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NURSING ADMINISTRATION IN SELECTED HOSPITALS
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Citation: Sharma SK. Nursing administration in selected hospitals (Chapter-2). Nursing Care
Administration: A study of patients’ satisfaction in selected government and private hospitals
at Ludhiana [PhD Thesis]. Chandigarh: Punjab University; 2009.
CHAPTER-2
NURSING ADMINISTRATION IN SELECTED HOSPITALS
2.1 Introduction
Human society has been organized and administered in one form or the other
right from the beginning of social interaction. The word ‘administer’ is derived from
the Latin word ‘ad+minister’ which means ‘to care for’ or ‘to look after people’, ‘to
manage their affairs’. Administration is a universal process permeating all collective
efforts, it is public or private, civil or military, at large scale or otherwise. It is
cooperative effort directed towards the realization of a consciously laid down
objectives. Thus, administration is a characteristic of all enterprises in pursuit of
conscious purposes. Pfiffner and Presthus defined administration as; “the organization
and direction of human and material resources to achieve desired ends”. 1 According
to White, administration is “the direction, coordination and control of many persons to
achieve some purposes or objectives. Administration is not only concerned with the
modern civilization but also with the cherished efforts of the early man. Building the
pyramid in Egypt was also an astonishing administrative feat; the Roman Empire or
British Empire where, it is said that, the sun never sets, are the most suitable examples
of high pinnacle of administration. In modern time, Public Administration however,
has three distinguishing features; its purposes have been completely reoriented; its
functions have increased manifold; its variety, complexity and methodology has
grown from the trial and error stage into an orderly discipline with an organized, ever
increasing body of knowledge and experience.2
Public administration of any state or country has also the responsibility to
meet the health needs of its citizens. Health administration is an integral part of the
Public Administration. It deals with all the aspects of health of its people. It may be
related to promotion of health, preventive services, medical care, nursing care,
rehabilitation, medical education and delivering the health care services through
various health care agencies including hospitals.3
The hospital is an integral part of the social and medical organization, the
function of which is to provide complete health care for the population, both curative
and preventive and whose out patient services reach out to the families and its
environment. The hospital is also a center for the training of health workers and
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biosocial research. Today, a hospital means an institution in which sick or injured
persons are treated and healthy persons are helped to promote and maintain an
optimum level of well being.
Hospital provides healthcare services to the needy people through a variety of
personnel including technical, administrative and auxiliary staff etc. Nursing is a
major component of any hospital and nurses make up the largest employment group
within these institutions. Nursing services are necessary virtually for every patient
seeking any type of health care. Nurses are responsible for direct patient care, as well
as many activities related to the organization and structure of care. Nursing is such an
important part of any hospital that success of any such institution largely depends on
the nurses’ participation in delivering quality patient care.4
2.2 Nursing Administration

Nursing administration is a coordinated system of activities, which provide all
the facilities necessary for rendering nursing care to patients, so it is an integral part of
any health care organization that strives to provide effective nursing care. According
to Herman Finer “Nursing administration is a segment of the total care administration
which actively takes part to fulfill the objectives of health programs and policies to
constitute, to serve the patients, with the help of other health workers, to make the
services more friendly and effective.5 Nursing administration combines the
perspective of nursing care with the methods of administration. Expressing similar
viewpoints Gorddard stated “Nursing administration at any level is the application of
the principles of administration for the ultimate purpose of providing nursing services
to the individual. The practice of nursing administration focuses on the administration
of organized nursing care services to a group of patients for the purpose of delivering
a quality nursing care.6
Nursing administration therefore, has taken all the principles and practices,
available and suitable from the parent body of Public Administration. The principles
of Public Administration are generic and nursing administration is just one field
where these generic principles have been applied. The primary function of nursing
administration will be to create an environment in which the nurse manpower
resources will be utilized, preserved and developed to make it the most effective
element in achieving the objectives of the hospital.
83
The objectives of the nursing administration focus on three basic elements: a)
high quality of nursing care services rendered to patients by trained nurses and
technical assistants; b) a structured yet flexible and stimulating environment in which
all the personnel may gain job satisfaction from their work and have opportunities to
develop their own knowledge and skill potentials; and c) a management process that
results in an efficient and effective pattern of nursing care and nursing services in the
most economical manner.7
2.3 Objectives of Nursing Administration

Alexander L. Edythe (1972)8 in his book ‘Nursing administration in the
hospital healthcare system’ discussed the objectives of nursing administration, which
are as follows.
1. Establish a flexible organizational design consisting of a set of human
relationships through which all the levels of nursing service personnel can
accomplish their job duties and responsibilities through systematic
management processes of planning, organizing, controlling, coordinating, and
evaluating, which are reflective of good management, work satisfaction, high
morale, and the achievement of the goals of the total hospital system.
2. Establish a systematic nursing service and staffing pattern for patient care so
that all members of each department can function in accordance with their
skill level for the maintenance of continuity of nursing care and management
of nursing services.
3. Evolve, articulate, and interpret hospital and nursing service standards and
nursing practice consistent with biomedical, social, and technological
advances through a communication system within the departments of the
division and with other related professionals.
4. Develop and maintain programs for analysis and evaluation of nursing care
services and utilization of personnel as a mean of improving the quality of
patient care and the economy of human and material resources. Work with
personnel experts and scientific management researchers to develop more
empirical evidences for further improvement in patient care.
84
5. Develop job descriptions for the various positions in the nursing service
department in cooperation with the operations; research staff; revise
descriptions of jobs in accordance with changes in the organizational structure
and the role and functions of nursing services in the delivery of patient care.
6. Assist hospital management in the maintenance of effective personnel

appraisal and recruitment programs.
7. Share nursing care information with others in the hospital and with other
patient care agencies through an established system of relationships.
8. Establish and interpret nursing service policies consistent with the general
policies of the hospital and make recommendations to the executive officers
for the improvement of policies and procedures of the hospital.
9. Initiate a system with hospital management for predicting and determining

budgetary cost containments of the departments and for controlling and
evaluating performance against the established philosophy and objectives of
each department.
10. Participate in interdepartmental programs and hospital committees delegated

to improvement of patient care services.
11. Encourage a stimulating environment in which the personnel have

opportunities to be creative innovators in the improvement of nursing care
services.
12. Develop and initiate orientation and training programs for new employees in
cooperation with hospital management and other health disciplines.
13. Provide an environment conducive to learning of students for formal programs

affiliated with the hospital and participate through established channels for
sharing of information and establishing an effective partnership between the
faculty and nursing service leaders.
14. Assist in the development of a sound, constructive program of leadership in

the management of nursing care services to assure intelligent management by
the people and for the people they serve.
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15. Safeguard, conserve, and preserve nursing resources of the hospital through
the use of expert nurse leaders having necessary capacities.
16. Initiate programs to improve the practices of nursing to keep up with the
advances in the biomedical and social sciences affecting the quality of nursing.
17. Participate in use of evidence based information useful for patient care.
18. Provide an environment conducive to advanced educational nursing programs.
2.4 Nursing Administrative Office

Nursing Administrative office is responsible for administration and
coordination of the hospital nursing services based on the philosophy of the
institution. Some of the prominent activities or functions of the nursing administrative
office include.9
 Organize the nurses in a manner so as to render high quality of nursing care
consistent with the philosophy and objectives of the hospital.
 Establish and implement the philosophy, standards, policies, rules, and
procedures for smooth and efficient functioning of the nursing services in the
hospital.
 Formulating rules and regulations applicable to nurses, including their
working hours, code of conduct, discipline, reporting system, and appraisal.
 Developing and periodically revising nursing policies and procedures related
to patient care in general and nursing care in particular.
 Delineate the responsibilities and duties to nursing officials and various
categories of nursing personnel.
 Estimate the requirement for nursing personnel, advise on appointment of
adequate and competent nurses and establish policies and programs for their
orientation, placement, on the job training and supervision.
 Selecting and assigning/ reassigning nurses to various wards and specialized
service areas depending on vacancies/ need and abilities/ interests of the staff
concerned.
 Establish the need for facilities, equipments and supplies and implement a
system for evaluation and control within the administrative and financial
framework of the hospital.
86
 Develop and maintain system of recording patient care and administrative
nursing data.
 Receiving periodical reports from the nursing units.
 Maintaining record of nursing service activities and compiling reports, plans
and budget as and when required.
 Monitoring personnel records of nurses.
 Organize and oversee the functioning of wards and other specialized service
areas (such as outpatient department, operation theaters, day care unit etc.),
which are generally managed by nurses.
 Ensure healthy work environment, close collaboration and mutually
supportive relationship between nursing and other departments in the
hospital.
 Establish good rapport between nurses and patients, patient attendants and
visitors.
 Periodically appraise the performance of nurses and carry out regular nursing
audit which is necessary to maintain and improve the standards of nursing
care.
 Carry out in-service training and thereby augment staff development to
update knowledge and skills of nursing staff.
 Train student nurses and provide facilities for advanced training of nurses
and other personnel.
 Dealing with professional and personal problems of individual nurses and
attending to their welfare.
 Investigating incidents, complaints and allegations of misconduct pertaining
to nursing staff.
 Provide grievances redressal facilities for nursing staff and ensure job
satisfaction among them.
 To ensure patients’ satisfaction by providing quality patient care.
It was observed that none of the nursing administrative offices of the selected
hospitals had written philosophy and objectives of nursing services. During
discussions with the Nursing Superintendent of DMC hospital, it was revealed that
87
management follows Aryan philosophy* but had not evolved objectives for the
nursing administrative office. Similarly, nursing administrative office of CMC
hospital follows Missionary philosophy** and they too had not developed any norms
in this regard. ESI hospital follows the norms laid down by Employees’ State
Insurance Corporation and Civil hospital follows the norms laid down by
Departments of Health & Family welfare, Govt. of Punjab. However, nursing
administrative offices of these hospitals also did not develop separate objectives for
their department.
2.5 Location and Facilities of Nursing Administrative Office

The nurses constitute one of the largest professional group of employees in a
hospital and the nursing administrative office caters to the varied needs of the nurses
working in the respective hospitals. Since a large number of people visit this office on
each day, Kunder (2004)10 suggested that nursing administrative office may be
centrally located in the administrative block from where it can improve coordination
of nursing services on different floors and visitors can come here without any
hindrance. In the selected private hospitals nursing administrative office was headed
by Nursing Superintendent and in government hospitals, it was headed by Matron.
Nursing administrative office was headed by Nursing Superintendent/ Matron, they
were responsible for overall management of nursing personnel to provide quality
nursing care. The author further stated that nursing administrative office should be
carefully designed with special attention to the location, staffing, furniture, storage
facility for nursing personnel records, communication facilities, and computerization
of personnel records.
Nursing administrative offices of the selected government and private
hospitals were closely observed and it was found that private hospitals and ESI
hospital were having separate office for Nursing Superintendent/ Matron, while in
Civil hospital Matron shared office with other subordinates. In CMC hospital, office
of Nursing Superintendent was located in administrative block close to the office of
*
Aryan philosophy: Om Bhur Bhuvah Svah, Tat Saviturvarenyam, Bhargo Devasya Dhimahi, Dhyiyo Yo Na
Prachodayat. Meaning: Thou O Supreme Lord, The Source of Existence, Intelligence and Bliss, The Creator of the
Universe! May we prove worthy of the choice and acceptance! May we meet the glorious grace! May Thou
vouchsafe an unerring guidance to our intellect and may we follow the lead unto righteousness.
**
Missionary philosophy: We greet three glorious; Our alma-mater proud and grand Dreaming halls of fame
Ancient and great clad in yellow, green and brown. At thine hallowed shrine, thou Edith Brown has taught us love
and not to count our fame, nor name for our worth, our work is for king. We thy magi bear thee gifts afar of
frankincense, myrrh and gold, our vision, portion and our strength, we will serve thee till the end.
88
the Medical Superintendent on the ground floor, while in other three hospitals it was
located away from administrative block. It was found that significant number of
respondents (72.3 percent)* were satisfied with location of nursing administrative
office in CMC hospital, while in rest of the selected hospitals only a meagre number
of respondents were satisfied with regard to the location of the nursing administrative
office in their respective hospitals viz. DMC (34.1 percent), ESI hospital (33.3
percent) and Civil hospital (20.0 percent).
The selected private hospitals comprised clerical staff in nursing
administrative office, while there was no clerical staff in ESI and Civil hospital.
Computer/ typewriter facility was present in nursing administrative office of private
hospitals, while it was not present in ESI and Civil hospital. Telephone facility was
available in nursing administrative office of private hospitals and ESI hospital, but in
Civil hospital telephone facility was not available in nursing administrative office.
Table 2.1: Type of facilities in Nursing Administrative Office

