NRS 204 ADVANCE NURSING MANAGEMENT

FINAL EXAM / PROJECT

HEALTH INSTITUTION MANAGEMENT ANALYSIS

1. I. Introduction

Sta. Clara de Montefalco Medical Center, formerly known as North Diversion
Emergency Hospital, opened in 1998 and was founded by the late Engr. Theodore
Dijamco. Located at Malhacan in Meycauayan, Bulacan, this 100-bed capacity, private
tertiary hospital provides diagnostic services as well as medical and surgical procedures.
It renders clinical services that include: medicine, surgery, pediatrics, obstetrics-
gynecology, otorhinolaryngology, ambulatory medicine (OPD), rehabilitation medicine,
and emergency medicine. Ancillary services are: pathology (clinical, surgical and
cytology), radiology, pharmacy, blood bank, cardiopulmonary laboratory, GIT-liver study
unit, and an endoscopy unit.

In 2008, the College of Nursing was established, providing rich clinical
experience to nursing students on the basis of the diversity of clinical cases, the
competence of the health care professionals and its facilities. The medical center has
served hundreds of patients in the last 16 years, and has produced a number of
specialists, with many becoming leaders in the different fields of services.




II. Mission and Vision Statement

MISSION
To assure the continuous development and advancement of its medical and
paramedical staff through scientific training and continuing medical and paramedical
activities.
To serve as a referral center for special diagnostic, medical, and surgical
services for nearby towns, cities, and provinces in the area, by providing them the
services of highly advanced and sophisticated equipment and instruments as well as the
services of various specialist and sub-specialists in the various fields of medicine and
surgery.
To undertake research studies and activities that could help contribute to the
advancement of medicine, and ultimately benefit its medical staff and patients.
To participate in civic-oriented activities geared towards helping the less
fortunate patients in our locality as well as in the nearby areas.

VISION
To render the highest quality of affordable patient care comparable, if not better, than
most tertiary medical centers in Metro Manila and other urban areas in the country.

Core Values
Service excellence
Competency
Teamwork
Dedication

III. Organizational Structure (Organization Chart)



Board of Trustees
President / Chairman of the Board
Medical Director / Administrator
Assistant Director
for Medical Services
Medicine
Surgery
Obstetrics /
Gynecology
Pediatrics
ENT
Anesthesia
OPD
Radiology
Ultrasound
Pathology
Laboratory
Dental Medicine
Pharmacy
Dietitian
Social Services
Medical Records
Assistant Director
for Administration
Personnel
Finance
Supply
Inventory
Marketing
Audit
Waste
Management
Security
Engineering /
Maintenance
Housekeeping
Linen Laundry
Admitting
Information
Communication
Ambulance
Assistant Director
for Nursing Services
Non-Critical
Care
Medical
Ward
Surgical
Ward
Pediatric
Ward
OB Ward
Orthopedic
Ward
Special
Care
OR/DR
Complex
Nursery
NICU
Critical
Care
ER
Intensive
Care
Intensive Care
IV. The Nursing Service / Unit
Nursing Service Organizational Chart




















President
Medical Director
Chief Nurse
ER/CP-Lab/Dialysis
Supervisor
ER Head Nurse
CP-Lab
Head Nurse
Dialysis
Head Nurse
ER Staff Nurse
CP-Lab
Staff Nurse
Dialysis
Staff Nurse
OR/DR/NICU
Supervisor
OR/DR
Head Nurse
NICU
Head Nurse
OR/DR
Staff Nurse
NICU
Staff Nurse
Ward/ICU
Supervisor
Ward Head Nurse
ICU Head Nurse
Ward Staff Nurse
Nurse Aid
ICU Staff Nurse
a. Number of people employed under Nursing service

As an integral part of the Sta. Clara de Montefalco Hospital, the Department of
Nursing Service is responsible for providing quality patient care and supports the
objectives of patient care, teaching, and research. The department has a total of 50
personnel, from the Chief Nurse to Nurse Attendants.

Positions:
1. Chief Nurse
2. Assistant Chief Nurse
3. Supervisors
a. ER / CP-Lab / Dialysis
b. OR / DR / NICU
c. Ward / ICU
4. Head Nurse
5. Staff Nurse
6. Nurse Attendant

b. Brief description of the roles /position / job description of each member of the
unit.

