Responsibilities of a nurse of a department of various profiles. Functional responsibilities of a nurse in a polyclinic. Nurse job description
1. This job description defines the job duties, rights and responsibilities of a nurse.
2. A person who has a secondary vocational education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "Nursing", " General practice"," Nursing in pediatrics "without presentation of requirements for work experience.
The senior nurse must have a secondary vocational education ( elevated level) in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "Nursing", "General Practice", "Nursing in Pediatrics" without any requirements for work experience.
3. The nurse needs to know: laws and other regulations legal acts RF acting in the field of health care; theoretical basis nursing; the basics of the treatment and diagnostic process, disease prevention, propaganda healthy way life; rules for the operation of medical instruments and equipment; statistical indicators characterizing the state of health of the population and the activities of medical organizations; rules for the collection, storage and disposal of waste from medical organizations; the basics of the functioning of budgetary insurance medicine and voluntary medical insurance; basics of valeology and sanology; fundamentals of dietetics; fundamentals of clinical examination, social significance of diseases; foundations of disaster medicine; rules for maintaining accounting and reporting documentation structural unit, the main types of medical documentation; medical ethics; psychology of professional communication; basics labor legislation; internal labor regulations; rules for labor protection and fire safety.
4. A nurse is appointed and dismissed by the order of the head of the medical organization in accordance with the current legislation of the Russian Federation.
5. A nurse is directly subordinate to the head of her structural unit (department), and in his absence, to the head of a medical organization or his deputy.
2. Job responsibilities
Provides first aid medical assistance, carries out the collection of biological materials for laboratory research. Carries out patient care in a medical organization and at home. Sterilizes medical instruments, dressings and patient care items. Assists with medical and diagnostic manipulations and minor operations in outpatient and inpatient settings. Prepares patients for various types of research, procedures, operations, for outpatient doctor's appointment. Ensures the fulfillment of medical appointments. Carries out accounting, storage, use of medicines and ethyl alcohol. Maintains personal records, information (computer) database of the health status of the population served. Supervises the activities of junior medical personnel. Maintains medical records. Conducts sanitary and educational work among patients and their relatives to improve health and prevent diseases, promote a healthy lifestyle. Collects and disposes of medical waste. Carries out measures to comply with the sanitary and hygienic regime, the rules of asepsis and antiseptics, the conditions for sterilization of instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.
3. Rights
A nurse has the right to:
1. make proposals to the management to improve the organization and improve the conditions of their work;
2. control, within the limits of their competence, the work of junior medical personnel (if any), give them orders and demand their strict implementation, make proposals to the management on their encouragement or imposition of penalties;
3. to request, receive and use information materials and regulatory documents necessary for the performance of their official duties;
4. take part in scientific and practical conferences and meetings, which consider issues related to its work;
5. to undergo certification in accordance with the established procedure with the right to obtain the appropriate qualification category;
6. improve their qualifications at advanced training courses at least once every 5 years.
The nurse takes advantage of everyone labor rights in accordance with the Labor Code of the Russian Federation.
4. Responsibility
The nurse is responsible for:
1.implementation of the duties assigned to it;
2. timely and qualified execution of orders, orders and instructions of the management, regulatory legal acts on their activities;
3.compliance with the rules internal regulations, fire safety and safety;
4. timely and high-quality registration of medical and other service documentation provided for by the current regulatory and legal documents;
5. provision of statistical and other information on their activities in accordance with the established procedure;
6. observance of performance discipline and performance of official duties by employees subordinate to it (if any);
7. Prompt adoption of measures, including timely notification of the management, to eliminate violations of safety, fire and sanitary rules that threaten the activities of a medical organization, its employees, patients and visitors.
For violation labor discipline, legislative and regulatory legal acts, a nurse may be brought to disciplinary, material, administrative and criminal liability in accordance with the current legislation, depending on the severity of the offense.
APPROVED:
[Job title]
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[Name of company]
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_______________________/[FULL NAME.]/
"______" _______________ 20___
JOB DESCRIPTION
Nurse
1.1. This job description defines and regulates the powers, functional and job responsibilities, rights and responsibilities of the nurse [Organization name in the genitive case] (hereinafter - the Medical organization).
1.2. A nurse is appointed and dismissed in accordance with the procedure established by the current labor legislation by order of the head Medical organization.
1.3. The nurse belongs to the category of specialists and is subordinate to [the names of the positions of subordinates in the dative case].
1.4. The nurse reports directly to the [name of the position of the immediate supervisor in the dative case] of the Medical Organization.
1.5. A person with secondary vocational education in the specialty "General Medicine", "Obstetrics", "Nursing" and a certificate of a specialist in the specialty "Nursing", "General Practice", "Nursing in Pediatrics" is appointed to the position of a nurse without presenting work experience requirements.
1.6. The nurse is responsible for:
- effective execution of the work entrusted to her;
- compliance with the requirements of performing, labor and technological discipline;
- the safety of the documents (information) containing (components) in her custody (which became known to her) trade secret Medical organization.
1.7. The nurse should know:
- laws and other regulatory legal acts Russian Federation in health care;
- theoretical foundations of nursing;
- the basics of the treatment and diagnostic process, disease prevention, promotion of a healthy lifestyle;
- rules for the operation of medical instruments and equipment;
- statistical indicators characterizing the state of health of the population and the activities of medical organizations;
- rules for the collection, storage and disposal of waste from medical organizations;
- the basics of the functioning of budgetary insurance medicine and voluntary medical insurance;
- basics of valeology and sanology;
- fundamentals of dietetics;
- fundamentals of clinical examination, social significance of diseases;
- foundations of disaster medicine;
- rules for maintaining accounting and reporting documentation of a structural unit, the main types of medical documentation;
- medical ethics;
- psychology of professional communication;
- fundamentals of labor legislation;
- internal labor regulations;
- rules for labor protection and fire safety.