Private Hospitals Government Hospitals
Facilities CMC DMC ESI CIVIL
Separate office Yes Yes Yes Shared
Clerical staff in office Yes Yes No No
Computer/ typewriter Yes Yes No No
Telephone facility Yes Yes Yes No
Storage facility for records Adequate Adequate Inadequate Inadequate
Conference/ meeting room Yes No No No
Educational cell Yes No No No
Computerized record system No No No No
Internet facility No No No No
Source: Unpublished office records
NS: Nursing Superintendent
There was adequate storage facility in nursing administrative office of the

private hospitals, while it was inadequate in ESI and civil hospital. Conference/
meeting room and educational cell was present only with nursing administrative
office of CMC hospital, while it was not available in other three selected hospitals.
*
Are you satisfied with location of the nursing administrative office? a) Yes b) No
89
Interestingly, in this high technology era none of the selected hospitals had
computerized record system and internet facility in nursing administrative office.
Furthermore, it was found that Majority of the respondents (69.2 percent)*
were satisfied with facilities of nursing administrative office of CMC hospital, while
in DMC, ESI and Civil hospital, majority of the respondents were not satisfied with
existing facilities of nursing administrative office.
2.6 Organizational Structure

An organization comprises group of people working together, under formal
and informal rules of behavior, to achieve a common goal. In simple term, structure is
the pattern in which various parts or components are interrelated or interconnected.
Thus, organization structure is the pattern of relationship among various components
or positions of an organization. Since these positions are held by various persons, the
structure is the relationship among people in the organization.11 “In other words
organizational structure refers to the line of authority, communication and delegation
in an organization; it can be formal or informal (Ann Boyle Grant, 1999).”12
The organization structure, being abstract, is not visible in the same way as a
biological or mechanical structure, though it can be inferred from the actual
operations and behaviour of the organization. The biological or mechanical system,
such as organism and machine, can be identified even when it is not working because
it has both anatomy and physiology. Organization structure chart is a picture of an
organization or department, which can help in identifying hierarchy.13 Organizational
structure in the nursing department of various hospitals under study had discussed in
the subsequent pages.
CMC hospital
The Nursing department of CMC hospital was headed by a Nursing
Superintendent (NS) as shown in Figure 2.1. The present incumbent simultaneously
holds the responsibilities of teaching in College of Nursing as a professor. Nursing
Superintendent was assisted by Deputy Nursing Superintendent (DNS). Nursing
Superintendent is responsible for the overall administration of nursing personnel to
provide quality nursing care. All categories of nursing personnel from DNS to
*
Are you satisfied with facilities of the nursing administrative office? a) Yes b) No
90
Auxiliary Nurse Midwife (ANM) work under his/her command. However, Nursing
Superintendent was not involved in budget planning and material management.
Nursing Superintendent (1)
Deputy Nursing Superintendent (1)
Assistant Nursing Superintendent (1)
Nursing Supervisors (29)
Nursing sisters/ Ward sisters (33)
Staff Nurses (475)
ANMs (64)
Fig. 2.1: Organizational structure of nursing department of CMC hospital
DNS was placed at second level in organizational hierarchy of nursing

department. DNS was further assisted by Assistant Nursing superintendent (ANS).
DNS was responsible for regular supervision of assigned clinical area(s)/ floor,
monitoring nursing personnel records in nursing administrative office, planning and
implementation of staff training and development programs to ensure a high quality of
nursing care. In addition, to administrative responsibilities, DNS also performed
teaching assignments as a Reader in College of Nursing.
The next layer in the organizational structure was occupied by ANS, who was
responsible for coordinating all nursing care activities for assigned clinical area/ floor,
conducts regular supervisory rounds, and evaluates nature and quantum of nursing
care requirements in reference to man and material. ANS also had additional teaching
responsibilities as a Lecturer in College of Nursing. Nursing Supervisors, constituting
middle management, occupying fourth level in the hierarchy of organizational
91
structure. Nursing Supervisors were assisted by Ward Sisters/ nursing sisters of their
assigned clinical area. Nursing Supervisors were responsible for regular nursing
rounds, supervision of nursing care, planning and implementation of educational
activities for nursing personnel, ensuring cleanliness, monitoring infection control and
waste management practices, ensuring balance in demand and supply of man and
material. In CMC hospital, Nursing Supervisors were also having teaching
responsibility as a Lecturer in College of Nursing. Ward Sisters/ Nursing Sisters were
subordinated by Staff Nurses. Ward Sisters/ Nursing Sisters were responsible for
ensuring continuous and effective nursing care to patients admitted in their assigned
wards, planning and assigning the duties to subordinates, carrying out ward
management activities, maintaining ward inventory, coordinating with
multidisciplinary team and other departments for better patient care, orient new
nursing staff and students and regularly conduct formal and informal educational
activities in the ward. Ward Sisters/ Nursing Sisters were directly responsible to ANS
as well as Nursing Supervisors. Staff Nurses were responsible for total direct patient
care, education of patients and relatives, assisting Ward Sister in ward management
and ward educational activities. Staff Nurses were assisted by ANMs. ANMs were
responsible for providing basic nursing care activities as well as they assisted staff
nurses in providing direct patient care. Nursing department of CMC hospital had
unique feature of integration of nursing education (College of Nursing) and nursing
services department to provide patient care and nursing education.
DMC hospital
The organizational structure of nursing department in DMC hospital was
headed by Nursing Superintendent (NS). As illustrated in the Figure 2.2., Nursing
Superintendent was subordinated by Deputy Nursing Superintendent (DNS). All the
nursing personnel below in the hierarchy were under the control of the NS for
providing quality nursing care. The rest of the hierarchical structure in this hospital
was the same as that of the CMC hospital. However, there were two main differences
that ANMs were placed equal to staff nurses in hierarchy and had equal chance to be
promoted to next position. Second most significant difference was that the services of
nursing administrators were not utilized for teaching in the nursing college.
92
Nursing Superintendent (1)
Deputy Nursing Superintendent (1)
Assistant Nursing Superintendent (8)
Nursing Supervisors (10)
Nursing sisters/ Ward sisters (62)
Staff Nurses (657) ANMs (48)
Fig. 2.2: Organizational structure of nursing department of DMC hospital
ESI hospital
Organizational structure of nursing department in ESI hospital is depicted in
the Figure 2.3.
Matron (1)
Ward Sisters/Nursing Sisters (8)
Staff Nurses (55)
Fig. 2.3: Organizational structure of nursing department of ESI hospital
The department was headed by a Matron. Matron was considered equivalent to

Assistant Nursing Superintendent. Matron was having authority to command all the
nursing personnel working in organization for the overall administration and for
providing quality nursing care to patients. Matron was assisted by Ward Sisters/
Nursing Sisters. Ward Sisters/ Nursing Sisters were required to ensure continuous and
93
effective delivery of nursing care to patients admitted in their assigned clinical area/
floor. They were also responsible for regular supervisory rounds, planning and
assigning duties to subordinates, carrying out ward management activities,
coordinating with multidisciplinary team and other departments for better patient care,
orienting new nursing staff and students and regularly conducting formal and informal
educational activities in the assigned areas. Ward Sisters/ Nursing Sisters were
assisted by Staff Nurses.
Civil hospital
The pattern of organizational structure in civil hospital was similar to the one
in ESI hospital as depicted in Figure 2.4. Matron headed the organizational structure
and commanded the nursing staff down below the hierarchy. Besides the Matron,
there were four Ward Sisters/ Nursing Sisters and fifty Staff Nurses.
Matron (1)
Ward Sisters/ Nursing Sisters (4)
Staff Nurses (50)
Fig. 2.4: Organization structure of nursing department of Civil hospital
Both the government hospitals had identical organizational structure. While

having a close look at the organizational structure charts of the selected hospitals, it
can be observed that Line organizational structure† was used in nursing departments
of selected hospitals. Further it was found that the Nursing Superintendent headed the
nursing department in the private hospitals; while matron headed the nursing
department in the government hospitals. The staff nurses were the first level
professional nurses in all the hospitals. They were responsible for providing direct
nursing care to the patients. Staff Nurses were accountable to Ward Sister/ Nursing
†
Line organizational structure: Bureaucratic organizational designs are commonly known as line structure or line
organization. Where authority lies on top positions and chain of command communication flows downward.
94
Sisters. In DMC hospital, ANMs were also considered equal to staff nurses in
hierarchical level and they were entitled for promotion to next position i.e. Nursing
Sister, while in CMC hospital, ANMs were assisting Staff Nurses in providing direct
nursing care and were only responsible for providing the basic nursing care to
patients. This level did not exist in the government hospitals.
a) Span of control
The concept of ‘span of control’ is central to the classical theory of
organization. ‘Span of control’ refers to the number of subordinates an administrator
can directly supervise in an effective manner.14 Every organization faces this problem.
How many subordinates can a supervisor manage effectively? Studies of management
have found that this number was usually four to eight subordinates at upper level of
organization and eight to fifteen or more at the lower level. There is no agreement for
the exact number, but generally it is believed that the shorter the span, the greater will
be contact, which leads to more effective control.15 According to the classical theory
an executive must have intimate and direct contact with his subordinates. Therefore,
the span of control should be such that it permits effective coordination. Five to eight
at higher level and ten to fifteen at supervisory level is considered appropriate span of
control.16
It was observed that in private hospitals Nursing Superintendent directly
supervised one Deputy Nursing Superintendent. In DMC hospital, one Deputy
Nursing Superintendent supervised eight Assistant Nursing Superintendents; while in
CMC hospital, one Deputy Nursing Superintendent supervised only one Assistant
Nursing Superintendent. In DMC hospital, one Assistant Nursing Superintendent
supervised about two Nursing Supervisors; while in CMC hospital, one Assistant
Nursing Superintendent supervised twenty five Nursing Supervisors. There was a
limited human capacity. If supervisors were engaged in supervising too many
subordinates, unsatisfactory results might occur. In DMC hospital, one Nursing
Supervisor supervised six Nursing Sisters; while in CMC hospital, one Nursing
Supervisor supervised two Nursing Sisters. In government hospitals, above said
categories were not available, the highest post Matron supervised eight Nursing
Sisters in ESI hospital, while in Civil hospital Matron supervised four Nursing Sisters.
The lowest supervisory cadre Nursing Sister supervised the Staff Nurses. In DMC
hospital, one Nursing Sister supervised twelve Staff Nurses, in CMC hospital, one
Nursing Sister supervised fifteen Staff Nurses, in ESI and civil hospital one Nursing
95
Sister supervised seven and thirteen Staff Nurses respectively. On an average in
private hospitals, one Nursing Sister supervised about fourteen staff nurses; while in
government hospitals, approximately ten Staff Nurses were supervised by one
Nursing Sister. The span of control existing among nursing personnel in selected
hospitals may be seen from Table 2.2.
Table 2.2: Span of control among nursing personnel in selected hospitals

Supervisor : Supervised
CMC DMC ESI CIVIL
1. NS: DNS 1:1 1:1 NA NA

2. DNS: ANS 1:1 1:8 NA NA
3. ANS: Nursing Supervisors 1:25 1:2 NA NA
4. Matron: Nursing sisters NA NA 1:8 1:4
5. Supervisors: Nursing Sisters 1:2 1:6 NA NA
6. Nursing Sister: Staff Nurses 1:16 1:12 1:7 1:13
Source: Unpublished office records, NS: Nursing Superintendent, DNS: Deputy Nursing
Superintendent, ANS: Assistant Nursing Superintendent, NA: Not Applicable.
It is very well said that too many people reporting to a single manager delays
decision making, whereas too few result in an inefficient, top-heavy organization. The
present study indicated a limited span of control in all the hospitals but one level in
CMC hospital, where one ANS had to supervise 25 Nursing Supervisors. Majority of
respondents (70 percent)* were satisfied with the span of control in government
hospitals, while in private hospitals, nearly half of them (53 percent) were not
satisfied with span of control in their organization as illustrated in Table 2.3.
Table 2.3: Nurses’ satisfaction with the span of control

Hospitals Total
Satisfied with span of Private Government
control N= 200
CMC DMC ESI CIVIL
n=50 n=50 n=50 n=50
f (%)
f (%) f (%) f (%) f (%)
Yes 25 (50.0) 28 (56.0) 40 (80.0) 30 (60.0) 123 (61.5)
No 25 (50.0) 22 (44.0) 10 (20.0) 20 (40.0) 77 (38.5)

