Clinical Bedside Orientation Workbook
Directions: Please use the attached checklist and activity booklet as a guide for Clinical
Orientation activities. It is also a tool for giving/receiving feedback between you, your clinical
guides (aka ‘buddy nurses). It is also helps you start to develop your day-to-day organization
and patient planning – a necessary practice element on 5A/B. By the end of your bedside
orientation this booklet should be completed and a copy submitted to Marie McCoy, CNE for
your file. If you have ANY questions along the way, PLEASE ask!
Clinical Bedside Objectives – Day 1: On the initial Bedside Orientation day with Marie or
Susan the New 5AB RN will:
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Give/receive verbal report using the Heart Centre Care Map
Interpret ECG rhythm strips
A basic understanding of the Drager® ECG monitoring system
Planning patient care for the day
Performing safety checks on patients
Performing a physical assessment, as per “Cardiac Ward Assessment” protocol
Administer medications as per CRNBC and PHC standards
Document patient care on PHC flow sheets (i.e. Cardiac Sx Clinical pathways/ 24 hour
Flow sheet).
Communicate patient needs using a variety of communication tools and
methods
Operate and check commonly used equipment
Locate regular used ward supplies
Date: _________________________
New 5AB RN:_____________________ with Marie McCoy or Susan Roth, CNE
Activity
Giving/Receiving Report
√
Comments

CNE demonstrates receiving report in a.m.
using the Heart Centre Care Map
 CNE reviews 5A/B specific ‘report cheat
sheets’ and unit layout
 CNE review additional tools that could be
used to give/receive report
-


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Flow sheets, MAR, Chart, Unit white board
New RN gives a break report to break
buddy
New RN to gives end of shift report
CNE feedback to New RN on report giving
Unit Socialization
 Orientates RN to the ward layout
 Verbally review ward routines
During the shift, the CNE introduces the new hire
to:
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CNL
NP(s) (as available)
Unit Clerk(s)
Ward Aide(s)
Other RNs working this shift

Multi disciplinary team (as available):
-
Physiotherapist
Dietician
Pharmacist
Occupational Therapist
Pastoral Care
-
Social Worker
Physicians (as available)
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Plan care for the day

CNE leads discussion regarding plan for pt
care, including:
-
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a.m. care
medication administration
discharge planning and teaching
- diagnostic tests or interventions, etc.
CNE review ‘care planning’ document (to
be completed on 1 patient per ‘buddy’
shift).
New RN follows through with planned
activities
CNE provides on-going feedback (see
comments)
Safety Check(s)

CNE demonstrates safety check and give
rationale
Performing Safety Check(s)

Safety checks to include:
-
-
ECG/cardiac monitoring alarms appropriate
Bed in lowest position
Railings down
Suction equipment working & available
(canister, tubing, yankauer)
Oxygen equipment available (nipple, simple
FM, meter)
IV patent
-
Call bell within reach
-
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Interpreting ECG Rhythms – Review
Review tele protocol:
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CNE explains when to take strips
-
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Look up protocol
What is the difference between Class 1 & 2
tele?
Other d/c criteria i.e. VAD pts or Cardiac Sx
pts
Frequency of electrode changes
At start of shift
- With each change in condition
- Demonstrates where ‘strips ‘are documented
New RN to analyze pt’s ECG strip and
document appropriately
New RN to explain any possible signs or
symptoms related to the rhythm analyzed
CNE and New RN to demonstrate
appropriate care for rhythm
CNE and New RN reviews 3-5 other pt’s
ECG rhythms currently on ward
Cardiac Monitoring System Review and Practice
 Printing/recording strips
 Personalizing alarm settings & protocol for
 Alarm ‘re-learning’
 Tele suspension
 Transfer rooms
 Transfer tele packs
 Full disclosure/event disclosure
 Printing of above
 Calipers – how to use
 Equipment location and care/cleaning
expectations
Transport Monitors
 Where they are
 When they used
 How to use it – basic functions
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Cardiac Physical Assessment


CNE reviews cardiac assessment as per
protocol
CNE demonstrates listening to heart sounds
and includes the following information:
-
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S1S2 audible (not responsible for extra heart
sounds)
Discusses trend sounds (are they different
than the a.m., after epi wire removal)
Extra/abnormal sounds can be reviewed
with NP
New RN listens to heart sounds
CNE demonstrates listening to lung sounds
Auscultation Tips
- Don’t listen through gown
Provide privacy
CNE reviews all aspects of New RN’s
physical assessment and documentation provides feedback

See blue handout regarding
breath sounds in orientation
binder
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Medication Administration

New RN to explain 7 rights of medication
administration (Right medication, right patient,
right time, right does, right route, right reason, right
documentation).