1.8. A nurse in her activities is guided by:
- local acts and organizational and administrative documents of the Medical Organization;
- internal labor regulations;
- occupational health and safety rules, industrial sanitation and fire protection;
- instructions, orders, decisions and instructions of the immediate supervisor;
- this job description.
1.9. During the temporary absence of a nurse, her duties are assigned to [the name of the position of the deputy].
A nurse performs the following labor functions:
2.1. Provides first aid medical assistance, carries out the collection of biological materials for laboratory research.
2.2. Carries out patient care in a medical organization and at home.
2.3. Sterilizes medical instruments, dressings and patient care items.
2.4. Assists with medical and diagnostic manipulations and minor operations in outpatient and inpatient settings.
2.5. Prepares patients for various types of research, procedures, operations, for outpatient doctor's appointment.
2.6. Ensures the fulfillment of medical appointments.
2.7. Carries out accounting, storage, use of medicines and ethyl alcohol.
2.8. Maintains personal records, information (computer) database of the health status of the population served.
2.9. Supervises the activities of junior medical personnel.
2.10. Maintains medical records.
2.11. Conducts sanitary and educational work among patients and their relatives to improve health and prevent diseases, promote a healthy lifestyle.
2.12. Collects and disposes of medical waste.
2.13. Carries out measures to comply with the sanitary and hygienic regime, the rules of asepsis and antiseptics, the conditions for sterilization of instruments and materials, the prevention of post-injection complications, hepatitis, HIV infection.
In case of official necessity, a nurse may be involved in the performance of her official duties overtime, in the manner prescribed by the provisions of federal labor legislation.
3. Rights
A nurse has the right to:
3.1. Give subordinate employees and services assignments, tasks on a range of issues included in her functional duties.
3.2. Control the execution of production tasks, the timely execution of individual orders and tasks by subordinate services.
3.3. Request and receive necessary materials and documents related to the activities of a nurse, subordinate services and units.
3.4. Interact with other enterprises, organizations and institutions on production and other issues related to the competence of a nurse.
3.5. Sign and endorse documents within their competence.
3.6. Submit to the head of the Medical Organization for consideration the idea of \u200b\u200bthe appointment, relocation and dismissal of employees of subordinate units; proposals to encourage them or to impose penalties on them.
3.7. Enjoy other rights established by the Labor Code of the Russian Federation and other legislative acts of the Russian Federation.
4. Responsibility and performance evaluation
4.1. A nurse bears administrative, disciplinary and material (and in some cases stipulated by the legislation of the Russian Federation - and criminal) responsibility for:
4.1.1. Failure or improper performance service instructions of the immediate supervisor.
4.1.2. Failure to perform or improper performance of her labor functions and the tasks assigned to her.
4.1.3. Misuse granted official powers, as well as their use for personal purposes.
4.1.4. Inaccurate information about the status of the work assigned to her.
4.1.5. Failure to take measures to suppress identified violations of safety regulations, fire safety and other rules that pose a threat to the activities of the enterprise and its employees.
4.1.6. Failure to enforce labor discipline.
4.2. The assessment of the work of a nurse is carried out:
4.2.1. Immediate supervisor - regularly, in the process of the employee's daily performance of his labor functions.
4.2.2. Attestation Commission enterprises - periodically, but at least once every two years on the basis of the documented results of work for the evaluation period.
4.3. The main criterion for evaluating the work of a nurse is the quality, completeness and timeliness of her fulfillment of the tasks provided for in this instruction.
5. Working conditions
5.1. The work schedule of a nurse is determined in accordance with the internal labor regulations established in the Medical Organization.
6. Authority to sign
6.1. To ensure her activities, a nurse is given the right to sign organizational and administrative documents on issues attributed to her competence by this job description.
Acquainted with the instructions ___________ / ____________ / "____" _______ 20__
Job responsibilities nurse may vary depending on what kind of medical institution she works in (hospital, clinic). Therefore, the proposed sample job description for a nurse needs to be adapted to a specific work situation.
Nurse job description
1. General Provisions
1.1. The nurse is a specialist.
1.2. A nurse is appointed and dismissed by order of the head of the institution.
1.3. The nurse reports directly to the head of the department / senior nurse of the department.
1.4. A person who meets the following requirements is appointed to the position of a nurse: secondary medical education in the specialty "Nursing".
1.5. During the absence of a nurse, his rights and obligations are transferred to another official, which is announced in the order for the organization.
1.6. The nurse should know:
- laws of the Russian Federation and others regulations on health issues;
- the basics of the medical and diagnostic process, disease prevention;
- organizational structure healthcare institutions;
- safety rules when working with medical instruments and equipment.
1.7. A nurse is guided in her activities by:
- legislative acts of the Russian Federation;
- the Charter of the organization, the Internal Labor Regulations, other regulations companies;
- orders and orders of the management;
- this job description.
2. Responsibilities of a nurse
A nurse performs the following job duties:
2.1. Carries out all stages of the nursing process in caring for patients (initial assessment of the patient's condition, interpretation of the data obtained, planning of care, final assessment of what has been achieved).
2.2. Timely and efficiently performs preventive and diagnostic and treatment procedures prescribed by a doctor.
2.3. Assists with medical and diagnostic manipulations and minor operations in outpatient and inpatient settings.
2.4. Provides emergency first aid in case of acute diseases, accidents and different types catastrophes with the subsequent call of the doctor to the patient or referral to the nearest medical and preventive institution.
