Management In Nursing Practice Nursing Essay

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The class of MSc-N 2014 visited the Jinnah Post Graduate Medical Hospital as a requisite of the course in Leadership and management on November, 14th 2012. The JPMC is located at Rafique Shaheed Road in Karachi, Sindh, Pakistan. The JPMC is a federally administered public hospital established in 1959. The purpose of the visit is to observe the infrastructure, management system and nursing department and to describe and analyze conflict management system of the organization in leadership and management perspective with the support of literature.


JPMC is a tertiary care hospital with 1160 beds capacity and provides medical facilities in almost every discipline of medicine. The investigation and treatment is free of cost for the public of Pakistan. It provides teaching facilities to a medical college, a nursing school and to a school of physiotherapy. It fulfills the teaching needs of Sindh Medical College (SMC). As per the briefing JPMC is the oldest and the biggest health care facility in the Pakistan. Its school of nursing is also the oldest institute of nursing education in the country. In the hierarchy of the organization, a Director General who is a grade 22 officer (according to the government scales) is on the top. The nursing department in the JPMC is headed by a chief nursing superintendent (CNS) who is in 20 scale officer. The office of the chief nursing superintendent is responsible for the management of nursing division of JPMC which take up more than five hundred employees. The structure of the nursing department is as follows as elucidated by Ms. Azrah Hameed; Nursing Superintended JPMC.

Post Grade No. of Posts

Chief Nursing Superintendent 20 01

Deputy Chief Nursing Superintendent 19 01

Head Nurse 17 47

Charge Nurse 16 500

Aid Nurse 04 100

Mid wife 04 70

Assistant mid wife 04 40

At the time of migration in 1947 from India, violence provoked all over India/Pakistan border that resulted in enormous amount of casualties and an immense shortage of nurses was felt at that time. There was a single nurse in the hospital and she migrated to Bengal. Nuns were performing the role of nurses. Facing the shortage of caring and compassionate nurses, the ministry of health sent ladies to various countries for training of nursing in 1949. Begum Rana Liaqat Ali (the wife of prime minister of Pakistan) and other renounced ladies made tremendous efforts to overcome the shortage of nurses. The first ever school of nursing in the history of Pakistan was then established in JPMC in 1956 which took seven students of nursing for the first batch.

The school of nursing is first ever nursing educational facility in Pakistan adopted apprenticeship model of teaching. Now the nursing school is offering diploma programs for the midwifery and nursing. It also offers degree programs in nursing. The school of nursing opens admission in the month of July every year and offers admissions to the bearer of high school certificate in medical to both diploma and in degree program. The structure of the Nursing School is as follows as explained by Ms. Azrah Hameed; NS JPMC.

Post Grade No. of Posts

Principal 19 01

Nursing Instructor 18 10

Student nurses (regular) - 235

Student nurses (self finance) - 160

Home sisters 04 10

Housekeeping 01 09

As JPMC is a federally administered institute the recruitment is made through Federal Public Service Commission (FPSC) as it does not has Human Resource Department. If the need for the new staff is identified by the CNS, she sends a requisition to Deputy Director for recruitment of new staff. The Deputy Director then collaborates with FPSC and ministry of health. Once the new positions are approved by the government, the FPSC then announces posts for nursing and conduct exams for the announced posts. As there is no well-defined criterion for on-job promotions FPSC and ministry of health are also responsible for promotions in nursing division on seniority bases. Financial planning and budgeting is also done by FPSC and ministry of health. Job incentives for the nurses in the government are more than that of the private sector. At the beginning of their career, students get stipend, as trainee nurses. Soon after completing the training the availability of the job is easier for the regular student nurses through FPSC. The nurses are recruited in scale 16, which is very encouraging for the nurses. The nurses have the facility of pension and general provident fund (GP fund) at the time of retirement.

Duty roster is made monthly. The timing of the morning and evening shifts is six hours and nights are of twelve hour duty. The roster is made on monthly bases and every nurse has to do the night duty every third month. Absenteeism is mostly dependent upon the law and order situation of the city. If situation worsen in the city the student nurses are called to cover for the regular staff under senior nurses. Annual leaves are according to the federal government leave schedule. The leave calendar for the nurses is as follows

Annual leaves 45days /year

Casual leaves 20days /year

Maternity leaves 90days / 3 times in the job life.

