SUMMER 2012

SECTION A

LONG ANSWERS:

I A) Describe the concept of nursing management.

 Management is an exercise in harmonizing men, money, machinery, materials and methods

towards fulfilling of set objectives leading to human development, excellent performance,
social benefit and global welfare.
 CONCEPTS OF MANAGEMENT :
Management can be viewed with different concepts.
Traditional concept- Management is viewed as an art of getting the things done. Mary Parker
Follett defines ‘ management is the art of getting things done through people’ and according
to George ‘management consists of getting things done through others. A manager is one
who accomplishes organizational objectives by directing the efforts of others.
Modern Concept- Managing not only limited to directing the efforts of others to accomplish
the goals of organization but also involves creating an environment or climate in the
organization whereby the individuals are motivated to work efficiently to achieve specific
objective.

B) Enlist the principles of nursing management

Management principles in nursing are statements of fundamental truth related to nursing field.
These principles serve as guidelines for decision and actions of nurse managers working at any level in
different settings. They are derived through observation and analysis of events which nurse managers have
to face in actual practice in clinical, educational institution or in any areas wherever they are working.

 Division of work

The principle implies that every employee should be assigned only one type of work so as to bring about
specialization in every activity. The specialization will help in creating specific personal and professional
development among the nurses and therefore increasing their efficiency. The principle of management is
also called principle of specialization.

 Authority and responsibility

Authority means the right to give order by superior to her subordinates: responsibility means the obligation
for performance. The principal suggests that there must be parity between authority and responsibility. They
co existent and go together and are two sides o f the same coin.

 Discipline

Disicline refers to getting obedience to rules and reghulation of the organization, proper conduct in relation
to others, respect of authority or for superior .It is essential for the smooth functioning of organization.

 Unity of command

Every subordinate must receive orders and instructions and be accountable to one and only to 9ne
superior.This will improve the performance of the employee.If the rmployee receivea orders from more than
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one superior,its likely to have the overlapping of orders amd instruction and create confusion and conflict. It
will be very difficult to maintain discilpine in the organization.

 Unity of direction.

Unity of direction means that one head should give the direction.All the activities of work unit or group
should be directedtowards the same goaland those working in the same line of avtivity mist undetstandqnd
pursue the same objectives.

 Subordination of individual interest to general interest

The management must put aside personal considerations and pit organisational objectives first.The general
interest can be shown by the subordinate through collective bargaining.

 Remuneration

The employee must be just fair to everyone so that each employee ge5s motivated to work.There should be
compensation for services by considering both financial and non financial factors mix.

 Centralization

It means the extend to which authority is centralized or decentralized .It also means that concentration of
authority rests at one place or at one level in the organization.

 Scalar chain of command or hierarchy

Scalar chain is the chain of superiors ranging from top management to the lwest rank.The principle suggests
that there should be clear line of authority from top to bottom.

 Order

Social order ensures that there should be place for everything and evryone.Material order ensures safety and
efficieny in the workplace.

 Equity

Equity means fair and impartial treatment.Employees must be treated with kindness and justice must be
enacted to ensure a just work environment.

 Stability of tenure

The job of employees should not be too short and they should not be rotated from positions frequently.

 Initiative

Subordinate should be given an opportunity to take some intiative in developing and initiating the plans as it
can become a source of strength for organization because it provides newand better ideas by the employees.

 Espirit de corps(union is strength)

This means sense of belonging, team spirit ,the spirit of loyality, devotion and cooperation which unites the
members of the group.

C) Discuss the trends and issues in nursing administration.

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A trend in nursing is a change that is taking place in present days in any filed of nursing, which
affects the profession as a whole.
Emerging trends in nursing are :
1. changing scenario of government towards health care-healthy people 2010.
2. Computers and technology change health care delivery.
3. Informatics and efforts to standardized and unify nursing language.
4. Case management, disease management and telehealth care expand.
5. Diverse responsibilities.
6. Educated consumers.
7. Changing role of women in society.
8. Change in medical, paramedical and allied professions
9. International influence and contribution of international organization.
10. Expanding Nurses role.
11. Nurses must prove value.
12. Nursing education goes online.
13. Evidenced based care and best practices are emphasized.
14. Nursing wellness and healthy working environment is stressed.
15. Wellness centres, holistic and alternative therapies.

