II.

Organizing Process in Nursing

Administration

Organizing: is the process of determining the activities to be performed,

arranging these activities to administrative units, as well as assigning
managerial authority and responsibilities to people employed in the
organization.

Importance of organizing:
1. Focus on objectives, and facilitate the attaining of objectives.
2. Arrangement of positions and jobs within the hierarchy.
3. Define clearly responsibilities and line of authority of all levels.
4. Creating relationships that will minimize friction.

Basic elements of formal organizations:

1) Centralization and decentralization.
2) Delegation of authority.
3) Span of control ( supervision).
4) Division of service.
5) Departmentation.

1) Centralization and decentralization:

It refers to the level at which most of the decisions are made within the
organization.

Centralization and decentralization are also commonly used with reference

to concentration or distribution of employees and physical facilities.

 Centralization: is concentration of decision-making and action at high-level

management.

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 Advantages of centralization:
1. Power and prestige are provided to the top manager.
2. Uniformity of policies, practices and decisions are promoted.
3. Duplication of function is minimized.
4. Extensive controlling procedures and practices are not required.

Disadvantages of centralization:
1. The functions that are usually performed by middle manager are neglected
and bedside personnel become unmotivated.
2. It is difficult for a nursing supervisor to function as a manager. She becomes
instead, link officer between nursing director and first-line management.

Decentralization: is systematic and consistent delegation of authority to the

lower levels where the work is performed.

Advantages of decentralization:
1. Raise morale and promote interpersonal relationships.
2. Relieve high-level management from the daily administration freeing them
for long-range planning, goal and policy development and system
integration.
3. Bring decision-making close to action.
4. Develop managers by allowing them to manage.
5. Promote employee’s enthusiasm and coordination.
6. Facilitate actions by lower-level managers without waiting for approval of
their decisions from superiors.
7. Improves coordination, especially for services.

Disadvantages of decentralization:
1. Top-level administration may not desire decentralization; they may feel it
would decrease their status.
2. People may not permit full and maximum utilization of highly qualified
personnel.

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 3. Increased costs. It requires more managers and large staff.

4. It may lead to overlapping and duplication of effort.

5. It may lead to lack of uniformity and lowering of standards in decision-

making.

6. Emergency decision may not be possible.

2) Delegation of authority:
Delegation: is the process of assigning work from a top organizational level to
a lower one or from superior to subordinate, and giving that person the
authority to accomplish them. It is the process of downward flow of authority
from top level in the organization to lower level.

The delegation process:

1. The allocation of duties.
2. The delegation of authority.
3. The assignment of responsibility.
4. Creation of accountability, i.e. subordinates must be held answerable to
properly carry out their duties.

Factors determining the degree to which authority is delegated:

There are many factors that the manager should consider when he/she decide
to delegate:
a. Organization’s size.
The larger the organization, the increased the needs for delegation
(delegation from top manager to lower level manager to take decision).

b. Importance of duty or decision.

The more important the duty or decision, the more likely it is to be
delegated.

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c. Task complexity.
The greater the complexity of the task to be done, the greater is the need for
delegation of authority.

d. Organizational culture.
If the top-level manager does not have confidence in the abilities of lower-
level managers, this will lead to the least amount of delegation.

e. Qualities of subordinates.
Delegation requires subordinates with the skills, abilities and motivation to
accept authority and act on it.

Main principles of delegation:

 Responsibility can not be delegated.
 Authority and responsibility should be in equal proportion.

Barriers to successful delegation:

 Lack of ability of the superior to direct the subordinates.
 Lack of confidence in subordinate.
 Absence of control.

Major causes of managers’ refusal to delegate:

1. Tendency to do things personally (i.e. by himself).
2. Desire to dominate the knowledge, information, and/or skills he has.
3. Unwillingness to accept risks of wrongs, (that some subordinates may
take wrong decisions, or are incapable of using authority properly).

Reasons for subordinates’ avoidance of accepting delegation:

1. Decision-making is a hard mental work, and people seek ways of
avoiding it.
2. Fear of criticism for mistakes.
3. Lack of necessary information and resources to do a good job.
4. Overload of work.

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 5. Positive incentives may be inadequate, (e.g. pay rate, opportunity
for promotion, improved status).

Authority
Is the right to take final decisions, to act or to command action of others.
It moves in a downward direction.

