1. Nursing Management M.Sc II
Year
Organization
Dr.Anjalatchi
Muthukumaran
Vice principal
Era college of Nursing , Era
University

2. Content of the syllabus
Total hours: 15 hours s
 Introduction
 Concept
 Principles
 Objectives
 Types
 Theories
 Minimum requirements for organization
 Developing an orgnizational structure
 Levels
 Organizational effectiveness
 Organizational climates

3. Continued
 Organizing nursing services and
patient care
 Methods of patients assignment
 Advantages and disadvantages
 Primary nursing care
 Planning and organizing : hospital ,
unit , ancillary services (specifically
CSSD dept, laundry , kitchen dept,
laoboratory services , emergency dept
)

4. Continued
 Disaster management plan :
 Plan
 Resource
 Mock drill etc.
 Application to nursing services and
nursing education , nursing
administration etc.
 Summary
 Conclusion
 Questions related to topic
 References

5. LEARNING OBJECTIVES
 The purpose of an organization structure
 The meaning of "organizing" and "organization."
 The distinction between formal and informal
organization.
 How organization structures and their levels are due to
the limitations of the span of management.
 The exact number of people a manager can effectively
supervise depends on a number of underlying variables
and situations.
 The nature of entrepreneuring and intrapreneuring.
 The key aspects and limitations of reengineering.
 The logic of organizing and its relationship to other
managerial functions.
 That organizing requires taking situations into account.

6. Organizing System of Roles
 What Part to Play How’s related to
each other Maintaining
 Designing ROLES
 Coordinating Efforts an understood
area of discretion or clear idea of the
major duties or activities involved
verifiable objectives
 TOOLS Supply of Needed Information
Performing in that role to exist and be
meaningful, it must incorporate

7. Organizing
 A basic process of combining /
integrating Human / Physical /
Financial resources in productive
interrelationship for the achievement
of enterprise objectives

8. Definition of Organization
 Organization implies a formalized
intentional structure of roles or
positions Effort Pooling towards
designated objectives through
definition / division of activities /
responsibilities / authority

9. Meaning of organization
 The word organization may convey at
least 3 meanings:
 Firstly it may refer to the activity of
management in arranging people, tasks
and resources in the most orderly and
efficient manner.
 Secondly it may also name the
arrangement itself, the outcome of the
organizing activity.
 Thirdly, it may describe any number of
businesses, behavioural and humanistic
concepts.

10. Definition of organization
 Definition: Organisation is a group of people
working together and with each other towards the
achievement of the common goals‟. Koontz and
O’Donnell, ‘essentially as the creation and
maintenance of an intentional structure of role’.
 From the above definitions it is clear that,
 Any organisation must have defined goals or
objectives.
 The functionaries shall endeavour to achieve
those goals and objectives.
 The structure of duties and activities necessary
for the conduct of or operation of activities
without which the organisational objectives
cannot be achieved.

11. Concept of organization
 The organisation must
 1) Reflect objectives and plans of the
organisation.
 2) Reflect the authority available to
various categories of managers
belonging to different management
levels.
 3) Reflect its environment.
 4) Be manned with trained and
appropriate people, commensurate with
their job requirements.

12. Identification and
classification
 identification and classification of
required activities grouping of activities
necessary to attain objectives Assigning
responsibility with necessary authority
 To a manager for each grouping Coordination
in organizational Structure Vertically,
Horizontally Departmentation Manageable
units
 Maximum possible specialization Delegation
Aptitude / Attitude Job Requirement /
Capabilities Organizing involves
Synchronization Interrelationship between
different positions must be clearly defined
From whom ? To whom ?

13. Organisation has
four connotations:
 Administrative function, as a system, as an operation and as
a result.
 1.Administrative Function : organisation is a process of
identification and grouping of activities with determination and
establishment of authority relationships for these group of
activities as well as arranging for men, materials, machines
and money.
 2. as a system, organization consists of many interrelated
and interdependent subsystems; each system and subsystem
has the component of:
 a) input: human resources, material resources, information
and energy serve as input.
 b) throughput: the methods through which functions are
carried out.
 c) Output: the actual outcome.
 d) management component: the system sees that the desired
outcomes are obtained.

