YETI HEALTH SCIENCE ACADEMY

PURBANCHAL UNIVERSITY
KANTIMARG, KATHMANDU

REPORT ON
“LEADERSHIP AND MANAGEMENT PRACTICUM”
GREEN CITY HOSPITAL, BASUNDHARA

Submitted to: Submitted By:

Ms Rupa Devi Thapa PBBN 3rd Year
PBBN Co-ordinator 9th batch
Ms Alisha Rijal YHSA
Ms Anisha Dhakal Sudmitted on: 2077/12/29
Clinical superviser
PBBN 3rd year
YHSA
ACKNOWLEDGEMENT
This report has been prepared during Leadership and Management Practicum in Green City
Hospital, Basundhara for the practical fulfillment of P.B.B.N Nursing 3rd year.

Perseverance, inspiration, and motivation have been always played a key role in the success of
any venture. It is often difficult to understand the wide spectrum of knowledge without proper
guidance and advice. Management process is not successful only by a single mind; there are so
many helping hands behind it. So, we want to acknowledge all of them for their kind
suggestions, guidance and help throughout the management period.

First, we would like to express our sincere gratitude to Purbanchal University and Yeti Health
Science Academy for providing us an opportunity to conduct this Leadership and Management
Practicum as a partial fulfillment of curriculum of post basic bachelor’s in nursing.

We would also like to thank Ms. Rupa Devi Thapa, PBBN 3rd year coordinator of Yeti Health
Science Academy as well as our clinical supervisors Ms. Alisha Rijal as well as Ms. Anisha
Dahal for their continuous guidance, support and supervision during our Leadership and
Management Practicum.

Similarly, we would like to thank the Director Mr. Lok Bahadur Tandan as well as Senior
Nursing Director Ms. Ganga Humagain of Green City Hospital for allowing us to perform our
Leadership and Management Practicum at Green City Hospital. Likewise, I would like to thank
the Nursing Director of Green City Hospital Ms. Sajina Dahal for her continuous supervision and
guidance throughout our practicum. We would also like to thank the nursing in-charges as well
as all the staff of Green City hospital for their support and cooperation during our practicum.

Yours Sincerely,

PBBN 3rd year

9th batch
 TABLE OF CONTENT

S. N Contents Page No.

1 Background
2 Objectives
3 Grand Presentation
Green City Hospital
 Mission
 Vision
 Goals
4 Managerial Function of Green city Hospital
 Planning
 Budgeting
 Communication and Coordination
 Logistic management
 Organogram of Green City Hospital
 Health Services
5 Change Process
6 Data Presentation
7 SWOT Analysis
8 Recommendation
9 Summary
10 Conclusion

1. BACKGROUND

This report is prepared as the fulfillment of the curriculum of PBBN 3 rd year of Leadership and
management practicum. For the practical fulfilment we were posted at Green city Hospital,
Bashundhara for three weeks i.e., Chaitra, 2077. We formed the group among the us and each
group were assigned to the relative departments i.e., General Ward, Semi cabin, ICU, Post-
operative Ward and Emergency department.

During our leadership and management practicum, we had to perform our duties as student in-
charge, student supervisor and sub-ordinate in our relative department. During our in-charge ship
we performed the managerial activities like resource management, ward management, work
assignments and conducting meetings as well as we also performed group activities like
providing continuous education (in-service education), change process and project planning.

2. OBJECTIVES

General Objective

To perform practicum of leadership and management for the fulfillment of requirements of

PBBN 3rd Year curriculum of Purbanchal University.
Specific Objectives

 To collect information of the hospital.

 To collect data of admitted patients of three months.
 To analyze collected data of admitted patients of three months.
 To develop logistics managerial skills.
 To do change process.
 To provide Inservice education according to needs of staffs.
 To perform the managerial activities like ward management, work assignments and
conducting meetings.
 To perform duties as student in-charge, student supervisor and sub-ordinate.

3. GRAND PRESENTATION

This grand presentation is the final presentation of all those activities whatever we did
throughout our posting in the Green City Hospital.
It is held on 2077/12/29 on the 7th floor meeting hall of Green city hospital.
GREEN CITY HOSPITAL
Green City Hospital (GCH) is a well-equipped multi-specialty private hospital. It is 100 bedded
hospital including 13 beds for ICU, 11 beds for POW/High Care Unit, and 7 beds for NICU,
modular operation theatre and fully automated laboratory. It was established on Magh 16, 2069
BS with a motive to provide highest quality care to the people. The hospital has been providing
different indoor and outdoor health Services and also free health camps.
Mission
To be the number one choice for patients, doctors, medical practitioners, stakeholders &
employees.
Vision
Improvement of health and the alleviation of pain, suffering and sickness for the people we
serve.
We will achieve this through providing high quality, cost effective and integrated health care
with compassion and through the constant quest for new treatment strategies and the
development of the people who work for us.
Our core values are Excellence,compassion,respect,delivery,Learning and Improvement.
Collaboration and partnership are central to our approach in delivering our triple functions of
patient care,education and research.
The patient is the heart of everything.GCH is committed to delivering high quality care to patient
sir respective of age,disability,religion,race,gender and sexual orientation, ensuring that its
services are accessible to all but tailored to the individual.
GCH strive for excellence in health care by encouraging a culture of support,respect,integrity
and team work by monitoring and assessing its performance against national and international
standards,by learning from its successes and setbacks, by striving to improve what it does
through innovationad change,and by working in partnership and collaboration with all the
agencies of health and social care in the area it serves. Atlast but not the least,Iwant to express
that ethics and integrity are critical components of our culture,and it's upto all of us to disclose
and any compliance violation and assist in doing the right thing without fear of retaliation.It's
through your actions that we preserve and advance our reputation and industry leadership.

