Dr Alamelu Venketaraman PhD (N)
Director, Nursing Education and Research Westfort College of Nursing Westfort Academy for Higher Education Thrissur, Kerala, India
Foreword
SA Samuel
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Newer Trends in Management of Nursing Services and Education
First Edition: 2017
9789386261595
fm5DEDICATED TOfm6
My husband, Dr S Venketaraman who has supported me in everything I have ever done or gone through and to my loving son, Vasudevan, a writer who constantly amazes me with his own work and his love for writing. His inspiration and advice has been invaluable.
fm7Foreword
Newer Trends in Management of Nursing Services and Education authored by Dr Alamelu Venketaraman is a long felt need of nurses in India, both in the areas of nursing practice and education. This era, characterized by rapid change in medical and health system technology, knowledge explosion, consumerism and the complex health care demands, challenges the nurses’ knowledge, technical competence, interpersonal skills and commitment today, more than ever before. Nurses are working in varied levels of health care system, shouldering responsibilities of contributing to Health for All are constantly in contact with people in health and sickness. Coping with this soaring demand and ensuring unlimited career opportunities for nurses, comparable to those in other disciplines, graduate and postgraduate nurses require knowledge and skill in managing nursing care. This textbook will ultimately prepare them to be nurse managers, hospital administrators and nurse leaders. Further, nurses with leadership skills and a clear vision for the future can motivate associates to work towards common goals of survival of the organization, strengthening the workforce and to thrive during rapid change.
It is a known fact that the development and use of Information Technology has revolutionized the world today. Thus, it has also influenced nursing service and educational administration. Significant developments are the use of management by objectives, program evalution review technique (PERT), critical path method, management information system in nursing and electronic health records.
I commend Dr Mrs Venketaraman is rising to the occasion to provide this invaluable book, designed with fifteen units containing twenty-eight chapters. The setting of the chapters with learning objectives, conceptualization of the contents, supportive figures, tables and examples in boxes, research highlights, summary points, review questions, selected readings, index and glossary are most useful to the students of BSc, post basic BSc and MSc nursing courses. Special care taken by the author to deal with application of principles of administration in nursing services and education, issues and challenges faced by nurse leaders and newer trends in management are a ready reckoner for students of management courses prescribed by the Indian Nursing Council.
This textbook, anchored on Dr Mrs Venketaraman's vast experience in varied levels of nursing services and education, focusing especially on the Indian settings, is a blessing in disguise to the learners. I have no doubt that our nursing students and faculty will enjoy learning and applying these principles in their professional practice and reach greater heights in their chosen career.
My heartiest congratulations to Dr Venketaraman, whom I have known for many years, for completing this book on management, which is very very close to my heart. She has met one of the unmet needs of nursing in India through this textbook. I eagerly look forward to the improvement in the quality of nursing services and education in the country to make nurses equal partners in health care with their medical counterparts to make India a healthier Nation.
Ms SA Samuel
Former Principal
College of Nursing National Institute of Nursing Education (NINE)
PGIMER, Chandigarh, India
fm9Preface
Nursing is a dynamic, progressive and developing profession which ensures unlimited career opportunities for graduate and postgraduate nurses. Clinical nurses, teaching nurses, unit management, departmental or hospital nursing service administrator or clinical nurse researcher are the major roles where nurses focus to take up in future. This denotes that nurses are not only health care providers, but also health care managers who exercise both clinical and administrative role.
Today, health care delivery system is more complex, chaotic and challenging. Medical and health-related technological advancements, global shortage of nurses, quality and patient safety as benchmark of nursing practice, increased diversified work force in work setting, greater accountability for nursing care practice, ethical and legal aspects of care, consumerism, accreditation preparedness, nursing standards, best practices evidence informed in administration and many other factors warrants effective nurse managers, administrators and educational administrators who demonstrate core competencies of nursing leadership at all levels of nursing service administration and education. The framework of nursing management and administration requires a conceptualization of various functions, roles and responsibilities of nurse manager and administrator in hospital and academic setting.
