BHOPAL MEMORIAL HOSPITAL & RESEARCH CENTRE, BHOPAL ICMR, (DEPT. OF HEALTH RESEARCH) Ministry of Health & Family Welfare, Govt of India. MANUAL OF DUTIES AND RESPONSIBILITES OF Nursing Superintendent / Dy. Nursing Superintendent/ Nursing Supervisor/Staff Nurse Grade II 1
BHOPAL MEMORIAL HOSPITAL & RESEARCH CENTRE, BHOPAL INDEX S.No Contents Page No. 1. Organisation Chart 3 2. Duties and Responsibilities of Nursing Superintendent 4 3. Duties and Responsibilities of Dy. Nursing Superintendent 6 4. Duties and Responsibilities of Nursing Supervisor 8 5. Duties and Responsibilities of Staff Nurse Grade II 12 6. Rotation Policy 14 2
ORGANISATION CHART NURSING DEPARTMENT NURSING SUPERINTENDENT DY. NURSING SUPERINTENDENT NURSING SUPERVISOR STAFF NURSE GRADE II 3
BHOPAL MEMORIAL HOSPITAL & RESEARCH CENTRE, BHOPAL. Department : NURSING Duties and Responsibilities I Post : NURSING SUPERINTENDENT 1.0 The Nursing Superintendent is responsible to the Director for planning organization and development of nursing services in the hospital. 1.1 The Nursing Superintendent is the Administrative Incharge of the Nursing Department of the Hospital and will ensure smooth functioning of all the nursing services in the Hospital and Mini Units. 1.2 To keep the administration and the Hospital Director informed of all the activities and problems in relation to the care of patients. 1.3 To implement hospital/centre policies in the various nursing units. 1.4 Recommend personnel and material requirement for nursing and various nursing service departments of the hospital. 1.5 Take regular rounds of the hospital. 1.6 Accompany the Director while making hospital rounds. 1.7 Responsible for high standards of nursing care and behavior towards all patients admitted in the hospital. 1.8 To organize, direct and supervise day, evening and night nursing services for competent nursing care. 1.9 To continuously analyze and evaluate the nursing services. 1.10 To counsel sub-ordinate staff. 1.11 Can attend hospital/intra hospital meetings and conferences with prior permission of the Director. 1.12 Investigate all complaints regarding nursing care and personnel, and submit report to the Director for further action. 1.13 Initiate and encourage research in nursing services. 1.14 Evaluate confidential reports of her sub-ordinate staff and recommend for higher studies etc. 4
1.15 Periodically interact with clinical heads to discuss problems in patient care. 1.16 Assist in formulating policies concerning nursing services. 1.17 To educate the supporting staff by programs conducting Continuing Nursing Education for the nursing staff of the hospital. 1.18 To provide awareness regarding cleanliness as part of infection control. 1.19 Liaison with other government and non-government agencies relating to nursing services. 1.20 Maintain personal files of all nursing staff. 1.21 Promote harmonious relation with physicians, departments, administration and volunteer organizations. 1.22 To attend professional meetings as a representative of nursing department. 1.23 To keep the Hospital Director informed of all the necessary activities, decisions and their outcomes. 1.24 Will be responsible for any other duties assigned by the Director from time to time. 1.25 The Nursing Superintendent will be on call and available 24/7. 5
II Post : Dy. NURSING SUPERINTENDENT 2.0 The Deputy Nursing Superintendent is responsible to the Nursing Superintendent and assist her in the administration of nursing service in the hospital. A. NURSING ADMINISTRATION : 2.1 Supervise the nursing care given to the patients in various departments by taking regular round of the bestowed area. 2.2 Act as a liaison officer between Nursing Superintendent and the nursing staff of the hospital. 2.3 Interpret the policies and procedures of the Nursing service department to sub-ordinate staff and others. 2.4 Submit proposals to the Director through N.S. for additional manpower to departments, if required. 2.5 Attend the emergency calls concerning nursing services. 2.6 Receive evening and night reports from the Nursing Supervisors. 2.7 Maintain the records of attendance of nursing staff and leave of any kind. 2.8 Drug checking/stock checking specially the controlled drugs. 2.9 Initiate procedure for condemnation. 2.10 Assist the Nursing Superintendent in making master duty roster of nursing personnel. 2.11 Assist the Nursing Superintendent on planning and organizing nursing services in the hospital. 2.12 Sr. most Deputy Nursing Superintendent will officiate in the absence of Nursing Superintendent. 2.13 Attend the official meetings. 2.14 Keep the Nursing Superintendent informed of the happenings in the wards. 2.15 Help the nursing staff in maintaining quality nursing care. 2.16 Ensure waste management as per the guidelines. 2.17 Regular checking of mid night census. 2.18 Night round in co-ordination with other DNS and record incidents if any in round book & inform NS immediately if there is any things very important. 6
