organizing nursing services, organizing patient care

1. ORGANIZING NURSING
SERVICES
DEEPTHY P. THOMAS
II YEAR M.Sc. NURSING
GOVT. COLLEGE OF NURSING
ALAPPUZHA

2. Nursing Service
Nursing service is the part of the total
health organization which aims at
satisfying the nursing needs of the
patients/community.

3. Nursing service administration
Nursing service administration is a
complex of elements in interaction and is
organized to achieve the excellence in
nursing care services.

4. DEFINITION OF NURSING
SERVICE
WHO expert committee on nursing
defines the nursing services as the part of
the total health organization which aims to
satisfy major objective of the nursing
services is to provide prevention of disease
and promotion of health.

5. OBJECTIVES OF NURSING
SERIVCE IN HOSPITAL
Management of nursing service and care
Initiate a set of human relationships at all
levels of nursing personnel.
Establish adequate staffing pattern.
Develop and implement proper
communication system.
Develop and initiate proper evaluation and
periodic monitoring system.

6.  proper job description for nursing
personnel.
Assist hospital authorities for effective
personnel management.
Share nursing information system with
other discipline.
Formulate and interpret nursing service
policies.
Assist hospital authorities for preparation
of budget.
Participate in inter departmental programs
and other programs.

7. Education training and staff developments
 Encourage a stimulating environment in which the
personnel have opportunities to be creating
innovators.
 Develop and initiate orientation and training
programs.
 Create an atmosphere that conducive to give
proper learning experiences for students.

8.  Assist in the development of a sound, constructive
program of leadership in nursing.
 Initiate programs to improve the practice of
nursing in keeping with advances in the relative
areas and disciplines affecting the quality of
nursing.

9. Research
Participate in identifying the areas of
research.
Participate in the application of data and
research.
Produce conducive environment for
research.

10. Community health program
Participate in community health programs,
associated with hospital.
Interpret the roles and responsibilities in
community health programs.
Participate in extramural health programs
of the hospital and other related
organizations.

11. FUNCTIONS OF NURSING
SERVICES
to assist the individual patient in
performance of those activities contributing
to his health or recovery.
To help and encourage the patient to carry
out the therapeutic plan initiated by the
physician.
To assist other members of the health team,
to assist other members of the team to plan
and carry out the total program of care

12. SOUND ORGANISATIONAL PLANNING
FOR HOSPITAL NURSING SERVICES
A written statement of the purpose and
objectives of the nursing service
A plan of organization
Policy and administrative manuals
Nursing practice manuals

13. Nursing service budget
A master staff planning
Plans of appraisal of nursing
Nursing service administrative meetings
Advisory committees:

14. Adequate facilities, supplies and
equipments
Written job descriptions and job
specifications
Personnel records
Health services
In-service education of nursing personnel
Meeting with personnel from other
departments

15. ORGANIZATION AND MANAGEMENT
OF NURSING SERVICE UNIT
factors influencing patient care
The type of service.
The acuteness of the service and the rate of
turnover in patients.
The experience of the nurse.
The number of non-nurses

16. The amount and quality of teaching.
The amount and quality of supervision and
ward teaching.
The method of appointment of the medical
staff.
The plan of ward floor plan.
The physical facilities.

17.  The amount, type and location of equipments
and supplies.
 The number of working hours
 The morale of the worker.
 Methods of performing nursing procedures.
 The time required for hospital routines
 The method of assignment.
 The standards of nursing care.
Good ward management.

18. Management
Assessment or data gathering.
Implementation-directing groups of nurses
to implement planned actions.
Evaluation step in management process,
includes the action of multiple care givers,
patient outcomes and costs.

19. DETERMINING THE NURSING
STAFF REQUIREMENT
Calculating staff needs based on the
number of beds in the hospitals.
Estimating the number of staff according to
the degree of dependency of the patients as
determined on a scale.
This method relies on observations of
nursing activity.

20. ORGANISATION OF NURSING
SERVICES
Chief nursing officer
Nursing Superintendent
Deputy Nursing Superintendent
Deputy Nursing Superintendent
Ward Sister - Clinical Supervisor
Staff nurse Student nurse

21. Organizational set-up at Directorate General
of Health Services

22.  Organizational set-up of Nursing Service at
Central Level
 Organizational set-up of Nursing Service at State
Level

23. ROLE AND FUNCTION OF
NURSE ADMINISTRATOR
 Administration
♣ Organizes, directs and supervises the nursing
services both day and night.
♣ Coordinates assignments of staff.
♣ Establishes the general pattern of delegation of
responsibilities and authority.
♣ Formulates standing orders for the nursing care.

