Unit –IV Nursing Management oragnization M,Sc II year 2023.pptx

Organization is aprocess of grouping the necessary responsibilities and activities into workable units, determining the lines of authority and communication and developing patterns of coordination." "It is conscious development of role structures of superior and subordinate, line and staff. "

1. Unit – IV N ursing M anagement M.Sc II Year Organization Dr.Anjalatchi Muthukumaran Vice principal Era college of Nursing , E ra University

2. Content of the syllabus Total hours: 15 hours s Introduction Concept Principles Objectives Types Theories Minimum requirements for organization Developing an orgnizational structure Levels Organizational effectiveness Organizational climates

3. Continued Organizing nursing services and patient care Methods of patients assignment Advantages and disadvantages Primary nursing care Planning and organizing : hospital , unit , ancillary services (specifically CSSD dept, laundry , kitchen dept, laoboratory services , emergency dept )

4. Continued Disaster management plan : Plan Resource Mock drill etc. Application to nursing services and nursing education , nursing administration etc. Summary Conclusion Questions related to topic References

5. LEARNING OBJECTIVES The purpose  of an organization structure The meaning of "organizing" and "organization." The distinction between formal and informal organization . How organization structures and their levels are due to the limitations of the span of management. The exact number of people a manager can effectively supervise depends on a number of underlying variables and situations. The nature of entrepreneuring and intrapreneuring . The key aspects and limitations of reengineering. The logic of organizing and its relationship to other managerial functions. That organizing requires taking situations into account.

6. Organizing System of Roles What Part to Play How’s related  to each other Maintaining Designing ROLES Coordinating Efforts an understood area of discretion or clear idea of the major duties or activities involved verifiable objectives TOOLS Supply of Needed Information Performing in that role to exist and be meaningful, it must incorporate 

7. Organizing A basic process  of combining / integrating Human / Physical / Financial resources in productive interrelationship for the achievement of enterprise objectives

8. Definition of Organization Organization  implies a formalized intentional structure of roles or positions Effort Pooling towards designated objectives through definition / division of activities / responsibilities / authority

9. Meaning of organization T he  word organization may convey at least 3 meanings: Firstly it may refer to the activity of management in arranging people, tasks and resources in the most orderly and efficient manner. Secondly it may also name the arrangement itself, the outcome of the organizing activity. Thirdly , it may describe any number of businesses, behavioural and humanistic concepts.

10. Definition of organization Definition: Organisation is a group of people working together and with each other towards the achievement of the common goals‟. Koontz and O’Donnell, ‘essentially as the creation and maintenance of an intentional structure of role’. From the above definitions it is clear that, Any organisation must have defined goals or objectives. The functionaries shall endeavour to achieve those goals and objectives. The structure of duties and activities necessary for the conduct of or operation of activities without which the organisational objectives cannot be achieved.

11. Concept of organization The organisation must 1) Reflect objectives and plans of the organisation . 2) Reflect the authority available to various categories of managers belonging to different management levels. 3) Reflect its environment. 4) Be manned with trained and appropriate people, commensurate with their job requirements.

12. Identification and classification identification and classification of required  activities grouping of activities necessary to attain objectives Assigning responsibility with necessary authority To a manager for each grouping Coordination in organizational Structure Vertically, Horizontally Departmentation Manageable units Maximum possible specialization Delegation Aptitude / Attitude Job Requirement / Capabilities Organizing involves Synchronization Interrelationship between different positions must be clearly defined From whom ? To whom ?

13. Organisation has four  connotations: Administrative function, as a system, as an operation and as a result. 1.Administrative Function : organisation is a process of identification and grouping of activities with determination and establishment of authority relationships for these group of activities as well as arranging for men, materials, machines and money. 2 . as a system, organization consists of many interrelated and interdependent subsystems; each system and subsystem has the component of: a ) input: human resources, material resources, information and energy serve as input. b ) throughput: the methods through which functions are carried out . c) Output: the actual outcome. d ) management component: the system sees that the desired outcomes are obtained.

