Head Nurse PDF

Nursing Administration Department Nursing Administration The Head Nurse Outlines: 1. Introduction 2. Definition 3. The management position of the head nurse 4. Criteria for selection of the head nurse 5. Other Qualities and...

Nursing Administration Department Nursing Administration The Head Nurse Outlines: 1. Introduction 2. Definition 3. The management position of the head nurse 4. Criteria for selection of the head nurse 5. Other Qualities and Characteristics 6. Functions of the head nurse Patient care management Staff management Unit management 22 Nursing Administration Department Nursing Administration The Head Nurse Objectives: At the end of this lecture, every student will be able to: 1. Define head nurse. 2. Identify different criteria and qualifications for selection of head nurses. 3. Illustrate head nurse management position in organization chart and her relation with different unit. 4. Differentiate between head nurse and supervisor. 5. Discuss tradition and change role of head nurse 6. Discuss purposes of nursing round, and medical round 7. Demonstrate the application of development appropriate head nurse report at different units in hospital. 23 Nursing Administration Department Nursing Administration The Head Nurse Introduction: The head nurse fills one of the most critical first line-managing roles in the administration of nursing services. He/she is the person in a position linking nursing management to nursing care. This position is crucial in co-ordination and integrating the practice of nursing toward the attainment of primary goal of nursing services that of rendering a high level of nursing care to each patient in each unit. Definition: The head nurse is defined as a professional nurse who is responsible for an organized hospital unit within which nursing care is directly and indirectly provided as medical or surgical unit. The management position of the head nurse The head nurse in the hospital setting fills a first line management position of the nursing management levels. Top management (Director of Nursing) Top Middle management (Nurse Supervisors Middle First management (Head Nurse) First 24 Nursing Administration Department Nursing Administration Criteria for selection of the head nurse: Selection of the first line manager to fill the head nurse position in nursing service department affects the effectiveness and efficiency of all nursing services and financial viability of the health care organization. The selection of the head nurse should be based on the following qualifications: 1. Educational Qualifications:  Completion of baccalaureate program  Advanced preparation in ward or unit management, principles of supervision and teaching are preferred.  Attended continuing education courses in both nursing management and administration. 2- Professional Qualifications:  Must be currently licensed to practice professional nursing.  Years of experience ranging from 2 to 5 in an area of clinical nursing, with at least one year experience as nurse in charge of nursing unit.  Possess professional qualities essential for leadership role such as:  Good judgment.  Sound decision making and communicative skills. 25 Nursing Administration Department Nursing Administration  Able to recognize and understand the common needs of all individuals.  Membership and active participation in a professional nursing organization. 3. Personal Qualifications: able to  Maintain optimum physical emotional health.  Demonstrate knowledge, skills gained from education and experience in the area of clinical practice.  Provide personnel supervision and teaching.  Accept responsibility for continuous self-improvement and professional progress to maintain up-to-date nursing knowledge and new development. Other Qualities and Characteristics 1. Compassionate Approach: A head nurses does not wane in the face of pressure under critical situations. 2. Coordination: A nursing manager or head nurse must be able to facilitate and deliver quality nursing care, while managing the environment. This includes coordinating with other nurses involved in patient care. 3. Analytical skills: The ability to quickly grasp a situation and analyze it is a carefully cultivated skill. A head nurse with strong analytical skills will know which nurse to place in care of which patient and how to handle patient‘s families, doctors and their 26 Nursing Administration Department Nursing Administration demands and how to defuse situations before they blow out of control. 4. Negotiation and Conflict Resolution: Nursing candidates for a head nurse post must possess effective negotiation and conflict resolution skills. The head nurse performs the initial evaluation, primary negotiations, necessary monitoring and disciplining of non-compliant staff. Matters are escalated to HR and hospital management only if they don‘t get sorted at the head nurse‘s level. 5. Humanistic Management Philosophy: Approaching any situation from a humanistic perspective allows for greater staff morale and better performance. 6. Ability to multi-task: This means the head nurse has to supervise patient treatments, progress, reporting to doctors, monitoring nurses, changing routines, managing staff schedules and so on. 7. Responsibility and Leadership: Some people have inherent leadership skills while others have to cultivate them. It‘s important for a head nurse to have a strong self-esteem, sense of responsibility and belief in himself or herself as the group leader. Without this, the head nurse has no hope of getting anyone to listen to him or her. Functions of the head nurse: The scope of head nurse's role can be classified to three areas: 1. Patient care management 27 Nursing Administration Department Nursing Administration 2. Staff management 3. Unit management I- Patient care management The head nurse's main area of responsibility in the patient care unit is to see that the patient's total needs are met; therefore all the unit activities are directed toward this goal. The head nurse must possess a body of scientific knowledge and proper competencies to be able to utilize the five steps of the nursing process activities in the management of patient care. 1. Assessment and analyzing the patient's needs:  Assessment is a continuous process of collecting; validating, analyzing and interpreting information about the patient in order to correctly identify his/her problems and needs.  