student nursing orientation

STUDENT NURSING ORIENTATIONSTUDENT NURSING ORIENTATION

NorthShore University HealthSystemNorthShore University HealthSystem

A Message from the Chief Nursing OfficerA Message from the Chief Nursing Officer

Nancy T. Semerdjian, RN, BSN, MBA, FACHENancy T. Semerdjian, RN, BSN, MBA, FACHE

Our Vision ~Our Vision ~

for Nursing at NorthShore University for Nursing at NorthShore University HealthSystem (NorthShore) is to be HealthSystem (NorthShore) is to be recognized nationally and locally for our recognized nationally and locally for our commitment to providing the very best quality commitment to providing the very best quality of care and to be a destination for superior of care and to be a destination for superior nursing care and leadership. We are nursing care and leadership. We are committed to embracing the core values of committed to embracing the core values of compassion, excellence, collaboration and compassion, excellence, collaboration and innovation. innovation.

Our Goals ~Our Goals ~

are to provide a professional environment that are to provide a professional environment that promotes superior patient care, shared decision promotes superior patient care, shared decision making, and collaborative practice for every nurse at making, and collaborative practice for every nurse at NorthShore. We are committed to the professional NorthShore. We are committed to the professional growth of our staff through continuous learning and growth of our staff through continuous learning and evidence-based nursing practice. We hope to evidence-based nursing practice. We hope to establish NorthShore as the destination of choice for establish NorthShore as the destination of choice for professional nurses to embark on a challenging and professional nurses to embark on a challenging and rewarding career path. The recruitment and retention rewarding career path. The recruitment and retention of knowledgeable, highly skilled, motivated nurses is of knowledgeable, highly skilled, motivated nurses is critical to our success. critical to our success.

Our Journey ~Our Journey ~

to Excellence offers the venue for to Excellence offers the venue for demonstrating our long term commitment to demonstrating our long term commitment to excellence to all of NorthShore and to the excellence to all of NorthShore and to the surrounding communities we serve. It is a surrounding communities we serve. It is a journey that fully supports the NorthShore journey that fully supports the NorthShore mission to preserve and improve human life mission to preserve and improve human life through the provision of superior care, through the provision of superior care, academic excellence and innovative academic excellence and innovative research. research.

Our Nursing Leadership Team ~Our Nursing Leadership Team ~

provides the foundation for achieving our goals.provides the foundation for achieving our goals. Nursing Administration promotes the development of Nursing Administration promotes the development of leaders at all levels through continuous learning and leaders at all levels through continuous learning and knowledge sharing. We create an environment that knowledge sharing. We create an environment that promotes data-based decision making, participative promotes data-based decision making, participative management, quality, and cost-effective care. management, quality, and cost-effective care.

Nursing Core ValuesNursing Core Values

• ExcellenceExcellence– Excellence in patient centered careExcellence in patient centered care

• Collaborative PracticeCollaborative Practice– Shared decision making that fosters Shared decision making that fosters

accountability, participation, and loyaltyaccountability, participation, and loyalty

• Innovative TechnologyInnovative Technology– Use state of the art technology to enhance Use state of the art technology to enhance

innovationinnovation

Nursing Core ValuesNursing Core Values

• EducationEducation– A learning environment that advances nursing A learning environment that advances nursing

clinical and administrative leadership.clinical and administrative leadership.

• ResearchResearch– Evidence based clinical research that focuses on Evidence based clinical research that focuses on

improved outcomes improved outcomes

Emergency CodesEmergency Codes

Color Code Quick Reference ChartColor Code Quick Reference Chart

Activating a CodeActivating a Code

• Activate the Emergency Code System by Activate the Emergency Code System by dialing 3199 and announcing the type of dialing 3199 and announcing the type of emergency and the location. All codes will be emergency and the location. All codes will be announced through the overhead public announced through the overhead public address system. Code actions are in effect address system. Code actions are in effect until an “all clear” is announced overhead.until an “all clear” is announced overhead.


Code RedCode Red FireFire

Code YellowCode Yellow Code Triage StandbyCode Triage Standby

Code Gray Code Gray Behavioral Dyscontrol Behavioral Dyscontrol

Code BlackCode Black Severe Weather Condition Severe Weather Condition

Code GreenCode Green Internal EmergencyInternal Emergency


Code BlueCode Blue Medical EmergencyMedical Emergency

Code PinkCode Pink Missing Infant/ChildMissing Infant/Child

Code WhiteCode White Bomb Threat Bomb Threat

Code PurpleCode Purple Evacuation Evacuation


Code Orange Code Orange Hazardous Material Hazardous Material

Code LavenderCode Lavender Facility LockdownFacility Lockdown

Code BeigeCode Beige Chemical/Biological/Chemical/Biological/

RadiologicalRadiological

Code SilverCode Silver Incident Command Incident Command ActivatedActivated

Pain ManagementPain Management

• The NorthShore philosopy towards pain and pain The NorthShore philosopy towards pain and pain management is: management is: – If a patient says he is in pain, we believe him.If a patient says he is in pain, we believe him.– Every patient has the right to pain managementEvery patient has the right to pain management

• Review the policy in Clinical Practice Manual Review the policy in Clinical Practice Manual (CP07-1003). (CP07-1003).

