UNIT 3 PLANNING AND

UTILISATION OF NURSING
SERVICES
Structure
3.0 Objectives
3.1 Introduction
3.2 Definition of Planning
3.2.1 Characteristics of Planning
3.2.2 Purpose and Importance of Planning
3.2.3 Types of Planning
3.2.4 Planning Process in Nursing Services
3.2.5 Decision Making and Problem Solving in Planning

3.3 Nursing Services Department

3.3.1 Objectives of the Nursing Service Department
3.3.2 Broad Areas of Nursing Service in Hospital
3.3.3 Director of Nursing Services-Roles and Responsibilities

3.4 Organisation and Management of Nursing Services Unit

3.4.1 Factors Influencing the Quality of Patient Care
3.4.2 Factors Influencing Ward Management
3.4.3 Methods of Assignment
3.4.4 Maximize Organization Time

3.5 Utilization of Nursing Services

3.5.1 Management of Nursing Personnel
3.5.2 Steps in Determining Nursing Time Available per Patient per Day

3.6 Let Us Sum Up

3.7 Answers to Check Your Progress

3.0 OBJECTIVES
After studying this unit you will be able to:

define planning;

explain characteristics and types of planning;

describe planning process in nursing services;

identify broad areas of nursing services in hospital;

identify the role and responsibilities of director of nursing services;

describe the organisation and management of nursing services;

identify factors influencing quality patient care;

ide~tifyfactors influencing ward management;

describe the methods of assignment for providing nursing care;

enumerate steps in determining nursing time available per patient per day; and

explain the utilization of nursing services.

 Planning and Utilisation of
Nursing Services
3.1 INTRODUCTION
Planning , the primary function of management enables the organization to deal with the
present and anticipate the future. It is a process whereby management decides where it is at
present, and where it wants to be after some time in future. Planning is the process of making
decisions and it aims to achieve a co-ordinated and consistent set of operations aimed at ,

desired objectives. For any work, planning is essential. The nurse manager needs to be familiar
with the decision making process and tools so that she can identify the purpose of the
institution, state the philosophy, define goals and objectives, prepare budget to implement the
plan and effectively manage her time and that of the organization.

3.2 DEFINITION OF PLANNING

Planning is a process that involves defining the organization's goals, establishing an overall
strategy for achieving those goals, and developing a comprehensive set of plms to integrate
and coordinate organizational work.
Planning can be fomml or informal. In Informal planning nothing is written done and there is
no sharing of goals with others in the organization. Informal planning is general and lacks
continuity.
In formal planning, specific goals covering a period of yearsltirne are defined. These goals are
written down and shared with organizational members.
Goals are desired outcome for individuals, groups or entire organizations.
Characteristics of well designed goals:
Written in terms.of outcome rather than actions.
Measurable and quantifiable.
Clear as to a time frame.
Challenging yet attainable.
Written down.
Communicated to all members.

3.2.1 Characteristics of Planning

Primacy: Planning is an important element in the adinhistration that usually precedes
other elements or functions of administration. Without setting goals to be reached and
lines of action to be followed, there is nothing to be, organized, to direct or to control in
the organization.
Continuity: Planning is a continuous and never ending activity of an administrator or
manager. One plan leads to other activity for which further planning is essential.

Futuristic Orientation: Planning projects into the future, address to the needs and
demands looking ahead to make provisjons for future development, handling future
events and situations.
Flexibility: Planning leads to adoption of a specific c o m e of action and the rejection of
other possibilities. If future assumptions upon whjch planning is based prove wrong, the
course of action has to be adapted to altered situation.
Unity: Planning is made by different administrators or managers at different times.
Maintainance of consistency or unity of planning is one of the essential requirements.
Objectives provide the common focus for unifying planning.
Precision: Planning must be precise as to its meaning, scope and nature. Planning must
pinpoint the expected results
Administration of Pervasiveness: Managers at all levels are involved with the planning function i.e. it
Health Services in India pervades all the levels from the top to first level of management. In other words,
managers at all levels of hierarchy have to perform the planning function.
3.2.2 Purpose and Importance of Planning
Planning is considered important because it:
1) provides framework for giving directions to the different functions ivithin the
organization thus establishes w-ordinated efforts.
2) reduces the impact of change.
3) serves as an integral and primary part of other administrative function i.e. planning is
necessary for organizing, stafing, directing, co-ordinating and controlling.
4) avoids arbitary decisions.
5) provides flexibility and makes provision for future growth and development.
6) eliminates chances of uncertainity.
7) ensures order and control.
8) helps proper integration among the varied and diverse administrative functions with in
the organization.
9) leads to economise operations through the best possible course of action or minimises
wastes.
10) sets standards used in controlling, since without planning then would be no way to
control.
11) is associated with higher profits, quality (high performance).
3.2.3 Types of planning
The most popular way to describe planning is by their:
1) Breadth (strategic.versus operation)
2) Time (short term versus long term)
3) Specificity (directionalispecific)
4) Frequency of use (single use versus standing)
These planning classifications are not independent. Strategic plans are long term, directional
and single use.
O~erationalvlans are short term, specific and standing.