2.5. Introduces drugs, anti-shock agents (with anaphylactic shock) to patients for health reasons (if it is impossible for the doctor to arrive at the patient in time) in accordance with the established procedure for this condition.
2.6. Informs the doctor or the head, and in their absence, the doctor on duty about all detected serious complications and diseases of patients, complications arising from medical manipulations or about cases of violation of the internal regulations of the institution.
2.7. Ensures the correct storage, accounting and disposal of drugs, compliance with the rules for taking drugs by patients.
2.8. Maintains approved medical records and reports.
3. The rights of a nurse
A nurse has the right to:
3.1. Receive the information necessary for the efficient performance of their professional duties.
3.2. Make suggestions for improving the work of a nurse and the organization of nursing in the institution.
3.3. Require the senior nurse of the department to provide the post (workplace) with equipment, equipment, tools, care items, etc., necessary for the quality performance of their functional duties.
3.4. Improve their qualifications in the prescribed manner, undergo certification (recertification) in order to assign qualification categories.
3.5. Participate in the work of professional associations nurses and others public organizationsnot prohibited by the legislation of the Russian Federation.
4. Nurse responsibility
The nurse is responsible for:
4.1. For non-fulfillment and / or untimely, negligent fulfillment of their duties.
4.2. For non-compliance with the applicable instructions, orders and orders for the preservation of confidential information.
4.3. For violation of the internal labor regulations, labor discipline, safety regulations and fire safety.
CHAPTER 4 RESPONSIBILITIES OF JUNIOR AND SECONDARY MEDICAL PERSONNEL
CHAPTER 4 RESPONSIBILITIES OF JUNIOR AND SECONDARY MEDICAL PERSONNEL
Hospitals have a two-stage (doctor, nurse) and three-stage (doctor, nurse, junior nurse) system of patient care. Since 1968, in children's hospitals, instead of a nurse, the position of a junior nurse (nursing nurse) was introduced. In a two-stage system, the nurse not only fulfills the doctor's prescriptions and procedures, but also provides patient care. In a three-stage system, the junior nurse cleans the premises, monitors the timely change of linen, cleanliness of care items, helps the sick and takes care of them.
In duties junior nurseincludes:
Wet cleaning of wards, offices, operating rooms, corridors, common areas;
Change of underwear and bed linen;
Sanitary treatment of patients;
Daily toilet, care for skin, hair, ears, eyes, oral cavity of patients, etc .;
Submission of the vessel, urine bag, disinfection;
Prevention of bedsores;
Swaddling and washing children;
Monitoring the sanitary condition of bedside tables. Training of junior nurses is carried out directly in hospitals, as well as in short-term courses organized by the Union of Red Cross and Red Crescent Societies
(SOKK and KP).
Nurse- a representative of the average medical level. This is a doctor's assistant in treatment-and-prophylactic, preschool and school institutions, independent medical worker within their competence (care, manipulation, etc.).
The position of a nurse is assigned to persons who graduated from medical schools with a training period of at least 2 years and received a certificate of conferring medical qualifications
sisters. Medical sisters can work for medical students who have successfully completed three full-time courses.
Nurse of the department.A nurse must have a variety of skills to perform her duties. The nurse carefully and strictly fulfills all the appointments of the attending physician, and in emergency cases - the doctor on duty. She is obliged to make sure that the child takes the prescribed medicines, and, if necessary, help to wash them down with water, etc. At the same time, the nurse takes care of the sick, psychologically helps the sick child and his parents to overcome the difficulties of the period of illness. She monitors the sanitary condition of the wards assigned to her, makes the necessary entries in the medical records of inpatients about the implementation of medical and hygienic appointments.
The nurse is present at the doctor's round of patients, informs the doctor about the state of health of the children, receives further instructions for caring for the sick and carries them out. The duties of a nurse include measuring the patient's body temperature and registering it in the temperature sheet of the inpatient's medical record, counting the pulse, respiratory rate, determining blood pressure, body weight, filling out specialist consultation journals, etc. As prescribed by a doctor, a nurse ) measures the daily amount of urine and sputum.
As prescribed by the doctor, the nurse collects materials for analyzes (urine, feces, sputum, etc.), delivers them to the laboratory, receives the results of the tests and glues the answer forms to the medical records of inpatients. Accompanies children from one department to another (as prescribed by a doctor) for radiological, endoscopic, radiological and other examinations, transports patients (when transferring from department to department, etc.).
The nurse monitors the cleanliness, silence and order in the wards; teaches children and their parents the rules of personal hygiene; takes care of the timely supply of patients with everything necessary for treatment and care, conducts hygienic baths, as well as changes underwear and bed linen.
The duties of a nurse include monitoring nutritional therapy, and, if necessary, personal participation in the distribution of food,
feeding seriously ill patients and children younger age; control over transfers to patients and their correct storage. Based on the doctor's prescriptions, the nurse draws up portioned food requirements for patients in 2 copies and transfers them to the catering unit and to the buffet.
The nurse is responsible for monitoring the implementation by patients, as well as nursing staff, parents and visitors of the established hospital internal regulations. During the night watch, these duties are not duplicated by anyone.
The nurse is responsible for the exemplary maintenance of the nursing station, the good condition of medical and household equipment; observes the rules for storing medicines; draws up requirements for medicines, dressings and child-care items; monitors the timely return of medical records of inpatients from specialists, enters the results of research into them.
On the appointment of the head of the department or the attending physician, the nurse calls specialists from other departments for consultation, orders a car to transport the child to another medical and preventive institution.
