UNIT- III

MANAGEMENT OF NURSING
SERVICE IN HOSPITAL AND
COMMUNITY

BY: SONI PANGTEY

 INTRODUCTION
• Hospital is a place where pt’s are treated for their
illness & nurses provide to the sick. It is a rest house for
the sick people. A hospital should have all the basic
facilities in terms of manpower ,material and money.
Manpower consist of regular doctor’s nurses, class IV
workers & other health care team members.
• Material facilities include fully equipped instruments,
machines, linens & other supplies. Money and financial
resources should be adequate to meet out the various
expenditure of the hospital. Above all their need of
standard administration & management to run hospital
smoothly.
 Definition of a hospital
• According to the WHO
• ‘The hospital is an integral part of social & medical
organization, the function of which is to provide for
the population complete health care, both curative
and preventive & whose outpatient services reach
out to the family & its environment ; the hospital is
also a center for the training of health workers &
biosocial research’.
 OBJECTIVES OF A HOSPITAL
1. To deliver care to all patients irrespective of any status.
2. To promote and restore health, and prevent illness and
complications.
3. To cure illness.
4. To create awareness about health problems.
5. To detect, diagnose and treat illness at the earliest.
6. To provide tertiary care including disability limitation and
rehabilitation.
7. To maintain standards & provide quality care.
8. To educate & train the health care providers.
9. To enhance staff development activities.
 SCOPE OF HOSPITALS

1. Coordinated health care team approach.

2. Holistic care.
3. Comprehensive care or specialized care.
4. Integrated care.
5. Research based or evidence based care.
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS

• Reception: it receives patients with illness and

directs to OPD.

• Members: receptionist and nurse

• Functions:
Clarify the enquiry
Guide the patients to various departments.
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Outpatient department:
• Registration
• History collection and physical examination
• Consultation with the doctor
• References
• Referral system
• Initial admission procedures
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Inpatient department:
• Admission & discharge of patients.
• Provision of medical & nursing care.
• Investigations.
• Health education.
• Infection control.
• Material management.
• Staff development.
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Administrative department:
• Administrative officer
• Assistant officers
• Manager
• Secretary
• Treasury
• Clerks
• Accountants
• Class IV workers
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Administrative department : functions
• Staffing
• Maintenance of the hospital building
• Budgeting for the hospital
• Supervision
• Controlling and coordination among various functionaries.
• Medical and nursing audit
• Performance appraisal
• Patient welfare activities
• Quality assurance
• Accreditation
• Reporting
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Hierarchy of hospital administration
chief medical officer

Nursing superintendent

ANS

Head nurse

Ward incharge

Staff nurse

Interns/ student nurse

 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Nursing department- Nurse- patient Ratio
1. N-P Ratio for teaching hospital : 1:5
2. N-P Ratio for non-teaching hospital: 1:3
3. General ward: 1:6
4. Special wards ( burns, neurology…..): 1:4
5. NICU-2:1
6. ICU- 1:1
7. LT- 1:1
8. Major OT: 2:1 per table
9. Minor OT: 1:1 per table
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Nursing department- function of NS
1. Staffing
2. Preparation of duty roster
3. Supervision & monitoring
4. Prepare job description
5. Reporting to higher authority
6. Conduct nursing round
7. Nursing audit
8. Performance appraisal
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS

• Central sterile & supply department

1. Supply sterile equipment to the departments
2. Maintaining incoming, stock & outgoing registers
 ORGANIZATION AND FUNCTIONS OF
HOSPITALS
• Diagnostic department
• Dietary department . House keeping
• Emergency or casualty . Laundry
• Operation rooms . Ambulance
• ICUs . Public relation
• Isolation units . MRD
• Postmortem room/autopsy . HRD
• Forensic department . Blood bank
• Pharmacy . Physiotherapy
• Counseling department . Research
 CLASSIFICATION OF HOSPITALS
Based on the ownership
• Public hospitals
• Voluntary hospitals
• Private/ charitable/ nursing homes
• Corporate hospitals

Based on the length of stay

• Short term stay – acute illness
• Long term stay – chronic illness
 CLASSIFICATION OF HOSPITALS
• Based on the license to treat
• General hospitals
• Specialty hospital

• Based on the size

• Teaching hospitals- 500 beds
• District hospitals – 200 beds
• Taluka hospitals – 50 beds
• Primary health centers- 4-30 beds
 CLASSIFICATION OF HOSPITALS

• Based on the system

• Allopathic
• Ayurvedic
• Homeopathic
• Unani
• Siddha
• Naturopathy
• yoga
• Based on the ownership-
• Public hospitals: these hospitals are under the
control of central or state governments or local
bodies on non- commercial lines. They can be
general hospitals or specialized hospitals or both.

• Voluntary hospitals: these hospitals are recognized

& combined under the societies registration act
1860 or public trust act 1882 or any other act of
central or state governments. They are supported
by public or private funds on a non- commercial
basis.
• Private nursing homes: these are regulated by an
individual doctors or a group of doctors on a
commercial basis. Patients suffering from infirmity,
advanced age , illness, injury, chronic disease,
disability, etc. are admitted here. However, patients
having communicable disease, alcoholism, drug
addiction, or mental illness are not treated.

• Corporate hospitals: these hospitals are public

limited companies running on commercial lines and
formed under the companies act. They can be
general or specialized or both.
• Based on the license to treat-
• General hospital: these hospitals help for curing
common diseases. They have at least two or more
doctors.
• Specialized hospitals: these hospitals provide
medical and nursing care for one discipline or a
disease or a condition of one system. They
concentrate on a particular aspect of the body
organ & give medical & nursing care in the
particular field, e.g., tuberculosis, ENT,
Ophthalmology, leprosy, orthopedics, pediatrics,
cardiology, mental health/psychiatric, oncology,
STDs, maternal etc.
• Based on the size-
• Teaching hospitals- These hospitals have 500 beds &
can be increased depending on the number of student.

• District hospitals – these hospitals have 200 beds & can

be increased up to 300 depending on the population.

• Taluk hospitals- these hospitals have 50 beds & can be

increased depending on the population.

• Primary health centers- these hospitals have 6 beds and

can be increased up to 10 depending on the needs.
 Hospital planning process
I. Conceptualization of hospital: here the
imagination or idea of the originator takes into
practical shape, & compares his dreams with the
existing hospitals of country or outside world, tries
to fit dreams into any such project.

II. Support groups: once the idea is developed, the

entrepreneur, discuss project, & then finds
support groups to join hands & complete the
project.
III Temporary organization & securing funds: a group should
be formalized called as a hospital trust, which must be
registered under the society’s act or companies act. The
originator is the chairman & others are members who are
assigned different tasks.

IV A detailed workout as to how much capital will be required

for establishing the hospital.
Geographical , environmental & miscellaneous factors:
Meteorological information: temperature, rainfall, humidity
Geographical information: existing road & rail
communications, susceptibility to quakes/ floods, building
height restrictions due to proximity of airports.
Miscellaneous availability: trained manpower, water, sewage
disposal.
V. Hospital design-
Bed planning: It should be realized that the hospitals are not only
utilized by the population in the vicinity but also will constitute the
indirect population in the large catchment area. About 85% bed
occupancy is considered optimum.

Hospital size: As a very large hospital of 1000 beds or more becomes

extremely unwisely to operate, and small hospitals of 50 or less are
not profitable. From functional efficiency point of view, it is advisable
to plan two separate hospitals of 400 beds, each with scope of future
expansion, rather than a single one of 800 beds.