Computed from primary data
*
Are you satisfied with span of control in your department? a) Yes b) No
96
The personal capacities of the supervising officer, the capability of
comprehending quickly, getting along with people and commanding with loyalty and
respect, are some of the most important determinants of the manager’s ability to
reduce the frequency and severity of relationship being engaged in superior-
subordinate association. This ability naturally varies with supervisors and jobs, but
there are certain general factors that influence the number and frequency of such
relationships i.e. training of subordinates, extent and nature of planning, effectiveness
of communication technique and time limitations of attention.17 In the end, it can be
stated that there was adequate span of control in all the selected hospitals.
b) Communication
Communication’, strictly, stands for sharing of ideas in common. The term
‘Communication’ has many and varied meaning. Popularly speaking, it refers to the
various means or media of transmitting information from one individual to another or
from one place to another. Communication can be said to have taken place when
ideas, messages, information and feelings get transmitted from one person to the other
without loss of meaning and intent of the communication. Herbert A. Simon observes,
“Communication may formally be defined as any process whereby decisional
premises are transmitted from one member of an organization to another.”18 In
general communication is the meaningful exchange and understanding of ideas,
statistical data, opinion or emotions from a source to receiver. Today, professional
nurses are involved in human and labour relations, the development of quality and
quantity nursing services standards, the assessment of nursing care and a whole list of
other technical aspects of healthcare operations. The nurse administrator’s
effectiveness depends to a great degree on their awareness of communication concept,
their positive approach to communication and their skillful use of its mechanisms.
Communication is an integral part of nursing administration. Communication

failures have been markedly responsible for causing hindrance in providing smooth
patient care, thereby leading to frustration among patients and employees.
Communication therefore has to be accepted as a crucial and integral part of the
nursing administration. Chester I Bernard considered ‘communication as the
foundation of cooperative group activity’. Communication definitely plays a vital role
in the managerial functions of planning, organizing and controlling,19 as well as for
97
the effective and smooth administration. An average manager spends about 90 percent
of his time in communicating by one or other means. Better communication helps to
show better job performance, win the cooperation of others, get ideas and understand
instructions properly and bring about immediate and desired changes in work
performance. It is only through the process of communication that a nurse
administrator informs the subordinates about what, when, how and where the work is
to be done. It has been estimated that nearly half of the disputes of employees occur
due to faulty communication.20
A close observation was made on the modes of communication used in
nursing departments of selected hospitals as depicted in Table 2.4. In private
hospitals, nursing departments used written, face-to-face and telephone
communication methods, while in selected government hospitals major part of
organizational communication was accomplished by face-to-face mode. Written
method was used sparingly. Furthermore, it was observed that in private hospitals,
nursing department mainly used indirect means of communication, while in
government hospitals there was more of direct face-to-face communication. This was
probably because selected private hospitals were having large organizations, and it
was difficult to communicate directly. The government hospitals were small in size,
so it was possible to communicate directly face to face. The telephone facility was not
available in nursing administrative office of government hospitals. However, this
facility was available in selected private hospitals.
Table 2.4: Modes of communication in nursing departments of selected hospitals

Hospital Modes of Communication
- Written circulars, notices, memos and letters
CMC - Face-to-face during meetings, clinical rounds and supervision
PRIVATE - Telephonic communication
HOSPITALS - Written circulars, notices, memos and letters
DMC - Face-to-face during meetings, clinical rounds and supervision
- Telephonic communication
- Face-to-face during meetings, clinical rounds and supervision
ESI
GOVT. - Written circulars, notices, memos and letters
HOSPITALS - Face-to-face during meetings, clinical rounds and supervision
CIVIL
- Written circulars, notices, memos and letters
Source: Unpublished Office Records
98
In large organizations, it is impossible for supervisors to communicate
personally with each person or group involved in organizational decision-making.21
Despite the fact that selected private hospitals were big in size, but there has been
rarely any problem of communication as evident from the fact that majority of the
nurses (80.0 percent)* in private hospitals were satisfied with communication system
in their organization, may presented in Table 2.5.
Table 2.5: Nurses’ satisfaction with communication system in selected hospitals

Hospitals Total
Satisfied with Private Government
communication N= 200
facilities CMC DMC ESI CIVIL
n=50 n=50 n=50 n=50 f (%)
f (%) f (%) f (%) f (%)
Yes 41 (82.0) 39 (78.0) 07 (14.0) 04 (08.0) 91 (45.5)
No 09 (18.0) 11 (22.0) 43 (86.0) 46 (92.0) 109 (54.5)

Nurses from the private hospital mentioned that they were provided with
written communication from nursing administrative office about most of the
activities, and in addition they had telephone facility to clarify whenever any doubt
occurs. However, 20.0 percent respondents, which was a small fraction, mentioned
occasional delay in communication in their organization. On the other hand, in
government hospitals, there was lack of written and telephonic mode of
communication; nurses were communicating through face-to-face mode only. A good
number (89.0 percent) of respondents from government hospitals verbalized
dissatisfaction with communication system. About ninety percent respondents in
government hospitals expressed dire need of communication facilities, like telephone
or other advanced facilities. They further mentioned that messages were usually sent
through a messenger, which either did not reach in proper perspective or wrongly
communicated. During informal discussions few of the nurses mentioned that poor
communication in government hospitals was the major cause of most of the
administrative problems.
*
Are you satisfied with communication system in your department/ hospitals? a) Yes b) No
99
c) Coordination
In hospitals or healthcare system numerous departments are organized and
involved to achieve a common goal of quality patient care. It may be defined as the
process of bringing about unity and harmony of functioning among the diverse
elements and sub-systems of an organization. It is a conscious and rationale
administrative function of pulling together the different threads of organized activity
and weave them into a unified whole to achieve pre-determined goals in an effective
manner. According to James D. Mooney “Coordination is an orderly arrangement of
group efforts, to provide unity of action in the pursuit of common purpose.” Ordway
Tead defines the coordination as “the efforts to ensure the smooth interplay of the
functions and forces of all the different components and parts of an organization to the
end that its purposes will be realized with a minimum of friction and a maximum of
collaborative effectiveness. In words of Dalton McFarland, “Coordination is the
process whereby an executive develops an orderly pattern of group effort among his
subordinates and secure unity of action in the pursuit of common purpose.”22
During discussions with a group of nurses in private hospitals, the nursing
personnel of nursing department verbalized that; “their department had good amount
of coordination with other departments and vice versa, however, some times they face
isolated problems, which are managed through discussion”. One of the senior nurse
pointed out that they endeavour to strengthen coordination through informal
networking and effective communication but, it was not practical in all the situations.
It was also observed in private hospitals, that there was lack of coordination between
nurses and doctors because of lack of team spirit and mutual respect. Majority of the
nurses were of the view that despite their hard work towards patients care, doctors did
not give them due respect.
Lack of coordination among different departments was a common problem in
the government hospitals. Nurses faced delay in responses from doctors and other
nurses in their hospital, which ultimately affected patient care. Some of the
respondents mentioned that callous attitude of the employer, lack of team spirit, lack
of resources and inadequacy of manpower were some of the probable causes of the
poor coordination.
Lack of coordination between nursing department and other departments of
hospital ultimately affect the quality of patient care, which is the core component of
patients’ satisfaction.
100
2.7 Staffing Pattern
After planning and organizing, staffing is the third phase of administration. In
general staffing is a process comprising selection, training and retention of personnel
in an organization. However, staffing pattern are the plans for nursing personnel at
different levels to carry forward the goals of the particular units comprising it.
Staffing pattern determines the actual number of employees present at different
positions in an organization against recommended guidelines. Staffing pattern is an
important component of administrative process in hospitals, especially in nursing
department because such organizations are usually labour intensive (i.e. many
employees are required to accomplish its goals). Majority of the health care
organizations are open 24 hours a day; 365 days in a years and nurses have to work
round the clock with variable demands and needs of the patients seeking multiple
healthcare services. The large workforce of healthcare organization must have
appropriate balance of highly skilled, competent professional staff from
administrative to operational level. The main purpose of staffing pattern is
appropriate coverage of different positions to ensure effective services in the interest
of the patients visiting hospitals. It also facilitates equitable and effective utilization of
a nurse in an optimal manner.
In a hospital, staffing pattern depends on several factors including patient’s
needs, the needs of the patients varying according to pattern of illness e.g., Intensive
Care Unit requires more staff than the general wards. Staffing pattern in nursing
service also depend upon patient related factors, staff factors, environmental factors,
nursing and institutional objectives. Patient factors includes level, complexity and
duration of care needs; type of patient served, their condition, illness, age group and
other selective factors, number of patients and fluctuation in numbers, socio-economic
factors influencing health needs and patients’ expectations of care. Further, staff
factors depend upon number of nursing personnel, hours and rotation policies, job
descriptions and role functions, personnel policies, education and experience, levels
of personnel, competitive market for staff in community and the work ethics of staff
members. Environmental factors comprise physical layout of institution and patient
unit, number of patient beds, facilities, supplies available, supporting services from
other divisions and departments, supportive services from other agencies, strength of
medical staff and kind and frequency of treatment ordered and chosen by the medical
staff. Lastly, nursing and institutional objectives include type of hospital and type of
101
care in an institution desires to give to patients; selected care assignment patterns;
service education and other benefits that institution desires to give to the personnel,
nursing administrative supportive services; proportion of trained nurses to student
nurses, manner in which professional nursing services are used e.g. non-nursing duties
the professional nurses have to perform.23
The recommendations of Indian Nursing Council (2002)24 regarding staffing
pattern of nursing personnel in hospitals are depicted in Table 2.6. Indian Nursing
Council (INC) recommended one Chief Nursing Officer for 500 bedded hospitals.
One Nursing Superintendent, Deputy Nursing Superintendent and Assistant Nursing
Superintendent were recommended for 500 beds, 300 beds and 250 beds respectively.
One supervisor for 150 beds and one ward sister for 25 beds were also recommended.
INC recommended one staff nurse for nine beds in wards and in ICU one staff nurse
for three beds during each shift.
Table 2.6: Indian Nursing Council recommendations for staffing pattern

Categories Recommendations
Chief Nursing Office 1 for 500 beds or above
Nursing Superintendent 1: 500 beds
Deputy Nursing Superintendent 1:300 beds
Assistant Nursing Superintendent/ 2:500 & 1 more for every additional 50 beds
Matron
Supervisors 7:1000+ 1 for every additional 100 beds
Nursing Sisters/ Ward Sisters 1:25+ 30% leave reserve
Staff Nurses -----------
Wards 1:9 in each shift + 30% leave reserve
OPDs 1:100 out patients+30% leave reserve
Emergency/ICUs 1:3 in each shift +30% leave reserve
OTs 3:1 tables
Source: Indian Nursing Council published guidelines
Recommendations of Nurses Board of Victoria, Australia may be perused

from Table 2.7. Nurses Board of Victoria (2001)25, Australia recommended one nurse
for four patients with an incharge nurse during each shift in level-1 general medical
surgical wards, while in Level-3 general medical surgical wards one nurse was
recommended for five patients in each shift excluding one incharge nurse in each
shift. For special units like ICU, one nurse for every patient was recommended by
Nurses Board of Victoria.
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Table 2.7: Recommendations of Nurses Board of Victoria for staffing pattern
Type of Unit Hospital Category* Day shift Night shift
General medical/ Level-1 1:4 + Incharge nurse 1:4 + Incharge nurse
surgical wards Level-3 1:5 + Incharge nurse 1:6 + Incharge nurse
Ante/ postnatal ward All level 1:5 + Incharge nurse 1:6 + Incharge nurse
Operation Theater 3 nurses/ OT (1 scrub, 1 scout, 1 anesthetic nurse)
This may vary up and down depending on predetermined factors
Post anesthesia/ All shift 1:1 for unconscious patients
Recovery/ ICUs
* Hospitals are categorized into different levels according to acuity of care, size & location.
California Board of Registered Nursing, (1999)26 provided the

recommendations for minimum nurse patient ratio, which were implemented in 2004.
Those recommendations are as presented in Table 2.8.
Table 2.8: Recommendations of California Board of Registered Nursing, for

staffing pattern
Type of Unit/ Ward Nurse Type of Unit/ Ward Nurse
patient ratio patient ratio
Psychiatric ward 1:6 Postpartum (mother and 1:4
baby) ward
Emergency department 1:1 Operation Theater 1:1
Trauma unit 1:1 Pediatrics 1:4
Critical Care Unit/ ICU 1:2 Recovery Room 1:2
General medical surgical ward 1:5 Dialysis/ Oncology ward 1:4
Labor Room 1:2 Step-down Ward 1:4
Ante partum ward 1:4 Telemetry Unit 1:4
Postpartum ward 1:6 Well baby Clinic 1:8
Source: California Board of Registered Nursing guidelines
While perusing the Tables of recommendations provided by different national
and international nursing statuary bodies; it was observed that Indian Nursing Council
(INC) recommended one nurse for nine patients in general wards during each shift,
while Nurses Board of Victoria (2001), Australia and Board of Registered Nursing,
California recommended one nurse for five patients. For special units, INC
recommended one nurse for three beds, while Australian and American nursing
statutory bodies recommended one nurse for one bed in these units, which may be
103
perused from Table 2.9. In addition, Nurses Board of Victoria also added that ward/
unit incharge nurses should not be included in nurse patient ratio.
Table 2.9: Comparison of recommendations for nurse patient ratio

Categories Indian* Australia# USA$
General wards 1:9 1:5 1:5
Special Units like ICU 1:3 1:1 1:1
* Indian Nursing Council, #-Nurses Board of Victoria, $-Board of Registered Nursing, California
In CMC hospital, the strength of Chief Nursing Officer, Deputy Nursing

