Nursing Management

2. WARD MANAGEMENT
AND
METHODS OF PATIENT
ASSIGNMENT

3. INTRODUCTION
Management is a process that
involves planning, organizing, directing and controlling
resources to achieve desired goals. Resources include
man, money, material and methods. It is also an activity
that involves getting the work done through others by
directing their efforts, decision-making and interpersonal
relationship .

4. Introduction contd...
ward management plays a very important role in a
hospital. Wards are the local units of the hospital is
headed by the head nurse. she holds the responsibility to
manage each word peacefully without any issues, as it
reflects the quality of care at the hospital.

5. Definition Of Ward Management
🍓 Ward management can be defined as the optimal
utilization of the ward resources to produce maximum output
namely care and Comfort of patients.
- Net source.
🍓Ward management is managing the work of a ward
that involves planning, organizing, directing and controlling
the staff material and support services of the unit to achieve
the best patient care.
- Jogindra vati (2020)

6. CONCEPTS OF WARD MANAGEMENT
💉Ward is the place for patient care unit for the treatment
of admitted patients.
💉 It is also a block, which forms a division in hospital that
is shared by patients, who needs similar kinds of care.
💉Number and types of words depends upon the type of
hospital like District Hospital, General Hospital, referred
hospital and specialised hospitals and may be private
voluntary, aided or Government hospitals.

7. Concepts of ward management contd...
💉Mostly there are 2 types of warts i.e general and
special wards example intensive care units pediatric ward
and psychiatric ward.
💉 All the departments of a hospital including all wards
are involved in caring for the sick and injured in the
aspect of promoting health, preventing diseases,
education, teaching and research.
💉As the ward nursing unit is the place for patients to
stay it becomes the center for coordinating all efforts

8. ORGANIZATION OF WARD MANAGEMENT:
HEAD NURSE OF THE ENTIRE DEPARTMENT
MED
WARD
SUR
WARD
GERI
WARD
ORTHO
WARD
OT
OBG
WARD
PAED
WARD
MHN
WARD
WARD INCHARGE STAFF NURSE
EACH WARD HAS;
SENIOR NURSE – 1,
JUNIOR NURSE – 1.
STUDENT NURSE, ATTENDANT
AND SWEEPER

9. Objectives Of Ward Management :
Make sure that the highest possible quality of patient
care is provided.
Provide a clean, safe, comfortable and free from
infection, accident and hazards environment.
Help staff in achieving the highest level of work
satisfaction.
Ensure all the facilities are available to meet the needs of
the patient and their attendants.

10. Objectives Of Ward Management contd...
Direct and supervise staff working under a hesd nurse.
Coordinate and communicate with team members
Establish and maintain professional code of ethics in
clinical practice and among staff.
Provide the sense of highest job satisfaction among the
staff members.
Ensure maximum utilization of hospital resources.

11. PRINCIPLES OF WARD MANAGEMENT
The principles of ward management are as
follows;
📌 Identify the staff of the word as their most significant
asset.
📌 Recognize the value and importance of each person
associated and inspire them for their best thinking and
performance.
📌Approach every task in an organised conscious manner
to achieve the outcome.

12. Principles of ward management contd...
📌 Established definite short term and long range objectives
to ensure most significant accomplishment.
📌 Secure full attainment of goals through general
understanding and acceptance of them by others.
📌Utilise resources carefully to achieve the most significant
possible benefits.
📌Keep individual faculty of the team well adjusted by
ensuring that each one knows what he or she is supported to
do, how well with what authority and what type of work
relationship he are she has with others.

13. Principles of ward management contd...
📌Concentrate on individual improvement through regular
review of performance and potential.
📌 Private an opportunity for assistance and guidance in
self development and a fundamental of institution for
growth.
📌 Maintain adequate and timely incentive and rewards for
an increase in human efforts.
📌 Supply work satisfaction for those who perform their
work and those who are served by it.Be flexible to meet the
changing conditions and emergencies

15. RESPONSIBILITIES OF NURSING PERSONNEL
INVOLVED MANAGEMENT
Responsibilities of the head nurse :
* To plan the duty roaster
* To control and coordinate the activities of the special wards
* To plan all the activities done by ward in-charge.
* To supervisor nursing care being rendered for all patients
To conduct nursing rounds
* To conduct rounds to maintain enrolment register of all
the staff and ward in charge.

