Clinical Orientation Record Weekly Progress Evaluation Key Rating 1 2 3 4 Identifies own Relies on others to identify learning Seeks help when needed learning needs needs Assessment Relies on preceptor to perform system assessment Reports Clinical Data Prioritizing Relies on preceptor to report clinical data to the MD/other health care team members Responds to every situation without differentiating urgency Performs complete system assessment with minimal preceptor assistance Reports clinical data to the MD/ other health care team members with prompting from preceptor Seeks guidance to prioritize patient care needs Performs complete system assessment independently, relevant to the patient s age Reports accurate, complete clinical data to the MD/ other health care team members Differentiates urgent and non-urgent situations independently and able to re-prioritize care Recognizes subtle deviations from norm Communicates accurate, complete, structured clinical data to MD/ other health care team members Implements care in response to prioritized needs Rationales Implements care without identifying correct rationale Identifies rationales with prompting from preceptor Identifies scientific rationale for interventions, independently Applies rationales based on specific patient pathophysiology Planning and Implementation Implements interventions directed by preceptor Initiates immediate interventions essential for patient safety Plans and implements an age-specific care plan Anticipates patient needs, plans for discharge. Collaborates with other members of health care team. Patient Teaching Documentation Requires preceptor to identify teaching needs Omits documentation of pertinent information Evaluation Evaluates patient interventions only with prompting from preceptor Recognizes specific patient/family teaching relevant to patient s age, special learning needs and reinforces previous teaching Documents according to established guidelines with minimal assistance of preceptor Evaluates interventions independently Identifies and provides teaching materials for patient/family and documents appropriately. Documents independently without omissions according to established guidelines Identifies, evaluates desired outcomes independently; contacts appropriate health care provider if outcome not achieved Identifies potential or more subtle patient/family teaching needs Documents independently without omissions according to established guidelines in a timely fashion Anticipates medical/nursing interventions required Time Management Unable to prioritize or complete tasks in a timely manner even with assistance Prioritizes & completes tasks but requires frequent reminding Prioritizes, and completes tasks in a timely manner with minimal reminding Prioritizes and completes tasks in a timely manner with no assistance or reminding Communication / Interpersonal Relationships Patient Safety Medication Administration Responds negatively to customers/colleagues Implements age specific Patient Safety Goals as directed by preceptor Safely administers medications with frequent reminder from preceptor Needs preceptor to guide interpersonal relationships Implements age specific Patient Safety Goals with minimal help from preceptor Safely administers medications with minimal reminder from preceptor Responds positively to customers/colleagues States and implements age appropriate Patient Safety Goals Consistently follows policies for safe medication administration Responds to underlying issue; assesses satisfaction with communication process Identifies issues that place patients at risk; communicates to supervisor University of Pittsburgh Medical Center Revised 11/07 All rights Reserved
NAME: Start Date: End Date: Preceptor: Planned Date for Off Orientation: 1 = Novice Practice 2 = Progressing toward Independent Practice 3 = Safe Independent Practice 4= Consistently Exceeds Expectations * If orientee remains a 1 for 3 weeks: Notify Educator for goal planning. Week 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Conference Date Identifies own learning needs Assessment Reports Clinical Data Prioritizing Rationales Planning and Implementation Patient Teaching Documentation Evaluation Time Management Communication Interpersonal Skills Patient Safety Medication Administration Orientee initials Preceptor Initials Educator/Clinician/Director 2
