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Some aspects of nursing administration in the local authority services
fnr. J. Nun. Smf. Vol. 3. pp. 89-95, Pcrwmon Prcsr, 1966.
Printcd in Grr;lc Britam
Some Aspects of Nursing Administration in the Local Authority Services A. M. LAMB Su&riulendenl Nursing Ojicer, Public Health Depl., 10 Abbot’s Walk, The Forbury, Reading, Berks.
function of administration is to provide the means whereby the most effective use can be made of the knowledge and skills of those giving the service. Thus the main principle of nursing administration is to provide a framework wherein the individual is able to carry out her duty to her own satisfaction and to the satisfaction of others. During recent years the development of the nursing service has been enhanced by advances which have been made in professional skills and technical proficiencies. Unfortunately, the same advance has not been made in the art of administration and there is ample evidence that better use can be made of the skills acquired by those who make up the nursing team in local authority services. The art of administration is the carrying into effect of any policy, plan or undertaking. In its widest form it must embrace leadership, policy making and planning. In any work situation there are three factors involved:-
THE
i. Policy-what
shall be done;
ii. Organization-the iii. Execution-the
co-ordination carrying
of the efforts of the persons involved;
out of the operation.
1. Policy Policy decisions must be based on verifiable facts which must be collected and classified. At this stage reality must be applied. It is easy to produce an ideal plan, but if the resources necessary to implement it are not available it is useless. True planning takes into account all the limitations as well as the resources of the situation, for example, shortage of personnel, shortage of equipment, and consideration must be given to the financial implications. There are six major characteristics of a good plan, namely:i. It must be based on a clearly is intended to accomplish. ii. It must be simple.
defined objective,
setting out what the plan
The simpler the plan the more chance of success. 89
C
90
A. hf. z.AhfB
iii. It should provide for a proper analysis and classification of actions so that the best use is made of staff and that standards are set in order that quality as well as quantity of performance can be assessed. iv. It should be flexible. The plan must be capable of adaptation to meet emergencies or changing situations. v. It should be balanced, thus ensuring the successful integration of the plan into the total purpose of the undertaking. vi. It should use all available resources to the utmost. 2. Organization It is the process of organization which finds the means, human and material, to meet the situation. It is necessary to make a careful determination of what jobs are to be done and what staff are required. It is important to remember that technical and clerical workers are vitally important to the service and that professional and clerical staff are dependent upon each other. The material needs would include equipment, transport and conditions of service. Nursing administration can only accomplish results through the efforts of other people, thus the organization of work is very much a human affair dependent upon human effort. Therefore, the purpose of organization is to unify human effort which calls for a clear understanding of human relationships. 3. Execution It is essential that some one person should be responsible for the overall direction of the nursing services to ensure that everything is being done in accordance with the policy and principles. This would also ensure that sectional interests are not allowed to conflict with the main purpose. The following factors need to be carefully considered in the process of “execution” :i. The importance of delegation ; if delegation is to be effective, careful selection and placement of senior staff for this purpose is necessary. ii. The vital importance of a personnel programme to recruit, select, and place field staff so that they will be able to obtain as well as give satisfaction. iii. To provide and maintain the best possible working environment. iv. To practise effective methods of joint consultation. v. To make provision for “on the job” training and in-service education for all staff. The Local Authority Nursing Service includes the three branches of health visiting, midwifery and nursing, all working under the general direction of the Medical Officer of Health but with different functions. The aim of the National Health Service Act was to provide a comprehensive health service which would include the promotion and maintenance of physical and mental health, the prevention of ill health, the care and alleviation of disease, and the after care and rehabilitation. Ideally, none of these should be separated from one another, thus again showing the need for integration of the nursing, midwifery and health visiting services.
.w~siJ\iC.~DMIJVIS~R.~TI~KIJvL0c.a .~THORI~
In the report “Health April 1963) it was stated:
and Welf’are” (The Development
SERVICEI'
of Community
91
Care.
