Currents trends and issues in management in nursing

Management in nursing

1. CURRENTS TRENDS AND ISSUES IN MANAGEMENT IN NURSING SERVICE Anju B ista 1 st year, MSc nursing BPKMCH

2. INTRODUCTION Nursing has undergone dramatically change due to advancement of medical sciences and technology, abundance of clinical research and higher demands of consumer in response to social needs and influences. Nursing we practice today is different from nursing as it was practiced years ago and it is expanded to continue changing during the 21 st century. With rapid changes occurring in health care management system and more changes coming to take place, so the shift over in nursing is also taking place from the past.

3. Contd … In the previous days nursing service was limited within the hospital, with the advancement of time and technologies the nursing service has expanded as school health nurse, nursing administrator, nurse practitioner, nurse researcher, home care nurse, hospice nurse etc. There are many issues occurring in nursing management .these were the obstacles to provide proper nursing services to the patients and public at large and off course to up- liftment to the nursing profession at large.

4. Contd … Coming days, there is no doubt that our in management level in disease prevention diagnosis and treatment modalities for illness and disease ,with increasing demand for quality health care and health related information will disseminated by high technology.

5. Meaning Trends : Trends are the general direction in which something’s tends to move. Trends mean movement in a particular direction according to time, environment and situation as everything in this world is changeable. It also denotes general directions and tendencies especially of events, of opinion or movements in a particular direction .   Trends is the event that occurs overtime and shows a series of fluctuation in its patterns. ( Stanhope lancaser ).

6. Nursing trends: A trend in nursing is change that is taking place in present days in any field of nursing ,which affects the profession as a whole. Refers to direction towards which the different nursing event have moved or are moving as well as the opinion in and around nursing that are found in and about nursing profession. Nursing trend seen in these current days in different field of nursing which affects the profession as a whole, the current changes in nursing area and influencing the profession.

7. Historical perspective(as per India) Nursing has developed to their present status over the last hundred years. There has been much variation in the rate of development even though there are similarities in the basic pattern. The events, which have taken place, are being divided into four phases: The early period in which the foundation were laid. The year up to world war II in which a basic pattern was more or less standardized. The war years which gave an impetus to nursing education. The year after independence marked by the development of public health nursing and start of degree programmers in nursing.

8. Before independence. This is after criminal war where Florence nightingale played a noticeable role ,she sent questionnaire to British military for obtaining figures of sickness an d mortality rate among them . Recommendations made by Florence nightingale led to the beginning of organized nursing and lots of event took place in Nursing sectors are : Mission hospitals were being set in different part of India at about the same time. Religion prevented Hindu and Muslim girls from joining, so only Christian girls could be trained first .

9. Contd … She has raised a dufferin fund interest in care of children and women in 1885 and started the National Association for supplying for supplying aid by women to women of India. Ms Atkinson was brought from England to Bombay to set up and become superintendent of first modern training school for nurses in India in 1891.

10. After independence During the first 10 years of independence three has been a considerable development in all fields of social welfare; nursing has been one of them. A broader and more varied field of work has been opened for nurses, greater opportunities for further study and wider professional contacts, both at home and abroad have been available .

11. Trends in Nursing Area Past Present Focus Hospital community Purpose Curative Promotive and preventive Nature General specialized Simplicity Bedside   High-tech Assignment Functional centered Patient centered Patient perspective Patient as individual identity Holistic approach Role Basic role Multi roles. Practitioner. Dependent role Independent practitioner.

12. Emerging trends in Nursing managements. In the nursing service ,there are various changes that took place are related to care, nursing process and quality nursing , audit, theories , documentation etc.

13. Some others emerging trends are: Professional judgment Defining care Specialized care Concept of nursing process, nursing diagnosis. Quality assurance and nursing standards. Nursing audit. Nursing research and evidence based learning . Concept of nursing theories and application of theoretical models. Multi disciplinary health nursing. Concept of primary health care /community health nursing. Individualized care Information system Electric networking and tele - conferencing documentation. Independent areas of practice. In – service education programmers

14. Current trends in nursing managements are: Computerization for patient care management. Rising public expectations. Changing Demographics and Increasing Diversity Reduction in distance through use of advance communication. Decentralize approach used for care management. Quality assurance in nursing. Continuing nursing education. Evidence based practice. Nursing audits. Collective bargaining. Diverse of responsibilities. Increased specialization. Educated consumer. Creating safer work environment. Increased need for doctoral education. Changing role of women in society .

