work process schedules and related instruction …work process schedule and related instruction...

AppendixA

WORKPROCESSSCHEDULES

AND

RELATEDINSTRUCTIONOUTLINES

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AppendixA-1

APPENDIXA-1

WorkProcessScheduleandRelatedInstructionOutlineOccupation:Nurse

(CoreAdultInpatient)O*NET-SOCCode:29-2061.00

RAPIDSCode:0837

ThisscheduleisattachedtoandapartoftheseStandardsfortheaboveidentifiedoccupation.

1. TYPEOFOCCUPATION

Time-based Competency-based Hybrid

2. POSITIONREQUIREMENTS:

a. EDUCATION:(numberofyearsandtyperequiredtoperformthepositionduties):

GraduationfromanaccreditedSchoolofNursing,Licensed,andacurrentlyregisterednurseinthe

StateofConnecticut.AllnewlyhiredRegisteredNursesmusthavecurrentBCLScertificationormustobtainit

withinonemonthofhire.

b. EXPERIENCE:(numberofyearsandtyperequiredtomeetanacceptablelevelofperformance):

Clinical Nurse is the basic level for new graduates and all registered nurses. All RNs are expected to

advancetotheiroptimalleveloffunctioningthroughpromotion.

c. SPECIALSKILLS:

Excellentcommunications,interpersonal,coordinative,andorganizationalskills.

d. ACCOUNTABILITY: (how this position is held accountable for such as goals achievement, budgetadherence,orotherareasofaccountability):

• Provides nursing care to an individual or group of patients; recognizes changes in patient's

conditionandreportssuchchangestoPhysicianand/orPatientServicesManager.

• Utilizesandmanagesmaterialresourcesinacosteffectivemanner.

• In personal and job-related decisions and actions, consistently demonstrates the values of

integrity (doing theright thing),patient-centered(puttingpatientsand families first), respect

(valuingallpeopleandembracingalldifferences),accountability(beingresponsibleandtaking

action),andcompassion(beingempathetic).

e. COMPLEXITY:(describeplanning,problemsolving,decisionmaking,creativeactivity,orotherspecialfactorsinherentintheresponsibilitiesofthisposition):

Plans,developsandimplementspatientcareplans;evaluatestheeffectivenessofexistingpatientcare;

evaluates the effectiveness of existing patient care plan; and modifies plan of care to meet patient

needs.

AppendixA-2

f. SPECIALWORKINGCONDITIONSANDPHYSICALDEMAND:

Requiresprolongedstanding;walking;useofsight,hearing,andtouch;moving/liftingpatientsofvaryingweights.

3. POSITIONDESCRIPTION:

AsacorememberoftheCaredeliveryteam,theClinicalNursepracticesasthepatient’snurseandcollaborates

withtheteamto facilitate thecoordinationofpatientcareat theunit level. Throughutilizationof thenursing

process, the clinical nurse diagnoses and treats patient and family responses to actual or potential health

problems.TheClinicalNurseisaccountabletothepatient,family,peers,andManager.

Patientandfamilycenteredcare(PFCC)atYNHHisdemonstratedbyworkingwithpatientsandtheirfamiliesbased

onthe4principlesofPFCC:participation,dignityandrespect,informationsharing,andcollaboration.Thisincludes

providingserviceexcellencebycreatingagreat"FirstImpression"bydemonstratingexemplarycustomerservice

skills for all customer groups including patients, families/friends, physicians, staff, and support department

personnel.

Adheres to the "I Am YNHH" service excellence pledge and promotes a positive work environment.

EEO/AA/Disability/Veteran.

Weight(%) RESPONSIBILITIES

30% 1.NursingProcess

1.1 TheClinicalNurseI(CNI)utilizesthenursingprocessofassessment,planning,intervention,andevaluation

whilecaringforourpatientsmaintainingconfidentialityanddignity.TheClinicalNurseprovidessafe,effective

evidence-basedcaretailoredtotheindividualneedsofthepatientandfamily. Asacorememberofthecare

deliveryteam,theClinicalNursepartnerswiththeteamtofacilitatethecoordinationofpatientcareattheunit

levelutilizingtheprinciplesofpatient/familycenteredcare.

1.2 The clinical nurse uses a 5-step process to deliver high quality comprehensive and individualized care

incorporating:

1. Patientassessment

2. Problemidentification

3. Establishmentofdesiredoutcomes

4. Implementationofinterventions

5. Evaluationofcarewithnecessaryrevisions.

15%2.ClinicianPatientRelationship

2.1 Demonstratesaholisticandcaringapproachthroughoutthenurse-patientrelationship.

AppendixA-3

Weight(%) RESPONSIBILITIES

15%3.ClinicalExpertise/ProblemSolving

3.1 Collaborateswithmembersofthemultidisciplinaryteamtosupporttheworkoftheteam,unitactivities,and

theaccomplishmentofpositivepatientoutcomes.

20%4.Collaboration/Teamwork

4.1 Delegates responsibilities to appropriate members of the care delivery team based upon an

understanding of others' roles, scope of practice, knowledge, and capabilities to ensure optimal

utilizationofpersonnel.

4.2 Contributestoapositiveworkenvironmentbybeingresponsivetotheneedforchange.

4.3 Maintainsacollaborativeworkrelationshipwithstaffmembersthroughrespectandrecognitionofculturaland

humandiversity.

10% 5. Practice Development / Positive Impact (improvement of the self and improvement of the practice of

nursing)

5.1 Successfullycompletesthecompetencybasedorientationwithinthedesignatedtimeframe.

5.2 Participateswithteammembersinactivitiestoimprovethecareenvironment.

5.3 Responsibleforbeingcurrentwithstaffmeetingminutes.

5.4 Activelysupportsstudentlearning.

5.5 Assumesresponsibilityforcontinuedlearningandintegrationofevidencebasedpractice.

5.6 Identifies self-learningneeds and activelyparticipates inmeeting them in collaborationwith the leadership

team.Setsandachievesprofessionalgoals.

5.7 Deliversexcellenceinpatientcarethroughcompliancewithallpatientsafetyandregulatoryinitiatives.

10%6.Leadership

6.1 Communicates in a calmprofessionalmannerwithpatients, families, colleagues,members of the

careteam,andotherhospitalpersonnel;acceptsandelicitsfeedback;andworkstowardresolvingproblemsand

clarifyingissuesandconcerns.

