The challenges faced by nursing administrators are many and varies. An overview of such challenges will be helpful in working towards the managerial solutions.

1. Challenges in Nursing
Administration
Dr.Latha Venkatesan
Principal
Apollo College of Nursing, Chennai 600 095
drlatha_venkatesan@apollohospitals@yahoo.com

2. To Foresee…

3. Challenges in Nursing Administration
• Today, healthcare organizations are in the midst
of a period of rapid & unprecedented change.
• Nurses are at the forefront of this transformation.
• The landscape of healthcare leadership is
shifting to include new and exciting roles brought
by the need to effectively manage change.
• Innovative thinking is the most sought after and
difficult quality to find in a healthcare
leadership administration

4. Challenges-Vast & diverse
Nursing
Practice
Nursing
Education
Nursing
Research

5. Top Challenges faced by Organizations

6. Who is at Risk?

7. Accountability?
Non involvement of nursing administrators in planning and decision making in
hospital administration
Lack of knowledge in management among nursing administrators
Interference of non nursing personnel in nursing administration
No written nursing policies or manuals
No proper job description for various nursing cadres.
No organized staff development programs for nurses like orientation, in-service
education, continuing education etc.
No special incentives

8. Evidence Based Practice
Lack of
knowledgeable
Mentors
Lack of funds
Lack of time &
resources to
search for and
appraise
evidence
Organizational
constraints &
Lack of
administrative
support
Resistance to
change
The American Nurses Association (ANA) predicts that by
2020, 90% of all nursing practice will be based on EBP
research findings.

9. Challenges - Evidence Based
Practice
• Overwhelming workloads
• Misperceptions about EBP and research
• Peer pressure to continue with practices
that are steeped in tradition
“we’ve always done it this way and we are
not changing now”

10. Contt..
• Poor quality improvement initiatives
• No uniform standards
• Lack of Resources & Personnel problems
• Improper maintenance & poor technical support
• Absence of well-informed population
• Lack of incident review procedures
• Lack of good and hospital information system
• Absence of patient satisfaction surveys
• Poor documentation

11. Cont..
• Enhancing health systems,
• promoting continuous quality improvement,
• Informing decision-making
• Ensuring accountability to national health policies

12. Challenges in Infection Control
• Leadership
• Campaigns and advocacy
• Technical guidance and implementation
• Capacity building
• Physical infrastructure
• Measuring and Planning for infection control
practice

13. Infection Control
• Infection control manuals, protocols, and training
programs
• CDC website—protocols
• Engender Health training program—web-based
training for basic infection programs
• ICAT—tool that can be used in low-resource
countries to improve infection control practices

14. Medication Management
Challenges
• Near miss management
• Medication error
• Adverse drug events
• Storage requirements & issues
• Narcotic drugs management
• Psychotropic drug management
• Inventory control practices & its challenges

15. Skill gap analysis
• Urgent need of skilled professionals
• 97.9% skill gap across various verticals of healthcare
(Public Health Foundation of India for the Ministry of
Health and Family Welfare)
Current knowledge,
practice & skills
Gap between current
knowledge & best
practice
EBP,Technological
advancements,
innovations& Nursing
Excellence standards

17. Challenges in Innovations &
expanding technology
Strategic
challenges
Operational
challenges
Structural
challenges
Legal
challenges
Cultural
challenges

18. Budgeting
• Hospitals account for 40%–70% of the national health
budget.
• Efficiency in hospitals is demanded by all stakeholders &
administrators including nurse Managers.
• Personnel budget, nurse‘s welfare activities, staff
development programme, equipment and capital
expenditure, supplies and expenses.
• Challenges in analysis of past operation and anticipating
the future revenue and expenses.

19. Patient Safety Challenges
• Clear policies, organizational leadership
capacity
• Protection of patient rights
• Data to drive safety improvements
• Skilled health care professionals and effective
involvement of patients in their care
• Sustainable and significant improvements in the
safety of health care

20. Documentation
• Nursing managers have a broad spectrum of data
related to efficiency and are responsible for managing
staff and patient care.
User-friendly
dashboards
Ad-hoc
analysis
Analytics
Custom
reporting

21. Nursing Informatics
• Confidentiality of client
health information
• Ethics related to new
therapies
• Evaluating the quality of
information
• Information /cyber security
• Potential health and
personal problems from too
much technology.

22. Skyrocketing Healthcare Costs

23. Healthcare Consumerism and
"E-Health
• Honest packaging
• Labeling
• Advertising
• Fair pricing
• Improved safety standards

24. Challenges related to Staffing
• Inadequate accreditation standards-
adequate number of staff members in a
time of advancing patient activity and
limited resources.
• Inadequate staffing, i.e. short staffing.
• Floating staff from unit to unit

25. Multi-Generational Workforce
• Nursing leaders are faced with four distinct generations
of nurses which each offer their own set of values, work
ethics, and communications style. .
• Address generational differences as a whole in order to
nurture an environment of open and respected dialogue
concerning expectations as well as what factors both
attract and promote retention of these nurses

26. Multi-Generational Workforce

27. Day to day Problems in Nursing
Shortage of
nurses.
Lack of
motivation.
Negative
attitude.
Lack of
training.
Lack of team
approach.
Inactive
participation
of program
Lack of
interpersonal
relationship

28. Lack of Synchronicity in Team work
• Language barriers
• Distractions
• Physical proximity
• Difference in Personalities
• Workload
• Varying communication styles
• Conflict
• Lack of verification of information
• Shift change

29. Creating an empowered work
environment
• Strategies are simple to integrate into daily
practice and have been shown to improve
team performance:
• Situation−Background−Assessment–
Recommendation (SBAR)
• Call-Outs
• Check-Backs
• Handoffs

30. Compassion Satisfaction vs fatigue
• Compassion fatigue has been defined as loss of
satisfaction that comes from doing one’s job well, or job-
related distress that outweighs job satisfaction.
• A reaction to our work environment, burnout can stem
from such conditions as short-staffing, long work hours,
workplace incivility, and feeling dismissed or invalidated.

