Contoh OA

DOCUMENT RESUME

ED 069 898 VT 017 655

AUTHOR Gosman, Minna L.; And OthersTITLE Occupational Analysis: Nursing Unit Administration

(Ward Administration). Interim Report. The UCLAAllied Health Professions Project.

INSTITUTION California Univ., Los Angeles. Div. of VocationalEducation.

SPONS AGENCY Office of Education (DHEW), Washington, D.C. Bureauof Research.

PUB DATE Apr 71NOTE 89p.AVAILABLE FROM University of California, Allied Health Professions

Project, 1003 Wilshire Blvd., Santa Monica,California 90401 ($2.40)

EDRS PRICE MF-$0.65 HC-$3.29DESCRIPTORS Administrative Personnel; Career. Ladders; *Curriculum

Development; *Health Occupations Education; HealthServices; *Hospitals; *Institutional Administration;Job Analysis; Medical Services; Occupational Surveys;Paramedical Occupations; *Task Analysis; TaskPerformance

IDENTIFIERS *Hospital Ward Administration; UCLA Allied HealthProfessions Projects

ABSTRACTA national survey was conducted as part of the UCLA

Allied Health Professions Project to: (1) analyze the various levelsof personnel performing non-clinical tasks within the hospitalnursing unit (ward), (2) determine the components'of a curriculum fortraining such personnel, and (3) determine the feasibility ofdeveloping a pattern of upward career mobility in administration ofthe hospital nursing unit. A task inventory consisting of 169 tasksgrouped as either clerical or management functions was developed anddistributed to a panel of experts and to 243 unit administrationpersonnel. Responses from 189 employees and the expert panel revealedthat: (1) Tasks clustered into two groups, with one group comprisingtasks which might be accomplished by clerical personnel and the othercomprising tasks which might be performed by managerial personnel;(2) In general, the current performance of tasks by variousoccupational levels is at a variance with practices recommended bythe expert panel; and (3) The expert panel rated many tasks higher indifficulty than the personnel performing them. Implications forcurriculum development are included, and the survey questionnairesand other study materials are appended. pm

TIF. UCLA ALLIED HEALTH PROFESSIONS PROJECT

OCCUPATIONAL ANALYSIS

NURSING UNIT ADMINISTRATION

(WARD ADMINISTRATION)

UNIVERSITY OF CALIFORNIA, LOS ANGELESDIVISION OF VOCATIONAL EDUCATION

ALLIED HEALTH PROFESSIONS PROJECT

April 1971

ReprintedJune 1972

UNIVERSITY OF CALIFORNIA, LOS ANGELESDivision of Vocational Education

ALLIED HEALTH PROFESSIONS PROJECT

EXECUTIVE RESEARCH AND DESIGN GROUP(EXECUTIVE COMMITTEE)

Melvin L. Barlow, Professor of Education, ChairmanDirector, Division of Vocational EducationUniversity of California, Los Angeles

David A lien, Coerd inatorProfessional Resources Development Unit

'Bureau of Industrial EducationState Department of Education

Miles H. Anderson, .Acting DirectorAllied Health Professions ProjectDivision of Vocational EducationUniversity of California, Los Angeles

13. Lamar Johnson, Professor of EducationUniversity of California, Los Angeles

Richard S. Nelson, ChiefProgram OperationsVocational EducationBureau of Industrial EducationState Department of Education

Bernard R. StrohmAssistant Director of Hospitals and ClinicsUniversity of California, Los Angeles

STAFF

Melvin L. Barlow, Ed.D. Principal Investigator andProject Director

Miles H. Anderson, Ed.D. Acting Director

Thomas E. Freeland, Ph.D. Deputy Director

Carol Tripp Project Coordinating Assistant

Mary Ellison EditorsSvlva GrossmanSeba Kolb

1003 Wilshire Boulevard, Santa Monica, California 90401 (213) 393-9281

coCD-

C CD

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Occupational Analysis

NURSING UNIT ADMINISTRATION

(Ward Administration)

Interim Report

Minna L. Gosman, M.P.H.

G. B. Krishnamurty, Dr.P.H.

Glenn Reeder

Robert R. Henrich, M.S.

Katherine L. Goldsmith, Dr.P.H.

U.S DEPARTMENT OF HEALTH.EDUCATION & WELFAREOFFICE OF EDUCATION

THIS DOCUMENT HAS BEEH REPRODUCED EXACTLY AS RECEIVED FROMTHE PERSON OR ORGANIZATION ORIGMATING U POINTS OF VIEW OR OPENIONS STATED DO NOT NECESSARILYREPRESENT OFFICIAL OFFICE OF EDUCATION POSITION OR POLICY

Research and Demonstration Grant 8-0627U.S. Office of Education, Bureau of ResearchDepartment of Health, Education, and Welfare

UNIVERSITY OF CALIFORNIA, LOS ANGELESDivision of Vocational EducationALLIED HEALTH PROFESSIONS PROJECT

April 1971

ReprintedJune 1972

This publication is covered bycommon-law copyright and maynot be excerpted or reproducedin any way without permissionof the authors.

f

This publication was prepared pursuant toGrant No. 8-0627 with the Office of Education,U. S. Department of Health, Education, andWelfare. Points of view or opinions weredeveloped on the basis of advisory committeesuggestions and survey data. They do not,therefore, necessarily represent officialOffice of Education position or policy

FOREWORD

The Division of Vocational Education, University of California, is an

adMinistrative unit of the University concerned with responsibilities for

research, teacher education, and public service in the broad area of vocational

and technical education. During 1968 the Division entered into an agreement

with the U.S. Office of Education to prepare curricula and instructional

materials for a variety of allied health areas. For the most part such

materials are related to pre-service and in-service training from on-the-job

instruction through Associate degree programs.

This report is a summary of the functional analysis of the occupational

groups within the area of hospital Nursing Unit Administration (Ward Adminis-

tration). A national panel of experts, selected among the leaders in the

field, provided assistance in the identification and evaluation of the tasks

contained in a questionnaire distributed country-wide. The survey was used

to identify performance of tasks by job titles in the nursing unit in health

care facilities throughout the nation.

Melvin L. Barlow, DirectorDivision of Vocational EducationUniversity of California

Professor of Education, UCLA

Principal Investigator,Allied Health Professions Projects

iii

TABLE OF CONTENTS

Page

FOREWORD iii

TABLE OF CONTENTS

SUMMARY ix

A. Development of the Task List 3B. Objectives and Design of the Survey Instrument 5C. Other Data 5D. Background Information 5E. Survey Sample 6IF. Method of Administering the Questionnaire 6

III DATA ANALYSIS

I INTRODUCTION

The Projects and their Goals 1

II PROCEDURES

A. Analysis of Background Information from the Respondents . . . . 7B. Description of Statistics Used 16C. Compiling Data on Performance by Clerical and

Managerial Categories 16D. Task List Exclusions and Additions 17E. Distribution of Tasks by Occupational Category 17

IV RESULTS 19

A-(1) Clerical Functions - Record Keeping 22A-(2) Clerical Functions - Communications 26A-(3) Clerical Functions - Patient-Centered Activities 31A-(4) Clerical Functions - Supplies and Equipment 34A-(5) Clerical Functions - Safety and Sanitation 37B-(1) Administrative Functions - Establish Objectives and

Policies 39

Contents (continued) Page

B-(2) Administrative Functions - Plan DepartmentalOrganization 41

B-(3) Administrative Functions - Staff Selection andManagement 43

B-(4) Administrative Functions - Budgeting 46B-(5) Administrative Functions - Coordinate Activities

Within the Unit, Department, and Total Facility 48B-(6) Administrative Functions - Education and Training 50B-(7) Administrative Functions - Research 52

Other Findings Related to Tasks Performed by Administratorsand Nursing Directors 53

C. Distribution of Tasks by Occupational Title 55

V. CONCLUSIONS 59

APPENDICES

Appendix 1 Roster of Members of Expert Panel Participatingin National Sdrvey 61

Appendix 2-A Sample Page ofAppendix 2-A Sample Page of Survey Questionnaire Submitted

to Expert Panel 63

Appendix 2-B Sample Page of Survey Questionnaire Submittedto Respondents 64

Appendix 3 Background Information Sheet 65

Appendix 4-A Survey Directions to Survey Respondents 67

Appendix 4-B Survey Directions to Expert Panel 68

Appendix 5 Hospitals Selected for Study 69

Appendix 6 Tasks Judged by Expert Panel as Outside the Purviewof the Nursing Administration Unit in the HealthFacility 75

Appendix 7 Block I: Tasks Clustered into Major Content AreasPerformed by Clerks and Managers 76

Appendix 8 Block II: Tasks Clustered into Major Content AreasPerformed by Managers Only 80

vi

LIST OF TABLES

Page

1. Number of Questionnaires Distributed and Percent ResponsesReceived, by Geographic Area 7

2. Respondents by Position-Title 8

3. Respondents by Occupational Category and Geographic Area 9

4. :Description of Respondents by Occupational Category and SelectedVariables

Size of Hospital and Area of Patient Care 12

Sex, Age, and Academic Education 13

Technical or Training Programs, Certification, License,Registration, and Salary 14

Previous Position Held and Years in Present Position 15

5. Tasks Currently Performed Exclusively by Directors ofNursing and Administrators 54

vii

A-(1)

A-(4)

A-(5)

B-(1)

B-(2)

B-(3)

B-(4)

B-(5)

FIGURES

Page

Clerical Functions - Record Keeping . 20

A-(2) Clerical Functions - Communications 24

A-(3) Clerical Functions - Patient-Centered Activities 28

Clerical Functions - Supplies and Equipment 33

Clerical Functions - Safety and Sanitation 36

Administrative Functions -Policies

Administrative FunctionsOrganization

Administrative FUnctions

Administrative Functions

Administrative Functions

Establishing Objectives and

- Planning Departmental

38

40

- Staff Selection and Management . . . 42

45- Budgeting

- Coordinating Activities Withinthe Unit, Department, and Total Facility 47

B-(6) Administrative Functions - Education and Training 49

B-(7) Administrative Functions - Research 51

C. Pattern of Upward Mobility

viii

57

SUMMARY

Objectives

1. To analyze the various levels of personnel currently performing thenon-clinical tasks within the hospital nursing unit (ward).

