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    Executive summary

    Rapid changes are taking place in the knowledge explosion, in technology and in addition to these complex and increasing numbers of health care demands pose huge challenges for the nursing managers’ technical competence, commitments, knowledge and interpersonal skills. The involvements of the nurses are spread across the health care system’s each level. So they maintain constant touch with the people and play different types of roles. As nurses have to deal with responsibilities that too with dynamism, they need to possess some managerial skills with adequate knowledge. With this, it is quite obvious that a leader must get the work done. For this, it is equally important that the nursing leader must involve his people for professionally getting the works done. Besides these, a proactive nursing leader with the vision and motivating power can bring his people under his fold for achieving a common goal, so that the organisation can not only survive but also thrive, when rapid changes take place in the organisation.

    Since there are several issues a nursing manager needs to take care, among them only the pointed issues have been discussed to fulfil the needs of the assignment by citing the case of IHT (Innlandet Hospital Trust) in Norway. The issues like political and policy environment is such an unavoidable domain, which a prudent institutional manager has to take care of in the institutional activities. Every political affair touches every walk of life; health service is also not spared. The issue related with organisational design and coordination is the backbone of any organisation, but due to the latest reforms in the health organisation’s control, many implications and complications have been visible in the case of IHT. The strong organisational setup, powered by the all-round coordination, can survive a health service institute. The illustration has been incorporated in the later part of this paper. The issue of leadership and teamwork is the main subject matter in this paper. The appropriate chapter discusses this issue with in-depth explanation and justifies the core of the subject matter here, with the case study of IHT. Appropriate utilisation of financial resources is the moral and ethical duty of any professional leader or manager, irrespective of the type of organisation. A studied synopsis can be found in this chapter in the later part of this paper. As pointed at the start of this section, modern day activities are fully dependent on the technology. No activity is possible without harnessing the technology. When we talk about health services, massive benefits have been gifted by this modern science & technologies. The world could have been different, if the science and technology could not offer numerous benefits to the mankind.


    The journey of management is as old as humankind. The trace of existence of management can be found ever since human being turned themselves as communities. In our modern organisation, managers can influence on all phases of his areas of operations. It would have been impossible for our society, if there were no managers and guide the organisation. The same view has been echoed by PeterDrucker, as he states that only effective management can turn the developed countries as the resource pool, and for the developing countries the same is considered as the most needed resources (Blake and Mouton, 1964). A manager’s role is essential to lead the organisation in such a way, through which the organisation can accomplish its goal. All organisations have some objectives and purposes, for this the managers are responsible for using and combining the resources of the organisation. While doing so, the managers are to ensure about achieving the purposes of the organisation.

    Political and policy environment

    A nursing manager must possess political skills, so that he/she can tackle the requirements of conflicting nature, arising from multiple constituencies. With this skill, the manager can think of renewals. A professional manager, as his/her routine job should have the tendency of accepting the structure, as existing. A nursing manager, with full knowledge of political and organisational policy environment, may tend to revise the structure and the process, as per the need and to cope with the ever changing realities, but a manager in IHT did not enjoy all of these.

    According to Cherie and Gebrekidan (2005), many types of external forces, such as competitive actions to technological advancements can pressurise a health care institute to modify its structure, methods of operations, and goals. Inclusive of political pressure, the other external pressures can arise from the organisational changes, legal, social changes, and technological changes, economic and competitive environments. A professional nursing manager must line the supports from the political parties.

