organisation Nursing administration

UNIT-IV
Organisation:
CONCEPTS,PRINCIPLES, OBJECTIVES,TYPES,THEORIES,etc…
Meaning: the word organization may convey at least 3 meanings:
Firstly it may refer to the activity of management in arranging people, tasks and resources
in the most orderly and efficient manner.
Secondly it may also name the arrangement itself, the outcome of the organizing activity.
Thirdly, it may describe any number of businesses, behavioural and humanistic concepts.
Definition: Organisation is „a group of people working together and with each other
towards the achievement of the common goals‟.
Koontz and O’Donnell, ‘essentially as the creation and maintenance of an intentional
structure of role’.
From the above definitions it is clear that,
 Any organisation must have defined goals or objectives.
 The functionaries shall endeavour to achieve those goals and objectives.
 The structure of duties and activities necessary for the conduct of or operation of
activities without which the organisational objectives cannot be achieved.
The organisation must
1) Reflect objectives and plans of the organisation.
2) Reflect the authority available to various categories of managers belonging to
different management levels.
3) Reflect its environment.
4) Be manned with trained and appropriate people, commensurate with their job
requirements.

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Organisation has four connotations:
Administrative function, as a system, as an operation and as a result.
1.Administrative Function : organisation is a process of identification and grouping of
activities with determination and establishment of authority relationships for these
group of activities as well as arranging for men, materials, machines and money.
2. as a system, orgn consists of many interrelated and interdependent subsystems; each
system and subsystem has the component of:
a) input: human resources, material resources, information and energy serve as input.
b) throughput: the methods through which functions are carried out.
c) Output: the actual outcome.
d) management component: the system sees that the desired outcomes are obtained.
3. in an operational: organisation is involved with determination and defining of duties
and responsibilities of the personnel and establishment of interrelationship between the
various activities within the organisation.
4. result: a gp of people working together to accomplish the laid down common objectives
or goals with in a defined and specific framework.
Steps in organisation
1. Determination of objectives for each activity.
2. Deciding on the various types of activities to be undertaken with in the framework
of the formulated plan to attain the goals of the organisation.
3. Grouping of activities , their similarity, interrelationships, competencies and
capacities required in performance of these activities, its importance in relation to
achievement of organizational goals.
4. Deciding different groups of activities in terms of
- The number of staff
- The eligibility requirement of staff

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Mr. Channabasappa.K.M.PCON
- The seating arrangements
- The material and supplies, consumable and non consumable required to perform
these activities.
- The machines and equipment required
- The funds required
- Methods for maintaining the morale of the performers.
5. Determining the authority, responsibility and accountability of different members
of the staff.
 Determining the lines of authority with the channels of communication.
 The relationship between different members, departments, supervisors, peers
and subordinates including professional members – vertical or line
relationship, horizontal or lateral relationships.
 Developing an organizational chart based on the above.
 Planning of the items listed above.
 Allotment of duties to individuals.
6. Integration between the identified group of activities through relationships and
organized communication system.
Characteristics of an organisation:
 Group of people
 Common goals or objectives
 Division of work
 Vertical and horizontal relationship (the relationship between supervisor and
subordinates or the relationship between different departments and divisions).
 Chain of command with laid down channels of communication. (flow of authority
from the higher to the lower levels of management in the hierarchy).
 Group dynamics - interations that takes place between the individuals and gps
within the orgn, based on their values, needs, sentiments, attitudes, beliefs and

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interests. Its a social, self generating and dynamic interative process gives rise to a
informal groups.
Importance:
 Assists administration in gearing the human, material and financial resources
towards fulfilment of the objectives of the enterprise.
 Provides the structure within which the functions of planning, staffing, directing,
coordinating and controlling are performed.
 Helps in growth and development of the establishment, in planning for need based
change through appropriate division and allotment of work.
 Makes optimum use of all resources, determines needs for innovative and new
technologies in terms of cost effectiveness and accomplishment of objectives of the
establishment.
 Encourages individual growth and development of personnel according to
individual potentials through job enrichments, training and participation from
them.
 Invites creative and innovative ideas to work through adopting human relations
approach.
 Also once the authority, responsibility and accountability are determined for each
worker, a person is required to work on his/her own which helps in confidence
building, creative thinking and motivation).
Principles of organisation
1. Principle of chain of command:
 Communication flows through the chain of command or channel of
communication tends to be one way downward..
 In a modern nursing organization, the chain of command is flat, with line
managers, technical, clerical staffs that support the clinical staff. The
communication flows freely in all directions, with authority and responsibility
delegated to the lowest operational level.
 This principle supports a centralised authority that aligns authority and
responsibility.

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 The organizations are established with hierarchial relationships, within which the
authority flows from top to bottom in order to be satisfying to members,
economically effective and successful in achieving the goals.
2. Principle of unity of command:
 An employee has one supervisor / one leader and one plan for a group of activities
with the same objective.
 Also called principle of responsibility. The organisational set up should be
arranged in such a way that a subordinate should receive the instruction or
direction from one authority or boss.
 Primary nursing and case management modality support this principle. (Many
professional nurses engage in matrix organisations in which they answer to more
than one supervisor).
 In the absence of unity of command
The subordinate may neglect his duties. It will result in the non completion
of any work.
There is no guidance available to the subordinates and there is no
controlling power for the top executives of the organisation.
Further some subordinates will have to do more work and some others will
not do any work at all.
3. Principle of span of control:
 Span of control refers to the maximum number of members effectively supervised
by a single individual. (The number of members may be increased or decreased
according to the nature of work done by the subordinates or the ability of the
supervisor.
 The span of control enables smooth functioning of the organisation.
 Person should be a supervisor of a group that she can manage in terms of numbers,
functions, and geography. The more highly trained the employee, the less
supervision is needed.
 Employees in training need more supervision to prevent blunders.
 When different levels of nursing employees are used, the nurse manager has more
to coordinate.

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 In the past the nurse managers had a narrow span of control. They were responsible
for one nursing unit and a limited number of staff.
 Recently the span of control has increased to the point that the nurse managers
have to cover several nursing units and departments with a large number of
employees.
 This is also called span of management or span of supervision . This principle is
based on the principle of relationship.
4. Principle of specialization or division of work:
 Each person should perform a single leading function.
 There is a division of labor: a differentiation among kinds of duties.
 Specialization is the best way to use individuals and groups.
 Division of work means that the entire activities of the organisation are suitably
grouped into departments and sections. (The dept and sections may be further
divided into several such units so as to ensure maximum efficiency).
 This will help to fix up the right man to the right job and reduce waste of time and
resources).
 The work is assigned to each person according to his educational qualification,
experience, skill and interests.
 He should be mentally and physically fit for performing the work assigned to him.
The required training may be provided to the needy persons.
 It will result in attaining specialisation in a particular work or area.
5. Hierarchy or scalar chain:
 It is the order of rank from top to bottom in an organisation.
 This is also called a chain of command or line authority. (Normally, the line of
authority flows from the top level to bottom level. It also establishes the line of
communication).
 Each and every person should know who is his supervisor and to whom he is
answerable.
6. Centrality :
It relates to the position or distance the person has on the organisational chart from
other workers.

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7. Unity of objectives:
 An establishment or enterprise exists to achieve certain laid down
objectives. The orgn requires to be geared towards fulfilment of these
objectives.
 Hence this principle dictates that it is essential for the organisational
objectives to be formulated in clear, unambiguous, achievable and
measurable terms which should be understood by all concerned.
8. Definition of jobs/ principle of definition:
 It is necessary to define and fix duties, responsibilities and authority of each
worker.
 In addition to that, the organisational relationship of each worker with
others should be clearly defined in the organisational set up.
9. Principle of balance: There are several units functioning separately under one
organisational set up. The work of one unit might have been commenced after
the completion of the work by another unit. So it is essential that the sequence of
work should be arranged scientifically.
10. Principle of equilibrium balance:
In certain periods, some sections or departments are overloaded and some
departments are underloaded. During this period, due weightage should be given
on the basis of the new workload. The overloaded sections or departments can be
further divided into subsections or subdepartments. It would entail in the
effective control over all the organisational acivities.
11. Principle of continuity:
 Administration is a continuing or ongoing process – recycling the
structure of the organistion based on the economic, environmental and
socio-political changes.
 There should be a reoperation of objectives, readjustments of plans and
provision of oppurtunities for the development of future management.
This process is taken over by every organisation periodically.

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12. Principle of exception:
Implies routine decision making should rest with lower levels of
management within the policy framework and only unusual or
exceptional matters should be referred to the higher levels of
management for taking decisions.
The junior officers are disturbed by the seniors only when the work is
not done according to the plans laid down. It automatically reduces the
work of middle level officers and top level officers. So the top level
officers may use the time gained by reduction in workload for framing
the policies and chalking out the plans of organisation.
13. Principle of unity of direction:
 Also called principle of co-ordination.
 The major plan is divided into sub plans. Each sub plan is taken up by a
particular group or department. All the gps or depts are requested to
cooperate to attain the main objectives or in implementing major plan of
the organisation.
14. Principle of communication:
A two way communication flow from top to bottom levels and from bottom to
top levels is a prerequisite to obtain an effective organisational set up.
15. Principle of flexibility: to meet the challenges of the increasing and changing
demands of the environment, an organisation structure is subjected to change. As
such rigidity has to be avoided and flexibility is essential in the organisation
structure, so that changes can be brought about without disrupting basic design
of the structure.
Classification of organisation
The organisation can be classified on the basis
 of authority and responsibility assigned to the personnel
 and the relationship with each other.