ISSUES IN NURSING ADMINISTRATION:

Nursing has its own identity as profession. It is no more a paramedical profession but still some
authorities call nursing as paramedical profession such an attitude towards nursing has done
considerable harm and lowered the image and status of profession. There are many issues occurring
in nursing service. Some of the issues identified by Henry Lorensen and Hirchfield are:
1. lack of nurses prepared to work in nursing administration
2. acute shortage of nurses
3. no relation between nursing service and nursing education
4. lack of authority in administrative structure.
5. Lack of participation by nurse administration to assess the organizational or community needs.
6. Strange relationship between nurses and other auxiliaries
And also with physicians
7. lack of teamwork spirit.
8. Lack of resources, both material and financial.
These are some of the current trends and issues in nursing administration.
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II) a) Define planning and control.

Planning is the function of manager, which involves the selection fron among alternativesfor enterprise as a
whole and each department within it.

-Koontz and O'Donnell.

Control

It is an organized attempt to anticipate and to make rational arrangement for dealing with future problem by
projecting trends.

-Dimock and Dimock

b) Write any three difference between operational and strategic planning.

An operational planning is a schedule of events and responsibilities that details the actions to be taken in
order to accomplish the goals and objectives laid out in the strategic planning.

Strategic planning is an essential element of effective management of organizations. Strategic planning is a

management tool, period.Strategic lanning is based on decision making because in order to answer the
questiond raised in the structured planning process, choices must be made.

Difference

Items Operational plan Strategic plan

Need Accurately forecast hiring and /or Develop the best talent strategies
tra8nning needs for longer term success.

Time and frame Planning usually 12 months wth a Usually 3 years or longer matches
quartely focus matches the yearly the organizational strategic plan.
bussiness plan.

Integrated with Annual or quarterly financial/ Strategic planning process.

bugeting process.

Input Mostlybinternal data, some Wide range of internal and

management decisions external informationincluding
demographics, bussiness
stategics ,global trends ,etc.

Output Staffing plans, skill gaps Human resources / people

strategics

Planning apporaches Uses variables to explore Uses futuring techniques to

different models of staffing question current paradigms and
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 explore alternative futures not
necessarly based on todays
approach.

Segmentation focus Internal demand Internal and ecternal demand

supply

Skills Competencies may ge audited or Staryegic capabilities analyzed

gathered at an indiviual level and gathered at the group level

Focus Operational management -line an: Strategic management -Executive

BU managers and board

Forecasting Key focus Only part of the process-

forecast8ng is too limited in terms
of timeline and scope to be core of
the process

Aligns with Business plan Strategic plan

Terms used Predict , calculated Exlpore, design.

c) Explain planning process in health services.

The process of planning usually comprises the following steps.

1) Identification of stituation

Gathering data: Before carring out the actual 0lanning ,one needs to exploreand gather the relevant and
related informationregarding possible opportunities.

2) Formulation or setting of objectives

Based on the availability of opportunities and resources ,the objectives are framed. Objectives specify the
results expected and indicatethe end point of what is to be done, where the preliminary emphasis is to be
placed and what is t9 be accomplished.

3) Developing premises or onditions (Forecast future)

These are expected environmental or external and internal conditions under which planning activities will be
undertaken.

3) Identificationof alternatives

After determining the various planning assumptions, the next steps is to work onto find out maximum
alternatives based on empirical evidences or experiences or intuitions. Then a shortlisting of alternatives is
done nfor detailed analysis.

4)Evaluation of alternatives

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In this step, an attempt has been made to evaluate the selected alternatives as per the criteria required for
achieving particular objectives .All the merits and demerits of the alternatives are listed.

5) Formulaution of supporting plans

After selecting the best plan,arious derivative plans such as policies, procedures, schedules, mehods,
budgets?etc are put into practices.

6) Defining various activities and preparations of action plans

Various related activities according to plans are developed and defined. T8me plans are prepared by using
various managerial techniques eg.PERT and CPM. These planning cum contrl techniques are important to
minimise the time and cost and for ensuring the comeletion of projects.

