Tamil Nadu Report

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f o | k f o f u ; k sx k f } d k l % AHM EDABAD DABAD

Assessment of Nursing Management Capacity in 

Tamil Nadu 

National Institute of Health and Family Welfare in colla collaboration boration with wi th Indian Institute of Management, Ahmedabad with support s upport from SIDA

 

Principal Investigators NIHFW Prof. Deoki Nandan

IIM, Ahmedabad Prof. Dileep Mavalankar

Research Investigators

Prof. Rajni Bagga Mr. Sherin Raj T.P.

Mrs. Jyoti Gade

Department of Management Sciences

National Institute of Health and Family Welfare Munirka, New Delhi-110 067 In collaboration with IIM, Ahemdaba Ahemdabad d With support from SIDA

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

PREFACE Since Nurses and Midwives are the back bone for the delivery of quality Maternal and

Child Health care services, their major contributions to health care development and to achieve the Millennium Development Goals is extremely crucial. India is committed to Millennium Development Goal 5, to improve maternal health by reducing Maternal Mortality Rate ¾ by 2015. But managing effective nursing care for maternal and child health in the health care institutions and at the community level, necessarily needs appropriate organizational and management structure at the state level. Various Various Committees and reports have pointed to the need for strengthening the nursing management capacity at the State Directorate level but there is a gap in policy formation documents and its actual translation. The nursing management manag ement capacity, in the country, is quite weak. This gets reflected, reflect ed, in lack of active participation by human resources in nursing in any of the policy decision making processes. Issues and concerns being sidelined though no doubt, nursing constitutes one of the largest health workforces in the country. country. It is important to identify the best practices of different states in order to develop a mechanism for its sharing and replication in other states. To To address this issue, an exploratory study wasand undertaken in with threeanselected states the of India i.e., Uttar Pradesh, West Bengal Tamil Nadu aim to review management of nursing and midwifery issues at the State Directorate, Teaching Teaching Institutions, Health Care Institutions and other Nursing Professional Bodies; and identify variations, bottlenecks and gaps, if any, any, in the Nursing Management Capacity at the state level. The study was a joint effort of the National Institute of Health and Family Welfare, New Delhi and the Indian Institute of Management, Ahmedabad. Ahmedabad. The study, in its findings, comes out with recommendations to have a separate nursing division at the state Directorate and preferably to be headed by a nursing professional on the post of 'Director Nursing' or its equivalent. The senior most nursing post must have total autonomy in decision making and to a member of all policy making bodies dealing with health and family welfare issues. The immense human potential among nursing professionals needs to be converted into reality by creating an enabling work environment for them in terms of providing more power in decision making, and sound Human Resource policies. This requires a complete image changeover, keeping in line with the ever emerging importance of nursing profession, accorded universally. The contribution of the nursing to the overall over all health of the natio nation n demands more visibility visibi lity.. Today Today the nurses need to be the equal partners in the betterment of health care delivery system.

Deoki Nandan Director, NIHFW

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

ACKNOWLEDGEMENT The pleasurable part of writing the research report is the opportunity to offer our profound gratitude to many individuals. It would not have been possible to complete this research work without the support and inspiration of these people. We are delighted to submit this study as a part of SIDA project ‘Developing InterInstitutional Collaboration between Institutions in India and Sweden for Improving Midwifery and EmOC Services in India improve maternal health’. We sincerely thank with gratitude to Prof. Deoki Nandan, Director, NIHFW and Prof. Dileep Mavalankar, IIM-A for providing expert guidance from inception to completion of this study. study. Their constant support and inspiration has been extremely valuable for the study. study. Our special appreciation appreciation and thanks for the Tamil Tamil Nadu State officials and the nursing professionals at the State Directorate, nursing schools, hospitals, training institutions, professional professional bodies, etc for extending active support to facilitate facilitate the research team in data collection. We are particularly grateful to each of the interviewees who provided their valuable time and shared the relevant information to make this study meaningful. The study could be successfully successfully carried out due to the active support and involvement involvement of research put team faculty members from K. NIHFW and during IIM-A and particularly on members record theand support extended by Prof. Kalaivani the process of data collection. We particularly particularly like to express our special appreciation for the sincere hardwork put in by Ms Deepti T.V. .V. for tirelessly working worki ng on the computer to put in shape all the figures and tables and typing the documents and without her hard work and patience the report could not have been compiled. We are very grateful for the technical support provided by Mr. Mr. Ravi Tewari Tewari for putting putt ing the report repo rt in its present prese nt shape. Last but not the least we appreciate the efforts of the accounts and administrative sections of the NIHFW who actively supported for timely logistic arrangements. Finally, we are grateful to all those who supported in this study directly or indirectly Finally, and whose names are not reflected but without their support completion of the study was not possible. In the end, we sincerely hope that the study would meet the expectations of those involved in this profession and desirable changes are made in our approach and attitudes towards nursing. Together, definitely we will contribute in reducing maternal deaths and morbidities by improving management capacities of nursing/midwifery professionals.   Research Team from NIHFW and IIM-Ahmedabad

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

CONTENTS   Sl. No.

  Topic

   Chapter -I       Chapter - II I II III IV V VI VII VII VIII VIII Chap Chapte terr - III III

 

I I.1 I.1 I.A. I.A. I.B. I.B. I.C. I.C. I.2 I.2 I.3. .3. I.3.i.   I.3.ii.   I.4.   I.4.i.   I.4.ii.   I.4.iii I.4.iv.    I.5.   II   II.i.   III   III.1.   III.1.i.   III.1.ii.   III.1.iii.   III.2. III.2.i .

  Acknowledgement Abbreviations List of Tables   List of Figures   List of Annexures   Introduction   Management of Nursing and Midwifery Services   Objectives and Methodology Objectives Methodology Study Area   Study tudy P Po opul pulat atio ion n   Tool oolss and tec techni hnique quess of data data ccoll ollect ection ion   Seco econda ndary dat data Da Data ta Mana Manage gemen mentt An Anal alys ysis is  Li Limi mita tati tion onss of of the the Stud Studyy  De Desc scri ripti ptive ve An Anal alys ysis is of Nursi Nursing ng Mana Manage geme ment nt Ca Capa paci city ty in Tam amil il Nadu Historical Perspective of Maternal Health Nursing/Midwifery in Tamil Nadu  Introduction State Profile Nurs Nursin ing g Iss Issue uess a att tthe he Sta State te Heal Health th Dir Direc ecto tora rate te   Orga Organi niza zati tion onal al str struc uctur ture e  Direct Directora orate te of Medica Medicall E Educ ducati ation on   Direct Directora orate te of Medic Medical al and R Rura urall Health Health Servic Services es   Dire Direct ctor orat ate e of Publ Public ic Hea Healt lth h and Preventive Medicine   Mana Manage geme ment nt pro proce cess sses es  Rec ecru ruit itme ment ntss  Job Profile of JD Nursing  (DME)  Job Profile of DD Nursing (DM&RHS)   Selection and Recruitment  Nursing (DME)  Nursing (DM&RHS)  Pre-Service Training Training s   Career Path and Promotions of Nursing   ACR and Performance Role of Nursing/Midwives in Promoting Maternal Health Care Services   Key Initiatives for Involving Nursing/Midwifery in Service Delivery Nursing Issues at the th e Educational and Training Institutions (especially the Nursing Schools and Nursing Colleges)   Government Schools and Colleges   CSI Kalyani, School of Nursing Madras College of Nursing   Managerial Issues of the Government T Teaching eaching Institutions   Colleges   Private Schools and Concerns Expressed by the P rivate Colleges

  Page   No.

1-5   3 9-13   9   9   9   9   10   13 13   13   17-47

17   18 18 18 21 24 25 27 28 29 29 29 30 30 30 30 32 32 32 34 37 39 40 41 41 43 44

                                                 

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

IV   Nursing Issues with the Professional Professional Bodies especially Nursing Council and Tamil Nadu Nursing Associations   IV.A.   Tamil Nadu Nurses and Midwives Council   IV.B.   Trained Nursing Association of India (TNAI) - Chennai chapter     Chapter –  IV   SWOT Analysis on Nursing Issues in Tamil Nadu 1.   SWOT Analysis for the Directorate of Tamil Nadu   2.   SWOT Analysis of the Nursing Services in Health Care Facilities of Tamil Nadu   3.   SWOT Analysis of the Education and T Training raining of Nurses in Tamil Nadu 4. SWOT Analysis of the Professional Bodies in Tamil Nadu   (State Nursing Council and TNAI)   Chapter – V Recommendations       References Annexures  

44

 

44 46 51-54 51 52

   

53 54 57-58 59-60 63-98

               

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

 Listt of Tables  Lis Tables Sl. No

 

Table

Page No.

1. 

Categories of key informants Interviewed in Tamil Nadu

10

2. 

Key variables

12

3. 

Socio-Demographic & Health Indicators of T Tamil amil Nadu & India

18

4. 

Total Number of Nursing Institutions Instituti ons in Tamil Nadu

19

5. 

Cadre Strength of Nursing Personnel. Personnel.

21

6. 

Staff strength of Nursin Nursing g in Directorate of Medical and Rural Health Services

22

7. 

Vacancy posts

23

8. 

Salary Structure/Norms

24

9. 

Registered Candidates with Tamil Nadu Nurses and Midwives Council

29

10. 

Number of Nursing Education Institutions and Intake of Students in Tamil Tamil Nadu State

37

11. 

Total Number of Institutions

38

12. 

Number of registered nurses with TNMC

45

13. 

Courses/Programmes Recognised Recognised Under TNMC

45

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

List of Figures Sl. No.

Figures

Page No.

1. 

Organizational of Health and Family Welfare Department Department Government of Structure Tamil Nadu Tamil

21

2. 

Administrative Structure, Directorate of Medical Education

25

3. 

Administrative Structure of Directorate of Medical and Rural Health Services

26

4. 

Organization Structure of PH&PM

28

5. 

Career paths for Nursing Professionals in Tamil Nadu

31

6. 

Streams of Nursing and Midwifery in Tamil Nadu centre

36

7. 

Organisational chart of Nursing staff at Education and T Training raining

40

8. 

Institutions Organization Chart for Govt. General Hospital, School of Nursing

41

ii

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

List of Annexure Annexuress Sl No.

 

Annexure

Page No.

1. 

Tamil Nadu Medical Service Counselling for Transfer and Promotion Promotio n Health and Family Family Welfare Welfare (A1) Department Department

2. 

Health and Family Welfare Department – Guidelines for Transfer and Promotion

64-68

3. 

Rules framed by the Governor-in-Council under Section 11 of the Madras Nurses and Midwives Act (Madras Act III of 1926)

69-72

4. 

Duties and Responsibiliti Responsibilities es of Nursing Staff

73-75

5. 

Constitution Constitut ion (Rules and Regulations) TNAI

76-86

6. 

Students’ Nurses Associat Association ion (SNA)

87-98

 –

iii

63

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

 List of Abbreviations Sl. No  1. 

Abbreviations 

Full Form Form

2. 

ACR ADME

Annual Confidential Report Additional Director of Medical Education

3.  4.  5.  6.  7.  8.  9. 

ANC ANM B.Sc. CHC CMAI CNE CEmONC

10.  DDME 11.  DME 12.  DNEA

Ante Natal Care Auxiliary Nurse Midwife Bachelor of Science Community Health Centre Christian Medical Association of India Continuing Nursing Education Emergency Obstetric Comprehensive Emergency Obstetric Deputy Director of Medical Education Director of Medical Education Diploma in Nursing Education and Administration

13.  FHW

Female Health Worker

14.  GNM 15.  GOI 16.  HIV/AIDS 17.  18.  19.  20.  21.  22.  23.  24. 

IGNOU IMR INC JAO J.D. JDME LHV MPW

General Nurse and Midwives Government of India Human Immunodeficiency Virus/Acquired Immuno Deficiency Syndrome Indira Gandhi National Open University Infant Mortality Rate Indian Nursing Council Joint Administrative Officer Joint Director Joint Director of Medical Education Lady Health Visitor Multi Purpose Worker

25.  26.  27.  28.  29.  30.  31.  32.  33.  34.  35.  36. 

M.Sc MCH MDG MH MMR MO MoHFW NGO NRHM OPD Ph.D PHC

Master of Science Maternal and Child Health Millennium Development Goal Maternal Health Maternal Mortality Rate Medical Officer Ministry of Health and Family Welfare Non Government Organisation National Rural Health Mission Outdoor Patients Department Doctorate of Philosophy Philosophy Primary Health Centre

iv

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

37. 38. 39. 40.

PHN PPH PPM RCH

Public Public Health Health Nurse Post Partum Hemorrhage Post Partum Management Reproductive Child Health

41. 42. 43. 44. 45. 46.  47.  48.  49. 

RMO SRS TFR TGNA TN TNAI TNMC VHN WHO

Regional Medical Officer Sample Sample Survey Researc Research h Total Fertility Rate Tamil Nadu Government Nursing Association Tamil Nadu Trained Nurses Associati on of India Tamil Nadu Nursing and Midwifery Council Village Health Nurse World Health organization

 

v

 

Chapter I INTRODUCTION

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

INTRODUCTION Nursing services in ancient medicine were practices in India since the times of King Ashoka. Ashoka. Florence Nightingale laid down the foundation of nursing education and services in the eighteen century in England. At about the same time British rulers in India organized health services first for their army in India and then gradually they were extended to civilians where nursing played a major role. By the end of British rule it was thought to have a more organized health care system including nursing and midwifery education. Professionalization of nursing in India began in 1905 when nine European nurse Professionalization superintendents formed an organization which then got expanded and the Trained Nurses Association Association of India (TNAI) was established in 1909. Through sustained efforts from the TNAI, the Indian Nursing Council Act was passed in 1947 and the first college of nursing affiliated to the University of Delhi was started which was a concrete step towards professionalization of nursing in India. The TNAI established three subassociations or leagues within TNAI; Health Visitors' League (1922), Midwives and Auxiliary Nurse-Midwives Association Association (1925) and Student Nurses Association (1929). Since independence, India has progressed rapidly on various socio-economic indices, but the improvement in maternal health indicators have been slow. The maternal mortality is highoccur at 307 100,000 live birthsassistance. (RGI, 2003) andvarious more than 50 per cent of rate deliveries at per home without skilled The committees and commissions appointed by the government with international agency's support that there is a need to develop a strong nursing and midwifery services in the rural areas area s where there is a paucity of skill skilled ed manpower. manpower. WHO has also emphasized that “Nursing and midwifery services are vital for attaining health including maternal health as they form the backbone of maternal health care”. They are representing over 50% of the health profession. As early as 1948, World Health Assembly (WHA) identified the need to strengthen the roles of nurses and midwives. After half a century later, in 2001, the member states in WHA again re-affirmed that nurses and midwives play a crucial and cost effective role in reducing excess mortality, mortality, morbidity and disability in promotion of healthy lifestyles. Nursing profession in India developed as “midwifery” constituting of antenatal, natal and postnatal care. Nurses were treated as General Nurses and were rotated in all departments equally (including midwifery). Since the health demands were high and with limited nurses available especially at the rural level, the t he Auxiliary Auxiliary Nurse Midwives (ANMs) were introduced at the (community level) to cater to the growing MCH MCH needs. needs. The The increase increase in their services ranged from from MCH to additional additional responsibilities of Immunization, family planning and other National Health Programmes, and this diluted the very important “midwifery component”. Resultantly the midwifery education, which was encouraged in pre-independence era, lost its importance after independence. As far as Nursing is considered, great imbalances in the manpower situation can be noticed. In comparison to the developed countries, the nurse population ratio in India is far from satisfactory. satisfactory. In 2004, the ratio was 1:2250 in India and 1:100-150 in Europe. The ratio in African countries, Sri Lanka and Thailand is 1:1400, 1:1100 and

1

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

1:850, respectively. respectively. Many States in India face a shortage of nurses and midwives (Dilip Kumar,, 2005). In the western countries, there are, on an average, 2 to 3 nurses to a Kumar doctor,, while in India doctor I ndia the nurse-patient ratio however varies from 1:5 to 1:60 or 1:100 in different institutions. It strongly indicates how our nursing care services are not adequately developed. Two of the major goals of MDG's relate to reduction of maternal and child mortality. Majority of these services are delivered by the nursing personnel at the community level. But the goals can not be achieved without strengthening the capacities of the nurses and midwives and presently their potential in terms of delivery of these services remains underutilized. Acknowledging the contributions made by nurses to society, the late Prime Minister Indira Gandhi  during a programme at the All-India Institute of Medical Sciences, New Delhi, observed that, "A nurse nurse is not merely an aid and assistant to a doctor,, she has an independent part to play in many areas where a doctor need not doctor necessarily be present. In the western world, a nurse anesthetist is properly trained, takes on important duties in minor surgical procedures and also takes care of newborns, among others. The nurse is in her own right a key member of the medical team”. Different committees since 1946 emphasized the importance of nurse in Health care delivery system. The Health Survey and Development Committee (Bhore Committee, 1946), was the most progressive in terms of its broad perspective and long-term vision for health in the Country. It is relevant to mention here that the Committee had aimed at a target of one nurse to a 500 population. population. Most of the recommendations of the Bhore Committee are relevant even today. However, majority of the recommendations have not been taken up for implementation and even those that were initiated have been discontinued. The Shetty Committee (1954) was set up on the recommendation of Central Committee of Health to review the then prevailing training and service conditions for nurses. The committee recommended that hospital nursing service staff and public health nursing service staff should be combined into a single cadre. The Mudaliar Committee (1961), recommended streamlining nursing personnel to three grades of nurses: basic nurse with four years of training (including six months midwifery and six months Public Nursing); Theterm Kartar Singh Committee (1972)recommended had the greatest impact in termsHealth of quality and long changes. This Committee the introduction of Multi Purpose Workers under Health and Family Planning Programme. Programme. The Shrivastav Committee (1975) further consolidated the recommendations of the Kartar Singh Committee. The Bajaj Committee (1986) strongly recommended that the health related vocational courses should be for ANM's. In 1983, the National Health Policy Policy was officially adopted by the Parliament. Parliament. “Health for all” principles and strategies were incorporated for strengthening and expansion of three tier-primary health care infrastructure - the sub centre, PHC and CHC. However, there was no qualitative difference in the job of any of the public health nursing personnel. Emphasis was given on orientation training to nursing personnel for implementing the new strategies. The working and living conditions of Nursing personnel have a direct bearing on the status of nursing services. The quality of Nursing care depends on the number and

2

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

quality of nursing manpower. manpower. It is also related to working conditions, equipment and supplies in the work place. The quality of Nursing service also depends on the opportunities available for enhancement of professional education and incentives for promotions, etc. Taking Taking a serious note of this, a High Power Committee on Nursing was appointed by the Government of India, Ministry of Health and Family Welfare in July 1987 to review the role, functions, status and preparation of nursing personnel; nursing services and other issues related to the development of the profession and to make suitable recommendations to the Government. The Committee observed that nurses are generally not involved in making policies that govern their status and practice. The committee made several recommendations related to working conditions, nursing education, continuing education and staff development, and also recommended norms for nursing services services and education. and recommended recommended for structural changes in administrative level, job descriptions for all nursing positions, working hours not not more than 40 hours hours a week, opportunity for higher higher education after 5 years of service, accommodation and transportation facility for safety and security of nursing personnel, nurses to be relieved from the non nursing duties etc. The National Health Policy (ref) - 2002 quotes “The ratio of nursing personnel in the country vis-à-vis doctors/beds is very low according to professionally accepted norms. There is also an acute shortage of nurses trained in super-speciality disciplines disciplines for deployment deployment in tertiary care facilities. The policy while emphasizing emphasizing the need for an improvement in the ratio of nurses vis-à-vis doctors/beds lays focuses on improving the skill -level of nurses, and on increasing the ratio of degree- holding nurses vis-à-vis diploma-holding nurses. It recognizes a need for the Central Government to subsidize the setting up, and the running of, training facilities for nurses on a decentralized basis. Also, the Policy recognizes the need for establishing training courses for superspeciality nurses required for tertiary care institutions. It has been projected that the country requires about 2,00,000 nursing personnel to provide comprehensive care under the National Rural Health Mission (NRHM) project. In order to meet the shortfall in providing quality patient care, the Centre has advised the state governments to enhance the capacity of the Auxiliary Nurse Midwives (ANMs) and GNMs by setting up additional nurse training institutions. With the objective of improving the standard of nursing education and nursing practice, it has been decided to promote evidence-based practice and nursing research and improve the working condition of nurses. Management of Nursing and Midwifery Services

Existing situation of nursing and midwifery in India regarding nursing services, nursing education, nursing management, evidence base, nursing research and regulation are reviewed in a paper by Dilip kumar (2005). While focusing on the Management of Nursing and Midwifery Services, the paper quotes” Nurses and midwives are not well accepted or recognized as leaders or administrators. Nursing management skills, leadership, lobbying and negotiating skills are poor. poor. There are an inadequate number of nurse and midwife leaders at the national and State levels for nursing practice, research, education, management, planning and policy development. Although the nurse is a member of the health team, she/he is never asked to represent the profession in planning and policy formulation for nursing services, education, etc. The nursing chief only looks after the nursing personnel and has no authority to make decisions on pay scales, number of posts, staff development

3

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

or new interventions”. In response to the demand of the Delhi Nurses' Union, the Government of India has sanctioned 5 nursing posts at the national level. It quotes the major nursing issues that need to be addressed as:  Insufficient

contribution of nurses and midwives to health care development due to: few positions for nurses and midwives at the State and national levels; inadequate nursing leadership and strategic management; inappropriate nurse to population/patient ratio;  Poor quality of nursing and midwifery care due to: inadequate number of nursing positions as per the recommended staffing norms; migration issues; insufficient number of nurses with Bachelors' and Masters' degrees and in clinical specialties;  Limited competency of nurses and midwives due to: unclear roles and responsibilities of nurses and midwives; ineffective clinical preparation and supervision during training;  Inadequate standards and guidelines for nursing practice and also ineffective regulation of nursing and midwifery practice;  Inadequate infrastructure for nursing and midwifery practice;  Inadequate motivation to provide effective care;  Poor quality of nursing education to produce qualified graduates for service due to: an inadequate national nursing and midwifery education plan and development; limited involvement of nurses and midwives at the policy level; shortage of qualified nurse educators; inadequate infrastructure for nursing education; and  Limited role and authority of the INC in nursing development due to: limited roles prescribed in the Indian Nursing Council Act, 1947; inconsistency in the Indian Nursing Council and State Nursing Council Acts; insufficient information systems in nursing and midwifery services; and shortage of staff at the INC and State Nursing Councils. While addressing to the future of nursing and midwifery in India, the paper suggests, that for the Millennium Development Goals to be achieved, Nurses and Midwives in India have to play a major role to improve the health and quality-of-life of people. For meeting the challenges, the paper recommends for involvement of nurses in health and nursing policy formulation bodies and to empower the nursing workforce to develop leadership and management skills. It may be concluded, that since the Nurses and Midwives are the back bone for the delivery of effective quality care of MCH services, their major contributions to health care development and to achieve the Millennium Development Goals is extremely crucial. The available research information as presented above does provide strong indication for inherent potential of nursing professionals. Though the various Committees and reports, (National Health Policy; High Power Committee on Nursing; Macroeconomics Macroeconomics and Health) have very very articulately articulately listed the main main recommendations for strengthening the nursing management capacity but there is gap in policy formation documents and its actual translation. And this requires a strong support at the policy level to ensure policy implementation of the key recommendations of earlier reports. It's important to identify the best practices of different states in order to develop a mechanism for its sharing and replication in other states. Nurses and Midwives need to focus to empower themselves and to strengthen their competencies.

4

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Organizing effective nursing care for maternal and child health in the health care institutions and at the community level, necessarily needs good management and administrative practices. Based on the above facts, the present study was undertaken to describe, besides the current Nursing Organizational/administrative structure, the key nursing management issues at the state Directorate, Teaching Teaching Institutions, Health Care Institutions and other Nursing Professionals Bodies, in selected states of the country. The study is aimed to identify the bottlenecks and gaps in the Nursing Management Capacity and delivery of services at all the levels. The first part of the study was conducted in the two states i.e. Uttar Pradesh and West Bengal and the present study was conducted in the state of Tamil Nadu.

