Surry-Yadkin Works

On-the-job Training

• Competencies
  • Internal Disaster (Fire [including RACE] & Electrical Safety, Bomb Threat).
  • External Disaster (Emergency Preparedness).
  • Infection Control: Bloodborne Pathogens and Tuberculosis Exposure Control Plans.
  • Body Mechanics.
  • Domestic Violence/Reporting of Suspected Abuse.
  • Risk management (including Hazardous Materials and MSDS).
  • Radiation Safety.
  • Patient call system.
  • Code Blue Responsibilities.
  • Current BLS-Healthcare Provider. (exp. / )
  • Tour of department(s)/unit(s).
  • Mechanism for tracking time and attendance (TimeForce).
  • Telephone system; etiquette.
  • Answering call light; use of alphanumeric beepers; hospital cell phones.
  • Hospital/departmental policy manager/resource texts.
  • Departmental staff meetings.
  • Role of the Charge Nurse.
  • Standard of professional attire.
  • Ethics committee role and access.
  • Participate in Caring for Patient's Mental Health and Social Needs. Determines level of orientation
  • Identifies behaviors exhibited by patients with psychological and/or emotional needs.
  • Describes appropriate techniques of behavior management to deescalate negative behavior, informs Charge RN.
  • Identifies types of effective communication: verbal and non-verbal.
  • Identifies alternate methods of communication for patients with special needs.
  • Describes characteristics of therapeutic communication.
  • Describes barriers to effective communication.
  • Recognizes and reports important observations to the appropriate member of the health care team.
  • Discusses the importance of collaboration and communication with all members of the health care team. Proper Hand off Communication and Hourly Rounding/Walking Round Report.
  • Documents the following in the patient's medical record: 1.) Intake and output, Daily Weights., 2.) Vital signs/EKG's via Phillips interface., 3.) Fingerstick blood glucose testing., 4.) Calorie counts., 5.) Patient care provided and/or refusals of, 6.) Safety checks
  • Identifies acceptable medical abbreviation terminology using current approved list.
  • Defines the term medical asepsis.
  • Describes common mechanisms of hospital-acquired infections.
  • Identifies measures to prevent infections: 1) Demonstrates proper hand washing., 2) Separates clean and dirty items., 3) Disinfects supplies and equipment., 4) Properly handles & stores food., 5) Properly handles and disposes of linen., 6) Properly disposes body fluids/waste., 7) Maintenance of own health., 8) Identification of visitor illness.
  • Identifies isolation procedures, including signage: 1) Standard precautions., 2) Contact precautions., 3) Contact (special enteric) precautions., 4) Droplet precautions, 5) Respiratory/Airborne precautions (negative pressure)., 6) Portable Hepafilter., 7) Identifies negative pressure rooms.
  • Restraint Management: 1) Articulates legal and ethical considerations of restraint application., 2) Articulates devices not classified as restraints., 3) Collaborates with the nurse to ensure appropriate medical order is in place, including time limit., 4) Articulates indications/contraindications of restraint application., 5) Collaborates with the nurse and implements alternatives to restraint application., 6) Educates the patient/significant other regarding purpose of the restraint, and necessity for use., 7) Correctly applies the following restraints: a) Vest restraint. b) Limb restraints. c) Behavioral restraints. 8) Assesses, at a minimum every two-three (2-3) Hour intervals: a) Circulation., b) Condition of skin., c) Hygiene and toileting needs., d) Comfort and safety., e) Nutritional needs., 9) Removes restraint devices every two-three (2-3) hours for 10 minutes, and a) Performs ROM on extremity(ies). b) Repositions patient. c) Reapplies restraint, if indicated. 10) Documents on restraint interventions 11) Articulates indications for removal of restraints.
