INTRODUCTION Each person in his or her daily life confronted with finding answers to a variety of problems.

These ranges from what to wear to major administrative and personal decisions. Decision is an act of choice, where in an executive forms a conclusion about what must be done in a given situation. A decision presents a course of behavior chosen from a number of possible alternatives. Decision making and problem solving are integral aspects of administration. Decision making is the heart of all administrative and managerial functions. Within authority vested in the administrator or manager, he/she must take decision for implementing plans of organization to achieve its objectives. Decisions may involve allocating resources, appointing people, investing capital or introducing new things. Decision making is at the core of all planed activities. This process is also adopted in the nursing administration and the success or failure depends on the quality of decisions they make. DEFINITION Decision making is a process of selection from a set of alternative courses of action which is thought to fulfill the objectives of the decision problem more satisfactorily than others. - CHHABRA Decision making is defined as the process of choosing between alternatives to achieve a goal. CHARECERISTICS OF DECISION MAKING: y y y y y y y It is a process of choosing a course of action from among alternatives It is a human process involving to a great extent the application of intellectual abilities It is the end process preceded by delibration and reasoning It is always related to the environment It involves a time dimension and a time lag It always has a purpose. It involves all actions like defining the problem and probing and analyzing the various alternatives which takes place before a final choice is made.

TYPES OF DECISION MAKING There are four types of managerial decisions, i.e. mechanistic, analytical, judgmental and adoptive decision. 1. Mechanistic decision: is one that is routine and repetitive in nature. It usually occurs in a situation involving a limited number of decision variables where the outcome of each alternative is known. Most mechanist decisions solve problems by habitual responses, standard operating procedures or lerical routines. Tools used for this type of decision include charts, lists, matrices, decision tree etc. this is useful daily routine and scheduled activities. 2. Analytical decision: is one which involves a problem with a large number of decision variables, where the outcomes of each decision alternative can be computed. The computational techniques used to find optimal solutions include the linear programming, network analysis, inventory recorder model, queuing theory, stastical analysis and so forth. This decision helps to solve complex problems. 3. Judgmental decision: involve s a problem with a limited number of decision variables, but the outcomes of decision alternatives are unknown. Good judgment is needed to increase the possibility of desired outcomes. These type of decisions are useful in marketing investment and to solve personal problems. 4. Adaptive decisions: involve a problem with a large number of decision variables, where outcomes are not predictable. Because of the complexity and uncertainty of such problems, decision makers are not able to agree on their nature or on decision strategies. Such ill structured problems usually require the contributions of many people with diverse technical backgrounds. In such situation, strategies have to be frequently modified to accommodate new development in technology and environment, e.g. research findings. Another classification of managerial decision suggests three types, i.e. strategic, administrative and operational. 1. Strategic decisions are those made by top executives that commit valuable agency resource to achieve major long term goals. The nurse executives who were successful in making these decisions contacted members of an extensive support network to obtain crucial problem informations, used mixed scanning to analyze problem causes, and obtain support of the agencys dominant coalition in shifting through alternatives for the best problem solution.

2. Administrative decisions are those made by mid-level managers to resolve usual problem and develop innovative methods for improving agency function. Mid-level nurse managers are responsible for making this type of decision that determines patient care quality. 3. Operational decisions are routine decisions governing day-to-day events that have been delegated to first-level managers and are made according to the prescribed rules and regulations and instructions. Management decision may be programmed or non-programmed. Programmed decisions (routine, repetitive) are typically handled through structured or bureaucratic techniques (standard operative procedures), which are needed in problem situations, where it is immediately apparent what information is needed and where the information can be obtained. Non-programmed decisions are novel, unstructured, creative decisions that are made to solve problems for which no well defined strategies are available as is often the case with managers, and however, decisions are made under the pressure of time. Decisions encountered by the nursing administrator generally fall into two basic categories (Ann Bill Taylor): 1. Non-Routine decisions: decisions that is non-routine, non-recurring and uncertain. For example, changing the way of organizing for the delivery of nursing care. 2. Routine decisions: decisions that are more routine, recurring and certain. For example, assigning daily coverage. Usually decisions are made at different levels. Non-routine decisions are made at the top level management, for example, policy matters etc, whereas routine decisions are made at the level of middle level managers(CNO NS) and lower levels(DNS, HN, SSN), e.g. assigning duties, maintenance, duty roster, sanctioning leave etc.). DECISION MAKING TECHNIQUE: The decision making techniques are: a. Marginal cost analysis: the profits are maximum at the level where marginal revenues and marginal costs are equal. Marginal analysis can also be used in comparing factors other than costs and revenues. b. Cost-benefit analysis: it is a technique of weighing alternatives where the optimum solution cannot be conveniently reduced to monitory terms as in the case of marginal cost analysis.

