Institute of Liver and Biliary Sciences

COLLEGE OF NURSING

PANEL DISCUSSION
Topic: Nursing regulatory mechanism

Subject: Nursing management

Submitted to Submitted by

Dr. Sunita Srivastava Pema Chukla

Reader, M.Sc. Nursing 2nd Year

College of nursing College of nursing

ILBS, Vasant Kunj ILBS, Vasant Kunj

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Introduction
Regulatory system is a system that provides enrichment of care through improved standards of
education, for the development of practice and for the creation of codes of conduct and ethics. It
is compared with the cardiovascular system of the body. As human cardiovascular system is vital
to life, a nursing regulatory system is also concerened with the lifeblood of the profession and its
destiny. In India, nursing profession has established its regulatory system through regulatory
bodies.

Regulatory body
A professional association (also called a professional body, professional organization, or
professional society) is usually a non-profit organization seeking to further a particular
profession, the interests of individuals engaged in that profession and the public interest.

Professional body
DEFINITION

"A group of people in a learned occupation who are entrusted with maintaining control or
oversight of the legitimate practice of the occupation;" also a body acting "to safeguard the
public interest;" organizations which "represent the interest of the professional practitioners," and
so "act to maintain their own privileged and powerful position as a controlling body."

UNION

MEANING

A union or labor organization is any organization in which employees participate for the
purpose of dealing with their employer about grievances, labour disagreements,wages,hours of
work, and conditions of employment.

PROFESSIONAL ORGANIZATIONS AT CENTRE LEVEL

TRAINED NURSES ASSOCIATION OF INDIA (TNAI)

INTERNATIONAL COUNCIL FOR NURSES (ICN)

THE COMMONWEALTH NURSES FEDERATION

THE INDIAN NURSING COUNCIL (INC)

THE RED CROSS SOCIETY

WORLD HEALTH ORGANISATION (WHO)

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AT STATE LEVEL

THE STUDENT NURSES ASSOCIATION (SNA)

THE NURSES LEAGUE OF CHRISTIAN MEDICAL ASSOCIATION

THE CHRISTIAN MEDICAL ASSOCIATION OF INDIA

TRAINED NURSES ASSOCIATION OF INDIA (TNAI)

The Trained nurses association of India is a national professional association of Nurses. The
present name and organization were established in 1922.

Aims

Upgrading.

Development and standardization of nursing education.

Improvement of living and working condition for nurses in India.

Registration for qualified nurses.

ACTIVITIES

TNAI gives scholarships for nurses who wish to go on for advanced study either here or abroad.

It helped to remove discrimination against male nurses.

Initiated much needed study and improvement of economic conditions for nurses.

The TNAI opposes strikes unless all other means of negotiating have failed to bring about
satisfactory working conditions.

INTERNATIONAL COUNCIL FOR NURSES (ICN) It was formed in 1899. It’s an

international association for all nurses in the world. Great emphasis has been on non-
discrimination.

OBJECTIVES

Promote the development of strong national nurses associations.

Assist national nurses association to improve the standards of nursing and the competence of
nurses.

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 Assist national nurses associations to improve the status of nurses within their countries.

Serve as the authoritative voice for nurses and nursing internationally.

ACTIVITIES

Makes policy statements on health and social issues.

Offers a great variety of seminars

Maintaining and improving the status of Nursing around the world

STANDARD AND PRACTICE DEVELOPED BY INTERNATIONAL COUNCIL OF

NURSES, 1949

The INC act,is the only national legislation directly related to nursing practice

FUNDAMENTAL DUTIES

 To exercise a reasonable degree of skill and knowledge in treating patient.

 Owns a relationship to a patient has been established

 A practitioner must give personal attention to his case and answer calls

 Children must be protected from harming themselves

 Special precaution must be taken in case of adults who are incapable to take care of
themselves.

 Dangerous diseases must be reported.