Though many textbooks on management are available in the country, yet this book on Newer Trends in Management of Nursing Services and Education reflects on application of principles of administration in ward units, hospital and nursing school, administrative theories, leadership, innovations in nursing service administration, nursing standards, quality control in nursing and other features for undergraduates, post basic BSc nursing and postgraduate nursing program in nursing in management of nursing services and education course.
This textbook is very comprehensive and can be used by hospital nursing administrators, ward sisters and academic administrators.
Dr Alamelu Venketaraman
fm10Acknowledgments
With a deep sense of fulfillment and gratitude, first and foremost I thank the Omnipotent, Omnipresent Almighty God for enabling me to complete the First Edition of this textbook Newer Trends in Management of Nursing Services and Education.
It was my long cherished desire to write a book on Nursing Administration and this was made possible when Mr Jayanandan, Senior Commissioning Editor, and Mr Senthil, Team Leader, Jaypee Brothers Medical Publishers, Chennai, encouraged me to write this textbook. I whole heartedly thank them for their constant support and guidance.
My special gratitude to Ms Ruby Sharma, Project Manager, Jaypee Brothers Medical Publishers, for her untiring support which kept me more engaged and updated. I also appreciate the production team for their cooperation in maintaining precision in completing this textbook. I appreciate the extraordinary patience of the team members that provided me a source of inspiration.
I wish to express my solemn sentiments and heartiest thanks to each of the authors of various textbooks, journal articles, and websites whose references are being cited in the textbook without which the scientific base for the facts would not be possible.
I wish to thank personally Mr K Mohan Das, our Managing Director of Westfort Hospital Group, a farsighted visionary leader and administrator to permit me to include in the mission, vision and philosophy of nursing service administration, performance appraisal format, and philosophy of staffing of Westfort College of Nursing as example in the related topics. I accord a special gratitude to Prof Shirley Prakash, Principal, Westfort College of Nursing for her sincere support.
I am grateful to Prof R Rekha, Principal, VNSS College of Nursing, Kollam (Kerala) for her constant encouragement and Library support.
I accord special gratitude to Dr Gayatri Vyas Mahindroo, Director, National Accreditation Board for Hospitals and Healthcare Providers (NABH) for granting permission to include the National Assessment and Accreditation Council (NAAC), India.
I owe deepest gratitude and huge thanks to Dr Annie Grace Kalaimathi, Registrar, Tamil Nadu Nurses and Midwives Council and Dr Latha R, Principal, Goverment College of Nursing, Thrissur Medical College, Kerala and former Registrar of Kerala Nurses and Midwives Council for providing information regarding State Nursing Council and excellent support.
It is a pleasure to thank those who made contributions by sharing their research findings related to the topic and expanded knowledge to this textbook.
- Dr Susan Armstrong, Faculty of Health Sciences, Johannesburg, South Africa.
- Dr Hemant Kumar, Commandant, Rajouri Hospital, Jammu and Kashmir, India.
- Dr Usha Marath, Prof-cum-Principal, Lisie College of Nursing, Ernakulum, Kerala, India.
- Dr Sunita Lawrence, Principal, Pragyan College of Nursing, Bhopal, Madhya Pradesh, India.
- Dr Usha Ukhande and Faculty Members, Choithram College of Nursing, Indore, Madhya Pradesh, India.
- Prof Shija Binoy and Prof Jaya Binoy, Faculty, Pragyan College of Nursing, Bhopal, Madhya Pradesh, India.
I owe my special thanks to all principals, nursing faculties, and nursing students of colleges of nursing for their request to write this textbook and their encouragement and confidence showed on me.
The responsibility of completing this edition would have been impossible without the sacrifice made by Dr S Venketaraman, my dear husband and Vasudevan, my beloved son, allowing me to spare the family time in writing this humble textbook. I appreciate my heartiest appreciation and sentiments to them.
Finally, I thank all those who helped me directly or indirectly to complete this textbook.
Dr Alamelu Venketaraman
fm23Introduction
This textbook on Newer Trends in Management of Nursing Services and Education comprising of fifteen units with twenty-eight chapters covering all the contents comprehensively, built on sequential order and presented systematically in a simple manner.
