Welcome to the Pathway…..

Welcome to the Humboldt-Del Norte Regional Student Nurse Orientation.

Four health systems and two academic institutions in the California North Coast Counties of Humboldt and Del Norte are

pleased to support this academic program.

College of the Redwoods Humboldt State University Saint Joseph’s Hospital, Eureka Redwood Memorial Hospital,

Fortuna Mad River Hospital, Arcata Sutter Coast Hospital, Crescent City

As a student you will participate in clinical rotations in our facilities; please read this presentation carefully, it is your source of general information regarding your responsibilities as a student within our facilities.

Throughout this program are short quizzes that will help to evaluate your understanding of the material and document your understanding of certain regulations and responsibilities that you hold as you learn clinically within our facilities.

You are responsible for reading all the material contained within the ___ modules of this orientation and completing the ___ on-line quizzes with a score of 80% or better on each unit.

These quizzes must be completed, submitted on-line and reviewed by your instructor before you begin your clinical rotation.

Various accrediting agencies and Department of Health surveyors may stop you, as a student, at any time and ask you questions about the clinical facility you have been assigned to do your rotation in. You are accountable to know the

answers, especially related to safety for patients and yourself.

The material in this orientation will prepare you to answer questions appropriately as well as provide safe patient care.

As a nursing student at your clinical facility, you join a team of people dedicated to high-quality patient care. How you conduct yourself while you are providing patient care and how prepared you are to provide patient care reflects a standard of excellence to both customers and staff.

Students, instructors, staff and physicians at our regional hospitals are committed to providing services to patients in a caring, respectful way. Anxieties and fears related to illness, separation from home, and loss of control make hospitalization a stressful event in the life of each patient. As a student, you must always remain constantly alert to these stresses and remain professional through understanding, and compassionate behavior.

Thank you, in advance, for the caring contribution you will make to our patients and their families.

May your student experience be both gratifying and personally rewarding.

Your Clinical Agency

Module 1:

May perform procedures/tasks normally performed by a RN consistent with California Registered Nurse Practice Act.

Perform patient care according to the written policies, standards, and resource manuals of each institution

Student and/or instructor shall inform staff of student’s capabilities in performing assigned procedures

All new skills should be performed under the supervision of the instructor unless prior arrangements have been agreed upon between the instructor and involved staff

It is the student’s responsibility to request supervision by the clinical instructor BEFORE attempting a task that requires supervision

Document care provided. Have all entries in the patient’s medical record reviewed by the instructor prior to making the entry and/or end of shift and co-signed by instructor or supervising RN

Report IMMEDIATELY any change in patient’s condition promptly to assigned nurse

Respect the confidentiality of all patient information

Wear identification badge issued by the school During emergency situations, students are

expected to perform ONLY basic life support. Students DO NOT defibrillate or administer IV push emergency medications

The role of the RN, LVN and Nursing Assistance (NA or CNA) are defined by State Law

The scope of practice of the RN, LVN and NA/CNA are further defined within the context of the policy of the healthcare agency… honoring the legal limitations of practice.

The following slides contrast the legal roles generally held by RN, LVN and NA/CNA

RN RoleA registered nurse is responsible for the planning, supervision, implementation, and evaluation of the nursing care provided to each patient. The implementation of nursing care may be delegated by the registered nurse responsible for the patient to other licensed nursing staff, or may be assigned to unlicensed staff, subject to any limitations of their licensure, certification, level of validated competency, and/or regulation.The RN may not complete every aspect of each patient’s care, but must supervise that care and is responsible for the ultimate outcome of the patient.The RN is assigned to every patient cared for by a student nurse.

LVN RoleWorks under the direction of the RN and provides care delegated by the RNperforms services requiring technical and manual skills

NA RoleWorks under the direction of the RN and provides care delegated by the RN

Responsibility….

RN RoleAssessment includes observation of signs and symptoms of illness, reactions to treatment, general behavior, or general physical condition, and determination of whether the signs, symptoms, reactions, behavior, or general appearance exhibit abnormal characteristicsThe RN is responsible for assessing patient/family learning needsData is gathered by the RN or by other healthcare providers. Information is gathered on admission, at the beginning of and throughout the shift, and before and after any surgery or procedure, and before and after transfer

LVN RoleUses and practices basic assessment (data collection)

NA Role•Does not legally “assess” clients, but reports changes to LVN or RN immediately

Assessment…..