THE COMMONWEALTH NURSES FEDERATION

The Commonwealth Nurses Federation was formally organized in 1973 and operates in Six
regions of the world which are East, Africa, Atlantic, Australia, Pacific, South Asia and Europe.

The TNAI is also affiliated with the Commonwealth Nurses Federation .It is made up of nurses
associations from commonwealth countries.

AIMS
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 Promote sharing, better communications and closer relationships between its member
associations.

Provides expert professional advice.

Scholarships for advanced study.

Financial assistance for professional meetings and seminars.

THE INDIAN NURSING COUNCIL (INC)

The Indian Nursing Council, which was authorized by the Indian Nursing Council Act of 1947,
was established in 1949.

PURPOSE

Providing uniform standards in Nursing education and reciprocity in Nursing Registration

throughout the country.

RESPONSIBILITIES

Prescribes curricula for nursing education in all the states.

Refuses or Recognizes Programmes of Nursing Education according to standards required.

Support high standards in Nursing.

Providing registration for foreign nurses.

Maintenance of the Indian Nurses Register. This register contains the names of all nurses,
midwives, auxiliary nurse midwives who are enrolled on all state registers.

STANDARD BY THE INC

 The council has in the framework- For post- registration nursing practice education (May
2001) provides the framework on which particular competencies for a defined specially
area.
 It defined as specially nursing practice is the exercise of highly improving the quality of
professional service.
 Standard must be evidence based.
 Must use standards to evaluate their practice

THE WORLD HEALTH ORGANISATION

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 The world health organisation, commonly called the WHO is also a specialized agency of the
United Nations. It was organized in 1948 for the purpose of helping to achieve the highest
possible level of health for all people

The WHO has been active in nursing education and practice in a number of ways in India. It
has offered guidance in setting up programmes of Nursing Education. The WHO promotes
public health in many ways around the world. It is currently known for the declaration of
working towards “Health for all by 2000 AD”. This declaration has given a tremendous push to
developing primary health care and recognizing the very essential role of nursing in health care
system.

STATE NURSING COUNCIL (SNC)

The state nurses and midwives council was established in 1948 under the provisions of nurses
and midwives act with the purpose of “better training of nurses, midwives & health visitors. It
works as an autonomous body under the government of respective states , department of health
and family welfare.

Registration in state nursing council is very necessary for every nurse. It is necessary to be
registered in order to function officially as a professional nurse. Registration councils are
functioning in all the states of India and they are affiliated to I.N.C.

Power of the state registration council

The state registration councils are autonomous to a great extent except that powers to prescribe
regulations and syllabus for the various training courses, to recognize examining bodies.

COUNCIL MEMBERS

1. President (Director of state health service)

2. Vice president
3. Other member ( 4 Nursing suprintendtent,2 RN,1RM.1Health visitors)

FUNCTIONS OF STATE REGISTRATION COUNCIL

 To inspect school of nursing in their state.

 To conduct examination for GNM & ANM courses.
 To prescribe rules of conduct, take disciplinary actions.
 Registration of nurses & midwives & other.
 Maintenance of register of nurses, Midwives & other.
 To renew registration & upgrade registration.

Registration:

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- A register is maintained by each state registration council. This registration is very important as
regards to its purposes.

- Registration system helps to maintain the high standards amongst the professional nurses.

- It serves as the legal protection to the nurse and also to the public.

- The nursing council exerts official control of standards of nursing through the registration system.

Procedure for registration

1. The institution where the student nurse has received education initiates the registration
process.

2. The SNC issue diploma to the nurse. After that the application for registration is filled
through a form.

3. This form has to be sending to the registrar with the required process fee & a copy of
diploma with the registration process, the name of the nurse is entered in the state register
maintained in the council.

4. Registration certificate is issued to the nurse.

THE STUDENT NURSES ASSOCIATION (SNA)

The Student Nurses Association organized in 1920, is associated with and under jurisdiction of
the TNAI. In addition to providing a means of personal and professional development for the
nursing student. The assistant secretary of the TNAI serves as advisor for the SNA.

