Waitematamanual District Health Boardorientation / Competency

WaitemataManual
District Health BoardOrientation / Competency

Orientation

Overview

This document / This document supports the orientation for Registered nurses on the Nursing Entry to Practice Programme.
Contents / This document contains the following topics
Topic Page
Welcome
Finding your way around4
Job Description6
Preceptor period7
In the first days 8
Practice Development Log 10
Key Competencies14
Documentation 20
Competence assessment - Wound assessment and aseptic technique 21
Weeks 1-1022
Competence assessment - PICC/CVC dressing 24

This book belongs to: ______

Orientation book; Complete & submitwith RN1 portfolio on:November 14th2014

Welcome

Welcome to Waitemata District Health Board. We are pleased that you chose to work for our organisation and we look forward to making this a good experience for you.
Waitemata DHB aims to make your work experience a fulfilling one, a two-way experience, that aids your development as a professional at the same time supporting you as you provide service to our community.
This workbook is designed to assist your orientation to our organisation. If there is any additional information you require, please ask. We look forward to working with you as part of our team. Please take advantage of the learning opportunities available to you.
The aim / This competency-based programme helps you to familiarise yourself with the policies, procedures and standards required of nurses in this area. The programme has been designed to allow you to take responsibility for your own learning, while ensuring consistent standards throughout the service.
Support is provided in a number of ways, including NEtP clinical coaches, available 5 days a week to support you in all clinical issues.
About WDHB / Waitemata DHB provides services to the largest community in New Zealand. We serve a population of 525,000 people in the communities of NorthShoreCity, WaitakereCity and Rodney. We employ around 5,500 people in more than 30 different locations and manage a budget of over a billion dollars a year.
Our Values
In 2012 we redefined our values to reflect how we make a healthy difference to the community. At the heart of this is the need to respect the dignity of every single person and the fact that in health we are entrusted with the care of people. This is a privilege and profound responsibility which we can sometimes lose sight of in the business of everyday service delivery.
Promise

• Best care for everyone. This is our promise to the Waitemata Community and the standard for how we work together.

Values

• Everyone Matters
• With Compassion
• Connected
• Better, Best,Brilliant

Welcome, Continued

Leadership / The Chief Executive Officer (CEO) is Dr Dale Bramley
The Director of Nursing & Midwifery (DON&M) is Dr Jocelyn Peach
General Manager of clinical/provider services are:
Cath Cronin (Surgical & Ambulatory)
Debbie Eastwood (Medical & Older People)
Helen Wood (Mental Health)
Linda Harun (Child, Women and Family)
Associate Director of Nursing
Jenny Parr
Alex Craig (Mental Health)
Head of Division Nursing
Kate Gilmour(Surgical & Ambulatory Services)
Shirley Ross(Medical & Health of Older People)
Marianne Cameron (Child, Women & Family Services)
Emma Farmer (Midwifery)
Jean McQueen (Primary Health)
Clinical Nurse Director Older Adults & Home Help (OAHH)
Margaret O’Sullivan
Head of Division Allied Health
Tamzin Brott
Professional Development / Our commitment to your professional development
All nurses are included in the professional development and Recognition programme (PDRP) on employment at WDHB.
A component of the programme includes Levels of Practice.
Level 1: new professional, new graduate
Level 2: competent professional
Level 3: proficient professional
Level 4: advanced professional, clinical expert

Finding your way around- North Shore

Charge Nurse/Midwife Manager
Lower Ground Floor / Conference Rooms, Library
Learning & Development
Nursing Development Service
Staff cafeteria /
Ground / Main Reception
Public cafeteria
Pharmacy
ED
ADU
Radiology
Outpatients Clinics
Cultural Health Centre / Sue Lamb
Gina Watkinson
Annie Ashby
Marjorie Sands
Ground / Wd 11 Medical / Yolanda Titus
Ground / Wd 12 Psycho-Geriatric / Sue Smith
Ground / Wd 14 AT&R plus ortho-geriatric unit / Jo ClarkKirsten Ter Braak
Ground / Wd 15 AT&R plus stoke unit / Adrienne Reed
1st floor / Intensive Care Unit /High Dependency Unit
Operating Theatres
PACU
Lakeview Cardiology Centre (LCC)
Cardiology Services - CVU
Gastroenterology
Laboratory
Haematology Day Stay / Liz Dalby
Katherine Lee
Linda Gray
Shelley Berge
Deb Hogan
Susie Moncur
2nd floor / Birthing Suite, Post Natal ward, Antenatal Clinic
SCBU
Ward 2 / Lucy Casey
Diane Chesney
Jason Russell
3rd floor / Wd 3 Medical / Melanie Simpson
4th floor / Wd 4 Surgical / Sue Johnston
5th floor / Wd 5 Medical / Linda Moses
6th floor / Wd 6 Medical / Surgical / Carole Oosterhoff
7th floor / Wd 7 Acute Orthopaedic / Ros Bell
8th floor / Wd 8 Surgical / Frances Scheirlinck
9th floor / Wd 9 Elective Orthopaedic / Sue Huskinson
10th floor / Wd 10 Medical / Yogen Rajah