5

 

Chapter II OBJECTIVES AND METHODOLOGY

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

I. Objectives

The main objectives of the study were: 1. To review review the current Nursing and midwifery midwifery Organizational/administrative Organizational/administrative structure and highlight issues in the state of Tamil Tamil Nadu and identify variations and best practices, if any in the state. 2. To review review the managemen managementt of nursing nursing and midwifery midwifery issues issues at the state state Directorate, Teaching Institutions, Health Care Institutions and other Nursing Professionals Professi onals Bodies and identify any constraints. 3. To obtain a perspective perspective and the ideas to strengthen nursing and midwifery management capacities to address maternal health issues appropriately. appropriately. 4. To draft the recommendations recommendations to strengthen nursing nursing and midwifery management capacities. II. Methodology

This study was exploratory in nature. Both primary and secondary data was collected to obtain qualitative as well as quantitative information. information. III. Study Area

The study was carried out in the states of Tamil Nadu. The rationale for choosing this state was to identify the nursing management capacity of the state with the relatively better MCH indicators. indicators. The relevant information information was collected, from from the officials of the following organizations in the t he state of Tamil Nadu: 1. State State Health Health Direct Directora orate te 2. Health Health Care Care Servi Services, ces, especiall especiallyy Hospital Hospitalss 3. Educationa Educationall and Traini Training ng Institutions Institutions (especi (especially ally the Nursing Nursing Schools Schools and Nursing College) 4. The State State nursin nursing g coun council cil 5. Profess rofession ional al Bodie Bodiess such such as TNAI. TNAI. IV IV.. Study Population Populatio n Interviews were conducted with the following and a nd information collected:

1. 2. 3. 4. 5. 6. 7. 8.

Senior Senior A Admin dministrat istrators ors from from the State State Health Health Directo Directorates rates Nursin Nursing g offici officials als at the the Direc Director torate ate Health Health Secretar Secretaryy , Health Health and and Family Family Welfare elfare Missio Mission n Direc Director tor,, NRHM NRHM All the concer concerned ned Direct Directors ors Matron Matronss of of Civi Civill Hosp Hospita itals ls Head Head of State State Nursin Nursing g Counc Council il Pr Princip incipals als and other other faculty faculty members members of the Nursing Nursing Schools Schools and colleges colleges

9

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

V. Tools and Techniqu Techniques es used for data collection collec tion

Both primary and secondary data was collected to obtain qualitative as well as quantitative information. Primary Data was obtained by conducting in-depth interviews by using semi structured interview schedules with key respondents. T Total otal 47 key informants including Sr. Administrators, policy makers and State level nursing/midwifery managers from various nursing bodies, clinical and teaching Institutions etc. were were interviewed (Interviews were conducted during during November 1014, 2008 at Chennai). Using a checklist, a detailed review of secondary data in the form of reports and documents was carried out. The detail list is given below in Table  1 and 2. For secondary data, information was collected from various policy documents were reviewed such as Acts/Amendments, organizational structures, reports, data registers and searched the data from internet. Indepth interviews were carried out from the 19 key informants in Tamil Nadu. The lists of the official's interviewed is attached at Annexure-1. Table 1: Categories of key informants Interviewed in Tamil Tamil Nadu

Sl. No 1. 

Designation

Principal Secretary (Health & FW)

Address

Department of Health & Family Welfare Welfare Government of Tamil Tamil Nadu , Fort St. George, Secretariat,   Chen Ch enna naii

2. 

Special Commissioner & Commissioner for MCH & Welfare and Mission Director

3. 

Director Medical Education

4. 

Director Public Health

5. 

Director of Medical & Rural Health Services

6. 

Joint Director Nursing

– 600 600 00 009, 9,

Tam amil il Na Nadu du

State Health Mission, SHS-TN & Project Project Director, Director, RCH Project Project,, Government of Tamil Tamil Nadu , V Floor, Floor, DMS Complex, 359, Anna Salai, Chennai- 600 006 Directorate of Medical Education 359-Anna Salai, Teynampet, Chennai-600006, Tamil Nadu 359-Anna Salai, Teynampet, Chennai-600006, Tamil Nadu Directorate of Medical and Rural Health Services 359, Anna Salai, Teynampet, Govt. of Tamil Tamil Nadu, Chennai-600006 Directorate of Medical Education 162, EVR Periyar Salai, Kilpauk, Chennai 600 010

10

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

7. 

Dy. Director Medical Education

8. 

Dy. Dy. Director

9. 

Director

10.

Princ rincipal ipal

11.

Princ rincipal ipal

12.

Princ rincipal ipal

13.

Trustee

14.

Dean

15.

Prin Principal cipal

16.  Registra Registrarr

17.  Secretary

18.  Vice President President

19.  Nurse

Directorate of Medical Education 359-Anna Salai, Teynampet, Chennai-600 Chennai-600006, 006, Tamil Nadu Medical & Health Services (Nursing) Office of the Director of Medical and Rural Health Services, 359, Anna Salai, Teynampet, Govt. of Tamil Tamil Nadu, Chennai -600 006 Kilpau Kilpauk k Medical College & Hospital, Chennai-600 010, Tamil Tamil Nadu Scho School ol of Nur Nursing sing,, Kilpauk Kilpau k Medical College & Hospital, Chennai-600 010, Tamil Tamil Nadu Scho School ol of Nur Nursing sing,, Govt. General Hospital, Chennai-600 003, Tamil Tamil Nadu Coll College ege of Nur Nursing sing,, Madras Medical College, Chennai- 600 003, Tamil Tamil Nadu Nurs Nursing ing Coll College, ege, Omayalatchi College College of Nursing (Pvt) King Cross Road, Sathyamurthy Nagar, Avadi, Ava di, Chennai 600 062. Nurs Nursing ing Coll College, ege, Omayalatchi College College of Nursing (Pvt) King Cross Road, Road, Sathyamurthy Sathyamurt hy Nagar Nagar,, Avadi, Ava di, Chennai 600 062. Apollo School of Nursing (Pvt.) Vth Floor, 21, Greams Lane, Off Greams Road, Chennai 600006, Tamil Tamil Nadu State TNAI GS-3 India Pvt. Limited No-10, Dr. Dr. TV Road Chetpet, Chennai - 31 Tamil Nadu State TNAI GS-3 India Pvt. Limited No-10, Dr. TV Road, Chetpet, Chennai – 31, Tamil Tamil Nadu State TNAI, Reader, Medical College, Chennai- 600 003 Prim Primary ary Health Centre, Medavakkam

11

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Experiences of data collection: All the officials, interviewed for the study, study, were very cooperative and provided all the information requested for. Permission was availed from all the respondents for audio recrding the interviews and barring a few all agreed for the audio recording. But during the t he discussion for the sensitive issues like gender discrimination etc. faced by the nurses, the respondents asked for the audios to be switched off.

The data and information, as presented in this report, in the form of figures and tables was further validated by getting them appraised from the key informants. The In-depth interviews focused on the following key variables:p Table 2: Key Variables

Organizational Structure and Functioning

HR policy for nursing

Training and education (pre service, induction and in service)

Health directorates (education, clinical and public health services) State nursing councils Hospitals ?  Service and conduct rules for Nursing Professionals ?  Selection and Recruitment Recruitment ?  Placement and Transfer Transfer ?  Pe Performance rformance appr appraisal aisal system in place ?  Job profile ?  Nursing Cadre ?  Carrier planning /Carrier graph ?  Perceptions/observations/experience for transfer/placement ?  Continued Nursing Education (CNE) ?  Methodology for induction training for nursing personnel ?  Content areas for induction training for Nursing personnel ?  Methodology for promotional training for nursing personnel ? 

Pr Procedures ocedures for training and development

The In-depth interviews also collected feedback on the following: Policy Guidelines to Health and related activities in the context of nursing Policy services  Administrative set-up and functioning of Nursing Personnel Personnel and their role, responsibilities and job description of nursing functionaries  Involvement in Decision making  Perception Perce ption and views on communication patterns in the Directorate  Perception Perce ption and views on coordination with other related units in the Directorate



12

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

VI. Secondary Data: Following secondary data was collected: Secondary data was collected from the following in T Tamil amil Nadu:

1.

Trained Nu Nurses Association of of In India

2.

State Nursing Council

3.

Dir irec ecto tora rate te of Medic edica al Educ Educat atio ion n (DM DME) E)

4.

Directorate of of Me Medical Se Services (D (DMS)

5.

Sc Scho hool ol of Nurs ursin ing g ((Go Govt vt.. Gen Gener eral al Hos ospi pita tal) l)

6.

Scho School ol of of Nurs Nursin ing g (CSI (CSI Kal Kalya yani ni,, Mult Multis ispe peci cial alit ityy Hosp Hospit ital al))

7.

Kilpauk Medical College, Chennai

8.

Col College lege of Nursi ursin ng, Mad adrras Medic edical al Coll Colleg ege e

9.

Omayalatchi College of Nurses

10. 10.

Tamil amil Nadu Nadu Heal Health th Syst System emss Proje roject ct

11. 11.

Dire Direct ctor or of of P Pub ubli licc Hea Healt lth h and and Pre Preve vent ntiv ive e Med Medic icin ine e

VII. Data management and Analysis   Detailed notes were taken of each In-depth interview and these were also recorded on the audio tapes. t apes. Information was analyzed manually. manually. The responses were categorized into themes against the pre-decided categories and triangulated across interviews and with secondary data collected. VIII. Limitations of the study

The observations should be viewed in light of the fact that this was a descriptive study based the interviews of study key informants, and primary data was not throughona sample survey. The survey. results derive from the opinions from thecollected personal experiences of the key informants and the researchers' interpretations from the interviews and secondary data sources.

13

 

Chapter III DESCRIPTIVE ANALYSIS DESCRIPTIVE ANALYSIS OF NURSING MANAGEMENT CAP C APACITY ACITY IN TAMIL NADU

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Historical Perspective of Maternal Health and Nursing/Midwifery in Tamil Nadu Reduction of maternal mortality is an important Reduction important goal of MDG-5, applie appliess to India. The Maternal Health (MH) Programme, a component of the Reproductive and Child Health (RCH) Programme Programme aims at reducing maternal mortality less than 100 by the 2010. The State of Tamil Tamil Nadu is getting near to achieving this aim. IIn n fact the official data of the year 2007 shows 95 MMR, already achieved the target.(mohfw.nic.in/ NRHM/NPCC_Presentation/Tam Tamii l Nadu _NPCC_08_09_  _NPCC_08_09_PIP PIP.pps -).   The senior health administrators of the state agreed, that besides effective implementation of various maternal health programmes and upgradation of PHCs, the nursing and midwifery cadre has played an important role in the state's endeavor to better the health indicators. In Tamil Tamil Nadu, nursing services commenced since 1664 by the East India Company for the army personnel, subsequent by Florence Nightingale in 1854.  Their work inevitably led reforms to provide a health service for all the people of India, particularly for those in the Madras Presidency. As a result, a Lying-in Hospital was built in 1797 for the poor. It was in this institution that in 1854 the government sanctioned the opening of the first training school of Midwives as there were 150 beds exclusively for women. Descriptive Analysis of Nursing Management Capacity in T Tamil amil Nadu

17

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

INTRODUCTION State Profile

Tamil Nadu is situated on the southeastern side of the Indian peninsula. It is bounded on the east by Bay of Bengal, in the south by the Indian Ocean, in the west by the states of Kerala and Karnataka and in the north by the Karnataka and Andhra Pradesh Pradesh.. The state of Tamil Nadu has an area of 130058 sq. km. and a population of 62.41 million. There are 30 districts, 385 blocks and 16317 villages. The state has population density of 479 per sq. km. (as against the national average of 312). The decadal growth rate of the state is 11.72% against 21.54% for the country. country. The TFR of the state is 1.7 against the national average of 2.8. The Infant Mortality Rate and Maternal Mortality Ratio are 37 and 134 respectively for Tamil Tamil Nadu, which are lower than the national average. Sex ratio is 987, much better than the national level at 933 9 33 (Table (Table 3). (http://cyberjournalist.org.in/census/censex.html) Table 3: Socio-Demographic and Health Hea lth Indicators of Tamil Nadu & India Vital Events Total population (Census 2001) (in millions) Crude Birth Rate (SRS 2007) Crude Death Rate (SRS 2007) Total Fertility Rate (SRS 2006) Infant Mortality Rate (SRS 2007) Maternal Mortality Ratio (SRS, 2001 - 2003) Institutional Deliveries (DLHS-3) (2007-2008), NFHS-3, India (2005-2006) Sex Ratio (Census 2001) Child Sex Ratio (0-6,Census 2001) Female Literacy Rate (Census 2001) (%) Population Populati on below Poverty line (%) Expectation of Life at Birth (2006-10) Male Female

Tamil Nadu 62.41 16.2 7.5 1.7 37 134 94%

India 1028.61 23.5 7.5 2.8 57 301 41 %

986 942 64.55 21.12 67.6 70.6

933 927 53.7 26.10 65.8 68.1

Source:  http://mohfw http://mohfw.nic.in/NRHM/State%20Files/tamilnadu.htm .nic.in/NRHM/State%20Files/tamilnadu.htm cited on 11 Feb 09.   http://mohfw http://mohfw.nic.in/dlhs/State_Fact/T .nic.in/dlhs/State_Fact/TamilNadu.pdf amilNadu.pdf cited on 17 Feb 09.   mohfw mohfw.nic.in/NFHS-3%20Maternal%20Healt .nic.in/NFHS-3%20Maternal%20Health.ppt h.ppt – cited on 17 Feb 09.

The above table shows the main health indicators like birth rate, death rate, TFR, IMR, MMR lower than the national level. This indicates better socio-demographic conditions conditio ns in Tamil Tamil Nadu than the national nat ional level. The state's institutional deliveries are 94%, against the national average of 41%. The respondents in the study mentioned, every year 1.2 lakh deliveries are conducted in government health setup , where nursing/midwifery nursing/midwifery services plays a key role in antenatal, natal and post-natal care.

Better socio-demographic and health indicators in TN are reflective of good MCH/ midwifery services and better organizational structure of the health and family welfare in the state.

18

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Table 4: Total Number of Nursing Institutions in Tamil Nadu  Nam e of the th e Pr ogr ogram am me  

 No. of Instit In stitut ut ions  ions   Govt. Pr ivate Diploma in Auxiliary Nurse Midwife/Multipurpose 14 Health Worker Worker Health Vi Visitor/Mult sitor/Multipurpose Sup ervisor Diploma in Generalipurpose Nursing Health and Midwifery Basic B.Sc., Nursing Post Basic B.Sc., Nursing M.Sc., Nursing Diploma in Nursing Education and Administration Administra tion (DNEA) Total

Intake of Students Govt. Pr ivate 357

1 22 3 1 1 -

161 116 11 34 1

60 1336 110 40 8 -

28

337

1554 10818 12372

365   365

3685 6020 280 461 15

Source: Tamil Tamil Nadu Nursing Council, 2008.

 

The number of nursing institutions shown in Table 4 indicates that private nursing educational institutes, in the state, hugely outnumber the government nursing educational institutions. TN has private institutions, of higher learning, indicating enhanced capacity building of nursing human power for delivering nursing education and quality of services. The present chapter describes the management structures and the management. Processes especially human resource issues of nursing in the following institutions/organizations: I. Nursi Nursing ng Issue Issuess at the State State Heal Health th Direc Director torate ates. s. II. Role of Nursing/Midwives Nursing/Midwives in Promoting Promoting Maternal Maternal Health Care Services. Services. III. Nursing Issues at the Educational Educational and Training Training Institutions (especially (especially the Nursing Schools and Nursing Colleges). IV IV.. Nursing Issues with the Professional Professional Bodies especially especially Nursing Council and Tamil Tamil Nursing Association. The detailed analytical description, of the data collected is presented under the following management issues broadly management strategies and human resource issues: The following Directorates and corporations are functioning under the control of Health and Family Fami ly Welfare Department of Tamil Tamil Nadu. 1. Direct Directora orate te of Medic Medical al Educa Educatio tion. n. 2. Director Directorate ate of Medic Medical al and Rural Rural Health Health Service Services. s. 3. Director Directorate ate of Public Public Health Health and and Preven Preventive tive Medici Medicine. ne. 4. Director Directorate ate of Indian Indian Medicin Medicine e and Homeop Homeopathy athy.. 5. Direct Directora orate te of Fami Family ly Welf Welfare are..

19

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

6. Direc Director torate ate of Drugs Drugs Cont Control rol.. 7. Tamil Nadu Medical Medical Service Servicess Corporat Corporation. ion. 8. Tamil Nadu Nadu State Health Health Transp Transport ort Departme Department. nt. 9. Tamil Nadu Nadu State State AIDS Contro Controll Society Society.. 10. Tamil Nadu State Blindness Control Society. Society. 11. Reproductive Reproductive Child Health Health Project. Project. 12. DANIDA Health Care Project. Project. I.

Nurs Nursin ing g IIss ssue uess at at tthe he St Stat ate e Hea Healt lth h Dir Direc ecto torrate ate

Since the state of Tamil Nadu has a unique organizational structure of Health and Family Welfare Welfare in the state, which is divided as viz . Directorate of Medical Education, Directorate of Medical and Rural Health Services, and the Directorate of Public Health and Preventive Medicine the following discussion focuses on these three Directorates which play a key role in nursing management capacity building at the state level. The post of DD Nursing upgraded to JD Nursing comes under the Directorate of Medical Education and there is another post of Deputy Director, Nursing under the Directorate of Medical and Rural Health Services. These two important positions, dealing directly with nursing services will be discussed under three Directorates as mentioned in the Figure 1. Unlike WB, which has clear cut objectives for the nursing branch, no such objectives are listed for the nursing positions in the TN Directorate.

TN appears to have a unique organizational setup wherein nursing issues are taken care of by the three Directorates viz: Directorate of Medical Education, Directorate of Medical and Rural Health Services, and the Directorate of Public Health and Preventive Medicine, indicating an positive impact on better rural health care services and more enhanced nursing and midwifery services .  

20

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

I.1 Organizational structure   Fig. 1: Organizational Structure of Health and Family Welfare Department Government of Tamil Nadu

Honourable Minister Health and Family Welfare Department Secretary H & FW Department

Directorate of Medical Education Joint Director  Nursing

Directorate of Public Health

DM & RHS

Deputy Director  Nursing

Table 5: Cadre Strength of Nursing Personnel, 2007

Name of the Cadre

DME

DPH & PM 363/3100 10367

DMS(ESI)

Total Total

24 67 388 5353 102 59 40 104 39 -

DM & RHS 22 42 206 3346/54 3346/541 1 71 290 257 4 135 -

Nursing Supdt. I Nursing Supdt. II Nursing Supdt. III Staff Nurse Physiotherapist Ph ysiotherapist ANM Mat. Asst. Social Wor Worker ker HV Village Health Nurse (Female)/ANM Sector Health Nurse (F) Community Health Nurse (F) Public Health Nurse (F) Health Inspector (Male) Health Supervisor (Male) Non-Medicall Superviso Non-Medica Supervisorr Total

1 7 40 552 10 48 138 8 9 -

47 116 634 13255 183 397 435 116 183 10367

6176

4914

1610 384 100 4311 384 384 21003

813

1610 384 100 4311 384 384 32906

Source: Directorate of Medical Education.

21

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Table 6: Staff Strength of Nursing in Directorate of Medical and Rural Health Services (DM&RHS)

Types of Cadre

*Assistant Director of Health services (Nursing)(now *State Public Health Nursing supervisor *Nursing Superintendent Grade I Deputy Nursing Superintendent (Nursing Superintendent *Assistant Nursing Superintendent

Sanctioned Number

Appointed Number

Number of Vacancies

In Position (%)

Vacant (%)

1

1

0

100

0

-

-

-

19

4

15

21.05

78.94

40

35

5

87.5

12.5 -

-

-

-

-

-

-

*Registrar *Deputy Registrar *Auxiliary Nurse Midwife (ANM) *Staff Nurses on contract basis (including Male Staff Nurse Regular (including Male Nurse) Matron (Now Nursing Superintendent Maternity Assistant Health Visitor Social Worker

Details will be furnished by the Tamil Tamil Nadu Nursing Coun cil 236

204

32

86.44

13.56

4964

4701

263

94.7

5.29

3233

3138

95

97.06

2.94

196

154

42

78.57

21.4

272

238

34

87.5

12.5

257

181

76

70.43

29.57

4

2

2

50

50

Source: Directorate of Medical and Rural Health Services (DM&RHS), Tamil Tamil Nadu.

22

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Table 7: Vacant Posts Sl. No.  

Name of the Post  

Sanctio ned   Strengt h

In Vacant Position   (%)  

1.   Principal   2.   Vice-Principal 3.   Reader

  2   1   10  

4.   Lecturer in Nursing 5.   Nursing Supdt. Gr. I   6.   Nuring Supdt. Gr. II  

15   26   68  

14  

7.   Nuring Supdt. Gr. III  

392  

295  

8.

27

20

9.

   

Nursing Tutor Gr Gr.. I Nursing Tutor Gr Gr.. II

32   68   5410 5410

13. Auxili Auxiliary ary Nurse Nurse Midwife   Assist 14. Matern Maternity ity Assistant ant 15. Social Social Worker orker   16. Health Health Vi Visit sitor or

59

  17. Social Social Welfa Welfare re Officer Officer

27

  18. Assist Assistant ant Lect Lecture urerr   19 19.. Le Lect ctur urer er in in Physiotherapy  

  7 2    

 

 

Panel

 

Panel 158     (37.70) 5 (15.63)  Panel       3 (4.41) Panel       237 (4.38 Will be filled in     Counselling )  

 

27   65   4937

59

 

59

 

7 (25.93)

 

261

 

10. Physiot Physiotherap herapist ist Gr.I Gr.I 11. Physiot Physiotherap herapist ist Gr. Gr. II   12. Staff Staff Nurse Nurse

40 104 

2 (100)   No eligible person 1 (100)   No eligible person 10 (100)   Proposal under process   1(6.67)   Proposal sent Promotion   15   Promotion   (22.06)   Promotion   87   (29.12)  

48  

 

419

 

-   -   -  

Reason for not filled up  

 

Nil

 

40 59     12   14   -    

 

Nil 45   (43.27) 47 (79.66) 13   (48.15) 7 (100)   2 (100)

         

   

H & FW. Dept.  

Director of Medical and Rural Health Services, Chennai   H & FW Dept.  

Director of Medical and Rural Health Services, Chennai Head of   Institution

 

Vacancy not approved by government

  Adhoc rules not framed  

Director of Medical Education Government  

Source: Directorate of Medical Education.

Salaries

Table 8 describes the pay scales of nursing cadre. The cadre is certainly not happy with the present pay scale as they are not equal to central level.

23

 

Appointing Authority  

 

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Table 8: Salary Structure/Norms of Basic Salary of Various Cadres (DME)

Sl. No 1. 2 3

Name of the category Joint Director (Nursing) Deputy Director (Nursing) Nursing Superintenden Superintendentt Gr.I Gr.I

Scale of pay 14300-18300 Rs.10000-325-15200/Rs.8000-275-13500/-

4 5 6 7 8

Nursing Superintenden Superintendentt Gr.II Gr.II Nursing Superintenden Superintendentt Gr III Nursing Tutor Grade II Staff Nurse (Regul (Regular) ar) Staff Nurse (Contract Basis)

9 10 11

Health Visitor Auxiliary Nursing Midwife Maternity Assistant

Rs.6500-200-10500/Rs.5500-175-9000/Rs.6500-200-10500/Rs.5000-150-8000/Rs.3500/- in Ist year Rs.4000/- in 2nd year Rs.5000/- from 3rd year till regular absorption Rs.5000-150-8000/Rs.3200-85-4900/Rs.3200-85-4900/-

Under NRHM the contract Staff (Nurse) is appointed on a fixed salary of Rs, 4000/- per month. The Government of Tamil Tamil Nadu plan to absorb them after two years of service at a salary of Rs.11 thousand per month. In the hope to absorb as a permanent, many joined even on o n a low salary. I.A.

Directorate of Medical Education

The Directorate of Medical Education, which is functioning since July 1966, plays a pivotal role in developing medical and para-medical personnel to cater to the health needs of the State. The prime responsibilities of the Directorate are as follows: 1. Developm Development ent of Medical Medical Educatio Education n includin including g Nursing Nursing 2. Administration of Medical Medical Colleges and Teaching Teaching Hospitals Hospitals including including Nursing Nursing institutions 3. Effective Effective Supervisi Supervision on of selection selection committee committee for admission admission to specified specified medical medical and nursing courses of study (details mentioned in T Table able 8). Out of the total 21 Nursing Schools and Colleges, 13 are under the control of DME and the 8 under the control of DMRHS and are being run by the Government.   The department also has a role to play in establishment and maintenance of wellequipped teaching institutions, which are the premier referral centers with state of the art equipment and technology. Research is another area of activity for Medical Education Department. The Joint Director, Nursing is the Executive Officer and looking after the nursing issues under the Directorate of Medical Education (Figure 2). Tamil Nadu does not have a separate Nursing Division in the Directorate of Medical Education.