16. Responsibilities of the head nurse contd...
* To allocate the alternative staff in case of absentee.
* To conduct meeting the subordinate staff and provide
guidance and teaching.
* To ensure proper functioning of all class iv workers.
* To frequently supervise all wards to maintain
cleanliness.

17. RESPONSIBILITIES OF THE WARD IN-CHARGE
SISTERS:
* Report to the head nurse about any issues.
* Plan control and supervise the activity of the subordinates.
* Ensure ward cleanliness safety and security
* Oversee the patient conditions regularly.
* Conduct ward rounds with staff nurse and plan her daily
activities accordingly.
* Coordinate the shift schedule day or night.
* Meet the healthcare needs of all patients in the ward.

18. RESPONSIBILITIES OF THE SENIOR STAFF NURSES:
* They have to report to the ward duty in time and sign in
the register.
* The allocate duties the juniors and student nurses.
* They provide individual care to the patients.
* They write and record the patient details.
* They report the patient care to ward in-charge regularly.
* They maintain the patient care sheets.

19. Responsibilities of the senior staff nurses contd...
* They maintain the patient care sheets.
* They oversee the work of class iv workers.
* They keep in the units neat and clean.
* They identify and order and need of the supplies for
approval from ward in-charge for patient care.

20. FACTORS AFFECTING WARD MANAGEMENT :
1.Knowledge of the ward means knowledge of the ward
duties and activities.
2.Planning the schedule.
3.Starting the work on time.
4.Preventing interruptions.
5.Establishment of word routines.
6.Use of democratic method in establishing ward policy.
7.Orientation of new personnel.

21. Factors affecting ward management contd...
8.Organization of
- hospital and
- ward / unit
9.Maintenance of suitable environment
10.Providing supplies and equipments in hospital
11.Clear cut, specific orders for medical therapy and
nursing
12.Record keeping, maintaining accurate record is essential
for good management.

22. Factors affecting ward management contd...
13.Reporting.
14.Maintenance of high morale.
15.Establishment of good relationship
16.Delegating responsibility
17.Assigning duties and responsibilities.
18.Time planning.
19.Good teaching
20.Good supervision

23. COMPONENTS OF WARD MANAGEMENT
Patient
care
Personnel
Supplies and
equipment
Environment
Interpretation
of ward
policies

24. COMPONENTS OF WARD MANAGEMENT
a. MANAGEMENT OF PATIENT CARE
1.Admission and orientation of the patient
2.Assessment of the needs of patients and planning care
3.Prioritizes nursing care
4.Planned and incidental teaching
5.Supervision of patient care
6.Planning a program for the improvement of patient care
7.Preparing patient for discharge.

25. Management of patient care contd...
8.Assignment of personnel for patient care
9.Planning the time schedules and work schedules.
10.Ward rounds
11.Reports and records
12.Management of emergencies
13.Patient education
14.Appraisal of nursing services

26. b. MANAGEMENT OF PERSONNEL
A. Management of
nursing staff
B.Management of
class IV staffs
Management of
personnel

27. A. Components of Managing the Nursing Staff
Induction and orientation
Supervision and delegation
Interpersonal relationship
Performance evaluation
Staff conferences
Staff development
Health, safety and staff welfare

28. B.Management of class IV staffs:
🧴Prepares the duty schedule and keeps a record of their off
days.
🧴Adjust casual leaves, compensatory leaves and earned
leaves
🧴Forwards late attendance and absentesim to the sanitary
inspector
🧴Request for a substitute against absenties.
🧴Fills the annual confidence report and send to sanitary
inspector.

29. C.MANAGEMENT OF SUPPLIES AND
EQUIPMENTS :
✂️Apply the principles of material management
✂️The head nurse ensures proper utilization of the supplies
and equipment by the stuff.
✂️ Follow the hospital policies regarding indentings and
maintaining supplies and equipment.