Waitakere

Charge Nurse manager
Lower Ground Floor / Therapies, Staff cafeteria
Muriwai Ward AT&R / Gerry Fennelly
Wainamu / Trenna Wilkinson
Ground
/ Main Reception
Emergency Care Centre
Radiology
Outpatients Clinics
Operating Theatres / Marja Peters
Geraldine Kirkwood
Faye Letham
Karekare ADU / Shelley Vaudrey
Titirangi Medical/Surgical / Angela Nightingill
Anawhata Medical / Donna Riddell
Rangitira Paediatric Medical Ward / Adelle Rongokea
SCBU - Special Care Baby Unit / Diane Chesney
Maternity Unit / Helen Ngatai
Wilson Centre
CNM Adrienne Barkle
Villa 1 / Rehabilitation and child development
Villa 2 / Respite Care
Villa 3 / Playroom
Villa 4 / Respite Care
Villa 5 / Respite Care
Villa 6 / Parent Accommodation

ESC

Operating Theatres / Ground Floor / CNM Lili Virtosu
Cullen Ward / First Floor / CNM Gerda du Preez
ACCN Sarah Redpath

Job Description

Responsible to / Charge Nurse of the ward/unit - For meeting performance objectives and service strategies
Director of Nursing and Midwifery - For maintenance of professional standards
Purpose of the position
To meet the needs of patients and their families using contemporary nursing care that is safe, appropriate and effective. The care is based on comprehensive assessment, ensures continuity, is client-centered, culturally sensitive and research-based.
Key accountabilities

1. To practice to the highest professional standard possible to provide patient-focused care.
2. To practice collaboratively and professionally as a member of the multidisciplinary health care team.
3. To contribute to continuous quality improvement to achieve care of the highest standard possible.
4. To provide clinical leadership, practicing responsibly and accountably at all times.

NETP Resource Folder

This folder is stored in your ward/unit. It contains useful information for your self and your preceptor/s including

- the study day timetable

- an outline of the due dates for completion of your course assessments

Development Log

One Nursing Council requirement of the NEtP programme is that you receive a minimum of sixteen (16) hours of practice development time. These hours are supplementary to study days and will provide the opportunity for feedback, reflection or clinical tutorials. While most of these sessions will occur with your preceptor/s, the clinical coach team may also provide practice development support. Each session is to be recorded and signed.

Preceptor period

Patient Load / You should be taking a patient load of 2 by the 5th shift. This should increase to 4, by the 9th shift. In the last week of supernumerary time increase your patient allocation to 5.
You will be supernumerary for 20 rostered shifts (excluding study days-approximately five weeks). During this time you are not counted in the ward staffing numbers, however share the responsibility with your preceptor for the patient load.
You then remain under the guidance of your preceptor and on the same shifts (mirrored shifts) for six (6) weeks, while taking your own patient load.
Remember that every learning opportunity that you experience during preceptorship will ease your transition to independent practice.
Medication Administration / You are able to prepare and administer all medications under direct supervision i.e. Your preceptor is supervising you at every step in the preparation and administration of medications.
You will complete the on-line medication administration test by 4 weeks.
You must then complete all practical administration competencies and submit the completed documentation to the Nurse Educator/Clinical Coach for your area.
NEtP Clinical Support / You will be supported by the Nurse Consultant, New Graduate Educator and Clinical Coach

• Jacqui Finch: 0212419510

• Sylvie Dombroski: Nurse Educator 93 1045 ext 3288

• Helen McGregorClinical Coach: 93 1803 ext 3970
• Pauline ScottClinical Coach: 93 1819 ext 7926

In the first days

Safety / Locate the fire exits
Identify the location of the fire hose and fire extinguisher
Locate three fire alarms in your work area.
Locate the visual display panel
Where is your ward evacuation point?
When does the fire test take place?
Locate your Emergency trolley
How often is it checked?
Check the resuscitation equipment daily. Familiarise yourself with the equipment; trolley, AED, portable O2 and suction
Does the emergency equipment have portable suction?
Where are the resuscitation forms kept?
What is their purpose? Where are they sent once completed?
How do you contact somebody urgently using the pager system?
Locate emergency call bells/call points.
Preceptor / Sign / Date

