SELF-PACED
NURSING
ORIENTATION
Revised 8/2014
Care Values

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Community
 Committed to Exceptional Customer Service
Accountability
 In Action and Results
Respect and Dignity
 “The Golden Rule”
Excellence
 Is Our Only Standard
Big Hairy Audacious Goals
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High Satisfaction
 Customer Service
High Quality
 In all Services
Low Cost
 Productivity, Economics
Best People
 People Growth, Organizational Climate,
Innovation
Philosophy of Nursing

Holistic View


Views people as open, integrated, biological,
psychological, sociological, and spiritual system
whose beliefs, responses, and behaviors are
culturally determined.
3 Roles in Department of Nursing

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Service
Education
Research
QUESTIONS
1.
What is the CARE Vision?
a. A financial policy regarding payment for
hospital services
b. A series of protocols addressing the utilization
of new medications
c. Vision in service which includes community,
accountability, respect, & dignity for all, &
excellence in service.
QUESTIONS
2.
What is the philosophy of the Department of
Nursing Service?
a. Provide patient care based on the medical
model
b. Provide a curative, medical approach
c. Provide a collaborative, holistic approach to
patient care.
Organizational Chart



Chief Executive Officer (CEO)
 James Valenti
Chief Financial Officer (CFO)
 Michael Nunez
VP Ancillary & Support Services
 Maria Zampini
Chief Nursing Officer (Interim)
Dr. Joe Garcia
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Ortho
Medical
Surgical
Critical Care
Emergency
Mother Baby
Cardio-Vascular Svcs
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Specialty Care Nurseries
Labor & Delivery
Perioperative
Family Planning
Respiratory Therapy
Nsg Support Svcs
Care Management
House Staff/Medical Staff
Lines of Authority
Chief of Staff
Clinical Chief
Attending
Senior Resident
Resident
House Staff/Medical Staff



Residents = House Staff
Attending = Medical Staff
Notify Nurse Manager (during daytime hours)
or Administrator of Day (after hours) of
communication problems with physicians
Medical Specialties

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Anesthesiology – 4 years
Emergency Medicine – 3 years
Family Medicine – 3 years
Internal Medicine – 3 years
Obstetrics & Gynecology – 4 years
General Surgery – 5 years (2 teams- one is
trauma)
Orthopedic – 4 years
Transitional – 1 year
Questions
3.
4.
A second or third year physician is referred to as
a. Senior resident
b. Attending physician
c. Chief of Staff
Who do you notify if there is a concern about a
resident?
a. Nurse Manager/Chief of Staff
b. Chief of Staff/Administrator of the Day
c. Senior Resident/Nurse Manager/Administrator of
the Day
Competency Assessment Forms

Orientation Record
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

Beige form that must be completed within 3 months of
being employed. Must be checked off & signed by
preceptor and nurse manager.
Must be turned into nurse manager before 3 month
evaluation & it will be forwarded to Nursing Education
for your file.
Obtain unit specific competency packet for Nursing
Support Services-Education Division
Competency Assessment Forms

Competency Assessment Form



Table listing skills that must be checked off during
orientation period on the unit. Skills are specific to
area. Must be checked off by preceptor.
Skills checked off as “yes” indicate person was
competent to perform listed skills at that particular
time.
Forms must be turned in to Nurse Manager before 3
month evaluation. Will be forwarded to Nursing
Support Services-Education Division to be placed in
your education file.
Dress Code


Uniform colors – depend on unit
L&D and Perioperative associates have access
to hospital furnished scrubs.
 Must wear long lab coat over uniform when
outside unit.
 Must wear street clothes to work, change into
uniform at work, and change back into street
clothes when leaving for the day.
Dress Code
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No prosthetic nails
No dangling jewelry
No rings in nose, lips, eyebrows, tongue,
or other body parts other than ear lobe
No open toed shoes, no canvas shoes
Shoes/tennis shoes must be white with
minimal decoration.
Dress Code

