NAGARIK COLLEGE OF HEALTH SCIENCE

AFFILIATED TO PURBANCHAL UNIVERSITY

GATTHAGHAR, BHAKTAPUR

Unit 14: Human Resource Development

SUBMITTED TO: SUBMITTED BY:

Mrs. Ashmita Adhikari Manju Thakur (07)
Nursing Lecturer Binusha Tamang (03)
Reshma Dangol (13)
B.Sc. Nursing 4th year
8th Batch
 Unit 14: Human Resource Development

PERFORMANCE APPRAISAL
Performance appraisal is one of the most universal management practice used for the purpose of
evaluating the contributions, personalities and potentiality of a group member. It is used for the purpose
of developing skill among employees by finding out how the staff members have performed their
duties during a specific time period and providing feedback regarding their performance. Therefore, it
has to be individual evaluation of work performance.

DEFINITION
“Performance appraisal is the parodic evaluation of an employee’s job performance measured against
the job stated or presumed requirements.” – Scot, Clothier and Spriega
“Performance appraisal means to ascertain the extent or relative value of an individual’s performance
for the organization” – Alfred and Beatty

PURPOSES
 It promotes mutual understanding and respect between the manager and the employees as it
gives them then an opportunity to communicate their needs, expectations and concern.
 It promotes the rational basis for promotion, wages and other benefits.
 It helps to identify the employee’s strength and weakness and provides guidance and support
needed to improve the performance.
 It helps to design the need based staff development program for employees
 It helps the employees to analyze his own performance and make self-effort towards meeting
the standard of performance
 It serves as a basis for taking any disciplinary action as a control measure in case of deviations
in performance.

PRINCIPLES
 Two ratters evaluate the single employee. For precise rating, the comparison is produced.
 Continuous and personal observation of an employee is essential to make effective
performance appraisal.
 The rating should be done by an immediate superior od any subordinate of an organization.
 A separate department may be created for effective performance appraisal.
 The rating should be conveyed to the concerned employee. It helps to understand the position
where he stands and where he should go,
 The plus points could be recognized of an employee. also, the minus points should not be
highlighted too much but may be hinted to him.
 The management should create confidence in the minds of employees. The standard for each
job should be determined by the government.
  Separate printed forms should be used for the performance appraisal to each job according to
the nature of the job.

