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PADMASHREE INSTITUTE OF NURSING. M.Sc.

Nursing II years (2009-2011 batch)


PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
A Text book on
Nursing
Management
(According to Indian Nursing Council Syllabus)
AUTHORS :
Mr. Anoop.N
Mr. Chetan Kumar.M.R
Mr. Deepak.K
Mr. Lingaraju.C.M
Mr. Mithun Kumar.B.P
Mr. Sarath Chandran.C



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Dedicated to all
M.Sc. Nursing
students


From:
M.Sc. (Nursing) II year
Batch: 2009-2011

PADMASHREE INSTITUTE
OF NURSING
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Forward
It gives me an immense happiness to forward this Text Book of Nursing Management
written by budding authors Mr.Annop, Mr. Chetan.M.R, Mr. Deepak.K, Mr. Sarath
Chandran, Mr.Mithun Kumar, Mr.Lingaraj.C.M, studying in Padmashree Institute of
Nursing, Bangalore, Karnataka.
This book is designed according to INC syllabus of M.Sc. Nursing. Each unit is described in
detailed according to the updated with recent and advanced information on nursing
management and administration. All the authors struggled a lot tirelessly round the clock
for the birth of this successful text book.
It is not an easy task to deliver such excellent knowledge information on nursing
management topics. It is the effort, dedication and commitment of Mr.Deepak.K who was
the backbone, pillars and implanted the seed to initiate, organized arrange systematically
the flow contents of Mr.Anoop, Mr. Chetan Kumar. C.M, Mr.Sarath Chandran,
Mr.Mithun Kumar, Mr.Lingaraj.C.M has joined their efforts with Mr.Deepak.K in
delievering the sweet essence on the units they selected and written in simple language.
I hope this book will be benefitted to Postgraduate nursing students to develop
understanding and apply the nursing management services in clinical setting and
educational institution too.
I am sure that this book will be widely used and will make a worthy contribution to the
nursing profession. I wish all the best for the authors for such a contribution in the field of
nursing management.

Mr. Ellakuvana Bhaskara Raj.D
Associate Professor
HOD of Psychiatric Nursing Department
Padmashree Institute of Nursing
Kommagatta village, Bangalore-60



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Acknowledgement
Service to mankind is service to GOD. We believe in invisible power which guided us
throughout our success.

Thandhe, Tayee, Guru, Devaru. We are very much indebted to our lovable parents for
their continuous guidance, support and encouragement for accomplishment of our dream,
the release of this text book.

Guide us when we are in need, we extremely thankful to Asso. Prof. Ellakuvana Bhaskara
Raj.D, for his encouragement, timely guidance, constant advice and support for successful
completion of this book.

We also thank all PG faculties of Padmashree Institute of Nursing who guided, supported
in all our endeavors.
An evergreen unforgettable memory is friendship. We express our deep sense of gratitude
and heartfelt thanks to all my classmates who are the main inspiration behind this book.




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

UNIT I:






Introduction
Philosophy, purpose, elements, principles and scope of
Administration

Indian Constitution, Indian Administrative system vis a
vis health care delivery system: National, State and Local

Organization and functions of nursing services and
education at National, State , District and institutions:
Hospital and Community

Planning process: Five year plans, Various Committee
Reports on health, State and National Health policies,
national population policy, national policy on AYUSH and
plans,


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
UNIT I: INTRODUCTION:
Administer derived from the Latin word ad + ministraire, - to care for or to look after
people to manage affairs. Administration is the activities of groups co-operating to accomplish
common goals. -Herbert A Simon
Administration may be defined as the management of affairs with the use of well thought out
principles and practices and rationalized techniques to achieve certain objectives. - Goel
DEFINITION:
ADMINISTRATION:
Administration is the organization and direction of human and material resources to achieve
desired ends - Pfiffner and presthus
Administration has to do with getting things done; with the accomplishment of defined
objectives. - Luther Gullick
MANAGEMENT:
Management may be defined as the art of securing maximum results with a minimum of
effort so as to secure maximum prosperity and happiness for both employer and
employee and give the public the best possible service. - John Mee
Management is distinct process consisting of planning, organising, actuating, activating
and controlling, performed to determine and accomplish the objectives by the use of
people and resources. - George
Management and Administration:
These two words are slightly similar and can employ interchangeable.
Management refers to private sector. Whereas administration refers to public sector.
Management or Administration is the process for exceeding the goal expected."
- Derek French and Heather Saward.




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Difference between administration and management
Basis of difference Administration Management
Nature of work It is concerned about the
determination of objectives
and major policies of an
organization
It puts into action the policies
and plans laid down by the
administration.
Type of function It is a determinative function It is an executive function
Scope It takes major decisions of an
enterprise as a whole
It takes decisions within the
framework set by the
administration.
Level of authority It is a top-level activity. It is a middle level activity
Nature of status It consists of owners who
invest capital in and receive
profits from an enterprise.
It is a group of managerial
personnel who use their
specialized knowledge to
fulfill the objectives of an
enterprise
Nature of usage It is popular with government,
military, educational, and
religious organizations.
It is used in business
enterprises.
Decision making Its decisions are influenced by
public opinion, government
policies, social, and religious
factors.
Its decisions are influenced by
the values, opinions, and
beliefs of the managers.
Main functions Planning and organizing
functions are involved in it.
Motivating and controlling
functions are involved in it.
Abilities It needs administrative rather
than technical abilities.
It requires technical activities
Managerial Concerns:
Efficiency - Doing things right Getting the most output for the least inputs
Effectiveness - Doing the right things Attaining organizational goals
Efficiency and Effectiveness in management



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Managerial levels









Who are Managers?
Someone who coordinates and overseas the work of other people so that organizational goals are
accomplished.
First-line Managers
Individuals who manage the work of non-managerial employees.
Middle Managers
Individuals who manage the work of first-line managers.
Top Managers
Individuals who are responsible for making organization-wide decisions and establishing plans
and goals that affect the entire organization.
Functions:
Planning - Defining goals, establishing strategies to achieve goals, developing plans to
integrate and coordinate activities.
Organizing - Arranging and structuring work to accomplish organizational goals.
Leading - Working with and through people to accomplish goals.
Controlling - Monitoring, comparing, and correcting work.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Role:
Interpersonal roles - Figurehead, leader, liaison
Informational roles - Monitor, disseminator, Spokesperson
Decisional roles - Entrepreneur, Disturbance handler, resource allocator, negotiator
Skills:
Technical skills - Knowledge and proficiency in a specific field
Human skills - The ability to work well with other people
Conceptual skills - The ability to think and conceptualize about abstract and complex
situations concerning the organization
Skills Needed at Different Management Levels






Importance of management:
The Value of Studying Management:
- The universality of management
- Good management is needed in all organizations.
- The reality of work
- Employees either manage or are managed.
- Rewards and challenges of being a manager
- Management offers challenging, exciting and creative opportunities for meaningful and
fulfilling work.
- Successful managers receive significant monetary rewards for their efforts.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Universal Need for Management
























PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
PHILOSOPHIES OF ADMINISTRATION
Philosophy is based on the following key points: Administration believes in:
Cost effectiveness
Execution and control of work plans
Delegation of responsibility
Human relations and good morale
Effective communication
Flexibility in certain situation
PRINCIPLES OF ADMINISTRATION
Meaning of management principles: Management principles are statements of fundamental truth
which act as guidelines for taking managerial action.
Management principles are derived and developed in the following two steps.
(a) Deep Observations
(b) Repeated experiments
Henri Fayol (1841 - 1925): Graduated from the National School of Mines in Saint Etrenne in
1860
Fayols 14 principles of management
1. Division of Work. Specialization allows the individual to build up experience, and to
continuously improve his skills. Thereby he can be more productive. Small task, Competent,
Specialization, Efficiency, Effectiveness

2. Principle of Authority and Responsibility Authority means power to take decisions.
Responsibility means obligation to complete the job assigned

3. Principle of discipline: General rules and regulations for systematic working in an
organization.
4. Principle of unity of command: Employee should receive orders from one boss only.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
5. Unity of direction: All the efforts of the members and employees of the organization must be
directed to one direction that is the achievement of common goal.
6. Subordination of individual interest to general interest: Subordination of individual
interest to general interest the interest of the organization must supersede the interest of the
individuals.
7. Principle of remuneration of persons: Employees must be paid fairly or adequately to give
them maximum satisfaction
8. Principle of centralization and decentralization: Centralization refers to concentration of
power in few hands. Decentralization means evenly distribution of power at every level.
9. Principle of scalar chain: Means line of authority or chain of superiors from highest to
lowest rank
10. Principle of Order: Principle of Order It refers to orderly arrangement of men and material
a fixed place for everything and everyone in the organization
11. Principle of Equity: Principle of Equity Fair and just treatment to employees.
12. Stability of tenure of personnel: Stability of tenure of personnel No frequent termination or
transfer.
13. Principle of Initiative: Principle of Initiative Employees must be given opportunity to take
some initiative in making and executing a plan
14. Principle of Esprit De Corps: Principle of Esprit De Corps Means union is strength.
PRINCIPLES OF ADMINISTRATION








PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Fayol's definition of management roles and actions distinguishes between Five Elements:






Five Elements: management roles and actions
Prevoyance. (Forecast & Plan)- Examining the future and drawing up a plan of action.
The elements of strategy.
To organize - Build up the structure, both material and human, of the undertaking.
To command - Maintain the activity among the personnel.
To coordinate - Binding together, unifying and harmonizing all activity and effort.
To control -Seeing that everything occurs in conformity with established rule and
expressed command.
ELEMENTS OF ADMINISTRATION:
POSDCORB
Planning
Organizing
Staffing
Directing
Co-ordinating
Reporting
Budgeting

SCOPE OF ADMINISTRATION
Political: Functions of the administration includes the executive legislative relationship.
Defensive: It covers the hospital protective functions.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Economic: Concerns with the vast area of the health care activities.
Educational: Its involves educational administration in its broadest senses.
Legislative: It includes most not mealy delegated legislation, but the preparatory work
done by the administrative officials.
Financial: It includes the whole of financial, budget, inventory control managements.
Social: It includes the activities of the department s concerned with food, social factors.
Local: It concerned with the activities of the local bodies.
INDIAN CONSTITUTION
Introduction
The majority of the Indian subcontinent was under British colonial rule from 1858 to
1947. This period saw the gradual rise of the Indian nationalist movement to gain independence
from the foreign rule. The movement culminated in the formation of the on 15 August 1947,
along with the Dominion of Pakistan. The constitution of India was adopted on 26 January 1950,
which proclaimed India to be a sovereign democratic republic.
Evolution of the Constitution
Acts of British Parliament before 1935
After the Indian Rebellion of 1857, the British Parliament took over the reign of India
from the British East India Company, and British India came under the direct rule of the Crown.
The British Parliament passed the Government of India Act of 1858 to this effect, which set up
the structure of British government in India.
Government of India Act 1935
The provisions of the Government of India Act of 1935, though never implemented fully,
had a great impact on the constitution of India. The federal structure of government, provincial
autonomy, bicameral legislature consisting of a federal assembly and a Council of States,
separation of legislative powers between center and provinces are some of the provisions of the
Act which are present in the Indian constitution.
The Cabinet Mission Plan
In 1946, at the initiative of British Prime Minister Clement Attlee, a cabinet mission to
India was formulated to discuss and finalize plans for the transfer of power from the British Raj
to Indian leadership and providing India with independence under Dominion status in the
Commonwealth of Nations. The Mission discussed the framework of the constitution and laid
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
down in some detail the procedure to be followed by the constitution drafting body. Elections for
the 296 seats assigned to the British Indian provinces were completed by August 1946. The
Constituent Assembly first met and began work on 9 December 1946.
Indian Independence Act 1947
The Indian Independence Act, which came into force on 18 July 1947, divided the British
Indian territory into two new states of India and Pakistan, which were to be dominions under the
Commonwealth of Nations until their constitutions were in effect.
Constituent Assembly
The Constitution was drafted by the Constituent Assembly, which was elected by the
elected members of the provincial assemblies.

Jawaharlal Nehru, C. Rajagopalachari, Rajendra
Prasad, SardarVallabhbhai Patel, MaulanaAbulKalam Azad, Shyama Prasad Mukherjee and
NaliniRanjanGhosh were some important figures in the Assembly.
In the 14 August 1947 meeting of the Assembly, a proposal for forming various
committees was presented. Such committees included a Committee on Fundamental Rights, the
Union Powers Committee and Union Constitution Committee. On 29 August 1947, the Drafting
Committee was appointed, with DrAmbedkar as the Chairman along with six other members. A
Draft Constitution was prepared by the committee and submitted to the Assembly on 4
November 1947.
Parts
Parts are the individual chapters in the Constitution, focused in single broad field of laws,
containing articles that address the issues in question.

Preamble
Part I - Union and its Territory
Part II - Citizenship.
Part III- Fundamental Rights
Part IV - Directive Principles and
Fundamental Duties.
Part V- The Union.
Part VI- The States.
Part XII - Finance, Property, Contracts and
Suits
Part XIII - Trade and Commerce within the
territory of India
Part XIV - Services Under the Union, the
States and Tribunals
Part XV - Elections
Part XVI - Special Provisions Relating to
certain Classes.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Part VII - States in the B part of
the First schedule (Repealed).
Part VIII - The Union Territories
Part IX - Panchayat system and
Municipalities.
Part X - The scheduled and Tribal
Areas
Part XI - Relations between the
Union and the States.
Part XVII - Languages
Part XVIII - Emergency Provisions
Part XIX - Miscellaneous
Part XX - Amendment of the Constitution
Part XXI - Temporary, Transitional and
Special Provisions
Part XXII - Short title, date of
commencement, Authoritative text in Hindi
and Repeals
Federal Structure
The constitution provides for distribution of powers between the Union and the States.
It enumerates the powers of the Parliament and State Legislatures in three lists, namely Union
list, State list and Concurrent list. Subjects like national defense, foreign policy, issuance of
currency are reserved to the Union list. Public order, local governments, certain taxes are
examples of subjects of the State List, on which the Parliament has no power to enact laws in
those regards, barring exceptional conditions. Education, transportation, criminal laws are a few
subjects of the Concurrent list, where both the State Legislature as well as the Parliament has
powers to enact laws.
Changing the constitution
In 2000 the National Commission to Review the Working of the Constitution (NCRWC) was
setup to look into updating the constitution of India.
Judicial review of laws

This section requires expansion.
Judicial review is actually adopted in the Indian constitution from the constitution of the United
States of America. In the Indian constitution, Judicial Review is dealt under Article 13. Judicial
Review actually refers that the Constitution is the supreme power of the nation and all laws are
under its supremacy. Article 13 deals that
1. All pre-constitutional laws, after the coming into force of constitution, if in conflict with it in
all or some of its provisions then the provisions of constitution will prevail. If it is compatible
with the constitution as amended. This is called the Theory of Eclipse.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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2. In a similar manner, laws made after adoption of the Constitution by the Constituent Assembly
must be compatible with the constitution, otherwise the laws and amendments will be deemed to
be void-ab-initio.
In such situations, the Supreme Court or High Court interprets the laws as if they are in
conformity with the constitution.
HEALTH CARE DELIVERY SYSTEM IN INDIA
Introduction
Health is the birth right of every individual. Today health is considered more than a basic
human right; it has become a matter of public concern, national priority and political action. Our
health system has traditionally been a disease-oriented system but the current trend is to
emphasize health and its promotion.
Selected health care definitions:
Health: According to WHO, health is defined as a dynamic state of complete physical,
mental and social well-being not merely an absence of disease or infirmity.
Health care services: It is defined as multitude of services rendered to individuals,
families or communities by the agents of the health services or professions for the
purpose of promoting, maintaining, monitoring or restoring health.
Definitions of health care delivery:
1. Health care delivery system refers to the totality of resources that a population or
society distributes in the organization and delivery of health population services. It
also includes all personal and public services performed by individuals or institutions
for the purpose of maintaining or restoring health. -Stanhope(2001)

2. It implies the organization, delivery staffing regulation and quality control.
J.C.Pak(2001)
Philosophy of Health Care Delivery System:
Everyone from birth to death is part of the market potential for health care services.
The consumer of health care services is a client and not customer.
Consumers are less informed about health services than anything else they purchase.
Health care system is unique because it is not a competitive market.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Restricted entry in to the health care system.
Goals/Objectives of Health Care Delivery System:
1) To improve the health status of population and the clinical outcomes of care.
2) To improve the experience of care of patients families and communities.
3) To reduce the total economic burden of care and illness.
4) To improve social justice equity in the health status of the population.
Principles of Health Care Delivery System:
1. Supports a coordinated, cohesive health-care delivery system.
2. Opposes the concept that fee-for-practice.
3. Supports the concept of prepaid group practice.
4. Supports the establishment of community based, community controlled health-care
system.
5. Urges an emphasis be placed on development of primary care
6. Emphasizes on quality assurance of the care
7. Supports health care as basic human right for all people.
8. Opposes the accrual of profits by health-care-related industries.
Functions of Health Care Delivery System:
1) To provide health services.
2) To raise and pool the resources accessible to pay for health care.
3) To generate human and physical sources that makes the delivery service possible.
4) To set and enforce rules of the game and provide strategic direction for all the different
players involved.
Characters of Health Care Delivery System:
1) Orientation toward health.
2) Population perspective.
3) Intensive use of information.
4) Focus on consumer.
5) Knowledge of treatment outcome.
6) Constrained resources.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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HEALTH CARE DELIVERY SYSTEM IN INDIA
In India it is represented by five major sectors or agencies which differ from each other
by health technology applied and by the source of fund available. These are:
I. PUBLIC HEALTH SECTOR
A. Primary Health Care
Primary health centres.
Sub- centres.
B. Hospital/Health Centres
Community health centres.
Rural health centres.
District hospitals/health centre.
Specialist hospitals.
Teaching hospitals.
C. Health Insurance Schemes
Employees State Insurance.
Central Govt. Health Scheme.
D. Other Agencies
Defence services.
Railways.
II. PRIVATE SECTOR
A. Private hospitals, polyclinics, nursing homes and dispensaries.
B. General practitioners and clinics.
III. INDIGENOUS SYSTEMS OF MEDICINE
Ayurveda
Sidda
Unani
Homeopathy
Naturopathy
Yoga
Unregistered practioners.

IV. VOLUNTARY HEALTH AGENCIES
V. NATIONAL HEALTH PROGRAMMES
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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ORGANIZATION AND ADMINISTRATION OF HEALTH SERVICES IN INDIA AT
DIFFERENT LEVELS.
India is a union of 28 states and 7 Union territories. Under the constitution states are
largely independent in matters relating to the delivery of health care to the people. Each State,
therefore, as developed its own system of health care delivery, independent of the Central
Government.
Health system in India has 3 links
1. Central level. 2. State level 3. District level

Synoptic view of the health system in India
1/80,000 1,20,000
1/30,000
1/3,000 5,000
1/1,000
Community Health
Centres
Sub-district/Taluka
hospital
PHC
Sub-centres
Health worker (M & F)
Village health
guide, trained dai
District health organisation and basic
specialities hospital/districts
States (28) an Union Territories (7)
Ministry of Health and Directorate of Health
National Level
Ministry of Health and Family Welfare
People in the
population
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Health administration at the central level
The official organs of the health system at the national level consist of 3 units:
1. Union Ministry of Health and Family Welfare.
2. The Directorate General of Health Services.
3. The Central Council of Health and Family Welfare.

I. Union Ministry of Health and Family Welfare
Organisation
The Union Ministry of Health and Family Welfare is headed by a Cabinet Minister, a
Minister of State, and a Deputy Health Minister. These are political appointment and have dual
role to serve political as well as administrative responsibilities for health.
Currently the union health ministry has the following departments:
1. Department of Health
2. Department of Family Welfare
3. Department of Indian System of Medicine and Homoeopathy
a. Department of Health
It is headed by a secretary to the Government of India as its executive head, assisted by
joint secretaries, deputy secretaries, and a large administrative staff.
Functions
Union list
1. International health relations and administration of port-quarantine
2. Administration of central health institutes such as All India Institute of Hygiene and
Public Health, Kolkata; National Institute for Control of Communicable Diseases, Delhi,
etc.
3. Promotion of research through research centres and other bodies.
4. Regulation and development of medical, nursing and other allied health professions.
5. Establishment and maintenance of drug standards.
6. Census, and collection and publication of other statistical data.
7. Immigration and emigration.
8. Regulation of labour in the working of mines and oil fields and

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Concurrent list
The functions listed under the concurrent list are the responsibility of both the union and
state governments. The centre and states have simultaneous powers of legislation. They are as
follows:
1. Prevention of extension of communicable diseases from one unit to another.
2. Prevention of adulteration of food stuffs.
3. Control of drugs and poisons.
4. Vital statistics.
5. Labour welfare.
6. Ports other than major.
7. Economic and social health planning
8. Population control and family planning.
Department of Family Welfare
It was created in 1966 within the Ministry of Health and Family Welfare. The secretary
to the Government of India in the Ministry of Health and Family Welfare is in overall charge of
the Department of Family Welfare. He is assisted by an additional secretary and commissioner,
and one joint secretary.
The following divisions are functioning in the department of family welfare.
1. Programme appraisal and special scheme
2. Technical operations: looks after all components of the technical programme viz.
Sterilization/IUD/Nirodh, post partum, maternal and child health, UPI, etc.
3. Maternal and child health
4. Evaluation and intelligence: helps in planning, monitoring and evaluating the
programme performance and coordinates demographic research.
5. Nirodh marketing supply/ distribution
Functions
a. To organize family welfare programme through family welfare centres.
b. To create an atmosphere of social acceptance of the programme and to support all voluntary
organizations interested in the programme.
c. To educate every individual to develop a conviction that a small family size is valuable and to
popularize appropriate and acceptable method of family planning
d. To disseminate the knowledge on the practice of family planning as widely as possible and to
provide service agencies nearest to the community.
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Ministry of Health and Family Welfare

3. The department of Indian system of medicine and homeopathy
It was established in March 1995 and had continued to make steady progress. Emphasis
was on implementation of the various schemes introduced such as education, standardization of
drugs, enhancement of availability of raw materials, research and development, information,
education and communication and involvement of ISM and Homeopathy in national health care.
Most of the functions of this ministry are implemented through an autonomous
organization called DGHS.

Minister of State
Deputy Ministers
Dept. of Family Welfare Dept. of Health Dept. of Indian
System of Medicine
and Homoeopathy
Secretary
JS
(ISM)
Director
Ayurveda & Sidha
Secretary
Secretary health
Additional Secretary
Joint Secretaries (9)
Director General of
Health Services
Addl. Director Generals (4)
Chief Director
(1)
Cabinet Minister
Joint Secretary
(3)
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II. Directorate General of Health Services
Organisation
The DGHS is the principal adviser to the Union Government in both medical and public
health matters. He is assisted by a team of deputies and a large administrative staff. The
Directorate comprises of three main units:
i. Medical care and hospitals
ii. Public health
iii. General administration
Functions
1. General functions: The general functions are surveys, planning, coordination,
programming and appraisal of all health matters in the country.
2. Specific functions
a. International health relations and quarantine:
b. Control of drug standards
c. Medical store depots
d. Postgraduate training
e. Medical education
f. Medical research
g. Central Government Health Scheme.
Family welfare services
h. National Health Programmes.
i. Central Health Education Bureau
j. Health intelligence.
k. National Medical Library

III. Central Council of Health
The Central Council of Health was set up by a Presidential Order on August 9, 1952,
under Article 263 of the Constitution of India for promoting coordinated and concerted action
between the centre and the states in the implementation of all the programmes and measures
pertaining to the health of the nation. The Union Health Minister is the chairman and the state
health ministers are the members.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Functions
1. To consider and recommend broad outlines of policy in regard to matters concerning
health in all its aspects such as the provision of remedial and preventive care,
environmental hygiene, nutrition, health education and the promotion of facilities for
training and research.
2. To make proposals for legislation in fields of activity related to medical and public health
matters and to lay down the pattern of development for the country as a whole.
3. To make recommendations to the Central Government regarding distribution of available
grants-in-aid for health purposes to the states and to review periodically the work
accomplished in different areas through the utilisation of these grants-in-aid.
4. To establish any organisation or organisations invested with appropriate functions for
promoting and maintaining cooperation between the Central and State Health
administrations.

AT THE STATE LEVEL
Historically, the first milestone in the state health administration was the year 1919,
when the states (provinces) obtained autonomy, under the Montague-Chelmsford reforms, from
the central Government in matters of public health. By 1921-22, all the states had created some
form of public health organisation. The Government of India Act, 1935 gave further autonomy to
the states. The state is the ultimate authority responsible for health services operating within its
jurisdiction.
State health administration
At present there are 31 states in India, with each state having its own health
administration. In all the states, the management sector comprises the state ministry of Health
and a Directorate of Health.
1. State Ministry of Health
The State Ministry of Health is headed by a Minister of Health and FW and a Deputy
Minister of Health and FW. In some states, the Health Minister is also in charge of other
portfolios. The Health secretariat is the official organ of the State Ministry of Health and is
headed by a Secretary who is assisted by Deputy Secretaries, and a large administrative staff.




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Organisational structure of the health and family welfare services at state level

Functions: Health services provided at the state level
- Rural health services through minimum needs programme
- Medical development programme
- M.C.H., family welfare & immunization programme
- NMIP (malaria) & NFCP(filarial)
- NLEP, NTCP, NPCB, prevention and control of communicable diseases like
diarrheal disease, KFD, JE,
- School health programme, nutrition programme, and national goitre control
programme
- Laboratory services and vaccine production units
Minister in charge of health and family welfare portfolio in the state
Secretary or commissioner, Department of Health and Family Welfare
Director
Health Services
Director
FW Services
Director
Medical education
& research
Director
ISM and
Homoeopathy
Additional/deputy
joint directors of
health services
dealing with one or
more programmes
Assistant Directors
health services
dealing with one or
more programmes
Principal/Deans of
medical colleges
Divisional set up in
some states
District health
organisation
Taluk Health
organisation
Block level health
organisation
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- Health education and training programme, curative services, national Aids control
programme
2. State Health Directorate
The Director of Health Services is the chief technical adviser to the state Government on
all matters relating to medicine and public health. He is also responsible for the organization and
direction of all health activities. The Director of Health and Family Welfare is assisted by a
suitable number of deputies and assistants. The Deputy and Assistant Directors of Health may be
of two types
Regional
Functional.
The regional directors inspect all the branches of public health within their jurisdiction,
irrespective of their specialty. The functional directors are usually specialists in a particular
branch of public health such as mother and child health, family planning, nutrition, tuberculosis,
leprosy, health education, etc.
AT THE DISTRICT LEVEL
The district is the most crucial level in the administration and implementation of medical /health
services. At the district level there is a district medical and health officer or CMO who is overall
Subdivisions
i. Tehsils (talukas)
ii. Community development blocks
iii. Municipalities and corporations
iv. Villages
v. Panchayaths
Most of the districts in India are divided into two or more subdivisions, each in charge of
an assistant collector or sub-collector. Each division is again divided into tehsils in charge of a
Tehsildar. A tehsil usually comprises between 200 and 600 villages.
Finally, there are the village panchayaths, which are institutions of rural local self-
government.
The urban areas of the district are organised into the following local self-government:
Town area committee 5,000 10,000
Municipal boards 10,000 2,00,000
Corporations population above 2,00,000.
The towns area committees are like panchayaths. They provide sanitary services.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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The municipal boards are headed by a chairman/president, elected usually by the
members.
Corporations are headed by mayors. The councilors are elected from different wards of
the city. The executive agency includes the commissioner, the secretary, the engineer, and the
health officer. The activities are similar to those of the municipalities but on a much wider scale.
Primary Healthcare Infrastructure of District Level


Sub-
Centre
T.B.A.
VHG
T.B.A.
VHG
T.B.A.
VHG
T.B.A.
VHG
T.B.A.
VHG
Primary
Health
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
Sub-
Centre
PHC
PHC
District Health and
Family Welfare
PHC
CEO
Zilla
parishad
Community
Health Centre
Covers 1,00,000 population
Covers
30,000
population
Covers
5,000
population
Covers
1,000
population
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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PANCHAYATHI RAJ
The panchayath Raj is a 3-tier structure of rural local self-government in India linking the
villages to the district. The three institutions are:
a. Panchayath at the village level.
b. Panchayath samithi at the block level.
c. Zilla parishad at the district level.
The panchayathi Raj institutions are accepted as agencies of public welfare. All
development programmes are channelled through these bodies. The panchayathi Raj institutions
strengthen democracy at its root and ensure more effective and better participation of the people
in the government.
At the village level
The panchayathi Raj at the village level consists of:
1. The gram sabha
2. The gram panchayath
3. The nyaya panchayath
At the block level
The panchayathi raj agency at the block level is the panchayath samithi. The panchayathi
samithi consists of all sarpanchs of the village panchayaths in the block. The block development
officer is the ex-officio secretary of the panchayath samithi.
The prime function of the panchayat samiti is the execution of the community
development programme in the block.
The block development officer and his staff give technical assistance and guidance to the
village panchayaths engaged in the development work.
At the district level
The zilla parishad is the agency of rural local self-government at the district level. The
members of the zilla parishad include all leaders of the panchayath samithis in the district, MPs,
MLAs of the district, representatives of SC, SD and women, and 2 persons of experience in
administration. The collector of the district is a non-voting member. Thus, the membership of the
zilla parishad is fairly large varying from 40 to 70.
The zilla parishad is primarily supervisory and coordinating body. Its functions and
powers vary from state to state. In some states, the zilla parishads are vested with the
administrative functions.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Healthcare systems

The healthcare system is intended to deliver the healthcare services. It constitutes the
management sector and involves the organisational matters. It operates in the context of the
socioeconomic and political framework of the country. In India, it is represented by five major
sectors and agencies which differ from each other by the health technology applied and by the
source of funds for the operation.
i. Public health sector
ii. Private sectors
District
Level
Zilla Panchayat
(ZP)
Taluka
Level
Taluka Panchayat
(TP)
Village
Level
Gram Panchayat
(GP)
Gram
Sabha
Direct election @ 1:40,000
(except Uttara Kannada, Coorg
and Chickmagalore where it is
1:30,000). 20 months term for
Adhyakshas and Upadhyakshas
and 5 standing committees.
Direct election @ 1:10,000.
Voting rights to MPs, MLAs,
MLCs. One year membership to
1/5 of Gram Panchayat
Adhyakshas and 5 standing
committees.
Direct election @ 1:4,000. Ban on
political parties. 5 years term.3
standing committees.
Minimum of two meetings per
annum, under the chairmanship of
GP Adhyaksha, for approval of
Budget/accounts, review of
development programme
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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iii. Indigenous system of medicine
iv. Voluntary health agencies
v. National health programmes
Primary healthcare in India
It is a three-tier system of healthcare delivery in rural areas based on the
recommendations of the Shrivastav Committee in 1975.
1. Village level: The following schemes are operational at the village level:
a. Village health guides scheme
b. Training of local dais
c. ICDS scheme
2. Sub-centre level: This is the peripheral outpost of the existing health delivery system in
rural areas. They are being established on the basis of one sub-centre for every 5000
population in general and one for every 3000 population in hilly tribal and backward
areas. Each sub-centre is manned by one male and one female multipurpose health
worker.
Functions
a. Mother and child healthcare
b. Family planning
c. Immunization
d. IUD insertion
e. Simple laboratory investigations
3. Primary health centre level: The Bhore committee in 1946 gave the concept of a
primary health centre as a basic health unit to provide as close to the people as possible.
The Bhore committee aimed at having a health centre to serve a population of 10,000 to
20,000. The national health plan, 1983 proposed reorganization of primary health centres
on the basis of one PHC for every 30,000 rural population in the plains, and one PHC for
every 20,000 population in hilly, tribal and backward areas for more effective coverage.
Functions of the PHC
a. Medical care.
b. MCH including family planning.
c. Safe water supply and basic sanitation.
d. Prevention and control of locally endemic diseases.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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e. Collection and reporting of vital statistics.
f. Education about health.
g. National health programmes as relevant.
h. Referral services.
i. Training of health guides, health workers, local dais, and health assistants.
j. Basic laboratory services.
Community health centres
As on 31
st
March 2003, 3076 community health centres were established by upgrading
the primary health centres, each CHC covering a population of 80,000 to 1.20 lakh with 30 beds
and specialist in surgery, medicine, obstetrics and gynecology, and pediatrics with x-ray and
laboratory facilities.
Functions
1. Care of routine and emergency cases in surgery.
2. Care of routine and emergency cases in medicine.
3. 24-hour delivery services including normal and assisted deliveries.
4. Essential and emergency obstetric cases including surgical interventions.
5. Full range of family planning services including laparoscopic services.
6. Safe abortion services.
7. Newborn care.
8. Routine and emergency care of sick children.
9. Other management including nasal packing, tracheostomy, foreign body removal, etc.
10. All national health programmes should be delivered.
11. Blood shortage facility.
12. Essential laboratory services.
13. Referral services.





PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Organisational Structure of Panchayat Raj Institutions

District
Level
Zilla Panchayat
(ZP)
Taluka
Level
Taluka Panchayat
(TP)
Village
Level
Gram Panchayat
(GP)
Gram
Sabha
Direct election @ 1:40,000
(except Uttara Kannada, Coorg
and Chickmagalore where it is
1:30,000). 20 months term for
Adhyakshas and Upadhyakshas
and 5 standing committees.
Direct election @ 1:10,000.
Voting rights to MPs, MLAs,
MLCs. One year membership to
1/5 of Gram Panchayat
Adhyakshas and 5 standing
committees.
Direct election @ 1:4,000. Ban on
political parties. 5 years term.3
standing committees.
Minimum of two meetings per
annum, under the chairmanship of
GP Adhyaksha, for approval of
Budget/accounts, review of
development programme
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Organisational structure of health department at district level

DISTRICT HEALTH AND FAMILY WELFARE OFFICER
Dy. CMO/
Medical
Officer (FW
& MCH)
Asst. District
Health &
Family
Welfare
Officer (HQ)
Asst. District
Health and
Family
Welfare
Officer (Sub-
division
level/Dy.
CMOs)
District
Malaria
Officer
Senior
Malaria
Officer
Senior
Medical
Superin
tendent
Medical officers of
Dt. General
Hospital and other
Govt. Hospitals
District
Leprosy
Officer
District
Health
Education
Officer/
Dmeio
Medical
Officer
(District
Lab.)
District
Tubercul
osis
Officer
(TB
Centre)
Gazetted
Assistant
District
Nursing
Supervisor
Medical Officers
of Primary
Health centres
(Coordinators at
PHC level)
Assistant
Statistical
Officer
Lady
Medical
Officers/
11 MO of
Primary
Health
Centres
Service
Engineer
(Mobile
Workshop)
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Planning and organizing nursing service at various levels local, regional, national, and
international
Placement of nurses in the healthcare organization
A high power committee on nursing and nursing profession was set up by the
Government of India in July 1987 under the chairmanship of Smt. Sarojini Vasadapan, an
eminent social worker and former chairperson of Central Social Welfare Board with Smt.
Rajkumari Sood, Nursing Advisor to Government of India, as the member secretary. The terms
of reference of the committee were as follows:
a. Looking into the existing working conditions of nurses with particular reference to the
status of the nursing care services both in rural and urban areas.
b. To study and recommend the staffing norms necessary for providing adequate nursing
personnel to give the best possible care, both in the hospitals and community.
c. To look into the training of all categories and levels of nursing, midwifery personnel to
meet the nursing manpower needs at all levels of health service and education.
d. To study and clarify the role of nursing personnel in the healthcare delivery system
including their interaction with other members of the health team at every level of health
services management.
e. To examine the need for organisation of the nursing services at the national, state,
district, and lower levels with particular reference to the need for planning and
implementing the comprehensive nursing care services with the overall healthcare system
of the country at their respective levels.
f. To look into all other aspects which the committee may consider relevant with reference
to their terms of reference.
g. While considering the various issues under the above norms of reference, the committee
will hold consultations with the state governments.
The findings of this committee give a grim picture of the existing working condition of
nurses, staffing norms for providing adequate nursing personnel, education of nursing personnel
to meet the nursing manpower needs at all levels and the role of nursing personnel in the
healthcare delivery system.
Their recommendations on the organisation of nursing services at central, state and
district levels, and the norms of nursing service and education are given below.
Placement of nurses at the central level
At the central level there is a post of nursing advisor in the medical division of
Directorate General of Health Services. The nursing advisor is directly responsible to the Deputy
Director General (Medical). The nursing advisor is assisted by nursing officer and support staff
for all his/her work. She/he advises the DGHS, Ministry of Health and Family Welfare as well as
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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other ministries and departments, for example, railways, labour, Delhi Administration, etc. on all
matters of nursing services, nursing education, and research. The nursing advisor also takes care
of administration aspects of Raj Kumari Amrit Kaur College of Nursing and Lady Hardinge
Health School, Delhi.
There is a post of deputy nursing advisor at the rank of Assistant Director General (ADG-
Nsg) in the training division of Department of F. W. Presently the deputy nursing advisor deals
with training of ANMs, dais, health supervisor, etc. There is no direct linkage between the
nursing advisor and deputy nursing advisor as there are independent posts.
Nursing organisational set up at the central level


DGHS
Additional DG (N) Additional DG (M) Additional DG (PH)
DDG (N)
ADG (Nursing education
& research)
ADG (Hospital nursing
service)
ADG (Community
nursing service)
DADG DADG DADG
Community &
nursing officer
PHN Supervisor
PHN
LHV
ANM
Principal tutor SON
Senior tutor
Tutor
Clinical instructors
Nursing superintendent
Deputy Nursing
superintendent
Assistant Nursing
superintendent
Ward sister
Staff nurse
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Placement of nurses at state level
There is no proper and definite pattern of nursing structure in the state directorates except
the state of West Bengal. Usually one or two nurses are posted with varying designations, e.g., in
Tamilnadu there is one assistant director nursing who is responsible to Director, Medical
Services, and Director, Medical Education.
In Maharashtra, two nurses work, one each in the office of the Director, Medical
Education, and Director, Health Services.

Recommended organization at state level (union territory level)

Secretary (Health)
ADNS (Nursing
education & research)
ADNS (Hospital/
nursing service)
ADNS (Community
nursing)
DADNS Nursing Superintendent District Nursing
Officer
Public health
nursing officer
PHN at PHC
LHV (HSV)
LHV
ANM
Principal SON
Senior tutor
Tutor
Clinical instructors
Deputy Nursing
superintendent
Assistant nursing
superintendent
Ward sister
Staff nurse
Director, Nursing Services
Joint/Deputy Director, Nursing Services
DADNS (Nursing
education & research)
DADNS (Nursing
service)
DADNS (Community
health nursing)
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Note
The Principal, College of Nursing will be equal to the rank of ADNS and will be eligible
for promotion to the post of DDNS/DNS. The salary scales and structure of the staff of colleges
of nursing will be as per norms of the Indian Nursing Council and the UGC.
Placement of nurses at district level
Nurses, public health nurses, lady health visitors, auxiliary nurse midwives, etc. have
played vital role in providing healthcare services at various levels in both urban and rural areas
of the district. They have been the mainstream in providing primary healthcare services in the
rural and urban areas from the very beginning.

Director nursing
officer
DHO DMO
Dist. P. N. O. Nsg. Superintendent/Dy.
Nsg. Suptd.
Asst. Nsg. Suptd.
Ward sister
Staff nurse
P. N. Supervisor
(CHC)
PN (PHC)
LHV/HS
ANM
Director, Nursing Services
Dy. Asst. Director, Nursing Services
Assistant Dist. Nsg. Officer
(Hosp. & Nsg. Edu)
Dy. Director, Nursing Services
Asst. Director, Nursing Services
Assistant Dist. Nsg. Officer
(Community)
LHV
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The above recommended organisational set up will need full administrative and financial
support of the government. It will look after the overall nursing components, development of
nursing standards, norms, policies, ethics, recruitment, selection and placement roles__ for both
hospitals and community health nursing, development in speciality nursing, higher education in
nursing, and research. These will promote professional autonomy and accountability.

NATIONAL RURAL HEALTH MISSION
The National Rural Health Mission (NRHM) has been launched with a view to bringing
about dramatic improvement in the health system and the health status of the people, especially
those who live in the rural areas of the country..
To achieve these goals NRHM will:
Facilitate increased access and utilization of quality health services by all.
Forge a partnership between the Central, state and the local governments.
Set up a platform for involving the Panchayati Raj institutions and community in the
management of primary health programmes and infrastructure.
Provide an opportunity for promoting equity and social justice.
The Vision of the Mission
To provide effective healthcare to rural population throughout the country with
special focus on 18 states, which have weak public health indicators and/or weak
infrastructure.
18 special focus states are Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Himachal
Pradesh, Jharkhand, Jammu and Kashmir, Manipur, Mizoram, Meghalaya, Madhya
Pradesh, Nagaland, Orissa, Rajasthan, Sikkim, Tripura, Uttaranchal and Uttar Pradesh.
To rise public spending on health from 0.9% GDP to 2-3% of GDP, with improved
arrangement for community financing and risk pooling.
To undertake architectural correction of the health system to enable it to effectively
handle increased allocations and promote policies that strengthen public health
management and service delivery in the country.
To revitalize local health traditions and mainstream AYUSH into the public health
system.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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The Objectives of the Mission
Reduction in child and maternal mortality.
Universal access to public services for food and nutrition, sanitation and hygiene and
universal access to public health care services with emphasis on services addressing
womens and childrens health and universal immunization.
Prevention and control of communicable and non-communicable diseases, including
locally endemic diseases.
Access to integrated comprehensive primary health care.
Population stabilization, gender and demographic balance.
Revitalize local health traditions & mainstream AYUSH.
Promotion of healthy life styles.
The core strategies of the Mission
Train and enhance capacity of Panchayati Raj Institutions (PRIs) to own, control and
manage public health services.
Promote access to improved healthcare at household level through the female health
activist (ASHA).
Health Plan for each village through Village Health Committee of the Panchayat.
Strengthening sub-centre through better human resource development, clear quality
standards, better community support and an untied fund to enable local planning and
action and more Multi Purpose Workers (MPWs).
Provision of 30-50 bedded CHC per lakh population for improved curative care to a
normative standard. (IPHS defining personnel, equipment and management standards, its
decentralized administration by a hospital management committee and the provision of
adequate funds and powers to enable these committees to reach desired levels)
District and Block levels.
Programmes
Reproductive and Child Health Programme II (RCH-II) and the Janani Suraksha
Yojana (JSY) launched.
Polio eradication programme intensified cases reduced from 134 in 2004-05 to 63 (up
to now).
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Accelerated implementation of the Routine Immunization programme taken up. Catch up
rounds taken up this year in the States of Bihar, Jharkhand and Orisaa.
Ground work for introduction of JE vaccine completed.
Ground work for Hepatitis vaccines to all States completed.
Auto Disabled Syringes introduced throughout the country.
State Programme Implementation Plans for RCH II appraised by the National Programme
Coordination Committee set up by the Ministry. Funds to the extent of 26.14% i.e. Rs.
1811.74 core have been released under NRHM Outlay.

Mission on nursing education:
The Mission would support strengthening of Nursing Colleges wherever required, as the
demand for ANMs and Staff Nurses and their development is likely to increase significantly.
Special attention would be given to setting up ANM training centers in tribal blocks which are
currently para-medically underserved by linking up with higher secondary schools and existing
nursing institutions.
ORGANISATION OF THE HEALTH CARE SYSTEM
Public sector
Public agencies are financed with tax monies, thus these are accountable to the public. The
public sector includes official (governmental) agencies and voluntary agencies.
Organization of the public health system
The public health system is organised in too many levels in the
Federal,
State,
Local systems.
THE FEDERAL SYSTEM:
Federal Government has the responsibility for the following aspects of health care.
At the federal level, the primary agencies are concerned with health are organized under the
Department of Health and Human Services (DHHS).
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Providing direct care for certain groups such as Native Americans, military personnel,
and veterans.
Safeguarding the public health by regulating quarantines and immigration laws and the
marketing food, drugs and products used in medical care.
Prevents environmental hazards, gives grantsin aids to states, local areas and individuals
and supports research.
Administration of social security, social welfare and related programmes
Organization and Functions of Nursing Services and Education at National, State,
District, and Institutions: Hospital and Community
Organization and functions of nursing services and education At centre/ national level
Organization of health care at centre level is done by three structures these are
1) Union ministry of health and family welfare
2) Centre council of health
3) Centre family welfare council
Functions:
The functions which are performed by the department of health and through DGHS are given in
the union list and concurrent list and these are as under:
1. Conducting health and morbidity surveys, planning and organizing health programmes
with active participate of state governments, co-ordination of health care activities
through central health council, consultative committee of parliament, statutory bodies
etc.; appraisal of health schemes and feed back in order to maintain uniformity, norms
etc.
2. Maintenance of international health relations, administration of port health and
quarantine laws..
3. Administration of central health institutions, training colleges, laboratories and hospitals,
4. Promotion and maintenance of appropriate standards of education in medical, nursing,
dental, pharmaceutical and ancillary health personnel through statutory bodies.
5. Promotion of medical and public health research.
6. Establishing and maintenance of drug standards,
7. Health intelligence.
8. Central bureau of health intelligence was set up in 1961 for collection, complication,
analysis and evaluation of information.
9. Maintenance of a central medical library.

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Central family welfare council
This department mainly deals with FW matters. Secretary with support of team members, plan
co-ordinates, evaluates and supervises the implementations of FW programme in the state and
co-ordinates the activities and the functions of the technical divisions of the FW department like
Programme appraisal co-ordination and training and sterilization division
Technical operation division
Maternal child health division
Evaluation and intelligence division

Centre council of health

Health is a state subject. The union government has mainly an advisory, guiding and
coordinating function. The main functions of the council are as under:
To consider and recommend broad lines of policy on all matters of health like, primary
health care, medical care, nutrition, environmental health, health education etc.
To make proposal for legislation in the field of medical and public health matters
To lay down the pattern of development in the country as a whole
To make recommendations regarding distribution of available grants-in-aid
Apart from Governmental actions, Nursing education and services are organized by Indian
nursing council and other statutory bodies in national level.
AT STATE LEVEL
State ministry of health and family welfare
They have political responsibilities, responsibilities towards their constituencies as per
their political agenda, and responsibilities for administration and management of health and
family welfare services in their state.
Health secretariat
It is the official organ of the ministry. Major function of the secretariat include helping
minister in
Formulation, review and modification of board policy outlines
Execution of policies programmes etc.
Coordination with government of India and other state governments
Control for smooth and efficient functioning of administrative machinery.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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State health directorate
Providing curative and preventive services
Provision for control of milk and food sanitation
Assumes for total responsibility for taking all steps in the prevention of any outbreak of
communicable diseases specially during festivals and special seasons
Establishment and maintenance of central laboratories for preparation of vaccines, etc
Promotion of health education
Collection, tabulation and publication of vital statistics
Apart from governmental actions it will be organized by state nursing councils and universities
Functions of university are
Organize the courses
Plan for the examinations
Setting question papers
Planning the examination date
Plan the curriculum
AT DISTRICT LEVEL
At district level health organisation is maintained by taluks or block, their main function
is, to plan and implement community development programmes.
Panchayati raj system is a local self governing system in rural area which work parallel
to official structure of administration. It consists of three tier structure of rural local self
government.
Gram sabha- it is comprised of all the adult men and women of the village. This body
meets at least twice in a year and discusses important issues and considers proposals pertaining
to various developmental aspects including health matters
Gram Panchayat- it is the executive organ of the gram sabha. Its main function is
overall planning and development of the villages. The Panchayat secretary has been given
powers to function for wide areas such as maintenance of sanitation and public health, socio
economic development of villages.
Panchayat samiti- it is responsible for the block development programme. The funds for
the development activities are processed through Panchayat samiti. The block development
officer and his/her technical staff extend assistance and guidance to gram Panchayats in carrying
out developmental activities in their villages.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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INSTITUTIONAL LEVEL
AT HOSPITAL
Organization of nursing services and education
Director of nursing
Nursing services must function under a senior competent nursing administrator
variously called as director of nursing, nursing superintendent, principal matron, or matron-in-
chief. She is responsible to the hospital administrator for overall programme and activities of
nursing care of all patients in the hospital. Nursing programme is administered by her through
appropriate planning of services, determining nursing policies in collaboration with hospital
management and nursing procedures in collaboration with nursing staff, giving general
supervision, delegation of responsibility, coordination of interdepartmental nursing activities,
and counseling the hospital administration on nursing problems.
She has a dual role: the first one is the administrative responsibility towards hospital
administration, and the second one is the coordinating of all professional activities of nursing
staff with those of medical staff.
The role of the nursing superintendent starts in a new hospital from helping to establish
the overall goals, policies and organization, and facilities to accomplish these goals in the most
effective and efficient manner. The functional elements of the role of nursing superintendent
includes the following
Formation of the aims, objectives and policies of nursing services as an integral part of
hospital service
Staffing based on nursing requirements in relation to accepted standard of medical care
Planning and directing nursing services
Maintaining supplies and equipments
Budgeting
Records and reports

Nursing supervisor
Each department or clinical division, e.g. Medical, surgical, obstetrical, operation
theatres, outpatient department, nurseries, etc. should have a supervisor. As they may be more
than one nursing unit in each division or department, supervisors have a general administrative
and coordinating function within their respective division. However, supervisors will also have
limited clinical functions
Head nurse / nursing tutor
A head nurse is assigned to a nursing unit, or ward, or a section of department. She works
under the general direction of the supervisor of the division.

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Staff nurse / clinical instructor
Staff nurses are employed at the floor level for carrying out skilled bedside nursing.
This is the real work force of the hospital upon whose competency, state of training and
dedication depend the success of the nursing department.
Student nurse
Students nurse cannot be employed on nursing duties except under supervision of fully
qualified staff nurses.
Policies and procedures
In order that a good standard of nursing care be maintained, the nursing superintendent
should develop written policies and procedures to serve as a guides for nurses of the various
units of the hospital. Important topics that should be incorporated are as follows
Organization
Status and relationship
Responsibilities
Staffing pattern, shift pattern
Departmental functions
Requisitioning of supplies
Utilization, care and maintenance of equipment
Nursing procedures, coordination with domestic services
Handling of the patients clothing and valuables
Isolation technique
Functions
Of hospital in nursing services and education
As a basic function, to assist the individual patient in performance of those activities
contributing to his health or recovery that he would otherwise perform unaided has had
the strength will, or knowledge.
As an extension of the above basic function, to help and encourage the patients to carry
out the therapeutic plan initiated by the physician
As a member of health team, to assist other members of the team to plan and carryout the
total programme of care





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AT COMMUNITY
PHCs (Primary Health Care)
Introduction
The PHC is the first contact point between the village community and the medical
officer. These are established and maintained by the state government under minimum needs/
basic minimum services programme. It acts as a referral unit for six sub centre and has 4-6 beds.
A PHC covers population of 30000 in plain area and 20000 in hilly remote and tribal area. The
activities of PHCs involve curative, preventive, promotive and family welfare services. The
number of PHCs functioning in the country is 22975.
Definition
Primary health centre is the basic structural and functional unit of public health services
for rendering primary health care in peripheral areas.
Elements of PHC
e- Ensure safe water supply
l- Locally endemic disease control
E- Education/ expanded programme on immunization
m- Maternal and child health
e- Environmental sanitation
n- Nutritional services
t- Treatment of minor aliments
s- School health services
Standards of PHC
The IPHHS for PHCs has been prepared keeping in view the resources available with respect to
functional requirement for PHCs with minimum standards such as-
Building
Man power
Instrument
Equipments
Drugs
Other facilities
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The standards prescribed are , a PHC covering 20000-30000 population with six beds on well the
block level PHC are ultimately going to be upgraded as CHC with 30 beds of providing
specialized services.
The objectives of IPHS for PHCs are:-
To provide comprehensive primary health care to the community through the PHC
To achieve and maintain an acceptable standards of quality of care
To make the services more responsible and sensitive to the needs of the community
Minimum requirements are:-
The assured services cover all the essentials of preventive, promotive, curative and rehabilitative
primary health care. This implies a wider range of services that includes
Medical care
Maternal and child health care
Full rage family planning services including counseling and appropriate referral for
couples having infertility
MTP services
Health education for prevention and management of malnutrition, anemia and vitamin A
deficiency and co-ordinates with ICDS
School health services
Adolescent health care
Disease surveillance and control of epidemics
Collection and reporting of vital events
Promotion of sanitation
Testing water quality
Nutritional health programme
Training health workers
Training of ASHA



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Staffing pattern
The man power that should be available in the PHC is as follows
STAFF EXISTING RECOMMENDED
Medical officer 1 3(at least 1 female)
AYUSH practitioner - 1
Accountant manager - 1
Pharmacist 1 2
Nurse midwife(staff) nurse 1 5
Health worker 1 1
Health educator 1 1
Health assistant (m/f) 2 2
Clerks 2 2
Laboratory technician 1 2
Driver 1 OPTIONAL / vehicle
may be from out side
Class IV 4

Major role of nurse in PHC
Facilitative role
Developmental role
Clinical role
Supportive role
Functions of PHC
Medical care
Maternal and child health
Control of communicable diseases
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Collection and reporting of vital statistics
Immunization services
Improvement in environmental sanitation
School health programmes
CHCs (community health centres)
Introduction
The community health centres are established and maintained by state government under
MNP/BMS programme. It has 30 indoor beds with x-ray labour room, operation theatre, and
laboratory facilities. It is managed by four medical specialists i.e. surgeon, physician,
gynecologist and pediatrician. On 31
st
march 2003, 3076 CHC were established each covering a
population of 80000 to 1.20 lakh.
Definition
Community health centres are the nonprofit community governed health organizations
that provide primary health care, health promotion and community development services, using
them inter disciplinary terms of health providers.
Principles
Excellence
Innovations
Accountability
Collaboration
Accessibility
Integrity
Environment

Elements
Primary care
Illness prevention
Health promotion
Community capacity building
Service integration

Standards of CHC
In order to provide quality care in CHCs IPHS are being prescribed to provide optimal expert
care to the community and achieve and maintain an acceptable standards of quality of care.
These standards would help to monitor and improve the functioning of CHCs.
CHCs has to provide the following services like
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Care of routine and emergency cases in surgery
Care of routine and emergency cases in medicine
24 hour delivery services
Essentials of emergency obstetric care.
Full range of family planning services including laparoscopic services
Safe abortion services
New born care
Routine and emergency care of sick children
Other management of medical and accidental conditions
All the national health programmes should be delivered through CHCs

PLANNING PROCESS
HEALTH IN FIVE YEARS PLANS
INTRODUCTION
Five years plan is mechanism to bring about uniformity in policy formulation in programmes of
national importance
The specific objectives of the health programme, during Five years plan, are as follows:
1. Control & eradication of major communicable diseases.
2. Strengthening of basic health services through the establishment of the PHC & sub
enters.
3. Population control.
4. Development of health manpower resources.
For the purpose of planning the health sectors has been divided in two following sub sectors.
1. Water supply & sanitation.
2. Control of communicable diseases.
3. Medical education, training & research.
4. Medical care including hospitals, dispensaries & PHCs.
5. Public health services.
6. Family planning.
7. Indigenous system of medicine.
FIRST FIVE YEAR PLAN (1951 1956)
The first Indian Prime Minister, Jawaharlal Nehru presented the first five-year plan to the
Parliament of India on 8 December 1951. The first plan sought to get the country's economy out
of the cycle of poverty. The plan addressed, mainly, the agrarian sector, including investments in
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dams and irrigation. The agricultural sector was hit hardest by the partition of India and needed
urgent attention.
[2]
The total planned budget of 206.8 billion was allocated to seven broad areas:
1) Irrigation and energy
2) Agriculture and community development
3) Transport and communications
4) Industry
5) Social services
6) Land rehabilitation
7) Other sectors and services
The specific objectives were;
1. Provision of water supply & sanitation.
2. Control of malaria.
3. Preventive health care of the rural population.
4. Health services for mother & children.
5. Education & training in health.
6. Self sufficiency in drug & equipments.
7. Family planning & population control.
During this plan period the public sector outlay was Rs. 2356 crore of which Rs. 140 crore were
allotted for health programs.

SECOND FIVE YEAR PLAN (1956-1961)
The second five-year plan focused on industry, especially heavy industry. Unlike the First
plan, which focused mainly on agriculture, domestic production of industrial products was
encouraged in the Second plan, particularly in the development of the public sector.
The plan followed the Mahalanobis model, an economic development model developed by
the Indian statistician Prasanta Chandra Mahalanobis in 1953. The plan attempted to determine
the optimal allocation of investment between productive sectors in order to maximize long-run
economic growth.
The specific objectives were;
1. Establishment of institutional facilities to serve as a basis from which service could be
render to the people both locally & surrounding territory.
2. Development of technical man power through appropriate training programmes.
3. Intensifying measures to control widely spread communicable disease.
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4. Encouraging active campaign for environmental hygiene.
5. Provision of family planning and other supporting services.
During this plan period the public sector outlay was Rs. 4,800 crore of which Rs. 225 crore were
allotted for health programs.

THIRD FIVE YEAR PLAN (1961-1966)
The third plan stressed on agriculture and improving production of rice
Many primary schools were started in rural areas. In an effort to bring democracy to the
grassroots level, Panchayat elections were started and the states were given more development
responsibilities.
State electricity boards and state secondary education boards were formed. States were made
responsible for secondary and higher education.
The specific objectives were in tuned with the 1
st
& 2
nd
five years plan except that integration of
public health with maternal & child welfare, nutrition & health education was planned.
During this plan period the public sector outlay was Rs. 7,500 crore of which Rs. 341.8 crores
were allotted for health programs.

FOURTH FIVE YEAR PLAN (1969-1974)
At this time Indira Gandhi was the Prime Minister. The Indira Gandhi government nationalized
Green Revolution in India advanced agriculture
Certain objectives of the Mudaliar committee were the base for this plan in relation to health.
1. To provide an effective base for health services in rural areas by strengthening the PHCs.
2. Strengthening of sub-division & district hospitals to provide effective referral services
for PHCs,
3. Expansion of medical & nursing education & training of Para medical personnel to meet
the minimum technical man power requirements.
During this plan period the public sector outlay was Rs. 16,774 crore of which Rs. 1,156 crore
were allotted for health programs.
FIFTH FIVE YEARS PLAN (1974-1979)
Stress was laid on employment, poverty alleviation, and justice. The plan also focused on self-
reliance in agricultural production and defense. In 1978 the newly elected Morarji Desai
government rejected the plan. Electricity Supply Act was enacted in 1975,
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The emphasis of the plan was on removing imbalance in respect of medical facilities &
strengthening the health infrastructure in rural areas.
Specific objectives to be pursued during the plan were:
1. Increase accessibility of health services to rural areas.
2. Correcting regional imbalance.
3. Further development of referral services.
4. Integration of health, family planning & nutrition.
5. Intensification of the control & eradication of communicable diseases especially malaria
& smallpox.
6. Quantitative improvement in the education & training of health personnel.

During this plan period the public sector outlay was Rs. 37,250 crore of which Rs. 3,277 crores
were allotted for health programs.
The sixth plan also marked the beginning of economic liberalization. Price controls were
eliminated and ration shops were closed. This led to an increase in food prices and an increase in
the cost of living.
Family planning was also expanded in order to prevent overpopulation. In contrast to China's
strict and binding one-child policy, Indian policy did not rely on the threat of force. More
prosperous areas of India adopted family planning more rapidly than less prosperous areas,
which continued to have a high birth rate.

SEVENTH FIVE YEAR PLAN (1985-89)
The main objectives of the 7th five year plans were to establish growth in the areas of increasing
economic productivity, production of food grains, and generating employment opportunities.
The thrust areas of the 7th Five year plan have been enlisted below:
Social Justice
Removal of oppression of the weak
Using modern technology
Agricultural development
Anti-poverty programs
The objectives were
1. Eliminate poverty & illiteracy by 2000
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2. Achieve near full employment secure satisfaction of the basic needs of food, cloth,
shelter
and provide health for all.
3. To provide an effective base for health services in rural areas by strengthening the PHCs.
4. universal immunization programme
5. Promotion of voluntary acceptance of contraceptives
During this plan period the public sector outlay was Rs. 1.80.000 crores of which Rs. 3,392
crores were allotted for health programs.
Period between 1989-91
P.V. Narasimha Rao was the twelfth Prime Minister of the Republic of India and head of
Congress Party
1989-91 was a period of political instability in India and hence no five year plan was
implemented. Between 1990 and 1992, there were only Annual Plans.