Strategic Planning
Strategic Planning is applied to the entire organisation, establish the organisation's overall goals
and seek to position the organisation in terms of its environment. Usuallythe strategic and long
term planning is undertaken by the top level. It canies a wider perspective for the whole of the
organisation at the highest planning level, which involves following activities:
Detail analysis of strengths, weakness, opportunities and threats (SWOT) of
organization both internal and external environment.
SWOT

1) Strength: Any activities the organisation does well or any unique resource it has.
 Weekness: Activities the organisation does not do well or resources it needs but Planning and Utilisation of
2) Nursing Services
.does not possess.

3) Opportunities: Positive trends in external environmental factors.

4) Threats: Negative trends in external environmental factors.

Developing philosophy and formulation of policies and objectives on the basis of
analysis of the organization.
Allocation of resources, assign responsibilities.
Evaluation of activities to increase efficiency.
Providing proper direction to avoid duplication of services.
Operational Planning
It specifies the details of how the over all goals are to be achieved. Usually the operational
planning is short term planning and is under taken by middle or supervisory level personnel.
Nurse managers are more likely to be involved in the operational or short range planning. This
focuses on :
Programme fopnulation and implementation.
Planning for a few months to a financial year.
Planning for details budgeting, provision for short range goods which are to be achieved
within given period.
~xtensionalaspect of long range plan.
In nursing situation, budgeting time and other provision for providing nursing care
according to the events and situations.

Components of Planning

Controls
policies, programmes Type and amount Design procedure for
of resources (budget) of execution detecting errors

3.2.4 Planning Process in Nursing Services

Planning is essential for all the jobs. The careful planning helps to achieve success in any
programme because it saves time in the long run. Planning leads to more effective and rapid
achievement because, every one involved is clear about what is to be done, how, when and
why ? It ensures unity of purpose, clear cut methods of doing things and focus on the
objectives and targets to be achieved. Although planning is continuous process, there should be
a provision for flexibility to some extent according to changes due to event or situation, or due
to technological changes that may be due to change m population. Plan should not be based on
high ideals and be blind to social and political condition in the environment i.e., there must be
complete identification with the organization and with the environment. Planning must be
documented because it serves as a blue print for implementation. For planning following steps
are considered:

1) Analysis and understanding of the situation. It involves collection, assessment and

interpretation of information.
2) Formulation of objedtivedgoals.

3) Assessment of current organization capabilities-In terms of resources (3M).

4) Designing alternative course of action and selection.

5) Preparation of implementation plan i.e. detailed action plan.

6) Control and Monitoring
7) Evaluation.
Administration of 3.2.5 Decision Making and Problem Solving in Planning
Health Services in India
Decision making, the process of selecting one course of action from alternatives, is a
continuing responsibility of the nurse manager. It is the heart of administration. Hospital or
agency policies provide guidelines for dealing with routine situations. Problem solving is a
skill that can be learned, and because staff nurses can learn by observing their leaders good
decision making by the leader may do more than solve immediate problems and foster good
decision making by staff nurses. These are the skills needed for planning, both are
interdependent and intangible, its effect can only be felt. Decision making is defined as
thinking process for selecting the right alternatives from among the various alternatives
available, Decision making relies on the scientific problem solving process: identifying the
problem and analyzing the situation, exploring alternatives and considering their
consequences, choosing the most reliable alternative, implementing the decision, and
evaluating the results.

