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INSTITUTIONAL NURSING Nursing in hospitals and related health facilities such as extended care facilities, nursing homes, and neighbourhood clinics, comprises all of the basic components of comprehensive patient care and family health. The educational qualification for beginning practitioners is a Bachelor of Science in Nursing degree .The nurse, as a member of the health care team, participates in all phases of patient care of the acutely ill, the convalescing and the ambulatory patient. The nurse cares for the patient in the hospital or in the out patient department and plans for the nursing care needs of the patient about to be discharge. The nurse performs nursing measures that will meet the patients physical, emotional, social and spiritual health needs while in the institution and helps him and his family plan for his further health care needs when he returns home. The nurses functions involve assessment of the patients needs nursing and planning for giving or providing the care indicated whether this be personal care, rehabilitation measures or health instructions. These functions include participation in the research and training carried on in the hospital, teaching auxiliary personnel and assisting in teaching and supervision of nursing and/or midwifery students, if there are affiliates in the said institution.

ADVANTAGES OF STAFF NURSING IN HOSPITALS 1. There is always a supervisor whom one can consult if problems exist. 2. Nurses are updated with new trends in medicine and in the nursing care of patients. 3. They undergo rotation to different units and have a chance to determine their special area of choice before they are assigned permanently in one area such as Medicine, Pediatrics, Surgery, ICU-CCU, Obstetrics, Operating room, Delivery room, etc. 4. They have an eight-hour day and a forty-hour week duty which provide for two days of rest away from duty. They have provisions for sick leaves, holidays, and vacations with pay according to personnel policies of the institution. 5. They have the chance to get promoted to higher positions if they are qualified. 6. Salary increases are given periodically according to merit system thereby increasing their initiative and best efforts. 7. They are considered an important member of the health team in providing care to the patients. 8. More staff development programs are available in hospitals.

DISADVANTAGES OF STAFF NURSING IN HOSPITALS The disadvantages usually do not outweigh the advantages. 1. There is a great possibility of understaffing which may require nurses to put in overtime work and sacrifice some of their plans. This is especially true in hospitals where budget for personnel is limited. 2. Because of the bulk of work, some staff nurses do not find time to improve their skills through continuing education programs. Or, if the hospitals are far-flung, no continuing education programs are provided. 3. Administrative problems and over work may tend to dissatisfy the staff nurse. QUALIFICATIONS OF NURSING SERVICE ADMINISTRATORS Section 29 of RA 9173 specifies that a person occupying supervisory or managerial positions requiring knowledge of nursing must: a) Be a registered nurse in the Philippines; b) Have at least two (2) years of experience in general nursing service administration; c) Posses a degree of Bachelor of Science in Nursing, with at least nine (9) units in management and administration courses at the graduate level; and d) Be a member of good standing of the accredited professional organization of nurses. It is provided, however, that a person occupying the position of chief nurse or director of nursing service shall, in addition to the foregoing qualifications, posses; a) At least five (5) years of experience in supervisory or managerial position in nursing; and b) A masters degree major in Nursing. A new trend in hospital nursing is clinical specialization. Nurses train in a special field of nursing of their choice. Courses to prepare nurses desiring to perfect their clinical opportunities are offered in universities, usually at the masters level. The nurse must have the experience required before applying for a position as an expert practitioner.

NURSING SPECIALTY CERTIFICATIONS In this country, a Nursing Specialty Certification Program has been adopted by the Board of Nursing through Resolution No. 14 series of 1999, and created a Nursing Certification Council under to over see the administration of new programs by the Specialty Certification Boards (refer to Appendices L and M). SEC. 29. Comprehensive Nursing Specialty Program. within ninety (90) days from the effectivity of this Act, the Board coordination with the accredited professional organization, recognized specialty organizations and the Department of Health is hereby mandated to formulate and develop a

comprehensive nursing specialty program that would upgrade the level of skill competence of specialty nurse clinicians in the country, such as but not limited to the areas of critical care, oncology, renal and such other areas as may be determined by the Board. The beneficiaries of this program are obliged to serve in any Philippine hospital for a period of at least two (2) years of continuous service. SEC. 33. Funding for the Comprehensive Nursing Specialty Program.-the annual financial requirement needed to train at least ten percent (10%) of the nursing staff of the participating government hospital shall be chargeable against the income of the Philippine Charity Sweepstakes Office and the Philippine Amusement and Gaming Corporation, which shall equally share in the costs and shall be released to the Department of Health subject to accounting and auditing procedures: Provided, That the Department of Health shall set the criteria for the availment of this program.

