Management in nursing

1. CURRENTS TRENDS AND
ISSUES IN
MANAGEMENT IN
NURSING SERVICE
- Anju Bista
1st year, MSc nursing
BPKMCH

2. INTRODUCTION
 Nursing has undergone dramatically change due to
advancement of medical sciences and technology,
abundance of clinical research and higher demands of
consumer in response to social needs and influences.
Nursing we practice today is different from nursing as
it was practiced years ago and it is expanded to
continue changing during the 21st century.
 With rapid changes occurring in health care
management system and more changes coming to take
place, so the shift over in nursing is also taking place
from the past.

3. Contd…
 In the previous days nursing service was limited within
the hospital, with the advancement of time and
technologies the nursing service has expanded as
school health nurse, nursing administrator, nurse
practitioner, nurse researcher, home care nurse, hospice
nurse etc.
 There are many issues occurring in nursing
management .these were the obstacles to provide
proper nursing services to the patients and public at
large and off course to up-liftment to the nursing
profession at large.

4. Contd…
 Coming days, there is no doubt that our in management
level in disease prevention diagnosis and treatment
modalities for illness and disease ,with increasing
demand for quality health care and health related
information will disseminated by high technology.

5. Meaning
Trends :
 Trends are the general direction in which something’s
tends to move.
 Trends mean movement in a particular direction
according to time, environment and situation as
everything in this world is changeable.
 It also denotes general directions and tendencies
especially of events, of opinion or movements in a
particular direction.
 Trends is the event that occurs overtime and shows a
series of fluctuation in its patterns. ( Stanhope
lancaser).

6. Nursing trends:
 A trend in nursing is change that is taking place in
present days in any field of nursing ,which affects the
profession as a whole.
 Refers to direction towards which the different nursing
event have moved or are moving as well as the opinion
in and around nursing that are found in and about
nursing profession.
 Nursing trend seen in these current days in different
field of nursing which affects the profession as a
whole, the current changes in nursing area and
influencing the profession.

7. Historical perspective(as per India)
 Nursing has developed to their present status over the last hundred
years. There has been much variation in the rate of development
even though there are similarities in the basic pattern. The events,
which have taken place, are being divided into four phases:
 The early period in which the foundation were laid.
 The year up to world war II in which a basic pattern was more or
less standardized.
 The war years which gave an impetus to nursing education.
 The year after independence marked by the development of public
health nursing and start of degree programmers in nursing.

8. Before independence.
 This is after criminal war where Florence nightingale played a noticeable
role ,she sent questionnaire to British military for obtaining figures of
sickness an d mortality rate among them.
 Recommendations made by Florence nightingale led to the beginning of
organized nursing and lots of event took place in Nursing sectors are:
 Mission hospitals were being set in different part of India at about the same
time. Religion prevented Hindu and Muslim girls from joining, so only
Christian girls could be trained first.

9. Contd…
 She has raised a dufferin fund interest in care of
children and women in 1885 and started the National
Association for supplying for supplying aid by women
to women of India.
 Ms Atkinson was brought from England to Bombay to
set up and become superintendent of first modern
training school for nurses in India in 1891.

10. After independence
 During the first 10 years of independence three has been a considerable
development in all fields of social welfare; nursing has been one of them.
 A broader and more varied field of work has been opened for nurses,
greater opportunities for further study and wider professional contacts,
both at home and abroad have been available.

11. Trends in Nursing
Area Past Present
Focus Hospital community
Purpose Curative Promotive and
preventive
Nature General specialized
Simplicity Bedside High-tech
Assignment Functional centered Patient centered
Patient perspective Patient as individual
identity
Holistic approach
Role Basic role Multi roles.
Practitioner. Dependent role Independent
practitioner.

12. Emerging trends in Nursing
managements.
 In the nursing service ,there are various changes that
took place are related to care, nursing process and
quality nursing ,audit, theories, documentation etc.

13. Some others emerging trends
are:
1. Professional judgment
2. Defining care
3. Specialized care
4. Concept of nursing process,
nursing diagnosis.
5. Quality assurance and
nursing standards.
6. Nursing audit.
7. Nursing research and
evidence based learning.
8. Concept of nursing theories
and application of theoretical
models.
9. Multi disciplinary health
nursing.
10. Concept of primary health
care /community health
nursing.
11. Individualized care
12. Information system
13. Electric networking and tele-
conferencing documentation.
14. Independent areas of
practice.
15. In – service education
programmers

14. Current trends in nursing
managements are:
1. Computerization for patient
care management.
2. Rising public expectations.
3. Changing Demographics and
Increasing Diversity
4. Reduction in distance
through use of advance
communication.
5. Decentralize approach used
for care management.
6. Quality assurance in nursing.
7. Continuing nursing
education.
8. Evidence based practice.
9. Nursing audits.
10. Collective bargaining.
11. Diverse of responsibilities.
12. Increased specialization.
13. Educated consumer.
14. Creating safer work
environment.
15. Increased need for doctoral
education.
16. Changing role of women in
society .

