SURGICAL UNIT COMPETENCY BASED ORIENTATION
Developed: 2014 Revised: 2018 Welcome to B5 Surgical – Planned Care Value Stream
Competency Based Orientation
Competency based orientation Defines skills and expectations required to perform the job safely and effectively Provides a “blueprint” for performance excellence Evaluates performance and identifies skill and competency gaps Defines resources available to aid new staff in meeting expectations Provides a “map” for ongoing direction and support Describes expectations of preceptor for teaching and validation Outputs of the learning experience
What is Competence
Competence is ability of a nurse to integrate & apply the knowledge, skills, judgements, attitudes, values and beliefs required to practice safely and ethically in a designated role or setting. (CNO 2008)
Competencies can be defined as a set of statements about the knowledge, skills, attitudes and judgements required to perform safely within the scope of an individual’s nursing practice or in a designated role or setting. (CNO 2008)
Continuing competence is the ongoing ability to integrate & apply knowledge, skills & judgement required to practice safely and ethically. It involves a continual process of linking the code of ethics, standards of practice & lifelong learning. Reflection and continued practice improvement is an ongoing process.
1
Scope of practice defines activities that nurses are educated and authorized to perform as set out in jurisdictional legislation. (CNO 2008)
Self Assessment is defined as learners taking initiative to assess their own education needs, set goals and objectives, plan and identify appropriate educational activities, implement these activities and evaluate the outcomes.
BENEFITS, BELIEFS AND GUIDING PRINCIPLES OF A COMPETNENCY BASED ORIENTATION PROGRAM
1. Provides safe practice & identifies expectations of competence per codes of ethics & standards of practice. 2. Defines a required behavior within a job role. 3. Provides consistency in the orientation process. 4. Links individual performance to goals of the organization. 5. Individualizes the orientation process to meet individual needs. 6. Provides ongoing direction and support to staff. 7. Encourages individuals to take responsibility for their own educational needs. 8. Monitors performance & identifies when an individual does not meet expectations. 9. Provides justification for an extension of the orientation process & identifying goals to be met.
2 Summary This section has identified the College's expectations of entry-level RNs and practice settings with regard to practice decision-making. The framework and elements to support decision-making have been described. Practice experience will further contribute to the development of skills and confidence in making nursing practice decisions that promote quality client care.
Decision Tree: A Guide to Practice Decision Making for the Entry-Level Registered Nurse
Assessment Gather the data.
Analyze the data Determine if help needed to analyze data: NO Consult/collaborate. • Can I make sense of the data? • Is the assessment corrYfS.,
Identify options of care • Can Iidentify: A range of care options? NO Consult/collaborate . The indications and contraindications for each? The client's preferences? YES
Choose the care option NO Consult/collaborate. •Am Isatisfied that the option chosen is the best, most appropriate? * YES
NO • Do Ihave the authority to pr011ide the care? Can I get it (physician·s NO order)? YES YES
• Am Icompetent to perform the care? • Can Imanage the potential outcomes? YES NO
Perform care Seek assistance
Evaluate care • Has care achieved the desired outcome? NO YES
Reassess. End .
..The nurse's advocacy efforts m;r.; be required in situations where efforts to obtain a physician's order for the care option identified by the nurse as "the best and most appropriate" have been unsuccessful.
Adapted for College of Nurses of Ontario 27 A guide to practice decision-making for the entry-level RPN
Has the acuity of the client been established? NO
Consult/collaborate.
Complete assessment and analyze the data ■ Do I have a complete understanding of the data? ■ Is the assessment complete? ■ Have I met the consultation requirements? NO YES
Choose the care option(s) (in consultation) NO Consult/collaborate. ■ Am I satisfied that the option chosen is the best, most appropriate?* YES
Can I get it Do I have the authority to provide the care? NO (e.g., physician’s order)? YES YES
■ Does the competency require consultation? NO YES
Am I competent to perform Does my "consultant" have the required the care? Can I manage the NO knowledge, skill and judgment to perform NO potential outcomes? the competency independently? YES YES
Perform care. YES Seek assistance. YES
Evaluate care ■ Has care achieved the desired outcome? NO YES
Reassess. End. * The nurse’s advocacy efforts may be required in situations where efforts to obtain a physician’s order for the care option identified by the nurse as “the best and most appropriate” have been unsuccessful.
College of Nurses of Ontario Entry-to-Practice Competencies for Ontario Registered Practical Nurses 13
KEY POINTS ABOUT COMPETENCY – BASED
ORIENTATION AND EDUCATION C
Learning is a process that should continue along the continuum of novice to expert. Competency must be assessed at 3 levels:
1. Technical 2. Critical Thinking 3. Interpersonal Skills
Traditionally, the technical component has been focused on during orientation; however, most performance issues arise due to critical thinking or relational components.
Methods of assessing competence should be varied, & include
Self – assessment Preceptor assessment Written Tests Return Demonstrations Mock scenarios Observation of care given / tasks performed Medworxx
Surgical Unit Competence Program Components
1. Interprofessional Communication 2. Teamwork 3. Knowledge Based Practice
3 B5 SURGICAL COMPETENCY BASED ORIENTATION
GREAT PLACE INTERPROFESSIONAL TO WORK COMMUNICATION
PATIENTS FIRST TEAMWORK
GOAL Performance Excellence within The Organization
USING RESOURCES KNOWLEDGE BASED WISELY PRACTICE The Orientation Process
Initial Meeting with Manager
Once hired you will meet with the Clinical Manager or the Clinician for the unit you will be reporting to. You will receive the orientation folder. Your Role Model/Mentor will explain the orientation program and answers questions Your Role Model/Mentor will provide you with an orientation of the unit and hospital way finding. You will be asked to complete the clinical experience rating of the Competency based assessment tool. The new staff member, Role Model/Mentor will establish a plan for orientation based on the identified learning needs.