“There is another change in public attitude which must profoundly al-I&t the health and welfare services. Along with a wider acceptance of these services, and a more general awareness of their value, has come the realisation that they should be so udminiskwd as to meet more precisely the varying needs of special groups and even of different individuals. In the past the emphasis was on the provision of a range of services; now it is on ascertaining and meeting particular needs. In the future the services will be increasingly sensitive to the specific needs and individual characteristics of the people they are designed to serve.”
Having discussed the function and meaning of administration of the local authority nursing services, I would like to mention nursing administration as it affects myself. As a nursing officer, my duties appear to be threefold:i. To serve the community
by plamling
a programme
and the needs some aspects of
based on human
needs,
ii. to serve the staff, iii. to evaluate
the service and to bc concerned
with “forward
planning”.
1. *To serve the community
The nurse administrator must plan a programme based on the needs of‘ tht community. Such a programme would include all age groups, especially cxpcctant and nursing mothers, parents and young children, the aged, the physically and mentally handicapped and those requiring care and after care scrviccs. In ordci to promote such a programme, it is vital that there is full integration of’the nursing, midwifery and health visiting services. 2. To serve the staf
True leadership is not domination but a process of mutual stimulation in which the leader not only stimulates the group, but is in turn influenced by it, and is thus able to assemble the various skills into one unified driving force. For stimulation to occur, good communication must exist between all members of staff and the employing authority. This basic principle is essential in order to maintain a happy and efficient service. In my own area I arrange staff meetings at regular intervals so that I am able to meet each individual member of staff at least five times a year. Policy is able to be discussed and it is an opportunity to orientate staff to accept changing attitudes and future developments. Nurses, midwives and health visitors attend these meetings so that they are able to interchange their ideas. The principal nursing officer should remcmbcr that all administrative acts have some bearing on human relations, but the most important arc that achievement should be noted, confidence displayed and potential ability recognized and encouraged. 3. Evaluation oj’the service and “j&ward klanning”
Evaluation is a thoughtful appraisal of programme and performance which has as its objective the improvement of the nursing services. Such evaluation would include work progress and outcomes, to develop intelligent methods of selection of priorities, and to make changes which will result in a higher quality of service.
-4. M. LAMB
92
The principal nursing officer is an adviser to the Medical Officer of Health on all nursing matters. In my own case, I attend meetings of the Nursing, Maternity and Child Health Sub-Committee and the Health Committee. It is thus expected that I should prepare reports for committee on any nursing matter, and speak to those reports if required. I am then responsible for implementing these plans after Council’s approval. When working as a principal nursing officer there are certain points to be considered and ones which may present difficulties. These points would include the school health service, the non-medical supervision of midwives, and the fear of co-ordination and control. 1. School Health Service. This service is an admirable preventative service but it is not part of the National Health Service Act. Ninety per cent of local authorities arrange for school nursing duties to be undertaken by health visitors, who then have assistance of ancillary help with routine duties. As the health visitor is a basic family visitor, it is only logical that she should continue to work with the school children whose family background she knows so well. Some authorities still maintain a separate school nursing service and in such cotmties it should still be possible to maintain a link between the school nurse and health visitor so that the service remains firmly centred. There are five basic principles for relationships, namely:i. The fields of the various professions should be clearly defined, ii. each should potentialities, iii. that a personal iv. joint planning
understand approach
the
other
is desirable
and
respect
their
capabilities
and
at all times,
should occur when possible,
v. to decide together
which is the most suitable service in a given situation.
and not 2. .Non-medical supervision of midwives. The word here is “supervisor” The 1937 regulations of the C.M.B. govern the qualifications of administrator. supervisors of midwives. Supervision by itself cannot compensate for poor administration. The purpose of supervision is to improve the quality of the service and to provide a continuous appraisal of the work situation. A supervisor must have mastered the foundations upon which good human relationships are built. With this in mind the non-medical supervisor will then fit happily into the overall nursing administration, although her advice on professional and technical aspects will be sought by the Medical Officer of Health and others whenever required. 3. The fear of co-ordination and control. Co-ordination and control are a logical outcome of the principles of administration, policy, organization and execution. Mary Parker Follet points out that there is a fear of the word “control”, which to many people implies a domination of one individual over others. It is therefore important to appreciate that control means control by facts and not by persons. There are four principles to guide the administrator in securing control:i. Co-ordination by direct control. People actually engaged on the job should be encouraged to get together, pool their ideas and settle differences.