15. 1. Computerization for patient care
management
 Easy reference on direction for patient care, record keeping,
reporting complication of information, stock monitoring
,auditing are some of the function which have taken over.
 Ability to use computers for patient care management has
become essential qualities for nurses.

16. 2.Rising public expectations
 The public is becoming better informed and more assertive
about health services, sometimes challenging the
professional decision. Patients group are increasing
negotiating with professional about the care they want.
 At the same time concerns with human rights, equity,
accountability and ethical issues will come to the forefront
of debate and action.

17. 3.Changing Demographics and
Increasing Diversity
 One of the more obvious trends affecting the nursing
profession, and even the healthcare world, in general, is one
of patient demographics.
 Global migration, changes in composition and ethnic
mixture of populations, changes in family structures and
functions and growing aging population will challenge the
health care system’s ability to provide efficient and
effective continuing care.

18. 4.Reduction in distance through us
of advance communication
 Use of this advance communication application in this
current time have made it all possible for the nurses to
reach patient, doctor and profession whenever need arise.
 Along with verbal and non verbal communication skill,
nurses also need to gain competencies in using information
and technology.

19. 5. Decentralize approach used for
health care management
 This makes nurse accountable and responsible care of
assigned patient.
 It focuses on problem solving on the spot with the joint
participation of the supervisee and supervisor.
 This approach is most applicable where work responsibility
will be decentralized.
 This is effective in terms of patient satisfaction, quality care
and smooth functioning of the units

20. 6. Quality assurance in
nursing
 Public knows their right, human rights commissions,
protection acts and process etc , are putting constant
pressure on the professionals to deliver their best.
 Nurse managers have to ensure delivery of quality care by
practicing as per standard laid down by their counsels and
institutions.

21. 7. Continuing nursing
education
 Continuing nursing education become essential to keep up
with the changing needs of patient care.
 Nurses have to continuous update themselves with new and
innovative approaches in patient care management.
 To update and enhance the knowledge they should enables
themselves with workshops ,seminars, short term in-service
training programs, attend conferences, and bedside
discussion will lead to update with newer techniques and
information.

22. 8. Evidence based practice
 For this nurses should have scientific bend of mind and
dynamic approach to patient care.
 There has been a significant advancement in nursing
science and research .there is need for enhanced mentorship
for new researcher to strengthen skills and capacity to
conduct meaningful nursing research.

23. 9. Nursing audit
 Nursing audits is required to keep the activities on the right
track. It build knowledge for the profession.
 Regular nursing audits promotes ensures quality of care
provided to the client and up-liftment of standard.

24. 10. Collective bargaining
 Collective bargaining is the uniting of the
employee for the purpose of increasing their
ability to influence their employees for the
purpose of increasing their ability to influence
their employer and to improve the working
conditions.

25. 11.Diverse of responsibilities
 Nurse working in the hospital, homes , communities are
accountable for diagnosis, prevention and management of
various health problems.
 Primary health care, patient education, health promotion,
rehabilitation ,self care and alternative methods of healing
are the added responsibilities.
 To carry out such responsibilities , the nurses need to have
diverse skills.

26. 12. Increased specialization
 The demand for nurses who specialize in specific area like
leadership in nursing ,nursing manager, psychiatry,
gerontology e.t.c is on the rise.
 Specialization enables the nurse to be an expert in the area
in which he or she is providing care.
 It also opens the door to opportunities for career
advancement.
 Specialization and subsequent certification provides the
patient and the health care institution with assurance that
the nurse is highly knowledgeable and competent in a
specific area of care.

27. 13. Educated Consumer
 Education and technology advancement brings about a
growing awareness of health needs among people.
 Patient is a well-informed consumer – expects to participate
in decisions affecting personal and family health care.
 Previously unavailable information is now public
information.
 People have knowledge about health promotion as well as
disease prevention and also there is an increased acceptance
and demand for alternative and complementary health
options.