.Problem solving may be defined as decision making for solving a problem, a problem being
defined as the difference existing between a situation or condition prevailing and the desired
situation. Problem solving consists of following steps :

Identification and specification of t'he problem

Collection of data in relation to the problem

Analysis of available data and inference

Identifying possibles solutions and selection of the best solution

Implementation of solution with feedback

Modification of solution of necessary on the basis of feedback data

- -

3.3 NURSING SERVICES DEPARTMENT

Nursing service is one of the most important components of hospital services. Nursing service
in a wider context is that part of the total health organization which aims to satisfy the nursing
needs of the community, the major objectives of which are to provide:

i) Nursing care required for the prevention of disease and promotion of health, and

ii) the nursing care of sick patients:

a) in the interest of his or her mental and physical comfort and

b) by reason of the disease from which he or she is suffering.

Nursing service administration is the system of activities directed towards the nursing care of
patients including the establishment of over all goals and policies within the aims of the health
agency and provision for organization, personnel and facilities to accomplish these goals in the
most effective and economical manner through co-ordinated efforts of all members.
Nurses form a very important group - the longest single technical group of personnel engaged
in patient care in hospitals next to doctors, consuming approximately one-third of hospital
costs.

3.3.1 Objectives of the Nursing Service Department

1) To give the highest possible quality of nursing care as per needs of the patient.

2) To assist the doctor in the medical care of the patient, and to carry out treatment
prescribed.

3) To promote of nursing education: to provide facilities for the development of all

categories of nursing service personnel.

4) To promote and encourage nursing research studies in order that the quality of
performance may be improved.
5) To promote maximum utilization of personnel. Planning and Utilisation of
Nursing Services
6) To assess the quality of the nursing service and prepare personnel to improve upon the
quality.

7) To promote participation of various health organizations and support community

activities.

3.3.2 Broad Areas of Nursing Service in Hospital

In this sub-section you will learn more about nursing services in hospital. It includes:

i) Management of Nursing Care and Services

a) Establish relationships at all levels of nursing personnel to accomplish their job and
responsibilities through systematic management process

b) Establish adequate staffing for rendering efficient nursing services to

clients.

c) Develop methods of evaluation and periodic monitoring system for proper

utilization of personnel.

d) Develop policies for updating advance knowledge.

e) Develop proper job description of nursing personnel at all levels and all events for
proper delivery of nursing care.

f) Assist hospital authorities for effective personal management.

g) Share nursing information system with other discipline functionaries of the

hospital.

h) Formulate policies for component of patient care.

i) Assist hospital authorities for preparation of budget.

j) Participate in interdepartmental programmes conducted by other disciplines for

improvement of hospital services.

ii) Education, Training and Staff Development

a) Encourage a stimulating environment to which the personnel act as innovators for

improving nursing services.

b) Orientation programmes for new employees.

c) Provide and conduct atmosphere to give required learning experiences as planned

for students.

d) Assist in development of sound programme of leadership in nursing to safeguard,

conserve and preserve nursing resources of hospital.

e) Initiate programmes to improve the practice of nursing in keeping with advances in

relative areas and disciplines affecting the quality of nursing.

iii) ~eskarch

a) Participate in identifying the areas of research.

b) Participate in the application of research.

c) Provide conducive environment for research.

iv) Community Health Programmes

a) Participate in community health programmes associated with hospital.

b) Interpret the roles and responsibilities of community health programmes.

Administration of
Health Services in India

3.3.3 Director of Nursing Services-Roles and Responsibilities

The Director of nursing services must be a nurse and she will have to delegate her
responsibility of organizing nursing services. Nursing service must function under a senior
competent nurse administrator - called director of nursing, nursing superintendent, Principal
matron. or chief nursing officer. She is responsible to the hospital administration for the
overall programme and activities of nursing care of the patients in the hospital. The nursing
programme is administered by her through;
Appropriate planning of services.
Determining nursing policies in collaboration with hospital management and nursing
procedures in collaboration with nursing staff.
Supervision

Delegation of responsibility
Co-ordination of interdepartmental nursing activities
Counselling the hospital administrator on nursing outcomes

She has a dual role. The first one is the administrative responsibility towards the hospital
administration, and the second one is the co-ordination of all professional activities of nursing
staff with that of medical staff.