Superintendent and Nursing Sisters was less than the recommended guidelines.
However, in other categories the strength was more than recommendations of Indian
Nursing Council, which can be perused from Table 2.10.
Table 2.10: Staffing pattern of nursing department in CMC hospital

Total beds =663
Categories Expected* Existing** Deficit Remarks
Chief Nursing Officer 01 -Nil- 01 ----

Nursing Superintendent 01 01 -Nil- ----
Deputy Nursing Superintendent 03 01 02 ----
Assistant Nursing Superintendent 05 01 04 03 extra
Supervisors 04 29 ----- 25 extra$
Nursing Sisters/ Ward Sisters 35 33 02 ----
Staff Nurses# 367 475 ----- 108 extra
268 348 ----- 80 extra
Wards (618 beds)
(1:9) (1:6)
OPDs (average 1000) 13 22 ----- 09 extra
59 75 ----- 16 extra
Emergency/ICUs (45 beds)
(1:3) (1:2)
OTs (09 tables) 27 30 ----- 03 extra
Source: Unpublished Office Records, # Sixty four ANMs are included in the Staff Nurses
*As per Indian Nursing Council recommendations
** Ratio is calculated for each shift with 30% leave reserve staff
$ Supervisors also included nursing teachers
The staffing pattern existed in DMC hospital may be perused from Table 2.11.
The data illustrated in the table clearly indicated that in the top three categories the
requisite strength was not up to the mark, it was found that 71.4 percent deficit. The
104
staff was in excess (24.2 percent) at the middle level. While operational staffs like
staff nurses were close to the recommendations.
Table 2.11: Staffing pattern of nursing department in DMC hospital

Total beds =1036
Chief Nursing Officer 01 -Nil- 01 71.4%

Nursing Superintendent 02 01 01 deficit at
Deputy Nursing Superintendent 04 01 03 top level
Assistant Nursing Superintendent 05 08 ---- 03 extra
Supervisors 07 10 ----- 03 extra
Nursing Sisters/ Ward Sisters 54 62 ---- 8 extra
Staff Nurses# 665 657 08 1.2% deficit
382 380 02 ----

Wards (881 beds)
(1:9) (1:9)
OPDs (average 1200) 15 12 03 ----
202 200 02 ----
Emergency/ICUs (155 beds)
(1:3) (1:3)
OTs (22 tables) 66 65 01 ----
Source: Unpublished Office Records *As per Indian Nursing Council recommendations
# Forty eight ANMs are included in the Staff Nurses
The staffing pattern existed in ESI hospital may be perused from Table 2.12.
It was clearly evident that in the top two categories (supervisors and ward sisters) the
requisite strength was not up to the mark, deficit was found as high as about fifty
percent. Recommended nurse patient ratio for general wards was one nurse for every
nine patients in each shift, while there was only one for thirty patients in a shift.
Situation was worst for nurse patient ratio in special units like emergency and ICU,
where only one nurse was available for 15 patients, whereas Indian Nursing council
has recommended one nurse for every three patients in each shift.
105
Table 2.12: Staffing pattern of nursing department in ESI hospital
Total beds =270
Matron 01 01 -Nil- ----
Supervisors 03 -Nil- 03 ----
Nursing Sisters/Ward Sisters 14 08 06 ----
Staff Nurses 145 55 90 62.1% deficit
110 44 66 ----
Wards (255 beds)
(1:9) (1:30)
OPDs (average 500) 06 01 05 ----
Emergency/ICUs (15 beds) 20 06 14 ----

(1:3) (1:15)
OTs (03 tables) 09 04 05 ----
Source: Unpublished Office Records, As per Indian Nursing Council recommendations
The staffing pattern existed in Civil hospital may be perused from Table 2.13.
In Civil hospital, one Supervisor and three Nursing Sisters were less than
recommended number. In addition, there was only one nurse available for fourteen
patients in general wards. Situation was same in special units where one nurse was
caring for six patients in emergency and ICU. Shortage of nurses in Civil hospital was
as high as fifty percent.
Table 2.13: Staffing pattern of nursing department in Civil hospital

Total beds =130
Categories Expected* Existing Deficit Remarks
Matron 01 01 -Nil- ----
Supervisors 01 -Nil- 01 ----
Nursing Sisters/Ward Sisters 07 04 03 ----
Staff Nurses 89 50 39 43.8% deficit
53 38 15 ----
Wards (122 beds)
(1:9) (1:14)
OPDs (average 600) 08 01 07 ----
Emergency/ICUs (08 beds) 10 06 04 ----

(1:3) (1:6)
OTs (06 tables) 18 05 13 ----
Source: Unpublished Office Records * As per Indian Nursing Council recommendations
106
Comparative data regarding nurse patient ratio in selected government and
private hospitals may be perused form Table 2.14.
Table 2.14: Comparative analysis of staffing pattern in selected hospitals

Categories* Private Hospitals Government Hospitals INC
CMC DMC CIVIL recommendations27
ESI
Staff: beds Staff: beds Staff: beds Staff: beds
1:25+ 30% leave
Ward Sister 1:30 1:23 1:68 1:65
reserve
Staff Nurses
1:9 in each shift +
Wards 1:6 1:9 1:30 1:14
30% leave reserve
1:100 out
OPDs 1:56 1:120 1:500 1:600 patients+30% leave
reserve
1:3 in each shift +30%
Emergency/ICUs 1:2 1:3 1:15 1:6
leave reserve
OTs 4:1 3:1 1:3 1:6 3:1 tables

* Staff is calculated for each shift with 30% leave reserve except for OPDs in government hospitals
A simple comparison of strength of ward sisters and staff nurses in the

selected hospitals indicated:
i) Acute shortage of nurses in government hospitals
ii) Adequate nurses in DMC hospital and
iii) Excess nurses in CMC hospital.
This situation of nursing staff shortage not only prevailed in selected

government hospitals but also was present in other hospitals as reported by Serena
Josephene (2003)27 that in government hospitals of Puducherry one nurse was taking
care for 40-60 patients in general wards and 20-30 patients in special wards. Similar
findings were reported by Anuja Jaiswal (2008)28 at PGIMER, Chandigarh, where
shortage of nurses was as high as 30-40 percent.
It was thus inferred that in private hospitals nurses were either adequate or
surplus. However, in government hospitals there was acute shortage of nurses, so that
nurses overworked in wards of government hospitals. During observation, it was also
found that in government hospitals most of the nursing care activities were performed
107
by patients’ attendants, which might have serious consequences. The number of staff
nurses and their skill play a critical role in patients’ outcome; research29,30,31,32 has
reported that poor nurse patient ratio leads to several negative outcomes for patients
and nurses.
Majority of nurses (average 68 percent)* in government hospitals expressed
dissatisfaction because of poor nurse patient ratio. While in private hospitals,
dissatisfaction was found among 37 percent nurses, which may be perused from Table
2.15. Some of them felt that they were being forced to care for too many patients at
one time and if they ever get an opportunity will leave the job.
Table 2.15: Nurses’ satisfaction with nurse patient ratio in selected hospitals
Hospitals Total
Satisfied with Private Government
nurse patient ratio N= 200
of ward CMC DMC ESI CIVIL
n=50 n=50 n=50 n=50
f (%)
f (%) f (%) f (%) f (%)
Yes 34 (68.0) 29 (58.0) 15 (30.0) 17 (34.0) 95 (47.5)
No 16 (32.0) 21 (42.0) 35 (70.0) 33 (66.0) 105 (52.5)

As a matter of fact it is suggested that government hospitals may look at it

seriously and evolve methods to enhance the staff strength. They may have a MOU
with private nursing college from where the nursing interns may be posted for
experience; they can perform some of the basic nursing care activities under
supervision of nursing teachers or staff nurses.
2.8 Staff Recruitment

Sound recruitment policy is one of the essential components of an efficient
organization. No element of career service is more important than recruitment policy,
since no amount of in-service training transform wrongly recruited persons bright and
efficient. A faulty recruitment policy inflicts a permanent weakness upon the
administration. If recruitment policies are faulty in an organization then whole
recruitment procedure will be misdirected and there may be selection of undeserving
people in the organization.33 There is nothing more precious than human beings on
*
Are you satisfied with nurse patient ratio in your ward? a) Yes b) No
108
this earth, for their well being, hospitals are the organizations where staff is recruited
to handle and care human being. Therefore, in these organizations little laps in
recruitment policies can cause serious consequences. So healthcare organizations need
sound recruitment policies to recruit the right and deserving persons for the right
place and at right time.
Indian Nursing Council has provided detailed recruitment guidelines for
selecting nursing personnel for healthcare organization. Hospitals are supposed to
follow these guidelines for recruitment of nursing staff.
Once the human resources planning is done, the next step is to find out the
requisite type of candidates for employment. This can be possibly achieved through
two different modes; direct recruitment and promotions. Direct recruitment helps to
infuse new blood into the organization, which prevents the system from becoming
stagnant and repetitious. Promotion is yet another method of recruitment. It is the
process of filling up vacancies from within the organization.
In CMC hospital, except ward sisters rest of the categories in nursing
personnel were recruited through direct method. Candidate applying for Nursing
Superintendent position must have M. Sc. Nursing qualification with minimum 5
years of experience as Deputy Nursing Superintendent, but at present a person with B.
Sc. Nursing qualification was working on this position. For the post of Deputy
Nursing Superintendent candidate must have M. Sc. Nursing qualification with
minimum 5 years experience as Assistant Nursing Superintendent. At present, person
working on this position was possessing M. Sc. Nursing qualification with more than
25 years of experience. Educational and experience prerequisites for appointment of
Assistant Nursing Superintendent was M. Sc. Nursing with 5 years of administrative
or educational experience. Staff Nurses were also recruited through direct mode and
suitable candidate must have GNM/ B. Sc. Nursing qualification with or without
experience. However, this institution prefers to recruit their own passed out GNM/
B.Sc. Nursing students even without experience.
In DMC hospital, except Staff Nurses rest of the categories in nursing
personnel were recruited through promotion. Nursing Superintendent, Deputy Nursing
Superintendent, and Assistant Nursing Superintendent were recruited by promotion.
However, in case of non-availability of suitable person, direct mode may be adopted.
Educational requirement and experience for Nursing Superintendent was M. Sc.
Nursing with 10 years administrative experience. However, because of non-
109
availability even B. Sc. Nursing with fewer experience is also considered. At present
person with M. Sc. Nursing qualification was working on this position. For
recruitment of Deputy Nursing Superintendent; candidate must posses B. Sc. Nursing
qualification and 7 years of nursing experience. At present, candidate with similar
qualification and experience was working on this position. Assistant Nursing
Superintendent was recruited with B. Sc. Nursing/ GNM qualification and minimum
of 5-7 years of nursing experience. At present candidates working on this position
were promoted on seniority basis and were having GNM qualification with more than
20 years of nursing experience. Nursing Sisters were recruited through departmental
promotion on seniority basis and they must have basic nursing qualification (B. Sc.
(N)/ GNM), minimum experience was not specified for this position. Staff Nurses
were recruited though direct written test and interview, the suitable candidates must
have basic nursing qualification with or without experience. However, experienced
and competent candidates were preferred.
In ESI hospital, except Staff Nurses all other categories of the nursing
personnel were recruited through promotion. Matron was recruited through promotion
on state level seniority basis and they must have B. Sc. Nursing/ GNM qualification
with minimum 5 years of administrative experience as Nursing Sister. At present
person working on this position was possessing GNM qualification and more than 20
years of nursing experience. Nursing Sisters also recruited through promotion on
seniority basis and they must have GNM qualification with minimum 5 years of
experience as Staff Nurse. Recruitment of Staff Nurses was made through direct mode
on the basis of merit of qualifying examination and interview. A suitable candidate
must have basic nursing qualification (B.Sc. (N)/ GNM) with or without experience.
Identical recruitment policies were present in Civil hospital.
Detailed charts comprising the recruitment policies of the selected hospitals
along with recruitment guidelines of the Indian Nursing Council are depicted in Table
2.16.
110
Table 2.16: Recruitment policies for nursing personnel in selected hospitals
Categories Private Hospitals Government Hospitals
INC Recommendations
CMC DMC ESI CIVIL
Nursing Suptt.
Through promotion
Method of Direct recruitment (If not available
recruitment by direct recruitment)
Qualification M. Sc. (Nursing), ‘A’ M. Sc. (Nursing) -NA- -NA- M. Sc. (Nursing)
grade Registered Nurse
& Midwife
Experience Ten years in Nursing

5 years as DNS 10 years administrative 3 years as DNS or
7 years ANS
DNS
Direct Through promotion
Method of (If not available
recruitment by direct recruitment)
A Grade registered Nurse & Midwife