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In this way organisation can be either formal or informal.
Formal organisation:
Provides a framework for defining responsibility, authority, delegation and accountability.
Depending on the organizational philosophy, the formal structure may be rigid or loose.
The formal organisation represents
 the classification of activities within the enterprise,
 indicates who reports to whom and
 explains the vertical journal of communication which connects the chief executive
to the ordinary workers.
 An organisational structure clearly defines the duties, responsibilities, authority
and relationships as prescribed by the top management. (In an organisation, each
and every person is assigned the duties and given the required amount of authority
and responsibility to carry out this job).
 It creates the coordination of activities of every person to achieve the common
objectives. It indirectly induces the worker to work most efficiently.
 The interrelationship of staff members can be shown in the organisation chart and
manuals under formal organisation.
Characteristics of formal organisation:
 It is properly planned.
 It is based on delegated authority.
 It is deliberately impersonal.
 The responsibility and accountability at all levels of organisation should be clearly
defined.
 Organisational charts are usually drawn.
 Unity of command is normally maintained.
 It provides for division of labour.
Advantages of formal organisation:
1. The definite boundaries of each worker is clearly fixed. It automatically reduces
conflict among the workers. The entire building is kept under control.

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2. Overlapping of responsibility is easily avoided. The gaps between the
responsibilities of the employees are filled up.
3. Buck passing is very difficult under the formal organisation. (Normally exact
standards of performance are established under formal organisation. It results in
the motivating of employees).
4. A sense of security arises from classification of the task.
5. There is no choice for favouritism in evaluation and placement of the employee.
6. It makes the organisation less dependant on one man.
Keith davis observes that formal organisation is and should be our paramount
organisation type as a general rule. It is the pinnacle of man‟s achievement in a
disorganised society. It is man‟s orderly, conscious and intelligent creation for human
benefit.
Criticisms:
 In certain cases, the formal organisation may reduce the spirit of initiative.
 Sometimes authority is used for the sake of convenience of the employee without
considering the need for using the authority.
 It does not consider the sentiments and values of the employees in the social
organisation.
 It may reduce the speed of informal communication (rules/reg‟s).
Informal organisation:
 Informal organisation is an organisational structure which establishes the
relationship on the basis of the likes and dislikes of officers without considering
the rules, regulations and procedures.
 These types of relationships are not recognised by officers but only felt. The
friendship, mutual understanding and confidence are some of the reasons for
existing informal organisation.
(For eg., a salesman receives orders or instructions directly from the sales manager
instead of his supervisors).
 The informal organisation relationship or informal relations give a greater job
satisfaction and result in maximum production.

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 According C.J. Bernard, „informal organisation brings cohesiveness to formal
organisation.
 It brings to the members of the formal organisation a feeling of belonging, status of
self respect and gregarious satisfaction.
 Informal organisations are important means of maintaining the personality of the
individual against certain effects of formal organisation which tends to
disintegrated personality.
Characteristics of informal organisation:
1. Informal organisation arises without any external cause ie., voluntarily.
2. It is a social structure formed to meet personal needs.
3. Informal organisation has no place in the organisation chart.
4. It acts as an agency of self control.
5. Informal organisation can be found on all levels of organisation with in the
managerial hierarchy.
6. The rules and traditions of informal organisation are not written but are commonly
followed.
7. Informal organisation develops from habits, conduct, customs and behaviour of
social groups.
8. Informal orgn is one of the parts of total organisation.
9. There is no structure and definiteness to the informal organisation.
Advantages of informal organisation:
 It fills up the gaps and deficiency of the formal organisation.
 Informal organisation gives satisfaction to the workers and maintains the stability
of the work.
 It is a useful channel of communication.
 It encourages the executives to plan the work correctly and act accordingly.
 It fills up the gaps among the abilities of the managers.
Disadvantages of informal organisation:
 It has the nature of upsetting the morality of the workers.
 It acts according to mob psychology.

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 It indirectly reduces the efforts of management to promote greater productivity.
 It spreads rumour among the workers regarding the functioning of the organisation
unnecessarily.
Difference between formal and informal organisation
Formal organisation Informal organisation
It arises due to delegation of authority. It arises due to social interaction of people.
It gives importance to terms of authority
and functions.
It gives importance to people and their
relationships.
It is created deliberately It is spontaneous and natural.
The formal authority is attached to a
position.
The informal authority is attached to a
person.
Rules, duties and responsibilities of
workers are given in writing.
No such written rules and duties followed in
informal organisation.
Formal organisation comes from outsiders
who are superior in the line of
organisation.
Informal organisation comes from those
persons who are objects of its control.
Formal authority flows from upwards to
downwards.
Authority flows upwards to downwards
from or horizontally.
Formal organisation may grow to
maximum size.
Informal organisation tends to remain
smaller.
It is created fortechnological purpose. It arises from man‟s quest for social
satisfaction.
It is permanent and stable There is no such permanent nature and
stability.
Types of organisation (Levels of Organisation):
Broadly there are 3 types of organisation:

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1. Line organisation
2. Staff organisation
3. Functional organisation.
An institution or enterprise may adopt one or other type of organisation or more than
one type of organisation depending upon its needs.
Line organisation:
 It is the oldest and the simplest form of organisation.
 It is also known as the military or scalar organization.
 Line functions -where superior exercises direct supervision over a subordinate – an
authority relationship in direct line or steps.
 The line of authority is straight and vertical and each person at the same level
performs the same functions.
 In an enterprise or institution, the chief executive leads the entire organisation.
Here the maximum authority rests on the top or highest levels of management and
the quantum of authority decreases in a step ladder fashion for the subsequent
levels of management in the hierarchy.
The line or straight or vertical line of authority serves as the channel of:
i) Command
ii) Communication
iii) Direction
iv) Coordination
v) Control And accountability
 The departments/divisions are formed depending upon the responsibilities involved
and work to be carried out by each department / division.
 each department and each division is headed by a divisional/departmental head.
The following two figures will describe the functions of a line organisation
Board of Director/Management
Chief executive
Manager manager manager manager manager
Productionmaterials marketing financeadmn

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Supervisor supervisor supervisor supervisor supervisor
Staff staff staff staff staff
Medical superintendent
Nursing superintendent
Deputy nursing superintendent
ANS ANS ANS ANS
Surgical medical paediatric outpatients
Division division division division
Ward sister W/S W/S W/S
Staff nurse S/N S/N S/N
Line organization in hospital nursing services
 There are possibilities that more subsections/ divisions may exist under each
branch.
 In this type of organisation the direction flows from top, transmitted through the
managers to the supervisors and then to the workers or staff.
 The hierarchy is maintained as per the figures shown.
 There is no scope for downward to upward or upward to lower downward
movements. (The authority is only the chief executive and what he describes must
be carried out. If one has to say something to the lower level he/she can only
approach the immediate boss and not anyone above).
 Only one supervisor issues command and the number of persons normally limited
less than one supervisor.
There are advantages or merits:
 Simplicity

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 Unity of control
 Better discipline
 Fixed responsibility: responsibities are well defined and persons are accountable
to someone in the line form.
 Flexibility: the executives generally enjoy autonomy and freedom with in their
defined sphere of activities.
 Prompt decision: because of the chain of command, unified control and fixed
responsibilities, it is possible to take prompt decisions.
Demerits:
 Lack of specialization: this system does not provide any scope for employing
specialists.
 Overloading or overreliance: the departmental head is all in all of his department/
division in this type of organisation.
 Inadequate communication: there is no down to upward communication in this
type of organisation.
 Favouritism: since one man is the decision maker and also opinion maker it is
possible he/she may be influenced by a few people.
Functional organisation:
Under line organisation, a single person is incharge of all the activities of the concerned
dept.
 Here the person incharge finds it difficult to supervise all the activities efficiently.
The reason is that the person does not have enough capacity and require training.
 In this the functional departments are created at the factory, office or enterprise
level to deal with the problems of business at each successive level. (Although the
expert and specialized services are mainly concentrated on the top, every section or
unit can make use of their services).
 The functions under this type of organisation may be classified as purchasing,
marketing, production, research and development, finance, office management,
personnel etc in a business enterprise.
 Functional dept as patient care services, pharmaceutical services, laboratory
services etc in a hospital setting.

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Although agreed to be a scientific type of system, there are certain prerequisites for
this system:
 All activities must be divided into functions carefully and then allotted to
functional departments.
 Only interrelated jobs are allotted to one department
 There should be no duplication i.e activity allotted to one dept cannot be allotted to
another.
The figure below illustrates a functional organization:
M.D or Genel.Mg
Chief Admn. Service
Recruitment finance training office public relations
Staff and workers
 Functional organisation, follows the scientific management method to overcome
the limitations of line organisation, (F.W.Taylor, the father of scientific
management, recommended a functional organisation of activities at the top level).
 According to Taylor, a foreman should not be burdened with looking after all the
activities of work. Instead he should be assisted by a number of specialists in
solving the problems.
 Various specialists are selected for various functions performed in an organisation.
 Workers, under functional organisation, receive instructions from various
specialists. The specialists are working at the supervision level.
 Thus, workers are accountable not only to one specialist but also to specialist from
whom instructions are received.
 Directions of work should be decided by functions and not by mere authority.

