Introduction to Nursing Service Administration
Placement : Second year
Time allotted : Theory -60 Hrs Practical –180Hrs
COURSE CONTENTS
UNIT I
Different authorities define management differently but have strong unifying similarities in all the definitions.
The term management can be used in several ways. For instance, it can simply refer to the process that managers follow to accomplish organizational goals. The term can be used, however, to refer to a body of knowledge. In this context, management is a cumulative body of information that furnishes insight on how to manage. Management is the art of getting things done through people. It is the process of reaching organizational goals by working with and through people and other organizational resources. It is the process of planning, organizing, leading and controlling the work of organization members and of using all available organizational resources to reach stated organizational goals. It is the process of directing, coordinating and influencing the operation of an organization to obtain desired result and enhance total performance.
Nursing service administration
Nursing service administration is a coordinated activity, which provides all of the facilities necessary for the rendering of nursing service to clients.
Nursing service administration is the system of activities directed toward the nursing care of clients, and includes the establishment of over-all goals and policies within the aims of the health agency and provision of organization, personnel, and facilities to accomplish this goals in the most effective and economical manner through cooperative efforts of all members of the staff, coordinating the service with other departments of the institution.
Nursing service administration is the marshaling of resources to accomplish a purpose. It is both an art and a science. It is a science in the sense that one may systematically study and analyze the behavior of people as a collective endeavor and, even their individual behavior in relationship to their individual purposes and to draw generalizations from them that are valid guides to foresight and action. It is an art because it requires qualities of dynamic character to make them effective in application.
Nursing service administration is the process of planning, organizing, leading and controlling that encompasses human, material, financial and informational resources in an organizational environment to achieve the predetermined objectives.
Mission
A mission statement is a broad general goal of an organization that describes its purpose in the community. The mission statement of a small community hospital may indicate that its purpose is to serve the health care needs of the immediate community and provide care for commonly occurring illnesses. A large university hospital may have a mission statement that encompasses research, teaching and care for complex problems. These two organizations will establish different priorities for spending, choose different technologies as essential to their missions, and structure their staff in different ways. These mission statements provide the overall umbrella under which all functions of the organization take place. In addition to or even in place of a mission statement a general statement of philosophy may be used. When both are present, they should agree. The philosophy is typically longer and more detailed.
Organizational Philosophy and philosophy of Nursing Service Administration
Organizational Philosophy is its explicit and implied view of itself and what it is. Generally it is expressed in mission statements. The philosophy is directly linked to and rooted in the organizations cultural beliefs and values. Philosophy depicts the desired nature of the relationships between health service organizations and its customers, employees and external constituents. It is a set of beliefs that determines how organizational purposes are achieved and that serves as the foundation for agency objectives, policies and procedures. Nurses have the right to know the beliefs about nursing care, nursing practice and nursing management held by the collective group, which they are a part of the nursing department. A statement of philosophy is a valuable management tool. Nurses should be given a copy before they join the staff so that they can judge whether their personal philosophy is sufficiently in agreement with the organizational philosophy to enable them to become a contributing member of the department. Philosophy statements are relatively enduring documents because stated beliefs are usually expressions of firm commitment to the best that can be achieved and are derived from the broad goals of the agency. A useful philosophy has a timeless quality because basic premises change only under unusual conditions. Nevertheless, philosophy statements need to be reviewed periodically. If a review by all members of the department reveals that the statement still reflects the guiding beliefs of the collective group, there is no need to revise the document. If scrutiny indicates that the statement is not consistent with current agency goals or philosophy or is not effective in directing the actions of the department, then the statement should be rewritten to assure that it meets the criteria of compatibility, attainability, intelligibility, acceptability, measurability and accountability. When developing or reevaluating a philosophy, the manager should consider theory, education, practice, research, and nursing's role in the total organization.
Goals / Aims
Goals are the broad statements of overall intent of an organization or individual. They are usually stated in general terms. The purpose of writing goals is to identify where you are going and to enable you to evaluate when you have arrived there. A meaningful stated goal is one that succeeds in communicating the intent of those generating the goal. It should be stated in such a way that it will be understood clearly by others. As a nurse in a health care institution, you need to be aware of the existence of several levels of goals: the institutional level, the nursing department level and the nursing unit level. The goal levels all need to relate to the health needs of the community, because these are the focus of health care.