c. Operations research: operations research has been defined as the scientific method of analysis of decision problems to provide the executive the needed quantitative information in making the decisions. d. Linear programming: a technique devised for determining the optimum combination of limited resources to achieve a given objective. It is based on the assumption that there exists a relationship between variables and that the limits of variations could be ascertained. e. Network analysis: used for planning and controlling the project activities. Under this a project is broken down to small operations which are engaged in a logical cycle f. Decision grid: it allows one to visually examine the alternatives and compare each against the same criteria. Although any criteria may be selected, the same criteria are used to analyze each alternative. g. Pay off tables: this have a cost-profit-volume relationship and are very helpful when some quantitative information is available, such as the items cost or predicted use. To use of the pay off tables, one must determine probabilities and use historical data, such as a hospital census or a report on the number of operating procedures performed. This does not guarantee that a correct decision will be made, but they assist in visualizing data. h. Decision trees: decisions are often tied to the outcome of other events, management analysis has developed decision trees. DECISION STRATEGIES A strategy in an artful or clever plan for applying techniques pursuit of a goal. Before selecting any method of decision, manager should adopt a decision strategy. Some strategies suited for some types of problems than the others as follows: Optimizing Making decision that will yield the greatest possible payoff for a specific input of time, energy and material. It is an approach in which an individual analyses a problem, determines desired outcomes, identified possible solutions, predicts the consequences of each action, and selects the course that yields the greatest amount of preferred outcomes. Satisfying Making a decision that is good enough to meet a set of minimum requirements. It an approach, whereby an individual chooses a problem solution, that is non-ideal, but that is good enough to meet a set of minimum requirements. It is an approach whereby individual chooses a problem solution that is an ideal but that is good enough to meet the minimum standards of acceptance.

Mixed scanning Making a decision that satisfies to remove least promising solutions, then select best of remaining options. Opportunistic Making a decision after waiting for the storm to pass. Eliminate critical limiting factor Making a decision by removing most powerful obstacle to success. Maxima An optimistic approach in which, while assuming the highest possible payoff from use of any action, the individual chooses that action alternative that will yield the largest payoff. Mini-regret An approach designed to minimize the surprise resulting from any action decision by selecting the action alternative that will yield a result midway between the most desired and the least desired outcome. Precautionary Making a decision by choosing action that will maximize gain or minimize loss regardless opponents actions. It is useful when the manager engaged in a zero-sum conflict with another; i.e. each party gains only expense of other. Evolutionary While taking a decision, individual has to make series of small changes leading towards goal. It is based on the assumption that subordinates can better adjust to a series of small changes than a quantum leap. Chameleon Taking a decision by making vague plan, adjusted to changing circumstances. It consists of framing management decisions in general terms, so that they can be interpreted differently at different times.

DECISION MAKING PROCESS: Necessary conditions that are required for the decision making process are the existence of a problem and the problem must suggest more than one alternative. Decision making process involves series of sequential steps, they are: 1. Recognizing the problem: i.e. to determine what the real and correct problem is

2. Gathering and processing information: Data relating to the situation are collected and thoroughly analyzed to find out adequate background information. Gathering and processing information are separate yet related actions. Gathering information is the second step in the decision making process and processing information comes in both second and third step of decision making process. 3. Evaluating alternatives: Before making a decision, the decision makers should develop feasible alternatives so that they can evaluate the potential consequences of each. This is a step continues with the information processing step, where internal and external factors determine the cost and the time constraints associated with each potential alternative. 4. Deciding, selecting, or choosing: Rarely the solutions to problems are clear-cut-black or white clothes; most tend to be shades of gray. Clearly, selecting an alternative from some combinations will be more difficult than others and becomes more complicated when the interaction of one activity on another. 5. Implementing post decision activities: Once the decision maker has selected an alternative, it must be converted into action. Obviously, any decision is worthless if it is never implemented. Therefore in the last step of decision making process, imnmplementing post decision activities, the effective decision maker uses the knowledge and skill to transform the solution into behavior through skilflful implementation, effective communication, and evaluation through individuals and groups. MODELS OF DECISION-MAKING PROCESS Decision- making is deliberative, cognitive process, through introspective analysis, an individual can identify her/his underlying attitudes and modify them to improve decision accurately. A manager may approach decision-making from following models. 1. Econogical model oreconomic man. 2. Bounded rationality model or administrative man. 3. Simplicitry favourite model or view of games man.

1. Econological model It is an ideal view of economic man, in which a manager who is faced with a problem weighs the economic aspects of all possible courses of action and chooses the action that is expected to yield the economic aspects of all possible courses of actions that is expected to yield the greatest net gain or the least loss. In this model following steps have been observed(Simon). 1. Discover symptoms of the problem of difficulty. 2. Determine the goal to be achieved or define the problem to be solved. 3. Develop a criterian against which alternative solution can be evaluated. 4. Identify all alternative course of action. 5. Consider the consequences of each alternativeas well as the likelihood of occurrence of each. 6. Choose th best alternative by comparing the consequences of each alternative 7. Act or implement the decision. Discover Symptoms

Set goal or define problem

Develop criterion

Develop alternatives Determine all outcomes Select alternatives Act or implement decision Econological model This model represents a useful prescription of how decision should be made; but it does not adequately portray how decisions are actually made. It has following assumptions that make about the capabilities of human beings: y Human beings have the capability to gather all necessary information for decision, i.e. people can have complete information. y Human beings can mentally store this information in some stable form, i.e. they can accurately recall at any time events.