Mid-Orientation Evaluation
The Role Model/Mentor will meet with the new staff member to Review the competency based assessment to identify strategies to meet learning needs
End of Orientation
The Role Model/Mentor will meet with the new staff member to: Review the competency based assessment for incomplete items, establish a learning plan for meeting learning needs. Evaluate the need for further orientation Suggest ongoing resources based on continuing learning needs Orientee: Preceptors: Important Phone Extensions
Phone Numbers Extensions
Hospital Numbers Switchboard 519-752-7871 back door 519-751-5544 Patient Registration 2253 B5 Desk 2310
Clinical Director – Chris Churchill
Clinical Manager – Jordon Dewar 4282
PACU 4801
Clinician 2678
Staff Phone Numbers see staff scheduling folder B5 sick calls
SICK CALLS For days – call the night before if possible or by 0530 am 519 751 5544 EXT 2310 For Nights – Call by 1400 If an extended sick leave call org health @2248 Human Resources 5526 Payroll 2428
IT Help Desk HELP - 4357 e-Learning Medworxx: http://bchs.lms.medworx.com/ BCHS Website www.bchsys.org
Scavenger Hunt
Out and About on the Unit Completed
Clinical Manager’s Office Ext…….. Nurse Clinician’s Office Ext…….. Main desk/communication station Ext…….. Nurse Call Bell system – demonstrate use Fax Machine/Photocopier, Printer Schedule: Sdrive, staff scheduling, B5, RN or RPN then date Sign in sheets, request process, how to indicate availability, call in procedure for illness/absence Staff Phone numbers Ensure your number is there Daily assignment sheets, review and understand break times Discharge Action Round Board Unit daily communication board Phone lists for hospital and Physicians Locate Unit Manuals: BCHS manual, Patient Services, Sdrive IV, WHIMS, Emergency, Infection Control Locate medication room (pharmacy drop box), med fridge, COWS, Narcotic Keys Locate Tube system Locate Dumb Waiter Lab labeler, lab label box Locate Glucometer Equip Find the Staff room / Staff Fridge Locker area Staff Washroom Visitor Washroom Patient Fridge, ice machine, microwave . Cups, utensils, snacks Procedure for items in Patient Fridge Public Phone Companion Phones – how to operate (not for patient use) Find the dirty core – biohazard garbage / battery disposal Scavenger Hunt
Isolation gowns, isolation signs Find Patient shower areas – understand rules of infection control and patients alone in shower Flashlights for night shift Find Supply Cart in Clean Core Look around . IV Fluids L/R, NACL, 2/3 1/3 20kcl . O2 Supplies . Batteries . Syringes . Dressing supplies . Ostomy supplies Equipment IV pumps, PCA pump, Feed Pumps Where do epidural pumps come from? Wheelchairs, Stretchers, walkers Locate fire extinguishers, pull stations and exits Locate O2 / Air shut off valves (at nurses station) Locate Code Blue equipment Find the staff mail slots Patient education materials – review what is available, check out BCHSYS web site as well Patients room . Emergency call bell in bathroom . Bedside call bell . Code blue button . O2 set up . Suction setup . Pocket masks . Bed controls / Alarms . How to properly plug in a call bell Locate Unit Huddle Board
STANDARDS FOR POST-OP CARE
Mandatory q shift documentation: VS & SpO2 or per vital sign chart Review: Physical Assessment labs Drsg & pressure area inspection diagnostic results Mobility & ADL’s progress notes I & O “bubbles” CAM delirium assessment
Elements of Care Goal Actions & Patient Outcomes Cardiovascular Within 10% of pre-op Vital signs as per vital sign chart Circulatory status PCA Pts: Pain level, sedation level, RR, # of doses received, # of dose attempts, total in mg, nausea, pruritis q4h
TED stockings / SCD device, if ordered remove daily for bathing Respiratory Consistent with pre-op Chest assessment q shift status DB&C q4h x 24h then prn O2 until SpO2 maintained > 92% on RA Sensory Consistent with pre-op Orthopaedic pts: status Assess CSM of affected limb (include colour, sensation, cap refill, temp, pedal pulses, edema and movement) q4h x 24h then q shift Integumentary Skin intact, incisions well Braden scale completed on admission approximated, open areas Dressing – reinforce only first 24h post-op; diminished in size or change dressing 24h post-op and prn (unless stabilized otherwise ordered) Inspect heels & all other pressure points q shift Ostomy pts: Change ostomy appliance q 5 days & prn Document appliance size & date to change in “bubbles” Musculoskeletal Patient will do ADL with Position for comfort & airway management minimal assist Sitting at bedside day of surgery, ambulate Patient will ambulate safely post-op day 1 to bathroom, day 2 in hallway, day 3 continue in hallway (unless ordered otherwise) Total Knee Replacements: No pillows under operative knee, do not raise FOB Neuro Consistant with pre-op Monitor LOC q shift status Monitor sedation level / potential side effects of any administered narcotics GI/GU – nutrition Able to resume normal diet Clear fluids to DAT, as ordered If NPO, monitor any IV / TPN infusion q1h
GI /GU - elimination Patient will maintain GU adequate urinary output Record accurate I &O q 2-4h x 24h then q shift prn Urine output must remain within renal /physician guidelines (20-30cc/h) Patient must void within 6-8h post-op, if not consider I &O catheter N-IV-209 Epi-morph pts: Assessment of urinary retention is ongoing; documentation is done 2-4h (I&O catheter prn) TURP pts: Strict I&O Encourage +++ fluid intake Record urine amount, colour, presence of clots q2-4h x 24h then q shift & prn GI/GU - elimination Patient will resume their GI normal bowel function 48- Abdominal assessment q shift & prn, until 72h after any abdominal or passing flatus or has BM & abdo assessment is bowel surgery normal Encourage ambulation Chewing gum may promote bowel stimulation; check with MRP if allowed NG pts: Abdominal assessment q shift (distention , rigidity, bowel sounds, pain) Record amt. of drainage on container & on I&O sheet q4h. Record colour & characteristic of drainage on progress notes Monitor patency & irrigate prn Monitor lab values (K+, NA+, HCO3) Ostomy pts: Record amount, colour, consistency of ostomy contents q4h x 24h then q shift & prn Assess colour, size, shape of stoma Psychosocial Patient will demonstrate Assess pt. / family knowledge & understanding effective coping, reduced of illness / surgery / disease process anxiety Review plan of care with patient / family Patient & or family will Provide emotional support as needed understand & participate in Be aware of ethnic / cultural beliefs their plan of care Provide ongoing health teaching & reinforcement of new learning as needed Provide learning packages where available Discharge Provide pt with optimal Ensure that health teaching is complete upon tools to maintain optimal discharge health & a healthy lifestyle Review d/c instructions with pt. / family Patient / family will verbalize Review medications with pt. /family understanding of pertinent subjects Ensure that special health teaching / learning Wound care, drain care needs have been initiated during hospital stay Activity level, diet & have been met before d/c. S&S to report to physician Ongoing documentation of health teaching in Follow up appointments teaching intervention. Ex. Ostomy care, Medications diabetes, catheters.