28. 14. Creating Safer Work
Environments
 Today’s nurse works in very complex, stressful
environments. In addition to needle sticks, infections,
musculoskeletal injuries, and other typical workplace
dangers, viral outbreaks like Ebola, H1N1 ,covid 19 and
more have served to increase the attention being placed on
creating and maintaining safer working environments.
 Nurses must be prepared to handle whatever the next “big
thing” is that comes along.

29. 15. Increasing need for doctoral
education
 The number of nurses enrolling in doctoral education
programs is growing, specifically for the doctor of nursing
practice.

30. 16. Changing role of women in
society
 Women are now becoming educated and active .
 The status of nurses as women is improving in the society.
They are now independent ,good leadership skill, can take
decision independently for themselves and client in any
critical condition.

31. Factors involve in affecting current
nursing service trends
 Changing scenario of government towards health care.
 Computers and technology changes health care delivery
 Information and efforts to standardize and unify nursing
language.
 Case management, disease management, and tale-health
care expand.

32. Contd…
 Diverse responsibilities.
 Educated consumers.
 Changing role of women in society.
 Changes in medical, paramedical, and allied professions.
 International influence and contribution of international
organizations.
 Expanding nursing roles.

33. Contd…
 Evidence –based care and best practices are emphasized.
 New ethical concerns.
 Wellness centers, holistic and alternative therapies.
 Nursing wellness and healthy working environment is
stressed.
 Lifelong learning is required

34. Contd…
 Nurses must prove value.
 Nurses’ roles as leaders and managers essential.
 Shared governance and collaborative decision making.
 Nursing shortage threatens patients care.
 Nursing education goes online.
 Standards and practice guidance’s.

35. Issues:-
 A point or matter of discussion, debate or dispute or a
matter of public concern.
 Issues are those point or subject matter of discussion,
debate or dispute or a matter of public concerns.

36. Issue
 Further it can also be defined as:-
 A misgiving, objection ,or complaint.
 The essential point.
 It is a culminating point leading to a decision.

37. Current issues in nursing service.
 Nursing has its own identity as profession. It is no more a
paramedical profession. This nomenclature is respected of
nursing personnel has long been dropped by WHO but still
we find some of the authorities call nursing as paramedical
profession.
 Such an attitude towards nursing has done considerable
harm and lowered nursing I
 mages and status as profession.

38. Contd..
 Even though some changes have occurred but issues
occurring in nursing service is same, tough the government
has made some effort.
 As per delocia ,Ott and palmier(2009 ) they said there are
working situation issues for nurses as they are found to
work in poor environmental condition.
 There are many issues occurring in nursing service ,which
turn and can turn as the obstacles to render the nursing care
to the patient and public.

39. Issues at the sate and districts
level:
 No availability of documents related to policy , planning
and budget.
 Power vested with medical personnel in the planning of
nursing services.
 Shortage of nursing manpower.
 Accountability of nursing personnel towards the duties
other than nursing care .
 Negative role perception and role demand.
 Extremely poor maintenance of supply of equipment and
drugs.

40. Contd..
 Poor infrastructure.
 Irregular pattern of working.
 Negligible in-service training and absence of a good
reference library.
 Very poor maintenance of patient records system.
 Unsatisfactory pay and no incentives for promotion and
offering better service.
 No concern for occupational hazard and health safety for
nurses.
 No nursing auditing.

41. Issues in management in local levels
 Role confusion.
 Restricted power and authority.
 Scarce of resource allocation.
 Poor supervision and health monitoring in health institution
 Role confusion.
 Staff health and safety issues.
 Poor job security.
 Exploitation.

42. Issues related to nursing
administration and services.
 As per Henery Lorensen and Hirchfield.
Major issues are:
1. Lack of nurses prepared to work in nursing administration.
2. Acute shortage of nurses.
3. No relationship between nursing service and nursing education.
4. Lack of authority in administrative structure.
5. Lack of participation by nurses and other auxiliaries and also with
physicians.
6. Lack of teamwork spirit.
7. Lack of resources, both material and financial.

43. Current challenges in
management in health service
in Nepal:
 A finding of US (Buchan , j 2010) health personnel
management has been through the challenges of shortage
and most vacant position which are unfulfilled where as
there is issues and challenges of nurse patient ratio which
leads to risky and regression of quality nurse care.

