LOURDE COLLEGE OF NURSING, TALIPARAMBA, KANNUR.

MANAGEMENT OF NURSING SERVICE AND EDUCATION

QUESTIONS AND ANSWER KEY

UNIT-I

1.Define management and principles of management. (September 2017, April 2018)

Management is distinct process consisting of planning, organising, actuating, activating and

controlling, performed to determine and accomplish the objectives by the use of people and
resources.
Fayol‟s 14 principles of management

1. Division of Work. Specialization allows the individual to build up experience, and to

continuously improve his skills. Thereby he can be more productive. Small task, Competent,
Specialization, Efficiency, Effectiveness

2. Principle of Authority and Responsibility Authority means power to take decisions.

Responsibility means obligation to complete the job assigned

3. Principle of discipline: General rules and regulations for systematic working in an

organization. 4. Principle of unity of command: Employee should receive orders from one boss
only.

5. Unity of direction: All the efforts of the members and employees of the organization must be
directed to one direction that is the achievement of common goal.

6. Subordination of individual interest to general interest: Subordination of individual

interest to general interest the interest of the organization must supersede the interest of the
individuals.

7. Principle of remuneration of persons: Employees must be paid fairly or adequately to give

them maximum satisfaction

8. Principle of centralization and decentralization: Centralization refers to concentration of

power in few hands. Decentralization means evenly distribution of power at every level.

9. Principle of scalar chain: Means line of authority or chain of superiors from highest to
lowest rank

10. Principle of Order: Principle of Order It refers to orderly arrangement of men and material
a fixed place for everything and everyone iin the organization

11. Principle of Equity: Principle of Equity Fair and just treatment to employees.
12. Stability of tenure of personnel: Stability of tenure of personnel No frequent termination or
transfer.

13. Principle of Initiative: Principle of Initiative Employees must be given opportunity to take
some initiative in making and executing a plan

14. Principle of Esprit De Corps: Principle of Esprit De Corps Means union is strength.

1.Difference between administration and management (OCT 2016, April

2019)
Basis of difference Administration Management
Nature of work It is concerned about the It puts into action the policies
determination of objectives and plans laid down by the
and major policies of an administration.
organization
Type of function It is a determinative function It is an executive function
Scope It takes major decisions of an It takes decisions within the
enterprise as a whole framework set by the
administration.
Level of authority It is a top-level activity. It is a middle level activity
Nature of status It consists of owners who It is a group of managerial
invest capital in and receive personnel who use their
profits from an enterprise. specialized knowledge to
fulfill the objectives of an
enterprise
Nature of usage It is popular with It is used in business
government, military, enterprises.
educational, and religious
organizations.
Decision making Its decisions are influenced Its decisions are influenced
by public opinion, by the values, opinions, and
government policies, social, beliefs of the managers.
and religious factors.
Main functions Planning and organizing Motivating and controlling
functions are involved in it. functions are involved in it.
Abilities It needs administrative rather It requires technical activities
than technical abilities.

2.Difference between administrator and manager (May 2017)

 Someone who coordinates and overseas the • Assists Principal in the overall
work of other people so that organizational administration of the College.
goals are accomplished. • General administrative duties normally
First-line Managers Individuals who entrusted to an Administrative Officer
manage the work of non-managerial • Education administrators set
employees. educational standards and goals and
Middle Managers Individuals who manage establish the policies and procedures
the work of first-line managers. required to achieve them.
Top Managers Individuals who are • They also supervise managers, of
responsible for making organization-wide office staff, teachers, counselors,
decisions and establishing plans and goals librarians, coaches, and other
that affect the entire organization. employees.
Functions: • They develop academic programs,
• Planning - Defining goals, establishing monitor students’ educational progress,
strategies to achieve goals, developing plans train and motivate teachers and other
to integrate and coordinate activities. staff, manage career counseling and
other student services, administer
• Organizing - Arranging and structuring recordkeeping, prepare budgets, and
work to accomplish organizational goals. perform many other duties.
• Supervision of maintenance College
• Leading - Working with and through people
property.
to accomplish goals.
• To ensure delivery of school plans,
especially in areas of maintenance,
• Controlling - Monitoring, comparing, and
building and upkeep of the assets
correcting work.
• To be the school’s principal money
manager, overseeing the School
Accountant and Cashier and ensuring
that effective control over stocks, etc
will be achieved
• Assists in preparation and utilization of
budget.

ENUMERATE THE FOLLOWING:

1.Functions of management (September 2018)

• Determination of Objectives : The objectives of any organization are determined by the

management . They are put into writing and communicated to all employees in the
organization.

• Achievement of objectives : Management is an important force for the accomplishment

of the objectives of any group. Efficient management provides leadership to the business
and helps in achieving its objectives.
 • Efficient Use of Resources : The role of professional managers has increased these days.
They can ensure the efficient use of various resources and increase the productivity of the
enterprise.

• Coordinated Human Efforts : Management provides leadership and guidance to the

workers . It also motivates them with the help of various incentive schemes.

• Meeting Challenges: Management is the brain of any enterprise. It helps in predicting

what is going to happen I future which will influence the working of the enterprise. It
also steps to ensure that the enterprise is able to meet the demands of changing
environment.

• Economic Development : According to Peter Drucker “ Management is the crucial

factor in economic and social development”.

2.Principles of administration (April 2019)

• Principle of Objective

• Principle of Correspondence

• Principle of Responsibility

• Scalar Principle

• Principle of Span of control

• Principle of Specification

• Principle of Co-ordination

• Principle of Definition

3.Functions of good nurse manager

A nurse manager‘s functions include the following;
• The nurse administrator needs to know the plans and programs of the health facility
administrator and of other departments in which personnel contribute to the joint effort of
providing health care services.
• Should be a participatory , voting member of all committees of the institution including
those dealing with budgeting, planning, credentialing, auditing, utilization, infection
control, patient care improvement, library or any other committees concerned with
nursing services, nursing activities and nursing personnel.
• Should develop a marketing operational plan based on the overall view of the agency
problems and activities.
• Marketing plan should include gathering and analysis of data related to product or service
 • Operational plan consist of pinpointing possible strengths, weaknesses, problems and
opportunities.
• Before launching a venture, a control plan is made to measure performance of
implementation of venture within a time frame.
• Selected and trained personnel will be assigned to compare expected results with actual
results for making corrections in all elements of plan and its implementation in future.

UNIT: II

ESSAY:

Define organization. Explain the principles of organization and prepare organization chart of a
school/ college of nursing (May 2016)

Introduction:

Collectivity of elements with a relatively identifiable boundary, a normative order (rules) ranks of
authority (hierarchy), communications systems, and membership coordinating systems (procedures). This
collectivity exists on a relatively continuous basis, in an environment, and engages in activities that are
usually related to a set of goals; the activities have outcomes for organizational members, for the
organization itself, and for society.

Definition: Organization is the form of every human association for the attainment of common purpose
and the process of relating specific duties or function in a whole. -J D Mooney

Organization consists of the relationship of individuals to individuals and groups to groups which are
related as to bring about an orderly division of labour. – Pfiffiner

Principles :

 Hierarchy / chain of command

 Integration Vs Disintegration

 Span of control/management

 Delegation

 Centralization Vs Decentralization

 Unity of command /coordination

Chain of Command

 Line of authority from the top to the bottom of the organization.

 Tells you who your boss is and who to go to for help.

  To work quickly, employees at all levels need to communicate directly, and who the boss is can
change according to the task to be performed.

 Integration  Disintegration
 All the executive authority is conferred by  The system where executive authority is
law or constitution on one single person distributed by statute or constitution
who thereupon becomes chief executive. among a number of co-level bodies or
 E.g., President of India, PM agencies.
 E.g., UPSC, KPSC, Election commission.

 Span of Management

 It is the number of employees reporting to a manager.

 The number of employees reporting to one manager affects the number of levels of
managers.

 With downsizing, the trend has clearly been to increase the span of management.

Delegation

 The device of distributing his authority is ‘delegation’.

It means conferring of specific authority by a higher authority. It is devolution of authority by a person to

his agent or subordinate, subject to his right of supervision and control.

 Division of Labor and Departmentalization

 Division of labor - Degree to which tasks are subdivided into separate jobs.

 Specialization can lead to efficiency and increased performance, but if jobs become too
specialized and boring, performance can decrease.

 Departmentalization – Grouping of related activities into units.

 Centralized and Decentralized Authority

 With centralized authority, top managers make important decisions.

 With decentralized authority, middle and first-line managers make important decisions
where the action is.

 Decentralization allows more input into decision making and greater employee
commitment to carrying out the decisions.

 Coordination

 With the division of labor and departmentalization comes the need to coordinate the work
of all departments.
 Is difficult with wider spans of management and decentralization.
 LOURDE COLLEGE OF NURSING, TALIPARAMBA.
ORGANIZATION CHART

KANATE FOUNDATION

CHAIRMAN

MANAGING DIRECTOR

DIRECTOR -LOURDE EDUCATION ACADEMY

PRINCIPAL

VICE PRINCIPAL

HOD s OF VARIOUS DEPARTMENT

PROFESSORS

ASSOCIATE PROFESSORS

ASSISTANT PROFESSORS

LIBRARIAN LECTURERS OFFICE SUPERINTENDENT

ASSISTANT WARDEN ASSISTANT LIBRARIAN ASSISTANT LECTURERS CLERKS

HOSTEL STAFF LIBRARY ASSISTANT STUDENTS HOUSE KEEPING STAFF

DRIVERS

CLEANERS
2.Explain the techniques of performance appraisal. Prepare a rating scale for performance
appraisal of clinical instructor in school of nursing.

Definition:

“Performance appraisal is the process of evaluating the performance and qualifications of

the employees in terms of the requirements of the job for which he is employed for purposes of
administration including placement, selection for promotion, providing financial rewards and other
actions which require differential treatment among the members of a group as distinguished from
actions affecting all members equally” – Heigel.

Objectives:

Performance appraisal can be carried out with multifarious objectives in mind and that
objectives can be classified under four head.

a. Work related objectives:

i. To provide a control for work done.
ii. To improve efficiency
iii. To help in assigning work and plan future work assignment.
iv. To carry out job evaluation.

b. Career development objectives

i. To identify strong and weak points and encourage finding remedies for weak points
through training.
ii. To determine career potential.
iii. To plan developmental (promotional or lateral ) assignments.
iv. To plan carrier goals.

c. Communication:
i. To provide adequate feed back on performance
ii. To clearly establish goals i.e. what is expected of the staff member in terms of
performance and future work assignments.
iii. To provide counselling and job satisfaction through open discussion of performance, and
iv. To let employees assess where they stand within the organization in terms of their
performance.
d. Administration:
i. To serve as a basis for promotion or demotion.
ii. To serve as a basis for allocating incentives
iii. To serve as a basis for determining transfer

Essentials of a Good Appraisal System:

• Ease of understanding
 • Support of line workers
• Suitability to the operations and structure
• Validity and reliability
• Provision of incentives
• Periodical evaluation
Methods of Appraisal:

I. Individual Evaluation:
a. Confidential report
b. Essay evaluation
c. Critical incidence evaluation
d. Check list evaluation
e. Behaviour evaluation
II. Multi person Evaluation (Group evaluation)
a. Ranking method
b. Raised comparison method
c. Random sampling method
d. Group appraisal
e. Assessment centered method
f. Field review method
g. Human resource accounting
3. Discuss public relation. List down the functions of public relation. Describe the role of
administrator of a school/college of nursing in maintaining public relation.

Public relation is a combination of philosophy, sociology, economics, language, psychology, journalism,

communication and other knowledges’ into a system of human understanding

Herbert M Baus

FUNCTIONS OF PUBLIC RELATIONS

➢ Public Relations is establishing the relationship among the two groups

(organisation and public).

➢ Art or Science of developing reciprocal understanding and goodwill.

➢ 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.
➢ SOME POSSIBILITIES THAT WOULD CALL FOR PUBLIC RELATIONS
➢ Promotional Opportunity:
➢ To inform the new service / policy which call for Public Relations to make wider publicity.
➢ Competitive:
➢ To over come the resistance (pre-set mind condition).
➢ Controversy:
➢ To eliminate the contradictory conditions in between the organisation and the public.
➢ Adverse publicity:
➢ To inform the truth or correct issues and thereby removing the misunderstanding.
➢ Catastrophe:
➢ Announcement of any unfavourable issues.
➢ Crisis:
➢ Whenever threats arises.
4. Define material management. Describe the steps in material management. Explain the role of
nurse manager in material management.