24. ♣ Ensures appropriate allocation of duties and
responsibilities to all nursing staff working under
her.
♣ Formulates nursing policies to ensure quality
patient care and adequate attention at all times.
♣ Responsible for efficient functioning of the
nursing staff.
♣ Evaluates the personal performance of the nursing
staff.

25. Discipline
♣ Ensure that a standard of discipline of
nursing staff is high at all times.
♣ Maintain good order and discipline in wards
/ departments.
♣ Makes daily rounds of the hospital wards /
departments and also seriously ill patients.
♣ Brings immediately to the notice of the
medical superintendent all matters
concerning neglect of duty, insubordination
either by nursing staff, patients or visitors or
any un-towards incident.

26. Public Relations
♣ Promotes and maintains harmonious and effective
relationship with the various administrative
departments of the hospital and related community
agencies.
♣ Maintain cordial relationships with the patients and
their families.
Office duties
♣ Scrutinizes the reports and returns and submits in
accordance with existing orders.

27. Confidential Reports
♣ Initiates the confidential reports of nursing staff
on due dates.
♣ Responsible for the nursing budget.
Education
♣ Carries out in-service training for all categories of
nursing staff and paramedical personnel and keeps
the records of such trainings.
♣ Conduct various update courses based on the
needs.
♣ Encourages the personnel to participate in the
continuing education program.

28. Welfare
♣ Responsible for health and welfare of nursing
staff.
♣ Ensures annual and periodical health examination
and maintenance of health records.
Conferences
♣ Responsible for organizing and conducting staff
meeting of the nursing staff once in three months.
♣ Holds conference in nursing care problems and
discuss policies as regards to working conditions,
working hrs and other facilities.

29.  Supervision
♣ Supervises nursing care given to the patients and
all nursing activities within the nursing unit.
♣ Supervises the work of all paramedical staff of the
hospital.
 Records and Reports
♣ Maintains various records such as duty roster
nursing staff, day off book, personal bio-data,
leave plan, staff conference book, courses file etc.

30. PROBLEMS AND CHALLENGES FACED
BY THE NURSE ADMINISTRATOR
♠ Lack of adequate training.
♠ Problem of personnel management.
♠ Inadequate number of nursing staff.
♠ Shortage of trained manpower.
♠ Lack of motivation.
♠ No involvement in planning.

31. ♠ Poor role model.
♠ No research scope.
♠ Professional risk/hazards.
♠ No autonomy in nursing activities.

32. Day to day problem in nursing services
♠ Shortage of nurses.
♠ Lack of motivation.
♠ Negative attitude.
♠ Lack of training.
♠ Lack of team approach.
♠ Inactive participation of program
♠ Lack of interpersonal relationship
♠ Less involvement in patients care by nursing supervisors.
♠ Lack of supervision.

33. ORGANIZING PATIENT CARE
DEFINITION OF PATIENT CARE
 The services rendered by members of the health
profession and non-professionals under their
supervision for the benefit of the patient.

34. 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. The primary aim of PCS is to be
able to respond to constant variation in the care
needs of patients.

35. 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.

36. 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.

37. Purposes
◘ The system will establish a unit of measure for
nursing.
◘ Program costing and formulation of the nursing
budget.
◘ Tracking changes in patients care needs.
◘ Determining the values of the productivity
equations
◘ Determine the quality

38. LEADERHIP ROLES AND MANAGEMENT
FUNCTION ASSOCIATED WITH
ORGANIZING PATIENT CARE
Leadership roles:
 evaluate the effectiveness of the organizational
structure
 Determines adequacy of resources and support
 Examines the human element
 Inspires the work group towards a team effort.
 Inspires subordinates to achieve higher.
 Ensures that chosen nursing care delivery models
advance the practice of professional nursing.

39. Management functions:
 Examines the philosophy.
 Select nursing delivery system.
 Use scientific research and current literature.
 Uses patient care delivery system that maximizes
human and physical resources as well as time.
 Ensure that non- professional staff are
appropriately trained and supervised.

40.  Organizes work activities to attain organizational
goals.
 Groups activities in a manner that facilitates
communication and co-ordination
 Organizes work so that it is cost- effective
possible.
 Makes changes in the work design
 Clearly delineate criteria to be used for
differentiated practice roles

41.  Organizes work activities to attain organizational
goals.
 Groups activities in a manner that facilitates
communication and co-ordination
 Organizes work so that it is cost- effective
possible.
 Makes changes in the work design
 Clearly delineate criteria to be used for
differentiated practice roles

42. MODES OF ORGANIZING PATIENT CARE
 Case method nursing or total patient care.
 Functional nursing
 Team nursing or modular nursing
 Primary nursing
 Case management or managed care

43. Case method
 In this method, nurses assume total responsibility
for meeting all the needs of assigned patients
during their time on duty.