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The need for functional organisation arises out of :
1) The complexity of modern and large scale organisation.
2) A desire to use the specialisation in full.
3) To avoid the workload of line managers with complex problems and decision
making.
Characteristics of Functional Organisation:
 The work is divided according to specified functions.
 Authority is given to a specialist to give orders and instructions in relation to
specific function.
 Functional authority has right and power to give command throughout the line with
reference to his specified area.
 The decision is taken only after making consultations with the functional authority
relating to his specialised area.
 The executives and supervisors discharge the responsibilities of functional
authority.
Advantages of functional organisation:
1. Benefit of specialisation:
Under the functional organisation, each work is performed by a specialist. It helps
to maintain efficiency of the organisation. Each work is divided among the workers
scrupulously.
2. Application of expert knowledge:
Planning function and execution function are divided separately and each function
is entrusted to a specialist in the line organisation. So the specialists can use their
expert knowledge in the actual performance of work.
3. Reducing the work load:
Each person is expected to look after only one type of work. Hence the quality of
work and effective control over the work are achieved.
4. Efficiency:
Since each worker is responsible for each work, the workers can concentrate on the
work allotted to them. They could assure proficiency in the work.
5. Adequate supervision:

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Each staff member is incharge of a work. So he can devote enough time to
supervise the workers.
6. Relief to line executives:
The instructions are given by the specialist directly to the actual workers. Hence
the line executive does not have any problems regarding the routine works.
7. Mass production: large scale production can be achieved with the help of
specialisation and standardisation.
8. Economy: each specialist is responsible to the performance of the work. Wastage
in the production can be avoided and the expenditure could be considerably
reduced.
9. Flexibity: any change in the orgn can be introduced without any difficulty.
Disadvantages of functional orgn
1. Complex relationship: a single worker is working under 8 specialists it is very
difficult for the worker to be responsible to all persons. This results in conflict
between the workers and the specialists.
2. Discipline: it is very difficult to maintain discipline among the workers when a
single worker has to serve many masters.
3. Over specialisation: There might be overlapping of authority and divided
responsibility.
4. Ineffective coordination: the extent of authority of a specialist is not correctly
defined. It creates problems while getting the cooperation among the specialists.
5. Speed of action: when the control of a worker is divided among the specialists, the
speed of action of the workers may be hampered.
6. Centralisation: eight specialists are guiding and directing the workers to perform
the work. So the workers do not have any scope for doing the job on their own.
This leads to the centralisation of authority.
7. Lack of responsibility: if there is any defect in the performance of work, the
management is not in a position to fix the responsibility for it. The reason is that
none of the eight specialists is ready to own the responsibility. They may shift the
responsibility to any one among themselves for the poor performance of work.
8. Poor admn: since many specialists control the same gp of workers no effective
admn of workers could be ensured.
It is very suitable to a business unit which is engaged in manufacturing activities.
C. The line and staff organisation:
In order to strike a balance between the line and functional organisation, it is believed that
the best system to adopt in any progressive and elite organization is the line and staff
organisation.

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 The line officers have authority to take decisions and implement them to achieve
the objectives of the orgn.
 The line officers may be assisted by the staff officers while framing the policies
and plans and taking decisions.
 In the fast developing industrial world, the line officers are not in a position to
acquire the technical knowledge. For eg., while taking decisions regarding the
production, technical knowledge is needed to take correct decisions.
 This type of gap may be bridged with the help of staff officers. The staff officers
may be experts in a particular field.
 Then the line officers can get expert advice from the staff officers before taking the
final decisions.
 Here there is scope for having experts and advisors to advice the commander or
leader of the team whenever and wherever required. The suggestions are honoured
and implemented by the manager to the extent possible.
 The staff or workers are permitted to voice their views in this type of organisations.
Their views and concerns are appreciated, implemented wherever necessary.
 While maintaining the line type of organisation it also takes care of the staff and
coordination between / among the staff with in hierarchial framework makes a
good organisation.
 Staff or worker and their functions get lot of prominence in this type of
organisation.
Staff functions can be divided into 2 areas.
A) Staff advice and b) staff service.
While staff advice relates to staff functions at the higher levels; the staff service
relates to staff functions at lower levels.
Normally there are two types of staff:
General staff: they are normally located at the head quarters or regional offices to assist,
support and advise top management on day to day activities and problems in the
organisation in general and are shared by different divisions.

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Spec
Specialised staff: each line official has special assistants or advisors to provide advice and
services to the executives with whom they are attached.Nurses, doctors and other
professionals belong to the category of staff advice, in the industrial concerns.
Merits:
Expert‟s advice becomes available to the line management.
 There is benefit of planned specialization.
 Line managers get more time to devote to their own functions. This results in
greater efficiency.
 Chances of advancement of employees become better as more jobs become
available.
Demerits:
 Staff tend to assume line authority and thus may become a cause of friction
between the two.
 Sometimes staff do not give sound advice because the staff are not accountable for
the implementation of the advice.
 Staff steal credit, although the direction and planning are done by the manager
through sheer hard work and intelligence.
 Staff fail to see the whole picture as they lack the mind of relating advice to the
task and objectives of the enterprise.
Figure:
Advisor specialist
In hosp mgmt
Chief administrator ialist Advisor
hospital
All headsof depts
surgery,
Medicine,obs&gyn,
paediatrics
Dy.Chief (admn) Dy.chief (finance &
accounts)
Nsgsuptdt

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(S)el
(Here the Heads of departments of surgery, medicine etc and nursing superintendent while
acting as line managers for their respective departments, act as specialised staff for
advising matters related to their respective disciplines like surgery, medicine, nursing etc.,
......... shows staff authority.
Fig 2.
Clerks(s) clerks(s)
 Committee organisation
 Project organisation:
Matrix organisation:
 Matrix structures are characterised by teams built directly into the organisational
structure.
 These teams are coordinated both vertically (within the hierarchy) and horizontally
(among the groups involved).
 The team has formal authority to make and enforce decisions.
 Matrix structure involves less rigid adherence to rules and procedures.
 Free form organisational structures are called matrix organisations.
Marketing
(L) manager
(L)
(S)
(personal staff)
Asst managing
director
Works
manager (L)
Company
secretary
accountant
(L) (L) Personnal
manager
ement fn
(L)operators (L) clerks (L) sales rep
Training
(S) officer
(S)
Employme
nt officer
Sales
manger
Personal asst
to the
managing
director

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 The matrix organisation design enables timely response to external competition
and to facilitate efficiency and effectiveness internally through cooperation among
disciplines.
Characteristics:
1. Maintenance of old-line authority structures.
2. Specialist resources obtained from functional areas.
3. Promotion of formation of new organisational units.
4. Occurrence of decision making at the organisational level of group consensus, the
middle management level.
5. The matrix manager exercising authority over the functional manager.
6. Cooperative planning of program development and allocation of resources to
accomplish program objectives.
7. Assignment of functional managers to teams that respond to the chief of the
functional discipline and matrix manager.
Advantages:
1. Improved communication through vertical, horizontal control and coordination of
interdisciplinary patient care systems.
2. Increased organizational adaptability and flexibility to respond to environmental
changes.
3. Increased efficiency of resource use with fewer organisational levels and decision
making closer to primary care operations.
4. Improved human resource management because of increased job satisfaction with
achievement and fulfilment, improved communication, improved interpersonal
skills and improved collegial relationships.
Disadvantages:
 Potential conflict because of dual or multiple lines of authority, responsibility and
accountability relationships.
 Role ambiguity.
 Loss of control over functional discipline due to multidisciplinary team approach.

23
Adhocracy:
 Adhocracy models of organisation are like matrix models. There are simple teams
or task forces that exists on an adhoc basis.
 They are formed, complete their goals and are disbanded.
 New groups are then formed to meet changing and dynamic mission and
objectives. It employs participatory management.
Theories of organisation
Organisation theory means the study of the structure, functioning and performance of
organisation and the behaviour of individual and groups within it.
The various theories of organisation are given below:
1. Classical theory
2. Neo-classical theory
3. Modern theory
4. Motivation theory
5. Decision theory
Classical theory:
The classical theory mainly deals with each and every part of a formal organisation. The
classical theory was found by the father of scientific management. Frederick W. Taylor.
Next, a systematic approach to the organisation was made by Monney and Reicey.
The classical theory is based on the following 4 principles:
A. Division of labour
B. Scalar and functional processes
C. Structure
D. Span of control

24
L
L
L
L
L
S L
S
S
L S
S
S
S
S
L
L
L
S
S
L
S
L L
L
Classic organisational theorists believe that the size, structure, division of labour, number
of supervisory levels and span of control are key variables in determining the success or
efficiency of an organization.
Figure
It is based on the belief that breaking down the operation into specialized components is
necessary for the assignment and completion of responsibilities.
Creating these specialized segments demands coordination that is best handled by
delegation of authority to supervisory personnel such as the nursing administrator or a
head nurse.
Structure is essentially the height of the organisation as compared to its width, whereas
span of control defines the number of employees managed by the supervisor.
A flatter organisation may increase the span of control while decreasing the levels of
authority. Most health care facilities are moving in the direction of a flatter organizational
design.
Classic orgn theory differentiates staff and line relationships. Those with line roles, such
as a head nurse, have direct responsibility for employees and services.
S S

25
Line authority has traditionally been defined as the right to hire and fire. In contrast the
clinical specialist, has traditionally held a staff position, indirectly responsible for the same
services through employee education, consulting and role modelling.
Criticism:
Lack of decision making oppurtunities for employees is a result of structure itself. Often
the individual who makes the decisions and the individual who implements them occupy
different positions on the organisational chart.
This criticism has led to a study of the psychology of work behaviour and research into
employee participation as a means of increasing motivation and commitment.
This theory is based on authoritarian approach.
It does not care about human element in an organisation.
It does not give 2 way communication.
It underestimates or ignores the influence of outside factors on individual behaviour.
The generalisations of classical theories have not been tested by strict scientific methods.
The motivational assumptions underlying the theories are incomplete and consequently
inaccurate.
NEO CLASSICAL THEORY:
This theory is developed to fill the gaps and deficiencies in the classical theory.
It is concerned with human relations movement.
Study of organisation is based on human behaviour such as how people behave and why
they do so in a particular situation.
It points out the practical difficulties of the working of scalar and functional processes.
The main contribution of this theory highlights the importance of the committee
management and better communication.
Besides this theory emphasised that workers should be encouraged and motivated to
evince active participation in the production process.

