violations of their respective laws,
the rules
and regulation, promulgated thereunder and their Code of ethics
4. to delegate the hearing or investigation of administrative cases
5. to conduct summary proceedings on minor violations of their respective
regulatory
laws, violations of the rules and regulationsissued by the board through the
Legal officers of the Commission.
6. subject to the final approval by the Commission, to recommend registration
without
examination and issuance of corresponding certificate of registration and
professional
identification
7. after due process, to suspend, revoke or reinstate certificate of registration or
license
provided by law
8. to prepare, adopt and issue the syllabi or tables of specifications of the
subjects for
examination in consultation with the academe.
9.to prepare an annual report of accomplishments on programs , projects and
activities
of the Board

DIFFERENT FIELDS OF NURSING

CLASSIFICATION OF FIELDS OF NURSING IN GENERAL
1. Hospital or Institutional nursing
Nursing in hospital and related health facilities , nursing homes, and
neighborhood clinics comprises all of the basics components of comprehensive
patient
care and family health. The nurse, as a member of a health care team,participate
in all
phases of patient care of the acutely ill, convalescing and ambulatory patient.

2. Public Health Nursing or Community Health Nursing

The National Health Program of the Philippines gives as much emphasis
on the
promotion of health and prevention of diseases rather than the care of the sick.

Members of the Health Team

1. Physician 6. Sanitary engineers
2. Nurse 7. Nutritionist
3. Epidemiologist 8. Health Educators
4. Dentist 9. Social Workers
5. Sanitary Inspectors 10 .Community and Barangay
leaders
Effective coordination can best be achieved if all members have an
understanding of,
and respect, each other function

3.Private Duty or Special Duty Nursing

1. Nurses in private practice are expected to be expert clinicians as well as
expert
generalists in Nursing
2. Private Duty Nurse, Private Nurse Practitioner, Specil Duty Nurse or
PrivateDuty Nurse Specialist
Categories: 1. General Private Duty Nurse—has the capabilities for providing
basics
nursing care to any type of patient.
2. Private Duty Nurse Specialist—in addition to the foregoing
abilities
expected her or his specialized preparation

4. Industrial or Occupational Health Nursing

1. In this field, the nurses are work alone and must therefore possess maturity,
experience and wise judgment.
2. They must give immediate cate to the patients with serious injuries, they need
to be fully informed about legal responsibilities.
3.The first consideration is the patients welfare.

5. Nursing Education
Career opportunities in nursing education are better today than ever
before.
QUALIFICATIONS OF THE FACULTY
1. be a registered nurse in the Philippines
2. have atleast one year of clinical practice in the field of specialization

3. be a member of good standing in the accredited professional organization of

nurses
4. be holder of master’s degree in nursing, education, or other allied medical and
health
 sciences

6. Military Nursing
Provides comprehensive and quality nursing care to all military personnel,
their
dependents and authorized relatives.

7. School Nursing
They are responsible for the school activities in the areas of health
services,
health education and environmental health and safety. The primary function of
the
school nurse is education.

8. Clinic Nursing
Clinic nursing requires that a nurse possess general skills.
Nurses in this field must have excellent teaching and communication
skills, exhibit
organizational and leadership ability, possess good assessment skills and good
insight to
anticipate and interpretthe needs of their patients.

9. Independent Nursing Practice

The nurse is self—employed and provides professional nursing services
to a client/patients and their families

NURSING OPPORTUNITIES ABROAD

New nurses are advised to serve the country first before planning to go
abroad.
The reason for this are:
1. to acquire a better perspective of the actual health status of the people in the
country
2.to be able to participate in and contribute to the implementation of the national
health programs for the people.
3. to develop skills not only in the cure and preventive aspects of care but also in
the art
of good working relationship with the health team and community
4. to gain more experience in a variety of situation and enble them to be more
mature
in judgment
5. to acquire the satisfaction of having been able to serve our people first before
serving others

CHOOSING , RETAINING, RESIGNING AND DISMISSAL FROM A POSITION

Guidelines in choosing a field of nursing
The first consideration that nurses must take is SELF EVALUATION.
Factors to consider in making self evaluation
1. qualifications
—What is your educational qualifications?
2. years of experience and training
—Are these relevant to the position you are applying for?

3. age and physical condition

—Most employers prefer young nurses for beginning positios.
4. emotonal stability and good life
 —Can you be calm even under stress?

Factors in selecting a field in nursing

1. kind of work to be performed
2. availability of the work
3. hours of works
4. qualifiacations
5. opportunities for advancement
6. method of entering
7. earning
8. fringe benefits
9. other benifits

USEFUL POINTERS IN MAKING ALETTER OF APPLICATION

1. use clean, white unlined paper
—if you are working in an agency, do not use the agency stationary with
letterhead
2. use ink or ballpen in writing

3. use proper salutation

—preferably know the name of the person to whom the letter is to be
addressed
4. observe proper margin and paragraphing
—use good English and correct spelling
5.write in courteous manner
—ask permission before using a person’s name as reference.
6.enclose return postage
—the person to whom the letter is addressed will be encouraged to reply.

A letter application ussually contains the following facts:

1. source and purpose
2. qualifications
3. reference
4. a request for personal interview

PERSONAL INTERVIEW
—face to face conference between two people about something
--the applicant and prospective employer gives both a chance to assess each
other
--two way process in which both the employer and applicant discuss conditions of
work
and other related topics

Employer—assess the applicant personality

alertness in answering the questions
poise, command of the spoken language

Applicants—background of the institutions

its potential as a working place
its philosophy and objectives
working conditions

POINTERS IN PREPARING FOR AN INTERVIEW

1. make an appointment either by mail or telephone
—the Nursing Office or Personnel Division schedules time to conduct.
2. be at the place at the appointed time
—it is necessary that you start early from your place so that you are at the
agency
ten to fifteen minutes before the time so you can relax and appear unhurried.
3. know something about the institution where you will apply so that you can
answer
intiligently
—know the name of the person who will interview you.
4. be at your best
—be neat and simple hair—do, moderate make—up, modest dress. For male—
clean specially at the collar line, descent haircut and be well shaven.

