 Module No.

4 : Organizing

 Module No. 4.1 Organizing nursing services and patient care
i.e.
 methods of patient care

 Bahirdar university College of

 Medicine and Health Sciences

 Gebre Yitayih/PhD,Asst.prof)
 October,2019

1
 OBJECTIVE

Overall objective is to understand about the concept of

organization and organizing the nursing service unit in all
the levels of health care systems and to develop the skills to
impart the different methods of patient care by analyzing the
patients needs.

2
 Learning Outcome
At the end of this module the students will be able to
 Define organizing.
 Explain about the organizing structure design
 List out the objectives of nursing service
 List down the functions of nursing service
 Enumerate the organizing and management of nursing
service unit.
 Explain about the nursing staff requirement
 Describe about organizing the nursing services at central,
state and district
 Explain about the patient classification system.
 Describe about the methods of patient care
3
 List of Topics
 Introduction
 Meaning and definition
 Organizing nursing service design
 Nursing service
 Nursing staff requirement
 Organizing of nursing service unit
 Role and functions of nursing administrators
 Problems faced by nursing administrators
 Patient classification system
 Leadership roles
 Methods of patient care
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 List of Topics Contd..

 Principles and Practice of Nursing Administration and

Management
 Elements / Functions of Nursing Administration and
Management
 Process of Nursing Administration and Management
 Summary
 Reference

5
 Introduction

Organizing, the foremost of management functions which

enables the organization to deal with the present and anticipate the
future, is a process whereby management decides where it is at
present, and where it wants to be at some time in the future. The
process is one of forecasting, because forecasting seeks to provide
the manager with information about the future.

6
 Meaning & Definition

ORGANIZING:

A basic process of combining / integrating

Human / Physical / Financial resources in productive
interrelationship for the achievement of health care
setting objectives

8
 Meaning & Definition Cont…

ORGANIZATION:
Organization implies a formalized intentional
structure of roles or positions

Effort Pooling towards designated objectives

through definition / division of activities /
responsibilities / authority

9
Organizational Structure Design
Who

Is to do Give what

Results
What

Fitting various activities

Smoothly

Efficiently

Effectively
 intentional structure of
roles in a formally
organized enterprise

Well
Should
defined
not be
jobs
flexible

Formal
Channeled Definite
organization
individual and authority /
group efforts responsibility
Nursing Service and Nursing
administration

Nursing service is the part of the total health

organization which aims at satisfying the nursing needs of the
patients/community.

Nursing service administration Nursing service

administration is a complex of elements in interaction and is
organized to achieve the excellence in nursing care services.

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DEFINITION OF NURSING SERVICE

WHO expert committee on nursing defines the nursing

services as the part of the total health organization which aims to
satisfy major objective of the nursing services is to provide
prevention of disease and promotion of health.

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OBJECTIVES OF NURSING SERIVCE IN HOSPITAL
 Management of nursing service and care Initiate a set of human relationships
at all levels of nursing personnel. Establish adequate staffing pattern.
 Develop and implement proper communication system.
 Develop and initiate proper evaluation and
 periodic monitoring system.
 Proper job description for nursing personnel.
 Assist hospital authorities for effective personnel management.
 Share nursing information system with other discipline. Formulate and
interpret nursing service policies.

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 OBJECTIVES OF NURSING SERIVCE IN HOSPITAL
Cont….
 Assist hospital authorities f inter departmental programs and other
programs.
 Education training and staff developments
 Encourage a stimulating environment in which the personnel have
opportunities to be creating innovators.
 Develop and initiate orientation and training programs.
 Create an atmosphere that conducive to give proper learning
experiences for students.
 Assist in the development of a sound, constructive program of
leadership in nursing.
 Initiate programs to improve the practice of nursing in keeping with
advances in the relative areas and disciplines affecting the quality of
nursing or preparation of budget

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 OBJECTIVES OF NURSING SERIVCE IN HOSPITAL
Cont….
 Participate in inter departmental programs and other programs.
 Education training and staff developments
 Encourage a stimulating environment in which the personnel have
opportunities to be creating innovators.
 Develop and initiate orientation and training programs. Create an
atmosphere that conducive to give proper learning experiences for
students.
 Assist in the development of a sound, constructive program of
leadership in nursing.
 Initiate programs to improve the practice of nursing in keeping with
advances in the relative areas and disciplines affecting the quality of
nursing.