6.2 Usesresourcesinafiscallysoundmanner.

AppendixA-4

4. TERMOFAPPRENTICESHIP

ThetermoftheapprenticeshipisoneyearwithanOJLattainmentof1860.25-2000hours,includingthe

minimumrequired144hoursofrelatedinstruction.

5. RATIOOFAPPRENTICESTOJOURNEYWORKERS

Theapprenticetojourneyworkerratioisone(1)Apprenticeto(1)Mentor.

6. APPRENTICEWAGESCHEDULE

ApprenticesshallbepaidinaccordancewithwagessetbyYaleNewHavenHospital.

7. WORKPROCESSSCHEDULE

YaleNewHavenHospitalNewNursesOnboardingCurriculum

Medicine Educational Activity Content Time Frame Hours Months 1-3 New Employee Orientation Generic new employee information provided to clinical & non-clinical staff Day 1 of Employment 8

Nursing Core Orientation (NCO) Prepare for unit-based orientation First Week of Employment 13

EPIC provide education for electronic medical record functionality First Week of Employment 8 Unit-based Orientation complete a competency unit-based orientation facilitated by a preceptor after NCO 331

SENO: Simulation-Enhanced Nursing Orientation To close the gap in knowledge related to essential patient care skills, techniques, and procedures within one month of hire 8

SENO Port - 4 different sessions To close the gap in knowledge related to essential patient care skills, techniques, and procedures within one month of hire 14

HealthStream (ALL) EKG modules within one month of hire 8

Cardiac Rhythm Recognition Nurses will consistently recognize & interpret cardiac rhythms, utilizing findings to direct optimal care for telemetry monitored patients within one month of hire 2

Nurse Residency Program Months 1-3 Vizient EBP curriculum: designed to support the new graduate nurses transition into practice during first year within first 3 months of

hire 12 HealthStream (ALL) Adult Heparin Infusion Protocol 25 Days 0.5 HealthStream (ALL) Dementia Signs & Symptoms 25 Days 0.25 HealthStream (ALL) Spine Surgery 25 Days 0.75 HealthStream (ALL) Cervical Collar 25 Days 0.5

HealthStream (ALL) Safely Lifting & Transferring Bariatric Patients 25 Days 0.5 HealthStream (ALL) Preventing Surgical Site Infections 25 Days 0.25 HealthStream (ALL) Preventing CLABSI 25 Days 1

HealthStream (ALL) MRI Level 1 Safety Training 25 Days 0.5 HealthStream (ALL) Intro to Bariatric Surgery: Care of the Patient 25 Days 0.5 HealthStream (ALL) EPIC Beaker Education 25 Days 0.25 HealthStream (ALL) CADD Solis 25 days 1.25

HealthStream (ALL) Bloodborne Pathogens Training Program 25 Days 1 HealthStream (ALL) Bariatric Surgery Complications: Rec & Treatment 25 Days 0.5 HealthStream (ALL) Acute Coronary Syndrome 1 25 Days 0.5 HealthStream (ALL) Acute Coronary Syndrome 2 25 Days 0.5 HealthStream (ALL) Blood Product Safety II 25 Days 1.5

Geriatric Resource Nurse Program Provide EBP curriculum regarding care of the geriatric patient within 2 months of hire 8

HealthStream (ALL) Electrical Safety 45 Days 0.5

HealthStream (ALL) Hazard Communication 45 Days 1.5 HealthStream (ALL) Workplace Violence 45 Days 0.75

HealthStream (ALL) Stroke Awareness The ABCs 45 Days 0.25 HealthStream (ALL) Preventing Hospital Infections: It's in Our Hands 45 Days 0.5 HealthStream (ALL) Fire Safety 45 Days 0.75 HealthStream (ALL) Ergonomics 45 Days 0.5

HealthStream (ALL) Emergency Preparedness 45 Days 0.75 Experiential learning with Unit Resource New hire assigned a resource after Unit-based Competency Orientation completed; continue to advance skills with Benner's model -

novice to expert start after 360 hours

orientation 72

AppendixA-5

Months 4- 6

Nurse Residency Program - months 4- 6 12.5

Experiential learning with Unit Resource ongoing 432 Months 7 -12

Experiential teaming with Unit Resource RN ongoing 864 Nurse Residency Program months 7 -12 includes didactic plus EBP project work support and ends with final presentation 46 Charge Nurse Workshop provide overview of charge nurse role during end of first year 6

TOTAL 1860.25

Yale New Haven Hospital Center for Professional Practice Excellence

Core Adult Inpatient- Competency Based Orientation (CBO) Tool

AppendixA-6

Topic Document Section Initial Education Provided Page

Acute Coronary Syndrome

Patient Populations Simulation Enhanced Nursing Orientation (SENO) 15

Adverse Drug Reaction (ADR)

Procedures & Therapies Nursing Core Orientation (NCO) 12

Aggressive/Assaultive Behavior

Patient Populations SENO 14

Alarm Management

Procedures & Therapies NCO 11

Allergies

Procedures & Therapies NCO/Electronic Medical Record (EMR) 11, 19

Bariatrics


Blood and Blood Components

Procedures & Therapies SENO 4

Central Venous Access Devices (CVAD)


Chest Tube/Pleurx Drain


Clinical Work Station

Safety NCO 18

Continuous Electrocardiogram (ECG)/Telemetry Monitoring

Procedures & Therapies CLASS 4

Topic Document Section Initial Education Provided Page Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar)

Nursing process SENO 1

Deep Vein Thrombosis (DVT)


Delegation

Leadership Nurse Residency Program (NRP) 23

Delirium/Dementia


Diabetes

Patient Populations SENO/NRP 16-17

Documentation of the Nursing Process: Care planning/Admission/ Discharge/Transfer

Nursing Process EMR 2

ECG 12-lead Procedures & Therapies NCO 4



AppendixA-7

End of Life Care (Comfort Care)

Patient Populations NRP 17

Enteral Feeding


Environment of Care

Safety New Employee Orientation (NEO) 18

Equipment Safe Use of

Safety SENO 18

Event Reporting ( Electronic Event Reporting System)

