Planning of Nursing Unit

It is the process of determining the objectives of administrative effort and devising the means calculated to achieve them.

-Millet

Planning is a comprehensive term and involves choosing a course of action from all available alternatives for accomplishing the desired results which are economical and certain

Setting goals and objectives

Laying out plan of action

Implementation

Review

Feedback

Modifications

Planning is a continuous process, beginning with the

setting of goals and objectives and then laying out a

plan of action to accomplish them, put them into play,

review the process and the outcomes, provide

feedbacks to the personnel, and modify as needed

Hospital is an institution or the

organization for the treatment, care, and

cure of the sick and wounded, for the

study of disease, and for the training of

physicians (teaching hospitals), nurses,

and allied health care personnel

The hospital is divided into blocks and

each block is divided into wards/units

A ward is that area of the hospital where all amenities- physical, social and especially medical care-are made available to facilitate patient’s treatment and make the patients feel at home till they are discharged

In other words, a ward is a temporary home for the patients admitted there

A nursing unit is an area in a hospital or other health care delivery setting where patients with similar needs are grouped to facilitate the delivery of care by health care professionals trained in that specialty

Typically a Nurse manager/Head nurse/Assistant nurse supervisor is in-charge of the unit

As planning is put into action, the

management functions of organizing,

leading, and evaluating are

implemented, making all unit

management functions interdependent

Planning must focus on purposes. It should always be based on clearly defined objectives

Continuity and flexibility should be maintained in planning cycle

Planning should be simple and there should be provision for proper analysis and classification of actions

In planning there should be good harmony with organization and environment

Planning is hierarchical in nature and must have an organizational identification

Planning should cover the entire setup, all connected departments, and different levels of administration, and it should be balanced

It should be realistic in its scope and pinpoints the expected results

Provision should be made to use available recourses

Planning should always be documented

The implementation of the overall plan for the nursing department provides for the establishment of a number of units or departments, each charged with the responsibility of accomplishing some portion of the plan

Head nurse/Assistant nurse supervisor is in-charge of a small individual nursing unit. She is responsible to the director of the nursing service either directly or through a supervisor. The director of the nursing service to the director of the hospital for competent management of their departments

There are three other groups in the line of responsibility all of which are directly responsible to the head nurse

› General staff nurses and student nurses who gives bedside care to the patients

› Nonprofessional workers (nurse aids, orderlies, and clerks)

› Housekeeping personnel

Staff nurses at their level too take part in

the process of planning e.g., daily

planning related to patient care

including history taking, assessment, and

nursing diagnosis.

Matching people jobs e.g., patient assignment, special assignment distribution among nurses

Developing policies and procedures specific to the client’s cared for e.g., procedure manual

Identifying training needs e.g., regular ACLS classes

Preparing and conducting training programs

Coordinating all patient care activities by coordinated making of duty roaster, patient assignment and class arrangements.

Meeting needs of the patients

Supervising personnel i.e., nursing as well as non professional workers under her

Proper maintenance of records and reports of patients

Evaluating the planning process and its results

1) Objective formulation and goals

Objectives are the short statements of

outcome or what must be done

As a guide of action, objectives must be

specific, informative, and clear enough

to indicate what is to be done

They may include objectives such as› To give the highest possible quality of nursing

care

› To assist the physician in the medical care of patient and to carry out such therapy as is prescribed

› To promote programs of in-service training; to provide facilities for the clinical instructions necessary for the preparation of nurses and of auxiliary nursing personnel

› To promote and encourage nursing studies

› To evaluate the quality of the services given by staff nurses

It is suggested that it will be of great assistance

to her if she does this according to the

functional areas of work. These are three in

number, and may be defined as follows:

› Nursing care: this embraces all activities

necessary to supply total nursing care.

› Organization: these are the activities concerned

with the management of the ward work and the

personnel involved.

› Domestic: these are the activities concerned

with the cleanliness of the ward.