44.  Research done in central level hospital finding illustrate
that the challenges for health management and health
personnel were employment problem, security problem( job
and social security), workload, lack of professional
empowerment, low pay job setting ,exploitation, lack of
monitoring in health institution for quality care services.(
poudel, 2010)

45. Challenges:
1. Staffing:
 Staffing issues is experienced by maximum nurse
manager. Staffing takes a tremendous amount of time of
nurse leader.
 Nurse leaders schedule shifts, but ensuring safe staffing
involves careful calculation. Nurse leaders must account for
the potential for overtime and preventing it as much as
possible.

46. 2. Budgeting:
 Budget allocation is not appropriate each time so nurse
leaders must walk a tight line to manage the use of staff and
supplies to provide safe and efficient care within tough
financial constraints.
 Nurse managers and their staff are increasingly being called
upon to do more with less which forces them to continuing
look for ways to improve efficiency.

47. 3. Boosting morale and avoiding burnout:-
 Morale issues and burnout can also have detrimental effects on the
physical and psychological health of those employees who have no
intention of leaving the unit.
 Nurse leaders are in a prime position to boost team morale and help
staff avoid burnout. Forging strong relationships with nursing team
members, acknowledging and addressing their concerns, and
rewarding them when they succeed can help show them that they are
cared for and respected and that can go a long way toward making
them feel appreciated and helping them avoid burning out.

48. 4. Retaining Nurses.
 Retention is a constant concern for nursing leaders. The constant demands
of patient care, pitted against staffing limitations, long shifts, and corporate
quality initiatives that complicate the delivery of care, have many nurses
rethinking their career goal.
 Being sensitive to those differences and managing with generational
sensitivity is crucial to retaining good nurses from all generations.
 But many of the biggest imperatives related to job satisfaction for nurses
could be respecting work/life balance, providing the tools and resources to
succeed, acknowledging good work, and building more authentic, personal
relationships. Providing this personal care for every nurse can help keep
them invested in their roles.

49. 5. Migration of Nurses.
 Migration of health worker is one of the biggest issues that
is faced by country today. Since most of the nurses
graduated from different institutions have started leaving
the country in search of better jobs abroad and further study
as the demand of nurses in developed countries is
increasing.

50. 6. Employment problem.
 Global need of the nurse are increasing day by day with
progression of disease ,illness and need of for preventive
care too. Even though we have so many count of hospitals
but many certified nurses are having issue in job placement.
 The reason behind this could be massive production of
nursing colleges due to which nursing products are in
increasing state thus only few getting
opportunities.(chhetri,B & koirala, P, 2017)
 Hospitals are running with inadequate number of nursing
staffs in spite of huge patients’ flow and at the same time
not maintaining nurse patients ’ ratio.

51. 7. Political influence in health system management.
 Instability in political sector, health ministry is major issue
in nurse service management.
 As one appointed health minister makes the health policy
and development plan but before implementation of these
plan whole department will change and plan and policy will
be aborted.

52. 8. Lack of resources during this pandemic.
 Country and county people are facing a huge
communicable disease covid -19 .almost every sector are
effected and monthly heath personnel.
 The great challenges if to service towards covid19 patients
or normal patients with minimum supply of personnel
protective equipment.

53. How to meet these
challenges?
 Strengthen involvement of nurses in health and nursing
policy formulation and planning.
 Empower nursing leadership.
 Develop and implement a quality assurance system for the
nursing service.
 Ensure nursing workforce management as an integral part
of human resource planning and human system
development.

54. Contd…
 Enhance nursing autonomy in practice.
 Enforce implementation of recommendation norms on
nurse patient ratio.
 Produce advanced practice nurses.
 Ensure appropriate facilities and adequate equipment and
suppliers.

55.  Promote evidence based practice and nursing research.
 Establish a continuing nursing education system.
 Improve pay scales, incentives systems and working
condition.
 Ensure quality of nursing education by strengthening
nursing programs, increasing qualified nurse educators and
allocate appropriate resources to maximize efficiency and
effectiveness.

56. Reference
 https://nursinganswers.net/essays/the-contemporary-issues-in-the-
professional-practice-nursing-essay.php.
 https://www.ukessays.com/essays/nursing/current-issues-and-future-
perspectives-of-nursing-workloads.php.
 http://nhrc.gov.np/wp-content/uploads/2019/04/Annual-Report-of-NHRC-
2074-75.pdf.
 Vatti, J.Principles and practice of nursing management and administration
for bsc and msc nursing.1st edi(20). jyapee publication.
 Sharma, M.Nursing concepts and principles.samiskhya publication
pvt.ltd.3rd edi(2019).new plaza,putalisadak.

57. Thank you