Human being can manipulate all this information in a series of complex calculations designed to provide expected values.

Human beings can rank the consequences in a consistent fashion for the purposes of identifying the preferred alternative.

This model focuses on the decision maker as an optimizer. Where an alternative is optimal, i.e. (a) there exists a set of criteria that permits all alternatives to be compared and (b) the alternative in question is preferred, by these criteria to all other alternatives. 2. Bounded Rationality Model It is pragmatic view of administrative man. As the name implies, this model assumes that people, while they may seek the best solutions, usually settle for much less, because the decisions they confront typically demand greater information processing capabilities than they possess. They seek a kind of bounded (or limited) rationally in decisions. The concept of bounded rationality attempts process three mechanisms as given below: 1. Sequential attention to alternatives: here, persons examine possible solutions of a of a problem sequentially, i.e. if first solution fails to work it is discarded and next solution is considered till he gets acceptable solutions and discontinued after acceptable solutions and discontinued after acceptable one. 2. Heuristics a heuristic is a rule which guides the search for alternatives into areas that have a high probability for yielding satisfactory solutions. Accordingly, the decision makers use heuristics to reduce large problems to manageable proportions, so that decisions can be made rapidly. They look for obvious solutions that worked in similar situations. 3. Satisfying this model sees decision-maker in a satisficer. Where an alternative is satisfactory if: s(a) there exists a set of criteria that describes minimally satisfactory alternatives; and (b) the alternative in question meets or exceeds all these criteria. This model is descriptive that describes how decision-makers actually arrive at the identification of solutions to organizational problems. This model consists of eight steps as follows: i. ii. iii. iv. v. Set the goal to be pursued or define the problem to be solved. Set the goal to be pursued or define the problem to be solved. Establish an appropriate level of aspiration or criterion level. Employ heuristics to narrow problem space to a single promising alternative If no feasible alternative is identified (a) lower the aspiration level and (b) begin the search for new alternative solution

vi. vii. viii. ix.

After identifying a feasible alternative (a) evaluate it to determine its acceptability. If the identified alternative is inacceptable, initiate search for a new alternative solution If the identified alternative is acceptable (a) implement the solution. Following implementation, evaluate the ease with which goal was (or was not) attained and raise or lower level of aspiration accordingly on future decisions of this type.

DECENTRALIZATION Decentralization increasingly a subordinates freedom of action a way of fulfillment of self expression needs. The higher the degree of decentralization, the greater the freedom allowed. Decentralization denotes to a process or situation of transfer of authority and responsibility for public functions from the central authority to intermediate and local authorities or quasi independent organizations and/or the private sector, is a complex multifaceted concept. Decentralization means dispersal of decision making power to the lower levels of the organization. Decentralization is a situation in which ultimate authority to command and ultimate responsibility for results is localized as far down in the organization as efficient management of the organization permits. -Mc.Farland Decentralization refers to the systemic effort to delegate to the lowest levels all authority except that which can only be exercised at central points. - Allen Different types of Decentralization should be distinguished because they have different characteristics, policy implications, and conditions for success. The different types of decentralization are political, administrative, fiscal, and market Decentralization selected within a country will depend on its design. FACTORS AFFECTING DECENTRALIZATION y y y y y Size of the organization History and age of the organization Abilities of the lower level managers Strategy and the organizations environment Nature of management function

Goals of Decentralization The goals of decentralization are developed for the better running of any organization especially in a large sector where all the power of the supreme authority cannot be sufficient to control large organization. E.g.: government  To promise more effective and efficient government, as well as an improvement in the quality of the services delivered.  To bring the authorities closer to the people and to increase transparency and accountability.  To give regions more autonomy with the aim of taking the wind out of the sails of separatist movements. Administrative Decentralization in nursing seeks to redistribute authority, responsibility and financial resources for providing services among different levels of health care department. It is the transfer of responsibility for the planning, financing and management of certain functions from the central authority and its agencies to field units of health departments, subordinate units or levels, organizations, regional or functional authorities. Advantages of Decentralization:        Reduction in the burden of chief executive Quick decisions Diversification of activities Development of managerial personnel Effective control and supervision Improvement of motivation and morale Miscellaneous economies

Limitations of decentralization:    Increases the administrative expenses May create problem in bringing coordination of various units May bring inconsistencies in the company

MANAGEMENT Introduction Management, in simple terms the act of getting people together to accomplish desired goals. The verb manage comes from the Italian maneggiare ((to handle- especially a horse), which in turn derives from the Laatin mamis(hand). The French word mesnagement (later management) influenced the development in meaning of the English word management in the 17th and 18th centuries. Harbison and myers offered a classic threefold concept for emphasizing a broader scope for the viewpoint of management. They observe management as 1. An economic resource, 2. A system of authority and 3. A class or elite. As viewed by economist Management is one of the factors of production together with land, labor and capital. As the industrialization of nation increases, the need for management becomes greater as is substituted for capital and labor. As viewed by a specialist in administration and organization Management is a system of authority. Historically, management first developed an authoritarian philosophy with a small number of top individuals determining all actions of the rank and file. Later, humanitarian concepts cause some management to develop paternalistic approaches Still later, constitutional management emerged, characterized by a concern for definite and consistent policies and procedures for dealing with the working group. As more employees received higher education, the trend of management was toward a democratic and participative approach. Modern management can be viewed as synthesis of these four approaches to authority. As viewed by a sociologist Management is a class and status system The increase in the complexity of relationship in modern society demands that managers become elite (most powerful, rich) of brains and educations. Entrance into this class is based more and more on education and knowledge instead of on family or political connections.

