NURSING MANAGEMENT

Meaning of management principles: Management

principles are statements of fundamental truth which
act as guidelines for taking managerial action.
Management principles are derived and
developed in the following two steps.
(a) Deep Observations
(b) Repeated experiments
Henri Fayol (1841 - 1925): Graduated from the
National School of Mines in Saint Etrenne in 1860
 Fayol‟s 14 principles of management
1. Division of Work.
2. Principle of Authority and Responsibility
3. Principle of discipline:
4. Principle of unity of command:
5. Unity of direction:
6. Subordination of individual interest to general
interest:
7. Principle of remuneration of persons:
 Fayol‟s 14 principles of management
8. Principle of centralization and
decentralization:
9. Principle of scalar chain:
10. Principle of Order:
11. Principle of Equity:
12. Stability of tenure of personnel:
13. Principle of Initiative:
14. Principle of Esprit De Corps:
 Fayol‟s 14 principles of management
1. Division of Work:
Specialization allows the individual to build up
experience, and to continuously improve his skills. Thereby
he can be more productive. Small task, Competent,
Specialization, Efficiency, Effectiveness

2. Principle of Authority and Responsibility:

•Authority means power to take decisions.
•Responsibility means obligation to complete the job
assigned
Conti....

3. Principle of discipline:
General rules and regulations for systematic
working in an organization.

4. Principle of unity of command:

Employee should receive orders from one
boss only.
 Conti....

5. Unity of direction:

All the efforts of the members and employees of the

organization must be directed to one direction that is the
achievement of common goal.

6. Subordination of individual interest to general interest:

Subordination of individual interest to general

interest the interest of the organization must supersede the
interest of the individuals.
Conti....

7. Principle of remuneration of persons:

Employees must be paid fairly or adequately
to give them maximum satisfaction

8. Principle of centralization and decentralization:

Centralization refers to concentration of
power in few hands. Decentralization means
evenly distribution of power at every level.
Conti....

9. Principle of scalar chain:

Means line of authority or chain of superiors
from highest to lowest rank

10. Principle of Order:

Principle of Order It refers to orderly
arrangement of men and material a fixed place for
everything and everyone in the organization
Conti....

11. Principle of Equity:

Principle of Equity Fair and just treatment to
employees.

12. Stability of tenure of personnel:

Stability of tenure of personnel No frequent
termination or transfer.
Conti....

13. Principle of Initiative:

Principle of Initiative Employees must be
given opportunity to take some initiative in making
and executing a plan

14. Principle of Esprit De Corps:

Principle of Esprit De Corps Means union is
strength.
 AIM OF NURSING MANAGEMENT
To ensure effective utilization of resources for
the attainment of goals and make decisions regarding-

 -what activities are to be performed

 -by whom to be performed
 -where these are to be carried out.
 OBJECTIVES OF NURSING MANAGEMENT

The overall objective is to enable different limbs of

nursing organization to function harmoniously in happy
coordination blending themselves into a composite
personality to facilitate growth and development of
individuals and through them of the society and nation as
a whole.
Conti…..

 To provide efficient social life to nurses and thus

prepare them in the art of living together.
 To bring school or college and community closer to
each other.
 To prepare the nurse for some specialized vocation.
 To help the nurses in unfolding, blossoming of
personality.
 To enable the nurse to have the right type of
philosophy in life.
 To conserve all the good practices and conventions of
the past.
Conti…..

 To help in the realization of objectives of education as

laid down by the experts according to their selected
vocation or profession.
 To bring harmony between and the tasks.
 To make maximum use of all educational facilities in
order to attain the desired objectives and to help
minimize the wastage.
 To provide healthy atmosphere for experimentation
and research.
 MISSION AND VISION STATEMENTS

As Bioethist Bartnar 1998 said “Despair

should not eclipse hope” and hope is the oxygen of
the human spirit”. It is essential for us to
remember that imaginative global thinking and
visionary actions can have major long term
advantage for mankind.
 Conti…..