44. Characteristics:
Complete care.
nurses with high autonomy and
responsibility.
 It is developed and communicated through
written sources, its usage remains in
contemporary practice.
The lines of authority and accountability
are clear.

45. Merits:
 The nurses attend to total needs of clients
 Continuity of care.
 Client/ nurse interaction/rapport can be developed.
 Client may feel more comfortable
 Educational needs of the client can be closely
monitored.
 Family and friends became better known by the
nurse
Workload of the patient can be equally divided.
 Nurse’s accountability for their function is built-in.

46. Demerits:
 Many clients do not require the inherent care of
intensity in this type of service.
 This method need to be modified if professional
workers are to be involved effectively.
 It is difficult for the nurses to use this method to
become involved in long term planning and
evaluation of care.
 It is not possible if the nurses are not adequately
trained for the total care of the patient.

47. Functional method:
 In this, persons were assigned to complete certain
tasks rather than care of specific patients. Eg.
Checking BP, administering medications

48. Characteristics:
 Afunctional method is a technical approach of
nursing care.
 The available staff in the unit, for a particular
period of time, are assigned selected functions of
nursing practice such as vital signs, treatments,
medications.
 All the responsibilities are assigned in accordance
with the expertise.
 The only person who has responsibility of the
client is the head nurse or nurse acting the role.

49. Merits:
 person become specifically skilled in performing
certain assigned task.
 best utilization of a person’s aptitudes,
experiences and desires.
 Less equipment is needed.
 saves time.
 development of technical skill
 sense of productivity for the task oriented nurse
 easy to organize the work of the unit and staff

50. Demerits:
 Client care become impersonal,
compartmentalized and fragmented.
 diminishing continuity of care.
 Staff may become bored and have little motivation.
 only the nurse in-charge has accountability for the
client.

51.  little avenue for the staff development.
 Client may tend to feel insecure.
 Only parts of the nursing care plan are known
 difficult to establish the client priorities.
 only safe when the head nurse co-ordinate all the
activities of the members.

52. Team nursing:
 Team nursing is based in the philosophy in which a
group of professional and non- professional
personnel work together who identify, plan,
implement and evaluate comprehensive centered
care.

53. Characteristics:
 ancillary personnel collaborate in providing care.
 Team nursing involves decentralization of nursing
unit and professional head nurse authority.
 Each team composed of a team leader, team
members and patients.
 Comprehensive care is the responsibility of the
entire team.

54.  The head nurse has the responsibility to know the
conditions of all patients assigned to the team and
planning individual care.
 democratic leadership.
 Group members are given as much as autonomy

55. Merits:
 includes all health care personnel in the group
functioning and goals.
 Feelings of participation and belonging
Workload can be balanced and shared.
 Division of labour allows members the opportunity
to develop leadership skills
 Every team members has the opportunity to learn
from and teach collegues.

56. Demerits:
 Establishing the team concept takes time, effort
and constancy of personnel.
 Unstable staffing patterns make team nursing
skills patterns make team nursing difficult.
 All personnel must be client centered.
 This leads to blurred lines of responsibility,
errors, and fragmented care.
 For the team nursing to be effective the leader
must be excellent practitioner and have good
communication, organizational, management,
and leadership skills.

57. Primary nursing:
 It is also called relationship based nursing. It
involves total nursing care, directed by a nurse on
24 hour basis as long as the client is under the
care.

58. Characteristics:
 The RN primary nurse assumes 24-hour
responsibility from admission or start of treatment
to discharge or the treatment’s end.
 During work hours, primary nurse provides total
direct care for that patient.

59. When the primary nurse is not on duty, care is
provided by other junior nurses.
 An integral responsibility of the primary nurse is
to establish a good communication
 The combination of clear interdisciplinary group
communication and consistent, direct patient care
by relatively few nursing staff allows for holistic,
high quality patient care.

60. Merits:
 opportunity for the nurse to see the client and
family as one system.
 Nursing accountability, responsibility and
independence are increased.
 The nurse is able to use wide range of skills,
knowledge and expertise.
 potentiates creativity by the nurse and thereby
work satisfaction increases
 increased trust and satisfaction for both

61. Demerits:
 The nurse may be isolated from the colleagues.
 Little avenue for group planning of care.
 Nurse must be mature and independently
competent.
 It must be cost effective.

62.  Staffing patterns may necessitate a heavy client
load.
 It may be difficult to recruit and retain enough
staff, especially in times of nursing shortage.
 An inadequately prepared or incompetent primary
nurse may be incapable of coordinating a
multidisciplinary team or identifying complex
patient needs and condition changes.

