Nursing administration

Introduction
UNIT V
HUMAN RESOURCESFOR HEALTH
1. STAFFING METHODS AND PHILOSOPHY
Organization is the formal structure of authority calculated to define, distribute and
provide for the co-ordination of the tasks as contribution to the whole. When the aims of
the organization properly design the planning of its institutions and its functional standard,
it will have identified the kind and numbers of personnel it needs.
The nurse executive or head of the institution will be the top of the organization. His/ her
powers and duties have, therefore, to be all-embracing and he has to develop a great share
of theirs to his subordinates, but even after doing so, he has to supervise, control and co-
ordinate that work.
Kind of staff:
The concept of Line and Staff, developed first in military organization was
barrowed from there and applied to civil organization and administration. Line refers to
the officers and units that assist the chief and other executives in their function of
planning, organization, direction, co-ordination, control, etc.,
There are three kinds of staff services and units- General Staff, Technical Staff and
Auxiliary Staff.
General staff: is the staff which helps the chief or other highly placed executive in his
administrative work generally, by advice, collection of information, research and shifting
of the important from unimportant ones, which is to go up to him, i.e. they act as filter and
funnel.
Technical staff: Consists of the technical officer who are qualified in their own field, like
engineers, doctors, nurses and experts etc.
Auxiliary staff: Consists of officers or units which perform certain duties and functions
common to the various departments but which are incidental in character, i.e. not directly a
part of those department main activities.
Terminologies
Staffing: Staffing is the systematic approach to the problem of selecting, training,
motivating and retaining professional and non professional personnel in any organization.
Promotion: To excel in a situation , rank or honor , to elevate or to advance from a given
grade or class as qualified for on higher.
Budget : A budget is a plan that uses numerical data to predict the activities of an
organization over a period of time.
Utilization : This means the nursing personnel must be assigned work in such a way that
her/his knowledge and skills are learnt best used for the purpose she/he was educated or
trained.
Responsibility : It is the obligation to account for‘s ones conduct with respect to our
assigned talk.

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STAFFING
Definition
Staffing is the systematic approach to the problem of selecting, training, motivating
and retaining professional and non professional personnel in any organization.
It involves manpower planning to have the right person in the right place and avoid
―Square peg in round hole‖.
Staffing Philosophy
Staffing is certainly one of the major problems of any nursing organization,
whether it is a hospital, nursing home, home health care agency, ambulatory care agency
or another type of facility.
Nurse staffing methodology should be an orderly, systematic process, based upon sound
rationale, applied to determine the number and kind of nursing personnel required to
provide nursing care of a predetermined standard to a group of patients in a particular
setting. The end result is prediction of the kind and number of staff required to give care to
patients. Aydelotte.
Components of the staffing process as a control system include a staffing study, a
master staffing plan, a scheduling plan, and a nursing management information system
(NMIS).
NMIS includes these five elements;
1. Quality of patient care to be delivered and its measurement.
2. Characteristics and care requirements of patients.
3. Prediction of the supply of nurse power required for components 1 &2.
4. Logistics of the staffing program pattern and its control.
5. Evaluation of the quality of care desired, thereby measuring the success of the
staffing itself.
Philosophy of staffing in nursing
Nurse administrators of a hospital nursing department might adopt the following
philosophy.
1. Nurse administrators believe that it is possible to match employee‘s knowledge
and skills to patient care needs in a manner that optimizes job satisfaction and
care quality.
2. Nurse administrators believe that the technical and humanistic care needs of
critically ill patients are complex that all aspects of that care should be
provided by professional nurses.
3. Nurse administrative believe that the health teaching and rehabilitation needs
of chronically ill patients are so complex that direct care for chronically ill
patients should be provided by professional and technical nurses.
4. Should believe that believe that patient assessment, work quantification and job
analysis should be used to determine the number of personnel in each category
to be assigned to care for patients of each type (such as coronary care, renal
failure, etc.,).
5. Should believe that a master staffing plan and policies to implement the plan in
all units should be developed centrally by the nursing heads and staff of the
hospital.
6. Should the staffing plan should be administrated at the unit level by the head
nurse, so that can change based on unit workload and workflow.

3
Mr. Channabasappa.K.M. PCON.
Staffing Policies
A policy is a predetermined and accepted curse of thoughts and actions established
as a guide towards accepted goals and objectives. Policies are generally framed by the
board of directors or the higher management while procedures are framed by high
officials.
Personnel policies serve as a guide toward the organizational purposes and assist in
preventing decisions contrary to its objective. Personnel policy is a total commitment of
the organization to act in the specified ways.
Personnel Policies gives
1. This is a predetermined course of rules or actions.
2. Policies guide the performance of objectives.
3. Policies provide the standard or ground for the decision.
The process of developing personnel policies involves the assessment of following factors:
 Identification of the purpose and objectives, which the organizations wish to attain
with regard to its work force.
 Analysis of all the factors under which the organization‘s personnel policy will be
operating.
 Examining the possible alternatives in each area in which the personnel policy
statement is necessary.
 Implementation of the policy through the development of procedures adapted to
the entire organization.
 Auditing the policy so as to reveal the necessary change.
 Continuous re-evaluation and revision of policies to meet the current needs of the
organization.
Objectives of staffing in nursing
1. Provide an all professional nurse staff in critical care units, operating rooms, labor,
delivery unit, emergency room.
2. Provide sufficient staff to permit a 1:1 nurse-patient ratio for each shift in every
critical care unit.
3. Staff the general medical ,surgical ,Obsteritic and gynecology, pediatric and
psychiatric units to achieve a 2:1 professional –practical nurse ratio.
4. Provide sufficient nursing staff in general medical, surgical, Obsteritic, pediatric
and psychiatric units to permit a 1: 5 nurse-patient ratio on a day and after noon
shifts an d1:10 nurse –patient ratio on the night shift.
5. Involves the head of the nursing staff and all nursing personnel in designing the
department overall staffing programme.
6. Design a staffing plan that specifies how many nursing personnel in each
classification will be assigned to each nursing unit for each shift and how vacation
and holiday time will be requested and scheduled .
7. Hold each head nurse responsible for translating the department master staffing
plan to sequential eight week time schedules for personnel assigned to her / his
unit.
8. Post time schedules for all personnel at least eight weeks in advance.

4
9. Empower the head nurse to adjust work schedules for unit nursing personnel to
remedy any staff excess or deficiency caused by census fluctuation or employee
absence.
10. Inform each nursing employee that request for specific vacation holiday time will
be honored within the limits imposed by patients care and labor contract
requirements .
11. Reward employees for long term services by granting individuals special time
requests on the basis of seniority.
Unit checklists of employee staffing policies
1. The person responsible for the staffing schedule and the authority of the
individuals if it is other than the employee immediate supervisor.
2. Type and length of the staffing cycle used
3. Rotation policies , if shift rotation is used
4. Fixed shift transfer policies , if fixed shifts are used.
5. Time and location of schedule posting
6. When shifts begins and end
7. Day of week schedule begins
8. Weekend off policy.
9. Tardiness policy
10. Low census procedures
11. Policy for trading days off
12. Procedure for days off request
13. Absenteeism policies
14. Policy regarding rotating to other units
15. Procedures for vacation time requests
16. Procedure for holiday time requests
17. Procedures for resolving conflicts regarding requests for days off, holidays, or
requested time off.
18. Emergency requested time off
19. Policies an procedures regarding requesting transfer to other units.
Staffing study
A staffing study should gather data about environmental factors within and outside the
organization that affect staffing requirements.
Aydelotte listed four techniques drawn from engineering to measure the work of nurses,
all of which involve the concept of time required for performance.
1. Time study and task frequency
a. Tasks and tasks elements (procedure )
b. Point and time started
c. Point and time ended
d. Sample size
e. Average time
f. Allowance for fatigue , personal variation and unavoidable standby.
g. Standard time = step 1.5 + step 1.6

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h. Frequency of task × standard time = volume of nursing work.
2. Work sampling ( variation of task frequency and time ); the procedure is as follows
a. Identify major and minor categories of nursing activities
b. Determine number of observation to be made
c. Observe random sample of nursing personnel performing activities.
d. Analyze observations: frequency occurring in a specific category = percentage
of total time spent in that activity. Most work sampling studies sample direct
care and indirect care to determine ratio.
3. Continuous sampling (variation of task frequency and time). Technique is the same
as for work sampling except that,
a. Observer follows one individual in the performance of a task.
b. Observer may observe work performed for one or more patients if they can be
observed concurrently.
4. Self-reporting ( variation of task frequency and time )
a. The individual records the work sampling or continuous sampling on himself
or herself.
b. Tasks are logged using time intervals or time tasks start and end.
c. Logs are analyzed.
According to West, ―There are three cardinal rules forecasting staffing requirements‖. The
first is to staffing projections on past staffing history; data sheet collected census report
and other data needed are sick time, overtime, holiday and vacation time.
The second cardinal rule for staffing is to review current staffing levels. Review of future
plans for the institution is the third cardinal rule. Clinical nurses who are involved in
staffing plans will have confidence in the plans. These staffing studies can be made with
electronic spreadsheets.
Staffing Methods/ Procedure
Staffing modules
Cyclic scheduling
It is one of the best ways of staffing to meet the requirements of equitable distribution of
hours of work and time. A basic time pattern for a certain number of weeks is established
and then repeated in cycles. Advantages of cyclic scheduling include the following;
 Once developed , it is a relatively permanent schedule, requiring only temporary
adjustments.
 Nurses no longer have to live in anticipation of their time off-duty, because it may
be scheduled for as long as 6 months in advance.
 Personal plans may be made in advance with a reasonable degree of reliability
 Requests plans may be made in advance with a minimum.
 It can be used with rotating, permanent or mixed shifts and can be modified to
allow fixed days off and uneven works periods , based on personnel needs and
work period preferences
 It can be modified to fit known or anticipated periods of heavy workloads of heavy
workloads and can be temporarily adjusted

6
Because cyclic scheduling relatively inflexible, it works only with a staff that rotates by
policy and personal choice. Personal who need flexible staffing to meet their personal
needs, such as those related to family and educational pursuits do not generally accept it.
An infinite number of basic cyclic patterns can be developed and tailored to suit the needs
of each unit. Patterns should reflect policy, workload, and staff preferences. Nursing
personnel may use a staffing board to develop a pattern and cycle satisfactory to them.
The staffing board is used to show the number of number of nursing personnel required for
each day of the week for 6 weeks.
Self scheduling
Self scheduling is an activity that may make a staff happier, more cohesive and more
committed. It should be planned carefully on a unit basis. Planning may use either a self-
directed work team or a quality circle technique approach. Self scheduling matches staff to
individual preferences.
It has been found to shorten scheduling time; increase retention and job satisfaction; and
reduce conflicts, illness time, voluntary absenteeism and turnover.
Self scheduling leads to more responsible employees. It meets personal goals such as
family, social life, education, childcare, and commuting. It is an example of participatory
management with decentralized decision-making. The planning must include the givens,
or rules, to be followed. These rules should be minimal to meet legal and professional
standards.
Patient Classification Systems
Patient classification system( PCS) ,which quantifies the quality of the nursing care, is
essential to staffing nursing units of hospitals and nursing homes. In selecting or
implementing a PCS , a representative committee of nurse manager can include a
representative of hospital administration, which would decrease skepticism about the PCS.
The primary aim of PCS is to be able to respond to constant variation in the care needs of
patients.
Characteristics
 Differentiate intensity of care among definite classes
 Measure and quantify care to develop a management engineering standard.
 Match nursing resources to patient care requirement .
 Relate to time and effort spent on the associated activity.
 Be economical and convenient to repot and use
 Be mutually exclusive , continuing new item under more than one unit.
 Be open to audit.
 Be understood by those who plan , schedule and control the work.
 Be individually standardized as to the procedure needed for accomplishment.
 Separate requirement for registered nurse from those of other staff.
Purposes
 The system will establish a unit of measure for nursing, that is , time , which will
be used to determine numbers and kinds of staff needed.
 Program costing and formulation of the nursing budget.
 Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service
 Determining the values of the productivity equations

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 Determine the quality: once a standards time element has been established, staffing
is adjusted to meet the aggregate times. A nurse manager can elect to staff below
the standard time to reduce costs.
Components: The first component of a PCS is a method for grouping patients categories
.Johnson indicates two methods of categorizing patients. Using categorizing method each
patient is rated on independent elements of care, each element is scorded , scores are
summarized and the patient is place din a category based on the total numerical value
obtained.
The second component of a PCS is a set of guidelines describing the way in which
patients will be classified, the frequency of the classification, and the method of reporting
data.. The third component of a PCS is the average amount of the time required for care of
a patient in each category. A method for calculating required nursing care hours is the
fourth and final component of a PCS .
Patient Care Classification
Patient Care classification using four levels of nursing care intensity
Area of care Category I Category II Category III Category IV
Eating Feeds self Needs some
help in
preparing
Cannot feed self
but is able to
chew and
swallowing
Cannot feed self
any may have
difficulty
swallowing
Grooming Almost entirely
self sufficient
Need some help
in bathing, oral
hygiene …
Unable to do
much for self
Completely
dependent
Excretion Up and to
bathroom alone
Needs some
help in getting
up to bathroom
/urinal
In bed, needs
bedpan / urinal
placed;
Completely
dependent
Comfort Self sufficient Needs some
help with
adjusting
position/ bed..
Cannot turn
without help, get
drink, adjust
position of
extremities …
Completely
dependent
General health Good Mild symptoms Acute symptoms Critically ill
Treatment Simple –
supervised,
simple
dressing…
Any Treatment
more than once
per shift, foley
catheter care,
I&O….
Any treatment
more than twice
/shift…
Any elaborate/
delicate
procedure
requiring two
nurses, vital
signs more
often than every
two hours..
Health
education and
teaching
Routine follow
up teaching
Initial teaching
of care of
ostomies; new
diabetics;
patients with
mild adverse
reactions to
their illness…
More intensive
items; teaching
of apprehensive/
mildly resistive
patients….
Teaching of
resistive
patients,

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Calculating Staffing Needs
The following are the hours of nursing care needed for each level patient per shift:
Category I Category II Category III Category IV
NCHPPD for
Day shift
2.3 2.9 3.4 4.6
NCHPPD for
P.M (Evening)
shift
2.0 2.3 2.8 3.4
NCHPPD for
night shift
0.5 1.0 2.0 2.8
A guide to staffing nursing services
1. Projecting Staffing Needs
Some steps to be taken in projecting staffing needs include:
1. Identify the components of nursing care and nursing service.
2. Define the standards of patient care to be maintained.
3. Estimate the average number of nursing hours needed for the required hours.
4. Determine the proportion of nursing hours to be provided by registered nurses
and other nursing service personnel
5. Determine polices regarding these positions and for rotation of personnel.
2. Computing number of nurses required on a Yearly Basis
1. Find the total number of general nursing hours needed in one year. Average
patient census X average nursing hours per patient for 24 hours X days in week
X weeks in year.
2. Find the number of general nursing hours needed in one year which should be
given by registered nurses and the number which should be given by ancillary
nursing personnel.
a. Number of general nursing hours per year X percent to be given by
registered nurses.
b. Number of general nursing hours per year X percent to be given be
ancillary nursing personnel.
Computing number of nurses assigned on weekly basis
1. Find the total number of general nursing hours needed in one week. Average
patient censes X average nursing hours per patient in 24 hours X days in week.
2. Find the number of general nursing hours needed in the week which should be
given by registered nurses and the number which could be given by ancillary
nursing personnel.
a. Number of general nursing hours per week X percent to be given by registered
nurses.
b. Number of general nursing hours per week X percent to be given by ancillary
nurses.

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2. STAFF INSPECTION,BAJAJ COMMITTEE, HIGH POWER
COMMITEE AND INDIAN NURSING COUNCIL
INTRODUCTION:
Nurse staffing is a constant challenge for health care facilities. Before the selection
of the employees, one has to make analysis of the particular job, which is required in the
organization, then comes the selection of personnel.
TERMINOLOGIES:
1. Staffing: Selecting and training individuals for specific job functions, and charging
them with the associated responsibilities.
2. Norms: Formal rule or standard laid down by legal, religious, or social authority against
which appropriateness (what is right or wrong) of an individual's behaviour is judged.
3. Manpower: Power in terms of the workers available to a particular group or required
for a particular task.
4. Vocationalization: Relating to, providing, or undergoing training in a special skill to be
pursued in a trade.
5. Budget: A budget is a plan that outlines an organization's financial and operational
goals.
6. Reciprocity: Mutual action; give and take.
7. Myriad: Innumerable
8. Gazetted: Gazetted is a status symbol and makes a person recognizable all over.
DEFINITION:
Staffing is a selection, training, motivating and retaining of a personnel in the
organization.
ANA PRINCIPLES OF NURSING STAFFING
The nine principles are:
I. Patient Care Unit Related
a) Appropriate staffing levels for a patient care unit reflect analysis of individual and
aggregate patient needs.
b) There is a critical need to either retire or seriously question the usefulness of the
concept of nursing hours per patient day (HPPD).
c) Unit functions necessary to support delivery of quality patient care must also be
considered in determining staffing levels.
II. Staff Related
a) The specific needs of various patient populations should determine the appropriate
clinical competencies required of the nurse practicing in that area.
b) Registered nurses must have nursing management support and representation at
both the operational level and the executive level.
c) Clinical support from experienced RNs should be readily available to those RNs
with less proficiency.

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III. Institution/Organization Related
a) Organizational policy should reflect an organizational climate that values
registered nurses and other employees as strategic assets and exhibit a true
commitment to filling budgeted positions in a timely manner.
b) All institutions should have documented competencies for nursing staff, including
agency or supplemental and travelling RNs, for those activities that they have been
authorized to perform.
c) Organizational policies should recognize the myriad needs of both patients and
nursing staff.
STAFF INSPECTION UNIT (S.I.U)
The Staff Inspection Unit was set up in 1964 with the object of effecting economy
in manpower consistent with administrative efficiency and evolving performance
standards and work norms in Government offices and Institutions wholly or substantially
dependent on Government Grants. Its officers also serve as Core Member on the
Committees appointed to scrutinize manpower requirements of Scientific and Technical
Organisations.
NORMS OF STAFFING (S I U- staff inspection unit)
Norms
Norms are standards that guide, control, and regulate individuals and communities.
For planning nursing manpower we have to follow some norms. The nursing norms are
recommended by various committees, such as; the Nursing Man Power Committee, the
High-power Committee, Dr. Bajaj Committee, and the staff inspection committee, TNAI
and INC. The norms has been recommended taking into account the workload projected in
the wards and the other areas of the hospital.
All the above committees and the staff inspection unit recommended the norms for
optimum nurse-patient ratio, such as 1:3 for Non Teaching Hospital and 1:5 for the
Teaching Hospital. The Staff Inspection Unit (S.I.U.) is the unit which has recommended
the nursing norms in the year 1991-92. As per this S.I.U. norm the present nurse-patient
ratio is based and practiced in all central government hospitals.
Recommendations of S.I.U:
1. The norms for providing staff nurses and nursing sisters in Government hospital
has been recommended taking into account the workload projected in the wards
and the other areas of the hospital.
2. The posts of nursing sisters and staff nurses have been clubbed together for
calculating the staff entitlement for performing nursing care work which the staff
nurse will continue to perform even after she is promoted to the existing scale of
nursing sister.
3. Out of the entitlement worked out on the basis of the norms, 30%posts may be
sanctioned as nursing sister. This would further improve the existing ratio of 1
nursing sister to 3 staff nurses fixed by the government in settlement with the Delhi
nurse union in May 1990.

11
4. The assistant nursing superintendents are recommended in the ratio of 1 ANS to
every 4 nursing sisters. The ANS will perform the duty presently performed by
nursing sisters and perform duty in shift also.
5. The posts of Deputy Nursing Superintendent may continue at the level of 1 DNS
per every 7 ANS
6. There will be a post of Nursing Superintendent for every hospital having 250 or
more beds.
7. There will be a post of 1 Chief Nursing Officer for every hospital having 500 or
more beds.
8. It is recommended that 45% posts added for the area of 365 days working
including 10% leave reserve (maternity leave, earned leave, and days off as nurses
are entitled for 8 days off per month and 3 National Holidays per year when doing
3 shift duties).
Most of the hospital today is following the S.I.U. norms. In this the post of the Nursing
Sisters and the Staff Nurses has been clubbed together and the work of the ward sister is
remained same as staff nurse even after promotion. The Assistant Nursing Superintendent
and the Deputy Nursing Superintendent have to do the duty of one category below of their
rank.
The Nurse-patient Ratio as per the S.I.U. Norms
1. General Ward
2. Special Ward - ( pediatrics, burns, neuro
surgery, cardio thoracic, neuro medicine,
nursing home, spinal injury, emergency
wards attached to casuality)
1:6
1:4
3. Nursery 1:2
4. I.C.U. 1:1(Nothing mentioned about the shifts)
5. Labour Room 1:l per table
6. O.T. Major - 1 :2 per table
Minor - 1:l per table
7. Casualty-
a. Casualty main attendance up to 100
patients per day thereafter
b. For every additional attendance of 35
patients
c. Gynae/ obstetric attendance
3 staff nurses for 24 hours, 1:1per shift.
1:35
3 staff nurses for 24 hours, 1:1/ shift

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d. Thereafter every additional attendance
of 15 patients.
1:15
8. Injection room OPD Attendance upto 100 patients per day 1
staff nurse
120-220 patients: 2 staff nurses
9. OPD
NAME OF THE DEPARTMENT
· Blood bank
· Paediatric
· Immunization
· Eye
· ENT
· Pre anaesthetic
· Cardio lab
· Bronchoscopy lab
· Vaccination anti rabies
· Family planning
· Medical
· Dental
· Central sample collection centre
· Orthopaedic
· Gyne
· X-ray
· Skin
· V D centre
· Chemotherapy
· Neurology
· Microbiology
· Psychiatry
· Burns
1
2
2
1
1
1
1
1
1
2
1
1
1
1
2
2
3
2
2
2
1
2
1
2

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In addition to the 10% reserve as per the extent rules, 45% posts may be added
where services are provided for 365 days in a year/ 24 hours.
The Nurse-patient Ratio as per the norms of TNAI and INC (The Indian Nursing
Council, 1985)
The norms are based on Hospital Beds.
Chief Nursing Officer: 1 per 500 beds
Nursing Superintendent: 1 per 400 beds or above
D.N.S.: 1 per 300 beds and 1 additional for every 200
beds
A.N.S.: 1 for 100-150 beds or 3-4 wards
Ward Sister: 1 for 25-30 beds or one ward. 30% leave
reserve
Staff Nurse: 1 for 3 beds in Teaching Hospital in general ward& 1 for 5 beds in Non-
teaching Hospital +30% Leave reserve.
Extra Nursing staff to be provided for departmental research function.
For OPD and Emergency: 1 staff nurse for 100 patients (1: 100) + 30% leave reserve
For Intensive Care unit (I.C.U.) - 1:1 or (1:3 for each shift) +30% leave reserve.
It is suggested that for 250 bedded hospitals there should be One Infection Control Nurse
(ICN).
For specialised departments, such as Operation Theatre, Labour Room, etc. 1:25 +30%
leave reserve. Norms are not based on Nursing Hours or Patient's Needs here.
The key to success of any hospital primarily depends upon its human resource
than any other single factor. The core determinants of staffing in the hospital organization
are quality, quantity and utilization of its personnel keeping in view the structure and
process. The staffing norms should aim at matching the individual aspiration to the aims
and objectives of the organization.
MAN-POWER PLANNING:
Man power planning may be defined as a strategy for the acquisition, utilization,
improvement and preservation of the human resources of an organization. This involves
ensuring that organization has enough of the right kind of people at the right time and also
adjusting the requirements to the available supply.
The main objectives of man power planning
1. Ensuring maximum utilization of the personnel
2. Assessing future requirements of the organization
3. Determining the recruitment sources.
4. Anticipating from past records, i.e. resignations, simple discharge, dismissal and
retirements.

14
5. Determining training requirements for management‘s development and
organizational development.
Major activities of manpower planning
1. Forecasting future manpower requirements
2. Inventorying, present manpower resources and analysing the degree to which these
resources are employed optimally.
3. Anticipating manpower problem by projecting present resources into the future and
comparing them with forecast of requirement of requirement to determine their
adequacy, both quantitatively, and qualitatively
4. Planning the necessary program, recruitment, selection, training, development,
motivation and compensation, so that future manpower requirements will be met.
Steps of manpower planning:
1. Scrutiny of present personnel strength.
2. Anticipation of man power needs.
3. Investigation of turnover of personnel
4. Planning job requirements and job descriptions
BAJAJ COMMITTEE, 1986
An "Expert Committee for Health Manpower Planning, Production and
Management" was constituted in 1985 under Dr. J.S. Bajaj, the then professor at AIIMS.
Manpower is one of the most vital resources for the labour intensive health services
industry. Health for all (HFA) can be achieved only by improving the utilization of these
resources.
Major recommendations are:-
1. Formulation of National Medical & Health Education Policy.
2. Formulate on of National Health Manpower Policy.
3.Establishment of an Educational Commission for Health Sciences (ECHS) on the lines
of UGC.
4.Establishment of Health Science Universities in various states and union territories.
5.Establishment of health manpower cells at centre and in the states.
6.Vocationalisation of education at 10+2 levels as regards health related fields with
appropriate incentives, so that good quality paramedical personnel may be available in
adequate numbers.
7.Carrying out a realistic health manpower survey.
In relation to nursing, the Bajaj Committee recommended staffing norms for nursing
manpower requirements for hospital nursing services and requirements for community
health centres and primary health centres on the basis of calculations as follow:

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Hospital Nursing Services-
1. Nursing superintendents. 1:200 beds
2. Deputy nursing superintendents 1:300 beds
3. Departmental nursing 7:1000 + 1 Addl:1000 beds
(991 x 7 + 991)
4. Ward nursing 8:200 + 30% leave reserve
supervisors/sisters
5. Staff nurse for wards 1:3 (or 1:9 for each shift)
+30 leave reserve
6. For OPD, Blood Bank, X-ray,
Diabetic clinics, CSR, etc 1:100 (1:5 OPD)
+30% leave reserve
7.For intensive units 1:8 (1:3 for each shift)
(8 beds ICU/200 beds) + 30% leave reserve
8. For specialized deptts and
clinics, OT, Labour room 8:200 + 30% leave reserve
Community Nursing Service
Projected population - 991,479,200 (medium assumption) by 2000 AD
1 Community Health Centre - 1,000,00 population
1 Primary Health Services - 30,000 population in plain area
1 Primary Health Services - 20,000 population in difficult areas
1 Sub-centre - 5000 population in plain area
1 Sub-centre - 3000 population for difficult area
It also requires nursing manpower to cater to the needs of the rural community as follows:
Manpower requirements by 2000 AD:
 Sub-centre ANM/FHW 323882
 Health supervisors /LHV 107960
 Primary Health Centres PHN 26439

16
 Community health centre Nurse-midwives 26439
 Public health nursing supervisor 7436
 Nurse-midwives 52,052
 District public health nursing officer 900
In additional to the above, 74361 Traditional Birth Attendants will be required.
HIGH POWER COMMITTEE ON NURSING AND NURSING
PROFESSION(1987-1989)
High power committee on nursing and nursing profession was set up by the
Government of India in July 1987, under the chairmanship of Dr. Jyothi former vice-
chancellor of SNDT Women University, Mrs. Rajkumari Sood, Nursing Advisor to Union
Government as the member-secretary and CPB Kurup, Principal, Government College of
Nursing, Bangalore and the then President. TNAI is also one among the prominent
members of this committee. Later on the committee was headed by Smt. Sarojini
Varadappan, former Chairman of Central Social Welfare Board.
The terms of reference of the Committee are:
 To look into the existing working conditions of nurses with particular reference to
the status of the nursing care services both in the rural and urban areas.
 To study and recommend the staffing norms necessary for providing adequate
nursing personnel to give the best possible care, both in the hospitals and
community.
 To look into the training of all categories and levels of nursing, midwifery
personnel to meet the nursing manpower needs at all levels o health services and
education.
 To study and clarify the role of nursing personnel in the health care delivery
system including their interaction with other members of the health team at every
level of health service management.
 To examine the need for organised nursing services at the national, state, district
and local levels with particular reference to the need for planning service with the
overall health care system of the country at the respective levels.
 To look into all other aspects, the Committee will hold consultations with the State
Governments.
ECOMMENDATIONS OF HIGH POWER COMMITTEE ON NURSING AND
NURSING PROFESSION
Working conditions of nursing personnel

17
1. Employment
Uniformity in employment procedures to be made.
Recruitment rules are made for all categories of nursing posts. The qualifications and
experience required or these be made thought the country.
There should not be a bond for nursing students as some of the states do not give them
employment during the stipulated period. Keeping in view of the shortage of nurses in
hospitals and community health field states should create posts and appointment these
nurses in the appropriate positions.
2. Job description
 Job description of all categories of nursing personnel is prepared by the central
government to provide guidelines.
3. Working hours
The weekly working hours should be reduced to 4o hrs per week. Straight shift should be
implemented in all states. extra working hours to be compensated either by leave or by
extra emoluments depending on the state policy .nurses to be given weekly day off and all
the gazetted holidays as per the government rules.
4. Work load/ working facilities
 Nursing norms for patient care and community care to be adopted as recommended
by the committee.
 Hospitals to develop central sterile supply departments, central linen services, and
central drug supply system. Group D employees are responsible for housekeeping
department.
 Policies for breakage and losses to be developed and nurses not are made responsible
for breakage and losses.
5. Pay and allowances
Uniformity of pay scales of all categories of nursing personnel is not feasible. However
special allowance for nursing personnel, i.e.; uniform allowance, washing, mess allowance
etc should be uniform throughout the country.
6. Promotional opportunities
For promotion to the post of ward sister, post basic B.Sc. Nursing is made an essential
qualification. The principle of possessing higher qualification than the category to be
supervised, should apply for all levels and categories of nursing personnel in the rural and
urban areas. The committee recommends that along with education and experience, there
is a need to increase the number of posts in the supervisory cadre, and for making
provision of guidance and supervision during evening and night shifts in the hospital.
-Each nurse must have 3 promotions during the service period.
-Promotion is based on merit cum seniority.
-Promotion to the senior most administrative teaching posts is made only by open
selection.
-In cases of stagnation, selection grade and running scales to be given.

