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I.

PRACTICES

A. Brief history of the institution

The Rafael Lazatin Memorial Medical Center (Ospital Ning Angeles) was
founded on June 19, 1965. It was then known as the Angeles City General
Hospital. The hospital first operated in a hotel building that was converted
into a hospital in Barangay Balibago. It was later transferred to Barangay
Pampang and was situated near the Bank of the Abacan River.

During the eruption of Mount Pinatubo at the height of a typhoon in


June 15, 1991, the hospital building, equipment, and records were swept
away by lahar and floodwaters. Hospital operations were then conducted at
the city parish hall, then at Clinica Henson and later at the Pampanga
Medical Specialist Center building along MacArthur Highway.

On August 22, 1995 the hospital war renamed OSPITAL NING ANGELES
with the approval of City Council Resolution No.175-08, S-95

And on September 11, 2006 an Ordinance No 197, S-2006 was


approved renaming Ospital Ning Angeles to Rafael Lazatin Memorial Medical
Center (RLMMC) in honor of the late Honorable Mayor and Governor Rafael
Lazatin.

On March 25, 1995, the hospital operations transferred to its present


site in Visitacion st. cor. Pampang Road, Villa Rosario, Barangay Pampang.
The United States Agency for International Development (USAID) donated
the 1,800 square meter building. It was built on a city government lot
measuring more than a hectare. The World Medical Relief of Michigan, U.S.A
Donated many of its equipment and instruments at that time.

During a visit of His excellency President Joseph E. Estrada in October


1998, he pledged Php20,000,000.00 to finance the expansion of the hospital
building and the acquisition of medical equipment. On May 25, 2000, the six
additional wards were inaugurated. The floor area of these wards measured
around 1,300 square meters. The additional space relieved the congested
conditions at the wards, lobby and hallways.

The Operating Room Complex was named Auberlin Hall after Irene M.
Auberlin, founder of the World Medical Relief. The new Pediatric building was
named Rafael L. Lazatin Building after former Pampanga Governor and
Angeles City Mayor. The rest of the new wards were collectively named
Ospital ni Erap Para sa Mahirap Wing.

On June 2004 an additional building was constructed donated by the


Office of Senator Juan Flavier. It has twelve wards beds whrein patients
which need to be isolated, are being accommodated.

In 2006, several alterations were made for the improvement of


facilities through the efforts of the Rotary Club of Clark Centennial inviting
other NGO’s to finance the needed improvements. The Presidential
Management Staff (PMS) also contributed Php1,000,000.00 for other
renovations of the hospital building.

RLMMC (ONA) has an authorized bed capacity of 120 as approved by the


Department of Health. The Surgical and Medical Wards have eighteen beds
each including those in four semi-isolation and two isolation rooms. The
Medicare Wards has twelve ward beds (the newly-constructed building
donated by the Office of the Senator Juan Flavier is now being utilized as
Medicare Wards). The OB-gyn ward has twenty one beds, including one in
the isolation room. The previously utilized Medicare ward (with fourteen
ward beds and four isolation rooms) is being utilized as additional ward for
OB patients. The Pediatric Ward has nineteen ward beds and four beds in
the four isolation rooms.

The two Neonate Intensive Care Units have fourteen cribs

There are ten private air-conditioned rooms


The Labor and Delivery Rooms are located near the Operating Room
and NICU. There are three Operating Rooms and a single Recovery Room.
There is one Minor Room inside the Operating Room Complex.

RLMMC (ONA) is licensed as a first level referral (secondary level)


hospital by the Department of Health. The medical services include the
following specialties: general, orthopedic, and neurological surgery, internal
medicine and pulmonary, pediatrics, OB-GYN, anesthesia, ophthalmology,
otolaryngology, radiology, clinical pathology, ultrasound, and family
medicine.

The emergency, operating and delivery rooms, laboratory, pharmacy


and central supply, radiology, ambulance, and the admitting, cashier and
billing services operate twenty four hours a day.

UNICEF has recognized RLMMC (ONA) as a Baby-Friendly hospital. It is


also accredited in the Newborn Screening Program of the National Institute of
Health. The Philippine Health Insurance Corporation OWWA, and PVAO
accredit ONA as a service provider. It is a member of the Philippine Hospital
Association. The residency in Family Medicine is accredited by the Philippine
Academy of Family Physicians.

B. Roles that manager fulfill in organization

Chief Nurse

1. Plans, directs, and controls various activities of the Nursing Services


that are related to quality assurance, excellent patient care, diligent
and accurate chart completion, use and care of equipments and
supplies, continuing professional education and training, personnel
hiring, distribution, promotion, and assignment of tasks, and
maintenance of clean and orderly in-patient areas.

2. Supervises the performance of the task by the housekeeping, ward


clinical, and ward utility workers.
3. Reviews and approves duty schedules of Nursing Services personnel.
4. Endorses approval/disapproval of leave application of subordinates.
5. Receives complaints against Nursing Services personnel, conducts
initial investigation, and submits preliminary reports to the office of the
Hospital Director.
6. Submits request for the equipment, instruments, and additional or new
supplies.
7. Conducts staff meetings, initiates in-house training, and seminars.
8. Submits recommendation to further improve nursing and hospital
services.
9. Sees to the observance of the hospital and nursing policies and
procedures.
10. Updates the Nursing Census Board.
11. Promotes breastfeeding and family planning programs and
observance of hospital rules by patient and their relatives.
12. Conducts daily rounds in all nursing areas noting and addressing
concerns of patients, nursing, and medical staff, and other hospital
personnel.
13. Promotes smooth interpersonal relationship between the Nursing
Services Staff and the patients and their relatives.
14. Answer referrals from duty nurses even after office hours.
15. Coordinates with other hospital units and government offices or
community organizations for mutual concerns.
16. Sees to the proper performance appraisal of Nursing Services
personnel and their evaluation for promotions.
17. Assesses the efficiency and effectiveness of the Nursing Services
and recommends measures to further improve the organization.
18. Prepares the data for the monthly Nursing Audit and Quality
Assurance Program meetings.
19. Does other task assigned from time to time.
Assistant Chief Nurse, Nursing Area I

A. Administrative Management
1. Evaluate the performance of Nurse Supervisors and Head Nurse and
participate in the validation of performance evaluations of lower
ranked nurses.
2. Orients newly employed Nursing Services personnel and provides them
with their needed training.
3. Sees to the observance of Hospital and Nursing Services policies and
procedures.
4. Prepares duty schedule of all subordinates.
5. Assist the Chief Nurse in conducting preliminary investigation of
complaints against or made by Nursing Services personnel.
6. Conducts meetings, in-house training and seminars.
7. Compliments the efforts of the Chief-Nurse in promoting good
interpersonal relationships between the Nursing Services personnel
and the patient and their relatives.
8. Sees to the punctual submission of Daily Time Records by subordinates
and coordinates with the Personal Service with problems regarding
this.
9. Assist the Chief Nurse in supervising housekeeping, ward clinical, and
ward utility workers.
10. Suggest to the Chief Nurse measures to further improve the
Nursing Services.
11. Helps the Chief Nurse to prepare the monthly Nursing Audit and
Quality Assurance Reports.
12. Reports to the Chief Nurses cases of personnel who needs
counseling and join the former in the counseling session.
13. Notifies the Supply, Maintenance, and other hospital units for
their services.
14. Coordinates with the Security Service for the authorization
presence of persons in the Nursing 1 areas and for other immediate
security concerns.
15. Enters the data concerning Area1 in the Nursing Board in the
absence of the Chief Nurse
16. Coordinates with the other hospital personnel for mutual
concerns.
17. Receives leave applications from Head Nurses and disallows or
endorses them to the Chief Nurse.
18. Does other task assigned from time to time.

B. Supervision of Nursing Care


1. Randomly reviews nursing entries in the patients’ charts and discusses
these with the concerned nurses as needed. Nursing entries include
among others the Admission and Discharge Record, nurses’ notes,
medication and other charts, etc.
2. Routinely inquires about patients who are unable to buy medicines,
unable to have diagnostic procedures done, and/or have no watchers.
Refers these patients to the Social Services.
3. Promotes breastfeeding and family planning programs and reports to
the Chief Nurse violations of policies regarding them.
4. Provides nursing care as needed.

Assistant Chief Nurse, Nursing Area II


The following duties and responsibilities all pertain to Nursing Area II
operations and activities.
A. Administrative Management
1. Evaluate the performance of Nurse Supervisors and Head Nurse and
participate in the validation of performance evaluations of lower
ranked nurses.
2. Orients newly employed Nursing Services personnel and provides them
with their needed training.
3. Sees to the observance of Hospital and Nursing Services policies and
procedures.
4. Prepares duty schedule of all subordinates.
5. Assist the Chief Nurse in conducting preliminary investigation of
complaints against or made by Nursing Services personnel.
6. Conducts meetings, in-house training and seminars.
7. Compliments the efforts of the Chief-Nurse in promoting good
interpersonal relationships between the Nursing Services personnel
and the patient and their relatives.
8. Sees to the punctual submission of Daily Time Records by subordinates
and coordinates with the Personal Service with problems regarding
this.
9. Assist the Chief Nurse in supervising housekeeping, ward clinical, and
ward utility workers.
10. Suggest to the Chief Nurse measures to further improve the
Nursing Services.
11. Reports to the Chief Nurses cases of personnel who needs
counseling and join the former in the counseling session.
12. Notifies the Supply, Maintenance, and other hospital units for
their services.
13. Coordinates with the Security Service for the authorization
presence of persons in the Nursing 1 areas and for other immediate
security concerns.
14. Enters the data concerning Area II in the Nursing Board in the
absence of the Chief Nurse
15. Helps the Chief Nurse to prepare the monthly Nursing Audit and
Quality Assurance Reports.
16. Coordinates with the other hospital personnel for mutual
concerns.
17. Receives leave applications from Head Nurses and disallows or
endorses them to the Chief Nurse.
18. Does other task assigned from time to time.

B. Supervision of Nursing Care


1. Randomly reviews nursing entries in the patients’ charts and discusses
these with the concerned nurses as needed. Nursing entries include
among others the Admission and Discharge Record, nurses’ notes,
medication and other charts, ER Logbook, ICU Medicine/ Supply Stock
Card, etc.
2. Routinely inquires about patients who are unable to buy medicines,
unable to have diagnostic procedures done, and/or have no watchers.
Refers these patients to the Social Services.
3. Promotes breastfeeding and family planning programs and reports to
the Chief Nurse violations of policies regarding them.
4. Provides nursing care as needed.

Nursing Supervisor, Nursing Area I and II


The following duties and responsibilities pertain to Nursing Area I and II
activities.
1. Monitor and realigns, as needed, the available nursing personnel
during her shift and keeps a record of absences. Submit the Chief
Nurse a weekly report of absences.
2. Monitors the proper labeling of IVF and rate of infusion
3. Periodically checks the cleanliness of the in-patient areas particularly
vacant beds/cubicles and rooms, comfort rooms, and dishwashing
areas. Notifies the housekeeping workers as needed.
4. Inspect Nurse Station for their orderliness, availability, and safe
keeping of instruments, equipments, and supplies. Calls the attention
of the Head of Charge Nurse for deficiencies.
5. Randomly talks to patients and their families assessing their
sentiments about the Nursing and Medical Services and the hospital as
a whole. Keeps a record of these dialogues and recommends to the
Chief \Nurse measures to address negative sentiments.
6. Informally assesses the morale, competency, and attitudes of nursing
personnel with regards their hospital work. Submits a corresponding
weekly report to the Chief Nurse.
7. Randomly review patients’ charts for completion of doctor’s orders
especially referrals, diagnostic and laboratory examinations,
medications, and various kinds of monitoring.
8. Keeps a record of untoward incidents and decides whether to notify the
Chief Nurse or the Senior House Officer immediately or later.
9. Assist or guides nursing personnel with difficult task and addresses
nursing problems encountered during her shift.
10. Monitors the efficient and effective performance of task of duty
nursing personnel.
11. Sees to the adherence of Nursing and Hospital Policies and
Procedures by everyone concerned.
12. Sees to it that unoccupied rooms are locked and not being used
by any person.
13. Renders Nursing Care as needed.
14. Sees to the proper released of corpses to funeral parlors.
15. Coordinates and assist clinical instructress of affiliated nursing
and allied course s and monitors their activities. Reports to the Chief
Nurse any problems in their scope of activities.
16. Coordinates with the Security Guard violations in visiting hours,
number of watchers, unruly behavior, and other security concerns.
17. Coordinates with other hospital personnel for mutual concerns.
18. Assist ER Nursing Service personnel during busy hours.
19. Sees the proper distribution of patients confined at the pay
Wards to economize on energy consumption.
20. Does the task of checking if the oxygen tanks for disposal are
completely empty if the Chief Nurse is absent.

Head Nurse, Nursing Station I


1. Helps her subordinates in providing nursing care to patients and
accomplishing nursing tasks.
2. Sees to the completeness of entries to patients’ charts at all times.
3. Inspects the availability or completeness of supplies, instruments, and
equipment in station; request for and receive these items.
4. Notifies the Medical and Office Equipments Technician for defective
instruments and equipment.
5. Sees to the cleanliness of wards, windows, toilets, mattresses, and the
orderliness of its files and forms.
6. Sees to the cleanliness of the station, its instruments and equipment,
and orderliness of its files and forms
7. Secure the morning laboratory results and distributes it among the
staff nurses for posting in the patients’ charts.
8. Reminds staff nurses about giving medications, administering fluids,
and referring patients to physicians on time.
9. Collects and signs daily time records of subordinates and forwards
these to the Personnel Service; sees to the prompt submission of these
by subordinates.
10. Assists the Assistant Chief Nurse, Area I in making the schedule
of duties of her subordinates.
11. Receives applications for leave filed by subordinates and
recommends its approval/disapproval to her superior.
12. Submits performance appraisal of her subordinates to Assistant
Chief Nurse every four months.
13. Monitor complaints and comments of patients and their relatives
and relays these to the Chief Nurse.
14. Sees to the observance of Hospital and Nursing Policies and
Procedures.
15. Assign the personnel who is in charge of door keys of emergency
exits and emphasizes that these keys should always be in their
possession.
16. Refers to the Hospital Social Worker patients who are unable to
buy medicine have a diagnostic exam done, and for other
administrative problems.
17. Coordinates with other hospital personnel for mutual concerns.
18. Coordinates with the Clinical Instructors of students of affiliated
schools and reports to the Chief Nurse Problems and deficiencies
observed.
19. Notifies most senior nurse present of reportable incidents.
20. Does other task assigned from time to time.

Head Nurse, Nursing Station II


1. Provides nursing care to her assigned patients and accomplishes the
required nursing task.
2. Receives the endorsements of, and in turn endorsers to the following
shift, the station’s furniture, instruments, equipment, and supplies.
3. Acts on, or refers accordingly, nursing and administrative problems
encountered by their station.
4. Sees to the observance of Nursing and Hospital Policies and
Procedures.
5. Forward charts of discharged patients to concerned hospital unit for
billing of hospital charges.
6. Sees to the completeness of supplies, cleanliness and orderliness of
the station.
7. Sees to the proper use of semi-isolation cubicles and isolation rooms.
8. Coordinates with other hospital personnel for mutual concerns.
9. Submits to Assistant Chief Nurse the performance appraisal of her
subordinates every four months.
10. Does other task assigned from time to time.