24

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

The Directorate of Medical Education has two posts for nursing i.e. one is Deputy Director of Medical Education Edu cation (DDME, Nursing) Nursi ng) and the other is Paramedical T Technical echnical (Nursing). The selection to this post is on seniority basis. Recently the post of Deputy Director,, Nursing has been upgraded to Joint Director Nursing. The Directorate has put Director up the proposal to have an additional post of DD Nursing to be filled up and this is under process. Fig. 2: Administrative Structure, Directorate of Medical Education Edu cation    

DME

 

 

Dean Addl. DME

 

(Selection

Financial Advisor and Chief Accounts Officer

JDME (Board of Pharmacy)

 

JDME (Nursing)

DDME (Academic & Research) Director &

Committee)

 

Superintendent JDME

DDME (Academic & Research)

RMO

AO

Asstt. Director

DDME (2)

MO

JAO DDME (Admin)

Nursing Paramedical Technical DDME (Planning & Development)

DDME (Hospital & Dispensaries)

I.B.

Directorate of Medical and Rural Health Services

The Directorate Medical and Rural Health Services (DMRHS) are incharge of planning and execution of all programmes of Medical and Rural Health Services Departmen Departmentt of Tamil Nadu. Director Direc tor,, Medical and Rural Health Healt h Services is the overall o verall in charge charg e of all the medical health care services through the grid of district hospitals, taluk hospitals, non-taluk hospitals, dispensaries, mobile medical units, women and children hospitals and non-teaching medical institutions. Historically during the early eighties, the Directorate of Family Welfare was disintegrated from the Directorate of Medical Services and Family Welfare for better co-ordination and implementation of Family Welfare Programme. Programme. In the year 1999 the Directorate of Medical Services was bifurcated and a separate Directorate to look after the implementation of the ESI Scheme was formed on 1.1.1999. Thus the

25

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Department of Medical Services which was a huge composite department at the time of inception has decade by decade paved way for organisation of various separate departments for better administration and from 1.1.99 onwards, this Department namely the Department of Medical and Rural Health Services is being entrusted with the responsibility of rendering medical care services to the public through the nonteaching medical institutions. Appointment of the staff nurses are under DMRHS. Recently the government has accorded permission to recruit 660 staff nurses on contract basis. These measures are being taken to improve 24 hours round the clock maternal and child health care activities under State Rural Health Mission by allotting three staff nurses to each of the 220 primary health centres. 200 staff nurses were appointed to the 32 CEmONC hospitals. During the year 2007-08, 1400 staff nurses were appointed on contract basis in the various schemes. Fig. 3: Administr Administrative ative Structure of Directorate of Medical a and nd Rural Health Services  

Director of Medical and Rural Health Services

   

 

Addl. Director

Addl. Director

(Medical)

(P&D)

Joint Director

Administrative Officer (P&D)

 

(Medical)

  Deputy Director (Nursing)

 

Addl. Director

 

Addl. Director (TM) (Inspection) Joint Director Joint Director

 

(TM)

 

(Stores) Stat. Officer

Public Officer

  (TM)

(TM)

 

Addl. Director

Addl. Director (Leprosy)

(PHC)

  Addl. Director FA & CAO

 

 

(Admn.)

Deputy Director

Accounts Officer

 

(Admn.)

  Assistant Director

Admn. Officer

(Admn.)

(Services)

Assistant Accounts Officer

   

Source: www.tnhealth.org/ www.tnhealth.org/mrhsorg.htm mrhsorg.htm

26

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

I.C.

Directorate of Public Health and Preventive Medicine

The Directorate of Public Health works closely with the DME and DM&RHS for Nursing issues particularly for the placement and training of nurses for strengthening the midwifery aspects. This cell does not have any separate post of nursing official but they coordinate with other Directorates. The Director of Public Health and Preventive Preventive Medicine is providing primary health care services through a network of 1421 Primary Health Centre and 8706 Health SubCenters spread over the entire state. During the year 2007-08 up to March 2008, 683.50 lakhs outpatients and 6.47 lakhs of in patients were treated by these Primary Health Centers and deliveries at the rate of 9 Primary Primary Health Centre per month. The average out-patient in the Primary Health Centre per day is 133 (March 2008). The average inpatient to the Primary Health Centre per month is 38 (March 2008). 1000 Primary Health Centres have been upgraded to t o provide 24×7 delivery services. 3000 staff nurses were recruited and posted in these 24×7 Primary Health Centers to ensure round the clock delivery services. 1,53,968 deliveries were conducted in the Primary Health Centers. The Primary Health Centres have conducted 86.5% more deliveries when compared with the 2006-07 for the same corresponding period. The Departmentofofvarious Public National Health and Medicine is responsible for the implementation and Preventive State Health Programmes. This department also plans and implements measures to prevent the occurrence of communicable diseases thereby reducing the burden of morbidity, mortality and disability in the state. The activities undertaken by the department of public Health and Preventive Medicine are provisions of primary health care, which includes maternity and child health services, immunisation of children against vaccine preventable diseases, control of communicable diseases, control of malaria, filaria, japanese encephalitis, elimination of leprosy, leprosy, iodine deficiency disorder control programme, prevention of food adulteration, health check up of school children, health education of the community and collection of vital statistics under birth and death registration system and environmental sanitation. Nurses are the prime human resources in these centres to deliver health care services service s qualitatively qualitativ ely..

27

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Fig. 4: Organization Structure of PH&PM

Director of PH & PM

Additional Directors PH&PM and M&F(2)

Joint Director (HEB)

Joint Director (IMM)

Joint Director (VBDC)

Joint Director (Epi)

Joint Director (INSPN)

Joint Director (PFA) (PFA)

Joint Director (PHC)

Joint Director (SBHI)

 

I.2.

Management Process

  There are more than 80,000 registered nurses and more than 90,000 midwifery personnel in the state. state . The detailed breakup break up is given in Table Table 9. Tamil Tamil Nadu does not no t have a separate separat e HR policy for the nursing professionals in the state. There are guidelines for transfer/posting and job responsibilities of each nursing cadre in the state shown as in Annexure 1.

28

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Table 9: Registered Candidates with w ith Tamil Tamil Nadu Nurses and Midwives Mid wives Council as on 14.11.2008

HV ANM

2578 19214

Nurse Midwife

87254 91642

I. 3. Recruitments

Every year 1200 nursing students are passed from the government school/colleges and all of them get absorbed in the government sector. sector. They are necessary to sign a bond for 2 years to work with the government. The government does not take the students from the private schools/colleges. The TNMC is not in favor of the government's decision, as per their views the quality of education is better in private colleges/schools as compared to the government, especially trust colleges. One of the private college principal mentioned, “Government does not provided job opportunities to our students hence even though they want to serve the community they have no option but to join private/corporate hospital or to go abroad”. I.3.i. Job Profile of JD Nursing (DME)

JD Nursing is a state level administrative post and DMS is the appointing authority for this post. The main job profile and responsibility includes looking after primarily the service matter and other matters related with state level nursing personnel in the Directorate of Medical Education. JD Nursing also co-ordinates with training section under DME. Though JD Nursing gives views about transfer/placement of nursing personnel but she is not a member of any high level committees. But a strong need was felt for the JD Nursing to have full decision-making power for transfer/placeme transfer/placement nt of nursing personnel as it was observed in WB. To fulfil all these lacunae, a separate Nursing Directorate at the state level, is required to streamline all the nursing issues. In the absence of any additional senior level nursing professional, at present the workload is very heavy and an additional post of DD/Assistant Nursing Director was required to share the work at the Directorate level with JD (N) and the proposal for DD, Nursing is under process. The proposal to make the present pay scales at par with the central government pay scales is under consideration. At At present the salary of the JD (Nursing) is paid from the central government, there is a proposal in pipeline by Government of India that the salary should be paid by the state government. I.3.ii. Job Profile of DD Nursing (DM&RHS)

Under the Directorate of Medical and Rural Health Services, the nursing issues are looked after by Deputy Director Nursingp and she is the lone officer managing these affairs. Since the job profile was not specifically laid out, this post is takes care of administrative and management work with regard to nursing personnel.

29

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

1.4. 1.4.

Se Sele lect ctio ion n and and Re Recr crui uitm tmen entt

I.4.i. Nursing (DME)

The selection to the post of DD Nursing is as per the following criteria/method by transfer from the category of Reader in Nursing, or by promotion from category of Deputy Director (Nursing) from the Director of Medical and Rural Health Services,  or by promotion from the category of Lecturer in Nursing, or by promotion from the category of Nursing Tutor-Grade Tutor-Grade I, or by direct recruitmen recruitment. t. But recently the post of DD Nursing has been upgraded to the post of JD (Nursing). At present the salary of the JD (Nursing) is paid from the central government, there is a proposal in pipeline by Government of India that the salary should be paid by the state government. I.4.ii. Nursing (DM&RHS)

Recruitment of Deputy Director (Nursing) Director of Medical and Rural Health Services is by the promotion from among the Nursing Superintendents Grade I and Nursing Tutors Tutors Grade I or by direct recruitment. recrui tment. I.4.iii. Pre-Service Pre-Serv ice Trainings Trainings In the state there are 119 colleges (3 government and 116 private) conducting B.Sc Nursing courses. For M.Sc Nursing course, there are 35 colleges (1 government and 34 private). Post Basic B.Sc Nursing courses are provided by 12 colleges (1 government and 11 private). Thus total 166 nursing colleges are running at present, which both include government and private institutions. All the teaching institutions are governed by the guidelines of Nursing Council of India. The list of these schools, and type of courses run in the state, are given in Annexure-II. Due to the increasing demand for nursing human power 69 new colleges and 22  schools are in the process to be sanctioned. ANM schools closed since 1990 as there were surplus ANM in the state those days.  Now need to initiate these t hese schools as we may required more ANM ANM at the community 

level. Selection to B.Sc (Nursing) courses is done by a selection committee under single window system following the rules of reservation under the chairmanship of Director of Medical Education in accordance with the policy of government announced every year as per the DME guidelines. Admissions to postgraduate courses are done by the selection committee through a common entrance examination followed by counselling, adopting the rule of reservation. Admission to Diploma courses in Nursing is also done by the selection on merit basis (+2 marks) followed by counseling and adopting the rules of reservation. DME is looking after all these matters.

30

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu    

  n   o   r    t   a    M

 

   f   e    i    h    C

  n   o    i    t   o   m   o   r    P

 

 

  u    d   a    N    l    i   m   a    T   n    i   s    l   a   n    i   o   s   s   e    f   o   r    P   g   n    i   s   r   u    N   r   o    f   s    h    t   a    P   r   e   e   r   a    C   :    5   g  .    i    F

   l   a   p    i   c   n    i   r    P

    r   e   r   u    t   c   e    L   r   o    i   n   e    S

   l   a   p    i   c   n    i   r    P   e   c    i    V

   I    I   s   s   a    l    C   n   o   r    t   a    M

   

  r   r   e   u    t   c   e    L

   I    I   n   o   s   r    t   s   a   a   l    M    C

   h    t    l   a   e  r      H  e   c   c   i    f    i    f    l    b   O   u    P  e   s    t   r   c   u    i   r   N    t   s    i    D

 

 

   V    H    L

    r   e   r   u    t   c   e    L

  e

  s     r   u

  r   o    t   u    T

 

 

  r   e   r   u    t   c   e    L   r   o    i   n   e    S

  c    S  .    B   c    i   s   a    B    t   s   o    P

   N    d   a   e    H

  e   s   r     u   o    C    N    H    P   r   a   e   y    1

  e   s   r   u    N    f      f   a    t    S

  r   o    t   a   r    t   s   n   o   m   e    D

   d   n   a   g   y   n  r    i   e   s    i   r   f   u  w    N   d  .   i   c   M    S  .      B

   d   n   a   g   n  y   r    i   s   e   r   f   u   i    N  w    l   d    i   a   r   M   e   n     e    G

  c   e    i    l   s    b  r   u  u    P   N    t      i   c   h    t    l   r   a    t   e   s    i   H    D

 

   W    F    H    /    M    N    A

 

   M    N    A

 

  r    Y    1   r   o    f   r   o    t   u    T

  g   n    i   s   r   u    N   c    S  .    M

 

 

 

31

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

I.4.iv. Career Path and Promotions of Nursing Figure 5 describes the career paths for nurse-midwives with various qualifications. A Ass seen, there is a clear demarcation between careers in teaching and careers in clinical and public health services with different requirements for qualification. Usually degree holders make a career in teaching and diploma holders have hospital based careers. Generally as a policy there is very little mixing/movement or transfers of professionals from the teaching and clinical side. One reason for this according to the respondents is because the salary structures are higher on the teaching side. For example the tutor in a nursing school gets higher salary compared to a head nurse in a hospital although their level is the same. Further the nurse-midwives in the public health side have very few promotional posts. Their career paths are very short. For example the staff nurses who qualify as Public Health Nurse get appointed as District Public Health Nurse (DPHN) which has only one further promotion, that of DPHN Officer. Similarly an ANM/FHW has negligible growth in her career- there is only one possibility of becoming a Female Health Supervisor (FHS). Those ANM/FHWs ANM/FHWs who take the 6 month training for female health supervisor have to wait for a long time for promotion as there are many more ANMs compared to the posts of FHS (IIM PHN study). Overall in theside nursing cadre are After very-very slow slow.. of Within slow system, clinical promotions and community is the worst. 30 years job, the staff nurses are promoted as Nursing Superintendent Grade III. At times they are even retired without getting any promotion. Though teachers are highly qualified with more than 20-25 years experience, their late promotions is a serious concern. As per the respondents, frequent change in the leadership and frequent transfers of the high level officers, responsible for the slow process of promotions. The top officers should be at the same place at least for 5 years to provide justice for promotions, set the system and bring the changes in the existing system. The records from the service register and ACR are used for promotions. I.5. ACR and Performance

Annual Confidential Report (ACR) appraisal system exists, and these reports are only used for the purpose of promotions. ACR is duly filled by the immediate supervisor supervisor.. This is mandatory for any diplomacy action, although most promotions are based on the seniority. The ACR format is same for all streams including teaching, medical services and health. II II..

Role Role of N Nur ursi sing ng/M /Mid idwiv wives es in Pro Promo moti ting ng Mate Matern rnal al Heal Health th Care Care Servi Service cess

India's Eleventh Five Year Plan (2007-2012) on health of women and children emphasizes a crucial role of nursing/midwifery in maternal health for achieving the MDGs. The report quoted “investments in nursing will provide more return in terms of impact and therefore makes the suggestions – the states should take action for having a nursing cadre se up in the State. A dedicated nursing and paramedical manpower division/unit should be established at the national and state levels”.   (http://planningcommission.gov.in/aboutus/committee/wrkgrp11/wg11_rphfw. pdf cited on 16 February 2009).

32

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Further solution exchange for maternal and child health compiled by Meghendra Banerjee, 22 October 2007, suggested nursing/midwives roles and responsibilities for their better output to save our mothers. Health Assistant or Health Workers (Male & Female) for home visits in a rotation, running sickness clinics, doing all preventive and promotive work and providing population based services, counseling and empowering families for household care. Senior Health Assistants, LHVs, Senior Health Inspectors, Sanitary Inspectors    for on job skill training, looking at supplies and making inventories, doing primary outbreak monitoring, micro planning and community based resource mobilization. Nurses in Sub-district Hospitals and PHCs for managing labour rooms, maternity  wards, and providing support in surgical procedures like sterilization operations (laparoscopic or otherwise). Junior 

www.solutionexchange-un.net.in/en/Downlo www.solutionexchange-u n.net.in/en/Download-document/687-Red ad-document/687-Redefining-theefining-theRole-of-Allied-Staff-in-Healthcare.html - cited on Feb 16/02/09.

In accordance with the directions given in the Eleventh Five Y Year ear Plan (2007-2012), all the senior health administrators/professionals interviewed in various hospitals   is thethey main core for promoting maternalnatal, health and besides quoted 'Nursing conducting deliveries, play a crucial role in ante-natal, postnatal care, incentive care unit, reproductive and child health including adolescent health care and Post Partum Haemorrhage care'. ( Dr. Dr. M. Dhanpal, Dean of Kilpauk Medica Medicall College Hospital, Tamil Nadu 2008).  Other state level cadre also supported this views, “involvement of nursing cadre is absolutely necessary to reduce MMR/IMR, hence nursing education should be taken seriously by the government.   Most of the supervisory cadre and matron mentioned about the capacities of nurses to manage even complicated deliveries. 

In government health setup of Tamil Nadu, staff nurses conducts most normal deliveries and labour wards are managed by the nursing cadre. They are trained for early identification of maternal complications, referral, obstetric first aid and treatment of minor ailments and also assist the doctors for performing tubectomy operations. They are authorized to sign delivery papers.

“I can conduct any delivery confidently even complicated delivery delivery.. In PPM we give oxytocine injection, do uterine massage for contraction, remove placenta and give breastfeeding immediately immediately.. In case of serious complication, refer the patient to CHC or district hospital. We accompany with a patient, admit in the hospital and then come back. If possible also do the follow-up by telephone” (Nursing Cadre).

33

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

a. Although Although they they are managing managing maternal maternal health health care and their their importan importance ce is realized by the state, the staff nurses themselves feel that their efforts are not been valued. As all of them expressed, “We manage all the complications breech presentation, eclampsia, postoperative cases, lobour wards, ICCU, cardiologist ward, paediatric ward, trauma centre but no credit or recognition to us, all the credit goes to doctors”. (Nursing cadre respondent) The nursing/midwives are providing, round the clock services in three shifts, 24 hours x 7 days basis in all 1421 PHCs. Due to round the clock availability of staff nurse, the institutional deliveries increased by 50% within two two years. Besides, they are responsible to organize maternity picnics, to provide transportation allowance to the public vehicle which carries woman for a delivery. The task of verbal autopsy for maternal deaths is also taken care of by them. The nurses/midwives are concerned about the, “Maternal mortality in their respective hospitals/CHC/PHC, hospitals/CHC/PHC, as family members transport woman very late with bleeding and eclampsia”. To reduce these deaths, they suggested awareness promotion schemes like IEC and BCC to sensitize the community and family about the danger signs during pregnancy and post partum period. Another serious concern, was the employment of non-registered nursing cadre, who are poorly trained from the non-registered institutions, institutions, in private hospitals in a low salary salary.. It is estimated by the government out of totalThere 94% institutional about 60% are conducted inregisters, the private hospitals. is no 'Law' todeliveries, stop unregistered nursing cadre from practicing. The respondent expressed the strong need to pass amendment to stop illegal practices. The Government nursing cadre, advocates for such an amendment in collaboration collaboration with TNAI. TNAI. As per their views, INC should should play an important role in this endeavour endeavour.. They are also concerned about the appointment of un-trained 'Ayas' (Female Attendant), in maternal wards. T To o summarize the t he state and the central government is realized the importance to nursing/midwifery to improve maternal health, the cadre themselves are confident to address maternal health effectively. II.i.

Key Initiatives for Involving Nursing/Midwifery in Service Delivery

Establishment of 24x7 PHCs with good facilities and good infrastructure has been a very successful initiative of Tamil Tamil Nadu. 421 PHCs have been upgraded into 24 hours

functioning PHCs. PHCs. In each each of these these PHCs 3 staff nurses nurses are appointed who who work on 8 hours of shift duty. From 15-09-2008 all 1421 PHCs (100%) functioning as 24 hours PHCs. These upgraded PH's have ensured round the clock availability of staff nurse trained in obstetric and newborn care, the staff nurses conduct deliveries, do early identification of maternal complications and referral, provide minor ailments treatment and obstetric first aid, assists the doctor in the PHC OT for performing tubectomy operations: As per the data of PHC deliveries performed during 2006-07 and 2007-08 given below there is a marked improvement in institutional deliveries and as reported with great pride by senior policy makers makers of the state, institutional institutional deliveries are more than 99 percent pe rcent in Tamil Tamil Nadu. Deliveries for the year 2006-07 (November 06 to October 07) : 98,883  Deliveries for the year 2007-08 (November 07 to October 08) : 2,28,085  

34

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

No. of Deliveries increased for current year No. of deliveries increased during this year

 

: 1,29,202 : 130.66%

Establishment of 24x7 PHCs

Free Transport Transport for Pregnant Women

To PHC for Delivery

Automan getting from SN for transporting pregnant mother

To Home after Delivery

The visit by the research team to one of the 24x7 PHCs confirmed the upgradation of maternity wards under NRHM programme. The labour rooms were fully equipped along with the operation theater for caesarean deliveries. The PHCs were equipped with the latest computer technology to maintain maternal and child health data with online reporting. The staff nurses are trained to update patient's data regularly to provide to the block/districts authorities. All PHCs are installed with a solar energy system and hot water facilities available for

35

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

24 hours. Add on to it, inverter facility, semi-auto analyser, scan facilities were all provided.  Privacy of women is assured with curtains. Very clean toilets observed during the visit! Some PHCs are also equipped with steam laundry unit, and gradually the state plan to install in all PHCs. Garden is developed developed in front and backside of PHCs. Nurses, doctors and other staff were found to be very enthusiastic to work in such an enabling environment. The increase in number of deliveries, since last two years, shows how the upgrade facilities have changed the community's attitude towards the public publi c health sector sector.. The PHN cadre is also provided the facilities of scooter, scooter, bicycle and mobile phones to reach to mothers on time and to improve communication with the community and their supervisors. supervisors. Quarters in PHC premises are made available available with all the basic facilities. The state has shown the improvement of nursing capacities and their output due to these basic facilities. The state also initiated the birth companion scheme, where one of the family members, especially husband, mother or near relatives are permitted to be with woman during delivery to provide emotional support. All these benefits have led to, increase in institutional deliveries, improved breastfeeding practices, better mother and child interaction, decreased postpartum depression and other problems. Nutritious food is provided, at the tnurse he PHC, toprovides the ANC women coming check-up and those admitted for delivery and staff also nutrition education and counseling to the women. To encourage institutional deliveries, the government compensates the wage loss incurred of BPL families' up to two deliveries. Total Rs. 6500/- are given, which includes Rs. 3000/- given during the last 3 months of pregnancy to eat nutritious food Rs. 3000 in post-natal period and Rs. 500/- given from Janani Janani Suraksha Yojana. ANM plays an important role to propagate the scheme and to guide the community to avail   the benefits of this scheme. Fig. 6: Streams of Nursing and an d Midwifery in Tamil Tamil Nadu centrep Nursing and Midwifery

 

 

 

Education

Services

Medical

Public health Clinical

   

Course for Auxiliary Nurse Midwife

Graduate/Post graduate Graduate/Post Degree

 

 

Course for Multipurpose heal health th supe supervis rvisor or Diploma in General Nursing & Midwifery (Schools of Nursing)

 

(Hospital Based)

Public Health

(Colleges of Nursing)

 

 

(Community-based)

In-service Training

 

Diploma in Nursing Education & Administration

36

Centres-District Training Teams

 

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Though diploma course for ANM is on the official record, this has been stopped from 1990 as there were surplus cadre during those years. After GNM, certain years of experience, one year course in Public Health Nurse, Diploma in Nursing Education and Administration is conducted.This is required for district level supervisory/ administrative position. The practice side is again divided into clinical and public health. The clinical side comprises of nurses and midwives largely diploma holders, posted in the hospitals large teaching hospitals/civil hospitals, district and sub-district hospitals and Community Health Centres. Centres. The public health health side comprises comprises of Public Health N Nurses urses (PHNs). The PHNs are posted at the district level and are supposed to monitor the work of the Lady Health Visitors and the Auxiliary Nurse Midwives/Female Health Wor Workers kers (ANM/FHW) below the district level posted largely at the Primary Primary Health Centres. III III..

Nursin Nursing g Issues Issues at the Educatio Educational nal and Tra raini ining ng Instit Institutio utions ns the Nursing Schools and Nursing Colleges)

(es (espec pecial ially ly

The ancient history of nursing/midwifery of Tamil Tamil Nadu is accountable for the highest number of schools and colleges, as compared to other states of India. There are 28 government and 320 private schools/colleges (Table 11),  producing more than 12 thousand nursing nu rsing cadre per pe r year. year. Besides Kerala and an d Andhra Pradesh, Pradesh, Tamil Tamil Nadu is one of the main suppliers of these cadres to other states of India and abroad. Table 10: Number of Nursing Education Institutions and Intake of Students in Tamil Tamil Nadu p

 

S. No

Institutions

Intake  Students   off  Private Govt.

Govt.

Private

Total number

1.  Nursing Colleges

14

45

59

2.  Basic B. Sc. (Nursing)

3

116

119

110

6020

3.  Post Basic B. Sc. (Nursing)

1

11

13

40

280

4.  M. Sc. (Nursing)

1

34

35

08

461

5.  Total

5

161

166

110

6020

6.  Nursing Schools (Govt)

21

149

170

7.  Diploma in General Nursing & Midwifery

22

161

183

1336-

3685

-

1

1

8.  Diploma in Nursing Education & Administration (DNEA)

37

15

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

S. No

Institutions

Govt.