Overall administration of department of nursing

a Assistance to the hospital administrator

- Direct reporting about patients and her departmental activities
- Responsibility for delegated tasks in his absence

Interdepartmental "top level" relationships

- morale setter
- determines boundary lines of departmental responsibility
Intradepartmental"top level" decisions maker and describes jobs of nursing personnel

Personnel administration
- appointment
evaluation
- problem solving
- staff development

Major Functions
- Planning
- Organising
- Staff~ng
- Directing Planning and Utilisation of
Nursing Services
- Co-ordinating
- Reporting

- Budgeting

Primary Direct Contacts

1) Nursing staff - Assistants, Supervisors, Secretary

2) Hospital administrators

3) Peers
- other departmental heads

- members of the executive committee

4) Nursing personnel -for evaluation, problem situation including Personal, family,

professional, appointments, termination interviews.
5) Medical staff
- executive committee
- members of committees e.g. infection control, patient care records, safety disaster
etc.
6) Patient families.
7) Private duty nurses.

8) Applicants of staff positions, aspirants to nursing profession.

9) Volunteers.
1 0) Community groups.
Contact with Patients
1) Round with nursing personnd
a to get acquainted, share and guide
to evaluate patient care and workers performance
to determine with staff how best to improve the work climate including equipment
and other factors.

2) Rounds with the hospital administrators

a To follow up verbal reports of hospital activities.
To inspect equipment and supplies for maintenance; efficiency and safety factors.
To determine attitude of patients towards workers and the "hospital".
To help obtain facts for hospital administrators reporting to the board and to
validate budget requests and adjustments.
3) Round alone
To appraise selected situations on overall functioning of department and to set
guidelines for improvement of care and work performance.
a To spot check problem areas.
To evaluate performance of those under her direct supervision.
To impart information, discuss administrative policies and regulations.
To gather data for the study of specific situations.
Administration of
Health Services in India 3.4 ORGANISATION AND MANAGEMENT OF
NURSING SERVICES UNIT
Nursing services is one service which must be maintained continuously throughout the 24 hour
period (round the clock), 365 days in a year. Good nursing considers the whole patient body ,
mind and spirit and recognizes him as an indiv'idual. It deals with prevention as well as care
and assures a larger responsibility for health teaching. Good nursing care needs good nurses,
but they alone are no assurance that patients will be nursed. Other factors enter into the
situation, i.e. amount of nursing care provided, the stability of the service and quality of work
management.

3.4.1 Factors Influencing the Quality of Patient Care

The type of service, i.e. medical, surgical, obstetrics and gynaecology, paediatrics,
psychology etc.

The acuteness of the service and the role of turn over of patients according to the degree
or periods of illness.

The experience of nurses who have to give the nursing care.

The number of non-nurses (nursing aides) who are involved in patient care, the quality
of their work, their stability i.e.service.
The amount and quality of teaching which proceeds the assignment of personnel to the
service as well a s that given as in service preparation.

The amount of quality of supervisors and ward teaching.

Affiliation of hospital with medical college /nursing /school.

The plan of the ward floor plan.

The physical facilities.

The amount, type and location of equipment and supplies.

The number of working hourslweeks of nurses.

The morale of' tire workers.

The rime required for hospital routines- the more complex the system of record keeping
and reporting, the m 9 nursing
~ time is consumed in desk work. ,

0 The method of assignment t h e hctional method is more efficient and less 'time
consuming than patient method of assignment.

The standards of nursing care - the fiequrncy of giving bath, changing beds, turning
patients, giving back care.

. aement
3.4.2 Factors Influencing W-ard Mana,
In this sub-section you will learn about factors influencing ward management.

Wa~druanagement is one of the pre requisites for goocl nursing care. There are many factors
involved in good ward management, which the nurse management /supervisor need to
understand thoroughly for good management of ~ l ward.
~ c They are:

Knowledge of the ward means that knowledge of all the duties and activities to be
perfomled in ward.