Definition:

Material management is an organizational concept in which a single manager has authority

and responsibility for all activities, principles concerned with the flow of materials in an
organization.

--National Association of Purchasing Management

Objectives:

▪ Low purchase price.

▪ Maintaining continuous supply.
▪ Low pay bill cost.
▪ To high inventory turnover.
▪ Maintaining quality of purchase.
▪ Development of vendors.
▪ Low storage cost.
▪ Cordial relation with suppliers.
▪ Good records.
▪ Standardization
▪ Product improvement
▪ Interdepartmental harmony

Golden rules of Material Management

• Successful material management is built upon an effective management system and good
supervision.
• Proper purchase order- this umbilical cord of purchasing process.
• Centralized purchased system- this eliminates uncontrolled purchases by individual
department secure reduction in prices.
• Negotiation- Negotiation for bulk price for the quantity of hospital needs. Sometimes
buying bulk quantities like yearly quota we can ask for discounts and supply may be made
in stages.
• Have an effective receiving program with responsibility, accountability and internal
control.
• Establish an optimum level of inventory and a simple but effective inventory control
system.
• Establish effective and result oriented requisition and distribution system.
• Establish a return policy and procedures.
• Standardization and evaluation of all products.
• Whenever possible make contract purchasing through prime vendors.
Elements:

• Budgeting and material planning

• Demand forecasting
• Procurement
• Receipt, inspection and payment
• Storage
• Inventory control
• Issue and distribution
• Usage
• Maintenance
• Inspection
• Disposal
• Pilferage
Role of nurse in material management:

The utilization of supplies and equipment is mostly done in the ward/ departments managed by the head
nurse. In relation to supplies and equipment the responsibilities of the ward sister are as follows;

• Keeping an adequate supply of materials in planning and management. Materials should be in

good condition and conveniently located.
• Assigning someone the responsibility for handling supplies and equipment.
• Looking for wastage or misuse and minimize it.
• Educating all the nurses, doctors and other personnel in the ward in the economical use of
materials.

5. Define leadership. Explain the theories of leadership with suitable examples. List down the
qualities required for a good nurse leader.

Definition:

Leadership is the process of influencing people to accomplish goals.

It is the ability to influence the behavior of others towards the achievement of a mutually set goal.

Leadership is a function of knowing yourself, having a vision that is well communicated,

building trust among colleagues, and taking effective action to realize your own leadership
potentials.

LEADERSHIP STYLES-THEORIES

HISTORICAL DEVELOPMENT OF LEADERSHIP THEORY (1900-PRESENT)

Style is a distinctive or characteristic manner of performance. Style is defined as the

effective privilege of the expert. Leadership style is the specific way that the leader influences the
group to accomplish goals.
 • Because strong management skills were historically valued more than strong leadership
skills, the scientific study of leadership did not begin until the 20th century. Early works
focused on broad conceptualizations of leadership, such as the traits or behaviors of the
leader. Contemporary research focuses more on leadership as a process of influencing
others within an organizational culture and the interactive relationship of the leader and
follower.

SCIENTIFIC LEADER/STYLE’S THEORY:

The theory was developed by Frederick Winslow Taylor (1856-1915).He emphasized

technology as the basis of increasing productivity. He introduced time and motion to analyze tasks
based on the belief that improving the performance of would improve the efficiency of the
organization. The leader who utilizes this principle will be the most competent individual and
organizing the work of subordinates.

THE GREAT MAN THEORY/TRAIT THEORIES (1900-1940)

The Great man theory and trait theories were the basis for most leadership research until
the mid-1940s. The Great Man theory, from Aristotelian philosophy, asserts that some people are
born to lead whereas others are born to be led. It also suggests that great leaders will arise when
the situation demands it.

Trait theories assume that some people have certain characteristics or personality traits that make
them better leaders than others. To determine the traits that distinguish great leaders, researchers
studied the lives of prominent people throughout history. The effect of followers and the impact
of the situation were ignored. Contemporary opponents of these theories argue, however, that
leadership skills can be developed, not just inherited.

Although trait theories have obvious shortcomings, (they neglect the impact of others or the
situation on the leadership role), they are worth examining.

BEHAVIOURAL THEORIES (1940-1980)

During the human relations era, many behavioural and social scientists studying
management also studied leadership. For example, McGregor’s (1960) theories had as much
influence on leadership research as they did on management science. As leadership theory
developed, researchers moved away from studying what traits the leader had and placed emphasis
on what he or she did – the leader’s style of leadership.

A major breakthrough occurred when Lewin (1951) and White and Lippitt (1960) isolated
common leadership styles. Later, these styles came to be called authoritarian, democratic, and
laissez-faire.

TRANSACTIONAL AND TRANSFORMATIONAL LEADERSHIP:

 Burns (2003) suggest that both leaders and followers have the ability to raise each other to
higher levels of motivation and morality. Identifying this concept as transformational leadership,
Burns maintained that there are two primary types of leaders in management. The traditional
manager, concerned with the day-to-day operations, was termed a transactional leader.

“The transactional leader sets goals, gives directions, and uses rewards to reinforce
employee behaviors associated with meeting or exceeding established goals” (McGuire &
Kennerly 2006) The transactional leader then emphasizes process in setting goals and giving
directions and seeks to control both situations and followers (McGuire and Kennerly, 2006).

Qualities of a transformational leader-

• Charisma-a leader one who has a clear vision for the organization and is able to easily
communicate that vision to group members
• Confidence-a leader one who has a good business sense and is able to see what decision
will positively affect the organization. This gives the leader the ability to act confidently, inspiring
trust in team members
• Respect and loyalty- a leader who inspires respect and loyalty in individuals by talking the time
to let them know they are important
• Expressive praise-a leader who often is expressive and praise individuals and the team on a well
done job. He let them to know how much they have contributed to success
• Inspiration- a leader who is a master at helping people do something in which they weren’t sure,
they were capable of doing. A leader achieves this through praise and encouraging statements.

LEADERSHIP QUALITIES:

Gardner (1990) identified several attributes of leaders, including physical vitality and
stamina, intelligence, good judgment, willingness to accept responsibilities, task competence (i.e.
knowing what needs to be done), understanding of followers’ needs, ability to work effectively
with others, a need to achieve, ability to motivate others, and courage.

In a presentation at the April 2004 American Society of Association Executives Foundation

Forum, one of the most influential individuals in the area of leadership, Warren Bennis, offered
his ideas about exemplary leaders. He asserted that leaders have the following six competencies:

1. Leaders must foster a clear vision with an endowed purpose that is owned by the people
involved with the leader. To illustrate this competency, Bennis gave the following example
of how Howard Schultz, founder of the Starbucks Coffee conglomeration, views his
company’s vision: “We aren’t in the coffee business serving people; we’re in the people
business serving coffee.”
2. Getting people to support a vision or mission takes work. Leaders must “keep reminding
people of what is important (because) people really can forget what they are there for”.
 Followers also need regular recognition in order to maintain their engagement with and
commitment to the vision.
3. Leaders must be optimistic and see possibilities. Leaders must be adaptive to the constant
change in our society, which “takes a hardiness attitude that allows (them) to face
challenges and adapt all of it in a way that results in alignment”.
4. Leaders must create a culture of candor. Bennis asserted that such a culture requires
integrity, which evolves from a balance of ambition, competence, and having “a moral
compass”. When ambition surpasses competence or overrides one’s moral compass, for
example, integrity is lost, a culture of candor cannot be created, and one cannot be an
effective leader.
5. Leaders must mentor others and acknowledge their ideas and accomplishments. Bennis
said, “Drawing out the leadership qualities (of others) is the way of the true leader”.
6. Good leaders must be in tune to getting results. Bennis shared a conversation he had with
Jack Welch, previous CEO of General Electric. This highly successful corporate manager
and leader noted that “getting results depends on customer satisfaction, employee
satisfaction, and cash flow. If I have those three measurements, I can win. “Thus, vision,
good intentions, and strong desires are not enough; leaders are leaders because they make
things happen.

SHORT NOTES:

1.LEADERSHIP STYLE:

Leaders typically are the ones who “go first “.the verb “lead” is said or defined in several
ways,-to guide, to run in a specific direction, to direct, to go at the head, to be first.

Definition:

Leadership is the process of influencing people to accomplish goals.

It is the ability to influence the behavior of others towards the achievement of a mutually set goal.

Leadership is a function of knowing yourself, having a vision that is well communicated,

building trust among colleagues, and taking effective action to realize your own leadership
potentials.

The origin of the word “lead” is a word meaning “to go”

TYPES OF LEADERSHIP:

a. formal leadership:
 The leadership and functions are established by law or custom, and the identities of the
leaders being determined arbitrarily or externally.

b. Informal leadership:
In formal groups are temporary groups which are formed on the basis of some
immediate circumstance, that throws a member of people into close dynamic
relationship ones a period of short duration. The leader have no opportunity to emerge,
eg. group of guests at a party.

c. Authoritarian leadership:
The authoritarian leader wields more absolute power than the democratic leader, he
alone determines policies of the groups he alone makes major plans. He dictates the
activities of the members and the pattern of inter relations among the members and he
alone serves us the ultimate agent and judge of rewards and punishments for the
individual members.

d. Democratic leadership: The democratic leader seeks of evoke the maximum

involvement and the participation of every members in the group activities and in the
determination of objectives.
He seeks to encourage and reinforce interpersonal contacts, and relations.

2.Principles of planning (May 2016)

 Principle of contribution to objectives.

 Principle of pervasiveness of planning .

 Principle of limiting factors.

 Principle of flexibility.

 Principle of Navigational change.

 Principle of Commitment .

3.Inventory control

Inventory means list of items thus inventory control means control of items inside the stores
/ it is also called control of stock/ proper stocking.

Ideal stocking of supplies, so that;

• Over stocking is avoided

• Saving of cost of material stock
 • Under stocking is avoided, so that demand is met and patient care not hindered, or/
otherwise, it is an attempt to answer the question, when to place the order and how much
to order.
Advantages of proper inventory control;

• Control over the system of receipt, store, and issues.

• Economy of storage
• Reduction of handling and administrative cost
• Avoid locking up of funds (dead investments)
• Avoid absoluteness.
• Avid spoilage, pilferage.
Concepts relevant in Inventory control:

Periodic/ cyclic system- checking stock at periodic/ fixed intervals and placing order on the basis
of that. Here ordering interval is fixed but order quality varies each time.

Two-Bin system- maintain two bins for each item. One larger to stock items to meet the demand
between arrival of quantity and placing next order.

Second smaller bin to stock items to meet the demand from order date to the supply date.

Lead time- this is the time interval between placing an order and receiving the item/ material.

Minimum stock- this is also called buffer stock or safety stock to be kept in reserved to avoid
stock out situation. In case consumption increases unexpectedly or lead time prolong unduely.

Reorder level- predetermined stock level at which stock is replenished. (fresh stock is added)

Maximum stock- predetermined level of stock beyond which the item should not exceed under
normal condition.

Economic order quantity- most economical quantity that should be order at any point of time.

Stock should not excess, but the same time we have to supply.

Order in cost- the cost involved in getting an item into the stores like quotations, comparing
statements, placing order, follow-up, transportation etc.

Inventory carrying cost- cost of physical storage of inventory till it is issued, plus opportunity
cost of money locked up.

Inventory control method:

Popular method of selecting inventory control.

The usual methods are,

➢ ABC Analysis
➢ VED Analysis
➢ FNS Analysis
ABC Analysis:

Here we list the items, according to the annual consumption cost.

A- Denotes items for which annual cost is higher.

B- Annual cost is medium or moderate.
C- Annual cost is low.

A- Quantity wise 10%, cost wise 70%

B- Quantity of 20%, cost of 20%
C- Quantity 70%, cost is 10%
Managing the inventory control according to ABC analysis means;

A-Item require high level of stock, low safety stock, frequent stock verification, close checking of
movements. Give maximum attention.

B-Moderate items need moderate control.

C-Inexpensive items need large purchase, large safety stocks, need minimum attention.

VED Analysis:

Listing items according to criticality of each item.

V-Vital (very important) items who’s’ shortage hampers the work, so cannot risk the shortage of
stock.

E-Essential. The shortage of these items can be tolerated for a day or too. Absence of these work
can go on for sometime.

D-Desirable. other items.

The disadvantages of ABC analysis are overcome by this method.