Private

Total number

1

-

1

-

14

14

11 11.. Total otal

23

176 176

199 199

12. Grand Grand Total Total of Teaching Institutions and Nursing students

28

337

365

9.  Health Visitor/Multipurpose Health Supervisor 10. Diploma Diploma in Auxiliary Auxiliary Nurse Midwife/Multipurpose Health Worker Worker

Intake  Students   off  Private Govt. 60

357

Source: http://www.tamilnadunursingcouncil.com/siw.asp  and Tamil Tamil Nadu Nursing Council, 2008.

The State is in pipeline to initiate/sanction 69 more colleges and 22 schools as there is great demand in foreign countries. Table 11: Total No. of Institutions

Name of the Course 

Govern ment (26)

 

GNM

05   (Withhel d) 22  

 

08

11

183

 

 

034   320

-   035 17 365

11

CMA I

Tot al

0227

130

035 7 

3345

340

502 1  60 015   613 0    320 46 9

 

-

01 001   119

Source: Nursing Council, Tamil Nadu 2008.

38

-

 

1336

  -   012

01   01   28

014

     

P.B.B.Sc. ,(N) M.Sc.,(N) Tot al

 

06

 

01   116

 

 

 

01   03

Priva te

 

 

 

150

H.V. D.N.E.A. B.Sc.,(N)

 

Intake of Students

Govern CMA Tota ment l I     (17) (243   )

Priva te (200 )

 

ANM

 

No. of Institutions

 

60 110

 

 

015   6020

 

  -

 

40

  280

  - 

08

  461



12372

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Till 2008 only science group students were eligible to join the GNM course but recently in 2009 the state government has opened the GNM course to even the arts group also and this is definitely a positive step for widening the scope of nursing profession. Moreover the government has also introduced nursing as one of the optional subject for eleventh and twelfth standard. (Source: Nursing Higher Secondary Second Year, Volume 2 Tamil Nadu Textbook Corporation, College Road, Chennai 2005). http://www.textbooksonline. tn.nic.in/Books/12/Nursing-EM/Vol2/Covers%20and%20Authors.pdf  The Government ANM schools had been been closed since 1990 due to surplus cadre in the state. But due to the need emerging under NRHM, the state is planning to re-open these schools. III.1.

Government Schools and Colleges

Total number government schools of nursing in the state 21. And only 2 government nursing colleges at Government Rajaji Hospital, Madurai, and Madras Medical College, Chennai. The student teacher ratio in government GNM schools is 21:1 consisting of 5370 students teachers. Though as perare INChighly norms it should be experienced 10:1.   Most of and the teachers and in 252 nursing schools/colleges 'educated, enthusiastic, and some also have a doctorate degree. INC has reduced the norms for M.Sc and B.Sc to work in the college of nursing and school of nursing (Information given by Department of MRHS). The admissions in the teaching institutions are given on the merit basis (marks). INC curriculum is followed in the State with some additional topics as suggested by the state. As per their norms, nursing students should conduct 20 deliveries and assist in 20 deliveries during their study. But in Tamil Nadu the students of government college/schools are privileged to get enough hands on experience. In the headquarters hospitals in Tamil Nadu, the bed to students ratio is higher than the needed quantity. quantity. The total bed strength of the old and ne new w GGH is 2029 and 2722 respectively,, so there are more number of beds than the students. respectively The exact hours for the maternal health in the GNM schools, as per new syllabus (midwifery and Gynae) are 208 hours for theory in Midwifery and Gynae and along with clinical practice in midwifery and Gynae for 918 hours. As reported the students, learn PPH management during their night duty. Another benefit in the government hospital is nursing students are allowed to do episiotomy, episiotomy, which is not the case in the private colleges. This advantage to the students may be due to higher institutional deliveries conducted in Tamil Nadu (90.04%), Hostel is compulsory for students in both government and private colleges. The research team visited two nursing schools, one is school of nursing under the Government General Hospital, Chennai and other is School of Nursing under CSI Kalyani Hospital, Mylapore. This school of nursing is attached with Government General Hospital.

39

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

III.1.i. CSI Kalyani, School of Nursing

The school of nursing was started in 1955, to impart education in general nursing and midwifery. The programme remained suspended from 1977-86. Then the school of nursing was restarted in the year 1987.

Fig 7: Organisational chart of Nursing staff at Education and T Training raining Institutions Principal

Vic e - Principal

 

Senior Tutors 3

Tutors

Clinical Instructor

The diploma programme in nursing is 3 years and 6 months duration, practical experience is provided throughout the period of education. They take 25 students in each batch. The admission is given only for girls. Upon successful completion of 3 years and 6 months course the candidates has to do 1 year of compulsory internship. Diploma is awarded by Board of Nursing Education. The diploma to be registered with the Tamil Nadu Nurses and Midwives Council. Here the admission for the diploma course is only for girls. One course is of three and half years of duration i.e., GNM Diploma Course. They are also taking one year service bond from each student.

40

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

  Fig. 8: Organization Chart for Govt. General Hospital, School of Nursing

CONTORLLING AUTHORITY - DEAN

PRINCIPAL PRINCIP AL NURSING SUPERINTENDENT

VICE PRINCIPAL PRINCIPAL

ASST. NURSING ASST. SUPERINTENDENT

SENIOR TUTOR

WARD SISTER TUTOR STAFF STAFF NURSE WARDEN ASST.. WARDEN ASST WARDEN HOUSE KEEPING STAFF STAFF

STUDENTS

III.1.ii. Madras College of Nursing

The post of Principal is lying vacant for some years and since the regular post is not filled up, presently presently the college college has a Principal Principal in-charge for the last four years. Besides the lack of human resources there are enormous infrastructure problems. The land provided to nursing college is overpowered by the medical college and they built the hostel for the medical students. Government gives less importance to nursing college as compared to medical college. Also the financial grant, given by government, for nursing education is very less as compared to medical education. III.1.iii. Managerial Issues of the Government Teaching Institutions

The main managerial functions performed by the in-charge of the schools amd colleges are carrying out day to day administrative, supervisory, supervisory, coordinating and monitoring for educational activities like teaching and training. Nursing faculties are not a part of the decision-making body, and are not involved in the selection and recruitment. Director Medical Education is the Chairman and Dean is the Deputy Chairman of the decision-making body. All the policy decisions are taken by the Director Medical

41

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Education and the Director Medical and Rural Health Services. In the nursing school committee we discuss our issues and necessities which will be sent to Dean for recommendations.. Dean will forward it to DME. recommendations There are no specific guidelines for involvement of nursing officials in the policy decision-making. But while framing any policy concerning teaching institutions, the nursing tutors are consulted and invited for discussions from time to time. They are not part of any task group. For nursing school they have separate budget. Budget is operated by the Principal Principal and Medical Director. For hospital, they have separate general budget. Nursing Superintendent has to submit the budget whatever things they want. Nursing Superintendent comes under Medical Superintendent. Lack of facilities for the teaching cadre: Nursing teachers do not enough space to read & study.  Recently, due to efforts of the principal, they managed to get some funds from the private company for getting tables and chairs for the college staff. Less number of teachers than required: One of the GNM schools visited, had only 25 teaching staff for 450 students. The ratio comes one teacher for 18 students, against the INC norms of teacher students' ratio 1:10. Teaching cadre is not involved in any policy or admission procedures:   Neither Principal, nor senior teaching staff of any government college are included in any policy decision-making body for nursing education but ironically medical doctors are involved in decision-making. Principal's Post is not Regular  Lack of transportation: As per INC norms, there should be transport facility for staff & students to visit community/villages for nursing/midwives practice. Most of the government colleges and schools, have only one vehicle for 250-270 students and that too not in working condition. As per respondents, most of the students and tutors travel by public buses. 170 students in one class: Teachers cannot pay individual attention to so many

students. Furthermore, it is difficult to manage the practical classes with large number of students. Library need to be strengthened: It was expressed by the teachers that financial assistance should be increased for the library. Poor infrastructure: There is only one computer in the college as compared to private colleges having computers computers lab. The schools and colleges have put the the request for 10 more computers in each, Furniture and curtains in the school/colleges are very old. No euro plant for the purified water, as their students quite often suffer from waterborne infections. No indoor or outdoor game facility for the students. Due to lack of space the game's room is converted into classroom. There should be separate auditorium for the guest lecture and educational, cultural functions. Poor hostel facilities: The hostel facility and infrastructure of the government nursing education institutions really need to be improved.

42

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

III.2.

Private Schools and Colleges

There are total 218 private colleges and schools producing more than 6 thousand cadres mostly for foreign countries and other states of India. Most of the private colleges are affiliated to Medical University, INC and The Tamil Nadu Nurses and Midwives Council (TNMC) and established strategic alliances with the College of Medicine and Nursing. They run Bachelors and Masters Degree courses and few of them are in process to start a doctorate programme. The research team visited private private and trust institutions institutions also. In one of the college college visited, 40 faculty members with 16 visiting professors are working for 270 students. In CMA college, college, even doctors deliver lectures for nursing students. They have liberty to invite eminent guest lectures. In private colleges, fee ranges from Rs. 1050/- to 5000/- per month, per student. Some private colleges, offers scholarship to disadvantaged students and some gives concession. Omayal Achi College of Nursing offers scholarship to 5 students every year, year, SC/ST given the priority. priority. Most of the private colleges visited, prefer the diploma and degree courses to female students as male students are difficult to handle and not sincere. Many of the private colleges admit only unmarried girls. Some of the privatesign colleges and schools absorb in their ownthe hospitals. Such as - Apollo hospital 5 years bond to work withstudents them while getting admission to captivate all the students, in their hospital chain all over India. On the other hand, some private schools/colleges do not have their own hospital to provide hands on experience to the students. They have established linkages linkages with the private hospital hospital as government hospitals do not allow. allow. Those are Cancer Hospital, Apollo Hospital, JJ Hospital, Subramanian Hospital, Sunderam Neonatal Hospital etc. The private colleges are inspected by the State Council offer every three t hree years. Christian Medical Association, Association, board college allotted 35 beds for maternity ward out of the total 250 total beds. Every day 3-4 deliveries conducted in the hospital, provide required hands-on experience to the nursing students. Nursing students are well trained in breech presentation and other complications. They are able to maintain the ratio of nurse/bed 1:1 in emergency and maternal ward and 1: 6 in the common ward. Nursing staff is appointed on the basis basis of recommended recommended ratio by INC - 1: 3 beds. beds. After certain years of clinical service experience, Christian Medical A Association, ssociation, have the provision that the staff can shift to t o teaching line and vice-versa as both the cadre get equal salary norms. This enriches both the knowledge and skill of the nursing tutors. To provide practical experience in community nursing, the college has adopted nearby villages. Nursing students regularly visit and stay in the villages while conducting health survey, ANC check-up or during health education educati on campaign. Christian Medical Association Association absorb their own students in tthe he hospital and teaching cadre. In rare case, recruitment is done through advertisement in the newspaper. Selection of the cadre is through comprehensive interview includ including ing oral, written and aptitude test. There is separate budget for the nursing school and a local advisory committee and a

43

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

management committee. The nursing cadre is included in all the decision making bodies of the hospitals/schools. All the posts of principals, vice-principals, senior tutors, tutors, clinical inspectors are filled up. III.2.i. Concerns Expressed by the Private Colleges for seats: It is mandatory for the private colleges to take permission for the number of students to be admitted in their college. But the decision making process takes a long time loosing on crucial time.

Permission 

opportunity in the government sector:  The students passed out from the private schools and colleges are not eligible to get a job in the government sector. sector.

No job 

hands on experience: As some of the private colleges, do not have their own hospital to provide hands on experience, especially in conducting deliveries.

Lack of 

IV IV.. Nursing Issues with the Professional Bodies especially Nursing Council and Tamil Nadu Nursing Associations IV IV.A. .A. Tamil Tamil Nadu Nurses and Midwives Council

The Tamil Nadu Nurses and Midwives Council is the earliest Nursing Council in the whole South-East Asia. This Council is an autonomous statutory registering body for the Nurses, Midwives, Auxiliary Auxiliary Nurse Midwives/Multipurpose Midwives/Multipurpose Health Workers/Health Workers/Health Visitors. This Council regulates training programmes and granting recognition to the institutions. The Council aims for the advancement of nursing education and champion the cause of the nursing profession. The Council was registered under the Madras Nurses and Midwives Midwives Act 1926. It was amended as per Nurses and Midwives Act VII of 1934 and Act XXVI (26) of 1960. This Council also extends its registration to Union Territories erritorie s of Pondicherry and Andaman & Nicobar Islands. Functions of the Tamil Tamil Nadu Nursing and Midwives Council are as follows:

Registration of Qualification Registration Reciprocal Registration.  Foreign Verification.   Regulation Regulatio n of training programmes and granting recognition to the nursing institutions in Tamil Nadu, Pondicherry and Andaman and Nicobar Islands. Monitoring the professional ethics.  Regulation Regulatio n and surveillance of professional conduct conduct and to check and take action  against malpractice 

Since the Council does not take any fund from the state government, it generates its own funds from the registration fees, school/college inspection fees and other donations. The Council regulates training programmes and granting recognition to the institutions and aims for the advancement of nursing education and champion the cause of the nursing profession. The rules and regulations framed have been amended on several occasions to suit the rapid changes in science and technologies. Previously the registration of the nursing cadre was for life. Now they have introduced the system of re-registration after every five years to be able to keep the track of number of nurses working in the state. There were more than one lakh registered nurses. The registration fee for the nursing is Rs.780/- for every five years.

44

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Table 12: No. of Registered Nurses with TNMC (as on 14/11/2008)

Category Health Visitor Visitorss ANM Nurse Midwife Total

Registered Numbers 2578 19214 87254 91642 200688

Annual financial turnover of State Nursing Council is Rs.31, 20,000/-. Since the council does not take any financial assistance from the government, they are able to retain their autonomy. autonomy. But the state government is very supportive of the activities of the council. The council headed by President is consisting of total 18 members including - 8 government ex-officio, 5 elected members and 5 are nominated. Registrar Registrar who looks after the day to day affairs of the council is not a council member. member. The council has 9 administrative staff members whose salaries are paid by the council.

Table 13: Courses /Programmes Recognised under this Council Registered Courses Name of the course

Entry Level as per INC

Diploma in Auxiliary Nurse Midwife/Multipurpose Health Worker Health Visitor/Multipurpose Health Supervisor (F) Diploma in General Nursing and Midwifery Basic B.Sc., Nursing

Entry 10th Passed  Level as per INC 

Post Basic B.Sc., Nursing M.Sc., Nursing Diploma in Nursing Education and Administration (DNEA)

D Course Duration  Duration   Duration 18 months (1-½ ye year ars s)

MPHW – Passed  

6 Months

10+2 Passed – 45% (Science group) 10+2 Passed 50% (Science group) Diploma in Nursing with 2 years experience B.Sc.(N) with 1 year experience Diploma in GNM

3-½ years

 

4 years 2 years 2 years 10 months

The Council is monitoring the standard of nursing education as prescribed by INC which is imparted through the INC and TNC recognized institutions in Tamil Nadu for the purpose of registering the recognized qualification conferred by the recognized examining bodies.

In the last two decades, the Council gave its approval and recognition to the syllabus

45

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

for the degree course in [B.Sc.(N)] Nursing beginning with the College of Nursing attached to the Christian Medical College, Vellore and later in the College of Nursing of the Government General Hospital, Madras.  Through its efforts PostGraduate Courses in Nursing', 'Nursing Tutor Tutor Course', 'Hospital Administration', 'Ward 'Ward Management', etc. beside M.Sc.(N) were introduced. Great impetus has been given to the speedy advancement of nursing education in this state. Concerns expressed by the Registrar of the Council The Council expressed the need for more sanctioned posts  in the state as more  than 70% of the passed nursing cadre move out of the country for better opportunities. According to them, the present requirement of nursing cadre is much more than the sanctioned posts. As per WHO standards there should be 2 beds for 1000 population. Considering this ratio, Tamil Tamil Nadu's 7 crore population population will require require total nursing nursing strength of 1 lakh 10 thousand. But But the state has only 31 thousand nurses nurses appointed appointed and out of which 16 thousand are are in the government government sector and 15 thousand workforce in the private sector. sector. The Council is proposing to the government to increase the number of sanctioned posts.

The Council also expressed the concern for quality of education in nursing schools and colleges. The Council strongly advocates for more hours of hands on experience in the hospital/community for the degree and diploma nursing courses



and do not favour to recognize the Distance Learning degree/ diploma nursing courses in the state. The Nursing Council is attempting to establish simulator labs to enhance the clinical skills of the students and are planning to spend about one crore rupees for this purpose.



At present, the Council is in process of computerization of all the Council data right from its inception. IV IV.. B. Trained Trained Nursing Association of India (TNAI) - Chennai C hennai chapter

TNAI established in 1908 at the national level having 30 state branches. At present, about 3 lakh trained nurses and about 95000 student nurses are registered in all the states in the country. country. This body is registered and recognized by GOI. TNAI promotes high standards of health care & nursing practice and advances professional, educational socio-economic and general welfare of the nurses. TNAI-Chennai chapter has about 16975 nurses/midwives registered as on Dec' 2008. The President, VicePresident Presid ent and Treasurers Treasurers are working on the honorary basis from their home or their professional work place. The administrative cost is adjusted from the grant received from GOI for conducting conducting the CNE programmes. There are total of 11 Executive Members. Due to lack of separate budget for the infrastructure TNAI-Chennai chapter does not have separate building for their office. Every alternate alternat e year, year, TNAI organizes the conference on the current issues and facilitate the process of award to the students, secured first position in various categories. Two students are selected each year from government and as well as private schools/colleges. The State Chapter is a member of decision-making body to select nominee for the Florence Nightangle award from the state. They are in a process to bring out state

46

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

level newsletter to encourage students and nursing cadre to write ttheir heir experiences, research studies, case studies, their concerns and networking among all the colleges and schools. The concerns expressed by the State chapter of TNAI 

Lack of human resource to perform space/infrastructure, computer facility.administrative work and also no office Inadequate sanctioned post in the government and private hospitals resulting in  disproportionate nurse patient ratio. Health sector unable to tap the potential of the nursing personnel leading to  “brain drain”. This leading to more and more nurses heading for foreign shores.  Poor/unsatisfactory Poor/u nsatisfactory living conditions for nursing cadre and students. Lack of autonomy in decision-making and planning to nursing/midwifery nursing/midwifery cadre.  Non-uniformity in pay structure at all levels. Limited scope for career  development. Least Least opportunities for nursing cadre for specialization.

47

 

Chapter IV SWOT ANALYSIS ANALYSIS ON NURSING ISSUES IN TAMIL TAMIL NADU

 

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   U    D    A    N    L    I    M    A    T    F    O    S    E    S    R    U    N    F    O    G    N    I    N    I    A    R    T    D    N    A    N    O    T    I    A    C    U    D    E    E    H    T    F    O    S    I    S    Y    L    A    N      A    T    O    W    S  .    3

 .  .    1   2

 .    5

 .    4

 .    3

  s    l   o   o    h   c   s

 .    6

   l    d    d    l   e   e  ,   a    d   g    d   o   e    l   e    d   t    t    i   n   n   v    i   a   r   y   a    i     r   l   s   s   a   c   u   p   e  s    d   a   e   s   g   g   e  e   e   e   t   e    i   r   n    l   c   y   a   p  n    i    l    l   s   s   o   e    h   s   o   r   c   n   g    l   h   e   u    /   o    h   n    l   e    i    h   o   s   o   r   r   t   e    h   a   o   e   e   n    t   c  .   r   a   a    h  y  .   s   t   r   h   a   e      t   v   c   e    /    i     s   h   n   s   e  e   a   t   r    t   u   r   r   g   q   p   n   T  e   e   g   g   l   e   d  e   m  .   y   e   r   e   e   n   l    h    l    l   o   r   l   d   l   g   o   a   e   i    t   a   m    i   n  c   e   o   e  c   c   s   c   o   /   a   t   e  e   e   r   s   v   n   H   e   h    i   s   t   r   v   t   g   l   p   e   t    h   o   o   s   o   o   e    i    S   e   g   n   h   o   t   e   t   h   c   m   n   t   n   I    H   t   a   o   r   e   c    T   u    h  m  .   r    d   e    h   s   s    G   b    t   n   e    t    ’   r   i   g   a   v   o   c   t  ,    N   s   w   n   e  g   n   n   m  e    E   l   v    i    f   e   e    k   s   v    R   o   o   r   o   a   o   i   r   d   g   r   r    T   o  .   f   u    h   u   o   e   t    S   h  s   d  e   n   s   p    t   c   w   s   o    h   e   s   e   x   s   n   e   o   n   s   t   o    l   e    t   o   s   n   t    g   a   d   a   n    i  .   n   s    i   u   n   e    i   p    t   o   d   r   s    t   r   v   e   d   a   s   s   m   s   e   r   u  o   r   e   o   e   d  e   e   s    b    N   G  a   b   r   y   h    h   n   a   e    f   e   t   s   o    2   c   d   t   s   o   h   n   b  r   a   n  ,   h   h   r   t   e  a   o   e   a   u   h   t   e  s   d   t   f   t   d   d  g  ,    b  r   u   u  e   d  e   e  a   u   e   t    h   c   N  o   d  .   m   g   n    b   o   t   n   l   n   a   y   u   s    b   f   e   i   e   N   t   n  m  g   m    i    t   l   t   n  e   a   o   i   r   m    i   e  u   n   e   i   n    t   a   e    h   s   g    t   n   s   p   T  g   m  a   r   t   r     a   u   u   f   g   o   x   n   o   a   u    L   o   N  o   i   s   M  e   I   t   T  q  .    1  

 

 .    2

 

 .    3

 

 .    4

 

  s   s     l   e   o   s   o   e    h    h   c    t   s    f  .    t   g   n   o   v   i   o   s  .   d   n   g   r   e  a   u   t   e   n  a   m    h   e   t    t   s   e   r   t   e   d   a   e   i     e   v   h    b   r    t    t   m  p   i   n   h   u   f    t   n   o   n  e    t   o   e    i   u    t   m    o   e   a   o   c    h   c    t   c   n   u  s   a   d    i   n  e  r    h   i   w   g   e   n    S   s   m   o   i   n   i   a    T   l   r    d   o    A   o   s   s   r   t    E   h   i    d    R   c   h  u   n   i   e    H   s   t   f    i    T   g   o   f    l   n   d   t   a    i   s   u   n   s   r   a   o   q   u   s   c   f   n   n  r   o   e   o   h   e   i    t    l   a   t    i   u  g   l   a   v   t    h    i    f    i   r   t    t   e   p  s   h  r   n   o    f   I   o   l   t   h   o   s   e   a   t   c   n  s   a  .   o   s   s   n   i   a   t   d    d   i   e    i   n   g   e   c   r   a   e   o   m  a   e   l   u  s    l   o   d   l    h   o    D  e  a   T  c  .    1

 

 .    2

 

 

  y    t   g   l    l   n   n   i   a    i   e   r   c    i   m  r   e   o   u   n   f   r   q  p   s   e   e   e   s   e   r   v   i   o   t   g   s    i   n    l    G   n   o    i    l   i    i   c   s   t   a   a   a   u   r   f   e    t    t   r   i   n   g   c   t  .   e   i   n   s    I   n    i   i   n    C   C     i   n   s   l    N  e   a    i    I    h   r   r   a   y   t   t   e   n  ,   o   r   f    b    i   w   o   o   t   a   n   f   o  .   p   c    i   o   d   g    M   n   u    t   e   n    H    S   a   d   a   e   i    E    R   e   c   n   n    I   n   m   u   u    N    T    u   g    d  e   r    I   r   n   e   h    N   h   i    t   e   e   s   g   d   h    d    U   g   r   n   u    i   n   e   t   n    T   i  .   u   n   s    R   s   z   d   i   s   r   f   r    i    O   u   o   u   s   n   s   d    P   n   n   a   a   a   e   z      P   r   r   r    h  ,   b   i   e   o   p  p   s    O   f   o   b    d    f   m  u   e  a    h    d  m   s   e   g   i   z   n   u   e   y   i   n   l   p  .   i   n   d   t   m   a   n  r   a   r   e   o   l   a   t   e   t   m  r    t   e   e   e   s   n  g   e    d   l   r   n    d  o   c   e   i     e   e   u   c   i   s   a   m   n   e   g    h    i   e    h   p  e   t   s   t   d  a    t   a   e   r   u   t   u   h   y   a   z   a   t   v   o   2   i    l    i    l   g   n  e   n   r    d    i   p   d   c   a   t    i   o   i    i   0   s    0   s   a    b  s   v   r   t    l   r   e  e   l   2   e   s   -   u   e   e    h   l   P   v    t   s   s    i   s   r   r   n   o   n  e   H  o   u    n    U   f   i   W    N   t   n   I  .    1

 .  .    2   3

 

   

 

 .    4

 

53

 

Chapter V RECOMMENDATIONS

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

RECOMMENDATIONS

Nursing profession needs a complete image changeover keeping in line with the ever emerging importance of nursing profession accorded universally. The contribution of the nursing to the overall health of the nation demands more



visibility. Today the nurses toNations' be the equal partners in the process of health care delivery to achieve theneed United Millennium Development Developmen t Goals. From the image of being submissive and at the receiving end, the nurses need to shift to play the more proactive role. This requires a change in the mindset right from the top level of the t he planners up to the community and stakeholders.