All new Hires will complete Week 1 & Week 2 Timeline Targeted Experiences Strategies/Content UPMC New Beginnings Class CHP New Beginnings Class Patient Care Orientation classes Caring & Listening/Dignity & Respect Quality & Safety Responsibility & Integrity Excellence & Innovation Week 1 Week 2 _ Complete Patient Care Orientation Assessments Medication Assessment Section 1 Section 2 Restraints Assessment Phlebotomy Assessment Glucometer Assessment ph paper Assessment Urine Screen Assessment Continue to attend Patient Care Orientation Class Continue to work with Unit Educator Spend time with Unit Technicians Observe interdisciplinary rounds Spend time with Clinical Leaders Tour Hospital Attend Patient Care Orientation Class (Content Below) Medication Administration Blood Administration Chest Tubes Phlebotomy Tracheostomy Care Nutrition and Feeding Tubes Restraints Peripheral IV assessment and Care Central Line & Mediport Documentation, PPID/Collection Manager Quality Skin Care Operational Issues Emergency Conditions Visitor Code of Conduct Ethics Patient Safety/ Risk Management Infection Control Patient and Family Education Magnet Professionalism/Shared Governance National Patient Safety Goals Hands on Skills Demonstration Phlebotomy/peripheral IV placement PCA pumps Large volume administration pumps Syringe pumps Enteral feeding pumps Receive Schedule from educator Begin New Pediatric Nurse CHEX modules Tour of Unit/Scavenger Hunt Review Emergency Equipment and procedures Meeting with Nicu Nurse manager/supervisor Pyxis Tutorial Calculating Calories Worksheet NICU specific education and self-learning binders Review safety checks 3
Week 1 with preceptor _ Begin Orienting with Preceptor on NICU A for 1-2 weeks. Progression to NICU C is individually based. Week 2 with preceptor _ Progression to NICU C usually begins here. Preceptors may return to NICU A at any point and is recommended to do so before the end of orientation Week 3 & 4 Date Neonatal Assessment: Obtaining the baseline Understand importance of Vital Signs and Safety Checks Observe Patient Care Rounds Calculate Calories Prepare and administer feedings Prime and connect IV tubing Safe administration of medications- PPID Transport stable patients Developmental Interventions Nursing Han- off Communication Learn about Neonatal specific pathophysiology Continue to develop baseline assessment skills Follows Neonatal Standards of Care Utilize all equipment properly Assesses patient status and identifies norms and abnormalities Participation in patient care rounds Safe administration of medications-ppid Monitors and utilizes IV access Initial communication with family Accurate calculation of calories Accurate documentation Hand-off report Response to alarms Prepare and administer feedings Discharge Planning and Patient/Family Education Advancing Assessment: Recognize changes in patients baseline Improved Documentation Patient Discharge Improved Patient and Family Education Initiate Multidisciplinary communication Post Recovery Care of a stable Post-op patient on 8A Safe administration of medications-ppid Prioritizing and Time Management Care for patient assignments on NICU A Orient to NICU A Orientee and Preceptor will work as a team: Orientee may observe preceptor giving care during this time Review Unit operations Review orientation checklist, binder, expectations Review monitors, nurse call, emergin Review operation of beds Practice basic Nursing Skills, assessment, and documentation Attend Rounds Complete Neonatal Orientation CHEX modules Work with preceptor to continue to practice nursing skills, observe procedures, look up and administer select medications Feed and reposition, and adjust to unit environment Observe preceptor presenting patient in rounds Observe preceptor giving handoff report at bedside Orientee and preceptor will work as a team Preceptor will provide information on patient diagnosis, encourage orientee to read patients chart Review round sheets and discuss information Nurse Educator can provide additional reading materials if requested Preceptor will review all medications with orientee for 5 Rights Assist orientee with communication. Review Neonatal Diagnosis Check medication and calorie calculations Review documentation for accuracy Continue to check medications, documentation Assist orientee to organize care Continue to review diagnosis information utilize CHEX Assess orientee s readiness to present patient during rounds Manage Nursing Handoff Report Communicate changes in patient status to appropriate team members Meet with Director or Supervisor and Educator to review checklist. Anticipate 1 st Meeting with Educator and/or Clinician 4
