Unit -2

Management process

Nurses are familiar with the application of nursing process such as assessing,
diagnosing, planning, implementing and evaluating pt. care in the management of their
patients/clients in any setting. Similarly, nurse leaders must also be aware of various steps
involved in the management process
In 1937 Luther Gullick introduced two more activities to the management process in
addition to planning, organizing, staffing, directing and coordinating. These were reporting and
budgeting leading to the term POSDCORB.
PLANNING
Planning is preparing a blue print.
Planning is the preliminary and most imp. Step in the management process.
Def: Planning is a thinking process, the organized foresight, the vision based on facts and
experience that is required for intelligent action. Alfred & Beatty.
Mission of planning
The mission of the organization is to provide benefits to its customers. Mission always implies
concern with this in mind, planning:
1) Leads to success in achieving goals.
2) Provides meaning to effective use of available resources such as personnel and facilities
in the organization.
3) Helps to cope with situational crises.
4) Ensures effective control leading to cost effectiveness and
5) Help to discover the need for change.
Philosophy of planning
- The planning process sets guidelines and constraints for the behavior of the firm.
- Planning requires flexibility, energy and specificity. It should be simple, realistic a guide
for action in reaching the goal.
- Planning is essential: a manager must be able to overcome barriers that impede
planning.
- Planning must be done by hierarchical order and must be congruent in its flow.
Objectives/goals
Objectives are end towards which the activity is aimed.
Operational plan (steps in planning)
- Being aware of opportunities
- Establishing objectives
- Developing premises
- Determining alternative courses
- Evaluating alternative courses
- Selecting a course
- Formulating derivative plans
- Numbering plans by budgeting
STAFFING
DEF: Staffing may be defined as the process of planning, employing, and developing human
resources at different levels of an organization for carrying out the various managerial and other
functions required.
Philosophy of staffing
The nurse administrator believes that:
1. The knowledge and skill of the staff can adequately fulfill the needs of the pt. an there by
ensure both job satisfaction and quality care.
2. Only professionally trained nurses can provide a high quality of pt. care and handle
critically ill patients by providing both technical and intrapersonal skills
3. A professional nurse can not only treat chronically ill patients, but also provide health
education and rehabilitative care, which is more complex.
4. By determining pt. needs and doing assignments job quantification and analysis can be
done.
5. All sorts of nursing related plans, e.g., master rotation plan, duty roster, etc, should be
done only by nursing heads.
6. A staffing plan should be delegated to each unit level head nurse so that the activities of
each ward and details of each shift are planned well.
Staffing study
A staffing study should accumulate information regarding environmental elements both
within and outside the organization that might affect staffing necessities.
Aydelotte has made a list of four techniques as given in the below the table from
engineering which he opines can be utilized to evaluate the work of nurses. All of these
techniques involve the concept of time needed for a performance.



Techniques used to measure the nurses work (Aydelotte)
S.No techniques Description
1 Time study & task frequency - Average time
- Sample size
- Standard time frequency of task =
volume of nursing work
- Standard time = step1.5+ step 1.6
- Tasks and tasks elements ( procedure)
- Point & time started
- Point & time ended
- Allowance for personnel variation,
unavoidable standby and fatigue.

2 Work sampling (variation of
time which the procedure
follows and task frequency)
- Recognize both major and minor classes
of nursing activities
- Find out the no. of observations to do
- Determine random sample of nursing
personnel who are executing the policies.
- Study the observations

3 Self reporting(variation of time
and task frequency)
- Observer keeps an eye on one individual
in the execution of a task
- Observer my check the work carried out
for one or more patients if they can be
observed at the same time
4 Uninterrupted sampling
(variation of time and task
frequency). Technique is
similar as for work sampling.
- The person records continuous sampling
or the work sampling on himself or herself
- The task is documented using task start
and end data and the intervals or time
- Logs are examined

Norms & activities
Most hospitals today follow the staff inspection unit norms. In this activity the nursing
sister and staff nurses are clubbed together and the work of the ward sister remains the same
as staff nurses even after promotion.
Recommendations of the staff inspection unit
- Norms have taken into the account the work load projected in the wards and other areas
of the hospital.
- The post of nursing sisters and staff nurses have been clubbed together for calculating
the duties as nursing sisters. A staff nurse will continue to perform the same duties even
after she is promoted to the level of nursing sister.
- According to delhi nurses union the existing ratio of 1 nursing sister to 36 staff nurses
fixed by the govt.
- 1 ANS to every 4-5 nursing sisters.
- 1 DNS to every 7-5 ANS.
- There will be a post of Nursing Supdt for every Hospital having 250 or more beds.
- There will be a post of CNO for every hospital having 500 or more beds.

Nurse-Patient ratio as per the norms of TNAI & INC(norms are based on hospital beds)
1. CNO: 1 for 500 beds
2. NS: 1 for 400 beds or above
3. DNS: 1 for 300 beds and 1 additional for every 200 beds.
4. ANS: 1 for 100-150 beds or 3-4 wards.
5. Ward Sister: 1 for 25-30 beds or 1 ward, 30% .
6. Staff Nurse: 1 for 3 beds in teaching hospital, in general wards and 1 for 5 beds in non
teaching hospital + 30% leave reserve.
7. Extra nursing staff to be provided for departmental research functions.
8. OPD and emergency 1 staff nurse for 100 patients+ 30% leave reserve
9. ICU: 1:1 or 1:3 for each shift + 30% leave reserve
10. It is suggested that for 250 bed hospitals there should be 1 infection control nurse (ICN).
Scheduling/Duty Roster
In nursing management of any unit, time planning for the workers is a prerequisite for
successful nsg operations because the scheduling of work and non working hours directly affect
the employees productivity, work satisfaction & job tenure.
scheduling is therefore defined as a pattern of on-off duty hours for employees in a
particular unit.
Purposes of scheduling
- To ensure adequate pt.care while overstaffing is avoided.
- To achieve desired distribution of days off
- To ensure fair treatment of all nursing staff
- To let individuals know in advance what their schedules are
- To achieve good unit management
- To determine when help is required from the relief nurse
Patient classification system (PCS)
The PCS groups pts as per the complexity and amount of their nursing care necessities. The
intention of PCS is to evaluate pts, group them with other pts having similar needs of pts in
different groups.
PCS is a way of determining the amount and type of care a pt. requires as well as
providing a means of standardizing nsg care practice.