philosophy and current trends in nursing management

AIMS,OBJECTIVES,PHILOSOPHY CURRENT TRENDS AND ISSUES

IN NURSING MANAGEMENT

BY: SAVITA M.SC NURSING

Management is art of knowing what you want to do and then

seeing that is done….in the best way and cheapest way…by

securing maximum use of men and machine.

INTRODUCTION

AIMS OF NURSING MANAGEMENT

To ensure effective utilization of resources for the attainment of goals and make decisions regarding-

What activities are to be performedBy whom to be performedWhere these are to be carried out.

OBJECTIVES

AN OBJECTIVE

GIVES

AN OBJECTIVE

GIVES

ACTIONACTION

EVALUATION

EVALUATION

IMPORTANCE OF OBJECTIVES

Clear direction for

Sound basis for

• The process of management starts with setting of objectives then the other managerial functions come into picture. Only then the manager is able to measure the performance, once it is implemented as per plan.

• Thus an organization without objectives is like a ship without a rudder. So objectives are the end points on which all the efforts of the organizations cover.

COND…..

Objectives state the end results, but these are not the ends itself. The overall objectives need to be supported by sub objectives and

also as per the level in the hierarchy.

Objectives state the end results, but these are not the ends itself. The overall objectives need to be supported by sub objectives and

also as per the level in the hierarchy.

NATURE OF OBJECTIVESNATURE OF OBJECTIVES

FORMULATION OF NURSING OBJECTIVES

All the Organizations need to set the objectives. Setting objectives are

important; it focuses the organization on specific aims over a period of time

and can motivate staff to meet the objectives set. Objectives can be

formulated on the following bases.

All the Organizations need to set the objectives. Setting objectives are

important; it focuses the organization on specific aims over a period of time

and can motivate staff to meet the objectives set. Objectives can be

formulated on the following bases.

CHARACTERISTICS OF NURSING OBJECTIVES

CHARACTERISTICS OF NURSING OBJECTIVES

CLASSIFICATION OF NURSING OBJECTIVES

• LEVEL OF OBJECTIVESMajor or organizational objectivesDepartmental objectivesGroup objectivesUnit objectivesIndividual objectives

TYPES OF OBJECTIVES

BASED ON HIERARCHY OR OPERATIONAL OBJECTIVES:

• Primary objectives: The main primary objectives of hospital services are to

provide the curative services by ensuring patient care to indoor patients.

• Subsidiary objectives: These objectives are based on the managerial

professional activities e.G human relation, communication, teaching or research.

EXAMPLE OF OBJECTIVES

1) To provide efficient social life to nurses and thus prepare them in the art of living together.

2) To bring school or college and community closer to each other.

3) To help the nurses in unfolding, blossoming of personality.

4) To enable the nurse to have the right type of philosophy in life.

5) To conserve all the good practices and conventions of the past.

6) To help in the realization of objectives of education as laid down by the experts according to their selected vocation or profession.

7) To bring harmony between and the tasks.

8) To make maximum use of all educational facilities in order to attain the desired objectives and to help minimize the wastage.

9) To provide healthy atmosphere for experimentation and research.

PHILOSOPHY OF ADMINISTRATION

NURSING PHILOSOPHY

For example: philosophy of nursing of the department of nursing services and patient

care

• ‘Nursing is an art and a science dedicated to improving

the physical and psychological well being of patients. The department of nursing services and patient care supports the practice of nursing within the service, education and research mission in order to benefit patients, the people of country, and the health care professions. We are committed to excellence in practice, education, informatics, research and administration’.

BASES FOR DEVELOPING NURSING PHILOSOPHY

The concept of caring where cognitive, moral and attitudinal aspects are examined.

The importance of gaining a moral and political consciousness of assumptions underlying a nurse’s work.

A discussion of some ethical and other implications in adopting a systems approach to the nursing process.