PURPOSES AND FUNCTIONS

Help student Nurses learn how the professional organisation serves to uphold the dignity and
ideals of the nursing profession.

Promote a close rapport with other student Nurses.

Furnish student Nurses advice in their courses of study leading up to professional qualifications.

Encourages leadership ability and help students to gain a wide knowledge of the nursing
profession in all of its different branches.

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 Encourage both professional and recreational meetings, Games and Sports.

Encourage students nurses develop a co-operative spirit with other student nurses which will
help them in future professional relationships.

ACTIVITIES

Fund raising for the TNAI.

Fund raising done for fine arts and sports competitions and conferences.

Special prizes given for outstanding achievement in specific areas of nursing education.

Unit activities include maintaining the diary of unit activities, giving quarterly reports, preparing
articles for publication and distributing application forms for membership in the TNAI.

THE NURSES LEAGUE OF THE CHRITIAN MEDICAL ASSOCIATION

The Nurses league of the clinical medical association of India was founded in 1930. It became
affiliated to the TNAI in 1936 and promotes membership in this organisation.

OBJECTIVES

Promote cooperation and encouragement among Christian Nurses.

Promote efficiency in nursing education and service.

Secure the highest standards possible in Christian nursing education through the Christian
schools of nursing.

Considering the special work and problems of Christian nurses wherever employed.

ACTIVITIES

Activities include national and area conferences and retreats for its members. Development of
leadership abilities is encouraged by participation in these meetings.

Each meeting also allows for sharing of problems common to the Christian

nurse. Provides expert professional advice.

Provides scholarships for advanced study.

Provides financial assistance for professional meetings and seminars

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THE CHRISTIAN MEDICAL ASSOCIATION OF INDIA

The CMAI began in 1905 as a fellowship of Christian missionary doctors to provide spiritual
sharing and support. It gradually developed into a larger organisation which included other
Christian health professionals and health institutions

FUNCTIONS

To provide professional training through formal and informal education, publication of

textbooks and other materials and scholarships.

To encourage community health work through training, advisory services and technical support.

To assist and support churches and health institutions with study and training. To disperse
health related information which will help with health education and lean towards a more healthy
and just society.

UNIONS

OBJECTIVES OF UNIONS

Wages

Promotions

Layoffs

Discipline

Grievances procedures

Fringe benefits

UNIONS IN INDIA

At present three unions of nurses are working at the central level.

1. All India Government Nurses Federation (AIGNF)-

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1980’s had achieved many milestones in Indian Nursing history like formation of Delhi Nurses
Union, High Power Committee for Nursing Profession and formation of All India Government
Nurses Federation.

There was a felt need among the nursing leaders to unite all the nurses and to bring the reform in
the nursing profession. Leaders from Rajasthan and Uttar Pradesh took initiative to meet all the
leaders from different states and called for a conference in May 1988 at Delhi and formed All
India Government Nurses Federation (AIGNF). A Head quarter is located at
Dr.RamManoharLohia Hospital, New Delhi.

Vision

 To unite all categories of nursing professionals under one umbrella.

 To build a platform for the members to express their concern.
 To strengthen the nurses to stand for their rights.

Mission

 To update the nurses with the issues and trends in the profession.
 To capacitate nurses potentials to realize their rights and stand for that.

2. Trained Nurses Association of India (TNAI)-

It is the national professional association of nurses.It was founded in 1905 at Lucknow.The

organisation composed of nine European nurses holding administrative posts in hospitals.They
want to develop nursing as a profession and also help the professional nurses meet and plan to
achieve these ends

OBJECTIVES

□ Uphold the dignity and honour of nursing profession.

□ Promote a sense of spirit de- corps among all nurses profession.

To provide registration for qualified nurses and to provide opportunity of registration within
different states in the country and within different countries.

To upgrade and develop the nursing education.

□To improve the living and working conditions of the nurses and also develop the educational
conditions available for nursing.To improve the economic standards of nurses in India.