15. 1. Computerization for patient care management Easy reference on direction for patient care, record keeping, reporting complication of information, stock monitoring ,auditing are some of the function which have taken over. Ability to use computers for patient care management has become essential qualities for nurses.

16. 2.Rising public expectations The public is becoming better informed and more assertive about health services, sometimes challenging the professional decision. Patients group are increasing negotiating with professional about the care they want. At the same time concerns with human rights, equity , accountability and ethical issues will come to the forefront of debate and action.

17. 3.Changing Demographics and Increasing Diversity One of the more obvious trends affecting the nursing profession, and even the healthcare world, in general, is one of patient demographics. Global migration, changes in composition and ethnic mixture of populations, changes in family structures and functions and growing aging population will challenge the health care system’s ability to provide efficient and effective continuing care.

18. 4.Reduction in distance through us of advance communication   Use of this advance communication application in this current time have made it all possible for the nurses to reach patient, doctor and profession whenever need arise. Along with verbal and non verbal communication skill, nurses also need to gain competencies in using information and technology.

19. 5. Decentralize approach used for health care management This makes nurse accountable and responsible care of assigned patient. It focuses on problem solving on the spot with the joint participation of the supervisee and supervisor. This approach is most applicable where work responsibility will be decentralized. This is effective in terms of patient satisfaction, quality care and smooth functioning of the units

20. 6. Quality assurance in nursing Public knows their right, human rights commissions, protection acts and process etc , are putting constant pressure on the professionals to deliver their best. Nurse managers have to ensure delivery of quality care by practicing as per standard laid down by their counsels and institutions.

21. 7. Continuing nursing education Continuing nursing education become essential to keep up with the changing needs of patient care. Nurses have to continuous update themselves with new and innovative approaches in patient care management. To update and enhance the knowledge they should enables themselves with workshops ,seminars, short term in-service training programs, attend conferences, and bedside discussion will lead to update with newer techniques and information.

22. 8. Evidence based practice For this nurses should have scientific bend of mind and dynamic approach to patient care. There has been a significant advancement in nursing science and research .there is need for enhanced mentorship for new researcher to strengthen skills and capacity to conduct meaningful nursing research.

23. 9. Nursing audit Nursing audits is required to keep the activities on the right track. It build knowledge for the profession. Regular nursing audits promotes ensures quality of care provided to the client and up- liftment of standard.

24. 10. Collective bargaining Collective bargaining is the uniting of the employee for the purpose of increasing their ability to influence their employees for the purpose of increasing their ability to influence their employer and to improve the working conditions.

25. 11.Diverse of responsibilities Nurse working in the hospital, homes , communities are accountable for diagnosis, prevention and management of various health problems. Primary health care, patient education, health promotion, rehabilitation ,self care and alternative methods of healing are the added responsibilities. To carry out such responsibilities , the nurses need to have diverse skills.

26. 12. Increased specialization The demand for nurses who specialize in specific area like leadership in nursing ,nursing manager, psychiatry, gerontology e.t.c is on the rise. Specialization enables the nurse to be an expert in the area in which he or she is providing care. It also opens the door to opportunities for career advancement. Specialization and subsequent certification provides the patient and the health care institution with assurance that the nurse is highly knowledgeable and competent in a specific area of care.

27. 13. Educated Consumer Education and technology advancement brings about a growing awareness of health needs among people. Patient is a well-informed consumer – expects to participate in decisions affecting personal and family health care. Previously unavailable information is now public information. People have knowledge about health promotion as well as disease prevention and also there is an increased acceptance and demand for alternative and complementary health options .