Institutional Goals
Based on the community’s health needs, the institution forms goals and objectives. An institution that focuses thinking on goals for the future and activities that will move the organization toward these goals is referred to as a proactive institution. The managers of such institutions spend a great deal of time, money and energy on identifying possible future events and on preparing the institution to deal with them. Institutions that do not have specific or future oriented goals are reactive institutions. They spend their time reacting to events, that is, “putting out fires” rather than “preventing them.” A reactive facility would wait until such emergencies occurred and then would handle them as a crisis rather than as an anticipated event.
Nursing Department Goals
The goals of the institution definitely affect those of nursing service, which must support and complement institutional goals. In an institution with an overall goal of developing a mental health program, a nursing department goal may include developing nurses in psychiatry. The astute manager of a nursing department must also be proactive about the national issues facing nursing, community needs for nursing, and the needs within the institution itself. This manager would formulate goals to help the nursing department meet the challenges of care in the future, because the ultimate nursing department goal is quality client care.
Nursing Unit Goals
It is important that each employee understand the institutional and nursing department goals, because the group or unit goals develop from them. Each nurse should be able to contribute to the formation of unit goals in terms of philosophy of care, quality of care, and development of nursing expertise. Helping to formulate the goals for your unit is important, because these goals can also represent your individual goals. Unit goals develop from the group as a whole and often include individual goals in the process. Development and implementation of goals must be
meaningful to the group if they are to be successful. The member of the group must feel that they are the originators of the unit goals and objectives.
Organizational Climate
The climate of an organization refers to the prevailing feelings and values experienced by individuals. The feeling of thrust, belonging, esteem and loyalty are part of the climate. Values for competence and accomplishment are also part of the climate. The climate is bases on the official policies and procedures of the organization, and the feedback provided within the organization
Planning a New Hospital
Introduction
•Planning is the most important aspect of establishing a hospital.
•Planning a new hospital starts with setting goals for the hospital, without which the organisation cannot have a definite direction or focus.
•The hospital planning exercise covers the study of the section of the population it proposes to serve, the geographical area to be covered, variety of services to be provided, quality standards to be met, equipment to be provided and manpower to be recruited and trained.
PROMOTER’S OBJECTIVE
•The promoter needs to determine the objectives of the project with clarity. These include the type of services to be provided:
–• Secondary care/tertiary care.
–• Sophistication in the building plan and equipments.
–• The investments and returns the promoter is looking for.
LOCATION
•• The land size should be adequate for housing the institution and also have ample provision for future expansion. Areas ideal for various bed capacities should be indicated.
•• Good infrastructural facilities, such as water, power, transportation and communication should be available.
•• Proximity of the location to the different segments of the potential market is an important factor.
MARKET SURVEY
•To determine the feasibility of the project, the first consideration in the survey is to study the character, needs and possibilities of the community which the hospital is going to serve.
•The existing medical facilities in the region should be studied in terms of:
–• Quality and number of hospitals.
–• The areas of specialisation—doctors/specialists/paramedical staff.
–• Level of technology, latest medical equipment.
–• Patient flow, disease pattern.
–• Costs of investigation and treatment.
•Public opinion regarding the existing facilities, the need for more departments, and the response from the medical community are vital to the study.
AVERAGE COSTS
•The cost computed per bed depends on various factors, such as the cost of the land in a particular place, the wage and salary rate, accessibility of materials, and so on.
•The average costs for a typical hospital would approximately be:
Primary care: Rs 8 lakh.
–• Secondary care: Rs 12 lakh.
–• Tertiary care: Rs 20 lakh.
FINANCIAL PLANNING
•Modern hospitals are cost-intensive. Financial planning is crucial.
•Financial needs should be anticipated and planned for. This covers both operational needs as well as funds for acquisition of capital items.
SOURCES OF FUNDS
•Long-term funds
–Generally the long-term funds are not taken out of the business. Once invested, these are traditionally used for acquiring long-term assets and for the provision of working capital.
•Short-term funds
–These funds are used to meet current expenses such as payments to staff, suppliers, for services, and for items of working capital.
Some Important Considerations
•Some of the important considerations while planning a hospital are
–PROVISION FOR DISASTERS
•In locations where there is a history of floods, earthquakes, or other natural disasters, planning and design should consider the need to protect the life and safety of all health care facility occupants, and the potential need for continuing services following disaster.
•FUNCTIONAL REQUIREMENTS
–the facility should satisfy the functional requirement for the appropriate classification, such as general hospital, tertiary care, single-specialty centre, etc.
•SITING AND ORIENTATION
–siting provides protection from dusty wards, utilisation of the prevailing breeze(wind),
–orientation effects and window arrangement for exposure to the sun’s rays should be made.
