Organizing

Nursing Service
Unit
DEFINITION OF NURSING SERVICE

 WHO expert committee on nursing

defines the nursing services as the
part of the total health organization
which aims to satisfy major objective
of the nursing services is to provide
prevention of disease and promotion
of health.
 PHILOSOPHY OF NURSING SERVICE
IN HOSPITAL

 The department of nursing services of

hospital recognizes and appreciates the
objectives of the hospital and
acknowledges that the primary purpose of
nursing is to provide the highest quality
care services.
 The quality in nursing care and
management of nursing services is
achieved through professional nurses who
assist in the development of
comprehensive programs of delivering
 PHILOSOPHY OF NURSING SERVICE
IN HOSPITAL Cont..

 The quality of nursing care services is

clearly and directly related to continuing
growth and development of nursing
personnel.
 High quality of nursing care can be best
provided by a mixture of professional and
non professional personnel who are
organized into self directed work teams.
 To ensure continuous improvement of
nursing care quality, the role of
professional nurse must include
 OBJECTIVES IN RELATION TO PATIENT CARE

The primary emphasis is on total patient care

To assist the physician in providing medical care to the
patients.
To provide preventive and rehabilitative services.
To provide round the clock nursing care to all the
patients.
To render timely and appropriate nursing service to
emergency patients.
To provide cost effective quality care as per the needs
of patients.
Confidentiality and privacy of each patient should be
maintained.
 OBJECTIVES IN RELATION
TO EDUCATION

 Planning of education and training

programme for nurses
 To provide regular staff development
 To conduct regular orientation
programme
 To conduct training for operating
procedure
 OBJECTIVES IN RELATION TO
ADMINISTRATION AND ORGANIZATION

• To make regular supervision through rounds.

• To ensure that the essential equipment is provided in
functional status for nursing care
• To provide regular flow of essential supplies to render
quality nursingcare.
• To have a proper system of rotation of staff
• Establish a communication system for nursing personnel.
• Ensure that each nurse identifies her job responsibilities
and accountability.
• Counseling for health personnel, patients and the public.
• The formulation of policies, standards, goals of nursing
service, education and practice.
• Maintaining proper documentation of the personnel
employed in nursing service.
OBJECTIVES IN RELATION TO RESEARCH

• Establish a system for collection of essential

information, research and studies
concerning all aspects of nursing.
• To contribute in research programme
conducted by hospitals and by other health
personnel.
• To encourage and support the nurse to
conduct research projects/ activities.
OBJECTIVES IN RELATION TO
PERFORMANCE APPRAISAL

Appraise the performance of

nursing service personnel
regularly against set standards
and performance indicators
objectively with a view to
maintain quality-nursing
services.
 PRINCIPLES OF NURSING SERVICE

1. Initiate a set of human relationships at all

levels of nursing personnel to accomplish
their job and responsibilities
2. Establish adequate staffing pattern for
rendering efficient nursing service to clients
3. Develop and implement proper
communication system for communicating
policies, procedures and updating advance
knowledge.
 PRINCIPLES OF NURSING
SERVICE Cont..

4. Develop and initiate proper evaluation and

periodic monitoring system for proper
utilization of personnel
5. Develop or revise proper job description for
nursing personnel at all the levels and all
units
6. Share nursing information system with other
discipline functionaries in the hospital.
 PRINCIPLES OF NURSING
SERVICE Cont..

7. Participate in interdepartmental programs

conducted by other disciplinaries for
improvement of hospital services.
8. Develop and initiate orientation and
training programs for new employees
9. Create an atmosphere that conducive to
give proper required learning experience
for the students
PRINCIPLES OF NURSING SERVICE Cont..

10.Participate in the application of data and

research
11. Participate in community health
programs, associated with hospital
 FUNCTIONS OF NURSING
SERVICE

 To assist the individual patient in

performance of those activities
contributing to his health or recovery that
he would otherwise perform unaided has
had the strength, will or knowledge.
 To help and encourage the patient to
carry out the therapeutic plan initiated by
the physician.
 To assist other members of the team to
plan and carry out the total programme of
 ESSENTIAL CHARACTERISTICS
OF GOOD NURSING SERVICES

 Purposes and objectives of the nursing

service
 Plan of organization
 Policy and administrative manuals
 Nursing practice manual
 Nursing service budget
 Master staffing pattern
 Nursing care appraisal plan
 Nursing service administrative meetings

 ESSENTIAL CHARACTERISTICS
OF GOOD NURSING SERVICES
 Adequate infrastructure facilities
supplies and equipments
 Written job descriptions and job
specifications:
 Personnel records
 Personnel policies
 Health services
 In-service education
 Co-ordination
 Advisory committee
 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR

ADMINISTRATION
 Organizes, directs and supervises the nursing services both
day and night
 Coordinates assignments of staff.
 Establishes the general pattern of delegation of
responsibilities and authority.
 Formulates standing orders for the nursing care.
 Ensures appropriate allocation of duties and responsibilities
to all nursing staff working under her.
 Formulates nursing policies to ensure quality patient care
and adequate attention at all times.
 Responsible for efficient functioning of the nursing staff.
 Evaluates the personal performance of the nursing staff.
 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont..

