NURSING ADMINISTRATION

 A REPORT ON NURSING MANAGEMENT

1.0 INTRODUCTION

Management is seen as a process that directs and guides the operations of an organisation in order to realize the established goals. In health care, management is a process of both interpersonal and technical aspects through which the objectives of the health services are organized and accomplished by utilising human, material and technology.

The discussion in this report will be based on the objectives of practical sessions, which are follows:

1. Identify organisation characteristics of the unit and department.

2. Assess how the characteristics of the management of care and staff performance.

3. Identify and critique management theory being applied in the department.

4. Assess the types of planning and rationale taking place in the department.

5. Analyse the decision making process and identify the impact of the day-to-day running of the unit.

6. Analyse how delegation and management of change are applied.

7. Identify leadership styles and assess how they impact patient care outcomes.

 

Some key terms will also be defined and some recommendations will be made to the ward manager.

1.1 Definitions of terms

Management: “Management is a process of planning, organising, leading and controlling the work of the organisation in order to accomplish set goals”. (Basavanthappa, 2003) 

Theory: A theory can be defined as a supposition or a system of ideas that is proposed to explain a given phenomenon. (Oxford English Dictionary)

Decision-making: “This is a process of identifying and selecting the course of action to solve a specific problem”. (Stoner, 2004)

Delegation: “Delegation is a process by which an individual manager or supervisor transfers part of his legitimate authority to a subordinate but without passing on the ultimate responsibility which has been entrusted to him by his own supervisor”. (Cole, 2003:154)

Leadership

“This is a process of directing and inspiring workers to perform the task related activities of the group”. (Stoner, 1989)

Ward Policy

1. To render best/acceptable-nursing care at all times.

2. Prioritise activities needed to be done at any given time.

3. To attend to emergencies promptly.

4. To execute self-discipline at all times.

5. To have respect for each other, clients and their relatives, or anybody you come in contact with while on duty.

6. Patient’s diagnosis and any other information must be kept confidential.

7. Observe silence all the time when on duty.

8. Noone, is allowed to stay away from duty without permission, it is an offence.

9. In the absence of the ward sister, the senior Registered Nurse or Enrolled Nurse on duty at that particular shift acts as incharege.

10. Be security conscious and report any incidents while on duty.

11. All elderly patients, semiconscious, disoriented, and confused and all patients going for operation must have identification bands bearing the name, ward and sex.

12. To be accountable for every thing while on duty.

13. All mothers with breastfeeding children must be allowed to be on the bedside.

14. Wear smart, correct uniform all the time and don’t forget a smile.

Ward Profile

G22 is a female surgical ward found on the first floor. The ward currently has a bed capacity of 40. The ward has 2 side wards, which are mainly for patients with burns. The ward also admits children below the age of 14 years who have surgical conditions.

Admission Procedure

Patients are admitted to G222 as trans-in from female surgical admission according to the firm on call.

Staffing

Nursing Sister…………………………………………………………………………….1

Registered Nurses………………………………………………………………………...3

Enrolled Nurses…………………………………………………………………………..4

Ward Attendants…………………………………………………………………………2

Casual Daily Employees………………………………………………………………….5

Porters…………………………………………………………………………………….1

The staffing levels for nurses are so low, that the ward only depends on part-time staff in order to keep the work progress. The situation, which has compromised the nursing care being given to clients. The normal nurse-patient ratio is at least 1:3 but the current ratio is at a minimum of 1:40.

2.0 ORGANISATIONAL CHARACTERISTICS OF WARD G22

In a broader sense, organisation may be defined as a consciously coordinated institution or functional group in which work is so arranged and allocated among its members that its goals can be efficiently achieved. In other wards, an organisation is an entity where people join together in a common endeavour and where the relationship between persons, work and resources are integrated. Organisations enable the objectives to be achieved, which could not be realised through individual efforts. Organisations exist in order to serve society and also to provide careers to the citizens. Ward G222 exists to serve the Zambian people. The purpose of the ward is to provide cost effective quality care to all surgical patients.

The ward has the following characteristics that make it to be organisation:

· Wholeness

· Sense of individuality

· Has an organisational hierarchy

· Has an open system

· Has a pattern of change and growth

(a) Wholeness

The health workers in the department work in unity despite being of different categories and ranks. They work together for the purpose of providing quality care to the clients.

(b) Sense of individuality

The ward operates within its boundaries. The health workers’ daily operations are not highly dependent on others. The ward has its own policies and guidelines that govern the operations of the ward. Although the ward has a sense of individuality it collaborates with other wards/departments

(c) Hierarchy

The ward has an organisational hierarchy for the purpose of enhancing a chain of command. The hierarchy is essential in the span management control of staff. The chain of command for G222 is followed with the ward sister being on the top most, then the Registered Nurses, Enrolled Nurses in that order.