There is no Quality Assurance (QA) department in the JPMC. There is no well-defined policy for staff motivation in that health care facility. The staff is encouraged for their extraordinary work only by verbal reassurance. However a statistics department in JPMC is working for electronic registry of patients’ record. Nurses maintain data on several registers that are described below.

Admission and discharge register

Treatment register

Death reporting register

Medico legal register

The nurses have to report the data of their respective ward to the central statistics department. The statistics department compiles all the data and records it. The data can be retrieved for research purposes and also presented in the annual symposium. Yearly educational planning is not there in the JPMC hospital for nursing division.

JPMC is located in provincial capital Karachi. Being the federally administered institute, it welcomes individuals from the Sindh province and from all over Pakistan. People come with diversity of linguistic and cultural background. Nurses have to interact with different people in their day to day job. The people may include patients and the colleagues in the hospital. There is a natural tendency of the conflicts to arrive during the duty.

When asked for the resolution of Conflicts, the speaker replied that they have a procedure for conflict management. If the conflict occurs between the nurse and the medical services or with any other department, then the nurse will report to her supervisor and the same procedure will be followed by the other services. The upraised issues will then be presented in front of the ethical review committee to solve the issue. The decision is then made with the consensus of the committee. Both persons are then counseled by the heads of respective department. The process of conflict resolution is time consuming and less effective as there are other methods available for conflict resolution.


Conflicts are inevitable and have both positive and negative effects. As these challenge the problem solving skills and promote team building on one side but could be devastating to normal individual and organizational functioning. Conflicts may occur due to verity of value system, philosophy, personality structure and personal preferences and style of work. The increasing complexity of health care institutions, specialization role, and hierarchical nature of many health care organizations raises the potential for conflict for all health care providers (Huber, 2006, P.179).

According to Huber (2006) conflict is a natural role of self-interest behavior. Conflicts have its effects both on personal and organizational performance. If the conflicts are not handled meticulously, they may result in to the disruption of the functioning of the organization. This is of immense importance to nursing profession as it derives the energy from productivity of care to unattended work of nurses. Being the biggest department in any health care institution, interdepartmental and intradepartmental conflicts of nurses could have devastating effects on the finance and the on the reputation of the organization. Conflicts have the capacity to reduce the individual performance and can result in health related outcomes. Interdepartmental conflicts could lead to low work output, low morale, and can be the cause of absenteeism. Unresolved conflicts may result in termination and could claim loss of resource of the organization as elaborated by Goodyear (2006). There must be some preemptive, to stop the conflict occur, as well as inquisitive strategy, in case of occurrence of conflict, to overcome this problem at the organizational level and to keep the process of organization going on. Keeping both positive and negative outcome of conflicts in planning, organizations keep conflict management programs. Goodyear (2006) mentioned a study conducted by the American Arbitration Association demonstrated that those organizations that were ‘Dispute-wise’ in conflict management demonstrated stronger relationships with customers, suppliers, business partners and employees, lower legal costs and better utilization of legal resources. Conflict management needs to be incorporated into personal skill so there must be some training and workshops for the health care providers to boost the capacity of problem solving of individuals. If the conflict is managed by the committee than the decision must be collaborative having the input of all stake holders, including nursing and the decision must be not solitary. Hiemer (2008) further elaborates that joint decision making that limit participation of individual, who were involved in conflict, would result in rejection of decision and unacceptable outcomes.


JPMC is a well established, tertiary care, public sector hospital that provides medical service in almost every discipline of medicine and surgery. Where it offers services to public for the treatment of ailment it also furnishes educational facilities to students of medicine and nursing. It developed much since its beginning. It still has an enormous capacity to improve its departments, procedures and policies. Conflict prevention and timely resolution, that is collaborative in decision making, should be the part of its risk management plan. Individuals must be trained to avoid the conflict to occur by incorporating the teaching of management strategies at basic skills training level for all health care disciplines. The organization must adapt to the modern methods of dealing with the conflicts by equipping with policy and procedure that are followed in day to day routine.