30. D.MANAGEMENT OF ENVIRONMENT:
* Regulation of atmospheric temperature humidity and ventilation.
* Adequate lighting.
* Prevention of noise
* Safe water supply
* Elimination of unpleasant odors.
* Safe disposal of excreta.
* Dust control
* Free from insects and pest

31. Management of environment contd...
* Protection from all types of injuries
* Protection from radiation
* Provide adequate privacy
* Restriction of visitors
* Prevention of infection

32. e. INTEGRATING WARD POLICIES:
Patient and patient
care
Ward management
Staff
Medical staff
Policies
related
to

33. *Admission policy.
*Orientation policy
* Visiting hour policy
* Diet policy
* Policy regarding sample
collection,
* Preoperative and post -
operative policy
* Transfer policy
* Discharge policy
* Leave against medical advice
and discharge on request
* Last office policy
* For absconding policy and
* policy for medico legal
cases.
Policies related to patient and patient care :

34. * Central sterile supply
* Indent policy
* Records and report policy
* Census policy
* Drug policy
* Linen policy
* Sanitation policy
* Hand washing policy
* Policy for prevention of
infection
* Waste management policy
* Ward rounds policy
* Standard operative
procedures
Policies related to ward management

35. * Policy on orientation for new team.
* Policy for time schedule and assignment of staff
* Leave policy
* Discipline policy
* Supervision and appraisal
* Policy for staff development
Policies related to staff

36. Policies for the medical staff
* The staff this is the mediator between doctors and patients
* The ward sister / senior sisters should accompany on
medical rounds
* All instructions are written by a doctor
* The senior staff should inform the senior doctor during an
emergency during the day or night.

37. FACTORS INVOLVED IN GOOD WARD
MANAGEMENT :
The factors involving in good ward
management are as follows:
1.A planned program/ work schedule for each day’s work
2.Beginning the day on time
3.Preventing interruptions
4.Establishment of ward routines and policies
5. Use of democratic method in establishing ward policies
6. Orientation to newly joined staffs.

38. FACTORS INVOLVED IN GOOD WARD MANAGEMENT :
7.Maintaining a safe and healthy work environment
8.Provision of adequate supplies and equipment for efficient work
9.Clear cut doctors and nurses instructions
10.Accurate reports and records
11.Keeping high morale and interpersonal relationship among
staffs
12.Delegation of responsibility
13.Proper schedule plans
14.Good teaching and supervision
15.Periodically evaluation of the team.

39. CRITERIA TO BE FULFILLED FOR GOOD NURSING
MANAGEMENT :
1.All the staff should work with team spirit.
2.Organization should ensure positive reinforcement by rewarding
staff talent.
3.Good economic and improve working conditions for all the staff
should be established.
4.Following unity in direction and unity in command.
5.Strict observation of rules and regulations.

40. Criteria to be fulfilled for good nursing management contd...
6.Organization should ensure conducting regular medical and
nursing audit.
7.Organization should provide orientation, training for the newly
appointed staff and encourage their talents.
8.Provision in service education and continuing education
9.Guidance and the counselling
10.Trained talented administration to control and oversee the
entire environment process of patient care.

41. ROLE OF HEAD NURSE IN PATIENT CARE
1.Admissions and discharges
2.Management of patient discharges
3.Doctors rounds activities to be performed
- before activities
- during the doctors rounds
- after rounds
4.Drug administration
5.Operation Theatre administration
6.Inter departmental coordination and Reporting.

43. METHODS OF PATIENT ASSIGNMENT
INTRODUCTION
One important function of the professional
nurse at the first line management position of nursing
service department organising the activities of the staff into
a workable pattern to meet patient needs

44. Methods of patient assignment contd...
Planning of patient assignment is not a mere
matter of dividing up the patients among the available
members of the staff but it is an assigning an individual
patient or group of patients to nurses according to the
patients nursing care needs and nurses ability to give care to
those assigned patients.

45. MEANING OF PATIENT ASSIGNMENT :
The patient assignment is delegating or
assigning duties to the trained nurses for the care of a group
of patients admitted in the unit
The terms nursing assignment patterns,
nursing assignment systems and
organization mode of nursing care synonymously refer to
the methods of patient assignment.

