Mad River Community HospitalNursing Student Orientation

Topics Presented in this Orientation:• Our Vision/ Standards of

Excellence• Services offered at

MRCH• Parking• Student Nurse

Responsibilities• History of MRCH• Emergency Codes• Fire Safety & Prevention

• Safety/ Hospital-wide manuals• Patient Confidentiality• Infection Control• Waste Disposal• Documentation• Performance

Improvement• Cultural Awareness• Back Care / Lifting

Techniques

** Please complete the attached post-test following your review of this orientation.

Our Vision• WE ARE Mad River Community Hospital.

• OUR QUEST is to become California’s leading and most innovative community health center.

• WE COMMIT to providing excellent care to patients.

• WE PLEDGE to always respect and care for those who choose us for wellness healthcare, employment, or as a place to practice the art and science of medicine.

Standards of Excellence

~ Mad River Community Hospital’s mission is “to provide the highest quality health care to meet the needs of the people and communities we serve”. All Mad River Community Hospital team members are expected to help fulfill this mission.

More Than A Hospital * Mad River Community Hospital has a full network of health

services:

• Adult Day Health Care of Mad River• Center for Wound Care and Hyperbaric Medicine.• Home Health Services of Mad River• Humboldt Family Medical Care• Mad River Rehab and Sports Medicine• Occupational Health Services of Mad River• Six Rivers Medical Center• Women’s Health Center• Endoscopy/GI Suites

Parking

› Park in the north or south gravel parking lots› Park to accommodate patients getting into the

hospital› Do not park in MD, patient, lab, handicapped, or

blocked off areas. › Do not move cones: may be blocking off areas

for helicopter landing or blood banking personnel

As a student, what are you responsible for during clinicals?

• Reporting to the clinical assignment at the designated time, and receiving your assignment

• Reporting information relative to the patient’s plan of care to the clinical instructor and staff assigned to the patient

• Communicating with the appropriate staff in order to coordinate care

As a student, what are you responsible for during clinicals?

• Informing the instructor or staff if you feel unable or unsafe to provide a care measure

• Contributing to the care planning process and documenting in the appropriate interdisciplinary care records according to standards

• Document care provided in the appropriate locations

As a student, what are you responsible for during clinicals?

• Conducting care, treatments, assessments and documentation according to published standards of the academic institution and the hospital

• Protecting the rights of the patient according to standards, including confidentiality, respect and dignity; and requesting patient’s permission for the student to participate in her/ his care

Students may NOT perform the following:

• Administer chemotherapeutic agents• Prepare and/or administer medications in emergent

situations• Access/administer narcotics independently• Carry narcotic keys• Conduct point of care testing • Urine dipstick • Nitrazine paper• Occult blood and whole blood glucose testing* *Once glucometer competency training complete, student will

be able to perform testing

Students may NOT perform the following:

• Participate in emergency response for cardiac and respiratory arrest (may observe with instructor permission)

• Pick up blood from the Lab

• Provide care to the following patient populations:• Patients who are inmates• Patients in respiratory isolation requiring individually fitted

masks• Patients with radiation implants

Students may NOT sign or complete the following:

• Patient Belonging Sheet• Labor Record• Blood Transfusion Record• Record of Death• Code Blue Record• Leaving Against Medical Advice• TPA Checklist• Transfer Forms• Intra-operative Record• Discharge Instruction Sheet

History of Mad River Community Hospital

Our HistoryThe original Trinity Hospital

built on the corner of 13th & G Streets in Arcata in 1911.

• 25 beds• Nursery• Two sun rooms• Operating room on the

top floor for maximum lighting

• On February 3, 1943, a tragic fire swept through the hospital causing extensive damage.

• On March 25, 1943 rebuilding began with the purchase of a full city block at 14th & C Streets by the Arcata Chamber of Commerce with contributions from the community.

Financial Factors for Change• Humboldt State College (now University)

announced they intended to purchase the Trinity Hospital site in 1968.

• The Sisters of St. Joseph of Orange announced closure of Trinity Hospital on June 30, 1969, in order to consolidate Arcata & Eureka services into new facility in Eureka.

Community Support for Arcata Based Hospital• Arcata Mayor Ward Falor called a town

meeting to discuss the future of Trinity Hospital.• Community members formed the

Trinity Hospital Action Committee (THAC).• National attention was brought into the

plight of Trinity Hospital.