FNS Analysis: (not useful in hospital setting)

F- Fast moving items

N-Normal movement items

S-Slow movement items.

This classification is based on the number of items need for a period of time.
Combined Analysis of ABC- VED

V E D

A Category- I

Category-II

B CD
Category-III

Under this via media analysis category-I items have to be given high care.

Category-II items moderate attention is necessary

Category-III items given least attention.

4. BENCH MARKING

Definition

 Benchmarking is defined as a continuous process to identify and implement the best

practices which leads to superior or excellent performance.

Purpose

 To improve competitive position

 To gain a better understanding of efficiency of business process.

 To recognize the strength and weakness

 To learn from those who are excelling in performance

 To check the process of management in terms of quality, speed and service

 To incorporate the best practices made possible through benchmarking

 To widen the organization’s experience by creating an insight

 To pool the resources or ideas for improvement of organization

 To perform objective evaluation of companies business

Process of Benchmarking

It has four phases. 1. Planning, 2. Analysis of Benchmarking, 3. Integration of Benchmarking, 4.

Action in Benchmarking.

Stages of benchmarking

 Select subject : this includes any kind of informal talk with customers, workers, different
kinds of research methods and surveys.

 Define the process: be clear with what should be benchmarked – why , where and to
whom and how it should be done

 Identify potential partners – identify as to with whom comparisons are made, their
strengths and weakness

 Identify data sources – identify from where the information is obtained about
benchmarking

 Collect data and select partners – analyse the information whether it is true or not. Select
the partners after detailed analysis

 Determine the gap – find out the correction that should be made right from the beginning
of the bare line. Therefore, there is need to fill the inadequacies that are sorted out by
benchmarking

 Establish difference in Benchmarking process – show individuality, specialty,

difference, creativity innovation in performance and more focus to quality

 Target future performance – always target the future. Stability is needed for success in
every company. Benchmarking helps to bring stability by targeting the future

 Communicating efficiently :- maintaining interpersonal skills is most important in

uplifting any business best practices, and communicating to all the partners involved

 Modifying the goals framed – once a standardized goal is identified with bench marking
process, pre – determined goals of the organization are modified accordingly in order to
achieve the quality of the work performance

 Implementing the newly framed goals of bench marking – benefits, profits and quality
are analysed, goals are implemented after obtaining best practices

 Review and recalibrate – once the act of benchmarking is completed, it has to be

evaluated to determine to what extent it has helped to attain the predetermined goal

Cost of Benchmarking
 Visit cost – expenditure e.g., stay, gift, TA/DA, refreshment, labour time lost.

Time cost – time spent by the markers, invest their time in benchmarking, at times at the cost
of their regular everyday work.

Database cost – money spent for getting actual data.

Types

 Process benchmarking :- It mainly focuses on observing and identifying the entire work
process in the business firm, and finding out the best practices, cost and efficiency of
practices etc

 Financial benchmarking :- compairing the fiscal plans of two different compnies and
their final results helps to asses the complete strength and productivity

 investor benchmarking :- one of the best benchmarking practices identified

 Performance benchmarking :-

 Product benchmarking :-it helps to assess the quality of the procedure and its
performance

 Strategic benchmarking :- it helps to find out how other companies compete, how and
why the compete and for what and where they compete

 Functional benchmarking :- it focuses surely on activities done by the companies leading

to success and mainly stresses on single successful function not complex functions like
finance, accounting, human resources, etc

 Best-in-class benchmarking :- it involves identifying something special or a spark that

brings profit and success to the company

 Operational benchmarking :- it takes in to account everything right from staffing and

productivity, to office flow and analysis of activities done, which bring profits to the firm

 Energy benchmarking: it implies constructing a correct model so that it prevents wastage

of resources like energy consumption.

Advantages

 Helps to estimate strength and weakness

 Helps to create yardstick comparison with in the industry

 Many tools are used by many countries to find out best practice.
Barriers to successful Benchmarking

• Business process may go unexamined clearly, needs an import guidance.

• Adequate resources are needed to launch the benchmarking programme’s findings.
• Companies may not reveal the success matters.
• Inadequate follow up and training
• Business profit may be lost if the changes are not brought at the right time
• Resistant and fault finding management never accept the new ideas or changes.

5.PERFORMANCE APPRAISAL

Definition:

“Performance appraisal is the process of evaluating the performance and qualifications of

the employees in terms of the requirements of the job for which he is employed for purposes of
administration including placement, selection for promotion, providing financial rewards and other
actions which require differential treatment among the members of a group as distinguished from
actions affecting all members equally” – Heigel.

Criteria of performance appraisal:

➢ The employees should be made aware of the performance in terms of goals, targets, behavior
etc. expected of them. A personal equation between the evaluator and the evaluate has to be
developed to achieve mutual understanding of the criteria of evaluation.
➢ The employees should be encouraged to express themselves freely on the performance reports
➢ The organization should feel that the appraisal system itself is job related, performance – based,
uniform and non variable, fair, just and equitable and appraises are honest, rational and objective
in their approach, judgement and behavioural orientation.
➢ Supervisions responsible for performance appraisal should be well trained in the art and science
of performance appraisal to ensure uniformity consistency and reliability. The ultimate success
for evaluation risks with the evaluation; it does not depend on any system, however support it
may ensure.
➢ Performance appraisal reports should be examined meticulously before taking any positive or
negative action.
➢ To promote intra and inter departmental consistency and uniformity, line and staff co-ordination
should be ensured.
➢ There should be provisions for appeals of appraisals to ensure confidence of the employees and
their associations / unions.

Objectives:
 Performance appraisal can be carried out with multifarious objectives in mind and that
objectives can be classified under four head.

e. Work related objectives:

i. To provide a control for work done.
ii. To improve efficiency
iii. To help in assigning work and plan future work assignment.
iv. To carry out job evaluation.

f. Career development objectives

i. To identify strong and weak points and encourage finding remedies for weak points
through training.
ii. To determine career potential.
iii. To plan developmental (promotional or lateral ) assignments.
iv. To plan carrier goals.

g. Communication:
i. To provide adequate feed back on performance
ii. To clearly establish goals i.e. what is expected of the staff member in terms of
performance and future work assignments.
iii. To provide counselling and job satisfaction through open discussion of performance, and
iv. To let employees assess where they stand within the organization in terms of their
performance.
h. Administration:
i. To serve as a basis for promotion or demotion.
ii. To serve as a basis for allocating incentives
iii. To serve as a basis for determining transfer

Purposes and Benefits:

Performance appraisal can serve many purposes and has several benefits. Among them are

1. To provide back up data for management decisions concerning salary standards, merit increases
selection of qualified individuals for hiring, promotion or transfer, and demotion or termination
of unsatisfactory employees.
2. To serve as a check on hiring and recruiting practices and as validation of employment tests
3. To motivate employees by providing feedback about their work.
4. To discover the aspirations of employees and to reconcile them with the goals of the organization.
5. To provide employees with recognition for accomplishments.
6. To improve communication between supervisor and employee and to reach an understanding on
the objectives of the job.
7. To help the supervisors deserve their subordinates more, closely to do a better coaching job, and
to give supervisors a stronger part to play in personnel management and employee development.
 8. To establish standards of job performance
9. To improve organizational development by indentifying training and development needs to
employees and designing objectives for training programs based on those needs.
10. To earmark candidates for supervisory and management developments and
11. To help the organization determine if it is meeting its goals.

What to appraise:

1. Ability to plan, delegate, control and co-ordinate

2. Knowledge of job
3. Clarity on different things
4. Cost conscious and result
5. Communication skills (verbal and written)
6. Decision making
7. Integration
8. Use of discretion and judgement
9. Co-operation and team involvement
10. Dealings with seniors and juniors
11. Leadership
12. Courage to disagree and to reason out faithfully
13. Loyalty and initiative
14. Attitude towards the organization and work
15. Responsibility
16. Availability
17. Punctuality and tidiness
18. Pleasing personality
19. Present ability

Who will appraise

➢ Superiors
➢ Supervisors
➢ Peer/ colleagues
➢ Subordinates
➢ Use of services / customers
➢ Consultant
➢ Self appraisal

Methods of Appraisal:

III. Individual Evaluation:

a. Confidential report
b. Essay evaluation
c. Critical incidence evaluation
 d. Check list evaluation
e. Behaviour evaluation
IV. Multi person Evaluation (Group evaluation)
a. Ranking method
b. Raised comparison method
c. Random sampling method
d. Group appraisal
e. Assessment centered method
f. Field review method
g. Human resource accounting

Problems with Appraisal:

• Judgement errors
• Poor appraisal forms
• Lack of preparedness
• Lack of seriousness
• Lack of information
• Lack of Appraising skills

Uses of Performance Appraisal:

• Basis of suitable personnel policies

• Judging the effectiveness of recruitment
• Assessment of individual potentials
• Basis for planning
• Boost the morale
• Motivates the employees
• Develops confidence

DIFFERENTIATE BETWEEN

1.Delegation Vs Decentralization (April 2018)

Delegation is defined as transferring of Decision making- decentralization basic

responsibility to subordinates on behalf of the goals of decentralization.
manager. It is an act through which a manager Definition
gives authority to others to attain certain Decision making is a systematic process of
assignments. choosing among alternatives and putting the
Salient Features: choice in to action. -Lancaster and Lancaster
1. Not to delegate total authority Types of decision making There are 4
managerial decisions
2. Not to delegate authority which he himself a. Mechanistic decision
does not possess b. Analytical decision
c. Judgmental decision
 3. Should be only for organisational purpose d. Adoptive decision
and not personal purpose
Models of decision making
4. It does not imply reduction in power 1. The Normative Model
Characteristics:
2. The Decision Tree Model
1. Delegation of authority can be exercised
only by higher authority
3. The Descriptive Model
2. Delegation can be of any kind
3. Delegation does not mean transfer of final 4. The Strategic Model
authority
5. Optimizing Model
4. Does not involve surrender of power
6. Satisfying Model
Kinds of delegation:
1. Full delegation
2. Partial delegation

Conditional delegation
4. Formal delegation
5. Informal delegation

2.Coordination vs Cooperation (April 2018)

Definitions Co-ordination is the integrating

process in an orderly pattern of group efforts in
an organization toward the accomplishment of
a common objective.

Co-ordination is the orderly arrangement of

group efforts to provide unity of an action in
pursuit of common purpose.

Characteristics
Group effort: The financial, human and
technical resources are properly organized and
co-ordinate.co-ordination transcends and
permeates all managerial functions.
Unity of action: Co-ordination applies to the
group effort, not individual effort, co-
ordination stress the unity of effort and unity of
action.
Important features of co-ordination
Co-ordination is a integrity process.
 If subdivision of work is in escapable, co-
ordination becomes mandatory.
Undue confusion is a symptom of poor co-
ordination.
Co-ordination is a process. It is a process of
achieving integration among different
organizational units.
Unity of effort is the heart of co-ordination
problem. The idea that co-ordination is a fixed
entity that either exists or does not exist is
totally unrealistic.co-ordination is present in all
organizations but in varying degrees.
The chief objective of co-ordination is a
common purpose.

3.PERT and Gantt chart (September 2018)

Gantt was concerned with problems related

PERT is a network system model for to efficiency. He contributed to scientific
planning and control under certain management by refining the previous work of
conditions. It involves identifying the key Taylor than introducing new concepts.
activates in a project, sequencing the 1. He studied the amount of work planned or
activities in a flow diagram, and assessing the completed on one axis to the time needed or
duration for each phase of work. taken to complete a task on the other axis.
2. Gantt also developed a task and bonus
a. It is appropriate for project work that remuneration plan whereby workers received
involves extensive research and development. a guaranteed day‘s wages plus a bonus for
production above the standard to stimulate
b. Helps to predict time. higher performance.
3. Gantt recommended to select workers
c. Helps to determine priorities. scientifically and provided with detailed
instructions for their tasks.
d. Use of recourses can be considered when 4. He argued for a more Humanitarian
setting priorities. approach by management, placing emphasis
on service rather than profit objectives.
e. Assignment can be changes temporarily. 5. He recognized useful non –monetary
incentives such as job security and
f. Overtime or temporary help can be given to encouraging staff development.
facilitate the activity flow.

g. Can manipulate the time required to move

from one event to another.
4.Operational vs strategic planning (May 2016)

 Operational plans specify details Strategic planning is the process of

on how individual objectives are to be documenting and establishing a direction of
achieved. your small business—by assessing both
 An operational planning is a subset of where you are and where you’re going.
strategic work plan.
 It describes short-term ways of achieving
milestones and explains how, or what
The strategic plan gives you a place to record
portion of, a strategic plan will be put into your mission, vision, and values, as well as
operation during a given operational your long-term goals and the action plans
period, in the case of commercial you’ll use to reach them.
application, a fiscal year or another given
budgetary term. A well-written strategic plan can play a
Operational plans should contain: pivotal role in your small business’s growth
 clear objectives and success because it tells you and your
 activities to be delivered employees how best to respond to
 quality standards opportunities and challenges.
 desired outcomes
 staffing and resource requirements
Benefits of Strategic Planning
 implementation timetables
 a process for monitoring progress.
The strategic planning process can take some
time, but it’s beneficial for everyone
involved. As the small business owner, you’ll
have a better idea of the goals and objectives
you want to accomplish and a path to do that.
For your employees, the process can foster an
increase in productivity—contributing to the
success of the business.

