organization and functions of nursing services

1. KRISHNA INSTITUTE OF NURSING
SCIENCES KARAD
SUBJECT:- NURSING MANAGEMENT AND
SERVICES
TOPIC:- ORGANIZATION AND NURSING
SERVICES
PRESENTED BY:-
MS.POOJA MHALATKAR
2ND YEAR MSC(N)
KINS KARAD

2. GENERAL OBJECTIVES
At the end of the class the student will able to understand
the organization and functions of nursing services.

3. SPECIFIC OBJECTIVES
At the end of the class students will be able to:-
1) Define the hospital.
2) List down the aims of hospital planning.
3) Understand the organization of hospital services.
4) understand about the space requirement in hospital
organization.
5) Explain about the staffing pattern of hospital.
6) Describe the policies and procedures.
7) Define the primary health center.

4. 8) Explain about the principles,elements,standards,objectives,
functions, major role of nurse, Staffing pattern and minimum
requirements in PHC.
9) Define community health centre, its elements, principles
and standard.
10) Elaborate the functions of nursing services.

5. DEFINITION OF HOSPITAL
• The word hospital is derived from the latin word
hospitalis’, which comes from hospis, meaning a host.
• “The hospital is an integral part of social and medical
organization, the function of which is to provide for the
population complete health care, both ‘ curative and
‘preventive’ and whose outpatient services reach out to
the family and its environment, the hospital is also a
centre for the training of health workers and biosocial
research” (WHO expert committee on organization of
medical care, 1957).

6. AIMS OF HOSPITAL PLANNING
• To enlarge the existing hospital by introducing new facilities
• To increase utilization of hospital facilities
• To increase population coverage
• To increase productivity of hospital
• Modernization of the already existing facilities
• To reduce the cost of operations and maximize efficiency
of services.

7. GOVERNING BODY
CHIEF EXECUTIVE OFFICER
DIRECTOR OF NURSING/CHIEF NURSING OFFICER
DEPUTY NURSING
OFFICER/ASSISTANT DIRECTOR
DEPUTY NURSING
OFFICER/ASSISTANT DIRECTOR
ASST.NURSING
OFFICER/SUPERVISOR/DEP
ARTMENTAL SISTERS
ASST.NURSING
OFFICER/SUPERVISOR/DEPAT
MENTAL SISTERS
ASST.NURSING
OFFICER/SUPERVISOR/DEPARTEMTAL
SISTERS
ASST.NURSING
OFFICER/SUPERVISOR/DEPART
MENTAL SISTERS
HEAD NURSE/WARD
SISTERS
HEAD NURSE/WARD
SISTERS
HEAD NURSE/WARD
SISTERS
HEAD NURSE/WARD
SISTERS
STAFF NURSES
ANMs WARD
CLERKS WARD
BOYS/AYAHS
STAFF NURSES
ANMs WARD
CLERKS WARD
BOYS/AYAHS
STAFF NURSES
ANMs WARD
CLERKS WARD
BOYS/AYAHS
STAFF NURSES
ANMs WARD
CLERKS WARD
BOYS/AYAHS

8. ORGANIZATION
Have a hospitals nursing service is organized is determined
by many factors the size and kind of hospital, education and
skill of the nursing staff, type of medical staff organization,
relationship between the nursing staff and other
departments and the extent to which personnel in various
departments comes in contact with the nursing department.
 Although positions in the nursing service hierarchy vary
from hospital to hospital, one can usually see the following
nursing positions in most hospitals.

9. Listed in descending order of responsibility are director of nursing (
or nursing superintendent), assistant director of nursing ( assisting
nursing superintendent), supervisor( department sister), charge nurse
(ward sister, head nurse), senior staff nurse and staff nurse.
The director of nursing may have one or more assistant directors and
several supervisors to cover all areas of the hospitals ans shifts since
the nursing services works and is staffed round the clock.

10. there may be specialist supervisory staff or departmental sisters for
paediatrics, maternity, psychiatry, operating rooms,CCU and ICUs the
head nurse or ward sister who is next in the hierarchy is in charge of
the ward or unit and is responsible for nursing in her respective unit
or ward.
There is generally a night supervisor and in large hospitals,a
supervisor or assistant director incharge of in service education.

