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ASSIGNMENT OF PATIENT CARE:- There are generally four types of

assignment system for patient care. These are:-

A)CASE METHOD/ TOTAL PATIENT CARE:- It is an oldest method for

patient Care. It is also known as allocation method. In this method , one patient one
patient can be considered as one Case. Here one nurse is assigned or allocated for
the total care of a patient . She is responsible for all the activities of the patient
during the total shift of her. She must do the checking for TPR of the patient,
administration of medication, NG tube feeding or oral feeding etc. In her off duty
she must handover all the responsibilities for the patient to another nurse and she
must look after the patient same like the previous one. Now it is her responsibility
to fulfill all the medical as well as nursing needs during her duty hours. It is a
cyclic process from one shift to another. In this method one nurse can look after
more than one patient at a time.


i) The work load of a Ward can be equally divided among all the staffs.

ii) Good interpersonal relationship is developed between the Nurse and the patient.

iii) The Nurse can identify the problems of the patient properly as she is taking
total care of the patient.

iv) The nurses can develop their knowledge more by studying about the case,
related to the patient.

i) In a staff crisis situation, it is difficult to manage a ward.


ii) Need more efficient and experienced nurses.

B) FUNCTIONAL NURSING METHOD:- It is another method of patient care.

In this method the nurses can work as per their particular function. A nurse is
responsible for a specific job, related to patient care. For example suppose a nurse
is responsible for taking TPR. So, it is her duty to check TPR of all the patients in
her ward during her shift. She will not take any other responsibilities of any


i) Fast nursing services can be provided as everyone is doing their duties.

ii) Nurses become efficient in a particular job by doing it regularly.

iii) Quality of care can be maintained in this method.


i) No one is bothered much about patient’s problem as everyone is busy with their
own function.

ii) Less communication with the patient.

iii)Nurses can’t increase their skill and knowledge , as they are doing same duty

C) TEAM NURSING METHOD:- In this method of nursing care, every nurses do

work in a team basis. The superior leads the team by checking doctor’s order and
other direction , the subordinates just follow the orders.

i) Everybody can develop team spirit by this method.

ii) The team leader can develop her leadership capability.

iii) Very fast nursing care is possible as everyone is working as a team.

(iv)The team leader can develop her knowledge and skill daily while leading the


i) No one can take responsibility for any job.

ii) Communication with patient is very less.

iii) Quality of care is not possible.

PRIMARY NURSING: In this method of nursing care a nurse is responsible for a

patient from his admission to till discharge or till the end of his treatment. In this
method of nursing care a nurse generally works in a 24 hours basis for her patient.
A nurse control every step of care of the patient in the hospital from admission
procedure till discharge.


i) As the nurse is taking total care of the patient from the beginning so, she is more
knowledgeable about the patient’s problem.

ii) Any patient can rely on a nurse as she/he is looking total process of the patient
of the patient in the hospital.

(iii) High quality of nursing care is possible.

(iv) The nurse can make further study about that particular disease of the patient.
As the nurse is working daily with that case it will be helpful for her study.


i) The nurse may feel isolated from her colleagues.

ii) It’s quite difficult to work in 24 hours schedule.

iii) Need more expert or efficient nurses to handle the total treatment process of a

1)Goals and principles of nursing services department:

GOALS:-To identify the goals of nursing service department, we must find out:-

i) Hospital as an institutional goal.

ii) Nursing departmental goal

iii) Nursing as a unit and goal.


a) To provide quality of health care to the all the patients irrespective of age , sex
caste , socio-economic conditions etc.

b) To maintain all the rights of patients and maintain privacy.

c) To arrange education system for professionals like Doctors, nurses, dentists,

dietician etc.

d) To arrange in-service and continue education classes for staffs.

e) To maintain the standard of hospital.


a) To provide best possible nursing care to the patients.

b) To find out the needs for the client, whether he/she is totally dependent or
partially dependent to nursing care.

c) To look after, wheather the physician’s orders are strictly followed or not.

d) To encourage staffs for in service education classes for their own update.

e) To encourage staff nurses for doing specialization courses.

f) To provide job- description to all the nursing staffs, so that they can feel their
self actualization and job satisfactions.


i)The basic principles of nursing service department is to provide care to all the
clients irrespective of it’s age, sex, socio- economic condition, Nationality etc.

ii) The nursing department must have to maintain good interpersonal relationship
with any other department in the hospital. To maintain a good standard of the
hospital. It is very important to maintain good nursing intervention.

iii) There are some particular code of ethics in nursing. Every nursing department
must follow the ethics while treating patients.

iv) Not only in hospital setup but also in community area the nursing services
should be increased.
v) The nurses should empathetic to the patients but not to be sympathetic, while
giving care.

3) Nursing is the act of utilizing the environment of the patient to assist him in his
recovery. Nursing is all about management and art.

Management is art of knowing what you want to do and then seeing it is

done in the best and cheapest way. Nursing and management are interdependent to
each other. So, nurses must know the management principals.

i) EFFECTIVE COMMUNICATION:- For providing optimal level of nursing

service, effective communication is very important. The nurse should know how to

communicate with patient, patient parties as well as other departments of the

hospital. In nursing service every communication should occur in a particular
channel. It is the duty of the nurse manager to communicate all the decisions
among all his subordinates. The subordinates should also know the effective
channels of communication.

ii) DIVISION OF WORK:- The nursing-in-charge or supervisor must know how to

divide the work among the subordinates. The working should be divided in such a
manner, that any staff should not get over load. On the other hand, the supervisor
should manage the task in the way that the critical most patient can get efficient
and experienced nursing care.

iii) UNITY OF COMMAND:- While working in any department the nursing staffs
should follow a particular command from any of their subordinates. If there is
various commands, then everybody become confused. It is the responsibility of the
nursing department to make a single decision and that must be followed. Nursing
supervisors should discuss with each other that who will convey the decision
among subordinates. Every time one supervisor should convey the decision to
avoid further confusion and chaos.

iv) UNITY OF DIRECTION:- It is also same like the previous principle , that
nurses should follow. The nursing department should take decision about which
direction supposed to be followed and only then instruct the staffs.

v) SELF MANAGEMENT:- Every nurses should know the self management. They
must be empathetic for their patient but not be sympathetic. They must respect the
various patient’s religious beliefs, values and Nationality. They must know how to
behave and what to do in an emergency situation.

5)b) HEALTH CARE DELIVERY SYSTEM IN INDIA:- Health care delivery

means providing multiple of services related to health to individuals or community
people in order to promote good health, reduce illness and alleviate the suffering.
The healthcare delivery system also provides health education.

Components of health care delivery system:

 Structure of health system: Aspects of the design of health services that

influences the way in which they are delivered includes :- i) number and
type of personnel and staff. ii) Nature and extent of facility and equipment.
iii) Way of these personnel organized to work. Iv) Financing

Process of health care delivery:- It consists of two parts i) Behavior of professionals-

Diagnostic procedure , appropriate follow up , recommendation of treatment or management.

ii) Participation of people – Utilization of services , understanding the recommendations , participation

in decision making.

 Outcomes of health care:- aspects of health that results from

interventions provided by the health system.
 Flow of patients in health care system:- It varies from country to country. Indian system is more
cost effective if health workers are skilled and efficiently supervised.
In our country there are three levels of health care delivery:- Primary,
Secondary, Tertiary .

PRIMARY HEALTH CARE DELIVERY:- It provides the basic level of health

care delivery, like First Aid, Providing health education, taking care of postnatal
mothers etc. These are done by subcentres , primary health centres etc.

SECONDARY HEALTH CARE DELIVERY:- It is the first referral unit for the
primary health care system. Secondary health care delivery provides, care for the
antenatal mothers, normal vaginal delivery, medical aseptic dressing etc. These are
done by Sub-Divisional Hospital, District hospital etc.

TERTITARY HEALTH CARE DELIVERY:- All the critical patients from both
primary and secondary health care delivery can be referred to here. The services,
that are provided here are lower uterine caesarean section, any surgical procedure,
medical emergencies etc. mainly any medical College and Hospitals are
responsible for providing these services.

ELEMENT OF PRIMARY HEALTH CARE:- Maternal and child health care,

immunization, availability of drugs , treatment, safe water supply and sanitations ,
nutrition’s, educations, prevention of chronic deceases.

PRIMARY HEALTH CARE:- Primary health care is essential health care made
universally accessible to individuals and acceptable to them, through their full
participation and at a cost the community and Country can afford.
PRINCIPLES:- i) The basic principle for primary healthcare is equitable
distribution. The services should be provided to every individuals irrespective of
its age, sex or socio- economic condition.

ii) INTERSECTORAL CO- ORDINATION:- It is an important factor.