.hTJRSING i4DAfINISTR.4
TIOh’ 1.1; I.OC4L
-4 tTHORlTT-
.FERT’ICE,S
93
ii. Co-ordination in the early stages of a plan. Any plan needs the co-operation of others, and all who play a part should contribute to the plan and thus have an opportunity of foreseeing difficulties. . .. 111. Co-ordination as the reciprocal relating of all the factors in a situation. The process of adjustment creates a new situation, the relationship between one individual and another, or one department and another may be influenced by other individuals or departments. iv. Co-ordination as a continuing process. This rests on the fact that as the situation changes, so there must be machinery to work out new methods to meet the change. Conclusions
Two recent reports have made reference to the need of administering the three nursing services under the direction of a principal nursing officer. The Chief Medical Officer to the Ministry of Health stated in his Annual Report 1963 that “Public health nursing services are becoming more complex. Early discharge from hospital of sick patients and of mothers after confinement and the increasing age and frailty of large numbers of people cared for at home, emphasize the need for closer working between general practitioners, hospital staff, social workers and voluntary agencies. It is evident that there is need for increasing flexibility in the service, and for good management of local authority nursing services. Many authorities have appointed Principal Nursing Officers to do this, with advantages in flexibility, co-ordination and efficiency.” The Report of the Sub-Committee of the Standing Nursing Advisory Committee, 25th June, 1965, stated that “The best use of the local health authority nursing service requires that all three services should be under the general direction of a single principal nursing officer. The primary requirement of the principal nursing officer is administrative ability; she should be able to look for advice on technical aspects to her assistants, the superintendents or supervisors of the individual services.” The channel of promotion thus remains open within each branch of the nursing service. It would not be possible for the principal nursing officer to have wide experience in all three branches of the service-thus the job is open to all and should rest purely on administrative ability. In concluding this paper, I would like to suggest that more thought needs to be given to the selection and training of the future nurse administrator. With the increasing number of integrated training schemes and degree courses the selection in the future should become easier. Are we, the present generation of nurse administrators, ready to accept new concepts in our work? Recently, I received an application from a nurse who had a B.A. honours degree in Latin, Greek and Ancient History. Her hospital reference stated that she was an excellent nurse but a little critical of her nurse training. Surely it is time that we allowed ourselves to be criticized so that we could become more objective and dispassionate in our work. The quality of the administrator will be reflected in the quality of the staff, so it is vitally important to prepare the nurse administrator for the role of leadership.
A. Al. LAAfB
94 R&um&Les les
services
domaines
d’assurer
que
possible,
ces
visites
trois
permet d’une
ses assistantes,
sur des questions
La fonction
de l’administration
la plus effective tout
projet
suivants
programme
entrent
en jeu:
Les obligations 1. servir
la communaute. le personnel.
surveillance
par
La qualite rxtr&nement
lesfaits
doit
secteur,
les moyens b mettre
n’importe
organisation
Afin
manitre
des infirmieres,
qualite
primordiale
pouvoir pour
se referer
lrur
a
demander
qui permettront assurant en pratique
quelle
l’utilisation
le fonctionnement
tlche.
toute
politique.
les trois
facteurs
et execution.
des infirm&es
la directrice
se groupent
doit se rappeler
et non surveillance
de l’administratrice pour
La
dans
soins.
meilleure
directrice
elle de
la
et
en trois categories:
des plans.
ces taches,
important
soigneusement
Dans
politique.
et proposer
d’une
du personnel
consiste
prtvu.