Qualification M. Sc. (Nursing), ‘A’ B. Sc. (Nursing) -NA- -NA- Diploma in General Nursing &
grade Registered Nurse Midwifery
& Midwife Certificate in Education &
Administration or B. Sc. Nursing
Experience 5 years as ANS 7 years 5 years as ANS
Source: Unpublished Office Records, DNS: Deputy Nursing Superintendent, NA: Not Applicable, GNM: General Nursing & Midwifery
112
Table 2.16: Recruitment rules for nursing personnel in selected hospitals
INC Recommendations
CMC DMC ESI CIVIL
ANS/ Matron
Direct recruitment Through promotion Through promotion Through promotion A Grade registered Nurse &
Method of (seniority-wise) (seniority-wise)
recruitment (If not available Midwife
by direct recruitment) Certificate in General
B. Sc. (Nursing) / B. Sc. (Nursing) / Nursing & Midwifery
Diploma in General Diploma in General Certificate in Education &
Qualification M. Sc. (Nursing) B. Sc. (Nursing)/ GNM Administration or B. Sc.
Nursing & Midwifery Nursing & Midwifery
(GNM) Nursing
Experience 5 years teaching 5 - 7 years 5 years as Nursing 5 years as Nursing 5 years as Nursing Sister
Sister Sister
Nursing Sister
Method of Through promotion Through promotion Through promotion Through promotion

recruitment
A Grade registered Nurse &
Midwife
Certificate in General
Diploma in General Diploma in General Diploma in General Nursing & Midwifery
Qualification B. Sc. (Nursing)/ GNM Nursing & Midwifery Nursing & Nursing & Certificate in Education &
Midwifery Midwifery Administration or B. Sc.
Nursing
Experience 5 years as Staff Nurse As per seniority 5 years as Staff 5 years as Staff
Nurse Nurse 5 years as Staff Nurse
Source: Unpublished Office Records, ANS: Assistant Nursing Superintendent, NA: Not Applicable, GNM: General Nursing & Midwifery
113
Table 2.16: Recruitment rules for nursing personnel in selected hospitals
INC recommendations
CMC DMC ESI CIVIL
Staff Nurses
Method of Direct recruitment Direct recruitment Direct recruitment Direct recruitment

recruitment
Qualification
B. Sc. (Nursing)/ GNM B. Sc. (Nursing)/ GNM B. Sc. (Nursing)/ B. Sc. (Nursing)/ A Grade registered Nurse &
GNM GNM Midwife
Certificate in General
Experience No experience required No experience required/ No experience No experience Nursing & Midwifery or B.
experienced preferred required required Sc. Nursing
Source: Unpublished Office Records, NA: Not Applicable, GNM: General Nursing & Midwifery
A comparative analysis of recruitment policies in selected hospitals revealed that there was lack of uniformity in recruitment policies.
Furthermore, none of the selected hospitals exactly follow the recruitment policies laid down by Indian Nursing Council for recruitment of
nursing personnel. Recruitment of lower level staff viz. staff nurses was done through direct mode in selected hospitals. Higher positions were
usually filled through promotion on permanent basis, while recruitment of Staff Nurses was primarily done on contract basis* in selected
hospitals. Staffs recruited on contract basis were not getting full salary and leave benefits. During informal discussions with a group of nurses
working on contract, it was also found that majority of contract staff was not satisfied with pay and benefits they received for their respective
organization.
*
Contract Staff: Nursing personnel, who are not recruited on the full pay scale of respective position, but get consolidated wages, without any allowances and benefits.
114
a) Promotion:
Promotion, in the words of L.D. White, “means an appointment from a given
position to a more difficult type of work and greater responsibilities, accompanied by
change of title and usually an increase in pay”34. In other words, promotion means
rising to a higher post carrying a higher grade. The change in duties and
responsibilities form the essential characteristics of the promotion process. A
promotion system keeps the employees interested in the job and work as a
continuously effective incentive to them. As Procter35 has put it;
“To the employee promotion is of direct significance as a reward or possibility of
reward. Actual promotion is a reward, while the opportunity for promotion is a
possible reward, something still in the future.”
Promotion system helps in retaining the services of the most deserving
amongst its employees and also giving them an incentive to improve their capabilities
and qualifications. In the absence of promotion, ambitious, intelligent and capable
persons leave the job. Promotions are, in fact, one of the most important aspects of
personnel management, meant to keep the employees contented, disciplined, and
efficient. It serves as an inspirational source for hard working among employees. The
inclination of candidate for a job depends to a great extent upon the promotional
opportunities available in an organization as one qualified and experienced person is
likely to join any service and stick to it, if the chances of promotion in the service are
bleak.36 In other words it helps in retaining men of potential ability in service.
Promotions of nurses during last five years in selected hospitals may be
perused from Table 2.17.
Table 2.17: Promotions of nurses during last five years in selected hospitals
Categories* Private Hospitals Government Hospitals
CMC DMC ESI CIVIL

Nursing Superintendent 02 01 --- ---
Deputy Nursing Superintendent ---- 01 NA NA
Assistant Nursing Superintendent/ Matron 01 07 NA NA
Ward Sisters 06 17 --- 01
* Number of people promoted for given position in respective hospital
115
In CMC hospital, only Ward Sister post was filled through promotion, on
liberal seniority basis and candidate must have General Nursing & Midwifery
(GNM)/ B. Sc. Nursing qualification and minimum 5 years of experience as Staff
Nurse. In DMC, NS, DNS, ANS and Ward Sister posts were filled through promotion
on seniority basis irrespective of their years of experience. In government hospitals,
post of Matron and Ward Sisters were filled through promotion on seniority basis.
During discussions, it was found that in government hospitals nurses were
getting very less opportunities of promotion as stated above, nurses were working on
same position for about 30 years, which was the prominent cause of their
dissatisfaction. However, they were availing an opportunity of Assured Career
Progression Scheme (1995), where they were getting two financial upgradations in
their career, if not promoted to next position in due time. While private hospitals were
expanding faster, as well as senior people tend to move towards government
organizations whenever they got chance, therefore, nurses were getting higher
opportunities of promotions. Further it was found that in government hospitals only
20 percent* nurses were satisfied with the existing promotional opportunities in their
organization. While in private hospitals 70 percent nurses were satisfied with existing
promotional opportunities in their organization.
Sixth Pay Commission (2008)37 highlighted the need for a promotional policy
to provide adequate career progression to the employees in general. The Sixth Pay
Commission recommended the existing scheme of Assured Career Progression
Scheme (ACPS) with two financial upgradations and the following modifications; i)
The scheme will also be available to all posts belonging to Group A - whether isolated
or not. Organized Group A services will, however, not be covered under the scheme.
ii) Benefit of pay fixation available at the time of normal promotion shall be allowed
at the time of financial upgradations under the scheme. Thus, an increase of 2.5
percent of pay and grade pay shall be available as financial upgradation under the
scheme. iii) The grade pay shall change at the time of financial upgradation under this
scheme. The grade pay given at the time of financial upgradation under ACPS will be
the immediate next higher grade pay in the hierarchy of revised pay bands and grade
pay being recommended. Thus, grade pay at the time of financial upgradation under
ACPS can benefit the certain cases where regular promotion is not between two
*
Are you satisfied with promotional opportunities in your organization? a) Yes b) No
116
successive grades, be different than what is available at the time of regular promotion.
In such cases, the higher-grade pay attached to the next promotion post in the
hierarchy of the concerned cadre/ organization will be given only at the time of
regular promotion. iv) Financial upgradation under the scheme will be available
whenever a person has spent 12 years continuously in the same grade. However, not
more than two financial upgradations shall be given in the entire career. The scheme
with aforesaid modifications shall be called modified ACPS and will ensure suitable
progression uniformly to all the employees. Scientists and Doctors are presently
covered under separate promotion schemes viz. Flexible Complementing Scheme and
Dynamic Assured Career Progression Scheme respectively.
Case study: A case study regarding promotion of the nurses was conducted on 80
nurses, working on different positions in selected government and private hospitals
(40 nurses from each). The data pertaining to promotion of the nurses in government
hospitals may be perused from Table 2.18.
Table 2.18: Case study analysis with regard to promotions of nurses in govt. hospitals
Categories of No. of Total years No. of Average time Average time
st
post at time of cases of service promotions in 1 in 2nd
joining promotion promotion
2 38 2 31 5
3 38 1 33 ---
7 36 1 29 ---
4 32 -- --- ---
Staff Nurses 8 27 -- --- ---
6 23 -- --- ---
3 21 -- --- ---
2 19 -- --- ---
4 16 -- --- ---
1 07 -- --- ---
Average time in first promotion: 31 years
It was found that 28 nurses out of 40 cases, i.e. 70 percent had not got any
promotion in spite of the fact that 4 nurses have put in more than 32 years of service
and other 17 nurses put in more than 20 years of service. It was also found that 11
117
nurses got one promotion and only two got two promotions. The study also indicated
that the time taken for promotion was too much. For example, staff nurse got first
promotion after putting in more than 30 years of service.
Promotion of the nurses in private hospitals were better than government
hospitals may be perused from Table 2.19.
Table 2.19: Case study analysis with regard to promotions of nurses in private hospitals
Categories of No. of Total years No. of Average time Average time
post at time of cases of service promotions in 1st in 2nd
joining promotion promotion
3 33 2 6 24
2 26 1 09 ---
1 24 1 10 ---
7 19 1 11 ---
2 16 1 12 ---
Staff Nurses 5 13 --- --- ---
6 12 --- --- ---
2 11 --- --- ---
5 9 --- --- ---
3 8 --- --- ---
1 5 --- --- ---
2 3 --- --- ---
1 2 --- --- ---
Average time in first promotion: 9.6 years
It may therefore be inferred that promotional policies in selected hospitals

were not implemented according to Indian Nursing Council guidelines. Promotions of
the nurses were more in private hospitals as compared to their counterparts in
government hospitals. However, stagnation at higher level was of the same degree in
government as well as private hospitals. Similarly nurses working in government
hospitals were more dissatisfied with promotional opportunities as compared to their
counterparts in private hospitals.
118
2.9 Staff Training
Training is concerned with imparting and developing, specific skills for a
particular purpose. Flippo has defined training as “the act of increasing the skills of an
employee for doing a particular job”. In other words, training is the systematic
imposition of skilled knowledge to all categories of employees for their advancement
and efficiency in services. Thus training is a process of learning a sequence of
programmed behaviour. This behaviour, being programmed, is relevant to a specific
phenomenon, that is an endeavors, so as to meet the challenges of continuing
advancement in science and technology, the healthcare professionals of today and
tomorrow have to be kept abreast of the latest development in healthcare practices to
deal with all kind of situations. Training helps the employee to acquire occupational
skills and knowledge and contribute his best towards the objectives of the
organization. Training moulds and shapes the employees to internalize the
organizational skills and character, and also helps them to adapt to new
environment.38
Training is very essential for nursing professionals because social change and
scientific advancements in the field of science and technology have increased the
demand of nursing services and improved nursing response capabilities. Therefore,
there is need for a career long learning to keep abstract of changing demands and
capabilities. The main purpose of training program for nurses is to provide the
opportunity for nurses to continually acquire and implement the knowledge, skills,
attitudes, ideas and values essential for the maintenance of high quality of care. The
training program must be concerned with the growth and development of personnel
right from joining health care agency until relieved from services.39
Whereas, Pigros and Mayers40 mentioned that no organization can choose
whether or not to train employees. The only choice left to management is whether
training shall be haphazard, causal and possibly misdirected or whether it shall be
made a carefully planned part of an integrated program.
a) Orientation
Orientation is an individualized training program intended to acquaint newly
recruited employees with job responsibilities, work place, clients and coworkers. In
fact it is provided to introduce the new employees to the organization and to help
them become acquainted and accommodated with it. Moreover, considerable
119
information is received from the prospective employees through their applications,
written tests and interviews but little job related information is provided by the
organization to new employee. Thus, the new employees may not really know what is
expected of them at the job. Consequently, if there is incompatibility between what
the employees expect in their new job and the realities, they are confronted with
reality shock.41 An effective orientation can help to minimize the shock by way of
creating a sense of security, belongingness and confidence among new employees.42
It was found that CMC hospital had one week mandatory orientation program
for newly recruited nursing personnel. Three days mandatory orientation program is
provided to newly recruited nurses in DMC hospital, while in government hospitals,
there were no such practices of orientation programs.
It is suggested that in government hospitals also orientation program may be
made mandatory. Medical Superintendent and Nursing Superintendent/ Matron may
himself welcome the new appointees. In addition, to make an initial impact a
beautifully printed small ‘Employee’ orientation Handbook’* may be distributed
among them on the first day so that they can raise queries on the following days, if
there is any.
b) On the job training

