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Registered Nurse Orientation

Welcome to UPMC Shadyside!

Tell us your

name…

Where you went

to school…

What unit you will

be working

on…

And something

about you…

Getting to know you…

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Nurses... the “Heartbeat of Shadyside”

Kellie Antinori-Lent MSN, RN, CDEInpatient and Outpatient Diabetes Educator/Consultant

Bethanne McCabe MSN, RN, CNRNStroke Coordinator/Stroke Assessment Team6 West, NSICU

Cindie Archer BSN, RNNA/PCT Educator, BLS Educator

Nicolette Mininni MEd, RN, CCRN SICU, CT/ICU, Dialysis, ICU Float Pool, CDU

Janet Cipkala-Gaffin DrPH, RNResearch, Evidence-Based Practice

Lois Pizzi MSN, RN-BCHospital Pain CNSPACU, DAS, ASC, Short Stay Unit

Faith Colen MSN, RN, CENEmergency Department

Mary Ellen Pritchard MSN, RN, CNL, CEN2 Pavilion/2 South, 3 Pavilion, 5 West, Med/Surg Float Pool, CDU

Karen Henery ~ Administrative CoordinatorNursing Education and Research

Lauren Saul MSN, RN MICU/CCU, 4/5 Pavilion, 4 South, 3 Main

Linda Lakdawala DNP, RN CPAN6/7 Pavilion, 3 East, 4 East, 4 Main

Anne Sillaman MSN, RN, OCN5 Main, 7 Main, 7 West

Wendy Lucas MSN, RN, CCRNMSICU, MICU/CCU, 6 Main

Joanne Turka MSN, RN-BC,CCRN Critical Care Nurse Educator, BLS/ACLS Educator

Carol Mathews BSN, RN, CWOCNEnterostomal and Wound Care Therapy

Shelley Watters DNP, RN ~ Director - Nursing Education and Research, Professional Development

Nursing Education and Research Department

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Relationship-Based Care

In what ways has your care impacted patients and others?

Authentic Caring

http://www.youtube.com/watch?v=cDDWvj_q-o8

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Effective Care Happens When We Work as a Team

Enjoying your Job and Colleagues!

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Shared Leadership – Professional Practice Model

Principles of Shared Leadership • Promotion of an environment that supports professional

nursing practice• Identification of nursing excellence in the delivery services

to patients• Providing mechanisms for the dissemination of “best

practices”• Supports autonomy and authority for nurse decision making.

Those at the bedside delivering care make the decisions related how best to provide care

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Shared Leadership at UPMC Shadyside

• 7 Councils

o Operations

o Professional Practice and Development

o Quality and Safety

o Evidence Based Practice and Research

o Transformational Leadership

o Informatics and Technology

o Support Services • Membership ~ nurses and other clinical staff from inpatient units

and all other departments that impact patient care delivery

Evaluating Success

• NDNQI Nursing Satisfaction Survey

• Evaluation of patient satisfaction scores (Press Ganey)

• Review of Quality Indicators

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UPMC Shadyside 1st Magnet Designation ~ March, 2010

Your 1st Year as a Nurse at UPMC Shadyside… Resources and Advice for Success!

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Changes

Some nurses experience separation anxiety during the transition period from:

Nurses transferring from other facilities are not immunePersonal and professional growth comes from facing challenges

Student Nurse

Graduate Nurse

Professional Staff Nurse

• Reality of being out in the real world• Surrounded by experienced people who know the

“unwritten” rules• Now responsible for taking care of patients• May be a time of self-doubt… did I make the right career

choice?

Apprehension and Fear

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• Be realistic• Immerse yourself in learning• Do your homework• Seek help and support• Deal with mistakes• Celebrate small accomplishments• Use positive self-talk• Trust your instincts!

Overcoming the Challenges

Mama said there would be days like this….

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Head it off at the pass…

• Set boundaries• Manage your stress• Take care of yourself• Take care of each other too• Develop support systems• Use humor

Stay Focused and Positive

• In your previous nursing experience…reflect on a day that you felt that you made a difference…what happened that day?

• Gravitate towards co-workers who are positive

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Practical Tips

for a Successful Orientation

• At bedside report:o Greet and introduce yourself.o Do a “touch and eyeball

assessment”.o Decide who needs to be

assessed first…promotes prioritization.

o Let them know you will be back after you ______.

How to organize your shift…

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• If you are having difficulty with getting your meds out on time…remember you have one hour before and after for most medications

• There are some exceptions…

How to organize your shift…

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o Experiment…now is the time to try out different techniques

o May choose to pass all meds first and then assess all patients or…the other way around

o Find out what works best for you

How to organize your shift…

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SBAR Communication

• Situationo Name o Unito Patient Name and Room #o Do you know this patient?

- If you are talking to the patient’s attending physician you may be able to abbreviate your Situation and Background.

o I am concerned about_____

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SBAR Communication

• Backgroundo The patient is in the hospital because… o Vital signs are…

• Assessmento My assessment of the situation is …o Tell physician if problem is life-threatening

• Recommendationo Do you want to order……?