Information gathering from assessment should include; physiological, psychological and social data about the patient for the assessment to be as accurate as possible. Methods of collecting information: a. Patient health record:  Includes past and present history reports of diagnostic examination, recorded observation on patient's response to illness and medical and nursing therapy 28 Nursing Administration Department Nursing Administration b. Patient interview: Collect information (from patient and /or family) about:  Medical and social history.  Occupation.  Level of knowledge and understanding.  Patterns of daily living.  Relationship with others.  Coping mechanism. c. Observation:  The head nurse uses the senses of vision, smell, touch, and hearing. The head nurse collects information about facial expressions and postures. 2. Identifying nursing diagnosis: - After collecting information, the head nurse should categorize it in order to identify needs, patient problems, nursing problems to arrive at a nursing diagnosis. - Patient needs: as hygiene, rest, diet, exercise, elimination, communication, environmental safety sleep etc….. - Patient problems: developed when needs are unrecognized or unmet or conflict between one or more needs - Arriving at nursing diagnosis: when the nurse has reached a conclusion concerning the unmet needs of a patient and decides what can be done to help the patient, he/she has made a nursing diagnosis. 29 Nursing Administration Department Nursing Administration 3. Planning nursing intervention: - Planning nursing care should begin upon admission after the nursing assessment. - Nursing care plan should identify long range problems and the immediate problems. The nursing care plan: The purpose of the nursing care plan is to communicate the formulated plan of care to nursing staff so that the patient's care is administered as consistently as possible. The plan should be reviewed and evaluated daily by the head nurse or the team leader. The head nurse utilizes the plan as a guide to direct nursing actions so that the patient's nursing care objectives are achieved and his health problems are corrected. Keeping the nursing care plan up-to-date: a. During rounds b. When reviewing kardex c. When giving and receiving reports d. During nursing conference Planning process includes: 1. Determining priorities. 2. Selecting objectives for nursing care. 3. Deciding plan of action. 4. Recording nursing orders. 30 Nursing Administration Department Nursing Administration 4. Implementation of patient care plan: The head nurse supervises nursing staff in using the patient care plan to give good patient care. 1. Discuss with the nursing staff the purpose of the plan of care 2. Promote cooperation among staff and workers 3. Give report about each patient's condition and problem before distribution of assignments and at the end of the shift 4. Prepare assignment based on its basic principles 5. Ensure continuity of care throughout the 24 hours 6. Use nursing care plan as a basis for documentation of patient care. 5. Evaluation of nursing care: - The head nurse establishes standards or objectives to evaluate quality and quantity of patient's care during the planning phase. - The head nurse should share her/his staff in evaluation process which leads to the improvement in patient's care and staff development. II- Staff management The head nurse role in staff management  A unit's nursing staff may be made up of registered nurses, practical nurses, student nurses, and nurses' aids. There are wide variation in the education, experience and personality within each of these categories and among all groups. 31 Nursing Administration Department Nursing Administration  The head nurse must be will informed concerning these differences in order to develop the highest potential of all workers and to ensure that patients receive safe effective care. The administrative responsibilities of the head nurse toward her staff include: 1) Staff utilization, 2) Staff supervision, 3) Staff development. 4) Staff evaluation. 1) Staff utilization 1- The head nurse is responsible for all nursing functions carried out by her staff. He/she delegates tasks and enough responsibility and authority for penalty accountability. 2- The staff member have greater satisfaction in her work if he/she is given responsibility for a job and permitted to carry it out in her own way provided. 3- The head nurse must ensure that each staff member on the unit knows the limits of his or her responsibility - To whom he/she is responsible, - Who is responsible to him/her and for what these limits are prepared the job descriptions. - To whom he/she may go for counseling. 32 Nursing Administration Department Nursing Administration 4- The head nurse should be familiar with them to enable staff to ensure conformity with hospital policies. 5- Plans time schedules of a staff in advance and in a way that comply with good personnel practices and maintain staff morale by taking into account personal requests of the staff. 6- Observe conditions under which the personnel function and ensure that the surrounding environment is conductive to clear thinking and free from destructors which interfere with the achievement of goals. E.g. beginning the day on time, putting things in order, prevent interruptions. 7- Maintains an effective system of communication with staff (scheduled and unscheduled) to aid the functioning of the staff, build their morale and facilitate getting the work done. 8- Planned conferences, written reports and records, discussions, informal teaching is methods of fostering effective communication. 9- Development of routines for frequently performed activities is most important in achievement of coordination, timing, and sequencing activities such as ordering of supplies, transcribing doctors’ orders, giving transfer reports, assignment of new patients, contribute to saving of time for the personnel and in improving the care of the patients. 