Orientee Name Emp # Position. CMH WMC Other, specify. ARHS General Orientation Date / / Previous Work Experience/#Years Worked/Last Year Worked

Transcription

1 Orientation Validation of Competency RN Level I The purpose of this form is to document validation of competency and to serve as a guide for the orientation process. Orientee Name Emp # Position Department Facility BRR CMH WMC Other, specify ARHS General Orientation Date / / Previous Work Experience/#Years Worked/Last Year Worked Education Level/Degree(s) Registration/License Exp Date / Certifications BLS Exp Date / ACLS Exp Date / PALS Exp Date / Other, specify Exp Date / Other, specify Exp Date / Other, specify Exp Date / Orientee Self-Assessment Key N = No - I do NOT have adequate knowledge or skills, nor do I feel confident to meet the requirements of this competency. Y = Yes - I have the knowledge, skills, attitudes and judgments to adequately meet all the requirements for this competency. NA = Not Applicable - This competency does NOT apply to me; it may be outside my legislated scope of practice, or not part of my current nursing practice. Evaluator Method of Assessment & Instruction Key O = Observation RD = Return Demonstration T = Written Test V = Verbal Review E = Education (Computer-Based Learning, Class) P = Protocol/Procedure Review Evaluators (Print Name) Signature Initials Performance Criteria 1. Professional Responsibilities Demonstrates ability to complete order entry Self- Assessment Y, N, or NA Method of Assessment/ Instruction Met Evaluator Initials & Date Comments 2. Professional Responsibilities Demonstrates ability to establish a priority for patient care, delegate activities as appropriate, and utilize resources including other team members 3. Safety Demonstrates reporting occurrences using RiskWeb 4. Safety Demonstrates safe use of oxygen delivery systems 5. Safety Identifies fire alarm pull stations and exits within department 6. Safety Locates Employee Injury Report under Occupational Health on the ARHS Intranet 7. Safety Verbalize steps for reporting a critical test result to physician RN Level I Emp # 1 Dec2012

2 8. Safety Verbalizes department-specific response to emergencies Code Blue, Code Pink, Code Red, Code Silver, Code Yellow, Code Orange, Code Gray, Code Black, Code Triage 9. Safety Demonstrate retrieval of a Safety Data Sheet (MSDS) for a chemical located within the department 10. Safety Demonstrates use of mechanical lift equipment per Minimal Lift Policy. 11. Stroke Lists the signs, symptoms and response for a patient having a stroke 12. Fall Prevention - Implement Fall Prevention Precautions based on Morse Scale 13. Restraints Demonstrate tying a quick-release slip-knot 14. Restraints - Initiates Restraint Policy per physician order 15. Infection Control Demonstrates application of standard and transmission-based precautions 16. Infection Control Demonstrates proper hand hygiene when entering every patient environment 17. Infection Control Locates and verbalizes the ARHS Bloodborne Pathogens Exposure Control Plan in the Infection Control Manual 18. Waste Management Demonstrates disposal of all medication wastes in designated containers 19. Waste Management - Verbalize management of a chemotherapy spill and proper disposal of chemotherapy supplies 20. Communication Demonstrates use of hand-off tools including SBAR and Ticket-To-Ride 21. Communication Identifies communication barriers for patients and tools to alleviate communication problems (i.e. translation, hearing impairment) 22. Communication Locate list of unapproved abbreviations on the ARHS Intranet 23. Admission Conduct an initial holistic/multidimensional assessment to gather data relevant to the patient s needs including all systems 24. Admission Identify and initiate Plan of Care/Teaching Guidelines or Care Path based on assessment 25. Admission Make referrals to an interdisciplinary team based on information gathered on the Admission Form 26. Admission Send medications from home to the Pharmacy 27. Admission Send patient s valuables to the Admissions Office to be secured 28. Admission Use the Admission Form to gather patient information on health history and current condition RN Level I Emp # 2 Dec2012