Coordination from all other is very important to maintain a successful primary
health care like agriculture, education, food industry etc.

iii) ACTIVE COMMUNITY PARTICIPATION:- All the members of a

community should participate. They should use their primary health care services
for their need. They should involve their family members in their own health of

iv) APPROPRIATE TECHNOLOGY:- Which is scientifically sound and

adoptable at local level, that must be used. The National health policy is being
reformed and recognized in terms of health infrastructure and health team


5)a) CHANGING TRENDS IN HEALTH CARE:- i) Earlier in the 20th century,

the treatment for various diseases were given in the home only. Treatment was
given by some physician or nurses. Home delivery of pregnant women by some
dais were very common practice during that time.

ii) Later in the 20th century, there was some specialization for courses like
Pediatrician, Psychiatrist , Medical, surgical etc. Physicians in their
specialization courses gave treatment to their patients.

iii) Last in the 20th century there was no boundaries in patient care. For any
treatment, patient can avail hospital (24x7). Hospitals are becoming more and
more technology based day by day. There are super -specialty and multispecialty
hospitals in every big cities even in the towns also.

iv) Now-a-days there is advancement of technology. We can do any investigation

for any part of our body. So, treatment is very specific now.

v) Attitude of the peoples are also changing day by day. They prefer any accredit
or standard hospital for their relative’s treatment. Money is not a bar now-a-days
for treatment.



was large family structure. Peoples were not that much concern about their regular
health. But now-a-days the family has become constricted and concern about
health. So now nurses have the role to do the remote health check up. In the remote
area peoples are not at all concern about various disease condition. Nurse should
provide health education to them and make them aware about changing trends of
health and health care.

ii) ADVANCEMENT OF TECHNOLOGY:- Through advancement of technology,

now it is possible to investigate and treat any disease. Here the nurses should work
as an educator. They must make themselves update about the technology as well as
give education to clients, so that patients can have an idea about treatment to
various disease.

iii) ALTERNATIVE THERAPIES:- Today’s Nurses are already highly skilled,

trained and educated in the ways of traditional medical care. But they can receive
an increased amount of training and education through alternative therapies. By
this knowledge they can act as a therapist and take care for the patients.
Now-a-days there is an advancement of technology. Various investigation related
to health is possible today but that is obviously cost effective. Various health care

organizations or hospitals are providing best possible health care to us. Their
principle is to do the optimum level of cost but without compromising the quality.

PURPOSE:- To review systematically evidence of the association between health

care quality and cost.

In a review of the evidence currently available there was no clear

relationship between the two. Lead author Peter S. hussy and his colleagues
conducted a systematic reviewof61 studies and found inconsistence evidence on
both the direction and the magnitude of the association between health care quality
and cost.

These results are a stark reminder of how little researchers and

caregivers know about the optimal allocation of scarce health care resources to
achieve the best health outcomes. To assess quality measures, the reviewers used 5
categories defined by the national quality measures. Structure, process, outcome,
patient experience and access. They also added a sixth category that included
composites of measures in 2 or more of those categories. Cost measures were
divided into 4 categories:- accounting costs, charges, expenditure and a care
intensity index, used in some studies as a measure of resource use relative to the
services provided.

Of the 61 studies that met the inclusion criteria, higher cost was
associated with better quality of carein34% indicating a positive or mixed positive
association between the two. In 18 studies(30%) the association was negative or
mixed negative (lower cost was associated with higher quality) and in 22 studies
( 36%) the association was non existents, mixed, imprecise or indeterminate.


Still more data are needed for clinicians and policy makers to make
effective decisions that effect the clinical and fiscal health of the Nation. Payers
should reconsider the extent to which they shift financial risk onto provider
organizations and incentives for quality targets should be offered to promote
process of care that are well supported by evidence or conversely to discourage
care shown to be inappropriate or of poor value.

Finally, they write all parties should participate in ongoing monitoring

of access, care process, patient experiences and outcome to ensure that we not
only detect any unfairness problems but that we can also continue to learn what
works to produce value in health care.


1. STRUCTURE OF HEALTH SYSTEM:- Aspect of health services that

influence the way in which they are delivered includes:- i) Number and type of
personnel and staff.

ii) Way of these personnel organized to work

iii) Nature and extent of facility and equipment.

iv) Financing.

v) Governance and decision making.

2. PROCESS OF HEALTH CARE DELIVERY:- It consists of two parts-

Behavior of professionals and participation of people.


Diagnostic Procedure.

Appropriate follow up.

Recommendation of treatment or management.


Utilization of services

Understanding the recommendations.

Participation in decision making

3. OUTCOMES OF HEALTH CARE:- Aspects of health that results from

interventions provided by the health system.


Varies from Country to Country Indian system is more cost effective if health
workers are skilled and effectively supervised.


2) Henry Fayol was known as father of Administrative/ operational management

based upon his studies, he established principles of management. According to his
principle, management is not rigid but it is flexible. The principles are as follows:-

i) DIVISION OF WORK:- In any organization there are multiple goals to be

achieved. It is not possible for a person to achieve all the goals efficiently at a time.
So, it is the principle of management to divide all the responsibilities among all the
employees, so that the organizational goals must be fulfilled. For example:- in
hospital the nursing department has the objective to provide the optimum possible
care to patients. For that reason the nursing Director or nursing Superintendent is
responsible for recruiting efficient and knowledgeable nurses. Nursing supervisor
or in-charge are responsible for doing communication with other departments,
related to patient care, look after for available resources and indent them as per
need. Nursing staffs are responsible directly for patient care and his/her regular
activities. All the works can’t be possible for a single individual. So, decision of
work is very important.

ii)AUTHORITY & RESPONSIBILITY:_ When management is dividing work

among all the employees, then every employee must have authority or power for
their job. They should be responsible enough for doing their own job. For
example:- Every nursing staff must have the power or authority to take prompt
decision in emergency situation. If she has to wait for the supervision of higher
authority then it is impossible to handle critical situation.
iii) DISCIPLINE:_ An important principle of management is discipline. Without
maintaining discipline it is difficult to run any Organization. All the employees


should follow particular rules and regulations to work together. For example: In
hospital every nurses should wear uniform while doing their duty. They should
come to their duty on proper time. Without prior information they can’t take leave.
These are the disciplines.

iv) UTILITY OF COMMAND:- In every organization there are various

departments and departmental heads. Bur before passing any information or
command to the subordinates the superiors must discuss with each other’s and the
subordinate should receive information or command from only the superior. If they
receive different in formations from different superiors, then there will be chaos
and confusion. For example:- When any policy or protocol is changed in hospital
then the nurses or other employees should be conveyed by one supervisor only.
Every employees should know whose advice to be followed.

v) UNITY OF DIRECTION:- It is same like the previous principle. All the

employees should receive directions from one supervisor only. Supervisors should
decide who will direct the employees and how will be directed. By providing
various direction to the subordinates will increase chaos and confusion.


INTEREST:- In any organization, interest or need of the organization will have
more priority than the need or interest of any employee. Everybody in concern
about the goals of the organization to be fulfilled. For example:- if any employee
needs 2 days leave on any particular date due to some personal issue. At the same
time the hospital has some audit programme on the particular date. So the
management will not sanction any leave for the employee and he/she must
participate in the organization. So the organization is always priority.


vi) SCALAR CHAIN:- It means maintaining proper channel. Every

communication or passing of any information must be done through proper
channel only. For Example:- If any nursing staff need any leave then firstly she
must contact with her Sister-in-charge. If she agrees then only she can go to
nursing supervisor for sanctioning the leave.

vii) ORDER:- the principle of management is to do any job or duty in any arranged
and organized manner. If there is no organized or ordered way to do the functions
then chaos or confusion will arose. For example:- While checking the store or
available resources in the ward or department the nursing- In-charge must note
down what are in crisis and what are needed extremely in daily basis, then only she
can do the indent. Without checking the store the indent will be of no use. So,
everybody should do their duties in orderly manner.

ix) EQUITY:-The principle of management is to do work without doing any

discrimination among people. Most commonly it is applicable in hospitals. The
hospitals should not do any discrimination of patients according to their age, sex
socio economic condition, Nationality or caste. Every patients should have the
treatment according to their illness only.

x) STABILITY OF TENURE:-Employees can have much interest in their job if

they have stability in their work or job security. So management must provide job
security to their employees to fulfill organizational goal.
xi) CENTRALIZATION:- It is the principle of management to take decision or do
any process centrally. For example:- In hospital when any policy is implemented
hen the decision of the superior or supervisors is final. The decision of
subordinates is not applicable.


xii) REMUNERATION:- Management should provide proper remuneration to

their employees to improve their interest and increase the standard of organization .
For example:- in hospital if nurses are provided adequate salary according to their
work then the standard of patient care will be increased.

xiii) INITIATIVE:- Employees should give freedom to conceive and carry out
their ideas and plans, even if there are mistakes in their work. This will encourage
them to innovate and take decisions.

xiv) ESPRIT DECORPS:- Promoting team spirit will give the organization a sense
of unity and unity in strength. Fayol says that even small factors should help to
develop team spirit. He suggested use of verbal communication to develop team

Thus Fayol for the first time systemized the managerial behavior. He
focused on total organizational management. Fayol advocated that management
can be taught and need not be inborn.