Besides, there are state level unions, namely,

1. United nurse association (UNA)

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UNITED NURSES ASSOCIATION (UNA)

It is a professional association of registered nurses in the state of Kerala in India. It was

founded on November 2011 by a small group of nurses in Kerala with Jasminsha as the founding
president. The UNA was mostly noted for bringing up the issue of exploitation of nurses as
underpaid laborers in the thriving private hospital industry in the state. Since 2012 lasts, UNA
working as a trade union with the help of no political parties and not receiving any benefits from
them.

ACCREDATION
Accreditation is the mark of quality given , after evaluation , by an external body . The
dictionary meaning of this term is an official recognition , general acceptance and assurance of
quality and certificate of meeting all the requirements . Generally the meaning of accreditatio’ to
trust ' , ‘to give authority to ' , ' to give credit to’ is accepted .

Accreditation is a process in which certification of competency authority , or credibility is

presented . It is a voluntary proce whereby its standards are usually regarded as optimal are
achievable .

Definition

According to Selden

“Accrediting is the process whereby an organization agency recognizes a college or

university or a program of study as having met certain predetermined
qualifications and standard”.

Accreditation refers to a voluntary review process of educational programs by a professional

organization.

Needs and Objective

▪ Up-gradation

▪ Improve patient satisfaction

▪ Recognition of institution

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 ▪ Offer Advice

Purposes

■ Administration requirements

■ Uniform standards of nursing education,

■ Institutional self-improvement by evaluation and inspection.

■ Safeguard the institution from social, educational and political pressure.

■ Prescribe syllabus

■ Grant recognition

■ Inspection

■ Improve the quality of nursing education

Functions

■ Protect the autonomy of health service programme

■ Preserves the quality of nursing education

■ Protects the public from ill-prepared nurses

■ Protects the institution from political pressure

■ helps the practioner for the ever expanding or the broad scope of nursing practices

Advantages

■ Statutory power to punish the wrong doers

■ Maintain the standards education

Disadvantages

■ Time consuming process

■ Expensive

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Classification
Accrediting Agencies in Higher Education

■ National accrediting agency.

■ National professional accreditingagency

■ State accrediting bodies.

1. National accrediting agency

▪ Concerned with appraising the total of institution of higher learning and safeguarding
the quality of education

▪ Each agency establishes criteria for the evaluation of the institution and it publishes
from time to time a list of those agencies which it has accredited

 Indian Education and training council

 Central advisory board of education
 All India council for elementary education
 All India council for secondary education
 University grants commission
 All India council for technical education
 National assessment and accreditation council.

2. National professional accrediting agency

■ Professional accrediting is supported by state license laws.

In the field of health All nationalprofessional accreditingagencies, have

existed:

■ Medical council of India

■ Indian nursing council

■ Dental council of India

■ Pharmacy council of India

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State accrediting agency

State universities commissions and other agency are authorized in some state to evaluate college,
to give initial approval to institutions to higher learning to formulate standards, to issue licenses
and to have various other responsibilities.

Process of accreditation

■ Applying for the institution to be accredited.

■ Preparing a report by the institutional head according to the criteria and format sent by
the accrediting agency.

■ Visit to the site by the inspector appoint by the accrediting agency to verify the self
study report.

■ Preparing a report by the visitors.

■ Report made by the visitors along with the institutional report is sent to the review board
of council.

■ The board of review on the basis of all data and reports makes the final decisions
whether accreditation should be granted or not.