Their immense human potential needs to be converted in to reality by creating an enabling work environment for them in terms of providing more power in decision making, and sound HR policies.



The state Directorate should have a separate Nursing Division and preferably to be headed by a nursing professional at the post of 'Director Nursing' or its equivalent. The senior most nursing post must have total autonomy in decision-making and to be member of all policy making bodies dealing with health and family welfare



issues. This proposed nursing division should be appropriately staffed with nursing officialss to assist the Director, official Director, Nursing.



The structure of the Nursing Division to have Joint Directors/Additional Directors/Additional Directors each for nursing services, nursing education and training and Public Health Nursing/Community Nursing.



Clear cut 

job profiles to be developed for all levels of the nursing cadre from top to bottom.

There should be 

uniformity in the pay scales preferably at par with the central

pay scales.

For effective manpower planning and development for nursing, it's extremely important is to develop the human resource (HR) policy which will take in to consideration future human resource planning for nurses. The HR policy also to focus on developing guidelines for training and development of the nurses keeping in view the demand generation.



The career path should provide flexible opportunities i.e. the transfer from service delivery side to educational and vice versa. But the transfer and placement should be supported by the t he requisite skill development.



Higher educational qualifications should be linked to career growth. But seniority should not be completely ignored, and there can be a certain percentage for seniority-based promotions.





Since the working and enabling work environment are the pre-requisite for the

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

quality of nursing services, the nursing service rules must re-frame guidelines for issues like security, accommodation, accommodat ion, and transport. More decentralization with budgetary powers to senior nursing functionaries in the hospitals.





The government to focus creating educational institutions (both schools andneed colleges), byon keeping in more mind nursing the demand and supply gap for nurses in the service servic e as well as the education sect sector or..

The skills of the teaching faculty of the institutions should be strengthened, and the infrastructure and other resources to be provided to facilitate quality nursing education.



With the emerging demand for super-specialization in the health sector, sector, the need is to increase the number of super-specialty skill-based courses.



For continuous updating of the skills, it will be beneficial to have a separate Continued Nursing Education (CNE) Cell, both at the centre and the state level.



Along with developing the clinical skills of the nurses, it is extremely important to



provide behavioral skill training especially in leadership skills, assertive skills, communication skill, conflict management and negotiation skills etc. Adequate opportunities for development of midwifery skills for hands on training need to be worked out.



To address the need for providing quality health services, the feasibility of developing nurse practitioners and their placement needs to be worked out. WB has already initiated the process.



Moreover teaching posts also need to be created for adequate placement. This can be compensated by the creation of more nursing colleges i.e., both B.Sc and M.Sc.



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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

REFERENCES 1.

A Report Report of Nursing Committee to Review Conditions, Emoluments etc., 1954, Shetty Committee, Ministry of Health and Family Welfare, Government of India, New Delhi.

2.

A Rep Repor ortt of the the Gro Group up on on Medi Medica call Educ Educat atio ion n and and Supp Suppor ortt Manp Manpow ower er,, 1975 1975,, Shrivastava Committee, Health Series and Medical Education: A Programme Programme for Immediate Action, Ministry of Health and Family Planning, Government of India, New Delhi.

3.

Hist Histor oryy and and Trend rendss iin n IInd ndia ia,, 2 200 001, 1, TNAI TNAI,, New New Delh Delhi. i.

4.

Nati Nation onal al Hea Healt lth h Pol Polic icyy, 2002 2002,, Mini Minist stry ry of of Heal Health th and and Fam Famil ilyy Wel Welfa fare re,, Government of India, New Delhi.

5.

Nurs Nursin ing g fo forr the the Deli Delive very ry of Es Esse sent ntia iall Heal Health th In Inte terv rven enti tion ons. s. Fi Fina nanc ncin ing g a and nd Delivery of Health Care Services in India, 2005, Dillep Kumar, National Commission on Macro Economics and Health, Background Papers, Ministry of Health and Family Welfare, Welfare, Government of India, New Delhi.

6.

Rep epor ortt of Exp Exper ertt Comm Commit itte tee e on Heal Health th Man Manpo powe werr Pl Plan anni ning ng,, Pro Produ duct ctio ion n and and Management, 1986, Bajaj J.S. Committee, Ministry of Health and Family Welfare, Welfa re, Government of India, New Delhi.

7.

Re Repor portt of Histor Historica icall Pers Perspec pectiv tive e of of Nurs Nursing ing and Midwif Midwifery ery Trainin raining, g, Educat Education ion and Practice in India, Draft, 2007. Mr. Anand Kulkarni and Ms Anita Deodhar, TNAI, IIM Ahmedabad.

8.

Rep epor ortt of the the Com Commi mitt ttee ee of of Mult Multii-pu purp rpos ose e Wor Worke kers rs und under er Hea Healt lth h and and Fami Family ly Planning Programme, 1972, Kartar Singh Committee, Ministry of Health and Family Planning, Government of India, New Delhi.

9.

Rep epor ortt of of the the Heal Health th Su Surv rvey ey an and d Dev Devel elop opme ment nt Comm Commit itte tee, e, Vol.I ol.II, I, 1946 1946.. Bhor Bhore e J. Committee: Manager of Publications, Delhi.

10.

Report eport of the the Health Health Survey Survey and Planni Planning ng Commit Committee tee,, 1961 1961.. Muda Mudalia liarr Committee, Ministry of Health and Family Welfare, Government Government of India, New Delhi.

11.

Report eport on High High Powe Powerr Commi Committe ttee e on Nurs Nursing ing and and Nurs Nursing ing Profess rofession ion,, 1990, 1990, Ministry of Health and Family Welfare, Government of India, New Delhi.

12.

Role of Regu Regulat latory ory Bodi Bodies es in Nursi Nursing ng and Midw Midwife ifery ry Trai Trainin ning g and Prac Practic tices, es, IIM, IIM, Ahmedabad (Unpublished report).

59

 

Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Situational Analysis of Public Health Nursing Personnel in India, 2005, Conducted by Academy for Nursing Studies, Hyderabad, (Andhra Pradesh). 14.

The Trained rained Nurs Nurses es Associ Associati ation on of India India,, Indian Indian Nurs Nursing ing Year Year Book Book,, 2000, 2000, New New Delhi.

15.

Hand Hand Book Book of Right Right to to Inform Informati ation on Ac Actt 2005, 2005, Dire Directo ctorat rate e of Medi Medical cal Educat Education ion,, Tamil Nadu Na du

16. 16.

ht http tp:/ ://w /ww ww.tnhe tnheal alth th.o .orrg.

17.

http:/ http://ww /www w.tnhea .tnhealth lth.go .govv.in/de .in/depar partme tment/ nt/hfw hfw.ht .htm m

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ANNEXURES

 

Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Annexure 1 Tamil Nadu Medical Med ical Service – Counselling for Transfer Transfer and Promotion Health and Family Welfare (A1) Department

G.O (2D) No. 131 1. G.O.(D) G.O.(D) No. 508, Health Health dated. dated. 10.4.2002. 10.4.2002. 2. G.O.(Rt) G.O.(Rt) No. 2143, Health, Health, dated dated 8.20.2002 8.20.2002 3. Governmen Governmentt Letter No. No. 35497/A1/ 35497/A1/02-1 02-1.Heal .Health, th, dated dated 18.10.2002 18.10.2002 4. Governmen Governmentt Letter No. No. 52668/A1/ 52668/A1/02-1 02-1,, Health, Health, dated 23.10.0 23.10.02 2 5. Governmen Governmentt Letter No. No. 54453/A1/ 54453/A1/20022002-01, 01, Health, Health, dated dated 23.12.02 23.12.02 6. Governmen Governmentt Letter No. No. 55147/A1/ 55147/A1/02-0 02-03, 3, Health, Health, dated dated 14.1.2003 14.1.2003 7. Governmen Governmentt Letter No. No. 54453/A1/ 54453/A1/02-0 02-03, 3, Health, Health, dated dated 12.3.2003 12.3.2003 8. Governmen Governmentt Letter No. No. 429441/A1 429441/A1/03/03-1, 1, Health, Health, dated dated 29.10.03 29.10.03 9. Governmen Governmentt Letter No. No. 50250/A1/ 50250/A1/03-1 03-1,, Health, Health, dated 27.11. 27.11.03 03 10. Government Letter No. No. 50250/A1/03-1, Health, dated 27.11.03 11. Government Letter No. No. 52427A1/03-1, Health, dated dated 16.12.03 12. Government D.O Letter Letter No. 12858/A1/04, Health, Health, dated 10.3.04 13. Government Letter No.32639/A1/04-1, No.32639/A1/04-1, Health, Health, dated 5.8.04 14. G.O. (Rt) No. 1277, Health, dated dated 5.8.2004. ORDER 

1.

Th The e Gove Govern rnme ment nt hav have e intr introd oduc uced ed a ou ouns nsel elin ing g syst system em and and iss issue ued d guid guidel elin ines es from time to time for conducting ounseling for transfer and promotion of ounsel/para medical personnel working in Health and Family Welfare Department in the government orders and government letters.

2.

Th The e gove govern rnme ment nt aga again in ex exam amin ined ed the the matte matterr and and have have dec decid ided ed to ext exten end d the the salient features of the guidelines being followed in transfer and promotion of teachers in education department to the Health and Family Welfare Department. They accordingly direct that the revised guidelines laid down in the Annexure to this order shall followed for conducting ounseling for promotion/transfer of the medical para, medical and non-medical staff under the administrative control of the Health and Family Welfare Department with immediate effect. (BY ORDER OF THE GOVERNOR)

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Annexure 2 HEALTH AND FAMILY WELFARE DEPARTMENT GUIDELINES FOR TRANSFER AND PROMOTION (Issued with G.O. (2D) No. 131 H&FW Dept. dated 20.11.2007) 1. 1.1. Periodi eriodicit city y of Counsel Coun ling g within the Directorate Counselling forsellin transfer Directorate shall be held once in a year during May. May. 1.2. Counselling for inter-Directorate inter-Directorate transfer shall be held once in a year during June. However, However, this condition is not applicable for the transfer of staff nurses. 1.3. Counselling for the post of nurses for transfer transfer and promotion shall be conducted jointly by the Director of Medical Education and the Director of Medical and Rural Health Services. 2. Re-counsell Re-counselling ing for filling filling up vacancie vacanciess arising arising as a result of of Counselling Counselling 2.1. Re-counselling Re-counselling for filling up of the vacancies arising as a result of counselling should be conducted seven days after the original date of counselling. Promotion Prom otion counselling may be conducted on the date of re-counselling itself. No re-counselling should be conducted in respect of other Directorates. 3. Venue for the Counsel Counsellin ling g 3.1. Counselling and Re-counselling Re-counselling should be conducted in an Auditorium or a large hall fitted with a Public Address System. 4. Vacancies acancies to be notified notified for for Counsell Counselling ing 4.1. Promotion Promotion or transfer shall be considered for the following categories categories only: Vacancies arising due to ? retire retiremen mentt includ including ing volunt voluntary ary retire retiremen ment, t, ? death, ? promot promotion ion of incu incumbe mbents nts newly newly crea created ted posts posts and and ? ad admi min nistr istrat ativ ive e tran transf sfe er 4.2. Promotion Promotion counselling shall be conducted based on regular panels prepar prepared ed and published by competent authority. aut hority. 4.3. Vacancies arising up to the end of April shall be taken into account for transfer and promotion counselling. 4.4. Posts wherein wherein the incumbent is on leave or unauthorized absence for more than two months shall be notified as vacancies for counselling. 4.5. However, However, the following vacancies shall not be notified: In the case of teaching institutions, specialties where the vacancies in the category (say Professor, Reader etc.) are less than 10% of the sanctioned strength (until such time the vacancy position in that specialty in each teaching institution reaches the level of 10% or less). 5. Who is is not eligible eligible to to particip participate ate in Counselling Counselling 5.1. In the case of teaching institutions, the staff from the specialties wh where ere the vacancies in the post are 10% or more; 5.2. In the case of medical institutions under the control of Director of Medical and Rural Health Services, the staff from the districts where the total vacancies for the post are 20% or more or the staff from an institution where the total

vacancies that category are 20% more even if the total vacancies in that category ininthe district are less thanor 20%.

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

5.3. In the case of Primary Health Centres, (a) staff from a district where the total vacancies in that category (Medical Officers/Para Officers/Para Medical Staff) in the district are 10% or more; (b) staff from a Primary Health Centre where there is already a vacancy; (c) a lady Medical Officer from a Primary Health Centre where the posts of all other Medical Officers are vacant. 5.4. Medical Officers/Staff who were were transferred earlier but had gone on leave there. Para 5.5. without Medical joining Officers/other Para Medical Staff/Staff Nurses/and other staff who have been transferred on disciplinary grounds and those who are getting transfer as opted earlier and subsequently cancelled the posting on transfer for their own reason. They are not eligible to attend counselling for 3 years (or) till the t he disciplinary disciplin ary case is over ov er,, whichever is earlier ea rlier.. 5.6. Medical Officers, whether appointed through Tamil Tamil Nadu Public Service Commission or through Employment Exchange who have not completed one year of service. 5.7. Medical Officers, Para Para Medical Staff and Staff Nurse who have not completed one year after their last Counselling, excluding the period. The Staff Nurse, who were appointed on contract basis, shall be allowed to participate in the next counselling, as they were posted in far of places at the time of initial appointment. 5.8. Medical Officers with Post Graduate/diploma Graduate/diploma qualification/super-specialties qualification/super-specialties shall not be considered for posting in ESI Dispensaries. 5.9. Medical Officers and Para Para Medical Staff who are newly recruited as well as the Medical Officers who report for duty on completion of Post Graduate Degree Course should be posted only in the Districts where there are more vacancies, viz., more than 15% in the case of Directorate of Medical and Rural Health Services and more than 10% in the case of Primary Health Centres. 5.10. As pointed out in para 5.7 above, any person who who is posted to a particular particular place after counselling will have to work there for a minimum period of one year excluding any leave period and he or she is not eligible to attend any counselling counselli ng till that period perio d is over. over. 5.11. In the interest interest of maintaining the quality of the Medical Education and the Medical Services, the government reserve the right to interchange (or) transfer person occupying in the top posts in the premier institutions. 5.12. It is the responsibility responsibility of the Deans or Heads of of Institutions or Departments to ensure that Medical Officers/para-medical staff, staff nurses ineligible to take part in counselling as narrated in paragraphs 5.1 to 5.7 are not issued the clearance to attend the counselling. 5.13. In the case of Primary Primary Health Centres, where there are only 2 sanctioned sanctioned posts of Medical Officers, at least one Medical Officer should be available and in the case of Primary Health Centres, Non-Taluk/Taluk Hospitals and ESI Dispensaries, where there are 3 sanctioned posts of Medical Officers, minimum 2 Medical Officers should be available. Wherever there are no lady doctors available in Primary Health Centre, vacancies in such Primary Health Centres shall be reserved for women. 6. Vacancies acancies should should be notified notified in the the website website every every month month 6.1. Every month month end, end, the details details of vacanci vacancies, es, the cause of each each vacancy vacancy and the the date from which the vacancy arose should be displayed in the official website of Health Department viz., www.tnhealth.org and a report in this regard th

be sent to the government the 5 of e the succeeding succeeding month. monthvacan 6.2. should Consolidat Consolidated ed vacancie vaca ncies s to be publishe publby ished d before befor Counsellin Couns elling g - These v.acancies, cies,

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

compiled and published every month, should be consolidated and published before the counselling date. To be specific, the vacancies to be filled up during the counselling should be published in the official website of the Health Department (viz., www.tnhealth.org) www.tnhealth.org) and in the Notice Boards of all the Medical Medical Institution Institutionss by 7th April/7 April/7th May for the counsel counselling ling to be be held in in May/June May/Jun e respectively. respectively. 6.3. the Listapproval of vacanc vacancies iesthe once onc e notified notified for counse counselling lling,, should should not be modifi modified ed without without of government. 7. Notification Notification of the the schedule schedule and venue of of counselling counselling and the the vacancies vacancies 7.1. Along with the the consolida consolidated ted list list of vacanci vacancies, es, the schedule schedule and and venue venue for counselling should be published in the official website of the Health Department (viz., www.tnhealth.org) and in the Notice Boards of all the th th Medical Medic al Instituti Institutions ons by the the 7 of the previous previous month, month, viz., viz., 7 April April for the the th Counselling to be held in May May,, by 7 May for the Counselling to be be held in June. 7.2. Similarly Similarly,, in respect respect of the vacancie vacancies, s, arising arising as a result of Transf Transfer er Counselling, the schedule, venue and vacancies to be filled up during recounselling should be published in the website and in the Notice Boards of the concerned Heads of Departments within seven days of counselling. There should be a clear gap of atleast five working days between the date of publication of the schedule and the actual date of re-counselling. Even for re-

counselling, vacancies once notified cannot be modified without the approval of the government. 8. Persons Persons seeking seeking trans transfers fers should should bring bring applicat applications ions 8.1. All persons persons seeking seeking transfer transferss should bring bring their their applicati applications ons duly duly certified certified by the Head of the Office for attending counselling. Production of fraudulent certificate will be viewed seriously and is liable for disciplinary action/suspension. 8.2. Before Before forwardin forwarding g the applica application, tion, the the Head Head of the Institu Institution tion should should ensur ensure e that the officer is not ineligible for taking part in counselling. 8.3. The transfe transferr applicati application on shall shall be registe registered red by the the Head Head of Departm Department ent assigning serial numbers in the order of the date of receipt of application and an acknowledgement with the Serial Number should be provided to the applicants. 9. Criteria Criteria and method method for Promotion/T Promotion/Trans ransfer fer 9.1.. No mutu 9.1 mutual al trans transfer ferss shall shall be ccons onside idered red.. 9.2. Transfer ransfer counsel counselling ling should should be comple completed ted on the same same day before before starting starting promotion counselling. 9.3. Pr Promoti omotion on to the posts posts shall shall be made by by counselling counselling in in the order order of seniority seniority.. If the senior is not willing to take up the posts, he should relinquish his right for promotion in writing either temporarily or permanently at the time of counselling and the next eligible person may be promoted and posted in that vacancy. 9.4. If a person person eligible eligible for promotio promotion n does not not relinqui relinquish sh his right, right, but but chooses chooses to absent himself on the day of counselling, or if he attends the counselling but fails to relinquish, it shall be deemed that he is willing to be considered for promotion and shall be promoted and posted to one of the vacancies at the discretion of the Director Government. If he does not join the new post, it will

be viewed as an actaction. of indiscipline disobedience and dereliction of duty entailing disciplinary

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

9.5. For transfer transfer within within the Direct Directorate orate,, station station seniority seniority will will be the the criterion criterion for for priority whereas in the case of inter Directorate transfers, service seniority will be criteria for priority pri ority.. 9.6. For counting counting station station senior seniority ity,, actual actual period period of duty in the the present present posting posting alone will be counted, excluding period spent on leave like earned leave, medical leave, extra-ordinary leave etc., and period of unauthorised 9.7. absence. In respect respect of vacanc vacancies ies in the the teaching teaching instituti institutions ons in Chennai Chennai City City listed listed out in in (a) and (b) below, seniority as per the Civil Medical List (CML) for Assistant Surgeon and panel seniority/seniority as per date of promotion for Readers and other higher categories will be the criterion for priority and not station seniority for the Medical Officer's working in the Chennai City Institutions. For the remaining vacancies the Medical Officer's from Institution will be considered considere d as per station seniority. (a) Madras Medical Medical College, Chennai including including Government Government General Hospital, Chennai, Institute of Child Health and Hospital for Children, Chennai, Institute of Obstetrics and Gynaecology and Hospital for Women Wom en and Children, Chennai, Regional Institute of Opthalmology and Government Ophthalmic Hospital, Chennai, Institute of Mental Health, Chennai, Kasturba Gandhi Hospital for Women and Children, Chennai and Institute of Thoracic Medicine, Chetpuet, Chennai.

9.8. 9.9. 9.10. 9.11.

9.12.

9.13.

(b) Stanley Medical College/Hospital, Chennai including including Governemnt RSRM Lying-in Hospital, Chennai, Government Thiruvotteeswarar Hospital for Thoracic Medicine, Otteri, Chennai and Government Hospital for Thoracic Medicine, Medicin e, Tambaram, Tambaram, Chennai. Chenna i. (c) Kilpauk Medical College/Hospital, Chennai. Medical Medical Officer Officerss reporting reporting from from unauthor unauthorised ised absenc absence e should should be treated treated as the junior most and posting should be given accordingly and they are not eligible for appearing for counselling for a period of one year. year. Outcome Outcome of the the counselli counselling ng shall shall be determin determined ed and exhibit exhibited ed (except (except the cases where the Government is the transferring authority) on the day of counselling itself. Wherever government government orders are requested, proposals should reach the government within 48 hours of completion of the counselling. Transfer on administrative administrative grounds, or on complaints complaints shall be effected effected only after conducting a detailed enquiry on the complaints, duly recording the reason in the file. All such transfers should be reported to the government within a week. In respect of ministerial staff, there is a General General Ban for transfer at present, present, as per the orders issued in Letter No.5880/S/2002-3, Personnel and Administrative reforms department dated 3.4.2002. However request transfers and mutual transfers can be considered, subject to the conditions mentioned therein. However, However, promotion counselling for filling up vacancies in respect of categories like Administrative Officers, non-medical staff, drivers, ministerial staff and basic services is permissible. As a rule, rule, no transfer should be effected in-between in-between the counselling counselling periods, periods, other than those required on administrative grounds, or in the public interest or in the interest of the medical education or public health. The transferring authorities can effect transfers of Medical Officers on administrative grounds, if warranted. The government should be kept informed regarding these transfers. the transfer is based on allegations and charges, which should be recorded inIfwriting.

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9.14. Those transferred transferred on account of administrative grounds/grounds of allegation will not be eligible for transfer for the next three years. 9.15. Those who have have obtained transfer transfer orders on request cannot apply for transfer transfer atleast for the next one year. year. This minimum period will not be applicable in case of those who are promoted. 9.16. However, However, vacancies arising arising in the inter-counselling inter-counselling period which in the opinion of may the be Director/government cannot be left tillmay next Counselling filled up by the Director/government Director/governm ent asvacant the case be purely on a temporary basis. Similarly when an officer reports for duty from leave or absence, he may be posted temporarily in a vacancy, but such postings should not be done in the institutions in Chennai City and its adjoining districts, Madurai or Coimbatore cities. A report on all such postings made by the Director of Medical Education should be sent to the government for ratification within a week with full justification for the postings. The posts so filled up must invariably be notified as vacancies for the next counselling and the individuals posted temporarily in those posts must be directed to appear for counselling. No exceptions should be made to this rule. 10.Directorate to be obtained in respect of staff under Director of Public Health and Preventive Medicine after counselling 10.1. The Direc Director tor of Public Public Health Health and Preven Preventive tive Medic Medicine ine shall shall incorporat incorporate e the

following condition/undertaking in the declaration given by the Doctors, Village Health Nurse/Community Health Nurse at the time of counselling: ? In the case case of of conc concedi eding ng thei theirr requ request est for transf transfer er to thei theirr plac place e of of requirement, they must remain at the residential quarters/headquarters as the case may be of the Primary Health Centre/Health Sub-centre concerned concerned and in case they fail to remain at the residential quarters/headquarters they accept to face disciplinary action against them including their transfer to a far away place. ? When When such such a condit condition ion/un /under dertak taking ing is accept accepted ed by more more than than one one individual for the same place, then the station seniority will be considered among amo ng such of those persons person s for transfer. transfer.

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Annexure 3   RULES FRAMED BY THE GOVERNOR-IN-COUNCIL UNDER SECTION 11 OF THE MADRAS NURSES AND MIDWIVES ACT (MADRAS ACT III OF 1926) NOTIFICATION G.O.No.324 P.H., P.H., dated 11 February 1926, as amended a mended by (1) G.O. No. 348, P.H. nd dated dat ed 2 Marc March h 193 1931, 1, (3) G.O. No. No. 732, P.H. P.H. dated 31st --------------------------------------------------I

In exercise of the powers conferred under sub-section (3) section I of the Madras Nurses and Midwives Act, 1926 (Madras Act II of 1926), the Governor-in-Council is hereby pleased to appoint on the 14th day of February February 1926 as the date on which which the said Act shall come into force. II

In exercise of the powers conferred by section 11 of the Madras Nurses and Midwives Act, 1926 (Madras Act III of 1926), the Governor in Council is hereby pleased to make the following rules to carry out the purposes of the said Act, namely: RULES UNDER THE NURSES AND MIDWIVES ACT, ACT, 1926 GENERAL

1.