PLANNING:- Planning can be defined as the process of identifying any particular

problem or situation, look after the premises, where the situation on problem is
actually exists, selecting goal or objective to solve the situation and prioritize them
and then ultimately mentioning or evolution to solve it. Before doing any step
whether it is official or not proper planning is very important. Planning help us to
do any work in a systematic and organized manner. It reduces the uncertainty of
future. By doing planning we can get an approximate estimation and accordingly
we can do our job.


For doing planning properly at first we have to select objectives then

accordingly the process will be forwarded.

STRATEGIC PLANNING:- Strategic planning mean to identify major objectives

of the Organization and to achieve them. It is a broad perspective.

TAVTICAL PLANNING:- Tactical planning means to utilize the available

resources to achieve the strategic planning. It is a specific and detailed prospective.


a) Strategic planning means to identify a) Tactical planning means to utilize the

major objectives and to achieve them. available resources to achieve the
strategic planning

b)Top level of management. b)Middle & lower level of management.

c) Broad prospective c) Minute and detailed prospective.

d) long term process d) Short term process

e) Based on long term forecasting. e) Based on past Data.

STEPS OF PLANNING:- By doing proper planning, we can reduce the uncertainty
of future. But proper planning requires various steps to be followed:-


i) SELECTING OBJECTIVE:-Before doing planning firstly we have to know for

what we are going to do planning. For that reason selecting objective is very
important. By knowing the objective, we can chalk out about what we are going to
do and approximately how much time is required. Values of organization play a
vital role in it. After selecting the objectives, prioritizing them is a difficult task.
People must know what to do first and what to do next. Wrong prioritization will
hamper the total planning process.

ii) SELECTING PLANNING PREMISES:- After selecting the object, we must

identify the premise in which the planning can be implemented. It may be inside of
the Organization or outside of the organization.

iii) TANGIBLE & INTANGIBLEPREMISES:- Tangible premises means it is

quantitative in nature. It can be measurable. Growth of the population can be

On the other hand intangible premise means it is qualitative in nature. It

can’t be measured. Attitude of the people is intangible in nature.


planning premise is controllable by the planner or by the organization, then it is
called Controllable premise. For example:- resource policies, strategic etc.
But when the planning premise can’t be controlled by any one, then it is
named as uncontrollable planning process. For example:- Any type of natural

v) SELECTING PLANNING TIME PERIOD:- When we are doing planning then

we must know the given time period to implement the planning. It may be short


term planning or long term planning, where period may be extended up to 5 to 10

years. The factors influencing the planning period areas under:-

a) LEAD TIME :-In Developing and Commercial Launching of a Product. For

example:- Pharmaceutical Company develops a drug for some disease. Everything
is finalized, tests are carried out, suitable permissions are obtained, the Company
may go in for commercial production. The intervening period is the lead time.

b) PAY BACK PERIOD:- Time requirement to recover capital investment

machinery, equipment etc. For example:- A machine costing Rs. 10,00,000/-,
generates cash flow of Rs. 2,00,000/- per year. Then the length of planning period
should be at least 5 years.


but choosing from alternatives. After selecting the planning premises or time
period, if it is not suited for the organization or it is not good for all- then we must
think an alternative planning. Planning must be done in such a way, so that it must
fulfill everybody’s need as well as fulfill organizational objective.

vii) EVALUTION:- After thinking for alternative course of action, the planner
must evaluate the planning. He/she must look after every steps of it. Once the
planning is implemented, it can’t be changed.
viii)IMPLEMENTATION OFPLANNING:- Once the course of action is finalized,
plans are drawn/ formulated to derive it. Now, it lies the main action, operations
and process. Usually it is done by middle and lower level of management.

ix) MEASURING AND CONTROLLING:- This is the process of monitoring. Any

midway corrections if necessary are carried out to ensure the success of planning.


5) a) MANAGERIAL SKILL:-In the process of management, the basic quality of

all the managers must be skill. A skillful manager can take prompt decision in any
situation and handle the situation to overcome from it.

Management can be defined as ‘the process of designing and maintaining an

environment, in which individuals working together in groups, efficiently
accomplish selected aims’ It is a process of knowing what you want to do and then
seeing it is done in the best and cheapest way.

Skill can be defined as the process of utilizing one’s knowledge in to action.

In any organization, skill full person is very necessary. Bookish knowledge is
sufficient for completion of any study. When we are implementing that knowledge
into action, then that is our achievement or key to success.

For maintaining a successful management, some managerial skill is very


i) TECHNICAL SKILL:_ Now a days, the advancement of technology is going on.

The technology is becoming critical and advance day by day. In any organization if
we can use the advancement of technology then success can be achieved. For that
reason the management or the managers must know the technical skill properly to
handle the technology. Technical skill includes many more procedure, policies and
techniques. If the managers know the techniques and policies then only they can
utilize the technology for their organization. Generally drivers, surgeons must
know the technical skill. For example:- Knowing anatomy is only the bookish
knowledge but by the best use of scalpel and other surgical instruments a surgeon
can operate human body. That is the technical skill. A surgeon should become skill
full enough to fulfill the organizational i.e. Hospital’s goal.


ii) HUMAN SKILL:- It means the ability to communicate with peoples.

Communication should be done with all the levels. By a successful communication
we can get to know other’s feelings towards us and obviously our management and
organization. If there is any criticism in the management process that can be
identified only by communication with others. So the managers in any organization
must adopt the human skill. For example:- In any hospital, nursing department is
the key to maintain successor standard of organization. If the nursing services are
good, then the quality of the hospital automatically be good. So, it is the
responsibility of the nurse managers to do communication with the clients to short
out the limitations of their services. Nurse managers must have the communication
skill to communicate interdepartmentally to improve the quality of services.

iii) CONCEPTUAL SKILL:- It means the ability to know the concept of the job.
This skill is necessary mainly for the top level of the managers. It is the ability to
take broad and futuristic view, to analyze various forces and ability to assess
environment and deciding about the changes to be implemented. It is the creative
and innovative ability and having a vision. These skills enable them toset for
themselves the organizations and the people.
All these skills are necessary for all the managers, their relative importance
depends mainly upon the rank of the manager in the organization.

c) SWOT ANALYSIS:- SWOT analysis is the best way to identify one’s own
strength, weakness opportunities as well as threats. It is generally used in business,
deals and large organizations but it can be used by individual also to find out his
personal views. Here



W- Weakness

O- Opportunities

T- Threats

Before doing a large business deal or before launching a new product in

market, one should look after the SWOT for success and his achievement.

HOW TO USE THE SWOT ANALYSIS:- Here S stands for strength

i) If you can’t find any strength for your organization or your business product then
write down the characteristics of it. Definitely one can find strength from it.

ii) Look at your competitor and the strength of his/her product. It will help to find
out own strength.

iii) What do people in your market see as your strength?

iv) What is the USP ( Unique selling proposition) of your Organization? When
looking at your strength, think about them in relation to your competitors. For
example:- if all of your competitors provide high quality products, then a high
quality production process is not a strength in your organization market, its

WEAKNESS:- i) What could you do improve?

ii) What should you avoid?

iii) What factors lose you sales?


iv) What are people in your market likely to see as weaknesses?

Again, consider this from an internal and external perspective:- Do other

people seem to perceive weakness that you don’t see? Are you competitors, doing
any better than you.

It’s best to be realistic now, and face any unpleasant truths as soon as


i) What good opportunities can you spot?

ii) What interesting trends are you aware of?

 Useful opportunities can come from such things as:- Changes in technology
and markets on both abroad and narrow scale.
 Changes in Govt. policy related to your field.
 Changes in social patterns, population profiles, life style changes and so on.
 Local events
i) What obstacles do you face?
ii) What your competitors are doing?
iii) Are quality standards or specifications for your job, products or services
iv) Do you have bad debt or cash-flow problems?
v) Could any weakness seriously threatening your business?
SWOT analysis is a simple but useful framework for analyzing
organization’s strength and weakness and the opportunities and threats that
can be faced. It will help to focus on the strengths, minimize weakness and
threats and help for greatest possible advantage of opportunities.
When carrying out this analysis, one should be realistic and vigorous.
It should be applied at the right level and supplement it with other option
generation tools where appropriate.

3) DIRECTING:- An important principle in the management process is

directing. It means doing the planning in to action. In this step the managers
instruct, guide and oversee the employees to achieve the desired goals.
Directing is said to be importance if direction function does not take place.
Directing includes building an effective work climate and creating
opportunity for motivation, supervising, scheduling and discipline.
An important element of directing is co-ordination. While making the
planning into implementation, the managers must follow the basic principle
of management i.e. division of work. They must divide their employees in a
small groups, but every group members must have good understanding and
effective communication for fulfilling the organizational goal. This is known
as co-ordination.


i) SPECIALIZATION:- Division and sub-division of work into specialized
functions and departments lead to diversity of tasks and lack of uniformity.
Specialists in charge of various departments focus on their own functions.
For example:- Production department may insist on the manufacturer of
those products which are convenient and economical to produce overlooking
their stability to consumers. It becomes necessary to synchronize the diverse

and specialized activities of different units to create unity in the midst of

ii) CLASH OF INTERESTS:-Individuals join an organization to fulfill their

personal goals (Physiological or psychological). Often individuals fail to
appreciate how the achievement organizational goal will satisfy their own
They tend to work at cross-purposes. Co-ordination helps to avoid
conflict between individual and organizational goal. It brings about harmony
between the two types of goals by making individuals see how their jobs
contribute to the common goals of the organization.

iii) CONFLICT:-In an organization, conflict may arise between line

managers and staff specialists or between management and workers. Human
nature is such that a person emphasizes his own area of interest and does not
want to get involved in the activities of the others. Co-ordination avoids
potential sources of conflict.