2. servir
En remplissant
generales
et habiletes
de la directrice
3. &valuer
de
et l’efficacitt.
est de fournir
des connaissances
ou
generale
travaillent
obstetrique
techniques.
L’nrt de l’administrateur
des services.
municipalite
administrative;
et surveillantes
leurs conseils
la
fonctionnent
la coordination
est sa capacitt
adjointes
de
sociales,
d’activitts
sous la direction
la souplesse, directrice
relevant
d’assistantes
secteurs
ils ont et6 places
ce qui exigte
d’infirmieres
suivants:
de
se refltte
preparer
l’extcution
de
par
que la surveillance
signifie
les personnes.
dans la qualite
l’administratrice
du personnel; du
service
il est done
des
infirmieres
ses tkhes.
Resumen-El servicio municipal de enfermeras incluye la visita sanitaria, servicios de maternidad. y enfermeras. Para asegurar la mejor utilization de todos 10s tres srrvicios, estos dcberian estar bajo la direction general de una enfermera jefa principal, de esta manera dando lugar a flexibilidad. coordination y eficacia. El requisito primario de la enfermera jefa principal es la capacidad administrativa; deberia ser capaz de poder aconsejar a sus asistentas. la inspectoras de 10s servicios individuales, en 10s asuntos tecnocos. La jiincidn de administration consiste en disponer 10s medios con 10s que pueda y habilidades de1 personal afecto al servicio. realizarse mejor uso de1 conocimiento La fnrea de administration consiste en llevar a efecto cualquier politica, plan o empress. En toda realization de un trabajo hay tres factorrs involucrados, politica. organizacibn y ejecucion. Los deberes de una enfermera jefa son triples:
1. servir a la comunidad. 2. estar encargada 3. evaluar
de1 personal.
y concebir
10s planes.
En el desarralllo de estos deberes debe tener en cuenta que control significa control por hechos y no por personas. La calidad de la administradora se reflejara en la calidad de1 personal, por lo que es de vital importancia preparar para su tarca a la enfcrmera administradora.
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Printcd in Grr;lc Britam
Some Aspects of Nursing Administration in the Local Authority Services A. M. LAMB Su&riulendenl Nursing Ojicer, Public Health Depl., 10 Abbot’s Walk, The Forbury, Reading, Berks.
function of administration is to provide the means whereby the most effective use can be made of the knowledge and skills of those giving the service. Thus the main principle of nursing administration is to provide a framework wherein the individual is able to carry out her duty to her own satisfaction and to the satisfaction of others. During recent years the development of the nursing service has been enhanced by advances which have been made in professional skills and technical proficiencies. Unfortunately, the same advance has not been made in the art of administration and there is ample evidence that better use can be made of the skills acquired by those who make up the nursing team in local authority services. The art of administration is the carrying into effect of any policy, plan or undertaking. In its widest form it must embrace leadership, policy making and planning. In any work situation there are three factors involved:-
THE
i. Policy-what
shall be done;
ii. Organization-the iii. Execution-the
co-ordination carrying
of the efforts of the persons involved;
out of the operation.
1. Policy Policy decisions must be based on verifiable facts which must be collected and classified. At this stage reality must be applied. It is easy to produce an ideal plan, but if the resources necessary to implement it are not available it is useless. True planning takes into account all the limitations as well as the resources of the situation, for example, shortage of personnel, shortage of equipment, and consideration must be given to the financial implications. There are six major characteristics of a good plan, namely:i. It must be based on a clearly is intended to accomplish. ii. It must be simple.
