Learning Outcome: Managing a nursing service in a hospital setting (Responsibility 4, NNCCS)

Teaching-Learning Activity: Vignette

Assessment: Rubrics

Ms. Patricia Garcia is the charge nurse of the morning shift in the Adult Care Services Unit of the
hospital. The census for the day is 20 and the nursing team is composed of three staff nurses (2
regular staff nurses, one trainee, who just came on board two weeks ago), one nursing assistant
and 1 administrative assistant (ward clerk). The night shift endorsed that 2 patients are scheduled
for surgery at 7:00 and 9:00 in the morning, one will undergo hemodialysis at 8:00 and still another
will be brought to the Ultrasound for pelvic sonography.

Two patients are scheduled for blood extraction for CBC, FBS, cholesterol, triglycerides, BUN,
creatinine, Total A/G ratio. Two patients are bedridden and are receiving osteorized feedings every
four hours through PEG and NGT.

The staff in the Emergency Room called up to inform Patricia that a 60 year-old female patient
with chronic asthma is now ready to be transferred to one of the private rooms in the unit. She
needs oxygen and a pulse oximeter to evaluate the oxygen saturation of the patient.

Given the above scenario and guided by the competencies under the responsibility on managing a
nursing service unit in a hospital, propose how will you manage the nursing services requirement
of the unit?

Instructions:
1. Read the relevant information from the 2012 National Core Competenct Standards,
management and leadership reference books and the following websites:
http://www.ahrq.gov/research/findings/factsheets/services, nursestaffing, nursestaff.pdf
http://www.workingnurse.com/The-Nurse-Patient-Ratio-Five-Years-Later
http:// www.wpro.who.int/topics/nursing/ichrn fat sheet.pdf
http://www.icn.ch/projects/positive-practice-environments/
http://www.pna.ph.org/downloads.asp
2. Discuss case among your team and develop your strategies how to manage the nursing unit
if you were Ms. Patricia Garcia.

Guide Questions:
1. How will Patricia carry out her functions of management in terms of plalning, organizing,
directing and controlling?
Planning: The objective is to deliver quality patient care, this will be done by first,
dividing the work to nurses equally, depending on the severity of the cases of the
patients. Second, considering the trainee to handle cases that are not critical like giving
health teachings to those who are going to undergo laboratory tests and for ultrasound or
 delivering the patients to the where the tests will be done. Third, by dividing the
preoperative patients and the bedridden patients and the hemodialysis patient to the 2
nurses. Fourth, by delegating the administrative assistant to organize files and schedule
appointments to the places needed like the laboratory, ultrasound, operating room and
hemodialysis. Lastly, the nursing assistant can also help in procedures like changing of
linens or changing of diaper of patients and delivering them to the place needed.

Organizing: The activities will include having 20 patients, preparing 2 patients

preoperatively, preparing one patient to undergo hemodialysis, one to undergo pelvic
sonography, 2 to undergo laboratory tests and 2 that have PEG and NGT feeding. 20
patients will be divided to the 3 nurses depending on the cases, the trainee nurse will have
those patients who are to undergo laboratory tests and sonography wherein health
teachings should be given, preparation about the labs and can help to deliver patients,
also, she can handle the monitoring of the asthma patient. The 2 nurses will handle the
preoperative patients and the hemodialysis as preparing them can be complicated for a
trainee nurse and the bedridden patients too as the trainee nurse can observe and help in
some things first. The administrative assistant is the one responsible for the files and for
the scheduling of the appointments to the needed tests or procedures. Lastly, the nursing
assistant can be responsible for things like changing of linens, changing of diapers,
delivering of patients to the procedures.

Directing: To see if the team is doing all the responsibilities assigned to them,
supervision is needed. Monitoring the team if they can follow the plan is important in this
stage but, if things are not going as planned, leading the team, giving guidance and help
can make the team be motivated. Evaluations can be given upon the things the team
members do and whether they were able to do it correctly or is there any lacking in the
care given. Directing works when there is an effective communication in the team, so
given that there are 20 patients with different cases, communication about the things
needed to be done and recognition and criticisms can help give the team a better
teamwork to help each other in giving patient care.