14.  3. in an operational: organisation is involved with
determination and defining of duties and responsibilities of
the personnel and establishment of interrelationship between
the various activities within the organisation.
 4. result: a gp of people working together to accomplish the
laid down common objectives or goals with in a defined and
specific framework. Steps in organisation
 1. Determination of objectives for each activity.
 2. Deciding on the various types of activities to be undertaken
with in the framework of the formulated plan to attain the
goals of the organisation.
 3. Grouping of activities , their similarity, interrelationships,
competencies and capacities required in performance of
these activities, its importance in relation to achievement of
organizational goals.
 4. Deciding different groups of activities in terms of - The
number of staff - The eligibility requirement of staff

15. ORGANIZATIONAL DESIGN

19. ORGANIZATIONAL DESIGN
(SMALL BUSSINESS )

20. ORGANIZING INVOLVES

21. STRUCTURE DESIGN

22. FORMAL ORGANIZATION

23. INFORMAL ORGANIZATION

24. ORGANIZATION WITH NARROW
SPAN

25. ORGANIZATION WITH WIDE SPAN

26. Principles of organisation
 1. Principle of chain of command: Communication
flows through the chain of command or channel of
communication tends to be one way downward.
 In a modern nursing organization, the chain of
command is flat, with line managers, technical, clerical
staffs that support the clinical staff.
 The communication flows freely in all directions, with
authority and responsibility delegated to the lowest
operational level.
 This principle supports a centralised authority that
aligns authority and responsibility.
 The organizations are established with hierarchial
relationships, within which the authority flows from top
to bottom in order to be satisfying to members,
economically effective and successful in achieving the
goals

27. 2. Principle of unity of
command:
 . An employee has one supervisor / one leader and one
plan for a group of activities with the same objective.
 Also called principle of responsibility. The
organisational set up should be arranged in such a way
that a subordinate should receive the instruction or
direction from one authority or boss.
 Primary nursing and case management modality
support this principle. (Many professional nurses
engage in matrix organisations in which they answer to
more than one supervisor).
 In the absence of unity of command The subordinate
may neglect his duties. It will result in the non
completion of any work. There is no guidance available
to the subordinates and there is no controlling power for
the top executives of the organisation. Further some
subordinates will have to do more work and some
others will not do any work at all.

28. 3. Principle of span of control:
 Span of control refers to the maximum number of members
effectively supervised by a single individual. (The number of
members may be increased or decreased according to the nature of
work done by the subordinates or the ability of the supervisor.
 The span of control enables smooth functioning of the organisation.
 Person should be a supervisor of a group that she can manage in
terms of numbers, functions, and geography. The more highly
trained the employee, the less supervision is needed.
 Employees in training need more supervision to prevent blunders.
When different levels of nursing employees are used, the nurse
manager has more to coordinate.
 In the past the nurse managers had a narrow span of control. They
were responsible for one nursing unit and a limited number of staff.
 Recently the span of control has increased to the point that the
nurse managers have to cover several nursing units and
departments with a large number of employees.
 This is also called span of management or span of supervision .
This principle is based on the principle of relationship.

29. 4. Principle of specialization or
division of work:
 Each person should perform a single leading function.
 There is a division of labor: a differentiation among kinds of
duties.
 Specialization is the best way to use individuals and groups.
 Division of work means that the entire activities of the
organisation are suitably grouped into departments and
sections. (The dept and sections may be further divided into
several such units so as to ensure maximum efficiency).
 This will help to fix up the right man to the right job and
reduce waste of time and resources).
 The work is assigned to each person according to his
educational qualification, experience, skill and interests.
 He should be mentally and physically fit for performing the
work assigned to him. The required training may be provided
to the needy persons.
 It will result in attaining specialisation in a particular work or
area

30. 5. Hierarchy or scalar chain
 It is the order of rank from top to
bottom in an organisation.
 This is also called a chain of
command or line authority. (Normally,
the line of authority flows from the top
level to bottom level. It also
establishes the line of
communication).
 Each and every person should know
who is his supervisor and to whom he
is answerable.

