RECRUITMENT & SELECTION OF FACULTY

INTRODUCTION:
Recruitment is the process of searching for prospective employees and
stimulating them to apply for jobs in the organization. It is a positive process because
it increased the selection ratio by attracting a large number of applicants for the
advertised jobs.
DEFINITION
1. “Recruitment is the development and maintenance of adequate manpower
resources. It involves the creation of a pool of available labor upon whom the
organization can depend when it needs additional employees”
2. “Recruitment is the process of searching for prospective employees and
Stimulating them to apply for jobs in the organization”(Flippo Edwin, B, 2003)
IMPORTANCE OF RECTUITMENT METHOD
1. It determines the number of qualified applicants applying for a particular
position.
2. It also involves activity searching for qualified women when filling positions not
traditionally held by women.
3. It can sometimes affect the subsequent turnover rates of employees.
SOURCES OF RECRUITMENT
1. Internal Sources
Recruitment from within the enterprise.
i) Transfer
It involves the shifting of an employee from one job to another. At the time of
transfer, it is ensured that the employee to be transferred to the new job is capable of
performing it.
ii) Promotion
To shifting an employee to a higher position carrying higher responsibilities,
facilities, status and pay.
2. External sources
Every new enterprise has external sources for various positions. Running
enterprises have also recruitment employees from outside.
i) Unsolicited applications
This type of recruitment service as a valuable source of manpower.

1
 ii) Advertisement
Advertisement in newspaper or trade and professional journals in generally
used when qualified or experienced personnel are not available from other sources.
iii) Employment agencies
Employment exchanges run by the government are regarded as a good
source of recruitment for skilled, semi skilled operative job.
iv) Educational institutions
Recruitment from educational institutions is the well-established practice of
thousands of business and other organization.
iv) Recommendations
When present employees or a business friend recommends a person, a type
of preliminary screening takes place.
v) Labour contractors
Workers are recruited through labour contractors who are themselves
employees of the organization.
Purpose
To facilitate the recruitment and selection process and to ensure compliance
with university hiring policies, affirmative action and equal employment opportunity
guidelines and the respective, collective bargaining agreements.
Objectives
To prescribe procedures for recruitment and selection of faculty and
administrative, professional and technical (APT) personnel.
Recruitment Policy:
 Discovery and cultivation of the employment market posts / posts marketing a
job in the public / private services.
 Use of attractive recruitment literature and publicity.
 Use of scientific tests for determining abilities of the candidates.
 Tapping capable candidates from within the service.
 Placement programme, which assigns the right man to the right job.
 A follow- up probationary programme as an integral part of the recruitment
process.

Method of Recruitment

2
A . Recruitment procedures
1. Advertising
By giving advertisements in newspapers of local, regional, national and
international levels and journal advertisements.
2. Career day programmes
In some places nursing schools and colleges hold, annual career day
programmers during which recruiting officers from local health agencies, inform
senior students about employment opportunities in those organizations.
3. Open house
It is showcase of the opening of a new service or educational programme. If
health agency is well organized of their setting will be attractive to idealistic, service-
oriented nurses. Invitation to an open house may sent to individual nurses, group of
speciality nurses, professional organizations final year students nurses schools /
colleges to attend open house for recruitment.
4. Employee referrals
It is the procedure in which the present staff recruitment their nurse
acquaintance i,e., recruiter who wishes to fill positions in a particular nursing unit
should ask employees in the unit to recruit nurses with whom they have worked
comfortably in other settings.
B . Vacancy Announcement procedures
The appropriate chief executive campus officer shall review the recruitment
sources. All pertinent aspects of the position must be advertised.
1. Recruitment period
a. Administrative, professional and Technical (APT) vacancies: All APT
positions must be advertised at least ten (10) working days prior to the closing date
b. Faculty positions: At the community colleges and temporary/ non- tenurial
faculty positions at four year campuses may be filled through local recruitment only,
unless the applicant pool is inadequate. Such positions must be advertised in a
newspaper with statewide distribution at least 10 working days prior to the closing
date.
c. National faculty: Faculty positions to be filled through national recruitment
must be advertised at least fifteen (15) working days prior to the closing date.
d. Closing Dates: Vacancy announcements with specific closing dates should
have the same date in all advertising venues.

3
2. Guidelines, apply to advertisements
 Faculty positions filled only through local recruitment must be advertised in a
newspaper with local wide distribution.
 Faculty positions filled through national, recruitment may be advertised in a
newspaper for appointment in the absence distribution.
 No applicant from outside the university APT workforce shall be approved for
appointment in the absence of statewide recruitment.
3. National Advertising
 All tenure – track positions on four-year campuses
 Temporary faculty appointments of your year campuses when the local
applicant pool may be inadequate.
4. Closing dates
a). All APT vacancy announcements shall have closing dates and the closing
dates should be the same for all advertising venues.
B). Faculty vacancy announcements may have closing dates or may have
continuous recruitments for hand to fill positions.
5. After the announcement has been approved for publication, the hiring unit is
responsible for funding and placing the advertisement in newspapers, journals
or other appropriate media.
6. All Advertisements will include the phrase “Equal opportunity/ Affirmative
action institution”

SUGGESTED CHECKLIST FOR RECRUITING

Recruiting Process
o Position was analyzed for underutilized groups (Women or minority groups).
o Position vacancy announcement was reviewed to insure that the minimum
qualifications and desirable qualifications are job related and are based on
knowledge skills and abilities.
o Recruiting methods and selected advertising media are adequate.
o Position was advertised for a last 10-15 working days as appropriate.
o If underutilization exists, affirmative action recruitments was carried out.
o Verified the advertising and clipped copies of published job announcements.

4
 o If a casual hire is appointed after minimal recruiting due to exigency (such as
lack of time) the hiring unit is notified that such appointment is contingent
upon open recruitments.
o Appointment was informed of availability of campus security and crime
statistics information.
SELECTION PROCEDURE
Selection procedure is a tool in the hands of the management to differentiate
the qualified and unqualified by applying various techniques such as interviews, tests
etc.
STEP IN SELECTION PROCEDURE
It requires a heavy investment of money to set right type of people. Indication
and training costs are also rising. If the right type of persons are not chosen, it will
lead to be a huge loss of the employer in terms of time, effort and money, Modern
organization to get right type of persons are as follows.
1. Scrutiny of application forms
2. Preliminary interview
3. Application blank
a. Identification
b. Education
c. Experience salaries
d. Expected salaries
e. Community activities
f. References
4. Employment tests
a. Aptitude test
b. Intelligence test
c. Interest test
d. Knowledge test
e. Projective test
g. Personality test
h. Dexterity test

5. Employment interview

5
6. Physical medical examination
7. Reference check
8. Final selection
1. Scrutiny of application forms
The applications are screened out at each step.
2. Preliminary interview
This procedure is to eliminate the unqualified at unsuitable candidates.
3. Application blank
It is supplied to the successful candidates in preliminary interviews. Application
blank is used to obtain information in the applicant’s own handwriting sufficient to
properly identify him and to make tentative inferences regarding his suitability for
employment.
4. Employment tests
This will require the use of employment test, which are as follows
A) Trade tests
Technical jobs require trade test to assess the capabilities for the candidates
for the type of job.
B ) Psychology test
i) Aptitude test
Aptitude test measure an applicants capacity and his potential for
development .These are designed to measure the aptitude of applicants and their
capacity to learn the skills required on a particular job.
ii) Intelligence test
These aim at testing the mental capacity of a person with respect to various
things. It measures the individual learning ability to grasp or understand instructions
and ability to reason and make judgment.
iii) Interest test
Interest test are more often used for vocational guidance also. They help the
individuals in selecting occupations of their interest.
iv) Knowledge tests
These are devised to measure the depth of the knowledge and proficiency in
certain skills already achieved by the applicants such as engineering, accounting,
etc.
v) Projective tests

6
 The applicant projects his personality into free responses about pictures
shown to him which are ambiguous.
vi) Personality test
These determine personality traits of the candidate, such as
cooperativeness against dominance or the emotional balance, the temperamental
qualities of a person.
vii) Judgment test
These are used for evaluating ability to apply knowledge judiciously in solving
a problem.
viii) Dexterity test
These are used to discover the ability to use the different parts of body in a cp-
ordinate manner. These are useful in identifying accident prone candidates for
certain manufacturing jobs.
5. Employment interviews
This type of interview must be conducted in a friendly atmosphere. The
candidate must be made to feel al ease. The questions should better be asked
based on job specifications. Unwarranted questions should avoid. A verification of
the information furnished by the candidate in application blank may be made.
Individual information may be sought for future record. The candidate should be
given a chance to ask question to satisfy himself regarding the history of the concern
future prospects salary offered and nature of job etc.
Further, the proper physical arrangement for the interview is a great importance.
It enhances the reputation of the organization in the eyes of the candidates.
The interview should be conducted in a room free from any disturbance, notes
and interpretation, so that interview may be held confidentially and in quiet
environment.
6. Checking reference
If the applicant crosses all the above hardless, an investigation maybe made
on the reference supplied by the applicant regarding his past employment,
education, character, personnel reputation, and etc. References may be called upon
telephones. They may be contacted through mail or personnel visit.
7. Medical examination

7
 It is conducted after the final decision has been made to select the candidate. A
through physical examination is also essential to ensure that the candidate is able to
handle job effectively.
Purposes
 It serves to ascertain the applicants’ physical capability to meet the job
requirements.
 It serves to protect the organization against the unwarranted claims under
workers compensation laws or against law suits for damages.
 It helps to prevent communicable diseases entering the organization.
8. Final selection
If a candidates successfully passes through the appointment letter may be
given to him mentioning the post on which selected, the terms of appointment, pay
scales, etc. normally is the initial stage the candidates are appointment on probation
basis because it is considered better to try them for a few month on the job itself. If
this period, an employee is not found, suitable, the management may transfer him to
some other job to which he may be expected to do justice.
But if the organization can not offer him a job which he can do well, the
management may back him or give time and training to improve him.

FACULTY SELECTION PROCEDURE

1. No application form is required for faculty expect at the community colleges.
Letters of interest should be submitted in response to advertisements. Curriculum
vitae, Letters of references, etc may be requested or indicated in the advertisement.

2. Receiving Office: All applications must be received by the individual or office

specified in the vacancy announcements. Inform the applicant as to the anticipated
length of the screening process and that she / he will be notified once a decision has
been made on / his application.
3. Closing date: All applications received during the open recruitment period must
be considered. Only those applications postmarked or date stamped by the receiving
officer on the closing date is considered to have met the filling deadline.
4. Applicant evaluation form: applicant evaluation form may be developed. It is
recommended that an evaluation form be completed for each applicant. The

8
minimum qualification and the additional desirable qualifications listed in the
advertisement and position description shall be listed on the applicant evaluation
form and used as a checklist in screening the applications.
5. Screening Process:
a. Before conducting the screening process hiring units should contact her/ his
officer.
b. If the faculty position provides for equivalencies for education and or experience
requirements, the equivalences should be determined prior to screening
applications,
c. The entire selection process is confidential and shall not be discussed with any the
applicants or with any one outside the process.
d. It is recommended that the selection committee maintain minutes of its meetings.
6. Interview process: It is recommended that job related interview questions
along with the acceptable responses be developed prior to any interview. The hiring
unit may develop a rating sheet. The head of the hiring unit shall consult with the
college administrative services director, personnel officer.
7. The best-qualified available applicant shall be selected. In cases where the
qualifications of the top applicants are relatively equal, the applicant who is a
member of an under utilized or under represented group should be selected.
8. Reference checks are integral in the decision making process. It is
imperative that reference checks be done fairly and consistently, so that they may
serve as a valuable tool in the selection process. Please remember that he same
discrimination laws applicable to interview questions also apply to reference checks.

9. Keep applicants informed throughout the process. If there are unusual

delays, modify the applicants. Applicants who have not been selected for the final
interview process may be so informed. Once the selection has been made and
approved, inform the remaining applicants.
APPLICATION FORMS
The application form should elicit the following information:
1. Name
2. Age of the candidate
3. Address
4. Name of the parents / guardians

9
 5. Details of education
6. Details of employment
7. Particular aptitudes / abilities (Sports, typing, computer, languages)
8. Medical certificate to be enclosed
9. Evidence for date of birth with exact address
10. Contact certificate
11. Residential certificate
12. Certificate
13. Experience certificate

CONCLUSION
Thus we have seen regarding recruitment and selection of faculty.
Recruitment is the process of searching for prospective employees and stimulating
them to apply for jobs in the organization. it is a positive process because it
increased the selection ratio by attracting a large number of applicants for the
advertised jobs

MOTIVATION SITUATION
Definition
Motivation is the complex of force starting and keeping a person at work in an
organization. Motivation is something that moves the person to action, and continues
him in the course of action already initiated.
- Dublin
Motivation refers to the way in which urges, drives, desires, aspirations,
strivings or needs direct, control or explain the behaviour of human beings.
-DaltonE. McFarlan
Nature of motivation
The features of motivation are as under:
 Motivation is an internal feeling of an individual. It can’t be observed directly;
we can observe an individuals action and then interpret his behaviour in terms
of underlying motives. This leaves a wide margin of error. Our interpretation
may not reveal the individual’s true motivation.
 Motivation is a continues process that produces goal directed behaviour. The
individual tries to find alternatives to satisfy his needs.

10
  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.
 Motives of an individual change from time to time, even though he may
continue to behave in the same way. For example, a temporary worker may
produce more in the beginning to become more, this time to get promotion.
 Motivation is different from Job satisfaction. Motivation implies a drive towards
an outcome while satisfaction involves outcomes already experienced.
Satisfaction is the contentment experienced when a want has been satisfied.
Types of motivation
1) Positive or negative
2) Extrinsic and intrinsic motivation
3) Financial and non-financial motivation

Positive or negative motivation

Positive motivation is the process of attempting to influence the employee’s
behaviour through the possibility of reward. People work for incentives in the form of
the four ‘P’s of motivation; Praise, prestige, Promotion and Pay cheque.
Negative or fear motivation is based on force and fear. Fear causes persons
to act in a certain way because they are afraid of the consequences if they don’t. I.e.
demotion and lay off etc.

Extrinsic and intrinsic motivation

Extrinsic motivation is arise away from the job. They do not occur on the job.
These factors include wages, fringe benefits, medical reimbursement, retirement
plans, holidays and vacations.
Intrinsic motivators occur on the job and provide satisfaction during the
performance of work activity itself. It includes recognition, status, authority,
participation and competition.

11
Financial and non-financial motivationFinancial motivators are those which are
associated with money. They include wages and salaries, fringe benefits, bonus,
retirement benefits, etc.
Non-financial motivators are those which are not associated with monetary
rewards. They include intangible incentives like ego-satisfaction, self-actualization
and responsibility.

Guidelines for motivating employees and the managers

Following guidance for motivating people
 The management should let his people know that he considers them valuable,
capable individuals, i.e. should treat the people with respect and honesty.
 He should make sure that subordinates have the tools to get the job done for
achieving goals.
 The person should be fitted on the job where he can set his own standard, get
concrete feedback and deal with moderate risks.
 He should avoid building “dissatisfires” into the job, i.e. he should make sure
that salary and working conditions are adequate.
 He should set fair, achievable goals and communicate them to the
employees, for understanding what they are shooting for helps them adequate
accomplishment of the goals.
 The people should be made known, through feedback, how they are doing.
 All such techniques as reinforcement incentives, MBO, job enrichment and
maintenance of high morale should be utilized.
 Job analyses, selection and training should be used to ensure that people are
hired who could do the jobs if they wanted to-people with the required skills
and abilities.
Managers may be rewarded through recognition, advancement, achievement,
and other kinds of more advanced fulfillment.

Management techniques designed to increase motivation

a) Financial motivators
b) Non-financial motivators

12
a) Financial motivatorsThis type of motivation is connected directly or indirectly
with money. Wages and salary, bonuses, profit-sharing, leave with pay, medical
reimbursement etc.
Role of money in motivations
 Money plays an important role in motivation. Management generally makes
use of financial incentives to motivate the workers. However, such incentives
may not always prove to be motivating.
 Money is a real motivating factor when physiological and security needs of the
workers have been fully satisfied. Therefore, management can use financial
incentives for motivation.
 Money also helps in satisfying the social needs of the workers to some extent
because money is often recognized as a basis of status, respect and power.
But this should not lead one to conclude that money will always be a
motivating factor for all the peoples.

b) Non-financial motivators
These motivators are not connected with monetary rewards. In the words of
Dublin, “non-financial incentives are the psychic rewards, or the rewards of
enhanced position, that can be secured in the work organization.”

Some of the commonly used non-financial motivations are

1. Appraisal, Praise or Recognition
2. Status and Pride
3. Competition
4. Delegation of Authority
5. Participation
6. Job Security
7. Job Enlargement
8. Job Rotation
9. Job Loading
10. Job Enrichment
11. Reinforcement
12. Quality of work-life
13. Others

13
Appraisal, Praise or Recognition
When employee does his work well, naturally wants it to be praised and
recognized by his boss and fellow-workers.
Praise satisfies one’s ego needs. Sometimes, praise is more effective than
any other incentives. People will respond better for praise. However, these
incentives should be used with greater degree of care because praising an
incompetent employee would create resentment among competent employees.
Recognition satisfies human need for esteem by others and for self-esteem.
Collective recognition may be given by the award of a shield or a banner or a
certificate, or by giving certificate, special privileges or a money bonus to the
employees.

Status and Pride

Status refers to “social rank of a person” and satisfies social and egoistic
needs. A management often tries to satisfy these needs by establishing status
symbols and distinctions in its organization providing costly furniture, carpets on the
floor, picture on the wall, artistic curtains, a separate stenographer, a few peons, and
a personal assistant. Individuals try hard to gain these status symbols; and once
these have been achieved, there is craving for higher status symbols.
Pride is a nebulous concept. However, good products, dynamic leadership,
fair treatment, service to the community etc stimulate an employee pride in his work
and organization.

Competition
As a form of motivation, competition is widely used in an organization.
Individuals do compete with one another if they feel they have chance of winning and
satisfying their “ego”. This completion may be regard to sales, production, or safety
measures. The person who is adjudged the best is awarded the coveted prize. But
sometimes competition generates jealousy and hostility among the competition
members and may even destroy team-spirit.

Delegation of Authority
Authority is the right to act, to direct and to resources needed to properly
perform the job. The delegation of a substantial amount of responsibility to execute a

14
given task often proves to be a strong motivating force. The subordinate is more or
less on his own. The supervisor trusts him. He feels that he must show results, but
for persons who lack confidence, this technique of motivation often proves
disastrous.

Participation
It implies the physical and mental involvement of the people in an activity,
especially in that of decision-making. This satisfies one’s ego and self-esteem, and
the needs of creativeness and initiative. A management may encourage employees
to help in such areas of decision-making as production methods, materials handling,
safety measures, cost reduction, employee-management problems, and
improvement in working conditions.

Job security
Job security implies that an employee would continue on the job in the same
plant or elsewhere, and that he shall enjoy economic and social security through
health and welfare programmes providing security against sickness, unemployment,
disability, old age, and death.

Job enlargement or whole job concept

It is the process of increasing the complexity of the job in order to appeal to
the higher-order needs of workers. It implies that the employee performs more varied
tasks, which are all on the same level, the idea being to make the jobs less
monotonous.
Job enlargement motivates employees in so far as it reduces the monotony of
repetitiveness. It increases efficiency and interest in work because fatigue is
lessened.
Job rotation
It implies the shifting of an employee from one job to another so that
monotony and boredom are reduced. The basic objective of job rotation is to
increase the skill and knowledge of the employee about related jobs. In job rotation,
workers learn to do all the different activities necessary for an operation or unit of
work.
Job loading

15
 It implies making the job more interesting. A horizontal job loading assumes
that if employees are given more work at the same level at which they are currently
performing, they will be motivated to work harder and also be more satisfied with
their work.
In vertical job loading jobs are restructured so that they will become basically
more interesting. The worker is motivated because his job is more challenging and
more meaningful. He is given much responsibility as possible and is encouraged to
be accountable for his work with little supervision.

Job enrichment
It is a form of changing or improving a job so that a worker is likely to be
motivated. It provides the employee with the opportunity for greater recognition,
advancement, growth and responsibility. The goal of job enrichment is not merely the
work more varied but to make “every employee a manager”.
It results the morale because
 By making the job more challenging, it appeals the employee’s higher needs
of achievement. He gets satisfaction of doing the job well even if he is not
watched.
 Repetitive jobs lead to monotony, boredom and dissatisfaction but job
enrichment removes these.
Reinforcement
Reinforcement is a powerful motivation tool. Reinforcement is built on two
principles
i) That behaviour appears to lead to a positive consequence (or reward)
tends to be repeated; while behavour that appears to lead to a negative
consequence tends not to be repeated; and
ii) Therefore by, providing the properly scheduled rewards, it is possible to
influence people’s behaviour.
Positive and negative reinforcement focus on getting employees to learn the
‘desired’ behaviour. Extinction (withholding merit raises) and punishment focus on
unlearning the desired behaviour and cannot be of much use in teaching persons the
correct, desired behaviour.

16
Quality of work lifeThe term “quality of work life” means different things to different
persons. For e.g to a worker on an assembly line, it may it may just mean a fair day’s
pay, safe working conditions, and a supervisor who treats him with dignity.

According to Walton factors and suggestion which can contribute to ‘quality of work
life’ are

i) Adequate and fair compensation

Adequacy to the extent to which the income from full tie work needs of the
socially determined standard of living.

ii) Safety and healthy working conditions

Including reasonable hours of work and rest pauses, physical working
conditions that ensure safety, minimize risk of illness and occupational diseases and
special measures for protection and children.

iii) Security and growth opportunity

Including security of employment and opportunity fo advancement and self-
improvement.

iv) Opportunity to use and develop creativity

Such as work autonomy, nature of supervision, use of multiple skills, workers’
role in total process and his appreciation of the outcome of his own effort and self-
regulation.

v) Respect for the individual’s personnel rights

Acceptance of the right of free speech and the right to personal privacy in
respect of the workers off-the-job behaviour.

vi) Work and family life.

Including transfers, schedule of hours of work, travel requirements, overtime
requirements etc.

Others
a) Job sharing or TwinningIt is a novel system, under which two workers (especially
mothers and fathers who want to spend more time with their families) and the older

17
people (who want to retire gradually) and those with physical limitations, and
students, prefer to divide one fulltime job. Not only are the hours split but so are
salary and fringe benefits. Absenteeism also tends to be less since one of the ‘Twins’
can cover for the other in the event of illness or other reasons for being absent.

b) Flexible or Flexible working Hours

Under this system, the employees have the freedom to choose, within certain
limitations, what times they begin and quit their job each day. Flexibility of work
hours wipes out the 8 to 3 or 9 to 5. Maximum 40-48 hours per week. Such type of
arrangement generally improves morale, increases productivity and gives employees
a greater sense of control over their own lives.
Role of motivation in management or organization
The role of motivation in an management or organization is discussed in detail
as follows
 High performance level is must for an organization
 Willingness of the people to work
 It is helpful in building good labour relations
 Improvement of skill and knowledge
 Motivation builds human relations
 It is an important tool of management
 Motivated employee stays in the organization more and their absenteeism is
quite low

High performance level is must for an organization

Motivated employees put higher performance as compared to other
employees. The high performance is a must for an organization and motivation is a
vital requirement for high performance.

Willingness of the people to work

Motivation influences the willingness of people to work and willingness comes
from within. A man may have a capacity to work and he may be physically, mentally
and technically fit for work but he may not be willing to work. Motivation creates a
need and desire on the part of the workman to present his better performance.

18
It is helpful in building good labour relations:In an organization all the members of the
staff make their efforts to achieve the objectives of the organization with their policy
and programmes laid down by the organization if the management introduces
motivational plans. Both employees and management are benefited by such plans.

Improvement of skill and knowledge

All the members of an organization try to be as efficient as possible and to
improve upon skill and knowledge so that they may be able to contribute to the
progress of the organization as much as possible because they know that they will
get what has been promised and ultimately they will be able to satisfy their personal
as well as social needs.

Motivation builds human relations

As the human concept of labour has changed and now laborer is treated as a
man and not a commodity. This attitude contributes towards motivating the people at
work. Workers are motivated to participate in the decision-making function of the
management.
It is an important tool of management
Motivation is an important tool in the hands of management to direct the
behavior of sub-ordinate in the desired and appropriate direction and thus minimizing
the wastage of human and other resources.
Motivated employee stays in the organization more and their absenteeism is quite
low
High turnover and absenteeism create many problems in the organization.
Recruiting, training and development of new personnel does not take long time but
it’s expensive too. In a competitive economy this is almost an impossible task.
Motivation brings these rates lower.
Conclusion
The nurse administrator and manager should know the motivation techniques
to bring out and meet the organizational goals to develop the health’s care or
organization.

ORGANIZATIONAL THEORY
INTRODUCTION:
Organizing basically involves analysis of activities to be performed for
achieving organizational objectives, groupings them into various department and

19
section so that can be assigned individual and delegations them appropriate so that
they can carry the work properly. This are various approached to carry these
activities.
DEFINITION:
Fred IV kerlingar defines theory as “a set of interelated constructs (concept)
definitions’ and propositions’ that present a systemic view of phenomena by specify
relations among variables with the purpose or explaining and protecting the
phenomena”
Applying the concept of theory in organizations it can be defined as “the study
of structure and design of organization”
Tosi defines organization theory as “a set of interrelated concepts definitions
and propositions that present a systematic view of behavior of individuals, groups
and subgroups interacting in some relatively patterned sequence of activity the intent
of which is goal directed”
FEATURES OF ORGANIZATION THEORY:-
 It contains various formulations dealings with organizational phenomenon
 It can be treated as macro examinations of organization because it analysis
whole organization as a unit.
 It prescribes relationships among variables in the organization.

THEORIES ORGANIZATION:-
To understand the organizations of health care agency or any other kind of
institution one must be familiar with organizational theory. There are three principal
theories of organization.
 Classical organization theory
 Humanistic organizational theory
 Modern organizational theory

CLASSICAL DOCTRINE / ORGANIZATION THEORY:-

It is the oldest theory of organizational it emphasis rigid, centralized control of
worker to promote high production. An institution organized under classical theory
tends to treat workers in mechanical yet objective way. The institution is very
efficient and effective in accomplishing its goal.
 Many theorist have contributed to classical organizational theory
 Max weber in late 1800”s” and easily 1900‘s’ have developed the concept.

20
  Of bureaucracy as ideal forms of organization
 Fredrick Taylor in 1911 proposed principal of scientific management which
focuses primarily on improving individual productivity.
 Honey favor in 1940’s laid foundation for classical management function of
planning, organizing controlling and evaluating.

KEY CONCEPT:-
This theory is based on formal organizational strict known as bureaucracy and
on individual productivity kept elements or bureaucracy include.
 Centralized authority, structure
 Highly specialized division of labor
 Rigid hierarchy or management
 Rigid rules and regulation
 Routine formal communication and detail record keeping
 Emphasizes task communication, efficient operation and high individual
productivity.
 Views mentally reward as primary incentive for encouraging high individual
productivity.
 Promotes many level of management with in an organization with each level
overseeing one aspect of work and employees developing expertise in
particulars task or set of task.
 Promotes managers rigid, yet fays control of employee and employee’s strict
obedience to those in authority

APPLICATION TO NURSING:-
 Most health care organization is structured based on applied principals of
classical organizational theory.
 Health care organizations have specific chains of commands, clearly
delineated levels of authority written policies and procedure, specific rules and
regulations for employees.
 Health care organization emphasizes tasks efficiency and productivity in
patient care.
 Functional and team system or patient care are based on this theory
 Nurse and other professionals receive training, in the form of in-service and
orientation, to job expertise.

21
  Personnel receive monetary rewards for their work
 In future health care organization may become move flexible structure with
decentralized authority.

HUMANISTIC ORGANIZATIONAL THEORY:-

It was the demonstrated lack of concern for the workers that led to the
formation of new theory of organization in 1930’s. This theory is also known as
behavioral or new classical theory. It identifies two major functions of organizations.
One is maintaining the internal balance that is social organization of the workers
through which they satisfy their own desires and needs by working together. Second
is maintaining the external balance that is economics much this therapy grew out of
the Hawthorne experiment a study done between 1927 and 1933 researchers form
Harvard University.
 The major assumption- people desire social relation ship, respond to
group pressure a search for personal fulfillments.
 The Hawthorne experiment studied certain as per of classical
organization theory in particular the relationship between working
conditions and working productivity.
 Researchers discovered that various psycho and social factors in work
situation exert more influence on productivity than do actual physical
condition.
 Hawthorne experiment altered the course of organization study and
moved it towards the exploration of organization the informal
organization all structures.

KEY CONCEPT:-
 Humanistic organizational theory is concerned with formal and informal
organization structure and with the people working with the organization.
 Focus of group productivity rather than on individual productivity and factors
which increases or decreases it.
 Promote general job satisfaction or workers because according to this theory,
concern for workers need, as well as for profit and production will lead to
improve production and economic effectiveness.
 Promote workers morale
 This theory has led the way for active study of informal and formal structure.

22
APPLICATION TO NURSING:-
 Staff nurse must understand the informal and form structure of health care
organization.
 Nurse Managers fosteling or group cohesion and loyalty encourages the
nurse to work to capacity even certain work environment is less than ideal.
 Encouraging staff nurse to participate in planning decision making, improve
decision making improved marale and increases productivity.
 Health care organization follow humanistic principle when it address
employees social needs by providing non-monetary benefits/ rewards as heal
benefits and an site child care.
 Primery patient care delivery is based on human organizational thearoy.
E.g.: primary nursing which aims at quality of patient care.
MODER N ORGANIZATION THEORY:-

This theory began in late 1950’s and early 1960’s as researchers recognized that in
the humanistic as well as in classical approach something was missing.
 This theory consists of two main approached
 Systems and
 Contingency
 Human system
 System and contingency: - This theory comes from field of sociology,
economics, Mathematics, engineering and administration but its unifying
stand is looking at human system in their totality.
 Human system on their totality:- This theory continues to evolve today and
as a result of this continuing evolution, modern organization theory takes
many forms.

[Link] THEORY:-
This stresses importance of team built directly into the organizing structure,
team communicate and co-ordinate with high management and with subordinates
affected, teams have authority make decision and implement them.
2. ORGANIZ THEORY:-
It is similar to system theory stresses interrelates needs of phenomena.
Postulate that it’s not possible to deal with problem in isolation.

23
3. TECHNICAL THEORY:-Emphasize role of technology with in organization
shapes communication and workers rock and responsibility. Provides workers with
access to rapidly and accurately.

[Link] THEORY:-
Describes mechanisms of organization. Used to identify problems and needs
and how decision are based an information.
5. INFORMATION PROCESSING THEORY:-
Stresses role and impact of mechanisms for assembling data and
communicating information to others, describes the characteristics of sender,
messenger and received.
KEY CONCEPT:-
 Views organizations as complex, dynamic social system in which individual, structure
and products and environment contribute to organization success.
 Focus on organization processes which include input through put, output, and
feed back.
 Theory highlights Inter relatedness of all the party of organization and
emphasized need for organization.
 Concerned with development of flexible individual role and relationship within
organizational structure.
 Role of management is to monitor and co-ordinate communication so as to
involve all the parts of system inputs, throughput, output and feed back.

APPLICATION TO NURSING:-
 Few health care organizations are organized according to the principles of this
theory.
 When working with in system of framework nurse are responsible for
gathering and assessing data and planning, implementing, and evaluating all
function of input, throughput, output.
 Nurse also communicated to society what nurses are, what theory do, why
their cost is justified and why patient need their services.
 Nurse must be conformable with role of flexibility and communication
expertise to facilitate achievement of organization goal.

24
IMPLICATION FOR NURSING:-
 Understanding organization structure farm historical and scientific
perspectives provided a basis for effective nursing leadership and
management.
 Nurse must bane aware of evolution of organization theory to be able to
contribute to organization.
 Knowledge of theories under health care organization function helps / enables
nurses to clarify their individual’s role functions, within the organization.

USE OR ORGANIZATION THEORIES BY HEALTH CARE FAMILIES:-

It is important for the nurse- leader to know the theory of organization used by
health care.
 Facility used by health care facility in which she functions. The treatment of
employees is
 Determined by theory and based an determination the nurse leaded may
decide whether or not
 She wishes to work in that facility.
 Most hospital and public health agency are & till organized according to the
classical approach i.e., high production at low labor cost.
 Many Hospitals have conducted time and motion studies to determine nurse-
patient ratio. When a hospital administrator determines through such studies,
that a 1-5 nurse – patient ratio is necessary, he or she is using the principles
of scientific management.
 Most hospitals still have centralized organizational structure. All authority and
communication come form and go to top level.
 Some health care facilities try to use the humanistic approach. Though still
centralized, such institutions may try to decrease the number of levels in the
institute.
 Another possibility is that some departments in an institution are humanistic
while others including centre hospital administration are classical.
 Few health care facilities have attempted to organize according to modern
organization theory, because administrating are comfortable with classical
theory.

25
 ORGANISATIONAL STRUCTURE
Definition
An organization is a group of individuals coordinate into different levels of
authority and segments of specialization or the purpose of achieving the goals and objectives
of the organization
Organizational Structure (OS) defines the formal system of reporting
mechanism between personnel placed at different positions in the organization.

Organization process
The organization process is the formation of structural inters personal
relationship. This process involves
 Determination of organizational goals or objectives to be strived for.
 Determination of the task requirement i.e. the amount of skills, effort and
knowledge, necessary to achieve the goals.
 Division of task into different jobs to find out how many personnel will
be needed for the complete tasks.
 Integration of jobs into departments of other work groups to take
advantage of the specialization and efficiency.
 Selection of personnel of fill jobs.
 Assignment of work position to the individual.
 Granting the authority to the people to carry but the duties of their jobs
 Determination of superior subordinate relationships for facilitation the
performance evaluation.
Function of organization
An organization tries to establish an effective behavioral relation ship among
selected employees and in selected work place in order that a group may work together
effectively. There are three kinds of work which must be performed and organization comes
into being.
 Division of labour
 Combination of labour
 Coordination
Division of labour
Since an organization is a structure of human association for the achievement
of common goals, it involves individuals and groups of individuals. When two or more
individuals join together to perform certain tasks, it follows the some division of work is
done.
Combination of labour
With work divided and assigned to the members of an organization, their
activities are grouped together, forming operation, and operations are arranged to establish
system and procedure. From a structural point of view this grouping of activities results in
units departments and divisions of an organization.

Coordination
This all inclusive principle emerges because of the need in every organization
for the integration of activities and the coordination of individuals and groups of individuals
performing their tasks. Coordination is achieved through leadership in the structural sense it
involves the fixing of responsibility and the delegation of authority
Concepts of organization structure

26
 Several fundamental concepts describing the essentials of a sound organization
structure have been presented by the traditional school of thought. There deal with the
following essential
I. Task accomplishment of personnel satisfaction
The emphasis is on organization accomplishment i.e. the structuring of work
relationship should be so planned that both the objectives of the organization and the
individual are released simultaneously.
II. Delegation of authority
It is the delivery by one individual to another the right to act , to make
decisions to requestion resources, to direct other to out and to perform other tasks in order to
fulfill job responsibilities . Authority is ineffective without ability to exercise it. Individual is
given the authority to make it possible for him to fulfill his organizational obligations.
III. Proper span of supervision
The span of supervision is important because et determines the amount of
attention each supervisor can give to each subordinate and it affect case in communicating,
methods of decision making that can be used and other superior subordinate relationship.

IV. The degree of specialization

Under specialization, limited duties are preformed regularly and repetitively,
from the individual’s point of view, specialization makes the learning of job routines easier
and makes the worker an expert in his job.
V. Communication channel should be proper
Communication between the subordinates and their bosses should pass
through each rung of the ladder without omission as a message is moved upward or
downward. No manager in the vertical chain should be bypassed as the communication quere
moves its way. When messages are to be conveyed at the horizontal level, they should move
upward vertically from the sender to the point where the sender and the receiver have
common superior then the message can move downward vertically to the receiver.
Types of organization structure
 Formal organization
 Informal organization
Formal organization
Formal organization means the intentional structure of roles in a formality
organized enterprise. Describing an organization as ‘formal’. How ever, does not mean there
is any thing inherently inflexible or unduly confining about it. Formal organization must be
flexible
Merits of formal organization structure
 Available resource will be utilizes in the most effective way
 Directional and operational goals and procedures will be determined clearly and
energies devoted to their achievement.
 Individual responsibilities will be known clearly and the authority to out would be
defined.
 The activities of the individuals and the group will become more rational, stable and
predictable.
Drawbacks
 Very often the fixed relationships and lines of authority seem inflexible and difficult
to adjust to meet changing needs.
 Individual creativity and originality may be suppress by the rather rigid determination
of duties and responsibilities

27
  Inter personal communication may be slowed or stopped as a result of strict formal
lines of communication
 Workers may become less willing to assume duties that are not formally a part of their
original assignment
 They produce anxiety in individual workers by pressing too heavily for routine and
conformity
 They become too costly in terms of time and human dignity in order to implement
organizational rules and regulations.
The formal organizational structure can be
Vertical structure
The vertical structure clearly states that the lines of authority pass from top to
bottom. The structure is bases upon two traditional principles.
Scale principles which are related to the chain of command and asserts that
authority and responsibility in an organization should flow in a clean unbroken line from the
point of ultimate authority to the workers at the bottom of the hierarchy. The unity of
command which means that no subordinate shall be responsible for more than one superior
principle.

Horizontal organization
Horizontal organization authority structure indicates the relation ship between
peers, colleagues, fellow workers across the organization. Individual located on the same
level normally have no authority over each other.

Functional organization
In this type of organization each department report to a man specially qualified
for a particular function regarding production, sale, financing etc.
The specialist attends to one function in all the departments.

II The informal organization

Informal organization work as joint personal activity without conscious joint
purpose, even though contributing to joint results. Informal organization is very difficult to
understand until and unless we examined the role of informal organization
Informal organization arises from the social interaction among the member of
an organization.

LEGAL AND ETHICAL ISSUES IN NURSING PRACTICE

INTRODUCTION

The role of nurses and professional nursing has expanded rapidly within the past ten
years to include expertise specialization autonomy and accountability, both from a legal and
ethical prospective. This empasion has forced new concern among nurses and a heightened
awareness of the interaction of legal and ethical principles.
This term law is derived from its tentoric root ‘lag’ which means something which
lies fixed or events. In English it means something which is uniform. The word ‘law’ is
employed in the modern usage in a variety of ways.

28
LEGAL RELATIONSHIPS
 Nurses were not considered to be responsible for their patients in a legal sense.
 The physician and or hospital were held legally liable for alleged harm suffered by a
patient while receiving medical care.
 As nurse gained recognition for their expertise and gained more autonomy,
dissatisfied patients (and their attorneys) began to look at nurses as potential
defendants.
ACCOUNTABILITY
Being responsible for one’s own actions is a concept that gives rise to a legal duty in
nursing.
 When the nurse assumes the responsibility for a patients care, a legal relationship is
formed (the nurse patient relationship).
 The nurse must safeguard this relationship and make every effort to promote a
therapeutic rapport with the patient.
 The failure to provide care to the expected level of expertise gives rise to legal
liability.
 In the nurse- patient relationships, the nurse accepts the role of an advocate for the
patient.
 An advocate is one who will defend or plead a cause or issues on behalf of another.
 A nurse advocate has a legal and ethical obligation to safeguard the patients interests.
REGULATION OF PRACTICE
Standards of Care
Define acts that are permitted to be performed or prohibited from being performed.
 There standards of care give direction to the practicing nurse, defining what should or
should not be done for patients.
 Every nurse is obligated to know and follow the established standards of care; failure
to adhere to these standards gives rise to legal liability.
 The nurse is held to the standards of care the state or province in which he or she
practices. Federal and state laws, rules, regulations, and other professional agencies /
organizations help define these standards.
Nurse Practice acts
 All U.S. legislatures and Canadian governments have adopted nurse practice acts,
although the specific scope of practice may vary.

29
  It is the individual nurses responsibility to know the nurse practice act that is in effect
for her of his geographical region.
 A free copy of a particular states nurse practice act can be obtained by writing to that
states board of nursing.
 The American Nurses Association (ANA) and the Canadian Nurses Association
(CAN) have been involved in developing standards of care for nursing practice. These
organizations regularly evaluate existing standards and revise them as needed.
LEGAL ISSUES
Many legal issues affect the licensed practical/Vocational nurse and influence the
level of care delivered to the patient. Statutory and common law both play important roles in
defining the rights and responsibilities of the patient and nursing professionals.
Malpractice
The nurse can be held legally liable for acts of commission (doing an act) or omission
(not doing an act). Malpractice (professional negligence) is one legal action that a nurse may
be charged with for failing to meet the standards of care.
The following elements must be present for a charge of malpractice.
1. Duty exists: The nurse/patient relationships establish a duty.
2. Breach of the duty: Failure to perform the duty in a reasonable, prudent manner.
3. Harm occurs: This does not have to be physical injury.
4. The breach of duty: Was the proximate cause of the harm – without the breach the harm
would not have happened.
Patient Rights
 Patients have expectations regarding the health care services they receive.
 In 1972 the American hospital Association (AHA) developed a patient’s Bill of
Rights.
 In 1980 the Mental Health patients Bill of Rights and the pregnant patients Bill of
Rights were adopted into law.
 The patient self Determination Act (included in the omnibus Budget Reconsiciliation
Act of 1990, 42 U.S.C and 1935 cc (a) (1)} was enacted to regulate any institution
receiving federal funding.
 Among the rights that health care institutions must provide to their patients are the
right to have occurs to health care without any prejudice; to be treated with respect
and dignity at all times; to privacy and confidentiality, to personal safety while in the

30
 institution; to complete information about their condition and treatment; and to give or
not give consent for care.
 Some of the responsibilities that patients have to the health care institution are to
provide accurate information about themselves; to give information regarding their
known conditions and to participate to indecision making regarding treatment/care.
Informed Consent
 The patient Bill of rights includes the patient’s right to make decisions regarding his
or her health care.
 Informed consent doctrine is a persons agreement to allow a particular treatment
based on full disclosure of the facts needed to make an intelligent (informed) decision.
 Before any invasive treatment or procedure an be performed, the patients needs to be
aware of the benefits of the treatment, the risks involved, any alternative treatments,
and the consequences of refusing the treatment or procedure.
 The patient has the right to choose to accept or reject the proposed care but only after
understanding fully what is being proposed.
 Procedures must be explained in non-technical terms and in a language the patient can
understand.
Confidentiality
 The licensed practical / Vocational nurse has a duty to protect information about a
patient no matter how that information is received.
 The information received about a patient must be guarded and occurs to their
information restricted to only those health care members who have a legitimate need
to know.
 Failure to maintain patient confidentiality gives rise to legal liability and legal
remedies exists to address confidentiality breaches.
 Whether on duty or off duty, the nurse can not breach a patient’s confidence.
 The duty does not end when the patients is discharged.
 If the nurse has questions regarding the disclosure of patient information, the nurse
should follow the policies of the employing institution.

Medical Records
 Laws govern the collection, maintenance, and disclosure of medical record
information.

31
  Each health care instititution will also have policies and procedures regarding the
patients medical record.
 Medical records are not public documents, and the information they contain is to
be guarded.
 Breaches in the confidentiality of information kept I the patients medical record
also gives rise to legal liability.
Invasion of privacy
 The legal concept of invasion of privacy involves a person’s right to be left alone
and go unnoticed if he chooses.
 When a patient consents to be cared for by a nurse, the patient does not waive the
right to privacy.
 Exposing the patients body parts unnecessarily, discussing the patient
inappropriately, or disclosing information about the patient may result in legal
liability.
 Using may authorized patient information (name, photograph, specific facts
regarding an illness and so on) is a violation of the patients legal rights. The nurse
needs to safeguard the patients right to privacy at all times.
Reporting Abuse
 There are exceptions to the right to privacy. The law prescribes when a health care
professional must report certain information to the appropriate to the appropriate
authorities.
 When man-dated to report information (eg. Certain communicable diseases or
gunshot wounds), the health care professional is protected from liability when acting
in good faith.
 The nurse must be alert for the signs of abuse, especially in high-risk populations such
as children and older adults.
 In response to the enormous problem of child abuse, the federal child abuse
prevention Treatment Act of 1973 was enacted.
 The child Abuse Amendments were enacted in 1984 in an attempt to protect the rights
of these handicapped infants.
 These regulations made any institutions receiving federal funds legally responsible to
investigate the withholding of medical treatment to an infant.
Physician – assisted Suicide

32
  The issues of physician – assisted suicide (PAS) has received much media
attention with the public actions of Dr. Kevorkian, PAS, a form of active
euthanasia, involves the physician taking an active role on helping to end a
patients life.
 Through the legal status of PAS remains unclear, ethical issues directly affect
health care professionals.
ETHICAL ISSUES IN NURSING PRACTICE
INTRODUCTION
Ethics is the study of good conduct, character and motives. It is concerned with
determining what is good or valuable for people. Acts are ethical often reflect a commitment
to standards beyond personal preferences. Standards on which individuals, professionals and
societies agree discussion and resolution of ethical issues require critical thinking skills
ETHICAL PRINCIPLES
Practitioners in health care delivery agree to a set of ethical principles that guide
professional practice and decision making.
1. Autonomy: Refers to a person’s independent as a principle in bioethics, autonomy
represented an agreement to respect the clients’ right to determine a course of action.
2. Justice: Refers to principle of fairness, you will often refers to this principle when
discussing issues of health care resources.
3. Fidelity: Refers to the agreement to keep promises, the principles of fidelity also
promotes your obligation as a nurse to follow through with the care of offered to
clients.
4. Beneficence: Promotes taking positive active steps to help others. It encourages you
to do good for the client.
5. Nomaleffecience: Refers to the fundamental agreement to do no harm. This principle
can be helpful in guiding your discussion about new or controversial technologies.
ETHICAL ISSUES
An ethical issue is difficult for the nurse because there is no absolutely wrong answer
to the question the issues presents. > Ethical issues, like many other issues in health care,
change as society changes, some of the current ethical issues in nursing include
 Physician- Assisted suicide
 The right to refuse treatment
 Death with dignity

33
  Right to refuse to care
 Genetic Research
Physician assisted suicide
 The issues of physician – assisted suicide (PSA) are complex.
 The ethics of PAS are being debated by health care professionals and patient
advocacy groups.
 ANA has taken a firm stand on the issue of PAS, holding that PAS is not
consistent with the philosophy of nursing.
 ANA’s specific objections to PAS are based on the principle of nonmaleficence
(the duty to protect life, to do no harm).
 Active euthanasia is opposed out of a commitment to protect life.
 The right to autonomy and the right to self-determination are argued to be the
ethical principles that support PAS.
 Nurses, as well as other health care professionals, are being forced to face the
issues of PAS and euthanasia.
Right to refuse treatment
 The right to refuse treatment is a right that a competent adult has in health care to
determine what does or does not happen to them.
 The ability of medicine to sustain life and prolong death makes this issues event
move complex.
 A patient may choose to accept or refuse a treatment, even if the refusal may or
will result in death.
 A patient can prepare an advanced directive that would specify what life saving
treatments he or she does or does not wish to have.
 A living will is one way to patient can exercise his or her right to refuse treatment.
 A patient may designate a health care proxy (durable power of attorney) to make
decisions regarding medical treatment if the patient is unable to make them.
 State laws vary on the legalities of the various forms of advanced directives, and
the nurse needs to know the applicable state laws.

Do not resuscitate orders

 The patient is not usually involved directly when a Do not resuscitate order
(DNR) is written.

34
  The patient is usually incapacitated with little hope for recovery.
 The physician, after consultation with the patients family, will write the DNR
order in the medical record.
 The physician is responsible for following the applicable policies and procedures
on writing DNR orders.
 When the DNR order is written in the chart, the nurse has a duty to follow the
order.
Refusal to treat
 The issue of refusing to treat a patient arises when the nurse encounters a situation
that conflicts with his or her own moral beliefs.
 One such situation involves assisting in or caring for a woman having an abortion.
 Though a legal right to an abortion exists, this does not mandate whether abortion
is morally right or wrong.
 If the nurse has a strong moral or religious belief regarding abortion, the nurse
must communicate with the appropriate supervisor and explain the moral
dilemma.
 The nurse cannot refuse to care for a patient because she disagrees with the
decisions the patient makes.
 The use does not have a legal right to refuse to care for a person with an infectious
disease, including those infected with the human immunodeficiency virus.
Genetic research
 Advances in medical technology have made genetic testing possible, and advances
continue in genetic research.
 The human Genoma project (Funded by the National Institutes of health) is a
comprehensive study of the genes that make up the human body.
 Valuable information has been (and will be ) gained about cancer and hereditary
diseases, but ethical issues must be dealt with.
 Questions regarding this genetic information will be used, who owns the
information, and who will have access to the information have already begun to
surface.

Ethical Dilemmas
 Ethical dilemmas are situation that do not have a clear right or wrong answer.

35
  They are very complex, confusing and often frustrating situations which require
careful, rational analysis.
 The nurse must be first identify the problem as an ethical one. This means that the
questions presented can not be answered using established laws, rules, policies,
and procedures.
 Many situations are a combination of legal and ethical questions. It is important
for the nurse to sort out the questions and seek guidance as needed.
 The next step is to assess the situation completely, gathering as much information
as possible to aid in the decision making process.
 Before coming to a decision, the nurse must consider any ethical principles that
might apply to the situation.
BIO-ETHICAL ISSUES
Nurses will deal the bioethical issues in a variety of ways. There are:
Quality of Life
In health care, researchers try to develop quality of life measures to help determine
the benefits of medical intervention. Some social scientists have proposed formular or other
objective measuring devices that can be applied to individual situation. These formulas take
into account the age of the client, the client’s ability to live independently and the client’s
ability to contribute to society in a gainful way.
A quality of life measures could help a client and family decide on the merits of a
certain risky interventions, such as an organ transplant or experimental drug management.
The Question of Quality of life is central to discussions about futile care, physician assisted
suicide and DNR Discussion.
Genetic Screening
Genetic testing alerts a client to a condition.
Example: The gene that indicates the presence of Huntington diseases is detectable upon
genetic screen. Huntington’s disease is an inherited degenerative neurological disease,
incurable at this time, and is affect cognitive and emotional and physical function. Symptoms
usually do not appear until the third or fourth decade of life. If a parent or grand parent has
the disease offspring are at risk for developing the disease.
Futile Care:The dictionary defines futile as something that is “useless, vain, hopeless,
lacking vigor or purpose”. In discussions about health care, the term usually refers to
interventions unlikely to produce benefit for the client. If the client is dying, in a condition
with little or no hope of recovery, then almost any intervention beyond pain management and

36
comfort measures might be deemed futile. In this situation, an agreement to label an
intervention as futile helps providers, families and client to refrain from prolonging the dying.
Reproductive Issues
Nurses are at the forefront of many of these issues, including birth control, abortion,
artificial insemination, in vitro fertilization, and use of fetal tissues, selective abortions for
multiple pregnancies and embryo implantation in post menopausal women may raise many
new Questions. The distinction of reproductive cloning centers around three areas.
1. Health risks from gene mutation
2. Emotional risk
3. Abuse of the technology
Therapeutic cloning, however, has received more support I the medical community
because this technology is aimed at transplanting an individuals own DNA into an
unfertilized egg to grow stem cells.
Stem Cell Issues
Ethical issues arise because of the origin of the stem cells. Sources of stem cells
include bone marrow and cord blood. How fetal tissues should be obtained or used for
medical research or treatment? Anti abortion groups oppose use of embryo stem cells on
ethical grounds.
ETHICAL ISSUES IN EACH FIELD
Ethical issues related to family
The nurse can serve as a catalytic agent the family, identifying the need for them. The
nurse can encourage open discussion of the problem with respect for the rights of all
concerned. The nurse can facilitate the process by raising questions to clarify understanding
of all the options.
Ethical issues in reproductive technology
Family Planning
In this policy proposals recommended that American aid to emerging countries should
be tied to population control. The counter argument is that food and aid should be given
solely on the basis of human need. Thus the ethical controversy continues regarding
individual liberty to produce as many children as desired and the duty of parents, and
ultimately, society, to provide children with the necessities of life, including health care.

Artificial Insemination

37
 The ethical arguments for and against artificial insemination are related to the
differing definitions of the meaning of marriage, parenthood and the family system and to the
rightness or wrongness of reproductive interventions. The ethical arguments in favor of
artificial insemination are based on a definition of marriage of mutuality and happiness. The
argument supporting artificial insemination by donor or by husband is that the human’s acts
of sexual intimacy and procreation are different and separate.
Fetal Therapy
With technological advances in perinatal medicine and surgery the foetus is accessible
to “in utero” diagnostic procedures and treatments. The aim is to identify deformities that
signal severe birth defects early in the pregnancy so as to cure or correct them.
Surrogate Motherhood
The ethical issue in surrogate motherhood is the woman’s right to her own body to
reproduce a baby for another person, but it is not for sale.
Genetics
The ethical issue is the patients liberty right to produce children without regard for
genetic consequences. Genetic screening is simple, effective way of determining their
transmission status regarding Tay - Sachs disease.
Sterilization
Another response to known hereditary defects, one that violates individuals liberty
rights, is compulsory sterilization. Sixteen states have compulsory sterilization laws.
In Abortion
The abortion issue seems to us to be either a statement or a case of communicating on
different levels. Abortion is now legal in all states. The nurse’s responsibility is to give the
patient objective information and referrals to appropriate resources before, during and after
an abortion.
Ethical issues in the nursing care of infants
The nurse’s primary commitment is to the clients care and safety. The nurse must be
alert to and take appropriate actions regarding and instances of incompetent, unethical or
illegal practice by any member of health care team. Nurses contribute their observations
regarding the infants health status when decisions are to be made regarding who lives, who
receives special consideration and who is left to die.
Ethical issues in End of life:The end of life issues is particularly troublesome as they test
competing claims of respect for autonomy beneficence and non-maleficence. At the end of
the spectrum patients sometimes believe they have a right to any and all treatments regardless

38
of their prognosis and predicted outcomes. Futile treatments need to be identified and
outcome data utilized in order to avoid needles prolongation of life. Questions of with
holding or withdrawing nutrition especially the provision or removal of hydration will
undergo much debate in the future.
Ethical issues in HIV and AIDS
HIV and AIDS focus the case manager on ethical obligations of confidentiality and
discrimination. Although studies have been made in relation to the societal attitude toward
clients with HIV and AIDS, the stigma and discrimination have not been totally erased.
Clients who are HIV positive continue to face compromising and dangerous situation. At the
same time, it is necessary to protect others, because clients are at risk for losing jobs, housing,
friends and certain services.
Ethical issues in multicultural
The case manger who confronts multicultural issue is faced with provocative
questions of relatively. Traditionally, the nursing profession has fostered respect for various
ethnic groups and their differing cultural beliefs. Nurses have been questioned to withhold
judgment and attempt to provide value free services.
Ethical issues in cultural perspectives
It involves cultural perspectives of congenital disorders and handicaps.
E.g.: Disfigured and malformed newborns are not always perceived as acceptable in the
country dare not of origin, these children would be left to die because it is a disgrace to
recognize their existence and care for them. This presents a significant dilemma for the case
manager who works with families whose children being life in the neonatal intensive care
unit. Many handicaps are compatibles with life, although they may create a disfiguring
appearance. Some of these infants are also candidates for reconstructive surgery where
normal or near to normal.
Ethical issues in Gender, age, race and Socio-economic class
These are separately or together are responsible for discriminatory practices in health
care. Prejudice and bias can occur with in any one individual case or when considering the
health care needs of a specific target population. Negative attitudes and practices create
conditions of oppression, suppression and repression for any disadvantages group. The
decision makes needs to ask given comparable situations and needs are possible alternatives
of the same regardless of gender, race or class? Are the options basically the same for men
and women? Black, Hispanic, American, Indian, or white? Poor, middle class or wealthy.
Ethical issues during Admission

39
  Does not force the patient for admission explain the advantages and disadvantages of
admissions?
 Explain about the hospital policies, routines of ward and procedures to the patient.
 Explain to him the time for the meal servings, the doctor’s visit, and the prayer
service.
 Explain the patient conditi9on to the relative.
 Make arrangements for paying the hospital.
 Enter the patient details is admission registers.
Ethical issues during pre-operative period
 Explain the procedures to the patient
 Obtain consent from the patient
 Obtain consent from the patient and relative for each operation after explain the
nature of operation.
 Proper explanation regarding the consent.
Ethical issues during discharge
 Patient should be discharged after doctor’s written order.
 No patient should be discharged until he is rehabilitated.
 If any patient leaves the hospital against advice the he should be asked to sign a
special form.
 If the patient discharges at request get the consent from the patient.
 In case of medico legal cases (MIC) get permission from the patient.
 In case of postmortem get consent from the relatives and handover the belongings.
 Give discharge summary and enter the discharge time and date into the case sheet as
well as admission register.
Ethical issues during Trilogy of a Dying patient Rights
 To respect a person consists in recognizing the dignity and inherent worth of threat
individuals as being uncompromisable. Respect for persons is in some religiously
oriented traditions defined as reverence for persons.
 A second right, the right to receive treatment, means that a patient has the right to be
given the best available treatment. The right to treatment flows out of the right to
respect and is a special health care right.

40
  The patients right to refuse and even to terminate all treatment is an especially
important right of component patients. Such as a right assumes that hospital personnel
are willing to take on the legal and moral responsibility associated with the death of
patients who wish to discontinue treatment. This decision implies that health
professionals will accept corresponding duties, such as providing component,
compassionate care while the patient in dying.
 The trilogy of a dying patient is rights means a dying patient is treated with care and
comfort and not left alone. For to show respect for a dying person is to provide
maximum well being for that person as long as there is life.
 The nurse at a dying patient’s bedside can give succor and support to that patient
helping the patient through the stages of dying, sharing the patient’s grief with
compassion, support and understanding. The nurse with ethical sensitivity, oriented
by love based ethics at dying patients last hours, gives as one person to another in the
recognition that they have this life and this fate in common.
CONCLUSION
Legal and ethical issues involves the negotiation of closely held personal values and
philosophies nor facts or measurable clinical data concept of ethical issues involves informed
consent, advance directible quality of life, allocation of scarce resources.
. REGULATORY MECHANISM
Introduction:
The world trend of professional accountability to an enlightened public com no longer
be ignored by nursing. We nurses easily use the words “Quality Nursing” but have we
defined what we mean by “Quality”? Do we know our deficiencies? Are we ready to admit
our deficiencies to our peers? Are we talking steps to remedy them? Only by such self
regulation we can retain our identity with the health professional as nature partners.
NURSING AUDIT
Definition:
1. According to Elison “Nursing audit refers to assessment of the quality of clinical
nursing”.
2. According to goiter walfer
a. Nursing audit is an exercise to find out whether good nursing practices are
followed.

