administration introduction.pdf

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Nursing and MidwiferyResearch Journal, Vol-4, No. 3, July, 2008
Organisational structure and nursing
service management of select Hospitals
Sushma Kumari Saini, Charanjeev Singh
Abstract : Organisational structure means the formal structure of authority calculated to define,
distribute and provide for the co-ordination of tasks and contributions to the whole which is very
essential for fulfilling the objectives of an organisation. In order to understand the functioning of an
organisation, it is important to study its organisation structure. Keeping it in mind a study was
conducted to study the organisation structure of nursing department and nursing service management
of three select hospitals i.e. one Autonomous hospital, one private hospital and one state government
hospital. Investigator visited all the three hospitals and information related to organisation structure
and nursing service management was collected from the nursing office. Results revealed that all the
three hospitals had different organisational structure with different nursing positions and cadres.
None of the hospital had all the positions as recommended by the Indian Nursing Council (a statuary
body) and High Power Committee 1990. However, there was partial implementation of the
recommendations in all the select hospitals. There was a wide scope for improvement in these
hospitals as regards the nursing personnel is concerned. If the decision making regarding nursing is
vested in the hands of nursing administrators then better nursing services can be rendered which will
help in turn in providing better services to patients.
Key words :
Organisational structure, nursing service
management.
Introduction
Whenever a group of people is involved
in the accomplishment of a task, some kind
of an organisation emerges. A sort of
hierarchy develops; some one assumes the
responsibility of leadership and direction in
particular part of task, and there is some
grouping.1
It is not exaggeration to say that
we are living in the age of an 'organisation
man' who accepts the organisation goals as
the value premises of his decisions. The
Correspondenceat :
SushmaKumari Saini
Lecturer
National Instituteof Nursing Education, Chandigarh
..

73
modern society is termed as 'organisation
society' - that is, a society in which a great
deal of our working time is spent in
organisations, such as schools, universities,
work place, places of worship, recreation and
health care.2
Organisation refers to the
structure of relationships among position
jobs, which is created to achieve certain
objective and control the activities of man with
a mechanism. Organisation is the process of
identifying and grouping the work to be
performed, specifying the work, defining and
delegating the responsibility with authority to
the personnel and establishing interpersonal
relationship for the purpose of co-ordination
of work, so as to get the work done together
effectively, and in accomplishing the objectives
of the organisation/institution/enterprise. 3
An
organisation comes into being when there are
persons who are:
i) Able to communicate with each other;
ii) Willing to contribute their services; and
iii) Linked together and who co-ordinate
their efforts to accomplish the common
objectives. 4
The hospital is also an organisation and
an integral part of the social and medical
organisation, the function of which is to
provide for the population, complete health
care, both 'curative' and 'preventive' and whose
out patient services reach out to the family
and its environment; the hospital is also a
centre for the training of health workers and
biosocial research. A modern hospital is an
institution, which possesses adequate
accommodation and well qualified and
experienced personnel to provide services of
curative, restorative preventive and promotive
characters of the highest quality possible to
all people, regardless of race, colour, creed
or economic status. It conducts educational
and training programmes for the health
personnel particularly required for patient care
and hospital services. It also conducts
research in assisting the advancement of
medical services and hospital services and
conducts programmes of health education. 4
Hospitals can be classified as per
ownership/control, clinical basis, length of
stay of patients and teaching or non-teaching
status. As per ownership basis the hospitals
can be public, voluntary, private and corporate
hospitals. The public hospitals can be further
classified as Central Government Hospitals
and State Government Hospitals. In the
present study we have covered three teaching
hospitals, which differ as per their ownership
i.e. an autonomous, a private and a State
Government hospital.
Irrespective of the classification of
hospital the primary function of a hospital is
the provision of medical care to a community,
to be a centre for education and research for
all types of health professionals. In order to
meet all these needs, the hospital works
through many departments, which deal with
different kinds of services e.g. medical,
nursing, pharmacy, laboratory services etc.
Among all these services the nursing service
is that part of the hospital which aims to
satisfy the nursing needs of the patient and
community. The nursing service is closest to
the patients 24 hours of the day and seven

