Nursing Administration & Management: Principles, Staffing, Patient Assignment, Leadership, Materials & Quality
Key Takeaways
Luther Gulick and Lyndall Urwick summarised administrative functions as POSDCORB: planning, organising, staffing, directing, coordinating, reporting and budgeting.
Henri Fayol described 14 principles of management, including unity of command, division of work and scalar chain.
In primary nursing one registered nurse is responsible for a patient's care 24 hours a day from admission to discharge, while functional nursing assigns tasks rather than patients.
ABC analysis classifies stores by annual consumption value, while VED analysis classifies them by how critical they are: vital, essential or desirable.
Kurt Lewin's change theory has three stages: unfreezing, moving (changing) and refreezing.
A Nursing Officer manages patients, staff, supplies and records every shift, and senior Nursing Officers become ward in-charges. This subject tests management theory, staffing and assignment methods, leadership styles and supply management.
1. Management Theories and Principles
| Theorist | Contribution |
|---|---|
| F. W. Taylor (1911) | Scientific management—time-and-motion study, standardised tasks; "father of scientific management" |
| Henri Fayol (1916) | 14 principles (division of work, authority and responsibility, discipline, unity of command, unity of direction, subordination of individual interest, remuneration, centralisation, scalar chain, order, equity, stability of tenure, initiative, esprit de corps) and five functions: plan, organise, command, coordinate, control |
| Gulick and Urwick (1937) | POSDCORB: Planning, Organising, Staffing, Directing, COordinating, Reporting, Budgeting |
| Max Weber | Bureaucracy—hierarchy, written rules, impersonal relationships |
| Elton Mayo (Hawthorne studies) | Human relations—attention and group norms raise productivity |
| Peter Drucker (1954) | Management by Objectives (MBO)—superior and subordinate agree measurable goals and review them |
2. Functions of Management
Planning
Deciding in advance what to do, how, when and by whom. Plans include the mission, objectives, policies, procedures and rules. A SWOT analysis (strengths, weaknesses, opportunities, threats) supports planning. Good plans are flexible, realistic and based on data.
Organising
- Organisational chart: shows lines of authority and communication.
- Line authority is direct command; staff authority is advisory.
- Span of control: the number of subordinates one supervisor can manage effectively.
- Chain of command and unity of command (each employee reports to one supervisor).
- Centralisation versus decentralisation of decision-making.
Staffing
Recruitment, selection, orientation, placement, scheduling, staff development and retention. Workload depends on patient classification (patients grouped by dependency), the number of beds, bed occupancy, shift pattern and leave reserve. Staffing norms are set by the INC for teaching hospitals and by the Indian Public Health Standards for public facilities.
Directing
Guiding, supervising, motivating and communicating. Supervision in nursing is supportive and educational, not merely inspection.
Controlling
Comparing performance with standards and correcting deviations—through nursing audit, quality indicators, incident reporting and performance appraisal.
3. Methods of Patient Assignment
| Method | How it works | Advantages | Disadvantages |
|---|---|---|---|
| Functional (task) method | Each nurse does particular tasks for all patients (one gives medicines, one takes vitals) | Efficient when staff are few | Fragmented care; no single nurse knows the whole patient |
| Case method / total patient care | One nurse gives all care to one or a few patients during a shift | Holistic care | Needs more staff |
| Team nursing (Eleanor Lambertsen, 1950s) | A team led by a registered nurse cares for a group of patients | Uses mixed skill levels; supervision built in | Depends on team leader's skill |
| Primary nursing (Marie Manthey, 1969) | One primary nurse is accountable for a patient's care 24 hours a day from admission to discharge; associate nurses follow her care plan on other shifts | Continuity and accountability | Needs well-qualified staff |
| Case management | A nurse case manager coordinates care across settings for complex patients | Cost-effective, outcome-focused | Requires coordination systems |
Delegation
Delegation transfers the task but not the accountability. The five rights of delegation: right task, right circumstance, right person, right direction/communication, and right supervision and evaluation. Assessment, care planning, evaluation and patient teaching that needs nursing judgement are not delegated to unlicensed staff.
