ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN)

ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) NAME: EMPLOYMENT/TRANSFER DATE: BLS RENEWAL DATE: ALLIANCE ORIENTATION DATE: HOSPITAL ORIENTATION DATE: NURSING ORIENTATION DATE: ACLS RENEWAL DATE: The purpose of this orientation competency clinical plan is to use Benner s Domains to address the various RN s skills within the appropriate domains. At the end of your orientation plan, you will have an understanding of what your role is as the circulating RN in the Endoscopy room. It is your responsibility to ensure that your preceptor(s) signs off the objectives as being completed. You are responsible for completing the reading sections identified in the plan. The staff educators in Perioperative Services will schedule you for any additional classes or courses within the organization if deemed appropriate. This copy of your orientation/clinical plan will be kept on site and will be available daily. The preceptor(s) will be responsible for signing off the skills, objectives, etc. when he/she feels you are competent. The preceptor(s) will fill in the date on the line beside the skill and will put his/her initials beside the description of the skill. The preceptor will put his/her initials along with his/her signature on the Orientee Evaluation sheet appropriate for the week the skill was signed off. The preceptor(s) should not date or initial any skill, etc until they are certain that you can perform the skill independently. The preceptor(s) will do weekly evaluations of your progress and will include reasons or variances for the objectives/skills not met. Meetings will be held with the clinical coordinator, preceptor(s), staff educator and yourself to discuss your progress and discuss your future goals. At the end of the orientation period, this clinical plan will be given to your clinical coordinator and it will be placed in your file. *Refer to the appropriate standards of care and policy and procedures for reference and/or guidance 7/14CQ/RH 1

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) WEEK #1&2 Nursing (includes Hospital and Nursing Orientation) HELPING ROLE TEACHING/ COACHING DIAGNOSTIC/ MONITORING Observes Endo nurses & advances to helping role as appropriate Assesses own learning needs Self Directed Learning Modules Reviews and completes posttest for week 1 & 2 Performs therapeutic interventions : BP monitor Pulse oximeter EKG monitor Reversal protocol IV fluid management Management of medications received preop and intraop Positioning Review recognize signs of pain RAPIDLY CHANGING SITUATIONS Locates emergency equipment: Crash carts Fire extinguishers & alarms Emergency exits Emergency oxygen supply Oxygen & gas shutoff Malignant Hyperthermia cart Identifies procedures for management of: Code Blue & Anesthesia stat Code T Code Green Occupational injury/exposure Condition Black Code Silver Condition 8 Code K Code H Terror Condition Red 2 THERAPEUTIC INTERVENTION Passes LGH pharmacology exam Accesses Pyxis and uses appropriately to: Inventory Return Waste Complete discrepancies Obtains Medications Demonstrates use of: Beds Litters QUALITY/PI RESEARCH Locates reference manuals Demonstrates use of: Paging system Telephone system Kronos e-health medication administration Image management system E-Health charting Obtains access for computer use e-health Intranet Kronos Provation ORGANIZATION AND WORK ROLE Meets with staff educators Obtains locker Shown location and use of time clocks Reviews: Sick Call Procedure Human Resource policies and manuals Unit specific manuals PTB and scheduling requests Dress Code Tour of department Meets with clinical coordinators/ manager Introductions to staff Initiates Clinical Orientation Plan

Orientee Evaluation Exceptional Meets Standards Needs Improvement 1. Employs an organized plan of care, manages time appropriately, revises priorities when needed. 2. Demonstrates safe patient care/procedures and safe use of equipment. 3. Demonstrates communication with Health Care Team 4. Demonstrates effective team building skills (delegates/accepts delegation, communicates & follows up appropriately with other team members). 5. Demonstrates good customer service (i.e. introducing self, assuring privacy, appropriate dress, no perfume, minimal jewelry, etc.). 6. Demonstrates patient education including the family. 7. Independently seeks out learning experiences. 8. Types of surgical cases experienced this week Additional : Goals for Next Week: 1. 2. 3. Signature of Orientee Signature of Educator Signature of Preceptor Signature of Manager Date: 3

