CURRENT TRENDS AND ISSUES IN NURSING ADMINISTRATION

INTRODUCTION
Administration is an essential factor in the development of any service. Administration
provides the means whereby most effective use can be made of the knowledge and the skills of all
those who are involved in it.

The development of nursing service has been enhanced greatly by advances made in
professional skills and technical proficiency. But it is apparent that the, same development has not
been made in nursing administration.

DEFINITION
"Administration is the organization & direction of human and material resources to achieve
desired ends".

-Pfiffner and Presthus.

"Administration is the direction, coordination and control of many persons to achieve same
purposes or objective

- Nigro
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

"Administration is the organization and use of men and materials to accomplish purposes. It is the
specialized vocation of managers who have skill of organizing and directing men and material just
as definitely as an engineer has skill of building structure"
- James L
AIMS OF NURSING ADMINISTRATION:
To ensure effective utilization of resources for the attainment of goals and make decisions
regarding,
 What activities are to be performed
 By whom to be performed
 Where these are to be carried
 NATURE OF ADMINISTRATION
Administrative process is intellectual, social, dynamic and creative as well as continuous.
The feature or natures of administration are:-

 It is universal- because irrespective of nature and objectives of the organization, all basic
elements of administration such as planning, organizing, staffing, directing, coordinating,
reporting, budgeting can apply for its effective achievement of goals.
 It is holistic:- the whole process of administration embraces the organization and its function
in entirely, i.e. involve total activities of the organizations.
 It is intangible: - Since administration is visualized as abstract. It cannot be transferable to
anywhere. So, every organization has to develop its own administrative style within the
contact of functional elements of administration.
 It is continuous and ongoing process. The cycle of administration goes on continuously.
 It is goal oriented:- administration is always struggling to achieve the laid down goals and
objectives of the organizations.
 It is social and human:- usually in administration group of people are there to achieve the
objective. It needs good social and interpersonal contact or relationship to achieving the goal.
 It is dynamic:- administration has the elements of flexibility and adaptability and
adjustability rising to the needs and demands of different situation.
 It is creative or innovative:- to have an effective administration existed administration
provides innovation, offers and invites creative ideas to its organizational teams

PRINCIPLES OF ADMINISTRATION
Fourteen principles of administration were identified by Henri Fayol as follows:-

1. Division of work:- In any organization administrator or manager cannot perform all the activities
to achieve its objective. So there should be division of work according to managerial and non-
managerial.

2. Authority, responsibility and accountability: If the person has to perform job assignment
effectively according to their own qualification and experience.

3. Discipline:- for smooth running of administration to achieve objectives, there should be proper
observance of the rules, regulations, norms, decorum, manners, code of ethics and respect; this
requires to be enforced within the organization by the managers.

4. Unity of Command: in any organization the subordinate should be supervised by a single

supervisor to whom he/she should be accountable.

5. Unity of direction: In any organization, there should be one supervisor to give direction to
his/her subordinate.
6. Subordination of individual interest to organizational interest. This implies that narrow selfish
interest should be overcome or should turn to common and broad interest of the organization for
its welfare.

7. Remuneration of personnel:- There should be fair policy for payment of the personnel
justifying the workload job hazards, efficiency and quality of performance.

8. Centralization: - There should be some amount greater and larger authority resting with top
level managers.

9. Scalar chain of command: This implies that there is chain or link of directional instructions
from the top level to the lowest rank of organizational members in the hierarchy.

10. Order: In an administration there should be proper systematic arrangement of staff, materials,
supplies and equipment according to requirement of specific job departments.

11. Equity: - In administration, there should be a fair and impartial treatment to all workers
irrespective of their job.

12. Stability of tenure of personnel: Organizations should make proper efforts to ensure stability
and continuity in the tenure of personnel, which gives security and promotes productions.

13. Initiative: Administration should always be encouraging initiative from each employee by
allowing him freedom to do his/her best.

14. Esprit de corps: It refers to sense of belonging. This fosters the team spirit, i.e. the spirit of
working together to achieve objectives efficiently

ELEMENTS OF ADMINISTRATION
Professor Luther Gullick (1937- summed up certain principles or elements in the word
“POSDCORB”). It is made up of initials and stands for the following.

“P” stands for planning

That is working out a broad outline.

“O” stands for staffing

That is the establishment of the formal structure of authority through which work of sub
division are arranged defined and coordinated for the defined objectives.