EIGHTH FIVE YEAR PLAN (1992-97)
India became a member of the World Trade Organization on 1 January 1995.This plan can be
termed as Rao and Manmohan model of Economic development. The major objectives included,
containing
1. population growth,
2. poverty reduction,
3. employment generation,
4. strengthening the infrastructure,
5. Institutional building,tourism management,
6. Human Resource development,
7. Involvement of Panchayat raj,
8. Nagarapalikas,
9. N.G.Os and
10. Decentralization and people's participation.
It is based on the national health policies.
1. Human development is the ultimate goal of this plan.
2. Employment generation, population control literacy, education, health, drinking water &
provision of adequate food &basic infrastructure.
3. Towards health for the underprivileged was the of the aim of this plan.
The PHCs were strengthened staff vacancies, by supplying essential equipment &drugs.
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AIDS control program was initiated during this plan.

NINTH FIVE YEAR PLAN (1997-2002)
Ninth Five Year Plan India runs through the period from 1997 to 2002 with the main aim of
attaining objectives like speedy industrialization, human development, full-scale employment,
poverty reduction, and self-reliance on domestic resources.
Background of Ninth Five Year Plan India: Ninth Five Year Plan was formulated amidst the
backdrop of India's Golden jubilee of Independence.
The main objectives of the Ninth Five Year Plan India are:
to prioritize agricultural sector and emphasize on the rural development
to generate adequate employment opportunities and promote poverty reduction
to stabilize the prices in order to accelerate the growth rate of the economy
to ensure food and nutritional security
to provide for the basic infrastructural facilities like education for all, safe drinking water,
primary health care, transport, energy
During this plan, vertical health program were integrated horizontally with general health
services.
The Reproductive & child health program was improved under following guidelines;
1. Decentralize RCH to the level of PHCs.
2. Base planning for RCH services on assessment of the local needs.
3. Meet the needs of contraceptives
4. Involve the general practitioners & industries in family welfare work.

TENTH FIVE YEAR PLAN (2002-2007)
Reduction of poverty ratio by 5 percentage points by 2007;
Providing gainful and high-quality employment at least to the addition to the labour
force;*All children in India in school by 2003; all children to complete 5 years of
schooling by 2007;
Reduction in gender gaps in literacy and wage rates by at least 50% by 2007
This plan has laid down the following targets
Bring down the decadal growth rate by 16.2% in the decade from 2001 to 2011.
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Reduce infant mortality rate to 35/1000 live births by 2007 & to 28/1000 live births by
2012
Reduce maternal mortality rate to 2/1000 live births by 2007 & 2/1000 live births by
2012.
To achieve the above, the government is planning to do the following
1. Restructure existing health infrastructure.
2. Upgrade the skills of health personnel
3. Improve the quality of reproductive & child health
4. Improve logistic supplies.
5. carry out the research on nutritional deficiency
6. Promote rational drug use.

ELEVENTH PLAN (2007-2012)
1. Income & Poverty
o Create 70 million new work opportunities.
o Reduce educated unemployment to below 5%.
o Raise real wage rate of unskilled workers by 20 percent.
2. Education
o Reduce dropout rates of children from elementary school from 52.2% in 2003-04
to 20% by 2011-12
o Develop minimum standards of educational attainment in elementary school, and
by regular testing monitor effectiveness of education to ensure quality
o Increase literacy rate for persons of age 7 years or above to 85%

3. Health
o Reduce infant mortality rate to 28 and maternal mortality ratio to 1 per 1000 live
births
o Reduce Total Fertility Rate to 2.1
o Provide clean drinking water for all by 2009 and ensure that there are no slip-
backs
o Reduce malnutrition among children of age group 0-3 to half its present level
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4. Women and Children
o Raise the sex ratio for age group 0-6 to 935 by 2011-12 and to 950 by 2016-17
o Ensure that at least 33 percent of the direct and indirect beneficiaries of all
government schemes are women and girl children
o Ensure that all children enjoy a safe childhood, without any compulsion to work
5. Infrastructure
o Ensure electricity connection to all villages and BPL households by 2009 and
round-the-clock power.
o Ensure all-weather road connection to all habitation with population 1000 and
above (500 in hilly and tribal areas) by 2009, and ensure coverage of all
significant habitation by 2015
o Connect every village by telephone by November 2007 and provide broadband
connectivity to all villages by 2012
o Provide homestead sites to all by 2012 and step up the pace of house construction
for rural poor to cover all the poor by 2016-17
6. Environment
o Increase forest and tree
o Attain WHO standards of air quality in all major cities by 2011-12.
o Treat all urban waste water by 2011-12 to clean river waters.
o Increase energy efficiency by 20 percentage points by 2016-17.
I. Various health and family welfare committees
1. Bhore committee
In 1946, the recommendations and guidance provided by the Bhore Committee formed
the basis for organization of basic health services in India. The report was submitted to
the government.-side was the focal point of these recommendation
The Bhore Committee made two types of recommendations;
a) A Comprehensive blue print for the distant future (20 to 40 years from then) and the
smallest service unit was to be Primary Health Unit, serving a population of 10,000 to
20,000
b) A short-term scheme covering 2 to 5 years period from then with emphasis on setting up
30 bedded hospitals, one for every two Primary Health Care

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The country side was the focal point of these recommendations. Other
recommendations were:
Formation of village health committee to secure active cooperation and support in the
development of health program.
Provision of Doctors of future who should be Social Doctor, combines both
curative and preventive of the public.
Formation of District Health Board for each district with district health officials and
representatives of the public.
To ensure suitable housing, sanitary surroundings, safe drinking water supply
elimination of unemployment and lay special emphasis on preventive work.
2. Mudaliar committee 1962
In 1959, the Government of India appointed another committee known as Health Survey
and Planning Committee popularly known as Mudaliar Committee under the
Chairmanship of Dr. A.L mudaliar.
Recommendations:
a) Consolidation of advances made in the first two-year plans
b) Strengthening of the district hospital with specialist services
c) Regional organizations in each state
d) Each primary health centre not to serve more than 40,000 populations.
e) To improve the quality of health care provided by primary health centres
f) Integration of medical and health services on the pattern of Indian Administrative
service.
3. Chadah Committee, 1963
Under the chairmanship of Dr. M.S. Chadah, Government of India appointed a committee
to study the arrangement necessary for the maintenance phase of the National Malaria
Eradication Programe.
Recommendations
1. Vigilance operations in respect of the NMEP should be the responsibility of the
general health services (e.g.) PHC.
2. The vigilance operations should be should be done through monthly home visits by
basic workers (Junior Health Assistant male)
3. Now each Junior Health Assistant Male to cover 3 5000 population
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4. Mukherjee Committee, 1965
Under the chairmanship of Shri Mukerji, the then secretary of health to the Government
of India was appointed to review the strategy for the family planning program.
Recommendations
To have separate staff for the family planning program.
The family planning assistants were to undertake family planning duties only
The basic health workers were to be utilized for purposes other than family planning.
To delink the malaria activities from family planning of its that the later would receive
undivided attention of its staff.
Mukherjee Committee, 1966
Multiple activities of the mass programmes like family planning, small pox, leprosy,
trachoma, etc. were making it difficult for the states to undertake these effectively because of
shortage of funds. A committee of state health secretaries, headed by the Union Health
Secretary, Shri Mukherjee, was set up to look into this problem.
5. Jungalwalla Committee, 1967
Under the Chaimanship of Dr. Jungalwalla Director, National Institute of Health
Administration and Education, New Delhi was appointed to examine the various
problems of service conditions of doctors. This committee is known as the committee on
integration of Health Services.
Recommendation
1. The main steps recommended towards integration were
a) Unified cadre
b) Common Seniority
c) Recognition of extra qualifications
d) Equal pay for equal work
e) No private practice and good service conditions
6. Kartar Singh committee, 1973
The Government of India constituted a committee in 1922, known as the committee on
multipurpose workers under Health and Family Planning, under the Chairmanship of
kartar Singh, Additional Secretary, Ministry of Health and Family Planning, Government
of India.

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Recommendations
The Present Auxiliary Nurse Midwives to be replaced by the newly designated Female
Health Workers and the present day Basic Health Workers, malaria surveillance
workers, vaccinators, health education assistants (Trachoma)and the family planning
health assistants to redesignated by Male Health Workers.
The program has to be introduced in areas where malaria is in maintenance phase and
smallpox has been controlled and later to other areas.
One primary health centre for 50,000 populations.
Each PHC should be divided into 16 sub centers and each covers 3,000 to 35, 00
population.
Each sub centre to be staffed by a male and female health worker.
One male health supervisor to supervise 3 to 4 male health workers and one female health
supervisor to supervise the work of 4 female health workers.
The lady health visitors to be designated as female health supervisors.
The doctor in charge of a primary health centre should have the overall in charge of all
the supervisors and health workers in the area.
7. Shrivastav Committee, 1975
The Government of India in the Ministry of Health and Family Planning had in
November 1974 set up a Group on Medical Education and Support Manpower
popularly known as Shrivastav Committee.
Recommendations
Creation of bands of paraprofessional and semiprofessional health workers from within
the community itself (e.g. school teachers, postmasters, gram sevaks) to provide simple
promotive, preventive and curative health services needed by the community.
Establishment of 2 cadres of health workers, namely multipurpose health workers and
health assistants between the community level workers and doctors at PHC.
Development of a Referral Services Complex by establishing proper linkages between
PHC and higher level referral services.
Establishment of a Medical and Health Education Commission for planning and
implementing the referrals needed in health and medical education on the lines of the
University Grants Commission.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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8. Balaji Committee 1986-19877
The Ministry of Health and Family welfare, Government of India, following the adoption
of the National Policy on education, 1986, set-up a committee on Health Manpower,
Planning, Production and Management in 1986 under the chairmanship of Prof. JS Balaji,
Professor of Medicine, AIIMS, and New Delhi
Recommendations
To formulate a National Policy on education in Health Services
To prepare curriculum for schoolteachers this should constitute a holistic approach
including social, moral, health and physical education.
Health service statistics needs to be improved in quality
To utilize the services of Indian system of medicine viz. Homeopathy, in the area of
National Health Program.
Health related components to be included in IX, X Grades
Continuing education program for the health personnel.
Health manpower requirements for nursing personnel.
NATIONAL HEALTH POLICY - 2002
Introduction
National Health Policy was last formulated in 1983, and since then there have been
marked changes in the determinant factors relating to the health sector. Some of the policy
initiatives outlined in the NHP-1983 have yielded results, while, in several other areas, the
outcome has not been as expected.
Current scenario
Financial resources: The public health investment in the country over the years has been
comparatively low, and as a percentage of GDP has declined from 1.3 percent in 1990 to 0.9
percent in 1999. The aggregate expenditure in the Health sector is 5.2 percent of the GDP. Out of
this, about 17 percent of the aggregate expenditure is public health spending, the balance being
out-of-pocket expenditure.
Equity: In the period when centralized planning was accepted as a key instrument of
development in the country, the attainment of an equitable regional distribution was considered
one of its major objectives.
Delivery of national public health programmes
Extending public health services
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Policy of devolving programmes and funds in the health sector through different levels of
the Panchayati Raj Institutions.
Need for specialists in public health and family medicine
Use of generic drugs and vaccines
Urban health, Mental health, Womens health
Information, education and communication
Health research and National disease surveillance network
Health statistics and Medical ethics
Enforcement of quality standards for food and drug
Regulation of standards in para medical disciplines
Environmental and occupational health
Providing medical facilities to users from overseas
Globalization on the health sector
Objectives
- The main objective of this policy is to achieve an acceptable standard of good health
amongst the general population of the country.
- Decentralized public health system by establishing new infrastructure in deficient areas,
and by upgrading the infrastructure in the existing institutions.
- Ensuring a more equitable access to health services across the social and geographical
expanse of the country.
- Emphasis will be given to increasing the aggregate public health investment through a
substantially increased contribution by the Central Government.
- Strengthen the capacity of the public health administration at the State level to render
effective service delivery.
NHP-2002 - Policy prescriptions
Financial resources
Equity
Delivery of national public health programmes
The state of public health infrastructure
Extending public health services
Role of local self-government institutions
Need for national health policy
Population stabilization
Medical and Health Education
Providing primary health care with special emphasis on the preventive, promotive and
rehabilitative aspects
Re-orientation of the existing health personnel
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Practitioners of indigenous and other systems of medicine and their role in health care
AYUSH
The Indian Systems of Medicine and Homoeopathy (External website that opens in a new
window) (ISM&H) were given an independent identity in the Ministry of Health and Family
Welfare in 1995 by creating a separate Department of Ayurveda, Yoga and Naturopathy, Unani,
Siddha and Homoeopathy (External website that opens in a new window) (AYUSH) in
November 2003.
The infrastructure under AYUSH sector consists of 1355 hospitals with 53296 bed capacity,
22635 dispensaries, 450 Undergraduate colleges, 99 colleges having Post Graduate Departments,
9,493 licensed manufacturing units and 7.18 lakh registered practitioners of Indian Systems of
Medicine and Homoeopathy in the country.
Budget: An outlay of Rs.775 crore has been allocated for the Department during the Tenth Five-
year Plan. The Plan allocation for 2006-07 is Rs. 381.60 crore.
Subordinate Offices
Pharmacopoeial Laboratory for Indian Medicine (PLIM)
Homoeopathic Pharmacopoeial Laboratory (HPL)
Ayurved Hospital, Lodhi Road, New Delhi
National Population Policy of India
Population Policy pursues to achieve following Socio-Demographic goals by 2010:
Address the unmet needs for basic reproductive and child health services, supplies and
infrastructure.
Make school education up to age 14 free and compulsory, and reduce dropouts at primary and
secondary school levels to below 20 percent for both boys and girls.
Reduce infant mortality rate to below 30 per 1000 live births.
Reduce maternal mortality ratio to below 100 per 100,000 live births.
Achieve universal immunization of children against all vaccine preventable diseases.
Promote delayed marriage for girls, not earlier than age 18 and preferably after 20 years of
age.
Achieve 80 percent institutional deliveries and 100 percent deliveries by trained persons.
Achieve universal access to information/counseling, and services for fertility regulation and
contraception with a wide basket of choices.
Achieve 100 per cent registration of births, deaths, marriage and pregnancy.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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UNIT II



Management
Functions of administration
Planning and control
Co-ordination and delegation
Decision making decentralization basic
goals of decentralization.
Concept of management
Nursing
management
Concept, types, principles and techniques
Vision and Mission Statements
Philosophy, aims and objective
Current trends and issues in Nursing
Administration
Theories and models
Application to nursing service and
education
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Management: Refer unit 1
Functions of administration: Refer unit 1
PLANNING AND CONTROL
Planning
Planning means to decide in advance what is to be done. It charts a course of actions for the
future. It is an intellectual process and it aims to achieve a coordinated and consistent set of
operations aimed at desired objectives.
Essentials of good planning
Yields reasonable organizational objectives and develops alternative approaches to meet
these objectives.
Helps to eliminate or reduce the future uncertainty and chance.
Helps to gain economical operations.
Lays the foundation for organizing.
Facilitates co-ordination.
Helps to facilitate control.
Dictates those activities to which employers are directed.
Controlling
Controlling can be defined as the regulation of activities in accordance with the
requirements of plans.
Steps of control:
o The control function, whether it is applied to cash, medical care, employee morale
or anything else, involves four steps.
1. Establishments of standards.
2. Measuring performance
3. Comparing the actual results with the standards.
4. Correcting deviations from standards.

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CO-ORDINATION AND DELEGATION
CO-ORDINATION
Definitions
Co-ordination is the integrating process in an orderly pattern of group efforts in an organization
toward the accomplishment of a common objective.
Co-ordination is the orderly arrangement of group efforts to provide unity of an action in pursuit
of common purpose.
Co-ordination is the orderly synchronization of efforts to provide the proper amount, timing and
directing of execution resulting in harmonious and unified actions to a stated objective. (NEW
MAN,1953)
Characteristics
- Group effort: The financial, human and technical resources are properly organized and
co-ordinate.co-ordination transcends and permeates all managerial functions.
- Unity of action: Co-ordination applies to the group effort, not individual effort, co-
ordination stress the unity of effort and unity of action.
Common purpose
Effective co-ordination is good management. Co-ordination is not a one-shot deal.
It is a never ending process of ensuring the achievement of organizational goals
effectively.
Important features of co-ordination
- Co-ordination is a integrity process.
- If subdivision of work is in escapable, co-ordination becomes mandatory.
- Undue confusion is a symptom of poor co-ordination.
- Co-ordination is a process. It is a process of achieving integration among different
organizational units.
- Unity of effort is the heart of co-ordination problem. The idea that co-ordination is a
fixed entity that either exists or does not exist is totally unrealistic.co-ordination is
present in all organizations but in varying degrees.
- The chief objective of co-ordination is a common purpose.
Principles of co-ordination
Co-ordination is a process whereby an executive develops an orderly pattern of group effort
among his subordinates and secures unity of action in the pursuit of common objectives. Co-
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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ordination is the continuous and dynamic process and emphasizes unity of efforts of achieve the
desired objectives. Co-ordination the managerial responsibility.
1. Principle of direct contact: co-ordination can be achieves by direct contact among the
responsible people concerned. Co-ordination can be easily obtained by direct
interpersonal relationships and direct personal communications.

2. Principle of early stages: co-ordination should start from the very beginning of planning
process. At the time of policy formulation and objective setting.

3. Reciprocal relationships: As the third principle: all factors in a situation are reciprocally
related, in other words all the parts influence and are influenced by other parts. For
example when A works with B and he is turn works with C and D, each of the four finds
himself influenced by others influenced by the people in the total situation.

4. Principles of self co-ordination: in this when a particular department affects other
function or department or function in turn affected, may not have direct control over the
other department that is influencing the said department.

Importance of co-ordination
Co-ordination is crucial factor in the survival of any enterprise.
It resolves conflicts between line and staff inter-department, intra-departmental conflicts
and restores harmony in operations.
It results in the accomplishment of organizational goals
It helps to increase the effectiveness of management
Co-ordination helps to increase the effectiveness of management in the following ways
Co-ordination pulls all the function and activities together
Co-ordination brings unity of action and direction. it resolves effectively the dangerous
conflicts between individual and organizational goals.
Activities are dividing and sub-divide in organizations.
Modern organizations are considered as open system these open systems are
characterized by information flows, resource flows, and the flow of activities.
Co-ordination ensures the smooth flow of resources into productive units and brings
required quality output.



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Techniques to achieve co-ordination
1. Co-ordination by rules or procedures
In the work that need to be accomplished is highly predictable and hence can be planned in
advance, a manager can specify a head of time what actions his subordinating the routine
rescuing activities, rules and procedures are helpful which specify in detail a head of time, what
courses of action the subordinates should take if some situation should arise.
2. Co-ordination by targets or goals
Most of the managers assign specific goals/ targets to their subordinates facilitate co-ordination.
3. Co-ordination through hierarchy
Rules, regulations and procedures as well as the goals apart, managers also use the chain of
command to achieve co-ordination. When situations arise the specified rules or targets do not
cover that, subordinates are trained to bring the problem to their concerned manager. Co-
ordination through the hierarchy works well as long as the number of problems that must be
brought to the boss is not great.
4. Co-ordination through departmentalization
Departmentalization also serves as a technique to bring about effective co-ordination. Some
forms of departmentalization also facilitate co-ordination better than do others. a matrix
approach means each project has the continuous and undivided attention of its own project
manager and the project team.
5. Using a staff assistant for co-ordination
To make his job of coordinating easier, a manager may hire an assistant. When subordinate
brings a problem to him, the assistant can comic the information on the problem, research the
problem, provide alternative solutions available. This increases, undoubtedly, the managers
ability to handle the problems and coordinate the work of his subordinates.
6. Using a liaison for coordination
In some big organizations where the volume of contacts between two departments grows, many
managers appoint a special liaison person to facilitate coordination.
7. Using committee for coordination
Another sound technique of coordination is to from committee for understanding various
functions and problems. Committees are increasingly useful for coordinating, planning and
executing programs and controlling the various activities..
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8. Using independent integrators for coordination
In some special circumstances, independent integrator may be recruited by organizations. An
independent integrators job is to coordinate the activities of several interdependent
departments..
9. Conferences
Conferences at regular intervals also ensure better coordination. Conferences provide adequate
platform for discussion of various problems being encountered by different departments.
10. The techniques of communication
To promote coordination, communication system must be perfect. It must be well designed.
Communication is an artery through which the decisions flow top to bottom and reports flow
from bottom to top.
11. Miscellaneous
Other coordinating techniques include :grouping the similar activities, reorganization of
departments to ensure coordination, cross functioning of the departments, project management
organization hierarchy, planning techniques, creation of certain staff positions, periodical staff
meetings ect.
Types of co-ordination
Coordination can be classified into two broad categories, one on the basis of its shape in the
organization and other on the basis of its scope and coverage. On the former basis, it can be
classified into vertical and horizontal coordination and on, the latter basis, into internal and
external coordination.
1. Vertical and horizontal coordination
The term vertical coordination is used when coordination is to be achieved between various links
or different levels of the organization vertical coordination is needed to ensure that all the levels
in the organization act in harmony and in accordance with organizational policies and
programmers. It is the function of the top executives to bring about this co-ordination. Vertical
coordination is secured through delegation of authority and with the help of directing and
controlling.
The term horizontal coordination is used when coordination has to be achieved between
departments on the same level in the management hierarchy. Thus, when coordination is brought
between production department, sales department, personnel department etc it is said to be
horizontal coordination.
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2. Internal and external coordination
Coordination may be internal or external to be organization. Coordination is internal when it is
achieved between different departments, sections, and units of an enterprise. It is both vertical
and horizontal.
The various factors with whom it has interaction include government, customs, supplies and
competitors. An enterprise has to keep proper coordination with these. Such type of coordination
is known as external co-ordination and it is essential for the survival of the enterprise. External
coordination also involves interaction with other business, economic and research institutions to
have the benefits of latest information and technological advances.
DIFFICULTIES OF CO-ORDINATION
Lack of coordination and understanding between and among individuals, groups, and
departments.
lack of good interpersonal relations
failure in accomplishing objectives according to time and work schedule
Lack of direction and consequently aimless individual efforts.
Functioning of departments in the organization as watertight compartments.
Lack of initiative and loyalty towards the organization.
DELEGATION
Delegation is defined as transferring of responsibility to subordinates on behalf of the manager.
It is an act through which a manager gives authority to others to attain certain assignments.
Salient Features:
1. Not to delegate total authority
2. Not to delegate authority which he himself does not possess
3. Should be only for organisational purpose and not personal purpose
4. It does not imply reduction in power
Characteristics:
1. Delegation of authority can be exercised only by higher authority
2. Delegation can be of any kind
3. Delegation does not mean transfer of final authority
4. Does not involve surrender of power
Kinds of delegation:
1. Full delegation
2. Partial delegation
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3. Conditional delegation
4. Formal delegation
5. Informal delegation
Principles of delegation:
1. Should be written and specific
2. Authority and responsibility should be equal
3. Should be properly planned and exercised
4. Right person should be chosen
5. Good reporting system should be established
6. Should have certain objectives to get certain results
7. Superiors should be ready to give support and guidance
8. Overall responsibility lies with the superior
Symptoms of poor delegation
1. Dissatisfied subordinates
2. Disorganized effort
3. Long queue in front of boss office
4. Boss always busy
5. Boss carrying big suitcase
6. Work never completed in time
7. Constant time pressure
8. Hold up of activities due to pending orders from boss
Decision making- decentralization basic goals of decentralization.
Definition
Decision making is a systematic process of choosing among alternatives and putting the
choice in to action. -Lancaster and Lancaster
Decision making is a necessary component of leadership, power, influence, authority and
delegations. -John 1993
Decision making process is a conscious, intellectual activity involving judgment, evaluation
and selection from among several alternatives. -According to Claude
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Types of decision making
There are 4 managerial decisions
a. Mechanistic decision b. Analytical decision
c. Judgmental decision d. Adoptive decision
Mechanistic decision
Routine and repetitive in nature
It usually occurs in a situation involving a limited number of decision variables where the
outcome of each alternative is known.
Tools used for these kinds of decisions are charts, list, decision tree etc.
Analytical decision
This decision helps to solve the complex problems.
It involves a problem with a large number of decision variables where the outcome of
each decision alternatives can be computed.
Computational techniques involve linear programming and statistical analysis.
Judgmental decision
Decision involves a problem with a limited number of decision variables but the out of
the decision alternatives are unknown.
These types of decision are useful in marketing investment and to solve the personal
problems.
Adaptive decision
Decisions involving a problem with a large number of decision variables where outcomes
are not predictable.
Such ill structured problems require contribution of many people with diverse technical
background. Eg. Research finding.
1. Nursing Administration decision making
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According to Ann Bill Taylor
a. Non routine decision: made by directors of nursing. The out of the problem will be
unpredictable. Eg. Changing ways of organizing for the delivery of nursing care.
b. Routine decision: Routine decision: made by mid level and low level managers, the
outcome will be predictable. Eg. Assigning the duty roster, assign the security laws.
Generally decisions are broadly divided into two categories:
1. Typical, routine, unimportant decisions
2. Important, vital or strategic decisions
Routine decisions: Involve no extraordinary judgment, analysis and authority, since they are
dealing with less important problems. Routine decisions demand power to select the shortest
path, within the given means and ends.
Strategic decisions: Aim at determining or changing the means and ends of the enterprise. They
require a thorough study, analysis and reflective thinking on the part of administrators. Strategic
decisions are usually taken by top managers, while routine decisions are made mostly by lower
level managers.
DECISION STRATEGIES
A strategy is an artful or cleaver plan for applying technique in pursuit of a goal. Before
selecting any method of decision manager should adopt a decision strategy. Some strategy suited
for some type of problems than others, they are;
1. Optimizing: It is an approach in which an individual analyze a problem, determines desired
out comes, identifies possible solutions, predict the consequences of each actions, and select
the courses that yields the greatest amount of preferred outcomes.
2. Satisfying: It is an approach, where by an individual chooses a problem solutions, and then
select best of remaining options.
3. Mixed scanning: making a decision that satisfies to remove least promising solutions, and
then select best of remaining options.
4. Opportunistic: making a decision for the solution chosen by problem identifier.
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5. Do nothing: taking decision after waiting for the storm to pass.
6. Eliminate critical limiting factor: making a decision by removing most powerful obstacle
to success.
7. Maxima: an optimistic approach in which, while assuming the highest possible p ay off
from use of any action the individual chooses that action alternative that will yield the
largest pay off.
8. Mini-regret: an approach designed to minimize the surprise resulting from any action
decision by selecting the action alternative that will yield a result midway between the most
desired and the least desired out comes.
9. Precautionary: making a decision by choosing the action that will maximize gain of
minimize loss regardless of opponents actions. It is useful when the manager engaged in a
zero sum conflict with another.
10. Evolutionary: while taking a decision individual has to make series of small changes
leading towards goal. It is based on the assumption that subordinates can better adjust to
series of small changes than a quantum leap.
11. Chameleon: taking a decision by making vague plan, adjusted to changing circumstances.
It consists of farming management decision in general terms, so that they can be interpreted,
differently at different times.
Time and basis for decision making
There are six important bases for decision making which are referred to as aids to
decision making and they include experience, authority, facts, intuition, research, analysis and
experimentation.
1. Experience: Experience is the most important and valued basis for making decisions.
Experience gives the administrator the requisite vision, that trains him to apply his
knowledge to the best of its use and that helps him to recognize the crucial factors from
unnecessary details.
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2. Authority: Provides an important basis for enabling managers to take quick and sound
decisions.
3. Facts: Provide the solid basis for decision making. Decisions become wrong only when
adequate facts are not available on the problem. The computer technology has been
introduced for supplying greater facts to operating managers.
4. Intuition: It is the residuary basis for covering up deficiencies in other three bases of
decision making. It includes guess work, and common sense views.
5. Research and analysis: These are the most effective basis for choosing among alternatives.
It helps in finding out relationships among the other important variables.
6. Experimentation: This provides another means by which various alternatives can be
evaluated. Since experimentation becomes and expensive basis for decision making in many
cases, it is used sparingly for indicating the best course of actions in problems like policy
formation, product development, introduction of new organizational technique etc.
Factor affecting decision making
Internal factors
Decision makers physical and emotional status
Personal characteristics and values
Past experience and interest
Knowledge and Attitude
Self awareness and courage
Energy and creativity
Resistance to change
Sensitivity and flexibility
External factors
Cultural environment
Philosophical environment
Social back ground
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Time
Poor communication
Cooperation
Coordination
Steps in decision making
1. Making the diagnosis
2. Analysing the problem
3. Searching alternative solutions
4. Selecting best possible solution
5. Putting the decision into effect
6. Following up the decision
1. Making the diagnosis
The first step is to determine what the real problem is?. If the problem is not ascertained
correctly at the beginning, money and effort spent on the decision making will be a waste. The
original situation will not come under control. But new problems will start from this incorrect
appraisal of the situation.
2. Analyzing the problem
The problem should be thoroughly analysed to find out adequate background information
and data relating to the situation. This analysis may provide the manager with some revealing
circumstances that will help him to gain an insight into the problem. The whole approach should
be based around the important factors. Only pertinent and closely connected factors are selected,
as dictated by the principle of the limiting or strategic factor.
3. Searching alternative solution
After anodizing the problem attempts are made to find alternative solutions to the
problem. In the absence of alternatives decision making process will become.
4. Selecting best possible solution
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Selection of one best course of action among the several alternatives developed; require
an ability to draw distinctions between tangible and intangible factors as well as facts and
guesses. The four criteria have been suggested by Dracker in selecting the best solution.
1. Proportion of risk to the expected gain.
2. Relevance between the economy of effort and the possibility of results.
3. The time considerations that meet the needs of the situation.
4. The limitation of recourses.
Instead of picking the best solution managers have to really on a course of action that is
satisfactory enough under the existing circumstances and limitations.
5. Putting the decision in to effort
The decisions can be made effective through the action of other people. In order to
overcome the opposing on the part of employees managers can make three important
preparations.
a. Communication of decisions
b. Securing employee acceptance
c. The timing of decisions
6. Follow up the decision
As a safe guard against the incorrect decisions managers are required to a system of
follow up care of the decisions so as to modify them at the earliest.
Decision making authorities
1. Individual
2. Group
3. Committees


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Individuals as decision makers
The autocratic managers fears that decisions made by others may be more costly, less
effective and represents a threat to his/ her position. There are mainly 3 behavioural
characteristics that influence the decision making.
Perception of the problem: it is affected by ones previous experience and value system.
Personal value system: basic convictions about what is right, good or desirable.
The role theory: it predicts how actions will be performed in certain roles and how it will
be affected certain circumstances. Specific behaviour associated with position constitutes
roles.
Group factors in decision making
Group comprises two or more people who share common interest and come together to
accomplish an activity through face to face interaction. Commitment to the decision and to the
implementation is important and may be increased by participation in the decision making
process.
Advantages of group participation
Increasing self expression, innovation and development.
Increases the commitment.
Disadvantages of group participation
Change in the participants may create problems.
Few people may dominate in the group.
Members may become more interested in arguments and winning than finding a solution.
The decisions can be most acceptable but not optional.
Committee Aspects in Decision Making
A committee a group of people chosen to deal with a particular topic or problem. It can
be formal or informal committee. A committee appointed to collect data analyze finding make
recommendations is an ad hoc committee.
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Advantages of decision making by committee
Time consuming
Expensive
Indecisiveness can be result in the adjournment of the committee.
Pressure for unanimity discourages creativity from the members.
Models of decision making
1. The Normative Model
2. The Decision Tree Model
3. The Descriptive Model
4. The Strategic Model
5. Optimizing Model
6. Satisfying Model
1. The Normative Model
This model is at least 200 years old. It is assumed to maximize satisfaction and fulfils the
perfect knowledge assumption that in any given situation calling for a decision, all possible
choices and the consequences and potential outcome of each are known. Seven steps are
identified in this analytically precise model:
a. Define and analyze the problem.
b. Identify all available alternatives.
c. Evaluate the pros and cons of each alternative.
d. Rank the alternatives.
e. Select the alternative that maximizes satisfaction.
f. Implement.
g. Follow up.
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The normative model for decision making is unrealistic because of its assumption that there are
clear-cut choices between identified alternatives.
Vroan and Yeltons Normative M odel
They define decision making as a social process and emphasis how mangers work rather
than should behave in their normative way. It is used when information is rather than should
behave in their normative way. It is used when information is objective, the problem is structured
or routine, and options are known and predictable. They identified 5 alternative decision making
process:
A- Autocratic
C Consultative
G Group
I First variant
II Second variant
AI making decision by yourself using information available to you at that time.
AII obtain necessary information from your subordinates then decide on a solution to your
problem. But subordinates will be unaware about the problem.
CI - shares the problem with subordinates individually, and gets their ideas and suggestions.
Then you make a decision that may or may not reflect your subordinates influence.
CII- you share the problem with subordinates as a group, together you generate and evaluate
alternatives and attempt to reach agreement on a solution. You do not try to influence the group
to adopt your solutions but are willing to accept and to implement any solution that has the
support of the entire topic.
GI is applicable only in more comprehensive models.
Vroan identified 7 rules that do most of the work of the model. Three rules protect the decision
and quality and four rules protect the acceptance.
The information rule: If the quality of decision is important and the leader doesnt poses
adequate information to solve the problem then AI is eliminated from the feasible set.
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The goal congruence rule: if the quality of decision is important and the subordinates do
not share the organizational goals to be obtained in solving the problem then GII is
eliminated.
The unstructured problem rule: If the quality of decision is important and the leader
doesnt poses adequate information to solve the problem and if the problem is
unstructured then eliminate AI, AII, and CI.
The acceptance rule: If the acceptance of the decision by the subordinates is critical for
the effective implementation, if it is uncertain that an autocratic decision made by the
leader would receives the acceptance then AI, AII are eliminated from the feasible set.
The conflict rule: if the acceptance of the decision is critical and if it is uncertain that an
autocratic decision made by the leader would receives the acceptance and subordinates
are likely to be in conflict over the appropriate solution then AI, AII, CI is eliminated
from the feasible set.
The fairness rule: if the quality of the decision is unimportant, acceptance is critical, and
an uncertain to result from an autocratic decision. AI, AII, CI and CII are eliminated.
The acceptance priority rule: if acceptance is critical, not assured by an autocratic
decision and if subordinates can be trusted then AI, AII, CI, and CII are eliminate.
2. The Decision Tree Model
Various adaptations of decision tree analysis are found in the literature; the essential
elements described in the 1960s are standard. All factors considered important to a decision can
be represented on a decision tree. Vroom arranged answers to seven diagnostic questions in the
form of a decision tree to identify types of leadership style used in management decision making
models. The questions focus on protecting the quality and acceptance of the decision and deal
with adequacy of information, goal congruence, structure of the problem, acceptance by
subordinates, conflict, fairness, and priority for implementation.
Magee and Brown depict decision trees as starting with a basic problem and use branches
to represent event forks and action forks. The number of branches at each fork corresponds
to the number of identified alternatives. Every path through the tree corresponds to a possible
sequence of actions events, each with its own distinct consequences. Probabilities of both
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positive and negative consequences of each action and event are estimated and recorded on the
appropriate branch.

A1
A2

A3

Alternatives A4


Chance events Probable consequences
3. The Descriptive Model
Simon developed the descriptive model based on the assumption that the decision maker
is a rational person looking for acceptable solutions based on known information. This model
allows for the fact that many decisions are made with incomplete information because of time,
money, or people limitations, and the cause of time, money, or people limitations, and the fact
that people do not always make the best choices. Simon wrote that few decisions would ever be
made if we always sought optimal solutions. Instead, he contended, we identify acceptable
alternatives. Steps in the descriptive model are as follows:
a. Establish acceptable goal.
b. Define subjective perceptions of the problem.
c. Identify acceptable alternatives.
d. Evaluate each alternative.
e. Select alternative.
f. Implement decision.
g. Follow up.
Decision point 1
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The descriptive model may lend itself well to nurses faced with daily decision making
that must be completed rapidly and with significant consequences. Steps in the model are not
unlike those in the familiar nursing process, although the sequencing is different. Readers may
readily identify conditions in their own environments similar to those described by Simon and
see immediate application of this model. Lancaster and Lancaster illustrated the use of this
model for nursing administrators.
4. The Strategic Model
Strategic decision making usually relates to long-range planning. As an example,
hospitals are beginning to merge, and certainly nursing departments will be affected. Among the
decisions that will be made are the need for one top manager or department head versus two or
more, whether to decentralize and eliminate middle managers, and what maximize the use of
scarce resources and provide for their efficient use.
Nagelkerk and Henry used a model designed by Mintzberg, Raisinghani, and Teoret (the
MRT model) to design and test the nature of strategic decision making that entailed substantial
risk. They worked with chief nurse executives employed in six acute care hospitals with 400 or
more beds each.




Supporting Activities
In decision making



Identifying
the Problem
Selecting
the Single
Best Choice
Developing
Potential
Solutions
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In applying this model, participants used mixed scanning of general and specific
information from subordinates to identify complex problems. To develop potential solutions they
gathered facts from hospital documents. They made their selection of the single best solution by
Screening solutions using predetermined criteria
Identifying the costs and benefits as nearly as possible, and
Selecting the single best solution.
It was concluded that top managers make these final choices using intuition, formal
analysis, and knowledge of organizational politics. In making good choices, top managers do
extensive planning, communicating, and politicking.
5. Optimizing Model
Decision maker select the solution that maximally meet the objective for a decision.
Usually this process involves assessing the pros and cons of each known outcomes as well as
listing benefits and costs associated with each option. The goal is to select the most ideal
solution. This process is most expedient and may be the most appropriate when time is an issue.
6. Satisfying Model
Decision maker selects the solution that minimally meets the objective for a decision. It is
more conservative method compared to an optimizing approach. This process is most expedient
and may be the most appropriate when time is an issue.
Tool of decision making
1. Judgemental technique
2. Operational research technique
3. Delphi technique
4. Decision tree
1. Judgmental technique
a) This is the oldest technique and subjective in decision making.
b) Based on past experience and intuition about future.
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c) Useful in making routine decision.
d) Cheap and not time consuming.
e) Hazardous due to a chance for taking wrong decision.
f) Rarely used in large capital commitments.
2. Operational Research Technique (OR)
It can be defined as the analysis of decision problem using scientific method to provide
manager the needed quantitative information in making decision.
a) Operational research makes the decision analytic, objective and quantitative based.
b) Steps of OR technique
Construction of mathematical model that pinpoints the important factor in the
situation.
Definition of criteria to be used for comparing the relative merits of various
possible courses of action.
Procuring empirical estimates of the numerical parameters in the model that
specify that particular situation to which it is applied.
Carrying out through the mathematical process of finding and series of action
which will give optimal solution.
Types of Operational Research Technique
1. Linear programming: Uses linear mathematical equations to determine the best way to use
limited resources to achieve maximum results. This technique is based on the assumption
that a linear relationship exists between the variables and the limits of variation can be
calculated. Linear programming is a sophisticated short cut technique in which computers
can be used. Three conditions must be existing before linear programming must be utilized.
a. Either a maximal or a minimal value is sought to optimize the objective. The value may be
expressed in terms of cost or quantity.
b. The variables affecting the goal must have a linear relationship. The ratio of change in one
variable to the changes in the other variable must be constant.
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c. Constraints to the relationship of the variable exist.
It can be used to determine a minimal cost nutrition diet or determine a class size, class
hours, and instructors in school of nursing.
2. Queuing theory: It deals with waiting lines or intermittent servicing problems. It balances
the cost of waiting versus the prevention of waiting by increasing the services. A group of
items waiting to receive service is known as a queue. By decreasing or eliminating the
waiting line to reduce waiting line cost, there is an increase in cost of labor and physical
facilities.
3. Games theory: In normal games, each player or group of player tries to choose a course of
action which will frustrate opponents action and help in winning the game. The same will
apply in the context of business by maximize his loss.
4. Programme evaluation and review technique (PERT): PERT is a network system model
for planning and control under certain conditions. It involves identifying the key activates in
a project, sequencing the activities in a flow diagram, and assessing the duration for each
phase of work.
a. It is appropriate for project work that involves extensive research and development.
b. Helps to predict time.
c. Helps to determine priorities.
d. Use of recourses can be considered when setting priorities.
e. Assignment can be changes temporarily.
f. Overtime or temporary help can be given to facilitate the activity flow.
g. Can manipulate the time required to move from one event to another.
5. Critical path method (CPM):
Closely related to PERT. Critical path method calculates a single time estimate for each
activity, the longest possible time. CPM is useful where the cost is a significant factor.


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6. Computers in decision making:
In management information system computers can be used for various activities like
patient classification system, supplies and material management system, staff scheduling,
policy and procedure changes and announcements, patient charges, budget information and
management, personal records, statistical reports, administrative reports and memos etc.
3. Delphi technique
It allows members who are dispersed over a geographic area to participate in decision
making without meeting face to face. This is possible through the use of questionnaire. The
members will return the questionnaires anonymously; the results of the first questionnaire are
centrally compiled and sent to each member. Again the members are asked for suggestions.
This process continues until the consensus is reached. Little changes usually occur after the
second round.
The Delphi technique is free from others influence.
Doesnt require physical presence.
Appropriate for scattered group.
But it is true consuming.
4. Decision trees
A decision tree is a graphic method that can help the supervisor in visualizing the
alternatives available, outcomes, risk and information needs for a specific problem over a
period of time. It helps to see the possible directions that actions may take from each decision
point and to evaluate the consequences of a series of decisions. The process begins with a
primary decision having at least two alternatives. Then the predicted outcome of each
decision considered and the need for further decision is contemplated.
Advantages of decision making
1. It is characterized by order and direction that enables managers to determine where they
are.
2. Provide a frame work data gathering which is relevant to the decision.
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3. Allows application of previous knowledge and experience that minimize errors and
improve quality of patient care and work of an organization.
4. Increase managers confidence and ability in making decision.
DECENTRALIZATION
Introduction
Decentralization is the division of activities by forming departments. In nursing service,
departmentalization aims on attaining a better quality of patient care through benefits derived
from specialist nurses. Departmentalization aims to provide better arrangements, control of
facilities, equipments and materials required to perform the necessary service.
The nursing service administrator should explicitly define the standards, policies, and
scope of decision to be undertaken by top administration and those to be handled by departments
and their subunits.
Decentralization versus Centralization
The term centralized and decentralized refer to the degree to which an organization has
spread its lines of authority, power, and communication.
The centralization tends to concentrate decision making at the top level of the
organization, whereas decentralization disperses decision making and authority throughout
decision making and authority throughout and further down the organizational hierarchy. The
centralization and decentralization can be thought of as two theoretical extremes of one
continuum. In other words the decentralization is the extent of authority is passed down to lower
levels in the organization. The centralization is the extent to which authority is retained at the top
of the organization.
Complete centralization complete decentralization




Authority decentralization

Authority not delegated
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Definition of decentralization
Decentralization is the dispersion or delegation of responsibilities and the authority to
lower levels of an organization. Institution makes use of both centralization & decentralization.
Top management needs a positive attitude towards decentralization and they need competent
personal to whom they can delegate authority.
Decentralized structure
The decentralized structure is flat in nature and organizational power is spread out
throughout the structure. These are few layers in the reporting structure, and managers have a
broad span of control. Communication patterns are simplified and problems tend to be addressed
with ease and efficiency at the level at which they occur. Employees have autonomy and
increased job satisfaction within this type of structure.






Dec
Decentralization (Flat, Horizontal, Participatory) Structure
Flat organizational structures are characteristic of decentralized management.
Decentralization refers to the degree of which authority is shifted downward within an
organization to its divisions, services, and units. Decentralization is delegating decision making
In nursing, as in other organizations, delegation fosters participation, teamwork, and
accountability. A first line manger with delegated authority will contact another department to
solve a problem in providing a service. The first line manager does not need to go to his or her
department head of the other service, creating a communication bottleneck. The people closest to
the problem solve it, resulting in efficient and cost effective management.
Nursing Administrator
Maternity
supervisor
Pediatric
supervisor
Surgery
supervisor
s
Nurse Nurse Nurse Nurse Nurse Nurse
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Research conducted on Magnet hospitals found the most of the hospitals has a
decentralized structure in which nurses had a feeling of control over their unit work environment.
Porter OGrady identified the following conditions as essential for effective decentralization:
Freedom to function effectively
Support from Peers and leaders
Concise and clear expectations of the work environment
Appropriate resources
Advantages and limitations of decentralization
Advantages
The advantages of decentralization are as follows:
1. Relieves top manager from burden of managing.
2. Encourages subordinates to undertake responsibility.
3. More freedom to managers.
4. Increases motivation of subordinates.
5. Enhances competition among various departments/units.
6. Helps setting up of profit centres.
7. Promotes development of general managers.
8. Prepares mangers for rapid change in the organization.
Limitations
The limitations of decentralization are as follows:
1. Maintenance of uniform policy throughout organization becomes difficult.
2. Increases complexity of coordination.
3. May lead to loss of control by superior level managers.
4. May be limited by inadequate control techniques.
5. May be constrained by inadequate planning.
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6. Limited by inadequate training.
7. Limited by inadequate number of qualified personnel at lower level.
8. It may be limited by external factors like; government regulations, taxation policy of
government, etc.
Concepts of management
The concept of management is not fixed. It has changing according to time and circumstances.
The concept of management has been used in integration and authority etc.
The concept of management.
The concept of management is not fixed. It has changing according to time and circumstances.
The concept of management has been used in integration and authority etc. Different authors on
management have given different concepts of management. The main concepts of management
are as follows:
Functional Concept:
According to this concept 'management is what a manager does'. The man followers of this
concept are Louis Allen, George R. Terry, Henry Fayol, E.F.L. Brech, James L. Lundy, Koontz
and O. Donnel, G.E Milward, mcfarland etc. The functional concept as given by some of the
authors is given below:
I. Louis Allen, "Management is what a manager does."
II. James L. Lundy, " Management is principally the task of planning, coordinating, motivating
and controlling the effort of others towards a specific objective. Management is what
management does. It is the task of planning, executing and controlling."
III. George R. Terry, "Management is a distinct process consisting of planning, organizing,
activating and controlling performed to determine and accomplish the objective by the use of
human beings and other resources."
IV. Howard M. Carlisle, "Management is defined as the process by which the elements of a
group are integrated, coordinated and/or utilized so as to effectively and efficiently achieve
organizational objectives."
V. Henry Fayol, "To manage is to forecast, and plan, to organize, to command, to coordinate and
to control."


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'Getting Things Done Through Others' Concept:
According to this concept, 'Management is the art of getting things done through others'.
It is very narrow and traditional concept of management. The followers of this concept are
Koontz and O Donnell, Mooney and Railey, Lawrence A. Appley, S. George, Mary Parker Follet
etc. Under this concept, the workers are treated as a factor of production only and the work of the
manager is confined to taking work from the workers. He need not do any work himself. Modern
management experts do not agree with this concept of management. Some of these authors have
explained this concept in the following words:
I. Mary Parker Follet, "Management is the art of getting things done through others."
II. Harold Koontz, "Management is the art of getting things done through and wit people in
formally organized groups. It is the art of creating and environment in which people can perform
as individuals and yet cooperate towards attaining of group goals.
III. J.D. Mooney and A.C. Railey, "Management is the art of directing and inspiring people."
Leadership and Decision-making Concept:
According to this concept, "management is an art and science of decision-making and
leadership." Most of the time of managers is consumed in taking decisions. Achievement of
objects depends on the quality of decisions. Similarly, production and productivity both can be
increased by efficient leadership only. Leadership provides efficiency, coordination and
continuity in an organization. Leadership and decision-making concept as given by some authors
is given below:
I. Donald J. Clough, "Management is the art and science of decision-making and leadership".
II. Ralph, C. Davix, "Management is the function of executive leadership anywhere."
III. Association of Mechanical Engineers, U.S.A., "Management is the art and science of
preparing, organizing and directing human efforts applied to control the forces and utilize the
materials of nature for the benefit to man."
IV. F.W. Taylor, "Management implies substitution of exact scientific investigation and
knowledge for the old individual judgment or opinion, in all matters in the establishment."
Productivity Concept:
According to this concept, "management is an art of increasing productivity."
Economists treat management as an important factor of production. According to them,
"Management is also a factor of production like land, labor, capital and enterprise." The main
followers of this concept of management are John F. Mee, Marry Cushing Niles, F.W. Taylor
etc. The productivity concept, as given by the authors is given below:
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I. Jon, F. Mee, "Management may be defined as the art of securing maximum prosperity with a
minimum of effort so as to secure maximum prosperity and happiness for both employer and
employee and give the public the best possible service."
II. F. W. Taylor, "Management is the art of knowing what you want to do in the best and
cheapest way."
III. Marry Cushing Niles, "Good management achieves a social objectives with the best use of
human and material energy and time and with satisfaction of the participants and the public.
Universality Concept:
According to this concept, "Management is universal". Management is universal in the sense that
it is applicable anywhere whether social, religious or business and industrial. The followers of
this concept are Henry Fayol, Lawrence A. Appley, F.W. Taylor, Theo Haimann etc. According
to-
I. Henry Fayol, "Management is an universal activity which is equally applicable in all types of
organization whether social, religious or business and industrial".
II. Megginson, "Management is management, whether it is in Lisbon, or in London or in Los
Angeles."
III.Theo Haimann, "Management principles are universal. It may be applied to any kind of
enterprises, where the human efforts are coordinated."

Management is principally the task of planning, coordinating, motivating, and controlling the
efforts of others towards a specific objective. -James lundy 1963

Management is the creation and control of technological and human environment of an
organization in which human skill and capacities of individuals and groups find full scope for
their effective use in order to accomplish the objective for which an enterprise has been set up. It
is involved in the relationship of the individual, group, the organization and the environment.
-A dasgupta 1969
Management is a good planning, organizing directing, co ordinating and controlling to eliminate
chaos, errors and waste and get better utilization of manpower and materials.
-George A Melresh
Management is the process and agency which directs and guides the operations of an
organization on the realizing established aims.
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NURSING MANAGEMENT
MISSION STATEMENTS
A Mission Statement defines the organization's purpose and primary objectives. Its prime
function is internal to define the key measure or measures of the organizations success and
its prime audience is the leadership team and stockholders. Mission statements are the starting
points of an organisations strategic planning and goal setting process. They focus attention and
assure that internal and external stakeholders understand what the organization is attempting to
accomplish.
Dimensions of Mission statements:
According to Bart, the strongest organizational impact occurs when mission statements contain 7
essential dimensions.
Key values and beliefs
Distinctive competence
Desired competitive position
Competitive strategy
Compelling goal/vision
Specific customers served and products or services offered
Concern for satisfying multiple stakeholders

The mission statement of an; organization describes the purpose for which that
organization exists.
Mission statements provide information and inspiration that clearly and explicitly outline
the way ahead for the organization. They provide vision.
Individuals want productive and meaningful lives .therefore, the purpose of the
organization and of each of its units should be defined a teamwork approach should be
properly trained: and all individuals within the organization should be treated with
respect.
Organizational purpose moves and guides the organization toward a perceived goal.
Many writers indicate that the purpose or mission statement should be created from
mission statement should be properly trained and all individual s within the organization
should be treated with respect.
Organizational purpose moves and guides the organization toward a perceived goal.
The mission or purpose statement incorporates the culture of the organization, including
strong leadership, rules and regulations, achievement of goals, and the notion that people
are more important than work.
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Employees who participate in developing the vision statement believe in their own
abilities and are more committed to the organization.
The vision statement is shared companywide so that employees live the vision.
The mental exercise of creating one is more meaningful than the contents of the statement
itself. Vision, values, mission or purpose statements are meaningful only to the creators.
VISION
+ Employees who participate in developing the vision statement believe in their own
abilities and are more committed to the organization than employees who do not
participate.
+ The vision statement is shared companywide so that employees may live the vision. It is
updated to keep pae with technology and trends. A vision statement is sometimes.
+ The mental exercise of creating one is more meaningful than are the contents of the
statement itself.
+ Vision values, mission, or purpose statements are meaningful only to the creators.
+ Translated for the community, these statements place value on the way nurses care for
people.
+ It follows that ethnic populations are considered in developing vision and values
statements for nursing entities. Nursing education teaches the meaning of values such as
tolerance and compromise.
+ Examples of values are informality, creativity, honesty, quality, courtesy, and caring.
Philosophy
Cost effectiveness
In management or administration of any enterprises for organization, the quality,
quantity, timing and cost of the necessary to reach the objective of the enterprises are
interrelated factor which must be given constant attention.
Execution and control of work plan:
One of the greatest possible contributors to wastage of our precious recourses, whether at
the local or national level, is the failure of those at any level of administration, and at all
stages in the management of the activity, to base all decision on verifiable facts.
Delegation of responsibility and authority:
The delegation of responsibility and authority is an important aspect of successful
administration, to place the responsibility for decision at the lowest possible
organizational level in order to attain decision as speedily as possible.
Human relation and good morale:
Since the function of administration is to attain an established objective through the
management of people, administration if deeply concerned with human relation. Good
morale of the staff is essential to the success of any organization.
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Effective communication:
Effective communication are essential for all aspect of effective administration .staff
must be adequately and correctly informed about plan, methods ,schedules, problems
events and progress.
Flexibility:
Administrators must be completely flexible to meet the changing needs of the
situation.
TRENDS IN NURSING ADMINISTRATION
I. Historical and
II. Educational trends
I. HISTORICAL
Late nineteenth century.
Beginning of twentieth century
Early twentieth century to 1946
The post independence period
LATE NINETEENTH CENTUR. The states of nursing that today had its beginning in
madras around the 17s in the 19
TH
century. This started with training for women for
improving nursing in military hospitals.
BEGINNING OF TWENTIETH CENTURY: The trend set in the late 19
th
century
found its effect in the period .by the start of this century we find establishment of nursing
training by the start of this century we find establishment of nursing training centers.
1905: The association of nursing superintend was formed .
The missionary nurses were meeting has members of the medical missionary
association of India set up by the missionary doctors in 1905.
1908: The association of nursing of superintends broadened its scope and the trained
nurses and association of India (TNAI) was found this year.
1909-1912: SAW The publication of nursing journals of India this provided a forum for
sharing of ideas and experience.
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Filling the need for systematic preparation of nurses for better patients care services from
1909 the north India board was set up by the missionary nurses and are the medical
association of India in 1911.
The early 20
th
century to 1946
1926: The first nurses registration at was enacted in madras presidency.
1934: The Bengal nurses act was enacted for the nurses midwives and health visitors of
undivided Bengal.
1936: The mid-India board of education was formed in 1934 and was affiliated to
Christian nurses league in 1936.
1939: By this time we need all the provinces in India except Assam had nursing councils
1920-1940: It will be interest for you to know that during 1920 to 1940 nursing was
lapping forward in the Weston countries nurses in India to did not want to lag behind.
1940-1946: The Second World War ravaged the world during this period. For obvious
regions expansions of military and civil hospitals took place during the war years.
1943: Commissioned rank was given to the Indian military nursing systems.
1941 -46: During the period the state nursing services with standardized pay scales and
terms of services were established in madras in UP (1944)
1946: The university nursing programmed leading to bachelors degrees in nursing were
lunched at the college of nursing ,Delhi and Christian medical college Vellore under delhi
and madras university respectively.
1947: We earned our independence on august 15
th
in 1947. Two nations were also burned
in this date, this brought on foreseen change in its wake, which has responsible for
bringing many human in to the field of nursing.
1949: The first meeting of India nursing council was held
1950: This also replaced the various junior grade courses in nursing and midwifery in the
standardized courses shorter and simpler than the sinuous nursing and senior midwifery
courses
1953: The registering nurses trained in countries were no reciprocal registration existed,
and maintained Indian nurses register.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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1963: A WHO assisted technical project was undertaken at the INC revise general
nursing midwifery.
1965: A WHO publication on guide for schools of nursing in India came out this year.
This period also saw the formation of many commissions and commits to recommended
nurses for improving the health care delivery systems
1. The health service development committee
2. The health serving planning committee
3. The committee to review conditions of service.
4. Chads committee
5. Mukerjee committee.
6. Mukerjee committee.committe
7. Jungalwala karthar singh committee.
8. Srivasthav committee.
Educational trends
FMHW Programme :
1. Meant to work at sub centers.
2. Main thrust: MCH service, implementing intervention of national health
programme.
3. Including IMR, MMR child mortality rates.
Old ANM programme
1. Meant to meet the demands generalized service
GNM programme
Bachelors degree programme .
Post certificate diploma programme in
1. Public health nursing
2. Psychiatric nursing
3. Pediatric nursing
4. Cancer nursing
5. Nursing education and administration
6. Other nursing specialities
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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M.Sc.
M Phil
PhD programmes
1. University of Delhi.
2. Jawaharlal Nehru University.
3. Calcutta university
4. MGR university of health science, madras
5. Madras university
6. IGNOU
7. RGUHS
8. MANGALORE UNIVERSITY
9. SNDT university
10. Punjab university, Chandigarh
11. MAHE- maniple
Central institutions.
1. AIIMS ,New Delhi
2. All India institute of hygiene and public health, Calcutta
3. PGI, Chandigarh
4. IPGMER, Pondicherry
5. MAHE, maniple
6. NIMHANS, Bangalore.
7. NIHFW, New Delhi.
ISSUES IN NURSING ADMINISTRATION
A. Profession of NSG :
The issue related to nursing are.
Status of nursing in society in the health care delivery system.
Values reflected in our nursing performances.
Attitude, human approach.
Quality in nursing vis-vis education and practice.
Unique function of nursing.
Different levels of nurses that we need in our country.
Define and delineation of nursing functions at the different level.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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B. Nursing education :
Taken in to consideration the national health policy goals and
programmes
Shifted its emphasis from traditional to community health oriented
approach and re-oriented nursing circular accordingly.
Be making sincere efforts to prepare nurses for the job they are
accepted to perform in their work field in terms of appropriate skills,
knowledge and right attitude and the desired behaviour patterns
reflecting the values for caring and at the level of .
Been preparing nurses keeping in the status and countries health
needs in minds.
Made studies on our west countries nursing training needs and
training load.
C. Nursing practice :
In the community setting and
In the institutional setting at the level of primary, secondary, and
tertiary levels of care.
Are nurses as matter of policy conceited in all matters related
decisions area for nursing practice?
Can it be said that nursing service rendered reflect quality of nursing
care do there have the necessary back up support from the system for
performing the way they are required to perform.
Are the nurses aware of the shift of emphasis on the primary health
care approach.
D. Nurse themselves:
Long hours of duties with very little time for recreation.
Non availability of health care programme of nurses.
Pressure from influence people
Non involvement of nurses in nursing matters.
Poor pay structures.
Lack of security and safety.
Non availability of basic communities like toilet facility, in
residential accommodation of community nurses.

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Nursing in different prospective
Traditional nurse role
The traditional roles of nursing revolve round sick individual who are hospitalized.
Here the nurses work by large in the shadow of the physician and very few
independent decision making area left to them.
Community nurse role
Doctor halfdal mehalar former director general of the world health organization
1. Health maintenance and promotion.
2. Specific protection.
3. Disease prevention.
4. Rehabilitation.
5. Treatment of minor ailments.
6. Referral appropriate contumely.
7. Community mobilization.
8. MCH and family welfare services covering
9. child survival and safe mother hood program me.
10. School health services
Expanded nurse role
1. Performs not only the basic nursing care activities.
2. To have sound knowledge of operating the equipment to adopt appropriate
emergency measures
3. To the patterns and co-coordinators giving patients care services in the
hospitals.
4. To act managers teachers and supervisors while rendering patient care services.
Role of nurse administration
Provide visibility for organization goal
Provide recourses and define constraints
Mediate conflict
Serve as a coach
Monitor result


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THEORIES AND MODELS
A. SCIENTIFIC MANAGEMENT THEORY:
Principles: the scientific management focuses on
Observation
The measurement of outcome
The pioneers of scientific management are:
1. Frederick W. Taylor (1856-1915)
2. Gantt Henry I. Gantt (1861-1910)
3. Emerson (1853-1936)
1) Frederick W. Taylor (1856-1915):
Taylor is recognized as father of scientific management. He conducted Time-And-
Motion studies to time the workers, Analyze their movements and set their standards. He
used stop watches. He applied the principles of observation, measurement and scientific
comparison to determine the most effective way to accomplish a task.
Achievements of Taylor:
1. He trained his workers to follow the time to complete the task given. The most
productive workers were hired even when they were paid an incentive or wage.
2. Labour costs per unit were reduced as a result.
3. Responsibilities of management were separated from the functions of the workers.
4. Developed systematic approach to determine the most efficient means of
production.
5. He considered management function is to plan.
6. Working conditions and methods to be standardized to maximize the production.
7. It was the managements responsibility to select and train the workers rather than
allow them to choose their own jobs and train by themselves.
8. He introduced an incentive plan to pay the workers according to the rate of
production to minimize workers dissent and reduce resistance to improved
methods.
9. Increased production and produce higher profits.
The effect of time- motion study of Taylor:
1. Reduced wasted efforts
2. Set standards of performance
3. Encouraged specialization and stressed on the selection of qualified workers who
could be developed for a particular job.