11. The head nurse is a key member of the nursing staff. within the
organized nursing care unit,she is responsible for the administration
and coordination of patient care and other activities including
preparing nursing care plans, instructing nurses and supervising
personnel in the unit.
she is responsible for the ward 24 hours of the day in the senses that
personnel of evening and night shifts report to her she assigns duties
to them.
the head nurse must exercise good judgement, adhere to the policies,
rules and regulations of the institutions and make sound decisions that
results in good care of patients.

12. The night supervisors supervises and coordinated the activities of the
nursing personnel during the night so that continuing care is
maintained round the clock.
She visits nursing units to oversee nursing care and ascertain the
condition of patients, and gives advice to nurses regarding treatment,
medication and on any problem they may have.
When she goes off duty, she informs supervisors of the subsequent
shift of the patients condition, and other matters of importance
Education, training, experience and other qualifications required for
various nursing service positions vary from institutions to institutions,
but there are some similarities.

13. For example, the director of nursing may require an Msc degree in
nursing and 8 to 10 years of experience, 5 to 6 of which is at least in
progressively responsible management positions.
Similarly , the assistant director should preferably have an Msc
degree and 6 to 8 years of experience.
The supervisor and head nurse must at least be graduates in nursing
(Bsc in nursing) with adequate experience, and the staff nurses in
charge of special units must have in additional special training in their
specialties, like operating room techniques, psychiatric nursing, CCU
and ICU nursing care, CSSD etc.

14. the registered staff nurse has a diploma/ certificate in
nursing which is currently a 3 year course or a Bsc degree
in nursing a four year course from in a recognized college or
school of nursing and is registered under the Nursing
Council.

15. There are other categories of personnel in the nursing service:-
Auxiliary Nurse Midwife( ANM) is a staff member who has received 2
year training in some aspects of nursing amd has a certificate awarded
by the nursing council.some hospitals use them to relieve the staff
nurses of some of the routine work.
Unit manager is a professional manager with a college degree who
supervises the administrative functions of the nursing unit.
Ward boy/Orderly,nurse aid and helper are non professional staff
members who assist the nursing staff in various activities of the ward.
Ward secretary and ward clerk are staff members who assist in
routine clerical and paperwork.

16. ORGANIZATION OF NURSING
SERVICES
AT HOSPITAL
DIRECTOR OF NURSING
Records and reports Nursing services must function under a
senior competent nursing administrator variously called as
director of nursing, nursing superintendent, matron, or
matron in chief. She is responsible to the hospital
administrator for overall programme and activities of nursing
care of all patients in the hospital.

17. Nursing programme is administered by her through
appropriate planning, of services, determining nursing
policies in collaboration with nursing staff, giving general
supervision, delegation of responsibility, coordination of
interdepartmental nursing activities, and counseling the
hospital administration on nursing problems.
 She has a dual role:- the first one is the administrative
responsibility towards hospital adminstration, and the
second one is the coordinating of all professional activities
of nursing staff with those of medical staff.
The role of the nursing superintendent starts in a new
hospital from helping to establish the overall goals, policies
and organization and facilities to accomplish these goals in
the most effective and efficient manner.

18. The functional elements of the role of nursing superintendent
includes the following:-
 Formation of the aims. Objectives and policies of nursing
services as an integral part of hospital service.
 Staffing based on nursing requirements in relation to
accepted standard of medical care.
 Planning and directing nursing services.
 Maintaining supplies and equipments.
 Budgeting.

19.  NURSING SUPERVISOR
Each department or clinical division e.g ,Medical, surgical,
Obstetrical, operation theatres, outpatient department,
nurseries etc should have a supervisor. As they may be more
than one nursing unit in each division or department,
supervisors have a general administrative and coordinating
function within their respective division. However,
supervisors will also have limited clinical functions.

20. HEAD NURSE
A head nurse is assigned to a nursing unit, or ward, or a
section of department. She works under the general direction
of the supervisor of the division.
STAFF NURSE
Staff nurses are employed at the ‘floor’ level for carrying out
skilled bedside nursing. This is the real work force of the
hospital upon whose competency, state of training and
dedication depends the success of the nursing department.