VITAL SIGNS CHART
STANDARD POST OP VITALS BLOOD VITALS EPI VITALS ADMISSION VITALS
QID X 48H Then daily Q2h x 2 then q4h x 5 >Baseline STABLE EPI VITALS and prn then BID and prn BP,P,RR,temp,SaO2 prior to >baseline on arrival, q1h until stable (stable Ortho (no epi) transfusion =within 20% of baseline) Q1h x 3 then q4h x 48h >q15 min x 2, then >temp, BP, P q4h minimum Then BID until d/c >q 1h &prn until transfusion >O2sats q2h, RR & sedation q1h x 16h post LD of complete Epimorph or q4h post LD of Fentanyl >post transfusion for each >may do 02 sats q4h, and may do RR & sedation unit q2h if sleeping or ambulatory & RR >12 & pre >if there is a suspected Spo2 > 92% reaction TOP UPS
>stable epi vitals plus TPN VITALS baseline (temp,BP,P, O2sat, RR, pain & sedation) prior to each top up dose & >TPR, BP, SaO2 TID and PRN immediately post top up dose then… Q5min x 3, then q30min x 2 then…as per stable epi vitals
CONTINOUS >stable epi vitals plus after increase in infusion rate continue stable epi vitals after PCA dose q5 min x 3 then.. q30min x 2 then.. q1h until stable, then continue with stable epi vitals
Benner’ s Novice to Expert Framework
Please refer to the following definitions and examples to further assist you in the self- assessment process
Novice Has yet to receive the theory The novice nurse has not been taught how Component and has never to insert a foley catheter or discussed the performed the skill expected care standards in a classroom setting. Advanced Has received the theory This level practitioner has learned how to Beginner component and performed the insert a foley catheter and the expected skill in a lab setting only. care standards, but has not practiced these skills in a clinical setting. Competent Has performed the skill in This practitioner can safely and clinical practice but would competently insert a foley catheter, but prefer to have a clinical may request that a colleague observe the preceptor or peer nearby. process and confirm standard norms. Proficient Has achieved independence in This practitioner takes appropriate action in performing the skill. response to the patient’s changing Recognizes relevant clinical genitourinary status and interpretation of changes and the patient’s signs/symptoms organizes/implements skilled (Initiates emergency intervention prn, responses to these changes. collaborates with the physician to revise Frequently assumes preceptor the plan of care.) role. Expert Consistently demonstrates This practitioner enters the room and as a competence in selected skills. result of extensive experience with similar Multiple experiences in the experiences, knows that a patient is clinical setting. Has an compromised. This nurse quickly and intuitive grasp of situations. holistically assesses the situation & Anticipates identifies priorities. Anticipates revised situations/complications. plan of care. Masterful in solving problems. Acts as a preceptor.
Complete the self-assessment on the following pages, and based on your evaluation, assign yourself a level, from Novice to Expert. This will enable you to focus on your present and future learning needs.
Learning Needs Assessment/Competency Model
How to Complete the Competency Model
Criteria This column lists general and specific knowledge, technical skills, communication/leadership and critical thinking skills that need to be covered during orientation. This knowledge provides a foundation for professional nursing in the surgical unit. The professional nurse practices according to this knowledge, and builds upon it in order to develop and progress along the continuum from novice to expert within the identified core competencies.
Learning Resources/Strategies This column provides suggested resources i.e.: videos, learning packages, articles, policy numbers, texts, & personnel that you may utilize to achieve the required knowledge or skill.
Evidence of Competence This column suggests ways for you to demonstrate that you have achieved the knowledge, skill and judgment in this area of practice.
Self Assessment Rating This provides an opportunity for you to evaluate and document your current learning needs. Review each skill and rate your ability according to the Novice to Expert continuum. If you rate yourself as an expert in an area, you should still review the unit’s current policy on that subject. The self-assessment is important because it provides the foundation for your orientation needs. You and your preceptor will review this information and devise an orientation plan based on your learning needs.
Completed by date & Is a Learning Plan Required ? When you have performed a skill independently, you and your preceptor will initial the column to indicate this. If you have not completed all items, a learning plan will be established to meet your learning needs. Mark a “P” (for plan) in this column to identify areas where further assistance is required.
INTERPROFFESIONAL COMMUNICATION
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating Discusses the model of care utilized in the Manager/Clinician/Preceptor Discusses the main concepts Surgical Program Or of Collaborative Care Model CNO Professional Standards for RN’s & RPN’s Responds to changing workloads & patient acuity As above Discusses the decision making to maximize resources process & collaboration expectations Clearly & concisely report to oncoming shift. TOA Observe preceptor. Transfer of Accountability to Establishes priority of problems & needs Discussion with Nurse Clinician/ oncoming staff. according to actual & potential threats Preceptor Is able to give a detailed to the patient history & overview of the shift. Accurately initiates & documents of the following Documentation with Clinician Charting is accurate and Electronic Charting Observe Preceptor complete. BMV Demonstrates the importance Order Entry Information Technology of documenting response to OR package treatment. Day Surgery chart Laboratory Staff Documents referral of Halogen problems appropriately Risk Pro Unit Clerks Completes Order entry requisitions appropriately Recognizes & develops strategies to resolve Discuss communication and conflict Describes disruptive interpersonal conflict resolution with nurse clinician behaviour. Understands Bill 168 Policy IV 67, IV70, IV69 Passing grade on medworx Code of Conduct Complete medworx assignments assignment Respectful workplace Whistleblower Policy Collaborates with patients, families & Discussion with clinician/preceptor Discusses the Nurse’s prof. multidisciplinary team to implement and evaluate Policy IV180 responsibility to the patient, individualized care/services to enhance health Standards of Nursing Practice family & health care team. outcomes. Guidelines for Professional Behaviour Maintains confidentiality & Ensures confidentiality. (CNO) privacy
Updates Halogen and completes self assessment by probationary period. Continues to update Halogen performance appraisal system ongoing. Demonstrates ability to provide appropriate View teaching videos Client can verbalize and health teaching early in hospital Review items available on B5 for demonstrate teach back teaching
TEAMWORK Individuals can work more effectively within a team and achieve their potential.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating Understands principles of team dynamics & multidisciplinary collaboration. Able to describe individual role and CNO Discusses with that of others Multidisciplinary team preceptor members Participates in collaborative decision Demonstrated during making daily patient care. Considers roles of others in determining own professional & inter- professional roles. Demonstrates ability to access other team members skills & knowledge when required Attends multidisciplinary action Preceptor Demonstrated during rounds & effectively facilitates Team members daily rounds. discussions & interactions among team members. Participates & is respectful of all team members. Demonstrates a willingness to support other team members.