46. DEFINITION OF PATIENT ASSIGNMENT
Patient assignment refers to “ a written delegation
of duties to care for a group of patients by trained persons assigned
to the unit
- Nisha Clement (2018).
The method of patient assignment is a process or system
by which nurses deliver the care to the assigned patients.The
nurses are responsible and accountable for the care of patients.
- J.Vati(2020).

47. OBJECTIVES OF PATIENT ASSIGNMENT :
* To promote good health in the patient with the best
possible nursing care.
* To plan assignments that are interesting and stimulating
to professional growth.
* To provide a broad education and experience for each
student nurse.
* To achieve good ward management.

48. PURPOSES OF ASSIGNMENT IN HOSPITAL SERVICES :
* Explain what is to be done and describe to how to do it.
* Provide the instructions and tasks to subordinates to carry out
their work as scheduled.
*Control and supervise their activities assigned.
* Motivate to meet the firm goals
* Provide a proper leadership to control the hospital services.

49. PRINCIPLES OF PATIENT ASSIGNMENT :
The principles of assignments are as follows,
1.Assigning the task of patient care by that head nurse
2.Following the departmental policies and guidelines
3.Considering patients needs, unit activities and
geographical location of the unit.
4.Assigning equal and balanced workload among staff and
duty and rotation

50. Principles of patient assignment contd...
5.Considering capabilities experiences and interest of
nursing staff
6.Patient assignment planned for nurses to grow in
professional competencies and necessarily involve the
fulfillment of student education requirements
7.Assuring continuity of care and selecting the method well
in advance .
8.Documenting and making everyone familiar.

51. FACTORS INFLUENCING PATIENT ASSIGNMENT
* Availability of nursing workforce
* Organizational complexity
* Severity of illness
* Patient characteristics
* Physical design of the unit
* Nursing resources
* Organization support
* The financial health of the institution
* Recommendation of the accrediting body

52. METHODS OF PATIENT ASSIGNMENT :
Functional nursing
Team nursing
Modular or District nursing
Progressive patient care
Primary nursing
Case management
Private duty nursing
Collaborative practice
Differentiated practice

53. FUNCTIONAL NURSING :
The functional method of patient assignment is
efficient method,it aims to get the task at that least cost of
time and staff.
This method developed in the late of 1800’s due to the
acute sort of nurses, increased demand for hospital nursing
and tasks.

54. Head nurse
Nurse 1
Treatment
Nurse 3
planing care
Nurse 2
Checking
vital signs
Nurse 4
Hygeine
and care
Of All Unit Patient Care
FUNCTIONAL NURSING :

55. ADVANTAGES OF THE FUNCTIONAL NURSING :
* Emphasize the concept of specialization and division of
labor.
* Requires less number of nurses
* It is a quite economical and efficient way of doing work.
* Carries out some activities within the limited period of
time Makes the nurses competent to carried out the assigned
task repeatedly.

56. Advantages of functional nursing contd...
* Helps establish managerial control over the planning job.
* Is appropriate for handling emergencies
* Ensure the less confusion of the nurse over the
assignment.
* Requires minimum articles and equipment of care.

57. DISADVANTAGES OF FUNCTIONAL NURSING :
* Is task focused and not patient focused.
* More mechanical than the humanistic.
* Requires some nurses to look after one patient through
different activities.
* Causes communication barriers and among various persons.
* No nurse is responsible for overall responsibility of the
patient.
* Neglects the holistic approach
* Make the nurse task oriented rather than the patient oriented.

58. TEAM NURSING
The concept of team nursing was introduced in the
early 1950’s response to the dissatisfaction of the nurses
with the functional method.

59. Head nurse
TEAM LEADER
RN
TEAM LEADER RN
Assigned Patients
TEAM NURSING :
ASSOCIATE RN ASSOCIATE RN
NURSE AID NURSE AID
Assigned Patients

60. ADVANTAGES OF TEAM NURSING :
* Offer comprehensive care from all expertise
* Ensures the integration of nursing personnel with varying skills into
a team.
* Focuses on patient needs than on staff member needs.
* Enhances communication and coordination.
* Offers cohesive participation by the team members in decision
making
* Fosters a sense of contribution via the team
* Improves patient care by using diverse skills
* Economizes time and efforts.