Continued on next page

In the first days, Continued

Key learning Tasks in first days / Document the following
Daily routine
Document the shift times for your area:

• AM
• PM

• Night

How do the patients in your area receive their meals?
What times are the meals served in your area?
What happens if a diet is changed?How does the main kitchen know?
How do patients choose what they want to eat?
Locate where nursing handover takes place &discuss what key information is shared in your ward/team.
During each shift, how and when will your nursing team communicate (patient care, planning, problem solving and support) to ensure collaborative practice
What times are breaks taken during each shift? How is this arranged? Where is it written?
Demonstrate the use Trendcare for your patients.
What time on each shift are you required to predict & actualise the Trendcare data for each patient? (morning, afternoon & night shift)
Locate the staff toilet and restroom.
Locate the staff first aid kit
Find the duty roster
Discuss with your CNM how RITA (electronic roster & pay system) works
Locate where nurses receive their mail
How do you notify the ward of your sick call?
How do you request - a duty change? Annual leave?
Preceptor / Sign / Date

Practice Development Log

Please sitwith your preceptor/s at the beginning of your orientation.

You need to discuss;

The feedback process you will use (e.g following procedures, during duty, at end of the duty)

Identify your learning goals/needs for your 10 week orientation.

New Graduate: ______Start Date:______

Preceptor/s______

Negotiated Learning Goals/Needs for the Next 10 weeks

Discussion and Feedback regarding goals and general progress
______
______
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______
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Signatures. Preceptor: Date:
New Graduate: Date:
Total development hours:

Completion & sign off of orientation work book (10/52)______

Completion & discussion of peer review (10/52) ______

Completion & discussion of peer review for RN2 portfolio______

Continued on next page

NEtP Team Practice Development support

Session / NEtP team member signature / Date / Time taken
Initial contact with NEtP clinical coach /educator including orientation workbook
Coaching for medication test including workbook
Focused debrief. The RN role;
- what does it look like, sound like feel like
Focused debrief. RN transition;
- balancing your professional & personal life
Focused debrief. RN transition;
- identify strategies for coping & new learning
Coaching & preparation of interim portfolio
Goal setting & exemplar writing;
- identifying your practice development goals
- using critical reflection in your writing
Written feedback & hand back of reflective exemplar
(RN1 interim portfolio)
Focused debrief. RN practice;
- ideals & expectations - building resilience
- strategies to build clinical judgement
Focused debrief.
- reflecting on end of life care
Focused debrief;
- themes from NETP 10/52 survey
- strategies to cope with increasing complexity
AUT Postgraduate paper – Assessment 1
- written and articulated clinical reasoning
Coaching & preparation for L2 portfolio
Total development hours:

Continued on next page

Additional Sessions

In-service sessions, cultural support or debrief sessions

(Enter these on your Education record in your Portfolio)

Topic/Event / Signature / Date / Time
Total development hours:

Key competencies - Shock and Emergency

Communicating the needs of your patients: calling for assistance /

• Internal emergency Number

FIRE, SECURITY, CARDIAC ARREST
777

• Discuss the application and algorithm for the NEWS Policy within your service area
• Find the easy reference phone numbers lists
• Learn how to use the electronic telephone directory
• Ensure you know how to

 Powerpage and place a *1 call
 Locator
Preceptor / Sign / Date
Effective management of rapidly changing situations, managing a crisis (shock and emergencies)
Where do you locate the documented resuscitation status of a patient?
Describe the NEWS algorithm & process
In what situation do you ring three bells/call for emergency assistance?
What is an inotropic drug?
If your patient collapses with compromised respiration – what mask and flowrate of O2 do you administer? Why?
If your patient is unconscious and vomits, what sort of suction catheter is used?
What position do you place the patient in? Why?
Discuss & demonstrate the use of aLaryngeal Mask Airway (LMA)
What is the first line drug in an arrest? Why?
Preceptor / Sign / Date
Emergency & cardiac drugs

Medication

/ Action / Route / Dose / Interactions
side effects
contra-indications / Nursing considerations
Adrenaline
Atropine

