Faculty of Nursing/Nursing Administration Department

Clinical Nursing
Administration
For 8th semester/ 4th level

Prepared by
Nursing Administration
Teaching Staff
2024/2025

Assiut University- Faculty of nursing ‫جامعة أسيوط – كلية التمريض‬

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Tel: 088/2423500 - 088/2366204 - 088/2423505 Fax: 088/2366204
E_mail: [email protected] & nurse_dean@ aun.edu.eg Website: www.aun.edu.eg/Faculty-nursing
 Faculty of Nursing/Nursing Administration Department

List of content
Ser. Topics Pages

1 Head Nurse
3
2 Documentation 21

3 Method of Assignment 48

Scheduling
4 82
5 Material Recourses 94

6 Time Management 106

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 Faculty of Nursing/Nursing Administration Department

Head nurse role

Out lines:
 Introduction.
 Definition of the head nurse.
 Qualification and preparation of the head nurse:
- Educational qualification.
- Professional qualification.
- Personnel qualification.
 Management position of nurse managers.
 Functions of the head nurse:
-Patient care management.
- Unit management.
- Staff management.
 Head nurse responsibilities to improve relations with departments.
 References.

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 Faculty of Nursing/Nursing Administration Department

Head nurse role

Head nurse fills one of the most critical first line-managing roles in the
administration of nursing services. She/he is the person in a position
linking nursing management to nursing care. This position is crucial in co-
ordination and integrating the practice of nursing toward the attainment of
primary goal of nursing services that rendering a high level of nursing care
to each patient in each unit.
Definition:
She/he is the person responsible for direct and indirect nursing care of
patient within an organized unit of a clinical area as medical, surgical units-
---etc.
Qualification and preparation of the head nurse:
1- Educational qualification:
Completion of baccalaureate program, which has prepared her/him for
professional nursing, practice. Advanced preparation in ward or unit
management, principles of supervision and teaching are preferred.
2- Professional qualification:
Experience as professional nurse in which potential administration and
supervisory competence has been demonstrated. Should have at least one
year experience as a staff nurse. Active participation in the professional
Management and leadership and administration
nursing organization.
Personal qualification:
- Maintain optimum physical and emotional health. Effective Communication
- Demonstrate knowledge, skills gained from educational experience.
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- Provide personnel supervision and teaching.

Update of knowledge
- Accept responsibility for continuous self-improvement to maintain up to
date nursing knowledge and new development.
Management levels(hierarchy):
It included three levels
Top management level
(Director of nursing service department)
Middle management level
(Nurse Supervisor)
First line management level
(Head nurse)
Functions of the head nurse:
1- Patient care management.
2- Unit management
3- Staff management
I. Patient care management:
In this broad functional area the following sub-function are performed by
the head nurse:-
1-Assessing and analyzing patient needs and developing the plan of
care to meet needs
During assessment head nurse must take the following into
consideration:
 The patient condition and needs.
 Needs of patient‘s family.

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 The patient environment.

 The effects of care.
 Interaction between patients and personnel.
 Social climate and physical environment of the personnel.
 Signs and symptoms associated with the various disorders.
 Information about individual patients, including age, condition,
disabilities or special problem.
 Knowledge of the total program of medical cares for the individual
patients and the nurse‘s responsibility in relation to it in order to be able
to observe the patient.
 Be familiar with the nursing care plan for each patient in order to
determine whether it is being followed.
 Holding staff nurses accountable for performing nursing assessment.
2. Role of head nurse in personnel assignment:
 Determine the interests, abilities and numbers of the various member of
the nursing team to ensure their maximum utilization to do the task and
their educational level, experiences.
 Determine patients' needs, problems and numbers.
 Determine personal qualities as same nurses relate better than others to
some patients.
 Determine the amount of time necessary to give care indicated.
 Decide on which patient. needs the most expert care.

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 Determine what other tasks are necessary to give satisfactory care to

patients.
 Decide which method of nursing care you will employ ( case , function
, team)
 Check to see that the entire workload is covered with no overlapping of
assignment.
 Put the plan into written form.
3-Setting the standards by which extent performance of the nursing
functions on her unit can be measured:-
 The HN set standard which are challenging but still within the
ability limits of nursing personnel on other words not to high because it
will frustrate them because their inability to achieve not to low as they
will fail to meet patient needs.
The standard should be:
1- Flexible enough to meet changing situation.
2- The HN should refuse to let her standards drop below the minimum for
essential patient care.
3- Then the head nurse can check nursing personnel performance against
standard that was set to ensure quality patient. Care for the types or the
degree of illness that are present in the unit.
4- She also observes the patient response to all medical and nursing care.
Satisfaction can be a positive symptom for the HN of the quality and
effectiveness of patient care.

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5- When the standard is not met, the HN should analyze the reasons for
failure with her staff and plan for improvement.
3- Supervising all nursing activities related directly and indirectly to
patient care:
The most important sub-function of the HN is the supervision of all nursing
activities. This is done through:
 Daily and constant direct observation of all patients to see that their
conditions are satisfactory and that all nursing care given by each
member of nursing personnel is adequate and effective.
 She should see and talk with every patient at least once a day to see that
patients are aware with the nursing and hospital routine.
 HN can utilize any technique to stimulate the interest of the workers to
maintain everything in the word.
 Making quick short rounds at the beginning of the day with the night
nurse in the morning and at the end of the day. In the afternoon with the
evening charge nurse provides opportunity for the two together to raise
question, discuss problems and make plans.
Purpose of nursing rounds: Progress interactions following standards
Environment
When early in the morning before physicians rounds and in different
times in:
a. To observe the overall physical and mental condition of each patient and
note progress.
b. To observe the work effort of the nursing staff as a means of evaluating
quality nursing care.

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c. To a company physicians, supervisors or family.

d. To observe the patient‘s environment for cleanliness, orderliness
completeness of equipment and presence of hazards.
e. To conduct a teaching experience for students.
5- Promotion and participation in patient education and rehabilitation.
The HN should promote and participate in patient education. Should be
start with the first contact, if he is well enough to hear. Teaching is a part of
rehabilitation, which starts upon admission of the patient, during
hospitalization and before discharge.
II- Unit Management:
The HN during her work is running her unit is involved in different
administrative duties daily and whether these duties are delegated or, she is
still the responsible person .In fact many these duties may be delegated.
1-Patient admission administration:
a. The HN acts as courteous hostess when the patient is admitted to the
unit.
b. She great the new patient, and his relatives in friendly manner because
the first impression is important and it is lasting.
c. It is preferable for the HN to use patients on name if she knows it.
d. She introduces herself and the staff member who will assist in the
admission of the patient.
e. Understands the patients and gives them the mental and moral support
he is requiring.
f. Treats the patients as she would like to be treated in the same situation.

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Orientation of the new patients and his family should include:

1) Giving them information about hospital policies, regulations and
facilities available.
2) Introduce the patients to ward environment.
3) Orient the patient to staff personnel.
2. Patient Discharge Administration:
The HN is responsible for the preparation of the patient for his discharge
from the hospital.
She should continue her role as hostess through the time of the patient
discharge from the hospital:
(a)Inform members of the patient‘s family that the patient is being
discharged, and when they should arrive for him.
(b)Be sure the patient has the proper clothing to be when going to home.
(c) Assigns one of her staff members to assist the patient in dressing,
packing and leaving the ward.
(d)Talk to the patient and his family when they are leaving.
(e)Give all instruction-required drugs and further appointment.
(f)She asks the patient if he/she would like to discuss any problem with the
medical social service worker which may interfere with his recovery. If
indicated, she suggests community agencies that may help the patient at
home.

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3- Doctors Rounds:-
A. Administration before Dr. Round:
1- The HN should see that all investigation report for the patient is
available.
2- She should see that all patient‘s charts are complete and organized and
on order and ready.
3- She instructs:-
- Nursing staff on the order of the ward for the rounds.
- Should be on comfortable position and ready for rounds.
- Auxiliary staff to see that the ward is neat and tidy.
- The HN also should be knowledgeable about patient condition and is up
to date and received all reports and ready to discuss patient‘s problems.
B. Administration after Drs. Rounds:
-Inform nursing staff to put the patient at ease in a comfortable position and
continue what was performed for him.
- Inform auxiliary staff to keep wards tidy.
- Carrying out or putting into effect the changes ordered by Dr. during the
round.
4- Drug Administration:-
The HN should:
a. Check stocks of drugs she/he has in the unit against records.
b. Check patient's charts regularly to obtain patient prescriptions
c. Return expired dated drugs to the pharmacy.

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d. Give accurate and constant instruction and supervision of nurses in the

keeping of drug records.
e. Be sure that the nursing staff know conation, normal dosage, side effects
if the drugs given to patient‘s.
f. Be sure that patients are given instructions about medications.
4- Operating Room (OR) Administration:-
The head nurse should:
a. Check the list.
b. Inform patient of day and time of operation.
c. Be sure that pre-operative preparation was done for patients by the
responsible nurse who is assigned to the patient.
d. Check consent of patient if necessary.
e. Check to see if patients chart is complete and all investigations are
present.
f. Give support to patients family or relative and any necessary needed
information.
6- Para-medical Administration:
The HN is responsible to a considerable degree for the effective
coordination of the efforts of all those workers who not only engage in
direct patient care but also with whom who engage in indirect patient
care she is responsible for establishing an atmosphere and relationship
which will improve patient care by improving the joint functioning of
various departments with a common goal better patient care.

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HN responsibilities to improve relations with departments:

1. Know the organizational structure of the hospital.
2. Acquaints staff members in the unit with the policies, routines of the
departments that cooperative with the HN unit.
3. Offer help to every employee who comes to the unit to do a job.
4. Be sure that requests to other departments be done on time.
5. Keep the patient‘s appointment with other departments on the schedule
provided.
6. Coordinate patient's services on the unit and between all the departments
in the hospital.
7-Medical department:
a. Take the initiative as a HN to establish friendly relationship and mutual
understanding with the hospital staff.
b. Encourage mutual planning for patient care.
c. Explain the nursing situation to those your wards they will be more
cooperative if they know about unusual difficulties.
d. Ask for conference with medical staff when important problem arise.
e. Reports to them any inability to carry out his orders, and explain reasons.
f. Assist with any examinations made during round.
8- Pharmacy: - Delegation
A- In ordering, the needs must be determined accurately, sufficient stock
should be available to meet current needs with reserve in hand for
emergencies, but don‘t over – stock.
 Requisition forms should be completed properly.

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 He stores can keep an account of issues made and stock in hand.

 The accounts department can keep a record of expenditure.
 Requisitions should be simple to complete and easily understate and
written legible and should be sent to the pharmacy department at the
appointed time.
B- Dangerous drugs should be ordered with special care this responsibility
is normally undertaken by the HN.
9- Maintenance department:-
 The HN should learn what services the maintenance department should
provide.
 She/he should report any mechanical difficulty, minor fault and inform
them with the location of the trouble.
10- Laundry department:-
 Avoid loss of linens- be careful to check clean linen returned from
laundry
 Protection of the linen against dirt and loss should be understood by all
members of the staff.
 The linen cupboard should be keep in good order with linen folded
nearly until it is used and correctly stored.
11-Housekeeping department:
 The HN must be satisfied with standard of cleanliness as this has such
an important bearing on patient care.
 HN should observe and notice whether they use the approved methods
handle equipment properly and carry out the work arranged for them.

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12-Dietary Department:-
The HN is responsible for writing requisition to the dietary department and
should avoid over ordering in order to prevent waste. The request should
include the number and type of diets necessary for ward. Requests are
written in the proper form and on time.
13- Diagnostic and therapeutic services Department:-
 The HN should familiarize herself with the functions of this
department.
 The patient should be prepared correctly and nursing personnel should
be instructed to do so.
 The medical staff is responsible to prepare the request form and be
completed.
 The HN should see that the forms are available and easily located.
 The patient should arrive at the correct time and arranged should be
made for the return of the patient to the ward when the test is
completed.
14-Social service department:
a. The HN should inform her staff about the functions of the social service
department.
b. Maintain a friendly, cooperative attitude towards the department.
c. Accept the help which the medical social service worker can give in
understanding patients.
d. Encourage patients to talk with the social worker.