In these these rule rules, s, unles unlesss there there is anyt anythin hing g repugn repugnant ant the the subje subject ct or cont context ext::

“Act” means the Madras Nurses and Midwives Act, 1926. “General Nursing” means (a) in the case of women nurse training in the nursing of men, women and children, and (b) in the case of men nurse-training in the nursing of men and children under 12 years of age and nursing general patients, for not less than three years in institutions authorised in that behalf under rule 37. “Government” means the Government of Madras. “President”under means the 3President constituted section of the Act.of the Madras Nurses and Midwives Council “Registered “Register ed medical practitioner” means a medical practitioner registered under the Madras Medical Registration Act, 1914. Words Wor ds relating to the feminine gender in these rules shall include males. “Registrar” “Registr ar” includes any person duly authorised to act and acting on his behalf. There shall be a Registrar of the Council for performing the functions assigned to the Registrar by these rules and the by-laws, made under the Act. The first appointment of the Registrar shall be made by the President President and the subsequent appointments by the t he Council. Every person so appointed shall be removable at the pleasure of the Council. 2. The rules rules in AppendixAppendix-A A and the the forms forms set set out in in Appendix Appendix b to these these rules rules and all instructions contained the forms shall be deemed to be part of the rules and such form or forms substantially to the like effect shall be used in all cases for which the forms are provided.

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RULES REGULATING THE CONDITIONS OF ADMISSION TO THE REGISTER  (Section 11(2) (b) of the Act)

3. Every Every nurse, nurse, midwi midwife, fe, healt health h visitor visitor or auxi auxilia liary ry nursenurse-mid midwif wife e who desir desires es to have her name entered in Section I or II of the Register of nurses, midwives, health visitors, auxiliary-nurse-midwive s shall apply the Registrar inrequired Form IV-A Appendix-B to theseauxiliary-nurse-midwives rules and furnish full particulars of to the information therein. She shall attach to her application any diploma or certificate of training she holds in original together with a copy of each of such diplomas or certificates of training. EXPLANATION

A woman who desires to have her name entered as nurse and or midwife, health visitor, auxiliary nurse-midwife shall make separate applications therefore in the present form. Section I of the Register shall also include nurse or midwives who were practising in the territory within the meaning of the Madras Nurses and Midwives Amendment Act, 1960 and who were registered under the Travancore-Cochin Nurses and Midwives Act, 1953 (Travancore-Cochin (Travancore-Cochi n Act X of 1953). Provided that the course of training in Nursing Midwifery undergone and the examination passed by the persons registered under the Travancore-Cochin Nurses and Midwives Act, 1953 (Travancore-Cochin Act X of 1953) shall conform to those prescribed for entering the names of nurse and midwives under section 5 of the Act. Note: Part Part II of the register register contains the name of ever everyy woman who, though not in possession of any such diploma certificate of training, has been practising as a nurse or as a midwife at the date of commencement of the Act and was allowed to register under Act Act on the strength of certificate of having undergone instruction and training for a period of not less than two years under a register for a period of not less than two years under a registered medical practitioner or a certificate signed by two registered medical practitioners to show that she was nurse or midwife practising in the state of Madras at the commencement of the Act. The concession which was allowed for a period of three years from the date of commencement commencement of the Act, ceased from the 14th February 1931. 32 A) 1.

Subject to the provisions of these these rules rules a nurse nurse shall shall be entitled to have her name entered in Section Sect ion III of the Register. Register. as a ge gene nera rall tr trai aine ned d nur nurse se:: a) if she has comple completed ted three three years training training at an institu institution tion authoris authorised ed in that behalf under rule 37 and passed the qualifying examination in general nursing conducted by the Madras Government Board of Examiners in Nursing or the Examining Board of the Nurses Auxiliary Auxiliary of the Christian Medical Association Association of India (South India Branch) or b) if she possesses possesses a certifica certificate te or qualificati qualification on in B.Sc (Nursing (Nursing)) granted granted by the University of Madras. c) if she possesses possesses a certifica certificate te of qualificat qualification ion in general general nursing nursing recognised by the Indian Nursing Council as a registrable qualification and is registered by the Nursing Council of the State in which the qualification is granted or d) if her her name name has been been regi registe stered red by: by: i. the the General Gener al Nursin Nursin Nursing g Council Council Council Englan England dd,and anor d Wales, Wales, or ii. Gener General al Nu rsing g Coun cil for for for Scotlan Sc otland,

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

iii. a Board Altranais Altranais,, Eire, Dublin Dublin or iv iv.. the Joint Nursing Nursing and Midwives Council Council for Northern Ireland, Ireland, or e) if she possesse possessess to the qualific qualification ation granted granted by by an authority authority in a Part Part B State recognised by the Council. 2. as a nurse nurse trained trained in the Nursing Nursing of Women Women and and Children Children:: If shebehalf has completed years institution authorised in in that under rulethree 37 and hastraining passed at theanqualifying examination the Nursing of Women and Children conducted by the Examining Board of the Nursing Auxiliary of the Christian Medical Association Association of India. (South India Branch). 32 B) Subject to the provisions provisions of these rules, rules, a midwife shall be entitled to have her name entered entere d in Section I or o r II of the Register. Register. a) if she has has completed completed 18 months months training training or or six months months training training in in the case of trained nurses, at an institution authorised in that behalf under rule 37 and has passed the qualifying examination conducted by the Madras Government Board of Examiners for Midwives, or b) if she possesses possesses a certifica certificate te of qualificati qualification on in midwifery midwifery recognis recognised ed by the Indian Nursing Council as a registrable qualification and is registered by the Nurses and Midwives Council of the State in which the qualification is granted or c) if her her name name has has been been regist registere ered d by i. The Central Midwives Board of London or ii. The Central Midwives Board of Scotland or d) if she possesses possesses a certifi certificate cate of qualifi qualificatio cation n granted granted by an authority authority in a Part B State recognized by the Council. EXPLANATION

A midwife, midwife, who has satisfactorily completed one year training in midwifery before the 24th December, 1937, shall be eligible for registration in the register of midwives, if she had commenced her course of training before the introduction of the revised course of 18 months training if she produces, in addition to other documents, the certificate of professional efficiency referred to in rule 33 (b). 32 C) Subject to the provisions of these rules, a visitor shall be entitled entitled to have her her name entered in Section I or II of the register: a) if she has compl completed eted 18 months months trainin training g in health health visiting visiting or 2½ years years training in the integrated course in midwifery and health visiting in an institution in behalf and passed the qualifying examination conducted by the Madras Government Board of Examiners for Health Visitors, or b) if she possesses possesses a certific certificate ate of qualificati qualification on recognise recognised d by the Indian Nursing Council as a registered qualification and is registered by the Nurses and Midwifery Council of the State in which the qualification is granted. 32 D) Subject to the provisions of these these rules, rules, and auxiliary nurse-midwife shall be entitled to have her name entered in Section I or II of the register: a) if she has comple completed ted 2 years years training training at an institutio institution n authorised authorised in in that behalf under rule 37 and has passed the qualifying examination conducted by the Madras Boardof ofthe Examiners for auxiliary nurse and midwives or theGovernment Examining Board Nurses Auxilia Auxiliary ry the

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Christian Medical Association of India (South India Branch), or b) if she possesses possesses a certifica certificate te of qualificat qualification ion in Auxiliary Auxiliary Nursing Nursing Midwifery recognised by the Indian Nursing Council as a registrable qualification and is registered by the Nurses and Midwives Council of the State in which the qualification is granted. 4. applic applicant antoffor reg istrat ration ionpersons shall shall in willing all cases cases specif spe cifyyto in in give herevidence applic applicati ation on the namesA)andAn addresses at regist least three and able of her good social standing not being a relation for the applicant who known her personally for not less than three years, another another shall be a person in in whose employment employment the applicant is on the date date of the application or who has employed her at any time within three years prior to such date, and a third shall be a Superintendent of Nursing, registered medical practitioner or other responsible person with whom the t he applicant is working on the date or application or has worked at any time within three years prior to such date. B) The Council may invite the persons names names by the applicant to furnish testimonials as to her character and professional efficiency in Forms V and VI of Appendix B to these rules as the case may require, and any testimonials so furnished shall be sent direct to the Registrar by the persons furnishing them. 5. A dai dai who who is desir desirous ous of of having having her her name name enter entered ed on the the regis register ter of of dais dais shall shall apply to the Registrar in Form IV-C of Appendix B to these rules, and shall attach to her application a certificate showing that she has within a period, of two years immediately preceding the date of her application undergone a course of training for atleast six months at an approved hospital, and has passed an examination at the end thereof. She shall at the end of every second year from the date of her registration appear for re-examination, and if she fails in such re-examination her name may be removed from the register at the discretion of the Council. The training of dais was discontinued in this Note: 28-7-43 (G.O. No. 1776,P.H. dated 28- 7-43). 6. Every Every nurse, nurse, midwife, midwife, health health visitor visitor,, auxilia auxiliary ry nurse-m nurse-midwi idwife, fe, or or dai dai whose whose name name has been entered on the register shall be entitled to receive from the Registrar free of charge a certificate of registration in Form VII or Form VII-A of Appendix B to these rules.

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Annexure 4 Duties and Responsibilities of Nursing Staff  Nursing Superintendent

The Nursing Superintendent is directly responsible efficient Nursing Care to all patients in the hospital. to the Head of the Institution for 1. She is responsib responsible le for the general general supervi supervision sion of nursing nursing care care given given to the patients and all nursing activities within the nursing unit. 2. She prepares prepares the Master Master plan for for professiona professionall and non-profes non-professiona sionall staff under under her control. 3. She plans plans in co-operati co-operation on with the the Nursing Nursing Supervisor Supervisorss for effective effective administration and nursing care. 4. She gives gives orientati orientation on to all new new personn personnel el under under her contro control. l. 5. She is in-char in-charge ge of hospital hospital linen linen and and adequate adequate supply supply of the the same to wards/departments. 6. Maintains Maintains various various record recordss and reports reports such as as record record of health health leave sanctioned, confidential reports etc. 7. Supervises Supervises the the health needs needs and and welfare welfare for the nursin nursing g personnel personnel.. 8. Maintains Maintains discip discipline line of of nursing nursing and and auxiliar auxiliaryy staff. staff. 9. Conducts Conducts staff staff meeting meeting to discuss discuss ways ways and means means for improvi improving ng nursing nursing service. 10. Serves as counselor and guides guides to the nursing staff. 11. Conducts procedures connected connected selection and recruit-out of nursing stude students. nts. 12. Arrange for clinical clinical experience of the nursing nursing students. 13. Arranges for and conducts conducts examination for the trainees. trainees. Nursing Supervisor

A Nursing Supervisor is responsible to the Nursing Superintendent for the management of the wards/departments and supervision of the nursing and domestic staff. She is entirely responsible for the efficiency of nursing care. A. Patient Care 1. Prepare reparess patient patient care assig assignme nment. nt. 2. Assists Assists staff staff in planni planning ng nursin nursing g care. care. 3. Arranges Arranges duty duty hours for for profession professional al and non-prof non-professio essional nal staff. staff. 4. Co-ordinat Co-ordinates es and facili facilitates tates work work of para-m para-medic edical al staff. staff. 5. Evalua Evaluates tes patien patientt care care give given. n. 6. Gives Gives orien orientat tation ion to to new new staff staff.. 7. Accompan Accompanies ies the Medic Medical al Officer Officer during during the the ward rounds rounds.. B. Administration Responsibilities Respon sibilities for the t he General Administration of the Ward: 1. Maintains Maintains a health health and comfor comfortable table environ environment ment for for the patient. patient. 2. Maintains Maintains inventor inventories ies from time time to time verifies verifies the the articles articles against against the stock

3. register. Has an overall overall responsib responsibility ility for the the safe custody custody of ward linen, linen, furnitur furniture e and

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

4. 5. 6. 7. 8.

equipment. Respons Responsible ible for the the correct correct rendering rendering of indents, indents, memoran memorandum dum and reports. reports. Respons Responsible ible for for economy economy in the expendi expenditure ture for non-di non-diet et articles. articles. Verifies erifies indent indent of drugs drugs and check checkss the distribu distribution. tion. Supervise Supervise distri distributio bution n of diets diets to to the patients. patients. Maintains Maintains good public public relation relationss and investigate investigatess complaints complaints if any. any.

9. Restric estricts ts movem movement entss of visitor visitors. s. 10. Evaluates performance performance of staff. C. Clinical Supervision 1. Teaching eaching and supervisio supervision n of nursing nursing care. care. 2. Maintainin Maintaining g clinic clinical al experienc experience e recor records. ds. 3. Checki Checking ng and and signin signing g proced procedure ures. s. 4. Guides Guides student studentss with with nursing nursing care studies. studies. 5. Plan Plan and and carry carry out out ward ward teachi teaching. ng. 6. Evaluation Evaluation and conferenc conference e with with students. students. DUTIES AND RESPONSIBILITIES OF NURSING STAFF STAFF Nurses General Care of the Patient

1. 2. 3. 4. 5. 6. 7. 8.

Admi Admiss ssio ion n of pat patie ient nt.. Pe Persona rsonall care – including including bathing, bathing, mouth mouth care, care, hair combing combing and shampoo. shampoo. Treatme reatment nt of pedicu pediculos losis. is. Care Care of of hand hands, s, feet, feet, nails. nails. Care Care of pres pressu sure re poin points ts.. Giving Giving and and removal removal of bed bed pans pans and urinals. urinals. Applicati Application on of hot water water bottles bottles and ice caps. caps. Feed Feedin ing g of pati patien ents ts..

Technical echnica l Nursing Care 1. Taking and record recording ing of temperatur temperature, e, pulse and and respiration respiration.. 2. Administr Administration ation of medic medicines ines and inject injections. ions. 3. Elevate 4. Cath Cathet eter eris isat atio ion n 5. Dressing 6. Ir Irrrig igat atio ion ns 7. Oxyg Oxygen en Ther Therap apyy 8. Pre and and post post-op -opera erativ tive e care care 9. Pr Prepara eparation tion of patien patientt care care for discharge discharge 10. Last offices offices of the the dead Ancillary and Clerical 1. Assistance Assistance and instruc instructions tions to patients patients and and relative relatives. s. 2. Care of patien patients ts clothi clothing ng and valuables. valuables. 3. Bed maki making ng with with or or witho without ut patie patient. nt. 4. Maintenan Maintenance ce of nominal nominal register register.. 5. Prepara reparatio tion n of inva invalid lid diets. diets. 6. Dist Distri ribu buti tion on of of diet diets. s. 7. Recordi ecording ng of drugs drugs admin administ istere ered. d.

8. surgical Indenting Indenting and accoun accounting tingdiet, for urine drugs, drugs,collection, mainten maintenance ance of sub subtesting, store, store, indent inden t for supplies, stores, treatment reporting,

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

collecting, labeling and dispatching of specimen. 9. Pr Prepara eparation tion for and assista assistance nce in chemical chemical tests, tests, medical medical procedur procedures es and intravenous infusions, assisting the medical officer with various examinations of patients and treatment. Administrative and Supervisory

1. Handling Handling and taking over charge charge of of shift. shift. 2. Linen Linen furniture furniture and equip equipment ment up keep, keep, repairs repairs and and replaceme replacement. nt. 3. Maintenan Maintenance ce of stock registers registers and invent inventories ories.. 4. Custod Custodyy of of dang dangero erous us drugs. drugs. 5. Guidance Guidance and superv supervision ision of nursin nursing g students students and domestic domestic staff. staff. 6. Assistance Assistance in orien orientation tation of new nurses. nurses. 7. Mainte Maintenan nance ce of bed bed side side repo report. rt. 8. Maintainin Maintaining g a 12 12 hourly hourly report report on patien patients. ts. 9. Escorting Escorting patients patients to and and fro fro departm departments ents . 10. Writing Writing the prescriptions and Medical Officer's instructions in the instruction book writing of. 11. Writing Writing of diets in the diet book. Cleanliness 1. Clea Cleanl nlin ines esss of un unit it.. 2. Cleaning Cleaning and and setting setting up of dressin dressing g trolley trolley.. 3. Cleaning Cleaning of cupboard cupboards, s, rubber rubber articles, articles, metal, metal, glass glass and other other types of apparatus and equipment. 4. Cleaning Cleaning up of unit unit and equipm equipment ent after after a proce procedure dure.. 5. Arranging Arranging for the washin washing g of soiled soiled linen. linen. 6. Disi Disinf nfec ecti tion on..

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

Annexure 5 CONSTITUTION (RULES AND REGULATIONS) REGULATIONS) TNAI

The Trained Trained Nurses' Association of India (TNAI) is the national body of practitioners of Nursing at various levels. The main idea behind the establishment of the Association in 1908 was toteam uphold in every the dignity and Care honour ofNursing the Nursing profession and to promote spirit, highway standards of Health and Practice apart from enabling the members to represent their grievances and express their point of view to the concerned quarters in problematic situations. The stress is on orientating the members to the real needs of this noble profession, the routine activities of the Association are organized in such a way that those associated with it have a sense of participation in all the programmes of direct professional relevance along with treating the Association as a major source of inspiration and provider of little delights of life occasionally occasio nally.. While members at some of the Branches and Units are more active in their participation in the TNAI's activities than those at others, the Association has undoubtedly come to be recognized as a major link between the vast number of nurses in various parts part s of the country, country, and even some abroad. The Government of India has recognised the Association Association as a service organisation and a similar recognition by all the State Governments has been an asset to the promotion of the Association's objectives. The voice of the Association is accepted in most quarters as the voice of nurses in India, and resolutions adopted by it and presented to the various authorities are well received and generally accepted for implementation, sooner or later. The general improvement in living and service conditions of nurses over the years and the increase in salaries bear witness to the efforts of the TNAI and the attention paid by the Union and State Governments to its recommendations. Organisations like the Central Council of Health, the Indian Nursing Council and committees formed by official and non-official agencies to study the problems and prospects of Nursing, work in close collaboration with the Association. The Association is an associate member of certain other Associations and Societies doing good work in their realms of concern. These societies are; Indian Red Cross Society,, Indian Public Health Association, Association for Social Health, Indian Hospital Society Association, Federation of Delhi Hospital Welfare Welfare Societies, Tuberculosis Association of India and Indian Leprosy Association. It also takes part in the activities of important social organisations devoted to the welfare of women, especially National Council of Women in India, and All India Women's Conference. Confere nce. In its efforts to voice women cause, in February-March 2000 the Association had organised an International Women's Conference jointly with McMaster University Canada in Delhi attended by 489 delegates from 38 countries who deliberated on the theme “Women's Status: Vision and Reality”. The TNAIs membership of the International Council of Nurses (ICN) earlier offered many opportunities of extending our professional horizon to newer ideas. The ICN opened up many possibilities for nurses of India. Its “Nursing Abroad Programme” assisted Indian Nurses, as those in other parts of the world, in their work or study outsidehas theirbeen countries. TNAI affiliated with t heFederation the Commonwealth Nurses' Federation, which fruitful in ismany ways. The is doing a lot for the

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advancement of Nursing as a profession and its guidelines for the national associations have been of great value. Title, Philosophy, Philosophy, Objectives and Functions

The name of the Association shall be: The Trained Trained Nurses' Association of India. Philosophy The Trained Nurses' Association of India believes that good health is a fundamental right of every person and that it is the responsibility of the health profession, including Nursing, to provide the kind of health care, which will give each individual in society every opportunity to achieve optimum health.

As a professional person each nurse is ethically and morally responsible for giving the required care to each individual to the best of her/his ability. The profession as a whole, through the Trained Trained Nurses' Association of India, is, therefore obliged to help in every way to uphold these high standards and to promote the preparation of each nurse so that one is qualified to give the required preparation of each nurse so that one is qualified to give the required care. Finally, it is the belief of the Trained Nurses' Association of India that each nurse is a member of the society and is entitled to the same individual rights, privileges, and the goals of physical, mental, economic and social development as are available to other members of the society. society. The profession is responsible to give such assistance as may be necessary to achieve these goals. Objectives The objectives for which the Association is established are: a) To uphold uphold in every way way the dignity dignity and honour honour of the nursing nursing profess profession ion and to promote a sense of esprit de corps among all nurses. b) To promote promote high standards standards of health health care and nursing nursing practic practice. e. c) To advance professi professional, onal, educatio educational, nal, economic economic and general general welfare welfare of nurses. Functions ? To establ establish ish func functio tions, ns, stan standar dards ds and and qualif qualifica icatio tions ns for for nursi nursing ng pract practice ice.. ? To enunc enunciat iate e stand standard ardss of nursin nursing g educa educatio tion n and and imple implemen mentt these these throug through h appropriate channels. ? To enunc enunciat iate e stand standard ardss of nurs nursing ing servic service e and and imple implemen mentt these these throug through h appropriate channels. ? To esta establ blis ish h a code code of of ethi ethica call cond conduc uctt for for prac practi titi tion oner ers. s. ? To stimul stimulate ate and promot promote e resea research rch design designed ed to to incre increase ase the knowle knowledge dge on which the practice of Nursing is based. ? To promo promote te legi legisla slatio tion n and and to spea speak k for nurses nurses in in regar regard d to legi legisla slativ tive e actio action. n. ? To prom promot ote e and and prot protec ectt the the econ econom omic ic wel welfa fare re of of nurs nurses es.. ? To provi provide de prof profess ession ional al coun counsel sellin ling g and and place placemen mentt servic service e for for nurse nurses. s. ? To provi provide de for for the the conti continui nuing ng prof profess ession ional al deve develop lopmen mentt of prac practit tition ioners ers.. ? To repre represen sentt nurses nurses and serve serve as their their spok spokesm esman an with with alli allied ed nati nationa onall and and international organisations, governmental and other bodies and the public. ? To serve serve as the the offi officia ciall repre represen sentat tative ive of the the trai trained ned nurses nurses of Indi India a as a member of the International Council of Nurses (whenever possible). ? To promo promote te the the gene general ral health health and welfar welfare e of the public public throug through h the the Association programmes, relationships and activities.

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

RULES AND REGULATIONS REGULATIONS

(The existing Rules and Regulations, as recommended by the TNAI Council, at its meeting held at New Delhi in November 1980, and as adopted in the meeting of the House of Delegates held at Jaipur in October 1981 and subsequently amended at Cuttack in January 1990 and Chennai in September 1997 and Imphal 1999). 1. Name Name an and d Obj Objec ects ts:: The name and objects of the Association are as set out in the Memorandum of the Association. The Association is non-political and nonsectarian. 2. Patro Patron n and Vice-P Vice-Patro atrons: ns: The President of the Republic of India or his wife wif e or VicePresident Presid ent of India or Chief Justice of India or Speaker of Lok Sabha shall be invited to be Patron of the Association during the term of their office. The Governing Body of the Association, hereafter mentioned as the Council, may invite Governors of the States or the Union Territories of India, their wives or other distinguished holders of offices at the Centre or State levels or in public life of the country other than politicians to be Vice-Patron. 3. Preside President nt and Vice Vice-Pr -Presi esident dents: s: Members of the Association who form the House of Delegates shall elect at a General Meeting, one of the full members of the Association to be the President. Three other full members of the Association shall be elected as Vice-Presidents Vice-Presidents (First, Second and Third Vice-Presidents). Vice-Presidents). Out of the three Vice-Presidents, one Vice-President shall be from the place at which the headquarters is located. The term of office in each case shall be four years. The President shall not be eligible for re-election as President and/or for any other TNAI office, but shall be ex-officio member of the Council for one more term. Vacancies between General Meeting shall be filled by the Council at its discretion. 4. Me Memb mber ersh ship ip:: The Association shall consist of Patron, Vice-Patron and members. Members shall be of the following categories: a) Ful ulll Mem Membe bers rs:: A full members is a person who is a registered nurse fully trained from an institution recognized by the Indian Nursing Council and holds a certificate of training issued by a Registration Council or Board of Examinations recognized by the Indian Nursing Council. b) Assoc Associat iate e Memb Member ers: s: The following shall be eligible for Associate Membership: L.H.Vs, A.N.Ms/Health Workers, Midwives and Registered Dais who are interested in the furtherance of the objectives of the Association as laid down in the Constitution of the Association or the rules and regulations framed there th ere under. under. c) Affi Affili liat ate e Membe Members rs:: Nursing students of all categories and members of other Nursing organization shall be eligible for Affiliate Membership. d) Instit Institutio utional nal Member Membershi ship: p: Any institute or organization with similar objectives and philosophy as that of the TNAI shall be eligible for membership. e) Hono Honora rary ry Fel Fello lows: ws: The council shall select members of the Association who have rendered service of a very high order to the cause of nursing and confer on them honorary fellowships of TNAI.