An analysis of nursing theory and research which drawn attention to the value of non empirical work, reiterates criticism of the objectives approach as a research tool

STANDARDS FOR EVALUATING NURSING PHILOSOPHY

CURRENT TRENDS AND ISSUES IN NURSING ADMINISTRATION AND

MANAGEMENT

• Nursing as a profession has flourished from the time of Florance nightingale till present day nursing. At some levels in nursing, the question of professionalism takes on immense significance. However, to the busy staff nurse- who is trying to allocate client assignment for a shift , distribute the medications at 9am to 24 clients ;and supervises ward aide, nursing students-the issue may not seem very significant at all.

ISSUES IN NURSING ADMINISTRATION

PROFESSION IN NURSING

• Status of nursing in society in the health care delivery system.

• Values reflected in our nursing performances.• Attitude, human approach.• Quality in nursing vis-vis education and practice.

• Unique function of nursing.

• Different levels of nurses that we need in our country.• Define and delineation of nursing functions at the

different level.

•

Nursing practice

• In the community setting and in the institutional setting at the level of primary, secondary and tertiary levels of care.

• Are nurses as matter of policy conceited in all matters related decisions area for nursing practice.

• Can it be said that nursing service rendered, reflect quality of nursing care. They do there have the necessary back up support from the system for performing the way they are required to perform.

Nurse themselves

• Long hours of duties with very little time for recreation.

• Non availability of health care programme for nurses. • Pressure from influencing people.• Non involvement of nurses in nursing matters.• Poor pay structures.

• Lack of security and safety.

• Non availability of basic commodities like toilet facility, in residential accommodation of community nurses.

NURSING AND MIDWIFERY SERVICES

• The nurse to population/patient ratio is low compared to other countries. In 2014, the ratio was 1:2250 in india and 1:100-150 in Europe. This ratio in African countries, srilanka and Thailand is 1:1400,1:1100 and 1:850. Respectively. Only 40% of registered nurses are active because there is no system of live register in india. Nursing positions are created due to financial constraints, poor working conditions, low pay scale, emigration, retirement or death.

• The role and responsibilities of nurses are not clearly defined. In India the nurse to doctor ratio is almost 1.5:1 while it is 3:1 in developed countries. Working conditions in many hospitals and communities in India are poor and unsafe. Medical equipments and supplies are inadequate. incentives are limited. Limited opportunities are available for carrier advancement due to non creation and non existence of clinical speciality nurse and nurse practitioner positions.

COMMUNITY HEALTH NURSING SERVICES

• At the community level there are no position for nurses. Health care is provided by auxillary nurse midwives, lady health visitor and female health workers. Antenatal and delivery care are mostly provided by traditional birtg attendants, which result in high maternal and infant mortality rates.

• In the community setting, it is observed that ANMs/LHVs face problem related to transportation, accommodation , gender base harassment, lack of security, incentive and carrier prospects, and inadequate provision of living with their families and educating their children.

NURSING AND MIDWIFERY EDUCATION

• There are 635 nursing school and 165 nursing college in India. Between September 2014 and October 2014, 61.2% institutions were found unsuitable for teaching. The postgraduate curriculum in nursing is not adequate. Teacher with masters and doctoral degree are few. Research and academic work is scarce.

MAJOR ISSUES

• Poor quality of nursing and midwifery care due to-

• Shortage of nurses and midwive due to-

• Inadequate number of nursing positions as per the recommended staffing norms

• Migration

• Insufficient number of nurses with bachelor and master’s degree and in clinical specialities.

