Circular No. 31/2021/TT-BYT stipulates nursing activities in hospitals

CIRCULAR

REGULATIONS ON NURSING ACTIVITIES IN HOSPITALS

Pursuant to the Law on Diagnosis and Treatment No. 40/2009/QH12 dated November 23, 2009;

Pursuant to the Government's Decree No. 75/2017/NĐ-CP dated June 20, 2017 stipulating the functions, tasks, powers, and organizational structure of the Ministry of Health;

At the proposal of the Director of the Department of Medical Examination and Treatment,

The Minister of Health issues this Circular to regulate nursing activities in hospitals.

PART I
GENERAL PROVISIONS

Article 1. Scope of Regulation

1. This Circular stipulates the professional tasks of nursing care, the organization of nursing activities, and the responsibilities of specialized positions in patient care in hospitals, district health centers, urban districts, provincial cities, and centrally-administered municipalities that have been granted permits for medical examination and treatment services and meet the conditions to provide such services (hereinafter referred to as hospitals).

2. Other medical and healthcare facilities shall implement nursing activities in accordance with the provisions of this Circular based on their actual circumstances.

Article 2. Interpretation of Terms

1. Nursing Care is the process of assessing, intervening, and monitoring to meet the basic needs of each patient regarding: respiration, circulation, nutrition, excretion, movement and posture, sleep and rest, dressing and undressing, body temperature, personal hygiene, safe environment, communication, beliefs, activities, entertainment, and health protection knowledge.

2. Clinical assessment or nursing diagnosis is the process of evaluating the patient's response to their health condition. A nursing diagnosis serves as the basis for selecting appropriate nursing interventions within the scope of nursing practice to achieve desired outcomes.

Article 3. Principles of Implementing Nursing Care

1. Clinical assessments, care classification, and implementation of nursing interventions for patients must be accurate, comprehensive, continuous, safe, high-quality, equitable among patients, and tailored to the specific needs of each patient.

2. Nursing activities in hospitals must involve and coordinate with other units and specialized positions within the hospital.

Article 4. Patient Care Classification

1. Level I Care: Patients in critical condition who cannot perform daily personal activities independently or due to professional requirements must be completely dependent on continuous and comprehensive monitoring and care from nurses.

2. Level II Care: Patients in serious condition with limited mobility due to health status or professional requirements must limit movement and rely significantly on monitoring and care from nurses when performing daily personal activities.

3. Level III Care: Patients able to move freely without limitations and can independently perform all or most daily personal activities under the guidance of nurses.

Chapter II
PROFESSIONAL TASKS OF NURSING CARE

Article 5. Reception and Assessment of Patients

1. Reception, classification, screening, and initial emergency care:

a) Reception, coordination with doctors in classifying, screening, and providing initial emergency care for patients; arranging patients for medical examinations according to the priority of their disease severity, patient categories (elderly, war veterans, pregnant women, children, and other policy beneficiaries), and order of arrival; guiding or assisting patients to perform medical examinations and ancillary procedures as prescribed by doctors;

b) Reception, support for procedures, and arrangement of patients for inpatient treatment.

2. Clinical Assessment:

a) Examination and assessment of the current health status and basic needs of each patient;

b) Identification of health risks affecting the patient;

c) Determination of nursing diagnoses, prioritizing those directly impacting the patient's health and life;

d) Classification of patient care based on the nurse's assessment of the patient's health status and the doctor's evaluation of the severity and prognosis of the illness to collaborate with the doctor in classifying patient care;

e) Forecasting factors influencing and potential medical incidents that may occur during patient care.