MANAGEMENT AND NURSING MANAGEMENT Management is however, essentially same as administration in its two fold nature of purpose and the various means used to achieve that process. Management is the process of getting the work done through others. Nursing management is the process of working through nursing personnel to provide care cure and comfort to group of patients. The nurse managers/ supervisors task is to plan, organize, direct and control available financial, material and human resources in order to provide effective, economic care to groups of patients. The management process, like the nursing process has certain step, which includes gathering facts (assessment), diagnosing problems (diagnosis) planning interventions9planning), executing plans (implementation), and evaluating outcomes evaluation). The steps in management process are more complex than nursing process as follows. 1. Assessment or data gathering step of the management process consists of accumulating information not only about patient but also about agency, community, workforce and environmental constraints which for proper identification of problems. 2. Planning steps in management process consists of determining care needs of different patient groups, nursing objectives, budgetary allotment, required staff, and operational organizational structure and appropriate polices and procedures. 3. An implementation step in management process consists of directing groups of nurses to implement planned actions. This directing includes leading, communicating and motivating. 4. Evaluation step in management process includes the action of multiple care givers, patient outcomes and costs. It is cost control and quality improvement step. Each step in the management process i.e. data gathering, planning, organizing, staffing, leading and controlling affects all other steps and influences patient care quality. Since nursing management process consist of several steps and each entiles myriad facts and action be viewed as nursing management system. The management system is a series of interrelated event that influenced by environmental factors. It consists of five element input, processor, output, control and feedback mechanism as fallows. 1. Nursing management inputs are information (data) regarding personnel, equipment, supplies and patients, data gathering which includes information about agency, clients, employees, and resources. 2. The system processor is a group of nurse managers who have authority of planning, organizing, directing and controlling nursing operation.

a. The planning of nursing operation include formulation of objectives, system, standard, policies, procedure and budget. b. Organizing will include preparing table or organization ( organization chart), job evaluation, job description and group work and team building operation. c. Staffing operation will include patient satisfaction, determining staff need, recruitment, selection, orientation, scheduling, assigning jobs, minimizing absenteeism, decreasing turnover and staff development. d. Leading operation will include using the power or authority for problem solving, decision making, affecting change, handling conflict, communication and transitional analysis. e. Controlling operation will include quality improvement, patient audit, performance appraisal, discipline, labor relation and computer information system. 3. Nursing management output are patient care, staff development and research 4. Nursing management controls are agency, philosophy, nursing goals, nursing budget, personnel policy, disciplinary process, union contracts and licensing/accreditation regulation. 5. Nursing management feedback includes financial reports, quality monitoring reports, employees peer review and accreditation survey reports. Application of administration/management concepts at different levels in hospitals Nursing superintendent/chief nursing service 1. Planning for a. An organization of nursing service which provides for effective functioning of all nursing service personnel i. ii. Define lines of authority and areas of responsibility Delegate responsibility and authority consistent with position assignment.

b. Appropriate numbers and categories of personnel to meet nursing need i. Analyses with personnel concerned, nursing service needs of all areas in which nursing service personnel are assigned, considering, y y y y y Plan of medical therapy Physical, emotional, rehabilitative and teaching needs of patient Length of stay of patient Post hospital needs of patient Nursing service responsibility for assisting in medical research programs and orientation of medical personnel y y Preparation and abilities nursing service personnel Number of patient

y ii.

Kinds and amount of equipment and the effect of physical planned on the nursing work load.

Determine nursing service activities consistent with sound utilization of personnel and accepted nursing practice

iii. iv.

Establish quantitative standards of nursing care to patient. Analyze personnel abilities in light of activities to be performed

c. Promotion of the personnel and professional growth of all nursing service employees i. Provide for and participate in education and training programs for all professional and non professional nursing service personnel. ii. Provide for y y y iii. Counseling and guidance programmes Regularly scheduled group conferences Special committees and work group

Provide opportunity for direct experience and encourage advanced study.

2. Directing by: a. Interpreting the aim of voluntary agencys nursing service to the staff and to the community i. ii. Translate the nursing service objectives into a component of the medical care program. Administer personnel policy as established by voluntary agencies.

b. Utilizing sound personnel management practices in administering the nursing services. i. ii. iii. Select for employment qualify personnel and non professional personnel Provide for assignment personnel on the basis qualification and abilities Provide professional nurse supervision of personnel which promotes development to their highest potential in which contributes to efficiency and economy in providing nursing care. iv. Establish performance requirement for all employees which permit y y Identification of standard performance and form the basis for appropriate action. Identification of outstanding performance and form the basis for recognition and reward.