Stages in accredation process

 Health Check
 Application
 Inspection
 Inspection day
 Ratification
 Report and recommendations
 Accredation awarded

Hospital accreditation process

The accreditation program covers all aspects of an organization’s operations and standards apply
to hospitals (public or private, small or large), nursing homes, community health services, day
procedure facilities and home and community nursing agencies: There are five steps in the
accredation process as given below:

 Application submission

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  Hospital questionnaire
 Self assessment
 On- site assessment
 Commission review

The Indian Nursing Council and accreditation

Objectives

 To assess and accredit institutions

 To assist them to improve the quality of education
 Criteria for evaluating programme
 To define standards for nuring institutions
 To update the curriculum
 To have periodical inspections

Process of accreditation for the nursing institution by INC

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Criteria for assessment

 Philosophy and purpose of the programme should be clearly stated and periodically
reviewed.
 Organization and administration: Governing body . controlling body , policies and
committees , organization chart , budget fees and other charges
 Faculty : Staffing norms for number , qualification , selection appointment promotion ,
salary scale , welfare , teaching load faculty development
 Physical facility: Building , should be separate , affiliated hospital , area : 23720 square
feet with annual admission capacity of 60 students , classroom , laboratories including
computer lab , auditorium , multipurpose hall , common room staff room , principal room

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 , vice principal room , audio visual aids room , library , offices for faculty and other staff ,
record room , store room , rooms for audio visual aids Examination hall , Other facilities -
drinking water , toilet , transport , clinica facilities , hospital type , bed strength , staffing ,
community health nursing field practice area , specialty areas
 Hostel facilities : Hostel rooms , toilets & bathrooms , recreation rooms , visitor's room ,
kitchen and dinning room , pantry washing and ironing room , sick room , guest room ,
warde room , staff for hostel
 Accommodation to the staff in the campus , crèche facility, Canteen
 Student Number of seats , admission strength , admission terms and conditions , admission
/ selection committee , heal services , vocation / holidays , training programme ,
curriculum syllabus , plans , course , unit , clinical , method of teaching lear ning
experiences , method of evaluation , records of student student results
 Material and financial management , as per norms.

Inspections

The inspection of various programmes are done by INC as follow:

 First inspection
 Re-inspection
 Periodic inspection
 Inspection for enhancement of seats

First inspection

The first inspection is initiated after getting the proposal along with the application from the
concerned institute by Indian Nursing Council . The institute is required to submit the following
with the proposal:

 Permission letter by state government / essentiality certificate of the respective state

government , duly attested by notary
 Duly attested registration certificate of society or trust deed
 A bank draft for Rs . 25,000 / - towards first inspection fee for School of nursing in
favour of secretary , Indian Nursing Council , New Delhi ( ANM , GNM , Post Basic
Diploma Course ) of a bank draft for Rs . 50,000 / - towards first inspection fee for
College of nursing in favour of Secretary , Indian Nursing Council , New Delhi
( P.B.B.Sc. ( N ) , B.Sc. ( N ) , M.Sc. ( N ) , M. Phil ( N ) , Ph.D ( N ) ) . The inspection
fee may be revised time to time
 Consent letter from the university only for starting college of nursing.
 Proposal for starting school of nursing college of nursing , which includes in detail
teaching , clinical & physical facility including budget .

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Reinspection
After the first inspection carried out by the INC inspectors and finally considered by INC , if
found deficient as per the requirement , the institution is informed according to strengthen or
improve upon the deficient areas . For the request for re inspection or for approval ; the
institution is required to submit the compliance report with documentary proof as per the report
given on first inspection along with the prescribed fees for consideration

Periodical Inspection
As per INC requirement , it conducts periodical inspections usually after 3 years for granting the
approval on payment basis every year. The approval is granted after it fulfills the norms/
requirement.

Inspection for enhancement of seats

For the enhancement of seats the institution is required to submit the proposal along with the fees
for conduction of inspection. Usually the inspection is conducted after one year from the last
inspection conducted subject to the condition that the students are admitted.

Accreditation of hospitals

Accreditation is not new to the health system . The first initiative towards accreditation was
taken in the United States of America as early as 1910. Over a period of time after several
experiments
, the Joint Commission on Accreditation of Healthcare Organization ( JCAHO ) , a national
accreditation programme , established itself as an esteemed accreditation body by 1987 JCAHO
has high standards of quality assurance and rigorous process of evaluation , which makes it a
much
- esteemed agency for accreditation . Health services certified by JCAHO are given deemed
status A decade ago , accreditation was the concern in American process , but it has also been
widespread in Central and South America and Eastern Europe and now has moved into the
European Union as a part of the Bologna Process . In India , the issue of accreditation of
hospitals has been taken up seriously at the local and national level since 1986 .