  • Prevention of Accidents: 1) Responds to emergency calls. 2) Follows plan of care at all times. 3) Answers call lights promptly. 4) Verifies accurate identification of patient prior to performing procedure(s). 5) Uses wheel locks on beds, lifts, stretchers, and wheelchairs. 6) Use side rails when indicated; bed in low position. 7) Cleans up spills immediately. 8) Removes sharps and disposes according to policy. 9) Prevents and removes hallway clutter. 10) Identifies, labels, reports and removes unsafe equipment. 11) Uses appropriate size equipment for patient needs.
  • Body Mechanics 1) Plans prior to doing. 2) Provides explanations to patients and/or significant other frequently. 3) Identifies tasks requiring assistance. 4) Uses appropriate body alignment techniques, e.g., wide base of support, avoid reaching etc: a. Side-lying or Lateral b. Lying prone c. Lying supine d. Sitting in bed: High/Semi-Fowler's e. Trendelenburg: Operation of bed f. Reverse Trendelenburg: Operation of bed g. Sitting in chair
  • Transfer Measures: 1) Collaborates with the nurse to ensure medical order is in place, develops a plan for transfer and explains to patient. 2) Identifies assistive devices needed. 3) Assisted sitting: Chair to bed, bed to chair, chair to chair. 4) Assisted Lying: Bed to stretcher, stretcher to bed. a) Uses lift shift. b) Uses log rolling technique. 5) Assists with ambulation. a) Demonstrates use of cane. b) Demonstrates use of walker. c) Demonstrates appropriate crutch walking procedure. d) Demonstrates use of mechanical lift device, including safety measures. e) Range of Motion Exercises (ROM) -Identifies the purpose of ROM. -Identifies patient populations at risk for complications of immobility related to the musculoskeletal system. - Educates patients on techniques of active ROM. -Demonstrates correct techniques of passive ROM, to include flexion, extension, abduction and adduction of appropriate joints.
  • Identification and Reporting of Emergent Situations: a) Evidence of pain. b) Skin changes (pale, flushed, cyanotic, diaphoretic, temperature, etc. Respiratory changes: c) Shortness of breath/noisy breathing and coughing. d) Change in respiratory rate + 4 breaths/minute. Digestive changes: e) Nausea, vomiting (with description). f) Changes(s) in stool color, consistency. g) Difficulty swallowing. h) Changes in appetite. Urinary changes: i) Difficulty in urinating. j) Changes in amount or color. Musculoskeletal changes: k) Cannot move arms and/or legs. l) Seizure activity/seizure precautions. Neurological changes. m) Changes in orientation status. n) Changes in level of consciousness. o) Restlessness. Cardiovascular Changes: p) Chest pain and/or discomfort. q) Changes in pulse + 10 beats/minutes and/or blood pressure + 20 mm Hg systolic or diastolic.
  • Articulates changes in skin related to age, disease process, bedrest nutrition, hydration and/or health status.
  • Identifies areas (bony prominences) that are prone to skin breakdown.
  • Inspects the skin and reports any signs of: Irritation; texture change; color change; growth; injury; pressure sores, and drainage.
  • Performs skin care interventions consistently using Solutions program: Ensures skin cleanliness; stimulates circulation; repositions patients at frequent intervals, and ensures hydration and nutrition as per plan of care.
  • Demonstrates the appropriate use of pressure-relieving devices: Sheepskin; protective elbow and heel pads; bed cradle, and overlay mattress.
  • Provide hygienic care: Bath: Self, partial, complete; Shave; Oral care including denture care, conscious and unconscious using appropriate supplies; hair care; perineal care male and female; foot care except for nail cutting unless ordered by physician; postmortem care; makes bed "occupied/unoccupied, head to toe, postoperative; specialty bed-special requirements."
  • Prothesis Care (Limb): Washes prosthesis; Identifies pressure areas under prothesis, apply prosthesis properly including stockinette, and report to nurse if prosthesis needs repair.
  • Applies the following devices: Bandages, slings, antiembolic stockings (including measurement).
  • Identifies the following diets: Regular; Cear liquids; full liquids; puree or mechanical soft; diabetic or calorie controlled; low sodium; NPO places appropriate sign over patient's bed.
  • Identifies foods to avoid on the above diets.