2. To determine the components of a curriculum needed for trainingpersonnel to perform non-clinical functions within the hospitalnursing unit.

3. To determine the feasibility of developing a pattern of upwardcareer mobility in the administration of the hospital nursing'unit.

Procedures Employed

1. Search of pertinent literature to determine current practices andtrends in Nursing Unit Administration ;(Ward Administration).

2. Development of a survey instrument based on an inventory of non-clinical tasks in Nursing Unit Administration (Ward Administration).

3. Survey by Expert Panel selected nationwide from leaders in theNursing Unit Administration (Ward Administration) field to evaluatethe performance of the tasks within the Nursing Unit Administration(Ward Administration) function.

4. Survey of the level of personnel performing the non-clinical tasksin the administration of the nursing unit (ward) in a nationalsample of hospitals.

5. Analysis of survey data,for the development of a curriculum.

Findings

1. Tasks were found to cluster into two groups: the first groupcomprised tasks which might be accomplished by clerical personnel,and a second-level group those which might be performed bymanagerial personnel. Survey results reveal that first-leveltasks were performed by both clerical and managerial personnel.Second-level tasks were performed only by managerial personnel.

2. For certain tasks, the Expert Panel recommends performance by ahigher level of occupational category than is currently thepractice. In other instances, the recommended level of occupationalcategory is lower. In general, the current performance of tasksby various occupational levels in Nursing Unit Administration isat variance-v/ 1th practices recommended by the expert panel.

3. The survey results reveal no discernible relationship betweencriticality and difficulty. When the Expert Panel rates a taskas being very critical they do not necessarily rate the task asbeing very difficult.

ix

10

4. The Expert Panel rates many tasks higher in difficulty than dothe personnel performing the tasks.

Implications for Curriculum Development

1. The core, or Step One of Unit Administration curriculum, isinstructional material to cover the skills and knowledge requiredto perform the tasks done by both clerical and managerial personnel.The balane of the curriculum consists of instructional material toprovide the skills and knowledge required to perform a secondgroup of tasks done only by managerial personnel. The progressionfrom first,level'skills through the second-level skills providesa method of upgrading (vertical mobility) from the entry-levelto the unit manager occupation.

2. The number of persons surveyed who had neither training norprevious hospital experience in unit administration suggeststhat the hospital must carry the burden of instruction. Instruc-tional modules for training new employees would be beneficial anddesirable.

3. Training and experience in unit management might bt logicallysequenced to provide an alternate route to the level of tospitaladministrator.

4. The administrator or manager of the hospital nursing unit isconsidered a "middle-management" position. Where these positionsare held by non-nursing personnel, the majority are male. Ifthe unit manager position were to be filled by non-nursing personnel,it is believed that more male personnel might be attracted to theoccupation.

x

OCCUPATIONAL ANALYSIS OF TASKS PERFORMEDIN HOSPITAL UNIT MANAGEMENT

I. INTRODUCTION

The Projects and Their Goals

Early in 1968 the United States Office of Education invited proposalsfor research and development programs to stimulate the recruitment and train-ing of manpower for the allied health occupations. One of the organizationsinvited to participate was the Division of Vocational Education of theUniversity of California at Los Angeles. A proposal submitted by the divisionwas approved by the Office of Education and funded for a four-year period.Designated as the Allied Health Professions Projects, the program beganoperations in August 1968.

The fundamental objectives of the Allied Health Professions Projectsare to develop curricula and instructional materials for those allied healthfunctions that can be taught to the Associate degree level, and to developin-service and pre-service instructional programs for those health-relatedoccupations for which on-the-job training may be appropriate.

The initial steps leading to the development of curricula involve theidentification and listing of all possible tasks in a specified functionalarea, and verification of their performance by personnel in the occupationalcategories under consideration. The use of a task inventory, it was believed,could provide performance goals and delineate the specific skills which mustbe learned to do the job. The health functions to be explored included bothfacility support services and clinical occupations.

Nursing Unit Administration (Ward Administration) was identified as oneof the major occupational areas for which the development of curricula wasenvisioned. The present report deals with the results of a survey of taskperformance in this field.

The nursing unit is the area of a hospital plant designated and equippedto deliver nursing care to a group of patients. The nursing units vary insize and according to the type of nursing care required.

Nursing Unit Administration is defined as a non-clinical patient carefunction found on the hospital nursing unit. It includes clerical, adminis-trative, and managerial operations.

Nursing Unit Administration is not a new concept. The presence of aclerk on the unit became standard practice in some hospitals as long as 30year ago.l

Freeing the Nurse to Nurse," AMERICAN JOURNAL OF NURSING, March 1964,page 73.

Historically, little work has been done in developing Unit Administrationcurricula. The growing complexity of the modern health care system has meantdemands of increasing scope and difficulty made on the nurse. As the roleof nursing has expanded, too few trained nurses have been available to meetthe needs of our hospitals. The occupations of Unit Clerk and Unit Managerhave emerged in response to the need for relieving the nurse of time-consumingclerical and non-clinical management duties that are not properly a part ofthe professional nursing function. In order to avoid semantic confusionsthat might arise from the lack of standardization of nomenclature, the word"unit" has been chosen in preference to "ward". Though Ward Administrationis a commonly accepted term, it may carry negative connotations and does notadequately describe the modern nursing unit with private and semi-privaterooms.

2

II. PROCEDURES

A. Development of the Task List

In keeping with the objectives of the Allied Health Professions Projects,a task analysis of Nursing Unit Administration occupations was undertaken.The project staff developed a survey instrument for the analysis of occupationsof all personnel who perform non-clinical tasks within the hospital nursingunit. What follows is a brief discussion of the survey instrument and thekind of information it provides in relation to the Nursing Unit Adminstration'soccupations.

1. Task identification

Materials for an initial list of Unit Administration tasks wereobtained by utilizing several sources. A survey of the relevant literaturewas made, job descriptions were obtained, practitioners were interviewed toprovide information regarding their job activities, and actual observationsof nursing unit clerical and managerial personnel in several hospitals inthe Los Angeles area were made by an Allied Health Professions Projectsresearch assistant.

Results of this research suggested that there are two principal categoriesof personnel engaged in Unit Administration functions: the first categoryis composed of persons performing mainly clerical and secretarial functionsand having such titles as unit clerk, ward clerk, station secretary, and unitsecretary; the second category is composed of persons performing administrative,managerial,and other non-clinical functions, including those concerned withproviding supplies to the nursing unit. These persons have such titles asunit manager, ward manager, pavilion manager, floor manager, unit supervisor,and patient service coordinator. While the occupations of unit clerk andunit manager are distinguishable in general terms, the degree of overlapbetween them with respect to specific functions is sufficient to make compi-lation of separate task lists for the two occupations impractical at thispoint. Consequently, a single task list has been developed to cover alltasks that might be performed by personnel in either or both categories asindicated by the literature and observations in the field.

Following task identification, the list consisted of 169 tasks groupedunder 12 major sub-headings defining broad areas of activities. The sub-headings were further clustered and designated as either clerical or adminis-trative functions. The functional areas, with examples of the kinds of taskscomprising them are:

Clerical Functions

Record Keeping:

Communications:

"Record appropriate information in Kardex."

"Requisition laboratory services."

Patient-Centered Activities: "Record admission of new patient onappropriate forms."

3

14

Supplies and Equipment: "Place supplies and equipment inassigned position."

Safety and Sanitation: "Fill out accident reports."

Administrative and Management Functions

Objectives and Policies:

Planning and DepartmentalOrganization:

"Formulate goals of nursing unit."

"Determine staffing needs."

Staff Selection and "Rotate duty assignment of employees."Management:

Budgeting: "Determine supply needs."

Coordinating Activities: "Conduct staff meetings."

Education and Training: "Give on-the-job training."

Research: "Test new equipment and procedures."