14. 3. in an operational: organisation is involved with determination and defining of duties and responsibilities of the personnel and establishment of interrelationship between the various activities within the organisation . 4. result: a gp of people working together to accomplish the laid down common objectives or goals with in a defined and specific framework. Steps in organisation 1. Determination of objectives for each activity. 2. Deciding on the various types of activities to be undertaken with in the framework of the formulated plan to attain the goals of the organisation . 3. Grouping of activities , their similarity, interrelationships, competencies and capacities required in performance of these activities, its importance in relation to achievement of organizational goals. 4. Deciding different groups of activities in terms of - The number of staff - The eligibility requirement of staff

15. ORGANIZATIONAL DESIGN

16. ORGANIZATIONAL DESIGN (SMALL BUSSINESS )

17. ORGANIZING INVOLVES

18. STRUCTURE DESIGN

19. FORMAL ORGANIZATION

20. INFORMAL ORGANIZATION

21. ORGANIZATION WITH NARROW SPAN

22. ORGANIZATION WITH WIDE SPAN

23. Principles of organisation 1 . Principle of chain of command: Communication flows through the chain of command or channel of communication tends to be one way downward . In a modern nursing organization, the chain of command is flat, with line managers, technical, clerical staffs that support the clinical staff. The communication flows freely in all directions, with authority and responsibility delegated to the lowest operational level. This principle supports a centralised authority that aligns authority and responsibility . The  organizations are established with hierarchial relationships, within which the authority flows from top to bottom in order to be satisfying to members, economically effective and successful in achieving the goals

24. 2. Principle of unity of command: . An employee has one supervisor / one leader and one plan for a group of activities with the same objective. Also called principle of responsibility. The organisational set up should be arranged in such a way that a subordinate should receive the instruction or direction from one authority or boss. Primary nursing and case management modality support this principle. (Many professional nurses engage in matrix organisations in which they answer to more than one supervisor). In the absence of unity of command The subordinate may neglect his duties. It will result in the non completion of any work. There is no guidance available to the subordinates and there is no controlling power for the top executives of the organisation . Further some subordinates will have to do more work and some others will not do any work at all. 

25. 3. Principle of span of control: Span of control refers to the maximum number of members effectively supervised by a single individual. (The number of members may be increased or decreased according to the nature of work done by the subordinates or the ability of the supervisor. The span of control enables smooth functioning of the organisation . Person should be a supervisor of a group that she can manage in terms of numbers, functions, and geography. The more highly trained the employee, the less supervision is needed. Employees in training need more supervision to prevent blunders. When different levels of nursing employees are used, the nurse manager has more to coordinate. In the  past the nurse managers had a narrow span of control. They were responsible for one nursing unit and a limited number of staff. Recently the span of control has increased to the point that the nurse managers have to cover several nursing units and departments with a large number of employees. This is also called span of management or span of supervision . This principle is based on the principle of relationship.

26. 4. Principle of specialization or division of work: Each person should perform a single leading function. There is a division of labor: a differentiation among kinds of duties. Specialization is the best way to use individuals and groups. Division of work means that the entire activities of the organisation are suitably grouped into departments and sections. (The dept and sections may be further divided into several such units so as to ensure maximum efficiency). This will help to fix up the right man to the right job and reduce waste of time and resources). The work is assigned to each person according to his educational qualification, experience, skill and interests. He should be mentally and physically fit for performing the work assigned to him. The required training may be provided to the needy persons. It will result in attaining specialisation in a particular work or area

27. 5. Hierarchy or scalar chain It is the order of rank from top to bottom in an organisation . This is also called a chain of command or line authority. (Normally, the line of authority flows from the top level to bottom level. It also establishes the line of communication). Each and every person should know who is his supervisor and to whom he is answerable.

28. 6. Centrality It relates to the position or distance the person has on the organisational chart from other workers.

29. 7. Unity  of objectives An establishment or enterprise exists to achieve certain laid down objectives . The orgn requires to be geared towards fulfilment of these objectives. Hence this principle dictates that it is essential for the organisational objectives to be formulated in clear, unambiguous, achievable and measurable terms which should be understood by all concerned.

30. 8. Definition of jobs/ principle of definition It is necessary to define and fix duties, responsibilities and authority of each worker. In addition to that, the organisational relationship of each worker with others should be clearly defined in the organisational set up.

31. 9. Principle of balance There are several units functioning separately under one organisational set up. The work of one unit might have been commenced after the completion of the work by another unit. So it is essential that the sequence of work should be arranged scientifically.