• The Clinical Practice Manual is located on the The Clinical Practice Manual is located on the NorthShore intranet, the NorthShore intranet, the Pulse, Pulse, which may be which may be accessed on the clinical unit from any computer.accessed on the clinical unit from any computer.

ParkingParking

• Evanston HospitalEvanston Hospital: On your first day, please park in : On your first day, please park in 1000 Central parking garage across the street from 1000 Central parking garage across the street from the hospital. Each student will be asked to fill out a the hospital. Each student will be asked to fill out a parking form and take it to the Hospital Parking Office parking form and take it to the Hospital Parking Office on Girard Street at the entrance to the parking on Girard Street at the entrance to the parking structure. Once a sticker is issued, students should structure. Once a sticker is issued, students should park in the Ryan West lot which is located on Central park in the Ryan West lot which is located on Central Street just West of Ryan Stadium, but before the Street just West of Ryan Stadium, but before the Metra tracks. Metra tracks.

• Glenbrook HospitalGlenbrook Hospital: Park in the Employee/Medical : Park in the Employee/Medical Office Building Staff parking WEST of the new Office Building Staff parking WEST of the new Ambulatory Care Center Building, parking lot sections Ambulatory Care Center Building, parking lot sections BLUE 1-12 closest to Landwehr RoadBLUE 1-12 closest to Landwehr Road

ParkingParking

• Highland Park HospitalHighland Park Hospital: Parking is available in the : Parking is available in the areas designated for employees. Please note that areas designated for employees. Please note that parking in spots designated for handicapped, parking in spots designated for handicapped, emergency, and patient/visitor parking is strictly emergency, and patient/visitor parking is strictly prohibited.prohibited.

• Skokie HospitalSkokie Hospital: Park in the Employee parking lot : Park in the Employee parking lot on the west side of the Kenton building off Knox Ave. on the west side of the Kenton building off Knox Ave. Park only in the yellow outlined spaces towards the Park only in the yellow outlined spaces towards the back. The white outlined spaces are reserved for back. The white outlined spaces are reserved for patients and visitors. Parking is free.patients and visitors. Parking is free.

Rapid Response TeamRapid Response Team

• PurposePurpose– To improve the quality of patient care, provide support and To improve the quality of patient care, provide support and

mentoring for the nursing staff outside of the critical care mentoring for the nursing staff outside of the critical care units in the care of patients with a deteriorating clinical units in the care of patients with a deteriorating clinical condition.condition.

• Team MembersTeam Members– ICU RN ICU RN – Respiratory TherapistRespiratory Therapist– Nursing ConsultantNursing Consultant


• Rapid Response Teams (RRT) reduce Rapid Response Teams (RRT) reduce incidents of cardiac and respiratory arrests incidents of cardiac and respiratory arrests and decrease mortality rates. The RRT may and decrease mortality rates. The RRT may be initiated by any member of the health care be initiated by any member of the health care team team


• When should I call?When should I call?– Acute change in RR: <8 or >28 breaths per minuteAcute change in RR: <8 or >28 breaths per minute– Acute change in O2 sat.: <90% despite O2 @ 4L/nasal Acute change in O2 sat.: <90% despite O2 @ 4L/nasal

cannula or mask @ 50%cannula or mask @ 50%– Acute change in heart rate: <40 or >130 beats/minute or Acute change in heart rate: <40 or >130 beats/minute or

change in rhythmchange in rhythm– Acute change in SBP: <90 mm HgAcute change in SBP: <90 mm Hg– Acute change in LOC and/or seizuresAcute change in LOC and/or seizures– Staff concern that “something is wrong” with the patientStaff concern that “something is wrong” with the patient


• How Do I Call?How Do I Call?– Dial “3199” and state, “The Rapid Response Team is Dial “3199” and state, “The Rapid Response Team is

needed, (provide the location).” needed, (provide the location).” – The operator will page the RRT; there will be no audible The operator will page the RRT; there will be no audible

announcement.announcement.– The RRT team will arrive within 5 minutes, assist the The RRT team will arrive within 5 minutes, assist the

primary nurse in the management of the patient and primary nurse in the management of the patient and determine if the patient will remain on the nursing unit or determine if the patient will remain on the nursing unit or transfer to the ICUtransfer to the ICU


• What is the responsibility of Primary Nurse before the What is the responsibility of Primary Nurse before the team arrives?team arrives?– Remain with the patientRemain with the patient– Alert other team members to cover other patientsAlert other team members to cover other patients– Take vital signsTake vital signs– Place patient on bedside monitor Place patient on bedside monitor – Have Jetson brought to the roomHave Jetson brought to the room– Have the 12-Lead EKG brought to outside of the room to Have the 12-Lead EKG brought to outside of the room to

have in the event it is needed.have in the event it is needed.