3. Controlling by a. Planning budgetary requests for nursing service and participating planning for equipment and supplies which affect nursing service programmes. i. ii. Submit budgetary estimate for nursing service personnel With appropriate personnel, participate in budgetary planning for equipments and supplies which increase efficiency and economy of nursing service activities. b. Establishing channels of communication and means for reporting nursing service activities

i.

Device a systematic plan for dissemination of information up and down the nursing service organization

ii.

Participate in interdivisional and intradivisional planning for effective communications which affects nursing service, including communications with regional office clinics, out-patient clinics, and community nursing agencies.

iii.

Prepare comprehensive reports on all phases of nursing service.

4. Coordinating by a. Interrelating nursing service activities with all other hospital services i. With services concerned, develop working arrangements which are mutually acceptable and which facilitate operational activities in providing care ii. Establish and maintain cooperative relationship withal hospital services

5. Evaluating by a. Conducting continuous analysis and review of nursing service programme i. Initiate studies of local problems in nursing service activities and coordinate plans of action for their execution ii. iii. Interpret findings of studies and initiate appropriate actions. Review functions of nursing service personnel to determine whether or not they are consistent with changes in therapeutic programmes and professional practices Staff nurses 1. Planning for a. Individualized nursing care to patients i. ii. iii. Evaluate and interpret the total nursing needs of each patient assigned to his/ her care Interpret the medical care plan as it relates in nursing needs Recognize nursing needs which will have to be met when the patient returns home. Determine the ways that these needs will be met iv. v. Appraise the abilities of each member of his or her team Appreciate the responsibilities inherent in professional nursing to y y a. Guide and direct non-professional nursing service personal Arrange work situation which provide for job satisfaction.

2. Directing by supervising the nursing care given to the patients assigned to his/her team i. ii. Assign specific nursing care activities to team members Assist team members to plan sequence and timing of nursing care activities for the accomplishment of the total nursing care of all patients

iii.

Promote the maintenance of desirable standards

b. Promote the development and self realization of team members i. Make individual assignments which are compatible with employees knowledge, interest, and skills and which motivate potential abilities ii. iii. Arrange assignments for essential enrichment of experience Recognize substandard performance and within his / her assigned responsibility assist in arranging for appropriate remedial action 3. Controlling by a. Serving as a leader of the nursing care system b. Serving as a member of nursing care system i. ii. iii. iv. Participating in evaluating the nursing care needs of each patient Participating in developing a nursing care plan and integrate it into the medical care plan Perform thos4e aspect of nursing care plan which require professional judgments and skill. Assist in the guidance and development of non-nursing personnel.

c. Appropriately utilizing materials i. Maintain awareness of individual responsibility for sound administration of nursing services through y y y y Economic use of expandable supplies and adequate safeguards to prevent misuse and loss Knowledge of the principled of operation of appropriate mechanical equipment and procedures. Guiding coworkers toward increased efficiency and productivity Suggesting methods and techniques leading to better utilization of supplies, equipment, and personnel d. Maintaining effective communication i. ii. iii. iv. Prepare meaningful clinical records of nursing care for each patient. Participate in team conferences and in service programmes Keep team members fully informed of the status of patients assigned to him/her. Participate in planning for patients post hospital plan

4. Coordinating by a. Interrelating patient care activities with the administration of the unit nursing service , total nursing service, and other hospital services 5. Evaluating by a. participating in the appraisal of the effectiveness of the administration of nursing service

Types of nursing management/ modes of organizing nursing care delivery system There are five primary means of organizing nursing care for patients namely:  Case method nursing or total patient care  Functional nursing  Team nursing or modular nursing  Primary nursing 1. Case management nursing or managed care It is the oldest mode of organizing patient care. In this method, nurses assume total responsibility for meeting all the needs of assigned patients, during their time on duty. It involves the assignment of one or more clients to a nurse for a specific period of time such as shift. Even though it is the most it is one of the earliest method of nursing care delivery, it is still widely used in hospitals and home health agencies. It is developed and communicated through written sources. Students most frequently learn within this model. This method provides nurses with high autonomy and responsibility. Assigning patient is simple and direct and does not require the planning. Advantages y The nurse attends to the total needs of the patient y y Continuity of care can be facilitated Work load for the unit can be equally divided among the available staff. y Client may feel more secure, knowing that one person is thoroughly familiar with the needs and the course of the treatment y Disadvantages y Nurses are not enough to comply the demands, cost effectiveness must be considered. Nurse should be adequately trained to provide total care to the patient

2.

Functional method The functional approach to nursing care grew out of a need to provide care to large number of patients.

It focused on organizing and distributing tasks or functions among the personal. Trained nurse provided care that required higher skill levels and untrained workers with little skill or education performed many less complex tasks. In functional nursing, personnel worked in isolation, each performing his or her tasks. The goal of functional nursing was efficient management of time, tasks and energy. Although this practice saved hospital money, patient care was fragmented, and patients had to relate to numerous personnel.

