ROLE OF THE HEAD NURSE in staff utilization, supervision, staff development and management of patient care

Head Nursing Roles and responsibilities

1. THE ROLE OF THE HEAD
NURSE

PREPARED BY: JESSICA M. SALDANA., MAN. RN., BSN

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By the end of the lecture, the attendee will be able to:

1. Mention the position and criteria for selection of the head nurse.

2.State the scope of the head nurse role.

3, List problems arising from the traditional organization of service.

4. Explain the head nurse's role in Staff utilization, supervision, and

development.

5.Discuss the relationship of the head nurse to other service personnel.

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By the end of the lecture, the attendee will be able to:

6. Explain the role of the head nurse in the management of patient care (implementation
nursing process).

7. Differentiate between head nurse roles in traditional and progressive organization patterns.

8. Differentiate between the role of the unit manager in subordinate, peer, and superior
relationships to the head nurse.

9. Apply the role of the head nurse in student clinical experience
Utilize principles of management in planning organization and implementing head nurse role

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OVERVIEW: ZA

ROLE OF THE HEAD NURSE : PATIENT, STAFF,
AND UNIT MANAGEMENT

5. is a professional nurse who is responsible for the
management of the nursing services in a single

nursing unit.

6. SP Je ur” D
THE HEAD NURSE"S ROLE

1. The management position of the head nurse:
The head nurse in the hospital setting fills first-line management (Fig 1), which is
viewed as a virtual position and an essential link in the health care organization.

TOP- LEVEL MANAGEMENT
(Nurse Director of nursing department)

MIDDLE-LEVEL MANAGEMENT
(Nurse Supervisor)

FIRST-LEVEL MANAGEMENT
(Head Nurse)

FIG (1): NURSING MANAGEMENT LEVELS. (Jones and George: 2003)

7. Il. CRITERIA FOR THE SELECTION OF
THE HEADNURSE

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Dr. Samir Abbas Hospital

CRITERIA FOR THE SELECTION
OF THE HEADNURSE:

The selection of the head nurse to fill
the first-level nursing position in the
nursing service department affects both
the effectiveness and efficiency of the
nursing services and health care
organization.

The selection of the head nurses should
be based on the following educational,
professional, and personal
qualifications:

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1. EDUCATIONAL QUALIFICATIONS:

| | Bacehlor of Science in Nursing

2. PROFESSIONAL QUALIFICATIONS:

Currently licensed to practice as a professioanal nurse.

-2 to 5 years of experience in an area of clinical nursing, with at least one year of experience
as a nurse in charge in the nursing unit
-Attended continuing education courses in both nursing management and administration

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-Possess professional qualities essential for leadership role such as:

+ Sound decision-making and communicative skills. a

+ Able to recognize and understand the common individuals’ needs.
+ A member of a professional nursing organization (nursing indicate, nursing
association...)

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Healthy (physically and emotionally).

+ Accept responsibility for continuous self-improvement and professional progress
through maintaining up to -date nursing knowledge and skills development. |

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+ The head nurse is resaponsible for:

* All staff assigned to in-patient care units, including PCA/PCAT, work clerk, and nurse
aids.

+ The head nurse is resaponsible to:
\ *the nurse supervisor, educators and the nurse director.

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The scope of the Head nurse’s can be classified to three main areas:

1.Patient-care management
2. Staff management
3.Unit [Management

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T. PATIENT CARE MANAGEMENT:

+ The HN's main area of
responsibility in the patient care
unit is to make sure that the
patient’s total needs are met, and
that all unit activities are directed

toward this goal.

The HN must possess a body of
scientific knowledge and proper
competencies to be able to utilize

the five (5) steps of the nursing
process in the management of
patient care. |

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Gathering data from patient interviews, physical oye Documentation Tool:
examinations, observation, medical records, STEP SLE ASSESSEMENT Initial assessment form

diagnostic reports & colleagues.