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III. Staff management:

The head nurse role in staff management:
- Nursing services personnel consists of registered nurses, practical nurses,
student nurses, and nurses‘ aides. There are wide variation in the education,
experience and personality within each of these categories and among all
groups.
- The head nurse must be informed and concerned with these differences in
order to develop the highest potential of all workers and ensure that
patients receive safe effective care.
The administrative responsibilities of the head nurse toward her/his
staff include:
1) Staff utilization.
2) Staff supervision.
3) Staff development.
4) Staff evaluation.
1. Staff utilization.
- The head nurse is responsible for all nursing functions carried out by her
staff. She delegates tasks and enough responsibility and authority and she
still accountable.
- The staff member have greater satisfaction in her work if she/he is given
responsibility for a job and permitted to carry it out in her own way
provided.
- The head nurse must ensure that each staff member on the unit knows the
limits of his/her responsibility, to whom he/she is responsible, to whom

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he/she may go for counsel and who is responsible to him/her and for what
these limits are prepared the job descriptions.
- The head nurse should be familiar with them to enable staff to ensure
conformity with hospital policies.
- Plans time schedules of a staff in advance and in a way that comply with
good personnel practices and maintain staff morale by taking into account
personal requests of the staff.
- Observe conditions under which the personnel function and ensure that
the surrounding environment is conductive to clear thinking and free from
destructors which interfere with the achievement of goals. E.g. beginning
the day on time, putting things in order, prevent interruptions.
- Maintains an effective system of communication with staff (scheduled
and unscheduled) to aid the functioning of the staff, build their morale and
facilitate getting the work done.
- Planned conferences, written reports and records, discussions, informal
teaching is methods of fostering effective communication.
2. Staff supervision:
- Supervises the quality of staff work by utilizing opportunities such as
(given reports, making assignments, conducting rounds, during conferences
and demonstrations).
- Establish a harmonious relationship with the staff by recognizing efforts
and achievements, and by encouraging free exchange of opinions and
ideas.

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- Plans supervisory methods that facilitate staff guidance motivation and

stimulate staff to continuous self-improvement by providing social,
psychological and physical atmosphere which allows the individual
freedom to function at their own level.
- Contribute in a variety of ways to the education of students and nursing
staff. E.g. uses conferences, rounds and demonstration techniques to teach
staff and students.
- Conferring with clinical instructors to explain activities, policies and
procedures related to students learning experiences to ensure coordination
and accountability.
- Discovers leadership skills and creative abilities among members of the
nursing staff and arrange for their expression.
3) Staff development: Education
- During everyday practices the head nurse has a marked influence on the
development of her staff, the quality care she expects through the example
she sets by her attitudes and behavior to a large extent , also she determine
the standards of care.
- Setting high standards for patient care is the greatest influential factor in
the growth of staff the head nurse should involve members of staff in
developing these standards and in establishing objectives and criteria for
their attainment.
-Encourage staff to participate in planning for improvement of nursing care
and applying findings of nursing practice studies is a fruitful means of
bringing out staff growth and better quality of nursing care.

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-The extent to which the head nurse capitalizes or learning opportunities

influence staff growth. She has to provide opportunities for staff
professional advancement and advanced study.
- Share in planning and participates in staff educational and training
programs of professional personnel.
4. Staff evaluation:
- Evaluate staff performance objectively and impartially by maintaining a
routine system for continuous evaluation of staff performance to ensure the
attainment of objectives.
- Encourage staff to evaluate their own work, analyze problems and decide
an action to resolve problems. Self-evaluation help individual to determine
progress.
- Although evaluation for administrative purpose of promotion and salary
increase its main focus should be on the education growth and development
of staff.
- Investigate any complaint or lack of cooperation between workers and
help establish atmosphere on the unit.

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References:
- Vuong, T. D. N., & Nguyen, L. T. (2022). The key strategies for
measuring employee performance in companies: a systematic
review. Sustainability, 14(21), 14017.
- Crawford, C., Black, P., Melby, V., & Fitzpatrick, B. (2021). An
exploration of the predictive validity of selection criteria on progress
outcomes for pre‐ registration nursing programmes—A systematic
review. Journal of clinical nursing, 30(17-18), 2489-2513.
- Miladiyah, N., & Sarwati, P. (2020). The Role of Leadership of Head
Nurses in Implementing a Culture of Patient Safety Applied by Associate
Nurse in Public Bekasi Hospital. Education, 104(51), 67
- Mohammed Qtait ( 2023). Systematic Review of Head Nurse Leadership
Style and Nurse Performance. International Journal of Africa Nursing
Sciences Volume 18, 2023, 10056.
- Kati, K., Marja K., Mika, H., & Tarja, S. (2017). Leadership and
management competencies of head nurses and directors of nursing .Social
and health care. DOI: http://dx.doi.org/10.1177/1744987117702692.
Reprinted by permission of SAGE Publications, 22(3) pp 228-244.

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Documentation
Outlines:
 Introduction.
 Definition of documentation.
 Importance of Documentation
 Characteristics of documentation
 Kinds of records.
 Records used by the nursing units.
 Records used by the nursing office.
 Different formats of record and report.
 Characteristics of good report.
 Legal guidelines for documentation.
 References.

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Documentation
Documentation of nurses‘ work is critical as well for effective
communication with each other and with other disciplines. It is how nurses
create a record of their services for use by payers, the legal system,
government agencies, accrediting bodies, researchers, and other groups and
individuals directly or indirectly involved with health care. It also provides
a basis for demonstrating and understanding nursing‘s contributions both to
patient care outcomes and to the viability and effectiveness of the
organizations that provide and support quality patient care.
Definitions:
•Documentation: is the written evidence of the interactions between and a
mong health care professionals, patients and their families, and health care
organizations; the administration procedures, treatments, and patient
education; and the results or patient‘s responses to them.

•Documentation: any written or electronically generated information

about a client that describes the care or service provided to that client.
―Client‖ refers to individuals, families, groups, populations or
entire communities who require nursing expertise.
Importance of Documentation
1- Communication within the Health Care Team:
Nurses and other health care providers aim to share information about
patients and organizational functions that is accurate, timely,
contemporaneous, concise, thorough, organized, and confidential.

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Information is communicated verbally and in written and electronic formats

across all settings. Written and electronic documentation are formats that
provide durable and retrievable records.
2- Communication with Other Professionals:
Patient documentation frequently is used by professionals who are not
directly involved with the patient‘s care. If patient documentation is not
timely, accurate, accessible, complete, legible, readable, and standardized,
it will interfere with the ability of those who were not involved in and are
not familiar with the patient‘s care to use the documentation.
3- Credentialing:
Nursing documentation, such as patient care documents, assessments of
processes, and outcome measures across organizational settings, serve to
monitor performance of health care practitioners‘ and the health care
facility‘s compliance with standards governing the profession and
provision of health care. Such documentation is used to determine what
credentials will be granted to health care practitioners within the
organization.
4- Legal:
Patient clinical reports, providers‘ documentation, administrators‘ records,
and other documents related to patients and organizations providing and
supporting patient care are important evidence in legal matters.
Documentation that is incomplete, inaccurate, untimely, illegible or
inaccessible, or that is false and misleading can lead to a number of
undesirable outcomes.

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5- Regulation and legislation:

Audits of reports and clinical documentation provide a method to evaluate
and improve the quality of patient care, maintain current standards of care,
or provide evaluative evidence when standards require modification in
order to achieve the goals, legislative mandates, or address quality
initiatives.
6- Reimbursement:
Documentation is utilized to determine the severity of illness, the intensity
of services, and the quality of care provided upon which payment or
reimbursement of health care services is based.
7- Research:
Data from documentation provides information about patient
characteristics and care outcomes. Evaluation and analysis of
documentation data are essential for attaining the goals of evidence-based
practice in nursing and quality health care.
8- Quality process and performance improvement:
Documentation is the primary source of evidence used to continuously
measure performance outcomes against predetermined standards, of
individual nurses, health care team members, groups of health care
providers (such as units or code teams), and organizations. This
information can be used to analyze variance from established guidelines
and measure and improve processes and performance related to patient
care.

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Characteristics of documentation
- Accessible.
- Accurate, relevant, and consistent.
- Auditable.
- Clear, concise, and complete.
- Legible/readable (particularly in terms of the resolution and related
qualities of EHR content as it is displayed on the screens of various
devices).
- Thoughtful.
- Timely, contemporaneous, and sequential.
- Reflective of the nursing process.
- Retrievable on a permanent basis in a nursing-specific manner.

Records and Reports

A. Records: Are administrative tools used to classify information and
prevent duplication of information, and using in administrative educational;
or research objective.

Kinds of records:
I- Records used by nursing unit:-
(A)Patient record:
It is an orderly written report of patient complaints: It includes:
1. Admission and discharge records:
It usually the top or first form of medical record.

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2. History of physical examination:

The primary purpose of a history and physical examination is to assist the
physician in establishing a diagnosis on what to base the care and treatment
of the patient.
3. Progress notes:
Should be specific statements relating to the course of the disease.
All procedures performed should be recorded, dated and signed in these
notes.
Should be written every day or even every few hours during the acute
phases of illness.
4. Physician’s orders:
The written medical orders constitute the physician‘s directions to the
nursing, and staff covering all medications and treatments given to the
patient.
5. Vital signs record
It is used to record frequent observations such as temperature, pulse,
respiration, blood pressure, and state of consciousness.
6. Nurses’ notes:
Are written records created by nurses that document a patient's clinical
status and the care provided during a particular shift or visit and It's crucial
for ensuring continuity of care, facilitating communication among
healthcare providers, and maintaining a legal record of the care provided.

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Importance of nurses’ notes

1-Continuity of Care:
They ensure that all healthcare providers have up-to-date information on a
patient‘s status, which is essential for delivering consistent and coordinated
care.
2-Communication:
Progress notes facilitate clear and effective communication among the
healthcare team, which helps in making informed clinical decisions.
3-Accountability and Professionalism:
Detailed documentation holds healthcare providers accountable for their
actions and decisions, promoting a high standard of care.
4-Patient Safety:
Accurate and timely notes help in identifying potential issues early, thus
preventing errors and improving patient outcomes.
Nurses’ notes consist of 4 categories:
1-Patients for: procedure (Bed sore, wound dressing, OR), lab analysis,
radiology, and taking blood.
2-Follow up: Blood pressure, RBS, GCS, Temperature, Labs results, Heart
rate , Labs, radiology.
3-Special instructions: COPD, Arm precautions, NPO, Restrain.
4-Recommendation: Critical care, Issue, Orders, pending tests required.

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Date: Time
Patient name: unit: diagnosis
Steps Remarks

Receiving …………………
Events …………………
Special instructions (HBV – HCV- Contact …………………
isolation- etc…)
Recommendation …………………

Nurses’ notes (Figure 1)

(B)Census record:
It is a daily record for each unit the form include:
- Number of beds in each unit
- The census of the patients‘
- Census record must be revised upon admission or discharge of
patients and corrections should be made and sent to administrative office.
Hospital Name:

Date Class Specialty No. of Patients

Total number of patients

Unit: Unit classes:

Type of specialty: No. of beds:

Census record (Figure 2)

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(C)Assignment records: Are records of the names of nursing personnel

and the patient‘s assignment to their care.
The record should it include:
- Name of the head nurses.
- Name and position of nursing personnel assigned during the shift.
- Name of the patient,
- Diagnosis and nursing care needs or special treatments.
- List of special assignments.
- Time and place of conference or meetings.
Importance of this record:
- To inform the nursing staff in writing of the patient who is
responsible for care.
- It is used for evaluating the nursing care given and for discussion and
conferences.
- It is a tool for fixing responsibilities for nursing care.

Date: Unit: Head nurse:

No. of beds: No. of patients:
No. of nursing staff:
Position/name of Basic duties Special duties Remarks
nursing staff

Assignment sheet (Figure 3)

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(D)Inventory record:
- It is an itemized record for all articles of furniture, equipment,
instruments, with identifying date of quantity and all elements of the
articles.
- Inventory count should be made at periodic times as hospital policy
indicates.
- There are certain items that need to be counted frequently, such as
instruments and syringes. Furniture and linen count is made throughout
the hospital at least once a year.

Importance of the inventory:

- Furnishes head nurses with information upon which to request
replacements needed either because of loss or breakage.
- All articles in excess of the standard number are returned to the
proper department.
- Location of missing items and all borrowed articles are returned.
Unit:
Responsible nurse for equipment:
No. Name Content Rest of Added Date Rest of Added Date of request Rest of Added Remark
of of invention or issued of article or date of articles or
article article (*) request issued receiving issued (*)
date of (*)
receivin
g

NB: (*) in case of issued, write by red ink

Inventory record (Figure 4)

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I- Records used by the nursing office: -

1-Master record of nursing hours: This record is derived from the
daily time records of the nursing unit and should show the distribution of
the hours by each category or nursing personnel in the hospital.
2-Personnel record: It is concerned with information about each
individual nurse, assembled in a file which includes:
- Application copy.
- Photograph.
- Basic nursing education and professional preparation.
- Evaluation records.
These records should be the responsibility of the assistant director for
personnel in the nursing office. The personnel records for non-professional
personnel should be kept in the personnel department.
Component of personnel record:
A-Employment record: includes:
- Position on employment.
- Professional preparation.
- Registration number.
- Date of employment.
- Date of promotion.
- Insurance.
- Date and reasons for termination of employment.
- Summary of nurse‘s achievements, weaknesses and
recommendations.