7) Communication and plans and securing cooperation

The supportive 0lans should be properly communicated to the lower levels in the organization.The staff
should be made aware of the plans ,its scope and benefits.Participation at this stage helps them to boost their
morale to implement the plans effectively to rhe best of their skills and abilities.

8) Follow upand review

After the plan has been put into practice ,it is essential to follow it up so as to remove difficulties in its
implementation.Thus planning is an continuous process and so as its appraisal or review.

III Write short answers

a) Decision making models

Herbert A. Simon Decision making model

According to Simon ,decision making is a core of administration actions that fills the gap between principles
and practice ab: organization as a structure of decision makers.

There are three phases of decision making ; intelligence activity, design activity ,and choice activity.

Intelligence activity

The first stage involves finding out the conditions requiring action.

 Design actvity

During second stage ,all possible alternatives courses of actions are identified ,developed and analyzed.

 Choice activity

In this phase, the executive select one of the best alternative course of action.Thus each decision consists of
logical combination of facts and value propositions.

He defined rationality as one concerned with the selection of preferred behaviour alternatives in terms of
some system of values whereby the consequences of behaviour can be evaluated.

The elements of rational behaviour model are:

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  A set of behaviour alternatives (alternatives of choice or decision)
 The subset of behaviour altrrnatives that the organism 'considers' or 'perceives'
 The possible future states of affairs or outcome of choice ,
 A 'pay-of' function ,representing the value or utiloty placed by organism upon each of the possible
outcomes of choice.
 Information as to which outcomes in S will actuallly ocvur if a particular alternatives is chosen.
 Information as to the probability that a particular outcomes wilt ensure if a particular behaviour
alternative is chosen.
Vroom and Jagodecision making model
The model was originally created by Vroom and Yetton in 1973 and later modified by Vroom and Jago.
Basically there are five situation for making decision ,from single indiviual making the decision with
varying amounts of input from the rest of the group, to the whole group making the decision.
This model identifies five styles along a continuum raging from autocratic to consultativebto group based.
 Autocratic I- Leader solves the problem along using information.
 AutocraticII- Leader obtains additional information from group members individually and asks for
information and evaluation.Group members do not meet collectively and leader makes decisions
alone.
 Consultative I- Leader shares problem with group members indiviually and asks for information and
evaluation. Group members do not meet collectively and leader makes decision alone.
 Consultative II- Leader shares problem with group members collectively but makes decision alone.
 Group II- Leader meets with group to discuss situation and the focuses and directs discussions.Group
usually makes final decision.

Vroom and Yetton, and later Vroom and Jayo found the following questions helpful in making decision:
1 Quality Requirement (QR)
How important is the technical quality of the decision?
2) Commitment Reqiurement(CR)
How important is the subrdinate commitment to the decision?
3) Leaders Information(LI)
Do you (the leader) have sufficient information to make a high quality decision on your own?
4) Problem Structure (ST)
It is the problem well structured (e.g.defined,clear,organized, lend itself to solution ,time limited, etc)?
5) Commitment Probability(CP)
If you were to make the decision by yourself, is it reasonably certain that your subordinates would be
committed to the decision?
6) Goal Congruence (GC)
Do subordinates share the organizational goals to be attained in solving the problem?
7) Subodrinate Conflict (CO)
Is conflict among subordinates over preferred solution likely?
8) Subordinate Information (SI)
Do subordinate have sufficient information to make a high quality decision.

b) Staff development programme

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Staff develpoment is a process that assists individuals in an agency or organization in attaining new skills
and knowledge, gaining increasing levels of competence, and growing professionally.The processmay
include such programs as orientation, in service education and continuing education.

Need for staff development

• Social change and scientific advancement.

• Advancements in the field of science including medical science and technology.
To provide the opportunity for nurses to acquire and implement the knowledge, skills, attitude, ideals and

valued essential for the maintenance of high quality of nursing care.

Functions :

- To provide educational activities for all nurses employed by the health care agency directed towards
change in behavior related to role expectations.
- It concerned with the growth and development of personnel from their initial concerned with a health
care agency until termination of services.
Steps of staff development program:-

• Assess the educational needs of all staff members

• Set priority
• Develop general objectives for the staff development program
• Determine the resources needed to reach the desired objectives
• Develop a master calendar for an entire year
• Develop and maintain staff development record system
• Establish files on major educational topics
• Regularly evaluate the staff development program

Types of staff development program

1. Induction training
2. Job orientation
2. In-service education
3. Continuing education
1.Induction training :
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 Induction training is a type of training give as an initial preparation upon taking up a post.