 New millennium is going to different as the health

problems would change in other aspects of life.

 To meet these challenges of nursing in new

millennium, mission and vision statement of nursing
profession plays a key role.

 Nurses hold the key to transforming health care and

pulling it into 21st century in terms of work practice and
reform.
Conti…..

This is because nurses are :

 Visionary

 Creative

 Involved in decision making at client level.

 MEANING AND CONCEPT
VISION - the strongly felt aim or calling. It defines
where the profession wants to be in future. it
reflects the optimize view of the professions
future.

MISSION -defines where the profession is going

now, basically describing the purpose. Why this
profession exists?
 MISSION STATEMENTS
A Mission Statement defines the organization's purpose
and primary objectives.
Its prime function is internal – to define the key measure or
measures of the organization‘s success – and its prime
audience is the leadership team and stockholders.
Mission statements are the starting points of an
organisation‘s strategic planning and goal setting process.
They focus attention and assure that internal and external
stakeholders understand what the organization is attempting
to accomplish.
 MISSION STATEMENTS
 It concentrates on present and informs you about the
desired level of performance.
 It will be achieved.
 It reflect the purpose or broader for being in existence in the
profession.
 It serves as an ongoing guide without a time frame.
 The mission can remain same for decades, if crafted well.
 It provides a path to realize the mission in line with its
values.
 It directs bearing on the bottom line and success in
profession.
 Dimensions of Mission statements:
According to Bart, the strongest organizational impact occurs
when mission statements contain 7 essential dimensions.
· Key values and beliefs
· Distinctive competence
· Desired competitive position
· Competitive strategy
· Compelling goal/vision
· Specific customers served and products or services offered
· Concern for satisfying multiple stakeholders
 VISION STATEMENTS
 Outlines what the profession wants to be.
 It concentrates on the future.
 It is a source of inspiration.
 It provides clear decision making criteria.
 Its more specific in terms of objective and future state.
 it is related to some form of achievement, if
successful.
 This can galvanize the people to achieve defined
objectives.
Conti…..

The vision is SMART

S – Specific
M - Measurable
A - Achievable
R - Relevant
T - Time bound
Which comes first it depends on new start up.
Conti…..

FEATURES OF VISION STATEMENT

- Clarity and lack of ambiguity.

- Paint a vivid and clear picture.
- Describing a bright future [hope]
- Memorable and engaging expression.
- Realistic aspiration- achievable
- Time bound
 Philosophy
žCost effectiveness
In management or administration of any enterprises
for organization, the quality, quantity, timing and cost of the
necessary to reach the objective of the enterprises are
interrelated factor which must be given constant attention.
Execution and control of work plan:
One of the greatest possible contributors to wastage of
our precious recourses, whether at the local or national level,
is the failure of those at any level of administration, and at all
stages in the management of the activity, to base all decision
on verifiable facts.
 Conti……….
žDelegation of responsibility and authority:
The delegation of responsibility and authority is an
important aspect of successful administration, to place the
responsibility for decision at the lowest possible
organizational level in order to attain decision as speedily as
possible.
Human relation and good morale:
Since the function of administration is to attain an
established objective through the management of people,
administration if deeply concerned with human relation.
Good morale of the staff is essential to the success of any
organization.
 Conti……….

žEffective communication:
Effective communication are essential for all aspect
of effective administration .staff must be adequately and
correctly informed about plan, methods ,schedules,
problems events and progress.
Flexibility:
Administrators must be completely flexible to meet
the changing needs of the situation.
 žNURSING TRENDS:-
Refers to direction towards which the different
nursing event have moved or are moving as well as the
opinion in and around nursing that are found in and
about nursing profession.