CNE review PHC Standards for Procedure for
Processing Orders, MAR: Discontinuing a medication
order procedure & MAR: Next-day Medication
Administration Record Verification

New hire to spend 1 hour with Unit
Coordinator to review their role and
reinforce above.

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New RN to administer all patient
medications; under CNR supervision
MAR to the bedside and using 2 patient
identifiers with every med administration
Medications remain in pharmacy
packaging until administered at the
bedside unless medication prep is required
New RN to explain/teach reason for
medications being given in regards to
individual patient history/diagnosis
New RN performs 3 safety checks

New RN signs for medication in MAR

New RN does NOT pre-pour medications
(show examples of pre-pouring and
reinforce ‘danger’ in this practice).
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New hire to review and practice
Procedure for Processing Orders,
MAR: Discontinuing a medication
order procedure & MAR: Next-day
Medication Administration Record
Verification Procedure during
Guided Clinical shifts.

They are:
_____________?
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Documentation

Clinical Teacher shows documentation
forms and where they are kept (i.e. 24 hour
flow sheet, Clinical record, Cardiac sx pathway
documentation tool, EKG record, MAR, ID progress
notes)

Clinical Teacher explains tips for good
charting:
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Using the DAR approach or “New” Cardiac
sx assessment record
Chart only what you need to
Don’t double chart
Chart as close to the time of the event as
possible
Keeping in mind who is reading the charting
Chart only the care you provide
Chart all the care you provide
Write legibly

CNE explains charting in ID notes (re: 5A
vs. 5B ‘nroms’)

New RN charts a.m. assessment and any
further care provided during the day

CNE provides direct feedback regarding
charting
Unit Communication

CNE reviews different forms of
communication and patient care planning to
New RN (i.e. board rounds, Interdisciplinary
rounds (Wednesdays-5B), documentation (as above),
one to one (face to face, telephone etc.), Show call list
location and who to call; review ‘who to call handout’
in orientation binder.