5.Autocratic leader vs Laissez-faire leader

Autocratic Leader Laissez-faire leader

• Power steps from outside the group ◆ Also known as the “hands-off¨ style
• The leader determine policies and make ◆ Little or no direction
plans ◆ Gives followers as much freedom as
• The authoritarian leader exploits possible
regressive, primitive unconscious needs ◆ All authority or power is given to the
and makes the group dependent on him. followers
• Authoritarian leader seeks to monopolize ◆ Followers must determine goals, make
all knowledge and initiative decisions, and resolve problems on their
• Allowed One way communication. own.
When to use: When to use:
◆ New, untrained employees
 ◆ Employees are motivated ◆ Employees are highly skilled,
◆ Employees do not respond to any other experienced, and educated
leadership style ◆ Employees have pride in their work and
◆ High-volume production needs the drive to do it successfully on their
◆ Limited time for decision making own
◆ Manager’s power is challenged by an ◆ Outside experts, such as staff specialists
employee or consultants are being used
◆ Employees are trustworthy and
experienced

6.Directing vs Controlling

It is that part of managerial function which It implies measurement of accomplishment

actuates the organizational methods to work against the standards and correction of
efficiently for achievement of organizational deviation if any to ensure achievement of
purposes. It is considered life-spark of the organizational goals.
enterprise which sets it in motion the action of
The purpose of controlling is to ensure that
people because planning, organizing and
everything occurs in conformities with the
staffing are the mere preparations for doing
standards. An efficient system of control helps
the work.
to predict deviations before they actually
Direction is that inert-personnel aspect of occur.
management which deals directly with
According to Theo Haimann, “Controlling is
influencing, guiding, supervising, motivating
the process of checking whether or not proper
sub-ordinate for the achievement of
progress is being made towards the objectives
organizational goals.
and goals and acting if necessary, to correct
Direction has following elements: any deviation”.

• Supervision According to Koontz & O’Donell

• Motivation “Controlling is the measurement & correction
• Leadership of performance activities of subordinates in
• Communication order to make sure that the enterprise
objectives and plans desired to obtain them as
being accomplished”.
 • Therefore controlling has following steps:
• Establishment of standard performance.
• Measurement of actual performance.
• Comparison of actual performance with
the standards and finding out deviation if
any.
• Corrective action.

7.Intrinsic Vs Extrinsic Motivation

• Intrinsic motivation is something • Extrinsic motivation is something

within the person that energizes outside the person that energizes
behavior. E.g., Interest, curiosity, behavior. E.g., Money,
personal challenge and improvement fame, power

8. Job description Vs Job Specification

Job description is a list of the general It is a standard of personnel and designates

tasks, or functions, and responsibilities of a
position. Typically, it also includes to whom the qualities required for an acceptable
the position reports, specifications such as the performance, it is written record of the
qualifications needed by the person in the job, requirements sought in an individual worker
salary range for the position, etc.
for a given job.
A job description is usually developed by
The job specification takes the job
conducting a job analysis, which includes
examining the tasks and sequences of tasks description and answers the question. "What
necessary to perform the job. human traits and experience are needed to
do the job well?" It tells what kind of person
The analysis looks at the areas of knowledge
and skills needed by the job. to recruit and for what qualities that person
should be tested.
Job specifications translate the job
description into terms of the human
qualifications which are required for a
successful performance of a job. They are
intended to serve as a guide in hiring and job
evaluation. As a guide in hiring, they deal
 with such characteristics as are available in
an application bank, with testing, interviews,
and checking of references.

ENUMERATE THE FOLLOWING

1.Four principles of planning

The important principles of planning are discussed below:

1. Principle of contribution to objectives: The purpose of plans and their components is to

develop and facilitate the realization of organizational aims.
2. Principle of pervasiveness of planning.
3. Principle of limiting factors: Planning must take the limiting factors (manpower, money,
machines, materials and management) into account by concentrating on them when
developing alternative plans, strategies, policies, procedures and standards.
4. Principle of flexibility: Flexibility should be built into organization plans. The principle
of flexibility states that management should be able to change and existing plan because of
change in environment without undue cost or delay so that activities keep moving towards
established goals.
5. Principle of Navigational change. It is the duty of the navigator to check constantly
whether his ship is following the right direction in the vast ocean to reach the destination
as scheduled. The navigator changes the path of the ship in case it is it is not going on the
right path. In the same way, a manager should check his plans to ensure that these are
progressing as required. He should change the direction of his plans if he faces unexpected
events.
6. Principle of Commitment. It suggests that the time period covered by planning should be
related to the commitments of the organization.

2.Pre-requisite of Collective Bargaining:

Collective bargaining involves a set of procedures by which employee representatives negotiate to obtain
a signed agreement that describes conditions of employment, especially wages, hours and benefits.
Collective bargaining has benefits not only for the present , but also for the future.

• To provide an opportunity to the workers , to voice their problems on issues related to

employment.
• To facilitate reaching a solution that is acceptable to all the parties involved.
• To resolve all conflicts and disputes in a mutually agreeable manner.
• To prevent any conflict/ disputes in the future through mutually signed contracts.
• To develop a conductive atmosphere to foster good organizations relations.
• To provide stable and peaceful organization(hospital) relations.
• To enhance the productivity of the organization by preventing strikes, lock-out etc.
3.Four techniques of employee motivation (Oct 2016)

Motivation is the process of arousing the action, sustaining the activity in process and regulating the
pattern of the activity.

Motivation, Performance and engagement:

Minimum motivation to go to work

Reach high job levels

Motivation happens by- Money, -Financial rewards,-Opportunities.

Motivation Techniques:

1.Provide meaningful and challenging work.

2.Set clear targets and expectations and measure performance

3.Give regular, direct, supportive feedback.

4.Design people’s roles so they can use their strengths.

5.Enables in-put and choice in how work gets done.

6. Mootivation through specific needs

7. Two factor theort- Motivation factor and Hygiene factor

4. Four functions of human resources management

Function of HRM

• Determining the organizational structure and manpower needs to effectively meet the
organization objectives.

• Seeking and attracting qualified applicants to fill job positions.

• Assigning each employee an appropriate position which clearly defines his responsibilities.
 • Ensuring that new recruits are provided with appropriate training to enable them to perform
their duties effectively.

• Further providing training for increasing the utilization of the employees’ capabilities.

• Providing opportunity for individual employees’ development.

• Arranging programs as required for developing existing personnel.

• Formulating work regulations and developing harmonious relationship.

• Appraising each employee’s performance objectively.

• Helping employees solve their personal problems.

• Developing facilities and procedure for the prevention of accidents.

• Preventing diseases and physical ailments of employees.

• Providing precautionary measures for safeguarding the organization and its property from
fire, theft etc.

• Improving employees’ attitudes and conditions of work.

5. Four types of budget

Budget consists of mainly three sections/ approaches i.e.

• Manpower budget (cash)

• Capital expenditure budget and
• Operating budget

The manpower budget- includes wages and other benefits provided for regular and temporary
workers.

The capital expenditure budget- includes purchase of land, building and major equipments of
considerable expenses and long life.

The operating budget- includes the cost of supplies, minor equipment repair and over head
expenses.

6.Four channels of communication

Communication is central to all meaningful collaboration and teamwork. Communication keeps
a whole organization moving. There are different ways we can communicate such as written
communication, verbal communication, non-verbal communication and visual communication.

It is important that whatever type of communication we choose, the information needs to be

conveyed effectively. Various modes or medium to transmit and receive the information is
referred as “communication channels”.

There are number of different types of communication channels exist as listed below:

1. Face-to-face conversations
2. Videoconferencing
3. Audio conferencing
4. Emails
5. Written letters and memos
6. Chats and messaging
7. Blogs
8. Formal written documents
9. Spreadsheets etc.

The above channels need to identified and used effectively for achieving maximum impact and
richness of information as desired.

7.Four barriers of communication

Barriers in communication:

There can be various hindrances to effective communication. These can be in relation to

communicator, message, medium of communication and receiver.

• Communication is ineffective if the communicator is not well versed with communication

process, principles and methods. He or she needs to be trained in that to be able to
communicate health messages which are relevant, understandable and effective.
• Communication is ineffective if the message which is given is not relevant to learning
needs of the clients, is not interesting, is not culturally accepted, is impractical, is not
understandable etc.
 • Communication is ineffective if the medium of communication is not appropriate in
accordance with the message, the clients level of maturity, cultural pattern etc. and also
which does not promote bi-way communication. It is best to have face to face
communication using different types of medium of communication which promotes
interactive approach and involves the use of more than one senses
• Communication is ineffective if the receiver (client) has any problem. The problems can
be due to physiological and psychological disorders. The physiological disorders include
hearing disorder, speech and expression disorder, or any other acute physical conditions.
Psychological disorder include emotional disturbances. Which may be due to physical
conditions or mental and emotional conditions.
• Communication is also ineffective when environment is not conducive to transmit and
receive information. It may be due to noise, poor light and ventilation, improper sitting
arrangement, hot environment etc.

8.FOUR SOURCES OF RECRUITMENT

The recruitment of manpower is met from internal or external sources.

I. INTERNAL SOURCES (Recruitment from within the organization)

a. Present permanent employees
b. Present temporary / casual employees
c. Retired employees
d. Dependants of diseased, disabled, retired and present employees.
II. EXTERNAL SOURCES: (Recruitment from outside the Organization)
a. Formal employees
b. Friends and relatives of present employees
c. Through intermediaries
d. Advertising
e. Employment exchange.
f. Direct recruitment
g. Contact with concern
h. Casual application
i. Through trade unions
j. Part time employees
k. Specialized institutions
l. Applicants pre applied and not selected
m. Use of special consultants for recruiting.

9.PRINCIPLES OF BUDGET(Any Four)

Budget is an operational plan for period, usually a year, expressed in financial terms and based
on expected income and expenditure. Budget needs certain principles as given below;

❖ Budget should provide sound financial management by focusing on requirement of the

organization.
❖ Budget should focus on objectives and policies of the organization.
 ❖ It should ensure the most effective use of scarce financial and non-financial resources.
❖ It requires that programme activities are planned in advance.
❖ Budgetary process requires consistent delegation for which fixed duties and responsibilities
are required to be allocated to managers at different levels for framing and executing
budget.
❖ Budget should include coordinating efforts of various departments establishing a frame of
reference for managerial decision and providing a criterion for evaluating managerial
performance.
❖ Budget period must be appropriate to the nature of business or service and to the type of
budget.
❖ Budget is prepared under the direction and supervision of the administrator or financial
officer.
❖ Budgets are to be prepared and interpreted consistently throughout the organization in the
communication of planning process.
❖ Budget necessitates a review of the performance of the previous year and an evaluation of
its adequacy and quality.
While developing a budget the provision should be made for its flexibility.

10.Objectives of manpower planning (Any four)

1. Effective utilization of human resources in the achievement of organizational goals.

2. Establishment and maintenance of an adequate organizational structure and desirable
working relationships among all members of the organization.
3. Securing integration of the individual and informal groups with the organization and
thereby ensuring their commitment involvement and loyalty.
4. Recognition and satisfaction of individual needs and group goals.
5. Provision of maximum opportunities for individual development and advancement
6. Maintenance of high morale in the organization.
7. Continuous strengthening and appreciations of human assets.