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2) Gantt Henry I. Gantt (1861-1910):
Gantt was concerned with problems related to efficiency. He contributed to scientific
management by refining the previous work of Taylor than introducing new concepts.
1. He studied the amount of work planned or completed on one axis to the time
needed or taken to complete a task on the other axis.
2. Gantt also developed a task and bonus remuneration plan whereby workers
received a guaranteed days wages plus a bonus for production above the standard
to stimulate higher performance.
3. Gantt recommended to select workers scientifically and provided with detailed
instructions for their tasks.
4. He argued for a more Humanitarian approach by management, placing emphasis
on service rather than profit objectives.
5. He recognized useful non monetary incentives such as job security and
encouraging staff development.
3) Emerson (1853-1936):
His emphasis was on conservation and organizational goals and objectives.
He defined principles of efficiency related to:
1. Interpersonal relations and to system in management.
2. Goals and ideas should be clear and well-defined as the primary objective is to
produce the best product as quickly as possible at minimal expense.
3. Changes should be evaluated-management should not ignore commonsense by
assuming that big is necessarily better.
4. Competent counsel is essential.
His theory explains about
1. Management can strengthen discipline or adherence to the rules by justice, or
equal enforcement on all records, including adequate, reliable and immediate
information about the expenses of equipment and personnel should be available as
a basis for decisions.
2. Dispatching or production scheduling is recommended.
3. Standardized schedules, conditions and written instructions should be there to
facilitate performance.
4. Efficiency rewards should be given for successful completion of tasks.
5. Emerson moved further beyond scientific management to classic organizational
theory.
4. Charles Babbage (1792-1871): Charles Babbage ,a scientist mainly interested in
mathematics, contributed to the management theory by developing the principles of cost
accounting and the nature of relationship between various disciplines. Charles
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Babbage laid the foundation for much of the work that later come to be known as
scientific management. He concentrated on production problems and stressed the
importance.
1) Division and assignment of work on the basis of skill and
2) The means of determining the feasibility of replacing manual operations with
automatic machinery.
B. CLASSIC ORGANIZATIONAL THEORY:
Importance of classic organization theory:
The classic administration-organization thinking began to receive attention in
1930.
Organization is viewed as whole rather than focusing solely in production.
The concepts of scalar levels, span of control, authority, responsibility,
accountability, line staff relationships, decentralization, and
departmentalization become prevalent.
Three pioneers of Classic organizational theory:
1) Henry Fayol (1841-1925):
Fayal was a French industrialist known as father of the management process
school concerned with management of production shops. He studied the functions of
managers and concluded that management is universal.
Functions of management:
1. Planning policies, programs and procedures.
2. Organization based on hierarchy of authority
3. Directing the business in order to gain optimum return from all workers.
4. Coordination, signifying harmony in activities of the organization and to
facilitate its working
5. Control, the errors of the functionaries of organization and ensure that such
errors do not occurs.
Fayol divided all the work carried out in a business enterprise into the following
categories.
1. Technical activities (production, manufacture, etc)
2. Commercial activities (buying, selling, personnel, and industrial relations)
3. Financial activities( to have optimum use of capitals)
4. Security activities(production of property and persons)
5. Managerial activities(planning organizing, commanding, directing, coordination
control, communication, motivation .leadership)
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Principles by which good organization can be recognized. They are as follows:
1. The number of organization units should be the minimum needed to cover the
major enterprise functions.
2. All related functions should be combined within one unit.
3. The number of levels of authority should be kept to a minimum.
4. There should be room for initiative with the limit of his assigned authority.
5. Functions should be assigned so as to minimize cross relations between
organizational units.
6. No more employees should report to a superior than he can effectively direct and
coordinate.
2) Max Webber theory (1864-1920):
He is German psychologist. He earned the title of father of organizational theory.
His emphasis was on rules instead of individuals and on competencies over favoritism.
His conceptualization was on bureaucracy, structure of authority that would facilitate the
accomplishment of organizational objectives:
The three basis for authority:
1. Traditional authority, which is accepted because it seems things have always been
that way such as the rule of a king in a monarchy.
2. Charisma, having a strong influential personality.
3. Rational legal authority which is considered rational in formal organizations
because the person has demonstrated the knowledge, skills and ability to fulfill the
position.
3) James Mooney Theory (1884-1957):
Moony believed that management to be the technique of directing people and
organization the technique of relating functions. Organization is managements
responsibility.
Four universal principles:
1. Coordination and synchronization of activities for the accomplishment of goal.
2. Functional affects the performance of ones job description.
3. Scalar process organizes level of commands.
4. Arrange authority in to a higher Archie.
Consequently people get their right to command from their position in the
organization.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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C. HUMAN RELATION THEORY:
The human relations movement began in 1940s.
Focused on the effect that the individuals have on the success or failure of an
organization.
Classic organization and management theory concentrated on the physical
environment fail to analyze the human element.
Instead of concentrating on the organizations structure, managers encourage workers to
develop their potentials and help them meet their needs for
Recognition
Accomplishment
Sense of belonging
1). Follett theory (1868-1933):
1. Follett stressed the importance of coordinating the psychological and sociological
aspects of management in 1920s.
2. She perceived the organization s a social system and management as a social
process.
3. Indicated that legitimate power is produced by a circular behaviour where by
superiors and subordinates mutually influence one another.
4. The law of the situation dictates that a person does not take orders from another
person but from the situation.
2). Lewin theory (1890-1947):
1. Lewin focused on the Group dynamics.
2. He maintained that groups have personalities of their own: composites of the
members personalities.
3. He showed that group forces can overcome individual interests.
D. BEHAVIORAL SCIENCE THEORY:
Emphasis is on:
1. Use of scientific procedures to study the psychological,
2. Sociological,
3. Anthropological aspects of human behaviour in organization.
Behavioural Science Indicated:
1. The importance of maintaining a positive attitude toward people,
2. Training managers,
3. Fitting supervisory actions to the situation,
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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4. Meeting employees needs.
5. Promoting employees sense of achievement,
6. Obtaining commitment through participation in planning and decision making.
1) Douglas McGregors Theory (1932):
McGregors is the father of the classical theory of management which termed
theory. He developed the managerial implications of Maslows theory. He noted that
ones style of management is dependent on ones philosophy of humans and categorized
those assumptions as theory X and theory Y.
Theory X
1. The managers emphasis is on the goal of organization.
2. The theory assumes that people dislike work and avoid it.
Consequence of theory X
Workers must be directed
Controlled
Coerced
Threatened
So that organizational goals can be met.
According to theory X
1. Most people want to be directed and to avoid responsibility because they have
little ambition.
2. They desire security.
Managers who accept the assumption of theory X
1. Will do the thinking and planning with little input from staff associates.
2. They will delegate little, supervise closely.
3. Motivate workers through fear ad threats
4. Failing to make use of the workers potentials.
Theory Y
It is focuses on goal.
1. People do not inherently dislike the work and that work can be a source of
satisfaction.
2. Workers have the self direction and self control necessary for meeting their
objectives.
3. Will respond to the rewards for the accomplishment of those goals.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Managers who believe in this Y theory:
1. Will allow participation
2. They will delegate
3. Give general supervision than close supervision
4. Support job enlargement
5. Use positive incentives such as praise and recognition.
They believe that under favourable conditions: people seek responsibility and display
imagination, unity and creativity. According to theory Y human potentials are only
partially used.
2).Rensis Likerts theory:
Dr Rensis Likert has studied human behaviour within many organisations. After
extensive research, Dr. Rensis Likert concluded that there are four systems of
management. According to Likert, the efficiency of an organisation or its departments is
influenced by their system of management. His theory of management is based on his
work at the University of Michigans institute for social research.Likert categorised his
four management systems as follows;
He identified three variables in organizations.
1. The casual variable includes leadership behaviour.
2. The intervening variables are perceptions, attitudes and motivations.
3. The end results variables are measures of profits, costs and productivity.
Factors measured by likert scale
The scale measures several factors related to leadership behaviour process:
Motivation
Managerial
Communication
Decision making process
Goal setting
Staff development
Four types of management system according to likert, effcets on the management
systems:
a). Exploitive-authoritative:
1. He associates the first system with the least effective in performance.
2. Managers show less confidence in staff associates and ignore their ideas.
3. Consequently staff associates do not feel free to discuss their jobs with their
managers
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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b). Benevolent- authoritative:
1. Staff associates ideas are sometimes sought, but they do not feel free to discuss
their jobs with the manager.
2. Top and middle management are responsible for setting goals.
3. There is minimal communication. Mostly downward and received with suspicion.
4. Decisions are made at the top with some delegation.
c). Consultative system:
1. The manager has substantial confidence in staff associates.
2. Their ideas are usually sought.
3. They fell free to discuss their job with the manager.
4. Goal setting is fairly general.
5. It has limited accuracy and accepted with some caution.
6. Broad policy is set at the top level.
7. There are decisions making throughout organization.
8. Control functions are delegated to lower level where.
9. Reward and self guidance are used.
10. There is some resistance from informal groups in the organization.
d) Participative group:
Group Participative is the most effective performance. Managers have complete
confidence in their staff associates. Their ideas are always sought, and they feel
completely free to discuss their jobs with the manager. Goals are set at all levels. There is
a great deal communication- upward, downward, and later that is accurate and received
with open mind.
E. MODERN MANAGEMENT THEORIES:
The modern era is characterized by trends in the management through viz:-
1. Microanalysis of human behaviour, motivation, group dynamics leadership
leading to many theories of organization.
2. The macro search for fusion of the many systems in business organization-
economic social technical political and quantitative methods in decision- making.
Modern management theories era can be father classified as the three streams viz:
1. Quantitative approach
2. System approach
3. Contingency approach
Indicating further refinement, extension and synthesis of all the classical and neo-
classical approaches to management.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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1. Quantitative approach: Management science refers to the application of Quantitative
methods to management. Management science has an interdisciplinary basis in other
words management science is a combination and interaction of different scientists.
2. System approach:-according to system approach the organization is the unified,
purposeful systems composed of interrelated parts and also interrelated with its
environment. Each unit must mesh/ interact with the organization as a whole, each
manager most interact/ communicate and deal with executives of other unites and the
organization itself must also interact with other organizations and society as whole.












An open system model
Ludwing Von Bertanffy:
Bertanffy, a biology is credited with coining the general system theory. His contention
were that it was possible to develop a theoretical framework for describing relationship in
the real world and different disciplines with similarities could be developed into a general
systems model. The similarities were:
1. Study of organization
2. State of equilibrium
3. Openness of all systems and their influence o the environment and environment
influence on the system.

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3. Contingency approach:

The contingency approach can be described as the behavioural approach.
Contingency theory does not prescribe the application of certain management
principles to any situation.
Contingency theory is recognition of the extreme importance of individual
manager performance in any given situation.
It rests on the extent of manager power and control over a situation and the degree
of uncertainty in any given situation.
The role of management in the contingency approach is to develop an appropriate
management solution for any given organizational environment.
It is principally directed at the management practitioner seeking to control a
distinct Organizational environment.

Luther Gulick:
He was influenced by Taylor and Fayol. He used Fayals five elements of
administration viz.Planning,Organizing,Command,Coordination and Control as a
frame work for his neutral principles. He condensed the duties of administration into a
famous acronymPOSDCORB.Each letter in the acronym stands for one of the seven
activities of the administrator as given below:
Planning (P): working out the things that need to be done and the methods for
doing them to accomplish the purpose set for the enterprise.
Organising (O): establishment of the formal structure of authority through which
work subdivisions are arranged, designed and coordinated for the defined
objective.
Staffing (S): the whole personnel function of bringing in and training the staff, and
maintaining favourable conditions of work.
Directing (D): continuous task of making decisions and embodying them in
specific and general orders and instructions, and serving as the leader of the
enterprise.
Coordinating (CO): all important duties of interrelating the various parts of the
work.
Reporting (R): keeping the executive informed as to what is going on, which
includes keeping himself and his subordinates informed through records, research
and inspection.
Budgeting (B): all that goes with budgeting in the form of fiscal planning,
accounting and control.
Luther Gulick was very much influenced by Fayals 14 basic elements of administration
in expressing his principles of administration as follows:
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1. Davison of work or specialization
2. Bases of departmental organization
3. Coordination though hierarchy
4. Deliberate coordination
5. Decentralization
6. Unity of command
7. Staff and line
8. Delegation
9. Span of control
Lyndal urwick:
Lyndal urwick also one of the among classical theorist, attached more important to the
structure of organization than the role of the people in the organization.
Lyndal urwick concentrated his efforts on the discovery of principles and identified eight
principles of administration applicable to all organization as given below:
1. The principle of objective-that all organizations should be an expression of a
purpose.
2. The principle of correspondence-that authority and responsibility must be co-
equal.
3. The principle of responsibility-that the responsibility of higher authorities of the
work of subordinates is absolute.
4. The scalar principle-that a paramedical type of structure is build up in an .
5. The principle of span control-
6. The principle of specialization-limiting ones work to single function.
7. The principle of coordination-
8. The principle of definition-clear prescribed of every duty.
4. Critical theory versus critical thinking:
Steffy and Grimes note that a strict natural science approach to social science is native,
since subjective or qualitative analysis is important to quantitative research. This holds
true for management and, consequently for nursing management. The authors suggest a
critical theory approach to organizational science rather than a phenomenological or
hermeneutic approach.
Phenomenological approach uses second order constructs interpretations of
interpretation. The nurse manager would interpret the meaning of nursing of nursing
management experience or observations and arrive at a nursing management theory from
aggregate of meanings.
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Hermeneutic approach is the art of textual interpretation. She would consider the specific
context and historic dimensions of data collected, and would reflect on the relationship
between theory and history.
Critical theory: Critical theory is an empirical philosophy of social institutions. It is
translated into practice by decision makers, in these case nurse managers. It includes
organizational development, management by objectives or results, performance appraisal,
and other practice- oriented activities performed by managers.
Aims:
To critique the ideology of scientism, the institutionalized form of reasoning
which accepts the idea that the meaning of knowledge is defined what the sciences
do and thus can be adequately explicated through analysis of sciencetific
producers.
To develop an organizational science capable of changing organizational
processes. it is used the practice of clinical nursing and nursing management.
Critical thinking: Concept analysis is advocated as a strategy for promoting critical
thinking. The rudiments of critical thinking: recalling facts, principles, theories, and
abstractions to make deductions, interpretations, and evaluations in solving problems,
making decisions, and implementing changes. Concept analysis uses critical thinking to
advance the knowledge base of nursing management as well as nursing practice.
Definition: critical thinking is reflecting on a situation, a plan an event under the rule of
standards and antecedent to making a decision.
(Mackenzie)
Critical thinking is both a philosophical orientation toward thinking and a cognitive
process characterized by reasoned judgment and reflective thinking.
(Jones and brown)

Abraham H. Maslow (1908-1970)
Receiving his doctorate in psychology, Abraham Maslow was the first psychologist to
develop a theory of motivation based upon a consideration of human needs.




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Maslows theory of human needs has three assumptions


Factor within Person
Maslows need hierarchy
Physiological. The need for food, drink, shelter and relief from pain
Safety and Security. The need for freedom from threat, that is, the security from
threatening events or surroundings.
Belongingness, Social and love. The need for friendship affiliation interaction
and love
Esteem. The need for self-esteem and for esteem from others
Self- Actualization. The need for fulfill oneself by making maximum use of
abilities skills and potential.



Human needs are never
completely satisfied
Human behaviour is
purposeful and is motivated
by need satisfaction.
Hierarchical structure of
importance from the lowest to
highest
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Douglas McGregor (1906-1964)
McGregor is the other major theorist associated with the Human Relations School of
management.
McGregor believes there are two basic kinds of managers. One type of manager, Theory
X, has a negative view of employees assuming they are lazy, untrustworthy and incapable
of assuming responsibility while the other type of Manager,
Theory Y, assumes employees are trustworthy and capable of assuming responsibility
having high levels of motivation.
Herzbergs two factor theory:
This theory was developed in 1959.It is based on realisation that work motivation and
job-satisfaction are two dimensions that influence the productivity of an employee.
Herzbergs finding that good working conditions, adequate salary, good physical
facilities, good human relation, quality of supervision might contribute to job satisfaction,
of employees, which are hygiene factors. Whereas factors like recognition of work
done, status, opportunities for growth, challenging task, play an important role in creating
work motivation for employees, which are the motivation factors.ltter, many authors
interpreted that all the motivation factors described by Herzberg do not give equal
amount of satisfaction to all employees.
Implications of management theories in nursing:
1. Taylors theory can be implemented in nursing to study complexity of care and
determine staffing needs and observe efficiency and nursing care.
2. Nurses can utilize Emersons theory of early notion of the importance of
objectives setting in an organization.
3. Nurses should be aware of the managerial tasks as defined by Fayol: Planning,
Organizing, Directing, Coordinating and Controlling.
4. The theory of human relations of Follett and Lewin emphasise the importance for
nurse managers to develop staff to their full potential and meeting their needs for
recognition, accomplishment and sense of belonging.
5. Mc Gregon and Likert support the benefits of positive attitudes towards people,
development of workers, satisfaction of their needs and commitment through
participation.





PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Unit III

PLANNING
Planning process: Concept, Principles, Institutional
policies
Mission, philosophy, objectives,
Strategic planning
Operational plans
Management plans
Programme evaluation and review technique(PERT),
Gantt chart,
Management by objectives(MBO)
Planning new venture
Planning for change
Innovations in nursing

Application to nursing service and education



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
PLANNING
INTRODUCTION
Planning is a deliberative, systematic phase of the nursing process that involves decision
making and problem solving. In planning the nurse refers to the clients assessment data and
diagnostic statements for direction and formulating client goals and designing the nursing
strategies required to prevent, reduce or eliminate the clients health problems.

ROGRAM EVALUATION AND REVIEW TECHNIQUE (PERT)
Meaning
The program evaluation & review technique (PERT) was developed by the Special Projects
Office of the U.S. Navy and applied to the planning &control of the Polaris Weapon system in
1958. It worked then, it still works; and it has been widely applied as a controlling process in
business & industry.
PERT uses a network of activities. Each activity is represented as a step on chart. It is an
important tool in the timing of decisions. In simplest form of PERT, a project is viewed as a total
system and consisting of setting up of a schedule of dates for various stages and exercise of
management control, mainly through project status reports on this progress.
Program Evaluation & Review Technique includes:
1. The finished product or service desired
2. The total time & budget needed to complete the project or program.
3. The starting date & completion date.
4. The sequence of steps or activities that will be required to accomplish the project or program.
5. The estimated time & cost of each step or activity.
Steps for accomplishing the project are:
a. The optimistic time: This occasionally happens when everything goes right.
b. The most likely time : It represents the most accurate forecast based on normal developments.
c. The pessimistic time: This is estimated on maximum potential difficulties.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Calculation of the critical path , the sequence of the events that would take the greatest
amount of time to complete the project or program by the planned completion date. The reason
this is the critical path because it will leave the least slack time.
USES
Why should nurse managers use the PERT system for controlling?
1. It forces planning and shows how pieces fit together.
2. It does this for all nursing line managers involved.
3. It establishes a system for periodic evaluation & control at critical points in the program.
4. It reveals problems & is forward- looking.
5. PERT is generally used for complicated & extensive projects or programs.
6. Many records are used to control expenses and otherwise conserve the budget.
These include personnel staffing reports, overtime reports, monthly financial reports and
others. All these reports should be available to nurse managers to help them monitor, evaluate,
and adjust the use of people and money as a part of the controlling process.
Modern and Philips enlist the advantages of PERT:
1. It encourages logical discipline in planning, scheduling and control of project.
2. It encourages more long range & detailed project planning
3. It provides a standard method of documenting and communicating project plans, schedules,
and time and cost- performance.
4. It identifies the most critical elements in the plan, thus focusing management attention .i.e.
most constraining on the schedule.
5. It illustrates the effects technical procedural changes on overall schedules.
GANTT CHARTS
Early in this century Henry L. Gantt developed the Gantt Chart as a means of
controlling production. It depicted a series of events essential to the completion of a project or
program . It is usually used for production activities.
Figure shows a modified Gantt chart that could be applied to a manager nursing administration
program or project. The 5 major activities that the nurse administrator has identified are
segments of a total program or project.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
It could be applied to a project such as implementing a modality of primary nursing or
implementing case management.
These are possible nursing actions for a project:
1. Gather data
2. Analyze data
3. Develop a plan
4. Implement the plan.
5. Evaluation, feedback, and modification

Figure is an only an example .Application of these controlling process by nurse managers
would be specific to the project or program, and the time elements for the various activities
would vary with each. Also these 5 major activities with estimated completion times. The nurse
managers goal is to complete each activity or phase on or before the projected date.

MBO (Management by Objectives)

Management by objectives (MBO) is a process whereby superiors &
subordinates jointly identify the common objectives ,set the results that should be achieved by
subordinates, asses the contribution of each individual, and integrate individuals with the
organization so as to make best use of organizational resources.

Definition
MBO is a comprehensive managerial system that integrates many key
managerial activities in a systematic manner, consciously directed toward the effective &
efficient achievement of organizational objectives.

MBO is a result centered, non-specialist, operational managerial process for the
effective utilization of material, physical & human resources of the organization by integrating
the individual with the organization & organization with the environment.

Objectives of MBO:
1. To measure and judge performance
2. To relate individual performance to organizational goals
3. To clarify both the job to be done and the expectations of accomplishment
4. To foster the increasing competence & growth of these subordinates
5. To enhance communication between superior and subordinates
6. To serve as a basis for judgments about salary and promotion
7. To stimulate the subordinates motivation and
8. To serve as a device for organizational control and integration.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Characteristics of MBO

1. MBO is an approach & philosophy to management & not merely a technique.

2. On the other hand, MBO is likely to affect every management technique. MBO
employs several technique but it is not merely the sum total of these techniques. It is a
way of thinking about management.

3. MBO is bound to have some relationship with every management technique. Certain
degree of overlapping is there. In fact often MBO provides the stimulus for the
introduction of new techniques of management & enhances the relevance & utility of
the existing ones.

4. The basic emphasis of MBO is an objectives.MBO is also concerned with
determining what these results & resources should be. This MBO tries to match
objectives & resources.

5. The MBO is characterized by the participation concerned managers in objective
setting, the performance reviews, and his performance.

6. Periodic review of performance is an important feature of MBO.

7. Objectives in MBO provide guidelines for appropriate systems procedures.
Steps in process of MBO
1. Setting of Organizational Purpose & Objectives

2. Identify the Key Result Areas(KRAs)

3. Establishment of the objectives of the supervision

4. Recommending objectives for the subordinates by the superiors.

5. Setting subordinates objectives

6. Periodic review of the performance of the subordinates.

7. Review of the performance by the superiors.

8. Final review of performance by the superiors.

9. Performance appraisal by superiors.

10. Providing feedback to the top level.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Steps of MBO
1. Setting Goals
1. Top managers formulate the overall organizational goals
2. Middle managers work with first line managers to set goals
3. This strengths organizations overall goals and commitment.
2. Planning
During action planning, managers decide in the who, what, whom, and how detail
needed to achieve each objective.
Implementing plans
1. To control their performance managers must be allowed to implement plans in their own
way.
2. Element of self control
Reviewing performance
Managers review the performance of the people by supervisor
Evaluate the plans to achieve individual & group goals
Discuss how can these obstacles be removed.
MBO Process Cycle

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Benefits of MBO
1. Better management of organization
i. Clarity of objectives
ii. Role clarity
iii. Periodic feedback of performance.
iv. Participation by managers in the management process
v. Realization that there is always scope for improvement of performance in every
situation.
2. Clarity in organizational action
3. Personnel satisfaction
4. Basis for organizational change.
Limitations of MBO
1. Time and cost
2. Failure to teach MBO philosophy
3. Problems in objective setting
4. Emphasis on short- term objectives
5. Inflexibility
6. Frustration
Pre requisites for installing MBO program
1. Purpose of MBO
2. Top management support

3. Training for MBO

4. Participation

5. Feedback for self direction & self control

6. Other factors:-
i. Implementing MBO at lower levels
ii.MBO & Salary Decision
iii. Conflicting objectives.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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VENTURE PLANNING
Venture Planning is a personal assessment of your feelings and the feasibility of a
venture. Venture Planning answers the question, should I be doing this and why? The Venture
Feasibility process examines seven key factors in any venture.
Venture Planning
It is not about writing a Business Plan. Sometimes a business plan is not needed. Venture
Planning does not require detailed funding, source analysis, professional opinions, entity
formation or detailed market analysis. Venture Planning is development of a means of comparing
various business models, usually through financial modeling to answer the following questions:
Which venture concept produces the most sales, the best margins, the highest net profit
and the lowest breakeven?
Which model requires the least investment by entrepreneurs and others?
Which concept requires equity as opposed to debt financing?
Which produces the highest "Return on Investment" and the best liquidity?
Which model requires the entrepreneur to give up the least equity?
Identify and quantify the risks involved with execution of each model.
Venture Formation involves all of the following stages:
Idea - Concept Development - Venture Development - Monitoring Progress - Initiating
New Changes - Venture Feasibility Analysis - Business or Operational Plan - Budget vs.
Actual - New Plans.
There are four keys to good venture planning:
Focus on one venture at a time in one business area at a time.
Discover the opportunity first, and then evaluate how to exploit it.
Develop three cases good, bad & likely for each scenario of a venture concept.
Identify what type of venture you want. Each type has an entirely different model,
implementation and end result. Each demands a different entrepreneurial approach and
each requires different management and style.
There Are 11 Keys to a Good First Venture
1) Founder's alignment with the mission.
2) Guaranteed or qualified customers.
3) Lifestyle of High Profit smaller business.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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4) Routine concept.
5) Available product.
6) Advantageous Cash Flow.
7) Supportive local environment.
8) Neutral State and Federal Environment.
9) Equity Control.
10) Relevant Experience.
11) Low Overhead.
Emerging venture areas in nursing that needs planning
There often occurs a crisis situation in the healthcare set- up when nurses try to defend existing
models of practice instead of embracing change. In order to gain successful planning of good
ventures, we should examine the existing realities (traditional), and analyze and adapt to the
changing context of nursing practice. Some of the traditional realities are;
Institution based care
Process oriented
Procedure driven
Based on mechanical and manual intervention
Provider driven
Treatment based
Reflective of late stage intervention
Based on vertical clinical relationships
According to Porter-O Grady (2003), the emerging realities for nursing practice for this century
will be;
o Mobility based on multiple settings
o Outcome driven
o Best- practice oriented
o Emphasized by technology and minimally invasive intervention
o User driven
o Health based
o Geared for early intervention
o Based on horizontal clinical relationships


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Functions of good nurse manager
A nurse managers functions include the following;
The nurse administrator needs to know the plans and programs of the health facility
administrator and of other departments in which personnel contribute to the joint effort of
providing health care services.
Should be a participatory , voting member of all committees of the institution including
those dealing with budgeting, planning, credentialing, auditing, utilization, infection
control, patient care improvement, library or any other committees concerned with
nursing services, nursing activities and nursing personnel.
Should develop a marketing operational plan based on the overall view of the agency
problems and activities.
Marketing plan should include gathering and analysis of data related to product or service
Operational plan consist of pinpointing possible strengths, weaknesses, problems and
opportunities.
Before launching a venture, a control plan is made to measure performance of
implementation of venture within a time frame.
Selected and trained personnel will be assigned to compare expected results with actual
results for making corrections in all elements of plan and its implementation in future.
PLANNING FOR CHANGE
Change occurs over time, often fluctuating between intervals of change then a time of
settling and stability. Change management entails thoughtful planning and sensitive
implementation, and above all, consultation with, and involvement of, the people affected by the
changes. If you force change on people normally problems arise. Change must be realistic,
achievable and measurable. These aspects are especially relevant to managing personal change.
Definition
Planning: Planning refers to thinking ahead of time and formulation of preliminary
thoughts.
Planned change: Planned change entails planning and application of strategic actions
designed to promote movement towards a desired goal.
o Planned change is a change that results from a well thought out and deliberates
effort to make something happen. It is the deliberate application of knowledge
and skills by a leader to bring about a change.
Tappen, 1995
Change agent: A change agent is one who generates ides, introduces the innovation,
and works to bring about the desired change.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Change agent
A change agent is someone who deliberately tries to bring about a change or innovation,
often associated with facilitating change in an organization or institution. To some degree,
change always involves the exercise of power, politics, and interpersonal influence. It is critical
to understand the existing power structure when change is being contemplated.
A change agent must understand the social, organizational, and political identities and
interests of those involved; must focus on what really matters; assess the agenda of all involved
parties; and plan for action. The change agent should have the following qualities;
The ability to combine ideas
The ability to energize others
Skills in human relations
Integrative thinking
Flexibility modify ideas
Persistent, confident and has realistic thinking
Trustworthy
Ability to articulate a vision, and
Ability to handle resistance.
Assumptions regarding change
Change represents loss. Even if the change is positive, there is a loss of stability. The
leader of change must be sensitive to the loss experienced by others.
The more consistent the change goal is with the individuals personal values and beliefs,
the more likely the change is to be accepted. Likewise the more difficult the goal is from
the individuals personal values; the more likely it is to be rejected.
Those who actively participate in change process feel accountable for the outcome.
Timing is important in change. With each successive change in a series of changes,
individuals psychological adjustment to the change occurs more slowly. And for this
reason the leader of change must avoid initiating too many changes at once.

The key principles driving the elements of the Change Management are:
1. Targeted Commitment Levels
2. Executive Ownership
3. Visible, sustained sponsorship
4. Deployment/Implementation Support and Monitoring
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5. Employee Support
6. Post Deployment Preparation
Strategies for planned change
In general, three categories of change models exist: empirical-rationale, power-coercive, and
normative-educative model. (Bennis, Benne and Chin [1969], The planning of change)
Rationale- empirical:
This strategy emphasizes reason and knowledge. People are considered rational beings
and will adopta change if it is justified and in their self- interest. Here the change agents role is
communicating the merit of the change to the group. If the change is understood by the group to
be justified and in the best interest of the organization, it is likely to be accepted. This strategy is
useful when little resistance to change is expected. It is assumed that once if the knowledge and
rationales are given, people will internalize the need for change and value the result.
Normative- re-educative:
This is based on the assumption that group norms are used to socialize individuals. The
success of this approach often requires a change in attitude, values, and/ or relationships. This
strategy is most used when the change is based on culture and relationships within the
organization. The power of the change agent, both positional and informal, becomes integral to
the change process.
Power- coercive:
This approach is based on power, authority, and control. Desired change is brought about
by political or economic power. It requires that the change agent have the positional power to
mandate the change. The outcome of change is often based either on followers desire to please
the leader or fear of the consequences for not complying with the change. This strategy is
effective for legislated changes, but other changes using this strategy are often short- lived.
Barriers to change and strategies to overcome
It is important to identify all potential barriers to change, to examine them contextually
with those affected by proposed change, and to develop strategies collectively to reduce or
remove the barriers.
Change requires movement, which as physics indicates, is a kinetic activity that that
requires energy to overcome resistance.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Barrier Discussion Strategy
Desire to remain in
our comfort zone
Those who become increasingly attached to a
familiar way of doing things (comfort zone)
often view change as an unwelcome disruption.
Rational- empirical
strategies
Inadequate access to
information
Lack of information, inability to read and
understand the available resources.
Rational- empirical
strategy
Lack of shared vision Lack of widespread involvement, input, and
ownership of change will cripple a change
effort.
Normative- re-
educative strategy
Lack of adequate
planning
Involving individuals in planning gives a sense
of control and decreases their resistance to
change.
Rational- empirical
and normative- re-
educative strategies
Lack of trust Trust in the change agent and ability of self to
bring about change is necessary.
Rational- empirical
and normative- re-
educative strategies
Resistance to change Co-operation and involvement of the whole
team will only bring effective and lasting
changes.
Normative- re-
educative strategy
Poor timing or
inadequate time
planned
Poor timing and lack of planning can fail to
bring desired change.
Introducing change
at a time when
people are ready to
change guarantees
success
Fear that power,
relationships, or
control will be lost
Every change represents potential for loss to
someone.
Normative- re-
educative strategy
Amount of personal
energy needed for
change may be great
Sometimes change is desired, but people are not
willing to do what is necessary to effect the
change.
Slow the change
process and give
time to catch- up and
energize

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Types of changes
Hohn (1998) identified four different types of change: Change by exception, Incremental
Change, Pendulum Change and Paradigm Change.
Change by Exception: This occurs when someone makes an exception to an existing
belief system. For instance, if a client believes that all nurses are bossy, but then
experiences nursing care from a much modulated nurse, they may change their belief
about that particular nurse, but not all nurses in general.
Incremental Change: A change that happens so gradually, that an individual is not aware
of it.
Pendulum Changes: Are changes that result in extreme exchanges of points of view.
Paradigm Change: Involves a fundamental rethinking of premises and assumptions, and
involve a changing of beliefs, values and assumptions about how the world works.
Change Theories in Nursing
Change theories are used in nursing to bring about planned change. Planned change
involves, recognizing a problem and creating a plan to address it. There are various change
theories that can be applied to change projects in nursing. Choosing the right change theory is
important as all change theories do not fit every change project. Some change theories used in
nursing are Lewins, Lippitts, and Havelocks theories of change. The characteristics of change
theories are;
Problem identification
Plan for innovation
Strategies to reduce innovation
Evaluation plan
Kurt Lewins change theory:
The theoretical foundations of change theory are robust: several theories now exist, many
coming from the disciplines of sociology, psychology, education, and organizational
management. Kurt Lewin (1890 1947) has been acknowledged as the father of social change
theories and presents a simple yet powerful model to begin the study of change theory and
processes. He is also lauded as the originator of social psychology, action research, as well as
organizational development.
"Unfreezing" involves finding a method of making it possible for people to let go of an old
pattern that was counterproductive in some way. In this stage, the need for change is recognized,
the process of creating awareness for change is begun and acceptance of the proposed change is
developed
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"Moving to a new level" involves a process of change--in thoughts, feelings, behavior, or all
three, that is in some way more liberating or more productive. The need for change is accepted
and implemented in this stage.
"Refreezing" is establishing the change as a new habit, so that it now becomes the "standard
operating procedure." Without some process of refreezing, it is easy to backslide into the old
ways.The new change is made permanent here.
Lewin also created a model called force field analysis which offers direction for
diagnosing situations and managing change within organizations and communities.
According to Lewins theories, human behavior is caused by forces beliefs,
expectations, cultural norms, and the like within the "life space" of an individual or society.
These forces can be positive, urging us toward a behavior, or negative, propelling us away from
a behavior.
Driving Forces- Driving forces are those forces affecting a situation that are pushing in a
particular direction; they tend to initiate a change and keep it going. In terms of improving
productivity in a work group, pressure from a supervisor, incentive earnings, and competition
may be examples of driving forces.
Restraining Forces- Restraining forces are forces acting to restrain or decrease the driving
forces. Apathy, hostility, and poor maintenance of equipment may be examples of restraining
forces against increased production.
Equilibrium - This equilibrium, or present level of productivity, can be raised or lowered by
changes in the relationship between the driving and the restraining forces. Equilibrium is reached
when the sum of the driving forces equals the sum of the restraining forces.
Lippitts phases of change theory:
Lippitts theory is based on bringing in an external change agent to put a plan in place to
effect change. There are seven stages in this theory. The first three stages correspond to Lewin's
unfreezing stage, the next two to his moving stage and the final two to his freezing change. In
this theory, there is a lot of focus on the change agent. The third stage assesses the change
agents stamina, commitment to change and power to make change happen. The fifth stage
describes what the change agents role will be so that it is understood by all the parties involved
and everyone will know what to expect from him. At the last stage, the change agent separates
himself from the change project. By this time, the change has become permanent.
The seven phases shift the change process to include the role of a change agent through the
evolution of the change.
Phase 1:Diagnose the problem
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Phase 2:Assess the motivation and capacity for change
Phase 3:Assess the resources and motivation of the change agent(commitment the
change, power, and stamina)
Phase 4:Define progressive stages of change
Phase 5: Ensure the role and responsibility of the change agent is clear and understood
(communicator, facilitator, and subject matter expert.
Phase 6:Maintain the change through communication, feedback, and group coordination
Phase 7:Gradually remove the change agent from the relationship, as the change becomes
part of an organizational culture.
Havelock's change model:
Havelock's change theory has six stages and is a modification of the Lewin's theory of
change. The six stages are building a relationship, diagnosing the problem, gathering resources,
choosing the solution, gaining acceptance and self renewal. In this theory, there is a lot of
information gathering in the initial stages of change during which staff nurses may realize the
need for change and be willing to accept any changes that are implemented. The first three stages
are described by Lewin's unfreezing stage the next two by his moving stage and the last by the
freezing stage.
John P Kotter's 'eight steps to successful change'
John Kotter's highly regarded books 'Leading Change' (1995) and the follow-up 'The
Heart Of Change' (2002) describes a helpful model for understanding and managing change.
Each stage acknowledges a key principle identified by Kotter relating to people's response and
approach to change, in which people see, feel and then change: Kotter's eight step change model
can be summarized as:
Increase urgency - inspire people to move, make objectives real and relevant.
Build the guiding team - get the right people in place with the right emotional
commitment, and the right mix of skills and levels.
Get the vision right - get the team to establish a simple vision and strategy focus on
emotional and creative aspects necessary to drive service and efficiency.
Communicate for buy-in - Involve as many people as possible, communicate the
essentials, simply, and to appeal and respond to people's needs. De-clutter
communications - make technology work for you rather than against.
Empower action - Remove obstacles, enable constructive feedback and lots of support
from leaders - reward and recognize progress and achievements.
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Create short-term wins - Set aims that are easy to achieve - in bite-size chunks.
Manageable numbers of initiatives. Finish current stages before starting new ones.
Don't let up - Foster and encourage determination and persistence - ongoing change -
encourage ongoing progress reporting - highlight achieved and future milestones.
Make change stick - Reinforce the value of successful change via recruitment,
promotion, and new change leaders. Weave change into culture.
General considerations for planning change
Secure and maintain commitment to change
Define and communicate desired end state
Identify critical success factors
Establish targets and prioritize activities
Develop a theme
Understand why the change is desired/ required
General considerations for planning change
Secure and maintain commitment to change
Define and communicate desired end state
Identify critical success factors
Establish targets and prioritize activities
Develop a theme
Understand why the change is desired/ required
Nurse Leader (manager) as role model for Planned Change
Implement a comprehensive and coordinated change management program: Discover,
develop, detect.
Identify change agents and engage people at all levels in the organization.
Ensure the message comes from the top, and executives and line managers are
walking the talk.
Make change visible with new tools and/or environment.
Ensure clear, concise, and compelling communication.
Integrate change goals with day-to-day activities, e.g., recruiting, performance
management, and budgeting.
Address short-term performance while setting high expectations about long-term
performance.
Help management avoid attempts to short circuit the change management process.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Foster change in peoples attitudes first, then focus on change in processes, then
change in the formal structure.
Manage both supporters and champions, as well opponents and possible detractors.
Accept that all people go through the same steps some faster, some slower and it
is not possible to skip steps.
Build a safe environment that enables people to express feelings, acknowledge fears,
and use support systems.
Acknowledge and celebrate successes regularly and publicly!
Mistakes by a leader manager
+ Fail to provide visible support and reinforce the change with other managers.
+ Do not take the time to understand how current business processes would be affected by
change.
+ Delayed decision-making, which leads to low morale and slow project progress.
+ Are not directly or actively involved with change project.
+ Fail to anticipate the impact on employees.
+ Underestimate the time and resources needed
+ Abdicate ownership of the project to another manager.
+ Fail to communicate both the business reasons for the change and the expected
outcome to employees and other managers
+ Change the project direction mid-stream
+ Do not set clear boundaries and objectives for the project
Organizational ageing
The organization has to undergo progress through certain developmental stages within
the organizational structure termed organizational ageing. The young organization is
characterized by high energy, movement and constant change and adaptation; while the aged
organizations will have established turf boundaries functioning in an orderly and predictable
fashion, and are focused on rules and regulations. In any type of ageing, organizations must find
a balance between chaos and stagnation. Some areas that undergo restructuring during an
organizational ageing are;
leadership changes
organizational restructuring
outsourcing and offshoring
new technologies and tools
new competitors and markets

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
INNOVATIONS IN NURSING
Introduction
Change is a natural social process of individuals, groups, organizations and society. The
source of change originates inside and outside health care organizations. Change today is
constant, inevitable, pervasive and unpredictable, and varies in rate and intensity, which
unavoidably influences individuals, technology and systems at all levels of the organization.

Creativity and innovation

Creativity is defined as artistic or intellectual inventiveness.
Innovation is defines as introduction of something new. These definitions suggest that the
terms are interchangeable. A person could say that creativity is the mental work or action
involved in bringing something new into existence, while innovation is the result of that effort.

A constant flow of new ideas is needed to procure new products, services, processes,
procedures and strategies for dealing with the change occurring in every sphere of endeavour:
technology social system, government and everyday living. Innovation is the key to survival and
growth of health care and nursing.

Change, innovation and creativity are comparison terms but can also be differentiated.
Changes occur when the system is disrupts; innovation uses changes to create new and different
approaches to resolve an issue and develop new products or procedures. (Huber 1996).

Systemic innovations according to (Drucker 1992) require willingness to look on changes
as an opportunity. Innovations do not create change. Successful innovations are accomplished by
exploiting the change not forcing it.

Process of Innovation
The process of the innovation may include several steps. They are:
Assessment
It is the first step of process and it requires a look at both the strength and
problems. An administrator must focus on what is specific content requirement the
expected outcome. Specific content requirement changes often in the health care, as new
technologies and research bring new knowledge needs.

Defining objectives
It is the second step. The administrator should search for research or technique
that could address the identical needs. Asking the peers for the suggestion is also helpful.
This is the place where the creativity begins. It is important to look at many different
ways to address the learning objectives before selecting one.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Planning
Once a strategy has been selected the third step, planning is important.
Understand who the stakeholders are and what their investment is in the status quo or in
change can be helpful in planning the strategies to bring them on board. Many stake
holders do not like the changes and will resist the new approaches. Using the change
theory it can assist in demonstrating the needs and provide information that can make
resistors more amenable to change. Its important to take time to develop a support for
the strategy. In more complex strategies it may be important to bring other
administrators.

Gaining support for the innovation
Some strategies require little or resources to implement where as others require
significant physical and financial resources. If resources are needed then gaining support
for the accusation of those resources are essential. Grants can provide good funding
sources but require time and effort to secure and may be for a limited time.
Administrative support may be required but administrators may also be an excellent
resource to tap to discuss the potential funding or acquisitions of the physical resource.

Preparing faculty members for the innovation
Rehearsal time may be required or additional education may be required. Planning
sufficient for those activities will increase everyones comfort level with this process.
This is the time where everyone agrees how the strategy will be in run. Use of perception,
validate and clarification can be a valuable tool.

Implementing the evaluation
In this step it is hope that the things will be going well, but flexibility may be
required if problems arise. Sometimes unintended consequences, such as surfacing of
emotional issues can occur. Administrator should be alert to the need for the follow up or
referral if problem arise.

Evaluating the outcome
It is the final step of the process. It may be possible to measure short term
attainment goals. A strong evaluation process provides an opportunity to evaluate the
outcome of the change.
Sources of innovation
Seven sources for innovative ideas have been identified by (Drucker 1992)




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Four sources are found internally within the institutions are:
Unexpected outcomes: Situation presents themselves that require different methods to
be adopted. Knowing what is happening in an institution allows an individual to prepare
for the impending changes.
Incongruous circumstances: Disruptions occur that require change to be made
discrepancies exists between the reality as it is and reality as it is assumed to be.
Innovations made on the process needs: Procedures and policies need to be altered to
respond to the new regulations, policies or law.
Changes in structure: Organizational changes require changes in method of the
operations.

Three sources are outside the institutions:
Change in the demographics: Alteration in the community statistics such as age and
income levels affect the organizational operations.
New information or knowledge: New technological knowledge requires change in
practice.
Change in perception, taste and meaning: Shifts in demographics, technologies and
social needs create different ways of looking at the situation.

Steps in Innovation adoption
Knowledge: Aware of new information and possible significance to practice.
Persuasion: Positive attitudes about importance and utility of new knowledge.
Decision: Trial use of new information to test relevance to practice.
Implementation: Change of care setting to facilitate use of the innovations.
Confirmation: Gathering of evidence to confirm appropriateness of using the
innovations.

Theories
Planned change using linear approaches
Theories for planned change

Six phases of planned change

Havelock (1973) is credited with this planned change model

Key idea: Change can be planned, implemented and evaluated in six sequential stages. The
model is advocated for development of effective change agents and use as a rational problem
solving process. The six stages are:-
1. Building a relationship
2. Diagnosing the problem
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
3. Acquiring relevant resources
4. Choosing the solution
5. Gaining acceptance
6. Stabilizing the innovation and generating self renewal

Application to practice: Useful for low level, low complexity change.

Seven phases of planned change

Lippitt, Watson and westly (1958) are credited with this planned change model

Key idea: change can be planned, implemented and evaluated in seven sequential phases.
Ongoing sensitivity to forces in the change process is essential. The seven phases are:
1. The client system become aware of the need for the change
2. The relationship is developed between the client system and change
3. The change problem is defined
4. The change goal are set and options for achievements are explored
5. The plan for the change is implemented
6. The change is accepted and stabilized
7. The change entities redefine their relationship

Application to practice: Useful for low level, low complexity change.

Innovation decision process

Rogers (1995) is credited with formulating this process.

Key idea: Change for an individual occurs over five phases when choosing to accept or reject an
innovation/idea. Decision is to not accept the new idea may occur at any five stages. The change
agent can promote acceptance by giving information about benefits and disadvantages and
encouragement. The five stages are:
1. Knowledge
2. Persuasion
3. Decision
4. Implementation and
5. Confirmation
Application to practice: Useful for individual change.



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Nonlinear change
Chaos theory
Organization can no longer rely on rules, policies, and hierarchies to get work
accomplished in flexible ways. According to the chaos theory perspectives because of rapidly
changing nature of human and world factors health organizations cannot control long term
outcomes. The assertion of chaos theory are that organization are potentially chaotic(thietat and
Forgues, 1995). In other words, order emerges through fluctuations and chaos. Organization
will experience periods of stability interrupted with periods of intense transformation.

Response to change / Human side of change

The human side of the managing change refers to staff responses to change that either
facilitate or interfere with change process. Responses to all or part of the change process by
individuals and group may vary from full acceptance and willing participation to open rejection.
Responses may be categorized behaviourally or emotionally. Some nurses may manifest their
dissatisfaction visibly; others may quietly accommodate the change. Some individuals
consistently reject any new thinking or way of doing things. The initial response to change may
be, but not always, reluctance and resistance. Resistance and reluctance are common when the
change threaten the personal security. Eg: -Changes in the structure of an agency can result in
changes of position for personnel.

The change agents recognition of the ideal and common patterns of the individuals
behaviour responses to change can facilitate an effective change process (Rogers 1983).

The responses and brief descriptions are as follows:
Innovators thrive on change, which may be disruptive to the unit stability.
Early adopters are respected by their peers and thus are sought out for advice and
information about innovations/changes.
Early majority prefer doing what has been done in the past but eventually will accept the
new ideas.
Late majority are openly negative and agree to change only after most others have
accepted the change.
Laggards prefer keeping tradition and openly express their resistance to new ideas.
Rejecters oppose change actively.

General characteristics of effective change agents

Is a respected member of the organization (insider) or community (outsider).
Possesses excellent communication skills.
Understands change process.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Knows how group functions.
Is trusted by others.
Participates actively in change processes.
Processes expert and legitimate power.

Principles characterizing effective change implementation
- The recipients of change feel they own the change.
- Administrators and other key personnel support the proposed change.
- The recipients of change anticipate benefit from the change.
- The recipient of change participates in identifying the problem warranting a
change.
- The change holds interest for the change recipients and other participants.
- Agreements exist within the work group about the benefit of the change.
- The change agents and recipients of change perceive a compatibility of values.
- Trust and empathy exist among the participants of the change process .
- Revision of the change goal and process is negotiable.
- The change process is designed to provide regular feedback to its participants.

Challenges met by the change leaders
Mc Daniels (1996) advocates that change leaders in healthcare organizations meet
the challenges of managing by applying 12 recomendations:
1. Dispense with controlling and planning.
2. Operate on the margin between order and disorder.
3. Develop new organizations with the help of everyone.
4. Allow individual autonomy.
5. Encourage information sharing among staffs.
6. Promote staffs knowledge of others work.
7. Stimulate open learning through discussion generating creative tension.
8. Considering the organization structure as dynamic.
9. Help staffs discover their goals.
10. Encourage cooperation not competition.
11. Approach work from smarter view, not harder.
12. Uncover values continuously to form organization wide visions.

*****



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Unit IV
ORGANISATION Concept , principles, objectives, Types and theories,
Minimum requirements for organisation,
Developing an organizational Structure, levels,
organizational Effectiveness and organizational
Climate,
Organizing nursing services and patient care:
Methods of patient
assignment- Advantages and disadvantages,
primary nursing care,
Planning and Organizing: hospital, unit and
ancillary services(specifically central sterile supply
department, laundry, kitchen, laboratory services,
emergency etc)
Disaster management: plan, resources, drill, etc
Application to nursing service and education






PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
ORGANIZATION
Definition
An organization may be defined as a formally constituted group of people who have
identified tasks and who work together to achieve a specific purpose defined by the
organization.
Organization is a form of every human association for the attainment of common
purpose and the process of relating specific duties or function in a whole
-J D Mooney
Organization consists of the relationship of individual to individuals and groups to groups
which are related as to bring about an orderly division of labor.
- Pfiffiner.
Organization is a formal structure of authority through which work subdivisions are
arranged, defined and coordinated for the defined objective.
- Luther Gullick
Organization is a system of co-operative activities of two or more persons.
-Chester I Bernard.
An organization is defined as a designed and structured process in which individuals
interact for objectives
-Hicks and Gullet, 1975.
Nature of organization
Four Ps are required to form the bases for organization,
P- Purposes
P- Process
P- Person target group
P- Place setting


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Importance of organization
- It increases managerial efficiency .
- It ensures an optimum use of human efforts through specialization and also make use of
all resources , determines needs for innovative and new technologies in terms of cost
effectiveness and accomplish objectives.
- It places a proportionate and balanced emphasis on various activities.
- It facilitates coordination in the enterprises.
- It provides scope for training and developing managers.
- It helps to consolidate growth and expansion of the institution/enterprise.
- It invites creative and innovative ideas.
- It prevents the growth of laggards, wire pullers or other forms of corrupters
Principles of organization
According to Ms. T.K.Adranvala
Division of labor
Hierarchy of authority
System for co-ordination and control
Span of control it depends on ,
-Unity of objectives
-Division of work &specialization
-Job description
-Unity of command
-Principle of adequate authority
-Span of supervision

According to BT Basavanthappa
There are six principles of organization as follows:
1. Hierarchy
2. Span of control
3. Integration vs. disintegration
4. Centralization vs. decentralization
5. Unity of command
6. Delegation

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
According to Russell C. Swansburg & Richard J. Swansburg

+ Principle of chain of command
+ Principle of unity of command
+ Principle of span of control
+ Principle of specialization
Theories of organization
Definition :
Organizational theory (OT) is the study of organizations for the benefit of identifying
common themes for the purpose of solving problems, maximizing efficiency and
productivity, and meeting he needs of stakeholders
Types of organizational theories
1)Classical
organization
theory
2)Neoclassical
theory
3)Modern theories 4)Individual
processes
a)Taylors
scientific
management
approach
a)The systems
approach
a)Motiv
ational
theory
b)Webers
bureaucratic
approach
b)Socio-technical
approach
b) Role theory
c)Administrative
theory
c)The contingency or
Situational approach
c)Personality
theory




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
TYPES OF ORGANIZATIONAL THEORIES
1) Classical organization theory
a) Taylors scientific management approach
b) Webers bureaucratic approach
c) Administrative theory
2) Neoclassical theory
3) Modern theories
a) The systems approach
b) Socio-technical approach
c) The contingency or situational approach
4) Individual processes:
a) Motivational theory
b) Role theory
c) Personality theory
1) Classical organization theories (Taylor, 1947; Weber, 1947; Fayol, 1949) deal
with the formal organization and concepts to increase management efficiency.
Taylor presented scientific management concepts,
Weber gave the bureaucratic approach, and
Fayol developed the administrative theory of the organization.

A) Taylor's scientific management approach
Is based on the concept of planning of work to achieve efficiency, standardization,
specialization and simplification.
Taylor suggested that, to increase productivity was through mutual trust between
management and workers,
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Taylor developed the following four principles of scientific management for improving
productivity:
1. Science, not rule-of-thumb Old rules-of-thumb should be supplanted by a scientific
approach to each element of a person's work.
2. Scientific selection of the worker Organizational members should be selected based on
some analysis, and then trained, taught and developed.
3. Management and labor cooperation rather than conflict Management should
collaborate with all organizational members so that all work can be done in conformity
with the scientific principles developed.
4. Scientific training of the worker Workers should be trained by experts, using scientific
methods.

B) Weber's bureaucratic approach
Weber (1947) based the concept of the formal organization on the following principles:
1. Structure: In the organization, positions should be arranged in a hierarchy, each with a
particular, established amount of responsibility and authority.
2. Specialization: Tasks should be distinguished on a functional basis, and then separated
according to specialization, each having a separate chain of command.
3. Predictability and stability The organization should operate according to a system of
procedures consisting of formal rules and regulations.
4. Rationality: Recruitment and selection of personnel should be impartial.
5. Democracy: Responsibility and authority should be recognized by designations and not
by persons.
C) Administrative theory
The elements of administrative theory (Henri Fayol, 1949) relate to accomplishment of tasks,
and include
- Principles of management,
- The concept of line and staff,
- Committees and
- Functions of management.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
i) Principles of management
Division of work
Authority and responsibility
Discipline
Unity of command
Unity of direction:
Subordination of individual interest to general interest
Remuneration of personnel
Centralization
Scalar chain
Order
Equity
Stability of tenure of personnel
Initiative
Esprit de corps

b) The concept of line and staff :
The concept of line and staff is relevant in organizations which are large and require
specialization of skill to achieve organizational goals.
Line personnel are those who work directly to achieve organizational goals.
Staff personnel include those whose basic function is to support and help line personnel.

c) Committees :
Committees are part of the organization.
Members from the same or different hierarchical levels from different departments can
form committees around a common goal.
They can be given different functions, such as managerial, decision making,
recommending or policy formulation.
Committees can take diverse forms, such as boards, commissions, task groups or ad hoc
committees.
Committees can be further divided according to their functions.
For e.g. In agricultural research organizations, committees are formed for research, staff
evaluation or even allocation of land for experiments
d) Functions of management
Fayol (1949) considered management as a set of ,
-Planning, Organizing, Training, Commanding and Coordinating functions.
Gulick and Urwick (1937) also considered organization in terms of management
functions such as,
- Planning, Organizing, Staffing, Directing, Coordinating, Reporting and Budgeting.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
2) Neoclassical theory
Classical theorists recognized the importance of individual or group behavior and
emphasized human relations.
Based on the Hawthorne experiments, the neoclassical approach emphasized social or
human relationships among the operators, researchers and supervisors
Productivity increases as a result of high morale, which was influenced by the amount of
individual, personal and intimate attention workers received.
Principles of the neoclassical approach
The individual :An individual is not a mechanical tool but a distinct social being, with
aspirations beyond mere fulfillment of a few economic and security works. Individuals
differ from each other in pursuing these desires. Thus, an individual should be recognized
as interacting with social and economic factors.
The work group: The neoclassical approach highlighted the social facets of work
groups or informal organizations that operate within a formal organization. The concept
of 'group' and its synergistic benefits were considered important.
Participative management :Participative management or decision making permits
workers to participate in the decision making process. This was a new form of
management to ensure increases in productivity.
3) Modern theories
It is based on the concept that the organization is a system which has to adapt to changes
in its environment.
Notable characteristics of the modern approaches to the organization are:
1. A systems viewpoint
2. A dynamic process of interaction
3. Multileveled and Multidimensional
4. Multi motivated
5. Probabilistic
6. Multidisciplinary
7. Descriptive
8. Multivariable
9. Adaptive



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
a) The Systems Approach:
The systems approach views organization as a system composed of
interconnected - and thus mutually dependent - sub-systems
Sub-systems can have their own sub-sub-systems.
A system can be perceived as composed of some components, functions and
processes (Albrecht, 1983).
The organization consists of the following three basic elements (Bakke, 1959):
(i) Components :
the individual,
the formal and informal organization,
patterns of behavior emerging from role demands of the organization,
role comprehension of the individual, and
the physical environment in which individuals work.
(ii) Linking processes-
Communication:
Is a means for eliciting action, exerting control and effecting coordination to link decision
centers in the system in a composite form.
Balance :
Is the equilibrium between different parts of the system so that they keep a harmoniously
structured relationship with one another.
Decision analysis:
Decisions may be to produce or participate in the system.
Decision to produce depends upon the attitude of the individual and the demands of the
organization.
Decision to participate refers to the individual's decisions to engross themselves in the
organization process. That depends on what they get and what they are expected to do in
participative decision making.
(iii) Goals of organization:
The goals of an organization may be growth, stability and interaction.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Interaction implies how best the members of an organization can interact with one another to
their mutual advantage.
b) Socio-technical approach
The socio-technical systems approach is based on the premise that every organization
consists of the people, the technical system and the environment (Pasmore, 1988).
People (the social system) use tools, techniques and knowledge (the technical system) to
produce goods or services valued by consumers or users (who are part of the
organization's external environment).
Therefore, an equilibrium among the social system, the technical system and the
environment is necessary to make the organization more effective.
c) The contingency or situational approach
The situational approach is based on the belief that there cannot be universal guidelines
which are suitable for all situations.
Organizational systems are inter-related with the environment.
The contingency approach suggests that different environments require different
organizational relationships for optimum effectiveness, taking into consideration various
social, legal, political, technical and economic factors
4) Individual Processes
a) Motivational Theory
Motivation drives behavior; it is the force behind an individuals decision to commit or
not commit to certain acts or behaviors.
An individual calculates an E (energy, enthusiasm, effort) the product of need, and
prediction for likelihood of achieving the desired results.

When a person enters into a contract with an organization some calculation will be made
in regards to the individuals E put forth.
Organizations also put forth an E, either by resources alone (salary), or by other items
such as prestige and stature. This exchange sets the limits of a physical and
psychological contract between the organization and the person
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Management must carefully consider how to maintain or adjust the psychological
contract in order to keep the person a productive member of the team.
c) Role Theory
- In an organization roles can help to clearly define boundaries between individuals .
- Organizations need to acknowledge that its employees manage many roles and that
problems or conflicts can arise and create tensions that can change the ability of the
individual to reach their goals.
- Organizations should be sure to support their team members in meeting new roles by
giving time for transition, or offering training and support.
- When role conflict arises the organization can nurture employees ability to relieve
tension by allowing time to devote to caring for roles outside the office.
d) Personality Theory
Personality is the unique and enduring traits, behaviors and emotional characteristics in
an individual.
Personality can either aid or hinder meeting work goals dependent on fit.
For e.g. Personality types are Type a vs. Type B
Type A personalities are competitive, impatient, seekers of efficiency and always seem to
be in a hurry.
Type B personalities are laid back and possess more patience and emotional stability, but
tend to be less competitive.
In a work environment Type As tend to be more productive in the short term and pursue
more challenging work. However, they also have a greater tendency towards health risks
and are less likely than Type Bs to be in top executive positions.
Organizations can play a role in developing their staff for success. Workshops, seminars,
even book clubs that focus on developing EQ an strengthen organizational success.
Allowing for a diverse set of experiences, with appropriate support can maximize and
expand the capabilities of each employee.