TEAMWORK Initiate Action in an Emergency Situation
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating Has up to date CPR certificate & maintains Education resources for Re- Current BCLS certification certificate. certification. card Brant CPR – classes on site Discusses the role of the nurse during Code Hospital orientation Demonstrates Blue Policy N-IV-235 oropharangeal airway Mock Code Blue insertion, use of pocket mask, bag valve mask Verbalizes when to activate code blue Demonstrates ability to locate Code Blue Preceptor Evidence of location equipment Clinician demonstrated Code Blue call button Pocket mask Code blue record Code blue cart on unit
Infection Prevention and Control
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating Demonstrates understanding of Nosocomial S:drive – Infection Control folder Locates appropriate policy Infection Control Policy M-IV-185 Practices routine & added Routine precautions Infection control nurse precautions Communicates Droplet, contact, airborne, enteric, Clinician/Preceptor concerns to appropriate etc. ..\Surgical Skills member of the MRSA/VRE/ESBL Book\Infection multidisciplinary team Febrile Respiratory Illness tool (FRI) Prevention and Locates patient/visitor Handwashing Control ppt.ppt handouts & educates re: specific nosocomial isolation Appropriate Infection Control signage on doors
KNOWLEDGE BASED PRACTICE Locates and adheres to relevant medical directives & unit specific policies and procedures.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating Defines individual level of skill functioning & Benners Framework Completion of competency individual scope of practice – knowledge, CNO Guidelines based orientation and skill, & judgement ongoing self assessment.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating Preparation of the Surgical Patient: Clinician/Preceptor, Unit Locates pre-op lab Prepares patient for OR per Clerk results, Understands physician orders and pre-op medical Surgical Nursing Staff when chest x-ray, ECG dierctives Policy N-IV 1550, N-IV 1530 are necessary NPO at Completes Pre-op Informed Consent by surgeon checklist Chest X-ray Has patient complete ECG pre op anesthetist Required Lab work sheet Initiates appropriate IV (site, Able to do phone size, & solution) consent when Up to date Nursing history necessary Follows hospital safety protocols Policy N-IV 802 Demonstrated Evidence Use of 2 patient identifiers prior to transfer to OR Completes pre-op surgical checklist Demonstrates Understanding of Pharmacy Manual Antibiotic Prophylaxis Ordered antibiotics hung and clamped for administration in OR
KNOWLEDGE BASED PRACTICE Locates and adheres to relevant medical directives & unit specific policies & procedures. Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating CARE OF THE POST – OP PATIENT Participates in post-op TOA SBAR Demonstrated by Receives timely report from knowledge of PACU clients history & Acquires accurate & precise current situation information Monitors for acute post-op problems Post operative learning Demonstrated Vitals package through Physical assessment falls Standards of Post – op care accurate within patients norm PACU course documentation Clinician / Preceptor / CRN Epidural Learning package
Monitors for & provides adequate Pain management learning Demonstrated pain management. package through Monitors for complications with pain Internet adequate & management. CPS appropriate Understands the use of Narcan for Pharmacist medication itching & narcotic reversal. administration Demonstrates principles of aseptic As Above Evidenced by wound care. CNO Best Practice appropriate post Guidelines – Wound Care – op wound care Understands reasons for drain Surgical Textbook/Internet Demonstrated insertion Team members through Types of drains N:\Surgical\Pre & Post OP appropriate Care required for post-op information\Post-Op Surgical documentation drains Powerpoint.pptx Output monitoring Knowledge of progression of care Discussion with from acute post-op phase to preceptor / CRN discharge. KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures.
Performance Criteria Strategies & Evidence of Self Date Comments Resources Competence Assessm’t Completed Rating MALIGNANT HYPERTHERMIA Demonstrates Knowledge of Malignant Discussion with Team Malignant Hyperthermia hyperthermia learning Lead / Preceptor package Completion of MH Malignant Learning Package Hyperthermia power point Internet MHAUS PACU team member PACU course Attends mock MH code blue Knowledge of MH Triggers As Above Recognizes signs and Learning package Demonstrates symptoms of MH Power point application of Understands etiology of ..\Surgical Skills knowledge as disease process Book\Malignant applicable Knowledge of diagnostics AsHyperthermia Above \MH required during MH code ..Handout.doc\Surgical Skills blue Book\Malignant Awareness of emergency ..Hyperthermia\Surgical Skills \MHslides Participation in mock treatment for MH Bookfrom\Malignant MHAUS.ppt code Awareness of necessity for Hyperthermia\MH ppt for Discussion with code blue during MH crisis Reference.pptx preceptor KNOWLEDGE BASED PRACITCE Locates & adheres to relevant medical directives & unit specific policies & procedures. Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating CARDIOVASCULAR NURSING MANAGEMENT Knowledge of the Anatomy & Physiology Cardiac Med/Surg textbooks Demonstrates application of the Heart C5 – “Recovery Road” binder of knowledge Performs Cardiac Assessment Internet & Librarian Performs assessment Demonstrates ability to perform accurate Orientation skills binder and completes CSM checks (circ., sensation, movement) documentation in Palpates pulses (radial, dorsalis appropriate screen in pedis, posterior tibial, popliteal, meditech femoral Anticipates & treats Assess capillary refill conditions quickly Assess for peripheral edema Contacts multidisciplinary S&S of altered cardiac output team member when appropriate Demonstrates ability to recognize and As above Demonstrates ability to treat the S&S of anticipate & treat Unstable angina / chest pain conditions quickly management Contacts MD in timely Myocardial Infarction, immediate and appropriate management situations with adequate CHF – acute and chronic information management Collaborates with A fib multidisciplinary team as Syncope – potential causes appropriate Accurate & timely documentation Demonstrates knowledge of cardiac labs Cardiology texts Discusses tests used at / tests ordered to identify myocardial Team Lead /Preceptor/MD the BGH site & labs to be damage Pharmacist monitored
Demonstrates understanding of cardiac Current drug manual By anticipating drug therapy Pharmacist hemodynamic effects KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures.