American Hospital Management Corporation

• The THAC requested help from American Hospital Management Corporation (AHMC) in building a new hospital and operating Trinity Hospital until a new facility could be built.

• Allen Shaw, President of AHMC, was impressed with the community and physician support.

A New Beginning

• In 1968, AHMC and Trinity Hospital Medical Staff purchased 47 acres located on the Mad River.• Community-wide efforts were

underway to purchase the old Trinity Hospital from the Sisters.• On July 1, 1969, with no interruption of

services or employee layoffs, AHMC assumed the operation of Trinity Hospital.

The Birth of A New Hospital

~ And so began the arduous, political process of gaining state approval to build a new hospital.

Mad River Community Hospital

• Without the assistance of state or federal funds, Mad River Community Hospital opened its doors with patients from Trinity Hospital in October, 1972.

• AHMC has sold its four other hospitals, thus managing only Mad River Community Hospital and devoting itself entirely to the people of the North Coast.

Another New Beginning

• Shaw Pavilion completed in August 2004.

Emergency Hospital Codes

Your Role In Any Code:

• Students can call any code in an emergent situation, but may not participate past the initial response.

To Call Any Code: (Emergency Phone System)

• Dial 3911 - Between the hours of 0700-2300- State the type of code and

the location. Repeat 3 times.

• Dial 55 - Between 2300-0700- You will be “live” on the overhead system. - Listen for 3 beeps. State type of

code and location. Repeat, pause, and repeat again.

MRCH Emergency CodesCode Blue Cardiac/ Medical Emergency

Code Red Fire

Code White Pediatric Medical Emergency

Rapid Response Team Patient needing emergency assistance

Code Pink Infant Abduction

Code Purple Child Abduction

Dr. Strong Manpower needed

Code Gray Combative Person

Code Silver Person with weapon &/or active shooter &/or hostage situation

Code Security Lock Down

Code Yellow Bomb Threat

Triage External Major External Disaster

Triage Internal Physical Plant Failure (other codes may follow)

Code Orange Hazardous Material Spill/Release

Code Shelter-In-Place Sealing of building to outside air

Fire Safety & Prevention

• Goals of Fire Safety• Your Role in Fire Safety• Fire Safety (Code Red)

Goals of Fire Safety

• Prevent fires from starting• Stop the spread of fire• Protect patients from fire

Your Role in Fire Safety

• Handle all flammables, electrical equipment, and medical devices correctly and safely

• Never leave trash or supplies laying around in hallways (potential “kindling”)

• Never block fire doors, exits, fire extinguishers, or hoses

• Report any equipment problem or hazard immediately

Fire Safety – Code Red

R Remove all persons in danger

A Activate Alarm- Page by calling 3911 (day) or 55 (night)- Pull the fire alarm

C Confine the Fire - Close doors and windows to help keep fire and

smoke from spreading

E Extinguish the Fire (if manageable)- Attempt to put out only if small- If not, evacuate the area!

Operating a Fire Extinguisher

P Pull the pin

A Aim at base of fire

S Squeeze the handle

S Sweep from side to side

Safety Manuals/ Hospital-wide Manuals

• Environment of Care manual• Organization Wide manual• Nursing Administrative and Clinical manual• Infection Control manual

* When your clinical orientation begins, make sure you know where these manuals are located in your department. * They are also accessible on the Intranet.* Know what type of information can be found in each.

Environment of Care Manual

• Emergency communication plan & call tree• Phone/power failure procedure• Staff safety policies/security plan• Patient emergency response & call system• Disaster plan• Hazardous substances• MSDS location

* Contains information on the following:

Patient Confidentiality

•HIPAA Privacy Rule (Health Insurance Portability and Accountability Act)

• Ensures personal medical information patients share with doctors, hospitals and others who provide and pay for healthcare is protected.

The Privacy Rule does the following:

• Imposes restrictions on the use and disclosure of personal health information

• Gives patients greater access to their medical records

• Gives patients greater protection of their medical records

What is Protected Health Information (PHI)?

• Includes any information (oral, recorded, on paper, email, etc.) about a person’s physical or mental health

• Includes any information on services rendered or payment for those services

Examples:

• Patient’s name or address

• Social security or other identification numbers

• Physician’s personal notes

• Billing information

Who is covered under the HIPAA Privacy Rule?