Safety NCO 21

Fall Prevention and Management

Nursing Process NCO 2

Functional Assessment

Nursing Process SENO 1

Handoff

Procedures & Therapies Leadership

NCO 10, 22

Healthy Work Environment

Leadership NEO 23

Heart Failure

Patient Populations UNIT SPECIFIC 14

High Reliability Organization

Leadership NEO/NCO 22

Infection Control Precautions: Standard, Isolation

Procedures & Therapies NCO/NRP 19

Topic Document Section Initial Education Provided Page Interdisciplinary Collaboration

Leadership NCO 23

Life Threatening Events: Rapid Response/Code Blue

Safety NCO 20

Medication Administration Procedures & Therapies

NCO 11-12

Mobility/Safe Lifting Devices

Procedures & Therapies UNIT SPECIFIC 10

Noninvasive Positive Pressure Ventilation (NIPPV): / BIPAP/CPAP


Organ & Tissue Donation

Procedures& Therapies NCO 6

Ostomy

Procedures & Therapies NRP 10



AppendixA-8

Oxygen Therapy


Pain and Sedation

Nursing Process SENO/NRP 2

Palliative Care


Patient Identification

Safety NCO 19

Patient/Family Experience

Leadership NCO 23

Peripheral Intravenous (IV) Therapy


Phlebotomy/ Blood Cultures (peripheral)


Physical Assessment


Pneumonia


Post Mortem Care


Pre & Post Procedure/Operative Care


Pressure Injury Prevention & Management


Topic Document Section Initial Education Provided Page Professional Development

Leadership NRP 24

Psychosocial Assessment

Nursing Process EPIC 1

Renal Failure, Acute and Chronic


Restraints

Safety NCO 20-21

Rounding with Purpose

Safety NCO 20

Sepsis


Shared Governance

Leadership NCO 22



AppendixA-9

Smart Pump


Special modes for communication

Safety HS 21

Stroke/Transient Ischemic Attack (TIA)


Suctioning: Oral/Nasopharyngeal/Tracheostomy


Suicide

Nursing Process NCO 1

Time Management

Leadership SENO/NRP 23

Tracheostomy


Transfer/Discharge

Nursing Process Procedures & Therapies

NCO/EPIC 2, 10

Urinary Catheterization and Devices


Warming Devices


Wound Vac

Nursing Process UNIT SPECIFIC 3



New employees must review relevant YNHH Policies and Procedures and be observed by unit resource(s) before performing skill/task for the first time in practice.

Methods of Validation Key: DO = Direct Observation HS = HealthStream PP = Policy and Procedure Review D = Discussion CS = Case Study SIM = Simulation/Mock Event AppendixA-10

NURSING PROCESS: Assesses, identifies problems, plans, implements, and evaluates patient and family needs to ensure outcomes that are acceptable to the patient and health care provider. An individualized evidence-based plan of care will include an interdisciplinary approach.

Topic Orientee Self-Assessment Evaluation Elements Method(s) of Validation

(choose all that apply) Validated by:

RN Name & Date Physical Assessment: the process of evaluating findings through the use of observation, palpation, percussion, and auscultation

r N r B r C

Recognizes normal and abnormal findings for the following organ systems: • Cardiovascular • Digestive • Integumentary • Musculoskeletal • Neurological • Respiratory • Urological • Other:______________________

r DO r CS r D r SIM

Psychosocial Assessment: the process of evaluating a person's mental health and social status

r N r B r C

Includes the following in the psychosocial assessment: • Advanced Directives

o Location in EMR (EPIC Media Tab) o Apply purple band once order is obtained and

signed by MD • Abuse/Neglect • Cultural/Religious Needs • Family Support • Homicide/Suicide Risk • Mental Health • Socioeconomic Status • Substance Use/Abuse—consider the need for:

o Guideline for Medication Management of Opioid Withdrawal

o Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA-Ar)

r CS r D r DO r HS r PP r SIM

Functional Assessment: the process of determining a person’s ability to perform in a desired/designated manner

r N r B r C

Includes the following in the functional assessment: • Adaptive Equipment • ADLs • Hearing/Language • Learning Readiness • Mobility • Lift equipment/devices • Vision






Topic

Orientee Self-Assessment

Evaluation Elements Method(s) of Validation (choose all that apply)

Validated by: RN Name & Date

Pain and Sedation Assessment and Management

r N r B r C

Includes the following: • Assessment (initial and ongoing) • Plan • Intervention

• Non-Pharmacological § Heat (obtain MD/LIP order) versus cold

Skin assessment before/after treatment § Alternative therapies (i.e. Reiki, etc.)

• Pharmacological • Pain Pump (PCA/Epidural/PNB) • Consultation

• Documentation: Evaluation and Reassessment • AIR Cycle • Sedation Scales

• Patient/Family Teaching


Fall Prevention and Management r N r B r C

Direct observation by preceptor: • Completes fall risk assessment tool appropriately • Implements fall prevention interventions based on low,

moderate, high risk for fall • High fall risk –need to implement all fall precaution

interventions • Review Post-Fall: post fall process algorithm including

appropriate documentation & debriefing • Patient/family teaching for fall risk patients


Documentation of the Nursing Process

r N r B r C

• Nursing Care Plan o Problem list- CPG

§ Individuality/Mutuality § Problem Resolution

o Interventions o Measurable Goals with achievable dates o Evaluation/ Measurable Outcomes

• Admission/Transfer/Discharge o Navigators/Flowsheets o Med Reconciliation o Patient/Family Education o W-10 o AVS/Educational Handouts o Referrals/Consults

• Review downtime documentation/forms






Topic

Orientee Self-Assessment



Pressure Injury Prevention and Management

r N r B r C

• Identify risk factors (Braden Scale) • Prevention strategies • Identify abnormal findings • Pressure injury staging and measurements • Wound care nurse consultation as indicated • Treatment modalities

o Pharmacological o Non-pharmacological

§ Dressings § Wound vacs § Specialty beds § Pressure relieving devices

• Document appropriate assessment and ongoing management


PROCEDURES & THERAPIES: Demonstrates integration of current knowledge and skills of selected procedures and therapies into practice, with consideration for cultural differences and age of patients.



