TIME PLANNING IN NURSING SERVICES

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BY: MS.ROHINI SHARMA, RAKCON. A PRESENTATION ON TIME PLANNING IN NURSING SERVICES.

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Cardona and colleagues (1997), found that the nurses in long-term care carried heavy- workloads, provided a larger portion of direct – care and experienced minimal amounts of non – productive time. The study by Prescott , Ryan and Thompson (1981) showed that the hospital nurses inappropriately used their time in work of other departments like dietary , housekeeping , transportation, .They were also required to do the work of less-trained professionals like vocational nurses , aides ,. Bassler and Goedde (1993) found that more than 30 hours each week of managerial work was spent on clerical work. The professional nurses who are self aware with clearly defined goals have a greater control over how they spend energy and what they accomplish. Hansten and Washburn (1998) suggest that there are three primary areas of practice that consume time of the professional registered nurse: professional, technical and amenity care. The three areas are important , but the professional role must be valued more highly and time allocated accordingly in determining work priorities . Fitzpatrick, J.M. “Shift Work and Its Impact upon nurse performance: Current knowledge and research issues”. Journal of Advanced Nursing . January, 1999. 29(1). Page No. 18-25 . The findings of the study reveals that the shift work of 12 – hour has heavy implications on the nurses while an 8 – hour shift work proves to be easily handled and good for the nurses to perform better.

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Time too is of importance for the nurses. If there is one problem that is universal for managers in all settings including nursing, it is most likely to get everything done. Most of the nursing services are time – consuming And demanding. The number of hours of day can’t Be Increased but the proper time planning and management can yield good results for time invested. Working smarter – not harder and longer is the key for the success of the nurses and nursing services. That’s why two individuals produce difference in their accomplishments.

WHAT IS TIME PLANNING? : 

WHAT IS TIME PLANNING? The plan of time consumption made for the days and hours which the personnel in the ward is to spend on duty and his Activities is time planning. Time planning is one of the elements or skills of time management which includes making optimal use / help of planning, organizing, directing and controlling.

AIM OF TIME PLANNING: : 

AIM OF TIME PLANNING: Aim is not to turn the workers into machines who work without interruptions nor to develop rigid routines but to organize and arrange time so that time pressures , overcrowded schedules and wastage are reduced with the provision of adequate rest periods without lowering work output.

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A study carried out by the WHO revealed that the time utilization by doctors in PHC for patient care is only 21%. This is even less in case of preventive health care as most of the time is wasted in traveling. Also, other medical personnels utilize time as: a. Many studies have found that nurses devote only 33 % of their time on nursing activities and rest of time is spent on the non- nursing activities. b. Multipurpose workers devote only 30% of their time for health activities. c. PHC doctors devote only 25% of time to the patient care. d. Doctors at district level waste 60% of their time in traveling and unwanted activities.   The statement “Time is Money” sums up the significance of time planning. All other resources can be increased when required but not time, as it is inelastic and thus, we must make the best use of the time. “ A STITCH IN TIME SAVES NINE”

PURPOSES OF THE TIME PLANNING: : 

PURPOSES OF THE TIME PLANNING: To perform nursing activities competently and furnish assistance needed by medical staff. Allow for better time periods / staffing to provide better patient care. Better morale and health of staff with reduction in workload on nurses. Provision of better learning experiences for the student nurses and staff. Provision of care to patients with the present infrastructure two to three times more. Allow better communication between the staff to share reports and read records.

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Maximize the control over time by the nurse manager / administrator whose job is demanding and all – encompassing. To work effectively and efficiently. To prioritize care, decide results and do important interventions first. Allows nurses to have time for fun, friends, exercise and professional development. To reduce fatigue of the nurses in the wards and critical care units. To allow better leadership and administrative skills.