26
The feelings and sentiments of the workers should be taken into account and respected
before any change is introduced in the organisation.
The classical theory is production oriented while neoclassical theory was people oriented.
Contributions of neoclassical theory:
Person should be the basis of an organisation.
Organisation should be viewed as a total unity.
Individual goals and organisation goals should be integrated.
Communication should be moved from bottom to top and from top to bottom.
People should be allowed to participate in fixing work standards and decision making.
The employee should be given more power, responsibility, authority and control.
Members usually belong to formal and informal groups and interact with others with in
each group or subgroup.
Criticism:
A survey conducted by AMA indicates that most of the companies reported found little or
nothing useful in behavioural theory.
According to ernest dale, „ neither classical theory nor neo classical theory provides clear
guidelines for the actual structuring of jobs and provision for coordination.
Modern organisational theory:(Flatter organization)
It was organised in the early 1950s. This theory composed of the ideas of different
approaches to management development.
The approach is fully based on empirical research data.
The approach reflects the formal and informal structures of the organisation and due
weightage is given to the status and roles of personnel in an organisation.
Like general systems theories, this theory studies the

27
1. Parts in aggregates and the movement of individuals and out of the system.
2. The interaction of individual with the environment found in the system.
3. The interaction among individual in the system.
Modern organisational theorists suggests that an essential element in understanding and
predicting organizational behaviour is the ability to predict the behaviour of the persons
within an organization.
These theorists contend that motivation, satisfaction, leadership and the manner in which
conflicts are resolved are key to organizational harmony and success.
Unlike the classic approach which focuses on structure and function, this approach
maximises the value of the individual.
It recognises that each employee has a set of unique processes, feelings, and thoughts that
may not fit with those of the organisation and may create tension among between
employer and employees.
The supervisor‟s role becomes one of initiating activities that help the employee and
supervisor to succeed together.
Figure:
Helping employers and employees to work together has been the focus of a variety of
theorists who are convinced that the structure and process of an organisation is a single
phenomenon.
L
L L
S S L S
S S S S S S
S
S
S
S
S
S
L
S S
S

28
For instance, douglas Mcgregor (1960) developed two fictional supervisory belief
systems, labelled theory X and Y, to describe relationships between supervisors and their
employees.
Supervisors who believed in theory X controlled and directed the behaviour of employees,
whereas those who believed in theory Y provided an atmosphere that encouraged
participation in decision making by controlling not the employee but the surrounding work
environment.
Mcgregor attempted to integrate the goals of the organization with those of the employees,
argyris(1972) pointed out the ways in which organisational structure restricts employee
development. For instance, one nurse may be better suited to work in the technical
atmosphere of the operating room, whereas another achieves and succeeds as a
professional in psychiatric nursing care.
A mismatch in either case would inevitably lead to tension between the nurse and the
health care facility.
These tensions require the employer action to be resolved.
Issues the supervisor might consider include the rates of absenteeism, turnover, and the
role of labor unions.
The employer may suggest relocating the employee to another section to give that
individual a better chance of succeeding.
One of the most important beliefs in modern organisational theory is that the individual
must fit the organisation and organisation must fit the individual,
Another central belief is that organisations are systems that function through relations of
many parts.
According to senge, systems thinking is a discipline for seeing wholes. Drawn from the
fields such as engineering, social sciences and cybernetics, system thinking focuses on
relations rather than on direct cause and effect, and on change over time rather than on
single events.

29
Systems thinking suggests that individual behaviour can have collective consequences
within an organisation. In health care organisations, this means that everyone within the
organisation influences the effectiveness of the organisation as a system.
Criticism of modern theory
This theory puts old wine into a new bottle.
It does not represent a unified body of knowledge. There is nothing new in this theory
because it is based on past empirical studies.
This theory forms only the questions and not the answers.It is based on behavioural,
social and mathematical theories. These are management theories in themselves.
4. Motivation theory: it is concerned with the study or work motivation of
employees of the organisation. The works are performed effectively if proper
motivation is given to the employees. The motivation may be in monetary and non
monetary terms. The inner talents of any person can be identified after giving
adequate motivation to employees. Maslow‟s hierarchy of needs theory and
honberg‟s two factor theory are some of the examples of motivation theory.
5. Decision theory: decision making theory. This theory is given by
Herbert.A.Simon. he was awarded nobel prize in the year of 1978 for this theory.
He regarded organisation as a structure of decision makers. The decisions were
taken at all levels of the organisation and policy decisions are taken at the higher
levels of organisation.
Simon s suggested that the organisational structure be designed through an
examination of points at which decisions are made and the persons from whom
information is required if decisions should be satisfactory.
Organisationstructure
Organizing is the second administrative function which is considered to be a process of
creating a structure or platform where various people can work together to attain their
common objectives effectively.

30
These people work together and combine their efforts consciously and harmoniously
towards attainment of the common goals of the establishment which is termed
organisation also.
There are two distinct features in this process:
1. Determining the divisions of work within the establishment and formation or
constitution of units and subunits or departments in the context of the
organisational strategies and objectives.
2. Establishing the pattern of authority relationships within the organization that will
link the top level managers to the bottom most level of work force. This is essential
for distribution and coordination of the various task required to be performed
within the organisation. This network or pattern of relationships within an
esatblisment is known as the organisation structure.
Content:
The organisation structure should indicate:
1. Well defined relationships (vertical, horizontal and lateral) of all categories of staff
belonging to all levels of management as well as the workforce.
2. Well defined duties and responsibilities of all categories of personnel – both
management and workforce.
3. Hierarchial relationship between the supervisors and the subordinates within the
establishment.
4. Assignment of tasks to individuals, divisions and department.
5. Coordination of activities and tasks.
6. Policies, rules, regulations, procedures and methods for performance of tasks and
activities as well as for evaluation of performance.
Functions:
Providing well defined authority relationships and delegation of authority(right to do or
the right to command others to do).
Definition of delegation:

31
Delegation is defined as assigning authority to a person who thereby assumes the right to
perform a task including decision making task and is accountable for the task.
Authority in an organisation may be defined as the right to command people within the
organization and use organisational resources for performance of tasks and activities
within the framework of the organizational policies, rules, regulations and procedures.
Develops and describes channels and patterns of communication between the management
and the workforce, between supervisors and subordinates, between the divisions and
departments within the organization.
Decides and identifies decision making centres within the organization for different
decision areas and communicates the same to all concerned.
Effects balance within the organization for different decision areas and communicates the
same to all concerned.
Encourages creativity and innovation through clearcut authority relationships and inviting
participation from those having potentials.
Provides oppurtunities for growth and development of the organization through capacity
building, maintaining a constant level of quality performance and consciously making
efforts to meet the needs and demands of the changing economic and environmental
climate.
Adapts to change, makes use of available and cost effectiveness new technologies that are
beneficial for the organisation; encourages operational research and studies to obtain prior
and valid information on the changing requirements and consequent notifications
necessary in the organization structure.
Committees in an organisation:
Committees can be formed for many reasons. i.e, to resolve a particular problem for a
particular period (adhoc committees), permanent committees like finance committee,
personnel selection committee, establishment committee to deliberate upon and resolve
issues on a regular basis (standing committees).
Organisational charts

32
 Organisation charts and manuals are prepared for the purpose of describing the
organization structure.
 These are used as tools of management control.
 They give full information on a particular organisation.
 An executive finds out his exact place in the organisation structure from the charts
and manuals.
 It shows the responsibility and authority of an executive. He knows his superior for
whom he is responsible and his subordinates whom he has to supervise.
J.Batty defines, “an organisation chart is a diagrammatic representation of the framework
or structure of an organisation”.
Terry defines, “an organisation chart is a diagrammatical form which shows the
important aspects of an organisation including the major functions and their respective
relationship, the channels of supervision and the relative authority of each employee who
is incharge of each respective function”.
Contents of organisation charts
1. Basic organisation structure and flow of authority.
2. Authority and responsibilities of various executives.
3. The relationship between the line and staff officers.
4. Names of components of organisation.
5. Positions of various office personnel.
6. Number of persons working in the organisation.
7. The present and proposed organisation structure.
8. Ways of promotion.
9. The requirements of management development.
10. Salary particulars
TYPES OF ORGANISATION CHART: all use a spatial relationship (i.e, a distance
between) to illustrate differences in rank, authority or status.
1. Basic(Vertical chart): the basic relationship is that between superior and
subordinate, and usually this is shown vertically. The lines of command flows