Unit Clerks
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
Office Associates
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Wear royal blue top and white pants/skirt or
uniform approved for the unit
Professional attire
Administration

Professional attire
Questions
5.
Which of the following are not allowed in the dress
code?
a. Prosthetic nails, dangling jewelry, & nose rings.
b. Leather white tennis shoes, small earring studs, &
one ring set per hand
c. Badge above the waist, closed toe shoes, & two
rings per hand
Scheduling


Call-in times: 2 hours
prior to AM shift; 3
hours prior to PM shift
Notify nurse
manager/nurse in
charge when calling in
sick/absent or tardy
Associate Requests Not to
Participate in Patient Care


Policy H-5-5
Requests are allowed when
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An associate demonstrates that a particular
procedure, treatment, or aspect of care
conflicts with his/her cultural values, ethics, or
religious beliefs.
An associate requests to be off certain days or
parts of the day based on specific requirements
of his/her religious beliefs.
Associate Requests Not to
Participate in Patient Care

Requests that WILL NOT be considered

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Requests not to care for patients with infectious
diseases or who are HIV+
Requests not to care for patients related to health
of associate or associate’s unborn child
Associate Request Not to
Participate in Patient Care

Processing of approved requests:

Must be in writing to associate’s
immediate supervisor & must include

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Specific procedure the associate does
not wish to participate in
Clear description of the nature of conflict
with cultural values, ethics, or religious beliefs
Suggestions regarding how request may be filled
without negatively impacting patient care.
Staff Requests Not to Participate in
Patient Care


Human Resources and the supervisor will
approve the request in writing if it can be
accommodated
Human Resources and the supervisor will deny
the request in writing if it can not be
accommodated
Mandatory
Inservice/Education
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
Policy NC-A-7.4
Mandatory annual inservice on General Safety, Infection
Control, & Electrical Safety
Basic Cardiac Life Support (BCLS) is mandated
biennially for the following:

EKG Technicians
Emergency Medical Technicians – Intermediate
Emergency Medical Technicians-Paramedic
Graduate Licensed Vocational Nurses
Graduate Professional Nurses
Health Unit Coordinators/Surgical Technicians
Health Unit Coordinators/Monitor Techs
Health Unit Coordinators/Nursing Assistants (Emergency Dept. and Float Pool
only)
Monitor Techs
Nurse Interns
Nurse Technicians
Nursing Assistants Emergency Department
OB Triage Advanced Practice RNs (APNs)
Patient Transporters
Stress Test Technicians
Surgical Technicians
Mandatory Inservice/Education

Advanced Cardiac Life Support (ACLS) is
mandated by the end of the first year of
employment for RNS in
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Emergency
Adult Critical Care Units
Telemetry
PAR
ASU/Endoscopy
OR (By end of second year)
Labor & Delivery/Antepartum
Cath Lab
Mandatory Inservice/Education

Pediatric Advanced Life Support
(PALS) is mandated by the end of
the first year of employment for
RNS in
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ED (or Emergency Nurses Pediatric Course)
Cath Lab
PAR (by end of second year)
Mock Code Training is required on an
annual basis for all licensed associates,
CNAs in Float Pool, CSTs & EMTs
Mandatory Inservice/Education

Mock Code Adult is required for:
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Medical
Surgical/Ortho/Trauma/Women’s
Mother Baby/Newborn Nursery
Labor & Delivery/Antepartum
ICU/CVICU
Emergency
Perioperative Services (OR,PAR,ASU,ENDO)
Acute Care Elderly (ACE)
Cath Lab
Mandatory Inservice/Education

Mock Code Pediatric is
required for
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Emergency
PAR
ASU
Endoscopy
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Neonatal Mock Code is
required for
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Labor and Delivery
Mother Baby
Emergency Room
Questions
6.
7.
Who do you notify when absent or tardy?
a. Unit Clerk
b. Nurse in Charge
c. Nursing Supervisor
Which inservices are not mandatory every year?
a. Infection control
b. General/Fire safety
c. Employee Survey
Departments

