General Instructions To Complete The PDQ Electronic Template Form

Position Description Questionnaire Electronic Template Form
Wake County, North Carolina

Classification Title:
Position Number:
(To be completed by consultant)
General Instructions to complete the PDQ Electronic Template Form:
Please complete this form to the best of your ability. Make sure to ask your supervisor for any assistance that you need
in completing this form. This is an electronic form, please use your Tab key to move forward and Shift + Tab to move
back through the selections, use your mouse when selection the checkboxes. If you placed an X in a box by mistake,
use your mouse to click on the box to remove the X. Supervisors please use the Supervisors comments field at the
end of each section (A, B, C, etc.) to add your comments pertaining to the section. Sorry, the spell check does not
work when completing this electronic form. Please send your completed form to your supervisor no later than Friday,
November 14, 2003.
A. Identification / General Information

Employee Name
Valerie Mitchell
(Note: If more than one Employee participated in completing this questionnaire, indicate "Multiple Employees" and attach a list of all
participants to this form.)
Working Title
Nurse Supervisor
Department Name
Human Services - Prenatal Clinic
Immediate Supervisors Name
Kim McDonald
Immediate Supervisors Title
Human Services Medical Director
Length of Service with Organization
Years
11
Months
Length of Service in Current Position
Years
Months
Describe your normal work schedule (Example: Monday Friday 8:00 a.m. to 5:00 p.m.)
Monday - Thursday, 7:30 am - 6:30 pm (10 hours per day)
Add Supervisors comments here:
B. Brief Description of the Position

(Use two or three brief specific statements to summarize the general purpose of the position.)
The purpose of this position is to:
In addition to duties as a Staff Nurse in the Maternal Health Clinic, the Nurse Manager provides administrative supervision and management
of all nurses and nursing assistants working in the Maternal Health Clinic. The Nurse manager attends meetings pertinent to clinical issues
and concerns as the clinic representative.
This is accomplished by:
This dual role includes direct patient care for clients seen in the Maternal Health Clinic. Health assessment and documentation appropriate to
the type of visit, with the ability to document all findings in the patient's EHR. Implementation of medical interventions ordered by the
physician and clinic director. Assure that nursing staff are adhering to the protocols and standing orders under the direction of the clinic
physician.
Duties also including assuring that the enhanced role nurses adhere to the state guidelines and complete all continuning education and clinical
hour requirements
Supervise day-to-day operations of the clinic and staff scheduling.
Attend and lead monthly departmental staff meetings regarding issues in the clinic.
Assure that staff complete required OSHA and cultural diversity training.
Assure that all nursing staff maintain a current active licensure with the NC Board of Nursing
Collaborate with other entities of the agency to promote community wellness.
Conduct yearly performance reviews and assign additional duties to staff as needed..
Other duties include:
Page 1

Participate in the recruitment, interview, and hiring process of nursing personel and provide input to the selection process of other employees
with in the work unit.
Page 2

C. Essential Functions
Description of Essential Function: Using the numbered boxes on pages 2 and 3 of this form, describe in detail the
primary or most important functions that you perform. In addition to each function, list the tasks performed that enable
you to accomplish each function. Use clear, concise sentences. Refer to the example below.
Percentage of Time Code: Using the numbered boxes below, estimate the percentage of total working time per year
that is taken up with that duty. These estimates should be made after all essential functions have been listed. The
percentages in this column must equal 100%. Duties that require less than 5% of your time should not be listed. Refer
to the example below.
Strength Column Code: Using the numbered boxes below, write ONE letter that best describes the strength demands of
the essential function during a typical 8-hour workday. Refer to the example below.
Use the abbreviations provided:
S = Sedentary
Exerting up to 10 lbs.
occasionally or negligible
weights frequently; sitting
most of the time.
L = Light
M = Medium
H = Heavy
VH = Very Heavy
occasionally, 10 lbs.
frequently, or negligible
amounts constantly OR
requires walking or standing to
a significant degree.
Exerting 20-50 lbs.

occasionally, 10-25 lbs.
frequently, or up to 10 lbs.
constantly.
Exerting 50-100 lbs.

frequently, or up to 10-20 lbs.
constantly.
Exerting over 100 lbs.