41
 b. The audit is a means by which nurses themselves can defined standards from
their point of view and describe the actual practice of nursing.
Purpose of nursing audit
1. Evaluating nursing care given
2. Achieves deserved and feasible quality of nursing care
3. Stimulant to better records
4. Focuses on care provided and not on care provider
5. Contributes to research
Methods of nursing audit:
There are two methods:
a. Retrospective view – this refers to an in-depth assessment of the quality after the
patient has been discharged, have the patients chart to the source of data.
Retrospective audit is method for evaluating the quality of nursing care by examining
the nursing care as it is reflected in the patient care records for discharged patients. In
this type of audit specific behaviors are described then they are converted into
questions and the examiner looks for answers in the records.
For example the examiner looks through the patient records and asks:
a. Was the problem solving process used in planning nursing care?
b. Whether patient data collected in a systematic manner?
c. Was a description of patient’s pre-hospital routines included?
d. Laboratory test results used in planning care
e. Did the nurse perform physical assessment?
f. Were nursing diagnosis stated?
g. Did nurse write nursing orders? And so on.
b. The concurrent view:
This refers to the evaluations conducted on behalf of patients who are still
undergoing care. It includes assessing the patient at the bedsides in relation to pre-
determined criteria, interviewing the staff responsible for this care and reviewing the
patient record and care plan.
Audit Committee
Before carrying out an audit, an audit committee should be formed, comprising of a minimum
of five members who are interested in quality assurance, are clinically competent and able to
work together in a group. It is recommended that each member should review not more than
10 patients each month and that the auditor should have the ability to carry out an audit in

42
about 15 minutes. If there are less than 50 discharges per month, then all the records may be
audited, if there are large number of records to be audited, then an auditor may select 10 per
cent of discharges.
Steps to problem Solving Process in Planning Care :
a. Collects patient data in a systematic manner,
1. includes description of patients pre-hospital routines,
2. has information about the severity of illness,
3. has information regarding lab tests,
4. has information regarding vital signs,
5. Has information from physical assessment etc.
b. States nurses diagnosis,
c. Writes nursing orders,
d. Suggests immediate and long term goals,
e. Implements the nursing care plan,
f. Plans health teaching for patients,
g. Evaluates the plan of care,
Advantages of Nursing Audit
1. Can be used as a method of measurement in all areas of nursing
2. Functions are easily understood
3. Scoring system in fairly simple
4. Results easily understood
5. Assesses the work of all those involved in recording care.
6. May be useful tool as part of a quality assurance programme in areas where accurate
records of care are kept.
Disadvantages of nursing audit:
1. Appraises the outcomes of nursing process, so it is not so useful in areas where the
nursing process has not been implemented.
2. Many of components overlap making analysis difficult.
3. It time consuming.
4. Require a team of trained auditors.
5. Deals with a large amount of information.

ACCOUNTABILITY IN NURSING
Definition

43
 According to A.N.A “Accountability refers to being answerable to some one for
something one has done. It means providing an explanation to self, to the client, to the
employing agency and to the nursing profession”.
Purpose
1. To evaluate new professional practice and reasses existing ones.
2. To maintain standards of health care
3. To facilitate personal reflection ethical thought and person growth on the part of
health care professional
4. To provide basis for ethical decision making.
To whom are nurses accountable?
Nurses are accountable to different people for different charges. The individual
practicing nurse is accountable to
 The patient or client for the standard of care given
 To her employer (via her manager) for providing the services which she is
employed to provide and for proper use of the resources provided by the employer
for the purpose.
 To her professional colleagues for her behavior as a professional, by which the
whole profession may be judged.
Accountability of a profession
To be accountable a profession must know that for which it is accountable. To do this, the
profession must establish professional standard and attempt to enforce them,
ANA set a standard of nursing practice, service, Education.
By using this standard as a guide the individual nurse can see, clearly laid down, the
scope, the limit of practice. Nurses can internalize that for which they are accountable.
Accountability to the client & public:
A professional must be accountable to the public because the consumer has a right to
receive the best possible quality of care.
Nurses must be aware of this increased consumer knowledge & sophistication and
must be prepare to respond to in an equally knowledgeable & sophistication manner. Nurse
must be able to demonstrate clearly those principles and concept on which practice & based
not only that are should in position & ability to solve the problem and know the method of
problem solving by using these principles and concepts.
Accountability to the profession:

44
 Nurses are also accountable to the professional when they consider with educational
system will prepare its member most satisfactory for practice. The individual nurse must
through careful thought be accountable on the matter & issue.
Accountability to self:
Involves acknowledging ones own limitation & knowing when further education is
needed to more fully and safely perform one’s role.
Includes refusing to work in situation that he/she consider & say.
For E.g., lack of knowledge or experience of area or because of insufficient staffing etc.
Accountable for their own mental & physical health for ensuring that they keep all
aspect of life in balance prospective.
Accountability to the employing Agency:
1. A another domain of the nurse accountability is the agency in which she is employed.
2. The agency is accountable to public for case provided under it organization.
Therefore in turn it has a right to expect the nurse to be accountable to that agency.
3. Quality is work is one aspect in which nurses must be accountable to the agency
which include
 Their own preparation for the job.
 Their fitness each time they appear
 Attitude towards that agency that the nurse projects to the
clients.
One of the objectivity and honesty – appropriate to promote agency strength to the extent that
it has them in a realistic manners & no to exaggerated its shortcoming.
The agency has contracted with the Nurse for a specific job to be done at a specific time and
place for a specific wages.
EVALUATION OF CARE
Definition
 It is a planned systematic comparison of client’s health status with the desired
expected outcome. It is an ongoing, continuous, deliberate activity which involves the
clients, nurse and other health care team members
Purpose of evaluation
1. To determine the client progress in meeting specified goal and objectives.
2. To judge the effectiveness of nursing care.
Forms of evaluations

45
 1. Ongoing evaluation
2. Intermittent evaluation
3. Terminal evaluation
1. Ongoing evaluation:
It is done immediately after implementing a nursing order it enable a nurse to
make on the spot modification in an intervention.
2. Intermittent evaluation:
It is performed at specified intervals (once a week) show the extend of progress
towards goal achievement and enable the nurse to correct any deficiency and modify the
care plan as needed.

3. Terminal evaluation:
It indicate the client condition at the time of discharge it include the status of goal
achievement and are evaluation of client self-care ability with regard of follow up care.

Process of evaluating client responses:

1. Identify desired outcomes
2. Collecting data
3. Comparing data with outcome
4. Relating nursing outcome to client goal
5. Drawing conclusion about problem status
6. Reviewing & modifying the nursing care plan.
LEGISLATION OF QUALITY CARE
Definition of law
It can be defined as “those rules made by humans who regulate social conduct in a
formally prescribed and legally binding manner”.
The law is a system composed of general rules governing conduct and the procedure
for resolving disputes when the rules are not followed.
(POZGAR, 1996)
Sources of laws
The legal guidelines that nurses must follow are derived from statutory law,
regulatory law, and common law.
1. Statutory law:

46
 It is created by elected legislative bodies such as state legislatures and the V. S
Congress. An example of state statues is the nurse practice acts found in all 50 states.
2. Regulatory law, administrative law:
It is created by administrative bodies such as state boards of nursing whom
they pass rules and regulations. An example of regulatory law is the duty to report
incompetent or unethical nursing conduct to the state board of nursing.
3. Common law:
It is created by judicial decision made in courts when individual legal cases
are decided. An example of common law is informed consent and the client’s right to
refuse treatment.
Types of law:
1. Private law:
Control relationship between private individual and private organization.
2. Public law:
Regulate relationship between the government and the agencies & the
individuals. E.g., criminal law and administrative law
3. Common law:
Recognize affairs and enforces rules and customs of society through of
individual decision.
4. Civil law:
Regulates disputes between individuals and group by providing money.
5. Criminal law:
Protect society by defining criminal behavior and punishing these whose conduct
violent and established rules.
6. Procedural law:
Sets requirements for specific manner of proceedings whom specific substance law is
violated.
Function of law in nursing:
1. It provides a framework for establishing which nursing action in the
case of client care legal.
2. It helps to establish the boundaries of independent nursing action
3. It differentiates the Nurses responsibilities from those of other health
professionals.

47
4. It assists in maintaining a standard of nursing practice by making
nurse accountable under the law.
LEGAL LIABILITY IN NURSING:
Minimizing liability through effective documentation and client response:
Nurse can reduce their chances of being named in law-suits by following standards of
care giving competent health care and developing an empathetic rapport with client. In
addition, careful, complete and objective documentation serve as evidence of standard of
nursing care provided.
Timely and truthful documentation is used in many ways that benefit the client and
demonstrate that the nurse is an effective care provider. Good documents also keep other
health care provider unto date on the most recent treatments received by the client so that
ongoing care can be safely provided. Nurses must be certain that documentation is legible
and signed.
Contracts:
Contract is a written or oral agreement between two people in which goods or services
are exchanged.
Employment contracts:
Many nurses are hired without a formal written contract. An oral contract is a legally
binding as a written one but may be more difficult to carry out the agreed on obligations.
Even though nurses employment agreements generally are not in the farm of written contract.
Insurance:
Insurance is a contract wherein for an agreed on amount of money one party
undertakes to compensate the other for loss on a specified subject by specified perils.
Health Insurance:
Health Insurance is a contract that provides for payment of physician bills, hospital
bills, diagnostic tests, laboratory work, and some time medication and dental work.
Malpractice Insurance:
Malpractice or professional liability insurance is a contract between the nurse
and the insurance company. Malpractice insurance provides for a defense when a nurse is
sued for professional negligence or medical malpractice.

Mother and babies:

48
 The newborns and mothers health protection act of 1986 was passed as a result
of what was refused to as” drive through deliveries”, which were attempts to cut utilization of
services and limit coverage for hospital stays for mothers and newborns.
Mental Health:The mental health parity act of 1996 forbids health plans from placing lifetime
or annual limits on mental health coverage that is less generous than those placed on medical
or surgical benefits.
CONCLUSION:
A profession concern for the quality of its service constitutes the heart of its
responsibility to the public. An regulatory mechanism helps to ensure that the quality of
nursing care desired and feasible is achieved. This concept is often referred to as quality
assurance.

COST EFFECTIVENESS OF COMPUTERIZATION AND

CONTINUING EDUCATION

INTRODUCTION

Nursing has only recently become interested and become involved with hospital
computers and new technologies. There are usually two reasons for implementing automated
system in health care that is to improve patient care and to reduce costs. The cost benefit
analysis is a tool which is useful in setting priorities for various courses of action to meet
objectives. The computers and also continuing education in nursing will be essential for
managing and delivering a patient care.

COST

Cost is the amount of expenditure actual (incurred) or notional (attributable) relating

to a cost object.

EFFECTIVENESS

“Is defined as the effect of producing the profit effect”

COST EFFECTIVENESS

Cost effectiveness is methods are those that search for the least costly way of
achieving a defined result.

COST EFFECTIVENESS ANALYSIS

49
 The cost effectiveness analysis is the technique for choosing from alternative courses
of action, a preferred choice when objectives are not very clear in such areas as sales, costs or
profits. In cost effectiveness analysis, decision criteria may include

a. Achieving a given objective at least cost

b. Attaining it with reasonable resources

c. Providing a trade – off of cost for effectiveness

Cost effectiveness analysis is not an analysis for cost reduction it is an optimization

approach to a specific set of goals. After the objectives have been determined, cost
effectiveness analysis considers the number and type of alternatives available. After
determining the possible alternatives, resources requirements for each alternative viz people,
money, equipment and facilities are determines and converted to monetary costs. The
analysis first determines the criteria to be used in determining the effectiveness of each cost
factor and then prepare cost effectiveness models for each alternative. Some of the criteria of
effectiveness are as follows.

1. Capacity

2. Accuracy

3. Degree of physician acceptance

4. Quantity of output

5. Performability

6. Quantity of output

7. Mean – time between repair

8. Professional Acceptance

9. Error rate

10. Flexibility

11. Inconvenience to other departments

12. Spill – over effects

13. Power Consumption

14. Personal Safety

USE OF COMPUTERS IN CLINICAL NURSING PRACTICE:

50
 a. Admission, discharge or transfer

b. Documentation

Computer can store standard nursing care plan in a format determined by the
institution to be used by nurses as the basis for developing individualized client care plan.
Computers help in the analysis of the data and even make interpretation regarding the
patients’ condition.

Patient’s histories and medical record can computerized. It improves the usability of
patient information. For Eg. Using a computer a nurse or a physician could lasily examine
the history of symptoms that a patient experience and leaves the nurse with more time or
reflect upon care plan.

Nurse’s notes can be recorded more easily since most rotations can be selected from a
menu of programmed entries. Care plans can also be developed more easily with a computer.

Computerization also facilitate communication among nurses particularly between

shifts.

USES OF COMPUTERS IN NURSING ADMINISTRATION :

Clients are assessed on a number of criteria and their abilities and needs for nursing
care are rated.

 Help in client billing system

 Word processing

 Shifts are all performed

 Computers can help in following areas

 Planning nursing care

 Monitoring and interpreting physiologic varies

 Administering medications

 Patient classification system

 Scheduling Shift

 Record keeping

51
 As health care delivery becomes more complex and care givers become more
dependent on each other for continuously updated patient information, each manager requires
a supply of information to control system operation.

Today’s nurse manager must communicate with machines increasingly used in

hospital and clinics to improve efficiency, decrease errors and reduce cost.

Superintendent can prepare separate file of each staff, which includes positions,
responsibilities, salary increments, leave record etc., She can prepare duty schedules. She can
get information of any particular patient on the screen immediately.

In nursing school for each student separate file can be prepared since admission and time to
time file can be updated till completion of the course and finally that file can be closed.
Paper Checking, calculation of marks, taking out percentage, preparing results graphs, for the
record of curriculum activities any disciplinary action taken and master file of college can be
prepared with the help of computer
EFFECTIVE LEADERSHIP
INTRODUCTION
A leader is one who uses interpersonal skills to influence others to accomplish
specific goals. The leader exerts influence by using a flexible repertoire of personal behaviors
and strategies. The leader is important n forging links – erecting connections among on
organizations members to promote high levels of performance and quality outcomes.

DEFINITION OF LEADERSHIP
“Leadership is the ability of a manager to induce sub-ordinates (followers) to work
with confidence and zeal”.
(Koontz and O’ Donell)

NATURE AND CHARACTERISTICS OF LEADERSHIP

1. Co-existence with follower ship
2. understanding feelings and problems
3. Assumptions of responsibility
4. Objectivity in relations
5. self awareness
6. Specific situations

52
1. Co-existence with followership:
It is axiomatic to say that there can not be any leader without the existence of
followers. The leader exercise authority over the group, and such authority is willing
accepted by followers. When authority is exposed over the group without the voluntary
acceptance of such authority, it results in reaction, not leadership of the group. It follows
therefore threat leadership cannot be conferred or ordered, it must be earned. The first feature
of leadership is thus to be sound in confidence, respect, loyalty and devotion shown by
followers.

2. Understanding feelings and problems:

The second characteristic of leadership lies in understanding both the group and
individual feelings and problems of followers. The leader must try for the satisfaction of
social and personal needs of his followers. The leader is looked upon as one dependable
friend, philosopher and guide by followers. Accordingly, followers accept the leader to
recognize their individual difficulties and to take every possible measure for their well-being.
This dependence of faith in the leader is made to prevail among personal through mutual
understanding. And to increase this understanding the leader is required to keep the followers
informed of all developments affecting the group and its work, to allow participation in
decision making.

3. Assumptions of Responsibility:
The third feature of leadership calls for the acceptance of full responsibility for all
situations. As the leader exercises authority and undertakes the task of guidance, he must
assume the responsibility for all actions and operations of his followers. He must steer the
group clean of all difficulties for arriving at the fixed destination. For the attainment of
objectives, he is required to encourage and develop the weak, to influence and control the
strong and to prepare the whole group for an effective teamwork. More over, leadership
demands the ability to stimulate the qualities of enthusiasm and initiative among individual
members.

4. Objectivity in Relations:
Another characteristic of leadership rests on maintaining objectivity and relations
through fair play and absolute justice in all affairs of the organization. This playing fair is to
be demonstrated in all delusions and actions, in communication and participation, in

53
reprimand and commendation, or in placement and transfer. The leader’s ability to inspire
can be retained intact though his impartiality in all separations and activities. Misjudgment
and his direction by the leader affect employee behavior and reduce the result of human
efforts members feel aggrieved and the leader poses their confidence and loyality.

5. Self-Awareness:
As the leaders actions influences he behaviors of followers, the leader needs to be
aware of his own preference and weaknesses with a view to learning what impression his
action make on followers. To be effective, leadership must also be supported by the technical
competence and personality traits. In the absence of a familiarity with technical details of the
work, necessary guidance and direction cannot be given. Personality traits must also be
conductive to the growth of self-confidence and conviction on the part of leaders. The leader
must have faith and determination to pursue a course of action to its logical ends without
being certain and positive about the results, he cannot inspire others in following him.

6. Specific Situations:
Leadership is not an abstract skill unrelated to people and the physical environment.
Leadership patterns are always molded by the composition of the group and the nature of
environment. Levels of education, training and experience of group members shape the
pattern of leadership in any situation. Moreover, the tradition of the company, the flexibility
in operations and the rise of emergency conditions cast a significant influence on leadership
roles and skills that are to be adopted in a specific situation.

FUNCTIONS OF LEADERSHIP
1. Motivating and Guiding Personnel:
Leadership provides the vital spark to motivation of human beings. Motivation has its
roots in human relations which, in turn, can be fostered and toned up by leadership. The
leadership that guides inspires and directs group members for achieving a unity of purpose
and efforts.

2. Influencing and Shaping the Social System:

Leadership emerges as a natural process in any grouping of human beings. If there is a
lack of formal and recognized leadership in the group, informal leadership is bound to
develop from the rank and file members of the group. After its emergence leadership is bound

54
to develop from the rank and file members of the group. After its emergence leadership
persuades the group of to have an identify of interest, outlook and action. Leadership
provides imagination, foresight, enthusiasm and initiative to the group. It exhibits an imitable
code of conduct and responsibility, prescribes a high standard of performance and stresses the
importance of respect for the individual unsatisfactory human performance in any
organization can be primarily attributed to poor leadership.

3. Understandg followers and securing their co-operation:

Not only the leader influence his followers, but he also is influenced by their
problems and feelings on the basis of information, responses and operational facts secured
from followers, leaders behavior and action one modified and made ready for their voluntary
co-operation. To groups followers problems and feelings properly, however, leadership
requires a skill of sympathetic contact, careful listening, correct diagnosis and winning their
confidence. A time spirit of co-operation grows principally out of the manner in which the
leader deals with his followers.

4. Creating a Climate for Performance:

For enabling the followers to apply their full capabilities for work accomplishment
and to extend their unselfish support he leader is required to create a climate or performance
with this end in view, the leader must know what motivates his followers and how these
motivators operate. The more thoroughly the leader understands the process of motivation,
the more effective he is likely to be in getting the work successfully done by his followers.

IMPORTANCE OF LEADERSHIP IN MANAGEMENT

1. Motivate Power to Group Efforts:
Management, for getting the work done by others, is to supply leadership in the
organization. As group efforts and team work are essential for realizing organizational goals,
leadership becomes vital for the execution of work.
2. AID to Authority:
Managers exercise authority in managing people of the organization and their task
becomes easy where ever they are aided by leadership. There are serious limits to the use of
authority and power in obtaining high performance. Authority alone can never generate the
initiative and resourcefulness required, I many jobs. But leadership can obtain tangible and an
improved result of human efforts because of its main reliance on influence leadership

55
contains all the essential ingredients of direction for inspiring people and providing the will-
to-do for successful work accomplishments.
3. Emphasis on human performance:
Effective leadership is needed at different levels of management from top
management down to supervisory management. Management is transformed as a social
process through its leadership action. It is the social skill of leadership that accomplishes
objectives by mobilization and utilization of people.
4. Creating a Climate for Performance:
For enabling the followers to apply their full capabilities for work accomplishment
and to extend their unselfish support he leader is required to create a climate or performance
with this end in view, the leader must know what motivates his followers and how these
motivators operate. The more thoroughly the leader understands the process of motivation,
the more effective he is likely to be in getting the work successfully done by his followers.
5. Basis for Co-operation:
Leadership provides the basis for co-operation in several ways. Good two ways
communication, man-to-man personal relationship, use of participation and creation of
opportunity for need satisfaction are meant for increasing understanding between the leader
and his subordinates of their mutual viewpoints. This increased understanding obtained
through the interactions of individual personalities promotes favorable feeling and attitudes
among them.
QUALITIES OF EFFECTIVE LEADER:
1. Energy
2. Strength
3. Intelligence
4. Values
5. Courage
6. Spirit
1. Energy:
According to La Guardia, a leader needs to demonstrate vibrancy and enthusiasm -energy
- in all activities.
2. Strength:
La Guardia was found strong in making decisions and resolute in defending and
marinating a certain course of action. Managing change is found frequently conceptualized in
the health care management and this requires strength.

56
3. Intelligence:
The underlying principles such a visibility, fully optimization of resources and
dependability are among the ethical standards for leadership strategies and conduct that are
essential for value-driven management.
4. Courage:
As a healthcare manager, take a stand to defend your position in many complex areas
and that requires courage.
5. Spirit:
Being a healthcare manager, you also need to establish a positive attitude to over
come adverse circumstances. The importance of establishing a sense of spirit throughout the
work group can be minimized, specially in hospitals where crisis and frustration are found
breeding freely.
BARRIERS TO EFFECTIVE LEADERSHIP:
1. Inability to handle the resistance when it occurs
2. lack of management support
3. Internal conflict over resources
4. Insufficient resources
5. Employees are not involved in the decision making
6. Ineffective policies or procedures
7. Differing organizational values
8. No one is in charge for accountability
9. Lack of skill which is necessary to handle resistance when it necessary.
DISCIPLINE AND CONSTRUCTIVE DISCIPLINE

Introduction:

Discipline means orderliness. It is the primary responsibility of the management to

maintain discipline. Hospitals and organized delivery system that have been organized by

unions hove found it necessary to establish formal labor relations divisions within their

human resources deportments which are delegated the responsibility of overseeing the

disciplinary, grievance and arbitration procedures.

Definition

57
 “Employee discipline is a tool that managers rely on to communicate to employees

that they need to change a behavior”

“Discipline can be defined as a training or molding of the mind or character to brig about

desired behavior” ( Marquis K.B and Huston’s. (2003).

Constructive discipline

The ward discipline comes from the Latin term discipline, which means teaching,

learning and growing.

Constructive discipline uses discipline as a means of helping the employee to grow it

as a punishitive measures. Punishment may be applied for improper behavior, but it is carried

out in a supportive, corrective manner.

Importance of discipline

A) Creation of a favorable environment:

- Discipline creates a climate under which individual excellence is encouraged, group

performance is improved.

B) Establishment of a code of conduct: Discipline set a pattern of acceptable behavior

and performance of the part of

human beings.

C) Morale building:

- Discipline is necessary for an ordered way of life in ay groupings of human being.

Causes of indiscipline

(i) Varying disciplinary measures

- Disciplinary cautions must be consistent enough to provide equal Justice to all

concerned.

- A different times and for everyone in the organization, the same standards of

disciplinary measures are to be taken.

58
(ii) Deferring settlement of employee grievances

- Employee grievance cannot be stawed off by determining or neglecting their solution.

- Known grievances are to ensure into and settled by manager within a reasonable

period.

(iii) Misjudgment in promotion and placement

Misjudgment in promotion and placements in personnel matters of promotions,

placements or recunerations contributes to the growth of indiscipline in and enterprise.

(iv) Lack of a well defined code of discipline

 Requirements and formalities of discipline are to be communicated to all employee

in a clear simple language

 The code of discipline should encompass sufficient rules. Regulations or customary

practices for the guidance and information of employees.

BASIC STANDAREDS OF DISCIPLINE: Two important elements of due process chat

manager need to consider in this area.

- Standards of discipline used to determine if the employee was treated fairly

- Whether or not the employee has a right to appeal a disciplinary action.

STANDARDS:

(i)Communication of rules and performance criteria

- Employees should be aware of the company’s rules and standard, and the

consequences of violating them.

- Every employee and supervisor should understand the company’s disciplinary

policies and procedure fully.

(ii) Documentation of the feats:

- Manager should gather a convincing amount of evidence to justify the discipline. Eg.

Videotapes could document a case of employee theft.

59
 (iii) Consistent response to rule violations:

It is important for employee to believe that discipline is administered

consistently, predictably and without discrimination or favoritism. Eg. An employee

with many years of seniority and an excellent work record who breaks a rule may be

punished less than a recently hired employee who breaks the same rule.

(iv) Misrule through dividing people:

- Henri fayols has pointed out that dividing enemy forces to weaken them in clever, but

dividing ones own team is a grave in against the business.

- Many managers obtain secret information about other employees thought the help of

their trusted consistent.

(v) Inappropriate supervision:

Supervision have a direct contact with employee and many disciplinary problems

have their origin in faculty supervision in the maintenance in discipline is the core of

supervisory responsibilities indiscipline may spring from the want of the right type of

supervision.

(vi) Inadequate attention to the personnel problems:

- Actions or relations of people are the direct outcome of their attitudes.

- Attitudes influence human beings and their operations.

- The Attitude intern is determined by the personnel problems of employee.

- The understanding of the personal problems and individual difficulties as well as

according with employees in necessary for the maintenance of discipline.

- Inadequate attention to individual problem may this give rise to indiscipline.

The hot stove rule:

60
 This model provides how a disciplinary action should be administered. Discipline

should be immediate, provide ample warning and be consistently applied to all. The rule

suggests that the disciplinary process is similar to touching a hot stove.

 Touching a hot stove cult in can immediate consequence, which is a burn. Discipline should

also be an immediate consequences that follows a rule infraction.

 The hot stove provides a warning that one will get burned of one touches it. Disciplinary

rules should inform employee of the consequences of breaking the rules as well.

 A hot stove is consistent in administering pain to any one who touches it. Disciplinary rules

should be consistently applied to all.

Form of discipline

i) Progressive discipline:

A series of management intervention that gives employees opportunities to correct

undesirable behaviour. Eg (Giving punishment)

A four step procedure in progressive discipline inducts the following steps.

i) Verbal warning:

An employee who commits a minor violation receives a verbal warning from the

superior and is told that it this problem continues within a specific periods of time, harsher

punishment will follow.

(ii) Written warning:The employee violates the same rule which the specified fime period

and now receives a written warning from the period the superior. This warning gores into the

employees records.

(iii) Suspension: The employee still fails to respond to warnings and again violates the

work rule. The employee is how suspended from employment without pay for a specific

amount of time.

61
(iv) Discharge:The employee violates the rule one/more time within the specifies time

period and is discharged.

Categories of Employee Misconduct

Minor violation Serious violations

Absenteeism Drug use at work

Dress code violation Theft

Incompetence Dishonesty

Safety rule violation Physical assault upon a supervisor

Sleeping on the job

ii) Positive discipline

A discipline procedure that encourages employee to monitor their own behaviors

and assume responsibility for their action.

A four step positive discipline procedure starts with a first consoling session

between employee and supervisor that ends with a verbal solution that as acceptable both

[Link] this solution does not work, the superior and employee meet again to discuss way it

failed and to develop a new plan and solve the problem.

Second step: new agreed upon solution to the problem written down. If there is no

improvement in performance.

Third step: final warning that employee is at risk of being discharged rather than suspend the

employee without pay

Fourth step: Positive discipline procedure incidents of gross misconduct are treated no

differently under a progressive discipline procedure in both systems theft will most likely

result in immediate discharge eg. Positive disciplines have effects companies bottom line .

Conclusion It is the primary responsibility of the management to maintain discipline.

Discipline is a tool that managers rely on to communicate to employees that they need to

62
change a behavior” “Discipline can be defined as a training or molding of the mind or

character to brig about desired behavior

BUDGET ESTIMATE

Definition of Budget:Budget is a concrete precise picture of the total operations of an

enterprise in monetary terms (Donovan H. M, 2000)

Purposes of Budgeting:
The purpose of budgeting is
1. Budget supplies the mechanism for translating fiscal objectives into projected
monthly spending pattern
2. Budget enhances fiscal planning and decision making
3. Budget clearly recognizes controllable and uncontrollable cost areas
4. Budget offers a useful format for communicating fiscal objectives
5. Budgeting allows feedback of utilization of budget
6. Budgeting helps to identify problem areas and facilitates for effective solution
7. Budgeting provides means for measuring and recording financial success with the
objectives of the institution.
Features of budget:
a. It should be flexible
b. It should be synthesis at past, present and future
c. It should be in the form of statistical standard laid down in the specific numerical
terms.
d. It should have a support at top management throughout the period of its planning and
implementation.
e. It should use available resources.
Types of budget:
Since budget express plans and an organization may have different types of plans; there
may be different types of budgets. These may be classified on the basis of
1. Coverage of functions – master & functional budgets
2. Nature of activities covered – Capital & revenue budget

63
 3. Period of budgets – long term and short term budgets
4. Flexibility adopted –fixed and flexible budgets
1. Master & functional budgets
A master budget is prepared for the entire organization incorporating the budget of
different functions. For example when we refer to the annual budget of government of India,
it incorporates the budget incorporates various functions and units and their outlays. It
generally sales, production, costs.
A functional budget is prepared incorporating a major function and its sub functions.
Since an organization may have a number of functions numerous functional budgets are
prepared. E.g. Production budget, cash budget in an organization.
2. Capital & Revenue budget
An organization activities involves two process – creating facilities for carrying out
activities and actual performance activities. Creating facilities carrying out activities include
capital expenditure whose returns occur over a number of years. For such activities, capital
budget is prepared which is essentially a list of what management believes to be worth while
projects for acquisition of new assets together with the estimated cost of each project.
Revenue budget involve the formulation of target for a year or so in respect of various
organizational activities such as production, marketing, finance etc. Thus a revenue budget
includes expenditure and earning for a specific period like one year.
3. Long term and short term budgets:
Many organizations integrate their yearly budgets with long term projections of
business activities and along with yearly budgets; they prepare budgets for a longer period of
2-3 years. When the budget period is over, budgets are prepared for the next year and
subsequent 2-3 years.
The short term budget is for a year and is divided into a number of periods for
effective implementation. For eg Cash budgets are prepared on yearly basis as well as on
monthly or quarterly basis to facilitate better cash management.
4. Fixed and flexible budgets:
Generally, organizations prepare budgets which pertain to only certain projected fixed
volume of operations for a year or so such budgets are known as fixed or static budgets.
When an organization’s volume of business can be predicted with fair amount of precision,
the fixed budget is satisfactory.
A budget which is designed to change in accordance with the activities of the
organization is known as flexible budget. It considers several level of activity and assumes

64
that labour, material or facilities used in production and hence cost vary with a known
relationship to the actual volume of activity. Flexible budget is quite useful for control as
well as for planning purposes in uncertain environment.
Stages of Budget Preparation:
1. Preparation of position papers
2. Preparation of budget
1. Preparation of position papers:
Preparation of position papers providing background on which strategic budget is
prepared such as position papers include environment, organizational resources and
constraints, past performance and direction for future activities.
a. Position paper on environment;
These include economic, regulatory, political, marketing and competitive
technological factors. The paper may cover the environments trends likely to affect the
organizations performance specifying the assumption involved. This position paper is likely
to provide reference base for the development of annual plan to ensure the required between
strategic plan and annual plan.
b. Position paper on organizational constraints and resources:
This paper would specify at broad level the resources available for achieving the
targets by way of personnel, funds, technological, capital expenditure etc. Similarly the
paper also suggests the likely constraints faced by the organization so that the resources are
deployed by keeping these constraints in mind.
c. Position paper on past performance:
This paper can show the performance based on strategic business units or
responsibility centers. There is alignment between needs and products.
d. Position papers on future direction of activities:
This paper would suggest the various short term or long term targets to be fulfilled.
The targets may be identified again for the organization as a whole and for different strategic
responsibility centers. The paper would also indicate the way the organization will take over
various activities to match itself with environmental requirements like meeting the
competitive threats.
The paper may also include the various tracts to be adopted to meet the above
objectives. These may include the fixation of levels for working capital, credit level, waitage
of materials and other physical factors.
2. Preparation of Budget:

65
 The strategic budget as prepared through the interaction between corporate level and
SBU level in the light of position papers. The process will go like the one given as follows.
 Budget preparation will actually start when SBU managers are communicated about
the likely covers of future action in the light of environmental factors, organizational
resources and constraints and past performance.

o It is better to initiate the budget preparation from the bottom in the light of
position papers.
o Everyone responsible in the organization must ask for resources allocation will
be integrated in a master budget for the organization as a whole.
o Since budget demand at each level is based on the chosen strategy of the
organization. Every possibility that master budget will allow the allocation of
various resources according to the needs and importance of various functions
products or business, thereby ensuring the better use of organizational
resources and achievements of organizational objectives.
Budgeting Expenditure:
- Salaries and wages
- Material
- Utilities
- Service and maintenance
- Expenditure an academic activities
- Research activities
- Miscellaneous Sports activities
Welfare of students
- Library
The responsibilities of nursing administrator in budget are
1. Participation in budget
2. Consultation with subordinate in determining the needs of the unit for ensuring year.
3. Requesting sufficient funds to suggest a sound programme such as to provide for
developing programme provision, expansion of programme, to attend and hold
qualified staff to provide for expansion of physical facilities, supplies etc.
4. Submit budget request with justification with proposal expenditure.
5. When the budget is allotted, the administrator should support the budget she should
interpret the budget to the subordinates.

66
 6. Budget controlling: once the administrator receives her approved budget, a plan of
action is necessary for review and control during the fiscal year.
types of budgeting
There are mainly two types of budgeting.
1. Performance Budgeting
2. Zero base budgeting.
performance budgeting
A performance budgeting is an input/output budget or costs and results budget. It
shows costs matching with operations. Performance budget emphasis on non financial
measures of performance which can be related to financial measures in explaining changes
and deviation from planned performance. Performance measurement are useful for
evaluating past performance and for planning future activities. Performance budgeting,
results into the following.
 It correlates the financial and physical aspects of every programme or activity.
 It improves budget formulation, review and decision making at all levels of the
organization.
 It facilitates better appreciation and review of organizational activities by the top
management.
 It makes possible move effective performance audit.
 It measures progress towards long term objectives.
2) ZERO BASE BUDGETING
This was applied for the first time in preparing the divisional budgets of Texas
instruments of the USA in 1971.
Zero base budget is based on a system where each function, irrespective of the fact
whether it is old or new, must be justified in its entirely each time a new budget is
formulated. It requires each managed to justify his entire budget in detail from scratch that
zero base.
The process of zero base involves four basic steps.
 Identification of decision units that is cluster of activities or assignments within a
manager’s operation for which he is accountable.
 Analysis of each decision unit in the context of total decision package.
 Evaluation and ranking of all decision units to develop the budget request.
 Allocation of resources to each unit based upon.
BENEFITS OF ZERO BASED BUDGETTING
 Effective allocation of resources.

67
  Improvement in productivity and cost effectiveness.
 Effective means to control costs.
 Eliminator of unnecessary activities.
 Better focus or organizational objectives.
Saving time of top management
FUNCTION OF BUDGET IN NURSING
 Identifies the importance of and develops short a long range fiscal plans that reflects
unit needs.
 Articulate and documents units needs effectively to higher administrative levels.
 Assess the internal and external environment of the organization in forecasting to
identify driving forces and barriers of fiscal planning.
 Demonstrate knowledge of budgeting and uses appropriate technique.
 Provide opportunities for subordinates to participate in relevant fiscal planning.
 Co-ordinates unit level fiscal planning to be congruent with organizational goals and
objective.
 Accurately assesses personal needs using predetermined standards or an established
patient classification system.
 Co-ordinates the monitoring aspects of budget control.
 Ensure that documentation of clients need for services in clear and complete for
facilitate organizational reimbursement.
Conclusion:
Budget is an important plan for building the nursing schools and colleges. It has to be
revised periodically to find deviatory and make correction in the plan and prepare them
effectively.
MANAGING CONFLICT
.
DEFINITION – CONFLICT
“Conflict is a process in which an effort is purposefully made by one person or unit to
block another that results in frustrating the attainment of other’s goals or the furthering of his
or her interests: (L.M. Prasad, 20001).
FUNCTIONAL AND DYSFUNCTIONAL ASPECT OF CONFLICT
 Functional aspects of conflict

68
 A minimum level of conflict is necessary because it helps organization in the following
ways:
1. Stimulant for change
Conflict provides stimulus for change in the systems which are not conducive to the
organization. Conflict spotlights problems that demand attention, forces clarification of their
nature and sources and channels organizational efforts toward finding better solution of the
problems.
2. Creativity and innovation
Normally a conflict of certain degree arouses creativity and innovation. A climate of
challenge compels to think through their own ideas before airing them out. Thus a conflict
can help people to test their capacities to learn and develop.
3. Group cohesion
Group cohesiveness is a situation in which all members of the group work together for
a common goal. If group cohesion is high, interaction among member is high and the amount
of agreement in group opinion is high. Thus members can derive more satisfaction from
group activities.
4. Avoidance of tension
Conflict can be used as a source of avoiding tension and frustration. People can
express their tension and frustration by means of conflict.
 Dysfunctional aspect of conflict
1. Disequilibrium in organization
Conflicts affects equilibrium of organization and produces disequilibrium. When there
is a conflict, the equilibrium is affected adversely because the individuals contributes do not
match their inducements as they are using some of their energies in conflict behaviour. This
crates problems to the organization, if it continues to exist, it will try to bring equilibrium
either getting rid of such individuals or modify them to increase their contributions.
2. Stress and tension
While group cohesion provides satisfaction conflict creates tension and stress. It
exacts its toll on the physical and mental health of the parties, to the conflict. Intense conflict
generates feelings of anxiety, guilt, frustration and hostility.
3. Diversion of energy
The most important dysfunctional aspect of conflict is that it leads to diversion of
energy from constructive activities to destructive activities. They spent more time to winning

69
up conflicts rather than organizational goals. Conflict will ultimately result into destructive
activities.
LEVELS OF CONFLICT
1. Individual level conflict
The analysis of conflict may start at individual level because organization is
composed of individuals and many conflicts may arise at this level. Within an individual,
there are usually a number of competing goals and roles. Thus there may be goal conflict and
role conflict within an individual.
a. Goal conflict
Goal conflict occurs at individual level when an individual faces the problems of
choosing among two or more goals which are mutually competing in some way. Existence of
mutually – competing goals may leads to three possible alternatives.
i. Approach avoidance conflict
This conflict arises when a person faces the problems of selecting among two or more
equally attractive goals which are mutually exclusive.
ii. Approach avoidance conflict
This arises when a person has an alternative which has positive and negative aspects.
Eg. A person gets job opportunity but at a place which he doesn’t like.
iii. Avoidance – Avoidance conflict
This conflict arises when a person has to choose between two mutually exclusive
goals, each of which possess equally negative aspects. In such a case, unless another
alternative is available, the conflict may be unresolved.
b. Role conflict
Role is a set of expectations people have about the behavior of a person in a position.
Such behaviour may be formally prescribed by job description, delegation, organizational
manuals.
Role conflict occurs when expectations of a role are materially different or opposite
from the behaviour anticipated by the person in that role. He may feel role conflict because
there is no way to meet one expectation without rejecting the other.
Reasons for role conflict
i. Role ambiguity
It occurs when an individual is not clear regarding his job duties and responsibilities.
As a result, he experiences difficulties in deciding the actual expectations from his role.
ii. Organizational positions

70
 This happens because there are different expectations from position, each individual
or group individuals has particular expectations which may not be compatible.
iii. Personal characteristics
Role conflict may arise because of personal characteristics. Certain personality
characteristics are more prone to experience role conflict. An individual who is strongly
achievement – oriented exhibits a high degree of personal involvement with his job.
2. Interpersonal conflict
Interpersonal conflict may be interpreted in two forms:
a. Vertical conflict
it also known as hierarchical conflict arises between superior and subordinates.
Vertical conflicts usually arise because superior attempts to control the behaviour of his
subordinates and subordinates resist such control.
b. Horizontal conflict
Horizontal conflict at interpersonal level is among the persons at the same hierarchical
level in the same function or in different functions.
Causes of interpersonal conflict
i. Ego States
Ego states are the person’s way of thinking feeling and behaving at any particular
time. If ego states are not complementary, the conflicting situation take place.
ii. Value systems
Value systems may develop conflict in their interaction. Value system is a framework
of personal philosophy which governs and influence individual reaction to any situation.
Thus people having different value systems may interpret the things and situations differently
which may reflect the choice of different methods of working and behaving. Such differences
become the basis of interpersonal conflict.
iii. Socio – cultural factors
People coming with different social and cultural background may develop conflict
among themselves. Conflicts based on caste, religion and family background based on social
– cultural differences.
3. Intergroup conflict
Intergroup conflict arises because of interaction of various groups. The factors are:
a. Incompatible groups.

71
 Intergroup conflicts arise when goals of two or more groups are incompatible, it is
goal attainment by one group may prevent or reduce the level of goal attainment of one or
more groups.
b. Resource sharing
Conflict arises because of discrepancy between aggregated demand and available
resources. Each party to the conflict has an interest in making total resources as large as
possible but also in securing as large a share of them as possible.
c. Task interdependence
Task dependence refers to the dependence of one unit on another for resources or
information. A dependant task relationship may result in one group having the ability to
dictate or unilaterally determine the outcome of interaction between two groups.
d. Absorption of uncertainty
Organization and its various groups may experience uncertainties of various types
because they interact, which environment. Conflict arises when uncertainly absorption by one
group is not in accordance with the expectations of other groups.
STAGES OF CONFLICT
The conflict will progress through the five stages
Stage – 1: Individual seek allies and support. People build relationships in which any one a
sympathetic becomes an enemy.
Stage - : Polarization and conflicts become visible. Overtime and conflicting
Groups behave in negative ways toward one another and compete to the detriment
of the organization.
Stage – 3: Conflict touches every aspect of the organization. Once the spread of conflict
begins, it is easy for others to jump on the board and remembers problems.
Stage – 4: Emotions and hostilities are pervasive. Soon it is impossible to find the original
source of the conflict, which is necessary to resolve it.
Stage – 5: Conflicts threatens survival of the organization. Customers are affected the quality
of service and product drop.
An awareness of the symptoms, sources and stages of conflict development should
help to spot the conflicts.
MANAGEMENT
Conflict beyond certain level is dysfunctional. Therefore an attempt should be made
to develop organizational procedures and practices through which organization functions in –
coordinative way and reducing conflict.

72
 Management should take effective steps to resolve it. Thus there can be two
approaches of managing conflict.
1. Preventive
2. curative measures
In preventive measures, attempts are made to create situations in which conflict
doesn’t take place which curative measures deal with resolving conflict amicably so that is
dysfunctional aspect is minimized.
If the conflict is not dysfunctional but it is leading to healthy competition, it can be
encouraged. However, it is unlikely that a conflict is constructive in the absence of proper
organizational climate.
A major part of organizational climate as relevant to conflict management is built
through
1. Establishment of common goals.
2. structural rearrangement
1. Establishment of common goals
Reducing conflict arising out of goal differentiation is the reference to super ordinate
goal.
A siperordinate goal is a common goal that appeals to all the parties involved and
cannot be achieved by the resourced of a single party separately
In the case of reference to superordinate goal, conflicting parties may be brought
together and they can sink their differences for the time being.
For example, in the case of national emergency, various political parties co – operate
together to face national emergency successfully while in normal situation, such parties can
pursue their own goals. This concept can be applied in organizations also.
2. Structural Rearrangement
Structural rearrangement in some part of the organization can reduce dysfunctional
conflict, particularly when the conflicts are taking place because of such factors. In general,
following structural arrangements helps in reducing conflict in the organization.
a. Reduction in interdependence
the potential for conflict is very great in situations where two or more departments
have to work in an interdependent manner and share scarce resources.
Therefore, conflict may be minimized by reducing interdependence among
departments.
b. Exchange of personnel

73
 a better way to minimize conflict among interdependent units is to exchange
personnel of these unit for specified period of times, specially if personnel of on unit can be
fitted well in another unit.
An exchange of people is very similar to role reversal which is aimed ate greater
understanding between people of various units by them to present and defend other’s
position.
When people understand the difficulties and problems of other units, they become
more considerate about these and change of conflict are lesser.
c. Creation of special integrators
To solve problems of conflict, organization may create provisions for appointments of
special integrators.
These integrators can resolve problems arising out of interdependent relationship
between two or more units.
While appointing such integrators, care should be taken that they are well acceptable
to interdependent units.
d. Reference of superior’s authority
The organization should keep provisions for referring conflict upward for its
resolution particularly when the cannot be solved at the levels of parties involved to the
conflict.
Since the superior has authority to dictate both the parties, be can succeed in bringing
the conflicting parities together.
However, the method should not be adopted quite frequently because it will resolve
the particular conflict in question but may not be suitable for minimizing the occurrence of
conflict in the organization.
Conflict resolution actions
Conflict resolution actions are curative methods to overcome the problems of conflict.
The major conflict – resolution actions may be as follows which can be taken depending on
the situations.
i. Problem solving
ii. Smoothing
iii. Compromise
iv. Confrontation
v. Avoidance
i. Problem solving

74
 Problem solving technique is the most suitable deal with conflict when it arises out of
misunderstanding of the parties to the conflict.
ii. Smoothing
Smoothing is the process of playing down differences that exist between parties to the
conflict and emphasizing common interests.
Differences are suppressed and similarities are accentuated.
During this process both parties realize that they are not far apart as was first believed
to be.
With shared view point on an issue, the ability to work together is increased because
misunderstanding, the common cause of conflict is removed.
Iii. Compromise
Compromise is a traditional technique of resolving conflict in which neither party is a
definite loser or distinct winner.
Each party is expected to give something of value in exchange to get something.
Compromise can be arrived at either through the process of bargaining or through
medication and arbitration.
In bargaining, parties involved to the conflict may negotiate among themselves and
can arrive at some decision on the basis of give and take.
In medication, there is third party intervention. However, third tries that two parties
arrive at certain mutually – agreed solution to the problem resulting conflict.
In arbitration, third party may give a verdict on the problem being acceptable to the
both parties.
iv. Confrontation
Confrontation is a technique in which parties to the conflict are left free to settle their
score by mobilizing their strength and capitalizing on the weakness of others.
This technique is adopted specially when both the parties adopt very right stand and
common superior doesn’t want to interfere in their working.
v. Avoidance
Against confrontation, avoidance involves withdrawal of parties from the séance of
the conflict.
When parties to the conflict fail to arrive at mutually agreed solution, they may detach
from the problem believing that conflict avoidance is more mature and reasonable rather than
involving into wasteful arguments and actions.

75
 They can take the chapter relating to conflict, as closed. They stay out of conflict,
ignore disagreement and take no position on tissue involved. Thus this doesn’t provide real
solution of the problem but avoids the problem itself.

QUALITY ASSURANCE
Definition of quality:-
Quality means usually think in terms of an excellent product or service that fulfills or
exceeds our expectations.
Quality is defined “as the degree to which a set of inherent characteristics fulfills
requirement”.
Definition of quality Assurance:-
Quality assurance is achievable through on going evaluation of patient care which
would assure the hospital that all that was done for the patient.
sakharkar B.M (1999)
Quality Assurance is a program adopted by an institution that is designed to promote
the best possible care.
Deloughery(1995)
Purpose of quality assurance:-
 Help patients and potential patients by improving quality of care.
 Assess competence of medical staff, serve as an impetus to keep up to date and
prevent future mistakes.
 Bring to notice of hospital administration the deficiencies and in correcting the
causative factors.
 Help to exercise a regulatory function.
 Restricting undesirable procedures.
Principles of quality assurance:-
1. Quality assurance is a never ending process of creative destruction, with rapid
advances in science and technology and reduced half life of medical knowledge
continuous updating is essential.
2. The emphasis is on establishing professional excellence patient satisfaction at a
reasonable cost.
3. Quality is not proportionate to the use of sophisticated technology or to be expense
incurred.
4. Motto of fees for service should not be pregnant with the comedy of needless services
for a fee and tragedy of no services if no fee
5. Technical imperative should not insist on prolonging life at any lost with no
consideration to quality of life.
Constraints in rendering quality care:-
1. Inadequate resources
2. Poor maintenance
3. Medical supply – inadequate ,interrupted
4. Delays
5. Poor work culture

76
 6. Attitudes of patients and public.
1. Inadequate Resources:-
a) Space – Shortage, wastage, unplanned growth empire building by
certain individuals
b) Infrastructure – inadequate, improper, irrelevant
c) Funds – inadequate, improper, lop sided priorities wastage.
d) Equipment – not available, not functioning overused, misused, abused
e) Staff – inadequate, poorly motivated, poorly trained, dishonest.

2. Maintenance:-
a) Building – poorly maintained, leakages, peeled off paint, hanging wires.
b) Premises – unclean, no sin ages, poor housekeeping
c) Equipments – non function, idle, poor functioning
d) Installations – poor safety precautions
e) Hazardous practices–improper waste disposal and improper sterilization.
3. Medical supplies:-
a) Faulty procedures for procurement, storage and distribution.
b) Shortages
c) Supply – inadequate, interrupted
d) Substandard items
e) Adulterated items
f) Pilferage
g) Unfair practices and kick back
4. Delay:-
a) Procedural bottle necks
b) Indifference
c) Negligence
d) Management by crisis
e) Poor accountability
f) Poor recognition of performance
5. Work Culture
a) Poor discipline
b) Too much job security
c) Too much job insecurity
d) Frequent transfers.
e) Poor leadership
f) Disruptive conflicts
g) Poor intersectional cooperation and coordination
h) Corruption
i) Interference from outside agencies e.g. politicians
6) Attitudes of patients and public:-
a) Prejudiced about hospital and staff.
b) Ignorance about disease
c) Ignorance about management of the disease

77
 d) Ignorance about likely outcome
e) Too much or unreasonable expectations
f) Uncooperative behavior
g) Crisis of confidence – poor doctor patient relationship
h) Resigned acceptance giving no feedback.
Effects of poor quality of care:-
If medical care given is substandard or it is of poor quality, its effects may be
immediately noticed e.g. Fall from cot, wound infection, sudden death etc, poor quality
care can effect:-
1. patients
2. family
3. society
4. hospitals
5. staff
1. Effects on patients:-
a. Physical discomfort: e.g.
 Disturbed sleep due to noise of staff talking loudly, cleaning utensils etc.
 Wound infection
 poor quality of food causing abdominal pain
 I V fluid going out vein causing swelling or thrombophlebitis
[Link] stress
[Link] in complication rate
[Link] mortality rate
[Link] of working days
[Link] expenses
2) Effects on family
a. Inconveniences
b. Higher expenses
c. Frequent changes
d. Loss of trust
e. Faulty finding even for genuine actions
f. Black mailing, particularly for iatrogenic complications, refusing to pay the bills.
g. Increased possibility of litigations.
3) Effects on society:-
a. Increased prevalence of certain disease
b. Increased risk of certain infections
c. Medicalization of social problems e.g. Alcohol dependence, substances abuse etc.
d. Diminished productivity, unhealthy person is medically more demanding and
economically less productive.
e. Avoiding use of scientific hospital management and taking treatment from quacks.
4) Effects on hospital:-

78
 a. Increased length of stay leading – overcrowding in public hospitals, cross infection,
reduction in turnover leading to longer waiting list for routine admissions, higher
expenses, and shortage of linen.
b. Higher rate of complications leading to additional investigations, additional
medications, need for revision surgery.
c. Accidents and mishaps
d. Litigations
e. Hospital image getting tarnished
f. Adverse publicity by media which undermines other good services.
5) Effects on staff:-
a. Reduced motivation
b. Indiscipline
c. Risk of infection to staff
d. Hostility towards management
e. Difficulty to attract good staff
f. Fast turn over
g. Frustration.
Method of quality assurance:-
A quality assurance programme can be either concurrent or retrospective.
1) Concurrent quality assurance: –
A hospital administrator uses this method routinely so far as no clinical aspects of
hospital care concerned, in the form of daily and periodical administrative rounds. Concurrent
evaluation provides opportunity for simultaneous corrective action. Nevertheless, this can
also profitably form part of the ward round of clinicians and consultants, because it is done
while the patient is still in the ward, oversees things as they happen from day - to- day.
2) The Retrospective quality assurance:-
Retrospective evaluation acts as a continuous and ongoing self, improvement process.
In many instances where people are keen to carryout such an evaluation, the whole process
has been gone through with no preparation and in the most haphazard manner. Needless to
add, any quality assurance programme requires a step by step approach to derive the desired
result.
Prerequisites of retrospective audit. There are three fundamental prerequisites that need to be
fulfilled before the programme is instituted:-
 good medical records
 establishment of criteria for diagnosis, investigations and treatment and
 cooperation and involvement of medical staff.
Types of quality assurance: - There are two
1. External quality assurance
2. internal quality assurance
1. External quality assurance:-
Quality assurance can be evaluated by independent assessors (or) people from outside
the institution/hospital.
2. Internal quality assurance:-

79
 Quality assurance can be evaluated by local assessors (or) senior person from the
same institution/hospital.
Quality Assurance Committee (QAC):-
The committee should consist of the following.
 Medical administrator
 Two senior clinicians
 Pathologist
 Radiologist
 Nurse administrator
 Medical records officer – secretary
 Additional personnel such as super specialist and consultants can be
co –opted on the committee as and when required.
Functions of QAC:-
1) Coordination:-
 Collecting information
 Consider activities that should be related, e.g. Quality appraisal and continuing
education
 Communication across patient care disciplines
 Co –ordinate actions of hospital authority groups.
2) Information:-
 Provide a centralized source of reports to the board.
 Suggest head for intervention to hospital authority groups.
3. Planning:-
Establish priorities
4. Prodding:-
Insist on effective, productive quality appraisal efforts from all hospital components
5. Consultation:-
Provide specific assistance, usually through the coordinator.
6. Response:-
 Internally, acknowledge issues of importance to individuals and departments when
suggesting high priority areas for immediate attention.
 Externally, provide the organization home for responding to quality requirement
of external agencies of any e.g. medical companies.
7. Search for expertise:-
Operate openly, not behind closed doors, seek out the specific clinical and or
management expertise necessary to reach sound conclusions.
8. Follow up:-
 Insist on reports if the impact if implemented changes.
 Committee members must recognize that their major functions are
 To coordinate not to control
 To inform, not to scold
 To plan and suggests priorities not to do detailed studies in committee and
 To recommend report, not to intervene directly.
Quality assurance model:-

80
 Quality assurance model in nursing is developed by Lang and adapted by the
American nurses Association. The evaluation model is open and circular, indicating a cyclical
process that can be entered at any point.
1. Identification of values –
Emphasizes the need to clarify the social, institutional, professional and individual
values, along with the advances in scientific knowledge which influence nursing practice.
Examination of these beliefs offers insight into what clients, nurses and others think is
important in nursing care. Consensus among all interested parties regarding what
constitutes good nursing care is needed in order to determine the standards and criteria
used to judge quality.

2. identify standards and criteria:-

The standards and criteria derived from the values describe the level of nursing care
considered acceptable. These standards may range from minimal to achievable, excellent
or comprehensive. Standards represent the agreed upon level of excellence, whereas
criteria are specific, measurable statements which reflect the intent of the standard and
can be compared to actual nursing practice.
There are three types of standards and criteria in general use – structure process and
out come.
a) Structure standards – describe organizational, financial and physical attributes if an
agency or service and provider characteristics. E.g. Patient classification system
used to determine staffing needs and all registered nurses must have a minimum of
a baccalaureate degree in nursing.
b) Process standards – focus on the nature of activities and interventions according
events in delivery of nursing [Link] includes nurse performance, the nurse
patient relationship, continuity and timeliness of care and interactions with other
health care professional. For eg: the nurse will systematically collect data about the
patient’s health status, and the nurse will treat all patients with respect.
c) Outcome standards:-
 This will pertain to the end result of nursing care and measurable changes in the
patient health status.
 Outcomes include increased health knowledge improved health status and patient
satisfaction for e.g.: The patient correctly states the names of all medications, and
the patient verbalizes that pain is controlled.
All three types of standards and criteria can be used alone or in
combination to evaluate the quality of nursing practice. However, experts agree that no
one type is sufficient to describe the quality of care.
3) Secure measurement:-
The next component involves the measurement of current nursing practice against the
established standards and criteria. There are many methods which could be used to perform
the comparison including concurrent and retrospective audit, direct observation of nurse or
patient performance, questionnaire, patient or nurse interview and knowledge testing. The
method selected is dependent upon the purpose of the evaluation study and the available

81
instruments and resources. Strengths and weakness of nursing practice should be revealed
through this comparison.
4) Make interpretations:-
Analysis and interpretation of the data follow as the next component of the model.
The purpose here is the identification of discrepancies between the established criteria and
current practice. If no variations are discovered, then the remainder of the model is by passed
and one begins again with value clarification .It is unlikely, however, that no discrepancies
will be found. Judgments are made about strengths, deficiencies and other problems in
quality.
5) Course of Action:-Suitable courses of action are then considered .Alternatives intended
to resolve discrepancies and reward strengths are identified and examined. Decisions may
range from simple actions to complex plans entailing many changes.
6) Choose Action:-
The last two components of the model consist of the selection and implementation of
the best actions. Judgments are made about strengths, deficiencies and other problems in
quality; it may be positive or negative.
7) Take Action:-
Some actions may need to be performed immediately while others take longer to
initiate. The decisions as to which action to choose are influenced by the organization context
and available resources. At this point the cycle is repeated and the actions are reassessed to
determine if the expected improvements in practice actually occurred or have been
maintained.
The comprehensive quality Assurance system (QAS):-
Professional reviews, concurrent evaluation medical audit, external evaluation, peer
review each these methods has strengthens that make them most appropriate in some
situations and limitations that make them in appropriate in others.
- Submits audit standards to the central QA committee for priority setting and
measurements
- Purpose for setting standards is not to create performance standards or directions for
proper practice

Factors affecting quality assurance in nursing care:-

Quality assurance necessitates that institutions and health professionals render care in
a most efficient, effective and economical manner, there are some factors which are affecting
quality assurance in nursing care. They are as follows.
1. lack of Resources
2. personal problems
3. unreasonable patients and attendants
4. improper maintenance
5. absence of well informed populance
6. absence of accreditation laws
7. legal redress
8. lack of incident review procedures
9. lack of good hospital information system

82
 10. absence of conducting patient satisfaction surveys
11. lack of nursing care records
12. Miscellaneous factors like lack of good supervision, Absence of knowledge about
philosophy of nursing care, substandard education and training, lack of policy and
administrative manuals.
CONCULSION:-
Quality assurance is the responsibility of the hospital management and (workers)
health personnel to assure a higher quality of care. The administrators generally have to face
the consequences in terms of poor reputation of the hospital, legal expenses and higher
hospital cost.