Land requirements: In rural and semi- urban areas, plentiful land may
be available permitting the hospital to grow horizontally, whereas in
urban areas there will always be great premium on land and only
avenue will be a vertical growth.
No. of beds Lands in acres Storey of building

50 beds 10 acres Single storey

100 beds 15- 20 acres -do-

200 beds 20-25 acres Double storey

500 beds 55-70 acres 3- 5 storey

700 beds 80- 90 acres 4- 6 storey

1000 beds 90-100 acres 6- 9 storey

• Public utilities: the national building code of 15 suggests
455 liters of water per consumer per day (LPCD) for
hospitals up to 100 beds and 340 LPCD for hospitals of 100
beds and over Additional availability of water in case, staff
quarters and nurse's hostel are a part of hospital campus.
The hospital sewage disposal is connected to the public
sewage disposal system, otherwise it needs to build and
operate its own sewage disposal plant.
• It is preferably that power supply should be available on a
multi-grid instead of uni-grid system in general use, to
ensure a continuous supply of electricity to hospital at all
times Electricity requirement is 1 KW per bed per day.
• Approval of plan by the local authorities once the detailed
plan has been formulated, the local bodies are consulted
and persuaded for approval of plans
VI Circulation routes: the utility and success of hospital
plans depend on the circulation routes on hospital
site and within building. There are two types of
circulation in the hospital.
• Internal circulation: The circulation space involves
corridors, stairways and lifts. Corridors with less than
8 ft width are not desirable in hospitals and protective
corner beading is necessity in hospital corridors
• External circulation: Only one entrance to the
hospital for vehicular traffic from the main road is
desirable. The entrance and the exit points should be
wide enough to take two lanes of traffic, one entry for
clarity of all visiting traffic and one exit for security
from administrative point of view.
• vii. Distance, compactness, parking and landscaping:
distance must be minimized for all movements of
patients, medical, nursing and other staff, for supplies
aiming at minimum of time and motion. Functional
efficiency depends on the compactness of the hospital
which achieved by constructing it multistoried as they
are convenient due to compactness as compared to
horizontal development of hospital which demands
more land involving extra costs and installation of
services, roads, water supply, sewage, etc. One car
parking space per two beds is desirable in metropolitan
town, lesser in smaller urban areas while much less in
semi-urban and rural areas: Separate parking for three
wheelers and scooters, employees and staff parking
areas separate from public parking should be considered.
• viii Zonal distribution and interrelationship of
departments: the departments which comes in the
close contact with the public (e.g. outpatient
department, emergency and casuality) should be
isolated from the main in-patient areas and allotted
areas closer to the main entrance. The supporting
services like X-ray and laboratory services need to be
located near the OPD's From the main entrance
should be main inpatient zone consisting of ICU
wards, OT and delivery Suit The other supportive and
clinico -administrative department in the hospital
consists of hospital stores, kitchen and dietary
department, pharmacy, etc. These departments
should be preferably grouped around a service core
IX. Gross space requirements: Grants Gross total area (building gross)
780-1000 Sq ft, additional walls , partition 95-120 Sq ft. A building gross
square footage figure includes everything a building’s perimeters ,viz
stairs, corridors ,wall thickness and mechanical areas. On average,
space will be required for reception and enquiry counter in the main
waiting area near the OPD entrance. The bed distribution is calculated
as:
Bed Population = A X S X 100/ 365 X PO
Where A = No. of inpatient admissions per 1000 population per year
S=average length of stay (ALS)
PO = percentage occupancy
Bed distribution among various specialties will vary from hospital to
hospital and confirms to following range:
Medical 30-40%
Surgical 25-30%
Obstetrical 15-18%
Pediatric 10-12%
X Climatic consideration in design: In very hot climate
buildings need to be cooled in summer by artificial
means. Some natural cooling can be achieved by
building orientation and design. The building should
be open and oriented in such a way that even a
slight breeze can pass through the building to cool
its inside Another way is to keep thick wall and
small windows where the thick walls absorb the
heat during day and dissipates during night, and
small windows minimize the amount of radiated
heat entering the building.
XI Equipping a hospital: Hospital equipments cover a broad range of items
necessary for functioning of all services. The universal application of
equipments in the hospital can be classified as :
Physical plant: It includes lifts, refrigeration and air-conditioning, incinerators,
boilers, kitchen equipments, mechanical laundry, central oxygen, etc.
Hospital furniture and appliances: Beds, stretchers, trolleys, bedside lockers,
movable screens, operation tables, instrument trolleys, etc.
General purpose furniture and appliances: It includes office machines
(typewriters, calculators , filling system and computers), office furniture,
crockery and cutlery.
Therapeutic and diagnostic equipments: it includes equipment for general use
(BP instruments, suction machines, glassware washers, etc.) and equipment
interacting with patients during diagnostic and therapeutic procedures
(defibrillators, X-ray machines, etc.)

xii. Cost evaluation of construction of hospital: The most common method of

estimating the cost is on the like teaching, basis of per bed cost. It will also
vary in type of facilities the hospital provides, training and research facilities.
 Functions of the hospital
1. Curative services: Hospitals through its emergency and
outdoor patient department offer services to the people who
seek assistance during sickness for early diagnosis and
appropriate treatment.

2. Diagnostic services: Hospital has various types of laboratory

facilities for diagnosing multiple ailments. Different medical
procedures are carried out in the hospital .

3. Emergency and disaster management services: Hospital is a

center for providing all types of emergency services, first aid
and manages any disasters at the time of any emergency occur
to the people at anytime and anywhere.
4. Specialized medical services: hospital provides
specialized services as per the patient’s need, e.g.
medical, surgical, neurological, nephrology,
oncology, mental health, geriatric care, & many
more.

5. Maternal and child health services: hospital has

the facility for providing care to antenatal,
intranatal, & postnatal care services. Each hospital
has a separate labor room to conduct normal and
abnormal deliveries & facilities to give immediate
care to the newborn.
6. Rehabilitative services : Hospital provides physical,
mental and social rehabilitation to both in or
outpatients through physiotherapy department and
occupational therapy department by a trained
physiotherapist.
7. Social services: Hospital has the provision to
provide social services and help the patients red
cross or other societies. A social worker is
appointed for this purpose.
8. Guidance and counseling services: Many general
and teaching hospitals provide guidance and
counseling services to children and parents and
marriage counseling.
9. Preventive services: hospital has the facilities of
antenatal services to prevent any obstetric
complications & includes immunization facilities,
monitor growth, and development of children;
prevention of prolonged illness, control of infectious
diseases, etc.

10. Community services: usually general hospitals have

its community department that takes care of the
health needs of the adopted community. Many
governments and private- aided projects are initiated
to prevent and promote the health of people. Many
health camps, healthy meals, blood donation camps,
eye camps, orthopedic camps, etc. are organized by
11. Hospital and training: Hospital is also a center of
providing education & training to medical
undergraduates, specialists, postgraduates, nurses and
midwives, medical social workers, health workers, &
other paramedical personnel. Hospital organizes various
orientation programs, skill training, management, &
continuing education programs for hospital health
professionals.

12. Research activities: Hospital provides a platform for

the health professionals to conduct various types of
research studies and clinical trial under ethical
consideration to improve the care of patients hospital
practices and administration, to provide innovative,
13. Infection control and biomedical waste
management: Each hospital should have infection
control and biomedical waste management policy
and programme.
14. Implementation of national health programmes:
Hospital plays a vital role to implement various
national health programmes to achieve health for
all community people.
15. Hospital information system services: Hospital
has the facility to receive, process, and store
information/ data from every department, section,
activity, and present information to all users
working in the hospital. It is a valuable aid in the
16. Logistic support services: Hospital provides other
support services such as pharmacy, dietary, laundry,
housekeeping, engineering, medical record,
security, fire safety, mortuary, and outreach
services.

17. Information and health education: Hospital

provides information about its available services,
before availing services; health professional before
starting briefs about treatment, disease/diagnosis,
possible causes, investigations required, treatment
procedures, after effects and potential
complications, chances of recovery and cost of
16. Logistic support services: Hospital provides other
support services such as pharmacy, dietary, laundry,
housekeeping, engineering, medical record,
security, fire safety, mortuary, and outreach
services.