33
B
A
from the top level to the bottom in vertical lines. This vertical chart is in the
form of a graph. This type is followed in companies.
Superior-supervisor,etc
Subordinate-operator,clerk,etc
This fig shows superior/subordinate relationship.
2. Horizontal chart: the lines of command flows horizontally. In this, the supervisor is
on the left side of the chart and the subordinate on the right side or vice versa. This is
not followed in any organisation.
3. Master and supplementary charts:
 a chart that shows the entire organisation is called master chart.
 It gives the clear picture of the organisation and major sections or divisions
in the organisation.
 A chart which shows a particular section or division of the organisation is
called supplementary or unit chart.
 It shows the details of relationship, authority and duties within the specified
area.
Scalar chain: most organisations that a manager or supervisor is likely to encounter will
have more than two members. Henry fayol produced what he called the „scalar chain or
chain of grades or steps‟ and his chart looked like a triangle without a connecting base
line.
A
B L
C M
D N
E O
F P
G Q

34
This chart looks odd to our eyes: as we have seen, we do not often meet a situation
where nearly every manager(i.e, F,E,D,C,B,L,M,N,O,P) has only one subordinate.
However it would appear fayol,s chart was even more abstract than the type of charts we
use commonly today.
It does however help us to understand that:
1. Authority and powerflow from the top (A) downward.
2. Accountability flows upward.
 Authority is the right or power to make decisions or give instructions or
orders.
 Accountability is the obligation to give an account of the stewardship of the
authority given, to a supervisor. Such supervisors are in turn are
accountable to their superiors.
This reporting or accounting chain is what fayol refers as to the scalar chain, and
some contemporary writers the ‘job task pyramid’.
The ‘T’ chart:
The job task pyramid idea becomes a little clearer if we use a‟T‟ chart, the most
widely used and understood map of the organization.
In its most basic form it consists of a series of inverted letter „T‟s (taking a ruler,
we can quite quickly draw a pyramid shape around the chart.)
Fig 2: Basic „T‟ chart or job task pyramid
The 3 supervisors are of pretty equal status, and the numbers of staff each control
are similar.
Wheel charts:
manager
supervisor
C
1 2 3 4 5 X Y P Q R S T
Supervisor
A
Supervisor
B

35
IPS
Production
Director
LON LP NC GL
Director
C
Director
A
Group managingdirector
Director
B
Sometimes, it is more useful to indicate, in addition to a superior/ subordinate relationship,
a geographical one.
Consider a firm with a head office in Birmingham and factories in London, Bristol,
Liverpool, Glasgow, Newcastle and Ipswich.
We could envisage such an organisation as a wheel with the group production director(A)
in the centre, and the factories at the ends of the various spokes.
GL
LP NC
A
BRIS
LON
Modified ‘T’ chart:
There are many ways of setting out relationships, and we are at liberty to combine
„T‟ charts with wheel chart (or any other variety).
The implication here is that London, Liverpool, Newcastle, and Glasgow do not
communicate with each other fig 2.1:
The illustration in fig 2.2 then we might feel that London, Liverpool etc., do
communicate.
FIG 2.1
FIG 2.2
LON LP NC GL
PRODUCTION DIRECTOR

36
Produc
manager
Managing
Director
Personnel manager
MODIFIED T CHART
Circular concentric charts:
 Here we place the top person in the centre and jobs at different levels are
shown in concentric circles surrounding the central job.
 The position of the top executive is shown in the centre of the chart.
 The subordinates of this top executive are shown in all directions outward
from the centre.
 It derivates the status of different levels of subordinates and shows clearly
each person‟s responsibility.
 It is the best representation of relationship existing among the employees in
an organisation structure.
Fig 2.3:
Chief
buyer

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The spatial implication here is the nearer the centre you are, the greater your position,
power and authority; conversely those at the outside of the circle have lower status and
position.
You can use any device you like to picture or model the organization, always provided
the chosen method is:
a) Appropriate
b) Accurate (about the aspects to be shown)
c) Easily understood.
The charts should describe, not prescribe, and there are inherent shortcomings in every
model.
Principles of organisation chart:
1. Observation of lines of authority by top executives: the executives should never by
pass the lines of authority. The executives should give orders or obtain information
by following the lines of authority.
2. Observation of lines of authority by subordinates;
3. Defining lines of position: the position of each individual in an organisation
should be clearly stated. The staff should be assured that there would not be
overlapping and two persons would not be appointed to the same position when
their authorities and responsibilities are different.
4. Non-assignment of same duty twice: an individual should not be compelled to
work under two masters for the same work performance.
5. Avoid unique concentration of duty: all work or maximum work should not be
concentrated in a single point. The work should be divided according to the duties
and responsibilities of each worker and the administrative relationship with others.
6. Organisation charts should be above personalities: a position should not be
assigned to a person since he is the son or relative of any one of the top executives

38
of the organisation. Importance should be given to an organisation than to an
individual.
7. Simple and flexible: understandable. Size and nature of the organisation may be
changed in course of time. Need may arise for periodical modification in the
organisation chart. Then the existing organisation chart should permit these
modifications.
Advantages of organisation charts:
1. They give a clear picture of the organisation in a simple way.
2. They show the levels of authority and relationship prevailing among employees at
a glance.
3. Dual reporting relationships and overlapping positions come to light in the
preparation of organisation chart.
4. Instructing work is simplified.
5. Newly hired personnel can understand their role in the organisation and behave
accordingly.
6. Strengths and weaknesses of an organisation are evaluated.
7. It act as authoritative sources of information.
8. The lines of authority shown are definite and formal.
9. The lines of promotion can be understood.
10. Organisation charts help planning and improve communication both inward and
outward.
11. Correct methods of checking and balances in the organisation are provided.
12. The degree of contribution to organisation and acheivements can be identified.
13. The obstacles to the efficient functioning of the mgmt can be found while drawing
the organisation chart.
14. The outsiders can have a quick understanding of each department and orgnal
disputes can be solved in the organisation.
Limitations of organisation charts:
1. Most of the org charts are like photos taken in an instant.
2. The organisation charts create more rigidity of relationship prevailing among the
employees of the organisation.

39
3. It is very difficult to maintain and ensure that the organisation charts uptodate. The
employees of the organisation are very reluctant to put up with the organisation
changes.
4. The organisation charts don‟t show the informal relationship existing among the
organisation staff members.
5. If the charts are not correctly prepared, they will lead to misleading inference. A
false picture may be developed by following the oversimplified organisation
structure.
6. There is no differentiation between line officers and staff officers in an
organisation chart.
7. The organisation charts produce a psychological complex such as superiors,
inferiors etc., in the minds of the employees.
8. The relationship shown in an organisation chart does not actually prevail among
the employees.
9. The words and lines used in an organisation charts give different meanings to
different people.
Organisation manuals:
Organisation manual is a document prepared in an organisation to furnish information on a
particular organisation.
A brief history of the organisation is given in this manual. It is usually prepared in the
form of small booklet.
Any person can
Developing an organisational structure:
An organisational structure for a division of nursing must meet the needs of that division
as written in the statements of mission, philosophy, vision, values and objectives.
Most existing institutions already have an organisational structure. Before the structure is
changed, the nurse managers should engage in a systematic analysis as well as some sound
thinking about altering the organisation‟s design and structure, starting with objectives and
strategy.

40
Minimum requirements of an organisational structure:
1. Clarity: N‟s sd know where they belong, where they stand in relation to the quality
and quantity of their performances, and where to go for assistance.
2. Economy: there should be the smallest possible number of overhead personnel
necessary to keep the division and units operating and well maintained.
3. Direction of vision: nurse managers must direct their vision and that of their
employees toward performance, towards the future and towards strength. Nurses
must understand their own tasks and the common tasks of the organisation. They
should see that their tasks fit the common tasks so that the structure helps
communication.
4. Decision making: nurses should be organized to make decisions on the right
issues and at the right levels. They should be organized to convert their decisions
into work and accomplishments. The chair of the department of nursing and the
staff make all nursing decisions and see that nursing work is done.
5. Stability and accountability: nurses should be organized to feel community
belonging. They can adapt to show objectives requiring changes in their functions
and productivity.
6. Perception and self renewal: nursing services should be organised to produce
future leaders. The organisational structure should produce continuous learning for
the job each nurse holds and for promotion.
To apply design principles that are appropriate, the nurse manager uses a mixture of all
that are productive, including the following:
 Organizational needs derive from the statements of mission and objectives and
from observation of work performed.
 Organisational design and structure develop to fit organizational needs, so that
people perform and contribute to achieving the work of the division of nursing.
 A formal organization should be flexible and based on policy that promotes
individual contributions to the achievement of organizational objectives.
 A formal organization is efficient when it promotes achievement of objectives with
a minimum of unplanned costs or outcomes.

41
 A formal organisation should build the least possible number of management
levels and forge the shortest possible chain of command. This eliminates stresses
and levels of friction, slack and inertia.
The standards for evaluating departmentation of authority in nursing division,
department, service or unit.
Organizational effectiveness
The product or output of an organization is termed as organizational effectiveness.
There should be a relationship between organizational effectiveness and
organizational performance.
Nurse managers define the goals and provide the resources for both organizational
effectiveness and organizational performance.
The goals have many dimensions, which include the following.
1. Patient satisfaction with care
2. Family satisfaction with care
3. Staff satisfaction with work
4. Staff satisfaction with rewards, intrinsic and extrinsic.
5. Staff satisfaction with professional development: career, personal and
educational.
6. Staff satisfaction with organisation
7. Management satisfaction with staff
8. Community relationships
9. Organizational health
Organisational climate:
The organisational climate is the personality of an orgn, the perceptions and feelings
shared by members of the system.
It can be formal, relaxed , defensive, cautious, accepting, trusting and so on.
It is employer‟s subjective impressions or perceptions of their organisation.