PERFORMANCE APPRAISAL TOOLS

Performance appraisal tool is a secure performance evaluation tool designed to support supervisors
and staffs in a simplified and meaningful performance process. It evaluates the employee’s
performance based on how he has performed.
It can either be formal or informal. An informal appraisal might be as simple as immediately
praising the employee or giving gestures such as patting his back for the performance recognized.
Whereas, formal appraisal involves a written document as per organizational guidelines.
There are different types of measurement tools used for performance appraisal such as:
1. Ranking: In this, the supervisor ranks the employee’s total performance against which that of
the co-workers.
E.g.: the nursing supervisor might rank a particular staff highest among five staffs in their ward
with regard to quality of the patient bedside care, along with the patient teaching.
So, such tool can be made even more reliable by developing a standardized scale.
2. Checklist: In this, the evaluation is done whether a behavior or characteristics is present or
not, or whether the action is taken or not. It consists listing of behavior or characteristics that
are essential for the successful performance at the left hand side and simple ‘yes-no” and
additional remarks at the right hand side. This type of tool helps to assess those competencies
area that are critical for gaining proficiency in the field. It can only record if the certain series
of characteristics or behavior are present or not.
3. Rating scale: It is the systematic procedure for obtaining and reporting the judgment of the
supervisor regarding the quality of the behavior of the employees. It consists of sets of
characteristics or behavior that needs to be judged on the left hand column and some type of
scale on right hand side indicating the degree to which each attribute is present.
4. Anecdotal report: They are factual description of the meaningful incidence and events, which
the supervisor observes in the employee and rates it on a plain paper or form. This should
include factual description of what happen to whom, when and where it happens, w\under what
circumstances it happened, and who had observed it.
5. Critical incidence report: In this technique, it identifies and describes particular events where
staff has done something really well or need to improve their performance. Some incidents may
have occurred due to inability of an employee, but the rating is done on all events occurred in
a particular period of time.
 Some incidents or events are given below:
– Refuses to co-operate with other employee
– Unwilling to attend further training
– Gets angry over work or with subordinates
– Suggested the change in the method of production
– Suggested a procedure to improve the quality of the good
– Suggestion of a method to avoid or minimize wastage, spoilage or scrap
– Refuses to obey orders
 – Refuses to follow clear cut instructions
6. Paired comparison method: It is a part of ranking method. This method has been developed
to be used in a big organization. Each employee is compared with other employee taking one
at a time. The evaluator compares two employees and puts a tick mark against an employee
whom he considers a better employee. Finally, an employee who gets maximum ticks for being
better employee is considered as the best employee.
7. Forced distribution method: This method forces the rater to distribute the ratings of overall
performance of an employee. Group wise rating is done under this method. It is suitable in
large organizations but the individual traits could not be appraised.
e.g. a group of workers doing the same job would fall into same group as superior, above
average, below average and poor.
8. Grading: Certain categories of abilities or performance of an employees are defined well in
advance to fall in certain grades under this method. Such grades are good, very good, average,
poor and very poor and individual’s characteristics / traits are identified.
9. Field review method: In this technique, employee’s performance is appraised through an
interview between the raptor and the immediate superior or superior o the concerned employee.
The raptor asks questions to the superior about the performance of an employee, the personal
department prepares a detailed report on the basis of collected information. A copy of the report
is placed in the personnel file of the concerned employee after getting approval from the
superior. The success of this type pf appraisal is based on the competence of the interview.

COMMON ERROR IN PERFORMANCE APPRAISAL

1. Halo effect: It is the tendency of rating the performance of an employee as a whole on the
basis of the good impression about her previous one or two activities. In a situation, a person
is rated higher than she should be.
2. Horn effect: It is the tendency of rating the performance of an employee more on lower
side than what they actually deserve.
3. Leniency effect: It is the tendency of rating the performance of an employee generously
by the nature and this reflects the rating to lean towards more on the higher side.
4. Central tendency: It is the tendency of evaluator to rate all the employees with in a very
narrow range of concentrating the measurement around the center in the rating scale
continuum regardless of their actual performance. Some people could be rated either higher
or lower than what they are being rated at.
5. Personal bias: It is the tendency in which evaluators substantially influences their
employee’s evaluation. Racial, gender, religious are more of the biases enter into rating the
performance of the employee.
6. Dunning Kruger Effect: It is a cognitive bias whereby people with low ability, expertise,
or experience regarding a certain type of a task or area of knowledge tend to overestimate
their ability or knowledge.
7. Recency Error: It is a type of error when the appraiser only bases their feedback on the
last few weeks of work or months rather than the entire evaluation period.
CHARACTERISTICS OF APPRAISAL TOOL
1. Validity: the behavior or the criteria included in the measurement tool to appraise the
performance of an employee should represent all the critical job behaviors from the description
of the employee. In other words, the evaluation tool should actually measure what it has
intended to measure.
2. Reliability: it should give significantly consistent results or scores each time. In other words,
the performance evaluation tool should be trustworthy and dependable all the time.
3. Objectivity: it should be formulated that there is minimum or no chance for evaluator’s
subjective judgement to enter in scoring. When the criteria on which the employee is being
measured are written in behavioral terms, it will increase both objectivity and reliability of
performance appraisal tool.
4. Practicality: the language used in the appraisal tool should be simple and there should be clear
direction about how to use it so that the chance of including error in its use is reduced.

IN-SERVICE EDUCATION
In-service education is an organized educational program to assist the individuals in an organization
in attaining new skills, knowledge and gaining increased level of competence with growing
professionally. It may be part of any staff development. It is a planned learning experience provided
by the agency for employees. It is also referred to a continuing education that is designed for the
retraining, reskilling and updating the knowledge.