(d) Open system

The ward is open to the public. All clients are free to inquire anything related to patient care, through the ward manager or any staff on duty at a particular time.

(e) Pattern of change and growth

According to the ward manager, nothing much has changed in the ward a couple of years except for the increase in staff shortage and equipment.

Ward G222 is divided into blue and yellow and plastic firms for the purpose of specialised patient management.

3.0       HOW THE CHARACTERISTICS AFFECT THE MANAGEMENT OF

CARE AND STAFF PERFORMANCE

Like any other ward in the hospital, the critical shortage of staff affects the quality of care to the clients. Usually, only 1 or 2 nurses are on duty, against 40 patients. Nursing care is often compromised with this kind of staff-patient ratio. Nursing care is normally based on routines, as opposed to identification of client’s individual problems, which provides a basis for holistic care to clients.

 

Shortage of equipment and drugs is another characteristic that affect client care and staff performance, for instance, during the experience, the department was facing shortage of gloves, which lead to most procedures like dressings undone since staff cannot touch patient’s body fluids without gloves. Infection prevention, in other wards was limited by the non-availability of gloves. When there are no materials, nurses tend to do shortcuts in their procedures and this compromises quality of care.

Shortage of drugs also makes patients lose confidence in the institution because they have to buy most of the drugs prescribed. With the poverty situation in the country, most patients fail to buy their own drugs, hence many are frustrated and sometimes request for premature discharge from hospital.

 

4.0 APPLICATION OF MANAGEMENT THEORY IN THE WARD

Theorists who have contributed to the understanding of management have included practical managers as well as social scientists. The contribution of practical managers has been to reflect on, and theorise about their own experiences in a wide variety of situations.

During the experience, I observed that the ward manager for G222 applies the x and y theory of management and the bureaucratic management theory.

According to McGregor, the x-theory is the traditional view of motivation that holds that work is distasteful to employees who must be motivated by force, money or praise. The y-theory is an assumption that people are inherently motivated to work and do a good job (Stoner, 2004).  In the x-theory, workers are viewed as lazy and irresponsible requiring constant supervision to achieve organisational goals. In theory y, workers want to work, have self-direction and control. These theories enhance the following in an organisation:

 

· Increased employees’ effectiveness through understanding individual, group and organisational process.

· Strengthens relationship among employees, managers and the work they perform.

 

Some nurses were motivated to work despite the shortage. They carried out duties on their own even when the ward manager did not allocate them certain tasks to do. For some, as in the x-theory, depended on task allocation and supervision from the in-charge in order to work.

On the other hand, bureaucratic type of management is also used. According to

Max Weber, bureaucracies are as follows:

 

· A continuous organisation of functions bound by rules

· The hierarchical arrangement of jobs

· Appointment of offices/jobs are made on grounds of technical competence

· Rules, decisions and actions are formulated and recorded in writing.

 

G222 has some rules and guidelines that govern the ward and the operations of the ward are based on set guidelines. For example, the procedure for preparing patients for operation are stated and that is what everyone in the ward is following.

The above scenario shows that no single theory is used on its on for effective management because each theory has merits and demerits. Actually, the ward manager could not recognise one constant theory to manage the ward.

 

5.0 TYPE OF PLANNING TAKING PLACE IN THE WARD

Planning is one of the fundamental elements of management. In planning, decisions are made on what needs to be done, how and when it has to be done, by whom and with what resources (Basavanthappa, 2003). Nurse managers need to plan to avoid confusion, error and wastage of resources. The planning process involves formulation of goals and objectives and designing alternative courses of action or plans for the purpose of achieving these goals and objectives. Planning also involves evaluating the effectiveness of these plans.

There are several types of planning that organisations can use, some of which are:

  

· Health care planning, this is a survey approach to determining the health needs of the population.

· Strategic planning, this includes determining, evaluating and adapting the aims or mission of an organisation and the patterns of decision that guide the achievement of those aims in the long term. Strategic management is usually done at top management level.

· Operational planning, involves providing details as to how strategic plans will be accomplished and it consists of single use plans. This is the planning that takes place at the lower level (Stoner, 1989:205).

The type of planning that takes place in ward G222 is operational planning, which involves making decisions short-term goals and decisions. Some of the plans done by the ward manager include manpower planning for the ward by use of weekly time tables, inventory, budgeting for the ward in collaboration with other members of staff and submit the budget to management through the Nursing Officer. Planning for day –day nursing care is done with the staff, although the latter is very difficult due tom shortage of staff.