C. Strategic planning process

This long range goal of improved nursing care which is spread over 3
½ years may be broken down into short range goals.
Six months increments devoted to:
1. An assessment program.
2. Selection and priority setting.
3. Increase in discharge plans and referrals.
4. Upgrading of the psychological and emotional components of care.
5. Improved physical care.
6. Incorporation of rehabilitation techniques.
7. Evaluation of progress in the achievement of these short range goals.

D. Vision/ mission/ philosophy/ objectives

MISSION

Rafael Lazatin Memorial Medical center is located within the heart of


Angeles City, owned, operated and manage by Angeles City Government.
Although primarily established for the welfare of Angeles City residents,
patients coming from neighboring towns can likewise avail of the hospitals
services and facilities.

OUR MISSION

1. To provide wellness to our community through the provision of quality


health services delivered in a compassionate and cost effective
manner.
2. To train health care professionals to become competent, humae,
ethical, health care providers, educators, counselor and good
community leaders.

3. To make a system of referral network efficient to address the health


care problems of the patients.

VISION

1. Patients choose to come to our Hospital because they are confident


that they and their love ones, will receive quality and compassionate
care.

2. Our employees find their work professionally rewarding and are


recognized and respected for their skills, commitment, teamwork, and
contributions, excellence in patient care.

3. Our physicians are professionals partners who shares a sense of pride


in our hospital and community it serves.

4. Our hospital is designed and equipped as a place to fully support


curing and healing.

5. Our hospital is viewed with pride as the community’s primary resource


for health care and the encouragement of healthy lifestyle.

Now our hospitals is looking forward to become ISO certified tertiary


hospital with accredited residency training programs providing high
quality health care to indigent patients receiving full and dedicated
support from government and private sectors.

PHILOSOPHY OF THE NURSING SERVICES


1. Clients have the right to the best possible health care regardless of
their race, creed, color, sex, social status, capability to pay, and
political belief.
2. The clients are unique individuals with physiological, physical,
psychological, social and spiritual needs.
3. Medical interventions require the coordinated efforts of all the various
components of the health care delivery system since health and illness
are multi-casual.
4. A health care system should be dynamic to improve the delivery of
health services.
5. An integrated health service (including the Nursing Service) should be
adequately operational zed to be responsive to the health needs of the
clientele.
6. Nursing personnel should be adequately prepared to assume their
various roles in the promotion, maintenance and restoration of health.

OBJECTIVES OF THE NURSING SERVICE


General:
To provide quality nursing care.
Specific:
1. To establish and maintain acceptable standards of nursing care.
2. To provide the nursing personnel with opportunities for continuing
education and training.
3. To conduct and participate in researches to nursing and nursing care.
4. To strengthen linkage with other components and agencies outside the
health facilities.
5. To provide nursing and midwifery students with related learning
experiences.

E. Standards of nursing practice


Policies, Standard and Procedures

Are management guidelines in establishing the framework for


conformity to pre-established regulation.
o Polices – are guides for basic rules that govern action at all levels in
the organization. They are intended to achieve pre-determined
objectives.

o Standards – indicate the minimal level of achievements acceptable to


meet the objectives.

o Procedures – provides the direction for carrying out policies, standard


and objectives.

Nursing Service Policies

1. Schedule of working Hours.

All Nursing service employees should be punctual and observe


productive working hours. We should avoid unnecessary absences,
tardiness and under time because, these leads to ineffectively,
inefficiency, disruption of regular schedules and additional burden to
our fellow employees.

1.1 Signing – in and signing-out of time of the incoming and outgoing


duty should be strictly followed at the PPAO.

1.2 All must remain on post when duty or on official working hours.

Leaving one’s post or office temporarily for a reasonable duration


may be allowed for emergency and reasonable circumstances
provided that:

a. Permission is granted by one’s immediate superior.

b. Such absence will not jeopardize the services.

c. Somebody will take over the responsibilities of the personnel


who left his post.
d. And the immediate superior assumes ultimate responsibility
for untoward incidents or inconvenience that may arise from
such temporary absence.

1.3 temporary exchange of duties is allowed provided that:

a. The section and division chief duty approve it and the PPAO is
officially notified.

b. There is no undue disruption or alteration of the regular


schedule of the others non-involved personnel.

1.4 There must be proper endorsement between ongoing and


incoming personnel.

1.5 Sleeping is not allowed during working hours except for those on
24 hours duty whose tempo and demands of works allow them to
sleep. Those assigned at the ER-ambulance Nurse by the virtue
of the preceding work characteristics and previous agreements
are not allowed to sleep.

1.6 Everyone should work in a harmonious professional smooth


interpersonal relationship. Differences settled in a civil manner
among involved parties preferably in the presence of their
immediate superior.

Discipline:

While discipline should involve through proper motivation of


individuals, regulatory measures are still necessary.

Rile XVI of Executive order 292 Enumerates the guidelines in


maintaining discipline among government employees. Administrative
offenses provided for under the pre-civil service law and code of conduct
classified into Grave, less grave and Light grave and their corresponding
penalties are:

Examples of Grave offenses:

1. Dishonesty

2. Gross neglect of duty

3. Grave misconduct

4. Insubordination

5. Habitual Drunkenness

6. Gross discourtesy in the course of official duty

1st Offense: Dismissal

Examples of less grave Offenses:

1. Simple neglect of duty

2. Simple misconduct

3. Insubordination

4. Habitual Drunkenness

5. Gross discourtesy in the course of official duty

1st Offense: Suspension of 1 month and 1 day- 6 months

2nd Offense: Dismissal

Examples of Light Grave:

1. Neglect of duty

2. Discourtesy in the course of official duty


3. Violation of reasonable office rules/regulation

4. Refusal to render overtime service

5. Failure to comply with a written or verbal order to submit a letter of


explanation.

1st Offense: Reprimands 2nd Offense: Suspension of 1-30 days

3rd Offense: Dismissal

Dress code:

a. The General physician appearance of an individual are prerequisite to


gaining trust and respect, neat appearance and grooming are qualities
that each personnel should maintain.

b. As part of organizational identity, pride and discipline, prescribed


uniforms should be worn at all times when on duty.

c. Violation of the dress code falls the light offense as a violation of office
rules and regulation.

General Conduct of a Nurse:

1. Because we are concern with giving care to those who are sick or
injured, a lot of patience and understanding should be given patients
and their relatives.

a. All should be cautious but firm when firmness is warranted.

b. Patient’s needs and complains should be attended to without


unjustifiable delay if there will be reasonable delay in a personnel’s
response, it should be properly explained to the soliciting party
response, it should be properly explained to the soliciting party.

c. Quarreling with patients or their relatives should be avoided at all


times.

2. Loitering, horsing around, chatting or gossiping should not be done.

3. Everyone should work on a harmonious professional working


interrelationship. Differences are settled in a civil manner among
involved parties, preferably in the presence of their immediate
superior.

4. Grievances should be course through the proper channels for


resolution and not just discussed among parties who feel aggrieved. In
this manner, misconception and aggravation of conflicts will be
avoided.

5. Unethical and corrupt practices, which lead to the detriment and loss
of opportunities or income from the hospital and the city government
or committed against patients or their relatives will be dealth with
sternly.

6. Coming to work under the influence of liquor is prohibited. Under the


influence of liquor refers to the presence of even slightest physical sign
of liquor intake.

7. Gambling and drinking are prohibited anywhere in the hospital and its
premises.

8. Smoking is allowed only at the designated places/areas.

9. Soliciting favors, money, gifts and the like from patients or their
relatives is strictly prohibited.
10 . Donations of any kind from private or public sources for use in the
hospital are obligatory properties of the hospital.

Admission and Discharge

1. No house patient will be admitted without order of Admission from the


resident on duty.

a. Admission of patient with private attending physician should be


processed at the Emergency room and the ROD notified of the
Admission.

b. The ROD is likewise notified of direct admission.

c. All patients staying in the hospital should be formally admitted, “For


observation status is prohibited.”

2. Admitted patients of E.R., the following are to be done:

a. Prepare the patient chart/records.

b. Carrying out of doctors orders like IVF insertion, ECG, X-rays


request, Lab request, instruction to medicines etc.

3. Proper endorsement between ER nurse – Ward nurses must be done at


all times for continuity of care.

4. Orient relatives about hospital rules and policies. Tell them whom to
approach for any questions or problems/location of Nurse’s station.

5. The nursing section will notify the dietary service of the prescribed
diet. The dietician coordinates with the meal concessionaire regarding
the prescribed diet.
Discharge of Patient

1. No patient’s will be discharged without doctor’s order for discharge.

2. Discharge against medical advice must be properly documented.

3. The nurse, in-patient nursing service submits the patient’s chart to the
billing section after it has been checked for its completeness.

4. The Clearance certificate is routed and the hospital bill is prepared.


The patient/relative are instructed to follow up their bill at the PPAO for
charity patient and to the cashier for semi-private/private room
patients. 30 minutes after it has been submitted for billing.

5. Checks patient’s belonging and collect hospital equipments for


private/semi-private patients.

6. Collect all the patient’s medicine in one container and give him the
discharge instruction on how to take his medicine, his/her date time of
visit

The transfer of Visit

A patient is transferred when he is moved out to another unit or


another institution for more appropriate care.

1. The nurse should tactfully explain the reason for transfer (to other
institution) as ordered by the ROD.

2. The physician prepares an abstract history of the patients and this is


brought to the hospital of choice where he/she is being moved.

3. The ambulance nurse will be responsible for conducting the patients to


HOC.
4. Clearance-discharged procedures and the same as describe previously
before conducting patient to HOC.

Clergy Service/Counseling of Families

Of Terminally Ill Patients and

Release of Corpses

1. Counseling families of terminally ill patients: when the attending


physician has declared that a patient is beyond saving and death is
imminent.

a. Ask the family and patient if they want clergy service and they may
do so according to their beliefs.

b. Mrs. M. Baluyut shall be notified for the counseling of the families of


these patients in preparation of what to be happening. To keep
them aware of the situation.

c. Care of the body after death.

1. Post-mortem care include the following:

a. The body is placed in anatomically normal position.

b. All life giving tube are removed.

c. Arms are placed on abdomen, the legs are tied together at


the ankles.

d. The body is wrapped with linen.

D. Death certificate accomplish by NOD and signed by ROD.

e. use of the holding area for corpses as for privacy and for separation of the
corpses from the patient ward.
Procedures on the Release of Corpses to Funeral Parlor

1. It is the responsibility of the NSOD or the Charge nurse on document


the release of corpses to the funeral parlor.

a. A log book shall be kept for the purpose and signature of the
nearest kin.

b. Representative of the name funeral parlor.

c. The nurse shall attest to the release.

d. The security guard shall also sign in the logbook as witness.

2. Corpses of patient who have no relatives or companion.

a. A waiting for 2 hours shall be observed before these corpses are


released to the funeral parlor. This is to provide sufficient time for
the arrival of relative who went home to notify and ask other the
policy before being allowed to leave the corpse.

b. Problem arising from lack of identification shall be referred to Senior


house officer.
OSPITAL NING ANGELES

EMERGENCY ROOM NURSING SERVICE

Angeles City

POLICIES AND PROCEDURES

INTRODUCTION

The Emergency (ER) attends to both emergency and non-emergency


cases.
The primary objective of ER in the emergency case is to ensure that
the patient could survive the initial period of trauma or the present gravity of
the illness.

Non-emergency cases are attended to when the Outpatient clinic is


closed. However, the care of emergency cases takes precedence over the
care of non-emergency cares.

It has been said that working in a hospital, particularly in the setting of


a busy Emergency Room of a government hospital, is a terrible obligation. ER
personnel work in a tense environment-harassed by relatives and friends of
the patients, pressured to attend to attend to patients all the same time, and
often times, faced with lack of ready resources inside the ER. The ER staff is
vulnerable to complaints by the people it has served.

A terrible obligation may seem to be, yet something must be done to


make life in the ER a little better for both the personnel and the patients.

Senior nurses, those who have had the most numbers of years in ONA,
have been assigned to every shift. The skill, wisdom, and decisiveness
should enhance the capability of the entire ER staff to meet the challenges in
the ER.

This updated manual of [policies and procedures, is aimed at


establishing written norms of conduct. This manual should provide the
nurses’ adequate information that would help them fulfill their role in the
provision of nursing care in the Emergency Room.

This manual may not provide all the answers. In time, however,
concerted efforts led by the Senior Nurses assigned at the ER will truly
established the ER as the showcase of our hospital’s competence and quality
of care.
Section 1. Receiving Patients and Their management and Disposition in
General

All persons seeing treatment are to be received, logged, and referred


to the ER Physician on Duty. These include, but are not limited to, the
following;

a. Emergency cases

b. Non-emergency cases

c. All medico-legal cases, regardless of the date and place of incident

d. Referral from other hospitals and physicians even of there are no


vacant beds if they are for admission.

Patients are seeking help and must be assisted. The management and
disposition may differ but no patients will be turned away. They will all be
seen by the Duty Physician and their visits to the ER properly
documented.

The financial disposition of the patient rests with the Duty Physician
and the Duty Nurse should see to it that all pertinent data are entered in
the logbook.

If the duty Physician refuses to enter the date of the patient in the
logbook, the Charge Nurse should be notified.

The Charge Nurse shall then ask the Duty Physician to complete the
logbook entries. If the Duty Physician refuses to do so, the Charge Nurse
should notes the incident in his/her logbook. This shall be the basis of the
incident report that will be filed after his/her shift. The Charge Nurse may,
likewise, report the matter at once at the Senior House Officer on Duty.

Section 2. Receiving Emergency cases and ER Nurse


Responsibilities

Recognition and prioritization are two key decisions.

2.a. What constitutes an emergency case?

2.a.1. Emergency Cases include conditions where patients are likely to


die as in the following:

Presence of or impending cardiac and/or respiratory arrest shock


especially from hypovolemia.

Increase intracranial pressure as in head trauma or CVA

Hemorrhage

Cyanosis

Severe asthmatic attacks

Cardiac arrhythmias

Injuries to vital organs

Profuse bleeding

Hypersensitivity reactions, particularly those with dyspnea and

Shock

Status epilepticus

Aspiration

Asphyxia

Poisoning

Myocardial infarction

Hemothorax
Pneumothorax

Severe pain

Severe burn injuries

Severe dehydration

Lightning injuries

Drowning

Choking

Neck injuries

Metabolic acidosis/alakalosis

Heat strokes

2.a.2. Conditions which may not be acutely life threatening but may rapidly
deteriorate to cause death or complications are also emergency cases.