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Minimum requirements for organization
Clarity:
Nurses need to know
-Where they belong,
-Where they stand in relation to the quality and quantity of their performances
-Where to go for assistance.
Economy:
Nurses need as much self-control of their work as they can possibly be given.
They need to be self motivating .
There should be the smallest possible number of overhead personnel necessary to keep
the division and units operating and well maintained.
Direction of vision-
Nurse managers must direct their vision and that of their employees
-toward performance,
-toward the future and
- toward strength.
Decision making-
Nurses should be organized to make decisions on the right issues and at the right levels.
They should be organized to convert their decisions into work and accomplishments.
Stability and Accountability-
Nurses should be organized to feel community belongingness .
They can adapt to show objectives requiring changes in their functions and productivity.
Perception and Self renewal-
Nursing services should be organized to produce future leaders.
The organizational structure should produce continuous learning for the job each nurse
holds and for promotion.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
TYPES OF ORGANIZATIONAL STRUCTURE
1) Tall or Centralized Structure.
2) Flat or Decentralized Structure.
3) Matrix Structure.
4) Adhocracy Structure.
5) Shared Governance.

Tall or Centralized Structure
A Tall organization is named so because a chart of its relationship appears tall and
narrow.
It is also called Centralized, because most of the decision making authority and power is
held by few persons in central positions.
e.g. In an acute care hospital, the nursing position would be that of the chief nursing
officer, with 2 or 3 assistants.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
ADVANTAGES DISADVANTAGES
Enables an individual to
be an expert in the
narrow area over which
he or she is responsible.
Because the supervisor
has fewer people to
supervise, close
supervision is possible.
The top level authority
are the primary decision
makers and have a great
deal of control over
actions of others.
The most skilled
individuals may end
up doing nothing but
supervising, whereas
those less capable do
the actual tasks.
Those who are
closely supervised
may feel stifled and
even mistrusted
sometimes.
Communication is
difficult because it
may pass through
many layers.
Implementation of
decisions may
excessively delay.

Flat or Decentralized Structure
The chart of relationships shows few levels and a broad span of control.
Decision making is commonly spread out among many people and those closest to the
situation are given wide latitude in determining appropriate actions.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN














Matrix Structure
These structures are most often found in very large, multifaceted organizations.
Many organizations try to apply principles of business to health care.
ADVANTAGES DISADVANTAGES
There is simplification of
communication patterns,
flowing easily from lower
levels to higher levels in a
direct manner.
Greater speed with which
the organization can
respond to problems or new
opportunities, as decisions
can be made by those in the
situation.
Less chance of
communication becoming
lost or distorted as it moves
within an organization
Managers may lack
expertise in wide variety of
operations for which they
are responsible and thus
make inappropriate
decisions.
If individuals within the
organization are not
competent, their
inappropriate decisions
and actions may do great
harm .
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
This resulted in the organization of areas around product lines (which focuses on end
product of health care) and service line (represents the tasks required to accomplish the
delivery of the product)

ADVANTAGES DISADVANTAGES
A team approach to projects or
problems brings together wide
expertise and often generates
more creative solutions
Leadership conflict
There is flexible use of human
resources
Lack of understanding of
roles and expectations
The team members learn more
about one anothers concerns and
thus improves working
relationships, functional
integration
Confusion, Conflict and
Ambiguity
Communication is also improved
by close contact with all
organizational groups.
Time allocation between
working for team and
working for department
may become an issue.






PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN



Adhocracy Structure
- This type of structure uses teams of specialists who are organized to complete a
particular project or task.
- These groups are referred to as project team or task force.
- It is composed of highly specialized professionals, the work is delegated by a director
to members of the project team who provide particular expertise.
Shared Governance
It represents a professional practice model in which the nursing staff and nursing
management are both involved in making decisions as opposed to having the decisions
made at an administrative level only.
Implementations Of Shared Governance:
President
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
It requires the staff nurses participate in professional development designed to increase
the nurses understanding of decision making, team building, group dynamics, leadership
and budgeting.
Disadvantages:
Time involved in shared governance is costly to organizations.
Its cost effectiveness in terms of patient outcomes is questioned sometimes.

ORGANIZATIONAL EFFECTIVENESS
The product or output of an organization is termed organizational effectiveness (O.E).
There should be a relationship between organizational effectiveness and performance
(O.P).
Nurse Managers define the goals and provide the resources for both the organizational
effectiveness and organizational performance.
For e.g-
The dimensions include:
Patient satisfaction with care
Family satisfaction with care
Staff satisfaction with work
Staff satisfaction with rewards , intrinsic and extrinsic
Staff satisfaction with professional development career, personal and educational
Staff satisfaction with organization
Management satisfaction with staff.
Community relationships.
Organizational
Nurse administrators control these dimensions of organizational effectiveness.
The organization is effective or productive when the people are performing care that
meets clients needs and for which employees have a sense of accomplishment.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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An organization can be shaped through:
- Job enlargement that is qualitative- meaningful, interesting, and intellectually rewarding.
- Making the structure more manageable. Increasing clinical nurses autonomy reduces the
organization's size.
- Increasing the span of control of the manager.
- Shortening the hierarchy.
- Involving the employees in participation.
- Decentralization.
- Increasing the employees stake in his or her own performance.
- Increasing creativity while maintaining fiscal responsibility.
- Replacing direction and control with advice.
- Meeting employees need.
ORGANIZATIONAL CLIMATE
It is the emotional state and the perceptions and feelings shared by members of the
system.
It can be formal, relaxed, defensive, cautions, accepting, trusting etc.
It is the employees subjective impression or perception of their organization.
It relates to the personality of an organization and can be changed.
Organizational climate, defined differently by many researchers and scholars, generally refers to
the degree to which an organization focuses on and emphasizes:
Innovation
Flexibility
Appreciation and recognition
Concern for employee well-being
Learning and development
Citizenship and ethics
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Quality performance
Involvement and empowerment
Leadership
Sociological dimensions of organizational climate:
Clarity in specifying certification of the organizational goals and policies. This is
facilitated by smooth flow of information and management support of employees.
Commitment to goal achievement through employee involvement.
Standards of performance that challenge promote pride and improve individual
performance.
Responsibility for one's own work fostered and supported by managers.
Teamwork- a sense of belonging, mutual trust and respect.
Environmental dimensions of climate:
It includes
-Room attractiveness
-Illumine
-Shape of the furniture
Practicing nurses wants a climate that will give them
-Job satisfaction
-Good working conditions
-High salaries
-Opportunities for professional growth
-Career development experiences that will help them to determine and direct their
professional futures.
-Administrative support that includes adequate staffing and shift options
-To develop their self esteem through self actualization.
Hellriegel and Slocum (2006) explain that organizations can take steps to build a more positive
and employee-centered climate through:
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Communication How often and the types of means by which information is
communicated in the organization
Values The guiding principles of the organization and whether or not they are modeled
by all employees, including leaders
Expectations Types of expectations regarding how managers behave and make
decisions
Norms The normal, routine ways of behaving and treating one another in the
organization
Policies and rules - These convey the degree of flexibility and restriction in the
organization
Programs Programming and formal initiatives help support and emphasize a
workplace climate
Leadership Leaders that consistently support the climate desired

Role of Nurse Managers In Organizational Climate
Nurse Managers should emphasize management tasks or activities that stimulate
motivation in nursing employees.
Nurse Managers should establish a management strategy to support new nurses and
involve them in decision making.
Nurse Managers should establish a climate in which discipline is applied fairly and
uniformly.
Nurse manager will work to establish an organizational climate that provides
-Incentives for clinical nurses,
-Places them on committees,
-Is creative and equitable in all staffing matters;
-Emphasizes pride,
-Promotes participation,
-Rewards seniority and achievements,
-Reduces boredom and frustrations.
Nurse Managers need management education and training.
(Nurse managers and practicing nurses can work together to manage the work and the work
environment so that energy channeled into accomplishing personal and organizational goals.)
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Activities to promote positive organizational climate
Developing the organization's mission, philosophy, vision , goals and objectives
statements with input from practicing nurses , including their personal goals.
Establishing trust and openness through communication that includes prompt and
frequent feedback and stimulates motivation.
Providing opportunities for growth and development, including career development and
continuing education programs.
Promoting team work.
Asking practicing nurses to state their satisfactions and dissatisfactions during meetings
and conferences and through surveys.
Marketing the nursing organization to the practicing nurses, other employees and the
public.
Analyzing the compensation system for the entire organization and structuring it to
reward competence, productivity and longevity.
Promoting self esteem, autonomy, and self fulfillment for practicing nurses including
feelings that their work experiences are of high quality.
Emphasizing programs to recognize practicing nurses contributions to the organization.
Assessing needed threats and punishments and eliminating them.
Providing job security with an environment that enables free expression of ideas and
exchange of opinions.
Being inclusive in all relationships with practicing nurses.
Helping practicing nurses to overcome their short comings and to develop their strengths.
Encouraging and supporting loyalty, friendliness, and civic consciousness.
Developing strategic plans that include decentralization of decision making and
participation by practicing nurses.
Being a role model of performance desired of practicing nurses.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
ORGANIZING NURSING SERVICES AND PATIENT CARE
INTRODUCTION
A hospital may be soundly organized, beautifully situated and well equipped, but if the
nursing care is not of high quality the hospital will fail in its responsibility.
ORGANIZING NURSING SERVICES
Meaning of nursing service and nursing service administration
Nursing Service
Nursing service is the part of the total health organization which aims at satisfying the
nursing needs of the patients/community. In nursing services, the nurse works with the members
of allied disciples such as dietetics, medical social service, pharmacy etc. in supplying a
comprehensive program of patient care in the hospital.
Nursing service administration
Nursing service administration is a complex of elements in interaction and is organized to
achieve the excellence in nursing care services. It results in output of clients whose health is
unavoidably deteriorating, maintained or improved through input of personnel and material
resources used in a process of nursing services.
DEFINITION OF NURSING SERVICE
WHO expert committee on nursing defines the nursing services as the part of the total
health organization which aims to satisfy major objective of the nursing services is to provide
prevention of disease and promotion of health.
OBJECTIVES OF NURSING SERVICE
The first component of nursing service administration is the planning and it should be
based on clearly defined objectives. The objectives of nursing service department are as follows:

Objectives in relation to Patient care
The primary emphasis is on total patient care that is:
To give highest possible quality care in terms of total patients need which include
physical, psychological, social, educational and spiritual needs by collaborating with
other health tem members.
To assist the physician in providing medical care to the patients.
To provide preventive and rehabilitative services.
To provide round the clock nursing care to all the patients.
To render timely and appropriate nursing service to emergency patients.
To provide cost effective quality care as per the needs of patients.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Confidentiality and privacy of each patient should be maintained.
Constant monitoring and evaluating is of utmost importance to improve patient care
continuously.

Objectives in relation to Education
Planning of education and training programme for nurses are must for professional
growth and development needs through in-service education and research support.
To provide regular staff development, in-service education and guidance services for all
members of nursing staff.
To conduct regular orientation programme for new entrants and for those have been on
the job for a long time.
To conduct training for operating procedure of latest gadgets and on handling
sophisticated bio-medical equipment.

Objectives in relation to Administration and Organization
To make regular supervision through rounds.
To ensure that the essential equipment is provided in functional status for nursing care
services.
To provide regular flow of essential supplies to render quality nursingcare.
To have a proper system of rotation of staff, provision for annual leave and days off for
the nursing staff without hampering patient care.
Establish a communication system for nursing personnel, other health worker, patients,
health authorities, government authorities and public.
Ensure that each nurse identifies her job responsibilities and accountability.
Counseling for health personnel, patients and the public.
The formulation of policies, standards, goals of nursing service, education and practice.
Maintaining proper documentation of the personnel employed in nursing service.

Objectives in relation to Research
Establish a system for collection of essential information, research and studies concerning
all aspects of nursing.
To contribute in research programme conducted by hospitals and by other health
personnel.
To encourage and support the nurse to conduct research projects/ activities.

Objectives in relation to Performance appraisal
Appraise the performance of nursing service personnel regularly against set standards and
performance indicators objectively with a view to maintain quality-nursing services.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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PRINCIPLES OF NURSING SERVICE
Initiate a set of human relationships at all levels of nursing personnel to accomplish their
job and responsibilities through systematic management process by establishing flexible
organizational design
Establish adequate staffing pattern for rendering efficient nursing service to clients and its
management
Develop and implement proper communication system for communicating policies,
procedures and updating advance knowledge.
Develop and initiate proper evaluation and periodic monitoring system for proper
utilization of personnel
Develop or revise proper job description for nursing personnel at all the levels and all
units for proper delivery of nursing care.
Share nursing information system with other discipline functionaries in the hospital.
Assist the hospital authorities for preparation of budget by involvement.
Participate in interdepartmental programs and other programs conducted by other
disciplinaries for improvement of hospital services.
Develop and initiate orientation and training programs for new employees in cooperative
with authorities and other health disciplines
Create an atmosphere that conductive to give proper required learning experience for the
students
Assist in the development of a sound, constructive program of leadership in nursing to
assure intellectual administration and management to safeguard, conserve and preserve
nursing resources of the hospitals.
Participate in the application of data and research
Participate in community health programs, associated with hospital.
FUNCTIONS OF NURSING SERVICE
To assist the individual patient in performance of those activities contributing to his
health or recovery that he would otherwise perform unaided has had the strength, will or
knowledge.
To help and encourage the patient to carry out the therapeutic plan initiated by the
physician.
To assist other members of the team to plan and carry out the total programme of care.
The organization of nursing care constitutes a subsystem for achieving the hospitals overall
objective. Nursing care of patients generally takes forms:
Technical
Educational
Trusting relationship
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
The director of nursing service is delegated the authority and responsibilities for
organizing and administrating the nursing services in hospital. It is her duty to institute the
essential characteristics of good nursing services in her institute such as:













Purposes and objectives of the nursing service:
The purposes should be in accordance with the hospital philosophy regarding patient
care and approved by administration. It must characterize the principles of excellence in
service, in practice and leadership. Objectives are specific, practical, attainable,
measurable and understandable to all the nursing staff.

Plan of organization:
Every hospital has the basic system of coordination of vast number of activities
i.e. the Director of Nursing service, she is responsible for maintaining standards for
patient care in terms of quality nursing service must be familiar with the formal
organizational structure of the hospital and its relationship in various department and
their functions. The plan of organization should indicate inter as well as intra-department
relationship. The plan also should indicate area of responsibility and to whom and for
whom each person is accountable and the channels of communication.
Written statement of purposes and objectives of nursing
services
Plan of organization
Policy and administrative manuals
Nursing practice manual
Nursing service budget
Master staffing pattern
Nursing care appraisal plan
Nursing service administrative meetings
Adequate infrastructure facilities, supplies and equipment
Written job description & job specifications
Personnel records
Personnel policies
Health services
Inservice education
Co-ordination
Advisory committee
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Policy and administrative manuals:
The policy and procedure manual are required for the operation of the hospital.
Policies are established within the department to guide the nursing staff, which includes
duty hrs, rules and regulations etc. These are periodically revised and reviewed at regular
intervals.

Nursing practice manual:
This the written procedure available as evidence of the standards of performance
established by nursing service organization for safe and effective practice after taking
into consideration the best use of available resources. Liberal use of diagram and
precautions in nursing manual helps to keep instruction direct and exact. The advantages
are ensure economy of time effort & material and provides basis for training for new
personnel to acquire knowledge and current skill.

Nursing service budget:
It is required for personnel budget, nurses welfare activities, staff development
programme, equipment and capital expenditure, supplies and expenses. Budget
preparation should includes analysis of past operation and anticipating the future revenue
and expenses.


Master staffing pattern:
It is the number and composition of nursing personnel assigned to work in a hospital
in different department / wards at a given time. This helps the director to visualize the
equitable distribution of nursing personnel among various nursing unit. It serves as a
guide for planning daily, weekly and monthly schedules.

Nursing care appraisal plan:
Employing various techniques such as supervision, ward rounds, conference,
anecdotal record, rating scale, checklist, suggestion box and peer review can do
performance appraisal of nurses. This is done to improve the quality of service provided,
determine the job competence and to enhance staff development.
Nursing service administrative meetings:
This meeting gives opportunity for free communication, planning and evaluation of
the nursing service through regular meeting of the director of nursing with total nursing
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
staff. The purposes are regular exchange of view between management and nursing
service for improving working condition, welfare of patient and improvement in methods
and organization of work.

Adequate infrastructure facilities, supplies and equipments:
The director of nursing evaluates periodically the adequate resources and arranges
new facilities needed for patient care in discussion with the hospital administrator.

Written job descriptions and job specifications:
In job description the responsibility are clearly spelt out as precisely including the job
content, activities to be performed, responsibility and result expected from various role
required by the organization. It is useful for reducing conflict, frustration, overlapping
duties and acts as a guide to direct and evaluate person.

Personnel records:
Personnel records include the information relating to the individual such as
recruitment and selection, medical records, training and development, transfer records,
promotion, disciplinary action records, performance records, absenteeism data, leave
record and salary records, etc.

Personnel policies:
It reflects an analysis of the total job of nursing in accordance with the types of
functions to be performed. It also indicates the qualitative and quantity of service to be
maintained and the purpose for which the hospital exist.

Health services:
Supervision of health of each employee by means of pre-employment physical
examination, periodic examination, immunization and provision of diagnostic, preventive
and therapeutic measures. The education of employee in the principle of health and
hygiene so that they may develop healthy habit of living and working.

I n-service education:
It is the essential components of staff development programme, which aims at
augmenting, reinforcing nurses knowledge, skill and attitude. It includes orientation
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
programme, skill training, leadership and management training, on the job training, staff
development.

Co-ordination:
Regular consultation and discussion between the heads of departments and with
members of the medical staff could be an integral part of the administration.

Advisory committee:
Each committee has a clear statement and its membership is appropriate to the
purpose. After carefully weighing the advice of the committee, she makes the final
decision about the matter within her area of responsibility and becomes accountable for
implementation.


ORGANISATION OF NURSING SERVICES:

DIRECTOR (hospital) DIRECTOR OF HEALTH
SERVICE
Chief Nursing Officer Asst. Director of Health Service
Nursing Superintendent Nursing Superintendent Grade-I
Deputy Nursing Superintendent Nursing Superintendent Grade-II
Assistant Nursing Superintendent Head Nurse
Ward Sister - Clinical Supervisor Staff Nurse
Staff nurse Student nurse


ORGANIZING NURSING SERVICE AT VARIOUS LEVELS
The organization of nursing service varies from institution to institution.
Organizational set-up at Directorate General of Health Services


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
DGHS

Addl.DG (PH) Addl.DG (N) Addl.DG (M)


ADG ADG ADG
(Community Nsg service) (Nsg-education & research) (Hospital Nsg service)

DADG DADG DADG
Community & Nsg officer Principal Nsg.Supdt
PHN Supervisor Senior Tutor Dy.Nsg.Supt
PHN Tutor Asst.Nsg.Supt
LHV Clinical Instructor Ward sister
ANM Staff Nurse

Organizational set-up of Nursing Service at Central Level
Secretary, Health
Director Nursing Service
Joint/Deputy Director Nursing services

ADNS ADNS ADNS
(Community Nsg service) (Nsg-education & research) (Hospital Nsg service)

DADNS DADNS DADNS
(Community Nsg service) (Nsg-education & research) (Hospital Nsg service)

DADNS DADNS DADNS
Dist. Nsg officer DADNS Nsg.Supdt
PH. Nsg officer Principal Dy.Nsg.Supt
PHN at PHC Senior Tutor Asst.Nsg.Supt
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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LHV Tutor Ward sister
ANM Clinical Instructor Staff Nurse

Organizational set-up of Nursing Service at State Level
Director Nursing Services
Deputy Director Nursing Services
Assistant Director Nursing Services
Deputy Assistant Director Nursing Services

DMO DNO DHO

ADNO (Hosp&Nsg.Edu) ADNO (Community)

Nsg Supt/Dy.Nsg.Supt Principal tutor Dist.PNO
Asst.Nsg.Supt Tutor PHN Supervisor (CHC)
Ward Sister Clinical Instructor PHN (PHC)
Staff Nurse LHV
ANM
KEYS:
- DGHS - Director General of Health Services
- Addl. DG (PH) - Additional Director General (Primary Health)
- Addl. DG (M) - Additional Director General (Medical)
- Addl. DG (N) - Additional Director General (Nursing )
- ADG - Assistant Director General
- DADG - Deputy Assistant Director General
- PHN - Primary Health Nurse
- LHV - Lady Health Visitor
- ANM - Auxiliary Nurse Midwives
- ADNS - Assistant Director Nursing Service
- DADNS - Deputy Assistant Director Nursing Service
- DMO - Director of Medical Office
- DNO - Director of Nursing Office
- DHO - Director of Health Office
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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ROLE AND FUNCTION OF NURSE ADMINISTRATOR
The Principal Matron of the hospital will be responsible to the Commandant of the
hospital for the following duties:
Administration
Organizes, directs and supervises the nursing services both day and night.
Coordinates assignments of staff.
Establishes the general pattern of delegation of responsibilities and authority.
Formulates standing orders for the nursing care.
Ensures appropriate allocation of duties and responsibilities to all nursing staff
working under her.
Formulates nursing policies to ensure quality patient care and adequate attention
at all times.
Responsible for efficient functioning of the nursing staff.
Evaluates the personal performance of the nursing staff.
Discipline
Ensure that a standard of discipline of nursing staff is high at all times.
Maintain good order and discipline in wards/departments.
Makes daily rounds of the hospital wards/departments and also seriously ill
patients. In addition she will make unscheduled rounds in the hospital in the
evenings.
Brings immediately to the notice of the medical superintendent all matters
concerning neglect of duty, insubordination either by nursing staff, patients or
visitors or any un-towards incident, which comes to her notice for taking suitable
action as required as per the orders on the subject.
Public Relations
Promotes and maintains harmonious and effective relationship with the various
administrative departments of the hospital and related community agencies.
Maintain cordial relationships with the patients and their families.
Office Routine
Scrutinizes the reports and returns and submits in accordance with existing orders.
Confidential Reports
Initiates the confidential reports of nursing staff on due dates.
Responsible for the nursing budget.
Education
Carries out in-service training for all categories of nursing staff and paramedical
personnel and keeps the records of such trainings.
Conduct various update courses based on the needs.
Encourages the personnel to participate in the continuing education programme.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Welfare
Responsible for health and welfare of nursing staff.
Ensures annual and periodical health examination and maintenance of health
records.
Conferences
Responsible for organizing and conducting staff meeting of the nursing staff once
in three months.
Holds conference in nursing care problems and discuss policies as regards to
working conditions, working hrs and other facilities.
Supervision
Supervises nursing care given to the patients and all nursing activities within the
nursing unit.
Supervises the work of all paramedical staff of the hospital.
Records and Reports
Maintains various records such as duty roster nursing staff, day off book, personal
bio-data, leave plan, staff conference book, courses file etc.
PROBLEMS AND CHALLENGES FACED BY THE NURSE ADMINISTRATOR
Lack of adequate training.
Problem of personnel management.
Inadequate number of nursing staff.
Shortage of trained manpower.
Lack of motivation.
No involvement in planning.
No career mobility.
Poor role model.
No research scope.
Professional risk/hazards.
No autonomy in nursing activities.
Day to day problem in nursing services
Shortage of nurses.
Lack of motivation.
Negative attitude.
Lack of training.
Lack of team approach.
Inactive participation of program
Lack of interpersonal relationship
Less involvement in patients care by the nursing supervisors.
Lack of supervision.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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ORGANIZING PATIENT CARE
The overall goal of nursing is to meet the patient nursing needs with the available
resources for providing smooth day and night 24 hrs quality care to patients and to honor his
rights. To ensure that nursing care is provided to patients, the work must be organized. A
Nursing Care Delivery Model organizes the work of caring for patients. The decision of which
nursing care delivery model is used is based on the needs of the patients and the availability of
competent staff in the different skill levels. For organizing function to be productive and
facilitate meeting the organizations needs, the leader must know the organization and its
members well.
The top level manager who influence the philosophy and resources necessary for any
selected care delivery system to be effective
The first and middle level managers generally have their greatest influence on the
organizing phase of the management process at the unit or departmental level. The
managers organize how work is to be done, shape the organizational climate, and
determine how patient care delivery is organized.
The unit leader-manager determines how best to plan work activities so organizational
goals are met effectively and efficiently, involves using resources wisely and
coordinating activities with other departments.
DEFINITION OF PATIENT CARE
The services rendered by members of the health profession and non-professionals under
their supervision for the benefit of the patient.
OR
The prevention, treatment and management of illness and the preservation of mental and
physical well-being through the services offered by the medical and allied health
professions.
PATIENT CLASSIFICATION SYSTEMS
Patient classification system (PCS), which quantifies the quality of the nursing care, is
essential to staffing nursing units of hospitals and nursing homes. In selecting or implementing a
PCS, a representative committee of nurse manager can include a representative of hospital
administration. The primary aim of PCS is to be able to respond to constant variation in the care
needs of patients.
Characteristics
Differentiate intensity of care among definite classes.
Measure and quantify care to develop a management engineering standard.
Match nursing resources to patient care requirement.
Relate to time and effort spent on the associated activity.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Be economical and convenient to repot and use.
Be mutually exclusive, continuing new item under more than one unit.
Be open to audit.
Be understood by those who plan, schedule and control the work.
Be individually standardized as to the procedure needed for accomplishment.
Separate requirement for registered nurse from those of other staff.
Purposes
The system will establish a unit of measure for nursing, that is, time, which will be used
to determine numbers and kinds of staff needed.
Program costing and formulation of the nursing budget.
Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service
Determining the values of the productivity equations
Determine the quality: once a standards time element has been established, staffing is
adjusted to meet the aggregate times. A nurse manager can elect to staff below the
standard time to reduce costs.
Components
The first component of a PCS is a method for grouping patients categories. Johnson
indicates two methods of categorizing patients. Using categorizing method each patient is
rated on independent elements of care, each element is scored, scores are summarized
and the patient is placed in a category based on the total numerical value obtained.
Johnson describes prototype evaluation with four basic categories for a typical patient
requiring one on- one care. Each category addresses activities of daily living, general
health, teaching and emotional support, treatment and medications. Data are collected on
average time spent on direct and indirect care.
The second component of a PCS is a set of guidelines describing the way in which
patients will be classified, the frequency of the classification, and the method of reporting
data.
The third component of a PCS is the average amount of the time required for care of a
patient in each category.
A method for calculating required nursing care hours is the fourth and final component
of a PCS.




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Patient Care Classification
Area of care Category I Category II Category III Category IV
Eating Feeds self Needs some help in
preparing
Cannot feed self but is
able to chew and
swallowing
Cannot feed self
any may have
difficulty
swallowing
Grooming Almost
entirely self
sufficient
Need some help in
bathing, oral hygiene
Unable to do much for
self
Completely
dependent
Excretion Up and to
bathroom
alone
Needs some help in
getting up to bathroom
/urinal
In bed, needs bedpan /
urinal placed;
Completely
dependent
Comfort Self
sufficient
Needs some help with
adjusting position/ bed..
Cannot turn without
help, get drink, adjust
position of extremities

Completely
dependent
General
health
Good Mild symptoms Acute symptoms Critically ill
Treatment Simple
supervised,
simple
dressing
Any Treatment more
than once per shift,
foley catheter care,
I&O.
Any treatment more
than twice /shift
Any elaborate/
delicate procedure
requiring two
nurses, vital signs
more often than
every two hours..
Health
education &
teaching
Routine
follow up
teaching
Initial teaching of care
of ostomies; new
diabetics; patients with
mild adverse reactions
to their illness
More intensive items;
teaching of
apprehensive/ mildly
resistive patients.
Teaching of
resistive patients,



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
MODES OF ORGANIZING PATIENT CARE / METHODS OF PATIENT
ASSIGNMENT
The most well known means of organizing nursing care for patient care delivery are,
Case method or Total patient care
Functional nursing
Team nursing
Modular or district nursing
Progressive patient care
Primary nursing
Case management
Each of these basic types has undergone many modifications, often resulting in new
terminology. For example, primary nursing has been called case method nursing in the past and
is now frequently referred to as a professional practice model. Team nursing is sometimes called
partners in care or patient service partners and case managers assume different titles, depending
on the setting in which they provide care. When closely examined most of the newer models are
merely recycled, modified or retitled versions of older models. Choosing the most appropriate
organizational mode to deliver patient care for each unit depends on the skill and expertise of the
staff, the availability of registered professional nurse, the economic resources of the organization
and the complexity of the task to be completely.

CASE METHOD
Features:
It was the first type of nursing care delivery system. In this method, nurses assume total
responsibility for meeting all the needs of assigned patients during their time on duty. It involves
assignment of one or more clients to a nurse for a specific period of time such as shift. The
patient has a different nurse each shift and no guarantee of having the same nurses the next day.
Nurses responsibility includes complete care including treatments, medication and
administration and planning of nursing care. This is the way most nursing students were taught
take one patient and care for all of their needs. This model is used in critical care areas, labor and
delivery, or any area where one nurse cares for one patients total needs. Here nurses were self-
employed when the case method came into being, because they were primarily practicing in
homes. It lost much of that autonomy when healthcare became institutionalized in hospitals and
clinics and now called as private duty nursing.
Merits:
The nurse can attend to the total needs of clients due to the adequate time and proximity
of the interactions.
Good client nurse interaction and rapport can be developed.
Client may feel more secure.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
RNs were self-employed.
Work load can be equally divided by the staff.
Nurses accountability for their function is built-it.
It is used in critical care settings where one nurse provides total care to a small group of
critically ill patients.
Demerits:
Cost-effectiveness.
The greater disadvantage to case nursing occurs, when the nurse is inadequately trained
or prepared to provide total care to the patient.
Nurse may feel overworked if most of her assigned patients are sick.
She/he may tend to neglect the needs of patient when the other patients problem or
need demands more time.

FUNCTIONAL NURSING
Features:
This system emerged in 1930s in U.S.A during WWII when there was a severe shortage
of nurses in US. A number of Licensed Practice Nurses (LPNs) and nurse aides were employed
to compensate for less number of registered nurses (RNs) who demanded increased salaries. It is
task focused, not patient-focused. In this model, the tasks are divided with one nurse assuming
responsibility for specific tasks. For example, one nurse does the hygiene and dressing changes,
whereas another nurse assumes responsibility for medication administration. Typically a lead
nurse responsible for a specific shift assigns available nursing staff members according to their
qualifications, their particular abilities, and tasks to be completed.











RN
Medication Nurse

RN
Treatment Nurse

LPN
Vital signs Nurse

UAP
Hygiene
Nurse

Patients assigned to the team

Charge Nurse
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Merits:
Each person become very efficient at specific tasks and a great amount of work can be
done in a short time (time saving).
It is easy to organize the work of the unit and staff.
The best utilization can be made of a persons aptitudes, experience and desires.
The organization benefits financially from this strategy because patient care can be
delivered to a large number of patients by mixing staff with a large number of unlicensed
assistive personnel.
Nurses become highly competent with tasks that are repeatedly assigned to them.
Less equipment is needed and what is available is usually better cared for when used only
by a few personnel.

Demerits:
Client care may become impersonal, compartmentalized and fragmented.
Continuity of care may not be possible.
Staff may become bored and have little motivation to develop self and others.
The staff members are accountable for the task.
Client may feel insecure.
Only parts of the nursing care plan are known to personnel.
Patients get confused as so many nurses attend to them, e.g. head nurse, medicine nurse,
dressing nurse, temperature nurse, etc.
TEAM NURSING
Features:
Developed in 1950s because the functional method received criticism, a new system of
nursing was devised to improve patient satisfaction. Care through others became the hallmark of
team nursing. Team nursing is based on philosophy in which groups of professional and non-
professional personnel work together to identify, plan, implement and evaluate comprehensive
client-centered care. In team nursing an RN leads a team composed of other RNs, LPNs or LVNs
and nurse assistants or technicians. The team members provide direct patient care to group of
patients, under the direction of the RN team leader in coordinated effort. The charge nurse
delegates authority to a team leader who must be a professional nurse. This nurse leads the team
usually of 4 to 6 members in the care of between 15 and 25 patients. The team leader assigns
tasks, schedules care, and instructs team members in details of care. A conference is held at the
beginning and end of each shift to allow team members to exchange information and the team
leader to make changes in the nursing care plan for any patient. The team leader also provides
care requiring complex nursing skills and assists the team in evaluating the effectiveness of their
care.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN











Advantages:
High quality comprehensive care can be provided to the patient
Each member of the team is able to participate in decision making and problem solving.
Each team member is able to contribute his or her own special expertise or skills in caring
for the patient.
Improved patient satisfaction.
Feeling of participation and belonging are facilitated with team members.
Work load can be balanced and shared.
Division of labour allows members the opportunity to develop leadership skills.
There is a variety in the daily assignment.
Nursing care hours are usually cost effective.
The client is able to identify personnel who are responsible for his care.
Barriers between professional and non-professional workers can be minimized, the group
efforts prevail.
Disadvantages:
Establishing a team concept takes time, effort and constancy of personnel. Merely
assigning people to a group does not make them a group or team.
Unstable staffing pattern make team nursing difficult.
All personnel must be client centered.
There is less individual responsibility and independence regarding nursing functions.
The team leader may not have the leadership skills required to effectively direct the team
and create a team spirit.
It is expensive because of the increased number of personnel needed.
Charge Nurse RN
Team Leader RN Team Leader RN
RN NA LPN NA LPN RN
Group of Patients Group of Patients
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Nurses are not always assigned to the same patients each day, which causes lack of
continuity of care.
Task orientation of the model leads to fragmentation of patient care and the lack of time
the team leader spends with patients.

MODULAR NURSING
Features:
Modular nursing is a modification of team nursing and focuses on the patients
geographic location for staff assignments. The concept of modular nursing calls for a smaller
group of staff providing care for a smaller group of patients. The goal is to increase the
involvement of the RN in planning and coordinating care. The patient unit is divided into
modules or districts, and the same team of caregivers is assigned consistently to the same
geographic location. Each location, or module, has an RN assigned as the team leader, and the
other team members may include LVN/LPN or UAP. The team leader is accountable for all
patient care and is responsible for providing leadership for team members and creating a
cooperative work environment. The success of the modular nursing depends greatly on the
leadership abilities of the team leader.
Merits:
Nursing care hours are usually cost-effective.
The client is able to identify personnel who are responsible for his care.
All care is directed by a registered nurse.
Continuity of care is improved when staff members are consistently assigned to the same
module
The RN as team leader is able to be more involved in planning & coordinating care.
Geographic closeness and more efficient communication save staff time.
Feelings of participation and belonging are facilitated with team members.
Work load can be balanced and shared.
Division of labor allows members the opportunity to develop leadership skills
Continuity care is facilitated especially if teams are constant.
Everyone has the opportunity to contribute to the care plan.
Demerits:
Costs may be increased to stock each module with the necessary patient care supplies
(medication cart, linens and dressings).
Establishing the team concepts takes time, effort, and constancy of personnel.
Unstable staffing pattern make team difficult.
There is less individual responsibility and autonomy regarding nursing function.
All personnel must be client centered.
The team leader must have complex skills and knowledge.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
PROGRESSIVE PATIENT CARE:
Features:
It is a method in which client care areas provide various levels of care. The central theme
is better utilization of facilities, services and personnel for the better patient care. Here the clients
are evaluated with respect to all level (intensity) of care needed. As they progress towards
increased self care (as they become less ethically ill or in need of intensive care or monitoring)
they are marred to units/ wards staffed to best provide the type of care needed.
Principal elements of PPC are:
i) Intensive care or critical care: Patients who require close monitoring and intensive care
round the clock, e.g. patients with acute MI, fatal dysarythmias, those who need artificial
ventilation, major burns, premature neonates, immediate post or cardiothoracic, renal transplant,
neurosurgery patients. These units have 9-15 numbers of beds, life-saving equipment and skilled
personnel for assessment, revival, restoration and maintenance of vital functions of acutely ill
patients. Nursing approach in these units is patient-centered.
ii) Intermediate care: Critically ill patients are shifted to intermediate care units when their vital
signs and general condition stabilizes, e.g. cardiac care ward, chest ward, renal ward.
iii) Convalescent and Self Care: Although rehabilitation programme begins from acute care
setting, yet patients in these areas participate actively to achieve complete or partial self-care
status. Patients are taught administration of drugs, life style modification, exercises, ambulation,
self-administration of insulin, checking pulse, blood glucose and dietary management.
iv) Long-term care: Chronically ill, disabled and helpless patients are cared for in these units.
Nurses and other therapists help the patients and family members in coping, ambulation, physical
therapy, occupational therapy along with activities of daily living. Patients and family who need
long-term care are, cancer patients, paralyzed and patients with ostomies.
v) Home care: Some hospital/centers have home care services. A hospital based home care
package provides staff, equipment and supplies for care of patient at home, e.g. paralyzed
patients, post-operative, mentally retarded/spastic patient and patient on long chemotherapy.
vi) Ambulatory care: Ambulatory patients visit hospital for follow up, diagnostic, curative
rehabilitative and preventive services. These areas are outpatient departments, clinics, diagnostic
centers, day care centers etc.
Merits:
Efficient use is made of personnel and equipment.
Clients are in the best place to receive the care they require.
Use of nursing skills and expertise are maximized.
Clients are moved towards self care, independence is fostered where indicated.
Efficient use and placement of equipment is possible.
Personnel have greater probability to function towards their fullest capacity.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Demerits:
There may be discomfort to clients who are moved often.
Continuity care is difficult.
Long term nurse/client relationships are difficult to arrange.
Great emphasis is placed on comprehensive, written care plan.
There is often times difficulty in meeting administrative need of the organization, staffing
evaluation and accreditation.

PRIMARY CARE NURSING
Features:
It was developed in the 1960s with the aim of placing RNs at the bedside and improving
the professional relationships among staff members. The model became more popular in the
1970s and early 1980s as hospitals began to employ more RNs. It supports a philosophy
regarding nurse and patient relationship.
It is a system in which one nurse is caring for all the needs of a patient or more within a
24 hour from admission to discharge. He or she is responsible for coordinating and implementing
all the necessary nursing care that must be given to the patient during the shift. If the nurse is not
available, the associate nurse responsible for filling in for the nurses absence will provide
hospital care to the patient based on the original plan of care made by the nurse. In acute care the
primary care nurse may be responsible for only one patient; in intermediate care the primary care
nurse may be responsible for three or more patients This type of nursing care can also be used in
hospice nursing, or home care nursing.









PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN











Advantages:
Primary Nursing Care System is good for long-term care, rehabilitation units, nursing
clinics, geriatric, psychiatric, burn care settings where patients and family members can
establish good rapport with the primary nurse.
Primary nurses are in a position to care for the entire person-physically, emotionally,
socially and spiritually.
High patient and family satisfaction
Promotes RN responsibility, authority, autonomy, accountability and courage.
Patient-centered care that is comprehensive, individualized, and coordinated; and the
professional satisfaction of the nurse.
Increases coordination and continuity of care.
Disadvantages:
More nurses are required for this method of care delivery and it is more expensive than
other methods.
Level of expertise and commitment may vary from nurse to nurse which may affect
quality of patient care.
Associate nurse may find it difficult to follow the plans made by another if there is
disagreement or when patients condition changes.
It may be cost-effective especially in specialized units such as the ICU.
May create conflict between primary and associate nurses.
Stress of round the clock responsibility.
Difficult hiring all RN staff
Confines nurses talent to his/her own patients.
Patients
Total patient care 24 hrs/day
Communicates with
supervisors

Consults with physician
or other healthcare
providers

Associate (days)
when primary nurse is
not available

Associate (afternoon)
When primary nurse is
not available

Associate (evenings)
when primary nurse is
not available

PRIMARY
NURSE
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
CASE MANAGEMENT
Features:
The case manager (RN or social worker with managerial qualification) is assigned
responsibility of following a patients care and progress from the diagnostic phase through
hospitalization, rehabilitation and back to home care. For eg; case manager for cardiac surgery
patients assists them go through diagnostic procedures, pre-operative preparations, surgical
interventions, family counseling, post-operative care and rehabilitation.
Case management involves critical paths, variation analysis; inter shift reports, case
consultation, health care team meetings, and quality assurance. Critical paths visualize outcomes
within a time frame. Variation analysis notes positive or negative changes from the critical paths,
the cause, and the corrective action taken. Case consultation may be indicated when the clients
condition differs from the critical path as noted in the inter shift report. Case consultation is
conducted about once a week for a few minutes immediately after inter shift report to deal with
variations.
Health care team meetings provide an interdisciplinary approach to problem solving. The
case manager needs to identify no more than three priority goals and decide what team members
should be present after considering the patient, family physician, social service, various
therapists, and others involved. The case manager should set the time and place for the meeting,
make the arrangements, and post the date, time, place, and people to attend. The case manager
calls the meeting to order, states the goals, initiates discussion, documents the plans, and sets
time limits for follow through. The variance between what is expected and what happened is
assessed for quality assurance.
Responsibilities of case managers:
Assessing clients and their homes and communities.
Coordinating and planning client care.
Collaborating with other health professionals in the provision of care.
Monitoring client progress and client outcomes.
Advocating for clients moving through the services needed.
Serving as a liaison with third party payers in planning the clients care.
Merits:
Case management provides a well coordinated care experience that can improve the care
outcome, decrease the length of stay, and use multiple disciplines and services efficiently.
Provides comprehensive care for those with complex health problems.
It seeks the active involvement of the patient, family and diverse health care professionals


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Demerits:
Nurses identify major obstacles in the implementation of this service, financial barriers
and lack of administrative support.
Expensive
Nurse is client focused and outcome oriented
Facilitates and promotes co-ordination of cost effective care
Nursing case management is a professionally autonomous role that requires expert
clinical knowledge and decision making skills.

FACTORS INFLUENCING THE QUALITY PATIENT CARE
Many variable factors influence the number of nurses needed on a ward in order to render a
high quality of patient care.
The total number of patient to be nursed
The degree of illness of patients (physical dependency)
Type of service: medical, surgical, maternity, pediatrics and psychiatric
The total needs of the patients
Methods of nursing care
Number of nursing aids and other non professional available, the amount and quality of
supervision available
The amount, type and location of equipment and supplies
The acuteness of the service and the rate of turnover in patients according to the degree or
period of illness.
The experience of the nurses who are to give the patient care.
The number of non-nurses who involve in the patient care, the quality of their work, their
stability in service.
The physical facilities
The number of hours in the working week of nurses and other ward personnel and the
flexibility in hours
Methods of performing nursing procedures
Affiliation of the hospital with the medical school
Methods of assignment-individual, team or functional method
The standards of nursing care.



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
PLANNING AND ORGANIZING HOSPITAL UNITS AND ANCILLARY SERVICES
(SPECIFICALLY CSSD, LAUNDRY, KITCHEN, LABORATORY SERVICES,
EMERGENCY DEPARTMENT)
Planning and organization of hospital units:
A hospital is responsible to render an essential service. In fulfilling this responsibility, hospital
planning should be guided by certain universally acknowledged principles. The principles are
usually irrespective of the level of planning, i.e. whether at national level, state level or
individual hospital level.
Aims of hospital planning:
To enlarge the existing hospital by introducing new facilities.
To increase utilization of hospital facilities.
To increase population coverage
To increase productivity of hospital
Modernization of the already existing facilities
To reduce the cost of operations and maximize efficiency of services.
Guiding principles in planning:
Patient care of high quality: it can be achieved by the hospital through adopting following
measures:
a. Provision of appropriate technical equipments and supplies.
b. An organizational structure that assigns responsibility and requires accountability
for various functions within the organization.
c. A continuous review of adequacy of care provided by physicians, nursing staffs
and paramedical personnel.
Effective community orientation: this should be achieved by the hospital by adopting
following measures:-
a. A governing board made up of persons who have demonstrated concerns for
community and leadership ability.
b. Policies that assure availability of services to all people.
c. Participation of the hospital in community programmes to provide preventive
care.
Economic viability: this is achieved by adopting measures like:-
a. A corporate organization that accepts responsibility for sound financial
management in keeping with desirable quality of care.
b. A planned programme of expansion based solely on demonstrated community
need.
c. An annual budget plan that will permit the hospital to keep pace with times.
Orderly planning: orderly planning should be achieved by the hospital by following:-
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
a. Acceptance by the hospital administrator of primary responsibility for short and
long-range planning with support and assistance from competent financial,
organizational and functional advisors.
b. Preparation of a functional programme that describes the short range objectives
and facilities, equipments and staffing necessary to achieve them.
Sound architectural plan: it is achieved by the following:-
a. Selection of a site large enough to provide for future expansion and accessibility
of population.
b. Recognition of the need of uncluttered traffic patterns within for movement of
staff, patients and visitors and efficient transportation of supplies.
Medical technology and planning: development in medical technology is taking place so
rapidly that now the use of sophisticated technology determines the professional status.
Classification of hospitals:
Hospitals in general are classified into two categories depending upon the agencies which
finance them:
1. Government or public hospitals: they are managed by government services, either central
or state or public, municipal or departmental bodies that are financed from the overall
budget for public services.
2. Non-government hospitals: they are managed by individuals, charitable organizations,
religious groups, industrial undertakings etc.
On the basis of ownership patterns, non-governmental hospitals are classified as:
- Private (personal)
- Partnership
- Private (family) trust
- Public charitable trust
- Cooperative society
- Private limited company
- Public limited company
Hospital planning process:
i. Conceptualization of hospital: here the imagination or idea of the originator takes into a
practical shape, and compares his dreams with the existing hospitals of country or outside
world, tries to fit dreams into any such project.

ii. Support groups: once the idea is developed, the entrepreneur, discuss project, and then
finds support groups to join hands and complete the project.
iii. Temporary organization and securing funds: a group should be formalized called as a
hospital trust, which must be registered under the societys act or companies act. The
originator is the chairman and others are members who are assigned different tasks.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
A detailed work out as to how much capital will be required for establishing the hospital.

iv. Geographical, environmental and miscellaneous factors:
Meteorological information: temperature, rainfall, humidity
Geographical information: existing road and rail communications, susceptibility to
quakes/floods, building height restrictions due to proximity of airports.
Miscellaneous availability: trained manpower, water, sewage disposal.

v. Hospital design:
- Bed planning: it should be realized that the hospitals are not only utilized by the
population in the vicinity but also will constitute the indirect population in the larger
catchment area. About 85% bed occupancy is considered optimum.
- Hospital size: as a very large hospital of 1000 beds or more becomes extremely unwidely
to operate, and a small hospital of 50 or less are not profitable. From functional efficiency
point of view, it is advisable to plan two separate hospitals of 400 beds, each with a scope
of future expansion, rather than a single one of 800 beds.
- Land requirements: in rural and semi-urban areas, plentiful land may be available
permitting the hospital to grow horizontally, whereas in urban areas there will always be
great premium on land and only avenue will be a vertical growth.

No. of beds Land in acres Storey of building
50 beds 10 acres Single storey
100 beds 15-20 acres -do-
200 beds 20-25 acres Double storey
500 beds 55-70 acres 3-5 storey
700 beds 80-90 acres 4-6 storey
1000 beds 90-100 acres 6-9 storeys

- Public utilities: the national building code of ISI suggests 455 liters of water per
consumer per day (LPCD) for hospitals up to 100 beds and 340 LPCD for hospitals of
100 beds and over.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Additional availability of water in case, staff quarters and nurses hostel are a part of
hospital campus. The hospital sewage disposal is connected to the public sewage disposal
system, otherwise it needs to build and operate its own sewage disposal plant.
It is preferable that power supply should be available on a multi-grid instead of uni-grid
system in general use, to ensure a continuous supply of electricity to hospital at all times.
Electricity requirement is 1 KW per bed per day
2
.

- Approval of plan by the local authorities: once the detailed plan has been formulated,
the local bodies are consulted and persuaded for approval of plans.

vi. Circulation routes: the utility and success of hospital plans depend on the circulation
routes on hospital site and within building. there are two types of circulation in the
hospital :-
Internal circulation: the circulation space involves corridors, stairways and lifts.
Corridors with less than 8 ft. Width are not desirable in hospitals and protective corner
beading is a necessity in hospital corridors.
External circulation: only one entrance to the hospital for vehicular traffic from the main
road is desirable. the entrance and exit points should be wide enough to take two lanes of
traffic, one entry for clarity of all visiting traffic and one exit for security from
administrative viewpoint.
vii. Distances, compactness, parking and landscaping: distances must be minimized for all
movements of patients, medical, nursing and other staff, for supplies aiming at minimum
of time and motion.
Functional efficiency depends on the compactness of the hospital which is achieved by
constructing multistoried as they are convenient due to compactness as compared to
horizontal development of hospital which demands more land involving extra costs and
installation of services, roads, water supply, sewage etc.
One car parking space per 2 beds is desirable in metropolitan towns, lesser in smaller
urban areas while much less in semi-urban and rural areas. Separate parking for 3-
wheelers and scooters, employees and staff parking areas separate from public parking
should be considered.

viii. Zonal distribution and inter-relationship of departments: the departments which come in
close contact with the public (e.g. outpatient department, emergency and casualty) should
be isolated from the main in patient areas and allotted areas closer to the main entrance.
The supportive services like X-ray and laboratory services need to be located near the
OPDs. From the main entrance should be main inpatient zone consisting of ICU, wards,
OT and delivery suit. The other supportive and clinico-administrative department in the
hospital consists of hospital stores, kitchen and dietary department, pharmacy etc. these
departments should be preferably grouped around a service core area.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

ix. Gross space requirements: gross total area (building gross)-780-1005 sq ft, add walls,
partitions: 95-125 sq ft. a building gross square footage figure includes everything a
buildings perimeter viz. stairs, corridors, wall thickness and mechanical areas.
On average, space will be required for a reception and enquiry counter in the main
waiting area near the OPD entrance. The bed distribution is calculated as:
Bed:population= A x S x 100
365 x PO
Where, A= number of in-patient admissions per thousand population per year
S= average length of stay (ALS)
PO= percentage occupancy
Bed distribution among various specialties will vary from hospital to hospital and
conforms to following range:
Medical: 30-40%
Surgical: 25-30%
Obstetrical: 15-18%
Pediatric: 10-12%
Miscellaneous: 10-15% (including eye and ENT)
x. Climatic consideration in design: in very hot climate buildings need to be cooled in
summer by artificial means. Some natural cooling can be achieved by building
orientation and design. The building should be open, and oriented in such a way that even
a slight breeze can pass through the building to cool its insides. Another way is to keep
thick walls and small windows where the thick walls absorb the heat during day and
dissipates during night, and small windows minimize the amount of radiated heat
entering the building.
xi. Equipping a hospital: hospital equipment covers a broad range of items necessary for
functioning of all services. the universal application of equipment in the hospital can be
classified as:
Physical plant: it includes lifts, refrigeration and air-conditioning, incinerators, boilers,
kitchen equipments, mechanical laundry, central oxygen etc.
Hospital furniture and appliances: beds, stretchers, trolleys, bedside lockers, movable
screens, operation tables, instrument trolleys etc.
General purpose furniture and appliances: it includes office machines (typewriters,
calculators, filing system, and computers), office furniture, crockery and cutlery.
Therapeutic and diagnostic equipments: it includes equipments for general use (BP
instruments, suction machines, glassware washers etc.) and equipment interacting with
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
patients during diagnostic and therapeutic procedures ( defibrillators, X-ray machines
etc.)
xii. Cost evaluation of construction of hospital: the most common method of estimating the
cost is on the basis of per bed cost. It will also vary in type of facilities the hospital
provides, like teaching, training and research facilities.

Outpatient department:
Outpatient department is the one where all patients except those who require emergency
treatment, come for service in the hospital.
Planning and organization of the OPD:
Location: it should be easily accessible to those who come for outside, and should be a separate
wing for OPD attached to the hospital accessible from the main entrance to the hospital with
direct approach from the main road.
Space: the space requirement will depend upon the land available and location of the hospital.
Generally 0.66-1 sq ft area per annual outpatient attendance should be provided for OPD. If there
are 3 lakhs visit in a year, the total space requirement for OPD will be 2-3 lakh sq ft or 4.5-6.8
acres.
Size: the size of OPD depends upon the volume of attendance, clinics provided and extent of
facilities like blood bank, emergency department.
Zones of OPD:
FUNCTIONAL ZONE: this zone is mainly used by the patients attending the OPD,
attendants and relatives. This area includes parking area, entrance hall, waiting space,
enquiry and registration, and medical social services.
ADMINISTRATIVE ZONE: this zone is required in a large hospital to plan, organize,
supervise, evaluate and co-ordinate the facilities being provided. the various functional
units of this zone are
Office of the OPD in-charge
Administrative control nurses station
Cash counters
Medical record room
DIAGNOSTIC AND SUPPORTIVE ZONE: the various functional units in this area are:
Clinical laboratory
Imaging section
AMBULATORY ZONE: This is a zone where the patients come in direct contact with
the doctors and paramedical staff for consultancies, advice and treatment. it includes units
like:
Clinics for various medical disciplines
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Pharmacy
Treatment room
Minor OT

STAFF ZONE: this zone is used exclusively by the staff members only. It includes duty
rooms, stores, housekeeping and conference room.
Functional management:
OPD timings: it is recommended that OPD shall work 6 days in a week with facilities of
morning and evening clinics. The morning timings is usually from 8am-12 pm, whereas
the evening hours shall be from 3pm to 5 pm, and specialty clinics from 2 pm to 4pm.
overcrowding and waiting time of the patients and relatives must be minimized.
Records: a unit record system combining both in-patients record and continuous out
patient record is recommended.
Public relations: public complaints can be minimized and defused through public
relations, the entire staff of OPD including public relations persons should act as agents.
Facilities in OPD:
The waiting lines should have enough furniture so that patients dont have to
stand in queues but can sit comfortably.
The general procedure and rules should be painted on boards or walls for the
public.
The registration area should be easily recognized and reachable.
Health education messages can be promoted through TV-VCR system, closed
circuit TV and also to reduce the boredom of the waiting patients and their
relatives in OPD.
Staffing of OPD: It includes the medical staff (consultant, professor, senior lecturers,
medical officers, residents, junior and senior should be available), nursing staff (usually
one nurse/OPD/clinic), paramedical staff (for injection room, dressing room, registration
and MRD), receptionists and medico social worker.
Planning and organization of Wards:
A ward is the most important part of hospital where the sick persons are kept for supervised
treatment. It is also a nodal point for research in medicine and nursing field, training and
teaching of medical, nursing and paramedical personnel.
Types of wards:
a. General wards: in these wards, patients with non-specific ailments, requiring no life
saving care are admitted. The nurse patient ratio of 1:5 in big wards, and catering to the
patients routine investigation, treatment and care needs.
b. Specific wards: these include patients admitted for specific care due ti illness or social
reasons. It includes:
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Emergency ward
Intensive care unit
Intensive coronary care unit
Nursery
Special septic nursery
Burns ward
Post operative ward
Post natal ward
c. Units with specialist nursing, treatment and equipment: wards like burn ward, transplant
ward functions at national or regional centers where particular service skills are
concentrated.
Ward planning:
+ Physical facilities: it includes:
Size of ward: size of the ward depends on- types of patient (an area of 100-120 sq
ft/bed is required and smaller rooms of 2-4 beds are preferable), requirement of
ward staff (a small ward will have same requirement throughout the day, helped
by a head nurse and a clerk for administrative and clerical responsibilities)
Patient housing area: this is an area where patients are kept for treatment.
- The area per bed within the ward is 80 sq ft/bed but in acute ward it is 100
sq ft/bed
- Space left between two rows of bed is 5 ft.distance between two beds is
3
1/2
to 4 ft.
- Clearance between wall and side of bed is 2ft.
- Length of bed is 66, width of the bed is 3.
Size of rooms:
Single bed room should have a size of 125 sq ft/bed
2 bed room 160 sq ft/bed
4 bed room 320 sq ft/bed
6 bed room 400 sq ft/bed
ICU 120-150 sq ft/bed
Obstetrics and orthopedics 120 sq ft/bed

support service area: this section of ward includes:
Nursing station/duty room: it should be located at such a place that the
time taken by a nurse for moving from one place to another is limited.
Centralize location is desirable.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Treatment room: the room is meant for examination of patients and should
be equipped with examination table, spotlight, dressing material, hand
washing facility etc.
Clean work room: it is a working room for staff nurses in nursing unit,
contains work benches for preparation of trays, care of materials,
equipments and supplies etc.
Pantry: it is a place where the dishes are cleaned, washed and stored.
Unit store: it is meant for storing the supplies and linens.
Sanitary area: it includes baths and toilets, dirty utility room, store for
sweepers etc.
+ Ward design: the primary objective of a ward design is to facilitate the nurse to hear and
see everything in the ward and to enable the patients to easily call the nurse when need
help.
I. open ward: in an open hall, beds are placed in rows facing each other and nursing
station in the center of the hall.
II. Riggs ward: in this design, 3-4 beds are placed parallel to the windows in open
bays separated from each other by low partition.
III. Unilateral riggs ward: side beds are placed in each bay separated from nurses
station with its standby services by a common corridor.
IV. Bilateral ward: it has been accepted as most suitable and workable conditions, two
unilateral riggs wards are on either side of a central nursing station.
V. T-shaped ward: bed bays are placed in front of the nursing station and critical
patients bays are in front of nursing station. Isolation bays are at both sides and
ancillary and other service areas are behind the nursing station.

Open ward





Open ward

Rigg,s ward


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN





Riggs unilateral ward







Riggs bilateral ward


Ward management: it is the optimal utilization of the ward resources to produce maximum
output, namely care and comfort of patients. It includes:
Strategic management: responsibility of giving a strategic direction to a ward lies
within the nursing unit set up in each ward. Strategy formulation for ward has to
be done in the context and parameters defined by the strategy, direction, resources
and constraints of hospital.
Operational management: whereas strategic management gives an anchor and
direction, operational management works towards the strategy. The responsibility
of operational management of a ward rests with the ward head nurse/ nursing unit
with the help of other ward personnel like ward clerk. It includes objectives of
providing comfort and good care to the patients and long term objective of
improvement and establishment of systems in functioning of the ward.
Central Sterile Supply Department (CSSD):
Definition of CSSD: A CSSD is a department that furnishes all supplies required for the nursing
units and departments of a hospital- theatres, wards, out-patient and casualty departments with
complete, sterile equipment ready and available for immediate treatment of patients.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
These supplies include sterile linens, sterile kits, operating room packs, needles, syringes and
other medical surgical supplies. In addition, the personnel in this department clean, inspect,
repair, assemble, wrap and sterilize special treatment trays for various nursing units.
Planning and organizational consideration of CSSD:
Planning of CSSD: the CSSD should be planned in all hospitals above 100 beds. Theatre sterile
supply unit (TSSU) is to meet emergent and large requirement of OT and is established inside
OT complex. In large hospitals like 500 beds and above, TSSU is established in addition to the
CSSD in service area.
Bed size of the hospital Location of CSSD
Up to 100 beds In operation theatre
100-500 beds CSSD centrally located in service area
Above 500 beds CSSD in service area and a separate unit for
OT to be called theatre sterile supply unit (
TSSU).

The following areas are to be provided in CSSD:
i. Equipment storage room
ii. Receiving counter and clean up room
iii. Needles and syringes processing room
iv. Gloves assembling room with rubber goods processing room
v. Clean work area including sterilizers
vi. Sterile storage area and issue counter
vii. gauze and dressing assembly area
Percentage distribution of the space is as follows:
Clean area including sterilization- 40%
Sterile storage area-15%
Equipment storage-14%
Fluids, needles and syringes- 14%
Receiving and clean up area-12%
Glove processing area-5 to 7%
Additional 25% space located for future expansion


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Layout:
+ Location should be where the most rapid means of transportation of supplies and
equipment is possible.
+ There should be avoidance of back tracking of sterile goods.
+ There should be a continuous flow of equipment from the receiving counter to the
dispensing counter.
+ The contamination of sterile goods should be avoided.
+ Sterilizing area should be the last area before the sterile storage and dispensing counter.
+ The receipt and issue counters are separated by a corridor to avoid contamination.