Pharmacy
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Unit-based Pharmacists
support an interdisciplinary
approach to patient care.
Inpatient Pharmacy services
is available 24 hours-a-day,
seven days-a-week.
After hours, medication
orders are faxed or sent via
the pneumatic tube system to
Pharmacy.
Outpatient Pharmacy
services-Monday thru
Friday-07am-4:00pm,
Saturday-08am-5:00pm.
Closed on Sundays and
Holidays.
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Food & Nutritional Care
Services
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Cardiopulmonary
Services
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Open 6am – 10pm.
Tray line closed after 730
pm. Grill open till 1130
20% discount for associates
Open 24 hrs for respiratory
therapy
EEG open M-F
Materials Management

Open 24 hrs. All stock
items. Carts on units
Departments
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Radiology
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Open M-F 8am-5pm at
radiology dept
Nuclear Medicine done
after hrs in emergency
cases only
Satellite radiology area
open 24 hrs in the ED
Blood Bank
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In ED in west side
Open 24 hrs
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Morgue
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Located in basement
For after hrs contact Guest
Services
Must log in pt upon
entering & must know if
autopsy case or not
Environmental Services
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Open 24 hrs
Visitation
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Open visiting hours from 8am – 8pm
Limit 2 visitors per person
Children under 12 require special
permission to visit a pt. Special form must
be filled out by the nurse caring for patient
Disaster
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Emergency Code – Plan D
If internal or external Level 3, you will be
called to report to the personnel pool in the
auditorium.
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No one can go home until you are relieved
BE FAMILIAR WITH YOUR UNIT’S
DISASTER MANUAL!
Questions
8.
9.
Children under 12 are allowed to visit with
special permission.
a. True
b. False
In an internal disaster, associates report to the
auditorium.
a. True
b. False
On the Job Injury

Can be seen in the Associate health clinic
from 0730-1600 and after hours in the
Emergency Department at your own
expense.
Documentation
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Use only hospital-approved abbreviations
Documentation is required on every pt, every shift by all
associates involved in the care of pt
Errors are corrected with single line, error written above,
& initialed.
Use black ink (only when Cerner is down)
Document utilizing nursing process:
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Assessment
Nursing Dx
Patient Outcomes
Nursing Interventions
Evaluation of plan of care
Reassessment
Documentation
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Admission assessments should be
completed within 8 hours of admission

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A shift assessment is required for all patients.
The patient plan of care will be completed
within 8 hours of admission
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The plan of care will be reviewed/revised
every 72 hours
It will be revised/evaluated on an ongoing
basis & prior to transfers and discharges
Documentation
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Progress Notes
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Will reflect nursing process by documentation of
nursing interventions
Chart effectiveness of the interventions against the
stated outcomes
Each entry will be prefaced by date & time care was
provided
All entries will reflect a Nursing Dx if possible
Block charting is not acceptable
Documentation
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Admission Note
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Chart assessments or information pertinent to the
patient’s condition which are not included on the initial
admission assessment (CUA)
Chart notification of medical staff
Treatment/Procedure Note
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Patient preparation
Time started & ended
Type of procedure done
Response of patient including untoward reactions
Documentation
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Incident Report
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Not charted in progress notes
Chart only OBSERVED FACTS
Assessment of patient, interventions, & responses
Notification of appropriate resources
Discharge Note
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Enter after discharge instructions are completed
AMA patients – chart the details surrounding the
patient’s decision to leave & any nursing actions taken in
the progress notes
Questions
10.
11.
While charting on the paper Medical Record you
make an error, you would proceed to
a. Continue charting
b. Draw a line thru the error, write error, & your
initials
c. Use white-out over the mistaken entry
An admission assessment & care plan should be
completed within
a. 12 hours
b. 8 hours
c. 24 hours
Admission
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Introduce yourself & check
ID band
Assess the patient, perform H&P
Inform of advance directives
Review/assess medication hx
Notify admitting of any valuables & send to safe
Complete plan of care
Notify attending physician of admission, if necessary
Check MD’s orders & initiate appropriate action
Protective Devices