    Organization and its structure

    System Theory

    Behera (2016) cited Leadership & Management by Von Bertalanffy through his power point presentation. According to the theory, the applicable concept can be not only applied to all systems, its applications can be spread across all disciplines as well. The theory, proposed by VonBertalanffy, is one among the wholeness which can propose that the whole must be considered as the additional “to the sum of the individual parts”. This system is known as the holism, which is paradoxical to elementarism and is believed to have interrelated sets of elements. There is commonality in all elements of a system. Hospitals, human bodies, automobiles and societies are known as systems. According to Katz & Kahn, the theory of open system gives emphasis on relational attributes of systems, its relationships among the system’s different levels and its environments (1996), which as ben also cited in the Graduate School of Business (2017). Systems are either open or closed. Mainly physical science has closed system, which is self-contained. This system has hardly any relevance, if we study organisations. The perspectives of open system concern the system’s interactions and take care of its environments

    Organisational design and coordination

    A group of people works together in an organisation, under informal and formal behavioural rules, so that the organisation can achieve a purpose, which is of common interest. With a view to achieving the common purpose, an organisation tends to refer to the methods, policies and procedures involved. This tells about the process and structure of the organisation. The design of an organisation refers to the outlines of the informal or formal delegations, communications and the authority. The process of an organisation is related to the organisational methods being used for achieving organisational goals. The formal design of an organisation is visible through the organisational chart, which is otherwise known as the blueprint of the organisation and its design, which portrays about the activities, functions and formal relations, (Cherie and Gebrekidan, 2005).

    The main purpose of depicting the organisational diagram is to clarify about the span of control, chain of command, which should link with all the department personnel and maintain the channel for official communications. As a custom, the formal official structure must be shown, by the diagrammatic form. This form must have the models of three dimensions, with the components like width, height and depth. Various boxes with proper titles need to be positioned vertically, so that it can clarify about different responsibilities and status.The connections of the position boxes are done through lines for showing the flow of authority and communication, spread across the entire network. The lines that interconnect the boxes reveal about the varied types of relations. To exemplify it, a solid line connecting two positions, reveals about command giving relations or direct authority. If the line is broken or dashed or dotted, it is the indicator of consulting relationship and having no prearranged structural frequency. For the purpose of collaborating between controlling or planning, no frequency of the structure is prescribed. In this situation, there is hardly any flow of commands, Cherie and Gebrekidan (2005).

    Leadership & teamwork


    As a health care system’s manager, six management functions are to be implemented for carrying out the management process, as opined by Longest, Darr and Rakich (2000), No 1 is organising. This function entails overall designing of the organisation or the specific unit or division, or even service for which a manager is responsible. Other than these, a manager is expected to designate the interaction’s intentional pattern and reporting relationship. A leader is also expected to determine teamwork assignments, positions and distribution of responsibility and authority, which are critical elements of these functions.No 2 is planning, the role requires a leader to not only set a direction, but also to determine the accomplishment of the organisational goal. This means determining performance targets and setting priorities. No 3 is controlling. In this role management, a leader must monitor staff performance and activities, while taking the suitable actions, so that actions can be corrected for increasing performance. No 4 is staffing, in this role, a leader is expected to acquire and retain manpower resources. Further to it, a leader is expected to develop and maintain his/her workforce by adopting various tactics and strategies. No 5 is directing. For shouldering this responsibility, a leader must take care of this function, by initiating organisational action by means of effective motivation and leadership and keep communicating with his followers. No 6 is Decision making. As a decision maker, a leader ought to be critical to all above said management functions and also be enabling to take effective decision, which must base on the drawbacks and benefits, while searching for the alternatives, (Computers in Nursing Practice, N.D.)


    Achieving goals are teamwork dependant. No leader can do all the jobs on his/her own. A leader must build a team, which should give importance to what it knows and does which is worth some values. A clear standard must be set by a leader. The team member must be well explained about your expectations in terms of quality of work, following safety rules and also well abreast of time keeping. A leader must maintain not only high, but also realistic standards. A leader must explain to his/her subordinates about the “what” and “why” factors. This means, it is the duty of the members of the team what is the necessity of the task and why certain methods are to be adopted for accomplishing the task and finally hoe can it be achieved.