5. knock before you enter

—greet the person who lets you in and the person who will interview you. Wait
until you are offered to sit before you do so. Do not slouch
6. bring credebtials such as registration card, residence certificate tax account
number
—bring small photographs and ballpen.
7.ask question about the job
—it may help deciding if you like the position
8.thank the interviewerfor giving you someof his or her time
—do not delay the interview unnecessarily.
9.give yourself time to think about the position
—notify the prospective employer if have changed your mind or have tranferred
to another address
10. if the prospective employer does not answer, you may write a follow up letter
stating your interest in the position

RETAINING A POSITION
Once you have obtained a position, strive to retain it and be successful in that
chosen field.
This will lead to self satisfaction and building a career in nursing

How can you be successful in your chosen field of nursing?

There is no sure formula for success, the following are suggested

1. have adequate knowledge and preparation for the job.
2. have a well developed personality
3. develop good interpersonal relationship with your co-wokers by:
a.being enthusiastic in, dedicated to your work, being sincere and considerate to
others. Practice the “GOLDEN RULE”
b. being tactful and dependable. Practice self control
c. developing ability to adhere to social amenitiesand being socially
compatible
d. having self confidence and cheerful
e. offering help when needed.
4. develop proficiency in communication
5. be able to adjust to working conditions
Ability to relate with others—pakikipagkapwa-tao
Ability to get along with others—pakikisama
6. keep abreast with advances in medicine , nursing and related sciences
CAUSES OF FAILURE
Although nurses have the opportunity to get a good position, some may
fail in their jobs.
Causes of failure maybe due to any of the following:
1. incompetence
2. poor interpersonal relationship,lack of cooperation with co—workers,
dishonesty, boastfulness

3. personal defects imprudence in choosing friends, insincerity, sarcasm

4. inadequate knowledge in social conduct

How to turn failure into SUCCESS

Nurses who accept their limitations know their weaknesses, and those
who try to
overcome them are more likely to succeed than those who do not.
Those who are very bright in the classroom may not always be
successfulin the
field of nursing, while those who are willingto turn their weaknessess into assets
maybe
more successful.
Nurses should fit into and adjust into the position. This means being
competent
for the job taking it with prideand doing ones best at all times.
They must continue to develop themselves professionally
throughobservation,
staff development and reading professional literature.

RESIGNING FROM A JOB

Reasons why nurses resign from their jobs
1. to seek better positions wether in the Philippines or abroad
2. inability to adjust to the work situation
3.marriage
4. children/transfer of family from other places

HOW TO WRITE A LETTER OF RESIGNATION?

Observe the following points:
1.give the date of resignation
—it is good to complete the month from from the date the notice of resignation is
filed. The date ussually effective on the 15th or at the end of the month.
2. state the reason for resigning
—it is important to be courteous because the letter is ussually on file and
ussually
referred to when the need arises.
3. express gratitude for kindnesss andand consideration given during the period
of
employment
—express regret for leaving regardless of the reasons.
4.attach clearance for money, work and property responsibilities
—never walk off from a position. This will make one liablefor breach of contract
or abandonment of duty . “French Leave” or AWOL

Reason of Dismissal from a Position

a. negligence
b. incompetence
c. malpractice
d. unprofessional behavoir
e, breach of contract

CONTRACT
—is meeting of minds between two personswhereby one binds himself
with
respect to the her to give somethingor to render some service.
--is a promise or set of promisewhich the law recognizes as a duty and when that
duty is not performed, the law provides remedy.

KINDS OF CONTRACTS
1. FORMAL CONTRACT
—agreement among parties involved and is required to be in
writing by somespecial laws.
2. INFORMAL CONTRACT—does not require the same to be in writing.
3. EXPRESS CONTRACT—condition and terms of the contract are given orally
or in
writing by the parties concerned
4.IMPLIED CONTRACT—one that is concluded as a results of acts of conduct of
the
parties to which the Law ascribes an objective, intention to enter into
contract.
5.VOID CONTRACT—one that is inexistent from the very beginning and
therefore may
not be enforced
6.ILLEGAL CONTRACT—expressly prohibited by law

BREACH OF CONTRACT
1. prevention of performance
2.failure to perform because of inconvenience or difficulty
3. failure of cooperation in performance
4.abandonment of duty
5. subtitution of performance
6.failure to use due care

LEGAL EXCUSES IN REFUSING, NEGLECTING OR FAILURE TO PERFORM

A CONTRACT
1. discovery of material misrepresentation made and relied upon
2. where performance will be illegal
3. where performance is made possible by reason of illness
4.where performance is made impossible by death of patient or nurse
5. where performance is made for other reasons
6.where contract is insufficient

ADVANTAGES OF WRITTEN CONTRACTS

1. A written contract is certain. It avoids the uncertainty of human memory.
2.it can specify a definite time
3. It set a standards and relieves an individual professional person from
hanggling over compensation
4.it can provide a definite procedure in case of complaints about substandard of
work

5. it creates minimum of certainty and security for the professional employee so

that
he/she is free to concentrate on his/her work without concern for the details
which
the written contract has settled.

NURSING ETHICS
ETHICS—Greek word “ethos” which means moral duty
--refers to a standard to examine and understand moral life
--Ethical theories, , principles and code of conductserves as guide of
human
conduct provided by ethical system.
--studies how people make judgment in regard to right or wrong
MORAL
—specific ways of behavior or of accomplishing ethical practices
--Greek word moralis which refers to moral consensus about moral
conduct for
and society.
ETHICIST JOSEPH FLETCHER—differentiates morality from ethics
--Morality is what you believe is right and good while
Ethics is the critical reflection about morality and rational analysis about
it.
PROFESSIONAL ETHICS—branch of moral science concerned with
theobligations that a
of the professions owes to the public.
HEALTH CARE ETHICS—division of ethics that relates to human health.
BIO—ETHICS—specific domain of ethics that focuses on moral issues in the
field of health care.

