NIGHTINGALE INSTITUTE OF NURSING,

NOIDA

ASSIGNMENT

ON

CURRENT TRENDS AND ISSUES IN NURSING

ADMINISTRATION

(SUBJECT: NURSING MANAGEMENT)

SUBMITTED TO SUBMITTED BY
Ms. ANN GLADIS Ms. DHAIRYA ARORA
ASSOCIATE PROFESSOR M. Sc.(N) 2nd YEAR
NIN, NOIDA NIN, NOIDA
 INTRODUCTION
Administration is an essential factor in the development of any service. Administration
provides the means whereby most effective use can be made of the knowledge and the skills of all
those who are involved in it.
The development of nursing service has been enhanced greatly by advances made in
professional skills and technical proficiency. But it is apparent that the, same development has not
been made in nursing administration.
DEFINITION
"Administration is the organization & direction of human and material resources to achieve desired
ends".
-Pfiffner and Presthus.

"Administration is the direction, coordination and control of many persons to achieve same purposes
or objective
- Nigro

"Administration may be defined as the management of affairs with the use of well thought out
principles and practices and rationalized techniques to achieve certain objectives."
- Goel

"Administration is the organization and use of men and materials to accomplish purposes. It is the
specialized vocation of managers who have skill of organizing and directing men and material just as
definitely as an engineer has skill of building structure"
- James L

NATURE OF ADMINISTRATION

Administrative process is intellectual, social, dynamic and creative as well as continuous. The
feature or natures of administration are:-
1. It is universal- because irrespective of nature and objectives of the organization, all basic
elements of administration such as planning, organizing, staffing, directing, coordinating, reporting,
budgeting can apply for its effective achievement of goals.
2. It is holistic:- the whole process of administration embraces the organization and its function
in entirely, i.e. involve total activities of the organizations.
3. It is intangible: - Since administration is visualized as abstract. It cannot be transferable to
any where. So, every organization has to develop its own administrative style within the contact of
functional elements of administration.
4. It is continuous and on going process. The cycle of administration goes on continuously.
5. It is goal oriented:- administration is always struggling to achieve the laid down goals and
objectives of the organizations.
6. Its is social and human:- usually in administration group of people are there to achieve the
objective. It needs good social and interpersonal contact or relationship to achieving the goal.
7. It is dynamic:- administration has the elements of flexibility and adaptability and
adjustability rising to the needs and demands of different situation.
8. It is creative or innovative:- to have an effective administration existed administration
provides innovation, offers and invites creative ideas to its organizational teams.

PRINCIPLES OF ADMINISTRATION
Fourteen principles of administration were identified by Henri Fayol as follows:-
1. Division of work:- In any organization administrator or manager cannot perform all the
activities to achieve its objective. So there should be division of work according to managerial and
non-managerial.

2. Authority, responsibility and accountability: If the person has to perform job assignment
effectively according to their own qualification and experience.

3. Discipline:- for smooth running of administration to achieve objectives, there should be

proper observance of the rules, regulations, norms, decorum, manners, code of ethics and respect;
this requires to be enforced within the organization by the managers.

4. Unity of Command: in any organization the subordinate should be supervised by a single

supervisor to whom he/she should be accountable.

5. Unity of direction: In any organization, there should be one supervisor to give direction to
his/her subordinate.

6. Subordination of individual interest to organizational interest. This implies that narrow

selfish interest should be overcome or should turn to common and broad interest of the organization
for its welfare.

7. Remuneration of personnel:- There should be fair policy for payment of the personnel
justifying the workload job hazards, efficiency and quality of performance.

8. Centralization: - There should be some amount greater and larger authority resting with top
level managers.

9. Scalar chain of command: This implies that there is chain or link of directional instructions
from the top level to the lowest rank of organizational members in the hierarchy.

10. Order: In an administration there should be proper systematic arrangement of staff,

materials, supplies and equipment according to requirement of specific job departments.

11. Equity: - In administration, there should be a fair and impartial treatment to all workers
irrespective of their job.

12. Stability of tenure of personnel:- Organizations should make proper efforts to ensure
stability and continuity in the tenure of personnel, which gives security and promotes productions.

13. Initiative: Administration should always be encouraging initiative from each employee by
allowing him freedom to do his/her best.

