POSITION SUMMARY:
Reports to the Director of Surgical Services and/or Assistant Director and C harge Nurse, responsibilities include assessment, planning,
intervention, evaluation and documentation of surgical patients. Overall responsibility is for the nursing care of patients and for maintaining
standards of nursing practice and optimal outcomes, including supervision of all categories of nursing personnel.


Clinical/Technical Component
1. Assessment: C ompletes a thorough pre-operative assessment on all assigned patients. Making sure all test results, History & Physical and
consents are on chart prior to surgery.
2. Performs assessment on pediatric and geriatric patients taking into consideration the physiological and anatomical differences specific to each
age group. Identifies any specific consideration that may be necessary related to each age specific group.
3. Planning: Observes identifies and collects data to identify nursing care needs of the patients and initiates a comprehensive care plan.
4. Identifies supplies, instruments and equipment needed for the procedure, surgeons’ preference card, age, and special needs of patient. Plans
for the coordination of support services required during the intra operative period, i.e. x-ray, pathology, etc.
5. Implementation: Provides quality nursing care based on patient's needs and plan of care. Supervises the care given by other nursing
personnel.
6. Identifies and implements safety measure for patient, equipment and environment, i.e. positioning, sterile technique, universal precautions,
body mechanics, etc.
7. Establishes priorities and organizes nursing activities in a logical and effective sequence.
8. Performs syringe, instrument and needle count per policy and procedure. Initiates corrective action if indicated.
9. C ompletes a thorough report each time care of patient is transferred to another caregiver.
10. Medication Administration: Demonstrates safe and accurate administration and documentation of medication. Follows correct procedures for
obtaining, identifying and administering blood and blood products.
11. Responsibilities to the Unit/Other Departments: Demonstrates basic knowledge of surgical intervention associated with patients disease state.
Exhibits knowledge of technical skills required to implement safe nursing care and health promotion of the surgical patient as demonstrated
through practice: monitoring, IV placement, set up and maintenance of central lines, etc.
12. Participates in unit meetings at least 50% of the time.
13. Works closely to coordinate care given by all departments.
14. Provides concise and meaningful reports to fellow workers and physicians.
15. Orients new personnel to the unit.
16. Demonstrates proficiency in setup, operation and maintenance of equipment.
17. Evaluation and Documentation: C ompletes all required intra operative documentation, i.e. operative record, charge sheets, implant records,
pathology slips, etc. per policy and procedure. Documents any unusual occurrence on an incident trending report.
18. Patient Education: Verifies patients understanding of procedure and reinforces post operative teaching as appropriate.
19. Responsibilities to the Medical Unit: C ommunicates significant changes in patient conditions and abnormal diagnostic data requiring medical
attention.
20. Responsibilities as a C harge Nurse: Upholds the standards of patient care in a safe, efficient and cost effective manner.
21. Participates in QI.
22. Shows flexibility in hours to reflect case load and acuity.
23. C ompletes daily routine of the unit, pulls cases, completes special assignments, checks room at the end of shift etc.
24. Accurately transcribes, interprets, and carries out physician's orders. Maintains and updates physician preference cards.
25. Submits written documentation (SOC - Incident Reports) when applicable.