The nurse accepts newly admitted children to the department, examines the skin and scalp of the child to exclude infectious diseases and head lice, places sick children in the appropriate wards, reports on newly admitted patients to the doctor. Her duties include familiarizing newly admitted children with the internal regulations, daily routine and rules of personal hygiene, sanitary and educational work.
The distribution of the work of the ward nurse during the day is presented in table 9.
Table 9.An approximate work plan for a ward nurse during
days
The nurse in the pediatric ward of the hospital must
to be able to perform the following manipulations:
1) feed the child, including through a tube, wash the stomach;
2) put enemas of all types (cleansing, siphon, etc.);
3) introduce a gas outlet pipe;
4) carry out bladder catheterization with a soft catheter (in children over 1 year old);
5) put mustard plasters, cans, compresses;
6) give medicines by mouth;
7) rub in medicines;
8) instill medicinal solutions in the eyes, nose, ears;
9) apply a plaster;
10) to carry out intradermal, subcutaneous, intramuscular and intravenous (the latter - with the permission of the doctor) injections;
11) measure blood pressure;
12) perform an indirect heart massage;
13) carry out artificial lung ventilation (ALV);
14) take swabs from the throat;
15) collect material for laboratory research (urine, feces, sweat, vomit, etc.);
16) carry out physiotherapy procedures (as prescribed by a doctor);
17) monitor the patient and notice deviations on the display;
18) to carry out gastric and duodenal intubation.
The work of a nurse is carried out according to the schedule approved by the head of the department. While on duty, a nurse without the doctor's permission has no right to leave her post and leave the department.
Senior nurse.The senior nurse organizes the work of the middle and junior medical personnel, in addition, her duties include compliance with the sanitary-epidemic regime in the department, training incoming new workers, and organizing training sessions to improve their skills. Its role is extremely important in the proper organization of childcare, storage baby food and strict compliance with all medical (medical) appointments. She makes a schedule of nurses and time sheets for wages, monitors the availability of medicines in the pharmacy, orders the missing ones, monitors the replenishment of the department with the necessary tools and items for child care. In case of illness, the nurse promptly finds a replacement for duty. In the neonatal department, the head nurse examines staff and mothers every day before starting work (body temperature measurement, pharyngeal and skin examination).
The nurse in the treatment room.The staffing of the department provides for the position of a nurse in a procedural room, carrying out the most complex medical manipulations; she helps the doctor in carrying out those manipulations that only a doctor has the right to perform (blood transfusion, puncture, administration of contrast agents, etc.). In addition, there is also a position mistress sisters,responsible for household equipment, holding general cleaning all rooms, linen change.
Acceptance and delivery of shifts- the most crucial moment in the work of a nurse. A nurse does not have the right to leave the post on her own, even if her change has not appeared.
The reception and transfer of duty by nurses is carried out cover-up with visual control of the presence of each sick child. The nurse passing the post acquaints the receiving nurse with sick children, conveys the necessary information about the individual characteristics of their treatment and care. At the morning conference, the nurse makes a report on the work done.
When taking over the duty, the nurses (handing over and receiving the post) jointly walk around the patients, with special attention paid to the seriously ill, the sanitary condition of the wards, and the observance of the rules of personal hygiene. The shift log records the amount of work outstanding for the previous shift for a particular patient, as well as medical appointments of the doctor on duty, data on the distribution of potent drugs, preparation of children for laboratory and instrumental studies, etc. The nurse who comes on duty takes thermometers, syringes, medicines, care items (drinking cups, heating pads, bed vessels, urinals, etc.), inventory, keys to cabinets with medicines from the general list. She receives a pre-compiled list of research appointments and referrals to various laboratories and specialized offices. Checks that there is enough clean linen for the entire shift.
Nurses should pay particular attention to patients who are on bed and strict bed rest. If an individual post is not organized, then it is necessary to constantly approach and monitor the sick child, to prevent him from staying for a long time in the same position (for example, on his back), for which the patient should be turned from time to time from one side to another. It is necessary to change the position of a sick child in bed with great care and without sudden movements. Sometimes you have to keep the child in bed, as children are not always aware of the need to maintain peace or are excited.
At the end of the shift, the nurse compiles a summary of the movement of patients: the number of patients in the department at the beginning of the day, the number of admitted, discharged (separately: discharged, transferred to
other departments or medical institutions, deceased) and consisting at the beginning of the next day. This information is transmitted daily to the hospital's admission department.
Medical post- workplace nurse (Fig. 4).
Figure: 4.Nursing medical post
The medical post is located near the wards so that children, especially seriously ill children, are under constant visual control. For this purpose, the walls of the chambers or partitions between them are made of thick-layer or organic glass. The following necessary items should be on the post of a nurse:
A table with lockable drawers for storing medical records of inpatients, forms, medical instruments, etc.;
Medicine storage cabinet;
Telephones of the city and local network;
Fridge;
Computer (with a computerized data processing system) or monitor for communication with patients;
Drinking water;
Table lamp.
A nurse's workplace must be kept clean and stocked with the necessary items. The efficiency of the nurse's work largely depends on the state of the workplace. The senior nurse of the department, ending the working day, supplies the nursing posts with everything necessary for the next day.
Medical recordsapproved by the Ministry of Health and Social Development of the Russian Federation and is used in medical institutions in the form of unified forms.