74
days of the week. Nursing personnel also
usually constitute the largest proportion of the
hospital staff. Planning, organizing, directing
and coordinating the individualized care of
hospitalised patient is the most important
function of a hospital nursing service. All other
nursing functions and activities are related to
it. A hospital may be soundly organised,
beautifully situated and well equipped but if
nursing care is not of quality the hospital will
fail in its responsibility.4
Therefore, a study is
conducted to study the organisational
structure of Nursing department and nursing
service management in three selected
hospitals.
Methodology
The Union Territory (UT) Chandigarh is
surrounded by three states namely Punjab,
Haryana and Himachal Pradesh. The teaching
hospitals of Chandigarh and its surrounding
states were selected for study. UT Chandigarh
and States of Punjab, Haryana and Himachal
Pradesh have three types of teaching
hospitals i.e. State Government Hospitals,
Private Hospitals and Autonomous hospitals.
There were total seven State Government
Hospitals two Private Hospitals and one
autonomous hospital. One hospital from each
category was selected by lottery method i.e.
one Autonomous hospital, one private hospital
and one state government hospital was
selected for study. Bed strength of the
hospitals was 1359, 657, and 1260
respectively.
Permission for data collection was
sought from Medical Superintendents of the
three select hospitals. Investigator visited all
the three hospitals and information related to
organisation structure and nursing service
management was collected from the nursing
office. Secondary data was collected from
books, available records, bibliography and
review of documents.
Results
Organisational structure
Organisational structure of Nursing
Department of all three hospitals is depicted
in the organisation chart of nursing services
of these hospitals as shown in Figure 2.1, 2.2
and 2.3, respectively. Having a closer look at
these charts, it can be observed that the
Director was the overall incharge of the
Institute, and the Medical Superintendent was
overall incharge of the Hospital under whose
supervision the Nursing Department worked.
The Chief Nursing Officer headed the
Nursing Department in Autonomous hospital
and in the other two hospitals nursing
depar tment is headed by Nursing
Superintendent. She was responsible for
administration and management of the
Nursing Department. She was directly
responsible to Medical Superintendent and
through the Medical Superintendent to the
Director. In Autonomous hospital the post of
Nursing Superintendent was next to the Chief
Nursing Officer and she was responsible to
the Chief Nursing Officer in the hospital for
administration and management of nursing
services.

75
Next to the Nursing Superintendent in
Autonomous hospital were one Deputy
Nursing Superintendent Educator, one Deputy
Nursing Superintendent Epidemiologist and
11 Deputy Nursing Superintendents. The
Deputy Nursing Superintendent (Educator)
was responsible for in-service education of
nursing staff and Deputy Nursing
Superintendent (Epidemiologist) was
responsible for infection control in the hospital
in collaboration with the doctor in charge of
Infection Control from the Microbiology
Department. The Deputy Nursing
Superintendent was responsible for the
services in the area/block assigned to her e.g.
Operation Theatre, Emergency, Outpatient
Department, Advance Paediatric Centre or
different blocks of Nehru Hospitals (A, B, C,
D, F, Cobalt and Kidney Block).
Figure: 2.1: Organisational structure of nursing department of Autonomous hospital
Deputy
Nursing Superintendent
(Educator) (1)
Nursing
Sister Grade - II
(836)
Nursing
Sister Grade - I
(272)
Assistant
Nursing Superintendent (53)
Deputy
Nursing Superintendent (11)
Deputy
(Epidemologist) (1)
Chief Nursing Officer (1)
Medical Superintendent
Director

76
Figure: 2.2: Organisational structure of
nursing department or Private Hospital
Auxilliary
Nurse and
Midwife
(84)
Staff Nurse
(400)
Nursing Sisters
(33)
Supervisor/
Professors/
Readers/
Lecturers (29)
Assistant Nursing
Superintendent/
Reader (1)
Deputy Nursing
Superintendent/
Reader (1)
Nursing Superintendent/
Professor (1)
Director Principal
Staff Nurse
(463)
Nursing Sister
(92)
Matron
(4)
Nursing Superitendent
(1)
Director Principal
Figure 2.3: Organisational structure of
nursing department of State Government
Hospital
Each one of them was responsible to
the Chief Nursing Officer and Nursing
Superintendent. Whereas in Private hospital
next to the Nursing Superintendent there was
only one Deputy Nursing Superintendent who
was responsible to the Nursing
Superintendent and assisted her/him in the
Nursing Service Administration of the