B. EDUCATIONAL ACTIVITIES 2.19 Assist in planning/organizing and implementing staff development programmes. 2.20 Ensure clinical experience facilities for student nurses in various clinical areas of the hospital. 2.21 Provide guidance and counseling to nursing staff. 2.22 Arrange orientation programmes for new nursing staff. 2.23 Maintain discipline among nursing personnel. 2.24 Organize educational programmes for graduate/post graduate students with the coordination of Principal/clinical instructor/lecturer/tutor college of nursing. 2.25 Arranges and participates in professional and social functions of the staff and students. 2.26 Maintain good public relations. 2.27 Listen to the patient s problems/grievances and make suitable solution if possible or else put up to superiors for action. 2.28 Any other duties assigned to her from time to time by the higher authorities. 2.29 The Dy. Nursing Superintendent will be on call and available 24/7. 7
III Post : NURSING SUPERVISOR 3.0 The Nursing Supervisor will work under overall supervision of the Dy. N.S. and will report to the Dy. Nursing Superintendent and will be responsible for the total care of patients in the wards and supervision of the Staff Nurses, student nurses and Attendants technicians where applicable. The main aim should be to foster team spirit in her/his area of works as a Group team leader. The Nursing Supervisor will lead and be responsible for all related Supervisory functions within the Department of Nursing and the Hospital, during weekend and afterhours. The Nursing Supervisor will be on call and available 24/7. A.ROLE OF EFFECTIVE ADMINISTRATIVE, MANAGERIAL AND ORGANISATION SKILLS IN ESTABLISHED LINE OF AUTHORITY : 3.1 Ensure that care is delivered to each and all patients in accordance with Standards of Clinical Nursing Practice. 3.2 Ensure that Dy. Nursing Superintendent & Nursing Superintendent are informed and updated on all reportable situations. 3.3 Nursing Supervisors have to follow the Duty Schedule and have to priorly inform the Nursing Administration before proceeding to any kind of leave after adjusting the duty with the subordinates. 3.4 Ensures that Nursing Supervisors organize appropriate staffing for the shift based on recommended shift staffing levels, discussed with Nursing Administration. 3.5 Should personally evaluate departmental and unit acuity levels when making staffing decisions. 3.6 Will respond to all emergencies within the hospital and initiate the appropriate response. 3.7 Understand and can implement the appropriate response in dealing with patient problems e.g. deterioration of patient s clinical condition, dying patients, seriously ill patients and violent patients. 3.8 Ensures that regular patients rounds are conducted during duty hours. 3.9 Demonstrates ability to identify and solve problems. Utilises initiatives and sound judgment to reach quality decisions. 3.10 Promptly respond to and fully investigate complaints of patients, visitors and staff. 3.11 Making the duty list and submit the same on the last working day of the previous month (weekly and monthly checking for any shortage / mismanagement) to the Dy. Nursing Superintendent. 8
B. DEMONSTRATE APPROPRIATE PROFESSIONAL BEHAVIOR, DISPLAYS PROFESSIONALISM AND ADHERE THE PRINCIPLES OF PROFESSIONAL PRACTICE : 3.12 Demonstrate awareness of personal capabilities and limitations and understand how and when to seek assistance. 3.13 Work collaboratively with other staff members and be a good team player. 3.14 Be impartial with subordinates and other staffs. 3.15 Demonstrate good judgment and analytical ability in preparing work for review. 3.16 Promote confidentiality and use complete discretion when discussing information. 3.17 Maintain calm and effective behavior during stressful situations. 3.18 Establish good rapport and cooperate working relationships within all personnel in the Organization. 3.19 Serves as a Professional Role Model, Facilitator, Mentor and Resource Person to all staff. 3.20 Demonstrate ability to express self in all areas of communication (verbal, written, nonverbal). 3.21 Be professional, polite and courteous when dealing with colleagues and subordinates and patients. C. DEMONSTRATE MATURITY AND ACCOUNTABILITY FOR JOB PERFORMANCE : 3.22 Demonstrate knowledge of, and ability to utilize, the Computer Systems used in the Organisation. 3.23 Should willingly accept assignments to Special Projects. 3.24 Adheres to identified work schedule; notifies the Dy. Nursing Superintendent for needed changes in schedule. 3.25 Adjust personal schedule to complete assignments. D. NURSING CARE OF PATIENTS : 3.26 Anticipate potential problem situations and intervene with insight and understanding, to offset any adverse impact on the patient or patient care. 3.27 Receive and give report on seriously ill patients, unsolved problems, resources required and other pertinent information at the beginning and end of each shift. 3.28 To take frequent and regular rounds in the ward, patient to patient and clinical areas. 3.29 Supervising cleanliness of clinical areas. 3.30 Admission and discharge of patients. 3.31 Assist in rounds with Medical Physicians/Surgeons and help in examination of patients and treatment. 3.32 Supervise clinical investigations/procedures. 3.33 Supervise patients diet and diet list. 3.34 Staff Nurses to intimate Nursing Supervisors in any emergency or unusual occurrence in the ward. 9