Position title: Head Nurse, General Ward
Duties and Responsibilities:
1. Ensures all patients are admitted promptly and safely to the nursing unit.
2. Sees to it that patients and relatives are given proper orientation on specific
hospital policies and procedures.
3. Makes patient rounds and sees to it that all patients in the ward get the
necessary care.
4. Sees to it that all equipments are in order and properly kept and supplies are
available.
5. Checks and countersigns recording done by staff nurses.
6. Coordinates ward activities in the administration of nursing service with all other
hospital services.
7. Directs and supervises activities of non professional workers in the ward.
8. Participates in the orientation of new staff.
9. Represents her ward in the nursing service meetings and other hospital meetings
when necessary.
10. Acts as supervising nurse when so delegated.
11. Renders direct nursing care if the unit is understaffed.
12. Supervises cleanliness and orderliness of the ward.
13. Provides / maintains adequate facilities, equipment, and supplies necessary for
good patient care of the unit.
14. Establishes, promotes, and maintains good interpersonal relationship.
15. Evaluates nursing staff in the unit, and gives them assignments according to their
capacity.
16. Identifies nursing problems in the ward.

Position title: Staff Nurse, General Ward
Duties and Responsibilities:
1. Admits patient.
2. Gives direct nursing care.
3. Assists patient in moving, maintaining proper alignment of patients body, and
utilizing good body mechanics.
4. Takes and record vital signs.
5. Observe medical asepsis.
6. Observe and responds to patients emotional and spiritual needs.
7. Prepares patient for and assist physician with diagnostic and therapeutic
procedures.
8. Carries out doctors orders.
9. Assist physician when examining patients.
10. Performs post mortem care.
11. Discharge patients.
12. Acts as senior nurse when delegated.
13. Receives and endorse ward equipment and supplies.
14. Gives health teachings.

Position title: Head Nurse, OR/DR
Duties and Responsibilities:
1. Assumes responsibility of the nursing care needs of patient at operating room.
2. Demonstrate and teaches other members as team on special techniques in the
operating room.
3. Sees to it that all equipment is in order and properly kept supplies available.
4. Makes weekly schedules and assignment of staff.
5. Checks and countersigns recording done by staff nurse.
6. Represents her area (OR/DR) in the nursing service meetings and other hospital-
related meeting when necessary.
7. Acts as supervising nurse when delegated.
8. Supervise cleanliness and orderliness of OR.
9. Establishes, promotes and maintains good interpersonal relationship.
10. Acts as a liaison between patient and members of the health team.

Position title: Staff Nurse, OR/DR
Duties and Responsibilities:
1. Gives direct nursing care.
2. Identifies nursing need of patient.
3. Plans, gives, and evaluates nursing care.
4. Received patient from other department (ER/Ward/ICU) taking note of the initial
medical management given.
5. Prepares and checks medication and instruments needed.
6. Assist the surgeon in operation.
7. Acts as a liaison between patient and hospital personnel.
8. Interprets to the patient and his family their roles in promoting successful therapy
and rehabilitation.
9. Carries out doctors legal orders.
10. Administer and chart medication and patients reaction to the medication.
11. Endorse patient properly to other area.

Position title: Head Nurse, ICU-CCU
Duties and Responsibilities:
1. Direct supervision of patient care, as guided by established policies, procedures,
and work standards.
2. Organization of staffing and workload distribution to ICU/CCU.
3. Immediate problem solving and decision making on patient care.
4. Ensure that all patients are admitted promptly and safely to the ICU.
5. Counterchecks plans for patient care and sees to it that these are properly
implemented.
6. Handles overall orientation of newly hired nursing personnel.
7. Handles immediate concerns and complaints of doctors, patients, and family
members.
8. Coordinates closely with various sections/units to ensure smooth and systematic
delivery of patient care.
9. Performs thorough inspection of patients charts, kardexes, and medication cards
to ensure accuracy and completeness of all nursing intervention.
10. Assist the clinical instructor, prepares students assignments for their clinical
experience and assist in the evaluation of their performance.


Position title: Staff Nurse, ICU-CCU
Duties and Responsibilities:
1. Admits patient promptly and safely to the ICU.
2. Completes a head to toe physical assessment and social assessment of patient
upon admission.
3. Develops a written care plan upon admission, review and update daily.