Pregnant patients in labor who had previous caesarian section

Seizures

Moderate to severe hypertension

Mild to moderate severe hypertension

Mild to unconscious states even with vital signs

High grade fever

Lacerations

Amputating injuries

Injuries to organs of the senses like the eye, ears, and nose
Swallowed or inhaled foreign bodies

Fractures

Injuries from all kinds of trauma acute urinary retention

Ascending paralysis

Strokes in evolution

CNS infections

Dyspnea

Potential airway obstruction, i.e. peritonsillar abscess

Facial burns which may signify burns to the airway

Drug overdose

Tetanus

Electrolyte imbalance

2.a.3. Emergency cases also include distressing conditions which may signify
more serious conditions particularly if experience by the patient for the first
time.

Post-ictal states

Abnormal movements

Moderate to severe headache not relieved by over the counter


Analgesics and associated with vomiting.

Vomiting

Diarrhea

Fever and chills


Chest pain

Abdominal pain

Neurologic manifestations such as sudden numbness, diptopis, loss of


vision, loss of balance, hallucinations.

Moderate to severe ocular pain as in acute glaucoma

Dizziness or vertigo

Violent psychotic behavior

2.a.4. Conditions, which by their nature, are preferably managed in the


Emergency Room are considered emergency cases.

Medico-legal cases including rape.

2.b. Who gets attention first?

The general dictum is still “first – come, first serve”. However, at any
given time, patients belonging 2.a.1. receive the top priority followed by
2.a.2., etc. However, rape is a special case which will discussed in a later
section.

What happens if all four Er stretchers are full and a priority patient
arrives?

The above question drives home the point that non-emergency cases
should be seen elsewhere. Presently, non-emergency patients should be
seen at emergency patients come to the ER.

During weekdays, this period is from 4pm to 11pm. During Sundays


and Holidays, non-emergency cases must be seen at the OPC from 8am tp
12noon, and from 6pm to 10pm.
Regardless of the number of non-emergency cases, they must still be
seen at the OPC to avoid congestion at the ER and to make available the ER
stretchers for emergency cases.

The key to the OPC door is always available at the Pharmacy

When all four stretchers are full and a more priority patient arrives
and needs to be placed in the recumbent position, quickly assess which of
the patients can be asked to sit down or be transferred to the examining
tables at the adjoining OB/GYN Examination Room.

Temporarily, as the situation warrants, even the benches at the


hallway outside the ER may even be used for patients to lie on. As far as
applicable, the five examining tables resourcefulness must be called upon by
the nursing staff.

2.c. Approach to Patients in Cardio and/or Respiratory Arrest

2.c.1 Quick assessment to answer the questions: Is the patient alive?


How alive is the patient?

A – irway

B- reathing

C – irculation

Pressure is applied on invisible significant bleeding.

2.c.2. Call for the Duty Physician/ Institute basic CPR. It is presumed
that more than one nursing personnel are attending the patient.

2.c.3. Assist the duty Physician in doing resuscitation.

2.c.4. After resuscitation, enter identification data in the logbook and


ask Duty Physician to enter clinical data.

What if more than one patient needs resuscitation?


Stay calm but move swiftly. Be focused and decisive. Call for help from
other Nurse Stations. Give your best effort.

Section 3. Medico-Legal and Rape Cases

3.a. All Medico-legal cases must be examined by the ER Physician


regardless of the place or time of occurrence. If the place of
occurrence is not within Angeles City, give first aid treatment and
referring to the District Hospital may be enough depending on the
condition of the patient.

It is the Duty Physician who decides the final disposition of Medico-


legal cases when the place of occurrence is not Angeles City. It is the
responsibility of the ER nurses, however, to enter the patient’s
identifying data in the proper logbook and to remind the ER Physician
to complete the clinical and disposition data.

3.b. Alleged victims of sex crimes are to be treated with extra “sensitivity”.
They should be shielded from further embarrassment and
psychological trauma.

There should be no undue delay in attending to these patients. Nurses


should see to it that they are given privacy. When the examining
physician is a male there must always be an accompanying female
nurse who will ensure that the patient is handled properly.

3.c. Consent internal examination should be signed by the patient or by the


parent of guardian if the patient is below 21 years old.

Section 4. Non-Emergency Cases

4.a. Non-emergency cases has always been a problem group in the


Emergency Room. Time was when these patients were turned away by
security guards and ER personnel because their illnesses were not
emergency in nature. Patients were being reprimanded for not having
consulted earlier.

Sick persons are sick persons. They need assistance whatever


administrative shortcoming they may have. The policy is clear: all patients
must be seen and treated by the ER Physician on duty.

They may be educated in a nice way to consult at the OPC at an earlier


time.

4.b. Non-emergency patients must be seen at the OPC. At present, this


practice is limited from Monday to Friday, from the closing of the OPC to
11pm, the time when the shift of the Family Medicine Junior Consultants
ends.

Among the purposes of this procedure are to decongest the ER and to


reserve the Gurney carts to emergency cases, to make clear to non-
emergency patients that they are not priority patients at the ER, to provide
more privacy to ER patients who are undergoing diagnostic or therapeutic
manipulations, and to avoid psychological trauma especially among children
they see bloodied or dying patients.

4.c. As fast as applicable, non-emergency cases are given numbers, to wait


for their turn. They are advised to sit the benches in the hallway adjacent to
the ER.

4.d. Non-emergency cases are logged and all procedures documented.

Section 5. OB/Gyn Patient

While the ER is primarily tasked to receive Ob/Gyn patients, the ER


nursing service is still responsible for nursing care of these patients. The ER
midwife is part of the ER nursing Service and not the Delivery Room Service.
ER Nurses must have the necessary and knowledge of receiving
OB/Gyn patients and assisting the ER Physician in their examination and
treatment.

5.a. All patients must be logged and be seen by the ER Physician


including those in active labor and to be admitted to the labor Room.

5.b. OB/Gyn instruments must be kept clean and sterile.

Section 6. Difficult Patients/Relatives of Patients

Some persons are by nature difficult to deal with. This personality trait
is made worse by tension and anxiety over an illness or injury. The best way
to deal with them is to prevent a misunderstanding and to cut it short when
it does.

6.a. Develop a way of recognizing potentially difficult persons. Learn


from experience.

6.b. Exert more effort in communicating with such persons explaining


what is being done and inquiring about his/her condition if a medicine
has been given

6.c. Do not argue or quarrel with the person. Before things become
nasty, ask help from the ER NSOD to pacify the person. The help of the
ER Physician should be sought if the ER NSOD is unable to reason with
the person.

Important: If possible, talk to the person concerned in private, either in


the office of the Chief of the ER at the OPC.

6.d. Ask the help of the Security Guard if the “quarrel” is escalating. If
the person is not the patient, he may be ask may be asked to leave the
ER.
Police assistant must be sought with person threatening violence and
persons under he influence of alcohol to whom reasoning with useless.

6.e. Notify the SHO of untoward incidents and ask for his interventions,
if necessary.

Section 7. Admitting Patients

7.a. Admission and Discharge Form.

On the second block of this form, enter the names of the


following: Admitting Physician, Attending Physician, Admitting
Diagnosis, and Specialty Service that will manage the care of the
patient.

On the third block, the admitting nurse should affix her signature
opposite the ER Nursing service line.

7.b. Send the relative of the patient to the Admitting Office for
admission process. If the clinical record contains sensitive data or
which might cause anxiety, i.e. a diagnosis of cancer, the admitting
nurse should be the one to forward the patient’s chart to and receive it
from the Admitting Officer.

7.c. For pay and Medicare patients, it is the Admitting Officers to


notifies the attending Physician. The Admitting Officer assigns the
Attending Physician on walk-in pay and Medical Services.

7.d. All orders carried out in the ER must be noted down as carried on
the Nurses’ Remarks column.

7.e. All admissions must either be on wheelchair or Gurney Cart as the


case may be and must be accomplished by a hospital personnel from
the ER o the assigned hospital bed.

Serious cases must be accompanied by a physician or a nurse.


Section 8. ER Charges and Donations

8.a. ER Charges

8.a.1 All supplies and materials used in the treatment of an ER patient


should be charged accordingly. Professional fee repair of wounds
are, likewise charged.

8.a.2. Charges are written in a charged slip which is presented by the


relative/patient to the Cashier Service.

8.a.3. Discounts on non-payment of ER charges are given by the Chief


of the Administrative services during office hours and by the
Cash.

8.b. Donations

8.b.1. Donations are voluntarily given by patients/relatives who have


not been asked to pay any ER charges. Professional fees are not
charged for consultations.

8.b.2. Donations must be placed directly into the locked donation box
by the patients or relatives themselves.

8.b.3. Donations are to be regularly collected by the Cahier Service in


the presence of the ER Nurse Supervisor. The amount is used to
purchase items needed in the hospital operations.

Donations are not to be spent for personal benefits except for buying
medicines for indigent patient.

Section 8. The Ambulance Nurse

Because of the nature of work of the Ambulance Nurse, he is allowed


to go on twenty four hours duty together with the Ambulance Driver.
8.1. The Ambulance Nurse is a member of the ER Nursing Service and is
expected to help in the nursing chores at the Emergency Room.

8.2. The Ambulance attends to patients being conducted if they are patients
of ONA. Non-patients of ONA who are to be conducted by the ONA
ambulance are to be advised to secure their own ambulance nurse or
physicians.

8.3. After twelve hours of work, the Ambulance Nurse is given rest subject to
call if his service is needed at the ER or in a patient conduction.

Section 9. Do’s to Observe

This section enumerates the various details of work that may seem to
be routinely done or those with significance. However, these are the things
that make ER operations work efficient and effective.

Do the Following:

• Endorsements of patients, supplies, equipment, and instruments.

• Maintain cleanliness in the ER including various office and medical


equipment.

• Wear proper uniform.

• Maintain availability of Emergency Cart items.

• Refer all patients at the ER to the ER physician in Duty regardless of


complaint or hour.

• Log all patients into the Patients Log Book.

• Notify the Equipment Technician once malfunctions are detected in


any of the medical equipment.

• Regulate the use of air conditioners.


• Keep all the lights at the ER on all the time.

• Be alert, focused, and decisive.

• Inform the security guard of medico-legal cases.

• Communicate with the patients/relatives regarding their management.

• Be tactful but firm in enforcing ER rules and regulations.

• Avoid quarrelling or exchange of words with patients/relatives.

• Refer potential or real problems to ER Nurse Supervisor/ER Physician


on Duty/Senior House Officers accordingly.

• Call the Security Guard for any disturbance in the ER.

• Limit texting and phone chats to important occurrences and do this at


the ER office and not at the Nurse Station.

• Take your snacks or meals at the canteen or ER office and not at the
Nurses Stations especially when there are patients in the ER.

• Refrain from idle talk and boisterous laughter in the ER proper.

• Always provide a wheelchair or Gurney cart for patients going to the X-


ray room, laboratory, comfort room, or to the wards.

• Dress wounds and control bleeding before patients are sent out of the
ER for X-ray exams, etc.

• Attend to patient’s needs expeditiously.

• Make sure children, unconscious, and disoriented patients do not fall


from the Gurney cart.

• Have patients relatives sign consent forms for ER procedures.


• Remind physicians to write down their verbal orders carried out during
emergency procedures.

• Accompany serious patients to the x-ray room.

Special Mention: To avoid being suspected of favoring a certain drugstore,


always instruct the person buying medicines or supplies to first proceed to
the ONA pharmacy. The pharmacist on duty shall be the one to tell the
person that the items is not available in the hospital.

ICU NURSING SERVICE PROTOCOL

OSPITAL NING ANGELES

Angeles City

A. ADMISSION

1. Admissions of patient from any service units in the hospital or from


other hospitals shall depend on the availability of the ICU beds, staff
and the needed life support equipment.

1.a. In instance when any of the above are lacking or unavailable and
the family of the patient insist that the patient is admitted to the ONA
ICU or when it is inadvisable to transfer the patient, a responsible
member of the family must sign a waiver or consent.
The above document shall state lack or unavailable of any of the ICU
resources and that the family consents nevertheless confine the
patients on the ONA ICU.

1.b. Direct admission from the Emergency Room shall be accepted,


even if admitting documents are still lacking, provided the ER
Physician accompanies the patient so that proper endorsement is done
and the ER Nurse Service has duty notified the Admitting Service.

Completion of ER medical and nursing documents shall be done as


soon as the personnel have the time but must be done within the same
nursing shift.

1.c. Referring nursing units shall be preferably advise the ICU staff at
least five minutes ahead of time before transferring their patients to
the ICU, particularly if circumstances allow such time.

1.d. Nursing units are to inform ICU staff of any potential admission.
When informed as such, the ICU staff shall get the necessarily patient
information to evaluate if the ICU has available manpower and
equipment to manage the patient.

When the ICU can accommodate the potential admission, preliminary


preparations are to be made.

If the ICU lacks staff or equipment, the ICU shall notify the Nurse
Supervisor on duty who shall discuss the problems or conditions at the
ICU with the family. If the family insists that their patient be admitted
to the ONA ICU, refer to paragraph 1.a. above.

1.e. The minimum nurse: patient ratio in the ONA ICU is given below.
An actual ratio worse that the minimum means that there is a lack of
nurse at the ICU at the present time.
1.e.1 (1) nurse to (3) moderately serous patients where a
moderately serious patient is defined as one who needs routine
attention three times an hour.

1.e.2. (1) nurse to (2) severely serious patients; these patients


need routine attention not less than six times an hour.

1.e.3. (1) nurse to (2) moderately serious patients and (1)


severely serious patient.

1.f. Any problem regarding the number of admissions should be

referred to the Nurse Supervisor on Duty for final resolution.

2. Patients requiring close nursing and medical management are to be


admitted to the ICU. In general, these patients have life threatening
conditions and include the following patients:

2.a. Post-operative patients who has developed serious life threatening


complications whether they come from the Recovery

Room or the Wards.

2.b. Patients with cardiovascular problems, neurologic disorder, serious


traumatic injuries, and life-threatening obstetrical and gynecological
cases especially when they need to be place on life support and
monitoring equipment.

2.c. Patients with life threatening pulmonary problems and respiratory


insufficiency.

2.d. Pediatric patient with life threatening conditions and weighing


more than five kilograms.

2.e. Patients with foul smelling lesions or highly contagious diseases


may be admitted on a case to case basis. Examples of these conditions
are untreated or inadequately treated cases of PTB, meningococcemia,
viral diseases like measles and chicken pox when other patients have
not developed immunity against them.

2.e.1. The decision to admit the above-mentioned case must be


a consensus by the Attending Physician or the Resident-in-
Charge and the ICU Staff on duty.

2e.2. When no consensus is reached between the staff and


physicians, the matter shall be referred to the Chief of Clinics. In
the absence of the latter, it shall be referred to the Senior House
Officer for final resolution.

2.e.3. These patients can only be confined in the ICU Isolation


rooms.

2.e.4. If these patients are not admitted to the ONA ICU, they are
to be transferred to another hospital or will remain in their ward,
depending on what is best for the patient given the
circumstances present as determined by the Chief of Clinics of
the Senior House Officer.

3. The ICU isolation Rooms shall be reserved for the following patients:

• Patients with contagious diseases.