NURSING ETHICS—is related to all the principles of right conduct as they apply
to the
profession.
--reinforces the nurse ideals and motivesin order to maximizethe
effectivity of
the service.

ETHICAL PRINCIPLES AND OTHER APPROACH

1. TELELOGICAL APPROACH
Telelogy—Greek word “telos” or goal or end.
“the right to do is the good thing to do”
>also term as UTILITARIANISM—where the god resides in the promotion
of
happiness or the greatest net increase of pleasure over pain

FLETCHER PROVIDES GUIDELINES FOR MAKING ETHICAL DECISIONS

1. consideration for people as human beings
2. consideration of consequences
3. proportionate good to come from the choices
4. propriety of actual needs over ideal or potential needs
5. a desire to enlarge choices and reduce chance
6. a courageous acceptance of the consequences of the decision

2. DEONTOLOGICAL APPROACH OR DUTY ORRIENTED THEORY

Deontology—Greek word “deon” which means duty

In this theory, the basic rightness or wrongness of an act depends on the intrinsic
natureRather than upon the situation or its consequences.

“PRIMA FACIE DUTIES”

—which means ”what one should do when other relevant factor
in asituation are not considered”

duties of fidelity—telling the truth

duties of reparation—righting the wrong we have done to others
duties of gratitude—recognizing the service of others have done for us
duties of beneficence—helping to better the condition of other beings
merit of people involved
duties of self improvement—bearing ourselves with respect to virtue or
intelligence
duties of nonmaleficence—avoiding or preventing injury to others

3. VIRTUE ETHICS APPROACH

Virtue ethics—Greek word “arete” known as aretaic ethics
--focused primarily on the heart of a person performing the act
--it focuses on the traits and virtues of a good personsuch as courage,
temperance,
wisdom and justice.

4. DIVINE COMMAND ETHICS

Based on the theory that there is a Supreme or Divine being that set down
the to provide guidance to moral decisions.
For Christian these rules are found in the TEN COMMANDMENTS
5. UNIVERSAL PRINCIPLES OF BIOMEDICAL ETHICS
The basic ethical principles to assisst the health professionals to
determine right
or wrong in regard to value issues involving the a) pursuit of health, b)
alleviation of suffering, c) asssisting patients towards peaceful death.

AUTONOMY—Greek word ”autos” meaning self and “nomos” meaning

governance
It involves self—determination and freedom to choose and implement one’s
decisionfree from deciet, duress, constraint or coercion.
example: informed consent
VERACITY—intentionally witholds information according to his sound judgment
when
such revelation
Would do more harm to an emotionally unstable or depressed person.
BENIFICENCE—promotes of doing act of kindness and mercy that directly benifit
the
Patient,
1. promote the health of patient
2. prevent illness or complication
3. alleviate sufferings
4. assisst toward peaceful death if the inevitable comes
The PATIENT’S BILL OF RIGHTS helps the health practitionerprovide more
effective
patient care
1. considerate and restpectful care
2.relevant, current and understandable information corcerning diagnosis, tx,
specific
procedures,
prognosis, medically alternative benifits needed to make informed consent
3. make decisions regarding his plan of care
4. have advance directive concerning tx or designating surrogate decision maker
5. every consideration of his privacy such case discussion, consultation, and tx.
6.confidentiality of information and records
7. review his records concerning his medical care and have this explain to him
except
when restricted by law
8. be informed of business relationship among the hospital, educational
institution,
health provider that may influence the patients treatment and care
9. consent or decline to participate in experimental research affecting his care
10. resonable continuity of carewhen appropriate and informed of other care
options
whenhospital is no longer appropriate
11. be informed of hospital policies and practice that relate to patient care

NONMALIFECENCE—they should do what is best for the patient

JUSTICE—the right to demand to be treated justly, fairly, and equally

ETHICS COMMITTEES IN HOSPITALS

1. discuss sensitive issues such as when to withdraw or withold treatment for an
adult
and tratment of a severely handicapped newborn

2. right to die, informal consent, right to choose or refuse treatment, right to know
who
trating the patient
3. discussion begins ussually with the description of the patient’s condition and
medical
history
4. They composed of philosophers, doctors, nurses, lawyers, clergy, or social
workers

RESPONSIBILITIES OF THE NURSE TO THE PATIENT

1. to give him/ her the kind of care his/her conditionregardless of his race, creed,
color,
Nationality or status.
2. advised to become familiar with the patients Bill of Rights and observe its
provision
3. they should not accept tips or expensive gifts that may induce to give more
care to
favored the patient
4. treat patients in a manner that will show concern whether the patient is rich or
poor
5. when a nurse is engaged by a patient or agency he shall complete said
services on the
lenght of time stipulated in the contact
6. she/he may not leave the patient or agency without proper
permission/resignation or
without relief

7. they should commit themselves to the welfare of those entrusted to their care.
They should be loyal to their sworn duty

CONFIDENTIALITY OF INFORMATION
—also termed as privileged communication because it is given
based on trust.
1. the patient himself/herself permits such revealation
2. the case of medico—legal
3. the patient is ill of commmunicable disease and public safety will be
jeopardized
4. given to the members of the health team if information is relevant to his care

PATIENT’S RESPONSIBILITIES
1. providing information
2.complying with instructions
3. informing the physician of refusal to treatment
4. paying hospital charges
5. following hospital rules and regulations
6. showing respect and consideration

BILL OF RIGHT FOR REGISTERED NURSES

Registered nurses promote and restore health, prevent illness and protect
the people entrusted to their care. They work to alleviate the suffering experience
by individuals, families, groups and communities.

NURSES RESPONSIBILITIES IN RESEARCH ON HUMAN SUBJECTS

2 MAJOR TYPE OF RESEARCH
1. essentially therapeotic
2. directed toward developing scientific knowledge and has no therapeutic value
for the
subjects.

The declaration emphasizses that the research subjects must be informed

when a
clinical or non-clinical study will be of nopersonal benifitto them to avoid any
suspicion
to the contrary.