2. Pre-surveying the Task List

A pre-survey was conducted to test the preliminary Unit Administra-tion task list on a small group of respondents before presenting it to thelarger national survey sample. The pre-survey provided suggestions foradditions, deletions, and modifications of tasks from persons with experiencein the field of Unit Administration.

Whenever possible, the respondent completed the survey questionnairein the presence of an Allied Health Professions Projects research assistant.Thus, when a respondent appeared to experience confusion or difficulty inresponding to a task, it was possible to determine the cause and correct theproblem.

As the pre-survey progressed, the task list was continually revised,with modifications based on the suggestions and criticisms of successiverespondents being incorporated into the list before presenting the question-naire to later respondents. Tasks that a majority of respondents considerednot to be germane to the field were either eliminated or re-worded assuggested by respondents. As the pre-survey continued, fewer criticismswere voiced by successive respondents, and the final draft of the task listwas developed after the tenth respondent had been surveyed.

It was demonstrated in the pre-survey that the sequence of taskslisted in the questionnaire needed to be modified. The interest of bothclerical and managerial staff was sustained throughout the questionnaireby placing the "Clerical" section before the "Administrative" section. Incontrast, when the "Administrative" section was first, clerical personnelwho had little role in performing these tasks tended to be less interested.

4

15.

B. Objectives and Design of the Survey Instrument

With respect to an occupational function, the major intent of the AlliedHealth Professions Projects staff was to gather those data which would bemost relevant to the development of instructional materials. The survey wasspecifically directed to the following questions:

1. Does the individual perform the task?

2. Does the individual supervise the performance of the task?

3. What is the frequency with which each task is performed?

4. What is the level of difficulty of the task?

It was assumed that the employee himself could most accurately describethe frequency with which he performed a task. The assessment by personnelof the difficulty of a task was thought to be useful in determining the conceptsor skills involved in competent performance.

The results of the task survey do not by themselves provide the fullrange of information required for adequate task analysis. The knowledgeof effective dimensions essential to task performance are not all obtainablethrough questions directed to personnel. For example, the dimension of"difficulty" has both a subjective and an objective component. Informationon the former may be obtained by the responses of personnel in the taskinventory survey discussed above; to measure the objective component-requiresexpert analysis and evaluation of the task and its accompanying procedures.

A sample page of the survey instrument along with covering informationalmaterial appears in Appendix 2B. The entire task list and all survey questionsare given in tables which accompany the text.

C. Other Data

In addition to the responses of personnel, a group of leading expertsin the occupational area was asked to make judgments concerning dimensionsof task performance deemed important in the building of an innovative train-ing program. These dimensions are:

1. Difficulty

2. Criticality

3. Occupational Level

A description of the scales and the procedure for their application bythe panel of experts are found in Appendix 4. The roster of the panelparticipating in the study appears in Appendix 1.

D. Background Information

Each person to whom the questionnaire was given was also requested tofurnish background information covering his work situation and personal

5

characteristics. Questions were asked about education, certification,previous experience, age, sex, size of hospital and department. (See Appendix3 for a sample of the Background Information Questionnaire,)

E. Survey Sample

Since the curriculum and instructional materials developed were to havenational applicability, respondents to the task analysis survey were selectedso as to reflect for the country as a whole a generalized pattern of medicaland nursing care in a hospital unit. A panel of 48 hospitals (which becamethe standard group sample) was designated from which respondents were to beselected for all or most of the occupational analyses undertaken in theAllied Health Professions Projects.

Medical facilities were surveyed in six designated geographical areas,each centered in a metropolis and with a radius of approximately 200 miles.Both urban and rural hospitals were included. The centers were Boston,Chicago, Birmingham, Denver, Los Angeles, and Seattle. Other criteria forselection included hospital size (number of beds) and type of facility(acute general hospital or Extended Care Facility). Each area sampleincluded two hospitals with more than 200 beds, two hospitals with 100 to199 beds, two hospitals with less than 100 beds, and two Extended CareFacilities. Additional requirements imposed on the selection of the sampleinstitutions were that they be accredited by the Joint Commission on Accredita-tion of the American Hospital Association, that they meet the requirementsfor Medicare, and they be willing to participate. (See Appendix 5 for listof hospitals surveyed.)

F. Method of Administering the Questionnaire

Each hospital was requested to provide a list of employees in theoccupational group under study and to appoint one employee as the surveyadministrator. For the occupation of Unit Management, where there was noposition specifically named "Unit Manager" or "Unit Administrator", theperson performing this function was designated by the hospital.

The survey administrator distributed a survey packet to each respondent.The packet included the questionnaire, a background information sheet, a set*of instructions, and an envelope. The questionnaires were self-administered.They were returned to the survey administrator in a sealed envelope and allcompleted survey packets were forwarded to UCLA for processing.

Assistance in the processing and reduction of survey and backgroundinformation data and computer analysis of these data was provided by theSurvey Research Center of the University of California, Los Angeles.Distributions were obtained for frequency, supervision, and difficultyresponses to all tasks listed on the survey for all of the occupationalgroups. The mean, mode, and median were calculated for each distributionin terms of the numerical scale values. The responses to all tasks listedon the survey by the Expert Panel were hand tabulated. Mode scores fordifficulty, criticality, and occupational level were calculated accordingto numerical scale values.

6

17

III. DATA ANALYSIS

A. Analysis of Background Information from Respondents

A total of 243 questionnaires was distributed to the Unit Administrationpersonnel. Responses were received in time for processing from 189 respondents,a response rate of 78 percent (See Table 1). Several additional questionnairesreceived after the final cut-off date were not included in the analysis ofthe data. Of 189 questionnaires received, six were considered inappropriatefor inclusion in the analysis of the data. Consequently, analysis will bebased on 183 useable responses.

One respondent's title was that of Secretary. Her place of employmentwas a facility of more than 200 beds and her responses indicated that hertasks related to typical office secretarial functions. She performed onlyeight percent of the total number of tasks listed. Since her responses werecompletely unrelated to the response patterns of other position-titles, heranswers were not included with responses of the other clerical personnel.

Another respondent, whose job title was Nurse Aide, performed onlythree percent of the total number of tasks listed. Since this response wasalso unrelated to any pattern of any other position-title, her responseswere not included in the summation of either clerical or managerial personnel.

The two Nursing Directors and the two Administrators were deemed inappro-priate for inclusion in this study because the parameters of their responsibilitiesextend for beyond the nursing unit of a hospital facility.

From the total list of 169 tasks, 22 tasks were performed by Directorsof Nursing or Administrators, but not by the clerical or managerial group.To have included these responses with those of the other managerial personnelwould have distorted and overextended curricula based on required task per-formance within the unit.

Table 1. NUMBER OF QUESTIONNAIRES DISTRIBUTED ANDNUMBER AND PERCENT RESPONSES RECEIVED,BY GEOGRAPHIC AREA-

Geographic Area

Number of Birming- LosQuestionnaires ham Boston Chicago Denver Angeles Seattle Total

Distributed 45 43 45 36 34 40 243

Returned 31 31 37 31 25 34 189

Percent returned 69 72 82 86 74 85 78

7

Fifteen different position titles were reported by the respondents.These were reduced to ten, based upon the similarity in job descriptions. Astudy of patterns of task performance* suggested a further clustering of theposition titles. They divided into either a clerical or a managerial pattern.

The clerical category comprised respondents whose job titles includedward clerk, unit clerk, ward secretary and unit secretary. The managerialcategory included respondents who had identified their occupational titles tobe LVN-LPN, Staff Nurse, Charge Nurse, Floor Manager, Coordinator, Head Nurse,Floor Supervisor, and Supervisor of Nursing (see Table 2).

Table 2

Respondents by Position-Title

Position Title Number Reporting

Ward Clerk,Unit Clerk

74

Ward Secretary 16

Secretary 1

Nurses' Aide 1

LPN or LVN 5

Head Nurse, I 56Charge Nurse

Floor Manager, 12Coordinator

Supervisor of Nursing,Floor Supervisor 19

Director of Nursing I 2

Administrator 1 2

Total 1 189

"Performance* will be used hereafter to designate both performance andsupervision.

8 19

Table 3

Respondents by Occupational Categoryand Geographic Area

Geographic Area

TotalOccupationalCategory Birmingham Boston Chicago Denver Los Angeles

.11.1Seattle

Total UnitMgt.Personnel

N= 29 N= 31 N= 35 N= 30 N= 25 N= 33 183

Clerical 12 14 19 15 11 21 92

Managerial 17 17 16 15 14 12 91

Of the usable responses, approximately 51 percent represented the clericalcategory; 49 percent were from the managerial category.

Further response to the questionnaire on personal characteristics is summarizedin Table 4, pages 13 through 15.

9

20

4Respondents by Type of Health Care Facility:

The distribution of respondents by hospital size shows that 45 percentof the survey sample came from large hospitals (200 or more beds).

Respondents by Health Care Setting:

The largest proportion (91%) of respondents in all categories was employedon the nursing station. Two percent were in the Emergency Room and 1.5 percentworked in an Extended Care Facility.