-Making judgments based on assessment data, Teen
-Identifying types of nursing diagnosis STEP “2” NURSING DIAGNOSIS “Nursing Care Plan

-Setting priorities, establishing goals, describing Documentation Tool:

orders and devloping nurse STEP “3" PLANNING “Nursing Care tan

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Applying skills needed to implement nursing

orders Documentation Tool:
-Preparation of nursing actions SAS EATON =Iinursing progress notes

-nursing action -Routine nursing records as VS, | & 0

documentation Insulin Chart
“Shift report

Evaluating client progress through Dre
Evaluation of quality of written plans STEP “5” EVALUATION -Nursing Progress notes

Evaluation of patient's response to the nursing shureing pan
orders or interventions

19. Ividual patient s n

Assessment is a continuous process of collecting,
validating, analyzing, and interpreting information
about the patient to correctly identify his problem
and needs.

X Data gathered from the patient assessment
include physiological, psychological, and social
data and aaaaaahould be accurate as possible.

20. Patient’s health record:
Includes past and present history, reports of &
diagnostic examination, recorded observation on
patient’s response to illness , and the medical and
nursing therapy.

X Shift report:

Help in identifying patient’s conditions and

activities related to their care in the previous

shifts.

SOUS AND METHODS OF COLLECTING INFORMATION: ©

21. SOURCES AND METHODS OF COLLECTING INFORMATION: ©

Nursing Interview: @
Nurses interview the patient and/ or family to
identity:
+ Medical and social history
+ Occupation
+ Level of knowledge and understanding
+ Relationship with others
+ Coping Mechanism.

|, Patient care management:

22. Observation:

The nurse uses the senses of vision, smell, touch,

and hearing for the accuracy of the collected data:
1.Identifying nursing diagnosis:

After collecting data, the head nurse should
categorize them to identify patients' needs and
arrive at a nursing diagnosis.

2. Planning Nursing intervention:
The purpose

23. THE PLANNING PROCESS INCLUDES:

X a. Setting priorities:
e Problems related to survival and safety
e Relief of pain and

© prevention of complications

© coping mechanism

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24. THE PLANNING PROCESS INCLUDES:
X

The identified objectives are short-and long-
term expected outcomes. They must lead change
in patient behaviors, and be directed toward
eliminating or preventing problems, and
measures to cope with them.

25. THE PLANNING PROCESS INCLUDES:

c. Deciding a plan of action (nursing care plan):
+ Physicians’ orders may regulate a nursing
plan of action. |
+ Hospital policies and procedures should be
followed to determine which action will most
help the patient.
+ must consider the availability of equipment
and supplies, facilities, trained staff, time
and patient acceptance to carry out nursing
action effectively.

26. X d. Recording nursing orders:

Nursing actions (Nursing orders) are recorded o
in the form of a nursing care plan or (Kardex) |
which consists of :
+ The general part includes diet, fluids,hygiene...
+ Delegated medical care: investigations,
treatment, and physiotherapy,

e Nursing intervention: e.g. turn patient every
| two hours.

27. X

IMPLEMENTATION PROCESS

3. Implementation of the nursing care plan:
In which the head nurse:-

+ Discuss with the nursing staff the purpose of the plan of
care.

+ Promote cooperation among staff and workers.

+ Report about each patient's condition and problem before
the distribution of assignments and at the end of the shift
(on-duty and off-duty conferences).

+ Ensure continuity of care throughout the 24 hours.

+ Use a nursing care plan as the basis for supervision
and evaluation of patient care.

28. 5

EVALUATION PROCESS:

X 4. Evaluation of Nursing care:

+ The head nurse must be sure that the pre-established
standards are used to evaluate the quality and quantity of
patient care, standards include structure, process, and
outcomes.)

+ The head nurse should share her staff in the evaluation

process which leads to the improvement in the patient's
care and staff development.

29. PRINCIPLES OF EVALUATION:
x |

1.Evaluation tools are based on the hospital's standard

of care stipulated in the policies
2. Based on patient and family feedback.