17. Information and health education: Hospital

provides information about its available services,
before availing services; health professional before
starting briefs about treatment, disease/diagnosis,
possible causes, investigations required, treatment
procedures, after effects and potential
complications, chances of recovery and cost of
 Guiding Principles in Planning a Hospital
1 .Patient care of high quality: It can be achieved by
the hospital through adopting following measures:
a) Provision of appropriate technical equipments and
supplies.
b) An organizational structure that assigns within the
organization.
C ) A continuous review of adequacy of care provided
by physicians, nursing staffs and paramedical
personnel.
2. Effective community orientation: This should be
achieved by the hospital by adopting following
measures:
a) A governing board made-up of persons who have
demonstrated concerns for community and
leadership ability.
b) Policies that assure availability of services to all
people.
c) Participation of the hospital in community
programs to provide preventive care.
3. Economic viability: This is achieved by adopting
measures like:
a. A corporate organization that accepts
responsibility for sound financial management in
keeping with desirable quality of care.
b. A planned program of expansion based solely on
demonstrated community need.
c. An annual budget plan that will permit the hospital
to keep pace with times.
4. Orderly planning: Orderly planning should be
achieved by the hospital by following:
a. Acceptance by the hospital administrator of
primary responsibility for short and long-range
planning with support and assistance from
competent financial, organizational and functional
advisors.
b. Preparation of a functional program that describes
the short range objectives and facilities,
equipment and staffing necessary to achieve them.
5. Some architectural plan: It is achieved by the
following:
a. Selection of a site large enough to provide for
future expansion and accessibility of population.
b. Recognition of the need of uncluttered traffic
patterns within for movement of staff, patients.
visitors and efficient transportation of supplies.
6. Medical technology and planning: Development in
medical technology is taking place so rapidly that
now the use of sophisticated technology
determines the professional status.
 PLANNING OF PATIENT CARE UNIT
(PCU)
• Introduction:
The most basic management function is planning.
The essential stages of planning are analysis,
implementation, and evaluation.
 Meaning of Patient Care unit (PCU)

The PCU is also called the "ward," or nursing unit can

be defined as that unit of the hospital where the
patients admitted and nursed during their illnesses
for their treatment.
 Functional Goals of PCU
The PCUs should be designed to serve practical goals. An ideal PCU
must:
• Result in building at the lowest possible capital cost.
• Provide for the best possible physical facilities
• Enhance the nurse-patient interaction
• Be operated at the lowest possible cost
• Provide the most desirable patient environment
• Result in inefficient operation of the unit and ability of nurses
• Provide a friendly environment for nursing and medical staff
• Provide the highest level of satisfaction for nursing and medical staff
• Provision of the needs of the visitors.
• Regulate the highest quality of communication and information
system.
 Objectives of Patient Care Unit
The objectives of PCU are to:
1. Provide a safe, comfortable, pleasant environment for the
patients and staff
2. Make available required facilities to carry out all the out all the
activities.
3. Provide enough space to carry out various activities
4. Give attention to the economy of attendance and ease of
supervision
5. Meet the functional requirement and thus enhance
administrative efficiency and economy
6. Satisfy practical needs necessarily those of patients and nursing
staff
7. Achieve the role of the nursing unit through better handling of
 Types of PCUs
1. Open ward: In an open hall, beds are placed in rows
facing each other and nursing station in the center of the
hall.
• The disadvantages of this type of PCU/ward were lack of
privacy, difficulty in controlling noise , & climatic
conditions apart from a higher risk of hospital cross
infections.
2. Nightingale ward: it is the traditional type of PCU based
on the ward concept established by Florence nightingale.
• This is an open ward containing 30-40 or more patients.
Patients beds are located in two row in a long,
rectangular ward.
3. Rig’s ward: In this design, 3-4 beds are placed
parallel to the windows. The length was reduced
and width was increased as compared to the
nightingale pattern.
4. Unilateral rig’s ward : side beds are placed &
separated from nurse’s station with its standby
services by a common corridor.
5. Bilateral ward : it has been accepted as most
suitable and workable conditions, two unilateral
rig’s wards are on either side of a central nursing
station.
6. Single corridor design wards: these are rectangular
wards with a single corridor aimed to reduce travel
distance from the nursing station to patient’s beds.
These are of different shapes like, H shape, T shape,
Y shape , E shape design to reduce cost and
provides several facilities.

7. Double corridor/ cross design wards: double

corridor design of wards further reduce the travel
distance of nurses from the nursing station to
patients beds.
8. Circular design: In the circular design of wards
nursing station is in the center aiming to keep a
check on all the patients by nurses and doctors.
The patients beds are very close to the nursing
station.
9. Square design: Square type of PCUs are better for
nurses of varying degrees of skills and training
background, shortage of financial resources and to
meet the most vigorous functional requirements for
some time to come.
 Components of the PCU
• Components of the PCU are given below:
1. Patient areas/rooms: These rooms comprise
private, semiprivate or general wards. These rooms
provide a safe and esthetically pleasing treatment
area conducive for a speedy recovery. It must
contain space for equipment, staff, and various
needs of the patients, Bed strength is the criteria to
plan space.
2. Nursing station: The nurse control station provides
workspace for the nursing staff. The location and
design of nursing stations are such that the nurse can
observe patient rooms and direct the traffic entering
and leaving the unit and at the same time carry on
nursing care and safety of the patients' activities. It
must enhance nurse- patient interaction and reduces
the nurses' fatigue factor by minimizing to and fro
movement between the patient's bed and treatment
room, nursing station, storeroom, etc.
3. Service/work area: The function of service/work
area is related to handling material required for
patient care to meet the social and physical needs of
the patients and specific needs of the staff.
 Principles of Planning the PCU
A patient/nursing care unit in a hospital has been called by the planner as
the greatest common measure (GCM), regarding cost. The principles of
planning a nursing unit are as follows:
1. The nursing unit should suit the cultural background of the community
2. Minimize nurses fatigue factor
3. Sound planning should provide a safe environment for patients and
staffs to:
 Prevent chances for cross infections. Cross infection may be due to
overcrowding, poor ventilation, and inadequate sterilization.
 Prevent chances for accidents; accidents may be due to uneven or
slippery floors, poor lighting, and high beds, etc.
 Prevent chances for a fire that may be due to shortcircuits, faulty
electric equipment
 Prevent chances for negligence and nursing errors due to poor lighting.
4. Sound planning must provide a pleasant environment for
patients and staff by:
 Preventing opportunities for noise due to noisy plumbing,
the proximity of ward to kitchen or sluice room, etc.
 Lack of privacy for patients who may be due to non
availability of screen, bed curtains, or inadequate toilet
facilities
 Dull surroundings may be due to a poor choice of color,
high windows, etc.
5. Sound planning must promote efficiency and ease of
work of the staff
6. Maintain the principle of observability
7. Plan according to the number of sanctioned nurses
8. Keep the principle of flexibility in mind.
 INTRODUCTION
• Ward management is managing the work of a ward
that involves planning, organizing, directing and
controlling the staff, material and support services
of the unit to achieve the best patient care.
 WARD MANAGEMENT
• Ward management according to kozier Erb & burk
(2011) is a process where by the ward manager
through people & with people make use of ward
resources to achieve ward objective.