defined objective,
setting out what the plan
The simpler the plan the more chance of success. 89
C
90
A. hf. z.AhfB
iii. It should provide for a proper analysis and classification of actions so that the best use is made of staff and that standards are set in order that quality as well as quantity of performance can be assessed. iv. It should be flexible. The plan must be capable of adaptation to meet emergencies or changing situations. v. It should be balanced, thus ensuring the successful integration of the plan into the total purpose of the undertaking. vi. It should use all available resources to the utmost. 2. Organization It is the process of organization which finds the means, human and material, to meet the situation. It is necessary to make a careful determination of what jobs are to be done and what staff are required. It is important to remember that technical and clerical workers are vitally important to the service and that professional and clerical staff are dependent upon each other. The material needs would include equipment, transport and conditions of service. Nursing administration can only accomplish results through the efforts of other people, thus the organization of work is very much a human affair dependent upon human effort. Therefore, the purpose of organization is to unify human effort which calls for a clear understanding of human relationships. 3. Execution It is essential that some one person should be responsible for the overall direction of the nursing services to ensure that everything is being done in accordance with the policy and principles. This would also ensure that sectional interests are not allowed to conflict with the main purpose. The following factors need to be carefully considered in the process of “execution” :i. The importance of delegation ; if delegation is to be effective, careful selection and placement of senior staff for this purpose is necessary. ii. The vital importance of a personnel programme to recruit, select, and place field staff so that they will be able to obtain as well as give satisfaction. iii. To provide and maintain the best possible working environment. iv. To practise effective methods of joint consultation. v. To make provision for “on the job” training and in-service education for all staff. The Local Authority Nursing Service includes the three branches of health visiting, midwifery and nursing, all working under the general direction of the Medical Officer of Health but with different functions. The aim of the National Health Service Act was to provide a comprehensive health service which would include the promotion and maintenance of physical and mental health, the prevention of ill health, the care and alleviation of disease, and the after care and rehabilitation. Ideally, none of these should be separated from one another, thus again showing the need for integration of the nursing, midwifery and health visiting services.
.w~siJ\iC.~DMIJVIS~R.~TI~KIJvL0c.a .~THORI~
In the report “Health April 1963) it was stated:
and Welf’are” (The Development
SERVICEI'
of Community
91
Care.
“There is another change in public attitude which must profoundly al-I&t the health and welfare services. Along with a wider acceptance of these services, and a more general awareness of their value, has come the realisation that they should be so udminiskwd as to meet more precisely the varying needs of special groups and even of different individuals. In the past the emphasis was on the provision of a range of services; now it is on ascertaining and meeting particular needs. In the future the services will be increasingly sensitive to the specific needs and individual characteristics of the people they are designed to serve.”
Having discussed the function and meaning of administration of the local authority nursing services, I would like to mention nursing administration as it affects myself. As a nursing officer, my duties appear to be threefold:i. To serve the community
by plamling
a programme
and the needs some aspects of
based on human
needs,
ii. to serve the staff, iii. to evaluate
the service and to bc concerned
with “forward
planning”.
1. *To serve the community
The nurse administrator must plan a programme based on the needs of‘ tht community. Such a programme would include all age groups, especially cxpcctant and nursing mothers, parents and young children, the aged, the physically and mentally handicapped and those requiring care and after care scrviccs. In ordci to promote such a programme, it is vital that there is full integration of’the nursing, midwifery and health visiting services. 2. To serve the staf
True leadership is not domination but a process of mutual stimulation in which the leader not only stimulates the group, but is in turn influenced by it, and is thus able to assemble the various skills into one unified driving force. For stimulation to occur, good communication must exist between all members of staff and the employing authority. This basic principle is essential in order to maintain a happy and efficient service. In my own area I arrange staff meetings at regular intervals so that I am able to meet each individual member of staff at least five times a year. Policy is able to be discussed and it is an opportunity to orientate staff to accept changing attitudes and future developments. Nurses, midwives and health visitors attend these meetings so that they are able to interchange their ideas. The principal nursing officer should remcmbcr that all administrative acts have some bearing on human relations, but the most important arc that achievement should be noted, confidence displayed and potential ability recognized and encouraged. 3. Evaluation oj’the service and “j&ward klanning”
Evaluation is a thoughtful appraisal of programme and performance which has as its objective the improvement of the nursing services. Such evaluation would include work progress and outcomes, to develop intelligent methods of selection of priorities, and to make changes which will result in a higher quality of service.
