ST. ANNE COLLEGE LUCENA, INC.

Diversion Road, Brgy. Gulang-Gulang, Lucena City

Tel. No.710-5624

SCHOOL OF ALLIED HEALTH SCIENCES

In Partial Fulfillment of the Requirements in RLE,

COMPILATION OF FILES

Submitted by:
JESSA Z. MURCIA
BSN-IV

Submitted to:
PROF.LUZVIMINDAP.PORTE
Clinical Instructor

June 13, 2022

 ST. ANNE COLLEGE LUCENA, INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena City
Tel. No.710-5624

SCHOOL OF ALLIED HEALTH SCIENCES

College of Nursing

LEADERSHIP and MANAGEMENT

RELATED LEARNING EXPERIENCE

 ST. ANNE COLLEGE LUCENA, INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena City
Tel. No.710-5624

SCHOOL OF ALLIED HEALTHS CIENCES

CONTENTS
 SACLI
o VISION
o MISSION
o CORE VALUES

 COLLEGE OF NURSING AND MIDWIFERY

o VISION
o MISSION
o CORE VALUES

 CLINICAL FOCUS HEAD NURSING

 CLINICAL INSTRUCTOR’S EVALUATION GUIDE
 CLINICALPERFORMANCEEVALUATIONTOOLS
 TABLE OF CONTENTS FOR STUDENTH EAD NURSE’S COMPILATION
 SCHEDULE OF ACTIVITIES (DAILY)
 DAILY PATIENT ASSIGNMENT SHEET
 VITAL SIGNS SHEET
 I&O SHEET
 IV MONITORING SHEET
 FORMS AND SAMPLE
 OTHERS
 SACLI
VISION To become the seat of academic excellence and aesthetic transformation through university hood.

MISSION SACLI shall strive to be at the forefront of transformative education with accredited programs and diversified linkages to transcend lifelong
learning through instruction, research and community involvement.

COREVALUES Culture of Excellence Integrated pattern of valuable, qualities and distinction

Competence Citizenship Sufficiency of knowledge, skills and attitude for the necessities and convenience of life

Empathy to people or maka-tao;

Nationalistic fervor or maka-bayan;
Environment friendly or maka-kalikasan; and
God-fearing or maka-Diyos.
Creativity Ingenuity and innovative

COLLEGEOFNURSINGANDMIDWIFERY

VISION To become a passionately engaged community of highly qualified students, educators and scholars who:
 Prepares professional nurses that personify a culture of care
 Creates a learning environment where knowledge is created and shared
 Serves the rapidly-changing health care needs of individuals, families, communities and society at larger
 Provides leadership in the advancement of profession

MISSION To cultivate a learning environment that develops a set of critical thinking which will educate students in the development of Knowledge,
Attitude, Values and Skills (KAVS) and to provide competent good leaders in the future

COREVALUES SACLIANCARES: The landscape of learning is built on its commitment to demonstrate

Scholarship
Advocacy
Citizenship
Leadership
Involvement in Ecology Movement

Compassion for life

Assertive nursing care
Respect for human dignity
Excellence
Service oriented

GENERALOBJECTIVES:
At the end of_96_hour/s of clinical exposure, the students will have enhanced knowledge and skills on the planning, staffing, organizing, directing and controlling functions of
the nurse manager as well as on the performance of direct,indirect and health teaching activities of the staff nurses.
SPECIFICOBJECTIVE
State the objective of the
experience, schedule of
activities and requirements
State mission, vision, history,
capabilities/services offered,
organizational structure,
Standard Operating Procedures
for students and clinical
instructors
State the names of the staff, be
familiar with physical set –up
of the ward, state the Ward
SOP and policies, chart
arrangement
Identify the Head nurse and be 
familiar with her/his duties and 
responsibilities
CLINICAL FOCUS
LEADERSHIP&MANAGEMENT(Head Nursing)
CONTENT ACTIVITIES EVALUATION
DISCUSS:
 Objective of the experience  Attend Pre-exposure briefing  Paper and pencil test
 Schedule of Activities
 Requirements
ORIENTATIONON:
 Mission,vision
 History
 Orientation  Quiz
 Capabilities/Services Offered
 Organizational Structure
 Standard Operating Procedures of for students and
Clinical Instructors
WARDORIENTATION:
 Introduction toWard Staff
 Ward Staff  Random question and answer
 Read Ward Manual
 Physical set up sessions
 Browse Chart
 Ward SOP’ sand policies
 Chart arrangement
 Alternately assign students to
function as head nurse
Introduction to the Head nurse  Observe the Head nurse in the
 Let the student duplicate the
Orientation on the Duties and Responsibilities of the performance of her duties and
duties and responsibilities of a
Headnurse responsibilities
head nurse with her fellow
Students as her staff