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) WEEK #3 (Nursing)(Procedures) HELPING ROLE TEACHING/ COACHING assess & document patient s physiologic & psychologic status & provides interventions as appropriate Functions as a helper to all other members of the Endo team Denotes Age Specific Assesses own learning needs Reviews airway management strategies with educator/preceptor: Obstruction Silent Apnea Mandibular maneuver adult Mandibular maneuver child Oral airway adult Oral airway child NP Airway Laryngospasm Brochospasm Ambu Bag Pneumothrax DIAGNOSTIC/ MONITORING Performs patient assessment: Airway Breath sounds Respiratory rate Apical rate Heart sounds Blood pressure Oxygen saturation EKG interpretation RAPIDLY CHANGING SITUATIONS Locates and demonstrates use of: Crash cart Defibrillator Malignant Hyperthermia cart THERAPEUTIC INTERVENTION Effectively assesses the physiological health status of the patient Develops plan of care that prescribes nursing actions to achieve patient goals Plans agespecific nursing interventions for selected patient populations Reviews and implement MD orders Locate and release blood product from EPIC QUALITY/PI RESEARCH Follows Endoscopy Management Protocol Reviews, initiates and completes/or documents: Preop Navigator Operative permit Anesthesia permit Anesthesia record Endoscopy report sheet Endo charging MD orders Endo standing orders Endo Management Protocol Endo Pre-op checklist Delay codes Time out Provation ORGANIZATION AND WORK ROLE Assesses the physiological and psychological health status of the patient correct documentation of patient assessment Develops a plan of care that establishes patient goals based on nursing diagnosis Self Directed Learning Modules Reviews and completes posttest for week 3 4

Orientee Evaluation Exceptional Meets Standards Needs Improvement 1. Employs an organized plan of care, manages time appropriately, revises priorities when needed. 2. Demonstrates safe patient care/procedures and safe use of equipment. 3. Demonstrates communication with Health Care Team 4. Demonstrates effective team building skills (delegates/accepts delegation, communicates & follows up appropriately with other team members). 5. Demonstrates good customer service (i.e. introducing self, assuring privacy, appropriate dress, no perfume, minimal jewelry, etc.). 6. Demonstrates patient education including the family. 7. Independently seeks out learning experiences. 8. Types of surgical cases experienced this week Additional : Goals for Next Week: 1. 2. 3. Signature of Orientee Signature of Educator Signature of Preceptor Signature of Manager Date: 5

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) WEEK #4 (Nursing)(Procedures) HELPING ROLE TEACHING/ COACHING assess and document patient s pain Functions as a helper to all other members of the Endo team Denotes Age Specic Assesses own learning needs Self-Directed Leaning Modules: Reviews and completes posttest for week 4 & 5 DIAGNOSTIC/ MONITORING Demonstrates ability to monitor patient receiving conscious sedation: Take and record vital signs per guidelines Ability to read and interpret EKG strips Implement appropriate interventions if problems detected Demonstrates ability to prepare room for procedure: Reviews MD preference sheet Gathers all requested equipment supplies Assembles and tests equipment and supplies RAPIDLY CHANGING SITUATIONS Discusses or demonstrates the interventions needed for the adverse effects caused by pain medications Reviews position changes to alleviate flatulence THERAPEUTIC INTERVENTION Demonstrates ability to prepare patient for procedure: Vital Signs IV administration Preop Navigator completion Demonstrates ability to prepare patient in Endo room: Prepare for medication administration Take and record vital signs per guidelines Administration of medications including correct dose, route and time Assists with positioning Abbreviated Time Out Official Time Out QUALITY/PI RESEARCH Follows Perioperative Management Protocol Follows Procedural Sedation Protocol Demonstrates ability to document appropriately for: Conscious sedation navigator Intra-procedure record Verbal MD orders Protocols Chart notes Pathology sheets Universal Lab requests Cytology lab sheet Special Lab protocol list ORGANIZATION AND WORK ROLE function in role of caring for a patient in Endo with assistance from other Endo staff Demonstrates the use the following equipment: NIBP Oxygen flowmeters Suction units Neptune system (for use in Main OR) Cardiac Monitor 6

Orientee Evaluation Exceptional Meets Standards Needs Improvement 1. Employs an organized plan of care, manages time appropriately, revises priorities when needed. 2. Demonstrates safe patient care/procedures and safe use of equipment. 3. Demonstrates communication with Health Care Team 4. Demonstrates effective team building skills (delegates/accepts delegation, communicates & follows up appropriately with other team members). 5. Demonstrates good customer service (i.e. introducing self, assuring privacy, appropriate dress, no perfume, minimal jewelry, etc.). 6. Demonstrates patient education including the family. 7. Independently seeks out learning experiences. 8. Types of surgical cases experienced this week Additional : Goals for Next Week: 1. 2. 3. Signature of Orientee Signature of Educator Signature of Preceptor Signature of Manager Date: 7