    Financial Resource utilisation

    The administration of nursing service has the entitlement of organising, leading, planning and controlling those which all encompass financial, material information and human resources in an organisational atmosphere for achieving predetermined objectives. The government agencies and outside forces contribute major financial supports for continuing operational process and for fuelling the ongoing functions of the system.Budgeting is also known as the financial plan’s single use, as it covers a particular time length. It uses the numerical terms for those resources which are meant for the activities of the organisation. Budgeting helps a manager to identify organisational resources, i.e. human resources, material resources and monetary resources. Budgeting also communicates about the expected performances.Schedulingdenotes labours’ and resources’ commitments with some time frame works. Business plans are proposed programs’ projects and services’ detailed plan.These all include information for assessing the plan’s financial feasibility. Project’s objectives are stated by the business plan and link them to the strategic plan of the organisation (Cherie and Gebrekidan, 2005).

    Costing out the services of nursing

    Several benefits can be accrued, if a manager can cost out the services of nursing. The benefits are customers’ realisation about the direct care, which has the price value. By this way, customers can understand the health care costs, which turn to be ideally valued.By charging for the services of nursing, a customer does not hesitate paying for the service being rendered to him or her. The patients do not mind paying for the care and service being rendered. Nursing can be considered as the revenue generating centre, instead of cost generating profession (TrondTjerbo, 2009). Compensations can be received by the hospital for their rendered services while accruing the maximum profits. If nursing services are charged, it can help the organisation to boost the professionalism, following the traditional reimbursement pattern for services. By using a system of cost accounting, A manager can not only assess but also can change the department of nursing, which in turn, can help in establishing a reputation for leaderships and innovations. If the responses are quick, it can help the organisation to survive in the environments of rapid changes, (Cherie and Gebrekidan, 2005). By costing out the services of nursing, a manager can boost up productivity, of by taking care of the measures for productivity, which can increase the human resource’ use, while maintaining quality and containing costs.

    Attitude to technology and its utilisation

    It is the blessings of science for taking care of the delivery system, supported by the innovative and excellent applications in the nursing management science. Gan et al., (2005) inform that a huge contribution by the computerisation has helped the nursing practices. The other uncountable blessing from the computerisation is reductions in maintaining medical records and other associated problems. The computerisation has helped the medical fraternity in EMR (Electronic Medical Record System), Personal Digital Assistants, Electronic Prescriptions, Computerized Theatre Management Applications and Computer Automated Cancer Detection, (American Society of Registered Nurses, 2018). Chang et al., (2008) has been cited by American Society of Registered Nurses, (2018) to inform that voice recognition technology’s implementation is the extra feather in the cap of technology revolution.  

    EMR (Electronic Medical Record) systemis a valuable medical record keeping system, which follows digital format. Through this EMR system, the patient’s data can be easily accessed by nurses. The other expanded utilities of the EMR system are tracking all types of medical information. Of course, this system can invade the medical privacy of a patient. EHCR (Electronic Health Care Record)can be maintained through five levels. They are 1) CMR (Computerized Medical Record). 2) An Automated medical record, a paper based record keeping system, which is generated through the computer.3) The EPR (Electronic Patient Record) is another form of computerised record keeping. This record is patient centred; the information is collected from various institutes. 4) The EHR (Electronic Health Record) can add to the general health information to the information bank of EMR. EMRs are not only used in the USA, it is also used in the other parts of the world, but with some operational hitches. No practising nurses, pharmacies, physicians and health care institutions are barred from patient information. This is due to the fact that there are many operative facts, related to EMR, that prevent the free access of the medical data.

    Laerum et al., (2003) inform that the benefits of electronic prescriptions have authorised the nursing staff in the USA to prescribe the nursing procedures.But the system has been found to be with some problems. It has the glitches related to communication. PDA or (Personal digital assistants) are the hand held computers for managing patients. This is aimed at accessing the laboratory reports of patients, which can inform the nurse about the latest treatments, tests and therapies for the patient. PDA system can also update about the patient visits and billing records. This PDA can be instantly used by the nurse for transferring the prescriptions to the pharmacy department. Further to this, a nurse can refer to medical textbooks, and answer the e-mails of the patient.


    The paper has highlighted the crucial roles a manager needs to play in the specific areas of any health service organisation. The case of IHT is an ideal example for any manager to recommend the above issues to his/her Chief Executive or Board.

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