Innovative approaches in solving nursing services problems

byP.K a r t h i k e y a p r a s a t h

Introduction

• Nursing is the oldest of arts and the youngest of professions.

• Fundamental responsibility of the nurse is four fold:

1. To promote health, 2. To prevent illness,3. To restore health and4. To alleviate suffering.

Modern nursing involves :Introduction Contd……

1 • Basic sciences

2 • social sciences

3 • Growth and development

Committees :

1. Bhore committee (1946)2. Shetty Committee (1966),3. Kartarsingh committee (1973).4. Bajaj Committee (1986) and5. High power committee on nursing and

nursing profession (1989)

Introduction Contd……

Definition

• To innovate means to introduce something new, to be creative. An administrator must be innovative, an agent of change. If there is no change the organization/institution /country stagnates and goes down.

Classification:

1. Nursing services 2. Nursing education 3. Nursing administration

1. Nursing services:

1. Poor working conditions:2. Recruitment3. Job description 4. Lengthy hours of duty and split duty5. Less salary, Allowances and other Incentives6. Less Promotional opportunities7. Harassment of Nurses by others8. Improper supplies9. Improper supplies

1.Poor working conditions: I. Nursing Services Contd….

• To improper job descriptions, long hours of work and spilt duty. Less pay and allowances as compare to other equal cadre in government services. Less promotional opportunities, no special incentives, occupation risk. Harassment of nursing personnel by some office staff and medical personal and annoyance of group, ect.

2. Recruitment: I. Nursing Services Contd….

• Recruitment of trained nurses should be made by selecting candidates who are settled and trained in their respective states.

• For which earlier procedure for recruitment of staff nurses by the state Directorate of Health services was good. It is always better to withdraw the selection of nurses by the public services commissions immediately as it was badly experienced by the locally trained nurses’ candidates in recent selection procedure.

3. Job description I.Nursing Services Contd….

• Previously the job descriptions of nurses were made by the non-nursing persons. so it will not suit the present working pattern of nurses. The clear cut job descriptions of nurses of all categories need to be drafted and enforced in to practice.

4. Lengthy hours of duty and split duty: I. Nursing Services Contd

• In most of the states and union territories the duty schedule is “on duty”, “off duty” and night duty.

*on duty: I. Nursing Services Contd…..

• 7.30a.m to 1.00p.m• 1.00p.m to 4.00p.m

• 4.00p.m to 8.00p.m

• Total

• 5 1/2 hours duty• rest• 4 hours duty

• 9 1/2 hours duty

*off duty: I. Nursing Services Contd……

• 7.30a.m to 12.00 noon• 12.00 noon to 1.00p.m• 1.00p.m to 4.00p.m

• Total

*Night Duty: 7.30p.m. to 7.30a.m

• 4 1/2 hours duty• Break• 4 hours duty• 8 1/2 hours duty

12 hours duty

5. Less salary, Allowances and other Incentives: I. Nursing Services Contd……

• The pay scale of staff nurses has been recommended by the Tukol Pay Commission and implemented by the Karnataka Government. The Government to implement the pay scales of nurses of all categories.

• And also there is disparity in uniform allowance, washing allowance, risk allowance and compensatory allowance. It has been suggested to IV pay commission. ie., uniform and washing allowance and additional increment for nurses possessing additional diplomas and degrees in nursing should be given on the lines of central Government.

6. Less Promotional opportunities: I. Nursing Services Contd……

• These rules should be made flexible according to needs and as soon as vacancy arised, immediately it should be filled. In cases of stagnation, selection grade and running scale may be given.

• And also should take steps to increase promotional avenues for nurses to increase efficiency and also to prevent ‘brain drain’.

7. Harassment of Nurses by others: I. Nursing Services Contd……

• There are some instances occurred in various circumstances in different places, harassment of nurses by clerical staff, while taking their salaries and claiming other arrears, leave of their own credit and sometimes by the administrators of the institution.

• Legal security and protection also should be provided to nurses in the form of acts, eg ‘nurse’s protection act’ on the lines of ‘civil rights protection act.’

8. Improper supplies I. Nursing Services Contd……

• In most of the hospital and other health institutions, no standard has been followed in supply of drugs, equipment and linen etc.

2. Nursing education:

Government institutions Private Institutions

1.Government institutions:

1. No independent building for schools,

2. No independent principal for school,

3. Inadequate hostel facilities for students,

4. Acute shortage of qualified teachers in nursing,

5. Underutilization of clinical facilities

6. Inadequate library facilities

7. No transport facilities,

Contd…

8. No UGS status for college teachers in nursing .

9. Less stipend for nursing students.

10. Less supply of AV Aids.

11. Less promotional opportunity for teachers of both schools and colleges.

12. No separate budget for schools.

13. Msc Nursing course not started in the some government college.

2.Private Institutions:

• Just like medical, engineering and dental education, the nursing education is also in the hands of private bodies and encouraging commercialization of education.