  • Distinguishes signs and symptoms of dehydration/ overhydration/edema.
  • Assists with menu selection, meal preparation, and feeding. 1) Ensures accurate identification of patient with diet; ensures patient is not NPO. 2) Ensures a pleasant environment. 3) Washes patient's hands. 4) Ensures comfort and proper positions, e.g., HOB elevated to prevent aspiration. 5) Provides adaptive equipment, if appropriate. 6) Provides as much assistance as necessary to ensure proper nutrition. 7) Is alert to signs and symptoms or difficulty swallowing and/or choking.
  • Safety Precautions When Caring for Patient with an Indwelling Feeding Tube: 1) Does not pull or tug on tubing. 2) Maintains the skin around tube clean and dry. 3) Maintains HOB @30 degrees at all times for patients with a nasogastric tube/gastrostomy, unless contraindicated. 4) Temporarily discontinue tube feedings when repositioning patient. 5) Report to the nurse any alterations with the tube and/or equipment. 6) Refill & re-hang feedings (NAII only)
  • Intake and Output: 1) Explains procedure to patient. 2) Records all liquid sources of intake. 3) Records only the amount taken in by the patient. 4) Records all fluids lost from the body. 5) Measures ail output in a graduated device. 6) Reports to the nurse any blood/wound drainage or imbalances in intake and output.
  • Describes factors interfering with normal elimination.
  • Identifies characteristics used to describe urine.
  • Offers patient bedpan/fracture pan/commode.
  • Identifies reasons for Foley catheter insertion.
  • Performs Foley care according to standard (NAII).
  • Applies condom catheter.
  • Accurately obtains urine specimens: Routine urinalysis; clean catch; Foley catheter; 24-hour urine; notes completion of specimen collection on interventions lists & reports to RN.
  • Accurately obtains stool specimens: Stool for C & S; Stool for O & P; Stool for occult blood; Stool for clostridium difficile; Notes completion of speciment collection on intervention list & reports to RN.
  • Administers the following types of enemas: Fleet's Regular and Oil Retention; Tap water enema; Soap suds enema.
  • Uses the following principles when administering an enema: 1) Verifies with nurse type and amount of enema to be administered. 2) Follows procedure steps accurately related to enema administration.
  • Ostomy Care: 1) Independently cares for patients with ostomies greater than 2 months old and without complications. 2) Assesses and reports skin site surrounding stoma for redness, open areas, drainage and/or ulcerations. 3) Observes color and amount of drainage from stoma. 4) Observes existing pouch for leakage. 5) Reports to nurse immediately any pain or changing at stoma site. 6) Changes stoma appliance only if necessary, e.g., leakage from stoma. 7) Empties appliance per patient request & at least when half full.
  • Measure Vital Signs: Temperature (oral, axillary, rectal).
  • Measure Vital Signs: Pulse (apical and radial & per pulse ox reading).
  • Measure Vital Signs: Respirations (rate and quality).
  • Measure Vital Signs: Blood pressure (brachia! & per monitor cable).
  • Measure Vital Signs: Recognizes, reports and records above (manually & using monitor interface).
  • Measure Vital Signs: Height and weight; uses standing scale and bed scale.
  • Use Equipment: Oxygen tank and regulator, storage & stands.
  • Use Equipment: Hospital bed; specialty beds: ordering, set-up, and discontinuing, specialty mattresses.
  • Use Equipment: Stretcher; wheelchair.
  • Use Equipment: Sphygmomanometer.
  • Use Equipment: Suction apparatus: Wall and portable.
  • Use Equipment: Hypo/hyperthermia blanket.
  • Use Equipment: Pulse oximeter
  • Use Equipment: Traction: Set-up, care and discontinuing.
  • Use Equipment: Incentive spirometer.
  • Use Equipment: Transport monitor.
  • Use Equipment: Sequential compression device (ICD’s)
  • Use Equipment: CPM
  • Use Equipment: Reports defective medical equipment.
  • Performs 12-Lead ECG.
  • Perform Cardiac Monitoring Functions