Performance Criteria Strategies & Evidence of Self Date Comments Resources Competence Assessm’t Completed Rating IV THERAPY Understands indications for IV learning package Evidenced by IV therapy & solutions used. IV nurse, clinician, team discussion with team members members BCHS IV therapy policies
Reviews MD orders before Review of chart Demonstrates initiating IV therapy. application of knowledge Understands adverse, As above, Up to date therapeutic effects & Online interventions & precautions. ..\Surgical Skills Book\IV Understanding of IVTherapy, learning IV package Med Demonstrated during appropriate IV canula sites ..Admin\Surgical\IV TherapySkills Book- \IV IV insertion training for solutions & medications. Therapy,Solutions IV2012.pdf Med Able to program & run BaxterAdmin \CollIV Insertionegue Discussion/ infusion pumps. learning2012[1].pdf pac kage demonstration Able to set up appropriate previous experience. IV tubing. Understands steps for & Clinician, CRN, IV Demonstration during indications for flushing nurse IV insertion training saline lock. Documents appropriate Meditech, preceptor, Demonstrated by fluids, volume, procedure & CRN, clinician appropriate medication in appropriate ..\Surgical Skills documentation area in meditech Book\IV Therapy, IV documentation. Med Admin\Intravenous Medication Administration.ppt KNOWLEDGE BASED PRACTIC Locates & adheres to relevant medical directives & unit specific policies and procedures. Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating CENTRAL VENOUS ACCESS DEVICES Able to state the indications for use of CVAD Learning Package Discussion with IV nurse, Central Venous Access Devices. IV Team preceptor, team lead Preceptor, CRN Outlines vascular anatomy and N:\All Floors- As above recommended insertion sites for CVAD. Education\CVAD\Revised CVAD - Identify types of CVAD’s available and Self Directed Learning Package indications for use. 2012.pdf Understands the general principles of Performs individual skills post insertion care. for assessment Performs and identifies specific nursing interventions for each type of CVAD Blood sampling Dressing change Flushing Intermittent cap change Recognizes potential complications & nursing interventions for each of the complications Able to provide appropriate health Discussion with IV nurse, teaching related to CVAD preceptor, team lead Documents appropriate nursing care in Demonstrates meditech. documentation Able to locate polices B-NET - Document Source – NIV-829 Central Line Fever Clinical - Patient Services Protocol Manual NIV-881 PICC Blood Sampling NIV-882 PICC Declotting with tPA NIV-883 PICC Dressing Change NIV-884 PICC Flushing NIV-885 PICC Cap Change KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies and procedures.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating BLOOD PRODUCT ADMINISTRATION BCHS Policy N-IV- 845 Blood Evidence of Knowledge, Product Table Skill and Judgement BCHS Blood Administration Completion of Blood Learning Package Administration Package & Bloody Easy 2 published by competencies listed Canadian Blood Services Demonstrates understanding of the Patients history Lists the lab values that patients Multidisciplinary team need to be monitored. diagnosis and the purpose for the blood members Follows accepted BCHS product. N:\All Floors- guidelines Knowledge of the 8 rights of Education\Blood\Bloo Transfusion (patient, product, d Product amount, rate, time, reason, site, Administration at frequency) BCHS Learning Ensure physician’s order is written and Package April informed consent obtained. Knowledge 2012.pdf of who can obtain and witness consent. Demonstrates understanding and Demonstrates the process ability to administer blood product per to administer the product blood product administration checklist safely. after, completing BCHS Blood Administration package. Identifies and understands signs and symptoms of transfusion reaction. Able to identify actions if transfusion reaction occurs.
Demonstrates knowledge of proper disposal of blood tubing and blood bags. KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating ARTERIAL BLOOD GAS ANALYSIS Demonstrates an understanding of Preceptor/Clinician Discusses with Acid Base physiology Internet preceptor Acid Surgical skills binder Base ..\Surgical Skills Buffer Book\Arterial Blood ph, PaCO2, HCO3, PaO2, O2 Gases\ABG Powerpoint.pptx Knowledge of causes & S&S of As Above As Above Respiratory/Metabolic Acidosis ..\Surgical Skills Demonstrates through Respiratory/Metabolic Alkalosis Book\Arterial Blood knowledge of when to Hypoxemia Gases\abgpocket.pdf notify physician and expectation of ABG order Able to identify Steps for arterial blood Discussion with gas interpretation preceptor Able to identify normal Analysis of test results ph PCO2 HCO3 SaO2 Demonstrates k knowledge of when As above Arterial Blood gases may be a necessary measure Demonstrates basic knowledge of ABG Discusses test results interpretation & when to notify with preceptor Physician of abnormal results KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating RESPIRATORY NURSING MANAGEMENT Knowledge of the Anatomy & Med / Surg textbooks Demonstrates Physiology of the Respiratory System In house Respiratory application of Performs a Respiratory Assessment Therapist knowledge Ascultates Chest, recognizes Preceptor Demonstrates ability normal & abnormal breath Internet to collect data using sounds N:\Medical C\Education & non-invasive & Assess skin colour in relation Learning invasive techniques to oxygenation Packages\Hypoxia.ppt Documents findings appropriately Demonstrates ability to recognize & Anticipates & treats treat the S&S of conditions quickly CHF/Pulmonary Edema Pneumothorax Acute & long term issues Demonstrates knowledge & ability to Preceptor/Clinician Demonstrates correct set up Respiratory therapist O2 set up for patients Face mask, trach mask, nasal current state prongs, venti-mask, non- rebreather, Ambubag, portable O2 tanks, SpO2 monitor KNOWLEDGE BASED PRACTICE Locates and adheres to relevant medical directives & unit specific policies & procedures.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating CARE OF PATIENT WITH A CHEST TUBE Demonstrates understanding & Atrium “managing chest Able to discuss disease indications for chest tube insertion drainage guide” processes requiring BCHSYS chest tubes skills chest tube insertion package – Surgical skills binder Standard of Care for Chest Drainage System with Dry Seal System Able to locate equipment and supplies Team members Locates equipment and for care of chest tube. Preceptor prepares to set up Atrium chest tube drainage Unit team lead drainage system system Kelly forceps Wall suction setup Dressing supplies, elastoplast tape Demonstrates ability to set up Atrium “managing chest Demonstrates drainage system. drainage guide” application of Connects patients chest tube BCHSYS chest tubes skill knowledge to collection chamber. Ensures package – Surgical skills connections and dressing are binder taped securely ..\Surgical Skills Positions drainage system Book\Chest below patients chest Tubes\Pleur-Evac - Connects the suction source to Sahara instruction the suction port on the Poster (3)[1].pdf KNOWLEDGE BASED PRACTICE Locates and adheres to relevant medical directives & unit specific policies & procedures.