28. 14. Creating Safer Work Environments Today’s nurse works in very complex, stressful environments.  In addition to needle sticks, infections, musculoskeletal injuries, and other typical workplace dangers, viral outbreaks like Ebola, H1N1 , covid 19 and more have served to increase the attention being placed on creating and maintaining safer working environments.  Nurses must be prepared to handle whatever the next “big thing” is that comes along.

29. 15. Increasing need for doctoral education The number of nurses enrolling in doctoral education programs is growing, specifically for the doctor of nursing practice.

30. 16. Changing role of women in society Women are now becoming educated and active . The status of nurses as women is improving in the society. They are now independent ,good leadership skill, can take decision independently for themselves and client in any critical condition.

31. Factors involve in affecting current nursing service trends Changing scenario of government towards health care. Computers and technology changes health care delivery Information and efforts to standardize and unify nursing language. Case management, disease management, and tale-health care expand .

32. Contd … Diverse responsibilities. Educated consumers. Changing role of women in society. Changes in medical, paramedical, and allied professions. International influence and contribution of international organizations. Expanding nursing roles.

33. Contd … Evidence –based care and best practices are emphasized. New ethical concerns. Wellness centers, holistic and alternative therapies. Nursing wellness and healthy working environment is stressed. Lifelong learning is required

34. Contd … Nurses must prove value. Nurses’ roles as leaders and managers essential. Shared governance and collaborative decision making. Nursing shortage threatens patients care. Nursing education goes online. Standards and practice guidance’s.

35. Issues:- A point or matter of discussion, debate or dispute or a matter of public concern. Issues are those point or subject matter of discussion, debate or dispute or a matter of public concerns.

36. Issue Further it can also be defined as:- A misgiving, objection ,or complaint. The essential point. It is a culminating point leading to a decision .

37. Current issues in nursing service. Nursing has its own identity as profession. It is no more a paramedical profession. This nomenclature is respected of nursing personnel has long been dropped by WHO but still we find some of the authorities call nursing as paramedical profession. Such an attitude towards nursing has done considerable harm and lowered nursing I mages and status as profession.

38. Contd.. Even though some changes have occurred but issues occurring in nursing service is same, tough the government has made some effort. As per delocia , Ott and palmier (2009 ) they said there are working situation issues for nurses as they are found to work in poor environmental condition. There are many issues occurring in nursing service ,which turn and can turn as the obstacles to render the nursing care to the patient and public.

39. Issues at the sate and districts level : No availability of documents related to policy , planning and budget. Power vested with medical personnel in the planning of nursing services. Shortage of nursing manpower. Accountability of nursing personnel towards the duties other than nursing care . Negative role perception and role demand. Extremely poor maintenance of supply of equipment and drugs .

40. Contd.. Poor infrastructure. Irregular pattern of working. Negligible in-service training and absence of a good reference library. Very poor maintenance of patient records system. Unsatisfactory pay and no incentives for promotion and offering better service. No concern for occupational hazard and health safety for nurses. No nursing auditing.

41. Issues in management in local levels Role confusion. Restricted power and authority. Scarce of resource allocation. Poor supervision and health monitoring in health institution Role confusion. Staff health and safety issues. Poor job security. Exploitation .

42. Issues related to nursing administration and services. As per Henery Lorensen and Hirchfield . Major issues are: Lack of nurses prepared to work in nursing administration. Acute shortage of nurses. No relationship between nursing service and nursing education. Lack of authority in administrative structure. Lack of participation by nurses and other auxiliaries and also with physicians. Lack of teamwork spirit. Lack of resources, both material and financial.

43. Current challenges in management in health service in Nepal: A finding of US (Buchan , j 2010) health personnel management has been through the challenges of shortage and most vacant position which are unfulfilled where as there is issues and challenges of nurse patient ratio which leads to risky and regression of quality nurse care .  

44. Research done in central level hospital finding illustrate that the challenges for health management and health personnel were employment problem, security problem( job and social security), workload, lack of professional empowerment, low pay job setting ,exploitation, lack of monitoring in health institution for quality care services.( poudel , 2010)

45. Challenges : 1. Staffing : Staffing issues is experienced by maximum nurse manager. Staffing takes a tremendous amount of time of nurse leader . Nurse leaders schedule shifts, but ensuring safe staffing involves careful calculation. Nurse leaders must account for the potential for overtime and preventing it as much as possible.    