Nursing Station included all areas of patient care as well as thosedepartments which were listed as unit management, patient service, andpatient service coordination.

Respondents by Sex:

The overwhelming majority of unit administrative personnel is female.Of the 93 managerial respondents, 12 classified themselves as floor managersor patient service coordinators. Eight of these were males. Six of theeight male respondents designated as patient service coordinators are employedin a large hospital of 750 beds which has an ongoing formal patient servicecoordination organization. Another male respondent is from another largehospital, and is called "floor manager." The only other male respondent ina managerial position is the head nurse of his surgical department (Table 4).

Respondents by Age:

The total of 183 respondents excludes those six respondents whose question-naires were not utilized. The median age in the clerical group is 41 years;mode is in the classification of 20 - 29 years. The median age for both groupsis 38 years.

The age distribution of both clerical and managerial categories issimilar and evenly spread through ages 20 through 59. Neither of the occupa-tional groupings seems to indicate any age-specificity. Ages of males report-ing in the sample surveyed range from 23 to 30 years, with 26 years themedian age.

Respondents by Academic Education Completed:

Ninety-two percent of the clerical group had at least a high school orequivalent education; one person had earned a master's degree in BusinessAdministration; one had earned a bachelor's degree in Psychology. Eighty-twopercent of the managerial group had some college education. The bachelor'sdegrees were in Psychology, Biology, English, Education (History major),Political Science, Social Work, and Science. Six of the registered nurseswere graduates of baccalaureate programs. The only master's degree, held bya floor manager, was in Agronomy.

10

1

1Respondents by Technical or Training Programs Taken:

The clerks received on-the-job training, usually of less than one year.There were five who had received Ward Clerk certificates for a three-monthcourse. Other courses taken showed no relationship to the function of UnitManagement. Among the RN's, 89 percent were diploma school graduates.

Respondents by Salary:

Seven clerks and six managers were part-time employees. This partiallyaccounts for the seemingly low salaries in Table 4. The median salaries forclerks are scaled between $4,000 and $5,999 per annum. The median salariesfor managers are between $8,000 and $9,999 per annum.

Respondents by Certification, License, or Registration:

Among the clerical group, 89 percent had no certification. Among theeight other clerical respondents, five were certificated as having receiveda three-month Ward Clerk training. The other three had certifications inunrelated fields, such as cosmetology.

Among the managerial group, the RN's who were neither diploma schoolgraduates nor graduates of a baccalaureate program had received Associatelevel degrees. The other kinds of certification had no relationship tonursing or Unit Management functions.

Respondents by Previous Positions Held:

Of the 165 respondents reporting about previous positions, 54 persons(33%) had been employed in nursing or hospital-related occupations. In theremaining 67 percent, all had been previously employed in non-hospital-related activities.

The males in the managerial classification had been social workers,sales manager, food store manager, students, or had served with the armedforces. One female had been a station clerk for two years before progressingto her present position as a Patient Service Coordinator.

Respondents by Present Position:

The respondent population appeared to be unusually stable, with a highproportion employed at their present facilities for more than two years.

In the clerical group, 81 percent of the sample had been in the presentposition less than five years. The median is three years in the present position.In the managerial group, 80 percent of the sample had been in the presentposition less than five years. The median is four years in the present position.Most of the male respondents were from a facility which had adopted the "unitmanager" system only two and a half years earlier. Male respondents rangedfrom one month to two and a half years in their present position. The mediannumber of years in the present position for male respondents was one year andtwo months.

11

Table 4.

DESCRIPTION OF RESPONDENTS BY OCCUPATIONAL CATEGORY(By Size of Hospital and Area of Patient Care)

Occupational CategoryClerical ManagerialN=90 N=93

TotalN=183

Size and Type of Health Care Facility

Acute General Hospital

To 99 - Beds

100 - 199 Beds

200 Plus

Extended Care Facility

16 22

28 25

44 39

*2 7

38

53

83

9

Area of Patient Care

Hospital Nursing Station

Hospital Emergency Room

Extended Care Facility

No Answer

83 80

2 2

1 2

6 7

163

4

3

13

(Continued)

12

23

II

1

Table 4. (Continued)

DESCRIPTION OF RESPONDENTS BY OCCUPATIONAL CATEGORY(By Sex, Age, and Academic Education)

Item


TotalN=183

Sex

Male

Female

1

89

8'

85

9

174

Age

Under 20 Years

20 - 29 Years

30 - 39 Years

40 - 49 Years

50 - 59 Years

60 and Over

No Answer

3

20

19

27

19

3

6

1

33

22

18

12

3

1

4

53

41

45

31

6

7

Academic Education

Less than High School

High School or Equivalent

Some College (no degree)

Associate Degree

Bachelor's Degree

Master's Degree

Other

No Answer

8 0

47 14

20 24

0 6

12 1

1 1

9 34

6 1

8

61

44

6

13

2

43

7

(Continued)

-13.

241


DESCRIPTION OF RESPONDENTS BY OCCUPATIONAL CATEGORY(By Technical or Training Programs, Certification,

License, Registration, and Salary)

Item


TotalN=183

Technical or Training Programs

On-the-Job

Military Courses

Manufacturer's Courses

Vocational Schools

Certificates or Diplomas

Other Courses

None or No Answer

17

1

1

7

8

10

48

3

5

0

4

73

3

3

20

6

1

11

81

13

51

Certification, License, or Registration

R.N.

L.P.N. or L.V.N.

Other

None or No Answer

0 73

2 5

8 4

82 9

73

7

12

91

Salary

Less than $2,000

$2,000 - $3,999

$4,000 - $5,999

$6,000 - $7,999

$8,000 Plus

No Answer

1 1

35 4

47 6

4 32

1 46

2

39

53

36

47

6

(Continued)14

25


DESCRIPTION OF RESPONDENTS BY OCCUPATIONAL CATEGORY(By Previous Position Held, andYears in Present Position)

Item


TotalN=183

Previous Positions Held

Nursing

Hospital-Related

Non-Hospital Related(excluding studentsand military)

Student

Military

None

No Answer

22 23

7 2

37 10

3 16

0 2

17 26

4 14

Years in Present Position

45

9

47

19

2

43

18

Less than 1 Year

1 - 2 Years

2 - 5 Years

5 - 10 Years.

10 Plus

No Answer

16

27

30

13

4

0

24

27

24

15

0

3

40

54

54

28

4

3

15

4B. Description of Statistics Used

A special aim of this report is to determine which task activities aredifferentiated by occupational category. Another issue is the appropriatenessof personnel to the adequate performance of the task. The report relies uponthe judgment of its Expert Panel concerning the appropriate level of difficulty.The dimension of "criticality" is included to arrive at a preliminary assess-ment of those tasks which, in the experts' opinion, are critical to the efficientand effective operation of unit management. It serves to pinpoint those taskswhich require a given level of training for competent performance.

The mode (the scale value most frequently occurring for each task) wasused in preference to the mean as an indicator of the responses. In manyinstances it was found that the shape of a distribution was such that itsmean would not be representative of any respondents. Essentially, most ofthe data clustered around the modal value. It is interesting to note that,in many cases, mode and median (the mid-value which has just as many casesbelow is as above it) turned out to be the same. Whenever there was abimodal distribution, the upper modal value was taken. It was believedthat using the upper mode value when a choice was necessary, would act asa safeguard in assessing behavioral objectives for task performance.

The response to the question for each task could be that the person%either performed the task or supervised the task. When the results weretabulated, the numbers either performing or supervising were added together.This decision was based on the rationale that for purposes of developmentof curricula and instructional material, familiarity with the task was asessential for supervision as for performance. Further analysis wouldprovide evaluation criteria to establish acceptable performance standardsfor each task. The results of the occupational analysis are described interms of the following task parameters:

1. Percentage of respondents who either perform or supervise the task.

2. Modal frequency by respondents who perform or supervise the tasks.(See Appendix 4A for scale.)

3. Modal value of the difficulty ratings of the task by the respondentsas well as by the Expert Paiiel.

4. Modal value of the criticality rating of the task by the ExpertPanel. (See Appendix 4B for scale.)

5. The modal value of the appropriate level of occupational categoryas determined by the Expert Panel.

C. Compiling Data on Performance by Clerical and Managerial Personnel

Tabulation of tasks performed by clerical or managerial personnel wasmade in terms of whether the job was performed or supervised. This frequencyis reported by percentages in each classification according to five divisions.(See Figures A-(1) through B-(7), on pages 20 through 51).

16

427.

1. 0%; these tasks would obviously be excluded from curriculumconsideration.

2. 1-24%: this classification was intended to identify those tasksthat seemed to be related to specific procedures exclusiveto a particular hospital.

3. 25-49%: tasks performed at this level of frequency are currentlyand generally practiced in sufficient numbers to beconsidered common to many facilities and to warrantdevelopment of educational units for use in the appropriateeducational setting, on the job or in the classroom.

4. 50-74%: the tasks that are performed with this high degree offrequency are considered to be practices common to amajority of health care facilities. Teaching programsshould include such tasks.