BASIC HUMAN RIGHTS OF RESEARCH SUBJECTS

Adequate protection of human rights includes their legal as well as moral
rights.
1. RIGHT TO INFORMED CONSENT—self determination means free consent is
pre—
requisite to any human involvement. The subjects must know the risk involved,
benifits anticipated, time and energy requirements.
2. THE RIGHT TO REFUSE AND/OR WITHDRAW FROM PARTICIPATION—
the person has
 the right to refuse to participate. Nurses shall explore the subject’s reason for
refusing.
3.RIGHT TO PRIVACY—includes privacy of one thoughts, opinions and physical
presence
and privacy of one’s records. The subject has the freedom to decide.
4. RIGHT TO CONFIDENTIALITY OR ANONYMITY OF DATA—data about the
research
subjects shall be handled confidentiality. Data shall be available only to the
research
staff and shall be reported anonymously. The identity of the agency shall be
protected.

5. RIGHT TO PROTECT FROM HARM—there shall be appropriate balance

between
potentials benifitsof the research and the risks assumed by the subjects. This is
called
the risk—benifit ratio in the benifits outweigh the harm.

EXPERIMENTAL SUBJECT’S BILL OF RIGHTS

An experimental subjects has the right
1. to be told what that study is trying to find out
2. to be told what happen to himself /herself and wether the procedure, drugs or
devices are different from what are usedin standard practice
3. to be told of the frequent or important risks, side effects discomfort of the
things
4. to be told if he can expect any benifit from participating
5. to be told the other choices he may become better or worse than being in the
study
6. to be allowed to ask question concerning the study
7. to be told what sort of treatment is available if any complications arise
8. to refuse to participate at all or change his minds about participation after the
study is
started
9. to receive a copy of the signed and dated consent form
10.to be free pressure when considering wether he/she wishes to agree to be in
the
study

RESPONSIBILITIES OF THE NURSE TO THE PHYSICIAN

Nurses shall familiarize themselves with various routine, methods, or
idiosyncracies of the physician

RESPONSIBILITIES OF NURSES TO THEIR COLLEAGUES

1.Nurses are expected to be able to get along smoothly with their colleagues
2. Nurses shall adjust themselves to the organization and know its policies and
procedure
3.Nurses must know their place in the total organization so they may cooperate,
coordinate and maximize their work
4. Nurses who are cranky, too sensitive, who backbite, who do not see any good
in their
colleagues are the type of nurses who will not be happy in their work.
RESPONSIBILITIES OF NURSES TO THEMSELVES
1. it is expected that every possible means shall utilized by them to develop their
skills
2. conduct must bring credit to the profession
3. nurses on duty shall look neat and attractive
4.role models of nursing students

MORAL AND SPIRITUAL RESPONSIBILITIES

They must realize that the nursing profession is a commitment to both God and
people.

Emphasize the importance of providing the spiritual care as a vital aspect of

nursing care.
1. Moral principle—“Do unto others what you would like others unto to you”.
2. The Two—fold Effect—whe a nurse is faced with a situation may have both
good and
bad effects.
a. the action must be morally good
b. the good effect must be willed and the bad effect merely allowed
c. the good effect must not come from the evil action but from the initial
action
itself directly
d. the good effect must be greater than the bad effect
3. The Principle of Totality—the whole is greater than any of its parts
4. Epikia—“exception to the general rule”
5. One who acts through an agent is himself responsible
6. No one is obliged to betray himself/herself—no one can force a person to
answer a
question if will incriminate him/her.
7. The end does not justify the means
8. Defects of nature maybe corrected—patients with hairlip or cleft palate may
corrected by surgery
9. If one is willing to cooperate in the act, no injustice is done to him/her.
10. A little more or less does not change the substance of an act.
11. The greatest good for the greatest number
12. no one is held to the impossible

13. The morality of cooperation

14. Principle relating to the origin and destruction of life

THE CODE OF ETHICS FOR FILIPINO NURSES

Ethical codes are sytematic guides for developing ethical behavior.
The Code off Good Governance—promulgated by the PRC on July 23,2003
--states that the hallmark of all professional is their willingness to accept a
set of
professional and ethical principles which they will follow in conduct of their daily
lives

GENERAL PRINCIPLES
1. Service to others—commitment to a life of sacrifice and genuine selflessness
in
carrying duties even at the expense of personal gain
2. Integrity and Objectivity—professional should perform their responsibilities with
the
highest sense of integrity
3.Professional Competence—continuing education program
4. Solidarity and Teamwork—maintain and support one professional organization
5. Social and Civic Responsibility—contribute to the attainment of the countrys
national
objectives
6.Global Competitiveness—open to challenge of a more dynamic and
interconnected
world, rise up the global standards

7. Equality of All Profession—treat their colleagues with respect and strive to be

fair in
their dealing with one another.

LAWS GOVERNING THE PRACTICE OF NURSING

LAW—sum total of rules and regulations by which society is governed
--it is man—made and regulates social conduct in a formal and binding
way.
--it reflects society needs , attitudes and more.
-- also defined as a rule of conduct pronounced by controllingauthority and which
maybe enforced

3 ESSENTIAL CHARACTERISTICS OF EVERY LAW

1. the authority or the right to declare that the rule exist
2. such rule is pronounced or expressed and that its source can be identified
3. a right to enforce the same must be provided
Government—controlling authority in our system
Constitution—fundamental law of the government
The principal source of Pronouncements are:
1. the Constitution
2, the Statutes or legislations
3. the regulations issued by Executine branch of the government
4. case decisions or judicial opinions
5. Presedential Decrees

6. Letter of Instruction

HISTORY OF THE PHILIPPINE NURSING LAW

ACT No. 2493 0f 1915
—the first law that had to do with the practice of Nursing, which regulated
thePractice of medicine
1919—ACT 2808 was passed
--the First True Nursing Law
1920—first board examination in the Philippines was given
JUNE 19, 1953-- REPUBLIC ACT 877—the Philippine nursing law.
--provisions includes the organization of the Board of Examiner for nurses
--provisions regarding nursing school, and colleges, registration of
nursesincluding
sundry provisions relative to the practice of nursing