Iv) DIFFERENT OUT LOOKS:- Every individual in the organization has

his own way of working and approach towards problems, capacity, talent
and sped of people differs widely. It becomes imperative to reconcile
differences in approach, timing and effort of different departments to secure
unity of action.


Cooperation serves as the binding force in an organization in the face

of narrow and sectional outlook. Coordination becomes difficult due to
differences in the attitudes and working styles of personnel.

v) INTERDEPENCE OF UNITS:- Various units of an organization depend

upon one another for their successful functioning. The output of one unit serves as
the input of another unit in reciprocal interdependence ,different units are
reciprocally related and there is a give and take relationship among them. The
need for coordination increases with an increase in the interdependence between
organizational unit.

OBSTACLES IN CO ORDINATION:- Even though co-ordination is desired

in successfully achieving the objectives of the organization, it is not that simple.
There are certain obstacles;
i) UNCERTAIN BEHAVIOR:- Co-ordination is concerned with human
efforts. Human behavior is uncertain and can’t be predicted accurately. There is
difference between a man and a machine. A man has a mind as such a man has
feelings, emotions, likes, dislikes etc. A man may want recognition and
appreciation. This makes human behavior highly individualistic subject and has to
be handled properly.

a) Lack of knowledge, skill, experience, initiative.

b) Confused and complicating policies.

c) resistance to change.

ii) ABSENCE OF COORDINATION:- It will lead to
a) Chaos
b) Confusion
c) Inefficiency.
d) Expenditure on time, money and energy.
e) Either goals are not reached or difficulties are encountered in achieving
the goals.

4) A quality circle is a group of workers who do the same or similar work,

who meet regularly to identify, analyze and solve work related problems. Quality
circles are typically more formal groups.

Quality circle working is used as a main process to achieve it’s objectives.

Member’s creativity is tapped to solve their day to day work related problems. It is
through this process they become cohesive team and their organizational owner
ship get developed. Hence it is necessary that the group member should understand
this process very early.

The various steps are:-


a) Generate a list of problem using brainstorming

b)Prioritize the problems by using A,B,C analysis.


a) Rating based of post data

b) Register the selected problems with coordinator.



4) ANALYZE THE PROBLEMS : Data collection is important from all the
possible aspects.
5)IDENTIFICATIONOFCAUSES:- For this purpose we can use
brainstorming and cause and effect diagram.
6) FINDING THE ROOT CAUSES:-The method is to identify the main
relevant causes in cause & effect diagram by data collection and discussion.
7) DATA ANALYSIS:- The method is:-
a) Using techniques like bar, pie, areal graph, histogram, stratification,
scatters diagram etc.
b) Why-why analysis
a) identifying the probable constraints and finding ways to overcome them.
b) Make a presentation to all involved employees to explain the solution
selected, like departmental head, facilitator.
Method is:-
a) Data Collection after implementation.
b) Comparison of old and new data with histogram, control charts.
c) Watch process trends
d) Analyzed the results
e) Discuss and incorporate the changes needed.
a) Implementation evolution Procedure, use central charts.
b) Make modification if required.
JIT (JUST IN TIME): It is an inventory strategy Companies employ to
increase efficiency and decrease waste by receiving goods only as they are
needed in the production process, thereby reducing inventory costs. This
inventory supply system represents a shift away from the older just in case
strategy, in which producers carried large inventories in case higher
demands had to be met.
o A good example would be a car manufacturer that operates with
very low inventory levels, relying on its supply chain to deliver
the parts it needs to build cars. The parts needed to manufacture
the cars do not arrive before or after they are needed, instead,
they arrive just as they are needed.
ADVANTAGES:-It has several advantages over traditional models:-
i) LENS SPACE NEEDED:- With a faster turnaround of stock, we don’t
need as much ware house or storage space to store goods. This reduces the
amount of storage. An organization needs to provide rent or buy feeing up
funds for other parts of business.

ii)SMALLER INVESTMENT:-JIT inventory management is ideal for

smaller companies that don’t have the funds available to purchase huge
amounts of stock at once. Ordering stock as and when it’s needed helps to
maintain a healthy cash flow.
iii)WASTE REDUCTION:- A faster turnaround of stock prevents goods
becoming damaged or obsolete while sitting in storage , reducing waste.

This again saves money by preventing investment in unnecessary stock and
reducing the need to replace old stock.

i) RISK OF RUNNING OUT OF STOCK:- By not carrying much stock, it is
imperative. We have the correct procedures in place to ensure stock can
become readily available and quickly. To do this we need to have a god
relationship with the supplier. JIT means that one become extremely reliant
on the consistency of supply chain.
ii) LACK OF CONTROL OVER TIME FRAME:- Having to rely on the
timeliness of suppliers for each order puts one at risk of delaying the
customer’s receipt of goods. If anyone don’t meet customer’s expectations,
they could take their business elsewhere, which would have a huge impact
on business.
iii) MORE PLANNING IS NEEDED:- With JIT inventory management, it’s
imperative that companies understand their sales trends and variances in
close detail. Therefore one need a factor that in to planning for inventory
levels, ensuring supplies are able to meet different volume requirements at
different times.
If run properly JIT inventory management is seen as one of the best
ways of managing inventory. While it is not without risks, it has significant
rewards and is ideal for those who are able to plan carefully in advance and
build strong relationship with suppliers.



2) c) A financial manager is one, who is responsible for looking the financial

activities of an organization, selecting budget for their next financial year,
checking the assets and liabilities and also profit and loss of the organization.

The financial manager must have to follow various activities. These are:-

i) LONG TERM/SHORT TERM INVESMENT:- In any big business deal or

in any organization, at first the owner/ proprietor must invest a particular amount
of money. It is the duty of the financial manager to look after that how much
amount of investment is done and how can it be used. If it is a low amount of
money then that can be used for any short term management. For example:- If
some furniture’s are needed for the organization, that can be done by the low
amount of money. It is a short term use of money, because furnitures can be
changed or replaced after a year or so but if there is a large amount of money, that
can be used in long term management, like buying of a land or building etc. the
financial manager must look after about the investment and it’s uses.


financial activities are done as per financial year. Every financial year is started
from 1st April and end at 31st March. The financial manager is responsible for
checking the financial activities each year. He should prepare report about every
financial activities of the year. After seeing the report information, can be
calculated about profit & loss in a financial year, availability of resources, assets
and liabilities from these information further decision can be taken about
investment of the next year, need for up gradation of resources etc.



would look at:-

 Setting up of financial procedures and systems.

 Looking at ways to increase revenue and reduction of expenses and costs.
 Working capital Management like managing current assets and current
liabilities. This needs decision on whether to give credit, payment to
supplier, managing cash flow, managing inventory etc.
iv) PROFIT ALLOCATION:- If the income from the organization/business
is more than the investment, then it is known as profit. Now, it is the duty of
the financial manager to make the appropriate utilization of the profit. He
should select that how much amount should be distribute among the
employees and how much should retain for further use.
V) RISK MANAGEMENT:- In all the functions and analysis, there is
always going to be risk involved, which cannot be ignored. The aim to be to
balance the risk taken and to ensure that the returns are in tune with the risk.
Thus the financial management is an important function for the
success of any business. It has to be given adequate if not equal importance
as other fields as in this competitive scenario.

2) a)DEPRICIATION:- Whenever money is spent ,it is spent due to any long

term or short term investment. When money is spent due to any long term
investment, then it is known as Capital expenditure. For example:- If an
organization buy a land or buy a machinery then it is obviously for long

term use. When an organization spent money for their regular use or any
short term investment, then it is known as revenue expenditure. For
Example:- Paying electricity bills, buying any new materials etc.
Now let us concentrate on the concept of Depreciation. Depreciation
means gradual, continuous and permanent decline of the value of any asset.
In any organization depreciation is charged in the fixed assets. The amount
of depreciation is then taken as an expense. So, it reduces the profits in the
profit & loss account.

 To calculate proper profits.
 To show the assets at its reasonable value.
 To maintain the original monetary investment of the asset intact.
 Provision of depreciation results in some incidental advantages also.
 Depreciation is permitted to be deducted from profits for Tax purposes.

INTERNAL CAUSES:- Wear & tear maintenance, change in production,
restriction of production, reduced demand.
EXTERNAL CAUSE:-Obsolescence and effluxion of time.


 Straight line method or fixed installment.
 Sum of years digit Method.
 Inventory or revaluation Method.