77
hospital. While in State Government Hospital
next to the Nursing Superintendent there were
4 Matrons/Deputy Nursing Superintendents.
Each Matron/Deputy Nursing Superintendent
was responsible for the administration and
management of nursing services in a specified
area (e.g. one floor of main building) assigned
to her. She was responsible to the Nursing
Superintendent.
Next to 11 Deputy Nursing
Superintendents in Autonomous hospital there
were 53 Assistant Nursing Superintendents
who were responsible for management of
Nursing Services of one or more wards/areas
assigned to her. She was responsible to the
Deputy Nursing Superintendent of her area.
Whereas, in Private hospital there was only
one Assistant Nursing Superintendent who
assisted the Deputy Nursing Superintendent
and Nursing Superintendent for the over all
services of the entire hospital. She was
responsible to the Deputy Nursing
Superintendent. While in State Government
Hospital this level did not exist.
In Private hospital next to the Assistant
Nursing Superintendent there was another
level i.e. Supervisors. There were 29
Supervisors who were responsible for
services of their respective ward/area where
they were posted. This level did not exist in
other two hospitals.
Next level in all the hospitals was
Nursing Sister/Sister Grade-I who was
responsible for nursing care management of
a ward or area assigned to her/him. She was
responsible for ward management and
supervision and helped Sister Grade-II for
providing bedside patient care. She was
responsible for the safety and comfort of the
patient. In Autonomous hospital there were
3-4 Nursing Sister/Sister Grade-I in each ward
i.e. total 272 Nursing Sister/Sister Grade-I.
They were responsible to the Assistant
Nursing Superintendent of their ward/area,
whereas, in State Government Hospital there
were 92 Nursing Sister i.e. 1-3 Nursing
Sisters posted in each ward/area. They were
responsible to the Matron/Deputy Nursing
Superintendent of their area. While in Private
hospital there were 33 Nursing Sisters. Only
one Nursing Sister was posted in each ward/
area and she was responsible to the
Supervisor of the ward/ area.
Next level in all the hospitals was the
Staff Nurse/Sister Grade-II. They were the first
level professional nurses who provided direct
patient care to a patient or group of patients
assigned to her/him during duty shift. She was
responsible to the Nursing Sister/Sister Grade-
I of her ward/area. In Private hospital there
were 84 Auxiliary Nurses and midwives who
assisted the Sister Grade-II in providing
nursing care to the patients. This level did not
exist in other two hospitals.
The difference, which was observed in
three hospitals, was that in Autonomous
hospital and State Government Hospital the
nursing department of the hospital and the
nursing faculty of the College of Nursing were
working independently, whereas in Private

78
hospital they were working in collaboration.
Faculty of College of Nursing and hospital
nursing staff on senior positions with higher
qualification (M.Sc. Nursing and above) are
given dual responsibilities i.e. supervision of
nursing staff and teaching to Nursing students
of College of Nursing. They were given dual
designations such as Nursing
Superintendents/Professor, Deputy Nursing
Superintendent/Reader, Assistant Nursing
Superintendent/Reader and Nursing Sister/
Clinical Instructor. Similarly, the college faculty
was responsible for the supervision of nursing
personnel in hospitals along with the teaching
responsibilities of nursing students. They
were designated as Professor/Supervisor,
Reader/Supervisor or Lecturer/Supervisor
whereas Clinical Instructors from College were
not given this dual responsibility. The dual
responsibility helped the nursing personnel
to work in collaboration.
Job Cadre and Classification
The purpose of a classification scheme
is to categorize and rank different positions
so that the type and level of each rank can be
used as a mean of securing equal pay for
substantially equal work. The class or position
include those that is sufficiently similar in the
content of work, in the level of difficulty and
in the responsibility and qualification
requirement of the work as to warrant similar
treatment in personnel and pay
administration. A Grade includes all classes
of position which, they though differ in the
kind or content of the work, but are sufficiently
equivalent in the level of difficulty and
responsibility or qualification, required to
warrant including them in one range of basic
compensation. 1
Table 2.1 depicts cadre of nursing
personnel at select hospitals. A close look at
the data reveals that all the three hospitals had
different cadre classification. In Autonomous
hospital cadre classification of all staff was A,
B, C and D. Chief Nursing Officer and Nursing
Superintendent were covered under Cadre-
'A' while Deputy Nursing Superintendent and
Assistant Nursing Superintendent were
covered under Cadre-B and Nursing Sister
Grade-I and II were 'C' cadre employees
whereas in Private hospital their employees
were grouped under three categories i.e.
Group-I, II and III. Here Nursing
Superintendent, Deputy Nursing
Superintendent, Assistant Nursing
Superintendent, Supervisors and Nursing
Sisters were covered under Group-I
employees and Staff Nurses were covered
under Group-II employees. Whereas, in State
Government Hospital the employees were
grouped in four cadres i.e. Class-I, II, III and
IV. The Nursing Superintendent and Matron
were Class-II employees and Nursing Sister
and Staff Nurses were Class-III employees
whereas, no nursing personnel had come
under Class-I.