TWO IMPORTANT SECTIONS OF R.A. 877

SEC. 16 ART IV—Inhibition against practice of nursing
SEC. 30 ART V—prohibits the practice of nursing without certificate off
registration by
the Board of Nursing but also providesthe penalty of doing so.
JUNE 18, 1966—REPUBLIC ACT 4704—amended certain portion of R.A. 877
PHIL. NURSING ACT of 1991, R.A. 7164—they must belong to upper 40% of
the
graduating class in their high school

REPUBLIC ACT 7164—introduced by Sen. HEHERSON ALVAREZ, codified and

revised all
the laws Regulating the practice of nursing in the Philippines.
--It was known as the Philippine Nursing Act of 1991 with the following
changes:

1. redefinition of the scope of nursing practice to emphasize:

a. the use of the nursing process
b. teaching, management, leadership and decision making role of
the nurse
c. the undertaking of and participation in studies and research by
nurse
2. requiring a faculty member who was appointed by the Board of Nursing
to
resign
3. updating the facultys educational qualification by requiring a Master’s
Degree
4. specification of qualification of administrators of nursing service
5. unethical conduct—one of the reasons for revocation and suspension of
certificate

PROCLAMATION No - 539—October 17, 1958

--the President of the Philippine designated the last week of October of
the year,
beginning in 1958.
--one of the landmark in the history of the nursing profession
Purpose—dedicating a period in a year for the promotion of the ideals of
the
nursing profession was to develop conciousness and availability of nursing
resources in the Philippines.

PRESIDENTIAL DECREE No. 223 issued on June 23, 1973—created the PRC
and
prescribed its power and functions
IN 1972 R.A. 6511—was enacted to amend Republic Act 465
--standardized the examination and registration fees charged by various Board of
Examiners
--it took effect on July 1, 1972

LEGAL ASPECTS AND THE NURSE

As nurse begin their professional obligations, their legal responsibilities begin as
well.
PHILIPPINE NURSING ACT of 2002—the best guide the nurse can utilize as it
defines the
scope of nursing practice.

--Nurses need not be afraid of laws. They should be understood so that

their
scope and limitations maybe defined and identified
RESPONSIBILITY AND ACCOUNTABILITY FOR THE PRACTICE OF
PROFESSIONAL NURSING
NEGLIGENCE
—refers to the commision or ommision of an act, pursuant to a duty
Elements of Professional Negligence
1. existence of a duty on the part of the person charged to use due care
under
circumtances
2. failure to meet the standard of due care

3. the foreseeability of harm resulting from failure to meet the standard

4. the fact that the breach of this standard resulted in an injuryto the
plaintiff

EXAMPLE OF NEGLIGENCE
1. failure to report observation to attending physician
2. failure to exercise the degree of diligence which the circumtances of the
particular case demands
3. mistaken identity
4. wrong medication, wrong concentration wrong, wrong dose
5. defects in the equipments which may lead to falls thus injuring the patients
6. errors due to family assisstance
7. administration of medicine without doctors prescription

The DOCTRINE OF RES IPSA LOQUITOR

1. the injury was of such nature that it would not normally occur unless there was
a
negligent act on the part of someone
2. the injury was caused by an agency within control of the defendant
3. that the plaintiff himself did not engage in any manner that would tend to bring
about
the injury

MALPRACTICE
—improper or unskillful care of a patient by a nurse
--stepping beyond one’s authority with serious consequences
--term for negligence or carelessness of professional personnel
--refers to a negligent act committed in the course of professional
performance

DOCTRINE OF FORCE MAJEURE

—means an irresistible force , one that is unforeseen or inevitable
--circumtances such as floods, fire, earthquakes, and accidents fall under
this
doctrine and nurses who fail to render service during these circumtances are not
held
negligent.

DOCTRINE OF RESPONDEAT SUPERIOR

—“let the master answer for the act of the subordinate”
 --the liability is expanded to include the master as well as the employee
and not a
shift of liability from subordinate to the master
--private duty nurse are liable for their own negligent actions

INCOMPETENCE
—lack of ability , legal qualifications or fitness to discharge the required
duty.
--ground for revocation or suspension of her certificate of registration.

LIABILITY OF NURSES FOR THE WORK OF NURSING AIDS

1. nurses should not delegate their functions to nursing aids since the
Philippine
Nursing Act specifies the scope of nursing practice of professional
nurse
2. if the nursing aid commits mistake then the person rsponsible is the
nurse
3. nurses are enjoined to supervise their subordinates and see to it that
they
perform only those they have been taught.

FOR THE WORK OF NURSING STUDENTS

1. Under the Philippine Nursing Act of 2002 R.A. 9173, nursing students
do not
perform professional nursing duties.
2. must supervised by their Clinical Instructors

REPUBLIC ACT 6675

—only validly medical, dental, and veterinary practioners are authorized to
prescribed drugs.
--requires that the drugs be written in generic names

R.A. 2832—MEDICAL ACT of 1959

R.A. 5921—PHARMACY ACT as amended
--all prescription must contain the name of the prescriber, office address,
professional Registration nmber, professional tax reciept number, patients/client
name,sex and date.

INTRAVENOUS THERAPY AND LEGAL IMPLICATIONS

“in the administration of intravenous injections, special training shall be
required
according to protocol established”
Nurses should use the INTRAVENOUS NURSING STANDARDS OF
PRACTICE
developed by ANSAP
BOARD OF NURSING RESOLUTION No. 8—states that any registered nurse
without such
training and who administers intravenous injections to patients, shall be held
liable
either criminally
under Sec. 30 Art. VII of said law or administratively under Sec 21 Art. III
or both.