-4. M. LAMB
92
The principal nursing officer is an adviser to the Medical Officer of Health on all nursing matters. In my own case, I attend meetings of the Nursing, Maternity and Child Health Sub-Committee and the Health Committee. It is thus expected that I should prepare reports for committee on any nursing matter, and speak to those reports if required. I am then responsible for implementing these plans after Council’s approval. When working as a principal nursing officer there are certain points to be considered and ones which may present difficulties. These points would include the school health service, the non-medical supervision of midwives, and the fear of co-ordination and control. 1. School Health Service. This service is an admirable preventative service but it is not part of the National Health Service Act. Ninety per cent of local authorities arrange for school nursing duties to be undertaken by health visitors, who then have assistance of ancillary help with routine duties. As the health visitor is a basic family visitor, it is only logical that she should continue to work with the school children whose family background she knows so well. Some authorities still maintain a separate school nursing service and in such cotmties it should still be possible to maintain a link between the school nurse and health visitor so that the service remains firmly centred. There are five basic principles for relationships, namely:i. The fields of the various professions should be clearly defined, ii. each should potentialities, iii. that a personal iv. joint planning
understand approach
the
other
is desirable
and
respect
their
capabilities
and
at all times,
should occur when possible,
v. to decide together
which is the most suitable service in a given situation.
and not 2. .Non-medical supervision of midwives. The word here is “supervisor” The 1937 regulations of the C.M.B. govern the qualifications of administrator. supervisors of midwives. Supervision by itself cannot compensate for poor administration. The purpose of supervision is to improve the quality of the service and to provide a continuous appraisal of the work situation. A supervisor must have mastered the foundations upon which good human relationships are built. With this in mind the non-medical supervisor will then fit happily into the overall nursing administration, although her advice on professional and technical aspects will be sought by the Medical Officer of Health and others whenever required. 3. The fear of co-ordination and control. Co-ordination and control are a logical outcome of the principles of administration, policy, organization and execution. Mary Parker Follet points out that there is a fear of the word “control”, which to many people implies a domination of one individual over others. It is therefore important to appreciate that control means control by facts and not by persons. There are four principles to guide the administrator in securing control:i. Co-ordination by direct control. People actually engaged on the job should be encouraged to get together, pool their ideas and settle differences.
.hTJRSING i4DAfINISTR.4
TIOh’ 1.1; I.OC4L
-4 tTHORlTT-
.FERT’ICE,S
93
ii. Co-ordination in the early stages of a plan. Any plan needs the co-operation of others, and all who play a part should contribute to the plan and thus have an opportunity of foreseeing difficulties. . .. 111. Co-ordination as the reciprocal relating of all the factors in a situation. The process of adjustment creates a new situation, the relationship between one individual and another, or one department and another may be influenced by other individuals or departments. iv. Co-ordination as a continuing process. This rests on the fact that as the situation changes, so there must be machinery to work out new methods to meet the change. Conclusions
Two recent reports have made reference to the need of administering the three nursing services under the direction of a principal nursing officer. The Chief Medical Officer to the Ministry of Health stated in his Annual Report 1963 that “Public health nursing services are becoming more complex. Early discharge from hospital of sick patients and of mothers after confinement and the increasing age and frailty of large numbers of people cared for at home, emphasize the need for closer working between general practitioners, hospital staff, social workers and voluntary agencies. It is evident that there is need for increasing flexibility in the service, and for good management of local authority nursing services. Many authorities have appointed Principal Nursing Officers to do this, with advantages in flexibility, co-ordination and efficiency.” The Report of the Sub-Committee of the Standing Nursing Advisory Committee, 25th June, 1965, stated that “The best use of the local health authority nursing service requires that all three services should be under the general direction of a single principal nursing officer. The primary requirement of the principal nursing officer is administrative ability; she should be able to look for advice on technical aspects to her assistants, the superintendents or supervisors of the individual services.” The channel of promotion thus remains open within each branch of the nursing service. It would not be possible for the principal nursing officer to have wide experience in all three branches of the service-thus the job is open to all and should rest purely on administrative ability. In concluding this paper, I would like to suggest that more thought needs to be given to the selection and training of the future nurse administrator. With the increasing number of integrated training schemes and degree courses the selection in the future should become easier. Are we, the present generation of nurse administrators, ready to accept new concepts in our work? Recently, I received an application from a nurse who had a B.A. honours degree in Latin, Greek and Ancient History. Her hospital reference stated that she was an excellent nurse but a little critical of her nurse training. Surely it is time that we allowed ourselves to be criticized so that we could become more objective and dispassionate in our work. The quality of the administrator will be reflected in the quality of the staff, so it is vitally important to prepare the nurse administrator for the role of leadership.