Umbrella Organizations
The International Society for Quality in Health Care ( ISQua ): It is an umbrella organization for
such organizations providing international health care accreditation. Its offices are based in the
republic of Ireland.

The United Kingdom Accreditation forum or UKAF

It is a UK- based umbrella organization providing healthcare accreditation. Its offices are based
in London.
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The Society for International Healthcare Accreditation or SOFIHA
It is an organization devoted towards the development and promulgation of high –quality
accreditation of hospitals and healthcare facilities across international borders. SOFIHA is baed
in Sheffield, UK.

NATIONAL ACCREDITATION BOARD FOR HOSPITALS AND HEALTH CARE

PROVIDERS (NABH) AND QUALITY CONTROL OF INDIA (QCI)

Introduction

NABH is a constituent or comes under the purview of board of Quality Council of India, set up
with cooperation of Ministry of Health and Family Welfare , Government of India and the health
industry.

Aim
To establish and operate accreditation programme for healthcare organization

Composition
The board is structured to cater to much desired needs of the consumers and to set benchmarks
for progress of health industry The board while being supported by all stakeholders including
industry
, consumers , government , has full functional autonomy in its operation . It is an institutional
member of International society for Quality in Health Care ( ISQua ) . It has Accreditation
Committee , Technical Committee , Appeal Committee , Secretariat and a panel over 100
assessors surveyors selected among clinicians , hospital administrators and nursing supervisors .
They have been empanelled after having qualified through a five days training programme .

Focus
The main focus is on patient rights & benefits , patient safety control & prevention of infections
in hospitals , practicing good patient care protocols e.g. special care for vulnerable groups ,
critically ill patients and better and controlled clinical outcome and at the same time are
benchmarked with the best International standards .

Activities
Currently it accredits hospitals & nursing homes , and is expected to accredit Blood Banks ,
Diagnostic Centres ( Imaging ) , Dental Centres and Ayurvedic Hospitals . Clinics in future

NABH Accreditation Hospitals

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B.M. Birla Heart Research Centre , Kolkata : MIMS Hospital ( MIMS Ltd. ) . Calicut ; Kerala
Institute of Medical Science Thiruvananthapuram , Max Super Speciality Hospital , New Delhi ;
Max Devki Devi Heart & Vascular Institute , New Delhi : Moolchand hospital, New Delhi;
Narayana Hrudayalaya, Bangalore; Columbia Asia Medical Centre and about 45 hospitals have
further applied for NABH certification.

LICENSURE/REGISTRATION
Licensure is defined as the “process by which an agency of state government grant permission to
an individual to engage in a given profession upon finding that the applicant has attained the
essential degree of competency necessary to perform a unique scope of practice”(NCSBN,2004).

A document issued by a body charged with the exclusive right to determine eligibility for
practice in a specified profession, or field in the profession. It is generally used within a
regulatory system that prohibits practice without a license.

Purpose

o Licensure offers protection to the public

o It ensure minimum competency among professional.
o It ensures minimum standard among the professionals.
o It help to prevent malpractice.
o It helps to regulate the professional conduct.
o Licensing permits a person to offer special skills and knowledge to the public in a
particular jurisdiction when such practice would otherwise be unlawful. A particular
jurisdiction or area is covered by the license.
o In India all nurses are required to be licensed to work in any part of the country, for that
they have to be registered in any of the state nursing council.
o All over India each state running their own nursing council.
o Registration councils are functioning in all states of India and they are affiliated to INC.