RN Name & Date Blood & Blood Components r N

r B r C

Reviews the following processes per policy including but not limited to: • Pre-transfusion

o Patient assessment o Patient consent o Type and screen o Viable vascular access o Blood product request

• Administration of blood products o Dual sign off o Patient assessment- Monitoring/vital signs

• Post transfusion • Transfusion reaction

o Recognizes signs/symptoms o Assessment and Management


Continuous ECG Telemetry Monitoring r N Reviews the following processes per policy including but not r CS





r B r C

limited to: • Monitor Set up and maintenance- individualized alarm

limits • Patient preparation-skin, leads • ECG rhythm interpretation • Recognition of baseline/normal rhythm strips • Recognition of life-threatening/abnormal rhythm strips

r D r DO r HS r PP r ECG Class

12 Lead ECG r N r B r C

• Verifies order • Performs proper skin preparation • Performs proper lead placement • Performs 12 lead ECG • Troubleshooting/eliminate artifact as needed • Changes lead paper • Provider notification as appropriate

r D r DO r PP

Topic Orientee Self-Assessment



Peripheral IV r N r B r C

• Verifies order • Insertion per unit standard • Maintenance

o Assessment of site o Recognition of and interventions for

infiltration/extravasation/phlebitis • Removal

r D r DO r PP r SIM

Central Venous Access Device (CVAD) r N r B r C

Reviews the following processes per policy including but not limited to: • Discusses different types of CVADs

o Verifies patient specific type and location o Verifies correct order set

• Maintenance o Assessment of site o Dressing change o Verifies placement and patency prior to use o Verifies maintenance order present o Adheres to CLABSI Prevention Bundle o Demonstrates proper technique for blood

draw, flushing and medication administration o Proper cap and line changes

• Documentation o Daily documentation o Discharge/transfer-including line verification






report/ W10 • Troubleshooting problems associated with CVADs

o Identifies complications o Reports concerns to LIP/MD

• Patient/Family education as appropriate • Discontinuation of therapy

o Daily review of necessity and prompt removal of unnecessary lines

o De-access/flushing implanted ports

Smart Pump and IV Tubing

r N r B r C

• Performs line reconciliation at every hand off • Identifies and assemble appropriate tubing with proper

labeling • Smart Pump set-up

o Selects appropriate care area o Programs pump correctly o Troubleshooting/clinical advisories

r D r DO r PP r SIM




Peripheral Phlebotomy/Blood Cultures NOTE: If performing a blood culture from a CVAD, ensure patient meets appropriate algorithm criteria. Use central venous blood culture kit, central venous blood collection checklist and a two-person process.

r N r B r C

• Verifies order and rationale for lab test(s) • Prints labels and selects appropriate tubes • Verifies patient identification • Selects appropriate site • Gathers appropriate supplies specific to procedure

(phlebotomy vs. blood cultures) • Performs venipuncture and follows correct procedure

(phlebotomy vs. blood cultures) with correct order of draw

• Correctly labels each specimen at bedside • Performs Final Check

r D r DO r PP r SIM

Oxygen Therapy r N r B r C

• Verifies order • Correctly applies, administers and maintains patient

specific oxygen delivery system o Portable o Wall

• Documents oxygen therapy and patient response in EMR

r D r DO r PP r SIM

Post Mortem Care r N r B r C

• Gathers supplies • Performs post mortem care

r D r DO





• Ensures post mortem checklist is complete • Completes post mortem electronic documentation • Notifies New England Organ Bank (NEOB) within 1

hour of patient death • Discusses resources to support family/friends

r PP r SIM

Pre/Post-Operative/Procedure Care r N r B r C

• Completes Universal Protocol Verification Form (as appropriate for procedures)

• Determines which procedures require time-out verification

• Accesses and completes pre-op/pre-procedure checklist

• Incorporates and documents pre/post-operative and pre/post-procedure patient and family education

• Discusses potential risk and complications related to specific procedures

• Reconciles pre/post-operative/procedure orders o MAR Hold o Signed and Held orders o Medication Reconciliation

r D r DO r PP r SIM




Enteral Tubes ( Feeding and/or decompression)

Nasogastric Nasojejunal- NJ Tube Gastrojejunostomy - GJ-Tube Gastrostomy - G Tube Jejunostomy-J Tube

r N r B r C

Reviews the following processes per policy including but not limited to: • Discusses different types of enteral tubes and feedings • Setup & Maintenance

o Feed and flush or for decompression o Gastric Residual Volume Management

§ Via syringe § Via wall suction (intermittent vs.

continuous) o Aspiration precautions o Verifies label(s) o Infection control o Medication administration

• Troubleshooting • Patient/Family education • Discontinuation of therapy • Documents:

o Type of tube, placement verification (initial and ongoing when accessing tube), type of

r D r DO r PP r SIM





tube feeding, formula, amount of feeding and residual

o Patient tolerance o Skin integrity

Urinary Catheterization and Devices r N

r B r C

• Adheres to CAUTI Prevention Bundle o Discusses CDC indication for indwelling

catheter o Bladder scan prior to any urinary

catheterization o Two-person insertion checklist o Nurse driven foley removal algorithm o Perineal care and catheter care

• Discusses different types of catheters-including but not limited to condom, straight, indwelling, urostomy, suprapubic

• Documentation • Troubleshooting • Patient/Family education • Discontinuation of therapy





Suctioning Oral Nasopharyngeal Tracheal

r N r B r C

• Collaborates with Respiratory Therapy as indicated • Suction equipment

o Select appropriate suction equipment o Setup and demonstrate use of suction

equipment • Patient/family education • Techniques (select and demonstrate appropriate

method): o Clean o Sterile

• Documents: o Frequency o Amount o Description o Patient tolerance

r CS r D r DO r PP r SIM

Tracheostomy r N r B r C

• Collaborates with Respiratory Therapy as indicated • Inflation/deflation status of balloon • Equipment

o Identify types of tracheostomy

r CS r D r DO





tubes/equipment o Select appropriate tracheostomy supplies o Maintain at bedside: spare trach

tube/obturator, manual resuscitator, and oxygen flow meter, yankauer/suction catheters, and suction equipment