• Patients who need a quiet and dark environment with minimal or


no stimulation.

• Patient with low or depressed immune system that predisposes


them to infection.

• Patient with foul smelling lesions.

• Patient in agony or emitting sounds that may disturb or cause


distress to other ICU patients.
Important: Precautions shall be observed to avoid cross contamination
between the ICU Ward and the ICU isolation room.

4. The ICU Staff shall notify the Admitting Service regarding admissions of
inpatients.

B. ENTRY TO AND STAY AT THE ICU

1. The back door is for the entry of ICU personnel only. It must always be
locked. This is to ensure the safety of the ICU supplies and medicines
and the personal belongings of the staff.

This is also to better control the entry of non-ICU personnel.

2. All persons entering ICU must wear the provided gowns and slippers.

3. The anteroom at the front of the ICU is not a place where families of
ICU patients can stay, much less sleep, or eat. Benches are provided
for them outside of the ICU areas.

The anteroom is place where the provided slipper and gowns are
placed and where are worn by persons entering the ICU. This is place
where Staff can be briefly assess incoming patients for unusual
behavior or conditions before they are finally allowed to the ICU
proper.

4. Watchers are allowed inside the ICU.

4.a. They are to be oriented to ICU rules and regulations.

4.b. Their help should be solicited in the general care of their patients.
Proper instructions shall be given to them in them in this matter.
4.c. Only one watcher is allowed per patient. However, the privilege of
being a watcher can be suspended by the ICU Nurse on Duty if he/she
does not always follow ICU rules and regulations.

5. Visiting hours is limited between 3pm to 4pm. Only one visitor is


allowed at any given time. They must observe silence and stay inside
the ICU for not more than ten minutes.

The visiting hours may be temporarily suspended, to be resumed later,


when a situation so warrants.

6. Watchers and visitors are not allowed to eat inside the ICU. Only fruits
and plain crackers are allowed to be brought to patients of the ICU as
cooked food may be contrary to the diet prescribed to the patient.

ICU Staff should preferably take their meals and snacks at the Rear
Service area that is for their exclusive use.

C. MANAGEMENT OF PATIENTS AND THE ICU IN GENERAL

1. A manual of ICU nursing care shall be prepared and updated as


needed. This manual would serve as a concise and easy to read but
comprehensive reference material for the ICU Staff.

Outer sources of information would be reference books and direct


instructions of physicians.

2. With proper instructions and guidance, watchers can be asked to help


do ordinary tasks like giving up tepid sponge bath, turning of patients,
arranging bed sheets, calling for assistance for other hospital
personnel and the like, especially when there is only one ICU Personnel
on duty.
3. There must always be an ICU Personnel present when there are
patients in the ICU.

3.a. Especially when there is only one personnel on duty, the ICU staff
should arrange for her/his meals and snacks to be brought to the ICU
before starting her/his shift, or before the outgoing personnel leaves.

3.b. Supplies and other needed items should be acquired after the shift
endorsement by the outgoing staff.

3.c. In instances where there is only on staff on duty and it is very


necessary to leave the ICU, the following must be observed:

3.c.1. The lone ICU Staff must inform the Nurse Supervisor on
Duty (NSOD) of the necessity and ask fro permission to leave the
ICU temporarily.

3.c.2. Ask the NSOD for a temporary reliever. If no temporary


reliever is available, the NSOD will decide whether the ICU
personnel can temporarily leave the ICU.

3.c.3. Such temporary absence must be brief.

3.c.4. When there is no time to inform the NSOD because of an


emergency patient need and the personnel has to leave the ICU,
the watcher of the patient should know his/her whereabouts and
the emergency needed.

4. Stocks and Medicines Supplies in the ICU

4.a. Available stocks are to be used, or given, as patient needs them.


However, the family of the patient must be made to buy the
requirements.
The ICU Personnel must make it clear that such items have already
been used or given and must be replaced so those items will be readily
available they are needed.

4.b. Items not replaced shall be written in a Change Slip that is


incorporated in the patient’s chart and later included in the hospital
charges computed by the billing Clerk.

4.c. Regular endorsement of stock levels must be observed to avoid


zero levels of items.

4.d. When the inventory level of an item is only good for two weeks, it
should be requested from the Supply Service.

5. Families of patients must be continuity but accurately inform of their


patients’ conditions including the patients’ plan of management.

5.a. The person in the family who are primarily responsible for the
patient should be identified. It is important that they are aware of the
condition of their patient and are familiar with the management plan.

In this regard, ICU Personnel should discuss conditions of patients and


the plan of management with Attending Physicians and Residents in
Charge.

5.b. Personnel must be consistent in the information they relay to the


relatives. Information relayed to relatives it o be discussed during shift
endorsement session.

5.c. Information given to relatives must be within the personnel’s


competence and that which has been discussed by Attending Physician
and the Resident-in-Charge.

5.d. Relatives are to be referred to the Attending Physician or Resident-


in-Charge for questions which the ICU Staff cannot answer.
6. Member of patient’s family who may be “difficult” to deal with shall be
identified so that conflicts with them can be avoided.

6.a. The Chief Nurse or the NSOD shall be informed of their presence.

6.b. The Matter is discussed during shift endorsements.

6.c. Strategies should be formulated designed to avoid arguments or


conflicts with this particular kind of person.

6.d. It should always be remembered that the best way to deal with
difficult person is to let them know that everything to be done is being
done.

Extra efforts are to be made o communicate with them properly and


more often than usual.

7. Families must be informed that is advisable to have another member


of the family, aside from the watcher, to be available in the hospital for
emergency needs that have to be bought outside the hospital

7.a. The ICU Staff will provide special pass for them that will
enable them to enter the ICU when they are needed during
emergencies.

7.b. Families of Pay Patients can get a private room that they
have to pay for separately. Those who would want to avail this
privilege are to be referred to the Admitting Office.

F. Organizational structure
ORGANIZATIONAL STRUCTURE

1. Group of Services
RLMMC is a department directly under the Office of the Mayor. The
Hospital Director is the head of the hospital assisted by the Assistant
Hospital Director. Chiefs of services head various groupings of
services. There are five main groupings of services, namely:

Administrative Services

Medical Services

Nursing Services

Ancillary Services

Family Medicine Residency Training Services

The above Services are composed of different subgroups of


services. The assignment of subgroups depends upon operational
requisites and ease of control of a particular subgroup. It is ever
changing to adopt to existing situations.

2. Number of Personnel

There are three hundred twenty hospital personnel compared to fifty


five in 1992. This total number includes sixty doctors, seventy five
nurses, thirty eight midwives, fifty nursing attendants, eleven medical
technologist, five x-ray technicians and three pharmacists.

3. Committees

Several committees address particular concerns namely

Accreditation Committee

Therapeutic and Supplies Committee

Waste Management Committee

Quality Assurance Program Committee


Infection Control Committee

Fire Safety Committee

HIV/AIDS Committee

Blood Transfusion Committee

Medical Audit Committee

4. Employee Organization

Two organizations exist in the hospitals that are open to all hospital
employees. Both are independent from each other and the hospital
management, the hospital director not being a member of either
organization.

Ospital Ning Angeles Employees Association (ONAEA) is


concerned with the socio-political welfare of employees.

Ospital Ning Angeles Multipurpose Cooperative functions for the


economic welfare of employees. It operates the cooperative
pharmacy, canteen and physical therapy clinic.

Both organizations have consistently funded several projects in


the hospital. Among these are the construction of the chapel,
emergency room ramp, waiting shed, and duty physicians quarters,
purchase of the paging and audio-visual systems, OR and hospital
linen, lighted signage of ONA, lights and plants at the parking lot,
furnishing and maintenance of the Employees Hall, installation of steel
benches at the OPD, funding the Garden of Healing project, and
hosting the annual summer swimming party, foundation day and
Christmas party.

The ONAEA has been at the forefront in opposing plans that it


has deemed to be disadvantageous to hospital patients and personnel.
ORGANIZATIONAL STRUCTURE SHOWING THE
RELATIONSHIP OF THE NURSING SERVICE
WITH THE COLLEGE OF NURSING

MEDICAL CENTER
CHIEF

CHIEF DEAN
NURSE COLLEGE OF NURSING

ASST. CHIEF NURSE ASST. CHIEF NURSE CLINICAL


SERVICE (TRNG.)/SUPERVISING COORDINATOR
NURSE INSTR.

SUPERVISING NURSE CLINICAL


NURSE INSTRUCTOR INSTRUCTOR

SENIOR
NURSE STUDENTS
NURSE
LEGEND:
Direct line of authority & responsibility
Supervisor
Coordinated relationship

ORGANIZATIONAL STRUCTURE
OF THE NURSING SERVICE
SHOWING LEVELS OF POSITION

CHIEF OF
HOSPITAL

ADMINISTRATIVE CHIEF NURSE CHIEF OF


OFFICER IV/III CLINICS

CHIEF NURSE
III/II

NURSE NURSE NURSE


III III III

NURSE NURSE NURSE


II
NURSING
NURSE II
NURSING
NURSE II
NURSING
NURSE
ATTENDANT
I ATTENDANT
I ATTENDANT
I
G. Staffing (selection, orientation, job dercription)
OSPITAL NING ANGELES

Angeles City

Series Job Description

Designation Title: OR Staff Nurse

Immediate Supervisor: OR Head Nurse

Unit: OR Nursing Service

Nursing Area: Area II

Service: Nursing Services

General Description
Performs the nursing tasks in the Operating Room

Duties and Responsibilities

1. Assisting the OR Head Nurse in the completion of her tasks and takes
her place if she is not present.

2. Assist in surgeries as a scrub or circulating nurse.

3. Ensures the completeness, availability and sterility of items used in


surgery

4. Prepare surgical supplies and helps in the sterilization.

5. Helps in the cleaning of instruments and equipments and does


sterilizations chores of the OR areas.

6. Completes all record and change the O areas.

7. Coordinated with Laboratory Service and patient’s relatives regarding


tissues for histopathological studies at another hospital.

8. Coordinates with other hospital personnel for mutual concerns.

9. Does an evening round of confined patients who are schedule for


surgery the following morning checking the availability of required
items and liaises with patient’s relatives.

10. Keeps a record of untoward incidences in her duty shifts and


reports them to immediate superior.

11. Helps recovery and delivery room personnel as the need arises.

12. Does other tasks assigned from time to time.


Designation Qualifications

Licensed nurse with an aptitude suited for operating room nursing


tasks.

OSPITAL NING ANGELES


Angeles, City

Job Description

Designation title: OR Utility Worker


Immediate supervisor: OR Head Nurse
Unit: OR Nursing Service
Nursing area: Area II
Service: Nursing Service

General Description

Support the completion of nursing task at the operating room

Duties and responsibilities


1. Receives patient for surgery at the OR main door, assists in their
changing of gowns, brings patients to the operating rooms and vice versa,
and help in the proper positioning of patients.
2. Clean designated areas in the operating room and helps in its general
sterilization.
3. Cleans OR instruments and equipment, empties suction machine
receptacles, autoclave instruments, linen, and supplies of the OR and the DR.
4. Endorses OR linen to the laundry service and receives these back
making of their completeness.
5. Helps in the preparation of supplies to be autoclaved.
6. Does other tasks assigned from time to time.
Designation Qualification

At least an elementary school graduate literate enough to follow verbal


and written instructions.
OSPITAL NING ANGELES
Angeles, City

Job Description

Designation title: Staff Nurse, Nurse Station II


Immediate: Supervisor, Charged Nurse
Unit: Nurse Station II
Nursing area: Nursing Area I
Service: Nursing services

General Description

Provides nursing care and perform various nursing tasks.

Duties and responsibilities

1. Receives admitted patients and orients them and their relatives of the
basic nursing and hospital policies and procedures.
2. Carries out doctor’s orders, accomplishes monitoring charts, and writes
down the pertinent notes and nursing care plan.
3. Gives the necessary instructions and information to the patients or
their relatives regarding hygiene, precautions, and chores that they have to
do themselves.
4. Performs the various nursing tasks like giving medications, venoclysis,
monitoring vital signs, fluid input and output, etc.
5. Sees to the proper performance of tasks by nursing attendants.
6. Coordinates with attending physicians and resident in-charge
regarding the management of patients
7. Proper ancillary service request and prescriptions and gives the proper
instructions to relative of patients.
8. Sees to the proper preparations of patients who are undergo surgery
and other special procedures.
9. Assists doctors on their rounds or work.
10. Sees to the completion of the pertinent part of the admission and
discharge record.
11. Incorporates laboratory and diagnostic reports and results in the chart.
12. Helps her superior in maintaining cleanliness in the station and wards
and in the implementation of nursing and hospital policies and procedures
13. Enters into a logbook untoward incident and immediately notifies
superior about them.
14. Coordinates with other hospital personnel for mutual concerns.
15. Receives endorsement from, and I turn endorses to, co-nurses duties
and responsibilities.
16. Prepares to the proper charges for the use of supplies and equipment,
if applicable.
17. Sees to the safekeeping of supplies, equipment and instruments.
18. Operates the various equipment issued to the station and notifies
immediate superior of malfunctioning instruments and equipment non
availability of supplies.
19. Gives discharged instructions to patient and relatives.
20. Submit to the chief nurse the performance appraisal of nursing
attendant every four months.
21. Does other tasks assigned from time to time.

Designation and Classification

License nurse with the patience and the energy to work in a


government hospital.
OSPITAL NING ANGELES
Angeles, City

Job Description

Designation title: Staff Nurse, NICU


Immediate Supervisor: Charged Nurse
Unit: NICU Nursing service
Station: Nurse Station II
Nursing area: Nursing Area I
Service: Nursing services

General Description

Provides nursing care and perform various nursing tasks

Duties and Responsibilities

1. Receives admitted patients and orients them and their relatives of the
basic nursing and hospital policies and procedures.
2. Carries out doctor’s orders, accomplishes monitoring charts, and writes
down the pertinent notes and nursing care plan.
3. Gives the necessary instructions and information to the patients or their
relatives regarding hygiene, precautions, and chores that they have to do
themselves.
4. Performs the various nursing tasks like giving medications, venoclysis,
monitoring vital signs, fluid input and output, etc.
5. Sees to the proper performance of tasks by nursing attendants.
6. Coordinates with attending physicians and resident in-charge regarding
the management of patients
7. Proper ancillary service request and prescriptions and gives the proper
instructions to relative of patients.
8. Sees to the proper preparations of patients who are undergo surgery and
other special procedures.
9. Assists doctors on their rounds or work.
10. Sees to the completion of the pertinent part of the admission and
discharge record.
11. Incorporates laboratory and diagnostic reports and results in the chart.
12. Helps her superior in maintaining cleanliness in the station and wards
and in the implementation of nursing and hospital policies and procedures
13. Enters into a logbook untoward incident and immediately notifies
superior about them.
14. Coordinates with other hospital personnel for mutual concerns.
15. Receives endorsement from, and I turn endorses to, co-nurses duties
and responsibilities.
16. Prepares to the proper charges for the use of supplies and equipment,
if applicable.
17. Sees to the safekeeping of supplies, equipment and instruments.
18. Operates the various equipment issued to the stations and notifies
immediate superior of malfunctioning instruments and equipment non
availability of supplies.
19. Gives discharged instructions to patient and relatives.
20. Does other tasks assigned from time to time.
Designation and Classifications

License nurse with the patience and the energy to work in a


government hospital.
OSPITAL NING ANGELES
Angeles, City

Job Description

Designation title: Charged Nurse, NICU


Immediate: Supervisor, Head Nurse, Nurse Station II
Unit: NICU nursing service
Station: Nurse Station II
Area: Nursing Area I
Service: Nursing services

General Description

Unless specifically designated in the absence of the head nurse, the


most senior staff nurse on duty is the charged nurse. The charge nurse is the
leader of the duty nurses and helps them accomplish their tasks aside from
taking care of the patients assigned to her.