• The main goal of ward management includes

optimal utilization of ward resources to produce
maximum output in patient care , provide personal
training & advancement of patient care services.
 OBJECTIVES OF WARD
MANAGEMENT
• To provide highest quality nursing care for patient.
• To provide a clean, well ventilated environment for patient &
protect him/her from infection, accidents & hazards.
• To help the staff in achieving highest degree of job
satisfaction.
• To provide facilities to meet the need of patient and their
attendants.
• To foster team spirit in the ward that will provide highest
quality health care services.
• To optimally utilize ward resources for maximum output.
• To encourage personnel training , job satisfaction &
advancement for patient care.
 PRINCIPLES OF WARD MANAGEMENT
1. Identify the people of organization as its greatest
assets.
2. Make profit in order to continue rendering
services.
3. Establish the long & short term objective to ensure
greater accomplishment.
4. Concentrate on individual improvements through
regular review of performance & potentials.
5. Maintain adequate & timely incentives & rewards
for increases in human efforts.
 TOOLS FOR EFFECTIVE WARD
MANAGEMENT
1. Organizational philosophy
2. Organizational chart
3. Supervision
4. Delegation
5. Nursing audit
6. Formulation of policy & procedure
7. Budget
 TYPES OF WARDS
1. General ward: In these wards patients with
nonspecific ailments, requiring no life saving care
are admitted. The nurse patient ratio is 1:5 in big
wards, & catering to the patient’s routine
investigation, treatment and care needs. For
example , female medical ward, male medical
ward, etc.
2. Specialized wards : (Maternity, pediatric,
psychiatric , geriatrics , oncology)
 DESIGN FACTORS

1. Movement space
2. Number of beds in a room
3. Bed spacing- 6 feet max..
4. Position of nursing station
5. Category of the ward
6. Ancillary rooms
 COMPONENT OF WARD
MANAGEMENT
1. Management of client care.
2. Management of the personnel.
3. Management of supplies & equipment.
4. Management of environment.
1. MANAGEMENT OF CLIENT CARE

• A) Admission and Orientation of the Client:

 Hospital
Routine of hospital
Rules & regulations
Ward equipment
Ward procedures
B) Assessment of client’s needs and care:
To establish patent airway
To support of activities of daily living
Psychological support & spiritual needs.
Continuous monitoring of client

C) Progressive client care:

Intensive care units
Intermediate cafe unit
Self care units
D)Priority Nursing Care:
Self actualization
Self esteem
Love
Safety
Physiological
E) Assignment of personnel for client care:
1. Functional method
2. Team method
3. Primary care method
4. Care method.
F) Planning the time , Schedule & Work Schedule.
G) Ward Rounds
H) Records and Reports
24 hour Report
Census Report
Birth and Death Report
Anecdotal Report

I)Management of Emergencies
J) Client Teaching
K) Appraisal of Nursing Services
 2. MANAGEMENT OF THE
PERSONNEL
• Orientation of the new personnel
• Supervision of the personnel
• Delegation of authority
• Establishment of IPR
• Evaluation of the personnel
• Staff conferences
• Staff development programme
• Health, safety & welfare of the personnel.
 3.MANAGEMENT OF SUPPLIES &
EQUIPMENT
• Keeping an adequately supply at hand.
• Standard for quantity of each item.
• System for replacing broken equipment.
• Regular inventories.
• Intelligent ordering.
 4. MANAGEMENT OF
ENVIRONMENT
• Adequate lighting
• Prevention of noise
• Elimination of unpleasant odours
• Dust control
• Safe water supply
• Safe disposal of waste
• Freedom from insects
• Provision of adequate privacy
• Prevention of cross infection
•
 ACTIONS FOR WARD
MANAGEMENT
• Analyze nursing needs of patient and skill of person.
• Prepare monthly, weekly & daily time table for staff nurse.
• Give teaching & guidance
• Evaluate personnel
• Maintain inventories requesting for supplies & services
• Assign task to nurses
• Coordinate with other departments for effective patient
care
• Gain cooperation from subordinates & supervisors.
• Delegate responsibility for patient care.
 FACTOR AFFECTING WARD
MANAGEMENT
1. Knowledge of the ward
2. Planning the schedule of the ward
3. Starting the work on time
4. Preventing interruptions
5. Establishment of ward routines
6. Use of democratic method in establishing ward policy.
7. Orientation of new personnel.
8. Orientation of ward
9. Maintenance of suitable environment
10. Providing supplies & equipment in a hospital
11. Clear cut specific order for medical therapy & nursing .
12. Record keeping
14. Maintenance of high moral among all members of
the staff.
15. Establishment of good working relationship.
16. Delegating responsibility
17. Time planning
18.Good teaching
19. Good supervision
 HOSPITAL SUPPLIES AND EQUIPMENTS

INTRODUCTION
• Hospital supplies and equipments are dealt with
under material management. The supplies in
hospital include drugs, surgical goods (disposables,
glass wares), chemicals, antiseptics, food materials,
stationeries, the linen supply etc.

• The term equipment is used for more permanent

type of article and may be classified as fixed and
movables.
 PURCHASE OF SUPPLIES AND EQUIPMENT

• The purchase of supplies and equipments in a hospital is carried out through;

• General store
• Dietary department
• Pharmacy department
• When planning for the purchase of articles , budgeting is done not only for the
actual price of articles but also for the additional costs that are involved such
as ;
• Transport charges ( local delivery reduce the transport charge)
• Incidental costs
• Cost of chemicals and other consumable to be used with the equipment (e.g. ;
ECG paper for an ECG machine )
• Operating cost (hiring a technician )
• Cost of maintenance service; 10-20% of hospital equipment may remain idle if
serving is not done periodically.
• Cost of technology obsolesces: when a better quality appears in market there is
tendency to discard the old model.
 Selection of article
• While buying articles it has to meet the standards.
Articles that meet the criteria specified by the
Indian Standard Institution will be marked by ISI
markings. The articles bought should provide safety
to the patient and personnel. Faulty instruments
and equipments cause not only inconvenience in
the patient care, but also it may cause the loss of
life.
 Purchasing Article

• The material used for any equipment should be

durable, non-corroding, non toxic and safe for use.
• Should have standard shapes and dimensions to fit
into various situations.
• Reparability and spare part availability of the article.
• Interchange ability of the article.
• All surgical instruments used in a hospital should be
sterilizable and they should stand the tests for
leakage , hydraulic pressure tests for bursting etc
• Should have accuracy in measurements
• Should have ease of operation
 The central supply service

• Most hospitals have a central department where

equipments and supplies are stored and from which
they are distributed to the units. The type of
materials that is kept in the central supply room
varies from hospital to hospital. In some hospital
the central soppy room deals with only the sterile
supplies and ward trays. In other hospitals all types
of equipment such as oxygen, suction, ward trays,
catheters, syringes etc are stored here.
 Linen supply
• Methods of handling linen supply include;
• a) Departmentalized system: Here the supply of
linen for each department of the hospital is marked
for that department. The head of the department is
responsible for making a linen standard for his own
department.

• b) Centralized linen supply: Under centralized

system, linen is issued on exchange basis, that is
clean linen is exchanged for soiled linen.
 FACTORS TO BE CONSIDERED

• Type of service provided by the hospital: a

maternity hospital requires more equipment related
to gynecologic procedures than a cardiac hospital.
• Age of patients: children need different type and
amount of equipments than adults.
• Sex- men and women sometime require different
type of equipment.
• Degree and type of illness- neurologic patients
sometimes require more bedsides, rubber mattress
and linen than patients with other type of illness.
 GENERAL UTILITY SERVICES IN THE HOSPITAL

Electric supply and installations:

• A hospital must have a steady electrical supply at a
stable voltage. Voltage fluctuations play havoc with
sophisticated electronic equipment, endoscope,
sterilizers, X-ray equipments etc. While planning
hospital departments, provision should be made for
voltage stabilization in areas with heavy
concentration of electrical and electronic
equipment.
 Water supply:
• Since safe water supply is not always assured, hospitals must
have their own purification system. Also there should be
plumbing system.