Goals

To extend the health sector, provide effective health service and improve the condition of the
people's health and to provide different practical setting to students to produce efficient human
resources.
 4. MANAGERIAL FUNCTIONS OF GREEN CITY HOSPITAL

Planning

In Green City Hospital plans are made by hospital management team. Some futures of the
hospital are as follows:

1. Continue services from its own building.

2. Extension of hospital to 200 bedded hospital.
3. Advanced CT scan and MRI facility.
4. Mammography.
5. Staff transportation facilities.
6. Organize the parking area.
7. Separate high dependency unit.

Budgeting

Budgeting is the process of preparing detailed financial statement that cover a given time in
future. Budgets reflect the company’s financial targets and goal. It can be prepared for short,
mid, or long time.
Green city Hospital is providing all its services in very subsidized rates to the poor patients and
the patients from rural areas. In compliances with the government rule hospital is also serving the
senior citizen, free bed and a provision of discount to the needy and poor people.It also has the
history of serving the poor patient totally free of cost. During hospital establishing phase it has
provided free open-heart surgery to 16 patients in free of cost. Not only in hospital setting it also
conduct different free health camps outside valley like Nuwakot, Rasuwa, Dhading, Lamjung in
seasonal basis. Screening camp is conducted for which the budget is allocated from annual
budget. Fiscal year is on the month of Shrawan.
  Sources of budget in Green city Hospital: Revenue, Patient services, academic sources,
foreign pay (for internship). 
 Allocation of budget in different wards: Department wise budget allocation is not done.
As per demand logistic supply is done and recording is done accordingly.
 Health Camps: Mobile health camps are run with collaborating with local partners, clubs,
designated member of society for which budget is allocated as per the previous record.
 Environmental Sanitation: Every Saturday programme is launched as “Sarsafi Abhiyaan”
for which hospital provide only a logistic supply.
 Salary Distribution: As, per labour act salary is distributed to staff members including
night allowances, dress, leave, overtime. Rs. 500 is provided as grade since last 3 yrs.
 Budget for pharmacy: Pharmacy is run by outsources so; no budget is allocated for it.
 Budgeting for staff and poor patient: There is the provision of 25% discount to rural
people 10% free bed services to poor patient for which 10% of free bed is allocated from
total bed and 50% discount for the member of the hospital.

Staffing

The staffs are recruited not by advertisement. Human Resource Committee shortlist the name of
candidates then will take interview. Nursing turnover is very high as 3-4 staffs resigned monthly.
There are no volunteers in Greencity Hospital. Basic salary of staffs started from Rs. 10,000
which is increased by Rs. 500 each year. There is no provision of provident funds at Greencity
hospital. Best staff award is given annually.
Nurse Patient Ratio
 General Ward - 1:6
 Post-Operative Ward – 1:3
 Intensive Care Unit – 1:2
Leave Facility
There is no leave till 6 months of working period, after 6 months to 12 months 7 days leaves are
provided. After one-year total leave of 36 days are provided.
 6 days casual leave
 6 days annual leave
 12 days home leave
 12 days sick leave
Other Facilities
  Uniform is provided by hospital.
 On call payment
 Night allowance
 Leave payment in the end of year.
 Training according to seniority of staffs
 50% discount for staffs and 25% for family member of staffs.
 60 days of maternity leave. (60 days paid maternity leave and additional 1 month of
unpaid leave.)
 Festival Allowance/Dashain Allowance, equivalent to 1 month salary.
 Social Security Fund Contribution after 1 year of service.
Communication and Coordination

The term co-ordination means the unification, integration, synchronization of the efforts of group
members to provide unity of action in the pursuit of common goals. It is that hidden force which
binds all the function of management.
Linked Organization of Green City Hospital
 Ministry of health
 Department of health
 Police
 Cooperative link- cooperative organization, bank, finance

Referral of Cases
Refer to:
Cases are referred to the specialized hospital such as Teaching Hospital, Gangalal Hospital,
Neuro hospital, Bir hospital from Green City hospital.
Most of the cases are referred from clinic, rural area in Green City Hospital.
Refer from:
Cases are referred from clinic and rural area.
Means of Communication.
  The communication pattern of this hospital flows from higher to lower or lower to higher
or both ways.
 Different means and Medias like call, message, e- mail and notice, letter, verbal etc.
Barrier of Communication
 During means of communication some technical issues arise while circulating
information among the staff.
Logistics Management Process in Green City Hospital
Hospital logistics is a set of design, planning and execution activities which enable the purchase,
inventory management and replenishment of goods and services surrounding the provision of
medical services to patients. Each activities of the logistic management in this hospital focuses in
contributing excellence in customer services.
Logistics management in the hospital is done by the tender winning company and they manage
overall activities regarding logistics.
 Hospital management committee plans the inventory need, forcasting the inventory,
understand market trends and develop business strategies. Inventory needs are planned as
per the demand and supply of logistics resources in different units of hospital as well as
consumers satisfaction regarding the use of those inventory. Logistics resources in
hospital are as follow:
 Beds, trolley, furniture, equipments
 Electrical machines
 Drugs and medical instruements
 Linens
 Sterilization Machine
 Stationary as well as Toiletry equipments
 Cleaning Materials and many more.
 Next step is procurement, quantification (identification of requirement) and tender
opening by hospital.
 Tender compassion based on quantity, cost, delivery time and payment term.
 Indent issued by hospital administration.
 After cost analysis and negotiation between supplier and consumer, purchasing action is
done by hospital management committee.
 Transportation and storage of inventory in Green city Hospital premises.
 Inventories check for both quantity and quality of product as the product should satisfy
the needs of consumers with quality services and should be in adequate amount.
 The supplier posts the purchase invoice against the MRN (material receive note) and then
consumer makes the payment based on payment term.