TELEPHONE ORDERS
—there are legal risk in telephone orders
 --misuderstood or misinterpreted by the receiving nurse
--messages from telephones may sound unclear or garbled because of
some
trouble in the telephones lines.
--the signature of the ordering physician is not present and this order may latter
denied in case of error happen or court litigations arise

CONSENT TO MEDICAL AND SURGICAL PROCEDURES

—free and rational act that presupposes Knowledge of the thing to which
consent
is being given by a person who is legally capable to give consent
--before medical or surgical procedure the consent must obtain to the
patient or his authorized representative

--the physician should should give as much information about a

contemplated
procedureand the patient should recieve enough information to allow him to give
an
informed consent

NATURE OF CONSENT
1. INFORMED CONSENT
Elements of informed Consent
a. diagnosis and explanation of the condition
b. a fair explanation of the procedure
c. a description of alternative treatments or procedure
d.a description of benifits to be expected
e.material rights
f. the prognosis, if the recommended care, procedure is refused

TORTS
—is a legal wrong comitted against a person or property independent of a
contract which renders a person who commit it liable for damages in a
civil
action

Assault
—is the imminent threat of harmfol or offensive bodily contact

Battery
—is an intentional, unconsented touching of another person

FALSE IMPRISONMENT OR ILLEGAL DETENTION

—means the unjustifiable detention of a person without a legal warrantwithin
bounderies fixed by the defendant by an act or volation of duty
INVASION OF RIGHT TO PRIVACY AND BREACH OF CONFIDENTIALITY
—the right to be left alone.
DEFAMATION
—character assasination, be in written or spoken contitutes defamation
SLANDER
—oral defamation of a person by speaking unprivileged or false words by whis
his reputation is damaged
LIBEL
 —defamations by written words, cartoons or such representations that
cause a
person to be avoided, ridiculed, or held in contempt or tend to injure him in
work

CRIME
—is defined as act committed or omitted in violation of the law

--Criminal offense are composed of two elements

a. criminal act
b. evil/criminal intent
In criminal action, the state seeks the punishment of the wrongdoers
.
CONSPIRACY TO COMMIT A CRIME
—exists when two or more persons agree to commit a felony and decide to do
it.
--persons who commit felonies are either PRINCIPALS, ACCOMPLICES,
OR
ACCESSORIES.

PRINCIPALS
—are those who take a direct part in the execution of the act
--who directly force or induce others to commit it
ACCOMPLICES
—are those persons who cooperate in the executon of the offense by
previous or
simultaneous act.
--to hold the person liable as accomplice, it must be shown that he had the
knowledge of the criminal intention of the principal

ACCESSORIES
—those person having the knowledge of the commission of the crime either as
principal or accomplices take part subsequent to its commission by profiting
themselves or assissting
the offender to profit from the effect of the crime.

CRIMINAL ACTIONS
—deals with the act or offenses aginst public welfare.
Misdeameanor—general name for a criminal offense which does not in law
amount to
felony
--punishment ussually a fine or imprisonment for aterm for less than one
year
Felony—a public offense for which convicted person is liable to be sentenced to
death
or to be imprisoned in a penetentiary or prison.
--it is more atrocious than misdemeanor.
--comited with deciet and fault
CRIMINAL NEGLIGENCE
1. reckless imprudence
—a person does an act or fails to do it voluntarily but without malice, from
which material damage results immediately.

2. simple imprudence
—the person did not use precaution and the damage was not immediate or the
impending danger was not evident or manifest.

CLASSES OF FELONIES
Felonies are classified according to the degree of execution
1. CONSUMATED
—whe all the elements necessary for its execution and accomplishment
are present
2. FRUSTRATED
—when the offender perform all the acts or execution which will produce
the felony as
a consequence but which nevertheless, do not produce it by reason of
causes independent of
the will of the perpetrator.
3. ATTEMPTED
—when the offender commences the ommision of the same directly by
overt
(open or manifest) act

CIRCUMTANCES AFFECTING CRIMINAL LIABILITY

1. Justifying Circumtances
—a person may not incur criminal liability

2. Exempting Circumtances
—the law exempts a person from criminal liabilty for the commission of a
crime.
3. Mitigating Circumtances
—do not constitute justification or excuse of the offense in question, maybe
considered as extenuating or reducing the degree of moral culpability.
4.Aggravating Circumtances
—attending the commission of a crime and which increase the criminal liability
of the offender or make his guilt more severe.
5. Alternative Circumtances
—those which must be taken into consideration as aggravating or mitigating
according to the nature and effects of the crime and other condition attending its
commission.

LACK OF EDUCATION IS NOT MITIGATING IN:

1. rape 2. forcible abduction
3. arson 4. treason
5. crimes against chastity like seduction and acts of lasciviousness
6. those act comitted in a merciless or heinous manner

MORAL TURPITUDE
—an act contrary to the acceptedand customary rulle of right and duty between
men.
MURDER
—unlawful killing of a human being with intent to kill. It is very serious
crime

HOMICIDE
—killing of human beingby another.
--It maybe committed without criminal intent, by any person who kills
another
ABORTION
—expulsion of the product of conception before the age of viability
INFANTICIDE
—killing of a child less than three days of age.
--the mother of the child who commits this crime shall suffer the
penalty of

imprisonment of 2 years and 4 months and 1 day to six years.

ROBBERY
—crime against a person or property . The taking of personal property of
another
person from him or in his presence contitutes robbery.

CONTROLLED SUBTANCES
REPUBLIC ACT 6425
—known as Dangerous drug Act of 1972
--covers the administration and regulation of the manufacture, distribution
and
dispensing of controlled drugs.

--person authorized to prescribe or dispense these drug are required to register

and
have special license for this purpose
--Doctor’s with such license prescribe these drug in a YELLOW FORM
--Controlled drugs are kept locked in cabinets and only authorized persons
shall
have access to them.
--these drug are counted and endorse every shift.
--Nurses who violate this law are in danger of having their license revoked
aside
from the imposed fine and/or imprisonment.