3.35 Accepting suggestions from patients / relatives regarding improving the present system. 3.36 Accepting suggestions from doctors / consultants for improving the standard of patient care. 3.37 Make necessary adjustment in duty schedule when situation arise. 3.38 Maintenance of patient s record. 3.39 Giving and receiving reports. 3.40 Follow prescribed rules in case of accident or death of a patient. 3.41 Maintain discipline within the department and also outside. 3.42 Co-ordinate medical-nursing team activities. 3.43 Identify special abilities of individual nurse and utilise / guide them to function most effectively. 3.44 And any other duties assigned by the superiors. E. WARD MANAGEMENT : 3.45 Orientation of new staff. 3.46 Monitoring the attendance of nursing/paramedical staff. 3.47 Assign work to Staff Nurses and Ward Attendant. 3.48 Co-ordinate and facilitate work of other staff, e.g. physical therapist, social worker, dietician, voluntary worker etc. 3.49 Maintaining good inter personal relationship among all categories of staff and with patients and their relatives. 3.50 Assist the patients and relatives whenever required. 3.51 Maintain disposal of waste, cleanliness of ward, its annexes and environments. Proper upkeep and repairs of linen and ward equipment. 3.52 Make indents for drugs, surgical, stores and issue. 3.53 Keep custody of dangerous drugs, restricted and narcotics drugs and record of their administration. 3.54 To maintain narcotics empty vial, ampule and it should be kept under lock. 3.55 Daily check of emergency drugs and life saving equipments. 3.56 Maintenance of stock registers, inventories and check regularly. 3.57 Solving inter-personal/intradepartmental problems. 3.58 Investigating complaints made if any, by the patient, relatives, consultants / doctors regarding nursing care and forward them to superiors if required. 3.59 Initiating and introducing new ideas and techniques related to patient care and provide necessary equipments/drugs/other material adequate and in working condition. 3.60 Loss or damage of equipments of their units has to be reported to Dy. Nursing Superintendent, Nursing Superintendent, Engineering Services or Stores as indicated/required. 10
F.TEACHING AND SUPERVISION : 3.61 Orientation of new staff and student nurses. 3.62 Participate in-service education of nursing personnel and attend staff meetings. 3.63 Impart planned and incidental teaching. 3.64 Consult and co-operate with nursing tutor in arranging clinical teaching. 3.65 Encourage regular health teaching programme for patients and relatives in the ward. 3.66 Encourage in practice teaching programme in the department other than the usual regular in-service education programme. 3.67 Demonstrate efficient nursing care, administration of drugs and treatment, preoperative and post-operative care of patients, observation and recording of vital parameters. 3.68 Guide & Supervise the Nursing Staff and students for health education to the patients and their attendants. 3.69 Guide the nursing staff in practicing correct method of nursing care techniques. 3.70 Supervise Ward Attendant. 3.71 Regular checking of mid night census. 3.72 Participate in inter-departmental meetings 3.73 Perform any other duty as may be specified from time to time. ROTATION FOR NURSING SUPERVISOR IN BMHRC : 3.74 Rotation procedure be implemented for Supervisors too as per the Vigilance act of 2005, preventive vigilance by transfer. 3.75 Rotation for Supervisor is important to know working of other areas in the hospital thus making them ready for promotions by increasing their capabilities. 11
IV POST STAFF NURSE GRADE II 4.0 The Staff Nurse Grade II is directly responsible to Nursing Supervisor for total nursing care of the patient assigned to him/her. A. DIRECT PATIENT S CARE : 4.1 Admission and discharge of the patients. 4.2 To maintain the personal hygiene of the patients, including bathing, care of mouth, back nails, hair etc. 4.3 Assist physicians/surgeons in procedure. 4.4 All fundamental nursing procedure are to be done by Nurses. 4.5 Care of pressures points as needed. 4.6 To assist the patient in elimination, offering and removing the bed pans and urinals. 4.7 Bed making. 4.8 Assist in feeding the weak and debilitated patients. 4.9 Ensure Aseptic Measures during nursing procedures. 4.10 Writing of diet sheet, Supervision and distribution of diets. 4.11 Carry-out patient s teaching and demonstration according to the need. 4.12 Counseling the patients and relatives. 4.13 Care of the dying and dead. 4.14 Administration of Medicines and Injections to the patients. 4.15 Assist in administration of intravenous injections, infusion and Transfusion. 4.16 Observing, recording and reporting of all procedures and tests of vital signs e.g. T.P.R. and Blood pressure. 4.17 Collecting, labeling and dispatch of specimens. 4.18 Escorting serious patients to and from the department/wards for investigations. 4.19 Ensure Safety and security for the patient in the Hospital. 4.20 Do not entertain any admission/transfer unless it comes through the system. 4.21 Checking the patient data on file in the smart card, identify and point out mistakes to registration and Nursing Supervisor, if any. 4.22 And any other duties assigned by the Superiors. 12