31. 6. Centrality
 It relates to the position or distance
the person has on the organisational
chart from other workers.

32. 7. Unity of objectives
An establishment or enterprise exists to
achieve certain laid down objectives.
The orgn requires to be geared towards
fulfilment of these objectives.
Hence this principle dictates that it is
essential for the organisational
objectives to be formulated in clear,
unambiguous, achievable and
measurable terms which should be
understood by all concerned.

33. 8. Definition of jobs/ principle of
definition
 It is necessary to define and fix
duties, responsibilities and authority of
each worker.
 In addition to that, the organisational
relationship of each worker with others
should be clearly defined in the
organisational set up.

34. 9. Principle of balance
 There are several units functioning
separately under one organisational
set up.
 The work of one unit might have been
commenced after the completion of
the work by another unit.
 So it is essential that the sequence of
work should be arranged scientifically.

35. 10. Principle of equilibrium
balance
 In certain periods, some sections or
departments are overloaded and some
departments are underloaded.
 During this period, due weightage should
be given on the basis of the new
workload.
 The overloaded sections or departments
can be further divided into subsections or
subdepartments.
 It would entail in the effective control
over all the organisational acivities

36. 11. Principle of continuity
 Administration is a continuing or ongoing
process – recycling the structure of the
organistion based on the economic,
environmental and socio-political
changes.
 There should be a reoperation of
objectives, readjustments of plans and
provision of oppurtunities for the
development of future management.
 This process is taken over by every
organisation periodically.

37. 11. Principle of continuity
 Implies routine decision making should rest
with lower levels of management within the
policy framework and only unusual or
exceptional matters should be referred to the
higher levels of management for taking
decisions.
 The junior officers are disturbed by the
seniors only when the work is not done
according to the plans laid down.
 It automatically reduces the work of middle
level officers and top level officers.
 So the top level officers may use the time
gained by reduction in workload for framing
the policies and chalking out the plans of
organisation

38. 13. Principle of unity of
direction
 Also called principle of co-ordination.
 The major plan is divided into sub
plans.
 Each sub plan is taken up by a
particular group or department.
 All the gps or depts are requested to
cooperate to attain the main objectives
or in implementing major plan of the
organisation.

39. 14. Principle of
communication
 A two way communication flow from
top to bottom levels and from bottom
to top levels is a prerequisite to obtain
an effective organisational set up.

40. 15. Principle of flexibility
 to meet the challenges of the increasing and
changing demands of the environment, an
organisation structure is subjected to change.
 As such rigidity has to be avoided and
flexibility is essential in the organisation
structure, so that changes can be brought
about without disrupting basic design of the
structure.
 Classification of organisation The
organisation can be classified on the basis of
authority and responsibility assigned to the
personnel and the relationship with each
other.

41. In this way organisation can be
either formal or informal.
Provides a framework for defining
responsibility, authority, delegation and
accountability.
Depending on the organizational philosophy,
the formal structure may be rigid or loose.
The formal organisation represents
the classification of activities within the
enterprise,
indicates who reports to whom and explains
the vertical journal of communication which
connects the chief executive to the ordinary
workers.

42. Organizational structure
An organisational structure clearly defines the
duties, responsibilities, authority and
relationships as prescribed by the top
management.
(In an organisation, each and every person is
assigned the duties and given the required
amount of authority and responsibility to carry out
this job).
It creates the coordination of activities of every
person to achieve the common objectives.
It indirectly induces the worker to work most
efficiently.
The interrelationship of staff members can be
shown in the organisation chart and manuals
under formal organisation.