 ISSUES:-
A point or matter of discussion, debate or dispute
or a matter of public concern.
 CURRENT TRENDS IN NURSING
ADMINISTRATION
1. Changing demographics and increasing diversity
2. The Technological Explosion
3. Globalization of the world’s economy and society
4. Quality assurance in Nursing care
5. Decentralised approach to care Management
6. continuing Nursing education
7. Evidence based Practice
8. Nursing audits
9. Collective bargaining
10. Case management, disease management, and tele health care
expand:
11. Nursing education go online
1. Changing demographics and increasing diversity

• Increase in the diversity of the population which

affects the nature and the prevalence of illness and
disease, requiring changes in practice that reflect and
respect diverse values and beliefs.

• Disparities in morbidity, mortality, and access to care

among population sectors have increased.

• Ethnic and racial diversity of nursing institutes

creating a rich cultural environment for learning.
2. The Technological Explosion

• There is reduction in distance through speedy

communication. Advances in digital technology have
increased the applications of tele-health and telemedicine
mobiles, e-line, video conferences, bringing together
patient and provider without physical proximity.

• Nanotechnology is a new form of clinical diagnosis and

treatment, which is capable of detecting a wide range of
diseases from very minute specimens. There is
computerization for patient care management.
3. Globalization of the world’s economy and society
• Now there is potential for rapid disease transmission &
potential for dramatic improvements in health due to
knowledge transfer between cultures and health care
systems.
• Nursing science needs to address health care issues, such as
emerging and remerging infections, that result from
globalization.
• Nursing education and research must become more
internationally focused to disseminate information and
benefit from the multicultural experience.
4. Quality assurance in Nursing care

• Public knows their rights, human rights, commissions ,

protection acts and process etc, are putting constant pressures on
the professionals to deliver their best.

• Professionals cannot ignore or be careless in discharging duties

especially when it concerns people lives and health.

• Nurse managers have to ensure delivery of quality care by

practicing as per standards laid down by their counsels and
institutions.
5. Decentralized approach to care Management

• This makes each and every nurse responsible and

accountable for the care of assigned patients.

• Patients satisfaction, quality care and smooth

functioning of the units.

• It focuses on problem solving on the spot with the

joint participation of the supervisee and supervisor.
6. Continuing Nursing education

• It has become essential to keep up with the changing needs of

patient care.
• Nurses have to continuously update themselves with new and
innovative approaches in patient care management.
• For this they should enable themselves with workshops,
seminars, short term training programmes, attend conferences,
make use of library, subscribe and read periodicals and books.
• Discussion on bedside and supportive supervision helps to keep
abreast with newer techniques and information.
7. Evidence based Practice

• There has been a significant Advancement in Nursing Science

and Research.
• Most studies concern health behaviors, symptom.
• There is lack in focus on the scholarship and science of nursing
as top priorities.
• Doctorally prepared nursing professionals are not being
produced in large enough numbers to meet the growing need.
• There is need for enhanced mentorship for new researchers to
strengthen skills and capacity to conduct meaningful nursing
research.
8. Nursing audits

• Regular nursing audits promotes ensures quality of

care provided to the the clients and upliftment of
standards of nursing care.
9. Collective bargaining

• Collective bargaining is the uniting of the employees for

the purpose of increasing their ability to influence their
employer and to improve the working conditions.

• Collective bargaining is based on the principle that there

is greater strength in large numbers.
10. Case management, disease management, and tele
health care expand:

• There is a demand to manage the care from a

distance, being more people at home and in remote
areas with chronic diseases and complicated
treatment regimens, through the use of telephones,
television monitors, and telecommunication.
11. Nursing education go online

• Various courses of nursing education will go online

in future.

• Wellness centers, Holistic and Alternative therapies

• There is a great focus on promoting health and

triggering the body’s natural healing powers through
holistic and alternative therapies (e.g exercise, massage,
acupuncture etc.)
 ISSUES IN NURSING:-
žRenewal of nursing registration :-
Diploma V/S Degree in nursing for registration to
practice nursing:-

Specialization in clinical area:-

Nursing care standards:-

 ISSUES IN NURSING EDUCATION
 Nursing training school multiplied .
 Lack of independent building for school and college .
 Lack of independent principal for school and college.
 Inadequate hostel facility for student .
 Shortage of qualified teacher in nursing.
 Inadequate library facilities.
 Less supply of A.V. aids.
 Less promotional opportunities for teachers of both school
and college.
 Very less or no stipend for nursing student.
 ISSUES IN NURSING ADMINISTRATION
1. Non-involvement of nursing administrator in planning and
decision-making in the governmental hospital administration.