Disposal of waste –liquids and solids:

• Disposal of waste both solid and liquid is a totally neglected
area. A hospital incinerator good for the waste management.

Refrigeration, air conditioning, ventilation and environment

control:
• Air conditioning is required for protection of sophisticated
electronic equipment, X ray, machines etc.
Transport:
• Lifts are needed for vertical transport. There should be separate lifts for
patients, visitors, staff and supply. Patients lift should accommodate a
standard hospital bed. Sides of the lift must be protected to prevent
damage by trolleys. Lift surfaces and flooring should be capable of easy
cleaning and disinfection. Ventilation, communication and emergency
escape system should be provided on all lifts.

Supply of medical gases , compressed air, hot water, vacuum

suction and gas plants:
• Piped supply of medical gases , compressed air, vacuum suction , hot
water, steam, necessitates thoughtful planning at all stages to consider
problems of –
– Easy uninterrupted safe supply
– Fire and explosion hazards
– Easy of servicing and maintenance without disrupting hospital services.
Laundry- A hospital laundry has 2 separate areas, with
provision for decontamination and sterilizing of soiled
linen.

Fire hazard- there should be consideration of

ventilation, exhaust systems and adequate earthing of
all electrical installation.

Communication- Public telephone and internal

telephones are required in each hospital.

Repairs workshop- There should be provision for repair

and maintenance of necessary equipments used in
 MATERIALS USED IN HOSPITALS
Hospital material medical side Hospital material management side

Perfusion materials Computer, fax, telephone, stationary items

Surgical disposables Public address items overhead projector
Instruments Audiovisual systems
Drugs, medicine, oxygen, linen
Biomedical equipment
Disinfecting items
Computers, telephone and fax
Food and beverage materials
Anaesthetic equipment
Electro medical equipment
Glass ware, dental machines
Surgical dressing utensils
Artificial limbs ,bandages, cots for
patient, furniture
Engineering items and many others
ESSENTIAL EQUIPMENTS FOR A 50 BEDDED DISTRICT HOSPITAL (WHO)

• Scope of services
• Essential clinical services- medicine, surgery,
pediatrics., OBG, and acute psychiatry (when
necessary)
• Optional clinical services – oral surgery, orthopedic
surgery, otolaryngology, neurology and psychiatry.
• Essential clinical support- anesthesia, radiology and
clinical laboratory
• Optional clinical support services- pathology and
rehabilitation including physiotherapy.
• Essential medical equipment
• Diagnostic imaging equipment –it include x-ray and ultrasound
equipment.
• laboratory equipment –
– Microscope
– Blood counter
– Analytical balance
– Calorimeter( spectrophotometer)
– Centrifuge – a small centrifuge that can accommodate six 15ml tubes
should be available.
– Water bath – used for stabilizing temperature at 25, 37, 42, or 56degree
Celsius.
– Incubator/oven- a small hot air oven to carry out standard cultivations and
sensitizations.
• Refrigerator – an ordinary household refrigerator with a freezer
unit, for storing preparations, vaccines, blood etc.
• Instillation and purification apparatus - it should be made of metal
• Electrical medical equipment:
• Portable electrocardiograph
• Defibrillator( external)
• Portable anesthetic unit – 2 small aesthetic units should be
obtained, complete with a range of masks.
• Respirator – it should be applicable for prolonged administration
during post operative care.
• Dental chair unit- a complete unit should be available to carry
out standard dental operations.
• Suction pump –one portable and one other suction pump are
required.
• Operating theatre lamp- one main lamp with at least 8 shadows
lamp and an auxiliary of 4 lamp units.
• Delivery table- it should be standard and manually operated.
• Diathermy unit – a standard coagulating unit which is operated
by hand or foot switch, with variable poor control.
Other equipment:
• Autoclave – for general stabilization
• Small sterilizers- for specific services- eg. Stabilizer
• Cold chain and other preventive medical equipment
• Ambulance
5) Small , inexpensive equipment and instruments:
• Equipment and instrument, such as BP apparatus,
oxygen manifolds, stethoscope, diagnostic sets and
spotlights.
 EMERGENCY AND DISASTER
MANAGEMENT
• Introduction :
Disasters can violently disrupt our day to day lives
and change the history forever. As the population of
the world continues to grow, so does the potential
for mass casualty incidents associated with
disasters.
 DEFINITION
• Emergency: sudden, unexpected, or impending
situation that may cause injury, loss of life, damage
to the property, &/or interference with the normal
activities of a person or firm and which, therefore,
requires immediate attention & remedial action.

• Disaster: it can be defined as any occurrence that

cause damage, ecological disruption, loss of human
life, or deterioration of health & health services on
a scale sufficient to warrant an extraordinary
response from outside the effected community or
• Emergency management: it is the managerial function
charged with creating the framework within which
communities reduce vulnerabilities to hazards and
cope with disaster.

• Disaster management: it is the discipline of dealing

with and avoiding risks. It involves preparing for a
disaster before it happens, disaster response as well as
supporting, and rebuilding society after natural or
human made disaster have occurred.

• Disaster nursing: it can be defined as the adaptation of

professional nursing skills in recognizing and meeting
physical and emotional needs resulting from a disaster.
DISASTER ALPHABETICALLY MEANS

• D- Destructions
• I- Incidents
• S- Sufferings
• A- Administrative, financial failures
• S- Sentiments
• T- Tragedies
• E- Eruption of communicable diseases
• R- Research program and its implementation
 TYPES OF DISASTER
Major Natural Disasters Minor Natural Disaster
 Flood Cold wave
Cyclone Thunderstorms
Drought Heat waves
Earthquake Mud sides
Storm

Major Manmade Disaster Minor Manmade Disaster

Setting of fires Road/ train accidents/ riots
Epidemic Industrial disaster/ crisis
Deforestation Environmental pollution
Pollution due to prawn cultivation Food poisoning
Chemical pollution
Wars
 DISASTER MANAGEMENT CYCLE

• It includes the following stages/ phases

1. Disaster Phase
2. Response Phase
3. Recovery / Rehabilitation Phase
4. Mitigation Phase
5. Risk Reduction / Mitigation Phase
6. Preparedness Phase
1.Disaster phase: the phase during which the event of
the disaster takes place. This phase is characterized
by profound damage to the human society. This
damage/ loss may be that of human life, loss of
property, loss of environment, loss of health or
anything else. In this phase, the population is taken
by profound shock.

2. Response phase: this is the period that

immediately follows the occurrence of the disaster.
In a way, all individuals respond to the disaster , but
in their own ways.
3. Recovery phase: when the immediate needs of the
population are met, when all medical help has
arrived, they begin to enter the next phase, the
recovery phase which is the most significant, in
terms of long- terms outcome. It is during this time
that the victims actually realized the impact of
disaster . it is now that they perceive the meaning
of the loss that they have suffered.
4. Mitigation Phase: the mitigation phase occurs
before a disaster takes place. Here, an organization
will take steps to protect people & property.
The organization’s main goal is to reduce
vulnerability to disaster impacts ( such as property
damage, injuries, & loss of life)

