Head Nurse Role PDF

Head nurse role Introduction: The head nurse fills one of the most critical first line- managing roles in the administration of nursing services. She/he is the person in a position linking nursing management to nursing care. Definition: She/he is the person respons...

Head nurse role Introduction: The head nurse fills one of the most critical first line- managing roles in the administration of nursing services. She/he is the person in a position linking nursing management to nursing care. Definition: She/he is the person responsible for direct and indirect nursing care of patient within an organized unit of a clinical area as medical, surgical units----etc Qualification and preparation of the head nurse: 1- Educational qualification: Completion of baccalaureate program. Advanced preparation in ward or unit management, principles of supervision and teaching are preferred. 2- Professional qualification: Experience as professional nurse in which potential administration and supervisory competence has been demonstrated. Should have at least one year experience as a staff nurse. Active participation in the professional nursing organization. Nursing Administration book 4th year (12)  3- Personal qualification: - Maintain optimum physical and emotional health. - Demonstrate knowledge, skills gained from educational experience. - Provide personnel supervision and teaching. - Accept responsibility for continuous self-improvement to maintain up to date nursing knowledge and new development. Management positions of the head nurse: The head nurse positions in the hospital setting fills a first line management Top management (Director of nursing service department) Middle management (Nurse Supervisor) First line management (Head nurse) (Fig.1) Functions of the head nurse: 1- Patient care management. 2- Unit management 3- Staff management Nursing Administration book 4th year (13)  I. Patient care management: In this broad functional area the following sub-function are performed by the head nurse:- 1-Assessing and analyzing patient needs and developing the plan of care to meet needs During assessment head nurse must take the following into consideration:  The patient condition and needs.  Needs of patient’s family.  The patient environment.  Observation of the work peaches.  The effects of care.  Interaction between patients and personnel.  Social climate and physical environment of the personnel.  Signs and symptoms associated with the various disorders. What good nursing consists for patient on the service these vary with the age, degree of illness, and the disorders of the patient.  Information about individual patients, including age, condition, disabilities or special problem.  Knowledge of the total program of medical cares for the individual patients and the nurse’s responsibility in relation to it in order to be able to observe the patient.  Be familiar with the nursing care plan for each patient in order to determine whether it is being followed. Nursing Administration book 4th year (14)   Each staff nurse is informed that making nursing assessment is an expectation.  Provides opportunities for staff nurses to learn through practice, gain skill in assessing patients and their nursing care requirements.  Holding staff nurses accountable for performing nursing assessment. 2. Role of head nurse in personnel assignment:  The interests and abilities of the various member of the nursing team to ensure their maximum utilization.  Patient needs and problem.  Personal qualities as same nurses relate better than others to some patients.  The amount of time necessary to give care indicated.  Determine the number of patients on the word.  Check the number of nursing personnel Available to do the task and their educational level, experiences and needs abilities and interests.  Decide on which patient. Needs the most expert care.  Determine what other tasks are necessary to give satisfactory care to patients.  Decide which method of nursing care you will employ ( case , function , team)  Check to see that the entire workload is covered with no overlapping of assignment.  Put the plan into written form. Nursing Administration book 4th year (15)   3-Setting the standards by which extent performance of the nursing functions on her unit can be measured:-  The HN set standard which are challenging but still within the ability limits of nursing personnel on other words not to high because it will frustrate them because their inability to achieve not to low as they will fail to meet patient needs. The standard should be: 1- Flexible enough to meet changing situation. 2- The HN should refuse to let her standards drop below the minimum for essential patient care. 3- Then the head nurse can check nursing personnel performance against standard that was set to ensure quality patient. Care for the types or the degree of illness that are present in the unit. 4- She also observes the patient response to all medical and nursing care. Satisfaction can be a positive symptom for the HN of the quality and effectiveness of patient care. 5- When the standard is not met, the HN should analyze the reasons for failure with her staff and plan for improvement. 4- Supervising all nursing activities related directly and indirectly to patient care: The most important sub-function of the HN is the supervision of all nursing activities. This is done through:  Daily and constant direct observation of all patients to see that their conditions are satisfactory and that all nursing care given by each member of nursing personnel is adequate and effective. Nursing Administration book 4th year (16)   She should see and talk with every patient at least once a day to see that patients are contend with the nursing and hospital routine.  Under any circumstance there will be some patients the HN must see frequently throughout the day.  Moreover, any technique the HN can utilize to stimulate the interest of the workers to maintain everything in the word.  Making quick short rounds at the beginning of the day with the night nurse in the morning and at the end of the day. In the afternoon with the evening charge nurse provides opportunity for the two together to raise question, discuss problems and make plans. Purpose of nursing rounds: When early in the morning before physicians rounds and in different times in: a. Observe the overall physical and mental condition of each patient and note progress. b. Observe the work effort of the nursing staff as a means of evaluating quality nursing care. c. A company physicians, supervisors or family. d. Observe the patient’s environment for cleanliness, orderliness completeness of equipment and presence of hazards. e. Conduct a teaching experience for students. 5- Promotion and participation in patient education and rehabilitation. Nursing Administration book 4th year (17)  The HN should promote and participate in patient education. Should be start with the first contact, if he is well enough to hear. Teaching is a part of rehabilitation, which starts upon admission of the patient, during hospitalization and before discharge. II- Unit Management: The HN during her work is running her unit is involved in different administrative duties daily and whether these duties are delegated or, she is still the responsible person.In fact many these duties may be delegated. 1-Patient admission administration: a. The HN acts as courteous hostess when the patient is admitted to the unit. b. She great the new patient, and his relatives in friendly manner. c. It is preferable for the HN to use patients on name if she knows it. d. 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. f. Understands the patients and gives them the mental and moral support he is requiring. g. Treats the patients as she would like to be treated in the same situation. Nursing Administration book 4th year (18)  Orientation of the new patients and his family should include: 1) Giving them information about hospital policies, regulations and facilities available. 2) Introduce the patients to ward environment. 3) Orient the patient to staff personnel. 