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This record should be revised periodically either annually or semi-

annually for additional professional preparations.
B- Evaluation record: Is made periodically for all nursing personnel and
indicates the personal progress of the individual.
Importance:
- Act as an objective basis on which to base personnel promotion.
- Act as an incentive to individual progress.
- Provides reasons for poor performance, as well as recommendations
for work well done.

The areas for evaluation that need to be included in the record

are:
1. Nursing abilities, efficiency and quality of performance.
2. Attitudes and relationships with patients, workers and supervisors.
3. Attitudes towards and achievement of self-development. The
evaluation record should represent the opinion of more than one
supervisor and should be seen by concerned and discussed with him.
4. For professional and practical nurses, a quarterly record should be
kept for the first year of employment and twice a year after, depending
on the hospital policy.

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 Other administrative devices:

These are administrative directives and fall under the following
headings:
(A) Administrative procedures: referring mainly to rules and regulations
of the nursing services department.
(B) Unit procedures: outline of procedures carried out by nurses. These
procedures should be written in detailed from and specify the purpose for
which the procedure is to be used. The equipment needed and the steps and
precautions in the procedure to ensure uniformity. It is an aid for nurses
and for orientation of new employees.
B-Report: A report is a system of communication, prepared by
individuals delegated to bring or send information to others about the
existing situation.
Importance of reporting is:
1- A verbal communication regarding a patient‘s health status, needs,
treatments, outcomes, and oral response.
2- Continuity of care and problem solving. Whereas nursing
documentation is the recording of the pertinent and significant aspect of
daily care, reporting summarizes communication to facilitate the daily
continuity of care among care givers.
3- An important content of patient care problem solving among nurses and
other disciplinary caregivers.
4- Provides a better opportunity than recording for explaining the details of
a problem.

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5- The key to the effectiveness of reporting is the actual exchange of

information within the communication of those involved in the reporting
process.
To accomplish that effectively, information must be exchanged in the
following manner:
1- Those involved in reporting must value the exchange of information as
important to the care of patients.
2- Patient data must be pertinent, accurate, through and current.
3- The environment of the verbal exchange must be without distortion and
must be comfortable to all involved.
4- The timing and duration of the reporting should be acceptable to those
involved.
5-Participation in reporting should feel personally involved and
accountable for transmitting and receiving information.
6- All participants in the reporting process should exhibit communication
behaviors that show interest, attentiveness, respect, sensitivity and acute
perception.
7-Information should be personalized in the reporting process by calling
patients by name, not by room number or diagnosis.
Characteristics of a good report:
1- Well organized.
2- Brief notes, concise.
3- Clearly expressed and presented in an interesting manner.
4- Important points are emphasized.

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5- Objective and Complete.

6- Do not use clinical languages that other discipline will not understand
(Use universal a privation).
7- Date, Time and people concerned.
8- Identifying data are included.
9- Including signature of the person who prepared it.
10- Ask and answer questions after the other party has finished speaking.
Reports forms:
Reports may be classified as oral or written:
A. Oral report: It is given when the information is for immediate use and
not permanent.
Examples:
-Report between nurses.
-Report to doctor or supervisor.
-Report in case of changes in assignment.
-Report between head nurse and her assistants.
*Telephone Reporting: Nurses frequently communicate reports by
telephone, in transfers in obtaining patient data, in referrals, and in problem
solving. In giving or receiving a telephone report, some key, standard
guidelines are practical for any organization or professional
communication which include the following:-
- Organize the information to report.
- Identify the caller and nursing unit or organization.
- State the purpose of the call.

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- Be brief, avoid redundancy.

- Do not talk with other or take other calls during the call.
- Listen carefully. Repeat information to verify orders or diagnostic test
results.
- Take notes to accurately remember important communicated data.
- Always write down the name of the person talked with.
- End the call pleasantly, allowing the caller to hang up first.
- Writing the name of the person or whom you spoke and pertinent
information from the call facilitate recording pertinent information in an
organized, accurate manner.
B. Written report: Is written when the information is to be used by several
people or is more or less permanent value, included in this category are
daily, evening and night reports.
The written reports should be available in any general patient care
unit are the following:
(1)Day, evening and night shift report: Which should include the
following data:-
-Patient census.
-All actually ill patients.
-Post – operative patients,
-Patients with any change in the general condition, e.g. vital signs or those
who had social treatment.
-Admissions, discharges, transfers and deaths during the shift.

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-Patients‘ schedules for operations or special investigations; two copies are

made; one remains in the unit and the other is sent to the nursing services
office to provide them with information about the patients‘ conditions and
related activities for their care.
(2) Situation/Background/Assessment/Recommendation (SBAR)
Hand Over:
Are tools giving quick view about patient conditions and used in
communication, especially within healthcare settings, to standardize
information exchange.
SBAR tools consist of 4 categories:
- Situation: Briefly describe the current situation.
- Background: Provide context and background information relevant to the
situation.
- Assessment: Present your analysis or interpretation of the situation.
- Recommendation: Suggest actions or recommendations based on your
assessment.
Importance of SBAR:
1- Clarity and Conciseness:
SBAR helps in structuring information clearly and concisely, making it
easier for the recipient to understand the message quickly.
2- Improved Communication:
By standardizing communication, SBAR reduces the risk of
miscommunication and ensures that all critical information is conveyed
effectively. Effective communication is crucial for patient safety. SBAR

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helps in transmitting important patient information accurately, thus

reducing the likelihood of errors and adverse events.
3- Efficient Handoffs:
During shift changes or transfers between departments, SBAR ensures that
all essential information is passed on consistently, leading to better
continuity of care.
4- Better Decision-Making:
By clearly presenting the situation, background, assessment, and
recommendation, SBAR aids healthcare professionals in making informed
decisions quickly.
5- Increased Confidence:
Healthcare providers, especially those less experienced, can feel more
confident in their communications by following a structured approach like
SBAR.
(3) Occurrence Variance Report (OVR)
Definition:
An Occurrence Variance Report (OVR) is a document used in various
industries, especially in healthcare, to report and analyze unexpected
events, incidents, or deviations from standard procedures. The purpose of
an OVR is to identify, document, and investigate occurrences that could
affect the safety, quality, or efficiency of operations.

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Purpose:
1- To document incidents or variances from standard procedures.
2- To identify potential risks and areas for improvement.
3- To enhance safety and quality control.
Components:
1- Incident Details: Date, time, and location of the occurrence.
2- Description: A detailed account of what happened, including the
sequence of events.
3- Impact: The effect of the occurrence on operations, safety, quality, or
patient care.
4- Corrective Actions: Steps taken to address the issue and prevent future
occurrences.
Process:
5- Reporting: Staff members report incidents as soon as they are
identified.
6- Documentation: The incident is documented in the OVR form.
7- Investigation: The incident is investigated to determine the root cause.
8- Action Plan: Corrective and preventive actions are developed and
implemented.
9- Follow-Up: The effectiveness of the actions is monitored and evaluated.
Benefits:
1- Promotes a culture of safety and continuous improvement.
2- Helps identify trends and patterns in incidents.
3- Facilitates regulatory compliance.

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4- Improves communication and transparency within the organization.

Usage:
1- Commonly used in healthcare settings to report patient safety incidents,
medication errors, quality control issues or equipment failures.
Steps

Event First portion details Date……… of Date…………..……. Time ………...Location …………….Report of Incident

ICU NICU ER OPD Inpatient OR

Radiology Laboratory pharmacy endoscopy

Event type PpE

control infection. Policy Safety Violation

Emerrgency codes
Emergency Delay Security code

Shortage miss used adverse event Near miss Sentinel event

Person(s) affected
In-patient outpatient Visitor Employee
Medical registration
Patient name ……………………...….. MRN ………. ( optional )
number

Employee name ………………..……… ID no …………. ( optional )

Incident description …………………………………………………………………………………………….

Supervisor /head name ……………………………………………………………………………………………

Immediate action taken ……………………………………………………………………………………………...

Instruct

Corrective taken action ……………………………………………………………………………………………

Status of action taken -Appropriate and complete

-Inappropriate and incomplete

-Appropriate but further action needed

Occurrence Variance Report (OVR) (Figure 4)

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(4) Early Warning Score (EWS):

Definition:
The Early Warning Score (EWS) is a clinical tool designed to facilitate the
early detection of patient deterioration. It helps healthcare professionals
identify patients at risk of severe outcomes, such as cardiac arrest,
unplanned intensive care unit admission, or death.
Purpose:
1-Early Detection: Identify patients at risk of clinical deterioration.
2-Prompt Intervention: Facilitate timely and appropriate medical response.
3-Standardization: Provide a consistent method for assessing patient
condition across healthcare settings.
Components:
EWS is calculated based on the following physiological parameters,
each scored individually:
1- Respiratory Rate
2- Oxygen Saturation
3-Temperature
4- Systolic Blood Pressure
5- Heart Rate
6- Level of Consciousness (using the AVPU scale: Alert, Voice, Pain,
Unresponsive).

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Scoring System:
- Each parameter is assigned a score from 0 to 3 based on its deviation from
the normal range.
- The scores for all parameters are summed to give a total EWS.
Interpretation:
- 0-4: Low risk, routine monitoring.
- 5-6: Medium risk, increased monitoring and potential intervention.
- 7 or higher: High risk, immediate medical review and intervention.
Benefits:
- Improved Outcomes: Early detection and treatment can improve patient
outcomes.
- Consistency: Standardized assessment ensures uniformity in patient care.
- Enhanced Communication: Provides a clear, quantifiable measure to
communicate patient status among healthcare providers.
Steps

S – Situation Admission date …………. Admission diagnosis ……….

Transfer from …………. Transfer to ……….
(shift endorsement , condition improved , condition deterioration , other)
Patient ID verified through …….
(Verbal ………… ID wrist band ……………)
Patient is high risk for fall.

Yes NO
If yes: Precaution implemented during transfer
(Bed lower position, all side rails up, F wrist band applied
Isolation precaution:

Yes NO if yes ( type of isolation …………….. )

B – Background Critical panic result

Yes NO
If yes:
(lab , radiology )
Patient is:

-Hypertension. Yes NO

-Diabetic Yes NO

-IHD Yes NO

-HBV Yes NO

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Faculty of Nursing/Nursing Administration Department

-HCV Yes NO

-HIV Yes NO
Allergy unknown

Yes NO
if yes
(Drug …….…….. Food …………..….. other ……….…… )
Recent surgery / procedure

Yes NO
If yes: mention it………………………………….
Connection lines

-IV cannula Yes NO

-CV catheter Yes NO

-NGT Yes NO

-U. Cath Yes NO

-Jejunostomy Yes NO

-gastrectomy Yes NO

-Drain Yes NO

-Chest tube Yes NO

Wound / dressing Yes NO

If yes:
(type ………….……... location ………………………… color ………….... )
Vital sign
-Tam ………
-HR …………
-BP ………
-RR ……..
-Sao2 ……
Pressure ulcer

Yes NO
If yes
(Number ……………….…. Stage …....….. location……………………. _)
Arm precaution

Yes NO
If yes: mention it…………………………….
Neurological status
(Alert, confusion, GCS ………)
Respiratory status
(cough: productive, Dry)
(O2 ……. L/M )
Cardiovascular status
(Regular rhythm, SOB, Edema, Chest pain)
GIT
(regular diet, TPN, NPO ) (Vomiting , Nausea, Diarrhea, Constipation)

GUT
urine color: (yellow, Dark, concentrated, Red)

Musculoskeletal

Positioning Yes NO
If yes
Mobility issues …………………….………. )
Assistive device

(wheelchair, Cane, walker)

Complete hand over of

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(Medication …. Radiology p.t belongings )

Assessment What your concerns regarding this patient? ………………………………………………………………………………….
Discharge plan issues?...................................................................................................................
Shall be accompanied during transfer by
(doctor , nurse , nurse aid )
Recommendation
Nursing care plan handed over (yes No )
Follow up to
( critical result , issues , orders , pending test )
Endorsement name ………………. Time …… receiving name …….....…………….

Early Warning Score (EWS) (Figure 5)

(4)Report of complaint: Serious complaint which cannot be handled by

the ward personnel are reported to the nurse office.
The report should include:
- Statement of complaint,
- Justification as seen by the nurse,
- Measures taken to overcome the dissatisfaction,
- The result,
- Date and signature.
(5)Report indicating negligence: is a report including carelessness or
disregard of regulations on the part of a member of the nursing personnel to
the nursing office.
(6)Report for requisition: Written requests for supplies, equipment or
service, to be sent from the limit to the director of nursing office.