43. Characteristics of formal
organization:
 It is properly planned.
 It is based on delegated authority.
 It is deliberately impersonal.
 The responsibility and accountability at
all levels of organization should be
clearly defined.
 Organisational charts are usually drawn.
 Unity of command is normally
maintained.
 It provides for division of labour.


44. Advantages of formal
organisation:
 1. The definite boundaries of each
worker is clearly fixed.
 It automatically reduces conflict
among the workers. The entire
building is kept under control.
 2.Overlapping of responsibility is
easily avoided. The gaps between the
responsibilities of the employees are
filled up.

45.  3. Buck passing is very difficult under the
formal organisation. (Normally exact
standards of performance are
established under formal organisation. It
results in the motivating of employees).
 4. A sense of security arises from
classification of the task.
 5. There is no choice for favouritism in
evaluation and placement of the
employee.
 6. It makes the organisation less
dependant on one man.

46. Keith davis observes formal
organization
 Keith davis observes that formal organisation is and
should be our paramount organisation type as a general
rule. It is the pinnacle of man‟s achievement in a
disorganised society.
 It is man‟s orderly, conscious and intelligent creation for
human benefit. Criticisms::
 In certain cases, the formal organisation may reduce
the spirit of initiative.
 Sometimes authority is used for the sake of
convenience of the employee without considering the
need for using the authority.
 It does not consider the sentiments and values of the
employees in the social organisation.
 It may reduce the speed of informal communication
(rules/reg‟s).

47. Informal organisation:
 Informal organisation is an organisational
structure which establishes the relationship on
the basis of the likes and dislikes of officers
without considering the rules, regulations and
procedures.
 These types of relationships are not recognised
by officers but only felt. The friendship, mutual
understanding and confidence are some of the
reasons for existing informal organisation. (For
eg., a salesman receives orders or instructions
directly from the sales manager instead of his
supervisors).
 The informal organisation relationship or
informal relations give a greater job satisfaction
and result in maximum production.

48.  According C.J. Bernard, „informal
organisation brings cohesiveness to
formal organisation.
 It brings to the members of the formal
organisation a feeling of belonging,
status of self respect and gregarious
satisfaction.
 Informal organisations are important
means of maintaining the personality of
the individual against certain effects of
formal organisation which tends to
disintegrated personality.

49.  Characteristics of informal organisation: 1.
Informal organisation arises without any external
cause ie., voluntarily. 2. It is a social structure
formed to meet personal needs. 3. Informal
organisation has no place in the organisation
chart. 4. It acts as an agency of self control. 5.
Informal organisation can be found on all levels
of organisation with in the managerial hierarchy.
6. The rules and traditions of informal
organisation are not written but are commonly
followed. 7. Informal organisation develops from
habits, conduct, customs and behaviour of social
groups. 8. Informal orgn is one of the parts of
total organisation. 9. There is no structure and
definiteness to the informal organisation

50. Advantages of informal
organisation:
 It fills up the gaps and deficiency of the
formal organisation.
 Informal organisation gives satisfaction
to the workers and maintains the stability
of the work.
 It is a useful channel of communication.
 It encourages the executives to plan the
work correctly and act accordingly.
 It fills up the gaps among the abilities of
the managers.

51. Disadvantages of informal
organisation:
 It has the nature of upsetting the
morality of the workers.
 It acts according to mob psychology.
 It indirectly reduces the efforts of
management to promote greater
productivity.
 It spreads rumour among the workers
regarding the functioning of the
organisation unnecessarily.