79
Table-2.1: Cadre wise distribution of nursing staff of selected hospitals
Cadre
Designation Autonomous Private State Government
Hospital Hospital Hospital
Chief Nursing Officer 'A' N.A. N.A.
Nursing Superintendent 'A' Group - I Class - II
Deputy Nursing Superintendent/Matron 'B' Group - I Class - II
Deputy Nursing Superintendent (Educator) 'B' N.A. N.A.
Deputy Nursing Superintendent
(Epidemiologist) 'B' N.A. N.A.
Assistant Nursing Superintendent 'B' Group - I N.A.
Supervisor N.A. Group - I N.A.
Nursing Sister/Nursing Sister Grade-I 'C' Group - I Class - III
Staff Nurse /Nursing Sister Grade-II 'C' Group - II Class - III
N.A.: Not applicable
Pay Scale and Allowances of Nursing
Staff of Select Hospitals
Pay scales of Nursing Staff of select
hospitals are depicted in Table 2.2. It can be
observed thatNursing Superintendent, Deputy
Nursing Superintendent, Assistant Nursing
Superintendents from Private hospital had a
higher pay scale than their counterparts in
Autonomous hospital and State Government
Hospital. This was so, because they were
getting UGC pay scales, because of their dual
responsibility. Further, the Nursing
Superintendent and Deputy Nursing
Superintendent of Autonomous hospital were
getting higher pay scales than their
counterparts in the State Government
Hospital. The Nursing Sister/Nursing Sister
Grade-I and Staff.

80
Table 2.2: Pay scale of nursing staff of select hospitals
Pay Scale
Designation Autonomous Hospital Private Hospital State
Government Hospital
Chief Nursing Officer 10,000-325-15200 - -
Nursing Superintendent 8000-275-13500 16400-450-500-23000 6500-200-10500
Deputy Nursing Superintendent / Matron 7500-250-1200 12000-420-18300 6500-200-9900
Deputy Nursing Superintendent (Educator) 7500-250-12000 - -
Deputy Nursing Superintendent
(Epidemiologist) 7500-250-12000 - -
Assistant Nursing Superintendent 6500-200-10500 12000-420-18300
Supervisor/Professor/Reader/Lecturer
" Professor - 16400-450-500-23000 -
" Reader - 12000-420-18300 -
" Lecturer - 8000-275-13500 -
Nursing Sister/Nursing Sister Grade-I 5500-175-9000 5500-180-200-11100 5500-175-9000
Nursing Sister/Nursing Sister Grade-II 5000-150-8500 5000-150-200-8100 5000-150-7850

81
Table-2.3: Fringe benefits of nursing staff of select hospitals
Fringe Benefits Autonomous Private State Government
Hospital Hospital Hospital
Housing Accommodation in Accommodation in Accommodation in
campus for senior campus for campus for
nurses - All Group-I employees senior nurses
OR - 50% Group-II employees OR
Housing allowance OR Housing allowance
15% of basic pay Housing Allowance 7½% of basic pay
- Rs. 1000/- for
Nursing Sister
- Rs. 500/- for Staff Nurse
Medical Free medical facilities Group-I -50% medicine Rs. 125/- per
for self and dependents free and 50% employees month fixed
has to pay medical allowance.
Group-II -90% medicine For indoor admission
free and 10% reimbursement of bills
employees has to pay paid for self and
Group-III - 90% medicine dependents
free and 10%
employees has to pay
Nursing
Allowance Rs. 1600/- per month -NA- Rs. 200/- per month
Washing
Allowance Rs. 400/- per month -NA- Included in nursing
allowance
Transportation
Allowance Rs. 75/- to Rs. 200/- -NA- -NA-
for those who do not
stay in campus Staff
bus facility
Education
Allowance Two special increments One special increments -NA-
for higher qualification for higher qualification
Creche Facility A round the clock No -NA-
crèche facility