14. Esprit de corps: It refers to sense of belonging. This fosters the team spirit, i.e. the spirit of
working together to achieve objectives efficiently.

ELEMENTS OF ADMINISTRATION
Professor Luther Gullick (1937- summed up certain principles or elements in the word
“POSDCORB”). It is made up of initials and stands for the following.
“P” stands for planning
That is working out a broad outline.
“O” stands for staffing
That is the establishment of the formal structure of authority through which work of sub division
are arranged defined and coordinated for the defined objectives.
“S” Stands for staffing
That is the whole personnel function of bringing in and training the staff and maintaining
favorable conditions of work.
“D” Stands for Directing
That is the continuous task of making decision and embodying them, in specific and general
orders and instructions and serving as leader of the enterprise.
“CO” Stands for Coordinating
That is all important duty of inter-relating the various parts of the work and eliminating of
overlapping and conflict
“R” Stands for Reporting
That is keeping those to whom the executive is responsible informed as to what is going on,
which thus include keeping himself and his subordinate informed through records, research and
inspection.
“B” stands for Budgeting:
With all that goes with budgeting in the form of fiscal planning, accounting and control.
P-Planning

O-organizing
B- Budgeting

Elements
Of
Administration S-Staffing
R-Reporting

Co-Coordinating D-Directing
 TRENDS IN NURSING ADMINISTRATION
Trends denote general direction and tendencies especially of events, of opinion. So nursing
trends refer to the general direction towards which the different nursing events, have moved and are
moving, as well as the opinions in and around nursing and tendencies that we find in and about our
profession.

Nursing Service in Ancient times

 Study of the history will help us to know what nurse thought and did in the past and which
may still affect us and may have had some influence on what we think and do.
 The study of how problems were approached and solutions obtained in the past will help us to
understand and find solutions to problems of our own time.
 In the book of Charaka it is mentioned that “The physician, drug, nurse and patient constitute
an aggregate of four.”
 Nurse educations and administrations are now stating a new framework in which the graduate
nurse should function. They are making people aware of what virtues nursing service should possess
so as to help the patient regain or maintain hi maximum degree of health.

Influence of the Christian Era on Nursing Service.

 Scrutinizing the history of Christian era, we find the emergence of human relation in patient
care. The parable of Good Samaritan is closely interwoven into nursing services. The attitude of
taking care of person as a patient has continued to influence nursing services and hospitals.
 During the Greek medicine and in Christian era, nursing became a respected occupation in
which the most unpleasant work was made dignified by a sense of devotion.
 As the church grew in strength. It created position designed to provide simple service to
members of the community.
 The Deaconess order was organized in 400 AD. These women gave simple nursing care to
the needy and prisoners.
 Influence of the church silenced medical research. The existing medical practice slowly
deteriorated. The period of monastic medicine is usually called the Dark ages of medicine. The
monks played a predominant role in the practice of medicine, while the medical professionals almost
disappeared.
 In the 16th Century, with the reformation, nursing sank to its lowest level. Hospitals were
organized by the church.
 In that period, nursing was only an art. Scientific knowledge and its application to nursing, as
we conceive it nowadays was unknown in the middle ages. The nursing personnel in the secular
hospitals were illiterate and overworked. There was no status attached to the nursing personnel, even
though they were members of civic-controlled hospitals.

Emergence of Modern Nursing Service

 In the 19th century as men came up with new ideas about the material world and about the
world of human society. The development of modern medicine and nursing followed.
 The enlightenment movement liberated new ideas about things and their relation, belief in the
devil and his possessions began to disappear.
 Modern Medicine emerged, with the emergence of modern medicine and hospitals, adequate
nursing service became a prime necessity.
 Paster Fleidner and his wife re-established the Deaconess movement at Kaiserwerth,
Germany
 In 1960, Florence Nightingale’s concept of a new system of nursing became a reality through
the establishment of a training school at St. Thomas Hospital, London. This system of nursing
offered economic independence and secular vocation for women.
 Development of Nursing Service in the United States
 Nursing service in the United Stated came up from the concepts developed from the military
orders. Cathelic and Anglican sisterhoods, the Deaconess movement and from percepts of Florence
Nightingale and other nurse ancestors.
 In 1858, the American Medical Profession advocated the establishment of training schools
for women. The apprenticeship nursing in hospitals was started.
 In 1983, the problems of nursing were discussed by physicians and nurses at the Chicago’s
world Fair.
 In 1899, Teachers College, Columbia University realized the need for higher education,
offered courses in preparation for teaching.
 In 1910, the University of Minnesota established the basic school of nursing to become part
of the university system.
 At an American Nurses Association’s regional conference in 1961, Eleavor Lambertsen
emphasized the modern roe of the director of nursing and the role of director of nursing and the role
of the related institutional services with respect to the patients.
 Utilization of personnel and facilitation of services are major objective of administration.
 Between 1913 and 1917 more than 500 schools of nursing were established. The three year
courses duration had been generally adopted.
 With the First World War the responsibility and workload of nursing services was increased.
 By 1920 every hospital wanted its own school. The apprenticeship system in hospitals
improved nursing care.