Inpatient medical card(f.? 003 / y) (medical history) - the main primary medical document, which is filled in for each patient who is in the hospital of a medical institution. All data about the patient, including the results of dynamic observation and treatment, are entered into the medical record of an inpatient. The results of laboratory, instrumental and other studies are glued into it, the indicators of morning and evening body temperature, pulse and respiratory rate, blood pressure, and, if necessary, the daily amount of urine (diuresis) are recorded daily. In the medical record of the inpatient, the nurse notes the time of admission of the patient to the department and the results of the examination for the presence of head lice, signs. On the prescription list, notes the time of dispensing the drug, in the temperature list - the body weight and height of the child upon admission, the patient's body temperature in the morning and evening, then once every 7-10 days marks the days of taking a bath and changing clothes, daily - the child's stool.
An inpatient's medical record is a legal document. It is stored for 25 years and therefore must be kept strictly according to the established form. It does not allow any corrections; it is forbidden to glue, erase, cross out previously written, finish writing. The nurse is responsible for the safety of the medical records of inpatients, which are kept in a locker or cabinet, locked with a key, out of the reach of children and their parents.
Laboratory referrals are completed by a nurse. They indicate the surname, name and age of the child, the number of the inpatient's medical record, the name of the department and the list of indicators that should be determined.
IN sister sheetsa nurse enters from the medical records of inpatients medical appointments for each patient
mu. The filling form is arbitrary. It is better to draw up individual nursing sheets for each child separately, but you can fill them in according to the type of manipulations, diets, medicines, listing the names of the children.
IN change log(receiving and transmitting) shiftsnote the number of children at the post, the names of newly admitted and left patients with an indication of the diagnosis. In addition, they list febrile children with an indication of their body temperature, assess the dynamics of clinical symptoms in seriously ill patients, list all unscheduled manipulations and measures taken by the doctor on duty and by his appointment. Separately, a list of children prepared in accordance with medical prescriptions for diagnostic and therapeutic procedures (endoscopic, X-ray, ultrasound, etc.) is given.
IN patient Movement Journalinformation about the movement of patients is noted: the number of those who left and those who entered.
IN register of infectious patientsrecord the last name, first name, age of the child delivered with an infectious disease, diagnosis, date, contacts and measures taken.
To the journal of accounting and spending of narcotic drugsthe nurse enters the necessary information about the drugs available and used for the change. The same for accounting funds (this journal is sometimes filled in by the head nurse).
Emergency notificationabout an infectious disease, food, acute occupational poisoning, an unusual reaction to vaccination (form? 058 / y) is drawn up by a medical worker (sister) and sent to the center of sanitary and epidemiological surveillance.
Emergency nursefills in:
Inpatient medical card title page
(form? 003 / y);
Patient hospitalization log (form # 011 / y);
Hospitalization denial log;
Hospitalized Patient Log (alphabetical list for reference service);
Journal of free places in the branches (traffic);
Register of infectious patients (plus emergency notifications);
A log of hospitalization of unaccompanied patients with a description of the main external signs (neglected and street children).
Working with medicines.One of essential responsibilities a nurse is involved in the treatment process, which manifests itself primarily in the distribution of medicines. Medicines have a variety of effects on the body, including local and general. However, in addition to the main therapeutic, they can cause side or unwanted effects. The latter are reduced and even completely eliminated after dose reduction and drug withdrawal. Cases of intolerance to drugs are possible, leading to severe complications (for example, anaphylactic shock). A nurse is obliged not only to know about all possible adverse reactions to the introduction of a particular drug, but also to be able to provide emergency first aid.
Storage of medicinescarried out in special lockers under the supervision of a guard nurse. In the cabinet, medicines are placed in groups on separate shelves with the appropriate inscription: sterile, internal, external, eye drops, injection. Larger dishes are placed at the back wall, small ones in front. This allows, without rearranging the drugs, to read the label, select the desired drug. In addition, each shelf should be divided: for example, "internal" - into compartments for powders, tablets, mixtures. You can put powders, tablets, capsules on one shelf, potions, solutions, etc. on the other. This is how the medicines of the general list are stored. The storage of medicines without labels is unacceptable.
Particularly stringent requirements are imposed on poisonous and potent drugs. For them, small safes or metal cabinets are allocated, which are constantly under lock and key.
In the safe (cabinet) marked "A" there are poisonous and narcotic drugs, and in the safe (cabinet) marked "B" - potent drugs. On the inner surface of each of the safes, a list of poisonous and potent medicines is placed with an indication of the highest one-time and daily
doses (depending on the age of the child). There should also be tables of antidotes. Stocks of poisonous and narcotic drugs should not exceed 5-day requirements, for potent ones - 10 days.
To account for the arrival and consumption of poisonous and potent medicines, a specially numbered, laced and sealed with a wax seal of a medical institution is kept in a journal in the following form:
The journal, as well as the requirements for receiving and dispensing poisonous and potent medicines, remain in the department for 3 years. Then these documents are destroyed in the presence of the commission, about which they draw up an act.
Keys to safes (cabinets) "A" and "B" are kept only by persons appointed by order medical institution... Usually this is the older sister of the department. Responsible persons are criminally liable for non-compliance with the storage rules and theft of medicines, especially for poisonous and potent medicines.
Nurses should be instructed on the timing and manner of storing each medication used in the department.
Medicines with a strong odor (iodoform, lysol, ammonia, etc.) and highly flammable (ether, ethyl alcohol) are stored in a separate cabinet. Coloring drugs (iodine, brilliant green, etc.) are also stored separately.
The shelf life of prefabricated medicines, as a rule, is 2-5 years, but it can be long. The shelf life is determined by labeling. Each industrial batch of manufactured medicines is assigned a factory batch, which is marked with at least five digits. The last two digits are right
vA - year of release, the previous two - month of release, the rest - factory series.
