CARDIAC MEDICNE AND TELEMETRY UNIT COMPETENCY BASED .

CARDIAC MEDICNE ANDTELEMETRY UNITCOMPETENCY BASED ORIENTATIONDeveloped: 2014Revised: 2018

Welcome to C5Competency Based OrientationCompetency based orientation Defines skills and expectations required to perform the job safely andeffectively 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 experienceWhat is CompetenceCompetence is ability of a nurse to integrate & apply the knowledge, skills, judgments,attitudes, values and beliefs required to practice safely and ethically in a designated roleor setting. (CNO 2008)Competencies can be defined as a set of statements about the knowledge, skills,attitudes and judgments required to perform safely within the scope of an individual’snursing practice or in a designated role or setting. (CNO 2008)Continuing competence is the ongoing ability to integrate & apply knowledge, skills &judgment required to practice safely and ethically. It involves a continual process oflinking the code of ethics, standards of practice & lifelong learning. Reflection andcontinued practice improvement is an ongoing process.1

Scope of practice defines activities that nurses are educated and authorized toperform as set out in jurisdictional legislation. (CNO 2008)Self Assessment is defined as learners taking initiative to assess their owneducation needs, set goals and objectives, plan and identify appropriateeducational activities, implement these activities and evaluate the outcomes.BENEFITS, BELIEFS AND GUIDING PRINCIPLES OF ACOMPETNENCY BASED ORIENTATION PROGRAM1. Provides safe practice & identifies expectations ofcompetence 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 individualneeds.6. Provides ongoing direction and support to staff.7. Encourages individuals to take responsibility for their owneducational needs.8. Monitors performance & identifies when an individualdoes not meet expectations.9. Provides justification for an extension of the orientationprocess & identifying goals to be met.2

SummaryThis section has identified the College's expectations of entry-level RNs and practicesettings with regard to practice decision-making. The framework and elements to supportdecision-making have been described. Practice experience will further contribute to thedevelopment of skills and confidence in making nursing practice decisions that promotequality client care.Decision Tree: A Guide to Practice Decision Making for the Entry-Level RegisteredNurseAssessmentGather the data.Analyze the dataDetermine if help needed to analyze data: Can I make sense of the data? Do I have appropriate assessment skillsYESIdentify options of care Can Identify:A range of care options?The indications and contraindications for each?The client's orate .NOConsult/collaborate.NOCan I get it (physician’sorder)?YESChoose the care option I am satisfied that the option chosen is the best,Most appropriate? *YESNO Do I have the authority to pr011ide the care?YESYES I Am competent to perform the care? Can Manage the potential outcomes?YESNOPerform careSeek assistanceEvaluate care Has care achieved the desired outcome?NOReassess.YESEnd .The nurse's advocacy efforts m;r.; be required in situations where efforts to obtain a physician's order for the care option identified bythe nurse as "the best and most appropriate" have been unsuccessful.Adapted for College of Nurses of Ontario27

A guide to practice decision-making for the entry-level RPNHas the acuity of the client been established?NOConsult to determineif this is an appropriateclient assignment.Complete assessment and analyze the dataDo I have a complete understanding of the data?Is the assessment complete?Have I met the consultation borate.NOChoose the care option(s) (in consultation)Am I satisfied that the option chosen is the best, mostappropriate?*Consult/collaborate. YESIdentify options of careCan I identify :A range of care options?The indications and contraindications for each?The client’s preferences? YES YESDo I have the authority to provide the care?NOYES Can I get it(e.g., physician’s order)?YESDoes the competency require consultation?NOYESAm I competent to perform?the care? Can I manage thepotential outcomes?Does my "consultant" have the requiredknowledge, skill and judgment to performthe competency independently?NOYESPerform care.YESNOYESYESSeek assistance.Evaluate careHas care achieved the desired outcome? NOReassess.YESEnd.* The nurse’s advocacy efforts may be required in situations where efforts to obtain a physician’s order for the care optionidentified by the nurse as “the best and most appropriate” have been unsuccessful.College of Nurses of OntarioEntry-to-Practice Competencies for Ontario Registered Practical Nurses 13

KEY POINTS ABOUT COMPETENCY – BASEDORIENTATION ANDEDUCATIONCLearning is a process that should continue along the continuum of novice toexpert. Competency must be assessed at 3 levels:1. Technical2. Critical Thinking3. Interpersonal SkillsTraditionally, the technical component has been focused on during orientation;however, most performance issues arise due to critical thinking or relationalcomponents.Methods of assessing competence should be varied, & include Self – assessmentPreceptor assessmentWritten TestsReturn DemonstrationsMock scenariosObservation of care given / tasks performedMedworxxCardiac Medicine Unit Competence Program Components1. Inter-professional Communication2. Teamwork3. Knowledge Based Practice3

C5 CARDIAC MEDICINE COMPETENCY BASED ORIENTATIONGREAT PLACETO WORKINTERPROFESSIONALCOMMUNICATIONPATIENTS FIRSTTEAMWORKGOALPerformance Excellence withinThe OrganizationUSING RESOURCESWISELYKNOWLEDGE BASEDPRACTICE