18
7. Career development
-provision of deputation for higher studies after 5 yrs of regular services be made by all
states. The policy of giving deputation to 5 -10 % of each category be worked out by each
state. Every nursing personnel must have an opportunity to attend at least one refresher
course every 2 years.
8. Accommodation
As far as possible, the nursing staff should be considered for priority allotment of
accommodation near to work place. Hospitals should not build nurse's hostel for trained
nurses. Apartment type of accommodation is built where married/unmarried nurses can be
allowed to live. Housing colonies for hospital s must be considered in long run.
9. Transport
During odd hours, calamities etc arrangements for transport must be made for safety and
security of nursing personnel.
10. Special incentives
Scheme of special incentives in terms of awards, special increment for meritorious work
for nurses working in each state/district/PHC to be worked out.
11. Occupational hazards
Medical facilities as provided by the central govt. by extended by the state govt to nursing
personnel till such times medical services are provided free to all the nursing personnel.
Risk allowance to be paid to nursing personnel working in the rural $ urban area.
12. Other welfare services
Hospitals should provide welfare measures like crèche facilities for children of working
staff, children education allowance, as granted to other employees, be paid to nursing
personnel.
Additional Facilities for Nurses Working In the Rural Areas
 Family accommodation at sub centre is a must for safety and security of ANM's
/LHV.
 Women attendant, selected from the village must accompany the ANM for visits to
other villages.
 The district public health nurse is provided with a vehicle for field supervision.
 Fixed travel allowance with provision of enhancement from time to time.
 Rural allowance as granted to other employees is paid to nursing personnel.
NURSING EDUCATION
Nursing education to be fitted into national stream of education to bring about uniformity,
recognition and standards of nursing education. The committee recommends that;
1. There should be 2 levels of nursing personnel - professional nurse (degree level) and
auxiliary nurse (vocational nurse). Admission to professional nursing should be with
12 yrs of schooling with science. The duration of course should be 4 yrs at the
university level. admission to vocational /auxiliary nursing should be with 10 yrs of
schooling .The duration of course should be 2 yrs in health related vocational stream.

19
2. All school of nursing attached to medical college hospitals is upgraded to degree
level in a phased manner.
3. All ANM schools and school of nursing attached to district hospitals be affiliated
with senior secondary boards.
4. Post certificate B.Sc. Nursing degree to be continued to give opportunities to the
existing diploma nurses to continue higher education.
5. Master in nursing programme to be increased and strengthened.
6. Doctoral programme in nursing have to be started in selected universities.
7. Central assistance be provided for all levels of nursing education institutions in
terms of budget( capital and recurring)
8. Up gradation of degree level institutions be made in a phased manner as suggested in
report.
9. Each school should have separate budget till such time is phased to degree/vocational
programme. The principal of the school should be the drawing and the disbursing
officer.
10. Nursing personnel should have a complete say in matters of selection of students.
Selection is based completely on merit. Aptitude test is introduced for selection of
candidates.
11. All schools to have adequate budget for libraries and teaching equipments.
12. All schools to have independent teaching block called as School Of Nursing with
adequate class room facilities, library room, common room etc as per the
requirements of INC.
13. Adequate accommodations are provided to students. A maximum of 3 students to
share a room. Rooms to be furnished with light, study table , chair etc. Adequate
dining room, toilets and bathrooms facilities to be provided in each hostel as per
norms recommended.
14. Students should learn under supervision in the wards. Tutors/clinical instructors must
go to the ward with students. Students should not be used for the service of the
hospital.
15. Community nursing experience should be as per INC requirements. Necessary
transport and accommodation at PHC be made available for safety, security and
meaningful learning of students.
16. INC requirements for staffing the schools and meeting the minimum requirements are
followed by all schools as these are statutory requirements.
17. Speciality courses at post-graduate level be developed at certain special centres of
excellence eg; AIIMS.

20
18. Institutes like National Institute of Health and Family welfare, RAK College of
Nursing and several others may develop courses on nursing administration for
senior nursing leading to doctorate level.
19. Provision for higher training abroad and exchange programme is made.
Continuing Education and Staff Development
 Definite policies of deputing 5-10% of staff for higher studies are made by each
state. Provision for training reserve is made in each institution.
 Deputation for higher study is made compulsory after 5 yrs.
 Each nursing personnel must attend 1 or 2 refresher course every year.
 Necessary budgetary provision be made.
 A National Institute for Nursing Education Research and Training needs to be
established like NCERT, for development of educational technology, preparation of
textbooks, media, / manuals for nursing.
NURSING SERVICES: HOSPITALS/INSTITUTIONS (URBAN AREAS)
Definite nursing policies regarding nursing practice are available in each institution.
These policies include:
a) Qualification/recruitment rules
b) Job description/job specifications
c) Organizational chart of the institutions
d) Nursing care standards for different categories of patients.
1. Staffing of the hospitals should be as per norms recommended.
2. District hospitals /non teaching hospitals may appoint professional teaching nurses in
the ratio of 1; 3 as soon as nurses start qualifying from these institutions.
3. Students not to be counted for staffing in the hospitals
4. Adequate supplies and equipments, drugs etc be made available for practice of
nursing. The committee strongly recommends that minimum standards of basic
equipment needed for each patient be studied , norms laid down and provided to
enable nurses to perform some of the basic nursing functions . Also there should be
a separate budget head for nursing equipment and supplies in each hospitals/ PHC.
The NS and PHN should be a member of the purchase and condemnation committee.
5. Nurses to be relieved from non -nursing duties.
6. Duty station for nurses is provided in each ward.
7. Necessary facilities like central sterile supplies, linen, drugs are considered for all
major hospitals to improve patient care. Also nurses should not be made to pay for
breakage and losses. All hospitals should have some systems for regular assessment
of losses.
8. Provision of part time jobs for married nurses to be considered. (min 16-20hrs/week)

21
9. Re-entry by married nurses at the age of 35 or above may also be considered and
such nurse be given induction courses for updating their knowledge and skills before
employment.
10. Nurses in senior positions like ward sisters, Asst. nursing superintendents, Deputy
NS; N.S must have courses in management and administration before promotions.
11. Nurses working in speciality areas must have courses in specialities. Promotion
opportunities for clinical specialities like administrative posts are considered for
improving quality nursing services.
The committee recommends that Gazetted ranks be allowed for nurses working as ward
sister and above (minimum class II gazetted). Similarly the post of Health Supervisor
(female) is allowed gazetted rank and district public health nurse be given the status equal
to district medical/ health officers.
Community Nursing Services
 Appointment of ANM/LHV to be recommended.
- 1 ANM for 2500 population (2 per sub centre)
- 1 ANM for 1500 population for hilly areas
- 1 health supervisor for 7500 population (for supervision of 3 ANM's)
- 1 public health nurse for 1 PHC (30000 population to supervise 4 Health
Supervisors)
- 1 Public Health Nursing Officer for 100000 population (community health
centre)
- 2 district public health nursing for each district.
 ANM/LHV promoted to supervisory posts must undergo courses in administration
and management.
 Specific standing orders are made available for each ANM/LHV to function
effectively in the field.
 Adequate provision of supplies, drugs etc are made.
 Recording system be simplified.
 Posts of public health nurses and above are given gazetted status
Norms recommended for nursing service and education in hospital setting.
1. Nursing Superintendent -1: 200 beds (hospitals with 200 or more beds).
2. Deputy Nursing Superintendent. - 1: 300 beds ( wherever beds are over 200)
3. Assistant Nursing Superintendent - 1: 100
4. Ward sister/ward supervisor - 1:25 beds 30% leave reserve
5. Staff nurse for wards -1:3 ( or 1:9 for each shift ) 30% leave reserve
6. For nurses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients) 30%
leave reserve

22
7. For ICU -1:1(or 1:3 for each shift) 30% leave reserve
For specialized departments such as operation theatre, labour room etc- 1: 25 30% leave
reserve.
INDIAN NURSING COUNCIL (INC)
The Indian Nursing Council is an Autonomous Body under the Government of
India and was constituted by the Central Government under the Indian Nursing Council
Act, 1947 of parliament. It was established in 1949 for the purpose of providing uniform
standards in nursing education and reciprocity in nursing registration throughout the
country. Nurses registered in one state were not registered in another state before this time.
The condition of mutual recognition by the state nurses registration councils, called
reciprocity was possibly only if uniform standards of nursing education were maintained.
Functions of Indian Nursing Council.
 To establish and monitor a uniform standard of nursing education for nurses
midwife, Auxiliary Nurse-Midwives and health visitors by doing inspection of
the institutions.
 To recognize the qualifications under section 10(2)(4) of the Indian Nursing
Council Act, 1947 for the purpose of registration and employment in India and
abroad.
 To give approval for registration of Indian and Foreign Nurses possessing
foreign qualification under section 11(2) (a) of the Indian Nursing Council Act,
1947.
 To prescribe the syllabus & regulations for nursing programs.
 Power to withdraw the recognition of qualification under section 14 of the Act
in case the institution fails to maintain its standards under Section 14 (1)(b) that
an institution recognized by a State Council for the training of nurses,
midwives, auxiliary nurse midwives or health visitors does not satisfy the
requirements of the Council.
 To advise the State Nursing Councils, Examining Boards, State Governments
and Central Government in various important items regarding Nursing
Education in the Country.

23
THE EXISTING NORM BY INC WITH REGARD TO NURSING STAFF FOR
WARDS AND SPECIAL UNITS:
Staff nurse Sister(each
shift)
Departmental sister/ assistant nursing
superintendent
Medical ward 1:3 1:25 1 for 3-4 weeks
Surgical ward 1:3 1:25 1 for 3-4 weeks
Orthopedic ward 1:3 1:25 1 for 3-4 weeks
Pediatric ward 1:3 1:25 1 for 3-4 weeks
Gynecology ward 1:3 1:25 1 for 3-4 weeks
Maternity ward
including newborns
1:3 1:25 1 for 3-4 weeks
ICU 1:1(24 hours) 1
CCU 1:1(24 hours) 1
Nephrology 1:1(24 hours) 1 1 department sister/assistant nursing
superintendent for 3-4 units clubbed
together
Neurology &
neurosurgery
and 1:1(24 hours) 1
Special wards-
ENT etc.
eye, 1:1(24 hours) 1
Operation theatre 3 for 24 hours
per table
1 1 department sister/asst nursing
superintendent for 4-5 operating
rooms
Casuality
emergency unit
and 2-3 staff nurses
depending on the
number of beds
1 1 department sister/assistant nursing
superintendent
Staffing pattern according to the Indian Nursing Council (relaxed till 2012)
Collegiate programme-A
Qualifications and experience of teachers of college of nursing-
1. Professor-cum-Principal
 Masters Degree in Nursing
 Total 10 years of experience with minimum of 5 years of teaching experience

24
2. Professor-cum- Vice Principal
 Masters Degree in Nursing
 Total 10 years of experience with minimum of 5 years in teaching
3. Reader/Associate Professor
 -Masters Degree in Nursing
 Total 7 years of experience with minimum of 3 years in teaching
4. Lecturer
 Masters Degree in Nursing with 3 years of experience.
5. Tutor/Clinical Instructor
 M.Sc.(N) or B.Sc. (N) with 1 year experience or Basic B.Sc. (N) with post basic
diploma in clinical specialty
For B.Sc and M.Sc nursing:
Annual intake of 60 students for B.Sc (N) and 25 for M.Sc (N) programme
B.Sc (N) M.Sc (N)
Professor cum principal 1
Professor cum vice
principal
1
Reader/Associate
professor
1 2
Lecturer 2 3
Tutor/clinical instructor 19
Total 24 5
One in each speciality and all the M.Sc (N) qualified teaching faculty will participate in
both programmes.
Teacher-student ratio = 1:10
GNM and B.Sc. (N) with 60 annual intake in each programme
Professor cum principal 1
Professor cum vice
principal
1
Reader/Associate
professor
1

25
Lecturer 4
Tutor/clinical instructor 35
Total 42
Basic B.Sc (N)
Admission capacity
Annual intake 40-60 61-100
Professor cum principal 1 1
Professor cum vice
principal
1 1
Reader/Associate
professor
1 1
Lecturer 2 4
Tutor/clinical instructor 19 33
Total 24 40
Teacher student ratio= 1:10 (All nursing faculty including Principal and Vice principal)
Two M.Sc (N) qualified teaching faculty to start college of nursing for proposed less than
or equal to 60 students and 4 M.Sc (N) qualified teaching faculty for proposed 61 to 100
students and by fourth year they should have 5 and 7 M.Sc (N) qualified teaching faculty
respectively, preferably with one in each specialty.
Part time teachers and external teachers:
1. Microbiology
2. Bio-chemistry
3. Sociology.
4. Bio-physic
5. Psychology
6. Nutrition

26
7. English
8. Computer
9. Hindi/Any other language
10. Any other- clinical discipliners
11. Physical education
The above teachers should have post graduate qualification with teaching experience in
respective area
School of nursing-B
Qualification of teaching staff-
1. Professor cum principal M.Sc. (N) with 3 years of teaching experience or
B.Sc.(N) basic or post basic with 5 years of teaching
experience.
2. Professor cum vice
principal
M.Sc. (N) or B.Sc. (N) (Basic)/Post basic with 3 years of
teaching experience.
3. Tutor/clinical instructor M.Sc. (N) or B.Sc. (N) (Basic) / Post basic or diploma in
nursing education and Administration with two years of
professional experience.
For School of nursing with 60 students i.e. an annual intake of 20 students:
Teaching faculty No. required
Principal 1
Vice-principal 1
Tutor 4
Additional tutor for interns 1
Total 7
Teacher student ratio should be 1:10 for student sanctioned strength.

27
Conclusion:
Staffing is the process of determining and providing the acceptable number and mix of
nursing personnel to produce a desired level of care to meet the patients‘ demand
The purpose of all staffing activities is to provide each nursing unit with an appropriate
and acceptable number of workers in each category to perform the nursing tasks required.
Too few or an improper mixture of nursing personnel will adversely affect the quality and
quantity of work performed.
Journal Abstract:
Modern organizations struggle with staffing challenges stemming from increased
knowledge work, labor shortages, competition for applicants, and workforce diversity.
Yet, despite such critical needs for effective staffing practice, staffing research continues
to be neglected or misunderstood by many organizational decision makers. Solving these
challenges requires staffing scholars to expand their focus from individual-level
recruitment and selection research to multilevel research demonstrating the business
unit/organizational-level impact of staffing. This review provides a selective and critical
analysis of staffing best practices covering literature from roughly 2000 to the present.
Several research-practice gaps are also identified.
BIBLIOGRAPHY:
1. BT Basavanthappa. Community health nursing. 1st edition. New Delhi: Jaypee brothers;
2003
2. BT Basavanthappa. Nursing administration. Ist edn. New Delhi: Jaypee brothers; 2000.
3. Function of nursing management- Nursing management- open access articles on
nursing management
http://currentnursing.com/nursing_management/staffing_nursing_units.html
4. High power committee on nursing in India
http://nursingplanet.com/nr/blog6.php/2009/11/21/high_power_committee_nursing_ind
ia
5. Staff Inspection Unit
http://finmin.nic.in/the_ministry/dept_expenditure/staff_inspection_unit/index.html
6. Indian Nursing Council
http://www.indiannursingcouncil.org/pdf/Resolution-circular-12-03-2007.pdf
7. Staffing in nursing management
http://www.scribd.com/doc/16245136/Staffing-in-Nursing-Management

28
3. ESTIMATION OF NURSING STAFF REQUIRMENTS-ACTIVE
ANALYSIS AND RESEARCHSTUDIES
INTRODUCTION
Staffing is certainly one of the major problems of any nursing organization,
whether it be a hospital, nursing home, health care agency, or in educational organization.
Estimation of staff requirements is important for rendering good and quality nursing care
Patient Classification Systems
Patient classification system (PCS), which quantifies the quality of the nursing
care, is essential to staffing nursing units of hospitals and nursing homes. In selecting or
implementing a PCS, a representative committee of nurse manager can include a
representative of hospital administration, which would decrease skepticism about the PCS.
The primary aim of PCS is to be able to respond to constant variation in the care
needs of patients.
Characteristics
 Differentiate intensity of care among definite classes
 Measure and quantify care to develop a management engineering standard.
 Match nursing resources to patient care requirement .
 Relate to time and effort spent on the associated activity.
 Be economical and convenient to repot and use
 Be mutually exclusive , continuing new item under more than one unit.
 Be open to audit.
 Be understood by those who plan , schedule and control the work.
 Be individually standardized as to the procedure needed for accomplishment.
 Separate requirement for registered nurse from those of other staff.
Purposes
 The system will establish a unit of measure for nursing, that is , time , which will
be used to determine numbers and kinds of staff needed.
 Program costing and formulation of the nursing budget.
 Tracking changes in patients care needs. It helps the nurse managers the ability to
moderate and control delivery of nursing service
 Determining the values of the productivity equations
 Determine the quality: once a standards time element has been established, staffing
is adjusted to meet the aggregate times. A nurse manager can elect to staff below
the standard time to reduce costs.
Components: The first component of a PCS is a method for grouping patient‘s categories.
Johnson indicates two methods of categorizing patients. Using categorizing method each
patient is rated on independent elements of care, each element is scorded , scores are
summarized and the patient is placed in a category based on the total numerical value
obtained.

29
Johnson describes prototype evaluation with four basic category for a typical patient
requiring one –on- one care. Each category addresses activities of daily living , general
health, teaching and emotional support, treatment and medications. Data are collected on
average time spent on direct and indirect care.
The second component of a PCS is a set of guidelines describing the way in which patients
will be classified, the frequency of the classification, and the method of reporting data..
The third component of a PCS is the average amount of the time required for care of a
patient in each category. A method for calculating required nursing care hours is the fourth
and final component of a PCS.
Patient Care Classification
Patient Care classification using four levels of nursing care intensity
Area of care Category I Category II Category III Category IV
Eating Feeds self Needs some
help in
preparing
Cannot feed self
but is able to
chew and
swallowing
Cannot feed self
any may have
difficulty
swallowing
Grooming Almost entirely
self sufficient
Need some help
in bathing, oral
hygiene …
Unable to do
much for self
Completely
dependent
Excretion Up and to
bathroom alone
Needs some
help in getting
up to bathroom
/urinal
In bed, needs
bedpan / urinal
placed;
Completely
dependent
Comfort Self sufficient Needs some
help with
adjusting
position/ bed..
Cannot turn
without help, get
drink, adjust
position of
extremities …
Completely
dependent
General health Good Mild symptoms Acute symptoms Critically ill
Treatment Simple –
supervised,
simple
dressing…
Any Treatment
more than once
per shift, foley
catheter care,
I&O….
Any treatment
more than twice
/shift…
Any elaborate/
delicate
procedure
requiring two
nurses, vital
signs more
often than every
two hours..

30
Health
education and
teaching
Routine follow
up teaching
Initial teaching
of care of
ostomies; new
diabetics;
patients with
mild adverse
reactions to
their illness…
More intensive
items; teaching
of apprehensive/
mildly resistive
patients….
Teaching of
resistive
patients,
Calculating Staffing Needs
The following are the hours of nursing care needed for each level patient per shift:
Category I Category II Category III Category IV
NCHPPD for
Day shift
2.3 2.9 3.4 4.6
NCHPPD for
P.M (Evening)
shift
2.0 2.3 2.8 3.4
NCHPPD for
night shift
0.5 1.0 2.0 2.8
A guide to staffing nursing services
3. Projecting Staffing Needs
Some steps to be taken in projecting staffing needs include:
6. Identify the components of nursing care and nursing service.
7. Define the standards of patient care to be maintained.
8. Estimate the average number of nursing hours needed for the required hours.
9. Determine the proportion of nursing hours to be provided by registered nurses
and other nursing service personnel
10. Determine polices regarding these positions and for rotation of personnel.
4. Computing number of nurses required on a Yearly Basis
3. Find the total number of general nursing hours needed in one year. Average
patient census X average nursing hours per patient for 24 hours X days in week
X weeks in year.
4. Find the number of general nursing hours needed in one year which should be
given by registered nurses and the number which should be given by ancillary
nursing personnel.

31
c. Number of general nursing hours per year X percent to be given by
registered nurses.
d. Number of general nursing hours per year X percent to be given be
ancillary nursing personnel.
Computing number of nurses assigned on weekly basis
3. Find the total number of general nursing hours needed in one week. Average
patient censes X average nursing hours per patient in 24 hours X days in week.
4. Find the number of general nursing hours needed in the week which should be
given by registered nurses and the number which could be given by ancillary
nursing personnel.
c. Number of general nursing hours per week X percent to be given by registered
nurses.
d. Number of general nursing hours per week X percent to be given by ancillary
nurses.
One method for determining the nursing staff of a hospital
1. To determine the number of nursing staff for staffing a hospital involves
establishing the number of work days available for service per nurse per year.
Example : Analysis of how the days are used;
Days in the year 365
Days off 1 day/week 52
Casual leave 12
Privilege leave 30
1 Saturday /month 12
Public Holidays 18
Sick Leave 8
Total non-working days 132
Total working days /nurse/year 233
So
1 nurse = 233 working days /year
Example, 20 nurse means 20X233= 4660 hours
4660/365= 12.8 (13).
2. Work load measurement tools
Requirement for staffing are based on whatever standard unit of measurement for
productivity is used in a given unit. A formula for calculating nursing care hours
per patient day (NCH/PPD) is reviewed.
NCH/PPD = Nursing hours worked in 24 hours

32
Patient Census
As a result, patient classification systems (PCS), also known as workload management or
patient acuity tools, were developed in the 1960s.
Important Factors of staffing
There are 3 factors: quality, quantity, and utilization of personnel.
Quality and Quantity:
This factor depends on the appropriate education or training provided to the nursing
personnel for the kind of service they are being prepared for i.e., professional, skilled,
routine or ancillary.
Utilization of personnel: Nursing personnel must be assigned work in such a way that
her/his knowledge and skills learnt are based used for the purpose she was educated or
trained.
Other factors affecting staffing
1. Acutely Ill : Where the life saving is the priority or bed ridden condition which
might require 8-10 hours / patient /day ie., direct nursing care in 24 hours or nurse
patient ratio may have to be 1:1, 2:1,3:1…
2. Moderately Ill: here 3.5 HPD are required in 24 hours or nurse patient ration of 1:3
in teaching hospitals and 1:5 non-teaching hospitals.
3. Mildly Ill: this required 1-2 HPD and for such patients 1:6 or 1:10.
4. Fluctuation of workload: workload is not constant.
5. Number of medical staff: In PHC , 30,000 to 50,000 population getting care from 3
to 4 medical staff but only 1 PHN gives care for all… like in hospital the ratio is
vary from medical and nursing staff.
Modified approaches to nurse staffing and scheduling
Many different approaches to nurse staffing and scheduling are being tried in an
effort to satisfy needs of the employees and meet workload demands for patient care.
These include game theory, modified workweeks (10 or 12hours shifts), team rotation,
premium day, weekend nurse staffing .Such approaches should support the underlying
purpose, mission, philosophy and objectives of the organization and the division of
nursing and should be well defined in a staffing philosophy, statement and policies.
Modified work week: This using 10 and 12 hour shifts and other methods are common
place. A nurse administrator should be sure work schedules are fulfilling the staffing
philosophy and policies, particularly with regard to efficiency. Also, such schedules
should not be imposed on the nursing staff but should show a mutual benefits to employer,
employees and the client served.
 One modification of the worksheet is four 10 hour shifts per week in organized
time increments. One problem with this model is time overlaps of 6 hours per 24 –
hour day. The overlap can be used for patient –centered conference, nursing care
assessment and planning and staff development. It can be done by hour or by a
block of 3-4 hours. Starting and ending time for the 10 hours shifts can be

33
modified to provide minimal overlaps, the 4- hour gap being staffed by part-time
or temporary workers
 A second scheduling modification is the 12 hour shift, on which nurses work even
shifts , on which nurses work seven shift in 2 weeks: three on , four off: four on,
three off . They work a total 84 hours and are paid of overtime. Twelve hour shifts
and flexible staffing have been reported to have improved care and saved money
because nurses can better manage their home and personal lives.
 The weekend alternatives: another variation of flexible scheduling is the
weekend alternative. Nurses work two 12 hour shifts and are paid for 40 hours plus
benefits. They can use the weekdays for continued education or other personal
needs. The weekend scheduled has several variations. Nurses working Monday
through Friday have all weekends off.
 Other modified approaches: team rotation is a method of cyclic staffing in which
a nursing team is scheduled as a unit. It would be used if the team nursing
modality were a team practice.
 Premium day weekend: nursing staffing is a scheduling pattern that gives the
nurse an extra day off duty, called a premium day, when he/she volunteers to work
one additional weekend worked beyond those required by nurse staffing policy.
This technique does not add directly to hospital costs.
 Premium vacation night: staffing follows the same principle as does premium
day weekend staffing. An example would be the policy of giving extra 5 working
days of vacation to every nurse who works a permanent night shifts for a specific
period of time , say 3, 4, or 6 months.
 A flexible role: this programme has enabled the hospitals to better meet the
staffing needs of units whenever workload increases. Since establishment of the
resources acuity nurse position, nurses position, nurse‘s morale has improved
because they know short-term helps is more readily available and will be more
equitably distributed among units.
 Cross training: It can improve flexible scheduling. Nurses can be prepared
through cross-training to function effectively in more than one area of expertise.
To prevent errors and incidence job satisfaction during cross training nurses
assigned to units and in pools require complete orientation and ongoing staff
development.
Scheduling with Nursing Management Information Systems
Planning the duty schedule does not always match personnel with preferences.
This is one major dissatisfaction among clinical nurses. Posting the number of nurses
needed by time slot and allowing nurses to put colored pins in slots to select their own
times can improve satisfaction with the schedule.
Hanson defines a management information system as ―an array components designed to
transform a collective set of data into knowledge that is directly useful and applicable in
the process of directing and controlling resources and their application to the achievement
of specific objectives‖.