According to Stoner (1989:206), effective management must have a strategy and must operate on the day- day level. In other ways, strategic planning and operational planning overlap.

 

6.0 DECISION MAKING PROCESS

Decision-making is an accepted part of everyday human life. We make decisions on the spur of moment or after much thought and deliberation or at some point between these two extremes. (Cole, 1993:123). Usually, our decisions may be influenced by emotions, by reasoning or by a combination of both. Different problems require different approaches to solve them.

Decision making in ward G222 is based on ‘operations’. The ward manager makes decisions on which staff to put on duty on certain days, those who need to go on leave, items which need to be bought for the ward and also on the nursing care given to clients. Most of the decisions are made in consultation with the Nursing Officer; those decisions that relate to patient care are also made in collaboration with the ward doctors accordingly. However, according to the ward manager, the most challenging decision to make is on discipline. It is difficult to decide on what discipline and how to punish a nurse who may be found in error. Instead, she consults the Nursing Officer in such situations.

 

7.0 APPLICATION OF DELEGATION AND MANAGEMENT OF CHANGE

Delegation is essentially a power-sharing process in which individual managers transfer part of their legitimate authority to subordinates but without passing on their own responsibility for the completion of the overall task which has been instructed in them by supervisors (Cole, 2003:154).

The ward manager for G222 uses delegation in the ward in various areas, for instance, she delegates her immediate subordinate to run the ward in her absence. She also allocates tasks to nurses based on the identified need. Sometimes she delegates a nurse to order drugs from pharmacy or to prepare for doctors round and so on.

Change is a natural process. Change can originate inside and outside the organisation. Change can be inevitable, persuasive and unpredictable. The ward manager normally communicates to subordinates on any new developments in the hospital through meetings or during handover. The staff either receives the change readily or resist. For example when the manager moved to G222 from G122, some nurses expressed some negative attitude towards the manager, while others welcomed her.

 

8.0 LEADERSHIP STYLES AND THEIR IMPACT ON PATIENT CARE

A leader is one who is able to influence the actions of others. Nurse managers are leaders because they influence others to have work done. There are many styles of leadership, but managers usually use more than one style, depending on the situation at hand. Some of the leadership styles are:

· Autocratic

· Democratic

· Laissez faire

· Charismatic

· Principle centred

 

Autocratic leadership

In this style, the leader takes all decisions and assigns all responsibility to him; the leader is firm, insistent, self assured and dominating. (Basavanthappa, 2003:116). Such a leader stresses prompt, orderly and predictable performance from subordinates.

 

Democratic leadership

In democratic style of leadership, the leader values the individual characteristics and abilities of each subordinate. Here, the leader is a catalyst for group decision-making and shared responsibility. (Basavanthappa, 2003:116)

This style is people centred approach and allows greater individual participation in decision-making process.

 

Laissez Faire leadership

This is also referred to ‘freedom style or permissive leadership’. The leader assigns responsibility to the group in terms of decision making which abdicating the leadership position.

 

Charismatic leadership

A charismatic leader is one who influences others, like the former President of Zambia, Dr. Chiluba.

 

Principle Centred leadership

This is a leader whose approaches are influenced by moral and ethical principles involving considerations of equity, justice, integrity, honest, fairness and trust. (Cole, 2004:53).

Principle Centred leadership is common in nursing. Often times the ward manager in G222 used this style of leadership. But like it is with theories of management even leadership styles are used in combination depending on the situation. At certain times the manager used democratic style and at other times when she sees that the staff have gone out of the way, she applies autocratic leadership style. The latter however, brings more problems because nurses will simply leave everything to the in-charge and patients end up not receiving quality care.

 

 

CONCLUSION

The experience on Management Principles was a learning experience, though very short. It was rather a bit difficult for the in-charge to open up and accept me because I was viewed as a supervisor and not a student. I was able to appreciate the fact that management is an on going process, hence the need for managers to keep abreast with the changing world through reading and retraining.

 

RECOMMENDATIONS

1. Ward manager should consider having a book for writing minutes for the ward

     meetings. Meetings were held, but not documented anywhere, as a result follow   

     up was difficult. 

2.  To try by all means to use the nursing process in the care of very ill patients, so that

     holistic care is given.

3.  There is need to improve on documentation on patient care, i.e. report writing and any

     other interventions done in a span of duty.

 

REFERENCES

 

1. Basavanthappa, B.T.(2003),Nursing Administration,Jaypee Brothers Publishing Company, New Delhi.

2. Cole, G.A.(1993), Management Theory and Practice,4^th Edition,DP Publication Ltd, London.

3. Stoner, F.A. and Freeman, R (1989), Management, 4^th Edition, Prentice-hall, London.