42
Practicing nurses create or at the very least, contribute to the creation of the climate
perceived by the patients.
Manager creates the climate in which practicing nurses work. If managers trust them,
practicing nurses will provide their managers with good information to keep their
managers informed.
The following are 6 sociological dimensions of organisational climate:
1. Clarity in specifying certification of the organization‟s goals and policies. This is
facilitated by a smooth flow of information and management support of employee.
2. Commitment to goal achievement through employee involvement.
3. Standards of performance that challenge, promote provide and improve individual
performance.
4. Responsibility for one‟s own work, fostered and supported by managers.
5. Recognition for doing good work.
6. Teamwork- a sense of belonging, mutual trust and respect.
The environmental dimensions of climate incude: room attractiveness, illumination
and the shape of the furniture.
Practicing nurses want a climate that will give them job satisfaction. They achieve
job satisfaction when they are challenged and their acheivements are organised and
appreciated by managers and patients. They achieve satisfaction from a climate of
collegiality with managers and other health care providers, a climate in which they
have input into decision making.
Practicing nurses want a climate that provides good working conditions, high
salaries and oppurtunities for professional growth through counselling and career
development experiences that will enable them to determine and direct their
professional futures.
They want a climate of administrative support that includes adequate staffing and
shift options.

43
The following activities promote a positive organizational climate:
1. Developing statements of the organization‟s mission, philosophy, vision, goals
and objectives with input from practicing nurses, including their personal
goals.
2. Establishing trust and openness through communication that includes prompt
and frequent feedback and stimulates motivation.
3. Providing oppurtunities for growth and development, including career
development and continuing education programs.
4. Promoting team work.
5. Asking practicing nurses to state their satisfactions and dissatisfactions during
meetings and conferences and through surveys.
6. Marketing the nsg orgns to the practicing nurse, other employees and the
public.
7. Following through on all activities involving practicing nurses.
8. Analyzing the compensation system for the entire nsg orgn and structuring it to
reward competence, productivity and longevity.
9. Promoting self esteem, autonomy and self fulfilment for practicing nurses,
including feelings that their work experiences are of high quality.
10. Emphasizing programs to recognize practicing nurses contributions to
organization.
11. Assessing unneeded threats and punishments and eliminating them.
12. Providing job security and an environment that enables free expression of ideas
and exchange of opinions.(threats and recriminations, which may occur as
down scaled performance reports, negative counselling, confrontation, conflict
or job loss, are not part of a positive organisational climate).
13. Being inclusive in all relationships with practicing nurses.
14. Helping nurses overcoming their short comings and develop their strengths.
15. Encouraging and supporting loyalty, friendliness and civic consciousness.
16. Developing strategic plans that include decehtralization of decision making and
participation by practicing nurses.
17. Being a role model of performance desired for practicing nurses.

44
2.ORGANIZING NURSING SERVICES AND PATIENT CARE
INTRODUCTION
“A hospital may be soundly organized, beautifully situated and well equipped, but if the
nursing care is not of high quality the hospital will fail in its responsibility.”
Jean barrett
Who is the effective member of the patient care team? Sir William Osler said that the
nurse is one of the greatest blessings of humanity. Nursing has a large, important and unique role
in the health care delivery system of a country. Nursing care is extremely important for good
patient outcome. While the physician plans the treatment and surgeon carries out the operation, it
is the nurse who gives 24 hrs / round the clock nursing care and looks after the needs of the
patient. The success of the patient care depends upon the competence of the nursing staff.
Organizing the high level of nursing care is a big challenge for the nursing service administrator.
Setting of standards and goals for providing care to patients depends upon the philosophy of
nursing in order to organize the patient care.
OBJECTIVES
♪ General objective:
At the end of the seminar the student will be able to understand about the organizing of
nursing service and patient care and its detail.
TERMINOLOGIES:
Case method In this method, nurses assume total responsibility for meeting all the
needs of assigned patients during their time on duty.
Modular nursing The patient unit is divided into modules or districts, and the same team of
caregivers is assigned consistently to the same geographic location
Nursing service It is the part of the total health organization which aims at satisfying the
nursing needs of the patients/community.
Objective The goal intended to be attained (and which is believed to be attainable).
Organizing It involves grouping activities together and assigning the responsibility of
each group of activity to a manager who has adequate authority to
fructify the activity/task athand.
Patient classification
system
Patient classification system (PCS), which quantifies the quality of the
nursing care, is essential to staffing nursing units of hospitals and nursing
homes.
Patient care Care of the sick and injured and restoration of the health of a diseased
person without any decimation.

45
ORGANIZING NURSING SERVICES
Meaning ofnursing service and nursing service administration
Nursing Service
Nursing service is the part of the total health organization which aims at satisfying the
nursing needs of the patients/community. In nursing services, the nurse works with the members of
allied disciples such as dietetics, medical social service, pharmacy etc. in supplying a
comprehensive program of patient care in the hospital.
Nursing service administration
Nursing service administration is a complex of elements in interaction and is organized to
achieve the excellence in nursing care services. It results in output of clients whose health is
unavoidably deteriorating, maintained or improved through input of personnel and material
resources used in a process of nursing services.
DEFINITION OF NURSING SERVICE
WHO expert committee on nursing defines the nursing services as the part of the total
health organization which aims to satisfy major objective of the nursing services is to provide
prevention of disease and promotion of health.
PHILOSOPHYOF NURSING SERVICE IN HOSPITAL
The department of nursing services of hospital recognizes and appreciates the objectives
of the hospital and acknowledges that the primary purpose of nursing is to provide the highest
quality care services.
 The quality in nursing care and management of nursing services is achieved
through professional nurses who assist in the development of comprehensive
programs of delivering nursing care.
 The quality of nursing care services is clearly and directly related to continuing
growth and development of nursing personnel.
 High quality of nursing care can be best provided by a mixture of professional and
non professional personnel who are organized into self directed work teams.
 To ensure continuous improvement of nursing care quality, the role of professional
nurse must include responsibility of nursing research and nursing education.
OBJECTIVES OF NURSING SERVICE
The first component of nursing service administration is the planning and it should be
based on clearly defined objectives. The objectives of nursing service department are as follows:
Objectives in relation to Patient care
The primary emphasis is on total patient care that is:
 To give highest possible quality care in terms of total patients need which include
physical, psychological, social, educational and spiritual needs by collaborating
with other health tem members.
 To assist the physician in providing medical care to the patients.
 To provide preventive and rehabilitative services.

46
 To provide round the clock nursing care to all the patients.
 To render timely and appropriate nursing service to emergency patients.
 To provide cost effective quality care as per the needs of patients.
 Confidentiality and privacy of each patient should be maintained.
 Constant monitoring and evaluating is of utmost importance to improve patient
care continuously.
Objectives in relation to Education
 Planning of education and training programme for nurses are must for professional
growth and development needs through in-service education and research support.
 To provide regular staff development, in-service education and guidance services
for all members of nursing staff.
 To conduct regular orientation programme for new entrants and for those have
been on the job for a long time.
 To conduct training for operating procedure of latest gadgets and on handling
sophisticated bio-medical equipment.
Objectives in relation to Administration and Organization
 To make regular supervision through rounds.
 To ensure that the essential equipment is provided in functional status for nursing
care services.
 To provide regular flow of essential supplies to render quality nursingcare.
 To have a proper system of rotation of staff, provision for annual leave and days
off for the nursing staff without hampering patient care.
 Establish a communication system for nursing personnel, other health worker,
patients, health authorities, government authorities and public.
 Ensure that each nurse identifies her job responsibilities and accountability.
 Counseling for health personnel, patients and the public.
 The formulation of policies, standards, goals of nursing service, education and
practice.
 Maintaining proper documentation of the personnel employed in nursing service.
Objectives in relation to Research
 Establish a system for collection of essential information, research and studies
concerning all aspects of nursing.
 To contribute in research programme conducted by hospitals and by other health
personnel.
 To encourage and support the nurse to conduct research projects/ activities.
Objectives in relation to Performance appraisal
 Appraise the performance of nursing service personnel regularly against set
standards and performance indicators objectively with a view to maintain quality-
nursing services.
PRINCIPLES OF NURSING SERVICE
► Initiate a set of human relationships at all levels of nursing personnel to accomplish
their job and responsibilities through systematic management process by
establishing flexible organizational design