Unit I: Introduction to Health Administration
This unit consists of two chapters which are dealt with very important aspects of postgraduate nursing curriculum on management. Chapter 1 focuses on overview of Indian health care system constitutes Indian constitution, and Indian administrative system. Special emphasis is given on health care delivery system at national, state, district and local level. It also includes India's five year plans and has taken special attention to present the impact of five year plans in development of nursing services in the country.
Chapter 2 highlights India's health care policies. Author has presented all the health committee reports from its inception till date and a meticulous care has been taken to present the impact of various health committee reports on nursing profession. It also depicts national health policies, national population policies and national policies on AYUSH and plans.
Unit II: Introduction to Nursing Service Administration
This unit consists of two chapters. Chapter 3 concentrates on the basic and advanced concept of nursing administration and management with their differences in significance, principles and functions in an elaborate manner. It also describes various management theories in detail and its application in nursing service administration.
Chapter 4 presents the role of a nurse administrator and manager in a hospital. The role of nurse administrator in a hospital and a nurse manager in a unit (ward) describes, administrative, supervisory, educative, and research role in detail. Few nursing research highlights are presented in the end of chapter.
Unit III: Functions of Administration
This unit consists of two chapters. Chapter 5 mainly focuses on planning, its concept, definition, principles, goals and objectives. In-depth description is given in various types of planning like operational plan, strategic planning, proactive planning, organizational Planning and managerial planning and each of their application in nursing service administration and management. In this chapter the philosophy, vision and mission of administration is dealt in detail with an example planning for change and planning a new venture is a special feature which is very beneficial for nurse managers and administrators in the current scenario.
Chapter 6 describes the concept and purposes of program evaluation review technique (PERT), critical path method (CPM), use of Gantt chart and management by objectives (MBO) that are current trends in management. It describes the topics in an elaborate manner and has furnished examples from nursing. It ends with a related research highlight.
Unit IV: Organization
Organization is the second function of administration This unit consists of five chapters. Chapter 7 presents conceptualization of organization, organization structure of nursing service department and organization chart with diagram, advantages and disadvantages.fm24
Chapter 8 focuses on organization process. It is built on the major principles of organization such as centralization vs decentralization, delegation of authority, span of control (supervision), division of service, and departmentalization. Attempt has been made to apply each principle in nursing service administration with their advantages and disadvantages.
Chapter 9 reviews organizational theories. Organizational effectiveness, organizational climate and organizational culture are explained in detail with greater emphasis on application of these concepts and the role of nurse administrator in their work setting.
Chapter 10 focuses on organizing nursing services and patient care deals with patient classification system, advantages and their disadvantages. Methods of patient assignment is dealt in detail with diagrammatic representation for easy understanding. Planning and organizing of hospital unit is dealt elaborately with ancillary services. Planning and establishing an intensive care unit is presented as an example in this chapter.
Chapter 11 focuses on power and politics in an organization. It includes the concept, types and factors influencing political behavior in nursing. It also presents the role of nurse administrator in power and politics in administration.
Unit V: Staffing
Staffing is one of the important functions of administration. This unit consists of two chapters. Chapter 12 emphasizes the concept staffing and scheduling and staffing norms prescribed by various regulatory and government bodies. It highlights estimation of nursing staff requirement based on an activity analysis study.
Chapter 13 deals in detail the staffing process on personnel administration/human resource management. It focuses on recruitment: credentialing, selection, placement, promotion, retention, personnel policies, termination, staff development programme. Supervision, duties and responsibilities of various category of nursing personnel and their applications to nursing service and education. It ends with research highlights.
Unit VI: Directing
This unit consists of two chapters. Chapter 14 conceptualizes leadership in nursing, theories of motivation and emphasizes in depth the role of nurse administrator as a leader in creating a motivational climate in work setting for quality care outcome. It emphasizes on communication skills and communication strategies which are important for smooth administration of hospital/unit.
Chapter 15 presents organizational behavior and human relations that are backbone strength in nursing administration. Role of nurse administrator in group dynamics, human relations, public relation in context of nursing, decision-making, delegation, conflict management, negotiation and collective bargaining are explained in detail and the chapter ends with research highlights in leadership.