Article 6. Determination and Implementation of Nursing Interventions

1. Nursing interventions include:

a) Respiratory, circulatory, and body temperature care: monitoring and intervening to meet respiratory, circulatory, and body temperature needs based on nursing diagnosis and physician's orders; promptly reporting to the physician and coordinating treatment for abnormal respiratory, circulatory, and body temperature conditions of the patient;

b) Nutritional care: implementing or assisting the patient to follow a suitable nutritional regimen according to the physician's orders; observing the patient's tolerance and satisfaction with the nutritional regimen to report to the physician and dietitian for timely adjustments; performing the responsibilities of a nurse as stipulated in Clause 2 and Clause 3 of Article 13 of Circular No. 18/2020/TT-BYT dated November 12, 2020 issued by the Minister of Health regarding nutrition activities in hospitals;

c) Sleep and rest care: establishing a quiet and appropriate lighting environment in the patient room during sleep and rest hours as prescribed; guiding patients to implement measures to enhance sleep quality such as relaxation, light physical exercise suitable to their health condition, avoiding stimulants, reducing stress, and sleeping at regular times; monitoring and promptly informing the physician about any sleep disorders to support and coordinate timely assistance for the patient;

d) Personal hygiene care: implementing or assisting the patient to perform oral hygiene, body cleaning, secretion control, and clothing changes according to the level of care;

đ) Mental care: establishing a safe, friendly, close, sharing, and encouraging environment for patients to cooperate with specialized professionals in care; monitoring and identifying safety risks, negative psychological manifestations, and preventing behaviors that may harm the patient's health to promptly inform the physician; respecting beliefs and creating conditions for patients to practice their beliefs within permitted and regulated conditions;

e) Implementing professional technical procedures: administering medications and nursing interventions according to the physician's orders and within the scope of the nurse's expertise based on strict adherence to professional technical procedures and regulations for nursing care;

g) Functional rehabilitation for patients: collaborating with physicians, rehabilitation technicians, and other specialized professionals to assess, prescribe, guide, and implement functional rehabilitation techniques suitable to the patient's medical condition. Performing certain rehabilitation techniques as prescribed to help patients develop, achieve, maintain maximum functional activity, and reduce disabilities;

h) Patient management: establishing and updating daily patient management records in paper or electronic form for all inpatients and outpatients at the hospital; fully transferring the number of patients, issues requiring monitoring and care, especially between shifts;

i) Health communication and education: collaborating with physicians and other specialized professionals to advise and guide patients on disease knowledge, self-care methods, cooperation with healthcare staff in care and prevention, patient safety regulations, infection control, nutrition, and rehabilitation; guiding or assisting patients to comply fully with regulations and internal rules during inpatient treatment, department transfers, hospital transfers, and discharge;

2. Determining nursing interventions:

a) Based on the nursing interventions specified in Clause 1 of this Article, nursing diagnosis, care levels, available resources, the nurse determines the care interventions for each patient;

b) Establishing desired goals and outcomes of nursing care interventions.

3. Implementing nursing care interventions:

a) Implementing appropriate nursing care interventions for each patient.

b) Collaborating with other specialized professionals according to assigned care models including: primary nurse care model; team care model; group care model or task-based care model in implementing care interventions;

c) Promptly responding to emergency situations or changes in the patient's condition. Preventing and reporting incidents affecting the quality of nursing care interventions;

d) Advising patients on ways to improve health behaviors, prevent illness, self-care knowledge, and cooperation during the nursing care intervention process.

4. Recording all nursing care interventions for patients on hard copy or electronic care sheets as prescribed. Ensuring complete, accurate, timely, clear, and legible information recording; using, storing, and archiving care sheets according to regulations.

Article 7. Evaluation of the results of nursing interventions

1. Evaluate the patient's responses and the effectiveness of nursing care interventions according to the goals and outcomes of care on a continuous, accurate, and comprehensive basis regarding each patient's response status.

2. Timely adjust nursing care interventions based on evaluation results and reassessment of the patient's condition within the scope of nursing expertise.

3. Exchange with relevant members about priority issues, expected care goals, and adjust nursing care interventions according to the patient's response capacity.

4. Participate in the process of improving the quality of nursing care interventions based on evaluation results.

Chapter III
ORGANIZATION OF NURSING ACTIVITIES AND RESPONSIBILITIES

OF PROFESSIONAL TITLES IN CARE

Article 8. Nursing system in hospitals

1. Nursing council;

2. Nursing department;

3. Ward nurses.

Article 9. Organization and responsibilities of the Nursing Council

1. The Nursing Council is established by the hospital director's decision and specifies its tasks and operational regulations.