Controlling: To deliver quality care to patients, there are standards that we should follow
like the hospital policies. Also, by properly assessing the patients, we will know that they
have received quality care, like having enough knowledge about the procedures they will
undergo, there will be no problems in the chart and physical appearance of the
preoperative patient, there will be no complications in the hemodialysis patient, the
bedridden patients won't have pressure ulcers and they will be able to tolerate the
feedings, there will be no desaturation in the O2 sat of the asthma patient. If these
standards were not met, corrective actions will be done.

2. What are the strategies/methods/tools by which you coordinate the functions and tasks of
other members of your team during your clinical duty as a team leader tasked to manage
the nursing services to be rendered to your patients?

Planning and Organizing for the Effective Care of a Group of Patients

1. The staff nurse must be able to manage his/her time effectively to meet the quality and safety
requirement of patient care. In planning, the staff nurse determines the following data so that he/she
can effectively handle all assigned patients.

Take To Consideration :
a) Number of patients per patient classification that serves as basis for care
prioritization in the delivery of services
b) Patients with invasive procedures that serve as basis for care priorities for
appropriate clinical preparation, accurate handing off for seamless continuity of care
c) Know the kind and number of transport equipment, infusion pumps and other
medical devices available; the knowledge prepares the nurse to anticipate for the need
and coordinate in advance with other units to ensure availability of resources ahead of
time and ensure better patient care outcome.
d) Actual number of vacant rooms that serve as basis to anticipate admission and
give opportunity to plan.
e) Patients with order to go home that serve as basis to prioritize their care for a
timely discharge

2. Directing- The staff nurse directs the nursing assistants on basic nursing tasks and errands
necessary for the timely care of patients.

3. Controlling - The nurse assesses his/her duty accomplishment every end of the shift and ensures
that all required nursing actions were implemented during his/her tour of duty and that patient care
outcomes are measured in all patients assigned to him/her.

Examples of Nursing Actions to be watchful of :

• Medication error
• Falls
• Hospital acquired bedsore
• Prompt patient care or there was no delay in patient care
• No complaints

4. Delegation - The nurse works in a complex setting and needs assistance in the performance of
basic nursing procedures in order to finish tasks on time. Safe patient care is achieved when proper
work delegation to the nursing assistant is done.

Principles of delegation
 Delegation must always be in the best interest of the patient and not performed simply
in an effort to save time or money.
  The support worker must have been suitably trained to perform the task.
 The support worker should always keep full records of training given, including dates.
 There should be written evidence of competence assessment, preferably against
recognized standards such as National Occupational Standards. There should be clear
guidelines and protocols in place so that the support worker is not required to make a
clinical judgment that he/she is not competent to make.
 The role should be within the support worker’s job description.
 The team and any support staff need to be informed that the task has been delegated
 The person who delegates the task must ensure that an appropriate level of supervision
is available and that the support worker has the opportunity for mentorship.

Important Things To Note:

 If unsure of Competency of staff member, than the delegation would be
inappropriate and not in the best interest of the patient.
 If the staff themselves are unsure of their ability, they must inform the
delegating nurse or a senior colleague that they are not competent.

5. Communication - It is important that the staff nurse is dedicated to communication in various

channels to coordinate patient care activities and ensure effective continuity of care. This is a very
important competency as most of the root causes of errors in healthcare are communication related.

6. Collaboration and Teamwork - The nurse has a significant role because she/he is the one
responsible for providing other stakeholders important patient data as well as the bedside
implementers of their desired course of actions.

3. Who comprises the interdisciplinary team? What are the specific roles do they play in the
health care system? Why is it necessary to form an interdisciplinary team? How do these
teams develop? What strategies do you implement in collaborating with members of the
interdisciplinary team in implementing the healthservices for clients under your care?

