J Nurs Acad Soc.  1972 Dec;3(1):13-40.

A Study for Improvement of Nursing Service Administration

• Park JH

Abstract

Much has been changed in the field of hospital administration In the wake of the rapid development of sciences, tedmiques and systematic hospital manage- ment. However, we still have a long way to go in organization, in the quality of hospital employees and hospital equipment and facilities, and in financial sup- port in order to achieve proper hospital management. The above factors greatly effect the ability of hospitals to fulfill their obligation in patient care and nur- sing services. The purpose of this study is to determine the optimal methods of standardiza- ion and quality nursing so as to improve present nursing services through inve- stigations and analyses of various problems concerning nursing administration. This study has been undertaken during the six month period from October 1971 to March 1972. The 41 comprehensive hospitals have been selected from amongst the 139 in the whole country. These have been categorized according to the specific purposes of their establishment, such as 7 university hospitals, 18 national or public hospitals, 12 religious hospitals and 4 enterprise ones. The following conclusions have been acquired thus far from information obt- ained through interviews with nursing directors who are in charge of the nur- sing administration in each hospital, and further investigations concerning the purposes of establishment, the organization, personnel arrangements, working conditions, practices of service, and budgets of the nursing service department. 1. The nursing administration along with its activities in this country has been uncritically adopted from that of the developed countries. It is necessary for us to re-establish a new medical and nursing system which is adequate for our social environments through continuous study and research. 2. The survey shows that the 7 university hospitals wer chiefly concerned with education, medical care and research; the 18 national or public hospitals with medical care, public health and charity work; the 12 religious hospitals with medical rare, charily and missionary works; and the 4 enterprise hospitals with public health, medical care and charity works. In general, the main purp- oses of the hospitals were those of charity organizations in the pursuit of me- dical care, education and public benefits. 3. The survey shows that in general hospital facilities rate 64 per cent and medical care 60 per-cent against a 100 per cent optimum basis in accordance with the medical treatment law and approved criteria for training hospitals. In these respects, university hospitals have achieved the highest standards, followed by religious ones, enterprise ones, and national or public ones in that order. 4. The ages of nursing directors range from 30 to 50. The level of education achieved by most of the directors is that of graduation from a nursing techn- ical high school and a three year nursing junior college; a very few have gr- aduated from college or have taken graduate courses. 5. As for the career tenure of nurses in the hospitals: one-third of the nurses, or 38 per cent, have worked less than one year; those in the category of one year to two represent 24 per cent. This means that a total of 62 per cent of the career nurses have been practicing their profession for less than two years. Career nurses with over 5 years experience number only 16 per cent; therefore the efficiency of nursing services has been rated very low. 6. As for the standard of education of the nurses: 62 per cent of them have taken a three year course of nursing in junior colleges, and 22 per cent in nu- rsing technical high schools. College graduate nurses come up to only 15 per cent; and those with graduate course only 0.4 per cent. This indicates that most of the nurses are from nursing technical high schools and three year nursing junior colleges. Accordingly, it is advisable that nursing services be divided accor- ding to their functions, such as professional, technical nurses and nurse's aides. 7. The survey also shows that the purpose of nursing service administration in the hospitals has been regulated in writing in 74 per cent of the hospitals and not regulated in writing in 26 per cent of the hospitals.The general purp- oses of nursing are as follows: patient care, assistance in medical care and edu- cation. The main purpose of these nursing services is to establish proper ope- rational and personnel management which focus on in-service education. 8. The nursing service departments belong to the medical departments in alm- ost 60 per cent of the hospitals. Even though the nursing service department is formally separated, about 24 per cent of the hospitals regard it as a functional unit in the medical department. Only 5 per cent of the hospitals keep the department as a separate one. To the contrary, approximately 12 per cent of the hospitals have not established a nursing service department at all but surb- odinate it to the other department. In this respect, it is required that a new hospital organization be made to acknowledge the independent function of the nursing department In 76 per cent of the hospitals they have advisory commit- tees under the nursing department, such as a dormitory self-regulating commi- ttee, an in-service education committee and a nursing procedure and policy committee. 9. Personnel arrangement and working conditions of nurses 1) The ratio of nurses to patients is as follows: In university hospitals, 1 to 2.9 for hospitalized patients and 1 to 4.0 for out-patients; in religious hospitals, 1 to 2.3 for hospitalized patients and 1 to 5.4 for out-patients. Grouped together this indicates that one nurse covers 2.2 hospitalized patients and 4.3 out-patients on a daily basis. The current medical treatment law stipulates that one nurse should care for 2.5 hospitalized patients or 30.0 out-patients. Therefore the statistics indicate that nursing services are being performed with an insufficient number of nurses to cover out-patients. The current law concerns the minimum number of nurses and disregards the required number of nurses for operation rooms, recovery rooms, delivery rooms, new-born baby rooms, central supply rooms and emergency rooms. Accordingly, the medical treatment law has been requested to be amended. 