DEFINITION
“In-service education is a planned educational activities intended to build upon the educational
and experimental basis of the professional nurse for the enhancement practice, education,
administration and research or theoretical development aimed at improving the health of the
public.” – the American Nurses association
The education given to the nurses while in service for her professional growth is called in-
service education. – N.N. Yalayasamy
Planned continuous education for people already employed by the health authority. –Blackwell

PURPOSES
 Helps to improve professional competence
 Maintain high standard for nursing
 Helps to update the knowledge regarding current research and development
 Develops interest and job satisfaction among the staffs
 Encourages the employee in achieving staff development and self-confidence
 Develops leadership skills, motivation and better attitudes
 Develops willingness to learn while working in the institution

CHARACTERISTICS
  Provided in the job setting
 Well planned and ongoing
 Should be clearly related and identified with service component
 Helps the employee’s learning and improve his knowledge, skill and attitude.
 Designed to meet their demands of changing needs like scientifically, technically,
medically in respect to patient care and treatment.
 It mainly focuses on efficiency and quality of services


FACTORS INFLUENCING IN-SERVICE EDUCATION

In-service education in nursing field is influenced by economic, social, medical and technological
sciences that affects the society.
The following are some of the connected factors that have an impact on in-service education:
1. Cost of health care: it may increase the efficiency of the nursing services, but it adds additional
expenditure on health care delivery system.
2. Manpower: it requires qualified human resources which means an increase in human resources
component of nursing services.
3. Changes in nursing practice: it leads to frequent changes in the program of in-service
education.
4. Standards of nursing practice: it is essential to maintain the high quality of nursing practice.
5. Organization of nursing department: it is important to develop practicing approaches that
are organized well.

APPROACHES IN IN-SERVICE EDUCATION

1. Centralized approach: it should be conducted by nursing personnel in the agency’s central

management. The learners are not consulted or involved in the design of learning experiences,
but are expected to attend in the in-service session.

Advantages

 Budget is in control due to limited personnel involved

 Evaluation of program can be easy
 Prior decision of the resources, people, places and things
 Committees are directed to work on specific problem identified by the administration.

Disadvantages

 It may lead to spontaneous interest in participation and enthusiasm of the learners.

2. Decentralized approach: it is organized and carried out for the benefit of the personnel of one
or more units. Employees are expected to keep management informed of their actions and
maybe consult with them when support is needed, but they are also required to design and
 direct their own learning experience. Employees are responsible for their planning in in-
service.

Advantages

 Share the responsibilities for the meeting the in-service needs

 Proper contribution of the participant is expected
Disadvantages

 Individuals cooperate in same unit; disagreements may frequently arise conflicts.

 Lack of leadership
 Insufficiency
 Less budget

TYPES OF IN-SERVICE EDUCATION

1. Orientation: It assists the new employee in adjusting to their new work environment and
responsibilities. It helps to strengthen nursing service personnel’s capabilities so that they can
continue to improve the quality of care they deliver to patients.
2. Skill training: It equips employees with the skills and attitudes necessary for the job as well
as keeping them informed about new techniques and procedures. It gives a concept on how to
carry out complicated tasks and also helps to increase the employee’s skill in both regular and
specialized procedures.
3. Continuing education: It promotes employees in staying in current with the latest concepts
and improves knowledge, understanding, and competency. It improves the ability to solve
difficulty and interpret with others through educational programs and activities.
4. Conference: It is an academic gathering in which certain speaker comes prepared often by
invitation to an open discussion on some reasonably interesting or controversial theme.
Attenders comes and listens, question the main speakers, makes additional prepared or
spontaneous contributions to their own, evaluate opinions and points of view, discuss formally
or informally among themselves.
5. Workshops: It is an academic gathering with primary goal of offering selected functional
experiences that will improve participant’s performance on the job within their intellectual
boundaries.
6. Seminars: It is a type of an academic meeting where the main focus is on the problem analysis
or discussion. It is handled by the coordinators who is responsible for writing down a precise
or concise description on each member of the discussion panel’s point of view. At the end of
the session, the coordinator presents the highlights of views expressed and invites questions,
comments, observations from the audience to encourage total participation.
7. Exhibitions: It is regarded as a physical displays of scientific interest intended to enlighten
widen scientific community. They could be of classroom application or in a broader context
geared towards solving societal problems e.g. making dyes from local resources.
 STEPS IN PREPARING IN-SERVICE EDUCATION