5. Risk reduction phase: during this phase, the

population has returned to predisaster standards of
living. But, they recognize the need for certain
measures which may be needed to reduce the
extent or impact of damage during the next similar
disaster.
• Preparedness phase: this phase involves the
development of awareness among the population
on the general aspects of disaster & on how to
behave in the face of a future disaster.
• This includes educations on warning signs of
disasters, methods of safe & successful evacuation,
first aid measures and preventive measures.
 PRINCIPLES: EMERGENCY
MANAGEMENT MUST BE :
1. Comprehensive: emergency managers consider & take
into account all hazards, all phases, all stakeholders &
all impacts relevant to disasters.
2. Progressive: emergency managers anticipate future
disaster and take preventive and preparatory measures
to build disaster – resistant and disaster resilient
communities.
3. Risk- driven: emergency managers use sound risk
management principles ( hazards identification, risk
analysis, & impact analysis) in assigning priorities &
4. Integrated: emergency managers ensure unity of effort
among all levels of government & all elements of a
community.
5. Collaborative: emergency manager create & sustain broad
& sincere relationship among individuals and organizations
to encourage trust, advocate a team atmosphere, build
consensus, & facilitate communication.
6. Coordinated: emergency managers synchronize the
activities of all relevant stakeholders to achieve a common
purpose.
7. Flexible: emergency managers use creative and innovative
approaches in solving disaster challenges.
8. Professionals: emergency managers value a science &
knowledge based approach ; based on educations, training,
experience, ethical practice, public stewardship &
 DISASTER MANAGEMENT PLANS

Aims of disaster plans:

• To provide prompt and effective medical care to the
maximum possible in order to minimize morbidity
and mortality.
• To optimally prepare the staff & institutional
resources for effective performance in disaster
situation.
• To make the community aware of the sequential
steps that could be taken at individual and
organizational levels.
DISASTER MANAGEMENT COMMITTEE
• The following members would comprise the disaster
management committee under the chairmanship of medical
superintendent/ directors.
• Medical superintendent/ director
• Additional medical superintendent
• Nursing superintendent/ chief nursing officer
• Chief medical officer
• Head of departments- surgery, medicine, orthopedics,
radiology, anesthesiology, neurosurgery
• Blood bank incharge
• Security officer
• Transport officer
• Disaster control room:
• The existing casualty may be referred as the disaster
control room.
• Rapid response team:
• The medical superintendent will identify various
specialists, nurses and pharmacological staff to
respond within a short notice depending upon the
time and type of disaster.
• The list of members & their telephone numbers
should be displayed in the disaster control room.
• Information and communication:
• The disaster control team would be responsible for
collecting & disseminating the information about the
• Disaster beds:
• Requirement of beds depends upon the magnitude
of the disaster.
• Utilization of vacant beds, day care beds, &
preoperative beds.
• Convalescing patients, elective surgical cases &
patients who can have domiciliary care or OPD
management should be discharged.
• Utility areas to be converted into temporary wards
such as wards with side rooms, corridors, seminar
rooms etc.
• Creating additional beds capacity by using trolleys,
folding beds & flood beds.
 Logistic support system
• Resuscitation equipments.
• IV sets, IV fluids
• Disposable needles, syringes & gloves
• Dressing and suturing materials and splints
• Oxygen marks, nasal catheters, suction machine &
suction catheters
• ECG monitors, defibrillators, ventilators
• Cut down sets, tracheotomy sets and lumber puncture
sets.
• Linen and blankets
• Keys of these cupboards should be readily available at
 Training and drills
Mock exercise and drills at regular intervals are
conducted to ensure that all the staff in the general
and those associated with management of
causalities are fully prepared and aware of their
responsibilities
• Elements of disaster plan
• A disaster plan should have the following elements:
• Chain of authority
• Lines of communication
• Routes and modes of transport
• Mobilization
• Warning
• Evacuation
• Rescue and recovery. Triage
• Treatment
• Support of victims and families
• Care of dead bodies
• Activation of disaster management plans
• Standard operating procedures (SOP)
• Reception area
• Triage
 Priority one Needing immediate resuscitation, after
emergency treatment shifted to intensive care Unit
 Priority two Immediate surgery, transferred immediately to
operation theater.
 Priority three Needing first aid and possible surgery-give first
aid and admit if bed is available or shift to hospital
 Priority four. Needing only first aid-discharge after first aid
 Documentation
 Public relations
 Essential services
Disaster Management-Nurse's Role in Community
• Assess the community
• Assessment: The local climate conducive for disaster
occurrence, past history of disasters in the
community, available community disaster plans and
resources, personnel available in the community for
the disaster plans and management, local agencies
and organizations involved in the disaster
management activities , availability of health care
facilities in the community, etc.
• Diagnose community disaster threats
• Determine the actual and potential disaster threats
(e.g. explosions, mass accidents, tornados, floods,
• Community disaster planning
• Develop a disaster plan to prevent or deal with identified
disaster threats
• Identify local community communication system
• Identify disaster personnel, including private and professional
volunteers, local emergency personnel, agencies and
resources
• Identify regional back-up agencies and personnel
• Identify specific responsibilities for various personnel involved
in the disaster plans
• Set-up an emergency medical system and chain for activation
• Identify location and accessibility of equipment and supplies
• Check proper functioning of emergency equipments
• Identify outdated supplies and replenish for appropriate use.
• Implement disaster plans
• Focus on primary prevention activities to prevent
occurrence of manmade disasters
• Practice community disaster plans with all
personnel carrying out their previously identified
responsibilities (e.g emergency triage providing
supplies such as food, water, medicine, crises and
grief counseling)
• Practice using equipment, obtaining and
distributing supplies
• Evaluate effectiveness of disaster plan
• Critically evaluate all aspects of disaster plans and
practice drills for speed, effectiveness, gaps and
revisions
• Evaluate the disaster impact on community and
surrounding regions
• Evaluate the response of personnel involved in
disaster relief efforts.
 HUMAN RESOURCE MANAGEMENT

Human resource (HR) is essential for the survival of

any organization. One can develop and increase
human resources to an unlimited level.
 Human Resource Management
Definition :-
HRM is one of the managerial functions of the
organization. It focuses on attracting, managing and
guiding people working in the organization.

It is the process of managing people and deals with

personal and job-related issues of employees by
using a strategic and comprehensive approach.
 Features
It is universal.
It is result oriented
It focused on the full utilization of the individual
capacities
It deals with both personal and job related
problems of employees
It concerns attracting, managing and guiding people
It maintain cordial relations among employees
 Objectives

Maintain human relationships in the organization.

Attain the organizational goals
Helps in individual growth
Satisfy the needs of employees
Improve job satisfaction
Develop team spirit
 Functions
 Workforce planning
 Recruitment, selection and deployment
 Orientation and induction training and development
 Staffing and organization
 Promotion and transfer
 Motivating & mentoring and counseling
 Appraisal of employees
 Remuneration of employees
 Collective bargaining
 RECRUITMENT
Recruitment and selection are the two primary
functions of HRM.
Recruitment is the first step toward and so
competitive strength and a strategic advantage for
the organization.
It is a systematic process from sourcing the
candidates to arrange and conduct interviews and
requires a lot of resources and time.
 Meaning and Definitions
• Recruitment is the process to find out and attract
capable applicants for the job.
• It is an actual process of prospective employees and
stimulating them to apply valid selection to meet
staffing requirements.
Purposes and Importance:-
• Attract and encourage candidates to apply for the
post in the organization .
• Determine the present and future requirements of
the organization.
• Create a pool of candidates to enable the selection
of best candidate for the organization.
• Create a pool of candidates at low cost .
• Identify and prepare potential candidates.
 Recruitment Process
• The recruitment process is a systematic procedure
from searching for the candidates to arranging and
conducting the interviews, and it requires a lot of
resources and time.

1. Identifying vacancies: Identifying is the first step in

the recruitment process.
• It includes the post to be filled, number of
vacancies, duties to be performed and qualification
with experience.
. Identify
vacancies

Conducting
interviews Preparing
recruitment
specification

Arranging Recruitment
interviews process

Advertising
vacancies

Short listing

Managing
response
2. Preparing recruitment specification:
• It includes inventory for both job specification and
personal specification.

• The personal specification refers to individual

requirements. It includes essential requirements
like minimum qualification and work experience
and desirable requirements like additional
qualifications and personal qualities.
3. Locating and developing sources for recruitment
(advertising vacancies):
• Finding sources for recruiting candidates is an essential step in
recruitment.
• These include both internal and external sources.
• Method and material for advertisement are also decided and
finalized during this stage of the recruitment process.