“S” Stands for staffing

That is the whole personnel function of bringing in and training the staff and maintaining
favorable conditions of work.

“D” Stands for Directing

That is the continuous task of making decision and embodying them, in specific and general
orders and instructions and serving as leader of the enterprise.
 “CO” Stands for Coordinating
That is all important duty of inter-relating the various parts of the work and eliminating of
overlapping and conflict

“R” Stands for Reporting

That is keeping those to whom the executive is responsible informed as to what is going on,
which thus include keeping himself and his subordinate informed through records, research and
inspection.

“B” stands for Budgeting:

With all that goes with budgeting in the form of fiscal planning, accounting and control

TRENDS IN NURSING ADMINISTRATION

Trends denote general direction and tendencies especially of events, and opinion. So
nursing trends refer to the general direction towards which the different nursing events, have
moved and are moving, as well as the opinions in and around nursing and tendencies that we find
in and about our profession.

NURSING SERVICE IN ANCIENT TIMES

· Study of the history will help us to know what nurse thought and did in the past and which may
still affect us and may have had some influence on what we think and do.

· The study of how problems were approached and solutions obtained in the past will help us to
understand and find solutions to problems of our own time.

· In the book of Charaka it is mentioned that “The physician, drug, nurse and patient constitute an
aggregate of four.”

· Nurse educations and administrations are now stating a new framework in which the graduate
nurse should function. They are making people aware of what virtues nursing service should
possess so as to help the patient regain or maintain their maximum degree of health.

Influence of the Christian Era on Nursing Service.

·

Scrutinizing the history of Christian era, we find the emergence of human relation in patient care.
The parable of Good Samaritan is closely interwoven into nursing services. The attitude of taking
care of person as a patient has continued to influence nursing services and hospitals.

· During the Greek medicine and in Christian era, nursing became a respected occupation in
which the most unpleasant work was made dignified by a sense of devotion.

· As the church grew in strength. It created position designed to provide simple service to
members of the community.
· The Deaconess order was organized in 400 AD. These women gave simple nursing care to the
needy and prisoners.

· Influence of the church silenced medical research. The existing medical practice slowly
deteriorated. The period of monastic medicine is usually called the Dark ages of medicine. The
monks played a predominant role in the practice of medicine, while the medical professionals
almost disappeared.

· In the 16th Century, with the reformation, nursing sank to its lowest level. Hospitals were
organized by the church.

· In that period, nursing was only an art. Scientific knowledge and its application to nursing, as we
conceive it nowadays was unknown in the middle ages. The nursing personnel in the secular
hospitals were illiterate and overworked. There was no status attached to the nursing personnel,
even though they were members of civic-controlled hospitals.

EMERGENCE OF MODERN NURSING SERVICE:

·

In the 19th century as men came up with new ideas about the material world and about the world
of human society. The development of modern medicine and nursing followed.

The enlightenment movement liberated new ideas about things and their relation, belief in the
devil and his possessions began to disappear.

· Modern Medicine emerged, with the emergence of modern medicine and hospitals, adequate
nursing service became a prime necessity.

· Paster Fleidner and his wife re-established the Deaconess movement at Kaiserwerth, Germany

· In 1960, Florence Nightingale’s concept of a new system of nursing became a reality through the
establishment of a training school at St. Thomas Hospital, London. This system of nursing offered
economic independence and secular vocation for women.

Development of Nursing Service in the United States

· Nursing service in the United Stated came up from the concepts developed from the military
orders. Cathelic and Anglican sisterhoods, the Deaconess movement and from percepts of
Florence Nightingale and other nurse ancestors.

· In 1858, the American Medical Profession advocated the establishment of training schools for
women. The apprenticeship nursing in hospitals was started.

· In 1983, the problems of nursing were discussed by physicians and nurses at the Chicago’s
world Fair.
· In 1899, Teachers College, Columbia University realized the need for higher education, offered
courses in preparation for teaching.

· In 1910, the University of Minnesota established the basic school of nursing to become part of
the university system.

· At an American Nurses Association’s regional conference in 1961, Eleavor Lambertsen

emphasized the modern roe of the director of nursing and the role of director of nursing and the
role of the related institutional services with respect to the patients.

· Utilization of personnel and facilitation of services are major objective of administration.

· Between 1913 and 1917 more than 500 schools of nursing were established. The three year
courses duration had been generally adopted.

· With the First World War the responsibility and workload of nursing services was increased.