Duties and Responsibilities

1. Provides nursing care to her assigned patients accomplished the


required nursing tasks.
2. Receives the endorsements of, and in turn endorses to the following
shift, the stations furniture, instruments, equipments and supplies.
3. Acts on, or refers accordingly to the Nurse Supervisor, nursing and
administrative problems encountered by their station.
4. Sees to the observance of nursing and hospital unit for billing of
hospital charges.

5. Forward charts of discharged patients to concerned hospital unit for


billing of hospital charges.
6. Sees to the completeness of supplies, cleanliness and orderliness of
the station.
7. Coordinates with other hospital personnel for mutual concerns.
8. Submit to the Assistant Chief Nurse the performance appraisal of her
subordinates every four months.
9. Does other tasks assigned from time to time.

Designation and Qualifications

License nurse with at least six months of hospital work.


OSPITAL NING ANGELES
Angeles, City

Job description

Designation title: Charged Nurse, Nurse Station I


Immediate Supervisor: Head Nurse, Nursing Area I
Unit: Nurse Station II
Nursing Area: Nursing Area I
Service: Nursing services

General description

Unless specifically designated in the absence of the head nurse, the


most senior staff nurse on duty is the charged nurse. The charge nurse is the
leader of the duty nurses and helps them accomplish their tasks aside from
taking care of the patients assigned to her.

Duties and Responsibilities

1. Provides nursing care to her assigned patients accomplished the


required nursing tasks.
2. Receives the endorsements of, and in turn endorses to the following
shift, the stations furniture, instruments, equipments and supplies.
3. Acts on, or refers accordingly to the Nurse Supervisor, nursing and
administrative problems encountered by their station.
4. Sees to the observance of nursing and hospital unit for billing of
hospital charges.
5. Forward charts of discharged patients to concerned hospital unit for
billing of hospital charges.
6. Sees to the completeness of supplies, cleanliness and orderliness of
the station.
7. Sees to the proper use of semi-isolation cubicles and isolations rooms.
8. Coordinates with other hospital personnel for mutual concerns.
9. Submit to the Assistant Chief Nurse the performance appraisal of her
subordinates every four months.
10. Does other tasks assigned from time to time.

Designation and Qualifications

License nurse with at least six months of hospital work.

OSPITAL NING ANGELES


Angeles, City

Job description

Designation title: Head Nurse, Nursing Station I


Immediate Supervisor: Assistant Chief Nurse, Nursing Area I
Unit: Nursing Station II
Nursing Area: Nursing Area I
Service: Nursing services

General description

Supervises Nursing activities and Nurse Station II and sees to the


proper performance of tasks and responsibilities by her subordinates.

Duties and Responsibilities

1. Helps her subordinates in providing nursing care to patients and


accomplish nursing tasks.
2. Sees to the completeness of entries to patients’ charts at all time.
3. Inspect the availability and completeness of supplies, instruments, and
equipment in station; request for and receives these items.
4. Notifies the Medical and Office Equipment Technician for defective
instruments and equipments.
5. Sees to the cleanliness of the ward, windows, toilets, mattresses, and
furniture.
6. Sees the cleanliness of the station, its instruments and equipment, and
the orderliness of its files and forms.
7. Secures the morning laboratory results and distributes it among the
staff nurse for posting in the patients charts.
8. Reminds staff nurses about giving medications, administering fluids,
and referring patients to physicians on time.
9. Collects and signs daily time records of subordinates and forwards
these to the Personnel Service; sees to the prompt submission of these
by subordinates.
10. Assists the Assistant Chief Nurse, Area I in making the schedule
of duties of her subordinates.
11. Receives applications for leave filed by subordinates and
recommends its approval/disapproval to her superior.
12. Submits performance appraisal of her subordinates to Assistant
Chief Nurse every four months.
13. Monitor complaints and comments of patients and their relatives
and relays these to the Chief Nurse.
14. Sees to the observance of Hospital and Nursing Policies and
Procedures.
15. Assign the personnel who is in charge of door keys of emergency
exits and emphasizes that these keys should always be in their
possession.
16. Refers to the Hospital Social Worker patients who are unable to
buy medicine have a diagnostic exam done, and for other
administrative problems.
17. Coordinates with other hospital personnel for mutual concerns.
18. Coordinates with the Clinical Instructors of students of affiliated
schools and reports to the Chief Nurse Problems and deficiencies
observed.
19. Notifies most senior nurse present of reportable incidents.
20. Does other task assigned from time to time.

Designation Qualifications
Licensed nurse with at least two years operating room work
experience; with leadership and managerial abilities; preferably, with at least
12 master units in nursing

OSPITAL NING ANGELES


Angeles, City
Job description

Designation title: Head Nurse, Nursing Station II


Immediate Supervisor: Assistant Chief Nurse, Nursing Area I
Unit: Nursing Station II
Nursing Area: Nursing Area I
Service: Nursing services

General description

Supervises Nursing activities and Nurse Station III and sees to the
proper performance of tasks and responsibilities by her subordinates.

Duties and Responsibilities

1. Helps her subordinates in providing nursing care to patients and


accomplish nursing tasks.
2. Sees to the completeness of entries to patients’ charts at all time.
3. Inspect the availability and completeness of supplies, instruments, and
equipment in station; request for and receives these items.
4. Notifies the Medical and Office Equipment Technician for defective
instruments and equipments.
5. Sees to the cleanliness of the ward, windows, toilets, mattresses, and
furniture.
6. Sees the cleanliness of the station, its instruments and equipment, and
the orderliness of its files and forms.
7. Secures the morning laboratory results and distributes it among the
staff nurse for posting in the patients charts.
8. Reminds staff nurses about giving medications, administering fluids,
and referring patients to physicians on time.
9. Collects and signs daily time records of subordinates and forwards
these to the Personnel Service; sees to the prompt submission of these
by subordinates.
10. Assists the Assistant Chief Nurse, Area I in making the schedule
of duties of her subordinates.
11. Receives applications for leave filed by subordinates and
recommends its approval/disapproval to her superior.
12. Submits performance appraisal of her subordinates to Assistant
Chief Nurse every four months.
13. Monitor complaints and comments of patients and their relatives
and relays these to the Chief Nurse.
14. Sees to the observance of Hospital and Nursing Policies and
Procedures.
15. Assign the personnel who is in charge of door keys of emergency
exits and emphasizes that these keys should always be in their
possession.
16. Refers to the Hospital Social Worker patients who are unable to
buy medicine have a diagnostic exam done, and for other
administrative problems.
17. Coordinates with other hospital personnel for mutual concerns.
18. Coordinates with the Clinical Instructors of students of affiliated
schools and reports to the Chief Nurse Problems and deficiencies
observed.
19. Notifies most senior nurse present of reportable incidents.
20. Does other task assigned from time to time.

Designation Qualifications

Licensed nurse with at least two years operating room work


experience; with leadership and managerial abilities; preferably, with at least
12 master units in nursing.
OSPITAL NING ANGELES
Angeles, City

Job description
Designation title: Charged Nurse, Nurse Station III
Immediate Supervisor: Head Nurse, Nursing Area III
Unit: Nurse Station III
Nursing Area: Nursing Area I
Service: Nursing services

General description

Unless specifically designated in the absence of the head nurse, the


most senior staff nurse on duty is the charged nurse. The charge nurse is the
leader of the duty nurses and helps them accomplish their tasks aside from
taking care of the patients assigned to her.

Duties and Responsibilities

1. Provides nursing care to her assigned patients accomplished the


required nursing tasks.
2. Receives the endorsements of, and in turn endorses to the following
shift, the stations furniture, instruments, equipments and supplies.
3. Acts on, or refers accordingly to the Nurse Supervisor, nursing and
administrative problems encountered by their station.
4. Sees to the observance of nursing and hospital unit for billing of
hospital charges.
5. Forward charts of discharged patients to concerned hospital unit for
billing of hospital charges.
6. Sees to the completeness of supplies, cleanliness and orderliness of
the station.
7. Sees to the proper use of semi-isolation cubicles and isolations rooms.
8. Coordinates with other hospital personnel for mutual concerns.
9. Submit to the Assistant Chief Nurse the performance appraisal of her
subordinates every four months.
10. Does other tasks assigned from time to time.

Designation and Qualifications

License nurse with at least six months of hospital work.

OSPITAL NING ANGELES


Angeles, City

Job description

Designation title: Staff Nurse, Nurse Station III


Immediate: Charged Nurse
Unit: Nurse Station III
Nursing area: Nursing Area I
Service: Nursing services

General description

Provides nursing care and perform various nursing tasks

Duties and responsibilities

1. Receives admitted patients and orients them and their relatives of the
basic nursing and hospital policies and procedures.
2. Carries out doctor’s orders, accomplishes monitoring charts, and writes
down the pertinent notes and nursing care plan.
3. Gives the necessary instructions and information to the patients or
their relatives regarding hygiene, precautions, and chores that they
have to do themselves.
4. Performs the various nursing tasks like giving medications, venoclysis,
monitoring vital signs, fluid input and output, etc.
5. Sees to the proper performance of tasks by nursing attendants.
6. Coordinates with attending physicians and resident in-charge
regarding the management of patients
7. Proper ancillary service request and prescriptions and gives the proper
instructions to relative of patients.
8. Sees to the proper preparations of patients who are undergo surgery
and other special procedures.
9. Assists doctors on their rounds or work.
10. Sees to the completion of the pertinent part of the admission and
discharge record.
11. Incorporates laboratory and diagnostic reports and results in the
chart.
12. Helps her superior in maintaining cleanliness in the station and
wards and in the implementation of nursing and hospital policies and
procedures
13. Enters into a logbook untoward incident and immediately notifies
superior about them.
14. Coordinates with other hospital personnel for mutual concerns.
15. Receives endorsement from, and I turn endorses to, co-nurses
duties and responsibilities.
16. Prepares to the proper charges for the use of supplies and
equipment, if applicable.
17. Sees to the safekeeping of supplies, equipment and instruments.
18. Operates the various equipment issued to the station and
notifies immediate superior of malfunctioning instruments and
equipment non availability of supplies.
19. Gives discharged instructions to patient and relatives.
20. Submit to the chief nurse the performance appraisal of nursing
attendant every four months.
21. Does other tasks assigned from time to time.

Designation and Classifications

License nurse with the patience and the energy to work in a


government hospital.
OSPITAL NING ANGELES
Angeles City

Job Description

Designation Title Nursing Attendant, Nursing Station III


Immediate Superior: Staff Nurse
Station: Nurse Station III
Area: Nursing Area I
Service: Nursing Services
General Description

Helps in the performance of nursing tasks

Duties and Responsibilities

1. Check for incompleteness of curtains, beds, mattresses, benches, and


side cabinets.
2. Sends dirty linens and curtains to the laundry service, receives these
back, and check for their completeness.
3. Coordinates with the Housekeeping Workers in maintaining cleanliness
of wards, furniture, and toilets.
4. Upon proper orientation and specific instruction from her superiors
does the following:
• Taking and charting vital signs
• Pulling out NGTs, urethral catheters, and IV lines
• Cleansing enema
• Fluid input and output charting
• Positioning patients
5. Takes care of the basic needs of patients without watchers like
feeding, drinking water, hygiene, assisting when going to the toilet,
emptying and cleaning urinal and bedpan, etc.
6. Coordinates with and instructs patients’ watchers for the provision of
the basic needs of patients as mentioned above.
7. Assists nurses in preparing instruments to be used by doctors; cleans
and stores used instruments.
8. Empties and cleans suction bottles especially when the Ward Utility
Worker absent or too busy with his other chores.
9. Helps in cleaning the station, its furniture, and equipment.
10. Conducts patients’ able to ride in wheelchair to and from other
hospital areas for treatment or diagnostic procedures.
11. Prepares and provides specimen bottles for urinalysis and stool
exam.
12. Clean and defrosts station refrigerators twice a month and as
needed.
13. Does other task assigned from time to time.

Designation Qualification

Midwifery or nursing aide graduate with the patience and stamina to


work in a government hospital.

OSPITAL NING ANGELES


Angeles City

Job Description

Designation Title: Chief Nurse


Immediate Superior: Hospital Director
Service: Nursing Services
General Description

Manages the operation and the activities of the Nursing Services

Duties and Responsibilities

20. Plans, directs, and controls various activities of the Nursing


Services that are related to quality assurance, excellent patient care,
diligent and accurate chart completion, use and care of equipments
and supplies, continuing professional education and training, personnel
hiring, distribution, promotion, and assignment of tasks, and
maintenance of clean and orderly in-patient areas.

21. Supervises the performance of the task by the housekeeping,


ward clinical, and ward utility workers.
22. Reviews and approves duty schedules of Nursing Services
personnel.
23. Endorses approval/disapproval of leave application of
subordinates.
24. Receives complaints against Nursing Services personnel,
conducts initial investigation, and submits preliminary reports to the
office of the Hospital Director.
25. Submits request for the equipment, instruments, and additional
or new supplies.
26. Conducts staff meetings, initiates in-house training, and
seminars.
27. Submits recommendation to further improve nursing and
hospital services.
28. Sees to the observance of the hospital and nursing policies and
procedures.
29. Updates the Nursing Census Board.
30. Promotes breastfeeding and family planning programs and
observance of hospital rules by patient and their relatives.
31. Conducts daily rounds in all nursing areas noting and addressing
concerns of patients, nursing, and medical staff, and other hospital
personnel.
32. Promotes smooth interpersonal relationship between the Nursing
Services Staff and the patients and their relatives.
33. Answer referrals from duty nurses even after office hours.
34. Coordinates with other hospital units and government offices or
community organizations for mutual concerns.
35. Sees to the proper performance appraisal of Nursing Services
personnel and their evaluation for promotions.
36. Assesses the efficiency and effectiveness of the Nursing Services
and recommends measures to further improve the organization.
37. Prepares the data for the monthly Nursing Audit and Quality
Assurance Program meetings.
38. Does other task assigned from time to time.