Be familiar with the
endorsement procedure
Supervise Student Staff Nurse
Perform accurate nursing
assessment using the following
techniques:
Interview
Observation
Physical Assessment
Review of records
Require student staff nurse to
formulate a Nursing Care Plan
using standard format
Require student staff nurse to
accomplish Medication Sheet
Of their sample chart
Facilitate nurse-patient
interaction between student-
staff nurse and patient
 Attend and observe  Properly receive patients and
 Proper procedure of turning over the patient to the endorsement ,Student Head nurse endorse patients, graded, guided
in coming shift so as to maintain continuity of will endorse to incoming shift (if by CI
care permitted)
 Allow Head nurses to
assign individual patient
Assess patients through:
 Require student staff nurses to
make a baby chart and
 Interview  Performance Evaluation Tool,
accomplish the following (student
 Observation Baby Chart,guided by CI
copy only-students not allowed to
 Physical Assessment write anything on patients chart)
 Review of Records  Focused history taking
 Nursing system review chart
 NCP
 Kardex
NCP using the following format:
 Identify and prioritize nursing
 Assessment(Subjective/objective)  Graded discussion on NCP
problems
 Nursing Diagnosis details between student head
 Make sample charting nurse and student staff
 Background Knowledge  Develop individualized NCP
nurse(supervised by clinical
 Nursing Objectives
instructor)
 Nursing Intervention
 Rationale
 Evaluation
 Reflect the time of drug administration and sign the
 Sign the medication sheet with the  Check accomplished form
medication sheet accordingly time of administration accurately (supervised by Clinical
reflected Instructor)
 Communication skills and techniques in dealing with  Interact with the patient, discuss
 Observe and guide students
critically ill patients discharge plan with the patient
during interaction (supervised by
Clinical instructor)
Supervise student staff nurse in
preparing and administering
oral, intramuscular,
subcutaneous, intradermal
medications accurately
Supervise student staff nurse in
preparing and administering
parenteral medicines
Supervise Student staff nurse
 IV Fluids administration and Blood Transfusion
administer, check and regulate
IV fluids and blood transfusion
rate/flow
Basic Nursing Procedures:
Supervise student staff nurse in
performing basic nursing
procedures accurately and
efficiently
 Color coding of Medication cards  Observe aseptic techniques in
 Asepsis in preparation of medicines drug preparation
 Observanceofthe10R’singivingmedications  Drug study
 Proper identification and making of medication cards  Observe10R’singivingm
according to agency policy on color codes edications
 Closely supervise students in drug
administration
 Asepsis in preparation of medicines
 Asepsis in the preparation of
 Drug study medicines
 Computation  Drug Study
 Observanceofthe10R’singivingIVmedications  Observance of the 10 R’s in
giving IV medications
 Compute dosage
 Observe perform and assist in the
administration of IV Fluids and
Blood Transfusions
Observe, perform and assist in the
following basic nursing procedures:
 Vital sign staking and recording
 Hygienic care– oral, skin, perineal  Vital signs taking and recording
 Bed bath  Hygienic care – oral, skin,
 Bed making perineal
 Tepid Sponge Bath  Bed bath
 Suctioning  Bed making
 NGT insertion,removal&feeding  Tepid Sponge Bath
 Positioning  Suctioning
 Assisting patients in his daily needs  NGT insertion,
 Do back rub removal&feeding
 I &O Monitoring  Positioning
 Graded drug study prior to
administration (supervised by
clinical instructor)
 Discussion, question and answer
sessions, compute dosage
 Review on dosage and
solutions,graded drug study
prior to supervised
administration (supervised by
clinical
instructor)
 Observe and supervise students
in IV Fluids administration and
blood Transfusion(supervised
By the clinical instructor)
 Observe, supervise and evaluate
students in the performance of
the basic nursing procedures –
graded
 Debriefing and sharing of
experiences during post
conference (supervised by
clinical instructor)