Associate their and Affiliate Members be entitled to change vote only on be matters affecting own section of theshall Association, but no shall made

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thereby in the policy of the Association Association or the subscription payable or privilege enjoyed by the members without the approval of the Council. Institutional Members and Honorary Fellows shall have no voting rights. 5. Membe Members rshi hip p Fee Fees: s: All members shall pay an entrance fee and subscription as prescribed by the General Body Meeting from time to time. In all proceedings of

the Association no person shall be entitled to vote or be counted as a member whose subscription at the time shall have been in arrears for a period exceeding three months. Affiliation: The Council may affiliate the Associations/Organizations Associations/Organizations with similar objects and whose constitution is in harmony with that of the Association, on such terms as the Council may, by its bye-laws, prescribed from time to time. Any organisation to be affiliated shall be an All-India or State-level organization. 6. Br Bran anch ches es:: The Council shall constitute/dissolve Branches of the Association, either by State, St ate, Union Territory, Territory, District or by classes of members memb ers on such terms as the Council may prescribe from time to time.

The Branches so constituted shall not have separate registration and shall be as constituent parts of the main body and shall act under the guidance and control of the main parent pare nt body. body. 7. Ma Mana nage geme ment nt:: The management of the Association shall be entrusted to a Governing Body hereinafter called the Council which shall be constituted as follows: ( i) President ( ii) First Vice President (iii (iii)) Se Seco con nd Vic ice e Presid esiden entt (iv) Third Vice President (v) Hony. Treasurer (vi)) (vi Secret Secretary ary-Ge -Gener neral al (not (not e elig ligibl ible e to to vote vote if appoin appointed ted full full ttime ime)) (vii) (vi i) Assist Assistant ant Secre Secretar tary-c y-cumum-SNA SNA Adviso Advisorr (Not eligi eligible ble to vote vote if appoin appointed ted full time) (viii) (vi ii) Assist Assistant ant Secre Secretar taries ies (No (No vote vote if appoi appointe nted d full full time) time) (ix)) (ix Editor Editor (No (No vote vote if appo appoint inted ed full full time. time. A Nurse Nurse Edito Editorr only only shall shall be the the member of the Council). (x) Preside resident nt or or Vice Vice-P -Pres reside ident, nt, one from from each each State State/Un /Union ion Territo erritory ry.. (xi)) (xi Branc Branch h Secr Secreta etarie riess or Joint Joint Secr Secreta etarie riess (one (one from from each each State State and Union Union Territory Branches). Br anches). (xii (xii)) Co-o Co-opt pte ed Mem Memb bers ers (Fou (Four) r) (xiii)) Chairperso (xiii Chairpersons ns of Standing Standing Committee Committeess and and Interest Interest Sections. Sections. (xiv (xiv)) Exx-of offi fici cio o Memb Member erss i) One Electe Elected d Member Member of each each affi affilia liated ted Associ Associati ation. on. ii) ii) Hony Hony.. SSec ecre reta tary ry,, H.V H.V.L .L iii iii)) Hony Hony. Secret Secretary ary,, M&A M&ANM NMA/M A/MPHW PHW(F) (F) iv) Immedi Immediate ate Past Preside resident nt of TNAI TNAI v) Secr Secret etar aryy to to IInd ndia ian n Nur Nursi sing ng Coun Counci cill vi) Nursin Nursing g Office Officerr, Indian Indian Red Red Cross Cross Socie Society ty vi vii) i) Nursing Advisor/Dy Advisor/Dy.. Nursing Advisor/Nursing Advisor/Nursing Officer, Officer,

Government of India as nominated by TNAI viii) State Nursing Superintendent/DHS/DDHS/ADHS Superintendent/DHS/DDHS/ADHS Nursing/Nursing

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Officer of DHS, Nursing Officer from Metropolitan, Municipal Corporation, Armed Forces and Railways, nominated by the TNAI, not more than five at a time, by rotation, for a term of four years. The ex officio members shall not be eligible for the TNAI election, except Sl. No. 2 and 3 if full member of TNAI. 8. Execu Executi tive ve Commi Committe ttee: e: The following members of the Council shall constitute the Executive Committee: (i) President (ii) First V Viice-President (ii iii) i) Se Seccond ond Vice-P ce-Prresid eside ent (iv) Third Vi Vice-President (v) Hony. Treasurer (vi) Secretary General (vii (vii)) Assi Assist stan antt Secre Secreta tary ry-c -cum um-S -SNA NAAdvi Adviso sorr (vii (viii) i) As Assi sist stan antt Secre Secreta tari ries es (ix) (ix) Chai Chairp rper erso son, n, Soc Socio io-E -Eco cono nomi micc Wel Welfa fare re Com Commi mitte ttee e (x) Nine Nine memb members ers nomina nominated ted and electe elected d by by Coun Council cil in rotati rotation on from from State State branches. (xi) xi) Edit Editor or (if (if Ed Editor itor is a Nur Nursse) (xii) Ex-Officio Me Member (xiii) (xi ii) Immedi Immediate ate Past Preside resident nt of TNAI TNAI

The Executive Committee shall meet at such time and place as President President directs. It shall meet once in a year and if necessary one more time as may be decided by TNAI Council. The Executive Committee shall manage all the affairs of the Association on behalf of the Council in the intervals between the regular meetings of the Council, referring to the Council all matters involving changes of policy or having important financial implications. The quorum for the Executive Committee shall be nine of whom five shall be elected members. However, if quorum is not complete the meeting shall be adjourned for half an hour and meet at the same place and transact necessary Agenda even if the quorum is not complete. 9. House House of Dele Delegat gates es:: There shall be a House of Delegates consisting of Council members and one representative for every five hundred members from the States. For each fraction above hundred there shall be one representative. For Branches having 50-500 members there shall be one representative. House of Delegates shall conduct the business of the Association.

The Agenda Agenda for the meeting of the House of Delegates shall include the adoption of the biennial reports, the passing of the biennial accounts, approval of the biennial budget, and the election of the office bearers of TNAI. The House of Delegates shall meet biennially at such time and place as the Council decides. The President President shall preside over at all meetings. In I n her/his absence the First Vice-President shall take the chair. In the even of the absence of the Second Vice President, the Third Vice President shall preside over the meeting. In the absence of all the above-mentioned persons, the members present shall elect any

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other member to preside. The Chairperson shall have a casting vote. Two-third of the House Hou se of Delegates shall sha ll form the quorum. 10.Election a) Offi Office ce Bear Bearer erss of of the the Coun Counci cil: l: The office bearers of the Council of TNAI shall be the President, Vice-President and the Hony. Treasurer elected by the

House of Delegates. The members shall be eligible for re-election in accordance with the Rules and Regulations Regulati ons No. 3. Vacancies between meetings shall be filled by the Council at its discretion. The members so elected shall hold office only for the remainder of the term of those in whose place they are to be elected. No Council member shall serve more than two consecutive terms (8 years) unless the member is elected as President or is an ex-officio member of an affiliated Association. Association. No full member of the Association shall be on the Council for more than four terms. Extended terms of State Branches Office Bearers on the Council shall not be considered as eligibility for TNAI elections. A member nominated on the Council for interim period shall not be eligible to contest TNAI elections. A br break eak after two consecutive terms shall be for a period of not less than four years. The TNAI Office Bearers who held elected positions, prior to October 1981 Amendments, on TNAI Council, hereafter will not be entitled to preferential th status for President President and Vice Vice President's President's elections elections (the 12 House of Delegates, Delegates, in its meeting in September 1997 at Chennai, amended the earlier provision). Ex-officio member's term of office on the Council shall not be counted for TNAI elections. Hony. Secretaries (elected) of HVL and M&ANMA/MPHFW(F), if full members of the Association, shall be eligible for TNAI elections (President, Vice Presidents). Ex-officio term of the President President shall be exempted as fourth term on the Council as in the case of ex-officio member of affiliate association(s). Break if any irrespective of the term (i.e. one term or two terms) t erms) shall be for a period of one full term of four years. The person elected on a particular office shall hold the office for the full term (four years) and shall not contest and cross to another office prior to completion of the term of her/his existing elected office. Returning Officer shall not be eligible to contest for election to any of the offices. Returning Returning Officer shall be appointed by TNAI Council for one term of 4 years i.e. for two national level elections of the TNAI. b) Execu Executi tive ve Comm Commit itte tee: e: The Executive Committee shall consist of nine members from State Branches. The members of the Committee shall be elected by the Council at its meeting by ballot. The members of the Committee shall be elected members by rotation by the virtue of chair only. only. The term of members so elected shall be for four years. c) House House of Dele Delega gate tes: s: There shall be one representative for every five hundred members from the States. For each fraction or two hundred and fifty or above, there shall be one representative. For branches having fifty to five hundred members, there shall be one representative. They shall be

elected at the General Body Meeting of the Branch. The term of the members of the House of Delegates shall be elected at the General Body Meeting of the t he

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Branch. The term of the members of the House of Delegates shall be of four years and they shall be eligible for re-election for one term. 11.Council/Executive Meetings: The meeting shall be called at such time and place as provided for under the regulations.

The President shall preside over at all meetings of the Council, and of the Executive Committee. If she/he is not present, the First Vice Presiden Presidentt shall take the chair, and if she/he is not present, the Second Vice President shall preside. If she/he is not present, the Third Vice President shall preside. If all the aforesaid are not present, the Council/Executive Committee shall elect one of its members who is present to chair the meeting. The Chairperson shall have a casting vote. The Council shall meet once a year at such time and place as the President President directs. Two-third of the membership of the Council shall form the quorum. If, however, the quorum is not complete the meeting shall be adjourned for half an hour and meet at the same place and transact the necessary Agenda even if the quorum is not complete. The Council may appoint Standing or Sub-Committees, with power to co-opt members to deal with special subjects. The co-opted members shall not have the right to vote. Co-opted members are not elected members, hence shall not be eligible to contest TNAI. President's and Vice President's elections. The terms of reference and rules of procedure for Sub-Committees shall be prescribed by the Council. The SubCommittees shall submit their minutes to the Council but shall have no executive power. Any member of Council/Executive Committee/Standing Committee who fails to attend more than two consecutive meetings of the concerned body shall cease to be the member of the Council/Executive Committee or Standing Committee, as the case may be. 12.General Meetings: The General Meeting of the members of the Association shall

be held biennially at Patron such time and place asbe the Council may decide. the inaugural session the (if present) shall asked to preside, if not,For a VicePatron shall be asked to preside, if none of the aforesaid is present, the President, TNAI, shall preside. In care of her/his absence, the First Vice President President shall take the chair. In case of the inability of the First Vice-President, the Second Vice President Presi dent shall preside. In the event of the absence of the Second Vice-President, Vice-President, the Third Vice President shall sha ll take the chair cha ir.. 13.Special Meetings:  The President, TNAI, may call a Special Meeting of the Council/Executive/House Council/Executive/Ho use of Delegates at any time she/he deems necessary onethird of the Council/Executive/House of Delegates. The matter to be discussed shall be circulated circulat ed to the members and no other business bus iness shall be discussed. discu ssed. TwoTwothird of the membership shall form the quorum. If, however, the quorum is not complete the meeting shall adjourn for half an hour and meet at the same place and transact the business as per agenda. 14.Officers: The Officers of the Association shall consist of the following elected and

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appointed office bearers: a) President b) Vice-Presidents c) Hony. Treasurer d) The Secretary-General e) Assis ssista tant nt Se Seccret etar aryy-cu cum m-SNA -SNAAdv dviiso sorr f) g)

Assistant Secretaries Editor of tth he Nursing Jo Journal o off In India

Full time officers of the Association appointed by the Council shall have no voting right. TNAI members serving as full time office bearers (paid) on the Council shall not be eligible to contest TNAI elections (President, (President, Vice Presidents), unless prior to their appointment they would have held elected office(s) on the Council. 15.Grant 15. Grant of Money: The Association Association shall grant to each State Branch an annual grant for each full member in the Branch as decided by the Council from time to time. 16.Property 16. Property,, Bank Accounts and Securities: The property, property, movable and immovable, immov able, belongings to the Association shall be deemed to be vested in the name of the Council of the Association. In all proceedings, civil and criminal, it shall be described as the property of the Council by their proper title.

The Council shall authorize the President, Hony. Treasurer and Secretary-General to purchase, sell, pledge and endorse and otherwise deal with securities of the Association in such a manner as may from time to time vary or realize such investments and also to raise funds and borrow money against securities and investments of the Association. The investments etc. may preferably be made after taking advice from experts in the particular field or line wherein the investment is sought to be made. 17.Notices: Any notice required to be given to members may, unless otherwise required by the Societies Act, be given by publishing the same in the official Journal of the Association (NJI). 18.Amendments of Rules and Regulations:   Any alteration to the Rules and

Regulation Regulations s of the Association shall be affected by the a vote of atleast three-fifth the full members of the Association present at meeting of the House of Delegates. 19.Association's Representative to other Organizations: An individual elected by the Council/House of Delegates as representative of TNAI to another organization shall not be authorized to make commitments for the Association. She/he shall be required to report to the Council the findings, recommendations, terms and conditions of the organization to which she/he is elected. 20.Publications: All the books published by Zones, States or Union Territory Territory Branches shall be in the name of the Trained Trained Nurses' Association of India. All papers read at any meetings of the Association or at any educational programme sponsored by the Association, shall become the property of the Association. The Council may cause these to be copyrighted in the name of The Trained Trained Nurses' Association of India. 21.Employees of the Association/Service Conditions:  Persons serving under the

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

TNAI or in any of the institutions started by it, in accordance with its aims and objects, shall be employees of the Association under the control of the Council or its delegate, and will be amenable to all the disciplines of service. The service conditions of all such employees shall be regulated by their service contract as framed by the Rules and Regulations of the Association and accepted by the employees. 1. Offi Offici cial al Orga Organ n

The Nursing Journal of India shall be the official organ of the Association. Association. A copy of the Journal shall be sent free to all the Full Members and Associate Members who subscribe to the Journal, as decided by the Council from time to time. Each SNA unit shall get a minimum of two copies and a maximum of four copies of the Journal. Copies shall be provided as required under Bye-Laws 3 (e). 2. Duti Duties es of Of Offi fice cers rs

a)

b)

c)

d)

e)

f)

The Preside resident, nt, if if presen present, t, shall shall pres preside ide over over the meet meeting ingss of the the Counci Councill and the General Meetings of the Association and shall be an ex-officio member of all committees. She/he shall keep in continual touch with implementing the policies of the Association and the decisions made at Council meetings. In the the event event of a vaca vacancy ncy in in the offi office ce of of the Pres Preside ident, nt, or or her/hi her/hiss inabil inability ity to serve, her/his duties shall be assumed by the First Vice-President until the next General Meetings. In the event of a vacancy in the office of the Second Vice-President Vice-President or her/his inability to serve, her/his duties shall be assumed by the Third Vice-President Vice-President until the next General Meeting. The local Vice-President Vice-President shall keep in touch with the headquarters and take an active part in promoting the interests of the Association. It shall be obligatory on the part of all Vice-Presidents to attend all the meetings. If they fail to attend two consecutive meetings, they shall be disqualified from holding office. The Secr Secreta etaryry-Gen Genera erall shall shall act as the the Execut Executive ive Offi Officer cer of of the Associ Associati ation on to implement its policies. She/he shall be responsible for the preparation for the Meetings and shall be responsible for the management of the headquarters as prescribed in the standing as delegated by and the Council from time to time. The budget item orders for building, furnishing replacement of articles shall be expended at the discretion of the Building and Works Committee of which the Secretary-General shall be an exofficio member. member. The Assist Assistant ant Secre Secretar tary-c y-cumum-SNA SNA Adviso Advisorr shall shall act act as the Assi Assista stant nt to the Secretary-General to implement the policies in respect of SNA. She/he shall be responsible for such other duties in the Headquarters and work of the Association as may be prescribed in the Standing Orders and as delegated by the Council from time to time. The Edit Editor or shall shall edit edit and and publi publish sh the the Nursi Nursing ng Journ Journal al of India India and and other other publications of the Association. She/he shall be responsible to ensure that any official statements made in the Journal are in accordance with the policies of the Association. The Editor shall be the Business Manager of the Journal and also act as Public Relations Relations Officer of the Association. The The Hono Honora rary ry Treas reasur urer er sh shal all: l: (i) Receive Receive the quarter quarterly ly statement statement of accounts accounts together together with the bank

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

statement and reconciliation remarks; (ii) Countersi Countersign gn all pay vouchers; vouchers; (iii)Verify from bills that expenditure is properly regulated and accounted for; (iv) Verify that selected receipts are duly booked in the cash books; and (v) Report Report to the Executive Executive Committee and the Council, Council, TNAI, TNAI, the

g)

amount received and any investment or unusual expenditure or savings. She/he shall serve as ex-officio member on all the committees dealing with finances. The Honora Honorary ry Secre Secretar taryy of the the Health Health Visi Visitor tors' s' Leagu League e and of the the Midwi Midwives ves Association shall: (i) Organize Organize units in the the various various States States and keep in touch touch with with the the State State Branch Committees; (ii) Contact Contact members members person personally ally when when possible possible or by corresp corresponden ondence, ce, and through the Journal professional activities. She shall make efforts to recruit new members. (iii) Collect Collect State reports reports and submit submit a summarized summarized report report to the House of Delegates meeting through the Secretary-General two months prior to the meeting; (iv) Prepare repare the agenda agenda for biennial biennial meeting meeting of Health Health Visitors Visitors League/Midwives League/Midwi ves and Auxiliary Nurse-Midwives' Association, Association, held at the time of the House of Delegates meeting.

3. Meeti Meeting ngss of the the Coun Counci cill

a) b) c)

d) e)

f)

g)

Meetin Meetings gs shall shall be be called called at at such such time time and place place as are are provi provided ded for unde underr Clause 12 of the Rules and Regulations. Notice Notice of ever everyy meetin meeting g other other than than a spec special ial meet meeting ing,, shall shall be be issued issued by the Secretary-General not less than 40 days before the date of the meeting. In case of special meetings, 15 days' notice shall be given. The agenda agenda shall shall be be prepa prepared red by the the Secret Secretary ary-Ge -Gener neral al in consul consultat tation ion with the President; the agenda and explanatory notes in the final form shall be approved by the President, President, before being issued to members. These shall e issued not less than 15 days before the meeting of the Council. Addit Addition ional al items items for for the the agenda agenda shall shall be be prese presente nted d to the the Counci Councill and and Council decide which of the items are of sufficient importance to be added toshall the agenda. The Counci Councill shall shall appoi appoint nt a comm committ ittee ee to to frame frame resolu resolutio tions. ns. This This committee shall report at last session of the Council meeting. One copy of the resolutions shall be given to the President President and one copy to the Minutes Secretary.. Copies of previous resolutions with cross-references should be Secretary made available to the Resolution Committee. The minute minutess of the the Coun Council cil shall shall be be authe authenti nticat cated ed afte afterr confi confirma rmatio tion, n, by by the signature of the President. A copy of the minutes of the meetings shall be submitted to the President within 15 days of the meeting, and after being attested by her/him shall be sent to each member within four weeks of the meeting. The minutes shall be confirmed at the next meeting of the Council. If no obje objecti ction on regar regardin ding g the corr correct ectnes nesss of the the minute minutess is rece receive ived d within within 30 days of the dispatch of minutes, the decisions may be put into effect before the minutes are confirmed; provided the President may direct that action be taken on a decision of the Council before the expiry of the period

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

of 30 days mentioned above. Nursing Research Section a) To initiate and stimulate stimulate research research studies, inquiries/surveys on problems problems referred to it by the Council. b) To scrutinize scrutinize requests requests for grants for research studies, inquiries/surveys inquiries/surveys

and make appropriate recommendations to the Council. 4. Representatio Representation n on the Indian Nursing Nursing Council Council

The representative of the Trained Trained Nurses' Association of India on the Indian Nursing Council shall be the President, President, TNAI.

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Annexure 6 STUDENT NURSES' ASSOCIATION (SNA) History and Activities

The Student Nurses' Association (SNA) is a nation-wide organisation. It was established in 1929 at the time of Annual Conference of the Trained Trained Nurses' Association of India (TNAI). The Nursing Superintendent of the Government General Hospital, Madras, Miss. L.N. Jeans, was the first Honorary Organizing Secretary of this Association. Association. The pioneer unit of SNA was established at the General Hospital, Madras, followed by Christian Rainy Hospital, Madras and the Presidency General Hospital, Calcutta. It is remarkable that the growth of SNA Units has been persistent ever since its inception. In the year 1954, the SNA celebrated its Silver Jubilee and there was significant increase in the number of units by then. The number rose to 117 and the membership to 4,259. The SNA celebrated its Diamond Jubilee with almost three-fold increase in the number of units and seven times increase in the membership, i.e., 355 units and 29,233 members. The SNA and TNAI used to have combined Annual Conferences, but due to the increase in number of delegates it was felt in 1960 to hold separate Conferences for the Student Nurses. Since 1961 the Student Nurses are having separate Biennial Conferences. These are held alternately with TNAI Conferences. The students are being given more and more responsibility to manage their affairs both at the State and national levels. In 1975 it was agreed by the TNAI Council that one student representative be included in the State Branch Executive Committee on trial basis before the students are included in the TNAI Council as representatives of SNA. As work of the Association increased, the need for a full time Secretary for the SNA was felt and in 1947 Miss I. Dorabji was appointed as SNA Secretary. Miss M. Philip succeeded Miss Dorabji Dorab ji in 1964, when Miss Dorabji joined joi ned TNAI as Secretary. Miss Philip continued as SNA Secretary till 1967. In 1970 with the reorganisation of TNAI the designation of the SNA Secretary was changed to SNA Advisor. Mrs. Narender Nagpal was appointed first SNA Advisor in after 1974 and she served in this capacity upto ,1978. D.K. Singh succeeded succeede d Mrs. Nagpal the later's later' s appointment as Secretary Sec retary, TNAI.Miss Mr. Mr. T. Stephens Stephe ns succeeded succeede d Miss Singh Si ngh in 1982. 19 82. On Mr. Mr. T. T. Stephens' Stephe ns' retirement reti rement in 1984 Miss Jaiwanti P. Dhaulta Took Took over ove r as SNA Advisor and a nd continues contin ues to be in i n the post. post . Activities of SNA

A wide variety of activities are encouraged at all levels for the SNA members and this is done keeping in view the objects of the Association for which it was formed. The diversity of activities is derived from the professional, social, cultural and recreational spheres. The activities are geared to strengthen curricular and cocurricular components. Professional (a) Organisation Organisation of Meetings Meetings and Conference Conferences: s: The first one-day SNA Conference was held in 1951, and the first Biennial SNA Conference was held at Nagpur in 1961.

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

At the TNAI Conference two SNA members from each State are invited to attend as observers and these student representatives are the Vice-President and the Secretary of the State Branch. They They are free to attend social social functions also. They are invited to attend Business Meetings as observers. A three to four day Conference is held for SNA members biennially. The National SNA Advisor in consultation with General Committee of SNA arranges the programme for the Conference. The Presid President ent or any one of the Vice-Presidents Vice-Presidents of the TNAI presides over the inaugural session and the student Vice-Pre Vice-President sident of the State presides over the rest of the sessions. Organising meetings and conferences at all levels is one of the important activities which provides a forum for the members to discuss and find solutions for various problems faced by the students. At the State level the Conferences are held annually or biennially. biennially. At the unit level these are held annually or biennially. biennially. At the unit level these are usually in the form of meetings which are organised monthly or bi-monthly. bi-monthly. These Conferences and meetings with major professional components are flavoured with soico-cultural and recreational items. (b) Maintenance Maintenance of SNA Diary: Diary: The SNA Diary was instituted in 1939. This is a triennial record book drawn up for the use of the Unit Secretaries. Till 1976 the SNA Units used to send the SNA Diaries direct to the TNAI headquarters. for annual assessment but now the Diaries are assessed annually by the State SNA Advisors and the two best Diaries are sent by the State SNA Advisors to the National SNA Advisor for evaluation and awards. These Diaries are assessed keeping in view the Unit activities, viz, professional, educational, extra-curricu extra-curricular lar and social, cultural and recreational. Proper maintenance of Diary is another criterion. In general the focus of assessment is on the diversity of activities carried out by the Units. The professional component of activities is very important but it does not mean that other components are less important. Since 1988 [Minute No. SNA-GC/18/88/3(i)] Diaries of MPHW (F)/ANM students student s are evaluated separately separate ly.. (c) Exhibi Exhibitio tion: n: Exhibition is one of the oldest, useful and very popular activities of the

Association. Theand firstthe exhibition was inaugurated in 1933.a The grown in sized quality of exhibits has attained highexhibition standard. has All categories of students are eligible to participate either individually or in groups. They can prepare models, charts and posters on the subjects taught in their course of studies. The guidelines for the activity are published in The Nursing Journal of As the number of exhibits was India three to four months prior to the Conference. As increasing every year, it was decided in 1975 to display only those exhibits at national level which are assessed best at the State level. Now this activity is competed at the State level to begin with and only one best entry under each category and section is entertained at the national level. (d) Public Speaking Speaking and Writing Writing:: Public speaking and writing are encouraged at all levels for two reasons: one, to increase self-confidence self-confidence in the students and to help them gain skill in communication. In order to achieve this the Association arranges debated, panel discussions, seminars and extempore speeches. The topics for

these correlate with the theme of the Conference and the trend of the day. day. The students are encouraged to write on professional topics for The Nursing Journal of

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

India which is the official organ of the TNAI.