B. WARD MANAGEMENT : 4.23 Total patient care and follow instructions of treating physicians/surgeons and carry out their orders efficiently. 4.24 Handing over and taking over of each patient, bed to bed and all necessary equipments, drugs etc in the ward. 4.25 Maintenance of therapeutic environment in the ward. 4.26 Supervision over functions of ward boys / ayahs / sweepers. 4.27 Maintain cleanliness of wards and premises. 4.28 Care of clean and soiled linen. 4.29 Disinfection of linen, beds, floor and bed pans, and fumigation of rooms etc. 4.30 Preparation of room, trolleys, and sets for procedures. 4.31 Preparation of surgical procedures. 4.32 Maintaining interpersonal relationship with patients, relatives and health team members. 4.33 Orientation of new staff/students. 4.34 Demonstration and guidance to students nurses & domestic staff. 4.35 Participation in staff education and staff meetings. 4.36 Participation in professional activities. 4.37 Proper waste management as per guidelines. 4.38 Ensure safe custody of patient files and investigation reports, etc. 4.39 Ensure payments of bills in full before discharge of patient from the ward. 4.40 Send samples of investigation and collection of reports through the computer system. 4.41 All orders, admission/discharge/death/bills/diet/transfer etc. through computer system. 4.42 Check regularly and daily all emergency drugs, narcortic drugs, crash cart with check list and resuscitation equipments. 4.43 Report Expiry dates of Drugs and working condition of equipments. Keep every thing in working order. 4.44 Loss or damage of equipments during duty hours has to be informed to Nursing Supervisor. 4.45 To be vigilant regarding thefts in wards. 4.46 Control the visitors in non-visiting hours inside the ward. 4.47 Keep necessary materials available in the ward. 4.48 Prepare mid night census of patients. 4.49 Maintain strict discipline in Hospital Premises. 4.50 And any other duties assigned by the Superiors. 4.51 Staff Nurse will be on shift duty but will be available if required, even after end of the shift. 13
ROTATION PROCEDURE FOR STAFF NURSE FOR WARDS /OPERATION THEATRE The main aim is to retain experienced nurses by enabling them to experience in a new area of work and to develop new competencies and the second is to transfer fresh ideas into hard to staff from one clinical area to another area. To achieve these aims, the nurses are offered six-month placements in any of the departments of the main hospital of BMHRC. The combination allows them to work in both specialist and general areas, and is supported by a detailed framework of professional development. Procedure : Rotation of staff will be based on the following procedure : To train, update the quality of nursing services in all departments and to be professionally skilled in the services of the nurses in each stream. The rotational idea incorporates a number of themes: professional development, continuing education, support mechanisms, rewards and incentives. Nursing Supervisor of the concerned department will orient / train the Staff Nurses who are on rotation. The Nursing Supervisor should be well organized and be available with the staff to provide adequate guidance. The policy will also be implemented to Operation Theatre Staff, Cath Lab etc. The duration of the rotation will be priorly for six months and then vis-à-vis to 1 year at any given time and only one staff will be rotated in a department. The staff will be rotated departmental wise on six monthly basis to each department in the main hospital. The rotation will be planned based on the individual s year of joining in BMHRC in descending order. The duration for the staff for rotation will be for six months but in case of declaration of emergency can be transferred to any department likewise. Staff may be required to change shifts at short notice to ensure safe staffing levels. The size of the department, bed occupancy, work load of the particular area will be considered for staff rotation. The time schedule of the Staff Nurses will remain the same for the shift duty 8:00 a.m. to 2:00 p.m.; 2:00 p.m. to 8:00 p.m. and 8:00 p.m. to 8:00 a.m. respectively. The hours and offs (deduction of leaves) will remain same as per the cadre of the duty schedule. The rotational duty will be obligatory for all the shift / operation theatre staff. The success of the rotation is crystal clear; that it provides an ideal opportunity for newly qualified nurses to improve their clinical skills, develop academically and network with staff across the hospital. 14