UNIT – III – MANAGEMENT OF NURSING SERVICE DEPARTMENT

ESSAY

1. Define nursing audit. Explain the purposes and types of nursing audit. Describe the role
of head nurse in nursing audit ( 2+3+5+5=15) (2017)
ANS:

DEFINITION

Nursing Audit refers to assessment of the quality of clinical nursing.

PURPOSES

• Evaluating Nursing care given.

• Achieves deserved and feasible quality of nursing care.
• Stimulant to better records.
• Focuses on care provided and not on care provider.
• Can contribute to research.
• To revise and plan standards of nursing care.
TYPES OF AUDIT

• According to the timings of Audit

• Retrospective Audit:
• Concurrent Audit:
• Prospective Audit:
• On the basis of personal perspective
• Internal Audit :
• External Audit:
ROLE OF HEAD NURSE

• Encourages followers.
• Clearly communicates standards of care to subordinates.
• Encourages the setting of high standards.
• Implement quality control proactively.
• Uses control.
• Positively active in communicating quality control finding.
• Acts as a role model.
• In conjunctions with other personnel in the organization establishes clear cut, measurable
standards of care and determines the most appropriate methods for measuring if those
standards have been met.
• Selects and uses process, outcome and structure audits appropriately as quality control tools.
• Assesses appropriate sources of information in data gathering for quality control tools.
• Determines discrepancies between care provided and unit standards and seeks further
information regarding why standards were not met.
• Uses quality control findings as a measure of employee performance and rewards, coaches,
counsels or disciplines employees accordingly.
• Keeps abreast of current government and licensing regulations that affect quality control.

2.Explain the methods of recruiting staff nurse in a hospital. Describe the job specification
and job description for a staff nurse in medical ICU.
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.

Definition Staffing is the systematic approach to the problem of selecting, training, motivating
and retaining professional and non professional personnel in any organization.

It involves manpower planning to have the right person in the right place and avoid ―Square
peg in round hole‖.

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‖.

The procedural steps taken to make available suitable persons for a job.

◼ After deciding upon the classification of nursing personnel required

◼ By nursing personnel OR

◼ By the personnel department (must have a nurse recruiter)

The Nurse recruiter

◼ Represents the philosophy, purpose and program of the health agency to the public

◼ Should have a warm and attractive appearance and behaviour

◼ Constructs a nursing personnel profile

Planning a recruitment program

◼ Review –

◼ Records of exit interviews with nursing personnel

◼ Federal, state and local manpower statistics on graduating nurses and those
employed

◼ Familiarize with salary scales and fringe benefit packages offered

◼ Assess efficacy of previous recruitment activities

Four essential elements in recruiting strategy

 ◼ Where to look.

◼ How to look.

◼ When to look.

◼ How to sell.

Recruitment methods

◼ Advertising – (assess readership) - Local newspapers, Nursing journals & Nursing

organization bulletins

◼ Career day programs & recruitment literature – Arranged by the teaching institutions for
senior students and alumnae

◼ Open house – with a variety of activities – orientation, work assignments, continuing

education program etc

◼ Employee recommendations/ referral

Processing and interviewing applicants

◼ Do as quickly as possible (to prevent a promising candidate)

◼ Care in selecting secretaries, receptionists & employment interviewer

◼ Investigate – the position sought, previous education, experience, qualification

◼ Employment interviewer - discusses the salary ranges and personnel benefits

◼ Referral to the nurse manager – interview, tour and verification

Principles of the pre- employment interview

◼ Create & maintain a comfortable environment throughout

◼ Conduct as preplanned

◼ Explore background and future plans

◼ Encourage by asking non directive and open ended questions

◼ Listen actively and talk sparingly

◼ Be aware of non verbal communications on both sides

◼ Give info’ about job responsibility and work environment

 ◼ Identify both –ve and +ve aspects of job in detail

Selection

◼ Personnel selection - A process of choosing from several available candidates

◼ Placement selection – A process of choosing, from a number of possible jobs, the one
which is best suited for a particular candidate

Compare the strengths and weakness before making a decision

Comparing…

◼ Compare backgrounds of job applicant’s

 Basic education

◼ Weigh their personal characteristics –

 Check letters of reference

 Grooming & attire

 Vocal volume & tone

 Vocabulary

 Verbal & non verbal expression

 Warmth & openness

 Health status

Job specification and job description for a staff nurse in medical ICU.

Job Description of ICU Nurse:

ICU nurse is also known as critical care nurse. Critical care nurse provide most of the direct care
to patients in life threatening situations within intensive care unit. ICU nurse commonly provide
care to patients suffering from cardiac disease, brain injuries, accident victims and patients
recovering from complex surgeries that need frequently nursing care.

Duties and Responsibility of ICU nurse:

Specific critical care nurse or ICU nurse duties and responsibilities can include:

1. Monitor exact, detailed reports and records of critical ICU patient.

2. Monitor and record symptoms and changes in patients’ conditions and inform to physician.
3. Order, interpret and evaluate diagnostics tests to identify and assess patient’s condition.
4. Carefully observe and document patient medical information’s and vital signs.
 5. Document patients’ medical histories and assessment findings.
6. Document patients’ treatment plans, interventions, outcomes, or plan revisions.
7. Consult and coordinate with health care team members about whole patient care plans.
8. Modify patient treatment plans as indicated by patient’s response and conditions.
9. Monitor the critical patients for changes in status and indications of conditions such as
sepsis or shock and institute appropriate interventions.
10. Administering intravenous fluids and medications as per doctor order.
11. Monitor patients’ fluid intake and output to detect emerging problems such as fluid and
electrolyte imbalances.
12. Monitor all aspects of patient care, including diet and physical activity.
13. Identify patients who are at risk of complications due to nutritional status.
14. Direct and supervise less skilled nursing/health care personnel, or supervise a particular
unit on one shift to patient’s response and conditions.
15. Treating wounds and providing advanced life support.
16. Assist physicians with procedures such as bronchoscopy, endoscopy, endotracheal
intubation, and elective cardio version.
17. Ensuring that ventilator, monitors and other types of medical equipment function properly.
18. Ensure that equipment or devices are properly stored after use.
19. Identify malfunctioning equipment or devices.
20. Collaborating with fellow members of the critical care team.
21. Responding to life-saving situations, using nursing standards and protocols for treatment.
22. Critical care nurses may also care for pre- and post-operative patients when those patients
require ICU care.
23. In addition, some act as manager and policy makers, while others perform administrative
duties.
24. Assess patients’ pain levels and sedation requirements.
25. Prioritize nursing care for assigned critically ill patients based on assessment data and
identified needs.
26. Assess family adaptation levels and coping skills to determine whether intervention is
needed.
27. Acting as patient advocate.
28. Providing education and support to patient families.
29. ICU nurse must be able to draw ABG Blood and interpret report correctly.
30. ICU nurse should have enough knowledge about GCS (Glasgow Coma Scale) and also
evaluation capacity of patient condition.

SHORT NOTES – 5 MARKS

1. Job description of a head nurse (2014)

ANS :

JOB DESCRIPTIONOF HEAD NURSE

• To identify the duties and responsibilities of the head nurse.

• To implement the standard policy and procedure of ER.
• To direct and supervise functions and activities in ER.
POLICY

• Must possess a certificate in Bachelor of Science in Nursing and passed the licensure
examination.
• Must have a five years’ experience in critical care unit.
• Must have a certificate in nursing management as well as sufficient clinical experience with
proven managerial skills.
DUTIES AND RESPONSIBILITIES

• Organize and direct functions and activities in ER.

• Interpret and implement established policies, procedures, regulations to personnel patients,
medical staff and public.
• Utilize personnel efficiently and assure cost effective utilization of supplies and equipment.
• Provide a clean, orderly, safe and quiet environment.
• Assure adequate quantities of supplies and properly functioning equipment.
• Demonstrate care and safety measures and procedures.
• Evaluate area performance and effect changes as needed to improve services.
• Direct and supervise personnel and students.
• Design duties and orient, train, instruct personnel and may participate in in- service
education.
• Evaluate work performance, masked recommendation to supervisor for personnel action such
as merit, promotions, transfers and disciplinary action.
• Maintain good employer relations and solve problems and grievances.
• Maintain personnel records for emergency personnel.
• Provide counsel and guidance to the staff.
• Inspect the ward regularly for compliance of policy and procedure, regulations, standard and
take corrective action when violations occur.
• Maintain patient rights and compliance with hospital communication code.
• Assure maintenance of medical records and confidential treatment of patient information.
• Analyze area needs, study new trends and development and offer recommendation to nursing
administration.
• Establish and maintain free communication between administration, emergency department
staff, physicians and ambulance service.
• Make assignments, give instructions, and arrange for breaks.
• Reports staff shortages to supervisors and adjust work schedule accordingly.
• In emergency cases: Direct patient triage Perform duties of staff nurse, notify physician carry
out orders and obtained required permit and releases.
• Interact with patient and family, giving instructions and offering support.
• Set up and prepare instruments, supplies, equipment and drugs as needed and assist physician
in treating the patient.
• Administer prescribed medications and perform prescribed treatments.
• Complete emergency case records.
• Write changes and discharge patient or process in-patient admission and transfer patient with
records to assigned nursing unit.
• Maintain good interdepartmental relation, public relation.
• Direct care and maintenance of equipment and supplies.
• Check narcotics and comply with regulations concerning use and storage.
• Maintain emergency logs and other required records, reports, statistics for administrative
purpose.
• Maintain established hospital policies, procedure, objectives, quality assurance, safety and
environmental and infection control.
• Maintain adequate reference material for use by nursing staff.
• Conduct staff meetings, attend required meetings and participate on committees as directed.
• Maintain professional growth and development through seminars, workshops, professional
affiliation, and encourage subordinate staff to participate in educational programs

2. NURSING AUDIT ( 2015,2016,2019)

ANS:

DEFINITION

Nursing Audit refers to assessment of the quality of clinical nursing

PURPOSE

STEPS OF NURSING AUDIT

• Selection of topic for study.

• Selection of explicit (clarity) criteria for quality care.
• Review of record to see if criteria for quality care are met.
• Peer (equal) review of all cares that do not meet criteria for quality care.
• Specific recommendation to correct deficiency such as staff development Programme,
change in procedure etc.
• Follow up the topic to see that problems have been eliminated.

TYPES OF AUDIT

NURSING AUDIT TEAM

 Composition of audit team comprise about 5- 6 members and large in some extent change in
the type of consultants of different specialties.
Team consist representatives of:
• Nursing Administration
• Nursing Services
• Nursing Education
• Nursing Specialist
• Clinical Nurse
Eligibility: Minimum 5 members who are interested in quality assurance and clinically
competent and able to work together in group.

AUDIT CYCLE
Set standards

Implement change Observe practice

Compare with standard

ADVANTAGES OF NURSING AUDIT

• Can be used as a method of measurement in all areas of nursing.

• Seven functions are easily understood.
• Scoring system is fairly simple.
• Results easily understood.
• Assesses the work of all those involved in recording care.
• May be a useful tool as part to quality assurance Programme in areas where accurate records
of care are kept.
3. Nursing rounds (2016)

ANS:

DEFINITION
A nursing round is one which presents an overview of certain aspects of the nursing or
medical care of all patients on the ward or of selected patients.

PURPOSE
• To acquaint nurses with all patients on the more purposeful care may be achieved for each
patient.
• To help nurses to get acquainted with new patients.
• To carry out demonstration of therapeutic procedures on / for the patients.
• To illustrate skillful nursing care.
• To learn about disease, pattern of care and treatment.
• To demonstrate the effect of drugs used in the treatment.

STEPS INVOLVED IN ROUNDS

• The entire clinical group of students are assembled at the bedside of a pre-selected patient
who has agreed to participate and who has been briefed beforehand as to his role in the
learning experience.
• The instructor of the student who is caring for the patient briefs the nursing care.
• The staff nurses of the ward are also allowed to contribute certain genuine points regarding
patient care.
• Background information of the patient can be provided away from the bedside.
• The main focus is made on nursing care and only important aspects of the care are discussed.
• At the end the instructor concludes the discussion by giving her opinion, guidance and
relevant instructions.
• The patient is finally briefed up on the conclusions reached following discussion.
• The staff nurse on duty records all the instructions and suggestions given by the instructor
and a register (providing the information) is maintained in the ward.