· By 1920 every hospital wanted its own school. The apprenticeship system in hospitals improved
nursing care

Nursing Service within the Modern Hospital

EMERGENCE OF NURSING SERVICE STANDARDS

During 1935 to 1950 social forces had a tremendous influence upon the development of
nursing services.

· In 1936 the manual of essentials of good hospital service was published under the sponsorship of
the American hospital Association and the National League for Nursing Education. This was
published to give recognition to the minimum standards of average patient care.

· The manual was revised in 1942, and a third manual was published in 1950 under the title
hospital Nursing Service Manual.

· Nursing service was beginning to function on own. The value of scientific method and fact were
seen on the horizons of nursing service administration.

· As the hospital grew at the times of industrial revolution. It accepted norms of modern business
organization. The hospital was under the control of board of directors who delegated authority to
executive director or hospital administrator. The administration established personnel, dietary and
purchasing departments.

· Administration was concerned with placing of nursing service as a whole in the hospital. The
director of nurses won control over many administrative aspects of the nursing service. Nursing
 service continued to be responsible for supplies and equipment and for the employment and
discharge of nursing service personnel.

· With the expansion of services to patients, the nursing director was forced to delegate more
responsibility and authority to the nurses of the patient’s unit. The role of the graduate nurse in
most hospitals became one of co-coordinating and controlling nursing services and hospital
services.

· As the employee of the hospital, the nurse was and is still subjected to two distinct line of
authority the hospital administrative line and the clinical or therapeutic line headed by the medical
staff

NURSING SERVICE IN A BUREAUCRATIC SYSTEM:

· The second phase of hospital and nursing service administration is called the bureaucratic
system of control. The nursing service groups were brought under the line of authority.

· The informal relations unite people together and the vertical lines of communication unite the
levels of hierarchy.

· Through the vertical line of authority, the policies formulated by the management are
communicated to all the grievances and problems of the personnel are back to administration for
the fruitful selection.

· During the system, the decisions were usually made through the interaction of three groups- the
administration, the medical staff and the board of trustees. The nursing services were ignored.

HOSPITAL NURSING SERVICE AT MID CENTURY

· During the period from 1950, numerous studies were performed on problems related to patient
care

· Nurses, educators, physicians, hospital administrators and others were actively engaged in
various projects and experimentation.

· At mid century the tradition of the hospital as the clinical workshop for the doctor was changed
to the patient centered institution. Specialist began working together to meet the total needs of the
patient.

EMERGENCE OF TRENDS IN NURSING SERVICE ADMINISTRATION:

· The National Nursing Council published its report for the future which is known as the Brown’s
Report.

· The report indicated that in nursing service, administrative and supervisory staffs tend to be
authoritarian and nurses had little freedom in taking decisions and judgments for the care of
patients. Also it was found that administrative orders were issued from the top hospital
 administrator with little opportunity provided for nurse administrators to participate in the policy
decision making.

· Brown’s report pointed out the need for sound legislation regarding the training and function of
practical nurse and other health workers and also stressed the need for professional and highly
technical nursing education and mentioned that it should be undertaken by universities and
colleges.

· In 1950, the WK Kellog foundation conducted a 5- month seminar an nursing service education
administration, and in service education and research. This study conducted at Teachers college,
Columbia University resulted in the establishment of coursed in nursing service administration. At
the seminar the first definition of nursing administration was formulated- Nursing service
administration is a co-ordinate system of activities which provide all the facilities necessary for
rendering of nursing care to patients, it includes establishment of goals and policies

THE HOSPITAL HEALTH TEAM

Changing perceptions of nurses as members of the health team.

· Nurses have been accepted in health teams as functionary members; but they have had no part to
play in planning and policy formation.

· But during 1070s, nurses were becoming more active advocates for their patients and were
taking steps to personalize healthcare, rather than continuing to be hand-maidens in the health care
delivery system.

NATIONAL LABOUR RELATIONS ACT-1974 (NLRA)

The act is based on our society’s respect for the dignity of both man and his work.

· The NLRA encourages the utilization of collective bargaining and are a means of establishing
wages and conditions of worked of non-managerial and non-supervisory employees.

· In NLRA, a professional employee is defined as:-

1. Any employee engaged in work, predominantly intellectual and varied in character as opposed to
routine mental, manual, mechanical or physical work.

2. Involving the consistent exercise of discretion and judgment in its performance

3. Required knowledge of an advanced type (Course of specialized instruction) in an institution of

higher learning.