drainage system if ordered. Adjusts suction regulator on drainage system as ordered Adjusts suction source to appropriate level Injects sterile H2O into the air leak meter injection port until fluid reaches fill line Demonstrates understanding of Standard of care for chest Demonstrated patient monitoring tube drainage system evidence Monitors for air leaks q 15 min Preceptor until stable then q4h & prn Unit team lead Monitors for kinks loops q4h & Team members prn ..\Surgical Skills Evaluates vital signs, Book\Chest respiratory status , skin colour Tubes\ManagingCh comfort level and emotional estDrainage.ppt state initially then q4h & prn Provides appropriate patient Demonstrated education evidence Encourages deep breathing & coughing Encourages appropriate use of pain medications Demonstrates ability to document Demonstrated appropriate interventions, evidence assessments & health teaching in meditech Responds appropriately to BCHSYS chest tubes skill Discusses and complications and unexpected events. package demonstrates evidence KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating GASTROINTESTINAL NURSING MANAGEMENT Demonstrates knowledge of the Med/Surg textbook As observed through Anatomy & Physiology of the GI Preceptor/Clinician accurate system through an accurate Internet documentation in abdominal assessment Surgical Skills Binder meditech Recognizes normal & ..\Bowel Care booklet for abnormal bowel sounds Bowel Care Maps.docx Recognizes abnormal or excessive tympany Accurate monitoring & documentation of elimination patterns Accurate monitoring & documentation of nutritional intake Demonstrates knowledge & ability to Wound care team Ability to demonstrate care for a patient with an ostomy Preceptor/team members application of Appliance application Convatec patient handouts appliance and provide Skin care Surgical Skills Binder patient with teaching appropriate teaching As observed through accurate documentation in meditech Demonstrates knowledge & ability to Policy & Procedure N-IV- Return Demonstration care for a patient with a nasogastric 1310 As observed through tube N-IV- 401 accurate NG insertion Preceptor/Clinician documentation Determine accurate KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures placement N:\All Floors-Education\NG\NG Monitor & assess NG drainage Tubes Teaching Package - IPC Assembly & monitoring of Oct. 2012 ML.pdf Gomco Sump suction unit Assembly & monitoring of feeding pump Normal / abnormal lab values Assessment & Care of a patient with a gastrostomy/jejunostomy tube Managing feed pump Delivering nutrients & water flushes Care of tube site Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating GENITOURINARY NURSING MANAGEMENT Demonstrates knowledge & ability to Research articles Assessments validated perform accurate genitourinary Preceptor/Clinician by preceptor / clinician assessment Med/Surg Text Recognizes changes Measures accurate outputs that require Physician according to policies and notification physician orders Anticipates new orders Assesses for renal failure from physician Recognizes & monitors abnormal lab values Demonstrates an understanding of Preceptor/Clinician Insertion of foley Catheter Care including P&P N-IV-208, NIV-209, N- following policies & Catheter insertion & removal IV-214 procedures In & out catheterization Lists the S&S of Foley catheter infection Suprapubic catheters Nephrostomy Tubes KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures Continuous Bladder Irrigation (CBI)/Intermittent Bladder Irrigation Urostomy care & maintenance Care & maintenance of urinary drainage equipment Demonstrates knowledge of Med/Surg text Demonstration of S&S of urinary infection Internet bladder scanner & Accurate testing to determine Preceptor/Clinician accurate UTI Electronic Lab manual documentation, Demonstrates Accurate use of appropriate Bladder Scanner & Bladder Scan intervention post Protocol bladder scan Demonstrates understanding of post- P&P N-IV-1215 Evidenced by the op Mitomycin procedures & policies. P&P N-IV-1280 ability to locate the ..\Surgical Skills policy & discuss Book\Mitomycin Bladder procedure with Instillation.pptx preceptor KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating TOTAL PARENTAL NUTRITION Demonstrates understanding of TPN learning package Demonstrates indications for TPN ..\Surgical Skills application of Knows adverse, therapeutic effects Book\Total knowledge and expected outcomes. Parenteral Nutrition - Discussion with IPC Sept. 2012 support staff ML.pptx Dietician, Pharmacist Clinician, Team Lead, Recognizes the differences between Discussion peripheral and central TPN. Surgeon Policy manual Understands TPN orders and daily Discussion with team responsibilities surrounding acquiring members & evidenced TPN orders. by obtaining accurate orders Performs nursing responsibilities & Learning package, co- Demonstration of TPN understands rationale. workers, policy, Clinician, set up Demonstrates understanding Team Lead Evidenced by accurate of TPN set up with appropriate documentation tubing & rationale for tubing use. Performs appropriate documentation in meditech. KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating GYNECOLOGICAL NURSING MANAGEMENT Knowledge of the Anatomy & Physiology Textbooks of the reproductive system Internet Demonstrates understanding of need for Gyne care path Demonstration of acute pain control in this client B3 nursing staff, preceptor, knowledge population. team lead, nurse clinician Discussion with preceptor Demonstrates understanding of need for Med/Surg, obstectrics As evidenced by care of nausea control. textbooks patient Understands medication options Internet available on post-op orders for pain ..\HYSTERECTOMY.docx control and N&V control. Able to accurately describe and Evidenced by accurate document post-op vaginal flow. documentation in meditech Understands the requirement of Evidenced by documenting urine output and bladder demonstration of bladder scan protocol amounts post-op. scanner use and accurate documentation Knowledge of nursing skills to alleviate post-op symptoms Warm blanket to abdomen for cramps Up at bedside first night post-op to alleviate gas/ up in hallway thereafter KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating NEUROLOGICAL NURSING
