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Organizational Management

Trends in Nursing
Increasing Number of Elderly
By 2010 there will be more than 40 million people over the age of 65.
The frail elderly (those over 85) are projected to be the fastest growing population in US
and will number greater than 76.5 million by 2020 and almost 90 million by 2030.
Nursing will have a greater focus in geriatric care and the multiple system problems the
elderly have.
Advances in Technology
Improved diagnostics and equipment permit early detection of disease.
New medications.
Laser and microscopic techniques decrease stays and streamline treatment.
Computers.
Internet.
Data exchange via internet.
Telemedicine.
Globalization
Spread of a common culture around the world.
Blending of attitudes, services, religions, and products.
Health Care Delivery System Changes
Financing and reimbursement.
Increasing emphasis on prevention of disease and healthcare problems.
Location of services.
Downsizing and mergers of hospitals.
Social Changes
People are expecting and demanding more control over their healthcare.
Organizations changing from a dependant perspective to independent perspective.
Increasing number of people without healthcare.
Alternative health care options.
People are much more informed.
Litigation.

Organizational Structure
No “right” or best type – different types work better in different situations.
The employee should find a type they are comfortable in.
Most common types of organizational structures are:
Centralized.
Decentralized.

Centralized Organizational Structure

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Decisions are made from a central authority

In hospitals it is usually the chief nursing officer
Financial management
Overall nursing care delivery
changes
Frequently seen in smaller
organizations
Decentralized Organizational Structure
Number of persons are given a range of authority involving decision making and policy
making.
Research indicates that it improves accountability, job satisfaction, motivation.
Not for everyone, some do not want the increased responsibility.
Organizational Charts
Are used to indicate who reports to whom.
Typically decentralized organizations have a “flatter” organizational chart.
The shape of the chart is also dependent on the size of the organization.

Patterns of Nursing Care Delivery

Can, and has, been done in many ways.
Different ones are better in different situations.
Can be tailor made for given units and situations.
Different nurses are comfortable in different types of delivery systems.
Team Nursing
Group of clients are assigned to a “team” of caregivers.
The team leader – usually a RN assigns responsibilities to each member of the team.
Requires good communication to prevent fragmentation of care.
Team leader must continuously assess client and group needs – this can prevent the
team leader from providing direct client care.
If only a few RN’s it takes them away from the bedside to be team leaders.
Primary Nursing
Each client has a RN who plans and directs their care over a 24 hour period of time –
this eliminates fragmentation.
Puts the RN back at the bedside.
Became less used with the nursing shortage and fiscal cuts.
Patient Focused Care
Centralizing functions on the unit under direction of the RN and then cross training to
enable persons to perform multiple functions and increasing productivity.
RN becomes accountable for more services provided to the client.
Case Management
Used to coordinate care and reduce costs.
Typically only clients with complex needs and problems have case managers but it is
becoming more and more common for all clients.
May not be a RN, sometimes done by social worker, PT, or OT,- it depends on client
needs and the organization.
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Critical Pathways
Used to support the case management process and to reduce expensive variations in
client care.
They are interdisciplinary plans of care that outline optimal sequencing and timing of
interventions for particular diagnoses.
They are based on nationally accepted ways to manage the particular diagnosis.
They have outcomes and timelines and are collaborative and comprehensive.
Disease Management
Similar to clinical pathways but are for specific populations.
They consist of interventions, measurements, and refinements of health care delivery
designed to optimized clinical and economic outcomes.
They usually focus on prevention and education and are NOT designed to manage an
acute exacerbation of a disease.

Patient Classification and Staffing

Handled differently in every institution.
Staffing particularly difficult since client acuity changes constantly.
Staffing should reflect the needs of the clients.
JCAHO requires the staffing be based on some type of organized system.
Staffing may be based on client acuity or budgeted hours per patient per day or a
combination of both.
Patient Classification Systems
Also known as an acuity system.
It estimates the intensity of nursing care required to meet the needs of the clients.
Nurses must take doing patient classification seriously so that enough nurses are
scheduled to meet client needs.
Budgeted Hours Per Patient Per Day
Calculated by the number of patient care staff working during a single 24-hour period
and divided by the number of patients served in a day served a day.
Does not usually allow for the client that might require complex, time consuming nursing
care.
ANA Principles of Staffing
Designed to help nurses ensure adequate staffing in all situations.
Principles of staffing divided into client care related, staff related, and organization
related areas.
ANA questions the hours per patient per day because one formula will not fit all
situations.
Suggests that the number of client’s intensity of client needs, caregiver expertise, and
the environment of care be considered when staffing.

When Your Unit Is Short Staffed

Decide if clients can receive adequate care with what you have.
Notify appropriate persons of your staffing needs. (Supervisor, head nurse…).
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Can someone stay over?

Will someone come in?
Get help from float pool or agency (if allowed and available).

Consumer Relations
Treat people with respect.
Put yourself in their place.
Treat them they way you would want to be treated or you would want your family
members treated.
Be professional.
Act like you know what you are doing and that you enjoy your job!
Be nice – sometimes-nice people don’t get sued.
If clients feel like they were treated well then they will tell others and they will come back
– more clients = more revenues may = raise for nurses and improved job security.