This is the most common used method of training. In spite of the fact that the
management has so far not formulated any concrete policy, virtually each nurse from
staff nurse to higher positions, get some sort of on-the-job training. A practical reason
for this approach is that the trainees earn as they learn.43 William Tracy calls it as.
“the most common, the most widely accepted and the most necessary method of
training employees in the skill essential for acceptable performance.44
During personal discussions it was found that majority of the employees had
learnt their job by ‘hit and trail’ methods, but in profession like nursing it can not be
practically afforded. It was found that due to lack of interest and clinical expertise on
the part of the supervisors, the latter could not provide proper guidance to the fresh
appointees at the initial stages.
Further it was found that none of the selected hospital appointed a trained
nurse educator to provide on-the-job training to the new appointees. The effectiveness
of on the job training depends primarily upon the qualified trainers: “without them”,
*
Refer annexure-III, for details.
120
Pigors and Myers45 rightly say, “it is simply the old hands, who may have neither the
inclination nor the ability to teach the newcomer properly.” A. P. Saxena, however, is
not in favour of this method of training. To quote him: “it has intrinsically limited
potential for achievement as a training instrument.” Since on-the-job training is easy
to perform and involve low cost to operate,46 it is suggested that the administration of
selected hospitals may also try to formulate a systematic policy in this regard. Either
nurse educators may be appointed to accomplish this task or the existing supervisors
are trained to fulfill this responsibility.
c) Institutional training
It has, however, been found that on-the-job training alone is not sufficient. It
will not only stultify the growth but also delimit the vision of the new employees.
B.B.L. Bhardwaj opines that only person of exceptional initiatives would rise in spite
of several constraints; but this rise would not uplift the remaining. This calls for the
need of institutional training i.e., off-the-job training inside and outside the institution,
which should supplement on-the-job training.47
The empirical first hand data from nurses indicates that in private hospitals
significant number of such training activities were organized for nurses but
government hospitals were doing nothing in this regard. During discussions it was
found that CMC hospital has been organizing 5-6 workshops on current nursing topics
in the past years. As against DMC hospital also organized only 2 to 3 workshops
every year. In government hospitals during last five years no such training activity
was organized.
Further it was found that majority of nurses attended training programs in their
own organization and duration varied between two to five days. In addition, majority
of nurses got a chance to attend training programs after a period of 5-7 years.
Case study: Further a case study was conducted on as many as 80 nurses working in
selected government and private hospitals to assess training opportunities availed by
them during the last five years, the data may be perused from Table 2.20.
It was found that majority of nurses (80.0 percent) in private hospitals
attended training courses during last five years; while in government hospitals only
few of them (20 percent) had this opportunity. This clearly highlighted difference in

Have you attended any training program in last five years? a) Yes b) No
121
number of nurses who had attended training programs in government and private
hospitals. The difference was found statistically significant (p<0.001). Majority of
nurses (93.7 percent)** expressed the willingness to attend the training program in
selected hospitals. Senior nurses mentioned that training is significant no doubt but
because of shortage of nursing staff, hospital cannot afford to spare nurses for such
activities and added that government hospitals, did not have provision of official leave
for nurses to attend training programs that is another reason nurses did not attendant
training activities.
Table 2.20: Number of nurses having attended training programs during the last
five years
Training/ Hospitals
refresher course Total 2
attended Government Private
Yes 08 (20.0) 32 (80.0) 40
No 32 (80.0) 08 (20.0) 40 28.800*

Total
40 40 N = 80
Computed form primary data, * Significant ( p<0.001), d.f.=1

# Figure in parentheses are percentage
During personal discussions with a group of the nurses, the latter appreciated
the management’s action on the ground that this would help to maintain the quality of
patient care. One of nurses from government hospital, who had attended the training
course observed: “Till now we have been providing care on the basis of our old
knowledge and doing many things by hit and trail method, but now we have refreshed
our theoretical knowledge. Thus, from the learning viewpoint, this appears to
represent an ideal approach. A general opinion about this type of training is that it
does reduce time and yield more skillful performance.48
It has been found from the interview schedule that the employees did not hold
unanimous view in respect of the utility of the institutional training. Analysis of
interview schedule indicated two different set of views. Seventy three percent held
**
If given a chance would you like to attend the training program? a) Yes b) No

The relevant question in the interview schedule was: Training of nurses helps in (please tick either of two)
122
the view that training invariably added to the functional capability of the personnel,
broadened their mental horizon and endowed them with a perspective. On the other
hand twenty seven percent viewed training as a paid holiday, enabling the employees
to have pleasant time at the institution’s expenses. It seems that latter group had not
appreciated the utility of training and were not earnest about it.
It is true that no organization can do more than what the persons working in
the organization are capable of accomplishing, and the level of accomplishment
depends on other things, the in-service-training imparted to the personnel being one of
them. In fact, training is an investment in human resources development.49 William G.
Trophy has rightly opined, “training helps in increasing the effectiveness of
employees in their present position as well as preparing employees for future
positions.”50 Thus training is useful and relevant for the development and growth of
the individual as well as organization. The initial training i.e. orientation and on-job-
training, as already discussed above have necessarily been supplemented by in-
service-training which needs to be imparted at various stages of an nurses’ career.
Such a training helps in updating his/ her knowledge and skills and prevents trial and
error attempts, which is not affordable in sensitive profession like nursing. It makes
him/her grow with the growth in his job and responsibilities.
Sixth Pay Commission (2008)51 also emphasized that human resource
development is critical for the enhancement of knowledge, skills and competencies
and provides a critical input for greater performance focus for improved service
delivery. Life-long learning and regular courses with certification for required
competencies to make employees more effective and equip them to meet changing
work place requirements is necessary. Greater in-service training with certification for
desired competencies and skill upgradation is necessary for all levels of employees
and training for employees of other groups should also not be confined merely to the
induction level.
Medical technology is developing so fast that; time to time up-gradation of
knowledge is very essential for nurses to keep a pace with advancement in
technology. In addition, nursing care is a skillful job; therefore refreshing of skills is
very necessary to ensure safe and quality nursing care. It is suggested that
management may plan for sound training policies for nurses and nursing
a) Increasing functional capacity of the personnel by broadening their mental horizon;

b) Enabling the nurses to have a pleasant time at institutional expenses.
123
administrators of selected hospitals need to arrange some of training activities at least
within the organization, with the help of doctors of the hospital or nursing experts
both from within and outside the hospital as well as sister institutions. Hospital
authorities in government hospitals might consider the nursing staff on official leave
while they attend training activities. In addition the hospital authorities may request
the nearby private/government/private nursing institutes to deploy nursing interns
while the regular staff goes for training, so that nursing interns might take care for
patients and enrich their experience when few nurses go to attend training programs.
2.10 Pay Structure

In general, pay is the financial reward provided by the employer to an
employee for his/her work in an organization. Receiving pay for performance is one
of the fundamental objectives of an employee working in an organization. Employees
receive intrinsic satisfaction from public recognition and praise but they also obtain
extrinsic rewards and accolades from financial benefits. In other words, pay structure
is a comprehensive total picture of the emoluments of a post rather than being
fragmented into a number of allowances.52
The existing pay structure of the nursing personnel in selected hospitals is
depicted in Table 2.21.
Table 2.21: Pay structure of nursing personnel in selected hospitals

Categories
CMC DMC ESI CIVIL
16400-450-500-
NS 10000-325 -15200 NA NA
23000*
DNS 12000-420-18300* 7220-250-11660 NA NA
ANS/ Matron 12000-420-18300* 7220-250-11660 6400-250-10640 6400-250-10640
Supervisors 6400-250-13500* 5500-175-9000 NA NA
Nursing Sisters 5500-180-11100 5500-175-9000 5800-250-9200 5800-250-9200
Staff Nurses
Regular 5000-150-200- 5000-150-8100 5000-150-7850 5000-150-7850
8100
Contract -NA- 5000 fixed 3265 fixed 7500 fixed
ANM 3500-120-6500 5000-8100 NA NA
Source: Unpublished office records, NA: Not applicable, NS: Nursing Superintendent,
DNS: Deputy Nursing Superintendent, ANS: Assistant Nursing Superintendent, ANM: Auxiliary Nurse Midwife
* Has dual responsibility, therefore getting UGC Scale
124
It was found that basic pay structure was same for staff nurses in government
as well as private hospitals but variations in pay structure was observed for the staff
nurses on contract. Furthermore, it was found that ward sisters in government
hospitals were drawing slightly more pay as compared to their counterparts in private
hospitals. However matrons of the government hospitals were drawing slight lower
pay as compared to private hospitals. Other positions were not existing is government
hospitals. While comparing the pay scale between both private hospitals; it was found
that more amount of pay was drawn by nursing administrators of the CMC hospital
because they were performing dual responsibility as teaching and nursing
administration.
A High Power Committee on Nursing and Nursing Profession (1990)53 report
mentioned that uniformity of pay scale was not feasible and present in different areas
of India because health is a state subject and due to difference in different allowances
and benefits, pay scale can not be similar in different states. However, state health
departments should try to bring the uniformity in pay scale at the line of Central
Government.
Parnell (1991)54 mentioned that professional nurses, like other professional
workers, frequently responded positively to the strategy of linking financial benefit. It
was further, added that they wanted financial reward for accomplishing personal and
organizational objectives that would increase productivity and reduce turnover and
absenteeism. These rewards can be in the form of advancement of salary, status,
recognition, autonomy, and responsibility.
The Sixth Pay Commission (2008)55 has recommended higher pay scales for
the cadre of nurses, as can be seen from Table 2.22. This will affect some of the
existing relativities of nursing cadres vis-à-vis other Para medical staff. This,
however, is a conscious decision of the Commission for giving a better deal to the
Nurses in recognition of the duties being performed by them. Apart from the cadre of
Nurses, the Commission has made a conscious effort not to disturb any of the
established relativities between the other cadres of Para medical staff. In any case, the
different categories of Para medical staff will benefit from the re-organization of pay
scales being recommended by the Commission.
125
Table 2.22: Pay scales of nurses as recommended by Sixth Pay Commission
Categories Present pay Recommended Corresponding Pay band and pay
Scale Pay Scale grade
Pay Band Pay Grade
Staff Nurses 5000 - 8000 7450 – 11500 PB-2 4600
Nursing Sister 5500 – 9000 7500 – 12000 PB-2 4800
ANS 6500 – 10500 8000 – 13500 PB-3 5400
DNS 7500 – 12000 8000 – 13500 PB-3 5400
NS 8000 – 13500 10,000 – 15200 PB-3 6100
CNO 10,000 - 15200 12000 - 16500 PB-3 6600
CNO: Chief Nursing Officer, NS: Nursing Superintendent, DNS: Deputy Nursing Superintendent,
ANS: Assistant Nursing Superintendent
Sixth Pay Commission recommended higher pay scale for all nursing cadres.
These pay scales will definitely help the nurses to have better satisfaction and
complacency with wages they will draw. However, revised pay scales has kept ANS
and DNS on same scale and pay grade, which could be one of the drawback of these
recommendations but overall pay at all cadres would be significantly high. Majority
of nurses (76.5 percent)* were satisfied with recommendations of the sixth pay
commission in selected hospitals but they were critical about delay in implementation
of pay commission recommendations.
2.11 Allowances
There are several types of allowances and fringe benefits available to the
various categories of nursing staff. Pinkerton S. (2006)56 mentioned that these are
cardinal elements for a successful motivation of employees, since all these create
motivating climate and lead to satisfaction in workforce. Nurses who experience
satisfaction in job provide long services and contribute more enthusiastically towards
achievement of organizational objectives.
It was found that selected hospitals had similar pattern of Dearness
Allowances, Dearness Pay, House Rent Allowance and Interim Relief allowance for
nursing personnel. However, there was disparity in selected allowances like washing
allowance; city compensatory allowance, medical allowance and education allowance,
*
Are you satisfied with recommendations of sixth pay commission regarding pay scales of nurses? a) Yes b) No
126
where nurses in government hospitals got higher benefit as compared to their
counterparts in private hospitals may be perused from Table 2.23.
Table 2.23: Allowances for nursing personnel in selected hospitals

Allowances Private Hospitals Government Hospitals
CMC DMC ESI CIVIL
35% of basic pay + 35% of basic 35% of basic pay 35% of basic pay
DA
DP + IR pay + DP + IR + DP + IR + DP + IR
50% of basic
DP 50% of basic pay 50% of basic pay 50% of basic pay
pay
5% of basic 5% of basic pay
IR 5% of basic pay 5% of basic pay
pay
15% of basic to
senior posts
Rs. 1000/- for 15% of basic 15% of basic pay
HRA 15% of basic pay
Nursing Sisters pay
Rs. 500/- Staff
Nurses
Washing
allowance ----- 125 138 150
City
compensatory
----- ---- 180 180
allowance
Fixed
Medical
---- 100 350 250
allowance
One special
Education
allowances for NA ---- -----
allowance
higher qualification
-----
ESI allowance ---- ---- 250
Source: Unpublished office records, NA: Not applicable, DA: Dearness Allowance, DP: Dearness
Pay, IR: Interim relief , HRA: House Rent Allowance,
**There were no allowances for contractual staff
Even the High Pay Commission (1990)57 suggested Uniformity in allowances

such as Washing allowance, Risk allowance, Messing allowance, uniform allowance
etc. The Committee recommended that as far as possible the nursing staff should be
given in priority for allotment of accommodation near the work place. Hospital should
not build hostel for trained nurses. Instead of hostels, apartment type of
accommodation should be provided to married/unmarried nurses. During odd hours,
calamities etc. arrangement for transport must be made for safety and security of
nursing personnel. Chartered buses on payment may be provided for transportation
from housing colonies built for hospital staff.
127
There was disparity in uniform allowance, washing allowance, risk allowance
and compensatory allowance. It was suggested by 4th pay commission, that uniform
and washing allowance and additional increment for nurse possessing additional
diplomas and degrees in nursing should be given on the lines of Central
Government.58
Compensation other than wages or salaries is the most cherished demand of
each employee. Today fringe benefits provide protection from the contingencies of
life from the day of employment to retirement and beyond (George Strauss et al,
1975).59 Fringe benefits offered to nursing personnel in selected hospitals are
illustrated in Table 2.24.
Table 2.24: Fringe benefits for nursing personnel in selected hospitals

