organizing nursing services, methods of patient assignment

1. ORGANIZING NURSING
SERVICES & PATIENT
CARE
Presented by,
R.Sushma,
MSC (N) II Year,
Nursing Management (2023)
CON-SRIPMS,
CBE.

2. INTRODUCTION
 A hospital may be soundly organized, beautifully situated
and well equipped, but if the nursing care is not in high
quality the hospital will fail in its responsibility. In nursing
services, the nurse works with the members of allied
disciplines such as pharmacists, physicians, dieticians,
physiotherapists.

3. I ] ORGANIZING NURSING
SERVICES

4. NURSING SERVICE-DEFINITION
 Nursing service is the part of the total health organization
which aims at satisfying the needs of
patients/community. In nursing services, the nurse works
with the members of allied disciples such as dietetics,
medical social service, pharmacy etc

5. NURSING SERVICE ADMINISTRATION-DEFINITION
 Nursing service administration is a complex of elements
in interaction and is organized to achieve the excellence
in nursing care services.

6. OBJECTIVES OF NURSING SERVICE
 The first component of nursing service administration is the
planning and it should be based on clearly defined
objectives. The objectives of nursing service department are
as follows:

7.  1) Objectives in relation to patient care
 To give highest possible quality care in terms of total
patients need which include physical, psychological, social,
educational and spiritual needs by collaborating with other
health team members.
 To assist the physician in providing medical care to the
patients.
 To provide preventive and rehabilitative services.
 To provide round the clock nursing care to all the patients.

8.  To render timely and appropriate nursing service to
emergency patients.
 To provide cost effective quality care as per the needs of
patients.
 Confidentiality and privacy of each patient should be
maintained.
 Constant monitoring and evaluating is of utmost
importance to improve patient care continuously.

9.  2) Objectives in relation to Education
 Planning of education and training programme for nurses
are must for professional growth and development needs
through in-service education and research support.
 To provide regular staff development, in-service education
and guidance services for all members of nursing staff.
 To conduct regular orientation programme for new entrants
and for those have been on the job for a long time.
 To conduct training for operating procedure of latest
gadgets and on handling sophisticated bio-medical equipment.

10.  3) Objectives in relation to Administration and
Organization
 To make regular supervision through rounds.
 To ensure that the essential equipment is provided in
functional status for nursing care services.
 To provide regular flow of essential supplies to render
quality nursing care.
 To have a proper system of rotation of staff, provision for
annual leave and days off for the nursing staff without
hampering patient care.

11.  Establish a communication system for nursing
personnel, other health worker, patients, health
authorities, government authorities and public.
 Ensure that each nurse identifies her job
responsibilities and accountability.
 Counseling for health personnel, patients and the public.
 The formulation of policies, standards, goals of
nursing service, education and practice.
 Maintaining proper documentation of the personnel
employed in nursing service.

12.  4) Objectives in relation to Research
 To contribute in research programme conducted by
hospitals and by other health personnel.
 To encourage and support the nurse to conduct
research projects/ activities.

13.  5) Objectives in relation to Performance appraisal
 Appraise the performance of nursing service personnel
regularly against set standards and performance indicators
objectively with a view to maintain quality-nursing services.

14. FUNCTIONS OF NURSING SERVICE
 To help and encourage the patient to carry out the
therapeutic plan initiated by the physician.
 To assist other members of the team to plan and carry out
the total programme of care.

15.  The director of nursing service is delegated the authority
and responsibilities for organizing and administrating the
nursing services in hospital. It is her duty to institute the
essential characteristics of good nursing services in her
institute such as:
 Written statement of purposes and objectives of nursing
services
 Plan of organization
 Policy and administrative manuals
 Nursing practice manual
 Nursing service budget
 Master staffing pattern

16.  Nursing care appraisal plan
 Nursing service administrative meetings
 Adequate infrastructure facilities, supplies and
equipment
 Written job description & job specifications
 Personnel records
 Personnel policies
 Health services

17. ORGANIZING NURSING SERVICE AT
VARIOUS LEVELS

18. 1] ORGANIZATIONAL SET-UP OF NURSING
SERVICE AT CENTRAL LEVEL

20. 2] ORGANIZATIONAL SET-UP OF NURSING
SERVICE AT STATE LEVEL

22. ROLE AND FUNCTION OF NURSE
ADMINISTRATOR
1) In 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.
 Ensures appropriate allocation of duties and
responsibilities to all nursing staff working under her.

23.  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.
2) Discipline
 Ensure that a standard of discipline of nursing staff is high
at all times.
 Maintain good order and discipline in wards/departments
3) Public relation
 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.

24. 4) Confidential report
 Initiates the confidential reports of nursing staff on due
dates.
 Responsible for the nursing budget.
5) Education
 Carry 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 programme
6) Welfare
 Responsible for health and welfare of nursing staff.
 Ensures annual and periodical health examination and
maintenance of health records.