Narcan

Amiodarone

Equipment /

Find an Oxygen flow meter

Remove and re-insert it in the wall.
Where do you get new oxygen equipment from?
Where is 02 charted?
How do you get a Alaris/NikiT pump/ humidifier or PCA pump?
What happens when a pump is no longer needed, how do you get it collected?
Locate a wall suction unit. Discuss how it works with your preceptor
Practice adjusting the suction pressure flowrate. Check the tubing connections.
How do you change the suction from high to low pressure?
What units is the pressure measured in?
Identify 2 types of suction catheters
How do you change the bottle/unit? And when?
Preceptor / Sign / Date
Disposal systems / Explain the Standard Precautions requirements of Infection control.
In a four bedded screening room, when do you change your gown and wash your hands?
Explain each of the 5 Moments of hand hygiene.
What do you do with used meal trays, hygiene and toileting equipment that has been in an isolation room?
What type of rubbish goes in yellow bags?
What do you do with infected rubbish?
When do you use a rigid yellow bin?
What goes in the rigid blue bin?
What do you do with soiled or bloodstained laundry?
What swabs to you take for MRSA screening?
What swabs do you take for ESBL screening?
Who needs screening for VRE?
Preceptor / Sign / Date
General / Find your Lamson tube and use it to send something to the right place.
Identify the colour coded system of Lamson canisters
Find a blood result for a patient and print it out
Answer the phone at least once.
Fax machine. Fax a medication chart to pharmacy.
Discuss with your preceptor how & where acuity is allocated and recorded for your patients
Look at the patient board to identify the team your patient belongs to.
Identify how to contact the Doctors in each team
Preceptor / Sign / Date
General / Understand how patients are transported to different tests or procedures.
What is your understanding of Transit care?
Discuss the criteria for patients to require a Transit RN.
Discuss your role during doctors’ rounds
Explain the purpose, location and process of using the Patient Discharge lounge.
When and how to complete a Watch assessment form

• What are your responsibilities with the HCA performing a watch?

What is the role of the HCA’s on your ward?
Find the admission/ discharge book, discuss with ward clerk
How do patients get ECGs done?
Locate the ECG machine in your area and do an ECG.
Preceptor / Sign / Date
Observations / Look at the layout of an observation chart
Do a set of recordings on a patient, where was the equipment located?
What equipment do you use to monitor vital signs on a patient in isolation?
Discuss your responsibility in completing and reporting the NEWS score.
Where are the NEWS stickers kept?
Look at the layout of a fluid balance chart
When are they totalled?
Using an existing fluid balance chart, prepare the next bag of IV fluids and record output volumes.
Complete one with your preceptor
Preceptor / Sign / Date
Medicine administration /

Look at a prescription chart

Where are the forms kept?
Using a medication chart (or e-prescribing process), identify the next medication due.
Discuss the patient’s allergy status.
Familiarise yourself with the Pyxis machines.
Discuss strategies with your preceptor about how to minimise distractions and interruptions whilst you are on pyxis.
Prepare and administer medication, with direct supervision.
Discuss the WDHB policy for double checking Opioid administration from the pyxis to the bedside.
What is the ward/unit policy for safe administration of medication to patients in isolation?
Who is your ward pharmacist?
How do you obtain medications for patients that are not stock items?
What is your responsibility with the management of a patient’s own medication?
Preceptor / Sign / Date
Mandatory competence assessment / All New Graduates must complete the medicine administration competence assessment within 4 weeks of employment.
1. Calculations (computer test)
2. Theoretical Policy/procedures knowledge (computer test)
3. Specialty knowledge (computer test) as appropriate.
4. Clinical Practice competence (Practical assessment)
You will receive a Medication Administration handbook.
Please book the medication test with your Nurse Educator or Clinical Coach.
Documentation / Complete assessment toolsto identify patient’s needs and individualise care planning.
Documenting in the clinical record varies across service settings.
Patient focused nursing assessment & plan
PAAIRP; Current Problem, Assessment, Aim, Intervention, Response & Plan.

• Systems approach

General appearance, Observations, Treatments, Pain, Cardiovascular (CV), Respiratory, Genitourinary (GU)
Gastrointestinal (GI), Neurological (CNS), Skin, Mental Health, Musculoskeletal, Psychosocial.

• SOAPE

Subjective, Objective, Assessment, Plan & evaluation
Following any acute event with a patient, timely documentation is important.
A (airway) - compromised or spontaneous
B (breathing) - RR, work of breathing, oximetry
C (circulation) – capillary refill, vital signs
D (disability) - neurological; LOC, GCS, CG
E (exposure)- uncover the body, assess for injury, blood loss
OR
AVPU The assessor should always work from best (A) to worst (U) to avoid unnecessary tests on patients who are clearly conscious.
The four possible recordable outcomes are;
Alert - a fully awake (although not necessarily oriented) patient.
Voice - the patient makes some kind of response when you talk to them
Pain - the patient makes a response on the application of pain stimulus
Unresponsive - Sometimes seen noted as Unconscious, this outcome is recorded if the patient does not give any eye, voice or motor response to voice or pain.
Documentation ABCs
A = Accurate - date, time, contents
B = Brief - ‘to the point’, objective, factual and comprehensive
C = Clear - writing: signature (print name after) status is also part of signature e.g. RN

Competence assessment – Wound assessment & aseptic technique