Separation of sterilized items by a partition or corridor





Area requirements:
It is recommended that the area of 1.64 sq.m/bed for a CSSD would be appropriate up to 400
bedded hospitals, and for more than 400 beds an area of 1 sq.m/bed would be sufficient.
The manual of IGNOU has recommended following functional area for a 100 bedded hospitals:

Facilities In sq.meter
entrance
10.50
lockers
7.00
Staff change room
7.00
Dirty receipt and disassembly
7.00
Washing, disinfection and decontamination
17.50
assembly
10.50
Linen processing
10.50
sterilization
14.00
Sterile storage
21.00
distribution
10.50
Counter of receipt of
used items
Decontamination and
cleaning area
Processing
Packing of items

Sterilization Sterilized items store Distribution point
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Trolley wash
7.00
Trolley bay
10.50
Bulk store
17.50
Duty room
3.50
toilet
3.50
Total per 100 bed hospital
164.50

Staffing pattern:
One CSSD worker per 30 beds plus one supervisor is recommended. In 200-300 beds hospital,
you need 10-15 persons. Staff for 1000 bedded hospitals is:
Supervisor 1(senior most and trained technician)
Asst. Supervisor- one of the senior technician
Technicians 6 (promoted attendants)
Sweepers- 15
Clerk- 1
Equipments and materials required:
- Hot and cold running water
- Cleaning brushes and jet water gadgets
- Ultrasonic washers
- Hot air oven for drying instruments and sterilization
- Globe processing unit
- Instrument sharpener like needle sharpening machines
- Stem sterilizers and boiler for steam
- Autoclaves of various sizes including gas autoclave
- Testing equipment
- Chemicals to clean materials
- Wall fixtures like sinks, taps
- Trolleys for supply of sterilized items and separate trolleys for collection of used items
are needed
Methods of sterilization:
Sterilization is a process of freeing an article from all living organisms including bacteria,
fungus, using dry or wet heat, chemicals or irradiation.
a. Steam sterilization: autoclaving is the commonest method
b. Hot air sterilization: Vaseline and oils cannot be sterilized with steam. these items are
exposed to hot air to 160-180
0
c for 40 minutes.
c. Gas sterilization with ethylene oxide
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
d. Sub atmospheric pressure sterilization with formalin: it is meant to disinfect instruments
like endoscopes. the temperature required is 90
0
c for 10-30 minutes.
e. Chemical sterilization with activated glutaraldehyde
f. Gamma irradiation sterilization: it is used for disposable goods but is a costly method.
g. Formaldehyde steam sterilization
Inventory management:
i. Stock: to ensure the availability of sterilized items to the hospital units, five times the
average daily requirements. The replacement and procurement of condemned items
should be laid out so that situation of stock out can be avoided.
ii. Issue of materials: the principle of first in- first out ensures proper rotation of supplies
in CSSD and prevents any item from being kept for longer time so that its sterilization
date expires.
iii. Distribution of sterile items: the method that can be used for distribution of sterile items
are:
- Grocery system: in case CSSD is open 24 hrs, wards and departments can send
requisition to CSSD and stock is supplied accordingly.
- CSSD is open for limited hours:
Clean for dirty exchange system: one clean item is provided for each item
in the ward used.
Milk round system: it includes daily topping up of each ward/ department
stock level to a pre determined level decided by users.
Basket system: a basket with daily requirement of ward is changed
everyday irrespective sterile items used or not, and the items of the whole
basket is sterilized every day.

- In case the items are to be stocked in wards, the date of sterilization is written on
each item so that the unused items are returned to CSSD for re-sterilization after
72 hrs.

iv. Quality control methods:
- Routine temperature/pressure and holding time testing of each autoclave.
- Steam clox is also very handy and reliable. Changes color from brown to green
- Heat/time, moisture sensitive tapes may be used in same way as that of steam
clox
- Random samplings of sterilized items are also tested in laboratory
- Culture of wall/floor and scrapings.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Laundry services:
Functions of laundry:
+ Control of cross infection: it reduces the chances of cross infection.
+ Patient satisfaction: the patient likes to have clean linen which is changed and washed
frequently and has a psychological effect on patient.
+ Public relation: the image of hospital also depends on clean look of linen as it instills
confidence in patients and relatives.
Types of laundry:
a. In-plant or in-house laundry: in this system, the hospital has its own linen and laundry
and all activities of the hospital laundry services are done in hospital premises. A hospital
with more than 100 beds can run this type of laundry services.
b. Rental system: this system is used in advanced western countries. The owner of the linen
is also the supplier of linens to the hospitals and is also responsible for the replacement as
well as the laundering of patients and staff linen.
c. Contract system: in India, all hospitals have their own linen, majority of the hospitals get
the laundering done by contract dhobis. In some cases, a subsidized contract type is
prevalent and in some cases, the hospitals provide water and washing area within the
hospital premises.
d. Co-operative system: it is most beneficial to the smaller hospitals than the large hospitals
as they share the service of highly qualified laundry services.
Planning and organization of laundry services:
Location: if possible, the laundry should be in the same building as the hospital, and should have
separate entrance and exit areas. It is recommended to have a mechanized laundry in the
basement, with proper drainage arrangements.
Space requirements:
The requirement for any laundry services has been worked out to be approx. 10-15 sq.ft./bed.
No.of beds Space
200-300 beds 3750 sq.ft.
300-500 beds 5670 sq.ft.
500-600 beds 6460 sq.ft.
>650 beds 8210 sq.ft.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Floor area/space requirement:
According to Dr. Mc Gibony, the area for a laundry for a teaching hospital in India should be at
least 5800 sq.ft.
Physical layout:
1. Straight through flow: the planning of the building and installation of equipment in a
straight flow from the dirty end to the clean end.
2. U-flow: where the dirty and clean ends are in the same direction.
3. Gravity flow: this takes advantage of the underground, with dirty end at the top and clean
end at the bottom.
Laundry is divided into two distinct areas:
Dirty area: it comprises of
Reception of solid linen
Sorting of soiled linen into suitable quantities for processing
Clean area: it comprises of
drying
finishing
discharge
a barrier wall between the clean and dirty area is desirable


Schematic design of functional areas:












Reception of dirty
linen and storage
room
Decontamination and sluice
room
Boiler room
Toilet Washer
Laundry
manager
Staff room
Store of
detergent
Store of spare
linen
Linen mending Hydro extractor
Issue area Storage of
clean linen
Pressing and
laundering
Drier
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Ancillaries:
Laundry managers office
Stores
Tailoring bay
Workers rest room
Toilet
Boiler room
Material and decor:
The route of soiled linen from the using points to the laundry and the flow of clean linen
from laundry to the using points should be planned as to minimize the possibility of
contamination of clean linen.
The laundry should be grouped into specific separate areas.
Laundry managers office should be located as centrally as possible to properly supervise
the entire laundry operations.
The walls should have large vision panels to allow full view of each area.
A toilet, locker and shower facilities should be provided in the soiled linen receiving,
sorting and washer loading room and clean linen processing room.
Supply storage room should be adjacent and connected to the soiled linen receiving,
sorting and washer loading room.
Sufficient space should be provided for the storage of one weeks supply of detergents,
bleaches and others.
The floor for the laundry should have smooth, slip resistant and water proof surface, the
walls should have a smooth washable surface free from all corners, edges or projections
which create maintenance problems.
Utility services like piping, electrical wiring should be designed and sized with
appropriate consideration for future expansion.
The steam supply system should be designed to deliver steam to the equipment in right
quantity at a desired temperature.
Hot water should be available at 180
0
F by the pipeline to the laundry at the required
temperature from the boiler room.
The power supply to the laundry is usually 220 or 440 volts in three phases , four wire
alternative system and must be accessible
Lighting should be free of glare and shadows.
Fire extinguishers should be located in the laundry near the clean linen and the processing
areas.
There is a need for flow of drains in the sorting and washing areas.
Ventilation system must be able to provide a comfortable environment for the workers.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Sewing and mending room should be located near to the clean linen and pack preparation
room.

Laundry management:
The management of laundry contributes to morale of the staff and patients with fresh laundered
linen:
a. Sequence of operation:
Collection of laundry by laundry staffs in trolley with clean and dirty linen
separately and is sorted out as soiled, infected and foul linen to avoid nosocomial
infection.
Disinfection is done using disinfectants for infected linens.
Sluicing and washing: sluicing is done for foul linen in sluice machine and then the
linen along with those that are disinfected are put in washer for cleaning.
Hydro-extractor: it is then put in extractor for removing extra water.
Drier tumbler: the linens are put for drying.
Pressing: the linens are pressed
Mending: the torn linen is sent for repair or condemnation and replacement.
Repaired linen is again washed in washer and washing cycle after that is to be
completed.
Distribution to ward is done by laundry staff after it is ready for use.
b. Linen distribution system:
+ Topping up: in this, the ward is given certain number of stock of linen based on
24 hours requirement and shortfall of linen due to use is topped up by the laundry
staff everyday and used ones are collected.
+ Clean for dirty exchange: the issue of clean linen to exchange number of pieces
of dirty linen.
+ Exchange trolley system: this is expensive and not used in India. In this, total
trolley is supplied which has 24 hours requirement and next day fresh trolley is
supplied with same number of pieces and old trolley is taken back to laundry
irrespective as how many pieces have been used and linen is brought and washed.
c. Quality control of laundry services: the quality assurance of laundry should be developed
since laundry is important from where infection can be transmitted to other patients,
which should be seen by the hospital infection control committee.
d. Policies and procedures:
- Collection and distribution system of linens with periodicity to each ward and
department.
- Detailed instruction about handling infected and foul linen.
- Charter of duty of each person handling laundry and training schedule of staffs.
- Sluicing and disinfection procedures.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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- Operation of laundry machines.
- Maintenance and service contracts of machines.
- Provision of detergents
- Procedure for condemnation of linen and procurement of new linen
- Fire safety drills and fire extinguishing measures
- Record of distribution, collection, inventory of detergents and linen
procured/condemned.
- Security arrangements for laundry.
- Regular physical verification of linen and fixing responsibility of any type of loss.
Kitchen services:
A hospital dietary service includes most importantly a production unit that converts raw material
into palatable food. The preparation and distribution of food from store to spoon has many
challenges for the administration such as proper preparation, cost accounting, pilferage and
wastage.
Functions of dietary services:
The dietary services cater for the following:
therapeutic diet
in-patient catering
diet counseling
education and training
Staff requirements:
Category of employees Beds
100 200 300 500 750
Chief dietician - - - - 1
Senior Dietician - - - - 1
Dietician - - - 1 1
Asst. dietician 1 2 3 5 7
Steward - - 1 1 1
Storekeeper(ration) - - - 1 1
Storekeeper(general) - - - 1 1
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Clerk/typist - - - 1 1
Head cook 1 1 1 2 2
Therapeutic cooks - - 2 2 3
Cooks 4 6 8 10 16
Asst. cook 6 14 20 28 32
Cleaners, waiters 4 4 6 8 10
Store attendants - 1 1 2 2
Sweepers 1 1 2 2 3
Fig. 1 shows staff requirement
Location and space requirement:
Location: the dietary department should be located on the ground floor near wards where the
diets need to be taken and also accessible to road as supplies are to be carried to storage area.

Space requirement:
Hospital kitchen is divided into number of divisions which have a particular activity. The broad
areas are supplies receiving area, storage area, cooking area, pots and pan wash, garbage
disposal, LPG stove and refrigeration facilities, housekeeping, dietician, steward offices and
circulation area.
Following space requirements are recommended for different size of hospitals:
+ 200 beds or less: 20 sq ft per bed
+ 200-400 beds: 16 sq ft per bed or 18 sq ft per bed
+ 500 beds and above: 15 sq ft per bed
Functional areas in department:
a. Recipient area: this is the place where all provisions are off loaded. these are checked for
right quality and quantity, hence area should have unloading points, ramps, trolleys and
weighing scales.
b. Storage area: this area where the provisions are categorized and stored in separate areas.
the areas should have enough shelves and bins:
+ Dry provisions like flour, dal, sugar, oil etc.
+ Fresh provisions like vegetables, milk, butter, meat etc.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Office store
keeper
They are further divided based on temperature requirements:
+ items to be stored at room temperature like onion, potato etc
+ Items require cool temperature (8-10
0
c is maintained) for which walk-in cooler
can be provided to store milk, eggs, butter etc.
+ Deep fridge where temperature is below 0
0
c fish and meat should be stored.
c. Day store: it is an area where provisions for one days cooking issued to the cooks are
stored.
d. Preparation area: it is an area where provisions are cleaned, washed, soaked; meat is
chopped, cut and sliced etc. the items like kneader, weighing scale, slicer etc has to be
provided.
e. Cooking area: it should have pressure cooker, cooking range oven etc.
f. Service area: the food is put in service pots in trolleys and if it is a centralized distribution
system, it is put in service trays, with specifying the name of patients.
g. Washing area: this is meant for washing cooking and service pots, hence should have
liberal hot and cold water.
h. Disposal area: the area where all garbage and left over food is collected for disposal.

Fig 2. - The figure explains the layout of kitchen















Walk-in cold
store
Dry store Fresh store Recipient area of
provisioning
Preparation area Dry store
Cooking area
Trolley+ pot wash
area
Distribution area and service
Wards
Dietician
Supervisor
Staff room
Staff toilet
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Distribution of diet:
a. Centralized service: the food is set in individual tray centrally at dietary department
including therapeutic diet of patients and are transferred to wards in trolleys and served to
the patients.
b. Decentralized service: the food is sent to wards and served as per the need of the patient.
Dietary store management:
+ Storage of food items: for dry storage, the temperature should be 70
0
c, with adequate
ventilation has to be insured. The storing shelves, bins should be placed 10 above the
floor.
+ Purchase of food products: the items can be purchased from open market or through
calling tenders. The items to be purchased should have AG MARK OR IDI. For this, an
internal purchase committee may be constituted by the hospital administration.
+ Equipment planning: equipment purchase depends on the objectives and basic functions
of the department, workload and availability of the personnel, and quality standards.
Modern gadgets like mixer grinders, pressure cookers, dish washers etc. Should be a part
of hospital kitchen.
+ Financial control:
The first thing to be done for an effective financial control is to control the labor
costs.
Menu planning should be done in such a way that it reduces the inventory,
selection of items common to many areas of patient care, reduced handling,
wastage, use of automation or more equipment requiring less operational staff are
some measures that can be put to practice for an effective financial control.

Laboratory services:
The basic function of laboratory services is:
+ To assist doctors in arriving at or confirm a diagnosis and to assist in the treatment and
follow-up of patients.
+ The laboratory not only generates prompt and reliable reports, and also functions as store
house of reports for future references.
+ It also assists in teaching programmes for doctors, nurses and laboratory technologists.
+ It carries out urgent tests at any part of day or night.
Functional divisions:
The hospital laboratory work generally falls under the following five divisions:
a. Hematology
b. Microbiology
c. Clinical chemistry/ biochemistry
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
d. Histopathology
e. Urine and stool analysis
Functional planning:
It covers the following activities:
Determining approximate section wise workload.
Determining the services to be provided.
Determining the area and space requirement to accommodate equipment, furniture and
personnel in technical, administrative and auxiliary functions.
Dividing the areas into functional units i.e. Hematology, biochemistry, microbiology etc.
Determining the number of work stations in each functional units.
Determining the major equipments and appliances in each unit.
Determining the functional location of each section in relation to one another, from the
point of view of flow of work and technical work considerations.
Identifying the electrical and plumbing requirements for each area/ work station.
Considering utilities i.e. lighting, ventilation, isolation of equipments or work stations.
Working out the most suitable laboratory space unit, which is a standard module for work
areas.
Organization:
+ Location: it is preferable to have hospital laboratory planned on the ground floor and so
located that it is accessible to the wards. In large hospitals, the entry of outpatients to the
laboratory can be obviated by opening a sample collection counter in the outpatient
service area itself.
+ Outpatient sample collection: it should be located in the outpatient department itself. The
design of this area should include waiting room for patients, venepuncture area and
specimen toilets separately for male and female patients, along with provision of
containers with appropriate preservatives and keeping record of each patient.
+ Area/space: in a small hospital, the laboratory facility consists of a room in which all the
routine urinalysis, hematology and clinical chemistry investigations are carried out. As
the hospital size increases, the requirement of technical and administrative services also
increases with the necessity for departmentalization of the laboratory. The requirement of
space for the laboratory consists of :-
Primary space: this space is utilized by technical staff for the primary task of
carrying professional work.
Secondary space: it is utilized for all supportive activities.
Administrative space, i.e. Offers for the pathologists and others, staff toilets etc.
Circulation space: it is the space required for uncluttered movement of personnel
and materials within the department between various technical work stations,
rooms, stores and other auxiliary and administrative areas.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Laboratory space unit (LSU): it is a module of space and all calculations for
technical work areas and some auxiliary area are based on LSU. For allocation of
primary space, one of the most suitable sizes of a LSU is one measuring 10 x 20
giving a LSU module of 200 sq. ft. a rectangular module is functionally more
efficient because in the same overall space, it can accommodate longer runs of
benching due to its longer perimeter.
+ Layout: structural flexibility should be achieved by use of movable or adjustable
benching systems in association with an installation of service mains that has been
designed to permit the repositioning of outlets.
+ Administrative and auxiliary areas: the administrative area (the area is the central
collection point for receiving specimens and is the reception and interaction area for
patients and hospital staffs) is separated from the technical work area so that the non-
laboratory personnel need not enter the technical areas.
+ Reception and sample collection: this is the area should be well ventilated and lighted,
should have a chair where the patient can sit in comfort and where his arm can be
stretched for the phlebotomy, a bed where the patient can lie down for pediatric
collection or aspiration cytology.
+ Bar-coding system for samples: this system is used to trace the samples. The sample is
received and then bar coded, and then sent to processing area. This protects patient
identity.
+ Specimen toilet: it is provided for the collection of urine and stool specimens.
+ Pathologist office: it is so placed that the pathologist can have an easy access to the
technical areas particularly histopathology unit.
+ Glass washing and sterilizing unit: small labs collect blood in bottles that are washed and
reused. This is partitioned into washing and sterilizing area, containing sterilizer, pipette
washer and sinks.
+ Report issue: the reports should be issued in printed format. The hospital lab software can
be made as per the requirement of the hospitals.
+ Utility services: it includes water, gas and compressed air systems. Piping systems should
be easily accessible for maintenance and repairs with minimum disruption of work. For
safety purpose and to facilitate repairs, each individual piping system should be identified
by color, coding or labeling.
+ Internal design and fitments:
a. Work benches: the height of the work bench on which the technicians sit while
working (revolving stools) vary from 75-90 cm depending upon the height of the
workers.
b. Lighting: natural light should be used to the fullest. Each work bench should be
provided with adequate electric points especially fluorescent fixtures that give
uniform illumination and minimize heat.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
c. Storage: each laboratory bench length should have storage space for reagents,
chemicals, glass wares and other items, provided in the form of under bench
drawers, cupboards etc.
d. Partitions: it may be required between some laboratory spaces.
e. Air conditioning: whole or at least histopathology section of the laboratory
should be air conditioned due to accumulation of formalin vapors or else a
powerful exhaust system should be installed.
f. Working surface/ flooring: the surface of work benches should be resistant to
heat, chemicals, stain proof and easy to clean. Floor should be easy to clean, and
not slippery. Flexible vinyl flooring is preferred for laboratory floor coverings.
Staffing: the hospital laboratory services should be under the control and direction of
a doctor with qualifications in pathology or a PG degree in the new discipline of
laboratory medicine.
Number of personnel: staff requirement of laboratory technicians can be worked out
empirically on the basis of generally accepted norm which is about 30 tests per day
per technician.
Equipment:
Some of the core instruments that are needed are:
+ Colorimeters/ spectrophotometers: they were used in old days, are now
replaced by new auto-analyzers these days.
+ Auto analyzers: it is used maximum in biochemistry works.
+ Cell counter: it gives a more complete blood picture. The principle of the
instrument is to pass the cells through a thin capillary.
+ Centrifuge
+ Refrigerators
+ Pressure sterilizers
+ Pipette washers
+ Analytical balance
+ Semi auto analyzer
+ ELISA reader
+ Blood gas analyzer
+ PCR instrument
+ Flow cytometer
Emergency services:
An emergency department must be developed as a mini hospital within a hospital i.e.
Independent and self sufficient in day to day working.

Planning and organizational considerations:
1. Location: there are two essential location requirements:
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
- It must be on ground floor and easily accessible to both ambulatory and ambulance
patients, and there should be minimal separation between it and radiology department.
- Secondly, the emergency department should have ready access to the acute patient care
areas, eg. Operation theatre, ICU, blood bank etc.
Emergency department must be designed; usually 1000 sq.ft is required for daily patient load of
100 patients.
2. Stretcher, trolley, wheelchair store: a store for stretcher, trolley and wheelchairs should
be located adjacent to the entrance.
3. Ambulance attendants, police, mass media room: an equipped room of about 10 m
2
near
the entrance hall with attached toilet serves the needs of above personnel.
4. Work area: it should be spacious with enough room for personnel and patients.
5. Waiting area for emergency department patients: the main function of this is to be the
passageway to patient examination and treatment area.
6. Waiting area for relatives: patient relatives should not be allowed in the work areas of
emergency department. Waiting room with recreational facilities may be provided.
7. Visitors toilet: it should be provide near the main waiting space.
8. Nurses station and administrative office: this should be next to the entrance and manned
on 24 hr. basis. It should be provided with multiple telephones, bulletin board with duty
roster of doctors on call and directive pertaining to the emergency department should be
displayed. Nurses work room should be well stocked with drugs, IV fluids.
9. Examination and treatment area: this area should always be in readiness to receive
patients at all times, and should consist of a large room and number of separate smaller
rooms for examination and treatment. It should be well illuminated space with oxygen
supply, resuscitation equipment, suction, portable X-ray, electrocardiographs, and
Boyles apparatus.
10. Equipment:
+ Stretchers
+ On-the wall oxygen unit
+ On-the wall suction unit
+ BP apparatus, otoscope, stethoscope, opthalmoscope etc.
+ Spot lights
+ Utility table
+ Airways and resuscitation bags
11. Resuscitation room: the patient is to be stabilized in this room before shifting to treatment
or recovery room, or to ICU or nursing unit. It should be well equipped with resuscitation
equipment, ECG machine and X-ray viewing screening with facility for performing
minor operative procedures.
12. Operation room: a self sufficient operation room to serve patients who need minor
surgery and no admission or who are critically ill etc. in emergency department.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
13. Fracture room: a separate fracture room equipped similar to OT and additional facilities
for reduction of closed fractures under local anesthesia can be planned with hospitals
with turnover of emergency patients in excess of 15,000 per annum.
14. Plaster room: it is needed for treatment of fractures and application plasters.
15. Care of burns: a separate room with 20 m
2
area should be reserved for immediate care of
burn patients. An observation ward of about 6-8 beds for patients to be kept under
observation overnight or 24 hrs.
16. Isolation room: for obstetric patients, pediatric patients.
17. Other rooms: these should be planned based on the local needs:
+ Room for dead bodies
+ Pantry-7 m
2

+ Storage space
+ Utility and soiled linen room-7 m
2

+ Cleaners room-house keepers room 4m
2

+ Change room duty rooms 9m
2

+ Conference room and reference library 8m
2

Staffing pattern:
- Full time emergency physicians, especially trained in emergency medicine
- A well staffed emergency department needs 8 nurse shifts of 8 hours each per 100
daily patients visits. Additional staff nurses is required if there is observation
ward attached.
- For registration and records, usually 3 clerks work in day and afternoon shift,
and one during night.
- Security should be available round the clock
- Public relations and social worker should be available to take care of the anxious
and disturbed patients and their relatives.
Medico-legal aspects of emergency department:
a. Negligence: it is the breach of duty owed by a doctor to his patients to exercise
reasonable care/skills resulting in some bodily, mental or financial disability.
b. Duty to treat all: according to the recent supreme court decision, no doctor can refuse
giving first aid treatment to accident victims or any other patients.
c. Problem areas in emergency department:
Consent to treatment: a written consent must be obtained from the patient to treat
him, with the patients knowledge regarding procedures.
Medical records: medical records and proper record keeping are high priority in
any hospital. Proper documentation of patients case history with informed
consent is necessary.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Reporting to authorities: all medico-legal cases e.g. Assault and battery, child
abuse, accidents etc. Should be reported to proper authorities e.g. Police. The
cases of AIDS and venereal diseases should be reported to health authorities.

DISASTER MANAGEMENT
DEFINITION
Disaster is any occurrence that causes damage, economic disruption, loss of human life and
deterioration of health and health service on a scale sufficient to warrant an extraordinary
response from outside the affected community or area. (WHO)
Disaster can be defined as an overwhelming ecological disruption, which exceeds the capacity
of a community to adjust and consequently requires assistance from outside. -Pan American
Health Organisation(PAHO)
Disaster is an event, natural or manmade, sudden or progressive, which impacts with such
severity that the affected community has to respond by taking exceptional measures. -W. Nick
Carter
CLASSIFICATION OF DISASTERS
Disasters are commonly classified according to their causes into two distinct categories:
Natural disaster
Man-made disaster
Natural disasters
Metrological disaster: Storms (Cyclones, typhoons, hurricanes, tornados, hailstorms,
snowstorms), cold spells, heat waves and droughts.
Typological Disaster: landslides, avalanches, mudflows and floods.
Telluric and Teutonic (Disaster originate underground): Earthquake, volcanic
eruptions and tsunamis (seismic sea waves).
Biological Disaster: communicable disease, epidemics and insect swarms (locusts).
Man Made Disasters
Warfare: conventional warfare (bombardment, blockade and siege) and non-conventional
warfare (nuclear, chemical and biological).
Civil disasters: riots and demonstration.
Accidents: transportation (planes, trucks, automobiles, trains and ships); structural
collapse (building, dams, bridges, mines and other structures); explosions and fires.
Technological failures: A mishap at a nuclear power station, leak at a chemical plant
causing pollution of atmosphere or the breakdown of a public sanitation.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
PRINCIPLES OF DISASTER MANAGEMENT
- Prevent the disaster
- Minimize the casualties
- Prevent further casualties
- Rescue the victims
- First aid
- Evacuate
- Medical care
- Reconstruction
READINESS FOR DISASTER
Readiness for disaster involves two aspects:
1. Resource for readiness.
2. Disaster pre planning.
1. Resources for readiness:
RED CROSS: Its primary concern in a disaster situation is to provide relief for human
suffering in the form of food, shelter, clothing, medical care, and occupational rehabilitation
of victims.
COMMUNITY AND LOCAL GOVERNMENT: It shares the responsibility in clearing rubble,
maintaining law and order, determining the safety of a structure of habitation, repairing
bridges, resuming transportation, maintaining sanitation, providing safe food and drinking
water, etc.
CIVIL DEFENCE SERVICES: The civil defense and its medical facility programmers provide
for shelters, establishing communication linkage, post disaster services, assistance to affected
community in the area of health, sanitation, maintaining law and order, fire fighting, clearing
debris, prevention and control of epidemic of various diseases etc.

2. Disaster pre-planning: It is important to make the best possible use of the resources.
Some of the pre-planning aspects for disaster related to medical care as follows:
HOSPITAL DISASTER PLANING: Depending upon the hospitals location and size, it
mobilizes its resources to manage any disaster. It should provide for immediate action in the
event of:
i. An internal disaster in hospital itself eg. fire, explosion, etc.
ii. Some minor external disaster.
iii. Major external disaster.
iv. Threat of disaster.
v. Disaster in neighboring communities/country.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

EVACUATION: There is usually a system which on order of the medical superintendent, is
activated : eg.
i. Percentage of evacuation (discharge) of the patient from the hospital.
ii. Addition of extra beds.
iii. Preparation of emergency ward.
iv. Such facilities should be near to X-ray, operation theatre, central supply, medical store,
etc.

ORDERLY FLOW OF CASUALITY: It is important to minimize confusion in receiving
causalities. A team of well qualified physician and nurses at the reception itself sorts out
causalities and make quick decisions of the treatment.
i. Additional nursing staff volunteers may be called and posted.
ii. Services of all departments of the hospital should be well integrated in the disaster plan
viz. dietary department, laundry, public works department (PWD), engineering unit, etc.
iii. The planning should also take into consideration other aspects like traffic control, types of
medical records to be maintained, standardization of emergency medical tags, public
information centers, controlled dissemination of information without or with minimum
distortion, preparation of emergency supplies kept ready, all ambulance kept ready,
arrangement of additional vehicles.

COMMUNICATION SYSTEM: Additional communication system should be planned. It is
also important to keep the hospital informed about the inflow of the casualties from the scene.
THE DISASTER MANAGEMENT CYCLE
1. DISASTER EVENT: This refers to the REAL TIME event of the hazard occurring and
affecting elements of risk.
2. RESPONSE AND RELIEF: This refers to the first stage response to any calamity, which
include setting up control rooms, putting the contingency plan in action, issue warnings,
evacuating people to safe areas, rendering medical aid to the needy, etc.
3. RECOVERY: It has three overlapping phases of emergency relief rehabilitation and
reconstructing.
4. DEVELOPMENT: Evolving economy and long-term prevention/disaster reduction
measures like construction of houses capable of withstanding the onslought of heavy rains,
wind speeds and shocks of earthquakes.
5. REDUCTION AND MITIGATION: Protective or preventive actions that lessons the scale
of impact. Minimizing the effects of disaster. Eg. building codes and zoning, vulnerability
analyses, public education.
6. PREPAREDNESS: Includes the formulation and development of viable emergency plans,
of the warning system, the maintenance of inventories and the training of personnel.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
DISASTER
IMPACT
RESPONSE
RECOVERY
DEVELOPMENT PREVENTION
MITIGATION
PREPAREDNESS


TRIAGE
The word triage is derived from French word trier which means sorting or choosing.
Objectives of triage
An effective triage system should be able to achieve the following:
Ensure immediate medical intervention in life threatening situations.
Expedite the care of patents through a systematic initial assessment.
Ensure that patients are prioritised for treatment in accordance with the severity of their
medical condition.
Reduce morbidity through early medical intervention.
Improve public relations by communicating appropriate information to friends and
relatives who accompany patients.
Improve patients flow within emergency departments and/or disaster management
situation.
Provide supervised learning for appropriate personnel.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Principles of triage
The main principles of triage are as follows:
Every patient should be received and triaged by appropriate skilled health-care professionals.
Triage is a clinic-managerial decision and must involve collaborative planning.
The triage process should not cause a delay in the delivery of effective clinical care.
Triage system
Triage consists of rapidly classifying the injured on the bases of severity of their injuries and the
likelihood of their survival with prompt medical intervention
1. GOLDEN HOUR
A seriously injured patient has one hour in which they need to receive Advanced Trauma Life
Support. This is referred to as the golden hour
2. IMMEDIATE OR HIGH PRIORITY
Higher priority is granted to victims whos immediate or long term prognosis can be dramatically
affected by simple intensive care.
Immediate patients are at risk for early death
They usually fall into one of two categories. They are in shock from severe blood loss or
they have severe head injury
These patients should be transported as soon as possible

3. DELAYED OR MEDIUM PRIORITY:
- Delayed patients may have injuries that span a wide range
- They may have severe internal injuries, but are still compensating

Delayed patients have:
- Respirations under 30/minutes
- Capillary refill under 2 seconds
- Can do-follow simple commands

4. MINOR OR MINIMAL OR AMBULATORY PATIENTS
Patients with minor lacerations, contusions, sprains, superficial burns are identified as
minor/minimal
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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5. EXPECTANT OR LEAST PRIORITY
Morbid patients who require a great deal of attention with questionable benefit have the
lowest priority.
Patients with whom there are signs of impending death or massive injuries with poor
likelihood of survival are labeled as expectant

Color code
Red indicate high priority treatment or transfer
Yellow signals medium priority
Green indicate ambulatory patients
Black indicates dead or moribund patients

HOSPITAL DISASTER PLAN
The hospital is an integral part of the society and it has great role to play in the disaster
management. Every hospital big or small, public or private has to prepare a disaster plan, and
must learn to activate the disaster plan at the hour of need. Disasters in the hospital perspective
can be grouped into two categories:
1. Internal Hospital disasters like fire, building collapse, terrorism, etc
2. External disasters like earthquakes, floods, etc
OBJECTIVES OF HOSPITAL DISASTER PLAN
1. Preparedness of staff, optimising of resources and mobilisation of the logistics and
supplies within short notice
2. To make community aware about the hospital disaster plan and benefits of plan
3. Training and motivation of the staff
4. To carry out mock drills
5. Documentation of the plan and making hospital staff aware about the various steps of the
plan
DESIGNING OF HOSPITAL DISASTER PLAN
1. Disaster management committee:
The hospital disaster management committee is the decision making body for formulation of
the policy and plan for disaster management. It constitutes the following members.
a. Director of the hospital
b. HOD of accidents and emergency services
c. All heads of the departments
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
d. Nursing superintendent
e. Hospital administrator
f. Representatives of the staff

2. Functions of the disaster management committee- The functions of the committee are:
a. To prepare a hospital disaster plan for the hospital
b. To prepare departmental plan in support of the hospital plan
c. Assign duties to the staff
d. Establishment of criteria for emergency care
e. To conduct, supervise and evaluate the training programmes
f. To supervise the mock drills
g. Updating of plans as need arises
h. Organise community awareness programmes, through mass media
i. Assist in information, education, communication (IEC) programmes in respect of the
disaster preparedness, prevention and management.

3. Role and functions: The effective implementation of the program will depend upon clarity of
the plan, role and functions of the different members and the staff. They are:
a. Disaster co-ordinator: The co-ordinators role will be:
o Organising
o Communicating
o Assigning duties
o Deployment of staff
o Taking key decisions
b. Administrator: The responsibilities of the administrator is to execute the authority
through the departmental heads
c. Departmental heads: Development of departmental plans
d. Nursing superintendent : deployment of nursing staff
e. Medical staff: specific role of rendering medical care both pre-hospital and hospital care
f. Nursing staff: nursing care and support critical care

4. Important departments
The important department of the hospital have to play a key role in the disaster management.
a. Accident and emergency department
b. Operating department
c. Critical care units
d. Radiology departments
e. Laboratory
f. Bloodbank

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
5. Support areas
Prompt supply of drugs, linen and surgical items, fluids are required in the hospital and due
care has to be taken to incorporate the role and function of following units.
a. Laundry
b. CSSD
c. Dietary department
d. Housekeeping services
e. Medical records
f. Public relations
g. Communications
h. Transportation
i. Mortuary
j. Medic-social worker
k. Engineering department
l. Security and safety services
m. Media relations
DISASTER DRILL
Definition
A disaster drill is an exercise in which people simulate the circumstances of a disaster so that
they have an opportunity to practice their responses.
Features
On a basic level, drills can include responses by individuals to protect themselves, such as
learning how to shelter in place, understanding what to do in an evacuation, and organizing
meet up points so that people can find each other after a disaster.
Disaster drills handle topics like what to do when communications are cut off, how to deal
with lack of access to equipment, tools, and even basic services like water and power, and
how to handle evacuations.
It also provides a chance to practice for events such as mass casualties which can occur during
a disaster.
Regular disaster drills are often required for public buildings like government offices and
schools where people are expected to practice things like evacuating the building and assisting
each other so that they will know what to do when a real alarm sounds.
Community-based disaster drills such as whole-city drills provide a chance to practice the full
spectrum of disaster response. These drills can include actors and civilian volunteers who play
roles of victims, looters, and other people who may be encountered during a disaster, and
extensive planning may go into such drills. A disaster drill on this scale may be done once a
year or once every few years.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Benefits
- Used to identify weak points in a disaster response plan
- To get people familiar with the steps they need to take so that their response in a disaster
will be automatic.
ROLE OF NURSES IN DISASTER MANAGEMENT
I. In disaster preparedness
1) To facilitate preparation with community
For facilitating preparation within the community, the nurse can help initiate updating disaster
plan, provide educational programmes & material regarding disasters specific to areas.
2) To provide updated record of vulnerable populations within community
The nurse should be involved in educating these populations about what impact the disaster can
have on them.
3) Nurse leads a preparedness effort
Nurse can help recruit others within the organization that will help when a response is required.
It is wise to involve person in these efforts who demonstrate flexibility, decisiveness, stamina,
endurance and emotional stability.
4) Nurse play multi roles in community
Nurse might be involved in many roles. As a community advocate, the nurse should always seek
to keep a safe environment. She must assess and report environmental hazards.
5) Nurse should have understanding of community resources
Nurse should have an understanding of what community resources will be available after a
disaster strikes and how community will work together. A community wide disaster plan will
guide the nurse in understanding what should occur before, during and after the response and his
or her role in the plan.
6) Disaster Nurse must be involved in community organization
Nurse who sects greater involvement or a more in-depth understanding of disaster management
can be involved in any number of community organizations such as the American Red Cross,
Ambulance Corps etc.
II. In disaster response
1) Nurse must involve in community assessment, case finding and referring, prevention, health
education and surveillance
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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2) Once rescue workers begin to arrive at the scene, immediate plans for triage should begin.
Triage is the process of separating causalities and allocating treatment based on the victims
potential for survival.
o Higher priority is always given to victims potential who have life threatening injuries but
who have a high probability of survival once stabilized.
o Second Priority is given to victims who have injuries with systemic complications that are
not yet life threatening but who can wait up to 45-60 minutes of treatment.
o Last priority in given to those victims who have local injuries without immediate
complications and who can wait several hours for medical attention
3) Nurse work as a member of assessment team
Nurse working as members of an assessment team have the responsibility of give accurate feed
back to relief managers to facilitate rapid rescue and recovery.
4) To be involved in ongoing surveillance
Nurse involved in ongoing surveillance uses the following methods to gather information
interview, observation, physical examination, health and illness screening surveys, records etc.
III. In disaster recovery
1) Successful Recovery Preparation
Flexibility is an important component of successful recovery preparation.
Community clean up efforts can incure a host of physical and psychological problems. Eg.
Physical stress of moving heavy objects can cause back injury, severe fatigue and even death
from heart attacks.
2) Health teaching
The continuing threat of communicable disease will continue as long as the water supply remains
threat and the relieving conditions remain crowded. Nurses must remain vigilant in teaching
proper hygiene and making sure immunization records are up to date.
3) Psychological support
Acute and chronic illness can be exacerbated by prolonged effects of disaster. The psychological
stress of cleanup and moving can bring about feelings of severe hopelessness, depression and
grip.
4) Referrals to hospital as needed
Stress can lead to suicide and domestic abuse. Although most people recover from disasters,
mental distress may persist in vulnerable populations. Referrals to mental health professionals
should continue as long as the need exists.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
5) Remain alert for environmental health
Nurse must also remain alert for environment health hazards during recovery phase of a disaster.
Home visit may lead the nurse to uncover situations such as lack of water supply or lack of
electricity.
PARAMETERS FOR NURSING PRACTICE
All nurses providing health care at mass gatherings must be competent in the basic principles of
first aid including CPR and use of automated external defibrillator. In addition nurses should
possess the following minimum care competencies.
Nursing assessment
Perform respiratory airway assessment
Perform a cardiovascular assessment including vital signs, monitoring for signs of shade.
Perform an integumentary assessment, including burn assessment
Perform a pain assessment.
Perform a trauma assessment from head to toe
Perform a mental status including Glasgow coma scale
Know the indications of intubation





PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Unit V
Human Resource
for health
Staffing
Philosophy
Norms: Staff inspection unit(SIU), Bajaj
Committee, High power committee, Indian
nursing council (INC)
Estimation of nursing staff requirement-
activity analysis
Various research studies
Recruitment: credentialing, selection, placement,
promotion
Retention
Personnel policies
Termination
Staff development programme
Duties and responsibilities of various category of
nursing personnel
Applications to nursing service and education




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
HUMAN RESOURCES FOR HEALTH
Introduction
Organization is the formal structure of authority calculated to define, distribute and
provide for the co-ordination of the tasks as contribution to the whole. When the aims of the
organization properly design the planning of its institutions and its functional standard, it will
have identified the kind and numbers of personnel it needs.
STAFFING
Definition
Staffing is the systematic approach to the problem of selecting, training, motivating and
retaining professional and non professional personnel in any organization.
It involves manpower planning to have the right person in the right place and avoid Square peg
in round hole.
Philosophy
Components of the staffing process as a control system include a staffing study, a master
staffing plan, a scheduling plan, and a nursing management information system (NMIS).
NMIS includes these five elements;
1. Quality of patient care to be delivered and its measurement.
2. Characteristics and care requirements of patients.
3. Prediction of the supply of nurse power required for components 1 &2.
4. Logistics of the staffing program pattern and its control.
5. Evaluation of the quality of care desired, thereby measuring the success of the staffing
itself.
Philosophy of staffing in nursing
Nurse administrators of a hospital nursing department might adopt the following philosophy.
1. Nurse administrators believe that it is possible to match employees knowledge and
skills to patient care needs in a manner that optimizes job satisfaction and care
quality.
2. Nurse administrators believe that the technical and humanistic care needs of critically
ill patients are complex that all aspects of that care should be provided by
professional nurses.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
3. Nurse administrative believe that the health teaching and rehabilitation needs of
chronically ill patients are so complex that direct care for chronically ill patients
should be provided by professional and technical nurses.
4. Should believe that believe that patient assessment, work quantification and job
analysis should be used to determine the number of personnel in each category to be
assigned to care for patients of each type (such as coronary care, renal failure, etc.,).
5. Should believe that a master staffing plan and policies to implement the plan in all
units should be developed centrally by the nursing heads and staff of the hospital.
6. Should the staffing plan should be administrated at the unit level by the head nurse, so
that can change based on unit workload and workflow.
Objectives of staffing in nursing
1. Provide an all professional nurse staff in critical care units, operating rooms, labor,
delivery unit, emergency room.
2. Provide sufficient staff to permit a 1:1 nurse-patient ratio for each shift in every critical
care unit.
3. Staff the general medical, surgical, Obsteritic and gynecology, pediatric and psychiatric
units to achieve a 2:1 professional practical nurse ratio.
4. Provide sufficient nursing staff in general medical, surgical, Obsteritic, pediatric and
psychiatric units to permit a 1: 5 nurse-patient ratio on a day and after noon shifts an
d1:10 nurse patient ratio on the night shift.
NORMS OF STAFFING(S I U- staff inspection unit)
Norms
Norms are standards that guide, control, and regulate individuals and communities. For
planning nursing manpower we have to follow some norms. The nursing norms are
recommended by various committees, such as; the Nursing Man Power Committee, the High-
power Committee, Dr. Bajaj Committee, and the staff inspection committee, TNAI and INC. The
norms has been recommended taking into account the workload projected in the wards and the
other areas of the hospital.
All the above committees and the staff inspection unit recommended the norms for
optimum nurse-patient ratio. Such as 1:3 for Non Teaching Hospital and 1:5 for the Teaching
Hospital. The Staff Inspection Unit (S.I.U.) is the unit which has recommended the nursing
norms in the year 1991-92. As per this S.I.U. norm the present nurse-patient ratio is based and
practiced in all central government hospitals.
Recommendations of S.I.U:
1. The norms for providing staff nurses and nursing sisters in Government hospital is given
in annexure to this report. The norm has been recommended taking into account the
workload projected in the wards and the other areas of the hospital.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
2. The posts of nursing sisters and staff nurses have been clubbed together for calculating
the staff entitlement for performing nursing care work which the staff nurse will continue
to perform even after she is promoted to the existing scale of nursing sister.
3. Out of the entitlement worked out on the basis of the norms, 30%posts may be sanctioned
as nursing sister. This would further improve the existing ratio of 1 nursing sister to 3.6.
staff nurses fixed by the government in settlement with the Delhi nurse union in may
1990.
4. The assistant nursing superintendent are recommended in the ratio of 1 ANS to every 4.5
nursing sisters. The ANS will perform the duty presently performed by nursing sisters
and perform duty in shift also.
5. The posts of Deputy Nursing Superintendent may continue at the level of 1 DNS per
every 7.5 ANS
6. There will be a post of Nursing Superintendent for every hospital having 250 or beds.
7. There will be a post of 1 Chief Nursing Officer for every hospital having 500 or more
beds.
8. It is recommended that 45% posts added for the area of 365 days working including 10%
leave reserve (maternity leave, earned leave, and days off as nurses are entitled for 8 days
off per month and 3 National Holidays per year when doing 3 shift duties).
Most of the hospital today is following the S.I.U.norms. In this the post of the Nursing Sisters
and the Staff Nurses has been clubbed together and the work of the ward sister is remained same
as staff nurse even after promotion. The Assistant Nursing Superintendent and the Deputy
Nursing Superintendent have to do the duty of one category below of their rank.

BAJAJ COMMITTEE, 1986
An "Expert Committee for Health Manpower Planning, Production and Management"
was constituted in 1985 under Dr. J.S. Bajaj, the then professor at AIIMS.
Manpower is one of the most vital resources for the labour intensive health services industry.
Health for all (HFA) can be achieved only by improving the utilization of these resources.
Major recommendations are:-
1. Formulation of National Medical & Health Education Policy.
2. Formulate on of National Health Manpower Policy.
3. Establishment of an Educational Commission for Health Sciences (ECHS) on the lines of
UGC.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
4. Establishment of Health Science Universities in various states and union territories.
5. Establishment of health manpower cells at centre and in the states.
6. Vocationalisation of education at 10+2 levels as regards health related fields with appropriate
incentives, so that good quality paramedical personnel may be available in adequate numbers.
7. Carrying out a realistic health manpower survey.
In relation to nursing, the Bajaj Committee recommended staffing norms for nursing manpower
requirements for hospital nursing services and requirements for community health centres and
primary health centres on the basis of calculations as follow:
Hospital Nursing Services-
1. Nursing superintendents. 1:200 beds
2. Deputy nursing superintendents 1:300 beds
3. Departmental nursing 7:1000 + 1 Addl:1000 beds
(991 x 7 + 991)
4. Ward nursing 8:200 + 30% leave reserve
supervisors/sisters
5. Staff nurse for wards 1:3 (or 1:9 for each shift)
+30 leave reserve
6. For OPD, Blood Bank, X-ray,
Diabetic clinics, CSR, etc 1:100 (1:5 OPD)
+30% leave reserve

7. For intensive units 1:8 (1:3 for each shift)
(8 beds ICU/200 beds) + 30% leave reserve

8. For specialized deptts and
clinics, OT, Labour room 8:200 + 30% leave reserve




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Community Nursing Service
Projected population - 991,479,200 (medium assumption) by 2000 AD
1 Community Health Centre - 1,000,00 population
1 Primary Health Services - 30,000 population in plain area
1 Primary Health Services - 20,000 population in difficult areas
1 Sub-centre - 5000 population in plain area
1 Sub-centre - 3000 population for difficult area

It also requires nursing manpower to cater to the needs of the rural community as follows:
Manpower requirements by 2000 AD:
Sub-centre ANM/FHW 323882
Health supervisors /LHV 107960
Primary Health Centres PHN 26439
Community health centre Nurse-midwives 26439
Public health nursing supervisor 7436
Nurse-midwives 52,052
District public health nursing officer 900
In additional to the above, 74361 Traditional Birth Attendants will be required.

HIGH POWER COMMITTEE ON NURSING AND NURSING PROFESSION (1987-
1989)
High power committee on nursing and nursing profession was set up by the Government
of India in July 1987, under the chairmanship of Dr. Jyothi former vice-chancellor of SNDT
Women University, Mrs. Rajkumari Sood, Nursing Advisor to Union Government as the
member-secretary and CPB Kurup, Principal, Government College of Nursing, Bangalore and
the then President. TNAI is also one among the prominent members of this committee. Later on
the committee was headed by Smt. Sarojini Varadappan, former Chairman of Central Social
Welfare Board.
The terms of reference of the Committee are:
To look into the existing working conditions of nurses with particular reference to the
status of the nursing care services both in the rural and urban areas.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
To study and recommend the staffing norms necessary for providing adequate nursing
personnel to give the best possible care, both in the hospitals and community.
To look into the training of all categories and levels of nursing, midwifery personnel to
meet the nursing manpower needs at all levels o health services and education.
To study and clarify the role of nursing personnel in the health care delivery system
including their interaction with other members of the health team at every level of health
service management.
To examine the need for organised nursing services at the national, state, district and
local levels with particular reference to the need for planning service with the overall
health care system of the country at the respective levels.
To look into all other aspects, the Committee will hold consultations with the State
Governments.
ECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND
NURSING PROFESSION
Working conditions of nursing personnel
1. Employment
Uniformity in employment procedures to be made. Recruitment rules are made for all categories
of nursing posts. The qualifications and experience required or these be made thought the
country.
2. Job description
Job description of all categories of nursing personnel is prepared by the central government
to provide guidelines.
3. Working hours
The weekly working hours should be reduced to 40 hrs per week. Straight shift should be
implemented in all states. extra working hours to be compensated either by leave or by extra
emoluments depending on the state policy .nurses to be given weekly day off and all the gazetted
holidays as per the government rules.
4. Work load/ working facilities
Nursing norms for patient care and community care to be adopted as recommended by the
committee.
Hospitals to develop central sterile supply departments, central linen services, and central
drug supply system. Group D employees are responsible for housekeeping department.
Policies for breakage and losses to be developed and nurses not are made responsible for
breakage and losses.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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5. Pay and allowances
Uniformity of pay scales of all categories of nursing personnel is not feasible. However special
allowance for nursing personnel, i.e.; uniform allowance, washing, mess allowance etc should be
uniform throughout the country.
6. Promotional opportunities
The committee recommends that along with education and experience, there is a need to
increase the number of posts in the supervisory cadre, and for making provision of guidance and
supervision during evening and night shifts in the hospital.
-Each nurse must have 3 promotions during the service period.
-Promotion is based on merit cum seniority.
-Promotion to the senior most administrative teaching posts is made only by open selection.
-In cases of stagnation, selection grade and running scales to be given.
7. Career development
Provision of deputation for higher studies after 5 yrs of regular services be made by all
states. The policy of giving deputation to 5 -10 % of each category be worked out by each state.
8. Accommodation
As far as possible, the nursing staff should be considered for priority allotment of
accommodation near to work place. Apartment type of accommodation is built where
married/unmarried nurses can be allowed to live. Housing colonies for hospital s must be
considered in long run.
9. Transport
During odd hours, calamities etc arrangements for transport must be made for safety and security
of nursing personnel.
10. Special incentives
Scheme of special incentives in terms of awards, special increment for meritorious work for
nurses working in each state/district/PHC to be worked out.
11. Occupational hazards
Medical facilities as provided by the central govt. by extended by the state govt to nursing
personnel till such times medical services are provided free to all the nursing personnel. Risk
allowance to be paid to nursing personnel working in the rural $ urban area.
12. Other welfare services
Hospitals should provide welfare measures like crche facilities for children of working staff,
children education allowance, as granted to other employees, be paid to nursing personnel.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Additional Facilities for Nurses Working In the Rural Areas
Family accommodation at sub centre is a must for safety and security of ANM's /LHV.
Women attendant, selected from the village must accompany the ANM for visits to other
villages.
The district public health nurse is provided with a vehicle for field supervision.
Fixed travel allowance with provision of enhancement from time to time.
Rural allowance as granted to other employees is paid to nursing personnel.
NURSING EDUCATION
Nursing education to be fitted into national stream of education to bring about uniformity,
recognition and standards of nursing education. The committee recommends that;
1. There should be 2 levels of nursing personnel - professional nurse (degree level) and
auxiliary nurse (vocational nurse). Admission to professional nursing should be with 12 yrs
of schooling with science. The duration of course should be 4 yrs at the university level.
admission to vocational /auxiliary nursing should be with 10 yrs of schooling .The duration
of course should be 2 yrs in health related vocational stream.
2. All school of nursing attached to medical college hospitals is upgraded to degree level in a
phased manner.
3. All ANM schools and school of nursing attached to district hospitals be affiliated with
senior secondary boards.
4. Post certificate B.Sc. Nursing degree to be continued to give opportunities to the existing
diploma nurses to continue higher education.
5. Master in nursing programme to be increased and strengthened.
6. Doctoral programme in nursing have to be started in selected universities.
7. Central assistance be provided for all levels of nursing education institutions in terms of
budget( capital and recurring)
8. Up gradation of degree level institutions be made in a phased manner as suggested in report.
9. Each school should have separate budget till such time is phased to degree/vocational
programme. The principal of the school should be the drawing and the disbursing officer.
10. Nursing personnel should have a complete say in matters of selection of students. Selection
is based completely on merit. Aptitude test is introduced for selection of candidates.
11. All schools to have adequate budget for libraries and teaching equipments.
12. All schools to have independent teaching block called as School Of Nursing with adequate
class room facilities, library room, common room etc as per the requirements of INC.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Continuing Education and Staff Development
Definite policies of deputing 5-10% of staff for higher studies are made by each state.
Provision for training reserve is made in each institution.
Deputation for higher study is made compulsory after 5 yrs.
Each nursing personnel must attend 1 or 2 refresher course every year.
Necessary budgetary provision be made.
A National Institute for Nursing Education Research and Training needs to be established
like NCERT, for development of educational technology, preparation of textbooks, media, /
manuals for nursing.

NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS)
Definite nursing policies regarding nursing practice are available in each institution.
These policies include:
a) Qualification/recruitment rules
b) Job description/job specifications
c) Organizational chart of the institutions
d) Nursing care standards for different categories of patients.
1. Staffing of the hospitals should be as per norms recommended.
2. District hospitals /non teaching hospitals may appoint professional teaching nurses in the
ratio of 1; 3 as soon as nurses start qualifying from these institutions.
3. Students not to be counted for staffing in the hospitals
4. Adequate supplies and equipments, drugs etc be made available for practice of nursing. The
committee strongly recommends that minimum standards of basic equipment needed for
each patient be studied , norms laid down and provided to enable nurses to perform some
of the basic nursing functions . Also there should be a separate budget head for nursing
equipment and supplies in each hospitals/ PHC. The NS and PHN should be a member of
the purchase and condemnation committee.
5. Nurses to be relieved from non -nursing duties.
6. Duty station for nurses is provided in each ward.
7. Necessary facilities like central sterile supplies, linen, drugs are considered for all major
hospitals to improve patient care. Also nurses should not be made to pay for breakage and
losses. All hospitals should have some systems for regular assessment of losses.
8. Provision of part time jobs for married nurses to be considered. (min 16-20hrs/week)
9. Re-entry by married nurses at the age of 35 or above may also be considered and such
nurse be given induction courses for updating their knowledge and skills before
employment.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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10. Nurses in senior positions like ward sisters, Asst. nursing superintendents, Deputy NS;
N.S must have courses in management and administration before promotions.
11. Nurses working in speciality areas must have courses in specialities. Promotion
opportunities for clinical specialities like administrative posts are considered for
improving quality nursing services.
The committee recommends that Gazetted ranks be allowed for nurses working as ward sister
and above (minimum class II gazetted). Similarly the post of Health Supervisor (female) is
allowed gazetted rank and district public health nurse be given the status equal to district
medical/ health officers.
Community Nursing Services
Appointment of ANM/LHV to be recommended.
- 1 ANM for 2500 population (2 per sub centre)
- 1 ANM for 1500 population for hilly areas
- 1 health supervisor for 7500 population (for supervision of 3 ANM's)
- 1 public health nurse for 1 PHC (30000 population to supervise 4 Health
Supervisors)
- 1 Public Health Nursing Officer for 100000 population (community health centre)
- 2 district public health nursing for each district.
ANM/LHV promoted to supervisory posts must undergo courses in administration and
management.
Specific standing orders are made available for each ANM/LHV to function effectively in
the field.
Adequate provision of supplies, drugs etc are made.
Norms recommended for nursing service and education in hospital setting.
1. Nursing Superintendent -1: 200 beds (hospitals with 200 or more beds).
2. Deputy Nursing Superintendent. - 1: 300 beds ( wherever beds are over 200)
3. Assistant Nursing Superintendent - 1: 100
4. Ward sister/ward supervisor - 1:25 beds 30% leave reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients) 30% leave
reserve
7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve
For specialized departments such as operation theatre, labour room etc- 1: 25 30% leave reserve.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
INDIAN NURSING COUNCIL (INC)
The Indian Nursing Council is an Autonomous Body under the Government of India and
was constituted by the Central Government under the Indian Nursing Council Act, 1947 of
parliament. It was established in 1949 for the purpose of providing uniform standards in nursing
education and reciprocity in nursing registration throughout the country. Nurses registered in one
state were not registered in another state before this time. The condition of mutual recognition by
the state nurses registration councils, called reciprocity was possibly only if uniform standards of
nursing education were maintained.
Functions of Indian Nursing Council.


To establish and monitor a uniform standard of nursing education for nurses midwife,
Auxiliary Nurse-Midwives and health visitors by doing inspection of the institutions.
To recognize the qualifications under section 10(2)(4) of the Indian Nursing Council
Act, 1947 for the purpose of registration and employment in India and abroad.
To give approval for registration of Indian and Foreign Nurses possessing foreign
qualification under section 11(2) (a) of the Indian Nursing Council Act, 1947.
To prescribe the syllabus & regulations for nursing programs.
Power to withdraw the recognition of qualification under section 14 of the Act in case
the institution fails to maintain its standards under Section 14 (1)(b) that an institution
recognized by a State Council for the training of nurses, midwives, auxiliary nurse
midwives or health visitors does not satisfy the requirements of the Council.
To advise the State Nursing Councils, Examining Boards, State Governments and
Central Government in various important items regarding Nursing Education in the
Country.

THE EXISTING NORM BY INC WITH REGARD TO NURSING STAFF FOR WARDS
AND SPECIAL UNITS:
Staff nurse Sister(each
shift)
Departmental sister/ assistant nursing
superintendent
Medical ward 1:3 1:25 1 for 3-4 weeks
Surgical ward 1:3 1:25 1 for 3-4 weeks
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Orthopedic ward 1:3 1:25 1 for 3-4 weeks
Pediatric ward 1:3 1:25 1 for 3-4 weeks
Gynecology ward 1:3 1:25 1 for 3-4 weeks
Maternity ward
including newborns
1:3 1:25 1 for 3-4 weeks
ICU 1:1(24 hours) 1
CCU 1:1(24 hours) 1
Nephrology 1:1(24 hours) 1 1 department sister/assistant nursing
superintendent for 3-4 units clubbed
together
Neurology & and
neurosurgery
1:1(24 hours) 1
Special wards- eye,
ENT etc.
1:1(24 hours) 1
Operation theatre 3 for 24 hours
per table
1 1 department sister/asst nursing
superintendent for 4-5 operating
rooms
Casuality and
emergency unit
2-3 staff nurses
depending on the
number of beds
1 1 department sister/assistant nursing
superintendent

Staffing pattern according to the Indian Nursing Council (relaxed till 2012)
Collegiate programme-A
Qualifications and experience of teachers of college of nursing-
1. Professor-cum-Principal
Masters Degree in Nursing
Total 10 years of experience with minimum of 5 years of teaching experience
2. Professor-cum- Vice Principal
Masters Degree in Nursing
Total 10 years of experience with minimum of 5 years in teaching
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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3. Reader/Associate Professor
-Masters Degree in Nursing
Total 7 years of experience with minimum of 3 years in teaching
4. Lecturer
Masters Degree in Nursing with 3 years of experience.
5. Tutor/Clinical Instructor
M.Sc.(N) or B.Sc. (N) with 1 year experience or Basic B.Sc. (N) with post basic
diploma in clinical specialty

For B.Sc. and M.Sc. nursing:
Annual intake of 60 students for B.Sc. (N) and 25 for M.Sc. (N) programme

B.Sc. (N) M.Sc. (N)
Professor cum principal
1
Professor cum vice
principal
1
Reader/Associate
professor
1 2
Lecturer
2 3
Tutor/clinical instructor
19
Total
24 5
One in each specialty and all the M.Sc. (N) qualified teaching faculty will participate in both
programmes.
Teacher-student ratio = 1:10
GNM and B.Sc. (N) with 60 annual intake in each programme
Professor cum principal
1
Professor cum vice
principal
1
Reader/Associate
professor
1
Lecturer
4
Tutor/clinical instructor
35
Total
42
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Basic B.Sc. (N)

Admission capacity
Annual intake
40-60 61-100
Professor cum principal
1 1
Professor cum vice
principal
1 1
Reader/Associate
professor
1 1
Lecturer
2 4
Tutor/clinical instructor
19 33
Total
24 40

Teacher student ratio= 1:10 (All nursing faculty including Principal and Vice principal)
Two M.Sc (N) qualified teaching faculty to start college of nursing for proposed less than or
equal to 60 students and 4 M.Sc (N) qualified teaching faculty for proposed 61 to 100 students
and by fourth year they should have 5 and 7 M.Sc (N) qualified teaching faculty respectively,
preferably with one in each specialty.
Part time teachers and external teachers:
1.
Microbiology
2.
Bio-chemistry
3.
Sociology.
4.
Bio-physic
5.
Psychology
6.
Nutrition
7.
English
8.
Computer
9.
Hindi/Any other language
10.
Any other- clinical discipliners
11.
Physical education

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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The above teachers should have post graduate qualification with teaching experience in
respective area
School of nursing-B
Qualification of teaching staff-
1.
Professor cum principal
M.Sc. (N) with 3 years of teaching experience or B.Sc.(N)
basic or post basic with 5 years of teaching experience.
2.
Professor cum vice
principal
M.Sc. (N) or B.Sc. (N) (Basic)/Post basic with 3 years of
teaching experience.
3.
Tutor/clinical instructor
M.Sc. (N) or B.Sc. (N) (Basic) / Post basic or diploma in
nursing education and Administration with two years of
professional experience.