Medicines prepared in a pharmacy have shorter shelf life. All containers (boxes, jars, vials) containing medicinal products manufactured in a pharmacy are supplied with appropriate labels indicating the name, date of manufacture and shelf life.
The terms of storage and sale of medicines prepared in pharmacies have been established: 2 days - for injection solutions, eye drops, infusions, decoctions, mucus; 3 days - for emulsions; 10 days - for other medicines. Sterile solutions in bottles (not in ampoules) can be stored for no more than 3 days. Signs of drug spoilage are changes in appearance, in particular the appearance of plaque, flakes, stains on the tablets, additional odor, discoloration.
There should be no expired or unusable drugs at the medical post.
When storing medicines, certain temperature and humidity should be observed, the degree of illumination, the safety of packages, etc. should be controlled. Liquid medicines such as infusions and decoctions deteriorate quickly and therefore must be stored in the refrigerator at 2 to 10 ° C. The same requirements apply to the storage of emulsions, some antibiotics (penicillin, etc.), sera, solutions containing glucose, insulin, etc. Medicines that rapidly disintegrate in the light (bromine, iodine) should be stored in dark glass containers and in a dark room.
When storing medicinal products, it is prohibited to place them together with disinfectant solutions and agents for technical purposes. A nurse does not have the right to pour a medicine from one container to another, peel off and re-stick labels, randomly combine medicines (for example, tablets with powders, etc.).
Distribution of medicinescarried out by a nurse in strict accordance with the doctor's prescription, who indicates in the inpatient's medical record the date of appointment and discontinuation of drugs. Medicines are taken before, during, after meals and at bedtime. The most common, simple and convenient way of drug administration
is the enteral route, i.e. taking medicine by mouth or by mouth. This method is reliably controlled. Inside, they mainly take solid dosage forms: tablets, dragees, powders, capsules (Fig. 5). The powders in sachets are intended for dilution with water. Less often, liquid dosage forms are prescribed inside: solutions, decoctions, potions, etc. It should be remembered that the younger the child is, the more widely the appointment of liquid dosage forms is used.
Figure: five.Solid dosage forms:
a - tablets; b - dragee; c - powders (in sachets); d - enteric-coated powders or microspheres in gelatin capsules
When starting the distribution of drugs, the nurse should wash her hands with soap, if necessary, change the gown, put on a mask. In order to avoid mistakes, it is necessary to be able to identify drugs by shape, color, smell, taste. A child should take medicines only in the presence of medical personnel - a nurse, a doctor.
There are several ways of distributing medicines in the children's department. You can use trays, divided into cells with the names of patients. Medicines are placed in them in advance. Before putting the medicinal product into the compartment, the name indicated on the package should be checked.
forging, with the name of the drug in the inpatient's medical record or nursing sheet. Then the nurse goes around all the wards with the tray. Another way is to use a mobile table on which medicines for oral administration, a decanter of water, beakers, spoons, and clean pipettes are laid out. The nurse rolls this table into the ward and alternately moves each patient to the bed if he is on bed rest. Walking patients independently approach the table, where they take medicines under the supervision of their sister.
When distributing powders, a piece of paper in which the powder is packed is unrolled and, giving it the shape of a gutter, the powder is poured onto the child's tongue, then offered to be washed down with water. You should not give medicines to a child on the hands, especially several tablets at once. It is important to follow the sequence of taking medications. After swallowing the pill, you must drink it with liquid, taking small but frequent sips. This is explained by the fact that the tablet passes through the esophagus within 2-5 minutes. If you take a long sip, then the water quickly passes by the tablet and the latter can stay in the esophagus. Frequent small sips of water or lumps of food help the drug pass into the stomach more quickly.
Currently, a large number of drugs are produced in syrup. Children, especially young ones, are eager to accept them. Children hardly swallow pills, and children under 3 years old can hardly ever swallow them. Therefore, the tablets are crushed before taking. Sometimes you have to dissolve a tablet or powder in sweet water, syrup, give the powder with food, etc. In infants, the prescribed dose of the liquid drug is often given in divided doses to prevent choking. If the child does not want to take the medicine, then he has to forcibly open his mouth as follows: 1) gently press on the cheeks with two fingers; 2) pinch the nose and at this moment the child opens his mouth. Some potions (not irritating to the oral mucosa) can be given from the nipple to babies in the first months of life.
Mixtures, decoctions are given in graduated cups with divisions of 5, 10, 15, 20 ml. In the absence of graduated dishes, take into account that there is about 5 ml of an aqueous solution in a teaspoon, in a dessert one -
10 ml, in the dining room - 15 ml. Alcoholic infusions as well as liquid extracts are measured using clean single-use pipettes. Using the same pipette for dispensing different medicines is prohibited.
Some heart medications (validol, nitroglycerin) are taken under the tongue. If it is impossible to administer drugs through the mouth, they are administered in the form of suppositories into the rectum. Suppositories are administered to children only by nurses. In the treatment of respiratory diseases, the inhalation method of drug administration is actively used, which has numerous options in the form of aerosols and sprays, providing for the presence of special packaging and a valve-distribution system.
Features of the technique of drug administration in infants.Usually, a measuring spoon is used, which is placed on the edge of the child's lower lip and tilted so that the medicine gradually flows into the mouth. The medicine can be administered using a special syringe. To do this, the tip of the syringe is placed in the corner of the mouth and the syrup is directed to the inside of the cheek, but not to the throat. The procedure is performed slowly so that the child has time to swallow the contents. Alternatively, the medicine can be administered through a special nipple. Such a device allows you to simultaneously heal the child and calm him down.