32. 10. Principle of equilibrium balance In certain periods, some sections or departments are overloaded and some departments are underloaded . During this period, due weightage should be given on the basis of the new workload. The overloaded sections or departments can be further divided into subsections or subdepartments . It would entail in the effective control over all the organisational acivities

33. 11. Principle of continuity Administration is a continuing or ongoing process – recycling the structure of the organistion based on the economic, environmental and socio-political changes.  There should be a reoperation of objectives, readjustments of plans and provision of oppurtunities for the development of future management. This process is taken over by every organisation periodically.

34. 11. Principle of continuity Implies routine decision making should rest with lower levels of management within the policy framework and only unusual or exceptional matters should be referred to the higher levels of management for taking decisions. The junior officers are disturbed by the seniors only when the work is not done according to the plans laid down. It automatically reduces the work of middle level officers and top level officers. So the top level officers may use the time gained by reduction in workload for framing the policies and chalking out the plans of organisation

35. 13. Principle of unity of direction Also called principle of co-ordination. The major plan is divided into sub plans. Each sub plan is taken up by a particular group or department. All the gps or depts are requested to cooperate to attain the main objectives or in implementing major plan of the organisation .

36. 14. Principle of communication A two way communication flow from top to bottom levels and from bottom to top levels is a prerequisite to obtain an effective organisational set up.

37. 15. Principle of flexibility to meet the challenges of the increasing and changing demands of the environment, an organisation structure is subjected to change. As such rigidity has to be avoided and flexibility is essential in the organisation structure, so that changes can be brought about without disrupting basic design of the structure. Classification of organisation The organisation can be classified on the basis of authority and responsibility assigned to the personnel  and the relationship with each other.

38. In this  way organisation can be either formal or informal. Provides a framework for defining responsibility, authority, delegation and accountability . Depending on the organizational philosophy, the formal structure may be rigid or loose. The formal organisation represents the classification of activities within the enterprise, indicates who reports to whom and explains the vertical journal of communication which connects the chief executive to the ordinary workers.

39. Organizational structure An organisational structure clearly defines the duties, responsibilities, authority and relationships as prescribed by the top management. (In an organisation , each and every person is assigned the duties and given the required amount of authority and responsibility to carry out this job). It creates the coordination of activities of every person to achieve the common objectives. It indirectly induces the worker to work most efficiently. The interrelationship of staff members can be shown in the organisation chart and manuals under formal organisation .

40. Characteristics of formal organization: It is properly planned. It is based on delegated authority. It is deliberately impersonal. The responsibility and accountability at all levels of organization should be clearly defined. Organisational charts are usually drawn. Unity of command is normally maintained. It provides for division of labour .

41. Advantages of formal organisation : 1. The definite boundaries of each worker is clearly fixed. It automatically reduces conflict among the workers. The entire building is kept under control. 2.Overlapping of  responsibility is easily avoided. The gaps between the responsibilities of the employees are filled up.

42. 3 . Buck passing is very difficult under the formal organisation . (Normally exact standards of performance are established under formal organisation . It results in the motivating of employees). 4 . A sense of security arises from classification of the task. 5 . There is no choice for favouritism in evaluation and placement of the employee. 6 . It makes the organisation less dependant on one man.

43. Keith davis observes formal organization Keith davis observes that formal organisation is and should be our paramount organisation type as a general rule. It is the pinnacle of man‟s achievement in a disorganised society. It is man‟s orderly, conscious and intelligent creation for human benefit. Criticisms:: In certain cases, the formal organisation may reduce the spirit of initiative. Sometimes authority is used for the sake of convenience of the employee without considering the need for using the authority. It does not consider the sentiments and values of the employees in the social organisation . It may reduce the speed of informal communication (rules/ reg‟s ).

44. Informal organisation : Informal organisation is an organisational structure which establishes the relationship on the basis of the likes and dislikes of officers without considering the rules, regulations and procedures. These types of relationships are not recognised by officers but only felt. The friendship, mutual understanding and confidence are some of the reasons for existing informal organisation . (For eg ., a salesman receives orders or instructions directly from the sales manager instead of his supervisors). The informal organisation relationship or informal relations give a greater job satisfaction and result in maximum production.

45. According  C.J. Bernard, „informal organisation brings cohesiveness to formal organisation . It brings to the members of the formal organisation a feeling of belonging, status of self respect and gregarious satisfaction. Informal organisations are important means of maintaining the personality of the individual against certain effects of formal organisation which tends to disintegrated personality.