Insufficient contribution of nurses and midwives to health care development due to-

• Few position for nurses and midwives at the state and national levels

• Inadequate nursing leadership and strategic management

• Inappropriate nurse to population/patient ratio• Inadequate preparedness of nurses and

midwives• Inadequate recognition of nurses status in the

health care system• Limited active involvement of professional

organisations

Limited competency of nurse and midwives due to-

• Ineffective regulation of nursing and midwifery practices

• Inadequate structure for nursing and midwifery practices

• Inadequate motivation to provide effective care

Poor quality of nursing education to produce qualified graduates for

services due to-

• Limited involvement of nurses and midwives at the policy level

• Shortage of qualified nurse educators

• Inadequate infrastructure for nursing education

• Limited production of academic work and research

Limited role and authority of the INC in nursing development

• Limited roles prescribed in the Indian nursing council act, 1947

• Insufficient information systems in nursing and midwifery services

MEETING THE CHALLENGES

Create posts for professional nurses at the community level and strengthen the competency of the auxiliary

nurse-midwife

SUB CENTERPopulation 50000

- To be manned by 2 ANM with 2 yr training as per revised syllabus

- Male health worker and 1 PHN- Strengthening the infrastructural facilities

PHCPopulation 30,000

- 1 PHN practitioner and 1 PHN supervisor- 4 staff nurse for 24 hr services

CHC1 lakh population

- 14 staff nurses- 3 PHN supervisor- 1 PHN practitioner- 1 independent midwifery practitioner

District level - Strengthen the institution of the DPHN officer to supervise and monitor the nursing and midwifery system

- 2 PHN officers

NURSING SCENARIO IN INDIA

• Many States in India face a shortage of nurses and midwives. Most of the states have no system of re-registration of nurses. About 13-28 lakh nurses and 6.18 lakh ANMs have been registered with the various State Nursing Councils. However, only 40 percent of registered nurses in India are in service, the said figure includes all the nurses who have been trained since 1947 (Source: Address by Shri T. Dileep Kumar, President, INC published in The Nursing Journal of India, Jan.-Feb., 2013 Vol.CIV No.1).

Nurse to Population/Patient Ratio in India

Country Nurse to Doctor

Nurses and Midwives/population

Nurses midwives/ patient

India 1.5:1 1:1100 1:40

• NURSING STAFFING AND PATIENT CARE

• Overworked and underpaid nursing staff member are demotivated and dissatisfied and have impact on patient safety issues; patient care suffers and lack of time can lead to poor patient nurse communication. Quality of care also suffers. Understaffing and the consequent additional workload on nurses have been shown to:

• Stress and burnout among nursing personnel • Violations or work-around by nurses • Have a significant impact on nosocomial infections • Reduce time nurses have to help other nurses.

• Difficulty in training or supervision of new nurses.

NursiNg structure at MiNistry of HealtH aNd

faMily Welfare

• Nursing Cadre in Health care System

• Nursing Education/Research system in India

• Cadre in School of Nursing

• Cadre in College of Nursing

• Nursing faculty of all Colleges of Nursing should be granted UGC Scales and nomenclatures

• Cadre in Hospital Nursing Services

issues related to salary structure

• Nursing Allowance (NA)

• Non-Practicing Allowance (NPA)

• Qualification allowance

• Incentives for Ph.D and M.Phil Qualification

• House Rent Allowance

• Telephone/mobile/ internet allowance

• Conveyance Allowance

• Telephone/mobile/ internet allowance

• Conveyance Allowance

• Newspaper Allowance

• Continuing Nursing Education/In-service education

• Washing Allowance

• Overtime Allowance

• Uniform Allowance (UA)

• Special Allowance:

• Risk Allowance

• Field Allowance

• Rural/ Hill/Difficult Area Allowance

• Learning Resource Allowance

• Administrative allowances

recoMMeNdatioNs for faculities

• CRÈCHE FACILITY

• FACILITY DURING NIGHT DUTY

OTHER RECOMMENDATIONS

• Employment: uniformity in employment procedure

• Job description

• Working hours

HarassMeNt of Nurses by otHers

• There are some instances occurred in various circumstances in different places, harassment of nurses by clerical staff, it while taking their salaries and claiming other arrears leave of their own credit and some times by the administrators of the institution. On many occasion GNAK intervened and solved those problems to some extent.

