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HomeMy WebLinkAbout1989-0176.Bronkhurst et al.92-04-27  ONTARIO EMPLOYES DE LA COURONNE ¢~ ,. CROWN E-MPL Q YEES DE L '0 N TA R/Q 180 DUNDAS STREET WEST, SUITE 2100, TORONTO, ONTARIO. ~SG ]Z8 TELEPHON~i~LE~HONE. (z 1G) 225- tSO, ~UE DUNDAS OUEST, BUREAU 2]00, TORONTO (ONTAR~). MSG IZB FACSI~tLE,'T~L~COPiE : (4 iS] 325- 176/89, 362/89, 530/89, 580/89, 695/89, 697/89, 1089/89, 1150/89, 1219/89, 1244/89, 1245/89, 1278/89, 1353/89, 1541/89, 1582/89, 1613/89, 1772/89, 1774/89, 2155/90, 2260/90, 2637/90, 2831/90, 2832/90, 2833/90, 3082/90, 2540/91 IN THE MATTER OF AN ARBITRATION Under THE CROWN EMPLOYEES COLLECTIVE BARGAINING ACT Before OPSEU (Bronkhorst et al) Grievor - and - The Crown in Right of Ontario (Ministry of Health) Employer BEFORE: P. Knopf Vice-Chairperson M. Vorster Member H. Roberts Member FOR THE P. Peloso GRIEVOR Counsel Gowling, Strathy & Henderson Barristers & Solicitors FOR THE M. Farson EMPLOYER Counsel Fraser.& Beatty Barristers & Solicitors HEARING August 9, 1989 December 5, 1989 February 27, 1991 April 2, 1991 May 8, 1991 October 4, 1991 November 22, 1991 December 13, 1991 January 2, 1992 DECISION This is a classification case wherein the Union claims that the Psychiatric Nursing Assistants (PNA's) at two provincial psychiatric facilities are improperly classified. The grievers are recognized as health care professionals. They are trained at the Community College level and accredited by the College of Nurses of Ontario as Registered Nursing Assistants. They then take additional specialty training at psychiatric facilities to qualify as PISA's. The Union alleges that because of the level of responsibility and tasks expected of the PNA's they are improperly classified and should, instead, be classified as Nurse I General. This classification basically covers graduate nurses who have hot achieved registration with the College of Nurses. The Employer asserts that the PNA's are properly classified. It should be noted at the outset that the concept of a "usage" argument was raised by the Union during the course of this case, but specifically withdrawn on December 13, 1991. Thus, this analysis is based solely on the question of whether the PNA's are properly classified as such with respect to the applicable job standards. The case concerns the P~A 2's at both the London Psychiatric Hospital and the St. Thomas Psychiatric Hospital. The parties agreed that the case should proceed by way of representative grievers from each institution and the parties further agreed to lists of-grievers which are bound by this decision. Testifying as the representative griever on behalf of her colleagues at London was Kelly Sullivan. The basis of her complaint is that her Job Specification and Class Standard do Rot reflect tho duties and responsibilities she is expected to'assume on a daily basis. Her Job Specification is appended as ~p[3endix "A" and the Class Standard for the Psychiatric Nursing Assistant is appended as Appendix "B". [The Nurse I General Classification Standard is .appended as Appendix "C".] Ms. Sullivan accepts that her Job Specification is "reflective of some of her duties and responsibilities," but her testimony was offered to try to convince the Board that many other significant duties and responsibilities need to be recognized. Sp'?cifically, she spoke of her responsibilities to devise, formulate and implement individual nursing care plans fo~' individual psychiatric patients. Such a plan is formu'lated generally when the patient arrives at the Hospital. The PNA has 'the responsibility of taking the nursing history-and determining what "plan" should be put -in place to deal with the patient!s particular problems, and establish short an~d long term goals for dealing with and solving those problems. The plan ~is used to help assist in treatmen't and to determine wha.t levels of success have been achieved. She re'adc it' clea~ that the health care plan was an integral part of the patient treatment, however she conceded that the daily direction on what is to be done with the patient comes from their charge nurse, head nurse and the attendant doctor. In addition, Ms. Sullivan testif~ied as to other functions she feels are not reflected in the job specification. She listed her responsibilities to chart signs and symptoms of behavioural changes of the patient during conversations and treatment. Also, she is expected to maintain records of the patient's movement, hygiene, bowel functions, valuables and equipment. This does not include keeping track of medications which is the recording responsibility of the Nurse I General. In .addition, the PNA's participate in several therapeutic, programs for the patients including family counselling, drug[ and alcohol abuse, life st~le programs, medication awareness, disc.harge planning, group therapy, adolescent groups,, activity groups (leisure time) and abuse groups (rape and incest) and assertiveness training. The PNA's may get involved leading such groups on the adolescent unit. The PNA's are not required to lead any groups but where a therapeutic group is being held in aR area of expertise i~ which the PNA has an interest or specific training, s/he may, if s/he wishes, be assigned to lead such group. Ms. Sullivan also testified regarding the PNA's responsibility to provide reality orientation to patients to help them gain an awareness of time, place or person and to dispell delusional behaviour. They also must perform grief counselling when a chaplain or social worker cannot be found to help a distressed patient. In addition, the PNA's participate in a multi-disciplinary team and treatment plan. This team consists of a psychiatrist, occupational therapist, social workers, .psychologists, recreational therapists, nurses and PNA's. The team meets in conference four to six weeks after the admission of the patient to focus on the "overall picture ~or plan of care for a particular patient." The PNA has a great deal of input to give the team because of his/her direct contact with the patient on a continuous or regular basis. The PNA's also provide direct bedside nursing care to physically ill and dying Datients. This includes feeding, bathing, mouth care, taking blood pressure and TPR, changing dressing and administering topical medications as ordered. However, it is conceded that the PNA's do not do sterile dressings or administer oral medication. The PNA is also expected to assist with the care of a body after death which includes tending to the cleaning and washing of the dead body and placing the body in a shroud pack. Further, s/he is expected to assist the physician in the physical examination of patients, admissions, transfer' and discharge. With respect to electroconvulsive ther'apy, the PNA becomes involved by takin, g vital signs, accompanying the patient to treatment, remaining with the pa'.tient during the treatment, helping to restrain .the patient during treatment and helping to take the patient to recoveryl. However, the PNA is not left with the responsibility of ian unconscious patient in the recovery room. Instead, this is the responsibility o~ the Nurse I General. Further, the PNA's collect, bag, chart and send out specimens for diagnostic testing, including~, urine, stool and sputum samples. Further, the PNA's, like all other members of the staff, are responsible to provide and promote a safe and secure environment and to i~nplement remedial actio~ immediately by making use of safety bedrails, removal of sharp objects and calling emergency codes· when emergencies arise.