Evaluate student staff nurse
during comprehensive case
study/presentation before the
end of the rotation
 Indwelling Foley Catheter insertion and removal  Assisting patients in his daily
 O2administration needs
 Nebulization  Do back rub
 IV insertion  I &O Monitoring
 Collection of specimen  Indwelling Foley Catheter
 Hot and cold compress application insertion and removal
 Wound dressing  O2administration
 Post mortem care  Nebulization
 Carry out doctor’s order(with supervision)  IV insertion
 Make Lab request  Collection of specimen
 Hot and cold compress
application
 Wound dressing
 Post mortem care
 Carry out doctor’s order (with
supervision)
 Make Lab request
Formulate and develop a comprehensive case study using the
following format:
TITLEPAGE
TABLE OF CONTENT
SINTRODUCTION
 Background of the Study
 Rationale for choosing the case
 Significance of the study
CLINICAL SUMMARY
 General data
 Chief complaint
 History of Present Illness
 Past Medical History
 Familial History
 Physical Assessment
  Patterns of Functioning
 Laboratory and Diagnostic Examination
a. Sateordered
b. Examination ordered
c. Normal value
d. Actual value/result
e. Interpretation
f. Analysis
 Impression/Diagnosis
 Course in the Ward (day to day patient progress report)
a. Assessment
b. Nursing interventions
c. Medical and surgicalinterventions
d. Client’s response

CLINICALDISCUSSIONOFTHEDISEASE
 Anatomy and Physiology
 Schematic Diagram of the Disease
 Drug Study
a. Date ordered
b. Generic name
c. Brand name
d. Dosage, frequency and route
e. Classification
f. Specific indication
g. Action
h. Side effects
i. Adverse reactions
j. Nursing considerations

NURSINGCAREPLAN
 Problem list
a. Date identified
b. Nursing diagnosis (PES format)
c. Degree of priority
 Nursing Care Plan
a. Cues(Subjective/Objective)
b. Nursing Diagnosis
c. Background Knowledge (with reference)
d. Nursing goals and objectives
e. Nursing interventions (independent,
dependent,collaborative or developmental,
supplemental Facilitative)
f. Rationale (with reference)
g. Evaluation

 Discharge Planning
a. Medicines
b. Exercise/economic consideration
c. Treatment
d. Health teachings
e. Out patient follow up diet
f. Diet spiritual advise
 ST.ANNECOLLEGELUCENA,INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena City
Tel. No.710-5624

SCHOOL OF ALLIED HEALTH SCIENCES

LEADERSHIP AND MANAGEMENT (HEADNURSING)

RELATED LEARNING EXPERIENCE

Clinical Instructor’s Evaluation Guide

I. CLINICALPERFORMANCEEVALUATIONTOOL
a. ClinicalInstructortoStudentHeadNurse –30% 60%
b. ClinicalInstructortoStudent StaffNurse– 20%
c. StudentHeadNurse toStudentStaffNurse–5%
d. StudentStaffNurse toStudentHead Nurse –5%
II. PROBLEMSOLVINGPROCESS
Parameters:
a. WrittenPSPincludinglistofproblemsandalternateplans
10%
b. Budget Proposal
c. Implementation
d. Evaluation
III.EVALUATIONEXAM/QUIZZES 10%
IV.DOCUMENTATION/COMPILATION(PerSHN) 10%
V. CASE PRESENTATION(Per Group) 10%

Related Learning Experience Grade in Head Nursing = 100%

 ST. ANNE COLLEGE LUCENA, INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena City
Tel. No.710-5624

SCHOOL OF ALLIED HEALTH SCIENCES

RLE ON LEADERSHIP AND

MANAGEMENT (HEAD NURSING)