• You are termed a covered entity if you are a:• Healthcare provider• Health plan• Healthcare clearinghouse• Business associate

What are the rules for use and disclosure of PHI?

• PHI can be used or disclosed for: treatment, payment, and healthcare operations

• With authorization or agreement from the individual patient

• For disclosure to the individual patient

• For incidental uses such as physicians talking to patients in a semi-private room

HIPAA Security Rule

• Second set of federal standards to protect health information in electronic form• Protects:

• Confidentiality of electronic PHI (ePHI)

• Integrity of ePHI (once created, can’t be tampered with)

• Availability of ePHI (can’t be accessed without authority)

In general, use/ disclosure of PHI is limited to the minimum amount of health information necessary to get

the job done right.

Infection Control

WHAT IS INFECTION CONTROL?• Infection Control is the practice of preventing

infection• Take steps to ensure that patients don’t

acquire an infection while they are here in the hospital

• TERM: Nosocomial (Hospital-Acquired) Infection

FOR MORE INFORMATION, LOOK IN THE INFECTION CONTROL MANUAL

LOCATED IN YOUR DEPARTMENT

Breaking the Chain of Infection

THE MOST EFFECTIVE INFECTION CONTROL MEASURE TO PREVENT THE TRANSMISSION OF INFECTION IS:

** HAND HYGIENE

~ You can isolate a patient and wear your PPE, but if you DON’T CLEAN YOUR HANDS you will carry the infection to all the patients you touch

What’s on your hands?Hopefully not that!

Remember!

Hand hygiene prevents the spread of infection

Good hand hygiene is the most important

activity you can do to keep your patients infection free

Hand Hygiene at MRCH• Hand washing with soap and water:• Antimicrobial soap• Non antimicrobial soap

• Hand hygiene with alcohol gel• Exceptions for use:

• Physical debris on hands• Protein matter on hands• Spores

Give Healthcare a HAND by washing yours!

• Before you start work• Before patient care• After patient care• While providing care when moving

from not clean to clean areas• Before invasive procedures• Before sterile procedures• After you remove gloves• The opportunities are endless!!!

Personal Protective Equipment (PPE)

• Wear a barrier to protect against blood and bodily fluids:• Gloves• Gown• Mask• Eye Protection

STANDARD PRECAUTIONS• Based on the principle that

all body fluids and excretions may contain transmissible infectious agents

• Practiced for all patients, all the time

• When you find yourself in a situation that might result in exposure to bodily fluids, utilize a barrier

Make a Partnership with Safety• Use the appropriate personal

protective equipment every time you need it.

• Utilize safety engineered devices the way they are intended to be used.

IF YOU WAIT UNTIL YOU GET SPLASHED, SPRAYEDOR EXPOSED TO PUT YOUR PPE ON, IT IS TOO LATE!

THEY ARE INTENDED TO KEEP YOU SAFE!

TRANSMISSION BASED PRECAUTIONS• Used in addition to Standard Precautions• Used when patient has organism that we don’t

want to spread to other patients or acquire ourselves

• Prevent spread by wearing a barrier (Personal Protective Equipment: PPE) specific to that mode of transmission

Contact PrecautionsSignage• On the patient room door, you should see these

signs:

Contact PrecautionsThe Details• Used for organisms that are spread by “contact” –

by body surface to body surface: physical transfer• Contact transmission is the most important and

most frequent mode of transmission of nosocomial infections

KEEP ‘EM CLEAN!

Contact PrecautionsWhat Should I Wear?

• Wear GLOVES for all patient care – this includes hand contact with the environment!

• Wear GLOVES and GOWN for patient contact that could result in your uniform coming into contact with patient or patient’s environment

Contact PrecautionsUsed for What Diseases?• Methicillin Resistant Staphylococcus aureus

(MRSA)• Vancomycin Resistant Enterococcus (VRE)• Lice• Scabies• Clostridium difficile• E. coli 0157:H7

Droplet Precautions Signage• On the patient room door, you should see these

signs:

Droplet PrecautionsThe Details

• Used for organisms that are spread by respiratory droplets• Respiratory droplets are generated by

cough, sneeze, talk, laugh, suction, bronchoscopy, etc• Respiratory droplets spread 3 to 5 feet

from the source • Droplets do not remain suspended in

the air

Droplet PrecautionsWhat Should I Wear?