30. ver À À

31. X A. Staff Utilization: $
The head nurse can utilize the nursing staff members as
follows:

1. Assigns the tasks to staff members with proper authority.
2.Ensures that every member knows: |
-To whom is she responsible?
- For whom is she responsible?
-To whom may she go counseling?
3. Scheduling of staff for their personal requests and moral
issues.

32. X

A. Staff Utilization:
4. Maintain effective working conditions. e.g. preventing
interruption, beginning the day on time, and putting
things in order.

5. Maintain effective means of communication with staff
through planned conferences, written reports, nursing
notes, discussions, and informal teaching.

6. Ensuring that each staff nurse is competent in utilizing
the nursing process.

33. X

A. Staff Utilizati
7. Provides opportunities for staff nurses to learn, and
gain skills while applying the nursing process.

8. Holds staff nurses accountable for implementing the
nursing process.

9. Develop a routine for frequently performed activities eg.,
ordering supplies, carrying out doctor's orders, and
assignment of new patients.

34. X B. Staff Supervision: Oo
1. Supervise the quality of nursing activities by giving
reports, making assignments, and rounds, and conducting @
conferences, and demonstrations.
2. Establish harmonious relationships with the staff and |
encourage the expression of opinions and ideas.
3. Utilizes various supervisory methods such as guidance
and motivation.
4. Educate nursing students and nursing staff through
conferences, rounds, and procedural demonstrations.

35. B. Staff Supervision: Le)
5. Cooperates with clinical instructors to teach nursing
students. @
6. Discovers the leadership and creative abilities among
nursing staff.

x

36. X C. Staff development:
The head nurse can develop the nursing staff's knowledge
and skills through:
1. Setting and utilizing high standards for nursing staff
performance leads to growth.
1.Encouraging nursing staff:
- to participate in planning for the improvement of nursing
care.
- to apply findings of nursing research into practice.
3. Providing the opportunities to seek clinical advancement
and conducting advanced studies.
4. Sharing in planning, conducting, and participation in
training programs.

y

37. X

D. Staff evaluation (performance appraisal): $
It is a periodic evaluation that attempts to evaluate the
the extent to which the individual staff nurses' performance @
meets the pre-determined standards of performance.
The head nurse can evaluate the nurses’ performance |
through:
1. Evaluate nursing staff performance objectively by
maintaining a routine system for their continuous
evaluation to ensure the attainment of objectives.
2. Encourages staff to use staff to use self-evaluation to
determine progress and drawbacks.

38. D. Staff evaluation (performance appraisal): Le)
3. Evaluate the nurse's performance with the purpose of staff
development rather than punishment. @

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4. Conduct an appraisal interview and investigate any |
complaints nursing staff.

39. D. Staff evaluation (performance appraisal): Le)
3. Evaluate the nurse's performance with the purpose of staff
development rather than punishment. @

=<

4. Conduct an appraisal interview and investigate any |
complaints nursing staff.

40. There are two organizational patterns through
which unit management activities (services) can
be achieved: The traditional organizational
pattern, and progressive organizational patterns.

A: The traditional organizational pattern

The head nurse in this pattern is responsible for
most of the unit activities.

-Coordinates activities of many individuals who
perform tasks on the patients unit.

41. -Makes sure that records are kept and reports are ie
made.

-Ensure that supplies and equipment are >

provided. |
-Coordinates unit and hospital administration
with patient care.

42. X 2 PROBLEMS AROSE FROM TRADITIONAL $
ORGANIZATIONAL PATTERNS:
1. lt increases the volume of management œ
functions performed by the head nurse in the |
unit.
2.lt decreases the time spent by the head
nurse in the in-patient care management.

43. X B. Progressive Organization relationship: $
In this system, the hospital began the
reorganization of the patient care unit by
appointing a UNIT MANAGER to relieve the
head nurse from the management activities and
to be responsible for:

a. Coordinating the patient care services.
b. Managing the unit activities.
c. Maintaing of supplies and equipment.