Advantages y Efficient and economical can complete many tasks in a responsible time frame y Workers do only tasks they are educated do y Promotes organizational skill each worker must organize his or her work y y Promotes worker autonomy A sense of productivity for tasks oriented nurse

Disadvantages y Care is impersonal, compartmentalized and fragmented- emphasis on task, not person y y Risk for diminishing continuity of care The staff members are accountable for the task; only the nurse in charge has accountability for the individual, whole clientele y Clients may tend to feel insecure, not knowing who is their nurse is y RNs have little time to talk with patients or render personal care y Little avenue for staff development, except as it relates to work y It is difficult to establish client priorities and operationalise the care plan reflecting the same

E.g. a registered nurse (nurse(RN) on the evening shift at a local nursing home has been assigned to administer special skin care treatments to bed-bound patients, change dressings, and give all medications. A licensed practical nurse (LPN) monitors all patient temperatures and blood pressures, weighs the patient, records the amount they eat and drink and monitors the blood glucose of diabetic patient. The nursing assistants have been assigned a different group of patients for who they are responsible during the shift. They help these patients with personal hygiene, see that they receive their meals and snacks; and assist them with eating toileting, and other tasks. Because it is evening, the head nurse is not there. In her place there is a charge nurse, who signs all charts, indicating that care was administered; talks with physicians and family members and orders supplies and medications. As they go about their work, there is little interaction among the personnel. Often they can be heard telling a patient who asks for something, I am not assigned to do that night. Ill tell other nursing assistant that you need something. 3. Team nursing/ modular nursing Amberston (1953) designed team nursing. She envisioned nursing teams as democratic work groups with different skill levels represented by different team members. They are assigned as a team to a group of patients. It is widely used in hospitals and long term-care facilities. The members of the team are an RN who serves as team leader, an LPN, and one or more certified nursing assistants. The team leader is ultimately responsible for all the care provided, but certain patients each team member. The least skilled

experienced members care for the patients who require for the least complex care, and the most skilled experienced members for the sickest patients who require the most complex care. Team nursing team nursing knows the team leader to shift, match, and redistribute patient assignment to team members according to the level of education and expertise. Team nursing enables the RN team leader to supervise, coordinate the care given to all patients for the assigned shift. It is closer to functional nursing because the team leader delegates without overseeing the care given by team members or patient outcomes. The team leader reports to the head nurse. Team nursing is usually associated with democratic leadership. . group members are given as much autonomy as possible when performing assigned tasks, although responsibility and accountability are shared by the team collectively. Advantages y y y Potential for building team spirit Provides comprehensive care Each workers abilities are used to the fullest y y Promotes job satisfaction Decreases non-professional duties of RN y Includes all health care personnel in the groups functioning and goals y y Workload can be balanced and shared Division of labor allows members the opportunity to develop leadership skills y Every team member has the opportunity to learn from and teach colleagues y Interest in clients well being and care shared by several people, reliability of decision is increased y y All care is directed by a RN Continuity care is facilitated , especially if teams are constant y Barriers between professional and non y y y y y Disadvantages y Constant need to communicate among team members is time consuming All must promote team work or team nursing is unsuccessful Team composition varies from day to day, which can be confusing and disruptive Establishing the team concept takes time, effort and constancy of personnel. Merely assigning people to a group does not make them a {group or team All personnel must have complex skills and knowledge, i.e. communication, leadership; organization, nursing care, motivation and other skills Less individual responsibility and independence regarding nursing functions

professional workers can be minimized, the group effort prevails y Everyone has the opportunity to contribute to care plan

E.g. the team leader for 12 patients on a medical surgical unit during the night shift has one LPN and one certified nursing assistant (CAN) on his team. First, the RN team leader makes visit to all patients room to assess their condition. Based on it, he assigns LPN to 5 patients. In that 3 patients had surgery within the past 3 or 4 days and are recovering without any complications. The other 2 have routine conditions. The nursing assistant is assigned to 2 patients who are ready for discharge tomorrow, two more who are within 2 days of discharge, and one newly admitted patient who will have surgery tomorrow. One patient has had surgery that day and has IV fluids as well as lot of pain. There is a family member spending the night with him. The team leader takes this patient himself, but does not overload with patients because he needs the flexibility to assist where needed and to supervise the other team member. 4. Primary nursing: Developed by Manthey (1980), primary nursing was designed to promote the concept of having one identified nurse for every patient during the patients stay on a particular unit. The goal of primary nursing is to deliver the consistent, comprehensive care by identifying one nurse who is responsible, has the authority, and is accountable for the patients nursing care outcomes for the time the patient is on that unit. Each newly admitted patient is assigned to a primary nurse and they care for their patients when they are at work and delegate responsibility to associate nurses when they are off duty. There is a continuing relationship between the professional nurse and the patient. It promotes both autonomy and accountability because one nurse is responsible for all the nursing care for the patient. Advantages y y High patient and family satisfaction Promotes RN responsibility and authority y Patient knows nurse well and nurse knows patient well y y Promotes professionalism Promotes job satisfaction and a sense of accomplishment y y Disadvantages y Nurses do not know other patients- cannot cover for each other Stress of heavy responsibility, especially for new nurses There is little avenue for group planning of client care

