NORMS Norms are standards that guide, control and regukte individuak and communities, For phming nursing mnpower we have to follow some norms, The nursing norms are recommended by various comnitiees, such as; the Nursing Man Power Commitee, the High power Commitiee, Dr Bajaj Committee, and the staff inspection commitee, TNAL and INC. The norms has been recommended taking ino account the workload projected in the wards and the other areas of the ‘hospital 1, Nome of Staffing (SIU- Staff Inspection Unit) All the abow committees and the staif inspection unit recommended the norms for optimum nurse-patient ratio such as 1:3 for Non Teaching Hospital and 1:5 for the Teaching Hospital. The Staff Inspection Unit (S..U.) is the unit which has recommended the nursing norms in the year 1991-92. As per this $.L.U. nom the present nuse-patient ratio is based and practiced in all central gowernment ‘hospital. Recommendations: of S. 1, ‘The norm has been recommended taking into account the workload projected in the wards and the other areas of the hospital 2. The posts of nursing sisters and staff nurses have been clubbed together for calculating the staff entidement for performing nursing care work which the staff muse will contine to perform even affer she is promoted to the existing scale of mrsing sister Out of the entitlement worked out on the basis of the norms, 30% posts may be sanctioned as nursing sister. This woukl further improve the existing ratio of 1 musing sister to 3.6. Staif nurses fixed by the government in settlement with the Delhi nurse union in my 1990. 4, The assitant nursing superintendents are recommended in the ratio of | ANS to every 45 nursing sisters. The ANS will perform the duty presently performed by nursing sisters and perform duty in shift also, 5. The posts of Deputy Nursing Superintendent nny contime at the kvel of 1 DNS per every 7.5 ANS 6. There will be a post of Nursing Superintendert for every hospial having 250 or beds. ‘There will be a post of | Chief Nursing Officer for every hosptal having 500-or nore beds, 8. It & recommended that 45% posts added for the area of 365 days working inchuding 10% kave reserve (maternity Fave, eamed leave, and days off as nurses are emtied for 8 days off per month and 3National Holidays per year when doing 3 shift duties). ~ Most of the hospital today is following the S.LU. norms. In this the post of the Nursing Sisters and the Staff Nurses has been clubbed together and the work of the ward sister is remained same as staff murse even after promotion The Assistant Nursing Superintendent and the Deputy Nursing Superintendent hhave to do the duty of one category below of their rank.‘The Nurse-patient Ratio as per the $.LU. Norms 1. General Wards 1 Staif Nuse/Nusing Sister for every 6 beds (1:6) 2. Special Ward 1 Staif Nuse/Nusing Skier for every 4 i Pediatrics, beds (14) ii, Burns, iii, Neuro surgery, ix. Cardio thoracic, v. Neuro medicine, vi Nursing hone. vii, Spinal injury, viii, Emergency wards attached wo causal 3. Nursery 1 Staif Nuse/Nusing Sister for every 2 beds (12) 4. ICUNCCUACCR Nephwlogy 1 Staff Nuse/Nusing Siter for every | beds (1:1) 5. Labour Room 1 Staff Nurse/Nursing Sister for every bour table (1:1) 6 OF. 2 Suit NurseWNursng Sister for every Major functional operation tabk including Minor recovery room (2:1) 1 Staff Nurse/Nursing Sister for every functional operation tab (1:1) 7. Casualty i Casuahy (Main) 3 Staff Nuses/Nursing Sister for 24 Attendance up to 100 patients per day. | hours, ie. Isl per shift Thereafter for every additional | | Staff Nurse/Nursing Sister attendance of 35 patients per day ii, Bums Attendance up to 15 patients per day, | 3 Staff NuseyNursing Sister for 24 ‘Thereatter for every additional | hours. ic. 1:1 per shift attendance of 10 patients. per day 1 Staff Nurse/Nursing Sister ii, Onhopaedies 3 Staff NusevNursing Sister for 24 Attendance up to 45 patients per day. | hours, ie. Isl per shift Trereater for every additional | 1 gist? Nurse/Nursing Sister aliendance of 15 patients perday iv. Gynaey Obstetric For every additional attendance of 15 Attendance up to 45 patients per day. | Patients per day ‘Thereafter for every —_ additional | | Staff Nurse/Nursing Sister attendance of 15 patients_per da 8% O.P.D. (Injection wom) Attendance up to 100 patients. per day 1 Staff Nurse Attendance up 10 120-220 patients perday | 5 gut Nurses Attendance