44. The role of the unit manager:

The unit manager has one of the three lines of
relationship to the head nurse, it depends on the
organizational structure of the hospital.
Consequently, his/her role is determined
according to the relationship as follows:

45. X Subordinate relationship with the heart nurse: oO

¢ The unit manager is responsible to the head œ

nurse. |
e The HN is not completely free for nursing

activities and may still carry some r

management activities.

46. X Peer relationship to the head nurse: e

-The unit manager will have a staff that he/she supervises

and directs.

-He/she will be accountable for activities assigned to the |
staff that are accomplished correctly and timely.

-He/She will be responsible for the nursing supervise or or

the hospital administrator:

The manager and the head nurse are in relationship with

one another which allows the head nurse to be free from

increased management functions and carry out coordination
of the patient care management.

47. X

+ Superior relationship to the head nurse: $
-In this relationship
The unit manager is one of the hospital’s assistant
administrators and he/she is responsible for department of unit
management. |
-All heads of services on the unit; nursing, medical, dietary and
house keeping are administratively responsible to the unit

manager.
-This system permits the head nurse to engage in professional
practice and use her experience in developing herself and
herself.

48. X * although the unit manager is responsible for air

management activities to be carried out in the nursing
units, the head nurse must be familiar with thea
administrative methods, since she is in charge of this unit

and patient care services. |

49. 1. Clerical Responsibilities

a. Transcribing medical b. Assembling c. Preparing administrative
transcriptions records reports.

d. Handling telephone
messages.

e. Reception of visitors, messages,
and staff from other departments.

50. 1. Clerical Responsibilities
a. Transcribing medical
transcriptions

1. Checks the orders for diet and medications,
2.Establishes a routine for filling and handling prescriptions. |
3.Gives special instructions in medical terminology and in handling

medical prescriptions.

51. e CHECKS THE
ORDERS FOR
DIET AND
MEDICATIONS

e ESTABLISH A ROUTINE
FOR FILLING AND
HANDLING
PRESCRIPTIONS.

GIVES SPECIAL
INSTRUCTIONS IN
MEDICAL TERMINOLOGY
AND IN HANDLING
MEDICAL PRESCRIPTIONS.

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THE UNIT CLERK HAS FOUR FUNCTIONS
RELATED TO THE ORDER BOOK REQUEST:

+ Notifies nurses when a new prescription is written.
+ Keeps track of outdated prescriptions.

+ Reports to the head nurse if there are missing
prescriptions (diet, sedatives, etc.)

+ Orders for equipment needed to carry out new
prescriptios.

53. 1. Clerical Responsibilities

b.Assembling clinical records

1.This involves keeping charts ready for new patients, adding sheets
to patient's records when necessary, making sure that each sheet
contains identifying data , and filling report such as laboratory, X-

ray , ECG, etc...

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1. Clerical Responsibilities
c. Interdepartmental reports:

1.Reports on the census, patients admitted or to be discharged and
patients’ condition are sent daily on a special form to offices that
need this information,

2.Legal reports( accidents, complaints, etc.,) evaluation reports, time
schedules, shifts and reports between the director of nursing and
the unit are all the responsibility of the head nurse. She is

responsiblefor the accuracy and promptness of the reports.

55. 1. Clerical Responsibilities
d. Handling telephone
messages:

1.The unit manager or unit clerk is responsible for the activity. He/
She needs to know the hospital routines, the departments to be
called for information or to obtain equipment, and the way these
departments function. HE/SHe has to be knowledgeable to handle
telephone messages.