According to the indications of the nurse, it is necessary to use external methods of administering drugs: instilling drops, injecting ointment or inhaling powder into the nose, instilling drops in the ear, instilling drops in the conjunctival sac of the eyes or laying ointment behind the lower eyelid, applying ointments to the skin. All of these manipulations are performed on an individual basis and are usually separated from the distribution of drugs in time, as well as parenteral procedures associated with drug injections. However, their implementation is strictly regulated and requires constant attention and control from the nurse.
It is necessary to warn patients and their parents that when taking certain medicines (bismuth, iron, quinoline, etc.), the color of urine and feces may change.
Duties of a nurse in a polyclinic.Middle and junior medical staff in the children's polyclinic a special role is assigned. Less time is spent on direct work with a sick child, like in a hospital, and more on medical
the sky nurse performs the functions of a doctor's assistant, clerical work. Functional responsibilities the work of a nurse is largely determined by the characteristics of the work of a doctor of a particular profile.
District nurse.The main form of work of a nurse is preventive monitoring of the health of children. The method of dispensary control is used. The possibility of dispensary observation and assistance at its various stages is ensured by the structure of the organization of the children's polyclinic.
The district nurse (under the supervision of a doctor) conducts prenatal patronage of a pregnant woman, the purpose of which is to provide medical advice to the expectant mother (parents) in pediatric matters: breast preparation for lactation, rational nutrition, bad habits, ensuring optimal living conditions, creating a favorable psychological environment, the availability of child care items, the formation of a new family lifestyle when a child appears, etc. The first visit to a pregnant woman is carried out immediately after she is registered upon receipt of information from the antenatal clinic (12-23 weeks). The second patronage is carried out at a gestational age of 32 weeks (during the period of maternity leave), taking into account its normal course. The address of where the young family will live after the birth of the child, the presence of a children's room (corner of the newborn) are being specified.
Newborn patronage.According to the regulations, the pediatrician, together with the patronage nurse, visits the newborn at home in the first three days after discharge from the maternity hospital. If the child is the firstborn in the family, then the visit falls on the first day. An extract from the maternity hospital is studied, a thorough examination of the child is carried out with an assessment of his health. The nurse assesses the woman's lactation status, provides detailed instructions on breastfeeding techniques and child care. Carefully find out how the baby suckles the mother's breast, what breaks they take between feedings, whether there is vomiting, regurgitation, anxiety, whether the night break can withstand. An anthropometric study is being carried out: the length and weight of the body, the circumference of the head and chest are measured. At the end of the examination, an individual plan for the management of the newborn is drawn up (the number and terms of patronages, consultations with specialists, a set of health measures). Newborn baby follow-up is carried out by a doctor and a nurse.
vyvayut alternately. Medical (patronage)the nurse visits the newborn every 1-2 days during the first week, and then during the first month - weekly, alternating visits with the pediatrician.
Dispensary observation.When the child reaches the age of 1 month, the local doctor and nurse monthly assess the dynamics of physical development, give the necessary advice on the care and prevention of "controlled" diseases (rickets, anemia, iodine deficiency, etc.), carry out preventive vaccinations.
Children of the second year of life are examined once a quarter. Physical and neuropsychic development is assessed, according to indications, general urine and blood tests are prescribed, once a year, feces are examined for eggs of worms. From the age of three, children are examined once every six months, and from the age of four - once a year. The doctor identifies groups of children at increased risk for the development of a number of diseases and sick children who need special supervision, entrusting control over them to a local nurse. The nurse monitors the actual place of residence of the child.
Outpatient appointment.The district nurse prepares the workplace for the reception of patients, prepares forms, selects outpatient and dispensary cards for the doctor, makes sure that all test results are entered into the outpatient card. Under the supervision of a doctor, a nurse writes various certificates, directions for research, fills out statistical coupons ("Outpatient coupon", f.? 0325-12 / y), emergency notification cards, health resort cards, writes out prescriptions under the doctor's dictation, regulates the queue doctor's appointment, takes the necessary measurements (anthropometry, blood pressure measurement), etc.
The work of nurses in other offices (neuropathologist, cardiologist, endocrinologist, hematologist) has significant similarities with the work of a local nurse. In some cases, for example, at an appointment with an ophthalmologist, a special nursing area is allocated for the nurse, where, according to a special program, she examines children who come to see an ophthalmologist: she checks visual acuity, measures intraocular pressure according to indications, etc. The nurse of the otolaryngology office is usually charged with the study of whispering and colloquial speech, olfactometry, taking smears from
pharynx, nose, external auditory canal, etc. Nurses of surgical and applied specialties (surgical, dental, physiotherapy, balneological, otolaryngological offices) pay great attention to the preparation of instruments.
Patient care at home.The main reason for home visits to a sick child by a nurse is the fulfillment of medical appointments, mainly injections. District nurses are provided with special bags with sets of necessary supplies. When visiting a patient at home, a nurse is engaged in sanitary and educational work, gives the necessary recommendations for caring for a child. If it is necessary to organize a "hospital at home" and prescribe a comprehensive treatment, the nurse performs intramuscular injections and intravenous infusions, visiting the patient several times a day.
Dispensing medicines to children in the clinic.If a sick child needs medicines, the local doctor writes out conventional or preferential prescriptions (for children under 3 years old, disabled since childhood, disabled by illness), with partial or full payment. Nurses should know the main medicinal products used in pediatric practice, indications and contraindications for their appointment, rules of use (forms of medications, connection with food intake), possible side effects. In addition, non-prescription forms of drugs are available in domestic pharmacies, which allows the population to independently use certain dosage forms.
TEST QUESTIONS
1.What is a two- and three-step system of child care in a hospital?