82
Nurse/Nursing Sister Grade-II in all the
select hospitals had more or less similar pay
scales.
Allowances of Nursing Staff are
illustrated in Table 2.3. Findings reveal that all
the select hospitals provided free hostel
accommodation for nurses, while some
married nurses were given quarters and the
nursing personnel who did not get
accommodation, were given housing
allowance. In Autonomous hospital housing
allowance was 15 per cent of Basic Pay and
in State Government Hospital it was 7½ per
cent of Basic Pay whereas in Private hospital
a fixed amount was given to Staff Nurse (Rs.
500/- per month) and Nursing Sisters (Rs.
1000/- per month) and the rest were provided
accommodation within the institute. Regarding
medical allowance in Autonomous hospital
there were free medical facilities for self and
dependents whereas in Private hospital for
Group-I employee 50 per centmedicines were
free and for Group - II and III employees 90
per cent medicines were free of cost. While in
State Government Hospital employees got a
fixed Medical Allowance for outdoor treatment
and for indoor treatment bills for self and
dependents were reimbursed (being a state
government owned, the rules applicable to
government employees were in vogue).
The nursing allowance and washing
allowances were higher in Autonomous
hospital as compared to State Government
Hospital. No Nursing Allowance was given in
Private hospital. While transport allowance/
bus facility was available to the employees of
Autonomous hospital, it is not so for the
employees of the other two hospitals.
Similarly, round the clock crèche facility was
available for the children of the nursing staff
of Autonomous hospital, while such facility
was not available in the other two hospitals.
Data related to authorised leaves is
shown in Table 2.4. It indicates that
Autonomous hospital staff got similar number
of earned leave irrespective of cadre or length
of service whereas in Private hospital Group-
I employees gets more annual leaves as
compared to Group-II employees, and in State
Government Hospital the number of earned
leaves increased with the years in service.
Regarding casual leaves, State Government
Hospital nurses got 25 days casual leave
whereas it was 10 days in Private hospital and
8 days in Autonomous hospital. Further,
employees of Autonomous hospital and State
Government Hospital got 10 days medical
leave or 20 half days per year while nurses in
Private hospital got 15 days medical leave per
year.

83
Table 2.4: Leave pattern of nursing staff of select hospitals
Leave Autonomous Private Hospital State Government
Hospital Hospital
Earned leave • One month in a year Annual Leave Earned Leave:
• Group-I: 42days • 1st10 years - 15 days/year
• Group-II: 28days • Next10 years -20days/year
• After 20 years - 25 days/year
• After 25 years - 30 days/year
Casual Leave • 8 days in a year • 10 days in a year • 25 days/year
Medical Leave • 10days or 20half • 15 days in a year • 10 days or 20 half days in a year
days in a year
• Nine days off per • Eight days off per
monthfor shift monthfor shiftduty staff
duty staff
Days off • Six days off for • One and half • Four days off for straight
straight shift + day per week shift + Gazetted holidays
Gazetted holidays
Maternity Leave • 4½months •Three months • Maternity Leave - 6 months
(Only two permitted) (one andhalf month (only 2 permitted)
before delivery and
one and half month
after delivery
(Only two permitted)
Abortion Leave • 42days •15days •42 days
Tubectomy Leave • 15days •15days •15 days
Education Leave • Two years with •Two years with • Two Years with
full pay 50percent pay 50percent pay
(Permitted only once) (Permitted only (Permitted only once)
once)

84
Apart from the above Autonomous
hospital staff could avail four and half month
duration of maternity leave. Where as, in
Private hospital it was only for 3 months i.e.
one and half month each before and after
delivery and the staff of State Government
Hospital could avail 6 months Maternity Leave.
All the hospitals staff got equal number of
Abortion and/or Tubectomy Leave, Education
Leave of two years with pay was permissible
to nurses of Autonomous hospital. Whereas
in other two hospitals 2 years education leave
with 50 per cent basic pay was permissible.
Discussion
Indian Nursing Council (INC) is a
statutory body established by the Act of
Parliament in 1947. The INC lays down
standards of nursing education through out
the country besides recommending the
optimum nurse-patient ratio and education
requirements for various positions of the
nursing staff. Apart from it Government of
India had set up various committees fromtime
to time to lay down standards for nursing
practice. The latest of these committees was
the High Power Committee on Nursing
Profession set up by Central Government of
India, which presented its report in March
1990, and has been accepted by Government
of India in principle were not in accordance
to the recommendations as the High Power
Committee, which had recommended a
separate Directorate of Nursing in each state/
Union Territory. Under the Directorate of
Nursing all the three sections i.e. Nursing
Service, Nursing Education and Community
Nursing Services. 5,6 However, it was found
out that none of the states and the Union
Territory had established this directorate and
as such none of the select hospitals worked
under separate Directorate of Nursing. Apart
from a separate Directorate none of the select
hospitals had all the nursing positions as
recommended by it i.e. post of Chief Nursing
Office existed only in Autonomous hospital
whereas State Government Hospital did not
had the post of ANS and in Autonomous
hospital post of Supervisor did not existed.
As regards the organisation structure
of the select hospitals it was found that in
Private hospital nurses working in higher
positions were given dual responsibilities i.e.
of supervising nursing personnel in hospital
and teaching nursing students in College of
Nursing. Hence, they were given dual
designations i.e. Nursing Superintendent/
Professor,