5. 75%+: the preceding rationale applies to this classification.Additionally, however, the high commonality of performanceadds to the consideration of priority in the developmentof instructional materials.

D. Task List Exclusions and Additions

Of the 169 tasks listed on the survey, only one was not performed byany of the personnel working on the unit. This task related to the utiliza-tion of computer systems for research data analysis. The group of 22 taskswhich fell below the 25 percent performance level by either the clerical ormanagerial occupational groups is excluded from the development of a nationalcurriculum. These tasks were, however, performed by Nursing Directors andHospital Administrators.

Since none of the questionnaires contained any additions, the assumptionwas made that the original task inventory was complete.

E. Distribution of Tasks by Occupational Category

The total list of tasks was examined to identify the common tasksperformed by managers and clerks. There were 98 common tasks in this list.The examination also identified tasks performed uniquely by each group. Itappeared that the clerk did not perform any task which was not also done bythe manager. The manager performed 49 tasks not done by the clerk.

17

. 28

IV RESULTS

The questionnaire was divided into two section: Clerical Functionsand Administrative Functions. In each section there were several sub-headings.Each sub-heading with appropriate tasks was tabulated and recorded into thefollowing charts by Performance, Frequency, and Difficulty as reported bySurvey Respondents, and Difficulty, Criticality, and Occupational Level ratedby the Expert Panel.

19

29

FIGURE A-(1

)CLERICAL FUNCTIONS -- RECORD KEEPING

A.

CLERICAL FUNCTIONS

(1)

Reco

rd K

eepi

ng

Performed or Supervised

by r

espo

nden

tsFrequency

as rated by respondents

IDifficulty

rated

by r

espo

nden

tsand

Expert Panel

Criticality

'

rated

by E

xper

t Pa

nel

only

Occupatio

nal

Level

judg

ed b

yExpert Panel

00 es.

"1-1

apeV

CA

1.7.Vr

+er J1

6in

cv

In

r's

33

11

23

12

34

5only

1.Maintain unit census record.

6/.

,

.1%/

I:

,1H'

!!:1W

k:H1

1!:M

-

1MI

IFA

I/Ar

nii

irui

,,Hih

11:

JIIii;:;

2.Ma nta n list of new admissions,

transfe

rs,

and

disc

harg

es.

IIIKAIVZ059.,

11M. 07

72MIMI I Mim

i111II=1111

=w

i0:0

10:6

'!!!11

1-:!

I

3.Maintain check-in and check-out sheet

for

loca

tion

of

pati

ents

.MENEM=

Wir

elta

dd1=1::::

Iff

4.Maintain check-in and check-out sheet

for location of patient charts and

records.

Mill

,

girAor

,11

,,,1

1111

1119iiiirdin

MINIIMMEM

agra

itZOr 1.

11:;:!;:111111111:,ili

IIIIMMIMI

-5.

Maintain food tray service check list.

iliMMiNiMi

r4r

farl

draA

C

#74/

I5117

II

6.Provide information to appropriate

departments about "critical" patients.

MIMI=',xi')

igrAirr

i

11:U

1111

111

11.1

1,11

.',

1,2nowr

.,,....,

ii!i!i"1.

.,!..

MI11

111E

115

Ca

7.Assemble patients' records and forms,

and

othe

r ne

cess

ary

data

.11

/111

1.11

i

Wir

raMr

di

111.

111M

IMM

IIII

Wgi

a:

tAI:05

00'

.il

ki,i

1h,H

1111

X,

waa

aB.

Write in headings on appropriate forms.

, . . :.. , r. .4

I I I I

....II,

,..) ,,Ji.

1111

iIIIM

IlliIi

IIIIII

i111

1,11

1.11

11,

,

MII=MMII.

drofrfordi

9.stamp patient forms with imprinter.

IMMININ

mama'

///:#

.11

!!!".:

IliMMEMMM

ara

10.

Graph or chart information onto

appropriate f

orm.

MilrarWrifir

'0 %

/4 0

'ii.

J1:1

1111

'111

1m

iIIIM

INEIM

11.

Keep fi

les

in o

rder

.1M

MIN

NI1

1m

ord

dree

dnUt01

1I; " 'III

1111

1111

HWH11111;.JCI

alf

alfa

12.

Write tags and labels for specimens.

MMI MEN MI

igat

4

ri rrr

i ei 11

1111

Ili

iiiIIIIIIIIIIIiiiidiiiIIII

t eac

oiii

13.

Check cards for narcotic renewals.

MEI

/rei

r'm

inim

1111

1111

1111

1111

1111

111W

IMEMENI

14.

Compil

e na

rcot

ic s

umma

ry s

heet

s.

illi

ffil

lill

L5.

Labe

l tr

ays,

equ

ipme

nt,

cupb

oard

s.

Wirdfla

!IIIII

KEY TO SYMBOLS:

= mode

val

ues;

NMI

= c

leri

cal

resp

o:Ic

i,,n

ts:A

/Vi,

man

ager

tal

tsre

nden

tN:1

1111

11 =

ren

po:i

sPexurt ln

,!1:

410,

- no

n-un

it p

ftrs

onnt

:1

I

FIGURE A-(1

)CLERICAL FUNCTIONS -- RECORD KEEPING (Continued)

sue

A.

CLERICAL FUNCTIONS

(1) Record Keeping

(Co

ntin

ued)


by respondents

Frequency '

d bspondents

as rate

by

Dif

ficu

lty

rated by respondents

and

Expert Panel

Crit

ical

ity

arated

by E

xper

t Pa

nel

only

Occupational

Level

judg

ed b

yExpert Panel

co

eg,

CAer

mr

N1

1in

.-1

N

a r- I c) u+

+ op tri

r`

.i

31

31

1I

12

31

23

4only

16.

Prepare patie

nt c

harg

e fo

rms.

irlaff

I

'now05,

MEM

17.

Transcribe doctors' orders onto

appropria

te r

ecor

ds.

tff

IfiM

IIIN

INIII

IINIII

IIMIM

Ind

18.

Record appropriate information in

Kardex.

grtarff

t11

1111

1111

1111

1111

1111

1111

1111

1111

111

min

19.

Sign for packages and flowers.

lift'

=N

INA

20.

Duplicate forms as needed (photocopy).

./,'

q10

5,50

%i

iiii

,WHIN

21.

Report and record lost and found

articles.

=III

IIN11

1111

4111

111

IIIIII

IIM

22.

Maintain call roster of doctors.

////=

MUNININ11

1111

11

23.

Maintain log of long-distance phone

call

s.

Mad

:12

1111

111

III

24.

Maintain continuing file of information

for annual rep

orts

.11

1111

1=

1111

1111

1111

1111

INI

?VA

25.

Obt

ain

cons

ent

sign

atur

es.

'2,././

IrA1

1111

1111

1111

1111

1111

1111

111

',Z.

26.

Claim library books from patients

upon di

scha

rge.

....,

1111

11

27.

Deli

ver

mail

.

Wad

arar

gA17

,050

:

Orii

iiii

IIII

NII

.

MI=

28.

Maintain supply of stationery and

writ

ing

mate

rial

s.

tilifill

1

Or f

1111

111

29.

Clean up around nursing station.

ilifilif

NSW

1=II

IIIN

MB

30.

Maintain and file unit correspondence

and

dire

ctiv

es.

I1

II

Mffillliiiiiiiiii

MIIM

KEY

TO

SY

MBO

LS:

= mode

val

ues:

1MM

= clerical respoodonts:Wi!= managerial ro.q,ondoots;

1111

111

= re

mors

e 1,

7 ex

port

pat

e1:4

11=

non-

unit

uor

sonn

,21

A-(1) Clerical Functions -- Record Keeping

Description of Function

The 30 tasks comprising this functional area are related to the mainte-nance and production of records for patient care and details of administrativepractices.

Performance

Of all the tasks in the group, Task 13 (check for narcotic renewals)and Task 14 (compile narcotic summary sheet) were the two tasks reported asperformed by managerial but not clerical personnel.*

Task 23 (maintain log of long distance phone calls), Task 24 (maintaincontinuing file of information for annual reports) and Task 26 (claim librarybooks from patients upon discharge) fell below the 25 percent level fcr bothgroups of respondents performing.

The remaining 25 tasks in Function A-(1) were performed by both managerialand clerical personnel.

Frequency

With the exception of Task 15 (label trays, equipment, cupboards) andTask 22 (maintain call roster of doctors), all tasks were rated as beingdone more than once a week by the clerical group. With the single exceptionof Task 22, the managers reported tasks being done more frequently than oncea week.

Difficulty

Most of the tasks in this function were rated at Level 1, "easy." Nonewas rated above Level 2, "moderate," by any of the survey participants.

The Expert Panel rated Task 6 (provide information to appropriatedepartments about "critical" patients), Task 17 (transcribe doctor's ordersinto appropriate records), and Task 18 (record appropriate information inKardex), at Level 2 but rated all the others at Level 1, "easy." Theclerical group concurred with experts' rating for Task 17 and 24 but regardedthe other tasks in this function as "easy." The managerial group rated alltasks in the function as "easy."