Nursing Service within the Modern Hospital

Emergence of Nursing Service Standards
During 1935 to 1950 social forces had a tremendous influence upon the development of
nursing services.
 In 1936 the manual of essentials of good hospital service was published under the
sponsorship of the American hospital Association and the National League for Nursing Education.
This was published to give recognition to the minimum standards of average patient care.
 The manual was revised in 1942, and a third manual was published I 1950 under the title
hospital Nursing Service Manual.
 Nursing service was beginning to function an own. The value of scientific method and fact
were seen on the horizons of nursing service administration.
 As the hospital grew at the times of industrial revolution. It accepted norms of modern
business organization. The hospital was under the control of board of directors who delegated
authority to executive director or hospital administrator. The administration established personnel,
dietary and purchasing departments.
 Administration was concerned with placing of nursing service as a whole in the hospital. The
director of nurses won control over many administrative aspects of the nursing service. Nursing
service continued to be responsible for supplies and equipment and for the employment and
discharge of nursing service personnel.
 With the expansion of services to patients, the nursing director was forced to delegate more
responsibility and authority to the nurses of the patient’s unit. The role of the graduate nurse in most
hospitals became one of co-coordinating and controlling nursing services and hospital services.
 As the employee of the hospital, the nurse was and is still subjected to two distinct line of
authority the hospital administrative line and the clinical or therapeutic line headed by the medical
staff.

Nursing Service in a Bureaucratic System

 The second phase of hospital and nursing service administration is called the bureaucratic
system of control. The nursing service groups were brought under the line of authority.
 The informal relations unite people together and the vertical lines of communication unite the
levels of hierarchy.
 Through the vertical line of authority, the policies formulated by the management are
communicated to all the grievances and problems of the personnel are back to administration for the
fruitful selection.
 During the system, the decisions were usually made through the interaction of three groups-
the administration, the medical staff and the board of trustees. The nursing services were ignored.

Hospital Nursing Service at Mid Century

 During the period from 1950, numerous studies were performed on problems related to patient care
 Nurses, educators, physicians, hospital administrators and others were actively engaged in various
projects and experimentation.
 At mid century the tradition of the hospital as the clinical workshop for the doctor was changed to
the patient centered institution. Specialist began working together to meet the total needs of the
patient.
EMERGENCE OF NURSING SERVICE ADMINISTRATION
 The National Nursing Council published its report for the future which is known as the Brown’s
Report.
 The report indicated that in nursing service, administrative and supervisory staffs tend to be
authoritarian and nurses had little freedom in taking decisions and judgments for the care of patients.
Also it was found that administrative orders were issued from the top hospital administrator with
little opportunity provided for nurse administrators to participate in the policy decision making.
 Brown’s report pointed out the need for sound legislation regarding the training and function of
practical nurse and other health workers and also stressed the need for professional and highly
technical nursing education and mentioned that it should be undertaken by universities and colleges.
 In 1950, the WK Kellog foundation conducted a 5- month seminar an nursing service education
administration, and in service education and research
 The study conducted at Teachers college, Columbia University resulted in the establishment of
coursed in nursing service administration. At the seminar the first definition of nursing
administration was formulated- Nursing service administration is a co-ordinate system of activities
which provide all the facilities necessary for rendering of nursing care to patients, it includes
establishment of goals and policies.