frequently, or up to 20-50
lbs. constantly.
EXAMPLE
Function: Maintains exterior of facilities
Tasks performed to accomplish this function:
Percentage
of
Time
Physical
Strength Code
30%
Percentage
of
Time
Physical
Strength Code
20
by picking up and removing litter and debris from grounds, sweeping and edging
sidewalks, mowing lawns, trimming shrubs and raking leaves.
1. Function: Provide prenatal care for clients seen in the WCHS Maternal Health Clinic
Perform professional public health duties as a part of a multidisciplinary team in a clinical setting according to
protocols approved by WCHS and the clinic physician. Assess patient medical and family history including
menstrual and OB history. Assess patients or medical problems or concerns. Assure that appropriate labwork
is completed and assure that appropriate follow-up is completed for abnormal lab values. Perform appropriate
teaching and counselling according to gestation and history. Assess for high risk problems. Provide HIV pre
and post test counselling to all prenatal patients and offer testing. Offer AFP and genetic counselling and
testing when appropriate. Counsel patients regarding labor and delivery at Wake Medical Center. Assess
patient for nutritional concerns and refer t nutritionist if when indicated. Assess patient for psychocsocial
concerns and refer to social worker or clinical social worker as indicated. Consult with the physician extender
or physician as needed. Phone triage. Complete all documentation in the patient's EHR. Review records from
orther medical facilities.
Page 3

C. Essential Functions (continued)

2. Function: Supervise clinic operations
Percentage
of
Time
Physical
Strength Code
30
Percentage
of
Time
Physical
Strength Code
20
Percentage
of
Time
Physical
Strength Code
Maintain clinic flow and assure that patients are seen in a timely manner. Assure that there is adequate
staffing in the clinic on a daily basis. Assess and assure that medical supplies are available in the clinic.
Make adjustment to clinic schedule as needed. Assure that patient confidentiality is maintained and records
are secured appropriately. Attend and lead monthly staff meeting and monthly nurse staff meeting to assure
that staff are aware of changes in opeation or new development in the maternal health clinic. Perform client
satisfaction surveys.
3. Function: Collaborate with other entities in the matenal health clinic setting that impact on clinc
operations.
Tasks performed to accomplish this function: \
Meet and consult with supervisory staff within the agency and other agencies regarding issues that may impact
on the care provided to the maternal health patients, ie lab staff, social worker, nutritionist, pharmnacy, home
visitng nurses, health educator, outlying clinics, and Wake Med High Risk OB clinic staff
4. Function: Supervision of staff and management responsibilities
Tasks performed to accomplish this function: Provide supervision and instruction to the nursing staff,
30
interpreter, and administrative supervisor. Perform periodic reviews and yearly performance evaluations of
these employees. Assure that staff complete all training required within the agency and for their hired position.
Ensures all documentation for accreditation is received from direct reports. Actively participate in leadership
meeting with other clinic managers and supervisory. Participate in the recruitment, interviewing and hiring of
nursing personnel and provide input into the selection process of other employees.
5. Function:
Percentage
of
Time
Physical
Strength Code
Overall Strength Demands: Place an X next to one word below that best describes the overall strength demands of the position.
Sedentary
occasionally or negligible
weights frequently; sitting most
of the time.
Light
Exerting up to 20 lbs. occasionally,
10 lbs. frequently, or negligible
amounts constantly OR requires
walking or standing to a significant
degree.
Medium
Exerting 20-50 lbs. occasionally,
10-25 lbs. frequently, or up to 10
lbs. constantly.
Heavy
Exerting 50-100 lbs. occasionally,
25-50 lbs. frequently, or up to 1020 lbs. constantly.
Very Heavy
Exerting over 100 lbs.
frequently, or up to 20-50 lbs.
constantly.
Page 4

D. Physical Demands
Physical Demand Codes: Consider the overall position and use the following frequency code scale to indicate how often you perform the physical demands
listed below. Under Frequency Code, place an X next to the one letter, which best represents, the physical demand frequency code for each physical demand.
Then under Description, place an X next to all physical demand descriptions that apply. If you choose Other, please type a brief explanation.
C = Constantly
2/3 or more of the time.
Physical
Demand:
Standing
Fine Dexterity
Walking
Lifting
Carrying
Sitting
Reaching
Handling
Kneeling
Crawling
Other
Frequency
Code:
(Mark with an
X)
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
F = Frequently
From 1/3 to 2/3 of the time.
O = Occasionally
Up to 1/3 of the time.
Description:
Make with an X all that apply and
provide a BRIEF description for Other
as necessary.
Physical
Demand:
Making presentations
Observing work site
Observing work duties
Communicating with co-workers
Other: Comments at bottom of page
Pushing/Pulling
Computer keyboard
Telephone keypad
Calculator
Calibrating equipment
Climbing
To other departments offices and office

equipment
Around work site
Vision
Supplies
Equipment
Files
Foot Controls
Supplies
Equipment
Files
Balancing
Desk work
Meetings
Driving
Bending
For supplies
For files
Crouching
Paperwork
Monies
Hearing
Filing in lower drawers