• Patient family education • Techniques

o Tracheostomy care o Mouth care o Skin care under and around tracheostomy o Aspiration precautions o NPO status (as indicated)

• Communication methods • Documents:

o Skin integrity o Size o Need for supplemental oxygen o Respiratory therapy o Patient tolerance

r PP r SIM




Chest Tube/ pleurx drain Maintenance Post-removal

r N r B r C

• Indications for chest drainage • Types of chest drainage

o Systems/products § Setup § Measurement § Change

• Patient and family education • Maintenance/care

o Orders (e.g. CXR, frequency of drainage for pleurx cath.)

o Water seal o Dressing o Activity o Suction setting o Troubleshooting

• Explains correct method for transporting patient with a chest tube

• Documents: o Skin integrity o Size & location






o Output (amount and color) o Pain management o Patient tolerance

Noninvasive Positive Pressure Ventilation (NIPPV)

BIPAP CPAP

r N r B r C

• Collaborates with Respiratory Therapy • Indications for NIPPV, BIPAP, CPAP • Recognizes and responds to patient responses

requiring medical intervention • Orders

o Equipment from home (approved through engineering)

o Settings o Frequency/duration

§ Scope of service/patient placement • Documents:

o Skin integrity o Patient Tolerance

• Provides patient and family education





Mobility/Safe Lifting Devices r N r B r C

• Implements hospital initiative early mobilization program

• Collaborates with rehabilitation services/lift coordinator • Indications for lift equipment use

o Patient types o Equipment types

• Demonstrates proper use of unit-based safe-lifting devices

• Patient and family education • Documents:

o Patient specific activity level/frequency/distance

o Type of lift device or assistive devices o Communication/handoff


Ostomy • Colostomy • Ileostomy • Urostomy

r N r B r C

• Identifies various ostomy appliances • Provides ostomy care

o Assesses ostomy surrounding site and stoma o Assesses output characteristics o Changes appliance prn

• Collaborates with wound/ostomy nurse • Identifies abnormal findings and/or complications and






escalate concerns to MD/LIP • Provides patient/family education

Transfers/Discharges r N

r B r C

Transfers: • Handoff report to receiving area • Ticket to Ride • Documentation • If transferring to an ICU setting, transfers patient on

cardiac monitor with physician and/or RN • If transferring to a higher level of care, must give a

verbal report Discharges: • Collaborates with care management for ongoing

discharge needs • Completes W-10 as needed • Patient/family education • Provides After Visit Summary (AVS) • Discharge folders





Warming Device (hypothermia) r N r B r C

• Confirms patient meets criteria for therapy • Obtains/verifies MD/LIP order • Identifies process for obtaining equipment • Maintenance/Documentation

o Monitors VS as indicated o Assesses skin integrity o Identifies criteria for discontinuation

r D r DO r PP r SIM

Alarm Management • Physiologic monitoring • Patient care equipment alarms

r N r B r C

• Reviews and individualizes alarm settings upon application and as indicated

• Disables alarms when no longer indicated • Responds to and resolves clinical alarms per priority

level and response expectation o High: audible advisory alarms that require

immediate attention o Medium: audible advisory alarms that require

attention as quickly as possible, but are not considered an emergency

o Low: audible advisory alarms that require re-assessment of patient and/or equipment

r D r DO r HS r PP r SIM





Medication Administration

r N r B r C

• Observes and follows 5 Basic Rights for medication administration

• Medication Reconciliation verifies upon admission, transfer/pre-post procedure and discharge

• Verifies order o Appropriateness of medication o Consideration for dosing older adults/specific

patient populations i.e. onc, renal, hepatic, etc.

o self-administration of meds • Reviews drug use and potential side effects

o Teach back method with patient • Monitors appropriate VS and lab orders as needed • Verifies/documents presence of allergies (allergy band

present as applicable) • Collaborates with unit pharmacist • Utilizes pharmacy resources

o Drug use guidelines o IV compatibility o Micromedex o Exit Care o Adult IV guidelines

• Utilizes Pyxis med station o Ensures that medications not immediately

administered and/or not in original packaging should be labeled appropriately including drug name, dose, concentration, expiration date and two patient identifiers

o Ensures medications are properly secured o Proper narcotic waste with witness

• Utilizes Narcotic Proof of Usage sheet as needed • Identifies High Risk Medications

o Independent double-check/dual sign off o Tall man lettering o Look alike/sound alike drugs

• Use of vaccines o Verify need for vaccination upon admission,

transfer, prior to discharge o Provide vaccine Information Sheet (VIS) in

EPIC • Documentation

o Barcode Scanning –patient/medication o EMAR






o Downtime procedures o Patient response o Refusal o Adverse reactions

§ Recognition § Escalate concerns to appropriate

MD/LIP (Provider notification tab) § event reporting

• Rescheduling/canceling meds • Demonstrates proper procedure using aseptic

technique for adding medications to IV bags o Mini-bag plus diluent bag o Non mini-bag diluent bag

Patient Populations: Effectively cares for patients with consideration for cultural differences, age and developmental levels.



RN Name & Date Care of the patient with a Stroke/TIA r N

r B r C

• Completes Abbreviated NIHSS Training per unit standard

• Identifies risk factors • Assesses for signs and symptoms---FAST scale • Activates a Stroke Code and know responsibilities

during the code • Anticipates diagnostic testing: CT/MRI/MRA/Echo/

Cardiac Ultrasound • Monitors the following:

o BP o Glucose reading o Temperature o Telemetry o Seizure activity

• Identifies patient’s stroke type • Patient may require transfer to neuroscience unit/ICU • Performs dysphagia screening • Appropriately consults with services for rehabilitation

and stroke recovery care • Patient/family education: Take 5: Take 5 folder

o Warnings Signs: sudden weakness/difficulty with speech/vision/headache/dizziness-loss






of balance o Risk factors o Follow-up appointment o Medication review o Warning signs o Call 911

Care of the bariatric patient r N

r B r C

• Differentiates between bariatric and morbidly obsess based on BSI

• Skin care • Medication management/dosing implications • Safety-Bariatric Bundle • Mobility • Psychiatric considerations/consult as appropriate • Patient/family education