In this above process, inventory reach to the consumer hand from supplier.
 Logistic management in different departments of hospital
1. As the Medical Store Section keeps the overall records of logistics or inventory of the
hospital, the supplies are arranged throughout the ward Via the Ward Incharge.
2. All daily necessary materials like drugs, equipments, papers, and stationary items,
physical materials of wards, needed for ward are assessed by ward in-charge. Assessment
is usually done to assess the demand of inventory needs as can be done on the basis of
observation, stock calculation, comparison of previous demand and supply, regular drugs
and instruement recordings register as well as records of any breakage or damaged
articles and discussion with duty staffs.
3. Then, issued the needed supplies required for a week from the store by filling requisition
form by ward in-charge which is further signed by supervisor or management head or
nursing director. Requisition form is filled up every Sunday of week.
4. Supplies are provided to ward as per the requisition form according to patient flow ratio
by FIFO system (First in First out System).
5. Ward Incharge along with attendents brings the inventory from the medical store section
to the ward. If any inventory is out of stock in Store section, folow up with other
requisition form should be done next week.
6. Ward in-charge stores all the supplies appropriately in the ward and used the supplies
according to requirement of ward.
7. Overstock inventory can be sent back to supplies 3 month before from the expiry date.
8. As per the Ward Incharge, there is not maintainance of ependable and non expendable
stock book in ward.

Involvement of Student Incharge and Sub ordinates in Logistics Management

 Daily assessment and recording of supplies: Drug count, equipment count etc.
 Fill up the requisition form under guidance of Ward Incharge.
 Receive inventory needs from store with Ward Incharge.
 Keep the storage of inventory in assigned ward.
 Maintain stock book and check for expiry and returned to store section.
 Inform to Ward Incharge for any breakage or losses of any items.
Organogram of green city hospital
Health services
Health Services Outdoor
1.Orthopedic

2.Pediatrics and Adolescents Medicine

3.Obstetrics and Gynecology

4.Internal Medicine

5.Nephrology

6.Gastroenterology and Hepatobiliary

7. Medical Oncology
8. Neurosurgery

9. ENT Head and Neck Surgery

10.Burn, Plastic and Cosmetic Surgery

11. Thoracic, Breast and Thyroid Surgery

12. Cardio-Vascular Surgery

13. Psychiatry
14. Radiology

15. Pathology

16. Physiotherapy
Health Service Indoor

1.General Ward

 General Ward A- 13

 General Ward B- 14

2.Post-Operative Ward- 11

3.Intensive Care Unit- 11

4.Neonate Intensive Care Unit- 4

5.Dialysis- 6

6.Cabins

 Semi Cabin- 19

 Double Cabin- 6

 Single Cabin-6
7. Emergency- 10
5. Change process
 Semi Cabin, General A and B

Proper Disposal of Syringes

BEFORE
 AFTER
Hand dryer

BEFORE
Location and number of blood banks
BEFORE
AFTER
ECG trolley

BEFORE
AFTER
GCS chart
Placement of a notice board

Before
After
NPO tag

Before

After

Nursing station chart

Before
After
Placement of the direction chart

Before
 After

 Post-op Ward
 Change process on replacing towel with hand drier machine:

Before After
After

Proper management of the emergency drug counting register.

Before After
 ICU Department

Placed the patient’s information board little down

Before
After
Kept the staff’s notice board at appropriate place for its proper use.

Before
After
We keep continue the visitor card during visiting hour to control crowd.

Before
After
After
After
We placed the clear notice above the visitor shoes rack for its proper use.

Before
After
  Emergency

Maintained the information board properly by arranging the Emergency protocol, notice
and phone number in sequential manner.

Before
After
 After

Drew the new Glasgow coma scale chart and replace it in previous place
Before
 After

Made one medical diagnosis abbreviation binding book

Labelled the emergency drugs and make it clear

Before
After
 After

Made new instrument and emergency drugs count book

Before
After
After
Data Collection

Data was collected from general ward, semi-cabin, post-operative, emergency ward respectively
from the month of Poush,Magh and falgun of 2077.

AGE DISTRIBUTION
250
217
200 194200
163
138142 146
150 132 139
No of Patients

94 96
100 84 85 81 87
72 70 74
50
21 18 24
0
0-10 11- 21-30 31-40 41-50 51-60 >60

Poush Magh Falgun

 AGE DISTRIBUTION
250
217
200 194200
163
138142 146
150 132 139
No of Patients

94 96
100 84 85 81 87
72 70 74
50
21 18 24
0
0-10 11- 21-30 31-40 41-50 51-60 >60

Poush Magh Falgun

Fig 1: Bar Graph showing Age Distribution of Patients.

The Above Bar Graph shows that there were highest percentages of patients of age group 21-30 and
lowest percentages of patients of 0-10 age group admitted in 3 months.
 GENDER DISTRIBUTION
450 426
395 391
400 367
341 357
350
300
No of Patients

250
200
150
100
50
0
Poush Magh Falgun

Male Female
Fig 2: Bar graph showing Gender Distribution of Patients

The Above bar Graph shows that there were greater percentages of male patients than Female patients
admitted in 3 months.
 ETHNICITY DISTRIBUTION
450
400 381
350 330
298
300
250
No of Patients

207
192 190
200 165 173
160
150
100
58
50 39 33 28
24 26
0
Brahmin Chhetri Janajati Dalit Madhesi

Poush Magh Falgun

Fig 3: Bar Graph showing Ethnicity Distribution of Patients.

The Above Bar Graph shows that there were highest percentages of janajati and lowest percentages of
dalit patients admitted in 3 months.
 AREA OF RESIDENCE
500 464
450 426
392
400 357
344
350
No of Patients

294
300
250
200
150
100
50
0
Poush Magh Falgun

Inside Outside
Fig 4: Bar Graph showing Area of Residence of Patients.

The Above Bar Graph shows that there were greater percentages of patients of inside the valley than
patients of outside the valley in 3 months.

