48. 0 of 6 Resp. Neuro 1. Admit and manage 2 respiratory patients independently by 10/29/06 2. Give 4 organized reports to physicians by 10/29/06 10/20/06 - Admission for pneumonia with preceptor 10/22/06 - Admission for COPD done independently. Followed appropriate protocol. 10/23/06 – Managed PE pt. independently. Followed appropriate protocol. Participated in successful code. 2. 10/20/06 - Dr. Jones (+) 10/20/06 - Dr. Smith (+) 10/22/06 - Dr. Green (+ w/urgency) 10/23/06 - Dr. Davis (+) 1 4 DE Ima Newtoyou 10/16 -10/29/06
49. 2 of 6 Neuro 2 4 DE Ima Newtoyou 1. Admit and manage 2 neuro patients independently by 11/12/06 2. Complete all charting by end of shift by 11/12/06 1. 10/31/06 - Admission for closed head trauma done independently. Followed appropriate protocol. 11/6/06 - Admission for r/o CVA, followed protocol for thrombolytics. 2. 10/31/06 - All completed 11/6/06 - 20 min. OT 11/7/06 - All completed 11/9/06 - All completed 10/30-11/12/06
The purpose of this presentation is to give preceptors the resources and tools they need in order to precept any level orientee.
Level I: Novice A GN or RN with less than one year experience. • No experience with situations for which they are in • Need rules to guide actions • May be asked to perform tasks without any situational experience • Unable to use discretionary judgment, works better with rules than with guidelines • Must be backed up by a competent nurse • Has no rule about which tasks are most relevant in a real-world situation or when an exception to the rules is necessary Level II: Advanced Beginner An RN with one to three years experience: A Level I nurse may advance to Level II status after a minimum of one year experience and recommendation by a Clinical Manager. • Demonstrates marginally acceptable performance • May shift from teaching rules to teaching guidelines • Is gaining experience with real situations and able to note meaningful patterns • Needs assistance in prioritizing (or have priorities pointed out by preceptor) • Must be backed up by a competent nurse • Can formulate guidelines for actions in terms of patterns and attributes • Has difficulty identifying important aspects; treats all attributes as equally important Level III: Competent Nurse An RN with a minimum of three years experience may be hired into the level if he/she shows evidence of meeting specified criteria. A Level II RN can advance to Level III after a minimum of two years experience and recommendation by a Clinical Manager. All required unit-specific certification must be completed in order to advance to Level III. • Begins to see his or her actions in terms of relevance • May focus on improving decision-making of long-term goals or overall plan and ways to improve • Begins to distinguish relevance of care and of multiple, complicated care needs • Feels the ability to cope and manage the interdisciplinary needs of patients • A good preceptor for a novice nurse, can see unforeseen events • Lacks the speed and flexibility of a proficient Nurse Level IV: Proficient Nurse A Level III RN may advance to Level IV status after a minimum of three years or specialty experience. The nurse must meet specified criteria and be recommended by a Clinical Manager. Level IV requires the nurse to maintain his/her status by performing additional activities. A candidate for Level IV is usually approved by a Clinical Ladder Committee. • Can discern situations as wholes rather than concentrating on selected parts • Use complex case studies to facilitate learning rather than single pieces of information • Uses past experiences to judge situations rather than rules or guidelines alone • A good preceptor for a competent nurse guide • Can recognize when the expected normal picture is absent • Considers fewer options and hones in on accurate elements of a problem Level V: Expert Nurse A Level IV nurse may advance to Level V after a minimum of five years or specialty experience. The nurse must meet the specified criteria and be recommended by a Clinical Manager. Level V requires the nurse to maintain his/her status by performing certain activities. A candidate for Level V must be approved by a Clinical Ladder Committee. • Practices holistic rather than fractionated care • Grasps situations intuitively and correctly identifies processes and solutions without wasting time • Encourage other nurses in advance practice • Demonstrates excellent practice with extraordinary management of clinical problems • Considered an expert by others • A good preceptor for a competent nurse Benner, P. (1984) "From Novice to Expert: Excellence and Power in Clinical Nursing Practice." Addison-Wesley Publishing Company, Nursing Division, Menlo Park, California. Additional Data from Benner, P. (1982). From novice to expert. American Journal of Nursing, 82, 402-407.
Children start with no preconceived ideas They have no knowledge about the subject to begin with They have a natural curiosity Adults are autonomous and self-directed Adults have accumulated a foundation of life experiences and knowledge Adults need to be given rationales for why they are learning what they are learning. Adults learn what is necessary for them. Adults are problem-centered vs. subject-centered Most adult learners have specific expectations of a learning experience. Adults learn in supportive and positive environments.
Be realistic Set your orientee up to Succeed Be specific Don’t make people have to guess Make expectations clear Don’t leave your orientee wondering what you want from them
Record progress towards meeting goals Establish basic competence and compliance with ORHS standards Keep it to the point
Critical Checks (Clinical) Think Link (Education & Training) Patient Care Education (Clinical) Pharmacy Services (Departments) MRSA (Education & Training) SLP (Education & Training) CAI (Education & Training GN Roundtables (Education & Training) HR Resources for job description and personal stuff Policy & Procedures Incident Reporting - How to (Education & Training) Trach Care (E-Learning) UBE Corporate Education
Orientee Self Assessment (Adults can often determine their own learning needs) PBDS Report (Good indicator of orientation needs)
Critical Checks (Clinical) Think Link (Education & Training) Patient Care Education (Clinical) Pharmacy Services (Departments) MRSA (Education & Training) SLP (Education & Training) CAI (Education & Training GN Roundtables (Education & Training) HR Resources for job description and personal stuff Policy & Procedures Incident Reporting - How to (Education & Training) Trach Care (E-Learning) UBE Corporate Education
Daily & Weekly Goals Take 1 minute a day Take 5 minutes weekly Give Ongoing Expectations SMART Goals: Specific Measurable Attainable Realistic Time Bound
Plan Exactly what you want Daily & Weekly Goals Take 1 minute a day Take 5 minutes weekly Give Ongoing Expectations SMART Goals: Specific Measurable Attainable Realistic Time Bound
Did you accomplish the goals? If not, what do you need in order to do so? Assess daily and weekly.
Document, document, document Document Daily & Weekly
Look for common ground
Plan Exactly what you want Daily & Weekly Goals Take 1 minute a day Take 5 minutes weekly Give Ongoing Expectations SMART Goals: Specific Measurable Attainable Realistic Time Bound
Complete all initial assessments by 0800 and have them documented by 1000; all medications must be given within 30 minutes of scheduled time S pecific M easurable A ttainable R ealistic T ime Bound
Critical Checks (Clinical) Think Link (Education & Training) Patient Care Education (Clinical) Pharmacy Services (Departments) MRSA (Education & Training) SLP (Education & Training) CAI (Education & Training GN Roundtables (Education & Training) HR Resources for job description and personal stuff Policy & Procedures Incident Reporting - How to (Education & Training) Trach Care (E-Learning) UBE Corporate Education