61. DISADVANTAGES OF TEAM NURSING :
There is a possibility of in-continuity of care due to change
in the leaders, team members and patient assignment.
None is accountable for total patient care
There is role confusion and resentment against team leaders
It requires knowledgeable and skilled leader with leadership
qualities.
It needs more staff.

62. MODULAR (OR) DISTRICT NURSING:
The modular nursing method has a combination of
functional and team nursing methods with some
modifications.

63. Head nurse
Geographic patient
unit I
Geographic patient
unit II
Patient care team
MODULAR (or) DISTRICT NURSING :
ASSOCIATE RN
NURSE AID
Patient care team
ASSOCIATE RN
NURSE AID

64. MERITS OF MODULAR NURSING :
* Nursing care hours are usually cost –effective
* The client is he able to identify personnel who are
responsible for his care.
* All care is directed by a registered nurse
* Continuity of care is improved when staff members are
constantly assigned to the same schedule.
* The RN team leader is able to be more involved in
planning and coordinating care.

65. Merits of modular nursing contd...
* Geographic closeness and more efficient communication
save staff time.
* Feelings of participation and belonging are facilitated
with team members.
* Workload can be balanced and shared.
* Division of labour allows/members the opportunity to
develop leadership.
* Continuity of care is facilitated especially if teams are
constant. Everyone has the opportunity to contribute to the
care plan.

66. Demerits of Modular nursing :
* Cost may be increased to stock each module
* Establishing the team concepts takes more resources
* Unstable staffing pattern
* Less individual responsibility
* All personal must be client centered.
* The team leader must have complex skills and knowledge.

67. PROGRESSIVE PATIENT CARE ( PPC )
It is a method in which the client care
provide various levels of care. The clients are evaluated
with respect all the level of care.
PRINCIPLE ELEMENTS OF PPC :
Intensive
care
Inter
mediate
care
Convalescent
care
Long
Term
care
Home
care
Ambulatory
care

68. MERITS OF PPC :
* Efficient use in Made of personnel and equipment.
* Clients are in the best place to receive the care they require.
* Use of nursing skills and expertise are maximized.
* Clients are moved towards self care independence is fostered
where indicated.
* Efficient use and placement of equipment is possible *
Personnel have greater probability to function towards their fullest
capacity.

69. DEMERITS OF PPC :
* There may be discomfort to clients who are moved often.
* Continuity of care is difficult
* Long term nurse /client relationships are difficult to
arrange.
* Great emphasis is placed on comprehensive, written care
plan.
* There is often times difficulty in meeting administrative
need of the organization.

70. PRIMARY CARE NURSING
It was developed in 1960s with the aim of placing
RN at the bedside and improving the professional
relationship among the staff members.
* In acute care - 1 patient
* In intermediate care - 3 patients are under the Care of
primary care nursing

71. PRIMARY CARE NURSING
PRIMARY
NURSE
COMMUNICATE
WITH
SUPERVISORS
CONSULTS WITH
PHYSICIAN OR
OTHER
HEALTH CARE
ASSOCIATES [DAY OR AFTERNOON OR
EVENING]
WHEN PRIMARY NURSE IS NOT AVAILABLE
TOTAL PATIENT CARE 24 HRS / DAY
PATIENTS

72. ADVANTAGES PRIMARY CARE SYSTEM:
* Is good for long term care rehabilitation units and nursing
clinics.
* Primary nurses are in a position care of entire needs of
person holistically.
* High patient and family satisfaction.
* Promotes registered nurses responsibility or autonomy
accountability and coverage.
* Focusing Patients centred care
* Increases coordination and continuity of care

73. DISADVANTAGES OF PCN :
* More nurses are required for this method
* Level of expertise and commitment may differ from nurse
to nurse
* Associate nurses find the difficulties
* It may be cost effective
* May create conflict between primary and associate nurses
* Stress of round the clock responsibility
* Difficulty hiring all registered nurse.
* Confines talent to his/her own patient

74. CASE MANAGEMENT
The case manager (RN or social worker
with managerial qualification) is assigned responsibility
following a patient’s care and progress from the diagnostic
phase through hospitalization rehabilitation and back to
home care.