63. Case management:
Case management is defined as a
collaborative process that assesses, plans,
implements, coordinates, monitors and evaluates
opinions and services to meet an individual health
needs through communication and available
resources to promote quality, cost-effective
outcomes.
Case management society of America

64. Characteristics:
 Case mangers handle each case individually.
 In general case manger can handle a load of 25
patients [smith, 2003].
 Case mangers use critical pathways and
multidisciplinary action plans to plan patient
care.

65. Responsibilities of case managers:
 Assessing clients and their homes and
communities.
 Coordinating and planning client care.
 Collaborating with other health
 Monitoring client progress and client outcomes.
 Advocating for clients
 Serving as a liaison with third party

66. Merit:
 additional work efficiency due to geographical
proximity.
 Establishes solid relationships with nursing and
ancillary staff working on the unit.
 Case management provides a well coordinated
care.
 Provides comprehensive care
 It seeks the active involvement of the patient,
family and diverse health care professionals

67. Demerits:
 Some experts are argued that this role should be
reserved for the advance practitioner nurse or an
RN with advanced training or need 3 to 5 year
experience.
 The case manger should also be extremely bright,
have well developed interpersonal skills, be able to
multitask, have a strong foundation in utilization
review, and understand payer-patient specifics and
hospital reimbursement mechanisms.

68.  Nurses identify major obstacles in the
implementation of this service, financial barriers
and lack of administrative support.
 Expensive
 Nurse is client focused and outcome oriented
 Facilitates and promotes co-ordination of cost
effective care
 Nursing case management is a professionally
autonomous role that requires expert clinical
knowledge and decision making skills.

69. Modular nursing
Modular nursing is a modification of team
nursing and focuses on the patient‘s geographic
location for staff assignments. The concept of
modular nursing calls for a smaller group of staff
providing care for a smaller group of patients.

70. Characteristics:
 The patient unit is divided into modules or
districts, and the same team of caregivers is
assigned consistently to the same geographic
location.
 Each location, or module, has an RN assigned as
the team leader, and the other team members may
include LVN/LPN or UAP.

71.  The team leader is accountable for all patient care
and is responsible for providing leadership for
team members and creating a cooperative work
environment.
 The success of the modular nursing depends
greatly on the leadership abilities of the team
leader.

72. Merits:
♣ Nursing care hours are usually cost-effective.
♣ The client is able to identify personnel who are
responsible for his care.
♣ All care is directed by a registered nurse.
♣ Continuity of care is improved
♣ The RN as team leader is able to be more involved
in planning & coordinating care.

73. ♣ save staff time.
♣ Feelings of participation and belonging
♣ Work load can be balanced and shared.
♣ develop leadership skills
♣ Continuity care is facilitated
♣ Everyone has the opportunity to contribute to the
care plan.

74. Demerits:
♠ Costs may be increased to stock each
♠ takes time, effort, and constancy of personnel.
♠ Unstable staffing pattern make team difficult.
♠ There is less individual responsibility and
autonomy regarding nursing function.
♠ All personnel must be client centered.
♠ The team leader must have complex skills and
knowledge.

75. Progressive patient care:
It is a method in which client care areas
provide various levels of care. The central
theme is better utilization of facilities, services
and personnel for the better patient care.

76. Principal elements of PPC are:
 Intensive care or critical care
 Intermediate care
 Convalescent and Self Care
 Long-term care
 Home care
 Ambulatory care

77. Merits:
♣ Efficient use is made of personnel and equipment.
♣ Clients are in the best place to receive the care .
♣ Use of nursing skills and expertise are maximized.
♣ Clients are moved towards self care, independence
is fostered where indicated.
♣ Efficient use and placement of equipment is
possible.
♣ Personnel have greater probability to function
towards their fullest capacity.

78. Demerits:
♣ discomfort to clients who are moved often.
♣ Continuity care is difficult.
♣ nurse/client relationships are difficult to arrange.
♣ Great emphasis is placed on comprehensive,
written care plan.
♣ There is often times difficulty in meeting
administrative need of the organization, staffing
evaluation and accreditation.

79. DIFFERNTIATED NURSING
PRACTICE
 Differentiated nursing practice refers to an attempt
to separate nursing practice roles based on
education or experience or some combination of
both.

80.  Education model:
Role differentiation based upon type of educational
preparation [BSN, MSN etc]
 Competency model:
Role differentiation based on individual nursing
skills, expertise, experience etc.

81. Merits:
match patients needs with nursing
competencies.
efficient use of nursing resources.
Provide equitable compensation
 It increase nurse satisfaction, built loyalty
and increase the prestige of the nursing
profession.

82. a prominent characteristic among the new models
being tried is the nurse as a clinical expert
leading other members of the team partners.

83. THANK YOU…