ADVANTAGES
• It ensures high degree of autonomy among students.
• The presence of the patients as a means to illustrate assessment parameters or intervention
techniques.
• Nursing rounds provides input and feedback from the perspective of patient care and
therefore gives an opportunity to clarify issues related to patient care.
• It facilitates a detailed discussion on the nursing care of a single patient.
• Nursing Rounds helps the students to develop psychomotor skills and inculcate proper
attitude among the nurses.
• Interaction with the senior members promote team spirit and professionalism among
students.
• Nursing Rounds motivate students to develop an ability to discriminate or classify the
patients into high risk, risk, and no risk categories depending on the severity of illness.
• Helps students to learn in depth regarding a case management.

DISADVANTAGES
• The patient may overhear the discussion and he may not like the thought that he is being
talked about.
• Other patients in the same ward may over hear the discussion which the patient may not like.
• Insufficient information may lead to inappropriate result.
• There may be distractions in the ward and there could be problems for the nurses to stand in
the ward.
• It cannot be organized for large group and hence teaching cannot be done for more number of
nurses.
• If the nurses are familiar with all the patient’s the discussion may be held in the conference
room.

ENUMERATE THE FOLLOWING – 2 MARKS

1. Four uses of procedure manual (2014)

ANS:

• Improve Communication.
• Office Procedures Reduce Employee Training Time.
• Company Procedures Improve Employee Productivity.
• Policies and Procedures Strengthen Business Operations.

2. Four factors affecting ward management (2015)

ANS:

• Knowledge of the ward

• Planning the schedule of the ward
• Starting the work on time
• Preventing interruptions

3. Four methods of patient assignment (2015,2016,2019)

ANS:

• Case method nursing or total patient care.

• Functional nursing
• Team nursing or modular nursing
• Primary nursing
• Case management or managed care
• Progressive patient care

4. Four responsibilities of clinical instructor (2015)

ANS:

• Demonstrate standards for nursing practice.

• Supervise and teach the students in the clinical fields.
• Participate in evaluation of students.
• Assist the students in conducting health education Programme.
• Maintain students' records.
• Participate in the student counselling programmes.
• Participate and promote student welfare activities

5. Four functions of hospital (2016)

ANS:

• Patient care
• Diagnosis and treatment of disease
• Outpatient services
• Medical education and training
• Medical and nursing research
• Prevention of disease and promotion of health.

6. Four types of ward (2016)

ANS:

• General wards
• Specialized wards (maternity, paediatrics, psychiatric, geriatrics, oncology, and
detoxification wards)
• Emergency department
• Intensive care units.

7. Four purposes of anecdotal records (2017)

ANS:
• To furnish the multiplicity of evidence needed for good cumulative record.
• To substitute for vague generalizations about students specific exact description of behavior.
• To stimulate teachers to look for information i.e. pertinent in helping each student realize
good self- adjustment.
• To understand individual’s basic personality pattern and his reactions in different situations.
• The teacher is able to understand her pupil in a realistic manner.

8. Four steps of nursing audit cycle (2018)

ANS:

• Define the standards

• Measure current practice.
• Identify gaps
• Decide and implement action
• Review standards

9. Four advantages of nursing audit (2019)

ANS:

• Can be used as a method of measured in all areas of nursing

• Scoring system is fairly simple
• Results easily understood.
• Assess the work of all those involved in recording care.
• May be useful tool as part of a quality assurance Programme in areas where accurate records
of care are kept.

DIFFERENTIATE THE FOLLOWING – 2 MARKS

1. Team nursing and modular nursing (2014)

Team nursing Modular nursing

• RN as team leader coordinates care • Modification of team nursing
for a group of patients.
 • Goal was to reduce fragmented care • Patient unit is divided into modules
• Common use areas—most inpatient or units with an RN as team leader
and outpatient areas • The same team of caregivers is
assigned consistently to the same
geographic area
• Concept evolved to increase RN
involvement in care

2. Functional assignment and case method assignment (2015)

Functional assignment Case method assignment

• Functional nursing is efficiency – • A collaborative process of
based; tasks are completed quickly, assessment , planning , facilitation
with little confusion regarding and advocacy for options and
responsibilities. services to meet an individual’s
• Allow care to be provided with a health needs through communication
minimal number of RNs. and available resources to promote
quality cost- effective outcomes
• Nurses address each patient
individually, identifying the most
cost – effective providers,
treatments, and care settings
possible.

3. Functional method and team method (2017)

Functional method Team method

• Functional nursing is efficiency – • RN as team leader coordinates care
based; tasks are completed quickly, for a group of patients.
with little confusion regarding • Goal was to reduce fragmented care
responsibilities. • Common use areas—most inpatient
• Allow care to be provided with a and outpatient areas
minimal number of RNs

4. Nursing audit and nursing standards (2018)

Nursing audit Nursing standards

• Nursing audit is a way of ensuring • Nursing practice standard are
quality nursingcare. descriptive statements that affect the
 • Nursing audit is a detailed review nature of current nursing practice
and evaluationof selected clinical current knowledge and current
records by qualifiedprofessional quality of nursing care. As such they
personnel to identify, examine, or are a means of establishing
verify the performance of certain accountability of nursing care
specified aspectsof nursing care by rendered by the professional nurse.
using established criteria. • It give direction and provide
guidelines for performance of
nursing staff

UNIT IV

INSERVICE EDUCATION

Essay

1. Define in - service education. Enumerate the principles of adult learning. Prepare an

outline for one day in- service education for staff nurses on the topic emergency
management (Ans Key : assessment, environment and process,Sound relationship,
content and reinforcement, ,Respect, Domains, learning, team work, engaged activity)
Planning ,conduct of inservice education, evaluation)

DEFINITION

ANA defines in-service education as “those learning experiences provided in the work
setting for the purpose of assisting staff in performing their assigned functions in that particular
agency.

DETERMINING TRAINING NEEDS

It is the duty of the human resource department to determine the training needs of a
hospital. The first step in determining needs is to obtain evidence of needs. This evidence may be
gathered from various sources such as exit interviews, complaints from supervisors and
managers, staff turnover rate, complaints from patients and visitors etc.

William Mc Gehee and Paul W Tayer recommended the following three- step approach
to determine training needs:

1. Organization analysis to determine where training emphasis should be placed within the
organization.
2. Operations analysis to decide as to what a person should be taught, if he is to perform his
task with maximum effectiveness.
3. Man analysis to determine who needs to be trained and what skills, knowledge or
attitudes should be improved.
 As soon as the training needs are identified, a suitable training programme should be
developed for the concerned employees.

METHODS

There are two main methods of in-service education:

1. Self directed individual study

2. Institutional method

SELF DIRECTED INDIVIDUAL STUDY

In this method of in- service education, the interest of the person is required for the study.
The various methods of individual study are:

1. Attending conferences, seminars, workshops etc.

2. Attending post- graduate studies
3. By the use of T V, radio and video
4. Magazines, library and journals
5. By developing good reading and writing habits
6. Visits to other schools and colleges of nursing
7. By being a member of allied health organizations

FACTORS AFFECTING IN- SERVICE EDUCATION

The economic, social, medical and technological sciences which affect that society will
affect nursing in- service education. The related factors that affect the in- service education
programme are;

1. Cost of health care:- In-service education programme may increase the efficiency of
nursing services, but it adds additional expenditure on health care delivery system.
2. Man power:- In- service education requires qualified human resources, leading to
increased human resources.
3. Changes in nursing practical leads to frequent changes in the programmes and in- service
education.
4. Standards for nursing practice
5. Organization of nursing departmental planned approaches is regular
APPROACHES TO IN- SERVICE EDUCATION

The approaches are:

1. Centralized approach
2. Decentralized approach
3. Coordinated approach
 Whether the pattern of in- service education desired to centralized, decentralized or
coordinated approach will directly affect the organizations policies and practices.

Short Notes

1. Role of a nurse manager in-service education (Ans Key :explain each step- planning till
evaluation)

2. Importance of continuing education program in nursing (Ans Key :EBP, knowledge,

career advancement, technological advancement, nursing care, professional
advancement,administrative level)
3. Continuing education. (Refer unit-7) (Ans Key : definition, aims, functions,need,
elements, role of an educator, charecteristics, preparation and planning)

4. Principles of adult learning (Ans Key : assessment, environment and process,Sound

relationship, content and reinforcement, ,Respect, Domains, learning, team work,
engaged activity)
1. Needs assessmeent
2. Safety in the environment and the process
3. Sound relationship between teacher and learner and among learner
4. Sequence of content and reinforcement
5. Praxis, which mean action witih reflection or learning by doing
6. Respect for learner as decision maker
7. Involve cognitive, effective and psychomotor aspects of learning
8. Immediacy of the learning
9. Clear roles and role development
10. Team work and use of small groups
11. Engagement of the learner in what he/she is learning
12. Accountability: how do they know?

Enumerate the following

1. Four characteristics of adult learners (Ans Key : Motivation, Reinforcement, Retention,

Transference)
2. Four principles of adult learning (Ans Key : assessment, environment and process,Sound
relationship, content and reinforcement, ,Respect, Domains, learning, team work,
engaged activity)

Differentiate between (Refer answer in Unit-7)

 1. Continuing education and in-service education (Ans Key :aim, scope, planning,
responsibility, setting, examples)

UNIT-V -NURSING AS A PROFRSSION

Short Notes

1. Code of ethics for nurses (Ans Key : respect, fidelity, veracity, autonomy, beneficience,justice)
2. Legal responsibilities of a professional nurse (Ans Key : consent, privacy, records and
repors,patient care,rights)
3. Legal issues in nursing practice (Ans Key : negligence, malpractice, consent, privacy,
documentation, communication)

Code of professional conduct (for nurses in India)

1. Professional responsibility and accountability To maintain professional responsibility and

accountability, the nurse

• Appreciates a sense of self-worth and nurtures.

• Maintains standards of personal conduct, reflecting credit upon the profession.
• Carriers out responsibilities within the framework of the professional boundaries
• is accountable for maintaining practice standards set by the Indian Nursing Council.
• Is accountable for his/her own decisions and actions.
• Is compassionate.
• Is responsible for the continuous improvement of current practices
• Provides adequate information to individuals these allows them to make informed choices.
• Practices healthful behavior.
2. Nursing Practice In the course of practice of nursing, the nurse

• Provide care in accordance with set standards of practice

• Treats all individuals and families with human dignity in providing the physical, psychological,
emotional , social and spiritual and aspects of care
• Respects individuals and families in the context of traditional and cultural practicing, promoting
healthy practices and discouraging harmful practiced
• Presents realistic practices truthful in all situations for facilitating autonomous decisions making
by individuals and families
• Promote participation and individuals and significant others in the care
• Ensures safe practice
• Consults, co-ordinates, callboards and follow p approximately when an individuals care needs
exceed the his or her competence
3. Communication and interpersonal relationships This plays a key role in the interaction of the
nurse with his or her clients. To effect optimal interaction the nurse

• Establishments and maintains effective interpersonal relationships with individuals families and
communities
 • Upholds the dignity of team members and maintains effective interpersonal relationship with
them
• Appreciates a and nurtures the professional role of team members
• Co-operates with other health professionals to meet the needs of individuals , families and
communities
4. Valuing human being The nurse values human life. He or she

• Takes appropriate action to protect individuals from harmful unethical practices

• Considers relevant facts while taking cons… decisions in the best interest of individuals
• Encourages and supports individual in heir right to speak for themselves on issues affecting
health and welfare
• Respects and supports choices made by individuals.
5. Management Proper management of resources and unfortunate is essential for improving the
over all efficiency of the nurse. Hence the nurses

• Ensures appropriate allocation and utilization of available responses

• Participates in supervision and education of students and other formal providers
• Uses judgment in relation to individual competence which accepting and delegating
responsibility
• Facilitates conducive work culture in order to achieve institutional objectives
• Communicates effectively following appropriate channels if communication
• Participates in performance appraisal
• Participates in evaluation of nursing services
• Participates in policy decision, following the principles of equity and accessibility of
service
• Works individuals to identify the needs and sensitizes policy makers and funding
agencies for resource allocation

6.Professional Advancement
To escape that he or she is at part with contemporaries in the nursing field the nurse must.
• Ensures the protection of human rights, while pursuing the advancement of knowledge

• Participate in determine and implementing quality

• Take responsibility for updating one‘s own knowledge and competencies

• Contribute to the core of professional knowledge and conducting and participating in

research

Enumerate the following

1. Four characteristics of a professional nurse (Ans. Key: truthfulness, caring, empathy,

accountability…. Explain NURSE)
• Etiquette is a code of good manners that a nurse should follow.