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 OBJECTIVES OF NURSING SERIVCE IN HOSPITAL
Cont….
 Research Participate in identifying the areas of research. Participate
in the application of data and research.
 Produce conducive environment for research.
 Community health program Participate in community health
programs, associated with hospital.
 Interpret the roles and responsibilities in community health
programs.
 Participate in extramural health programs of the hospital and other
related organizations.

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 FUNCTIONS OF NURSING SERVICES
 To assist the individual patient in performance of those activities
contributing to his health or recovery.
 To help and encourage the patient to carry out the therapeutic
plan initiated by the physician.
 To assist other members of the health team,
 To assist other members of the team
 To plan and carry out the total program of care

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 SOUND ORGANISATIONAL PLANNING FOR
HOSPITAL NURSING SERVICES
 A written statement of the purpose and objectives of the nursing
service
 A plan of organization
 Policy and administrative manuals
 Nursing practice manuals
 Nursing service budget
 A master staff planning
 Plans of appraisal of nursing
 Nursing service administrative meetings
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SOUND ORGANISATIONAL PLANNING FOR
HOSPITAL NURSING SERVICES contd…
Advisory committees
 Adequate facilities, supplies and equipments
 Written job descriptions and job specifications
 Personnel records
 Health services
 In-service education of nursing personnel
 Meeting with personnel from other departments

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 ORGANIZATION AND MANAGEMENT OF
NURSING SERVICE UNIT
Factors influencing patient care
The type of service.
The acuteness of the service and the rate of turnover in patients.
The experience of the nurse.
The number of non-nurses amount and quality of teaching
.The amount and quality of supervision and ward teaching.
The method of appointment of the medical staff.
 The plan of ward floor plan. The physical facilities.
 The amount, type and location of equipments and supplies.

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ORGANIZATION AND MANAGEMENT OF
NURSING SERVICE UNIT
 The number of working hours
 The morale of the worker.
 Methods of performing nursing procedures.
 The time required for hospital routines
 The method of assignment.
 The standards of nursing care.
 Good ward management. Management Assessment or data
gathering.
 Implementation-directing groups of nurses to implement
planned actions.
 Evaluation step in management process, includes the action of
multiple care givers, patient outcomes and costs.
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 DETERMINING THE NURSING STAFF
REQUIREMENT
 Calculating staff needs based on the number of beds in the
hospitals.
 Estimating the number of staff according to the degree of
dependency of the patients as determined on a scale.
 This method relies on observations of nursing activity.

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ORGANISATION OF NURSING SERVICES

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DIRECTORATE GENERAL OF HEALTH
SERVICES

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 Nursing organization at central level

 At central level, nursing services are within the ministry of

health and family welfare and under the control of
directorate general of health services.
 DGHS is assisted by director general (nursing), Additional
director general, Deputy director generals.

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Organizational structure of nursing services
at state and district levels
 No special organizational structure for nursing services.
 Post of joint director and deputy director for nursing service
is under the state directorate of health.
 In some state at district level, there is a post of district public
health nurse (DPHN)

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 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR
 Administration, Organizes, directs and supervises the nursing
services both day and night.
 Coordinates assignments of staff.
 Establishes the general pattern of delegation of responsibilities and
authority.
 Formulates standing orders for the nursing care.
 Ensures appropriate allocation of duties and responsibilities to all
nursing staff working under her.
 Formulates nursing policies to ensure quality patient care and adequate
attention at all times.
 Responsible for efficient functioning of the nursing staff.
 Evaluates the personal performance of the nursing staff.


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 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont….
Discipline:
Ensure that a standard of discipline of nursing staff is high at all
times.
 Maintain good order and discipline in wards / departments.
Makes daily rounds of the hospital wards / departments and also
seriously ill patients.
 Brings immediately to the notice of the medical superintendent all
matters concerning neglect of duty, insubordination either by nursing
staff, patients or visitors or any un-towards incident.
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 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont….
Public Relations:
Promotes and maintains harmonious and effective relationship
with the various administrative departments of the hospital and
related community agencies.
 Maintain cordial relationships with the patients and their
families.
Office duties Scrutinizes the reports and returns and submits in
accordance with existing orders.