For School of nursing with 60 students i.e. an annual intake of 20 students:
Teaching faculty
No. required
Principal
1
Vice-principal
1
Tutor
4
Additional tutor for interns
1
Total
7
Teacher student ratio should be 1:10 for student sanctioned strength

ESTIMATION OF NURSING STAFF REQUIRMENTS- ACTIVE ANALYSIS AND
RESEARCH STUDIES

INTRODUCTION
Staffing is certainly one of the major problems of any nursing organization, whether it be
a hospital, nursing home, health care agency, or in educational organization. Estimation of staff
requirements is important for rendering good and quality nursing care
Patient Classification Systems
Patient classification system (PCS), which quantifies the quality of the nursing care, is
essential to staffing nursing units of hospitals and nursing homes. In selecting or implementing a
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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PCS, a representative committee of nurse manager can include a representative of hospital
administration, which would decrease skepticism about the PCS.
The primary aim of PCS is to be able to respond to constant variation in the care needs of
patients.
Characteristics
Differentiate intensity of care among definite classes
Measure and quantify care to develop a management engineering standard.
Match nursing resources to patient care requirement .
Relate to time and effort spent on the associated activity.
Be economical and convenient to repot and use
Be mutually exclusive , continuing new item under more than one unit.
Be open to audit.
Be understood by those who plan , schedule and control the work.
Be individually standardized as to the procedure needed for accomplishment.
Separate requirement for registered nurse from those of other staff.
Purposes
The system will establish a unit of measure for nursing, that is , time , which will be used
to determine numbers and kinds of staff needed.
Program costing and formulation of the nursing budget.
Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service
Determining the values of the productivity equations
Determine the quality: once a standards time element has been established, staffing is
adjusted to meet the aggregate times. A nurse manager can elect to staff below the
standard time to reduce costs.
Components:
The first component of a PCS is a method for grouping patients categories: Johnson
indicates two methods of categorizing patients. Using categorizing method each patient is
rated on independent elements of care, each element is scored, scores are summarized
and the patient is placed in a category based on the total numerical value obtained.
The second component of a PCS is a set of guidelines describing the way in which
patients will be classified, the frequency of the classification, and the method of reporting
data..
The third component of a PCS is the average amount of the time required for care of a
patient in each category. A method for calculating required nursing care hours is the
fourth and final component of a PCS.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Patient Care Classification
Patient Care classification using four levels of nursing care intensity
Area of care Category I Category II Category III Category IV
Eating Feeds self Needs some help in
preparing
Cannot feed self
but is able to
chew and
swallowing
Cannot feed self
any may have
difficulty
swallowing
Grooming Almost entirely self
sufficient
Need some help in
bathing, oral
hygiene
Unable to do
much for self
Completely
dependent
Excretion Up and to bathroom
alone
Needs some help in
getting up to
bathroom /urinal
In bed, needs
bedpan / urinal
placed;
Completely
dependent
Comfort Self sufficient Needs some help
with adjusting
position/ bed..
Cannot turn
without help, get
drink, adjust
position of
extremities
Completely
dependent
General
health
Good Mild symptoms Acute symptoms Critically ill
Treatment Simple
supervised, simple
dressing
Any Treatment
more than once per
shift, foley catheter
care, I&O.
Any treatment
more than twice
/shift
Any elaborate/
delicate procedure
requiring two
nurses, vital signs
more often than
every two hours..
Health
education
and teaching
Routine follow up
teaching
Initial teaching of
care of ostomies;
new diabetics;
patients with mild
adverse reactions to
their illness
More intensive
items; teaching of
apprehensive/
mildly resistive
patients.
Teaching of
resistive patients,
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Calculating Staffing Needs
The following are the hours of nursing care needed for each level patient per shift:
Category I Category II Category III Category IV
NCHPPD for
Day shift
2.3 2.9 3.4 4.6
NCHPPD for
P.M (Evening)
shift
2.0 2.3 2.8 3.4
NCHPPD for
night shift
0.5 1.0 2.0 2.8

A guide to staffing nursing services
1. Projecting Staffing Needs
Some steps to be taken in projecting staffing needs include:
1. Identify the components of nursing care and nursing service.
2. Define the standards of patient care to be maintained.
3. Estimate the average number of nursing hours needed for the required hours.
4. Determine the proportion of nursing hours to be provided by registered nurses and
other nursing service personnel
5. Determine polices regarding these positions and for rotation of personnel.
2. Computing number of nurses required on a Yearly Basis
1. Find the total number of general nursing hours needed in one year. Average patient
census X average nursing hours per patient for 24 hours X days in week X weeks in
year.
2. Find the number of general nursing hours needed in one year which should be given
by registered nurses and the number which should be given by ancillary nursing
personnel.
a. Number of general nursing hours per year X percent to be given by registered
nurses.
b. Number of general nursing hours per year X percent to be given be ancillary
nursing personnel.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Computing number of nurses assigned on weekly basis
1. Find the total number of general nursing hours needed in one week. Average patient
censes X average nursing hours per patient in 24 hours X days in week.
2. Find the number of general nursing hours needed in the week which should be given by
registered nurses and the number which could be given by ancillary nursing personnel.
a. Number of general nursing hours per week X percent to be given by registered
nurses.
b. Number of general nursing hours per week X percent to be given by ancillary nurses.

One method for determining the nursing staff of a hospital
1. To determine the number of nursing staff for staffing a hospital involves establishing the
number of work days available for service per nurse per year.
Example: Analysis of how the days are used;
Days in the year 365
Days off 1 day/week 52
Casual leave 12
Privilege leave 30
1 Saturday /month 12
Public Holidays 18
Sick Leave 8
Total non-working days 132
Total working days /nurse/year 233
So 1 nurse = 233 working days /year
Example, 20 nurse means 20X233= 4660 hours
4660/365= 12.8 (13).
2. Work load measurement tools
Requirement for staffing are based on whatever standard unit of measurement for
productivity is used in a given unit. A formula for calculating nursing care hours per
patient day (NCH/PPD) is reviewed.

NCH/PPD = Nursing hours worked in 24 hours

Patient Census
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
As a result, patient classification systems (PCS), also known as workload management or patient
acuity tools, were developed in the 1960s.
Important Factors of staffing
There are 3 factors: quality, quantity, and utilization of personnel.
Quality and Quantity:
This factor depends on the appropriate education or training provided to the nursing personnel
for the kind of service they are being prepared for i.e., professional, skilled, routine or ancillary.
Utilization of personnel: Nursing personnel must be assigned work in such a way that her/his
knowledge and skills learnt are based used for the purpose she was educated or trained.
Other factors affecting staffing
1. Acutely Ill : Where the life saving is the priority or bed ridden condition which might
require 8-10 hours / patient /day ie., direct nursing care in 24 hours or nurse patient ratio
may have to be 1:1, 2:1,3:1
2. Moderately Ill: here 3.5 HPD are required in 24 hours or nurse patient ration of 1:3 in
teaching hospitals and 1:5 non-teaching hospitals.
3. Mildly Ill: this required 1-2 HPD and for such patients 1:6 or 1:10.
4. Fluctuation of workload: workload is not constant.
5. Number of medical staff: In PHC , 30,000 to 50,000 population getting care from 3 to 4
medical staff but only 1 PHN gives care for all like in hospital the ratio is vary from
medical and nursing staff.
Modified approaches to nurse staffing and scheduling
Many different approaches to nurse staffing and scheduling are being tried in an effort to
satisfy needs of the employees and meet workload demands for patient care. These include
game theory, modified workweeks (10 or 12hours shifts), team rotation, premium day, weekend
nurse staffing .Such approaches should support the underlying purpose, mission, philosophy and
objectives of the organization and the division of nursing and should be well defined in a staffing
philosophy, statement and policies.
Modified work week: This using 10 and 12 hour shifts and other methods are common place.
A nurse administrator should be sure work schedules are fulfilling the staffing philosophy and
policies, particularly with regard to efficiency. Also, such schedules should not be imposed on
the nursing staff but should show a mutual benefits to employer, employees and the client
served.
One modification of the worksheet is four 10 hour shifts per week in organized time
increments. One problem with this model is time overlaps of 6 hours per 24 hour day.
The overlap can be used for patient centered conference, nursing care assessment and
planning and staff development. It can be done by hour or by a block of 3-4 hours.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Starting and ending time for the 10 hours shifts can be modified to provide minimal
overlaps, the 4- hour gap being staffed by part-time or temporary workers
A second scheduling modification is the 12 hour shift, on which nurses work even shifts ,
on which nurses work seven shift in 2 weeks: three on , four off: four on, three off . They
work a total 84 hours and are paid of overtime. Twelve hour shifts and flexible staffing
have been reported to have improved care and saved money because nurses can better
manage their home and personal lives.
The weekend alternatives: another variation of flexible scheduling is the weekend
alternative. Nurses work two 12 hour shifts and are paid for 40 hours plus benefits. They
can use the weekdays for continued education or other personal needs. The weekend
scheduled has several variations. Nurses working Monday through Friday have all
weekends off.
Other modified approaches: team rotation is a method of cyclic staffing in which a
nursing team is scheduled as a unit. It would be used if the team nursing modality were a
team practice.
Premium day weekend: nursing staffing is a scheduling pattern that gives the nurse an
extra day off duty, called a premium day, when he/she volunteers to work one additional
weekend worked beyond those required by nurse staffing policy. This technique does not
add directly to hospital costs.
Premium vacation night: staffing follows the same principle as does premium day
weekend staffing. An example would be the policy of giving extra 5 working days of
vacation to every nurse who works a permanent night shifts for a specific period of time ,
say 3, 4, or 6 months.
A flexible role: this programme has enabled the hospitals to better meet the staffing
needs of units whenever workload increases. Since establishment of the resources acuity
nurse position, nurses position, nurses morale has improved because they know short-
term helps is more readily available and will be more equitably distributed among units.
Cross training: It can improve flexible scheduling. Nurses can be prepared through
cross-training to function effectively in more than one area of expertise. To prevent errors
and incidence job satisfaction during cross training nurses assigned to units and in pools
require complete orientation and ongoing staff development.
Scheduling with Nursing Management Information Systems
Planning the duty schedule does not always match personnel with preferences. This is
one major dissatisfaction among clinical nurses. Posting the number of nurses needed by time
slot and allowing nurses to put colored pins in slots to select their own times can improve
satisfaction with the schedule.
Hanson defines a management information system as an array components designed to
transform a collective set of data into knowledge that is directly useful and applicable in the
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
process of directing and controlling resources and their application to the achievement of specific
objectives.
The following process for establishing any MIS:
1. State the management objective clearly.
2. Identify the actions required to meet the objective.
3. Identify the responsible position in the organization.
4. Identify the information required to meet the objective.
5. Determine the data required to produce the needed information.
6. Determine the systems requirement for processing the data.
7. Develop a flowchart.
Productivity
Productivity is commonly defined as output divided by input. Hanson translates this definition
into following:
Required staff hours
100
Provided staff hours
Example
380 hours
X 100 = 95% productivity
400 hours

Productivity can be increased by decreasing the provided staff hours holding the required staff
hours constant or increasing them.
Measurement
In developing a model for an MIS, Hanson indicates several formulas for translating data
into information. He indicates that in addition to the productivity formula, hours per patient day
(HPPD) are a data element that can provide meaningful information when provided for an
extended period of time.
HPPD is determined by the formula
Staff hours
Patient days
For example,
52000
2883
Answer = 18 HPPD
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Another useful formula
1. Budget utilization
Provided HPPD
X 100 = budget utilization
Budgeted HPPD

Example
18.03 % so, answer is 112.7% Budget utilization.
16

2. Budget adequacy
Budgeted HPPD X100, this is known as Budget adequacy
Required HPPD

16/18.03= 88.74% budget adequacy.



Nurse Staffing, Models of Care Delivery, and Interventions
Nurse Staffing
Measure
Definition
Nurse to patient ratio Number of patients cared for by one nurse typically specified by job
category (RN, Licensed Vocational or Practical Nurse-LVN or LPN);
this varies by shift and nursing unit; some researchers use this term to
mean nurse hours per inpatient day
Total nursing staff or
hours per patient day
All staff or all hours of care including RN, LVN, aides counted per
patient day (a patient day is the number of days any one patient stays in
the hospital, i.e., one patient staying 10 days would be 10 patient days)
RN or LVN FTEs per
patient day
RN or LVN full time equivalents per patient day (an FTE is 2080 hours
per year and can be composed of multiple part-time or one full-time
individual)
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Nursing skill (or
staff) mix
The proportion or percentage of hours of care provided by one category
of caregiver divided by the total hours of care (A 60% RN skill mix
indicates that RNs provide 60% of the total hours of care)
Nursing Care
Delivery Models
Definition
Patient Focused Care A model popularized in the 1990s that used RNs as care managers and
unlicensed assistive personnel (UAP) in expanded roles such as
drawing blood, performing EKGs, and performing certain assessment
activities
Primary or Total
Nursing Care
A model that generally uses an all-RN staff to provide all direct care
and allows the RN to care for the same patient throughout the patient's
stay; UAPs are not used and unlicensed staff do not provide patient care
Team or Functional
Nursing Care
A model using the RN as a team leader and LVNs/UAPs to perform
activities such as bathing, feeding, and other duties common to nurse
aides and orderlies; it can also divide the work by function such as
"medication nurse" or "treatment nurse"
Magnet Hospital
Environment/Shared
governance
Characterized as "good places for nurses to work" and includes a high
degree of RN autonomy, MD-RN collaboration, and RN control of
practice; allows for shared decisionmaking by RNs and managers Jean
Ann Seago, Ph.D.,RN








PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
VARIOUS RESEARCH STUDIES
1. ESTIMATION OF DIRECT COST AND RESOURCE ALLOCATION IN INTENSIVE
CARE: CORRELATION WITH OMEGA SYSTEM.
Department of Public Health & Medical Information, Hpital Ambroise Par, Boulogne, France.
Comment in: Intensive Care Med. 1999 Feb;25(2):245-6.
Abstract
OBJECTIVE: An instrument able to estimate the direct costs of stays in Intensive Care Units
(ICUs) simply would be very useful for resource allocation inside a hospital, through a global
budget system. The aim of this study was to propose such a tool.
DESIGN: Since 1991, a region-wide common data base has collected standard data of intensive
care such as the Omega Score, Simplified Acute Physiologic Score, length of stay, length of
ventilation, main diagnosis and procedures. The Omega Score, developed in France in 1986 and
proved to be related to the workload, was recorded on each patient of the study.
SETTING: Eighteen ICUs of Assistance Publique-Hpitaux de Paris (AP-HP) and suburbs.
PATIENTS: 1) Hundred twenty-one randomly selected ICU patients; 2) 12,000 consecutive
ICU stays collected in the common data base in 1993.
MEASUREMENTS: 1) On the sample of 121 patients, medical expenditure and nursing time
associated with interventions were measured through a prospective study. The correlation
between Omega points and direct costs was calculated, and regression equations were applied to
the 12,000 stays of the data base, leading to estimated costs. 2) From the analytic accounting of
AP-HP, the mean direct cost per stay and per unit was calculated, and compared with the mean
associated Omega score from the data base. In both methods a comparison of actual and
estimated costs was made.
RESULTS: The Omega Score is strongly correlated to total direct costs, medical direct costs
and nursing requirements. This correlation is observed both in the random sample of 121 stays
and on the data base' stays. The discrepancy of estimated costs through Omega Score and actual
costs may result from drugs, blood product underestimation and therapeutic procedures not
involved in the Omega Score.
CONCLUSIONS: The Omega system appears to be a simple and relevant indicator with which
to estimate the direct costs of each stay, and then to organise nursing requirements and resource
allocation.

2. THE IMPACT OF NURSING GRADE ON THE QUALITY AND OUTCOME OF
NURSING CARE.
Carr-Hill RA, Dixon P, Griffiths M, Higgins M, McCaughan D, Rice N, Wright K.
Centre for Health Economics, University of York, UK.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Abstract
The large industry which has grown up around the estimation of nursing requirements for a ward
or for a hospital takes little account of variations in nursing skill; meanwhile nursing researchers
tend to concentrate on the appropriate organisation of the nursing process to deliver best quality
care. This paper, drawing on a Department of Health funded study, analyses the relation between
skill mix of a group of nurses and the quality of care provided. Detailed data was collected on 15
wards at 7 sites on both the quality and outcome of care delivered by nurses of different grades,
which allowed for analysis at several levels from a specific nurse-patient interaction to the shift
sessions. The analysis shows a strong grade effect at the lowest level which is 'diluted' at each
succeeding level of aggregation; there is also a strong ward effect at each of the lower levels of
aggregation. The conclusion is simple; you pay for quality care.
PMID: 7780528 [PubMed - indexed for MEDLINE]

3. IMPACT OF SHIFT WORK ON THE HEALTH AND SAFETY OF NURSES AND
PATIENTS.
Berger AM, Hobbs BB.
College of Nursing, University of Nebraska Medical Center, Omaha, USA. aberger@unmc.edu
Abstract
Shift work generally is defined as work hours that are scheduled outside of daylight. Shift work
disrupts the synchronous relationship between the body's internal clock and the environment.
The disruption often results in problems such as sleep disturbances, increased accidents and
injuries, and social isolation. Physiologic effects include changes in rhythms of core temperature,
various hormonal levels, immune functioning, and activity-rest cycles. Adaptation to shift work
is promoted by reentrainment of the internally regulated functions and adjustment of activity-rest
and social patterns. Nurses working various shifts can improve shift-work tolerance when they
understand and adopt counter measures to reduce the feelings of jet lag. By learning how to
adjust internal rhythms to the same phase as working time, nurses can improve daytime sleep and
family functioning and reduce sleepiness and work-related errors. Modifying external factors
such as the direction of the rotation pattern, the number of consecutive night shifts worked, and
food and beverage intake patterns can help to reduce the negative health effects of shift work.
Nurses can adopt counter measures such as power napping, eliminating overtime on 12-hour
shifts, and completing challenging tasks before 4 am to reduce patient care errors.
PMID: 16927899 [PubMed - indexed for MEDLINE]

4. NURSE STAFFING AND PATIENT, NURSE, AND FINANCIAL OUTCOMES.
Unruh L.
Department of Health Professions, University of Central Florida, Orlando, FL, USA.
lunruh@mail.ucf.edu
Abstract
Because there's no scientific evidence to support specific nurse-patient ratios, and in order to
assess the impact of hospital nurse staffing levels on given patient, nurse, and financial
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
outcomes, the author conducted a literature review. The evidence shows that adequate staffing
and balanced workloads are central to achieving good outcomes, and the author offers
recommendations for ensuring appropriate nurse staffing and for further research.
Policy Polit Nurs Pract. 2009 Nov;10(4):240-51.

5. AN APPLIED SIMULATION MODEL FOR ESTIMATING THE SUPPLY OF AND
REQUIREMENTS FOR REGISTERED NURSES BASED ON POPULATION HEALTH
NEEDS.
Tomblin Murphy G, MacKenzie A, Alder R, Birch S, Kephart G, O'Brien-Pallas L.
Dalhousie University, Halifax, Nova Scotia, Canada, University of Toronto, Toronto, Ontario,
Canada. gail.tomblin.murphy@dal.ca
Abstract
Aging populations, limited budgets, changing public expectations, new technologies, and the
emergence of new diseases create challenges for health care systems as ways to meet needs and
protect, promote, and restore health are considered. Traditional planning methods for the
professionals required to provide these services have given little consideration to changes in the
needs of the populations they serve or to changes in the amount/types of services offered and the
way they are delivered. In the absence of dynamic planning models that simulate alternative
policies and test policy mixes for their relative effectiveness, planners have tended to rely on
projecting prevailing or arbitrarily determined target provider-population ratios. A simulation
model has been developed that addresses each of these shortcomings by simultaneously
estimating the supply of and requirements for registered nurses based on the identification and
interaction of the determinants. The model's use is illustrated using data for Nova Scotia,
Canada.
PMID: 20164064 [PubMed - indexed for MEDLINE]
J Public Health Manag Pract. 2009 Nov;15(6 Suppl):S56-61.

6. HEALTH HUMAN RESOURCES PLANNING AND THE PRODUCTION OF
HEALTH: DEVELOPMENT OF AN EXTENDED ANALYTICAL FRAMEWORK FOR
NEEDS-BASED HEALTH HUMAN RESOURCES PLANNING.
Birch S, Kephart G, Murphy GT, O'Brien-Pallas L, Alder R, MacKenzie A.
Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario,
Canada. birch@mcmaster
Comment in:
J Public Health Manag Pract. 2009 Nov;15(6 Suppl):S62-3.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Abstract
Health human resources planning is generally based on estimating the effects of demographic
change on the supply of and requirements for healthcare services. In this article, we develop and
apply an extended analytical framework that incorporates explicitly population health needs,
levels of service to respond to health needs, and provider productivity as additional variables in
determining the future requirements for the levels and mix of healthcare providers. Because the
model derives requirements for providers directly from the requirements for services, it can be
applied to a wide range of different provider types and practice structures including the public
health workforce. By identifying the separate determinants of provider requirements, the
analytical framework avoids the "illusions of necessity" that have generated continuous increases
in provider requirements. Moreover, the framework enables policy makers to evaluate the basis
of, and justification for, increases in the numbers of provider and increases in education and
training programs as a method of increasing supply. A broad range of policy instruments is
identified for responding to gaps between estimated future requirements for care and the
estimated future capacity of the healthcare workforce.
PMID: 19829233 [PubMed - indexed for MEDLINE]

RECRUITMENT CREDENTIALING, SELECTION, LACEMENT& RETENTION
RECRUITMENT
INTRODUCTION:
Recruitment is an important function of health manpower management, which
determines, whether the required will be available at the work spot, when a job is actually to be
undertaken. Recruitment procedures include the process and the methods by which vaccines are
notified, post are advertised, applications are handled and screened, interviews are conducted and
appointments are made.
MEANING:
In a simple term, recruitment is understood as the process of searching for and obtaining
applicants for job, from among whom the right people can be selected.
DEFINITION:
1. According to B Flippo: Recruitment is defined as the process of searching for prospective
employees and stimulating them to apply foe job in the organization.
2. According to IGNOU Module: It is a process in which the right person for the right post is
procured.
3. According to Yoder: Recruitment is a process to discover the sources of manpower to
meet the requirements of the staffing schedule and to employ effective measures for
attracting that manpower in adequate numbers to facilitate effective selection of an efficient
working force.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
TYPES OF RECRUITMENT:
There are three types of recruitment:
1. Planned: arise from changes in organization and recruitment policy
2. Anticipated: by studying trends in the internal and external organization.
3. Unexpected: arise due to accidents, transfer and illness.

LIKAGES OF REQUIREMENT TO HUMAN RESOURCE ACQUISITION
The requirement process is concerned with the identification of possible sources of
human resources supply and tapping those resources, the total process acquiring and placing
human resources in the organization. Requirement fails in between different sub process like:




BASIC ELEMENTS OF SOUND RECRUITMENT POLICY:
+ Discovery and cultivation of the employment market for post in the public service
+ Use of the attractive recruitment literature and publicity
+ Use of the scientific tests for determining abilities of the candidate
+ Tapping capable candidates from within the services
+ Placement program which assigns the right man to the right job.
+ A follow up probationally program as an integral process.
PURPOSES AND IMPORTANCE:
- Determine the present and future requirements of the organization in conjunction with the
personnel planning and job analysis activities
- Increase the pool of job candidates with minimum cost
Manpower
planning
Job analysis
Selection

Recruitment
Placement
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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- Help increase the success rate of the selection process reducing the number of obviously
under qualified or over qualified job applicants.
- Help reduce the probability tat the job applicants, once recruited and selected will leave
the organization only after short period of time.
- Meet the organizations legal and social obligations regarding the composition of its work
force
- Start identifying and preparing potential job applicants who will be appropriate
candidates
- Increase organizational and individual effectiveness in the short and long term.
- Evaluate the effectiveness of various recruiting techniques and sources for all types of job
applicants.
OBJECTIVES OF RECRUITMENT:
To attract people with multi-dimensional skills and experiences that suit the present and
future organizational strategies
To induct outsiders with new perspective to lead the company
To infuse fresh blood at all levels of organization
To develop an organizational culture that attracts competent people to the company
To search or heat hunt/ head pouch people whose skills fit the companys values
To devise methodologies for assessing psychological traits
To seek out non-conventional development grounds of talent
To search for talent globally and not just within the company
To design entry pay that competes on quality but not on quantum
To anticipate and find people for positions that does not exist yet.
PRINCIPLES OF RECRUITMENT:
Recruitment should be done from a central place. Eg: Administrative officer/Nursing Service
Administration.
1) Termination and creation of any post should be done by responsible officers, eg:
regarding nursing staff the Nursing superintendent along with her officers has to take the
decision and not the medical Superintendent.
2) Only the vacant positions should be filled and neither less nor more should be employed.
3) Job description/ work analysis should be made before recruitment.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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4) Procedure for recruitment should be developed by an experienced person
5) Recruitment of workers should be done from internal and external sources
6) Recruitment should be done on the basis of definite qualifications and set standards.
7) A recruitment policy should be followed
8) Chances of promotion should be clearly stated
9) Policy should be clear and changeable according to the need.
SOURCES OF RECRUITMENT:
The sources of recruitment are:

I) Internal sources:
Internal sources include present employees, employee referrals, former employee and
former applicants.
Present employees: promotion and transfers from among the present employees can be good
source of recruitment. Promotions to higher positions have several advantages. They are:
o It is good public relations
o It builds morale
o It encourages competent individuals who are ambitious
o It improves the probability of a good selection, since information of the
candidate is readily available
o It is less costly
o Those chosen internally are familiar with the organization.
However promotions can be dysfunctional to the organization as the advantage of hiring
outsiders who may be better qualified and skill is denied. Promotions also results in breeding
which is not good for the organization.
SOURCES OF
RECRUITMENT

DIRECT
SOURCES

INDIRECT
SOURCES
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Another way to recruit from among present employees is the transfer without promotion.
Transfers are often important in providing employees with a broad based view of the
organization, necessary for the future.
Employee referrals: this is the good source of internal recruitment. Employees can develop
good prospects for their families and friends by acquainting with the advantages of a job with the
company, furnishing cards introduction and even encouraging them to apply. This is very
effective because many qualified are reached at very low cost.
Former employees: some retired employees may be willing to come back to work on a part-
time basis or may recommend someone who would be interested in working for the company.
An advantage with these sources is that the performance of these people is already known.
Previous applicants: although not truly an internal source, those who have previously applied
for jobs can be contacted by mail, a quick and inexpensive way to fill an unexpected opening.
Evaluation of internal recruitment:
Advantages:
It is less costly
Organizations typically have a better knowledge of the internal candidates skills and
abilities than the ones acquired through external recruiting.
An organizational policy of promoting from within can enhance employees morale,
organizational commitment and job satisfaction.
Disadvantages:
Creative problem solving may be hindered by the lack of new talents.
Divisions complete for the same people
Politics probably has a greater impact on internal recruiting and selection than does
external recruiting.
II) External sources:
Sources external to an organization are professional or trade associations, advertisements,
employment exchanges, college/university/institute placement services, walk-ins and writer-ins,
consultants, contractors.
Professional or trade associations: many associations provide placement services for
their members. These services may consist of compiling seekers lists and providing
access to members during regional or national conventions.
Advertisements: these constitute a popular method of seeking recruits as many
recruiters; prefer advertisements because of their wide reach. For highly specialized
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
recruits, advertisements may be placed in professional/ business journals. Newspaper is
the most common medium.
Advertisement must contain the following information:
The job content ( primary tasks and responsibilities)
A realistic description of working conditions, particularly if they are unusual
The location of the job
The compensation, including the fringe benefits
Job specifications
Growth prospects and
To whom one applies.
Employment exchange: Employment exchanges have been set up all over the country in
deference to the provisions of the Employment exchanges (Compulsory Notification of
Vaccination) Act, 1959. The Act applies to all industrial establishments having 25 workers or
more. The Act requires all the industrial establishments to notify the vacancies before they are
filled. The major functions of the exchanges are to increase the pool of possible applicants and to
do preliminary screening. Thus, employment exchanges act as a link between the employers and
the prospective employees.
Campus recruitment: colleges, universities and institutes are fertile ground for recruitment,
particularly the institutes.
Walk-ins, write-ins and Talk-ins: write-ins those who send written enquire. These job-seekers
are asked to complete applications forms for further processing.
Talk-in is becoming popular now-in days. Job aspirants are required to meet the recruiter (on an
appropriated date) for detailed talks. No applications are required to be submitted to the recruiter.
Consultants: ABC consultants, Ferguson Association, Human Resources Consultants Head
Hunters, Bathiboi and Co, Consultancy Bureau, Aims Management Consultants and The Search
House are some among the numerous recruiting agents.
Contractors: Contractors are used to recruit casual workers. The names of the workers are not
entered in the company records and to this extent, difficulties experienced in maintaining
permanent workers are avoided.
Radio Television:
International Recruiting: Recruitment in foreign countries presents unique challenges
recruiters. In advanced industrial nations more or less similar channels of recruitment are
available for recruiters.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
MODERN SOURCES OF RECRUITMENT:
Walk-in
Consult in
Tele recruitment: Organizations advertise the job vacancies through World Wide Web
RECRUITMENT PROCESS / STEPS:
As was stated earlier, recruitment refers to the process of identifying and attracting job
seekers so as to build a pool of qualified job applicants. The process comprises five inter-related
stages, via:

FACTORS EFFCTING RECRUITMENT:
All organization, whether large or small, do engage in recruiting activity, though not to
the same extent. This differs with:
1) The size of the organization
2) The employment conditions in the community where the organization is located
3) The effects of past recruiting efforts which show the organizations ability to locate and
keep good performing people
4) Working conditions an salary and benefit packages offered by the organization- which
may influence turnover and necessitate future recruiting
5) The rate of growth of organization
6) The level of seasonality of operations and future expansion and production programs.
7) Culture, economical and legal factors etc.

STEPS
Planning
Strategy
development
Searching
Screening
Evaluation &
Control
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
CREDENTIALING
INTRODUCTION
Credentialing is the process of establishing the qualification of licensed professionals,
organizational members or organizations, and assessing their background and legitimacy. Many
health care institutions and provider networks conduct their own credentialing, generally through
a credentialing specialist or electronic service, with review by a medical staff or credentialing
committee. It may include granting and reviewing specific clinical privileges and medical or
allied health staff membership.

DEFINITION
1) Credentialing is the process by which selected professionals are granted privileges to practice
within an organization. In health care organizations this process has been largely confined to
physicians. Limited privileges have been granted to psychologists, social workers and selected
categories of nurses, such as nurse anesthetists, surgical nurses, and midwifes.
Russell C Swans burg
2) Credentialing is the process of establishing the qualifications of licensed professionals,
organizational members or organizations, and assessing their background and legitimacy.
3) A credential is an attestation of qualification, competence, or authority issued to an individual
by a third party with a relevant de jure or de facto authority or assumed competence to do so.
PURPOSE OF CREDENTIALING
The purpose of credentialing is:
1) To prevent a problem before it happens.
2) To research the qualifications and backgrounds of individuals and companies. Credentialing
is also the process of reviewing and verifying information.
SIGNIFIANCE
Credentialing is very significant because it shows that an individual or company
performing a service is qualified to do so. For example: your doctor must have certain credentials
to prescribe medicine to you.

LEGAL PROTECTION
It is a good idea to have credentialing process to protect you and your business from a
lawsuit or other legal problems. For instance, lets say you hire a teacher to work in your day
care center, and this person is a sex offender. The credentialing process could have prevented
this through a background check.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
PROFESSION
Almost all professions require, to a certain degree, some sort of credentials. Police
departments, Firefighters, lawyers, accountants and nurses all need credentials. You need
credentials to drive a car or semi-truck. All states require citizens to take a driving test.
HEALTH CARE CREDENTIALING
DEFINITION:
Health care credentialing is a system used by various organizations and agencies to
ensure that their health care practitioners meet all the necessary requirements and are
appropriately qualified. The credentials may vary depending on the specified area of the
practitioner. For example: An X-ray technician may have different credentialing forms than an
osteopathic physician.
WHO IS CREDENTIALED?
1) Practitioners: Medical Doctors (MD), Doctor of osteopathy (DO), Doctor of Podiatric
Medicine (DPM), Doctor of Chiropractic (DC), Doctor of dental Medicine (DMD), Doctor of
Dental Surgery (DDS), Doctor of Optometry (OD), Doctor of Psychology (PhD) and Doctor of
Philosophy (PhD).
2) Extenders: Physician of assistant (PA), Certified Nurse Practitioner (CRNP), Certified Nurse
Midwife (CNM).
Facility and Ancillary service Providers: Hospitals , Nursing Homes, Skilled Nursing
Facilities, Home Health, Home Infusion Therapy, Hospice, Rehabilitation Facilities,
Freestanding Surgery Centers, Freestanding Radiology Centers, Portable X-ray Suppliers, End
Stage Renal Disease Facilities, Clinical Laboratories, Outpatient Physical therapy and Speech
Therapy providers, Rural Health Clinics, Federally Qualified Health Centers Orthotic and
Prosthetic providers and Durable Medical Equipment (DME) providers.

COMPOTENTS OF CREDENTIALING
As with physicians, the components of a credentialing system for nurses would be:
1) Appointment: Evaluation and selection for nursing staff membership.
2) Clinical privileges: Delineation of the specific nursing specialties that may be managed
types of illnesses or patients that may be managed within the institution for each member of
the nursing staff.
3) Periodic reappraisal: Continuing review and evaluation of each member of the nursing staff
to assure that competence is maintained and consistent with privileges.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
CRETERIA FOR APPOINTMENT:
Criteria for appointments would include proof of licensure, education and training, specialty
board certification, previous experience, and recommendations.
Clinical privileges criteria would include the proof of specialty training and of performance of
nursing procedures or specialty care during training and previous appointments.
PRINCIPLES OF CREDENTIALING ACCORDING TO (ANA)
A report of the Committee for the study of Credentialing in Nursing was made in 1979. It
included fourteen principles of credentialing related to:
1) Those credentialed.
2) Legitimate interests of involved occupation, institution, and general public.
3) Accountability
4) A system of checks and balances
5) Periodic assessments
6) Objective standards and criteria and persons competent in their use
7) Representation of the community of the interests
8) Professional identity and responsibility
9) An effective system of role delineation
10) An effective system of program identification
11) Coordination of credentialing mechanisms
12) Geographic mobility
13) Definitions and terminology
14) Communications and understanding.

SELECTION
INTRODUCTION
The selection process starts when applications are screened in the personnel department.
Selecting includes interviewing, the employers offer, acceptance by the applicant, and signing
of a contract or written offer.
Those applicants who seem to meet the job requirements are sent blank job-application forms
and are directed to fill them up and return the same for further action. The job application form is
one of most important tools in the selection process.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
DEFINITION
It is the process of choosing from among applicants the best qualified individuals,
Selecting includes interviewing, the employers offer, acceptance by the applicant, and signing
of a contract or written offer. Selection may be carried out centrally or locally, but in either case
certain policies or methods are adopted.
SELECTION POLICIES
1. Application forms
The issue and receipt of application forms is the administrative responsibility, and much of the
preliminary work is handled by the clerical staff under the supervision of the administrative head
of the college. The information contained in the application form and reports received in
connection with them should be systematically tabulated and filed as they are useful for
evaluating the effectiveness of the form, analyzing entrance standards, assessing academic
achievement with subsequent performance, and knowing from which parts of the state or country
the students are most frequently admitted or apply for admission.
The application form should elicit the following information
Name
Address
Age of the candidate
Name of parents or guardians
Occupation of father
Details of education
Details of employment
Particular aptitudes or abilities
It may also ask the student to write short easy on her interests and her reasons for
choosing nursing as a career. It should give details of any material she should submit such as a
medical certificate, evidence of date of birth etc. and should give the exact address to which it
should be sent. The names of the persons given as references should be asked to furnish
information regarding the candidates character and personality, and the information to be given
by the head teacher should include candidates attendance at school, studies completed, grades,
rank in class and his or her own evaluation of the candidates suitability of nursing.
+ A job application form serves three main purpose:
1) It enables the hospital authorities to weed out unsuitable candidates.
2) It acts as a frame of reference for the interview.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
3) It forms the basis for the personal record file of the successful candidates
2. Selection committee:
Usually the selection occurs in the college itself. Otherwise, if the selection is carried outside the
college, it is important that at least representatives of the college be a part of committee and as
far as possible students be selected for a specific college according to its individual admission
policies and the programme it offers.
The members of the selection committee should include
a) The head of the college of nursing
b) Professor
c) Representative of the local controlling authority
d) Representative of the nursing division of the state
e) An educational psychologist
The procedure for selection should consist of a personal interview of the candidate and
possibly a separate interview with her parents. It may also include tests of previous
achievements, both written and oral, to assess her knowledge of various subjects such as
Arithmetic, English, the regional language and general science and her ability to express herself
orally and in writing. If psychological tests are given, only those devised by experts in their field
should be used.
It should be made clear to them that final acceptance for the course will be subject to a
satisfactory medical report and assessment during the preliminary training period. The college
should make every effort to start the course on the appointed day with the full quota of students.
Only in exceptional circumstances should students be admitted later and in their cases, special
arrangement should be made for them to cope up with the other students.
3. Orientation programme:
After admission an orientation programme is to be conducted to make the students aware
of the college rules, hostel rules and the hospital and the college building and associated parallel
medical education departments. Orientation should be given by a senior faculty of the college of
nursing. Orientation programme may take three to five days.
4. Development of master plan:
When a particular batch is admitted the class teacher may draw a master plan according
to which the whole programme is planned. Date of examinations and periodic evaluation
measures etc are formulated.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
5. Parent teachers association:
All parents are enrolled in the parent teachers association and this will help to have a
contact between the family members and teachers. This will help to improve the administration.
Meetings of PTA are held frequently and the parents are kept informed of the students progress.
Before taking any disciplinary actions PTA members are called when students unrest
occurs due to certain problems. Thus parents are also involved in the administration of students.
STEPS IN SELECTION: The steps which constitute the employee selection process are the
following:
I. Interview by personnel department
II. Pre-employment tests-written/oral/practical
III. Interview by department head
IV. Decision of administrator to accept or reject
V. Medical examination
VI. Check of references
VII. Issue of appointment letter.
I. Interviewing:
Interviewing is the main method of appraising an applicants suitability for a post. This is
the most intricate and difficult part of the selection process. The employment interview can
be divided into four parts:
The warm-up stage
The drawing-out stage
The information stage
The forming an-opinion stage
Main objectives of an interview:
1) For the employer to obtain all the information about the candidate to decide about his
suitability for the post.
2) To give the candidate a complete picture of the job as well as of the Organization.
3) To demonstrate fairness to all candidates.






PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
THE INTERVIEW LETTER:





Interviewing functions of the personnel manager:
The responsibilities of the personnel manager are:
A) To screen the application of the candidate
B) To give information about
a) general nature of work
b) hours of work
c) pay-scale, allowances and starting total salary
d) fringe benefits
e) leave policy
f) brief information about the background of the hospital
g) To discover any differences in the expectations of the hospital and those of the
candidate.

Name and Address of the hospital
INTERVIEW LETTER
Date
Address
Dear

With reference to your application dead for the post of. .
I am pleased to call you for an interview at .. on.in the personnel department.
You are required t fill up the enclosed job-application form and bring it with you at the time of the interview.
Please bring your original certificates and certificates and testimonials with you. We look forward to seeing you.

Your sincerely,
( Personnel Manager )

Encl: 1

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
The responsibilities of the department head are:
A) To review the job-application form to check pertinent data on experience;
B) To assess the professional competence of the candidate
C) To give detailed picture of the job requirement to the applicant;
D) To advise the personnel manager if he thinks that the previous training or experience or
both of the applicant justifies a higher starting salary.
II. Pre-employment tests:
To ensure selection of the most suitable candidates for various posts, interviews should
be conducted carefully & pre-employment tests should be held in a systematic manner wherever
necessary & possible.
For certain Categories of post, there is a need for testing the professional competence of the
candidates. These tests can broadly be divided in to four types:
1) Tests of general ability- intelligence
2) Tests of specific abilities- aptitude tests
3) Tests of achievement-trade tests
4) Personality tests- Tests of emotional stability, interest, values, traits etc.

1) Tests of general ability: These tests can give a useful indication of candidates mental
caliber. It has been observed that for various professions, there is an optimum level of
I.Q.while selecting individuals who have I.Q.s within the required optimum range-not higher
or lower.
2) Tests of aptitude: aptitude tests measure whether an individual has the capacity or latent
ability to learn a new job, if given adequate training .These tests measure skills & abilities
that have the potential for later development in the person tested.
3) Tests of achievement: Tests of achievement measure the present level of proficiency that a
person has achieved. In hospitals, these tests can be used for typists, stenographers,
laboratory technicians, radiographers, etc. These tests can also be used at the end of training
programmers to assess the level of proficiency achieved.
4) Personality tests: Personality tests are used to assess certain personality characteristics.
These tests are used in selecting candidates for sales jobs, supervisory job, management
trances, etc., because certain personality characteristics are essential to succeed in such jobs.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
III. Final approval by the head of the hospital:
In some hospitals, the selection committee consists of one person from the personnel
department, the department head/supervisor of the concerned department and one representative
of the head of the hospital. After the interviewing all the candidates, the selection committee
submits its recommendations for approval to the head of the hospital, who is generally the hiring
authority.
In other hospitals, the head of the hospital may prefer to interview all the candidates
himself for the key jobs and leave it to the selection committee for the less vital jobs. In case of
appointment of a department head, one expert is also usually included in the selection committee.
Different hospitals adopt different policies according to their own convenience for the selection
of their employees. Generally this authority lies with the Medical superintendent or
Administrator or Business Manager or Chief Executive who is legally termed the Occupier.
IV. References:
The references provided by the applicant should be cross-checked to ascertain his past
performance and to obtain relevant information from his past employer and others who have
knowledge of his professional competence.
The references letters should be brief and should require as little writing as possible by
the person to whom it is sent. If it is directed to a former employer, it should ask for the
following data:
+ Date of joining
+ Date of leaving
+ Job title
+ Last salary drawn
+ Promotion/demotion, if any
+ Unauthorized absentee record
+ Reason for termination/ leaving
+ Ability to work with others
+ Dependability
+ Emotional stability
+ Health conditions
+ Does the employee habitually borrow money?
+ Would you re-employ?
+ Any other information
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
V. Medical examination:
The medical examination of a prospective employee is an aid both to the employee and to
the management. The selection of the right type of employee who can give his best and be happy
requires a thorough knowledge of his physical capacities and handicaps. The purpose of the
medical examination is threefold:
a) It is for the protection of the applicant himself to know whether that job will suit him or not
from the medical point of view.
b) It is for the protection of the other employees so that they are not at risk of any communicable
or other disease which the prospective employee may have.
c) It is for the protection of the employer as well, so that he may avoid selecting a wrong person.
The medical examination will eliminate an applicant whose health is below the standard or one
who is medically unfit.
VI. Joining report by the employee:
When new employees reports for joining, he should be given an appointment letter, his
job description and handbook of the hospital. He should be asked to submit his joining report. A
model appointment letter and joining report form are given.
+ PLACEMENT
INTRODUCTION:
Placements are a credit bearing part of a degree course and all placements optional. If a
student opts out of a placement or there is no placement available, this means that placement is
not guaranteed.
DEFITION: State of being placed or arranged.
IMPORTANCE PLACEMENTS:
The school of service management believes that taking a placement is one of the most
important decisions you can make in your university carrier. Not only will you benefit from
building personal confidence during your placement year but you will also establish contacts in
your chosen sector which may provide invaluable for graduate opportunity.

IMPORTANCE OF SELECTION AND PLACEMENT:
+ To fairly and without any element of discrimination evaluate job applicants in view of
individual differences and capabilities
+ To employee qualified and competent hands tat can meet the job requirement of the
organization
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
+ To place job applicants in the best interests of the organization and the individual
+ To help in human resources man power planning purposes in organization
+ To reduce recruitment cost that may arise as a result of poor selection & placement
exercises.
PLACEMENT TEAM:
Our current placement team consists of a placement coordinator & four academic tutors,
each with specialist knowledge relevant to the degree courses you under the supervision are
studying. These tutors advice and support you throughout your preparation for placement.
+ PROMOTION
INTRODUCTION:
The promotion policy is one of the most controversial issues in every organization. The
management usually favors promotion on the basis of merits, and the unions vehemently oppose
it by saying that managements resort to favoritism. The unions generally favor promotions on the
basis of seniority. It is hence essential to examine this issue and arrive at an amicable solution.
DEFINITION:
A change for better prospects from one job to another job is deemed by the employee as a
promotion.
FACTORS IMPLYING PROMOTION:
The factors which are considered by employees as implying promotion are:




FACTORS
IMPLYING
PROMOTION
An increase in salary
An increase in
prestige
An upward movement in
the hierarchy of jobs
Additional supervisory
responsibility
A better future
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
NATURE AND SCOPE OF PROMOTION:
Seniority versus merits: There has been great deal of controversy over the relative values of
seniority and merit in any system of promotion. Seniority will always remain a factor to be
considered, but there be much greater opportunity for efficient personnel, irrespective of their
seniority, to move up speedily if merit is used as the basis for promotions. It is often said that at
least for the lower ranks, seniority alone should be the criterion for promotion. One cannot agree
with this. The quality of work is more important in the lower ranks as in the higher.
There are some who argue against this plea and advocate the merit policy for the following
reasons:
1) They believe that mere length of service evidence only of continued service but are surely
no indication of vast experience.
2) Promotion on the basis of seniority saps the initiative of the employees. Once they realize
that promotions in the organization are on the basis of seniority alone, they lose all
enthusiasm for showing better performance. Therefore, in terms of getting the best out of
employees, the merits of the individual employee will have to be considered.
3) There are individual differences amongst persons working o the same of them are most
efficient, some barely average and some below average. If their differences are not
distinguished and they are uniformly rewarded, all individual will gradually sink to the
level of the below-average employee.
PROMOTION POLICY:
The promotion policy is one of the most controversial issues in every organization. The
management usually favors promotion on the basis of merits, and the unions vehemently
opposite by saying that management resort to favoritism. The unions generally favor promotions
on the basis of seniority. However, in practice, both seniority and ability criteria should be taken
into consideration; but in order to allay the suspicious of the trade unions, there should be written
promotion policy which should be clearly understood by all.
Promotion policy may include the following:
1) Charts and diagrams showing job relationships and ladder of promotion should be prepared.
Those charts and diagrams clearly distinguish each job and connect various jobs by lines and
arrows showing the channels to promotion. These lines and arrows are always based on
analysis of job duties. These charts do not guarantee promotion but do point out various
avenues which exist in an organization.
2) There should be some definite system for making a waiting list after identification and
selection of those candidates who are to be promoted as and when vacancies occur.
3) All vacancies within the organization should be notified so that all potential candidates may
complete.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
4) The following eight factors must be the basis for promotion:
+ Outstanding service in terms of quality as well as quantity
+ Above average achievement in patient care and for public relations
+ Experience
+ Seniority
+ Initiative
+ Recognition by employee as a leader
+ Particular knowledge and experience necessary for a vacancy and
+ Record of loyalty and cooperation
In some instances, it may be possible to use pre-employment test, to determine eligibility for the
vacant position.
5) Though the department heads may initiate promotion of an employee, the final approval
should be with top management because a department head can think only of the
repercussions of the promotion in his department while top management looks at it from the
point of view of the organizations a whole. The personnel department can help at the stage by
proposing the names of prospective candidates out of the existing employees in the
organization and also submit their performance appraisal record of the last few years to the
department head.
6) All promotion should be for a trail period. In case the promoted person is not found capable
of handling the job. Normally, during this trail period, he draws salary at the higher pay-
scale, but it should specially be made clear to him in writing that if his performance is not
found up to the work, he will be reverted to his former post at the former scale.
7) In case of promotion, the personnel department should carefully follow the progress of the
promoted employees. A responsible person of the personnel department should hold a brief
interview with the promoted person and his department head to determine whether
everything is going on well or not. The promotional post should be continued after the
satisfactory report of the department head.

ADVANTAGES OF A SOUND PROMOTION POLICY:
From a scientific management view point, a sound promotion policy has many advantages.
+ It provides an incentive to employee to work more and show interest in their work. They
put in their best in their best and aim for promotion within the organization.
+ It develops loyalty amongst the employees, because a sound promotion policy assures
them of their promotions if they are found fit.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
+ It increases satisfaction among the employees.
+ It generates greater motivation as they do not have to depend on mere seniority for that
advancement.
+ A sound promotion policy retains competent employees, and provides them ample
opportunities to rise further
+ It generally results in increased productivity as promotion will be based on an evaluation
of the employees performance.
+ Finally, increases the effectiveness of an organization

SOLUTION TO PROMOTION PROBLEMS:
Difficult human relations problem can arise in promotion cases. These problems may be reduced
to the minimum if extra and following principles are observed.
In promoting an employee to a better job, his salary should be at least one step above his
present salary.
Specific job specifications will enable an employee to realize whether or not his
qualifications are equal to those called for.
There should be a well-defined plan for informing prospective employees may know the
various avenues for their promotion.
The organization chart and promotion charts should be made so that employees may know
the various avenues for their promotion.
The promotion policy should be made known to each and every organization.
Management should prepare and practice promotion policy sincerely.

+ RETENTION
NURSE RETENTION
By Lee Ann Runy
An Executives Guide to Keeping One of Your Hospitals Most Valuable Resources
With no end in sight for the nations nursing shortage, hospitals are placing greater
emphasis on retaining their current RN staff. Its a complex process, requiring in-depth
knowledge of the needs and wants of the nursing staff and lots of creativity. You have to know
what motivates nurses to stay, says Pamela Thompson, CEO of the American Organization of
Nurse Executives. To that end, many hospitals regularly conduct retention or exit surveys to
understand whats on nurses minds.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
The stresses of the job can be compounded by responsibilities outside of the workplace.
Hospitals are doing what they can to support nurses on a personal level, which is where
creativity mostly comes into play. From concierge services that help nurses with errands to day
care to flexible scheduling, hospitals are doing whatever it takes to allow nurses to focus on their
work and keep them in their jobs for years to come.

DEFINITION:
Staff choose to stay for long periods within a cost centre, turnover is under is 10% annually.
IMPORTANCE OF STAFF RETENTION:
+ The advantages of staff retention are fairly clear. Most importantly perhaps, key skills, ideas,
knowledge and experience remain within your organization. Client relationships and
networks are also preserved in conjunction with all the income that these areas generate.
+ Conversely, losing your key employees lays open the possibility that these people will than
assume roles with your direct competitors. As a result those invaluable skills, ideas,
knowledge, experience, relationships and networks are all transferred to another
organization.
+ On top of all these there are also direct costs involved in losing key employees. The cost of
replacing such an individual includes advertising, recruitment agency fees and the time spent
conducting actual interview process. Further more it is also worth considering the time and
expense spent on the induction new employees and lost revenue during the recruitment and
bedding in process.
+ All though an element of employee churns is both inevitable and healthy. It is nevertheless
clear that retention brings substantial benefits to your organization. Whilst attrition involves
significant direct and indirect financial costs.

PRINCIPLES ANE ELEMNTS OF A HELPFUL PRACTICE AND WORK
ENVIRONMENT:
To foster staff retention, organizations need to develop environments in which nurses
want to work. Among other things, nurses want safe workplaces that promote quality health care.
Its the role of the nurse executive and nurse manager to establish a work environment that
supports professional practice, says Pamela Thompson, CEO of the American Organization of
Nurse Executives. Thats one key piece to retention. Its also important that nurses play an
active role in shaping their environment. Nurses want to work in a place that brings high quality
to patients and know they have a role in the process, says Susan Shelander, director of
recruitment and retention for Memorial Hermann, Houston. Creating such an environment is not
easy.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
The Nursing Organizations Alliance developed a set of principles to help hospitals and other
health care entities create positive work environments. More than 40 nurse organizations,
including AONE, have endorsed the principles.
NINE PRINCIPLES TO HELP FOSTER STAFF RETENTION:
1.Respectful collegial
communication and behavior
Team orientation
Presence of trust
Respect for diversity
2. Communication-rich culture Clear and respectful
Open and trusting
3. A culture of accountability Role expectations are clearly defined
Everyone is accountable
4. The presence of adequate
numbers of qualified nurses
Ability to provide quality care to meet
client/patient needs
Work and home life balance
5. The presence of expert,
competent, credible, visible
leadership
Serve as an advocate for nursing practice
Support shared decision-making
Allocate resources to support nursing.
6.Shared decision-making at all
levels
Nurses participate in system, organizational and
process decisions
Formal structure exists to support shared
decision-making
Nurses have control over their practice.
7.The encouragement of
professional practice and continued
growth/ development
Continuing education/certification is
supported/encouraged
Participation in professional association
encouraged
An information-rich environment is supported.
8. Recognition of the value of
nursings contribution
Reward and pay for performance.

9. Recognition of nurses for their
meaningful contribution to the
practice
Career mobility and expansion
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
FIVE CHARACTERISTICS OF SUCCESSFUL RECRUITMENT AND RETENTION
PROGRAMS:
1. Sustained leadership commitment to workforce as a strategic imperative.
2. A culture centred around employees and patients.
3. Work with other organizations to address workforce needs
4. Systematic and structured approach
5. Excellence in human resource practice
PERSONNEL POLICIES
DEFINITION OF PERSONNEL POLICIES
Policy: 1. Statement of predetermined guidelines
2. Policies in general, they are guidelines to help in the safe and efficient achievement of
organizational objectives.
Personnel Policy-
1) A set of rules that define the manner in which an organization deals with a human
resources or personnel-related matter. A personnel policy should reflect good practice, be
written down, be communicated across the organization, and should adapt to changing
circumstances.
2) Personnel policy is an integrated function which encompasses many aspects of the
personnel management.
3) The written statement of an organizations goal and intent concerning matters that effect
the personnel working in an organization.
4) Personnel policies are the statements of the accepted personnel principles and the
resulting course of administrative action by which a specific organization pattern
determines the pattern of its employment conditions.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
IMPORTANCE:
1) To the employee it represents a guarantee of fair and equitable treatment.
The establishment of good personnel policies helps to give the employee a sense
of security and individual worth.
It gives employee pride and loyalty to the organization for which he/she works.
Policies that are planned in advance are likely to meet the needs of the
organization better.
2) To the supervisor it is a safeguard in that it relieves her of the responsibility of making a
personal decision which may conflict with decisions given by other supervisors.
Established personnel policies serve as guides to action so that a great deal of time
is saved by administrational personnel in handling individual cases.
A well understood clearly written policy saves the time of an employee as well as
the employer.
PHILOSOPHY:
The nursing service administration of.. believes that its supreme objective ; the best
possible patient care, can be achieved only by the full cooperation of all who are privileged to
take part in that care.
It seeks to establish a team dedicated to the protection of health and well being of the
patient in an environment that will enable every member of the team to obtain as well as give
satisfaction in his or her work.
OBJECTIVES:
1) To employ those persons best fitted by education, skill and experience to perform
prescribed work.
2) Guarantee fairness in the maintenance of the discipline
3) Upgrade and promote existing staff wherever possible.
4) Take all practical steps to avoid excessive hours of work.
5) Ensure the greatest practicable degree of permanent and continuous employment.
6) Maintain standards of remuneration
7) Provide and maintain high level of physical working conditions.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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8) Maintain effective methods of regular consultation between administration and
employees.
9) Provide suitable means for the orientation, on the job training and evaluation of
employees.
10) Encourage social and recreational facilities for employees.
11) Develop appropriate schemes for employees welfare.

FUNCTIONS AND TECHNIQUES OF ADMINISTRATION TO MEET THE
OBJECTIVES SPECIFIED BY THE STATEMENT OF POLICY.
SL NO. FUNCTIONS TECHNIQUES
1. Employment
Job analysis, job specifications, time schedules, works
Schedules, manuals, agreed code of regulations, assessment of
personnel
2. Remuneration Job evaluation
3. Health and safety
Physical examination, safety training, accident analysis,
sickness statistics
4. Welfare
Social and recreational programs, rest rooms, canteen, pension
schemes, employers counseling
5. Training On the training, training for leadership

TYPES OF POLICIES
a) Implied Policy:
It is the policy which is not directly voiced or written but is established by pattern
of decision.
They may have either favourable or unfavorable effects
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
It is the policy neither written nor expressed verbally have usually developed over
time and follow a presendent.
If you have people who are accountable to you, you dont need to formally issue
policy statements to create policy.
Parents, bosses, boards, government administrations, etc. are producing implied
policy all of the time.
For Example: Imagine that an employee comes to the boss and asks, What
should I do about this? If the boss responds by giving an instruction, that
employee will assume that this is how to cope with all similar situations. They
will interpret the instruction in terms of the implied values or the general policy
that would result in the instruction.
b) Expressed Policy:
These are delineated verbally or in writing.
Oral policies are more flexible than written ones and can be easily adjusted to
changing circumstances.
Most of the organization have many written policies that are readily available to
all people and promote consistency in action. It may include:
Formal dress code
Policy for sick leave or vacation time
Disciplinary procedures
ELEMENTS OF PERSONNEL POLICIES STATEMENT
Operating Procedures
The statement details the company's operating procedures, including how employees should
accomplish their assigned tasks; punctuality, work hours, and breaks; payment structure;
personal appearance and dress code; drug and alcohol policies; benefits; and other employee
guidance and responsibilities.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Employee Conduct
The statement defines the company's policies and guidelines about such matters as
professional conduct with other employees and clients.
Equipment Use Regulations
Employee use of office equipment is another key item. If personal or non-work-related use of
computers, telephones, other equipment, and office supplies is prohibited, this should be
outlined.
Professionalism
With an employer personnel policies statement in effect, business owners, managers, and
employees are afforded a greater air of professionalism, according to the National Restaurant
Association's guidelines for writing an employee manual.
Employer Authority
One of the principal functions of an employee statement is that it offers the employer a point
of reference in the event that an employee is reprimanded or terminated, thereby protecting
the employer from wrongful termination lawsuits.
PROCESS OF DEVELOPMENT OF PERSONNEL POLICIES
Every organization should have a complete set of well developed personnel policies before it
begins to function. The existing ones also need to be revised. At times, the policies may be
formulated simultaneously from the top management as well as the lower division management.
The stages and sequences of events in the process of development of policy are:
1) Clarification by top management of philosophy and the objectives of the organization.
2) Analysis of personnel policy requires assessment of relevant facts. Job is delegated to the
committee who through interviews and conferences collect data from inside and outside
the organization.
3) Consultation with staff representatives.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
4) Writing the first draft of the policy statement.
5) Further discussion to get the final approval of policies from top management and staff
representatives.
6) Communication of policy statements by means of training session, discussion groups and
staff hand books.
7) Periodic re evaluation and follow up













POLICIES RELATED TO NURSING PRACTICE:
SERVICE STAFFING POLICIES (HOSPITAL)
Employment- recruitment rules,
qualification
Job description
Working hours
Work load, working facilities
Vacations
Holidays
Sick Leave
Weekend Off
PROCESS
Communicating the Policy
Discussing the Proposed Policy
Appraising the Policy
Adopting and Launching Policy
Writing the Personnel Policy
Fact Finding
Reporting Of Personnel Policy
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Policies for breakage and losses
Special allowances- special duty/
hard duty allowance, medical
allowance. The nursing
personnel have demanded a
uniform allowance of Rs 3,000
per month and a nursing
allowance of Rs 1,600 per
month.
Promotional opportunities
Career development
Accommodation
Transport
Special incentives
Occupational hazards
Rotation To Different Shifts
Overtime
Part Time Personnel
Exchanging Hours


POLICIES RELATED TO NURSING EDUCATION
Policies For College Of Nursing
STUDENTS STAFFS HOSTEL POLICIES
Admission Policies
Working Hours
Attendance
Uniform
Medical Facilities
Internship
Holidays
Special Leave
Withdrawal From
Course
Discipline
Recruitment Policies
Policy On
Termination
Staff Benefits
Uniform
Duty Hours
Retirement Age


Permission to meet
only authorized
visitors
Permission for a
dayout
Visiting hours
Permission letter for
outing
Signing the register
Disciplinary action
on violation of rules


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
FACTORS INFLUENCING PERSONNEL POLICY
The following factors will influence determining of personnel policies of an organization:
i) Law of the country: The various laws and labor legislation govern the various
aspects of personnel matters. Policies should be in conformity with the laws of the
country
ii) Social values and customs: there are codes of behavior of any community which
should be taken in account in framing policies.
iii) Management philosophy and values: Management cannot work together for any
length of time without clear broad philosophy and set of values which influence their
actions on matters concerning the work force.
iv) Stage of development: All changes such as size of operations, scale of technology,
innovations, fluctuations in the composition of workforce, decentralization of
authority and change in financial structure influence the adoption of personnel
policies.
v) Financial position of the firm: The personnel policies cost money which will be
reflected in the price of the product. Because of this, prices set the absolute limit to
organizations personnel policies.
vi) Type of work force: The assessment of characteristics of workforce and what is
acceptable to them is the responsibility of the effective personnel staff.