POINTS TO OBSERVE IN ORDER TO AVOID CRIMINAL LIABILITY

Court litigation is not only expensive, it is also time consuming and
emotionally exhausting.
1. be very familiar with the Philippine Nursing Law
2. beware of laws that affect nursing practice
3. at the start of the employment, get a copy of your description, the agency’s
rules,
regulation and policies.
4. upgrade your skills and competence
5. accept such responsibility that is within the scope of employment and your job
description
6. do not delegate your responsibility to others
7. determine whether your subordinates are competent in the work you are
assigning
them

8. develop good interpersonal relationship.

9. consult your superiors for problems that may be too big for you to handle
10. verify orders that are not clear to you or those that seem to be erroneous
11. the doctor should be informed about the patient’s condition
12. keep in mind the value and necessity of keeping accurate and adquate
records
13. patients are entitled to an informed consent.

WILLS
—legal declaration of a person intention upon death.
--it is called testamentary document because it takes effect after the death of its
maker.
DECEDENT
—a person whose property is transmitted through successionwether or not he left
a will.
--if helf a will, he is also called TESTATOR.

TESTATRIX—person making a will is a woman

HEIR—a person called to succession either by the provision of a will or by
operation of a law.
TESTATE—a person who dies leaving a will.
INTESTATE—one who dies without a will.
PROBATE—validation of a will in court
ADMINISTRATOR—one who administer the provision of a will

HOLOGRAPHIC WILL—a written, dated, and signed by the testator

NUNCUPATIVE WILL OR NUNCUPATION—oral will

GIFTS—another way of disposing property

FOUR LEGAL REQUIREMENTS
1. the gift must consist of personal property
2. there must be an intention to make the gifts
3. there must be an indication of transfer of control over such property
4. there must be acceptance by the recipient

CONTINUING EDUCATION IN NURSING

Continuing education in nursing consist of planned learning experience
beyond
the basic education program.
OBJECTIVES:
1. to provide and ensure the continous education of registered professional with
the
latest trends
brought about by modernization and scientific and technological advancement
2. to raise and maintain the highest standard and quality of practice of the
professions
3. to meke the professional globally competitive
4. to promote the general welfare of the public
FORMAL STUDIES LEADING TO DEGREE COURSES
1. Bacalaureate Degree in Nursing
—there still nurses who do not have a Bachelor’s Degree in Nursing
2. The Graduate Education in Nursing
—graduate study is education program leading to a master’s degree in a chosen
area of study.
3. The Doctoral Degree Program
—is taken by nurseswho like to prepare themselves for various positions.

CONTINUING EDUCATION PROGRAM

1. NATIONAL PROFESSIONAL NURSING ASSOCIATION such as PNA , LGN,
and ANSAP
2. professional organization representing various nursing specialty such as:
Critical Care
Nurses Association of the Phil.
3. health agencies with specialties such as: PCMC, NKI, Lung Center
4. employing agencies in the form of in—servicr training program

Some other forms of continuing education program

1. SEMINARS
—refer to gathering of professionals and include, among others, workshops,
technical lectures, subject matter meetingscientific meeting
2. CONVENTIONS
—coferences, symposia, assemblies for round table discussion

3. RESIDENCY
—apprenticeship training at the graduate level, which beyond the basic
preparation for health professionals
4. DISTANCE LEARNING
—refers to correspondence learning which uses course manuals or
accredited
learning modules

NURSING ASSOCIATIONS IN THE PHILIPPINES

ALUMNI ASSOCIATIONs
—the first association a nurse joins upon graduation
--membership in the alumni association foster loyalty among its members.

PROFESSIONAL ASSOCIATIOS
PHILIPPINE NURSES ASSOCIATION—was organized on October 22, 1922
upon the
initiation of Mrs. Anastacia Giron Tupas.
MRS. ROSARIO DELGADO—the first president of PNA
--it was then called the FILIPINO NURSES ASSOCIATION and its journal, the
FILIPINO NURSE
--now the journal is the THE PHILIPPINE JOURNAL OF NURSING

OBJECTIVE:
1. to attain optimal level of professional standards
2. to work for the welfare of member nurses
3. to respond to the changing health needs of the Philippine society
4. to establish linkages with government, national and international agencies

THE NATIONAL LEAGUE OF GOVERNMENT NURSES

—is a duly incorporated organization of professional nurses employed by the
government of the Philippines.
--formerly known as Department of Health National League of Nurses, it was
founded by ANNIE SAND.
January 16, 1961—Nursing Consultant of the Department of Health

ASSOCIATION OF NURSING SERVICE ADMINISTRATORS OF THE

PHILIPPINES
—was founded in 1963 but was reorganized ten years later in 1973
--it was composed of nursing administrators both in gogernment and private
agencies.
--initiated the development of STANDARDS OF NURSING SERVICE AND
NURSING
PRACTICE in 1976.

ASSOCIATION OF DEANS OF COLLEGES OF NURSING IN THE

PHILIPPINES
—established in April 1959 with Deans of Colleges as its members

--its main purpose is

1. to promote, elevate and maintain the standards of clinical instruction
program of nursing student
2. to improve nursing service and facilities of the clinical field
in hospital and public health agencies.
Other purpose:
1. to participate in the formulation of legislations affecting nursing
education
2. to make representations in discussions of problems and solutions of the
same to the DOH,
Evaluation Committee on Accreditation of Training and the Student Affiliation,
Budget Office/Congress

THE MILITARY NURSES ASSOCIATION OF THE PHILIPPINES

—was officially organized on September 5, 1965 in V. Luna Hospital AFP in
Quezon City
--by a group of dynamic nurses and corps officers both active, inactive and
retired
who felt the need for putting up a medium wherein they can express their ideals
and aspirations to better serve their country.

THE OOCUPATIONAL HEALTH NURSES ASSOCIATION OF THE

PHILIPPINEs
—was organized on November 21, 1950 through the initiative of Mrs Magdalena
Valenzuela of the DOH.

--on September 20, 1969, the unit was renamed

Purpose:
1. promoting frienship and to organize nurses in the industrial and
commercial
enterprises Into an Industrial Nursing Unit
PHILIPPINE ASSOCIATION OF PUBLIC HEALTH NURSING FACULTY
—was organized on September 1961.
--dedicated to the high standards of objectives to standardize and broaden
instruction in thePublic Health Nursing and to undertake that which will enhance
professional growth.