4) 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. She asks the patient if he/she would like to discuss any problem with the medical social service worker which may interfere with his recovery. If indicated, she suggests community agencies that may help the patient at home. 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 when going to home. (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. Nursing Administration book 4th year (19)  3- Doctors Rounds:- A. Administration before Dr. Round: 1- The HN should see that all investigation report for the patient is available. 2- She should see that all patient’s charts are complete and organized and on order and ready. 3- She instructs:- - Nursing staff on the order of the ward for the rounds. - Should be on comfortable position and ready for rounds. - Auxiliary staff to see that the ward is neat and tidy. - The HN 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. - Carrying out or putting into effect the changes ordered by Dr. during the round. Nursing Administration book 4th year (20)  4- Drug Administration:- The HN should: a. Check stocks of drugs she/he has in the unit against records. b. Check patient's charts regularly to obtain patient prescriptions keep 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 know conation, normal dosage, side effects if the drugs given to patient’s. f. Be sure that patients are given instructions. 5- 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. 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. Nursing Administration book 4th year (21)  6- Para-medical Administration: The HN 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 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. HN 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 HN 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. 6. Coordinate patient's services on the unit and between all the departments in the hospital. 7-Medical department: a. Take the initiative as a HN to establish friendly relationship and mutual understanding with the hospital staff. b. Encourage mutual planning for patient care. c. Explain the nursing situation to those your wards they will be more cooperative if they know about unusual difficulties. Nursing Administration book 4th year (22)  d. Ask for conference with medical staff when important problem arise. e. Reports to them any inability to carry out his orders, and explain reasons. f. Reports symptoms, reactions and result of RN accurately. g. 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 stores can keep an account of issues made and stock in hand.  The accounts department can keep a record of expenditure.  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 HN. 9- Maintenance department:-  The HN should learn what services the maintenance department should provide.  She/he should report any mechanical difficulty, minor fault and inform them with the location of the trouble. Nursing Administration book 4th year (23)  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 keep in good order with linen folded nearly until it is used and correctly stored. 11-Housekeeping department: The HN 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 tin who is coming on or going off duty, the HN should observe and notice whether they use the approved methods handle equipment properly and carry out the work arranged for them. 12-Dietary Department:- The HN is responsible for writing requisition to the dietary department and should avoid over ordering in order to prevent waste. 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 HN should familiarize herself with the functions of this department. Nursing Administration book 4th year (24)  The patient should be prepared correctly and nursing personnel should be instructed to do so. The medical staff is 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 HN should inform her staff about the functions of the social service department. b- Maintain a friendly, cooperative attitude towards the department. c- Accept the help which the medical social service 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. Nursing Administration book 4th year (25)  III. Staff management: The head nurse role in staff management: - Nursing services personnel consists of registered nurses, practical nurses, student nurses, and nurses’ aides. There are wide variation in the education, experience and personality within each of these categories and among all groups. - The head nurse must be informed and concerned with these differences in order to develop the highest potential of all workers and ensure that patients receive safe effective care. The administrative responsibilities of the head nurse toward her/his staff include: 1) Staff utilization. 2) Staff supervision. 3) Staff development. 4) Staff evaluation. 1. Staff utilization. - The head nurse is responsible for all nursing functions carried out by her staff. She delegates tasks and enough responsibility and authority and she still accountable. - The staff member have greater satisfaction in her work if she/he is given responsibility for a job and permitted to carry it out in her own way provided. - The head nurse must ensure that each staff member on the unit knows the limits of his/her responsibility, to whom he/she is responsible, to whom he/she may go for counsel and who is Nursing Administration book 4th year (26)  responsible to him/her and for what these limits are prepared the job descriptions. - The head nurse should be familiar with them to enable staff to ensure conformity with hospital policies. - 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. - 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. - 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. - Planned conferences, written reports and records, discussions, informal teaching is methods of fostering effective communication. - Development of routines for frequently performed activities is one of the most important factors 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. Nursing Administration book 4th year (27)  2. Staff supervision: -Supervises the quality of staff work by utilizing opportunities such as (given reports, making assignments, conducting rounds, during conferences and demonstrations). - Establish a harmonious relationship with the staff by recognizing efforts and achievements, and by encouraging free exchange of opinions and ideas. - 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. -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. - Conferring with clinical instructors to explain activities, policies and procedures related to students learning experiences to ensure coordination and accountability. - Discovers leadership skills and creative abilities among members of the nursing staff and arrange for their expression. Nursing Administration book 4th year (28)  3) Staff development: - During everyday practices the head nurse has a marked influence on the development of her staff, the quality care she expects through the example she sets by her attitudes and behavior to a large extent , also she determine the standards of care. - 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. -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. -The extent to which the head nurse capitalizes or learning opportunities influence staff growth. She has to provide opportunities for staff professional advancement and advanced study. - Share in planning and participates in staff educational and training programs of professional personnel. 4. Staff evaluation: - Evaluate staff performance objectively and impartially by maintaining a routine system for continuous evaluation of staff performance to ensure the attainment of objectives. Nursing Administration book 4th year (29)  - Encourage staff to evaluate their own work, analyze problems and decide an action to resolve problems. Self-evaluation help individual to determine progress. - Although evaluation for administrative purpose of promotion and salary increase its main focus should be on the education growth and development of staff. - Investigate any complaint or lack of cooperation between workers and help establish atmosphere on the unit. Nursing Administration book 4th year (30)