2. No specific power assigned to nursing superintendents, but

he/se has been made in-charge of all inventories and linen of
hospital.

3. Nursing superintendent will have no authorities to sanction

leave to their subordinates.

4.Lack of knowledge in management of Hospital among

medical/nursing administration.
Conti......
5. Administration is always dependant on the advice of
clerical staff in all matters including technical aspects.
6.Prevalence of role ambiguity, among administration
administrators.
7. Unnecessary interference of non-nursing personnel
(Medical/ clerical) in nursing administration.
8. No written nursing policies and manuals.
9. No organized staff development programme which
includes orientation, in service education, continuing
education etc.
Conti......

10. No special incentives like , Rajyotsava Award,

Republic Day Awards , Teachers Awards, as Government
itself honor with these awards other government servants
like teachers, police persons etc.
11. Inefficiency of Nursing councils of state and union to
maintain standards in nursing.
12. No efforts at higher level for implementation of
separate Directorate of Nursing sanctioned by Karnataka
Govt.
 THEORIES AND MODELS
A. SCIENTIFIC MANAGEMENT THEORY:
1. Frederick W. Taylor (1856-1915)
2. Gantt Henry I. Gantt (1861-1910)
3. Emerson (1853-1936)
4. Charles Babbage (1792-1871):
B. CLASSIC ORGANIZATIONAL THEORY:
1) Henry Fayol (1841-1925):
2) Max Webber theory (1864-1920):
3) James Mooney Theory (1884-1957):
C. HUMAN RELATION THEORY:
1). Follett theory (1868-1933):
2). Lewin theory (1890-1947):
D. BEHAVIORAL SCIENCE THEORY:
1) Douglas McGregor‟s Theory (1932):
2).Rensis Likert‟s theory:
E. MODERN MANAGEMENT THEORIES:
 A. SCIENTIFIC MANAGEMENT THEORY:

Principles: The scientific management focuses on

 Observation
 The measurement of outcome
The pioneers of scientific management are:
1. Frederick W. Taylor (1856-1915)
2. Gantt Henry I. Gantt (1861-1910)
3. Emerson (1853-1936)
4. Charles Babbage (1792-1871):
1) Frederick W. Taylor (1856-1915):

Taylor is recognized as father of scientific management.

He conducted Time-And- Motion studies to time the
workers, Analyze their movements and set their
standards.
He used stop watches.
He applied the principles of observation, measurement
and scientific comparison to determine the most
effective way to accomplish a task.
The effect of time- motion study of Taylor:
1. Reduced wasted efforts
2. Set standards of performance
3. Encouraged specialization and stressed on the selection
of qualified workers who could be developed for a
particular job.
2) Gantt Henry I. Gantt (1861-1910):

 Gantt was concerned with problems related to

efficiency.
 He contributed to scientific management by refining
the previous work of Taylor than introducing new
concepts.
1. He studied the amount of work planned or completed
on one axis to the time needed or taken to complete a
task on the other axis.
2. Gantt also developed a task and bonus remuneration
plan whereby workers received a guaranteed day‘s wages
plus a bonus for production above the standard to
stimulate higher performance.
3. Gantt recommended to select workers scientifically and
provided with detailed instructions for their tasks.
4. He argued for a more Humanitarian approach by
management, placing emphasis on service rather than
profit objectives.
5. He recognized useful non –monetary incentives such as
job security and encouraging staff development.
3) Emerson (1853-1936):

His emphasis was on conservation and organizational goals

and objectives. He defined principles of efficiency related to:
1. Interpersonal relations and to system in management.
2. Goals and ideas should be clear and well-defined as the
primary objective is to produce the best product as quickly as
possible at minimal expense.
3. Changes should be evaluated-management should not ignore
commonsense by assuming that big is necessarily better.
4. Competent counsel is essential.
4. Charles Babbage (1792-1871):
Charles Babbage ,a scientist mainly interested in
mathematics, contributed to the management theory by
developing the principles of cost accounting and the nature of
relationship between various disciplines.