Care of the patient experiencing delirium or dementia

r N r B r C

• Differentiates between delirium and dementia • Assesses signs and symptoms: non ICU CAM tool • Treats the cause as ordered • Reviews medications and lab values with MD/LIP • Maintains a safe environment • Utilizes nonviolent non self-destructive restraints per

order and indication • Applies reality reorientation as needed • Obtains appropriate consults • Assists with self-care deficits


Care of the patient exhibiting aggressive or assaultive behavior

r N r B r C

• Recognizes signs of escalating behavior • Utilizes violent self-destructive restraints as ordered

and indicated • Maintains safe environment • Utilizes the panic button as necessary • Contacts Protective Services for emergency

intervention and support as needed


Care of the patient with heart failure r N r B r C

• Recognizes risk factors • Discusses precipitating factors • Describes key nursing assessments:

o Lungs sounds o Edema

r CS r D r DO r HS





o Daily weights o Urinary output

• Assists patient with psychological needs • Identifies appropriate consults • Documents:

o Signs and symptoms o Interventions o Complications

• Patient and family education utilizing the Heart Failure Management Plan as indicated

r PP r SIM

Care of the patient with acute and chronic renal failure

r N r B r C

• Identifies risk factors • Identifies symptoms including fluid overload • Monitors lab values • Monitors strict I and O • Discusses need for nutritional consult and/or renal diet • Discusses modes of dialysis-CAPD, cycler,

hemodialysis • Discusses nursing implications re: med management





Care of the patient with acute coronary syndrome

r N r B r C

• Identifies risk factors • Identifies symptoms

o Chest pain characteristics o Atypical symptoms (jaw, shoulder and back

pain, GI symptoms) • Performs timely ECG

o Recognize basic ECG changes o Notify physician in timely manner for

interpretation o Differentiate between ischemia and infarction

• Verbalizes understanding of cardiac markers • Verbalizes immediate interventions (MONA):

o Morphine o Oxygen o Nitroglycerine o Aspirin

• Discusses potential complications including but not limited to dysrhythmia, heart failure, pulmonary edema, pericarditis, cardiogenic shock, sudden death

• Documents: o Signs and symptoms






o Interventions o Complications o Patient and family education

Care of the patient with sepsis r N

r B r C

• Identifies risk factors • Recognizes symptoms

o Fever o Hemodynamic instability o Altered mental status o Decreased urine output

• Discusses appropriate interventions (as ordered): o IV fluids o Obtain blood cultures o Administer antibiotics o Transfer to a higher level of care as needed

• Documents: o Signs and symptoms o Interventions o Complications o Patient and family education





Care of the patient with deep vein thrombosis

r N r B r C

• Identifies risk factors • Discusses indications for the need for anticoagulation • Discusses anticoagulants and appropriate baseline

and ongoing lab tests • Initiates heparin therapy or the Adult Heparin Infusion

Protocol as ordered • Reports lab results outside of the prescribed

parameters • Documents:

o Signs and symptoms: warmth, swelling, possible pain

o Interventions o Complications o Patient and family education


Care of the patient with pneumonia r N r B r C

• Identifies risk factors • Recognizes symptoms • Discusses appropriate interventions (as ordered):

o Fluids o Rest

r CS r D r DO r HS





o Oxygen o Antibiotics as indicated o ABGs o CXR o Sputum culture

• Documents: o Signs and symptoms o Interventions o Complications o Patient and family education

r PP r SIM

Care of the patient with diabetes hypoglycemia diabetic ketoacidosis (DKA)

r N r B r C

• Differentiates type 1 from type 2 diabetes • Identifies precipitating factors, signs, and symptoms of

hypoglycemia and hyperglycemia • States critical high and low values of blood glucose • Demonstrates immediate interventions to take as

related to hypoglycemia/hyperglycemia • Describes onset, peak, and duration of various types of

insulin and oral hypoglycemic agents • Monitors bedside glucose as clinically indicated and as

ordered • Discusses the importance of patient education as it

relates to meal consumption and insulin administration • Coordinates insulin/hypoglycemic medication with

patient meals • Identifies consults required to assist with patient

management, education, and discharge needs • Newly diagnosed patients should have a consult

placed with the diabetic CNS • Initiates Non-Critical Care Insulin Infusion Protocol per

MD/LIP order


Care of the patient at end of life (comfort care)

r N r B r C

• Reviews patient’s advance directive • Obtains order for comfort care • Demonstrates interventions to ensure optimal symptom

management related to but not limited to: o Secretions o Pain-comfort care opioid infusion as clinically

indicated • Provides emotional support to patient/family • Offers Comfort Cart to family • Obtains appropriate consults, such as:

o Chaplin






o Virtual Hospice o Social Services

Care of the patient receiving palliative care: management of chronic or life threaning illness

r N r B r C

• Engages in early identification • Performs assessment of:

o Understanding of the illness o Pain o Physical problems o Psychosocial problems

§ Coping skills § Family supports

o Spiritual problems • Utilizes a multidisciplinary approach including the

family • Advance directives

r D r DO

SAFETY: Engages in proper safety practices according to YNHH regulations (CT, DPH, OSHA, TJC) and YNHH policies (i.e. Safety Manual, Infection Control manual, and Care Standards).




Environment of Care: Physical layout Fire safety Oxygen safety Evacuation plan

r N r B r C

• Discusses role in emergency response for the unit • Reviews department specific fire response

o Code red emergency number o PASS/RACE o Location of fire alarms

• Reviews emergency exits • Reviews department specific emergency evacuation

plan • Locates oxygen shut off valve

o Can only be tuned off by a certified respiratory therapist

• Locates gas shut off valve • Identifies clean/dirt equipment storage specific to area • Reviews hazardous waste disposal specific to area • Maintains proper egress

o Keeps fire doors clear o Keeps fire extinguisher unobstructed o Keeps oxygen shut off valve and gas shut off

valve unobstructed o Keeps stairwell clear

• D • DO • HS • PP





Safe Use of Equipment r N r B r C

• Verifies sticker with appropriate maintenance review date (notify appropriate personnel if outdated)