33 Nursing Administration Department Nursing Administration 2) Staff supervision 1- Supervises the quality of staff work by utilizing opportunities such as (given reports, making assignments, conducting rounds, during conferences· and demonstrations). 2- Establish a harmonious relationship with the staff by recognizing efforts and achievements, and by encouraging free exchange of opinions and ideas. 3- Plans supervisory methods that facilitate staff guidance motivation and stimulate staff to continuous self-improvement by providing social, psychological and physical atmosphere which allows the individual freedom to function at their own level. 4- Contribute in a variety of ways to the education of students and nursing staff. E.g. uses conferences, rounds and demonstration techniques to teach staff and students. 5- Conferring with clinical instructors to explain activities, policies and procedures related to students learning experiences. Workout with instructors a statement of the students' responsibilities to the head nurse to ensure coordination and accountability. 6- Discovers leadership skills and creative abilities among members of the nursing staff and arrange for their expression. 3) Staff development: 1- Everyday head nurse practices a marked influence on the development of her staff. The quality care he/she expects and the 34  Nursing Administration Department Nursing Administration example he/she sets by her attitudes and behavior to a large extent determine the standards and behavior of staff. Effectiveness of her unit management and the social environment also influence learning. 2- Setting high standards for patient care is the greatest influential factor in the growth of staff the head nurse should involve members of staff in developing these standards and in establishing objectives and criteria for their attainment. 3- Encourage staff to participate in planning for improvement of nursing care and applying findings of nursing practice studies is a fruitful means of bringing out staff growth and better quality of nursing care. 4- The extent to which the head nurse capitalizes of learning opportunities influence staff growth. He/she has to provide opportunities for staff professional advancement and advanced study. 5- Share in planning and participates in staff educational and training programs of professional personnel. 4) Staff evaluation 1- Evaluate staff performance objectively and impartially by maintaining a routine system for continuous evaluation of staff performance to ensure the attainment of objectives. 35  Nursing Administration Department Nursing Administration 2- Encourage staff to evaluation their own work, analyze problems and decide an actions to resolve problems. Self-evaluation help individual to determine progress and assist her in bringing it about. 3- Although evaluation for administrative purpose of promotion salary increase, its' focus should be on the education growth and development of staff. 4- Investigate any complaint or lack of cooperation between workers and help establish atmosphere on the unit. III- Unit Management: The Head Nurse during her work is running her unit is involved in different administrative duties daily and whether these duties are delegated or, he/she is still the responsible person.In fact many these duties -may-be – delegated. 1. Patient admission administration: a. The Head Nurse acts as courteous hostess when the Patient is admitted to the unit. b. He/she great the new patient. and his relatives in friendly manner c. It is preferable for the Head Nurse to use patients on name if he/she knows it. d. He/she introduces herself and the staff member who will assist in the admission of the patient. e. The first impression is important and it is lasting. 36 Nursing Administration Department Nursing Administration f. Understands the patients and gives them the mental and moral support he is requiring. g. Treats the patients as he/she would like to be treated in the same situation. Orientation of the new patients and his family should include: 1. Giving them information about hospital policies and regulation and facilities available. 2. Introduce the patients ward environment. 3. Orientation to staff personnel N.B., In emergency admission and upon being notified the HN must be sure that the bed is prepared and any equipment that may be required. 2. Patient Discharge Administration The HN is responsible for the preparation of the patient for his discharge from the hospital. He/she asks the patient if he would like to discuss any problem with the medical social service worker which may interfere with his recovery. If indicated, he/she suggests community agencies that may help the patient at home. He/she should continue her role as hostess through the time of the patient discharge from the hospital: a. Inform members of the patient's family that the patient. Is being discharged, and when they should arrive for him. b. Be sure the patient has the proper clothing to be home. 37 Nursing Administration Department Nursing Administration c. Assigns one of her staff members to assist the patient. In dressing. Packing and leaving the ward. d. Talk to the patient. And his family when they are leaving. e. Give all instruction-required drugs and further appointment. 3. Doctors Rounds: A. Administration before Dr. Round. 1- The Head Nurse should see that all investigation report for the patient is available. 2- He/she should see that all patient's charts are complete and organized and on order and ready. 3- He/she instructs:- - Nursing staff on the order of the word for the rounds. - Patient should be on comfortable position and ready for rounds - Auxiliary staff to see that the ward is neat and tidy. 4- The Head Nurse also should be knowledgeable about patient Condition and is up to date and received all reports and ready to discuss patient's problems. B. Administration after Drs Rounds:  Nursing staff to put the patient. At ease in a comfortable position and continue what was performed for him.  