Planning the schedule of the ward refers to a planned programme for each days work to
save time and use available time in an useful way for nursing the clients.

Starting the wmk on time. Proper assignments are made so that all nurses do their job in
right time as assigned promptly.
Preventing interruptions: good management requires avoidance of interruptions Planning and Utilkation of
whenever possible. Nursing Services

Establishment of ward routines: having hospital manuals available to establish ward

routine which includes policies of the institution.
Involving entire staff members when policies are established or changed so as to have
democratic method of hctioning.

Orientation of new personnel: well developed orientation programme helps good ward
management for new recruits. Orientation to include: orientation of wardlunit,
introducing to ward personnel, methods of assignment, working schedule of the day,
visiting hours, duties of non-professional workers, methods of obtaining daily
assignments - rounds, location of equipment, emergency equipment and other sources of
information of procedures, routines and ward policies.
Maintenance of suitable environment. Elements which help maintain suitable
environment in the ward include: prevention of noise, good ventilation, cleanliness of
ward , wall hctioning equipment, good house keeping, etc. A sanitary, safe, restful
environment is necessary to the patients welfare and comfort as well as that of all
members of the ward personnel.
Providing supplies and equipment in a hospital for efficient functioning. They should be
adequately conveniently located and maintain good exchange system.
There should be clear cut doctors order and nursing orders, which are very essential to
safeguard the patients welfare.

Record keeping, maintaining accurate records is essential for good management. They
might be patient clinical records, administrative records, nursing orders, nurses notes,
record of treatment etc.
Reporting: reports are of prime importance both to ward management and to well
functioning hospital. Reports may be oral which are concerned with immediate
hctioning of the ward or between nurses to doctors and supervisors, they may be
written in the form of day, evening, night, reports to serve as source of reference. Reports
save time and duplication of efforts, they must be prompt, complete, accurate and
objective.
Maintainance of high morale among all members of the staff.
Establishment of good 'working relationships is very essential. A warm, friendly
atmosphere adds to better work output.
Delegating responsibility is done according to the ability of individuals within the frame
of policy of the hospital.

Assigning duties and responsibilities in order to:

- provide best possible nursing care.
- plan assignment which are interesting and stimulating to professional growth.
- provide a well recorded educational experience for student nurses.
- achieve good ward management.

Time planning helps to provide adequate staff for good nursing care for 24 hours,
provide best possible experience for nursing students.
Good teaching techniques: Bedside clinics, incidental teaching, demonstration,
individual conference, nursing care conference, teaching round etc.
Good supervision: Unless ward personnel are supervised, good nursing is impossible. It
is generally accepted that a good nursing service depends upon strong supervision, no
matter, what type of nursing assignment seems best suited to hospital.
Administration of 3.4.3 Methods of Assignment
Health Services in India
There are three methods used for nursing care delivery. They are:
Case methodpatient assignment
Functional method
Team 'method
Case Methodmatient Method: In this method, nurse assures total responsibility for meeting
all the needs of assigned patients during their time on duty. It involves the assignment of one
or more clients to a nurse for a specific period of time, for carrying out complete care,
including treatments and nursing care. It is individualized method of nursing care delivery,
where nurse attends to all needs of patient. There is continuity of care and client feels more
secure and nurse is accountable to her care and gives greater satisfaction to the nurse. This
method is most suitable for training nurses where one nurse is responsible for the total care of
the patient.
This method is not suitable when nurse is inadequately trained to provide total care to patient
and if non- professional health workers are to be used effectively.
Functional Method: When hnctional method is used, nurses are assigned to specific
functions in the ward such as giving medications, sponging, T.P.R. taking etc. Here the
nursing care becomes fragmented, impersonal and compartmentalized. There is a risk of
continuity of care and clients feel insecure because of not knowing who is their own nurse.
The advantages of this method are that person become skilled in performing assigned tasks;
more can be accomplished in a given period of time. It is more economical, as less equipment
is needed and more efficient, because tasks are completed quickly with little confusion
regarding responsibility. The practice of this method is safe when the head nurse co-ordinates
the activities of all the members of the staff and nothing essential in client care is overlooked
or forgotten.
Team Method: It is based on a philosophy in which a group of professional and non-
professional personnel work together who identify, plan, implement and evaluate
comprehensive client centered care. The key concept is a group that works together towards a
common goal. The team method of assignment has resulted largely because there are no
longer enough professional nurses to give total care to great number of patients who require
hospitalization. As a result, it has been necessary to employ practical nurses and nurses aides
(non-professsional personnel) to help carry the load. It is known that many parts of patient
care do not require technical ability of the professional nurse, but can be performed by
individuals with less knowledge, skill provided they are adequately supervised.
The main advantage of this method is that, it is cost effective. All care is directed by a
registered nurse. Each member has the opportunity to learn from other colleagues. As team
members perform only those functions which fall within the scope of their education and
training, there is appropriate utilization of staff. It also provides scope for developing nursing
leadership skills in small groups. Well qualified, competent members can be given the
opportunity to serve as team leaders. Effective team work has some characteristics. They are:
Clear division of labour
Common agreed goals
Adequate resources - human and natural
Supportive and cooperative interpersonal relationship (IPR)
Open, honest communication
Provide for evaluation and improvement.
The only disadvantage of team nursing is fragmentation of nursing care due to division of
work.
A nursing team leader is expected to perform the following duties:
Plan and evaluate work related to care of patients
Assign work to team members
 Participate in direct care of patients and perform complex nursing functions. Planning and Utilisation of
Nursing Services
Supervise and guide team members