2. List the responsibilities of a junior nurse.
3. List the responsibilities of the ward nurse.
4. What is the approximate work plan for the ward nurse during the day?
5. What manipulations should a nurse have?
6. What is the delivery and acceptance of duty in the children's department of the hospital?
7.How is the nurse's post equipped?
8. What types of medical records are used in the therapy department?
9. What data is entered in the temperature sheet?
10. What are the requirements for storing medicines in the department?
11. Name the features of the distribution of drugs taken by mouth to children of different ages.
12. How are the shelf life of individual medicinal products regulated?
General care of children: A. M. Zaprudnov, K. I. Grigoriev textbook. allowance. - 4th ed., Rev. and add. - M. 2009 .-- 416 p. : ill.
Typical sample
APPROVED
___________________________________ (initials, surname)
(name of the organization, before - ________________________
acceptance, etc., his organizational- (director or other
legal form) legal entity, authorized
must approve
note instructions)
"" ____________ 20__.
Job description
nurse
______________________________________________
(name of organization, enterprise, etc.)
"" ______________ 20__ N_________
This job description was developed and approved for
basis employment contract from __________________________________________
(name of the position of the person for whom
______________________________________________________ and in accordance with
the present job description is drawn up)
provisions Labor Code Russian Federation and other regulatory
acts regulating labor relations in the Russian Federation.
1. General Provisions
1.1. The nurse is a specialist.
1.2. A person who has
secondary medical education in the specialty "Nursing" and
having a ______________________ qualification category.
(II, I, highest)
1.3. Nursing appointment and exemption from
it is made by order of the head of the institution.
1.4. The nurse should know:
- laws of the Russian Federation and other normative legal acts on
health issues;
- the basics of the treatment and diagnostic process, prevention
diseases, promotion of a healthy lifestyle;
- basic techniques and methods of providing first-aid medical care
sick and injured in accidents;
- organizational structure of a healthcare institution;
- safety rules when working with a medical
tools and equipment;
- fundamentals of labor legislation;
- internal labor regulations;
- rules and regulations of labor protection, safety measures,
industrial sanitation and fire protection;
- _________________________________________________________________.
1.5. The nurse reports directly
_________________________________________________________________________
(to the head nurse of the department; the doctor she works with)
and in its activities is guided by the charter of the institution, orders
his leader, his immediate superior and the present
job description.
1.6. ______________________________________________________________.
2. Job responsibilities
Nurse:
2.1. Provides infectious safety (follows the rules
sanitary and hygienic and anti-epidemic regime, asepsis,
stores, processes, sterilizes and uses products correctly
medical purposes).
2.2. Carries out all stages of the nursing process in caring for
patients (initial assessment of the patient's condition, interpretation of the received
data, planning of care with the patient, final assessment
achieved).
2.3. Timely and efficiently performs preventive and
medical and diagnostic procedures prescribed by a doctor.
2.4. Assists when a doctor carries out medical and diagnostic
manipulations and small operations in outpatient and inpatient conditions.
2.5. Provides emergency first aid for acute
diseases, accidents and various types of disasters with
subsequent call of the doctor to the patient or referral to the nearest
medical and preventive institution.
2.6. Introduces drugs, anti-shock agents (with
anaphylactic shock) to patients in terms of vital signs (with
impossibility of timely arrival of the doctor to the patient) in accordance with
the established procedure for this condition.
2.7. Tells the doctor or manager, and in their absence, the person on duty
to the doctor about all detected serious complications and diseases of patients,
complications arising from medical procedures
or about cases of violation of the internal order of the institution.
2.8. Ensures correct storage, accounting and disposal of medicinal
drugs, compliance with the rules for taking drugs by patients.
2.9. Interacts with colleagues and employees of other services in
the best interests of the patient.
2.10. Maintains approved medical records and reports.
2.11. He systematically improves his professional qualifications.
2.12. Conducts sanitary and educational work to strengthen
health and disease prevention, promotion of a healthy lifestyle.
2.13. Strictly observes the moral and legal norms of the professional
communication with patients.
3. Rights
A nurse has the right to:
3.1. Apply conservative treatment methods as directed by a doctor
patients, to carry out certain medical procedures.
3.2. Receive the information you need to accurately fulfill your
professional responsibilities.
3.3. Make suggestions for improving the work of medical
nurses and nursing organizations in the institution.
3.4. Require the senior nurse of the support department
post (workplace) equipment, equipment, tools,
care items, etc., necessary for the quality performance of their
functional responsibilities.
3.5. Improve your qualifications in the prescribed manner, pass
certification (recertification) in order to assign qualification
categories.
3.6. Participate in the work of professional associations of medical
sisters and other public organizations not prohibited
the legislation of the Russian Federation.
3.7. ______________________________________________________________.
4. Responsibility
The nurse is responsible for:
4.1. For improper performance or non-performance of their official
responsibilities provided for by this job description - in
within the current labor legislation of the Russian Federation.
4.2. For offenses committed in the process of exercising their
activities - within the limits of the current administrative, criminal and
civil legislation of the Russian Federation.
4.3. For causing material damage - within the current
labor and civil legislation of the Russian Federation.
4.4. For mistakes in the performance of their duties, which entailed
grave consequences for the life and health of patients, - within
the current legislation of the Russian Federation.
4.5. ______________________________________________________________.
The job description is developed in accordance with ________________
(name,
_____________________________.
document number and date)
Head of structural unit (initials, surname)
_________________________
(signature)
"" _____________ 20__
AGREED:
Head of the legal department
(initials, surname)
_____________________________
(signature)
"" ________________ 20__
I have read the instructions: (initials, surname)
_________________________
(signature)