• Wear a MASK and GLOVES for all patient contact – this includes hand contact with the environment!• If you are providing care that will likely

result in your uniform coming into contact with the patient or the patient’s environment, wear a GOWN• If you are suctioning, intubating, patient

has tracheostomy, etc – wear EYE PROTECTION

Droplet PrecautionsUsed for What Diseases?

• MRSA in sputum• Influenza• Meningitis• Measles (Rubella)

Airborne PrecautionsSignage• On the patient room door, you should see these

signs:

Airborne PrecautionsUsed for What Diseases?

• Mycobacterium tuberculosis• Varicella• Chicken Pox

Airborne PrecautionsThe Details• How Airborne Precautions differ from Droplet

Precautions:• Used for diseases spread by airborne droplet nuclei

(small particles) or evaporated droplets containing the microorganism

• The particles can remain suspended in the air for long periods of time

• The particles can be inhaled by others

Airborne PrecautionsWhat Should I Wear?• Wear a N-95 MASK and GLOVES for all patient

contact

• Wear the MASK, GLOVES and GOWN when providing care that may result in exposure to bodily fluids or your uniform may come into contact with the environment

Airborne PrecautionsAnything Else I Should Know?

• These particles are small and can remain suspended on air currents for great distances• Patients in Airborne Isolation need to

be placed in a room with specific ventilation:• Negative Pressure

HAI Prevention: Clean Equipment

- All equipment should be wiped down with a germicidal wipe (Sani Cloths)• Between patient use• When equipment leaves a patient room

(wheelchair, walkers, gurneys)

Disposal of Waste“Clear Bags”

• Diapers or incontinence pads soiled with urine or feces can be disposed of in the “regular” garbage• Dry, non-confidential waste may be

disposed of in the clear bags

Disposal of Waste“Biohazard”

• Waste material saturated with blood or bodily fluids must be discarded in the biohazard waste container• Liquid waste material must be

solidified before disposal (Isosorb)• Be sure to securely tie all biohazard

bags

Disposal of WasteSharps• Sharps containers are for all things

sharp• Sharp things include needles, scalpels,

lancets, syringes, ampules• Sharp things are considered sharp

even if the needle has been removed (syringe)• Sharp containers are not for tape,

cotton balls or random garbage

What is wrong with this picture?

Disposal of WastePharmaceutical Waste

• Pharmaceutical waste containers are for pharmaceutical waste • Pharmaceutical waste includes all

medications and additives that have any ingredient other than sugar, salt or water• Do not dispose of pharmaceutical

waste down the sink (Exception: IV fluid bags with electrolytes)

DocumentationImproving Your Charting

The chart remains as the only evidence of the

nursing care you have given!!!

If it was not charted it was not done!!!

But I swear it

did it!!

There are many factors required to be assessed for each and every patient:

• Patient needs

• Care necessary to meet those needs

• What needs to be done in respect to continuing care after patient is discharged

Nursing charting must contain:• Physical/psychosocial assessment to

determine the need of care and the frequency for additional assessments• Assessment of patient nutritional assessment• Assessment of functional abilities/status to

determine the need for post-discharge planning and rehabilitation

The charting must reflect:• Age specific and appropriate assessment and

interventions• On-going assessment of educational needs• Involvement of family and/or significant

others when appropriate• Adjustments in the plan of care with changes

in condition or diagnosis• Continual assessment of discharge planning

needs

All entries should reflect:• The care you have given• Adherence to MD orders or plan of care (Problem List)• Care should be consistent with standards of care (“Best

Practice”)

e.g. Your charting will be measured against what any other educated and prudent nurse would have delivered to the same patient in the same care situation

Finding Time to Chart

• Flowcharts help minimize the time required to document “routine” care, however,

Charting must also be individualized

So, how do you find the time to do this??

Multi-task !

• While assisting a patient to the BR who needs help getting back to bed….

• Combine care delivery with history taking, teaching, assessment (Bed Bath)

• While giving medications you can teach your patient about what they are receiving.

• What other ideas do you have??

Your Initial Assessment

Examples:Identify pressure ulcers in detail when admitting a patient:• Location, size, depth, drainage characteristics,

integrity of tissue margins. • If this is not done, it must be assumed that the

ulcer developed during the course of this hospital visit!!