Demonstrates knowledge of the Team Lead / Preceptor Able to identify motor Nervous System Med / Surg Texts & sensory pathway & Sensory – CSM checks post-op Surgical Skills binder their significance Motor Internet Identifies the effect of Knowledge of the autonomic nervous Physiotherapist the ANS & the system Occupational therapist significance Performs thorugh nero assessment, N:\All Floors- Able to perform a implementation, & evaluation of care Education\Neurological neurological Glasgow Coma Scale Education\CCSO Webinar-Adult assessment using the Canadian Neurological Scale BNO Guidelines-Nov 12 2015.pdf Glasgow coma scale Canadian Neurological scale Expresses the difference between As above Discusses difference delirium, dementia, and depression Least restraint policy between dementia & CAM observation record delirium Manages challenging Verbalizes techniques behavior using non- to manage patients pharmacological techniques behaviour Able to assess delirium using the CAM tool
KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directive & unit specific policies and procedures Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating COMPARTMENT SYNDROME Demonstrates an understanding of Preceptor/Clinician Discussion with compartment syndrome, anatomy & Internet preceptor disease process Surgical Skills Binder As evidenced by Defines compartment appropriate CSM syndrome & potential causes checks and accurate documentation Recognizes S&S of compartment Acute compartment As above syndrome & resulting medical syndrome learning package Demonstrates emergency N:\All Floors- application of Pain Education\Compartment knowledge Palpably tense Syndrome\Compartment when applicable Pain with passive stretch Syndrome ppt.pptx Paresthesia Paralysis Pulselessness/pallor Performs frequent & appropriate CSM As demonstrated checks per policy on high risk patients through documentation in meditech Demonstrates urgency to react to S&S Preceptor Timely calls to of compartment syndrome Team members physican Calls physician immediately Pre op medical directives Ability to react in Loosens splints if able Fracture Clinic urgent situations Contact fracture clinic for cast splitting if necessary Maintains elevation of affected limbs Applies O2 Prepares patient for OR
KNOWLEDGE BASED PRACTIC Locates & adheres to relevant medical directives & unit specific policies and procedures.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating DELIRIUM Delirium learning package Discussion with N:\All Floors- preceptor / Team Lead Education\CAM_Behaviou r Observation Record\CAM_Behaviour Demonstrates knowledge & AsObs. abo Recordve - Unit Ed..ppt understanding of predisposing risk ..Clinician,\Surgical P Skillsreceptor, Book Te\Keyam factors & precipitating risk factors FeaturesLead of Delirium.doc Utilizes confusion assessment for AsCAM abo tovole assessing 5 criteria for diagnosing delirium Documents on CAM tool As above Documentation in CAM appropriately in meditech tool Liaise with MD for appropriate orders As above As evidenced by when patient has a positive CAM tool recognition of delirium result and discussion with MD
KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating MUSCULOSKELETAL NURSING
Describes the anatomy and Textbooks As evidenced by physiology of the Musculoskeletal Internet appropriate care of the System orthopedic patient
Care of the patient with a Team Lead Documented Care Plan Bone fracture Clinician/Preceptor follows care guidelines Osteomyelitis Surgical nursing staff Care plan includes Total Joint Replacement Post op new Knee and Hip monitoring of potential External immobilizing device booklets complications Arthritis Allied Therapy Staff
Performs thorough musculoskeletal As evidenced by & neuromuscular assessment, accurate and thorough implementation & evaluation of care documentation
Promotes Demonstrates safe lifts and transfers Application of early mobilization knowledge ROM Positioning
KNOWLEDGED BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating INTEGUMENTARY
Demonstrates knowledge & ability of Wound Team As evidenced by head to toe integumentary Clinician accurate & appropriate assessment Team Lead charting Assess with Attend wound care Braden Scale weekly & prn conferences 5 levels of wound staging Textbooks Prevention of pressure ulcers Co-workers Order & apply special surfaces N:\Surgical\Pressure as appropriate Ulcers.pptx Utilizes best practice wound protocols Wound Care CNO Best Practice As evidenced by consults wound team as Guidelines demonstration needed Learning Packages follow CNO best practice guidelines as appropriate checks MD orders for specific wound care orders maintains aseptic technique VAC Dressings Learning package As evidenced by What is a vac dressing Internet demonstration Proper application of dressing Clinician Maintains aseptic technique KCI VAC Representative Operation of pump & VAC N:\All Floors- dressing settings Education\VAC\VAC Assessment of wound to meet therapy.ppt goals & objectives Wound Team
KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures. Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating LEAST RESTRAINTS Understanding of common terminology Learning Package Discussion with Team surrounding least restraints. N:\All Floors-Education\Least Lead, Clinician Demonstrates awareness of the key LearningRetraint\ packageNursing Orientation“Least - Evidenced by appropriate factors that influence the safe, effective Restraints”Restraints Sept. 2013..ppt choices when potential & ethical choices to minimize the use of Policy N-IV-1760, CNO restraints required restraints. Guidelines, Bill 85 Clinician, Team Lead Understanding of As above Policy of least restraints – Patient Services Manual N-IV-1760 Bill 85 CNO restraint standards
Able to identify & implement As above Consent requirements Alternative to restraints Demonstrates familiarity with the As above decision tree when considering restraint use Demonstrates appropriate & correct Learning package “Least Demonstration of procedure for applying physical restraints Restraints” application of Pinel to prevent injury to patient. Learning package “Pinel Basic Restraints Instructions” Reviews “code white” procedures. Appropriate documentation in meditech Demonstration of under correct interventions. documentation Completes & documents appropriate patient checks.
KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating ACUTE & PALLIATIVE PAIN MANAGEMENT Demonstrates awareness of pain in the Demonstrates application older adult of knowledge Presentation of pain in patients & Discussion with cognitively impaired older adult preceptor Describes goals of adequate pain control Able to describe the difference between Preceptor / Clinician Demonstrates application acute & chronic pain Pharmacist of knowledge Identifies & overcomes the barriers to Surgical Skills Binder effective pain management Utilizes Pain Assessment tools As above Uses systematic pain assessment Internet (PQRST U) Pain management articles / Uses specific pain assessment texts timelines Reassesses pain control post medication administration Understands differences between long & As evidenced by short acting narcotics discussion with preceptor Considers various pain management Appropriate & correct options medication Demonstrates skills of various administration pain management administration options Understands the myths and truths of As above providing appropriate & adequate pain medication Demonstrates appropriate As observed by preceptor documentation in meditech
KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures.
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating CARE OF CADD PUMP CADD pump Training Guide Evidence of Knowledge, – Smiths Medical located in Skill & Judgement Surgical Unit Skills Book Completion of CADD BCHSYS CADD Pump Pump Package & Learning Package Competencies listed N:\All Floors-Education\CADD Demonstrates understanding of the PatientsPumps\CADD histo ryShortened Reviews patients patient’s diagnosis & the purpose for MultidisciplVersion for Skillsinary Binderteam history and physicians using a CADD pump. memb2012.pptxers orders Demonstrates ability to install batteries Demonstrates ability to lock and & BCHSYS CADD Pump Demonstrates the unlock pump using code for pump. Learning Package process with a mentor. Demonstrates ability to set values as Completes competency ordered by physician. checklist for initiating a CADD Pump Demonstrates understanding of patients need for dosage increase. Understands rationale for independent double check of pump. Demonstrates ability to perform health teaching and proper usage of pump with patient and family. Demonstrates use of aseptic CNO best practice – aseptic technique. techniques Demonstrates accurate & Meditech CADD pump appropriate charting in meditech intervention system.
KNOWLEDGE BASED PRACTICE Locates & adheres to relevant medical directives & unit specific policies & procedures
Performance Criteria Strategies & Resources Evidence of Self Date Comments Competence Assessm’t Completed Rating EPIDURALS Knowledge of the anatomy & Epidural Learning Package Appropriate physiology of the vertebral column, Internet assessments spinal nerves spinal vessels BCH Library Completes epidural Understanding of spinal nerve Epidural Power Point learning package & distribution & dermatones Clinician, Team Lead, passes post test Assessment parameters , Preceptor monitoring, dermatones & Anesthetist, Pharmacist bromage scale Policy & Procedure Manual Knowledge of pharmacology, onset & Epidural Learning Package Discussion accurate duration of opiods used ..\Surgical Skills monitoring Understanding of EpiduralBook\Narcotics Learning Used Package in Demonstrated through Indications for us Epidural PTherapy.pptower Point discussion Contraindications N:\Surgical\Educatio Advantages nal Adverse effects Resources\Epidurals Complications \Epidural teaching Knowledge of physical appearance of Epiduralpackage.doc Learning Package Accurate epidural catheter – markings, ability to EpiduralAnesthetist Power Point documentation recognize & document level of Observation of epi caths catheter Understands & able to perform As Above Demonstrates removal of epidural catheter application of knowledge Knowledge of patient teaching As Above Accurate Patient parameters teaching Monitoring Symptoms to report Understanding of documentation Accurate documentation
Learning Plans
Your learning plan is an important part of orientation as well as nursing practice in general. The process of developing a learning plan is part of the College of Nurses of Ontario’s Quality Assurance program. The following will guide you to develop your own learning plan.
What is a learning plan? A document to help identify learning needs, and help to track and evaluate your learning. Why do I need one? Helps to clearly define learning objectives. Co-ordinates learning needs with strategies and resources to meet goals and objectives. Assists with the evaluation of learning
Your learning plan is required for your halogen performance appraisal. It is important to review and revise your learning plan on a regular basis. You are involved in learning every day. The learning plan simply formalizes and keeps track of your learning.
Developing a Learning Plan
Reviewing your orientation tool is a starting point for developing a learning plan. In the orientation tool are all the competencies that the surgical Nurse must demonstrate. It is expected that all surgical RN/RPNs will meet the minimum standards as demonstrated by the core competencies.
The new staff member identifies areas in which she/he requires further learning. These become the learning objectives. You do not have to limit yourself to objectives found within these documents. Common questions: What area do I want to focus on? What doI need/want to learn? Make your learning goals “smart goals” (Specific, Measurable, Attainable, Realistic, and Timely)
Next utilize the strategies and resources to help you learn what you want/need to learn. This will guide you in attaining your learning objectives.
Next , how will you demonstrate what you have learned? These are your evidence of competence. This is the evidence you must show to demonstrate that your learning goals have been met. It is also important to consider who will evaluate my learning?
Last, you must set a target date for completing your goals. The target date will vary depending on the complexity and urgency of your goals. Some goals will be easily met in a short time period, whereas learning for other goals may be ongoing.
Learning Plan for: Date: Team Lead: Preceptor/Mentor: Learning Objectives Strategies and Resources Evidence of Competence Target Date What do I need/want to learn? Where can I find the information I How will I demonstrate what I S-M-A-R-T Goals need to learn? have learned?
Next Steps/Future Learning:
REFERENCES
“A National Interprofessional Competency Framework” February 2010. www.cihc.ca/files/CIHC.IPCompetencies_Feb1210.pdf
CNO, “National Competencies in the context of entry-level Registered Nurse Practice” Revised June 2008
Brant Community Health Care System – Policies and Procedures, OR Competency Orientation package, General Hospital Orientation package, Skill Packages, Previous Surgical Orientation package