Forms of induction:

• Internship
• Preceptorship
• Mentorship

2. Job Orientation

The process of creating awareness with in the individual of his/her roles, responsibilities and new
relationships in new work situation.

3. In-service education :

It is a planned educational experience provided to the job setting and closely identified service in
order to help the person to perform more effectively as a person and as a worker.

4. Continuing education:

It is all learning activities that occurs after an individual has completed his basic education. It consist
of planned learning experiences designed to promote the development of knowledge, skills and
attitude for enhancement of professional practice.

- WHO 1980

 Continuing education is distinguished from academic pursuits.

 Continuing education is different from in service education.
 Continuing education differs from continuing learning.
 Outcomes of continuing education.

c) Organization structure

Organization structure refers to the formal establishment pattern of relationship amongst the various
parts of any organization. It also refers to the way divisions, departments, functions and people link
together and interact
Basic parts of an organization are.
 Strategic apex

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  Middle line
 Operating core
 Techno structure
 Supporting staff.

Design of organization structure-It is a basic framework within which managers decision making behavior
takes place. Structure basically deals with relationships. In management both the formal and informal
organization operate together to form the total relationship that determines the workflow and interpersonal
relationship.

 Formal organization-It is planned and publicized structure.

 Informal organization- It refers to social group or friendship which people working together may
form.
Forms of Formal organization structure.
There are various forms or types of formal organization structures in common use. Each organization
has to evolve its own organization structure. The form of organization mainly depends upon the
activity of organization, size and competence of personnel and philosophy of organization.Most of
the nursing departments use one or a combination of the following organization structures:
 Line organization structure.
 Line and staff organization structure.
 Functional organization structure.

Features of Line organization

 It is the simplest form of organization.

 Direct line of authority flows from top to bottom of organization hierarchy.
 Principle of unity of command and unity of direction, order and discipline are strictly observed.
 A two way communication is transmitted from top to bottom and vice versa
 Brings efficiency in communication and bringing stability to a concern.

Merits of line organization.

 Simplicity.
 Chain of command.
 Better discipline
 Fixed and clear cut responsibility.
 Flexibility.
 Prompt decision.
 Economical.
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  Attraction of talented person

Demerits

 Lack of specialization
 Overburden.
 Inadequate communication.
 Favoritism.
 Lack of coordination and cooperation.
 Authority leadership.
 Scope.
 Rigidity.

Line and staff organization structure:

It is the organization where control and specialization is handed over by two groups known as
line members and staff members and specialist are introduced in an advisory capacity and
without any apparent authority.

Characteristics of line and staff organization.

 It is the modification of line organization and is more complex

 It combines line and staff authority.
 Division of work and specialization takes place in line staff organization.
 Conflicts between the line and staff executives are quite common.

Merits

 Encouragement to specialization.
 Fewer burdens on line executive.
 Better decision making.
 Clear distinction between counseling and execution.
 Training opportunity to employees.
 Undivided responsibility.

Demerits

 Lack of understanding.
 Dependency.
 Delay in decision making.
 Lack of decision making.
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  Lack of accountability of staff.

Functional organization chart.

It is most widely used structure where the staff officers have been differentiated from the line organization
as no longer purely advisory in nature but have been some command authority over line employees.

Characteristics.

 There is specialization by work.

 The entire organization activities are divided into specified functions.
 The head of each functional department is functional specialist.
 Clear cut line and staff division.

Merits

 Specialization
 High morale and sense of belongingness among staff.
 Promote professional achievement and development
 Effective coordination.
 Flexibility.
 Effective supervision and better control.