• Nurses working 1n between doctors on one side and the other side Group _D_ officials are facing so many problems. Nowadays it is very difficult for nurses to control the Group D officials for so many reasons.

• To control these groups, co-ordination and cooperation is needed from the administrators of the institution and higher authorities.

treNds iN NursiNg MaNageMeNt

Trend means a change that is taking place in present days or movement in a particular

direction.

TRENDS IN NURSING

recoMMeNdatioN Made are

In 1888, Indian army nursing services were set up. Mission hospitals were being set in different parts of India at

about the same time. Religion prevented hindu and muslim girls from joining, so only Christian girls could be trained first.

Ms Atkinson was brought from England to Bombay to set up and become superintencent of first modern training school nurses in India in 1891.

After independence: Greater opportunities for further study and wider professional

contacts, both at home and abroad have become available. The changes took place from past to present in nursing are depicted below in table

after iNdePeNdeNce

AREAS PAST PRESENT

Focus Hospital Community

Purpose curative Promotive and preventive

Nature General Specialized

Simplicity Bedside High-tech

Assignment Functional centered Patient centered

Patient perspective Patient as individual identity

Holistic approach

Role Basic role Multi roles

Practitioner Dependent role Independent practitioner

eMergiNg treNds iN NursiNg Practice:

CHANGING DEMOGRAPHICS AND INCREASING DIVERSITY

• increase in the diversity of the population which affects the nature and the prevalence of illness and disease, requiring changes in practice that reflect and respect diverse values and beliefs.

• Disparities in morbidity, mortality, and access to care among population sectors have increased, even as socioeconomic and other factors have led to increased violence and substance abuse.

• Ethnic and racial diversity of nursing institutes creating a rich cultural environment for learning.

The Technological Explosion

• There is reduction in distance through speedy communication. Advances in digital technology have increased the applications of tele-health and telemedicine mobiles, e-line, video conferences, bringing together patient and provider without physical proximity.

• Nanotechnology is a new form of clinical diagnosis and treatment, which is capable of detecting a wide range of diseases from very minute specimens. There is computerization for patient care management.

globaliZatioN of tHe World’s ecoNoMy aNd society

• With the “death of distance” in the spread of disease and the delivery of health care, posing both extraordinary risks and benefits. Now there is potential for rapid disease transmission & potential for dramatic improvements in health due to knowledge transfer between cultures and health care systems. Nursing science needs to address health care issues, such as emerging and remerging infections, that result from globalization. Nursing education and research must become more internationally focused to disseminate information and benefit from the multicultural experience.

•

Quality assuraNce iN NursiNg care

• Public knows their rights, human rights, commissions , protection acts and process etc, are putting constant pressures on the professionals to deliver their best. Professionals cannot ignore or be careless in discharging duties especially when it concerns people lives and health .Nurse managers have to ensure delivery of quality care by practicing as per standards laid down by their counsels and institutions.

•

deceNtralised aPProacH to care MaNageMeNt

• This makes each and every nurse responsible and accountable for the care of assigned patients .

• patients satisfaction, quality care and smooth functioning of the units.

• The trend in span of authority appears to be towards large numbers. This is not the result of efforts to increase the span but rather to reduce the number of organizational levels for a given structure. Too many organizational levels impede communication.

•

• Concept of supportive supervision • Supportive supervision is a process that

promotes quality at all levels of the health system by strengthening relationships within the system, focusing on the resolution of problems, and helping to optimize the allocation of resources. It focuses on problem solving on the spot with the joint participation of the supervisee and supervisor.

coNtiNuiNg NursiNg educatioN

• It has become essential to keep up with the changing needs of patient care.

• Nurses have to continuously update themselves with new and innovative approaches in patient care management.

• For this they should enable themselves with workshops, seminars, short term training programmes, attend conferences, make use of library, subscribe and read periodicals and books.

• Discussion on bedside and supportive supervision helps to keep abreast with newer techniques and information.

•

eVideNce based Practice

• There has been a significant Advancement in Nursing Science and Research.