(e) Project Project Undertaking: Undertaking: It is a recent idea which is gaining popularity among nursing students. The students undertake community projects such as School Health Project, Projec t, Health Survey S urvey,, Nutrition Survey etc., Home Nursing and specific projects like medical camp, immunization, etc. at the t he time of celebration of International

Nurses' Day. Day. At some institutions regular projects are given to students as part of their field experience. (f) Propagation Propagation of Nursing Nursing Profession: Profession:  To acquaint the general public with the nursing profession, general public is invited to the celebrations and festivities of professional professi onal and non-professional non-profe ssional nature, natur e, such as Nurses' Week, World World Health Day, Day, Capping and Graduation ceremonies and other festivities like witnessing a variety entertainment programme, games, sports and tournaments, t ournaments, which are organised by nurses. There are a re also institution inst itution visits, v isits, Radio Rad io talks and an d T.V. .V. programmes. programmes . (g) Fund Raisin Raising: g: Fund raising is an important and necessary activity not only of the Head Office, but of all the SNA Units. It is done by getting voluntary donations, sale of donation tickets and by arranging some features. The SNA Units raise fund by organised variety entertainments, fetes, sales, and through other modes of fund raising. (h) Socio-Cultur Socio-Cultural al and Recreational Recreational Activities: Activities: The Association believes that the professional development remains incomplete without this component. Young students' energy can be channelled constructively into fine arts like dance, dramatics, music and painting, and competitions are arranged at the time of Conferences. Sports and games are becoming extremely popular and competitions are held at state level at present. A start in this regard has also been made form 1986 SNA Conference by including some items of Sports Competitions.

In addition to the t he aforesaid activities, there are numerous other activities which are carried out by the Units, in the form of quiz programmes on general knowledge, article writing, poetry writing, flower arrangements, smile competitions, beauty contests, etc. Hobbies like sewing, stitching, interior decorations, etc. are also encouraged. Awards and Prizes: Most of the prizes for the Association have been donated by the friends and well-wishers of the SNA.

The following are the categories of prizes: Special Awards: There are many special prizes given for the exhibitions and other competitions. There are: Indira Dorabji Cup, Dufferin Cups (4), Miss Edith Paul Shield, Mr. G. Kanthaia's Rolling Shields (2), Smt. Rajkumari Amrit Kaur Rollilng Cup, General Chakravorty Cup, Dettol Shield, MacNaughton Lamp, Sr. Elizabeth Shield, Mrs. H. Chabook Shield, Miss Adranvala Shield, Dr. Jiv Raj Mehta Rolling Shield and Prof. C. Chandrakanthy Rolling Cup. Apart from these there are three prizes for all the sections under each category in exhibition and also the other competition items.

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

SNA Rules and Regulations 1. N a m e

The name of the Association shall be the Student Nurses' Association. The Association is an associate organization of Trained Nurses' Association of India. 2. Objects

(a) To help students to uphold the dignity and ideals of the profession profession for which they are qualifying. (b) To promote a corporate spirit spirit among students for common common good. (c) To furnish nurses in training training with advice in their courses of study leading up to professional qualification. (d) To encourage leadership leadership ability and help students to gai gain n a wide knowledge of the nursing profession in all its different branches and aspects. (e) To increase the students' social contacts and general general knowledge in order to help them take their place in the world when they have finished their training. (f) To encourage both both professional and and recreational meetings, games and sports. (g) To provide a special section in The Nursing Journal of India for the benefit of students. (h) To encourage students to compete compete for prizes in the Student N Nurses' urses' Exhibition and various competitions, and also to attend national and regional Conferences. 3. President, President, State Vice Presidents, Presidents, Secretaries Secretaries

The President of the TNAI shall be the President of the Association. The SNA Vice President Presid ent and Secretary shall be one year, year, but they would be eligible for the reelection for one more term. 4. Membership Student Nurses of General Nursing and Midwifery, Midwifery, Basic B.Sc Nursing, Multipurpose Health Worker (Female)/Auxiliary Nurse-Midwives, Nurse-Midwives, Lady Health Visitors from the training institutions recognised by the Indian Nursing Council, in which a Student Nurses' Unit has been established. 5. Mana Manage geme ment nt

The governing body of the Association shall be the Council of TNAI which will receive the recommendations of the General Committee of the SNA for consideration. The General Committee of SNA shall consist of: (a) President President of TNAI or one of the Vice Presidents Presidents if the President President wishes to delegate this responsibility responsibi lity.. (b) Vice-Presidents Vice-Presidents of SNA State Branches. Branches. (c) Hony. Hony. Treasurer Treasurer of TNAI. (d) National SNA Advisor who must be a full member of TNAI. (e) State Branch Branch SNA Advisors. Advisors. (f) Secretarie Secretariess of the SNA State Branch Branches. es. (g) SecretarySecretary-Gene General, ral, TNAI. TNAI.

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

The General Committee shall meet once in a year at the time of TNAI Council meeting. 1/5th or 15 membe members rs form form a quorum quorum.. SNA General Body

The SNA General General Body at the National level shall comprise of: (i) (i) Memb Member erss of SNA SNA Gene Genera rall Comm Commit itte tee. e. (ii) Three Three representati representatives ves from each unit unit viz., SNA Vice Vice Preside President, nt, SNA Secreta Secretary ry and SNA Advisor. Advisor. (iii) All SNA Delegates Delegates attendin attending g the conference conference.. 6. Officers

The officers of TNAI shall be the officers of the Association. The National SNA Advisor of the Student Nurses' Association Association shall be full time officer appointed by TNAI Council and shall be a member of TNAI. She/he shall act as the administrative officer of the Association to implement its policies. She/he shall be responsible for the necessary preparation for the General Committee meeting, the Student Nurses' Exhibition competitions and for the management of the office as may be prescribed in the standing orders of the TNAI. 7. St State ate Br Bran anch ch Advis Advisor orss

The State Branch SNA Advisors shall be elected during the State Branch elections. Where there is no State Sta te SNA Branch, the Branch Executive Executi ve shall appoint appoin t an SNA Advisor. Advisor. He/she must be full member of TNAI who is keenly interested in the SNA and has experience of working with Student Nurses. In case of any vacancies of the SNA Advisor they will be filled by the State Executive, nominating a person for the interim period. State SNA Advisors shall advise SNA Unit Office Bearers to organise SNA Activities, coordinate these in their respective States and at the national level. They shall keep units in their branches informed of all SNA activities and be the liaison officers between their respective Branches and the National SNA Advisor Advisor of the Student Nurses' Association. They shall help the SNA Officers to organise students conference in the State and endeavour to attend such conference at the national level. They shall also help the students to fulfil the objects of the Association and implement decisions made at the SNA General Committee Meetings and Conferences. They shall assist in the enrolment of Student Nurses to the SNA and the formation of SNA Units in every training centre and help Student Nurses to realise the importance of becoming full members of TNAI on completion of their training. The General Body Meetings The General Body meeting of the Association shall be held at the time of the SNA Conference.

The President, TNAI, shall preside over the SNA meetings. SNA Office Bearers of the

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

host Branch shall conduct the SNA meetings alongwith the Presiden President. t. Agenda items from the Branches should be sent to National SNA A Advisor dvisor at least two months before the General Committee meeting. Resolutions passed at the General Committee and General Body meetings shall be forwarded by the National SNA Advisor for the Student Nurses' Association to concerned authorities and TNAI Council for consideration. The action taken by the Council and other concerned authorities shall be forwarded by the National SNA Advisor of the Student Nurses' Association to the State SNA Vice-Presidents, Secretaries and the State Branch SNA Advisors. 8. Unit Unit Or Orga gani nisat satio ion n

All officers shall be elected by the student members of the t he Unit as follows: (a) SNA Advisor Advisor shall shall be a member member of the TNAI TNAI whose whose function function shall shall be entirely entirely advisory in nature. (b) Vice-P Vice-Presi resident dent shall shall be a student student and presiden presidentt over all Unit's Unit's meetings. meetings. (c) Treasurer reasurer,, Convenors Convenors and members members of sub-com sub-committe mittees es may be elected elected to arrange for various activities as the Unit considers necessary. necessary. 9. Unit Unit Acti Activi viti ties es

(a) The Unit Unit shall decid decide e upon the the duties duties of their officers officers and commi committees ttees and and draw up a programme of activities in line with the objectives of the SNA. (b) The Diary Diary of Unit Unit activitie activitiess shall shall be kept kept by the Unit Unit Secretar Secretaryy and used used as the the basis for the quarterly reports and the annual reports which shall be a summary of important events. (c) Quarterly Quarterly reports reports of of activities activities shall shall be sent to the the State SNAAdvisor Advisor and copy copy to TNAI headquarters. (d) Student Student page page of the the Journa Journal: l: Suitabl Suitable e article articless written written by membe members rs shall shall be collected by the Unit Secretary and sent to the National SNA Advisor of the Student Nurses' Association through the Unit Advisor or they may be sent through the State SNA Advisor if so desired for publishing. (e) Applicati Application on forms forms for members membership hip in TNAI TNAI shall shall be given given to Unit members members as soon as they complete their training. The completed form, including the certification fromSecretary the Head of the School of Nursing Superintendent shall be forwarded to the Sec retary, , TNAI. 10.Proxies

No proxies are permitted for attending SNA General Committee meetings/General Body meetings. SNA Bye-Laws 1. Memb Member ersh ship ip (i) SNA Member Membershi ship p Enrolm Enrolment ent Membership shall be open to all student nurses of basic programmes: Auxiliary Auxiliary NurseMidwives/Multipurpose Midwives/Multipur pose Health Worker (Female), General Nursing and Midwifery and

Basic B.Sc Nursing students. Membership can only be effected through an unit. No individual student may be enrolled.

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

Application to form a Unit shall be made through the nursing head of the training institute. A student failing to complete her or his training shall cease automatically to be a member of the Student Nurses' Association and her name shall be taken off the roll by the Unit Secretary. Se cretary. Students failing to pay annual SNA subscriptio subscription n shall be debarred from contesting any SNA Office. (ii) SNA Members' Members' Record Record The Unit Secretaries shall furnish annually the statement of student members, yearwise, of their Units alongwith Annual Annual Subscription to the National SNA Advisor of the Student Nurses' Association to keep the Unit U nit membership-up-to-date. (iii)Transfer of SNA-to-TNAI Membership (iii)Transfer Members of the Student Nurses' Association on completion of their training shall be eligible for full membership in TNAI and M & ANMA. The application from a student for full membership, if it comes through the Unit Advisor or signed by the Head of her/his Nursing School or Nursing Superintendent, shall be considered valid without accompanying Registration Registration Certificate. Student members who apply within six months of the completion of the training and are successful in their examination, shall be eligible for the concessional rate of subscription as prescribed by the TNAI Council from time to time. No concession shall be given to the students who apply for membership of TNAI after six months from the time of declaration of the result. 2. Fees

The Membership Fee per annum per student for all categories of Nursing Students shall be as per revision made from time to time. Annual Subscription shall be paid upon joining the Association Associatio n and thereafter thereafte r renewed every year. year. 3. SNA SNA Scho Scholar larsh ship ip

In place of SNA-ICN Delegates earlier usedhave for sending student delegates to international conferences, four Fund SNA Scholarships been established since 1984. They shall be given for the entire training period after reviewing each year's performance. 4. Rules Rules and and Reg Regul ulat atio ions ns

A copy of the Rules and Regulations and Bye-Laws shall be supplied free to each Unit upon joining the Association. 5. The Nursin Nursing g Journ Journal al of India India

Two copies of the The Nursing Journal of India  shall be supplied free to each SNA Unit. One more copy of the Journal shall be supplied for every additional upto 25 members. Not more than 4 copies shall be supplied to any Unit. Students can also directly subscribe for the personal copy of the Journal at the rate

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

prescribed from time to time. 6. SNA State Branch Branch Advisor, Advisor, Vice President President and Secretar Secretary y

SNA Advisor, Vice President and Secretary shall represent the State Branches on the General Committee Committ ee which shall normally meet annually. annually. Vice-President and Secretary shall also represent the State Branches as observers at the TNAI House of Delegates meetings and the Conference. The Chairman of the General Committee shall be the Vice President President of the Branch hosting the meeting/Conference. meeting/Conference. In the event of inability expressed by the host Branch, the Vice President of any other State in rotation shall chair the SNA meetings. The minute Secretary shall be chosen from among the State Branch Secretaries or Vice Presidents Pre sidents assisted by one of the state SNA Advisors. Advisors. 7. St Stat ate e Br Bran anch ches es

(i)

The objec objectt of a State Branch Branch shall shall be to carry carry out out the objectives objectives of the the Student Student Nurses' Association Association as set out in the Rules and Regulations. (ii) Members Members of the the SNA resident resident in a State State shall be be members members of the the SNA State Branch of that State. The Branch may consist of one or more units. (iii) The SNA State Branch Branch Executive Committee shall be constituted as follows: follows: Elected Members i. President, TNAI of the Branch. ii. State SNA Advisor. iii. Sta tate te Branch SNA Vice-President iv. State Branch SNA Secretary v. State Branch SNA Treasurer vi. Sta tate te Branch SN SNA Programme Ch Chairman. Ex-Officio - Hony. Hony. Secretar Secretaryy of the TNAI Branch. Branch.

- Hony. Hony. Treas Treasurer urer of of the TNAI TNAI Branch. Branch. Elections of the officers of the State Branch shall be held at the time of annual or biennial meetings or Conferences. The term of office of a member of the State Branch Executive Committee shall be of one year, year, eligible for re-election for one more term. Vacancies occurring between annual meetings shall be filled by the State Branch Executive Committee. (iv) The SNA State State Branch Branch Executive Executive Committee Committee shall hold hold annual/bi-an annual/bi-annual nual meetings. (v) State Branch Branch Vice Vice Presid President/S ent/Secre ecretary tary shall shall submit submit an annual annual report report of Branch Branch to National Natio nal SNA Advisor through the t he State SNA Advisor. Advisor. (vi) In case a TNAI Branch Branch is dissolved dissolved or ceases ceases to function, function, the funds of the Branch shall be transferred to TNAI funds at headquarters. (vii) The Office Bearers Bearers of the State Branches and their Functions Functions i. State Branch Branch Vice-P Vice-Presiden resident: t: State Branch Vice-President shall represent the State Branch at the SNA General Committee and as observer at certain TNAI meetings, Conferences. She or he shall be the Chairperson of the SNA State Branch Committee and shall preside over at the annual meeting and State Branch Executive meetings.

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

ii. State Branch Branch Secretary: State Branch Secretary shall perform the duties usually pertaining to that office which shall include convening of meetings and keeping a record of meetings and the minutes of the meetings. She/he should submit her/his report to the State Branch Advisor who, in turn, would submit the report to the National SNA Advisor and keep her/him informed of the State Branch news and activities.

ii iii. i. Treas reasur urer er sh shal alll wor work k in in col colla labo bora rati tion on wi with th TNAI TNAI St Stat ate e Bra Branc nch. h. Treasurer and SNA Advisor shall help in raising funds for State Branch activities. iv.Programme Chairperson shall be responsible for drawing up the State Branch programme for the year. She or he shall be advised by the SNA Advisor. ( v iii) Quorum Three fifths of the members shall form a quorum for the State Branch Executive Committee Meeting. If the quorum is not complete the meeting may adjourn for half an hour and meet again at the same place and transact the Agenda. Where a State Branch has not been organised, Unit Secretary and Vice President Presi dent shall be chosen by the t he Units in the State to attend the Annual General Committee Meeting and the Observers' Meeting at the national level. 1. SNA General Body ody   The SNA General Body of the State shall shall consist of : (i) State SNA SNA Executive Executive Commit Committee tee member members; s; (ii) SNA unit representatives representatives (Vice President, President, Secretary and SNA Advisor or any other representatives elected or nominated by the Units). The State SNA General Body meeting of the SNA shall be held annually or bi-annually at the time of State Conference or otherwise. The President President of the State Branch, TNAI, shall preside over the SNA meetings in the State. In the absence of the President, the Vice President or any other State Branch Executive Committee member present may be nominated to chair the meeting. 8. Exp Expenses The expenses of the State SNA Office Bearers, viz., State SNA Advisors, Vice Presidents

and attending fromSecretaries SNA General Fund. national level SNA meetings will be met by the TNAI Council 9. Account ntss The Funds of the Association shall be kept by TNAI. The following shall be credited annually to the accounts of TNAI as per the rates revised from time to ttime. ime. ? Affi Affili liat atio ion n fee fee for for eve every ry mem membe berr of of SNA. SNA. ? Subs Subscr crip ipti tion on fo forr cop copie iess of of The Nursing Journal of India supplied to the Units. 10.

Exhibition

There shall be an exhibition at the t he time of SNA Conference. The judging of the exhibits shall be done by panel of judges and prizes awarded as per prescribed Conference guidelines. Student members may enter exhibits for all sections. Al Alll entries shall be made on a prescribed form and in accordance with the rules framed and revised from time to

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Tamil Nadu Assessment of Nursing Management Capacity in Tamil

time by TNAI Council or the General Committee of the SNA. All exhibits should be accompanied by a certificate from the unit SNA Advisors/State SNA Advisor as the case may be stating: a) That the the exhibit exhibit is the the bonafide bonafide work work of the studen studentt nurse. nurse. b) That the studen studentt nurse is a member member of the the SNA Unit of the hospit hospital. al. 1. Entry form form for each each exhibit exhibit should be be sent to the TNAI TNAI headquarte headquarters rs alongwith alongwith the required registration fee. 2. The follow following ing inform informati ation on must must acco accompa mpany ny each each exhibi exhibit: t: (a) Name of the exhibit exhibitor or.. (b) Name of the the hospital hospital.. (c) Category and section/division section/division in which which the exhibit exhibit is to be shown. shown. 3. The last last date date for entry will be fixed fixed by the Nationa Nationall SNA Advisor Advisor of the Student Student Nurses' Association. 11.SNA 11. SNA Election Procedures

(i) (i) (ii) (ii) (iii) (iii) (iv)) (iv (v) (vi)) (vi (vii) (vi i) (viii)) (viii

Any Any SNA SNA memb member er fro from m the the SNA SNA Unit Unit in in regu regula larr memb member ersh ship ip wit with h the the SNA SNA at national level may make nomination for the office of the State SNA Vice President, Secretary Secret ary,, T Treasurer reasurer and Porgramme Porgram me Chairperson. Chairpers on. The Electi Election on Comm Committ ittee ee and and the the Retu Returni rning ng Offi Officer cer shall shall be be appoi appointe nted d by the SNA Executive Committee. A nominee shall contest election for one office only. The electi election on comm committ ittee ee shall shall asce ascerta rtain in from from nomi nominee neess their their conse consent nt for for contesting the election and to undertake the choice of the office in case they are nominated for more than one office. The SNA Adviso Advisorr for for the the conce concerne rned d Unit Unit shall shall veri verify fy the the valid validity ity of of the the nominee. The Electi Election on Commit Committee tee would would call call the the nomina nominatio tion n eith either er at the time time of of election or earlier on a prescribed form or listing on the board whatever is convenient. Three Three high highest est nomina nominatio tions ns in in order order of meri meritt shall shall be list listed ed to to conte contest st any any one office either eith er on the black board or in a provisional provisio nal ballot paper. paper. Any cont contest esting ing cand candida idate te whose whose name name appe appeare ared d in the prov provisi isiona onall ballot ballot paper or on the black board may request the returning officer to withdraw her him on from contest before tballot he election. Theor electi election shall shathe ll be carried carried out out byholding secre secrett the ball ot at the the time time of SNA SNA General General Committee meeting of the State and also General Body meeting of the unit.

Eligibl e Voters Eligible Voters (i) The eligib eligible le vote voters rs shal shalll be the the repr represe esenta ntativ tives es of the SNA Units Units in their their respective States. (ii) (ii) Each Each State State unit unit shall shall furni furnish sh the list list of elig eligibl ible e voters voters to to the State State SNA SNA Advisor or the Returning Officer keeping some stand by names. (iii) Returni Returning ng Officer Officer or her or his deputy deputy will will have the custody custody of of the keys keys of the the Ballot Boxes if used. (iv) The Return Returning ing Office Officerr at the the time time of election election shall shall appoint appoint the the require required d number of Polling Officers. Tellers and Supervisors for the purpose of election. Voting Procedure a) No convas convassing sing shall be permi permitted tted on the the day day of the electi election. on. No person person other

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

b) c) d) e)

than the voters s1hall be permitted within the area of the polling booth. The voters voters shall queue queue up at the the polling polling counters counters and and shall shall indic indicate ate their their names and show recent Unit annual subscription receipt issued by the TNAI headquarters and sign the voter list before entering the election hall. Po Pollin lling g Officer Officer after checking checking voters' voters' identity identity would would score score off the the name name of voters in red ink. Voting may be be done done either either by by raising raising hands hands or secret secret ballot ballot whatever whatever is feasible for the Branch. The empty ballot ballot boxes boxes if if used used shall shall be inspec inspected ted by by the polling polling office officers, rs, supervisors and representatives of the contestants. These are then closed or locked properly and used for voting.

Election Results

1)

In case case voting voting is done done by by raising raising hands, hands, these these are are counted counted and written written each each contestant. In the secret ballot system immediately after polling is over, over, the Ballot Boxes shall be opened by the returning officer and these are counted in the presence of pollers, supervisors and contestants representative(s) if any.. Invalid votes any vote s are also counted and kept separately. sep arately.

2)

After the counting counting is comple completed, ted, contestants contestants are listed listed in order order of merit. merit. Results are signed by the returning officer and others involved in conducting the election and results announced immediately by the Returning Officer. Election results sheet is handed over to the State SNA Ad Advisor visor who shall make a note of the elections that have been held and declared valid in her/his presence and she/he should sign the same.

3)

The contestant contestant getting getting the the highest highest votes shall be decla declared red elected elected to the the concerned office.

4)

Ballot Ballot paper paper,, if any any used, used, shall shall be be destroye destroyed d after after 30 days if there there is is no dispute.

Election Disputes

All disputes will be settled by a committee consisting of President of the Branch, Returning Officer and the State SNA Advisor. Decision, if any, shall be made known to the Branch Executive within 30 days of the dispute committee's decision. 12.SNA 12. SNA Units

Each SNA Unit should elect its own office-bearers in its General Body meeting. These officers shall be elected to hold the following positions: SNA Unit Advisor (should be a TNAI member), Vice Vic e President, Secret Secretary ary,, T Treasurer reasurer and Programme Programm e Chairperson. Chairperso n. The above mentioned members shall be the members of Executive Committee of the Unit. The Executive Committee may formulate any member of committees the Chairpersons of which shall be members of the Executive Committee. The Chairperson may co-opt members on these committees, for assisting the Chairperson in implementation of the job responsibilities. The Executive Committee should hold meetings at regular intervals or at any other time as necessary neces sary.. The SNA General Body meetings should also be held at regular intervals. The agenda for these meetings will be according to the needs of the unit members and the aims

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Assessment of Nursing Management Capacity in Tamil Tamil Nadu

and objects of the SNA. The office bearers should make sincere efforts to make meetings interesting, stimulating and whole-some. The meetings should cover the socio-cultural and professional spheres of life. The students can undertake some useful community projects and report to the General Body Body.. There is need to make use of diverse programme in the meetings to avoid monotony and create interest in the members to be inquisitive and concerned to meet the health and welfare needs of the people. Unit Secretaries should write to their State Branch Advisors atleast once every three months to report the progress of the Units and ask for suggestions. Articles should be collected and sent to the National SNA Advisor for insertion in the Student Nurses page of the The Nursing Journal of India. The Unit SNA Advisor is responsible to see that as soon as a Nurse has graduated, she is given an SNA-to-TNAI from for membership in the TNAI. This form should be signed by the Nursing head of the training institution/Nursing Superintendent and sent to the Secretary of the TNAI before the nurse leaves her training school. Any change of address should be forwarded at once to the Secretary, Secretary, TNAI, including TNAI membership number and the date of enrolment. Any change of address should be forwarded at once to the Secretary, Secretary, TNAI indicating TNAI membership number and the date of enrolment. The SNA Advisor should explain the advantages gained by Student Nurses who join the TNAI directly when they pass their final examination. Students who join within six months of the declaration of the final year examination successful results shall be eligible for the concessional rate of subscription as prescribed by the TNAI Council from time to time.

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