52. Difference between formal and
informal organisation
 Formal organisation Informal organisation
 It arises due to delegation of authority.
 It arises due to social interaction of people.
 It gives importance to terms of authority and functions. It gives importance to people and their
relationships. It is created deliberately
 It is spontaneous and natural.
 The formal authority is attached to a position.
 The informal authority is attached to a person. Rules, duties and responsibilities of workers are
given in writing.
 No such written rules and duties followed in informal organisation.
 Formal organisation comes from outsiders who are superior in the line of organisation.
 Informal organisation comes from those persons who are objects of its control.
 Formal authority flows from upwards to downwards. Authority flows upwards to downwards
from or horizontally.
 Formal organisation may grow to maximum size.
 Informal organisation tends to remain smaller.
 It is created fortechnological purpose.
 It arises from man‟s quest for social satisfaction.
 It is permanent and stable
 There is no such permanent nature and stability

53. Types of organisation (Levels of
Organisation):
 Broadly there are 3 types of organisation:
 1. Line organisation
 2. Staff organisation
 3. Functional organisation.
 An institution or enterprise may adopt one or other type of
organisation or more than one type of organisation depending upon
its needs.
 Line organisation: It is the oldest and the simplest form of
organisation. It is also known as the military or scalar organization.
 Line functions -where superior exercises direct supervision over a
subordinate – an authority relationship in direct line or steps.
 The line of authority is straight and vertical and each person at the
same level performs the same functions.
 In an enterprise or institution, the chief executive leads the entire
organisation. Here the maximum authority rests on the top or highest
levels of management and the quantum of authority decreases in a
step ladder fashion for the subsequent levels of management in the
hierarchy.

54. The line or straight or vertical line of
authority serves as the channel of:
 i) Command ii) Communication iii) Direction iv)
Coordination v) Control And accountability
 The departments/divisions are formed depending upon
the responsibilities involved and work to be carried out
by each department / division.
 each department and each division is headed by a
divisional/departmental head.
 The following two figures will describe the functions of a
line organisation
 Board of Director/Management
 Chief executive
 Manager manager
 manager manager manager
 Productionmaterials
 marketing finance admn

56. Difference Between an Intrapreneur
and an Entrepreneur
• An intrapreneur is a person who
focuses on innovation and creativity
and who transforms a dream or an
idea into a profitable venture by
operating within the organizational
environment
• The entrepreneur is a person who
does similar things as the
intrapreneur, but outside the
organizational setting

57. Definition of Reengineering •
 “The fundamental rethinking and
radical redesign of business
processes to achieve dramatic
improvements in critical contemporary
measures of performance, such as
cost, quality, service, and speed.“

58. Key Aspects
of Reengineering
 Fundamental rethinking of what the
organization is doing and why.
 Radical redesign of the business
processes Reengineering calls for
dramatic results
 The need for carefully analyzing and
questioning business processes

59. Nursing services at hospital s
 Nurses form a very important group ,
the largest single technical group of
personnel engaged in patient care in
hospitals next to doctors, consuming
approximately one third of hospital
costs. Because they globally consider
24 hour non stop services towards
the patient care services .

60. Nursing care
is required for the prevention of
disease and for promotion of health.
The nursing care of sick patients –
a. in the interest of his or her mental
and physical comfort.
b. by reason of the disease from which
he or she is suffering.

61. Functions of nursing services
are
 1. Clinical
 2. Technical
 3. Caring relationship
 4. Administrative
 5. Educational

62. It is observed
 It is observed that 50% or more of
her time will be spent on non-nursing
functions like
 a. Clerical
 b. Answering telephones
 c. Supervise indent of drugs
 d. House keeping, etc

63. staffing The number of nurses
staffing The number of nurses required to man the
nursing services in a hospital depends on many
factors,
• Number of beds in a hospital
• The type of hospital and the prevailing medical
practice, including kinds of treatment and
medications given and tests and services required
for the patients.
• Pattern of assignment of nurses - based on
functional method, case method or teach method.
• The type and the number of emergency cases
coming into the hospital.
• Available labour - saving devices, automation,
mechanization, centralization
• Level of competence based on - qualification,

64. Work allocation Patterns
of assignment:
 the tasks of the nursing unit are carried out by 3 accepted
patterns of assignment, depending on the training,
experience and the rules of a particular institution.
 1. Functional method: The tasks are divided among the staff.
 2. Case method: Each nurse is assigned one or more cases.
 3. Team method : Under this system the nursing staff is
divided into teams each of which is guided by an experienced
nurse. The team leader is responsible to the ward sister and
she organizes the nursing care for her group of patients.
 4. Group Assignment method: one nurse is assigned to a
group of patient to provide total nursing care.
 5. Primary nursing method: the primary nurse assumes 24-
hour accountability for the care, planning and evaluation.
When on duty on a shift, the primary nurse herself assumes
responsibility for providing total care. Other functions of
primary nurse is the coordination of nursing activities with
physician and other health professionals.

