Introduction to ward management for nursing and head nurses

1. Introduction To Manager/ HN role
and Ward Management
By
Rahmat Ullah
Nursing Director MTI KTH, Peshawar

2. Dr.. Raj'a Zyoud
Nursing Management
• Is the process of working through nursing
members to achieve organizational
objectives.
• It is the coordination and integration of nursing
resources by applying the management process in
order to accomplish care and service, goals and
objectives. Successful nursing management must
use managerial functions; planning, organizing,
directing and controlling in an interrelated form to
solve the problem .

3. NURSE MANAGER/HEAD
• The nurse manager/ Head Nurse is a professional
nurse who is responsible for one hospital unit,
where nursing care is provided.
• The head nurse fills a first-line management
position of the nursing management levels.
• The nurse manager/ Head Nurse is a link between
top and middle management levels and staff
nurses

4. Characteristics of an Integrated Leader-
Manager (Gardner, 1990)
• They think long term.
• They look outward, toward the larger organization.
• They influence others beyond their own group.
• They emphasize vision, values and motivation.
• They are politically astute.
• They think in terms of change and renewal.

5. Dr.. Raj'a Zyoud
Manager
• A manager is someone who
plans, organizes, leads, and
controls the people and the
work of the organization in
such a way that the
organization achieve its
objectives

6. Dr.. Raj'a Zyoud
The Nurse Manager
• The nurse manager is neither
genuine, nor hero, but rather
he/she is
– persistent, tough-minded, hard
worker, intelligent and have
analytical ability.
• The key person who coordinate
the work through management
levels.

7. Dr.. Raj'a Zyoud
Manager Roles
• Informational
– Monitor
– Disseminator
– Spokesperson
• Interpersonal
– Figurehead
– Leader
– Liaison
• Decisional
– Entrepreneur
– Disturbance Handler
– Resource Allocator
– Negotiator

8. Nurse Managers
(Sullivan and Decker, 1988)
• 1. Perform these roles simultaneously:
– Subordinates
– Superiors
– Customer service representatives
• 2. Key leadership position directly related to
the delivery of nursing care

9. Job Description

10. Introduction
• Job Title
– Head Nurse
• Department And Division
– Nursing Division/Department, MTI-KTH, Peshawar
• Reporting Relationship
– Nursing Director
– Nurse Manager

11. JOB SUMMARY
• Take responsibility in leading and managing the Nursing Team/s as assigned.
• Takes unit/shift charge and directly supervises all nursing activities in absence
of Nurse Manager.
• Assists the Nurse Manager in planning, organizing and implementing goals
and objectives of the unit in providing optimum standards of patient care.
• Ensures availability and maintenance of all supplies and equipment in the
unit.
• Takes responsibility in making staff schedule / re-adjustment as necessary.
• Takes responsibility for orientation of new nurses and students etc.
• Takes responsibility in ensuring that all clinical competencies and procedures
are done according to the policy and procedure manual.
• Provides direct patient care and covers own caseload of patients and
maintains own clinical competence.
• Is able to teach individuals /groups of staff in either formal/ informal teaching
settings.

12. AUTHORITIES ASSIGNED
Has authority to;
• Initiate disciplinary action – as required, and is able
to resolve nursing issues.
• Re-adjust schedule as directed by the Nurse
Manager.
• Accommodate or grant a scheduled request of staff,
i.e. day off, leave etc and maintain quality of patient
care.
• Signs supply requests for the unit in absence of
Nurse Manager.

13. KNOWLEDGE AND COMPETENCIES
(State Skills, abilities and traits required)
• Must be able to communicate effectively in oral and
written form in both English and Urdu with all levels
of hospital personnel, patients and their families.
• The post holder is expected to be able to perform all
clinical nursing procedures according to the Policy
and Procedure Manual.
• Must be familiar with ISO & JCIA and all related
policies & procedures.
• Must be aware of audit process for ISO & JCIA.

14. DESCRIPTION OF DUTIES / RESPONSIBILITIES
REGULAR DUTIES/RESPONSIBILITIES
• He/She is to supervise all nursing activities and reports directly to the
nurse manager/Block Supervisor.
• He/She is competent in clinical nursing procedures.
• Participates in daily morning round of doctors and hand over report to
nurses.
• Assists the doctors in any procedure – as required.
• He/She is the focus of communication regarding nursing activities in
the unit/team.
• Maintains confidentiality of patients /relatives and staff issues at all
times.
• Ensure that the Quality Programme for Nursing is implemented.
• Manages the Crash Cart Medicine Trolley and Ordering of Supplies as
Requested.
• Participates in KP-HCC/ISO Audit and preparation.
• Works collaboratively with the M/D Team.

15. DESCRIPTION OF DUTIES/RESPONSIBILITIES
• PERIODIC DUTIES / RESPONSIBILITIES
– In consultation with the nurse manager and other appropriate
personnel, participates in budget setting for the unit.
– Participates in meetings as required.
– Participates in training and education programmes for nurses
and other staff in the unit/division.
– Is able to record statistical data based on patient acuity in the
unit.
– Is able to conduct regular unit meeting under the guidance of
the clinical nurse manager.
– Is able to implement job description to a high standard.
– Assists the clinical nurse manger in the performance appraisal of
staff in a timely manner.
– Assists in developing policies and procedures.
– Attends meetings at divisional/Departmental level as required.

16. DESCRIPTION OF DUTIES/RESPONSIBILITIES
ANY OTHER FACTORS:
• He/she is expected to work extra hours if required.
• He/She is expected to adhere to hospital policies to be an
effective role model for nursing staff. He/She is expected to
be able to demonstrate operation of equipment such as: IV
pump, syringe driver, etc, among the staff in the unit.
• Must be enthusiastic and committed to improving the
quality of nursing care. Is expected to collaborate with other
departments in the hospital with regards to patient care
issues.
• Must maintain own clinical competencies and be
committed to own professional nursing development.
• Must maintain confidentiality regarding patient, relative
and staff issues at all times.

17. Ward Management

18. Ward Management
• A Hospital ward– is a block (or area) forming a
division of a hospital (or a suite of rooms) shared
by patients who need a similar kind of care.
– It might be a large room, or combining couples of
rooms, or assimilation of some coups under single
management (in general).
• Management– is things done by others.
– the successful organization and implementation of
overall care plan by nursing department as per set
rules and expected outcomes. So, the process of
administration enters into these wards.

19. Goal of Ward Management
1. To provide highest quality nursing care for patient.
2. To provide a clean, well ventilated environment for
patient and protect her/him from infection,
accidents and hazards.
3. To help the staff in achieving highest degree of job
satisfaction.
4. To provide facilities to meet the needs of patient
and their attendants.

20. Components of Ward Managements
• Some important components of ward
management are;
1. Patient care
2. Personnel Management
3. Supply and equipment
4. Environment Cleanliness
5. Follow of policies and procedures

21. Patient Care
• This includes all activities necessary to provide
nursing care Concerned with –
– Comfort and well being of every patient
– Assessment of patients need & planning or care
– Carrying out of medical treatment
– Education of staff nurses

22. Personnel Care
• Assignment of personnel for patient care
according to patient or it can be functional
assignment.
• It is responsibility of sister (nurse) to take ward
round.
– Ward round is a tool of supervision, evaluation and
teaching.
• Ward round is of different types.
– a. Doctor round
– b. In-charge or Nursing supervisor round
– c. Nursing Director round
– d. Clinical Audit/round by ICN & RMN

23. Ward Management
Preparations for Round
• ƒWard should be clean and tidy.
• There should not be too many
relatives within the ward. ƒ
• Patient’s treatment charts should
be up to date and all relevant
information should be available. ƒ
• Have all patients in bed before
round. ƒ
• Diagnostic tray should be ready
for use. ƒ
• Do not conduct round during
lunch time/visiting hours.
Conducting Round
• ƒInstruct the staff nurse to
stay on patients left side to
help in patient's
examination. ƒ
• Remember the patients
record and informed it to
the doctor and report any
observation to doctor. ƒ
• Keep record orders/get
them written by doctors.

24. After the Ward Round
• ƒInstruct staff nurses to carry out orders; and ƒ
• Observe patient carefully.

25. Domestic Management
Sanitation and provision of therapeutic environment includes-
1. Temperature regulation
2. Proper light
3. Elimination of unpleasant odours
4. Safe water supply
5. Safe disposal of wastes
6. Dust control
7. Free from insects and pest
8. Protect patients from mechanical, thermal, chemical and
bacteriological injury
9. Protection from radiation
10. Provide adequate privacy
11. Control of visitors
12. Prevention of infection

26. Actions for ward management
• Evaluate nursing needs of patient and skill of person. ƒ
• Prepare monthly, weekly and daily time table for staff
nurses. ƒ
• Give teaching and guidance to juniors. ƒ
• Develop good human relations. ƒ
• Evaluate personnel. ƒ
• Maintain inventories, requesting for supplies and services. ƒ
• Assign tasks to nurses. ƒ
• Coordinate with other departments for effective patient
care. ƒ
• Gain co-operation from subordinates and supervisors. ƒ
• Delegate responsibility for patient care.

27. Record Keeping in the Wards
• The concept and ideology of record keeping
are-
1. Better information maintain
a) Automatic form and report creation
b) Avoid drudgery of repetitive typing
c) Eliminate Writing and problems of poor handwriting
2. More Efficiency
a) Eliminates paperwork and the need for getting a
range of letterheads and stationery
3. Speedy analysis of data.

28. PURPOSES OF CLINICAL RECORD
• To act as a working document for day-to-day recording of
patient care ƒ
• To store a chronological account of the patient’s life,
illnesses, its context and who did what and to what effect ƒ
• To enable the clinician to communicate with him or herself ƒ
• To aid communication between team members ƒ
• To allow continuity of approach in a continuing illness, ƒ
• To record any special factors that appear to affect the
patient or the patient’s response to treatment ƒ
• To record any factors that might render the patient more
vulnerable to an adverse reaction to management
treatment ƒ
• To record risk assessments to protect the patient and
others ƒ

29. PURPOSES OF CLINICAL RECORD
• To record the advice given to general practitioners, other
clinicians and other agencies ƒ
• To record the information received from others, including
careers ƒ
• To store a record to which the patient may have access ƒ
• To inform medico-legal investigations ƒ
• To inform clinical audit, governance and accreditation ƒ
• To inform bodies handling complaints and inquiries ƒ
• To inform research ƒ
• To inform analyses of clinical activity, and ƒ
• To allow contributions to national datasets, morbidity
registers, etc.

30. Records Maintained in the Hospitals
• Administrative Records and Reports
• Statistical Information
• Weekly/monthly/Annual Report
• Nursing Personnel Records
• Problem Oriented Medical Records …focusing
on the patient’s problem

31. Supplies & Equipments
• Supplies
– refer to expendable items-articles being used periodically
and reordered frequently to maintain. Sufficient amounts
on hand.
• Equipment
– Describes more permanent fixtures and apparatus of a
nonexpendable nature and should be further classic feed
as fixed or movable.
• Fixed Equipment
– Refers to objects built into the walls and floors of the
hospital and includes such things as sinless, sterilizers,
lockers, cabinets, intercommunication system etc.

32. Policy & Procedures
• A policy is a guide that clearly spells out
responsibilities and prescribes actions to be
taken under a given set of circumstances.
– Policies provide general direction for decision
making so that action can be taken within the
framework of the organizations beliefs and
principles
• A procedure prescribes the steps that should
be followed in order to conform to or carry
out a policy.

33. Usefulness of Policies
Written policies are useful for the following reasons:
1. Uniformity of action is assured, so that each time a
decision is made or task performed, it follows a
meaningful pattern. Policies do, however, leave room for
individual judgment.
2. It is easier to settle conflicts, issues or concerns. The basis
of conflict is the point for discussion rather than who is to
blame for it.
3. A standard of performance is established. Actual results
can be compared with the policy to determine how well
the staff members are fulfilling their roles.
4. Personnel are generally assured of consistent treatment.

34. Standards of Performance
• Standards are criteria against which performance
can be measured.
• Quality Assurance Program
– refers to the accountability of health personnel for the
quality of care they provide to patients.
– The accountability involves provision of evidence as
compared to an agreed upon standard.
• Providing Quality Nursing Care
– the wise use of knowledge, skill and compassion to
meet the needs of the patients”

35. ESSENTIALS OF RISK MANAGEMENT PROGRAM
• Following are the basic essentials of the risk management
program in a hospital:
1. Appointment of a Risk Manager Nurse who will have the support of
the overall hospital risk management program, Nursing and medical
staff, and other segments of the MTI- Khyber Teaching Hospital.
2. Risk Manager to make the rounds and meet department head Nurses
to acquaint each of them with his/her responsibilities.
3. Implement the following five-step program with the cooperation of the
Risk Management Committee to ensure that the hospital is doing all it
can in the area of risk management.

36. Objectives of the Nursing Risk
Management Program
• Promoting the quality of patient care, in collaboration with quality/performance
improvement activities
• Enhancing patient satisfaction with nursing care
• Minimizing the frequency and severity of adverse events
• Supporting a non-punitive culture that promotes awareness and empowers staff to
identify risk-related issues
• Enhancing patient safety through participation in International Patient Safety Goals,
organizational safety strategies and other patient safety initiatives
• Enhancing environmental safety for patients, visitors and staff through participation
in environment of care-related activities
• Utilizing risk management strategies to identify and minimize the frequency and
severity of near misses, incidents and claims
• Managing adverse events and injuries to minimize financial loss
• Evaluating systems that can contribute to patient care, error or injury
• Educating stakeholders on emerging and known risk exposures and risk reduction
initiatives
• Achieving requirements promulgated by accrediting organizations
• Complying with state-specific scope of practice, applicable laws, regulations and
standards

37. Risk Management Process
Communicate
and
Consult
Establishing the Context
Monitor
and
Review
Risk Identification
Risk Analysis
Risk Evaluation
Risk Treatment
Risk Management Process - Overview
Risk Register

38. Risk Identification
• The MTI-KTH uses the following prioritized risk to improve
staff and patient safety initiatives in the organization:
– Medications practices and Records
– Staff awareness about Hospital facilities and its use
– Updated Crash Cart & Records
– Complete patient care Documentation
– Isolation practices
– Waste and sharp disposal practices
– Continuous O2 supply in all clinical areas
– Calibration of equipment and Machines
– Inspection of patient and room/chamber
– Inspection of Refrigerators (Medicine and Food)
– Inspection of clinical areas (Stores, Kitchen, clean and dirty areas,
procedure room)
– Availability of various kits

39. 39
7 things you must give others if you want
to achieve success---
• Give others your HONESTY
• Give others your RESPECT
• Give others your VULNERABILITY
(capable of being wounded)
• Give others your CARE
• Give others your PASSION
• Give others your EXPERIENCE
• Give others your HELP

40. 40
Remember the 3 Rs
Respect for SELF
Respect for OTHERS
Responsibility for all
your ACTIONS