•CONSERVATION OF ENVIRONMENT AND INFECTION CONTROL
–This must be well-planned and adequate measures for successful implementation need to be addressed from the very outset of the project.
•ENVIRONMENTAL IMPACT ANALYSIS
–No adverse effect on the environment noise, polluted air, traffic noise— including air traffic—and location of incinerators need attention.
•FUTURE EXPANSION
–The functional programme should also address the potential for future expansion of essential services, such as X-rays, laboratories, and upgradation by adding on MRI, CT Scan, and so on.
•STANDARDS
–The hospital should meet all standards that have to be statutorily complied with and should not compromise with the safety standards, medical and nursing practices.
Basic Minimum Requirements for a Hospital of 30 Beds
•SECTION 1: FACILITIES
–Scope
•This standard covers the minimum basic requirements for 30-bedded hospitals, including physical space, staff and equipment.
–Functions
•A 30-bedded hospital should generally have the following facilities:
–Group 1: Medical and Allied Disciplines
Group 1: Medical and Allied Disciplines
•• Anaesthesiology
•• Blood bank
•• Dentistry (optional)
•• Emergency medicine
•• General medicine
•• General surgery
•• Obstetrics and Gynaecology
•• Paediatrics
Group 2: Health and Allied Services
•• Family welfare
•• Health education
•• Maternal and child health care
•• Nutrition
•• School health care
Group 3: Nursing, Paramedical and Allied Services
•• Dental technology (optional)
•• Dietetics and Therapeutic catering (optional)
•• Drugs and Pharmacy
•• ECG technology
•• Laboratory technology
•• Laundry technology (optional)
•• Medical record technology
•• Nursing services
•• Operating theatre technology (optional) including anaesthesia technology
•• Sterilisation and disinfection (CSSD) technology
•• Ultrasound imaging
•• X-ray imaging
Group 4: Engineering and Allied Services
•• Electric supply, including power generation and stabilisation
•• Horticulture, including landscaping
•• Liquid Petroleum Gas (LPG) supply (optional)
•• Mechanical transport, including ambulance service
•• Medical gases supply and vacuum (optional)
• Refrigeration
•• Sewage treatment and disposal (where required), including sanitation and drainage
•• Solar energy (optional)
•• Solid waste disposal, including incineration
•• Telephone and communication, including paging
•• Water treatment and supply (where required), including plumbing
•• Workshop (optional)
Group 5: Administrative and Ancillary Services
•• Audio-visual services, including field publicity
•• General administration
•• Housekeeping
•• Materials management, including inventory control
•• Medical social work (optional)
•• Security
SECTION 2: BED DISTRIBUTION
•Bed distribution
–It is suggested that the allocation of beds for obstetrics, gynaecology and paediatrics could be 20,
–and rest of the 10 beds could be suitably divided between other specialties, such as Medicine, Surgery, Emergency, and so on.
SECTION 3: SPACE AND PHYSICAL REQUIREMENTS
•General
–This section covers space, physical and environmental requirements for a 30-bedded hospital. The building can be divided according to their functions.
•Total area
–The total area to be provided for a hospital complex will depend on the availability of land. However, for guidance, an area of 1 hectare or more is recommended for a 30-bedded hospital.
•Site planning
–Hospital sites with a high degree of sensitivity to outside noise should be avoided.
•Residential accommodation
If adequate land is not available, residential accommodation should be provided only for the essential staff, which should include the resident medical officer, nurses and Class IV staff.
Functional and area analysis
•Entrance Zone
–Reception and Registration
•— Reception Counter
•— Record Storage
–Pharmacy
•— Issue Counter
•— Formulations
•— Drugs Storage
Ambulatory Zone
•Examination and Workup
•Out-patient Department (OPD)
–Examination Rooms, Sub-waiting
•Consultation
–Consultation Rooms, Toilets, Sub-waiting
•Nursing Station
–Nurses’ Desk, Clean Utility, Dirty Utility, Treatment Rooms, Injection and Dressing, Sample Collection, ECG, Ultrasound, Sub-waiting
•Public Utilities & Circulation space
Diagnostic Zone
•Clinical Laboratory
–Sample Collection, Bleeding Room, Laboratory, Washing/Disinfection, Storage, Sub-waiting
•Imaging
–Preparation, Change, Toilet, Treatment Room, Control, Dark Room, Sub-waiting
•Public Utilities
•Circulation Space
Intermediate Zone Ward
•Nursing Station
–Nurses’ Desk, Clean Utility, Dirty Utility, Pantry, Treatment Room, Store, Trolley Bay
•Patient Area
–Bed Space, Toilets, Day Room, Isolation
•Ancillary Rooms
–Doctor’s Rest Room, Nurse’s Duty Room
•Public Utilities
•Circulation Space
Critical Zone
•Patient Area
–Preparation, Pre-anaesthesia
•Staff Area
–Changing, Resting
•OT/LR Area
–Scrub and Gown, Preparation, Operation/Labour Room, Disposal
•Ancillary Area
–Trolley Bay, Equipment Storage, Sterile Storage
•Public Utilities & Circulation Space
Service Zone
•Kitchen
–Dry Store, Day Store, Preparation, Cooking, Delivery, Pot Wash, Utensil Wash, Trolley Park
•CSSD
–Receipt, Wash, Assembly, Sterilisation, Sterile Storage, Issue
•Laundry
–Receipt, Weight, Sluice-Wash, Hydro-Extraction, Calender, Press, Clean Storage, Issue.