TABLE OF CONTENTS

I. SCHEDULE OF ACTIVITIES……………………………………………………………………………………………………………..... 1
II. PATIENT ASSIGNMENT SHEET………………………………………………………………………………………………………….. 2
III. PARAPHERNALIA CHECK LIST…………………………………………………………………………………………………………... 3
IV. VITAL SIGNS SHEET……………………………………………………………………………………………………………………… 4
V. I&O………………………………………………………………………………………………………………………………………….. 5
VI. IV MONITORING SHEET………………………………………………………………………………………………………………….. 6
VII. DOCUMENTATION/PICTURES…………………………………………………………………………………………………………... 7
 RLE ON LEADERSHIP AND MANAGEMENT
(Head nursing)
SCHEDULE OF ACTIVITIES

Date: May 4, 2022 Clinical Area_____________________________

Time Activities
6:45 - 7:00 AM Pre-conference (Prayer and Briefings)
7:00 - 7:30 AM Patient Assignment
7:30 - 8:00 AM Checking of Paraphernalia
8:00 - 8:30 AM Initial Browsing of the Chart (Pt. Chart assigned)
8:30 - 9:30 AM Group rounds (NPI)
 Routine vital signs taking and History taking
 Physical Examination
 Preparation of 8:00 am medication and Treatment, Recording
9:30 - 10:00 AM Documentation of the Assessment
10:00 - 10:30 AM Break Time (15mins for every 5 students)
10:30 - 11:00 AM Nurse Patient Interaction
 IV Regulation
 Skills to be Performed
11:00 - 11:30 AM Browsing of the Patient Chart
 Laboratory Results
 Upcoming Procedure
 Special Consideration
11:00 - 12:00 PM Vital Sign Taking and Preparation of Medication for 1pm (if the doctor has ordered)
12:00 - 1:00 PM Lunch Break ( 30mins for every 5 students)
1:00 - 1:30 PM Group Rounds (NPI)
 Routine vital sign taking (if the patient need monitor)
 Giving Medication (if the doctor has ordered)
1:30 - 2:00 PM Documentation of Assessment
2:00 - 2:30 PM Group discussion; Patient Chart and FDAR Charting
2:30 - 2:50 PM Checking of the Charting
2:50 - 3:00 PM Endorsement
3:00 PM on Ward Post-conference

Prepared by: Jessa Z. Murcia Noted by: Prof. Luzviminda P. Porte

Student Headnurse Clinical Instructor 1
 ST. ANNE COLLEGE LUCENA,INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena City
Tel. No.710-5624

SCHOOL OF ALLIED HEALTHS CIENCES

RLE ON LEADERSHIP AND MANAGEMENT

(HEAD NURSING)

PATIENTASSIGNMENT SHEET

Date: May 4, 2022 Clinical Area: ER,OR,ICU, DR,NICU,WARD Shift:7:00a.m to 3:00 p.m

Name of Student Room/Bed Name of Patient Case Age Diagnosis Remarks

Number No.

Aguila, Camille Zara OR Larino, Obciana 514350 57

Arroyo, Alexa Lorraine
Beniga, Jasper Zam ICU Punzalan, Patricio 72 Acute MI CKD
Crispino, Shashca Amethyst Valencia, Czedrick 514414 1 Age with moderate dehydration to consider UTI to consider
electrolyte imbalance
Esguerra, Sarah Yvonne 202 Villa, Daisy B. 514348 48 Calculous Cholecystitis
Maribbay, Sheenalyn ICU Punzalan, Patricio 72 Acute MI CKD
Murcia, Jessa 203-A Fullosco, Eufrocina 514445 41 Renal Mass Left
Aranas
Peña, Mark Reiner Llego, Edith S. 514458 52
Villate, Aramina Cattleya-1 Dumanil, Karen Louise 514436 39 Calculous Cholecystitis
Pacana
Viñas, Lerey Joie Faith-A Katigbak, Paterna R. 51 Hypotension t/c alcohol intoxication t/c electrolyte imbalance

Prepared by: Jessa Z. Murcia Notedby: Prof. Luzviminda P. Porte

Student Head nurse Clinical Instructor

2
 ST. ANNE COLLEGE LUCENA, INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena City
Tel. No.710-5624

SCHOOL OF ALLIED HEALTH SCIENCES

RLE ON LEADERSHIP AND MANAGEMENT

(HEAD NURSING)

REQUIREMENT CHECKLIST
Date: May 4 , 2022 ClinicalArea: ER,OR,ICU, DR,NICU,WARD Shift:7:00a.m to 3:00 p.m