up 1 221-320 patients perday | 5 Anendance up to 321-420 patieas perday | 4 aa s ‘9, Name of Department oPpDi Bbod bank bod ii. Paediatric 2 ii Immunization work 2 iv, Eye 1 v. ENT vol vi Pre anaesthetic vol vii, Cardiac bb vii, 1 viii, Bronchoscopy lab vii, 1 ix Vaccination anti rabis, mo x Family planning me 2 xi Medical xi xii, Surgie xi xii, Dental xii, 1 xiv. Central sample collection centre xix, 1 xv. Orthopaedic xv. 2 xvi Gynae xvi 2 xvii, Obstetrics xvii, 3 xviii, Skin xviii, 2 xix VD centre xix 2 xx Chemotherapy xx 2 xxi Neurology xxi 1 xxii, Microbiology infection comrol xxii, 2 xxiii, Psychiatry xxiii, 1 xxi. Burns xxiv, 2 In addition to the 10% reserve as per the existent mules, 45% posts may be added for offs also where services are provided for 365 days in a year 24 hours. ‘The _Nurse-patient Ratio as per the norms of TNAI and INC (The Indian Nursing Council, 1985) ‘The norms are based on Hospital Beds. ankeDe meen Chief Nusing Offer 21 per 500 beds Nursing Superintendent I per 400 beds or above DNS Al per 300 beds and 1 additional for every 200 beds ANS, il for 100-150 beds or 3-4 wards: Ward Sister 2] for 25-30 beds or one ward. 30% kave reserve Staff Nurse Al for 3 beds in Teaching Hospital in general ward& 1 for 5 beds in Non-teaching, Hospital +30% Leave reserve Extra Nursing staff to be provided for departmental research fiction For OPD and Emergency I staff rurse for 100 patients (1 : 100 ) + 30% kave resene For Intensive Care unit (LC.U.): 14 or (1:3 for each shift ) +30% kave reserve. 0. Itis suggested that for 250 beded hospital there should be One Infection Control Nurse (ICN). For specialised depertments, such as Operation Theatre, Labour Room, ete, 125 +30% lave reserve.3, High Power Committee on Nursing And Nursing Profession (1987-1989) High power committee on nursing and nursing profession was set up by the Government of India in July 1987, under the chaitmanship of Dr. Jyothi former vice-chancellor of SNDT Women University, Mrs. Rajkumari Sood, Nursing Advisor to Union Government as the memiber-secretary and CPB Kunwp, Principal, Govemment College of Nursing, Bangalore and the then President, TNAL is ako one among the prominent members of this committee, Later on the committee was headed by Sant Sarojini Varadappan, former Chairman of Central Social Welfare Board ‘The terms of reference of the Committee are 1. To bok into the existing working conditions of muses with partcukir reference to the status of the nursing care services both in the rural and urban areas. 2. To study and recommend the staffing norms necessary for providing adequate mursin personnel to give the best possible care, both in the hnspitals and community. 3. To bok into the taining of all categories and level of nursing, midwifery persomel to meet the nursing manpower needs atall kvels o health services amd education 4. To stuly and chirify the rok of nursing persomel in the health care delivery system including their imeraction with other members of the heath team at every vel of health service management, 5. To examine the need for orginked nursing services at the mtional, state, district and local kveb with particular reference to the need for phnning service with the overall health care system of the country at the respective levebs. 6. To bok into all other aspects, the Committee will hold consubations with the State Governments, Recommendations of High Power Committee_on Nursing and Nursing Profession Working conditions of nursing persoun el 1, Employment: Uniformity in employmem procedures to be made. Recruitment rules are made for all categories of nursing posts. The qualifications and experience required or these be made thought the country. 2. Job description: Job description of all categories of nursing personnel is prepared by the central government to provide guidelines. 