PATIENT OUTSIDE VALLEY

120
105
100 91 92

80 74

55 59
60 53 53 53 52 50
44 47
38 39 36
40 29 25
20

0
Nuwakot Dhading Rasuwa Gorkha Kapilvastu Others

Poush Magh Falgun

Fig 5: Bar Graph showing patient outside valley.

The Above Bar Graph shows that there was highest percentage of patients from Nuwakot and lowest
percentages of others than from Dhading, Rasuwa, Gorkha and kapilbastu were admitted in 3 months

BED OCCUPANCY

60
52.97%
50
44.89% 43.13%
40
Percentage of Occupied Bed

30

20

10

0
P Bed occupancy Fa
Fig 6: Bar Graph showing Bed Occupancy

The Above Bar Graph shows that there were highest percentages of bed occupancy in magh and lowest
percentages of bed occupancy in falgun.
 MEDICO LEGAL CASES
80 76
70
60 57
54
50
No of Patients

40
40 34
31
30
20
10
0
Poush Magh Falgun

Male Female
Fig 7 : Bar Graph showing Medico Legal cases

The Above Bar Graph shows that there were greater percentages of female medico legal cases admitted
than male medico legal cases admitted in 3 months.
 CENSUS OF EMERGENCY
180
160 153

140
120 115 116 116
101
No. of Patients

97
100
80 69
60 52
40 29
23
20 12 7 6 3
4 6 3 2
0
Admission Discharge LAMA DOPR Refer Brought
Dead

Poush Magh Falgun

Fig 8 : Bar Graph showing census of emergency

The Above Bar Graph shows that there were highest number (116) of admission in Falgun and lowest
number (101) in Magh. Likewise there were highest number (153) of discharge in Falgun and lowest
number (97) in Poush. Similarly, there were highest number (29) of LAMA in Magh and lowest number
(12) in Poush. Likewise, there were highest number (69) of DOPR in Poush and lowest number (4) in
Magh. Similarly, there were highest numbers (6) of Refer in Poush and lowest number (2) in Falgun.
Likewise, there were highest number (7) of brought death in Poush and lowest number (3) in Falgun.
 250 CENSUS OF GENERAL AND SEMI CABIN WARD
211
204
200 186
161
150
150 135
No. of Patients

100
65 60
56 52
50 32
40

4 0 0 5 0 0 1 1 2
0
Admission Discharge Trans In Trans Out DOPR LAMA Refer
Poush Magh Falgun
Fig 9: Bar Graph showing census of general ward and semi cabin ward

The Above Bar Graph shows that there were highest numbers (211) of admission in Falgun and lowest
numbers (161) in Magh. Likewise, there were highest numbers (204) of discharge in Falgun and lowest
number (135) in Magh. Likesise, there were highest number (65) of transfer in and lowest number (32)
in Poush. Similarly, there were highest number (60) of transfer out in Falgun and lowest number (40) in
Poush. Likewise, there were highest numbers (4) of DOPR in Poush and no DOPR in Magh and Falgun
respectively. Similarly, there were highest number (5) of LAMA in Poush and no LAMA in Magh and
Falgun. Likewise, there were highest numbers (2) of Refer and lowest number (1) in Poush and Magh
respectively.
 Source of Admission of General & Semi Cabin
200
178
180
160
131 138
140
120
100
80
60 47
40 36
26 23 20
18 16
20 8 10
0
ER POW/HCU Annex Ward ICU

Poush Magh Falgun

Fig 10 : Bar Graph showing source of admission of general and semi- cabin

The Above Bar Graph shows that there were highest percentages of source of admission of general and
semi- cabin from ER and lowest percentages from ICU in 3 months.
 CENSUS OF ICU
45
39
40
34
35 32
30 26
No. of Patient

25 20
20 16
15 13 13
11 11 10
10 5 5 4
5 2 3 2 3 2
0 0
0
Admission DIScharge Trans In Trans Out DOPR LAMA Expired
Axis Title

Poush Magh Falgun

Fig 11: Bar Graph showing census of ICU

The Above Bar Graph shows that there were highest numbers (39) of admission in magh and lowest
number (20) in falgun. Likewise, there were highest numbers (11) of discharge in magh and no discharge
in Poush and Falgun. Similarly, there were highest number (16) of transfer in in Magh and lowest
number (11) in Falgun. Likewise, there were highest numbers (32) of transfer out in Poush and lowest
number (13) in Falgun. Similarly, there were highest number (3) of DOPR in Magh and lowest number (2)
in Poush and Falgun respectively. Likewise, there were highest number (5) of LAMA in Poush and Magh
respectively and lowest number (3) in Falgun. Similarly, there were highest numbers (10) of Expired in
Magh and lowest number (2) in Falgun.
 Source of Admission of ICU
35

30 29 30

25
20
20
15 16
15 12
10
6 5
5 3 2 3 3 2 2 4
2 1 1 1 1
0
0
ER Covid ICU Semi Cabin OT General Post Op Annex
Ward Ward

Poush Magh Falgun

Fig 12: Bar Graph showing source of admission of ICU

The Above Bar Graph shows that highest percentages of source of admission of ICU were from ER and
lowest percentages from Annex ward in 3 months.

CENSUS OF POST OP
180 164 161
158
160
140
120
No of Patients

100 85
81 78 76 77
80 75

60
40
20
1 1 0 0 1 0
0
Trans In Trans Out Discharge Death LAMA

Poush Magh Falgun

Fig13: Bar Graph showing census of post op

The Above Bar Graph shows that there were highest numbers of transfer in and lowest number of death
and LAMA respectively in 3 months.
 Source of Admission Of Post Op
100
90 87 85
82
80
70
60 52
50 45
40 37
30 25 24 24
20
11 9
10 7 4 5 5
0
OT ER ICU Semi Cabin General

Poush Magh Falgun

Fig 14: Bar Graph showing source of admission of post op

The Above Bar Graph shows that highest percentages of source of admission of post op were from OT
and lowest from Semi- Cabin in 3 months.