New RN to observe above communication
techniques throughout shift

New RN to participate board
rounds and in communication
using SBAR format during
guided bedside shifts
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Equipment Demonstration
 CNE shows storage location and
demonstrate correct use of the following
equipment (review related available
protocols on-line)
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Glucometers, including
 Maintenance checks (show nightly
‘checks’ binder
Hopper
PCA pumps (has protocol)
Least restrain equipment (has protocol)
Pinel restraints (has protocol)
- Trach equipment (has protocol)
- Portable ‘dressing carts’
New RN to describe where to find various
supplies and equipment
New RN to return demonstrate correct use of
equipment (described above).
Section I:
Clinical Bedside orientation day Homework!
1. Reflect on your classroom and bedside orientation. Send Marie
(mdmccoy@providencehealth.bc.ca) or Susan (sroth@providencehealth.bc.ca) an E mail
with the following evaluative information (within 1 week):
 The thing I enjoyed most about classroom orientation was…
 In class, I wish we had spent more time on….
 In class, I wish we had leant about…
 The thing I enjoyed most about the clinical bedside orientation was…
 Two questions I still have are…(please try to think of questions or topics that have ‘occupied’
your thoughts since classroom or bedside orientation).
2. Complete the following ‘Reverse Case Study’ and submit (via E mail or ‘hard copy’) during
your Orientation Check-In with Marie or Susan.
Reverse Case Study Directions: The goal of the exercise is to understand how pieces of information relate
and to anticipate the plan of care for your ‘imaginary’ patient.
Using your nursing knowledge, formulate this case study including:
 Previous medical history, considering risk factors for the current situation
 What you would assess and expected findings
 Nursing and medical interventions expected
 Expected lab and diagnostic tests that may be ordered and their results
 List at least 3 nursing diagnoses and the expected outcomes after the interventions
Remember, there are many ‘right’ answers. You decide what the medical history will be based on the
medications and the current course. The other boxes will be completed based on what you decide.
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Home Medications:
Metformin 500 mg po BID
Metoprolol 25mg po BID
Lasix 40 mg po daily
ASA 81 mg po daily
Atorvastatin 40 mg po daily
Ramipril 5 mg po BID
Pantoprazole 40mg po daily
Allopurinol 300mg TID
Digoxin 0.25mg po daily
Clopidogrel 75mg po daily
Current Course: Patient is a 73 yr old male who came
to ER complaining of palpitations, lightheadedness, and
chest pain beginning a few days ago. Also, increased
tiredness and short of breath with minimal exertion.
Previous Medical History
Your Assessment Data
Medical Diagnoses
Nursing Diagnoses
Expected lab and diagnostic tests with results
Anticipated/actual collaborative and
nursing interventions/orders
Expected outcomes for Nursing Diagnoses (at least
5)
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Section II: On a minimum of 5 Guided Clinical Shifts – Complete the following table for ONE of
your assigned patients (i.e. you should complete a minimum of 5 tables before you have completed your ‘buddy’ shifts).
Pt’s (1) Admitting Diagnosis:
Age:
Sex:
Known Cardiac Risk Factors:
5 key pieces of data I received from shift handover
(report):
Pt specific ‘head-to-toe’ assessment findings
(comment on a minimum of 3 systems).
1)
2)
3)
4)
5)
My TOP 3 goals for this pt on this shift:
To accomplish these goals I will…
1)
Goal 1:
2)
Goal 2:
3)
Goal 3:
Other information I feel is important to help me prioritize and plan my care for this pt is:
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September/October 2012
Pt’s (2) Admitting Diagnosis:
Age:
Sex:
Known Cardiac Risk Factors:
5 key pieces of data I received from shift handover
(report):
Pt specific ‘head-to-toe’ assessment findings
(comment on a minimum of 3 systems).
1)
2)
3)
4)
5)
My TOP 3 goals for this pt on this shift:
To accomplish these goals I will…
1)
Goal 1:
2)
Goal 2:
3)
Goal 3:
Other information I feel is important to help me prioritize and plan my care for this pt is:
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September/October 2012
Pt’s (3) Admitting Diagnosis:
Age:
Sex:
Known Cardiac Risk Factors:
5 key pieces of data I received from shift handover
(report):
Pt specific ‘head-to-toe’ assessment findings
(comment on a minimum of 3 systems).
1)
2)
3)
4)
5)
My TOP 3 goals for this pt on this shift:
To accomplish these goals I will…
1)
Goal 1:
2)
Goal 2:
3)
Goal 3:
Other information I feel is important to help me prioritize and plan my care for this pt is:
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September/October 2012
Pt’s (4) Admitting Diagnosis:
Age:
Sex:
Known Cardiac Risk Factors:
5 key pieces of data I received from shift
handover (report):
Pt specific ‘head-to-toe’ assessment findings
(comment on a minimum of 3 systems).
1)
2)
3)
4)
5)
My TOP 3 goals for this pt on this shift:
To accomplish these goals I will…
1)
Goal 1:
2)
Goal 2:
3)
Goal 3:
Other information I feel is important to help me prioritize and plan my care for this pt is:
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September/October 2012
Pt’s (5) Admitting Diagnosis:
Age:
Sex:
Known Cardiac Risk Factors:
5 key pieces of data I received from shift handover