3. Working hours: The weekly working hours should be reduced to 40 hrs per week. Straight shift should be implemented in all states, Extra working hours to be compensated either by kave or by extra emobmeris depending on the state policy. Nurses to be given weekly day off and all the gazetted holidays as perthe government rubs 4. Work load/ working facilities @ ‘Nursing norms for patient care and comnumiy care to be adopted as recommended by the committee. ® Hospitak to develop central sterile supply departments, central linen services, and central drug supply system Group D employees are responsible for housekeeping department, © Policies for breakage and bosses to be developed and nurses not are made responsible: for breakage and losses.5. Pay and allowances: Uniévmity of pay scales of all categories of nursing personnel is not easbk. Howevwr special allowance for nursing persomel ie.: uniform allowance, washing, mess allowance ete should be uniform throughout. the country 6. Pronptional opportunities: The committee recommends that along with education and experience, there is a need to increase the number of posts in the supervisory cadre, and for making provision of guidance and supervision during evening and night shifis in the hospital @ Each nurse must have 3 promotions during the service period ® Promotion is based on merit cum seniority. @ Promotion to the senior most administrative teaching posts is made only by open selection ® Incases of stagnation, selection grade and ruming scaks tobe given 7. Career development: Provision of deputation for higher studies afler 5 yrs of regular services is made by all states. The policy of giving deputation to 5 -10 % of each category be worked out by each state. %. Accommodation: As far as possible, the mrsing staff should be considered for priority alloument of accommodation near to work pkice. Apartment type of accommodation is buit’ where marred/iunmaried nurses can be allnwed to live. Housing colonies for hospital s must be considered in long run, 9, Transport: During odd hours, calamities ete amangements for transport must be made for safety and security of nursing persomel 10, Special incentives: Scheme of special incentives in terms of awards, special incremem for meritorious work for nurses working. in each stateddistric PHC to be worked out 11, Occupational hazards: Medical facilties as provided by the central govt, by extended by the state govt to nursing personnel till such times medical services are provided free to all the nursing personnel, Risk allowance 10 be paid to nursing personnel working in the rural $ urban area, 12, Other welfare services: Hospitals should provide welfare measures ike créche fuilities for cchikiren of working staff; chiklren education allowance, as granted to other employees, be paid to nursing personnel Additional Facilities for Nurses Working In the Rural Areas > Family accommodation atsub centre is a must for safety and security of ANM's /LHY. > Women aitendant, sekcted fiom the vilkge must accompany the ANM for visits to other villages. > The distict public heath nurse is provided with a vehicle for fieli supervision. > Fixed travel allowance with provision of enhancement from time to time > Rural allowance as granted to other empbyees. is paid to nursing. personnel Nursing Education Nursing education to be fitted into: national stream of education 10 bring about uniformity, recognition and standards of nursing education. The committee recommends that; 1, There should be 2 levels of nursing personnel - professional nurse (degree kvel) and auxiiary nurse (vocational nurse). Admission to professional nursing should be with 12 yrs of schooling with science, The duration of course should be 4 yrs at the university level. Admission to vocationall fauxikary nursing shoul! be with 10 yrs of schooling The dur be 2 yrs in health relted vocational stream. n of course shouldAll school of nursing attacked to medical colege hospia is upgraded to degree kvel ina phased manner AILANM schook and school of nursing attached to district hospital be afiliated with senior secondary boards. Post certificate B.Sc. Nursing degree to be continued to give opportunities to the existin diploma nurses to continue bigher education. Master in nusing programme tobe increased and strengthened, Doctoral programme in nursing have to be started in selected universities. Central assistance be provided for all kvek of nursing education institutions in terms of budget( capital and recurring) Up gradation of degree evel institutions be made in a phased manner as suggested in report. Each school shoul have separate budget till such time is phased to degree/vocational progamme. The principal of the school should be the drawing and the disbursing officer Nursing personnel should have a compte say in matters of selection of studerts. Selection is based completely on merit. Aptitude test is introduced for selection of candidates. All schools