Examples of protective devices:
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Side rails (2 full length or 4 half length)
Helmets
Gauze ties
Protective Devices – Side Rails

Before initiating side rail use, an RN will assess
the patient for the following risk factors:
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Patient’s age
Ability to walk
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Vision
Degree of muscle control
Pre/post op meds
- Mental Status
- Cerebral disorders
- Physician’s order
- Risk for withdrawal
- Meds causing
decreased sensorium
Protective Devices – Side Rails
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If patient qualifies for side rails, document in
progress notes the risk factors leading to side
rails
Initiate Nsg. Dx. of Injury, Potential for
Assure side rails locked in place & call bell
within reach. Instruct pt on how to use call bell
RN will routinely assess continued need for
side rails
Patient Entrapment

Patients at risk for entrapment when side rails
raised:
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Preoperative & Postoperative
Sedated
Disoriented/confused/senile
With seizure disorder
Under 6 years of age
With impaired vision
With cerebral disorders
Restlessness
Patient Entrapment


Assess bed for areas of potential entrapment
Utilize bed side rail protective barriers to
close off open spaces in which identified
patients may accidentally become entrapped
Questions
12.
13.
What do you do with a patient’s valuables if no one
from home can pick them up?
a. Keep them at bedside
b. Store at nurses’ station
c. Call admitting to pick up valuables
Which of the following patients are at risk for
entrapment?
a. Children under 6 years of age
b. Patients with seizure disorder
c. Both a & b
Restraints

If decision is made to restrain pt., MD
order will contain the following:


Patient’s behavior requiring restraints
Time limitation (not to exceed 24 hours)

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If restraints need to be continued, a new order will
be needed
Type of restraints


Consider how quickly it can be removed in an
emergency, i.e., fire
Adequate number of staff available to assist with
applying the restraint
Restraint

In an emergency (patient is in immediate
danger of hurting him/herself or others), a
licensed nurse, after assessing the patient,
may initiate restraints

Nurse must obtain a written physician’s order
within 1 hour of having placed the restraints
Restraints

Types of restraints

Soft Restraints (Wrists & Ankles)
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Tie straps in a square knot at wrists or ankles
Secure straps to bed frame or wheelchair
Assure the circulation distal to the restraint is not
compromised
Restraints

Leather Restraints

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Should no longer be used in this institution
Verify call bell is in easy reach of the patient
Explain to patient/family reason for placing
patients in restraints
Restraints
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A time-limited order for restraints does not
require application of the intervention for the
entire period.
If an improvement in behavior is demonstrated,
restraints can be released.
If the behavior escalates after the restraints have
been removed, the restraints can be re-instituted.
At the end of the time-limited order or daily, the
physician will reassess the patient & decide if the
restraints are meeting the assessed pt’s needs.
Restraints