Steps in the quality improvement process:

1. Select a nursing activity for improvement
2. Assemble a multidisciplinary team to review and revise the nursing activity.
3. Delineate all components of the activity using a flow chart.
4. collect data to measure the current status of the activity
5. Set a measurable standard for the activity.
6. discuss various plans to meet the standard
7. Select and implement one plan to meet the standard.
8. collect data to evaluate the implementation of the plan and revise an needed
PERFORMANCE APPRAISAL
Performance appraisal is a method of evaluating an employee’s job performance by
comparing actual results to expected outcomes .
CRITERIA OF PERFORMANCE APPRAISAL:
► Quality: the degree to which the process or result of carrying out an activity
approaches perfection.
► 2. Quantity: the amount produced, expressed in monetary terms, number of units, or
number of completed activity cycles.
► [Link] lines: the degree to which an activity or a result produced.
► Cost effectiveness: The degree to which the use of the organisation’s resources (eg.
Human, monetary, technological, material) is maximized in the senses of getting the
highest gain.
► Need for supervision: The degree to which a job performer can carryout a job function
without supervisory assistance.

83
 ► Interpersonal impact: The degree to which a performer promotes feelings of self-
esteem, good will and co-operation among co-workers and subordinates.
► Training: Need for training for improving his skills knowledge.
OBJECTIVES OF PERFORMANCE APPRAISAL
A) work- related objectives:
1. To provide a control for work done
2. To improve efficiency
3. To help in assessing work and plan future work assignment and
4. To carryout job evaluation
B) Career development objectives:
1. To identify strong and weak points and encourage finding remedies for weak points
through training
2. To determine career potential
3. To plan developmental ( promotional or lateral) assignments: and
[Link] plan career goals
C) objectives of communication:
1. To provide adequate feed back on performance.
2. To clearly establish goals i.e, what is expected of the staff member in terms of
performance and future work assignments.
3. To provide counselling and job satisfaction through open discussion on performance, and
[Link] let employees assess where they stand within the organization in terms of their
performance.
D) administrative objectives:
[Link] serve as a basis for promotion or demotion
2. To serve as a basis for allocating incentives
3 To serve as a basis for determining transfers, and
4 To serve as a basis for termination in case of reduction of staff.
METHODS OF PERFORMANCE APPRAISAL

Traditional methods Modern methods

1. Straight ranking method 1. Assessment centre
2. man-to-man comparison method [Link] by results or
[Link] management by

84
[Link] rating scales objectives
5. forced choice description method 3. Human asset accounting
[Link] method
7. forced distribution method 4. Behavioural anchored
[Link] from essay method rating scales
[Link] incidents
10. group appraisal
11. field review method

Using the performance appraisal to motivate employees

► Systematic employee appraisals have been used in management, since the 1920’s
using the appraisal as a tool to promote employee growth did not begin until the
1950’s
► Most formal appraisals focus on the professional worker rather than the hourly paid
worker. The evaluation of performance appraisals is reflected t in its changing
terminology.
► More recently, it was termed performance evaluation but because the term evaluation
implies that personal values are being placed on the performance review.
► The employee must believe that the appraisal is based in a standard to which other
employees in the service classification are held accountable.
► The employee should have some input into developing the standards or
goals on which his or her performance is judged.
► The employee must know how information will be obtained to determine
performance. Sources could include peers, co-workers, nursing care plans, patients
and personal observations.
► The appraiser should be one of the employee’s direct supervisors, eg. The charge
nurse who works directly with the staff nurse should be involved in the appraisal
process and interview.
► The performance appraisal is mire likely to have a positive outcome, if the appraisal
is viewed with trust and professional respect
Management functions
► Uses of formalized system of performance appraisal
► Gather data for performance appraisals that are fair and objective

85
► Uses the appraisal process to determine staff education and training needs.
► Bases performance appraisal on documented standards.
► Is an objective a possible in performance appraisal?
► Maintenance appropriate documentation of the appraisal process.
► Follows upon identified performance deficiencies.
► Conducts the appraisal interview in a manner that promotes a positive outcome.
► Provides frequent informed feedback on work performance.

Performance appraisal tools

► Trait rating scales:
A rating scale is a method of rating a person against a set standard which may be the
Job description, desired behaviours. The rating scale is probably the must widely
used of the many available appraisal methods.

Judgement
Decisions Makes some Good Sound Makes
are often decision decisions and good
wrong on errors made often logical complex
issues thinker decisions

1 2 3 4 5

► Job dimension scales

This technique requires that a rating scale be constructed for each job classification.
The rating factors are taken from the contract of the written job description.

 Behaviourally anchored rating scales:BARS sometimes called behavioural expectation

scales, overcome some of the weakness inherent in other rating systems. As in the job
dimension method. The BARS technique requires that a separate traiting form be developed
for each job classification. Then as in the job dimension rating scales, employees in
specific positions work with management to delineate key areas of responsibility.
However, in BARS, may specific examples are defined for each area of responsibility.

86
 These examples gives various degrees of importance by ranking example of a job
dimension is being met. It is less important that a lower ranked example is not.

Disadvantages:
► The greatest disadvantage in using this tool with large numbers of employees
is the time and expenses.
Advantages:
► It is an effective tool because it focuses on specific behaviours, allows employees to
know exactly what is expected to them and reduces rating errors.
Process failure
he performance appraisal process can fail for a number of reasons, but inevitably falls
back in the manager’s ability to communicate expectations and give relevant feed
back to an employee.
Some of the more common reasons include:
► The Manager conducting the performance appraisal has limited contact with the
employee and thus doesn’t really know how tie performs.
► The Manager isn’t skilled in giving timely feed back in dealing with an employee
who doesn’t take negative feed back well.
► The Manager view the performance appraisal process as one more annual task that
has to be done and checked off the list.
► The Manager separates the objective performance appraisal process from the more
subjective coaching process, failing to see that the true are i.e. extricable linked
► The Manager is new a fear she doesn’t know the employee or the Job well enough to
defend her observations – precisely why it’s vital that the performance appraisal be
based on written standards that are directly related to the critical job elements.
Components of performance appraisal
The performance appraisal process gives an employee recognition for his work
efforts. Great power rests in such recognition and, in fact, it’s well known that human
beings prefer even negative recognition to no recognition at all. The performance
appraisal process typically consists of four inter-related steps.
Step 1. Clear expectations
The first step occurs well before an evaluation is ever done. A new employee must be
told and must understand exactly what the job expectations are, how performance will
be measured, who will “judge” the work, and how often.

87
 Step 2 .Regular feed back:
An employee should also be aware that the performance appraisal process is just that,
a process and not a once-a-year drill. Ongoing assessment of performance and the
progress in meeting job expectations is vital. It isn’t good management style to wait
until an evaluation to tell and an employee that he’s consistently failing to meeting
expectations
Step 3. Documented Progress:
Through documentation of the employees performance using the facility’s policies,
procedures, and forms in the next step. If the facility was a self appraisal, peer
review, or 360 degree, make sure the employee clearly understands how he’s to be
rated before the actual meeting
Step 4. Future direction
Finally, set up a time to conduct the performance appraisal interview with the
employee. Allow time, and have all documents ready make sure you have coverage
for phone calls or other managerial duties so your time with the employee is
uninterrupted. Be prepared to end the review with a discussion of a Job related
development plan that’s tailored to that employee.
Ethics of appraisal
► Don’t appraise without knowing why the appraisal is needed.
► Appraise on the basis of representative information
► Appraise on the basis of sufficient information
► Appraise on the basis of relevant information
► Be honest in your assessment of all the facts you have obtained.
► Don’t write one thing and say another
► In offering an appraisal, make it plan that this is only your personal opinion of the
facts as you see them.
► Pass on appraisal information only to those who have good reason to want it.
► Don’t imply the existence of an appraisal that has not been made
► [Link]’t accept another’s appraisal without knowing the basis on which it was made.
COLLECTIVE BARGAINING
INTRODUCTION:-

An individual is free to bargain for himself and safeguard his own interest. If an
individual work seeks employment, his prospective employer. From his position of power

88
usually stands in better position to dictate his own terms. The individual often has to accept
even different if a bargain is made by a body or association of work.

MEANING:-
Collective
An organization or enterprise owned and controlled by the people who work in it or
related to a group or society as whole /joint/ shared.
Bargaining
An agreement in which both or all sides promise to do something for each other.

DEFINITION:
Collective bargaining is the “ process by which organized employees participation
with their employees in decisions about their rates of pay, hours of work, and other terms and
conditions of employment”. ( Swansberg, 2002).
Collective bargaining is the joining together of employees for the purpose of increase
their ability to influence the employer and improve working conditions’.

THE SUBJECTS Of BARGAINING:

The fundamental or mandatory subjects of employment about which labour and
management may bargain are
 The price of labour
 Rules that define how/ a hour is to be utilized including job practices and job
classifications.
 Individual job rights
 Methods of enforcement, interpretations and administration of the agreement
including resolution of grievances.

MAIN CHARACERTISTIC OF COLLECTIVE BARGAINING

 It is c complex procedure
 It is a group action as opposed to individual action and is initiated through the
representatives of workers
 It is flexible and mobile and not fixed or static
 It is a two party process
 It is a continuing process which provides a mechanism for continuing and
organized relationship between management and trade unions

Principles of collective bargaining

 The management must develop and consistently follow realistic labour policy ,
which should be accepted and carried out by its representatives
 The management should not assume that employee good will always exist .It should
be periodically examine the rules and regulation to determine the attitude and
degree of comfort for its employees and gain their good will and co operation .
 The management should deal only with one trade union in the organization
 Both parties to a dispute should command the respect of each other
 There must be mutual confidence and good faith and a desire to make collective
bargaining effective in practice
 There should be an honest , able and responsible leadership will brake collective
bargaining effective in practice .
ISSUES RELATED TO COLLECTIVE BARGAINING;
Among the major issues leading to unions and collective bargaining are the following:

89
  Absence of procedures for reporting unsafe or poor patient care. Quality of patient
care is the number one issue.
 Short staffing and improper skills mix to complement patient care.
 Floating without orientation and training.
 Use of temporary personal and unlicensed assistive personnel.
 Resistance of employers to accept joint decision making.
 Lack of respect for employees.
 Lack of autonomy, that is, Incursion by management in to the scope of practice.
 Lack of promotional opportunities.
 Lack of staff development and continuing education opportunities.
 Lack of child and eldercare.
 Lack lf involvement.
 Poor differentials for shift work education, and experience.
 No pension portability.
 Poor on-call arrangements and lack of flexible schedules.
 Over work and shift rotation.
 Poor management and poor communication
 Performance of non nursing duties.

PROCESS:
Once nurses have decided to pursue collective bargaining because they believe they
have no alternative, the general process is as follows.
1. An organization committee is formed. It should be broad based in structure and
representative of the major issues so as to respect all prospective members on all sifts and
in all practice areas members should be well known and respected.
2. The major campaign issues are identified and discussed.
3. The organization committee does research to obtain extensive knowledge of all facts of
the institution including history, structure organizations finances, administration.
4. A time table is prepared, delineating the specific organizing activities.
5. Possible employer tactics are identified and discussed, and specific strategies are
developed to manage them.
6. A system is established for keeping in constant communication with nurses.
7. A structural plan is made, including adaptation of a set of by laws and ejection of officers.
8. Recognition occurs by the employer or NLRB certification. Voluntary recognition
requires authorization card signed by a majority of nurses. If the employer will not
recognize the action. NLRB certification requires that at least 30% of the nurses sign
card. A majority is best.
9. An election is held in which nurse vote for or against a collective bargaining unit. The
NLRB sets the Election Day by mutual agreement. Notice posted on employee bulletin
boards. Payroll period for rater eligibility; description of the voting unit, a sample of the
ballot; and general rules for conduct of election. With a majority of voting nurse (50%)
voting for it, the NLRB certifies the petitioners as the exclusive bargaining unit. If there is
no majority; the NLRB will not accept and other petition for 1 year.
10. A bargaining committee is elected by the nurse to negotiate a contract.
11. A contract is negotiated. Members of the bargaining committee should survey full
membership to gather data for contract proposals.
12. When all proposals have been fully discussed and agreed on, the contract is written.
13. The contract is then presented to union members who vote to ratify or reject it. If ratified,
it is signed by both sides.

90
 14. The contract is enforced through grievance and arbitration procedures. It is reviewed or
an amended on a regular basis.

NURSE MANAGER’S ROLE IN COLLECTIVE BARGAINING:

 Nurse Managers should evaluate their management skills and take continuing
education courses to improve them.
 Motivational techniques are particularly important for nurse administrator to posses
because they work through others.
 They must listen carefully to staff concerns and represent associates wishes to
management.
 Nurse Managers need to know about labour relations.
 During negotiations, the director of nursing defines what is best for the nursing care
of patients.
 Once the contract has been negotiated, nurse managers must learn the terms of the
contract and copies of the contract available to them.
 Problems should be solved through problem-solving techniques as they arise.

ADVANTAGES AND DISADVANTAGES OF COLLECTIVE BARGAINING:-

Advantages:-
 Some equalization of power between administrators and faculty associates can be
obtained because of the staff association’s strength in numbers.
 Grievance procedure become viable staffing for systemic and equitable distribution of
work can be established.
 The quality of service can be influenced.

Disadvantages:-
 An adversary relationship may develop between administration and faculty
association may not be presented.
 Unionization is considered unprofessional by many nurses.
 Leadership for unions may be difficult to obtain because may professional nurses
have little experience in positions of authority.
 Women tend to view employment as a job instead of a career, minimizing interest in
leadership positions, and if the bargaining unit and the professional associations are
the same, top administrators may have to drop membership in the professional
organization, further depleting the leadership.

MATERIAL MANAGEMENT
Definition
Material management is a service function affecting the flow of materials in a manner in which its
helps in conserving the materials, cost ,best utilization of materials and maintaining the quality of both
incoming and outgoing materials.
Functions of material management :-
1) Planning and sourcing
2) Budgetting
3) Researching and analysis
4) Indenting, and procuring
5) Receiving, storing and preserving

91
6) Accounting and controlling
7) Issuing and dispatching
8) Disposing
Areas of material management:-
1. Material planning and programming
2. Purchasing and inventory control
3. Receiving, store housing
4. Transportation and material handling
MATERIAL MANAGEMENT
Material management is concerned with providing the drugs, supplies and equipment
needed by health personnel to deliver health services. Without proper material, health
personnel cannot work effectively, they feel frustrated and the community lacks confidence
in the health services and unless appropriate materials are provided in proper time and are
required quantity, productivity of personnel will not be up to expectation.
Good material managers adopt the following procedures:
 Taking inventory regularly and systematically,
 Requisitioning at indenting according to actual needs
 Receiving and inspecting incoming items,
 Storing and protecting items,
 Issuing items for use,
 Proper use of items.
INTRODUCTION
Materials are an essential resource to achieve the objectives of a health care
organization. While about 60% of the funds of health sector are consumed to provide
manpower, health care being a labour intensive activity, almost 40% of the funds are used up
for providing materials.
Good material managers adopt the following procedures:
 Taking inventory regularly and systematically
 Requisitioning at indenting according to actual needs
 Receiving and inspecting incoming items
 Storing and protecting items
 Issuing items for use
 Proper use of items.
The Main Purpose of material management:
1. Cost reduction
2. Avoidance of wastage and shortage
3. Ensuring adequate quality and quantity of material without delay in procurement
OBJECTIVES OF THE MATERIAL MANAGEMENT:
Material management brings about control over the acquisition, storage, retrevability,
distribution, use and disposal of supplies and equipment in order to carry out the primary
responsibilities of the organisation in an efficient, effective and economical manner. Material
management seeks to ensure availability of the right materials at the right time, to the right
place at the least cost.
ORGANISATION
Material management entails two basic functions: Purchase and Stores. These two
functions maybe carried out independently through a separate store department and a

92
purchase department, or the two functions may be integrated into a single store – purchase
department.
Separate departments for purchase and store functions ensure minimisation of confusion,
formalisation of data necessary for making effective purchases and specialisation of each of
the two functions, which intrinsically are independent in nature.
An integrated store – purchase department has the following advantage:
1) A single authority can be held responsibility for the availability and control of
materials. Thus there will be less chance for shifting blame from one department to
another and there will be better coordination between the purchase and store
functions.
2) Less paper work, as common recurs can be maintained (purchase and receipt registers
can be combined).
3) The speed of transactions can be expedited as common information can be shared
easily and informally between purchase and store personal.

PROCESS OF MATERIAL MANAGEMENT:

The process of material management involves planning, review and control of
1. Budgeting and material planning.
2. Demand forecasting.
3. Procurement, receipt, inspection and payment.
4. Storage and inventory control.
5. Issue and distribution.
6. Usage.
7. Maintenance.
8. Disposal.
9. Pilferage.

INVENTORY CONTROL, ABC ANALYSIS, VED ANALYSIS,

CONDEMNATION AND DISPOSAL
Introduction:
Inventory control is a major activity in any organization. Nearly the entire working capital is
utilized for inventory. In a manufacturing organization, stock out situation leads to
production hold-up, idling of men, and non-usage machines, delayed deliveries causing loss
both in financial and in terms of good will. Thus, inventory control is a balancing act and this
is the reason why modern management focuses on inventory control.
Definition Of inventory control:
Inventory: inventory is the list of moveable items which are required to manufacture a
product or to maintain equipment. Inventory is a unique item having identification number,
nomenclature and specification.
Following are the types of inventory:
 Raw materials
 Components
 Work in progress
 Finished goods
The inventory is basically of two types:

93
Official inventory: the materials lying in the main store s and being accounted for but have
not been issued to the user units.
a. Medical and surgical items
b. Dressings
c. Linens
d. X-ray supplies
e. Laboratory supplies
f. Housekeeping items
g. All processed sterile items
Unofficial inventory: the materials have been issued to the user units like the dispensary,
CSSD, laundry, wards, OPD, cast rooms etc. In case of forecasting or demand estimation,
these items are not taken into consideration by the hospital administration, so it is called as
un-official inventory for hospitals.
Functions of inventory control:
 To carry adequate stock to avoid stock-outs
 To order sufficient quantity per order to reduce order cost
 To stock just sufficient quantity to minimize inventory carrying cost
 To make judicial selection of limiting the quantity of perishable items and costly
materials
 To take advantage of seasonal cyclic variation on availability of materials to order the
right quantity at the right time.
 To provide safety stock to take care of fluctuation in demand/ consumption during
lead time.
 To ensure optimum level of inventory holding to minimize the total inventory cost.
Concepts relevant in controlling inventory costs:
The following concepts are relevant in controlling the inventory costs:
Periodic/ cyclic system: this system involves review of stock status at periodic/
fixed intervals and placement of orders depending on the stock on hand and rate of
consumption. The ordering interval is thus fixed but the quantity to be ordered
varies each time.
Two bin system: it is a system where the stock of each item is held in two bins,
one large bin containing sufficient stock to meet the demands during interval
between arrival of an order quantity and placing of next order, and the other bin
containing stocks large enough to satisfy probable demands during the period of
replenishment. When the first bin is empty, an order for replenishment is placed,
and the stock in the second bin is utilized until the ordered material is received.
Lead time: this is the period required to obtain the supply once the need is
determined. It is therefore the average number of days between placing an indent
and receiving the material. Lead time is composed of two elements: administrative
or buyer’s lead time (i.e. Time required for raising purchase requisitions,
obtaining quotations, raising purchase order, order to reach supplier etc) and
delivery or supplier’s leading time ( i.e. Time required for manufacture, packing
and forwarding, shipment, delays in transit)
Minimum/safety/ buffer stock: this is the amount of stock that should be kept in
reserve to avoid a stock-out in case consumption increases unexpectedly or in case

94
 the lead time turns out to be longer than normal. It is also the level at which fresh
supply should normally arrive, failing which action should be taken on an
emergency basis to expedite supply and replenish the stock.
Safety stock = maximum daily consumption-average daily consumption x total
lead time
Maximum order level: this is the maximum quantity of the materials to be
stocked, beyond which the item must not be in the inventory. If the inventory is
maintained beyond this point, there would be loss to the hospital by way of expiry
of life items beyond the shelf life of items, loss incurred on the capital locked up
in the inventory, unnecessary use of items just to exhaust the inventory.
Re-order level: this is the value which is very important from the point of view of
the inventory control. This is the point at which we have to place an order for
procurement for replenishing the stock. It is derived by the formula (minimum
order level + buffer stock )

Costs:
a. Ordering costs: this is the cost of getting an item into the store. The process of
ordering starts with raising requisition, placing an order, follow up, transportation
receipt and inspection, acceptance and placing in stores.
b. Carrying costs: this is the cost of holding an item in the store till it is issued out or
sold. Following are the elements:-
 Interest on capital cost incurred.
 Cost of obsolescence, wastages, damages.
 Rent, insurance, depreciation and taxes
 Maintenance costs of inventory like special treatment, stock taking etc.
 Operating costs of store like direct labor and overheads like electricity, dust
proofing etc.
c. Shortage costs: these are the costs incurred both directly and indirectly due to
shortages like intangible costs due to loss of goodwill, opportunity loss or production
hold costs.
d. Total inventory cost: A total inventory cost consists of carrying costs and ordering
costs.
e. Lead time: this is the time which has elapsed between placing an order till the same
items are received, stocked and ready to use.
Average inventory:
Average inventory is defined in two cases:
Average inventory at constant usage rate:
Average inventory = opening stock+ closing stock
2
Average inventory at variable usage rate:
 Simple average method:
Average inventory = opening stock+ closing stock

95
 2
 Six monthly average method:
Average inventory= opening stock+ stock after 6 months+ closing stock
2

 Quarterly average method:

Average inventory = sum of 4_- quarterly stock + closing stock
5
 Monthly average method:
Average inventory = sum of 12_- quarterly stock + closing stock
13
Selective inventory control:
Definition: selective inventory control means grouping the inventory and classifying for the
purpose of applying the right type of control based on their costs and functional importance.
Objective: the primary objective of inventory control is to minimize total cost of inventory. It
requires the following
 Supervision on planning and control of inventory functions like forecast of
requirements
 Purchase quantity fixation
 Storage and supply
Need for selective inventory control:
Inventory consists of many items, in which some are costly whereas some may be not.
Some inventories are required in large quantities whereas some are required in limited
quantities, thus each item require different type of control, some tight and some loose.
Methods of selective inventory control:
Following are the popular methods of selective inventory control:
a. ABC analysis
b. VED analysis
ABC ANALYSIS:
Also called as Pareto analysis. In ABC analysis, the entire lot of inventory is classified into
three groups based on their annual value and not on their individual cost given as:
Class A: high value items, which accounts for major share of annual inventory value.
Class B: medium value items, which do not belong to either of the classes.
Class C: Low values items, but are required in large quantities and consists of various types
and varieties like clips, washers.
Annual value (a) is defined as:
A= VQ, where, Q= annual consumption on quantity terms
V= value (cost) per item
ABC classification levels:
Items Class A Class B Class C
Number of items as a 10 20 70
% of total number
Annual usage value 70 20 10
as a % on total usage

96
 value

Procedure of ABC classification:

 Step 1:
List down item-wise annual consumption of inventory with its unit price and
determine the annual consumption of each item.
 Step 2:
Rewrite the above list in descending order of money value with additional column to
enter ‘cumulative % value’.
 Step 3:
a. From the list prepared, mark the serial number of items against which the
cumulative % value of annual consumption reaches a figure of 70%
approximately. These are called class A items and compute the number of
class A items as a percent of total items.
b. Continue this process down the list and note the serial number of items
against which the cumulative % value reads approx. 90%. These additional
items constitute class B.
c. The remaining items in the list form class C items and determine quantity in
percent of total number of items.
 Step 4:
Plot a curve with cumulative percentage of annual usage on quantity terms on X-axis
and money value on Y-axis.
Control:
 Class A items are controlled and purchased only on as-required basis to
minimize carrying cost. Higher level control is exercised, these being high
value items.
 Class C items can be purchased in bulk for the requirement of the entire year,
being of low value. The control is exercised at lower level.
 Class B items come in between A and C on degree of control.
Limitations of ABC analysis:
i. When number of items runs into several thousands, it is not convenient to compute
and carry out this analysis.
ii. More chances of deterioration in storage exist since class c items are purchased in
bulk and inventory on these piles up.
iii. Loose control on C may result in shortages.
iv. ABC focuses on money value and not on functional importance of such items,
resulting in shortages of critical items.
v. ABC does not take into account variation of prices of items as time goes.
vi. ABC ignores market conditions, market availability, competitions, seasonal
variations etc.
VED ANALYSIS:
ABC analysis does not tell anything about the criticality of the items. This is an important
variant in patient care services. Based on the estimation of the time length for which non
availability can be tolerated, there are three categories. The stores when subjected to analysis

97
based on their criticality can be classified into vital, essential and desirable stores. This
analysis is termed as VED analysis.
In VED analysis, the inventory is classified as per the functional importance under the
following three categories:
 Vital (V)
 Essential (E)
 Desirable (D)
 Vital: items without which treatment comes to standstill: i.e. non- availability cannot
be tolerated. The vital items are stocked in abundance.
 Essential: items whose non availability can be tolerated for 2-3 days, because similar
or alternative items are available. Essential items are stocked in medium amounts.
 Desirable: items whose non availability can be tolerated for a long period. Desirable
items we stocked in small amounts.
Although the proportion of vital, essential and desirable items varies from hospital to
hospital depending on the type and quantity of workload, on an average vital items are
10%, essential items are 40% and desirable items make 50% of total items available.
Purpose:
 In a manufacturing organization, there are number of items which are very vital or
critical in production.
 Their availability must be ensured at all times for smooth production, so need to be
strictly controlled.
 Essential items follow vital items in their hierarchy of importance.
 Desirable items are least importance in terms of functional considerations, which are
loosely controlled at the lower level.
Matrix of ABC/VED analysis:
There can be combination of these two categories like a matrix combining ABC and VED
categories. This matrix is more relevant in the hospitals. The AV category becomes the most
important for inventory control because the items are very much cost consuming being a
category and also vital for uses. These items can be controlled by the top-level management.
The CD category items are not very costly and at same time of desirable category. These
items can be controlled at the lower level.
V E D

A AV AE AD

B BV BE BD

C CV CE CD

Control of VED items:

a. Category I items: these items are the most important ones and require control by the
administrator himself.

98
 b. Category II items: these items are of intermediate importance and should be under
control of the officer in charge of the stores.
c. Category III items: these items are of least importance which can be left under the
control of the store keeper.
d. The grouping will essentially depend upon the strategy of management and the
environment of functioning. However these simple techniques can be effective in
material management system.
e.  Items with high criticality (V), but required in small quantity (A) should receive
highest priority. Items with low criticality (D) and which are required in big quantity
should receive least priority.
CONDEMNATION & DISPOSAL
The materials which could not be used within its shelf life, deteriorated and declared unfit for
use, became obsolete or banned due to legal provisions are considered for condemnation or
disposal.
Criteria for condemnation:
The equipment has become:
1. Non-functional & beyond economical repair
2. Non-functional & obsolete
3. Functional, but obsolete
4. Functional, but hazardous
5. Functional, but no longer required
PROCEDURE FOR CONDEMNATION
Following procedure is generally carried out in case of the materials particularly drugs and
non-drug items:
 A condemnation committee comprising of three or more members is constituted by
the competent authority, the terms of reference of the committee are:
i. To go in details of the reasons as to why this situation has occurred.
ii. The people who are responsible for the lapses on the aspects from acquisition
to storage and distribution of materials.
iii. To suggest measures to be taken for disposal of the items.
 The committee members go into details through inventory records right from the point
of demand estimation to the distribution level of materials, and will find out reasons
for being an item surplus and remained unused.
 The committee will declare the items condemned and make recommendation for
further disposal of items.
 The condemned items are to be destroyed, so it is to be taken out from the inventory
registers, a write off sanction of the competent authority is obtained before final
disposal.
 The items particularly medicines which are toxic and cannot be disposed of by burial
or as per the relevant laid down rules under the subject of waste disposal.
The effective measures are taken for disposal of surplus items before it becomes unfit for use
is:
A list of surplus material is circulated among the hospital staff/user units requesting
them to pay special attention for mobilizing such items and giving priority to this
category of items.
The surplus materials are transferred to other hospitals where these may be required.

99
 The surplus materials are offered to the manufacturer/ suppliers for buy back.
In case of materials other than drugs like equipments, instruments any such articles
are treated as salvage or scrap, whatever the case may be, action is taken accordingly:
 The materials may be sold by inviting tender.
 Open auctions of items through authorized auctioneers.
Net information:
Inventory control in hospitals is more than just procurement and usage. The proper controls
and processes can save millions in healthcare costs by enabling a hospital to efficiently order
and store just the right amount of supplies needed for patient care while tracking cost, tier
pricing and patient charges associated with supplies and/or custom kits.
ABC analysis is a business term used to define an inventory categorization technique often
used in materials management. It is also known as Selective Inventory Control.
ABC analysis provides a mechanism for identifying items that will have a significant impact
on overall inventory cost, whilst also providing a mechanism for identifying different
categories of stock that will require different management and controls.
When carrying out an ABC analysis, inventory items are valued (item cost multiplied by
quantity issued/consumed in period) with the results then ranked. The results are then
grouped typically into three band. These bands are called ABC codes.

Cost Accounting & Effectiveness for Nursing Practice

Introduction
In contrast to general accounting which maintains records of manufacturing costs and other
operation costs on an overall basis, the cost accounting system is designed to provide
mangers with the information for determining the cost products, processes or operations and
for exercising cost control in many directions. The cost accounting system has now become
major elements in the controlling function of management.
Definition
Cost accounting is concerned mainly with the techniques of product costing and deals with
only cost and price data. If is limited to product costing procedures and related information
processing. It helps management in planning and controlling costs relating to both
production and distribution activities.
Jawahar Lal, 2004
Objectives of Cost Accounting System
It has 3 important objectives
To determine Product costs.
To facilitates planning and control of regular business activities.
To supply information for short and run decision.
Feature of a Cost Accounting System
The cost accounting system may be used by all types of business organization-manufacturing
and non-manufacturing. The following are.
Basic for accumulation costs
Relationship with financial accounting
Basis of product cost
Full costing or marginal costing
Product Cost

100
The objective of determining the cost products is of prime importance in cost accounting.
The total product cost and cost per unit of a product are important in making inventory
valuation, deciding the price of the product, and managerial decision- making. Product
costing cover the entire cycle of accumulating manufacturing and others costs and
subsequently assigning them to work-in-progress and finished goods.
Planning and Control
Another important objective of cost accounting is the creation of useful cost data and
information for the purposes of planning and control by management.
The management control over business operations aims to establish a balance
between actual and budgeted performances. A properly designed cost accounting system
includes the following steps in the control process
• Comparing actual business performances with budgets and standards .
• Analyzing the variance between budgets and standards and actual by cause and
management responsibility so that corrective action may be taken.
• Providing managers with data and reports about their individual performances and
performance of subordinates.
Information for Decisions
• An important purpose of the cost accounting system is to provide data and special
analyses for short and long – run decision of a non-recurring nature . Appropriate cost
information must be accumulated to make a wide variety of short and long-run
decisions.
Advantages of Cost Accounting
• The cost accounting system provides data about profitable and unprofitable products.
After investigating the causes of low unprofitability , management can take suitable
corrective measures which may lead to higher profits.
• All items of costs can be analyzed to minimize the losses and wastage emerging from
the manufacturing process and reduce the costs associated with different actives.
• Production / manufacturing methods may be improved or changed so that costs can
be controlled and profits increased.
• Cost data can be obtained and compared with standard cost within the film or
industry.
• Cost accounting helps managements in avoiding losses arising due to factors such as
low demand, competitive conditions, change in technology, seasonal demand for the
product.
• It also provides cost data and information to determine the price of the product. The
cost of the product is perhaps the most important determinant of product pricing.
• Negotiations with government and labour unions can easily be made with the
information provided by the cost accounting system.
• Cost accounting helps managements in knowing the cost of different alternatives and
selecting the most advantageous course of action.
• More accurate and reliable financial accounts can be prepared promptly for the use of
management.
• An adequate cost accounting system ensures maximum utilization of physical and
human resources, chocks fraud and manipulations, and helps employees as well as

101
 the employer in their basic goals of getting higher earnings and maximizing the
profits of the concern.
Installation of Cost Accounting System
A cost accounting system is a system that accumulates costs, assigns them to cost objects,
i.e. products, jobs, processes etc. and reports accost information. In addition to this, a proper
cost accounting system assists management in the planning and control of business
operations, in analyzing product profitability, and in accomplishing business objectives
through optimum utilization of available resources.

FACTORS IN FLUENCING THE COST ACCOUNTING SYSTEM

Size of the firm

Manufacturing
External
process
factors
or methods

Nature and
Organizational
number of
structure
products
FACTORS

Management
Comparability control
needs

Staff efficiency Raw materials

Types pf Costing

• Cost Accounting has Developed Several Types pf Costing to Suit the Varing Needs
of Different Enterprises
• Department costing
Each production unit is made the primary basic for cost complication.
• Product cost
It is concerned with products and are accumulated expenses are divided in terms of
cost elements and allocated to individual unit of products.
• Process costing
It is applicable to those concerns in which the works department is organized with a
number of sections for each product and each section is based on a distinctive process.
• Job order costing

102
 Each job is treated as a distinct piece of work and costs are allocated mostly on an
actual basis.

Functions of the cost Accounting System

• Cost finding
Costs are analyzed in their elemental parts not only in the case of production or
service but also in respect of specific processes, operation jobs or departments.
• Responsibility accounting
Under this method of costing fixed costs over the period are written off from the
pool of contribution, the manager is charged with chose costs, which he can control by his
direct action.
• Product pricing
Product pricing presupposes a knowledge as to the accurate cost of producing
products, products pricing has been developed now a days through profit-volume (pv) ratio
• Profit determination:
Profit determination calls for the compilation of total costs for doing business.
• Cost control
Cost control aims at reducing the cost of operation. Cost control seeks cost
reduction in material through a closer check an purchasing, store keeping, handling and
processing of material.
Nurses Responsibility for Cost Accounting Method
• One of the primary objectives of the nursing care management system is to develop a
cost management information system that validates the patients’ use of clinical
resources and services and confirms the financial benefits of case management to the
institution.
• To maximize control over patient hospital stay by implementing definable and
attainable patient goals with in a short period of time.

• Fix the pattern of staffing and economize by brining down to reasonable level the
unrealistically high demand for staff by ensuring effective working.
• Cost accounting is thus a valuable management tool to identity, inefficient services,
local wasteful use of resources, take corrective action and bring efficiency into the
health care system.
Cost Effectiveness
Definition:
It is the technique for choosing from alternative courses of action, a preferred
choice when objectives are not very clear in such areas as sales, cost, and profits.
Jawaharal
Cost effectiveness analysis is not analysis for cost reduction. It is an
optimization appear to a specific set of goals.
Criteria of Effectiveness
– Capacity
– Accuracy
– Degree of physician acceptance
– Quantity of output
– Perform ability
– Quality of output

103
 – Men-time between repair
– Professional acceptance
– Error rate
– Flexibility
– Inconvenience to other department
– Spill – Over effects
– Power consumption
– Personal Safety
Cost Effectiveness of Nursing Practice
[Link] use of supplies.
There are many instances of inappropriate use of supplies – Suture kits are
opened and discarded only to use the scissors, lines is used restraints, adhesive plaster is used
for binding treatment books. Instead of rag pieces, cotton is used to wipe, treatment table etc.
• Units meeting can be held once a month to discuss the cost of commonly used item.
• Creating, awareness by putting price tags / Price list on each item.
2. Control of material management
• Nursing administrator has responsibility to estimate needs of the
department in relation to equipment and supplies. She also assess the needs, make
recommendation and implement a system for the evaluation and control of supplies
and equipment. The nurse administrator should establish inventory, proper requisition
to be made.
Cost Accounting Method Application in Nursing
Step: 1
Establishment of a resource use profile on the typical cesarean section patient. A
historical patient profile that was reflective of conventional practice patterns was
developed from the hospitals management information system. This procedure
involved a review of detailed changes based on the hospitals charge description and
general ledger code reports.
Step : 2
Establishment of a resource use profile for the caesarean section
patient based on the nursing care management concept. The historical data obtained
from the patient profiles were used to develop a patient profile adjusted for nursing
care management outcome standards, the major nursing, & medical outcome
indicators of care were derived from the cesarean section patients critical paths and
were used to asses the nursing care management models efficiency and productivity
cost standards were set by reducing patient length of stay by 2 days from 6 to 4 Days.
Step : 3
Comparison of the charge and resource use resource use associated with comparable
cesarean section cases.
3. Ineffective motivation teaching of patients
Motivation and teaching affect the recovery rate. The nurses can promote faster
recovery by using motivational and teaching techniques.
4. Poor patent scheduling
Involvement in non-nursing activities can delay the progress to wards discharge.
Such scheduling problems can be prevented by using the critical path method (CPM),
which is a basic management tool, which can be used to identify the sequence of time
consuming tests and procedures for each patient.
Specific Strategies

104
Appropriate change and innovations are necessary,
• Outsourcing of activities like security, kitchen is likely of be economical
• Reducing idle time of space, equipment & operation theatre.
• Cutting down on surplus
– Staff
– Stationary item
– Material
• Recycling items when ever possible and safe
– Linen
– Stationary
– Packing material
• Proper vigilance to minimize
– Pilferage
– Thefts
Frauds
Step : 4
Determination of the total average cost for the nursing case management model

HEALTH ECONOMICS
INTRODUCTION
Basic factors for the prosperity and wealth of India are its natural resources and
extensive manpower our country is sufficiently rich in natural resources, the full
development and exploitation of which can price the way of progress for Indian population.
DEFINITION
Health economics or economics of health is an economic system related to
medical, health and family welfare service. In our religious test, there are references
regarding many customs and concepts related to the wealth of health, body without any
diseases and immortality.
Methods of maintaining health with the help of available natural remedies are
above mentioned. Here health economics is a broad concept the following included in this.
 Health polices
 Health statistics
 Health budget and per capita health expenses
 Health Resources / Achievement / foreign aid.
 Evaluation of the results of health poleis and programmer.
 National health programmers and health education.
This all financial management related to health is components of health economics.
SOME ASPECTS RELATED TO HEALTH ECONOMICS
National health policy:
Under this, health for all, National population policy, Medicine policy and
financial aspect of Natural health goals are included. In this, expenses for preventive and
creative services and obo expenses at the primary, secondary and territory level of health
cause, are included.
Health Statistics and budget:
Under this, revenue of health sector. Financial provisions, estimates of income
and expenses And the health budget of the nation are included the expenditure on health,
family welfare, water and sanitation in the eighth plan (1992-1997) was 79,800 crores

105
rupees. In the IX plan (1997-2002) provision of 14 968 crores was made only for family
planning. In X plan (2002-2007) a sum of Rs 27125 crores has been kept for family welfare.
Expenses on health:
For medical facilities in three tire health are infrastructure of primary health was, availability
of workers and the projects estimates of future.
Quantitative evaluation of health services:
For evaluation in the health sector, cost benefit analysis, cost effective analysis etc., can be
used. Generally the result of expenses made for health can be clearly understood with the
help of health indicators.
Similarly, expenses made on national health programmers and health education, aid provided
by foreign agencies and contribution made by the nongovernmental organizations are also
important components of health economics.

SUPERVISION AND MANAGEMENT

INTRODUCTION
Supervision is defined as “An art or a process by which designated individual or
group of individuals oversee the work of others and establish controls to improve the work as
well as the worker”. Supervision is generally termed as an educational process in which a
person with better training or more experience takes the responsibility of training a person
with less training or less experience, and in this educational process the leadership of the
supervisor and the growth of the supervised combine to achieve and maintain progressively
the highest level of performance of which the worker is capable.
Supervision is observation and providing feedback to ensure the quality of the
program and to enable the staff to perform to their maximum potential. Traditional
approaches to supervision emphasized on ‘inspecting’ facilities and controlling individual
performance.
OBJECTIVES OF SUPERVISION
1. To help subordinate to do their job skillfully and efficiently.
2. To develop subordinates capacity to the fullest extent.
3. To promote team work
4. To promote moral and motivation among workers.
5. To bridge the gap between personal goal and organizational goal.
PURPOSE OF SUPERVISION:

To improve the quality

of work / performance Helping the person doing
the work and develop the
highest possible standard
PRINCIPLES OF SUPERVISION
1. Supervision should aim at growth in knowledge and improvement of skill of the
person.
2. Supervision should improve the ability in thinking and adjusting to the new situation.
3. It should help to formulate objects.
4. Good supervision stimulates their interest and effectors.
5. No undue pressure for achievement

106
 6. Autonomy to subordinate preferred
7. Supervision should have competence
8. Supervision should have receive training
9. Decision making is encouraged
10. Free communication to required
11. No over burdening to staff
12. Good leadership by supervisor
13. Suitable climate for work
14. Give guidance
15. Supervision should encourage innovation allowing free flow of ideas and share
positive experiences of personnel.
COMMON SUPERVISORY METHODS

[Link] conference [Link] of records

[Link] conference [Link] sessions

[Link] sessions [Link] observation

PRINCIPLES APPLIED TO NURSING:
 Supervision should be focused on the attainment of one goal, the giving of a high
quality of nursing care.
 Strives to make the ward a good learning situation.
 Supervision is well planned.
 It should posters the ability to think and act herself.
 Helps her to attain objectives stimulates interest and effort.
 Encourages and challenges her to greater endeavour through adequate approval
commendation and by recognition of work well done.
 To make pattern for analysis and to analyze continuously her success in reaching the
objectives.
 Respects the personality of the nurse.
 Stimulates the nurse’s ambition to grow in effective.
WHO IS SUPERVISOR?
• A supervisor is a person who is primarily incharge of a section & is responsible for
both quality & quantity of production, for the efficient performance of the equipment,
& for the employees in his charge & their efficiency, training & morale
• A supervisor drives authority from the departmental head for getting work done from
the workers by using the resources of the enterprises.
• He issues instructions to the workers, directs their activities & reports to the
department head on the performance of his section.
QUALITIES OF A GOOD SUPERVISOR:
• Trained person
• Understand the training background and ability of the supervised.

107
 • Good knowledge, the local practice
• Good in health, skills in T.G & PR/t have pleasing manner.
• Good listener.
• Supervisor should have leads examplenory life
• Creative enthusiasm
• Just impartial human, tolerant and tactful
• Helpful
• Good power of judgment.
SUPERVISION CONSIST OF

Leadership Communication

Motivation Evaluation

FUNCTIONS OF SUPERVISION:

A. Administrative B. Educative

C. Communicative D. Evaluative

A. Administrative:
• Assignment of the work loads of individual and groups according to the level of
physical and mental competence (or) preparing the duty roaster.
• Identify the needs for supplies and equipment and providing materials and supplies to
facilitate the staff performance.
• Identify the problem and helps to solve.
B. Educative:
• Orientation
• Teaching subordinates
• Plan and conduct in service education program
• Ensuring staff developments
C. Communicative
• The supervision act as a communicator between the staff and authorities and other
health team members.
• She facilitates communication
• She should encourage free communication among persons between worker and
community representatives and members of health team.
D. Evaluative:
 Supervisor is supposed to carryout performance appraisal of all the staff this include
identify the cause of difficulty.

108
  Providing C E and guidance.
OTHER FUNCTIONS ARE:
• Co-ordinates there of subordinates and agents and promote team worker.
• Promote social contact with in the team to bring staff together and increases group
cohesiveness.
• Develops mutual confidence
• Raises level of motivation
• Develops good IPR
• Maintains R & R
• Establish control over the subordinates
AS A MANAGER SUPERVISOR HAS TO PERFORM THE FOLLOWING
FUNCTIONS
 Planning the work
 Issuing orders
 Providing guidance & leadership
 Motivation
 Preserving records
 Controlling output – performance of the worker
 Liaison between management & workers
 Grievance handling
 Industrial safety
STEPS IN SUPERVISION:
When supervision is needed the spur has to make plan for supervision by using certain steps
to follow.
1. Defining of the job to be done
2. Selection and organization of supervisor activities based on available resources.
3. Anticipation of difficulties
4. Establishment of criterion for evaluation determining what extent the programme has
met problem / objectives acc to plan.
Types of supervision:
(1) Direct supervision – Face to face talk with worker
 Points to be considered:
- Do not loose temper
- Use democratic approach and avoid autographic
- Give workers chance to reply
- Do not talk too much and too fast
- Be human in behavior
- Do not give instructions – haphazard way.
(2) Indirect supervision: With the help of record and reports of the worker and through
written instructions.
This includes:
- Ensuring – carrying out allotted work
- Analysis of monthly progress – input efforts and achievement
- Analyzing amount of work allotted
- Support and guidance.

109
 Methods of supervision:
(1) Technical vs. creative supervision
(2) Co-operative vs. authoritarian
(3) Scientific vs. institutive
(4) Task oriented vs. employee oriented
I. Technical – These are basic supervisory skills and which need to be trained – group
discussion and conference
For example: techniques of service study, record construction, time study etc.
Creative – provides maximum adaptation to the situ
Ex. Instead of orientation period of two week for each new staff member, a variable plan
in both contents and time according to the needs of each individual should formulated.
II. Cooperative – full participation of each member of the group in planning, action and
decision.
Authorization: supervision responsibility centers entirely on the supervisor, with the
staff following his / her orders.
• Both are needed all to situation.
III. Scientific supervision – Relies on objective study and measurement than personal
judgment / opinion.
Intitutive supervision :It needs to maintain IPR
IV. Task oriented supervision emphasize the task more than performer.
Employee oriented: Supervisors are more concerned about worker staff their needs
and welfare than assigned tasks.
TOOLS FOR SUPERVISION
 Checklist
 Rating scales
 Nurses reports
 Nursing rounds
 Job descriptions
 Personnel policies
 Staff educations
 Problem solving approach
TECHNIQUES OF SUPERVISION
 A technique is a way of doing something. Techniques vary with the personality and
ability of the individuals who are being supervised, the activities that are being
performed under supervision and the immediate circumstances.
 Any technique used for supervision must be based on sound democratic psychological
principles which takes account the nurse’s individuality.
THE PROCESS OF SUPERVISION:
Stage 1: Preparation for supervision
1. A supervisor should focus on specific issue.
- Efficacy of service provided to the
- Relevant problems
- Efficacy problem utilization management of limited resources.
2. Study of document
3. Identification of priorities
4. Preparation of a supervision schedule

110
 Stage 2: supervision
Use tools: - Job description
- Task description
- Weekly time table
- Check list / rating for each work
• As a supervisor the following duties has to be performed.
• Establish contact
• Review the objectives, targets and norms
• Review job descriptions
• Note actual / potential conflict
• Observe the actual performance.
• Observe the individual nursing staff carries out his/her tasks.
• Identify the gaps & needs for follow up action based on feed back data attained
through the observation.
Stage 3: Follow up of supervision
Unless actions to follow-up the gaps and needs identified during stage are taken,
supervision remains incomplete. Each supervisor must prepare a report on the
observations made during supervision. The follow-up action may include:
• Organizing in-service training programmes/continuing education programmes for the
nursing personnel.
• Reorganization of time table / work plan/ duty roaster.
• Initiating changes in logistic support or supply system.
• Initiating actions for organizing staff welfare activities.
• Counseling and guidance regarding career development and professional growth.
THE EFFECTIVENESS OF SUPERVISION DEPENDS ON:
1. Human relations skill
2. Technical and Managerial knowledge
3. Leadership position
4. Improved upward relations
5. Relief from non-supervisory duties
6. General and lose supervision
1. Human relations skill:
Supervision is mainly concerned with instructing, guiding and inspiring human beings
towards greater performance. For purpose of direction, the supervisor has to rely on
leadership, counseling, communication and other determinants of human relations
2. Technical and Managerial knowledge:
Guidance implies a complete understanding of all work problems, for which supervisor
should have good knowledge about technical aspect of job and also the managerial aspect
3. Leadership position
The authority of supervisor must be made commensurate with their duty so as to make the
job of supervision a satisfying, rewarding and challenging one
4. Improved upward relations
To ensure god quality of supervisors, the supervisor’s should be regularly allowed to
present their views and suggestions to top executive in regard to the personnel and their
works performance.

111
5. Relief from non-supervisory duties
To make the supervisory duties purposeful, the supervisors are to be relieved of many
routine activities that divert their attention from the real job.
6. General and lose supervisionAccording to some experience, the general and loose
supervision is more productive than close supervision. Here the leader must allow
freedom and initiative to his followers for pursuing a common course of action.

PROBLEMS OF SUPERVISION
Problems in Nursing Service:
There are no perfect nursing service programs/situations without any problems
1. Shortage of nursing personnel.
2. Individual differences among personnel in interests, capacities and abilities.
3. Lack of information, insight and understanding of changes and developments in the
interest of the continuance and improvement of nursing.
4. Lack of clearly defined assignments, multiple responsibility and lack of planning on
the part of those to whom personnel is responsible
5. Outdated policies, procedures and guides to workmanship which cause them to be
disregarded and unused.
6. Inadequate, unsafe, and defective equipment.
7. . Ill health in the part of personnel
8. Undesirable personnel characteristics with special attention to attitudes.
COMMON PROBLEMS IN COMMUNITY HEALTH NURSING SUPERVISION:
1. Problems inherent to budgeting, planning and timing.
2. Personnel problems including problems of poor performance.
3. Grievances
4. Lack of financial resources.
5. Lack administrative support
6. Staff members who are inflexible and resist any type of change
7. Assignment to projects other than those committed to perform
8. Lack of political support
9. . Staff members who do not accept or support the program goals.
10. Conflict within the nursing unit itself.
11. Inability to proceed (for many reasons) because the timing is wrong
12. Inability to hire qualified personnel.
13. .Changes in program priorities.
14. Other issues can include anything from car rental, uniform allowance, security of the
staff within the community, need for supplies and equipment, duplication of services
provided by another organization.
SUPERVISION AND GUIDANCE
a) Supervise and guide the health worker female, dais and female health guides in the
delivery of health care services to community.
b) Strengthen the knowledge and skills of the health worker female.
c) Help the health worker female in improving her skills in working in the community.
d) Help and guide the health worker female in planning and organizing her program of
activities.

112
 e) Visit each sub centre at least one a week on a fixed day to observe and guide the
health worker female in her day – day action.
f) Assess fortnightly the progress of work of the health worker female and submit an
assessment report to the medical officer of the primary health programme.
g) Carryout supervisory Home visits in the area of the Health worker female with report
to their duties under various National Health Programmes.
h) Supervise referral of all pregnant women for VDRL testing to community health
centre/sub divisional hospital.
CONCLUSION
Concept of supervision in nursing, it is very important aspect for providing health care
services. In the beginning, supervision consisted of little more than inspectors. Its aim was to
detect that which was right or wrong and emphasis was placed on finding defects. Now it is a
part of health monitoring activities. “Management is only one element in the implementation
of primary health care, and much of its content and methods must reflect the programme as a
whole. Training should not only cover technical aspect of program but also focus on problem
solving skills of workers.

COMMUNICATION
INTRODUCTION
Communication is sharing ideas, or opinions with others. It is an integral part of the
management process, which involves an exchange of facts, feelings and information by two
or more persons and provides the means of putting the personnel into action in an
organization.
DEFINITION
Communication is a process in which a message is transferred from one person
(sender) to other person (receiver) through a suitable media and the intended message is
received and understood by the receiver.
PURPOSES OF COMMUNICATION
Proper communication is needed at every step and serves several purposes as follows.
It provides;
1. Information and understanding necessary for group work.
2. The attitudes necessary for motivation, co-operation, and job satisfaction.
3. Work satisfaction
4. Assistance in decision making because taking decision needs information.
5. Promotion of managerial efficiency.
6. Co- operation through understanding.
7. Basis for co- ordination.
8. Provision for job satisfaction.
Essentials of communication
According to Millet, there are some factors necessary to make communication
effective, namely – It should be clear, consistent with the expectation of the recipient,
adequate, timely uniform and acceptable.
Jerry recommends 8 practices to achieve the goal.
1. Inform yourself
2. Establish a mutual trust in each other,
3. Find a common ground of experience
4. Use mutually known words

113
 5. Have regard for context
6. Secure and hold the receivers attention
7. Employ examples and visual aids, and
8. Practice delaying reactions.
LEVELS OF COMMUNICATION
Communication takes place in the management at various levels every day with
various levels of people every day.
Intra personal communication
It occurs when a person communicates with himself, i.e. when the individual looks
outside and sees that it is very hot to go out during mid-afternoon and thinks to carry an
umbrella with him.
Interpersonal Communication
Is referred to when a communication takes place between two people either face- to –
face, or telephone, or small groups, etc.
Small group Communication
It is referred to when a communication occurs between three or more people
interacting with each other.
Organizational communication
This refers to the communication takes place between members of an organization
during the performance of organizational tasks, i.e. hospital, or educational institution, etc
Public communication
It involves interaction with the large groups of people, i.e. when a speaker addresses
an audience.
Mass Communication
It occurs when a small number of people send messages to a large, anonymous
audience through the use of some specialized media. Media , e.g. films, television, radio,
news papers and books etc.
TYPES OF COMMUNICATION
Mainly there are two types of communication. i.e. verbal communication and non- verbal
communication.
Verbal Communication:
Verbal communication involves spoken or written words. Words are tools or symbols
used to express ideas or feelings arouse emotional responses, describe objects, observations,
memories or interferences. To make a message clear nurses use effective verbal
communication technique such as:
 Clarity and brevity
Clarity can be achieved by speaking slowly and clearly. Using examples can make
explanation easier to understand. Brevity is best achieved by using words that express
an idea simply, i.e. “Tell me what is your problem.”
 Vocabulary
Instead of using purely technical words use, local words synonyms to technical words
for better understanding.
 Denotative and connotative meaning
A denotative meaning is one shared by individuals who use a common language that
is used to define a word so that it means the same to everyone. The connotative
meaning of a word is the thoughts, feelings or ideals that people have about the word.
 Pacing
Verbal communication is successful when expressed at an appropriate speed or pace.

114
  Timing and relevance
Timing is critical to reception. For example if the supervisor /manager is in bad mood,
the timing is wrong to ask for a raise. And relevance is also important, i.e. that
communication is most likely to have an impact when message pertain to an
individual interest and needs.
Humor
It can be a powerful tool in promoting all aspects in management and also for well-
being. Laughter is the best medicine. When it is used in good sense according to
circumstances and events.
The written communication must be based on four essential ‘C’s – clear, correct, complete,
and concise.
Non verbal Communication
Non- verbal communication is transmission of messages without the use of words. To
compensate for the inadequacy of verbal message information, people unconsciously use
facial expression, gesture, touch and vocal tone to amplify the meaning of spoken
communication. It is one of the powerful ways people conway messages to others.
1) Metacommunication
It is the message that conveys the sender’s attitudes, feelings, and intentions towards
listener. It may be verbal or non-verbal. Non –verbal shows genuine feelings or may
be an attempt to hide feeling, for example, smiling when angry.
2) Personal appearance
The general impression formed of another person influences the response to that
person. It is often leads to impressions about personality and self concept.
3) Intonation
The tone of the speaker’s voice can have a dramatic impact on a message’s meaning.
A person’s emotion can directly influence tone of voice.
4) Facial expression
The face is rich in communication potential. The fase and eyes send overt and subtle
clues that assist in interpretation of messages, e.g. surprise, fear, anger, disgust,
happiness and sadness.
5) Posture and gait
It reflect attitudes emotions, self- concept and physical wellness.
6) Gestures
It identifies 3 functions such as an illustrating an idea, expressing an emotional state
and signaling by use of sign.
7) Touch
It is a personal form of non- verbal communication. Persons engaged in
communication must be close to each other when touch is used.
FLOW OF COMMUNICATION PUT INTO CATEGORIES
1. General Communication
From one part of the organization to its other parts and man-to man. It is carried on
horizontally between chains of command for securing co- ordination in operation can be
upward, downward or a sidewise in the structure.
2. Personal Communication

115
It is between the superior and subordinate. It provides the basis for action and co-operation in
the enterprise.
3. One- way communication
One way communication goes only from the sender to the receiver. Here speaker believes
what he says is right. One – way communication usually used by the authoritative supervisor,
sometimes leads to confusion and misunderstanding.
4. Two- way communication
Two way communication goes back and froth between the sender and receiver. Here both
work together to understand. It means the active role of the receiver, who has the
responsibility to provide feedback to the sender.
Direction of communication
Communication can be in the following direction
1. Downward
2. Upward
3. Horizontal
4. Diagonal Communication
Downward communication
This is the traditional and most commonly used communication, where the management
gives orders to the subordinates at the bottom level to carry out the orders as per the
organizational hierarchy. e.g. Individual and group instructions, handbooks, interviews,
employee counseling, a loudspeaker, letters, posters, bulletin boards, annual reports.
Upward communication
It means the passing on information from the employee level to administration. This conveys
attitudes and feelings of the employees towards management. e.g. Face –to –face discussion,
open- door policies, staff meetings, written reports .
Horizontal (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. E.g. committees,
conferences, and meetings with the purpose of sharing information and solving the problem.
Diagonal communication
Diagonal communication occurs between two individuals or departments that are not on the
same level of the hierarchy.
Common means are: Unit in –charge ordering diet for the patient, X-ray department informs
appointments given to patients in a particular unit, etc.
FACTORS INFLUENCING COMMUNICATION
The factors influencing communication are:
1) Perception
It is the personal view of events, i.e. each persons senses, interprets , and
understands the events differently.
2) Values
These are standards that influence behavior. They are what person considers
important in life and thus influence expression of thoughts and ideas.
3) Emotions
These are person’s subjective feelings about events.
4) Socio- cultural background

116
 Culture is the sum total of the learned ways of doing, feeling, and thinking. It is a
form of conditioning that shows itself through behavior. Language, gestures,
values, attitudes reflect cultural origin.
5) Gender
Some studies have shown certain speaker and listeners behaviors support sex-
linked difference and dominance patterns.
6) Knowledge
Knowledge of handling different level persons is essential for communication.
7) Role and relationships
Communication is more effective when the participants remain aware of their
roles in a relationship.
8) Environment
Warm and comfortable environment facilitates good communication.
9) Space and territoriality
Territoriality is the drive to gain, maintain and defend an exclusive right to an area
of space. It provides people with a sense of identity, security and control.
FACTORS IMPAIR COMMUNICATION
The following psycho- social factors block or impair communication
1. Homophiles
It refers to communicate most with persons similar to self, i.e. age, race, social
status.
2. Chain of command
In this the message is altered with each interchange, e.g. formal and informal
sanctions for circumventing the official chain of command leads to subordinate’s
to discuss problems with high level administrator.
3. Frame of reference: Means perceive some messages and ignore others.
4. Self- preservation: Refers to distort information for self protection.
5. Crisis: Means that confusion, excitement and conflict increase the likelihood of
message distortion because of employees stress and fatigue.
COMMUNICATION MODEL
The goal of effective communication is understanding, not agreement or persuasion.
Understanding builds productive relationships and opens the door for agreement or
persuasion, eg. The first line nurse manager can send a message to the blood bank for a unit
of packed cells, but if it is not received or understood by someone which means no
communication has occurred.
Or
If an HOD has given the message to the class representative regarding the change of
time table for the class and no student turns up as per the change suggested then it means the
message is not understood clearly by the student representative or the message is not reached
respective class.
An effective communication model consists of 6 steps for effective communication
process.
1. The message
2. Encoding
3. Transmitting
4. Decoding action

117
 5. Continuous feedback
Senders must have something to say before they send a message. Message is the content of
intended communication.
 The sender
The sender chooses concept, idea or feeling to communicate. This is the content of
communication. It is the basis of a message. e.g. the first line manager (sender)
communicates information about patients, without a reason or goal, there is no need for
him to begin the communication process.
 Encoding
Encoding is translating the message into verbal (words) or non- verbal means
(expressions and gestures) that will communicate the intended message to the receiver.
 Transmitting
Transmitting is the channel used to communicate the message. The message can be in
any form that can be understood by receiver’s senses. For example, speech can be
heard; can be written word (read) electronic media (slides, projectors T V) gestures
facial expressions(seen or felt), a touch (comfort) .
 Decoding
The receiver perceives and interprets or decodes the sender’s message into information
that has meaning.
 Action
It is the behavior adopted by the receiver as a result of the message sent received and
perceived. It is the process of doing or performing something.
 Communication
It is not successful until the message received has been understood and acted upon
appropriately.
 Feedback
It is a continuous two way process in which senders receiver exchange information and
clarify meaning if the message sent. The communication process is not complete until
the feedback occurs.
IMPORTANCE OF COMMUNICATION
 It is the means through which nursing management achieves organizational goals.
 Nursing managers in carrying out their management functions, spend most of the time
communicating. i.e. with the nursing personnel, physicians, staff in supportive
services, patients/ clients, etc.
 Communication motivates staff members. i.e. sharing information of mutual interests,
explaining plans, etc.
 Communication leads to influence and power. i.e. the first line nurse manager can
improve quality patient care.
 It reduces anxiety, misunderstanding prejudices and enhances better interpersonal
relationships.
STEPS IN PLANNING COMMUNICATION
1. Know your objective
2. Identify your guidance
3. Determine your medium

118
 4. Tailor the communication to fit the relationship between sender and receiver.
5. Establish mutual interest- empathy
6. Watch your timings
7. Measure your results.
MODES OF COMMUNICATION
 Notice boards
 House magazine
 Suggestion scheme
 Meeting and conference
 Hospital and departmental letters
 Personnel policy manuals.
OCCUPATIONAL HEALTH AND SAFETY
Promotion of worker health and safety is the goal of occupational health and safety programs.
These programs are offered primarily by the employer at the work place, but the range of
services and the models for delivering them have been changing dramatically over the past
few years.
DEFINITION
Occupational health should aim at the promotion and maintenance of highest degree of
physical, mental and social well-being of workers in all occupations; the prevention among
workers of departures from health caused by their working conditions; the protection of
workers in their employment from risks resulting from factors adverse to health; the placing
and maintenance of the worker in an occupational environment adapted to his physiological
and psychological equipment and to summarize, the adaptation of work to man and of each
man to his job. (WHO 1950)
 Man and physical, chemical, and biological environment
 Man and machine
 Man and man

Heat Vibration
Physical
Light UV radiations
hazards
Noise Ionizing radiations

Chemical Local action

hazards Inhalation
Ingestion

Biological
hazards Living organisms

Mechanical
Machines
Building

119
Psychosocial Industrial stress
AIMS

 To increase  To decrease
the the
efficiency  To increase the production
accidents
OBJECTIVES

 To promote the health of the workers

 To maintain the highest degree of physical, mental and social well-being of the
workers
 To prevent the diseases by elimination of factors which are inimical to their health
THE OCCUPATIONAL SAFETY AND HEALTH ACT (OSHA)
The occupation and safety act became a public law in [Link] major purpose of OSHA is to
assure safe and healthy working conditions. Although the regulations were more explicitly
designed to protect the employees rather than the patients, the patients do receive secondary
benefits from them. The hospitals have become safer for both the employees and the patients
with reduction in the frequency of work-related injuries and illnesses because of OSHA.
Some of the regulations of OSHA require.
 Minimizing exposure to ionizing radiation.
 Safeguarding exposure from instruments that emit sound or radio waves, visible light,
infra-red, ultraviolet light, and non-ionizing electromagnetic radiations.
 Meeting the standards of electrical codes.
 Installing ventilation systems that maintain no more than maximum allowable
concentration of atmospheric contamination from toxic and inflammable chemical
vapors.
 Initiating procedures for safe handling, storage, and dispensing of flammable and
combustible liquids.
 Monitoring procedures for infection control including procedures for safe handling
and disposal of all types of the sharps used in the hospital, especially in the operation
rooms.
FUNCTIONS OSHA
 Determine and set standards for hazardous exposures in the workplace.
 Enforce the occupational health standards (including the right of entry for inspection)
 Educate employers about occupational health and safety.
 Develop and maintain a database of work-related injuries, illnesses, and deaths.
 Monitor compliance with occupational health and safety standards.
OCCUPATIONAL HEALTH AND SAFETY MEASURES

120
Essential occupational health and safety measures include the following:
 Meticulous practice of universal precautions as a part of work culture.
 Provision and proper use of clothing personal protective equipments.
 Conducting periodic medical check-ups and health examinations.
 Reporting and proper maintenance of records of morbidity, accidents and injuries.
 Establishment of an effective occupational health program that includes immunizations of
health- care personnel especially waste handlers against tetanus, typhoid, and hepatitis B;
post exposure prophylactic treatment; and medical surveillance.
 Proper training, retraining and continued training of health workers.
 Good housekeeping/safe and hygienic laundry practices.