CHARACTERISTICS OF PERSONNEL POLICIES
Specific Consistency, Permanency, Flexible with Purpose Recognize individual
differences.
Be formulated with regards for the interest of all parties, i.e. employer, employee
(individual/ groups) public and clients.
Confirm to the government regulations be written and formulated as a result of careful
analysis of all facts available.
Be forward looking and forward planning for continuing development
Recognize individual difference
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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ADVANTAGES
Helps to give employees a sense of security and individual worth.
Gives the employees pride and loyalty to the organization for which they work.
Employees tend to give good service and identify themselves with the goals of the
organization and they want to remain in the organization.
Are planned in advance and with due consideration on how policy will apply in various
situations to meet the needs of the organization
As guides to action, save a great deal of time of the administrator.
A clearly written policy saves the time of the employee as well.
TERMINATION
















PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
STAFF DEVELOPMENT PROGRAMME: IN-SERVICE AND CONTINUING
EDUCATION
INTRODUCTION:
Staff development is the process directed towards the personal and professional growth of
nurses and other personnel while they are employed by a health care agency. It is essential for
the upliftment of professional as well as administrative field. Staff development programme
helps in updating the knowledge and practice of professionals. It is applicable not only to the
nursing field but also to all the professional fields.
DEFINITION:
Staff development refers to all training and education provided by an employee to
improve the occupational and personal knowledge, skills and attitude of vested employees.
GOAL:
To assist each employee to improve performance in his or her present position and to
acquire personal and professional abilities that maximizes the possibility of career
advancement.
NEED FOR STAFF DEVELOPMENT:
To meet social change and scientific advancement. It causes rapid changes in nursing
knowledge and skills.
To provide the opportunity for nurses to continually acquire and implement the
knowledge, skills and attitudes, ideas and values essential to maintain high quality
nursing care.
To meet job related learning needs of the nurse (eg, continuing education, in-service
education, extramural education and post basic education).
Fill the gaps between theory and knowledge.
To achieve personal or professional development eg, promotion.
To prepare for future tasks or trends.

PRINCIPLES INVOLVED STAFF DEVELOPMENT:
Activities must base of needs and interest of employees and organization.
Learning is combination of theory and experience.
Learning is internal, personal and emotional process.
Learning involves changes in behavior.
Learner should be encouraged to contribute in learning process.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Problem solving approach is well suited because; effective learning takes place when
there is need/problem.
Positive reward is effective.
Teaching learning should be based on educational psychology.
Learning can be maximized by providing favorable condition.
Learning is active process i.e., teacher and learner should be active in learning.
Teaching must satisfy learning needs of an individual.
Use variety of sources for learning as adult learners have wide range of previous
experience.

STAFF DEVELOPMENT MODEL FOR GOAL ACHIVEMENT OF THE HEALTH
CARE AGENCY, THE NURSE AND THE NURSING PROFESSION
Staff development model is based on the aforementioned philosophical statement, that the
activities within a health care agency are directed towards achieving a high quality care through
the mutual goal oriented efforts of the health care agency, nursing profession and its
practitioners.
This model has three main components.
Education
Experience
Socio-economics

Educational component includes:
The educational component assumes that the nurse is motivated to continue learning
through involvement in educational activities endorse by a health care agency and the nursing
profession. It may take the form of continuing education in service education and extramural
education or post basic nursing education. Staff nurse is self-motivated for learning. She may
accept any type of staff developmental activity, comes under local agency or outside agency.
In-service education is referred to an agency based educational activity. It begins with
orientation to the health care agency and to a particular position and continues in the
form of specific skill training related to nursing or more generalized skill training related
to patient care within the context of the health care team.
Extramural education includes short courses, conferences, seminars and like, which are
planned for group learning, as well as programmed learning and correspondence courses.
Post basic education refers to formal study at degree-granting institution. It involves full
time commitment to an academic programme leading to university diploma, certificate,
baccalaureate degree, masters degree or doctorate degree etc.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Experience:
Nursing practice and experience in daily life are integral parts of staff development.
Planned approach to the daily assignment of nursing responsibilities is both a benefit to the
development of the nurse practitioner and prerequisites to high quality patient care. For quality
care experiences may be planned or unplanned. Experiences are curricular and co-curricular
and self.
Socio-economic component:
It involves health care agency, the nurse and nursing association in management,
planning, counseling and employee employer relations.
The effectiveness of man power planning depends on needs assessment, which is
influenced by the standards set by the nursing profession and the job commitment made
between the health care agency and the nurse.
Counseling includes career planning as well as performance evaluation for the benefit of
both the health care agency and the nurse.
Employee-employer relations are reflected in the personal practices, form the basics of
policies underlying staff development in any agency.
The interrelationship of the components provides the framework for purposeful staff
development structured to meet the needs of both a health care agency and the nurse.
TYPES OF STAFF DEVELOPMENT:
Staff development includes formal and informal group and individual training and
education. Staff development activities include the following:


Staff
development
Induction
training
Job
orientation
In service
education
Continuing
education
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
I nduction training (3 days): Is a brief standardized introduction to an agencys philosophy,
purpose policies and regulations given to each worker during her or his first two or three days of
employment in order to ensure his or her identification with agencys philosophy, goals and
norms.
J ob orientation (2- 24weeks): Is an individualized training programme intended to acquaint a
newly hired employee with job responsibilities work place, clients and co-workers.
I n-service education(2- 8hours): It is a planned educational experience provided in the job
setting and closely identified with service in order to help the person to perform more effectively
as a person and as a worker.
Continuing education: Is a planned activity directed towards meeting the learning needs of the
nurse following basic nursing education, exclusive of full time formal post basic education.
Extramural education: Is a community based education directed towards meeting the job related
learning needs of the nurse and other personal. Exclusive of full time formal study at a degree
granting institution.
FACTORS INFLUENCING STAFF DEVELOPMENT PROGRAMME
The major factors that determine the administrative structure of an agency-wide staff
development programme are:-
+ Administrative philosophy, policies and practices of health care agency
+ Policies, practices and standards of nursing and other health professionals
+ Human and material resources within the health care agency and community
+ Physical facilities within a health care agency and community
+ Financial resources within a health care agency and community
FUNCTIONS OF STAFF DEVELOPMENT PERSONNEL:
Personnel assigned to staff development should provide the following consultative
functions for health care agency.
Determination of the administrative structure of the staff development programme.
Determination and establishment of organizational methods, policies and procedures for
a staff development programme.
Determination and establishment of lines of communication for the utilization of
facilities and resources personnel for the staff development programme.
Determination of organizational and individual staff development needs and priority.
Development of measurable short and long term objectives for staff development
programmes.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Promotion, development, implementation and evaluation of programmes to meet these
objectives.
Planning, co-ordination and utilization of community resources to assist in meeting these
objectives.
Provision of a consultative service and a resource for information relative to staff
development.
PROGRAMMES FOR STAFF DEVELOPMENT
Orientation Programme
Skill Training Programme
Leadership and management development
Continuing education

1. Orientation Programme:
Is the process of acquiring anew staff with the existing work environment so that
he/she can relate quickly to his/ her new surroundings.
It is assigned for new staff. It is given at the initial stage of employment or when a
staff takes new responsibilities.
2. Skill Training Programme:
Skill training may be a manual or technical skill of doing for people or skill in
dealing and working well with people.
It provides the nursing staff with the skills and attitude required for job and to
keep them abreast of changing methods and new techniques.
Often it is the continuation of the orientation programme.
It is designed to new and older staff.
3. Leadership and management development:
To improve the managerial abilities of persons at every management level as well
as potential managers to produce the greatest degree of organizational progress.
It should be begin by establishing agreement among top and middle level
managers as to proper authority, responsibility and accountability for managers at
every level.
Need can identified by incident reports, turnover rates, patient audits and quality
control reports.
4. Continuing education:
Formal, organized, educational programme designed to promote the knowledge,
skills and professional attitude of nurses.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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OTHER ACTIVITIES OF STAFF DEVELOPMENT
Make rounds with the physicians
Attend medical round in a teaching centre
Visit another hospital to observe their method of patient care
Attend professional meetings, conferences, etc. and present papers
Read articles of special interest and report them to staff
BENEFITS OF STAFF DEVELOPMENT:
For the employees:
+ Leads to improved professional practice
+ Aids in updating knowledge and skills at all levels of organization
+ Keep the nurses abreast of the latest trends and developments in techniques
+ Equips the nurses with knowledge of current research and developments
+ Helps the nurses to learn new and to maintain old competencies
For the organizations/employer:
Keeps the nursing staff enthusiastic in their learning
Develop interest and job satisfaction amongst the staff
Develops the sense of responsibilities for being competent and knowledgeable
Creates an appropriate environment and sound decisions as well as using effective
problem solving techniques
Helps the nurse to adjust to change
Aids in developing leadership skills, motivation and better attitudes
Aids in encouraging and achieving self development and self confidence
Makes the organization a better place to worker
ROLE OF ADMINISTRATOR IN S.D.P
Preceptorship:
In most of the hospitals have a staff development coordinator who is responsible for
continuing and in-service education programmes. A staff nurse is selected as a preceptor
to assist the new nurse in the unit based on their skill and competence. The role of the
preceptor are:
As an orienteer
As a teacher
As a resource person
As a counselor
As a role model and evaluator
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
IN-SERVICE EDUCAION:
DEFINITION:
1. In service education is defined as a continued programme of education provided by
the employing authority, with the purpose of developing the competences of
personnel in their functions appropriate to the position they hold, or to which they
will be appointed in the service.
2. In-service education is a planned instructional or training programme provided by an
employing agency in the employment setting and designed to increase competence in
a specific area.
3. In-service education is an ongoing on-the-job instruction that is given to enhance, the
workers performance in their present job.
AIM OF IN-SERVICE EDUCATION:
In-service education aims at developing the ability for efficient working and the capacity
for continuous learning, so that one may adapt to changes with judgment and produce profitable
services which become an important tool for the health care of the society and nation.

CONCEPTS OF IN-SERVICE EDUCATION:







In hospital nursing services, it becomes the process of helping the nurse to carry out the
functions with their obligations for nursing services. It helps to develop their skills necessary to
reach the ultimate goals of health agency. i.e. (i) The highest quality of the patient care, and (ii)
to keep abreast of changing technique and use of sophisticated tools and equipment.


Concept
Planned education activities
Provided in a job setting
Help a persons
performance effectively
as a personal work
Closely identified with
service
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
CHARACTERISTICS
It should be given in job setting
Every programme should be planned and ongoing
It should be closely related and identified with service components
It should help the employees learning and improve her/his knowledge, skills and
attitude.

FACTORS INFLUENCING IN-SERVICE EDUCATION:
The economic, social, medical and technological sciences which affect that society will
affect nursing in-service education. The related factors affect the in-service education
programmes are:-
1. Cost of healthcare In-service education programme may increase the efficiency of
nursing services, but it adds additional expenditure on health care delivery system.
2. Manpower In-service education requires need qualified human resources, leads to
increase human resources.
3. Changes in nursing practices it leads to frequent changes in the programme and in-
service education.
4. Standards of nursing practice
5. Organization of nursing departmental planned approaches is regular.
APPROACHES TO IN-SERVICE EDUCATION:
The pattern of in-service education desired to be:
+ Centralized Approach
+ Decentralized Approach
+ Co-ordinated Approach

1. Centralized Approach: - The in-service curriculum ought to emanate from and be
conducted by nursing personnel in the central administration of the agency. None of the
learners are consulted or participate in planning learning experiences and yet are expected
to attend an in-service offering.
Advantages:
Budget control
Evaluation of programme can be facilitated
Prior decision on resources, people, places and things
Committees are directed to work on specific problems identified by administration.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Disadvantage:
It may lead to in reducing spontaneous, interested participation and enthusiasm of
learners.
2. Decentralized Approach: - It is planned by and conducted for the employees of one or
more units. The employees are expected to keep administration informed of their
activities and possibly consult with administration when help is wanted, but the
employees are expected to develop and direct their own learning experiences.
In this approach, control in planning for an in-service is a responsibility of employees and the
qualities which are valued more are self direction, initiative and participation.
Advantages:
Individuals are working in the same unit and confront problems are common
Share the responsibilities for meeting the in-service needs
Proper contribution of the participants is expected
Disadvantages:
Lack of leadership
Conflicts
Inefficiency
Less or no budget

3. Co-ordinated Approach: - It is a compromise between the centralized and decentralized
patterns in that, while the practicing nurse does indeed carry a large measure of
responsibility for the in-service curriculum, the central administration of nursing
personnel of the agency is responsible for a broad programme which is of importance to
all nursing personnel. This approach involves both nursing administrators and
practitioners in complementary way.
Advantages:
Mutual co-ordination and assistance to central administration is improved
Duplication is avoided
Unity of efforts is maintained
CONTINUING EDUCATION
DEFINITION:
1. Continuing education is any extension of opportunities for reading, study and training to
any person and adult following their completion of or withdrawal from full time school
and /or college programmes.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
2. Continuing education is an educational activity, primarily designed to keep the
registered nurses abreast of their particular field of interest and do not lead to any formal
advanced standing in the profession.
NEED FOR CONTINUING EDUCATION:
Respond effectively to the challenge of current social changes.
To improve the health care, economic and educational opportunities.
To improve the new health patterns of health care.
Due to increasing trend towards specialization.
Due to legislation and its impact on the education of health personnel.
PHILOSOPHY OF CONTINUING EDUCATION:
It has been believed that the system of higher education which provides the basic
preparation or the members of a profession must also provide opportunities for practitioners to
keep abreast of advances in their field.
PLANNING FOR CONTINUING EDUCATION:
Planning is the key stone for the administrative process. Without adequate planning,
continuing education offerings are fragmented, haphazardly constructed, and often unrelated. A
successful continuing education programme is the result of careful and detailed planning.
Effective planning is required at all levels, local, state, regional and national and
eventually international to avoid duplication and fragmentation of efforts and to help keep at
minimum gap in meeting the continuing education needs of nurses.
THE PLANNING FORMULA:
1. What is to be done?
Get a clear understanding of what your unit is expected to do in relation to the work
assigned to it. Break the units work into separate jobs in terms of the economical use of
the men, equipment, space, materials and money you have at your disposal.
2. Why is it necessary?
When breaking the units into separate jobs think of the objectives of each job. The best
way to improve any job is to eliminate unnecessary motion, materials etc.
3. How is it to be done?
In relation to each job, look for better ways of doing it n terms of the utilization ofmen,
materials, equipment and money.
4. Where is it to be done?
Study the flow of work and the availability of the materials and equipments best suited
men for doing the job.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
5. When is it to be done?
Fit the job into a time schedule that will permit the maximum utilization of men,
materials, equipment and money and the completion of the job at the wanted time.
Provisions must be made for possible delays and emergencies.
6. Who should do the job?
Determine what skills are needed to do the job successfully, select or train the man best
fitted for the job.

STEPS IN THE PLANNING PROCESS:
1. Establishing goals compatible with the purpose or mission of the organization.
2. Deciding upon specific objectives consistent with these goals.
3. Determining the course of action required to meet the specific objectives.
4. Assessing the available resources for establishing the programme.
5. Establishing a workable budget, appropriate for the programme.
6. Evaluating the results at stated intervals.
7. Reassessing he goals and updating the plan periodically.
ROLES AND FUNCTIONS OF ADMINISTRATOR/MANAGER IN STAFF
DEVELOPMENT:
ROLES: He/ she:
Applies adult learning principles when helping employees learn new skills or information
Uses teaching techniques that empower staff
Sensitive to the learning deficits of the staff and creatively minimize these difficulties
Prepare employees readily regarding knowledge and skill deficits.
Actively seeks out teaching opportunities
Frequently assess learning needs of the unit
FUNCTIONS:
Works with reduction department to delineate shared individual responsibility
Ensures that all staff are competent for roles assigned
Ensure that there are adequate resources for staff development
Assumes responsibly for quality and fiscal control of staff development.
Provides input in formulating staff development policies



PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
EVALUATION OF STAFF DEVELOPMENT PROGRAM
Staff development is an important part of assisting performance improvement at
organiational, faculty/central department, unit and individual levels. It is therefore important that
the transfer of learning into the workplace is assessed through a process of review and evaluation
so that its success or otherwise can be established and so that we can demonstrate the
contribution learning makes towards overall organisational success.
DEFINITION OF EVALUATION:
Evaluation is the process of finding out how the development or training process has
affected the individual, team and the organization. or
Evaluation is a value judgment on an observation, performance test or indeed any data whether
directly measured or inferred
TYPES OF EVALUATION
Formative evaluation: Evaluation that is used to modify or improve a professional development
program is called formative evaluation. Formative evaluation is done at intervals during a
professional development program. Participants are asked for feedback and comments, which
enable the staff developers to make mid-course corrections and do fine-tuning to improve the
quality of the program.
Summative evaluation: Evaluation to determine the overall effectiveness of a professional
development program is called summative evaluation. Summative evaluation is done at the
conclusion of the program. It is collected at three levels: educator practices, organizational
changes, and student outcomes.
LEVELS OF EVALUATION
An Evaluation Framework
The four stages of evaluation are intended to measure: (1) Reaction, (2) Learning, (3) Behavior
and actions, and (4) Results.
Reaction: Measures how those who participate in professional development activities
react to what has been presented. Although typically characterized as the happiness
quotient, participants need to have a positive reaction to a professional development
activity if information is to be learned and behavior is to be changed.
Learning: Measures the extent that professional development activities have improved
participants' knowledge, increased their skills, and changed their attitudes. Changes in
instructional behavior and actions cannot take place without these learning objectives
being accomplished.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Behavior: Measures what takes place when the participant completes a professional
development activity. It is important to understand, however, that instructors cannot
change their behavior unless they have an opportunity to do so.
Results: Measures the final results that occurred because an instructor participated in
professional development activities. Evaluating results represents the greatest challenge
in evaluating professional development approaches

DUTIES OF NURSING AND NON NURSING PERSONALS IN HOSPITAL
INTRODUCTION:
Nursing and non nursing personals in hospitals plays an important role in patient care and
the development of the hospital. Their entire role is very important to improve the standard of
care.
GENERAL ROLE OF REGISTERED NURSES IN HOSPITAL
ADMINISTRATOR:
A hospital administrator is usually an individual responsible for the day to day operational
running of the health care institution. Specific duties include recruitment and retention of
physicians, overseeing quality, improvement of processes for efficient delivery of patient care,
setting standards, oversight of budgets, creating financial and business strategies to assure fiscal
viability and health.
MANAGER:
The nurse plans, gives directions, develops staff, monitors operations, gives rewards fairly,
and represents both staff members and administration as needed. The nurse manages the nursing
care of individuals, groups, families and communities. The nurse manager delegates nursing
activities to ancillary workers and other nurses and supervises and evaluates their performance.
COUNSELOR:
In most organizations counselors' play an important role in the induction of new employees.
At this stage counselors can do much to help new employees. They take new employees round
the hospital, show them different departments and explain their functioning, explains rules and
regulations of hospital and of cafeteria, issue lockers and uniforms, and introduce them to the
administrator and medical superintend.
Counseling helps in reviewing training needs, improving better communication between
employees and employers and helps in solving personal and official problems of employees.
External and internal stress, lack of training, difficulties in job, emotional deprivation etc can be
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
tackled under employee counseling. Use of counseling methods and skills of the counselor can
be utilized effectively, to create a better harmonious hospital staff environment
Problems to be handled by the Counselor
The problems coming under employee counseling in a hospital setting are

1. Emotional Problem
2. Behavioral Problem
3. Personal Problem
4. Environmental Problem
5. Organizational Problem
1. Emotional Problem
Unpleasant emotions like fear, anger, and jealousy, which are harmful to the well-being and
development of individual employee in hospital setting.
2. Personal Problems
Common personal problems include, housing, transportation, admission of children in
schools etc.
3. Behavioural and Organisational problems
Major organisational problems are lack of group cohesiveness, role conflict, feeling of
inequality, role ambiguity, role over load, lack of supervisory support, constraints of rules and
regulations, job mismatch, inadequacy of role authority, absenteeism, job dissatisfaction, labour
turnover and job stress.
CHANGE AGENT
The nurse initiates changes and assist the client make modifications in the lifestyle to
promote health. This role involves, identifying the problem, assessing the clients motivations
and capacities for change, determining alternatives, assessing resources, determining appropriate
helping roles, establishing and maintaining a helping relationship, recognizing phases of the
change process, and guiding the client through these phases.
RESEARCHER
The nurse participates in scientific investigation and uses research findings in practice. The
nurse helps develop knowledge about health and promotion of health over the full life span; care
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
of person with health problems and disabilities; and nursing actions to enhance peoples ability
to respond effectively to actual or potential health problems.
CASE MANAGER
The nurse coordinates the activities of other members of health care team, such as nutritionists
and physical therapist, when managing a group of clients care.
COLLABORATOR
The nurse works in a combined effort with all those involved in care delivery, for a mutually
acceptable plan to be obtained that will achieve common goals. The nursing initiates nursing
actions within the health team
HEALTH EDUCATORS
Work to encourage healthy lifestyles and wellness through educating individuals and
communities about behaviors that can prevent diseases, injuries, and other health problems.
After assessing their audiences' needs, health educators must decide how to meet those needs.
Health educators have a lot of options in putting together programs. They may organize an event,
such as a lecture, class, demonstration or health screening, or they may develop educational
material, such as a video, pamphlet or brochure. Often, these tasks require working with other
people in a team or on a committee. Health educators must plan programs that are consistent
with the goals and objectives of their employers. For example, many nonprofit organizations
educate the public about one disease or health topic, and, therefore, limit the programs they
issue.
ADVICER:
Specific responsibilities:
1. Act as advisor in Tech-Serve project on matters relating to hospital management improvement
in provincial hospitals, based on previous experience.

2. Contribute to the development of provincial hospital planning and facilitating the
implementation of Standard Based Management in the Provincial Hospitals.

3. Work closely with the other national and international Tech-Serve Hospital Management
Advisors concerning the Tech-Serve Hospital Management Improvement Initiative, reviewing
and developing MOPH policies and active participation in the MOPH Hospital Management
Task Force.

4. Provide technical assistance to EPHS workshops conducted at the provincial and central level
as well as participate in visits to provincial hospitals for purposes of training, conducting quality
standards assessment or preparing necessary workshops of Tech-Serve.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
5. Travel regularly to the provincial hospitals for the purpose of supporting, training, and
monitoring the activities of the hospital leadership.

6. Act as a resource to provide models of best practice for hospital management through
research, training, document translation, and any other means as needed.

7. Participate in and sometimes leading quality assurance and performance improvement
activities as required by the hospitals.

8. Collect statistical data as needed for the purposes of monitoring hospital performance and
providing comparative information on hospital performance to peer facilities and MSH.

9. Advocate for external support as needed by the hospitals, both within MSH and at the MOPH
through the Hospital Management Task Force.

10. Any other duties, as requested by the Chief of Party, Program Directors, or Program Manager
for Capacity Building.
ADVOCATOR:
A patient advocate may be charged with a cadre of duties, from gathering information from
doctors and hospitals to helping discuss and decide treatment options.
Some duties of advocator:
Clarifying treatment and medical options.
Gathering information.
Asking specific questions.
Note taking, to make sure all the appropriate information received from caregivers is
captured and retained.
IMPLEMENTER:
The nurse should implement all of the hospital policies. They should implement patient
care according to their planning.
EVALUATOR:
The nurse evaluator should evaluate staff performance and give feedback about their
work. It helps the staff to improve their knowledge and practice.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
DUTIES OF NURSING PERSONALS IN HOSPITAL:
DUTIES OF NURSING SUPERINTENDENT:
A nursing superintendent supervises the nursing staff. The nursing superintendent, who is
also called the director of nursing, is responsible for the running and supervision of a nursing
department. Depending on the size of the facility, she may control subsidiary departments, such
as housekeeping. Nursing superintendents generally report to the hospital director or medical
director of their facility.
Supervise nursing staff
The top priority of a nursing superintendent is to ensure that the nursing staff members are
providing the best care for patients. She makes sure that individual nurses and nurses aides are
carrying out care plans and ensures that communication between shifts happens smoothly and
thoroughly. The superintendent also monitors stock and supplies to make sure that nurses have
the equipment they need to provide quality care.
Oversee hiring and training
The nursing superintendent is responsible for the hiring and training of new staff. She must
search for nurses that complement the existing team, design training programs and make sure
that nursing instructors and trainers are adequately preparing new staff for the workplace. Often
this includes hearing an evaluation of new nurses from the floor staff during the training period.
Patient care
Although the nursing superintendent does not have a high level of direct patient care, she is
responsible for the well-being of patients at the facility. This means that the superintendent must
monitor nurses' care and the attitude and health of the patients. In cases where the family
requests alternate care, the nursing superintendent must hear the request and make the final
decision.
Create work schedules
Each pay period, the nursing superintendent is responsible for setting the work schedules for
the entire department. She must take into account holidays, hear requests for time off, and create
a schedule that gives the appropriate number of hours to each nurse. As part of the process, the
nursing superintendent assigns duties and floor responsibilities to each nurse.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Make disciplinary decisions
In situations where a nurse, nurse's aide, or other staff member is involved in a dispute, the
nursing superintendent must handle disciplinary actions. In extreme cases like patient abuse or
staff coming to work under the influence, the nursing superintendent is responsible for
terminating contracts as needed.
Manage other departments
In a large facility, the nursing superintendent may be responsible for directing the activities
of the housekeeping, linen, and kitchen facilities. She must handle any problems that arise,
communicate with department leaders, and address any supply issues.
Negotiate with vendors
Because the nursing superintendent is responsible for the supply of equipment and medical
necessities, she often negotiates with vendors for the new contracts. In large facilities, a
purchasing manager may handle these duties and report to the superintendent.
DUTIES OF ASSISTANT NURSING SUPERINTENDENT:
Essential Functions/Responsibilities:
1. Take responsibility for a group of activities or subcontractors and manage the work to be
done. Provide liaison between field engineering, estimating, and subcontractors to ensure
compliance of construction with drawings and specifications.
2. Assist in planning work schedule, determining manpower levels, materials quantities,
equipment, requirements, etc. are maintained, including field engineering and construction
activities.
3. Monitor work performance and productivity of crafts to ensure project rules, procedures,
safety requirements, etc. are maintained.
4. Advise senior level supervision and project management of potential problems, work
interferences, schedule difficulties, etc. Assist in circumventing/resolving such problems as
required.
5. Maintain liaison with other departments, i.e., Purchasing, Accounting, Engineering, etc. as
required to support construction schedule. May provide assistance to the Superintendent in
resolving problems.
6. Perform additional assignments per supervisors direction.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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DUTIES OF WARD SISTER:
Functions:
A. Clinical Activities:
1. Assesses the situation of given unit in relation to different types of patients care,
facilities provided by the nursing personnel.
2. Identifies the patients need/problem in the unit.
3. Assigns the patients care and others activities to nursing personnel.
4. Evaluates the patients care given by nurses.
5. Attends Doctors round and Matron and Assistant Matrons Clinical rounds.
6. Checks and caries out and delegates Doctors instruction and order after round.
7. Participates and refers the patient for rehabilitation therapy.
8. Guides and conducts health education activities to client as required including MCH/FP
disease control and health promotion.
B. Supervisory Activities
1. Guides and supervises all staff for giving bed side nursing care.
2. Maintains regular records, report concerning the patients care.
3. Provides direct guidance and supervision of nursing and non-nursing personnel for the
efficient running of the wards and in carrying out nursing routines, bearing in mind the
individual needs of patients.
4. Encourages motivates, assesses the effectiveness of their own works and develops their
potential for giving good nursing care.
5. Uses the standard guideline and manual for supervision.
C. Administrative Activities
1. Makes duty roaster for 24 hrs coverage in unit of the Hospital.
2. Conducts nursing conference, meeting and individual conference when necessary.
3. Investigates complaints promptly and takes action according to rules and policy of the
hospital.
4. Reports and records absence and sickness of staff including leaves.
5. Maintains cleanliness of the ward and its environment, furniture, equipment, e.g.
ventilation, lighting, heating, noise, odors.
6. Maintains adequate linen, other supplies, requisition for ward stores and repairs, replaces
supplies as necessary.
7. Keeps up-to-date record of drugs and maintains records of its administration.
8. Checks and manages all equipment periodically, to see that it is in good order.
9. Checks daily availability and conditions of emergency equipment and supplies.
10. Maintains inventories, reports, breakages and losses.
11. Helps in Controlling the visitor of patients as needed.
12. Ensures that relatives of very ill patient are allowed to stay with patients when necessary.
13. Accompanies, the Matron on the round and reports to her any important incidents.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
14. Informs Matron immediately of any special emergencies or accidents in the ward, and
keeps a written record of nay incidents.
15. Coordinates between Matron and staff in her unit and also with other departments.
16. Takes active part in condemnation of useless materials.
17. Helps Matron for annual plans and budgets in her ward.
18. Delegates responsibilities to the responsible person in her absence.
19. Assist the Matron and Assistant Matron for disaster plan and organization.

D. Educative Activities
1. Identifies the learning need of staff in ward.
2. Plans, conducts and recommends the in-service education and training programme for her
staff.
3. Manages and facilitates the clinical teaching activities for the students and staffs.
DUTIES OF OTHER NURSING PERSONALS:
Duties and responsibilities of Perioperative nurses:
Perioperative registered nurses provide surgical patient care by assessing, planning, and
implementing the nursing care patients receive before, during and after surgery. These activities
include patient assessment, creating and maintaining a sterile and safe surgical environment, pre-
and post-operative patient education, monitoring the patients physical and emotional well-being,
and integrating and coordinating patient care throughout the surgical care continuum.
During surgery, the perioperative registered nurse may assume any of the following
responsibilities:
Scrub nurse works directly with the surgeon within the sterile field by passing
instruments, sponges, and other items needed during the surgical procedure.
Circulating nurse works outside the sterile field. Responsible for managing the nursing
care within the O.R. by observing the surgical team from a broad perspective and
assisting the team in creating and maintaining a safe, comfortable environment.
RN First Assistant after completing extensive additional education and training to
deliver direct surgical care, the RN First Assistant may directly assist the surgeon by
controlling bleeding and by providing wound exposure and suturing during the actual
procedure
Diabetes management nurses:
Diabetes Management Nurses are registered nurses who assist patients to
manage diabetes. Their main duty is to educate patients and their families about diabetes and
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
the self-management skills required. They provide advice on exercise, diet and medication and
monitoring insulin levels. These nurses often work in outpatient clinics and often travel to
hold clinics in regional areas.
The main duties of a Diabetes Management Nurse include:

-Dealing with complications of patients diagnosed with diabetes mellitus
-Working closely with physicians, pharmacists and other healthcare professionals
-Educating patients of the best practices in improving their health
-Informing patients families on living with diabetes
-Providing advice on diet and exercise
-Advising on injecting medications
-Administering tablets or insulin if the patient is unable
- Monitoring blood glucose levels
Duties and responsibilities of Dermatology nurses:
Those who are suffering from skin disorders or in need of skin care may seek the services
of a dermatology nurse. Dermatology nurses are registered nurses who specialize in treating skin
disorders and may administer treatments for their patients. In some cases, they may prescribe
medication. The nurse may also educate their patients on maintaining healthy skin.
Duties and responsibilities of geriatric nurses:
A geriatric nurse is a registered nurse who specializes in the care of elderly people.
Geriatric nurses must have the same educational background as registered nurses, including a
bachelor's degree from an accredited college or university. Duties of a geriatric nurse, however,
differ from other fields of nursing due to the unique problems that can arise in elderly patients.
Assess Problems
1. Geriatric nurses must be able to assess medical problems of their elderly patients. Often,
it is the geriatric nurse who must decide if his patient can preform every day tasks on her
own. Assessments may be in activities like driving, walking and taking medications.
Communication Skills
2. Geriatric nurses must be able to determine, through both verbal and non-verbal
communication, the health of patients by knowing symptoms, ailments and medications
being taken by patients. Geriatric nurses are the liaison between doctors, patients,
patients' families and other health-care facility workers.
3. Patient Relationships
Geriatric nurses often spend large amounts of time with their patients, causing them to
have close-knit relationships with the patients and their families. Geriatric nurses,
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
because of the time spent with their elderly patients, must be able to cope with the death
of patients as well as the decline of a patient's mental and physical health.
Duties and responsibilities of Pediatric oncology nurses:
A pediatric nurse works in the pediatric department of a hospital, children's clinics or at
their homes. The basic duties of a pediatric nurse involve performing physical examinations and
giving medicines administrated by the doctor to hospitalized patients. As little children are
usually afraid of medical settings, it is the duty of the pediatric nurse to make them comfortable
with encouraging words, so that they can conduct the necessary tests and treatment procedures
smoothly.

Responsibilities of a pediatric nurse involves taking temperature, blood pressure,
respiratory rate and heart rate of the patient. He/she also has the duty of starting intravenous
medications, performing head to toe examinations and also collecting samples of patient's urine
and stools for laboratory tests.

Ambulatory care nurses:
Provide preventive care and treat patients with a variety of illnesses and injuries in
physicians' offices or in clinics. Some ambulatory care nurses are involved in telehealth,
providing care and advice through electronic communications media such as videoconferencing,
the Internet, or by telephone.
Critical care nurses:
Critical care nurses provide care to patients with serious, complex, and acute illnesses or
injuries that require very close monitoring and extensive medication protocols and therapies.
Critical care nurses often work in critical or intensive care hospital units.
ICU nurses are specialized, trained nurse professionals working with patients who have life-
threatening situations that required an extended hospital stay in an intensive care or critical care
unit of the hospital. The ICU nurse must be skilled to make complex assessments, give the
patient intense therapy and provide intervention care. The nurse may also perform ongoing duties
for a patient in ICU unit during his stay.
Assessment
Individualized assessment is made by the ICU nurse to determine the immediate needs of the
critical care patient. Ongoing assessment is then established to keep tabs on the patient's
condition and make any changes in treatment based on hospital policy, procedure and protocol.
Assessment helps the nurse and other hospital staff determine what plan of action to take in care
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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of the patient. Assessment also allows the ICU nurse to educate the patient and her family on
what to expect in the days, weeks and months following ICU treatment.
Patient Care
Following doctor or head nurse instructions, the ICU nurse performs treatments and therapies for
the patient. She gives the patient all necessary medication. If the patient lapses into cardiac arrest
or another condition that requires resuscitation, the nurse follow hospital protocols and
administers life-saving techniques. When a patient's condition changes rapidly, the nurse makes
quick decisions to treat the patient effectively. As shift changes occur, it is the nurse's duty to
inform the relief nurse of all patient care information. If the patient requires special procedures,
the ICU nurse acts as an assistant to the doctor or head nurse.
Administrative
Documentation of assessments and drug therapy is recorded by the ICU nurse. She also makes
documentation of physical therapy and other treatments given. The nurse must also keep all
patient clinical records with doctor orders confidentially secure. The ICU nurse must be non-
discriminative and nonjudgmental when dealing with patients.
Emergency or trauma nurses:
Emergency or trauma nurses will work in hospital or stand-alone emergency departments,
providing initial assessments and care for patients with life-threatening conditions.
The main duties of an Emergency / Trauma Nurse include:
- Providing care to patients in an emergency situation
- Administering emergency procedures e.g. code blue and CPR
- Acting fast and thinking on their feet
- Handling complex and difficult situations
- Operating healthcare machines

Transport nurses:
Transport nurses will provide medical care to patients who are transported by helicopter or
airplane to the nearest medical facility.
Holistic nurses:
Holistic nurses will provide care such as acupuncture, massage and aroma therapy, and
biofeedback, which are meant to treat patients' mental and spiritual health in addition to their
physical health.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Home health care nurses:
Home health care nurses will provide at-home nursing care for patients, often as follow-up
care after discharge from a hospital or from a rehabilitation, long-term care, or skilled nursing
facility.
Hospice and palliative care nurses:
Hospice and palliative care nurses work in collaboration with other health providers (such
as physicians, social workers, or chaplains) within the context of an interdisciplinary
team. Composed of highly qualified, specially trained professionals and volunteers, the team
blends their strengths together to anticipate and meet the needs of the patient and family facing
terminal illness and bereavement.
Infusion nurses:
Infusion nurses administer medications, fluids, and blood to patients through injections into
patients' veins. Infusion nurses specialize in administering parenteral fluids, blood & blood
components, pharmacological agents, nutritional solutions and pain medications.
Long term care nurses:
Long term care nurses provide healthcare services on a recurring basis to patients with chronic
physical or mental disorders, often in long-term care or skilled nursing facilities.
Medical surgical nurses:
Surgical nurses are a vital part of the health care team that provides care for patients before,
during and after surgical procedures. They work both inside and outside of the sterile field to
provide both direct patient care and support to the surgical staff.
General Duties
Surgical nurses are RNs who work in the operating, pre-surgical or recovery areas of a
hospital, outpatient surgical center or emergency ward, under the supervision of the operating
physician. They perform many functions that allow surgeries to proceed smoothly, including
preparing patients for surgery, assisting the surgeon during procedures and following up with
patients during recovery.
Recovery nurses
Surgical prep and recovery nurses are RNs who care for individuals before surgery and
during recovery. They prepare patients for surgical procedures by starting intravenous lines,
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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administering medication, taking a complete health history, completing additional tests such as
blood work, and performing pre-surgical preparations such as shaving.
Scrub Nurses
Scrub nurses are RNs who work within the sterile field to assist the surgeon. The scrub
nurse has scrubbed with antimicrobial soap and is outfitted in a sterile suit. Scrub nurses prepare
the needed instruments and other supplies for surgery and hand them to the surgeon during the
procedure. Typically, scrub nurses acquire their position only after they have gained extensive
nursing experience.
Circulating Nurses
Circulating nurses assist the surgical team in various ways but do not work within the sterile
field. Some of the duties of a circulating nurse include obtaining additional equipment or
instruments for the team, monitoring the condition of the patients, preparing tissue samples for
transport to a lab, and disposing of biohazardous material..
Registered Nurse First Assistants
Registered nurse first assistants (RNFA) have extensive additional training and clinical
experience that qualifies them to assist surgeons by performing basic surgical procedures. An
RNFA must take coursework in perioperative care and surgical procedures and pass the CRNFA
(Certified Registered Nurse First Assistant) professional board exam. Duties of a RNFA may
include suturing, exposing a wound, controlling bleeding and assisting surgeons in holding or
operating other instruments.
Occupational health nurses:
The occupational health nurse role includes:
The prevention of health problems, promotion of healthy living and working conditions
Understanding the effects of work on health and health at work
Basic first aid and health screening
Workforce and workplace monitoring and health need assessment
Health promotion
Education and training
Counseling and support
Risk assessment and risk management


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Perianaesthesia nurses:
Perianaesthesia nurses provide preoperative and postoperative care to patients undergoing
anesthesia during surgery or other procedure.
Mental health nurses:
Mental health nurses help psychiatrists, psychologists and other mental health professionals
counsel and treat patients with a variety of emotional and psychiatric issues, from substance
abuse oriented problems to paranoid-schizophrenia. Mental health nurses also help with the
dispensing of medication for patients. Psychiatric nurses with an advanced education may be
able to prescribe medication on their own.
Radiology nurses:
Radiology nurses provide care to patients undergoing diagnostic radiation procedures such as
ultrasounds, magnetic resonance imaging, and radiation therapy for oncology diagnoses.
Radiology nurses routinely start or check peripheral i.v.s, assess infusaports, administer
medications, monitor vital signs, suction patients, insert foleys and help patients with their
personal needs.
Rehabilitation nurses:
The goal of the rehabilitation nursing profession is to treat patients who require a broad range
of medical services for their recovery. People who need rehabilitation nursing care may have
suffered from such things as work injuries, car accidents, strokes, head trauma, drug or alcohol
abuse, gunshot wound or other severe trauma. These nurses find work in general hospitals,
rehabilitation centers, drug and alcohol recovery facilities, mental hospitals, senior citizen
facilities, or private homes. Rehabilitation nurses are able to provide a broad range of services
depending on the facility they work in.
Transplant nurses:
Transplant nurses care for both transplant recipients and living donors and monitor signs of
organ rejection.
Addictions nurses:
Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other
addictions.
Some of the principal duties are:
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Oversee detoxification and substitute prescribing programmes;

Provide support to clients on an individual and group basis;

Liaise with mental health team, addictions team, psychology dept, social workers, medical staff
and general health team;

Delivering drug/alcohol education and awareness packages to clients and staff;

Promoting healthy living and harm reduction initiatives to clients, eg safer injecting;

Provide support and counseling for blood borne virus testing as required;

Liaise with community agencies from a clients admission through to preparation for and
release from prison.
This post has a diverse range of responsibilities and excellent communication and interpersonal
skills are essential.
Intellectual and developmental disability nurses:
Intellectual and developmental disabilities nurses provide care for patients with physical,
mental, or behavioral disabilities; care may include help with feeding, controlling bodily
functions, sitting or standing independently, and speaking or other communication.
The main duties of an Intellectual and Developmental Disabilities Nurse include:

- Providing care for patients with physical, mental or behavioral disabilities
- Caring for patients of all ages
- Assisting with feeding and controlling bodily functions
- Supporting patients and encouraging them to be independently mobile
- Educating patients and their families of Intellectual and Developmental Disabilities
- Assisting patients with language skills and other forms of communication
Genetic nurses:
Genetic nurses provide early detection screenings, counseling, and treatment of patients with
genetic disorders, including cystic fibrosis and Huntington's disease.
HIV/AIDS nurses:
HIV/AIDS nurses care for patients diagnosed with HIV and AIDS. They should give proper
care, education, psychological support and counseling to the patients.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Oncology nurses:
Oncology nurses care for patients with various types of cancer and may assist in the
administration of radiation and chemotherapies and follow-up monitoring.
The following discussion on the role of the oncology nurse focuses on patient assessment,
patient education, coordination of care, direct patient care, symptom management, and
supportive care. To illustrate how varied the role may be and its importance across the
continuum of cancer care, examples related to the role of the oncology nurse in direct patient
care, symptom management, and supportive care are provided.
Wound, ostomy and continence nurses:
Wound, ostomy, and continence nurses treat patients with wounds caused by traumatic
injury, ulcers, or arterial disease; provide postoperative care for patients with openings that allow
for alternative methods of bodily waste elimination; and treat patients with urinary and fecal
incontinence.
Cardiovascular nurses:
Cardiovascular nurses treat patients with coronary heart disease and those who have had
heart surgery, providing services such as postoperative rehabilitation.
Pre-Operative Responsibilities
Pre-operative care includes evaluating a patient's readiness for surgery by taking a detailed
medical history and performing a complete physical examination. This is followed by ordering
appropriate tests for assessment and prescribing necessary medications for surgery.
Operative Responsibilities
Operative responsibilities include assisting in preparation of the patient by positioning the patient
on the operating room table and applying appropriate draping for the surgical procedure.
Assisting the general operation as needed by a surgeon is also required.
Post-Operative Responsibilities
Post-operative care includes evaluating the patient's recovery process by checking vital signs,
administering intravenous lines, ordering medications and laboratory tests as needed and
monitoring the patient to ensure there are no complications after surgery.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Gynecology nurses:
Gynaecology nurses provide care to women with disorders of the reproductive system,
including endometriosis, cancer, and sexually transmitted diseases.
Nephrology nurses:
Nephrology nurses care for patients with kidney disease caused by diabetes, hypertension, or
substance abuse.
Before dialysis, the nurse assists the patient in seeking information about his disease,
prognoses and treatments. The nurse is responsible for ensuring that appropriate care is available.
Prior to the actual treatment, the nephrology nurse must evaluate if it's safe for treatment to
begin. If the patient has no new acute health issues, the nurse continues with the preparation for
dialysis.
Neuroscience nurses:
Neuroscience nurses care for patients with dysfunctions of the nervous system, including
brain and spinal cord injuries and seizures.
Ophthalmic nurses:
Ophthalmic nurses provide care to patients with disorders of the eyes, including blindness
and glaucoma, and to patients undergoing eye surgery.
Orthopedic nurses:
Orthopedic nurses care for patients with muscular and skeletal problems, including arthritis,
bone fractures, and muscular dystrophy.
Otorhinolaryngology nurses:
Otorhinolaryngology nurses care for patients with ear, nose, and throat disorders, such as
cleft palates, allergies, and sinus disorders.
Respiratory nurses:
The role of respiratory nurses is to promote good pulmonary (lung) health within
individuals, families and communities. By building close relationships with doctors and patients
in their community, respiratory nurses educate the public on the importance of healthy breathing
and proper exercise in people of all ages.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Urology nurses:
Urology nurses care for patients with disorders of the kidneys, urinary tract, and male
reproductive organs, including infections, kidney and bladder stones, and cancers.
A urology nurse cares for patients with urinary tract problems in a hospital, urology clinic, or
private doctor's office. A nurse performs initial evaluations of symptoms, assists doctors with
diagnostic and treatment procedures, and provides expert patient education and counseling
services. Professionals see patients who have urinary tract infections, kidney stones, cancers,
prostatitis, or any of a number of other specific conditions.
Clinical nurse specialist:
Clinical nurse specialists provide direct patient care and expert consultations in one of
many nursing specialties, such as psychiatric-mental health.
Nurse anesthetist:
Nurse anesthetist provides anesthesia and related care before and after surgical, therapeutic,
diagnostic and obstetrical procedures. They also provide pain management and emergency
services, such as airway management.
Nurse midwives:
Nurse midwives provide primary care to women, including gynecological exams, family
planning advice, prenatal care, assistance in labor and delivery, and neonatal care.
Nurse practitioners:
Nurse practitioners serve as primary and specialty care providers, providing a blend of nursing
and healthcare services to patients and families. The most common specialty areas for nurse
practitioners are family practice, adult practice, women's health, pediatrics, acute care, and
geriatrics. However, there are a variety of other specialties that nurse practitioners can choose,
including neonatology and mental health.
Forensics nurses:
Forensics nurses participate in the scientific investigation and treatment of abuse victims,
violence, criminal activity, and traumatic accident.
Main function of a forensic nurse is to collect information about crime and investigate details
about it but it is not the only work that they do. Forensic nurses even provide medication and
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
relief to the victims of any crime, they even provide counseling to offenders and even children
who at times go off track and start indulging in unethical activities.
Infection control nurses:
An infection control nurse has one primary role, and that is to prevent hospital infections in
their patients by carrying out infection prevention protocols diligently. nurses can play an
important role in controlling and preventing the spread of infectious diseases in health care
facilities. In fact, several nurse duties are aimed solely at infection control.

Nurse educators:
Nurse educators plan, develop, implement, and evaluate educational programs and curricula
for the professional development of student nurses and RNs.
Nurse informaticists:
Nurse informaticists manage and communicate nursing data and information to improve
decision making by consumers, patients, nurses, and other healthcare providers. RNs also may
work as healthcare consultants, public policy advisors, pharmaceutical and medical supply
researchers and salespersons, and medical writers and editors.
Work environment. Most RNs work in well-lit, comfortable healthcare facilities. Home health
and public health nurses travel to patients' homes, schools, community centers, and other sites. .
RNs may be in close contact with individuals who have infectious diseases and with toxic,
harmful, or potentially hazardous compounds, solutions, and medications. RNs must observe
rigid, standardized guidelines to guard against disease and other dangers, such as those posed by
radiation, accidental needle sticks, chemicals used to sterilize instruments, and anesthetics. In
addition, they are vulnerable to back injury when moving patients.
A. Principal (school of nursing, College of Nursing)
Job Summary
Principal, College of Nursing is the administrative head of the College of Nursing, will be
directly responsible to the Director of the Medical Education/Director of Health and Family
Welfare services and responsible for implementation and revision of curriculum for various
courses, and research activities of the college of Nursing.
Duties and Responsibilities
Administration
Planning
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Develops philosophy and objectives for educational program.
Identifies the present needs related to educational program.
Investigates, evaluates and secures resources.
Formulates the plan of action.
Selects and organizes learning experience.
Organizing
Determines the number of position and scope and responsibility of each faculty and staff.
Analyses the job to be done in terms of needs of education program.
Prepares the job description, indicate line of authority, responsibility in the relationship and
channels of communication by means of organizational chart and other methods.
Considers preparation, ability and interest personally in equating responsibility.
Delegates authority commensurate with responsibility.
Maintains a plan of work load among staff members.
Provides an organizational framework for effective staff functioning such as meeting of the
staff, etc.
Directing
Recommends appointment and promotion based on qualification and experience of the
Individual staff, scope of job and total staff composition.
Subscribes and encourages developmental aspects with reference to welfare of staff and
students.
Provides adequate orientation of staff members.
Guides and encourages staff members in their job activities.
Consistently makes administrative decision based on established policies.
Facilitates participation in community, professional and institutional activities by providing
time, opportunity for support for such participation.
Creates involvement in designing educationally sound program.
Maintenance of attitude rightly acceptable to staff and learners.
Provides for utilization in the development of total program and encourages their
contribution.
Provides freedom for staff to develop active training course within the framework for
curriculum.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Promotes staff participation in research.
Procures and maintains physical facilities which are of a standard.
Coordinating
Coordinates activities relating to the programs such as regular meetings, time schedule,
maintaining effective communication, etc.
Initiates ways of cooperation.
Interpretes nursing education to other related disciplines and to the public.
Controlling
Provides for continuous follow up and revision of education program.
Maintains recognition of the educational program by accrediting bodies. University, etc,
KNC, INC, etc.
Maintains a comprehensive system of records.
Prepares periodic report which revives the progress and problems of the entire program and
presents plans for its continuous development.
Prepares, secures approval and administrates the budget.
Instruction (Teaching)
Plans for participating in educational programs for further development.
Recognizes the needs for continuing education for self and staff provides stimulation of
opportunities for such development.
Participate as a teacher in the educational program.
Guiding
Provides for systematic guidance program for staff members and students.
Encourages studies, research and writing for publication.
Provides and maintains a program for recruitment, selection and promotion of students.
B.VICE- PRINCIPAL
Financial:
Assists Principal in carrying out financial activities:
Planning and revising budget
Monitoring College expenditure
In the absence of Principal, performs all the functions
Educational:
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Assists Principal in planning, implementation and evaluation of the programmes.
Assists Principal in identifying needs for professional development of faculty and
conducting staff development programme.
Supervises postgraduate students in conducting research.
Participates in teaching of various educational programmes.
In the absence of Principal, chairs the assigned committee meetings.
Supervises all educational programmes in coordination with the coordinators.
Guides faculty in day-to-day academic activities
Supervisory:
Shares responsibility with Principal and Professor in supervision of teaching and
nonteaching staff.
Plans academic staff assignments in consultation with Principal.
Participates in conduct of orientation programme
Supervises and guides staff in conducting their activities.
Writes staff performance report and reviews evaluation report of assigned staff.
Assists Principal in monitoring students welfare activities e.g. Mess, hostel, Health,
Sports , S.N.A. etc.
Assists Principal in administration and supervision of library.
Establishment:
Assists Principal in maintaining rules and regulations in college campus
Supervises overall functioning of staff and students' hostel.
Assists Principal in maintaining discipline in the college.
Assists Principal in reviewing recruitment and promotion policies of teaching and
non-teaching staff.
I nterpersonal:
Assists Principal in maintaining human relation and communication
Identifies conflict among staff members, initiates solution and reports to Principal
when necessary.
Communicates with staff in explaining administrative constraints.
Facilitates guidance and counselling students and staff as per need.
Any other responsibility assigned by the Principal.

C. PROFESSOR, COLLEGE OF NURSING AND ASSISTANT PROFESSOR
COLLEGE OF NURSING
1. Title: Professor, College of Nursing
Job Summary
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
The Professor is overall in charge of the department and thereby responsible for administration
teaching activity and guidance of that particular department.
Administration
Participating in determination of educational purposes and policies.
Contributes to the development and implementation of the philosophy and purposes of the
educational program.
Utilizes opportunities through group action to initiate improvement of the educational
program.
Interprets educational philosophy and policy to others.
Directs the activities of staff working in the department.
Instruction
Identifying needs of learners.
Identifies the needs of the learners in terms of objectives of the program and utilizing records
of previous experience, personal interviews, tests and observations.
Assists learners and identifying their needs.
Develops plan for learning experience.
Participates in the formulation and implementation of the philosophy and objectives program.
Selects and organizes learning experiences which are in accordance with their objectives.
Participates in the continuous development and the evaluation of the curriculum.
Plans within the educational unit, with the nursing services and allied groups.
Ascertains, selects and organizes facilities, equipment and materials necessary for learning.
Helping the Learners to Acquire
Desirable Attitudes, Knowledge and Skill
Seeks to create a climate conducive to learning.
Assists learners in using problem solving techniques.
Uses varied and appropriate teaching methods effectively.
Uses incidental and planned opportunities for teaching.
Encourages learners to assume increasing responsibility for own development.
Evaluating Learners Progress
Recognizes individual differences in apprasing the learners progress.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Uses appropriate devices for evaluation.
Measures and describes quality of performance objectively.
Helps learners for self evaluation.
Participates in staff evaluation of learners progress.
Recording and Reporting
Maintains and uses adequate and accurate records.
Prepares and channels clear and concise reports.
Shares information about learners needs and achievements with other concerned with
instruction and guidance.
Participates in the formulation and maintenance of comprehensive record system.

Investigative Way to improving Teaching
Measures effectiveness of instruction by use of the
Increases knowledge and skill in own curriculum area.
Analyzes and evaluates resources material.
Devices teaching methods appropriate to objectives and content.
Guidance
Cooperating in guidance program.
Shares in planning, developing and using guidance programme.
Gives guidance within own field of competence.
Helps the learner with special problems to seek and use additional helps as indicated.
Counseling
Helps the learner to grow in self understanding.
Promotes continuous growth and development towards maturity.
Continues to develop competence in problem solving process.
Cooperates in and/or initiates group activities in development and evaluation of studies.
Utilizes findings of research.
Makes data available concerning learners and concerning methods of teaching and
evaluation.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

1. Assistant Professor, College of Nursing, Title: Assistant Professor, College of
Nursing
Job Summary
The assistant professor usually works under professor and/HOD of the particular department of
specialty and assists him/her in administration, teaching and guidance and counseling and
research activities.
Administration
Participates in determination of educational purposes and policies.
Contributes to the development and implementation of the philosophy and purposes of the
total education program.
Utilizes opportunities through group action to initiate improvement of the total educational
program.
Interprets educational philosophy and policy to others.
Directs the activities of staff working in the department.
Instruction
Identifying the needs of learners.
Identifies the needs of the learners in terms of the objectives of the program by utilizing
records of previous experience, personal records of previous experience, personal interviews,
tests and observations.
Assists learners in identifying their needs.
Develops plan for learning experience.
Participates in the formulation and implementation of the philosophy and objectives of the
program.
Selects and organizes learning experience which are in accordance with their objectives.
Participates in the continue development and evaluation of the curriculum.
Plans within the educational, with the nursing services and allied groups.
Ascertains, selects and organizes facilities, equipment and materials necessary for learning.
Helping the Learners to Acquire Desirable Attitudes, Knowledge and skill.
Seeks to create a climate conductive to learning.
Assists learners using problem solving techniques.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Uses varied and appropriate teaching methods effectively.
Uses incidental and planned opportunities for teaching.
Encourages learners to assume increasing responsibility for own development.
Evaluative Learning Progress
Recognize individual differences in appraising the learners progress.
Uses appropriate devices for evaluation.
Measures and describes quality of performance objectively.
Helps learners for self evaluation.
Participates in staff evaluation of learners progress.
Recording and Reporting
Achievement with others concerned with co
Maintains and uses adequate and accurate records.
Prepares and channels clear and concise reports.
Shares information about learners needs and achievement with others concerned with
instruction and guidance.
Participates in the formulation and maintenance of comprehensive record system.
Investigating Ways Improving Teaching
Measures effectiveness of instruction by use of appropriate devices.
Increases knowledge and skill in own curriculum area.
Analyzes and evaluates resource material.
Devices teaching methods appropriate to objectives and content.
Guidance
Cooperating in guidance program.
Shares in planning, developing and using guidance program.
Gives guidance within own field of competence.
Helps the learners with special problems to seek and use additional help as indicated.
Counseling
Helps the learner to grow in self understanding.
Promotes continuous growth and development towards maturity.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Assisting in selection and Promotion of Learners
Participates in development of criteria for selection and promotion of learners.
Research
Imitates and participates in studies for the improvement of educational programs.
Identifies problems in which research is indicated or potentially desirable.
Continues to develop competence in problem solving process.
Cooperates in and/ or initiates group activity in development and evaluation of studies.
Utilizes findings of research.
Makes data available concerning learners and concerning methods of teaching and
evaluation.
D. LECTURER, COLLEGE OF NURSING, TITLE: LECTURER, COLLEGE OF
NURSING
Job Summary
He/She works under the direction of the department head and assists him in administration,
instruction and guidance activities.
Instruction
Identifies the needs of the learners in terms of the program by utilizing the records of
previous experience, personal interviews, tests and observation.
Assists the learners in identifying their needs.
Participates in formulation and implementation of the philosophies and objectives of the post.
Selects and organizes learning experiences which are in accordance with these objectives.
Plans with the educational unit with nursing service and allied groups.
Ascertains, selects and organizes facilities equipment and materials necessary for learning.
Assists the learners in using problem solving process.
Measures and describes quality of performance objectively.
Prepares clear and concise reports.
Share information about learners needs and achievements with others concerned.
Measures effectiveness of instruction by use of appropriate devices.
Increases knowledge and skill in own curriculum area.
Devices leaching methods appropriate to objectives and content.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Guidance and Counseling
1. Gives guidance with own field of competence.
2. Helps the learner to grow in self understanding.
Research
Assist in initiating and participating in studies for the improvement of educational program.
Identifies the problems in which research is indicated or potentially desirable.
Make data available concerning learners and concerning methods of teaching and evaluation.
Continues to develop competence in problem solving process.
Cooperate in and/ or initiates group activity in development and evaluation of studies.
Utilizes the findings of research.
E. SENIOR TUTOR
Participates in teaching and supervising the courses of undergraduate students.
Participates in curriculum development , evaluation and revision.
Guide in research projects for undergraduate students.
Acts as a Counsellor for staff and students.
Maintains various records.
Conducting and participating in department meetings and attending various meetings.
Participating in Administration activities of department.
F. TUTOR
Participates in teaching and supervising the courses of undergraduate students.
Coordinates with the external lecturer for various courses as assigned.
Participate in the evaluation of students.
Guide the students in conducting seminars, discussions and presentations etc.
Maintain students' records.
Participate in student counselling programmes.
G. CLINICAL INSTRUCTOR
Demonstrate standards for nursing practice.
Supervise and teach the students in the clinical fields.
Participate in evaluation of students.
Assist the students in conducting health education programme.
Maintain students' records.
Participate in the student counselling programmes.
Participate and promote student welfare activities.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN

Unit VI
DIRECTING Motivation: Intrinsic, extrinsic, Creating motivating
climate,
Motivational theories
Communication : process, types, strategies,
Interpersonal
communication, channels, barriers, problems,
Confidentiality,
Public relations
Delegation; common delegation errors
Managing conflict: process, management,
negotiation, consensus
Collective bargaining: health care labour laws,
unions, professional
associations, role of nurse manager
Occupational health and safety
Application to nursing service and education






PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
DIRECTING
MOTIVATION
INTRODUCTION
Motivation is an action that stimulates an individual to take a course of action, which will
result in an attainment of goals, or satisfaction of certain material or psychological needs of the
individual. Motivation is a powerful tool in the hands of leaders. It can persuade convince and
propel people to act.
DEFINITION
Motivation is defined as
Motivation is an inner impulse or an internal force that initiates and directs the individual to act
in a certain manner to satisfy a need.
Motivating force is a need that comes from within an individual, e.g. to make a living, gain status
and respect or to remove a source of frustration (Review of Maslows Hierarchy of Needs).
Motivation refers to the way in which urges, drives, desires, aspirations, striving or needs direct,
control or explain the behavior of human beings. -Dalton E. McFurland,
NEED FOR MOTIVATION:
The nurse manager must realize that nurses have different personalities, work habits, and
what motivates one nurse may not motivate others. Meanwhile, some nurses are skilled,
confident, and capable of self-direction and seem to motivate themselves, while other nurses lack
self-confidence; they do their jobs poorly and have little motivation. The nurse manager is
responsible to motivate the second group and to improve their performance.
Researchers have revealed that job performance is the result of the interaction of two
variables; the ability to perform the task and the amount of motivation.
Job Performance = Ability + Motivation.
Job dissatisfaction:
Job dissatisfaction contributes to higher turnover rates and decreased productivity and
considerable time and money are required to recruit and select a replacement for someone who
leaves the organization, it also takes time to socialize new employee to the organizational
culture, which is expensive time, beside that, other employees will need to carry more load to
cover the needs, and at last the kind of interruptions that results from the loss of this employee.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
For all those reasons the manager should be concerned about job satisfaction of employee, and to
do that there is a need to look at the different theories.
TYPES OF MOTIVATORS
1) Intrinsic motivation: Refers to motivation that comes from within the person, driving
him or her to be productive. It is related to a persons level of inspiration. The motivation
comes from the pleasure one gets from the task itself or from the sense of satisfaction in
completing or even working on the task rather than from external rewards.