BENEFITS OF CERTIFICATION Certification offers advantage to the individual nurse, the nursing profession, and the health care delivery system. 1. 2. 3. 4. 5. Nurses certified above minimum standards improve the quality of patient care. Certification measures expertise beyond that which is measured in basic licensure. Certification ensures continued competence in the changing world of health care. Certification is a means of confronting the demands of health care. It is a lifelong learning that advances nursing skill and knowledge to move the profession forward. 6. It enhances the nurses self image and the publics view of the profession.

PUBLIC HEALTH NURSING OR COMMUNITY HEALTH NURSING Public health nursing is also called community health nursing. The National Health Program of the Philippines gives as much emphasis on the promotion of the health prevention of diseases rather than care of the sick. It needs a deeper involvement and close cooperation with all members of the health team such as physicians, nurses, epidemiologist, dentist, sanitary inspectors, sanitary engineers, nutritionists, health educators, social workers, the community, and the barangay leaders.

ADVANTAGES OF PUBLIC HEALTH NURSING 1. The focus of nursing care is only on family and community health rather than on an individual basis. Here, the nurse will be able to see the total picture of family and community health.

2. It gives the nurse a better perspective of the health conditions of the community and the health programs conceived and implemented by the government, and to appreciate the nurses role in nation building. 3. It maximizes efforts to improvise where there are no sufficient facilities, supplies, and equipment. 4. It enables the nurse to utilize various community resources and maximized coordination with other members of the health team. 5. Focus of care is more on educational and preventive aspects. Thus, nurses have privilege of contributing to the program fro healthy citizenry especially among the rural poor. 6. Individuals, families and communities are motivated to assume responsibility for their own health care.

DISADVANTAGES OF PUBLIC HEALTH NURSING 1. Cases found in public health nursing are limited mostly to chronic and/or communicable diseases. 2. There are more hazards in public health than in hospital nursing, such as exposure to elements (inclement weather, heat of sun, rain), dog or snake bites, accidents, etc. 3. There are no fixed hours of work. The nurse may be called upon any time of the day or night. 4. Some claim that public health nursing is not as exciting nor as glamorous as hospital work. 5. Facilities for care of the sick are limited so that practice or skills may also be limited. 6. The public health nurse may not be immediately aware of changes or trends in the fields of medicine or nursing. 7. Public health nursing is not a place for introverts. A nurse has to be outgoing to meet people. 8. There is no immediate supervisor to consult in case of emergency. The entry salary of a community health nurse is the same as that of a Senior or Head Nurse in government hospitals.

NURSES IN IN-SERVICE EDUCATION PROGRAMS In-service education programs have been in existence for many years both in hospitals and public health agencies. This is one way of improving service in these agencies. Many tertiary hospitals and public health agencies have nursing staff in charge of staff development training and research. Nurses in this field need: 1. Skills in nursing practice, therefore they must have experience of at least two years in basic nursing practice; 2. Understanding of skills in teaching, supervision, an consultation;

3. Understanding of the relationship of these persons to the process of administration and research; 4. Understanding of the broad problems and desirable practices in patient-care planning; 5. Understanding of and skill in the use of problem-solving approach to resolve everyday problems in the practice of nursing and in-service education in the areas of concern; 6. Understanding of the role and functions of the revising personnel in this area of inservice education; 7. Understanding of self and others involved in-service education within the various agencies in nursing; and 8. Ability to plan and implement programs for different kinds of nursing personnel. Nursing Coordinators for Staff Development need to have at least four years of clinical practice and research and a Masters Degree in Nursing. Nurse Instructors for in-service training programs need at least two years of experience in clinical practice and research and a Masters Degree in Nursing preferably with a clinical specialization. With the advent of Quality Assurance Programs in health services, nurses may also be employed as Quality Assurance Coordinators in agencies where these programs are required. Nurses in this field need experience in clinical nursing and research too.

PRIVATE DUTY NURSING Nurses in private practice are expected to be the expert clinicians as well as expert generalist in nursing. They use the title Private Duty Nurse, Private Nurse Practitioner, Special Duty Nurse or Private Duty Nurse Specialist.