(report):
Pt specific ‘head-to-toe’ assessment findings
(comment on a minimum of 3 systems).
1)
2)
3)
4)
5)
My TOP 3 goals for this pt on this shift:
To accomplish these goals I will…
1)
Goal 1:
2)
Goal 2:
3)
Goal 3:
Other information I feel is important to help me prioritize and plan my care for this pt is:
Section III: Clinical Guide Shift Feedback: It is your responsibility to give these 3 feedback forms to 3
different clinical guides. Please have them complete this form and 1) Make a copy (for you to keep and 2)
Hand-in the originals during your orientation check-in or at the end of your bedside orientation.
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Written and verbal feedback is a vital component to building the confidence and skills of our new 5AB RN’s. Please
take a few moments to document key areas of strength and areas for improvement for your new colleague; please be
specific with your comments and provide examples (under each heading) to illustrate your comments where possible
(point form is acceptable). This feedback will be reviewed with the new hire on their orientation check-in. Thank you
for your hard work and continue support throughout the orientation process.
Assessment:
Example: Marie’s head-to-toe assessment was well organized and
comprehensive, but she needs more practice with identifying adventitious
lung sounds.
Documentation:
Example: Marie needs to work on concise documentation. One way she
could improve would be to document only by exception. Also, Marie needs
to remember to document the ‘Response’ of her ‘Actions.’
Medication Administration:
Example: Marie is conscientious regarding her 7 Right of Med
Administration. Always took the MAR to the beside; medications given in
appropriate time frame.
Clinical Thinking:
Example: Marie’s clinical judgment and knowledge translation is appropriate
for her experience level. For example, Marie was able to identify the ‘most
acute’ pt in our assignment and prioritized his care accordingly.
Time Management:
Example: Marie was frequently ‘running behind’ throughout her day. One way
she could improve her time management would be to ‘cluster’ her tasks and
ensure she has everything she needs before commencing.
Communication & Patient Teaching:
Example: Marie tends to be long winded. Marie needs to be more direct in her
communication style to ‘get her point across’ more efficiently. This will also help
to improve her time management.
ECG Interpretation:
Example: Marie was to correctly interpret ¾ pt ECG rhythms, but some
prompting was required. Marie needs to review her 2nd degree blocks.
General Observations:
Example: Marie is a compassionate and team oriented nurse – this is her
greatest strength. She needs to improve her time management and patient
teaching skills as she still feels uncomfortable with much of the discharge
teaching material. I think she could benefit from an additional Clinical
Transition shift.
15 of 20
September/October 2012
Written and verbal feedback is a vital component to building the confidence and skills of our new 5AB RN’s. Please
take a few moments to document key areas of strength and areas for improvement for your new colleague; please be
specific with your comments and provide examples (under each heading) to illustrate your comments where possible
(point form is acceptable). This feedback will be reviewed with the new hire on their orientation check-in. Thank you
for your hard work and continue support throughout the orientation process.
Assessment:
Example: Marie’s head-to-toe assessment was well organized and
comprehensive, but she needs more practice with identifying adventitious
lung sounds.
Documentation:
Example: Marie needs to work on concise documentation. One way she
could improve would be to document only by exception. Also, Marie needs
to remember to document the ‘Response’ of her ‘Actions.’
Medication Administration:
Example: Marie is conscientious regarding her 7 Right of Med
Administration. Always took the MAR to the beside; medications given in
appropriate time frame.
Clinical Thinking:
Example: Marie’s clinical judgment and knowledge translation is appropriate
for her experience level. For example, Marie was able to identify the ‘most
acute’ pt in our assignment and prioritized his care accordingly.
Time Management:
Example: Marie was frequently ‘running behind’ throughout her day. One way
she could improve her time management would be to ‘cluster’ her tasks and
ensure she has everything she needs before commencing.
Communication & Patient Teaching:
Example: Marie tends to be long winded. Marie needs to be more direct in her
communication style to ‘get her point across’ more efficiently. This will also help
to improve her time management.
ECG Interpretation:
Example: Marie was to correctly interpret ¾ pt ECG rhythms, but some
prompting was required. Marie needs to review her 2nd degree blocks.
General Observations:
Example: Marie is a compassionate and team oriented nurse – this is her
greatest strength. She needs to improve her time management and patient
teaching skills as she still feels uncomfortable with much of the discharge
teaching material. I think she could benefit from an additional Clinical
Transition shift.
Clinical Guide: ___________________ New Hire: ______________________ Unit: ______
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September/October 2012
Written and verbal feedback is a vital component to building the confidence and skills of our new 5AB RN’s. Please