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) WEEK #5&6(Tech Role) HELPING ROLE Functions as a helper to all other members of the Endo team TEACHING/ COACHING Assesses own learning needs Self-Directed Leaning Modules: Reviews and completes posttest for Week 6 DIAGNOSTIC/ MONITORING Demonstrates use of: TV monitor processor Printer Keyboard Camera Travel carts RAPIDLY CHANGING SITUATIONS recognize and implement appropriate intervention for complications of procedures: Respiratory compromise or arrest Bleeding/ shock Cardiac arrest- Code Blue Bowel perforation Esophageal perforation THERAPEUTIC INTERVENTION Traveling carts Computer/ processor Bronchoscopy cart Bronchoscopy cart on call Bronchoscopy video ERCP cart Reviews and initiates skills checklist QUALITY/PI RESEARCH Follows Endoscopy Management Protocol Initiates RN Skills Checklist ORGANIZATION AND WORK ROLE care for Endoscopy patient with assistance Endoscope types and accessories Completes sign off sheet for procedure equipment appropriately place Bovie pads changing of printer ribbon and paper Denotes Age Specific 8

Orientee Evaluation Exceptional Meets Standards Needs Improvement 1. Employs an organized plan of care, manages time appropriately, revises priorities when needed. 2. Demonstrates safe patient care/procedures and safe use of equipment. 3. Demonstrates communication with Health Care Team 4. Demonstrates effective team building skills (delegates/accepts delegation, communicates & follows up appropriately with other team members). 5. Demonstrates good customer service (i.e. introducing self, assuring privacy, appropriate dress, no perfume, minimal jewelry, etc.). 6. Demonstrates patient education including the family. 7. Independently seeks out learning experiences. 8. Types of surgical cases experienced this week Additional : Goals for Next Week: 1. 2. 3. Signature of Orientee Signature of Educator Signature of Preceptor Signature of Manager Date: 9

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDRUE REGISTERED NURSE (RN) WEEK #7&8 (Tech Role) HELPING ROLE Functions as a helper to all other members of the Endo team TEACHING/ COACHING Reinforces previously learned skills Assesses own learning needs DIAGNOSTIC/ MONITORING Demonstrates the prepare room for procedure Reviews MD preference sheet Gathers all needed supplies and equipment Assembles and tests equipment and supplies RAPIDLY CHANGING SITUATIONS prioritize interventions in emergent situations (may be verbalized) THERAPEUTIC INTERVENTION Reviews how to assist for various endo procedures as listed on checklist: QUALITY/PI RESEARCH handle and label specimen types as listed on checklist ORGANIZATION AND WORK ROLE the care for endoscopy patients in all areas with minimal assistance ) Denotes Age Specific 10

Orientee Evaluation Exceptional Meets Standards Needs Improvement 1. Employs an organized plan of care, manages time appropriately, revises priorities when needed. 2. Demonstrates safe patient care/procedures and safe use of equipment. 3. Demonstrates communication with Health Care Team 4. Demonstrates effective team building skills (delegates/accepts delegation, communicates & follows up appropriately with other team members). 5. Demonstrates good customer service (i.e. introducing self, assuring privacy, appropriate dress, no perfume, minimal jewelry, etc.). 6. Demonstrates patient education including the family. 7. Independently seeks out learning experiences. 8. Types of surgical cases experienced this week Additional : Goals for Next Week: 1. 2. 3. Signature of Orientee Signature of Educator Signature of Preceptor Signature of Manager Date: 11

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) WEEK #9 (Anesthesia/Scopes)* HELPING ROLE TEACHING/ COACHING Functions as a helper to all other members of the Endo team Assesses own learning needs Scheduled 1-2 days with anesthesia Scheduled in scope room for 2-3 days DIAGNOSTIC/ MONITORING RAPIDLY CHANGING SITUATIONS the prioritize interventions in emergent situations (may be verbalized) THERAPEUTIC INTERVENTION Completes skills checklist for scope cleaning procedure QUALITY/PI RESEARCH Follows Endoscopy Management Protocol ORGANIZATION AND WORK ROLE care for Endo patient with minimal assistance care for and clean various endoscopy equipment Observe anesthesia role and responsibility (CRNA/MD) Denotes Age Specific 12

Orientee Evaluation Exceptional Meets Standards Needs Improvement 1. Employs an organized plan of care, manages time appropriately, revises priorities when needed. 2. Demonstrates safe patient care/procedures and safe use of equipment. 3. Demonstrates communication with Health Care Team 4. Demonstrates effective team building skills (delegates/accepts delegation, communicates & follows up appropriately with other team members). 5. Demonstrates good customer service (i.e. introducing self, assuring privacy, appropriate dress, no perfume, minimal jewelry, etc.). 6. Demonstrates patient education including the family. 7. Independently seeks out learning experiences. 8. Types of surgical cases experienced this week Additional : Goals for Next Week: 1. 2. 3. Signature of Orientee Signature of Educator Signature of Preceptor Signature of Manager Date: 13