Nursing care: This may be considered under three main groups:

1. Concerned with the comfort and well being of every patient

i. The kind of reception patient receives

ii. Insistence on careful cleaning and daily dusting and checking of empty units for condition and completeness of equipment

iii. Before admission deciding where to place patient

iv. Set the standard for the quality of care given

v. Helping her staff to improve their nursing ability, for seeking and utilizing their contributions in planning and evaluating the care of the patient

vi. Look into general comforts of the patient and his/ her relatives.

Nursing care: 2. Those which are concerned with the carrying-out of

medical treatment

Review of equipments to determine completeness, availability for use, cleanliness, safety, and convenience in placement

Staff orientation to operation, purpose, and aftercare of them

Quantities of supplies on hand

Supervision to assure specific and intended use of equipments

Convenient and easy access of them

Provision for ordering on an emergency basis

Nursing care: 3. Those which are concerned with education

The head nurse in a hospital where student nurse receives their education has responsibilities in addition to the other administrative duties

› orientation programme for new nursing staff, student nurse and domestic staff

› Participation in ward teaching

› In-service education of nursing personnel

› Assignment of duties

› Keeping her knowledge up-to-date

› Supervision

› Ensuring good quality nursing care

Organization: these are the activities concerned with the management of the ward work and the personnel involved› Clear and accurate orders, reports, and

records

› Periodical check of all stocks and supplies

› Availability of adequate staff in each shift

› Changing the staff of a ward

› leaves or clinical offs

› Celebrations in ward

Domestic: these are the activities concerned with the cleanliness of the ward. e.g., to see the safety and general cleanliness of the department.› Fumigation

› Sweeping

› Dusting

› Washing

› Washing of the sanitary annexes (slippers in OT, sputum mugs, hand basins, cupboards etc)

› Disposal of biohazards

Once the objective is clear, there is need to assess the resources available to reach the goal. The factors which the head nurse has to consider are› The rate of turnover of the patient

› The total number of patients to be nursed

› The physical dependency of the patient

› The total nursing needs of the patients

› Patient assignment method

› The physical facilities, equipment, and supplies in hand and needed

› The amount of experience and teaching that staff has receives

This can be achieved by conducting

routine ward rounds and conducting

clinical rounds with doctors

With these factors thoroughly

investigated, the head nurse is in a

position to estimate the demands, in

terms of ward personnel and material

required for their efficient working

Intradepartmental reports› All preoperative and post operative patients

› All admissions, discharges, transfers and deaths

› All acutely ill patients

› All patients on critical list

› All emergencies

› All depressed and suicidal patients

Interdepartmental reports› Daily census report

› Medication, special equipment and supply register

› Patient’s list

Nursing cost per bed

Reported incidences

of violence

against nurse

Nursing staff per bed and number of reported patient accidents

Premises refer to the factors in the

environment that affect the

achievement of goals. They are

assumptions about the future or

understanding of the expected situation

› Emergency treatments

› Disaster planning

› Undue delays

For the effective implementation of the

program, the subordinates’ participation

has been found to be extremely essential

Plans must be communicated for increasing

their understanding of the proposed action

and for enlisting their cooperation in the

proper implementation of plan

This is done to avoid confusions and help

in planning evaluation

› Writing the staff register (Monthly or weekly

duty roaster, days of indents, list of

fumigation days in a given year)

› Maintaining the stock register

› Formulating the protocols

Programming and implementation are

the key steps in the planning process.

Here, the special attention is needed to

the use of strategy

Strategy means a set of decisions taken

to achieve the objectives

Since all pertinent facts are not available in most planning activities and since some guess work is inevitable, there should be a prior provision for following up the proposed program when it is put into action

Regular feedback both the way of written records and reports and by direct observation

Regular and surprised Supervision of patient care and staff as well

Investigate complaints if any

Evaluation is measuring what has been

done what has been planned to do. Any

deviation and lacunae have to be

explained and necessary action has to

be initiated to correct deviations

A group of people living in the same

locality and under the same government

having common cultural, religious,

ethnic, or other characteristics

It a field of nursing that is a blend of

primary health care and nursing practice

with public. The community health nurse

conducts a continuing and

comprehensive practice that is

preventive, curative, and rehabilitative.

