CURRENT TRENDS AND ISSUES IN NURSING ADMINISTRATION
INTRODUCTION
Administration is an essential factor in
the development of any service. Administration provides the means whereby most
effective use can be made of the knowledge and the skills of all those who are
involved in it.
The development of nursing service has been
enhanced greatly by advances made in professional skills and technical
proficiency. But it is apparent that the, same development has not been made in
nursing administration.
DEFINITION
"Administration
is the organization & direction of human and material resources to achieve
desired ends".
-Pfiffner and Presthus.
"Administration
is the direction, coordination and control of many persons to achieve same
purposes or objective
- Nigro
"Administration
may be defined as the management of affairs with the use of well thought out
principles and practices and rationalized techniques to achieve certain
objectives."
- Goel
"Administration
is the organization and use of men and materials to accomplish purposes. It is
the specialized vocation of managers who have skill of organizing and directing
men and material just as definitely as an engineer has skill of building structure"
- James L
NATURE OF ADMINISTRATION
Administrative process is intellectual,
social, dynamic and creative as well as continuous. The feature or natures of
administration are:-
1. It is universal- because
irrespective of nature and objectives of the organization, all basic elements
of administration such as planning, organizing, staffing, directing,
coordinating, reporting, budgeting can apply for its effective achievement of
goals.
2. It is holistic:- the
whole process of administration embraces the organization and its function in
entirely, i.e. involve total activities of the organizations.
3. It is intangible: - Since
administration is visualized as abstract. It cannot be transferable to any
where. So, every organization has to develop its own administrative style
within the contact of functional elements of administration.
4. It is continuous and on going process. The
cycle of administration goes on continuously.
5. It is goal oriented:-
administration is always struggling to achieve the laid down goals and
objectives of the organizations.
6. Its is social and human:- usually
in administration group of people are there to achieve the objective. It needs
good social and interpersonal contact or relationship to achieving the goal.
7. It is dynamic:- administration has
the elements of flexibility and adaptability and adjustability rising to the
needs and demands of different situation.
8. It is creative or innovative:- to have
an effective administration existed administration provides innovation, offers
and invites creative ideas to its organizational teams.
PRINCIPLES OF ADMINISTRATION
Fourteen principles of administration were
identified by Henri Fayol as follows:-
1.
Division
of work:-
In any organization administrator or manager cannot perform all the activities
to achieve its objective. So there should be division of work according to
managerial and non-managerial.
2.
Authority,
responsibility and accountability: If the person has to perform job
assignment effectively according to their own qualification and experience.
3.
Discipline:- for
smooth running of administration to achieve objectives, there should be proper
observance of the rules, regulations, norms, decorum, manners, code of ethics
and respect; this requires to be enforced within the organization by the
managers.
4.
Unity of
Command:
in any organization the subordinate should be supervised by a single supervisor
to whom he/she should be accountable.
5.
Unity of
direction:
In any organization, there should be one supervisor to give direction to
his/her subordinate.
6.
Subordination
of individual interest to organizational interest. This implies
that narrow selfish interest should be overcome or should turn to common and
broad interest of the organization for its welfare.
7.
Remuneration
of personnel:- There should be fair policy for payment of the
personnel justifying the workload job hazards, efficiency and quality of
performance.
8.
Centralization: -
There should be some amount greater and larger authority resting with top level
managers.
9.
Scalar
chain of command: This implies that there is chain or link of
directional instructions from the top level to the lowest rank of
organizational members in the hierarchy.
10.
Order: In an
administration there should be proper systematic arrangement of staff,
materials, supplies and equipment according to requirement of specific job
departments.
11.
Equity: - In
administration, there should be a fair and impartial treatment to all workers
irrespective of their job.
12.
Stability
of tenure of personnel:- Organizations should make proper efforts
to ensure stability and continuity in the tenure of personnel, which gives
security and promotes productions.
13.
Initiative:
Administration should always be encouraging initiative from each employee by
allowing him freedom to do his/her best.