Designation Qualification

Licensed Nurse with at least ten years of hospital work. Must possess
managerial and leadership qualities, a vision and direction for the Nursing
Services, and must have finished at least academic units required in the
Master in Nursing course.
OSPITAL NING ANGELES
Angeles City

Job Description

Designation Title: Assistant Chief Nurse, Nursing Area I


Immediate Superior: Chief Nurse
Service: Nursing Services

General Description
Oversees the operations and activities of the Nursing Area I that is
comprised of Wards 1 to 6, Pay Wards, and NICU

Duties and Responsibilities

The following duties and responsibilities all pertain to Nursing Area I


operations and activities.
C. Administrative Management
19. Evaluate the performance of Nurse Supervisors and Head Nurse
and participate in the validation of performance evaluations of lower
ranked nurses.
20. Orients newly employed Nursing Services personnel and provides
them with their needed training.
21. Sees to the observance of Hospital and Nursing Services policies
and procedures.
22. Prepares duty schedule of all subordinates.
23. Assist the Chief Nurse in conducting preliminary investigation of
complaints against or made by Nursing Services personnel.
24. Conducts meetings, in-house training and seminars.
25. Compliments the efforts of the Chief-Nurse in promoting good
interpersonal relationships between the Nursing Services personnel
and the patient and their relatives.
26. Sees to the punctual submission of Daily Time Records by
subordinates and coordinates with the Personal Service with problems
regarding this.
27. Assist the Chief Nurse in supervising housekeeping, ward clinical,
and ward utility workers.
28. Suggest to the Chief Nurse measures to further improve the
Nursing Services.
29. Helps the Chief Nurse to prepare the monthly Nursing Audit and
Quality Assurance Reports.
30. Reports to the Chief Nurses cases of personnel who needs
counseling and join the former in the counseling session.
31. Notifies the Supply, Maintenance, and other hospital units for
their services.
32. Coordinates with the Security Service for the authorization
presence of persons in the Nursing 1 areas and for other immediate
security concerns.
33. Enters the data concerning Area1 in the Nursing Board in the
absence of the Chief Nurse
34. Coordinates with the other hospital personnel for mutual
concerns.
35. Receives leave applications from Head Nurses and disallows or
endorses them to the Chief Nurse.
36. Does other task assigned from time to time.

D. Supervision of Nursing Care


5. Randomly reviews nursing entries in the patients’ charts and discusses
these with the concerned nurses as needed. Nursing entries include
among others the Admission and Discharge Record, nurses’ notes,
medication and other charts, etc.
6. Routinely inquires about patients who are unable to buy medicines,
unable to have diagnostic procedures done, and/or have no watchers.
Refers these patients to the Social Services.
7. Promotes breastfeeding and family planning programs and reports to
the Chief Nurse violations of policies regarding them.
8. Provides nursing care as needed.

Designation Qualifications
Licensed nurse with at least seven years of hospital work. Must
possess managerial and leadership qualities and preferably, must have
finished at least 12 units in the Master in Nursing Care.

OSPITAL NING ANGELES


Angeles City

Job Description

Designation Title: Assistant Chief Nurse, Nursing Area II


Immediate Superior: Chief Nurse
Service: Nursing Services

General Description

Oversees the operations and activities of the Nursing Area II that is


comprised of Emergency Room, Operating Room, and ICU
Duties and Responsibilities

The following duties and responsibilities all pertain to Nursing Area II


operations and activities.
C. Administrative Management
19. Evaluate the performance of Nurse Supervisors and Head Nurse
and participate in the validation of performance evaluations of lower
ranked nurses.
20. Orients newly employed Nursing Services personnel and provides them
with their needed training.
21. Sees to the observance of Hospital and Nursing Services policies
and procedures.
22. Prepares duty schedule of all subordinates.
23. Assist the Chief Nurse in conducting preliminary investigation of
complaints against or made by Nursing Services personnel.
24. Conducts meetings, in-house training and seminars.
25. Compliments the efforts of the Chief-Nurse in promoting good
interpersonal relationships between the Nursing Services personnel
and the patient and their relatives.
26. Sees to the punctual submission of Daily Time Records by
subordinates and coordinates with the Personal Service with problems
regarding this.
27. Assist the Chief Nurse in supervising housekeeping, ward clinical,
and ward utility workers.
28. Suggest to the Chief Nurse measures to further improve the
Nursing Services.
29. Reports to the Chief Nurses cases of personnel who needs
counseling and join the former in the counseling session.
30. Notifies the Supply, Maintenance, and other hospital units for
their services.
31. Coordinates with the Security Service for the authorization
presence of persons in the Nursing 1 areas and for other immediate
security concerns.
32. Enters the data concerning Area II in the Nursing Board in the
absence of the Chief Nurse
33. Helps the Chief Nurse to prepare the monthly Nursing Audit and
Quality Assurance Reports.
34. Coordinates with the other hospital personnel for mutual
concerns.
35. Receives leave applications from Head Nurses and disallows or
endorses them to the Chief Nurse.
36. Does other task assigned from time to time.

D. Supervision of Nursing Care


5. Randomly reviews nursing entries in the patients’ charts and discusses
these with the concerned nurses as needed. Nursing entries include
among others the Admission and Discharge Record, nurses’ notes,
medication and other charts, ER Logbook, ICU Medicine/ Supply Stock
Card, etc.
6. Routinely inquires about patients who are unable to buy medicines,
unable to have diagnostic procedures done, and/or have no watchers.
Refers these patients to the Social Services.
7. Promotes breastfeeding and family planning programs and reports to
the Chief Nurse violations of policies regarding them.
8. Provides nursing care as needed.

Designation Qualifications

Licensed nurse with at least seven years of hospital work. Must


possess managerial and leadership qualities and preferably, must have
finished at least 12 units in the Master in Nursing Course.
OSPITAL NING ANGELES
Angeles City

Job Description

Designation Title: Nursing Supervisor, Nursing Area I and II


Immediate Superior: Assistant Chief Nurse, Nursing Area I and II
Area: Nursing Area I
Service: Nursing Services

General Description

Assist the Assistant Chief Nurse in supervising nursing activities and


addresses all nursing matters during non-office hours

Duties and Responsibilities


The following duties and responsibilities pertain to Nursing Area I and II
activities.
21. Monitor and realigns, as needed, the available nursing personnel
during her shift and keeps a record of absences. Submit the Chief
Nurse a weekly report of absences.
22. Monitors the proper labeling of IVF and rate of infusion
23. Periodically checks the cleanliness of the in-patient areas
particularly vacant beds/cubicles and rooms, comfort rooms, and
dishwashing areas. Notifies the housekeeping workers as needed.
24. Inspect Nurse Station for their orderliness, availability, and safe
keeping of instruments, equipments, and supplies. Calls the attention
of the Head of Charge Nurse for deficiencies.
25. Randomly talks to patients and their families assessing their
sentiments about the Nursing and Medical Services and the hospital as
a whole. Keeps a record of these dialogues and recommends to the
Chief \Nurse measures to address negative sentiments.
26. Informally assesses the morale, competency, and attitudes of
nursing personnel with regards their hospital work. Submits a
corresponding weekly report to the Chief Nurse.
27. Randomly review patients’ charts for completion of doctor’s
orders especially referrals, diagnostic and laboratory examinations,
medications, and various kinds of monitoring.
28. Keeps a record of untoward incidents and decides whether to
notify the Chief Nurse or the Senior House Officer immediately or later.
29. Assist or guides nursing personnel with difficult task and
addresses nursing problems encountered during her shift.
30. Monitors the efficient and effective performance of task of duty
nursing personnel.
31. Sees to the adherence of Nursing and Hospital Policies and
Procedures by everyone concerned.
32. Sees to it that unoccupied rooms are locked and not being used
by any person.
33. Renders Nursing Care as needed.
34. Sees to the proper released of corpses to funeral parlors.
35. Coordinates and assist clinical instructress of affiliated nursing
and allied course s and monitors their activities. Reports to the Chief
Nurse any problems in their scope of activities.
36. Coordinates with the Security Guard violations in visiting hours,
number of watchers, unruly behavior, and other security concerns.
37. Coordinates with other hospital personnel for mutual concerns.
38. Assist ER Nursing Service personnel during busy hours.
39. Sees the proper distribution of patients confined at the pay
Wards to economize on energy consumption.
40. Does the task of checking if the oxygen tanks for disposal are
completely empty if the Chief Nurse is absent.
OSPITAL NING ANGELES
Angeles City

Job Description

Designation Title: Head Nurse, Nursing Station I


Immediate Superior: Assistant Chief Nurse, Nursing Area I
Area: Nursing Area I
Service: Nursing Services

General Description

Supervises Nursing activities at Nursing Station I and sees to the


proper performance of tasks and responsibilities by her subordinates

Duties and Responsibilities

21. Helps her subordinates in providing nursing care to patients and


accomplishing nursing tasks.
22. Sees to the completeness of entries to patients’ charts at all
times.
23. Inspects the availability or completeness of supplies,
instruments, and equipment in station; request for and receive these
items.
24. Notifies the Medical and Office Equipments Technician for
defective instruments and equipment.
25. Sees to the cleanliness of wards, windows, toilets, mattresses,
and the orderliness of its files and forms.
26. Sees to the cleanliness of the station, its instruments and
equipment, and orderliness of its files and forms
27. Secure the morning laboratory results and distributes it among
the staff nurses for posting in the patients’ charts.
28. Reminds staff nurses about giving medications, administering
fluids, and referring patients to physicians on time.
29. Collects and signs daily time records of subordinates and
forwards these to the Personnel Service; sees to the prompt
submission of these by subordinates.
30. Assists the Assistant Chief Nurse, Area I in making the schedule
of duties of her subordinates.
31. Receives applications for leave filed by subordinates and
recommends its approval/disapproval to her superior.
32. Submits performance appraisal of her subordinates to Assistant
Chief Nurse every four months.
33. Monitor complaints and comments of patients and their relatives
and relays these to the Chief Nurse.
34. Sees to the observance of Hospital and Nursing Policies and
Procedures.
35. Assign the personnel who is in charge of door keys of emergency
exits and emphasizes that these keys should always be in their
possession.
36. Refers to the Hospital Social Worker patients who are unable to
buy medicine have a diagnostic exam done, and for other
administrative problems.
37. Coordinates with other hospital personnel for mutual concerns.
38. Coordinates with the Clinical Instructors of students of affiliated
schools and reports to the Chief Nurse Problems and deficiencies
observed.
39. Notifies most senior nurse present of reportable incidents.
40. Does other task assigned from time to time.

Designation Qualifications

Licensed nurse with at least two years operating room work


experience; with leadership and managerial abilities; preferably, with at least
12 master units in nursing
OSPITAL NING ANGELES
Angeles City

Job Description

Designation Title: Head Nurse, Nursing Station II


Immediate Superior: Assistant Chief Nurse, Nursing Area I
Area: Nursing Area I
Service: Nursing Services

General Description

Unless specifically designated and in the absence of the Head Nurse,


the most senior staff nurse on the duty is the charge nurse. The charge
nurse is the leader of the duty nurses and helps them accomplish their tasks
aside talking care of the patients assigned to her.

Duties and Responsibilities

11. Provides nursing care to her assigned patients and accomplishes the
required nursing task.
12. Receives the endorsements of, and in turn endorsers to the
following shift, the station’s furniture, instruments, equipment, and
supplies.
13. Acts on, or refers accordingly, nursing and administrative
problems encountered by their station.
14. Sees to the observance of Nursing and Hospital Policies and
Procedures.
15. Forward charts of discharged patients to concerned hospital unit
for billing of hospital charges.
16. Sees to the completeness of supplies, cleanliness and orderliness
of the station.
17. Sees to the proper use of semi-isolation cubicles and isolation
rooms.
18. Coordinates with other hospital personnel for mutual concerns.
19. Submits to Assistant Chief Nurse the performance appraisal of
her subordinates every four months.
20. Does other task assigned from time to time.

Designation Qualification

Licensed nurse with at least six months of hospital work.


OSPITAL NING ANGELES
Angeles City

Job Description

Designation Title: Staff Nurse, Nursing Station II


Immediate Superior: Charge Nurse
Area: Nursing Area I
Service: Nursing Services

General Description

Provides nursing care and perform various nursing tasks

Duties and Responsibilities

1. Receives admitted patients and orients them and their relatives of the
basic nursing and hospital policies and procedures.
2. Carries out doctors’ order, accomplishes monitoring charts, and writes
down the pertinent notes and nursing care plan.
3. Gives necessary instructions and information to patients or their
relatives regarding hygiene, precautions and chores that they have to
do themselves.
4. Performs various nursing task like giving medications, venoclysis,
monitoring vital signs, fluid input and output, etc.
5. Sees to the proper performance of tasks by nursing attendants.
6. Coordinates with attending physicians and resident-in-charge
regarding the management of patients.
7. Prepares ancillary service request and prescriptions and gives the
proper instruction to relatives of patients.
8. Sees to the proper preparations patients who are to undergo surgery
and other special procedures.
9. Assist doctors on their ward rounds or work.
10. Sees to the completion of the pertinent part of the Admission and
Discharge Record.
11. Incorporates laboratory and diagnostic reports and results in the
chart.
12. Helps her superiors in maintaining cleanliness in the station and
wards and in the implementation of Nursing and Hospital policies and
procedures.
13. Enters into a logbook untoward incident and immediately notifies
superior about them.
14. Coordinates with other hospital personnel for mutual concerns.
15. Receive endorsement from, and in turn endorses to, Co-nurses
duties and responsibilities.
16. Prepares the proper changes for the use of supplies and
equipment, if applicable.
17. Sees to the safekeeping of supplies, equipments, and
instruments.
18. Operates the various equipments issued to the station and
notifies immediate superior of malfunctioning instruments and
equipment non-availability of supplies.
19. Gives discharge instruction to patients and their relatives.
20. Submits to the Chief Nurse the performance appraisal of nursing
attendants every four months.
21. Does other task assigned from time to time.

Designation Classification

Licensed nurse with the patience and the energy to work in a


government hospital.
OSPITAL NING ANGELES
Angeles City

Job Description

Designation Title: Nursing Attendant, Nursing Station II


Immediate Superior: Staff Nurse
Station: Nurse Station II
Area: Nursing Area I
Service: Nursing Services

General Description

Helps in the performance of nursing tasks

Duties and Responsibilities

Check for incompleteness of curtains, beds, mattresses, benches, and side


cabinets.
1. Sends dirty linens and curtains to the laundry service, receives
these back, and check for their completeness.
2. Coordinates with the Housekeeping Workers in maintaining
cleanliness of wards, furniture, and toilets.
3. Upon proper orientation and specific instruction from her superiors
does the following:
• Taking and charting vital signs
• Pulling out NGTs, urethral catheters, and IV lines
• Cleansing enema
• Fluid input and output charting
• Positioning patient
4. Takes care of the basic needs of patients without watchers like
feeding, drinking water, hygiene, assisting when going to the toilet,
emptying and cleaning urinal and bedpan, etc.
5. Coordinates with and instructs patients’ watchers for the provision
of the basic needs of patients as mentioned above.
6. Assists nurses in preparing instruments to be used by doctors;
cleans and stores used instruments.
7. Empties and cleans suction bottles especially when the Ward Utility
Worker absent or too busy with his other chores.
8. Helps in cleaning the station, its furniture, and equipment.
9. Conducts patients’ able to ride in wheelchair to and from other
hospital areas for treatment or diagnostic procedures.
10. Prepares and provides specimen bottles for urinalysis and stool
exam.
11. Clean and defrosts station refrigerators twice a month and as
needed.
12. Does other task assigned from time to time.