PREVENTION AND CONTROL OF OCCUPATIONAL HAZARDS

1. Primary prevention
Health promotion of workers: The workers should have a state of positive health the different
measure recommended are:
a. Pre-placement examination: It is the examination of the worker before employing in
the occupation, to assess his physical and psychological fitness so that right person is
placed in right job, thereby there will be increased efficiency, increase production and
decreased accidents.
Provision of healthy physical environment: Many factors in the workers’ environment
contribute to promotion of their health and efficiency.
Machine safety and process control: Accidents are common among those, who are working
with unguarded, improperly installed, carelessly operated or defective machineries.
Following precautionary measures should be taken.
 Standard machinery and equipment to be used.
 They are placed as to leave sufficient space all around.
 Machinery should be fitted with a “built- in” safety device.
 The dangerous parts of the machine must be fenced or provided with a suitable guard.
 Installation of the machines should be proper.
 Machines to be cleaned periodically.
 All electrical connections should be properly earthed.
 The manufacturing process should be so controlled so as to expose the worker to the
least amount of noxious substances, e.g. providing filters to the X-ray machine.
 Mechanization of the plant is another aspect to protect the workers from dangers, i.e.
using machines to do the work instead of worker doing it, e.g. dermatitis can be
prevented if hand mixing is replaced by mechanical device, long- forceps is used to
handle radioactive substances, and acids are conveyed through pipes etc.
 Health education: This is also an important promotive, measure. This envisages at
both the levels in the industries-the worker and the management.
 Worker is educated about the risks involved and the measures to be taken for self-
protection. They are also educated of personal hygiene and also the importance of
maintaining a healthy social relationship with the co-workers and the management.
b. Specific protection:

121
 a. Personal protective equipments
 Head protection – is by wearing helmet of correct size. It should not be heavy and
made up of non-combustible material and non-conductor of heat and electricity.
 Eyes protection - is by suitable protective goggles, heat treated lenses, eye-shields,
visors etc. Such equipments are needed for workers engaged in welding, works
furnace work etc.
 Ear protection- is by using ear-plugs, ear-muffs etc, by those who are working in
intensive noise room.
 Skin protection is by using
-Protection clothes against chemicals, asbestos suit against heat, lead apron against
radiation etc.
-Protective ointments such as barrier creams against carcinogens,
-Personal cleanliness by daily bath and frequent washing of hands with soap.
-Log protection- is by using safety shoes, gum boots.
-Respiratory – is by using gas masks and respirators in cases of emergency and not
recommended for continuous use.
b. Personal health habits
-Smoking and alcoholism must always be avoided
-Nutrition must be adequate.
-Food should never be taken in the work-room, but only in the place meant for it.
-Moderate exercise like early morning walk keeps the worker healthy, active and
energetic.
c. Immunization: The workers should protect themselves against communicable
diseases such as cholera, tetanus, typhoid, hepatitis and also against rabies among workers in
the vetenery hospitals.
2. Secondary prevention:
It is early diagnosis and treatment
 Early diagnosis: is done by periodical medical examinations, including certain
laboratory investigations and radiological examinations. This is a very important
procedure because many occupational diseases develop slowly, over a long period of
time. So this procedure helps to detect the disease early, especially pneumoconioses,
dermatoses or cancers; the frequency of examination depends upon the type of
industry.
 Prompt treatment: As soon as the diagnosis is made, the worker is shifted to a safer
job and treated promptly to prevent the development of disability
 Personnel monitoring: This is especially important among those who are exposed to
radiation hazards, by wearing “Dosimeter” on shirt collar, which gives information
about the cumulative dose of the radiation the worker has received.

3. Tertiary prevention
a. Disability limitation: This consists of limiting the development of further disability
which occurs usually among the chronic patients and middle aged persons, by giving

122
 intensive treatment and aid to enable the worker to continue working effectively till
retirement.
b. Rehabilitation: Careful attention must be given to those workers who become
physically handicapped during the course of their employment, either by accident or
injury. Such persons are rehabilitated and given a suitable job, so that his/her
psychological trauma is countered and becomes an useful person to himself, to the
family and country.
STAFFING
 INTRODUCTION:
Nurse staffing is a constant challenge for health care facilities. Before the selection of
the employees, one has to make analysis of the particular job, which is required in the
organization, then comes the selection of personnel.
DEFINITION:
Staffing is a selection, training, motivating and retaining of a personnel in the organization.
ANA PRINCIPLES OF NURSING STAFFING
The nine principles are:
I. Patient Care Unit Related
a) Appropriate staffing levels for a patient care unit reflect analysis of individual and
aggregate patient needs.
b) There is a critical need to either retire or seriously question the usefulness of the
concept of nursing hours per patient day (HPPD).
c) Unit functions necessary to support delivery of quality patient care must also be
considered in determining staffing levels.
II. Staff Related
a) The specific needs of various patient populations should determine the appropriate
clinical competencies required of the nurse practicing in that area.
b) Registered nurses must have nursing management support and representation at both
the operational level and the executive level.
c) Clinical support from experienced RNs should be readily available to those RNs with
less proficiency.
III. Institution/Organization Related
a) Organizational policy should reflect an organizational climate that values registered
nurses and other employees as strategic assets and exhibit a true commitment to
filling budgeted positions in a timely manner.
b) All institutions should have documented competencies for nursing staff, including
agency or supplemental and travelling RNs, for those activities that they have been
authorized to perform.
c) Organizational policies should recognize the myriad needs of both patients and
nursing staff.
STAFF INSPECTION UNIT (S.I.U)
The Staff Inspection Unit was set up in 1964 with the object of effecting economy in
manpower consistent with administrative efficiency and evolving performance standards and
work norms in Government offices and Institutions wholly or substantially dependent on
Government Grants.  Its officers also serve as Core Member on the Committees appointed to
scrutinize manpower requirements of Scientific and Technical Organisations.  

123
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 has
been recommended taking into account the workload projected in the wards and the
other areas of the hospital.
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 staff nurses fixed by the government in settlement with the Delhi nurse
union in May 1990.
4. The assistant nursing superintendents are recommended in the ratio of 1 ANS to every
4 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 ANS
6. There will be a post of Nursing Superintendent for every hospital having 250 or more
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.
The Nurse-patient Ratio as per the S.I.U. Norms 
1. General Ward 1:6
2. Special Ward - ( pediatrics, burns, neuro 1:4
surgery, cardio thoracic, neuro medicine,  

124
nursing home, spinal injury, emergency wards
attached to casuality)
3.      Nursery 1:2 
4.      I.C.U. 1:1(Nothing mentioned about the shifts)
5.      Labour Room 1:l per table
6.      O.T. Major - 1 :2 per table
Minor - 1:l per table
7.      Casualty-   
a. Casualty main attendance up to 100 3 staff nurses for 24 hours, 1:1per shift.
patients per day thereafter  
 
b. For every additional attendance of 35 1:35
patients  
c. Gynae/ obstetric attendance 3 staff nurses for 24 hours, 1:1/ shift
   
d. Thereafter every additional attendance of 15 1:15
patients.

8.  Injection room OPD Attendance upto 100 patients per day 1 staff
nurse
120-220 patients: 2 staff nurses
221-320 patients: 3 staff nurses
321-420 patients: 4 staff nurses
9.   OPD  
NAME OF THE DEPARTMENT  
·        Blood bank 1
·        Paediatric 2
·        Immunization 2
·        Eye 1
·        ENT 1
·        Pre anaesthetic 1
·        Cardio lab 1
·        Bronchoscopy lab 1
·        Vaccination anti rabies 1
·        Family planning 2
·        Medical 1
·        Dental 1
·        Central sample collection centre 1
·        Orthopaedic 1
·        Gyne 2
·        X-ray 2
·        Skin 3
·        V D centre 2

125
·        Chemotherapy 2
·        Neurology 2
·        Microbiology 1
·        Psychiatry 2
·        Burns 1
  2
In addition to the 10% reserve as per the extent rules, 45% posts may be added where
services are provided for 365 days in a year/ 24 hours.
The Nurse-patient Ratio as per the norms of TNAI and INC (The Indian Nursing
Council, 1985)
The norms are based on Hospital Beds.
Chief Nursing Officer: 1 per 500 beds
Nursing Superintendent: 1 per 400 beds or above
D.N.S.: 1 per 300 beds and 1 additional for every 200
beds
A.N.S.: 1 for 100-150 beds or 3-4 wards
Ward Sister: 1 for 25-30 beds or one ward. 30% leave reserve
Staff Nurse: 1 for 3 beds in Teaching Hospital in general ward& 1 for 5 beds in Non-teaching
Hospital +30% Leave reserve.
Extra Nursing staff to be provided for departmental research function.
For OPD and Emergency: 1 staff nurse for 100 patients (1: 100) + 30% leave reserve
For Intensive Care unit (I.C.U.) - 1:1 or (1:3 for each shift) +30% leave reserve.
It is suggested that for 250 bedded hospitals there should be One Infection Control Nurse
(ICN).
For specialised departments, such as Operation Theatre, Labour Room, etc. 1:25 +30% leave
reserve. Norms are not based on Nursing Hours or Patient's Needs here.
The key to success of any hospital primarily depends upon its human resource than
any other single factor. The core determinants of staffing in the hospital organization are
quality, quantity and utilization of its personnel keeping in view the structure and process.
The staffing norms should aim at matching the individual aspiration to the aims and
objectives of the organization.

MAN-POWER PLANNING:
Man power planning may be defined as a strategy for the acquisition, utilization,
improvement and preservation of the human resources of an organization. This involves
ensuring that organization has enough of the right kind of people at the right time and also
adjusting the requirements to the available supply.
 The main objectives of man power planning
1. Ensuring maximum utilization of the personnel
2. Assessing future requirements of the organization
3. Determining the recruitment sources.
4. Anticipating from past records, i.e. resignations, simple discharge, dismissal and
retirements.
5. Determining training requirements for management’s development and organizational
development.
Major activities of manpower planning
1. Forecasting future manpower requirements

126
 2. Inventorying, present manpower resources and analysing the degree to which these
resources are employed optimally.
3. Anticipating manpower problem by projecting present resources into the future and
comparing them with forecast of requirement of requirement to determine their
adequacy, both quantitatively, and qualitatively
4. Planning the necessary program, recruitment, selection, training, development,
motivation and compensation, so that future manpower requirements will be met.
Steps of manpower planning:
1. Scrutiny of present personnel strength.
2. Anticipation of man power needs.
3. Investigation of turnover of personnel
4. Planning job requirements and job descriptions 
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.
[Link] of an Educational Commission for Health Sciences (ECHS) on the lines of
UGC.
[Link] of Health Science Universities in various states and union territories.
[Link] of health manpower cells at centre and in the states.
[Link] 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.
[Link] 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

127
 8. For specialized deptts and
clinics, OT, Labour room 8:200 + 30% leave reserve

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.
 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.

128
  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.

RECOMMENDATIONS 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.
There should not be a bond for nursing students as some of the states do not give them
employment during the stipulated period. Keeping in view of the shortage of nurses in
hospitals and community health field states should create posts and appointment these nurses
in the appropriate positions.
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 4o 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.
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
For promotion to the post of ward sister, post basic [Link]. Nursing is made an essential
qualification. The principle of possessing higher qualification than the category to be
supervised, should apply for all levels and categories of nursing personnel in the rural and
urban areas.  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.

129
 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. Every nursing personnel must have an opportunity to attend at least one refresher
course every 2 years.
8. Accommodation
As far as possible, the nursing staff should be considered for priority allotment of
accommodation near to work place. Hospitals should not build nurse's hostel for trained
nurses. 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 crèche facilities for children of working staff,
children education allowance, as granted to other employees, be paid to nursing personnel.
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 [Link]. 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.

130
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.
13. Adequate accommodations are provided to students. A maximum of 3 students to share
a room. Rooms to be furnished   with light, study table , chair etc. Adequate dining
room, toilets and bathrooms facilities to be provided in each hostel as per norms
recommended.
14. Students should learn under supervision in the wards. Tutors/clinical instructors must
go to the ward with students. Students should not be used for the service of the hospital.
15. Community nursing experience should be as per INC requirements. Necessary
transport and accommodation at PHC be made available for safety, security and
meaningful learning of students.
16. INC requirements for staffing the schools and meeting the minimum requirements are
followed by all schools as these are statutory requirements.
17. Speciality courses at post-graduate level be developed at certain special centres of
excellence eg; AIIMS.
18. Institutes like National Institute of Health and Family welfare, RAK College of
Nursing   and several others may develop courses on nursing administration for senior
nursing leading to doctorate level.
19. Provision for higher training abroad and exchange programme is made.
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

131
 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.
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.

132
 Specific standing orders are made available for each ANM/LHV to function effectively
in the field.
 Adequate provision of supplies, drugs etc are made.
 Recording system be simplified.
 Posts of public health   nurses and above are given gazetted status

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.
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.

133
THE EXISTING NORM BY INC WITH REGARD TO NURSING STAFF FOR
WARDS AND SPECIAL UNITS:
Staff nurse Sister(each Departmental sister/ assistant nursing
shift) superintendent

Medical ward 1:3 1:25 1 for 3-4 weeks

Surgical ward 1:3 1:25 1 for 3-4 weeks
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 1:3 1:25 1 for 3-4 weeks
including newborns

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 1:1(24 hours) 1
neurosurgery
Special wards- eye, 1:1(24 hours) 1

134
ENT etc.
Operation theatre 3 for 24 hours 1 1 department sister/asst nursing
per table superintendent for 4-5 operating
rooms
Casuality and 2-3 staff nurses 1 1 department sister/assistant nursing
emergency unit depending on the superintendent
number of beds

135
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
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
 [Link].(N) or [Link]. (N) with 1 year experience or Basic [Link]. (N) with post basic
diploma in clinical specialty

For [Link] and [Link] nursing:

Annual intake of 60 students for [Link] (N) and 25 for [Link] (N) programme

[Link] (N) [Link] (N)

Professor cum principal 1
Professor cum vice 1
principal
Reader/Associate 1 2
professor
Lecturer 2 3
Tutor/clinical instructor 19
Total 24 5

136
One in each speciality and all the [Link] (N) qualified teaching faculty will participate in both
programmes.
Teacher-student ratio = 1:10
GNM and [Link]. (N) with 60 annual intake in each programme
Professor cum principal 1
Professor cum vice 1
principal
Reader/Associate 1
professor
Lecturer 4
Tutor/clinical instructor 35
Total 42

Basic [Link] (N)

Admission capacity
Annual intake 40-60 61-100
Professor cum principal 1 1
Professor cum vice 1 1
principal
Reader/Associate 1 1
professor
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 [Link] (N) qualified teaching faculty to start college of nursing for proposed less than or
equal to 60 students and 4 [Link] (N) qualified teaching faculty for proposed 61 to 100
students and by fourth year they should have 5 and 7 [Link] (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

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 [Link]. (N) with 3 years of teaching experience or [Link].(N)
basic or post basic with 5 years of teaching experience.

137
 2. Professor cum vice [Link]. (N) or [Link]. (N) (Basic)/Post basic with 3 years of
principal teaching experience.
3. Tutor/clinical instructor [Link]. (N) or [Link]. (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.

Conclusion:
Staffing is the process of determining and providing the acceptable number and mix of
nursing personnel to produce a desired level of care to meet the patients’ demand
The purpose of all staffing activities is to provide each nursing unit with an appropriate and
acceptable number of workers in each category to perform the nursing tasks required. Too
few or an improper mixture of nursing personnel will adversely affect the quality and
quantity of work performed.

STAFF DEVOLOPMENT PROGRAMME

INTRODUCTION
Staff development is the process towards the personal and professional growth of
nurses and other personnel while they are employed by a health care agency. Staff
development refers to all training and education provided by an employee to improve the
occupational and personal knowledge, skills, and attitudes of vested employees.
DEFINITION
Staff development refers to all training and education provided by an employee to improve
the occupational and personal knowledge, skills, and attitudes of vested employees.
NEED FOR STAFF DEVELOPMENT
Staff development activities include training and education needed, because social change
and scientific advancement cause rapid obsolescence of nursing and skills. The main purpose
of staff development programe for nurses is to provide the opportunity to continually acquire
and implement the knowledge, skills, attitudes, and values essential for the maintenance of
high quality of nursing care.
Staff development activities are defined by its concepts such as competence, interest, needs
and learning and training.
PHILOSOPHY OF STAFF DEVELOPMENT
The department of continuing education is an integral part of the nursing division and
embraces the philosophy of the division. The primary goal of a health care agency is the
achievement of a high quality of health care for the people who use the agencies service. The
educational activities should be designed and implemented to promote a safe, effective,
nursing practice and to increase job enrichment through lifelong learning. Emphasis should
be on application of knowledge to the actual work environment. There is a three-way
responsibility involved in staff development for nurses are:

138
 1. The individual nurses responsibility for staff development based on a commitment
to learning as a means of personal and professional growth
2. The nursing professions responsibility for promoting the development of nursing
personnel based on standards for nursing practice and the needs of the nurse
FUNCTIONS OF STAFF DEVELOPMENT
The main purpose of staff development is to provide educational activities for all nurses
employed by the health care agency directed towards change in behaviour related to role
expectations, which build upon the individuals varied education and experimental basis.
The staff development programe must be concerned with the growth and development of
personnel from their initial contact with a health care agency untill termination of service.
Within a health care agency, the following components will provide a framework for
structuring a staff development programe
Socio-Economics
1. Manpower planning
 Recruitment
 Selection
 Placement
2. Counseling
 Performance evaluation
 Career planning
 Promotion
3. Employee-employer relation
 Personal [policies and practices
 Health services
 Labour relations
Experience
i. Nursing practices
 Direct patient care- general or specialties as independent patient care
assignment or team approach
 Indirect patient care- supervision, administration, teaching and research
ii. Other real life experiences
 Colleague interaction
 Voluntary activities related to health care
 Professional association participants personal life
Education
Continuing education
 In-service education
 Orientation
 Skills attitude and knowledge pertinent to nursing practice within the health care team
and to career planning for individual nurse practitioners
TYPES OF STAFF DEVELOPMENT
Staff development includes formal and informal, group and individual training and education.
The goals of staff development are to assist each employee to improve performance in her or
his present position and to acquire personal and professional abilities that maximize the
possibility of career advancement.

139
Staff development activities include the following:
1. Induction training
2. Job orientation
3. In-service education
4. Continuing education
Induction training: is a brief, standardized indoctrination to an agency’s 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 agency’s philosophy,
goals and norms
Job orientation: is an individualized training programe intended to acquaint a newly hired
employee with job responsibilities work place, clients and co-workers
In-service education: it is defined as a continued programe of education provided by the
employing authority, with the purpose of developing the competence of personal in their
functions appropriate to the position they hold, or to which they will be appointed in the
service.
In-service education is a planned instructional or training programe provided by an
employing agency in the employing setting and designed to increase competence in a specific
area
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 programs”
Continuing education in nursing consists of planned learning experiences beyond a basic
nursing educational program. These experiences are designed to promote the development of
knowledge, skills, and attitudes for the enhancement of nursing practice, thus improving
health care to the public
Intramural education: is community based continuing education directed towards meeting
the job related learning needs of the nurse and other personnel. Exclusive of full time formal
study at a degree granting institution.
PRINCIPLES FOR SUCCESSFUL STAFF DEVELOPMENT
A body of educational concepts and principles underlies successful staff development.
 The ultimate responsibility for continuing education or professional development rests
with the employee. Therefore, employee’s suggestions should be solicited when
planning, implementing, and evaluating staff-development programs.
 Most learning is a combination of experience and conceptualization. Therefore,
employees learn best when cast into situations that encourage self-discovery of
significant information, concepts, and skills
 Learning is an internal, personal, emotional process. Therefore, methods and
techniques that involve the individual on a deeply personal level produce the most
significant and last learning
 Learning involves a change in behaviour, and it is difficult to change habitual
behaviour. Hence, people learn best when they are slightly off balance or slightly
uncomfortable. Old ideas, and habits must be shaken or unfrozen before new
thoughts, pastimes, actions, and attitudes can be wholeheartedly undertaken
 Although a child learner rapidly accepts dependence on an adult teacher, the adult
learner demands autonomy in seeking, regulating, and using learning experiences.
Therefore, an authoritarian manner is ineffective in teaching adults. An adult learner

140
 should be encouraged to contribute questions, examples, and information during
instructional sessions
 Although a child is willing to postpone the application of new learning, adults learn
best when lesson content can be applied immediately. Therefore, a case method,
problem-solving teaching format is well suited for nursing staff development
 Behaviour that is positively rewarded is likely to be repeated. Learners need quick,
hearty applause or other positive feedback when they display a new behaviour that
they have been asked to perform
 Individuals tend to organize all aspects of a total learning situation into an integrated
whole. Therefore, each aspect of a learning situation should complement or
supplement every other, so all educational components interlock to support desired
objectives
 The transfer of learning is maximized when training occurs in situations closely
resembling those where the learned behaviour should be applied. Therefore,
illustrative examples, descriptive studies, and practice exercises should resemble work
problems frequently encountered by the employee
 The transfer of learning is maximized when managers reinforce changes in
employees’ behaviour resulting from staff development activities. When it becomes
necessary to change professional practice behaviors, several employees should be
educated simultaneously to display the desired knowledge, skills, or attitudes. Group
instruction will stimulate employees to support each other in perpetuating the desired
behaviour change and will motivate them to model the desired behaviour for other
employees
 Learning is an active not a passive phenomenon. Therefore, it is more effective to
give a trainee a task goal, guidelines for goal achievement, and opportunity to work
out details of optimum task performance than to direct the employee to mimic an
expert practitioners skilled performance of the task
 Adults are self-directed and possess a huge reservoir of experience from which to
draw when learning new knowledge and skill. Unfortunately, memory associations
cause proactive inhibition of learning for some content. To design individualized
staff development experiences, a teacher must obtain information about the adult
learners present life circumstances, past education and employment, and future career
aspirations
 Adult learners are heterogeneous, with extremely different life experiences,
motivation levels, cognitive styles, learning speeds, and sensual preferences. Each
staff development programe should include a variety source materials, teaching and
learning methods, and audio visual aids to satisfy the needs of diverse learners
ADMINISTRATIVE STRUCTURE OF A STAFF DEVELOPMENT
The major factors that determine the administrative structure of an agency-wide staff
development programe are
 Administrative philosophy, policies, and practices of health care agency
 Policies, practices and standards of nursing and other health professions
 Human and material resources within a health care agency and the community
 Physical facilities within a health care agency and the community

141
  Financial resources within a health care agency and the community
Qualifications of staff development personnel
The qualifications required in staff development personnel depend on the nature of staff
development task to be performed that is administration, teaching, counseling. People in
various disciplines must be used to help in assessing staff-staff development needs,
recommending where and how these needs can be met, and in planning, organizing,
implementing and evaluating staff development programme.

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 programe
 Determination and establishment of organizational methods, policies and procedures
for a staff development programe
 Determination and establishment of lines of communication for the utilization of
facilities and resources personnel for a staff development programe
 Determination of organizational and individual staff development needs and priority
 Development of measurable short and long term objectives for staff development
programmes
 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
Approaches to staff development
 Orientation
 Formal programmes
 Unit programmes
 Workshop and conferences
Guidelines for staff-development programs
In organizing staff development offerings, the advisory committee and staff-development
director should develop guidelines for program planners and teachers. The committee should
require teachers should evaluate both the process and outcomes of each programe and report
results to the vice-president of nursing. Finally, the committee should establish selection
criteria for hiring staff development instructors and assigning teaching responsibilities to in-
service teachers and clinical nurse specialists
 The head nurse or patient care managers, in-service teachers, clinical nurse specialists,
middle managers, staff development director and vice-president of nursing should
share for the educational development of staff nurses.
 To prevent duplication of efforts, the Advisory committee for staff development
should specify the educational role for each contributor
 The vice-president of nursing’s responsibility is to allocate educational funds and
facilities equitably among all nursing divisions

142
 The staff development Directors role is to solicit employee requests for training,
identify internal or external experts to teach needed courses, enroll employees in
available courses, and preserve records of employees participation in staff
development
 The head nurse or patient care manager’s role is ti identify staff members having
nursing and teaching expertise that enable them to teach selected staff-development
courses.
 The head nurses role includes scheduling employees for staff-development activities,
serving as preceptor for nurses needing a management practicum, helping employees
apply new theories and techniques to practice, and evaluating each nurses
achievement of staff development course objectives
The staff development instructor
Each staff development teacher should possess a high level of nursing knowledge and
skill in one clinical specialty. The staff development teacher’s personal power determines
her or his credibility as change agent and role model. Staff development teachers should
be skilled in using direct and indirect teaching methods in group and individual education.
The advantage of using a health agency employee to teach a staff-development course is
the insiders familiarity with the work situation in which the learner must implement new
knowledge and skill. The learner also feels more comfortable in contacting the teacher for
follow-up instruction when both are employees of the same agency
The course instructor should have a thorough understanding of the subject, display
enthusiasm for the topic, present abstract ideas clearly, interrelate theoretical and clinical
content and communicate respect for other’s idea
The role of staff-development teacher is not that of information giver but of role model
for effective learning
When needed information is available in printed, pictorial, or other media, the teacher
should devote course time to demonstrating how to extract information from clinical
situations, analyze sense data, draw conclusions from observations, manipulate ideas to
achieve professional goals, and evaluate outcomes of nursing interventions. He or she
should use patient care problems from the student’s clinical setting as course content and
show how observation, investigation, analysis, problem solving, and evaluation should be
applied to practice problems. The teacher should also reward students for discovering key
facts and relationships on their own, thereby encouraging the type of self-directed
learning that culminates in expert status
Preferred topics for staff development programs
To heighten employee’s motivation for seeking staff development, course offerings
should be linked to employee’s employment interests and career aspirations. The staff
development Advisory committee should poll all employees and managers and interview
a representative sample of each group to identify desired course topics. Some topics are
selected by nurse managers who identify a lack of employee knowledge or skill that can
be remedied through organized instruction.
Planning for staff development programs
When a topic has been selected for a staff development program, the instructor should
write course objectives that specify the exact behavioral change expected of participants.
These objectives should be few and written to describe observable behaviour whenever
possible and specify conditions under which the desired behaviour is to be observed
For instance, at the conclusion of 15 hours of instruction in electrocardiography for
nurses, the student will be shown electrocardiographic strips illustrating sinus arrythmia,

143
 sinus bradycardia, sinus tachycardia, paroxysmal atrial tachycardia, premature atrial
contractions, first degree atrioventricular block, premature ventricular contractions,
ventricular tachycardia, and ventricular fibrillation. The student will correctly identify ten
of the twelve arrhythmias within a ten-minute period.

ROLES AND FUNCTIONS OF ADMINISTRATOR/MANAGER IN STAFF

DEVELOPMENT
Roles He or she
 Applies adult learning principles when helping employees learn new skills or
information
 Coaches employees readily regarding knowledge and skill deficits
 Actively seeks out teaching opportunities
 Uses teaching techniques that empower staff
 Is sensitive to the learning deficits of the staff and creatively minimizes these
deficits
 Frequently assess learning needs of the unit
Functions
 Works with reduction department to delineate shared individual responsibility for
staff development.
 Ensures that there are adequate resources for staff development.
 Assumes responsibility for quality and fiscal control of staff development activity.
 Makes appropriate decisions regarding educational resource allocation in periods of
fiscal constraints.
 Ensures that all staff is competent for roles assigned.
 Provides input in formulating staff development policies.
TEACHING METHODS AND AIDS
Teaching methods for a staff-development course should cause students to actively
manipulate course content. The methods for each course should fit course objectives. The
lecture or expository method is effective when a fairly a large volume of new information
must be acquired by the student in a short time. The discussion method is preferred when
problem-solving skills and attitudinal changes are needed. Film or film strips and discussion
facilitate the transfer of new learning to the students work setting. Case studies are helpful in
sensitizing students to clinical issues, developing analytical skills, and teaching problem-
solving techniques.
 First, learner motivation is the single most powerful variable in the learning process.
 Second, course materials must be logically organized to be understood. When
preparing audiovisual aids, the teacher is forces to identify the two or three most
important lesson concepts and organize them according to some logical principle,
such as chronology, cause and effect, system components, or simple-to- complex
progression. This emphasis on a few key points facilitates students understanding of
lesson content.
 Third, repetition of lesson content improves retention of detailed information. Audio
visual materials can be organized as programmed learning packages that provide new
information in small increments, with frequent repetition and summarization
 Fourth, prompt feedback is needed to confirm students correct responses and
eliminate errors.

144
CONCLUSION
Staff development activities consist of the training and education provided by an
employer to improve employees’ occupational knowledge, skills, and attitudes. Staff
development activities are needed because societal change and scientific advancement cause
rapid obsoloscence of nursing knowledge and skills. Staff development program should be
carried out to transmit new knowledge to the employees to keep abreast of changing
demands and capabilities. Hence, staff development is necessary as it influences a workers
progress through all stages of adult development.

RECRUITMENT CREDENTIALING, SELECTION, PLACEMENT&

RETENTION
I. INTRODUCTION:
Personnel management is the most important assets of an organization. Planning for
human resources is the important managerial function. It ensures adequate supply, proper
quantity and quality as well as effective utilization of human resources. There is generally
shortage of suitable persons. The organization will determine its manpower needs and then
find out the sources from which the requirements will be met.
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. Recruitment of nurses are major concern.
Recruitment means finding out of the further workers. It is process of searching for
prospective employees and stimulating them to apply for job in an organization.
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.”
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.

145
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
 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 organization’s 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 company’s 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.
4) Procedure for recruitment should be developed by an experienced person

146
 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:

DIRECT SOURCES

SOURCES OF RECRUITMENT

INDIRECT SOURCES

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.
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. Most employees known from
their own experience about the recruitments for the job what sort of person is looking for? A
major concern with the employee recommendation is that referred individuals are likely to be
similar type (e.g. race and sex) to those who are already working for company.

147
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
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

148
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. These and other agencies in
the profession are retained by organizations for recruiting and selecting managerial and
executive personnel.
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.
MODERN SOURCES OF RECRUITMENT:
 Walk-in
 Consult in
 Tele recruitment: Organizations advertise the job vacancies through World Wide Web
(WWW)
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:

149
 Planning

Strategy development

Searching
STEPS

Screening

Evaluation & Control

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 organization’s 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.
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
Credentialing is the process of establishing the qualifications of licensed professionals,
organizational members or organizations, and assessing their background and legitimacy.
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.

150
 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, let’s 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.
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.
CRETERIA FOR APPOINTMENT:

151
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 employer’s offer, acceptance by the
applicant, and signing of a contract or written offer”.
.
DEFINITION
“It is the process of choosing from among applicants the best qualified individuals,
Selecting includes interviewing, the employer’s 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

152
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 candidate’s character and personality, and the information to be
given by the head teacher should include candidate’s attendance at school, studies completed,
grades, rank in class and his or her own evaluation of the candidate’s 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.
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

153
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.
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:
1) Interviewing:
Interviewing is the main method of appraising an applicant’s 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.
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.
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

154
 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.
2) 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 candidate’s mental
caliber. It has been observed that for various professions, there is an optimum level of
[Link] 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.
2) 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’.
4) References:

155
 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
5. 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.
6) 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.

156
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
 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 favours promotion on the basis of merits, and the unions
vehemently oppose it by saying that managements resort to favoritism. The unions generally
favour 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:

157
 An increase in salary

A better future An increase in prestige

FACTORS IMPLYING
PROMOTION

Additional supervisory responsibility

An upward movement in the hierarchy of jobs

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

158
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.
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.

159
  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.
 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 employee’s 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

With no end in sight for the nation’s nursing shortage, hospitals are placing greater
emphasis on retaining their current RN staff. It’s a complex process, requiring in-depth
knowledge of the needs and wants of the nursing staff and lots of creativity. .
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.
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.

160
 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. “It’s 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. “That’s one key piece to retention.” It’s 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.
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 • Team orientation
communication and behavior • 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 • Ability to provide quality care to meet
numbers of qualified nurses client/patient needs
• Work and home life balance
5) The presence of expert, • Serve as an advocate for nursing practice
competent, credible, visible • Support shared decision-making
leadership • Allocate resources to support nursing.
6)Shared decision-making at all • Nurses participate in system, organizational and
levels process decisions
• Formal structure exists to support shared

161
 decision-making
• Nurses have control over their practice.
7)The encouragement of • Continuing education/certification is
professional practice and continued supported/encouraged
growth/ development • Participation in professional association
encouraged
• An information-rich environment is supported.
8) Recognition of the value of • Reward and pay for performance.
nursing’s contribution
9) Recognition of nurses for their • Career mobility and expansion
meaningful contribution to the
practice

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 to four strategies outlined in the 2002 AHA report,
“In Our Hands.” They include: foster meaningful work, improve the workplace partnership,
broaden the base to attract a more diverse workforce and collaborate with other
organizations, including other hospitals in the community and schools, to ensure an adequate
workforce in the future.

5) Excellence in human resource practice

PERSONAL POLICY
\DEFINITION OF PERSONNEL POLICIES
 National industrial conference board defines personnel policies as ‘written statements
of an organisation’s goals and objectives concerning matters that affect the people in
the organization.’ Policies are stated in long range terms that express or stem from the
philosophy of the organization.
 Other writers defined personnel policies as basic rules established to govern functions
so that they are performed in line with desired objectives.
FORMULATION OF PERSONNEL POLICY
Formulation of personnel policies is a top management decision, affecting the
operation of the organization. Its consequences must be long lived over larger number of
people. But the members of top management may not have the total expertise to do justice to
the job. In certain organisations, the personnel manager may be totally responsible for the
entire process. A policy in which executives from different levels of hierarchy have
participated will have better chances of being accepted and implemented. The personnel
manager and other line managers who help in devising personnel policies must have the
specialized training and knowledge and the necessary time to study the requirements of the

162
organization so far as the man power management is concerned. All personnel policies should
be flexible enough to offer sufficient scope for the departmental managers to meet different
situations.
Whenever an organisation faces the problems of different situations, it may feel the
need for policy decisions. Thus, the suggestions for framing the policies are demanded from
all levels in the organisation. On receiving such suggestions, top management constitutes a
committee to find facts and make recommendations for a policy. The step of formulated
policy includes:
 Fact finding: It is usually a job delegated to the committee who through interviews
and conferences collect data from inside and outside the organisation. The facts
should dependable, diverse and qualitatively superb. When the investigation stage is
over, the committee proceed further in this matter.
 Reporting of proposed policy: Policy formulation committee shall report to the top
management its considered opinion integrating the committee’s judgements and
findings. The personnel manager plays a key role in this matter. He may be the
principal spokesman of the committee. He should take adequate precautions to ensure
correct timings and presentation of the report so that the management finds it
acceptable.
 Writing the proposed policy: Policies should always be in writing. There are two
compelling reasons for it. Firstly a policy will be vague unless it is written down.
Secondly if a policy is in writing, it will show what exactly the management means.
Special skill is required to select and adhere to policy language which will state and
synthesise principles and commitment for action and scope for discretion.
 Discussing the proposed policy: A proposed policy should always be discussed with
the participation of those who use and live with the results it gives. The discussion
stages offer an opportunity to gauge the thoughts of the employees. Management can
reasonably expect that those who have not testified against the proposed policy will
abide by it. If a group of employees is not convinced, the management should
examine their views in detail. Opportunity for upward communication should be
given to employees to respond constructively to the policy.
 Adopting and launching policy: Adopting and launching policy rests on the top
management. It is the top management who can decide whether the policy adequately
represents the organisational objectives or not. Generally, management hesitate to
release the policy accepted by them for fear of making commitments. Such a situation
will create not only confusion among employees but also lack of confidence in
management’s pronounced commitments. Hence, it is essential not to release the
policy unless the management means what it intends to mean.
 Communicating the policy: The Issuance of formal personnel policy is limited by
the management. The personnel policy manual or handbook should be maintained by
the personnel department on all policies and procedures of personnel matters.
Booklets on personnel policy giving important points of interest to employees should
be issued.

163
  Appraising the policy: Policy formation committee consisting of the representatives
of management and other employees who are affected by a given policy decision can
develop the experience to appraise its appropriateness and usefulness. Any serious
difficulty to overcome the new or revised policy should report to the top management
along with the constructive suggestions.
TYPES OF PERSONNEL POLICIES
 Personnel policies ensure consistency in company operations:
According to Encarta Online Dictionary, policies are sets of actions adopted by
groups, such as businesses and organizations. Policies reflect the group's principles
and form the basis for the organization's operations. Companies use personnel policies
to communicate their principles, official processes, procedures, and workplace laws to
their employees. Personnel policies ensure consistency throughout the company in
critical areas of operations and personnel management.
 Discrimination and Harassment
Discrimination and harassment policies are often included in personnel manual;
copies are often provided to new hires during orientation to read and sign for
placement in their personnel files. These policies may include instructions for
reporting discrimination and harassment. In addition, the policies are often displayed
on the organization’s website or Intranet.
 Hiring and New Employees
Hiring policies include instructions for posting vacancies, the application and
interview process, acceptable documentation for applicants, offers of employment and
employment discrimination policies. New employee processing may require the use
of a checklist to ensure completion of all tasks. Orientation may include discussion of
probationary periods and employment status, such as at-will, temporary or permanent.
The policy may list the documents new employees must read and sign, and the
contents required for new employee files.
 Work Schedule and Leave
Work schedule policies may specify strict work schedules, allowable flexible
schedules, and specify lunch and break period requirements. Company leave policies
may include the company’s annual paid holidays, the amount and allowable use of
personal and sick leave, and the amount of vacation time provided and how that time
is earned. Policies may include leaves of absence, leave for adverse weather
conditions, the Family Medical Leave Act, jury duty and leave for military or reserve
duty.
 Compensation
Compensation policies may include employee classification, salary ranges, and
requirements for promotions or salary raises, payment of overtime, salary advances
and required and voluntary payroll deductions. The policies may also include
timekeeping requirements such as the required forms and signatures, the pay period,
pay days, payment types and payment methods, such as direct deposit.
 Benefits
Benefit policies include employee eligibility for company benefits such as health,
life, and disability insurance; retirement accounts; and other company benefits such as

164
 childcare or tuition reimbursement. Benefits also include company policies for
extending benefits to separated employees. Benefits may describe the workers'
compensation policy, including legal requirements, company procedures for reporting
and responding to accidents and injuries, required forms and coverage of medical
expenses.
 Performance Appraisal
Company policies for performance appraisals are often related to compensation, and
usually detail how appraisals affect salary increases. The policies include the appraisal
cycles and processes, which performs the appraisals, the appropriate forms, required
conferences with the employee undergoing appraisals, and what is covered in the
appraisal, such as leave use, disciplinary issues and overall job performance.
 Termination of Employment
Policies concerning separated employees include the processes for employee
resignation, suspension and termination. Policies usually state the length of notice
resigning employees should provide to the company. Policies include the reasons an
employee may be suspended, the process to be followed and how compensation is
affected. Termination policies often include requirements for a process that involves
documentation of infractions and corrective measures leading to termination.
 Grievance
Company grievance policies provide instruction for employees to file official
complaints to supervisors or management. The process often describes a method that
involves submitting complaints through a hierarchy of supervision and management
and may address complaints of discrimination, harassment or other conflicts. The
policy describes the process for making a determination, the appeals process and
possible resolutions.
 Fiscal Management
Financial or fiscal policies may cover budget management, reporting, reimbursement
of personal expenses such as travel, use of company credit cards or accounts,
authorization for expenditures, requesting and ordering supplies and equipment,
forms, recordkeeping and procedures.
 Confidentiality
Companies use confidentiality policies to protect the privacy of employees, clients
and company records. Policies may include disclosure prohibitions, instructions for
disposal or destruction of records, restrictions for access to certain records and release
of information, appropriate use of email and correspondence and prohibited
communication.
 Tips
Some businesses may need extensive safety policies. Make a clear distinction in the
personnel manual between policy and procedure. Some companies may consider
guidelines for record destruction to be procedure, while other companies, such as
banks or healthcare facilities, may include the same guidelines as critical policy.
Clarify areas where there is no option except adherence, by making them policies.

165
  Warnings
Legal counsel may suggest improvements in personnel policies. Have legal counsel
review the personnel manual to ensure policies are enforceable and the company has
addressed issues of liability in matters of federal and state laws and regulations
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 behaviour of any community which
should be taken into 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 workforce.
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
organization’s personnel policies.
vi. Union objectives and practices: How well the employees are organised? What is
their bargaining capacity? What are their pressure techniques? All these factors are
responsible to personnel policy.
vii. Type of workforce: The assessment of the characteristics of workforce and what is
acceptable to them is the responsibility of the effective personnel staff. A policy
which is not appropriated is hardly worth implementation.
FUNCTIONS OF PERSONNEL POLICY
Personnel policies must generally be established in relation to various functions of personnel
management which are given below:
a. Employment
 Minimum required qualifications for the jobs.
 Sources of recruitment.
 Selection devices such as tests and interviews.
b. Development
 Induction, transfers and promotions
 Bases and type of training
 Executives and workers development programs.
c. Compensation
 Equitable and adequate remuneration.
 Non monetary rewards.
 Profit sharing and incentive plans.
 Bonus.

166
 d. Integration
 Efficient system of communication.
 Handling of grievances.
 Recognition of labor unions.
 Worker’s participation in management.
e. Working conditions and motivations
 Welfare measures for health, safety and high morale.
 Safety programs.
 Welfare services like canteen, rest-rooms, recreational facilities, group
insurance, etc.
 Financial and nonfinancial rewards for motivation.
PRINCIPLES OF PERSONNEL POLICIES
 Put the right man in the right place by a careful selection and placement to make sure
that he is physically, mentally and temperamentally fit for the job he is expected to
do.
 Train every one for the job to be done, so that they quality for better jobs, their
accomplishments are limited to their ambitions and abilities and they do their present
work very efficiently.
 Make the organization a coordinated team through a proper coordination and
administration of different departments and divisions, so that there is a minimum
amount of friction and unproductive or unnecessary work.
 Supply the right tools and the right conditions of work, for the better the tools,
facilities and working conditions, the larger the output produced with the same human
effort at lower costs.
 Give security with opportunity, incentive and recognition.
 Look ahead, plan ahead for more and better things.
Personnel policies should be founded on 3 social principles:
 Justice – code to ensure equitable and consistent treatment to all employees.
 Human needs – a policy fulfilling human needs.
 Democratic approach – for securing the willing cooperation of employees.

Change is one of the distinctive features of modern-day society. To ensure that Océ
achieves its aims, its personnel policy has been designed to encourage employees to meet
the challenges inherent in change, in their own interest and in the interest of the company.
The success of a company depends, first and foremost, on its staff. Océ's personnel policy
is based on the following principles:
 Deploying employees in a way that does justice to their abilities and satisfies their
ambition
 Encouraging creativity
 Giving employees clearly defined tasks with the appropriate level of responsibility
 Assessing employee performance objectively
 Offering employees equal opportunities based on their abilities, efforts and results

167
 Enabling employees to achieve personal growth in and through their work, so that
they are able to respond flexibly and effectively to change
 Allowing employees a share of the profits
 Limiting the number of management levels and the degree of bureaucracy
PRINCIPLES IN ADMINISTRATION
 The ultimate purpose of nursing personnel administration is to secure and hold
efficient nurses and administrators so that the nursing service may be effectively
conducted and constantly improved.
 The principles of personnel administration apply whenever there exists between
individuals and groups the relationship of employer and employee, director and
directed, supervisor and supervised.
 Sound personnel administration is good business policy.
CHARACTERISTICS OF PERSONNEL POLICIES
Personnel policies should possess the following characteristics:
 They should present the principle that will guide the organization’s actions and reflect
a faith in the ethical values of employees.
 They should be stated in the broadest possible terms so as to serve as a guide in
practice now and in future.
 They should be formulated after taking the long range plans and needs of the
organization.
 They should be flexible to cover a normal range of activity.
 They should be stable to preclude excessive alterations.
 They should be developed with the active participation of management and
employees.
 They should be definite so that it is easy to understand.
 They should be communicated in writing so as to remove any confusion.
POLICIES FOR NURSING
Management of nursing personnel –recruitment, training, promotion, conditions of
service, etc.- is an area which holds the key to the success of health care administration
especially the hospital services. Bacon, philosopher and administrator, has rightly said: It is
vain for princes to take counsel concerning matters if they take no counsel likewise
concerning persons; for all matters are as dead images; and the life of the execution of the
affairs lies in the good choice of person.
Because of the poor conditions of service, it is very difficult to attract better qualified
people to take up the nursing profession. Besides, their avenues of promotion are very
limited. A staff nurse can be promoted to a Ward sister and it is very difficult to be promoted
beyond that as the positions are very limited. The status of Nursing Superintendent in a
hospital is very low which affects the morale of the nursing personnel.
In other words, the aim of health care systems should be to create and maintain such
conditions whereby an employee feels like giving his best, gets satisfaction out of his job and
is suitably rewarded. Besides the conditions of service, the personnel management may look
after the following aspects of nursing personnel:

168
 a. To treat the nurses as key personnel and as partners along with other members of
health care and medical team.
b. To help the nursing personnel reach self-actualisation and thereby help release
their creative energy for the promotion of health.
c. To create facilities for continuous growth, development and training of nursing
personnel to make them fit for higher job;
d. To ensure adequate working arrangements and maximum participation in
management and decision making of the health system by nursing personnel.
e. To provide institutional safeguards for redressal of the their grievance esp. to bring
their emoluments at par with other professionals and improve their working
conditions;
f. Setting good professional standards by senior nursing personnel
g. Development of unity, energy, initiative and loyally among nursing personnel
h. To promote their creativity, insight and loyalty ;and
i. To improve the nurse-patient ratio from 1:12 to 1:3.
Responsibility for establishing personnel policies: The basic policies of an organisation
must always have the approval of top management. Approval of personnel policies must
come from the top. Nursing service administrators have important contributions to make, not
only to their department policies, but also to general hospital.
A democratic minded organization treats ‘everyone alike’. Each employee regardless of
department or rank should have the same benefits and work under identical personnel
policies. But each department has other specific requirements and benefits such as work
schedules, uniforms etc. These are established within the department and are approved by the
administrator as departmental policies.
Procedures for developing written policies: Ideally every new hospital should have a
complete set of well developed personnel policies before it begins to function. Every hospital
should review its policies, in order to determine what they are and how they can be improved
to meet the present and future needs.
Definite personnel policies include policies on salaries: A good personnel policy on
salaries informs the employee of her salary at the outset, when she can expect a raise on what
basis (merit or length of service) and if any premiums are paid for overtime, night duty etc.
Vocations and holidays: Paid vacations were given for the purpose of allowing the
employee to take rest and recuperate so that he or she could give the organization better
service.
Provisions for paid holidays are a fairly common practice. In some hospitals double pay is
given for employees who work on holidays.
Illness allowance: A policy of permitting employees to accumulate and use a sick- leave
allowance of a definite number of days is common in most of the hospitals.
Insurance benefits and pensions: Provision of insurance benefits or pensions for the
employees by the hospital is a really a kind of added compensation.
Other compensations: Many hospitals offer their employees compensation in addition to
salaries. Some furnish nurses with room and boarding in addition to a given salary. Some
hospitals provide opportunity to have meals in the hospital canteen on a low cost basis or

169
even free of cost. Some furnish uniform and some launder uniforms without charging. All of
such policies should be clearly stated and conscientiously followed.
ADVANTAGES OF PERSONNEL POLICIES
Personnel policies are set up by the management to achieve the following advantages:
 Helps managers at various levels of decision centers to act with confidence without
the need for consulting the superiors every time.
 Ensures prompt action for taking decision within the overall framework of the
objectives of the organisation whenever any situation arises.
 Provides a rational and continuous system of achieving results through better control.
 Clearly lays down and liberates the management form their personnel bias and self-
interest.
 Ensures long-term welfare of employees and makes good relation between
management and workers.
 Makes the employees aware of where they stand in the organization and creates
confidence in them.
 The establishment of personnel policies helps to give employees a sense of security
and individual worth. It gives the employees pride and loyalty to the organization for
which they work. When such feelings exist, employees tend to give good service,
identify themselves with the goals of the organisation. All this helps to produce better
patient services.
 Policies are planned in advance and with due consideration on how the policy will
apply in various situations to meet the needs of the hospital.
 Personnel policies, as guides to action, save a great deal of time of the administrator
in handling individual cases. A clearly written policy saves the time of the employee
as well.
DEFINITION OF TERMINATION
 The act of dismissing or the condition of being dismissed from employment
 Terminating an employee is never a joyous experience for the organization or the
recipient of the pink slip. However, terminations are a fact of doing business.
While termination is certainly possible with restructuring the shortage of nurses
makes it unlikely that nursing personnel would be let go. More often, it is the
unlicensed personnel whose jobs are in jeopardy.
 Termination should be the final step in the performance appraisal process, when other
measures have failed to bring about improvement of the employee’s performance. As
with other policies in the organisation, it is critical that a well defined procedure for
termination be in place. The guidelines should be followed strictly by, the nursing
administrator, after efforts at coaching, counselling and disciplining have proved
unsuccessful when an employee is a member of a collective bargaining unit, the
contract delineates the step leading to termination. In many organisation out
placement services are available for employees, have been terminated. This might be
a comprehensive program that helps individuals to prepare resumes and applications
and work with counsellors as they search for another job. This type of program may
also be instituted when an organisations is going through a major transition such as

170
 downsizing or closing. When valued employees must be terminated, they may be
recommended to other facilities within the corporate system.
Terminated employees should be paid all benefits they are accrued .Firing an employee
is an unpleasant job. It is done for the following reasons:
 Economic downturns when employees are in surplus.
 Personality mismatches occur, that is everything has been tried, including transfers,
but the employee does not fit anywhere.
 Progressive discipline in which the employee fails to meet previously agreed on
performance expectations.
 Incorrigibility that is employee has made, serious mistakes, stolen or has other gross
failures.
The nurse manager needs to plan the session well ahead and be prepared to do the
following
 Coordinate with the personnel office, superiors, unions, outplacement people, and
others.
 Keep the firing from the grapevine.
 Time the session for the end of the day and middle of the week to keep it confidential
and to rebuild the organization.
 Be straightforward and up-front.
 Have all documentation ready.
 Deal with four stages of employee reaction: Shock with physical symptoms, rejection,
emotion, and withdrawal. Be quit during the shock and emotion stages. Confirm the
message during rejection .Provide information during the withdrawal stage and
terminate the meeting.
EMPLOYEE TERMINATION RULES
 Following simple guidelines can make employee termination easier.
One of the most difficult parts of being an employer is the process of employee
termination. Employers hope the people they hire will enjoy a successful tenure of
employment, but under unresolvable circumstances such as excessive tardiness, low
productivity, inability to work well with others or financial setbacks within the
company, employees must be let go. Although there are no hard and fast rules
regarding employee termination, employers should follow certain guidelines to make
the process as painless as possible.
 At Will Employment
Companies often employ individuals "at will," meaning employers or employees can
terminate the professional relationship at any time, for any reason. Employers in states
that have "at will" employment should make termination easier by providing all
employees with official documentation outlining the company's "at will" policy. This
is often included in a company handbook that describes the employer's policies,
procedures, employee expectations and disciplinary consequences if those
expectations are not met. If termination becomes unavoidable, employees are aware
of the company's options and courses of action, as well as their own.
 Provide Sufficient Reasons

171
 Even in the case of "at will" employment, employers need to provide clear, legal
reasons for firing an employee. The lack of a clear and legal reason for termination
may incite an employee to sue the employer for wrongful termination. Federal law
prohibits employers firing an employee because of the person's race, colour, religion,
sexual orientation, pregnancy, nationality, disability or age. Most states expand the
reasons employees cannot be fired to include sexual orientation, time off due to
childbirth, illness or disability, political views, wage garnishment or whistle-blowing.
 Provide Documentation
When terminating an employee, employers should provide official written
documentation of the reason or reasons the employee is being fired or laid off. In the
case of employee misconduct, each instance of rule violations should be documented
and signed by the employee; documentation should include the employee's name,
title, date of hire, date of offense and Social Security number, as well as a detailed
summary of the offense and the title and signature of the supervisor issuing the
documentation. Each time the employee receives a written documentation of his rule
violation, he should provide a signature attesting to his understanding of the company
policy and the consequences of his behaviour, up to and including termination. This
paper trail eliminates any possible confusion about why the employee is being
terminated.
 Involve a Witness
Supervisors or managers preparing to fire an employee should first contact a superior,
colleague or member of the company's human resources department to sit at the
termination meeting as an official witness. In case the employee initiates litigious
action or other displays of disgruntlement, a witness can provide unbiased eyewitness
testimony to what occurred during termination.
 Carefully Choose a Time and Location
To respect employee privacy and dignity, termination meetings should be held in a
quiet, private, nonthreatening location. Although employees are traditionally fired at
the end of the week, it is better to fire an employee toward the beginning or middle of
the week to give her the rest of the workweek to file unemployment insurance and
begin looking for another job.
 Remain Firm
Employees are often aware they are about to be terminated. They know they have
violated company rules and regulations and understand the consequences of their
actions. During the meeting, employers should plainly state the reason for termination
and provide supporting documentation. Termination is not a negotiation; employers
should keep the meeting as brief as possible and escort the employee off the premises
once termination has occurred.
EMPLOYER TERMINATION PROCEDURES
Terminating an employee can be an unpleasant experience. Knowing the federal and
state regulations regarding termination and benefits will help ease the stress in this situation.
Maintaining a consistent termination process and communicating this process to all
management in the company will help to keep the company free from litigation.

172
Regulations
As long as the termination is warranted and the employer has documented the reasons
for termination, the company should be clear of a lawsuit. Upon employment, all employees
should understand the actionable offenses that will cause termination of employment. It is
widely recommended among human-resources professionals that employees sign an
acknowledgment that they have read and understand the employee handbook, which clearly
communicates the standard of conduct that is expected of all employees. It should be
understood that it is illegal to terminate an employee in retaliation for engaging in protected
activities, such as military leave, jury duty, workers' compensation and family medical leave.
Communicate
Orally and in writing, you need to explain the reason why the employee is being
terminated. In the perfect scenario, you should have documented warnings that the employee
has seen and signed off on. If, however, this offense is so severe that it requires immediate
termination, the reason needs to be clearly communicated. The date of termination and
reason for termination need to be written on a form consistent with all terminations. This
form should be signed by the human resources department, supervisor and, if possible, the
employee. This will avoid any confusion why employment is ending.
Loose Ends

Each state has its own requirements for when the employee must be paid his final
paycheck. Some states require that the employee must be paid at the time of termination, and
some states require that the employee must be paid in the pay period after termination. To
avoid wage and hour claims, you must be aware of the regulations in your state. In addition,
if your employee handbook states that employees will be paid their accrued vacation, sick or
personal time, this time must be paid on the final pay check.