Nursing Licensure

The process, sanctioned by the law, of granting exclusive power or privilege to persons meeting
established standards, which allows them to engage in a given occupation or profession, and to
use a specific title.-ICN

Current licensure activities

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 o Nurses are required to apply for licensure in each state in which they practice
o Nurses will be responsible for following the laws and regulations of those states

Components of nursing practice acts

o Two essential components

1. To protecting the health and safety of the public

2. Protection of the title of RN

o Nursing practice act describes the requirements for licensure

o Registered nurse, is reserved for those meeting the requirements to practice nursing in the
state

Renewal of licensure
 The process for periodic reissuing of the legal authority to practice.
 Renewal system in a proper way it will help to improve the professional competencies in
nursing.
 Renewal of Nursing Registration is mandatory to keep the nursing license valid. Nursing
registration is almost the same in each state. The nursing registration and renewal has to be done
from the respective nursing council of each state. In rajasthan nursing renewal is done after4
years of registration. Each candidate has to perform renewal of their license. The state nursing
council makes a rule that the nurse should renew her registration.
 The renewal is also obtained by filling an application from which is sent along with
Xerox copy of the registration certificate and necessary renewal fees.
 Renewal certificates indicate that she is still in active practice.

Professional responsibility
It is defined in terms of duty or activity assigned to an individual in an organization. It is not
merely duty but an obligation that the duty is performed. It refers to the activities which must be
performed to carry out the task assigned. Responsibility can be delegated. It moves downwards
in a hierarchy.

According to Murris B Hurley ‘Responsibility is the duty to which a person is bound by reason
of his status or task. Such responsibility implies compliance with directives of a person
making the initial delegation.’

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George and R Terry defined it ‘as the obligation of an individual to carry out assigned activities
to the best of his ability.’

It refers to execution of duties associated with nurse's particular role. A nurse who acts in a
responsible manner gains trust of patients and other professionals. She is competent in
knowledge, skills and carries out her duties within ethical guidelines of the profession.
Responsibility can be divided into two parts : ultimate responsibility and operating responsibility.

Ultimate responsibility

This the responsibility that is assigned originally for the total tasks . This cannot be delegated.

Operating Responsibility

Responsibility that is assigned by the superior who has ultimate responsibility to the subordinates
for getting the job done but if subordinates fail to perform the superior is held responsible for the
failure . According to Keith Davis " Responsibility operates somewhat like the fable of the magic
pitcher in which the water level always remains the same no matter how much water poured out’

Delegation of Responsibility in Nursing Services

Let us have a look at what all responsibilities are delegated by the superior and up to what level
the responsibilities are delegated. At the managerial level, the responsibilities in hospital nursing
services are categorized into two broad headings : administrative and supervisory . The activities
related to administration are carried out by the nurse administrators and supervisory activities by
middle level nurse administrators designated as nursing sisters / ward sisters . These
responsibilities are however are carried out by them usually in the moming hours but for evening
and night hours , these responsibilities are delegated to some extent . In most of the hospitals ,
nursing administrators work from 8 am to 2 pm or up to 4 pm in moring hours depending upon
the policy of the organization / State for timing schedule . Thereafter , nursing sisters handle the
administrative problems if arises ;otherwise routine administrative problems are solved by the
nurse administrators only . The supervisory activities are carried out by nursing sisters during
morning hours in their respective units . Though in few hospitals , these activities are carried out
by the nursing sisters during evening and night hours , but in many hospitals the responsibility is
delegated to operational level nurses.

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Accountability
Accountability is the obligation to account for , and report upon , carry out responsibility and
exercise authority as per established standards or norms , Hurley defines accountability as "
liability of reckoning of responsibilities received by delegation of authority , Robbins states
‘authority is the right to act , responsibility the obligation to carry out delegated authority ,
accountability establishes reliability for the proper discharge of the duties delegated to the
subordinate .’

Characteristics of accountability

 Accountability cannot be delegated

 Accountability of the superiors for the acts of their subordinates is absolute.
 Accountability always moves upwards in the hierarchy
 Subordinates are responsible for the completion of tasks assigned to them and are
accountable to their superior for the satisfactory performance of that work.
 Accountability is easy to establish if the standards and measures of performance are
predetermined.