He concentrated on production problems and stressed

the importance.
1) Division and assignment of work on the basis of skill and
2) The means of determining the feasibility of replacing
manual operations with automatic machinery.
 B. CLASSIC ORGANIZATIONAL THEORY:

Importance of classic organization theory:

 The classic administration-organization thinking
began to receive attention in1930.
 Organization is viewed as whole rather than focusing
solely in production.
 The concepts of scalar levels, span of control,
authority, responsibility, accountability, line staff
relationships, decentralization, and
departmentalization become prevalent.
1) Henry Fayol (1841-1925):
Fayal was a French industrialist known as father of the
management process school concerned with management of
production shops. He studied the functions of managers and
concluded that management is universal.
Functions of management:
1. Planning policies, programs and procedures.
2. Organization based on hierarchy of authority
3. Directing the business in order to gain optimum return from all
workers.
4. Coordination, signifying harmony in activities of the
organization and to facilitate its working
5. Control, the errors of the functionaries of organization and
ensure that such errors do not occurs.
2) Max Webber theory (1864-1920):
He is German psychologist. He earned the title of father of
organizational theory. His emphasis was on rules instead of
individuals and on competencies over favoritism. His
conceptualization was on bureaucracy, structure of authority that
would facilitate the accomplishment of organizational objectives:
The three basis for authority:
1. Traditional authority, which is accepted because it seems things
have always been that way such as the rule of a king in a
monarchy.
2. Charisma, having a strong influential personality.
3. Rational legal authority which is considered rational in
formal organizations because the person has demonstrated the
knowledge, skills and ability to fulfill the position.
3) James Mooney Theory (1884-1957):
Moony believed that management to be the technique of
directing people and organization the technique of relating
functions. Organization is managements responsibility.

Four universal principles:

1. Coordination and synchronization of activities for the
accomplishment of goal.
2. Functional affects the performance of one‘s job description.
3. Scalar process organizes level of commands.
4. Arrange authority in to a higher Archie.
Consequently people get their right to command from
their position in the organization.
 C. HUMAN RELATION THEORY:

The human relations movement began in 1940s.

Focused on the effect that the individuals have on the success or
failure of an organization.
Classic organization and management theory concentrated on
the physical environment fail to analyze the human element.
Instead of concentrating on the organizations structure, managers
encourage workers to develop their potentials and help them
meet their needs for
 Recognition
 Accomplishment
 Sense of belonging
1). Follett theory (1868-1933):

1. Follett stressed the importance of coordinating the

psychological and sociological aspects of management in
1920s.
2. She perceived the organization s a social system and
management as a social process.
3. Indicated that legitimate power is produced by a circular
behaviour where by superiors and subordinates mutually
influence one another.
4. The law of the situation dictates that a person does not take
orders from another person but from the situation.
2). Lewin theory (1890-1947):

1. Lewin focused on the Group dynamics.

2. He maintained that groups have personalities of their

own: composites of the member‘s personalities.

3. He showed that group forces can overcome individual

interests.
 D. BEHAVIORAL SCIENCE THEORY:
Emphasis is on:
1. Use of scientific procedures to study the psychological,
2. Sociological,
3. Anthropological aspects of human behaviour in organization.
Behavioural Science Indicated:
1. The importance of maintaining a positive attitude toward people,
2. Training managers,
3. Fitting supervisory actions to the situation,
4. Meeting employees needs.
5. Promoting employees sense of achievement,
6. Obtaining commitment through participation in planning and
decision making.
1) Douglas McGregor‟s Theory (1932):

McGregor‘s is the father of the classical theory of management

which termed theory.
He developed the managerial implications of Maslow‘s theory.
He noted that one‘s style of management is dependent on ones
philosophy of humans and categorized those assumptions as
theory X and theory Y.