Retrieving items from lower shelves or the
ground
Twisting
Under equipment
Inside attics/pipes/ditches
Talking
R = Rarely
Less than 1 hour per week.
Frequency
Code:
(Mark with
an X)
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N
R
O
F
C
N = Never
Never occurs.
Description:
Make with an X all that apply and provide a
BRIEF description for Other as necessary.
File drawers
Equipment
Tables and chairs
Hose
Stairs
Ladder
Step stool
Onto equipment
Reading
Computer screen
Driving
Observing work site
Driving
Operating heavy equipment
Dictaphone
On ladder
On equipment
On step stool
Retrieving items from lower shelves/ground
Making repairs
Retrieving items from lower shelves/ground
Communicating via telephone, radio/to co-workers,

the public
Listening to equipment
From computer to telephone
Getting inside vehicle
Communicating via telephone, radio/to co-workers,
the public
(Explain/Other Comments)
Page 5

D. Physical Demands (continued)

Machines, Tools, Equipment and Work Aids: List machines, tools and/or equipment that are required for this position. (Not including computer
equipment and software use the next section for this.)
Computer Equipment and Software: List all computer equipment and software that is required for this position.
Environmental Conditions and Health and Safety Conditions: Place an X next to any and all noted Conditions found on the position. Next, place
an X in the square, which would note how often each condition is encountered. For example, if you encounter Respiratory Hazards daily, you
would place an X next to Respiratory Hazards and an X in the box under Daily. If the condition never occurs, then skip the item completely.
Environmental Conditions
Daily
Several Times
Per Week
Several Times
Per Month
Seasonally
Daily
Several Times
Per Week
Several Times
Per Month
Seasonally
Extreme temperature (Heat, cold,

extreme temp. changes)
Wetness and/or humidity (Bodily
discomfort from moisture)
Respiratory hazards (Fumes, gases,
chemicals, dust and dirt)
Noise and vibration (Sufficient to cause
hearing loss)
Physical hazards (High voltage,
dangerous machinery, aggressive
prisoners or patients)
Health and Safety Conditions

Mechanical Hazards
Chemical Hazards
Electrical Hazards
Fire Hazards
Explosives
Communicable Diseases
Physical Danger or Abuse (Specify
below)
Other (Specify below)
Primary Work Location: Place an X next to the location where most of the position duties are performed.
Office Environment
Shop
Outdoors (specify below)
Clinic
Vehicle
Other (specify below)
Warehouse
Rec. Ctr./Neighborhood Ctr.
Protective Equipment Required: List any protective equipment that is required for this position.
Page 6

E. Non-Physical Demands
Non-physical Demands: If applicable for your position, insert the letter next to each Frequency Code for each
non-physical demand listed.
Frequency Codes:
F = Frequently
O
Time Pressures
O
Frequent Change of Tasks
F
Performing Multiple Tasks Simultaneously
F
Tedious or Exacting Work
R
Noisy/Distracting Environment
Explain your responses:
O = Occasionally
R
F
F
R = Rarely
N = Never
Emergency Situations
Irregular Schedule/Overtime
Working Closely with Others As Part of a Team
Other (Describe below):
F. Position Requirements
Formal Education: Place an X next to the minimum educational requirements for the position (not
necessarily what you individually possess).
Minimum
Requirements
Description of Education
Less than high school education
High school diploma or equivalent
Additional training beyond high school (Area of Training):
Two-year Associates degree or equivalent (Degree Area):
Four-year Bachelors degree or equivalent (Degree Area):
Graduate or professional work or advanced degree (specify):
Page 7

F. Position Requirements (continued)

Experience: Place an X next to the minimum experience requirements for the position (not necessarily
what you individually possess).
Minimum
Requirements
Description of Experience
No previous experience required
Six months to one year experience in/as:
Over one year experience in/as:
Over two years experience in/as:
Over three years experience in/as:
Over four years experience in/as:
Over five years experience in/as:
Over six years experience in/as:
Over seven years experience in/as:
Over eight years experience in/as:
Over nine years experience in/as:
Over ten years experience in/as:
Certification and Other Requirements: (List any licenses, certifications, statutory requirements, or
registrations required for this position. This does not necessarily mean the license you have, but what is
required to hire or promote someone into this position, either internally or from the outside. Use exact name
of license, certification, etc.)
What other certifications and licenses are required? (Fill in the blanks below and include professional licenses)
1. Registered Nurse License

2.
3.
4.
5.
Yes or No, Is a valid drivers license required?
If Yes, what type? Yes, regular
Page 8