3.Nursing Administration:1. Non-involvement of nursing administrators in planning and decision

making in the governmental hospital administration.

2. No specific power has been assigned to nursing superintendents but he /she has been made in charge of all inventories and linen of hospital.

3. Nursing superintendent will have no authorities to sanction leave to their subordinates.

4. Lack of knowledge in management of hospital among medical/nursing administrators.

5. Administrator, always dependent on the advice of clerical staff in all matters including technical aspects.

Contd….. 3.Nursing Administration

6. Prevalence of role ambiguity, among administration

administrators.

7. Unnecessary interference of non nursing personnel

(Medical/clerical) in nursing administration.

8. No written nursing policies and manuals.

9. No proper job description for various nursing cadres.

10. No organized staff development programs me which

includes orientation, in-services education, continuing

education etc.

Contd….. 3.Nursing Administration

11.No special incentive like, Rajyotsava Award, Republic day awards,

teachers awards, as government itself honors with these awards

other government servants like teachers, police persons etc.

12.Inefficiency of nursing councils of state and union to maintain

standards in nursing.

13.No efforts at higher level for implementation of separate directorate

of nursing sanctioned by the Karnataka government.

solution :

Present DesignationA. Medical wing:• Staff Nurse• Senior staff Nurse• Nursing Superintendent

Grade II• Nursing Superintendent

Grade I• Sr. Nursing Superintendent

Grade I(All seniors of this grade)

Suggested Designation

• Staff Nurse• Assistant Nursing Officer• Deputy Nursing Officer

• Nursing Officers• Chief Nursing Officer(To be

created)

Contd…

Present DesignationB. Public Health Wing• ANM/Jr.HAF• LHV/Sr.HAF• Asst. Nursing

Superintendent (PH)• Nursing Superintendent

(PH)• District Nursing Supervisor

(PH)

Suggested Designation

• Primary Health Nursing• Community Health Nursing • Asst. Nursing officer

(Community Health)• Deputy Nursing Officer (CH)

• District Nursing officer(CH)

SOLVING NURSING PROBLEMS

• Identifies opportunities for improvement or overcoming major problems.

• Has a readiness to accept change.• Creates and sustains the change effort.• Evaluates, reviews and modifies activities

appropriately for effective change and • Continues the effort till the desired goal is

achieved.

1.Grouping Problems:

I. Working Problems occurring in the field or settinga) Mistakes in the nature of omitting or forgetting

the important works that should be done.b) Failure to produce works according to job

specialization.c) Carelessness in workmanship-poor workd) Wastage of manpower, money and material

because of lack of knowledge.e) Grouping Problems

Contd…

II. Problems related to policies proceduresa) The issues of inadequate records and

appreciationb) Carelessness in the care and maintenance of

institutional and patients propertyc) Lack of knowledge regarding the procedure

and policies.

Contd…

III. Problems involving attitude and appreciation

a) Conservative attitude towards the acceptance of new and progressive ideas.

b) Lack or team spiritc) Lack of cooperation among the health

professional

Contd…

IV. Disciplinary problemsa) Leaving the patients who require constant

attention.b) Taking off duty without prior notification.c) Abuse of sick leave privilegesd) Negligence of Dutye) Lack of interest f) Quarrelsome.

Contd…

V. Nursing services Vs Nursing education problema) Lack of knowledge and unwillingness to make assignments,

which provides teaching opportunities.b) Failure on the part of staff nurses and head nurses to realize

their role and responsibility in terms of supervision and follow up.

c) Inadequate orientations programme with subsequent dissatisfaction with rotation, promotion and salary requirement.

d) Failure to provide in-service education programme and continuing education.

e) Failure to issue personal evaluation records.

Contd…

VI. Intangible and unpredictable problems of personal

a) Illness, death and accidents to members in the family causing emotional, social and economic pressures apart from work.

b) Personal health problems.

Ways to resolve problems:

Cost Containment

Economic

status of

nurses

Ethical

Creativity and innovat

ion

Nurse manages can plan to nourish creativity in nursing personnel by:

1. Noting creative abilities of those persons who develop new methods and techniques.

2. Providing time and opportunity for people to do creative work.

3. Recognizing those who are experts in clinical practice, teaching research and management.

4. Encouraging risk taking and acceptance of personnel responsibility.

Conclusion:

• Innovative means to introduce something new

on the creative various problems are occurring

in nursing profession, so it is the duty of an

administrator. To be innovative, an agent of

change.

Thank you