• Most studies concern health behaviors, symptom management, & improvement of patients’ and families’ experiences with illness, treatment, and disease prevention.

• There is lack in focus on the scholarship and science of nursing as top priorities.

• Doctorally prepared nursing professionals are not being produced in large enough numbers to meet the growing need.

• There is need for enhanced mentorship for new researchers to strengthen skills and capacity to conduct meaningful nursing research.

•

NursiNg audits

collectiVe bargaiNiNg

Collective bargaining is the uniting of the employees for the pupose of increasing their ability to influence their employer and to improve the working conditions. Collective bargaining is based on the principle that there is greater strength in large numbers.

CASE MANAGEMENT, DISEASE MANAGEMENT, AND TELEHEALTH CARE

EXPAND:

• There is a demand to manage the care from a distance, being more people at home and in remote areas with chronic diseases and complicated treatment regimens, through the use of telephones, television monitors, and telecommunication.

•

• Nursing education go online

• Various courses of nursing education will go online in future.

• Wellness centers, Holistic and Alternative therapies

• There is a great focus on promoting health and triggering the body’s natural healing powers through holistic and alternative therapies (e.g exercise, massage, acupuncture etc.)

•

RESEARCH ARTICLE

• ISSUES AND TRENDS IN NURSING SERVICE ADMINISTRATION EDUCATION.

• Tilbury MS 2012 Feb;22(2):13-4.• The Council on Graduate Education for Administration in Nursing

(CGEAN) was established to further the development and improvement of graduate education for administration in nursing. The Council seeks to identify the nature and direction of education for administration in nursing in various healthcare systems, providing guidelines for programs offering administration. A major goal of CGEAN is facilitating dialogue between nursing service administrators and graduate level educators who are engaged in teaching and research related to administration in nursing. This column, sponsored by members of the Council, will analyze and respond to position statements and trends related to the delivery of health services and graduate education for administrators in nursing.

• Lawrence h ganong in 2014 published an article in journal of family nursing on the topic current trends and

• issues in nursing management. The purposes of this article are: (a) to examine current trends and issues in family nursing research from the perspective of an intimate outsider to the field, and (b) to offer predictions regarding future trends for nursing management. The article is divided into three sections.

• First, the unique dimensions of families are identified and the problems these characteristics present to researchers are briefly examined. Second, a brief overview of the topics studied in family nursing research and the methodological issues of that body of literature are presented. Finally, conclusions are drawn and observations are made about the current status of family nursing research, and recommendations for the future are offered. Among the predictions are an increase in multidisciplinary research teams, greater use of midrange theories, an increase in conceptual and methodological complexity, more study of family diversity, greater use of feminist frameworks, and an increase in the number of Family nursing scholars who have programs of research.

• A qualitative descriptive study was conducted by Rathi Balachandran on challenges of nursing sisters in government hospitals among 36 nursing sisters of Central government hospitals in Delhi by focus group discussion. Challenges identified were managing staff performance, lack of role clarity and powerlessness in the system. Solutions suggested by nursing sisters were formal education in management, communication skills, managing staff performance and development and leadership support.

• MATERIALS AND METHODS• A qualitative descriptive design was used to

obtain direct information via focus groups of nursing sisters in Central government hospitals of India located in Delhi. This design was selected to produce a summary of participant concerns and proposed solutions using

• their own words in order to avoid overly interpreting comments. Institutional review board approval was granted for the study. Support was obtained from nursing superintendent and continuing nursing education coordinator to recruit nurses to participate in the focus groups.

• A convenience sample of 36 nursing sisters who volunteered to participate was placed in four groups. Groups were assigned according to their department and years of experience. Each focus group was led by a faculty member and a second faculty member took notes and audio recorded the session. During the interview, the researcher, as the moderator, put forward the questions and then led the discussion strategically when awkward silences arose, particularly during the open stage of the interview. Once the discussion warmed up, the researcher balanced the speech time of all the participants.