When developing the termination procedure, keep the following key points in
mind:
Always inform the employee of their termination with at least one other witness.
When possible, hold a private meeting to perform the firing activity.
 Immediately disable the terminated employee's network access
 Retrieve any keys, smart cards, IDs, or other physical access devices
 Perform an exit interview
 Escort the ex-employee off the premises
 Arrange for the return of any off-site equipment that the ex-employee may possess,
such as notebooks, documentation, PDAs, etc.
 Notify human resources of the termination and have them arrange the final paycheck
including vacation pay. HR should also discuss the cessation or transfer of benefits
(health insurance, life insurance, stock options, retirement, etc.) with the employee.
 Arrange to return any personal property of the ex-employee from their work
environment. This should include a review of any removable media and
documentation for proprietary or confidential data belonging to the organization.
CONCLUSION

173
 Personnel policies are an expression of intents and plans of managements design to
attain the objectives of an organisation, they are a guide for management’s decision and plans
of action and which govern the enterprise in its relationship with its employees. Such policies
are established in consultation with the employees. Such policies are established in
consultation with the employees themselves, and to ensure uniformity in action and to give
the security of knowing what to expect, they are generally always put into writing.

DUTIES AND RESPONSIBILITIES OF VARIOUS CATEGORY OF

NURSING PERSONNEL
INTRODUCTION
There is a need for job descriptions, because it is learnt through some studies that
the most workers function in a mechanical fashion and are not conscious of the role
assignment to them. It has been commented that lack of knowledge of one’s job and functions
and that of other team members is one of the reasons for many problems in the functioning of
the health team (Delta 1978).
According to one study; the medical officers interviewed and observed were not clear
about their own duties and responsibilities (Ramchandran 1980). It is fact that many persons
who are expected to perform certain role according to their job show some deficiencies in it.
Thus it is imperative that the role of each category of health manpower should be clarified
through providing written job description, training and through participative approach.
VARIOUS CATEGORY OF NURSING PERSONNEL
A. Staff Nurse
1. Staff Nurse
2. Senior Staff Nurse
B. Nursing Superintendent Grade II
1. Nursing Superintendent Grade II
C. Nursing Superintendent Grade I
1. Nursing Superintendent Grade I
D. Nursing Tutor and Clinical Instructors
1. Nursing Tutor in School of Nursing
2. Clinical Instructor in College of Nursing
E. Principal, School of Nursing/College of Nursing
1. Principal, School of General Nursing/Midwifery or Psychiatry
2. Principal, College of Nursing
F. Lecturer, College of Nursing
1. Lecturer, College of Nursing
G. Professor, College of Nursing
1. Professor, College of Nursing
2. Assistant Professor, College of Nursing
H. Joint Director of Nursing/Deputy Director of Nursing/Assisant Director of Nursing
1. Joint Director of Nursing/Deputy Director of Nursing/Assisant Director of Nursing
I. Public Health Nurse-District Family Welfare Bureau.
A. Staff Nurse

174
1. Staff Nurse , Title: Staff Nurse
Educational Qualifications
a. General preuniversity course/ 10+2 or equivalent exam.
b. Professional: 3 years General Nursing/9 months/6 months Midwifery/Psychiatric Nursing
Diploma/Certificate, recognized by Indian Nursing Council. Or Revised General Nursing
and Midwifery/Psychiatric nursing diploma/Certificate Recognized by Indian Nursing
Council. Or Basic [Link] Nursing from a recognized University according to Indian
Nursing council norms.
c. Registration: Registered with the Karnataka State Nursing Council/Indian Nursing
Council (INC)/Respective State Nursing Councils.
Standard Norms and Inc (Nurse – Patient Ratio)
a. General Wards
 1:3 (Hospital attached with school or college of nursing)
 1:5 (Hospital and attached with school or college of nursing)
b. ICU, ICCU and other specialty 1:1 for 24 hours.
c. Labour room 4 in each shift.
d. Operation Theater 3 for 24 hours/ table
e. Outpatient Department 1 in each clinic room of the OPD
f. Casualty and emergency 1:1 in each shift
g. Pediatric unit 1:2 beds
h. And 30% leave reserve post of staff nurses should be maintained
Job Summary
Staff Nurse is a first level professional nurse who provides direct patient care to one patient
or group of patients assigned to her/ him during duty shift and assist in management of
wards/units/special departments. She/ he is directly responsible to Senior Staff Nurse or ward
in charge nurse/ Nursing Superintendent Grade II.
Duties and Responsibilities
Direct Patient Care
a. Carry out the procedures of admission and discharge of the patient.
b. Makes beds of serious patients and helps or guide students or Group “D” employees to
make beds, by supplying linen.
c. Maintains personal hygiene and comforts of the patient.
d. Attends to the nutritional needs of the patient and feeds the helpless patients.
e. Maintains clean and safe environment for the patient.
f. Implements and maintains ward policies and routines.
g. Coordinate patient care with other team members.
h. Take round with the doctors when called to list new orders and see that they are carried
out.
i. Performs various technical task related to nursing care.
a. Administration of medication, i.e tablets, injections, infusions and transfusion on
prescription or according to standing instructions.
b. Assisting doctors in various medical and surgical diagnostic procedures by preparing
patients and getting ready with required things.
c. Performing simple diagnostic procedures, [Link] analysis hemoglobin percent, etc.

175
 d. Collecting and sending of specimens for labarotory diagnostic procedures.
e. Recording of vital signs, [Link], pulse, respiration and blood pressure.
f. Performing gastric lavage, giving enema, etc.
g. Prepares patient for operation and see that he or she is send to operation theatre with
all necessary papers and medications.
h. Takes care of eyes, ears, back, bowel, bladder, perineum, and breast, etc, whenever
needed.
i. Observers all patients conditions and take suitable actions accordingly and /or reports
changes to ward incharge and /or doctor.
j. Give expert bedside nursing to all patients.
k. Attends last officers in case of a patient dying during shifts and arrange to preserve
dead body in mortuary, or hand over the body with respect to concern family
members/relatives/authorities.
Ward/Unit Management
a. Helps the ward in charge to carry out her/his work or act as ward in charge during their
absence.
b. Maintains general cleanliness of the ward and the sanitary annexure.
c. Supervise the duties of Group “D” employees and guides them and reports accordingly.
d. Writes the diet register and supervises the distribution of diet and report if any, necessary.
e. Maintains scheduled poisonous drug registers.
f. Supervises nursing care and other tasks carried out by the students.
g. Maintains duly room trays, sterilizes instruments and see that procedural trays are in
readiness.
h. Take over from duty nurse of the previous, new and serious patients, intruments, supplies,
drugs etc and handover the same accordingly.
i. Maintains all the records pertaining to ward/unit.
 Maintains case papers, investigation reports, etc.
 Maintains vital signs charts, intake output charts and other special charts, if necessary.
 Takes special care of medicolegal case papers and records.
 Writes day and night orders and maintains ward statistics.
Operation Theater Management
a. Maintains aseptic environment of the operation theater.
b. Autoclaving of articles, instruments, gloves, linen etc. required for various types of
surgery.
c. Receives patients from the ward intact for surgery.
d. Prepares anesthetic trolley and trolley for surgery, according to type and procedures.
e. Assist the surgeon and anesthetist in every step, skillfully while performing various types
of surgery.
f. Indenting and procuring surgical instruments, drugs, gloves, sufuring materials and O 2,
N2, CO2 etc. required for operation theater.
g. Maintains safety of the Boyle’s apparatus, oxygen cylinder, nitrogen cylinder, anesthetic
drugs and autoclave, etc in the operation theater.
Management of Labour Room
a. Preparation of expectant mother for aseptic safe delivery.

176
b. Conducts normal deliveries and reports.
c. Attend and assists the doctors in all obstetrical emergencies.
d. Attend and assists in difficult and abnormal deliveries.
e. Takes care of the newborn and premature babies.
f. Maintains records and reports pertaining to labour room.
g. Indent and procure necessary drugs, supplies linen, etc. to labour room.
Management of Postoperative/ICU/Burns Units
a. Indent and procurement of all the necessary equipments, drugs, oxygen cylinder, which
are required for the units.
b. Operates ECG, EEG, cardiac resuscitation, etc or other sophisticated high technical
machines whenever needed or assist the doctors in operating such machines.
Psychiatric Unit
a. Assists the doctors in admission and discharge of patients.
b. Prepares patient for ECT and other procedures, and therapies.
c. Assists in management of aggressive, suicidal as grief as other symptoms of the patient.
d. Maintains records and reports of the units.
Educational Function
a. Helps in orientation of new staff and students.
b. Teachers and guides the domestic staff (Group D) for handling bedpans, urinals, etc.
c. Carries out health teaching for individual or group of patients.
d. Extends cooperation and participates in clinical teaching.
e. Provides for and demonstrates methods and procedure whenever needed.
f. Participates in in-service education programs.
g. Plans and implements formal and informal health education program and teaching
program.
h. Assists and extends cooperation in medical and nursing research program.
2. Senior Staff Nurse, Title: Senior Staff Nurse
Educational Qualifications
a. General: As prescribed for staff nurse.
b. Professional : As prescribed for staff nurse
c. Registration: Registered with Karnataka Nursing Council/ Indian Nursing Council.
d. Experience: Should have experience as staff nurse of not less than 5 years.
Standard Norms
Since it is a first level nursing supervisory role which needs at least one senior staff nurse for
the staff nurse (1:5).
Job Summary
Senior staff nurse is a first level nursing supervisor who is accountable for nursing care
management of a ward or a unit assigned to her/him. She/he is responsible to the Nursing
Superintendent Grade II for her/his ward/unit management. She or he takes full charge of the
ward and assigns work for various categories of nursing and non nursing personnel working
with her/ him. She or he is responsible for safety and comforts of the patients in her/his ward.
Direct Patient Care
a. Ensure proper admission, discharge of patients.
b. Plans nursing care and make patients assignments as per their nursing needs.

177
c. Assists in the direct care/ provides direct care to patients as and when required.
d. She/he sees that total health needs of his/her patients as met.
e. Ensures safety, comfort and good personal hygiene of her/his patient.
f. Assists in planning and administration of the therapeutic diet to his/her/patient.
g. Ensures the helpless patients are regularly fed as per direction.
h. Ensures that proper observation records of the patients are made and necessary
information imparted to the concerned authorities.
i. Takes nursing rounds with staffs and students.
j. Makes rounds with doctors, assisting them in diagnosing and treatment of patients.
k. Implements doctors instructions concerning patient treatment.
l. Assists patient and his/her relatives to adjust in the hospital and its routine.
m. Coordinates patient care with other departments.
Supervision and Administration
 Ensures sale and clean environment for the ward/Unit/Special department.
 Makes duty and works assignment.
 Identifying and procurement of ward supplies and equipments and keep records.
 Does regular inventory checking of his/her ward/unit.
 Makes list for condemnation of articles and submits it to all the concerned.
 Assists in making ward requirement.
 Establishes and reinforces standards prescribed in the procedures and manuals of hospital
and policies that are in force.
 Acts as liaison officer between ward staff and hospital administration.
 Maintains good public relations in her/his ward/unit.
 Ensures that ward statistics are regularly submitted.
 Maintains discipline among the personnel working in the particular ward/unit, e.g. staff
nurses, students and domestic staffs.
 Deals appropriately with any adverse situation that occurs in the ward/unit and report to
the concerned authorities.
 Reports about any medico legal cases in the ward/unit.
 Writers and submit confidential reports of the staff (it is not in force but should be).
 Ensures that students get desired learning experience in the ward/ unit.
Educational Function
 Organizes orientation programs for new staff.
 Organizes formal and informal ward teaching, conducts beside clinics and demonstration,
etc.
 Conducts ward conferences/meetings.
 Gives incidental teaching to patient, relatives, staff nurses, students and the domestic
staff.
 Guides in formulation of nursing care studies, and nursing care plans etc.
 Evaluates the students performances and submit reports to the school authorities.
 Helps in medical and nursing research.
 Encourages staff development program in her/ his ward/unit.
B. Nursing Superintendent Grade II, Nursing Superintendent Grade II
Title: Nursing Superintendent Grade II

178
Educational Qualifications
 General education: As prescribed for staff nurse.
 Professional education: As prescribed for staff nurse.
 Registration: As prescribed for staff nurse, registered with Karnataka Nursing
Council/INC ISNC (State Nursing Council)
 Experience: Should have experience as senior staff nurse.
Standard Norms
Since it is the second level nursing supervisory role, it needs at least the nursing
superintendent Grade II for three senior staff nurses (1:3).
Job Summary
She/ he is responsible for developing and supervising nursing services of a department or a
floor consisting of two or more wards or units managed by the senior staff nurses. These units
may be in patient wards, out patient department clinics, operation theaters, obstetric units,
central supply department, etc she/he is responsible to the nursing superintendent Grade I.
Patient Care and Ward/Unit Management
a. Organizes and plans nursing care activities of the department of floor according to the
hospital polices and service needs.
b. Plans staffing pattern and the other necessary requirements of her/his department.
c. Complies and submits nursing statistics to the concerned authorities.
d. Conducts and attends to the departmental and interdepartmental meetings/conferences
time to time.
e. Make regular rounds of her/his department.
f. Ensures to the safety and general dealings of the department.
g. Looks into general comforts of the patient and his/her relatives.
h. Receives report from the night supervisor of her/his departments.
i. Evaluates nature and quantum of care required in each unit/ward.
j. Makes rotation plan for the nursing staff and domestic staff under her/his jurisdiction.
k. Plans ward management with the each ward/unit.
l. Reindorces the principles of good ward management in ward.
m. Helps ward/unit supervisiors to procure their ward/unit.
n. Supervise the proper use and care of the equipment and supplies in the department.
o. Acts as the public relation officer of the units and deals with the problems faced by the
supervisor if any, specially with group “D” employees patients attenders.
p. Keeps the Nursing Superintendent Grade I and office informed of the needs of the nursing
wards under her/his charge and of any special problem/problems.
q. Officiates in the absence of nursing superintendent Grade I.
Educational Function
a. Arranges classes and clinical teaching of nursing students in the departments, related to
the specially experience.
b. Implements the ward teaching program and clinical experience of the students with the
help of doctors and nurses.
c. Does counseling and guidance of staff and students.
d. Arranges and conducts staff development programs of her/his department.
e. Assists in planning for and participation in the training of auxiliary personnel.

179
General
a. Escorts nursing superintend Grade I, Medical Superintendent and special visitors for
hospital rounds.
b. Arranges and participates in professional and social function of staff and students.
c. Acts as a liaison officer between the nursing department and higher hospital authorities.
d. Carries out any other duties delegated by the Nursing Superintendent Grade I.
C. Nursing Superintendent Grade I, Title: Nursing Superintendent Grade I
Educational Qualifications
a. General: As prescribed for staff nurse.
b. Professional: As prescribed for staff nurse
c. Registration: As prescribed for staff nurse.
d. Experience: Should have experience as nursing superintendent Grade II.
Standard Norms
There should be one nursing superintendent Grade I for 200 bedded hospital, one nursing
superintendent Grade I for 2 t0 4 nursing superintendent Grade II.
Job Summary
Nursing superintendent is responsible to the medical superintendent, in a hospital having 200
or above bed strength. She is accountable for the safe and efficient running of the various
nursing departments in the hospital. She is assisted in carrying out her duties by the Deputy
Nursing Superintendent/ Assistant Nursing Superintendent, ward supervisors and clerical,
linen room and domestic staff.
Nursing Services
1. Participates in the formulation of the philosophy of the hospital in general and those
specific to the nursing service.
2. Determines goals, aims, objectives and policies of the nursing services.
3. Implements hospital policies and rules through various nursing units.
4. Decides and recommends personnel and materials requirement for running various
nursing services departments of the hospital.
5. Interviews and recruits nursing staff.
6. Assists in students selection and recruitment of other auxiliary staff whose duties are
related to nursing.
7. Ensures the safe and efficient care rendered in the various nursing departments of the
hospital.
8. Makes regular visits in hospitals and wards.
9. Checks if standard of care is maintained and patients are nursed in a clean, orderly and
safe environment.
10. Takes hospital rounds with Medical Superintendent.
11. Selects and secures proper equipment needed for the hospital of nursing home.
12. Looks after the welfare of the patients, their relatives and the nursing staff.
13. Prepares budgets for the nursing services department.
14. Functions as the members of the condemnation board for linen and other hospital or
nursing home equipments.
15. Prepares duly roster, plans staff leave and disburses salary.
16. Gives counseling and guidance to the subordinate staff.

180
17. Maintains discipline among nurses and other auxiliary staff.
18. Enforces implementation of the hospital rules, regulations and policies.
19. Participates in hospital and interhospital meetings/ conferences.
20. Investigates complaints and takes necessary steps.
21. Evaluates confidential staff reports and recommends for promotion of higher studies.
22. Plans staff development program and arranges for inservice education and orientation
programs, etc.
23. Inspects hospital kitchen and dietary services of the hospital.
24. Arranges student’s clinical experience and councils examinations.
25. Initates and participates in nursing research.
26. Supervision, guidance and control of group “D” employees of the hospital.
General and Office Duties
 Attends to general correspondence.
 Maintains necessary records concerning the nursing staff, students, confidential reports
and health records, etc.
 Submits annual reports of the nursing service departments of Medical Superintendent,
India Nursing Council and Nurses Registration Council.
 Participates in professional and community activities.
 Maintains, cordial relations with public and voluntary.
D. Nursing Tutor and Clinical Instructors, Title: Nursing Tutor in School of Nursing
Clinical Instructor in College of Nursing
Educational Qualifications and Experience
General: As prescribed for staff nurse.
Professional : [Link]. Nursing (Postgraduate) or [Link]. Nursing or equivalent examination.
Registration: Registered with Karnataka State Nursing Council.
Experience: Should have experience as staff nurse not less than 5 years.
Standard Norms
According to Nursing Council.
Job Summary
She/he is teacher in nursing school, responsible to the vice principal/ principal of the nursing
school and responsible for planning and implementation of teaching program and assists in
administration of school of nursing.
Academic Function
 Responsible for planning and implementation of teaching program.
 Teaching subjects in the curriculum.
 Overall supervision of clinical teaching program of subjects in hospital/community health
setting.
 Maintains class room equipments, supplies and teaching aids.
 Conduct tests for (theory and practical and evaluation of students assignments and
performance of other teachers.
 Helping the students with extracurricular activities
 Preparing teaching materials and implementing it under the guidance of other teachers.
Administration and Evaluation

181
 Assisting in the administration of the school of nursing.
 Supervision of student health, welfare and security.
 Assisting the selections of students and administration.
 Supervision of living condition of students in the hostel.
 Assist in teaching of other categories of personnel in the hospital and community.
 Assisting in the procurement of school supplies and equipment.
 Assisting in the library work.
 Assisting in maintaining school records.
 Planning and implementation and evaluation of specification courses.
 Shall carry out any other duties assigned by the principal or head of the departments in
the interest of education.
E. Principal, School of Nursing and Principal, College of Nursing
1. Title: Principal, School of General Nursing/ Midwifery or Psychiatry
Educational qualifications and Experience
 General: As prescribed for staff Nurse.
 Professional: Master degree in Nursing recognized by Indian Nursing Council.
 0r
 BSc Nursing (Post –Certificate)
 Registration: Registered with Karnataka State Nursing Council.
 Experience: Should have teaching experience in school of nursing not less than 5 years.
Standard Norms
As per Indian Nursing Council.
Job Summary
Principal the administrative head of the general nursing school will be responsible to the
Medical Superintendent or District Surgeon of the hospital. Once the financial control of
school handed over the principal of Medical Education and Directorate of Health and Family
Welfare Services. As the head of the school she/he will be responsible for the smooth
implementation of the INC syllabus and school administration.
Duties and Responsibilities
Administrative
1. Advertizing and calling for candidates for nursing [Link] applications,
preparing merit list and calling them for interview.
2. Scrutining applications, preparing merit list and calling them for interview.
3. Conducting interview through the set up committee and selecting candidates and
informing them.
4. Planning for orientation program for new students and staff.
5. Distributing teaching work load and departments to each tutor along with teaching
materials connected with that e.g. nursing arts, anatomy, psychology, etc.
6. Carrying out correspondence with other departments, agencies, or individuals in
connection with the program.
7. Maintaining students records, admission, register, results, registers master roll call for
staff, teachers and student, etc.

182
8. Countersigning records of each department, library and hostel after annual verification by
the concerned incharge of the department and the warden in case of the hostel.
9. Seeing to the supply of audio-visual aids, teaching materials as requested by the
concerned department incharge.
10. Placing indents with the government for stationary, uniform for certain category of Class
– IV servants.
11. Purchasing lines, furnitures, equipments, books and journals as per requirement of the
office hostel and nursing department.
12. Authorising repairs of vechicles and purchase of oil, petrol and minor parts for
replacement.
13. Sending proposals yearly for new items stall, costly equipments etc.
14. Countersigning cash book after periodical verification of cash.
15. Seeing that monthly pay bills are sent in time, so also TA bills or any other type of bills.
16. Assisting the auditors to do their jobs well, and replying to and complying with audit
paras.
17. Countersigning stamp register every month.
18. Seeing that office-timings and other rules of service are observed.
19. Writing annually the confidential report of staff and teachers.
20. Holdings meetings with teachers staff of office, hostel staff, students and their
committees.
21. Representing the college and the profession on various committees.
22. Working out the philosophy and objective of institution.
Educational
1. The Principal/ Principal Nursing Officer will be responsible for the smooth
implementation of the prescribed syllabus, keeping in mind the goal to be achieved.
She/he will therefore, be responsible for:
2. Working out the syllabus and the curriculum keeping within the framework lay down by
the Indian Nursing Council.
3. Arranging for the theory and practical work for each group, with the help of tutor/clinical
instructors so as to meet the laid down objectives.
4. Contacting agencies, institutions, for arranging field visits, clinical experience etc,
students get the best possible experience in that area.
5. Initiating changes in curriculum keeping within the guidelines of the syllabus.
6. Cooperating with the State Council/Board to conduct examinations by providing all
facilities.
7. Guiding students in filling examination forms, registration fees, and seeing that they are
submitted to the council in time.
8. Taking classes in her/his subjects.
9. Preparing and displaying weekly/monthly class, schedule clinical experience of relation
plan etc, in consultation with tutors.
10. Maintaining records of examination results.
11. Communicating to the council any relevant information regarding students.

183
12. Encouraging teachers to experiment with newer methods of teaching and to find out
newer clinical areas which would provide the best possible exposure of students to that
area.
13. Encourage and supporting co curricular activities.
14. Issuing transcripts to students.
Miscellaneous
 Besides her/his responsibilities in the administrative and teaching areas certain functions
not reached to these two areas are also carried out.
 Encouraging faculty members to take up further studies, attend seminars workshops and a
participate in professional activities.
 Participating in activities of the professional Organization.
 Encouraging students to actively participate in SNA activities and to join TNA I and
GNAK on graduation.
 Arranging graduation and candle lighting ceremonies with help from tutors.
 Meetings visitors and discussing issues, pertaining to the school program.
 Meetings parents or guardians of the students as and when necessary.
 Preparing for the cooperation with inspectors from the state level bodies (Council or
Directorate) or national council.
Note
The Principal, General Nursing School is an overall in charge of the school. However for
running of the institution, it is necessary for her/him to delegate the responsibility of the
hostel, library, laboratories, nursing sciences, nutrition community health, to the senior most
person in the department or the warden or tutor- in charge of that subject/ area. E.g. tutor
teaching should be made responsible for charts, models wet specimen, skeleton, etc.
2. Principal, College of Nursing, Title: Principal, College of Nursing
Educational Qualification and Experience
 General: As prescribed for staff Nurse.
 Professional [Link], Nursing or equivalent degree
 Or
 Ph.D, in nursing or other equivalent doctoral degree through convocation.
 Registration: Registered with Karnataka State Nursing Council/INC.
 Experience: Teaching experience in college not less than 5 years.
Standard Norms
As per Indian Nursing Council.
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 of Nursing
Administration
 Planning
 Develops philosophy and objectives for educational program.

184
 Identifies the present needs related to educational program.
 Investigates, evaluates and secures resources.
 Formulates the plan of action.
 Selects and organizes learning experience.
Organising
 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.
 Directs activities of staff working under.
 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.
 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.

185
 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.
F. Lecturer, College of Nursing, Title: Lecturer, College of Nursing
 Educational Qualifications and experience
 General: As prescribed for staff nurse.
 Professional: [Link], nursing/MN or equivalent degree recognized by the Indian Nursing
Council.
 Registration: Registered with Karnataka State Nursing Council or State Nursing Council.
 Experience: Should have experience as staff nurse not less than 5 years in government
hospitals.
Standard norms
As per Indian Nursing Council
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.
 Participates in evaluation of the curriculum.
 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.
 Maintains and uses adequate and accurate records.
 Prepares clear and concise reports.
 Share information about learners needs and achievements with others concerned.

186
 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.
Guidance and Counselling
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.
G. Professor, College of Nursing and Assistant Professor College of Nursing
1. Title: Professor, College of Nursing
Educational Qualifications and Experience
 General: As prescribed for Staff Nurse.
 Professional: [Link], Nursing/MN or equivalent degree in nursing recognized by INC.
 Or
 PhD in nursing with any speciality or other equivalent doctoral degree in nursing through
convocation.
 Registration: Registered with Karnataka State Nursing Council/INC.
 Experience: Should have teaching experience in the College of Nursing not less than 5
years.
Standard Norms: As per Indian Nursing Council.
Job Summary
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.

187
 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 Learner’s Progress
 Recognizes individual differences in apprasing 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
 Maintains and uses adequate and accurate records.
 Prepares and channels clear and concise reports.
 Shares information about learner’s 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.
Counselling
 Helps the learner to grow in self – understanding.
 Promotes continuous growth and development towards maturity.
 Continues to develop competence in problem solving process.

188
 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.
2. Assistant Professor, College of Nursing, Title: Assistant Professor, College of Nursing
Educational Qualification and Experience
 General: As prescribed for staff nurse
 Professional: [Link], Nursing/MN or equivalent degree in Nursing recognized by INC.
 Or
 Ph.D in Nursing with any speciality or other equivalent doctoral degree in nursing
through convocation.
 Registration: Registered with Karnataka State Nursing council/INC/State Nursing
Council.
 Experience: Should have teaching experience in the College of Nursing not less than 5
years.
Standard Norms
As per Indian Nursing Council.
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.

189
 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.
 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 informations about learner’s 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.
Counselling
 Helps the learner to grow in self understanding.
 Promotes continuous growth and development towards maturity.
Assisting in selection and Promotion of Learners
 Participates in development of criteria for selection and promotion of learners.
Research
 Initates and participates in studiesfor 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.

190
 Makes data available concerning learners and concerning methods of teaching and
evaluation.
H. Joint Director of Nursing/Deputy Director of Nursing/Assisant Director of Nursing
Title: Joint Director of Nursing/Deputy Director of Nursing/Assisant Director of Nursing
Educational Qualifications and Experience
 General: As prescribed for Staff Nurse.
 Professional: [Link], Nursing or equivalent Master Degree in Nursing recognized by any
University.
 Registration: Registered with Karnataka State Nursing Council or respective State
Nursing Councils.
 Experience: Should have about 10 years experience in nursing service: of which 5 years
in administration and education.
Standard Norms
As per Indian Nursing Council or State Nursing Council.
Job Summary
Senior Assistant: Director of Nursing is at present rate, head of the nursing service under
Directorate of Health and Family Welfare Services, directly responsible to both the Director
of Health and Family Welfare Services and the Director of Medical Educational as well.
He/She should responsible for all activities concern and improvements of the nursing services
in the State of Karnataka.
Duties and Responsibilities
She/he is responsible mainly to see that the nursing services in the State run smoothly
regarding:
1. Leave
2. Transfer of:
 Nursing Personnel
 Student nurses from one school to another in consultation with superintendent of
nursing services of other section.
 Promotion and postings
 Appointments in consultation with superintendent of nursing services of other
sections.
 Review of confidential reports.
 Correspondence with government and non Governmental institutions.
 Educational programs.
 Proposal to government
 Inspections.
 Representing nursing interest on health committees.
 Participating in health care planning.
 Deputation for [Link], Nursing [Link], Nursing in State or out of state and other training
higher learning programs, two years or less to nursing personnel.
 Sanction of preaudit bills.
 Granting permission for workshop seminar and special leave.

191
  No objection certificate for passport.
 Administrative works pertaining to nursing personnel.
I. Public Health Nurse-District Family Welfare Bureau
Title: Public Health Nurse-District Family Welfare Bureau
Essential Qualification
[Link] degree in nursing from any University or institute or certificate in Public Health Nursing
from any recognized institution.
Professional Qualification
Experience of working with rural communities.
Pay Scales
The pay scale should be the same as prescribed by the State Government for similar
categories of personnel under them.
Membership
The Public Health Nurse will be a member of the District Health Welfare Team in the District
Health Organization and will enjoy the status equivalent to that of the District Mass
Education and information Officer.
Job Description
a. Working Relationship
The public health nurse will assist the District Medical Officer/District Family Welfare
Officer in planning, implementing and evaluating Material and Child Health Program
undertaken in the district. She will receive technical guidance from him and under the
administrative control. She will work in collaboration with other functionaries in the District
Family Welfare Bureau like the Mass media and the Extension Officer, Health Education
Officer, Statistical Officer, etc.
b. Duties and Functions
 To help in organization of maternal and child health program as a whole and in the
implementation of the special plan scheme, centrally sponsored and otherwise in
particular like the immunization program, training of traditional birth attendants (Dias)
and their active involvement in MCH/FP work, prophylaxis against nutritional deficiency
disease, etc.
 To promote health and nutrition education activities through the lady health visitors,
Auxiliary Nurse Midwives by providing them with “taking points” are printed materials
produced by various agencies.
 To ensure that the lady health visitors/ANMs/female multipurpose workers, etc integrated
MCH, Family Planning and Health and Nutrition/Education in their day to day activities.
 To help in developing school health program in the district.
 To ensure regular supply of equipment, records, registers drugs, vaccines, and other
sundries necessary for MCH work in the Primary Health Centers and sub centers by
assisting storekeeper in procuring and distributing the supplies.
 To ensure the maintenance of prescribed records and submission of periodical progress of
MCH/FP/Nutrition work activities.
 To help the Statistical Officer in the District Family Welfare Bureau in compiling the
periodical progress reports of MCH activities.

192
 To review the periodical progress reports on MCH/FP work done by the LHVs/ANMs,
female, multipurpose workers, etc and put up to the District Medical Officer/District
Family Welfare Officer the points requiring attention and further action.
 To give technical guidance, supervision and support to the ANM, female multipurpose
workers, LHVs, Public Health Nurse working in MCH/FP program in the district and to
review the annual confidential reports in respect of these functionaries.
 To investigate into complaints against female paramedical personnel in the district and
submit reports/recommend to the District Medical Officer/District Family Welfare
Officer.
 To provide for continuing education of the female MCH/FP functionaries in the district
through short in-service training sources.
 To work together with the functionaries of other government departments like Social
Welfare, Rural Development and Education engaged in programs for women and
children.
 To cooperate MCH/FP activities undertaken through the voluntary organization in the
districts and provide health inputs to the possible extent for mothers and children
organized in Balwadis, Anganwadis, etc.
 To tour for a minimum of 15 days in a month and visit Primary Health
Centers,Subcenters, Village Dais, Balwadi, Mahila Mandais etc. According to an advance
program duly approved by the District Medical Officer/District Family Welfare Officer.
CONCLUSION
Thus duties and responsibilities are imperative that the role of each category of health
manpower should be clarified through providing written job description, training and through
participative approach. There are different health personnel in clinical and educational area.
PUBLIC RELATION
DEFINITIONS OF PUBLIC RELATIONS
 'Public Relations are the term that refers to a planned way of establishing and
maintaining goodwill and mutual understanding between an organization and all those
with whom an organisation needs to communicate. It includes the media, government
bodies, financial institutions, pressure groups, customers and suppliers.
 “Public Relations are the deliberate, planned and sustained effort to establish and
maintain mutual understanding between on organization and its publics.” (Institute of
Public Relations, USA)
 “Public relations are the attempt by information persuasion and adjustment to
engineer public support for an activity, cause, movement or institution.”(Edward L.
Bernays)
 Public relations are the skilled communication of ideas to the various public with
objective of producing a desired result.
 Public relations is finding out what people like about you and doing more of it,
finding out what they don’t like about you and doing less of it. Bernays
 "Public Relations is distinctive management function which helps establish and
maintain mutual lines of communication, understanding, acceptance and cooperation

193
 between an organization and its publics; involves the management of problems or
issues; helps management to keep informed on and responsive to public opinion;
defines and emphasizes the responsibility of management to serve the public interest;
helps management keep abreast of and effectively utilize change, serving as an early
warning system to help anticipate trends; and uses research and sound and ethical
communication as its principal tools."Rex F. Harlow
ORIGIN OF PUBLIC RELATIONS
Thomas Jefferson (1807) used the phrase "Public relations" in the place of "State of thought"
while writing his seventh address to the US Congress. In India, Great Indian Peninsular
Railway Company Limited (GIP Railways) carried on publicity in Public Relations campaign
in England for promote tourism to India through mass media and pamphlets. During the time
of First World War a central publicity board was set up at Bombay (now Mumbai) for
disseminating war news to the public and press. After Second World War the Public
Relations activity gained importance both privates as well as Government started Public
Relations campaigns.
IMPORTANCE OF PUBLIC RELATIONS
 Public relations make an organization known to public.
 Public relations help in achieving goodwill.
 Public relations help in communicating information timely.
 Public relations allow a firm to broaden its reach.
 Public relations enable a company to understand its customers in a better way.
 Public relations also fill the gap between a firm and the global markets.
 Public relations help a company to know if its customers are satisfied, but what
people expect from the organization in future.
NEED FOR PUBLIC RELATIONS
Investing on Public relations will help the organisation to achieve its objective effectively and
smoothly. Public Relations is not creating good image for a bad team. Since false image
cannot be sustained for a long time. Though the organisation product or services are good it
need an effective Public Relations campaign for attracting, motivating the public to the
product or service or towards the purpose of the programme. It is not only encouraging the
involvement from the public and also resulting in better image.
An effective Public Relations can create and build up the image of an individual or an
organisation or a nation. At the time of adverse publicity or when the organisation is under
crisis an effective Public Relations can remove the "misunderstanding" and can create mutual
understanding between the organisation and the public.
NEED FOR THE PUBLIC RELATION
• Lessens patients anxiety
• Promotes early recovery
• Establishes confidence in hospital
• Support chronic patients

FUNCTIONS OF PUBLIC RELATIONS

 Public Relations are establishing the relationship among the two groups (organisation
and public).

194
  Art or Science of developing reciprocal understanding and goodwill.
o It analyses the public perception & attitude, identifies the organisation 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 organisation and its publics
 Evaluation of public attitudes and opinions.
 An organisation's policies, procedures and actions as they relate to said organisation's
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.
PRINCIPLES OF PUBLIC RELATION
• In developing a public relations program such item as the following should be
checked
• Is there a system for dispersing information to local radio and press out sets
• After all the information has been gathered a program should be developed which
meets the needs as shown by the research that has been done.
• The formation of public relations will be determined by the need of the organization
effectively for a well rounded program.
• The person directly in charge of the public relations program must have complete
knowledge of the professional and organization represented
• Individual assigned public relations work should modestly stay in the background
instead as seeking the time light keep abreast of the things that affect the program
develop make contact that will be helpful.
PUBLIC RELATION OPERATES IN TWO AREAS
• A within an organization:
• Between an organization and in environment

TECHNIQUES AND ATTRACTIVE PUBLIC RELATIONS

• First level relationship school to community to convey information
• Second level relationship school initiates but community is more active school invites
community to visit the school and observe to give a feed back
• Third level relationship is enables the member of community representations two way
communications
• Fourth level relationship the community is given greater opportunity to participate in
planning and decision making process on some areas of school operations
THE COMPONENTS AND TOOLS OF PUBLIC RELATIONS
"Public"

195
A group of similar individuals; an assortment of persons having the same interests, problems,
circumstances, goals; it is from such persons that opinion emanates. Public is a varied
creature; it comes in many forms and sizes. Public has a multitude of wants and desires; it has
its likes and dislikes, sometimes, strong likes and strong dislikes.
Employers make for a public and employees another public; the government is a public and
citizens constitute another public, and so on, each of these groups is a public of the sort, tries
to attract a different audience with its own tools and techniques.
"Relations"
Human wants to create the need to establish relations with one another. The representative
wants of the individuals will profoundly affect their relationship. To understand any
relationship, therefore, one must understand the wants of those involved.
'Relationships are of all possible types. We have relationship by ran-superior to inferior,
inferior to superior, and equal to equal. We have relationship by sentiment-benevolent,
Friendly, suspicious, jealous, hostile. A relationship may be active, or it may be passive it
may be good or it may be bad, or it may be neutral. At any rate, the relationship is there to be
accepted, ignored or altered, as desired.
Propaganda:
Propaganda is the manipulation of symbols to transmit accepted attitudes and skills. It
describes political application of publicity and advertising, also on a large scale, to the end of
selling an idea cause or candidate or all three.
Campaigns:
These consist of concerted, single-purpose publicity programme, usually on a more or less
elaborate scale, employing coordinated publicity through a variety of media, aimed, at a
number of targets, but focussed on specific objectives. A campaign objective may be the
election of a candidate, the promotion of political cause or issue, the reaching of a sales goal,
or the raising of a quota of funds.
Lobbying:
It entails the exertion of influence, smooth and measured pressure on other, exercise of
persuasion cum-pressure. In essence, it means a group putting its points of view forward in an
attempt to win the other groups support.
METHODS OF PUBLIC RELATION
Operative methods
Operative methods are essentially connected with almost every aspect of the hospital’s
operations, including those that are carried out by such workmen as telephone operators,
inquiry office personnel and admission office clerks to mention a few. All those coming in
contact with patients, as well as those operating behind the screen share the same burden.
The three fundamental ingredients of a hospital’s operations are
 Cheerful and courteous behaviour,
 Prompt and efficient treatment, and
 Clean surroundings and well-kept appearance of workers.
Some of the important aspects are enumerated below.
1. A high quality of patient care is the sine quo non of good public relations. No amount
of smiles and propaganda can compensate for poor professional care.

196
 2. Adequate physical facilities with a good functional layout. Adequate waiting areas,
toilets, drinking water and refreshment facility in the outpatient department and such
facilities which take care of the basic creature comforts of the patients and others.
3. To make others happy, one must be happy himself. Good morale of workers not only
increases efficiency, but workers with high morale interact in a positive manner with
one another and also with patients and the community.
4. By placing more emphasis on technology in dealing with the diagnosis and treatment,
there must always be a continuous effort not be create other anxieties and concerns, as
Florence Nightingale exhorted that the first concern of the hospital is to do patient no
harm.
5. Operating efficiency with effective coordination among all clinical departments and
other supportive services stems from good administration. Organisational structure
policies and procedures, authority and accountability should be clearly understood by
each other.
6. Sensitive areas:
 Many misunderstandings by patients and public originate in the OPD. Efforts
should be made to reduce high waiting time of the patients in OPD.
 Delay in receiving specimens at the laboratory counter and delay at the
dispensary should be curtailed.
 Casualty department must be organised to deal with any type of casualty, at
the time causing least confusion when a number of relations accompany the
patient.
7. Other activities: The hospital premises should be kept clean at all times and not only
during the morning working hours. Hospital visitors should be dealt with courteously-
their visit to a hospital inpatient is of great emotional value to the patient. A member
of nursing or medical staff should be available in the ward during visiting hours to
answer their queries.
Communicative methods
These methods employ means of communication in all possible forms to enable the hospital
to convey its message to the public. Some of these are also intermixed with the intramural
functions of the hospital and operative methods. The others deal with the media.
Communication methods may be used in the following ways.
 Making available appropriate information to the patients, their relatives and visitors at
Enquiry and Registration, and also on patients’ discharge regarding his or her health
status and follow-up. A discharge interview with the attending physician can serve
this purpose well.
 An open-house approach to the visitors without interfering in the routine medical care
functions. Large number of visitors to patients cannot be avoided in our peculiar
sociocultural ethos.
 The queries of the relatives and visitors can be satisfied if a doctor or senior nurse
conversant with the ward is made available in the ward during the visiting hours for
this purpose.

197
  Administrative rounds by hospital administrators at different levels. However, they
should be as informal as possible.
 A provision to listen to verbal complaints instead of insisting or written ones.
 Written communications: prompt replies to questions.
 Provision of a suggestion box at an appropriate place.
 Visual communication – film shows, exhibitions, hospital brochure.
 Hospital tours by groups such as school teachers and students, housewives and
members of women’s organisations, peoples’ representatives, and religious leaders.
 Holding of an annual “hospital day” or open-house day where public can be shown
every aspect of the hospital’s operations including some of the highly technical
functions.
 Advisory committee- its role should be to suggest to hospital administration the
methods to overcome their shortcomings and interprete the functioning of the hospital
to the community.
 Talks and interviews on radio and television.
INDICATORS FOR MEASURING PUBLIC RELATIONS
The following are the means though which the extent of public relations can be gauged
 Patient satisfaction surveys
 General opinion poll
 Number of complaints received
 Extent of voluntary effort by community
 Turnover of medical staff
 Consistency in attendance by patients
 Donations
 Letters to editors in local papers
 Inpatients leaving against medical advice (LAMA)
IMPORTANT HOSPITAL AREAS FOR MAINTAINING GOOD PUBLIC
RELATIONS ARE
• administrative office procedures
• O.P.D. & emergency – waiting time
• Therapeutic and diagnostic area- x ray lab
• Supportive services – oxygen supply, linen, diet
• Inpatient areas wards

FACTORS RESPONSIBLE FOR GOOD PUBLIC RELATIONS IN THE HOSPITALS

1. Service provided by the hospital: If hospital enjoys a good reputation in respect of the
services provided by the hospital to the public, i.e. the quality of medical care, it is the
single largest factor responsible for the good image of the hospital.
2. Hospital administration must attempt to find out the changing needs and demands of
the public, what is there need? What is demand” which kind of services? What are the
requirements of the people? The services should be provided in the manner, people

198
 want to avail them. Survey methods are very important tools to find out the public’s
expectations.
3. The management should feel social responsibility and should be responsive to the
society’s needs.
4. The public must have easy access to the information of hospital, many a times people
feel that the hospital does not provide the information in the desired manner. The
information must be user friendly. In the present information age, the hospital can
maintain their websites and all relevant information must be available on the site, and
it should be updated in time.
5. Publicity materials and promotional methods should be designed as per the
functioning of the hospital. If a facility is not available, right now, it should not be
promoted, but it may be published as a future development.
6. The publicity should be relevant, accurate and no exaggeration.
7. The vision, mission and long term goals of the hospital must be published well and
projected to the public. Every hospital must have a mission statement, written at the
prominent place of the hospital and must find a place in the house journal and
important stationary items of the hospital.
8. The promotional material must be in the current topics as well as on the relevant
topics. We should take only on those aspects of care, which we actually provide. Like
we talk of telemedicine, and we don’t have any such facility. We talk of HIV/AIDS
and we don’t have counselling centres etc in our hospital, it is of no use.
9. Follow the principle that if the person are honest to the public, the public will
reciprocate accordingly.
RESPONSIBILITY OF PUBLIC RELATION DEPARTMENT
Public relation officer is the executive officer of the public relations. The responsibilities
of the public relation department can be enumerated as:
 To detail the management regarding different viewpoints of the various strata of
public.
 To study the activities of the management and also study the likely impact of the
activities taken chance of unfavourable impart, the department will appraise to the
management.
 Collection and analysis of data to improve the communication between hospital and
public to conduct opinion polls.
 To conduct market survey.
 To develop communication material like, news letter, publications, audio visuals,
press releases, health topics feature articles for press. To promote hospital’s goals and
objectives and direct them to reach specific target populations.
 Establish channels of communication between public, i.e. internal public and
management of the hospitals.
 Help in fund raising activities for the hospitals.
 Develop media relation program.
 To organizes press conferences on important events of the hospitals.

199
  To develop liaison with the outside agencies, like universities, clubs, civil
administration, transport, catering services, etc.
COMMON PROBLEMS OF PUBLIC RELATIONS IN THE HOSPITAL
The public relation department of the hospital has to face common problems, which are being
enumerated as follows:
 Indifferent attitude of the workers deputed at sensitive points like reception,
registration, enquiry, billing counter, etc.
 Rough behaviour of staff.
 Negligent behaviour of hospital staff.
 Prolonged waiting time.
 Poor sanitation.
 Use of influence in getting out of turn work
 Poor information and guidance mechanism.
 Non –availability of equipments, supplies, machines, gloves, syringes, dressing
materials in hospital and asking patient to being these items from market directly.
 Increased awareness among beneficiaries leads to increased expectations and the
hospitals find difficult to meet out the demands.
 Overcrowding, lack of sitting arrangements, trolleys, stretchers, etc.
ADDITIONAL IMPORTANT CONSIDERATIONS
 Communication to the press
A prudent administrator must get to know the local press. The local press can be the
hospital’s principle helper in this regard. A hostile press can do a lot of harm. If an
editor understands the hospital’s problems, he can help enormously. However
sensational reporting cannot always be prevented. In cases, it may be worthwhile to
hold a press conference and be frank. When something has gone seriously wrong and
consequences may be of legitimate public concern, to await questions and then
provide patchy answers is to court disaster. Legitimate information must be
volunteered as early as possible.
Clearance of all material intended for release must be controlled by the chief of public
relations who would consult the concerned departmental chief. The material should be
put on a formal and released in a manner calculated to benefit the hospital.
Information regarding the condition of hospital. Information regarding the condition
of hospital patients, especially VIP’s and very serious patients, should be guarded and
preferably governed by an approved code.

 Medical information and information regarding patients

Information concerning the medical staff for release for public consumption, except
medical papers for professional publications, is required to be cleared by publics
relations. Needless to say, such information and medical facts should be within the
ambit of medical ethics. No information regarding patients should be released without
the consent of the patient, and the consent should be “informed consent”. All
questions about the hospital its operations and its patients which are likely to be

200
 publicly quoted or published must be cleared and replied only by the chief of public
relations.
 Nursing services
Whatever may be their physical condition, the psychological needs of patients
demand a strong sense of its recognition by nurses. The nursing staff must learn to
assess with a refined judgement what the patients’ needs are without, more often than
not, the voluntary declaration of how he or she feels or wants. To this end, the nursing
education programme should be able to prepare them adequately for performance of
the patient activities related to their cultural bases. The hospital administrator on his
part must determine the patient expectations from the hospital, communicate, them
effectively to all levels of supervision and through them to the nursing staff for
creation of better team spirit. Problems identified through consumer critique can be
tackled by managerial efforts which involve nothing but thoughtfulness, concern for
patients’ needs are respect for human dignity than anything else
 Role of women’s voluntary organisation
There is considerable scope of women’s voluntary organisations not only to improve
public relations but also in easing some of the administrative burdens of the hospital.
These organisations have been doing commendable work for many worthwhile
causes, including health care, and there is no reason why their services should not be
utilised on a bigger scale in hospitals.
Voluntary effort by such organisation can be utilised in hospital wards, in the OPD, at
the reception and enquiry counter, in managing gift shop and in fund raising.
However, contact and educating the community, that their public relations value lies.
The volunteers should be made conversant with the general functioning of the hospital
in order to make effective community contact.
Conclusion
It is necessary to strive to provide a high quality of service as well as to educate the public on
the hospital’s problems or limitations. The hospital has to exist, function, survive and grow as
a part of the social system; it cannot function, in its own ivory tower. It is bound to be
influenced by the external and internal environment as in turn it influences them. The
warmth, concern, perception, sensitivity, and compassion are integral to the art and business
of healing- it can never be replaced by technology. Nursing service has an extremely
important role to play in this respect. The patients and the community have a legitimate right
to respect a reasonably satisfactory

EVALUATION OF PERSONNEL

Introduction
It is a periodic for evolution of how well the nurses have performed their duties
during a specific time.
MEANING AND DEFINITION

201
The term evaluation is derived from the word ‘valoir’ which means ‘to be worth’. Thus
evaluation is the process of judging the value or worth of an individuals achievements or
characteristics.
“It is an act or process that involves the assignment of a numerical index to whatever is being
assessed”
“Evaluation is an act or process that allows one to make a judgement about the desirability or
value of a measure”
Definition
“Evaluation a defined as the method used to determine whether a service is needed
and likely to be used, whether it is conducted as planned, and whether the service actually
helps the people in need.”
Usually the supervisory personnel have long been held responsible for mentally at least,
evaluate the programs of their subordinates performance.
Principle of evaluation
1) Evaluation Techniques should be selected according to the purposes to be served.
When the particular aspects of pupil performance to be evaluated has been precisely
defined, the evaluation Technique that is most appropriates for evaluating that
performance should be selected.
2) Determine and clarifying what is to be evaluated always has priority in the
evaluation process.
3) Comprehensive evaluation requires a variety of evaluation techniques. Most
evaluation Techniques are rather limited in scope. To obtain a complete picture of pupil
achievement, we typically need to combine the result from a variety of Techniques.
4) Proper use of evaluation Techniques an awareness of both their limitation and
strength.
5) Evaluation Techniques varies from fairly well developed measuring instrument to
rather crude observational method. A major source of error arises from improper
interpretation of evaluation results.
Principle of performance evaluation
To fair and accurate evaluation of the subordinate, job performance, certain principles must
be followed.
1. Assess performance in relation to behaviorally stated work goals.
2. Observe a representative sample of employees total work activities.
3. Compare supervisors evaluation with employees self evaluation
4. Indicate which job areas have highest priority for improvement
5. The purpose pf evaluation is to improve work performance and job satisfaction.
Purpose of the Evaluation of Personal
1. To determine training and development needs of nurses.
2. To discover the employees aspirations and to give recognition for this
accomplishment.
3. To determine job competencies.

202
 4. To improve communication between supervisors and the staff so as to each one
understand about the objectives of the job and the agency.
5. To improve performance by examining and encouraging better interrelationships
between nurses.
6. To identify unsatisfied employees.

Steps of Evaluation
The basic steps involved in evaluation process are as follows.
1. Deciding for what is to be evaluated.
2. Establish standard and criteria
3. Selection of appropriate method.
4. Gather information.
5. Analyse the results.
6. Taking action.
7. Re evaluation or replan for it.
Using the Performance Appraisal to Motivate Employees
Although systemic employee appraisals have been used in management since the
1920. Most formal appraisals focus on the professional worker rather than the hourly paid
worker who is often guaranteed automatic pay raises. The evaluation of performance
appraisals is reflected in its changing Terminology. It was termed performance evaluation.
Most health care organizations, however, use the term performance appraisals because this
term implies an appraisal of how well employee performs the duties of their job.
Management research has shown that the following factors influence whether the appraisal
ultimately results in increased motivation and productivity:
1) The employee must believe that the appraisal is based on a standard to which
other employees in the same classification are held accountable. This standard,
which must be communicated clearly to employee at the time they are hired, may
be a job description or individual goals set by staff for the purpose of performance
appraisal.
2) The employee should have some input into developing the standards or goal on
which his or her performance is judged..
3) The employee must know in advance what happens if the expected performance
standards are not met.
4) The employee needs to know how information will be obtained to determine
performance. The appraisal tends to be more accurate if various sources and types
of information are solicited. Sources could include peers, coworkers; nursing care
plans patients and personal observation.
5) The appraiser should be one of the employee’s direct supervisors.
For examples, the charge nurse who works directly with the staff nurse should be
involved in the appraisal process and interview. It is appropriate and advisable in
most instances for the head nurse and supervisors also to be involved. How ever,
employees must believe that the person doing the major portion of the review has
actually observed their work. Mauer and Tarulli (1996) found that the belief that

203
 appraisers has adequate opportunity to observe relevant work behaviors was a key
factor in the attitudes of subordinates towards the appraisal system.
The performance appraisal is more likely to have a positive out come if the appraiser is
view with trust and professional respect. This increase the chance that the employee will
view the appraisal as a fair and accurate assessment of work performance.
Use of performance appraisal in hospital setting
1) Appraisal process is used to motivate employee and promote growth in hospital.
2) Appraisal process is used to determine staff education and training needs.
3) It is needed to provide better services and proper care to the patient in the hospital.
4) Performance appraisal can motivate staff and increase retention and productivity.
5) Provide frequent informal feedback on work performance.
6) Performance appraisal also generates information for salary adjustments,
promotions, transfer, disciplinary actions, and Terminations.
PEER REVIEW
Peer review is a process through which Team members give one another formal
feedback on their performance. It is usually replace the traditional performance appraisal
process in team - based organization.
DEFINITION
Peer review is a process by which employees of the same rank, profession, and setting
evaluate one another’s job performance against accepted standards.
- O’ Loughlin and Kaulbach
Purpose of Peer Review in Health Care
Peer review is widely used in medicine and by faculty in universities.
1) Peer review increased professionalism, performance and professional
accountability among practicing staff.
2) Maintaining professional and organizational standard.
3) Curtin (1994) states that the one of the most effective way to promote excellence
in nursing practice is for nurses to offer information, support, guidance, criticism
and direction to one another.
4) It gives valuable feedback.
5) It also can provide learning opportunities for peer reviewer.
6) Mortin (1994) found that peer reviewers who critiqued patient records completed
by their peers increased the accuracy and precision of their own patients records
by decreasing unnecessary, confusing, illegible entries.
In a peer review model, an employee is evaluated by the people with whom he works
and whom he has to backup and support on daily basis.
Lying the ground work
For the peer review process to be effective, certain groundwork must be laid. The peer
group needs extensive training so the process is valuable to them and not a means to reward
friends or hurt foes. There must be an objective approach to the measurements being selected.
Implementing Peer Review

204
 Peer review that are carefully thought out and fairly implemented can have a high
level of worker acceptance and involvement. Peer review may also help people get along
better and thus improve overall organizational performance. It can also help alleviate
frustration in the workplace and minimize the role of workplace politics.
The critical role of peer view in patient care is widely accepted in the health care
professions. A major component of the peer review process is the peer evaluation of clinical
judgment using written documentation, established clinical guidelines, and patient care
protocols, more over, the process evaluates technical skills, appropriateness of care, and the
outcome of the care rendered.
The 360-Degree Evaluation
One of the best methods of performance appraisal combines several tool and known as
the 360-Degree evaluation. This process solicits performance feed back from:
 Self
 Coworkers (peer review)
 Supervisors and managers
 Patients
This method covers the gamut of job responsibilities, including “Customer”
services, with the ‘Customer’ (Patient) being involved in the appraisal process. It also
allow the manger to maintain control over such issues as merit and other pay increases
that are based on behavior other than what the peer group sees. It gives people a chance to
learn how others see them, to see their skills and styles and to improve communication
with others.
Steps for Peer Review
1) The employee selects peers to conduct the evaluation. Usually, two to four peers
are identified through predetermined process.
2) The employee submits a self-evaluation portfolio. The portfolio might describe
how he or she met objectives and / or predetermined standards during the past
evaluation cycle. Supporting materials are included.
3) The peer evaluation the employee. This may be done individually or in a group.
The individual or group then submits a written evaluation to the manager.
4) Manager and employee meet to discuss the evaluation. The Manager’s evaluation
is included, and objectives for the coming evaluation cycle are finalized.

Peer Evaluation Strategies

Some facilities are using peer evaluation as one component of the formal evaluation
system. When peer evaluation is used, the individual often is allowed to choose the peer who
will be involved in the evaluation process.
Peers are given specific evaluation from and asked to complete it regarding the
individual. These may be used along with a self-evaluation to try to build a more
comprehensive picture of the person’s performance. Peer evaluations may be especially
important when a supervisor has a very broad span of control and has limited contact with
individuals to be evaluated, and, therefore, limited behavioral observation to support
evaluation.

205
Advantages
1) It can make a realistic evaluation.
2) It can recognize the positive and negative aspects of their performance.
3) It helps to make future improvement.
Disadvantages
1) Staffs are poorly oriented to the peer review method.
2) Peers feels uncomfortable sharing feedback with people with whom they work
closely.
3) It is very time consuming.
4) Inter personal conflict may arise in unfair appraisals.
5) The insecure manager may feel threatened because of peer review shifts the
authority away from management.
THE SUCCESS OF PEER EVALUATION DEPENDS ON
 Short but objective method
 Trained observers
 Constructive feedback for faulty development
 Open communication and trust
METHODS OF PEER EVALUATION
Direct observation
Videotaping
Evaluation of course materials
Analysis of portfolios
PROCESS OF PEER REVIEW
I. Establish a policy requiring peer reviews
II. Establish criteria for peer evaluations
III. Procedure for conducting peer evaluations
a. Faculty chosen to conduct peer evaluations shall be tenured and hold on academic
rank higher than that of the faculty member being evaluated
b. A written report, addressing the criteria, shall be prepared and signed by the
evaluator
c. The department shall archive the written evaluations for use in future evaluations
d. One copy of the peer evaluation shall be placed in the permanent personnel file of
the person being evaluated
e. All reports of peer evaluations shall be included in the tenure file, and are to be
carefully reviewed at the department.
SELF EVALUATION
The self-review performance appraisal model is based on the idea that an employee is
most familiar with his own work. How he think he’s doing his job is essential to the appraisal
process. An employee rates himself on a number of criteria on a formal survey form that
includes a section for self-improvement suggestions the employee feels are needs. He’s given
an opportunity to clarify his goals and state his areas of weakness as a focus for improvement

206
during the next review period. In most cases, the self-review is done as part of the entire
review process, usually in advance of the formal manager – and – employee interview.
The self-evaluation tool must be carefully selected and must correlate to the questions
and criteria on the formal review tool. Both the tool and the process itself need to be
carefully and thoroughly reviewed with each new employee at the time of hire as well as
immediately before the actual review.
DEFINITION
Self evaluation is defined as judging the quality of one’s work, based on evidence and
explicit criteria, for the purpose of doing better work in the future.
PURPOSES OF SELF EVALUATION
1. To encourage continuing self-evaluation and reflection and to promote an ongoing,
innovative approach.
2. To encourage individual professional growth in areas of interest to the employee
3. To improve morale and motivation by treating the employee as a professional in charge of
his or her own professional growth.
4. To encourage collegiality and discussion about practices among peers in an organisation
5. To support employees as they experiment with approaches that will move them to higher
levels of performance
Self Evaluation Strategies
Self-evaluation is a critical component of professional practice. Self Evaluation
guides your growth and development as a nurse, directing you to education sources and
focusing your career directions. In addition, in many institutions employee are asked to come
to their formal performance appraisal meeting having completed their own self-Evaluation.
The employee is asked to use the same criteria and even the same form that will be used by
the supervisor. At the performance appraisal interview, the two documents are compared.
Areas of agreement are noted and areas of discrepancy are then discussed.
Formal self Evaluation is more often a successful strategies when it focuses on either
personal goals and objectives or areas for growth rather than areas of deficiency. Most people
are reluctant to introduce the idea that they might not be meeting minimum standard of
performance.
BENEFITS OF SELF EVALUATION
1. Increased confidence in their own learning, in trying out new ideas, in changing their
practice and in their power to make a difference.
2. Enthusiasm for collaborative working, despite initial anxieties about being observed and
receiving feedback
3. Improved team-work and greater flexibility in their use of their skills
4. Increased awareness of new techniques and greater insight into thinking
5. Enhanced planning skills to ensure more effective task management.
TOOLS FOR SELF EVALUATION
Staff annual professional review procedures

207
 Peer support
o Coaching
o Joint preparation of materials
o Planning
o Team building
Observation can involve experts, can be informal or formal procedures. Feedback from
such observation is very valuable, but must be handled sensitively
Audit checklist
Conclusion
Evaluation of personnel is a periodic evaluation of how well the employee has
performed their duties and job during a specific period. It is a process of judging the value or
worth of an individual’s achievement.