· They can also be assigned onto special observation routines and close nursing observation of p~rticular patients when the need arises. Approximately once a month, the PNA's provide in-service lectures and seminars to other PNA's. They also participate in staff devel·opment programs. ~Finally, the PNA's offer assistance to the patients in g~tting them access to their patient advocate and rights advisors. A further responsibility referred to by Ms. Sullivan Was that of becoming a-team leader. This~is the responsibility of a PNA when a registered nurse is not on the floor or the ward - and thus the PNA becomes a "de facto', team ~eader. However, in cross-examination, Ms. Sullivan conceded'that this occurs only about once a month and in situations in the night when · the patients are usually asleep. Further, in those situations, the PNA is not left with responsibility for the medications room. Finally, Ms. Sullivan testified that the job description does not reflect the fact that the PNA's can direct or assign specific tasks to summer students. Bonnie Kotnik testified on behalf of the Employer.. She is the Assistant Manager of the Nursing Department aX London. Her testimony, coupled with that of Kelly Sullivan, made clear the educational distinctions between a PNA and a Nurse I General. PNA's are Registered Nursing Assistants holding certificates of competence with the College of Nurses. They have completed a College level program of approximately one academic year to get the Certificate and have had specialized training at psychiatric facilities. A Nurse I General has a Diploma in Nursing in that she has' graduated from a Nursing School at a College or University level which involves as least a two-year course. Typically, these "grad nurses" are in the process of writing their registration examinations with the College and once registered, become RN's. There is one permanent Nurse I General at London Psychiatric Hospital but all the others operate on a temporary basis until they receive registration, i.e. six to eight weeks. At London, the RN's can do injections, whereas the Nurse I General-s cannot. However, in all other respects, their duties and responsibilities are the same. The Hospital then uses the standards of the College of Nurses to establish work assignments and job responsibilities for the PNA's as opposed to the grad or registered nurses. These standards permit nurses to do many things'which the PNA's are not allowed to do. For example, the PNA's are not allowed to administer sterile dressings, remove sutures or perform any "intrusive procedures". Further, except on the odd occasion in the night time as specified above, the PNA's are not left in charge of a ward on their'own. Other examples of different levels of responsibilities are that the PNA cannot take a telephone order from a doctor, whereas a nurse can. Further, a Nurse I General, as a Charge Nurse, could be responsible for a patient who is put in seclusion and for monitoring the case and, indeed, for having the authority to .put the patient in seclusion prior to receiving a doctor's order to so. The P~A has no such authority. While the P~A may make valid and valuable suggestions as to when seclusion should begin or end, they have no authority to make the actual orders. The same is true for close nursing observation and for isolation. In terms of supervision, Ms. Kotn'ik testified that the P~A's are supervised by the ~urse I Generals or the nurses 'on duty, whereas the ~urse I Generals are indirectly superv'ised by the ~ursing Service Co-ordinator. .Finally, the PNA's do not do intravenous therapy.. They may monitor the drip amounts but have no authority to adjust them as does the Nurse I General. 'The PNk's cannot do a nasal gastric fe~ding. Peggy Mildren testified as. the representative grievor at the St. Thomas Psychiatric Hospital. She accepted that the Job Specification in place at the time of her grievance (Appendix'~ was basically accurate as far as it went but, like Ms. Sullivan, asserted that the Specification does not recognize adequately all the responsibilities regularly assigned to her. Specifically, she said that the specification did not ~eco~nize their important responsibilities with regard to the Nursing Care Plans and Primary Nursing. The Nursing Care Plan is an individual care plan formulated for patients and contains the P~A's assessment of diagnosis and suggestions for treatment and goals to be achieved. Further, the PNA reviews and updates this Nursing Care Plan as necessary. The second item of significance to the PNA's at St..Thomas was the responsibility ~ith regard to Primary Nursing. The concept of Primary Nursisg is defined in the St. Thomas Psychiatric Hospital's publication called "~ursi~g Framework". It sets forth exactly what a primary nurse is and is expected to be. (See Appendix "E".) basically this involves individul responsibility and accountability by each nursing professional towards his/her assigned patient. The PNA's at St. Thomas are assigned the responsibility of primary nursing care to the more stable patients. It is con.ceded by Ms. Mildren that if one of a PNA's primary patients becomes more unstable, the assignment is likely to be changed to a grad nurse or a registered nurse. In addition, the PNA's at St. Thomas are responsible for administering medications such as anti-psychotics, anti-anxiety, anti-depressants and any other oral medications ordered by a doctor except narcotics. Further, the PNA's function on the multi-disciplinary teams with doctors, social workers, occupatinal .therapists, psychologists and the nursing~ staff to discuss the patients and their progress and report on their patient's physical and emotional status. Indeed, it ~s the responsibility of the PNA's to record and report any changes in condition in status to the attending nurses or doctors. Ms. Mildren's