34
The following process for establishing any MIS:
1. State the management objective clearly.
2. Identify the actions required to meet the objective.
3. Identify the responsible position in the organization.
4. Identify the information required to meet the objective.
5. Determine the data required to produce the needed information.
6. Determine the system‘s requirement for processing the data.
7. Develop a flowchart.
Productivity
Productivity is commonly defined as output divided by input. Hanson translates this
definition into following:
Required staff hours
Provided staff hours
Example
×100
380 hours
400 hours
X 100 = 95% productivity
Productivity can be increased by decreasing the provided staff hours holding the required
staff hours constant or increasing them.
Measurement
In developing a model for an MIS, Hanson indicates several formulas for
translating data into information. He indicates that in addition to the productivity formula,
hours per patient day (HPPD) are a data element that can provide meaningful information
when provided for an extended period of time.
HPPD is determined by the formula
Staff hours
Patient days
For example,
52000
2883
Answer = 18 HPPD
Another useful formula
1. Budget utilization

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Provided HPPD
X 100 = budget utilization
Budgeted HPPD
Example
18.03 % so, answer is 112.7% Budget utilization.
16
2. Budget adequacy
Budgeted HPPD X100, this is known as Budget adequacy
Required HPPD
16/18.03= 88.74% budget adequacy.
Nurse Staffing, Models of Care Delivery, and Interventions
Nurse Staffing
Measure
Definition
Nurse to patient ratio Number of patients cared for by one nurse typically specified by
job category (RN, Licensed Vocational or Practical Nurse-LVN or
LPN); this varies by shift and nursing unit; some researchers use
this term to mean nurse hours per inpatient day
Total nursing staff or
hours per patient day
All staff or all hours of care including RN, LVN, aides counted per
patient day (a patient day is the number of days any one patient
stays in the hospital, i.e., one patient staying 10 days would be 10
patient days)
RN or LVN FTEs per
patient day
RN or LVN full time equivalents per patient day (an FTE is 2080
hours per year and can be composed of multiple part-time or one
full-time individual)
Nursing skill (or staff)
mix
The proportion or percentage of hours of care provided by one
category of caregiver divided by the total hours of care (A 60%

36
RN skill mix indicates that RNs provide 60% of the total hours of
care)
Nursing Care Delivery
Models
Definition
Patient Focused Care A model popularized in the 1990s that used RNs as care managers
and unlicensed assistive personnel (UAP) in expanded roles such
as drawing blood, performing EKGs, and performing certain
assessment activities
Primary or Total
Nursing Care
A model that generally uses an all-RN staff to provide all direct
care and allows the RN to care for the same patient throughout the
patient's stay; UAPs are not used and unlicensed staff do not
provide patient care
Team or Functional
Nursing Care
A model using the RN as a team leader and LVNs/UAPs to
perform activities such as bathing, feeding, and other duties
common to nurse aides and orderlies; it can also divide the work by
function such as "medication nurse" or "treatment nurse"
Magnet Hospital
Environment/Shared
governance
Characterized as "good places for nurses to work" and includes a
high degree of RN autonomy, MD-RN collaboration, and RN
control of practice; allows for shared decisionmaking by RNs and
managers Jean Ann Seago, Ph.D.,RN
NORMS OF STAFFING( S I U- staff inspection unit)
Norms
Norms are standards that guide, control, and regulate individuals and communities.
For planning nursing manpower we have to follow some norms. The nursing norms are
recommended by various committees, such as; the Nursing Man Power Committee, the
High-power Committee, Dr. Bajaj Committee, and the staff inspection committee, TNAI
and INC. The norms has been recommended taking into account the workload projected in
the wards and the other areas of the hospital.
All the above committees and the staff inspection unit recommended the norms for
optimum nurse-patient ratio. Such as 1:3 for Non Teaching Hospital and 1:5 for the
Teaching Hospital. The Staff Inspection Unit (S.I.U.) is the unit which has recommended
the nursing norms in the year 1991-92. As per this S.I.U. norm the present nurse-patient
ratio is based and practiced in all central government hospitals.

37
Recommendations of S.I.U:
1. The norms for providing staff nurses and nursing sisters in Government hospital is
given in annexure to this report. The norm has been recommended taking into
account the workload projected in the wards and the other areas of the hospital.
2. The posts of nursing sisters and staff nurses have been clubbed together for
calculating the staff entitlement for performing nursing care work which the staff
nurse will continue to perform even after she is promoted to the existing scale of
nursing sister.
3. Out of the entitlement worked out on the basis of the norms, 30%posts may be
sanctioned as nursing sister. This would further improve the existing ratio of 1
nursing sister to 3.6. staff nurses fixed by the government in settlement with the
Delhi nurse union in may 1990.
4. The assistant nursing superintendent are recommended in the ratio of 1 ANS to
every 4.5 nursing sisters. The ANS will perform the duty presently performed by
nursing sisters and perform duty in shift also.
5. The posts of Deputy Nursing Superintendent may continue at the level of 1 DNS
per every 7.5 ANS
6. There will be a post of Nursing Superintendent for every hospital having 250 or
beds.
7. There will be a post of 1 Chief Nursing Officer for every hospital having 500 or
more beds.
8. It is recommended that 45% posts added for the area of 365 days working
including 10% leave reserve (maternity leave, earned leave, and days off as nurses
are entitled for 8 days off per month and 3 National Holidays per year when doing
3 shift duties).
Most of the hospital today is following the S.I.U.norms. In this the post of the Nursing
Sisters and the Staff Nurses has been clubbed together and the work of the ward sister is
remained same as staff nurse even after promotion. The Assistant Nursing Superintendent
and the Deputy Nursing Superintendent have to do the duty of one category below of their
rank.
BIBLIOGRAPHY:
8. BT Basavanthappa. Community health nursing. 1st edition. New Delhi: Jaypee brothers;
2003
9. BT Basavanthappa. Nursing administration. Ist edn. New Delhi: Jaypee brothers; 2000.
10.Management and leadership for nurse managers, second edition, russel
c.swansburg
11.Function of nursing management- Nursing management- open access articles on
nursing management
http://currentnursing.com/nursing_management/staffing_nursing_units.html

38
12. Staff Inspection Unit
http://finmin.nic.in/the_ministry/dept_expenditure/staff_inspection_unit/index.html
13. Staffing in nursing management
http://www.scribd.com/doc/16245136/Staffing-in-Nursing-Management
14. Staffing in the 21st Century: New Challenges and Strategic Opportunities
http://jom.sagepub.com/content/32/6/868.abstract
VARIOUS RESEARCH STUDIES
Intensive Care Med. 1998 Jun;24(6):582-9.
Estimation of direct cost and resource allocation in intensive care: correlation with
Omega system.
Sznajder M, Leleu G, Buonamico G, Auvert B, Aegerter P, Merlière Y, Dutheil M, Guidet
B, Le Gall JR.
Department of Public Health & Medical Information, Hôpital Ambroise Parè, Boulogne,
France.
Comment in:
 Intensive Care Med. 1999 Feb;25(2):245-6.
Abstract
OBJECTIVE: An instrument able to estimate the direct costs of stays in Intensive Care
Units (ICUs) simply would be very useful for resource allocation inside a hospital,
through a global budget system. The aim of this study was to propose such a tool.
DESIGN: Since 1991, a region-wide common data base has collected standard data of
intensive care such as the Omega Score, Simplified Acute Physiologic Score, length of
stay, length of ventilation, main diagnosis and procedures. The Omega Score, developed
in France in 1986 and proved to be related to the workload, was recorded on each patient
of the study.
SETTING: Eighteen ICUs of Assistance Publique-Hôpitaux de Paris (AP-HP) and
suburbs.
PATIENTS: 1) Hundred twenty-one randomly selected ICU patients; 2) 12,000
consecutive ICU stays collected in the common data base in 1993.
MEASUREMENTS: 1) On the sample of 121 patients, medical expenditure and nursing
time associated with interventions were measured through a prospective study. The
correlation between Omega points and direct costs was calculated, and regression
equations were applied to the 12,000 stays of the data base, leading to estimated costs. 2)
From the analytic accounting of AP-HP, the mean direct cost per stay and per unit was
calculated, and compared with the mean associated Omega score from the data base. In
both methods a comparison of actual and estimated costs was made.
RESULTS: The Omega Score is strongly correlated to total direct costs, medical direct
costs and nursing requirements. This correlation is observed both in the random sample of
121 stays and on the data base' stays. The discrepancy of estimated costs through Omega
Score and actual costs may result from drugs, blood product underestimation and
therapeutic procedures not involved in the Omega Score.

39
CONCLUSIONS: The Omega system appears to be a simple and relevant indicator with
which to estimate the direct costs of each stay, and then to organise nursing requirements
and resource allocation.
PMID: 9681780 [PubMed - indexed for MEDLINE]
Health Econ. 1995 Jan-Feb;4(1):57-72.
The impact of nursing grade on the quality and outcome of nursing care.
Carr-Hill RA, Dixon P, Griffiths M, Higgins M, McCaughan D, Rice N, Wright K.
Centre for Health Economics, University of York, UK.
Abstract
The large industry which has grown up around the estimation of nursing requirements for
a ward or for a hospital takes little account of variations in nursing skill; meanwhile
nursing researchers tend to concentrate on the appropriate organisation of the nursing
process to deliver best quality care. This paper, drawing on a Department of Health funded
study, analyses the relation between skill mix of a group of nurses and the quality of care
provided. Detailed data was collected on 15 wards at 7 sites on both the quality and
outcome of care delivered by nurses of different grades, which allowed for analysis at
several levels from a specific nurse-patient interaction to the shift sessions. The analysis
shows a strong grade effect at the lowest level which is 'diluted' at each succeeding level
of aggregation; there is also a strong ward effect at each of the lower levels of aggregation.
The conclusion is simple; you pay for quality care.
Impact of shift work on the health and safety of nurses and patients.
Berger AM, Hobbs BB.
College of Nursing, University of Nebraska Medical Center, Omaha, USA.
aberger@unmc.edu
Abstract
Shift work generally is defined as work hours that are scheduled outside of daylight. Shift
work disrupts the synchronous relationship between the body's internal clock and the
environment. The disruption often results in problems such as sleep disturbances,
increased accidents and injuries, and social isolation. Physiologic effects include changes
in rhythms of core temperature, various hormonal levels, immune functioning, and
activity-rest cycles. Adaptation to shift work is promoted by reentrainment of the
internally regulated functions and adjustment of activity-rest and social patterns. Nurses
working various shifts can improve shift-work tolerance when they understand and adopt
counter measures to reduce the feelings of jet lag. By learning how to adjust internal
rhythms to the same phase as working time, nurses can improve daytime sleep and family
functioning and reduce sleepiness and work-related errors. Modifying external factors
such as the direction of the rotation pattern, the number of consecutive night shifts
worked, and food and beverage intake patterns can help to reduce the negative health
effects of shift work. Nurses can adopt counter measures such as power napping,
eliminating overtime on 12-hour shifts, and completing challenging tasks before 4 am to
reduce patient care errors.

40
At the Presbyterian hospital of Dallas , a study reveled that more time was spend on
clerical functions, telephone calls, and reporting patient conditions to other care givers
than on direct patient care. Several action were taken to change this;
 A FAX machine network was instituted between nursing units and pharmacy,
which reduce telephone calls and medication errors.
 A key less narcotics system that included a personnel pass code was installed. The
main control was in the pharmacy, but nurses could enter their personnel pass code
at the narcotics cabinet. This reduced time wasted in searching for keys and also
produced an audit trail.
 A unit beeper system with 8 beepers was purchased at a local store for $375
.beepers given to every staff members at the beginning of each shift made nursing
assistants feel valued.
 These changes improved productivity greatly
Am J Nurs. 2008 Jan;108(1):62-71; quiz 72.
Nurse staffing and patient, nurse, and financial outcomes.
Unruh L.
Department of Health Professions, University of Central Florida, Orlando, FL, USA.
lunruh@mail.ucf.edu
Comment in:
 Am J Nurs. 2008 Apr;108(4):13.
Abstract
Because there's no scientific evidence to support specific nurse-patient ratios, and in order
to assess the impact of hospital nurse staffing levels on given patient, nurse, and financial
outcomes, the author conducted a literature review. The evidence shows that adequate
staffing and balanced workloads are central to achieving good outcomes, and the author
offers recommendations for ensuring appropriate nurse staffing and for further research.
Policy Polit Nurs Pract. 2009 Nov;10(4):240-51.
An applied simulation model for estimating the supply of and requirements for
registered nurses based on population health needs.
Tomblin Murphy G, MacKenzie A, Alder R, Birch S, Kephart G, O'Brien-Pallas L.
Dalhousie University, Halifax, Nova Scotia, Canada, University of Toronto, Toronto,
Ontario, Canada. gail.tomblin.murphy@dal.ca
Abstract
Aging populations, limited budgets, changing public expectations, new technologies, and
the emergence of new diseases create challenges for health care systems as ways to meet
needs and protect, promote, and restore health are considered. Traditional planning
methods for the professionals required to provide these services have given little
consideration to changes in the needs of the populations they serve or to changes in the

41
amount/types of services offered and the way they are delivered. In the absence of
dynamic planning models that simulate alternative policies and test policy mixes for their
relative effectiveness, planners have tended to rely on projecting prevailing or arbitrarily
determined target provider-population ratios. A simulation model has been developed that
addresses each of these shortcomings by simultaneously estimating the supply of and
requirements for registered nurses based on the identification and interaction of the
determinants. The model's use is illustrated using data for Nova Scotia, Canada.
J Public Health Manag Pract. 2009 Nov;15(6 Suppl):S56-61.
Health human resources planning and the production of health: development of an
extended analytical framework for needs-based health human resources planning.
Birch S, Kephart G, Murphy GT, O'Brien-Pallas L, Alder R, MacKenzie A.
Centre for Health Economics and Policy Analysis, McMaster University, Hamilton,
Ontario, Canada. birch@mcmaster
Comment in:
 J Public Health Manag Pract. 2009 Nov;15(6 Suppl):S62-3.
Abstract
Health human resources planning is generally based on estimating the effects of
demographic change on the supply of and requirements for healthcare services. In this
article, we develop and apply an extended analytical framework that incorporates
explicitly population health needs, levels of service to respond to health needs, and
provider productivity as additional variables in determining the future requirements for the
levels and mix of healthcare providers. Because the model derives requirements for
providers directly from the requirements for services, it can be applied to a wide range of
different provider types and practice structures including the public health workforce. By
identifying the separate determinants of provider requirements, the analytical framework
avoids the "illusions of necessity" that have generated continuous increases in provider
requirements. Moreover, the framework enables policy makers to evaluate the basis of,
and justification for, increases in the numbers of provider and increases in education and
training programs as a method of increasing supply. A broad range of policy instruments is
identified for responding to gaps between estimated future requirements for care and the
estimated future capacity of the healthcare workforce.
Is your nursing staff ready for magnet hospital status? An application of the revised
Nursing Work Index.
Wagner CM.
College of Nursing, University of Iowa, Iowa City, IA, USA. c.wagner@mchsi.com
Abstract
There has been a slow, steady exodus of nurses from the acute care setting. However,
magnet hospital status is closely correlated with increased retention of nursing staff. The
author outlines an assessment plan for nursing staff to determine if magnet status
application efforts may be successful for an organization.

42
4. RECRUITMENTCREDENTIALING, SELECTION, LACEMENT&
RETENTION
I. INTRODUCTION:
Personnel management is the most important assets of an organization.
Planning for human resources is the important managerial function. It ensures
adequate supply, proper quantity and quality as well as effective utilization of
human resources. There is generally shortage of suitable persons. The organization
will determine its manpower needs and then find out the sources from which the
requirements will be met.
II. TERMINOLOGY:
1. Recruitment: It is a process in which the right people for the right post is
procured.
2. Selection: It is the process of choosing from among applicants the best qualified
individuals.
3. Administration: It is the organization and direction of human and material
resources to achieve desired ends.
4. Admission: The right or permission to enter
5. Student: A person who studies, especially at college, university etc
6. Discipline: A training in an orderly way of life, order kept by means of control.
7. Turnover: The number of staff that leave a cost centre annually.
RECRUITMENT
INTRODUCTION:
Recruitment is an important function of health manpower management,
which determines, whether the required will be available at the work spot, when a
job is actually to be undertaken. Recruitment procedures include the process and
the methods by which vaccines are notified, post are advertised, applications are
handled and screened, interviews are conducted and appointments are made.
Recruitment of nurses are major concern. Recruitment means finding out of the
further workers. It is process of searching for prospective employees and
stimulating them to apply for job in an organization.

43
MEANING:
In a simple term, recruitment is understood as the process of searching for
and obtaining applicants for job, from among whom the right people can be
selected.
DEFINITION:
1) According to B Flippo: ―Recruitment is defined as the process of searching for
prospective employees and stimulating them to apply foe job in the organization‖.
2) According to IGNOU Module: ―It is a process in which the right person for the
right post is procured‖.
3) According to Yoder: ―Recruitment is a process to discover the sources of
manpower to meet the requirements of the staffing schedule and to employ
effective measures for attracting that manpower in adequate numbers
to facilitate effective selectionof an efficient working force.‖
TYPES OF RECRUITMENT:
There are three types of recruitment:
1. Planned: arise from changes in organization and recruitment policy
2. Anticipated: by studying trends in the internal and external organization.
3. Unexpected: arise due to accidents, transfer and illness.
LIKAGES OF REQUIREMENT TO HUMAN RESOURCE ACQUISITION
The requirement process is concerned with the identification of possible
sources of human resources supply and tapping those resources, the total process
acquiring and placing human resources in the organization. Requirement fails in
between different sub process like:
Planned
Anticipated
Unexpected

44
BASIC ELEMENTS OF SOUND RECRUITMENT POLICY:
 Discovery and cultivation of the employment market for post in the public
service
 Use of the attractive recruitment literature and publicity
 Use of the scientific tests for determining abilities of the candidate
 Tapping capable candidates from within the services
 Placement program which assigns the right man to the right job.
 A follow up probationally program as an integral process.
PURPOSES AND IMPORTANCE:
 Determine the present and future requirements of the organization in
conjunction with the personnel planning and job analysis activities
 Increase the pool of job candidates with minimum cost
 Help increase the success rate of the selectionprocess reducing the number
of obviously under qualified or over qualified job applicants.
 Help reduce the probability tat the job applicants, once recruited and
selectedwill leave the organization only after short period of time.
 Meet the organization‘s legal and social obligations regarding the
composition of its work force
 Start identifying and preparing potential job applicants who will be
appropriate candidates
 Increase organizational and individual effectiveness in the short and long
term.
 Evaluate the effectiveness of various recruiting techniques and sources for
all types of job applicants.
Manpower
planning Recruitment
Selection Placement
Job analysis

45
OBJECTIVES OF RECRUITMENT:
To attract people with multi-dimensional skills and experiences that suit the
present and future organizational strategies
To induct outsiders with new perspective to lead the company
To infuse fresh blood at all levels of organization
To develop an organizational culture that attracts competent people to the
company
To search or heat hunt/ head pouch people whose skills fit the company‘s
values
To devise methodologies for assessing psychological traits
To seek out non-conventional development grounds of talent
To search for talent globally and not just within the company
To design entry pay that competes on quality but not on quantum
To anticipate and find people for positions that does not exist yet.
PRINCIPLES OF RECRUITMENT:
Recruitment should be done from a central place. Eg: Administrative
officer/Nursing Service Administration.
1) Termination and creation of any post should be done by responsible officers,
eg: regarding nursing staff the Nursing superintendent along with her
officers has to take the decision and not the medical Superintendent.
2) Only the vacant positions should be filled and neither less nor more should
be employed.
3) Job description/ work analysis should be made before recruitment.
4) Procedure for recruitment should be developed by an experienced person
5) Recruitment of workers should be done from internal and external sources
6) Recruitment should be done on the basis of definite qualifications and set
standards.
7) A recruitment policy should be followed
8) Chances of promotion should be clearly stated
9) Policy should be clear and changeable according to the need.

46
SOURCES OF RECRUITMENT:
The sources of recruitment are:
I) Internal sources:
Internal sources include present employees, employee referrals, former
employee and former applicants.
Present employees: promotion and transfers from among the present employees
can be good source of recruitment. Promotions to higher positions have several
advantages. They are:
o It is good public relations
o It builds morale
o It encourages competent individuals who are ambitious
o It improves the probability of a good selection, since information
of the candidate is readily available
o It is less costly
o Those chosen internally are familiar with the organization.
However promotions can be dysfunctional to the organization as the advantage of
hiring outsiders who may be better qualified and skill is denied. Promotions also
results in breeding which is not good for the organization.
Another way to recruit from among present employees is the transfer without
promotion. Transfers are often important in providing employees with a broad
based view of the organization, necessary for the future.
Employee referrals: this is the good source of internal recruitment. Employees can
develop good prospects for their families and friends by ac quainting with the
advantages of a job with the company, furnishing cards introduction and even
encouraging them to apply. This is very effective because many qualified are
reached at very low cost. Most employees known from their own experience about
DIRECT
SOUR CES
SOURCES OF
RECRUITMENT
INDIRECT
SOURCES

47
the recruitments for the job what sort of person is looking for? A major concern
with the employee recommendation is that referred individuals are likely to be
similar type (e.g. race and sex) to those who are already working for company.
Former employees: some retired employees may be willing to come back to work
on a part-time basis or may recommend someone who would be interested in
working for the company. An advantage with these sources is that the performance
of these people is already known.
Previous applicants: although not truly an internal source, those who have
previously applied for jobs can be contacted by mail, a quick and inexpensive way
to fill an unexpected opening.
Evaluation of internal recruitment:
Advantages:
 It is less costly
 Organizations typically have a better knowledge of the internal candidates‘
skills and abilities than the ones acquired through external recruiting.
 An organizational policy of promoting from within can enhance employees‘
morale, organizational commitment and job satisfaction.
Disadvantages:
 Creative problem solving may be hindered by the lack of new talents.
 Divisions complete for the same people
 Politics probably has a greater impact on internal recruiting and selection
than does external recruiting.
II) External sources:
Sources external to an organization are professional or trade associations,
advertisements, employment exchanges, college/university/institute placement
services, walk-ins and writer-ins, consultants, contractors.
 Professional or trade associations: many associations provide placement
services for their members. These services may consist of compiling
seekers‘ lists and providing access to members during regional or national
conventions.
 Advertisements: these constitute a popular method of seeking recruits as
many recruiters; prefer advertisements because of their wide reach. For
highly specialized recruits, advertisements may be placed in professional/
business journals. Newspaper is the most common medium.

48
Advertisement must contain the following information:
 the job content ( primary tasks and responsibilities)
 a realistic description of working conditions, particularly if they are unusual
 the location of the job
 the compensation, including the fringe benefits
 job specifications
 growth prospects and
 To whom one applies.
Employment exchange: employment exchanges have been set up all over the
country in deference to the provisions of the Employment exchanges (Compulsory
Notification of Vaccination) Act, 1959. The Act applies to all industrial
establishments having 25 workers or more. The Act requires all the industrial
establishments to notify the vacancies before they are filled. The major functions of
the exchanges are to increase the pool of possible applicants and to do preliminary
screening. Thus, employment exchanges act as a link between the employers and
the prospective employees.
Campus recruitment: colleges, universities and institutes are fertile ground for
recruitment, particularly the institutes.
Walk-ins, write-ins and Talk-ins: write-ins those who send written enquire.
These job-seekers are asked to complete applications forms for further processing.
Talk-in is becoming popular now-in days. Job aspirants are required to meet the
recruiter (on an appropriated date) for detailed talks. No applications are required to
be submitted to the recruiter.
Consultants: ABC consultants, Ferguson Association, Human Resources
Consultants Head Hunters, Bathiboi and Co, Consultancy Bureau, Aims
Management Consultants and The Search House are some among the numerous
recruiting agents. These and other agencies in the profession are retained by
organizations for recruiting and selecting managerial and executive personnel.
Contractors: Contractors are used to recruit casual workers. The names of the
workers are not entered in the company records and to this extent, difficulties
experienced in maintaining permanent workers are avoided.
Radio Television:
International Recruiting: Recruitment in foreign countries presents unique
challenges recruiters. In advanced industrial nations more or less similar channels
of recruitment are available for recruiters.

49
MODERN SOURCES OF RECRUITMENT:
 Walk-in
 Consult in
 Tele recruitment: Organizations advertise the job vacancies through World
Wide Web (WWW)
RECRUITMENT PROCESS / STEPS:
As was stated earlier, recruitment refers to the process of identifying and
attracting job seekers so as to build a pool of qualified job applicants. The process
comprises five inter-related stages, via:
FACTORS EFFCTING RECRUITMENT:
All organization, whether large or small, do engage in recruiting activity,
though not to the same extent. This differs with:
1) The size of the organization
2) The employment conditions in the community where the organization is
located
3) The effects of past recruiting efforts which show the organization‘s ability to
locate and keep good performing people
4) Working conditions an salary and benefit packages offeredby the
organization- which may influence turnover and necessitate future recruiting
5) The rate of growth of organization
Strategy
development
STEPS
Searching
Screening
Evaluation &
Control
Planning

50
6) The level of seasonality of operations and future expansion and production
programs.
7) Culture, economical and legal factors etc.
CREDENTIALING
INTRODUCTION
Credentialing is the process of establishing the qualification of licensed
professionals, organizational members or organizations, and assessing their
background and legitimacy. Many health care institutions and provider networks
conduct their own credentialing, generally through a credentialing specialist or
electronic service, with review by a medical staff or credentialing committee. It
may include granting and reviewing specific clinical privileges and medical or
allied health staff membership.
DEFINITION
1) Credentialing is the process by which selected professionals are granted
privileges to practice within an organization. In health care organizations this
process has been largely confined to physicians. Limited privileges have been
granted to psychologists, social workers and selected categories of nurses, such as
nurse anesthetists, surgical nurses, and midwifes.
Russell C Swan‘s burg
2) Credentialing is the process of establishing the qualifications of licensed
professionals, organizational members or organizations, and assessing their
background and legitimacy.
3) A credential is an attestation of qualification, competence, or authority issued to
an individual by a third party with a relevant de jure or de facto authority or
assumed competence to do so.
PURPOSE OF CREDENTIALING
The purpose of credentialing is:
1) To prevent a problem before it happens.
2) To research the qualifications and backgrounds of individuals and companies.
Credentialing is also the process of reviewing and verifying information.
SIGNIFIANCE
Credentialing is very significant because it shows that an individual or
company performing a service is qualified to do so. For example: your doctor
must have certain credentials to prescribe medicine to you.