DEPARTMENTS IN EMERGENCY
140 132
118 123
120 114
100 104
100
80
No of Patients

60 53 52
40
40
20 15 13 15 15 16 17
2 2 2 6 5 9
0

Poush Magh Falgun

Fig 15 : Bar Graph showing departments in emergency

The Above Bar Graph shows that there were highest percentages of patients of medicine and lowest
percentages of patients of ENT in emergency in 3 months.

DEPARTMENTS OF GENERAL WARD

80 67
60
46
39
40 2933 33
18 18 18 17
20 8 11
2 1 4 6 6 7 4 6 4
No. of Patients

Poush Magh Falgun

Fig 16: Bar Graph showing department of general ward

The Above Bar Graph shows that there were highest percentages of patients of medicine and lowest
percentages of patients of hematology + oncology in general ward in 3 months.
 DEPARTMENT IN SEMI CABIN
70
60 60
60
50
40
30 28
20
No of Patients

20 16 13 14 15 13
11
10 6
2 2 1 0 0 1 2 2 3 4
0

Poush Magh Falgun

Fig 17: Bar Graph showing department s in semi cabin

The Above Bar Graph shows that there were highest percentages of patients of medicine and lowest
percentages of patients of hematology+oncology in semi-cabin in 3 months.
 DEPARTMENT OF ICU
45 42
40
40
35 34
30
25
No of Patients

20
15 11
10 8
6 5
5 2 2 2 2 3
0 1 0
0
Medicine Surgery Orthopedics Oncology Cardiology+CTVS

Poush Magh Falgun

Fig 18: Bar Graph showing departments of ICU

The Above Bar graph shows that there were highest percentages of patients of medicine and lowest
percentages of patients of oncology in ICU in 3 months.
 DEPARTMENTS OF POST OP
70 66 64

60 57 55

50
40 40
No of Patients

40

30 26
20 18 18
20 17 15
13 12 13
10 10
10 6

0
Medicine Surgery Ortho ENT Cardio+CTVS Gynae

Poush Magh Falgun

Fig 19: Bar Graph showing departments of post op

The Above Bar Graph shows that there were highest percentages of patients of surgery and lowest
percentages of patients of ENT in post op in 3 months.
 RESPIRATORY CASE IN EMERGENCY
14 13 13
12
10
10
No of Patients

8
6
4 3
2 2 2
2 1 1 1
0 0 0 0 0
0
AE of COPD Pneumonia Apnea PTB Acidosis

Poush Magh Falgun

Fig 20: Bar Graph showing respiratory cases in emergency

The Above Bar Graph shows that there were highest percentages of patients of AE of COPD and lowest
percentages of patients of Acidosis in emergency in 3 months.
 NEPHRO MEDICINE CASE IN EMERGENCY
7
6
6
5 5
5
No of Patients

4
4

3
2 2 2
2
1 1
1

0
CKD/AKI RPGN UTI

Poush Magh Falgun

Fig 21: Bar Graph showing nephro medicine case in emergency

The Above Bar Graph shows that there were highest percentages (55.55%) of patients of UTI and lowest
percentages (22.22 %) of patients of CKD/AKI and RPGN respectively in Poush. likewise; there were
highest percentages (46.15%) of patients of CKD/AKI and lowest percentages (15.38%) of patient s of
RPGN in Magh. Similarly, there were highest percentages (66.66%) of patients of UTI and lowest
percentages (16.66%) of patients of CKD/AKI and RPGN respectively in Falgun.
 GASTRO MEDICINE CASE IN EMERGENCY
16 15
14
12 12
12 11
No of Patients

10 9 9 9
8
8 7 7
6 5
4
4

0
Liver disease APD AGE GRD+UGI bleed

ER Poush ER Magh ER Falgun

Fig 22: Bar Graph showing gastro medicine case in emergency

The Above Bar Graph shows that there were highest percentages (29.03%) of patients of liver disease
and APD and lowest percentages (16.12%) of patients of GRD+ UGI bleed in Poush. Likewise, there were
highest percentages (37.5%) of patients of APD and lowest percentages (12.55) of patients of GRD+UGI
Bleed in Magh. Similarly, there were highest percentages (33.33%) of patients of liver disease and lowest
percentages (15.55%) of patients of GRD+ UGI Bleed in Falgun.
 NEURO MEDICINE CASE IN EMERGENCY
9
8
8
7
7
6
6
No of Patients

5
4 4
4
3
3
2 2 2 2
2
1
1
0 0 0 0 0 0 0
0
Seizure disorder TIA Migraine GBS Bellspalsy Stroke

Poush Magh Falgun

Fig 23: Bar Graph showing neuro medicine case in emergency

The Above Bar Graph shows that there were highest percentages (53.84%) of patients of Seizure
disorder and no patients of Migraine, GBS and Bellspalsy in Poush. Likewise, there were highest
percentages (34.78%) of patients of Seizure disorder and lowest percentages (8.69%) in Magh. Similarly,
there were highest percentages (40%) of patients of Seizure disorder and Migrain and no patients of
GBS, Bellspalsy and Stroke in Falgun.
 GENERAL MEDICINE CASE IN EMERGENCY
20 19
17
16 14
12 11 10 9
8 7 7 8
5
No of Patients

3 4 3
4 2 2
0 0 0 0 0 0
0

Poush Magh Falgun

Fig 24: Bar Graph showing general medicine case in emergency

The Above Bar Graph shows that there were highest percentages (38%) of patients of Physical Assault
and no patients of Electric Shock and Vitamin deficiency in Poush. Likewise, there were highest
percentages (32.55%) of patients of Physical Assault and no patients of Vitamin deficiency in Magh.
Similarly, there were highest percentages (39.28%) of patients of Physical Assault and no patients of Dog
bite and Electric Shock in Falgun.
 GI SURGERY CASE IN EMERGENCY
40
35
35
30
25
20
No of Patients