Community health nursing has a responsibility to participate in the total community health program and to coordinate nursing plans with those of all other community health services.

› It should be based on human needs

› Should take account of cultural and social factors

› Planning should be realistically related to present facilities and personnel and to those expected in the “foreseeable future”

› The size and composition of staff needed to carry out an adequate community health nursing program must be determined within each state in relation to local situations

› Assignment of staff should provide for utilization

of every worker at her/his highest level of skill

› Provision should be made to assure adequate

professional nursing direction of community

health nursing practice

› Authority should be delegated so that decisions

are made as close to the field of action as is

consistent with competence to make the

judgment

› The staff should be organized so as to provide

generalized family nursing services

Community health nurses need to understand the system where she is working, consisting of other health care workers, community and higher authorities

It involves the collection, assessment and interpretation of information. The steps also involves the analysis and projection of health situation and identifying problems › population characteristics

› health statistics

› health care facilities

› health manpower

› training facilities

› Knowledge

› attitude belief and health practices

Maternal and child health Family welfare Immunization Diarrhea control Control of communicable

diseases

They include› Provision for health counseling to the individual,

families, and community groups

› Provision of nursing care when necessary and teaching and supervision of nursing care provided

› Promotion of environmental sanitation

› Conduction of educational programmes for nurses, other professionals, and members of the community

› Reducing prevalence of anaemia by 25% and moderate and severe anemia by50% in children

The resources include manpower, i.e.,

staff strength, money and material.

STAFF FOR SUB - CENTRE Number of Posts

1. Health Worker (Female)/ANM : 12.Health Worker (Male) : 13.Voluntary Worker /ASHA : 1

Total: : 3

1. Medical Officer: 12. Pharmacist : 13. Nurse Mid-wife

(Staff Nurse) : 14. Health Worker

(Female)/ANM : 15. Health Educator: 16. Health Assistant

(Male) : 1

1. Health Assistant (Female)/LHV :1

2. Upper Division Clerk:13. Lower Division Clerk:14. Laboratory Technician

:1 5. Driver (Subject to

availability of Vehicle:1 6. Class IV :4

Total :15

Procedure manuals compiled and kept current through group action include those for nursing procedures, standing orders, and administrative policies

Adequate records and reports must be kept to assist the individual staff members in planning their work and to serve as tool in the evaluation of the programme

Priorities must also be fixed according to financial constraints and magnitude of problem

The public health nursing administrator

co-operates with recruitment

programmes and has the responsibility

for selecting and placing the necessary

staff.

In her budget request to the director, the

nursing administrator makes the provision

for the equipment and supplies

necessary for carrying out nursing

activities

To ensure the effectiveness of the

service, the administrator of public

health nursing reviews programme

activities of the agency and health

needs of the community.

Lack of accurate information

Time consuming process

Expensive

Inflexibility

Resistance to change

Environmental constraints

Lack of ability and commitment

False sense of security

Reluctance to established goals

Planning is the key element in nursing that gives it direction, cohesion, and thrust

It causes all nursing personnel to focus on goals and objectives and stimulates their motivation

Through the planning process, nurse managers select and retain the elements of the past and present plans that work. They focus on the future, and they implement and evaluate

Through planning they successfully manage nursing personnel and material resources to achieve the objective of the nursing enterprise

Swansburg R. C. Introduction to Nursing Management and Leadership for Nurse Managers. 3rd edition. Jones and Barlett Publisher, Sudbury 2002: 58-76.

Basvanthapa BT. Nursing administration. 1st edition, Jaypee brothers medical publishers: New Delhi 2004: 120-134.

Goddard H. A. Principles of administration applied to nursing service. 3rd impression. World health organization 1958:20-38.

Barabas M. H. Contemporary Head Nursing. The Macmillan Company, New York 1962:31-72

Margret, Scales. Handbook for ward sister. 1958:201-226.