SECTION 1

INTRODUCTION

Introduction To Ward Management

 
INTRODUCTION
Ward management is the responsibility of the head nurse and her nursing
team. The ward management includes: Management of client care,
management of the personnel, management of supplies and equipments and
management of environment. The head nurse is in-charge of a small
individual nursing unit. She is responsible to the director of the nursing
service either directly or through a supervisor. Head nurse holds one of the
important positions in the hospital. She is administrative officer who receives
her authority in direct line from the director of the hospital through the
director of nursing service. In democratic institutions she has an opportunity
to participate in the formulation of hospital policy which affects her work.
Head nurse in a hospital in which student nurses are educated is responsible
to the director of the school of nursing for providing on her ward a suitable
educational field. The head nurse may or may not have responsibility for
formal ward teaching.2
 
FACTORS INFLUENCING WARD MANAGEMENT
Ward management is one of the prerequisites for good nursing care. There
are many factors involved in good ward management, which the nurse
manager/supervisor needs to understand thoroughly for good management of
the ward as follows.
1. Knowledge of the ward means that knowledge of all the duties and
activities to be performed in ward.
2. Planning the schedule of the ward refers to a planned program for each
day's work to save time and use available time in a useful way for nursing
the clients.
3. Starting the work on time: Proper arrangements are made so that all
nurses do their job in right time as assigned promptly.
4. Preventing interruptions: Good management requires avoidance of
interruption whenever possible, e.g. changing assignments are anticipated.
5. Establishment of ward routines: These provide a plan for delegation of
duties and getting the work done in an efficient way. Policy manuals of the
institution help to establish ward routines which include handling orders,
writing and giving reports, checking medicine cards, summarizing charts,
handling telephone calls, checking and ordering, supplies, keeping
cupboards stocked distributing linen, collecting specimens, there is more
time left for individualized nursing, supervision and teaching.
6. Use of democratic method in establishing ward policy: When ward
objectives are to be determined and policies to be established or changed,
better co-operation are achieved if participation of the entire staff is
encouraged.
7. Orientation of new personnel: Well developed orientation program helps
good ward management. When new staff has entered the hospital, they
must be oriented to hospital as well as the ward, which helps new nurses
develop desirable understanding and attitudes.
 8A. Orientation of hospital will include the type of hospital, organization
of hospital, aim of nursing service, relationship of hospital with
medical/nursing schools or colleges, doctors, different departments in
relation to nursing services, health services for nurses, meal hours, plans
for periodical conferences and staff development.3
 8B. Orientation of ward/unit will include the introduction of new nurses
to ward personnel. Services represented on the ward (medical, surgical,
gynecology, etc), methods of assignment working schedule of the day
(patients time of awakening, taking JPR, meal timings, etc.) resting hours,
visiting hours, etc. duties of non-professional workers, methods of
obtaining daily assignments (Handling orders, charting, etc.), ward
 tour/rounds. Location of equipment. Location of existing and emergency
equipments, and other sources of information such as procedures routines,
and ward policy book, etc. and also introduction of required special
experiences.
9. Maintenance of suitable environment: Elements which help maintain
suitable environment in the ward include prevention of noise, good
ventilation, cleanliness of ward, well functioning equipments, good
housekeeping, etc. Because, noise hampers relaxation and rest; improper
ventilation is harmful to health. A sanitary, safe, restful environment is
necessary to the patient's welfare and comfort as well as that of all
members of the ward personnel. Cleanliness and order improve morale and
tend to make workers careful and neat in their habits. Maintenance of
building and equipment in good repair is economical as well as safe and
efficient.
10. Providing supplies and equipment in a hospital: There should be
provision for proper supplies and equipment for efficient work supplies are
expendable items or those articles which are used up and must be recorded