21. STUDENT NURSE
Students nurse cannot be employed on nursing duties expect under
supervision of fully qualified staff nurses.

22. SPACE REQUIREMENT
• In the nursing service administration unit, provision should
be made for the following:-
• Nursing director’s office
• Assistant director (s) and supervisors offices
• Reception control area with waiting areas for visitors
• Secretarial and clerical work area
• Conference room.
• Toilet facilities
• Storage for personnel files, administrative files ansd office
supplies.

23. STAFFING PATTERN
• The complement of nurses required for a hospital, generally
referred to in terms of nurse bed ratio, is a much debated
and misunderstood subject. The indian Nursing council
stipulations are so high that not many hospitals adhere to
them.be that as it may, it is good to keep those stipulations in
mind so that managements do not keep theirs hospitals grossly
understaffed.
• For a 150-bed hospital:
• Nursing Superintendent -1 (for minimum of 150 beds)
• Deputy Nursing Superintendent-1
• Assistant Nursing Superintendent-2
• For every additional 50 beds one more assistant nursing
superintendent.)

24. In addition with regard to staffing pattern the Nursing
Council recommends 30% leave reserve posts because a nurse
is entitled to 30 days of earned leave, 10- 12 days of casual
leave and a certain number of days of sick leave and
maternity leave, and in some hospitals, 24 days off duty in a
year in addition to one or one and a half days a weekly off.it
is observed that on any working day, 25% of the nursing staff
is off duty on casual leave, earned leave, etc. a a nurse,
therefore works for about 240 days in a year whereas the
hospital requires nursing round the clock on 365 days of the
year,which means that 30% more nurses are required on the
rolls.

25. The classification is aslo used to determine the category for
personnel – registered nurse, ANM, or nurse aide who should
provide the required care.
CATEGORY 1:- A patient who requires only minimal amount of
nursing care an average of 2.8 of nursing per 24 hours.
CATEGORY 2:- A patient who requires an average amount of
nursing care-an average of 4.3 hours of nursing per 24 hours.
CATEGORY 3:- A patient who requires about average nursing
care- an average of 5.8 hours of nursing per 24 hours.
CATEGORY 4:- A patient who requires maximum nursing care-
an average of 8.6 hours of nursing per 24 hours.

26. Examples of what the patient can do himself (herself) and
what is required only minimal amount of nursing care( an
average of 2.8 hours per 24 hours) is given below:-
A patient who is mildy ill.
A patient who required little treatment and observation and
or/ instruction.
A patient who is up and about, takes his own bath.
A patient who does not exhibit any unusual behavior
patterns.
A patient without intravenous therapy or many medications.

27. WARDS AND SPECIAL
UNITS
STAFF NURSE SISTER EACH SHIFT DEPARTMENTAL SISTER
/ASSISTANT
SUPERINTENDENT
MEDICAL WARD 1:3 1:25 1 FOR 3-4 WEEKS
SURGICAL WARD 1:3 1:25 1 FOR 3-4 WEEKS
ORTHOPEDIC WARD 1:3 1:25 1 FOR 3-4 WEEKS
PAEDIATRIC WARD 1:3 1:25 1 FOR 3-4 WEEKS
GYNECOLOGY WARD 1:3 1:25 1 FOR 3-4 WEEKS
MATERNITY WARD(
INCLUDING NEWBORNS)
1:3 1:25 1 FOR 3-4 WEEKS
INTENSIVE CARE UNIT 1:1 (24 HOURS) 1