1. NEED ASSESSMENT FOR IN-SERVICE EDUCATION PROGRAM

A systematic method of obtaining relevant and sufficient information in order to build an effective
educational program that meets requirements and desires of the target groups. The following are some
of the most common methods used for determining need for in-service education.

a) Job performance analysis

A job performance could be related with single person or group of people. When there are issues about
incomplete, unsatisfactory, or inappropriate performance, the analysis has been conducted. The
information acquired can be used to see f education will help people perform better.

a. Training need analysis

The term “training” is linked with the workplace skill development. When new equipment, procedures,
or processes are introduced into workplace, training is required. Examples include fire and safety
training, harassment training, infection prevention, and similar themes.

b. Analysis of consumer needs

Patient happiness, and changes in the services required to fulfill respectfully the patient’s need in the
healthcare stings. Falls, hospital-acquired infection, and pressure ulcers are patient outcome
measurements. To Identify and to prevent all those complications, we have to fill the gap between
theory and practical by a formal gap analysis, assessment of adverse occurrences, observation, audits,
or job performance can all be used to identify needs related to patient outcome measures.

c. Analysis of learner- identified needs

Individuals learning requirements range from educational requirements identified by institution and
hospitals. The individual learners learning needs are particular, specific and discovered through
practice experience, reflection, questioning, practice audits, self-assessments tests, peer review, and
other sources.

d. Anticipation of future needs

Educators must be forward thinking as they prepare education for future, given the ever-changing
healthcare context. Education will continue to be required as new technology, treatments, diseases,
suggested care methods, and research discoveries emerge. Educators can predict the requirements by
remaining current on literature, best practices, and trends in their field of specialization.

b) PLANNING FOR IN-SERVICE EDUCATION PROGRAM

a. Assess needs
In planning of in-service program, it is most important to detect need of changes in nursing care,
technology, public demands, and patient occupancy must be recognized.

b. Set goals and define specific objectives

Set goals and objectives of the in-service program. The core objective of an in-service education
program is to provide knowledge in order to influence how people perform, perceive, or react.

c. Select resource person

When selecting the individual as resource person, the attributes that should be kept in mind are:
i. Ability to serve as model for learners.
ii. Knowledge about concepts of adult learning.
iii. Expertise experience and clinical competence in the area to be covered.
iv. Should know how to communicate knowledge.
v. Willingness to assist in evaluation process.

d. Resource
Assessing available resources for establishing the program. People and financial resources are of
particular significance.

e. Location, time, and duration

Location, time and duration of in-service program should be fixed in this planning phase.
f. Budget
Establish a workable budget appropriate for the program.

g. Evaluation
Assessing the results at stated intervals, that is soon after the program or within one week.

h. Reassessing
Checking the goals and updating the plan periodically.

c) IMPLEMENTING OF IN-SERVICE EDUCATION

The in-service program is then actually started, presented and implemented, which involve scheduling
training events and organizing any necessary resources (facility, equipment etc.). Participant’s
progress should be assessed during training to ensure that the program is productive. Trainees are
continually checked during the training program to evaluate if it is effective and able to maintain the
employee’s interest. Participants must complete a pre-test before beginning the program and a post-
test at the end.
d) EVALUATION OF IN-SERVICE EDUCATION
W.B. Werthis and K. Devis in “Personnel management and Human Resources” suggested five steps
of evaluation of staff development program (in-service education program).
a) Evaluation criteria should be established.
b) Participant should be given a pretest.
c) After training post-test should be given.
d) Transfer of the learning to the job setting performance area.
 e) Follow up studies should be undertaken to see how well learning was established.