*Non-performance is hereafter defined as performance reported by lessthan 25 percent of respondents in each category. For explanation,seePage 17.

22

:

1.

I

1

1

Criticality

The Expert Panel rated Task 9 (stamp patient forms with imprinter),Task 17, (transcribe doctors' orders onto appropriate records), and Task 18(record appropriate information in Kardex), at Level 5 in criticality. Ofthe nine tasks rated at Level 4, eight were concerned with the obtainingand accurate recording of information, and the one other at this level wasTask 6 (provide information to appropriate departments about "critical"patients). Only 10 of this group of 30 tasks were rated below Level 2.

Occupational Level Judged by Expert Panel

Two tasks, Task 24 (maintain continuing file of information for annualreports) and Task 25 (obtain consent signatures) were judged to be managerial;all others were designated as belonging to the clerical level.

General Remarks

Forty percent of the tasks from the total inventory judged by the ExpertPanel to be performed by the clerical occupational level were found in FunctionA-(1) Clerical Functions -- Record Keeping.

The high criticality rating of Function A-(1) by the Expert Panelstressed the necessity for requiring high levels of acceptable studentperformance in the design of the instructional material.

23

FIGURE A-(2

)CLERICAL FUNCTIONS

-- C

O:11

1:IC

ATIO

NS

A CLERICAL TASKS

(2)

Comm

unic

atio

ns


by respondents

Frequency

as

rate

d by

resp

onde

nts

Dif

ficu

lty

rated

by r

espo

nden

tsand

Expert Panel

Criticality

rated

by E

xper

t Pa

nel

only

Occupatio

nal

Level

judg

ed b

yExpert Panel

only

0.*

er c..4 1

.-1

co

cr%

er 1 cv

00 yr+

e- ein

ct u,1

23

12

34

5,......

1.Receive and deliver telephone messages

to unit

per

sonn

el.

MINN

1 lial

sesNili

..

101111111

'FtWIN ra

1111

111M

=11

1111

1111

1111

1111

1111

=111111E11111111111

111111

2.Info

rm p

atie

nts

of c

alls

rec

eive

d.

O-

gam

ma

ammo

3.Page doctors and other hospital

personnel.

11 111

111111

1111111111111

4.Answer the intercom and relay messages

to unit

per

sonn

el.

WO

WWI

Warif

fla

=11

111/

1NEM

5.Announce the close of visiting hours.

ill

4111

1111

1111

1111

1111

1111

6.Operate pneumatic tube.

a11

1111

mm

ulm

i11

1111

11.

Operate dumbwaiter and transveyor.

Wag

1 1

I11

1111

1111

11111101111111111111

1111

111

'/ /A

IR

8.Question physicians about patients.

///

16In

=Im

om

um

mm

int

'A/7

.ra

retin

g9.

Answer questions asked by unit

personnel.

lit

=11

1111

1111

1II

HII

1111

1111

1111

1/./

t/.irlartagra

10.

Relay information about unit activities

--

.

IM 1

1111

1111

111

1111

1111

f///

/.w

isifir

mififirarrarig

11.

Visit and interview patients.

///

111111111M

1111111111111

1111

111

Z/ZZ

12.

Info

rm v

isit

ors

of h

ospi

tal

rule

s.

fir

rr

111

i11

1111

1.

Imo

I.?.

Dir

ect

visi

tors

to

appr

opri

ate

room

s.

WO

W WM

=1111111111111

1111

11M

IIIM

Wadi

14.

Locate doctors or nurses as requested

by visitors.

Or 1

I1

111

1111

11

i111

1111

1111

1

t1111111

15.

Requisition meals and nourishment from

Dietary.

KEY TO SY

MBOL

S:v.m.:;1; 0. con -ur.i

sonr.:1

= m

ode

val

ues;

1111

111=

cle

rical

res.!

crrj

er.tc.

;rt

z; o

rr:lr

:r0.:s

:111

1111

1re

s:

A. CLERICAL TASKS

(2)

Comm

unic

atio

ns (

Cont

inue

d)

16.

Requis

itio

n la

bora

tory

ser

vice

s.

FIGURE A-(2

)CLERICAL FUNCTIONS -- COMMUNICATIONS (Continued)


by r

espo

nden

tscr

aa

.o

.CM

'.

r-

IN I .IIN

r-

Frequency


Dif

ficu

lty

rated

by r

espo

nden

tsand

Ex)e

rt P

anel

i.:r

itic

alit

yrated

by L

xper

t Pa

nel

only

12

equis tion sery cs

rem P arin

acy.

18.

Requisition the services of House-

keeping.

19.

Requisition services from Laundry.

20.

Request repairs from Maintenance.

OMMOINEMENOMMEM

'gra(

21.

Request equipment from Central Supply.

22.

Request supplies from Storeroom.

23.

Give information to other departments.

24.

Communicate with government agencies.

25.

Maintain unit reading materials.

26.

Distribute reports, manuals, and

directives.

27.

Run errands to other departments.

KEY TO SYMBOLS:

31

23

45

occupatio

nal

Level

judg

ed b

yLxpert Panel

only

1111

11 1

1111

11 1

1111

1

M11

1111

1111

1111

1111

1111

1111

1111

HIM

1MM

MI"

1111

1111

1111

1

1111

1111

1111

1111

1111

1111

1111

111

1111

1111

1111

1111

1111

1111

1111

1111

1

1111

1;11

1111

1

II

= mode

= cle

rica

l re

spon

dent

s:Wi

e.=

mana

geri

al r

,.?s

?,o;

:den

t:sz

nIll

fil

respons,,

expl:rt

rt.i

ron-uli

t ;,

:ers

onne

l

A-(2) Clerical Functions -- Communications

Description of Function

The 27 tasks in this functional area include inter-unit and intra-unitcommunication for the patient, services, and visitors.

Performance

Task 5 (announce the close of visiting hours) and Task 24 (communicatewith government agencies) were the only two tasks performed by neither clerksnor managers. Most of the other tasks (13 in number) were performed by morethan 75 percent of the clerical and managerial respondents.

Frequency

Tasks 1 through 18 were performed at equally high frequency by managersand clerks.

With the exception of Task 24 (communicate with government agencies),all other tasks in this function were performed more frequently than oncea month, most of them being done several times a day.

Difficulty

Clerks rated all the tasks in this function at Level 1, "easy."Managers concurred with the clerical group except for Task 24 (communicatewith government agencies) which they rated at Level 2, "moderate." TheExpert Panel was at variance with the unit personnel for 13 tasks whichwere rated by the experts as "moderately difficult."

Criticality

Tasks 1, 2, 8, 16, 17, 23, and 24, having to do with delivery ofmessages, obtaining information from patients, requisitioning certainsupplies, and giving information, were rated more critical than the othertasks. Tasks 3, 5, 13, and 25, dealing with paging doctors, announcingclosing hours, directing visitors and maintaining reading materials,emerged as the least critical.


AcCording to the experts, Task 27 (run errands to other departments)should be performed by neither clerks nor managers but by a speciallydesignated messenger service.

Of the remaining 26 tasks, 13 were to be performed by clerks and theother 13 by the managers.

General Remarks

Although the Expert Panel recommended distinct personnel levels forperformance, in actual prictice the two groups reported that they performedthe tasks, and did so with equal frequency. The assignment of task responsi-bilities to distinct personnel levels may become more noticeable as thispattern of hospital organization becomes more prevalent.

The preparation of educational materials for this function should coverthe mechanics of communication, such as operating pneumatic tube, transveyor,and telephone, requesting services from other hospital departments, andrelaying information. Certain of these could involve judgmental considerations.

27

Is)

03

FIGURE A-(3

)CLERICAL FUNCTIONS -- PATIENT CENTERED ACTIVITIES

A. CLERICAL FUNCTIONS

(3)

Pati

ent-

Center

ed A

ctiv

itie

s


by respondents

Frequency

s rated

by r

espo

nden

ts.1

Dif

ficu

lt:

rated

by r

espo

nden

tsand

Expert Panel

crit

ical

ity

rated

by E

xper

t Pa

nel

only

J

Occupatio

nal

Level

'ju

dged

by

Expert Panel

only

)

o.a.

C4 I

.-1

co

CA

.a.

I in CNI

co

V.

r--

I gmLn

+ 00 Ln4

32

l1

23

12

34

5

1.Greet and welcome new patient.

2 3 2 E 2 2 I r a l

III.MIIII

1 I 11 I

1111

1111

11

2.Notify appropriate unit personnel upon

adm

issi

on o

f ne

w pa

tien

t.Wirigratail

/./

/I

I I

111111

1111

111

3.Make

bed

ass

ignm

ent.

I li I i

1111

1111

111

1111

1111

1000

011

/ZZ,

4.Make and apply patient identification

tags.

;71

7,71

099

MI

Prr

. e

l1 1 1

I

1111

1111

1111

1111

1111

111

1111

11

5.Inform patient of hospital procedures.

///////.

66i f

t13'

1111

1115

1111

1101

111

',e/

./6.