3 29. Assessment - Conduct ongoing assessments and with change in condition per unit policy 30. Assessment - Document patient classification 31. Assessment Weigh patient using appropriate weight measurement scale 32. Pain Management Assess, intervene, reassess and document pain per policy 33. PCA Management Educates the patient and family 34. PCA Management - Initiates Patient Control Analgesia (PCA) Protocol per physician order 35. PCA Management Monitors the patient s condition 36. Education - Document on Plan of Care/Teaching Guidelines per policy 37. Education - Educate patient and caregiver(s) per policy 38. Physician Orders Comply with shift chart check per policy 39. Physician Orders Comply with verbal order read-back and documentation policy 40. Physician Orders - Confirm and note physician s orders according to hospital policy 41. Patient Monitoring Demonstrate measurement and documentation of patient intake and output 42. Medications Complete a medication pass including patient identification, retrieval, dispensing, and documentation 43. Safe Patient Handling Demonstrate selection and use of lift/movement equipment for transferring patients 44. Medications Complete the computer-based MedStation/Pyxis Tutorial 45. Medications Demonstrate medication reconciliation process from admission through discharge 46. Medications Demonstrate oxygen administration per physician order 47. Medications Demonstrate retrieval and education of medication information from LexiComp/Pyxis 48. IV Therapy Demonstrate starting an IV including setting-up/programming the pump and managing the site per physician order. 49. IV Therapy Manage a central line/picc line/port-a-cath including accessing, flushing, troubleshooting, sterile dressing changes and discontinuing per policy RN Level I Emp # 3 Dec2012

4 50. IV Therapy Monitor patient for IV Therapy complications 51. Medications Verbalize department-specific policy on vaccinations 52. Blood Administration Administer blood/blood product per policy 53. Blood Administration Verbalize signs and symptoms of blood transfusion reactions and appropriate interventions 54. Skin Care Demonstrate maintenance and troubleshooting of Wound Vac 55. Skin Care Demonstrate use of Skin Care Protocol and Addendum 56. Skin Care Implement Skin Integrity Protocol based on Braden Scale Score 57. Lab Specimens/Values Demonstrate collection, labeling, and routing specimens to the lab per policy 58. Lab Specimens/Values Demonstrates use of glucometer 59. Lab Specimens/Values Verbalize significance of CPK, Troponin, Potassium, BUN, Creatinine, Sodium, Pt, PTT, Magnesium, and Glucose 60. Lab Specimens/Values Verbalizes signs and symptoms of hyper/hypoglycemia and interventions. 61. Ostomy Care Follow Ostomy Care Plan for patients with ostomies 62. Surgery Communicate and document patient received from PACU/OR 63. Surgery - Complete the pre-operative checklist prior to surgery 64. Surgical Dressings and Drains Demonstrate application of sterile dressing per physician order 65. Surgical Dressings and Drains Demonstrate assessment and maintenance of postsurgical drains (JP, Penrose, HemoVac) 66. Surgical Dressings and Drains Demonstrate removal of sutures or staples or simulate procedure 67. Orthopedic Care Demonstrate proper application of knee immobilizer 68. Orthopedic Care Demonstrate proper position and transfer of post-hip surgery patient 69. Orthopedic Care Demonstrate setting up and use of Buck's traction and trapeze 70. Orthopedic Care Demonstrate sling application RN Level I Emp # 4 Dec2012

5 71. Orthopedic Care Demonstrate use of assistive devices for mobility gate belt, walker, crutches, cane, lift devices 72. Orthopedic Care Monitor and document circulation, sensation, movement of extremity, and obtain pedal pulses by palpation and with Doppler 73. PEG Tube Care Demonstrate dressing change, continuous & bolus enteral feeding per policy, and administer medications per physician order 74. Equipment Demonstrate application and management of Continuous Passive Motion (CPM) 75. Nasogastric Tube Demonstrate insertion, verify placement 3 ways, maintain patency, troubleshoot, irrigate and administer medications per policy 76. Equipment Demonstrate use of Crash Cart - Defibrillator/AED 77. Equipment Demonstrate use of department/facility-specific equipment (i.e. bladder scanner, Kangaroo K Pump). List 78. Equipment Demonstrate use of inspirometer 79. Equipment Demonstrate use of pulse oximeter 80. Procedure - Demonstrate Foley Catheter and continuous bladder irrigation per policy 81. Procedure - Insert and remove Foley Catheter per physician order and CAUTI Protocol 82. Protocols Locate DVT Protocol and apply compression per physician order (sequential & TED) 83. Transfers Assures completion of documentation to transfer patient out of the facility per policy including medical record, transfer packet, EMS documents, and bed confirmation at receiving facility 84. Transfers Use the Situation, Background, Assessment and Recommendation (SBAR) form to transfers patients from one nursing department to another 85. End-of-Life Care Follows End-Of-Life Care Addendum 86. End-of-Life Care Initiates Palliative Care Protocol per physician order 87. Postmortem Care Follow the Postmortem Care checklist 88. Postmortem Care Notify organ donation center per policy 89. Discharges Uses Discharge Instruction Sheet, Medication Reconciliation form, and Care Plans/Paths per policy 90. Discharges Uses the Against Medical Advice (AMA) form per policy RN Level I Emp # 5 Dec2012

6 Additional Evaluators (Print Name) Signature Initials Orientation Completed Date / / Employee Signature Director/Manager Signature RN Level I Emp # 6 Dec2012