14.5 Problem Solving

Problem Solving is the act of defining problems, determining the cause of the problem, identifying,
prioritizing and selecting alternatives for a solution and also implementing the solution.
The goal of a good problem-solving process is to make us and our organization more “conflict-
friendly” (kindly and pleasantly) and “conflict-competent” (cognitive skills). Problems and conflict
happens all the time and they are opportunities to improve the system and the relationships.

Need of Problem solving

 To resolve the conflict
Personal and business environments are full of things, activities, interactions and processes that are
not operating in the way they are desired to work. Problem-solving gives us a mechanism for
identifying these things, figuring out why there are conflicts and determining a course of action to fix
them.

 To address risk
Humans have learned to identify trends and developed an awareness of cause-and-effect relationships
in their environment. These skills not only enable us to fix things when they break but also anticipate
what may happen in the future (based on past-experience and current events). Problem-solving can be
applied to the anticipated future events and used to enable action in the present to influence the
likelihood of the event occurring and/or alter the impact if the event does occur.

 To improve performance
Problem-solving helps us understand relationships and implement the changes and improvements
needed to compete and survive in a continually changing environment.

 To Seize opportunities
Problem solving isn’t just about responding to (and fixing) the environment that exists today. It is also
about innovating, creating new things and changing the environment to be more desirable. Problem-
solving enables us to identify and exploit opportunities in the environment and exert (some level of)
control over the future.

Problem solving process

In order to effectively manage and run a successful organization, manager must guide their employees
and develop problem solving techniques. Finding a suitable solution for issues can be accomplished
by the following the basic four steps of problem solving process.

1. Define the Problem

2. Generate alternative solution
3. Evaluate and select an alternative
4. Implement and follow up on the solution

1.Define the Problem

Diagnose the situation and the problem, not just the symptoms, identify the expected steps of a process
and analyze the root cause. List out the identifies key steps for defining problems. These steps support
the involvement of interested parties, the use of factual information, comparison of expectations to
reality and a focus on root cause of a problem. Differentiate the facts from the opinion, specify
underlying cause of the problem and state the problem specifically.

2.Generate alternative solution

Many alternative solutions should be generated and proposed, postpone the selection of one solution
until several alternative have been proposed. A common mistake in problem solving is that alternatives
are evaluated as they are proposed, so the first acceptable solution is chosen, even if it’s not the best
fit. If we focus on trying to get the result we want, we miss the potential for learning something new
that will allow for real improvement. Brainstorming and team problem-solving technique are both
useful tools in this stage of problem solving.

3. Evaluate and select an alternative

Skilled problem solvers use a series of considerations when selecting the best alternative. Postpone
evaluating alternative initially, include all the involved individuals in the generation of the alternative
and specify alternative consistent with the organizational goal. Evaluate alternative relative to a target
standard also evaluate all the alternative without the biasness. Both proven and possible outcomes
should be evaluated and select the alternative solution.

4.Implement and follow up on the solution

Plan and implement a pilot test of the chosen alternative solution. Every individual in the organization
should be involved for the implementation of the alternative solution. The most effective approach by
far, has been to involve others in the implementation as a way of minimizing resistance to subsequent
change. Feedback channel must be built into the implementation of the solution, to produce continuous
monitoring and testing of actual event against expectation. Problem solving can only be effective in
an organization if the solution remains in the place and is update to respond to future changes.

Roles of a Nurse Manager in Problem Solving

1. Good listener

Active listeners are generally great problem solvers. They can listen to those around them to gather
the information needed to solve the problem at hand. They recognize the importance of valuing
others’ opinions and experiences to help understand why the problem occurred and the best course of
action to remedy it.

2. Analytical thinker

Analytical thinkers can identify the logical reasons why a problem occurred, what the long-term effects
of the issue could be, and identify how effective different solutions might be to select the most practical
one. Creative thinkers can balance their analytical skills with creative solutions.