Reading: Place an X next to the level of reading ability required for this position by identifying examples
of typical reading requirements.
None
Basic - Ability to recognize meaning of common two- or three-syllable words.
Ordinarily, such education is obtained in elementary school up to high school.
However, it may be obtained from experience and self-study.
Intermediate - Ability to read papers, periodicals, journals, manuals, dictionaries,
thesauruses, and encyclopedias. Ordinarily, such education is obtained in high school
up to college. However, it may be obtained from experience and self-study.
Advanced - Ability to read literature, books, reviews, scientific or technical journals,
abstracts, financial reports, and/or legal documents. Ordinarily, such education is
obtained in at the college level or above. However, it may be obtained from experience
and self-study.
Math: Place an X next to the level of math ability required for this position by identifying examples of
typical mathematical calculations required by the position.
None
Basic - Ability to perform the four basic arithmetic operations. Ordinarily, such
education is obtained in elementary school up to high school. However, it may be
obtained from experience and self-study.
Intermediate - Ability to deal with system of real numbers; practical application of
fractions, percentages, ratios/proportions and measurement. Ordinarily, such education is
obtained in high school up to college. However, it may be obtained from experience and
self-study.
Advanced - Ability to apply fundamental concepts of theories, work with advanced
mathematical operations methods, and functions of real and complex variables.
Ordinarily, such education is obtained in at the college level or above. However, it may
be obtained from experience and self-study.
Page 9


Writing: Place an X next to the level of writing ability required for this position by identifying examples of
typical writing assignments.
None
Basic - Ability to write simple sentences containing subject, verb, and object, and/or
series of numbers, names, and addresses. Ordinarily, such education is obtained in
elementary school up to high school. However, it may be obtained from experience and
self-study.
Intermediate - Ability to write reports, prepare business letters, expositions, and
summaries with proper format, punctuation, spelling, and grammar, using all parts of
speech. Ordinarily, such education is obtained in high school up to college. However, it
may be obtained from experience and self-study.
Advanced - Ability to write editorials, journals, speeches, manuals, or critiques.
Ordinarily, such education is obtained in at the college level or above. However, it may
be obtained from experience and self-study.
Problem Solving and Analytical Skills: What is the minimum level of problem solving ability and/or
analytical skills required for this position? Describe the situations that require the use of problem
solving and/or analytical skills.
Page 10

G. Planning and Management Requirements

Planning: Yes or No, does this position involve planning responsibilities dealing with work activities or
projects?
If Yes, describe the planning or project management activities associated with this position.
Budgetary Responsibility: Yes or No, does this position involve preparing, monitoring or administering the
annual budget?
If Yes, please indicate the types of budgetary activities required by placing an X next to it. Select only one.
1. Prepares documents and does research to justify language used in documents for a department. May
recommend budget allocations.
2. Does research for documents, compiles data for computer entry, and/or enters or oversees data entry.
Has responsibility for monitoring budget expenditures (typically non-discretionary expenditures) for
a work unit of less than department size.
3. Oversees budget preparation of department budget. Reviews and approves expenditures of
significant budgeted funds for the department or does research and prepares recommendations for
County-wide budget expenditures.
4. Has responsibility for the final approval of at least one departmental budget and presents the
budget(s) to County Manager. Monitors progress toward fiscal objectives and adjusts plans as
necessary to reach them.
Scope of Budgetary Responsibility: Please provide the total amount of the budget in dollars for which you
are responsible. This amount should include project management or organizational budget responsibility.
Total amount of budget that I am responsible for is $
Additional Comments:
Page 11

G. Planning and Management Requirements (continued)

Supervisory Responsibility: Yes or No, does this position involve directing the work of others?
If Yes, please list the classification titles (not working titles) and number of employees you supervise.
1.
2.
3.
4.
5.
6.
7.
8.
Classification Title(s)
Registered Nurse
Licensed Practical Nurse
Certified Nursing Assistant
Administrative Supervisor
Interpreter
Physician
Number of Employees
7
2
3
1
1
1
Nature of Work Direction: If you answered Yes to the question above, please indicate the nature of work
direction provided by the position by placing an X next to it.
Nature of
Work Direction
Work requires the occasional direction of helpers, assistants, seasonal employees, interns, volunteers
or temporary employees.
Work requires functioning as a lead worker performing essentially the same work as those directed
and includes overseeing work quality, training, instructing, and scheduling work.
Work requires supervising and monitoring performance for a regular group of employees or a work
unit including providing input on hiring/disciplinary actions and work objectives/effectiveness and
realigning work as needed.
Work requires managing and monitoring work performance by directing subordinate supervisors or
administrators including making final decisions on hiring and disciplinary actions, evaluating
program/work objectives and effectiveness, and realigning work and staffing assignments, as
needed.
Work requires managing and monitoring work performance of senior department managers
including evaluating program/work objectives and effectiveness, establishing broad organizational
goals and realigning work and staffing for the department.
Page 12