periodically such as soap, and detergents, paper towels, stationery, food,
sterile goods, etc. Equipments include more permanent articles and may be
classified as fixed or movable. Fixed equipment is not a part of the
structure of the building but is attached to its walls or floor such as
sterilizers and sinks. Movable equipments include furniture, instruments,
syringes, dishes, etc.
For good management, all materials (supplies and equipment) should be
adequate free from repair, accessible, and conveniently located and should
maintain the standard, in the materials, according to their use, maintain
good exchange system, inventory and requisition (proper polices and
performs are used for material management). It is always better to
have 4controls. Apply department in every hospital for providing efficient
nursing service.
11. Clear cut, specific orders for medical therapy and nursing: Good
ward management needs a clear cut doctor's orders and nursing orders,
which are very essential to safeguard the patient welfare. They help prevent
 errors and thus they protect the doctor, the nurse and the hospital. It is
always better that orders be written and signed by the doctor. There are
some standing orders that also should be written in the policy book of the
hospital, and then only the nurses are able to carry out the standing orders.
Nursing orders, given by the nurse supervisor, should be specific and easily
communicated to the concerns nurses to carry out and the same which
avoid confusion and other odd events.
12. Record keeping, maintaining accurate records is essential for good
management: They might be patient clinical records, administrative
records, all have legal and scientific value, so that recording competence
should be maintained. Records will include administrative records.
Doctor's orders, nursing orders, nurse's notes, record of treatment, etc.
While using records proper instruction to be followed by proper use of
clinical records. In addition proper maintenance of records of equipments
losses and replacements, records of personnel performance are also a part
of good management.
13. Reporting: Reports are of prime importance both to good ward
management and to a well-functioning hospital. Many reports are oral and
are concerned mainly with the immediate functioning of the ward such as
reports between nurses and reports to doctors and supervisors. Reports are
written as they may be needed for legal purposes, when they are to serve as
a source of reference, or to be used by several people.
Written reports include day, evening and night reports and those relating to
accidents and unusual condition which may reflect the quality of care the
patient has received, Reports to other departments in the hospital and to
agencies outside the institution are usually written. A report to be of the
greatest use and to save time and duplication of efforts must be prompt,
complete, accurate and objective. Reports which have legal 5significance,
especially those describing accidents and mistakes, are written by the
individuals involved and should include all identifying information, which
in any way may have contributed to the situation.
14. Maintenance of high morale among all members of the staff.
15. Establishment of good relationship: Establishing good working
relationship within the ward and with other associates is an essential factor
in good work management. In the hospital where every individual and
every department exists for its contribution to the patient and his well-
being, there are interdependencies and interrelationships which must be
understood and respected. When good relationship exists, people are
enthusiastic about their work. They feel themselves to be a part of the
institution. A warm, friendly atmosphere prevails; the hospital. The attitude
of nurses and other employees is reflected to the patients.
16. Delegating responsibility: Whenever an individual is responsible to
another person, delegation of duties is essential. In a hospital ward the
bedside care o the patients is delegated to the staff and student nurses,
housekeeping duties are assigned to other personnel. The delegation of
responsibility will be made in accordance with the ability of individuals
within the frame of policy of the hospital.
17. Assigning duties and responsibility: Well-planned assignments of
duties and responsibilities have following objectives.
1. To provide the patient with the best possible nursing care.
2. To plan assignment which are interesting and stimulating to professional
growth?
3. To provide a well rounded educational experience for student nurses.
4. To achieve good ward management.
To achieve good ward management, seven principles should be kept in
mind when planning assignments which include:
 