The Orientation ProcessInitial Meeting with Role Model/MentorOnce hired you will meet with the Clinical Manager and your Role Model/Mentoron the unit you will be reporting to. You will receive the orientation folder. Role Model/Mentor explains the orientation program and answers questions Role Model/Mentor will provide you with an orientation of the unit andhospital way finding. You will be asked to complete the clinical experience rating of theCompetency based assessment tool.The new staff member, Role Model/Mentor will establish a plan for orientationbased on the identified learning needs.Mid-Orientation Evaluation New staff are accountable for identifying their learning needs andseeking out opportunities to meet them The Role Model/Mentor will meet with the new staff member to reviewthe competency based assessment to identify strategies to meetlearning needsEnd of OrientationThe Role Model/Mentor will meet with the new staff member to: Review the competency based assessment for incomplete items &establishes 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 ExtensionsPhone NumbersStaff SchedulingHospital NumbersExtensions2527Patient RegistrationC5 DeskSwitchboard 519-7527871Auto-attendant 519-751554422532566Clinical Manager – Mila Rozhko2654Clinical director – Lori Petrie-Mulrain2991Clinician2678SICK CALLSFor days – call the night before if possible or by0530 amFor Nights – Call by 1400If an extended sick leave call Org health @2248Human ResourcesPayrollRisk Pro Assistance Christina AndrewsIT Help Deske-Learning Medworxx:http://bchs.lms.medworx.com/BCHS Website519 751 5544 EXT 2566552624282435HELP - 4357Karen Arnott2522www.bchsys.org

Scavenger HuntOut and About on the UnitCompletedClinical Manager’s OfficeNurse Clinician’s OfficeMain desk/communication stationNurse Call Bell system – demonstrate useFax Machine/Photocopier, PrinterSchedule: S drive, staff scheduling, c5, RN or RPN thendateSign in sheets, request process, how to indicateavailability, call in procedure for illness/absenceStaff Phone numbersExt .Ext .Ext .Daily assignment sheets, review and understand break timesDischarge Action Round BoardPhone lists for hospital and PhysiciansLocate Unit Manuals: BCHS manual, Patient Services, IV,WHIMS, Emergency, Infection ControlLocate medication room (pharmacy drop box), med fridge,COWS, Narcotic KeysLocate Tube systemLocate Dumb WaiterLab labeler, lab label boxLocate Glucometer EquipmentFind the Staff room / Staff FridgeLocker areaStaff WashroomVisitor WashroomPatient Fridge, ice machine, microwave Cups, utensils, snacksProcedure for items in Patient FridgePublic PhoneCompanion Phones and Procedures – how to operate (notfor patient use)Find the dirty core – biohazard, garbage / batterydisposalS:drive

Scavenger HuntIsolation gowns, isolation signsFind Patient shower areas – understand rules ie infectioncontrol and patients alone in showerFlashlights for night shiftFind Supply Cart in Clean CoreLook around IV Fluids O2 Supplies Batteries Syringes Dressing supplies Ostomy suppliesEquipment IV pumps, Enteral Feeding PumpsTelemetry monitorsWheelchairs, Stretchers, walkersLocate fire extinguishers, pull stations and exitsLocate O2 / Air shut off valves (at nurses station)Locate Code Blue equipmentFind the staff mail slotsPatient education materials – review what’s available,check out BCHSYS web site as wellPatient’s room: Emergency call bell in bathroom Bedside call bell Code blue button O2 set up Suction setup Pocket masks Review standard instructions for call bells and bedalarms Howproperlyplug in a call bellLocateUnit toHuddleBoard

STANDARDS OF CAREInterventionFrequencyAdmission Physical And HistoryAdmission Part OneAdmission Part TwoTeaching assessmentHendrich ll Falls Risk AssessmentARI screening tool if not completedAdmission swabs if requiredTobacco use recordWound assessmentTeaching recordOn admissionOn admissionOn admissionOn admission and Q shiftOn admission and PRNOn admission and with status changeOn admission and PRNOn admissionOn admissionOn admission and PRNPhysical assessmentVSQ shiftQ4h x 24 then Q6h for the next 24 then Qshiftwhen stableQ 24hrsQ shift and PRNQ shiftQ shiftTelemetry assessment by InternistRhythm reviewPain assessmentTeach backCAM AssessmentDaily activity assessmentIV Peripheral Line AssessmentIn/OutTOAReview and update text bubbles in kardexCare plan review48 hour conversationBraden Skin Risk ScaleTurn and positionTeaching recordTrillium Gift of LifeQ shiftQ 4hrsQ shiftQ shiftQ shiftQ shiftQ shiftDay 2 post admissionQ Monday and with change in statusQ 2 hrs as neededQ shiftOn patients 79 yrs or younger before or afterdeath Review: lab results, diagnostic test results, physician progress notes, physician orders on ongoing bases thought out the shift, communicate with physicians report abnormal findings to physician,communicate with other members of multidisciplinary team throughout the shift.