THE HOSPITAL HEALTH TEAM

Changing perceptions of nurses as members of the health team.
 Nurses have been accepted in health teams as functionary members; but they have had no part to
play in planning and policy formation.
 But during 1070s, nurses were becoming more active advocates for their patients and were taking
steps to personalize healthcare, rather than continuing to be hand-maidens in the health care delivery
system.
NATIONAL LABOUR RELATIONS ACT-1974 (NLRA)
The act in based on our society’s respect for the dignity of both man and his work.
 The NLRA encourages the utilization of collective bargaining and are a means of establishing wages
and conditions of worked of non-managerial and non-supervisory employees.
 In NLRA, a professional employee is defined as:-
1. Any employee engaged in work, predominantly intellectual and varied in character as opposed to
routine mental, manual, mechanical or physical work.
2. Involving the consistent exercise of discretion and judgment in its performance
3. Required knowledge of an advanced type (Course of specialized instruction) in an institution of
higher learning.
 This definition of a professional by NLRA encourages nurse upgrading effectively the practice of
nursing in accordance with the nurse practice act of their state.
 Per reviews and profession standards review organization (PSPO) will strengthen professionalism in
nursing as well as enhance the status and economic interests of nurses.

Strike: - The right to strike is defined as the moral and political right of employees to withdraw or
withheld labor in order to gain concessions from their employees. Nurses should strengthen their
professional responsibilities in nursing practice. With support from their administrative leaders,
nurses should create a professional model that includes standards of nursing practice. Patient care
committee should be established in the hospitals with administrative medicine and nursing
representatives.

Arbitration: - From a practical view point, arbitration resolves problem. Arbitration involves a legal
contract between two parties.

Voluntary arbitration is decided by employees and employers, when they make the contract.
An arbitrator may be called when a dispute cannot be resolved through negotiations. Both parties
agree on the selection of an arbitrator when one is needed.

Arbitration of nurse-employer issues eliminates the need for strikes. If hospital and health
agency administrations want to avoid strikes and their consequences, they may accept voluntary or
compulsory arbitration as the best method for setting disputes.

Fact Finding: - In fact finding, both parties agree to call in an impartial person or person to hear
both sides. The fact finder will prepare a series of recommendation based on the facts presented.

 In 1966, California nurses voted to use the fact finding procedures rather than to go on strike,
and the fact finders recommendation were affected.

Mediation-arbitration: - In mediation- arbitration, a neutral and experienced arbitrator sits in

during the contract negotiations or disputes. If difficulties arise, he endeavors to mediate between the
parties and secure a voluntary agreement.

Mediation and conciliation: Mediation and conciliation are used in traditional bargaining. The
mediator is called in and he tries to achieve voluntary agreement.

CREDENTIALING IN THE NURSING PROFESSION

Licensure, certification and accreditation process comprise credentialing. All are closely
inter-related. This system is being scrutinized critically by consumes professionals and others in our
society. The consumer patients want quality care at a fair price.

The department of health, education and welfare defines the various aspects of credentialing.

Licensure:- A process by which a governmental agency grants permission to individuals who have
met pre-determined qualifications to engage in a given profession or occupation, use a particular title
or grant permission to institutions to perform specified functions.

Certification or Registration: - in the process by which non-government agency or association

grant recognition to an individual who has met certain pre-determined qualification by that agency or
association.

Accreditation:- The process by which an agency or organization evaluate and recognizes an

institution or programme of study, meeting certain predetermined qualification

THE NEW STATE NURSING PRACTICE ACT

(Amended in 1972)
 The practice of the profession of nursing encompasses diagnosing and treating human
responses to actual or potential health problems through services such as case finding, health
teaching, health counseling and provision of care supportive to or restorative of life and wellbeing.

Mandatory and voluntary Licensure

It means all individuals who practice nursing or medicine must get license. Only individuals
holding a license are authorized to use a designated title such as RN or LPN. Unlicensed individuals
may work in a field, but they cannot use protected title.
Mandatory Continuing Education and Voluntary Continuing Competence.
In most states, licensed health practitioner has to renew their licenses. Some professional
groups encourage the adoption of mandatory continuing education for professional reuse licensure.
These should be continuing programs and educational opportunities for the development of nursing
personnel.

Some professionals are against mandatory continuing education. The believe that legal
requirements downgrade professional autonomy and each practitioner’s right to determine what
learning experience is best suited to her professional needs.