· This definition of a professional by NLRA encourages nurse upgrading effectively the practice
of nursing in accordance with the nurse practice act of their state.
· Per reviews and profession standards review organization (PPSO) will strengthen
professionalism in nursing as well as enhance the status and economic interests of nurses.

Strike: - The right to strike is defined as the moral and political right of employees to withdraw or
withheld labor in order to gain concessions from their employees. Nurses should strengthen their
professional responsibilities in nursing practice. With support from their administrative leaders,
nurses should create a professional model that includes standards of nursing practice. Patient care
committee should be established in the hospitals with administrative medicine and nursing
representatives.

Arbitration: - From a practical view point, arbitration resolves problem. Arbitration involves a
legal contract between two parties.

Voluntary arbitration is decided by employees and employers, when they make the contract. An
arbitrator may be called when a dispute cannot be resolved through negotiations. Both parties
agree on the selection of an arbitrator when one is needed.

Arbitration of nurse-employer issues eliminates the need for strikes. If hospital and health agency
administrations want to avoid strikes and their consequences, they may accept voluntary or
compulsory arbitration as the best method for setting disputes.

Fact Finding: - In fact finding, both parties agree to call in an impartial person or person to hear
both sides. The fact finder will prepare a series of recommendation based on the facts presented.

In 1966, California nurses voted to use the fact finding procedures rather than to go on strike, and
the fact finders recommendation were affected.

Mediation-arbitration: - In mediation- arbitration, a neutral and experienced arbitrator sits in

during the contract negotiations or disputes. If difficulties arise, he endeavors to mediate between
the parties and secure a voluntary agreement.

Mediation and conciliation: Mediation and conciliation are used in traditional bargaining. The
mediator is called in and he tries to achieve voluntary agreement

CREDENTIALING IN THE NURSING PROFESSION

Licensure, certification and accreditation process comprise credentialing. All are closely
inter-related. This system is being scrutinized critically by consumes professionals and others in
our society. The consumer patients want quality care at a fair price. The department of health,
education and welfare defines the various aspects of credentialing.

Licensure:- A process by which a governmental agency grants permission to individuals who

have met pre-determined qualifications to engage in a given profession or occupation, use a
particular title or grant permission to institutions to perform specified functions.
Certification or Registration: - in the process by which non-government agency or association
grant recognition to an individual who has met certain pre-determined qualification by that agency
or association.

Accreditation:- The process by which an agency or organization evaluate and recognizes an

institution or programme of study, meeting certain predetermined qualification

THE NEW STATE NURSING PRACTICE ACT(Amended in 1972)

The practice of the profession of nursing encompasses diagnosing and treating human responses to
actual or potential health problems through services such as case finding, health teaching, health
counseling and provision of care supportive to or restorative of life and wellbeing.

Mandatory and voluntary Licensure

It means all individuals who practice nursing or medicine must get license. Only
individuals holding a license are authorized to use a designated title such as RN or LPN.
Unlicensed individuals may work in a field, but they cannot use protected title.

Mandatory Continuing Education and Voluntary Continuing Competence.

In most states, licensed health practitioner has to renew their licenses. Some professional
groups encourage the adoption of mandatory continuing education for professional reuse licensure.
These should be continuing programs and educational opportunities for the development of
nursing personnel.

Some professionals are against mandatory continuing education. The believe that legal
requirements downgrade professional autonomy and each practitioner’s right to determine what
learning experience is best suited to her professional needs.

MODERN TRENDS OF NURSING MANAGEMENT:

MODERN TECHNIQUES OF NURSING ADMINISTRATION:

 Qualitative technique
 Quantitative technique

QUALITATIVE TECHNIQUE:
It is also known as behavioural technique.following are the major behavioural technique.
 Organizational design
 Personal management
 Communication
 Health information system
 Management By Objectives(MBO)
QUANTITATIVE TECHNIQUES:
 Cost benefit analysis
 Cost effective analysis
 ABC analysis
 Cost accounting
 Input, output analysis
 System analysis
 Network analysis

ORGANIZATIONAL DESIGN:
Organization means the formal structure of authority calculated to define, distribute and provide
for the co-ordination of tasks and contribution to the whole
Each organisation has a formal and informal structure that governs work flow and interpersonal
relationship. The formal structures are planned and established and the informal structures are
unplanned and covert.
Poor organization is a waste of resources. It is a theory of management that organization must be
suited to its current situation and the needs to be served. The organisation of 52 the health services
should therefore be so designed as to meet the health needs and demands of the people.