Accountability of Nursing Personnel in the hospitals and their views

Accountability means being answerable for one's own actions A nurse is accountable to self , the
patients , the profession , the employer and society. For example , if operational nurse gives
wrong medication , she is accountable to the patient who received it .

 For material : The accountability of the use of linen , drugs and loss and breakage of
equipments in the hospital is vested on nursing supervisors and operational level nurses
and about 30-100 % nursing supervisors affirmed this accountability .
 For nursing care : In most of the hospitals , all the nursing sisters and operational level
nurses opined that they are accountable for rendering patients care , but in few hospitals
the nursing supervisors were not accountable for these activities
 Providing safe and therapeutic environment for the patients
 Delivering component and personalised care.
 Maintaining adequate supplies of material and equipment for smooth functioning of the
ward/unit.
 Maintaining accurate and up to date records and reports.
 Maintaining good personal relationship.
 Protecting client’s legal rights and privacy.
 Working within ethical and legal boundaries.
 Keeping pace with changing health needs and developing technology.

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  Delivering care as per standards lay down by profession, statutory body and institution.
 Delegating responsibility appropriately
 Contributing to development of the profession.

INC has explained about professional responsibility and accountability under

codes of professional conduct for nurses.

 Appreciates sense of self worth and nurtures it.

 Maintains standards of personal conduct, reflecting credit upon the profession.
 Carries out responsibilities within the framework of the professional boundaries.
 Is accountable for maintaining practice standards set by Indian Nursing Council
 Is compassionate
 Is responsible for continuous improvement of current practices.
 Provides adequate information to individuals that allow them informed choice
 Practice healthful behaviours.

Summary: Today we have discussed about the nursing regulatory mechanism which included
various nursing regulatory body at national and international level. Then we have discussed
about the accreditation, meaning, objectives, process, accreditation of nursing college and
hospital. After that we discussed licensure and renewal of nursing registration. Then we
discussed about nursing professional responsibility and accountability.

Conclusion: Nursing regulatory mechanism is very much essential to laid down rules and
regulation in nursing profession. It helps in providing advancement in nursing profession,
increases standards of practice. It helps in providing quality of care to the patient.

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 RELATED RESEARCH

Magnet/NABH “Setting Standards in Nursing Practice” - Indian Scenario by Ms.AnjuDhiron

March 2016 IJSDR | Volume 1, Issue 3

This article explores some of the major developmental changes being brought over the last few
years in the healthcare industry in India. It is an effort to take inspiration from Magnet Hospitals
in America and to improve nursing services in India. The background of it and the issues that
need to be resolved in order to have standards equal to Magnet Credentials are also being
touched. In US, hospitals are evaluated after every four years to observe the improvements being
applied in patient care and quality of other procedures.So to get Magnet status, each and every
hospital or clinics have to bring improvements in every field of patient care. The professionals
from the nursing council evaluate these hospitals, which includes very stringent quantitative and
qualitative measures. Right from the entry of customer in hospital to clinical outcomes, and
nursing care all are scrutinized. It is considered as the highest recognition for nursing excellence.
The program also offers an avenue to disseminate successful nursing practices and strategies. It’s
a growing body of research and indicates that Magnet hospitals have higher percentage of
satisfied nurses, lower vacancy of nurses, improved clinical outcomes and improved patient
satisfaction.

Bibliography
1. VatiJogindra. Principles and Practice of Nursing Management and Administration for BSc
and MSc Nursing. 2nd edition. Jaypee Publishers pvt. Ltd.; 2020
2. Basavanthappa BT. Management of Nursing Services & Education. 1st edition. Jaypee
Publishers pvt ltd.; 2011
3. Clement I. Management of Nursing Services and Education. 2nd edition. Elsevier
publication.; 2015
4. Advanced Nursing Practice, an integrative approach, Fourth edition, Page no: 267- 268.
5. Ann.J.Zwemier, Professional Adjustments and Ethics for Nurses in India, Page no: 232- 254.

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