51
LEGAL PROTECTION
It is a good idea to have credentialing process to protect you and your
business from a lawsuit or other legal problems. For instance, let‘s say you hire a
teacher to work in your day care center, and this person is a sex offender. The
credentialing process could have prevented this through a background check.
PROFESSION
Almost all professions require, to a certain degree, some sort of credentials.
Police departments, Firefighters, lawyers, accountants and nurses all need
credentials. You need credentials to drive a car or semi-truck. All states require
citizens to take a driving test.
HEALTH CARE CREDENTIALING
DEFINITION:
Health care credentialing is a system used by various organizations and
agencies to ensure that their health care practitioners meet all the necessary
requirements and are appropriately qualified. The credentials may vary depending
on the specified area of the practitioner. For example: An X-ray technician may
have different credentialing forms than an osteopathic physician.
WHO IS CREDENTIALED?
1) Practitioners: Medical Doctors (MD), Doctor of osteopathy (DO), Doctor of
Podiatric Medicine (DPM), Doctor of Chiropractic (DC), Doctor of dental
Medicine (DMD), Doctor of Dental Surgery (DDS), Doctor of Optometry (OD),
Doctor of Psychology (PhD) and Doctor of Philosophy (PhD).
2) Extenders: Physician of assistant (PA), Certified Nurse Practitioner (CRNP),
Certified Nurse Midwife (CNM).
Facility and Ancillary service Providers: Hospitals , Nursing Homes, Skilled
Nursing Facilities, Home Health, Home Infusion Therapy, Hospice, Rehabilitation
Facilities, Freestanding Surgery Centers, Freestanding Radiology Centers, Portable
X-ray Suppliers, End Stage Renal Disease Facilities, Clinical Laboratories,
Outpatient Physical therapy and Speech Therapy providers, Rural Health Clinics,
Federally Qualified Health Centers Orthotic and Prosthetic providers and Durable
Medical Equipment (DME) providers.
COMPOTENTS OF CREDENTIALING
As with physicians, the components of a credentialing system for nurses would be:
1) Appointment: Evaluation and selectionfor nursing staff membership.

52
2) Clinical privileges: Delineation of the specific nursing specialties that may be
managed types of illnesses or patients that may be managed within the
institution for each member of the nursing staff.
3) Periodic reappraisal: Continuing review and evaluation of each member of the
nursing staff to assure that competence is maintained and consistent with
privileges.
CRETERIA FOR APPOINTMENT:
Criteria for appointments would include proof of licensure, education and training,
specialty board certification, previous experience, and recommendations.
Clinical privileges criteria would include the proof of specialty training and of
performance of nursing procedures or specialty care during training and previous
appointments.
PRINCIPLES OF CREDENTIALING ACCORDING TO (ANA)
A report of the Committee for the study of Credentialing in Nursing was
made in 1979. It included fourteen principles of credentialing related to:
1) Those credentialed.
2) Legitimate interests of involved occupation, institution, and general public.
3) Accountability
4) A system of checks and balances
5) Periodic assessments
6) Objective standards and criteriaand persons competent in their use
7) Representation of the community of the interests
8) Professional identity and responsibility
9) An effective system of role delineation
10) An effective system of program identification
11) Coordination of credentialing mechanisms
12) Geographic mobility
13) Definitions and terminology
14) Communications and understanding.

53
SELECTION
INTRODUCTION
“The selection process starts when applications are screened in the personnel
department. Selecting includes interviewing, the employer‘s offer, acceptance by
the applicant, and signing of a contract or written offer‖.
Those applicants who seem to meet the job requirements are sent blank job-
application forms and are directed to fill them up and return the same for further
action. The job application form is one of most important tools in the selection
process.
DEFINITION
―It is the process of choosing from among applicants the best qualified individuals,
Selecting includes interviewing, the employer‘s offer, acceptance by the applicant,
and signing of a contract or written offer‖. Selection may be carried out centrally or
locally, but in either case certain policies or methods are adopted.
SELECTION POLICIES
1. Application forms
The issue and receipt of application forms is the administrative responsibility, and
much of the preliminary work is handled by the clerical staff under the supervision
of the administrative head of the college. The information contained in the
application form and reports received in connection with them should be
systematically tabulated and filed as they are useful for evaluating the effectiveness
of the form, analyzing entrance standards, assessing academic achievement with
subsequent performance, and knowing from which parts of the state or country the
students are most frequently admitted or apply for admission.
The applicationform should elicit the following information
Name
Address
Age of the candidate
Name of parents or guardians
Occupation of father
Details of education
Details of employment
Particular aptitudes or abilities

54
It may also ask the student to write short easy on her interests and her
reasons for choosing nursing as a career. It should give details of any material she
should submit such as a medical certificate, evidence of date of birth etc. and
should give the exact address to which it should be sent. The names of the persons
given as references should be asked to furnish information regarding the
candidate‘s character and personality, and the information to be given by the head
teacher should include candidate‘s attendance at school, studies completed, grades,
rank in class and his or her own evaluation of the candidate‘s suitability of nursing.
 A job applicationform serves three main purpose:
1) It enables the hospital authorities to weed out unsuitable candidates.
2) It acts as a frame of reference for the interview.
3) It forms the basis for the personal record file of the successful candidates
2. Selection committee:
Usually the selection occurs in the college itself. Otherwise, if the selection is
carried outside the college, it is important that at least representatives of the college
be a part of committee and as far as possible students be selected for a specific
college according to its individual admission policies and the programme it offers.
The members of the selectioncommittee shouldinclude
a) The head of the college of nursing
b) Professor
c) Representative of the local controlling authority
d) Representative of the nursing division of the state
e) An educational psychologist
The procedure for selection should consist of a personal interview of the
candidate and possibly a separate interview with her parents. It may also include
tests of previous achievements, both written and oral, to assess her knowledge of
various subjects such as Arithmetic, English, the regional language and general
science and her ability to express herself orally and in writing. If psychological
tests are given, only those devised by experts in their field should be used.
It should be made clear to them that final acceptance for the course will be
subject to a satisfactory medical report and assessment during the preliminary
training period. The college should make every effort to start the course on the
appointed day with the full quota of students. Only in exceptional circumstances
should students be admitted later and in their cases, special arrangement should be
made for them to cope up with the other students.

55
3. Orientation programme:
After admission an orientation programme is to be conducted to make the
students aware of the college rules, hostel rules and the hospital and the college
building and associated parallel medical education departments. Orientation should
be given by a senior faculty of the college of nursing. Orientation programme may
take three to five days.
4. Development of master plan:
When a particular batch is admitted the class teacher may draw a master
plan according to which the whole programme is planned. Date of examinations
and periodic evaluation measures etc are formulated.
5. Parent teachers association:
All parents are enrolled in the parent teachers association and this will help
to have a contact between the family members and teachers. This will help to
improve the administration. Meetings of PTA are held frequently and the parents
are kept informed of the students progress.
Before taking any disciplinary actions PTA members are called when
students unrest occurs due to certain problems. Thus parents are also involved in
the administration of students.
STEPS IN SELECTION: The steps which constitute the employee selection
process are the following:
STEPS IN SELECTION
1) Interview by personnel department
2) Pre-employment tests-written/oral/practical
3) Interview by department head
4) Decision of administrator to accept or reject
5) Medical examination
6) Check of references
7) Issue of appointment letter.

56
1) Interviewing:
Interviewing is the main method of appraising an applicant‘s suitability for a
post. This is the most intricate and difficult part of the selection process. The
employment interview can be divided into four parts:
 The warm-up stage
 The drawing-out stage
 The information stage
 The forming an-opinion stage
Main objectives of an interview:
1) For the employer to obtain all the information about the candidate to decide
about his suitability for the post.
2) To give the candidate a complete picture of the job as well as of the
Organization.
3) To demonstrate fairness to all candidates.
THE INTERVIEW LETTER:
Your sincerely,
( Personnel Manager)
You are required t fill up the enclosed job-application form and bring it with you at the time of the interview.
Please bring your original certificates and certificates and testimonials with you. We look forward to seeing you.
.
in the personnel department.
for the post of
on
Dear
With reference to yourapplication dead
I am pleased to call you for an interview at
Address
Date
Name and Address ofthe hospital
INTERVIEW LETTER

57
INTERVIEWING FUNCTIONS OF THE PERSONNEL MANAGER:
The responsibilities of the personnel manager are:
A) To screenthe application of the candidate
B) To give information about
a) general nature of work
b) hours of work
c) pay-scale, allowances and starting total salary
d) fringe benefits
e) leave policy
f) ‗brief‘ information about the background of the hospital
g) To discover any differences in the expectations of the hospital and those
of the candidate.
The responsibilities of the department head are:
A) To review the job-application form to check pertinent data on experience;
B) To assess the professional competence of the candidate
C) To give detailed picture of the job requirement to the applicant;
D) To advise the personnel manager if he thinks that the previous training or
experience or both of the applicant justifies a higher starting salary.
2) Pre-employment tests:
To ensure selection of the most suitable candidates for various posts,
interviews should be conducted carefully & pre-employment tests should be held in
a systematic manner wherever necessary & possible.
For certain Categories of post, there is a need for testing the professional
competence of the candidates. These tests can broadly be divided in to four types:
1) Tests of general ability- intelligence
2) Tests of specific abilities- aptitude tests
3) Tests of achievement-trade tests
4) Personality tests- Tests of emotional stability, interest, values, traits etc.
1) Tests of general ability: These tests can give a useful indication of candidate‘s
mental caliber. It has been observed that for various professions, there is an

58
optimum level of I.Q.while selecting individuals who have I.Q.s within the
required optimum range-not higher or lower.
2) Tests of aptitude: aptitude tests measure whether an individual has the capacity
or latent ability to learn a new job, if given adequate training .These tests
measure skills & abilities that have the potential for later development in the
person tested.
3) Tests of achievement: Tests of achievement measure the present level of
proficiency that a person has achieved. In hospitals, these tests can be used for
typists, stenographers, laboratory technicians, radiographers, etc. These tests
can also be used at the end of training programmers to assess the level of
proficiency achieved.
4) Personality tests: Personality tests are used to assess certain personality
characteristics. These tests are used in selecting candidates for sales jobs,
supervisory job, management trances, etc., because certain personality
characteristics are essential to succeed in such jobs.
2) Final approval by the head of the hospital:
In some hospitals, the selection committee consists of one person from the
personnel department, the department head/supervisor of the concerned department
and one representative of the head of the hospital. After the interviewing all the
candidates, the selection committee submits its recommendations for approval to
the head of the hospital, who is generally the hiring authority.
In other hospitals, the head of the hospital may prefer to interview all the
candidates himself for the key jobs and leave it to the selection committee for the
less vital jobs. In case of appointment of a department head, one expert is also
usually included in the selection committee. Different hospitals adopt different
policies according to their own convenience for the selection of their employees.
Generally this authority lies with the Medical superintendent or Administrator or
Business Manager or Chief Executive who is legally termed the ‗Occupier‘.
4) References:
The references provided by the applicant should be cross-checked to
ascertain his past performance and to obtain relevant information from his past
employer and others who have knowledge of his professional competence.
The references letters should be brief and should require as little writing as
possible by the person to whom it is sent. If it is directed to a former employer, it
should ask for the following data:

59
 Date of joining
 Date of leaving
 Job title
 Last salary drawn
 Promotion/demotion, if any
 Unauthorized absentee record
 Reason for termination/ leaving
 Ability to work with others
 Dependability
 Emotional stability
 Health conditions
 Does the employee habitually borrow money?
 Would you re-employ?
 Any other information
5. Medical examination:
The medical examination of a prospective employee is an aid both to the
employee and to the management. The selection of the right type of employee who
can give his best and be happy requires a thorough knowledge of his physical
capacities and handicaps. The purpose of the medical examination is threefold:
a) It is for the protection of the applicant himself to know whether that job will suit
him or not from the medical point of view.
b) It is for the protection of the other employees so that they are not at risk of any
communicable or other disease which the prospective employee may have.
c) It is for the protection of the employer as well, so that he may avoid selecting a
wrong person.
The medical examination will eliminate an applicant whose health is below the
standard or one who is medically unfit.
6) Joining report by the employee:
When new employees reports for joining, he should be given an appointment
letter, his job description and handbook of the hospital. He should be asked to
submit his joining report. A model appointment letter and joining report form are
given.

60
PLACEMENT
INTRODUCTION:
Placements are a credit bearing part of a degree course and all placements
optional. If a student opts out of a placement or there is no placement available, this
means that placement is not guaranteed.
DEFITION: State of being placed or arranged.
IMPORTANCE PLACEMENTS:
The school of service management believes that taking a placement is one of
the most important decisions you can make in your university carrier. Not only will
you benefit from building personal confidence during your placement year but you
will also establish contacts in your chosen sector which may provide invaluable for
graduate opportunity.
IMPORTANCE OF SELECTION AND PLACEMENT:
 To fairly and without any element of discrimination evaluate job applicants
in view of individual differences and capabilities
 To employee qualified and competent hands tat can meet the job
requirement of the organization
 To place job applicants in the best interests of the organization and the
individual
 To help in human resources man power planning purposes in organization
 To reduce recruitment cost that may arise as a result of poor selection&
placement exercises.
PLACEMENT TEAM:
Our current placement team consists of a placement coordinator & four
academic tutors, each with specialist knowledge relevant to the degree courses you
under the supervision are studying. These tutors advice and support you throughout
your preparation for placement.

61
PROMOTION
INTRODUCTION:
The promotion policy is one of the most controversial issues in every
organization. The management usually favours promotion on the basis of merits,
and the unions vehemently oppose it by saying that managements resort to
favoritism. The unions generally favour promotions on the basis of seniority. It is
hence essential to examine this issue and arrive at an amicable solution.
DEFINITION:
A change for better prospects from one job to another job is deemed by the
employee as a promotion‖.
FACTORS IMPLYING PROMOTION:
The factors which are considered by employees as implying promotion are:
NATURE AND SCOPE OF PROMOTION:
 Seniority versus merits: There has been great deal of controversy over
the relative values of seniority and merit in any system of promotion.
Seniority will always remain a factor to be considered, but there be
much greater opportunity for efficient personnel, irrespective of their
seniority, to move up speedily if merit is used as the basis for
promotions. It is often said that at least for the lower ranks, seniority
alone should be the criterionfor promotion. One cannot agree with this.
An increase in salary
A better future An increase in
prestige
FACTORS
IMPLYING
PROMOTION
Additional supervisory
responsibility
An upward movement
in the hierarchy of jobs

62
The quality of work is more important in the lower ranks as in the
higher.
There are some who argue against this plea and advocate the merit policy for
the following reasons:
1) They believe that mere length of service evidence only of continued service
but are surely no indication of vast experience.
2) Promotion on the basis of seniority saps the initiative of the employees.
Once they realize that promotions in the organization are on the basis of
seniority alone, they lose all enthusiasm for showing better performance.
Therefore, in terms of getting the best out of employees, the merits of the
individual employee will have to be considered.
3) There are individual differences amongst persons working o the same of
them are most efficient, some barely average and some below average. If
their differences are not distinguished and they are uniformly rewarded, all
individual will gradually sink to the level of the below-average employee.
PROMOTIONPOLICY:
The promotion policy is one of the most controversial issues in every
organization. The management usually favors promotion on the basis of merits, and
the unions vehemently opposite by saying that management resort to favoritism.
The unions generally favor promotions on the basis of seniority. However, in
practice, both seniority and ability criteria should be taken into consideration; but in
order to allay the suspicious of the trade unions, there should be written promotion
policy which should be clearly understood by all.
Promotionpolicymay include the following:
1) Charts and diagrams showing job relationships and ladder of promotion should
be prepared. Those charts and diagrams clearly distinguish each job and connect
various jobs by lines and arrows showing the channels to promotion. These
lines and arrows are always based on analysis of job duties. These charts do not
guarantee promotion but do point out various avenues which exist in an
organization.
2) There should be some definite system for making a waiting list after
identification and selection of those candidates who are to be promoted as and
when vacancies occur.
3) All vacancies within the organization should be notified so that all potential
candidates may complete.

63
4) The following eight factors must be the basis for promotion:
 Outstanding service in terms of quality as well as quantity
 Above average achievement in patient care and for public relations
 Experience
 Seniority
 Initiative
 Recognition by employee as a leader
 Particular knowledge and experience necessary for a vacancy and
 Record of loyalty and cooperation
In some instances, it may be possible to use pre-employment test, to determine
eligibility for the vacant position.
5) Though the department heads may initiate promotion of an employee, the final
approval should be with top management because a department head can think
only of the repercussions of the promotion in his department while top
management looks at it from the point of view of the organizations a whole. The
personnel department can help at the stage by proposing the names of
prospective candidates out of the existing employees in the organization and
also submit their performance appraisal record of the last few years to the
department head.
6) All promotion should be for a trail period. In case the promoted person is not
found capable of handling the job. Normally, during this trail period, he draws
salary at the higher pay-scale, but it should specially be made clear to him in
writing that if his performance is not found up to the work, he will be reverted
to his former post at the former scale.
7) In case of promotion, the personnel department should carefully follow the
progress of the promoted employees. A responsible person of the personnel
department should hold a brief interview with the promoted person and his
department head to determine whether everything is going on well or not. The
promotional post should be continued after the satisfactory report of the
department head.

64
ADVANTAGES OF A SOUND PROMOTION POLICY:
From a scientific management view point, a sound promotion policy has many
advantages.
 It provides an incentive to employee to work more and show interest in their
work. They put in their best in their best and aim for promotion within the
organization.
 It develops loyalty amongst the employees, because a sound promotion
policy assures them of their promotions if they are found fit.
 It increases satisfaction among the employees.
 It generates greater motivation as they do not have to depend on mere
seniority for that advancement.
 A sound promotion policy retains competent employees, and provides them
ample opportunities to rise further
 It generally results in increased productivity as promotion will be based on
an evaluation of the employee‘s performance.
 Finally, increases the effectiveness of an organization
SOLUTION TO PROMOTION PROBLEMS:
Difficult human relations problem can arise in promotion cases. These problems
may be reduced to the minimum if extra and following principles are observed.
In promoting an employee to a better job, his salary should be at least one step
above his present salary.
Specific job specifications will enable an employee to realize whether or not his
qualifications are equal to those called for.
There should be a well-defined plan for informing prospective employees may
know the various avenues for their promotion.
The organization chart and promotion charts should be made so that employees
may know the various avenues for their promotion.
The promotion policy should be made known to each and every organization.
Management should prepare and practice promotion policy sincerely.

65
 RETENTION
NURSE RETENTION
By Lee Ann Runy
An Executive’s Guide to Keeping One of Your Hospital’s Most Valuable
Resources
With no end in sight for the nation‘s nursing shortage, hospitals are placing
greater emphasis on retaining their current RN staff. It‘s a complex process,
requiring in-depth knowledge of the needs and wants of the nursing staff and lots of
creativity. ―You have to know what motivates nurses to stay,‖ says Pamela
Thompson, CEO of the American Organization of Nurse Executives. To that end,
many hospitals regularly conduct retention or exit surveys to understand what‘s on
nurses‘ minds.
For hospitals that have successfully implemented retention programs, the trick
seems to be in providing good working environments and professional development
and to accommodate individual lifestyles.
―The stresses of the job can be compounded by responsibilities outside of the
workplace. Hospitals are doing what they can to support nurses on a personal level,
which is where creativity mostly comes into play. From concierge services that
help nurses with errands to day care to flexible scheduling, hospitals are doing
whatever it takes to allow nurses to focus on their work and keep them in their jobs
for years to come.
DEFINITION:
Staff choose to stay for long periods within a cost centre, turnover is under is 10%
annually.
IMPORTANCE OF STAFF RETENTION:
 The advantages of staff retention are fairly clear. Most importantly perhaps, key
skills, ideas, knowledge and experience remain within your organization. Client
relationships and networks are also preserved in conjunction with all the income
that these areas generate.
 Conversely, losing your key employees lays open the possibility that these
people will than assume roles with your direct competitors. As a result those
invaluable skills, ideas, knowledge, experience, relationships and networks are
all transferred to another organization.
 On top of all these there are also direct costs involved in losing key employees.
The cost of replacing such an individual includes advertising, recruitment
agency fees and the time spent conducting actual interview process. Further

66
more it is also worth considering the time and expense spent on the induction
new employees and lost revenue during the recruitment and bedding in process.
 All though an element of employee churns is both inevitable and healthy. It is
nevertheless clear that retention brings substantial benefits to your organization.
Whilst attrition involves significant direct and indirect financial costs.
PRINCIPLES ANE ELEMNTS OF A HELPFUL PRACTICE AND WORK
ENVIRONMENT:
To foster staff retention, organizations need to develop environments in
which nurses want to work. Among other things, nurses want safe workplaces that
promote quality health care. ―It‘s the role of the nurse executive and nurse manager
to establish a work environment that supports professional practice,‖ says Pamela
Thompson, CEO of the American Organization of Nurse Executives. ―That‘s one
key piece to retention.‖ It‘s also important that nurses play an active role in shaping
their environment. ―Nurses want to work in a place that brings high quality to
patients and know they have a role in the process,‖ says Susan Shelander, director
of recruitment and retention for Memorial Hermann, Houston. Creating such an
environment is not easy.
The Nursing Organizations Alliance developed a set of principles to help hospitals
and other health care entities create positive work environments. More than 40
nurse organizations, including AONE, have endorsed the principles.
NINE PRINCIPLES TO HELP FOSTER STAFF RETENTION:
1)Respectful collegial
communication and behavior
• Team orientation
• Presence of trust
• Respect for diversity
2) Communication-rich culture • Clear and respectful
• Open and trusting
3) A culture of accountability • Role expectations are clearly defined
• Everyone is accountable
4) The presence of adequate
numbers of qualified nurses
• Ability to provide quality care to meet
client/patient needs
• Work and home life balance
5) The presence of expert,
competent, credible, visible
• Serve as an advocate for nursing practice
• Support shared decision-making

67
leadership • Allocate resources to support nursing.
6)Shared decision-making at all
levels
• Nurses participate in system, organizational
and process decisions
• Formal structure exists to support shared
decision-making
• Nurses have control over their practice.
7)The encouragement of
professional practice and
continued growth/ development
• Continuing education/certification is
supported/encouraged
• Participation in professional association
encouraged
• An information-rich environment is
supported.
8) Recognition of the value of
nursing‘s contribution
• Reward and pay for performance.
9) Recognition of nurses for
their meaningful contribution to
the practice
• Career mobility and expansion
FIVE CHARACTERISTICS OF SUCCESSFUL RECRUITMENT AND
RETENTION PROGRAMS:
1) Sustained leadership commitment to workforce as a strategic imperative.
2) A culture centred around employees and patients.
3) Work with other organizations to address workforce needs
4) Systematic and structured approach to four strategies outlined in the 2002
AHA report, ―In Our Hands.‖ They include: foster meaningful work, improve the
workplace partnership, broaden the base to attract a more diverse workforce and
collaborate with other organizations, including other hospitals in the community
and schools, to ensure an adequate workforce in the future.
5) Excellence in human resource practice
BIBLIOGRAPHY:
1. Linda Roussel, Management and Leadership for Nurse Administrators, 4th
Edition, Jones and Bartlett publications; 2006.

68
5. PERSONNEL MANAGEMENT AND PERSONNEL
POLICIES
INTRODUCTION
A head nurse should be fully aware of the remuneration she will receive, the hospital
policy regarding salary increases, vacation, sick leave, health benefits, working hours,
opportunity for college study. It is important for her to decide, before accepting the
position, whether she can be content with the personnel policies of the institution. If not,
she should look elsewhere for a position for having accepted an appointment she has
agreed to the policies of the hospital and thus has no justification for complaint.
TERMINOLOGIES
1) Supreme:Highest;greatest;mostexcellentormostextreme;utmost; greatest.
2) Privileged:rightorbenefitenjoyedonlybya personbeyondthe advantagesof most.
3) Remuneration:Payorcompensationthatone receiveforthe service.
PERSONNEL MANAGEMENT
DEFINITIONS
Personnel Management – It is the process of developing, applying and evaluating
policies, procedures, methods and programmes relating to individuals in an organization
for achievement of organizational goals in the desired manner.
AIMS OF PERSONNEL MANAGEMENT
 Determination of future staffing requirements in order to meet the service demands in
the most effective and economical way, and to ensure that the suitable staff are
recruited,trainedandretainedtofulfill this objectives.
 Ensuringachievementof effective developmentof all groupsandall levelsof staff.This
shouldinclude careerdevelopment,staff training,safety,healthand welfare.
 Developmentof effective communication,consultationandrelationswithinthe
organization.
 Developmentanddesigningproceduresforsolvingpersonnelandinstitutional
differencesbymeansof joint consultation.

69
 Provisionfororganizedstructure andworkingenvironmentmostsuitableforthe
performance of the task.
 Developmentof personnel policies,andgeneral policiestoachieve the above objectives.
ACTIVITIES OF PERSONNEL MANAGEMENT
Good personnel management, like any other management, uses the principles of planning,
organizing, directing, and controlling. It discharges its functions through policy formation,
design and development of an organization appropriate for the work .
Good personnel management provides for:
1) Man powerplanning:
o A service for looking at work and estimating staffing levels, types of staffing and
ensuringthe successionof jobs.
o It is to explain, predict and influence manpower changes in relation to the
developing operational, technical, economical and social situations in an
organization.
2) Selection procedures:
o Having planned the man power needs, selecting the staff in the methodological
way, designed to make the best choice possible. Right man for the right job is to
be employed.
3) Induction:
o Having selected the personnel to do the job, helping in the induction process to
settle him in the job and into the organization as quickly and as effectively as
necessarytoachieve these objectives.
4) Training:
o Assessing the training needs, in the interest of further development of staff such
as refreshercourses,shortterm training.
5) Recognizingthe effortsand appraisals:
o Everyone thrives on praise and recognition. Every effort must be made to
recognize andrewardthe workwhichiswell done.
6) Environmentforeffectivedelegationand supervision:
o Staff will notworkinan organizationwhichhasrestrictive,negative atmosphere.
o In such an organization people become automatous with a dulled sense of
commitment/responsibility.
o A conducive environmentforworkis necessary

70
7) Systemof consultationandworking relations
o The more people know of whatisgoingon,the lessthreatenedthey feel.
o The likelihoodof poorworkingrelationsislessenedwhenthereiseffective
communicationandeffective involvementbyall through consultation.
8) Opportunityforcounsellingandwelfare channelsof communication.
9) Staff development
o Staff are preparedandchanneledintotheirmosteffective areaof service.
PERSONNEL POLICIES
DEFINITION OF PERSONNEL POLICIES
Policy-
1) Statementof predetermined guidelines
2) Policiesingeneral,theyare guidelinestohelpinthe safe andefficientachievementof
organizational objectives
Personnel Policy-
1) A set of rules that define the manner in which an organization deals with a human
resources or personnel-related matter. A personnel policy should reflect good practice,
be written down, be communicated across the organization, and should adapt to
changingcircumstances.
2) Personnel policyisanintegratedfunctionwhichencompassesmanyaspectsof the
personnel management.
3) The writtenstatementof anorganization’sgoal andintentconcerningmattersthateffect
the personnel workinginan organization.
4) Personnel policies are the statements of the accepted personnel principles and the
resulting course of administrative action by which a specific organization pattern
determinesthe patternof itsemployment conditions.
IMPORTANCE:
1) To the employee itrepresentsaguarantee of fairandequitable treatment.
 The establishmentof goodpersonnelpolicieshelpstogive the employee asense
of securityandindividual worth.
 It givesemployee pride andloyaltytothe organizationforwhichhe/she works.