PERSONAL MANAGEMENT:
It is a responsibility of all those who manage people as well as being a description of the work of
those who are employed as specialists. It is that part of management which is concerned with
people at work and within an enterprise
Obligations of personal management:
 It must satisfy the employee by ensuring the security of job,income, prestige & opportunity
to raise
 It must satisfy the owners by maximising the economic efficient
 It must satisfy the community and community at large, by supplying them goods and
services as efficiently as possible and by preserving and advancing goodwill, morale,
loyalty and its reputation
Functions of personal management
 Anticipating vacancies
 Recruitment
 Organizational planning
 Selection of employees
  Classification of employees
 Induction of new employees
 Transfer & promotion
 Manpower development
 Training of employees
 Evaluation of jobs

COMMUNICATION:
Nursing is a communicative intervention and the foundation of nursing lies in the communicative
attitude‘.
Levels of communicationa are
 Intrapersonal communication
 Interpersonal communication
 Public communication
Types of communication may be
 Verbal communication
 Non verbal communication

HEALTH INFORMATION SYSTEM:

 The function of an information system consists of classification, transmission, storage,
transformation and display of information.
 A good information system provides data for monitoring and evaluation of health
programmes and gives the requisite feedback to health administration and planners at all
levels.
 Such information is required not only assisting in planning and decision making but also to
provide timely planning about emerging health problems and for reviewing, monitoring
and evaluating the various ongoing health programmes.

MANAGEMENT BY OBJECTIVE (MBO)

A process whereby the superior and the subordinate managers of an enterprise jointly identify its
common goals, define each individuals major areas of responsibility in terms of the results
expected to him, and use these measures as guides for operating the units and assessing the
contribution of each of its members
By George. S. Odiorne.
Steps of MBO:
 Setting the organisational objectives and its purposes.
 Key result area
 Setting subordinates objectives.
 Matching resources with objectives
 Appraisal
 Recycling
Benefits of MBO:
 Helps in better managing of the organizational resources and activities
 Organisational objectives are defined clearly and they help in relating the organisation with
its environment.
 Provides a greatest opportunity of personal satisfaction
 It stimulate organizational change and provide a framework & guidelines for planned
change, enabling the top management to initiate plan direct and control the direction and
speed of change.
Problem & limitation of MBO:
 It requires a large amount of time and requires a large amount of the most scare resources
in the organisational time of senior manager
 Sometimes the manager fails to understand and appreciate this new approach
 MBO represents the danger of inflexibility in the organization, particularly when the
objectives need to be changed

QUANTITATIVE TECHNIQUES:
Quantitative techniques are derived from the field of economics, operation research. Some of the
techniques have a great role in a management of health services.
COST EFFECTIVE ANALYSIS:
Cost-benefit analysis is a planning technique that answers the following questions.
 What are the cost pursuing goals, an objectives, a programme or specific nursing
intervention?
 How do costs compare with the benefits?
 Is the project worthwhile?
It is a management technique which is attracted the widest attention for application in the health
field. The economic benefits are expressed in monitory terms to determine whether a given
programme is economically sound and to select the best out of several alternative programme.
Operating cash budget:
 The cash budget is the actual operating budget in detail, usually excluding the capital
budget. A cash budget indicates whether cash flow will be adequate to meet anticipated
payment including replacement and expansion of facilities, unanticipated requirements,
payroll, payment of supplies and services and a prudent investment programme.
 The cash budget is the day-to-day budget and represents money coming in and going out. It
is advisable to have a cash reserves so that cash flow and the money coming will pay the
bills.
Negative cash flow:
The 4 major factors that influence negative cash flow are as follows----
 Time lag between delivery of services and collection of payments
 The difference in cycles between the timing of net income and flow of cash
 Lag created by large up and down cycles of volume during different seasons
 Labour expenses paid out in salary and wages does not cycle concurrently with collections
Drawback :
The main draw back with this technique is that the benefits in the health field. As a result of a
particular programme cannot always be expressed in monitory terms. We generally express the
benefits in terms of births and deaths or illnesses avoided or overcome. Hence the scope of
applying this method is rather vague

COST EFFECTIVE ANALYSIS:

Cost effective methods are those that search for the least costly way of achieving the defined
result. Cost effective analysis is easier to make, as that is clear. It helps the administrator in
managing his health resources at the local level. The problem is to find the way of achieving the
objectives at the lower cost