Document on Daily Restraint Checklist:
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Explanation to family
Time limit of current physician’s order
Behavior required for restraints to be released
Patient’s behavior every 30 minutes
Every 2 hours document the following:
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Skin integrity
Remove/loosen extremity restraints for 5 min.
Reposition patient
Offer fluids
Offer bathroom privileges
Alternatives to Restraints
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Sitting in geri-chair
Applying side rails to bed
Reorienting to person, place, time, & situation
Padding/filling side rails
Retaping life lines & tubes
Engaging patient in diversional activity
Modifying pt’s environment (decrease noise,light)
Allowing family member to remain with patient
Questions
14.
15.
How often should patient behavior be checked?
a. Every 2 hours
b. Every 30 minutes
c. Every hour
When restraints are applied in an emergency, a
written order should be obtained in
a. One hour
b. 24 hours
c. 4 hours
Questions
16.
17.
An alternative to restraints would be to allow
a family member to stay.
a. True
b. False
Documentation should include patient’s
behavior and explanation to the family
a. True
b. False
Transfers
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Transfers should occur within 30 min.to 1 hr
Transfer form should be filled out & given to
receiving unit
Transfers to critical care area require a nurse to
accompany pt & give report
Patients admitted/transferred to Telemetry or
Critical Care must be on a cardiac monitor and
Gomco suction machine taken
Transfers from Mother Baby to L & D may be
transferred by a nurse or nursing assistant
Intranursery transfers – parents should be notified of
transfer by physician
Out of Hospital Transfers
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Memorandum of Transfer form must be filled out
by hospital sending patient
Consents for transfer must be signed & in the
chart
Copies of medical record, labs, x-rays, etc. must
be ready for transfer
Must have a receiving physician & administrative
approval
Refer to nurse in charge if transferring patient
Questions
18.
19.
20.
Intrahospital transfers to Critical Care or Telemetry require that
the patient be on a cardiac monitor.
a. True
b. False
Transfers to Critical Care do not require a nurse accompany the
patient.
a. True
b. False
Out of hospital transfers require a receiving physician &
administrative approval.
a. True
b. False
Standard Precautions


Apply to blood, all body fluids, secretions,
excretions (except sweat), non-intact skin, & mucous
membranes
Transmission Based Precautions


For patients with documented or suspected highly
transmissible or epidemiologically important pathogens
Three types of precautions

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Airborne
Droplet
Contact
Standard Precautions

Airborne
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Reduce the risk of airborne transmission of infectious
agents
Place pt in private room with negative air pressure
Keep door closed with appropriate sign
Wear a disposable particulate respirator mask when
entering room of pulmonary TB pt.
Susceptible people should not enter the room of a
measles or chickenpox pt if immune persons can care for
pt.
Immune persons do not need a mask to enter the room
Standard Precautions

Droplet Precaution
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Suspected or known infection where transmission
is via large particle droplets
Private room for pt & sign on door
Maintain spatial distance of at least 3 feet
between infected pt & other pts/visitors
Wear surgical mask to enter room
Mask pt if transporting elsewhere
Standard Precautions

Contact Precautions
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
Known or suspected infection colonized with
epidemiologically important microorganisms
that are transmitted via direct or indirect
contact
Private room with sign on
door
Wear gloves and wash
hands
before & after contact
Standard Precautions



Standard precaution cabinets located outside
rooms or next to pt
Do not report to work if infectious disease is
present. i.e., conjunctivitis, diarrhea, chicken pox
Report patient cases of infectious diseases to
Infection Control Dept.
Questions
21.
22.
Standard precautions has 3 types of precautions:
Airborne, Contact, & Droplet
a. True
b. False
You do not report to work if you have conjunctivitis .
a. True
b. False
Cardiac Arrest


Avoid touching EKG wires with defibrillation
paddles when defibrillating
Person defibrillating will shout “Everyone clear!”
Crash Cart



Cart should be kept locked at all times
If found open, return it to Central Supply
Crash cart O2 cylinders with blue regulators are to
be used in emergencies only
Crash Cart

Crash cart should be checked once per day by nurse



Biphasic defibrillator should be checked the same way
using the attached plug housing and at 30 joules.
Oxygen cylinder should be checked to ensure enough
oxygen available
Ensure crash cart locked and serial number matches on
tag and lock
Questions
23. The Emergency Code for Cardiac arrest is
a.Code Orange
b.Doctor Red
c.Code Blue
24. Defibrillation is performed by
a. ACLS trained nurse
b.Physician
c.Both a & b
Questions
25. Avoid touching EKG wires with defibrillator pads when
defibrillating
a. True
b.False
26. Crash cart should be locked at all times
a. True
b.False
27. If crash cart is found open it should be
a. Returned to Central Supply
b.Relock it yourself
c.Restocked by yourself