WORLD OF THE HEALTH CARE EMPLYMENT SPECIFICLY IN RAPARIN PEFIATRIC TEACHING HOSPITAL /ERBIL

1. THE WORLD OF HEALTH CARE
EMPLOYMENT IN RAPARIN
PEDIATRIC TEACHING
HOSPITAL /ERBIL
Hawler Medical University
BY:
Raveen Ismael Abdullah
B.Sc in Nursing
5th
of JUN 2017

2. Contents
Introduction............................................................................................................................... 1
Hierarchy of commanding in hospital........................................................................................ 1
Organizational chart .................................................................................................................. 1
Job description and hospital guidelines..................................................................................... 2
Head Nurse of Raparin pediatric teaching hospital................................................................... 3
Employment process ................................................................................................................. 3
System of staff hiring and promotion........................................................................................ 4
Staff monitoring system and safety concerns ........................................................................... 5
Staff and Client complains (hotline for complains) ................................................................... 5

3. 1
Introduction
Raparin Pediatric teaching hospital provides general pediatric care for children while they are in
the hospital. The hospital building been renovated and specified for children care in 1980,
Consist of many caring departments such as Medical, Surgical, Operation rooms, Emergency,
NICU, and Nutrition department. In addition to mentioned departments a hospital has a
consultation department receiving outpatients for short term care.
It provides more than one type of care based on the acuity, which is the seriousness of the illness
and the rate of change that is occurring such as acute care, long term acute care, sub-acute care,
and ambulatory care.
Hospital have different types of professional health care providers such as physician,
pediatrician, resident doctor, pharmacist, surgeon, Nurse with Bachelor, Master and Diploma.
Total of 260 nurses been employed and working in different parts of the hospital 45 nurses out
of 260 nurses work as volunteers.
The aim of report is to clarify the world of employment within Raparin pediatric teaching
hospital and defining the commanding system within mentioned hospital.
Hierarchy of commanding in hospital
The centralized authority is in use as a system of commanding which compose of hospital
manager, vice manager, head nurse ,audit manager and head of each department of hospital .the
top management take all important decisions ,these decisions are then enforced on the lower tiers
of the hospital.
Organizational chart
It identifies formal chains of command, communication channels, and the authority for decision
making. The hospital formal chart composed of Hospital manager, Vice manager, Head of resident
doctors, Audit unit, Nursing and health care providers unit, Administration and service unit,
administration section ,legal section, accountancy section ,salary section, statistic section,
engineering section ,self-division ,service section, section of repairing devices scientific and
technical unit, Dressing section, X-ray section, Emergency section, Pharmacy section, Laboratory
section, Blood bank ,General health section, Profession development section, Medical word,

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Consultation section, Premature section(NICU),Anesthesia section, Surgical section, and
Pediatric word section .
A broad span of control exist within the hospital managerial system, authority and
responsibility for decision making is in the hands of fewer individuals, with each manager
supervising a large number of employees.
Within the official hierarchy of commanding the head of sections and head nurse not been
mentioned this implies that nurses rights been lost and the hospital is not giving a power to
nurses!
Job description and hospital guidelines
Job descriptions are written statements, usually found in policy manuals, that specify the duties
and functions of the various jobs within the organization and the scope of authority,
responsibility, and accountability involved in each position.
Nurses job description not been obeyed and applied in Raparin pediatric teaching hospital in
spite of having the formal document of job description from the ministry of health. During my

