Management of nursing service

1. Management of Nursing
Services in hospital &
community

2. Definitions of hospital
1. WHO: Hospital is an integral part of a social and
medical organization, the function of which is to provide
for the population complete health care, both curative
and preventive, and whose outpatient services reach out
to the family and its environment; the hospital is also a
centre for the training of health workers and biosocial
research.
2. Stedman's Medical Dictionary: Hospital is an institution
for the care, cure and treatment of the sick and wounded,
for the study of diseases and for the training of doctors
and nurses.

3. Organisation & function of hospital
Reception
It receives patients with illnesses and directs to OPD or
emergency.
Hospital members taking care of reception are as follows:
1. Receptionist, who is skilled in communication skills.
2. Nurse, who will be present to clarify the enquiry and guide
the patients to whichever department they need to go to.
She will maintain all kinds of registers like patient admission
register, IPD register, OPD register, staff enrolment register,
complaint register, fee collection register and bill book.

4. Inpatient department
Nurse collects the inpatient number and directs the patient
towards the specific ward, checks T-P-R, weight, height and
anthropometric measurement of the patient.
She also
1. receives the patient and provides care.
2. fills the nurse's record and case sheet of patient details.
3. carries out all orders given by the physician.
4. keeps the beds and patient units clean.
5. checks all equipment, linen and supplies, and keeps them
well-stocked and in perfect working condition.
6. takes care of the patient until he/she gets discharged.
7. sends the patient to diagnostics if required.

5. Outpatient department
This department performs the following functions:
1. It receives the patient, writes the data about the
patient, collects the history and does the physical
examination in the room specified as per the patient's
disease condition.
2. Patient will be enrolled in the OPD register, given a
number for the specific consultation room. The patient
will be guided by the nurse to meet the doctor concerned.
3. After consultation, the doctor decides whether the
patient needs to be admitted for bedside care or not.

6. 4. If admission is required, OPD nurse commits the IPD
nurse to get the patient admitted.
5. OPD nurse also receives patients transferred from
other hospitals, emergency department after first aid
or from other ward transfers.
6. Nurse in OPD should be alert to direct all kind of
patients, specific to ward as per their condition.
7. Nurse maintains outpatient register and staff
register, and issues outpatient chits or cards to
patients.

7. Administrative department
There will be an administration office with a chief
administrative officer. The office will also have assistant
officers (1), secretary (1), treasury (1), clerks (2),
accountants (2 or 3), peons (2) and sweepers (2).
They function to coordinate the management activities of
the hospital. They are responsible for the following:
1. Providing salary and reimbursement to all the staff in the
hospital.
2. Maintaining and repairing the hospital building
requirements.

8. 3. Providing finance for all kinds of expenditure made
in the hospital welfare.
4. Supervising the work of all the staff.
5. Coordinating with chief medical officer and nursing
superintendent to ensure the smooth functioning of
the hospital.
6. Conducting medical and nursing audit.
7. Reporting all the functions, problems to the
governing board, providing leadership, delegating the
work to all members of the hospital.

9. Nursing department
According to the INC nurse-patient ratio, nursing
superintendent should allocate nurses as mentioned
below.
1. Nurse-patient ratio for teaching hospital-1:5
2. Nurse-patient ratio for nonteaching hospital-1:3
3. General ward-1:6
4. Special wards like child health, burns, neurology,
surgery, cardiothoracic, emergency department-1:4
5. NICU-1:2
6. ICU-1:1
7. Labour room-1:1 per table

10. 8. Operation theatre (OT): major OT-1:2 per table, minor OT-1:1
per table
9. Casualty: (a) 3 staff nurses for 24h-1:1 per shift for every 100
patients per day
10. In OPD (injection room)-if patient attendance is more than
100 patients
Per day 1 staff nurse should be allotted. For increase at 120-122
patients-2 staff nurses
For increase at 221-320 patients-3 staff nurses for increase at
321-420 patients 4 staff nurses

11. Functions of chief nursing officer
1. Nursing superintendent is the chief officer for all
the staff nurses in the hospital. She does planning,
coordination, supervision, controlling, reporting to
higher medical officer and delegating the work
schedules to other nurses.
2. She follows and adapts the patient classification
system (PCS), which helps to recruit, assign and
allocate the required staff at the right place and right
time. The PCS helps to quantify the qualities of the
needed nursing care that are essential to the
requirements of nursing unit of hospital and nursing
norms.

12. According to TNAI and INC, nursing superintendent
follows the hospital bed strength to allocate the nurses.
As per the norms, staff is delegated as follows:
a. Chief nursing officer (CNO): 1 per 500 beds
b. Nursing superintendent: 1 per 100 beds
c. Deputy nursing superintendent: 1 per 300 beds d.
Assistant nursing superintendent: 1 for 100-150 beds
e. Ward sister in charge: 1 for every 25-35 beds.

13. f. Staff nurses are allocated 1 for each 3 beds in general
ward of a teaching hospital and 1 for 5 beds in a
nonteaching hospital
g. 1 staff nurse for nursing research activities
h. For outpatient department and emergency, I staff
nurse to 100 patients
i. For ICU-1:3 or 1:1
j. Infection control nurses-1 nurse for a 250-bedded
isolation unit

14. Central sterile and supply department
(CSSD)
This is the main department responsible for supplying
sterile equipment to all the departments. It takes care
of the following:
1. Maintaining incoming stock and registers
2. Segregating trays, articles, linens and supplies that
are autocleaned, packed, labelled and readied to be
sent to each department.

15. Diagnostic department
Biomedical engineering
Dietary department
Emergency or casualty-
This is a 24-h working department equipped with
machines, beds, cots and staff. An ambulance vehicle
is always ready to collect a patient under emergency
conditions. There is always an emergency team that
keeps ready; it includes the doctor in charge,
emergency staff nurses, ward boys and anaesthetist.
They also maintain their staff and patient registers.

16. Operation theatre (OT), recovery rooms
Specialized departments
The intensive care unit (ICC), the intensive coronary
care unit (ICCU), the inten- sive medical care unit
(IMCU) and the neonatal intensive care unit (NICU) are
the specialized departments in a hospital.
Biomedical waste management department
Isolation unit
Postmortem room/ autopsy
Forensic department
Pharmacy
Physiotherapy
Research department

17. Counseling department
Housekeeping
Laundary department
Rehabilitation centre
Nursing station