• Completes equipment repair form/ call for repair as required

• Completes emergency equipment checklist daily or as delegated

• Notifies engineering for any personal equipment from home


Nursing Resources: Clinical Work Station

r N r B r C

• Demonstrates ability to access: o Policies and procedures o Nursing website o Nursing resource Index o Mosby’s Skills o Micromedex o Pharmacy resource o LIP credentialing o Materials Safety Data Sheets (MSDS)





Infection Control Precautions: Standard Isolation

r N r B r C

• Demonstrates proper hand hygiene • Utilizes standard precautions with all patients • Follows additional isolation precautions when indicated • Utilizes personal protective equipment (PPE)

appropriately when indicated • Disinfects all medical equipment in contact with

patients between patient use o Ensure proper wet time of disinfecting wipes o Ensure proper wet time of bleach wipes

• Demonstrates proper sharps disposal • Notifies environmental associate to replace sharps

disposal container when >3/4 full • Patient/family education

o Hand hygiene o Isolation precautions in use o Use of PPE o Discontinues isolation precautions when

appropriate


Patient Identification

r N r B r C

• Verifies patient identification using 2 accepted identifiers

o Patient name

r CS r D





o Date of birth • Engages patient in identification process • Verifies presence of identification band • Discusses process of rebanding • Reviews special alert bands/color bands • Performs bar code scanning for identification and safe

practice (i.e. med admin, lab specimens) • Performs “Final Check” as applicable

r DO r HS r PP r SIM

Allergies Food Environment Latex

r N r B r C

• Confirms patient allergies in the medical record and/or with patient

• Documents allergies in EMR • Verifies the presence of an allergy band • Consults dietician regarding food allergies


Topics Orientee Self-Assessment



Rounding with Purpose r N r B r C

• Discusses the 5 P’s and why they are important-Potty, Pain, Positioning, Proximity, Preference

• Demonstrates key behaviors • Utilizes white boards in patient rooms


Life Threatening Events Rapid Response (RRT) Code Events

r N r B r C

• Discusses process for escalation of care • Discusses procedure on activating an emergency • Identifies criteria used to call RRT vs code • Identifies roles (see supervisor for assigned role) • Discusses appropriate hand off communication (SBAR)

o RRT o Code Team o Receiving unit

• Identifies emergency equipment/ discuss proper use of o Code cart o AED/defibrillator o EKG machine

• Discusses family/significant other support resources • Documentation

o RRT






o Code o Code evaluation form o Transfer to a higher level of care

• Verbalizes procedure for code cart replacement • Discusses family presence at bedside

Restraints

r N r B r C

• Discusses alternatives for restraint use • Identifies potential triggers that may lead to restraint

use • Differentiates between the following restraint

standards: o Violent/Self Destructive o Non-violent/Non-self-destructive

• Discusses use of and care of custodial restraints • Discusses purpose/use of the restraint crisis bag • Identifies non-physical interventions (i.e. de-escalation,

reducing stimulation, verbal redirection) • Obtains original order from LIP • Discusses order renewal process/frequency • Chooses least restrictive device for the situation • Demonstrates/discusses proper application (quick

release) and removal • Discusses/identifies signs of physical/psychological

distress due to restraint use • Identifies indications that restraints are no longer

needed • Documents:

o Restraint flow sheet ü Alternative interventions tried ü Clinical justification ü Restraint monitoring-visual

checks, circulation, ROM, fluids, food, and elimination

o Assessment of continued need o Patient/family education o Modify plan of care as needed o Use of restraint downtime forms


Special Modes for Communication with Patients and Families

Deaf or Hard of Hearing Patients Non-English Speaking Patients and Families

r N r B r C

• Identifies language barrier needs • Identifies procedure for obtaining interpreter services • Requests interpreter services or equipment within 15

minutes of patient/family contact • Locates appropriate auxiliary aids such as

r CS r DO r HS r PP





telecommunication or personal listening device

r SIM

Event Reporting Adverse events Medication variance

r N r B r C

• Reviews steps for on-line event reporting • Discusses unit chain of command for problem solving

patient care issues • Discusses escalation of care issues • Adverse events:

o Identify circumstances and/or events that require reporting

• Medication variance o Notify the appropriate action(s) to take o Notify MD/LIP


LEADERSHIP: Effectively and professionally communicates and interacts with patients, families and colleagues.




Shared Governance r N r B r C

• Discusses Shared Governance Structure and the role of the clinical nurse

o Locate and review nursing website o Practice change requests o Practice change alerts o Open comments

• Identifies unit representatives • Professional Practice Model (PPM) • Magnet designation:

o Ethics resources o Evidenced Based Practice (EBP) resources o Peer Review o Nurse sensitive indicators

r D r DO r HS

High Reliability Organization (HRO) r N r B r C

CHAMP Behaviors: • Communicates clearly and effectively

o Reads back/read backs with clarifying questions

o Phonetic and numeric clarifications o Discusses procedure for accepting verbal

orders, critical lab results • Handoff effectively

o SBAR o Reviews hand off tools and unit-specific tools

r D r DO r SIM





• Attention to Detail o Self-check using Stop, Think, Act, Review

(STAR) • Mentor each other-200% accountability

o Cross checks and coaches teammates o Speaks up for safety

• Practices and accepts a Questioning Attitude o Validates and verifies o Stops the Line o Seeks clarification when needed o Demonstrates effective problem-solving skills

Topic Orientee Self-

Assessment Evaluation Elements Method(s) of Validation


RN Name & Date Interdisciplinary Collaboration r N

r B r C

• Identifies team members • Shows respect for team members • Differentiates roles and responsibilities of the

interdisciplinary team o Nursing o Medicine/surgery o Ancillary services

r D r DO r SIM

Delegation r N r B r C

• Demonstrates the ability to delegate appropriately to the following staff within their scope of practice:

o RNs o LPNs o Unlicensed Assistive Personnel

• Performs appropriate follow up with staff on assigned delegated activity

• Evaluates outcome of delegated tasks

r CS r D r DO r SIM

Healthy Work Environment r N r B r C

• Exercises courtesy and helpfulness towards all customers

• Professional appearance/uniform • Displays ID badge • Accepts responsibility for own actions • Role models professional behavior • Respects cultural and personal differences • Manages change effectively

r D r DO r PP r SIM

Time Management r N r B r C

• Able to prioritize shift’s activities appropriately • Effective organizational skills