• What does the Primary Nurse do when the RRT What does the Primary Nurse do when the RRT arrives?arrives?– Provide the team an “SBAR” report Provide the team an “SBAR” report – Remain in the room with the RRTRemain in the room with the RRT– Continues to function as the Primary Nurse for the Continues to function as the Primary Nurse for the

patientpatient

The SBAR ReportThe SBAR Report

• Before paging the physician:Before paging the physician:1- Assess the patient head to toe1- Assess the patient head to toe2- Review the chart for appropriate physician & appropriate call2- Review the chart for appropriate physician & appropriate call3- Know the admitting diagnosis3- Know the admitting diagnosis4- Read the most recent Progress Notes and the assessment 4- Read the most recent Progress Notes and the assessment

from the nurse of the prior shiftfrom the nurse of the prior shift5- Have available when speaking with the physician: 5- Have available when speaking with the physician:

The Epic chart The Epic chart Allergies Allergies Meds Meds IV’s IV’s Labs/results Labs/results Recent VS [you took] Recent VS [you took] Code Status Code Status

6- Text page the physician using the computer. Always include 6- Text page the physician using the computer. Always include your name and # so the doctor will know who to ask for. Let your name and # so the doctor will know who to ask for. Let the concierge know you have placed the callthe concierge know you have placed the call


• SituationSituation– State your name and clinical unit. State your name and clinical unit. – I am calling about: [Name & Room Number]I am calling about: [Name & Room Number]– ““The The problemproblem I am calling about is: _____________” I am calling about is: _____________” – I am concerned about: example: BP I am concerned about: example: BP ≥≥

200 200 ≤≤100 or a change of 30 mm 100 or a change of 30 mm – Pulse Pulse ≥≥ 140 140 ≤≤ 50 Resp. 50 Resp. ≤≤ 5 5 ≥≥ 40 Temp 40 Temp ≤≤ 96 ≥ 104 96 ≥ 104


• BackgroundBackgroundBe prepared to discuss the following, especially with Be prepared to discuss the following, especially with

an on-call/consulting MDan on-call/consulting MD – Admission diagnosis and date of admissionAdmission diagnosis and date of admission– Pertinent medical history Pertinent medical history – Brief synopsis of the treatment to date Brief synopsis of the treatment to date


• AssessmentAssessmentState what you think the problem is ~ changes inState what you think the problem is ~ changes in

BP _______ BP _______ Pulse ________ Pulse ________ Temp._____ Temp._____

Pain Eval ____ Pain Eval ____ O2 Sats ________ O2 Sats ________ O2 ______ O2 ______

Mental Status Mental Status Respiratory rate/quality Respiratory rate/quality

Heart rhythm Heart rhythm Breathing Breathing Neuro Signs Neuro Signs

BP, BP, Pulse, rate/quality Pulse, rate/quality Wound drainage Wound drainage

GI/GU GI/GU N&V N&V Diarrhea Diarrhea Skin Color Skin Color


• Request/RecommendationRequest/Recommendation Pt. seems unstable & may get worse. We need to do Pt. seems unstable & may get worse. We need to do

somethingsomething I am not sure what the problem is but the patient is I am not sure what the problem is but the patient is

deteriorating.deteriorating.REQUEST:REQUEST: Transfer to a higher level of care Transfer to a higher level of care Come to see the patient Come to see the patient Ask for a consultantAsk for a consultantASKASK: Do you need any tests? : Do you need any tests? CXR CXR ABG ABG EKG EKG CBC CBC BMP BMP BNP BNP Other OtherDo you want to change?Do you want to change? Medication Medication Treatments TreatmentsWhat parameters do you want to be called about? What parameters do you want to be called about?


• DOCUMENTDOCUMENT – The change in patient’s condition, in notesThe change in patient’s condition, in notes– Orders receivedOrders received– Physician notification: time and report givenPhysician notification: time and report given

student nursing orientation

Documents

nursing clinical

superior nursing care

code actions

emergency code system

nursing administration

nursing leadership team

superior patient care

chief nursing officer