G. Planning and Management Requirements (continued)

Freedom to Act: This factor will assist in determining the positions level of freedom to act. Limitations of
freedom to act or position independence may include: supervisory control, the nature of the work, established
policies and procedures, and/or legal constraints. Please indicate the extent to which you are free to act in the
absence of supervision and/or policies and procedures by placing an X next to it. (Choose only one level.)
Receives Immediate Direction: Within this position, the employee normally performs the duty
assignment after receiving detailed instructions as to methods, procedures, and desired end results.
These detailed instructions normally allow little room for deviation. The immediate supervisor may,
at times, provide close and constant review while work is under way and when the assignment is
completed.
Receives Direction: Within this position, the employee normally performs the duty assignment after
receiving general instructions as to methods, procedures, and desired end results. The employee has
some opportunity for discretion when making selections among a few, easily identifiable choices.
The assignment is usually reviewed upon completion.
Receives General Direction: Within this position, the employee normally performs the position by
following established standard operating procedures and/or policies. The employee may choose the
appropriate procedure or policy to apply to duties. Performance is reviewed periodically.
Receives Limited Direction: Within this position, the employee normally performs the duty
assignment according to his or her own judgment, requesting supervisory assistance only when
necessary. The assignment may be reviewed upon completion. Performance is reviewed
periodically.
Receives Broad Direction: Within this position, the employee normally performs the duty
assignment within broad parameters defined by general organizational requirements and accepted
practices. Total end results determine effectiveness of position performance.
Page 13

H. Human Relations
Interpersonal/Human Relations Skills: This factor measures the position requirements of personal interaction
with others outside direct reporting relationships (i.e. internal and external customers and suppliers). The
interaction may include the general public, volunteers, other divisions in the County and its branches
including boards and commissions, governmental organizations and officials, vendors, suppliers, etc. Choose
only one level by placing an X next to it.
Description of
Level of Interaction
Work requires minimum or limited contact with individuals. The purpose of contact is to exchange
and/or receive basic information.
Work requires regular contact with individuals and may require providing advice to others on specific
issues and/or general policies. Contacts may require the consideration of different points of view to
reach agreement. Elements of persuasion may be necessary to gain cooperation and acceptance of
ideas.
Work requires frequent and regular contact with others in a direct reporting relationship and may
involve contact with others outside of the direct reporting relationship. The purpose of the contact is
to address specific issues and/or general policies. Contact may involve support of controversial
positions or the negotiation of sensitive issues.
Work requires frequent and regular contact with others in a direct reporting relationship as well as
others outside of a direct reporting relationship. The purpose of the contact is to address specific
issues and/or general policies. Contact may involve support of controversial positions or the
negotiation of sensitive issues. Evaluates customer satisfaction, develops cooperative associations
and relationships, and utilizes resources to continuously improve external customer relations and
satisfaction. Makes presentations and answers questions in regard to presentation materials and
findings.
Work requires very frequent and regular contact with others in a direct reporting relationship as well
as others outside of a direct reporting relationship. The purpose of the contact broad reaching and
dynamic and may include the communication specific issues and/or general policies. Interaction with
others outside of the department requires exercising participative management and negotiation skills
that support County strategy and organizational goals. Work also requires the communication with
direct reports to ensure maximum productivity in work assignments. Makes presentations and
answers questions in regard to presentation materials and findings.
Page 14

I. Career Path Definition

Please indicate other County positions that are related to this position as part of a career family.
Other classifications in the County to which those
1. Nursing Supervisor
that hold my current classification might be
2.
promoted.
3.
My Current Classification
Other classifications in the County that would
1. Registered Nurse
prepare applicants for my current classification.
2.
3.
J. Signature/Approval
To the best of my ability, I have completed this questionnaire, and believe it to be an accurate description of my position.
X
Employee Signature
X
Immediate Supervisor Signature
Comments:
X
Next Level Supervisor Signature (if applicable)
Comments:
X
Department Head Signature
Comments:
Date
Date
Date
Date
Page 15

General Instructions To Complete The PDQ Electronic Template Form

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General Instructions To Complete The PDQ Electronic Template Form

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Position Description Questionnaire Electronic Template Form

Wake County, North Carolina