TRENDS IN NURSING MANAGEMENT:

It is defined as the general direction in which something tends to move. Or it is a general tendency or
inclination or current style.
Trend is the event that occurs overtime and shows a series of fluctuation in its patterns. (Stanhope
Lancaster )
Nursing trends
It is the general direction towards which the different nursing events have moved and are moving, as
well as the opinions in and about our profession.
ISSUE
A point or matter of discussion, debate, or dispute or a matter of public concern. It can also be
defined as:
 A misgiving, objection, or complaint
 The essential point; crux
 A culminating point leading to a decision
FACTORS AFFECTING CURRENT NURSING TRENDS
Following are the international trends in nursing profession
o   Health needs of society
o   Awareness of health needs of the society
o   Economic conditions – if money is available to pay for nursing service
o   New developments in medicine
o   New knowledge and procedures developed through research in science
o   Need for specialization in medicine and nursing
o   Opportunities for services and education abroad
o   Changes in nursing education and the role of nursing student
o   Increased industrialization
o   Expansion of community health services
o   Govt. support programmes
o   Increased number of private nursing homes, private hospitals
o   Necessary military services
o   Development of nursing research
TRENDS IN NURSING MANAGEMENT
1. Changing Demographics and Increasing Diversity
2. The Technological Explosion
3. Globalization of the World’s Economy and Society
4. The Era of the Educated Consumer, Alternative Therapies and Genomics
5. Quality assurance in nursing care
6. Decentralised approach to care management
7. Interdisciplinary Education for Collaborative Practice
8. The Current Nursing Shortage/Opportunities for Lifelong Learning and Workforce
Development
9. Continuing nursing education
10. Evidence based practice
11. Nursing audits
12. Collective bargaining
13. Incentives for the health care professionals
14. Trend in span of authority
1. Changing Demographics and Increasing Diversity
With advances in public health and clinical care the average life span is increasing rapidly.
This poses a challenge the health care system’s ability to provide efficient and effective continuing
care. There is a significant 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, even as socioeconomic and other factors have led to increased violence and substance
abuse. Ethnic and racial diversity of nursing institutes has increased dramatically, creating a rich
cultural environment for learning. Older aged students bring varying college and work experiences,
as well as more sophisticated expectations for their education. Nursing practice, education, and
research embraced and responded to these changing demographics. Nurses are now focusing on
spiritual health, as well as the physical and psychosocial health of the population. Nurses must focus
on spiritual health, as well as the physical and psychosocial health of the population. There are
preparations to confront the challenges associated with today’s more mature student body,
educational methods and policies, curriculum, and clinical practice settings. Research priorities need
to value and reflect the diversity of the student body, as well as the population in general.
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. Easy reference on directions for patient care, record keeping, reporting, compilation of
information, stock monitoring, auditing are some of the functions which computers have taken over
ability to use computers for patient care management have become essential qualification for nurses.
Accessibility of clinical data across settings and time has improved both outcomes and care
management. Electronic recording replace traditional documentation systems. Through the Internet,
consumers will be increasingly armed with information previously available only to clinicians.
Electronic commerce will become routine for transacting health care services and products. Nurses
of the 21st century need to be skilled in the use of computer technology. There is growing evidence
of distance learning modalities for continuing professional education, for e.g IGNOU is offering
number of speciality courses. Even in nursing education technically sophisticated preclinical
simulation laboratories will stimulate critical thinking and skill acquisition in a safe and user-friendly
environment. Faster and more flexible access to data and new means of observation and
communication are having an impact on how nursing research is conducted.