71
 Policiesthatare plannedinadvance are likelytomeetthe needsof the
organization better.
2) To the supervisor it is a safeguard in that it relieves her of the responsibility of
making a personal decision which may conflict with decisions given by other
supervisors.
 Establishedpersonnel policiesserve asguidestoactionsothat a great deal of
time issavedbyadministrational personnel inhandlingindividual cases.
 A well understoodclearlywrittenpolicysavesthe time of anemployee aswell as
the employer.
PHILOSOPHY:
―The nursing service administration of…….. believes that its supreme objective ;
the best possible patient care, can be achieved only by the full cooperation of all who are
privileged to take part in that care‖.
―It seeks to establish a team dedicated to the protection of health and well being of
the patient in an environment that will enable every member of the team to obtain as well
as give satisfaction in his or her work‖.
OBJECTIVES:
1) To employ those persons best fitted by education, skill and experience to
perform prescribed work.
2) Guarantee fairness in the maintenance of the discipline
3) Upgrade and promote existing staff wherever possible.
4) Take all practical steps to avoid excessive hours of work.
5) Ensure the greatest practicable degree of permanent and continuous
employment.
6) Maintain standards of remuneration
7) Provide and maintain high level of physical working conditions.
8) Maintain effective methods of regular consultation between administration and
employees.
9) Provide suitable means for the orientation, on the job training and evaluation of
employees.
10) Encourage social and recreational facilities for employees.
11) Develop appropriate schemes for employees welfare.

72
FUNCTIONS AND TECHNIQUES OF ADMINISTRATION TO MEET THE
OBJECTIVES SPECIFIED BY THE STATEMENT OF POLICY.
FUNCTIONS TECHNIQUES
Employment Job analysis, job specifications, time schedules,
works Schedules, manuals, agreed code of
regulations, assessment of personnel.
Remuneration Job evaluation
Health and safety Physical examination, safety training, accident
analysis, sickness statistics.
Welfare Social and recreational programs, rest rooms,
canteen, pension schemes, employers counseling
Training On the training, training for leadership.
TYPES OF POLICIES
a) Implied Policy:
 It is the policy which is not directly voiced or written but is established by
pattern of decision.
 They may have either favourable or unfavorable effects
 It is the policy neither written nor expressed verbally have usually
developed over time and follow a presendent.
 If you have people who are accountable to you, you don‘t need to formally
issue policy statements to create policy.
 Parents, bosses, boards, government administrations, etc. are producing
implied policy all of the time.

73
 For Example: Imagine that an employee comes to the boss and asks,
―What should I do about this?‖ If the boss responds by giving an
instruction, that employee will assume that this is how to cope with all
similar situations. They will interpret the instruction in terms of the implied
values or the general policy that would result in the instruction.
b) Expressed Policy:
 These are delineated verbally or in writing.
 Oral policies are more flexible than written ones and can be easily adjusted
to changing circumstances.
 Most of the organization have many written policies that are readily
available to all people and promote consistency in action. It may include:
Formal dress code
Policy for sick leave or vacation time
Disciplinary procedures
ELEMENTS OF PERSONNEL POLICIES STATEMENT
Operating Procedures
The statement details the company's operating procedures, including how employees
should accomplish their assigned tasks; punctuality, work hours, and breaks; payment
structure; personal appearance and dress code; drug and alcohol policies; benefits; and
other employee guidance and responsibilities.
Employee Conduct
The statement defines the company's policies and guidelines about such matters as
professional conduct with other employees and clients.
Equipment Use Regulations
Employee use of office equipment is another key item. If personal or non-work-related
use of computers, telephones, other equipment, and office supplies is prohibited, this
should be outlined.

74
Professionalism
With an employer personnel policies statement in effect, business owners, managers,
and employees are afforded a greater air of professionalism, according to the National
Restaurant Association's guidelines for writing an employee manual.
Employer Authority
One of the principal functions of an employee statement is that it offers the employer a
point of reference in the event that an employee is reprimanded or terminated, thereby
protecting the employer from wrongful termination lawsuits.
PROCESS OF DEVELOPMENT OF PERSONNEL POLICIES
Every organization should have a complete set of well developed personnel policies before
it begins to function. The existing ones also need to be revised. At times, the policies may
be formulated simultaneously from the top management as well as the lower division
management. The stages and sequences of events in the process of development of policy
are:
1) Clarification by top management of philosophy and the objectives of the
organization.
2) Analysis of personnel policy requires assessment of relevant facts. Job is delegated
to the committee who through interviews and conferences collect data from inside
and outside the organization.
3) Consultation with staff representatives.
4) Writing the first draft of the policy statement.
5) Further discussion to get the final approval of policies from top management and
staff representatives.
6) Communication of policy statements by means of training session, discussion
groups and staff hand books.
7) Periodic re evaluation and follow up

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PROCESS
POLICIES RELATED TO NURSING PRACTICE:
SERVICE STAFFING POLICIES (HOSPITAL)
 Employment- recruitment rules,
qualification
 Job description
 Working hours
 Work load, working facilities
 Policies for breakage and losses
 Special allowances- special duty/
hard duty allowance, medical
allowance. The nursing
personnel have demanded a
uniform allowance of Rs 3,000
per month and a nursing
allowance of Rs 1,600 per
month.
 Promotional opportunities
 Career development
 Vacations
 Holidays
 Sick Leave
 Weekend Off
 Rotation To Different Shifts
 Overtime
 Part Time Personnel
 Exchanging Hours
Fact Finding
Appraising The
Policy
Reporting Of Personnel
Policy
Communicating The
Policy
Writing The Personnel
Policy
Adopting And Launching
Policy
Discussing The
Proposed Policy

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POLICIES RELATED TO NURSING EDUCATION
Policies For College Of Nursing
STUDENTS STAFFS HOSTEL POLICIES
 Admission Policies
 Working Hours
 Attendance
 Uniform
 Medical Facilities
 Internship
 Holidays
 Special Leave
 Withdrawal From
Course
 Discipline
 Recruitment Policies
 Policy On
Termination
 Staff Benefits
 Uniform
 Duty Hours
 Retirement Age
 Permission to meet
only authorized
visitors
 Permission for a
dayout
 Visiting hours
 Permission letter for
outing
 Signing the register
 Disciplinary action
on violation of rules
FACTORS INFLUENCING PERSONNEL POLICY
The following factors will influence determining of personnel policies of an organization:
i) Law of the country: The various laws and labor legislation govern the various
aspects of personnel matters. Policies should be in conformity with the laws of
the country
ii) Social values and customs: there are codes of behavior of any community
which should be taken in account in framing policies.
 Accommodation
 Transport
 Special incentives
 Occupational hazards

77
iii) Management philosophy and values: Management cannot work together for
any length of time without clear broad philosophy and set of values which
influence their actions on matters concerning the work force.
iv) Stage of development: All changes such as size of operations, scale of
technology, innovations, fluctuations in the composition of workforce,
decentralization of authority and change in financial structure influence the
adoption of personnel policies.
v) Financial position of the firm: The personnel policies cost money which will
be reflected in the price of the product. Because of this, prices set the absolute
limit to organization‘s personnel policies.
vi) Type of work force: The assessment of characteristics of workforce and what
is acceptable to them is the responsibility of the effective personnel staff.
CHARACTERISTICS OF PERSONNEL POLICIES
 Specific Consistency, Permanency, Flexible with Purpose Recognize individual
differences.
 Be formulated with regards for the interest of all parties, i.e. employer, employee
(individual/ groups) public and clients.
 Confirm to the government regulations be written and formulated as a result of
careful analysis of all facts available.
 Be forward looking and forward planning for continuing development
 Recognize individual difference
ADVANTAGES
 Helps to give employees a sense of security and individual worth.
 Gives the employees pride and loyalty to the organization for which they work.
 Employees tend to give good service and identify themselves with the goals of the
organization and they want to remain in the organization.
 Are planned in advance and with due consideration on how policy will apply in
various situations to meet the needs of the organization
 As guides to action, save a great deal of time of the administrator.
 A clearly written policy saves the time of the employee as well.

78
SUMMARY AND CONCLUSION
A personnel policy is much the safest practice in applying for a position. And before she
visits the hospital the nurse will do well to think through the questions which she wishes to
have answered. Loyalty to the institution in which she is working and to its personnel is an
essential in any field of work. So it is important to realize that no new appointee to a
position of leadership makes a very marked contribution to the institution until she has
learned well its policy and practice.
JOURNAL ABSTRACT
Debra Kirkley, A. Patricia Johnson, Mary Ann Anderson conducted a study on
Technology Support of Nursing Excellence: Personnel Policies and Programs and
published in Medscape Today on May 2010. The abstract of the study states that
salaries and benefits are competitive so creative flexible staffing models are used.
Personnel policies are created with staff involvement. There are significant opportunities
for growth in administrative and clinical areas.
Information systems support more than clinical care delivery. They serve administrative
needs as well, including scheduling and financial activities. For example, nurse managers
can use a system's reporting capabilities to analyze patient needs and nursing activities to
support data-driven staffing models.
BIBLIOGRAPHY
1) http://www.slideshare.net/michaelbonito/final-nursing-managemen
2) http://managementhelp.org/policies/policies/polslist.htm
3) http://www.authorstream.com/Presentation/dhavaselvi-209479-personnel-policies-
policy-1-education-ppt-powerpoint/
4) http://www.ehow.com/facts_5753162_personnel-policies_.html
5) http://www.ehow.com/facts_5771883_employer-personnel-policies-statement_.html
6) Dr. Basavanthappa BT. Nursing administration. 2ed. St Louis (USA): jaypee
brothers medical publishers; 2009. p809-36.
7) Jean Barrett, ward management and teaching, konark publications, page no 416.
8) http://books.google.co.in/books?id=h7vOCnafby8C&pg=PA138&lpg=PA138&dq
=expressed+policy&source

79
6. STAFF DEVELOPMENTPROGRAMME:IN-SERVICE AND
CONTINUING EDUCATION
INTRODUCTION:
Staff development is the process directed towards the personal and professional
growth of nurses and other personnel while they are employed by a health care agency. It
is essential for the upliftment of professional as well as administrative field. Staff
development programme helps in updating the knowledge and practice of professionals. It
is applicable not only to the nursing field but also to all the professional fields.
TERMINOLOGIES:
Abreast: - knows about the most recent changes in a subject
Confront: - deal with
Fiscal: - government money, tax
DEFINITION:
Staff development refers to all training and education provided by an employee to
improve the occupational and personal knowledge, skills and attitude of vested employees.
GOAL:
 To assist each employee to improve performance in his or her present position and
to acquire personal and professional abilities that maximizes the possibility of
career advancement.
NEED FOR STAFF DEVELOPMENT:
 To meet social change and scientific advancement. It causes rapid changes in
nursing knowledge and skills.
 To provide the opportunity for nurses to continually acquire and implement the
knowledge, skills and attitudes, ideas and values essential to maintain high quality
nursing care.
 To meet job related learning needs of the nurse – (eg, continuing education, in-
service education, extramural education and post basic education).
 Fill the gaps between theory and knowledge.
 To achieve personal or professional development eg, promotion.
 To prepare for future tasks or trends.
PRINCIPLES INVOLVED STAFF DEVELOPMENT:
 Activities must base of needs and interest of employees and organization.
 Learning is combination of theory and experience.
 Learning is internal, personal and emotional process.
 Learning involves changes in behavior.
 Learner should be encouraged to contribute in learning process.
 Problem solving approach is well suited because; effective learning takes place
when there is need/problem.
 Positive reward is effective.
 Teaching – learning should be based on educational psychology.
 Learning can be maximized by providing favorable condition.
 Learning is active process i.e., teacher and learner should be active in learning.

80
 Teaching must satisfy learning needs of an individual.
 Use variety of sources for learning as adult learners have wide range of previous
experience.
STAFF DEVELOPMENT MODEL FOR GOAL ACHIVEMENT OF THE
HEALTH CARE AGENCY, THE NURSE AND THE NURSING PROFESSION
Staff development model is based on the aforementioned philosophical statement,
that the activities within a health care agency are directed towards achieving a high quality
care through the mutual goal oriented efforts of the health care agency, nursing profession
and its practitioners.
This model has three main components.
 Education
 Experience
 Socio-economics
Educational component includes:
The educational component assumes that the nurse is motivated to continue
learning through involvement in educational activities endorse by a health care agency and
the nursing profession. It may take the form of continuing education – in service education
and extramural education or post basic nursing education. Staff nurse is self-motivated for
learning. She may accept any type of staff developmental activity, comes under local
agency or outside agency.
 In-service education is referred to an agency based educational activity. It begins
with orientation to the health care agency and to a particular position and
continues in the form of specific skill training related to nursing or more
generalized skill training related to patient care within the context of the health
care team.
 Extramural education includes short courses, conferences, seminars and like,
which are planned for group learning, as well as programmed learning and
correspondence courses.
 Post basic education refers to formal study at degree-granting institution. It
involves full time commitment to an academic programme leading to university
diploma, certificate, baccalaureate degree, master‘s degree or doctorate degree etc.
Experience:
Nursing practice and experience in daily life are integral parts of staff
development. Planned approach to the daily assignment of nursing responsibilities is both
a benefit to the development of the nurse practitioner and prerequisites to high quality
patient care. For quality care – experiences may be planned or unplanned. Experiences are
curricular and co-curricular and self.
Socio-economic component:
It involves health care agency, the nurse and nursing association in management,
planning, counseling and employee – employer relations.
 The effectiveness of man power planning depends on needs assessment, which is
influenced by the standards set by the nursing profession and the job commitment
made between the health care agency and the nurse.

81
 Counseling includes career planning as well as performance evaluation for the
benefit of both the health care agency and the nurse.
 Employee-employer relations are reflected in the personal practices, form the
basics of policies underlying staff development in any agency.
The interrelationship of the components provides the framework for purposeful staff
development structured to meet the needs of both a health care agency and the nurse.
TYPES OF STAFF DEVELOPMENT:
Staff development includes formal and informal group and individual training and
education. Staff development activities include the following:
Induction training (3 days): Is a brief standardized introduction to an agency‘s
philosophy, purpose policies and regulations given to each worker during her or his first
two or three days of employment in order to ensure his or her identification with agency‘s
philosophy, goals and norms.
Job orientation (2- 24weeks): Is an individualized training programme intended to
acquaint a newly hired employee with job responsibilities work place, clients and co-
workers.
In-service education(2- 8hours): It is a planned educational experience provided in the
job setting and closely identified with service in order to help the person to perform more
effectively as a person and as a worker.
Continuing education: Is a planned activity directed towards meeting the learning needs
of the nurse following basic nursing education, exclusive of full time formal post basic
education.
Extramural education: Is a community based education directed towards meeting the job
related learning needs of the nurse and other personal. Exclusive of full time formal study
at a degree granting institution.
Induction
training
Continuin
g
education
Staff
develop
ment
Job
orientatio
In service
education

82
FACTORS INFLUENCING STAFF DEVELOPMENT PROGRAMME
The major factors that determine the administrative structure of an agency-wide
staff development programme are:-
 Administrative philosophy, policies and practices of health care agency
 Policies, practices and standards of nursing and other health professionals
 Human and material resources within the health care agency and community
 Physical facilities within a health care agency and community
 Financial resources within a health care agency and community
FUNCTIONS OF STAFF DEVELOPMENT PERSONNEL:
Personnel assigned to staff development should provide the following consultative
functions for health care agency.
 Determination of the administrative structure of the staff development programme.
 Determination and establishment of organizational methods, policies and
procedures for a staff development programme.
 Determination and establishment of lines of communication for the utilization of
facilities and resources personnel for the staff development programme.
 Determination of organizational and individual staff development needs and
priority.
 Development of measurable short and long term objectives for staff development
programmes.
 Promotion, development, implementation and evaluation of programmes to meet
these objectives.
 Planning, co-ordination and utilization of community resources to assist in
meeting these objectives.
 Provision of a consultative service and a resource for information relative to staff
development.
PROGRAMMES FOR STAFF DEVELOPMENT
Orientation Programme
Skill Training Programme
Leadership and management development
Continuing education
1. Orientation Programme:
 Is the process of acquiring anew staff with the existing work environment
so that he/she can relate quickly to his/ her new surroundings.
 It is assigned for new staff. It is given at the initial stage of employment or
when a staff takes new responsibilities.
2. Skill Training Programme:
 Skill training may be a manual or technical skill of doing for people or skill
in dealing and working well with people.
 It provides the nursing staff with the skills and attitude required for job and
to keep them abreast of changing methods and new techniques.
 Often it is the continuation of the orientation programme.

83
 It is designed to new and older staff.
3. Leadership and management development:
 To improve the managerial abilities of persons at every management level
as well as potential managers to produce the greatest degree of
organizational progress.
 It should be begin by establishing agreement among top and middle level
managers as to proper authority, responsibility and accountability for
managers at every level.
 Need can identified by incident reports, turnover rates, patient audits and
quality control reports.
4. Continuing education:
 Formal, organized, educational programme designed to promote the
knowledge, skills and professional attitude of nurses.
OTHER ACTIVITIES OF STAFF DEVELOPMENT
 Make rounds with the physicians
 Attend medical round in a teaching centre
 Visit another hospital to observe their method of patient care
 Attend professional meetings, conferences, etc. and present papers
 Read articles of special interest and report them to staff
BENEFITS OF STAFF DEVELOPMENT:
For the employees:
 Leads to improved professional practice
 Aids in updating knowledge and skills at all levels of organization
 Keep the nurses abreast of the latest trends and developments in techniques
 Equips the nurses with knowledge of current research and developments
 Helps the nurses to learn new and to maintain old competencies
For the organizations/employer:
Keeps the nursing staff enthusiastic in their learning
Develop interest and job satisfaction amongst the staff
Develops the sense of responsibilities for being competent and knowledgeable
Creates an appropriate environment and sound decisions as well as using effective
problem solving techniques
Helps the nurse to adjust to change
Aids in developing leadership skills, motivation and better attitudes
Aids in encouraging and achieving self development and self confidence
Makes the organization a better place to worker
ROLE OF ADMINISTRATOR IN S.D.P
Preceptorship:
 In most of the hospitals have a staff development coordinator who is responsible
for continuing and in-service education programmes. A staff nurse is selected as a

84
preceptor to assist the new nurse in the unit based on their skill and competence.
The role of the preceptor are:
 As an orienteer
 As a teacher
 As a resource person
 As a counselor
 As a role model and evaluator
IN-SERVICE EDUCAION:
DEFINITION:
1. In service education is defined as a continued programme of education
provided by the employing authority, with the purpose of developing the
competences of personnel in their functions appropriate to the position they
hold, or to which they will be appointed in the service.
2. In-service education is a planned instructional or training programme provided
by an employing agency in the employment setting and designed to increase
competence in a specific area.
3. In-service education is an ongoing on-the-job instruction that is given to
enhance, the worker‘s performance in their present job.
AIM OF IN-SERVICE EDUCATION:
In-service education aims at developing the ability for efficient working and the
capacity for continuous learning, so that one may adapt to changes with judgment and
produce profitable services which become an important tool for the health care of the
society and nation.
CONCEPTS OF IN-SERVICE EDUCATION:
In hospital nursing services, it becomes the process of helping the nurse to carry
out the functions with their obligations for nursing services. It helps to develop their skills
necessary to reach the ultimate goals of health agency. i.e. (i) The highest quality of the
patient care, and (ii) to keep abreast of changing technique and use of sophisticated tools
and equipment.
Help a person‘s
performance
effectively as a
Planned education
activities
Concept
Closely identified
with service
Provided in a job

85
CHARACTERISTICS
 It should be given in job setting
 Every programme should be planned and ongoing
 It should be closely related and identified with service components
 It should help the employees‘ learning and improve her/his knowledge, skills and
attitude.
FACTORS INFLUENCING IN-SERVICE EDUCATION:
The economic, social, medical and technological sciences which affect that society
will affect nursing in-service education. The related factors affect the in-service education
programmes are:-
1. Cost of healthcare – In-service education programme may increase the efficiency
of nursing services, but it adds additional expenditure on health care delivery
system.
2. Manpower – In-service education requires need qualified human resources, leads
to increase human resources.
3. Changes in nursing practices – it leads to frequent changes in the programme and
in-service education.
4. Standards of nursing practice
5. Organization of nursing departmental planned approaches is regular.
APPROACHES TO IN-SERVICE EDUCATION:
The pattern of in-service education desired to be:
 Centralized Approach
 Decentralized Approach
 Co-ordinated Approach
1. Centralized Approach: - The in-service curriculum ought to emanate from and be
conducted by nursing personnel in the central administration of the agency. None
of the learners are consulted or participate in planning learning experiences and yet
are expected to attend an in-service offering.
Advantages:
 Budget control
 Evaluation of programme can be facilitated
 Prior decision on resources, people, places and things
 Committees are directed to work on specific problems identified by administration.
Disadvantage:
 It may lead to in reducing spontaneous, interested participation and enthusiasm of
learners.
2. Decentralized Approach: - It is planned by and conducted for the employees of
one or more units. The employees are expected to keep administration informed of
their activities and possibly consult with administration when help is wanted, but
the employees are expected to develop and direct their own learning experiences.

86
In this approach, control in planning for an in-service is a responsibility of employees
and the qualities which are valued more are self direction, initiative and participation.
Advantages:
 Individuals are working in the same unit and confront problems are common
 Share the responsibilities for meeting the in-service needs
 Proper contribution of the participants is expected
Disadvantages:
 Lack of leadership
 Conflicts
 Inefficiency
 Less or no budget
3. Co-ordinated Approach: - It is a compromise between the centralized and
decentralized patterns in that, while the practicing nurse does indeed carry a large
measure of responsibility for the in-service curriculum, the central administration
of nursing personnel of the agency is responsible for a broad programme which is
of importance to all nursing personnel. This approach involves both nursing
administrators and practitioners in complementary way.
Advantages:
 Mutual co-ordination and assistance to central administration is improved
 Duplication is avoided
 Unity of efforts is maintained
DEFINITION:
CONTINUING EDUCATION
1. Continuing education is ―any extension of opportunities for reading, study and
training to any person and adult following their completion of or withdrawal from
full time school and /or college programmes.‖
2. Continuing education is an ―educational activity, primarily designed to keep the
registered nurses abreast of their particular field of interest and do not lead to any
formal advanced standing in the profession.‖
NEED FOR CONTINUING EDUCATION:
 Respond effectively to the challenge of current social changes.
 To improve the health care, economic and educational opportunities.
 To improve the new health patterns of health care.
 Due to increasing trend towards specialization.
 Due to legislation and its impact on the education of health personnel.

87
PHILOSOPHY OF CONTINUING EDUCATION:
It has been believed that the system of higher education which provides the basic
preparation or the members of a profession must also provide opportunities for
practitioners to keep abreast of advances in their field.
PLANNING FOR CONTINUING EDUCATION:
Planning is the key stone for the administrative process. Without adequate
planning, continuing education offerings are fragmented, haphazardly constructed, and
often unrelated. A successful continuing education programme is the result of careful and
detailed planning.
Effective planning is required at all levels, local, state, regional and national and
eventually international – to avoid duplication and fragmentation of efforts and to help
keep at minimum gap in meeting the continuing education needs of nurses.
THE PLANNING FORMULA:
1. What is to be done?
Get a clear understanding of what your unit is expected to do in relation to the
work assigned to it. Break the unit‘s work into separate jobs in terms of the
economical use of the men, equipment, space, materials and money you have at
your disposal.
2. Why is it necessary?
When breaking the units into separate jobs think of the objectives of each job. The
best way to improve any job is to eliminate unnecessary motion, materials etc.
3. How is it to be done?
In relation to each job, look for better ways of doing it n terms of the utilization
ofmen, materials, equipment and money.
4. Where is it to be done?
Study the flow of work and the availability of the materials and equipments best
suited men for doing the job.
5. When is it to be done?
Fit the job into a time schedule that will permit the maximum utilization of men,
materials, equipment and money and the completion of the job at the wanted time.
Provisions must be made for possible delays and emergencies.
6. Who should do the job?
Determine what skills are needed to do the job successfully, select or train the man
best fitted for the job.

