Hierarchy of Nursing Staff

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by Asem Kabanbaeva

Almaty Medical College (AMC) trains nurses at four levels. The City Perinatal Center (CPC) is in partnership with AMC and the Tucson/Almaty Health Care Coalition in Tucson, Arizona. After graduating from AMC, I worked at the CPC in the 50-bed post-natal department, staffed with AMC graduates of all levels:

Level 1---assistant nurse
Level 2---registered nurse
Level 3---special nurse
Level 4---nurse manager

Nurses in the department work as a team. Nurses at Levels 1, 2 and 3 are subordinate to nurses at Level 4. A nurse manager deals with distribution of tasks among teams. I analyze and forecast the practical work of the department. I exercise supervision of medical care, evaluate the professional activities of personnel and personal strengths of nurses of different types. I select department personnel and allocate duties to them. I check the quality of medical documentation, and work out special training plans and refresher courses.

In terms of health education, the departmental regimen is strictly maintained. Women in the postnatal period are instructed on diet. Groups have been organized to instruct women; slide shows are used. Special attention is paid to breast feeding?there are studies for parturient women, and nurses instruct them in how to save breast milk. Rooms for breast feeding have been set aside. Nurses trained in obstetrics and pediatrics deal with parturient women. Doctors in the department work as visiting medical doctors?they consult once a week. Nurse managers make daily rounds on their own to check on the status of female patients, and orders are given.

Level 1 nurses deal directly with the care of maternity patients and infants (changing bedclothes, infant care, feeding, swaddling, etc.). Level 2 nurses give injections and perform other therapeutic and diagnostic procedures, such as making dressings. Specialized Level 3 nurses take part in rounds together with Level 4 nurses; supervise Level 1 and Level 2 nurses; handle deliveries on their own in the obstetric suite; and check the response of pregnant women, women in labor and maternity patients to procedures and drugs.

Nurse Manager Functions

Nurse managers ensure adherence to regulations, the medical and prevention regimen and infection control. They supervise medical record keeping, and arrange and carry out the certification of nurses of different types. They are the leaders of all levels of nursing, and follow the moral and ethical principles of leadership.

The nurse manager maintains liaisons with the administration of the maternity hospital and specialized departments, carries out her own administrative activity, and bears responsibility for the department's personnel work. The nurse manager's duties include:

Asem Kabanbaeva is Nurse Manager at Almaty City Perinatal Center
Almaty, Kazakstan
tel: (3272) 24 08 05

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