• The nurse is an important member of health team that must work in co-operation &
harmony for the care of the sick.
• Nurse should follow certain essential good manners for the smooth functioning and
maintaining good interpersonal relationship.

❖ You should be courteous to all. Be gentle and polite in your talk.

❖ You should greet your seniors ,co-workers, your clients etc with appropriate words and
according to the time of the day.

❖ You should address the seniors with proper title. Eg ; Sir, Madam, Sister, Mister etc

• Stand up when answering questions in the classrooms.

• Stand up when people of higher rank enter your room.

• Open the door for the seniors and stand aside for them to pass.

• Excuse yourself when overtaking a senior person.

• Stand aside and give way to seniors when you cross them on the way, eg .in the corridors,
staircases etc.

• Maintain silence wherever and whenever necessary. Eg : classroom, library

• Keep your dress neat and tidy

• While on duty never use any form of jewellary that may interfere with work.

• Obey seniors without arguing.

• Help the seniors to carry a heavy load if you find them on the way.

• Say “thank you ‘’ when someone does a favour you,and also when someone corrects you.

• Get prior permission from the sister-in charge before you take any articles from any
department.

• Do not delay the answers to the questions , give the answer immediately and
appropriately.

• Be punctual always

• Avoid thumb sucking and nail biting.

• In an assembly let the seniors take the seat first.

• Keep eye contact and sit face to face when listening to someone.

• Say “excuse me “ even if you hurt others accidently.

 • Never let others’ secret go out of you.

• Always close the door after getting into a room, or when you get out of the room ,if so
desired.

• Knock at the door and wait for the answer , before you enter other’s room.

• Do not cover the mouth while taking to others, cover your mouth when you cough or
sneeze.

• Excuse yourself before you interfere with others engaged in taking or doing some work.

• You should not give and receive any gifts or present especially from the clients and their
relatives.

2.LEGAL RESPONSIBILITIES OF NURSE:

1. Responsibility of appointing and assigning

2. Responsibility in quality control

3. Responsibility for equipment

4. Responsibility for observation and reporting

5. Responsibility to protect public

6. Responsibility for record keeping and reporting

7. Responsibility for death and dying

3. Legal Issues Specific to Nursing

Nurses face legal issues daily. Those issues may be in connection to negligence, administering
medication and advocating for the patient. The Nurse Practice Act lists all of the duties and role of a
nurse, except the legal and ethical issues. If these duties and regulations are not followed, the nurse is
at risk of losing his license and facing a malpractice suit.
• Duty to seek Medical Care for the patient
• Confidentiality
• Permission to treat
• Informed consent
• Advance Directives
• Negligence
• Malpractice
• Fraud
• Assault and Battery
 • False Imprisonment
• Invasion of privacy

Consumer protection act: Consumer protection act (CPA in short) was enacted by Parliament
in December 1986 and came into force on 1 September 1987. The aim of act is to provide a
simple, speedy and inexpensive redressal for consumer grievances relating to defective goods,
deficient services and unfair trade practices.

The consumer protection Act defines the obligation of traders and manufacturers as well as of
service providers, and if the consumer feels that the goods provided or the services given are not
to his satisfaction, are defective, and below the standards prescribed normally, he is entitled for
what he has paid.

CONSUMER PROTECTION COUNCILS

They are at two levels namely Central and State protection councils Central consumer
protection council

The objectives of this council shall be to promote and protect the rights of consumer such as,
• The right to be protected against the marketing of goods and services which are
hazardous to life and property
• The right to be informed about the quality, quantity, potency , purity, standard and price
of goods and services, as the case may be so as to protect the consumer against unfair
trade practices
• The right to be assured , wherever possible, access to variety of goods and services at
competitive prices
• The right to be heard and to be assured that the consumers interest will receive due
consideration at appropriate forums
• The right to seek redressal against unfair trade practices

State consumer protection councils

The state council shall consists of following members
• The minister incharge of consumer affairs in the state Government, who shall be its
Chairman and
• Such number of other official or non official members representing such interest as may be
prescribed by state Government
• The State Council shall meet as and when necessary, but not less than two meetings shall be
held every year
The objective of every state council shall be to promote and protect within the state , the rights of
consumer

Differentiate between

1.Malpractice and negligence (Ans. Key: offence, damage to the patient, examples, punishment)
 Malpractice is defined as improper or
negligent practice by a lawyer, physician, Negligence refers to the act of doing
or other professional who injures a client something or refraining from doing
or patient. something that any other reasonable
medical professional would do or refrain
The fields in which a judgment of from doing in a similar situation.
malpractice can be made are those that
require training and skills beyond the level It goes without saying that every situation
of most people's abilities. is different, and that is where the law
becomes somewhat cloudy.
Medical malpractice is defined as a
However, when reviewing a nursing
wrongful act by a physician, nurse, or
negligence case, assumptions and
other medical professional in the
circumstantial evidence are taken into
administration of treatment— or at times, account to determine if there was
the omission of medical treatment, to a negligence.
patient under his or her care.

Although dentists, architects, accountants,

and engineers are also liable to malpractice
suits, most lawsuits of this type in the
United States involve medical malpractice.

Types of Nursing Malpractice

Nursing malpractice takes many forms,
including: -
• Medication errors
• giving a patient the wrong
medication or the wrong dose, or
dispensing medication to the wrong
patient
• Failure to follow a physician‘s
orders
• Delaying patient care and/or failure
to monitor a patient
• Incorrectly performing a
procedure, or trying to perform a
procedure without training
• Documentation error -Failure to get
informed patient consent

2.Code of ethics and code of professional conduct

Ethics:- Ethics is the study of good conduct, • Professional responsibility and

character and motives. It is concerned with accountability To maintain professional
determining what is good or valuable for all
 people. Act that are ethical often reflect a responsibility and accountability, the
commitment to standards beyond personal nurse.
preference standards on which individuals,
professions and societies agree. • Nursing Practice In the course of practice
of nursing, the nurse.
Code of ethics:- Code of ethics is the
providing guidelines for safe and • Communication and interpersonal
compassionate care. Nurse‘s commitment to a relationships This plays a key role in the
code of ethics guarantees the public that interaction of the nurse with his or her
nurses adhere to professional practice clients. To effect optimal interaction the
standards. nurse.

Elements: • . Valuing human being The nurse values

Nurse and people human life. He or she.
Nurse and practice
Nurse and society • Management Proper management of
Nurse and co-worker resources and unfortunate is essential for
improving the over all efficiency of the
nurse. Hence the nurses
• Professional Advancement

UNIT-VI

ESSAY:

Describe the role of administrator in planning annd implementing clinical learning

experiences to the BSc nursing students of college of nursing.

Education of health care professionals has moved from an apprenticeship model in the first half
of the twentieth century to an academic environment that involves both liberal and discipline
specific education which includes clinical field practice experience. The clinical practice
component in nursing education will be reviewed in its total spectrum regarding significance of
the clinical field in nursing education; clinical practice in nursing education and entry level
nursing competence.

Significance of the Clinical Field in Nursing Education

• The clinical field provides students the opportunity to experience the complexity of the
human interaction and response embedded in the nursing profession that is not possible in
the classroom setting.
• Students are given opportunity to develop clinical judgment and utilize knowledge in the
contextual whole of the learning experience .
• The clinical practice in a professional program extends beyond the general purpose of
providing opportunity to apply theory to practice with real patients in real life settings.
• The emphasis is on the development of competencies of the professional person who is
capable and practices in a manner that supports responsibility and accountability in a
dynamic diverse society within complex health systems.
• Clinical education promotes student learning encounters with the artistic aspects of
nursing and assists students in making meaningful relationships, see patterns and gain
new insights which are limited in structured, controlled classroom environments.
• Students are able to observe and interact with nurses as they practice the art of nursing
and serve as role models in various stages of development and nursing expertise. Benner
(1984) contends that knowledge is discovered and embedded in actual nursing clinical
practice and supports a situation based approach to learning.
• Situation based learning strategies such as provided in clinical practice learning
environments assists in explaining the differences in clinical performance and the growth
and development of nursing competence.
• The purpose of the clinical component of nursing education as one of the means in which
“students can use newly acquired knowledge and skills, think critically, make clinical
decisions, and acquire professional values necessary to work” in the nursing profession.
• The purpose of clinical practice in an educational program includes assisting students in
learning how to learn, dealing with ambiguity, and thinking like professionals and
developing the commitment to accept personal responsibility for one’s own actions and
behavior.
• Utilize the theoretical framework to assist in understanding the purpose of the clinical
practice component in nursing education.
• Foundational elements of this action theory are based on the assumption that specific
practice situations will yield intended student outcomes and that learning is enhanced and
more effective when the student is engaged and assumes the role of active participant.
Knowledge is applied in context during each student clinical experience.
• Viewing the clinical practice setting as a learning experience implies active involvement
of the student as the nursing student experiences the practice of nursing .
• This concept of learning and behavioral change contends that experience leads to
learning and then in turn results in a change in behavior.
• Learning through the experience involves a change of behavior from that of nursing
student to the desired educational outcome as the student thinks and performs like a
nurse.
• The essence of this lived experience is to prepare the learner for more complex situations
that is typical in the practice of nursing. Included in the lived experience of the nursing
student in clinical practice settings is the opportunity to observe nurses actively engaged
in nursing practice.
 • Nurses and clinical nursing faculty serve as role models for nursing students during
clinical learning experiences.
• Role modeling is an effective teaching/learning strategy that is a significant part of the
clinical learning experience for students.

2.Describe the role of administrator in organizing physical facilities for a college of nursing
according to INC norms.

Nurses have never been more critical to success of health care system than they are now. The
education and practice of nursing is based on a range of scientific principles from both the
physical and behavioural sciences. Diversity is the main characteristics of nursing education
today. A variety of nursing education programmes exist today. The proper administration of
these programmes and educational institutions is important.

The several studies done on the nursing education suggested the following:-

1. The nursing education should be established within the system of higher education.
2. The nurses should be highly educated.
3. The student nurses should not be used as staff nurses in hospitals.
4. All nurses should have certain qualification upon graduation.

NURSING COLLEGE ADMINISTRATION

The various aspects in the administration of nursing educational institutions are:-

1. Formulation of the philosophy of the college of nursing.

2. Formulation of the board of management.
3. Permission from the state nursing council
4. Permission from the state government
5. Permission from the Indian Nursing Council
6. Permission from the university
7. Infrastructure and other facilities
8. Selection, recruitment and appointment of faculty members
9. Selection and recruitment of the students
10. Budgeting
11. Curriculum development and administration
12. Periodic credentialing and accreditation
13. Extracurricular and co-curricular activities
14. Student government
15. Maintenance of records and reports.

PHYSICAL FACILITIES

➢ Architectural plan of college building hostel

➢ Equipment needed
➢ Furniture: hostel, labs, library, classroom, offices and seminar hall.

Clinical facilities

College of nursing should have a 120-150 bedded Parent/Affiliated Hospital for 40 annual intake
in each programme:

Distribution of beds in different areas

• Medical - 30
• Surgical - 30
• Obst. &Gynecology - 30
• Pediatrics - 20
• Ortho - 10
❖ Bed Occupancy of the Hospital should be minimum 75%.
❖ The size of the Hospital/Nursing Home for affiliation should not be less than 50 beds.
o Other Specialties/Facilities for clinical experience required are as follows:
• Major OT
• Minor OT
• Dental
• Eye/ENT
• Burns and Plastic
• Neonatology with Nursery
• Communicable disease
• Community Health Nursing
• Cardiology
• Oncology
• Neurology/Neuro-surgery
• Nephrology etc.
• ICU/ICCU
o Affiliation of psychiatric hospital should be of minimum 30-50 beds.
o The Nursing Staffing norms in the affiliated Hospital should be as per the INC norms.
o The affiliated Hospital should give student status to the candidates of the nursing programme.
o Affiliated hospitals should be in the radius of 15-30 kms.
o 1:3 student patient ratio to be maintained.
❖ If the institution is having both GNM and B.Sc(N) programme, it would require 240 bedded
parent/affiliated hospital for 40 annual intake in each programme to maintain 1:3 student
patient ratio.
o Proportionately the size of the built-up area will increase according to the number of students
admitted.
o College of nursing can share laboratories, if they are in same campus under same name and
under same trust, that is the institution is one but offering different nursing programmes.
However they should have equipment and articles proportionate to the strength of admission.
 And the class rooms should be available as per the requirement stipulated by Indian Nursing
Council of each programme

Short Notes:

1.Student welfare services in college of nursing

Student welfare is an integral part of the total programme and is of vital importance. It covers the
physical and mental well being of the students. Such needs of the students are partly met by
facilities provided in hostel and partly through an active and adequate student health, guidance
and counseling service and opportunities for recreational and for cultural and religious activities.