3. Communicator

Problem solvers should also possess great communication skills. The ability to effectively relay
complex information thoroughly yet succinctly is a huge benefit for employers working in fast-paced
environments. Communicating efficiently with all the sub-ordinates helps in solving the problems.

4. Decision-maker

Those with problem-solving skills will also possess the ability to make decisions and be confident in
them. This is important, as most problem-solving steps involve making firm decisions to provide a
successful outcome.

5.Teamwork

Although problem-solvers need to be independent thinkers, it’s also vital for them to work well as part
of a team. Determining the best solution often requires collaboration, so it’s important that candidates
can demonstrate how they can motivate others to come up with the best solutions and work with them
to help develop and implement solutions,

14.3 Recruitment/De-recruitment Process

 Recruitment
 Definition

Recruitment is the process of finding and attracting capable applicants for employment. The process begins
when new recruits are sought and ends when their applicants are submitted.
 -William B Werther and K. Devis

Recruitment is defined as the process of searching for prospective employees and stimulating them to apply for
jobs in the organization.

-Edwin Flippo

 Recruitment Process
– Identify Vacancy
o It begins with the human resource department receiving requisitions for recruitment from
different departments in the organization. It provides opportunities for departments to align
staff skill sets to initiatives and goals for department and individual growth. It includes
post to be filled, number of vacancies, duties to be performed and qualification with
experience. Proper planning and evaluation of the need will lead to hiring the right person
for the role and team.
– Preparing Job and Personnel Specification
o Job specification is helpful to think of job under board heading: main characteristics of the
training, background of the job, main responsibilities and job boundaries, experience of job
holder, resources and constraints affecting the job. It has to be decided what types of
candidates are to be invited and what would be their characteristics.
o Personnel specification can be divide into personal recruitment e.g. work experience and
qualification seen as essential, desirable and personal qualities.
– Advertising Vacancies
o This is the method by which the candidates will be located it is either through internal or
external resources and also decides the method of advertising for the post.
– Managing Response and Short Listing
o This step is adopted to receive the applications and scrutinize each application as per the
recruitment policy by the scrutiny committee. After the scrutiny, the eligible candidates are
shortlisted and a list is prepared.
– Arrange the Interview with Short Listed Employee
o Interview dates are finalized. Criteria for merit list are prepared by the committee and
candidates are informed. The selection committee is formulated.
– Conducting the Interview and Decision Making
 o Interview is conducted by the selection committee, then candidates are selected. The best
candidates for the position are chosen based on the qualifications and requirements. Then
the candidates are selected.
 Selection Process
It is the process of differentiations between applicants in order to identify (and hire) those with
the greater likelihood of success. The following steps of selection process:
o Preliminary Interview
The purpose of this interview is to scrutinize the applicants, i.e. to elimination of unqualified
applicants. Interviewing is the main method of appraising an applicant’s suitability for the post.
The main objectives of interview are:
i) For employer to obtain all information about the candidate to decide about the suitability for the
post.
ii) To give candidate complete picture of the job as well as the organization.
iii) To demonstrate fairness to all candidates.
o Pre- employment Test
Different types of selection test may be administered depending on the job and the company.
Generally, tests are used to determine the applicant’s ability, aptitude, and personality. These
tests include:
a) Test in general ability
b) Test in specific ability
c) Test in achievement
d) Personality test
e) Intelligence test
f) Aptitude test

After conducting tests and interview, the head of department conducts an interview to facilitate in
decision making. In making a selection decision, the manager pays close attention to candidate’s
present abilities, interest, satisfies organizational goals and long range career plans.

o Reference and Background Checks

Many employers request names, address, telephone number or references for the purpose to verify
information and gaining additional background information of an applicant.

o Selection Decision
Selection decision is the most crucial of all the steps in selection process. The final decision has to be
made from the pool of individual who pass the tests, interviews and reference checks.