OPERATING ROOM NURSES ASSOCIATION OF THE PHILIPPINES

—they are committed to the improvement of operating room management
techniques and facilities.
--to insure maximum service to all patients
--to promote professional development, personal growth and well being of
its
membersby keeping them abreast with the new and sophisticated method in the
field of
operating room management.

PSYCHIATRIC NURSING SPECIALIST FOUNDATION OF THE PHILIPPINES

—views mental health and illness as states of adaptation used by individual in
coping with the circumtances in life.

--adheres to the goal of psychiatric care which is to effect improvement in the

individual
competence in living with himself and others

SERVICES OFFERED BY THE PNSI

1. Nursing Supportive Care
a. child day care
—the main objective is to create an opportunity for children to develop
emotionally, socially, intellectually, physically and spiritually.
b. adult care
—main goal is the provision of healthy, therapeutic millieu to its adult
client.
2. Continuing Education
—sponsor regular seminars in the field of mental health and psychiatric
nursing
3. Psychological Testing and Evaluation
—involve the administration of battery of psychological test to the client to
determine his aptitude, abilities, and personality traits, profile including career
counselling.
4. Nursing research
—periodic nursing researc studies
5. Training and Extension Services—
6. Library
—library are open to members and non—members
7. Publications
—official publication: Perspective in Mental Psychiatric Nursing

CATHOLIC NURSE GUILD

—national organization of Filipino nurses.
--the movement to organize the Guild began in 1956 at the instance of the
Apostolic Nuncio of the Philippines.
--the organization of the Guild was subsequently sactioned by the Vatican
Secretariat State.
 --the GUILD has it headquarters at 988 Genaral Solano street San Miguel
Manila
--Catholic Nurses Guild Magazine –official organ

INTEGRATED REGISTERED NURSES OF THE PHILIPPINES

—as eraly 1960, the concept of integration was already being discussed by
many
nurse leaders and various nursing group in several fora.
--the direct tie—up of IRNUP with the PRC—BON begets a national
perspective
on nursing and health related issues .
--the IRNUP will serve as the official national and regional coordination for
nurses
and nursing.

PURPOSE:
--to provide a mediumthrough which the Filipino nurses can share their
common
interest working in unified manner to develop the contribution of nursing to the
health
of the Filipino and to the achievement of national health development goals.

INTEGRATION
—means bringing together all individual registered nurses in the country under
the corporate body, parallel to the integration of the Philippine Bar.

INTERNATIONAL NURSING FOUNDATION OF JAPAN SCHOLARS

ASSOCIATION OF THE
PHILIPPINES
—the third formal organization of INFJ was initiated by Miss Maria Linda B.
Buhat, Nursing Director of Phil. Heart Center
--dedicated to the constant endeavor of promoting the highest professional
and
providing expertise and assisstance in various setting in our country.

The PNA maintains aliason relationship with other organization based on

intra—
professional colleagueship. The relationship recognize common goals—
the
professional develpment of nursing, autonomy of ursing organizations,
interdependence between PNA and nursing organization, and peer
relationships.

PHILIPPINE NATIONAL RED CROSS

—Red Cross movement in the Philippines dates back to the year of
1905.
--the Filipino and American leaders formally convened to organize the
Phil. Branch
of the American Red Cross.
1917—the branch in the Philippines was officially recognized as an Insular
Chapter of the AmericanRed Cross.

PNRC—was created by republic Act No. 95 on March 22, 1947.

INTERNATIONAL NURSING AND ALLIED ORGANIZATION
INTERNATIONAL COUNCIL OF NURSES
—the organizations through which nurses all over the world collaborate in
strengthening nursing service, nursing education and professional ethics.
--composed of national nursing association from each member—country.
--the council objective, “ to provide a medium through which national
nurses
association may share their common interest by working together to
develop t
contribution of nursing to the promotion of health of the people and care of the
sick.
--the ICN meets every quadrennially of every two years.
--its official organ is the IINTERNATIONAL NURSING REVIEW which published
4
times a year.

INTERNATIONAL COMMITTEE OF CATHOLIC NURSES

—1933 the international commitee was officially organized.
--as of january 2002, the ICN has 124 national nurses associations as
members.

THE WORLD HEALTH ORGANIZATION

—one of the specialized agencies in the United States.

--April 7, 1948—official existence as an intergovernmental agency of the United

Nations.
--it acts as an international health coordinating authority.
Main Activity:
1. assisstance to the countries for the improvement of health services
2.education and training in the field of health
3.for fighting communicable disease
4.coordination and stimulation of medical research
5. exchange of information on public health and worldwide reporting off
outbreak
of Dangerous diseases.
6. programs involving malaria and small pox eradication
7. cancer and heart disease research
8.air and water pollution
9.dangerous drug and water supply

INTERNATIONAL RED CROSS

The fundamental Principle of the International Red Cross and the Red
Crescent Movement
1. Humanity
—born of a desire to bring assisstance without discrimanation of the wounded on
the battlefield, endeavors,
--to alleviate human suffering wherever it may found.
--its purpose is to protect life and health and ensure respect for human
being.

--it promotes mutual understanding, friendship, cooperation,and lasting peace,

amongst
people
2. Impartiality
—it makes no discrimanation as to nationality, race, religious, beliefs, class or
political opinion.
--it give priority to the most urgent distress
3. Neutrality
—the Movement may not take sides in both hostilities or engage at any time in
controversies of a political, racial, religious or ideological in nature
4. independence
—the movement is independent.
--must always maintain their autonomy so that they be able at all times to
act in accordance
with the principles of the movement.
5.Voluntary Service
—not prompted in any manner by desire for gain
6. Unity
—it must carry on its humanitarian work throughout its territory.
--there can be only one movement—one Red Cross or one Red Crescent
Society
7. Universality
—worldwide organizations have equal status and equal responsibilities and
duties
in helping each other.