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 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.

208
  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 patient’s
categories. Johnson indicates two methods of categorizing patients. Using
categorizing method each patient is rated on independent elements of care, each
element is scorded , 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 category 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.
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 Cannot feed Cannot feed

help in self but is able self any may
preparing to chew and have difficulty
swallowing swallowing

Grooming Almost entirely Need some Unable to do Completely

self sufficient help in much for self dependent
bathing, oral
hygiene …

Excretion Up and to Needs some In bed, needs Completely

bathroom alone help in getting bedpan / urinal dependent
up to bathroom placed;
/urinal

Comfort Self sufficient Needs some Cannot turn Completely

help with without help, dependent
adjusting get drink,

209
 position/ bed.. adjust position
of extremities
…

General health Good Mild Acute Critically ill

symptoms symptoms

Treatment Simple – Any Treatment Any treatment Any elaborate/

supervised, more than once more than delicate
simple per shift, foley twice /shift… procedure
dressing… catheter care, requiring two
I&O…. nurses, vital
signs more
often than
every two
hours..

Health Routine follow Initial teaching More intensive Teaching of

education and up teaching of care of items; teaching resistive
teaching ostomies; new of patients,
diabetics; apprehensive/
patients with mildly resistive
mild adverse patients….
reactions to
their illness…

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 2.3 2.9 3.4 4.6

Day shift

NCHPPD for 2.0 2.3 2.8 3.4

P.M
(Evening)
shift

NCHPPD for 0.5 1.0 2.0 2.8

night shift

210
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.
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

211
 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
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

212
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. 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

213
 the resources acuity nurse position, nurses position, nurse’s 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 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 system’s 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

214
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
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.

STAFFING PATTERN
Staffing in educational setting
Staffing of colleges of nursing at university level and schools of nursing at hospital
level with handful of nurse teachers for clinical and public health nursing practice
much is to be desired. Due to lack of trained nurse teachers majority of he classes are
taken by the doctors or other non teachers who cannot relate their subject to the
practice. Every subject taught in nursing must be taught by nurses only to that extent
which can be and should be translated in to practice.

As per INC Staffing norms to the Nursing Institution is

[Link]. (N) and [Link]. (N)

Annual intake of 60 students in [Link].(N) and 25 students for [Link].(N) programme
Professor-cum-Principal 1
Professor-cum-Vice Principal 1

215
Reader / Associate Professor 5
Lecturer 8
Tutor / Clinical Instructor 19
---------------
Total 34
One in each specialty and the entire [Link] (N) qualified teaching faculty will
participate in all collegiate programmes.
Teacher Student Ratio = 1: 10 for [Link]. (N) Programme.
Other Staff (Minimum requirements)
(To be reviewed and revised and rationalized keeping in mind the mechanization and
contract service)
• Ministerial
a) Administrative Officer 1
b) Office Superintendent 1
c) PA to Principal 1
d) Accountant/Cashier 1
• Upper Division Clerk 2
• Lower Division Clerk 2
• Store Keeper 1
a) Maintenance of stores 1
b) Classroom attendants 2
c) Sanitary staff As per the physical space
d) Security Staff As per the requirement
• Peons/Office attendants 4
• Library
a) Librarian 2
b) Library Attendants As per the requirement
• Hostel
a) Wardens 2
b) Cooks, Bearers, As per the requirement Sanitary Staff
c) Ayas /Peons As per the requirement
d) Security Staff As per the requirement
e) Gardeners & Dhobi Depends on structural facilities
(desirable)

BASIC [Link]. NURSING Teaching Faculty

Admission Capacity

216
 Annual Intake 25-50 51-100
Professor-cum-Principal 1 1
Professor-cum-Vice Principal 1 1
Reader/Associate Professor 1 2
Lecturer 5 10
Tutor/Clinical Instructor 14 28
Total 22 42
Teacher Student Ratio= 1:10
Staffing in hospital setting
Most of the hospitals have the chief nurse but not in an executive position. She acts
more like a middle level manager and she may be assisted by one, two or eight
assistants to look after a hospitals.
The existing norm stipulated by INC with regard to nursing staff for wards and
special units (excluding out patient department)

Staff nurse Staff ( each Department sister/assistant

shift ) nursing superintendent

Medical ward 1:3 1:25 1 for 3-4 wards

Surgical ward 1:3 1:25 1for 3-4 weeks

Orthopedic ward 1:3 1:25 1 for 3-4 weeks

Pediatric ward 1:3 1:25 1 for 3-4 weeks

Gynecology 1:3 1:25 1for 3-4 weeks

Maternity ward 1:3 1:25 1 for 3-4 weeks

Intensive care 1:1 (24 hours ) 1

unit

Coronary care 1:1( 24hours ) 1

unit

Nephrology 1:1 (24hours ) 1 1 department sister/ assistant

nursing ,superintendent for 3-4
units clubbed together

217
 Special wards – 1:1 (24hours ) 1
eye ,ENT,etc

Operation theatre 3 for 24 hours per 1 1 departmental sister/assistant

table nursing superintendent for 4-5
operating rooms

Causality and 2-3 staff nurses 1 1 departmental sister/ assistant

emergency unit depending on the nursing, superintendent for
number of beds emergency , causality etc.

Nurse Staffing, Models of Care Delivery, and Interventions

Nurse Staffing Definition

Measure

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 All staff or all hours of care including RN, LVN, aides
hours per patient day 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 RN or LVN full time equivalents per patient day (an FTE is
patient day 2080 hours per year and can be composed of multiple part-
time or one full-time individual)

Nursing skill (or staff) The proportion or percentage of hours of care provided by one
mix 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 Definition

Models

218
 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 A model that generally uses an all-RN staff to provide all
Nursing Care 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 A model using the RN as a team leader and LVNs/UAPs to

Nursing Care 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 Characterized as "good places for nurses to work" and

Environment/Shared includes a high degree of RN autonomy, MD-RN
governance collaboration, and RN control of practice; allows for shared
decisionmaking by RNs and managers Jean Ann Seago,
Ph.D.,RN

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

219
 taking into account the workload projected in the wards and the other areas of
the hospital.
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 [Link]. 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.
The Nurse-patient Ratio as per the S.I.U. Norms 
1. General Ward 1:6
2. Special Ward - ( pediatrics, burns, 1:4
neuro surgery, cardio thoracic, neuro  
medicine, nursing home, spinal injury,
emergency wards attached to casuality)
3.      Nursery 1:2 
4.      I.C.U.  1:1(Nothing mentioned about the
shifts)
5.      Labour Room  1:l per table
6.      O.T.  Major - 1 :2 per table
 Minor - 1:l per table

220
    Casualty-   
a. Casualty main attendance up to 100 3 staff nurses for 24 hours, 1:1per shift.
patients per day thereafter  
  1:35
[Link] every additional attendance of 35  
patients ·3 staff nurses for 24 hours, 1:1/ shift
c.       gynae/ obstetric attendance  
  1:15
d.      thereafter every additional
attendance of 15 patients.

8.  Injection room OPD Attendance upto 100 patients per day 1
staff nurse
120-220 patients: 2 staff nurses
221-320 patients: 3 staff nurses
321-420 patients: 4 staff nurses
9.   OPD  
NAME OF THE DEPARTMENT  
·        Blood bank 1
·        Paediatric 2
·        Immunization 2
·        Eye 1
·        ENT 1
·        Pre anaesthetic 1
·        Cardio lab 1
·        Bronchoscopy lab 1
·        Vaccination anti rabis 1
·        Family planning 2
·        Medical 1
·        Dental 1
·        Central sample collection centre 1
·        Orthopaedic 1
·        Gyne 2
·        Xray 2
·        Skin 3
·        V D centre 2
·        Chemotherapy 2
·        Neurology 2

221
·        Microbiology 1
·        Psychiatry 2
·        Burns 1
  2
In addition to the 10% reserve as per the extent rules, 45% posts may be added where
services are provided for 365 days in a year/ 24 hours.

THEORIES AND MODELS OF NURSING MANAGEMENT

I. INTRODUCTION:
The knowledge on theories of management for nurse leaders can be useful in creating and
developing their own management styles. One needs to understand that no single theory can
be well fit and guide nursing leaders in every situation. The important theories developed at
different periods of time are discussed in order to help nurse managers to adapt and function
effectively.
III. CONTENT:
Management:
Definition : Management is the process and agency, which directs and guides the operations
of an organization in realizing, established aims.
[Link].
Management is defined as the process by which a co-operative group direct action towards
common goals.
Joseph messie (1973)
Management is principally the task of planning, co-coordinating, motivating and controlling
the efforts of others towards a specific objective.
James lunde (1968)
There are several theories of administration and management. Although strictly
speaking the word “theory” may not be correct word to use at the present stage. Since the
term “theory” is used because of its popularity. Actually the systematic study and analysis of
organization started in later part of 19th century and early 20th centuries. Few prominent
figures who attempted to study the organization as mentioned below.
The four important theories focused for nurse managers are:
 Scientific management theory
 Classic organizational theory
 Human relations theory
 Behavioural science theory
 Modern management theory
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

222
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 management’s 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.
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 day’s 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.

223
 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 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.
All the managers regardless of the type of organization or their level in organization have
essentially the same tasks such as planning, organizing, issuing orders, coordinating and
controlling. These six aspects of administration, falling into two main groups related as to
process and effect as follows:
Process effect
1. Forecasting plan
2. Organization coordination
3. Command control
These six aspects of administration follow each other in logical sequences. The plan
needs organization which in turn needs coordination of the effort of the person involved. In
this sense, the schematic representation of the elements of administration can be shown
below,
 Principles- process- objective- effect
 Investigation- forecasting
 Reality- organization- plan- coordination of control
 Order- command
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.

224
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)
He derived general principles of management:
1. Division of work
2. Authority and responsibility
3. Discipline
4. Unity of command
5. Unity of management
6. Subordination of industrial interests to the common good
7. Remunerative
8. Centralization
9. Hierarchy
10. Order of team members justice
11. justice
12. Stability of tenure
13. Initiative
14. Sense of union
The requirements listed above, there, are still more 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.
Fayal also stressed that managers should possess physica,mental,moral,educational and
technical qualities to conduct the multifaceted operations of business enterprise.
Fayol desired that management training should be provided to imbibe the principle and
qualities essential for management. Technical ability is most important and managerial ability
becomes more significant and quality to be cultivated for top-level executives. Fayol
advocated some valuable concepts in management which can be incorporated usefully in
present day analysis of management science. His emphasis on unity of command and
direction, non-financial incentive, decentralization, coordination has greater relevance even
today.
1. Division of work: there should be division of work and task specialization than
different workers consistently carrying out different job responsibilities.
2. Authority: each worker should be given authority to commensurate with the amount
of his responsibility.
3. Discipline: each worker and management should maintain proper discipline,
voluntarily according to their placement.

225
 4. Unity of command: each employee should receive orders from one supervisor only.
5. Unity of direction: one person should direct all activities that support a single
objective.
6. Subordination of individual interest to general interest,i.e the interest of the
individual work, should be subordinated to the interest of the total work group.
7. Remuneration: proper remuneration which includes salaries, allowance and other
incentives to be given to all employees according to their level of performance and
responsibility by the management or employee.
8. Centralization or decentralization: certain power and functions reserved with top
level authorities and other power and functions are distributed to executives and co –
executives and workers also to some extent.
9. Scalar chain: there should be an unbroken scalar chain/hierarchy of authority
extending from the top executive to the lowest level worker.
10. Order: there should be proper policies, rules and regulations to maintain an orderly
situation in the organization.
11. Equity: All employees should be treated with equity and justice.
12. Stability and tenure: there should be prescribed tenure which is needed for all
employees.
13. Initiative: all employees and management should take proper Initiative to achieve the
objectives of the organization.
14. Esprit de corps: the group spirit and group morale can be cultivated among
employees and employer to accomplish objectives.
Fayol recognized the tentative and flexible nature of these principles, stressing that
effective management result from basing each action on the appropriate principle.
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 favouritism. 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 fulfil 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 one’s 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.
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.

226
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
member’s 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,
4. Meeting employees needs.
5. Promoting employees sense of achievement,
6. Obtaining commitment through participation in planning and decision making.
1) Douglas McGregor’s Theory (1932):
McGregor’s is the father of the classical theory of management which termed theory.
He developed the managerial implications of Maslow’s theory. He noted that one’s style of
management is dependent on ones philosophy of humans and categorized those assumptions
as theory X and theory Y.
Theory X
1. The manager’s 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.

227
 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.
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 Likert’s 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
Michigan’s institute for social [Link] 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.
Likert believes that the managers may act in ways harmful to the organization because they
evaluate end results to the exclusion of intervening variables.
So, he developed a Likert scale questionnaire that includes measures of casual and
intervention variables.
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 [Link] 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
b). Benevolent- authoritative:
1. Staff associates ideas are sometimes sought, but they do not feel free to discuss their
jobs with the manager.

228
 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.
He is strong believer of participative management and supportive relationships. His linking –
pin concept is based on studies about the differences between good and poor managers a
measured by their level of productivity. Good mangers found to have more influence on their
own managers than did poor managers. Their managerial abilities and procedures were better
received by their staff associates. When middle managers have the opportunity for interaction
with their manager, workers can have input and there is a chance for the individuals and the
organizational goal to become similar.
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.
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.

229
 External Environment

Transformation process

Input Output
Nursing personal management of nursing care resolution of nursing Supplies
of clients by nursing personal problems of client
Equipments critical thinking application improvement; client
Clients, knowledge, valus, nursing theory in management health care goals met
Ethics skills and beliefs . and clinical care. Healing, peaceful death

Feed back

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

230
 3. Openness of all systems and their influence o the environment and environment
influence on the system.
3. Contingency approach: The contingency approach can be described as the behavioural
approach.
Luther Gulick:
He was influenced by Taylor and Fayol. He used Fayal’s five elements of administration
[Link],Organizing,Command,Coordination and Control as a frame work for his
neutral principles. He condensed the duties of administration into a famous
acronym”POSDCORB”.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 Fayal’s 14 basic elements of administration in
expressing his principles of administration as follows:
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.

231
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.
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 MASLOW:
Abraham Maslow an American psychologist has given best known classification of human
needs as “Need Hierarchy”
Abraham Maslow arranges individual needs in a Hierarchical manner.
1. Physiological needs:-the basic things necessary for human survival e.g. hunger thirst,
shelter etc.
2. Security needs:- include job security or safety and the work place, thus giving
psychological security to human being.
3. Social needs:-represent the relationship between and among groups of people
working in the organization.
4. Self Esteem needs :-represent higher level needs of human being
5. Self –actualization:-is a higher level need represents culmination of all other needs.

 Abraham Maslow's Hierarchy of Needs motivational model

232
 Abraham Maslow developed the Hierarchy of Needs model in 1940-50s USA, and the
Hierarchy of Needs theory remains valid today for understanding human motivation,
management training, and personal development. Indeed, Maslow's ideas surrounding the
Hierarchy of Needs concerning the responsibility of employers to provide a workplace
environment that encourages and enables employees to fulfil their own unique potential (self-
actualization) are today more relevant than ever. Abraham Maslow's book Motivation and
Personality, published in 1954 (second edition 1970) introduced the Hierarchy of Needs, and
Maslow extended his ideas in other work, notably his later book Toward A Psychology Of
Being, a significant and relevant commentary, which has been revised in recent times by
Richard Lowry, who is in his own right a leading academic in the field of motivational
psychology.
Abraham Maslow was born in New York in 1908 and died in 1970, although various
publications appear in Maslow's name in later years. Maslow's PhD in psychology in 1934 at
the University of Wisconsin formed the basis of his motivational research, initially studying
rhesus monkeys. Maslow later moved to New York's Brooklyn College.
The Maslow's Hierarchy of Needs five-stage model below (structure and terminology - not
the precise pyramid diagram itself) is clearly and directly attributable to Maslow; later
versions of the theory with added motivational stages are not so clearly attributable to
Maslow. These extended models have instead been inferred by others from Maslow's work.
Specifically Maslow refers to the needs Cognitive, Aesthetic and Transcendence
(subsequently shown as distinct needs levels in some interpretations of his theory) as
additional aspects of motivation, but not as distinct levels in the Hierarchy of Needs.
Where Maslow's Hierarchy of Needs is shown with more than five levels these models have
been extended through interpretation of Maslow's work by other people. These augmented
models and diagrams are shown as the adapted seven and eight-stage Hierarchy of Needs
pyramid diagrams and models below.
There have been very many interpretations of Maslow's Hierarchy of Needs in the form of
pyramid diagrams. The diagrams on this page are my own interpretations and are not offered
as Maslow's original work. Interestingly in Maslow's book Motivation and Personality, which
first introduced the Hierarchy of Needs, there is not a pyramid to be seen.

233
 HERZBERG’S TWO FACTOR THEORY:
This theory was developed in [Link] is based on realisation that work motivation and job-
satisfaction are two dimensions that influence the productivity of an employee. Herzberg’s
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 [Link], 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. Taylor’s 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 Emerson’s 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.

234
Conclusion:
The theories is very important in management of health care setting .proper planning of work
will improve the quality of services provided in the organization. So the nurse managers
should know about types of theories and model of nursing management. It is a process by
which a co –operative group direct action towards common goals.
CURRENT TRENDS IN MANAGEMENT
Introduction:
From an almost unrecognized position nearly two centuries age, management has
risen today to the central activity of our age and economy a powerful and innovative force on
which our society depends for material support and national well being.
Meaning:-
Management is the art of getting things done through others (Parker. F.M)
Definition:-
1) Management is the art of getting things done through and with people in formally
organized groups (Harold koontz)
2) Management is a multipurpose organ that manages a business and manages managers
and manager’s workers and work. (Druker)

MANAGEMENT DEVELOPMENT:-
During the last hundred years, management has become a more scientific discipline
with certain standardized principles and practices. The evaluation of management thought
during this period can be studied in two parts as under.
1) Early management approaches represented by scientific management administrative
management theory and human relations movement
2) Modern management approaches represented by behavioral approach quantitative /
management science approach, systems approach and contingency approach.
1) Early management approaches:-
A) Scientific management:-
Frederick Winslow Tylor(1856 – 1915) is considered to be the father of scientific
management. He exerted a great influence in the development of management thought,
through his experiment and writings.
Principles:-
a) Development of true science for each element of man’s job to replace the old rule of
thumb method
b) Scientific selection, training and development of workers for every job.
c) An almost equal division of work and responsibility between management and
workman, management entrusted with the planning of work and workman to look
after execution of plans.
Techniques:-
1) Time study:-

235
 Time study group or work management designed to established the standard time
required to carryout a job under specified conditions. It involves analysis of a job in to a
constituents elements and recording the time taken in performing each elements.
2) Motion study:-
It is a systematic and critical study of the movement of both the worker and the
machine.
3) Differential payments:-
Taylor introduced a new payment plan called the differential piece work in which he
linked incentives with production under this plan a worker received low piece rate if he
produced the standard number of pieces and high rate if he surpassed the standard. So the
attraction of high piece rate would motivate workers to increase production.
4) Drastic reorganization of supervision:-
It has two concepts.
a) separation of planning and doing
b) Functional foremanship.
In these days it used to be customary for each worker to plan his own work. The work
himself used to select his tools and decide the order in which the operations were to be
performed.
Taylor suggested that the work should be planned by a foreman and not by the
worker. Further, there should be as many foreman as there are special functional involved in
doing a job and each of these foreman should give orders to the workers on his specialty.
5) Scientific recruitment and training:-
The management should develop and train every worker to bring out his best facilities
and to enable him to do a higher, more interesting and more profitable class of work than he
has done in the past.
6) Intimate friendly co – operation between the management and workers.
Rather than quarrel over whatever profits there were, they should both try to increase
production. By doing so, profits would be increased to such an extent that labour and
management would no longer have to complete for them. So the management and labourhas a
common interestin increasing productivity.
B) Administrative management:-
Fayol wrote that all activities of business enterprise could be divided into six groups.
a) Technical
b) Commercial
c) Financial
d) Accounting
e) Security
f) Administrative or management
Principles:-
1) Division of work:-
Division of work in the management process more and better work with the same
effort, various functions of management like planning, organizing, directing and controlling
cannot be performed efficiently by a single superior or by a group of directors.
2) Authority and responsibility:-
 As the management consists of getting the work done through others, it implies that
the manager should have the right to give orders and power to exact obedience.
 A manager may exercise formal authority and also personal power.

236
  Formal authority is derived from his official position, while personal power is the
result of intelligence, experience, moral worth, ability to lead, past service, etc.
 An individual who is willing to exercise authority, must also be prepared to bear
responsibility to perform the work in the manner desired.
3) Discipline:-
Discipline is absolutely essential for the smooth, running of business. By discipline
we mean, the obedience of authority, observance of the rules of service and norms of
performance, respect for agreements, sincere efforts for completing the given job, respect for
superiors etc.
4) Unity of command;-
 This principles require that each employee receive instructions about a particular
work from one superior only
 If an employee was to report to more than one superior, he would be confused due to
conflict in instructions and also it would be difficult to pinpoint responsibility to him.
5) Unity of Direction:-
It means that there should be complete identity between individual and organizational
goals on the one hand and between departmental goal inters on the other. They should not
pull in different directions.
6) Subordination of individual interest to general:-
 In a business concern an individual is always interested in maximizing his own
satisfaction through more money, recognition, status etc
 This is very often against the general interest which lies in maximizing production
hence, the need to subordinate the individual interest to general interest.
7) Remuneration:-
 The remuneration pay to the personnel of the firm should be fair. If should be based
on general business conditions, cost of living, productivity of the concerned
employees and the capacity of the firm to pay.
 Fair remuneration increases workers efficiency and morale and foster good relations
between them and the management.
8) Centralization
 If subordinates are given more role and importance in the management and
organization of the firm, it is decentralization.
 The management must decide the degree of centralization or decentralization of
authority on the basis of the nature of the circumstance, size of understanding, the
type of activities and the nature of organizational structure.
9) Scalar chain:-
 Scalar chain means the hierarchy of authority from the highest executive to the
lowest one for the purpose of communication
 It states superior – subordinate relationship and the authority of superiors in relation
to subordinate at various levels.
 As per this principle the order or communications should pass through the proper
channels of authority along the scalar chain.
10) Order:-
 To put things in an order needs effort management should obtain orderliness in work
through suitable organization of men and materials

237
  The principle of ‘right place for everything and for every man” should be observed by
the management.
 So there is need for scientific selection of competent personnel, correct assignment of
duties to personnel and good organizations.
11) Equity:-
 Equity means equality of fair [Link] results from a combination of
kindness and justice. Employees expect management to be equally just to
everybody.
 It requires mangers to be free from all prejudices, personal likes and dislikes.
 Equity ensures healthy industrial relations between management and labour which
is essential for the successful working of the enterprise.
12) Stability of tenure of personnel:-
 In order to motivate workers to. do more and better work its necessary that they
should be assured security of job by the management.
 If they have fear in insecurity of job their morale will be low and they cannot give
more and better work. Further, they will not have any sense of attachment to they firm
and they will always be on the lookout for a job elsewhere.
13) Initiative:-
 Initiative is one of the keenest satisfactions for an intelligent man to experience and
hence, he advices managers to give their employees sufficient scope to show their
initiative .
 Employees should be encouraged to make all kinds of suggestions to conceive and
carry out their plans even when source mistakes result;
14) Esprit decorps:
 This means team spirit; since “union is strength” the management should create team
spirit among the employees. Only when all the personnel pull together as team there is
scope for realizing the objectives of the concern.
 To achieve this one the motto of divide rule should be avoided and two way verbal
communications should be used for removing misunderstandings.
2) MODERN MANAGEMENT APPROACHES;-
Modern management has developed through several stages of approaches. These
approaches to the study of management may be classified as under.
a) Classical approach:-
The classical or empirical approach is based on the following tenets.
1) Management is a continuous process consisting of interrelated functions performed to
achieve the desired goals.
2) From the experience of managers in different organization, principles or guidelines
can be derived.
3) Principles are basic truths which can be applied in different organizations to improve
managerial efficiency.
4) Managers can be developed through formal education and training
5) People are motivated by mainly by incentive and penalties. Therefore,managers use
and control economic rewards.
6) Theoretical research in to management helps to develop a body of knowledge which
is necessary to improve the act of management.

238
Merits:-
 It offers a convenient framework for the education and training of future mangers.
 It focuses attention on what mangers actually do i.e. functions of management
 It highlights the universal nature of managements
 It provides a foundation for further research in management

Demerits:-
1) It is a mechanical approach which under mines the role of human factors in
management. The focus on technical and economic aspects at the socio –
psychological issues in management.
2) The validity and universality of management principles is doubtful due to
environmental changes
3) There is a danger in relying too much on past expense as two managerial situations
are never identical.
b) Behavioral approach:-
This approach is an improved and a more mature version of the human relations
approach to management. Dougles MC. AbrahamMaslow, kurtlewin are some of the
foremost behavioral scientists who made signal contributions to the development of the
behavioral approach to management. These scientist were more rigorously trained in various
social sciences (such as psychology, sociology and anthropology) and used more
sophisticated research method, the main propositions of this approaches are
1) A Business organization is not merely a techno – economic system. It is much more a
social system of interpersonal and intergroup relations.
2) The attitudes and performance of an employee are dominated by the social group to
which he belongs. Members of an organization behave not an individuals but as
members or some group.
3) Social and psychological incentives exercise a greater influence on employee
motivation than working conditions and economic rewards.
4) Management must understand and develop harmonious interpersonal relations
among his subordinates. There should be harmony between human needs and
organizational goals.
5) Employees are capable of self direction and control. Therefore, participate leadership
is more productive than task centered leadership.
6) Management requires social skills to make employees feel apart of the organization.
Merits:-
1) It is much disciplinary
2) It has made significant contributions to our understanding of people at work and
groups in organizations.
3) It recognizes an organization as a social organization subject to the attitudes, culture
of people.
4) Motivation, leadership, work designs, group dynamics and participation are the main
concept of behavioral science approach.
Demerits:-
1) It lacks the precision of classical theory because human behavior is conpredictable

239
 2) It conclusions lack scientific validity and suffer from a clinical bias. Its findings are
tentative.
3) Management is much wider than organizational behavior.
c) Quantitative approach:-
The Management science approach was evolved after the second world war. It
involves the application of sophisticated Quantitative / mathematical techniques for solving
problems. Several mathematicians, engineers and economists like Herberk. A Simon, Von
Newman, R. M. Cyert made significant contributions to this approach. This is known by
several names, eg – Decision theory approach, mathematical approach operation research etc.
The Quantitative approach differs from the classical and behavioral approaches in
several ways. It distinguishing features are given below.
i) Rational decision making:-
An organization is considered a decision making unit and the main job of a manger is
to make decision and solve problems. The quality of information system and other techniques
should be used for making rational decisions.
ii) Mathematical model.
A model is a simplified representation of a real life situation. If understand
mathematical symbols and relationships. It reduces a managerial decision to mathematical
form so the decision making process can be simulated and evaluated before the actual
decision is made.
iii) Computer applications:-
The use of computers has been the deriving force in the development of management
science approach.
iv) Evaluation criteria;-
As the main focus of the management science approach is on scientific decision
making models are evaluated for effectiveness against the set criteria like Cost reduction,
return on investment, schedules and deadlines etc.
 The management science approach has made a significant impact on the practice of
management.
 The method and techniques developed under it are being increasingly used for
managerial decision making.
 This approach has contributed a lot in developing orderly thinking in management
leading to more exactness.
 The management science approach has given effective tools to solve problems of
planning and control.
 The approach covers only a part of the mangers job as it cannot effectively deal with
interpersonal and group relationships. Decision making is only a part of management.
d) The system approach:-
The system approach management was developed during the late 1950. The few many
pioneers such as E.S. Trist, A.K. Rise, F.E. kast have made significant contributions to this
made approaches. The fundamental features to this system approach are as follows.
1) An organization is a system consisting of many interrelated and interdependent parts
or orderly according to some scheme such as that the whole is more than sum of the
parts. This is called “synergy”
2) As a system an organization draws inputs (energy, information, materials, etc,) from
its return the output into the environmental. It transforms these inputs and returns the
output into the environment in the form of goods and services.

240
 3) Energy system is a part of a supra system (environment)
4) Organization is an open system and it interacts with its environment. It is also
dynamics systems as the equilibrium in its always changing. An organization
operates in a dynamic environment which certainty, it is probabilistic.
5) Management is expected to regulate and adjust the system to secure better
performance.
6) Management is multi disciplinary as it draws and integrates knowledge from various
disciplines.
Types of system approach:-
1. Closed system
A system is considered closed if it doses not interact with the environment physical
and mechanical system are closed systems because they are insulated from their external
environment.
2. Open system
A system is considered open if it interacts with its environment. All the biological,
human and social systems are open system because they interact with the environment.
Organization are open systems, constant interacting with their environment.

Environment

Input Out put

Transformation
process

Feedback

Organization an open system

Merits:-
 The system approach highlights the multidimensional and multidisciplinary nature of
management.
 It provides a better conceptual framework for analyzing and understanding
organizations and their management.
 It helps to focuses on dynamic interdependency between specialized functions.
 It is conductive to better understanding of the complicated interlocking network of
institutions.
Demerits:-
 Systems concepts are said to be abstract and usage.

241
  Too many subsystems and interdependence among them make the task of manager
very difficult.
e) Contingency approach:-
The contingency approach to management emerged from the real life experience of
managers who found that no single approach worked consistently in every situation. John
wodwad, P. R. Lorsch, J. Burns, T.M. have made significant contributions to the contingency
approach.
The main determinants of a contingency are related to the external and internal
environment of an organization.
a) External:-
Environment comprises, economic, social, technical and political factors influencing
the organization.
b) Internal:-
Internal environment or state of the organization refers to various constraints and
resources that are available. These includes
1) Technological constraints:-
Nature and type of the process used to produce goals and services.
2) Task constraints:-
Nature of task performed by individual workers.
3) People constraints;-
Type of individual employed and their level of competence.
Features of contingency approach:-
1) Management is entirely situational:-
There is no one best way managing an organization.
2) No one organization design can be suitable for all situations. The suitable design should be
determined keeping in views the size, technology,people and environment of the enterprise.
3) An organization interacts with its environment and must therefore, adopt itself to
environmental changes.
4) Management style and practice should match the requirements of the situation.
5) Success in management depends upon the ability to cope with environment demands.
Trends in management
Management development
During the last hundred years, management has become a more scientific discipline
with certain standardized principles and practices. It is two parts-
1) Early management
2) Modern management
1) Early management
i) Scientific management
ii) Administrative management
iii) Human relation movement
iv) Illumination experiments
2) Modern management
i) Classical approach
ii) Behavioural approach
iii) Quantitative approach
iv) System approach
V) Contingency approach
Summary:-

242
 Management is the act of gathering things done through others. Management
development is divided in to two type’s early management and modern management. In
modern management there are five approaches, classical behavioral science, management
science, systems and contingency approach.
MANAGEMENT BY OBJECTIVES

The concept
MBO is a way of practicing five basic management functions;
Planning, organizing, leading and controlling . George S. odiorne has stated MBO as
A process where by 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 of him, and use these measures as guides for operating the units and
assessing the contribution of each of its members.
Management by objectives (MBO) is a systematic and organized approach that allows
management to focus on achievable goals and to attain the best possible results from
available resources.
Management by Objectives (MBO) is a process of defining objectives within an
organization so that management and employees agree to the objectives and understand
what they are in the organization.
The term "management by objectives" was first popularized by Peter Drucker in his 1954
book 'The Practice of Management'.
The essence of MBO is participative goal setting, choosing course of actions and decision
making. An important part of the MBO is the measurement and the comparison of the
employee’s actual performance with the standards set. Ideally, when employees themselves
have been involved with the goal setting and choosing the course of action to be followed
by them, they are more likely to fulfill their responsibilities.
Unique features and advantages of the MBO process
The basic principle behind Management by Objectives (MBO) is for employees to have a
clear understanding of the roles and responsibilities expected of them. They can then
understand how their activities relate to the achievement of the organization's goal. MBO also
places importance on fulfilling the personal goals of each employee.
Some of the important features and advantages of MBO are:
1. Motivation – Involving employees in the whole process of goal setting and increasing
employee empowerment. This increases employee job satisfaction and commitment.
2. Better communication and Coordination – Frequent reviews and interactions between
superiors and subordinates helps to maintain harmonious relationships within the
organization and also to solve many problems.
3. Clarity of goals
4. Subordinates tend to have a higher commitment to objectives they set for themselves
than those imposed on them by another person.
5. Managers can ensure that objectives of the subordinates are linked to the
organization's objectives.

243
Limitations

There are several limitations to the assumptive base underlying the impact of managing by
objectives, including:
1. It over-emphasizes the setting of goals over the working of a plan as a driver of outcomes.
2. It underemphasizes the importance of the environment or context in which the goals are
set. That context includes everything from the availability and quality of resources, to relative
buy-in by leadership and stake-holders. As an example of the influence of management buy-
in as a contextual influencer, in a 1991 comprehensive review of thirty years of research on
the impact of Management by Objectives, Robert Rodgers and John Hunter concluded that
companies whose CEOs demonstrated high commitment to MBO showed, on average, a 56%
gain in productivity. Companies with CEOs who showed low commitment only saw a 6%
gain in productivity.
3. Companies evaluated their employees by comparing them with the "ideal" employee. Trait
appraisal only looks at what employees should be, not at what they should do.
When this approach is not properly set, agreed and managed by organizations, self-centered
employees might be prone to distort results, falsely representing achievement of targets that
were set in a short-term, narrow fashion. In this case, managing by objectives would be
counterproductive.
The use of MBO must be carefully aligned with the culture of the organization. While MBO
is not as fashionable as it was before the 'empowerment' fad, it still has its place in
management today. The key difference is that rather than 'set' objectives from a cascade
process, objectives are discussed and agreed upon. Employees are often involved in this
process, which can be advantageous.
A saying around MBO -- "What gets measured gets done", ‘Why measure performance?
Different purposes require different measures’ -- is perhaps the most famous aphorism of
performance measurement; therefore, to avoid potential problems SMART and SMARTER
objectives need to be agreed upon in the true sense rather than set.
AIMS of MBO
It aims to increase organizational performance by aligning goals and subordinate objectives
throughout the organization. Ideally, employees get strong input to identify their
objectives, time lines for completion, etc. MBO includes ongoing tracking and feedback in
the process to reach objectives.
Management by Objectives (MBO) was first outlined by Peter Drucker in 1954 in his book
'The Practice of Management'. In the 90s, Peter Drucker himself decreased the significance
of this organization management method, when he said: "It's just another tool. It is not the
great cure for management inefficiency... Management by Objectives works if you
know the  objectives, 90% of the time you don't."

BASIC TENENTS OF MBO

1. RESULT ORIENTATION

244
 One of the basic tenets of MBO is result orientation the other is the concept of human
behavior and motivation .MBO is thus the result orientation and motivation or aims
at achieving the laid down objectives influence policy, organization personnel,
leadership. And control.
2. HUMAN BEHAVIOUR AND MOTIVATION
The second basic tent that supports the concept of MBO is human behaviour and
motivation. In this respect let us discuss the theory of Abraham Maslow which is
popularly known as “Needs Theory”. The need theory is considered as a type of internal
motivation because an individual’s wants and needs exist within herself or himself. He or
she is consciously aware of some of his or her needs but not conscious about others. Need
theory is based on certain assumptions like:
 No need can ever be completely satisfied; hence only partial fulfilment of a need
is required before another need is allowed to appear.
 Needs are constantly changing within an individual, and they are often hidden
from one’s consciousness.
 Since needs are often group related, they are often interdependent. How a person
satisfies his/ her social needs is determined by his/ her socio-economic status.
Maslow’s theory of Hierarchy of Human Needs was formulated in 1943. Kalish has
further defined these needs into:
1) Survival needs
2) Stimulation needs
3) Safety needs
4) Love and belongingness needs
5) Esteem needs
6) Self actualisation needs
Fredrick Herzberg is another pioneer who has developed the “Motivation-Hygiene Theory”.
The development of the MBO concept owes a lot to the motivation theories. The
assumptions that MBO takes into account about human behaviour are also dependent on
these theories. MBO is essentially achievement and participation oriented.
In practising MBO, it is essential that the employees are directly and actively involved
in planning, directing and controlling of their jobs. Involvement brings in commitment, which
in turn acts as the motivator for achievement of the organization objectives.
What is the MBO System?
MBO is the process by which the members of an organization jointly formulate the
organizational goals. With the assistance from his/her supervision, each member:
 Define his/her area of responsibility accountability.
 Formulates specific objectives which he/ she is expected to accomplish.
 Develops performance measures to be used as standards for evaluation of his/her
performance in terms of his/her contribution towards achievement of goals
Laid down
objectives

Human Result
behavior & orientation
motivation
Programme implementation MBO

245
 Setting objectives

Action planning

Periodic review

Performance appraisal

3. System approach to management

4. Computer technology in management
MBO Process

246
THE MBO PROCESS

the six stages ofManagement by Objectives (MBO) are:

1. Define corporate objectives at board level

2. Analyze management tasks and devise formal job specifications, which allocate
responsibilities and decisions to individual managers
3. Set performance standards
4. Agree and set specific objectives
5. Align individual targets with corporate objectives
[Link] a management information system to monitor achievements against objectives.
Advantages
 MBO programs continually emphasize what should be done in an organization to
achieve organizational goals.
 MBO process secures employee commitment to attaining organizational goals.
Disadvantages
 The development of objectives can be time consuming, leaving both managers and
employees less time in which to do their actual work.

247
 The elaborate written goals, careful communication of goals, and detailed performance
evaluation required in an MBO program increase the volume of paperwork in an
organization.
MBO Strategy: Three Basic Parts5

1. All individuals within an organization are assigned a

special set of objectives that they try to reach during a
normal operating period. These objectives are mutually set
and agreed upon by individuals and their managers.
2. Performance reviews are conducted periodically to
determine how close individuals are to attaining their
objectives.
3. Rewards are given to individuals on the basis of how close
they come to reaching their goals.

Management Management by Objectives (MBO) Principles by Objectives (MBO)

Princ
Management by Objectives (MBO) Principles

 goals and objectives

 Specific objectives for each member
 Participative decision making
 Explicit time period
 Performance evaluation and feedback

248
 PLANNING AND ORGANIZING HOSPITAL UNITS AND ANCILLARY
SERVICES (SPECIFICALLY CSSD, LAUNDRY, KITCHEN,
LABORATORY SERVICES, EMERGENCY DEPARTMENT.
INTRODUCTION:
A hospital is a human invention, and as such can be reinvented at any time. Hospitals design
has been subject to many changes over the past 100 years or so in both layout and size. In the
early 20th century hospitals were basically places where the very sick spent their last days.
But today, emerging concepts of a hospital are calling for designs that promote wellness and
wellbeing rather than merely the treatment of diseases.
Health care organization, medical and pharmaceutical advances and medical technology
developments and patient expectations are continuously changing at a fast pace. The
implications of these changes on the planning and design of health care facilities are direct
and evident and the design response to them manifests itself in emerging planning concepts
and ideas.
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.

249
 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:-
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 society’s act or companies act. The
originator is the chairman and others are members who are assigned different tasks.

250
 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.
Additional availability of water in case, staff quarters and nurse’s 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 day2.
 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.

251
 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 OPD’s. 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.
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
building’s 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:

252
 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 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:

253
  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
 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 don’t 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.

254
  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 patient’s routine investigation, treatment and care needs.
b. Specific wards: these include patients admitted for specific care due ti illness or social
reasons. It includes:
 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 [Link] between two beds
is 31/2 to 4 ft.
 Clearance between wall and side of bed is 2ft.
 Length of bed is 6’6”, 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

255
  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.
 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.
 Auxillary areas: this section includes duty room for doctors, clinical side
room, seminar room, attendant room, locker room for staff.
 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. Rigg’s 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 rigg’s ward: side beds are placed in each bay separated from nurse’s
station with its standby services by a common corridor.
IV. Bilateral ward: it has been accepted as most suitable and workable conditions,
two unilateral rigg’s 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.
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

256
 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.
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
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.

257
  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.
Counter of receipt of
Decontamination and
used items
cleaning area
Processing
Separation of sterilized items by a partition or corridor
Packing of items

Distribution point Sterilized items store Sterilization

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 [Link]

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

Trolley wash 7.00

Trolley bay 10.50

Bulk store 17.50

258
 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 160-1800c for 40 minutes.
c. Gas sterilization with ethylene oxide
d. Sub atmospheric pressure sterilization with formalin: it is meant to disinfect
instruments like endoscopes. the temperature required is 900c 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:

259
 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.
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.

260
 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 [Link]./bed.
[Link] beds Space
200-300 beds 3750 [Link].
300-500 beds 5670 [Link].
500.600 Beds 6460 [Link].
>650 beds 8210 [Link].

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 [Link].
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 Decontamination and Boiler room
linen and storage sluice room
room

Toilet Washer

261
Laundry Staff room Store of Store of spare
manager detergent linen

Linen mending Hydro extractor

Issue area Storage of Pressing Drier

clean linen and

Ancillaries:
Laundry manager’s office
Stores
Tailoring bay
Worker’s 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 manager’s 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 week’s 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 1800F 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.

262
  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.
 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.

263
  Charter of duty of each person handling laundry and training schedule of
staffs.
 Sluicing and disinfection procedures.
 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
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.

264
 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.
They are further divided based on temperature requirements:
 items to be stored at room temperature like onion, potato etc
 Items require cool temperature (8-100c is maintained) for which walk-in
cooler can be provided to store milk, eggs, butter etc.
 Deep fridge where temperature is below 00c 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
Recipient area of Office store Walk-in Dry store Fresh store
provisioning keeper cold store

Dry store Preparation area

Dietician Trolley+ pot
Cooking
Supervisor wash area
area
Staff room Distribution area and
service
Staff toilet

265
 Wards

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 0c, 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
d. Histopathology
e. Urine and stool analysis
Functional planning:

266
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.
 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

267
 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.
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.

268
  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
Policies and procedures:
Laboratory samples: samples to be examined falls in two categories:
 Samples collected by nursing staffs in nursing units
 Samples obtained by lab. Personnel.
All requests for lab. Examinations must be in writing.
Sample receiving: in the reception area, all samples of blood, urine, body fluids etc
should be received at the reception counter. Sufficient racks and hand washing facility
should be provided in this area.
Request forms: all request forms should be uniform in size and contain only pertinent
information.
Time for accepting specimens: a time schedule for accepting certain types of
specimen will facilitate the operations of the laboratory.
Containers: all specimens sent should be in proper containers. Instructions on the time
of taking specimens, minimum volume required, type of container etc. Should be
posted at the nurse’s station in wards.
Identification of specimen: the lab. Personnel should be responsible for proper
disposition of all specimens and requests within the lab. to identify the specimen
received, the specimen and request form should be numbered with same number and
is also entered in the request register.
Reports and records: lab. Personnel should give reports only to authorized ward/ OPD
personnel and never directly to patients. A daily record register should be kept of all
examinations performed in the lab. In order to maintain a monthly and yearly account
of the work done.
Blood bank services: it should be controlled by the officer in charge and the technical
supervisor, to ensure that all are aware of the establishment of written procedures for
identification of blood samples, storage facility etc.
Outpatient samples: it is necessity in large hospitals where the volume of workload
from outpatient department is considerable.
HIV: necessary safety precaution should be clearly understood by all concerned while
drawing blood samples from suspected HIV and hepatitis patients.
Liaison with clinicians: differences between the patients lab. reports as compared to
their clinical status arises which should be discussed in the medical audit committee.
Motivation and cross-training: the in charge should discuss professional, technical and
administrative matters concerning the laboratory during periodical meetings with
staff. The lab. Policy must lie down that all staff is cross-trained to work in all the
different sections of the laboratory.
Waste disposal: histopathology and microbiology laboratory waste be considered as
hazardous waste and should be disposed accordingly.

269
 Optimal utilization of laboratory services: to better utilize the laboratory services, a
constant emphasis is needed on ordering only the appropriate tests required for
diagnosis or prognosis based on clinical judgment and filling the required form s
completely.
Quality control: as a part of quality control function, standard operating procedure
should be laid down by the in charge pathologist for each function and each
functionary in the laboratory.
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:
 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 [Link] 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. Visitor’s toilet: it should be provide near the main waiting space.
8. Nurse’s 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 Boyle’s 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

270
 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.
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 m2
 Storage space
 Utility and soiled linen room-7 m2
 Cleaners room-house keepers room 4m2
 Change room duty rooms 9m2
 Conference room and reference library 8m2
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 patient’s knowledge regarding procedures.
Medical records: medical records and proper record keeping are high priority
in any hospital. Proper documentation of patient’s case history with informed
consent is necessary.
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.

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.”

271
 Jean barrett
Who is the effective member of the patient care team? Sir William Osler said that the
nurse is one of the greatest blessings of humanity. Nursing has a large, important and unique
role in the health care delivery system of a country. Nursing care is extremely important for
good patient outcome. While the physician plans the treatment and surgeon carries out the
operation, it is the nurse who gives 24 hrs / round the clock nursing care and looks after the
needs of the patient. The success of the patient care depends upon the competence of the
nursing staff. Organizing the high level of nursing care is a big challenge for the nursing
service administrator. Setting of standards and goals for providing care to patients depends
upon the philosophy of nursing in order to organize the patient care.
OBJECTIVES
♪ General objective:
At the end of the seminar the student will be able to understand about the organizing
of nursing service and patient care and its detail.
♪ Specific objectives:
By the end of the seminar, the students will be able to:
► Explain the meaning of nursing service and nursing service administration.
► Define nursing service and patient care.
► Understand the philosophy of nursing service.
► Describe the objectives of nursing service.
► Know the principles of nursing service.
► Identify the functions of nursing service.
► Enumerate the essential characteristics of good nursing service department.
► Describe the organization of nursing service at various levels.
► List out the role and functions of nurse administrator.
► Mention the problems and challenges faced by the nursing service.
► Know about the patient classification system.
► Enumerate the modes of organizing patient care.
► Explain the factors influencing the quality patient care.

TERMINOLOGIES:

Case method In this method, nurses assume total responsibility for meeting all the
needs of assigned patients during their time on duty.

Modular nursing The patient unit is divided into modules or districts, and the same
team of caregivers is assigned consistently to the same geographic
location

Nursing service It is the part of the total health organization which aims at satisfying
the nursing needs of the patients/community.

Objective The goal intended to be attained (and which is believed to be

attainable).

272
 Organizing It involves grouping activities together and assigning the
responsibility of each group of activity to a manager who has
adequate authority to fructify the activity/task at hand.

Patient Patient classification system (PCS), which quantifies the quality of

classification system the nursing care, is essential to staffing nursing units of hospitals and
nursing homes.

Patient care Care of the sick and injured and restoration of the health of a diseased
person without any decimation.

Performance A formal assessment of an employee’s performance.

appraisal

Philosophy Statement of beliefs and values that directs behavior.

Primary nursing It is a method of nursing practice which emphasizes continuity of care

by having one nurse provides complete care for a small group of
inpatients within a nursing unit of a hospital.

Team nursing It is a group that works together toward a common goal, providing
qualitative comprehensive nursing care.

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.
PHILOSOPHY OF NURSING SERVICE IN HOSPITAL
The department of nursing services of hospital recognizes and appreciates the
objectives of the hospital and acknowledges that the primary purpose of nursing is to provide
the highest quality care services.
 The quality in nursing care and management of nursing services is achieved through
professional nurses who assist in the development of comprehensive programs of delivering
nursing care.
 The quality of nursing care services is clearly and directly related to continuing growth and
development of nursing personnel.

273
  High quality of nursing care can be best provided by a mixture of professional and non
professional personnel who are organized into self directed work teams.
 To ensure continuous improvement of nursing care quality, the role of professional nurse
must include responsibility of nursing research and nursing education.
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.
 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.

274
  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.
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 assiststatement
Written other members of theand
of purposes team to plan and
objectives carry out
of nursing the total programme of care.
services
The Plan
organization of nursing care constitutes a subsystem for achieving the hospital’s
of organization
overall objective.
Policy Nursing care
and administrative of patients generally takes forms:
manuals
 Technical
Nursing practice manual
Nursing service budget
 Educational
Master
 staffing
Trustingpattern
relationship
Nursing care appraisal plan
The director
Nursing serviceof nursing service
administrative is delegated the authority
meetings and responsibilities for
organizing and administrating
Adequate the nursing
infrastructure facilities, services
supplies in hospital. It is
and equipment her duty to institute the
essentialWritten
characteristics of good
job description nursing
& job services in her institute such
specifications as:
Personnel records
Personnel policies
Health services
In–service education
Co-ordination
Advisory committee

275
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.
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, nurse’s 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

276
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 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.
In-service education:
It is the essential components of staff development programme, which aims at
augmenting, reinforcing nurse’s knowledge, skill and attitude. It includes orientation
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.

277
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
DGHS

[Link] (PH) [Link] (N) [Link] (M)

ADG ADG ADG

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

DADG DADG
DADG
Community & Nsg officer Principal [Link]
PHN Supervisor Senior Tutor [Link]
PHN Tutor [Link]
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

278
 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 [Link]
PH. Nsg officer Principal [Link]
PHN at PHC Senior Tutor [Link]
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&[Link]) ADNO (Community)

Nsg Supt/[Link] Principal tutor [Link]

[Link] 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

279
  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
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.
♪ Welfare
♣ Responsible for health and welfare of nursing staff.
♣ Ensures annual and periodical health examination and maintenance of health records.
♪ Conferences

280
 ♣ 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.
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 organization’s 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

281
 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.
 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 patient’s 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

282
 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.
Patient Care Classification
Area of care Category I Category II Category III Category IV
Eating Feeds self Needs some help in Cannot feed self but is Cannot feed self
preparing able to chew and any may have
swallowing difficulty
swallowing
Grooming Almost Need some help in Unable to do much for Completely
entirely self bathing, oral hygiene … self dependent
sufficient

Excretion Up and to Needs some help in In bed, needs bedpan / Completely

bathroom getting up to urinal placed; dependent
alone bathroom /urinal

Comfort Self Needs some help with Cannot turn without Completely
sufficient adjusting position/ bed.. help, get drink, adjust dependent
position of extremities
…

General Good Mild symptoms Acute symptoms Critically ill

health

Treatment Simple – Any Treatment more Any treatment more Any elaborate/
supervised, than once per shift, foley than twice /shift… delicate procedure
simple catheter care, I&O…. requiring two
dressing… nurses, vital signs
more often than
every two hours..

Health Routine Initial teaching of care More intensive items; Teaching of

education & follow up of ostomies; new teaching of resistive patients,
teaching teaching diabetics; patients with apprehensive/ mildly
mild adverse reactions resistive patients….
to their illness…

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

283
 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. Nurse’s 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 patient’s 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.
♣ RNs were self-employed.
♣ Work load can be equally divided by the staff.
♣ Nurse’s 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:

284
 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.

Charge Nurse

RN RN LPN UAP
Medication Nurse Treatment Nurse Vital signs Nurse Hygiene
Nurse

Patients assigned to the team

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 person’s 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:

285
 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.

Charge Nurse RN

Team Leader RN Team Leader RN

RN LPN NA RN LPN NA

Group of Patients Group of Patients

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”.

286
 ♠ It is expensive because of the increased number of personnel needed.
♠ 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 patient’s
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.

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

287
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.
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

288
 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 nurse’s 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.

Patients

Total patient care 24 hrs/day

Communicates with PRIMARY NURSE

Consults with physician
supervisors or other healthcare
providers

Associate (days) Associate (afternoon) Associate (evenings)

when primary nurse when primary nurse is when primary nurse
is not available not available is not available

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:

289
 ♠ 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 patient’s 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 nurse’s talent to his/her own patients.

CASE MANAGEMENT
Features:
The case manager (RN or social worker with managerial qualification) is assigned
responsibility of following a patient’s 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
managers are employed by third party payers (e.g. insurance companies) by the hospital
authorities (e.g. for heart surgeries, renal transplant, reconstructive surgeries, etc.), by clubs,
industrialists and associations or by individuals, e.g. geriatric, family or private patients case
managers. No direct care by the manager whose main roles are of teaching, advocacy and
coordinating with health care providers. Case manager (nurse) ensures quality care that is
holistic and assisting the patient to attain self care status according to his/her potential. It
emphasizes achievement of outcomes in designated time frames with limited resources.
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 client’s 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 client’s care.
Merits:

290
 ♣ 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
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.
CONCLUSION
Nursing is vital aspect of health care and needs to be properly organized. A nurse is in
frequent contact with of the patients hence his/her role in educational aspect and service aspect in
restoring health and confidence of the patient is of utmost importance. The quality of nursing care and
the management of the nursing staff, reflects an image of the hospital/ nursing home. Many changes
have taken place in the health care delivery system as it struggles with cost and providing care
corresponding to changes in the education of health professionals and their function within the
system. According to their educational qualification and patient acuity they are delivering care to the
patients throughout their hospital stay. The structures of the delivery of care have taken many
different formats.

Organization

291
INTRODUCTION
Organization is the backbone of management. Without efficient organization, no
management can perform its functions smoothly. Sound organization contributes greatly to
the continuity and success of the enterprise. A poor organization structure makes good
performance impossible, no matter how good the individuals may be. The right
organizational structure is the necessary foundation, without it the best performance will be
ineffectual and frustrated.
MEANING
Organization implies a formalized intentional structure of roles or positions. (Harold
Kooutz)
DEFINITION
An organization is a group of individrels coordinate into different levels of authority
and segments of specialization or the purpose of achieving the goals and objectives of
organization (Jcootz Herriod , 1993)
It is an attempt to explain predict and influence behaviour of individuals income
enterprise. (Chabbra. T. 2003)
NATURE AND CHARACTERISTICS OF ORGANIZATION
The nature and characteristics of organization can be studied under following headings:
1. Organization as a group of persons
2. Communication
3. Organizing is a basic function of management
4. Organizing is a continuous process
5. Organizing is always related to certain objectives
6. Organization connotes a structure of relationships
7. Organization involves a network of authority and responsibility relationships
(i) Organization as a group of persons
It is an identifiable group of people contributing their efforts towards the attainment of
goals.
(ii) Communication
It is the nervous system of organization. The organizational members are able to
communicate with each other and they coordinate their activities.
(iii) Organizing is a basic function of management
It is essential for the achievement of organizational objectives. It is done in relation to
all other functions of management, namely, planning, staffing, directing and controlling and
all the areas of business, namely, purchasing, production, marketing, personnel etc.
(iv) It is a continuous process
It is not a one step function. Managers are continuously engaged in organizing and re-
organizing. It is a process of defining and grouping the activities of the enterprise and
establishing authority relationships among them.
(v) It is always related to certain objectives
The operations are divided and authority and responsibility are determined to achieve
the predetermined objectives.

292
 (vi) Organization connotes a structure of relationships
Both formal and informal relationships is necessary to understand the nature of any
organization.
(vii) Organization involves a network of authority and responsibility relationships
–
Organization must be clearly defined to achieve coordination and to avoid conflicts
between individuals and departments.
PRINCIPLES OF ORGANIZATION
 Consideration of objectives
 Division of work and specialization
 Definition of jobs
 Separation of line and staff functions
 Chain of Command
 Parity of authority and responsibility
 Unity of Command
 Exceptional Matters
 Span of supervision
 Balancing of various factors
 Communication
 Flexibility
 Continuity
1. Consideration of objectives
An enterprise strives to accomplish certain objectives. Organization serves as a tool to
attain these objectives. The principle of consideration of objectives states that only after the
objectives have been stated, an organization structure should be developed to achieve them.
2. Division of work and specialization
The entire work in the organization should be divided into various parts, so that every
individual is confined to the performance of single job, as far as possible, according to his
ability and aptitudes.
3. Definition of jobs
The duties and responsibilities assigned to every position and its relationship with other
positions should be clearly defined so that there may not be any overlapping of functions.
4. Separation of line and staff functions
Whenever possible line functions should be separated from staff activities line
functions are those which accomplish the main objectives of the company.
5. Chain of Command
There must be clear lines of authority running from the top to the bottom of the
organization. Authority has the right to decide, direct and coordinate.
6. Parity of authority and responsibility
Responsibility should always be coupled with corresponding authority. Each
subordinate must have sufficient authority to discharge the responsibility entrusted to him.

293
7. Unity of Command
No one in the organization should report to more than one supervisor. Everyone in the
organization should know who he reports and who reports to him. Receiving directions from
several supervisors may result in confusion, chaos, conflicts and lack of action.
8. Exceptional Matters
This principle requires that organization structure should be so designed that managers
are required to go through the exceptional matters only.
9. Span of supervision
The span of supervision means the number of persons a manager or a supervisor can
direct.
10. Balancing of various factors
There should be proper balance in the formal structure of the organization as regard
factors having conflicting claims,
Ex., between centralization and decentralization, span of supervision and lines of
communication and authority allocated to departments and personnel at various levels.
11. Communication
A good communication network is essential to achieve the objectives of an
organization
12. Flexibility
The organization structure should be flexible so that it can be easily any economically
adapted to the changes in the nature of business as well as technical innovations. Flexibility
of organization structure ensures the ability to change with the environment before something
serious may occur.
13. Continuity
Change in the law of nature. Many changes take place outside the organization. These
changes must be reflected in the organization. For this, the form of organization structure
must be organic which would help attain its objectives and ensure its effectiveness over a
long period of time.