4. Managing response: it refers to the way adopted to receive

the applications and scrutinizing each application as per the
requirement by the scrutiny committee.

5. Shortlisting and identifying prospective candidates:

After the scrutiny, the eligible candidates need to be shortlisted
 6. Arranging interviews with shortlisted candidates:
The administration finalizes interview dates either in
the beginning or after scrutiny. Based on criteria for
qualifying, the committee prepares a merit list of
candidates and according to it, calls them for
interviews.
• The institution formulates a selection committee.
7. Conducting interview and decision-making: The
selection committee interviews on the scheduled
date and selects candidates according to their
performance.
• The committee members prepare and sign a list of
selected candidates, including a waiting list,
Sources of recruitment
Internal sources
1. Transfer
2. Promotion
3. Notices
4. Recommendation

External resources
5. Advertisement
6. Employment exchange
7. Deputation
8. On campus
9. Online
a. Transfers: Transferring candidates are those who hold a similar
type of job but shift from one unit to another. There are no
drastic changes in their responsibilities, pay and status.

b. Promotions: Promotional candidates are those who apply for

the promotional post to attain a higher position to carry out
more senior responsibilities, facilities, status and pay.

c. Notices: It is another method to attract internal candidates by

displaying advertisements on the notice board, circulating notes
in the different departments or preparing a list of eligible
candidates below the rank of the advertising post.

d. Recommendations: Sometimes, employees recommend their

known. It is suitable for lower posts.
a. Advertisement: It is the most effective means or commonly used
method to search for potential candidates from outside the health
organizations for higher and skilled jobs. Advertisement is usually
given in leading, local newspapers or in professional journals,
Organizations also use their sites for vacant posts.

b. Employment exchanges: It is a good source of recruitment.

• In some cases, the employment exchange puts compulsory
notifications of vacancies by law.
• There are two types of employment exchanges, namely, public and
private employment exchanges.
• The government runs the public employment exchanges in all the
districts.
• Private employment exchange provides employment services,
particularly, for selecting the higher level and middle- level
executives.
d. On-campus: On-campus recruitment is a preliminary the selection of search of
prospective employees through interviews on the campus.
• The suitable candidates are called for process. Recruit further meetings at
particular places.

Online: Online recruitment is a quick method.

• The job seeking candidates apply online with all details.
• In less than a minute, the candidate can carry in his or her name and
curriculum vitae (CV), much faster than with earlier systems.
• The recruiter reviews the CV and decides to go ahead.
• The candidate clicks on the interview zone and chooses the time and place for
an interview.
• The selected candidate is introduced to a mentor.

Telecasting: It is the practice of telecasting vacant posts over media.

• TV (Doordarshan and another channel) is gaining importance these days.
Programs like "Job Watch," "Youth Pulse" and "Employment News" over the
TV have become quite popular in recruitment for various types of posts.
Characteristics of recruitment policy
1. Integrate employees needs with organization
needs
2. Follow government policy & legislation.
3. Treat equally
4. Unbiased, transparent, task orientation & merit
based.
 Selection

• Selection is defined as the process of choosing the

most suitable candidates within the organization or
outside the organization to fill the current and
future job positions.
 Selection Process
1. Preliminary screening
2. Screening of application
3. Selection test
4. Selection interview
5. Checking references
6. Medical test
7. Issuing job offer
1. Preliminary screening:
• In the 1st step of selection process, initial screening
of application is performed.
• Incomplete applications are rejected, applicants
who don’t fulfill job requirement i.e., ineligible are
also rejected as so many applicants apply for job.
• It is preformed by lower level executives
• It saves time for higher level executives, as they
focus on eligible candidates only.
 Screening of application:
• After initial screening of application are handed
over to screening committee.
• Screening committee checks all applications one by
one to verify candidate qualification, work
experience, skills, gender, age, address etc.
• Selected applicants are called for selection test.
 Selection test:
• Usually a written test based on the job requirement
is conducted to testify the ability, knowledge and
skill of candidate.
• There are 4 type of employment tests (intelligence
test, technical test, aptitude test, psychometric
test).
• Merit is established based on results of written test.
• Candidates who pass the employment test are
called for interview.
 Selection interview:
• A panel of experts is formed for selection interview.
• Candidates who pass the employment test are
appeared before interview panel.
• Experts asks different questions related to job
nature, technical questions, situational questions,
background , work experience, why he want to join
the organization.
• Panel judge the ability, skill, & confidence of the
candidate.
 Checking References:
• Usually two references are asked by the to produce.
• These references are demanded to verify the
information given in application and in interview.
• Company contact about potential of the candidate
and verification of information given earlier.
 Medical test:
• Selected candidates are asked to produce medical
fitness certificate from authorized doctor or from
panel hospital.
• Candidates having any kind of disease are asked to
get treatment prior to joining the company, or
rejected if the disease is critical in nature.
 Issuing job offer:
• Selected candidates are issued job offer letter, and
they are asked to join the company with in given
time.
• Offer letter include job terms & conditions,
agreement, pay package, incentives, service
structure etc.
• After joining, appointment letter is issued.
 Staff Deployment
• It is systematic and organized way of introducing
the staff members into a activity process or into a
particular working area in an organization.
• In nursing service the nurses are given orientation
on the policies, procedures, standards, protocols
and practices of an institute.
 Objectives
• To become familiar with policies, standards and protocols
of an institution.
• To instill confidence to carry out the duties and
responsibilities.
• To maintain smooth and systematic functioning of the
working unit.
• To provide quality nursing care to the patient.
• To maintain the professional standards in the workplace.
• To maintain emergency situation.
• To keep the nurses equipped with optimum knowledge
and skill.
 Effective deployment of staff
• The staff distribution in the any school or any firm should
be as per rules and regulations.
• Effective deployment increases virtuousness among the
workers which leads to put output and increases profits in
an organization.
• It provides a competitive edge for attracting and retaining
highly efficient staff.
• Right distribution of staff in right place produces higher
level of stress and conflict among the staff and the
management.
• It provides higher level of productivity and output,
thereby promoting the social status of the staff and the
 Advantages of staff deployment
• The area of the deployment should be selected
based on the competency of the staff.
• The workers give good work output since their skills
and matched as per their interest and ability.
• No duplication of work is possible.
• There will be no interruption in work made by the
staff in any case.
• Staff has a sense of belongingness and right mind to
work with team spirit.
 Effective mode of staff deployment
The effectiveness of the deployment depends on the
following.
• Framing the staff policies, rules and regulations.
• Evaluation of the staff activity and performance.
• Identifying the area of excellence where the staff
distribution can be done effectively.
• latest information technology is installed for
maximum profit and immediate reach of the
management goals.
 Checklist for effective deployment
• Total no. of current staff.
• Find the performance level of the staff deployed
• Deploy the highly efficient staff in the challenging
work environment.
• Adequate supplies and fulfilling other requirements
ensure good working environment for the staff.
• Motivate them by rewarding the best performer.
• There should be continuous evaluation of the staff
performance in order to have efficient deployment.
 Retaining Staff
• The quality of care depends on the quality staff
members present in the unit.
• It is very important for the smooth functioning of an
organization.
• The important role of the management for a
manager is to keep the current good working staff
for longer duration by providing various facitilities
such as increments, promotions or sponsoring them
for higher education.
 Various ways to Retain Staff
• Salary increments
• Application for their outstanding work
• Contests and incentives
• Motivating conversation and good communication
• Fostering employee and management relationship.
• The advantage of staff retention are fairly clear. Most
importantly, perhaps, key skills, ideas, knowledge and
experience remain within the organization.
• Because of improper staff retaining, valuable skills,
ideas, knowledge, experience, relationship & networks
are all transferred to another organization.
 Advantages
• It helps to save man, money, material and time.
• Its helps to save the advertisement, recruitment,
orientation and training expenses.
• Increase the productivity of an organization.
• It motivates the staff members to work efficiently in
the organization.
• It maintains the smooth functioning in the working
environment.
 Promotion
It refers to upward movement of an employee from
his current job position to another that is higher in
pay, responsibility and hierarchy within an
organization.
Sales persons to area sales manager
HOD to director,
Accountant to finance manager
 Promotion
Edwin B. Flippo Defined as,
“It involves a change from one job to another that is
better in terms of status and responsibilities.”