Fringe benefits Private Hospitals Government Hospitals
CMC DMC ESI CIVIL
All group-I
employee
Hostel for staff Family Few family
50% group-II
In campus housing nurses, No quarters for quarters for
employee
family quarters seniors seniors
Others get
HRA
Free medical
Yes Yes Yes Yes
consultation
Yes
Free diagnostic tests Yes Yes
Yes
50% cost of Medicine bill
Free medicines No
medicine free reimbursement Yes
Yes but >18
Free hospital care for yrs or married
Yes Yes
dependents Yes not considered
dependent
No
Transportation No No No
No
Crèche Yes No No
Organizing Organizing
Entertainment entrainment entrainment & No No
activities sports activities
Yes
Staff canteen Yes No No
Yes
Loans/ advance pay Yes No Yes: GPF
Only to NS &
Mobile facility No No No
supervisors
Source: Unpublished office records, NA: Not applicable, NS: Nursing Superintendent,
HRA: House Rent Allowance, GPF: Gratuity Provident Fund
128
It was found that in DMC hospital, only hostel was provided to unmarried
nurses but there were no family accommodation. In CMC hospital, all group-I
employees were given compulsory family accommodation, 50 percent group-II
employees do get this facility, rest others were given House Rent Allowance. While,
government hospitals provided family accommodation to senior staff inside the
campus. Free medical consultation, diagnostic tests and indoor hospital care for
nurse’s dependents was provided in all selected hospitals. In DMC and Civil hospital,
all medicine bills were reimbursed, while in CMC hospital, only 50 percent of
medicine bills were reimbursed and in ESI hospital nurses were receiving all
medicines free during their illness. Crèche facility for children of nursing personnel
was provided in CMC hospital, while in other three selected hospitals this facility was
not available. Entertainment activities and Staff canteen facilities were provided to
nurses in both private hospitals, while in other two hospitals it was not available for
nurses. Hence, there was not much difference in the fringe benefits in selected
hospitals; however, few facilities were better in private hospitals as compared to
government hospitals. Aswathappa K (2008)60 documented that fringe benefits may
fail in their motivational effect as they are not tied to employee’s performance but to
organizational relationship. In addition, most of the employees perceive benefits and
services provided by an organization as a part of their large social responsibility
actions.
2.12 Attrition Rate

Developing countries often complained of the ‘brain-drain syndrome.
According to a survey conducted by International Council of Nurses (2005)61 on
migration of Asian nurses to west. It was found that nurses did not leave on their own
accord but were compelled to leave due to the existence of poor service conditions in
the own country, poor salaries, inadequate educational opportunities and lack of
recognition etc. Migration thus represented an opportunity for nurses to exercise their
power and values; it has become an absolute option. Even in the past, International
Council of Nurses (2001),62 identified some of the significant factors responsible for
attrition among nurses were poor remuneration, poor working conditions, insufficient
career development opportunities and social and political factors. The pull factors
provided opportunities for professional development, improved pay and better quality
of life.
129
It was found that the number of nurses leaving the private hospitals were been
more (10.9 percent) as compared to nurses left from the government hospitals (2.8
percent), which may be perused from Table 2.25.
Table 2.25: Mean attrition rate of nurse/ year in selected hospitals

Hospital Mean Percentage
Private hospitals 59.2 10.9
CMC 65.0 13.7
DMC 53.3 08.1
Government hospitals 03.0 02.8
ESI 02.7 04.8
Civil 00.3 00.7
This trend was higher in CMC hospital (13.7 percent) as compared to DMC
hospital (8.1 percent). The ESI hospital presented a higher trend (4.8 percent) in this
regard as compared to Civil hospital (0.7 percent). Hence, it was clear that attrition
rate was high in private hospitals (10.9 percent) as compared to government hospitals
(2.8 percent).
Case study:
Furthermore a case study was conducted on 80 nurses to assess their intent to
leave the hospitals for other countries. The details may be perused from Table 2.26.
It was found that in private hospitals 47.5 percent* nurses were trying to go
abroad. Whereas in government hospitals only 12.5 percent of them were trying do so.
Further it was found that majority of nurses were willing to migrate to developed
countries, where Canada dominated the figure, followed by USA, UK and Australia.
Similar findings were reported by George T. (2007)63 that most of the nurses from
developing countries would choose UK, USA, New Zealand, and Australia because of
attractive professional opportunities, similar education system, colonial ties and
language etc.
*
Are you trying to go abroad? a) Yes b) No
If yes, please specify the country of your choice:……………………………………….
130
Table 2.26: Nurse’s intent to migrate in other countries from selected hospitals
Hospitals
Variables Government Private
Trying to go to Yes 05 (12.5) 19 (47.5)
other country No 35 (87.5) 21 (52.5)
Canada=09
Canada = 3
USA=5
Country of first choice USA=2
UK = 3
Australia=2
-Better job opportunities.
-Better quality of life
Reasons for leaving -More salaries
present job - Better recognition of nursing profession
- Good opportunities for education of children
- Since family/husband/relatives had settled abroad
# Figure in parentheses are percentage
Some of the prominent reasons** for going abroad were; better lucrative job
opportunities, high salaries, better quality of life and recognition of nursing profession
and better future of their children. In addition, some of nurses wanted leave because
of husband/family/relatives living abroad. International Council of Nurses, 2005
mentioned that some of developing countries like India and others have not put in
place effective strategies for retaining their nurses. Migration of nurses will continue
to unabated until the developing countries demonstrate a commitment to the needs of
nurses and firm recognition of the value for nursing care and nursing profession.64
2.13 Job Satisfaction

Job satisfaction is a complex concept and difficult to measure objectively. The
level of job satisfaction is affected by a wide range of variables relating to individual,
social, cultural, organizational and environmental factors. Employees may be satisfied
with certain aspects of the work and dissatisfied with the others. In fact, job
satisfaction is the degree to which one’s important needs for health; security,
nourishment, affiliation and esteem are fulfilled on the job or as a result of the job. In
**
Please specify the reason(s) for going abroad:…………………………………………………………………
131
the context of the development and maintenance of good human relation in business
and industry, job satisfaction is significantly related to the feeling and emotional
aspect, as different from intellectual and rational aspect of an individual’s experience
towards his job.65
The term job satisfaction can be defined as a positive feeling about one’s job
resulting from an evaluation of its characteristics. A person with a high level of job
satisfaction holds positive feelings about the job, while a person who is dissatisfied
holds negative feelings about job.66
It was observed that there was high level of job satisfaction among nurses
working in private hospitals (28 percent)* as compared to nurses working in
government hospitals (5 percent). In government hospitals, more than half of the
nurses were dissatisfied with their job, while in private hospitals only 17 percent
nurses expressed dissatisfaction as may be perused from Table 2.27.
Table 2.27: Level of job satisfaction among nurses in selected hospitals

Hospitals
Level of satisfaction Total 2
Government Private
Highly satisfied 05 28 33
Moderately satisfied 40 55 95
Uncertain/dissatisfied 55 17 72
14.937*
Total 100 100 N = 200
Computed from primary data, N=200, * Significant (p value < 0.001), df = 2
Hence, Job satisfaction was more among nurses working in private hospitals
as compared to nurses working in government hospitals. These findings were found to
be statistically significant (p<0.001).
a) Determinants of Job satisfaction

Certain selected determinant factors of job satisfaction among nurses working
in wards of selected hospitals were also studied. The factors included in study were
satisfaction with pay, leaves, working conditions, respect, recognition, workload,
*
Please see the detailed questionnaire in Annexure-I (B).
132
professional development, promotional avenues, autonomy in work and team
harmony. A detailed data has been presented in Table 2.28.
Table 2.28: Determinants of job satisfaction among nurses in selected hospitals

Hospitals
Job attributes of Government Private
nurses (n= 100) (n= 100)
Satisfied Dissatisfied Satisfied Dissatisfied
Pay 55 45 45 55
Leaves 60 40 50 50
Working conditions 30 70 75 25
Respect received 55 45 60 40
Recognition 40 60 70 30
Workload 50 50 55 45
Professional
25 75 67 33
development
Promotion avenues 20 80 70 30
Autonomy in work 55 45 60 40
Team harmony 45 55 57 43
Computed from primary data, # Figure in parentheses are percentage
Pay is financial reward received by an employee against his/ her work carried-
out for an employer. Pay is one of the important determinants of job satisfaction
among employees. SL Goel (2005)67 mentioned that government employees are more
satisfied with their pay as compared to their counterparts in corporate or private
organizations. In present study it was found that in government hospitals slightly
more number of nurses (55 percent) were satisfied with the pay they received as
compared to nurses working in private hospitals (45.0 percent). Hence, it is clear that
nurses working in government hospitals were more satisfied with their pay as
compared to their counterparts in private hospitals. There is an interesting relationship
between salary and job satisfaction, pay really matters a lot for poor people but for a
very rich person pay does not has significant role in their satisfaction.68
Leaves are the privileges or facilities for employee to remain disengaged from
work for a stipulated time period. Employee may fall sick or may have some personal,
133
professional or social engagement, where it will not be possible for him to be on
work. In these circumstances employees need leaves. There was provision of several
types of leaves available to the employees in selected hospitals. The complete details
are depicted in Table 2.29.
Table 2.29: Leave pattern for nursing personnel of selected hospitals

Leaves CMC DMC ESI CIVIL
10 days, If service is <
10 Yrs.
Casual 15 days, If service is
10 days 20 days 20 days
Leaves/ Year 10 – 20 Yrs.
20 days if service is
> 20 Yrs.
16 days If service is < 15 days if service 15 days if service is
10 Yrs. is < 15 Yrs. < 15 Yrs.
Earned Group-I: 42 days 20 days If service is 20 days If service 20 days If service is
Leaves/ Year Group-II: 28 days 10 – 20 Yrs. is 15-20 Yrs. 15-–20 Yrs.
26 days If service is > 30 days If service 30 days If service is
20 Yrs. is > 20 Yrs. > 20 Yrs.
240 days in full
Medical 15 days service period +
15 days
Leaves/ Year Nil 480 days half pay
medical leave
Three months (one &
3 months (twice only)
Maternity half month before
(1 month extension in 6 months 6 months
Leaves and after delivery)
special circumstances)
twice only
Abortion 15 days
Nil 42 days 42 days
Leaves
Tubectomy
15 days 7 days 15 days 15 days
Leaves
Two years with 50% Two years with full
Educational
pay (permitted once pay (permitted once Nil Nil
Leaves only) only)
Six days for straight
One & half day per 8 days/ Month+
Day off week
shift/ month + 8 days/ Month
Gazetted Holiday
Gazetted Holiday
Without Pay Maximum 2 months Maximum 2 months
10 days/ Year 10 days/ Year
Leaves after 1 year service after 1 year service
Compensatory Yes or overtime Yes, with approval
Leaves Yes payment Yes of Medical
Superintendent
Business Not fixed, but can be Once in a year if
given recommended No provision No provision
Leaves
 Contract staff in ESI hospital gets only 1 off/ week+ Gazette holiday.
 Contract staff in Civil hospital gets only 8 offs/ month+ 8 Casual Leaves in a Year.
 Contract staff in DMCH avail all leaves as mentioned above, While get medical leaves, maternity
leavse, tubectomy leaves, educational leaves and business leaves after one year service.
134
S.K. Kataria (1993)69 mentioned that people working in government
enterprises avail more number of leaves as compared to people working in private
organizations. In present study, 60 percent of nurses working in government hospitals
were satisfied with leaves they availed in their job, while among nurses working in
private hospitals only 50 percent of them were satisfied with the leave pattern in their
respective organizations.
As per Herzbergs theory of job satisfaction, working conditions at job are one
of the important hygiene factors of job satisfaction among employees. It was found
that only 30 percent nurses were satisfied with working conditions in the government
hospitals. In comparison to it 75 percent nurses were satisfied with working
conditions in private hospitals. Findings by Seymour and Buscherhot (1991)70
documented that “the main motivating factors for nurses were interest in work and
service of others (25.7 percent). Professional and personal development opportunity
(25.1 percent) ranked 2nd, material reward (19.4 percent) ranked third, whereas
working conditions and counter productive attitude within the employing organization
were more serious source of dissatisfaction.”
Respect, recognition, workload, professional development and promotional
avenues were categorized as most important motivating factors in Herzberg’s dual
factor theory of job satisfaction. In the present study, nurses working in government
hospitals were more dissatisfied with promotional avenues (20 percent) and
professional development (25 percent) in their job as compared to nurses working in
private hospitals. Borda and Norman (1997)71 reported contrast findings, where they
reported that nurses working in public healthcare facilities were more satisfied with
recognition and professional development as compared to nurses working in private
healthcare facilities.
Finn CP (2001)72 viewed autonomy as an important component of nurses’ job
satisfaction followed by other factors of job. The study findings revealed that in
private hospitals 60 percent of nurses were satisfied with their work autonomy, while
only 55 percent nurses were satisfied with work autonomy in government hospitals.
About team harmony, in selected wards of government hospitals only 45 percent
nurses were satisfied; while in private hospitals nearly more than half of nurses (57
percent) were satisfied with their team harmony in ward. However, Teng Huey Ming
135
(2004)73 mentioned that autonomy, co-worker’s support, role conflict, distributed
justice and job growth has no significant effect on job satisfaction.
Table 2.30: Comparative analysis of nurses’ job satisfaction in selected hospitals