CRITERIA Aguila Arroyo Beniga Crispino Esguerra Maribbay Murcia Peña Villate Viñas
I. ATTENDANCE          
II. PARAPHERNALIA          
BP app/set          
Calculator          
Thermometer          
Bandage Scissor          
Tourniquet          
Tape Measure          
Canister with dry cotton balls          
Canister with cotton balls soaked in alcohol          
Medicine Tray          
Ballpen: Black/Blue/Red/Pencil          
Micropore          
Small Notebook          
Small Alcohol          
Penlight with batteries          
Signature of Student Staff Nurse
Prepared by: Jessa Z. Murcia Notedby: Prof. LuzvimindaP. Porte
Student Headnurse Clinical Instructor 3
 ST.ANNECOLLEGELUCENA,INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena
CityTel. No.710-5624

SCHOOLOFALLIED HEALTHSCIENCES

RLE ON LEADERSHIP AND MANAGEMENT

(HEADNURSING)

VITAL SIGNS SHEET

Date:May 2, 2022 ClinicalArea: ER,OR,ICU, DR,NICU,WARD Shift: 7:00a.m to 3:00 p.m

Time: Time:
Name of Student Room# Name of Patient 8:00AM 2:00 PM
BP PR RR T O2 Sat BP PR RR T 02 Sat
Aguila, Camille Zara OR Larino, Obciana
Arroyo, Alexa Lorraine OR Punzalan, Patricio
Beniga, Jasper Zam ICU Punzalan, Patricio 140/70 124 16 36.0 96% 140/60 128 18 36.2 96%
Crispino, Shashca Amethyst Valencia, Czedrick 133 30 36.8 92% 124 28 36.8 95%
Esguerra, Sarah Yvonne 202 Villa, Daisy B. 120/70 83 20 36.4 98% 120/80 87 24 36.7 98%
Maribbay, Sheenalyn ICU Punzalan, Patricio 140/70 124 16 36.0 96% 140/60 128 18 36.2 96%
Murcia, Jessa 203-A Fullosco, Eufrocina Aranas 100/70 79 22 36.3 98% 110/70 81 22 36.3 95%
Peña, Mark Reiner OR Llego, Edith S.
Villate, Aramina Cattleya-1 Dumanil, Karen Louise Pacana 100/70 105 22 36.1 98% 100/70 99 23 36.5 97%
Viñas, Lerey Joie Faith-A Katigbak, Paterna R. 120/80 76 23 36.7 97% 130/80 79 25 36.6 98%

Prepared by: Jessa Z. Murcia. Notedby: Prof. Luzviminda P. Porte

Student Headnurse Clinical Instructor

4
 ST.ANNECOLLEGELUCENA,INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena
CityTel. No.710-5624

SCHOOLOFALLIED HEALTHSCIENCES

RLE ON LEADERSHIP AND MANAGEMENT

(HEADNURSING)

I& OSHEET

Date: May 4, 2022 ClinicalArea: ER,OR,ICU, DR,NICU,WARD Shift: 7:00a.m to 3:00 p.m

Name of Student Room# Nameof the Patient Intake Output Total

I&O
Oral IVF Urine Stool
Aguila, Camille Zara OR Larino, Obciana
Arroyo, Alexa Lorraine
Beniga, Jasper Zam ICU Punzalan, Patricio 100+60 10 0 0 170
Crispino, Shashca Amethyst Valencia, Czedrick 90 40 2 0 130
Esguerra, Sarah Yvonne 202 Villa, Daisy B. 70 30 1 0 100
Maribbay, Sheenalyn ICU Punzalan, Patricio 100+60 10 0 0 170
Murcia, Jessa 203-A Fullosco, Eufrocina Aranas 90 50 2 1 140
Peña, Mark Reiner OR Llego, Edith S.
Villate, Aramina Cattleya-1 Dumanil, Karen Louise Pacana 50 80 1 1 130
Viñas, Lerey Joie Faith-A Katigbak, Paterna R. 110 40 2 1 150