Scott & Spriegal defined as,

“ It is the transfer of an employee to a job that pays
more money or that enjoys some batter status.”
 Purpose of Promotion
To attract the retain the services of qualified and
competent people
To motivate employees to higher productivity
To develop competitive spirit
To reward employees
To fill up higher vacancies from within the
organization.
 Types of Promotion
Horizontal Promotion
• When an employee is shifted in the same category
with increase in pay, responsibilities and change in
designation, it is called horizontal promotion.
• Employee remain at same classification of job but
with more responsibilities and increased salary.
Example: an analyst becomes senior analyst.
Vertical Promotion
• There is a change in rank, responsibilities, salary and
classification of job
Example: Assistant supervisor promoted to manager a
sales manager is promoted as General Manager in
the company.

Dry Promotion
• There is increase in rank and responsibilities but no
increment in salary or other financial benefits.
Example : professor of a college become HOD,
increase in grade but no increase in salary.
 Basis of promotion
Promotion on Merit Basis
• Skills, knowledge, ability, efficiency, aptitude are
considered

Promotion on Seniority Basis

• Length of service or experience of an employee

Promotion on Merit Cum Seniority Basis

 Benefits of Promotion

• Reward to Superior Performance

• Reduce Training Cost
• Improve Morale of Employee
• Promote Employee Growth
 Demotion
• Opposite of Promotion
• Employee move to lower rank from a higher
position.
• It is a downward movement in the organizational
hierarchy along with reduction pay.

According to Dale Yoder

• It may be defined as a shift to a position in which
responsibilities are decreased.
 Reasons of Demotion
• Lack of employee competence
• To maintain discipline ( if found guilty)
• Work life balance ( employee need time for family,
career studies etc.)
• Closure one or more unit
• Promotion mistake
• Demand for new and higher level skills.
 Ways to Cope with Demotion
On the part of organization
• Cloaking ( provide with good location, cooperative fellow
workers)
• Zigzag mobility ( if performed better then again promotion)
• Avoid salary Reduction
• Organize workshop (for counseling, future options career
planning )
On the part of Employee
• Accept demotion
• Learn to cope with it ( behave normally, do not take stress)
• Do not get stress
• Take help from friends and family
 Transfer
• Moving and being moved from one place, job or
state to another
• Movement from one department to another
One location to another
One branch to another branch
• Pay status , responsibilities remains unchanged
 Transfer
According to B. Flippo
It is a change in job where the new job is substantially
equal to the old in terms of pay, status, &
responsibilities.
 Types of Transfer
On the basis of Purpose
Production Transfer
• When there is excessive number of employee at a
place then an employee may be transferred from
one department to another department where
there is less number of employee to avoid layoff.
 Replacement Transfer
• An employee with a long service may be transferred
in some other department to replace a person with
a shorter service.

Shift Transfer
• From morning to evening shift
Versatility Transfer
• An employee is trained on different jobs so as adjust
him on a different job when there is no work at his
seat or job.

Remedial Transfer:

Departmental Transfer:

Interplant Transfer
 Reasons of Transfer

• Surpluses or shortage of personnel

• To train the employee
• As per policy
• On request- health ground, family circumstances
etc.
 Superannuation
• It is retirement fund or pension given to the
employee at the time of retirement. Every
organization has a plan of superannuation for there
employees.
• It is also a basic right of the employee to the paid
for by the employer or the organization for there
hard work for service to the institute.
Benefits of the Superannuation
• It help the employee to plan for future life.
• To motivate the current working employ work
effectively.
• It is the additional amount paid by the employer for
the sincere service by the employ.
• It refers the institutional or organization image.
• It help to increase the productivity & quality directly
or indirectly.
Duties & responsibilities of various
category of nursing personnel
• Job description-
• It is defined as the specification of roles and functions of
the nature of job of each individual who has to deliver
effectively in order to be retained in the institution.
• The details in the job description guidelines include the
following-
1. Job designation
2. Types of department
3. Category of job
4. Duty timing
• General role of Registered nurses in Hospital
1. Administrator
2. Manager
3. Counselor
4. Change agent
5. Researcher
6. Case manager
7. Collaborator
8. Health educator
9. Adviser
10.Advocator
11.Implementer and evaluator
 Duties of Nursing Personnel in
Hospital
1. Nursing director –
 Formation of the aims and the objective policies of
the new nursing service
 Staffing based on the nursing requirement.
 Planning and directing the nursing care.
 Coordinating the interdepartmental activities.
 Maintaining the supplies and the equipment
 Budgeting
 Keeping record and reporting
2. Chief Nursing Officer ( CNO) –
 She does planning , coordination, supervision ,
controlling ,reporting.
 Explain the job description , supervision, and
delegating responsibilities to subordinate.
 Recruit the staff needed
 Conduct in –service educations, encourage,
continuing education.
Conduct nursing audit, does anecdotal reporting to
evaluate nursing care.
Encourage & participates in all round development
of nursing personnel.
3. Nursing Superintendent (NS):-
Organize & plan nursing care activities of the
department.
Planning staffing pattern.
Complies & submits nursing statistics to the
concerned authorities.
Make regular rounds in departments.
Receives report from nursing supervisor.
Make rotation plan for the nursing staff
Act as public relation officer
Make disciplinary decisions
4. Nursing Supervisor:-
 Provide direct bedside nursing care.
 Perform supervision & administrative work.
 Health advocate-
 Conduct orientation programmers for newly appointed
staff.
 Performance appraisal
5. Assistant Nursing Superintendent (ANS):-
 Assist in planning work schedule, staffing ,material
management.
 Maintain work performance
 Advice senior level supervision
 Maintain liaison with other department i.e. p
6. Head Nurse / Ward Incharge:-
a) Clinical activities
b) Supervisory activities
c) Administrative activities
d) Educative activities
 To plan duty roster specific to wards
 To control and coordinate the activities of the specific ward
 To supervise the nursing care
 To conduct nursing rounds
 To conduct meeting with subordinate staff
 Keeping the ward equipment in optimum state of readiness
 Making an indent of various items of medical, quality material and
other stores
 Ensure all specimens sent to laboratory
 Ensure sufficient linen
 Maintain all registers and documents
7. Staff Nurse ( Nursing Officer )-
Preoperative nurse
Diabetic nurse
Geriatric nurse
Oncology nurse
Ambulatory care nurse
Critical care nurse
Home health care nurse
Infection control nurse
• Role in Nursing Education –
1) Director of Nursing Education-
 Leave
 Transfer of nursing personnel
 Promotion and posting
 Correspondence with government and non
governmental institutions.
 Educational Programme
 Inspection
 Participate in health care planning
 Granting permission for workshop/ seminar
2. Principal College of Nursing- ( M. Sc. Nursing/PhD
Nursing, 5 year teaching experience)
 Administration
Organizational
Staff developmental and welfare activities
Coordination
Supervision
Teaching
Guidance
3. Professor College of Nursing-
Administrator role
Educator role
Guidance and counselor's role
Evaluators role
Role in documentation
Creativity and innovators role
Researcher role
4. Lecturer
5. Nursing tutor
• Role in community area-
Community Health Nurse
Female Health Workers
ANM