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STEPS IN THE PLANNING PROCESS:
1. Establishing goals compatible with the purpose or mission of the organization.
2. Deciding upon specific objectives consistent with these goals.
3. Determining the course of action required to meet the specific objectives.
4. Assessing the available resources for establishing the programme.
5. Establishing a workable budget, appropriate for the programme.
6. Evaluating the results at stated intervals.
7. Reassessing he goals and updating the plan periodically.
ROLES AND FUNCTIONS OF ADMINISTRATOR/MANAGER IN STAFF
DEVELOPMENT:
ROLES: He/ she:
 Applies adult learning principles when helping employees learn new skills or
information
 Uses teaching techniques that empower staff
 Sensitive to the learning deficits of the staff and creatively minimize these
difficulties
 Prepare employees readily regarding knowledge and skill deficits.
 Actively seeks out teaching opportunities
 Frequently assess learning needs of the unit
FUNCTIONS:
 Works with reduction department to delineate shared individual responsibility
 Ensures that all staff are competent for roles assigned
 Ensure that there are adequate resources for staff development
 Assumes responsibly for quality and fiscal control of staff development.
 Provides input in formulating staff development policies
CONCLUSION:
The staff development programme is a planned activity in which the employee and
employer get benefited from the programmes. In most of the organizations staff
development programmes are an encouraging phenomena because in this technological era
everyone has to competent in their profession to make sure their position in the field.
Moreover in nursing profession the trend in health care is advancing day by day, so the
staff development programmes become a compulsory one to make sure their job.
BIBLIOGRAPHY:
1. Dr. Basavanthappa B.T, Nursing administration, 1st edition, Jaypee Brothers
Publications, New Delhi (2002), page no: 511- 530
2. Dr. Rebacca Samson, Leadership and management in nursing practice and
education, 1st edition, Jaypee Brothers Publications, New Delhi (2009), Page
no:118-123
3. Indira Gandhi national Open University School of Health Sciences, 1997

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7. EVALUATION OF STAFF DEVELOPMENT PROGRAM
Staff development is an important part of assisting performance
improvement at organiational, faculty/central department, unit and individual levels. It is
therefore important that the transfer of learning into the workplace is assessed through a
process of review and evaluation so that its success or otherwise can be established and so
that we can demonstrate the contribution learning makes towards overall organisational
success. Evaluation is the process of finding out how the development or training process
has affected the individual, team and the organisation.
Evaluation of the staff development process, focuses on the assessments
necessary to judge the extent to which the stated goals for the program are being met.
Definition of evaluation:
Evaluation is the process of finding out how the development or training process
has affected the individual, team and the organization. or
Evaluation is a value judgment on an observation, ― performance test‖ or indeed any data
whether directly measured or inferred
TYPES OF EVALUATION
Formative evaluation: Evaluation that is used to modify or improve a professional
development program is called formative evaluation. Formative evaluation is done at
intervals during a professional development program. Participants are asked for feedback
and comments, which enable the staff developers to make mid-course corrections and do
fine-tuning to improve the quality of the program. Formative evaluation helps ensure that
each professional development program meets the participants' needs and expectations, is
a meaningful experience, and can be translated into action in the classroom. Some staff
developers use formative evaluation on a daily basis during their program
Summative evaluation: Evaluation to determine the overall effectiveness of a professional
development program is called summative evaluation. Summative evaluation is done at the
conclusion of the program. It is collected at three levels: educator practices, organizational
changes, and student outcomes.
LEVELS OF EVALUATION
An Evaluation Framework
The next exhibit presents a framework for evaluating process and impact, based on
Kirkpatrick‘s (1994) sequential levels of evaluation for training programs. While his
evaluation approach was developed primarily for evaluating business and industry training
programs, consisting largely of what we characterize in this Guide as the
Workshop/Presentation approach, many of his concepts and aspects of his design are
applicable to a broader base of adult programs. The four stages of evaluation are intended
to measure: (1) reaction, (2) learning, (3) behavior and actions, and (4) results.
 Reaction: Measures how those who participate in professional development
activities react to what has been presented. Although typically characterized as
―the happiness quotient,‖ participants need to have a positive reaction to a

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professional development activity if information is to be learned and behavior is to
be changed.
 Learning: Measures the extent that professional development activities have
improved participants' knowledge, increased their skills, and changed their
attitudes. Changes in instructional behavior and actions cannot take place without
these learning objectives being accomplished.
 Behavior: Measures what takes place when the participant completes a
professional development activity. It is important to understand, however, that
instructors cannot change their behavior unless they have an opportunity to do so.
 Results: Measures the final results that occurred because an instructor participated
in professional development activities. Evaluating results represents the greatest
challenge in evaluating professional development approaches.
STAFF EVALUATION (PERFORMANCE APPRAISAL)
Definition
A periodic formal evaluation of how well personnel have performed their duties
during a specific
period, it is a systemic, interpersonal, continuous process between manager, and employee
involving job guideline and objectives and job descriptions.
It is a Process by which a manager or consultant (1) examines and evaluates an
employee's work behavior by comparing it with preset standards, (2) documents the results
of the comparison, and (3) uses the results to provide feedback to the employee to show
where improvements are needed and why. Performance appraisals are employed to
determine who needs what training, and who will be promoted, demoted, retained, or
fired.
Purposes:
• Enhance job performance
• Encourage professional growth
• Improve program quality and meet the core indicators of performance
Objectives
1. To determine job competence.
2. To select qualified individual for promotion or transfer.
3. To establish and improve communication between supervisors and subordinates.
4. To determine training and developmental needs of staff salary standard and to
avoid merits
5. To provide the staff with recognition for accomplishment.
6. To discover the aspirations and talents of the staff.
7. To check the efficacy of staff development program.
8. To identify unsatisfactory staff for demotion or termination.
9. To aid the manager in coaching and counseling.

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Principles Of Performance Appraisal
1. Based on behavior: Employees evaluation based on his/her behavior
stated performance standard which should be reflected in the job
description and related performance standards, and the employee should be
aware of the desirable performance goal.
2. Based on
observation :
An adequate representative of the nurses job should be
observed to provide the basis of evaluation Based on job description.
The employee should be given a copy of job description, performance
standards, and performance evaluation form, to understand how he/she was
evaluated.
3. Based on satisfaction: While documenting the evaluation the manger
should indicate the satisfactory and unsatisfactory area of performance.
4. Based on performance: The employees performance need should be stated
according to the priority.
5. Based on time and environment: The evaluation interview should be
schedule in proper time and environment.
6. Based on satisfaction: The goal of evaluation should improved performance
and satisfaction rather than punishment.
Approaches of performance appraisal
There are three different approaches for conducting performance appraisal. They are as
 Appraising against absolute standard (established standard)
 Relative standard (where the subjects are compared against other
individual)
 Objective (how well employees accomplished specific objective)
QUALITIES TO BE EVALUATED
Since, evaluation will be made by various individuals; if necessary to define carefully
each quality should be evaluated. The qualities most frequently evaluated fall under five
major headings:
1. Quality of performance: - i.e. the evaluation of both the quantity and quality of
work, neatness, orderliness, reliability, accuracy, knowledge of work, execution,
etc.
2. Mental qualities: - i.e. The ability to learn, adaptability, reasoning power,
judgment, memory, etc.
3. Supervisory qualities: - i.e. leadership and organizational ability, communication
skill co-operation, etc.
4. Personnel qualities: - i.e. honesty, self control, self confidence, initiative, attitude
towards others, team work, appearance, etc.
5. Capacity of further development:- i.e. intelligence, acceptance, of responsibility
and other features inherent in leadership.
APPRAISER (WHO WILL APPRAISE)
Appraiser may be any person who has a thorough knowledge about the job content,
contents to be appraised, standards of contents and who observes the employee while
performing a job. The appraiser should be capable of determining what is more important
and what is relatively less important. He should prepare reports and make judgment
without bias.

92
a) Supervisors: it include superior of the employee, other superiors having knowledge
about the work of the employee and departmental heads or manager. General
practice is that immediate superiors appraise the performance, which in turn is
reviewed by the departmental heads. This is because supervisors are responsible
for managing their subordinates and they have the opportunity to directly observe
and control the subordinate continuously.
b) Peers: It can be reliable if the work group is stable over a reasonably long period of
time and performs task that require interaction.
c) Subordinates: superior being rated by subordinate are used in most organization
today especially in developed countries. Example is student evaluating a teacher
performance in the classroom.
d) Self appraisal: if individual understand the objectives they are expected to achieve
and the standards by which they are evaluated, they are to a great extent, in the best
position to appraise their own performance.
e) User of the service: Employees performance in service organization relating to
behavior, promptness, speed in doing the job and accuracy can be better judged by
the customers or users of services. Example: patient evaluating performance of
attending nurse.
STAGES OF PERFORMANCE APPRAISAL
 Stage 1: Pre-Evaluation: Activities that the administrator, the evaluators, and
evaluate engage in prior to the formal evaluation.
 Stage 2: Evaluation: Activities that comprise the formal evaluation as conducted by
the evaluator/s such as observing, collecting data, interviewing, and planning.
 Stage 3: Follow-up: Periodic discussions or checks on employee progress during
the
Program year.
PROCESS OF PERFORMANCE APPRAISAL
Performance appraisal is planned, developed and implemented through a series of
steps. They are as
a) Establish performance standards: Appraisal systems require performance
standards which serves as benchmark against which performance is measured. To
be useful, standards should be relate to the desired results of each job. Performance
standard should be clear to the both appraiser and the appraise. Performance
standard should be written down after thorough analysis of the job. They must be
measurable within short period of time.
b) Communicating the standard: performance appraisal involves at least two
parties, the appraiser and the appraise. Appraiser should prepare job descriptions
clearly, help appraise to set his goals and targets, analyze results objectively.
Performance standard must be communicated to appraises clearly..
c) Measure actual performance: after the performance standard are set and
accepted, the next step is to measure actual performance. This requires the use of
dependable performance measures to be helpful must be easy to use, reliable, and
report on the critical behaviors that determine performance four common sources
of information which are generally used by managers regarding how to measure
actual performance are personal observation, statistical reports, oral report and
written report.
d) Compare actual performance with standards and discuss the appraisal: actual
performance may be better than expected and sometimes it may go off the track.

93
Whatever the consequences, there is a way to communicate and discuss the final
outcome. The assessment of another person contribution and ability is not an easy
task. It has serious emotional overtones as it may effect the self esteem of the
employee.
e) Taking corrective action, if necessary: corrective action is of two types: one puts
out the fires immediately, while the other destroys the root of the problem
permanently immediate action sets things right and get things back on track
whereas the basic corrective action gets to the source of deviation and seeks to
adjust the difference permanently.
TOOLS AND TECHNIQUES OF PERFORMANCE APPRAISAL
A) Individual evaluation methods:
 Confidential report: mostly used in government organization. It is a descriptive
report prepared, generally at the end of every year, by the employee‘s immediate
superior. The report highlight the strengths and weakness of the subordinate. The
report is not data based. The impression of the superior about the subordinate are
merely recorded here. It does not provide any feedback to the appraise. The
appraise is not very sure why his performance has fallen despite his best effort.
 The essay:-the rater writes one or more paragraph about how well the employee
performs and his or her strength and weaknesses in relations to the tasks identified
in the job description this method needs time and efforts. On the other hand. It can
give data about an employee‘s developmental needs. It is a non quantitative
technique. Advantage is that the essay provides a good deal of information about
the employee and also reveals about the evaluator. Limitations are that
 It is highly subjective; evaluator may write a biased essay
 Some evaluator may be poor in writing essays, some may be superficial
and it is time consuming so the evaluator may simply write superficially.
 Critical-incident technique:- In this technique, the rater records of positive and
negative behaviors considered critical to the employee‘s success on the job
behaviors are recorded not the manager‘s interpretation or judgment of the
behavior.
o Critical incidents should be related of the job duties and responsibilities or
to individual goals the following is an example related to a job duty of a
staff nurse .that is formulating and recording appropriate nursing care plan
for assigned patients
 Rating scale: - The most common only used tool in nursing service. It consists of
set of behaviors or characteristics to be rated and same types of scales for
indicating the degree to which each present. the scale my take several forms,
numerical, graphic or descriptive
 Forced choice rating:-the technique requires the rater to select from groups of
statements, two of which will be positive and two of which will be negative that
best fit and least the individuals being rated. The statement are in behavioral terms
and are weighed and scored. The primary purpose of this is for eliminating the bias
of an evaluator who consistently higher or lower rating for employee.
 Check-list:-it is compressed of a series of descriptive statement in behavioral
terms about the standard of nursing performance of the job expected of the
individual nurse. the rater places a mark in the ―yes‖ or ―no‖ column in accordance
with individual‘s behavior. A space is provided for those item which are not

94
applicable the items are weighed in pre-established values to secure total rating this
tool is easier and tend to reduce bias but it needs time and effort to develop a valid
check-list tool. The check list is an efficient tool of assessing technical procedures
and in handling large number of staff
.
 Management by objective (MBO):-the nurse manager(rater)evaluates the staff
according to predetermined goals or objective that have been jointly arrived at by
her/him and the individual staff. Comparing staff output to goals is an inherent
part of the MBO concept. In MBO the source from which behaviors are to be rated.
come from individual employee‘s goals while the source of the others tools is the
job description of the individual staff
Example for each patient to whom I am assigned ,I will establish a nursing
diagnosis write short-range goals to guide nursing care construct a written plan for
nursing care
B) MULTIPLE-PERSON EVALUATION TECHNIQUE
In the above discussed methods employees are evaluated one at a time. Here are
some other methods used to evaluate one employee in comparison to another.
Three such frequently used methods in organization are
 Ranking method: this is a relatively easy method of performance evaluation.
Under this method ranking of an employee in a work group is done against that of
an another employee. The relative position of each employee is expressed in terms
of his numerical rank. It may also be done by ranking a person on his job
performance against another member of the competitive group. The quintessence
of this method is that the performance of the employee is rated in terms of the level
of another employee.
Advantage is that it is easy and limitations are that difficult to rank the average
employee, only speak about the position of the employee does not tell how much
better or how much worse an employee is.
 Forced distribution method: under this system, the performance rater is asked to
appraise the employee according to a predetermined distribution scale. The rater
bias is sought to be eliminated here because worker are not placed at a higher or
lower end of the scale. Normally the two criteria used here for rating are job
performance and promotability. Worker are placed between two extremes of good
and bad.
c) OTHER METHODS
Peer-review :-in this method, the individual staff evaluated at the same time by the
immediate supervisor plus three or four other supervisors who have knowledge of that
individual work performance the virtue of this method is it‘s thoroughness it is possible
for multiple raters to modify or cancel out bias displayed by the immediate supervisor. It
focuses on what to be accomplished rather than how to accomplish.

95
Tools and techniques to be used while assessing knowledge, attitude and practice can be
classified as follows
Assessing the knowledge
a) Subjective type question
- Essay type
- Descriptive type –short notes
b) Objective type question
- Multiple choice
- matching type
- True or false, fill in the blanks
- Sentence completion etc
c) problem-solving type situational
Assessing the attitude
 Interview
 Assignments
 Communicative records
 Anecdotal records
 Observation during performance
 Critical incident technique
 Discussion skills
Assessing the skills
 Rating scale
 Observation check list
 Anecdotal record
 Critical incident technique
GUIDELINES FOR DEVELOPING STAFF EVALUATION POLICY
 The purpose of the evaluation
 ‗ An explanation of what will be used to judge performance
 ‗ A listing of the participants in the evaluation and their roles
 ‗ A description of how the evaluation will be conducted
 ‗ A time line for conducting the evaluation
 ‗ The instrument/s that will be used to record the evaluation (if a variety of options
are
offered, a brief explanation of the best uses for each should be included)
 ‗ The methods for collecting employee input throughout the three stages of the
evaluation process
 ‗ Any methods for collecting input from sources other than the employee, such as
students, peers, and other stakeholders
 ‗ An outline of follow-up actions, including administrative support and
professional
development
 ‗ A plan for storing records

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 ‗ A plan for communicating the policy to all participants
 ‗ A plan for periodic review and revision of the evaluation policy by all staff
CHARACTERISTIC’S OF AN EFFECTIVE APPRAISAL SYSTEM
Performance appraisal system should be effective as a number of crucial decisions are
made on the basis score or rating given by the appraiser, which in turn, is heavily based on
the appraisal system. So an appraisal to be effective should possess the following essential
characteristics:
a. Reliability and validity: appraisal system should provide consistent, reliable and valid
information and data, which can be used to defend the organization-even in legal
challenges.
b. Job relatedness: appraisal system should measure the performance and provide
information in job related activities/areas.
c. Standardization: appraisal forms, procedures, administration of techniques, ratings,
should be standardized as appraisal decisions‘ affect all employees of the group.
d. Practical viability: The techniques should be practically viable to administer, possible
to implement and economical to undertake continuously.
e. Legal sanction: appraisals must meet the laws of the land. They must comply with
provisions of various statutes relating to labor.
f. Training to appraisers: because appraisal is important and sometimes difficult, it
would be useful to provide training appraisers. Some ideas on documenting, rating,
conducting appraisal interviews should be provided.
g. Open communication: A good appraisal system provides the needed feedback on a
continuing basis. The appraisal interviews should permit both parties to learn about
the gaps and prepare themselves for future.
h. Employee access to results: employee should know the rules of the game. They should
receive adequate feedback on their performance. If performance appraisals are meant
for improving employee performance, then withholding appraisal result would not
serve any purpose. Permitting employees to review the results of their appraisal
allows them to detect any errors that may have been made.
THE APPRAISAL INTERVIEW:- Guidelines for nurse manager
The objective of a personal interview in to evaluate past, present, and future potential
of an individual
The following points are general guidelines for the nurse manager:-
1. Establish a friendly atmosphere by selecting the right time and place for the
interview. Be sure the interview will be free of interruptions
2. Ensure freedom from work assignment. Arrange for coverage during the time of
meeting. Begin and end the session on time.
3. Establish rapport – a few brief chit-chat before the actual interview.
4. Let the individual talk first. Include all important issues in the discussion. Be alert
present criticism carefully. Never combine positive and negative comments and
use the guidance approach. Use a concerned tone of voice. Discuss the work never
the worker.
5. Make a final overall judgment about the individual progress, as well as any
recommendations on the evaluations form
6. Let the individual sign the report and explain that the signatures does not
necessarily signify that she/he agrees with content, but it indicates

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For the appraisee
 Better understanding of his role in the organization—what is expected and what
needs to be done to meet those expectations
 Clear understanding of his strengths and weaknesses to develop himself into a
better performer in future that she/he has seen it.
 Never create a threatening or bargaining environment. Increased motivation, job
satisfaction, and self-esteem
 Opportunity to discuss work problems and how they can be overcome
 Opportunity to discuss aspirations and any guidance, support or training needed to
fulfil those aspirations
 Improved working relationships with supervisors
For the Management
 Identification of performers and non-performers and their development towards
better performance
 Opportunity to prepare employees for assuming higher responsibilities Opportunity
to improve communication between the employees and management
 Identification of training and development needs
 Generation of ideas for improvements
 Better identification of potential and formulation of career plans
For the Organization
 Improved performance throughout the organization
 Creation of a culture of continuous improvement and success
 Conveying the message that people are valued
PROBLEMS IN PERFORMANCE APPRAISAL:
A. Judgmental errors: biases and judgment errors of various kinds may spoil the
show. Biases here refer to distortion of measurement.
1. First impressions (primacy effect): the appraiser first impression of a
candidate may color his evaluation of all subsequent behavior. In the case
of negative primacy effect, the employee may seem to do nothing right, in
the case of positive primacy effect the employee can do wrong.
2. Halo effect, is the tendency to overrate a person because of his pleasant
personality, strong social skills, he performed well in past, recent good
performance not the whole year, or share the interests of the manager.
3. Horn effect, is the tendency to rate employees lower than what he deserves
because: she/ he committed a serious error recently, disagrees with the
manager, fails to meet manager standards for dress and behavior, or poor
performing peers.
4. The central tendency error: It is the tendency to rate the employee in the
middle of the range for each dimension. Also this occurs when appraisers
rate all employees as average performers.

98
5. Leniency: Here every employee is rated high, not differentiating among
employee.
6. Recency effect: here the rater gives high weightage to recent occurrences
than earlier performance.
7. Spill over effect: Here the past performance of the employee influences the
present ratings.
B. Poor appraisal forms: appraisal process may also be influenced by the
following factors relating to the forms that are used by raters
The rating scale may be vague and unclear
The rating form may ignore important aspects of job performance
The rating form may contain additional, irrelevant performance
dimension
The forms may be too long
C. Lack of rater preparedness: the raters may not be adequately trained to carry
out performance and management activities. This becomes a serious limitation
when the technical competence of a rate is going to be evaluated by a rater who
has limited functional specialization in that area.
D. Ineffective organizational policies and practices
If the sincere effort put in by a rater is not suitably rewarded, the motivation to
do the job thoroughly finishes off.
EVALUATION REPORT:
Employee reviews and appraisals are some of the hardest meetings to have, and
writing the report can create conflict or fear. Rather than being a manager who instills
negative feelings in his employees, it can be writen in such a way that the employee feels
prepared to meet new challenges or fix current issues.
Characteristics of appraisal report
 Is to be written jointly by the nurse manager and staff nurse.
 It should be reliable,
 It should be Valid and accurate,
 Should show progress made by the staff nurse
 Giving illustrations to substantiate value judgments.
 Any improvements are to be noted
If both have kept notes that they have periodically assessed and if the staff
nurse believes the nurse manger‘s intent is to help rather than to blame, the staff
nurse will feel more free to be honest in an evaluation of her/his strengths and
weaknesses. If the staff nurse has not been functioning satisfactorily, she/he will
already be aware of it. If her/his performance has not improved adequately since
previous interviews, the staff nurse should be informed so that the weakness will
be included in the report, and the staff nurse should know exactly where she/he
stands. It may be necessary to tell her/him that she/he has to make certain
improvements within a definite time period.

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Instructions for writing appraisal report
Step 1
Decide on criteria for reviewing. Any manager that goes into a review completely
subjectively will be respected less, and All Business notes that many employees
already find written reviews to be "artificial and unfair." A good idea is to think about
the role of the employee under review, create categories regarding that role
(punctuality, work ethic, ability to meet deadlines, etc.) and use a numeric scale to rate
the employee's effectiveness. For instance, for each of the categories above, make a
numeric scale (from one to five) and circle which number best fits. For punctuality, if
the employee is always on time, he would receive a 5; mostly on time, a 4; average
punctuality a 3; less than desirable punctuality, a 2; and consistently late, a 1. Provide
employees with their own copies of the report.
Step 2
Prepare a report based on current conditions--in other words, how the employee is
currently performing. Rehashing the first few weeks of the employee's work history--
often the most difficult and awkward--will make the employee feel despondent and
unmotivated. Compliment the ways the employee is contributing, note where she can
perform better, and recommend ways that the employee can contribute further in the
future. For example, you might say, "You have really grown in your Excel skills, and
I'd like to add on some work with Visio now."
Step 3
Evaluate based on your own observations, not hearsay. Office gossip is not an accurate
indicator of an employee's performance. For instance, saying, "I hear that many of the
employees see you with personal email sites open," would cause the employee to feel
upset and vulnerable. Only bring up a point if you have witnessed it yourself.
Step 4
Use specific examples for your employee review. In any observation--whether positive
or negative--be sure to have an example to back it up. For instance, if you want the
employee to note his punctuality, say, "I appreciate the days you make it into the
office by 8:30. Perhaps if you are going to be later, you could give a phone call."
Employees will not grow unless they can understand what they did right or wrong in a
specific scenario.
Step 5
Encourage the employee under review to indicate her goals for the next year. This type
of positive reinforcement makes the manager-worker relationship feel more reciprocal
and motivates the employee to achieve more than she already has. Ask, "What do you
feel you are capable of adding on to your duties?" or recommend a new task yourself,
"I think that you are ready to move into increased client invoicing responsibility."

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8 A . DUTIES OF NURSING AND NON NURSING
PERSONALS IN HOSPITAL
INTRODUCTION:
Nursing and non nursing personals in hospitals plays an important role in patient
care and the development of the hospital. Their entire role is very important to improve the
standard of care.
GENERAL ROLE OF REGISTERED NURSES IN HOSPITAL
ADMINISTRATOR:
A hospital administrator is usually an individual responsible for the day to day
operational running of the health care institution. In addition, the administrator participates
in and coordinates the setting of strategic priorities for the direction of the hospital.
Specific duties include recruitment and retention of physicians, overseeing quality,
improvement of processes for efficient delivery of patient care, setting standards, oversight
of budgets, creating financial and business strategies to assure fiscal viability and health.
The hospital administrators also become involved in press relations, public and
community affairs, grants management, billing, collections, purchasing of equipment and
meeting regulatory standards. Hospitals typically have Chief Executive Officers/Presidents
and administrative hierarchies report up through this individual.
MANAGER :
The nurse plans, gives directions, develops staff, monitors operations, gives rewards
fairly, and represents both staff members and administration as needed. The nurse
manages the nursing care of individuals, groups, families and communities. The nurse
manager delegates nursing activities to ancillary workers and other nurses and supervises
and evaluates their performance.
COUNSELOR:
In most organisations counselors' play an important role in the induction of new
employees. The first few days at place of work are always be wildering. At this stage
counselors can do much to help new employees. They take new employees round the
hospital, show them different departments and explain their functioning, explains rules and
regulations of hospital and of cafeteria, issue lockers and uniforms, and introduce them to
the administrator and medical superintend.
counselling is a procedure which consists in a personal relationship between client and
counselor., in which the client aided by the counselor examine the causes underlying the
growth of his problem and learns a new and more satisfying way of adjusting himself to an
organisational environment. Counselling helps in reviewing training needs, improving
better communication between employees and employers and helps in solving personal
and official problems of employees. External and internal stress, lack of training,
difficulties in job, emotional deprivation etc can be tackled under employee counselling.
Use of counselling methods and skills of the counselor can be utilized effectively, to create
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Problems to be handled by the Counselor
The problems coming under employee counselling in a hospital setting are
1. Emotional Problem
2. Behavioural Problem
3. Personal Problem
4. Environmental Problem
5. Organisational Problem
Emotional Problem
Unpleasant emotions like fear, anger, and jealousy, which are harmful to the well-
being and development of individual employee in hospital setting.
Personal Problems
Common personal problems include, housing, transportation, admission of children in
schools etc.
Behavioural and Organisational problems
Major organisational problems are lack of group cohesiveness, role conflict, feeling of
inequality, role ambiguity, role over load, lack of supervisory support, constraints of rules
and regulations, job mismatch, inadequacy of role authority, absenteeism, job
dissatisfaction, labour turnover and job stress.
Change Agent
The nurse initiates changes and assist the client make modifications in the lifestyle to
promote health. This role involves, identifying the problem, assessing the client‘s
motivations and capacities for change, determining alternatives, assessing resources,
determining appropriate helping roles, establishing and maintaining a helping relationship,
recognizing phases of the change process, and guiding the client through these phases.
Researcher
The nurse participates in scientific investigation and uses research findings in practice.
The nurse helps develop knowledge about health and promotion of health over the full life
span; care of person with health problems and disabilities; and nursing actions to enhance
people‘s ability to respond effectively to actual or potential health problems.
 First, the Standards for Nursing Service, defined research as the responsibility of a
clinical service organization.[5] This standard necessitates a nursing service position
on clinical nursing research. Second, the Guidelines on the Investigative Functions of
Nurses, described that nurses, roles in research, regardless of work setting, are
determined by their educational backgrounds and roles in nursing.[3] Nurses are
essential for the application of research to practice; and, to the extent they are able by
their backgrounds, nurses have a responsibility to participate in research. The ultimate

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goal of nursing research is to provide a scientific base for practice, and this is
described in Issues in Professional Nursing Practice.
CASE MANAGER
The nurse coordinates the activities of other members of health care team, such as
nutritionists and physical therapist, when managing a group of client‘s care.
COLLABORATOR
The nurse works in a combined effort with all those involved in care delivery, for a
mutually acceptable plan to be obtained that will achieve common goals. The nursing
initiates nursing actions within the health team
HEALTH EDUCATORS
work to encourage healthy lifestyles and wellness through educating individuals and
communities about behaviors that can prevent diseases, injuries, and other health
problems.
After assessing their audiences' needs, health educators must decide how to meet those
needs. Health educators have a lot of options in putting together programs. They may
organize an event, such as a lecture, class, demonstration or health screening, or they may
develop educational material, such as a video, pamphlet or brochure. Often, these tasks
require working with other people in a team or on a committee. Health educators must
plan programs that are consistent with the goals and objectives of their employers. For
example, many nonprofit organizations educate the public about one disease or health
topic, and, therefore, limit the programs they issue.
Next, health educators need to implement their proposed plan. This may require
locating funding by applying for grants, writing curriculums for classes, or creating
materials that would be made available to the public. Also, programs may require
dealing with logistical tasks, such as finding speakers or locations for the event.
Generally, after a program is presented, health educators evaluate its success.
Methods of evaluation vary based on the program in question. For example, they may ask
participants to provide feedback using a survey about the program. Through evaluation,
health educators can improve plans for the future by learning from mistakes and
capitalizing on strengths.
ADVICER:
specific responsibilities:
1. Act as advisor in Tech-Serve project on matters relating to hospital management
improvement in provincial hospitals, based on previous experience.
2. Contribute to the development of provincial hospital planning and facilitating the
implementation of Standard Based Management in the Provincial Hospitals.
3. Work closely with the other national and international Tech-Serve Hospital
Management Advisors concerning the Tech-Serve Hospital Management Improvement

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Initiative, reviewing and developing MOPH policies and active participation in the MOPH
Hospital Management Task Force.
4. Provide technical assistance to EPHS workshops conducted at the provincial and central
level as well as participate in visits to provincial hospitals for purposes of training,
conducting quality standards assessment or preparing necessary workshops of Tech-Serve.
5. Travel regularly to the provincial hospitals for the purpose of supporting, training, and
monitoring the activities of the hospital leadership.
6. Act as a resource to provide models of best practice for hospital management through
research, training, document translation, and any other means as needed.
7. Participate in and sometimes leading quality assurance and performance improvement
activities as required by the hospitals.
8. Collect statistical data as needed for the purposes of monitoring hospital performance
and providing comparative information on hospital performance to peer facilities and
MSH.
9. Advocate for external support as needed by the hospitals, both within MSH and at the
MOPH through the Hospital Management Task Force.
10. Any other duties, as requested by the Chief of Party, Program Directors, or Program
Manager for Capacity Building.
ADVOCATOR:
A patient advocate may be charged with a cadre of duties, from gathering information
from doctors and hospitals to helping discuss and decide treatment options.
Some duties of advocator:
 Clarifying treatment and medical options.
 Gathering information.
 Asking specific questions.
 Note taking, to make sure all the appropriate information received from caregivers
is captured and retained.
IMPLEMENTER:
The nurse should implement all of the hospital policies. They should implement
patient care according to their planning.
EVALUATOR:
The nurse evaluator should evaluate staff performance and give feedback about
their work. It helps the staff to improve their knowledge and practice.