20
15 14

10 8
5 4
5 2 3 3
1 0 1
0
Pain abdomen Cholelithiasis Appendicitis Hernia

Poush Magh Falgun

Fig 25: Bar Graph showing Gi surgery case in emergency

The Above Bar Graph shows that there were highest percentages (81.3%) of patients of Pain abdomen
and no patients of Hernia in Poush. Likewise, there were highest percentages (53.84%) of patients of
Pain abdomen and lowest percentages (3.84%) of patients of Appendicitis in Magh. Similarly, there were
highest percentages (74.07%) of patients of Pain abdomen and lowest percentages (3.7%) of patients of
hernia in falgun.
 URO SURGERY CASE IN EMERGENCY
12
10
10

8
No of Patients

6 5 5
4
4 3

2 1
0 0
0
Ureteric calculus Nephrolithiasis BEP

Poush Magh Falgun

Fig 26: Bar Graph showing Uro surgery case in emergency

The Above Bar Graph shows that there were highest percentages (50%) of patients of Ureteric calculus
and Nephrolithiasis and no patient of BEP in Poush. Likewise, there were highest percentages (63.63%)
of patients of Ureteric calculus and lowest percentages (9.09%) of patients of BEP in Magh. Similarly,
there were highest percentages (71.42%) of patients of Ureteric calculus and no patient of BEP in
Falgun.
 NEURO SURGERY CASE IN EMERGENCY
2.5
2 2
2
1.5
1 1 1 1 1 1 1 1
1
No of Patients

0.5
0 0 0 0 0 0 0 0
0

Poush Magh Falgun

Fig 27: Bar Graph showing neuro surgery case in emergency

The Above Bar Graph shows that there were highest percentages (33.34%) of patients of Hemorrhagic
stroke and no patient of Head injury, intracranial bleed and Glioma in Poush. Likewise, there were
highest percentages (28.57%) of patients of SDH and no patient of Glioma in Magh. Similarly, there were
highest percentages (50%) of patients of Intracranial bleed and Glioma and no patient of SDH, Head
injury and CVA in Falgun.
 CARDIOLOGY CASE IN EMERGENCY
14 13
12 11
10
No of Patients

8
6
6
4
4 3 3
2
2 1 1 1 1 1
0 0 0 0 0 0
0
HTN MI Anemia Arrythmia Cardiomegaly RHD

Poush Magh Falgun

Fig 28: Bar Graph showing cardiology case in emergency

The Above Bar Graph shows that there were highest percentages (61.1%) of HTN and no patient of RHD
in Poush. Likewise, there were highest percentages (65%) of patients of HTN and no patient of Arrythmia
and Cardiomegaly in Magh. Similarly, there were highest percentages (37.5%) of patients of Anemia and
no patient of Arrythmia, Cardiomegaly and RHD in Falgun.
 GYNAE/OBS CASE IN EMERGENCY
9
8
8
7
6
6
5
No of Patients

5
4 4
4
3 3
3
2 2 2 2 2
2
1
0 0 0
0
ANC PV Bleed Ectopic Dysmenorrhea LSCS

Poush Magh Falgun

Fig 29: Bar Graph showing gynae/obs case in emergency

The Above bar Graph shows that there were highest percentages (40%) of patients of ANC and no
patient of LSCS. Likewise, there were highest percentages (40%) of patients of ANC and no patient of
Dysmenorrhea. Similarly, there were highest percentages (25%)) of patients of ANC, PV Bleed,
Dysmennorrhea and LSCS and no patient of Ectopic in Falgun.
 ENT CASE IN EMERGENCY
1.2
1 1 1 1 1 1
1

0.8
No of Patients

0.6

0.4

0.2
0 0 0
0
Tonsillitis Epistaxis Foreign body

Poush Magh Falgun

Fig 30: Bar Graph showing ENT case in emergency

The Above Bar Graph shows that there were highest percentages (50%) of patients of Tonsillitis and
Foreign body and no patient of Epistaxis in Poush. Likewise, there were highest percentages (50%) of
patients of Tonsillitis and Epistaxis and no patient of foreign body in Magh. Similarly, there were highest
percentages (50%) of patients of Epistaxis and Foreign body and no patient of Tonsillitis in Falgun.
 ORTHO CASE IN EMERGENCY
100 94
90
80
70
60 58 54
No of Patients

50
40
30 28
20 18
14
8 9
10 2
0 0 0
0
RTA Osteoarthritis Fall+cut injury Fracture

Poush Magh Falgun

Fig 31: Bar Graph showing ortho case in emergency

The Above Bar Graph shows that there were highest percentages (55.23%) of patients of RTA and no
patient of Osteoarthritis and Fracture in Poush. Likewise, there were highest percentages (71.21%) of
patients of RTA and lowest percentages (1.5%) in Magh. Similarly, there were highest percentages
(66.66%) of patients of RTA and no patient of Osteoarthritis in Falgun.
 PSYCHIATRIC CASE IN EMERGENCY
9
8
8
7
6
5
No of Patients

5
4
3
3
2 2
2
1
0 0 0 0
0
Anxiety disorder Panic attack Conversion disorder

Poush Magh Falgun

Fig 32: Bar Graph showing psychiatric case in emergency

The Above Bar Graph shows that there were highest percentages (71.42%) of patients of Anxiety
disorder and no patient of Panic attack in Poush. Likewise, there were highest percentages (60%) of
patients of Panic attack and no patient of Conversion disorder in Magh. Similarly, there were highest
percentages (100%) of patients of Anxiety disorder and no patient of Panic attack and Conversion
disorder in Falgun.
 TOTAL RESPIRATORY CASES
60 56
51
50 46
40
40