2. Structure and membership of the Council:

a) The Chairman of the Council is the hospital leadership;

b) Vice Chairmen of the Council:

- The Vice Chairman of the Council is the Deputy Head of the Nursing Department and a nurse in the Nursing Department;

- The Permanent Vice Chairman of the Council is the Head of the Nursing Department.

c) Members of the Council are ward head nurses, ward head midwives, ward head technicians, and representatives of leaders from certain clinical departments, paraclinical departments, and functional rooms; ensuring that more than 50% of the Council members are nurses and midwives.

3. Tasks:

a) Advise the hospital director on strategies, directions, annual and periodic plans for developing nursing, midwifery, and assistant care activities;

b) Advise the hospital director on revising, supplementing, and updating regulations, guidelines, technical procedures, and professional materials for nurses, midwives, and assistant caregivers in line with the overall development of the hospital and each specialty.

Article 10. Responsibilities of the Nursing Department

1. Develop and implement activity plans, guidelines, technical procedures, and related documents for nursing activities:

a) Lead the development and implementation of nursing activity plans, regulations, technical procedures, and related documents for the hospital's nursing activities;

b) Develop care models at point b clause 3 Article 6 of this Circular in accordance with the hospital's resources and organizational structure.

2. Professional management:

a) Implement and supervise the execution of nursing activities as stipulated in this Circular;

b) Periodically review, summarize, and report on the results of nursing activities as prescribed.

3. Human resource management:

a) Coordinate with relevant departments to develop recruitment plans, propose recruitment, arrange, and transfer nurses, midwives, technicians, and assistant caregivers in the hospital;

b) Develop job descriptions for members of the Nursing Department, ward head nurses, ward head midwives, ward head technicians, nurses, midwives, technicians, and assistant caregivers in accordance with this Circular and Joint Circular No. 26/2015/TTLT-BYT-BNV dated October 7, 2015 of the Minister of Health and the Minister of Home Affairs on job code and qualification standards for nurses, midwives, and technicians suitable for the hospital's scope of operation;

c) Participate in building evaluation criteria and be responsible for evaluating the annual and pre-recruitment capabilities of nurses;

d) Participate in proposing appointments and dismissals of ward head nurses, ward head midwives, and ward head technicians;

đ) Participate in proposing rewards and disciplinary actions for individuals and groups of nurses, midwives, technicians, and assistant caregivers who have achievements or violations as prescribed.

4. Training and scientific research:

a) Research and survey to identify areas needing improvement in the management and implementation of nursing activities in the hospital;

b) Regularly evaluate, propose, and test solutions to improve the quality of nursing activities in the hospital;

c) Participate in building and implementing training plans to enhance the capabilities of nursing staff for lower-level facilities;

d) Propose participation in upgrading professional qualifications and promotion exams for nurses, midwives, and technicians as prescribed;

đ) Develop plans, programs, materials, and conduct new and continuous training; organize surveys, evaluations, and identification of areas needing improvement in training;

e) Organize the implementation of scientific research activities, quality improvement, evidence-based care practices to enhance patient care quality.

5. Participate in proposing procurement of equipment, means, supplies, medicines, chemicals related to nursing activities, monitor quality, and check usage and storage as prescribed.

6. Perform other tasks assigned by the hospital director.

Article 11. Duties of the Head of the Nursing Department

1. Perform general duties of the Head of the Department.

2. Advise the hospital director on nursing activities within the hospital.

3. Develop and organize the implementation of the department's activity plan, periodically review, summarize, and report according to regulations.

4. Inspect and require departments, rooms, medical staff, trainees, patients, patient relatives, and visitors to comply with regulations regarding nursing activities within the hospital.

5. Organize and chair regular and ad hoc nursing head meetings.

6. Coordinate with relevant departments to request the hospital director to temporarily mobilize nurses and nursing assistants for care support when necessary, in accordance with hospital regulations, to promptly care for and serve patients.