DEFENITION OF PRIVATE DUTY PRACTITIONER A private duty nurse is a registered nurse who undertakes to give comprehensive nursing care to a client on a one-to-one ratio. She/he is an independent in the hospital or in the home. Private duty nurse practitioners are grouped in to two categories. 1. General Private Duty Nurse. The general private duty nurse has the capabilities for providing basic nursing care to any type of patient, among which are: a. Assessment of the physical conditions and interpretation of the significance of is/her findings as basis for planning the nursing care; b. Identification of emotional and social factors and relating these to signs and symptoms observed; c. Application of scientific principles in the performance of nursing techniques;

d. Working with the patients family so that they gain understanding of his/her illness and cooperate towards promoting early recovery of the patient; e. Utilization of laboratory and diagnostic test in promoting progress of care and enhancing his/her own usefulness as a health teacher and counsellor; f. Knowledge and recognition of pharmacological effects of drugs and medications, their implications for nursing actions as needed; and g. Interpretation of doctors orders concerning medicines and treatments and communicating the same effectively to the patient and carrying them out promptly and accurately with understanding of cause and effects. 2. Private Duty Nurse Specialist. In addition to the foregoing abilities of the general nurse practitioner and as a result of his/her specialized preparation, a private duty nurse specialist also demonstrate the following competencies: a. Skill in handling, operating, and monitoring other complicated devices; b. Skill in interpreting data gathered from ECG, EEG, laboratory diagnostic results and vital signs; c. Skill in observing sign and symptoms and their favourable or untoward significance in the progress of patient care; and d. Promptness and adeptness in instituting appropriate nursing measures.

QUALIFICATIONS OF A PRIVATE NURSE PRACTITIONER A private nurse practitioner must: 1. Be a registered nurse in the Philippines; 2. Have the following documents for the current year: a. Professional Tax Receipt (PTR) b. Professional Regulation Commission Card (PRC), and c. Residence Certificate 3. Have at least two (2) years of beside nursing experience as a professional nurse in a general hospital immediately prior to application. 4. Be acceptable to the Director of Nursing Service as suitable for orientation to do private duty nursing; 5. Be a full time private duty nurse; 6. Preferably have undergone a Critical Care Nursing Course; and 7. Be a certified I. V. Nurse therapist by the ANSAP (Association of Nursing Science Administrators of the Philippines).

REQUIREMENTS A private nurse practitioner is required 1. To undergo orientation in the hospital as conducted by the Nursing Service Office; 2. To have the complete paraphernalia, e. g., blood pressure apparatus, pen light, bandage scissors, red and blue or black pens, and clip board; 3. To wear full white nurses uniform (cap, stockings, closed white shoes, I. D. Pin). Uniform blazers may be used if required by the hospital; 4. To have medical certificate from a certified medical center or laboratory with chest-x-ray result, complete blood count, urine and stool examination; 5. To give two (2) character references; 6. To acquire, for succeeding years, certificate of three (3) seminars or continuing programs attended; and 7. To show certification as an I. V. Therapist by the ANSAP.

GENERAL GUIDELINES 1. Although a private duty nurse is considered an independent contractor, he/she is directly under the supervision of the nursing service in the hospital, or of the Head Nurse in the unit. She/he is expected to make a comprehensive verbal report to the Chief Nurse or Supervisor when they visit the patient and submit a written report to the Head Nurse at the close of the shift. If relief is needed during meals or in time of other necessities, the Head Nurse should be notified so that a reliever can be provided. 2. The private duty nurse is responsible for the nursing care of the patient. Nursing care encompasses the patients welfare physically, mentally and spiritually. The nurse is equally responsible for maintaining a safe, sanitary, and healthful environment for the patient, and for the care of equipment used and other facilities provided in the room. 3. The private duty nurse shall endeavour to give complete nursing care before going off-duty. 4. While the private duty nurse on the house case is directly responsible to the attending physician of the patient, regular monthly service audit shall be given to the Director of Nursing a Service who referred her/him for employment.