o Medical Examination

The pre- employment medical examination of a candidate is an important step in the selection process.
In the suggested selection procedure, medical test is located near the end, this sequence is not rigid, an
organization may place relatively early in the process so as to avoid time and expenditure to be incurred
on the selection of medically unfit person. Some organization may advice the candidates to get
themselves examined.

o Job Offer

The next step in the selection process is job offer. Job offer is made through a letter of appointment.
Such letter generally contains a date by which the appointee must report on duty.

o Contract of employment

Basic information is written in the contract of employment that varies according to the levels of job.
After the offer and acceptance of the job certain documents is required for attestation form.

o Evaluation of Selection Program

The board test of effectiveness of the selection process is a systemic evaluation. A periodic audit is
conducted in the HR department that outlines and highlights the areas which need to be evaluated in
the selection process.

 Sources of Recruitment
Sources of recruitment can be grouped into two categories:
- Internal Sources
Internal recruitment is done within the organization. It includes:
a) Transfers
It involves shifting from one department to another or from one hospital to other, or from
one shift to other. It does not allow any drastic change in responsibilities, pay and status of
employee.
b) Promotion
It leads to shifting of nurse employee to a higher position carrying higher responsibilities,
facilities, status and pay.
- External Sources
 These sources lie outside the organization. The methods include:
a) Advertisement (e.g. Newspaper, journal)
b) Employment agencies (public or private agencies)
c) Deputation
The employee of one organization are selected or taken on deputation from other
organization for filling the vacancies. Such employee are given choice either to return
to their original organization after a certain time or to opt for the present organization.
d) Online recruitment
The recruiter reviews the CV and decides whether to go ahead or not. The candidate
chooses time and place for interview. The system tells the recruiter details of the
interview. The candidate gets reminder and can change time and place, if necessary.
The candidate is interviewed and if successful, clicks into offer zone, he or she will also
be introduced to a mentor who will help with introducing the organization.
e) Telecasting (e.g. TV Channels)
 De-recruitment/Turnover
The rate at which employees leave a company and are replaced is called turnover. Employee
turnover refers to the total number of workers who leave a company over a certain time period.
It includes those who exit voluntarily as well as employees who are fired, that is, involuntary
turnover.
 Definition
The term “turnover” is defined the ratio of the number of organizational members who have
left during the period being considered divided by the average number of people in that
organization during the period.
-Price (1977)

 Determinants of De-recruitment

The following are the main causes or determinants of de-recruitment:

i. Job Satisfaction
Low job satisfaction is the cause among newly qualified and highly educated nurses and
associated with the administrative promotional prospect and employment security.
ii. Professional and Organizational Commitment
 The nurses who are less committed to their profession and organization are more likely to leave
that those who are committed to both their career and their organization.
iii. Personal Disposition
Personal disposition has been found to moderate the relationship between job satisfaction and
voluntary turnover. The employee with positive mindset may take proactive action such as
quitting their jobs than the employee with negative disposition.
iv. Professional Attachment
The nurses who are not much professionally attached quit the job, whereas the nurses who are
attached to nursing, have motive to remain in their job.
v. Workload, Stress and Burnout
Organizational factors like workload: management style, empowerment and autonomy,
promotional opportunities, work schedule etc have influence on de-recruitment.
vi. Management Style
The leadership styles that value the staff contribution or that of participatory or democratic
style exhibited by superior promote retention of their subordinates. A decentralized
organizational structure, commitment to flexible working hours, autonomy, and high level of
communication accounts low de-recruitment.
vii. Empowerment and Autonomy
The empowerment and autonomy is associated with job satisfaction, thereby there is a strong
relationship with retention.
viii. Promotional Avenues
It has been well documented that dissatisfaction with promotion and training opportunities have
a stronger impact on de-recruitment.
ix. Work Schedule
Highly qualified nurses are more likely to quit in order to seek career advancement, especially
if they have limited opportunities in their current organization.
x. Economic Factors
Remuneration though considered as one of the predictor of job satisfaction, but found to having
little impact on de-recruitment.
 Impact of De-recruitment