Position title: Head Nurse, NICU
Duties and Responsibilities:
1. Direct supervision of patient care as guided by established policies, procedures,
and work standards.
2. Monitoring and assessment of compliance to nursing standards and patient care
work processes.
3. Administrative management of the NICU/Nursery department.
4. Organization of staffing and workload distribution.
5. Training and development of nursing staff of NICU/Nursery department.

Position title: Staff Nurse, NICU
Duties and Responsibilities:
1. Gives direct nursing care.
2. Identifies nursing needs of patient.
3. Plans, gives and evaluates nursing care.
4. Performs nursing activities such as routine newborn care.
5. Takes and record vital signs.
6. Observe signs and symptoms, institutes remedial action when appropriate, and
records these in the chart.
Position title: Staff Nurse, Dialysis
Duties and Responsibilities:
1. Describe signs and symptoms, cause or precipitating factors of a renal disease.
2. Indication for a renal hemodialysis/peritoneal dialysis and how it is done.
3. Admits, receives, and categorizes patients (in-patient, out-patient, scheduled,
etc.)
4. Prepares, checks materials, supplies and machine.
5. Assess patients status (using the nursing process) pre and post dialysis, and
report any unquestionable state.
6. Informs and refers to attending Nephrologist ongoing and further clarification of
orders.
7. Maintains safe and therapeutic environment.
8. Observe emergency policies and protocols.
9. Coordinates with other departments.

Position title: Head Nurse, CP-Lab
Duties and Responsibilities:
1. Handle the over-all supervision and management services rendered by the
Cardio-Pulmonary Laboratory.
2. Performs functions of a Respiratory Therapist.
3. Conducts patient rounds to monitor status of patients condition and assess
efficiency of cardio-pulmonary care rendered to patients.
4. Supervises and counterchecks accuracy of CP procedures carried out by
respiratory therapists. Ensures all interventions are in conformance to policies
and standards.
5. Reinforces health care instructions given to patients and relatives.
6. Counterchecks documentation and notations made by the respiratory therapist in
the flow sheet and patients chart.
7. Coordinates with the attending physician, resident on duty, head nurse concerns
as regards to overall plan of management of patients with pulmonary care.

Position title: Nursing Attendant
Duties and Responsibilities:
1. Check and receives articles from outgoing aide.
2. Accounts for all linens during her shift and endorses them to the nursing aide of
the next shift.
3. Attends morning rounds with the nurses.
4. Assists in giving baths to ambulatory patients.
5. Gives/performs simple treatment like perineal care, soap suds enema.
6. Measures fluid intake and output.
7. Take and chart vital signs when delegated.
8. Provides clean linen and orderliness of the patients unit at all times.
9. Removes all used or discontinued equipment from patients areas and returns
them to the utility room.




c. Type of duty hours / schedule of work shift

The Chief Nurse and Assistant Chief Nurse works on weekdays, with an 8-hour
per day schedule. All remaining nursing personnel works on a shifting schedule (6am-
2pm, 2pm-10pm, 10pm-6am) rendering 8 hours per day or 40 hours per week.

d. Type of Nursing Care Modality

To provide a structure that enables nurses to render nursing care to a specified
group of patients, an efficient care delivery system should be implemented in a unit or in
the institution. This includes assessment of the care needs, formulation of a care plan,
implementation of the plan, and evaluation of patient outcomes to the intervention
(Sullivan & Decker, 2009). There are four common nursing care models: functional
nursing, team nursing, primary nursing, and case management nursing.

The hospital uses the functional nursing approach, wherein members of the unit
are practicing within their scope of care, or as delegated by the registered nurse. The
registered nurse would perform assessments, administration of medications and blood
products, care of patients central lines, etc. Nursing aids would be in charge of the
linens, providing and assisting in patients personal care, etc.

e. Leadership Style

Effective leaders acquire a pattern of learned behavior according to behavior-based
theories (Sullivan & Decker, 2009). The four patterns or style of leadership are:
autocratic leadership, democratic leadership, laissez-faire leadership, and bureaucratic
leadership.

Sta. Clara de Montefalco hospital has a democratic leadership style, wherein
employees are allowed to take part in the goal setting and decision making process.
Staffs are given responsibility, accountability, and feedback regarding their performance.
Professional growth and advances is also encouraged.