Week 5 & 6 Date Week 7& 8 Week 9 &10 Advancing Assessment: Recognize changes in patients baseline Improved Documentation Increase knowledge on neonatal airway management Assessing and Securing airways Stable vented patients or patients with tracheostomies Stable Patient Transport Stable Admissions Initiating and Participating in communication with healthcare team Prioritizing patient care Safe administration of medications-ppid Identifies emergency medical equipment Patient with moderate vent settings Preventing extubation Organizing care for a patient with a chest tube Admissions and transports Prioritize patient care Recognition of potential problems Assisting with intubation, extubation, line placement Introduction to vasoactive medications and continuous medications Practice with arterial lines & umbilical lines Understanding Hemodynamics Challenging admission Ventilated transport Adapting to unplanned events, re-evaluating patient care plans and priorities Review ABG results with orientee Assist with bag-valve-mask ventilation Assist with suctioning as needed Direct orientee to communicate to health team members Crash cart review Continue to work on organization of care Perform all double checks with orientee Preceptor will check and observe safe medication administration-ppid Review documentation for accuracy Review Syringe pumps Discuss ventilator weaning, review all ventilator changes with orientee Continue to enhanced ABG concepts Participate in bedside procedures Perform all double checks with orientee Preceptor will check and observe safe medication administration-ppid Review documentation for accuracy Continue to work on building and reinforcing skills Provide care to more complex patients Assist with blood drawing from arterial line Understand concepts of continuous hemodynamic monitoring Work on problem solving, prioritizing, and decision making Initiating and participating in discussions on patient care planning with multidisciplinary team members Educating the family, reinforcing educating and evaluating learner Anticipate 2 nd meeting Educator and or Supervisor Week 11 & 12 _ Increased independence with patient care assignment Enhanced Assessment Documenting independently Unstable patient with multiple lines, increased vent support, oscillators Continuous medication infusions Unstable transport or transport with advanced airway management Delegation to PCT Recognize/anticipate problems & plan ahead Admissions, discharges and transports Decrease reliance on preceptor Continue to develop organizational skills Review emergency drug sheets Seeks needed opportunities Participates in care of a patient at end of life Participates in Code event 5
Week 13 & Week 15 & Week 17 through 20 May require specific target goals and education plan. Beyond week 20 Busy paired assignment Proficiency in nursing skills Time management Prioritizing and Reprioritizing Delegation Critical Thinking Patient and Family Education Provide care to a normal 2 patient assignment Demonstrate independence in providing care Proficiency in nursing skills Time management Prioritizing and Reprioritizing Delegation Critical Thinking Patient and Family Education May require written developmental/education plan based on orientee s progress and needs to target specific goals needed to be met to successfully complete orientation. May adjust assignments based on orientee/preceptor comfort and appropriate patient assignment opportunities to pick up additional patients not to exceed a total of 4 patients between preceptor and orientee. Positive reinforcement of orientees strengths Review checklist for completions Seek needed opportunities Verbalize a plan to target skills that are still developing Orientee and precepeptor continue to work as a team. Meet with Educator to review checklist if there remain concerns about progress. Continue to target patient experiences that to this point have been unable to obtain due to availability. Communicate with Clinical Leaders and Educator what targeted experiences the orientee needs. For example, Discharge, Admission, OR etc. Preceptor and Orientee may advance to pick up more than 2 patients Anticipate End of Orientation meeting or 3 rd meeting with Educator, Supervisor and or Director Preceptor will be a Resource for last days of orientation Post last day of orientation a Resource RN will be assigned Meet with Educator, Unit Director and or Unit Supervisors to discuss specific plan for remainder of orientation. Set goals and target completion dates specific to plan based on orientee, preceptor and clinical leader s feedback. Reminders: o Orientation Competencies must be validated in TowerMetrix within 6 months of hire o New Pediatric Nurse CHEX courses must be completed within 3 months of hire o NICU RN CHEX courses must be completed within 6 months of hire o At the completion of Orientation Neonatal Resuscitation Course (NRP) should be scheduled o All New Hires will complete Crisis Intervention Course offered by Public Safety o All Nurses in which this is their first professional nursing job will complete RN Residency as part of their orientation 6