Patient at risk for Falls:• If a patient was to fall and fracture a hip, you

have no evidence that steps were taken for the patient’s safety to prevent falls if you don’t document that you:

• Instructed the patient NOT to get up to the bathroom without using the call light (and the call light was at the bedside)

• Ensured that the bed was left in the lowest position

Patient refusing medications:• Document the exact reason why the patient refused

medication or treatment:

Example: Mr. Dysphasia states, “I cannot swallow pills.”

You chart: “Instructed patient regarding importance of taking potassium replacement,

with understanding verbalized. Call to Dr. Jones to notify of patients

refusal and request liquid alternative.”

NOT “Patient refused.”

A complete chart contains:• Identification of patient (stamp/sticker)• Date and time of assessment or intervention• Assessment of problem, knowledge deficit

requiring teaching, patient concern etc.• Assessment contains subjective and

objective information

A complete chart contains:• Statement of problem or knowledge deficit • Measurable goals: outcomes• Implementation measures: interventions taken

to correct the problem or knowledge deficit• Evaluation of patients response to interventions

What about flowcharts??* Excellent for recording repetitive data: Vital signs, I/Os, routine care

Don’t forget to chart patient’s response to interventions:If pain is rated as 8/10, and you give a pain medication, be sure to:

•Document their pain level or response (e.g. asleep) 30min - 1 hour afterward.

Common reasons for lawsuits involving nursing care :• Failure to question inappropriate physician’s

orders• Failure to adequately monitor a patient• Failure to protect the patient from an avoidable

injury• Failure to document care that was given in an

adequate manner• Failure to properly administer medications• Failure to take a complete and appropriate

nursing history

Common reasons for lawsuits involving nursing care :• Failure to follow orders correctly and timely• Failure to perform procedures properly• Failure to protect patient confidentiality• Failure to assess an emergency situation properly

and initiate appropriate resuscitative measures• Functioning outside the scope of nursing practice• Failure to request help when the nurse is unable

to meet the needs of a patient

Common reasons for lawsuits involving nursing care :• Failure to notify the physician of test results• Failure to follow hospital policy and procedure

when restraining patients

Why make such a big deal??• Charting is a professional responsibility

• Medical record may be scrutinized by insurance companies or Medicare or Medical and evaluated for errors

• Length of stay justification

• Quality of care assessment through chart review by accreditation organizations

• Risk management reviews chart to evaluate safety concerns

• To protect hospitals/nurses in the event of a lawsuit.

What about handwriting??•How you write is as important as what you write!

Up to 25% of medication errors are related to illegible

handwriting!

What about typing??

•Type in clear, concise statements. •Use flowchart pre-filled answers but elaborate as appropriate

•PRINT PRINT PRINT

•SLOW DOWN

•NUMBERS MUST BE WRITTEN CLEARLY

2 not 2.0 0.2 not .2

You Should Never…

• Never leave blank spaces for others to “catch up”

• Never destroy or change any part of the medical record after it has been created

• Never chart in advance!

You Should Never..

• Chart for others• Chart the observations that others have made.

Ex. “Patient fell on the floor” (NO)

“Patient found on the floor next to bed” (YES)

• Never chart in a way that could be determined as a negative assault on the patient’s character.

i.e. “Patient was a drunk and obnoxious jerk”

• Instead chart specific behaviors: i.e. “The patient refuses to have x-rays

performed, refused assessment, was observed to have a very unsteady gait while ambulating in the waiting room and urinated in the trash can in the waiting room.”

Dangerous Abbreviations

* Know where the list is located on your unit and in the

Org. Wide manual.

DO NOT USE THEM!

* There is also a list of Acceptable Abbreviations in the Org Wide Manual.

Performance ImprovementRegulatory Agencies, Occurrence Reports, Risk Management

Performance Improvement

• All nursing departments have a planned, systematic and ongoing monitoring and evaluation program to assess the quality of care delivered to patients

• The Performance Improvement Coordinator as well as the unit managers, are responsible and accountable for assuring this process is in place and that consistent standards are used to monitor and evaluate patient care

Performance Improvement

• Performance Improvement data is presented to the staff during their staff meetings. • This is an opportunity for all to review the data, analyze the

scores, and provide ideas for how improvements can be achieved.

• The findings from the Performance Improvement activities are used to formulate continuing education programs for the staff.