evidence also showed some differences between the responsibilities of the PNA's and the Nurse I Generals. While the PNA's can transcribe physician's orders onto the Kardex and documentation on the patient's chart, this can be done if they have been written by a doctor. But it must be cosigned by an R.N. Further, only an R.N. can take a verbal or a telephoned order from a doctor. Further, PNA's can use their own judgment and knowledge for determining when a restricted group of medications can be administered, such as A.S.A.,. Malox, laxatives and cough syrup without narcotics. Other medications can only be administered upo~ authorization by an R.N.. Further, PNA's can administer eye drops unless the eyes are infected. The PNA's cannot apply sterile dressings. They can monitou vital signs, blood 9ressure, temperature and level of ~consciousness of patients. However, if a patient is' unconscious, all these must be done by a nurse.. Further, a P.N.A. may implement isolation once a nurse o~ doctor decides that it ~s necessary, but their order is required. Finally, the PNA's take on responsibility for orienting new PNA's and giving direction to summer students. The PNA's do no bladder irrigation, removal of sutures, intravenous work', gastric feedings or administration of continuous oxygen. Ms. Mildren's evidence was far more extensive and covered all the functions that the PNA's perform, but this outline has touchod only those particular elements which the Union stressed took her beyond the'bounds of he PNA Class Standard and the existing Job Specification. The Employer offered no evidence with respect to the St. Thomas institution. The Argument Counsel for the Union began by pointi'ng out that the Job standards were drafted in January of 1972 and suggested that they were outdated because ~be PNA position had evolved into something fundamentally different than what was contempla'ted so long ago. It was submitted that the PNA's are now required to exercise professional judgment and expertise, are actively responsible for the treatment and care of patients and that these are not contemplated by the original Standa-rds. This was said to be evidenced by the ne%~ concepts of Primary Nursing and the evolution of D~ursing Care Plans and the PNA's responsibility on the multi~disc, iplinary teams. All these things were said to be-missing from the Job Standards and from the PNA's Specifications in both facilities. With regard to the specifi.c institutions, it was argued that the Employer's decision to call no evidence with regard to St. Thomas means that Peggy Mildren's evidence must be accepted as wholly accurate and that the very significant role of Primary Nursing must be recognized. Fhrther, it was said that the Employer ~ailed to offer any rationale fo~ distinguishing between, the different levels of training required of PNA's and the Nurse I Generals. With regard to the London facility, it was argued that Kelly Sullivan's evidence established the 'functional independence of the PNA's and the large amount of reliance institution places upon them to advise aad assist 5or treatment purposes. It was said that management calls upon the PNA's to exercise professional judgment and use their professional traini'ng, particularly with regard to the Nursing Care Plans used in the Institution. For both institutions, it was stressed that the PNA's have the most direct and immediate impact on the health and wellbeing of the patients but that their present level of classificatiQn does not adequately recognize this~. Counsel for the Union summarized by saying that the PNA's were not properly classified and that the Union has satisfied its onus of proving this. The Union argued that the Nurse I General provided a'"better fit" for the classification or, in the alternative, a Berry order ought-to be issued. The following cases were relied upbn: Brick v. Ministry o~ of Transportation and Communications, GSB File 564/80 (Samuels) Berry v. Ministry o~ Community and Social Services, Ont. Div. Ct., March 13, 1986; Attorney General of Ontario v. Canning, Ont. Div. Ct. October 20, 1987; Sabo v. Ministr~ of Community and Social Services, GSB File 777/$6 (Dissanayake); Cabeza v. Ministr~ of Labour, GSB File 909/86 (Epstein) and Piffard v. Ministry of Community and Social Serv'ices, GSB File 602/84 (Roberts). Counsel for the Employer argued that the grievers are properly classified and that the Nurse I General is not a better fit for the category. .~ocusing on the Class Standards themselves, counsel for the Employer stressed the preambles to both the PNA and the Nursing Class series contain simi!ar~ties_ w~th regard to the provision of general nursing serv. ices, direct patient contact, being members of the "nursing team" administering oral medications and assistin'g %~ith the carrying out of therapy. However, the differences between the two series were stressed in that the nursing series, and the' Nurse I General in particular, provide a more medical focus, whereas the PNA series contemplate more duties along the lines of "daily living, counselling and therapeutic" programs. The differences were said to. be more a matter of degree than anything, but are' said to.be significant. .Further, the differences were said to indicate a' different level of Supervision, and different levels of responsibility with regard to the administration of medications, recording of doctor's orders, treatment, supervisory responsibilities, knowledge and qualifications. All these theoretical differences were said to have been illustrated by the evidence .of all the witnesses indicating the different degrees of responsibilities and expectations of the Nurse I Generals and PNA's of the two institutions. These differences were said to.reflect the College of Nurses' distinctions between nursing assistants and nurses. Many specific examples were given in the arg~4ment. They were all offered in support of the submissions that there was nothing in the PNA 2 Standard that did not fit the grievers. Further~ it was argued that the Nurse I General Standard would not serve as a "better fit" for these duties because it' " did not reflect the actual level of supervision that was given, or the level of supervision exercised by the grievers, nor did it reflect their level of training. Thus, we were asked to dismiss the grievances. - 11 - The Decision As always, the function of a Board in a case such as this is to determine first, whether or not the grievers are properly classified in their existing classification. To do this, we must look at the Class Standards as a whole and determine the the griever's essential and fundamental responsibilities on a regular basis in order to determine their proper classification. But