Health programme in school of nursing may be extensive or limited. Regardless to this provision
is made for reporting illnesses and maintaining the health of students. Routine physical
examination serves as an asset to the students as it helps them to perform their duties efficiently
and to obviate any risk to which they might be exposed or to which they might expose others.

Objectives

The main objectives of the student health programme are to help students to: promote good
health habits.

• maintain good health.

• prevent and control the diseases by early detection and treatment.
• prevent themselves from certain infectious diseases by taking the protective inoculations.
• maintain students' health cards.

Golden Rules of Physical and Mental Health

i) Six Golden Rules of Maintaining Physical Health Adequate rest and sleep.
ii) Positive attitude towards exercise and daily activities.
iii) Well-balanced food habit. Adequate fluid intake and regularity in elimination.
iv) Personal hygiene in general (Necessary feminine hygiene during menstrual period).
v) Good body posture.
vi) ii) Six Golden Rulesof Maintaining Mental Health Respect yourself and others.
vii) Organize and plan your day-to-day activities.
viii) Permit your mind to control your entire "self' Realize that life is a series of ups and
downs.
ix) Accepts correction, rules and new ideas with an open mind.
x) Develops your strong points and minimize your weak ones in an intelligent manner.
• Health Assessment Programme
• Schedule of health assessment
 • Medical examination on admission
• Annual medical examination
• Health assessment during illness
• Health Care Facilities

The health care facilities in a school of nursing should include following facilities.

i)Health clinic

Students health clinic could be according to the policy of institution (may be staff clinic or
separate students clinic with all facilities).

ii) Sick Room For Students

There should be arrangement for those students who fall sick. This arrangement may vary from
school to school. The main purpose of having sick room in the hostel is where a student can be
observed during her brief illness when hospitalization is not must. The Public Health TutorIThe
Home SisterIWarden of the hostel is responsible for looking after these students during their
minor ailment.

Health Record

The student's health record should be cumulative one and should contain summary of complete
record of the student's health for the entire period of her training. It would be ideal and essential
to have the provision of monthly health records of the students in order for early and detection
taking correct measure to address any health problems.

STUDENT GUIDANCE AND COUNSELING SERVICES

Definition of Guidance and Counseling

Guidance and counseling is assistance made available to an individual 1 group of students to

help him I them to manage his own life activities and problem, develop his own point of view,
make his own decision in identifying the solution to his problem with the assistance of qualified
and adequately trained personnel.

Objectives of Guidance and Counseling

• To help the students to adjust to group living and educational programme

• meet or solve his problem
• make his own decision
• discover and understand their academic potentialities, abilities and limitations
• develop the ability of self guidance.

STUDENT NURSES ASSOCIATION (SNA)

The involvement of the students as an organized group is an important factor in the
administration of the school of nursing and meeting the objectives of the educational
programme. This is achieved by the formation of the Student Government.

Need for SNA

The student organization is an essential for the development of the leadership qualities and
professional growth in the students and it helps to maintain a sprit of cooperation and mutual
help among the members. Moreover it provides better opportunity for self-directed work.

ENUMERATE THE FOLLOWING:

1.Four advantages of student evaluation

• Student evaluation helps to develop important meta-cognitive skills that contribute to a

range of important graduate capabilities. All professionals must be able to evaluate their
own performance, so this practice should be embedded in higher education learning as
early as possible.

• Increases self-awareness through reflective practice, making the criteria for self-
evaluation explicit, and making performance improvement practices intrinsic to ongoing
learning.

• Contributes to the development of critical reviewing skills, enabling the learner to more
objectively evaluate their own performance—and others’, when used in conjunction with
peer assessment. With peer assessment they become more practised in giving
constructive feedback, and receiving and acting on feedback received.

• Helps students to take control of their own learning and assessment, and giving them the
chance to manage their own learning and development more independently.

• Gives students greater agency regarding assessment, thus enriching their learning.

• Possibly, in the long run, reduces the teacher’s assessment workload—although on its
own this benefit is not sufficient to introduce student self-assessment.

DIFFERENTIATE BETWEEN

1.Accreditation vs Affiliation

Accreditation is vital of the welfare of an The relationship resulting from affiliating

institution of higher education. Those one thing with another.
institutions that fail to attain accreditation or
are removed from the list of an accrediting
 agency may be handicapped in a number of Formal relationships established between
ways. otherwise independent organizations. These
Definition: include affiliation agreements, interlocking
Accreditation as a process of whereby any boards, common controls, hospital medical
agency recognizes a college or school school affiliations, etc.
program of study as having met certain
predetermined qualification or standards. An example of affiliation is being a member
of a community organization.
Purposes:
Adequate admission requirement
Minimum academic standard
Institutional self improvement
Protection of institutions of higher education
against educationally and socially harmful
pressures.
Agencies :
NAAC, AICTE, UGC, CABE

UNIT-VII –Professional Advancement

Short Notes:

1.Continue education

Continuing education is a planned activity directed towards meeting the learning needs of
the nurse following basic nursing education, exclusive of fulltime formal post- basic education.

Definition

Continuing education in nursing consists of planned learning experiences beyond a basic

nursing educational programme. 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 (ANA).

It is the other component of staff development programme, which encompasses both

formal and in formal teaching learning activities both within and outside the organisation.

Philosophy of continuing education

It has been believed that the system of higher education which provides the basic
preparation for the members of a profession must also provide opportunities or practitioners to
keep abreast of advances in their field.

Objectives
To help the employee to:

• Keep up to date with new concepts and developments in health fields

• To increase their basis knowledge ,skills and develop positive attitude’

• Develop an ability to analyse problems and to work with others

• Meet challenges of changes in technology

• Maintain standards of health care at acceptable levels

• Help in setting standards of performance

• Help in career development

• Motivate staff for better patient care

• Meet new needs of the community

Need for Continuing Education

• Basically, the need for continuing education emerges from the phenomena of change,

• change in what is known about man and how he functions in health and illness,

• changes in the ways in which people meet the challenges to survive in a dynamic age, and
change in the objectives, organization and financing of health services.

• To ensure safe and effective nursing care, nurses should update their knowledge with the
advancing technologies.

• To meet the needs of the population.

• Helps to develop knowledge by updating it and prepare them for specialization.

• Alteration in professional roles as society changes and as new knowledge and technology
emerge.

• To recognize current social changes and to foresee future changes in order to respond
effectively to the changes.

• Clinical specialists are needed for direct patient care and for teaching and consultative roles
to help students and staff nurses to reach higher level of competency.

• Nurses with research aptitudes and preparation are needed.

• Increase in demand for specialized nursing service.

Functions

• To meet health needs and public expectations.

• To develop practicing abilities of nurse.

• Recruitment function

• To recognize gaps in knowledge

• To test ability to do formal academic study

• To improve communication between participants, faculty, community and health sector.

• To shape or support university educational policies and practices.

• To ensure quality of education

• To grant budget for extension studies

• To maintain academic standards

• To meet educational requirements.

Different areas in continuing education

1. Post- certificate bachelor degree programme.

2. Master of Science in nursing degree.

3. PhD in nursing degree.

4. Nursing education abroad.

5. Post- certificate courses like
1. Ward administration course
2. Nursing tutor and administration course.
3. General tutor certificate course.
4. Nursing administration certificate course.
5. Public health nursing certificate course.
6. Community health and family planning certificate course.
7. Orthopaedic nursing certificate course.
8. Ophthalmic nursing
9. Coronary care nursing
10. Psychiatric nursing certificate course
11. Midwifery tutor certificate course
 12. Paediatric nursing certificate course

Planning, Implementing and evaluation of continuing education programme

Planning:

Planning results in the formulation of a ‘plan’. Plan is a blue print for taking action.

Careful and detailed planning is needed for a successful continuing nursing education
programme.

Aspects of planning: there are two aspects;

• Broad planning by the institution and agencies responsible for continuing education.

• Specific planning by individuals for their own continuing education.

– Planning is essential to:

• Meet the nursing needs

• Use available resources

• Meet needs at all levels; local, state, regional, national and international

• Avoid duplication and fragmentation of efforts

• To meet ever changing learning needs.

Planning Process

A. Establishing goals with purpose or philosophy of the organization.

• Purpose gives direction in planning and identifies the reason for existence.

B. Establishing goals and objectives

• Planning moves towards goals which are significant and realistic, which can be attained.
Goals serve to stimulate and direct actions.

• An objective is specific; it is a desired end or accomplishment to be sought.

C. Determining the needs and Priority:

• Assessment of needs will be done by survey, mailed questionnaire, interview, formal and
informal discussions with participants and check list.

• After assessing, the needs are prioritized.

 – E.g., legal aspects in nursing.

D. Assess the available resources for establishing programme.

• Careful assessment of ways and means to meet the established goals is done. Faculty
finance and facilities are seen as major resources.

• A broad survey of major resources are necessary to the continuing education programme.

E. Plan the budget appropriate for the programme.

• Separate budget is needed for each specific activity and each individual offering is
expected to be self-supporting.

• The fee is set on the basis of cost involved and the expected enrollment.

2. Career Opportunities

Nursing practice has changed greatly in recent years with regard to the kinds of career
opportunities available to professional nurses. Not only is there a greater variety of nursing
service, but there are also many different ways in which a nurse can practice within given area of
nursing.

Definitions:

A career is an individual’s journey through learning, work and other aspects of life.

A person’s course or progress through life.

The progress and actions taken by a person throughout a lifetime, especially those related to that
person’s occupations. A career is often composed of the jobs held, titles earned and work
accomplished over a long period of time, rather than just referring to one position.

While employees in some cultures and economies stay with one job during their career,
there is an increasing trend to employees changing jobs more frequently. For example, an
individual’s career could involve being a nurse, through the individual could work for several
different health sector and in several different areas of health care system over a lifetime.

Nursing career influenced by following factors

• International trends in the nursing profession

• Healthy needs of society

• Awareness of healthy needs by society

 • Economic conditions-if money is available to pay for nursing services

• New developments in medicine

• New knowledge and procedure developed through research in science

• Need for specialization because of the foregoing

• Opportunity for service and education abroad

• Changes in nursing education and the role of the nursing student

• Increased industrialization

• Expansion of community health services

• Government support to health programmes

• Increased number of private nursing homes

• Necessary military activities

• Development of nursing research

1.Hospital nursing service

• Staff nurse

• Part time staff nurse

• Ward sister/ charge nurse/ supervisor

• Home sister or warden

• Department supervisor/ Assistant Nursing Superintendent

• Deputy nursing superintendent

• Nursing superintendent

• Director of nursing

2.Community health nursing

• Rural health centre (PHC)

• Urban health centre (CHC)

3.Teaching in nursing
 School of Nursing College of Nursing
• Clinical instructor • Assistant Lecturer
• Tutor/ teacher • Lecturer
• Senior tutor/teacher • Assistant professor/reader
• Director/dean/principal • Associate professor
• Professor
• Dean/Principal
• Director
4.Nursing in the Red Cross

– Volunteer nurses’ Aid Service.

– Disaster team nurse

5.Industrial Nursing

6.Opportunities for married nurses

– As scheduled and regular nursing services

– Nurse informatics

– Nurse medical coder and transcriptor

7.Private duty nursing

8.Opportunities for male nurses

• Operation theatre

• Emergency room

• Ambulance nurse

• Psychiatric nurse

• Disaster team nurse

9.Military nursing

10.Nursing service abroad

• Student nurse (study visa)

• Nurse employee (work visa)

• Temporary

• Permanent
11.Nursing service in other areas

• Research and writing and editing

• Fulltime secretaries on the state and national level TNAI

• Nursing service administrative position on a state level

• Nursing advisor to the government of India

Difference between

IN-SERVICE EDUCATION CONTINUING EDUCATION

1.Given within the organisation 1. Given within and outside the organisation.
2.Is planned and ongoing Covers
3.Is designed to meet the demands of Extension courses
changing needs Includes Post diploma
Orientation Post graduate courses in other
Skill training institutions
Leadership and management Field observations and other experiences
development training Workshops
On the job training Exchange programmes
Seminars
Professional conferences
Educational activities outside the
Organisation.