28. STAFF NURSE SISTER (EACH SHIFT) DEPARTMENTAL
SISTER/ASSISTANT NURSING
SUPERITENDENT
CORONARY CARE UNIT 1:1 ( 24 HOURS) 1
NEPHROLOGY 1:1 ( 24 HOURS) 1 1 DEPARTMENTAL
SISTER/ASSISTANT NURSING
SUPERITENDENT FOR 3-4 UNITS
CLUBBED TOGETHER
NEUROLOGY AND
NEUROSURGERY
1:1 ( 24 HOURS) 1
SPECIAL WARDS- EYE,ENT,ETC 1:1 ( 24 HOURS) 1
OPERATION THEATRE 3 FOR 24 HOURS PER TABLE 1 1 DEPARTMENTAL
SISTER/ASSISTANT NURSING
SUPERITENDENT FOR 4-5
OPERATING ROOM
CASUALTY AND EMERGENCY
UNIT
2-3 STAFF NURSES
DEPENDING ON THE NUMBER
OF BEDS
1 1 DEPARTMENTAL
SISTER/ASSISTANT NURSING
SUPERITENTEND FOR
EMERGENCY, CAUSUALTY

29. POLICIES AND PROCEDURES
In order that a good standard of nursing care be maintained,
the nursing superintendent should develop written policies
and procedures to serve as a guides for nurses of the various
units of the hospitals. Important topics that should be
incorporated are as follows:-
 Organization
 Status and relationship
 Responsibilities
 Staffing pattern
 Departmental functions

30.  Requistioning of supplies
 Utilization, care and maintenance of equipment
 Nursing procedures, coordination with domestic services
 Handling of the patients clothing and valuables
 Isolation technique

31. AT COMMUNITY- PRIMARY HEALTH
CENTRES INTRODUCTION
The PHC is the first contact point between the village
community any the medical officer. There are established and
maintained by the state government under minimum
needs/basic minimum services programme. It acts as a
referral unit for six sun centre and has 4-6 beds. A PH C
covers population of 30000 in plain area and 20000 in hilly
remote and tribal area. The activities of PHCs involve
curative, preventive and family welfare services. There were
23,391 PHCs functioning as on March 2009 in the country.

32. DEFINITION
Primary health centre is the basic
structural and functional unit of
public health care in peripheral
areas.

33. ELEMENTS OF PHC
 E- Ensure safe water supply.
 L- Locally endemic diseases control.
 E- Education/ expanded programme on immunization.
 M- Maternal and child health.
 E- Environmental sanitation.
 N- Nutritional services.
 T- Treatment of minor aliments.
 S- School health services.

34. PRINCIPLES OF PHC
 Equitable distribution
 Intersectoral co-ordination
Appropriate technology
 Community participation
 Focus on prevention

35. STANDARD OF PHC
 The PHC has been prepared keeping in view the resources
available with respect to functional requirement for PHCs
with minimum standards such as-
Building
Man power
Instrument
Drugs
Other facilities

36. The standards prescribed are a PHC covering 20000 to
30000 population wit six beds on well the block level PHC
are ultimately going to be upgraded as CHC with 30 beds of
providing specialized services.

37. OBJECTIVES
 To provide comprehensive primary health care to the
community through the PHC.
 To achieve and maintain an acceptable standards of quality
of care.
 To make the services more responsible and sensitive to the
needs of the community.

38. MINIMUM REQUIREMENTS ARE
The assured services cover all the essentials of
preventive, promotive, curative and rehabilitative
primary health care. This implies a wider range of services
that includes:-
1) Medical care.
2) Maternal and child health care.
3) Full range family planning services including counseling
and appropriate referral for couples have infertility .
4) MTP services
5) Health education for prevention and management of
malnutrition, anemia and vitamin A deficiency and
coordinates with ICDS.

39. 6) School health services.
7) Adolescent health care.
8) Diseases survelliance and control of epidemics.
9) Collection and reporting of vital events.
10) Promotion of sanitation .
11) Testing water quality .
12) Nutritional health programme.
13) Training health workers.
14) Training of ASHA.