DISCIPLINE
 Ensure that a standard of discipline of nursing staff is
high at all times.
 Maintain good order and discipline in
wards/departments.
 Makes daily rounds of the hospital
wards/departments and also seriously ill patients. In
addition she will make unscheduled rounds in the
hospital in the evenings.
 Brings immediately to the notice of the medical
superintendent all matters concerning neglect of
duty, insubordination either by nursing staff, patients
or visitors or any un-towards incident, which comes
ROLE AND FUNCTION OF NURSE ADMINISTRATOR Cont..

 PUBLIC RELATIONS
 Promotes and maintains harmonious and effective
relationship with the various administrative
departments of the hospital and related
community agencies.
 Maintain cordial relationships with the patients
and their families.
 OFFICE ROUTINE
 Scrutinizes the reports and returns and submits in
accordance with existing orders.
 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont..

 CONFIDENTIAL REPORTS
 Initiates the confidential reports of nursing staff on
due dates.
 Responsible for the nursing budget.
 EDUCATION
 Carries out in-service training for all categories of
nursing staff and paramedical personnel and keeps
the records of such trainings.
 Conduct various update courses based on the needs.
 Encourages the personnel to participate in the
continuing education programme.
 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont..

 WELFARE
 Responsible for health and welfare of nursing staff.
 Ensures annual and periodical health examination
and maintenance of health records.
 CONFERENCES
 Responsible for organizing and conducting staff
meeting of the nursing staff once in three months.
 Holds conference in nursing care problems and
discuss policies as regards to working conditions,
working hrs and other facilities.
 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont..

 SUPERVISION
 Supervises nursing care given to the
patients and all nursing activities within the
nursing unit.
 Supervises the work of all paramedical staff
of the hospital.
 RECORDS AND REPORTS
 Maintains various records such as duty
roster nursing staff, day off book, personal
bio-data, leave plan, staff conference book,
 PROBLEMS AND CHALLENGES
FACED BY THE NURSE
ADMINISTRATOR
 Lack of adequate training.
 Problem of personnel management.
 Inadequate number of nursing staff.
 Shortage of trained manpower.
 Lack of motivation.
 No involvement in planning.
 No career mobility.
 Poor role model.
 No research scope.
 Professional risk/hazards.
 No autonomy in nursing activities
DAY TO DAY PROBLEM IN NURSING SERVICES

o Shortage of nurses.
o Lack of motivation.
o Negative attitude.
o Lack of training.
o Lack of team approach.
o Inactive participation of program
o Lack of interpersonal relationship
o Less involvement in patients care by the
nursing supervisors.
o Lack of supervision
ORGANIZING PATIENT CARE
DEFINITION OF PATIENT CARE

The services rendered by members of the

health profession and non-professionals
under their supervision for the benefit of
the patient.
OR
The prevention, treatment and
management of illness and the
preservation of mental and physical well-
being through the services offered by the
medical and allied health professions.
 PATIENT CLASSIFICATION
SYSTEMS

• Patient classification system (PCS), which

quantifies the quality of the nursing care, is
essential to staffing nursing units of hospitals
and nursing homes. In selecting or
implementing a PCS, a representative
committee of nurse manager can include a
representative of hospital administration. The
primary aim of PCS is to be able to respond to
constant variation in the care needs of patients.
 PATIENT CLASSIFICATION
SYSTEMS Cont..
CHARACTERISTICS
 Differentiate intensity of care among definite classes.
 Measure and quantify care to develop a management
engineering standard.
 Match nursing resources to patient care requirement.
 Relate to time and effort spent on the associated activity.
 Be open to audit.
 Be understood by those who plan, schedule and control the
work.
 Be individually standardized as to the procedure needed for
accomplishment.
 PATIENT CLASSIFICATION
SYSTEMS Cont..
PURPOSES
• The system will establish a unit of measure for nursing,
that is, time, which will be used to determine numbers
and kinds of staff needed.
• Program costing and formulation of the nursing budget.
• Tracking changes in patients care needs. It helps the
nurse managers the ability to moderate and control
delivery of nursing service
• Determining the values of the productivity equations
• Determine the quality: once a standards time element
has been established, staffing is adjusted to meet the
aggregate times. A nurse manager can elect to staff
below the standard time to reduce costs.
 PATIENT CLASSIFICATION
SYSTEMS Cont..
 COMPONENTS
 The first component of a PCS is a method for grouping patient’s
categories.Each category addresses activities of daily living, general
health, teaching and emotional support, treatment and medications.
Data are collected on average time spent on direct and indirect care.
 The second component of a PCS is a set of guidelines describing the
way in which patients will be classified, the frequency of the
classification, and the method of reporting data.
 The third component of a PCS is the average amount of the time
required for care of a patient in each category.
 A method for calculating required nursing care hours is the fourth and
final component of a PCS