Conduct team conference

Team conference is necessary to :

share report of patients progress"

evaluate and modify nursing activities according to patients condition

discuss problems and alternative solutions

guide staff
In order to be successful, the nursing team need to develop a helpful attitude towards each
other for best results.

3.4.4 Maximize Organization Time

Plan: Much time can be saved through appropriate organizational planning. The nurse
manager determines who is responsible for co-ordinating activities, who makes what decisions
and who needs to be informed about certain decisions. She also determines what decision need
to be made before others, what action needs to be taken first, and what deadlines must be set.
The determining and ranking of goals focus activities and prevent people from spending time
doing inappropriate or unimportant tasks. People who are adequately informed of what is
expected of them do not waste time wondering what they are supposed to do. Making time
estimates and setting time limits help regulate work flow. Through appropriate planning,
problems can be prevented.

Organize: The manager structures the agency to accomplish the tasks necessary to meet the
agency's goal. Organizational checks help clarify, who is responsible to whom and for what
job. Job descriptions further clarify these matters. Multiple bosses, confusion over who is
responsible and who has authority for what, and duplication of tasks can be prevented with
planning. Autonomy and independence reduce the amount of time otherwise spent in conflict
management.

Staff.. Selection of well qualified staff is critical for time saving, because they require less
supervisory time for development and corrective actions. Staff development further reduces
time lost by better preparing staff to do their jobs. Appropriate use of manpower through
assessment of work to be done, careful planning of the number and mix of personnel, and
matching the staff members interest and abilities to her job hnher reduces waste. When the
nurses interests are matched to the organizational goals and she feels appreciated, she is likely
to have increased job satisfaction. Consequently there is little absenteeism and less turnover.
Administration of The nurse manager should watch for chronic absenteeism, try to determine the reason, and
Health Services in India correct it. She also expects punctuality, because tardiness is a loss of time. If the nurse manager
finds that employees personal problems are affecting their work, one should refer personnel
for appropriate assistance so that they will have more energy to do their jobs.

Direct: It is the nurse manager's responsibility to delegate what a less qualified, low paid
person can handle. She is the one who identifies the task to be delegated, determines the best
person to do the job, and communicates the assignment clearly. She allows the staff associate
to help determine how the task will be accomplished and keeps authority commensurate with
the responsibility. She sets controls, monitors results, and provides support as needed. It is
essential that the manager teach others how to do the work instead of doing it herself. The
nurse manager should also facilitate open communications and assertive behaviour and handle
conflict immediately before it drains time and energy.

Control: The nurse manager sets standards, monitors results, and gives feedback. She adjusts
closeness of supervision to the needs of the employee, takes disciplinary action as soon as it is
justified and fires personnel who are not meeting minimum standards.

3.5 UTILIZATION OF NURSING SERVICES

In this section you will come to know about management of nursing personnel.

