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Innovative approaches in solving

nursing services problems

P.K a r t h i k e y a p r a s a t h
• 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 and
4. To alleviate suffering.
Modern nursing involves
Committees :
1. Bhore committee (1946)
2. Shetty Committee (1966),
3. Kartarsingh committee (1973).
4. Bajaj Committee (1986) and
5. High power committee on nursing
and nursing profession (1989)

Introduction Contd……

• 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.
1. Nursing services:

1. Poor working conditions:

2. Recruitment
3. Job description
4. Lengthy hours of duty and split duty
5. Less salary, Allowances and other
6. Less Promotional opportunities
7. Harassment of Nurses by others
8. Improper supplies
9. Improper supplies
1.Poor working
• 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,
2. Recruitment:
I. Nursing Services Contd….

• Recruitment of trained nurses should be

made by selecting candidates who are
settled and trained in their respective
• 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
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:

• In most of the states and union

territories the duty schedule is “on
duty”, “off duty” and night duty.
*on duty:

• 7.30a.m to
• 5 1/2 hours duty
• 1.00p.m to
• rest
• 4 hours duty
• 4.00p.m to

• 9 1/2 hours duty

• Total
*off duty:

• 7.30a.m to 12.00 • 4 1/2 hours duty

noon • Break
• 12.00 noon to • 4 hours duty
1.00p.m • 8 1/2 hours duty
• 1.00p.m to
• Total

12 hours duty

*Night Duty:
5. Less salary, Allowances and
other Incentives:
• The pay scale of staff nurses has been
recommended by the TukolPay Commission
and implemented by the Karnataka
Government. The Government to
implement the pay scales of nurses of all
• 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
6. Less Promotional
• 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
• 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
8. Improper supplies

• 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:
1.Government institutions:
1. No independent building for
2. No independent principal for
3. Inadequate hostel facilities for
4. Acute shortage of qualified
teachers in nursing,
5. Underutilization of clinical facilities
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.
1. Non-involvement of nursing administrators in planning and
decision making in the governmental hospital

3. No specific power has been assigned to nursing

superintendents but he /she has been made in charge of all
inventories and linen of hospital.

5. Nursing superintendent will have no authorities to sanction

leave to their subordinates.

7. Lack of knowledge in management of hospital among

medical/nursing administrators.

9. Administrator, always dependent on the advice of clerical

3.Nursing Administration

6. Prevalence of role ambiguity, among administration

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.
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 Designation
A. Medical wing:
• Staff Nurse • Staff Nurse
• Senior staff Nurse • Assistant Nursing
• Nursing Officer
Superintendent Grade • Deputy Nursing Officer
• Nursing
Superintendent Grade • Nursing Officers
I • Chief Nursing
• Sr. Nursing Officer(To be created)
Superintendent Grade
Present Designation
B. Public Health Wing
• ANM/Jr.HAF • Primary Health
• LHV/Sr.HAF Nursing
• Asst. Nursing • Community Health
Superintendent (PH) Nursing
• Nursing • Asst. Nursing officer
Superintendent (PH) (Community Health)
• District Nursing • Deputy Nursing Officer
Supervisor (PH) (CH)
• Identifies opportunities for
improvement or overcoming major
• Has a readiness to accept change.
• Creates and sustains the change
• Evaluates, reviews and modifies
activities appropriately for effective
change and
1.Grouping Problems:

I. Working Problems occurring in the

field or setting
b) Mistakes in the nature of omitting or
forgetting the important works that
should be done.
c) Failure to produce works according to
job specialization.
d) Carelessness in workmanship-poor
e) Wastage of manpower, money and
material because of lack of knowledge.
f) Grouping Problems
II. Problems related to policies
b) The issues of inadequate records
and appreciation
c) Carelessness in the care and
maintenance of institutional and
patients property
d) Lack of knowledge regarding the
procedure and policies.
III. Problems involving attitude
and appreciation
b) Conservative attitude towards the
acceptance of new and progressive
c) Lack or team spirit
d) Lack of cooperation among the
health professional
IV. Disciplinary problems
b) Leaving the patients who require
constant attention.
c) Taking off duty without prior
d) Abuse of sick leave privileges
e) Negligence of Duty
f) Lack of interest
g) Quarrelsome.
V. Nursing services Vs Nursing
education problem
a) 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
VI. Intangible and unpredictable
problems of personal
b) Illness, death and accidents to
members in the family causing
emotional, social and economic
pressures apart from work.
c) Personal health problems.
Ways to resolve
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
4. Encouraging risk taking and
• 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