POLICIES AND GUIDELINES FOR NURSES ACCOMPANYING PATIENTS OUT OF THE COUNTRY 1. Passport and other travel papers. All expenses for fees and processing of visa and travel papers are paid for by the patient ar his/her representative. a. Passport, paid round trip ticket, and other papers should be in the possession of the private duty nurse at all times.

b. A travel and accidental insurance in the amount of P50, 000.00 shall be provided for the private duty nurse and paid for by the patient or his representative effective 72 hours before departure and throughout the period to stay abroad while the employment of the patient. c. The corresponding amount of salary computed at eight (8) hours multiplied by two (2) shifts and the number of days the patient plans to be out of the country shall be left in the Philippines for ready withdrawal by the private duty nurses authorized representative on designated dates per agreement of parties concerned. d. A daily travel allowance in addition to the Private Duty Nurses regular salary while out of the country is negotiable with the employer. e. The female private duty nurse who caring for a male patient must be provided a separate room for rest periods. f. All hotel, lodging and food expenses while out of town or out of the country shall be paid by the employer. 2. The private duty nurse is required to: a. Leave with the Private Duty Nurses Association in the Philippines her/his possible address of destination and tentative duration of duty; b. Report presence to the nearest nursing organization in the area; and c. Report to the PNA his/her arrival in the country.

ADVANTAGES OF PRIVATE DUTY PRACTICE 1. The chance to see life as it really is, to study human nature and to know at close range interesting people of different nationalities, cultures, religions, and status; 2. The opportunity to make real friends through close association with the patient and his family; 3. The chance to travel and see the world; 4. The ability to own time, adjust work and private life satisfactorily, and direct off-duty time in to enjoyable leisure; 5. The chance to keep abreast with new knowledge and procedures which provide an exciting, stimulating experience, with infinite variety of problems to solve and personal satisfaction to be gleaned; and 6. The challenge of giving of his/her best in providing care and having the satisfaction of seeing its result.

DIS ADVANTAGES OF PRIVATE DUTY PRACTICE 1. Some private duty nurses create situation in which the patient become totally dependent on them. 2. Many private nurses graduated so long ago and have not upgraded their knowledge and skills.

3. There are not enough nurses for evening and night shifts, for holiday, week-ends, and vacation periods. 4. Being a lone practitioner minimizes opportunity for developing good relationship with other hospital personnel. 5. Some private duty nurses resent supervision by hospital staff. 6. Little assistance is given by the Head Nurse when the patient is critically ill and the private duty nurse needs help in giving treatment or in changing of the patient. The private duty nurse sometimes goes with meals because the Head Nurse does not arrange for relief when the patient cannot be left alone. 7. Private duty nurses have very little or no participation in professional activities. If they ever do, they do so on their own time and expense. 8. Nurses who are experienced and well qualified receive the same fees as the new graduates. 9. Private duty nurses face problems in private practice being independent contractors and there is greater need for liability insurance. 10. There no retirement, insurance, and Medicare benefits unless the private duty nurses provide this for themselves.

OCCUPATIONAL HEALTH NURSING OR INDUSTRIAL NURSING Occupational health nursing was once called Industrial nursing. In 1958, industrial nurses in the U. S . Elected to call themselves occupational health nurses to reflect the broader and changing scope of practice within the specialty. Few nurses go into occupational health nursing. This is because occupational health nurses often work alone, and must therefore posses maturity, experience, wise judgement. Occupational health nursing is the specialty practice that provides and delivers health care services to workers. The practice focuses on promotion; protection, and supervision of workers health within the context of a safe and healthy work environment. Occupational health nursing is autonomous and occupational health nurses make independent nursing judgements in providing health services. Since occupational health nurses work alone in situation where they may have to give immediate care to patients with serious injuries, they need to be fully informed about their legal responsibilities. The first consideration in the patients welfare. They must make sure use of whatever first aid and nursing measures they judge necessary, bearing in mind their professional limitations. Emergency or more extreme measures may be used during life-and-death situation. Their actions will be judged against yardstick of reasonable, prudent nursing practice. As in other fields of nursing, a Bachelors degree in Nursing is required of occupational health nurses. This field of nursing requires special skills. A good preparation is a year or more in emergency nursing, such as actual nursing experienced under the direction of a skilful nurse in this field. Helpful

skills include ability to take and read ECGs, eye screening, audiometer testing, laboratory test, and x ray. Fortunately beginners in this field have a wide variety of help available. Valuable literature may be obtained from many resources. They may also seek support from fellow practitioners through the Occupational Health Nurses Association of the Philippines.