• During the discussion, when the interviewee strayed away from the subject, the researcher reminded them of the correct topic, so as to control the interview process. The researcher concluded the topic and advised participants of the conclusions, to enable them to correct or complement the conclusion. The groups lasted about 90 minutes with a 15 mts break at the halfway point.

RESULTS• Demographics of focus group members were as

follows, 28 (77.7%) undergone general nursing and midwifery course, 26 (72.2%) undergone their training in government institutions whereas 8 (22.2%) did from mission hospitals. Regarding exposure to in service education, 35 (97.2%) got Opportunity to attend in service education, of which only 4 (11.43%) attended in management topics, 23 (65.7%) attended in-service education in their own hospital, 31 (88.6%) attended workshop and 22 (62.9%) had attended in-service

• education more than one year back. Mean age of nursing sisters were 47.33 with SD 4.78, average professional experience was 24.47 years with SD 4.26, mean years of experience as ward sister was 7.21 with SD 6.14 and average experience as staff nurse was 15.09 with 5.28.

• NURSING SISTERS CHALLENGES: Challenges reported by nursing sisters were grouped into 3 themes:

• Managing staff performance: The challenges of managing staff performance included sustaining staff

• motivation, lack of accountability, responsibility and initiative among staff, and unprofessional attitude among staff members and other forms of conflict. Nursing sisters described. the difficulties of lack of resources for motivating and sustaining self enthusiasm.

• Role Clarity(job description): There was a lack of understanding regarding the role among the nursing

• Sister as well as among staff nurses. Lack of role clarity leading to inappropriate expectations of the role was a common theme that resulted in role overload: "as time goes on, more things are added to your role’.

•

• Powerlessness regarding system complexity: The High level of technology, vast amounts of paperwork

• and documentation requirements and limited resources were examples of system complexities identified by participants. Nursing sisters felt powerless in the face of these challenges. Nursing sisters expressed concern about their inability to fully support staff nurses because they have more work to do and less help to get it done. They described the lack of nurses input in decisions made by hospital administrators. Hospital

• authority tells us what we need, but they never talk to people who do the work.

• SOLUTIONS TO CHALLENGES OF NURSING SISTERS

• Formal educational opportunities to learn the nursing sister role and leadership support were the main themes in proposed solutions to nursing sister challenges. Nursing sisters wanted to learn duties and responsibilities, staff. performance management and development, communication skills and patient relations.

•

• Formal Education

• Learning Responsibilities of the role: Nursing sisters explained the need for a structured orientation program to the role. They voiced the need to rotate through other areas of the hospital to learn how to work together synergistically and to role model others. Although the nursing sisters did not have direct budgetary responsibilities, they voiced a need to understand how decisions are made so they could better support those decisions

• Managing staff performance and development:

• Participants described the need to better understand other team member’s job and scopes of practice. The group discussed the need to know how to nurture their staff and help them develop their own leadership skills.

• Communication skills: Ongoing mandatory training in effective communication was

• mentioned as a solution to eliminate confusion in patient care situations. Examples of ineffective communication included nurse to nurse and nurse to physician, nurse to workers etc. Managing difficult patient and family situations was another area where nursing sisters reported that formal education would be beneficial. Frictions between patients, their families and staff become sometimes heightened.

• Leadership support

• All focus groups commented about leadership support and how good support helps incredibly, whereas lack of support hinders their work. They also mentioned a need for their opinion to be heard and to have a voice on committees. Nursing sisters explained that they needed their own peer group to connect with nursing sisters in other organizations.

CONCLUSION

• Nursing sisters are not adequately prepared and oriented to carry out their role. Hospital Administrators and Nursing administrators need to organize orientation programmes and in~service education programmes to orient and update nursing sisters on management techniques. Nursing sisters should utilize every opportunity to empower them as a responsible and accountable leader of her team in the ward to provide quality health care to the patients.

•