even before we do this, we feel compelled to emphasize that we were very impressed by the grievers. They perform extremely important functions. It is clear that they offer the direct and extensive patient cent. act and care that is essential for the treatment of these very troubled and · troubling individuals. The grievers are certainly health care professionals. Many of the tasks they are required to perform may be routine and thankless. However, a vast majority of the work that they perform is highly skilled, calling for the exercise of professional judgment, expertise and indeed profound wisdom. The representative grievers whom we had the privilege of hearing were extremely articulate and obviously a credit to their profession and the institutions they serve. However, our function, as we stated above, is to determine whether all these responsibilities are adequately reflected by their present level of classification. To do these we must turn to the Class Standards for the PNA 2's. The preamble to the Standard indicates that PNA's are expected to participate and contribute to the "treatment and rehabilitation of patients through the provision of general nursing services and personal care." Further, they have "extensive and continuous direct contact with patients and, as members of the nursing team, they have major responsibility to provide continuity in their daily programs." The preamble continues by settinng out the responsibilities to observe, report and advise on patients' behaviour and changes. It also includes the administration of oral medications and the carrying out of therapies. All this recognizes the skilled "nursing" components and day-.to-day theragy and care required to .be given by of a person in that position. Specific to the PNA 2's is the partic.ipation in therapeutic programs, supervising in ~aily living, administering oral medications, collecting and recording information on behaviour symtomology and reaction to drugs. Further, it recognizes that the incumbents would assist with special therapies such as ECT and, on an occasional basis, assume duties of supervisory personnel. While we recognize that the Class Standards are two decades old, they must also be recognized as very broad. They contemplat~ clearly that~PNA's exercise nursing skills, participate as part of the nu.rsing team and provide direct patien't therapy. While the concepts of the Nursing Care Plans or "Prima~y Nursing" may not have been devised two decades ago, they simply seem to be administrative devices to better provide treatment and rehabilitation to patients and to assign and share responsibilities. Close examination of the duties at both facilities, especially with regard to the concepts of Primary ~ursing and the Health Care Plans, fail to convince us that anything expected of the grievors is not covered in the broad characterizations of the Job Standards of PNA 2's. It is easy for this Board to see where the grievors' discontent arose. Neither of the Job Specifications for the facilities pays tribute to concepts such as the Primary Nursing or the Hea~th Care Plan. Indeed, there are many job functions which the PNA's perform which ar~ not reflective in the Job Specifications. The representative grievors' testimonies made that clear. However, job specifications are nbt required to be detailed jbb descriptions. While it is in both parties' best interest to maintain acCurate and respectful job specifications honouring the duties and expectations of incumbents, it is the Job Standard that this Board must use to assess whether the job has been adequately classified. In the case at ~hand, we are convinced that the Standard of the PNA 2's adequately a~d completely covers all the job functions revealed to us by the grievors because of its recognition of the nursing skills and therapeutic contributions exercised by PNA 2's. With this conclusion, need go no further. But in fairness to both parties's extensive submissions, we wish also. to say that the'evidence falls far short of establishing that the Nurse I General would be a better fit for the job. The Nurse I General Standards contemplate the person working "under direction df a supervising nurse", whereas the PNA's receive "general supervision" in that they are much more limited in the scope -of their authority. Further, Nurse 1 Generals are responsible for assigning duties and checking work of subordinate staff. The PNA 2's in these facilities have some supervisory responsibility over summer students. But this is far ~'ifferent from the quasi-supervisory responsibility· expected of Nurse I Generals and as evidenced by their ability to function as team leaders over PNA's in the absence of a R.N. on a regular basis. Finally, the PNA's simply do not have the educational requirements of the Nurse I Generals. Give~ the different level of medical responsibility o~ the Nurse I General with respect to administering of medicatiion, sterile dressings, oxygen, intravenous, care of unconscious patients and ordering intrusive p~ocedures, the Employer has'satisfied the Board that the higher education requirements are necessary to fulfil the added medical responsbilities of the nursing series. We recognize that the spec~alized psychological component of the PNA's training equips them well for their tasks and that they develop an invaluab.le expertise and specialized knowledqe from their continuinq professional development. But we accept the Employer's evidence that the further depth achieved in the accredited nursing course of at least two years' duration is a valid job requirement for the Nurse I General position. The grievers deserve everyone's deep respect and appreciation for the demanding and difficult jobs they perform. But, fpr all the reasons stated above, the evidence offered has not convinced us that the Union has established that the PNA's 'at London and St. Thomas Psychiatric Hospital are improperly classified. Hence both grievances are dismissed. DATED at Toronto, Ontario this2?~h day of Apri ! , 1992, "I Dissent" (dissent ~o follow) M. Vorster - Membe'r H. Roberts - Member POSITION SPECIFICATION ANO CLASS ALLOCATION FORM · , . ,ART 1 ~o~,o- T*T~II [~ NIEW PSYCHIATRIC NURSING ASS[STANT ~ .~v~s~o ?hlatrtc Nursing Assistant I Psychiatric Nursing Ass't. 2 I 41502 I 05-93~1-20 Ward Head Nurse m HEALTH Public & ~ntal Health ~ntal Health Nursing ~ London Psychiatric ~ospttal o LO~ON, O~tarto N6A To assist as a team member with total ~tient care under general supervision. 