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Patients have the right to:• Participate in their plan of care• Make informed decisions

– Use understandable language– Health status, diagnosis and prognosis– Anticipated outcomes of treatment and services

• Have provided services without discrimination• Privacy, Respect, Dignity and Comfort • Quality, Support, Advocacy

Patient Bill of Rights: Nursing Responsibilities

http://infonet2.upmc.com/News/Initiatives/AskOnce/PhysAmb/Documents/Patient%20Rights.pdf

• All UPMC employees have the utmost duty and obligation to:o exercise a set of values o exhibit right intentions and virtueso provide quality healthcare

• We consistently exercise honesty and integrity while adhering to all compliance and ethical standards governing our industry

Ethical Standards

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As an employee of UPMC, you have access to clinical systems to perform your job. You know your neighbor is in the hospital, but you don’t know why. You are concerned about your neighbor and decide to look up her records to see what the problem is. You are not involved in your neighbor’s care.

Was this access permissible?

Ethical Case Study

• You have done an excellent job caring for Mrs. Plumb and the family wants to thank you. Can you accept?

A $100 gift card to your favorite storeA Daisy nominationAn above and beyond recommendationA pizza to share with the staff and they ask what kind they should orderA box of candy for the staff

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Ethical Case Study

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About patient privacy…

• UPMC SHY’s Personal Information Number (PIN)o PIN is the first 2 and last 2 numbers of the patient’s medical record

number (although patient can request a number of his or her own choosing)

o Example: MR # is 463 527 793 8497 - What is this patient’s PIN number?

o Assigned to every admitted patiento Improves communication between staff and patient’s family and

friends

• Initiated based on patient’s entry point into the hospital o Admission Team, ICU nurses, nurses in the DAS/ASC

and SSU• PIN documented in electronic health record and on a canary yellow form

kept in the patient’s “paper” chart• When family or friends call or presents on

the unit asking for information on the patient – we must request the PIN number prior to sharing information

Personal Information Number (PIN) Process

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Progression of Assignments

A simple way to remember this…• At the beginning Preceptor will

help a great deal• Then the preceptor helps, but

pulls away somewhat to allow for growth

• And finally the preceptor will allow independence

• Preceptor knows…”You can let them tread water but …NEVER LET THEM SINK.”

• Preceptor is your guideo May choose to have you shadow first day or do part of a one-patient

assignment- Based on your experience

o Will be a role model and introduce you to other staff and clinicianso Listens to your report and reviews your documentation

• Advanced Clinical Education Specialist meets periodically with you and your Preceptor

o Support o Unit Director along with Preceptor and Clinical Educator monitors

your orientation

Your Supporters

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Used for Unit-Based Orientation• Keep the green book available when caring for patients so

Preceptor can fill in observations• Only sign evaluation page after the Preceptor reviews what

he/she has written• DO NOT take your green book home or put it in your locker!

o Nurse Manager or APN will want to review

• Ensure that the SHY and Unit-Based Orientation Competencies are being completed and signed by your Preceptor

Green Book Documentation

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Items with asterisks (***) must be completed during the clinical orientation.Others during Annual Competencies – preferably within 6 months.

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uLearn ModulesComponent Completed Component Completed

Age-related care/ abuse Quality of Care

Infection Prevention (Advanced) • Quality Improvement and Measures of Quality

• Healthcare Associated Infections (HAI)

• Clostridium difficile Infection (C. diff) • Partnering for Life: Core Measures

• Device-related Infections • Falls – Best Practices

• Surgical Site Infection Prevention • The Joint Commission’s National Patient Safety GoalsRestraints

Pain Management Stroke Education (search and select in catalogue then select item below from list to enroll)

Ketamine CD Bedside Dysphagia

Controlled Substances Blood Bank Label Change (collection mgr.)

Kangaroo (Coviden Pump)Alaris Pump Module

Improving Line SafetyCentral Line Care (toolkit)

CMS 30 minute rule SKIN module

Bedside Dysphagia testing (neuro, resource, ED)

Some other thoughts for support…

• Build in 15 minutes of reflective time as often as possible at the end of the shift

o Ask your Preceptors any questions to clarify what occurred during the shift

• Once your are off of Orientation, your UD will try to have you follow your preceptor’s schedule to continue those mentoring benefits

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Questions

Bibliography:

Anthony, G. (2004) Shared governance models: the theory, practice, and evidence.Online J Issues Nursing Available at: www.nursingworld.org/ojin/topic23/tpc23_4.htm. Accessed November 8, 2007

Hess, R. (1994) Shared governance: innovation or imitation? Nursing Economics 1228-34

Pierson, P., Miller, J. & Moore, K. (2007) Engaging staff in the Magnet journey: The key is communication. MEDSURG Nursing, 16 (1), 23-28

Porter-O’Grady, T. (2003) Research shared governance: a futility of focus. Journal of Nursing Administration 3 251-252

Porter-O’Grady, T., Alexander, D., Blaylock, J., Minkara, N. & Surel, D. (2006)Constructing a team model: creating a foundation for evidenced-based teams.Nursing Administration Quarterly. 30(3), 211-220.