FUNCTIONS OF WARD SISTER
The ward sister is responsible to the nursing superintendent/Matron for the
management of the wards and supervisions of the nursing and domestic
staff.6
Fig. 1.1: Functions of ward sister
She would be assisted in carrying out the following duties by staff nurse
clinical and domestic staff as the case may be. The main aim of the ward
sister should be to foster team spirit in her area of work (Fig. 1.1).
1. TEACHING OF NURSING STUDENTS
1. Planned and incidental teaching.
2. Supervision of student's work.
3. Consultation and cooperation with sister tutor in arranging
demonstration.
4. Discussion with students to promote good attitudes, complete ‘record of
practical work’ and in valuation to confidential reports.
2. WARD STAFF
1. Assignment of work and arrangement of duties by taking rott-calls of
nursing and domestic staff.
2. Co-ordination and facilitating work of other staff, e.g. occupational
therapist, social worker, dietician, voluntary worker.
3. In-service training.
4. Orientation of new staff.
5. Maintaining good relationships among all categories of staff and with
patients and their relatives.
6. Discipline of nursing and domestic staff. Reporting on absence of staff.
 7. Confidential reports.
3. WARD MANAGEMENT
1. Cleanliness of ward, its annexes and environments.7
2. Linen and ward equipment-up-keep and repairs.
3. Custody of dangerous drugs. Records of their administration.
4. Indents for drugs, surgical supplies, stores, diets.
5. Maintenance of stock registers, inventories.
6. Interpretations of hospital policies and regulations and their
implementation.
7. Investigation of complaints.
8. Issue of stores, etc.
4. GENERAL
1. Rounds with medical staff and Nursing Superintendent/Matron.
2. Taking round special visitors.
3. Participation in staff education and staff meetings.
4. Participation in professional activities.
5. Any other duty as may be specified from time to time.
5. NURSING CARE OF PATIENT
1. Admissions and discharges: Management of patient admissions: Greet
new patient, introduce self and others. Orientation of patients to services
of the unit policies, rules, regulation, visiting hours, food timings, etc.
2. Management of patient discharge: Give all instructions for follow-up
care; inform family, hand over belongings.
3. Doctor's rounds: Activities to be performed before rounds:
1. To keep ready all investigations.
2. To complete patient charts organized, in order and ready.
3. To keep unit ready.
4. All equipment in order.
5. All the patients are in bed.
 Activities during Doctor's rounds
1. Assist with the examinations
2. Take notes on significant comments
3. Report symptoms, reactions, etc.
Activities after rounds:
4. See that the patients are comfortable.
5. Carry out the changes ordered, e.g. investigations, new medication,
stat orders, etc.
4. Drug administration: Check for drug stocks, narcotics and drugs
nearing expiry date and take necessary action.8
5. Operation theatre administration (OT): Check OT list, patient and
family is informed, preoperative preparation, patient consent and chart is
complete, etc.
6. Interdepartmental coordination: Establish good interpersonal
relationship with other health service departments in the hospital and
ensure effective coordination to improve patient care. For example:
Dietary, laundry, laboratory, X-ray, blood bank, general services,
biomedical engineering department, etc.
7. Reporting: (A) Make daily written report of problems of patient care
and unit management to the supervisor or the director of nursing service
(Nursing officer) at the end of the shift. (B) Maintain incident reports of
any untoward happenings.
Nursing care of patients in general:
1. Admission and discharge of patient.
2. Efficient nursing care personal comfort and toiled of patient, administration
of drugs and treatment, observation and recording.
3. Patient's diet.
4. Assistance, to medical staff in examination of patients and treatment.
5. Rounds with medical staff.
6. Assistance at or supervision of clinical investigations, pre-operative and
postoperative care.
7. Maintenance of patient records.
8. Care of patient's personal effects in accordance with hospital rules.
9. Following of prescribed rules regarding accident or death of a patient.
10. Giving and receiving reports.
11. Information to relatives and friends.
12. Intimation to Nursing Superintendent/Matron of any special emergency
in the ward.
 
ORGANIZATION PRINCIPLES IN WARD MANAGEMENT
Basic principles of this so-called authoritarian organization are listed by Barr.
Burton and Brueckner and are here adapted to hospital organization.9
1. Authority is centralized in the individual, the director of the hospital.
2. Responsibility may be delegated along established lines. The director of the
hospital delegates to the director of the nursing service the responsibility
for seeing that the patients in the hospital are well-nursed. The standards of
good nursing are determined by the director of nursing service and her staff
members.
3. Clear and unambiguous delegation of authority must accompany the
delegation of responsibility. The director of nursing service, since she is
responsible for the quality of nursing care, must have the authority to
employ and discharge nurses and other nursing service personnel.
4. Lines through which this delegated authority will flow must be clearly and
ambiguously defined. No individual should receive suggestions covering
the same item from more than one person.
5. Duties and activities must be assigned down through the line of authority.
6. The performance of duties assigned to any level will be checked by the
next higher level through the system.
7. Facility for cooperation and coordination must be provided through group
meetings, conferences, common planning, written instructions, reports and
the like.
8. There must be flexibility of operation. Sometimes conditions within the
institution make it advisable to vary relationships from the usual pattern.