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Legal guidelines for documentation:

1. Do not erase, apply correction fluid, or scratch out errors made while
recording. Draw single line through error, write word error above it, and
sign your name Correct all errors promptly.

2. Record only facts.

3. Do not leave blank spaces in nurses' notes. If space is left, draw the
horizontally through it and sign your name at end.
4. Record all entries legibly and in ink.
5. Avoid using generalized, empty phrases such as "status unchanged" or
"had good day". Use complete, concise descriptions of care.
6. Begins each entry with complete date, time, and end with your signature
and title.
7. Do not wait until end of shift to record important changes.

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References:
1. www.si-tex.com/html/charting_systems.html
3. www.sightings-in1.com/nursing/nursing-documentation.htm
4. www.medleague.com/webstore/med_league/nursing_documentation.htm
5. www.medtrng.com/blackboard/nursing_documentation.htm

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Methods of organizing patient care

Outlines:
 Introduction.
 Definition.
 Key characteristics of good patient assignment in a hospital ward.
 The process of patient care assignment in a hospital ward.
 Principles underlying all patient‘s assignments:
 Factors to be considered in organizing patient care in wards
 Characteristics of a good assignment.
 Process of organizing patient care.
 Methods of organizing patient care assignment:
 A. The traditional methods:
1. Case method. 2. Functional method.
3. Team method. 4. Primary nursing method.
5. Modular nursing.
B. The alternative methods:
1. Case management.
2. Patient –centered care (focused patient care).
3. Partnership model (co-primary nursing).
4. Differentiated practice.
 References.

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Methods of organizing patient care

The prime responsibility of the Nursing Service Department lies in
planning, organizing, directing and coordinating and evaluating the total
patient care in the hospital. Setting of standards and goals for providing
care to patients depends upon the philosophy of nursing in order to
organize the patient care. The overall goal of nursing is to meet the patient
nursing needs with the available resources for providing smooth day and
night 24 hours quality care to patients and to honor his rights.
Definition:
Assignment, refers to a ‗written delegation of duties in the care of a group
of patients by trained employee assigned to the unit, based on their
knowledge, skills, job description and patient‘s nursing needs ‖.
Key characteristics of good patient assignment
1. Patient Acuity Consideration.
2. Balanced Workload.
3. Continuity of Care.
4. Skill and Experience Alignment.
5. Effective Communication.
6. Consideration of Patient Preferences.
7. Encouragement of Learning Opportunities.
8. Resource Accessibility.
9. Patient-Centered Approach.
10. Equitable Distribution of Patients.

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The process of patient care assignment in a hospital ward:

1. Assessment of Patient Needs
- Patient Acuity Evaluation: Assess each patient‘s condition to determine
their acuity level (e.g., critical, moderate, stable). High-acuity patients
require more intensive monitoring and care.
- Care Requirements: Identify specific care needs, such as specialized
treatments, mobility assistance, or frequent monitoring.
- Patient Preferences: Consider patient preferences, such as requests for
a specific gender of caregiver, language needs, or cultural considerations.
2. Assessment of Nursing and Staff Resources
- Staff Availability: Review the number of staff available during the shift,
including nurses, aides, and other healthcare professionals.
- Skill and Experience: Evaluate the skills, experience, and certifications
of available staff to ensure that they match the care needs of the patients.
- Workload Capacity: Consider the current workload of each staff
member, including the number of patients already under their care and the
complexity of those cases.
3. Assignment Planning
- Matching Patients to Staff: Assign patients to staff members based on
their acuity level, care needs, and the staff‘s skills and experience. Ensure a
balanced distribution of workload across the team.
- Continuity of Care: Whenever possible, assign the same nurse or
caregiver to a patient they have previously cared for to maintain continuity.

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- Specialized Care Consideration: Assign patients with specialized needs

(e.g., dialysis, wound care) to staff with the relevant expertise.
4. Review and Adjustment
- Team Collaboration: Discuss the preliminary assignments with the
nursing team or charge nurse to gather input and make any necessary
adjustments.
- Flexibility for Changes: Ensure that the assignment plan has built-in
flexibility to accommodate unexpected changes, such as a new patient
admission, patient condition changes, or staff unavailability.
5. Communication of Assignments
- Clear Communication: Communicate the final assignments clearly to
all staff members, typically at the beginning of the shift during a handover
or team briefing.
- Documentation: Record the assignments in the appropriate system or
chart, ensuring that all staff is aware of their responsibilities and patient
assignments.
6. Implementation of Assignments
- Patient Introduction: Nurses and caregivers should introduce
themselves to their assigned patients at the start of the shift, explaining
their role and the care they will provide.
- Care Delivery: Staff carries out the assigned patient care tasks
throughout the shift, ensuring that all care needs are met according to the
plan.

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7. Monitoring and Adjustment during the Shift

- Ongoing Evaluation: Continuously monitor patient conditions and staff
workload throughout the shift. Adjust assignments as needed if a patient‘s
condition changes or if staff members require assistance.
- Collaborative Support: Encourage team members to support each
other, especially if certain patients require more attention than anticipated.
8. End-of-Shift Handover
- Handover Briefing: At the end of the shift, staff should provide a
detailed handover to the incoming team, including any updates on patient
conditions and care provided.
- Documentation Update: Ensure that all patient records are updated with
the care provided during the shift, and any changes to the care plan are
documented.
Principles underlying all patient’s assignments:
Assignment must be:
1. Made by the first line manager (head nurse, nurse in charge).
2. Based on nursing needs of each patient and approximate time required to
care for him.
3. Planned from week to week rather than from day to day to assure
continuity of care.
4. Consider the capabilities of staff, skill level, and their experiences.
5. All indirect unit activities.
6. Geographic location of the unit.
7. That each task must be the responsibility of one nurse.

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Factors to be considered in organizing patient care in wards

1- Administrative policies pertaining to patient care and to nursing service
in a ward.
2- Needs of patients
3- Personnel available
4- The total number of patient to be nursed
5- The degree of illness of patients (physical dependency of patients)
6- Type of service: medical, surgical, maternity, pediatric and psychiatric
7- The total needs of patients
8- The physical facilities and design of wards
9- Equipment and supplies needed
10- Methods of nursing care (patient assignment, functional and team)
11- Number of nursing aids and other nonprofessional available.
12- The amount and quality of supervision available
13-Hours of working
14- The amount of, type and location of equipment and supplies such as
central sterile supply etc.
15-Knowledge of the duties to be performed
16- Morale of workers
17- Good ward management

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Methods of organizing patient care assignment:

A. The traditional methods:
1. Case method. 2. Functional method.
3. Team method. 4. Primary nursing method.
5. Modular nursing.
B. The alternative methods:
1. Case management.
2. Patient –centered care (focused patient care).
3. Partnership model (co-primary nursing).
4. Differentiated practice
The traditional methods:
I- Case method:
The case method of patient care assignment is a traditional approach in
nursing where one nurse is responsible for the comprehensive care of one
or a few patients during their entire shift. This method is particularly
effective in settings where patients require complex, individualized care.
Key Features of the Case Method:
1. Comprehensive Responsibility: The nurse is fully responsible for all
aspects of a patient‘s care during their shift. This includes administering
medications, providing physical care, performing assessments, developing
care plans, and communicating with the patient and their family.

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2. Continuity of Care: Since one nurse handles all aspects of a patient‘s

care, this method ensures a high level of continuity. The nurse becomes
very familiar with the patient‘s needs, preferences, and condition, leading
to more personalized care.
3. Holistic Care: The case method encourages a holistic approach, as the
nurse is responsible for addressing the patient‘s physical, emotional, and
psychological needs. This approach is beneficial in fostering a strong
nurse-patient relationship.
4. Clear Accountability: With the case method, accountability is
straightforward because one nurse is responsible for the patient‘s outcomes.
This clear line of responsibility can lead to more meticulous care.
When to Use the case Method:
1. Complex or Specialized Care Needs: It is ideal for patients requiring
continuous, highly individualized care, such as those in critical care units,
hospice, or with complex medical conditions (e.g., post-surgical patients or
those with severe disabilities).
2. Home Health and Hospice Care: This method is often employed in
home care and hospice settings, where a single nurse or caregiver is
assigned to oversee all aspects of a patient's care over time.
3. Intensive Care Units (ICUs): In intensive care units, where patients
have acute and complex needs, the case method allows one nurse to focus
on all aspects of a patient's care during their shift.

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4. Private Duty Nursing: In private duty nursing, where a nurse or

caregiver is hired to provide individualized care to a patient, the case
method ensures continuous, personalized care.
5. Short-Term, Intensive Care Needs: The case method may be used for
patients undergoing short-term but intensive treatments, such as
chemotherapy or post-operative recovery, where consistent monitoring and
intervention are critical
Advantages of the Case Method
1- Personalized Care: Patients receive more personalized and consistent
care, as one nurse is intimately involved in all aspects of their treatment.
2- Stronger Nurse-Patient Relationship: The nurse builds a strong
rapport with the patient, which can enhance trust and improve patient
satisfaction.
3- Comprehensive Understanding: The nurse develops a deep
understanding of the patient‘s needs and condition, which can lead to more
effective care.
Challenges of the Case Method:
1-Resource-Intensive: This method can be resource-intensive, as it
requires more nurses to ensure that each patient receives the attention they
need.
2-Potential for Nurse Fatigue: Because the nurse is responsible for all
aspects of care, this method can lead to fatigue, especially in cases where
patients have complex needs.

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3- Limited Flexibility: If unexpected issues arise, such as a sudden change

in a patient‘s condition, it may be challenging for the nurse to manage
without additional support.

II-Functional method:
The functional method of patient assignment, also known as functional
nursing, is an approach where each nurse or healthcare provider is assigned
specific tasks or functions to perform for all patients, rather than being
responsible for the total care of a particular group of patients. This method
is often used in situations where efficiency and task completion are
prioritized, such as in high-volume or high-acuity settings.

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Key Features of the Functional Method:

1. Task-Oriented: Nurses and other healthcare staff are assigned specific
tasks (e.g., medication administration, wound care, vital signs monitoring)
rather than being responsible for the total care of individual patients.
2. Division of Labor: The workload is divided among staff based on their
skills and the tasks that need to be accomplished, which can lead to a more
efficient use of resources.
3. Specialization: Staff members can develop expertise in particular tasks,
which may lead to increased proficiency and speed in performing those
tasks.
4. Centralized Decision-Making: A charge nurse or nurse manager
typically oversees the care and assigns tasks, coordinating the efforts of the
team.
Advantages of the Functional Method:
1- Efficiency: This method can be highly efficient, especially in busy
settings with high patient turnover, as it allows staff to focus on specific
tasks and complete them quickly.
2-Task Specialization: Staff members can become highly skilled at
performing particular tasks, which can improve the speed and quality of
care.
3-Resource Utilization: It allows for the effective use of limited resources
by optimizing the assignment of tasks based on staff availability and
expertise.

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Challenges of the Functional Method:

1- Fragmentation of Care: Because care is divided into tasks rather
than being patient-centered, it can lead to fragmented care, where no
one nurse has a complete picture of the patient‘s condition.
2- Lack of Continuity: Patients may receive care from multiple staff
members, which can reduce the continuity of care and make it
harder to build a therapeutic nurse-patient relationship.
3- Communication Challenges: Effective communication is critical,
but can be challenging, especially in larger teams or busy
environments, potentially leading to errors or omissions.
4- Potential for Reduced Job Satisfaction: Nurses may feel less
satisfied with their work if they are limited to repetitive tasks, rather
than providing holistic patient care.
When to Use the Functional Method:
The functional method is most effective in environments where
efficiency and task completion are critical, such as:
1- Emergency Departments: Where quick, task-based interventions are
necessary.
2- Operating Rooms: Where specific roles (e.g., scrub nurse, circulating
nurse) are clearly defined and task-oriented.
3- High-Volume Units: Such as post-operative recovery or dialysis units,
where a high number of patients require standardized care.

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III-Team method:
The team method of patient care, also known as team nursing, is an
approach where a group of healthcare professionals, led by a registered
nurse (RN), works collaboratively to care for a group of patients. This
method is designed to combine the skills and expertise of various team
members, including patient care technicians (PCTs), to provide
comprehensive and coordinated care.
Key Features of the Team Method:
1. Collaborative Approach: The team method emphasizes collaboration
among all team members, with each member contributing their specific
skills and knowledge to care for patients.