E.g. a primary nurse in a rehabilitation centre is assigned a new patient. He is a 25 year old man who sustain spinal cord injury in an accident. He has been in trauma ICU, and now his condition has stabilized, he has been transferred. He is paralyzed from the shoulders down. In addition to providing care, the nurse assesses that the patients wife has few sources of emotional support and is growing anxious about the future. The primary nurse acknowledges and discusses these feelings. She refers the couple to a rehabilitation psychologist who works with them in re-planning and reprioritizing their life goals. 5. Case management nursing The most recent evolution in nursing care delivery system is case management nursing. In this nurses are coordinators; integrators, collaborators ensuring that that the desired health care needs of and outcome for the patient are met while using the fewest resources. Key skill for nurses in this role include critical thinking, communication, advocacy, negotiation, holistic planning and evaluation and the ability to set both long term and short term goals. Advantages y y Nurses has increased responsibility Disadvantages y Requires additional training Requires nurses to be off unit for periods of time y Time consuming

Promotes collaboration with other health y team members Cost-effective Eases patient service from hospital community services

y y

E.g. an RN case manager is working with a patient scheduled for a modified mastectomy the following day. He explains the sequence of events to the patient and family and tells them what to expect. He gives the patient and family a tour of the hospital, including the surgical unit and post-anesthesia unit. He follows the patient after surgery and may or may not provide direct nursing care. He makes sure a reach to recovery volunteer fro the American cancer society is called into see his patient before she leaves the hospital and that she has a follow up home visit planned with the volunteer. Before discharge, he provides any discharge planning or teaching she may need. He makes sure she has a follow up appointment scheduled with the surgeon and that she has transportation to appointment. If indicated, she refers her to an on going support group.

Principles of nursing service/ management: The deportment of nursing at hospital is committed to upholding the corporate values of the nursing personnel and promoting the hospital services. Therefore it has been believed that the following principles past characterize the department of nursing. 1. Principles of excellence in service: Authorities believe That each of our patients, regardless of circumstances, possess intrinsic value from god and should be treated with dignity and respect That each encounter with patients and families should portray compassion and concern. That each patient should receive quality care that is cost-effective, competitive and based on the latest technology That patient confidentiality and privacy should be prepared That meeting the needs of needs of the patients and other customers should always be our number one priority 2. Principles of excellence in practice

Authorities believe That our profession is a science and art, the essence of which is nurturing and caring That our primary duty is to restore and maintain the health of our patients in a spirit of compassion and concern That the nursing process is an integral part of our practice as a professional nurses That nurses should collaborate with other health care team members to meet the holistic needs of our patients which include physical, psychological and spiritual aspects of care. That we should aggressively promote patient and family education to allow each individual to prevent illness. That we are accountable to our patients, their families and to each other for our professional practice That monitoring and evaluating nursing practice is our responsibility and is necessary to continuously improve care. That we should pursue professional growth and development through education, participation in professional organization and support research. 3. Principles of excellence in leadership Authorities believe: That we should provide a progressive environment, utilizing current technology, guided by responsible stewardship to promote the highest quality patient care and employees satisfaction

That we should encourage and support collective decision making by those who are closest to the situation, even at the list of failure That compassion should be characterized in our day to day personal interaction as well as being a motivating factor in management decisions. That we should be sensitive to individual needs and give support, praise and recognition to encourage professional and personal development. That we should processes an energy level and personal style that empowers and inspires enthusiasm in others. That we should consider suggestions and criticisms as challenges for improvement and innovation. That justice should be applied equitably in all employment practices and personnel policies. Techniques of nursing management The various techniques of nursing management include       Supervision Formative and summative evalution Performance appraisal anecdotal reports Critical incident records Quality control(Nursing standards and nursing audit) Discipline CONCLUSION Administration is a body of knowledge, along with the practice of nursing administration, holds the enterprise together. It gives cohesiveness, coherence, and order to the great task of providing nursing services or encourages efficiency, comprehensiveness, and economy in carrying forward the purpose and goals of nursing services.

INTRODUCTION Setting of organizational objectives is the starting point of managerial actions. An organizations end results for which an organization strives is termed as mission, purpose, objective, goal, target etc. Many times these terms are used interchangeably as all these denote end results. MISSION STATEMENTS A Mission Statement defines the organization's purpose and primary objectives. Its prime function is internal to define the key measure or measures of the organizations success and its prime audience is the leadership team and stockholders. Mission statements are the starting points of an organizations strategic planning and goal setting process. They focus attention and assure that internal and external stakeholders understand what the organization is attempting to accomplish. MISSION AND PURPOSE Mission and purpose are used interchangeably, though at theoretical level, there is a difference between two. Mission has external orientation and relates the organization to the society in which it operates. A mission statement helps the organization to link its activities to the needs of the society and legitimize its existence. Purpose is also externally focused but it relates to that segment of the society to which it serves; it defines the business which the institution will undertake. Dimensions of Mission statements: According to Bart, the strongest organizational impact occurs when mission statements contain 7 essential dimensions. y y y y y y y Key values and beliefs Distinctive competence Desired competitive position Competitive strategy Compelling goal/vision Specific customers served and products or services offered Concern for satisfying multiple stakeholders