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 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont….
Confidential Reports

Initiates the confidential reports of nursing staff on due dates.

Responsible for the nursing budget.

 Education Carries out in-service training for all categories of nursing staff
and paramedical personnel and
 keeps the records of such trainings.
 Conduct various update courses based on the needs.
 Encourages the personnel to participate in the continuing education program.
 28

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 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont….
Welfare
 Responsible for health and welfare of nursing staff. Ensures
annual and periodical health examination and maintenance of
health records.
Conferences
Responsible for organizing and conducting staff meeting of the
nursing staff once in three months.
 Holds conference in nursing care problems and discuss policies
as regards to working conditions, working hrs and other facilities.

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 ROLE AND FUNCTION OF NURSE
ADMINISTRATOR Cont….

Supervision:
Supervises nursing care given to the patients and all nursing
activities within the nursing unit.
 Supervises the work of all paramedical staff of the hospital.
Records and Reports
 Maintains various records such as duty roster nursing staff, day off
book, personal bio-data, leave plan, staff conference book, courses
file etc.

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PROBLEMS AND CHALLENGESFACED
BY THE NURSE ADMINISTRATOR

34
PROBLEMS AND CHALLENGESFACED BY
THE NURSE ADMINISTRATOR Cont…

35
PROBLEMS AND CHALLENGESFACED BY
THE NURSE ADMINISTRATOR Cont…

36
 PATIENT CLASSIFICATION SYSTEMS
Patient classification system (PCS), which quantifies the
quality of the nursing care, is essential to staffing nursing units of
hospitals and nursing homes. In selecting or implementing a
PCS, a representative committee of nurse manager can include a
representative of hospital administration. The primary aim of
PCS is to be able to respond to constant variation in the care
needs of patients.
Characteristics Differentiate intensity of care among
definite classes. Measure and quantify care to develop a
management engineering standard. Match nursing resources to
patient care requirement. Relate to time and effort spent on the
associated activity. Be economical and convenient to repot and
use.
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 PATIENT CLASSIFICATION SYSTEMS
Be mutually exclusive, continuing new item under more
than one unit. Be open to audit. Be understood by those who
plan, schedule and control the work. Be individually standardized
as to the procedure needed for accomplishment. Separate
requirement for registered nurse from those of other staff.

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 Purposes

 The system will establish a unit of measure for nursing.

 Program costing and formulation of the nursing budget.
Tracking changes in patients care needs.
 Determining the values of the productivity equations
Determine the quality

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 LEADERHIP ROLES AND MANAGEMENT FUNCTION
ASSOCIATED WITH ORGANIZING PATIENT CARE

Leadership roles:
Evaluate the effectiveness of the organizational structure
Determines adequacy of resources and support Examines the
human element
Inspires the work group towards a team effort Inspires
subordinates to achieve higher.
Ensures that chosen nursing care delivery models advance the
practice of professional nursing.

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 Management functions
 Examines the philosophy.
 Select nursing delivery system.
 Use scientific research and current literature.
 Uses patient care delivery system that maximizes human and physical
resources as well as time.
 Ensure that non- professional staff are appropriately trained and supervised.
Organizes work activities to attain organizational goals.
 Groups activities in a manner that facilitates communication and co-
ordination
Organizes work so that it is cost- effective possible.
 Makes changes in the work design
 Clearly delineate criteria to be used for differentiated practice roles

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 Methods of patient care

CASE METHOD : 

Oldest mode of organizing patient care. It involves the

assignment of one or more patients to a nurse for a specific
period of time. Complete care including treatment, medication
administration etc Nurses assume total responsibility for meeting
all the needs of assigned patients. Widely used in hospitals & in
nursing homes. Students, private duty nurses, & specialty units
such as ICU, ICCU etc.

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 Methods of patient care Cont…
MERITS : 
Nurse can see better & attend to the total needs.
Continuity of care can be facilitated .
Client/nurse interaction & Rapport can be developed
Client may feel more secure.