 Annuity Method.
 Depreciation fund Method
 Depletion Method.
An example of depreciation is:- If a company purchase a delivery
truck of Rs. 1,00,000/- and the expected use of the said truck is 5 years, the
business might depreciate the asset under depreciation expense of Rs.
20,000/- every year for a period of 5 years.
For the purpose of keeping books of account, the choice of amount of
depreciation is with the management. For companies, the minimum amount
of depreciation is suggested by schedule 14 of the Companies Act, 1956.
This is the minimum to be charged. A business could change different rates
for different assets, based on life, use and other factors.
i) In every organization, investment is done to achieve some amount
of profit. There is a financial manager in every organization and his
responsibility is to analyze various financial activities and plan for further
investment accordingly. For that reason basic financial statements are used
very commonly. These are:-
* Balance sheet
* Profit and loss statement.

i) BALANCE SHEET:- Balance sheet is a statement, that is prepared

by the organization at the end of the particular financial time period, which
shows the total investment to the organization during that financial period,
how the investment is applied in which area and how much profit or loss is
occurred from the total investment.


 To find out how much investment is done.

 To notify detail informations that how much money is spent in which area.
 To get information about profit and loss statement.
 To take further decision accordingly.

TYPES:- Balance sheet is of two types:- Horizontal balance Sheet &

Vertical Balance sheet.
Source From where money is collected Amount
Application From where money is used Amount

The total of both source and application must be same.

Liabilities Amount Assets Amount

Total: Total:
Here also the total of both the column must be same.
Now various terminologies are used in balance sheet. Let us
concentrate on that:-

a) CAPITAL:- When any business or organization is started then a particular

amount of money must be invested. That money is known as Capital. It is of two

OWNED CAPITAL:- When the owner of the organization himself invests

money in the business then it is known as Owned Capital.

BORROWED CAPITAL:- When the owner is borrowing the money from

others, then it is known as Borrowed Capital.

b) RESERVES:- The profit that is done from the total investment of the
money, that is added up with the capital amount, it is known as reserves.


c) ASSETS:- Assets mean the property of the Organization/ business. It may

be tangible or intangible. These assets will help the organization to make further
income. Assets may be of various types:-

* FIXED ASSETS:- By doing large amount of investment, organization can

have assets, which is of long term use or permanent. These are called fixed assets.
Like:- any land, building etc.

* CURRENT ASSETS:- These are some major components, like cash,

inventories, loans etc.
d) LIABILITIES:- Liabilities means the payable amount, by which the
properties or assets can be gained. It is the claim of getting the properties for the
organization These can be further divided in to:-

SECURED LOANS:- Borrowing of the firm against which collateral is

provided are referred to as secured loans.

UNSECURED LOANS:- Borrowings of the firm against which no specific

security has been provided are referred to as unsecured loans.

These two types of loans are under long term liabilities.

CURRENT LIABILITIES:- These are short termliabilities, that needed to

pay against the goods purchased on bank credit or a bank draft.

ii) PROFIT & LOSS STATEMENT:- In a business deal or in an

organization, if the investment is more than the income, that means they are having
loss. But if the income is more than the investment that means they are
havingprofit. Various profit and loss statements are:-


a) REVENUE:- The income that is gaining from the organization/ business

is known as revenue.

b) EXPENDITURE:-The amount of money that is spent by the organization

in various segment is termed as Expenditure. It is of two types:-

* CAPITAL EXPENDITURE:- When the money is used for any long term
purpose, then it is known as Capital Expenditure. For Example:- buying a land
buying a machinery etc.
* REVENUE EXPENDITURE:- When the money is used for any short
term investment by the organization or for any regular purpose then it is known as
revenue expenditure. For example:- paying electric bills etc.

c) DEPRECIATION:- Depreciation means gradual, continuous and

permanent declining of the value of any asset. Generally depreciation is charged in
any fixed assets Furtherly this amount is helpful for the profit of the organization.

d) INTERST:- This includes interest on various forms of borrowings like

debentures, fixed deposits, working capital, advances etc. Commissions for
guarantees and other finance charges.

e) SALES:-Sales is activity related to selling or the amount of goods or

services sold in a given time period. This is usually defined as gross sales inclusive
of excise duty.

f) PROFIT AFTER TAX:- The difference between income and expenditure

is the profit after Tax.


g) PROVISION FOR TAXES:- This represents the estimated income Tax

liability for the period.

2)b) The determinants of working capital are not uniform in all enterprises
and therefore factors responsible for a particular size of working capital in one
company are different than in other enterprise. Therefore a set pattern of factors
determining the optimum size of working capital is difficult to suggest. Some of
more important working capital are:-
i) NATURE OF BUSINESS:- It is an important factor for determining the
amount of working capital needed by various companies. The trading or
manufacturing concerns will require more amount of working capital along with
their fixed investment of stock, raw materials and finished products.

Public utilities and railway Companies with huge fixed investment usually
the lowest needs for current assets, partly because of cash, nature of their business
and partly due to their selling a service instead of a commodity.

ii) LEGTH PERIOD OF MANUFACURE:- The average length of the

period of manufacture, that is the time which elapses between the commencement
and end of the manufacturing process is an important factor in determining the
amount of the working capital. If it takes less time to make the finished product,
the working capital required will be less.

iii) VOLUME OF BUSINESS:- Generally the size of the company has a

direct relation with the working capital needs. Big concerns have to keep higher
working capital for investment in current assets and for paying current liabilities.



TOTAL COST:- Where the cost of raw materials to be used in manufacturing of a
product is very large in proportion to the total cost and its final value, working
capital required will also be more.

That is why, in a cotton textile mill or in a sugar mill, huge funds are
required for this purpose.
intensive industries, larger working capital will be required than in the highly
mechanized ones. The latter will have a large proportion of fixed capital. It may be
remembered however, that to some extent the decision to use manual labour or
machineries lies with the management. Therefore it is possible in most cases to
reduce the requirements of working capital and increase investments in fixed assets
and vice-versa.

vi) TERMS OF CREDIT:-A company purchasing all raw materials in cash

and selling on credit will be requiring more amount of working capital. The
essence of this is that the period which elapses between the purchase of materials
and sell of finished goods and receipt of sale proceeds, will determine the
requirements of working capital.

vii)REQUIREMENTS OF CASH:- The need to have cash in hand to meet

various requirements, that is payment of salaries, rents etc. has an effect on the
working capital. The more the cash requirements the higher will be working capital
needs of the company and vice-versa.



5a) Competence can be defined as standardized requirement of an employee

or individual to perform a specific job properly with adequate knowledge, attitude
and skill.

Competence map means to list down the required competencies of an

individual to perform a given job in a specific time period.
There are several types of competencies. These are:-

i) ORGANIZATIONAL:- Every organization must have some particular

standard to be maintained to reach to the customer’s satisfaction. For maintaining
that standard every organization should concentrate to fulfill the predetermined
objective of the organization. For example:- If a hospital is an organization then
every employee should concentrate to provide the optimum level of health care
facilities to all the patients. Here, the patients are the customers of the hospital.

ii) JOB ORIENTED:- To perform a specific job, every individual should

know the details of that job. Without having any depth concept, no one will able to
perform his job or duties. For example:- If someone is performing the job of a
computer operator, then he must know languages of computer, Microsoft and other
details. He should handle all the parameters skillfully. These are the competencies

iii) PERSONAL:- Every individual must have some self competencies to

improve his/her self position. He/ she must develop skill and positive attitude. This
is known as personal competency. For example:- In a hospital both nurse ‘A’ and
nurse ‘B’ doing the same duty, like inserting an IV canula. While nurse ‘A’ is
inserting then she is doing it with a single prick and patient doesn’t feel that much


of pain. But when nurse ‘B’ is inserting, patient is feeling pain and she is doing it
in her second/ third prick. So, automatically, while doing performance appraisal
nurse ‘A’ will get more grade. This is possible only due to her personal

Some other competencies are there. These are:-

i)MANAGERIAL:- An employee working in a designated post of a
renowned organization must adopt the managerial competence. This can be
achieved by positive attitude and skill towards his/her own work. For example:-
Nurses working in a specific department should know how to handle emergency
situation without the supervision of others. They must know how to deal with
patient parties in various situations. This is the managerial competence. On the
other hand nurses should know the leadership capability because nursing is a team
work. If the nurse knows the leadership competency then she can leader team.

ii) TECHNICAL:- This is a specific competence that is essential for

performing any job in the organization with a defined technical or functional area
of work. For example:- Human resources management , investment management

iii) GENERIC:- These are competencies that are considered essential for all
staff members regardless of their function like communication, processing tools

iv) INVENTORY CONTROL:- Inventory control and it’s maintenance is

generally occurred in hospitals care sectors. In every hospital there is a store or
stock where all the necessary equipments, articles, drugs, consumable items,


disposable items can be stored in sufficient amount. This is called inventory.

Inventory must be stored in sufficient amounts, so that it can be used as and when
required. Excessive stock should be avoided, otherwise it will be cost effective and
there must be a chance of stock out.
In every organization, there is some particular rules and regulations for
ordering items. It is known as procurement.


