department of nursing is most genera 'v the largest one and includes the mos vo ved suborganizational struc ture.... Appendix I The department of nursing is the one which has the most direct and consistent contact with the patient. It is the one that, no matter the organizational structure of the institution, is always staffed on a 7-day a week, 24 hour a day basis. The structure of this department usually has a director of nursing, nurse supervisors, so-called "head nurses," staff or general duty nurses, practical nurses, nursing aides, orderlies, and attendants. Also, there are often ward maids, ward secretaries, and the like. The head nurse is the senior nurse within a patient care unit structure within the department. In more complex structures, there may be within the patient care unit so-called "charge nurses," team leaders, nurse clinical specialists, and ward managers. staffing this department is the registered nurse. The registered nurse is the professional worker who is "assigned to the patients' care unit and remains there while all other workers come and go. This implies that 5 she is charged with the totality and continuity of the patients' care." However, it can be seen that the professional person 5 Mauksch, H. O., "Nursing Dilemmas in the Organization of Patient Care," in Bullough and Builough, eds., issues in Nursing, Springer Fublishing Co., Inc., New York, 1966, p. 129. Appendix I P. 5 Other sociologists cite this role of the registered nurse within the modern hospital structure: 6 "One of the social conditions which has contributed to the emergence of nurses as leaders is the fact "The nurse also stands at the communication center mation for them so they can work effectively in the Thus, all registered nurses within the hospital, regardless of position title, at some time or other perform the function of interpreting hospital policy and instructing those with lesser qualifications. Furthermore, each 6 Mumford and Skipper, Sociology in Hospital Care, Harper and Row, Appendix I P. 6 registered nurse is legally responsible for her own acts. In carrying out her duties as a professional, regardless of position title, she must exercise independent judgment in interpreting medical directives and caring for the patients for whom she is responsible. - it Since, in today's hospital, the health team providing the actual care to the patients within the unit may consist of several types of personnel the nursing aide, the practical nurse, and the registered nurse becomes the responsibility of the registered nurse, the professional and most educated of this group, to provide the direction for the care of the patient within the nursing unit. In this sense, the senior nurse, or the nurse "in charge" of the unit or a group of patients, becomes a patient care coordinator. This person, in determining a patient's needs, can determine who among the staff or the unit shall care for the patient and provide the advice and consultation needed by the less prepared or less experienced member of the team within the unit. She needs to utilize her professional judgment in evaluating whether good and adequate care is being given, whether medical directives are being carried out appropriately and whether records are adequately maintained within the unit so that continuity of care can go on despite the shifts in personnel. Because of the 7-day, 24 hour operation within a patient care unit, several registered nurses within the unit may perform some facet of this operation at times. Conversely, the registered nurse "in charge" also functions largely in the capacity of providing direct professional care to the patient. When dealing with a professional group one needs to look at the profession as a whole. One of the characteristics of a profession is its community of interest. The members of a profession are bound by a "sense of identity;' Appendix I P. 7 they share common values, and have a common language peculiar to the 7 profession and only partially understood by outsiders. In determining the appropriate bargaining unit for a group of registered nurses care needs to be taken that this community of interest not be severed or fractionalized by equating fine distinctions in role or responsibility with traditional industrial concepts of "supervisor." Basically, the role of the professional nurse within the hospital structure is that of administering, planning and organizing nursing care. As one nursing leader has put it "Rank, as such, is nonexistent within the team member8 ship or within the total organization of the nursing service." The basic concern of all registered nurses is the patient and the real determinant of who does what is the nursing needs of the patient and the diagnosis and prescription of the physician. A professional must utilize his unique skill and education within the bureaucratic structure in which he finds himself. While in some few situations today and more frequently in yesterday's world one would find the role of the registered nurse that of both developing the nursing care plan for a patient and completely carrying it out, this is not the case in most hospitals today. Today we find a number of subprofessional categories carrying some of the functions involved in the care of the 7 Goode, William J., "Community Within A Community: The Professions," American Sociological Review, Vol. 22, April, 1957. 8 Lambertsen, Eleanor, Nursing Team Organization and Functioning, Bureau of Publications, Teachers College, Columbia University, 1953, p. 13. 86-073 - 72 - 3 Appendix I patient. Thus, the exigencies of the modern system of the delivery of health care place the registered nurse to a certain extent in a coordinating, directing, and teaching role as well as one of administering direct care. The complexity of the modern hospital requires a certain pyramiding of nurse positions to handle the various aspects of this role. One of the nurse leaders in an article describing the release of this person from having to develop time and vacation assignments for individuals has indicated that the "most vital role" of the head nurse is that of "nursing care 9 management." The professional responsibility of all registered nurses and the goal toward which their education is directed is that of providing quality care regardless of position within the structure. The degree of responsibility of a particular registered nurse for the organization of this care may be of greater or lesser dimension, but all registered nurses working within a patient care unit carry some aspect of this responsibility in exercising their professional judgment of the type of care which a patient requires. This does not make them supervisors within Section 2(11) of the Act, since all of them are bedside (or operating room, etc.) nurses, engaged primarily in direct care to the patients, with any other functions sporadic and incidental thereto. All of the registered nurses within the unit have and must have a colleague relationship with the other to achieve the goals of quality care for the patients within the unit. This mutuality of interest and concerns should be maintained in all aspects of the working relationship. Q Stryker, Ruth P., "A Staffing Secretary Releases Nursing Time." American Journal of Nursing, Vol. 66, No. 11, November 1966, pp. 2478. |