7. Participate in infection control councils and other councils as prescribed and assigned by the hospital director.

8. Perform other tasks as assigned by the hospital director.

Article 12. Duties of Nurses in the Nursing Department

1. Carry out specialized tasks suitable to their assignments by the Head of the Nursing Department.

2. Organize inspections and supervision of the implementation of specialized nursing care tasks as stipulated in this Circular at assigned units.

3. Participate in personnel management, training, scientific research, and quality improvement in nursing care as assigned.

4. Participate in building and organizing the implementation of activity plans, guidelines, technical procedures, and related documents concerning nursing activities in the hospital.

5. Participate in hospital councils and networks as assigned.

6. Periodically review, summarize, and report on the results of assigned tasks according to regulations.

Article 13. Duties of the Chief Nurse of the Ward

1. Be responsible to the ward chief and the Head of the Nursing Department for nursing activities in the ward.

2. Plan and organize the implementation of the ward's nursing activity plan.

3. Develop job descriptions and assign tasks to nurses, nursing assistants, and other positions as directed by the ward chief.

4. Manage patients: number, condition, progression, treatment orders, care to timely allocate and coordinate human resources for nursing care.

5. Participate in daily ward rounds with ward leadership.

6. Organize and chair regular and ad hoc nursing meetings and patient and patient relative meetings as needed.

7. Manage, train, and develop nursing human resources in the ward.

8. Propose recruitment, transfer, training needs for nurses, midwives, medical technicians, and nursing assistants in the ward.

9. Participate in scientific research, quality improvement, and direct guidance as assigned.

10. Participate in on-call duty and directly care for patients when necessary.

11. Participate in proposing provision, repair, maintenance of infrastructure, equipment, supplies, medicines, materials, chemicals serving patient care and monitoring usage in the ward. Monitor usage and storage according to regulations.

12. Supervise, inspect, and evaluate the implementation of the ward's nursing work plan and improve nursing care quality.

13. Periodically review, summarize, and report on nursing activities in the ward.

14. Evaluate, propose rewards, disciplinary actions, salary increases, and training for nurses and nursing assistants in the ward.

15. Perform other tasks as assigned by the ward chief and the Head of the Nursing Department.

Article 14. Duties of Clinical Nursing Staff

1. Perform professional tasks in accordance with the division of labor assigned by the Head of Department and the Chief Nurse as stipulated in this Circular and Joint Circular No. 26/2015/TTLT-BYT-BNV dated October 7, 2015 of the Minister of Health and the Minister of Home Affairs on job code and occupational standards for nurses, midwives, and medical technicians.

2. Adhere strictly to all regulations, professional procedures, ethical standards, and relevant laws in nursing care.

3. Implement or apply research results and evidence-based practices to improve the quality of care.

4. Conduct training and supervise new nursing staff, interns, and auxiliary caregivers when assigned.

5. Engage in continuous learning to update knowledge and skills, and apply learned knowledge to enhance the quality of nursing interventions.

6. Participate in developing nursing work plans at the department, guidelines, regulations, professional procedures, and related documents for nursing care as assigned.

Article 15. Duties of the Head of Clinical Department

1. Be responsible to the hospital director for nursing activities in the department.

2. Coordinate with the Nursing Department to organize and implement nursing activities in the department.

Article 16. Duties of Heads of Other Departments

1. Head of Pharmacy: Organize the timely and adequate supply of high-quality medicines according to prescriptions in clinical departments and outpatient clinics; advise, support, monitor, and supervise nursing staff in managing and using medicines for patients in various departments and wards.

2. Head of Infection Control: Organize and oversee the implementation of infection control regulations related to patient care activities in the hospital; provide appropriate equipment, textiles, and supplies for patient care activities and collect used equipment and textiles from clinical departments.

3. Head of Nutrition: Organize the acceptance of proposals and provision of suitable nutritional regimes for each patient; support, monitor, and supervise the implementation of nutritional regimes for patients in clinical departments; improve the quality of patient nutrition based on evaluations and proposals from patients.