Job factors Hospitals
with….. Government Private
More number of - Working conditions
- Pay
nurses satisfied - Promotional avenues
- Leaves
with… - Professional development
Less number of - Promotional avenues - Pay
nurses satisfied - Professional development - Leaves
with…. - Working conditions - Work load
Computed form primary data
A close comparative analysis about nurses’ satisfaction with selected

determinants of job revealed that in government hospitals, nurses were more satisfied
with the leaves they availed (60 percent) and pay they received (55 percent), which
may be perused from Table 2.30. However, nurses in government hospitals were least
satisfied with promotional avenues (20 percent) and professional development (25
percent). In private hospitals, higher satisfaction was found among nurses with
working conditions (75 percent), promotional avenues (70 percent) and professional
development (67 percent), while nurses were least satisfied with pay they received (45
percent), leaves they availed (50 percent) and amount of work they performed (55
percent). Hence, except pay and leave opportunities, nurses working in private
hospitals were more satisfied with their job as compared to nurses working in
government hospitals.
There is strong relationship between nurses’ job satisfaction and patients’
perception about the quality of the care they receive. Employee dissatisfaction can
negatively affect quality of care and had an adverse effect on patients’ satisfaction.
Therefore, health care organization should regularly measure employees’ satisfaction
as one of the way to monitor quality of service. Health care organizations might work
more closely with their human-resource departments to understand and influence
employees' work environment and maintain a high level of job satisfaction so as to
achieve a higher level of patients’ satisfaction (Atkins PM et al, 1996).74 During
136
discussions a good number of nurses also expressed similar view point that job
satisfaction of nurses is closely related to patients’ satisfaction with the quality of
nursing care.
Major Observations
 Location and facilities of the Nursing Administrative Office: Nursing
administrative office of CMC hospital was located in administrative block, while
in other three selected hospitals it was located away from administrative block. In
CMC hospital significant good number of nurses were satisfied with location of
nursing administrative office, while in other three hospitals majority of them were
not satisfied with the location of office. In private hospitals, nursing
administrative office was well equipped with storage facility, telephone, and
computer/typewriter etc. While in government hospitals this office was lacking
most of the necessities. Ministerial staff was available in nursing administrative
office of private hospitals but in government hospitals even clerical work was
accomplished by nurses. Majority of respondents were satisfied with facilities of
nursing administrative office in CMC hospital, while in other three hospitals
majority of them were not satisfied.
 Organizational structure: Organizational structure in selected government and
private hospitals was not uniform. Line organizational structure was observed in
all selected hospitals, where authority was concentrated at top administrative
level. In addition, existing organizational structure of nursing departments at
selected government and private hospitals was not in accordance with Indian
Nursing Council guidelines.
 Span of control: Span of control was satisfactory in selected hospitals. Where at
upper level in private hospitals 2 to 6 subordinates (Nursing sisters) were
supervised by one supervisor, while in government hospitals one supervisor
supervised about 4 to 8 subordinates (Nursing sisters). At operational level, in
private hospitals one nursing sister supervised 12 to 16 staff nurses, while in
government hospitals one nursing sister supervised 7 to 13 staff nurses. Hence at
operational level, span of control in government hospitals was relatively better
than private hospitals. Majority of respondents were satisfied with span of control
137
in government hospitals, while in private hospitals only half of them were
satisfied.
 Communication: In private hospitals, nursing departments used written, face-to-
face and telephone communication methods, while in selected government
hospitals major part of organizational communication was accomplished by face-
to-face mode. The telephone facility was not available in nursing administrative
office of government hospitals. However, this facility was available in selected
private hospitals. Majority of respondents (80 percent) in private hospitals
expressed satisfaction with communication system in their organization, while in
government hospitals majority of them were dissatisfied.
 Coordination: Good amount of coordination existed between nursing and other
departments of private hospitals. On the contrary, in government hospitals nurses
expressed delay in responses from other departments, where callous attitude of the
employer, lack of team spirit, lack of resources and inadequacy of manpower were
some of the probable causes of poor coordination.
 Staffing pattern: In CMC hospital, number of nursing administrative staff such as
Chief Nursing Officer, Deputy Nursing Superintendent, and Assistant Nursing
Superintendent was less than recommendations of the Indian Nursing Council,
while staff at middle management level (Supervisors, Ward Sisters) and
operational level (Staff Nurses) was in excess than recommendations. Similarly in
DMC hospital, several senior positions were laying vacant, but middle
management staff was in excess than recommendations. Whereas staff nurses
were close to the recommendations of Indian Nursing Council. However, in
government hospitals shortage of nursing staff was as high as whooping 62.1
percent in ESI hospital and 43.8 percent in Civil hospital.
 Staff recruitment and promotion: In selected hospitals, there was lack of
uniformity in recruitment policies. Furthermore, none of the selected hospitals
exactly followed the recruitment policies laid down by Indian Nursing Council for
recruitment of nursing personnel. Recruitment of lower level staff viz. staff nurses
was done through direct mode in selected hospitals. Higher positions were usually
filled through promotion on permanent basis, while recruitment of Staff Nurses
was primarily done on contract basis. Majority of contract staff was not satisfied
138
with pay and benefits they received since they did not get full salary and leave
benefits from their respective organization. Promotional opportunities were better
in private hospitals, while in government hospitals nurses were working on the
same position since last more than last 30 years. Similarly 63 percent nurses were
satisfied with promotional opportunities in private hospitals, while in government
hospitals close to half of them were satisfied.
 Staff Training: In private hospitals, few workshops were organized for nurses on
current nursing topics every year, while in government hospitals during last five
years no such training activities were organized. A compulsory orientation
program was organized for newly recruited nurses in private hospitals, while such
programs did not exist in government hospitals. In addition, majority of nurses in
private hospitals had attended one or other training program in last five years,
while in government hospitals majority of them did not get chance to attend such
activities. Majority of nurses expressed willingness to attend training activities, if
they were given a chance. Senior nurses in government hospitals mentioned that
they did felt the need of refresher training for their staff but because of shortage of
staff it was difficult to spare the staff as well as they did not had the provision of
official leaves to attend training activities.
 Pay and allowances and fringe benefits: Basic pay scale, dearness allowance,
dearness pay, interim relief and house rent allowance were nearly same in selected
hospitals, while other allowances like washing allowance, city compensatory
allowances, fixed medical allowances, were more in government hospitals as
compared to private hospitals. Fringe benefits were not much different in selected
hospitals.
 Attrition rate: In the last five years, more number of nurses left the private
hospitals (10.9 percent) as compared to government hospitals (2.8 percent). Only
staff nurses were leaving the hospitals and there was no resignation from senior
positions. In addition, it was found that 40 percent nurses in private hospitals were
in process to migrate to other developed countries, while in government hospitals
only 10 percent of them were trying to migrate in developed countries.
 Nurses’ job satisfaction: Overall job satisfaction among nurses in government
hospitals was low, where only close to half of the nurses were dissatisfied with
139
their job, while in private hospitals majority of the nurses (83 percent) were
satisfied with their job. In government hospitals, main determinants of job
satisfaction among nurses were pay and leaves they received, while in private
hospitals more nurses were satisfied with professional development and working
conditions.
Inferences drawn
 Location of nursing administrative office was not ideal in DMC and government
hospitals.
 Nursing administrative offices of government hospitals were poorly equipped
with storage and communication facilities.
 There was poor upward communication in existing line organizational structure of
nursing departments in selected hospitals.
 Span of control in nursing departments of selected hospitals was satisfactory.
 Communication facilities and system was poor in nursing departments of
government hospitals.
 There was poor coordination in nursing departments of government hospitals.
 Staffing pattern was not in accordance with Indian Nursing Council in selected
hospitals and nurse patient ratio was very poor in government hospitals.
 Staff recruitment policies were neither uniform and nor in accordance with Indian
Nursing Council in selected hospitals.
 Promotions of nurses were less in government hospitals.
 Nursing staff training was not given due consideration in government hospitals.
 Pay and fringe benefits for nurses were nearly similar in selected hospitals but
allowances were better in government hospitals.
 Nurses’ attrition rate was high in private hospitals.
 Nurses’ job satisfaction was high in private hospitals as compared to government
hospitals. In government hospitals, the main factors of dissatisfaction among
nurses were poor working conditions, lack of promotions and professional
development.
140
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NURSING ADMINISTRATION IN SELECTED HOSPITALS

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NURSING ADMINISTRATION IN SELECTED HOSPITALS

2.2 Nursing Administration

2.3 Objectives of Nursing Administration

6. Assist hospital management in the maintenance of effective personnel

9. Initiate a system with hospital management for predicting and determining

10. Participate in interdepartmental programs and hospital committees delegated

11. Encourage a stimulating environment in which the personnel have

13. Provide an environment conducive to learning of students for formal programs

14. Assist in the development of a sound, constructive program of leadership in

18. Provide an environment conducive to advanced educational nursing programs.

2.4 Nursing Administrative Office

2.5 Location and Facilities of Nursing Administrative Office

Table 2.1: Type of facilities in Nursing Administrative Office

There was adequate storage facility in nursing administrative office of the

2.6 Organizational Structure

Nursing Superintendent (1)

Deputy Nursing Superintendent (1)

Assistant Nursing Superintendent (1)

Nursing Supervisors (29)

Nursing sisters/ Ward sisters (33)

Staff Nurses (475)

Fig. 2.1: Organizational structure of nursing department of CMC hospital

DNS was placed at second level in organizational hierarchy of nursing

Deputy Nursing Superintendent (1)

Assistant Nursing Superintendent (8)

Nursing Supervisors (10)

Nursing sisters/ Ward sisters (62)

Staff Nurses (657) ANMs (48)

Fig. 2.2: Organizational structure of nursing department of DMC hospital

Ward Sisters/Nursing Sisters (8)

Staff Nurses (55)

Fig. 2.3: Organizational structure of nursing department of ESI hospital

The department was headed by a Matron. Matron was considered equivalent to

Ward Sisters/ Nursing Sisters (4)

Staff Nurses (50)

Fig. 2.4: Organization structure of nursing department of Civil hospital

Both the government hospitals had identical organizational structure. While

Table 2.2: Span of control among nursing personnel in selected hospitals

1. NS: DNS 1:1 1:1 NA NA

Table 2.3: Nurses’ satisfaction with the span of control

Yes 25 (50.0) 28 (56.0) 40 (80.0) 30 (60.0) 123 (61.5)

No 25 (50.0) 22 (44.0) 10 (20.0) 20 (40.0) 77 (38.5)

Communication is an integral part of nursing administration. Communication

Table 2.4: Modes of communication in nursing departments of selected hospitals

Table 2.5: Nurses’ satisfaction with communication system in selected hospitals

No 09 (18.0) 11 (22.0) 43 (86.0) 46 (92.0) 109 (54.5)

Table 2.6: Indian Nursing Council recommendations for staffing pattern

Recommendations of Nurses Board of Victoria, Australia may be perused

California Board of Registered Nursing, (1999)26 provided the

Table 2.8: Recommendations of California Board of Registered Nursing, for

Table 2.9: Comparison of recommendations for nurse patient ratio

In CMC hospital, the strength of Chief Nursing Officer, Deputy Nursing

Table 2.10: Staffing pattern of nursing department in CMC hospital

Chief Nursing Officer 01 -Nil- 01 ----

Table 2.11: Staffing pattern of nursing department in DMC hospital

Chief Nursing Officer 01 -Nil- 01 71.4%

382 380 02 ----

Emergency/ICUs (15 beds) 20 06 14 ----