Designation Qualification

Midwifery or nursing aide graduate with the patience and stamina to


work in a government hospital.
OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: Nursing Supervisor, Nursing Area II

Immediate Superior: Assistant Chief Nurse, Nursing Area II

Area: Nursing Area II

Service: Nursing Services

General Description

Assists the Assistant Chief Nurse in supervising nursing activities and


addresses all nursing matters during non-office hour. The Nuse Supervisors
of Area II mostly stays and works at the Emergency Room.

Duties and Responsibilities

The following duties and responsibilities pertain to the Nursing Area II


activities.

1. Monitors and realigns, as neede, the available nursing pesonnel


during her shift and keeps a record absences. Submits to the Chief
Nurse a weekly report of absences.
2. Quickly assesses ER patients whether they are emergency of non-
emergency cases and prioritize referrals to duty physicians; identify
potebtial problems with patients and prevents the occurrence of
such.

3. Sees to the cleanliness and orderliness of the ER.

4. Periodically checks the cleanliness of the public comfort rooms used


ER patients and notifies the housekeeping workers as needed.

5. Randomly talks topatients and their families asssessing their


sentiments about the Nursing and Medical Services and the hospital
as a whole. Keeps a record of these dialogues and recommends to
the Chief Nurse measures to address negative sentiments.

6. Informally assesses the morale, competency, and attitudes of


nursing personnel with regards their hospital work. Submit a
corresponding weekly report to the Chief Nurse.

7. Keeps a record of untoward incidences and decides whether to


notify the Chief Nurse of the Senior House Officer immediately or
later.

8. Assists or guides nursing personnel with difficult tasks and


addresses nursing problems encounteredduring her shift.

9. Monitors the efficient and effective performance of tasks of on duty


nursing personnel.

10. Renders nursing care as needed.

11. Sees the adherence to Nursing and Hospital Policies and


procedures by everyone concerned.

12. Requests, through his immediate superior, additional ER


equipment and instruments.
13. Requisitions and receives ER medicines and supplies.

14. Sees to the proper storage and utilizationof ER resources.

15. Coordinates with other hospital personnel for mutual concerns.

16. Coordinates with physicians in the accurate and complete entries


in the patients logbook.

17. Endorses to the Nursing Services Supervisor of Nursing Area I


bodies of patients who died at Area II for the proper release of
corpses to funeral parlors.

18. Coordinates and assists clinical instructors of affiliated nursing


and allied courses and monitors their activities. Reports to the Chief
Nurse any violationsin their scope of activities.

19. Coordinates with the Security guard violations in visiting hours,


number of watchers, unruly behavior, and other security concerns.

20. Does other tasks assigned from time to time.

Designation Qualifications

Licensed nurse with at least three years of hospital experience, has


leadership and managerial qualities, and preferably with at least twelve units
in the Master in the Nursing course.
OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: Charge Nurse, Emergency Room

Immediate Superior: Nurse Supervisor, ER

Unit: ER Nursing Service

Area: Nursing Area II

Service: Nursing Services

General Description

Unless specifically designated and in the absence of the ER nurse


Supervisor, the most senior staff nurse on duty is the charge nurse. The
charge nurse is the leader of the duty nurses and helps them accomplish thei
tasks aside from taking care of the patients assigned to her.
Duties and Responsibilities

1. Provide nursing care to her assigned patients and accomplishes the


required nursing tasks.

2. Receives the endorsement of, and in turn endorsers to the following


shift, the station’s furniture, instruments, equipment, and supplies.

3. Acts on, or refers accordingly, nursing and administrative problems


encountered by their station.

4. Sees to the observance of\Nursing and Hospital Policies and


Procedures.

5. Prepares change slips and instructs relatives of patients to see the


Cashier Service for the payment of charges.

6. Sees to the completeness of supplies, cleanliness and orderliness of


the station

7. Coordinates with other hospital personnel for mutual concerns.

8. Submits to the Assistant Chief Nurse the performance appraisal of her


subordinates every four months.

9. Does other tasks assigned from time to time.

Designation Qualifications

Licensed nurse with at least six months of hospital work.


OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: Emergency Room Staff Nurse

Immediate Superior: Nurse Supervisor, Area II

Unit: ER Nursing Service

Area: Area II

Service: Nursing Services

General Description

Performs nursing tasks at the Emergency Room.


Duties and Responsibilities

1. Receives patients, makes a quick assessment, institutes initial


emergency care as needed, and notifies the duty physician at the ER.

2. Enters identifying and other pertinent patient data in the logbook and
reminds duty physicians to complete clinical data of patients.

3. Prepares equipment, intruments, and supplies needed in the care of ER


patients.

4. Carries out nursing chores as ordered by the physicians such as


venoclysis, administration of medications, oxygen inhalation,
nebulization, suctioning secretions, placing of indwelling catheter, etc.

5. Operates the various ER equipments like the ECG, defibrillator, pulse


oximeter, etc.

6. Assists physicians in the repair of lacerations, orthopedic


manipulations, and other procedures.

7. Sutures minor and non-facial lacerations as ordered and supervised by


physicians.

8. Monitors vital signs, does or supervises the giving of tepid sponge


bath.

9. Draws blood and other specimen for laboratory examinations when the
medical technologist on duty csnnot response to ER on call on time.

10. Assist the duty physicians in filling up request forms and giving
instructions to the patients or their relatives.

11. Assists the Nursing Supervisor in assessing and prioritizing care


of patients whether they are emegency cases or non-emergency cases.
12. Asssists the ER Midwife when they need help.

13. Assists the Ambulance Nurse in the preparations needed in the


conduction of ER patients.

14. Supervises the ER Nursing Attendant in the performance of his


tasks.

15. Accomplishes the pertinent data in the Admission–Discharge


Form.

16. Endorses admitted pateints to the corresponding nursing service


after duly carrying out ER Doctor’s Order and writing down the Nurses
Remarks.

17. Notifies the Nurse Supervisor of the need for ER medicines and
supplies, repair instruments and equipment, and reprtable incidences.

18. Accompanies seriously ill or injured patients to and from the ER.

19. Coordinates with other hospital personnel for mutual concerns.

20. Endorses work and resources to incoming duty personnel.

21. Does other tasks assigned from time to time.

Designation Qualifications

Licensed nurse with the patience and stamina to work in a government


hospital.
OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: Ambulance Nurse

Immediate Superior: Nurse Supervisor, Area II

Unit: ER Nursing Service

Nursing Area: Area II


Service: Nursing Services

General Description

Goes with the ambulance during conduction of patients and when the
ambulance is responding to emergency calls providing nursing and
paramedical care.

Duties and Responsibilities

1. Prepares and secure medicines, supplis, instruments, and equipment


needed in the ambulance.

2. Ensures the sufficient supply of oxygen gas in the ambulance.

3. Monitors conditions of patients while being conducted and institutes


the necessary emergency care; and, makes the decision whether to
complete conduction of patients or proceed to the nearest hospital in
the absence of an accompanying physician.

4. Coordinates with the duty physician in ensuring proper coordination


with the receiving health facility.

5. Secures endorsement letter from the duty physician and endorses


patients to the receiving health facility.

6. Keeps a logbook of activities and informs Nurse Supervisor of


reportable incidents.

7. When infomed of a conduction of a non-ONA patient, explains to the


relatives of the patient that they have to provide their own ambulance
nurse.

8. Does the task of an ER Staff Nurse when not conducting patients.


9. Coordinates with the ambulance driver regarding a safe trip and
conduction of patients.

10. Decides on/or refers problems encountered during an ambulance


conduction.

11. Implements pertinent Nursing and Hospital Rules and


Regulations in the performance of his tasks.

12. Does other task assigned from time to time.

Designation Qualifications

Licensed nurse with the patience and stamina to work in a government


hospital; must be able to work alone and make decisions regarding
disposition of patients being conducted by the ambulance.

OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: ER Nursing Attendant

Immediate Superior: ER Staff Nurse


Unit: ER Nursing Service

Area: Area II

Service: Nursing Services

General Description

Helps in theaccomplisment of Nursing Tasks in the emergency room.

Duties and Responsibilities

1. Receives patients and places them on the stretchers and notifies


the ER nurse.

2. Assists the ER Nurse and the RE Midwife in the performance of their


tasks by helping prepare instruments, equipment and supplies,
assissting patients coordinating with laboratory, x-ray,
pharmacytaking vital signs,entering personal data of patients into
the logbook, etc.

3. Conducts non-seriously ill or injured to and from the ER;


accompanies ER Staff Nurse in conducting patients in serious
conditions.

4. Helps Housekeeping Workers in making the ER clean and orderly.

5. Ensyres the availability of urine and stool specimen bottles.

6. Prepares IV splint for ER use

7. Assists in suturing wounds.

8. Cleans ER equipment daily.


9. Cleans and defrosts the refrigerator at the ER twice a month and as
needed.

10. Does other tasks from time to time.

Designation Qualifications

Midwifery or Nursing Aide graduate wuth the patience and stamina to


work in a government hospital.

OSPITAL NING ANGELES

Angeles City

Job Description
Designation Title: Midwife

Immediate Superior: ER Staff Nurse

Unit: ER Nursing Service

Area: Area II

Service: Nursing Services

General Description

Receives obstetrical and gynecological patients and helps in the


performance of nursing tasks in the ER.

Duties and Responsibilities

1. Receive OB-Gyn patients, takes their vital signs, does routine


examination and care of pregnant patient, enters the required data in
the patients logbook, and prepares them for examination by the duty
physician.

2. With instructions from the duty physician, may do internal examination


in uncomplicated cases of pregnancies.

3. Assists the physician in the management of OB –Gyn patients and in


giving them instructions

4. Carries out Doctor’s Orders in the admission of uncomplicated


pregnancies, refers Doctor’s Orders to the ERStaff Nurse in
gynecological patients and complicated cases of pregnancies.

5. Coordinates with the Deliver Room Personnel regarding patients for


admission and accompanies the admitted patients to the labor room.
6. Assists the ER Nurses in their tasks when not busy in OB/Gyn patients
by taking vital signs, preparing instruments, equipments, and supplies,
instructing patients, accompanying patients, suturing minor and non-
facial lacerations under a physicians supervision, receiving patients
and entering data in the logbook, keeping the ER and its implements
clean and orderly, etc.

7. Sees to the cleanliness and orderliness of the OB-ER area and its
instruments and furniture.

8. Sees to the availability and safekeping of supplies and instruments in


the OB-ER area.

9. Notifies the Nursing Supervisor of defective instruments.

10. Endorse patients and materials to the incoming duty ER Midwife.

11. Does other tasks assigned from time to time.

Designation Qualificatiion

Licensed midwife who has the patience and stamina to work in a


government hospital.

OSPITAL NING ANGELES

Angeles City
Job Description

Designation Title: ICU Head Nurse

Immediate Superior: Assistant Chief Nurse, Area II

Unit: ICU Nursing Service

Area: Area II

Service: Nursing Services

General Description

Sees to the efficient and effective performance of nursing tasks at the


ICU.

Duties and Responsibilities

1. Ensures the availability of medicines, linen, and supplies at the ICU;


requisitions and receives these items.

2. Regularly checks the availability and proper functioning of instruments


and equipment and coordinates their preventive and repair
maintenance.

3. Reviews charts and sees to the faithful implementation of all nursing


care plans and doctors orders.

4. Ensures the completeness of data in the patients charts,


logbooks,medicine card, stock cards, charge slips, etc.

5. Sees to the proper implementation of nursing tasks and hospital


policies and procedures.
6. Renders nursing care.

7. Sees to it incidents are properly logged and reported to the Assistant


chief Nurse, Area II.

8. Coordinates with his immediate superior regarding untoward incidents


at the ICU.

9. Endorses to immediate superior or disallows applications for leave filed


by subordinates.

10. Sees to the cleanliness and orderliness of the ICU and its
equipment and instruments.

11. Promotes harmonious relationship between the ICU Nursing Staff


and the ICU patients and their relatives.

12. Coordinates with other hospital personnel for mutual concerns.

13. Submits to the Assistant Chief Nurse the performance appraisal

14. Does tasks assigned from time to time.

Designation Qualifications

Licensed nurse with at least one year of ICU nursing experience, with
leadership and managerial abilities; preferably, with at least 12master units
in nursing.
OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: Charge Nurse, ICU

Immediate Superior: Head Nurse, ICU

Unit: ICU Nursing Service

Area: Nursing Area II

Service: Nursing Services

General Description

Unless specifically designated and in the absence of the ER nurse


Supervisor, the most senior staff nurse on duty is the charge nurse. The
charge nurse is the leader of the duty nurses and helps them accomplish thei
tasks aside from taking care of the patients assigned to her.

Duties and Responsibilities

1. Provide nursing care to her assigned patients and accomplishes the


required nursing tasks.

2. Receives the endorsement of, and in turn endorsers to the following


shift, the station’s furniture, instruments, equipment, and supplies.
3. Acts on, or refers accordingly, nursing and administrative problems
encountered by their station.

4. Sees to the observance of\Nursing and Hospital Policies and


Procedures.

5. Forwards charts of discharged patients to concerned hospital unit for


billing of hospital charges.

6. Sees to the completeness of supplies, cleanliness and orderliness of


the station

7. Coordinates with other hospital personnel for mutual concerns.

8. Submits to the Assistant Chief Nurse the performance appraisal of her


subordinates every four months.

9. Does other tasks assigned from time to time.

Designation Qualifications

Licensed nurse with at least six months of hospital work.


OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: ICU Staff Nurse

Immediate Superior: ICU Head Nurse

Unit: ICU Nursing Service

Area: Nursing Area II

Service: Nursing Services

General Description

Performs the various tasks at the ICU.

Duties and Responsibilities

1. Receives newly admitted patients, and sees to the completion of


doctor,s order.

2. Performs various tasks like giving of medications, venoclysis, vital


signs monitoring, turning of patients, sending of requests for
diagnostic procedures and getting their results, completion of
nursing records and charts, etc..

3. Sees implementation of Nursing and Hospital Policies and


procedures specially in the absence of the immediate superior.

4. Operates the various ICU equipments.

5. Accomplishes charge slips of ICU items used by patients and


attaches theses to the chart.

6. Safeguards ICU medicine, supplies, and equipment and updates


stock cards.

7. Receives endorsements of previous duty nurse and endorses


patients and ICU items to incoming nurse.

8. Sees to the cleanliness and orderliness of ICU area.

9. Sees to the availability of ICU medicines and supplies; requests for


various ICU stocks as the need arises.

10. Coordinates with the equipment technician for preventive and


repair maintenance of ICU machines and other equipment.