Receive and store patient's valuables.

mili

mim

mil

1111

1"A

i,ar

gra

liffliff

pliu

mm

usl

in;

7.Orient patient to his room and

roommates.

1111

1111

1111

0111

11

//1

11II

III

IIIN

IIIII

IIII

II8.

Record admission of new patient on

appropria

te u

nit

reco

rds.

iMai

itag

ai9.

Make appointments for patient.

/ /

// / / /

11I I

IIIIIIIIII

illt.cialiii

1111

1111

101

10.

Requisition physician consultations at

doct

or's

req

uest

.

imow

p I

i I

IIIIIIIII

1111

1111111111111111il

lili

IIIIIIIIIIIIIIIIIIII

11.

Collect and forward transfer patient's

medical records to receiving unit.

,./.

/./.

/".

////

)ii

IIIIIIIIII

12.

Record patient transfer on appropriate

unit records.

.//

/ ,

//Z.',/,'

I 11 I

IIIIIIIIIIIIIIIIIIII

NMI

13.

Alert receiving unit to be sure a bed

is ready for a transfer patient.

71/1/ wag

// //

MOM M

itai

iii

1111

1111

1111

1111

1111

1111

1

-

e1

1 III

1011

1111

111

1111

1011

1111

1111

11'/Z

e14

.Receive '.rans

fer

pati

ent

comi

ng f

rom

anothe

r un

it.

IIIIIIIIMMIIII

artragf

II III

15.

Receive notification of discharge

orde

r./ / / //

KEY TO SY

MBOL

S:= mode

val

ues:

MONI

V, clerical respondents:OW/= managerial resionaents:MMIF -es! Ons:, IY ex!

art panel:

410

= no

n-un

it p

erso

nnel

FIGURE A-(3

)CLERICAL FUNCTIONS -- PATIENT CENTERED ACTIVITIES (Continued)

A.

CLERICAL FUNCTIONS

(3) Patient Centered Activities (Continued)


by respondents

as rated

.i

Frequency

by r

espo

nden

ts

3I

Dif

ficu

lty

ratd by respondents

and

Expert Panel

Criticality

rated

by E

xper

t Pa

nel

only

Occupatio

nal

Level

judg

ed b

yExpert Pane:

rr C3 1 .-1

00

'4

xr.

II

trt

0ty

WI

+ 0 mil r-1

23

ronly

16.

Notify appropriate departments of

patie

nt d

isch

arge

.WM

Magill"

illiMMENO

II I

1111

111

111

1111

11

T

17.

Arrange transportation or escort

servic

e fo

r pa

tien

t.ad

raeadada

I

1111

111

1111

111

1111

18.

Inform patient of discharge procedure

and other pertinent information.

riff

(maim

11 1

1111

1111

111

=1 irs laartra.

19.

Return patient's valuables upon

disc

harg

e.lir

11

Idi1

1111

111111

111111111111

e.,/,

1.-

Walf

aal

20.

Make record of unused medications upon

disc

harg

e or

pat

ient

.r

I11111

11111

11111

ENE

agfa

ira

.

111111

111111

111111

/MN

21.

Collect and forward patient's

prescription drugs to Pharmacy.

KIM

MOWN

11

111111

11111111114t

411

22.

Give patient his prescriptions and

drug

s up

on d

isch

arge

.

rr1

IIiii

iii11

111

1111

11II

III,

23.

Note discharge on appropriate unit

records.

,Vil

ialV

d

M(

Kfli

galtr

a1

(1111

1'11

111

1111

1111

1111

124.

Send patient's charts and forms to

Medical Records Department upon

sliac

hara

r..or

arom

a11

1111

1111

111

1111

25.

Notify patient's family of discharge.

rall

1111

1111

M11

1111

1111

111

1111

1111

111

26.

Locate and inform the patient's

phy

sici

an o

f pa

tien

t's

deat

h.MI ZZ.r/1

01111

l

II 1

d11

1111

1111

111

1111

1111

1111

1111

127

.Inform patient's family of patient's

death.

MI.Z.J

I

1111

111

1111

4111

111

MIM

E28

.Notif

y ap

prop

riat

e de

part

ment

s, s

uch

asAdmitting and Business of patient's

deat

h.WarM

%//

I II

I11111111

1111

1111

111

1111

1111

1111

1111

111

M.

29.

Obtain autopsy and consent forms.

tirMIMI".

I1

1I I

4111

1111

111

1111

1111

1111

111

111

eZZ

,30

.Obtain a death certificate.

KEY TO SY

MMS:

* -= mode values; = clerical resp(ndents:Vd!O= managerial respondents:1111111

.response

exertr Panel;

non-unit

per

sonn

el-

FIGURE A-(3

)CLERICAL FUNCTIONS -- PATIENT CENTERED ACTI

VITIES (Continued)

A.

CLERICAL FUNCTIONS

(3) Patient Cent

ered

Act

ivit

ies

(Con

tinu

ed)

31.

Requis

itio

n a

shro

ud p

ack.

42.

Collect and identify patient's

belongings upon patient's death.

33.

Record patient's death on appropriate

records.

34.

Meet and escort funeral director.

35.

Contact attorney, barber, insurance

agent, religious personnel, etc. on

_patie

nt's

beh

alf,

as

requ

este

d.36

.Obt

ain

television set, reading

material, cigarettes, and other comfort

0for patient.

37.

Contact bi

llin

g of

fice

on

beha

lf o

f.patient.

38.

Distribute patient menus.

39.

Go on daily rounds.

40.

Control boisterous patient and/or

visitor.

41.

Respond

to p

atie

nt c

ompl

aint

s.

Performed or Superis,%1

by respondents

00 0 C3

Frequency


ZZ

1,Iffi-zulty

by r

espo

na,

and

!:x .ort Panel

11

2

I1

I d

I II

II III

1(11

1111

1111

1

101

11id

1 1

In'

1 11

I

KEY TO SYMBOLS:

criticality

Ated

by E

xper

t Pa

nel

only

occupattonal

Level

judg

ed b

yExpert Panel

only

31

23

4S

1111

111

1111

1111

1111

1N

EM

IIIIII

I111

111

1111

11Ze

Z,

1111

111

1111

1111

111

1111

1111

1111

1111

111

'///.

1111

1111

1111

111

1111

HM

I11

1111"III

'IM

MO

DM

1111

11N

EM

1111

1111

1111

1111

111

1111

1111

1111

1111

11///

111

1111

IIIII

II11

1111

1111

1111

1111

1III

IIMW

.

= mode values:MIMI= clerical rspondonts:,%/ie:= manaqcrial 1-spo:idents; MIMI = resonne

i:12

1:41

1= n

on-u

nit

pers

onne

l

VA-(3) Clerical Functions -- Patient-Centered Activities

Description of Area

The 41 tasks in this function ere all related to patient-centeredactivities from time of admission to the unit until time of discharge. Theyinvolve the non-clinical tasks that pertain to the patient's comfort, safety,and care.

Performance

Task 30 (obtain death certificate) was not performed by clerks ormanagers. Task 26 (inform patient's family of patient's death), Task 32(meet and escort funeral director), and Task 39 (go on daily rounds) wereperformed by managerial personnel but not by clerks. All of the remaining35 tasks were performed by clerks and managers. A higher percentage ofclerks than managers performed Task 16 (notify appropriate department ofpatient discharge), Task 22 (give patient his prescriptions and drugs upondischarge), Task 24 (send patient's charts and forms to Medical RecordsDepartment upon discharge), and Task 38 (distribute patient menus).

Frequency

Death-related activities were least frequently performed--less frequentlythan once a month. Task 37 (contact billing office on behalf of patient), wasperformed at Level 2 by the clerical group but at Level 1 by the managerialgroup. Task 40 (control boisterous patient and/or visitor) was performed atLevel 2 by the managerial group but at Level 1 by the clerical group. Allother tasks were performed at Levels.3 or 4.

Difficulty

Clerks and managers gave identical ratings for all but Task 27 (inform,.patient's family of patient's death). This one was rated moderately difficultby the managerial group and difficult by the clerical group. Two other taskswere rated "moderate" and the remaining 38 tasks were rated "easy" by bothgroups. The Expert Panel rated ten tasks at a higher level of difficultythan did the survey respondents.


Task 7 (orient patient to his room and roommates) , Task 22 (give patienthis prescriptions and drugs upon discharge), and Task 27 (inform patient'sfamily of patient's death), were designated by the Expert Panel as nursingfunctions. The experts also recommended that Task 27 be most appropriatelyperformed by the patient's doctor. Task 38 (distribute patient menus) wassuggested as most appropriately belonging to the dietary department.

Twelve tasks were judged as managerial tasks whereas the 25 remainingtasks were considered as clerical.

31

41

Where the experts recommended that tasks be performed at a manageriallevel, the percentage of the managerial group performing the task was ineach case higher than that of the clerical group. This was reported for12 tasks. Task 4 (make and apply patient identification tags), Task 15(receive notification of discharge order), Task 26 (locate and inform patient'sphysician of patient's death), and Task 28 (notify appropriate departmentssuch as admitting and busineie office of patient's death) were tasks judgedby the Expert Panel as those which should be performed by the unit clerk,whereas the report showed a higher percentage of managerial personnel performingthem.