r D





• Asks for help when appropriate • Performs assignment responsibilities with appropriate

timeliness

r DO r SIM

Patient and Family Experience r N r B r C

• Shows respect for patients and families • Demonstrates cultural & spiritual sensitivity • Applies principles of patient/family centered care • Establishes mutual goals with patient/family • Ensures privacy • Responds to patient/family concerns • Performs bedside report • Utilizes white boards • Performs service recovery when indicated • Identifies unit performance based on:

o HCHAPS / Press Ganey





Professional Development r N r B r C

• Recognition Clinical Advancement Program (RCAP) • Committee involvement • Specialty certification • Educational advancement • Ongoing annual competencies

o Regulatory o Unit based

• Professional organizations

r D r PP

AppendixA-33

8. RELATEDINSTRUCTIONOUTLINEVizient/AACNNurseResidencyProgramatYale-NewHavenHospital

vizient. 2016 Nurse Residency Program

Monthly Syllabus

Yale NewHaven Health Yale New Haven Hospital

Time Topic * = 8-hour session MONTH 1

0700-0815 Introduction to NRP & RF

0820-0915 Nurse Centered Stress Management & Clinical Reflections

0930-1030 Stress Management & Self Care

1030-1100 Completion of NRP Surveys MONTH 2

0700-0815 Nurse Centered Stress Management & Clinical Reflections 0830-0900 Communication; Chain of Command; Culture of Safety

0900-0945 Interdisciplinary Communication & Teamwork

1000-1100 Delegation MONTH 3


0830-0915 Evidence-Based Fall Prevention 0915-1000 Evidence-Based Infection Prevention & Control 1000-1100 Evidence-Based Pain Management

MONTH 4 0700-0815 Nurse Centered Stress Management & Clinical Reflections

0830-0930 Professional Development Plan & Leadership Project Guidelines

0930-1100 EMR and Professional Documentation Standards

MONTH 5 0700-0815 Nurse Centered Stress Management & Clinical Reflections

0830-0945 Conflict Resolution & Ethical Decision Making

0945-1100 Holistic Care for the Nurse MONTH 6


0830-0945 Regulatory Readiness and Patient Safety & Quality

0945-1100 Quality Improvement Initiatives

1100-1130 Completion of NRP Surveys MONTH 7


0830-0915 Nursing Research at YNHH

0915-1230 Evidence Based Practice

1300-1530 Independent Project Work MONTH 8*


0830-0930 Evidence-Based Diabetes Care

0930-1100 Evidence-Based Skin & Wound Care

1100-1200 RCAP and Clinical Advancement

1230-1530 Independent Project Work MONTH 9*

0700-0815 Nurse Centered Stress Management & Clinical Reflections 0830-0930 RRT & End of Life Decisions 0930-1100 End of Life Care 1130-1530 Independent Project Work

MONTH 10* 0700-0815 Nurse Centered Stress Management & Clinical Reflections 0830-0945 Accountability & Professionalism in Nursing 0945-1100 Cultural Competence In the Nursing Care Environment 1100-1200 Informatics and Innovation 1230-1530 Independent Project Work

MONTH 11* 0700-0815 Nurse Centered Stress Management & Clinical Reflections 0830-0945 Professional Quality of Life (ProQOL) 0945-1100 Managing Patient Changing Condition 1130-1530 Independent Project Work

MONTH 12

0800-1400 (or until all present) Presentation of Leadership Projects (& NRP Survey Completion)

AppendixA-34

Vizient/AACNNurseResidencyProgramatYale-NewHavenHospital

vizient Nurse Residency Program Missed Session Assignment

Yale NewHaven Health Yale New Haven Hospital

Nurse Resident: Click here to enter text. Cohort Choose an item.

Missed Session and Topics: Choose an item

Approved by (Executive Leader Name): Choose an item.

Date Assigned: Click here to enter a date. Date Completed: Click here to enter a date.

Patient Services Manager: Click here to enter text. Unit: Click here to enter text. PSM Signature Validating Completion: _____________________________________________

Background: The Vizient/AACN Nurse Residency Program (NRP) at YNHH provides Nurse Residents the opportunity to network with colleagues and engage in learning that helps to prepare you for transition into professional nursing practice. Completion of the NRP is a requirement of employment, and attendance at each session is mandatory. On rare occasions, a conflict or unplanned life event may necessitate missing a required session. This activity will provide the framework for learning that was missed as a result, but is not intended to take the place of the rich experience participation in the NRP provides.

Purpose: To provide the Nurse Resident with the opportunity to continue in the Vizient/AACN Nurse Residency Program at YNHH when

absence from a session was unavoidable and approved by Executive Nursing Leadership

Completion Requirements:

1. Clinical Reflection • Complete form attached

2. Nurse Centered Stress Management strategy • Review and incorporate into practice

3. Present NRP Content to your department • Develop a 10-15 minute presentation (based upon the topics missed) using the provided materials (Month Overview) and any

supplemental literature • Coordinate with your PSM to present your content at the next available staff meeting, and obtain their signature of validation

above. Must be completed within 60 days from original session date

4. Finally, scan and email Tales from the Bedside and signed Missed Session Assignment form (this document) to [email protected]

REFERENCES

Vizient/AACNNurseResidencyProgram(2015)

RELATEDPOLICIESCellularPhonesandOtherWirelessDevicesNursingOrientationStandardsofAppearance

AppendixA-35

TimeandAttendance

AppendixA-36

TestNameandProctor(yesorno)

Howadministered(i.e.:paper/pen;computer,via

LMS,etc.)

Whenadministered

Pass/fail Whatisdoneiffail

CHA(CTHospitalAssociation)MedicationTestYes

Paper&pen Firstweek2nddayofNCO

Graded-passingis>80%

RemediationprovidedandretestwithversionB

EssentialsofCriticalCareOrientation3.0No

Computer-thirdpartypurchasedeliveredviaLearningManagementSystem

Duringorientation

80% Theykeepstudying&takingituntiltheypass.

Telemetry–atotalof8modulesNo

Computer,self-pacedviaLearningManagementSystem

Duringorientation

80%Modulesareassigned.Learnerscangoinanyorder.

Sameasabove