V. In-service Staff Development Program

New nursing practices and technology requires dynamic education to enhance
staff performance (Sullivan & Decker, 2009).

Updates regarding waste management and infectious control are disseminated,
headed by the Chief Nurse, on a regular basis. Seminar on breastfeeding methods are
conducted once a year (every April) to NICU nurses to enhance their knowledge
regarding the said topic. Nutrition topics and issues are also discussed amongst nurses
on a quarterly basis, as part of the Nursing Services role in health education. There is
also an ongoing training program of nurses for ICU-CCU nursing done semi-annually to
enhance the competencies of nurses.

VI. Performance Appraisal

Performance appraisals are conducted to give constructive feedback, serve as a
basis for administrative decisions, and for issues concerning fair employment practice
laws (Sullivan & Decker, 2009).

In Montefalco hospital, performance reviews are given to probationary staff as
well as regular employees on a bi-annual basis. A sample of the appraisal form can be
seen on the Attachments.

VII. Quality Awards / Recognition of the Institution

Sta. Clara de Montefalco received various awards and recognition over the
years, the most recent was the Mother-Baby Friendly Hospital given by the Department
of Healths Center for Health District III on October of last year. The hospital was also
recognized for its participation in Online Electronic Injury Surveillance, conducted last
year by the Department of Health.


2. Strengths and Weaknesses of the Institution

STRENGTH WEAKNESS

1. Competent, flexible and efficient
nursing personnel linked to exposure
to various medical and surgical cases.

2. Staffs are evaluated twice a year.

3. Good work innovations and creative
work atmosphere.

4. Volunteer nurses are being trained
periodically.

5. Cost of hospitalization is rather low
and affordable compared to other
hospitals nearby.

6. Wide variety of services is offered,
from diagnostic procedures to
medicine and surgery concerns.

7. Hospital is located near the North
Luzon Expressway, making it
accessible to clients from parts of
Metro Manila and nearby provinces
(Bulacan, Pampanga).


1. High turnover rate of nursing
personnel.

2. Rewards and recognition for nurses
are insufficient.

3. A resource for development is
lacking.

4. Units are understaffed.

5. Information dissemination regarding
the hospital and its services is not
adequate.

6. There are 6 other hospitals in the
area.


3. Conclusion

Nurse managers today are given a challenging task to manage with decreasing
resources, to help design new systems of care, to supervise teams of professionals and
non-professionals from a variety of cultures, and finally, to teach personnel how to
function well in the new system. Nurses and managers should be committed, involved,
enthusiastic, flexible, and innovative; above all else, they required to have good mental
and physical health. Because the nurse managers of today are responsible for others
work, the nurse manager must also be coach, teacher, and a facilitator. The manager
works through others to meet the goals of individuals, of the unit, and of the
organization. Most importantly, the nurse manager must be a leader who can motivate
and inspire.

Sta. Clara de Montefalco is an institution that, despite of limited physical
resources, still manages to provide quality health services to its client. This can be
attributed to the competent nursing personnel, rendering efficient and effective nursing
care, which is considered the core business of any health institution. The spirit of
competition has also led Montefalcos managers and staff to become more and more
customer-oriented in their decisions.


4. Recommendations

There is a need for improvement on the physical settings of the hospital, as it is
not very conducive for health restoration and recovery, considering this is a privately-
owned establishment. Providing intensive staff training, equipment maintenance and
repair of facilities should also be done to attain economies of scale. Lastly, the
management should take advantage of its proximity to possible clients by advertising
and increasing information dissemination about the institution.


5. Bibliography / References Cited

Sullivan, E.J. & Decker, P.J. (2009). Effective Leadership and Management in
Nursing 7
th
Edition. Pearson.

6. Attachments

a. Job description
b. Appraisal form













ATTACHMENTS







ANGELES UNIVERSITY FOUNDATION
Graduate School
Angeles City








NRS-204 ADVANCE NURSING MANAGEMENT
Final Examination

In partial fulfillment of the requirements in Advance Nursing Management
3
rd
Trimester AY 2013-2014




\






Submitted by:
Jericho S. Javier, R.N.


Submitted to:
Dr. Debbie Q. Ramirez


05 June 2014