According to Vern McGinis, a mission should: y y y y y Define what the company is Define what the company aspires to be Limited to exclude some ventures Broad enough to allow for creative growth Distinguish the company from all others

y y

Serve as framework to evaluate current activities Stated clearly so that it is understood by all

Developing a Mission Statement Structure of a mission statement The following elements can be included in a mission statement. Their sequence can be different. It is important, however, that some elements supporting the accomplishment of the mission be present and not just the mission as a "wish" or dream. y Purpose and values of the organization (products or services, market) or who are the organization's primary "clients" (stakeholders) y y What are the responsibilities of the organization towards these "clients" What are the main objectives supporting the company in accomplishing its mission

A mission statement explains the company's core purpose and values. 1. At is most basic, the mission statement describes the overall purpose of the organization. 2. If the organization elects to develop a vision statement before developing the mission statement, ask Why does the image, the vision exist -- what is its purpose? This purpose is often the same as the mission. 3. Developing a mission statement can be quick culture-specific, i.e., participants may use methods ranging from highly analytical and rational to highly creative and divergent, e.g., focused discussions, divergent experiences around daydreams, sharing stories, etc. Therefore, visit with the participants how they might like to arrive at description of their organizational mission. 4. When wording the mission statement, consider the organization's products, services, markets, values, and concern for public image, and maybe priorities of activities for survival. 5. Consider any changes that may be needed in wording of the mission statement because of any new suggested strategies during a recent strategic planning process. 6. Ensure that wording of the mission is to the extent that management and employees can infer some order of priorities in how products and services are delivered. 7. When refining the mission, a useful exercise is to add or delete a word from the mission to realize the change in scope of the mission statement and assess how concise is its wording. 8. Does the mission statement include sufficient description that the statement clearly separates the mission of the organization from other organizations?

VISION STATEMENTS Vision statements reflect the ideal image of the organization in the future. They create a focal point for strategic planning and are time bound, with most vision statements projected for a period of 5 to 10 years. The vision statement communicates both the purpose and values of the organization. For employees, it gives direction about how they are expected to behave and inspires them to give their best. Shared with customers, it shapes customers understanding of why they should work with the organization. Developing a Vision Statement 1. The vision statement includes vivid description of the organization as it effectively carries out its operations. 2. Developing a vision statement can be quick culture-specific, i.e., participants may use methods ranging from highly analytical and rational to highly creative and divergent, e.g., focused discussions, divergent experiences around daydreams, sharing stories, etc. Therefore, visit with the participants how they might like to arrive at description of their organizational vision. 3. Developing the vision can be the most enjoyable part of planning, but the part where time easily gets away from you. 4. Note that originally, the vision was a compelling description of the state and function of the organization once it had implemented the strategic plan, i.e., a very attractive image toward which the organization was attracted and guided by the strategic plan. Recently, the vision has become more of a motivational tool, too often including highly idealistic phrasing and activities which the organization cannot realistically aspire. VALUE STATEMENTS Value statements define the organizations basic philosophy, principles and ideals. They also set the ethical tone for the institution. An organizations values are evident in the statements that define the organization and the processes used to achieve its mission and vision. Developing a Values Statement 1. Values represent the core priorities in the organizations culture, including what drives members priorities and how they truly act in the organization, etc. Values are increasingly important in strategic planning. They often drive the intent and direction for organic planners. 2. Developing a values statement can be quick culture-specific, i.e., participants may use methods ranging from highly analytical and rational to highly creative and divergent, e.g., focused discussions, divergent experiences around daydreams, sharing stories, etc. Therefore, visit with the participants how they might like to arrive at description of their organizational values.

3. Establish four to six core values from which the organization would like to operate. Consider values of customers, shareholders, employees and the community. 4. Notice any differences between the organizations preferred values and its true values (the values actually reflected by members behaviors in the organization). 5. Incorporate into the strategic plan, actions to align actual behavior with preferred behaviors.

References 1. Basavanthappa BT. Nursing administration. 1st edn. Newdelhi: jaypee brothers: 2003. p. 55-64 2. Nursing administration quarterly 3. The journal of asian hospital and health care management 4. Wehrich H, Koontz H. Management; a global perspective. 11th edn. Newdelhi:Tata McGraw-Hill publishing company; 2003 5. Marquis BL, Huston CJ. Leadership and management functions in nursing-theory and application. 5th edn. Philadelphia; Lippincot William and Wilkins publishers; 2006 6. http://currentnursing.com/nursing_management/mission_vision_values_of_organizations.html

PRESENTATION ON NURSING MANAGEMENT

Topic: nursing managementconcepts, types, principles and techniques

SUBMITTED TO: Ms. Kogila Assit. Professor, H.O.D. OBG nursing College of Nursing, GGSMHT.

SUBMITTED BY: Ms. Ashwini.K .N II year M.Sc Nursing Student, Dept of Pediatric Nursing, College of Nursing, GGSMHT