General Remarks

The general headings which include all the tasks in this function are:Direct Patient Contact, Handling Patient Records and Belongings, and ActivitiesRelated to Death of Patient.

Of the 41 tasks listed under the function of patient-centered activities,only two were designated as most appropriately being handled by the nurse.All other tasks were designated by the Expert Panel as managerial or clericalduties. Nursing training, then, would not seem prerequisite for performingthem.

32

42

FIGURE A-(4

)CLERICAL FUNCTIONS -- SUPPLIES AND EQUIPMENT

.

A.

CLERICAL FUNCTIONS

(4)

Supp

lies

and

Equ

ipme

nt


by respondents

Frequency '


Dif

ficu

lty

rated by respondents

and

Exie

rt P

anel

Criticality

raced

by E

xper

t. P

anel

only

occupatio

nal

Level

judg

ed b

yExpert Panel

only

I

a

12

31

23

45

'

1.Specify the type of equipment and

supplies needed on the unit.

11

111

1111

1111

111

1111

-

1111

1111

1111

t'

I'2.

Establ sh standard quantit es o

supplies.

11 I

Imm

o,H

im11

111

mull

7/./.

.3.

Make rounds to discover repair and

rede

cora

ting

nee

ds.

1111

1111

1111

1111

1111

1111

1111

e/z,

4.Insure that maintenance schedules for

equip

ment

are

met

.1

111

1111

1111

111

1111

111111111Li

/././

5.Evaluate and approve requisitions for

supplies and equipment.

1 11

111

1111

1111

MI 11

1111

atm

imm

VW

w.

'11

1II

IIII

IIH

411N

111

1111

1111

1111

1111

1.././

Z6.

Purchase supplies and equipment.

7.Check receipt of new supplies and

equip

ment

.1

1 1

1.

1111

111

1111E1111111

///.

4

111111111

1111111111111.111111

e/Z

8.Assign and list location of supplies

and

equi

pmen

t.

9.Place supplies and equipment in

assigned positions.

11 I

1111

1111

1111

1110

111

10.

Maintain inventory of supplies and

equipment.

11 I

1M1111111111

111111

1111

111

e/./

1.

I II

1111

11-

e/./

,11.

Maintain record of equipment loaned

to or bo

rrow

ed f

rom

othe

r ar

eas.

12.

Maintain linen supplies.

1=1r

1111

1111

1111

1111

ffim

mi-..,

13.

Maintain a doctor's drawer (for medica

suppli

es).

WI

111111.11111

111111

1111

111

KEY

'10

SYM

BOLS

:=

mo

de v

alue

s; M

il =

cler

ical

resp

=reJpoude

ws;

1111

111=

res

pons

e !.

.; e

xpor

t1,

1nel

All=

non

-uni

t pe

rson

nel

A-(4) Clerical Functions -- Supplies and Equipment

Description of Area

The 13 tasks listed in this function consist of control and supply ofmaterial needs for the unit. They include such activities as distributionand maintenance of supplies and equipment.

Performance

Unit personnel did not perform Task 6 (purchase supplies and equipment).Managers but not clerks performed Task 3 (make rounds to discover repair andredecorating needs), Task 4 (insure that maintenance schedules for equipmentare met), Task 5 (evaluate and approve requisitions for supplies and equipment),and Task 12 (maintain linen supplies). Both managers and clerks performedall the remaining tasks in this function.

Frequency

Task 5 (evaluate and approve requisitions for supplies and equipment)was the most frequently performed task in this function. It is done bythe clerical group.

Difficulty

All the tasks in this function were rated as easy by clerks and managersalike; the experts concurred with them on six tasks and rated the remainingseven tasks at a higher level of difficulty.

Criticality

Experts rated the purchase and inventory of supplies, including linenand medical supplies, as more critical than other tasks in this function.Task 11 (maintain record of equipment loaned to or borrowed from other areas)was rated as the least critical.


Most tasks in this function were judged to be managerial tasks. Onlytwo tasks in the list, Task 9 (place supplies and equipment in assignedpositions), and Task 13 (maintain a doctor's drawer for medical supplies),were desigfiated as clerical tasks.

The occupational level performing four tasks conformed with the expertrecommendation.

General Remarks

Function A-(4) covers the determination of back-up supplies and equipmentneeded on the unit and the flow of these materials in order to provide patientcare. It is essentially a managerial function involving a high degree ofjudgment; the clerical group participates by implementing the decisions.

34

44:

I(

This organizational experience on the unit might be considered as providingthe manager with a background for further advancement into the higher admini-strative functions of the hospital.

35

. 45

FIGURE A-(5

)CLERICAL FUNCTIONS -- SAFETY AND SANI

TATION

A.

CLERICAL FUNCTIONS

(5)

Safe

ty a

nd S

anit

atio

n

v

Performed or SupervIoed

by respondents

Frequency

as rated

by r

espo

nden

ts s

Dif

ficu

lty

rated

by r

espo

nden

tsand

Expert Panel

Criticality

rated

by E

xper

t Pa

nel

only

Occupatio

nal

Level

judg

ed b

yExpert Panel

co el 1

,-.1

,w 1 in 03

64 I rz) In

+ In t's

_..

12

31

23

45

only

21

MEI

II

=1141111111111

111111

111111

11111

11111

11111

11111

111111

111111

11111

- VZ,/

,,

1.Conduct regular fire and disaster

drills.

//,

9131

41//

,,,7

4

n/t/M7d

FYIrt-/

2.Check availability of fire control

equip

ment

,

1111

1111

111111

111111

1111

1111111

//A3.

Fill out accident reports.

.71

"11

1111

1111

111111

111111

11111

11111

///..

4.Conduct safety inspection.

"Mil

Or 1

1 1

111111111

111111

11111

11111

#771

5.Schedule cleaning of unit, including

patient

roam

s.0,

111H.

=I111111

1111

1111

1W./

6.Inspect cleanliness and sanitation of

the unit.

MI

/ /Z

.

1111

1111

1111

111

INI1

1111

1 i

III

///,

47.

Investigate loss and damage claims.

11 11

111111111

11111111111MU

UM

f/Z1

8.Participate in emergency mobilization of

unit

per

sonn

el.

IWZ.

.-

-

--

s.&

KEY

TO

SIT

IBO

IS :

= mode

val

ues;

11E

l =

cler

ical

res

pond

ents

:' /

/1=

mana

geri

al r

espe

nden

ts.I

fifi

lj1=

res

cons

.,ex4.ert

rv.:1;

411=

non

-uni

t pe

rson

nel

A-(5) Clerical Functions -- Safety and Sanitation

Description of Area

The eight tasks in this function deal with the safety and sanitationaspects of patient care. They include scheduling the cleaning of the unitand the checking of safety equipment as well as periodic drills for conductin emergency situations.

Performance

Managerial personnel reported performing all the safety and sanitationtasks. None were performed by clerical personnel. Task 3 (fill out accidentreports) was the task in this function most frequently performed by managerialrespondents.

Frequency

Task 5 (scheduling the cleaning of units) emerged as the most frequentlyperformed task. Task 4 (conduct safety inspection) and Task 6 (inspectcleanliness and sanitation of the unit) were the other frequently-performedtasks in this function.

Difficulty

Clerks rated Task 4 (conduct safety inspection) as the most difficulttask. Both clerks and managers indicated that all but Task 1 (conductregular fire and disaster drills) were easy. Experts rated Task 6 (inspectcleanliness and sanitation of the unit) as easy and all other tasks asmoderate in difficulty.

Criticality

Experts assigned all but one task to managerial personnel. Task 1(conduct regular fire and disaster drills), which is currently performedby managers, was considered a task to be done by a person outside theunit. They recommended the administrator as the individual who shouldmake this determination.

General Remarks

In developing curriculum for Function A-(5), it would appear thatinstruction regarding fundamental policies pertaining to legal implicationsand sanitation requirements would be beneficial preparation for the workexperience. Since no two health care facilities are identical, however,many of the details of implementing the programs are best provided by in-house preparation for procedures, development of check lists, etc.

37

FIGURE B-(1

)ADMINISTRATIVE FUNCTIONS -- ESTABLISHING OBJECT

IVES AND POLICIES

B.

ADMINISTRATIVE FUNCTIONS

(1)

Establishing Objectives and Policies


by respondents

Frequency '


;

Dif

ficu

lty

rated

by r

espo

nden

tsand

Expert Panel

Criticality

rated

by E

xper

t Pa

nel

only

Occupatio

nal

Level

judg

ed b

yExpert Panel

only

as v C1 ,!1

as

cm v I CVin

co qe h inc)

+ cP hin1

23

12

33

2I

= t#

1111

1111

1111

1111

111

///..

1.Formulate goals of nursing unit.

r, v

. m

. gr

. r. c

,'

i11

1111

11IU

MIN

IMH

MI

1111

11//Z

.2.

Develop policies and establish procedure

for activities within the unit.

Documents

Contoh OA