70% 1. Provides under general supervtston~ care to meet patients' physical, psychologlca) and social needs by: - feeding, grooming, instructing and supervising patients in thet~ activities ~ of daily living; ~ - m ' assisting patients to beco~ oriented to the hospital and encouraging ~rticipation ,-. tn therapeutic ~mgra~s, e.g. OaT. and ).T.; - reporting and recording changes In patient' ph~lcal and/or ~ttonal-condttton; - participating in ward meetings, discussion groups, medical and other staff conferences; ' - assisting with Psychiatric and Physical E~ergencies, e.g. 7-~ and - maintaining and ~elivering C.S.R. supplies while ~rking tn s~(ial areas, - assisting in various clinics, e.g. ~n., Escort Services ~nd accompanying patients to clinic both in and out of hosp(~l and delivers mail to other depa~nts; - ~intaining accurate records of patients' belongings, accom~nying and introducing patients to ward personnel. ~0% ~. ~intatns good interpersonal relationships with patients, relstives and other members of treatment team; participles in st~ff develo~ent 5% 3. Perfoms other related duties Including assisting with physical treatments such as electm-convulsive therapy. · 5% 4. Perfo~ other relateU 4utles as required ~r assigned. CLASSIFICATION:~ P~iatr~ur~tstant 2 (4X502 IC-OXB) REC0~ENDED Personn~j 0f(t~r~~ ~~G ~z . ~. A. ~entoff tursing Assis~nt registration In 0nt~rto with passing o~ ~attonal ~ea~e of Nursing, ~sychiatrfc nursing examination, o~ successful completion of the ~lntstry of Health Nurse Aide and Attendant training course. Pemonal suitability. Skill tn res~nding appmpriatety to psychiatric and physical emerqenctes such as ts achieved by completion of a course fn the .. s~GNATuRES Management of Oisturbed 8eha~ijur er i~,~juiv~le~. /~ - ~ ~m,- - .... = Under general supervision assists ~ttents tn re-acquiring daily living, skills, and '- ~tt~t~tes tn therapeuti~ Collects ~nd records relevant ~tient ~ttvtty tnfo~t(o~. ~ As required, a~ists with special therapies and/or ts responsible for a ward or group of APPENDIX ~B" ..... CATEGORy: institutional Care GROUP= IC-018 Institutional Care SERIES: Psychiatric Nursing CLASS CODE: 41500 ~o 41506 PREAMBLE This class series covers the po~i~io~ of P~a~ric in ~e psychia~ric hospices .op~rat~ ~ ~hm ~ployees p~icipa~m ~ ~ cou~ribu~m :o ~he ~rea~u~ ~ r~bili~a~iou of patients. ~h~ ~ pro.sion of geneu~ u~si~ me.cee ~d ~erso~ in acco~anc~ ~ ~ro~es de~d by ~ cli~ ~ v~ =e~ pa=ients~ needs, They ~so assist with ~ ~s=~cc indi~u~ ~ g~ups of patients in therapeutic ac=ivi~ies such as spots, g~es ~d hobbies. Psy=hiatric Nursi~ Assistants have ~e~iv~ ~d coutinuous ~rect contact with patients ~, as ~bers of the nurse8 ~e~ they ~ve a ~jor responsibility to provide contrary ~ their davy proxies. Th~ obm~r~ reco~ ~ report patien~ beha~our, pro~ess, s~tomolo~, ~t=., notin~ a~ ~dica=io~ of ch~e. Th~ a~i~ster or~ me~ca~io~ ~ assis~ wi~h or ~ out speci~ ~herapies ~eu qualified or authoriz~ =o do so. ~ r~r~, ~ ~sist ~d patients ~ ~he ac=i~ties of d~ly liv~ su~ as 8ressi~, eat~{, perso~ care, ' de,orient: observance of he~th practices ~d safe~ ~e~. Under the direction of professional st~f or in collaboration with te~ni~ st~f, th~ assis~ patients to pa~icipa=e in sports, hobbies, soci~ events, industr~ or occupatio~l train~. The work i~ perffo~ed on a.shif~ basis. In addition to the duties described~ ~he roll,in6 factors shoed be considered in ev~tin~ the level of re~po~i~i~i=y of a posi=iou: 1. The ~e or ~o~ition of patients ~ a ~t 2. The e~ant of treatment or ac~ivi~ dura{ ~e 3. Th~ size ~ physi~ arr~g~en~s of ~he hospi~ The e.~en= ~d ~e (e.6. Profession1} of supe~ision over =he position. · , ~ ~he hospi=~ as =he basic u~= pu~oses of a~is=r;=~onz mediz~ ~rez=men= ~ residenc~. m~~=ra=ive Uui=m - Oue or more ~s as desis~=~, ~he n~ber va~{ wi=h =he ~e of p~ien= ~d ~he ~o~= of a~ivi~ dur~g shift. On =he day s~f= ~en ac=ivi=y is a= =he ~, oue wa~ no~]_ly ~ons=i~uues an a~n~s~ra=ive u~=. .. wards ~y be ~rouped ~o fo~ lar.~er .. PRF_AMB~ (¢ont'd) CLASS CODE: 41500-06 The Class Series consists of four levels: Firs~ Level - tra.tnee level for employees enrolled in a Nursing Assistant Trai~ Centre of ~e Men~ He~th Di~sio~. ~ erection ~ ~rac:ic~ :~ are giv~ ~ ~e ei~t hours of du~. Seco~ ~vel - ~e wor~ level for the P~iatric Nurs~ ~s~c~t ~o ~s successfully co~leted ~ app~ved co,se ~ has ~he requ~ed s~ls ~ psy~ietric nurs~g ~re. Thi~ Level - group le~der or te~c~ assist~t to ~ ~istrative supe~sor. ~our~ Level - wa~ or a~str~tive ,,~t supe~isor. Revised JanuarT '~,-_ 197~ CATEGORY: Institutional Care ~ROUP: IC-01B Institutional Care CLASS CODE: 41500 PSYCHIATRIC E1~RS32~O ASSISTkWI' 1 This class covers trainee pos.i:ions of employees enrolled in a depa,-~ental Nursin§ Assistant Training Centre. Employees receive formal ins:ruction and practice experience under the direction ind " supervisio~ of the educational staff who evaluate their performance. ?rainees who fail to meet the standards required must,be released or, pr~vi~e~ a vacancy exista~ ~ay be a~siGned to other work covered by an. appropriate classification. Proficiency in reading~ writing ~d spe~ ~glish; abi~ zo ~de~t~d ~d follow s~ple oral and ~i~:en ~t~ctions; desire of the m~:~y i~; ab~i~ to ma~ good vo~g ~lationships with co-worke~ ~d accept su~ision. Revised .Tanuar7 2, CATEGORY: Ins~l~u=ional Care STANDARD: PS~TR~C NU~B ASSISTANT 2 This class covers the positions of quaIified P~ychiatric .~'ursin$ ~si~=~ts ~o f~ction as membe~ of ~he nu~ ~e=. Under g~eral ~upe~ision, ~e7 ~sis~ pa~ien~ ~o hecta o~a~ed ~o ~e hospital ~viro~ ~d to ~icipa~e ~ ~e ther~utic p~gr~es. They ~st~ct ~d ~u~ise ~ti~t~ ~ the ac:ivities of davy liv~g. · They a~ter o~1 indications ~fomz~on ~t~t ~ ~ti~e ~d f~lyi ~ patien~ be~our~ sys~olo~ ~ac~ions to t~e ~d o~er ~leva~ da~a. U~der supe~ision, ~ey may assiS~ ~ s~ci~ ~herapies such as E.C.T; o~pply behavioural ~ec~iques. Occasiona~y, ~hey may be required ~o ~s~e the duties o~ supe~o~ pe~o~el, ~d be . ~porar~y res~nsible for a-~ or g~up SEI'LI~ AKD ~NOWI.EDGE ~EQUIRED: Demonstrated proficiency in the knowledge and skil. Is of nursing care a~ ~:he Nursing Assistant level; demons~ra~:ed ability ~:o anderstand and work effectively with the men~ally Lll; ability to observe and record patient behaviour; ability ~o maintain good w~rkin§ relationships and follow instructions. Revi~ed January 2, laT2 CATEGORY: Institutional Care ~ROUP: iC-OIB Ins=itutional Care SER/ES: Psychiatric Nursing Assis~ant ~$ ~DE: 41504 CLASS STANDARD; 'PSYCHIATBI0 NURSING ASSISTANT This class covers the positions of experienced Psychiatric Nu~ing Assistants who are assigned more responsible duties as a group leader or as a technical a~sistant to r~ae nurse in charge of the w~rd. They ensure that patient records are maintained, issue instructions or assign work to nursing assistant s~aff~ and may assume tempora~f charge of ~he ward. On the day shift, employees perform the duties of ~taff assistant to the nurse in charge of a ward of patients under actual treatment or requiring special care. They a~si~t their supervisor with adminis~rativ~ responsibilities ~nd may direc% the work of the nursing as s is~ant staff.' On other shifts, they have continuing responsibility for the work of at leas: two nursing assistants in a~ administrative unit under %he general supervision of the Nurse or Psychiatric Nursing .