to have adequate budget for ibraries and teaching equipments, All schools to have independent teaching block called as School OF Nursing with adequate class room facilities, Hbrary room, common room etc as per the requirements of INC Continuing Education and Staff Development ARK KS Definite policies of deputing 5-10% of staff for higher studies are made by each state Provision for training reserve is made in each institution. Deputation for higher study is made compulsory after 5 yrs. Each nursing persone! must attend 1or2 refresher couse every year. Necessary budgetary provision is made. A National Instinnte for Nursing Education Research and Training needs to be established ike NCERT, for development of educational technobgy, preparation of textbooks, media, /manuals for nursing, Nursing Services: Hospitals/Institutions (Urban Areas) Definite nursing policies regan ng nursing practice are avalible in each inaiution ‘These policies inchude : a) Quulificatio wrecruitment rus b)Job deseription/job specifications ¢) Organizational chart of the institutions 4) Nursing care slandards for different categories of patients. 1 2 Staffing of the hospitals should be as per noms. recommended. District bospia oon teaching hospital may appoint professional leaching murses in the ratio of 1; 3.as soon as muses start qualifying from these institutions. Students not to be counted for staffing in the hospitals Adequate supples and equipments, drugs ete be made available for practice of nursing. The committee strongly recommends that minimum standards of basic equipmem needed for each patient be studied , noms bid down and provided to enabk nurses to perform some of the basic nursing functions . Abo there shoul be a separate budget head for nursing equipment‘and supplies in each hospitalY PHC. The NS and PHN shoul! be a member of the purchase and condemnation committee. 5. Nurses to be relieved fiom non -nursing duties. Duty station for nurses. is provided in each ward. 7. Necessary facilities like central sterile supplies, linen, drugs are considered for all major hospitals to improve patient care. Abo nurses shoukl mot be made to pay for breakage and losses. All hospitals should have some systems for regukir assessment of Insses. 8. Provision of part time jobs for married nurses to be considered. (min 16-20hrs/veek) 9. Re-entry by married nurses at the age of 35 or above may also be considered and such nurse be given induction courses for updating their knowledge and skills before employment. 10. Nurses in senior positions ike ward sisters, Asst. nursing superintendents, Deputy NS; N.S must have courses in munagement and administration before promotions. 11, Nurses working in speciality areas must hae courses in specialites. Promotion opportunities for clinical spectalties like adminktrathe posts are comidered for improving quality nursing services. a 12. The commitice recommends that Gazetted ranks be allowed for nurses working as ward sister and above (mininum class I gazetted), Similarly the post of Heath Supervisor (female) is medical) heath officers. Community Nursing Services a. « 4. Appointment of ANM/LHV to be recommended. 1 ANM for 2500 popubtion (2 per sub centre) 1 ANM for 1500 popubtion for hilly areas health supervisor for 7500 population (for supervision of 3 ANM's) 1 public health muse for 1 PHC (30000 population to supervise 4 Health Supervisors) 1 Publ Healh Nursing Officer for 100000 popubtions (community health centre) district public health nursing for each district ANM/LHY promoted to supervisory posts must undergo courses in administration and manageme nt Specific standing orders are made available for each ANM/LHV to function effectively im the field. Adequate provision of supplies, drugs etc are made. eeeeee Norms recommended for nursing service and education in hospital setting. Nursing Superintendent -1:200 beds (hospitals with 200 or more beds), Deputy Nursing Superintendent. - 1:300 beds (wherever beds are over 200) ‘Assistant Nursing Superintendent - 1: 100 Ward sistenfward supervisor ~ 1:25 beds 304% leave reserve Staff murse for wards -13 (or 19 for each shift ) 30% leave tesene For muses OPD and emergency etc - 1: 100 patients ( 1 bed : 5 out patients) 30% ave reserve For ICU -1:l{or 1:3 for each shift) 30% ave reserve For specialized departments such as operation theatre, libour room ete- 1: 25 30% leave reserve. Pane