46. Characteristics of informal organisation : 1. Informal organisation arises without any external cause ie ., voluntarily. 2. It is a social structure formed to meet personal needs. 3. Informal organisation has no place in the organisation chart. 4. It acts as an agency of self control. 5. Informal organisation can be found on all levels of organisation with in the managerial hierarchy. 6. The rules and traditions of informal organisation are not written but are commonly followed. 7. Informal organisation develops from habits, conduct, customs and behaviour of social groups. 8. Informal orgn is one of the parts of total organisation . 9. There is no structure and definiteness to the informal organisation

47. Advantages of informal organisation : It fills up the gaps and deficiency of the formal organisation . Informal organisation gives satisfaction to the workers and maintains the stability of the work. It is a useful channel of communication. It encourages the executives to plan the work correctly and act accordingly. It fills up the gaps among the abilities of the managers.

48. Disadvantages of informal organisation : It has the nature of upsetting the morality of the workers. It acts according to mob psychology. It indirectly  reduces the efforts of management to promote greater productivity. It spreads rumour among the workers regarding the functioning of the organisation unnecessarily.

49. Difference between formal and informal organisation Formal organisation Informal organisation It arises due to delegation of authority. It arises due to social interaction of people. It gives importance to terms of authority and functions. It gives importance to people and their relationships. It is created deliberately It is spontaneous and natural. The formal authority is attached to a position. The informal authority is attached to a person. Rules, duties and responsibilities of workers are given in writing. No such written rules and duties followed in informal organisation . Formal organisation comes from outsiders who are superior in the line of organisation . Informal organisation comes from those persons who are objects of its control. Formal authority flows from upwards to downwards. Authority flows upwards to downwards from or horizontally. Formal organisation may grow to maximum size. Informal organisation tends to remain smaller. It is created fortechnological purpose. It arises from man‟s quest for social satisfaction. It is permanent and stable There is no such permanent nature and stability

50.  Types of organisation (Levels of Organisation ): Broadly there are 3 types of organisation : 1. Line   organisation 2. Staff organisation 3. Functional organisation . An institution or enterprise may adopt one or other type of organisation or more than one type of organisation depending upon its needs. Line organisation : It is the oldest and the simplest form of organisation . It is also known as the military or scalar organization. Line functions -where superior exercises direct supervision over a subordinate – an authority relationship in direct line or steps. The line of authority is straight and vertical and each person at the same level performs the same functions. In an enterprise or institution, the chief executive leads the entire organisation . Here the maximum authority rests on the top or highest levels of management and the quantum of authority decreases in a step ladder fashion for the subsequent levels of management in the hierarchy.

51. The line or straight or vertical line of authority serves as the channel of: i ) Command ii) Communication iii) Direction iv) Coordination v) Control And accountability The departments/divisions are formed depending upon the responsibilities involved and work to be carried out by each department / division. each department and each division is headed by a divisional/departmental head. The following two figures will describe the functions of a line organisation Board of Director/Management Chief executive Manager manager manager manager manager Productionmaterials marketing finance admn

52. Difference Between an   Intrapreneur and an Entrepreneur • An intrapreneur is a person who focuses on innovation and creativity and who transforms a dream or an idea into a profitable venture by operating within the organizational environment • The entrepreneur is a person who does similar things as the intrapreneur , but outside the organizational setting

53. Definition of Reengineering •  “The fundamental rethinking and radical redesign of business processes to achieve dramatic improvements in critical contemporary measures of performance, such as cost, quality, service, and speed.“

54. Key Aspects of  Reengineering Fundamental rethinking of what the organization is doing and why. Radical redesign of the business processes Reengineering calls for dramatic results The need for carefully analyzing and questioning business processes

55. Nursing services at hospital s Nurses form a  very important group , the largest single technical group of personnel engaged in patient care in hospitals next to doctors, consuming approximately one third of hospital costs. Because they globally consider 24 hour non stop services towards the patient care services .

56. Nursing care  is required for the prevention of disease and for promotion of health. The nursing care of sick patients – a. in the interest of his or her mental and physical comfort. b . by reason of the disease from which he or she is suffering.

57. Functions of nursing  services are 1 . Clinical 2 . Technical 3 . Caring relationship 4 . Administrative 5 . Educational 

58. It is observed It is observed  that 50% or more of her time will be spent on non-nursing functions like a . Clerical b . Answering telephones c . Supervise indent of drugs d . House keeping, etc

59. staffing The number of  nurses staffing The number of  nurses required to man the nursing services in a hospital depends on many factors, • Number of beds in a hospital • The type of hospital and the prevailing medical practice, including kinds of treatment and medications given and tests and services required for the patients . • Pattern of assignment of nurses - based on functional method, case method or teach method. • The type and the number of emergency cases coming into the hospital. • Available labour - saving devices, automation, mechanization, centralization • Level of competence based on - qualification, experience, efficiency and sincerity.