PRINCIPLE OF TIME PLANNING: : 

PRINCIPLE OF TIME PLANNING: The simple principle, Pareto Principle, which states that 20% of effort results in 80% of results or conversely 80% of unfocused effort results in 20% of results. Given by Vilfredo, effective time management requires 80% of time/effort for achieving 20% of results but planned and focused efforts use only 20% of time or effort to achieve 80% of desired results. 80% of effort Time management 20% of effort ↓ ∩ ↓ 20% of results Requires shift 80% of results

OBJECTIVES TO BE KEPT IN MIND : 

OBJECTIVES TO BE KEPT IN MIND To staff the Ward adequately. To provide best possible student experience. To comply with good personnel practices. To keep nurses happy. To dispose experienced personnels for patient care.

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To provide adequate coverage for nursing services. To launch adequate schemes for time management. To question strategies and techniques used. To maximize the managerial time. To maximize the organization time.

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WHO DOES THE TIME PLANNING IN NURSING SERVICES? The Nurse administrator, head nurses, nurse manager and nurses them selves do the time planning in the Nursing Services.

STRATEGIES FOR TIME PLANNING : 

STRATEGIES FOR TIME PLANNING

TIME MANAGEMENT TECHNIQUES : 

TIME MANAGEMENT TECHNIQUES

METHODS UTILIZED TO PLAN TIME : 

METHODS UTILIZED TO PLAN TIME 1.Planning time of the staff in the ward : For staffing the ward adequately the head nurse needs to distribute the nurses time within a week and also to distribute the time within 24 hour period.

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a. Distribution of time through out the week: > Determine on which days of the week the nursing load is heaviest such as admitting days or operating days . > Calculate the number of nursing hours which are assigned to the ward for the week by adding together the number of hours each nurse is assigned to work during the week. > Find the daily average nursing hours by dividing the hours assigned for the week by the number of days in the week . > Plan the days off duty so that the ward is comparably staffed with professional and non-professional staff members on each day.

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b. Distribution of time through out 24 hours: > Analyze the activities that normally occur during the 24 hour period. > Estimate the number and type of personnel needed at various times of day to carry nursing load . > Estimate the total number of nurses and aides needed to perform the ward activities and to permit time off duty for each person according to the hospital policy.

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2. Planning time for nursing team: The time planning for the team members varies with the composition of the team. When team method of assignment is used to care for all patients in the ward , the teams should, if possible be so composed that members relieve one another for the days off. The day when two members are scheduled to be absent should be the day of the week presumed to be lightest i.e. Saturday or Sunday.

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3. Complying with good Personnel Practices: The Nurses should have time provided for leisure and personal and family affairs. Also the hospital needs to formulate policies in regards to time planning: > A straight eight-hour day for all nurses instead of a day of split hours. > The work day planned to fall within a 12-hour span such as 8:00am and 8:00 PM. > Regular day, evening and night periods for nurses and rotation through them. > The arrangement of the work week, that is, the amount of consecutive off duty time that may be assigned. > The advance time is to be planning – day to day or week or month ahead.

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4. Providing Coverage: It is important to provide the coverage of the ward in relation to the experience of individuals comprising the staff. The head nurse makes certain that the ward is covered at all times with a sufficient number of nurses. This necessitates a professional nurse being charge of the floor every hour for 24 hours and the time of nurses, students and nonprofessional workers well balanced. Old staff with the new staff for supervising and teaching . Time is also planned so that good reports between nurses are possible .

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5. Providing best experience to student nurses: There is close connection between time planning and assignment planning .The following points are to be considered in planning time: Consecutive experience with the same patients or activities probably provides better learning than uninterrupted experience. The nurse new to the ward to be given experience for 4-5 days and then give her off. Sod duty limited is important. Some of the experiences are available only once a week. The student nurses should be assigned to be on duty at the hours when the experience is the best for their educational needs. The hours which the head nurse and staff nurses work may affect the experience of the student nurse.