75. Responsibilities of the case manager :
* Accessing clients and their homes and communities
* Coordinating and planning client care
* Collaborating with other health professionals in the
provision of care
* Monitoring client progress and outcomes
* Advocating for clients moving through the services
needed
* Serving as liasion with the 3rd party payers in planning the
client care.

76. MERITS OF CASE MANAGEMENT :
* Case management provides a well coordinated care
experience that can improve the care outcome.
* Provides comprehensive care for those with complex
health problems
* It seeks the active involvement of the patient family and
diverse healthcare professionals

77. DEMERITS OF CASE MANAGEMENT :
* Nurses identify more obstacles in the implementation of this
service, financial barriers and lack of administrative support.
* Expensive
* Nurse is client focused and outcome oriented.
* Facilitated and promotes coordination of cost effective care
* It requires professionally autonomous role of the nurses.

78. PRIVATE NURSING
This nursing care delivery system was a popular as
care nursing, private duty nursing is one nurse carrying for
one client. According to this system the private duty nurse
responsible for one patient who is responsible for adding total
care.
ADVANTAGES
* Is based on the need of the patient.
* Focuses on the therapeutic nurse client relationship
* Increases nurse and client satisfaction with care delivery

79. DISADVANTAGES OF PRIVATE NURSING :
*Is a costly model
*Offers slow efficiency
*Lacks of job security and job motility.

80. Collaborative practice
Collaborative practice can include
interdisciplinary team nurse physician interaction in joint
practice nurse physician collaboration in care giving.
The American Nurses Association and the
American nurses Medical Association established the
National joint practice committee in 1972 is suppoerts the
collaborative nursing care.

82. DIFFERENTIATED PRACTICE
It refers to the difference between professional
and technical nursing. Completion of decision making,
timeline of care and structure of setting are its main
distinctive features.
Professional nurses received a baccalaureate or
graduate degree. They give direct care to the clients with
complex interactions of nursing diagnosis and related to
their families from pre admission to post discharge in a
variety of more or less structured settings.

83. Factors influencing the quality of patient care :
The total number of patient to be nursed.
The degree of illness of patients
Types of services(medical or surgical)
The total needs of the patient
Method of nursing care
Number of nursing aids and other non professisonal available.
The amount type and location of equipment and supplies
The acuteness of the service and rate of turnover of patients
according to the degree or period of illness
The experience of the analysis who are give patient care.
The physical facilities
The number of non nurses who giving care to the patients
The number of working hours in the working week of the nurses
Method of performing nursing procedures
Affliation of the hospital with the medical school
Methods of assignment individual or functional method

84. Summary
so far we discussed about the ward management
by the head nurse in the various aspects, objectives
functions, principles and the good qualities, factors
affecting in ward management and components of word
management, factors improved to the ward management
and criteria to be fulfilled for effective word management
and the methods of patient assignment, we in detail
discussed about the patient assignment objectives purposes
and principles under the various methods advantages and
disadvantages.

85. Conclusion :
Ward is a place nursing and patient care unit
for the treatment of admitting patients. Hospitals are the
institutions where the patients are treated and provided
shelter during their illness. The coordinated effort of all
healthcare workers helps the patient to recover quickly
from the illness. A nurse is an important part of the
healthcare team the overall goal of nursing is to meet the
patients nursing needs with the available resources
effectively by the method of patient assignment

86. THEORY APPLICATION
• FLORENCE NIGHTINGALE’S ENVIRONMENTAL
THEORY
NURSING ACTIONS
methods of patient
assignment Team Nursing
HEALTH
PATIENT
ENVIRONMENT
Patients treatment room
arrangement according to
his comfort

87. Journal application
Title of the study
Nursing management of general ward under the COVID-19
outbreak
Author : Fanglian yi.et.al.,
Findings of the study
COVID-19 is complicated and is of high possibility of
management of cross infection management of patients
should be isolated during treatment with relatively long
recovering period. Therefore effective nursing management
with following of cleaning and disinfection of the medical
ward takes important place in the prevention and control of
the pandemic.

88. Assignment
write an assignment about the methods of patient
assignment followed in Government Medical College
hospital, Cuddalore in their respective department
intensive care units.