60. Work allocation Patterns of  assignment: the tasks of the nursing unit are carried out by 3 accepted patterns of assignment, depending on the training, experience and the rules of a particular institution. 1 . Functional method: The tasks are divided among the staff. 2 . Case method: Each nurse is assigned one or more cases. 3 . Team method : Under this system the nursing staff is divided into teams each of which is guided by an experienced nurse. The team leader is responsible to the ward sister and she organizes the nursing care for her group of patients . 4. Group Assignment method: one nurse is assigned to a group of patient to provide total nursing care. 5 . Primary nursing method: the primary nurse assumes 24-hour accountability for the care, planning and evaluation. When on duty on a shift, the primary nurse herself assumes responsibility for providing total care. Other functions of primary nurse is the coordination of nursing activities with physician and other health professionals.

61. Physical dependency of  patients This is an important factor in assessing the workload. The patients can be classified under the following headings: a . Totally ambulant b . Partially bedfast c. Bedfast but not helpless d . Partially helpless e . Totally helpless 

62. Indices of hospital  nurses The nursing time provided per patient per day is the most useful and realistic index, since it takes into account Occupancy rates, working hours, and days absent from work

63. How to find out the nurses work plan To find out  the average number of working days per year by a nurse : Earned leave 30 days Sick leave 10 days Casual leave 14 days Weekly off 85 days Non-working days 139 days Total working days in year 365 days How Therefore total working days is 226 days 

64. To find out  the average number To find out  the average number of hours worked per year by a nurse Average number of working days per year X Average number of working hours 226 x 8 = 1808 nursing hours To find out  the total number of nursing hours per day The hours worked per year by a nurse X total number of nurses For example Total bed capacity of hospital = 500 Required number of nurses = 217 nurses (as per INC norms 1808 x 217 = 361736

65. To find out  the number To find out  the number of nursing hours per day Total number of nursing hours per year( 365) 361736 divided by 365 =991.21 nursing hours per day To find out the number of nursing hours per Patient 991 divide by 500 = 1.98 nursing hours per patient per day approximately 

66. Duties of different  categories of nursing staff Director of nursing The nursing director has very little or no technical duty to perform. The work is mainly administrative and conceptual. 1. Supervision - working pattern 2 . Maintaining discipline 3 . Planning diff. services 4 . Preparing policies to upgrade the routines. 5 . Participating in recruitment of staff 6 . Organizing for academic purposes. 7 . Arrange (in-service) training programmes .

67. Sister-in-charge Sister-in-charge is the  administrative head of the ward/section. Therefore the duties are based on responsible attitude and supervision. 1 . Maintaining cleanliness and orderliness in the ward. 2 . Supervising housekeeping activities. 3 . Supervise staff nurse, nurse-aides, labour staff, patients. 4 . Maintaining inventory . 5. Accompany senior clinician during their rounds/ discussion and actively participate in taking and implementing the decisions. 

68. Problems faced: 1 . Shortage  of nurses due to a . improper ratio of nurse : patient b. recruitment policy c . non availability d . migration to other hospitals e . increase in requirement. 2 . Dissatisfaction 3 . Absenteeism : particularly for night duty . 4. Unionization 5 . Deterioration in standard of performance

69. Staff Nurse This category  is the most active. The duties they are expected to carry out are 1 . General and routine care of patients as per clinicians instructions. She is an active bridge between treating clinician and patients. 2 . To assist clinician. 3 . Assist or independently perform certain procedure like a . collecting blood, b . catheterization of bladder , c. giving IV fluids, d . first aid. 4 . Assist actively at ante natal clinic, post natal clinic, diabetes, asthma, etc . 5. Educational activity like health talk, counseling, etc. 6 . Attend outdoor activities. 7 . Admit and discharge patients.

70. Professional Hazards 1 . Risk  of infection 2. Stress and burn out 3. Backache due to prolonged standing and walking on hard surface . 4. Fatigue due to shift duties . 5. Improper behavior of some patients, relatives, labour staff and even doctors. 6 . Frustration.

71. Thank you so much for listening