Regulatory Agency Umbrella

CMS

AOA Joint Commission

CDPH

CMS • Centers for Medicare & Medicaid Systems• Reimbursement for Medi-Cal and

Medicare patients• Reimbursements effected by performance• Improved Performance = Increased

Reimbursement

What does CMS do with info about our performance?

• We are mandated to submit our performance

• CMS publicly reports our performance compared with other hospitals

• CMS pro-rates our reimbursement based on our performance and “grades” us on a scale with other hospitals

• Rewards for being in top 10%

CDPH Evaluation

• California Department of Public Health• For State of California licensure• Investigates complaints and

deficiencies• Deficiencies can incur fines

OSHA: Occupational Safety & Health Administration

• Federal and State• Primary concern: YOU• Safe work place

How do Regulatory Agencies decide on what to focus on?

• Focus on QUALITY• Focus on PATIENT SAFETY• Focus on BEST PRACTICE• Focus on PATIENT SATISFACTION• Input from:• Institute for Healthcare Improvement• National Quality Forum

Why Participate?

• Because QUALITY, BEST PRACTICES & Patient Safety are IMPORTANT!

nd because we are rewarded for good practice

What do we focus on here?• Best Practices around

patients with:• Pneumonia• Heart Failure• Heart Attack (Acute

Myocardial Infarction)• Surgical Infection• Stroke• Deep Vein Thrombosis• Immunizations • Smoking Cessation

• Quality in all the services we provide: • from food to diagnostic

tests

• Patient Satisfaction• All inpatients and

outpatients are surveyed

What do we focus on here?

• Patient Safety• Culture of Safety

• Recognition of unsafe conditions and environments• Recognition of situations that could result in a problem or undesired

outcome• Talking about what we can do to make our workplace safer• Communication!

Core Measures• What is it?• Best Practices identified by CMS as contributors to better

outcomes, decreased length of stay and decreased occurrence of readmission

• The diagnoses include:• Heart Failure• Pneumonia• Acute Myocardial Infarction• Surgical Care Improvement Project• Immunizations

Occurrence Report

• Used for reporting unanticipated events such as:• Equipment failures• Patients leaving AMA• Falls

• If you notice a potential problem:• Isolate the problem (the

piece of equipment, etc)

• Report the problem to your supervisor or the department that can fix the problem

Risk Management• Uses Occurrence Report information• Patient/Family complaints• If you hear a family or patient complaining, address the complaint if

you can• If you can not address the complaint, report it to someone who can

• “ABUSE”• “HARRASSMENT”• RED FLAGS!

Cultural

Awareness

Cultural Awareness

• Why learn about cultural awareness?

Cultural Awareness

• Help patients receive more effective care.• Improve your job performance and your job

satisfaction.• Meet expectations of regulatory agencies.

Cultural Awareness

• What is Cultural Awareness?

Cultural Awareness

• Considering every patient’s culture when giving care.

• Treating every patient, family member, visitor and co-worker as an individual.

BACK CARE

BODY MECHANICS and LIFTING TECHNIQUES

A Healthy Back• Composed of 24 movable bones called vertebrae• Disks act like cushions• Muscles and ligaments support the back• Injury or disease = PAIN

A Balanced Back • Cervical, Thoracic, and Lumbar curves must be aligned• Ears shoulders and hips stacked• A healthy back is also protected and supported by well

conditioned muscles

Preventive Back Care• Always warm up

• Exercise the muscles that support your back

• Stretch to improve flexibility

• Posture is important

TASK ANALYSIS

• Fancy name for “PLANNING AHEAD”• Break task into steps• Think it through

PLANNING AHEAD.....

• Can I do the task by myself in a safe manner? • If not, determine the number of people it will take.• What equipment or materials are needed to do the job?

Use Your POWER ZONE! • Floor to shoulders, directly in front of the body

• The maximum Power Zone is from the knees to the waist

• You have 5-7 times the load capacity when using the Power Zone

Keep it “Locked In”• Keep your back muscles “Locked In” while lifting• 10x disk pressure when “Bowed Out”• Head and shoulders up

BACK SAVING TIPS• Always lift with your legs• Support lower back • “Nose between the toes!”• Be aware of trip or slip hazards• Push, don’t pull• Exercise

Thank you for reviewing the MRCH Student Nurse Orientation

Please complete the post test, and bring it with you on the first day of your hospital

orientation.

We welcome you to our hospital team!