65. Physical dependency
of patients
 This is an important factor in
assessing the workload.
 The patients can be classified under
the following headings:
 a. Totally ambulant
 b. Partially bedfast
 c. Bedfast but not helpless
 d. Partially helpless
 e. Totally helpless

66. Indices of hospital nurses
 The nursing time provided per patient
per day is the most useful and realistic
index, since it takes into account
Occupancy rates, working hours, and
days absent from work

67. How to find out the nurses work
plan
 To find out the average number of
working days per year by a nurse:
 Earned leave 30 days
 Sick leave 10 days
 Casual leave 14 days
 Weekly off 85 days
 Non-working days 139 days
 Total working days in year 365 days
 How Therefore total working days is 226
days

68. To find out the average
number
 To find out the average number of hours
worked per year by a nurse
 Average number of working days per year X
Average number of working hours 226 x 8 =
1808 nursing hours
 To find out the total number of nursing hours
per day
 The hours worked per year by a nurse X total
number of nurses
 For example Total bed capacity of hospital =
500 Required number of nurses = 217 nurses
(as per INC norms 1808 x 217 = 361736

69. To find out the number
 To find out the number of nursing
hours per day
 Total number of nursing hours per
year( 365) 361736 divided by 365
=991.21 nursing hours per day
 To find out the number of nursing
hours per Patient 991 divide by 500 =
1.98 nursing hours per patient per day
approximately

71. Duties of different categories of
nursing staff
 Director of nursing The nursing director
has very little or no technical duty to
perform. The work is mainly
administrative and conceptual. 1.
Supervision - working pattern
 2. Maintaining discipline
 3. Planning diff. services
 4. Preparing policies to upgrade the
routines.
 5. Participating in recruitment of staff
 6. Organizing for academic purposes.
 7. Arrange (in-service) training

72. Sister-in-charge
 Sister-in-charge is the administrative head
of the ward/section. Therefore the duties are
based on responsible attitude and
supervision.
 1. Maintaining cleanliness and orderliness in
the ward.
 2. Supervising housekeeping activities.
 3. Supervise staff nurse, nurse-aides, labour
staff, patients.
 4. Maintaining inventory.
 5. Accompany senior clinician during their
rounds/ discussion and actively participate in
taking and implementing the decisions.

73. Problems faced:
 1. Shortage of nurses due to
 a. improper ratio of nurse : patient
 b. recruitment policy
 c. non availability
 d. migration to other hospitals
 e. increase in requirement.
 2. Dissatisfaction
 3. Absenteeism : particularly for night
duty.
 4. Unionization
 5. Deterioration in standard of
performance

74. Staff Nurse
This category is the most active.
The duties they are expected to carry out are
1. General and routine care of patients as per clinicians
instructions. She is an active bridge between treating clinician
and patients.
2. To assist clinician.
3. Assist or independently perform certain procedure like
a. collecting blood,
b. catheterization of bladder,
c. giving IV fluids,
d. first aid.
4. Assist actively at ante natal clinic, post natal clinic, diabetes,
asthma, etc.
5. Educational activity like health talk, counseling, etc.
6. Attend outdoor activities.
7. Admit and discharge patients.

75. Professional Hazards
 1. Risk of infection
 2. Stress and burn out
 3. Backache due to prolonged
standing and walking on hard surface.
 4. Fatigue due to shift duties.
 5. Improper behavior of some
patients, relatives, labour staff and
even doctors.
 6. Frustration.

76. Thank you so much for
listening