I0 To preserve various equipments, articles and drugs in sufficient amount for

using as and when required.

ii) To maintain the standard of the organization.

iii) To avoid stock out.

iv) To provide the optimum level of health care facilities to the patients.

v) To cope up with various emergency situation n the hospital.

VARIOUS COST FOR INVENTORY CONTROL:- There are 4 types of costs,

that every organization must maintain for inventory control. These are:- Purchase
cost, carrying cost, ordering cost.

i) PURCHASE COST:- For buying every items, some particular amount of cost
must be paid by the organization to the supplier. This is called Purchase cost.

ii) CARRYING COST:- It means the cost of interest of any product like insurance
cost, Staff involved in buying the product etc.

iii) STOCK OUT COST:- It means end of the stock. If any emergency situation
arises at the time of stock out ,then it is much costlier to arrange the drug or
product as early as possible than to preserve it as stock earlier.

So it is the duty of the organization to preserve their stock insufficient



Pareto classified the inventory control system in several types. According to him in
a town 80% of peoples share 20% of money and 20% people share 80% of the
money This is his 80/20 rule for classification of inventory. The various
classifications are:-

i) ABC ANALYSIS:- Here all the necessary drug items are stored. A items are
20% of all the drugs but it costs 70% of the total costs of drugs. So, it should be
handled by top level of the management very carefully.

B items are 20% of all the drugs and costs 20% of the total costs of drugs. It can
be managed by middle level managers.

C items are the 70% of all the drugs and it costs only 20% of the costs of drugs. So,
it can be handled by lower level of management.

VED ANALYSIS:- It means vital, essential and desirable items.

V items includes various equipments and articles, dressing materials, life saving
drugs etc. without which the hospital can’t run a single moment.

E items includes some essential antibiotics and others without which a hospital can
run 2-3 days. But as early as possible these items should be arranged.

D items includes some consumable or non consumable products. Without which a

hospital can maintain it’s regular duty, but replacement is needed.

By compiling thses two classifications of inventory control, there are three

categories of items. These are:-

CATEGORY- I:- These are the most important articles and drugs needed in a
hospital like life saving drugs, equipments and others. These are to be kept in
double safety method under top level management control system.

CATEGORY-II:- These are important items but not more than category –I. These
are the medium cost items and without these items hospital can continue it’s duty
for 1-2 days.

CATEGORY_III:- These are least important items and can be controlled by lower
level of management system. Other classifications of inventory control are:-

i) FSN CLASSIFICATION:- These are fast moving, slow moving and non-moving

ii) HML CLASSIFICATION:- High, medium and low based unit price.

iii) SOS:- season and off season requirement.

FUNCTIONS OFINVENTORY CONTROL:-i) Inventory organization, in the

process of procurement, a particular time is needed. This is called as lead time.
Inventory should supply necessary items in this lead time.

ii) Some items should be stored in reverse stock for safety. This is called as safety

iii) If there is any improper procurement system, then safety stok should be
increased for emergency need.


 FIXED INTERVALMETHOD:- In this method the organization order items

in a gap of fixed interval every time. The amount of order doesn’t matter
here, but the interval should the same.
 FIXED ORDER METHOD:- In this method of inventory control, every
time the amount of ordering items should be same.
 ECONOMIC ORDER QUANTITY:- This idea was proposed by Harris in
1915. Here EOQ= 2AD
A= Fixed cost of ordering ( Rupees/order)
D=Average annual demand ( Unit/year)
H- Holding cost (Unit/year)
2) CREDENTIALING:- Credentialing means the collection, verification and
assessment of information regarding three critical parameters, current licensive
education and relevant training and experience ability and current competence to
perform the requested privilege(s).

Privileging means granting the authority of a health care personnel to

perform his/her responsible duties in the specific organization.

‘P’, the first step is collection of information. It means the organization collects all
the necessary documents from the health care practioner for verification of it’s

The second step is verification. Verification can be done by two sources.

i) PRIMARY SOURCES VERIFICATION:- It means the verification of the

documents from it’s original sources. The organization can verify internet
verification, telephonic verification from the previous organization, where he/she
was working, verification from the organization, where formal training was done
for the verification of the registration etc.

ii) SECONDARY SOURCE VERIFICATION:- It is method of verifying a

credential which is not considered an acceptable form of primary source
verification. Examples are the notarized copy of the credential, the original
credential etc.

The process of credentialing and privileging is started from the

advertisement of the recruitment of the organization.

The final step of credentialing and privileging is assessment

. It is also occurring in step by step:-

 Step-1:- DETERMINING THE IDENTITY:- In this step the details of the

applicant is checked like name, age, sex, address, institution of formal
education etc.

 Step-2:- FORM FILLING STEP:- It is the step in which a form is given to
the applicant from the organization to give the details of his/her formal
training, internship, experience etc. If it is found reliable by the HR
department, then it is forwarded furtherly for next procedure.
 The head of the medical practioner assessed all the details of the documents
and if found reliable after his verification, then call the applicant for
 The organization arrange a structural interview for the applicant in a
particular date.
 If he/she performs well in the interview then the organizations grant the
authority of the applicant to perform his/her schedule duty.
 It is the responsibility of the organization to check, if there is any medico
legal case or not against the staff.


i) To maintain the patient’s safety and protection.
ii) To provide the optimum level of health care services to the patients.
iii) To maintain and improve the standard of the organization
iv) To maintain the flexibility and stability of the working environment.

BARRIERS OF THE PROCESS:- Certain barriers and limitations are

present :-
a) GAPS IN THE FORM FILLING:- While the organization is providing
form to the applicant, then there are various gaps can be found, like name of

the organization of the formal training. Some of the health care practioners
don’t have the so called formal training from any recognized organizations,
but they have much experiences of working, so sometimes it become
difficult to rely.
b) HUGE PAPER WORKS:- In the total process of ‘C’ &’P’, the HR
department must do a huge number of paper works. They are responsible

for document verification, assessment of all. For doing all these ,they must
maintain paper work.
c) DIFFICULT CALL:- It means to deny any applicant for his/her post. For
example:- A practioner may not have that formal training but he/she has
huge working experiences and record shows that his/her performance is
good. But the organization will not accept him/her for the lack of formal
training. So, it is difficult to announce it.
d) URGENT RECRUITMENT:- Sometimes the HR department has pressure
from the top level management to make immediate recruitment of staffs. To
perform all the procedures immediately is quite impossible.
e) UP DATES RULES:- There are various certifying agencies that update
the terms & conditions for a practioner to remain in practice. One needs to
be evaluated on these terms & conditions. Credentialing committee also
evaluate on the same points.

5)b) After the infrastructure development of an organization the main

objective is to run the organization and fulfills it’s objective. For that reason
adequate numbers of employees are needed to work. This process of
recruiting employees for the organization is known as staffing. In the
nursing also the matter of staffing is same. Here, the hospital is the
organization and nurses are responsible to provide optimum health care to
the patients and maintain the patient’s satisfaction. Staffing in nursing does
not only depend on the manage of the number of nurses bit also from the
process of recruitment, document verifications, interview etc. All are related
with staffing in nursing.

So, while doing the staffing, the nurse administrator must follow
various principles;-
i) Every staff should have adequate knowledge, skill and positive attitude.
ii) The nurse manager must know that if the nurses are more experienced
and skillful then they can handle various emergency situations.
iii) Nurse administrator should strive to meet the technical and humanistic
care of the critically ill patient.
iv) Nurse administrator should maintain the principle of knowledge of the
nurses, to meet the health teaching and rehabilitation of chronically ill
v) Nurse administrators ensures that patient assessment, work qualification
and jobs analysis are used to determine the number of personnel in each
category to be assigned to the care of patients of each type ( such as
coronary care, renal failure etc.
vi) Nurse administrators ensures that there is a master staffing plan and
policies to be implemented in all units and this is to be developed centrally
by the nursing head of the hospital.
vii) Nurse administrators must ensure that the staffing plan details such as
shift time, the number of staff members assigned on holidays and the
member of employees assigned to each shift can be modified to
accommodate the unit’s work load and work flow.