A. Al. LAAfB
94 R&um&Les les
services
domaines
d’assurer
que
possible,
ces
visites
trois
permet d’une
ses assistantes,
sur des questions
La fonction
de l’administration
la plus effective tout
projet
suivants
programme
entrent
en jeu:
Les obligations 1. servir
la communaute. le personnel.
surveillance
par
La qualite rxtr&nement
lesfaits
doit
secteur,
les moyens b mettre
n’importe
organisation
Afin
manitre
des infirmieres,
qualite
primordiale
pouvoir pour
se referer
lrur
a
demander
qui permettront assurant en pratique
quelle
l’utilisation
le fonctionnement
tlche.
toute
politique.
les trois
facteurs
et execution.
des infirm&es
la directrice
se groupent
doit se rappeler
et non surveillance
de l’administratrice pour
La
dans
soins.
meilleure
directrice
elle de
la
et
en trois categories:
des plans.
ces taches,
important
soigneusement
Dans
politique.
et proposer
d’une
du personnel
consiste
prtvu.
2. servir
En remplissant
generales
et habiletes
de la directrice
3. &valuer
de
et l’efficacitt.
est de fournir
des connaissances
ou
generale
travaillent
obstetrique
techniques.
L’nrt de l’administrateur
des services.
municipalite
administrative;
et surveillantes
leurs conseils
la
fonctionnent
la coordination
est sa capacitt
adjointes
de
sociales,
d’activitts
sous la direction
la souplesse, directrice
relevant
d’assistantes
secteurs
ils ont et6 places
ce qui exigte
d’infirmieres
suivants:
de
se refltte
preparer
l’extcution
de
par
que la surveillance
signifie
les personnes.
dans la qualite
l’administratrice
du personnel; du
service
il est done
des
infirmieres
ses tkhes.
Resumen-El servicio municipal de enfermeras incluye la visita sanitaria, servicios de maternidad. y enfermeras. Para asegurar la mejor utilization de todos 10s tres srrvicios, estos dcberian estar bajo la direction general de una enfermera jefa principal, de esta manera dando lugar a flexibilidad. coordination y eficacia. El requisito primario de la enfermera jefa principal es la capacidad administrativa; deberia ser capaz de poder aconsejar a sus asistentas. la inspectoras de 10s servicios individuales, en 10s asuntos tecnocos. La jiincidn de administration consiste en disponer 10s medios con 10s que pueda y habilidades de1 personal afecto al servicio. realizarse mejor uso de1 conocimiento La fnrea de administration consiste en llevar a efecto cualquier politica, plan o empress. En toda realization de un trabajo hay tres factorrs involucrados, politica. organizacibn y ejecucion. Los deberes de una enfermera jefa son triples:
1. servir a la comunidad. 2. estar encargada 3. evaluar
de1 personal.
y concebir
10s planes.
En el desarralllo de estos deberes debe tener en cuenta que control significa control por hechos y no por personas. La calidad de la administradora se reflejara en la calidad de1 personal, por lo que es de vital importancia preparar para su tarca a la enfcrmera administradora.
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