25. 7) 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.
8) Supervision
 Supervises nursing care given to the patients and all nursing
activities within the nursing unit.
9) 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.

26. 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.
 No career mobility.
 Poor role model.
 No research scope.
 Professional risk/hazards.
 No autonomy in nursing
activities.

27. 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
 Lack of supervision.

28. II] ORGANIZING PATIENT
CARE

29. ORGANIZING PATIENT CARE
 The overall goal of nursing is to meet the patients needs
with the available resources for providing smooth day and
night 24 hrs quality care to patients and to honor his rights.
Definition
 The prevention, treatment and management of illness and
the preservation of mental and physical well-being through
the services offered by the medical and allied health
professions

30. PATIENT CLASSIFICATION SYSTEMS (PCS)
 Patient Classification System (PCS),which quantifies
the quality of the nursing care, is essential to staff the
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.

31. DEFINITION
 It is a structured method used in health care to categorize
patients into different groups based on factors such as
diagnosis, severity of illness, requires level of care.

32. CHARACTERISTICS OF PCS
 Differentiate the intensity of care among definite classes
 Match nursing resources to patient care requirement
 Relate to time and effort spent on the associated activity
 Be economical and convenient to report and use

33.  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

34. PURPOSES OF PCS
 To establish a unit of measure for nursing, that is time
 Program costing and formulation of the nursing budget
 Tracking changes in patient care needs
 Determining the values of the productivity equations
 Determine the quality

35. COMPONENTS OF PCS
 Method for grouping patient’s categories
 Set of guidelines for patient classification
 Amount of time required for care of a patient in each
category.

36. MODES OR METHOD OF ORGANIZING PATIENT
CARE
 Traditional methods
 Case method or Total
patient care
 Functional nursing
 Team nursing
 Modular or district nursing
 Progressive patient care
 Primary nursing
 Advance method
 Case management

37. TRADITIONAL METHOD
1) CASE METHOD/ TOTAL PATIENT CARE
 In this method, nurses assume total responsibility for meeting
all the needs of assigned patients during their time on duty.
It involves assignment of one or more clients to a nurse for a
specific period of time such as shift.
 Nurse‘s responsibility includes complete care including
treatments, medication and administration and planning of
nursing care.
 Merits
 The nurse can attend to the total needs of clients due to the
adequate time and proximity of the interactions.
 Client may feel more secure

38.  Good client nurse interaction and rapport can be developed.
 Nurse‘s accountability for their function is built-it.
 It is used in critical care settings where one nurse provides
total care to a small group of critically ill patients.
 Demerits
 Nurse may feel overworked if most of her assigned patients
are sick.

39. 2) FUNCTIONAL NURSING
 This system emerged in 1930s in U.S.A during WWII when
there was a severe shortage of nurses in US.
 In this model, the tasks are divided with one nurse
assuming responsibility for specific tasks. For example, one
nurse does the hygiene and dressing changes, whereas another
nurse assumes responsibility for medication administration.

41.  Merits
 Each person become very efficient at specific tasks and a
great amount of work can be done in a short time (time
saving).
 It is easy to organize the work of the unit and staff.
 Nurses become highly competent.
 Demerits
 Client care may become impersonal, compartmentalized
and fragmented.
 Continuity of care may not be possible.

42.  little motivation to develop self and others.
 Client may feel insecure.
Patients get confused as so many nurses attend to them,
e.g. head nurse, medicine nurse, dressing nurse,
temperature nurse, etc.

43. 3) TEAM NURSING
 Developed in 1950s because the functional method received
criticism, a new system of nursing was devised to improve
patient satisfaction.
 Team nursing is based on philosophy in which groups of
professional and non-professional personnel work
together to identify, plan, implement and evaluate
comprehensive client-centered care.

45.  Advantages
 High quality comprehensive care can be provided to the
patient
 Each member of the team is able to participate in decision
making and problem solving.
 Each team member is able to contribute his or her own
special expertise or skills in caring for the patient.
 Improved patient satisfaction.
 Work load can be balanced and shared.
 There is a variety in the daily assignment.

46.  Disadvantages
 Establishing a team concept takes time, effort of
personnel.
 Unstable staffing pattern make team nursing difficult.
 All personnel must be client centered.
 There is less individual responsibility

47. 4) 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.
 A mini team ( 2-3 members).

48.  Merits
 Continuity of care is improved
 Work load can be balanced and shared
 Allows members to continue their own special expertise or
skill.
 Geographic closeness and more efficient communication
save staff time.
 Demerits
 Establishing the team concepts takes time, effort, and
constancy of personnel.
 Unstable staffing pattern make team difficult.
 There is less individual responsibility and autonomy
regarding nursing function.