40. MAJOR ROLE OF NURSE IN PHC
 Facilitative role
 Developmental role
 Clinical role
 Supportive role

41. FUNCTION OF PHC
1 Medical care
2 Maternal and child health
3 Control of communicable diseases
4 Collection and reporting of vital statistics
5 Immunization services
6 Improvement in environmental sanitation
7 School health programmes

42. STAFFING PATTERN
STAFF EXISTING RECOMMENDED
MEDICAL OFFICER
1 4 ( AT LEAST ONE FEMALE)
AYUSH PRACTITIONER
- 1
ACCOUNTANT MANAGER
- 2
PHARMACIST
1 7
NURSE MIDWIFE(STAFF)NURSE
1 1
HEALTH WORKER
1 1
HEALTH EDUCATOR
2 2
HEALTH ASSISTANT
2 2
CLERKS
1 2
LABORATORY TECHNICIAN
1 OPTIONAL/VEHICAL MAY BE FROM
OUTSIDE
DRIVER
1
4

43. COMMUNITY HEALTH CENTRES
INTRODUCTION
The community health centres are established and maintained
by state government under MNP/BMS ( Minimum Need
programme/Basic Minimum services) programme. It has 30
indoor beds with x-ray labour room, operation theatre and
laboratory facilities. It is managed by four medical specialists
i.e surgeon, physician, gynecologist and pediatrician. On 31st
march 2003, 3076 CHC were established each covering a
population of 80000 to 1.20 lakh.

44. DEFINITION
Community health centres ate the nonprofit community
governed health organizations that provide primary health
care, health promotion and community development services,
using them inter disciplinary terms of health providers

45. PRINCIPLES
A) EXCELLENCE
B) INNOVATIONS
C) ACCOUNTABILITY
D) COLLABORATION
E) ACCESSIBILITY
F) INTEGRITY
G) ENVIRONMENT

46. ELEMENTS
I) PRIMARY CARE
II) ILLNESS PREVENTION
III) HEALTH PROMOTION
IV) COMMUNITY CAPACITY BUILDING
V ) SERVICE INTEGRATION

47. STANDARD OF CHC
In order to provide quality care in CHCs IPHS are being
prescribed to provide optimal expert care to the community
and achieve and maintain an acceptable standards of quality
of care. These standards would help to monitor and improve
the functioning of CHCs
CHCs has to provide the following services like:-
A) Care of routine and emergency cases in surgery.
B) Care of routine and emergency cases in medicine.
C) 24 hour delivery services.

48. D) Essentials of emergency obstetric care.
E) Full range of family planning services including laproscopic
services.
F) Safe abortion services.
G) New born care.
H) Routine and emergency care of sick children .
I) Other management of medical and accidental conditions .
J) All national health programmes should be delivered
through CHCs.

49. FUNCTIONS OF NURSING
SERVICES
As a basic function, to assist the individual patient in
performance of those activities contributing to his health
or recovery that he would otherwise perform unaided has
had the strength will, or knowledge.]
As an extension of the above basic function, to help and
encourage the patients to carry out the therapeutic plan
initiated by the physician.
As a member of health team, to assist others members of
the team to plan and carryout the total programme of care.

50. Formulating nursing service policies and procedures, and for
keeping them up to date.
Putting into effort and interpreting the administrative
policies established by the governing board.
Maintaining stable staffing pattern.
Selecting and assigning nursing personnel.
Planning and directing orientation and in service training
programs for professionals and non- professional nursing
staff.

51. Constantly evaluating and improving nursing care of patients
and establishing nursing standard.
Maintaining proper nursing records for clinical and
administrative purposes.
Assisting in the preparation of and administering the
budget for the department.

52. Coordination of activities of various activities nursing units.
Promoting and maintaining effective and harmonious
relationships among nursing personnel, and between the
nursing service department and medical staff, patient and
public.
Participating in community health and health education
programs.

53. CONCLUSION
Administration is a combination of purpose and means of
achievement of that purpose. Nursing service administration
results in out put of patient whose health is unavoidably
detorioating, maintained or improved through input of
personnel and material resources used in an orderly process
of nursing service. Management is the process of getting
work done through others. the nurse managers/ supervisors
task is to plan, organize, direct and control available financial,
material and human resources In order to provide effective,
economic care to groups of patients.

54. REFERENCES
1) DEEPAK. K textbook of nursing management published by Emmess
Medical publishers page no 22-33.
2) SUKHBIR KAUR JAGJIT KAUR textbook of nursing management and
services jaypee brothers Medical publishers; 2007, page no. 73-75.