~sistant in charge of the unit. SK'O',r.~ AND ~NOWLEDGE REQUIRED: Ou~standin~ ability as a ~y~hia~ric Nursing Assistant working ~-ith the mentally ill; abili~- to give or ¢~rr? out ins~ructi~ns; ability, to work as a member of a therapeutic temm; good knowledge of hospital rules, practices and procedures. Revised January. 2. 1972 CATEGORY: Instl=ution&l C&=e / , SERZF_~ Peychtat. rl6 Nurelng Asal$~an= CLASS COD£: 41506 NURSING ASSISTANT 4 This class covers ~he positions of senior psychiatric Nursing . Assistants who carry out responsible duties as a ward supervisor or as a s~aff assistant to the nurse in charge of an administrative unit. On ~he day shift, under ~he general supervision of senior nursing s~aff, employees function as ~he supervisor of a ward or a~ministra~ive unit ia which ~he patients do no~ require active men=. Employees are responsible for ~he' practical nursing care 'of the patients aad the creation of. a therapeutic ad. lieu. They assign duties · o subordinate nursing assistants, provide ~ha~ a daily schedule of activities is arranged for each pa=ich= and co-ordina=e activities. They meet visitors, and handle rela=ives' complaints an~ requests for imfarma~ioa. On tJxe o~/~er sh_tf~a, ~he7 ~ay be in charge of ~wo or ~ore such w~rds in an administrative uni~ under the general supervision of a Nurse. In large hospitals on any shift employees may function as staff assis~an~ to ~he nurse in charge of an a~ministra~ive uni= consis=ing o~ more ~han two wards. ~ AND KNO~LEDOE ~EQUIRED: Outstanding abili~7 as a Psyckiatric Nursing As~is~an~ workin§ ~ith the mentally ill; demonstrated ability. ~o supervise and instruct subordinate war~ $:aff; ability :o or§~ni*.e and co-ordina:e :her~peucic ~c~i¥i~ies for [ndividu~l~ and ~ups; ability to m~in~ain ~ood ~ork~n§ .-ela~ionships; thorough know'ledge of hospital rules, policies and procedures. Revised .!~nuary 2. 197"- APPENDIX CATEGORY: Sc'~encLf£c ~nd Pr~f_~s~'~n_al ~erv-~_~s" '- C=S, COD.: 500~0 KIND OF ~ORK COVEK~D: Employees &n ~sicions allocated ~ ~eSe c~sses pr~ide, or su~ise ~d a~aisCer, nursing cra ~ ~=iencs ~ ~ OnC~ Hos~i=ai, o= o~er hospi~l seCtS. ~C ~sC ~siCioas, shift =o~Cioa is necess~ a~ %~91oyees ~sC spe~ ~e major p~=, if no= ~i, of ~eir ~rk~g ~ provides personal nursi~ c~e c~ .patient. ~O$ITIONS TO BE ~CL~D~: Posiciohs of n~ses engage4 ~ n~sing e~caCion; pr~id~g consults= ~d ~spe=cional se~ices in ~e p~lic ~alCh n~s~ng field; oc ~rk~g ~ nurses ~n a cl~i= se=C~g without shi~= roCaC~n. ~t~i~n~ ~f ~loyees with n.~rsi~.q ~a!i~icacio~s~ buC who ~a!yz~ Co daCe~e w~ =he duties ~arfo~ ~r~= inclus~n ~ t~s series. 'ge=~l ~alifica=~ns alone ~ hoc a fac:or ~ alloca=ing a ~sicion Co ~3 class series M~THOD. OF PO~IT!ON EVA/.UATION: · hese class levels are esc~[ishe4 by a co~ina=io~ In.vidal posi=ians al~ =~ ~ evalua=~ ~y a :--bins:ion =~ese ~ ~c~s, ~ ensue full :onsld~a=ion ~d at.race assessmen: o~ al! ~siCion data. This is ~r=icui~[y ~aiv~du~ ~sitions may va~ ~onsid~ly ~epend~ on o~ hospitals, ~lscA~ ~ea~enc ~d ~ucation 9=o~es. and =kc d~r~ of au~ri=y and =espons~ili~y which ~el~ac~ Co the ~sicioa. 2ec ~-m. be.'' L~62 CAT~C~RY: "'entitle a~d Pro~e~onal $~rv~s CLASS CODE: 500S0 Su~T~ary Specification ~LASS ~EF~ITION: E~ployees in posit~ons ~llocated to this class provide genera/ nursing ~d person~ c~e ~der ~fession~ zupe~isio~ to patients of ~ta~o Hospices. ~eir du~ ho~s ~ usury rotated on a shift Under d~rec:ion of a supe~is~ n~se or physical, ~ese employees perfom a v~rie~ of duties su~ as ~co~& ~d out physicals' ~st~ctions on t~a~ents ~d crosiers, medic~es as authori:e~, obt~& Datie~ts' confidence ~ encour~&~& their ~te~st ~ activities, vatch~ for patients' s~pto~ or ~ac:ions personal needs ~d c~, ch~c~E pacientat c~ditions, ~d ~us~l ~cidents to superiors. -~ ~y acc~p~y patients their location, assist ~ cl~ic~ or,or surlic~ p~ce~es occupacion~ or ocher .~era~, ~ assist ~ or supe~ise.patient fee~[ ~ wa~ housekeep~g. ~loyees ~ ~is class ~r asa~ duties ~d check, the wo~ of subo~ate ~:aff on :he s~e sh~t. Depends& on factor~ such a~ the hours of du~, :he size ~d the ~o~: of active n=si~ req=red a~is:rative ~i:, chef are responsible to a supe~is=& nurse for or part of :he .~s~$ =d person~ ca~ ~ ~ a~is:rative assi~ed. The~ ~, on occa~n,,relieve supe~s=& Grade :0 education in Ontario, preferably Grade 12, or its eye'va/eno; certificate or other doc~enta~'y proof of Eraduation fro~ an accredite~ nursin& course of at least ~rwo rears' duration; &ood knowledge of ~enera/ nursing preferably as related to the duties to be performed. Preferably some nurGLng e.~perience s~nce &raduation. Ability. to work w~th mentallF ill patients; ability to m~intain goed ~orkin& relations w:th co-workers; ability to follow and to pass on verbal and written instructions on patient care; Eood judgnent; go:d ~hy$ical and mental heai~h. Dece~er. i942. ~ROUP: $~-06 Nu£sLng SER/ES: Nurse, General CLASS coo~: $0052. Specification CL%$$ DEF~'[T[ON: ~nployees Ln positions allocated to this class perfor~ a variety of profess£onal nur$i~ duties for patients Ln O~cario Hospit~l~ tn ~ft~rEes of p~v~nc~ schools ~d ~sti~ons. ~eir hours a~' usually ~tat~ be~een ~y of ~hree Under direction of a supe~is~& nurse, phyaici~ or ocher institutional officer, they ~co~ ~d ca~ out ~hrsici~s' ~sc~c- tmons on trea~ents ~d tr~sfers, a~ister m~ic~es ~d h~ode~c ~njecc:ons as author~zed,.obt~ patients' confidence ~d encourage their mtere~t tn ac:~vL:ie$, ~atch for patient~ ~p~ or reactions ~ r~e remedial action as requi~ed~ a~ist ~ or ~upe~ise patient feed~n~ ~d wa~ housekeeper, assist pat~ent~ wt:h ~eir ~er~on~ ~d care. reco~ pacients' conditions ~ repot: ~u~i ~ci4ents supertcr~ ~ey ~y acc~p~y patient~ to speci~ trea~ents or on cr~sfers as ~equired ~d p~v~de ~fo~cion ~d co, sci to patients relat~ve~ as authcri:ed. fa ad~ic~on, these employee~ ~y ~so ~e atr~emencs for preparation, stertl~:ation and ~s~ of ~gicat ~d operat~ suppl:es ensure aseptic condition of cperac~g ~o~, assisc'~ surgical procedures and provide pre or postoperative n~s~& care of [n ~ome posz~Lons. ~ere these e~ployees ~y be ce ~en~ fo~ ho~ c~l as tequzr~, pr~cip~ dutzes of ~p~oyees ~ ~s class ~y be of first'aid, cZ~c~. ~d ~ft~ ca~ ~der direction of a f~Z or parc-t~e physici~. ~playees ~ c~Ls class ~y assist ~ or su~e~ise the ~ssi~ent autzes ~ caeck :he ~o~ of subo~ace scarf on the s~e shift.. on factors such as the hours of ~u~'~ the si:e ~ ~e ~o~c ef active nurs:ns req~ m the a~iscraci~e ~ic, trier'are'responsible suge~s~ nurse for ~l or parc of the n~s:n$ ~ personal care a~niscr~czve ~zc as assi~e~ ~ey ~y. on occasion, tel:eve super- ~$~n~ nurses qL'ALrF [C%TIONS: Re~.:stration a~ a nurse in Ontario; preferabiy completion ~f ~raduate cer:~f:cate courses fr~m ~ ~iversity of rec~i:ed .