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) WEEK #10 (Nursing/PrePost) HELPING ROLE TEACHING/ COACHING Functions as a helper to all other members of the Endo team Denotes Age Specific Assesses own learning needs Reinforces previously learned skills start IV lines preprocedure manage medications given and respond appropriately to adverse effects Reviews position changes for alleviation of flatulence recognize pain and treat accordingly DIAGNOSTIC/ MONITORING Demonstrates ability to assess and monitor patient pre and post procedure: VS monitoring LOC evaluation post conscious sedation Sensory evaluation post conscious sedation Observe for adverse medication reaction and respond accordingly Evaluate patient appropriately for DC criteria Demonstrate manage IV fluids in the pre and post patient RAPIDLY CHANGING SITUATIONS prioritize interventions in emergent situations Appropriately assesses for need and administers reversal agents if required THERAPEUTIC INTERVENTION Reviews, intiates and completes: PreOp Navigator Operative Permit Anesthesia Permit EPIC Endo charge slip Endo standing orders Physician orders Endo Management protocol PostOp Navigator QUALITY/PI RESEARCH Follows Endoscopy management protocol assist with Pre/Post procedure documentation ORGANIZATION AND WORK ROLE care for Endo patients with minimal assistance 14

Orientee Evaluation Exceptional Meets Standards Needs Improvement 1. Employs an organized plan of care, manages time appropriately, revises priorities when needed. 2. Demonstrates safe patient care/procedures and safe use of equipment. 3. Demonstrates communication with Health Care Team 5. Demonstrates effective team building skills (delegates/accepts delegation, communicates & follows up appropriately with other team members). 5. Demonstrates good customer service (i.e. introducing self, assuring privacy, appropriate dress, no perfume, minimal jewelry, etc.). 6. Demonstrates patient education including the family. 7. Independently seeks out learning experiences. 8. Types of surgical cases experienced this week Additional : Goals for Next Week: 1. 2. 3. Signature of Orientee Signature of Educator Signature of Preceptor Signature of Manager Date: 15

NAME: ENDOSCOPY ORIENTATION COMPETENCY CLINICAL PLAN PROCEDURE REGISTERED NURSE (RN) WEEK #11 & 12 (summary) HELPING ROLE TEACHING/ COACHING Functions as a helper to all other members of the Endo team Denotes Age Specific Assesses own learning needs Reinforces previously learned skills DIAGNOSTIC/ MONITORING Assists with (or verbalizes) appropriate measures for rapidly changing situations monitor patient undergoing endoscopy procedure and respond appropriately to adverse medication reactions and/or procedural complications RAPIDLY CHANGING SITUATIONS prioritize interventions in emergent situations Cares for patient undergoing conscious sedations with minimal assistance THERAPEUTIC INTERVENTION Assists physician in tech role with minimal to no assistance Circulates procedure room with minimal to no assistance QUALITY/PI RESEARCH Verbalizes on call weekend responsibilities and pager use ORGANIZATION AND WORK ROLE care for Endo patients with various procedures independently Completes all patient charting with minimal assistance care for and prepare endo equipment with minimal assistance 16

Clinical Orientation/Preceptor Evaluation Preceptor s Name New Employee s Name Unit Date Directions: Rate the extent to which each statement describes your preceptor s teaching behavior by checking a number following each item. 17

4 = To a large extent 3 = To a moderate extent 2 = To a small extent 1 = Not at all 1. There was enough time spent for orientation. 2. The staff on this unit made me feel welcomed. 3. The Clinical Plan helped me know what would be expected of me on this unit. 4. The primary preceptor was an excellent professional role model. 5. The preceptor guided my clinical problem solving. 6. The preceptor helped me to apply theory to clinical practice. 7. The preceptor was responsive to my individual learning needs. 8. The preceptor provided constructive feedback about my performance. 9. The preceptor communicated clearly and effectively. 10. The preceptor encouraged my independence. 11. Overall, the preceptor was an excellent clinical teacher. 12. I would recommend this preceptor for other new employees. If not, why? What was particularly helpful for you? What suggestions would you make to improve orientation? Additional Orientation Requirements Initials/ Signature 18

Initials Signature Initials Signature Additional Orientation Requirements Within the next year you will be scheduled to attend the following courses: 1. Basic arrhythmia: (or challenge test equivalent) 2. ACLS: 3. Peripheral IV Insertion Class 4. PACU Class The following are CBLs available through MyLearning: (Intranet>>>Applications>>>MyLearning>>>Course Catalog Search): Malignant Hyperthermia Fire Safety in the OR Lateral Violence Universal Protocol 19