3. Globalization of the World’s Economy and Society

With the “death of distance” in the spread of disease and the delivery of health care, posing both
extraordinary risks and benefits. 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. The Era of the Educated Consumer, Alternative Therapies and Genomics
Patient is a well-informed consumer – expects to participate in decisions affecting personal and
family health care. Previously unavailable information is now public information. Technological
advances in the treatment of disease have led to the need for ethical, informed decision making by
patients and families. People have knowledge about health promotion as well as disease prevention
and also there is an increased acceptance and demand for alternative and complementary health
options. The increased power of the consumer creates a heightened demand for more sophisticated
health education techniques. Voracious demand for alternative therapies has begun to influence
mainstream health care delivery. Increasingly, major health systems are seeking ways to provide
both, Western medicine as well as alternative therapies to their patients. Alternative Therapies holds
both promise and peril. Although it may unlock behavioral and spiritual components of health and
healing, risks of consumer fraud, therapeutic conflict, and patient noncompliance are real. Increase in
gene mapping will drive rapid advances in the development of new drugs and the treatment and
prevention of disease. Nursing research has the potential to enhance knowledge regarding what
constitutes a “healing” therapy. Nursing education and practice must expand to include the
implications of the emerging therapies from both genetic research and alternative medicine, while
managing ethical conflicts and questions.
5. 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.
6. Decentralised approach to care management
This makes each and every nurse responsible and accountable for the care of assigned patients .This
approach is found applicable and effective in terms of patients satisfaction, quality care and smooth
functioning of the units.The trend in span of authority appears to be towards large numbers. This is
not the result of efforts to increase the span but rather to reduce the number of organizational levels
for a given structure. Too many organizational levels impede communication. This forces the
executive to select subordinates with good potential or proven executive ability.
7. Interdisciplinary Education for Collaborative Practice
There is a need for coordinated care and a significant increase in the use of midlevel providers, such
as ANPs, as part of the health care team. There is an increased collaboration between nursing
practice and nursing education.Team-based, interdisciplinary approaches are highly effective for
improving clinical outcomes and reducing cost. There is a growing need of teaching methods that
incorporate opportunities for interdisciplinary education and collaborative practice.Now a days there
is increased emphasis on collaboration between healthcare disciplines. Also there is increased
student and nurse mobility (including increased licensure mobility),increased distance (online)
learning. Schools of nursing providing ongoing professional development for competence
requirements. Also there is an increased teaching of evidence-based practice.
8. The Current Nursing Shortage, Opportunities for Lifelong Learning and Workforce
Development
There is significant nursing manpower shortage both in acute and long-term care settings. That
results from many factors such as :
–nurses of the “baby boom” generation are beginning to retire.
–women today have numerous career opportunities; and
–perception of nursing as a “trade,” versus a “profession,” contributes to the lack of individuals.
As the age of entering students rises, the number of years of practice decreases also affects supply.
While the number of male and minority students has been steadily rising, their ranks are still
underrepresented. Workforce Development is a positive recent advances which includes the
opportunity to practice in a variety of clinical settings has resulted in dramatic increase in
opportunities for ANP`S, new careers in care management and case management. There is an
increasing interest in biotechnology, information technology, and pharmaceutical companies in
hiring skilled nursing professionals.Occupation attracted more women of superior class.Nursing
 training in regional languages also started.There different levels of education –graduate, post
graduate & doctoral levels.
Continuing & in-service education is introduced for the working nurses.Nursing education must
partner with the health care industry to develop innovative short and long-term solutions that address
the nursing shortage, including aggressive student recruitment and the initiation of an intense
media/marketing campaign. The public image of the nursing role must be revitalized to change
outdated perceptions.
 
The image of nursing has always been one of dedication, service to the patient, and selflessness.
Now as nursing profession, the issue of collective bargaining has become more important. 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. The nurses who have joined nursing unions have
increased. Nursing practices have often been defined and controlled by other groups also such as
physician and hospital administrators. These groups saw the potential power of an organized large
group of well educated and dedicated nurses and feared the time when they would become
independent. Even though , in area of the country where collective bargaining of health care workers
is not the part of the system, many hospital administrators react to any unionization attempts on the
part of nurses with hostility and resistance.
 
Concept of supportive supervision is coming up. Supportive supervision is a process that promotes
quality at all levels of the health system by strengthening relationships within the system, focusing
on the resolution of problems, and helping to optimize the allocation of resources. It focuses on
problem solving on the spot with the joint participation of the supervisee and supervisor.
Financial incentives are integral to the employment contract. It has been quoted in a study by
Hongoro and Normand that at least half of the variation in turnover can be attributed to financial
incentives. Now a day there is rise in performance linked payments. In one country in Africa,Nurses
and officials posted in remote health facilities in areas of high HIV prevalence are given a 31%
bonus if they stay on for more then 3 years. Also non financial incentives are also been introduced
into the work place as it has been seen that financial incentives are not enough to motivate the
employees e.g of non financial incentives are as follows:
 Career and professional development (inservice education programmes, study leave)
 Workload management
 Overtime payments
 Letter of appreciation to the good worker or for their extraordinary performance(best nurse
award)
 Flexible working arrangements
 Positive working environment
 Access to benefits and support(Child care leave, housing loan, Earned leave )
9. 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.
 