3.5.1 Management of Nursing Personnel

The nursing care of patient in hospital fully depends upon the number and the quality of
nursing personnel on duty at all times of the day and night.
The following factors should be considered before planning the nursing manpower:

1) Number of beds in a hospital.

2) The type of hospital and the available services.

3) The design and the lay -out of the hospital.

4) Available pattern of arrangement of nurses.

5) The type and number of emergency cases coming to the hospital per day.

A substantial amount of nurses time is spent on activities that are non-nursing in nature. The
staff nurses have to cany out certain less skilled job which can be carried out by less skilled
personne1.e.g. arranging dispatch of samples, housekeeping, attending to relatives and visitors,
certain records, exchange of articles from CSSD, stores, laundry etc. In one of the study on
nursing staff time utilization, it was found that 92% of available nursing staff was employed on
direct patient care duties and the remaining 8% on purely administrative duties. Of the nurses
employed on direct patient care duties 20.7 to 44% of their time was accounted for by nbn-
professional duties. The employment of the staff during the day was 83.3 % for the day shiRs
and 16.7% for the night shifts which was totally disproportionate to the workload requirement
in wards.

It is seen that employment of a ward clerk or secretary could relieve the disproportionate
amount of professional nurses time devoted to clerical work and permit more attention to
nursing care functions, resulting in economy. The head nurse time for clerical work reduced
from 38 to 3 percent by addition of ward clerk.

Nursing Time by Patlent Dependency Shifts

Patient Morning Evening Night Total

Category

I 1 I I I
Such studies help the nursing administrator to estimate the total number of nurses needed and the
staffing plan for a ward according to the categorization of ~atienl%mddemee of their denendence
3.5.2 Steps in Determining Nursing Time Available per Patient Planning and Utilisation of
Nursing Services
per Day
Step I: Find out average number of days worked by a nurse (i.e. 365 minus holidays, leaves,
sickness, etc)
Step 11: Find out average number of hours worked by a nurse (multiply average number of
days by number of hours worked per day usually 8 hours.)
Step 111: Multiply the hours worked per year by a nurse by the total number of nurses in that
ward to obtain total number of nursing hours per year.
Step IV: Divide the total number of nursing hours per year by 365 to obtain nursing hours per
day.
Step V: Divide the total number of nursing hours per day by the average daily patient census in
the ward to obtain the number of the nursing hours actually devoted for patient.

3.6 LET US SUM UP

In this unit you have learnt that the nursing services play a very crucial role in the health care
delivery system. The role of nursing service towards patients has similar responsibilities as the
medical service, and the need for also co-ordination between the doctor and the nurse, and
other health workers is essential to maintain the quality of care and patient satisfaction. You
have also learnt about one of the main function of administration i.e., planning and the role of
nurse in planning process in nursing services and how the nursing services are organized for
better utilization of services.
We hope you enjoyed reading this unit.

3.7 ANSWERS TO CHECK YOUR PROGRESS

Check Your Progress 1

i) Management of nursing care and services.

ii) Education, training and staff development programmes.

iii) Nursing research
iv) Community Health Programmes.
Check Your Progress 2
1) i) Case Method
ii) Functional Method

iii) Team Method

2) The type of service, i.e. medical, surgical, obstetrics and gynaecology, paediatrics,
psychology etc.
The acuteness of the service and the role of turn over of patients according to the
degree or periods of illness.
The experience of nurses who have to give the nursing care.
The number of non-nurses (nursing aides) who are involved in patient care, the
quality of their work, their stability i.e.service.
The amount and quality of teaching which proceeds the assignment of personnel to
the service as well as that given as in service preparation.
The amount of quality of supervisors and ward teaching.

Affiliation of hospital with medical college /nursing /school.

Administration of • The plan of the ward floor plan.
Health Services in India
a The physical facilities.

The amount, type and location of equipment and supplies.

The number of working hourdweeks of nurses.

The morale of the workers.

The time required for hospital routines -the more complex the system of record
keeping and reporting, the more nursing time is consumed in desk work.
The method of assignment -the fkctional method is more efficient and less time
consuming than patient method of assignment.

The standards of nursing care - the frequency of giving bath, changing beds,
turning patients, giving back care.