•
 MODES OF ORGANIZING
PATIENT CARE / METHODS OF
PATIENT ASSIGNMENT
 CASE METHOD

Merits:
The nurse can attend to the total needs of clients
due to the adequate time and proximity of the
interactions.
Good client nurse interaction and rapport can be
developed.
 Client may feel more secure.
RNs were self-employed.
Work load can be equally divided by the staff.
 Nurse’s accountability for their function is built.
 CASE METHOD

Demerits:
 Cost-effectiveness.
 The greater disadvantage to case nursing
occurs, when the nurse is inadequately
trained or prepared to provide total care to
the patient.
 Nurse may feel overworked if most of her
assigned patients are sick.
 She/he may tend to ‘neglect’ the needs of
patient when the other patients ‘problem’
or ‘need’ demands more time.
 FUNCTIONAL NURSING

Merits:
 Each person become very efficient at specific tasks and a
great amount of work can be done in a short time (time
saving).
 It is easy to organize the work of the unit and staff.
 The best utilization can be made of a person’s aptitudes,
experience and desires.
 The organization benefits financially from this strategy
because patient care can be delivered to a large number of
patients by mixing staff with a large number of unlicensed
assistive personnel.
 Nurses become highly competent with tasks that are
repeatedly assigned to them.
 Less equipment is needed and what is available is usually
 FUNCTIONAL NURSING

DEMERITS:
 Client care may become impersonal, compartmentalized
and fragmented.
 Continuity of care may not be possible.
 Staff may become bored and have little motivation to
develop self and others.
 The staff members are accountable for the task.
 Client may feel insecure.
 Only parts of the nursing care plan are known to
personnel.
 Patients get confused as so many nurses attend to them,
e.g. head nurse, medicine nurse, dressing nurse,
TEAM NURSING
 TEAM NURSING

• ADVANTAGES:
 High quality comprehensive care can be provided to the patient
 Each member of the team is able to participate in decision making
and problem solving.
 Each team member is able to contribute his or her own special
expertise or skills in caring for the patient.
 Improved patient satisfaction.
 Feeling of participation and belonging are facilitated with team
members.
 High quality comprehensive care can be provided to the patient
TEAM NURSING
• ADVANTAGES:Cont…
 Work load can be balanced and shared.
 Division of labour allows members the opportunity to develop
leadership skills.
 There is a variety in the daily assignment.
 Nursing care hours are usually cost effective.
 The client is able to identify personnel who are responsible
for his care.
 Barriers between professional and non-professional workers
can be minimized, the group efforts prevail.
 TEAM NURSING
DISADVANTAGES:
 Establishing a team concept takes time, effort and constancy of
personnel. Merely assigning people to a group does not make
them a ‘group’ or ‘team’.
 Unstable staffing pattern make team nursing difficult.
 All personnel must be client centered.
 There is less individual responsibility and independence
regarding nursing functions.
 The team leader may not have the leadership skills required to
effectively direct the team and create a “team spirit”.
 It is expensive because of the increased number of personnel
needed.
 Nurses are not always assigned to the same patients each day,
which causes lack of continuity of care.
 MODULAR NURSING
MERITS:

Nursing care hours are usually cost-

effective.
 The client is able to identify personnel who
are responsible for his care.
 All care is directed by a registered nurse.
 Continuity of care is improved when staff
members are consistently assigned to the
same module
 The RN as team leader is able to be more
involved in planning & coordinating care.
 MODULAR NURSING
MERITS:
Geographic closeness and more efficient
communication save staff time.
 Feelings of participation and belonging are
facilitated with team members.
 Work load can be balanced and shared.
 Division of labor allows members the opportunity to
develop leadership skills
 Continuity care is facilitated especially if teams are
constant.
Everyone has the opportunity to contribute to the
care plan.
 MODULAR NURSING

DEMERITS:
 Costs may be increased to stock each module with
the necessary patient care supplies (medication cart,
linens and dressings).
 Establishing the team concepts takes time, effort,
and constancy of personnel.
 Unstable staffing pattern make team difficult.
 There is less individual responsibility and autonomy
regarding nursing function.
 All personnel must be client centered.
 The team leader must have complex skills and
 PROGRESSIVE PATIENT CARE:

Principal elements of PPC are:

I. Intensive care or critical care:
II. Intermediate care:
III. Convalescent and Self Care:
IV. Long-term care:.
V. Home care:
VI. Ambulatory care:
 PROGRESSIVE PATIENT CARE
MERITS:
Efficient use is made of personnel and equipment.
Clients are in the best place to receive the care
they require.
Use of nursing skills and expertise are maximized.
Clients are moved towards self care, independence
is fostered where indicated.
 Efficient use and placement of equipment is
possible.
Personnel have greater probability to function
towards their fullest capacity.
 PROGRESSIVE PATIENT CARE
DEMERITS:
 There may be discomfort to clients who are moved
often.
 Continuity care is difficult.
 Long term nurse/client relationships are difficult to
arrange.
 Great emphasis is placed on comprehensive,
written care plan.
 There is often times difficulty in meeting
administrative need of the organization, staffing
evaluation and accreditation.
 PRIMARY CARE NURSING

ADVANTAGES
 Primary Nursing Care System is good for long-term care,
rehabilitation units, nursing clinics, geriatric, psychiatric, burn
care settings where patients and family members can
establish good rapport with the primary nurse.
 Primary nurses are in a position to care for the entire person-
physically, emotionally, socially and spiritually.
 High patient and family satisfaction
 Promotes RN responsibility, authority, autonomy,
accountability and courage.
 Patient-centered care that is comprehensive, individualized,
and coordinated; and the professional satisfaction of the
nurse.
 Increases coordination and continuity of care.
 PRIMARY CARE NURSING

DISADVANTAGES
 More nurses are required for this method of care delivery and
it is more expensive than other methods.
 Level of expertise and commitment may vary from nurse to
nurse which may affect quality of patient care.
 Associate nurse may find it difficult to follow the plans made
by another if there is disagreement or when patient’s
condition changes.
 It may be cost-effective especially in specialized units such as
the ICU.
 May create conflict between primary and associate nurses.
 Stress of round the clock responsibility.
 Difficult hiring all RN staff
 Confines nurse’s talent to his/her own patients.
 CASE MANAGEMENT

RESPONSIBILITIES OF CASE MANAGERS

Assessing clients and their homes and
communities.
Coordinating and planning client care.
Collaborating with other health professionals in
the provision of care.
Monitoring client progress and client outcomes.
Advocating for clients moving through the services
needed.
Serving as a liaison with third party payers in
planning the client’s care.
 CASE MANAGEMENT

MERITS
Case management provides a well
coordinated care experience that can
improve the care outcome, decrease the
length of stay, and use multiple disciplines
and services efficiently.
Provides comprehensive care for those with
complex health problems.
 It seeks the active involvement of the
patient, family and diverse health care
professionals
 CASE MANAGEMENT

DEMERITS:
Nurses identify major obstacles in the
implementation of this service, financial barriers and
lack of administrative support.
Expensive
Nurse is client focused and outcome oriented
Facilitates and promotes co-ordination of cost
effective care
Nursing case management is a professionally
autonomous role that requires expert clinical
knowledge and decision making skills.
 FACTORS INFLUENCING THE QUALITY PATIENT CARE

 Many variable factors influence the number of

nurses needed on a ward in order to render a
high quality of patient care.
 The total number of patient to be nursed
 The degree of illness of patients (physical
dependency)
 Type of service: medical, surgical, maternity,
pediatrics and psychiatric
 The total needs of the patients
 Methods of nursing care
 Number of nursing aids and other non
professional available, the amount and quality of
 FACTORS INFLUENCING THE QUALITY PATIENT CARE Cont…

 The amount, type and location of equipment and

supplies
 The acuteness of the service and the rate of
turnover in patients according to the degree or
period of illness.
 The experience of the nurses who are to give the
patient care.
 The number of non-nurses who involve in the
patient care, the quality of their work, their
stability in service.
 The physical facilities
 FACTORS INFLUENCING THE QUALITY PATIENT CARE Cont…

 The number of hours in the working week of

nurses and other ward personnel and the
flexibility in hours
 Methods of performing nursing procedures
 Affiliation of the hospital with the medical
school
 Methods of assignment-individual, team or
functional method
 The standards of nursing care.
 BIBLIOGRAPHY

4. BT Basavanthappa ; Nursing
administration ; Jaypee publications ;
Second edition ; Newdelhi ; 2009
5. C. Vargheese ; The nurse administrators ;
New age interventional publishers ; New
Delhi ; 2016
https://www.jaypeedigital.com/book/97893
86261595/chapter/ch10
6. https://academic.oup.com/agening/article-
abstract/6/suppl/108/166386?
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