Family & friends become better known by nurse & get more
involved Equal Workload
DEMEIRTS : 
Many clients do not require the inherent care.
Must be modified if non-professional health workers are used.
Great disadvantage, when nurse is inadequately trained and Cost-
effectiveness.
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 FUNCTIONAL METHOD
 In 1950s, when few registered & only some practical nurses
were available, much patient care was given by nurse’s aides.
 RNs were keep busy with managerial & non-nursing duties &
nurse’s aides deliver the majority of patient care.
 The functional method of delivering nursing care evolved as a
result of World War II
 .Ancillary personnel were used to assist in patient care
 Unskilled workers were trained & assigning persons to
complete certain tasks. Eg checking BP, changing linen,
bathing patients etc

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 FUNCTIONAL METHOD Cont….
MERITS : 
 Person can become particularly skilled in performing assigned tasks, The
best utilization can be made Less equipment is needed Saves times Potential
for development of technical skills is amplified .There is a sense of
productivity for the task oriented nurse .It is easy to organize the work of the
unit & staff.
DEMERITS : 
Client care become impersonal Tremendous risk for diminishing continuity

of care .Staff may become bored & have little motivation to develop self &
others, Work may become monotonous .The staff nurse are accountable for the
task, Client may tend to feel insecure. Only parts of the nursing care plan are
known to personnel.
 

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 TEAM NURSING
 After II World War, RNs were still scarce, although the number of
auxiliary personnel had increased. It was introduced during the
1950s To improve nursing services by using the knowledge and skills
of professional nurses & supervise the work of auxiliary staff. The
result was an improvement in patient and self satisfaction. Auxiliary
personnel collaborate in providing care to a group of patients under
the direction of a professional nurse. Based on philosophy that
supports the achievement of goals through group action.
 Team is led by a professional or technical nurse who plans,
interprets, coordinates, supervise, and evaluates the nursing care.
Team leader assign team members to patients by matching patient
needs with staffs knowledge and skills. Main features of team
nursing is, - nursing care conference - team conference - nursing care
plan

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 TEAM NURSING Cont….
RESPONSIBILITIES OF TEAM LEADER:
Responsible for knowing the condition and needs of all
assigned patients. Duty vary depending on the workload. i.e.
assisting the members and giving direct personal care to the
patient. Planning and conducting the conference
LIMITATIONS:
Continuity of care is not given Changing team
membership makes it difficult for the team leader to assign the
patient.

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 Primary nursing
 It is also called relationship based nursing. It involves total
nursing care, directed by a nurse on 24 hour basis as long as the
client is under the care.
 Characteristics: The RN primary nurse assumes 24-hour
responsibility from admission or start of treatment to discharge
or the treatment’s end. During work hours, primary nurse
provides total direct care for that patient.
 When the primary nurse is not on duty, care is provided by other
junior nurses. An integral responsibility of the primary nurse is
to establish a good communication .The combination of clear
interdisciplinary group communication and consistent, direct
patient care by relatively few nursing staff allows for holistic,
high quality patient care.
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 Primary nursing Cont….
Merits:
Opportunity for the nurse to see the client and family as one
system. Nursing accountability, responsibility and independence
are increased. The nurse is able to use wide range of skills,
knowledge and expertise. potentiates creativity by the nurse and
thereby work satisfaction increases increased trust and
satisfaction for both
Demerits
The nurse may be isolated from the colleagues. Little avenue for
group planning of care. Nurse must be mature and independently
competent. It must be cost effective

49
 Case management
 Case management is defined as a collaborative process that
assesses, plans, implements, coordinates, monitors and
evaluates opinions and services to meet an individual health
needs through communication and available resources to
promote quality, cost-effective outcomes. Case management
society of America
Characteristics:
 Case mangers handle each case individually. In general case
manger can handle a load of 25 patients [smith, 2003]. Case
mangers use critical pathways and multidisciplinary action
plans to plan patient care.

50
 Case management Cont….
Responsibilities of case managers:
Assessing clients and their homes and communities.
Coordinating and planning client care. Collaborating with other
health Monitoring client progress and client outcomes.
Advocating for clients Serving as a liaison with third party.
Merit:
Additional work efficiency due to geographical proximity.
Establishes solid relationships with nursing and ancillary staff
working on the unit. Case management provides a well
coordinated care. Provides comprehensive care, It seeks the
active involvement of the patient, family and diverse health care
professionals .
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 Case management Cont….
Demerits:
Some experts are argued that this role should be reserved for the
advance practitioner nurse or an RN with advanced training or
need 3 to 5 year experience. The case manger should also be
extremely bright, have well developed interpersonal skills, be
able to multitask, have a strong foundation in utilization review,
and understand payer-patient specifics and hospital
reimbursement mechanisms.