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2. Team Leadership: A registered nurse (RN) typically acts as the team

leader, responsible for coordinating the care, delegating tasks, and ensuring
that the care plan is followed.
3. Role Flexibility: Each team member, including patient care technicians
(PCTs), has defined roles, but there is flexibility to adjust roles and
responsibilities based on the needs of the patients and the skills of the team.
4. Patient Grouping: Patients are grouped and assigned to a specific team
rather than individual nurses, allowing for more comprehensive and
continuous care.
Roles and Responsibilities in the Team Method:
1- Team Leader (RN):
- Develops and oversees the patient care plan.
- Assigns tasks to team members based on their skills and patient needs.
- Provides guidance and support to team members.
- Communicates with other healthcare providers and the patient‘s family.
2 - Patient Care Technician (PCT):
- Assists with basic patient care tasks, such as bathing, dressing, toileting,
and feeding.
- Measures and records vital signs.
- Assists with mobility and transportation of patients.
- Helps with activities of daily living (ADLs).
- Observes and reports changes in the patient‘s condition to the RN.

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3- Licensed Practical Nurse (LPN)* (if part of the team):

- Administers medications.
- Performs certain medical procedures, such as wound care.
- Assists with patient assessments under the supervision of the RN.
- Provides support and education to patients and their families.
Advantages of the Team Method:
1- Comprehensive Care: By combining the skills of various team
members, the team method ensures that all aspects of a patient‘s care are
addressed.
2- Efficient Use of Resources: This method allows for the efficient use of
each team member‘s skills, with RNs focusing on complex tasks while
PCTs handle routine care.
3- Enhanced Communication: The team approach encourages regular
communication among members, which can improve coordination and
reduce the risk of errors.
4-Job Satisfaction: Team members, including PCTs, may experience
greater job satisfaction from working collaboratively and contributing to
patient outcomes.
Challenges of the Team Method:
1- Coordination: Effective coordination is crucial, and any breakdown in
communication can lead to gaps in care or duplication of efforts.
2- Varying Skill Levels: The team‘s effectiveness depends on the skill
levels of its members; if there is a wide disparity, it may impact care
quality.

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3- Time-Consuming: The need for regular team meetings and coordination

can be time-consuming, especially in busy environments.
When to Use the Team Method
It is commonly used in:
1- Medical-Surgical Units: Where patients have a range of care needs that
require the collaboration of different healthcare providers.
2- Long-Term Care Facilities: Where ongoing, coordinated care is
essential for patient well-being.
3- Rehabilitation Centers: Where multidisciplinary care is needed to
address the physical, emotional, and psychological needs of patients.

15

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VI. Primary nursing method:

The primary method of patient care assignment, also known as primary
nursing, is a model where a single nurse (the primary nurse) is responsible
for overseeing and coordinating the comprehensive care of a specific group
of patients throughout their hospital stay. This model emphasizes
continuity of care and a strong nurse-patient relationship. Here‘s an
overview of the primary method.
Key Features of the Primary Method:
1. Continuity of Care: The primary nurse is responsible for the care of a
specific group of patients from admission to discharge, ensuring a
consistent approach and deeper understanding of each patient's needs.
2. Personalized Care: Because the primary nurse is responsible for a
smaller number of patients, they can provide more individualized and
holistic care, addressing not only medical needs but also emotional and
psychosocial aspects.
3. Coordination: The primary nurse coordinates all aspects of care,
including assessments, interventions, and communication with other
healthcare team members, ensuring that the care plan is consistently
followed.
4. Patient Advocacy: The primary nurse advocates for the patient‘s needs,
preferences, and rights, serving as a consistent point of contact for the
patient and their family.

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Advantages of the Primary Method:

1- Enhanced Continuity: Patients benefit from consistent care by the
same nurse, leading to a more thorough understanding of their needs and
preferences.
2- Improved Patient Relationships: The primary nurse builds a stronger
rapport with patients and their families, which can improve patient
satisfaction and trust.
3- Holistic Care: The primary nurse can address all aspects of the patient‘s
care, including physical, emotional, and psychological needs.
4- Increased Accountability: The primary nurse is accountable for the
overall care of their assigned patients, which can lead to more thorough and
attentive care.
Challenges of the Primary Method:
1- Workload Management: The primary nurse may experience a higher
workload and responsibility, which can be challenging in busy or high-
acuity settings.
2- Resource Constraints: This model requires sufficient staffing to ensure
that primary nurses have manageable patient loads and can provide
comprehensive care.
3- Shift Handover: Effective communication during shift changes is
crucial to maintain continuity and avoid gaps in care.

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When to Use the Primary Method:

The primary method is most effective in environments where
continuity of care and a personalized approach are essential. It is
commonly used in:
1- Long-Term Care Facilities: Where patients benefit from consistent,
ongoing care and relationships.
2- Chronic Illness Management: For patients with chronic conditions
requiring continuous coordinated care.
3- Pediatric Units: Where familiar caregivers can reduce anxiety and
improve outcomes for children and their families.

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V. Modular nursing:
The modular method of patient care assignment, also known as modular
nursing, is a model where patient care is organized into distinct units or
modules, each managed by a specific team or unit. This approach aims to
improve efficiency, coordination, and quality of care by dividing the care
area into manageable segments. Each module is responsible for a defined
group of patients, with a focus on streamlined care delivery within that
module.
Key Features of the Modular Method:
1. Defined Care Modules: The care area is divided into modules, with
each module responsible for a specific group of patients. This can be based
on patient type, acuity level, or geographical location within the unit.
2. Team-Based Care: Each module operates as a self-contained team, with
designated roles for nurses, patient care technicians, and other healthcare
providers within the module.
3. Efficient Resource Use: By organizing care into modules, resources
such as equipment, supplies, and staff are allocated more efficiently,
potentially reducing waste and improving access to necessary resources.
4. Enhanced Communication: Communication and coordination are
facilitated within each module, leading to better team collaboration and
more effective care delivery.

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Advantages of the Modular Method:

1- Improved Efficiency: By dividing care into modules, resources can be
allocated more effectively, and team members can focus on a specific
group of patients, potentially improving care efficiency.
2- Enhanced Team Coordination: Teams within each module can work
closely together, fostering better communication and collaboration.
3- Specialization: Modules can be designed to handle specific types of
care or patient populations, allowing for specialized and targeted care
delivery.
- Streamlined Operations: The modular approach can simplify
operational management, making it easier to address issues and implement
changes within defined segments.
Challenges of the Modular Method:
1- Potential for Silos: There is a risk of creating silos within the care area,
where teams within different modules may have limited communication
and coordination with each other.
2- Resource Allocation: Ensuring that each module has the appropriate
resources and staff can be challenging, especially in high-demand or
resource-constrained environments.
3- Flexibility Needs: The modular approach requires flexibility to adapt to
changing patient needs and to handle fluctuations in patient volume or
acuity levels.

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When to Use the Modular Method:-

1- High Patient Volume: There is a need to manage a large number of
patients efficiently.
2- Specialized Care: Patients have specialized or distinct care needs that
can be effectively managed within dedicated modules.
3- Operational Efficiency: There is a need to streamline operations and
improve resource utilization.
B -The alternative methods:
1- Case management.
2- Patient –centered care (focused patient care).
3- Partnership model (co-primary nursing).
4- Differentiated practice.
These models were designed to reduce the demand for registered nurse by
better using of their skills and supporting them with ancillary personnel.
1. Case management:
Case management is a comprehensive approach to coordinating and
delivering healthcare services to individuals, particularly those with
complex needs. It involves the assessment, planning, implementation, and
evaluation of care to ensure that patients receive appropriate, efficient, and
effective healthcare services. Case management aims to improve patient
outcomes by addressing medical, psychological, and social factors that
impact health and well-being.

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Key Features of Case Management:

1. Patient-Centered Approach: Case management focuses on the
individual patient, tailoring care to their specific needs and circumstances.
2. Coordination of Services: Case managers coordinate various services
and resources across different providers and settings to ensure
comprehensive care.
3. Holistic Care: Case management addresses not only medical needs but
also psychological, social, and environmental factors affecting the patient's
health.
4. Resource Utilization: Case managers work to optimize the use of
healthcare resources, preventing unnecessary hospitalizations and reducing
costs.
5. Advocacy: Case managers advocate for patients, helping them navigate
the healthcare system and access necessary services and support.
Advantages of Case Management:
1- Improved Outcomes: By coordinating care and addressing all aspects
of a patient‘s needs, case management can lead to better health outcomes
and enhanced quality of life.
2- Efficiency: Reduces duplication of services, unnecessary
hospitalizations, and overall healthcare costs by ensuring that resources are
used effectively.
3- Patient Satisfaction: Patients often experience higher satisfaction due to
the personalized care and advocacy provided by case managers.

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4- Comprehensive Care: Addresses the full spectrum of patient needs,

including medical, psychological, and social factors.
Challenges of Case Management:
- Complexity: Managing complex cases with multiple healthcare providers
and services can be challenging and requires strong organizational skills.
- Resource Constraints: Limited resources and funding can impact the
ability to provide comprehensive case management services.
- Coordination: Ensuring effective communication and coordination
among various providers and services can be difficult.
When to Use Case Management:
Case management is particularly beneficial in scenarios involving:
1- Chronic Conditions: Patients with chronic illnesses requiring ongoing,
coordinated care.
2- High Utilizers: Individuals who frequently use healthcare services and
may benefit from a more structured approach to managing their care.
3- Complex Cases: Patients with multiple medical, psychological, and
social issues that require a comprehensive care strategy.
4- Transitions of Care: Patients transitioning from one care setting to
another, such as from hospital to home, which need support to manage
their care effectively.
Who is the case manager:
Is an individual "professional nurse" assigned and accept responsibility for
this process. May be registered nurse, social workers, or physicians are
case managers.

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Case manager role:

1-Has the responsibility and authority for planning, implementing,
coordinating and evaluating care for the patient throughout the entire
episode of illness regardless the patient's movement among various units
and services (such as emergency room, surgical unit, recovery unit, etc.).
2-Handle each case individually identifying the most cost effective
providers.
3- Has advanced nursing skills, managerial and communication skills.
4- Follow the patient from the diagnostic phase through hospitalization,
rehabilitation and back to home care.
5- Ensures that plans are made in advance for the next needed step.
Case manager’s approaches:
1-Internal case manager: case managers are employed by the hospitals
follow a patient from the time admission through the time of discharge.
This case manager might plan the admitting process to ensure that all
preadmission work-ups are completed and that the patients are being
admitted at the appropriate time.
2-External case managers in private practice: may focus on a particular
group of client. For example, the geriatric case manager focuses on
managing care for the older client. The private case manager is paid by the
client or family usually based on the hours of service provided. The case
manager may help the family to identify all the options for care and
treatment, ask questions to obtain greater understanding of the overall
problem, and work with the family in the decision-making process.

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Case management tools:

The case manager uses two tools:
1-Case Manager Plan (CMP): Is a multicolumn plan with accompanying
time line that includes medical and nursing diagnosis, desired care
outcomes, intermediate daily goals to supports each outcome, and the
daily activities required of nurse, physicians, and other care givers to
achieve intermediate goal.
2-Critical Path Diagnosis (Clinical Pathways): is an abbreviated , one -
page version of the required physician and nurse action listed in the CMP,
together with the exact data on which all key events must occur to
achieve the desired outcome by the target date. Are one of the main tools
used to manage the quality in healthcare concerning the standardization of
care processes. It has been proven that their implementation reduces the
variability in clinical practice and improves outcomes. Clinical Pathways
promote organized and efficient patient care based on the evidence based
practice. Clinical pathways optimize outcomes in the acute care and
homecare settings.

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Critical Path Diagnosis (Clinical Pathways)

2-Patient –centered care (focused patient care):

Patient-centered care is an approach that prioritizes the needs, preferences,
and values of patients in the planning and delivery of healthcare services.
In the context of patient assignment, it means organizing care assignments
in a way that aligns with each patient's individual needs and preferences,
enhancing their overall experience and outcomes.
Key Features of Patient-Centered Care in Patient Assignment:
1. Personalized Care: Assignments are based on understanding each
patient's unique needs, preferences, and values. This involves considering
their medical conditions, personal circumstances, and preferences for care.