47
► Establish adequate staffing pattern for rendering efficient nursing service to clients
and its management
► Develop and implement proper communication system for communicating
policies, procedures and updating advance knowledge.
► Develop and initiate proper evaluation and periodic monitoring system for proper
utilization of personnel
► Develop or revise proper job description for nursing personnel at all the levels and
all units for proper delivery of nursing care.
► Share nursing information system with other discipline functionaries in the
hospital.
► Assist the hospital authorities for preparation of budget by involvement.
► Participate in interdepartmental programs and other programs conducted by other
disciplinaries for improvement of hospital services.
► Develop and initiate orientation and training programs for new employees in
cooperative with authorities and other health disciplines
► Create an atmosphere that conductive to give proper required learning experience
for the students
► Assist in the development of a sound, constructive program of leadership in
nursing to assure intellectual administration and management to safeguard,
conserve and preserve nursing resources of the hospitals.
► Participate in the application of data and research
► Participate in community health programs, associated with hospital.
FUNCTIONS OF NURSING SERVICE
◘ To assist the individual patient in performance of those activities contributing to
his health or recovery that he would otherwise perform unaided has had the
strength, will or knowledge.
◘ To help and encourage the patient to carry out the therapeutic plan initiated by the
physician.
◘ To assist other members of the team to plan and carry out the total programme of
care.
The organization of nursing care constitutes a subsystem for achieving the hospital‟s overall
objective. Nursing care of patients generally takes forms:
 Technical
 Educational
 Trusting relationship
The director of nursing service is delegated the authority and responsibilities for
organizing and administrating the nursing services in hospital. It is her duty to institute the
essential characteristics of good nursing services in her institute such as:

48
Purposes and objectives of the nursing service:
The purposes should be in accordance with the hospital philosophy regarding patient
care and approved by administration. It must characterize the principles of excellence in
service, in practice and leadership. Objectives are specific, practical, attainable,
measurable and understandable to all the nursing staff.
Plan of organization:
Every hospital has the basic system of coordination of vast number of activities
i.e. the Director of Nursing service, she is responsible for maintaining standards for patient
care in terms of quality nursing service must be familiar with the formal organizational
structure of the hospital and its relationship in various department and their functions. The
plan of organization should indicate inter as well as intra-department relationship. The
plan also should indicate area of responsibility and to whom and for whom each person is
accountable and the channels of communication.
Policy and administrative manuals:
The policy and procedure manual are required for the operation of the hospital.
Policies are established within the department to guide the nursing staff, which includes
duty hrs, rules and regulations etc. These are periodically revised and reviewed at regular
intervals.
Nursing practice manual:
This the written procedure available as evidence of the standards of performance
established by nursing service organization for safe and effective practice after taking into
consideration the best use of available resources. Liberal use of diagram and precautions in
Written statement of purposes and objectives of nursing services
Plan of organization
Policy and administrative manuals
Nursing practice manual
Nursing service budget
Master staffing pattern
Nursing care appraisal plan
Nursing service administrative meetings
Adequate infrastructure facilities, supplies and equipment
Written job description & job specifications
Personnel records
Personnel policies
Health services In–
service education
Co-ordination
Advisory committee

49
nursing manual helps to keep instruction direct and exact. The advantages are ensure
economy of time effort & material and provides basis for training for new personnel to
acquire knowledge and current skill.
Nursing service budget:
It is required for personnel budget, nurse‟s welfare activities, staff
development programme, equipment and capital expenditure, supplies and
expenses. Budget preparation should includes analysis of past operation and
anticipating the future revenue and expenses.
Master staffing pattern:
It is the number and composition of nursing personnel assigned to work in a hospital
in different department / wards at a given time. This helps the director to visualize the
equitable distribution of nursing personnel among various nursing unit. It serves as a guide
for planning daily, weekly and monthly schedules.
Nursing care appraisal plan:
Employing various techniques such as supervision, ward rounds, conference,
anecdotal record, rating scale, checklist, suggestion box and peer review can do
performance appraisal of nurses. This is done to improve the quality of service provided,
determine the job competence and to enhance staff development.
Nursing service administrative meetings:
This meeting gives opportunity for free communication, planning and evaluation of
the nursing service through regular meeting of the director of nursing with total nursing
staff. The purposes are regular exchange of view between management and nursing
service for improving working condition, welfare of patient and improvement in methods
and organization of work.
Adequate infrastructure facilities, supplies and equipments:
The director of nursing evaluates periodically the adequate resources and arranges new
facilities needed for patient care in discussion with the hospital administrator.
Written job descriptions and job specifications:
In job description the responsibility are clearly spelt out as precisely including the job
content, activities to be performed, responsibility and result expected from various role
required by the organization. It is useful for reducing conflict, frustration, overlapping
duties and acts as a guide to direct and evaluate person.
Personnel records:
Personnel records include the information relating to the individual such as
recruitment and selection, medical records, training and development, transfer records,
promotion, disciplinary action records, performance records, absenteeism data, leave
record and salary records, etc.
Personnel policies:
It reflects an analysis of the total job of nursing in accordance with the types of
functions to be performed. It also indicates the qualitative and quantity of service to be
maintained and the purpose for which the hospital exist.

50
Health services:
Supervision of health of each employee by means of pre-employment physical
examination, periodic examination, immunization and provision of diagnostic, preventive
and therapeutic measures. The education of employee in the principle of health and
hygiene so that they may develop healthy habit of living and working.
In-service education:
It is the essential components of staff development programme, which aims at
augmenting, reinforcing nurse‟s knowledge, skill and attitude. It includes orientation
programme, skill training, leadership and management training, on the job training, staff
development.
Co-ordination:
Regular consultation and discussion between the heads of departments and with
members of the medical staff could be an integral part of the administration.
Advisory committee:
Each committee has a clear statement and its membership is appropriate to the
purpose. After carefully weighing the advice of the committee, she makes the final
decision about the matter within her area of responsibility and becomes accountable for
implementation.
ORGANISATION OF NURSING SERVICES:
DIRECTOR (hospital) DIRECTOR OF HEALTH
SERVICE
Chief Nursing Officer Asst. Director of Health Service
Nursing Superintendent Nursing Superintendent Grade-I
Deputy Nursing Superintendent Nursing Superintendent Grade-II
Assistant Nursing Superintendent Head Nurse
Ward Sister - Clinical Supervisor Staff Nurse
Staff nurse Student nurse
ORGANIZING NURSING SERVICE AT VARIOUS LEVELS
The organization of nursing service varies from institution to institution.
Organizational set-up at Directorate General of Health Services

51
DADG DADG DADG
DADNS DADNS DADNS
DGHS
Addl.DG (PH) Addl.DG (N) Addl.DG (M)
ADG ADG ADG
(Community Nsg service) (Nsg-education & research) (Hospital Nsg service)
Community & Nsg officer Principal Nsg.Supdt
PHN Supervisor Senior Tutor Dy.Nsg.Supt
PHN Tutor
Asst.Nsg.Supt
LHV Clinical Instructor Ward sister
ANM Staff Nurse
Organizational set-up of Nursing Service at Central Level
Secretary, Health
Director Nursing Service
Joint/Deputy Director Nursing services
ADNS ADNS ADNS
DADNS DADNS DADNS
Dist. Nsg officer DADNS Nsg.Supdt
PH. Nsg officer Principal Dy.Nsg.Supt
PHN at PHC Senior Tutor Asst.Nsg.Supt
LHV Tutor Ward sister
ANM Clinical Instructor Staff Nurse

52
Organizational set-up of Nursing Service at State Level
Director Nursing Services
Deputy Director Nursing Services
Assistant Director Nursing Services
Deputy Assistant Director Nursing Services
DMO DNO DHO
ADNO (Hosp&Nsg.Edu) ADNO (Community)
Nsg Supt/Dy.Nsg.Supt Principal tutor Dist.PNO
Asst.Nsg.Supt Tutor PHN Supervisor (CHC)
Ward Sister Clinical Instructor PHN (PHC)
Staff Nurse LHV
ANM
KEYS:
 DGHS - Director General of Health Services
 Addl. DG (PH) - Additional Director General (Primary Health)
 Addl. DG (M) - Additional Director General (Medical)
 Addl. DG (N) - Additional Director General (Nursing )
 ADG - Assistant Director General
 DADG - Deputy Assistant Director General
 PHN - Primary Health Nurse
 LHV - Lady Health Visitor
 ANM - Auxiliary Nurse Midwives
 ADNS - Assistant Director Nursing Service
 DADNS - Deputy Assistant Director Nursing Service
 DMO - Director of Medical Office
 DNO - Director of Nursing Office
 DHO - Director of Health Office
ROLE AND FUNCTION OF NURSE ADMINISTRATOR
The Principal Matron of the hospital will be responsible to the Commandant of the
hospital for the following duties:
♪ Administration
♣ Organizes, directs and supervises the nursing services both day and night.
♣ Coordinates assignments of staff.