ABC ANALYSIS:
It is a technique which would enable a busy executive to chase those activities ardently which
would quicken the wheel of administrative machinery. By arranging his work into an order of
priorities, he can decide on which item to concentrate first, which can be deal later and yet which
others to delegate to his assistants.
A – Items:
 Tight control
 Rigid estimates
 Strict and close watch
  Safety stocks should be low
 Management of items should be at top management level
B- Items
 Moderate control
 Purchase based on rigid requirements
 Reasonably strict watch and control
 Safety stocks moderate
 Management be done at middle level
C-Items
 Ordinary control measure
 Purchase based on usage estimate
 Control exercises by store keeper
 Safety stocks high
 Management be done at lower level
VED items:
In this method each stock item is classified as vital, essential and desirable based on how critical
the item is for providing health services.
The vitals items are stocked in abundance, essential items are stocked in medium amount, and
desirable items are stocked in small amounts.
By stoking items are always in stock which means a minimum disruption in the services offered

COST ACCOUNTING:
 It provides basic on cost structure of day programme. Financial records are kept by a
manager permitting costs to be associated with the purpose for which they are incurred.
 The important purposes of cost accounting in health services are cost control planning and
allocation of people and financial resources

INPUT OUTPUT ANALYSIS:

Input analysis is an economic technique in the health field. Input refers to all health service
activities which consume resources, manpower, material and time. On the other hand output refers
to such useful outcome as treated lives saved or inoculations performed. Input-output table shows
how much of each input is needed to produce a unit of output.
SYSTEM ANALYSIS:
It is a scientific and detailed definition of a system that it examines:
---- The system purpose
----Overall requirements
----Number and type of subsystem
----Nature of subsystem interaction
The purpose of the system analysis is to keep the decision maker to choose and appreciate course
of action by investigating his problems, searching out objectives, finding out alternative solutions,
evaluation of alternative solutions, evaluation of alternatives in terms of cost effectiveness.

NETWORK ANALYSIS:
A network is a graphic plan of all activities to be composed greater discipline in planning. The two
common types of network technique are--
 PERT—Programme evaluation review technique
 CPM--- Critical path method
PERT:
The programme evaluation and review technique was developed by a special Projects Office of the
US Navy and applied to the planning and control of the Polaris weapon system in 1958.
The PERT system has been widely applied as a controlling process in business and industry. It can
be considered as a road map of a particular project in which all major events have been identified
and relationship among events clearly indicated.
PERT uses a network of activities, each of which is represented as a step on a chart. A time
measurement and an estimated budget should be worked out that include the following.
 Finished product or service desired.
 Total time and budget needed to complete the project or programme.
 Start and completion dates.
 Sequence of steps or activities required to accomplish the project or programme.
 Estimated time and cost of each step or activity.
Three path in step 3 & 4
 Optimistic time----This occasionally happens when everything goes right. This estimate is
predicted on minimal and routine difficulties in the activity.
 Most likely time----It represents the most accurate forecast based on normal developments
if only one estimated was given, this would be it.
  Pessimistic time----This is estimated on maximum potential difficulties. The assumption is
that here is whatever can go wrong will go wrong.
Activating time formula is (O+4M+P)/6
Whereas, O is optimistic time
M is most likely time and
P is pessimistic time
Calculation of the critical path, the sequence of the events that would take the longest time to
complete the project or programme by the planned completion date. This is the critical path
because it will leave the slack time.
 The longest pathway between events is the critical path. It is used as a planning,
scheduling, organising, co-ordinating and controlling technique.
 Atypical PERT analysis may run into hundred of events
Importance of PERT system:
It forces planning and shows how the pieces fit for all nursing line managers involved.
 It establishes a system for periodic evaluation and control at critical points in the
programme.
 It reveals problems and is forward-looking

Advantages of PERT:
 Provides logical sequence of activities.
 Clarifies where additional resources are required to complete the task.
 Clarifies where delays are permissible and where not essential deadlines become evident.
 Depicts a large number of independent activities that make up the total task.
 Every principle activity can assign to a person whose attention is constantly drawn to
deadlines in particular areas.