14.
Esprit
de corps:
It refers to sense of belonging. This fosters the team spirit, i.e. the spirit
of working together to achieve objectives efficiently.
ELEMENTS OF ADMINISTRATION
Professor Luther Gullick (1937- summed up
certain principles or elements in the word “POSDCORB”). It is made up of
initials and stands for the following.
“P” stands
for planning
That is working out a broad outline.
“O” stands
for staffing
That is the establishment of the formal
structure of authority through which work of sub division are arranged defined
and coordinated for the defined objectives.
“S” Stands
for staffing
That is the whole personnel function of
bringing in and training the staff and maintaining favorable conditions of
work.
“D”
Stands for Directing
That is the continuous task of making
decision and embodying them, in specific and general orders and instructions
and serving as leader of the enterprise.
“CO”
Stands for Coordinating
That is all important duty of inter-relating
the various parts of the work and eliminating of overlapping and conflict
“R”
Stands for Reporting
That is keeping those to whom the executive
is responsible informed as to what is going on, which thus include keeping
himself and his subordinate informed through records, research and inspection.
“B”
stands for Budgeting:
With all that goes with budgeting in the
form of fiscal planning, accounting and control.
TRENDS IN NURSING ADMINISTRATION
Trends denote general direction and
tendencies especially of events, of opinion. So nursing trends refer to the
general direction towards which the different nursing events, have moved and
are moving, as well as the opinions in and around nursing and tendencies that
we find in and about our profession.
Nursing Service in
Ancient times
·
Study of the history will help us to know
what nurse thought and did in the past and which may still affect us and may
have had some influence on what we think and do.
·
The study of how problems were approached
and solutions obtained in the past will help us to understand and find
solutions to problems of our own time.
·
In the book of Charaka it is mentioned that
“The physician, drug, nurse and patient constitute an aggregate of four.”
·
Nurse educations and administrations are
now stating a new framework in which the graduate nurse should function. They
are making people aware of what virtues nursing service should possess so as to
help the patient regain or maintain hi maximum degree of health.
Influence of the
Christian Era on Nursing Service.
·
Scrutinizing the history of Christian era,
we find the emergence of human relation in patient care. The parable of Good Samaritan
is closely interwoven into nursing services. The attitude of taking care of
person as a patient has continued to influence nursing services and hospitals.
·
During the Greek medicine and in Christian
era, nursing became a respected occupation in which the most unpleasant work was
made dignified by a sense of devotion.
·
As the church grew in strength. It created
position designed to provide simple service to members of the community.
·
The Deaconess order was organized in 400 AD. These women
gave simple nursing care to the needy and prisoners.
·
Influence of the church silenced medical
research. The existing medical practice slowly deteriorated. The period of
monastic medicine is usually called the Dark ages of medicine. The monks played
a predominant role in the practice of medicine, while the medical professionals
almost disappeared.
·
In the 16th Century, with the
reformation, nursing sank to its lowest level. Hospitals were organized by the
church.
·
In that period, nursing was only an art.
Scientific knowledge and its application to nursing, as we conceive it nowadays
was unknown in the middle ages. The nursing personnel in the secular hospitals
were illiterate and overworked. There was no status attached to the nursing
personnel, even though they were members of civic-controlled hospitals.
Emergence of Modern
Nursing Service
·
In the 19th century as men came
up with new ideas about the material world and about the world of human
society. The development of modern medicine and nursing followed.
·
The enlightenment movement liberated new ideas
about things and their relation, belief in the devil and his possessions began
to disappear.
·
Modern Medicine emerged, with the emergence
of modern medicine and hospitals, adequate nursing service became a prime
necessity.
·
Paster Fleidner and his wife re-established
the Deaconess movement at Kaiserwerth ,
Germany
·
In 1960, Florence Nightingale’s concept of
a new system of nursing became a reality through the establishment of a
training school at St. Thomas Hospital , London
Development of
Nursing Service in the United
States
·
Nursing service in the United Stated came
up from the concepts developed from the military orders. Cathelic and Anglican
sisterhoods, the Deaconess movement and from percepts of Florence Nightingale
and other nurse ancestors.