85
Figure 2.4: Recommended organisational structure at State/Union Territory Level by
High Power Committee
Public Health
Nurse
at PHC
Public Health
Nursing Officer
District Nursing
Officer
Deputy Additional
Director
Nursing Services
Community Nursing
Additional Director
Nursing Services
Community Nursing
Tutor
Senior Tutor
Principal
School of Nursing
Deputy Additional
Director
Nursing Services
Nursing Education and Researh
Additional Director
Nursing Services
Nursing Education
and Research
Assistant
Deputy
Deputy Additional
Director
Nursing Services
Hospital Nursing Services
Nursing Services
Hospital Nursing
Service
Joint Deputy
Director
Nursing Services
Director
Nursing Service
Secretary Health
Additional Director
Auxilliary Nurse
and Midwife
Lady Health
Visitor
(HSP)
Clinical Instructor
Staff Nurse
Ward Sister

86
DNS/Reader, ANS/Reader, Supervisor/
Professor/ Reader/ Lecturers. This helped in
promoting close association and collaboration
of nursing education and nursing service
department. This kind of collaboration was
not there in other two hospitals.
It was observed that more than 90 per
cent of nurses from Autonomous hospital and
State Government Hospital were Group-C/
Class-III employees. In Private hospital more
than 85 per cent of nurses were Group-II
employees. The High Power Committee had
recommended at least Class-II Gazetted Ranks
for the positions of Nursing Sister and above.
5,6 However, only Private hospital the
grouping of nursing personnel was according
to recommendations where positions of
Nursing Sister and above were included in
Group-I. In other two hospitals, Nursing Sister
is included in Group-C/Class-III employees.
There is no Class-I position for nurses in State
Government Hospital.
Staff Nurses and Nursing Sisters in all
the select hospitals were placed in more or
less equal pay scales. However, a lot of
variation was observed for higher positions.
The pay scales of nurses in administrative
positions were the highest in Private hospital
followed by Autonomous hospital and the
lowest were in State Government Hospital.
Higher pay scales in Private hospital were
because they were granted University Grants
Commission (UGC) pay scales owing to their
dual responsibilities. Similarly, no uniformity
was observed for allowances albeit the High
Power Committee had recommended that
throughout the country the allowances
should be similar.
Hence, it was concluded from the
analysis that none of the select hospitals at
the time of present study had all the positions
as recommended by the INC and High Power
Committee 1990. However, there was partial
implementation of the recommendations in all
the select hospitals. There was a wide scope
for improvement in the hospitals as regards
the nursing personnel is concerned, if the
decision making related to nursing services
is vested in the hands of nursing
administrators then there will be improvement
in rendering nursing services which will help
in turn in providing better services to patients.
References
1. Freeman Ruth B, Holmes Edward M.
Administration of Public Health Services. 1st
edition. WB Saunders Company; Philadelphia
1960.
2. Rosembloom David H, Goldman
Deborah D. Public Administration. 2nd edition.
McGrawHill Book Company; New York 1989.
3. Basavanthappa BT. Nursing
Administration. 1st edition. Jaypee Brothers
Medical Publishers; New Delhi 1998.
4. Trained Nurses Association of India.
Nursing Administration and Management. 1st
edition. TNAI Publication; New Delhi 2000.
5. Trained Nurses Association of India.
IndianNursing YearBook. TNAIPublication; New
Delhi1990-92.
6. High Power Committee. High Power
Committeeon Nursing and Nursing Profession -
conclusion and recommendations. Nursing
JournalofIndia1990; 81:141-144,161-164

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