NURSING SHIFT WORK SCHEDULE IN TONGA PRESENTER: Mrs. ‘ELENISI MA’AKE, Quality Assurance and Risk Management Nurse Leader. Mrs. MELEANE SIALE, General Secretariat TNRA.

OUTLINE Introduction Health and Nursing Structures Shift works designing Hospital charges and pricing for nursing services Conclusion Acknowledgement

ESTIMATED POPULATION (‘000) 103.6 INDICATOR 2010 1 ESTIMATED POPULATION (‘000) 103.6 2 CRUDE BIRTH RATE (per 1,000) 26.0 3 CRUDE DEATH RATE (per 1,000) 5.3 4 MATERNAL MORTALITY RATE (per 100,000) 37.1 5 INFANT MORTALITY RATE (per 1,000) 21.5 6 LIFE EXPECTANCY AT BIRTH (COMBINED) MALE FEMALE 65 69 7 HEALTH WORKFORCE MEDICAL OFFICER AT POST HEALTH OFFICER AT POST NURSING AND MIDWIFERY AT POST 60 21 388 China Tonga

2.1 Health Structure

2.2 Nursing Structure

Total Nursing Staff in Tonga 2014

3.1 Designing Shift Work History of shift work designed in Tonga – ( length of shifts - 8hrs shift and 12hrs) Principals of rotations – staff placement - AM, PM and NIGHT SHIFTS Model of Care Patients Allocation Team Work

3.2 Shift work schedule Constructing schedule – decentralised schedule Predetermined block of time – schedule are constructed bi – weekly Shift Rotation Skill mixed Flexibility NUM rostered staff shift works – we entitled to work for only 40hrs with a 2days off but it’s up to the NUM to decide decision on approval in consideration of having enough staff to be on duty Shift work are schedule biweekly by NUM and then summitted to the matron’s office for review and approval and also monitoring any further changes or quarries. Shift rotation: every staff must take turn in doing night shifts….and it’s a must for each and everyone to commit to the duty rostered accordingly. Skill mixed is one of the main factors that the NUM is looking into it when doing the shift work schedule is to considered that each shift must have a complete skilled mixed – senior nurses, mid – level and junior nurses – however if ever they need to change their duty they must consult the NUM first before make any changes, it’s is of at most vital for the nurses to change within their level thus to make sure a productive and quality care will delivered at each shifts. Flexibility of duty are strongly contributed to the patient safety and staff satisfaction - however, if someone shedule to do 3nights shifts but she couldn’t be able to take the 3rd day she will then consult the NUM and of course she will be looked for someone to cover thus to make sure safe environment in working area. . Shift work schedule are done biweekly and then submitted to the Matron’s Office for approval, review and monitoring any further quarries or changes.

4. Hospital Charges and pricing for nursing services ITEMS TONGAN CITIZENSHIP FOREINGERS 1. PATIENTS CONSULTATION AT OPD + ED FREE OF CHARGE CHARGES IS SAME TO ALL Top $25.00 Pg= Top $ 12.50 US 2. MEDICATIONS FREE OF CHARGES EXCEPT P.P/CL DEPENDS ON TX. AND PRODURES USED 3. IMPATIENTS FEES – ROOMS 4Beded RM Pivate RM New Born – 14yrs +70yrs and above Top $5.00 Pg = Top $2.50US Top $30.00 = Top $ 60 US Top $20.00 = Top $10US Top $ 70.00 = Top $140US THERE IS NO PANALTIES FOR THE NURSES SHIFT WORK IN TONGA …THE PRICING FOR THE NURSES SERVICES ARE THE SAME GOES TO EVERY SHIFT…UNLESS IF YOU HAVE EXCCEDED YOUR 40 HRS AND YOU ARE ALLOW TO CLAIM IT AS OVERTIME.

5. Conclusion Shifts work designing in Tonga is fair enough according to our financial status Nurses Competency Standard and Core values are contributed to the strengthening of the nursing profession in Tonga despite attained M.O.H mission “To support and improve the health of the nation by providing quality, effective and sustainable health services and being accountable for the health outcomes”.

6. Acknowledgement Professor Cui Yongqiang M.D, O.M.D The Guang’anmen Hospital and Staff of TCM, Beijing His Excellency Mr. Siamelie Latu – Tongan Chinese Ambassador Madam Sesilia Latu – First Secretary to the Chinese Tongan Ambassador Ministry of Health Tonga Ministry of Health CEO – Dr. Siale ‘Akau’ola CNO – Dr. ‘Amelia.A.Tu’ipulotu Matron – Sr Siu Pifeleti Clinical Nursing Supervisors.

MALO ‘AUPITO THANK YOU “xie xie” ANY QUESTIONS??