·
In 1858, the American Medical Profession
advocated the establishment of training schools for women. The apprenticeship nursing
in hospitals was started.
·
In 1983, the problems of nursing were
discussed by physicians and nurses at the Chicago
·
In 1899, Teachers College, Columbia University
·
In 1910, the University of Minnesota
·
At an American Nurses Association’s
regional conference in 1961, Eleavor Lambertsen emphasized the modern roe of
the director of nursing and the role of director of nursing and the role of the
related institutional services with respect to the patients.
·
Utilization of personnel and facilitation
of services are major objective of administration.
·
Between 1913 and 1917 more than 500 schools
of nursing were established. The three year courses duration had been generally
adopted.
·
With the First World War the responsibility
and workload of nursing services was increased.
·
By 1920 every hospital wanted its own
school. The apprenticeship system in hospitals improved nursing care.
Nursing Service
within the Modern
Hospital
Emergence of
Nursing Service Standards
During 1935 to 1950 social forces had a
tremendous influence upon the development of nursing services.
·
In 1936 the manual of essentials of good
hospital service was published under the sponsorship of the American hospital
Association and the National League for Nursing Education. This was published
to give recognition to the minimum standards of average patient care.
·
The manual was revised in 1942, and a third
manual was published I 1950 under the title hospital Nursing Service Manual.
·
Nursing service was beginning to function
an own. The value of scientific method and fact were seen on the horizons of
nursing service administration.
·
As the hospital grew at the times of
industrial revolution. It accepted norms of modern business organization. The
hospital was under the control of board of directors who delegated authority to
executive director or hospital administrator. The administration established
personnel, dietary and purchasing departments.
·
Administration was concerned with placing
of nursing service as a whole in the hospital. The director of nurses won
control over many administrative aspects of the nursing service. Nursing
service continued to be responsible for supplies and equipment and for the
employment and discharge of nursing service personnel.
·
With the expansion of services to patients,
the nursing director was forced to delegate more responsibility and authority
to the nurses of the patient’s unit. The role of the graduate nurse in most
hospitals became one of co-coordinating and controlling nursing services and
hospital services.
·
As the employee of the hospital, the nurse
was and is still subjected to two distinct line of authority the hospital
administrative line and the clinical or therapeutic line headed by the medical
staff.
Nursing Service in
a Bureaucratic System
·
The second phase of hospital and nursing
service administration is called the bureaucratic system of control. The
nursing service groups were brought under the line of authority.
·
The informal relations unite people
together and the vertical lines of communication unite the levels of hierarchy.
·
Through the vertical line of authority, the
policies formulated by the management are communicated to all the grievances
and problems of the personnel are back to administration for the fruitful
selection.
·
During the system, the decisions were
usually made through the interaction of three groups- the administration, the
medical staff and the board of trustees. The nursing services were ignored.
Hospital Nursing
Service at Mid Century
·
During the period from 1950, numerous
studies were performed on problems related to patient care
·
Nurses, educators, physicians, hospital
administrators and others were actively engaged in various projects and
experimentation.
·
At mid century the tradition of the
hospital as the clinical workshop for the doctor was changed to the patient
centered institution. Specialist began working together to meet the total needs
of the patient.
EMERGENCE OF NURSING SERVICE ADMINISTRATION
·
The National Nursing Council published its
report for the future which is known as the Brown’s Report.
·
The report indicated that in nursing
service, administrative and supervisory staffs tend to be authoritarian and
nurses had little freedom in taking decisions and judgments for the care of
patients. Also it was found that administrative orders were issued from the top
hospital administrator with little opportunity provided for nurse
administrators to participate in the policy decision making.
·
Brown’s report pointed out the need for
sound legislation regarding the training and function of practical nurse and
other health workers and also stressed the need for professional and highly
technical nursing education and mentioned that it should be undertaken by
universities and colleges.