4. Leadership and Motivation
Leadership styles
| Style | Features | Best use |
|---|---|---|
| Autocratic | Leader decides alone; close control | Emergencies, disasters, cardiac arrest |
| Democratic (participative) | Staff share in decisions | Routine ward management, change projects |
| Laissez-faire | Minimal direction; group decides | Highly skilled, self-motivated teams |
| Transformational | Inspires a shared vision and growth | Long-term improvement |
| Transactional | Rewards and corrections for performance | Routine, rule-based work |
| Situational (Hersey and Blanchard) | Style matched to staff readiness: telling, selling, participating, delegating | Mixed-experience teams |
Motivation theories
- Maslow: hierarchy of needs.
- Herzberg's two-factor theory: hygiene factors (salary, policies, working conditions, supervision) prevent dissatisfaction; motivators (achievement, recognition, responsibility, advancement, the work itself) create satisfaction.
- McGregor's Theory X and Theory Y (1960): Theory X assumes people dislike work and need control; Theory Y assumes people seek responsibility and are self-directed.
5. Budgeting and Material Management
- Types of budget: operating (day-to-day running costs), capital (major equipment and buildings), personnel (salaries). Zero-based budgeting justifies every item afresh each year.
- ABC analysis (by annual consumption value):
- A items: about 10% of items but about 70% of the value—tightest control.
- B items: about 20% of items and 20% of the value.
- C items: about 70% of items but only about 10% of the value.
- VED analysis (by criticality): Vital (life-saving, must never be out of stock, e.g., emergency drugs, oxygen), Essential, Desirable.
- Stock rotation: FIFO (first in, first out) and FEFO (first expiry, first out) to prevent expiry.
- Indent is the formal requisition for supplies; inventory is the periodic count; condemnation is the formal write-off of unserviceable articles by a board.
6. Records and Reports
- Purposes: communication, continuity of care, legal evidence, audit, research, and teaching.
- Common ward records: patient case file, nursing care plan and notes, Kardex (summary card of each patient's care), medication administration record, intake-output chart, ward census, stock and indent registers, and handover reports.
- Reports: shift handover, daily ward report, incident (adverse event) reports, and statistical returns.
- Good records are accurate, complete, legible, concise, signed, dated and timed, and never altered.
7. Quality Assurance in Indian Health Care
- NABH (National Accreditation Board for Hospitals & Healthcare Providers) accredits hospitals against quality and patient-safety standards.
- National Quality Assurance Standards (NQAS) for public health facilities.
- Kayakalp (launched 2015): awards public facilities for cleanliness, hygiene and infection control.
- LaQshya (launched 2017): improves quality of care in labour rooms and maternity operation theatres.
- Nursing audit reviews records (retrospective) or ongoing care (concurrent) against standards.
8. Conflict, Change and Time Management
- Conflict-handling modes (Thomas-Kilmann): competing, collaborating (win-win), compromising, avoiding, accommodating.
- Kurt Lewin's change theory: unfreezing (creating readiness for change), moving/changing (implementing the new practice), refreezing (making it the new norm).
- Time management: set priorities, plan the shift, group tasks, delegate appropriately and avoid interruptions.
In a ward, one nurse gives all the medicines, another takes all the vital signs and a third does all the dressings. Which method of patient assignment is this?
Functional nursing
Case method (total care)
Team nursing method
Primary nursing
A hospital store classifies items as vital, essential or desirable. Which management technique is being used?
VED analysis
FIFO stock rotation
ABC analysis
Zero-based budgeting
According to Herzberg's two-factor theory, which of these is a motivator rather than a hygiene factor?
Hospital policies and administration
Recognition for achievement
Salary and annual increments
Good physical working conditions
Sections you finish are checked off in the contents.