Nurse Series, GS-0610 TS-8 June 1977
application of independent judgment as to which professional procedures will best serve the
nursing needs of particular individuals or groups. This judgment takes into account information
about the patient as an individual, the medical condition, and relevant data on background that is
available in medical records.
This process necessarily includes an evaluation of the kind of physical care needed; dietary
needs; emotional problems exhibited; the patient's abilities in such self-care activities as walking,
bathing, dressing, feeding, and care of dressings, braces, etc.; the need of the patient or the
family for social services, etc.; as well as calling to the attention of the physician any conditions
requiring medical attention other than those under treatment, such as vision or hearing problems,
the need for dental care, etc. The nurse must recognize and make specific recommendations to
the physician for the alleviation of the patients problems dealing with personal care, activities of
daily living, and other health related needs.
There is a wide range of possibilities in the ways in which responsibility for planning and
responsibility for providing nursing care can be organized and assigned. The responsibility for
"planning patient care" may be segmented in countless ways among the staff of the hospital. It is
difficult to identify any nurse or nursing assistant position that is completely without some
element of responsibility in planning patient care. Certainly every employee associated with a
patient observes the patient, makes a judgment concerning the observations, and acts or
recommends action based on judgment. This is, loosely speaking, a part of planning patient care.
At the other extreme, the director of a nursing service for a hospital plans the care for patients in
every policy decision made that relates to nursing care procedures. Within such a broad
framework the whole nursing service is concerned with planning patient care.
Responsibilities and skill demands of the highly demanding type are not present in all nursing
assignments. Such competence must be acquired through periods of learning and practice under
the supervision and guidance of professional nurses. These developmental and confidence
building periods, although seldom identified as such by management officials, are basic to the
concept underlying the structure of nursing positions described in this standard. The nature of
these developmental periods varies according to the nature of the assignment and the education,
experience, and ability of the nurse. Each such period, however, is characterized by greater or
more specific supervisory guidance, which may take the form of pre-checking patient care plans,
regular and frequent review of work performed, periodic discussions of the particular nursing
procedures and principles involved, etc. Developmental activities may be seen in the following
activities: studying the specialized nursing care required; learning to deal effectively with
personal contacts with patients and their families; and gaining knowledge of and experience in
working with members of other disciplines (e.g., social workers, psychologists, occupational
therapists, etc.) and health and welfare agencies in the public sector.
Nurse positions at every level may include both full performance of duties and also the learning
of more advanced, difficult, and responsible procedures or care for patients with conditions
requiring greater specialized nursing knowledge. This stems from the fact that nurses
traditionally undergo continuing training to gain higher level skills in the immediate assignment
area, to learn new skills in other areas, to become able to bear additional responsibilities as
necessary, and to learn newly developed nursing processes and techniques.
U.S. Office of Personnel Management 4