ORGANIZATION PROCESS
The organization process is the formation of structural inters personal relationship.
This process involves
 Determination of organization goals or objectives to be strived for
 Determination of the basic requirement. ie. amount of skills, effort and
knowledge, necessary to achieve the goals.
 Szlection of personnel of fill jobs.
 Assignment of work position to the individuals.
 Determination of superior subordinate relationship for facilitation the
performance evaluation.
Function of organization

294
 An organization fives of stabilizations effective behavioral relationship among selected
employees and in selected work place in order that a group them work together effectively.
There are three kinas of work which must be performed and organization comes into being.
 Division of labour
 Combination of labour
 Co-ordination
Division of labour
Since an organization is a structure of human association for the achievement of
common goals, it involves individuals and groups of individurels. When two or more
individuals join together to perform certain tasks, it follows the some division of work is
done.
Combination of labour
With work divides and assignee to the members of an organization, their divivites are
group together, forming operation and operations are corrected to stabilization system and
processes.
Co-ordination
This all inclusive principle emerges because of the need in every organization for the
integration of activities and the co-ordination of individuals and groups of individuals
performing their tasks. It is achieved thmoges leadership in the structural sense it involves the
fixing of responsibility and the delegation of authority.
1. Concepts of organization structures
2. Task accomplishment of personnel statistician
3. Delegation of authority
4. Degree of specialization
5. Communication channel should be proper.
STEPS IN ORGANIZING
1. Determination of objectives
2. Identification and grouping of activities
3. Assignment of duties
4. Developing authority – Responsibility Relationships
1. Determination of objectives :
 Organization is always related to certain objectives.
 Therefore, it is essential for the management to identify the objectives before starting
any activity.
 It will help the management in the choice of men and materials with the help of which
it can achieve its objectives.
2. Identification and grouping of activities :
 If the members of the group are to pool their efforts effectively.
 There must be proper division of the major activities.
 Each job should be properly classified and grouped.
3. Assignment of duties :

295
 After classifying and grouping the activities into various jobs, they should be allotted to
the individuals so that there are round pegs in round holes.
4. Developing authority – Responsibility Relationships :
Everybody should clearly know to whom he is accountable. This will help in the
smooth working of the enterprise by facilitating delegation of responsibility and authority.
types of organization
formal
informal
formal organization
definition
it is a executive decision determined by planning. It can be diagrammed to show the
relationships among people and their positions. It describes positions, task responsibilities
and relationship.
it is a inflexible one.
there should be room for discretion for advantages, utilization of creative talents and for
recognition of individual likes and capacities in the most formal organization.
it should be co operative activity.
merits of formal organization structure
available resource will be utilize in the most effective way.
directional and operational goals and procedure will be determined clearly and energies
devoted to their achievement.
the activities of the individuals and the group will become more rational, stable and
predictable.
Drawbacks
very often the fixed relaltionships and lines of authority seem inflexible and difficult to adjust
to meet changing needs.
interpersonal communication may be slowed or stopped as a result of strict formal lines of
communication.
workers may become less willing to assume duties that are not formally part of their original
assignment.
they produce anxiety in individual worker by pressing too heavily for routine and conformity.
individual creativity and originality may be suppress by the rather rigid determination of
duties and responsibilities.
informal organization
informal organization is very difficult to understand until and unless we examine the
role of informal organization
function of informal group members
they are natural units where the actual operations for getting thing done are determined.
they provide simultaneously the climate for supporting experimental with new methods of
work
they provide each member with sympathetic human consideration which supports his self
image, personality and integrity.

296
 Planning for Change
 
It is surprising how many change efforts are done with inadequate planning, and with
consequent problems during implementation.
Understand the people
As covered other areas, but worth repeating here, you need to understand the people, both in
terms of the legitimate needs they have regarding the change and also the personal concerns
and potential responses.
 Stakeholders in Change: Who are they? How might they behave?
 The Psychology of Change: How will they react when they are told?
 Resistance to Change: How might they push back against the change?
Understand the task
The basic part of change is the simple 'task' making the changes as if people would be fully
committed without any problem. Getting this right has to be balanced with understanding the
people. One of the key problems in change is managing this balance. Often, the people side
is under-done, although it also possible to fret too much about the people and forget the
nitty-gritty detail of getting things done.
 Diagnosing Change: Investigation to understand the need for change.
 Scope of Change: both 'what' and 'who' affect the size of the project.
 Five Levels of Change: From small to huge.
Build the plans
When planning for change, you need to consider both the actions to make the change and the
(often far more problematic) problems you might meet in gaining the required commitment
to carry the actions through.
 Styles of Change: the style used should match the scope.
 The Change Delivery Plan: Creating an unstoppable train of events.
 The Commitment Plan: Bringing the people with you.
 Sponsorship of Change: You will need senior management support.
 Cultural Change Planning: Understanding links between thoughts and actions.
 Change Strategy: Approaches that can be used.

Planning and Analysis in Change Management

By Susan M. Heathfield, [Link] Guide
 change management
 action plans
 strategic planning
 communication
 trust
While the executive vision and support, clearly communicated, is important, it is not enough.
More fundamental approaches to planning and analysis need to occur to encourage effective
change management.
 Assess the readiness of your organization to participate in the change. Instruments are
available to help you assess readiness, as well as qualitative information from internal or
external staff and consultants. Answer questions such as these. What is the level of trust
within your organization? Do people feel generally positive about their work environment.

297
 Do you have a history of open communication? Do you share financial information?

These factors have a tremendous impact on people’s acceptance of and willingness to

change. If you can start building this positive and supportive environment prior to the
change, you have a great head start on the change implementation.

 Turn the change vision into an overall plan and timeline, and plan to practice
forgiveness when the timeline encounters barriers. Solicit input to the plan from people
who “own” or work on the processes that are changing.

 Gather information about and determine ways to communicate the reasons for the
changes. These may include the changing economic environment, customer needs and
expectations, vendor capabilities, government regulations, population demographics,
financial considerations, resource availability and company direction.

 Assess each potential impact to organization processes, systems, customers and staff.
Assess the risks and have a specific improvement or mitigation plan developed for each
risk.

 Plan the communication of the change. People have to understand the context, the
reasons for the change, the plan and the organization’s clear expectations for their changed
roles and responsibilities. Nothing communicates expectations better than improved
measurements and rewards and recognition.

 Determine the WIIFM (what’s in it for me) of the change for each individual in your
organization. Work on how the change will affect each individual directly, and how to
make the change fit his or her needs as well as those of the organization.

 Some respondents found the development of a theoretical underpinning for the change
effective in helping individuals understand the need for change.

 Be honest and worthy of trust. Treat people with the same respect you expect from
them.

New Venture Plan

A new venture plan usually refers to a plan for starting and operating a new business venture.
A new venture is usually a business enterprise involving some risk in expectation of gain.
Venture is often used to refer to a risky start-up. The term is broad enough however to
encompass tasks related to any new venture whether initiated by an individual, group or
organization for a profit or non-profit motive. 
What Is Venture Planning?
1. Venture Planning is a personal assessment of your feelings and the feasibility of a
venture.
2. Venture Planning answers the question, should I be doing this and why?
3. The Venture Feasibility process examines seven key factors in any venture.

298
 a. The Founders' Compelling Interest:  The force that drives you.
b. Customer Opportunities based on customer wants and needs.
c. Customer Profiles defines the target market and potential customers
d. Venture Concepts evaluates alternatives to filling those needs.
e. Financial Resources identifies and evaluates the financial resources need to
pursue alternative venture models.
f. Entrepreneurial Assessment to find out if the entrepreneur and the venture
are in alignment with respect to goals rewards, compelling interests and the
ventures mission.
g. Final venture evaluation of feasibility and comparison of alternatives.
4. What Venture Planning is not?  It is not about writing a Business Plan.  Sometimes a
business plan is not needed.
5. Venture Planning does not require detailed funding source analysis, professional
opinions, entity formation or detailed market analysis.
6. Venture Planning is development of a means of comparing various business models,
usually through financial modeling to answer the six questions.
7. 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.
8. There are four keys to good venture planning:
a. Focus on one venture at a time in one business area at a time.
b. Discover the opportunity first, and then evaluate how to exploit it.
c. Develop three cases good, bad & likely for each scenario of a venture
concept.
d. 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.  Do you want:
i. a Lifestyle Business with $1 million in annual sales, 1-4 employees
and a solo operation?
ii. a Smaller High Profit Business with $1-$20 million in sales, 5 - 50
employees, where partners are required?, or
iii. a High Growth Business with $20-50 million or more in sales with
more than 50 employees, that requires venture capital, investment banks
and a public company?

Management plans and strategies

 Protected area management plan register
 Management Strategies
Protected area management plans
The Nature Conservation Act requires the Minister, as soon as practicable after the
dedication of a national park (scientific), a national park, a national park (recovery), a
conservation park or a resources reserve or after the declaration of a nature refuge, a co-

299
 ordinated conservation or a wilderness area, to prepare a management plan for the area.
Each protected area will be managed according to provisions of the plan.
A proposal to prepare a draft management plan must be advertised publicly and
submissions invited from landholders, local governments, interested groups and persons
including Aborigines and Torres Strait Islanders and members of the public. All
submissions properly made must be considered.
The draft plan must then be advertised similarly and submissions invited.
A final plan must be consistent with the management principles for the area and specify
management outcomes for the protection, presentation, and use of the area and the
policies, guidelines and actions to achieve the outcomes.
On approval of the management plan by the Governor-in-Council, the chief executive
must give effect to the plan.
Approved plans are listed in the Protected area management plan register.
Requests for copies of approved management plans should be made to the particular
QPWS park office or to the relevant QPWS District office.
Management strategies can be prepared for QPWS-managed areas before the development
of one or more management plans.

MANAGEMENT BY OBJECTIVES
The concept
MBO is a way of practicing five basic management functions;
Planning, organizing, leading and controlling . George S. odiorne has stated MBO as
A process where by 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 of him, and use these measures as guides for operating the units and
assessing the contribution of each of its members.
Management by objectives (MBO) is a systematic and organized approach that allows
management to focus on achievable goals and to attain the best possible results from
available resources.
Management by Objectives (MBO) is a process of defining objectives within an
organization so that management and employees agree to the objectives and understand
what they are in the organization.
The term "management by objectives" was first popularized by Peter Drucker in his 1954
book 'The Practice of Management'.
The essence of MBO is participative goal setting, choosing course of actions and decision
making. An important part of the MBO is the measurement and the comparison of the
employee’s actual performance with the standards set. Ideally, when employees themselves
have been involved with the goal setting and choosing the course of action to be followed
by them, they are more likely to fulfill their responsibilities.
Unique features and advantages of the MBO process
The basic principle behind Management by Objectives (MBO) is for employees to have a
clear understanding of the roles and responsibilities expected of them. They can then
understand how their activities relate to the achievement of the organization's goal. MBO also
places importance on fulfilling the personal goals of each employee.
Some of the important features and advantages of MBO are:

300
 6. Motivation – Involving employees in the whole process of goal setting and increasing
employee empowerment. This increases employee job satisfaction and commitment.
7. Better communication and Coordination – Frequent reviews and interactions between
superiors and subordinates helps to maintain harmonious relationships within the
organization and also to solve many problems.
8. Clarity of goals
9. Subordinates tend to have a higher commitment to objectives they set for themselves
than those imposed on them by another person.
[Link] can ensure that objectives of the subordinates are linked to the
organization's objectives.
Limitations

There are several limitations to the assumptive base underlying the impact of managing by
objectives, including:
1. It over-emphasizes the setting of goals over the working of a plan as a driver of outcomes.
2. It underemphasizes the importance of the environment or context in which the goals are
set. That context includes everything from the availability and quality of resources, to relative
buy-in by leadership and stake-holders. As an example of the influence of management buy-
in as a contextual influencer, in a 1991 comprehensive review of thirty years of research on
the impact of Management by Objectives, Robert Rodgers and John Hunter concluded that
companies whose CEOs demonstrated high commitment to MBO showed, on average, a 56%
gain in productivity. Companies with CEOs who showed low commitment only saw a 6%
gain in productivity.
3. Companies evaluated their employees by comparing them with the "ideal" employee. Trait
appraisal only looks at what employees should be, not at what they should do.
When this approach is not properly set, agreed and managed by organizations, self-centered
employees might be prone to distort results, falsely representing achievement of targets that
were set in a short-term, narrow fashion. In this case, managing by objectives would be
counterproductive.
The use of MBO must be carefully aligned with the culture of the organization. While MBO
is not as fashionable as it was before the 'empowerment' fad, it still has its place in
management today. The key difference is that rather than 'set' objectives from a cascade
process, objectives are discussed and agreed upon. Employees are often involved in this
process, which can be advantageous.
A saying around MBO -- "What gets measured gets done", ‘Why measure performance?
Different purposes require different measures’ -- is perhaps the most famous aphorism of
performance measurement; therefore, to avoid potential problems SMART and SMARTER
objectives need to be agreed upon in the true sense rather than set.
AIMS of MBO

301
 It aims to increase organizational performance by aligning goals and subordinate objectives
throughout the organization. Ideally, employees get strong input to identify their
objectives, time lines for completion, etc. MBO includes ongoing tracking and feedback in
the process to reach objectives.
Management by Objectives (MBO) was first outlined by Peter Drucker in 1954 in his book
'The Practice of Management'. In the 90s, Peter Drucker himself decreased the significance
of this organization management method, when he said: "It's just another tool. It is not the
great cure for management inefficiency... Management by Objectives works if you
know the  objectives, 90% of the time you don't."

BASIC TENENTS OF MBO

5. RESULT ORIENTATION
One of the basic tenets of MBO is result orientation the other is the concept of human
behavior and motivation .MBO is thus the result orientation and motivation or aims
at achieving the laid down objectives influence policy, organization personnel,
leadership. And control.
6. HUMAN BEHAVIOUR AND MOTIVATION
The second basic tent that supports the concept of MBO is human behaviour and
motivation. In this respect let us discuss the theory of Abraham Maslow which is
popularly known as “Needs Theory”. The need theory is considered as a type of internal
motivation because an individual’s wants and needs exist within herself or himself. He or
she is consciously aware of some of his or her needs but not conscious about others. Need
theory is based on certain assumptions like:
 No need can ever be completely satisfied; hence only partial fulfilment of a need
is required before another need is allowed to appear.
 Needs are constantly changing within an individual, and they are often hidden
from one’s consciousness.
 Since needs are often group related, they are often interdependent. How a person
satisfies his/ her social needs is determined by his/ her socio-economic status.
Maslow’s theory of Hierarchy of Human Needs was formulated in 1943. Kalish has
further defined these needs into:
7) Survival needs
8) Stimulation needs
9) Safety needs
10) Love and belongingness needs
11) Esteem needs
12) Self actualisation needs
Fredrick Herzberg is another pioneer who has developed the “Motivation-Hygiene Theory”.
The development of the MBO concept owes a lot to the motivation theories. The
assumptions that MBO takes into account about human behaviour are also dependent on
these theories. MBO is essentially achievement and participation oriented.
In practising MBO, it is essential that the employees are directly and actively involved
in planning, directing and controlling of their jobs. Involvement brings in commitment, which
in turn acts as the motivator for achievement of the organization objectives.
What is the MBO System?
MBO is the process by which the members of an organization jointly formulate the
organizational goals. With the assistance from his/her supervision, each member:

302
  Define his/her area of responsibility accountability.
 Formulates specific objectives which he/ she is expected to accomplish.
 Develops performance measures to be used as standards for evaluation of his/her
performance in terms of his/her contribution towards achievement of goals.

Laid down
objectives

Human Result
behavior & orientation
motivation
Programme implementation MBO
Setting objectives

Action planning

Periodic review

Performance appraisal

7. System approach to management

8. Computer technology in management
MBO Process

303
THE MBO PROCESS

the six stages ofManagement by Objectives (MBO) are:

6. Define corporate objectives at board level

7. Analyze management tasks and devise formal job specifications, which allocate
responsibilities and decisions to individual managers

304
 8. Set performance standards
9. Agree and set specific objectives
10. Align individual targets with corporate objectives
[Link] a management information system to monitor achievements against objectives.
Advantages
 MBO programs continually emphasize what should be done in an organization to
achieve organizational goals.
 MBO process secures employee commitment to attaining organizational goals.
Disadvantages
 The development of objectives can be time consuming, leaving both managers and
employees less time in which to do their actual work.
The elaborate written goals, careful communication of goals, and detailed performance
evaluation required in an MBO program increase the volume of paperwork in an
organization.
MBO Strategy: Three Basic Parts5

4. All individuals within an organization are assigned a

special set of objectives that they try to reach during a
normal operating period. These objectives are mutually set
and agreed upon by individuals and their managers.
5. Performance reviews are conducted periodically to
determine how close individuals are to attaining their
objectives.
6. Rewards are given to individuals on the basis of how close
they come to reaching their goals.

Management Management by Objectives (MBO) Principles by Objectives (MBO)

Princ

305
 Management by Objectives (MBO) Principles

 goals and objectives

 Specific objectives for each member
 Participative decision making
 Explicit time period
 Performance evaluation and feedback

Gantt chart
A Gantt chart is a type of bar chart that illustrates a project schedule. Gantt charts illustrate
the start and finish dates of the terminal elementsand summary elements of a project.
Terminal elements and summary elements comprise the work breakdown structure of the
project. Some Gantt charts also show the dependency (i.e., precedence network) relationships
between activities. Gantt charts can be used to show current schedule status using percent-
complete shadings and a vertical "TODAY" line as shown here.
Although now regarded as a common charting technique, Gantt charts were considered
revolutionary when they were introduced. In recognition of Henry Gantt's contributions,
the Henry Laurence Gantt Medal is awarded for distinguished achievement in management
and in community service. This chart is used also in Information Technology to represent
data that have been collected.
Historical development
The first known tool of this type was reportedly developed in 1896 by Karol Adamiecki, who
called it a harmonogram. Adamiecki did not publish his chart until 1931, however, and then
only in Polish. The chart is named after Henry Gantt (1861–1919), who designed his chart
around the years 1910–1915.
In the 1980s, personal computers allowed for widespread creation of complex and elaborate
Gantt charts. The first desktop applications were intended mainly for project managers and
project schedulers. With the advent of the internet and increased collaboration over networks
at the end of the 1990s, Gantt charts became a common feature of web-based applications,
including collaborativegroupware.
Advantages and limitations
Gantt charts have become a common technique for representing the phases and activities of a
project work breakdown structure (WBS), so they can be understood by a wide audience all
over the world.
A common error made by those who equate Gantt chart design with project design is that
they attempt to define the project work breakdown structure at the same time that they define
schedule activities. This practice makes it very difficult to follow the 100% Rule. Instead the
WBS should be fully defined to follow the 100% Rule, then the project schedule can be
designed.
Although a Gantt chart is useful and valuable for small projects that fit on a single sheet or
screen, they can become quite unwieldy for projects with more than about 30 activities.
Larger Gantt charts may not be suitable for most computer displays. A related criticism is that

306
Gantt charts communicate relatively little information per unit area of display. That is,
projects are often considerably more complex than can be communicated effectively with a
Gantt chart.
Gantt charts only represent part of the triple constraints (cost, time and scope) of projects,
because they focus primarily on schedule management. Moreover, Gantt charts do not
represent the size of a project or the relative size of work elements, therefore the magnitude
of a behind-schedule condition is easily miscommunicated. If two projects are the same
number of days behind schedule, the larger project has a larger impact on resource utilization,
yet the Gantt does not represent this difference.
Although project management software can show schedule dependencies as lines between
activities, displaying a large number of dependencies may result in a cluttered or unreadable
chart.
Because the horizontal bars of a Gantt chart have a fixed height, they can misrepresent the
time-phased workload (resource requirements) of a project, which may cause confusion
especially in large projects. In the example shown in this article, Activities E and G appear to
be the same size, but in reality they may be orders of magnitude different. A related criticism
is that all activities of a Gantt chart show planned workload as constant. In practice, many
activities (especially summary elements) have front-loaded or back-loaded work plans, so a
Gantt chart with percent-complete shading may actually miscommunicate the true schedule
performance status.
Example
In the following example there are seven tasks, labeled A through G. Some tasks can be done
concurrently (A and B) while others cannot be done until their predecessor task is complete
(C cannot begin until A is complete). Additionally, each task has three time estimates: the
optimistic time estimate (O), the most likely or normal time estimate (M), and the pessimistic
time estimate (P). The expected time (TE) is computed using the formula (O + 4M + P) ÷ 6.

Time estimates
Activit
Predecessor Normal Expected time
y Opt. (O) Pess. (P)
(M)
A — 2 4 6 4.00
B — 3 5 9 5.33
C A 4 5 7 5.17
D A 4 6 10 6.33
E B, C 4 5 7 5.17
F D 3 4 8 4.50
G E 3 5 8 5.17
Once this step is complete, one can draw a Gantt chart or a network diagram.

307
 A Gantt chart created using Microsoft Project (MSP). Note (1) the critical path is in
red, (2) the slack is the black lines connected to non-critical activities, (3) since
Saturday and Sunday are not work days and are thus excluded from the schedule,
some bars on the Gantt chart are longer if they cut through a weekend.

DEFINITION –
A Gantt chart is a horizontal bar chart developed as a production control tool in 1917 by
Henry L. Gantt, an American engineer and social scientist. Frequently used in project
management, a Gantt chart provides a graphical illustration of a schedule that helps to plan,
coordinate, and track specific tasks in a project. 
Gantt charts may be simple versions created on graph paper or more complex automated
versions created using project management applications such as Microsoft Project or Excel.
A Gantt chart is constructed with a horizontal axis representing the total time span of the
project, broken down into increments (for example, days, weeks, or months) and a vertical
axis representing the tasks that make up the project (for example, if the project is outfitting
your computer with new software, the major tasks involved might be: conduct research,
choose software, install software). Horizontal bars of varying lengths represent the sequences,
timing, and time span for each task. Using the same example, you would put "conduct
research" at the top of the verticle axis and draw a bar on the graph that represents the amount
of time you expect to spend on the research, and then enter the other tasks below the first one
and representative bars at the points in time when you expect to undertake them. The bar
spans may overlap, as, for example, you may conduct research and choose software during
the same time span. As the project progresses, secondary bars, arrowheads, or darkened bars
may be added to indicate completed tasks, or the portions of tasks that have been completed.
A vertical line is used to represent the report date.
Gantt charts give a clear illustration of project status, but one problem with them is that they
don't indicate task dependencies - you cannot tell how one task falling behind schedule
affects other tasks. The PERT chart, another popular project management charting method, is
designed to do this. Automated Gantt charts store more information about tasks, such as the
individuals assigned to specific tasks, and notes about the procedures. They also offer the
benefit of being easy to change, which is helpful. Charts may be adjusted frequently to reflect
the actual status of project tasks as, almost inevitably, they diverge from the original plan.

Gantt Chart

308
During the era of scientific management, Henry Gantt developed a tool for displaying the
progression of a project in the form of a specialized chart. An early application was the
tracking of the progress of ship building projects. Today, Gantt's scheduling tool takes the
form of a horizontal bar graph and is known as a Gantt chart, a basic sample of which is
shown below:
Gantt Chart Format
Task Duration Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 2 mo.                    
2 2 mo.                    
3 2 mo.                    
4 2 mo.                    
5 2 mo.                    
6 2 mo.                    

The horizontal axis of the Gantt chart is a time scale, expressed either in absolute time or in
relative time referenced to the beginning of the project. The time resolution depends on the
project - the time unit typically is in weeks or months. Rows of bars in the chart show the
beginning and ending dates of the individual tasks in the project.
In the above example, each task is shown to begin when the task above it completes.
However, the bars may overlap in cases where a task can begin before the completion of
another, and there may be several tasks performed in parallel. For such cases, the Gantt chart
is quite useful for communicating the timing of the various tasks.
For larger projects, the tasks can be broken into subtasks having their own Gantt charts to
maintain readability.
Gantt Chart Enhancements
This basic version of the Gantt chart often is enhanced to communicate more information.
 A vertical marker can used to mark the present point in time.
 The progression of each activity may be shown by shading the bar as progress is
made, allowing the status of each activity to be known with just a glance.
 Dependencies can be depicted using link lines or color codes.
 Resource allocation can be specified for each task.
 Milestones can be shown.
Gantt Chart Role in Project Planning
For larger projects, a work breakdown structure would be developed to identify the tasks
before constructing a Gantt chart. For smaller projects, the Gantt chart itself may used to
identify the tasks.
The strength of the Gantt chart is its ability to display the status of each activity at a glance.
While often generated using project management software, it is easy to construct using a
spreadsheet, and often appears in simple ascii formatting in e-mails among managers.
For sequencing and critical path analysis, network models such as CPM or PERT are more
powerful for dealing with dependencies and project completion time. Even when network
models are used, the Gantt chart often is used as a reporting tool.
Alternative spellings: The name of this tool frequently is misspelled as "Gannt Chart".

309
 HEALTH ADMINISTRATION AT THE CENTRE AND STATE LEVEL.
Introduction
Constitutionally, every individual in India has the right of availing health services to
protect his/her basic right of being healthy. To this effect, the Government of India has
developed health administration machinery and mechanism to plan, organise, and deliver
healthcare services to the people in rural and urban areas.
For the purpose of achieving health goals and dealing with health subjects, the
Government of India has evolved healthcare organisation at the centre, state, district, and
local level.
Meaning and definition
Health administration is a branch of public administration which deals with matters
relating to the promotion of health, preventive services, medical care, rehabilitation, the
delivery of health services, the development of health manpower, medical education, and
training.
Public health administration is the science and art of organising and coordinating
government agencies whose purpose is to improve the physical, mental, and social wellbeing
of people. It aims at the prevention of disease, preservation, and promotion of health.
History of health administration in India
Health administration is a part of public administration of the country and is one of
the aspects of social welfare activities of the government. Modern public health organisation
and administration is designed to prevent disease, prolong life, and to promote physical and
mental efficiency through organised community efforts.
During the independence period the medical and public health service at the centre
were administered by two separate department heads – Director General of Indian Medical
Services and Commission of Public Health Service respectively, but after independence these
two offices were amalgamated into Directorate General of Health Services which was headed
by the Director of Health Services.
Post-independence era
For public health in post-independence year in 1947 after independence a democratic
regime was set up in India with new concept aimed towards the establishment of a welfare
state. The Bhore Committee report and recommendations became the basis for most of the
planning and measures adopted by the National Government.
1947: Ministries of health were established at the centre and states.
1948: India became the member of WHO.
1949: The post of Registrar General of India was created in the Ministry of Home Affairs.
1950: The Government of India set up a planning commission to make an assessment of
material, capital, human resources of the country and to draft developmental plans for
the most effective utilisation of these resources.
Five year plan: Planning commission has formulated successive five-year plans to rebuild
rural India to lay foundation of industrial progress and to secure the balanced
development of all parts of the country.
National health policy: The Ministry of Health and Family Welfare, Government of India,
evolved a national health policy in 1983 keeping in view the national commitment to
attain the goal of health for all by the year 2000. The main objective of this policy was
to achieve an acceptable standard of good health amongst the general population of
the country.
Objectives of health administration
1. To increase the average length of human life.
2. To decrease the mortality and morbidity rates.

310
3. To increase the physical, mental, and social wellbeing of the individual.
4. To provide total healthcare to enrich quality of life.
5. To increase the pace of adjustment of the individual to his environment.
6. To make provision of primary healthcare services to everyone.
7. To develop healthy manpower to provide proper services to the community.
8. To formulate health policies and their periodic revision from time to time.
Principles of health administration
i. Centralised director and decentralised activity.
ii. When a special function is to be undertaken, it should be undertaken by or in
cooperation with the official body.
iii. There should not be duplication and overlapping in rendering combined ____.
iv. Treatment and prevention of diseases should be administratively combined.
v. Administration must be based on a sound economic consideration and practicable
financial budgeting.
vi. A clear picture of the complete plan must be made before starting a programme.
vii. A programme of continuing staff education is essential.
viii. Programme should be planned on a scientific priority basis.
ix. Periodic appraisal of services rendered, effectiveness of the programme, and
evaluation of the results is the major responsibility of the health administration.
x. Provision must be made for desirable working conditions for all members of the staff.
xi. There should be sound national health policy.
xii. Sound healthy administrative structures may be designed for the implementation of
various health policies.
xiii. There should be integration of preventive and curative services at all administrative
levels.
xiv. Health should not be considered in isolation from other socioeconomic factors.
xv. Health opportunities need not be related to the purchasing power of the people.
xvi. Health consciousness should be fostered through education and by providing
opportunities for participation of people in the health programmes.
xvii. All the systems of medicine must be encouraged to provide decent health to people in
a coordinated fashion.
xviii. Health services should be organised form the bottom up and not from the top down.
xix. There should be a provision for staff development programmes.
Health system in India
India is a union of 28 states and 7 union territories. Under the constitution of India,
the states are largely independent in matters relating to the delivery of health care to the
people. Each state, therefore, has developed its own system of healthcare delivery
independent of the central government. The central responsibility consists mainly of policy
making, planning, guiding, assisting, evaluating, and coordinating the work of the state health
ministries so that health services cover every part of the country and no state lags behind for
want of these services.

The health system in India has 3 main links: central, state, and local or peripheral.

311
 Synoptic view of the health system in India

National Level
Ministry of Health and Family Welfare

States (28) an Union Territories (7)

Ministry of Health and Directorate of Health

District health organisation and basic specialities hospital/districts

Community Health Centres 1/80,000 – 1,20,000 Sub-district/Taluka hospital

PHC 1/30,000

Sub-centres 1/3,000 – 5,000

Health worker (M & F)

Village health guide, trained dai 1/1,000

People in the population

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.

312
 The Department of Health deals with planning, coordination, programming,
evaluation of medical and public health maters, including drug control and prevention of food
adulteration.
Functions
The functions of the Union Health Ministry are set out in the seventh schedule of the
Article 246 of the Constitution of India under union list and concurrent list.
Union list
1. International health relations and administration of port-quarantine
All the matters related to the international agencies, and coordination of their
activities in the country are undertaken by the DGHS. All the major ports in the
country such as Calcutta, Vishakapattanam, Chennai, Mumbai, Kandla and
international airports like Mumbai, Santa Cruz, Dum Dum, Meenambakkam, Trissur,
and Palam are directly controlled by DGHS.
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
9. Coordination with states and other ministries for promotion of health.
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.

313
 5. Nirodh marketing supply/ distribution
6. Transport
7. Universal immunization programme
8. Area project
9. Mass education and media: responsible for providing educational
publicity and extent support to education.
Functions
[Link] organise 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 popularise appropriate and acceptable method of family planning
[Link] disseminate the knowledge on the practice of family planning as widely as
possible and to provide service agencies nearest to the community.
e. To organise basic research of human fertility, genetics and population dynamics
and to on the evolution of easy and reliable method of contraception.
f. To study the social factors that affect fertility and to take such steps as will reduce
the number of children in a family.
[Link] coordinate the family planning programme with the child welfare and maternal
health services throughout the country.
[Link] organise production of contraceptive device in adequate quantities to maintain
the supply at all levels at a minimum cost.
i. Indian system of medicine and homeopathy helps to promote/ISM in the country
through training, research and use.

314
 Ministry of Health and Family Welfare

Cabinet Minister

Minister of State

Deputy Ministers

Dept. of Health Dept. of Family WelfareDept. of Indian System of Medicine and Homoeopath

Secretary
Secretary health
Secretary
Chief director (1) Joint Secretary (3)
Additional Secretary
Director JS
Ayurveda & Sidha (ISM)

Joint Secretaries (9)

Director General of
Health Services

Addl. Director Generals (4)

[Link] 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, standardisation 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
organisation called DGHS.

II. Directorate General of Health Services

Organisation

315
 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: All the major ports in the
country and international airports are directly controlled by the Director
General of Health Services. All matters relating to the obtaining of assistance
from international agencies and the coordination of their activities in the
country are undertaken by the Director General of Health Services.
b. Control of drug standards: The drugs control organisation is part of the
DGHS and is headed by the Drugs Controller. Its primary function is to lay
down and enforce standards and control the manufacture and distribution of
drugs through both Central and State Government offices. The Drugs Act
(1940) vests the central Government with the powers to test quality of
imported drugs.
c. Medical store depots: The Union Government runs medical store depots at
Mumbai, Chennai, Kolkata, Karnal, Gouhati and Hyderabad. These depots
supply the civil medical requirements of the Central Government and of the
various state governments. These depots also handle supplies from foreign
agencies. The medical stores organisation endeavours to ensure the highest
quality, cheaper bargain and prompt supplies.
d. Postgraduate training: The DGHS is responsible for the administration of
national institutions, which also provide postgraduate training to different
categories of health personnel.
 All India Institute of Hygiene and Public Health, Kolkata.
 All India Institute of Mental Health, Bangalore.
 National Institute of Communicable Diseases, Delhi, etc.
e. Medical education: The DGHS is directly in charge of the following medical
colleges in India:
 Lady Hardinge
 Maulana Azad
 Medical colleges at Pondicherry and Goa.
Besides these, there are many medical colleges in the country which
are guided and supported by the Centre.
f. Medical research: Medical research in the country is organised largely
through the ICMR, founded in 1911 in New Delhi. The council plays a
significant role in aiding, promoting and coordinating scientific research on
human diseases, their causation, prevention and cure. The research work is
done through the councils, and several permanent research institutes, e.g.,
Cancer Research Centre, TB Chemotherapy Centre at Chennai. The funds of
the council are wholly derived from the budget of the Union Ministry of
Health.

316
 g. Central Government Health Scheme.

It started in Delhi in 1954 to provide comprehensive care to the central

government employees stationed at delhi. The scope of the scheme has been
gradually extended over the years to cover cities outside
Delhi,Bombay,Allahabad, Meerut, Kanpur, Patna,Calcutta, Nagpur,
Msdras,Hyderabad, Bangalore,Jabalpur, Jaipur, Pune, Lucknow ahmedabad,
as well as other sectors of population, such as the employees of the
autonomous organisations, retired Central Government pensioners, existing
and ex- MPs,ex-Governors, and retired judges of supreme court and high
[Link] services provided are comprehensive and include:
Laboratory investigations
Outdoor treatment
In-patient treatment
Specialist care
Emergency services
Domicilary services
Supply of medicines
Ambulance services
Ante-natal confinement and post natal care
Optical and dental care
Family welfare services
h. National Health Programmes: The various national health programmes for
the eradication of malaria and for the control of tuberculosis, filarial, leprosy,
AIDS and other communicable diseases involve expenditure of crores of
rupees. The central directorate plays a very important part in planning, guiding
and coordinating all the national health programmes in the country.
i. Central Health Education Bureau: An outstanding activity of this Bureau is
the preparation of education material for creating health awareness among the
people. The bureau offers training courses in health education in different
categories of health workers.
j. Health intelligence: The Central Bureau of Health Intelligence was
established in 1961 to centralise collection, compilation, analysis, evaluation,
and dissemination of all information on health statistics for the nation as a
whole. It disseminates epidemic intelligence to states and international bodies.
k. National Medical Library: The Central Medical Library of DGHS was
declared the National Medical Library in 1966. The aim is to help in the
advancement of medical, health and related sciences by collection,
dissemination and exchange of information.
..............................................................................................327.
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.
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,

317
 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.

318
 Organisational structure of the health and family welfare services at state level

Minister in charge of health and family welfare portfolio in the s

Secretary or commissioner, Department of Health and Family W

Director Director Director

Health Services FW Services Medical education & research IS

Additional/deputy joint directors of health services dealing with one or more programmes
Principal/Deans of medical colleges

Divisional set up in some states

Assistant Directors health services dealing with one or more programmes

District health organisation

Taluk Health organisation

Block level health organisation

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(filaria)
NLEP, NTCP, NPCB, prevention and control of communicable diseases like
diarrhoeal disease, KFD, JE,
School health programme, nutrition programme ,national goitre control programme
Laboratory services and vaccine production units
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. With the advent of family planning as an

319
important programme, the designation of DHS has been changed in some states and is now
known as Director of Health and Family Welfare. 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 speciality. 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 responsible for the administration of medical /health services in the entire district.
Bhore Committee (1946) recommended integrated services at all levels and the setting
up of a unified health authority in each district. The principal unit of administration in India is
the district under a collector. There area 619 districts in India. Each district has 6 types of
administration areas.
i. Subdivisions
ii. Tehsils (talukas)
iii. Community development blocks
iv. Municipalities and corporations
v. Villages
vi. 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.
Since the launching of the community development programme in India in 1952, the
rural areas of the district have been organised into blocks known as community
development blocks. The block is a unit of rural planning and development and comprises
approximately 100 villages and about 80,000 to 1,20,000 population in charge of a block
development officer.
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.
The municipal boards are headed by a chairman/president, elected usually by the
members. The term of a municipal board ranges between 3 and 5 years. The functions of a
municipal board are construction and maintenance of roads, sanitation, and drainage, street
lighting, water supply, maintenance of hospitals and dispensaries, education, registration of
births and deaths, etc.
Corporations are headed by mayors. The councillors 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.

320
 Primary Healthcare Infrastructure of District Level

T.B.A. VHG
Covers 1,000 population
T.B.A. VHG T.B.A. VHG

T.B.A. VHG Sub-Centre T.B.A. VHG

Covers 5,000 population

Sub-Centre
Covers 30,000 population Sub-Centre

Primary Health Centre

Sub-Centre

Sub-Centre Sub-Centre

PHC
Covers 1,00,000 population
Community Health Centre
PHC PHC

District Health and Family Welfare

CEO Zilla parishad

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.

321
 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.
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
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

322
 a. Mother and child healthcare
b. Family planning
c. Immunisation
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 reorganisation 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.
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 31st 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 gynaecology, and paediatrics
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.

323
 Organisational Structure of Panchayat Raj Institutions

Direct election @ 1:40,000 (except Uttara Kannada, Coorg and Chickmagalore where it is 1:30,000). 20 m

District Level Zilla Panchayat (ZP)

Direct election @ 1:10,000. Voting rights to MPs, MLAs, MLCs. One year membership to 1/
Taluka Level Taluka Panchayat (TP)

Direct election @ 1:4,000. Ban on political parties. 5 years

Village Level Gram Panchayat (GP)

Minimum of two meetings per annum, under the chairmanship of GP Adhyaksha, for appr

Gram Sabha

324
 Organisational structure of health department at district level

DISTRICT HEALTH AND FAMILY WELFARE OFFICER

[Link].
CMO/District
MedicalHealth and
Officer Family
(FW Welfare Officer
& MCH) (Sub-division
District Malaria level/Dy.
Senior
Officer
MedicalCMOs) District Health Educat
Superintendent
Dmeio

Senior Malaria Officer

District Leprosy Officer

Asst. District Health & Family Welfare Officer (HQ)

Medical officers of Dt. General Hospital and other Govt. Hos

Medical Officer
District
(District
Tuberculosis
Lab.) Officer (TB
Gazetted
Lady
Centre)
Medical
Assistant
Officers/ 11 MOService
of Primary
Engineer
Health
(Mobile
Centres
Wo

District Nursing
Medical Officers of Primary Health centres (Coordinators Supervisor
Assistant
at PHC level) Statistical Officer

325
 Planning and organising nursing service at various levels – local, regional, national, and
international
Placement of nurses in the healthcare organisation
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 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.

326
 Nursing organisational set up at the central level
DGHS

Additional DG (PH) Additional DG (N) Additional DG (M)

DDG (N)

ADG (Community nursing service)ADG (Nursing education & research) ADG (Hospital nursing service)

DADG DADG DADG

Community & nursing officer Principal tutor SON Nursing superintendent

Deputy Nursing superintendent

Senior tutor
PHN Supervisor

PHN Tutor Assistant Nursing superintendent

LHV Clinical instructors Ward sister

ANM Staff nurse

Note
a. The positions up to the DADG level are proposed to be at the office of the directorate
general of health services. Positions below the level of DADG are to exist at the
institutions governed by the central government.
b. The principal of the College of Nursing will be equal to the rank of ADAG (N) and
will be eligible for promotion to the post of DDG (N) addl DG (N).
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.

327
 Recommended organization at state level (union territory level)
Secretary (Health)

Director, Nursing Services

Joint/Deputy Director, Nursing Services

ADNS (Community nursing) ADNS (Nursing education & research)ADNS (Hospital/ nursing service)

DADNS (Community health nursing)

DADNS (Nursing education & research) DADNS (Nursing service)

District Nursing Officer DADNS Nursing Superintendent

Public health nursing officer Principal SON Deputy Nursing superintendent

PHN at PHC Senior tutor Assistant nursing superintendent

LHV (HSV) Tutor Ward sister

LHV Clinical instructors Staff nurse

ANM

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.
Today, the ANM designated as multipurpose health worker is the key health worker
rendering multipurpose healthcare services in the rural area. In this context, the professional
nurses have a major role to play in providing support, guidance, supervision to ANMs
(MAPHW-F) and also in rendering direct comprehensive healthcare services which is beyond
the competency of the ANMs.

328
 Director, Nursing Services

Dy. Director, Nursing Services

Asst. Director, Nursing Services

Dy. Asst. Director, Nursing Services

DMO Director nursing officer DHO

Assistant Dist. Nsg. Officer (Hosp. & Nsg. Edu) Assistant Dist. Nsg. Officer (Community)

Nsg. Superintendent/Dy. Nsg. Suptd. Dist. P. N. O.

Asst. Nsg. Suptd. P. N. Supervisor

(CHC)
Ward sister
PN (PHC)
Staff nurse
LHV/HS

LHV

ANM

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.

329
 Loma Linda University Medical Centre, USA

Division of Nursing

Chief Executive Officer

Vice President of Nursing

Administrative Assistant

ClinicalManagement
cure Quality
coordinator
management
OP Surgery
director
centre Administrative
Resident operating
Parentsuit
child administration
Med. Surg. Administrator
Critical care nsg.
Emergency
Admin. service
Transplant
[Link]
CardiacAdmn.
transplant service Admn.
Director Director Director Director Director Director Director Clinical Director

Nurse manager

Clinical educator

AM charge nurse NOC charge nurse

Team leader Team leader

Clinical nurse Clinical nurse

Conclusion

The purpose of health administration at the centre and local level is to improve the
health status of the population. The scope of health services varies widely from country to
country and is influenced by general and ever-changing national, state, and local health
problems.

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 sovereigndemocraticrepublic. Constitution
of India is the supreme law of India. It lays down the framework defining fundamental
political principles, establishing the structure, procedures, powers and duties, of the
government and spells out the fundamental rights, directive principles and duties of citizens.
Passed by the Constituent Assembly on 26 November 1949, it came into effect on 26 January
1950.
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. It established in England the office of the
Secretary of State for India through whom the Parliament would exercise its rule, along with
a Council of India to aid him. It also established the office of the Governor-General of India
along with an Executive Council in India, which consisted of high officials of the British
Government.
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. Many key features of the constitution are directly
taken from this Act. 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.[6][7] The Mission discussed the framework of the constitution and
laid 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. The Constituent
Assembly was divided into two for the separate states. The Act relieved the British

331
Parliament of any further rights or obligations towards India or Pakistan, and granted
sovereignty over the lands to the respective Constituent Assemblies. When the Constitution
of India came into force on 26 January 1950, it overturned the Indian Independence Act.
India ceased to be a dominion of the British Crown and became a sovereign democratic
republic. 26 November 1949 is also known as national law day.
Constituent Assembly
The Constitution was drafted by the Constituent Assembly, which was elected by the elected
members of the provincial assemblies.[8]Jawaharlal Nehru, C. Rajagopalachari, Rajendra
Prasad, SardarVallabhbhai Patel, MaulanaAbulKalam Azad, Shyama Prasad Mukherjee and
NaliniRanjanGhosh were some important figures in the Assembly. There were more than 30
members of the scheduled classes. Frank Anthony represented the Anglo-Indian community,
and the Parsis were represented by H. P. Modi and R. K. Sidhwa. The Chairman of the
Minorities Committee was HarendraCoomarMookerjee, a distinguished Christian who
represented all Christians other than Anglo-Indians. Ari BahadurGururng represented the
Gorkha Community. Prominent jurists like AlladiKrishnaswamyIyer, B. R. Ambedkar,
BenegalNarsing Rau and K. M. Munshi, Ganesh Mavlankar were also members of the
Assembly. Sarojini Naidu, Hansa Mehta, DurgabaiDeshmukh and RajkumariAmritKaur were
important women members. The first president of the Constituent Assembly was
SachidanandSinhalater,Rajendra Prasad was elected president of the Constituent Assembly. [8]
The members of the Constituent Assembly met for the first time in the year 1946 on 9
December.[8]
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 addresses the issues in question.

 Preamble  Part XII - Finance, Property, Contracts

 Part I[9] - Union and its Territory and Suits
 Part II[10] - Citizenship.  Part XIII - Trade and Commerce within
 Part III - Fundamental Rights the territory of India
 Part IV[11] - Directive Principles  Part XIV - Services Under the Union, the
and Fundamental Duties. States and Tribunals
 Part V[12] - The Union.  Part XV - Elections
 Part VI[13] - The States.  Part XVI - Special Provisions Relating to
 Part VII[14] - States in the B part of certain Classes.
the First schedule (Repealed).  Part XVII - Languages
 Part VIII[15] - The Union  Part XVIII - Emergency Provisions
Territories  Part XIX - Miscellaneous
 Part IX[16] - Panchayat system and  Part XX - Amendment of the Constitution
Municipalities.  Part XXI - Temporary, Transitional and
 Part X - The scheduled and Tribal Special Provisions
Areas  Part XXII - Short title, date of
 Part XI - Relations between the commencement, Authoritative text in

332
 Union and the States. 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 law are a
few subjects of the Concurrent list, where both the State Legislature as well as the Parliament
have powers to enact laws.
Changing the constitution
Amendments to the constitution are made by Parliament. However they must be approved by
a super-majority in each house, and certain amendments must also be ratified by the states.
The procedure is laid out in Article 368. Despite these rules there have been over ninety
amendments to the constitution since it was enacted in 1950. The Supreme Court has ruled,
controversially, that not every constitutional amendment is permissible. An amendment must
respect the "basic structure" of the constitution, which is immutable.....
In 2000 the National Commission to Review the Working of the Constitution (NCRWC) [19]
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.
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.

GROUP DYNAMICS

INTRODUCTION
“Never doubt that a small group of thoughtful citizens can change the world. Indeed,
it is the only thing that ever has.” Margaret Mead
In today’s explosion of information technology, communication continues to be a
complex process. Group dynamics can be very positive and helpful where team members
support each other and do what is best. It can alternately become destructive if individuals
are allowed to continue with more selfish behaviors such as never helping someone else,
making their personal life and personal problems permeate their work, being negative about
everything that happens or complaining all the time. The nurse manager has an important
role in this situation, because it may be necessary to counsel individuals exhibiting negative
behavior to achieve positive group dynamics.
OBJECTIVES
♪ General objective:

333
 At the end of the seminar the student will be able to understand about the Group
dynamics and Stress management and its detail.
♪ Specific objective:
By the end of the seminar, the students will be able to:
I) GROUP DYNAMICS
► Define the group and group dynamics
► List out the type of groups
► Mention the criteria for a group
► Enlist the objective of group dynamics
► Explain the principles of group dynamics
► Identify the elements of group dynamics
► Enumerate the stages of group dynamics
► Describe the dimensions of group process
► Explain about the group dynamics process
2) STRESS MANAGEMENT
► Define the stress and stressor
► Enlist the types of stress and stressors
► Identify the sources of stress
► Know the indicators of stress
► Explain the theories of stress
► Describe the models of stress
► Enumerate the techniques of stress management
► ABC of stress management

TERMINOLOGIES
► Group - Is an association of two or more people in an interdependent relationship with shared
purposes.
► Group dynamics –Work done by a group of people working together.
► Group maturity - The ability and willingness of group members to set goals and work
toward their accomplishment.
► Relationships means how well people in the group work together
► Stress - a state of mental or emotional strain or suspense
► Stressors - Any agent that causes stress to an organism
► Task roles - which helps the group accomplish its task

► Relationship roles - which helps group members get along better.

► Forming - pretending to get on or get along with others
► Storming - letting down the politeness barrier and trying to get down to the issues even if
tempers flare up.
► Performing - working in a group to a common goal on a highly efficient and cooperative
basis.
► Norming - getting used to each other and developing trust and productivity.
► Meditation – It is a holistic discipline during which time the practitioner trains his or her
mind in order to realize some benefit.
► Relaxation technique (also known as relaxation training) is any method, process, procedure,
or activity that helps a person to relax.
► Fractional relaxation is a method of releasing muscular tension in one small part of the body
at a time, such as relaxing one finger, then relaxing another, then adding another

334
DEFINITION
GROUP:
 A group may be defined as a number of individuals who join together to achieve a goal.
People join groups to achieve goals that cannot be achieved by them alone.
Johnson & Johnson (2006)
 A collection of people who interact with one another, accept rights and obligations as
members and who share a common identity.
 A group is an association of two or more people in an interdependent relationship with shared
purposes.
GROUP DYNAMICS:
 A branch of social psychology which studies problems involving the structure of a group.
 The interactions that influence the attitudes and behavior of people when they are grouped
with others through either choice or accidental circumstances.
  A field of social psychology concerned with the nature of human groups, their development,
and their interactions with individuals, other groups, and larger organizations.
TYPE OF GROUPS
Formal groups: refers to those which are established under the legal or formal authority with
the view to achieve a particular end results. Eg: trade unions.
Informal groups: refers to aggregate of personal contact and interaction and network of
relationship among individual. Eg: friendship group.
Primary groups: are characterized by small size, face to face interaction and intimacy among
members of group. Eg: family, neighbourhood group.
Secondary groups: characterized by large size, individual identification with the values and
beliefs prevailing in them rather than cultural interaction.
Eg: occupational association and ethnic group.
Task groups: are composed of people who work together to perform a task but involve cross-
command relationship. Eg: for finding out who was responsible for causing wrong medication
order would require liaison between ward in charge, senior sister and head nurse.
Social groups: refers to integrated system of interrelated psychological group formed to
accomplish defined objectives. Eg: political party with its many local political clubs.
friendship group.
Reference groups: one in which they would like to belong.
Membership groups: those where the individual actually belongs.
Command groups: formed by subordinates reporting directly to the particular manager are
determined by formal organizational chart.
Functional groups: the individuals work together daily on similar tasks.
Problem solving groups: it focuses on specific issues in their areas of responsibility, develops
potential solution and often empowered to take action.
CRITERIA FOR A GROUP
♥ Formal social structure
♥ Face-to-face interaction
♥ 2 or more persons
♥ Common fate
♥ Common goals
♥ Interdependence
♥ Self-definition as group members
♥ Recognition by others

335
OBJECTIVES OF GROUP DYNAMICS
 To identify and analyze the social processes that impact on group development and
performance.
 To acquire the skills necessary to intervene and improve individual and group performance in
an organizational context.
 To build more successful organizations by applying techniques that provide positive impact
on goal achievement.
PRINCIPLES OF GROUP DYNAMICS
♪ The members of the group must have a strong sense of belonging to the group.
♪ Changes in one part of the group may produce stress in other person, which can be reduced
only by eliminating or allowing the change by bringing about readjustment in the related parts
♪ The group arises and functions owing to common motives.
♪ Groups survive by placing the members into functional hierarchy and facilitating the action
towards the goals
♪ The intergroup relations, group organization and member participation is essential for
effectiveness of a group.
♪ Information relating to needs for change, plans for change and consequences of changes must
be shared by members of a group.
ELEMENTS OF GROUP DYNAMICS
COMMUNICATION
One of the easiest aspects of group process to observe is the pattern of communication .
The kinds of observations we make give us clues to other important things which may be
going on in the group such as who leads whom or who influences whom.
♥ Who talks? For how long? How often?
♥ Who do people look at when they talk?
♥ Who talks after whom, or who interrupts whom?
♥ Style of communication used?
♥ How are silent people treated? Is silence due to disagreement, disinterest, fear,
fatigue?
CONTENT VS PROCESS
When we observe what the group is talking about, we are focusing on the content.
When we try to observe how the group is handling its communication, i.e., who talks how
much or who talks to whom, we are talking about group process. In fact, the content of group
discussion often tells us what process issue may be on people's minds.
At a simpler level, looking at process really means to focus on what is going on in the
group and trying to understand it in terms of other things that have gone on in the group.
DECISION
Many kinds of decisions are made in groups without considering the effects these
decisions have on other members. Some try to impose their own decisions on the group, while
others want all members to participate or share in the decisions that are made. Some decisions
are made consciously after much debate and voting. Others are made silently when no one
objects to suggestion.
INFLUENCE
Some people may speak very little, yet they may capture the attention of the whole
group. Others may talk a lot—but other members may pay little attention to them
TASK VS RELATIONSHIPS
The group's task is the job to be done. People who are concerned with the task tend
to:

336
 ♥ Make suggestions as to the best way to proceed or deal with a problem
♥ Attempt to summarize what has been covered or what has been going on in the group
♥ Give or ask for facts, ideas, opinions, feelings, feedback, or search for alternatives.
Relationships means how well people in the group work together. People who are
concerned with relationships tend to:
♥ Be more concerned with how people feel than how much they know
♥ Help others get into the discussion
♥ Encourage people with friendly remarks and gestures.
ROLES
Behavior in the group can be of 3 types:
♥ TASK ROLES (which helps the group accomplish its task)
 Initiator: proposing tasks or goals; defining a group problem; suggesting ways to
solve a problem.
 Information/opinion seeker: requesting facts; asking for expressions of feeling;
requesting a statement; seeking suggestions and ideas.
 Information or opinion giver: offering facts; providing relevant information; stating
an opinion; giving suggestions and ideas.
 Clarifier and elaborator: interpreting ideas or suggestions; clearing up confusion;
defining terms; indicating alternatives and issues before the group.
 Summarizor: pulling together related ideas; restating suggestions after the group has
discussed them; offering a decision or conclusion for the group to accept or reject.
 Energizer; who stimulates and prods the group to act and raise the level of their
actions.
 Coordinator: who clarifies and coordinates ideas, suggestions and activities of the
group members.
♥ RELATIONSHIP ROLES (which helps group members get along better)
 Harmonizer: who mediates, harmonizes and resolve conflicts.
 Gate keeper: helping to keep communication channels open; facilitating the
participation of others; suggesting procedures that permit sharing remarks.
 Encourager; being friendly, warm, and responsive to others; indicating by facial
expression or remarks the acceptance of others' contributions.
 Compromiser: when one's own idea or status is involved in a conflict, offering a
compromise which yields status; admitting error.
 Follower: who accepts the group’s ideas and listens to their discussion and decisions.
♥ SELF-ORIENTED ROLES (which contributes to neither group task nor group relationship)
 Dominator: interrupts others; launches on long monologues; is over-positive; tries to
lead group and assert authority; is generally autocratic.
 Negativist: rejects ideas suggested by others; takes a negative attitude on issues;
argues frequently and unnecessarily; is pessimistic, refuses to cooperate; pouts.
 Aggressor: tries to achieve importance in group; boasts; criticizes or blames others;
tries to get attention; shows anger or irritation against group or individuals; deflates
importance or position of others in group.
 Playboy: is not interested in the group except as it can help him or her to have a good
time.
 Storyteller: likes to tell long "fishing stories" which are not relevant to the group;
gets off on long tangents.
 Interrupter: talks over others; engages in side conversations; whispers to neighbour.
MEMBERSHIP

337
 One major concern for group members is the degree of acceptance or inclusion they
feel in the group.
♥ Are there any sub-groupings? Sometimes two or three members may consistently
agree and support each other or consistently disagree and oppose one another.
♥ Do some people seem to be outside the group? Do some members seem to be "in"?
How those “outside” are treated?
♥ Do some members move in and out of the group? Under what conditions do they
move in and out?
FEELINGS
During any group discussion, feelings are frequently generated by the interactions
between members. These feelings, however, are seldom talked about. Observers may have to
make guesses based on tone of voice, facial expressions, gestures and many other forms of
nonverbal cues.
NORMS
Standard or group rules always develop in a group in order to control the behavior of
members. Norms usually express the beliefs or desires of the majority of the group members
as to what behaviors should or should not take place in the group. These norms may be clear
to all members (explicit), known or sensed by only a few (implicit), or operating completely
below the level of awareness of any group members. Some norms help group progress and
some hinder it.
GROUP ATMOSPHERE
Something about the way a group works creates an atmosphere which in turn is
revealed in a general impression. Insight can be gained into the atmosphere characteristic of a
group by finding words which describe the general impression held by group members.
GROUP MATURITY
Group maturity is defined as the ability and willingness of group members to set
goals and work toward their accomplishment. Characteristic of mature group:
♥ An increasing ability to be self-directed (not dependent on the leader).
♥ An increased tolerance in accepting that progress takes time.
♥ An increasing sensitivity to their own feelings and those of others.
♥ Improvement in the ability to withstand tension, frustration and disagreement.
♥ An increased ability to change plans and methods as new situations develop.
Assessing group maturity is especially important for a group leader. An immature
group needs direction. Directive leadership is usually best. If a group is very mature,
nondirective leadership is usually best. In between the extremes of very mature and very
immature, democratic leadership will be the best bet depending on the situation.
STAGES OF GROUP DEVELOPMENT
[Link] W TUCKMAN is a respected educational psychologist who first described the
four stages of group development in 1965. The four-stage model is called as  Tuckman's
Stages for a group. Tuckman's model states that the ideal group decision-making process
should occur in four stages:

Stage 1: Forming (pretending to get on or get along with others)

338
 Individual behaviour is driven by a desire to be accepted by the others, and
avoid controversy or conflict.  Serious issues and feelings are avoided, and
people focus on being busy with routines, such as team organization, who
does what, when to meet, etc.  But individuals are also gathering
information and impressions - about each other, and about the scope of the
task and how to approach it.  This is a comfortable stage to be in, but the
avoidance of conflict and threat means that not much actually gets done.

Stage 2: Storming (letting down the politeness barrier and trying to get down to the issues
even if tempers flare up)
Individuals in the group can only remain nice to each other for so long, as
important issues start to be addressed.  Some people's patience will break
early, and minor confrontations will arise that are quickly dealt with or
glossed over.  These may relate to the work of the group itself, or to roles
and responsibilities within the group. Some will observe that it's good to be
getting into the real issues, whilst others will wish to remain in the comfort
and security of stage 1.  Depending on the culture of the organization and
individuals, the conflict will be more or less suppressed, but it'll be there,
under the surface. To deal with the conflict, individuals may feel they are
winning or losing battles, and will look for structural clarity and rules to
prevent the conflict persisting.

Stage 3: Norming (getting used to each other and developing trust and productivity)
As Stage 2 evolves, the "rules of engagement" for the group become
established, and the scopes of the group’s tasks or responsibilities are clear
and agreed.  Having had their arguments, they now understand each other
better, and can appreciate each other's skills and experience.  Individuals
listen to each other, appreciate and support each other, and are prepared to
change pre-conceived views: they feel they're part of a cohesive, effective
group.  However, individuals have had to work hard to attain this stage, and
may resist any pressure to change - especially from the outside - for fear
that the group will break up, or revert to a storm.

Stage 4: Performing (working in a group to a common goal on a highly efficient and

cooperative basis)

Not all groups reach this stage, characterised by a state of interdependence

and flexibility. Everyone knows each other well enough to be able to work
together, and trusts each other enough to allow independent activity.  Roles
and responsibilities change according to need in an almost seamless way. 
Group identity, loyalty and morale are all high, and everyone is equally
task-orientated and people-orientated.  This high degree of comfort means
that all the energy of the group can be directed towards the task(s) in hand.