31. Evolving professional models
• Magnet recognition: eg. Stem cell collection nurse
• Synergy model: patient’s characteristics (stability,
complexity, predictability, vulnerability, compensation,
anticipation in decision making)
• Clinical Nurse Leaders: nurse’s characteristics
(adequacy, advocacy, moral agency, caring practices,
facilitation of learning, collaboration, system thinking)

32. Burnout among Preceptors

33. Workforce demand
Large demand for nurses is anticipated

34. Challenges –Performance Appraisal

35. Other Challenges
• Collective Bargaining
• Recruitment and Retention Experienced Nurses
• Medical tourism
• Review of accident reports
• Risk management
• Utilization review
• Self – governance
• Stigma

36. Challenges in Nursing Audit
• It may be considered as a punishment to
professional group.
• Medico- legal importance- They feel that they
will be used in court of law as any document can
be called for in a court law.
• Many components may make analysis difficult.
• Time consuming
• It requires a team of trained auditors

37. Collaboration Issues
The nursing profession is faced with increasingly
complex health care issues driven by
• Technological and medical advancements
• An ageing population
• Increased numbers of people living with chronic
disease
• Spiraling costs.

38. Ethical Challenges
• Nurse administrators are held to a high standard of
ethics when it comes to patients, co-workers and
themselves.
• Protect & promote human rights and values
• Meeting the needs of the less fortunate and vulnerable
patients
• Keeping patients' information confidential
• Protecting patients from negligent co-workers who may
endanger them.
• The individual nurse must not endanger the patient and
has to be accountable to the standards of the field.

39. Cyberchondria
People who have an
“intolerance of uncertainty”
engage in “safety
behaviors” - such as
checking symptoms online
- to reduce their distress.

40. The Era of Educated Consumer, Alternative
Therapies, Genomics, & Palliative Care
• Today's patient is a well-informed consumer who expects
to participate in decisions affecting personal and family
health care.
• The impact of the Human Genome Project and related
genetic and cloning research is unparalleled
• Palliative and End-of-Life Care Technological
advancements in the treatment of illness and disease
have created new modalities that extend life while
challenging traditional ethical and societal values
regarding death and dying.

41. The New Face of Nursing: Challenges for
Workforce Advocacy
• Nurses have expressed advocacy is
contextually complex, controversial and risky
component of the nursing practice.
• Nurses need to be empowered by creating
opportunities to speak by overcoming the
barriers.

42. Facilitators & Barriers for Advocacy among
Nurses
• Descriptive Research designResearch Design
• 130 NursesSample
• Purposive Sampling Technique
Sampling
Technique
• Tertiary Care hospitalSetting
• Modified Hans Protective Nursing
Advocacy scale (HPNAS)Tools

43. Facilitators & Barriers of Advocacy
among Nurses

44. Nursing Empowerment
Objectives: To assess the status of nursing empowerment and the
areas of strengthening of nursing empowerment
• Descriptive research designResearch Design
• 40 nursing personnel in various cadresSample
• Purposive sampling techniqueSampling Technique
• Continental hospital, HyderabadSetting
• Structured questionnaire
Tools

45. Results
100% 100% 100%
10% 10%
27%
13%
7%
0%
5%
10%
15%
20%
25%
30%
Percentage Distribution of
Nurses Empowered Problem areas

46. Workplace Hazards& work
place violence

47. Challenges in Nursing Education

48. Challenges in Nursing Research
• Researcher competencies
• Culture prioritize more on clinical practice
• Ethical issues
• Evidence based practice
• Financial constraints
• Lack of guidance, support & resources
• Ambiguity in relation to research role
expectations
• Patient care outcomes

49. Nurses as Visionary leaders
• Strengthening nursing at the Directorates of both Central and State level
for policy level reforms
• Promoting Nurses role in the health care services
• Promoting reforms in the educational institutions for strengthening the
nurses workforce
• Strengthening nursing management issues at the INC & SNC and TNAI
• Networking, partnership and advocacy at the
national and international levels
• Resolving Human resources management issues

50. Breaking the barriers
• Encourage cooperation & healthy competition.
• Allow individual autonomy.
• Approach work from smarter view, not harder.
• Uncover values continuously to form
organization wide visions.
• Stimulate open learning through discussion
generating -creative tension.

51. Celebrating Nursing Power
• EBP cheerleaders
• Change agents-multiple benchmark systems
• Nursing auditors & Entrepreneurs.

52. Best practices for Nurse Leaders

53. Leadership governance

54. Conclusion
• Nurse managers are rich with ideas of what patients, providers, and
systems need.

55. Any queries ???