An interdisciplinary approach relies on health professionals from different disciplines,

along with the patient, working collaboratively as a team. The most effective teams share
responsibilities and promote role interdependence while respecting individuals. A good
communication between the other members of the teams will have a good impact
especially on the patient. • Ensure team members have clear goals, and an understanding
of their shared roles and responsibilities within the team structure. • Participate in joint
assessment, diagnosis and goal setting. • Recognize the overlap in knowledge and
expertise of staff from different disciplines. The Physical Therapist Similar to OT’s, a
Physical Therapist works to treat individuals whose medical problems or other health-
related conditions that impair their ability to move and perform activities of daily living.
Treatment plans focus on preventing further disability, alleviating pain, and restoring
function. The Respiratory Therapist Respiratory Therapists help evaluate and treat
 individuals suffering from respiratory ailments, injuries that involve the respiratory tract,
need pulmonary rehabilitation, or who require augmented or mechanical ventilation. The
Physical Therapist Similar to OT’s, a Physical Therapist works to treat individuals whose
medical problems or other health-related conditions that impair their ability to move and
perform activities of daily living. The Occupational Therapist Occupational Therapists
work with individuals of all demographics regain, master, or develop the everyday skills
that enable them to lead fulfilling, independent lives. The Speech and Language
Pathologist Speech and Language Pathologists evaluate, diagnose, and treat language,
speech, or swallowing difficulties in patients in various settings. The Clinical
Psychologist Psychologists study the inner workings of the mind. A clinical
psychologist’s aim is to reduce psychological and emotional distress and to promote
emotional well-being. The Pharmacist Pharmacists are medication experts, working with
physicians (or PAs) to ensure new prescriptions do not interact with a patient’s current
medications, that the right dosage for a particular medication has been prescribed, and to
answer any questions patients may have. The Registered Dietitian Dietitians help design
food plans and educate and counsel patients to help them manage disease states such as
obesity, high cholesterol, or heart disease. The Clinical Nurse Specialist Clinical nurse
specialists are experts in a specialized area of nursing practice such as geriatrics, wound
care or psychiatric care. Nurse Practitioner They are trained to diagnose and treat a
variety of conditions, and can order and interpret diagnostic tests and procedures, perform
health screenings, give immunizations, and may prescribe most medications. Nurse
practitioners often focus on health promotion, disease prevention and helping patients
make healthy lifestyle choices

4. What resources do you need in managing nursing services in terms of human, material,
physical, and technical resources? (What are the4 Ms in management?) How are these
resources mobilized for effective delivery of nursing services?

The 4 M’s of resources are important to the fulfillment of a personal goal, group goal or
organizational goal. It makes the nurses’ work more efficient and effective, at the same
time, having the work done at a short and faster pacing

a. Manpower – refer to the human resources that are needed to achieve the goal. Men as
the resource are the ones who carry out the tasks needed to achieve the goal.

b. Materials – physical resources used as inputs in any care process. They can be raw
materials or finished materials.

c. Methods – the body of techniques for investigating phenomena, acquiring new

knowledge, or correcting and integrating previous knowledge.

d. Machines – devices that help the organization by either performing tasks faster or
doing work that humans cannot..
5. What principles, policies and procedures are generally used to guide nurses in ensuring
safe, ethical and evidenced-based nursing practice? How will you apply these in this
scenario?

High reliability health-care organizations that provide safe and efficient care have much
in common with an evidence-based practice culture. The characteristics of each include:

• Commitment to delivering high-quality care, patient safety and reduced costs

• Strong leadership
• Emphasis on process and systems design
• Transdisciplinary teamwork
• Effective communication
• Delivery/standardization of best practices and policies
• An environment that promotes a spirit of inquiry and continuous learning
• Focus on continual process improvement
• Outcomes monitoring/evaluation

Nurse leaders have a responsibility to engage staff at all levels, support an evidence-
based practice culture and allocate resources to provide the necessary framework to
enable evidence-based practice. In the end, this can enhance a professional work
environment in which professionals feel engaged in clinical decisions and have the skills
to base their practice on the best available evidence.

6. What nursing sensitive patient outcomes are expected to be achieved as evidence that
nursing care delivery was effective? How can these be prevented?