Auxiliary staff to keep wards tidy. 38 Nursing Administration Department Nursing Administration  Carrying out or putting into effect the changes ordered by doctor during the round. Drug Administration: The RN should: a. Check stocks of drugs he/she has in the unit against records. b. Check patient's charts regularly to obtain patient prescription keeps accurate charts regular records of drugs given during all shift. c. Return expired dated drugs to the pharmacy. d. Give accurate and constant instruction and supervision of nurses in the keeping of drug records. e. Be sure that the nursing staff knows conation, normal dosage, side effects of the drugs given to patients. f. Be sure that patients are given instructions. 4. Operating room (OR) Administration: The head nurse should: a. Check the list. b. Inform patient of day and time of operation. c. Be sure that pre-operative preparation was done for patients by the responsible nurse who is assigned to the patient. d. Check consent of patient if necessary. 39 Nursing Administration Department Nursing Administration e. Check to see if patients chart is complete and all investigations are present. f. Give support to patients family or relative and any necessary needed information 5. Para-medical Administration: The Head Nurse is responsible to a considerable degree for the effective coordination of the efforts of all those workers who not only engage in direct patient care but also with whom who engage in indirect patient care he/she is responsible for establishing an atmosphere and relationship which will improve patient care by improving the joint functioning of various departments with a common goal better patient care. Head Nurse responsibilities' to improve Relations with departments: 1. Know the organizational structure of the hospital 2. Acquaints staff members in the unit with the policies, routines of the departments that cooperative with the Head Nurse unit. 3. Offer help to every employee who comes to the unit to do a job. 4. Be sure that requests to other departments be done on time. 5. Keep the patient's appointment with other departments on the schedule provided. 40 Nursing Administration Department Nursing Administration 6. Coordinate patients' services on the unit and between all the departments in the hospital. 7. Medical department:  Take the initiative as a Head Nurse to establish friendly relationship and mutual understanding with the hospital staff.  Encourage mutual planning for patient care.  Explain the nursing situation to those your wards they will be more cooperative if they know about unusual difficulties.  Ask for conference with medical staff when important problem arise.  Reports to them and any in ability to carry out his orders, and explain reasons.  Reports symptoms, reactions and result of x ray accurately.  Establish a mutually grabble time for rounds.  Assist with any examinations made during round 8. Pharmacy: a. In ordering, the needs must be determined accurately sufficient stock should be available to meet current needs with reserve in hand for emergencies, but don't over - stock.  Requisition forms should be completed properly.  The accounts department can keeps a record of expenditure. 41 Nursing Administration Department Nursing Administration  Requisitions should be simple to complete and easily understate and written legible and should be sent to the pharmacy department at the appointed time. b. Dangerous drugs should be ordered with special care this responsibility is normally undertaken by the RN. 9. Maintenance departments: The Head Nurse should learn what services the maintenance department should provide. He/she should report any mechanical difficulty, minor fault. Inform them with the location of the trouble. 10. Laundry department  Avoid loss of linens- be careful to check clean linen returned from laundry  Protection of the linen against dirt and loss should be understood by all members of the staff.  The linen cupboard should be kept in good order with linen folded nearly until it is used and correctly stored 11. Housekeeping department: The Head Nurse must be satisfied with standard of cleanliness as this has such an important bearing on patient care the domestic staff (housekeeping personnel) should report to the time that is coming on or going off duty the Head Nurse should observe and 42 Nursing Administration Department Nursing Administration notice whether they use the approved methods handle equipment properly and carry out the work arranged for them. 12. Dietary Department: The Head Nurse is responsible for writing requisition to the dietary department, and should avoid over ordering in order to prevent waste, and the request should include the number and type of diets necessary for ward. Requests are written in the proper form and on time. 13. Diagnostic and therapeutic services department-: The Head Nurse should familiarize herself with the functions of this department. The patient should be prepared correctly for investigations. The medical staffs are responsible to prepare the request form and be completed. The HN should see that the forms are available and easily located. The patient should arrive at the correct time and arranged should be made for the return of the patient to the ward when the test is completed. 14-Social service department: a- The Head Nurse should inform her staff about the functions of the social service department. b- Maintain a friendly, cooperative attitude towards the department. 43 Nursing Administration Department Nursing Administration c- Accept the help which the medical social worker can give in understanding patients. d- Encourage patients to talk with the social worker. Factors involved in good unit management: The HN is the: Planner. Organizer. Motivator. Evaluator. Educator; and In many instance the implementation of most activities that occur in her unit. Key Points: Head Nurse fills one of the most critical first line- management in nursing services administration. He/she is the person in a position linking nursing management to nursing care. The criteria and qualification for selection the head nurse position including, educational qualification, professional qualification and personal qualification. 44