49. 5) 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.
 Here the clients are evaluated with respect to all level
(intensity) of care needed.
 In this method collaboration among healthcare
professionals from various discipline to provide
comprehensive and coordinated care.

50. 1) Intensive care or critical care
o Patients who require close monitoring and intensive care
round the clock, e.g. patients with acute MI, fatal
dysarythmias.
o These units have 9-15 numbers of beds, life-saving
equipment and skilled personnel for assessment, revival,
restoration and maintenance of vital functions of acutely
ill patients.
o Nursing approach in these units is patient- centered.

51. 2) Intermediate care
o Critically ill patients are shifted to intermediate care
units when their vital signs and general condition
stabilizes, e.g. cardiac care ward, chest ward, renal ward.
3) Convalescent and Self Care
o Although rehabilitation programme begins from acute
care setting, yet patients in these areas participate actively
to achieve complete or partial self-care status.
4) Long term care
o Chronically ill, disabled and helpless patients are cared
for in these units. Nurses and other therapists help the
patients and family members in coping, ambulation,
physical therapy, occupational therapy along with activities
of daily living. E.g., cancer patients, paralyzed and patients
with ostomies.

52. 5) Home care
o Some hospital/centers have home care services. A
hospital based home care package provides staff,
equipment and supplies for care of patient at home, e.g.
paralyzed patients, post-operative, mentally
retarded/spastic patient and patient on long chemotherapy.
6) Ambulatory care
o Ambulatory patients visit hospital for follow up,
diagnostic, curative rehabilitative and preventive
services. These areas are outpatient departments, clinics,
diagnostic centers, day care centers etc.

53. Merits
 Efficient use is made of
personnel and equipment.
 Clients are in the best place
to receive the care they
require.
 Use of nursing skills and
expertise are maximized
Demerits
 Continuity care is difficult.
 Long term nurse/client
relationships are difficult to
arrange.

54. 6) PRIMARY NURSING
 It is a system in which one nurse is caring for all the needs
of a patient or more within a 24 hour from admission to
discharge.
 If the nurse is not available, the associate nurse responsible
for filling in for the nurse‘s absence will provide hospital care
to the patient based on the original plan of care made by the
nurse.
 In acute care the primary care nurse may be responsible for
only one patient; in intermediate care the primary care
nurse may be responsible for three or more patients This
type of nursing care can also be used in hospice nursing, or
home care nursing

56. Advantages
 Primary nurses are in a
position to care for the entire
person-physically,
emotionally, socially and
spiritually.
 High patient and family
satisfaction
 Increases coordination and
continuity of care
Disadvantages
 It may be cost-effective
especially in specialized units
such as the ICU.
 May create conflict between
primary and associate nurses.
 Stress of round the clock
responsibility.
 Difficult hiring all RN staff

57. ADVANCE METHOD
1) CASE MANAGEMENT
 The case manager (RN or social worker with managerial
qualification) is assigned responsibility of following a
patient‘s care and progress from the diagnostic phase
through hospitalization, rehabilitation and back to home
care.
 For eg; case manager for cardiac surgery patients assists them
go through diagnostic procedures, pre-operative preparations,
surgical interventions, family counseling, post-operative care
and rehabilitation.

58.  Case management involves
 Critical paths,
 Variation analysis; inter shift reports,
 Case consultation,
 Health care team meetings,
 Quality assurance

59. Responsibilities of case managers
 Assessing clients and their homes and communities.
 Coordinating and planning client care.
 Collaborating with other health professionals in the
provision of care.
 Monitoring client progress and client outcomes.

60. Advantages
 Case management provides a
well-coordinated care
experience that can improve
the care outcome, decrease
the length of stay, and use
multiple disciplines and
services efficiently.
 Provides comprehensive
care for those with complex
health problems.
Disadvantages
Financial barriers and
lack of administrative
support.
Expensive

61. CONCLUSION
 Nursing is a vital aspect of health care and needs to be
properly organized. A nurse is in frequent contact with the
patients hence his/her role in educational aspects and service
aspect in restoring health and confidence of the patient is of
utmost importance. The quality of nursing staff, reflects an
image of the hospital/ nursing home.

62. REFERRENCES
 Alamelu venketraman. Newer trends in management of
nursing services and education. 1st ed. Jaypee health science
publisher; New Delhi: 2017. P. 92-99.
 Vati Jogindra. Nursing Management and Administration.1st
edition.2013; Jaypee Brothers Medical Publishers (p) Ltd;New
Delhi
 Bhaskara Raj Elakkuvana. Management of Nursing Services
and Education.3rd edition.Emmess Medical Publishers;
Bangalore
 Basavathappa B.T. Nursing Administration.2nd edition. 2009.
Jaypee Brothers Medical Publishers; New Delhi
 Lin herlina et al- retrieved from advances in health sciences
research (AHSR), volume 2-Indonesia.