take a few moments to document key areas of strength and areas for improvement for your new colleague; please be
specific with your comments and provide examples (under each heading) to illustrate your comments where possible
(point form is acceptable). This feedback will be reviewed with the new hire on their orientation check-in. Thank you
for your hard work and continue support throughout the orientation process.
Assessment:
Example: Marie’s head-to-toe assessment was well organized and
comprehensive, but she needs more practice with identifying adventitious
lung sounds.
Documentation:
Example: Marie needs to work on concise documentation. One way she
could improve would be to document only by exception. Also, Marie needs
to remember to document the ‘Response’ of her ‘Actions.’
Medication Administration:
Example: Marie is conscientious regarding her 7 Right of Med
Administration. Always took the MAR to the beside; medications given in
appropriate time frame.
Clinical Thinking:
Example: Marie’s clinical judgment and knowledge translation is appropriate
for her experience level. For example, Marie was able to identify the ‘most
acute’ pt in our assignment and prioritized his care accordingly.
Time Management:
Example: Marie was frequently ‘running behind’ throughout her day. One way
she could improve her time management would be to ‘cluster’ her tasks and
ensure she has everything she needs before commencing.
Communication & Patient Teaching:
Example: Marie tends to be long winded. Marie needs to be more direct in her
communication style to ‘get her point across’ more efficiently. This will also help
to improve her time management.
ECG Interpretation:
Example: Marie was to correctly interpret ¾ pt ECG rhythms, but some
prompting was required. Marie needs to review her 2nd degree blocks.
General Observations:
Example: Marie is a compassionate and team oriented nurse – this is her
greatest strength. She needs to improve her time management and patient
teaching skills as she still feels uncomfortable with much of the discharge
teaching material. I think she could benefit from an additional Clinical
Transition shift.
Clinical Guide: ___________________ New Hire: ______________________ Unit: ______
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September/October 2012
Section IV: See attached ‘5AB Learning Plan.’ It is now a registration requirement of CRNBC for EVERY
nurse to complete an annual learning plan to help document and fulfill professional development goals.
Please complete 2 “Learning Goals” and the associated documentation for your 3 Month check-in. This
document will be reviewed and expanded with the CNE at each check-in session over the next year.
Assessment:
Example: Marie’s head-to-toe assessment was well organized and
comprehensive, but she needs more practice with identifying adventitious
lung sounds.
Documentation:
Example: Marie needs to work on concise documentation. One way she
could improve would be to document only by exception. Also, Marie needs
to remember to document the ‘Response’ of her ‘Actions.’
Medication Administration:
Example: Marie is conscientious regarding her 7 Right of Med
Administration. Always took the MAR to the beside; medications given in
appropriate time frame.
Clinical Thinking:
Example: Marie’s clinical judgment and knowledge translation is appropriate
for her experience level. For example, Marie was able to identify the ‘most
acute’ pt in our assignment and prioritized his care accordingly.
Time Management:
Example: Marie was frequently ‘running behind’ throughout her day. One way
she could improve her time management would be to ‘cluster’ her tasks and
ensure she has everything she needs before commencing.
Communication & Patient Teaching:
Example: Marie tends to be long winded. Marie needs to be more direct in her
communication style to ‘get her point across’ more efficiently. This will also help
to improve her time management.
ECG Interpretation:
Example: Marie was to correctly interpret ¾ pt ECG rhythms, but some
prompting was required. Marie needs to review her 2nd degree blocks.
General Observations:
Example: Marie is a compassionate and team oriented nurse – this is her
greatest strength. She needs to improve her time management and patient
teaching skills as she still feels uncomfortable with much of the discharge
teaching material. I think she could benefit from an additional Clinical
Transition shift.
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Learning Goal
“What do I want to
accomplish?”
Activities/Strategies
Strategy 1:
“How will I accomplish my
objectives?”
Strategy 2:
Strategy 3:
Indicators/Evidence
“How will I know I have
accomplished my objectives?”
“How will I measure that I met
my goal?”
Other Resources
(could include people, literature,
courses etc.)
Target dates
“When do I expect to
accomplish this by?”
Review with NE
(review progress of goal
achievement)
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September/October 2012
Learning Goal
“What do I want to
accomplish?”
Activities/Strategies
Strategy 1:
“How will I accomplish my
objectives?”
Strategy 2:
Strategy 3:
Indicators/Evidence
“How will I know I have
accomplished my objectives?”
“How will I measure that I met
my goal?”
Other Resources
(could include people, literature,
courses etc.)
Target dates
“When do I expect to
accomplish this by?”
Review with NE
(review progress of goal
achievement)
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September/October 2012