10. Evidence based practice
There has been a significant Advancement in Nursing Science and Research. The growing body of
nursing research provides a scientific basis for patient care and should be regularly used by the
nurses. Most studies concern health behaviors, symptom management, & improvement of patients’
and families’ experiences with illness, treatment, and disease prevention. 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.
 
11. Nursing audits
A careful review of nursing care and its effectiveness is done by the administrators of nursing
services. Not only clinical improvements but also emotional aspects of the patient need to be
measured to decide the quality of nursing care given.
 
12. Collective bargaining
The image of nursing has always been one of dedication, service to the patient, and selflessness.
Now as nursing profession, the issue of collective bargaining has become more important. Collective
bargaining is the uniting of the employees for the pupose 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. The nurses who have joined nursing unions have
increased. Nursing practices have often been defined and controlled by other groups also such as
physician and hospital administrators. These groups saw the potential power of an organized large
group of well educated and dedicated nurses and feared the time when they would become
independent. Even though , in area of the country where collective bargaining of health care workers
is not the part of the system, many hospital administration.
 
ISSUES IN NURSING ADMINISTRATION, NURSING PRACTICE AND , NURSING EDUCATION

 ISSUES IN NURSING PRACTICE

 Status of nursing in society in the health care delivery system.
 Renewal of nursing registration
 Diploma Vs degree in nursing for registration to practice nursing
 Nursing care standards
 Values reflected in our nursing performances.
 Attitude, human approach.
 Higher education for senior positions in nursing
 Nurse patient ratio
 Different levels of nurses that we need in our country.
 Quality in nursing v/s education and practice.
 Define and delineation of nursing functions at the different level.
 Non availability of health care programme of nurses.
 Non involvement of nurses in nursing matters.
 Poor pay structures.
 Many hospitals in India had no nurses at all.
 Lack of security and safety.
 Less promotional opportunities
 Harassment by other personnels
 Inadequate supplies
 INC has put forward the purposal to review nurse’s cadre to the health ministry.
 There are number of ethical issues related to nursing practice. By very nature of ethical
dilemma,there can never be one correct solution. Still there are number of ethical issues that nurses
are facing today for eg. Don`t resuscitate orders, Starting and withdrawing life support system, need
to disclosure HIV positive status to his wife against his wishes.
 
ISSUES IN NURSING EDUCATION
 Nursing Training schools multiplied.
 Lack of independent building for schools and colleges
 Lack of independent principal for schools and colleges
 Inadequate hostel facilities for students
 Shortage of qualified teachers in nursing
 Inadequate library facilities
 No UGC pay scales for college teachers in nursing
 Very less or no stipend for nursing students
 Less supply of A.V. aids
 Less promotional opportunities for teachers of both schools and colleges
 Insufficient efforts to prepare nurses for the job they are accepted to perform in their work
field in terms of appropriate skills, knowledge and right attitude and the desired behaviour patterns
reflecting the values for caring.
 
ISSUES IN NURSING ADMINISTRATION
Nursing as a profession has flourished from the time of Florance nightingale till present day nursing.
At some levels in nursing, the question of professionalism takes on immense significance. However,
to the busy staff nurse- who is trying to allocate client assignment for a shift , distribute the
medications at 9am to 24 clients ;and supervises ward aide, nursing students-the issue may not seem
very significant at all. There are number of issues related to the nursing administration few of them
are as follows:
 One of the concerns that plagued nurses and nursing almost from its development as a
separate health care speciality is the relatively large amount of personal responsibility shouldered by
nurses combined with a relatively small amount of control over their practice.
 Non involvement of nursing administrators in planning and decision making in hospital
administration
 Lack of knowledge in management among nursing administrators
 Interference of non nursing personnel in nursing administration
 No written nursing policies or manuals
 No proper job description for various nursing cadres.
 No organized staff development programs for nurses like orientation, in-service education,
continuing education etc.
 No special incentives
 Inefficiency of nursing councils of state and union to maintain standards in nursing
 
As far as nursing administration is concerned; it is in a pathetic condition. Health survey and
Development Committee (1946) recommended giving gazette ranks for Nurse Manager and WHO
guidelines are therefore giving decision making power to nurses. Both union and state government
have decided give some gazetted ranks to nurses.
Like this so many problems, prevailing in the nursing administration are as given below.
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.
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.
10. No special incentives like , Rajyosava 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 Govt.
 Measures to overcome these problems
 There should be one policy in the state in relation to nursing matters.
 All the nurses working in the different sector, i.e. Directorate of Health and family welfare,
Directorate of Medical Education, Directorate of ESI(M) Directorate of ISM and Director of
autonomous bodies, should be clubbed together and should be kept in one administration i.e.
“Directorate of Nursing”
Then only it is possible to bring some uniformity and improvement of nursing services in
hospitals and community setting.