52
 Case management Cont….
 Nurses identify major obstacles in the implementation of this
service, financial barriers and lack of administrative support.
Expensive Nurse is client focused and outcome oriented
Facilitates and promotes co-ordination of cost effective care .
Nursing case management is a professionally autonomous role
that requires expert clinical knowledge and decision making
skills.

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 Modular nursing
 Modular nursing is a modification of team nursing and focuses
on the patient‘s geographic location for staff assignments. The
concept of modular nursing calls for a smaller group of staff
providing care for a smaller group of patients.
Characteristics:
 The patient unit is divided into modules or districts, and the
same team of caregivers is assigned consistently to the same
geographic location. Each location, or module, has an RN
assigned as the team leader, and the other team members may
include LVN/LPN or UAP.

54
 Modular nursing Cont…
 The team leader is accountable for all patient care and is responsible
for providing leadership for team members and creating a
cooperative work environment. The success of the modular nursing
depends greatly on the leadership abilities of the team leader.
Merits:
 Nursing care hours are usually cost-effective.
 The client is able to identify personnel who are responsible for his
care.
 All care is directed by a registered nurse.
 Continuity of care is improved
 The RN as team leader is able to be more involved in planning &
coordinating care.

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 Modular nursing Cont…

Demerits:
Costs may be increased to stock each
Takes time, effort, and constancy of personnel.
Unstable staffing pattern make team difficult.
There is less individual responsibility and autonomy regarding
nursing function.
All personnel must be client centered.
The team leader must have complex skills and knowledge.
56
 Progressive patient care
 It is a method in which client care areas provide various levels
of care. The central theme is better utilization of facilities,
services and personnel for the better patient care.

Principal elements of PPC are:

 Intensive care or critical care
 Intermediate care
 Convalescent and Self Care
 Long-term care
 Home care
 Ambulatory care

57
 Progressive patient care
Merits:
Efficient use is made of personnel and equipment. Clients are in the
best place to receive the care . Use of nursing skills and expertise are
maximized. Clients are moved towards self care, independence is
fostered where indicated. Efficient use and placement of equipment is
possible. Personnel have greater probability to function towards their
fullest capacity.
Demerits:
Discomfort to clients who are moved often. Continuity care is
difficult. nurse/client relationships are difficult to arrange. Great
emphasis is placed on comprehensive, written care plan. There is often
times difficulty in meeting administrative need of the organization,
staffing evaluation and accreditation.

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 Summary

Organization of nursing services helps to develop the

nursing profession. It is helpful to improve the co- ordinate
activities of the nursing profession. It will enhance the
nursing profession. So far we discussed about the
organization pattern in nursing services

59
 References

 Sigamany.G., Nursing Service Administration (1st Edn.). New

Delhi, United India periodicals Pvt. Ltd., 2012.
 Basavanthappa. BT., Nursing Administration (3rd Edn.). New
Delhi, The Health Science Publishers, 2014
 Manjubala Dash., Ward Management and Administration for
Nurses (1st Edn.). New Delhi, The Health Science Publishers ,
2015.

60
 Suggested Readings

 Deepak. K,A Comprehensive Text Book on Nursing

Management (1STEdn.) , EMMESS Medical Publishers (P)
Ltd. Bangalore, 2013.
 Neelamkumari,Text Book of Management of Nursing
Services and Education (3rd Edn.), PV Publishers, Jalandhar,
2011.
 Madhu Sharma, Nursing Services and Administration

(1st Edn.) PV Publishers, Jalandhar, 2013.

61
 External Resources

 Rebecca Samson, Leadership and Management in Nursing

Practice and Education (1st Edn.), Jaypee brothers Medical
Publishers, New Delhi, 2009.
 Elakkuvana B.R., Management of Nursing Service and
Education (2nd Edn.) , EMMESS Medical Publishers (P) Ltd.
Bangalore, 2012.
 Joshi S.K., Quality Management in Hospital (1st Edn.),
Jaypee brothers Medical Publishers, New Delhi, 2009.

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 Thanks

Next Topic>>
Physical layout of
nursing unit and
necessary facilities

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