46. 2. Budgeting: Budget allocation is not appropriate each time so nurse leaders must walk a tight line to manage the use of staff and supplies to provide safe and efficient care within tough financial constraints. Nurse managers and their staff are increasingly being called upon to do more with less which forces them to continuing look for ways to improve efficiency.

47. 3. Boosting morale and avoiding burnout:-  Morale issues and burnout can also have detrimental effects on the physical and psychological health of those employees who have no intention of leaving the unit. Nurse leaders are in a prime position to boost team morale and help staff avoid burnout. Forging strong relationships with nursing team members, acknowledging and addressing their concerns, and rewarding them when they succeed can help show them that they are cared for and respected and that can go a long way toward making them feel appreciated and helping them avoid burning out.  

48. 4. Retaining Nurses. Retention is a constant concern for nursing leaders. The constant demands of patient care, pitted against staffing limitations, long shifts, and corporate quality initiatives that complicate the delivery of care, have many nurses rethinking their career goal. Being sensitive to those differences and managing with generational sensitivity is crucial to retaining good nurses from all generations. But many of the biggest imperatives related to job satisfaction for nurses could be respecting work/life balance, providing the tools and resources to succeed, acknowledging good work, and building more authentic, personal relationships. Providing this personal care for every nurse can help keep them invested in their roles.

49. 5. Migration of Nurses. Migration of health worker is one of the biggest issues that is faced by country today. Since most of the nurses graduated from different institutions have started leaving the country in search of better jobs abroad and further study as the demand of nurses in developed countries is increasing.    

50. 6. Employment problem. Global need of the nurse are increasing day by day with progression of disease ,illness and need of for preventive care too. Even though we have so many count of hospitals but many certified nurses are having issue in job placement. The reason behind this could be massive production of nursing colleges due to which nursing products are in increasing state thus only few getting opportunities.( chhetri,B & koirala , P, 2017) Hospitals are running with inadequate number of nursing staffs in spite of huge patients’ flow and at the same time not maintaining nurse patients ’ ratio.

51. 7. Political influence in health system management. Instability in political sector, health ministry is major issue in nurse service management. As one appointed health minister makes the health policy and development plan but before implementation of these plan whole department will change and plan and policy will be aborted.

52. 8. Lack of resources during this pandemic. Country and county people are facing a huge communicable disease covid -19 .almost every sector are effected and monthly heath personnel. The great challenges if to service towards covid19 patients or normal patients with minimum supply of personnel protective equipment.

53. How to meet these challenges? Strengthen involvement of nurses in health and nursing policy formulation and planning. Empower nursing leadership. Develop and implement a quality assurance system for the nursing service. Ensure nursing workforce management as an integral part of human resource planning and human system development .

54. Contd … Enhance nursing autonomy in practice. Enforce implementation of recommendation norms on nurse patient ratio. Produce advanced practice nurses. Ensure appropriate facilities and adequate equipment and suppliers.

55. Promote evidence based practice and nursing research. Establish a continuing nursing education system. Improve pay scales, incentives systems and working condition. Ensure quality of nursing education by strengthening nursing programs, increasing qualified nurse educators and allocate appropriate resources to maximize efficiency and effectiveness.

56. Reference https://nursinganswers.net/essays/the-contemporary-issues-in-the-professional-practice-nursing-essay.php . https://www.ukessays.com/essays/nursing/current-issues-and-future-perspectives-of-nursing-workloads.php . http://nhrc.gov.np/wp-content/uploads/2019/04/Annual-Report-of-NHRC-2074-75.pdf . Vatti , J.Principles and practice of nursing management and administration for bsc and msc nursing.1 st edi (20). jyapee publication. Sharma, M.Nursing concepts and principles.samiskhya publication pvt.ltd.3 rd edi (2019).new plaza,putalisadak .

57. Thank you