3) Within many health care systems worldwide, increased attention is being

focused on human resources management. Specifically human resources are
one of three principle health system inputs, with the other two major inputs
being physical capital and consumables.


i) RECRUITMENT AND RETENTION:- A proper human resource
planning will help the hospital for recruiting new staffs and their retention.
Retention is an important factor in patient care as experienced staff
members can be less likely to make errors and typically have the skills. And
knowledge to deliver high quality care, even in more challenging cases.
For the recruitment process, the nurse managers can arrange for a
thorough interview process, so that they can assess a candidate’s attitude
towards patient’s care.
By doing a proper human resources planning the nursing managers can
develop a significant impact on employee satisfaction, retention and
productivity. Effective managers offer staff nurses the opportunity to
participate in decision making, which gives nurses a sense of responsibility.
Nursing managers can build a positive work culture and environment by

clearly defining roles and responsibilities, being responsive to changes in
another effective site of having proper human resources planning. These
help in team structure, sometimes called collaborative practice or
interdisciplinary collaboration, encourage partnership and a multi
disciplinary approach to patient care.


challenge that the health care HR professionals are currently facing revolves
around the staffing of nurses. As demand around the country continues to
increase, candidates are finding that they have various options when it
comes to choose their work location ultimately causing a large shortage in
staff in certain area of the Country. With the rising trend towards
performance based career models in the healthcare industry, many HR
departments are at struggling to recruit and retain high performing workers.


in health care HR is the introduction of the affordable care act (ACA). Other
areas in which regular reporting and tracking is needed is that of annual
reviews. In order to receive federal or state funding, hospital based
employees are required to have annual reviews and performance evolutions.
Employees must also have background checks, certification renewals and
tracking is needed is that of annual reviews. In order to receive federal or
state funding, hospital based employees are required to have annual reviews
and performance evolutions. Employees must also have back ground checks,
certification, renewals and tracking of inoculations.


biggest challenge by the health care HR is securing funding for talent
management initiatives. It means that salaries must be competitive while
also fitting in to hospital’s financial plans. As funding gets cut and
insurance reimbursements are negotiated, hospital must stay on top of costs
to remain profitable. In the health care industry, talent management
programmes offering competitive salaries to hire and retain high performing
workers. Technology can support HR managers in overcoming challenges
related to staffing, regulations, reporting and talent management, but can’t
overcome poor human capital strategy and poor strategy worth force
planning. So, all the health Care HR managers must have right strategy and
right technology.
i) Budget is the written financial plan of any organization, aiming at
controlling and allocating resources.
In any of the described approaches to budgeting, the key point is that
the budget is a management tool to assess the business on track or
adjustments are required. Budgets should take account of market conditions,
such as margin pressure, macroeconomic factors, such as changing tax
legislations as well as internal factors such as resource allocation.
There are generally two approaches of budgeting. These are:-
i) Top down approach
ii) Bottom up budgeting.

TOP DOWN APPROACH:- It is called top-down approach because the
budgets are made by the top executed and then the money is passeddown the
line to various departments. This approach is applied in affordable method
percentage of sales, competitive parity method of budgeting (ROI)




ii) BOTTOM UP BUDGETING:- In this method promotion adjectives are set for
the tasks to be performed. All the necessary activities to achieve the objectives are
planned. The cost of these activities are ascertained and budgeted. The total
promotion budget is then approved by top management. This is also known as the
buildup approach of budgeting.






Money is the backbone of all organization. So, budget should be in

accordance with the objectives and the chosen media.

COMPETITIVE PARITY METHOD:- Many firms base their advertising

expenditure to compete with their rivals or their competitions. The information
regarding this is found in business magazines, journals and annual reports of the
company. They not only try to have the same expenditure but also try to choose
media accordingly. They also choose the media vehicle and the frequency of
advertisement to match with that of the competitors. The effect of expenditure is
know after the advertisement has been rebased and one does not know the next
move of the competitor for expenses on the advertisement and promotion.

AFFORDABLE METHOD:- This simply means what the firm can afford after
meeting all their expenses. The firm allocates the amounts to be spent on
production and after that allocation is done for advertising and promotions. The

tasks to be performed by advertising is not considered. In this method there can be
chances of overspending or understanding.

OBJECTIVE &TASK METHOD:- In this method objectives are defined and the
specific strategies are formulated to achieve them. The cost of implementing these
strategies is estimated. The strategies may include advertising in various media and
other elements of promotion mix. Then the cost of various media chosen is
estimated. It is also necessary to monitor the expenses and evaluate the results.

METHOD OF PERCENTAGE OF UNITCOST:- It is accost of a unit of Rs.

1000/-. If 1000 units are sold, revenue generated is 10,00,000 If the %decided is
10%, 1,00,000 advertising budget 1,00,000.

The percentage of expenditure allocated differs from one company to

another. Some companies go for a higher percentage and others for lower,
depending upon their needs and situations faced by them. This method is simple to
calculate and is safe.


1)Nursing service is the heart of the health care services. The customer’s
satisfaction depends largely upon the nursing services and care towards the
patients. Nursing department is the only department in any health care organization
that must maintain interpersonal relations among all the departments in the

There must be some essential characteristics of nursing services. These are:-

i) WRITTEN STATEMENT OF POLICY:-In every hospital there must be some

particular rules & regulations to be followed. For nursing services there should be
written statement of objectives of the hospital. It must includes various policy,
protocols and other rules & regulations of the hospital. If these are written, then it
will become easy to understand and any one can take help from it, whenever

ii) MANUALS OF NURSING PRACTICES:- Every nurses in their daily day to

day activities must perform various duties and responsibilities to save the patient’s
life. So, it must be the characteristics of the hospital to provide a manual to the
nurses, mentioning the details of the various nursing practices. By maintaining this
character, all the nurses can follow the manuals and perform according to that.
Then it become easy for the administration to evaluate the performances of the
nurses. Nurses can discuss with each other about their performances, as they are
practicing in an uniform manner.

iii) NURSING BUDGET:- Budget is a statement of plan for nursing services,
expressed in accounting terms; it is one segment of the overall hospital budget. The
nursing service budget is concerned primarily with four budget forms: salary,
supplies, equipment and capital expenditure. Steps involved in preparation of the
budget includes analyzing past operations and anticipating factors that will affect
future income and expense. The analysis of operations required in budget- making
help the director of nursing services weigh values and established priorities for the
nursing programmes.

iv) MASTER STAFFING PATTERN:- in every organization , a particular staffing

pattern should present. It includes, how much staffs are required in each shift,
rotation of the nurses, nurse and patient ratio in various departments, leave of the
staffs etc. Every departmental head must follow this pattern of staffing while doing
duty schedule.

v) PERFORMANCE APPRAISAL :- It’s an important character of the nursing

administration to do periodic performance appraisal to all the nurses. Performance
appraisal may include interview schedule, structured questionnaire , observations
of daily duties etc.


opportunity for free communication and a share in planning and evaluation is
provided through regular meetings of the director of nursing or her representatives
with day, evening and night assistants with supervisors, head nurses and total
nursing staffs. Records of these meetings include reports of decisions,
recommendations and help to assure that recommendations will be considered and
administrative decisions will be reported.

vii) WRITTEN JOB DESCRIPTIONS:- Written job descriptions and job
specification will help all the nurses to perform their regular duties. Qualification
of each category of personnel are defined in terms of responsibilities to be
assumed. These job descriptions and specifications help assure the objective
selection of personnel.

2) EVIDENCE BASED NURSING:- Evidence based nursing means providing

nursing care to the patients by using personal expertise and by taking help from
current relevant research studies from the related tropic/case. It will improve the
quality of care. Evidence based nursing practice requires new skills of the
clinician, including efficient literature searching and the application of formal rules
of evidence in evaluating the clinical literature.


i) Assess the patient:- Start with the patient- a clinical problem or question arises
from the care of the patient.

ii) ASK THE QUESTION:- Construct a well built clinical question derived from
the case.

iii) ACQUIRE THE EVIDENCE:-Select the appropriate resource(s) and conduct a


iv) APPRAISE THE EVIDENCE:- Appraise that evidence for it’s validity
(Closeness to the truth) and applicability(usefulness in clinical practice)

v) APPLY:-Return to the patient integrate that evidence with clinical expertise,

patient performances’ and apply it to practice.

vi) SELF EVALUATION:- Evaluate the performance with this patient.


evidence based nursing to standardize and improve access and quality of care
across the health care system.

i)IMPROVED PATIENT OUTCOME:- The heavy focus on raising the overall

quality of care may lead to improve outcomes and health for patients. Using the
most current health care research can help minimizing complications associated
with chronic illness and prevent additional illness or disease.

ii) LOWER COST OF CARE:- Roughly one in four Americans are living with
multiple chronic illnesses and the cost of caring for these patients can often be
substantial. Using EBN’s patient centered approach may help eliminate
unnecessary costs linked to treating chronically ill patients as well as reduce
expenses for healthier patients too.

iii) SUPERIOR NURSING SKILL:- Incorporating EBN throughout a nurse’s

education and clinical experiences develop more advanced critical thinking and
decision making skills. Nurses are better able to adopt to situations, utilize
informatics and work in interdisciplinary teams. They also feel a greater sense of
confidence and pride in their work.

Evidence based practice has become an integral component of delivering

high quality, patient entered care. Nursing students in an RN to BSN programme
will learn EBN theories and apply this knowledge in their career. Offering benefits
to both patient and nurses, evidence- based practice is helping to lead the way in
advancing patient care.