Article 17. Duties of Heads of Functional Departments

1. Head of Personnel Organization: Develop recruitment plans for nurses and auxiliary caregivers based on recommendations from the Nursing Department; coordinate with the Nursing Department to transfer nurses and auxiliary caregivers between departments to meet patient care requirements.

2. Head of Quality Management: Collaborate with the Nursing Department to establish criteria, conduct assessments, and improve the quality of nursing care based on assessment results.

3. Head of Planning and Consolidation: Collaborate with the Nursing Department to develop regulations and professional procedures related to nursing care activities; coordinate inspections and supervision of nursing care quality.

4. Head of Medical Supplies and Equipment: Ensure timely provision and repair of equipment, devices, and consumables for patient care based on recommendations from the Nursing Department and related units.

5. Head of Administrative Management: Timely repair infrastructure and equipment serving nursing care.

6. Head of Social Work: Support reception activities; guide and assist patients in seeking medical consultation, testing, imaging, admission, ward transfers, hospital transfers, and discharge; collaborate with clinical departments to identify and support patients in difficult circumstances.

7. Head of Finance and Accounting: Assist in implementing admission and discharge settlement procedures for patients.

8. Head of Information Technology: Design and support the development and application of software in nursing activities; manage patients, electronic medical records, and drug, material, and equipment usage, as well as other care-related activities.

Article 18. Duties of Treating Physicians

1. Closely coordinate with ward nurses in conducting examinations, assessing, and classifying care levels for each patient.

2. Coordinate with nurses in implementing specialized care tasks and nursing activities as prescribed.

3. Supervise and monitor the implementation of treatment instructions by nurses.

Article 19. Duties of Interns and Students

1. Strictly fulfill the nursing care duties as stipulated in this Circular and the internal regulations and rules of the hospital and the department where they are on internship.

2. Nursing students may only perform nursing procedures and techniques on patients with permission, under the supervision of their teacher or assigned nurse, and with the consent of the patient.

Chapter IV
IMPLEMENTING PROVISIONS

Article 20. Effective Date

1. This Circular takes effect from February 27, 2022.

2. Circular No. 07/2011/TT-BYT dated January 26, 2011, issued by the Minister of Health guiding nursing work in caring for patients in hospitals, shall cease to be effective from the date this Circular comes into force.

Article 21. Reference Provisions

In cases where referenced documents in this Circular are replaced or amended, the replaced or amended documents shall apply.

Article 22. Responsibilities for Implementation

1. Units under the Ministry of Health:

a) The Department of Medical Examination and Treatment shall be responsible for organizing the implementation, inspection, and supervision of this Circular nationwide;

b) The Department of Science, Technology and Training shall be responsible for directing nursing training institutions to continue to innovate nursing training programs to meet the appropriate care capabilities required by various specialties and international integration.

2. Provincial Departments of Health:

a) Shall be responsible for organizing the implementation, inspection, and evaluation of the implementation of this Circular at hospitals under their management;

b) Regularly or urgently report on the nursing activities of hospitals under their management as prescribed.

3. Health units under ministries and sectors shall be responsible for organizing the implementation, inspection, supervision, and monitoring of this Circular at hospitals under their jurisdiction.

4. Responsibilities of Hospital Directors:

a) Shall be fully responsible for all nursing activities within the hospital;

b) Issue relevant documents, regulations, and procedures related to nursing activities within the hospital;

c) Organize the implementation, inspection, supervision, and evaluation of this Circular within the hospital;

d) Adequately allocate personnel with appropriate professional qualifications to meet the nursing activities of the hospital as prescribed;

đ) Invest in infrastructure, equipment, means, and materials to serve patient care;

e) Allocate sufficient funds for nursing activities;

g) Develop and implement training programs and materials for nurses and auxiliary caregivers;

h) Reward units and individuals who perform well in nursing activities.

During the implementation process, if there are difficulties, agencies, organizations, and individuals should promptly reflect them to the Ministry of Health (Department of Medical Examination and Treatment) for research, consideration, and resolution./.