56. 1.Clerical Responsibilities
GUIDELINES FOR TELEPHONE REPOR
1. Identify both yourself and the clinical site clearly.
2.Use a natural tone and volume of voice.
3. Listen carefully and courteously.
4.Write done pertinent information.
5.Report important information (Such as laboratory reeslts, or
medication order) to ensure accuracy.
6. Verify the instruction by reading it back to the physicians clearly
and previouslywhen accepting verbal orders.
7.Write the informationthe appropriate location sin the record and
sign it.
8.Do not divulge confidential information about the patient unless
your sure the caller has a legitimate right to acces:

57. 1.Clerical Responsibilities

E. Reception of visitors:

+ The head nurse and the unit manager observe and manage the in-
flux of the visitors.

+ The unit clerk is taught the importance of customer relations.

+ The same manner is encouraged with porters.

+ He /She Manages and assigns personnel to control the congestion

in corridors and work rooms.

58. 2. Maintenance of supplies and equipment:

1.These are activities that involve ordering, handling, storage, and
maintenance of supplies and equipment. These are non-nursing
activities but were done by nursing staff and recently a ward clerk
assumed this responsibility Various departments that supply the
unit-laundry, central supply, pharmacy, and laboratory send
representatives to the units to make up and deliver orders
according to a standard. Modern rapid transportation systems
(tube system or dummy) allow delivery of medical supplies in a very
short time and do not necessitate storage of sterile items in the

unit. When such systems are not available, considerable storage

space is needed with cabinets for linens, medications.

59. care

2. Maintenance of supplies and equipment:

The unit manager or clerk is responsible for making the
requisitions and for checking the delivery and inventory.

Unit aides are responsible for caring for used equipment and
waste, for collecting, washing, and filling water pitchers.
they work under the supervision of the unit manager or clerk.

60. 3. Dietary and housekeeping services:

When dietary and housekeeping services are decentralized, supervision
at the unit level is the manager's responsibility A unit manager dietitian
is assigned to the unit or several units and the manager supervises tray
service and the dietary aides. If a housekeeping supervisor is assigned
to the unit he/she will be part of the unit managers’ staff. IF dietary
and housekeeping services are central services, they usually employ,
train, and assign the workers to the unit. Their supervisors serve as
consultants for the uni manager.

61. 4. Coordination of patient care services.

The objective of the unit manager or clerk is to keep the activities of
the unit functioning smoothly to facilitate medical and nursing care.
-equipment, linen, drugs, and supplies of all kinds must be in the right
quantity and ready for use at all times in the hospital unit. If these
goals are to be achieved, routine time for their accomplishment must
be established, and procedures for taking inventory and ordering
supplies must be devised . Also, the coordination of patient care
services of relevant health service departments must be achieved.
-Laboratory reports and operative permits are assured for patients
going to surgery (consent is filled in the presence of the physician or
the head nurse.)

62. 4. Coordination of pati

+ Discharge orders are prepared and outdated prescriptions are called to the
physician's attention.

+ Plumbers and electricians are called when needed and at a time decided by the
unit manager or clerk so they will not interfere with the patient's rest of the work
of staff.

+ Nursing staff are informed of patients’ appointments to other departments so that
the patients will be ready.

+ The whereabouts of the patient are known at all times through some kind of

recording device.

The unit manager or clerk makes sure that all messages are delivered and keeps

the machinery running. He/She notifies the head nurse of problems or

irregularities that will affect the patient’s welfare and makes no decision relative
to patient care.

63. + The unit manager or clerk is responsible for requisitioning or reporting needed
small repairs such as dripping taps, broken doors, light bulbs, and hard-to-open
windows. loose tiles and all staff help with this process. Nursing staff usually
discover the repair needs and report them to the unit manager or clerk.

Usually, there is a repair list that includes repairs required for wheelchairs,beds
and equipment. The list is prepared by the unit manager or clerk and he/ she
hangs it on the clipboard in the unit. The workers from the maintenance
department come and complete the work noted.

The unit manager or clerk makes rounds to make sure that the work is completed.
although a unit manager or clerk is responsible for all the administrative activities
to be carried on the hospital unit, the head nurse must be familiar with

administrative methods-sinca.she.is-in.charga af nursing-and patient care sanicas.

64. SP nme
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