Theory X
1. The manager‘s emphasis is on the goal of organization.
2. The theory assumes that people dislike work and avoid it.
Consequence of theory X
Workers must be directed, Controlled, Coerced (pressurized),
Threatened so that organizational goals can be met.
According to theory X
1. Most people want to be directed and to avoid responsibility
because they have little ambition.
2. They desire security.
Managers who accept the assumption of theory X
1. Will do the thinking and planning with little input from staff
associates.
2. They will delegate little, supervise closely.
3. Motivate workers through fear ad threats
4. Failing to make use of the workers potentials.
Theory Y
It is focuses on goal.
1. People do not inherently dislike the work and that work can be
a source of satisfaction.
2. Workers have the self direction and self control necessary
for meeting their objectives.
3. Will respond to the rewards for the accomplishment of those
goals.
Managers who believe in this Y theory:
1. Will allow participation
2. They will delegate
3. Give general supervision than close supervision
4. Support job enlargement
5. Use positive incentives such as praise and recognition.
2).Rensis Likert theory:
 Dr Rensis Likert has studied human behaviour within many
organisations.
 After extensive research, Dr. Rensis Likert concluded that there
are four systems of management.
 According to Likert, the efficiency of an organisation or its
departments is influenced by their system of management.
He identified three variables in organizations.
1. The casual variable includes leadership behaviour.
2. The intervening variables are perceptions, attitudes and
motivations.
3. The end results variables are measures of profits, costs and
productivity.
Factors measured by likert scale
 Motivation
 Managerial
 Communication
 Decision making process
 Goal setting
 Staff development
 E. MODERN MANAGEMENT THEORIES:

Modern management theories era can be father

classified as the three streams through:-
1. Quantitative approach
2. System approach
3. Contingency approach
Indicating further refinement, extension and
synthesis of all the classical and neo- classical approaches
to management.
1. Quantitative approach:

 Management science refers to the application of

Quantitative methods to management.
 Management science has an interdisciplinary basis in
other words management science is a combination and
interaction of different scientists.
2. System approach:-

 According to system approach the organization is the

unified, purposeful systems composed of interrelated
parts and also interrelated with its environment.
 Each unit must mesh/ interact with the organization as
a whole, each manager most interact/ communicate
and deal with executives of other unites and the
organization itself must also interact with other
organizations and society as whole.
3. Contingency approach:
 The contingency approach can be described as the
behavioural approach.
 Contingency theory does not prescribe the application of
certain management principles to any situation.
 Contingency theory is recognition of the extreme
importance of individual manager performance in any
given situation.
 It rests on the extent of manager power and control over a
situation and the degree of uncertainty in any given
situation.
 It is principally directed at the management practitioner
seeking to control a distinct Organizational environment.
 An open system model
Ludwing Von Bertanffy:
An open system model
Bertanffy, a biology is credited with coining the general
system theory. His contention were that it was possible to develop a
theoretical framework for describing relationship in the real world
and different disciplines with similarities could be developed into a
general systems model. The similarities were:
1. Study of organization
2. State of equilibrium
3. Openness of all systems and their influence o the environment
and environment influence on the system.
 Implications of management theories in
nursing:
1. Taylor‘s theory can be implemented in nursing to study complexity of care and
determine staffing needs and observe efficiency and nursing care.
2. Nurses can utilize Emerson‘s theory of early notion of the importance of
objectives setting in an organization.
3. Nurses should be aware of the managerial tasks as defined by Fayol: Planning,
Organizing, Directing, Coordinating and Controlling.
4. The theory of human relations of Follett and Lewin emphasize the importance
for nurse managers to develop staff to their full potential and meeting their needs
for recognition, accomplishment and sense of belonging.
5. Mc Gregon and Likert support the benefits of positive attitudes towards people,
development of workers, satisfaction of their needs and commitment through
participation.
Thank You