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visit to Raparin pediatric teaching hospital luckily I got chance to interview the head nurse of
hospital we talked and discussed about the system and employment of nurses in general once I
asked about job description the head nurse replied "unfortunately shortage of staff forced us not
to apply job description system and it created a big barrier not to develop nurses skills " This
implies that having limited number of nurses for a big hospital prevented nurses from doing
their job properly, unfortunately, if nurses are not aware of their rights and responsibilities
many errors might arise and patient safety will be in danger !
Regarding the nursing guidelines within the hospital were not fixed and vary from area to area ,
some departments had general guidelines according to the type of care they provide, while
some other departments didn’t have written working guidelines at all, maybe lack of written
document doesn’t mean that the department is not following any guidelines!
While in some other area of the hospital nurses apply and follow the verbal orders and
instructions from the head of the department.
Having verbal guidelines will put nurses in legal troubles when errors occur nurse might not be
able to defend herself. Therefore, having written guidelines is quite important for the entire
health care organizations to guarantee the safety of nurses and patients.
Head Nurse of Raparin pediatric teaching hospital
Person in charge of nursing in a hospital and the head of the nursing staff is responsible for the
process of planning, organizing, staffing, directing and controlling the nursing staff.
A formal document about rights and responsibilities of the head nurse been disseminated from
the ministry of health around five years ago ,I asked the head nurse about the hard copy of the
document unfortunately, he said I don’t have the document !it shows that the head nurse was
not aware of his legal rights and responsibilities .
Employment process
Employment is an agreement between an employer and an employee that the employee will
provide certain services on the job.
Employment process regarding nursing profession within Raparin pediatric teaching hospital is
not different from other governmental health care organizations.

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Three types of employment exist: contract (local and central), volunteerism, formal long term
employment.
Local contract is an agreement between hospital and nurse for short period according to the
needs of hospital, the contract might be renewed if the nurse is skillful also it might not be
renewed if the hospital do not need nurses or hospital is not able to afford the salary of
contracts despite of cleverness of the nurse. While the Central contract is a nursing job
agreement between General Directorate of health and nurse itself upon hospital request, the
contract might last for years, it depends on the finance potentiality of Directorate of health.
What drags my attention most was the volunteerism of nurses, despite economic crisis we live
in nowadays humanity found itself within nursing profession! Working without expecting
money in return.
Nurses after graduation and receiving their certifications such as bachelor and diploma in
nursing they become qualified to work according to the Kurdistan region health care system
law, upon request of ministry of health some of newly graduated nurses will get their long term
employment. They will receive a monthly salary from government and will become formal
worker within health care system.
The head nurse said the new graduated nurses have no right to work freely immediately after
they get employed, they will work under supervision for two months in morning shifts. During
two years of rotation period the new graduated nurses must work in all department of each of
the hospitals.
The sad thing regarding employment of nurses within Raparin pediatric hospital is that nurses
do not work according to their interest !some of nurses were interested in another branch of
health care but been forced to work in pediatric hospital, because of central process of
employment which is exist within KRG health care system .
System of staff hiring and promotion
Staff hiring mostly is central ,it’s the responsibility of the ministry of health and directorate of
health ,while promotion of nurses is done by head nurse .But, sometimes the hospital manager
have a role in it ,they have no specified evaluation system before promoting one of the nurses
they do not follow any standardized roles ,according to the words of head nurse "I know who is

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clever and who is not, when I find one of my nurses is a qualified nurse means hard worker
,obeying all the hospital orders and possess creative mind I must think of promoting them ".
Staff monitoring system and safety concerns
Health care services are provided to patients in an environment with complex interactions
among many factors, such as the disease process itself, clinicians, technology, policies,
procedures, and resources.When these complex factors interact, harmful and unexpected
outcomes (e.g., errors) can occur.
Reporting safety concerns is a job of every individual entering hospital avenue, usually The
head nurse is in charge of staff monitoring system the process is done through head of
departments each one is responsible of monitoring the work of specific group of nurses.
Staff monitoring and reporting errors is quite important to improve patient safety, improve
health care system and, and minimize death rate.
Staff and Client complains (hotline for complains)
The process of Reporting complains within Raparin pediatric teaching hospital can be done
directly by calling specific phone number which is available only for complains in Directorate
of health in Erbil city .there is a responsible person within legal unit of Directorate of health
for investigating and follow upping the reported complain .
While in some situations the complainer go directly to administration department of hospital
and report their complains to Head nurse or manager of hospital then a follow up committee
will be formed by order from head of hospital for further investigations regarding reported
error or complain.

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