339
 Ten years after first describing the four stages, Bruce Tuckman revisited his original
work and described another, final, stage in 1977:
Stage 5: Adjourning (mourning the adjournment of the group)

This is about completion and disengagement, both from the tasks and the
group members.  Individuals will be proud of having achieved much and
glad to have been part of such an enjoyable group.  They need to recognize
what they've done, and consciously move on.  Some authors describe stage
5 as "Deforming and Mourning", recognizing the sense of loss felt by group
members.

In the real world, groups are often forming and changing, and each time that happens,
they can move to a different Tuckman Stage.  A group might be happily Norming or
Performing, but a new member might force them back into Storming. Seasoned leaders will
be ready for this, and will help the group get back to Performing as quickly as possible. Many
work groups live in the comfort of Norming, and are fearful of moving back into Storming, or
forward into Performing. This will govern their behaviour towards each other, and especially
their reaction to change.
II. M. SCOTT PECK developed stages for larger-scale groups (i.e., communities) which are
similar to Tuckman's stages of group development.  Peck describes the stages of a community
as:
► Pseudo-community
► Chaos
► Emptiness
► True Community
DIMENSIONS OF GROUP PROCESS
Some of the aspects of group process that a process consultant would look at include:
♠ Patterns of communication and coordination
♠ Patterns of influence
♠ Roles / relationship
♠ Patterns of dominance (e.g. who leads, who defers)
♠ Balance of task focus Vs social focus
♠ Level of group effectiveness
GROUP DYNAMICS PROCESS
A. GROUP FORMATION
A group is able to share experiences, to provide feedback, to pool ideas, to generate
insights, and provide an arena for analysis of experiences. The group provides a measure
of support and reassurance. Moreover, as a group, learners may also plan collectively for
change action. Group discussion is a very effective learning method.
► Participation
Participation is a fundamental process within a group, because many of the other
processes depend upon participation of the various members. Levels and degrees of
participation vary. Some members are active participants while others are more
withdrawn and passive. In essence, participation means involvement, concern for the task,
and direct or indirect contribution to the group goal. If members do not participate, the
group ceases to exist.
Factors which affect member’s participation are;
◘ The content or task of the group- is it of interest, importance and relevance?
◘ The physical atmosphere - is it comfortable physically, socially and psychologically?

340
 ◘ The psychological atmosphere - is it accepting, non-threatening?
◘ Member’s personal preoccupations - are there any distracting thoughts in their mind?
◘ The level of interaction and discussions - is adequate information provided for everyone to
understand? - is it at a level everyone understands?
◘ Familiarity - between group members- do members know each other from before?
► Communication
Communication within a group deals with the spoken and the unspoken, the
verbal and the non-verbal, the explicit and the implied messages that are conveyed and
exchanged relating to information and ideas, and feelings.
Two-way communication implies a situation where not only the two parties talk to
each other, but that they are listening to each other as well. It helps in clarification of
doubts, confusions and misconceptions, both parties understanding each other, receiving
and giving of feedback.
Helpful hints for effective communication
◘ Have a circular seating arrangement so that everyone can see and interact with everyone else
◘ If there are two facilitators, they should sit apart so that communication flow is not in one
direction
◘ Respect individuals- let everyone call everyone else by name respectfully
◘ Encourage and support the quiet members to voice their opinions
◘ Try and persuade the people who speak too much to give others a chance
◘ Ensure that only one person speaks at a time or no one else will be heard
◘ Discourage sub groups from indulging in side talk
► Problem solving
Most groups find themselves unable to solve problems because they address the
problem at a superficial level. After that they find themselves blocked because they
cannot figure out why the problem occurred and how they can tackle it.
An effective problem solving procedure would be to:
◘ Clearly define the problem: Is it what appears on the surface or are there deep hidden aspects?
◘ Try to thoroughly explore and understand the causes behind the problem
◘ Collect additional information, from elsewhere if necessary, and analyze it to understand the
problem further
◘ The group should suspend criticism and judgment for a while and try to combine each other's
ideas or add on improvements. The objectives should be to generate as many ideas and
suggestions as possible. This is called "brainstorming" in a group, when individuals try lateral
thinking.
► Leadership
Leadership involves focusing the efforts of the people towards a common goal and
to enable them to work together as one. In general we designate one individual as a
leader. This individual may be chosen from within or appointed from outside. Thus, one
member may provide leadership with respect to achieving the goal while a different
individual may be providing leadership in maintaining the group as a group. These roles
can switch and change.
B. DEVELOPMENT OF GROUPS
The developmental process of small groups can be viewed in several ways. Firstly, it
is useful to know the persons who compose a particular small group.
◘ People bring their past experiences
◘ People come with their personalities (their perceptions, attitudes and values)
◘ People also come with a particular set of expectations.

341
 The priorities and expectations of persons comprising a group can influence the
manner in which the group develops over a period of time
Stages
Viewing the group as a whole we observe definite patterns of behavior occurring
within a group. These can be grouped into stages.
► FIRST STAGE
The initial stage in the life of a group is concerned with forming a group. This
stage is characterized by members seeking safety and protection, tentativeness of
response, seeking superficial contact with others, demonstrating dependency on existing
authority figures. Members at this stage either engage in busy type of activity or show
apathy.
► SECOND STAGE
The second stage in this group is marked by the formation of dyads and triads.
Members seek out familiar or similar individuals and begin a deeper sharing of self.
Continued attention to the subgroup creates a differentiation in the group and tensions
across the dyads /triads may appear. Pairing is a common phenomenon.
► THIRD STAGE
The third developmental stage is marked by a more serious concern about task
performance. The dyads/triads begin to open up and seek out other members in the group.
Efforts are made to establish various norms for task performance. Members begin to take
greater responsibility for their own group and relationship while the authority figure
becomes relaxed.
► FOURTH STAGE
This is a stage of a fully functional group where members see themselves as a
group and get involved in the task. Each person makes a contribution and the authority
figure is also seen as a part of the group. Group norms are followed and collective
pressure is exerted to ensure the effectiveness of the group. The group redefines its goals
in the light of information from the outside environment and shows an autonomous will to
pursue those goals. The long-term viability of the group is established and nurtured.
C. FACILITATING A GROUP
A group cannot automatically function effectively, it needs to be facilitated.
Facilitation can be described as a conscious process of assisting a group to successfully
achieve its task while functioning as a group. Facilitation can be performed by members
themselves, or with the help of an outsider.
To facilitate effectively the facilitator needs to:
◘ Understand what is happening within the group
◘ Be aware of his/her own personality and
◘ Know how to facilitate
CONCLUSION:
Group dynamics refers to the understanding of the behavior of people in groups, such
as task groups, that are trying to solve a problem or make a decision. Group norms are
followed and collective pressure is exerted to ensure the effectiveness of the group. The
group provides a measure of support and reassurance. Moreover, as a group, learners may
also plan collectively for change action.
STRESS MANAGEMENT
INTRODUCTION
Right from the time of birth till the last breath drawn, an individual is invariably
exposed to various stressful situations. The modern world which is said to be a world of
achievement is also a world of stress and has been called the “ Age of Anxiety and Stress”.
The word stress was originally used by Selyle in 1956 to describe the pressure experienced
342
by a person in response to life demands. These demands are referred to as stressors. Stress
can be positive or negative. Perception plays a key role in interpreting how stressful
situations are.
DEFINITION
STRESS
 According to Selye (1956), “Stress is defined as the pressure experienced by a person in
response to life demands. These demands are referred to as ‘stressors’ and include a range of
life events, physical factors (eg: cold, hunger, haemorrhage, pain), environmental conditions
and personal thoughts.”
 According to Selye (1976), “Stress is a process of adjusting to or dealing with circumstances
that disrupt or threaten to disrupt a person’s physical or psychological functioning.
 Stress is tension, strain, or pressure from a situation that requires us to use, adapt, or develop
new coping skills.
STRESSOR
 Stressor is the stimuli proceeding or precipitating a change. It may be internal (fear, guilt) or
external (trauma, peer pressure, etc).
TYPES OF STRESS
♪ Distress: Stress due to an excess of adaptive demands placed upon us. The demands are so
great that they lead to bodily and mental damage. eg: unexpected death of a loved one.
♪ Eustress: The optimal amount of stress, which helps to promote health and growth. eg: praise
from an superior for hard working.
TYPES OF STRESSORS
 Physiological stressors:
a. Chemical agents
b. Physical agents
c. Infectious agent
d. Nutrition imbalances
e. Genetic or immune disorders
 Psychological stressors:
a. Accidents can cause stress for the victim, the person who caused the accident and the
families of both
b. Stressful experiences of family members and friends
c. Fear of aggression or mutilation from others such as murder, rape, terrorist and attacks.
d. Events that we see on T.V. such as war, earthquake, violence
e. Developmental and life events
f. Rapid changes in our world, including economic and political structures and technology
SOURCES OF STRESS
There are many sources of stress, these are broadly classified as:
 Internal stressors: they originate within a person eg: cancer, feeling of depression.
 External stressors: it originates outside the individual eg: moving to another city, death in a
family.
 Developmental stressors: it occurs at predictable times throughout an individual’s life. eg:
child- beginning of school.
 Situational stressors: they are unpredictable and occur at any time during life. It may be
positive or negative. eg: death of family member, marriage/ divorce.
INDICATORS OF STRESS
It may be physiological, psychological and cognitive:

343
  Physiological indicators: the physiological signs and symptoms of stress result from
activation of sympathetic and neuro- endocrine systems of body.
♥ Pupils dilate to increase visual perception
♥ Sweat production increases
♥ Heart rate and cardiac output increases
♥ Skin is pallid due to peripheral blood vessel constriction
♥ Mouth may be dry
♥ Urine output decreases
♥ Blood sugar increases
 Psychologic indicators: the manifestations: of stress includes anxiety, fear, anger, depression
and unconscious ego defense mechanism.
♥ Anxiety: state of mental uneasiness, apprehension, dread or feeling of helpless. It can
be experienced at conscious, subconscious or unconscious level.
♥ Fear: It is an emotion/ feeling of apprehension aroused by impending or seeming
danger, pain or threat.
♥ Depression: It is an extreme feeling of sadness, despair, lack of worth or emptiness.
♥ Unconscious ego defense mechanism: It is a psychologic adaptive mechanism
developing as the personality attempts to defend itself and allay inner tensions.
Cognitive indicators:
♥ Problem solving: the person assesses the situation or problem analyzes, chose
alternatives, carries out selected alternatives and evaluates.
♥ Structuring: arrangement/ manipulation of a situation so that threatening events does
not occur.
♥ Self control: assuming a manner and facial expression that conveys a sense of being
in control or in change.
♥ Suppression: willfully putting a thought or feeling out of mind.
♥ Day dreaming: unfulfilled wishes and desires are imagined as fulfilled or a
threatening experience is re worked or re played so that it ends differently from
reality.
STRESS CYCLE

An event occurs of neutral

value or meaning

After a period of rest, the

The individual appraises
individual is able to prepare
whether the event is a
for and meet a new threat or
threat or a challenge
challenge

Fatigue follows the Bio-chemicals are

depletion of bio-chemicals released to enhance the
from the exertion ability of one’s mind and
body to respond
The bio-chemicals are The individual responds
depleted through the to the threat or challenge
exertion to meet the threat through fight or flight
or challenge

344
THEORIES OF STRESS
 SELYE’S GENERAL THEORY OF STRESS
During 1930’s and 40’s Selye performed the first extensive studies on stress
responses. His famous treatise “the physiology and pathology of stress” describes his general
theory of stress and influenced stress research throughout the world. Selye defined stress as a
physiological phenomenon.
Stress in biology is the non specific response of the body to any demand made upon
it. It suffices to keep in mind that by stress the physician means the common results of
exposure to the any stimulus. The bodily changes established when a person is exposed to
nervous tension, physical injury, infection, cold, heat, x-rays or anything are also called
stress.
 HOLMES AND RAHE’S MODEL RELATING LIFE CHANGES TO ILLNESS
They studied on relationship between change and illness. Change is a form of stress
requiring both psychological and physical adaptations. Adapting to change consumes energy
beyond that needed to maintain a steady state of life.
They developed the Social Readjustment Rating Scale, a ranking of major life change
units. They explored the link between the amount of changes in a person’s life and
subsequent illness and discovered that the higher a person’s life change score, the greater the
likelihood that an illness will subsequently develop.
 LASARUS’S THEORY OF STRESS AND COPING
This theory emphasizes that cognitive appraisal is central in determining what is stressful
and in coping with stress. He also pointed out that one of the major problems in defining
stress is that, emotions have been treated as a cause of stress response rather than the effect of
these responses. In the process of coping, the individual shapes as well as responds to a
demand or stress. Coping may change the stressful experience and thus may influence what
happens next.

STRESS MODELS
The adaptation of the concept of stress by the biological and behavioural sciences
resulted in the formulation of a number of models to describe stress and its effects. They are,
 STIMULUS BASED MODELS:
In this model, stress is defined as a stimulus, a life event or a set of circumstances that
arouses physiologic or psychologic reactions may increase the individual’s vulnerability
to illness. In this model person is viewed as being constantly exposed to environmental
stressors in their daily life, eg. the demand of work, family responsibilities, disablement
or to more specific stressors such as smell or poor lighting.
Here stress is a state that can generally be empirically observed, measured and
evaluated and which can potentially be removed or altered to reduce the individual stress.
 PSYCHOSOMATIC MODEL:
Stress is unique in the causation of diseases. It has not biological carrier such as germ
or virus. Rather it is the result of how mind and body function or interact. It is
psychosomatic in the true sense of word-psyche meaning ‘mind’ and soma ‘body’. It is
the disease created by the mind leading to different illness. Person may suppress the anger
and eventually develop the mental dysfunction of depression. Emotional stress leads to
physiological stress and results in psychosomatic illness.
 THE SYSTEM MODEL:
Stress response is here defined as carrying six components.

345
  Environmental stimuli- Some environmental stimuli activate stress response as a direct
consequence of their physical or biochemical properties. Eg. caffeine, nicotine, and
extreme cold and heat.
 Cognitive-Affective domain- The individual’s interpretation of the environment gives rise
to most of the stress reactions.
 Neurological triggering mechanisms- The limbic system and the hypothalamic nuclei
are the anatomical site for the integration of sensory cognitive, affective and visceral
activity. It is the basis for a host of psychiatric and psycho physiological disorders.
 The physiological stress response axis- Stress response occurs sequentially along the
neurological, neuro endocrine and endocrine axes and results in neural and hormonal
activity directed at target organs.
 Coping- In this final phase of stress response, the individual attempts to reduce their level
of arousal by manipulating the environment or making cognitive adjustment.
 Target organ effects- If coping are unsuccessful and arousal is either excessive or
prolonged, the physiological process of stress response is likely to lead to target organ
dysfunction or disease.
 TRANSACTION BASED MODEL:
It is based on the works of Lazarus (1966) who states that stimulus theory and
response theory do not consider individual differences. It encompasses a set of cognitive,
affective and adaptive responses that arises out of person environment transactions. As
the person and environment are inseparable, each affects and is affected by other. There
are moderating factors such as one’s copying behavior and cognitive appraisal. Effective
preventive and health promotion strategies can be planned based on this model.
 RESPONSE BASED MODEL:
In this model the word stress is used to describe the experience of a person who feels
they are in a threatening or difficult situation. Stress is thus a person’s response to threat
as in the stimulus based model, is not necessarily inherent in the environment or situation.
By using the response based model, it is possible to make sense of an individual’s unique
stress response and even of responses that might seem, within the stimulus based model,
to be irrational, such as birds , spiders or flying. It consists of mainly 2 responses,
1) Local adaptation syndrome: It is a localized response of body to stress and it
involves only specific body part (tissues, organs) instead of the whole body. It may be
traumatic or pathologic. eg: inflammatory responses of a body part in response to a
trauma or injury. It is a short term adaptive response which primarily is homeostatic. 2
most common stress responses that influence nursing care are reflex pain response and
the inflammatory response
 Reflex pain response:
It is the response of central nervous system to pain. It is rapid, automatic and
serves as a protective mechanism to prevent injury. eg: if you are about to step into a
bath tub filled with dangerous hot water, skin senses the heat and immediately sends a
message to the spinal cord. A message is then sent to motor nerve, which consciously
realize that the water is too hot not safe.
 Inflammatory response:
It is a local response to injury or infection. It helps to localize and prevent the
spread of infection and promote wound healing. There are 3 phases:
 First phase: vasoconstriction occurs to control bleeding initially. Histamines are
realized and capillary permeability increases resulting in increased blood flow to the
area. Then the blood flow returns to normal but remain to help resist the infection.

346
  Second phase: exudates (made up of fluids, cells and inflammatory by products) are
realized from the wound. The amount of exudates depends up on the site, severity of
wound.
 Third phase: damaged cells are repaired by regeneration (replacement with identical
cells) or formation of scar tissue.
2) General adaptation syndrome: It describes body’s general response to stress. It consists
of 3 stages
 The alarm reaction: it is initiated when a person perceives a specific stressor, various
defence mechanisms are activated. The autonomic nervous system initiates the flight
or flight response preparing the body to either fight off the stressor or to run away
from it.
 Resistance: the body attempts to adapt to stressor, after perceiving the threat. Vital
signs and hormone levels return to normal. If the stress can be managed or confirmed
to small area the body regains homeostasis.
 Exhaustion: it results when the adaptive mechanism are exhausted. Without defence
against the stressor, the body either rest or mobilize its defence to return to normal or
reach total exhaustion and die.
 STRESS ADAPTATION MODEL:
The model was given by Gail Stuart so it is called Stuart stress adaptation model. It
integrates biological, socio-cultural, psychological, environmental and legal- ethical
aspects of patient care into a unified frame work for practice.
 The first assumption of Stuart stress adaptation model is the nature is ordered as a
society hierarchy from the simplest unit to the most complex. Each level is a part next
higher level, so nothing exists in isolation. Thus individual is a part of family, group,
community, society and the large biosphere, through which material and information
flows across various levels.

BIOSPHERE

SOCIETY

COMMUNITY

GROUP

FAMILY

INDIVIDUAL

BODY SYSTEM

ORGAN

TISSUE

CELL

347
  Second assumption of the model is that nursing care is provided within a biological,
psychological, socio-cultural, environmental and legal- ethical context. The nurse must
understand each of them to provide holistic nursing care.
 Third assumption of the model is that health/ illness and adaptation / maladaptation are
2 distinct continuums: The health/illness continuum comes from a medical world view,
the adaptation/ maladaptation continuum comes from a nursing world view. This means
that a person with a medically diagnosed illness may be adapting well to it. In contrast a
person without a medical illness may have adaptative coping resources.
 Fourth assumption is that the model includes the primary, secondary, and tertiary levels
of prevention by describing four stages of psychiatric treatment: crisis, acute,
maintenance and health promotion. For each stage of treatment, the model suggests a
treatment goal, a focus of nursing assessment, nature of interventions and expected
outcomes of nursing care.
 Fifth assumption is based on the use of nursing process and standards of care
professional performance. Each step of the process is important and it is a local response
to injury or infection. It helps to localize and prevent the spread of infection and promote
wound healing.
TECHNIQUES OF STRESS MANAGEMENT
Stress management involves controlling and reducing the tension that occurs in
stressful situations by making emotional and physical changes. The degree of stress and the
desire to make the changes will determine how much change takes place. Some of the
techniques of stress management are:
Laughter
Adopting a humorous view towards life`s situations can take the edge off everyday
stressors. Not being too serious or in a constant alert mode helps maintain the equanimity of
mind and promote clear thinking. Being able to laugh stress away is the smartest way to
ward off its effects.
Benefits of laughter:
 Laughter lowers blood pressure and reduces hypertension.
 It provides good cardiac conditioning especially for those who are unable to perform physical
exercise.
 Reduces stress hormones (studies shows, laughter induces reduction of at least four of
neuroendocrine hormones—epinep hrine, cortisol, dopamine and growth hormone, associated
with stress response).
 Boosts immune function by raising levels of infection-fighting T-cells, disease-fighting
proteins called Gamma-interferon and disease-destroying antibodies called B-cells.
 Laughter triggers the release of endorphins—body`s natural painkillers.
 Produces a general sense of well-being.
AUTOGENIC TRAINING:
It is a relaxation technique developed by the German psychiatrist Johannes Heinrich
Schultz and first published in 1932. The technique involves the daily practice of sessions that
last around 15 minutes, usually in the morning, at lunch time, and in the evening. During
each session, the practitioner will repeat a set of visualizations that induce a state of
relaxation. Each session can be practiced in a position chosen amongst a set of recommended
postures (for eg: lying down, sitting meditation). The technique can be used to alleviate
many stress-induced psychosomatic disorders. Eg of an autogenic training session are:
♣ Sit in the meditative posture and scan the body
♣ "my right arm is heavy"

348
 ♣ "my arms and legs are heavy and warm" (repeat 3 or more times)
♣ "my heartbeat is calm and regular" (repeat 3 times)
♣ "my forehead is cool"
♣ "my neck and shoulders are heavy" (repeat 3 times)
♣ "I am at peace" (repeat 3 times)
Effects of autogenic training:
Autogenic Training restores the balance between the activity of the sympathetic
(flight or fight) and the parasympathetic (rest and digest) branches of the autonomic nervous
system. This has important health benefits, as the parasympathetic activity promotes
digestion and bowel movements, lowers the blood pressure, slows the heart rate, and
promotes the functions of the immune system.
GETTING A HOBBY:
Hobby is an activity or interest that is undertaken for pleasure or relaxation, typically
done during one's leisure [Link]: collecting, games, outdoor recreation, gardening,
performing the arts, reading, cooking and etc.
MEDITATION:
Meditation is a holistic discipline during which time the practitioner trains his or her
mind in order to realize some benefit. Meditation is generally a subjective, personal
experience and most often done without any external involvement, except perhaps prayer
beads to count prayers. Meditation often involves invoking and cultivating a feeling or
internal state, such as compassion, or attending to some focal point, etc. The term can refer to
the process of reaching this state, as well as to the state itself.
DEEP BREATHING:
Diaphragmatic breathing, abdominal breathing, belly breathing, deep breathing or
costal breathing is the act of breathing deep into one's lungs by flexing one's diaphragm rather
than breathing shallowly by flexing one's rib cage. This deep breathing is marked by
expansion of the abdomen rather than the chest when breathing. It is generally considered a
healthier and fuller way to ingest oxygen and is often used as a therapy for hyperventilation
and anxiety disorders.
A common diaphragmatic breathing exercise is as follows:
1. Sit or lie comfortably, with loose garments.
2. Put one hand on your chest and one on your stomach.
3. Slowly inhale through your nose or through pursed lips (to slow down the intake of
breath).
4. As you inhale, feel your stomach expand with your hand.
5. Slowly exhale through pursed lips to regulate the release of air.
6. Rest and repeat.
Another diaphragmatic breathing exercise for raising oxygen levels in the blood and
energy in the body is to take several negative breaths, immediately followed by an equal
number of positive breaths.
 During negative breaths, one inhales, immediately exhales and then holds one's breathe for a
short time. The emphasis is on keeping one's lungs empty. Negative breaths reduce the
amount of oxygen in one's blood.

349
  During positive breaths, one inhales, holds one's breath, and then exhales. The emphasis is in
keeping one's lungs full of air. Positive breaths increase the oxygen in one's blood. Although
not always taught, continuing to breathe into the chest at the same time can provide an ever
more "fulfilling" exercise. The goal is to have the entire torso move in & out when breathing,
as if one is surrounded by an expanding and contracting inner tube.
YOGA NIDRA
Yoga-nidra may be rendered in English as "yoga sleep". It is a sleep-like state that
occurs with some practitioners of meditation, details of which have been handed down by
guru-to-disciple transmission (parampara) within the Indian religions. These aspects may
include relaxation and guided visualization techniques as well as the psychology of dream,
sleep and yoga. Yoga-nidra should not be confused with hypnotic states, known as "yoga
tandra". The practice of yoga relaxation has been found to reduce tension and anxiety. The
autonomic symptoms of high anxiety such as headache, giddiness, chest pain, palpitations,
sweating, abdominal pain respond well.
NOOTROPICS
Nootropics also referred to as smart drugs, memory enhancers, and cognitive
enhancers, are drugs, supplements, nutraceuticals, and functional foods that are purported to
improve mental functions such as cognition, memory, intelligence, motivation, attention, and
concentration. Nootropics are thought to work by altering the availability of the brain's
supply of neurochemicals (neurotransmitters, enzymes, and hormones), by improving the
brain's oxygen supply, or by stimulating nerve growth. However the efficacy of nootropic
substances, in most cases, has not been conclusively determined.
RELAXATION TECHNIQUES:
Relaxation technique (also known as relaxation training) is any method, process,
procedure, or activity that helps a person to relax; to attain a state of increased calmness; or
otherwise reduce levels of anxiety, stress or anger. Relaxation techniques are often employed
as one element of a wider stress management program and can decrease muscle tension,
lower the blood pressure and slow heart and breath rates, among other health benefits.
FRACTIONAL RELAXATION:
Fractional relaxation is a method of releasing muscular tension in one small part of
the body at a time, such as relaxing one finger, then relaxing another, then adding another...
Then the whole hand is relaxed, followed by the forearm, and then the upper arm... The other
arm is relaxed next, starting with a finger... Then the legs (each starting with a toe)... and so
on, including all body parts (including all the parts of the head) until the entire body is
relaxed. The fractional relaxation approach is often used in preparation for trance induction
and hypnosis, but is very useful as a relaxation technique by itself. The theory behind this
tension release method is that it is easier to relax a fraction of the body than it is to relax the
whole body all at once.
‘ABC’ OF STRESS MANAGEMENT

Always take time for yourself at least 30 min/ day.

Be aware of your own stress meter; know when to step back and cool down.
Concentrate on controlling your own situation, without controlling everybody else.
Daily exercise will burn off the stress chemicals.
Eat lots of fresh fruit, veggies, bread and water; give your body the best for it to perform at its
best.

350
 Forgive others, do not hold grudges and be tolerant; not everyone is capable as you.
Gain perspective on things, how important is the issue?
Hugs, kisses and laughter; have fun and don’t be afraid to share your feelings with others.
Identify stressors and plan to deal with them better next time.
Judge your own performance realistically; don’t set goals out of your own reach.
Keep a positive attitude, your outlook will influence outcomes and the way others treat you.
Limit alcohol, drugs and other stimulants, they affect your perception and behavior.
Manage money well, seek advice and save at least 10% of what you earn.
No is a word you need to learn to use without feeling guilty.
Outdoor activities by yourself, or with friends and families, can be a great way to relax.
Play your favorite music rather than watching TV.
Quit smoking; it is stressing your body daily, not to mention killing you too.
Relationships; nurture and enjoy them, learn to listen more and talk less.
Sleep well, with firm mattress and supportive pillow; don’t over heat yourself and allow
plenty of ventilation.
Treat yourself once a week with a massage, dinner out and the movies.
Understand things from the other person point of view.
Verify information from the source before exploding.
Worry less, it really doesn’t get things completed better or quicker.
Xpress ; make a regular retreat to your favorite space, make holidays part of your yearly plan
and budget.
Yearly goal setting; plan what you want to achieve based on your priorities in your career,
relationships etc
Zest for life; each day is a gift, smile and be thankful that you’re the part of the bigger picture.
LEADERSHIP BEHAVIORAL STYLES
INTRODUCTION
A leader one, who uses interpersonal skills to influence others to accomplish specific
goals. The leader exerts influence using a flexible repertoire of personal behavior and
strategies. Effective utilization of the capacity of human resources depends upon leadership.
The leadership is an essential ingredient for successful organization.
DEFINITION
“Leadership is an ability of a leader/manager to induce subordinates (followers) to
work with confidence and zeal”.
(Koontz & O Connell, 04)
“Leadership refers to the relation between an individual and group around some
common interest and behaving in a manner directed or determined by leader”.
(Encyclopedia of Social Sciences)
FEATURES OF LEADERSHIP
1. Leadership is a continuous process of behaviors, it is not one-shot activity.
2. Leadership may be in terms of relations between a leader and his followers which
arise out of their functioning for common goals.
351
 3. By exercising his leadership, the leader tries to influence the behavior of individuals
or group of individuals around him to achieve common goals.
4. The followers work willingly and enthusiastically to achieve these goals.
IMPORTANCE OF LEADERSHIP
Leadership is an important factor for making any type of organizations successful.
The importance of good leadership can be discussed as follow;
i) Motivating employees
Motivation is necessary for work performance, higher the motivation, better the
performance. A good leader, by exercising his leadership, motivates the employees
for high performance.
ii) Creating confidence
A good leader may create confidence in his followers by directing them, giving them
advice and getting through them good results in the organization.
iii) Building morale
Morale is expressed as attitude of employees towards organization, management and
voluntary co-operation to offer their ability to the organization. High morale leads to
high productivity and organization stability.
TYPES OF LEADERSHIP
According to the personal research board of the Ohio university, there are five types
of leadership, these are:
a. The Bureaucrat Leadership
Who sticks to routine, appease his superiors, and avoid his subordinates.
b. The diplomat leadership
Who, is opportunistic and exploits people. He generally rouses distrust.
c. The autocrat leadership
Who is directive and expects objects obedience. His subordinates to be antagonistic to
him.
d. The expert
The leader, who is concerned only with his own field of specialization. He treats his
subordinates as fellow-workers.
e. The quarter back
The leader, who identifies himself with his subordinates even at risk of displeasing his
superiors.

352
 LEADERSHIP STYLES
INTRODUCTION
Leadership styles are the patters of behaviors, which a leader adopts in influencing the
behavior of his followers. Various researchers have proposes different leadership styles.
These styles are based either on behavioral approach or on situational approach of leadership.
Based on behavioral approach
1. Power orientation
2. Leadership as a continuum
3. Employee production system
4. Managerial grid
Based on situational approach
1. Fielder’s contingency model
2. Hersey and Blanchard’s situational model
3. Path goal model
1. Power orientation
Power orientation approach of leadership is based on the degree of authority which a
leader influencing the behavior of his subordinates. Based on the degree of use of power,
there are three leadership styles;
a. Autocratic leadership
b. Participative leadership
c. Free-rein leadership
a. Autocratic leadership
Autocratic leadership is also known as authoritarian, directive or monothetic style. In
autocratic leadership style, a manager centralized decision-making power in him. He
structures the complete situation for his employees and they do what they are told. There
are three categories of autocratic leader.
i) Strict autocrat
He follows autocratic styles in a very strict sense.
ii) Benevolent autocrat
He also centralizes decision-making power in him, but his motivation style is positive.
iii) Incompetent autocrat
Sometimes superiors adopt autocratic leadership style just to hide their incompetence.
b. Participative leadership

353
 Participation is defined as mental and emotional involvement of patient in a group
situation which encourages him to contribute to group goals and share responsibility in
them.
A participative manager decentralizes his decision making process, instead of taking
unilateral decision, he emphasizes on consultation and participation of his subordinate.
Subordinates are broadly informed about the conditions affecting them and their job.
c. Free-rein leadership
Free rein or laisses-fair technique means giving complete freedom to sub-ordinates. In
this style, manager once deter mines policy, programmes limitation for action and the
entire process is left to subordinates. Group members perform everything and the
manager usually maintains contacts with outside persons to bring the information and
materials which the group needs.
2. Leadership as a continuum

A variety of styles of leadership behavior between two extremes of autocratic and free-
rein. A broad range of style on a continuum moving from authoritarian leadership behavior at
one end to free-rein behavior at the other end.

Autocratic Leadership free-rein Leadership

(Boss centered) (Subordinate centered)

3. Likert’s management system

Likert and his associate Michigan, USA, have studied the patterns and styles of
manager for three decades and have developed certain concepts and approaches important to
understanding leadership behavior.
In his management system, Likert has taken seven variables of different management
systems. These variables include leadership, motivation, communication, interaction
influence, decision making process, goal setting and control process.
Likert’s four system of management in terms of leadership styles may be referred to
as exploitative autocratic (system 1), benevolent autocratic (system 2), participative (system
3) and democratic (system 4).

System 2 System 3 System 4

Leadership System 1

354
 variable

Trust and Has no trust & Has Substantial but Complete

confidence in confidence in condescending not complete confidence and
subordinates subordinates. confidence and confidence and trust in all
trust in trust; still matters
subordinates, wishes to keep
such as master control of
has to a servant decisions.
Subordinates Subordinates do Subordinates do Subordinates Subordinates
feeling of not feel at all not feel very free feel rather free feel completely
freedom free to discuss to discuss things to discuss things free to discuss
things about the about job with about the job things about the
job with their their superior. with their job with their
superior. superior superior
Superior Seldom gets Sometimes gets Usually gets Always gets
seeking ideas and ideas & opinion ideas and ideas and
involvement opinion of of subordinates opinions and opinion &
with subordinates in in solving job usually tries to always tries to
subordinates solving job problems. make make
problems constructive use constructive use
of them of them.
Likert’s management system

355
Employee production orientation
The leadership behavior by locating clusters characteristic that seemed to be
related to each other and various indicators of effectiveness. The studies identified
two concepts which were called employee orientation and production orientation. The
employee orientation stresses the relationship aspects of employees’ job. It
emphasizes that everyone, accepting his or her individuality and personal needs. This
is parallel to democratic concept of leadership behavior. Production orientation
emphasis production and technical aspects of jobs and employees are taken as tools
for accomplishing the jobs. This is parallel to the authoritarian concepts of leadership
behavior.
4. Managerial grid
One of the most widely known approaches of leadership styles is the
managerial grid developed by Blake and Mouton. They emphasize that leadership
style consists of task oriented and relation oriented behavior in varying degrees.
The managerial gird identified five leadership styles based upon these two
factors founds in organization as shows below.
High
91,9 9,9
(Country club)
8
(Team)

5
5, 5
Middle road
4

Low 1,1 9,1

1 2 3 4 5 6 7 8 9
Low
High
Concern of Production
Blake and Mouton have described the five styles as follows

356
1,1 Exertion of minimum effort is required to get work done and sustain
organizational moral
1,9 Thoughtful attention to need of people leads to a friendly and comfortable
organizational atmosphere and work tempo.
9,1 Efficiency results from arranging work in such a way that human elements
have little effect.
5,5 Adequate performance through balance of work requirement and maintaining
satisfactory morale
9,9 Work accomplished is from committed people with interdependence through a
common stake in organizational purpose and with trust and respect.
Each style points out the relative contents of consent for production or people and
implies that the most desirable leader’s behavior is 9,9 (maximum concern for
production and people). In fact, Blake and Mouton have developed training
programmes that attempts to change managers towards 9,9 management style.
5. Tri-dimensional grid
Reddin conceptualized a three-dimensional grid, also known as 3-D
management borrowing some of the ideas from managerial grid. Three dimensional
axes represent task orientation, relationship orientation to the task oriented and
relationship oriented behavior dimensions, Reddin has integrated the concept of
leadership style with the situational demand of a specific environment.
Task orientation (TO) is defined as the extent to which a manager directs his
subordinates’ efforts towards goal attainment. It is characterized by planning,
organizing and controlling. Relationship orientation is defined as the extent to which a
manager has personal relationships. It is characterized by mutual trust, respect for
subordinates ideas and suggestions & their feeling, effectiveness is defined as the
extent to which a manger is successful in his position when the style of a leader is
appropriate to a given situating it is termed as effective, when the style is
inappropriate to a given situation, it is termed as ineffective.
Either degree of TO & RO, or a combination of both, is used by leaders. On
this basis there are four styles.

357
 High
Related Integrated
Relationship
Orientation
Separated Dedicated
Low
Low High
Task orientation
Task and Relationship Orientation
The four basic styles result into eight styles. These eight styles results from the
eight possible combinations of task orientation, relationship-orientation and
effectiveness.
According to this, following are ineffective styles;
1. Deserter : low task and low people orientation
2. Missionary: interest in harmony, believes in easy life
3. Autocrat : immeate jobs and has no concern for other; decisions are unilateral
and centralized
4. Compromiser: high risk task and relationship orientation in either is par decision
maker and avoid decisions.
The four corresponding effective styles are as follows;
1. Bureaucrat: He has high orientation towards organizational rules and relationships,
is impersonal, less task and relationship oriented; produces only few ideas, and does
not take initiative.

2. Developer: He tends to display implicit trust in people, relies on high relationship

orientation and less task orientation, believes in commitment to work, openness,
freedom to act, self-expression and development of subordinates.
3. Benevolent autocrat
He is directive manager who knows that he wants and often gets it with out
creating resentment, is high task and less people oriented, adopts positive economic
motivation for getting things done and follow feudalistic approach in managing the
organization.
4. Executive

358
 He has a high risk and high relationship orientation in a situation where such
behavior is appropriate, emphasizes team management; task is regarded as
interdependent and integrated. The style acts as a powerful motivational instrument in
the organization. This is a democratic leadership style.
FIEDLER’S CONTINGENCY MODEL
Fielder’s contingency model of leadership has the basic contention that the
appropriateness of leadership styles depends on their matching with situational
requirement. Fiedler along with his associates made an attempt to identify the
situational variables and their relationship with appropriateness of leadership styles.
Fiedler’s model consists of three elements;
1. Leadership styles
2. Situational variables
3. interrelationship
1. Leadership styles
Task directed and human relations oriented. Task directed styles is primarily
concerned with the achievement of task performance. The leader derives satisfaction
out of the task performance. The leader derives satisfaction out of the task
performance. Human relation style is concerned with achieving good interpersonal
relations and achieving a position of personal prominence.
2. Situational variables
These are leader’s position power, task structure and leader member relations.
Leader position power:
This is determined by the degree to which a leader derives power from the
position held by him in the organization which enables him to influence the behavior
of others.
Task structure:
Task structure refers to the degree to which the task requirements are clearly
defined in terms of task objectives, processes and relationship with other tasks.
Leader member relations
It refers the degree to which followers have confidences, trust and respect in
the leader as his position, power and task structure are subject to control by the
organization and these can be prescribed.
All these situational variables taken together may define the situation
to be favourable or unfavourable.

359
 Good Poor
H Lo High Low
igh w
strong weak strong weak strong weak strong weak
Leader-member relations
Task structure

Position power

Cells 1 2 3 4 5 6 7
8
Very favourable
Unfavourable
A very favourable situation is one (cell 1) where leader member
relations are good, task is highly structured and the leader has enormous
position power to influence his subordinates. At the other extreme, a very
unfavourable situation is one (Cell 8) where leader member relations are poor,
task is highly unstructured and leader’s position power is weak between these
two extremes, the degrees of favourableness/unfavourableness varies.
Relation between styles and situation
Fielder feels that the effectiveness of leadership style depends upon the
situation.

Style of Leadership

Task directed
0

Human relations
Very- Very-

360
 Favourable Favourable 0 Unfavourable
unfavourable

Favourableness of the situation

I. Task directed leadership style tends to be better in group situation that are
either very favourable or very unfavourable to the leader
II. Human relations oriented relationship style tends to be in group situation that
are intermediate in favourableness.
HERSEY-BLANCHARD’S SITUATIONAL MODEL
Hersey-Blanchard’s situational leadership model takes a different perspective
of situational variables as compared to fielder’s model. Hursey and Blanchard feel
that the leader has to match her leadership style according to the needs of maturity of
subordinates which moves in stage and has a cycle. Therefore, this study is also
known as life-cycle theory of leadership. There are two basic considerations in this
model; leadership styles & maturity of subordinates.
Leadership style
Leadership style may be classified in to four categories based on the
combination of two considerations; relationship behavior and task behavior.
Relationship behavior is determined by socio-economic support provided by the
leader. Task behavior is seen in terms of the amount of guidance and direction
provided by the leader. Combination of these two dimensions results into four styles.

High relationship and low task High relationship and high task

Low relationship and low task Low relationship and high task
High

Relationship behaviour

Low
Low High
Task orientation
Subordinate maturity
Maturity in this model has been used in the context to ability and willingness
of the people to directing their own behavior and not strictly in accordance with the

361
immaturity maturity theory of Argyris. Ability refers to the knowledge and skills of an
individual to do the job and is called job maturity. Willingness refers to the
psychological maturity and has much to do with confidence and commitment of the
individual. When both components of maturity-ability and willingness are combined,
we can get four combinations.
1. Low ability and low willingness – low maturity
2. Low ability and high willingness – low and moderate maturity
3. High ability and high willingness – moderate to high maturity
4. High ability and high willingness – high maturity
Combining leadership style and maturity
The leadership style which is appropriate at a given level of maturity,
we may arrive at the relationship between two,
Thus there are four leadership styles, each being appropriate to a
specific level of maturity. The four leadership styles are;
Telling
Where the subordinates have low maturity, that is neither they have ability nor
they are willing to do, they require telling leadership style. It emphasizes directive
behavior and involves high task behavior and low relationship behavior.
Selling
For subordinates of moderate maturity who have high willingness but lack
ability, selling leadership style is appropriate. The subordinate require both supportive
and directive behavior which is marked by high task and high relationship behavior.
Participating
Subordinates with moderate to high maturity who have ability to do but
willingness require high external motivating force, in such a situation, participating
leadership style with low task behavior and high relationship behavior is more
appropriate.

Delegating
Subordinate with high maturity that is they have both ability and willingness
to work, hardly any leadership support. The most appropriate leadership style in such
a situation is delegating which involves low task behavior and low relationship
behavior.

362
 Hersey-Blanchard’s model of situational leadership styles
SUMMARY
So far we have discussed about definition of leadership, features and
importance of leadership, qualities of leadership, theories of leadership, theories of
leadership, leader behavior, situational leader, leadership styles.

CONCLUSION
The leadership is the process of influencing and supporting others. The
qualities include innate and acquired qualities. Various theories are found in
leadership. The leadership styles are based on behavioral approach and situational
approach.
POWER AND POLITICS
INTRODUCTION
Power is strong and basic human needs. It is most important to people and
more central to understanding their behavior then many health care providers,
recognize Power is once capacity to influence others, ones power may be greater or
less than the authority of the position. It realizing many benefits that can accrue.
When people become active participants in there care and are attempting to empower
clients of health care system.
DEFINITION
The Word Power is derived from the Latin verb potere (To be able) ; Thus
power may be appropriately defined as that which enable one to accomplish goals.
Henin (1998) state that to process power implies the ability to change the attitude and
behaviors of individual people and groups.

363
Power can be defined as the capacity to act or the strength and potency to accomplish
some thing.
Marquis X Huston
Types of Power
There are five type of power are seen in organizations.
1 Reward Power
2 Punishment or Coercive Power
3 Legitimate Power
4 Expert Power
5 Referent Power
1 Reward Power
Reward Power is obtained by the ability to grant favors or reward
others with whatever they value. The arsenal of Reward that a manager can
dispense to get employees to work toward meeting organization goals is very
broad a great deal of loyalty towards leader.
2 Punishment Power
The Punishment Power is opposite of Reward power is based on fear
of punishment if the expectation are not met. The manager may obtain compliance
through Threat of Transfer, demotion, or dismissal
3 Legitimate Power
It is the position power. Authority also is called legitimate power. It is
the power gained by a title or official position with in an organization. The
socialization and culture of sub ordinate employees will influence to some degree
how much power a manager has due to his or her position.
4. Expert power
It is gained through knowledge, expertise or experience having critical
knowledge allows a manager to gain power over others who needs that
knowledge. This type of power is limited to a specialized area. For e.g. Some one
with vast expertise in music would only be powerful in that area, not in another
specialization.
5. Referent power.
Referent power is power a person has because others identify with that
leader. Referent power is given to others through association with the powerful.
People also may develop referent power because others perceive them a powerful
it is based on respect
SOURCES OF POWER
[Link] Type Source
1. Reward Ability to grant favors
2. Coercive Fear
3. Legitimate Position
4. Expert Knowledge and skills
5. Referent Association with others

STRATEGIES TO ENTRANCE POWER

364
 Marquis and Hustorn (1998) suggest that following strategies for enhancing
power.
1. Expend personal resources:- Power nd energy goes hand in hand. The
manager must relax and talking time for significant relationship as well as
develop outside interest to expand their resources.
2. Present a powerful picture to others
3. Determine the powerful in the organization
4. Understanding and working with in the formal and informal power structures
are necessary
5. Learn the langrage and symbols of the organization
6. Learn how to use the organization priorities
7. Increase professional skill and knowledge
8. Maintain a broad vision
9. Use experts and seek and knowledge
10. Be flexible
11. Develop visibility and voice in the organization
12. Maintain a sense of humor
13. Empower others.
Uses of power
1. The holder of power may use it constrictive or distinctively for personal gain
or for the good of the organization
2. Power should be understood respect and used widely according to the goals.
Improper uses power can disrupt the group and will affect the performance of
the recipient of the power.
3. The person using power with others should maintain respect for the person.
Power and Nurses Roles
Nurse historically had limited power in the health care system. But nor nursing
organization are working to provide nurses with a voice at higher decision making
level in health care
1. Working together:
By understanding the political realities and the way in which decisions are by
working together to speak with a unified voice, nurses can increase their power in the
system
2. Nursing education programs
Increasingly try to educate nurses to out as client advocate and agent of
change. The higher educations like [Link] (N), [Link](N), and Ph.D in nursing and
specialized courses will help the nurses to gain power in health system.
3. Collective bargaining and shared governance
It helps the nurses with mechanism for demanding recognition of the
importance of their role for being participants in decision-making process.
a. Collective bargaining
It is a process that allows employees who are member of the union to
participate in management decisions with regard to terms of employment
salaries, benefits, working conditions and similar issues. Nurses believe that

365
 people who choose nursing as a carrier should have the opportunity to have
same voice in patient care assignment length of work day and week benefits
any wages etc.
b. Shared governance
It is a professional proactive modern in which the nursing staff and the
nursing management are both involved in decision-making this allows the
nursing staff to make major decisions with in the organization and helps in
quality improvement and gaining power
4. Power as a tool for leadership
Power is an increasingly important form of influence of nursing leader.
Leaders are found throughout the organization and have formal and informal
leadership responsibility gain from respect and regard for the knowledge and good
judgment of the person
POLITICS
INTRODUCTION
Politics is an interpersonal endeavor it involves skills of communication and
persuasion. Their communication skills make nurses particularly effective in political
activities. It also a collective endeavor. It often requires the support and action of
many people to bring effective politics to bear on a situation or issue.
DEFINITION
1. Politics is the art of influencing the allocation of scarce resources.
[ Mason & albott, 1985.]
2. Politics is a means to an end, a means for influencing events and the decisions of
others
[Stevens, 1980]
PURPOSES:-
1. Protection of the interests of the whole group or a particular part of a group
against subordinates groups.
2. The preservation of order in the interest of the group of power or of the whole
population.
3. It is important for Analysis and planning.
A FRAMEWORK FOR POLITICAL ACTION:-
Although most people associate the word politics with government, it pertains
to every aspect of life that involves competition for allocating scarce resources or
influencing decision making. As such, it is relevant to what Nurse do in their daily
practice, whether as a Nurse in a home heath agency, a Nurse practitioner in a clinic,
or a Nurse Manager in a hospital.
What nurse do in their every day practice is influenced by, and in Turn
influences. What governments do, what professional organization do. These
are over all political power.
1. Politics in work place
Politics in the work place is often regarded with disdain, as reflected in the
Remark, “She plays politics”. This statement is used to imply that the individual got

366
what he or she wanted because of personal connections rather than on Marit
Ehrat(1983) pointed out that politics is inherent in heath care delivery because heath
care involves multiple special interest groups all competing for their piece of a limited
pool of resources.
2. Politics in Government
Politics in government can influence who gets what kind of heath care, where,
and why. Inspite of many efforts to limit heath care costs, they continue to rise much
faster than inflation in general.
In an attempt to control cost and Medicaid programs are anticipated. Towers in
1995 suggested Nurse Take Responsibility for educating and communicating with
new legislators. Nurses must use their authoritative voices and political muscle to
shift resources to expend community Based services that promote greater access to
and availability of health care.
3. Politics in financing:-
Which individual qualifying to be cared for by a Nurse in an organization is, to a
certain extent, determined by the politics of heath care financing in the United States.
Finance also influences where patients receive their care. In
metropolitan Regions, one can find at least two tiers of heath care. One for the
poor (Public Hospital) and one for the middle and upper classes (Private
Institution and Private Physician). Although public heath care institution and
agencies can often provide excellent care, they frequently are underfinanced
and have limited resources (Staff, Equipment, Medication).
4. Politics in organization:-
Once a patient gets into a hospital bed, the kind and quality of nursing care he or
she receives also can be influenced by politics.
Politics decides policies of government; they also determine the shape and focus of
nursing organizations. These organizations are an important forum for nurses to learn,
develop, and apply their political skills.
5 Politics in the community:-
The workplace, government and organization all interact with the
community, whether local, regional, national or international. One nurse found
that her leadership in a community effort to eliminate improper garbage
dumping in her town enabled her to develop important connection to
government officials on both the state and local levels.
Applying power and politics to managing nursing care:-
The delivery of nursing services occurs at many levels in health care
organization. The effectiveness of care depends or linked to the application of power
and politics and marketing.
For the staff nurse, the politics of beside care involve influencing the
allocation of scarce resources (e.g.- equipment, supplies, time) for the delivery
of nursing care.
To maintain access to the resources needed for patient care. Nurses must
connect to the whole organization and beyond not just their own nursing unit.

367
 Staff nurse can use their power when the limitation Interfere with and place
restrictions on patient care whether the restriction come in the from of limited supply,
money or time, nurse can use their power and the political skills of artful
collaboration and networking to obtain the necessary resources to provide care.
Politics of nursing care calls for an action plan, not just a care plan. It is time to
force those who seek to establish policy without nursing’s input to listen to what nurse
have to say.
How nursing voice can become powerful:-
The first step in improving nursing’s power is to seek out opportunity for
change. When you are ready to influence policy, start in your own workplace, where
individuals and families known and understand the difference nurses make in the
health and healing process.

Identify where decisions are made and asked to be invited (e.g.-

Nursing council, policy and procedure committee). Focus your power on
political and policy issues that evolve from personal and professional value
and visions.
The professional organization provides an opportunity for developing political
skills that its member can use both in the association and in other area.
Seeking a leadership position with the committee provides additional
influence and visibility. Such visibility often is needed if you are interested in
serving on the major policy making body of the organization. Such as the
board of directors. There is no perfect strategy to using power and politics to
manage nursing care. It requires skill, Tact, and relationship building.
THE IMPACT OF POWER AND POLITICS ON NURSING’S FUTURE:-
Health care is in a state of constant change. Acute care hospitals are down
sizing and reorganizing while, at the same time, community sites to deliver nursing
care are expanding.
Nurses know the problems and have many of the solutions. Making a case for
nursing input into health care policy is no longer an option for nurse.
Nurses can have a tremendous impact on health care policy. The best impact is
often made with a bit of luck and timing, but never without knowledge of the whole
system. This includes knowledge of the policy agenda, the policy makers, and the
politics that are involved once you gain this knowledge; you are ready to move
forward with a political base to promote Nursing.
To convert your policy ideas into political realties, consider the following
power point:
1) Use Persuasion over coercion:-
Persuasion is the ability to share reasons and rational when making a strong care
for your position.
2) Use patience over impatience:-
Despite the inconveniences and failing caused by health care restructuring,
impatience in the nursing community can be detrimental. Patience, along with a long
term perspective on health care re-form, is needed.

368
3) Be open minded rather than closed minded:-
Acquiring accurate information is essential if you want to influence others
effectively.
4) Use compassion over confrontation:-
In times of change, error and mistakes are easy to pin point.
5) Use integrity over Dishonesty:-
Honest discourse must be matched with kind thoughts and actions.
To manage nursing care in the future, nurses must come to realize that nursing
expertise and clinical judgment are the best combination to effectively influence
nursing practice and policy changes. By applying power and politics to the work
place, nurse increase their professional influence.
SUMMARY:-
So far, we have discussed in this seminar about the introduction of power and
politics, Definitions, Types, sources, use in organization, Power as a tool for
leadership, frame work of political action, Applying power to manage Nursing care,
impact of power and politics on nursing future.

Program Evaluation and Review Technique

The Program (or Project) Evaluation and Review Technique, commonly
abbreviated PERT, is a model for project management designed to analyze and
represent the tasks involved in completing a given project. It is commonly used in
conjunction with the critical path method or CPM.
Overview
PERT is a method to analyze the involved tasks in completing a given project,
especially the time needed to complete each task, and identifying the minimum time
needed to complete the total project.
PERT was developed primarily to simplify the planning and scheduling of large and
complex projects. It was developed by Bill Pocock of Booz Allen Hamilton and
Gordon Perhson of the U.S. Navy Special Projects Office in 1957 to support the U.S.
Navy's Polaris nuclear submarine project. It was able to incorporate uncertainty by
making it possible to schedule a project while not knowing precisely the details and
durations of all the activities. It is more of an event-oriented technique rather than
start- and completion-oriented, and is used more in projects where time, rather than
cost, is the major factor. It is applied to very large-scale, one-time, complex, non-
routine infrastructure and Research and Development projects. An example of this
was for the 1968 Winter Olympics in Grenoble which applied PERT from 1965 until
the opening of the 1968 Games.[1]
This project model was the first of its kind, a revival for scientific management,
founded by Frederick Taylor (Taylorism) and later refined by Henry Ford

369
(Fordism). DuPont corporation's critical path method was invented at roughly the
same time as PERT.
Complex projects require a series of activities, some of which must be performed
sequentially and other that can be performed in parallel with other activities. This
collection of series and parallel task can be modelled as a network. . This has the
potential to reduce both the time and cost required to complete a project.

Terminology
 PERT event: a point that marks the start or completion of one or more
activities. It consumes no time and uses no resources. When it marks the
completion of one or more tasks, it is not “reached” (does not occur) until all of
the activities leading to that event have been completed.
 predecessor event: an event that immediately precedes some other event
without any other events intervening. An event can have multiple predecessor
events and can be the predecessor of multiple events.
 successor event: an event that immediately follows some other event without
any other intervening events. An event can have multiple successor events and can
be the successor of multiple events.
 PERT activity: the actual performance of a task which consumes time and
requires resources (such as labor, materials, space, machinery). It can be
understood as representing the time, effort, and resources required to move from
one event to another. A PERT activity cannot be performed until the predecessor
event has occurred.
 Optimistic time (O): the minimum possible time required to accomplish a task,
assuming everything proceeds better than is normally expected
 Pessimistic time (P): the maximum possible time required to accomplish a
task, assuming everything goes wrong (but excluding major catastrophes).
 Most likely time (M): the best estimate of the time required to accomplish a
task, assuming everything proceeds as normal.
 Expected time (TE): the best estimate of the time required to accomplish a task,
assuming everything proceeds as normal (the implication being that the expected
time is the average time the task would require if the task were repeated on a
number of occasions over an extended period of time).
TE = (O + 4M + P) ÷ 6

370
  Float  or Slack is the amount of time that a task in a project network can be
delayed without causing a delay - Subsequent tasks – (free float) or Project
Completion – (total float)
 Critical Path: the longest possible continuous pathway taken from the initial
event to the terminal event. It determines the total calendar time required for
the project; and, therefore, any time delays along the critical path will delay
the reaching of the terminal event by at least the same amount.
 Critical Activity: An activity that has total float equal to zero. Activity with
zero float does not mean it is on the critical path.
 Lead  time: the time by which a predecessor event must be completed in order
to allow sufficient time for the activities that must elapse before a specific
PERT event reaches completion.
 Lag time: the earliest time by which a successor event can follow a specific
PERT event.
 Slack: the slack of an event is a measure of the excess time and resources
available in achieving this event. Positive slack would indicateahead of
schedule; negative slack would indicate behind schedule; and zero slack
would indicate on schedule.
 Fast tracking: performing more critical activities in parallel
 Crashing critical path: Shortening duration of critical activities

Steps in the pert planning process

1. Identify the specific activities and milestones
2. Determine the proper sequence of the activities
3. Construct a network diagram
4. Estimate the time required for each activity
5. Determine the critical path
6. Update the pert chart as the project progresses

1. Identify activities and milestones

The activities are task required to complete the project. The milestones are the
events marking the beginning and end of one or more activities. It is helpful to list
the tasks in a table that in later steps can be expanded to include information on
sequence and duration.
2. Determine activity sequence
This step may be combined with the activity identification step since the activity
sequence is evident for some tasks. Other tasks may require more analysis to
determine the exact order in which they must be performed.
3. Construct the network diagram
Using the activity sequence information, a network diagram can be drawn showing
the sequence of the serial and parallel activities. For original activity on arc model,

371
 the activities are depicted by arrowed lines and milestones are depicted by circles of
“bubbles”.
If done manually, several drafts may be required to correctly portray the
relationships among activities. Software packages simplify this step by automatically
converting tabular activity information into a network diagram.
4. Estimate activity times
Weeks are a commonly used unit of time for activity completion, but any consistent
unit of time can be used. A distinguishing feature of pert is itis ability to deal with
uncertainty in activity completion times. For each activity, the model usually
includes three time estimates:
Optimistic time – generally the shortest time in which the activity can be completed.
It is common practice tospecify optimistic times to be three standard deviations
from the mean so that there is approximately a 1 % chance that the activity will be
completed within the optimistic time.
Most likely time – the completion time having the highest probability. It is different
from expected time
Pessimistic time – the longest time that an activity might require.

Pert assumes a beta probability distribution for the time estimates. For a beta
distribution, the expected time for each activity can be approximated using
following weighted average:
Expected time = (optimistic + 4 × most likely + pessimistic) / 6
This expected time may be displayed on network diagram.
To calculate the varience for each activity completion time, if three standard
deviations between them, so varience is givenny ;
[(pessimistic – optimistic )/ 6]2
5. Determine the critical path
The critical path is determined by adding the times for the activities in each
sequence and determining the longest path in the project. The critical path
determines the total calendar time required for the project. Ifthe activities outside
the critical path speed up or slow down (within limits) , the total project time
doesnot change. The amount of time that a non critical path activity can be delayed
without delaying the project isreffered to as slack time.
If the critical path is not immediately obvious, it may be helpful to determine the
following four quantities for each activity;
Es – earliest start time
Ef – earlist finish time
Ls – latest starttime
Lf – latestfinish time
These times are calculated using expected time for relevant activities. Since the
critical path determines the completion date of the project, the project can be
accelerated by adding the resourses required to decrease the time for the activities
in the critical path. Such a shortening of the project sometimes is referred to as
project crashing.
6. Update as project progresses

372
 Make adjustments inpert chart as the project progressses. As the project unfolds,
the estimated times can be replaced with actual times. In cases where there are
delays, additional resources may beneeded to stay on schedule and the pert chart
may be modifiedto reflect the new situation.

Advantages

 PERT chart explicitly defines and makes visible dependencies (precedence

relationships) between the WBS elements
 PERT facilitates identification of the critical path and makes this visible
 PERT facilitates identification of early start, late start, and slack for each
activity,
 PERT provides for potentially reduced project duration due to better
understanding of dependencies leading to improved overlapping of activities
and tasks where feasible.
 The large amount of project data can be organized & presented in diagram for
use in decision making.
Disadvantages
 There can be potentially hundreds or thousands of activities and individual
dependency relationships
 The network charts tend to be large and unwieldy requiring several pages to
print and requiring special size paper
 The lack of a timeframe on most PERT/CPM charts makes it harder to show
status although colours can help (e.g., specific colour for completed nodes)
 When the PERT/CPM charts become unwieldy, they are no longer used to
manage the project.

373