2) The ratio of doctors to nurses: In university hospitals, the ratio is 1 to 1.1; in national or public hospitals, 1 to 0.8; in religious hospitals 1 to 0.5; and in private hospitals 1 to 0.7. The average ratio is 1 to 0.8; generally the ideal ratio is 3 to 1. Since the number of doctors working in hospitals has been rece- ntly increasing, the nursing services have consequently been overloaded, sacrif- icing the services to the patients. 3) The ratio of nurses to clerical staff is 1 to 0.4. However, the ideal ratio is 5 to 1, that is, 1 to 0.2. This means that clerical personnel far outnumber the nursing staff. 4) The ratio of nurses to nurse's-aides, The average 2.5 to 1 indicates that most of the nursing services are delegated to nurse's-aides owing to the shortage of registered nurses. This is the main cause of the deterioration in the quality of nursing services. It is a real problem in the guest for better nursing services that certain hospitals employ a disproportionate number of nurse's-aides in order to meet financial requirements. 5) As for the working conditions, most of hospitals employ a three-shift day with 8 hours of duty each. However, certain hospitals still use two shifts a day. 6) As for the working environment, most of the hospitals lack welfare and hyginic facilities. 7) The salary basis is the highest in the private university hospitals, with enterprise hospitals next and religious hospitals and national or public ones lowest. 8) Method of employment is made through paper screening, and further that the appointment of nurses is conditional upon the favorable opinion of the nursing directors. 9) The unemployment ratio for one year in 1971 averaged 29 per cent.The reasons for unemployment indicate that the highest is because of marriage, up to 40 per cent, and next is because of overseas employment. This high unemp- loyment ratio further causes the deterioration of efficiency in nursing services and supplementary activities. The hospital authorities concerned should take this matter into a deep consideration in order to reduce unemployment. 10) The importance of in-service education is well recognized and establish- ed. It has been noted that on-the-job nurses' training has been most active, with nursing directors taking charge of the orientation programs of newly employed nurses. However, it is most necessary that a comprehensive study be made of instructors, contents and methods of education with a separate section for in-service education. 10. Nursing services' activities 1) Division of services and job descriptions are urgently required. 81 per cent of the hospitals keep written regulations of services in accordance with nursing service manuals. 19 per cent of the hospitals do not keep written regul- ations. Most of hospitals delegate to the nursing directors or certain supervisors the power of stipulating service regulations. In 21 per cent of the total hospit- als they have policy committees, standardization committees and advisory com- mittees to proceed with the stipulation of regulations. 2) Approximately 81 per cent of the hospitals have service channels in which directors, supervisors, head nurses and staff nurses perform their appro- priate services according to the service plans and make up the service reports. In approximately 19 per cent of the hospitals the staff perform their nursing services without utilizing the above channels. 3) In the performance of nursing services, a ward manual is considered the most important one to be utilized in about 32 percent of hospitals. 25 per cent of hospitals indicate they use a kardex; 17 per cent use ward-rounding, and others take advantage of work sheets or coordination with other departments through conferences. 4) In about 78 per cent of hospitals they have records which indicate the status of personnel, and in 22 per cent they have not. 5) It has been advised that morale among nurses may be increased, ensur- ing more efificent services, by their being able to exchange opinions and views with each other. 6) The satisfactory performance of nursing services rely on the following factors to the degree indicated; approximately 32 per cent to the systematic nursing activities and services; 27 per cent to the head nurses ability for nursi- ng diagnosis; 22 per cent to an effective supervisory system; 16 per cent to the hospital facilities and proper supply, and 3 per cent to effective in-service educ- ation. This means that nurses, supervisors, head nurses and directors play the most important roles in the performance of nursing servces. 11. About 87 per cent of the hospitals do not have separate budgets for their nursing departments, and only 13 per cent of the hospitals have separate budg- ets. It is recommended that the planning and execution of the nursing adminis- tration be delegated to the pertinent administrators in order to bring about im- proved per formances and activities in nursing services.

MeSH Terms

Administrative Personnel
Budgets
Charities
Congresses as Topic
Delivery Rooms
Developed Countries
Diagnosis
Education
Education, Medical
Emergency Service, Hospital
Employment
Equipment and Supplies, Hospital
Hospital Administration
Hospitals, General
Hospitals, Private
Hospitals, Public
Hospitals, Religious
Hospitals, University
Humans
Job Description
Jurisprudence
Marriage
Mass Screening
Missions and Missionaries
Morale
Nurses' Aides
Nursing Services*
Nursing Staff
Nursing*
Nursing, Supervisory
Outpatients
Patient Care
Personnel Management
Public Health
Recovery Room
Salaries and Fringe Benefits
Social Control, Formal
Social Environment
Unemployment
Writing