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2. Effective Communication: Ensures that patients and their families are

involved in care decisions and that their voices are heard throughout the
care process.
3. Coordination of Care: Integrates care across different providers and
settings to ensure a seamless experience for the patient.
4. Respect for Patient Preferences: Takes into account patient preferences
regarding their care environment, routines, and interactions with healthcare
providers.
Advantages of Patient-Centered Care in Patient Assignment:
1- Improved Patient Satisfaction: Patients are more likely to be satisfied
with their care when their preferences and needs are prioritized.
2- Enhanced Outcomes: Tailoring care to individual needs can lead to
better health outcomes and more effective management of chronic
conditions.
3- Increased Engagement: Engaged patients who are involved in their
care decisions are more likely to adhere to treatment plans and follow-up
care.
4- Better Provider-Patient Relationships: Building strong relationships
between providers and patients fosters trust and enhances the overall care
experience.
Challenges of Patient-Centered Care in Patient Assignment:
1- Resource Allocation: Implementing patient-centered care may require
additional resources and adjustments in scheduling and staffing.

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2- Consistency: Maintaining consistent care assignments while

accommodating patient preferences can be challenging, especially in
busy or high-acuity settings.
3- Training Needs: Ensuring that all staff members are trained in patient-
centered care principles and practices can be time-consuming and
requires ongoing effort.
When to Use Patient-Centered Care in Patient Assignment:
1- Chronic Disease Management: Where ongoing, individualized care is
essential for managing complex conditions.
2- Patient Transitions: During transitions between care settings where
continuity and alignment with patient preferences are crucial.
3-High-Volume Settings: In busy environments where understanding and
addressing patient needs can improve efficiency and satisfaction.
3-Partnership model (co-primary nursing):
Partner patient care assignment is a collaborative model in which two or
more nurses or healthcare providers work together as a team to manage the
care of a group of patients. This approach promotes teamwork, shared
responsibilities, and enhanced patient care through mutual support and
coordination.
Key Features of Partner Patient Care Assignment:
1. Team Collaboration: Two or more healthcare professionals, such as
nurses or nurse assistants, are paired to share responsibilities for a group of
patients. They work together to provide comprehensive care.

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2. Shared Responsibilities: Responsibilities and tasks are divided between

partners, allowing each to focus on specific aspects of patient care while
ensuring that all needs are addressed.
3. Enhanced Communication: Partners communicate regularly to
coordinate care, discuss patient needs, and address any issues that arise.
4. Increased Support: Working in pairs provides emotional and
professional support, reducing stress and improving job satisfaction for
healthcare providers.
Advantages of Partner Patient Care Assignment:
1- Enhanced Care Quality: Collaboration between partners can lead to
more comprehensive and coordinated care, improving patient outcomes.
2- Support and Reduced Stress: Working with a partner provides support
and reduces the burden on individual healthcare providers, which can
improve job satisfaction and reduce burnout.
3- Skill Utilization: Partners can leverage each other's strengths and skills,
providing more specialized and effective care.
4- Improved Communication: Regular communication between partners
ensures that patient needs are addressed promptly and that care is
consistent.
Challenges of Partner Patient Care Assignment
1- Coordination: Effective coordination and communication between
partners are crucial; any breakdown can impact patient care.

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2- Compatibility: Successful partnerships require compatible working

styles and mutual respect. Differences in approach or personality can affect
team dynamics.
3- Dependency: Over-reliance on one partner may lead to challenges if one
partner is unavailable or absent.
When to Use Partner Patient Care Assignment:
1- High-Acuity Units: Where complex patient needs require close
collaboration and constant monitoring.
2- Busy Wards: In high-volume settings where dividing responsibilities
can improve efficiency and care quality.
3- New Staff Integration: When onboarding new staff, pairing them with
experienced partners can provide mentorship and support.
4- Differentiated practice:
Differentiated practice of patient care assignment is a model that tailors
patient care roles and responsibilities based on the skills, experience, and
qualifications of healthcare professionals. This approach recognizes that
not all tasks or patient needs are suited to every level of caregiver, and it
aims to optimize the effectiveness of the care team by matching tasks to the
appropriate level of expertise.
Key Features of Differentiated Practice:
1. Role Specificity: Assigns tasks and responsibilities based on the skill
level and qualifications of each healthcare provider. For example, complex
procedures are handled by more experienced staff, while routine tasks are
assigned to less experienced personnel.

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2. Skill-Based Assignment: Utilizes the specialized skills and

competencies of healthcare professionals to improve care quality and
efficiency. For instance, advanced practice nurses (APNs) or specialists
handle complex cases, while registered nurses (RNs) or licensed practical
nurses (LPNs) manage less complex tasks.
3. Career Development: Provides opportunities for professional growth by
allowing nurses to advance their roles and responsibilities as they gain
experience and additional skills.
4. Patient-Centered Care: Ensures that patients receive care that is
appropriate to their needs and the skill level of the caregiver, enhancing the
overall quality of care.
Advantages of Differentiated Practice:
1- Enhanced Care Quality: By aligning tasks with the appropriate level of
expertise, patients receive care that is more effectively managed and
tailored to their needs.
2- Efficient Use of Resources: Optimizes the use of staff skills and
reduces the likelihood of tasks being performed by individuals who are not
adequately qualified.
3- Professional Development: Provides clear pathways for career
advancement and skill development, improving job satisfaction and
retention.
4- Improved Team Function: Promotes teamwork and collaboration by
clearly defining roles and responsibilities within the care team.

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Challenges of Differentiated Practice:

1- Role Clarity: Requires clear definition of roles and responsibilities to
avoid confusion and overlap.
2- Training Needs: May necessitate additional training and education to
ensure that staff can meet the competencies required for their roles.
3- Coordination: Effective coordination and communication are crucial to
ensure that care is seamless and that all team members are working towards
common goals.
When to Use Differentiated Practice:
1- Complex Care Needs: Patients require varying levels of care that
benefit from the expertise of different healthcare professionals.
2- Large Teams: There is a need to efficiently manage a large team of
healthcare providers with diverse skill sets.
3- Career Development: Organizations aim to support professional
growth and career advancement for their staff.

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References:
1-Marquis, B. & Huston, C.(2022):Leadership Roles in Nursing
Theory & application, Lippincott Company, New York.
2-http://academic.uofs.edu/faculty/zalonm1/casemgt.html
3- www.staffingmedical.com/longapp.htm
4-Work Methods for Nursing Care Delivery (2021)
5- Pedro Parreira,1,* Paulo Santos-Costa,1,* Manoel Neri,2 António
Marques,3 Paulo Queirós,1 and Anabela Salgueiro-Oliveira1
6-Paul B. Tchounwou, Academic Editor
7- https://www.freece.com/blog/delivery-of-modern-healthcare/
8/8/2024

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Time planning (Scheduling)

Out lines:
 Introduction.
 Definition.
 Goals of scheduling.
 Principles of scheduling.
 What can affect the schedule of a nurse?
 Types of scheduling.
 Systems of scheduling.
 Scheduling patterns of working hours.
 Role of nurse manager.
 References.

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Time planning (Scheduling)

Scheduling personnel is a complex, time–consuming, and frequently
perplexing task. However, it must be done. Appropriate work scheduling is
a prerequisite for successful nursing operations, because patterning of
working / non- working hours directly affects employee productivity, work
satisfaction, and job tenure.
Definition:
Time plan means distribution of hours to be worked by each person during
each 24 hours, seven days a week, i.e., assigning personnel specific days
and specific hours of work.
Goals of Scheduling:
1. Achievement of divisional, departmental, and unit objectives, those
related to patient care.
2. Accurate match of unit needs with staff abilities and numbers.
3. Maximum use of manpower.
4. Equity of treatment to all employees.
5. Optimization on use of professional expertise.
6. Satisfaction of personnel and maintain staff moral.
7. Consideration of unique needs of staff as well as patients.
8. Utilize experience and skill to the best advantage.
9. Provide adequate staffing to meet patient care and needs.

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Principles of time planning:

1- The plan should enable the staff to meet the objectives, standards, and
policies of the organization.
2- Rotation schedules should inform all staff of their work schedule for the
coming consecutive 3 to 6 weeks including days off and shifts of duty.
3- The plan must be in-accord with the current labor acts and policies
regarding maximum number of hours of work a week and the number of
days within a single shift and the number of days worked without a day off.
4-The plan should provide for flexibility in meeting changing needs of
personnel (sick leaves, vacations, and holidays).
5- Days off are so planned that there is enough staff present each days
during each shift of the day to provide essential care to patients.
6- One day apart must be planned between days off of the head nurse and
the nurse who is to relieve her to provide for adequate reporting.
7-A day off before and after a night on duty is given so that the nurse may
have proper rest.
8-Where possible, the plan should allow every employee one weekend off
per two weeks period with two days off together instead of split.
What can affect the schedule of a nurse?
1-Being On-Call
On-call shifts are outside a nurse‘s regular work schedule. Furthermore, on-
call shifts might be part of a contract and have higher pay. Whether or not
nurses work on-call shifts will depend on the details of their contracts.

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These shifts are also more common in certain nursing specialties, such
as Cardiac Catheter lab nursing.
Rapport
2-Low Patient Census
A low census in healthcare means there are fewer patients than the
facility‘s capacity. In a low patient census situation, nurses may experience
modifications to their schedules and even cancellations, so nurses may have
fewer work hours than planned. Again, depending on the contract, facilities
might offer nurses compensation for canceled shifts.
3- Shift Swapping
Shift swapping means exchanging a shift with another nurse, sometimes to
cover emergencies or sickness. This exchange might affect the nurses‘
schedules positively or negatively. Although shift swapping is common in
some settings, not all facilities allow it without consulting healthcare
staffing managers.
4- Overtime
Overtime typically refers to working more than 40 hours a week or more
hours than the time scheduled or agreed upon by the facility and the
nurse. Overtime shouldn‘t be mandatory and should be adequately
compensated.
Types of scheduling working hours:-
1. Blocking scheduling: Means that the work schedule for a unit is planned
in a ―block‖ of week, i.e. days to be worked by staff are blocked together.
Block scheduling is done for 3-6 weeks at a time.

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Advantages:
1- It can be calculated easily.
1- Has flexibility in that the next block of time does not necessarily
need to follow the pattern of the preceding block.
Disadvantage: This type of scheduling does not provide for maximum
level of care seven days a week.
Example of block time scheduling
X: days worked
O: days off in the week:
Days/ S S MT WT F S S MT WT F S S MT WT F S S MT WT F
nurse
A X x o o X x x x x x o o x x o o x x x x x o o x x x x x
B X x x x O o x x x x x x o o x x x o o x x x x o o x x x
C O o x x X x x o o x x x x x o o x x x x x o o x x x x x

2. Cyclic time scheduling:

It is a technique for assigning days and time off in a pattern that repeats
itself regularly while taking in consideration the need for the proper
number and mixes of personnel, continuity of care. Cyclic time scheduling
is done for ―six to eight weeks‘
Advantages:
1-This type of scheduling is desirable to many nurses since they can
calculate even month in advance when they will be on – duty and off.
2-This type also provide for coverage of professional nurses and allow each
employee to have at least one full weekend off every 4 weeks cycle and it
never has the nurse working more than five consecutive days .

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3-Also there are never less than 2RNs on duty, there are never more than 2
persons [RN and LPN considered together] off on the same day.
4-There is never a day without at least one LPN on duty.
Disadvantages:
Because it repeats without change, the only schedules that need careful
attention are those in which exception occur, as in a week containing a
holiday.
Examples of cyclic schedule:
D: day shift
E: evening shift
N: night shift
-: off duty
Week (1) (2) (3) (4)
Days/ S S M T W T F S S M T W T F S S M T W T F S S M T W T F
nurse
Charge D D D
D D D - D D D D D D - D D D D D D - D D D D D D -
1 N N N
N - - - E E E - - D D N N N N - - - E E E - - D D
2 D D -
- N N N - - - E E E E D D - - N N N - - - E E E E
3 E E E
- - D D N N N N - - - E E E - - D D N N N N - - -
4 - - -
E E E E D D - - N N N - - - E E E E D D - - N N N
Week (5) (6) (7) (8)
Days/ S S M T W T F S S M T W T F S S M T W T F S S M T W T F
nurse
Charge D D D D D D - D D D D D D - D D D D D D - D D D D D D -
1 N N N N - - - E E E - - D D N N N N - - - E E E - - D D
2 D D - - N N N - - - E E E E D D - - N N N - - - E E E E
3 E E E - - D D N N N N - - - E E E - - D D N N N N - - -
4 - - - E E E E D D - - N N N - - - E E E E D D - - N N N

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3-Computerized scheduling:
All data necessary for time planning are fed to the computer and a program
for scheduling is designed based on the fed data.
Advantages:
1-This type enables the user to devise a plan which considers more
variables than schedules done by individuals.
2- Computerized scheduling allows for maintaining the patterns to be used
and the choice of employee and the planning of holidays, days off and
vacation.
3-The computerized scheduling is more effective than the other types, it
saves the nurse's time spent working out schedules.
4-It reduces interpersonal conflicts between staff and supervisors created
by changes made in scheduling.
Disadvantages:
1-Not take in consideration individual differences.
2-Human relations are neglected.
3- Not useful in emergencies.
Systems of scheduling:
1- Centralized scheduling: One person in the nursing administration
office plans coverage for all nursing units.
Advantages:
1-Provide a central control of staff, i.e., personnel can be distributed in a
more balanced manner among the nursing units and under staffing or over
staffing is eliminated to some degree.