%~L~cy co obtain cooperation of staff ~d patients; ability f.~iow and co p~ss ~n ver~ ~d ~icten ~sc~cti~ns on patient care; ~=od physical ~d mental hea~t~. ~" G'ROOP: F*-06 Nu~s~n~ ~ $£]~ES= L se, Gene~ ~ CLASS CODE: 50054 S~ Spec~f~c~t~o~ ~LASS DEr:NTT'ION: ~ployees tn positions a~located to this class professional supervision o£ the nursing and ~erson~l care of a group of patients tn a~ infirmary, ward or acLm~nistrative unit of an Ontario Hospita~ or other provincial L~st~tution. ~ost positions ~n this class are found on the day shift. such positions these employees schedule duties, ar~a~e the rotation of shz£ts and ¢ou~ael and disciplZne staff as required. A~though empZoyees m th~s class receive d~rection supervtsor~ nursing, medical or Znstituttonal staff~ they are required to exercise some independent judgment and · ~ar:tcu~arly ~n emergencies. They oversee treatment procedures, review charts, prepare reports, m~L~tLLn records, ~nsur~ general maintenance and cleanliness of ua~ facilities, order supplies, supe~ise the provision of focx~ set-ices co patients and assist nn staff training pro&t~ms.~ They m~y conduct ¢lLnics or provide outpatient orthopaedic or emer&encr ca.re. QCAL£!rl:cATIO~$: 1. Registration as a nurse :n 0~ta. rio; good knowledge of ptofess:ona~ theorT a~d practice'as applied to ~stitu:ional nuzsLn~; preferably c~ple:ion of a post-~ra~te certificate · . course ~ nursing a~tstrat~on. ~. ~zn~ of ~o years o~ acceptabZe &r~d~te nursing e~er~ence, pte~erab~g re~ated to the ~ut~e~ to be perfo~ed. Ab:l:~ :n super%se wa~ or ~fi~ nurse& semites; ability relatLves as required; initiative: good physical ~d mental health. APPENDIX "D"  ' PO~ITION SPECIFICATION ~END C1. AS~ ALLO(:AT1ON FORM ~o aSs/SC ia the p~ovision of personas nu~s~n~ care Co p~CienCs within the the nursing process; Co ~ssis~ ~he patient Co accept, develop, achieve and ~inCsin their op:i.~l leve~ of .~n:al and physical health. the individuel -co~lec=ing perCinent'da~a through effectiv~ observation, intervie~og patients ~nd fa~lie~ and consulaing with the mulei-di$ciplinary ~m and referral sources; -~inCaining a current knowledge of the pa~ien='s physical and psychological health ~eed$ includkmg ~hera~u=ic ~nd rehabi!iaa=Ive program; 5% -assimting in =he develop~n~ and ~dificac~o~ of the p,. .C care plan; -ob=ervin~ and recording all peg~nenC phgsazal and p$~c tic nursing da=a ~ing a proble~ solving approach, also ~ncl~de$ anticipator? physi%al ~n ~havioural reactions to ~di- cations and Creat~nC. 2. A$$ists in the glancing and imple~ntatioD cf the nursing are -providing nursing care for panic,ts in stabilized co'nd!~ions and assisting the Registered Nurse in the provision of nursing c~re for individuals whos~ conditions are f~ucCuating; -perfog~ng basic nursing ~asures ~der the supervision cf C/?~ Registered Nurse, such simple dressings or ~omprmsses; collecting speci~n$, givi~%g skin care, etc.; ad~ni$tering 35~ oral ~dica~ions a$ prescribed In wri=lng b~ a physician: -assisting in =he mrovisi~ Of a therapeutic ~l!eu,and basic counselling of patients: -providing appropriate heal=h teaching ~o the individua~ and fa~l~ in c~ra=ion with other ~ers of health -co~ica=ing ~rtlnen= !nfor~tion accurately and p~ompt~~ ~o .~ppropkia~e nursir~q team ~r$, accuratelF reporting and recording of -assisting in ~intenance of safe and sanitar~ conditions in ~he ward b~ perfor~Rg hb~ekeeping and diecar9 -se~=ing priorities based on individual needs, organizing wosk assign~n~s, adjusting his/ her schedule to cope with anticipated event.~; [COhO'd) Regis:ered as a Nursing Assistant .in On=arlo plus successful completion of the Ministry' of Heal=h PSgchia=ric Nursing gxa~naCion for Nursing Assistants. ~bili~ to understand ~nd work effe==i~ly wi~h ~he ~n:allF ill; ab~l~ty ~o obser~ and record patient behaviour and fOll~ oral and wri=ten ins=ruction. Good ~nt~l amd physical health. 51GNATUR~$ CLASS ALLQCATION ~s~chi~t~ic ,Vu;sifq ~s~istan~ 2 [ 41502 ' tC 01~ . Under general supervision, responsible for ad~nis~erin9 prescribed oral ~dica=ionS, ~ 4ssist$ in therapeutic and rehabilitation programs and assists i'n provisio~ of ' of daily l~ving. ~Responsible for ~ollecting and recordfng'~ertinent pa=ien~ infor~ion from ~servagion 4nd ingerview, c Aszu~S ~es~nsibilit~ for w4r~ or an assign,~d group.of patients as requi~ed. ........... O n-[TM ..... -assisting ih ~he develop~n~ and ~dification of ~he Patient Ca~e Plan: -contributing ~o the es~ablish~n~ of shor~ and long term goals; -identifying appropri~t~ nursing actions for ~ndividuats whose cond~lon~ are .s=abil~zed and gathering patie~ .infor~t~on utilizing aua~lable resources including individual and fa~ly ihpu~; -ensuing the "in-charge" res~nsib~lit~ for ~he ~a~d or an assigned group -teco~ding all relevan~ infor~kon in patien~'$ fil~ according ~ p~escrib~d -~ran~cribing physicia~ orders under th~ guidance o6 ~ Rogiste~ed Nurse; ~5~ reports; guidance of a Registered Nurse; 4. Perfor~ o~her rela~eW Work is perfor.,-~d under general supervision. Incumbents are responsible for working on a shift rotation a~ scheduled i~ accordance with ~r~aaizatio~al and ~ro~rem requirements, fncumb :mau be assigned to and '- required CO work in sng a~ea of the hospital. Hours of work: 40 hours De= week Schedule: 4,7 APENDIX "E" CONTEXT Primary Nursing: - Primary Nursing is a philosophy of care in an organizational design that closely approaches a model of professional practice. As a philosophy of care it requires a patient and family centered focus, not merely with empty words and cliches but with individual responsibility and account- abilitiy for each nut.se. As an organizational design it reguires:- a] allocation and acce:~.tance of individual responsibility for decision making to one individual b) casa method of assi!]nment ¢) direct channels of communication d) change in the role of the head nurse. Primary Nurse: - The primary nurse is responsible and account- able for %h~ planning and coordinating of nursing care for his primary patients, 24 hours per day, from their admission .. through to discharge/transfer. When on duty, the primary nurse gives total care to his primary/associate/assigned patients, The primary nurse provides care giver :o care giver communication and coordinates nursing care through the nursing care plan. Associate~Nurse: - The associate nurse assumes shift responsibility and accountaDi~ity for nurning care when ~he primary nurse is not on duty. He follows the plan of care devised by the primary nurse unless ~here is a drastic change in the patient's condition. The associate nurse is a colleague who must always use his own professional judgement. He communicates directly with other care givers. In the Case of extended absence of the.primary .nurse, the ass¢ciate nurse fulfills all of the responsibilities of the primary nurse. Assigned Nurse: - The assigned nurse provides tot&% care t0 the patient in the absence of both the'primary an4 associate nurses. He assumes shift responsibility and accountability for nursing care and ~rovides care giver to care giver communication.' The assigned nurse follows the plan of care outlined in the nursing care plan unless there is a drastic chasge in the patient's condition. Qualifications: 1. Pr/mary Nurse: - Regis:sred nurses - psychiatric nursing assistants may fulfill the role of primary nurse under ~:he direction of the registered nurse. The primary patient's condition should be stabilized.* The degree of direction by the registered nurse will be dependent on the condition of the patient. A primary patient ma}' be reassigned if his condition becomes extremely un~table for an extended period of time. 2. Assocfa=e Nurse: - P.N.A. -' - When the primary-nurs~ is a PNA the associate nurse must be a registered nurse. 3. Assigned Nurse: -P.N.A. ~ - Nursing students - New~y hired nurses following hospital and ward orientation. "Stabilized describes the state of. an individual in which there- are no anticipated variations on a day to day basis and he is managed by treatment which has predic%ab~e outcomes. RESPONSIBILITIES OF THE PRIMARY NURSE: In addition to carrying out the duties as outlined in the position description, the primary nurse will carry out the following responsibilities'. The pr/mary nurse: - '- Adheres to and supports the philosophy of Primary Nursing. - Es responsible and accountable for the nursing care of his primary patients 24 hours a day from admission through to discharge/transfer. - Identifies the role of the primary, associate and assigned nurse to patients, family and the multidisciplinary team. - Is responsible for the initial .completion and biannual update of the nursing history. - Involves the patient and his family, or significant others, in the plan of care.. - Assesses, plans and evaluates nursing care with his nur~in~ colleagues. T £nsures adherence ~c his plan of care. - Provides total patient care when on duty acco~idinq to the ward standards. - Develops and maintains a therapeutic relationship with his primarypatients by providing regular contracted counselling.sessions. - Is responsible for all documentation on his primary/ associate/assigned patients when on duty. - Provides care giver to care giver communication. - Reviews the Care Plan/~ardex of his patient assignment prior to his shift to ensure continuity of care. · - Plans, reviews and revises the nursing care. plan with his .nursing colleagues. - Initiates contact with nurming colleagues and members of the multidisciplinary team to exchange information regarding his patients. - Presents and participates in multidiscipIin&'ry and nursing conferences. - Implements nursing orders. - Obtains and 9~ocessem physician'~ orders for his primary/ associate/assigned patients according to S.T.P.M. policy and procedure. - i~ responsible for functional tasks as well as ward programs. - I~itiates contact with. his patient's family, or significant others. .Supports, educates and communicates with the Zamily, whenever possible, throughout hospitalization. - Evaluates the need'for out of hospital visits. - P~ns for his.patient's transfer/discharge throughout hospitalization. Et is recognized that discharge may not be an appropriate goal for all patients. - I~ aware of community agencies and resources to aid the multidisciplinary team in planning for discharge'. - Assists in the orientation of staff to the role of pti,mary and associate nurse. - Is receptive to feedback from.colleagues and other health professionals. - Assumes any additional responsibility outlined in the ward standards. R£SPONSZBILZ?!£$ O? THE WARD SLPERVZSCR ~n add£tion to carryimg out ~he duties as outtzned in the position description, the ward supervisor will carry out the following responsibilities.- A. Quality of patient care_.24 hours per day. The ward supervisor: - - U~ho!ds the phllosoph? of primary nursing. - Establishes an atmosphere where patient care is focus. -Orqanizes alt shifts ~o ~ha~ ga~ient care objectives are met. - Kno~s and ~eve!ops staff capabilities and determines ~hen nursing s:aff are able to function as primary/a~sociate nurses.- - Assigns p~imary nurse and associate nurses ~o newly admitted/transferred patients by :he end of tke! ne:<~ working day. When assigning, ma:ches the needs of patient wi:h the ski'lla of the nurse. - Reviews and revises da(1F patient assignments. - Monitors the assessmem- and care plan of each pa~ien~ - Interprets patient's c.]:e plan wi~h associate/assigned nurse to ensure adherence to same. - Evaluates every patient's care and in.:ervenes as necessary. - Facilitates communication bet%~een ~rimary/associa:e/assi~ned nurses and the multidisciplinary - Provides ongoing direction to facilitate high quality care. B. Staff Development. The ward supervisor: - - ~erves as a role model in all aspects of nursing and patient care. Demonstrated committmen: ~o common nursing goals. - Assists staff in decision making utilizing the problem solving process. - [s rece'ptive to new approaches'to patient care. - Acts as clinica! resource person and teacher. - Is aware of resources-and directs staff to them. - Assists staff in identifying learning goals and provides learning experiences. - Counsels staff with problems related to patient care. - Cond'ucts weekly educa:lcma~ meetings and bi-weekly nursing conferences. c. Administration of Unit. - Continually support~ nursing staff to enable them to feel their personal worth and acceptance. - fncreases interaction and mutual respect among nursing staff, thereby bringing them closer together. - Sets challenging goals and encourages high performance. - Assists nurszng staff in reaching :heir goals through effective' scheduling, coordinating, planning and resource gathfring. C.' Administration of Unit c.~nt'd) - Provides cngoing feedback to staff re their performance. -' Completes written performance appraisals of staff as per policy and discusses their f~Jture develoF.ment t¢ith them. - Delegates administraC:.ve duties to a registered norse coordinator in case of ';aca~ion or extended absences.