53
♣ Establishes the general pattern of delegation of responsibilities and
authority.
♣ Formulates standing orders for the nursing care.
♣ Ensures appropriate allocation of duties and responsibilities to all nursing
staff working under her.
♣ Formulates nursing policies to ensure quality patient care and adequate
attention at all times.
♣ Responsible for efficient functioning of the nursing staff.
♣ Evaluates the personal performance of the nursing staff.
♪ Discipline
♣ Ensure that a standard of discipline of nursing staff is high at all times.
♣ Maintain good order and discipline in wards/departments.
♣ Makes daily rounds of the hospital wards/departments and also seriously ill
patients. In addition she will make unscheduled rounds in the hospital in the
evenings.
♣ Brings immediately to the notice of the medical superintendent all matters
concerning neglect of duty, insubordination either by nursing staff, patients
or visitors or any un-towards incident, which comes to her notice for taking
suitable action as required as per the orders on the subject.
♪ PublicRelations
♣ Promotes and maintains harmonious and effective relationship with the
various administrative departments of the hospital and related community
agencies.
♣ Maintain cordial relationships with the patients and their families.
♪ Office Routine
♣ Scrutinizes the reports and returns and submits in accordance with existing
orders.
♪ Confidential Reports
♣ Initiates the confidential reports of nursing staff on due dates.
♣ Responsible for the nursing budget.
♪ Education
♣ Carries out in-service training for all categories of nursing staff and
paramedical personnel and keeps the records of such trainings.
♣ Conduct various update courses based on the needs.
♣ Encourages the personnel to participate in the continuing education
programme.
♪ Welfare
♣ Responsible for health and welfare of nursing staff.
♣ Ensures annual and periodical health examination and maintenance of
health records.
♪ Conferences

54
♣ Responsible for organizing and conducting staff meeting of the nursing
staff once in three months.
♣ Holds conference in nursing care problems and discuss policies as regards
to working conditions, working hrs and other facilities.
♪ Supervision
♣ Supervises nursing care given to the patients and all nursing activities
within the nursing unit.
♣ Supervises the work of all paramedical staff of the hospital.
♪ Records and Reports
♣ Maintains various records such as duty roster nursing staff, day off book,
personal bio-data, leave plan, staff conference book, courses file etc.
PROBLEMS AND CHALLENGES FACED BYTHE NURSE ADMINISTRATOR
♠ Lack of adequate training.
♠ Problem of personnel management.
♠ Inadequate number of nursing staff.
♠ Shortage of trained manpower.
♠ Lack of motivation.
♠ No involvement in planning.
♠ No career mobility.
♠ Poor role model.
♠ No research scope.
♠ Professional risk/hazards.
♠ No autonomy in nursing activities.
Day to day problem in nursing services
♠ Shortage of nurses.
♠ Lack of motivation.
♠ Negative attitude.
♠ Lack of training.
♠ Lack of team approach.
♠ Inactive participation of program
♠ Lack of interpersonal relationship
♠ Less involvement in patients care by the nursing supervisors.
♠ Lack of supervision.
ORGANIZING PATIENT CARE
The overall goal of nursing is to meet the patient nursing needs with the available
resources for providing smooth day and night 24 hrs quality care to patients and to honor his
rights. To ensure that nursing care is provided to patients, the work must be organized. A Nursing
Care Delivery Model organizes the work of caring for patients. The decision of which nursing care
delivery model is used is based on the needs of the patients and the availability of competent staff
in the different skill levels. For organizing function to be productive and facilitate meeting the
organization‟s needs, the leader must know the organization and its members well.

55
♣ The top level manager who influence the philosophy and resources necessary for
any selected care delivery system to be effective
♣ The first and middle level managers generally have their greatest influence on the
organizing phase of the management process at the unit or departmental level. The
managers organize how work is to be done, shape the organizational climate, and
determine how patient care delivery is organized.
♣ The unit leader-manager determines how best to plan work activities so
organizational goals are met effectively and efficiently, involves using resources
wisely and coordinating activities with other departments.
DEFINITION OF PATIENT CARE
 The services rendered by members of the health profession and non-professionals under
their supervision for the benefit of the patient.
OR
 The prevention, treatment and management of illness and the preservation of mental and
physical well-being through the services offered by the medical and allied health
professions.
PATIENT CLASSIFICATIONSYSTEMS
Patient classification system (PCS), which quantifies the quality of the nursing care, is
essential to staffing nursing units of hospitals and nursing homes. In selecting or implementing a
PCS, a representative committee of nurse manager can include a representative of hospital
administration. The primary aim of PCS is to be able to respond to constant variation in the care
needs of patients.
Characteristics
 Differentiate intensity of care among definite classes.
 Measure and quantify care to develop a management engineering standard.
 Match nursing resources to patient care requirement.
 Relate to time and effort spent on the associated activity.
 Be economical and convenient to repot and use.
 Be mutually exclusive, continuing new item under more than one unit.
 Be open to audit.
 Be understood by those who plan, schedule and control the work.
 Be individually standardized as to the procedure needed for accomplishment.
 Separate requirement for registered nurse from those of other staff.
Purposes
◘ The system will establish a unit of measure for nursing, that is, time, which will be
used to determine numbers and kinds of staff needed.
◘ Program costing and formulation of the nursing budget.
◘ Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service
◘ Determining the values of the productivity equations

◘ Determine the quality: once a standards time element has been established, staffing
is adjusted to meet the aggregate times. A nurse manager can elect to staff below
the standard time to reduce costs.
Components
The first component of a PCS is a method for grouping patient‟s categories.
Johnson indicates two methods of categorizing patients. Using categorizing
method each patient is rated on independent elements of care, each element is
scored, scores are summarized and the patient is placed in a category based on the
total numerical value obtained. Johnson describes prototype evaluation with four
basic categories for a typical patient requiring one –on- one care. Each category
addresses activities of daily living, general health, teaching and emotional support,
treatment and medications. Data are collected on average time spent on direct and
indirect care.
The second component of a PCS is a set of guidelines describing the way in which
patients will be classified, the frequency of the classification, and the method of
reporting data.
The third component of a PCS is the average amount of the time required for care
of a patient in each category.
A method for calculating required nursing care hours is the fourth and final
component of a PCS.
Patient Care Classification
Area of care Category I Category II Category III Category IV
Eating Feeds self Needs some help in
preparing
Cannot feed self but is
able to chew and
swallowing
Cannot feed self any
may have difficulty
swallowing
Grooming Almost
entirely
sufficient
self
Need some help in
bathing, oral hygiene …
Unable to do much for self Completely
dependent
Excretion Up and
bathroom
alone
to Needs some help in
getting up to bathroom
/urinal
In bed, needs bedpan /
urinal placed;
Completely
dependent
Comfort Self
sufficient
Needs some help with
adjusting position/ bed..
Cannot turn without help,
get drink, adjust position
of extremities …
Completely
dependent
General
health
Good Mild symptoms Acute symptoms Critically ill
Treatment Simple –
supervised,
Any Treatment more than
once per shift, foley
Any treatment more than
twice /shift…
Any
delicate
elaborate/
procedure
56

simple
dressing…
catheter care,I&O…. requiring two nurses,
vital signs more often
than every two
hours..
Health
education &
teaching
Routine
follow up
teaching
Initial teaching of care of
ostomies; new diabetics;
patients with mild adverse
reactions to their illness…
More intensive items;
teaching of apprehensive/
mildly resistive patients….
Teaching of resistive
patients,
MODES OF ORGANIZING PATIENT CARE / METHODS OF PATIENT ASSIGNMENT
The most well known means of organizing nursing care for patient care delivery are,
Case method or Total patient care
Functional nursing
Team nursing
Modular or district nursing
Progressive patient care
Primary nursing
Case management
Each of these basic types has undergone many modifications, often resulting in new
terminology. For example, primary nursing has been called case method nursing in the past and is
now frequently referred to as a professional practice model. Team nursing is sometimes called
partners in care or patient service partners and case managers assume different titles, depending
on the setting in which they provide care. When closely examined most of the newer models are
merely recycled, modified or retitled versions of older models. Choosing the most appropriate
organizational mode to deliver patient care for each unit depends on the skill and expertise of the
staff, the availability of registered professional nurse, the economic resources of the organization
and the complexity of the task to be completely.
CASE METHOD
Features:
It was the first type of nursing care delivery system. In this method, nurses assume total
responsibility for meeting all the needs of assigned patients during their time on duty. It involves
assignment of one or more clients to a nurse for a specific period of time such as shift. The patient
has a different nurse each shift and no guarantee of having the same nurses the next day. Nurse‟s
responsibility includes complete care including treatments, medication and administration and
planning of nursing care. This is the way most nursing students were taught – take one patient and
care for all of their needs. This model is used in critical care areas, labor and delivery, or any area
where one nurse cares for one patient‟s total needs. Here nurses were self-employed when the case
method came into being, because they were primarily practicing in homes. It lost much of that
autonomy when healthcare became institutionalized in hospitals and clinics and now called as
private duty nursing.
Merits:
57

58
♣ The nurse can attend to the total needs of clients due to the adequate time and
proximity of the interactions.
♣ Good client nurse interaction and rapport can be developed.
♣ Client may feel more secure.
♣ RNs were self-employed.
♣ Work load can be equally divided by the staff.
♣ Nurse‟s accountability for their function is built-it.
♣ It is used in critical care settings where one nurse provides total care to a small
group of critically ill patients.
Demerits:
♠ Cost-effectiveness.
♠ The greater disadvantage to case nursing occurs, when the nurse is inadequately
trained or prepared to provide total care to the patient.
♠ Nurse may feel overworked if most of her assigned patients are sick.
♠ She/he may tend to „neglect‟ the needs of patient when the other patients „problem‟
or „need‟ demands more time.
FUNCTIONAL NURSING
Features:
This system emerged in 1930s in U.S.A during WWII when there was a severe shortage of
nurses in US. A number of Licensed Practice Nurses (LPNs) and nurse aides were employed to
compensate for less number of registered nurses (RNs) who demanded increased salaries. It is task
focused, not patient-focused. In this model, the tasks are divided with one nurse assuming
responsibility for specific tasks. For example, one nurse does the hygiene and dressing changes,
whereas another nurse assumes responsibility for medication administration. Typically a lead nurse
responsible for a specific shift assigns available nursing staff members according to their
qualifications, their particular abilities, and tasks to be completed.
Charge Nurse
RN
MedicationNurse
RN
TreatmentNurse
LPN
Vital signsNurse
UAP
Hygiene
Nurse
Patientsassignedtothe team

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