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DUTIES OF NURSING PERSONALS IN HOSPITAL:
DUTIES OF NURSING SUPERINTENDENT:
A nursing superintendent supervises the nursing staff. The nursing superintendent,
who is also called the director of nursing, is responsible for the running and supervision of
a nursing department. Depending on the size of the facility, she may control subsidiary
departments, such as housekeeping. Nursing superintendents generally report to the
hospital director or medical director of their facility.
Supervise nursing staff
The top priority of a nursing superintendent is to ensure that the nursing staff
members are providing the best care for patients. She makes sure that individual nurses
and nurses aides are carrying out care plans and ensures that communication between
shifts happens smoothly and thoroughly. The superintendent also monitors stock and
supplies to make sure that nurses have the equipment they need to provide quality care.
Oversee hiring and training
The nursing superintendent is responsible for the hiring and training of new staff.
She must search for nurses that complement the existing team, design training programs
and make sure that nursing instructors and trainers are adequately preparing new staff for
the workplace. Often this includes hearing an evaluation of new nurses from the floor staff
during the training period.
Patient care
Although the nursing superintendent does not have a high level of direct patient care,
she is responsible for the well-being of patients at the facility. This means that the
superintendent must monitor nurses' care and the attitude and health of the patients. In
cases where the family requests alternate care, the nursing superintendent must hear the
request and make the final decision.
Create work schedules
Each pay period, the nursing superintendent is responsible for setting the work
schedules for the entire department. She must take into account holidays, hear requests for
time off, and create a schedule that gives the appropriate number of hours to each nurse.
As part of the process, the nursing superintendent assigns duties and floor responsibilities
to each nurse.
Make disciplinary decisions
In situations where a nurse, nurse's aide, or other staff member is involved in a
dispute, the nursing superintendent must handle disciplinary actions. In extreme cases like
patient abuse or staff coming to work under the influence, the nursing superintendent is
responsible for terminating contracts as needed.

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Manage other departments
In a large facility, the nursing superintendent may be responsible for directing the
activities of the housekeeping, linen, and kitchen facilities. She must handle any problems
that arise, communicate with department leaders, and address any supply issues.
Negotiate with vendors
Because the nursing superintendent is responsible for the supply of equipment and
medical necessities, she often negotiates with vendors for the new contracts. In large
facilities, a purchasing manager may handle these duties and report to the superintendent.
DUTIES OF ASSISTANT NURSING SUPERINTENDENT:
Essential Functions/Responsibilities:
1. Take responsibility for a group of activities or subcontractors and manage the work to
be done. Provide liaison between field engineering, estimating, and subcontractors to
ensure compliance of construction with drawings and specifications.
2. Assist in planning work schedule, determining manpower levels, materials quantities,
equipment, requirements, etc. are maintained, including field engineering and construction
activities.
3. Monitor work performance and productivity of crafts to ensure project rules,
procedures, safety requirements, etc. are maintained.
4. Advise senior level supervision and project management of potential problems, work
interferences, schedule difficulties, etc. Assist in circumventing/resolving such problems
as required.
5. Maintain liaison with other departments, i.e., Purchasing, Accounting, Engineering, etc.
as required to support construction schedule. May provide assistance to the Superintendent
in resolving problems.
6. Perform additional assignments per supervisor‘s direction.
DUTIES OF WARD SISTER:
Functions:
A. Clinical Activities:
1. Assesses the situation of given unit in relation to different types of patient‘s care,
facilities provided by the nursing personnel.
2. Identifies the patient‘s need/problem in the unit.
3. Assigns the patient‘s care and others activities to nursing personnel.
4. Evaluates the patient‘s care given by nurses.
5. Attends Doctor‘s round and Matron and Assistant Matron‘s Clinical rounds.
6. Checks and caries out and delegates Doctor‘s instruction and order after round.

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7. Participates and refers the patient for rehabilitation therapy.
8. Guides and conducts health education activities to client as required including
MCH/FP disease control and health promotion.
h4. B. Supervisory Activities
1. guides and supervises all staff for giving bed side nursing care.
2. Maintains regular records, report concerning the patient‘s care.
3. Provides direct guidance and supervision of nursing and non-nursing personnel for
the efficient running of the wards and in carrying out nursing routines, bearing in
mind the individual needs of patients.
4. Encourages motivates, assesses the effectiveness of their own works and develops
their potential for giving good nursing care.
5. Uses the standard guideline and manual for supervision.
h4. Administrative Activities
1. Makes duty roaster for 24 hrs coverage in unit of the Hospital.
2. Conducts nursing conference, meeting and individual conference when necessary.
3. Investigates complaints promptly and takes action according to rules and policy of
the hospital.
4. Reports and records absence and sickness of staff including leaves.
5. Maintains cleanliness of the ward and its environment, furniture, equipment, e.g.
ventilation, lighting, heating, noise, odors.
6. Maintains adequate linen, other supplies, requisition for ward stores and repairs,
replaces supplies as necessary.
7. Keeps up-to-date record of drugs and maintains records of its administration.
8. Checks and manages all equipment periodically, to see that it is in good order.
9. Checks daily availability and conditions of emergency equipment and supplies.
10. Maintains inventories, reports, breakages and losses.
11. Helps in Controlling the visitor of patients as needed.
12. Ensures that relatives of very ill patient are allowed to stay with patients when
necessary.
13. Accompanies, the Matron on the round and reports to her any important incidents.
14. Informs Matron immediately of any special emergencies or accidents in the ward,
and keeps a written record of nay incidents.
15. Coordinates between Matron and staff in her unit and also with other departments.
16. Takes active part in condemnation of useless materials.
17. Helps Matron for annual plans and budgets in her ward.
18. Delegates responsibilities to the responsible person in her absence.
19. Assist the Matron and Assistant Matron for disaster plan and organization.
D. Educative Activities
1. Identifies the learning need of staff in ward.
2. Plans, conducts and recommends the in-service education and training programme
for her staff.
3. Manages and facilitates the clinical teaching activities for the students and staffs.

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DUTIES OF OTHER NURSING PERSONALS:
Duties and responsibilities of Perioperative nurses:
Perioperative registered nurses provide surgical patient care by assessing, planning,
and implementing the nursing care patients receive before, during and after surgery. These
activities include patient assessment, creating and maintaining a sterile and safe surgical
environment, pre- and post-operative patient education, monitoring the patient‘s physical
and emotional well-being, and integrating and coordinating patient care throughout the
surgical care continuum.
During surgery, the perioperative registered nurse may assume any of the following
responsibilities:
 Scrub nurse – works directly with the surgeon within the sterile field by passing
instruments, sponges, and other items needed during the surgical procedure.
 Circulating nurse – works outside the sterile field. Responsible for managing the
nursing care within the O.R. by observing the surgical team from a broad
perspective and assisting the team in creating and maintaining a safe, comfortable
environment.
RN First Assistant – after completing extensive additional education and training
to deliver direct surgical care, the RN First Assistant may directly assist the
surgeon by controlling bleeding and by providing wound exposure and suturing
during the actual procedure
Diabetes management nurses:
Diabetes Management Nurses are registered nurses who assist patients
to manage diabetes. Their main duty is to educate patients and their families about
diabetes and the self-management skills required. They provide advice on exercise, diet
and medication and monitoring insulin levels. These nurses often work in outpatient
clinics and often travel to hold clinics in regional areas.
 The main duties of a Diabetes Management Nurse include:
-Dealing with complications of patients diagnosed with diabetes mellitus
-Working closely with physicians, pharmacists and other healthcare professionals
-Educating patients of the best practices in improving their health
-Informing patient‘s families on living with diabetes
-Providing advice on diet and exercise
-Advising on injecting medications
-Administering tablets or insulin if the patient is unable
- Monitoring blood glucose levels
Duties and responsibilities of Dermatology nurses:
Those who are suffering from skin disorders or in need of skin care may seek the
services of a dermatology nurse. Dermatology nurses are registered nurses who specialize
in treating skin disorders and may administer treatments for their patients. In some cases,

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they may prescribe medication. The nurse may also educate their patients on maintaining
healthy skin.
Duties and responsibilities of geriatric nurses:
A geriatric nurse is a registered nurse who specializes in the care of elderly people.
Geriatric nurses must have the same educational background as registered nurses,
including a bachelor's degree from an accredited college or university. Duties of a geriatric
nurse, however, differ from other fields of nursing due to the unique problems that can
arise in elderly patients.
Assess Problems
1. Geriatric nurses must be able to assess medical problems of their elderly patients.
Often, it is the geriatric nurse who must decide if his patient can preform every day
tasks on her own. Assessments may be in activities like driving, walking and
taking medications.
Communication Skills
2. Geriatric nurses must be able to determine, through both verbal and non-verbal
communication, the health of patients by knowing symptoms, ailments and
medications being taken by patients. Geriatric nurses are the liaison between
doctors, patients, patients' families and other health-care facility workers.
3. Patient Relationships
Geriatric nurses often spend large amounts of time with their patients, causing
them to have close-knit relationships with the patients and their families. Geriatric
nurses, because of the time spent with their elderly patients, must be able to cope
with the death of patients as well as the decline of a patient's mental and physical
health.
Duties and responsibilities of Pediatric oncology nurses:
A pediatric nurse works in the pediatric department of a hospital, children's clinics
or at their homes. The basic duties of a pediatric nurse involve performing physical
examinations and giving medicines administrated by the doctor to hospitalized patients.
As little children are usually afraid of medical settings, it is the duty of the pediatric nurse
to make them comfortable with encouraging words, so that they can conduct the necessary
tests and treatment procedures smoothly.
Responsibilities of a pediatric nurse involves taking temperature, blood pressure,
respiratory rate and heart rate of the patient. He/she also has the duty of starting
intravenous medications, performing head to toe examinations and also collecting samples
of patient's urine and stools for laboratory tests.
Pediatric nurses can also specialize in certain areas like neonatal care, pediatric or
neonatal ICU, surgical and medical unit, hematology and oncology, etc. Some nurses also
specialize in certain diseases, for instance treating patients suffering from cancer, diabetes,
etc. Many pediatric nurses also work at emergency department of the hospital. This course

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trains nurses in giving immediate treatment to children who are injured and those who are
seriously ill. For this, they would have to do an emergency nursing pediatric course from
Emergency Nurse Association. They can also specialize in Advanced Cardiac Life
Support, Pediatric Basic Trauma Life Support, Pediatric Advanced Life Support, etc.
As pediatrics is based on the treatment and care of children, nurses have to deal
with depressed and tensed parents, especially if their wards are suffering from some
critical illness. It is the pediatric nurse's duty to inform the condition of children to their
parents truthfully, and at the same time offer them emotional support and strength.
Pediatric nurse duties also include educating the parents about how to take care of their
children once they are discharged from the hospital. This includes diet restrictions, how
and when to give the medicines, changing the dressing or bandages, and also about the
everyday care of children.
The duties of a pediatric nurse also involves supervising the regular check up of
healthy children and make sure that they are given immunizations on time. Besides
medical knowledge, a good pediatric nurse requires qualities such as patience and
understanding, as dealing with children is no easy task.
Ambulatory care nurses:
provide preventive care and treat patients with a variety of illnesses and injuries in
physicians' offices or in clinics. Some ambulatory care nurses are involved in telehealth,
providing care and advice through electronic communications media such as
videoconferencing, the Internet, or by telephone.
Critical care nurses:
Critical care nurses provide care to patients with serious, complex, and acute
illnesses or injuries that require very close monitoring and extensive medication protocols
and therapies. Critical care nurses often work in critical or intensive care hospital units.
ICU nurses are specialized, trained nurse professionals working with patients who have
life-threatening situations that required an extended hospital stay in an intensive care or
critical care unit of the hospital. The ICU nurse must be skilled to make complex
assessments, give the patient intense therapy and provide intervention care. The nurse may
also perform ongoing duties for a patient in ICU unit during his stay.
Assessment
Individualized assessment is made by the ICU nurse to determine the immediate needs
of the critical care patient. Ongoing assessment is then established to keep tabs on the
patient's condition and make any changes in treatment based on hospital policy, procedure
and protocol. Assessment helps the nurse and other hospital staff determine what plan of
action to take in care of the patient. Assessment also allows the ICU nurse to educate the
patient and her family on what to expect in the days, weeks and months following ICU
treatment.
Patient Care
Following doctor or head nurse instructions, the ICU nurse performs treatments and
therapies for the patient. She gives the patient all necessary medication. If the patient
lapses into cardiac arrest or another condition that requires resuscitation, the nurse follow
hospital protocols and administers life-saving techniques. When a patient's condition
changes rapidly, the nurse makes quick decisions to treat the patient effectively. As shift

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changes occur, it is the nurse's duty to inform the relief nurse of all patient care
information. If the patient requires special procedures, the ICU nurse acts as an assistant to
the doctor or head nurse.
Administrative
Documentation of assessments and drug therapy is recorded by the ICU nurse. She also
makes documentation of physical therapy and other treatments given. The nurse must also
keep all patient clinical records with doctor orders confidentially secure. The ICU nurse
must be nondiscriminative and nonjudgmental when dealing with patients.
In some cases, the ICU nurse is the team leader on the nursing staff and reports directly to
the head or charge nurse. In this position, she has the duty of directing and developing the
skills and abilities of the staff under her. She is also responsible for giving the team
assignments as directed by the head nurse. The nurse plays an active role in team
conferences, participating in in-service trainings and initiating CPR and codes classes
when needed.
Emergency or trauma nurses:
Emergency or trauma nurses will work in hospital or stand-alone emergency
departments, providing initial assessments and care for patients with life-threatening
conditions.
Emergency/Trauma Nurses are registered nurses that work in hospitals or stand-alone
emergency departments. Emergency/ Trauma nurses provide care to patients who have
suffered serious and sometimes life-threatening physical injuries e.g. Car accidents, work
related injuries and suicide attempts. These injuries can potentially result in secondary
complications such as respiratory failure, shock and death.
The main duties of an Emergency / Trauma Nurse include:
- Providing care to patients in an emergency situation
- Administering emergency procedures e.g. code blue and CPR
- Acting fast and thinking on their feet
- Handling complex and difficult situations
- Operating healthcare machines
Transport nurses:
Transport nurses will provide medical care to patients who are transported by
helicopter or airplane to the nearest medical facility.
Holistic nurses:
Holistic nurses will provide care such as acupuncture, massage and aroma therapy, and
biofeedback, which are meant to treat patients' mental and spiritual health in addition to
their physical health.

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Home health care nurses:
Home health care nurses will provide at-home nursing care for patients, often as
follow-up care after discharge from a hospital or from a rehabilitation, long-term care, or
skilled nursing facility.
Hospice and palliative care nurses:
Hospice and palliative care nurses work in collaboration with other health providers
(such as physicians, social workers, or chaplains) within the context of an interdisciplinary
team. Composed of highly qualified, specially trained professionals and volunteers, the
team blends their strengths together to anticipate and meet the needs of the patient and
family facing terminal illness and bereavement.
Hospice and palliative nurses distinguish themselves from their colleagues in other
nursing specialty practices by their unwavering focus on end-of-life care. Hospice and
palliative care includes 24-hour nursing availability, management of pain and other
symptoms, and family support. By providing expert management of pain and other
symptoms combined with compassionate listening and counseling skills, hospice and
palliative nurse promote the highest quality of life for the patient and family.
Hospice and palliative nursing is not only practiced at the bedside. Nurses,
consistent with their individual educational preparation, experience and roles, promote the
highest standards of end-of-lie care through community and professional education,
participation in demonstration grants, and in end-of-life research. As society‘s needs
change and awareness of the issues surrounding the end of life increases, nurses are called
to advocate for the terminally ill and their families through public policy forums, including
the legislative process.
Infusion nurses:
Infusion nurses administer medications, fluids, and blood to patients through injections
into patients' veins. Infusion nurses specialize in administering parenteral fluids, blood &
blood components, pharmacological agents, nutritional solutions and pain medications.
Long term care nurses:
Long term care nurses provide healthcare services on a recurring basis to patients with
chronic physical or mental disorders, often in long-term care or skilled nursing facilities.
Medical surgical nurses:
Surgical nurses are a vital part of the health care team that provides care for patients
before, during and after surgical procedures. They work both inside and outside of the
sterile field to provide both direct patient care and support to the surgical staff.
General Duties
Surgical nurses are RNs who work in the operating, pre-surgical or recovery areas
of a hospital, outpatient surgical center or emergency ward, under the supervision of the

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operating physician. They perform many functions that allow surgeries to proceed
smoothly, including preparing patients for surgery, assisting the surgeon during
procedures and following up with patients during recovery. Although working conditions
for nurses are generally good, they can be stressful, both physically and emotionally.
Surgical nurses are required to be on their feet for long periods of time and often work
extended shifts.
Recovery nurses
Surgical prep and recovery nurses are RNs who care for individuals before surgery
and during recovery. They prepare patients for surgical procedures by starting intravenous
lines, administering medication, taking a complete health history, completing additional
tests such as blood work, and performing pre-surgical preparations such as shaving.
Nurses who work in recovery are responsible for monitoring the patient as she awakens
from anesthesia. They watch the patient's vital signs, check dressings and wounds,
administer medication and assist with pain management. They serve an important role in
providing education and support for the patient and her family.
Scrub Nurses
Scrub nurses are RNs who work within the sterile field to assist the surgeon. The
scrub nurse has scrubbed with antimicrobial soap and is outfitted in a sterile suit. Scrub
nurses prepare the needed instruments and other supplies for surgery and hand them to the
surgeon during the procedure. Typically, scrub nurses acquire their position only after they
have gained extensive nursing experience.
Circulating Nurses
Circulating nurses assist the surgical team in various ways but do not work within the
sterile field. Some of the duties of a circulating nurse include obtaining additional
equipment or instruments for the team, monitoring the condition of the patients, preparing
tissue samples for transport to a lab, and disposing of biohazardous material. The
circulating nurse is also charged with keeping track of the instruments, dressings and other
equipment used during surgery.
RegisteredNurse First Assistants
Registered nurse first assistants (RNFA) have extensive additional training and
clinical experience that qualifies them to assist surgeons by performing basic surgical
procedures. An RNFA must take coursework in perioperative care and surgical procedures
and pass the CRNFA (Certified Registered Nurse First Assistant) professional board
exam. Duties of a RNFA may include suturing, exposing a wound, controlling bleeding
and assisting surgeons in holding or operating other instruments.
Occupational health nurses:
The occupational health nurse role includes:
 the prevention of health problems, promotion of healthy living and working
conditions

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 understanding the effects of work on health and health at work
 basic first aid and health screening
 workforce and workplace monitoring and health need assessment
 health promotion
 education and training
 counselling and support
 risk assessment and risk management
Perianaesthesia nurses:
Perianaesthesia nurses provide preoperative and postoperative care to patients
undergoing anesthesia during surgery or other procedure.
Mental health nurses:
Mental health nurses help psychiatrists, psychologists and other mental health
professionals counsel and treat patients with a variety of emotional and psychiatric issues,
from substance abuse oriented problems to paranoid-schizophrenia. Mental health nurses
also help with the dispensing of medication for patients. Psychiatric nurses with an
advanced education may be able to prescribe medication on their own.
Radiology nurses:
Radiology nurses provide care to patients undergoing diagnostic radiation procedures
such as ultrasounds, magnetic resonance imaging, and radiation therapy for oncology
diagnoses. Radiology nurses routinely start or check peripheral i.v.s, assess infusaports,
administer medications, monitor vital signs, suction patients, insert foleys and help
patients with their personal needs.
Rehabilitation nurses:
The goal of the rehabilitation nursing profession is to treat patients who require a
broad range of medical services for their recovery. People who need rehabilitation nursing
care may have suffered from such things as work injuries, car accidents, strokes, head
trauma, drug or alcohol abuse, gunshot wound or other severe trauma. These nurses find
work in general hospitals, rehabilitation centers, drug and alcohol recovery facilities,
mental hospitals, senior citizen facilities, or private homes. Rehabilitation nurses are able
to provide a broad range of services depending on the facility they work in.
The rehabilitation nursing staff also seeks to help the patient develop the mindset to
cope with their medical condition. The rehabilitation nurse works with the doctors,
psychologist and other staff to help the patient develop a plan in dealing with their medical
condition.
Transplant nurses:
Transplant nurses care for both transplant recipients and living donors and monitor
signs of organ rejection.

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Addictions nurses:
Addictions nurses care for patients seeking help with alcohol, drug, tobacco, and other
addictions.
Some of the principal duties are:
Oversee detoxification and substitute prescribing programmes;
• Provide support to clients on an individual and group basis;
• Liaise with mental health team, addictions team, psychology dept, social
workers, medical staff and general health team;
• Delivering drug/alcohol education and awareness packages to clients and
staff;
• Promoting healthy living and harm reduction initiatives to clients, eg safer
injecting;
• Provide support and counselling for blood borne virus testing as required;
• Liaise with community agencies from a client‘s admission through to
preparation for and release from prison.
This post has a diverse range of responsibilities and excellent communication and
interpersonal skills are essential.
Intellectual and developmental disability nurses:
Intellectual and developmental disabilities nurses provide care for patients with
physical, mental, or behavioral disabilities; care may include help with feeding,
controlling bodily functions, sitting or standing independently, and speaking or other
communication.
The main duties of an Intellectual and Developmental Disabilities Nurse include:
- Providing care for patients with physical, mental or behavioral disabilities
- Caring for patients of all ages
- Assisting with feeding and controlling bodily functions
- Supporting patients and encouraging them to be independently mobile
- Educating patients and their families of Intellectual and Developmental Disabilities
- Assisting patients with language skills and other forms of communication
Genetic nurses:
Genetic nurses provide early detection screenings, counseling, and treatment of
patients with genetic disorders, including cystic fibrosis and Huntington's disease.

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HIV/AIDS nurses:
HIV/AIDS nurses care for patients diagnosed with HIV and AIDS. They should give
proper care, education, psychological support and counselling to the patients.
Oncology nurses:
Oncology nurses care for patients with various types of cancer and may assist in the
administration of radiation and chemotherapies and follow-up monitoring.
The following discussion on the role of the oncology nurse focuses on patient
assessment, patient education, coordination of care, direct patient care, symptom
management, and supportive care. To illustrate how varied the role may be and its
importance across the continuum of cancer care, examples related to the role of the
oncology nurse in direct patient care, symptom management, and supportive care are
provided.
Wound, ostomy and continence nurses:
Wound, ostomy, and continence nurses treat patients with wounds caused by traumatic
injury, ulcers, or arterial disease; provide postoperative care for patients with openings that
allow for alternative methods of bodily waste elimination; and treat patients with urinary
and fecal incontinence.
Cardiovascular nurses:
Cardiovascular nurses treat patients with coronary heart disease and those who have
had heart surgery, providing services such as postoperative rehabilitation.
Pre-Operative Responsibilities
Pre-operative care includes evaluating a patient's readiness for surgery by taking a detailed
medical history and performing a complete physical examination. This is followed by
ordering appropriate tests for assessment and prescribing necessary medications for
surgery.
Operative Responsibilities
Operative responsibilities include assisting in preparation of the patient by positioning the
patient on the operating room table and applying appropriate draping for the surgical
procedure. Asssisting the general operation as needed by a surgeon is also required.
Post-Operative Responsibilities
Post-operative care includes evaluating the patient's recovery process by checking vital
signs, administering intravenous lines, ordering medications and laboratory tests as needed
and monitoring the patient to ensure there are no complications after surgery.

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Gynaecology nurses:
Gynaecology nurses provide care to women with disorders of the reproductive system,
including endometriosis, cancer, and sexually transmitted diseases.
Nephrology nurses:
Nephrology nurses care for patients with kidney disease caused by diabetes,
hypertension, or substance abuse.
Before dialysis, the nurse assists the patient in seeking information about his disease,
prognoses and treatments. The nurse is responsible for ensuring that appropriate care is
available. Prior to the actual treatment, the nephrology nurse must evaluate if it's safe for
treatment to begin. If the patient has no new acute health issues, the nurse continues with
the preparation for dialysis. The nurse determines how much salt and water has
accumulated in the patient that has to be removed. If the nurse decides that the patient is
ready for treatment, she may initiate the dialysis
Relationship With Doctor
The nephrology nurse must work very closely with the doctor and assists him with
therapeutic and diagnostic measures. If, for example, she discovers that the patient has
developed pneumonia or chest pain since the last treatment, she must contact the physician
immediately before beginning dialysis treatment. The nurse also informs the physician if
there are changes in vital signs. She serves as a coordinator with multidisciplinary teams,
such as patients and other physicians, including surgeons and transplant doctors.
Neuroscience nurses:
Neuroscience nurses care for patients with dysfunctions of the nervous system,
including brain and spinal cord injuries and seizures.
Ophthalmic nurses:
Ophthalmic nurses provide care to patients with disorders of the eyes, including
blindness and glaucoma, and to patients undergoing eye surgery.
Orthopedic nurses:
Orthopedic nurses care for patients with muscular and skeletal problems, including
arthritis, bone fractures, and muscular dystrophy.
Otorhinolaryngology nurses:
Otorhinolaryngology nurses care for patients with ear, nose, and throat disorders, such
as cleft palates, allergies, and sinus disorders.
Respiratory nurses:
The role of respiratory nurses is to promote good pulmonary (lung) health within
individuals, families and communities. By building close relationships with doctors and

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patients in their community, respiratory nurses educate the public on the importance of
healthy breathing and proper exercise in people of all ages.
Urology nurses:
Urology nurses care for patients with disorders of the kidneys, urinary tract, and male
reproductive organs, including infections, kidney and bladder stones, and cancers.
A urology nurse cares for patients with urinary tract problems in a hospital, urology clinic,
or private doctor's office. A nurse performs initial evaluations of symptoms, assists doctors
with diagnostic and treatment procedures, and provides expert patient education and
counseling services. Professionals see patients who have urinary tract infections, kidney
stones, cancers, prostatitis, or any of a number of other specific conditions.
Clinical nurse specialist:
Clinical nurse specialists provide direct patient care and expert consultations in one
of many nursing specialties, such as psychiatric-mental health.
Nurse anaesthetist:
Nurse anaesthetist provide anesthesia and related care before and after surgical,
therapeutic, diagnostic and obstetrical procedures. They also provide pain management
and emergency services, such as airway management.
Nurse midwives:
Nurse midwives provide primary care to women, including gynecological exams,
family planning advice, prenatal care, assistance in labor and delivery, and neonatal care.
Nurse practitioners:
Nurse practitioners serve as primary and specialty care providers, providing a blend
of nursing and healthcare services to patients and families. The most common specialty
areas for nurse practitioners are family practice, adult practice, women's health, pediatrics,
acute care, and geriatrics. However, there are a variety of other specialties that nurse
practitioners can choose, including neonatology and mental health.
Forensics nurses:
Forensics nurses participate in the scientific investigation and treatment of abuse
victims, violence, criminal activity, and traumatic accident.
main function of a forensic nurse is to collect information about crime and investigate
details about it but it is not the only work that they do. forensic nurses even provide
medication and relief to the victims of any crime, they even provide counseling to
offenders and even children who at times go off track and start indulging in unethical
activities.