1. Nursing Hours per Patient Day

2. Patient Falls
3. Patient Falls with Injury
4. Patient satisfaction with nursing care
5. Patient satisfaction with overall care
6. Pressure Ulcer Prevalence
7. Patient satisfaction with pain management
8. Restraint Prevalence2
9. RN Education /Certification
10. RN Satisfaction Survey Options
c. Practice Environment Scale
11. Skill Mix
12. Voluntary Nurse Turnover
13. Nurse Vacancy Rate
14. Nosocomial Infections Rates
15. Patient satisfaction with medical information provided

These can be prevented by ensuring adequate staffing to deliver quality and

individualized care to each patient.
7. What are the different elements of positive practice environment? What strategies can be
adopted to develop a PPE? What essential elements do we look for if there is a PPE in the
workplace? How do you promote a positive practice environment?

Elements of Positive Practice Environments

Positive practice environments are characterised by:

• Occupational health, safety and wellness policies that address workplace hazards,
discrimination, physical and psychological violence and issues pertaining to personal
security
• Fair and manageable workloads and job demands/stress
• Organisational climate reflective of effective management and leadership practices,
good peer support, worker participation in decision-making, shared values
• Healthy work-life balance
• Equal opportunity and treatment
• Opportunities for professional development and career advancement
• Professional identity, autonomy and control over practice
• Job security
• Decent pay and benefit
• Safe staffing levels
• Support and supervision
; Open communication and transparency
; Recognition programmes
; Access to adequate equipment, supplies and support staff
 Promoting Positive Practice Environments a Reality
Developing, promoting and maintaining positive practice environments is multifaceted,
occurs on many levels of an organisation and involves a range of players (e.g.
governments, employers, nursing organisations, regulatory bodies, unions, schools of
nursing, etc.). For their part, nurses and their representative organisations can advance the
development of positive practice environments by:

• Improving the recruitment and retention of nurses o

Continuing to promote the nursing role
o Defining the scope of nursing practice so that nurses work to their full potential for
patient care. This legal framework can then be used to raise the awareness of other
disciplines, as well as the public, of the profession’s competencies and evolution
o Lobbying for professional recognition and remuneration.
• Developing and disseminating a position statement on the importance of a safe work
environment.
• Building capacity of nurses and others involved in health sector management and policy-
making positions.
• Ensuring that the nurse voice is heard
o Strengthening nursing organisations
o Having access to decision-making bodies.
• Supporting research, collecting data for best practice, and disseminating the data once it is
available.
• Encouraging educational institutes to enhance teamwork by providing
opportunities for collaboration and emphasising teamwork theory.
• Presenting awards to health care facilities that demonstrate the effectiveness of positive
practice environments through recruitment and retention initiatives, reduced drop-out
rates, public opinion, improved care and patient satisfaction.
• Establishing alliances with other health professionals and health sector
stakeholders, e.g. patients/consumer associations.

8. What evaluation methods can be used to determine if the expected competencies on

managing a nursing service are effectively achieved? Recommend the best way to achieve
this purpose.

What evaluation method\s can be used to determine if the expected competencies on

managing a nursing service is effectively achieved? Recommend the best way to achieve
this purpose. (RON) Clinical examinations, self assessment and peer review are the
evaluation methods that can be used to determine if the expected competencies on
managing a nursing service is effectively achieved. Clinical examinations consist of
series of stations or exercises through which each nurses rotate individually to
demonstrate range of skills. It provides opportunity to practice skills in a safe and
controlled environment. Another method is the self assessment and peer review. Peer
review has been identified as one of the most valuable mechanism for providing feedback
and fostering professional growth. Proposed benefits of peer review includes
confirmation of previously held beliefs in an individual’s certain skills and provides a
medium for sharing colleague’s experience. Lastly, the self-assessment. It is has been
reported as the most common form of competence assessment. The benefits of self-
assessment is cost-effective. It assists nurses to maintain and improve their practice by
identifying strengths and areas that can be further develop