•Manifold
–Landing Bay, Manifold, Compressor, Vacuum
•Sub-station
–Transformer, Generator Set, Stabiliser
•Pump House
•Workshop
•Incinerator
•Mortuary
–Receipt/Issue, Body Store
•Public Utilities & Circulation Space
Administrative Zone
•General Administration
•General Stores
•Public Utilities
•Circulation Space
•Total Area 1800(square metre)
SECTION 4: STAFF REQUIREMENTS
Based on convenience, demand, buildup
»STAGES I II III Total
•Medical Staff
–General Medicine 1 – 1 2
–General Surgery 1 – 1 2
–Obstetrics & Gynae. 1 1 – 2
–Paediatrics 1 – – 1
–Anaesthesiology 1 – – 1
–Dentist (optional) 1 – – 1
–Pathologist (optional) – 1 – 1
–Radiologist (optional) – – 1 1
•Health Staff
–Female Health Assistant 1 – – 1
–Extension Educator 1 – – 1
–Nutritionist – 1 – 1
–Public Health Nurse – – 1 1
•Nursing Staff
–Matron 1 – – 1
–Operation Theatre Nurse 1 – 1 2
–Labour Room Nurse 1 1 – 2
–General Nurse 7 1 1 9
–Nursing Aides 7 1 1 9
•Paramedical Staff
–Pharmacist/Asst. Pharmacist 1 1 – 2
–Dietitian/Asst. Dietitian – 1 – 1
–Technologist/Technician ECG 1 – 1 2
–Technologist/ Tech. Imaging 1 – 1 2
–Technologist/Clinical Path 1 1 – 2
–Haematology/Blood Bank 1 – – 1
–Technologist/Laundry 1 – – 1
–Technologist/Medical Records1 – – 1
–Technologist/CSSD 5 1 1 7
•
•Engineering Staff
–Technologist/Technician Electrical 1 1 – 2
–Technologist/Mechanical/Plumbing 1 – 1 2
–Engineering Aides 2 – – 2
•Administrative and Ancillary Staff
–Stenographer 1 – – 1
–Store Keeper 1 – – 1
–Admn. Assistant 1 – 1 2
–Telephone Operator 1 – – 1
–Driver 1 1 – 2
–General Attendants 2 1 – 3
–Security Attendants 4 1 1 6
–Sanitary Attendants 5 1 1 7
•Grand Total 57 15 14 86
Conclusion
•Establishment of a hospital requires careful planning. The human factor is very essential, unlike in other industries, since a hospital involves care of the physical, clinical and psychological aspects of patients.
•Facilities should be appropriate according to the needs and affordability of the community.
HOSPITAL
Definition
Acc. to WHO: " Hospital is an integral part of a social and medical organization the functions of which are to provide service to the population. Complete health care both curative and preventive care with out. Patients services reaches out to the family in his own environment and also carry out training of health workers/functionaries and the biosocial research.
Acc. to Directory of Hospitals in India (1988): A hospital is an institution which is operated for the medical, surgical and obstetrical care of the patients and which is treated as a hospital by the appropriate authority".
Aims & Objectives
Provide optimum health services to all people irrespective of caste, creed, color & race.
Provide promotive, preventive & curative care to all the people.
Protects human rights of patients while providing care & treatment.
Provides training of professionals (eg: Doctors, Nurses, Pharmacist, dentists & other technician) in health care setting.
Provide inservice and staff development programme for their employees.
Participate in research activities
Classification of Hospitals:
General Hospitals
Rural Hospitals
Specialized Hospitals
Teaching Hospitals
Isolation Hospitals