30
No. of Patients

22 23
20
10 8
10 6
3 3 2 2 2 0
0
Pneumonia Pleural COPD TB URTI
effusion

Poush Magh Falgun

Fig 33: Bar Graph showing total respiratory cases

The Above Bar Graph shows that there were highest percentages (50%) of patients of COPD and lowest
percentages (2.5%) of patients of TB in Poush. Likewise, there were highest percentages (60.87%) of
patients of COPD and lowest percentages (2.17%) in Magh. Similarly, there were highest percentages
(50%) of patients of Pneumonia and no patient of URTI in Falgun.
 TOTAL NEPHRO CASES
30
26
25
22
20
17
15 13 14
No. of Patients

10 8
7 6
5 4 5
5
0
0
CKD AKI Nephritis Nephrotic
syndrome

Poush Magh Falgun

Fig 34: Bar Graph showing total nephron cases

The Above Bar Graph shows that there were highest percentages (50%) of patients of CKD and lowest
percentages (14.70%) of patients of AKI and Nephrotic syndrome in Poush. Likewise, there were highest
percentages (34.15%) of patients of AKI and lowest percentages (14.63%) of patients of Nephrotic
syndrome in Magh. Similarly, there were highest percentages (50%) of patients of AKI and no patient of
Nephrotic syndrome in Falgun.
 TOTAL GASTROMEDICINE CASES
18 17
16
16
14 13
12
12 11
10
10 9
No. of Patients

8
8
6 5
4
2
0
Liver Disease AGE UGI bleed

Poush Magh Falgun

Fig 35: Bar Graph showing total gastro medicine cases

The Above Bar Graph shows that there were highest percentages (40.97%) of patients of UGI bleed and
lowest percentages (30.95%) of patients of AGE in Poush. Likewise, there were highest percentages
(36.66%) of patients of UGI bleed and lowest percentages (30%) of patients of AGE in Magh. Similarly,
there were highest percentages (56.4%) of patients of Liver Disease and lowest percentages (16.66%) of
patients of UGI bleed in Falgun.
 TOTAL GENERAL MEDICINE CASES
18
16
16
14
12
10
No. of Patients

10 9
8
8
6
6 5 5
4 3
2 2 2
2 1 1 1
0 0 0 0
0
Poisoning DM DKA LOC Pancytopenia Anemia

Poush Magh Falgun

Fig 36: Bar Graph showing total general medicine cases

The Above Bar Graph shows that there were highest percentages (52.94%) of patients of poisoning and
no patient of DM in Poush. Likewise, there were highest percentages (43.24%) of patients of Poisoning
and no patient of LOC in Magh. Similarly, there were highest percentages (58.82%) of patients of
Poisoning and no patient of LOC and Anemia in Falgun.
 TOTAL GASTRO SURGERY CASES
30
25 24
22 22
20
20
15 11
9 9 10
10 6 5 6
4
No. of Patients

5 2 2
0
0

POUSH MAGH FALGUN

Fig 37: Bar Graph showing total gastro surgery cases

The Above Bar Graph shows that there were highest percentages (39.29%) of patients of Lap Chole and
Appendectomy and lowest percentages (3.57%) of patients of Haemorrhoidectomy. Likewise, there
were highest percentages (48%) of patients of Lap Chole and no patient of Haemorrhoidectomy.
Similarly, there were highest percentages (43.48%) of patients of Lap Chole and lowest percentages
(4.35%) of patients of Pancreatitis in Falgun.
 TOTAL UROSURGERY CASES
14
12
12 11
10
10 9
8
8 7
No. of Patients

6 6
6
4
4 3 3 3
2
0
URSL TURP PCNL Nephrolithiasis

POUSH MAGH FALGUN

Fig 38: Bar Graph showing total urosurgery cases

The Above Bar Graph shows that there were highest percentages (38.1%) of patients of URSL and lowest
percentages (14.29%) of patients of PCNL in Poush. Likewise, there were highest percentages (34.29%)
of patients of TURP and lowest percentages (8.6%) of patients of PCNL in Magh. Similarly, there were
highest percentages (38.46%) of patients of URSL and lowest percentages (11.54%) of patients of
Nephrolithiasis in Falgun.
 18 TOTAL NEUROSURGERY CASES
16
16
14
12
10 10
10
8
8 7
6 6
No. of Patients

6
4
4 3 3
2 2
2 1
0 0
0

POUSH MAGH FALGUN

Fig 39: Bar Graph showing total neurosurgery cases

The Above Bar graph shows that there were highest percentages (34.78%) of patients of Stroke and
lowest percentages (13.4%) of patients of Head Injury and Seizure in Poush. Likewise, there were highest
percentages (43.75%) of patients of Stroke and lowest percentages (6.25%) of patients of Seizures in
Magh. Similarly, there were highest percentages (62.5%) of patients of Stroke no patient of Deuroplasty
in Falgun.
 TOTAL CARDIOLOGY CASES
40
35 34

30
25
No. of Patients

20 18
15 12
10 8
5 4 5
5 3
1 1 0 0 2 3
0
0
HTN RHD CHD open heart vericose vein
surgery
poush magh falgun

Fig 40: Bar Graph showing total cardiology cases

The Above Bar Graph shows that there were highest percentages (60%) of patients of HTN and lowest
percentages (3.33%) of patients of open heart surgery in Poush. Likewise, there were highest
percentages (73.91%) of patients of HTN and no patient of open heart surgery in Magh. Similarly, there
were highest (25%) of patients of CHD and no patient of varicose vein in Falgun.
 TOTAL GYNAECOLOGY CASES
25
20
20

15 14
No. of Patients

10 8
7 7
6 6
5 5 5 5
5 4 4
3 3 3 3
2
0 0 0
0
ANC TAH PID Abortion Nd with Cyst LSCS
epi