Unit VII: Controlling
This unit consists of two chapters. Chapter 16 presents quality assurance in detail. It describes the concepts and the role of nurse administrator in quality control, quality assurance, total quality improvement and nursing audit. It also highlights quality improvement models.
Chapter 17 presents performance appraisal as a managerial tool to control administration with example format. It also elaborately discusses coaching and mentoring to improve performance of nurses/employees, discipline and disciplinary strategies for smooth running of the nursing administration and employee's grievance procedure to rectify their problems.
Unit VIII: Material Management
Utilization of resources is an important function of nurse administrator. Chapter 18 elaborately discusses concept, principles and procedures of material management. It also presents planning and procurement procedures and specifications, ABC analysis, and very important and essential daily use (VED) analysis. The essence of this chapter is the role of hospital nurse administrator and unit managers in planning equipments and supplies for nursing care: Unit and hospital, inventory control and condemnation.
Unit IX: Financial Administration
Like materials, finance is also essential to run a department. Chapter 19 presents budget for nursing service department in detail. Apart from conceptualizing budget, it emphasizes plan and non-plan, zero budgeting, mid-term appraisal, fm25capital and revenue. More focus is given on role of nurse administrator in budget estimate, revised estimate, performance budget and auditing. Cost effectiveness, cost accounting, critical pathways, health care reforms, health economics, and health insurance are other important features of this chapter. Example of nursing budget for nursing department is presented for easy understanding.
Unit X: Legal and Ethical Issues
Today, nurses are confronted with various legal issues and ethical dilemmas. Chapter 20 presents conceptualization of law and ethics, legal system, legal issues in nursing, medicolegal issues and patient care issues. The role of regulatory bodies in nursing ethics, patients’ rights, consumer protection act, professional responsibility and accountability, infection control, standard safety measures national accreditation boards for hospitals and ethical committee in an institution are special features in this chapter. It ends with research highlights.
Unit XI: Nursing Informatics
We are living in digital era today and the advances in information technology have created new roles for nurses, and stressed the need for all nursing personnel irrespective of their position to become more knowledgeable about health information concepts and the technology. Chapter 21 present concepts, use of computers by health care professional in hospital and community, patient record system, nursing records and reports including electronic medical records, management information and evaluation system (MIES), e-nursing, telemedicine, and telenursing.
Unit XII: Nursing Unit Management
Chapter 22 presents introduction to ward management. It emphasizes the role of ward manger or head nurse in planning physical facilities, floor space, time planning daily/weekly plan, and maintaining therapeutic environment for patients. It also elaborates the factors influencing ward management and the role of a head nurse in student education specifically nursing rounds, nursing care conference, etc. to enhance their clinical knowledge.
Unit XIII: Educational Administration
Chapter 23 on applications of principles of administration in nursing education focuses on the role of academic administrator in application of principles of, planning, organizing, staffing, directing, controlling and budgeting in nursing school administration.
Unit XIV: Issues and Challenges
This unit consists of three chapters. Chapter 24 presents issues and challenges in administration specific to nursing service and education.
Chapter 25 presents emergencies and disaster management specific to epidemiology of disasters, role of nurses in disaster management and rehabilitation.
Chapter 26 on nursing standards describe the concept, importance, characteristics and type of standards. The most important aspect of the chapter is, it describes the framework and steps in developing nursing standards.
Unit XV: Nursing as a Profession
This unit consists of two chapters. Chapter 27 focuses on introduction to nursing as a profession, philosophy of nursing practice, aims and objectives of nursing, characteristics of professional nurse and regulatory bodies—NINC, SNC acts and functions for nursing.
Chapter 28 stresses on professional advancement for nurses that include, continuing education, career opportunities, membership in professional organization participation in research activities and publication of research findings in journals and newspapers.
I am sure that the students may enjoy studying this textbook. However, there is always a room for improvement of this textbook. Your comments and suggestions for improvement of this humble book shall be highly appreciated.
Dr Alamelu Venketaraman