CPM:
CPM is the most versatile planning and control technique used in business. It was first employed
by the E.I. Nemours Company. Unlike PERT it is applied in those projects where activity timings
are relatively well known.
By breaking the project into activities that must be undertaken for its implementation and by
determining their time sequence, it is possible to isolate the most critical path schedule in their
implementation.
Under CPM, the project is analyzed into different operations or activities and their relationships
are determined and show on the network diagram
It is based on the assumption that the expected time is actually time taken to complete the project.
CPM is suitable for construction of projects and plant maintenance.
Besides asserting the schedule CPM provides standard method of communication project plans,
schedule and costs.
Advantages:
It provides on analytical approach to the achievement of project objectives which are defined
clearly.
 It identifies most critical demands and paths more attention on these on these activities.
 It helps in ascertaining the time schedules.
 It makes use of better and detailed planning.
 It assists in avoiding waste a time, energy and money on unimportant activities.
 It provides a standard method for communication project plan schedules and costs.
Steps of PERT/CPM:
a. Identification of all key activities and phases or events necessary for the completion of the
project.
b. Sequencing of activities and events
c. Determination of estimated time
d. Determinant of critical path
e. Modification of initial plan
f. Controlling the project
g. Planning, programming and budgeting system (PPBS)
h. Job analysis
i. GANTT charts
NURSING PROJECT:
 Gather data
 Analyze data
 Develop a plan
 Implement a plan
 Evaluation, give feedback and modify the plan as needed.
 CURRENT TRENDS OF ADMINISTRATION IN NURSING PRACTICE & IN
EDUCATIONAL INSTITUTION:
 Changing demographies and increasing diversity
 The technological explosion
 Globalization of nursing standards
 Decentralized approach to care management
 Evidence based practice
 Nursing informatics
 Nursing audits
 Collective bargaining
 Telehealth management
 Online nursing education
 Wellness centers, holistic and alternative therapies
 More importance for research activities

ISSUES IN NURSING ADMINSITRATION

As far as nursing administration is concerned; it is in a pathetic condition. Health survey
and Development Committee (1946) recommended giving gazette ranks for Nurse Manager and
WHO guidelines are therefore giving decision making power to nurses. Both union and state
government have decided give some gazetted ranks to nurses.

Accordingly, now we have very few gazetted post, but there is no independent power or authority.

· Most of the equivalent posts of other cadres in government elevated to the gazette ranks group A
and B but the key post like Nursing Superintended Grade I is only group B.

· In 1989, there is Government order considered Nursing Superintendent Grade II also gazette Class
II (Group B), it was not implemented so far, without any genuine reason.

· Now the situation has gone from bad to worse, worst to the extent that for filling up of the
vacancies of nursing cadre, the government Nurses Association has to go on agitation. After
agitation/Strike, they will fill up few vacancies.

Like this so many problems, prevailing in the nursing administration are as given below.

1. Non-involvement of nursing administrator in planning and decision-making in the governmental

hospital administration.
2. No specific power assigned to nursing superintendents, but he/se has been made in-charge of all
inventories and linen of hospital.

3. Nursing superintendent will have no authorities to sanction leave to their subordinates.

4. Lack of knowledge in management of Hospital among medical/nursing administration.

5. Administration is always dependant on the advice of clerical staff in all matters including technical
aspects.

6. Prevalence of role ambiguity, among administration administrators.

7. Unnecessary interference of non-nursing personnel (Medical/ clerical) in nursing administration.

8. No written nursing policies and manuals.

9. No organized staff development programme which includes orientation, in service education,

continuing education etc.

10. No special incentives like , Rajyosava Award, Republic Day Awards , Teachers Awards, as
Government itself honor with these awards other government servants like teachers, police persons
etc.

11. Inefficiency of Nursing councils of state and union to maintain standards in nursing.

12. No efforts at higher level for implementation of separate Directorate of Nursing sanctioned by
Karnataka Govt.

Issues in professioal nursing:

 Status of nursing in society in the health care delivery system

 Values reflected in our nursing performance
 Attitude & human approach
 Define and delineation of nursing function at the different level

Issues in nurse themselves:

 Long hours of duties with very little time for recreation
 Non availability of health are programmes for nurses
 Pressure from influencing people
 Non involvement of nurses in nursing matter
 Poor pay structure
 Lack of security & safety
 Non availability of basic commodities like toilet facility, in residential accomadation of
community nurses
 In community health services, poor nursing administration services. Care delivered by
ANM, health visitors, LHV, ASHA. At the community level, there is no stronger position
 for nurses to supervise & coordinate the subordinates. Hence it results in high mortality
and morbidity rates.
 In the community setting, it is observed that ANM/LHVs face problem related to
transportation, accomadation, gender base harassment, lack of security, incentives &
carrier prospects and inadequate provision of living with their families and educating their
children.
Issues in nursing education:
 There are 635 nursing school & 165 nursing college in India. Between September 2014
& October 2014, 61.2% institutions were found unsuitable for teaching. The post
graduate curriculum in nursing is not adequate. Teachers with master & doctoral degree
are few. Research & academic work is scarce.
 Shortage of qualified nurse educator
 Inadequate infrastructure for nursing education