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6. Preparing the time sheets: The time sheets can be daily or weekly. The time sheets show the distribution of work assignments. The weekly time-sheet with the time planned for each nurse is used by the nursing office to obtain an overview of the staffing situation. It is used by the clinical supervisor. The Daily time sheet is considered important in order to keep track of absence and illness. The sheet is easier to use if evening and night nurses are listed separately from day nurses.

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7. Making Time Inventory/ Schedules / writing “to do” lists: The priority also can be used when listing the activities that are to be done first and later. The list can be made monthly or weekly . It is a planning tool and there must be some flexibility in its implementation.

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8. Use advance scheduling: The hours should always be scheduled at least a week in advance and if possible further ahead. The off – duty time, straight hour assignments and overtime are issues. The splitting of the hours of duty for comfort of the staff has been recommended. But, the work has to be distributed thoroughly and throughout the day for having load during the day and less of it during the night.

9. PLANNING SCHEDULES. : 

9. PLANNING SCHEDULES.

TOOLS FOR TIME PLANNING: : 

TOOLS FOR TIME PLANNING: Time Inventory: The time inventory helps to identify patterns of behavior and maintain accurate perception of time spent by them. Daily time sheets: These sheets are prepared every day , weekly or monthly for the purpose of finding out the work to be done and scheduling of the time done. Nursing activity log: The log has to be used for several days. The nurse should record every activity from beginning of the shift to the end. Shift Action Plan: A written plan setting the priorities for the patients. The assignments can be made on this basis. Schedules: are made on the spot or the advance scheduling is done which is useful for the nurses to know when, where and how their services are requires.

ROLE OF NURSE IN TIME PLANNING : : 

ROLE OF NURSE IN TIME PLANNING : 1. Leadership Roles: a. Is self – aware . b. Functions as role model. c. Assists the follower . d. Prevents and /or filters interruptions . e.Prioritizes professional over technical aspects. f. Role-models flexibility . g.To be vigilant for absenteeism h.Setting standards , monitoring results

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2. Management functions: a. Appropriately prioritizes day to day planning. b.Analyses the adequacy . c. Utilizes appropriate technology . d. Daily planning is to be done. e. Setting long-range or short-range goals. f. Plan strategies and schedules the jobs. g. Delegation of the job to others

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Vinjakumari, Ranga. “How do the Professional Nurses Utilize their Time during their Hours of Duty in a selected Government hospitals of Delhi”. Thesis of Master of Nursing, University of Delhi, 1966. The study was undertaken to find out the utilization of the professional nurses time on different activities in Medical Ward of Safdarjung Hospital, New Delhi. The investigator tried to study and analyze the percentage distribution of the time spent by the nursing personnel on nursing activities. The main findings cover as follows: Although 60- percent time is spent on the patient centered activities , all of it does not go to direct patient care , more that half of total i.e. 34 % is spent on indirect patient care and only 26% on the direct patient care. Time spent on Public Relations and interdepartmental relationships is rather low.’ That the professional nurses working in the Medical ward did not spent any time at all on in service education of the staff and education of the students. That the Head Nurse spent more time on administrative, clerical and off station activities most of the time. Based on this it has been recommended that the proper time planning is required for better utilization of nursing services.

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Waterworth, Susan. “Time Management strategies In Nursing Practice”. Journal of Advanced Nursing. April, 2003. 43(2). Page No. 432-440. The increasing emphasis on efficiency of health care is how the nurse manages her time. The qualitative study was conducted by Waterworth to explore how nurses organize and manage time. The findings demonstrate that the time management is complex with the nurses using a range of time management strategies .Six time strategies have been identified are: Prioritizing, Routinization, Concealment, Catch – Up, Juggling, Extending temporal boundaries. The repertoire of actions includes controlling interactions, focusing, avoidance, selective attention, short cutting, saying no, making compromises, delegation and synchronizing. Also, ignoring the influence of “other”, the team and the organization perpetuates a rather individualistic and self-critical perspective of time – management .This may lead to a failure to address problems in organizing the work and coordination of care involving other health care workers.

THANK YOU : 

THANK YOU