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2- Fairness to employees through consistent, objective, impartial

application of policies.
2- provides an overall picture of the staffing situation
4- Helps in making adjustments in cases of illness, emergencies, or changes
in patient care needs among nursing units.
5-Eliminates the personal contact that develops between a head nurse and
her personnel as it relates to employee work schedules.
6-Relieves the head nurses from time consuming duties, freeing them for
other activities.
2- Decentralized scheduling: Are planned at the unit level, under
responsibility of the head nurse.
Advantages:
1. Allows the head nurse to base her scheduling plan on her knowledge of
the personnel assigned to her unit.
2. Personnel feel that they get more personalized attention.
3. It is easier and less complicates when done for a small area instead of the
whole agency.
Disadvantages:
1. Each head nurse under decentralized staffing tends to develop and utilize
her scheduling pattern, and as workers on various units compare schedules,
dissatisfaction may arise.
2. Sometimes makes staff members feel that the head nurse is not objective.
3 - Self scheduling: A self-scheduling process has the potential to promote
staff autonomy and to increase staff accountability. Successful self-

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scheduling is achieved when each individual's personal schedule is

balances with the unit's patient care needs.
It was defined as:
A process in which staff on a unit collectively develop and implement the
work schedule.‖
Causes of self-scheduling:
1. To give nurses more control over their time, hence easing their lives and
freeing them for better patient care.
2. To decrease the time and annoyance of scheduling for the nurse manager
and thus free her for other activities; and.
3. To reduce change requests and sick calls.
Benefits of self-scheduling including:
1. Make a difference in nurses personality.
2. Strengthen team communication skills.
3. Improve problem solving skills.
4. Enhance negotiation skills.
5. Empowering nursing staff.
6. Enhancing the communication.
Scheduling patterns of working hours:-
1. Straight shift: This is a traditional pattern that uses 8 hours shifts for
time planning for the 24 hours period. The pattern may be as such:
Morning: 7am to 3:30pm
Evening: 3pm to 11:30am
Night: 11pm to 7:30am

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This pattern allows each employee to work 8 hours a day five days a week.
This is mostly a block hour system and thus allows for underutilization
(poor) of staff on weekends. It cannot meet patient care needs seven days a
week.
2. The 10 hours shift: Block
This pattern allows staff to work 10 hours a day for 4 days a week and
three days off. This is a 6 week cyclical pattern that has advantages over
the 8 hours/day. Shifts developed for the 10 hours day are: started from
Morning: 7am to 5:30pm
Evening: 1pm to 11:30am
Night: 9pm to 7:30am
The 10 hours shift has the disadvantages of not falling evenly into a 24
hours day, but it can be planned so that the overlaps occur in peak (heavy)
work hours. This pattern is very effective in staffing ICU. Nurses are
satisfied they can give comprehensive continuous care and care get a longer
weekend and an extra day off.
3. The 12 hours shift:
This pattern consists of working 12 hours a day with 2 days off prior to a
change of shift. The shift hours are usually 7am to 7:30pm and 7pm to
7:30am. This pattern was introduced due to inadequate staffing, but it
proved to be appropriate in ICU and modified ICU. It strengthens the
relationship between the nurses, doctors and the patients; also time is saved
in personnel shift change over.

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4. Irregular hours scheduling pattern:

Nurses work a number of hours each week and the hours of work may vary
depending on patient care requirements or service demands. Nurse may
work 10 hours, 12 hours or other irregular length shift. This system is
implemented for the services of highly trained clinical nurse specialist or
for nurses in in-service training supervision programs. It can be useful in
increasing productivity but it is often costly because it ends up increasing
the number of required staff.
Role of the nurse manager :-
There are several steps in determining employees on –and off- duty time
.After analyzing the unit's work flow.
1- The manager should review schedules and scheduling policies regularly.
2- The manager must determine hours of maximum and minimum work
load so as to decide hours of peak and least need for employees in each
category.
3- The manager should check the completed schedule for errors, such as
names omitted, requested, and approved holidays or vacations not
provided.
4- The manager should plan each employee's work hours for 4-to- 8
week's so as to group available staff into desired configurations.
5- The manager may be required to secure approval of the proposed time
schedule from the divisional nursing director and should post time
schedules to notify employees of assigned duty several weeks in
advance.

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References:
1. Huber, D., (2020): Nursing management: A system approach.
Philadelphia: W.B. Saunders Co.
2. www.utmb.edu/policy/nursing/search/03-57.pdf
3. http://www.btinternet.com/~vrota/
4. hyper.vcsun.org/HyperNews/mhighfield/get/hs427/staff.html
5. Marquis, B. &Huston,C. (2017) : Leadership role and management
function in nursing theory and application, 9th edition lippincott Williams &
Wilkins.
6. Graf, C; Millar, S; Feilteau, C; Coakley, P; and Erickson, J (2019):
Patients needs for nursing care, Journal of Nursing Administration, 33(2), Pp.
76-81.
7. https://nursa.com/blog/nurse-schedule

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Material resources of nursing management

Outlines:
 Introduction.
 Types of material of resources.
 Procedures of managing of equipment and supplies.
 Head nurse responsibilities regarding controlling and managing
equipment.
 Skills needed for controlling and maintaining equipment
 Differentiation between expendable and nonexpendable equipment.
 Factors affecting determination of needed supplies and equipment.
 References.

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Material resources of nursing management

The material resources of nursing management include supplies, equipment
and facilities of the division as they are distributed over space and time.
Types of material resources:
I. Supplies: refers to expendable items (also called consumable or
recurrent), articles being used periodically and recorded frequently to
maintain sufficient amount on hand; ie, used within a short time e.g.,
cotton, food , laboratory stains, paper, disposable syringes, etc.
II- Equipment : refers to non-expendable equipment (also called capital or
non – recurrent) that lasts for several years and needs care and
maintenance, e.g., microscope, furniture, weighing scales, vehicles,
bedpans, etc., non-expendable equipment can be classified as : fixed or
movable.
A. Fixed equipment: refers to objects built into the walls and floors of the
hospital, e.g., sinks, sterilizers, intercommunication system, etc.
B. Movable items( equipment) may be subdivided into:
1- Articles that should last for more than 5years, e.g., furniture, stretches,
wheel chairs, etc.
3- Articles having less than 5years and are capable of being used
repeatedly before being replaced e.g., linens, bedpans.
II- Facilities: aids, circumstances which make it easy to do things, e.g.,
nursing room, units store and cupboard, etc.

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Procedures managing of equipment and supplies:

The four main procedures in the management of equipment and
supplies are:
1. Ordering equipment : ( obtaining equipment from stores shops). Only
some health workers (usually senior staff are authorized to order
equipment).
To order equipment the following skills are needed:
a. To list requirements, from a knowledge of past use and estimates of
present use.
b. To balance requirement with available resources and make cost –
estimates.
C. Use a catalogue.
d. Completing an order form or requisition form.
2. Storing equipment :( recording, labeling and holding equipment in a
stock or store-room).
Equipment is stored in two kinds of places: A main store or reserve store
where stocks are kept but not used.
1. The place of use, after issue.
To store equipment the following skills are necessary:
a. To record the reception of new articles and to record the issue of
articles.
b. To keep a stock-book or stock- ledger in balance.

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3. Issuing equipment:
Issuing: (giving, receiving and recorded in stock book, is used when
needed). A health unit may have several sections. E.g. a maternity ward, a
treatment room, a laboratory, a Mobil clinic. The health worker in charge
of each section of work is responsible for the equipment under his care.
Thus, a maternity nurse is responsible for weighing – scales, syringes and
vaccines, record cards, delivery kits and other apparatus. A laboratory
worker is responsible for the microscope, test-tubes, glass-slides and stains,
etc.
 After equipment has been ordered, and then received and recorded in
the stock-book, or ledger, it is issued for use when it is needed.
 There are three paper procedures used in issuing equipment:
a. A ledger record, i.e., writing the issue in the stock ledger (is a book
in which all business firm account are kept on.
b. Issuing a voucher to be signed.
c. An inventory record of the section receiving the equipment and using it.
a. Ledger record: When an issue is written in the stock ledger, the
balance remaining in stock can be found by subtracting the amount issued
from the total in the stock. When the balance is getting low, it is time to
order new equipment.
a. Issue voucher:
There is an official form on which are recorded:
- Date of issue
- What is issued and how much, and its page number in the ledger.

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- Where it is to be used (section of health center).

- Who is responsible (usually head of section).
- Signature of person responsible for its use.
- The person who signs the issue voucher takes responsibility for the care
of the apparatus or equipment.
- Issue vouchers must be filled and kept in the store.
- Duplication copies are given to the department that receives the
equipment.
c. Inventory:
- An inventory is a list of items that are kept at a certain place. Each section
of a health unit keeps an inventory of its non- expendable equipment.
- New equipment issued must be added to his inventory. This inventory is
used to check stocks of equipment in use, at intervals.
4. Controlling and maintaining
Controlling and maintaining: (controlling expendable equipment,
maintaining and repairing non-expendable equipment).
Head nurse responsibilities regarding controlling and managing
equipment: As the head nurse have a primary and very important role in
managing resources in her unit, thus she must know the necessary
principles and conditions which must be available in managing equipment
and supplies used in the unit to make the work easier.

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How can the head nurse control and manage equipments?

The head nurse's responsibilities in relation to management of
equipment may be stated as follows:
- Non – expendable equipment needs to be maintained i.e. kept in good
working condition.
- Expendable equipment needs to be controlled i.e. to avoid wastage.
To control and maintain equipment the following skills are
needed:
I- Convince staff.
II- Economize.
III- Use an inspection checklist and inspection schedule.
IV- Detect discrepancies and explain them.
I- Convince staff of the importance of cleaning, inspection and keeping
equipment in good order, of reporting defects immediately , and of
returning equipment to its correct place after use.
-There is no easy way to convince staff of the need to clean equipment and
keep it in good condition. The best way is for the supervisor (head nurse/
unit manager) to set a good example and to emphasize that equipment must
be cared for:
a. To prevent transmission of infection e.g., by a dirty instrument.
b. To keep it in good condition (dirty or damp equipment deteriorates more
rapidly than equipment that is kept clean and dry).

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II- Economize:
- One works economically by making the best use of equipment and
supplies. Well –cared-for equipment last longer and material used correctly
is not wasted.
- The head nurse must be a good observant for waste and misuse
(Examples of wasting resources are: using cotton wool for cleaning
purposes, not turning the lamp down or turning off the light when it is not
needed).
- Therefore, one of the important roles of the head nurse is to educate
nurses, doctors and other personnel in the economical use of the materials.
- Equipment should be returned clean and in good order to its correct place
after use. In this way equipment lasts longer and has to be replaced less
often.
III- Use an inspection checklist and inspection schedule:
- Seeing what is present and checking it against the inventory.
- How often equipment should be checked depends on whether it is
consumable or long lasting and weather it is liable to break down
a. Consumable items need to be checked often to avoid wastage and
extravagance (wasteful or not probably controlled).
b. Long lasting equipment such as beds, tables and chairs need to be
checked only once a year.
c. Equipment and machinery that liable to break down (e.g.
sphygmomanometers, electric sterilizers, vehicles), needs regular and more
frequent check-ups.

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- Inspection is un-interesting work and is, therefore, often forgotten or

overlooked. As a reminder to the health workers' manager, it is useful to
have special set items for inspection, set out on an inspection schedule.
- In a busy division, the head nurse cannot carry responsibilities for all
details of unit management ,some aspects of management in regard to
equipment can easily be delegated to other individuals in her department,
e.g., keeping shelves stocked: any one of these individuals could easily
keep a check on the amount in cupboards or on shelves ready for use,
making sure that there is always enough available of the excess is kept in
storage and a small amount removed at a time, to keep the shelves stocked.
IV- Detect discrepancies and explain them:
- A "discrepancy" is a difference between what is reported and what is
found, e.g., a difference between the amount of something actually used
and the amount normally expected to be used, or a difference between the
equipment entered on the inventory list and the equipment actually present.
Example:
Twenty 2cc non-disposable syringes were issued to a mobile clinic. After
one month only 5 remain. This is a discrepancy.
Explanation:
Perhaps the syringes were badly packed in a box and many were broken in
transport. Perhaps they were left behind in a distant clinic.
Or: some health workers may have been careless and have broken many
syringes.
Or: the syringes may have been stolen.