Preparedby: Jessa Z. Murcia Notedby: Prof. Luzviminda P. Porte

Student Headnurse Clinical Instructor

5
 ST.ANNECOLLEGELUCENA,INC.
Diversion Road, Brgy. Gulang-Gulang, Lucena
CityTel. No.710-5624

SCHOOLOFALLIED HEALTHSCIENCES

RLEONLEADERSHIPANDMANAGEMENT(HE
ADNURSING)

IVFMONITORINGSHEET

Date:May 4, 2022 ClinicalArea: ER,OR,ICU,DR, NICU,WARD Shift:7:00a.m to 3:00 p.m

Nameof Student Room# Name of the IVF IVF LEVEL

Patient
Aguila, Camille Zara OR Larino, Obciana
Arroyo, Alexa Lorraine
Beniga, Jasper Zam ICU Punzalan, Patricio PNSS 500cc
Crispino, Shashca Amethyst Valencia, Czedrick PNSS 1L
Esguerra, Sarah Yvonne 202 Villa, Daisy B. PNSS 1L
Maribbay, Sheenalyn ICU Punzalan, Patricio PNSS 500cc
Murcia, Jessa 203-A Fullosco, Eufrocina Aranas PNSS Nacl 1L
Peña, Mark Reiner OR Llego, Edith S.
Villate, Aramina Cattleya-1 Dumanil, Karen Louise Pacana D5LR 1L
Viñas, Lerey Joie Faith-A Katigbak, Paterna R. PNSS 1L

Preparedby: Jessa Z. Murcia Notedby: Prof. Luzviminda P. Porte

StudentHeadnurse Clinical Instructor
6
DOCUMENTATION/PICTURES

Aguila, Camille Zara
We are in the OR area for the second time; we had no class
yesterday, but we need to get in so that we may take the cases.
However, Maam Porte is not there, so we can only observe, but
right now our C.I. is already here, so we can immediately assist
the doctors.The first is Yvonne, who is in charge of the major
case. I'm nervous to assist, but there are other cases in another
room at the same time, so my heart starts racing again. Ma'am
Porte told me to wash my hands and use gloves. Then I take care
of the patient and help the doctors.
Arroyo, Alexa Lorraine
OR
Esguerra, Sarah Yvonne
So may 4 today and sa Or uli kami naka assign. nag handle ako sa
Procedure which is Partial mastectomy ang super kinakabahan
talaga ko kanina sa pag aabot ng mga instruments pero buti nalang
mabait si Maam Sheryl at inaassist ako together with Maam Porte.
then after e naghugas hugas kami ng instruments and nag observe
sa mga kasunod na operations. si Camile naman nag assist sa
Wound Debridement. tapos yon lang umakyat na kami for lunch
and bumalik ng 1 then wala na patients kaya nag browse nalang
kami ng mga cases habang nagiintay ng out hehe. yon lang
salamat.
Peña, Mark Reiner
ICU
 Beniga, Jasper Zam Maribbay, Sheenalyn

We assigned on the NICU department but there is no case or

patient so we are being pulled from that department and we pt on
NGT Feeding ICU . After we being endorsed by our CI together with my partner
we met ma'am Giselle & ma'am Melissa and over patient Papa P.
on the morning we have on orientation whereas there discussed
about the different materials & equipment in the ICU. We tackled
about different colours of medications, we teach how to vital
signs. and they teach how to NGT feeding. On the afternoon we
took our lunch and back to duty. We monitor again the vital signs
of the patient.

SN 2
 NS 3
Crispino, Shashca Viñas, Lerey Joie
WARD AREA
 Browsing the patient chart. Also Charting,
documentation and recording the patient chart
chart.
Admitting form
and admitting the
patient.

Making medication
Organizing the
cards.
patient chart in OPD
 Requesting Medication to Fill-up the form for Bed making for
pharmacy for the patients. returning medications. patient admitting.

Administer
Removing cannula to Changing and Regulate
medication thue IV.
the patient. IVF of the patient.

OR
 Handling as
Scrub Nurse
for Mesh
Hernioplasty
surgery.

Handling as
Scrub Nurse for
Radical
Nephrectomy
surgery.

On the first day of duty it's terrifying and in the same time excited because after 2 years we are in the hospital again. First day is
orientation and spinning around the hospital to show different departments, also knowing the board members, doctors, head nurse of every