11. Coordinates with other hospital personnel for mutual concerns.

12. Does other tasks assigned from time to time.

Designation Qualifications

Licensed nurse preferably with at least one year hospital experience.


OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: OR Head Nurse

Immediate Superior: Assistant Chief Nurse, Area II

Unit: OR Nursing Service

Area: Area II

Service: Nursing Services

General Description

Sees to the efficient and effective performance of nursing tasks at the


operating room.

Duties and Responsibilities


1. Recieves requests for surgery and coordinates with the OR-Anesthesia
for scheduling of the surgical case.

2. Sees to the availability of the instruments, supplies, equipment, and


other items required in the surgery.

3. Coordinates with the doctors concerened regarding changes and


problems in their scheduled surgery.

4. Sees to the cleanliness and orderliness of the operating room complex


and recommends sanctions againts its violator.

5. Enforces the dress code for the operating room complex and
recommends sactions againts its violators.

6. Sees to the proper cleaning and proper sterilization of surgical items.

7. Keeps an inventory of OR instruments, equipment, and supplies and


sees to their safety and proper storage and issuance.

8. Requests for and recieves needed OR items.

9. Sees to the proper completion of OR nursing records and charge slips.

10. Prepares and submits required reports of the service.

11. Trains newly assigned personnel to the OR.’

12. Submits to the Chief Nurse Performance appraisal of


subordinates every four months.

13. Assists or acts as circulating nurse when the need arises.

14. Informs immediate superior of untoward incidents in the OR and


makes certain that these are entered in a logbook.

15. Coordinates with other personnel for mutual concerns.

16. Coordinates with relatives of patients as the need arises.


17. Reports to immediate superior lost or damaged OR items.

18. Sees to the implementation of hospital and nursing policies and


procedures.

19. Recommends approval/disapproval of leave applications filed by


subordinates.

20. Assists the Assistant Chief Nurse in making the duty schedule of
OR Nursing Services personnel.

21. Submits to the Assistant Chief Nurse the performance appraisal


of subordinates every three months.

22. Does other tasks assigned from time to time.

Designation Qualifications

Licensed nurse with at least two years work in the operating


room; with leadership and managerial abilities; preferably with 12
masteral units in nursing.
OSPITAL NING ANGELES

Angeles City

Job Description

Designation Title: Charge Nurse, Operating Room

Immediate Superior: OR Head Nurse

Unit: OR Nursing Service

Nursing Area: Nursing Area II

Service: Nursing Services

General Description

Unless specifically designated and in the absence of the OR Head


Nurse, the most senior staff nurse on duty is the charge nurse. The
charge nurse is the leader of the duty nurses and helps them
accomplish their tasks aside from taking care of the patients assigned
to her.

Duties and Responsilities

1. Provides nursing care to her assigned patients and accomplised the


required nursing tasks.

2. Recieves the endorsements of, and in turn endorses to the following


shift, the station’s furniture, instruments, equipment, and supplies.
3. Acts on, or refers accordingly, nursing and administrative problems
encountered by their station.

4. Sees to the observance of Nursing and Hospital Policies and


Procedures.

5. Prepares the OR charge slips and incorporate these to the charts.

6. Sees to the completeness of supplies, cleanliness and orderliness of


the station.

7. Coordinates with other hospital personnel for mutual concerns.

8. Submits to the Assistant Chief Nurse the performance appraisal of her


subordinates every four months.

9. Does other tasks assigned from time to time.

Designation Qualifications

Licensed nurse with at least six months of hospital work.

H. Patient classification system


In RLMMC (ONA) the patient classification systems, patients are divided
into three categories on the basis of their dependency needs and the level of
personnel required to satisfy these needs. A Three-category classification
system consist of: (1) self-care or minimal care; (2) practical care or
moderate of intermediate care; and(3) total care or intensive care. For a
three-category system, the total care and intensive care categories are
combined.

Levels of Care of RLMMC (ONA):


Level I – Self – care or nominal care category. Under this category, the
patient is capable of carrying out daily activities as long as the nurse
provides the necessary materials and supplies.
A patient who enters a hospital for diagnostic work-up that includes
numerous laboratory, x-ray and other non-invasive tests, is often a self-care
patient for the duration of his work-up.
Level II – Intermediate or moderate or partial care category. Under this
category, the patient can feed, bathe, toilet and dress himself without help,
but requires some assistance from the nursing staff for special treatment or
certain aspects of personal care. For example, a partial care patient might
require wound debridement or dressing, catheterization, colostomy
irrigation, intravenous fluid therapy, intramuscular or subcutaneous injection
or chest physiotherapy.
The patient being prepared for surgery or has just passed through the
acute post-operative period, and convalescing from surgery may be in the
partial care category.
Level III – Total Care/intensive Care Category. Under this category, a
bed-ridden patient who lacks the strength or mobility, needs nursing
assistance with all his/her daily activities, such as, feeding, bathing, dressing,
moving, positioning, eliminating, comfort-seeking and injury avoidance.

RLMMC (ONA) PERCENTAGE OF PATIENTS IN VARIOUS


LEVELS OF CARE
Minimal Moderat Intensive Highly
Care e Care Specialized
Care Care
65 30 5 -
Secondary Hospital

I. Scheduling
The number of working hours and off-duties in RLMMC (ONA) is largely
dependent on the Forty-Hour-Per-Week Law, otherwise known as R.A. 5901.
This law specifies that personnel working in agencies with a population of
one million and in hospitals with a one hundred bed capacity and over are
entitled to work forty hours per week. On the other hand, nursing personnel
who work in agencies with a population of less than one million, will have to
render forty-eight working hours a week, therefore, only getting one day off
a week.

The following policies as regards to work leaves are assumed to be


given regardless of the number of working hours per week:
1. 15 days each per year for vacation and sick leaves
2. 10 legal holidays per year
3. 2 special holidays per year
4. 3 days for continuing professional education per year, for a total of
45 days per year.

RLMMC (ONA) is a licensed secondary level hospital. It has an average


patients of 120 approved by the Department of Health.

Step 1. Categorize patients according to levels of care.


120 (pts.) x .65 - 78 pts. Needing minimal care
120 (pts.) x .30 - 36 pts. Needing moderate/intermediate care
120 (pts.) x .05 - 6 pts. Needing intensive care
Total = 120 pts

Step 2. Find the number of Nursing Care Hours (NCH) needed by the
patient per day at each categorized level.
78 x 1.5 (Nsg. Care hrs. needed = 117 nsg. Care hrs. needed
Per day at level 1) by 78 patients
36 x 3 (Nsg. Care hrs. needed
Per day at level 2) = 108 nsg. Care hrs. needed by
36 patients
6x 4.5 (Nsg. Care hrs. needed
Per day) = 27 nsg. Care hrs. needed by
6 patients
Total = 252 Nursing Care Hours/day

Step 3. Find the actual number of NCH needed by 120 patients per
year
252 x 365 = 91,980 total NCH needed per year.

Step 4. Find the number of nursing personnel needed


a. 91,980 (NCH/year) = 54 Nursing Personnel
1704 (working hrs/yr)
b. 54 x .15 = 8 Nursing Personnel as Relief
c. 54 + 8 = 62 Total Nursing Personnel Needed

Step 5. Categorize according to professional and nonprofessional


personnel.
54 x .60 = 32 Nurses 54 x .40 = 22 Nursing Attendants

Step 6. Distribute by shifts


32 x .45 = 14 nurses on 7-3 22x .45 = 10 nursing attendants on 7-3
32 x .37 = 12 nurses on 3-11 22 x .37 = 8 nursing attendants on 3-11
32 x .18 = 6 nurses on 11-7 22 x .18 = 4 nursing attendants on 11-7
Total = 32 Total = 22

J. Modalities of care
Nursing modalities of patterns of care in RLMMC (ONA):

1. The functional method assumes an assembley line approach where major


tasks are delegated by the senior nurse to individual members of the
working group. Such tasks are divided into segments, such as, medications,
giving bath, monitoring intravenous fluids, or taking vital signs.

This method is the most economical way of delivering nursing services


since it gives greater control of work activities and fewer interruptions. The
workers feel more secure in a dependent role. In addition, the senior nurse
becomes adept in assigning tasks and in conserving workers use and cost.
This type of nursing modality is advisable when there are only a few nurses
to take care of many patients.

There are however some disadvantages to this modality. Because the


work is fragmented, patients have to deal with many nurses instead of just
one with whom they can relate to. Consequently, the nurse may fail to
recognize the nursing needs and coping mechanism of the patients.

2. Under the same method, a nurse is assigned for eight (8) hours to take
care of the needs of one or two patients. This is done when the nurses
outnumber the patients. Under this arrangement, the patient is able to relate
with his nurse and vice versa. A disadvantage, however, is that the nurses
are not given the opportunity to know other patients in the unit. This can be
reminded through nursing rounds. Special duty nurses or those in intensive
care units usually practice this method.

3. In team nursing, leadership comes from the team leader who is usually the
professional nurse, since he/she performs the highest degree of nursing skills
including assessment, making the nursing diagnosis, planning and directing
nursing care. He/she is assisted by auxiliary nursing personnel.

The team works with a group of patients. Each member performs the
tasks he/she has been assigned to perform. The team has a daily planning
care conference wherein the case is discussed and all members are
encouraged to suggest measures to improve patient care. This joint effort
improves nursing care plans for the patients. Under this modality, the
emphasis is on the patient, the worker and the work.

4. Primary nursing involves accountability for a small case load of individual


patients from admission to discharge. This arrangement permit’s a one-on-
one nurse-patient relationship and utilizes the nursing process and the
problem-solving approach.

The primary nurse is accountable for the assessment, planning of


nursing care, implementation and evaluation of the nursing care of the
patient for twenty-four (24) hours. Nursing care is reviewed and evaluated
through regular meetings.

Under this modality, care is focused on the patient. The nurse knows
the needs and could be more responsive and effective in her nursing care.
He/she also has a greater capacity to utilize his/her functions and skills.

A disadvantage of this modality is its costliness. Leadership tends to be


restricted to a small group of patients and nurses may not be prepared for
his kind of role.

5. Acuity of Illness- under this modality, care is focused on the degree of care
for illness or condition of the patient wherein the nurse/team utilizes the
progression patient care concepts.
II. PROBLEM (Problem and Analysis)

The following are the discrepancies that we as researcher have seen in the
institution RLMMC (ONA):

1. Lack of Funds is considered to be a discrepancies in the institution so as to


have a good nursing management in the said institution. For the reason that
lack of funds is included in the management process specifically in
controlling. Monetary, and budgeting of such institution is included in the
process of controlling. The said discrepancies is a hindrance to have a good
nursing management so as to have a “Win Win” situation, results, a positive
or a successful management both on the institution side and the personnel
site (head, managers, supervisors, staff, etc.) Lack of funds may also affect
the performance of the staff, and even the supplies of the hospital for them
to render a good or quality nursing care for the patient. An institution having
an adequate funds is one of a good way wherein nursing management or the
controlling maybe said successful.

2. Political factor is the second discrepancies in the said institution. The said
institution is a government hospital. Wherein most of the management
process is affected. Planning is affected for the reason that whoever in
incumbent mayor and the new mayor will always have a different planning,
organizing, staffing, directing and controlling. New Mayor means new Staff…
meaning there is no permanent staffing in the said institution.

3. Negligence is the third discrepancies that we researcher have seen in the


institution. Specifically in the side of the nursing students are the affiliated
school in the said intuitions. Such as wrong medication or wrong dosages
and wrong intervals of the medicine to be taken or administered to the
patient. Wherein it is considered as one of the hindrances to the institution
to have a good nursing management, or to give a quality care to the patient.
Institution giving quality care to the patient may it be a secondary or tertiary
hospital will always follow a certain standard or procedure in giving care to
the patient so as to avoid the occurrence of some sentinel events or
negligence. And this will affect the process of the nursing management
process.
III. PROPOSALS

LACK OF FUNDS:

Throughout the interview, it was mentioned that one of the most


common problem that the researchers’ picked hospital is none other than
lack of funds. An example of this is that people who had their confinement or
those significant others tend to run out of the hospital as soon as they have
given an appropriate treatment for their disease or conditions without even
paying their bills. The analysis of the researchers regarding this issue would
have been there are still many people who do not get pay as much as they
need or most are still unemployed. The best solution for this should come
from our government of course, where they should be aware in distributing
enough funds needed for those people who are categorized as poor in our
country. Also they should distribute enough amount of funds in public
hospitals due to most of them are lacking funds which could lead to not
having enough budget in getting the basic equipments needed in giving care
to patients. However as researchers, we suggest or propose that if possible
we could also try some techniques in solving these issues into our own. The
strategy of being resourceful might help in terms of spending the small
amount of budget given to the institution to the equipments or things that
are only important. Also if possible, they should build a small pharmacy in
the institution itself that sells cheaper amount of medicines for the patients
which may help them somehow to lessen the expenses that they have to pay
during their confinement.
POLITICAL FACTORS:

Political issue is also one of the most common concerns in hospital


institutions especially in Ospital Ning Angeles. It was mentioned that every
new major was elected every term, there will also be new set of heads in the
hospital and sometimes even a new members in the staff while the recent
ones will be driven out of the institution. As a researchers and a future
nurses a year ahead believes that this kind of strategy is not fair as everyone
deserves a job and should not be rejected in terms of discriminations. Also
we cannot deny the fact that for us Filipinos the attitude “sipsip” is common
and for worse they are the one who often gets the job where in fact they
don’t sometimes deserves. As how we interpreted it, this actually acts as an
autocratic terms of management whereas the heads are just assigning into
their position without even undergoing through a proper elections. We
suggest that one of the possible solution for this kind of problem is by
forming an own set of boards or heads in certain institution or hospitals.
Thus, this will prevent losing of jobs by some of the personnel in health care
team. It could also prevent or lessen the occurrences of the
misunderstanding between the personnel that could inhibit the proper care
that should be given to the patient in the hospital.

NEGLIGENCE:

This would have been the most common problem in different hospitals
and also the most wanted to prevent its occurrence into either in private or
in public hospitals. As one of the public hospitals where most of the time also
has a tremendous amount of population and through this, it is possible that
sometimes nurses can not implement to ideal nursing care for the entire
patient who are confine in the hospital. Through this type of situation, it is
hard to prevent negligence because of the over crowded population
especially whenever there is only few nurses who are handling a large
amount of patients. They have also mentioned that the presence of large
amount of student nurses could also lead into such negligence because of
having a hard time in controlling or keeping track with those large amount of
students. Thus sometimes some student nurses do not have to will to give
care with the patients and have the mentally attitude of just doing
something although the management that they are giving is no longer
appropriate for their patients. Also in giving medicine where sometimes the
students gives delayed medicine or wrong medicine to their patients. As
researchers, we came out with the possible solution for this problem such as
first; if possible, maybe it is appropriate to give a sufficient amount of time
for training or giving assistant for those who are new into the job that are not
that yet confident in different nursing management. Secondly, it might be
also helpful to also assist the student nurses in performing special nursing
procedure to the patients as it could also help in preventing the occurrences
of negligence.