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There is a one other significant role that a forensic nurse might perform, they can also
work as a medical consultant for a firm or even can provide legal medical help to the
victims.
At times these nurses also work as psychiatrics and help in giving counseling to offenders
and even under privilege children too.
Infection control nurses:
An infection control nurse has one primary role, and that is to prevent hospital
infections in their patients by carrying out infection prevention protocols diligently. nurses
can play an important role in controlling and preventing the spread of infectious diseases
in health care facilities. In fact, several nurse duties are aimed solely at infection control.
Nurse educators:
Nurse educators plan, develop, implement, and evaluate educational programs and
curricula for the professional development of student nurses and RNs.
Nurse informaticists:
Nurse informaticists manage and communicate nursing data and information to
improve decision making by consumers, patients, nurses, and other healthcare providers.
RNs also may work as healthcare consultants, public policy advisors, pharmaceutical and
medical supply researchers and salespersons, and medical writers and editors.
Work environment. Most RNs work in well-lit, comfortable healthcare facilities. Home
health and public health nurses travel to patients' homes, schools, community centers, and
other sites. .
RNs may be in close contact with individuals who have infectious diseases and with toxic,
harmful, or potentially hazardous compounds, solutions, and medications. RNs must
observe rigid, standardized guidelines to guard against disease and other dangers, such as
those posed by radiation, accidental needle sticks, chemicals used to sterilize instruments,
and anesthetics. In addition, they are vulnerable to back injury when moving patients.
DUTIES OF NON NURSING PERSONALS IN HOSPITAL:
Hospital manager:
Hospital Managers are responsible for making decisions regarding the financing and
structure of a hospital. Because health care is constantly changing and new technology is
improving everyday, Hospital Managers need to continue to evaluate procedures and
health care efficiency.
Responsibilities-
Ensure all statutory and registration requirements are met within the hospital.
Ensure all corporate policies and procedures are observed.
Maintain appropriate staffing levels.
Facilitate training and development of staff.

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Reviewing work assignments, preparing and reviewing clinical paperwork.
Communicate with care managers, family members and regulatory bodies.
Attend and actively participate in MDT meetings.
Assistant manager:
Assistant managers outrank the position of a supervisor and team leader, but typically
report to a deputy or general manager.
Assistant managers, as the name implies, are positions whereby he or she supports the
manager in the day-to-day running of a specific department, office or store. Specific
responsibilities vary; however, in larger organizations assistant managers may lead a team
of staff. In smaller organizations, assistant managers may have greater responsibility,
focusing their time on directing the work of subordinates. They may also be responsible
for ensuring that health and safety policies are adhered to.
Assistant managers are typically given management authority to make key decisions
quickly, are heavily involved in training of other staff, and perform paperwork duties.
PROFESSIONAL AND TECHNICAL EMPLOYERS:
Physicians:
Social workers:
Hospital social workers provide psychological and social support for patients, helping
them and their families cope with chronic and terminal illnesses, such as AIDS, cancer or
Alzheimer's Disease. They also help patients meet their needs following discharge from
hospitals and other medical facilities. Hospital social workers may, for example, arrange
for patients to receive needed at-home services such as home health care or meals on
wheels.
Physician assistants:
A physician is a medical professional who examines the sick and tries to find a way to
help them. Doctors can prescribe medicines, different treatments, and can give health
advice. A doctor will usually make observations first, then make a list of possible causes
and perform tests to find the right treatment. Most doctors have a doctor of medicine, or an
M.D.
Pharmacists:
 checking prescriptions to ensure that there are no errors and that they are
appropriate and safe for the individual patient;
 providing advice on the dosage of medicines and the most appropriate form of
medication, for example tablet, injection, ointment or inhaler;
 participating in ward rounds, taking patient drug histories and involvement in
decision-making on appropriate treatments;
 discussing treatments with patients' relatives, community pharmacists and general
practitioners;
 ensuring medicines are stored appropriately and securely;
 supervising the work of less experienced and less qualified staff;

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 answering questions about medicines from within the hospital, other hospitals and
the general public;
 keeping up to date with, and contributing to, research and development;
 writing guidelines for drug use within the hospital and implementing hospital
regulations;
 providing information on expenditure on drugs;
 preparing and quality-checking sterile medications, for example intravenous
medications;
 setting up and supervising clinical trials.
Radiologist:
JOB RESPONSIBILITIES
1. Examine and diagnose disorders and diseases of the human body using x-ray and
ultrasound.
2. Consult with patients to determine the appropriate course of treatment.
3. If need be explain procedures to patients and ensure that the patient is prepared
properly before the x-rays or sonography‘s are taken.
4. Administer radiopaque substances by injection to render internal structures and
organs visible on x-ray films.
5. Instruct radiologic personnel in desired techniques, positions, and projections.
6. Work in conjunction with doctors and make diagnosis based on the results of
multiple tests.
7. Prepare comprehensive interpretive reports of findings.
8. Maintain patient records and reports in the department.
9. Deal with complaints of the patients if any.
10. Ensure the meeting of medical policies, completing documentation, patient reviews
and staff-to-staff communication.
11. Manage radiological services and formulate plans and procedures for radiological
services.
12. Coordinate radiological services with other medical activities.
13. Determine capability of available resources, and advise regarding future needs.
14. Establish and enforce standards for protection of patients and personnel.
15. Assure adequate quality control of images and advise on kind and quantity of
radiological supplies and equipment.

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16. Ensure timely renewals of the registrations/certification of the machines in the
department.
17. Ensure timely servicing and AMC‘s of the machines in the department.
Physical therapist:
Physiotherapists help and treat people of all ages with physical problems caused by
illness, accident or ageing.
Physiotherapy is a healthcare profession which sees human movement as central to the
health and well-being of individuals. Physiotherapists identify and maximise movement
potential through health promotion, preventive healthcare, treatment and rehabilitation.
The core skills used by physiotherapists include manual therapy, therapeutic exercise and
the application of electro-physical modalities. Physiotherapists also have an appreciation
of psychological, cultural and social factors which influence their clients.
Hospitals often have physiotherapy gyms, hydrotherapy and high-tech equipment so that
specialist therapy can be carried out.
Lab technician:
Clinical laboratory testing plays a crucial role in the detection, diagnosis, and
treatment of disease. After testing and examining a specimen, they analyze the results and
relay them to physicians.
Clinical laboratory technologists perform complex chemical, biological, hematological,
immunologic, microscopic, and bacteriological tests. Technologists microscopically
examine blood and other body fluids. They make cultures of body fluid and tissue
samples, to determine the presence of bacteria, fungi, parasites, or other microorganisms.
Technologists analyze samples for chemical content or a chemical reaction and determine
concentrations of compounds such as blood glucose and cholesterol levels. They also type
and cross match blood samples for transfusions.
DUTIES OF A HOSPITAL CHAPLAIN:
A hospital chaplain provides pastoral care to patients, their family members and
hospital employees. She offers spiritual support and crisis intervention 24 hours a day.
Hospital chaplains may work in hospitals or in nursing homes and other long-term care
facilities. They typically are ordained ministers with special training involving spiritual
needs in clinical and hospital environments.
Support for Patients
Hospital chaplains often make rounds just as physicians do, offering spiritual support to
patients and their families, talking with them, reading the Bible and praying together.
Support for Staff
Hospital chaplains provide spiritual counseling for hospital employees experiencing
professional or personal problems.

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Support for the Gravely Ill
The chaplains provide support for patients who are critically ill or dying, and for their
families and other loved ones. This is especially important for patients who do not have a
minister or are not near their home.
Worship Services
Another duty of the chaplain is conducting worship services in the hospital chapel for
patients and hospital staff.
Community Education
Hospital chaplains conduct community seminars on topics such as terminal illness, the
spiritual meaning of death and the grieving process.
NURSING HOME WORKERS:
Workers in human service:
The field of Human Services is a broadly defined one, uniquely approaching the
objective of meeting human needs through an interdisciplinary knowledge base, focusing
on prevention as well as remediation of problems and maintaining a commitment to
improving the overall quality of life of service populations. The Human Services
profession is one which promotes improved service delivery systems by addressing not
only the quality of direct services, but by also seeking to improve accessibility,
accountability, and coordination among professionals and agencies in service delivery.
DUTIES OF HOUSEKEEPERS:
Housekeeping refers to the general cleaning of hospitals and clinics, including the
floors, walls, and certain types of equipment, tables and other surfaces. The purpose of
general housekeeping is to:
 reduce the number of microorganisms that may come in contact with patients,
visitors, staff and the community; and
 provide a clean and pleasant atmosphere for patients and staff.
Waste:
Hospital housekeepers empty garbage cans and dispose of trash in Dumpsters. They are
responsible for attending to recyclables according to the hospital's regulations and
properly disposing medical waste.
Other Duties:
Managers in hospital housekeeping may be responsible for scheduling routine
maintenance to the facility's heating, cooling, water and sewage systems.
Porters: Hospital porters take patients and goods to different hospital departments, e.g.
to the operating theatre or to the X-ray department, or from ward to ward. Main activities
are:

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 taking meals to patients
 transferring patient from one ward to another ward.
 transferring clean linen to wards from the laundry
 moving furniture and valuable or intricate equipment safely
 disposing of waste, which may be hazardous
 delivering post, files and specimens to different parts of the hospital
 moving patients who have died, from a ward and to the mortuary.
Technical workers:
Plumbers:
Plumbers are trained to repair, replace, and service in and outdoor toilets, water tanks,
air locks, waste disposal, leaking or busted pipes, hot water problems, central heating,
pump failures, tanks, boilers, radiators, pipes, and so forth.
Electrician:
Electricians undertake a number of roles regarding the installation, maintenance and
testing of electrical works.
Electrician Responsibilities:
• An electrician‘s work may include work with technical plans. This is required for
complicated designs of lighting systems, as well as socket and switch installations.
Electricians will use these capabilities for the maintenance of electrical appliances as well.
• Electricians and electrical contractors will do periodic testing to ensure health and safety
compliance of the electrical installations.
• Electricians will identify faults and will attempt to fix faulty electrical devises and
equipment.

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8 B). DUTIES AND RESPONSIBILITIES OF VARIOUS CATEGORIES
OF NURSING AND NON NURSING PERSONNEL IN AN
EDUCATIONAL INSTITUTION
INTRODUCTION
There is a need for job descriptions, because it is learnt through some studies that
the most workers function in a mechanical fashion and are not conscious of the role
assignment to them. It has been commented that lack of knowledge of one‘s job and
functions and that of other team members is one of the reasons for many problems in the
functioning of the health team (Delta 1978).
TERMINOLOGIES
Standing Instructions: Orders, Rules, Regulations or procedures prepared by the
professional staff.
Sophisticated: Discriminating in taste and judgment.
Authorities: The power or right to enforce obedience, An expert in a subject.
Quantum: A required or allowed amount.
Jurisdiction: The administration of justice, A legal or other authority.
Recruit: A service man or a service woman newly enlisted and not yet fully trained, a new
member of a society.
Disburse: Expend money, Defray a cost.
Cordial relations: Heartfelt, sincere, warm, friendly.
Scrutining applications: A close investigations or examination of details.
VARIOUS CATEGORY OF NURSING PERSONNEL
A. Principal, School of Nursing/College of Nursing
1. Principal, School of General Nursing/Midwifery or Psychiatry
2. Principal, College of Nursing
B. Vice Principal
C. Lecturer, College of Nursing
1. Lecturer, College of Nursing
D. Professor, College of Nursing
1. Professor, College of Nursing
2. Assistant Professor, College of Nursing
E. Lecturer, college of nursing
F. Senior tutor
G. Tutor

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H. Clinical instructor
I. Senior librarian
J. Assistant librarian
K. Office staff
L. Office clerk
A. Principal (school of nursing, College of Nursing)
Job Summary
Principal, College of Nursing is the administrative head of the College of Nursing, will be
directly responsible to the Director of the Medical Education/Director of Health and
Family Welfare services and responsible for implementation and revision of curriculum
for various courses, and research activities of the college of Nursing.
Duties and Responsibilities
Administration
 Planning
 Develops philosophy and objectives for educational program.
 Identifies the present needs related to educational program.
 Investigates, evaluates and secures resources.
 Formulates the plan of action.
 Selects and organizes learning experience.
Organising
 Determines the number of position and scope and responsibility of each faculty and
staff.
 Analyses the job to be done in terms of needs of education program.
 Prepares the job description, indicate line of authority, responsibility in the relationship
and channels of communication by means of organizational chart and other methods.
 Considers preparation, ability and interest personally in equating responsibility.
 Delegates authority commensurate with responsibility.
 Maintains a plan of work load among staff members.
 Provides an organizational framework for effective staff functioning such as meeting
of the staff, etc.
Directing
 Recommends appointment and promotion based on qualification and experience of the
Individual staff, scope of job and total staff composition.

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 Subscribes and encourages developmental aspects with reference to welfare of staff
and students.
 Directs activities of staff working under.
 Provides adequate orientation of staff members.
 Guides and encourages staff members in their job activities.
 Consistently makes administrative decision based on established policies.
 Facilitates participation in community, professional and institutional activities by
providing time, opportunity for support for such participation.
 Creates involvement in designing educationally sound program.
 Maintenance of attitude rightly acceptable to staff and learners.
 Provides for utilization in the development of total program and encourages their
contribution.
 Provides freedom for staff to develop active training course within the framework for
curriculum.
 Promotes staff participation in research.
 Procures and maintains physical facilities which are of a standard.
Coordinating
 Coordinates activities relating to the programs such as regular meetings, time schedule,
maintaining effective communication, etc.
 Initiates ways of cooperation.
 Interpretes nursing education to other related disciplines and to the public.
Controlling
 Provides for continuous follow up and revision of education program.
 Maintains recognition of the educational program by accrediting bodies. University,
etc, KNC, INC, etc.
 Maintains a comprehensive system of records.
 Prepares periodic report which revives the progress and problems of the entire
program and presents plans for its continuous development.
 Prepares, secures approval and administrates the budget.
Instruction (Teaching)
 Plans for participating in educational programs for further development.
 Recognizes the needs for continuing education for self and staff provides stimulation
of opportunities for such development.

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 Participate as a teacher in the educational program.
Guiding
 Provides for systematic guidance program for staff members and students.
 Encourages studies, research and writing for publication.
 Provides and maintains a program for recruitment, selection and promotion of
students.
B. ICE- PRINCIPAL
Financial:
 Assists Principal in carrying out financial activities:
 Planning and revising budget
 Monitoring College expenditure
 In the absence of Principal, performs all the functions
Educational:
 Assists Principal in planning, implementation and evaluation of the
programmes.
 Assists Principal in identifying needs for professional development of faculty
and conducting staff development programme.
 Supervises postgraduate students in conducting research.
 Participates in teaching of various educational programmes.
 In the absence of Principal, chairs the assigned committee meetings.
 Supervises all educational programmes in coordination with the coordinators.
 Guides faculty in day-to-day academic activities
Supervisory:
 Shares responsibility with Principal and Professor in supervision of teaching
and nonteaching staff.
 Plans academic staff assignments in consultation with Principal.
 Participates in conduct of orientation programme
 Supervises and guides staff in conducting their activities.
 Writes staff performance report and reviews evaluation report of assigned staff.
 Assists Principal in monitoring students welfare activities e.g. Mess, hostel,
Health, Sports , S.N.A. etc.
 Assists Principal in administration and supervision of library.
Establishment:
 Assists Principal in maintaining rules and regulations in college campus
 Supervises overall functioning of staff and students' hostel.
 Assists Principal in maintaining discipline in the college.

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 Assists Principal in reviewing recruitment and promotion policies of teaching
and non-teaching staff.
Interpersonal:
 Assists Principal in maintaining human relation and communication
 Identifies conflict among staff members, initiates solution and reports to
Principal when necessary.
 Communicates with staff in explaining administrative constraints.
 Facilitates guidance and counselling students and staff as per need.
 Any other responsibility assigned by the Principal.
C. PROFESSOR, COLLEGE OF NURSING AND ASSISTANT PROFESSOR
COLLEGE OF NURSING
1. Title: Professor, College of Nursing
Job Summary
The Professor is overall in charge of the department and thereby responsible for
administration teaching activity and guidance of that particular department.
Administration
 Participating in determination of educational purposes and policies.
 Contributes to the development and implementation of the philosophy and purposes of
the educational program.
 Utilizes opportunities through group action to initiate improvement of the educational
program.
 Interprets educational philosophy and policy to others.
 Directs the activities of staff working in the department.
Instruction
 Identifying needs of learners.
 Identifies the needs of the learners in terms of objectives of the program and utilizing
records of previous experience, personal interviews, tests and observations.
 Assists learners and identifying their needs.
 Develops plan for learning experience.
 Participates in the formulation and implementation of the philosophy and objectives
program.
 Selects and organizes learning experiences which are in accordance with their
objectives.
 Participates in the continuous development and the evaluation of the curriculum.
 Plans within the educational unit, with the nursing services and allied groups.

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 Ascertains, selects and organizes facilities, equipment and materials necessary for
learning.
Helping the Learners to Acquire
Desirable Attitudes, Knowledge and Skill
 Seeks to create a climate conducive to learning.
 Assists learners in using problem solving techniques.
 Uses varied and appropriate teaching methods effectively.
 Uses incidental and planned opportunities for teaching.
 Encourages learners to assume increasing responsibility for own development.
Evaluating Learner’s Progress
 Recognizes individual differences in apprasing the learners progress.
 Uses appropriate devices for evaluation.
 Measures and describes quality of performance objectively.
 Helps learners for self evaluation.
 Participates in staff evaluation of learners progress.
Recording and Reporting
 Maintains and uses adequate and accurate records.
 Prepares and channels clear and concise reports.
 Shares information about learner‘s needs and achievements with other concerned with
instruction and guidance.
 Participates in the formulation and maintenance of comprehensive record system.
Investigative Way to improving Teaching
 Measures effectiveness of instruction by use of the
 Increases knowledge and skill in own curriculum area.
 Analyzes and evaluates resources material.
 Devices teaching methods appropriate to objectives and content.
Guidance
 Cooperating in guidance program.
 Shares in planning, developing and using guidance programme.
 Gives guidance within own field of competence.

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 Helps the learner with special problems to seek and use additional helps as indicated.
Counselling
 Helps the learner to grow in self – understanding.
 Promotes continuous growth and development towards maturity.
 Continues to develop competence in problem solving process.
 Cooperates in and/or initiates group activities in development and evaluation of
studies.
 Utilizes findings of research.
 Makes data available concerning learners and concerning methods of teaching and
evaluation.
3. Assistant Professor, College of Nursing, Title: Assistant Professor, College of
Nursing
Job Summary
The assistant professor usually works under professor and/HOD of the particular
department of specialty and assists him/her in administration, teaching and guidance and
counseling and research activities.
Administration
 Participates in determination of educational purposes and policies.
 Contributes to the development and implementation of the philosophy and purposes of
the total education program.
 Utilizes opportunities through group action to initiate improvement of the total
educational program.
 Interprets educational philosophy and policy to others.
 Directs the activities of staff working in the department.
Instruction
 Identifying the needs of learners.
 Identifies the needs of the learners in terms of the objectives of the program by
utilizing records of previous experience, personal records of previous experience,
personal interviews, tests and observations.
 Assists learners in identifying their needs.
 Develops plan for learning experience.

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 Participates in the formulation and implementation of the philosophy and objectives of
the program.
 Selects and organizes learning experience which are in accordance with their
objectives.
 Participates in the continue development and evaluation of the curriculum.
 Plans within the educational, with the nursing services and allied groups.
 Ascertains, selects and organizes facilities, equipment and materials necessary for
learning.
Helping the Learners to Acquire Desirable Attitudes, Knowledge and skill.
 Seeks to create a climate conductive to learning.
 Assists learners using problem solving techniques.
 Uses varied and appropriate teaching methods effectively.
 Uses incidental and planned opportunities for teaching.
 Encourages learners to assume increasing responsibility for own development.
Evaluative Learning Progress
 Recognize individual differences in appraising the learners progress.
 Uses appropriate devices for evaluation.
 Helps learners for self evaluation.
 Participates in staff evaluation of learners progress.
Recording and Reporting
 Achievement with others concerned with co
 Prepares and channels clear and concise reports.
 Shares informations about learner‘s needs and achievement with others concerned with
instruction and guidance.
 Participates in the formulation and maintenance of comprehensive record system.
Investigating Ways Improving Teaching
 Measures effectiveness of instruction by use of appropriate devices.
 Analyzes and evaluates resource material.
 Devices teaching methods appropriate to objectives and content.

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Guidance
 Cooperating in guidance program.
 Shares in planning, developing and using guidance program.
 Gives guidance within own field of competence.
 Helps the learners with special problems to seek and use additional help as indicated.
Counselling
 Helps the learner to grow in self understanding.
 Promotes continuous growth and development towards maturity.
Assisting in selectionand Promotion of Learners
 Participates in development of criteria for selection and promotion of learners.
Research
 Initates and participates in studiesfor the improvement of educational programs.
 Identifies problems in which research is indicated or potentially desirable.
 Cooperates in and/ or initiates group activity in development and evaluation of studies.
 Utilizes findings of research.
 Makes data available concerning learners and concerning methods of teaching and
evaluation.
D. LECTURER, COLLEGE OF NURSING, TITLE: LECTURER, COLLEGE OF
NURSING
Job Summary
He/She works under the direction of the department head and assists him in
administration, instruction and guidance activities.
Instruction
 Identifies the needs of the learners in terms of the program by utilizing the records of
previous experience, personal interviews, tests and observation.
 Assists the learners in identifying their needs.
 Participates in formulation and implementation of the philosophies and objectives of
the post.
 Selects and organizes learning experiences which are in accordance with these
objectives.
 Participates in evaluation of the curriculum.

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 Plans with the educational unit with nursing service and allied groups.
 Ascertains, selects and organizes facilities equipment and materials necessary for
learning.
 Assists the learners in using problem solving process.
 Prepares clear and concise reports.
 Share information about learner‘s needs and achievements with others concerned.
 Measures effectiveness of instruction by use of appropriate devices.
 Devices leaching methods appropriate to objectives and content.
Guidance and Counseling
1. Gives guidance with own field of competence.
2. Helps the learner to grow in self understanding.
Research
 Assist in initiating and participating in studies for the improvement of educational
program.
 Identifies the problems in which research is indicated or potentially desirable.
 Make data available concerning learners and concerning methods of teaching and
evaluation.
 Cooperate in and/ or initiates group activity in development and evaluation of studies.
 Utilizes the findings of research.
E. SENIOR TUTOR
 Participates in teaching and supervising the courses of undergraduate students.
 Participates in curriculum development , evaluation and revision.
 Guide in research projects for undergraduate students.
 Acts as a Counsellor for staff and students.
 Maintains various records.
 Conducting and participating in department meetings and attending various
meetings.
 Participating in Administration activities of department.
 Any other responsibility assigned by Principal.

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F. TUTOR
 Participates in teaching and supervising the courses of undergraduate students.
 Coordinates with the external lecturer for various courses as assigned.
 Participate in the evaluation of students.
 Guide the students in conducting seminars, discussions and presentations etc.
 Maintain students' records.
 Participate in student counselling programmes.
 Participate and promote students' welfare activities.
G. CLINICAL INSTRUCTOR
 Demonstrate standards for nursing practice.
 Supervise and teach the students in the clinical fields.
 Participate in evaluation of students.
 Assist the students in conducting health education programme.
 Maintain students' records.
 Participate in the student counselling programmes.
 Participate and promote student welfare activities.
 Any other duty assigned by the Principal.
H.S ENIOR LIBRARIAN
 Assist Principal in purchasing and maintaining of library materials and
inventory including records and reports.
 Classify and cataloguing the library materials.
 Orienting and helping students, faculty members and visitors.
 Provide reference services regarding library material to all library users and
members.
 Updating the current information through magazine, journal, pamphlets,
newspaper and newsletters etc.
 Issuing, returning and reservation of important books as per need.
 Maintaining for selective Dissertation information and bibliography data for
the library users.
 Supervising library staff working under her.
I. ASSISTANT LIBRARIAN
 Changing and discharging shelf arrangement and searching missing books
receding, recording, displaying the periodical acquired.
 Preparing periodicals and books for binding.
 Overall assisting in the services and development all activities.
J. OFFICE STAFF
 Maintenance of files and records.

135
 Receipt, typing and dispatch of correspondence.
 Maintenance of accounts and identifying and care of office supplies.
K. OFFICE CLERK
 The office clerk is responsible for safe keeping of all the files and records. Be able
to assist the Principal with correspondence and contracting different departments
and agencies..
 Reports to the principal about day to day activities.
 Carryout the typing job related to the office and the educational programme.
 Provides assistance for the admission procedure and maintenance of related
registers and records
 Provides assistance to faculty in typing and preparing important documents,
question papers, rotation plans etc.
 Carries the activities related to day to day running of the college as directed by the
Principal.
 Deals with the person visiting the college for various reasons.
 Take care of incoming and outgoing from university, INC, KNC and other
institutions.
CONCLUSION
Thus duties and responsibilities are imperative that the role of each category of health
manpower should be clarified through providing written job description, training and
through participative approach. There are different health personnel in clinical and
educational area.
JOURNAL ABSTRACT
Globalization of Higher Education in Nursing By Andrea Baumann, PhD, RN; Jennifer
Blythe, MLS, PhD
Abstract
The demand for higher education has increased worldwide and the response has been an
impressive expansion of educational offerings both within and across countries. Education
has been made more accessible through online offerings and the development of onsite,
external campuses in foreign countries. In recent years, there has been a proliferation of
educational courses that target international clientele. This has led to concerns about
quality and consistency and also the need for international standards of education.
The purpose of this manuscript is to emphasize the necessity of common educational
standards for nurses in a globalize world. Common standards are crucial in regulated
professions, such as nursing in which lives depend on the possession of specific
competencies. This article will define and describe globalization and the
internationalization of education, discuss the exporting of education, nursing education,

136
identify the challenges and current solutions related to nurse migration, and present current
standards and future trends in harmonizing nursing education internationally.
BIBLIOGRAPHY
BT Basavanthappa.Nursing Administration. 2nd edition. New Delhi: Jaypee Brothers
Medical Publishers; 2009.
BT Basavanthappa.Nursing Administration. 1st edition. New Delhi: Jaypee Brothers
Medical Publishers; 2004.
Dc Joshi, Mamta Joshi.Hospital Administration. 1st edition. New Delhi: Jaypee
Brothers Medical Publishers; 2009.
4. Harit R. ieldman, Martha j Green berg, Education nurses for leadership.
5. Maya George –Teaching and learning the school of Nursing.
JOURNAL
Andrea Baumann, PhD, RN; Jennifer Blythe , Globalization of Higher Education in
Nursing,The Online Journal of Issues in Nursing, 9 (2):217-223.
INTERNET
http://www.faqs.org/abstracts/Human-resources-and-labor
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