2) Extrinsic motivation: It refers to motivation that comes from outside an individual, i.e.
enhanced by the work environment or external rewards such as money or grades. The
rewards provide a satisfaction and pleasure that the task itself may not provide. An
extrinsically motivated person will work on a task even when they have little interest in it
because of the anticipated satisfaction they will get from the reward. e.g.- reward for a
student would obtain good grade on an assignment or in the class.

TYPES OF MOTIVATION
1) Achievement motivation
It is the drive to peruse and attain goals. An individual with achievement
motivation wishes to achieve objectives and advance up the ladder of success. Hence,
accomplishment is important for his/her own sake and not for the rewards that accompany
it.
2) Affiliation motivation
It is a drive to relate to people on a social basis. Individuals with affiliation
motivation perform work better when they are complimented for their favourable attitude
and co-operation.

3) Competence motivation
It is the drive to be good at something, allowing the individual to perform high
quality work. Competence/skill motivated individuals seek job mastery, take pride in
developing and in using their problem solving skills and strive to be creative when
confronted with obstacles. They learn from their experiences.
4) Power motivation
It is the drive to influence people and change situations. Power motivated people
wish to create an impact on their organisation and are willing to take risks.

5) Attitude motivation
Attitude motivation is how people think and feel. It is their self-confidence, their
belief in themselves and their attitude to life. It is how they feel about the future and how
they react to the past.

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6) Incentive motivation
It is where the people are motivated through external rewards. Here, a person or
team reaps a reward from an activity. It is the type of rewards that drive people to work
harder.
7) Fear motivation
Fear motivation coercions a person to act against will. It is instantaneous and gets
the job done more quickly. Fear motivation is helpful in the short run.
Nature of motivation
Unending process: human wants keep changing & increasing.
A psychological concept: deals with the human mind.
Whole individual is motivated: as it is based on psychology of the individual.
Motivation may be financial or non-financial: Financial includes increasing wages,
allowance, bonus, etc.
Motivation can be positive or negative: positive motivation means use of incentives -
financial or non-financial. E.g. of positive motivation: confirmation, pay rise, praise etc.
Negative motivation means emphasizing penalties. It is based on force of fear. Eg.
demotion, termination.
Motivation is goal-oriented behaviour.
Motivation is an internal feeling of an individual. It cant be observed directly; we can
observe an individuals action and interpret his behavior in terms of underlying motives.
This leaves a wide margin of error. Our interpretation may not reveal the individuals true
behavior.
Motivation is a continuous process that produces goal directed behavior. The individual
tries to find alternatives to satisfy his needs.
Motivation is a complex process. Individual may differ in their motivation even though
they are performing the same type of job. For example, if two men are engaged in cutting
stones for constructing a temple, one may be motivated by the amount of wages he gets
and the other by the satisfaction he gets by performing the job.

COMPONENTS OF MOTIVATION
Motivation comprises of three main components:
Direction
Effort
Persistence
We start off by deciding what we want, which is our direction as we know where we want to
go and what we have to achieve. Then we make an effort towards our goal. We start to do things
and we continue our making the efforts for some time and give it everything that we have. Now
comes the part where we have to be persistent with our efforts and keep doing them.
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SOURCES OF MOTIVATION
1) Internal or push forces:
Needs
For security
For self-esteem
For achievement
For power
Attitudes
About self
About job
About supervisor
About organization
Goals
Task completion
Performance level
Career advancement

2) External or pull forces:
a. Characteristics of the job
Feedback
Amount
Timing
Work load
Tasks
Variety
Scope
Discretion
How job is performed
b. Characteristics of the work situation
Immediate Social Environment
Supervisor(s)
Workgroup members
Subordinates
Organizational actions
Rewards & compensation
Availability of training
Pressure for high levels of output

REQUISITES TO MOTIVATE
We have to be Motivated to Motivate
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Motivation requires a goal
Motivation once established, does not last if not repeated
Motivation requires Recognition
Participation has motivating effect
Seeing ourselves progressing Motivates us
Challenge only motivates if you can win
Everybody has a motivational fuse i.e. everybody can be motivated
Group belonging motivates


In the initiation, a person starts feeling lacknesses. There is an arousal of need so urgent,
that the bearer has to venture in search to satisfy it. This leads to creation of tension, which urges
the person to forget everything else and cater to the aroused need first. This tension also creates
drives and attitudes regarding the type of satisfaction that is desired. This leads a person to
venture into the search of information. This ultimately leads to evaluation of alternatives where
the best alternative is chosen. After choosing the alternative, an action is taken. Because of the
performance of the activity satisfaction is achieved which than relieves the tension in the
individual.

CREATING A MOTIVATING CLIMATE
As the organization has an impact on intrinsic and extrinsic motivation, it is
important to examine organizational climates or attitudes that influence workers morale and
motivation. Employees want achievement, recognition and feedback, the opportunity to
assume responsibility, a chance for advancement, fairness, good leadership, job security and
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acceptance and adequate monetary compensation. All these create a motivating climate and
lead to satisfaction in the work place.
e.g. nurses who experience satisfaction stay where they are, contributing to organizations
retention.

STRATEGIES TO CREATE A MOTIVATING CLIMATE
1. Have a clear expectation for workers and communicate effectively.
2. Be fair and consistent when dealing with all employees.
3. Be a firm decision maker.
4. Develop a team work/team spirit.
5. Integrate the staffs needs and wants with the organizations interest and purpose.
6. Know the uniqueness of each employee.
7. Remove traditional blocks between the employee and the work to be done.
8. Provide opportunities for growth.
9. Encourage participation in decision-making.
10. Give recognition and credit.
11. Be certain that employees understand the reason behind decisions and actions.
12. Reward desirable behaviour.
13. Allow employees exercise individual judgement as much as possible.
14. Create a trustful and helping relation with employees.
15. Let employees exercise as much control as possible over their work environment.

Leadership Roles and Management Function Associated With Creating A Motivating
Work Climate:-
Leadership Roles:
1. Recognize each worker as unique individual who is motivated by different things.
2. Identifies the individuals and collective value system of the unit and implements a reward
system that is consistent with those values.
3. Listen attentively to individual and collective work values and attitudes to identify unmet
collective needs that can cause dissatisfaction
4. Encourage workers to stretch themselves in an effort to promote self growth and self
actualization.
5. Maintains a positive and enthusiastic image as a role model to subordinates in the clinical
setting
6. Encourage mentoring, sponsorship and coaching with subordinates.
7. Develop time and energy to create an environment that is supportive and encouraging to the
discouraging individual.
8. Develop a unit philosophy that recognizes the unique worth of each employee and promote
reward systems that make each employee feel like a winner.
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9. Demonstrates through actions and words a belief in subordinates that they desire to meet
organizational goals.
10. Is self- aware regarding own enthusiasm for work and takes steps to motivate self as
necessary.

MEASURES TAKEN BY THE NURSE MANAGER TO FACILITATE NURSES
MOTIVATION: -
The nurse manager while managing the nursing unit will have to choose a combination of the
following measures to facilitate nurses motivation.
1) Act as a Role model (Set a good example):-
a) Set high standards in the units.
b) Maintain a positive attitude towards the work and staff.
c) Be optimistic; in other words, be aware of how difficult the job is and how it can be done.
d) Ask for help when in need.
e) Admit mistakes.

2) Develop and maintain Good Personal Relations:-
a) Use two-way communication.
b) Be friendly, not to criticize staff in front of others and be fair.
c) Keep a sense of humor and avoid getting angry.
d) Try to understand nurses attitudes, likes, dislike their experience, previous training,
problems in their work and needs.
These measures will help in understanding nurses behavior. Understanding is the first step
toward motivating nurses. Trust comes with understanding and it develops slowly based on the
respect and acceptance of the manager. Motivation is based on understanding and trust.
Some guidelines for developing trust:-
a) Apply rules equally and consistently.
b) Avoid favoring some nurses over others, be fair.
c) Share information show respect for ideas and opinions and confidentiality.
d) Be supportive at all times.


3) Post Each Nurse where she can work best:-
The nurse is more likely to succeed and be motivated if her/his interests and skills are
considered in the assignment. Success is the best motivator.

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4) Use a participative style:-
Participation and sharing information will motivate nurses since they feel they are taking part
in decisions. Motivation requires more than physical involvement in a job. It also demands
mental and emotional involvement.
5) Guide, encourage and support continuously:-
Guidance means helping nurses in planning, evaluating their work and in solving work and
personal problems..
Encouragement means helping and reassuring nurses regardless of the type of problems.
Develop a supportive environment by reducing physical stresses associated with the job.
Support means removing obstructions and providing nurses with satisfying work
environment which include personnel and facilities and suitable learning materials needed to do
their job.
Reward Good work:-
a) Give recognition for successful achievement of the job. Praise frequently and informally.
It can be in front of other staff.
b) Reward includes: Pay increase, promotion, training for advancement to a higher level
within a job.
c) Thank you is a type of reward that helps to increase self-confidence.

6) Build team work (Team spirit)
a) Schedule regular meetings.
b) Make nurses feel that their job is important to the success of the team.
c) Integrate the needs and wants of the staff nurses with those of the nursing unit.
d) Think of nurses in the unit as a group and do what is best for them.
7) Provide continuing education:-
Nurses enjoy learning new knowledge and skills or updating the existing knowledge and
skills or taking new responsibilities through continuing education.
SYMPTOMS OF MOTIVATED NURSES:-
1. Show interest, enthusiasm and have a positive attitude.
2. Believe their work is important and work hard.
3. Work well with their supervisors and others.
4. Take part willingly in planning, implementing and evaluating their work.
5. Show responsible behavior.
Strive to find the best way to produce optimal job performance.

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THEORIES OF MOTIVATION
The word motivation theory is concerned with the processes that describe why and how
the human behaviour is activated and directed. It is considered as one of the most important areas
of study in the field of organizational behaviour. There are two different categories of motivation
theories- the content theories and the process theories.
A) Content theories of motivation
This is also called as the Need theory. It mainly focuses on the internal factors that
energize and direct human behaviour. Some of the need theories are-

1) Abraham Maslow (1943)
Maslows theory included 5 basic needs in his theory, namely the- The physiological
needs, Safety and security needs, Love needs, self-esteem needs and self-actualization
needs. Maslow suggested that human needs are ordered in a hierarchy from simplex to
complex. Higher level needs do not emerge as motivators until lower needs are satisfied
and a satisfied need no longer motivates behaviour.
Physiological needs: Food, water, warmth, shelter, sleep, medicine and education, etc.
Once the physiological needs are met, the next level becomes predominant.
Safety and security needs: These are the needs to be free of physical danger and of the
fear of losing a job, property, food or shelter. It also includes protection against any
emotional harm.
Social needs: Since people are social beings, they need to belong and be accepted by
others. People try to satisfy their need for affection, acceptance and friendship. After the
lower needs are well satisfied, affiliation or acceptance will emerge as dominant and the
person strives for meaningful social relationship.
Esteem needs: According to Maslow, once people begin to satisfy their need to belong,
they tend to want to be held in esteem both by themselves and by others. This kind of need
produces such satisfaction as power, prestige status and self-confidence.
Need for self-actualization: Maslow regards this as the highest need in his hierarchy. It is
the drive to become what one is capable of becoming; it includes growth, achieving ones
potential and self-fulfilment. It is to maximize ones potential and to accomplish
something.
2) Alderfer ERG theory
ERG theory is similar to Maslows hierarchy of needs. The existence (E) needs are
equivalent to physiological and safety needs; relatedness (R) needs to belongingness,
social and love needs. The growth (G) needs to self-esteem and self actualization- personal
achievement and self-actualization. The major conclusions of this theory are:
w In an individual, more than one need may be operative at the same time.
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w If a higher need goes unsatisfied than the desire to satisfy a lower need intensifies.
w When the higher level needs is frustrated; people will regress to the satisfaction of the
lower-level needs. This phenomenon is known as frustration-regression process

3) Frederick Herzberg Two Factor need theory (1966)
Herzberg felt that job satisfaction and dissatisfaction exists on dual scales. Workers are
motivated by two types of needs/factors-
Needs relating to the work itself called intrinsic/motivation factors (satisfiers):
challenging aspects of the work, achievement, added responsibility, opportunities for
growth and opportunities for advancement
Needs relating to working conditions called extrinsic/hygiene factors (dissatisfiers):
salary, status, working conditions, quality of supervision, job security and agency policies.
According to Herzberg, the hygiene factors must be maintained in quantity and quality to
prevent dissatisfaction. They become dissatisfiers when not equitably administered,
causing low performance and negative attitudes.
The motivation factors create opportunities for high satisfaction, high motivation and
high performance. Absence of motivation factors causes a lack of job satisfaction.
4) David McClelland(1961)
David McClelland has developed a theory on three types of motivating needs:
Need for Power
Need for Affiliation
Need for Achievement
People with high need for power are inclined towards influence and control. They like to
be at the center and are good orators. They are demanding in nature, forceful in manners and
ambitious in life. They can be motivated to perform if they are given key positions or power
positions.
In the second category are the people who are social in nature. They try to affiliate
themselves with individuals and groups. They are driven by love and faith. They like to build
a friendly environment around themselves. Social recognition and affiliation with others
provides them motivation.
People in the third category are driven by the challenge of success and the fear of failure.
Their need for achievement is moderate and they set for themselves moderately difficult tasks.
They are analytical in nature and take calculated risks. Such people are motivated to perform
when they see atleast some chances of success.
McClelland observed that with the advancement in hierarchy the need for power and
achievement increased rather than Affiliation. He also observed that people who were at the
top, later ceased to be motivated by this drives.
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5) McGregors Theory X and Theory Y
Douglas McGregor proposed two different motivational theories- theory X and theory Y.
He states that people inside the organization can be managed in two ways. The first is
basically negative, which falls under the category X and the other is positive, which falls
under the category Y.
Assumptions of theory X:
Employees inherently do not like work and whenever possible, will attempt to avoid it.
Because employees dislike work, they have to be forced, coerced or threatened with
punishment to achieve goals.
Employees avoid responsibilities and do not work until formal directions are issued.
Most workers place a greater importance on security over all other factors and display little
ambition.
Assumptions of theory Y:
Physical and mental effort at work is as natural as rest or play.
People do exercise self-control and self-direction and if they are committed to those goals.
Average human beings are willing to take responsibility and exercise imagination,
ingenuity and creativity in solving the problems of the organization.
That the way the things are organized, the average human beings brainpower is only partly
used.
On analysis of the assumptions it can be detected that theory X assumes that lower-order
needs dominate individuals and theory Y assumes that higher-order needs dominate
individuals. An organization that is run on Theory X lines tends to be authoritarian in nature-
power to enforce obedience and the right to command. In contrast Theory Y
organizations can be described as participative, where the aims of the organization and of
the individuals in it are integrated; individuals can achieve their own goals best by directing
their efforts towards the success of the organization

B) Process theories of motivation
Process theories of motivation provide an opportunity to understand thought processes
that influence behaviour. The major process theories are- Vrooms expectancy theory, goal-
setting theory and reinforcement theory.
1) Reinforcement theory
B.F. Skinners theory (1969) suggests that an employees work motivation is controlled
by conditions in the external environment, that is, by designing the environment properly,
individuals can be motivated. Instead of considering internal factors like impressions,
feelings, attitudes and other cognitive behaviour, individuals are directed by what happens in
the environment external to them. Skinner states that work environment should be made
suitable to the individuals and that punishment actually leads to frustration and de-
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motivation. Hence, the only way to motivate is to keep on making positive changes in the
external environment of the organization.
Positive behaviour should be reinforced or rewarded as this increase the strength of a
response or induces its repetition. Reinforcers tend to weaken over time and new ones have
to be developed.
Negative reinforcement occurs when desired behaviour occurs to avoid negative
consequences of punishment. Punishment creates negative attitude and can increase costs.

2) Expectancy theory of Vroom
This theory postulates that most behaviours are voluntarily controlled by a person and are
therefore motivated. It focuses on peoples effort-performance expectancy, or a persons
belief that a chance exists for a certain effort to lead to a particular level of performance. This
theory states that motivation depends on three variables-
Attractiveness: the person sees the outcome as desirable.
Performance-reward linkage: the person perceives that a desired outcome will result
from a certain degree of performance.
Effort-performance: the person believes that a certain amount of effort will lead to
performance.

3) J. Stacy Adams Equity theory
Third process theory and focuses on fair treatment. Persons believe that they are being
treated with equity when the ratio of their efforts to rewards equals those of others. Equity
can be achieved or restored by changing outputs, attitudes, the reference person, inputs or
outputs of the reference person or the situation. People have a tendency to use subjective
judgment to balance the outcomes and inputs in the relationship for comparisons between
different individuals. Accordingly,
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4) Jeremy Benthams The Carrot and the Stick Approach
English philosopher, Jeremy Bentham ideas developed his ideas in the early years of
the Industrial Revolution, around 1800. Benthams view was that all people are self-
interested and are motivated by the desire to avoid pain and find pleasure. Any worker will
work only if the reward is big enough, or the punishment sufficiently unpleasant. With this
view, the carrot and stick approach was built into the philosophies of the age.
This metaphor relates to the use of rewards and penalties in order to induce desired
behaviour. It came from the old story that to make a donkey move, one must put a carrot in
front of him or dab him with a stick from behind. Despite all the research on the theories of
motivation, reward and punishment are still considered strong motivators.
In almost all theories of motivation, the inducements of some kind of carrot are
recognized. Often this is money in the form of pay or bonuses. Even though money is not the
only motivating force, it has been and will continue to be an important one. The trouble with
the money carrot approach is that too often everyone gets a carrot, regardless of
performance through such practices as salary increase and promotion by seniority, automatic
merit increases, and executive bonuses not based on individual manager performance.
The stick, in the form of fearfear of loss of job, loss of income, reduction of bonus,
demotion, or some other penalty has been and continues to be a strong motivator. It often
gives rise to defensive or retaliatory behaviour, such as union organization, poor-quality
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work, executive indifferences, and failure of a manager to take any risks in decision-making
or even dishonesty. However, fear of penalty cannot be overlooked. Whether managers are
first-level supervisors or chief executives, the power of their position to give or with hold
rewards or impose penalties of various kinds gives them an ability to control, to a very great
extent, the economic and social well-being of their subordinates

5) Goal-setting theory of Edwin Locke
This theory is based on goals as determinants of behaviour. The theory states that when
the goals to be achieved are set at a higher standard than, employees are motivated to
perform better and put in maximum effort. The more specific the goals, the better the results
produced. The goals must be achievable, and their difficulty level must be increased only to
the ceiling to which the person will commit. Goal clarity and accurate feedback increases
security. It revolves around the concept of Self-efficacy i.e. individuals belief that he or
she is capable of performing a hard task.
6) Arousal/ Cognitive Evaluation theory
Focuses on internal processes that mediate the effects of conditions of work on performance.
This theory states, a shift from external rewards to internal rewards results into motivation. It
believes that even after the stoppage of external stimulus, internal stimulus survives. It relates
to the pay structure in the organization. Instead of treating external factors like pay,
incentives, promotion etc and internal factors like interests, drives, responsibility etc,
separately, they should be treated as contemporary to each other. The cognition is to be such
that even when external motivators are not there the internal motivation continues.

7) Attitude theory
Focuses on favorable attitudes of job satisfaction and job involvement leading to high
performance.

8) Attrition/self-efficacy theory
Focuses on explanations for events or behaviour. Perceptions of self efficacy and self
esteem affect performance.
Motivational theories for Better Nursing Management
The needs of an individual are important motivators. These make the person work with
enthusiasm & interest. The significant individual needs are:
* Need for Power: Which results in a strong desire to influence staff, stimulate them to work,
making them achieve positions of leadership e.g. making the nursing supervisor wholly
responsible to take care of whole ward.
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* The need for achievement results in a desire to do something better or more efficiently than
others. People with a high need of achievement have an intense desire for success & equally
intense fear of failure. They want to be challenged, prefer to assume personal responsibility to
get work done and like to work for long hours. Training and orientation (refresher) course
increase this need. All the staff working in a particular area should be given equal chance to
attend the refresher courses related to that particular area.
* Need for affiliation: - Some people derive pleasure from being loved and tend to avoid the pain
of being rejected by social group. They enjoy social relationships, intimacy, empathise and help
others in trouble. There is close intimacy when a staff nurse is allowed to plan and decide patient
care along with ward supervisor.
In order to satisfy the employees, a manger can also use Maslow's Motivation Theory in these
ways:
* Improving physical working conditions to satisfy needs e.g. grilled door and escorts to secure
the nursing staff at night, providing rest rooms for lunch and dinner.
* Increasing the level of training, development and skill in order to meet the self esteem needs
e.g. uniform, leave facilities, vacation to nursing students. If these facilities are inadequate it
harms their self esteem.
* Having congenial social group and peer group interaction to fulfill affiliation needs.
* Placing the person in position which match their self concept to fulfill the self actualization
need.
Job Design
Job design is another motivator to satisfy, signify and give value to employees encouraging them
to perform well.
Koul Jyoti conducted a study on job satisfaction of 126 staff nurses of different hospitals in J&K
State and showed that only 8% were highly satisfied. Maximum satisfaction was found for the
work itself and with the competency of supervision. The areas of best satisfaction were
concerned with material rewards and individual agency. The older age group and experienced
persons were found more satisfied.
Work Environment
There are many conditions in the environment which could possibly effect the motivation of
staff. It is seen by Behaviour Modification Theorist that employees perform positively if
environment is favorable which is made by pay/ reward policies, democratic leadership style,
peer group interaction etc.
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To effect the performance of employees, their input (e.g. efforts, training, experience, skill,
education, seniority) should be equitable to their output e.g. pay, rights, benefits, job-status,
status symbol's (vacation, clothing, satisfactory superior).
The employees feel inequity if unrewarded or if given undesirable placement. The employees
always respond to the environment & these responses influence their behaviour. A nursing
Manager can accomplish this by using following motivational techniques.
* Positive Reinforcement: Annual reward for better performance in the form of money,
recognition, praise, promotion etc. Give reward to the most clean and best patient care ward on
Annual days.
* Avoidance Learning: Some staff nurses improve their behaviour in order to avoid criticism of
Nursing. Superintendent or to avoid any disciplinary action against her.
* Punishment: Nursing Superintendent, for example, can withhold reward or promotion so as to
change the behaviour of staff. Scolding in front of others or humiliating should be avoided.
* Be sure to tell a person she / he is doing wrong and what type of behaviour is desired e.g. RT
feeding given with force by use of piston should be corrected and demonstrated so that goes with
gravity.
* Making the staff participate in different activities which give them affiliation, acceptance and
recognition, e.g. in conferences, Nurses'-Day, Hospital Annual Day etc.
* Giving feeling of personal responsibility or keeping interactions. The newly appointed staff
should be left independent but be observed closely.
* Warmth, support and identity motivate the staff to perform better. Every staff member has her
own potential. Respect their individual capabilities. Don't scold if she is performing badly in
other field. Let her develop potential gradually.
PROBLEMS IN APPLYING MOTIVATION THEORIES
This article presents a non-exhaustive account of some problems in applying motivational
theories to the actual conditions of the workplace. It should give readers a general idea of some
of the less effective and more effective methods for motivating employees.

Reward vs. Punishment
It is generally conceded that while rewards can offer workers a variety of incentives which can
not only motivate them to work harder but also produce feelings of good-will towards
management, punishment often functions only to cultivate feelings of hostility between managers
and workers, which can directly and negatively effect productivity.
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Personal Satisfaction vs. Financial Satisfaction
One of the most successful ways of fostering a productive and motivated workforce is to ensure
that workers are satisfied with their jobs, not just with their pay. It is interesting to note that
people are quite often more concerned with how much they like their job than they are with how
much money they actually make. Making employees feel important in the workplace can make
them feel like part of the team, which makes them feel personally invested in the health of a
business.
Persuasion vs. Coersion
By appealing to a worker's sentiments and reason a manager can persuade a worker to take
initiative and build their morale, which are internal drivers of motivation. However, by appealing
to fear and coercion a manager may actually cause a decline in internal motivation, leaving
instead feelings of hostility or anxiety which can negatively effect production.
Knowing Your Workers
Understanding what is important to an individual is endemic for understanding how to motivate
that person effectively. Is an individual motivated by the opportunity to develop professionally or
by the possibility of making more money? Does he or she want more responsibility or more
clearly defined responsibilities? Is it important that he or she see the end-product of their work or
not? Usually, employees are not motivated by just one thing, which can make it difficult to
determine the best strategy for motivation.
Involvement
One of the top things leading workers to feel productive and motivated in the workplace is
knowing that they have a good management team. When people feel close to their managers they
oftentimes do not want to disappoint, and may even feel the desire to win approval. By being
invested in workers, managers can get workers to feel reciprocally invested in their workplace
and their work. Fostering motivation in the workplace is first and foremost about fostering good
management practices.
METHODS FOR MOTIVATING EMPLOYEES
1. Job rotation: This is also known as cross training. It can be effective for employees that
perform repetitive tasks in the job. This allows the employees to learn new skills by
shifting them from one task to another.

2. Job enlargement: is a motivation technique used for employees that perform a very few
and simple tasks. It increases the number and variety of tasks that the employee performs,
resulting in a feeling of importance
3. Job enrichment: this method increases the employees control over the work being
performed. It allows the employees to control the planning, execution and evaluation of
their own work, resulting in freedom, independence and added responsibility.
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4. Flexible time: this allows the employees to choose their own work schedule to a certain
extend.
5. Job sharing: a less common method but very effective in preventing boredom. It allows
employees to share two different jobs
6. Employee involvement: people want to feel like they are a part of something. Letting the
employees to be more active in decision-making related to their job makes them feel
valued and important to the company and increases job motivation.

7. Variable pay programs: merit based pay, bonuses, gain sharing, and stock ownership
plans are some good motivators for employees. They should be offered as an incentive or
reward for outstanding performance.

COMMUNICATION MEANING, PROCESS, PRINCIPLES AND
TECHNIQUES, TYPES, ADVANTAGES, DISADVANTAGES,

I NTRODUCTI ON:
Nurse Managers are required to be aware of the techniques that can help them ensure
effective management of educational/service unit. Communication is one of the most important
activities in the nursing management. It is the foundation upon which the manager achieves
organizational objectives.
MEANING OF COMMUNICATION:
Communication is a process of change. In order to achieve the desired result, the
communication necessarily is effective and purposive.
DEFINITION OF COMMUNICATION:
Communication is a process in which a message is transferred from one person to other
person through a suitable media and the intended message is received and understood by the
receiver.
IMPORTANCE OF COMMUNICATION:
Promotes motivation:
Communication promotes motivation by informing and clarifying the employees about the
task to be done, the manner they are performing the task, and how to improve their performance
if it is not up to the mark.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Source of information:
Communication is a source of information to the organizational members for decision-
making process as it helps identifying and assessing alternative course of actions.
Altering individuals attitudes:
Communication also plays a crucial role in altering individuals attitudes, i.e., a well
informed individual will have better attitude than a less-informed individual. Organizational
magazines, journals, meetings and various other forms of oral and written communication help in
moulding employees attitudes.
Helps in socializing:
Communication also helps in socializing. In todays life the only presence of another
individual fosters communication. It is also said that one cannot survive without communication.
Controlling process:
Communication also assists in controlling process. It helps controlling organizational
members behavior in various ways. There are various levels of hierarchy and certain principles
and guidelines that employees must follow in an organization. They must comply with
organizational policies, perform their job role efficiently and communicate any work problem
and grievance to their superiors. Thus, communication helps in controlling function of
management.
ELEMENTS:
There are seven elements of communication:

Source idea
Message
Encoding
Channel
Receiver
Decoding
Feedback
Source idea:
The Source idea is the process by which one formulates an idea to communicate to another
party. This process can be influenced by external stimuli such as books or radio, or it can come
about internally by thinking about a particular subject. The source idea is the basis for the
communication.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Message:
The Message is what will be communicated to another party. It is based on the source idea,
but the message is crafted to meet the needs of the audience. For example, if the message is
between two friends, the message will take a different form than if communicating with a
superior.
Encoding:
Encoding is how the message is transmitted to another party. The message is converted into
a suitable form for transmission. The medium of transmission will determine the form of the
communication. For example, the message will take a different form if the communication will
be spoken or written.
Channel:
The Channel is the medium of the communication. The channel must be able to transmit
the message from one party to another without changing the content of the message. The channel
can be a piece of paper, a communications medium such as radio, or it can be an email. The
channel is the path of the communication from sender to receiver. An email can use the Internet
as a channel.
Receiver:
The Receiver is the party receiving the communication. The party uses the channel to get
the communication from the transmitter. A receiver can be a television set, a computer, or a
piece of paper depending on the channel used for the communication.
Decoding:
Decoding is the process where the message is interpreted for its content. It also means the
receiver thinks about the message's content and internalizes the message. This step of the process
is where the receiver compares the message to prior experiences or external stimuli.
Feedback:
Feedback is the final step in the communications process. This step conveys to the
transmitter that the message is understood by the receiver. The receiver formats an appropriate
reply to the first communication based on the channel and sends it to the transmitter of the
original message.




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
CHARACTERISTICS OF COMMUNICATION:
1. Clarity:

* One of the most essential characteristics of an impressive communication is "Clarity".
* Use Simple and Sound words, so that listeners can grab it easily.
* Be clear in your thoughts, jumbled and confused mind cannot deliver a good and clear saying.
* Avoid using any technical terms, try to explain in laymen language.
* Use Examples to explain & support complex scenarios.
* Work a little bit on your accent and pronunciation.

2. Aim or Goal:

* At every stage of your talk/communication, don't forget your "Aim or Goal".
* Try to deduce an acceptable stuff by judging Pros & Cons impartially.
* Communicate with a broad and practical mind.

3. Precision:

* Be precise & exact in your approach. Neither be too deep nor be too short.
* Include some good facts acknowledging your topic.

4. Avoid Repeatability, unless required so.

5. Linkage :
* Try to maintain a logic link between your sayings.
* Don't put two opposite faces of coin at a same time.
* Deliver in a structured & planned way.

6. Globalization and Localization:

* Try to explain the broader aspects but not on the cost of local values.
* Aggregation of local values should result into global and broader aspects.

7. Style of Expressing:

* Control various speech parameters like pitch, tone, intensity etc. according to the environment.
* Don't be too fast or too slow.
* Light Humor at the right time is always accepted.
* Look straight & forward. Keep a light smile on your face.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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* Avoid using words that show arrogance.
* Feel what you say.
* Avoid being too formal, be natural and practical.

8. Know and Analyze the audiences.

9. Do a good Homework.

10. Dress properly:

* 25% confidence and 25% Respect from audiences comes automatically, if you have dressed up
well.
* Be neat, clean, ironed and polished irrespective of the fact that you have dressed up formally or
informally.
* Do a good hair styling; avoid any casual or unethical looks.

PROCESS OF COMMUNICATION:
All of the managers functions involve communication. The communication process
involves six steps.
Ideation encoding transmission receiving decoding response

Response decoding receiving transmission encoding
Ideation:
The first step, ideation, begins when the sender decides to share the content of her message
with someone, senses a need to communicate, develops an idea or selects information to share.
The purpose of communication may be inform, persuade, command, inquire or entertain.
Encoding:
Encoding is the second step, involves putting meaning into symbolic forms. Speaking,
writing or non verbal behavior. Ones personal, cultural and professional biases affect the goals
and encoding process. Use of clearly understood symbols and communication of all the receiver
needs to know are important.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Transmission:
The third step, transmission of the message, must overcome interference such as garbled
speech, unintelligible use of words, long complex sentences, distortion from recording devices,
noise and illegible handwriting.
Receiving:
The receivers senses of seeing and hearing are activated as the transmitted message is
received. People tend to have selective attention (hear the message of interest to them but not
others) and selective perception (hear the parts of the message that conform with what they want
to hear) that cause incomplete and distorted interpretation of the communication. Sometimes
people tune out the message because they anticipate the content and think they know what is
going to be said. The receiver may preoccupied with other activities and consequently not be
ready to listen.
Decoding:
Decoding of the message by the receiver is the critical fifth step. Written messages allow
more time for decoding, as the receiver assesses the explicit meaning and implications of the
message based on what the symbols mean to her. The communication process is depend on the
receivers understanding of the information.
Response or feedback:
It is the final step. It is important for the manager or sender to know that the message has
been received and accurately interpreted.
PRINCIPLES OF COMMUNICATION:
Communication should be conviction.
Communication should be appropriate to situation.
Communication should have objective and purposes.
Communication should promote total achievement of purposes.
Communication should represent the personality and individuality of the communication.
Communication involves special preparation.
Communication should be oriented to the interest and needs of the receiver.
Communication through personal contact.
Communication should seek attention.
Communication should be familiar.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
TECHNIQUES TO IMPROVE THE COMMUNICATION:
- Listening
- Broad openings
- Restating
- Clarification
- Reflection
- Focusing
- Sharing perceptions
- Silence
- Humor
- Informing
- Suggesting
Listening:
An active process of receiving information. The complete attention of the nurse is required
and there should be no preoccupation with oneself. Listening is a sign of respect for the person
who is talking and a powerful reinforce of relationships. It allows the patients to talk more,
without which the relationship cannot progress.
Broad openings:
These encourage the patient to select topics for discussion, and indicate that nurse is there,
listening to him and following him. For e.g. questions such as what shall we discuss today? can
you tell me more about that? And then what happened? from the part of the nurse encourages
the patient to talk.
Restating:
The nurse repeats to the patient the main thought he has expressed. it indicates that the
nurses is listening. It also brings attention to something important.
Clarification:
The persons verbalization, especially when he is disturbed or feeling deeply, is not always
clear. The patients remarks may be confused, incomplete or disordered due to their illness. So,
the nurses need to clarify the feelings and ideas expressed by the patients. The nurses need to
provide correlation between the patients feeling and action. For example I am not sure what
you mean ? Could you tell me once again? clarifies the unintelligible ideas of the patients.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Reflection:
This means directing back to the patient his ideas, feeling questions and content.
Reflection of content is also called validation. Reflection of feeling consists of responses to the
patients feeling about the content.
Focusing:
It means expanding the discussion on a topic of importance. It helps the patient to become
more specific, move from vagueness to clarity and focus on reality.
Sharing perceptions:
These are the techniques of asking the patient to verify the nurse understands of what he
is thinking or feeling. For e.g. the nurse could ask the patient, as you are smiling, but I sense
that you are really very angry with me.
Theme identification:
This involves identifying the underlying issues or problem experienced by the patient
that emerges repeatedly during the course of the nurse-patient interaction. Once we identify the
basis themes, it becomes easy to decide which of the patients feeling and thoughts to respond to
and pursue.
Silence:
This is lack of verbal communication for a therapeutic reason. Then the nurses silence
prompts patient to talk. For e.g. just sitting with a patient without talking, non verbally
communicates our interest in the patient better.
Humor:
This is the discharge of energy through the comic enjoyment of the imperfect. It is a
socially acceptable form of sublimation. It is a part of nurse client relationship. It is constructive
coping behavior, and by learning to express humor, a patient learns to express how others feel.
Informing:
This is the skill of giving information. The nurse shares simple facts with the patient.
Suggesting:
This is the presentation of alternative ideas related to problem solving. It is the most
useful communication technique when the patient has analyzed his problem area, and is ready to
explore alternative coping mechanisms. At that time suggesting technique increase the patients
choices.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
TYPES OF COMMUNICATION:

Communication


On the basis of relationship on the basis of flow on the basis of
expression


Formal informal vertical horizontal verbal non verbal

Downward upward oral written.

ONE-WAY V/S TWO WAY COMMUNICATION:
One-way communication:
The flow of communication is one way from the communicator to the audience. Example
receive method.
Drawbacks are:
- Knowledge is imposed.
- Learning is authoritative.
- Little audience participation.
- No feedback.
- Does not influence human behavior.
Two way communication:
In this both the communicators and the audience take place. The process of communication
is active and democratic. It is more likely to influence behavior than one way communication.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
FORMAL V/S INFORMAL COMMUNICATION:
Communication has been classified into formal (follows lines of authority) and informal
(group line) communication.
Formal communication:
It is officially organized channels of communication and it is delayed communication. It is
generally used for all practices purposes. This authoritative, specific, accurate and reaches
everybody. The medium of formal communication may be department meeting, conferences,
telephone calls, interviews, circular etc.
Informal network:
Gossip circles such as friends internet group, like minded people and casual groups.
Communication is very faster here. The informal channels may be more active. It follows
grapewine route. It may be a fact but more in native of rumor. It does not reach every one
informal communications are quite fast and spontaneous.
Physiological communication:
It is a stimulus received by the body immediately the brain receives the information and
transmits to the respective organs through the nervous, where it has to be passed.
Psychic communication:
Extra sensory perception occurs, i.e something which will occur in future. The person
pertains and predicts that in advance is called psychic communication.
Serial communication:
Person to person the message will be passed line a chain. Sender passes the message to one
person, then that receiver passes information to other and so on.

Symbolic communication:
Good communication requires awareness of symbolic communication, the verbal and
nonverbal symbolism used by others to convey meaning.
Visual communication:
The visual forma of communication comprise charts and graphs, pictograms, tables, maps,
posters etc.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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VERBAL V/S NONVERBAL COMMUNICATION:
The traditional way of communication has been by word of mouth language is the chief
vehicle of communication. Through it, one can interact with other can be passes through. Direct
verbal communication by word of mouth may be loaded with hidden meanings. The important
aspects if verbal communications are as follows.
Vocabulary:
Communication is unsuccessful if senders and receivers cannot translate each others word
and phrases when a nurses cases for a client who speaks another language an interpret may be
necessary.
Denotative and connotative meaning:
A single word has several meaning. Individuals who use a common language share the
denotative meaning, baseball has the same meaning for everyone who speaks English, but code
denotes cardiac arrest primarily to health care providers.
The connotative meaning is the shade or interpretation of a words meaning influences
by the thoughts, feelings or ideas people have about the word.
Pacing:
Conversation is more successful at an appropriate speed or pace nurse should speak
slowly enough to enunciate clearly. Pacing is improved by thinking before.
Adoptability:
Spoken messages need to be altered a according with behavioural due from the receiver.
Intonation:
Tone of voice dramatically affects a meaning. The nurse must be aware of voice line to
avoid sending unintended messages.
Clarity and brevity:
Effective communication is simple, brief and direct. Clarity is achieved by speaking
slowly, enunciating clearly and using, repeating important parts of a message also clarifies
communication.
Brevity is achieved by using short sentences and words that expresses an idea simply
and directly.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Credibility:
Credibility means worthiness of belief, trustworthiness and reliability.
Time and relevance:
Timing is critical in communication. Even though message is clear, poor timing can
prevent it from being effective. Often the best time for interaction is when a client express an
interest in communication. If message are relevant of important to the situation at hand, they are
more effective.
Oral communication:
Oral communication is a transmitting message orally either by meeting the person through
artificial media of communication such as telephone and intercom systems.
Written communication:
It is transmitting message in writing. Written communication can be followed when a
record of communication is necessary.
NON VERBAL COMMUNICATION:
Communication can occur even without word. Non-verbal communication is message
transmission through body language without using words. It includes bodily movements,
positive, facial expression. Silence is non verbal communication. It can speak louder than words.
Personal appearance:
Nurse learn to develop a general impression of clients health and emotion status through
appearance and clients develop a general expression of the nurses professionalism and caring in
the same way personal appearance includes physical characteristics, facial expression, manner of
dress and grooming first impressions are largely based on appearance.
Poster and gait:
Poster and gait are forms of self expressions. The way people sit, stand and more reflect
attitudes, emotion and self concept and health status.
Facial expression:
The face is the most expressive part of the body. Facial expression convey emotion such as
surprise, fear, anger, happiness and sadness. People can be unaware of the messages their
expression convey doing procedure and the client may interpret. This is anger or disapproval.

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Eye contact:
Maintaining eye contact during conversation shows respect and willingness to listen, lack
of eye contact may indicate anxiety, discomfort or lack of confidence in communicating.
Hand movements and gestures:
Hands also communicate by touch, slapping or caring anothers head communicates
obvious feelings.
MECHANICAL COMMUNICATION:
By using mechanical devices the communication will be sent. For e.g. internet, radio,
T.V. etc.
ADVANTAGES OF COMMUNICATION:
Oral communication:
+ It is face to face system and hence can be clarified.
+ There is an opportunity to ask questions, exchange ideas and clarify meaning.
+ It can develop a friendly and co-operative spirit.
+ It is easy and quick.
+ It is flexible and hence effective.
Written communication:
+ It has permanent record for future reference.
+ It is less likely to be misunderstood.
+ It will have adequate coverage and accuracy.
+ Suitable for communicating lengthy messages.
+ It is an authoritative communication.
DISADVANTAGES OF COMMUNICATION:
Oral communication:
+ The spoken words may be misunderstood.
+ The facial expression and tone of voice of the communicator may misled the receiver.
+ Not suitable for lengthy communication.
+ It requires the art of effective specificity
+ It has no record for future reference.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Written communication:
+ It requires skill and education for understanding.
+ It is also one way communication and hence may not be effective.
+ There is no opportunity for the subordinates to ask questions and exchange ideas.
+ It may not communicate all aspects.
STRATEGIES OF COMMUNICATION:
Think before you speak:
Think about the purpose of your communication. What do you hope to accomplish with
your words or actions? Are your comments about something you are responsible for doing, such
as parenting or managing someone or about an activity you are doing together with the other
person? Or, is it an opinion about something that is not your business, maybe even something
that the other person has already asked you to stop discussing?
"Before you speak, ask yourself: Is it kind? Is it necessary? Is it true? Does it improve
on the silence?" . Also, think about the structure of your communication.

Listening:
The most effective leaders know when to stop talking and start listening. This is especially
important in three particular situations: when emotions are high, in team situations and when
employees are sharing ideas.
First, listening is crucial when emotions are high. Extreme emotions, such as anger, resentment
and excitement, warrant attention from a personal and a business standpoint. On a personal level,
people feel acknowledged when others validate their feelings. Managers who ignore feelings can
create distance between themselves and their employees, eroding the relationship and ultimately
affecting the working environment.
Questioning:
Many leaders need information but aren't sure how to get it. Similarly, their employees may have
information but don't know how to impart it. Managers can open the lines of communication by
asking good questions. Note that different kinds of questions yield different kinds of results.
Here is a short primer on questioning:
* Closed questions are those that elicit yes/no answers. These are beneficial when a manager
simply needs to check the status of an issue. Has the report been completed? Do you know what
to do? Can you get that to me by Friday? These are examples of closed questions that are
perfectly appropriate in the right situations.
* Open questions are those that elicit longer responses. They are useful almost anytime a
manager wants more than a yes/no answer--for instance, when seeking input from others,
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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looking for information about a particular topic or exploring a problem. What do you think
would be the best way to go about this? How are you doing on that project? What went wrong?
These kinds of questions give others the chance to give all of the information they have and to
avoid the innumerable consequences that can come when leaders make assumptions without
becoming well-informed.
* Personal questions have a special role in leadership. Inappropriate personal questions can
alienate employees. Asking direct reports if they are dating anyone or why they haven't bought a
house can be perceived as prying, even if the questions are well intended. Appropriate personal
questions, however, can create a sense of camaraderie between employee and boss.
Using Discretion:
Knowing when not to speak as a leader is just as important as speaking. Managers must
understand that the moment they don a new title, they become a leader--one whom others look to
for guidance, direction and even protection. Good leaders adopt a policy of discretion, if not
confidentiality, with their employees. Only then can they develop the trust that is so vital to
productivity.
Confidential situations may arise in a number of areas, personal and professional. Here are some
topics that may warrant discretion:
* An employee is having a direct conflict with another employee.
* An employee is concerned about another employee's conduct.
* An employee's performance has dropped substantially.
* An employee has a health issue or personal problem.
* An employee wants genuine advice on how to excel but doesn't want to be seen as cozying up
to the boss.
Directing
Notice that directing comes last on the list of communication strategies. It may not be the least
important, but it is definitely one to use less often. Many managers direct their employees
because they believe it's the only way to get things done. It is not.
But directing has its place. Directing means giving directions clearly and unequivocally, such
that people know exactly what to do and when. It is best used in times of confusion, or when
efficiency is the most important goal. Although it can be effective, directing also can lead to
complacency on the part of employees who may adopt an "I just do what they tell me" attitude.
Use it sparingly

PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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CHANNELS OF MANAGERIAL COMMUNICATION:
There are four levels of managerial communication:
Downward communication.
Upward communication.
Lateral communication.
Diagonal communication.
Downward communication:
This is the traditional and most used communication, where the management gives orders to
the subordinates at the bottom level to carry out the orders as per the organizational hierarchy.





All the written and oral communication which are carried out from the top management
to the employees by various means in order that the employees carry out their duties in the
organization in achieving its goals.
Upward communication:
Upward communication in the management levels from staff, lower and middle
management personnel and continuous up to the organizational hierarchy. It provides a means
for motivating satisfying personnel by encouraging employees input.







Management
Subordinates Subordinates
Management
Subordinates Subordinates
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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Lateral communication:
Lateral or horizontal communication is referred to the communication which takes place
between the departments or personnel on the same level of the hierarchy.





Diagonal communication:
Diagonal communication occurs between two individuals or departments that are not on
the same level of the hierarchy.









Laboratory x-ray laundry
CSSD
Common means are: unit in-charge ordering diet for the patient, X-ray department informs
appointments given to patients in a particular unit, etc.



Management
Subordinates
Subordinates
Management
Nursing department
Medical department
departm departmen
Pediatrics Surgical Medical Pathology Surgical unit Medical unit
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
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BARRIERS OF COMMUNICATION:
Communication barriers create problem of misunderstanding and conflict between men who
live together in the same community, who work together on the same job and even between men
living in the distinct parts of the world who have never seen one another.
Following are the main barriers to overcome:
1. Due to organization structure:
The breakdown or distribution in communication sometimes arises due to:
1. Several layers of management;
2. Long lines of communication;
3. Special distance of subordinates from top management;
4. Lack of instructions for passing information to the subordinates;
5. Heavy pressures of work at certain levels of authority.
2. Due to status and position:
1. The attitude exhibited by the supervisor are sometimes a hurdle in two way
communication. One common illustration is non listening habit. A supervisor may guard
information for:
a. consideration of prestige, ego and strategy.
b. underrating the understanding and intelligence of subordinates.
2. Prejudice among the supervisors and subordinates may stand in the way of a free flow of
information and understanding.
3. The supervisors particularly at the middle level may sometimes like to be in good books of
top management by:
a. not seeking clarification on instructions which are subject to different interpretations; and
b. acting as screen for passing only such information which may please the boss.
3. semantic barriers:
Semantic is the science of meaning. Words seldom mean same thing to two person. Symbols
or
Words usually have a variety of meaning arid the sender and the receiver have to choose
one meaning from among many. If both of them choose the same meaning, communication will
be perfect. But this is not so always because of differences in formal education and specific
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
situations of the people. Strictly one cannot convey meaning, only one can do it to convey words.
But the same words may suggest quite different meaning to different people, e.g. profits may
mean to management efficiency and growth, whereas to employees it may suggest excess funds
piled up through paying inadequate wages.
4. Tendency to evaluate:
A major barrier to the communication is the natural tendency to judge the statement of the
person or other group. Every one tries to evaluate others from his own point of view or
experience. Communication requires an open mind and willingness to see things through the
eyes of others. Some intelligent brains even complimented him on his excellent style of
imagination.
Heightened emotions:
Barriers may also arise but in specific situations, e.g. emotional reactions, physical
conditions like noise or insufficient light, past experience, etc. when emotions are strong, it is
most difficult to know the frame of mind of the other person or group.
Lack of ability to communicate:
All persons do not have the skill to communicate. Skill in communication may come
naturally to some, but an average man may need some sort of training and practice by way of
interviewing and public speaking, etc.
Inattention:
The simple failure to read bulletins, notices, minutes and reports is a common feature.
With regard to failure to listen to oral communications, it has been seen that non listeners are
often turned off while they are preoccupied with other affairs, like their family problems.
Unclarified assumptions:
This can be clarified by an illustration. A customer send a message that he will visit a
vendors plant at particular time on some particular date. Then he may assume that vendor will
receive him and arrange for his lunch, etc. whereas vendor may assume that the customer was
arriving in the city to attend some personal work and would make a routine call at the plant. This
is an unclarified assumption with possible loss of goodwill.
Resistance to change:
It is the general tendency of human-being to maintain status quo. When new ideas are
being communicated, the listening apparatus may act as a filter in rejecting new ideas. Thus,
resistance to change is an important obstacle to effective communication.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Sometimes, organizations announce changes which seriously affect the employees,
e.g. shifts in timings, place and order of work, installation of new plant, etc. changes affect
people in different ways and it may take sometime to think through the full meaning of the
message. Hence, it is important for the management not to force changes before people are in a
position to adjust to their implications.
Closed minds:
Certain people who think that they know everything about a particular subject also
create obstacles in the way of effective communication.
THEORIES OF COMMUNICATION:
Related to management:
+ The decibal theory
+ The sell theory
+ The minimet theory
The decibal theory:
It argues that the best way to get the message across is to state ones point loudly and
frequently. its effectiveness over a period of time is nil, but many of us still need to be reminded
that shouting only makes poor communication louder.
The sell theory:
It lays down that the total burden of communication is on the communicator while the
receiver is passive and pliable. One of the problem created by this approach is that it tends to
increase the barriers between the individuals and thus reduces the chances of hearing each other.
The minimet theory:
It assumes that the receiver probably is not much interested in what is being communicated.
By telling an individual what he needs to know, he will have little to object and little to question.






PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
4. PUBLIC RELATIONS
INTRODUCTION:
Public relation is an essential and integrated component of public policy or service. The
professional public relation activity will ensure the benefit to the citizens, for whom the policies or
services are meant for. An effective public relations can create and build up the image of an individual or
an organization or a nation. At the time of adverse publicity or when the organization is under crisis an
effective public relations can remove the "misunderstanding" and can create mutual understanding
between the organization and the public.

OBJECTIVES:
On completion of the seminar the participant will be able to:
Explain public relation concept and its importance.
Explain the importance of organizational image.
Develop public relation programmes in the hospital.
Explain about the methods of maintaining public relation in the community.
Tell about the public relation in an educational institution.
Understand the role of dean in public relation.

TERMINOLOGIES:
(1) Fortitude: Happening by chance.
(2) Composite: Made up of different part or material.
(3) Humility: Quality of being humble
(4) Persuasive: Able to give good reason for doing something.

DEFINITION OF PUBLIC RELATION:
Public relation are knowing what the public expects and explaining how administration is
meeting these desires.. - John Millet

Public relation in Government is the composit of all the primary and secondary contacts
between the bureaucracy and citizens and all the interactions of influences and attitudes established in
these contracts. - J.L MeCamy,

Public relation means the development of cordial, equitable and therefore mutually profitable
relations between a business industry organization and the public it serves. - W.T. Parry

Public relations are the process whereby an organization analyses the needs and desires of all
interested parties in order to conduct itself more responsively towards them. - Rex Harlow,
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
NEED OF PUBLIC RELATION:
Not many years ago, management decisions took no consideration of public attitudes but today
management cannot ignore the views of employees, and the community in making policy decisions. It
has been estimated that eighty per cent of the problems confronting management have public relations
implications. Management has to foresee the impact of policy decisions on the opinion of the public.
There is normally four distinct reasons for ever increasing necessity of public relations:
(1) Increased governmental activities.
(2) Population explosion creating communication problems.
(3) Increased educational standards resulting in rise in expectations.
(4) Progress in communication techniques.
Well-executed public relations will
Increase visibility for the hospital, employees, programs and services.
Position the hospital as a health care leader and authority within the community or
region.
Expand awareness of the hospitals entire range of programs and services.
Enhance the hospitals image.
Aid in recruitment and retention of employees.
Support efforts to raise funds for new programs and services or assist with the passage
of levies and bonds.
Act as a foundation when negative news about the hospital occurs.
Boost employee morale.
Functions of public relation:
Public Relation is establishing the relationship among the two groups
(organization and public).
Art or Science of developing reciprocal understanding and goodwill.
It analyses the public perception & attitude, identifies the organization policy with
public interest and then executes the programmes for communication with the
public.

ELEMENTS OF PUBLIC RELATIONS:
A planned effort or management function.
The relationship between an organization and its publics.
Evaluation of public attitudes and opinions.
An organizations policies, procedures and actions as they relate to said organizations
publics.
Steps taken to ensure that said policies, procedures and actions are in the public interest
and socially responsible.
Execution of an action and or communication programme.
Development of rapport, goodwill, understanding and acceptance as the chief end result
sought by public relations activities.




PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
FORMS OF PUBLIC RELATION:
Public relation is a general term that may include many other relations with different audiences,
strategies and tactics. For example:
Employee relations:
It is a function of public relations that includes responding to employee concerns and informing and
motivating staff. Some tactics used for employee relations may include new employee education,
employee award programs and recognitions, new-hire press releases and newsletters to name a few.

Community relations:
It is the function of actively planning and participating with and within a community for the benefit
of the community and the hospital. Tactics within this category include community events, volunteer
activities and co-sponsorship opportunities with other community organizations. Community relations
may also include fundraising and development activities.

Government relations:
It is a function of relating to government officials and agencies about issues that impact the hospital
and its audiences. Hill climb events in Olympia, letter writing campaigns, and op-ed placements in the
newspaper are often part of government relations.

Media relations:
It is often considered synonymous with public relations, is the function of working with the media
to communicate news. Media relations can be active seeking positive publicity for a newsworthy topic at
the hospital or reactive responding to a news inquiry about a positive or negative story of interest to
the media and its readers or viewers.

PUBLIC RELATION PLAN FOR A HOSPITAL:
Every hospital should have a current public relations plan that outlines goals and desired
outcomes for a period of three to five years. Once a general PR plan is in place, periodic planning and
updating is critical. The plan and its updates will not only help guide employees responsible for public
relations work, but will result in an effective tool to communicate with the board and other staff.
Following are the key elements of an effective PR plan:

Goals:
Public relations goals help direct the strategies and tactics in future public relations endeavors. The
goals should clearly support hospital mission statement. While a mission statement may include what the
hospital wants to accomplish, a public relations goal should be focused on what you want the public to
think and know about the hospital
Examples:
General Washington Hospital is a community leader committed to providing high quality
health care for the people of Carter, Key and Kangley counties.
Highland Valley Medical Center provides superior primary care services in a comfortable, safe
environment for people in the Highland Valley region.
Ivy River Hospital, with its friendly, helpful physicians and nurses, is the most dependable
health care service provider in the state.


PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Objectives:
Objectives help determine specific outcomes from your public relations efforts. Objectives should be
clear and concise, and include timing.
Examples:
Increase awareness of the technology and medical advances used at the hospital within Evergreen
County over the next six months.
Build the reputation of the hospital in the next three to four years as a cornerstone of the
community that provides health care services, jobs and community leadership.
Encourage renewed interest in specialty hospital services such as childbirth classes over the next
two years.

Target Audiences:
Detail the groups of people that are important to inform or influence, and why.
Examples:
Patients: They purchase health care services and generate revenue for the hospital.
Physicians: They use hospital facilities and generate revenue for the hospital. They control where
patients go for care in the hospital or outside of the community.
Media: They write both positive and negative stories about the hospital, its staff and services. They
have considerable influence and access to all of the hospitals target audiences.
Other audiences to consider may include employees, board members, community leaders, local
government officials, state legislators, vendors and suppliers.

Tactics:
Its easy for busy hospital professionals to think about tactics first, but it is critical to have a solid
strategy in place. Only pursue the tactics that will help achieve the goals. Here are some best uses for
specific tactics.
Brochure/Collateral To inform patients and community members about programs and services
provided at the hospital for promotional use only. It may be provided to media for background, but
not to be used instead of effective media tools, such as press releases or fact sheets.
Direct mail To help create awareness for programs or services with target audiences. Message is
controlled.
Letters Good for personal or business communication. Adjustable length (1-2 pages).
Postcards Good for event invitations or welcome cards. Inexpensive postage.
Direct mail packages Good for inclusion in new neighbor welcome packages or community
coupon envelopes. Consider including brochures or inserts. Costs are typically part of an
advertising or sponsorship package. Production of materials likely not included.
Specialty mailings Good for awareness efforts, such as a child safety campaign sponsored by
the hospital. Mailing may include a magnet with safety tips and local emergency contact
information.

Distribution Methods:
How you distribute materials is often as important as what the organization send. It is a good idea
to know which methods the target audiences, especially reporters, prefer.
Mail Good to use when timing is less sensitive (one to three days). Good for newsletter mailings,
new neighbor welcome packets, media kits, and other materials that are difficult to fax or e-mail.
Mail can also be certified to verify receipt or insured to avoid loss.
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
Fax Good for timely communication (faster than mail). Good for press releases, event reminders,
and some forms of newsletters (such as weekly news notices). Less effective for documents with
images or graphics.
E-mail Good for timely and direct communication with an individual. Good for press releases,
media reminders, media personnel questions, and pitch letters. Access to e-mail and electronic
document size can be limitations.
Face-to-face meetings Best way to make a personal connection. It allows for detailed
explanation of a point-of view or complicated subject. Best way to demonstrate excitement,
concern, tolerance, empathy, etc.
Phone conference call Allows for personal contact when face-to-face is not possible. Good for
back-and-forth communication. Inexpensive method for communicating with large groups in
different locations (cities/states).
Web site Web pages allow interested parties to pull information thereby facilitating distribution.
Directing people to a web site may be done through mailings, publicity or other notices.
Newsletter To regularly update a variety of target audiences about the happenings at the
hospital. Good way to establish and maintain community support for the hospital and services.
Public service announcement (PSA) To create awareness of a problem or issue through radio
or television.
Press release To distribute straightforward news to the media.
Press kit To provide extensive information about a topic. It may precede an event or new
program launch.
Press conference To disseminate time sensitive and critical news to multiple media contacts at
once. It should be rarely used.
Special event To make a personal connection with target audiences in a positive environment. It
is good way to recognize people for good work or launch new programs of facilities.
Speaking engagement To reach a target audience, establish the speaker as an expert and build
credibility for the speaker and the hospital.
Video To communicate messages with emotion through visuals. It is good for town meetings,
new employee education, fundraising projects, special events, etc.
Web site To provide 24-hour access to information about the hospital. It may include health
information or links to health information depending on site design. It is good for general
information about the hospital, its services and staff.

Budgets:
Public relations budgets may come in a variety of ways. It may be pre-determined and passed down
from the overall hospital budget. It may include general guidelines but is open to the tactics decided upon.
It may be non-existent, in which case the tactics will need to rely on investments in staff time, instead of
materials. All of these factors will determine where budgeting fits into the overall public relations
planning. Regardless of where budgeting fits into the plan, consider the following:
Nothing is free------- Consider all of the direct and indirect costs. Even a press release, one of the
least expensive tactics, has a price tag, the time spent writing and editing the release, the paper it is
printed on and the postage its mailed with at a minimum.
Dont underestimate time investments-------- Every public relations activity has time investments
and opportunity costs and dont just consider the time investments for the PR staff. Administrative
oversight and involvement, interview source preparation and even volunteer efforts all play into
PADMASHREE INSTITUTE OF NURSING. M.Sc. Nursing II years (2009-2011 batch)
PREPARED BY: ANOOP, CHETAN, DEEPAK, LINGARAJ, SARATH CHANDRAN, MITHUN
the opportunity costs of public relations. When planning and prioritizing projects, consider all
necessary staff time and what else they would be doing with their time if not promoting the
hospital.
Shop around--------- When producing brochures or printed materials; be sure to get more than one
estimate. Printing shops with more capacity at certain times may discount their ra