Types of authority:
a. Ultimate authority:
It deals with the original source from which one derives the right to
take actions. Thus, in the health sector, the ministry of health has
ultimate authority.

b. Legal authority:
Means that an individual is legally permitted by the virtue of the
position to take an action; a hospital director delegates to director of
nursing service to act on behalf of the department.

c. Technical authority:
It refers to a person who is a recognized expert in some particular
field. This does not necessarily mean that it is derived from position.

d. Operational authority:
Is giving someone permission to assure certain responsibilities through
delegation of authority.

Types of organizational relationships:

There are two types of organizational relationships, the line relation
and the staff relation.

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  The line relation:
Refers to levels of hierarchy, superior-subordinate relationships, and
provides the framework for the organization.

The superior has the right to give orders and demand accountability. Each
member knows from whom he/she receives orders and to whom he/she reports.

Line authority is sometimes called “Direct Operative Authority.” It is

shown by a solid line in the organizational chart.

 Staff relation:
It has no command, personnel in the staff relation have only the right to
advise, assist, support those in the line authority in the performance of their
duties, it is showed by a dotted line in the organizational chart.

Responsibility
Refers to the obligation involved when one accepts an assignment.

Responsibility cannot be delegated, it may be continued or it may be

terminated with the accomplishment of a single action.

Accountability
The subordinates must be held answerable, to a predetermined superior, for
the assigned duties in order to properly carry out their duties. It moves in an
upward direction.

3) Span of control (span of supervision):

Refers to the number of subordinates that can be adequately supervised by
one supervisor.

Dimensions of span of control:

Span of control can be implemented through one of the following
dimensions: either narrow or wide.

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a. Narrow span of control:
In which the manager supervises a small number of workers ( fig 8)

Fig. 6 Narrow span of control

Advantages:
1. Close supervision.
2. Close control.
3. Fast communication between subordinates and superiors.

Disadvantages:
1. Superiors tend to get too involved in subordinates’ work.
2. Many levels of management.
3. High costs due to many levels.

b. Wide span of control:

The manager supervises a large number of workers (fig. 9).

Fig. 7 Wide span of control

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Advantages:
1. Superiors are forced to delegate.
2. Clear policies must be made.
3. Subordinates must be carefully selected.

Disadvantages:
1. Tendency of overload superiors to take most or all decisions.
2. Danger of superior’s loss of control.
3. Requires exceptional quality of managers.

Factors determining the span of control:

1. The competence of both the supervisor and the subordinate.

2. The degree of interaction between the units or personnel being

supervised.

3. Other duties of the top manager. Lower-level managers have a wider

range of span than top-level manager.

4. The similarity or dissimilarity of activities being supervised.

5. The incidence of new problems in the unit.

6. Availability of plans of work, policies and standardized procedures.

7. The degree of physical distribution.

8. The nature of work (stability, complexity, etc…).

4) Division of service (or work):

Division of work means dividing large activities to be distributed among
several people.

Advantage:
Allow an employee to master a task with a maximum skill, a minimum time
and effort.

Disadvantages:
1. Division of service creates many different, narrow jobs, which need
effective managerial coordination.

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 2. Human problems have been created from division of service, fatigue and
stress, and which lead to less quantity and quality of work, increased
absenteeism and higher turnover.

5) Departmentation:
It is the process of grouping activities into administrative units.

Types of Departmentation:
Departmentation can be implemented through one or more of the
following types:
1. Departmentation by services: activities are grouped according to
similarities of skills needed to accomplish the goal, i.e. medical, surgical and
pediatric units. It is simple and commonly used.

2. Departmentation by time: activities that need coverage twenty four hours a

day, seven days a week (e.g. acute care settings), or activities coverage for
eight to twelve hours a day for five or six days a week (e.g. preventive
services) at the most.

3. Departmentation by degree of acuteness of illness of the patients: five

progressive patient care (PPC), i.e. Intensive Care Unit, Intermediate Care
Unit, Self-Care Unit, Long-Term Care Unit, and Home Care Unit.

4. Departmentation by function: This method places all the resources and

authority under one manager, e.g. laundry, pharmacy, dietary services.

5. Departmentation by location: activities that are used with wide geographic

activities in a given location that are grouped and assigned to a manager, i.e.
inpatient department, outpatient department, and administrative department.

6. Departmentation by patient: making sense when service is important and

the welfare of the patient is of primary interest, i.e. sex: male, female, age:
geriatric, pediatric, economic status: paying, free unit.

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