 The Director of Nursing should be made Chairman/ President of State Nursing Council with
the assistance of “Nurse Registrar” of Joint Director Scale rested with powers to maintain standards
of nursing uniformity throughout the state.

RESEARCH

Priorities and challenges for health leadership and workforce management globally: a rapid review
By- Carah Alyssa Figueroa, Reema Harrison, Ashfaq Chauhan & Lois Meyer 2019
Abstract
Background
Health systems are complex and continually changing across a variety of contexts and health service
levels. The capacities needed by health managers and leaders to respond to current and emerging
issues are not yet well understood. Studies to date have been country-specific and have not integrated
different international and multi-level insights. This review examines the current and emerging
challenges for health leadership and workforce management in diverse contexts and health systems
at three structural levels, from the overarching macro (international, national) context to the meso
context of organisations through to the micro context of individual healthcare managers.
Methods
A rapid review of evidence was undertaken using a systematic search of a selected segment of the
diverse literature related to health leadership and management. A range of text words, synonyms and
subject headings were developed for the major concepts of global health, health service management
and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed
and Scopus) was undertaken to identify the key publication outlets for relevant content between
January 2010 to July 2018. A search strategy was then applied to the key journals identified, in
addition to hand searching the journals and reference list of relevant papers identified. Inclusion
criteria were independently applied to potentially relevant articles by three reviewers. Data were
subject to a narrative synthesis to highlight key concepts identified.
Results
Sixty-three articles were included. A set of consistent challenges and emerging trends within
healthcare sectors internationally for health leadership and management were represented at the three
structural levels. At the macro level these included societal, demographic, historical and cultural
factors; at the meso level, human resource management challenges, changing structures and
performance measures and intensified management; and at the micro level shifting roles and
expectations in the workplace for health care managers.
Conclusion
Contemporary challenges and emerging needs of the global health management workforce orient
around efficiency-saving, change and human resource management. The role of health managers is
evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and
managers have the capabilities to respond to the current landscape is critical.
SUMMARY
Nursing is facing new challenges. To participate actively in decision making concerning the
delivery of quality care to consumer patients, nurse practitioners, nurse administrators and nurse
educators must take on active role through their organization of the standards of nursing practice,
peer review and legislative programs and assure the public of quality care at a reasonable price.
Today’s professional nurses assume leadership and management responsibility regardless of
the activity in which they are involved. Nurses may assume leadership role their work setting, their
profession and their community, whether or not they have designated positions of leadership.

CONCLUSION: 
It has been rightly said “The Decisions that you make and the actions that you take upon the
earth are the means by which you evolve.” By demonstrating their knowledge in nursing practice ,
education and administration nurses can demonstrate their expert power. This knowledge may
increase the amount of respect that they are given by physicians and the society as such along with
personal professional satisfaction.
“Today’s issues are tomorrow’s trends”
 BIBLIOGRAPHY

1. Basavanthappa B.T., Nursing Administration, 2nd Edition, Jaypee

Publication, Chapter 5 & 31, Page No. 92-105, 843-844

2. Dr. Ashok Sahni, Clinical Updates and Management of Nursing

Services, 2nd Edition, Chapter 2, page No. 11-13

3. Mary Lucita, Nursing: Practice and Public Health Administration, 2nd

Edition, Elsevier Publication, Chapter 1, Page No. 3-17

4. Mohanti B., School Administration and Supervision, 1st Edition, Deep &
Deep Publication, Chapter 1, Page No. 21-24

JOURNALS

1. The Nursing Journal of India, 1969 Sep. Vol. XIV, Modern Trends in
Nursing Administration, Page No. – 69-70

INTERNET REFERENCE

 trends and issues nursing administration, content available at

www.publicadministation.org/trends
 trends and issues nursing administration , content available at
www.americanjournalofadm.co.in/trends