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Find the cause of discrepancies and take appropriate action

V- Good management takes care of equipment by instructing and
motivating staff to feel responsible for the equipment they use, storing
them safely and controlling their use.
VI- Ordering supplies when needed and keep and adequate supply of
material on hand at all times in good condition, available for use, and
conveniently located.

Process of determining the needs from expendable equipment

(supplies)?
1. determine patients census in the unit ( this for the already working units,
but for the new developed units, consider the standard of supplies
consumed in the previous years for the units with the same number of
patients and the same services offered).
2. Determine kind of nursing procedures (tasks) that should be done for
each patient in the unit e.g., Intramuscular injection, I.V injection,
Catheter….etc).
3. Determine number of procedure (tasks or activities) to be done for each
patient.
4. Determine the supplies that should be used for each nursing activity.
5. Calculate number of supplies needed for each patient / unit.
6. Calculate the total amount of supplies needed (*requested) for patient
census per unit.
7. Remember to keep a suitable percent of stock and another percent for
emergencies (5-10%).
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Determining the needed equipment (non-expendable items)

Determination of the non-expendable items e.g., beds, cupboard, chairs,
etc, based on the number of beds/unit i.e. the maximum number of
patient/unit, and type of patients should be considered (surgical, medical or
pediatric….etc).
Determining the needed equipment (non-expendable items):
Using the following equation:
• Rn = pt * Tn / Ta * Ut
• Rn Number of needed resources units
• pt Average of patients number
• Tn number of minutes for services
• Ta Number of minutes for each unit
• Ut needed utilization rate
*Exercise: Analyzing the demand for materials
A certain hospital providing gynecological and obstetrical services, the
hospital manager needs to prepare a future plan to determine the number of
beds required to care for patients. So, he assigned health planners and gave
them the following information:
- Each patient needs (45 minutes) for examination/visit
- The expected weekly demand for services = 750 examination/visit
- The management estimates the utilization rate by 95%
- The hospital works 7 days/week
- The healthcare team works for 9 hours daily

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Request:
- Estimate the number of beds required for gynecological and obstetrical
services
Solution
• Rn Number of rooms needed
• Pt Average of patients visits number = 750/7 = 107 visits
• Tn number of minutes for services = 45 minutes
• Ta Number of minutes for each unit. 60 * 9 = 540 minutes
• Ut needed utilization rate. 80 %
45*107 / 540 * 0.80 = 4815/432 = (11) Rooms

Factors affecting determination of needed supplies and

equipment:
1. Cost containment and economic use.
2. Availability of it in the local market.
3. Method of storing of supplies and availability of maintenance of
apparatuses and equipment.
4. Presence of training and trained personnel for using equipment and
apparatuses.

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References:
1. Yoder-wise, P (2019): leading and managing in nursing, chapter 8
managing resources, 7th edition, by mosby, inc, P.p (159-175).
2. Mansour, E., (2001): Nursing administration protocols, Maternal
and child health nursing care, chapter, 4, Supplies and Equipment,
Nursing faculty. Cairo, Egypt, Pp33-38.
3. Divincenti, N.,(2018): Administrating nursing service, 2 nd edition,
Little, Brown and company Boston , Pp263-269.
4. McMahon R., Barton E., and Piot. M.,(2013): On Being in charge
, A Guide for Middle- level management in primary health care
,5thed world health organization ,Geneva .

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Time management
Outlines:
 Introduction.
 Requirements for effective time management.
 Definitions of time management.
 Importance of time management.
 Principles of time management.
 Definition of time wasters.
 Types of time wasters.
 Comparison between the time management process and problem
solving.
 Strategies of time management.
 Consequences of poor time management.
 Nurse Manager Role in time management.

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Time management

Time is a basic characteristic of the universe: it is often called the ―fourth

dimension‖, (coming after length, breadth and height). Time is a sort of
capital, just as money is, to be spent and used in the most effective way.
But, as with money, people both waste time and misuse it, despite the fact
that time is such a valuable and limited resource.
Requirements for effective time management:
1- Analysis of the characteristic of the work and the individual work habits
of the team members.
2- Intervention where a non-production use of time is found.
3-Effective time management requires diligence, discipline, and flexibility.
Definitions of time management:
1) Making optimal use of available time.
2) Time management is the process of organizing and planning how to
divide your time between specific activities or tasks.
Importance of time management:
1-Stress Reduction:
-When you manage your time effectively, you can avoid last-minute rushes
and the stress associated with procrastination. Knowing what needs to be
done and when it needs to be done reduces anxiety and promotes a sense of
control.

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2-Better Decision Making:

-With a structured approach to time, you can make more informed
decisions about how to allocate your resources. This leads to better choices
about how to spend your time and energy.
3-Improved Quality of Work:
-Time management allows for better focus on the task at hand, leading to
higher quality output. When tasks are rushed due to poor time management,
the quality of work often suffers.
4- Work-Life Balance:
- Effective time management can help maintain a balance between work
responsibilities and personal life. By allocating time appropriately, you
ensure that work does not overwhelm your personal time, leading to a
healthier and more fulfilling life.
5- Achieving Goals:
- Proper time management is crucial in setting and achieving goals. It
allows for setting clear, actionable steps towards accomplishing objectives,
whether they are short-term tasks or long-term ambitions.
6- Increased Opportunities:
- With effective time management, you are able to take on new
opportunities without feeling overwhelmed. This is because you can handle
your existing responsibilities efficiently while exploring new possibilities

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Principles of time management:

1-List goals and set priorities: one simple means of prioritizing what needs
to be accomplished is to divide all requests into four categories (do not do,
do later, and do now, and done by others)
2- Delegation
3- Make a daily ―to do ―list (daily planning)
4- Interruption control
5- Start with the problems that need immediate decision
6- Ask what is the best use of my time right now?
7- Handle each piece of paper only once.
8- Do it now.
9- Follow pareto principle: is a way of explaining that normally the trivial
many situational problems use 80% of the groups time in producing
20% of the positive results, in contrast, the vital few situations or
problems use 20% of the expended time to produce 80% of the positive
results.
Definition of time wasters:
A time waster is something that prevents a person from accomplishing the
job or achieving goal.
Types of time wasters:
1. Internal Time Wasters:
These are distractions or inefficiencies that come from within ourselves,
often related to personal habits, mindset, or lack of organization.

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Key features of Internal Time Wasters:

1- Perfectionism:
Spending excessive time trying to make something perfect, which often
isn't necessary.
2-Lack of Prioritization:
Focusing on less important tasks while neglecting more critical ones.
3- Multitasking:
Attempting to do multiple tasks at once, leading to reduced efficiency and
errors.
4- Disorganization:
Having a cluttered workspace or a lack of planning, resulting in wasted
time searching for things or figuring out what to do next.
5- Overthinking:
Spending too much time analyzing or second-guessing decisions, which
delays progress.
6- Lack of Focus:
Difficulty concentrating on a single task due to internal distractions or a
wandering mind.
7- Procrastination:
Procrastination is the act of delaying or postponing tasks or decisions, often
to the point where it impacts productivity and effectiveness.

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Causes of Procrastination
1 - Lack of Motivation: Feeling unmotivated or uninterested in
completing tasks.
2 - Fear of Failure: Avoiding tasks due to anxiety about not performing
well.
3 - Overwhelm: Feeling overwhelmed by the size or complexity of a task.
4 - Perfectionism: Delaying tasks due to the desire to complete them
perfectly.
5 - Poor Time Management: Difficulty in prioritizing tasks and managing
time effectively.
Strategies to Overcome Procrastination:
1 - Prioritize Tasks: Use tools like to-do lists or prioritization techniques
to manage and organize tasks effectively.
2 - Break Tasks into Smaller Steps: Divide larger tasks into smaller,
manageable parts to make them less overwhelming and easier to start. 3 -
Set Clear Deadlines: Establish specific deadlines for tasks to create a
sense of urgency and accountability.
4 - Use Time Management Techniques: Implement techniques such as
the Pomodoro Technique or time blocking to manage time and maintain
focus.
5 - Address Underlying Issues: Identify and address any underlying
causes of procrastination, such as fear of failure or lack of motivation,
through self-reflection or professional support.

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6 - Seek Support: Collaborate with colleagues or supervisors for support,

advice, and accountability to stay on track with tasks.
2. External Time Wasters
These are distractions or inefficiencies that come from outside influences,
often beyond one's immediate control.
Key features of Internal Time Wasters:
1-Interruptions:
Unplanned disruptions like phone calls, emails, or colleagues dropping by
unexpectedly.
2-Unnecessary Meetings:
Attending meetings that are unproductive, too long, or lack a clear agenda.
3-Social Media and Digital Distractions:
Getting sidetracked by notifications, social media platforms, or browsing
the internet.
4- Office Chit-Chat:
Engaging in excessive or unplanned social interactions with colleagues
during work hours.
5- Waiting for Others:
Delays caused by waiting for responses, approvals, or input from others.
6- Technology Failures:
Time lost due to software crashes, slow internet, or other technical issues.
- External Obligations:
Commitments or tasks imposed by others that imposed by others that take
time away from more important activities.

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Comparison between time management process and problem

solving:
Time management process Problem solving process
-Analyzing the present situation (where - Problem identification
lam now)?
-Developing relevant assumptions (what - Point of view
conditions will most likely exist within
the time span of the plan )
-Establishing objectives ( what do 1 - Problem definition and/or
goal statement and problem
want to achieve )
analysis
Strategies of time management:
1. Prioritization
- Eisenhower Matrix: Categorize tasks into four quadrants based on
urgency and importance
- Urgent and Important: Do immediately.
- Important but Not Urgent: Schedule for later.
- Urgent but Not Important: Delegate if possible.
- Not Urgent and Not Important: Minimize or eliminate.
- ABC Method: Rank tasks as A (high priority), B (medium priority), or C
(low priority).

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2. Goal Setting
- SMART Goals: Make your goals Specific, Measurable, Achievable,
Relevant, and Time-bound.
- Break down Large Tasks: Divide big tasks into smaller, manageable parts
with specific deadlines.
3. Time Blocking
- Allocate specific time blocks for different activities or tasks. This helps
in maintaining focus and reducing the temptation to multitask.
4. Task Batching
- Group similar tasks together and complete them in one go. For example,
respond to all emails during a set time instead of sporadically throughout
the day.
5. Pomodoro Technique
- Work in short, focused bursts (e.g., 25 minutes), and followed by a short
break. Repeat the cycle several times before taking a longer break.
6. Delegation
- Delegate tasks that others can do to free up your time for higher-priority
activities.
7. Avoid Multitasking
- Focus on one task at a time to increase efficiency and the quality of your
work.
8. Set Deadlines
- Even for tasks that don't have a strict deadline, setting one can help create
a sense of urgency and prevent procrastination.

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9. Review and Reflect

- Regularly review your progress and reflect on what‘s working or what
needs adjustment. Adjust your strategies as needed.
10. Limit Distractions
- Identify common distractions (e.g., social media, unnecessary meetings)
and find ways to minimize them during work hours.
11. Use Tools and Apps
- Utilize time management tools like to-do lists, calendars, or apps like, to
do list, or Asana to keep track of tasks and deadlines.
12. Self-Care
- Ensure you‘re getting enough sleep, exercise, and relaxation. Proper self-
care improves focus and energy levels.
Consequences of poor time management:
1- Activity mania, because every day begins without a proper plan,
fragmentation of jobs. So the manager is left rushing from one crisis to
another.
2- Reacting to not controlling, events.
3- Living the present, rather than the future
4- Becoming less effective
5-Work overload
6- Less leisure time
7- Stress.

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Nurse manager role in time management:

1-Appropriately prioritizes day-to day planning to meet short – term and
long-term unit needs.
2-Accurately assesses subordinates capabilities and motivation when
delegating.
3- Delegates a level of authority necessary to complete delegated tasks.
4-Develops and implements a periodic review process for all delegated
tasks.
5-Provides recognition or reward for the completion of delegated tasks.
6-Builds time for planning into the work schedule.

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References:
1. Sullivan, J and Decker, (2005): Effective leadership management
in nursing.
2. http://www.timethoughts.com/time-management.htm.
3. http://timemanagement-goalsetting.com/.
4. http://www.timemanagerpro.com/time-management/principles-of-

time-management.html.
5. https://eatyourcareer.com/2021/02/the-3-essential-functions-of-time-

management/
6. https://www.coursera.org/articles/time-management
7. https://www.indeed.com/career-advice/caree development/time-
wasters-and-how-to-avoid-them

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