·
In 1950, the WK Kellog foundation conducted
a 5- month seminar an nursing service education administration, and in service
education and research
·
The study conducted at Teachers college, Columbia University
THE HOSPITAL HEALTH TEAM
Changing
perceptions of nurses as members of the health team.
·
Nurses have been accepted in health teams
as functionary members; but they have had no part to play in planning and
policy formation.
·
But during 1070s, nurses were becoming more
active advocates for their patients and were taking steps to personalize
healthcare, rather than continuing to be hand-maidens in the health care
delivery system.
NATIONAL LABOUR RELATIONS ACT-1974 (NLRA)
The act in based on our society’s respect
for the dignity of both man and his work.
·
The NLRA encourages the utilization of
collective bargaining and are a means of establishing wages and conditions of
worked of non-managerial and non-supervisory employees.
·
In NLRA, a professional employee is defined
as:-
1.
Any employee engaged in work, predominantly
intellectual and varied in character as opposed to routine mental, manual,
mechanical or physical work.
2.
Involving the consistent exercise of
discretion and judgment in its performance
3.
Required knowledge of an advanced type
(Course of specialized instruction) in an institution of higher learning.
·
This definition of a professional by NLRA
encourages nurse upgrading effectively the practice of nursing in accordance
with the nurse practice act of their state.
·
Per reviews and profession standards review
organization (PSPO) will strengthen professionalism in nursing as well as
enhance the status and economic interests of nurses.
Strike: - The
right to strike is defined as the moral and political right of employees to
withdraw or withheld labor in order to gain concessions from their employees.
Nurses should strengthen their professional responsibilities in nursing
practice. With support from their administrative leaders, nurses should create
a professional model that includes standards of nursing practice. Patient care
committee should be established in the hospitals with administrative medicine
and nursing representatives.
Arbitration: - From a
practical view point, arbitration resolves problem. Arbitration involves a
legal contract between two parties.
Voluntary arbitration is decided by
employees and employers, when they make the contract. An arbitrator may be
called when a dispute cannot be resolved through negotiations. Both parties
agree on the selection of an arbitrator when one is needed.
Arbitration of nurse-employer issues
eliminates the need for strikes. If hospital and health agency administrations want
to avoid strikes and their consequences, they may accept voluntary or
compulsory arbitration as the best method for setting disputes.
Fact Finding: - In fact
finding, both parties agree to call in an impartial person or person to hear
both sides. The fact finder will prepare a series of recommendation based on
the facts presented.
·
In 1966, California
Mediation-arbitration:
- In
mediation- arbitration, a neutral and experienced arbitrator sits in during the
contract negotiations or disputes. If difficulties arise, he endeavors to
mediate between the parties and secure a voluntary agreement.
Mediation and
conciliation: Mediation and conciliation are used in traditional
bargaining. The mediator is called in and he tries to achieve voluntary
agreement.
CREDENTIALING IN THE NURSING PROFESSION
Licensure, certification and accreditation
process comprise credentialing. All are closely inter-related. This system is
being scrutinized critically by consumes professionals and others in our
society. The consumer patients want quality care at a fair price.
The department of health, education and
welfare defines the various aspects of credentialing.
Licensure:- A process by which a governmental agency
grants permission to individuals who have met pre-determined qualifications to
engage in a given profession or occupation, use a particular title or grant
permission to institutions to perform specified functions.
Certification or
Registration: - in the process by which non-government agency or
association grant recognition to an individual who has met certain
pre-determined qualification by that agency or association.
Accreditation:- The
process by which an agency or organization evaluate and recognizes an
institution or programme of study, meeting certain predetermined qualification
THE NEW STATE NURSING PRACTICE ACT
(Amended
in 1972)
The practice of the profession of nursing encompasses
diagnosing and treating human responses to actual or potential health problems
through services such as case finding, health teaching, health counseling and
provision of care supportive to or restorative of life and wellbeing.