High staff de-recruitment can impact negatively or positively on an organization to meet its
organizational objectives and needs. The effects are the driving forces that compel nurse manager
to look at the issue in depth.
1. Negative Impact
a) Direct and Indirect Costs
The cost of staff turnover can be measured in terms of increased recruitment, selection and
placement and termination cost etc.
b) Cost of Lost Performance
It takes time for a new staff to get up to speed on the job, cost associated with training, cost
associated with the period prior to voluntary termination when workers tend to be less
productive.
c) Disruption in Psycho-social Environment
When an employee leaves, other employee who were sociable with the leaver may feel
distressed.
d) Decline in Morale
If an employee leaves, the morale of the remaining employee may be shaken. As
highlighted before, communication patterns will be disrupted and social contact will be
hindered.
e) Damage the Reputation of the Organization
A large number of voluntary and involuntary terminations might damage the reputation of
the organization which is important for the organization to survive and increase public
relations costs.
f) Health and Safety of Nurses
It has adverse effect on the health of nurses due to inadequate nurse staffing and decline of
morale among them.
g) Quality of Patient Care
Quality of patient care is reduced due to frequent de-recruitment and hours of patient care
decreases and deteriorate the practice environment.
2. Positive Impact
a) It creates opportunities to produce a wider experience with new ideas employee to the
organization.
b) Bring new skills and enthusiasm to the existing workforce.
c) Provides career development opportunities for staff.
d) Staff de-recruitment offers an opportunity for cost reduction with decreases salaries,
benefit costs and vacation pay for new employee.
e) Productivity could increase by providing better person for job position.
 Role of nurse manager to reduce staff de-recruitment
The nurse manager can play an important role in reducing the de-recruitment by adopting the
following ways and means:
1) Identify the specific cause of personal de-recruitment.
2) Reduce stress among nurses.
3) Improve each step of staffing process and make necessary changes in job description,
in recruitment, selection method, placement, and induction and orientation of staff.
4) Flexibility in scheduling practices, method of assignment, supervisory techniques and
in evaluation method.
5) Review institutional policies.
6) Promote good working environment that should be supportive, flexible, encouraging
and rewarding.
7) Institute participative management and decentralization of clinical decision making.
8) Describe nursing position more accurately to applicants.
9) Responding promptly and effectively to nurses complaints.
10) Team building and group development activities can be encouraged.
 Nursing Human Resource Planning
 Definition
“A health manpower plan is meant to ensure that the right number and quality of manpower
are available to staff the health facilities as the needs expand, so as to keep the current and
future demands of the services from people.”
-Dev Ray
- Planning human resource in nursing is important for the following reasons:
i. Human resources becomes a critical component as health institution are highly labor
incentive organization.
ii. Human resources in health are highly skilled group of people that cannot be easily
replaced.
iii. The efficient utilization of other resources in health and the effective delivery of health
services depends upon how capable is the human resource in health.
iv. Determining the human resource requirement for the organization.
v. Making adjustments in the estimates of human resource requirements for various
factors like expansion/contraction plans of the organization.
  The main objective of the planning of human resources in nursing is to provide rationale for
manpower mixes and utilization pattern in such a way that it makes possible to avail the right
number of people at the right ratio, at the right time with the motivation that is required to
provide the best care.

 Nursing Personnel Management

 Definition
Human resource management is “that part of management which is concerned with people at
work and with their relationship within an enterprise. It aims to bring together and develop into
an effective organization of the men and women who make up enterprise and having regard for
the wellbeing of the individuals and of working groups, to enable them to make their best
contribution to its success.”
National Institute of Personal Management (NIPM), India
Human resources management should be done in such a way that they can attain maximum
efficiency for themselves, their team and organization. It has three obligations:
a. It must satisfy the employee by ensuring the security of job, income, prestige and
opportunity to rise.
b. It must satisfy the community and society at large, by supplying them goods and services as
efficiently as possible.
c. It must satisfy the owners by maximizing the economic efficiency.