Demerits

 Multiple commands.
 Lack of responsiveness
 Delays in decision making.
 Interdepartmental confusion.
 Narrow perspective.
 Lack of coordination among the functional or departmental heads.
 Economy.
 Divided responsibility.

d) PERT

The program (or project)evaluation and review technique, commonly abbreviated PERT, is a statistical
tool, used in project management, which was designed to analyze and represent the tasks involved in
completing a given project. First developed by the United States Navy in the 1950s, it is commonly used in
conjunction with thecritical path method (CPM).
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Implementation

The first step to scheduling the project is to determine the tasks that the project requires and the order in
which they must be completed. The order may be easy to record for some tasks (e.g. When building a house,
the land must be graded before the foundation can be laid) while difficult for others (There are two areas that
need to be graded, but there are only enough bulldozers to do one). Additionally, the time estimates usually
reflect the normal, non-rushed time. Many times, the time required to execute the task can be reduced for an
additional cost or a reduction in the quality.

Advantages

PERT chart explicitly defines and makes visible dependencies (precedence relationships) between the work
breakdown structure (commonly WBS) elements.

PERT facilitates identification of the critical path and makes this visible.

PERT facilitates identification of early start, late start, and slack for each activity.

PERT provides for potentially reduced project duration due to better understanding of dependencies leading
to improved overlapping of activities and tasks where feasible.

The large amount of project data can be organized & presented in diagram for use in decision making.

PERT can provide a probability of completing before a given time.

Disadvantages

There can be potentially hundreds or thousands of activities and individual dependency relationships.

PERT is not easily scalable for smaller projects.

The network charts tend to be large and unwieldy requiring several pages to print and requiring specially
sized paper.

The lack of a timeframe on most PERT/CPM charts makes it harder to show status although colours can
help (e.g., specific colour for completed nodes).

e) Collective bargaining
Tudwig Teller defines “Collective Bargaining as an agreement between a single employer or an association
of employers on one hand and a labor union on the other which regulates the terms and conditions of the
employment”.

PREREQUISITES OF COLLECTIVE BARGAINING

Existence of a truly representative and strong trade union.

Existence of a progressive management.

Absence of any external pressure either on the employer or on the worker to come to the agreement desired
by the authority exerting the pressure.

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Delegation of authority to an officer involved in negotiation.

Acceptance of a fact finding approach by the management as well as union.

Existence of a measure of parties of strength or bargaining power between the trade union and management

CHARACTERISTICS

It is a group process, wherein one group, representing the employers, and the other, representing the
employees, sit together to negotiate terms of employment.

Negotiations form an important aspect of the process of collective bargaining i.e., there is considerable
scope for discussion, compromise or mutual give and take in collective bargaining.

Collective bargaining is a formalized process by which employers and independent trade unions negotiate
terms and conditions of employment and the ways in which certain employment-related issues are to be
regulated at national, organizational and workplace levels.

Collective bargaining is a process in the sense that it consists of a number of steps. It begins with the
presentation of the charter of demands and ends with reaching an agreement, which would serve as the basic
law governing labor management relations over a period of time in an enterprise. Moreover, it is flexible
process and not fixed or static. Mutual trust and understanding serve as the by-products of harmonious
relations between the two parties.

It a bipartite process. This means there are always two parties involved in the process of collective
bargaining. The negotiations generally take place between the employees and the management. It is a form
of participation.

Collective bargaining is a complementary process i.e. each party needs something that the other party has;
labor can increase productivity and management can pay better for their efforts.

Collective bargaining tends to improve the relations between workers and the union on the one hand and the
employer on the other.

Collective Bargaining is continuous process. It enables industrial democracy to be effective. It uses

cooperation and consensus for settling disputes rather than conflict and confrontation.

Collective bargaining takes into account day to day changes, policies, potentialities, capacities and interests.

It is a political activity frequently undertaken by professional negotiators.

PRINCIPLES OF COLLECTIVE BARGAINING

There should be a compelling sense of responsibility for the public interest and for what is mutually fair and
just.

There should be a willingness to bargain collectively and in good faith and to refrain from violence.

There should be recognition of the fact that in the collective bargaining process negotiation requires the
existence of recognized entities, each respecting the right of the other to exist.

There should be fidelity in the observation of agreements mutually entered into.

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There should be adherence to procedures agreed upon in advance for the peaceful settlement of issues that
arise in the interpretation and application of the terms of a contract.

Precautions should be taken by each side to refrain from exerting pressures, the intentions or consequences
of which would be a violation of the terms of contract.

The interests of the consuming and general public should be protected against possible abuses through
employer-union collusion in matters of prices and trade practices.

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