Nurses are heart of the health care system. In any health care
organization, staff nurses are the main health care workers for providing care to
the patients. So, the staff nurses should follow responsibilities in many aspects.
These are:-


a) Providing care for daily day to day activities for the patient.

b) Administration of medication.

c) Follow the doctor’s orders.

d) Assist the doctors in O.T.

e) Apply dressing to patient, wherever required.

f) Giving NG tube feeding to completely dependent patient and assist in feeding to

partially dependent patient.

g) Write the reports of patients accurately and handing over to the next shift.

h) Inform the patient about his/her treatment progress and take consent before any
invasive procedure.

i) Give health education to patient and patient parties etc.

j) Document all the details of his/her shift.

k) Maintain good interpersonal relationship with patient and make proper nursing


a) Check inventory periodically and inform the stock out to the supervisor.

b) Make proper disposal of wastes to maintain cleanliness of the Ward.

c) Arrive in duty on time to avoid chaos in the next duty shift.

d) Inform the higher authority before taking leave.

e) Check the available medicines and equipments of assigned patients and write to
superior for further indent to the supervisor.

f) Wear proper uniform of duty to maintain dignity of the profession.

g) Talk politely with all the clients to maintain the silence of the unit.


a) Give appropriate health education to patients and patient’s relatives regarding

patient’s care.

b) Attend meeting with supervisors for up gradation of him/her self.

c) Attend in service education classes to improve knowledge , attitude & skill.

d) Do personal studies for higher education.

e) Guide new joiners or juniors ,whenever needed.

f) Avoid rigging.

3) As a nurse, it has become an important necessity to be aware of the legal aspect

associated with caring and helping people in the health industry today.

Nurses must take as many precautions as they can during their daily shifts.
Recording, documenting and reporting daily routines and decisions is one of the
most common ways to make sure on track with patience and in the right.

GENERAL LEGAL CONCEPTS OF NURSING:- Law can be defined as those

rules made by humans who regulated social conduct in a formally prescribed and
legally binding manner. Laws are based upon concerns for fairness and justice.


i) It provides a frame work for establishing which nursing actions in the care of
client are legal.

ii) It differentiates the nurses responsibilities from those of other health


iii) It helps to establish the boundaries of independent nursing action.

iv) It assist in maintaining a standard of nursing practice by making nurses

accountable under the law.

REGULATIONS OF NURSING PRACTICE:- Nursing practice falls under both

public law and Civil law. In all the states, nurses are bound by rules and
regulations stipulated by the nursing practice Act as determined by the legislature.

Public Laws are designed to protect the public. When these Laws are
broken, a nurse can be punished by paying a fine, losing her license or being
incarcerated .

Civil laws deal with problems occurring between a nurse and a client. For
example:- If a nurse catheterizing a client perforates the bladder, the client sustain
injury. No Law affecting the populations as a whole has been broken, but the client
may bring a Civil Suit against the nurse. The client may receive compensations for
injuries, but the nurse receives no jail time.


agreement between two parties as to what will transpire and the rules and
regulations governing the service that will be provided. The legal agreement is
enforceable by Law and those who sign the agreement must be able to legally enter
into a contract. This means they must be of legal age and they must have the
mental capacity to sign a contract.


and apply legal aspects in their various roles:-

INFORMED CONSENT:- Informed consent is an agreement by a client to accept

a course of treatment or a procedure after being fully informed of it. Consents are
either expressed or implied. Express consent could be oral or written. If the
procedure is more invasive / high risk, then written consent is needed.

Implied consent exists when the clients non-verbal behavior indicates agreement
such as in positioning their bodies for an injection or when their vital signs are


i) The consent must be voluntary.

ii) The consent must be given by a client, who is capable and competent to

iii) The client must be given enough information to be the ultimate decision-

The nurse is not responsible for explaining the medical or surgical procedure
but for witnessing the client’s signature on the consent form. The nurse’s signature

 The client gave voluntary consent.

 The client’s signature is authentic.
 The client appears competent to give consent.

VIOLENCE, ABUSE & NEGLECT:- Violent behavior can include

domestic violence ,human abuse and sexual abuse.
Neglect is the absence of care, necessary to maintain the health safety
of a client. Nurses are in position to identify and assess cases of violence.
When any injury appears to be present resulting from abuse, neglect
or exploitation the nurse must report the situation to the appropriate
DELEGATION:- Delegation is the entrusting of responsibility to someone
to perform it, when there is excessive workload and that can’t be performed
by a person at a time efficiently. In USA the process of delegation is
governed by laws and regulations such as the nurse practice Act (NPA), job
description and skill level. The NPA defines and describes the scope of
nursing practice.

When delegation is to occur the nurse needs to determine the answers

to the following questions:-
 Does the NPA permit delegation?
 Is there a list of procedure that a nurse can delegate?
 Are there guide lines explaining the nurse’s responsibilities when

5) a) There are several important factors, that influence decision making.

Significant factors include past experiences, a variety of cognitive biases, an
escalation of commitment and sunk out comes, individual differences,
including age and socio-economic status a belief in personal relevance.

SIX C’s of decision making:-

i) Construct a clear picture of preciously, what must be decided.
ii) Compile a list of requirements that must be met.
iii) Collect informations on alternatives that meet the requirements.
iv) Compare alternatives that meet the requirements.
v) Consider the ‘what might go wrong’ factor with each alternative.

Whenever we are involved in making decisions a number of factors can
affect the process we follow and ultimately the decision we make.
They can be organized in to three major groups:-

 Perception issues
 Organizational issues
 Environmental issues.

PERCEPTION ISSUES:- perception can be influenced by the following:-

i) The Perceiver:- The types of personal characteristic that can affect an
individual’s perception include:- Background and experience, personal
values, personal expectation, personal interests.
ii) The situation:- Time, location and other situational factors can influence
our perception of an object. For example:- a team leader may notice team
members who work late on the same evenings as the team leader. However, ,
team members who work late on other evenings may not be noticed by the
team leader.

ISSUES WITH THE ORGANIZATION:- A number of organizational issues

can impact on the decision making process. These issues include:-
 Policies and procedures
 Organizational hierarchy
 Organizational politics.

Many organization have formalized policies and procedures which
have been developed to resolve common problems and to guide managers
when making decisions. For example:-
Many organizations have documented disciplinary procedures which
guide managers through a process of resolving issues with staff members.
Organizational hierarchy refers to the management structure of the
organization. Most organizations have different levels of management which
carry with them different degrees of authority. The degree of authority
directly impacts on the nature of the decisions an individual can make.
Organizational politics refers to behaviors displayed by individuals
and groups which is designed to influence others. Individuals and team will
often use politics to:- Advance their careers, advance their interests and
ideas, increase their rewards. Organizations are made up of individuals with
different believes, values and interests. These differences are often driving
forces behind organizational politics.

ENVIRONMENTAL ISSUES:- These are the external factors that affect the
organization. The types of external factors that can have an affect on decision
making include:- The market in which the organizations operates

 The Economy
 Government legislation
 Customer’s reaction to the organization’s products and services.
Other factors include personal factors ( like age, gender, stages in life- cycle,
education, occupation, economic position etc.) Personal psychographics
includes(life style, attitudes, self concept, concern about status, value system,
beliefs etc.) Cultural factors(Culture combined resulted of factors like
Religion, traditions, taboos , languages, education, upbringing, established pattern
of social behavior, values etc.) Influence of reference group (e-g family, friends,
peer groups, close colleagues, close knit, organizations) psychological
factors(Motivation, perception, learning process, memory process).

4) Conflict resolution is conceptualized as the methods and process involved in

facilitating the peaceful ending of conflict and retribution. The term conflict
resolution may be used interchangeably with dispute resolution, where arbitration
and litigation process are critically involved. Furthermore, the concept of conflict
resolution can be thought to encompass the use of nonviolent resistance measures
by conflicted parties in an attempt to promote effective resolution.
Various steps in conflict resolutions:-

i) CLARIFY WHAT THE DISAGREEMENT IS:- Clarifying involves getting to

the ear of the conflict. The goal of this step is to get both sides to agree on what
the disagreement is. To do this, we need to discuss what needs are not being met
on both sides of the conflict and ensure mutual understanding. During the process,
obtain as much information as possible on each sides point of view. Continue to
ask questions un till we are certain that all parties involved.


process, both sides agree on the desired outcome of the conflict. When people
know that they are working towards the same goal, then they are more apt to
participate truthfully to make sure that they reach that end goal together. To
accomplish this, discuss what each party would like to see happen and find a
commonality in both sides as a starting point for a shared outcome. That
commonality can be as simple as both sides want to end the conflict.
listening, communicating and brainstorming together. Continue with both sides
working together to discuss ways that they can meet the goal they agreed in step 2
(ii) . Keep going until all the options are exhausted.


the process, the two parties acknowledge what has brought them into the conflict
and talk about what problems may prevent a resolution. Understanding the
possible problems that may be encountered along the way lets we proactively find
solutions and have plans in place to handle issues.


need to come to a conclusion on the best resolution. Start by identifying solutions
that both sides can live with. Ask both sides and see where there is common
ground. Then start to discuss the responsibility each has in maintaining the
solution. It’s also important to use this opportunity to get the root cause to
ensurethis conflict will not come-up again.


sides need to own their responsibility in the resolution of the conflict and express
about what they have agreed to. After both parties have acknowledged a win-win
situation, ask both parties to use phrases such as ‘I agree to’………….. and ‘I
acknowledge that I have responsibility for………………..’
Epidemic means sudden increase of any disease or health related state in a given
population, that exceeds the normal frequency.
Epidemic means constantly presence of any disease or health related state in a
given population for a long period of time.