Planning Care…RN RoleThe planning and delivery of patient care shall reflect all elements of the nursing process: assessment, nursing diagnosis, planning, intervention, evaluation and, as circumstances require, patient advocacy, and shall be initiated by a registered nurse at the time of admission.Collaborates with other members of the interdisciplinary team: (Social services, Physical Therapy, Respiratory Therapy, Dietary, Volunteer services, Chaplain)

LVN Role

Participates in planning,Observes and provide data to the RN about the patient’s response to the plan of care

NA Role•Carries out aspects of the Nursing Care Plan under the direction of the RN/LVN and provides care delegated by the RN/LVN

Providing Direct Patient Care/Hygiene…•All members of the patient care team are responsible for patient hygiene, toileting, and linen changes

Communication…RN Role•Maintain open communication with other members of the health care team •Confer/collaborate with physician

LVN RoleApplies communication skills for the purpose of patient/client care

NA RoleReport directly to assigned RN/LVN

Education…RN Role•Provides patient and family education to facilitate adaptation to illness including ongoing discharge teaching of each patient. •Any assignment of specific patient education tasks to patient care personnel shall be made by the registered nurse responsible for the patient

LVN Role•Contributes to the development and implementation of a teaching plan related to self-care for the patient/client.•Document patient education

NA RoleReport directly to assigned RN/LVN any identified patient needs or requests related toEducation.

RN RoleObserve patients in restraints per policyMaintain bed in low positionMaintain side rails up if appropriateAssist with positioning patientsUse safety precautions when ambulating or toileting patientsObserve, report and intervene appropriately when problems are recognized in relation to:

oPhysical safetyoEmotional safetyoPatient rights

LVN RoleObserve patients in restraintsMaintain bed in low positionMaintain side rails up if appropriateAssist with positioning patientsUse safety precautions when ambulating or toileting patientsObserve, report and intervene appropriately when problems are recognized in relation to:

oPhysical safetyoEmotional safetyoPatient rights

NA RoleObserve patients in restraints Maintain bed in low positionMaintain side rails up if appropriateAssist with positioning patientsUse safety precautions when ambulating or toileting patientsObserve, report and intervene appropriately when problems are recognized in relation to:Physical safetyEmotional safetyPatients rights

Safety…

Observation…RN RoleMeasure vital signsMonitor I & OAnswer call lightsObserve and report changes in patient condition

LVN RoleMeasure vital signsMonitor I & OAnswer call lightsObserve and report changes in patient condition

NA RoleMeasure vital signsMonitor I & OAnswer call lightsObserve and report changes in patient condition

Procedures/Treatments…

RN RolePerform all nursing procedures/treatments, including sterile procedures, according to the appropriate standard/policy /procedureAssist physicians with procedures/treatments as necessary

LVN RolePerform nursing procedures/treatments that are within scope of practiceAssist physicians with procedures/treatments as appropriate

NA RoleProvides care as delegated by RN

RN RoleImplement pain management standard of practice/policy/procedure

LVN RoleImplement pain management standard of practice/policy/procedureDocument and report to RN effectiveness of care

NA RoleObserves and reports patient’s complaints of pain

Pain Management…

RN RoleMeasure and document intake and outputPrepare & feed patientsProvide fluids & nourishment’s

LVN RoleMeasure and document intake and outputPrepare & feed patientsProvide fluids & nourishment’s

NA RoleMeasure and document intake and outputPrepare & feed patientsProvide fluids & nourishment’s after checking with RN/LVN

Nutrition…

RN RoleUse “5 Rights” of medication administrationEvaluate effect of medicationDocument appropriatelyCompletes medication discrepancy reports

LVN RoleAdministers medications within scope of practice according to hospital policyUse “5 Rights” of medication administration

NA Role•Reports to RN/LVN patient requests or questions regarding•medication

RN RoleResponsible for all aspects of IV therapy:

oInitiate, monitor and evaluate therapyoFluid managementoMedication administration

May do phlebotomy as neededMaintains and accesses central lines

LVN RoleIf completed a course approved by the BVNPT, may withdraw blood from a patient and start and superimpose intravenous fluids If you are working with LVNs, check that hospital’s policy for LVN practice with IVs. Each hospital may be different!

NA Role•Reports to RN/LVN patient concerns or questions regarding IV therapy

Medication Administration…

IV Therapy…

RN RoleInformation related to the patient's initial assessment and reassessments, nursing diagnosis, plan, intervention, evaluation, and patient advocacy shall be permanently recorded in the patient's medical record.Nursing care providedPatient/family responses to carePatient /family educationNotes physician ordersReviews documentation of other members of the health care team including LVN and NA.

LVN RoleNursing care providedPatient/family responses to carePatient/family educationNote physician ordersTakes verbal or telephone orders for those functions within LVN scope of practice.Discontinues orders within their scope of practice

NA RoleDocuments I&O, hygiene and role-specific activities as delegated by the LVN or RN

RN RoleEvaluates the effectiveness of the care plan through observation of the client's physical condition and behavior, signs and symptoms of illness, and reactions to treatment

LVN RoleContributes to evaluation of individualized interventions related to the care plan or treatment plan; communicates to RN

NA RoleCommunicates observations to RN/LVN

Documentation…

Evaluation…

Contained within the Student Orientation section of your Web Program (Blackboard, Moodle, etc) is the quiz for “Module 1”.

Please complete that ten-item critical thinking quiz and submit your answers to your instructor via your web program.

When you have completed the “Module 1” quiz, move on to the Module 2 slide presentation.