MAJOR ISSUES:
Poor quality of nursing & midwifery care due to
 Shortage of nurses, midwifes and nurse specialist
 Inadequate number of nursing positions as per the recommended staffing norms
 Migration of nurses
 Inadequate structure for nursing & midwifery practices
 Inadequate motivation to provide effective care
 Insufficient information system
 Harassment of nurse by others

Harassment of nurses by others:

 There are some instances occurred in various circumstances in different places, harassment
of nurses by clerical staff, it while taking their salaries and claiming other arrears leave of
their own credit and some time by the administrators of the institution.
 Nurse working in between doctors on one side & in other side with group D official and
facing so many problem.nowadays it is difficult for the nurses to control the group D
officials for so many reasons.
 To control these groups, co-ordination and cooperation are needed from the administrators
of the institution and higher authorities.

MEETING THE CHALLENGES:

Strengthen involvement of nurses in health & nursing policy formation & planning

Empower nurses leader

Establishing quality assurance system for the nursing services

Enhance nursing autonomy in practice

 Enforce implementation of recommended norms on nurse to patient ratio

Measures to overcome these problems

 Role clarity
 Powerlessness regarding system complexity
 High tech low touch care
 Communication skill
 Leadership support
 Produce advanced practice nurse
 Ensure appropriate facilities & adequate medical equipments & supplies
 Promote evidence based practice & nursing research
 Establish a continuing nursing education
 Strengthen payment scale, incentives system & working conditions
 Ensure quality of nursing education by strengthening nursing programmes, increasing qualified
nurse educators & allocating appropriate resources to maximize efficiency & effectiveness.

There should be one policy in the state in relation to nursing matters.

· All the nurses working in the different sector, i.e. Directorate of Health and family welfare,
Directorate of Medical Education, Directorate of ESI(M) Directorate of ISM and Director of
autonomous bodies, should be clubbed together and should be kept in one administration i.e.
“Directorate of Nursing”

Then only it is possible to bring some uniformity and improvement of nursing services in hospitals
and community setting.

· The Director of Nursing should be made Chairman/ President of State Nursing Council with the
assistance of “Nurse Registrar” of Joint Director Scale rested with powers to maintain standards of
nursing uniformity throughout the state

SUMMARY:
Nursing is facing new challenges. To participate actively in decision making concerning
the delivery of quality care to consumer patients, nurse practitioners, nurse administrators and
nurse educators must take on active role through their organization of the standards of nursing
practice, peer review and legislative programs and assure the public of quality care at a reasonable
price.

Today’s professional nurses assume leadership and management responsibility regardless

of the activity in which they are involved. Nurses may assume leadership role their work setting,
their profession and their community, whether or not they have designated positions of leadership
BIBLIOGRAPHY:

JOURNAL REFERENCE:

Tilbury Mary S. EdD RN CNAA

JONA: The Journal of Nursing Administration: February 1992

Education For Administration:

Home > February 1992 - Volume 22 - Issue 2 > Issues and Trends in Nursing Service
Administration Educatio...
The Council on Graduate Education for Administration in Nursing (CGEAN) was established to
further the development and improvement of graduate education for administration in nursing. The
Council seeks to identify the nature and direction of education for administration in nursing in
various healthcare systems, providing guidelines for programs offering administration. A major
goal of CGEAN is facilitating dialogue between nursing service administrators and graduate level
educators who are engaged in teaching and research related to administration in nursing. This
column, sponsored by members of the Council, will analyze and respond to position statements
and trends related to the delivery of health services and graduate education for administrators in
nursing.

NET REFERENCE:

 https://nursingon.blogspot.com/2015/06/current-trentds-and-issues-in-nursing.html
https://www.researchgate.net/publication/326041721_SEMINAR_ON_CURRENT...
 https://onlinenursing.duq.edu/blog/trends-nursing-management/
 http://www.slideshare.net/Mnsavitha/philosophy-and-current-trends-in-nursing
 management?from_m_app=android
 https://sigmapubs.onlinelibrary.wiley.com/doi/abs/10.1111/j.1547-5069.1993.tb00755.x

BOOK REFERENCE: