WARDORGANISATIONANDWARDROUTINES

KEYPERSONNELONTHEWARDS ClinicalNurseManager(CNM)/ClinicalNurseSpecialist(CNS)/ClinicalNurseManager(CNM) The CNM/CNS is responsible for: maintaining and ensuring that a high standard of care is delivered, adequate staffing levels, rostering, bedmanagement and ensures that ward operates within budget. They are the ward leaders that: manage the allocation of patients to inpatient wards/units within the hospital, improve dischargepractices,promoteareaofexcellenceandpromotewardteamwork. StaffDevelopmentNurse(SDN) TheSDNisresponsibleforprovidingeducationtoallstaffmembersandisaresourceperson. ClinicalNurse(CN) TheCNhasabroadknowledgebasespecialisinginthatparticularclinicalareaandisanexpertclinician. ShiftCoordinator TheShiftcoordinatorcanbeaRNoraCNandhe/sheensuresthesmoothrunningofthewardforoneclinical shift. WardClerk Thewardclerkhasavastknowledgeofwarddynamicsinadditiontotheextensiveclericalrole. AssistantinNursing(AIN) TheAINdelivershighstandardofpatientcarewhilstpracticingwiththescopeoftheAssistantinNursingas directedbytheRegisteredNurse. PatientCareAssistant(PCA) ThePCAsupportsnursingstaffindeliveringhighqualitycaretopatientsandsignificantothers. Cleaningstaff Thecleaningstaffsmaintainahighstandardofwardcleanliness. NOTE: The nursing personnel at RPH are identified from the uniform (scrubs) they are wearing. The colour of the uniformisnavybluewithdifferentcolouredtrimmingswhiteforRegisteredNurse(RN),redforClinicalNurse (CN),greenforStaffDevelopmentNurse(SDN)and blueforAreaManagers(AM).Thejobtitleisembroidered onthepersonsrighthandsideandRPHlogoisonthelefthandsideofthescrubtop.TheRNandENgraduate nurses wear a sleeve badge to indicate their positions. In addition to the uniform, the ward leaders and the shiftcoordinatorsareidentifiedbythedifferentcolouredvesttheyarewearing. Itisaadvisablethatyoufindoutnamesofthekeypersonnel(CNM/CNS/CNM&SDN/CN/SHIFT COORDINATOR)whenyoufirstarrivedintheward/unitviayourpreceptor/buddynurseandintroduce yourselfwithconfidence

Version : 1.0 First issued: May 2010; Review date: December 2010 Authorised by Nursing Human Resource Council Authorised date: Verbal Acceptance Interim Document/25 August 2010

SHIFTTIME AMShift:Startat0700/0730 Finishat:1300/1430/1530hours PMShift:Startat1200/1300/1400/1500 Finishat:2130/2230hour NIGHTDUTYShift:Startat2100/2115 Finishat:0730/0715hours MEALBREAKTIMES Youwillbeallocatedyourteabreakwithyourbuddy.Thetimesare: Morningtea: 15minutesstartingat0900hours Lunch: 30minutesstartingat1145hours Afternoontea: 15minutesstartingat1430hours Dinner: 30minutesstartingat1700hours WARDROUTINES Wardroutinesmayvaryslightlyfromwardtoward.Theexamplebelowwillgiveyousomeideaofhowa medicalwardisrunduringamorningshift.ITISIMPORTANTTOREMEMBERYOURSCOPEOFPRACTICE BEFOREIMPLEMENTINGANYNURSINGCAREFORYOURPATIENTSANDIDENTIFYSKILLSTHATYOUNEEDTO ACHIEVEDURINGYOURCLINICALPLACEMENTINTHEFIRSTFEWDAYSOFYOURCLINICALPLACEMENT. AnexampleofwardroutinesperformedbyaRNinamedicalwardinamorningshift AM DUTIES SHIFT 0700 Collecthandoversheet CheckAllocationBoard Takehandover Establishifanyofyourpatientshaveappointments,specimenstobecollected, showers,dischargedrugsorspecificprocedures. 0715 Lastminuteverbalupdatesfromnightstaff.Checkmedchartshavebeensigned off.Clarifyanyissueswithnightstaffbeforetheyleave. CheckIV/SCinfusions,checkInsulintobegiven&givesuppositories.Complete timemanagementplanwhenreviewingNursingCarePlan(NCP). Performdailyobs(observation)andLying&StandingBPs(BloodPressure). SitpatientsoutforbreakfastToiletifrequired.Negotiateteabreakwithteam member. Iftimepermitsshoweronepatientpriortobreakfast 0730 RNcommencesdrugrounds.Ensuredrugdrawersarereplenishedandnon imprestdrugsordered. RNensuresthatmedicationChartsarecorrectandgiveRMOforrewriting,order drugsasrequired. RNdoSC/IV/IMmedicationsascharted.. AssistpatientswithfeedingPRN. 0800 Observedietaryintake,Completedietsheets,Fluidbalancechart(FBC)PRN. Continuetoileting&showering Observemobility&functionalstatus,ADLsability,skinintegrity,emotionalwell being. AllpatientsaretowearDayclothesunlessmedicallycontraindicated.
Version : 1.0 First issued: May 2010; Review date: December 2010 Authorised by Nursing Human Resource Council Authorised date: Verbal Acceptance Interim Document/25 August 2010

0900

Firstmorningteafor15minfollowedbysecondtea. SharedcareModel(SCM)Teammemberscovereachotherspatients

AnexampleofwardroutinesperformedbyaRNinamedicalwardinamorningshift(continue)
AMSHIFT DUTIES

1000

1100

1130

1145 1200

1300

1400

1430

1530

Doobservations,TPR,BPlyingandstanding,oxygensaturationasrequiredorif moreoftenthandaily. DoSharedCareModelrounds. Checkifshiftcoordinatorwantstoviewwounddressing. Patientsmayrestontheirbedsifc/opain. Dobladderscans Complete/reviewNursingcareplans DoContinencecharts/bowelcharts DoBarthelScoresandBradenscoreswhendueasperNURSINGPRACTICE STANDARDS(NPS) Handovertocoordinatorpatientsstatus Monitorbloodsugar&giveInsulin. Sitpatientsoutforlunch Feedingandtoileting Medicationsround. HandovertoSCMteammemberandgotofirstlunch. Assistpatientswithfeedingasrequired;completeintakecharts. Putpatientsbacktobedafterlunchforrestperiod Attendtoiletingneedsanddopostvoidbladderscans Answeranycallbellswardwide. Handovertoafternoonstafftakingoveryourpatientload;together,check patientsandcharts. CheckIVinfusions CompleteIntegratednotes,chartsetc Attendinserviceeducation(13.3015.00hrs.Variable) Sitpatientsoutforafternoontea Dovitalsigns&woundcareifrequiredmoreoftenthandaily. Medicationrounds,checkdrugchartsandreplenishdrugdrawers. PrepareequipmentfornextdoseofIVABs. Afternoonteaforafternoonstaff CompleteIntegratednotes,chartsetc Answeranycallbellswardwide. RNENSURESdrugkeysarerelocatedintodrugcupboardorhandedtoPMstaffand registerissigned. LastminuteverbalupdatestoPMstaff.Checkmedchartshavebeensignedoff. ClarifyanyissueswithPMstaffbeforeyouleave. CheckwithAMorPMshiftCoordinatorbeforegoinghome

REMINDERWITHMEDICATIONSADMINISTRATION: Asundergraduatenursingstudents,theabovewardroutineshowsthetimewhenmedicationsare administeredtopatients.Beforeadministeringanymedicationspleaserememberyourscopeofpractice andalladministrationofmedicationsmustbesupervisedbyaRegisteredNurse

Version : 1.0 First issued: May 2010; Review date: December 2010 Authorised by Nursing Human Resource Council Authorised date: Verbal Acceptance Interim Document/25 August 2010