POUSH MAGH FALGUN

Fig 41: Bar Graph showing total gynaecology cases

The Above Bar Graph shows that there were highest percentages (34.15%) of patients of ANC and no
patient of Cyst in Poush. Likewise, there were highest percentages (23.53%) of patients of TAH and
lowest percentages (5.8%) of patients of PID in Magh. Similarly, there were highest percentages
(48.78%) of patients of ANC and no patient of Abortion and Cyst in Falgun.
 TOTAL ORTHOPEDICS CASES
30 28

25 23

20
No. of Patients

15 15
15
12 12 11
10
6 7 6
5
5 3 3
2 2 1 2
0
0
Cut + Fall Arthritis ORIF CRIF RTA Fracture
injury

POUSH MAGH FALGUN

Fig 42: Bar Graph showing total orthopedics cases

The Above Bar Graph shows that there were highest percentages (48.28%) of patients of RTA and lowest
percentages (1.72%) of patient of CRIF. Likewise, there were highest percentages (35.38%) of patients of
RTA and lowest percentages (3.08%) of patients of Arthritis in Magh. Similarly, there were highest
percentages (50%) of patients of RTA and no patient of Cut+Fall injury in Falgun.
 TOTAL ENT AND ONCOLOGY CASES
6
5 5
5
4
4
3 3
3
2 22 2 2 2
2
No. of Patients

11 1
1
0 0 0 0 0 0 0
0

POUSH MAGH FALGUN

Fig 43: Bar Graph showing total ENT and Oncology cases

The Above Bar Graph shows that there were highest percentages (35.71%) of patients of
Hemithyroidectomy and no patient of CA Lungs in Poush. Likewise, there were highest percentages
(41.67% of patients of Septoplasty and no patient of Luekemia and CA lungs in Magh. Similarly there
were highest percentages (33.33%) of patients of CA Lungs and no patient of Hemithyroidectomy, CA
bladder and Luekemia in Falgun.

TYPES OF SURGERY

Common Operative
S.N Poush Magh Falgun
Procedure
1. Laparoscopic Cholecystectomy 22 24 20
2. Appendectomy 22 12 8
3. ORIF/CRIF 7 14 10
4. TURP 6 12 7
5. Craniotomy 10 2 4
6. LSCS 7 5 7

Fig 44: Table showing types of surgery

The Above table shows that there were highest numbers of laparoscopic Cholecystectomy and
Appendectomy and lowest number of LSCS done in 3 months.

DEATH RATE
9.00%

8.00% 7.64%

7.00%
Percentage of Patients

6.00%

5.00%

4.00%

3.00%
2.11%
2.00%

1.00% 0.67%

0.00%
POUSH MAGH FALGUN

Fig 45: bar Graph showing death rate of ICU, post op and General A, B and Semi cabin

The Above Bar Graph shows that there were highest death rate (7.64%) in Magh and lowest
death rate (0.67%) in Falgun.

SWOT Analysis
It is an examination of an organization’s internal strengths and weakness, its opportunities for
growth and improvement and threats, the external environment presents to its survival
S=Strength
 Well-equipped Multi- specialty Hospital
 Highly trained doctors, nurses and technicians
 Best nursing care to every patient through integrated clinical services
 Provide cost effective medical treatment
 Free health services to homeless people
 Free Health Camps in different area.
W= Weakness
 Lack of waste management committee.
 Salary not as per Government’ policy i. e Rs.28500 .
 Lack of Advanced diagnostic facilities
For example MRI, Mammogram
O= Opportunities
 It conducts free health camp to periphery level that provides opportunity for staff to work
outside the hospital setting
 Provides opportunities for staff to improve their skills via different training and in-
services education
 Hospital allows students for practicum. Thus, it helps for the trained health professional.
 It provides opportunity for students to conduct research.
 It collaborates with other organization for betterment of hospital, staff as well as patient.
T= Threats
 Potential for Health hazards due to improper waste management including cytotoxic
waste.
 Hospital management as well as patient care got hampered due to rapid turnover of staff
that results in less productivity of organization.

Recommendation
 Initiation of waste management committee.
 Availability of advanced diagnostic facilities.
 Provides in-service education and training to staffs frequently.
 Basic salary as per government’s policy. i. e Rs 28500.
 SUMMARY

As per the curriculum of PBBN 3 rd year affiliated to Purbanchal University, we need to fulfill our
leadership and management practicum for the fulfilment of which we were assigned to Green
city Hospital for one month i.e. chaitra 2077. During one month of Leadership and Management
Practicum in green city Hospital we had performed various useful activities which will surely
help in our future. The purpose of this Practicum is to develop Leadership style and to learn
managerial functions that will help to increase personal and professional growth.

In this practicum I had performed following activities:

1. Worked as a unit in-charge and performed various activities such as

 Prepared daily work assignment of sub-ordinates,
 Prepared duty Roster.
2. Performed Supervisory roles and responsibilities.
3. Conduct Meetings and learned about minuting.
4. Gain knowledge regarding Project work.
5. Performed in-service education according to the needs.
6. Applied change process.
7. Learned about Logistic management activities and Budgeting.
 CONCLUSION

This 1 month of practicum in Green city Hospital was the period of experience and learning.
Even it’s a part of our curriculum requirement, the knowledge we gained and skill we developed
will be an everlasting thing.
Moreover, this practicum enhances our hidden leadership qualities and managerial skills. We
came to know that as a nurse we don’t only provide care to the patient but also, we have great
responsibilities in administration sections. We were able to work as in qualities of nurse be like
“nurse as a leader” and “nurse as a manager”.
Nevertheless, we faced many challenges during the posting which helped us make memories and
learn lessons with the help of our respected supervisors.
Hence, the posting became very fruitful to us with more learning and little fun.
 Total Cases of Nephrology in Emergency department

CKD+AKI
14 RPGN
UTI

Fig 10: Pie Chart showing total cases of Nephrology in Emergency Department.