Mandatory and voluntary Licensure
It means all individuals who practice
nursing or medicine must get license. Only individuals holding a license are
authorized to use a designated title such as RN or LPN. Unlicensed individuals
may work in a field, but they cannot use protected title.
Mandatory
Continuing Education and Voluntary Continuing Competence.
In most states, licensed health
practitioner has to renew their licenses. Some professional groups encourage
the adoption of mandatory continuing education for professional reuse
licensure. These should be continuing programs and educational opportunities
for the development of nursing personnel.
Some professionals are against mandatory
continuing education. The believe that legal requirements downgrade
professional autonomy and each practitioner’s right to determine what learning
experience is best suited to her professional needs.
ISSUES IN NURSING ADMINSITRATION
As far as nursing administration is
concerned; it is in a pathetic condition. Health survey and Development Committee
(1946) recommended giving gazette ranks for Nurse Manager and WHO guidelines are
therefore giving decision making power to nurses. Both union and state
government have decided give some gazetted ranks to nurses.
·
Accordingly, now we have very few gazetted
post, but there is no independent power or authority.
·
Most of the equivalent posts of other
cadres in government elevated to the gazette ranks group A and B but the key post like Nursing Superintended
Grade I is only group B.
·
In 1989, there is Government order
considered Nursing Superintendent Grade II also gazette Class II (Group B), it
was not implemented so far, without any genuine reason.
·
Now the situation has gone from bad to
worse, worst to the extent that for filling up of the vacancies of nursing
cadre, the government Nurses Association has to go on agitation. After
agitation/Strike, they will fill up few vacancies.
Like this so many problems, prevailing in
the nursing administration are as given below.
1.
Non-involvement of nursing administrator in
planning and decision-making in the governmental hospital administration.
2.
No specific power assigned to nursing
superintendents, but he/se has been made in-charge of all inventories and linen
of hospital.
3.
Nursing superintendent will have no authorities
to sanction leave to their subordinates.
4.
Lack of knowledge in management of Hospital
among medical/nursing administration.
5.
Administration is always dependant on the
advice of clerical staff in all matters including technical aspects.
6.
Prevalence of role ambiguity, among
administration administrators.
7.
Unnecessary interference of non-nursing
personnel (Medical/ clerical) in nursing administration.
8.
No written nursing policies and manuals.
9.
No organized staff development programme
which includes orientation, in service education, continuing education etc.
10.
No
special incentives like , Rajyosava Award, Republic Day Awards ,
Teachers Awards, as Government itself
honor with these awards other government servants like teachers, police persons
etc.
11.
Inefficiency of Nursing councils of state
and union to maintain standards in nursing.
12.
No efforts at higher level for
implementation of separate Directorate of Nursing sanctioned by Karnataka Govt.
Measures to overcome these problems
·
There should be one policy in the state in
relation to nursing matters.
·
All the nurses working in the different
sector, i.e. Directorate of Health and family welfare, Directorate of Medical
Education, Directorate of ESI(M) Directorate of ISM and Director of autonomous
bodies, should be clubbed together and should be kept in one administration
i.e. “Directorate of Nursing”
Then only it is possible to bring some
uniformity and improvement of nursing services in hospitals and community
setting.
·
The Director of Nursing should be made
Chairman/ President of State Nursing Council with the assistance of “Nurse
Registrar” of Joint Director Scale rested with powers to maintain standards of
nursing uniformity throughout the state.
SUMMARY
Nursing is facing new challenges. To
participate actively in decision making concerning the delivery of quality care
to consumer patients, nurse practitioners, nurse administrators and nurse
educators must take on active role through their organization of the standards
of nursing practice, peer review and legislative programs and assure the public
of quality care at a reasonable price.
Today’s professional nurses assume
leadership and management responsibility regardless of the activity in which
they are involved. Nurses may assume leadership role their work setting, their
profession and their community, whether or not they have designated positions
of leadership.
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