ORIENTATION PROGRAMfor

NEW NURSESin

EMERGENCY DEPARTMENT

Outline Introduction Main Goal & Objectives Who Needs Orientation? The Importance of Orientation Program Preceptorship Orientation Program Development Orientation Program Schedule:1. Scope of Service2. Emergency Department Safety Orientation3. Infection Control Policy4. Professional/ Technical Skills Summary

IntroductionEmergency Department (ED) is among those

professional arenas in the forefront of the nursing Transition (Schriver J, et al 2003), it operates 24 hours a day, to treat patients who are suffering from an acute illness, or seriously injured; that may lead to severe complications if not treated quickly (CSAHS, 2002).

Since Emergency Nursing is both fascinating and challenging area in which to work, a comprehensive orientation program for new nurses has to be accomplished by a knowledgeable, well experienced nurse (Preceptor), for a pre- designated period of time, according to the characteristics of that new employee.

Orientation is a formal process to orient a new employee about organization and the individual place within the structure (Douglass L,

1997), Every new nurse needs to be introduced to the work environment and instructed in the performance of specific tasks, the orientation is intended to get the new employee off to a good start by establishing a sense of belonging creating welcoming work environment, supplying necessary information that will answer his/ her questions, and removing any uncertainties.

Main Goal

To Provide New Nurses in the Emergency Department with Orientation to Practice Nursing in Keeping with The Hospital’s Mission & Goals, Thus Increasing their Awareness towards Work Safety & High Standards of Care Provision in ED.

ObjectivesAt the end of the orientation program the

orientee will be able to develop self-efficiency, & focused continuous learning in order to function safely, effectively and competently.

Moreover, throughout the orientation period the orientee will be able to:

Recognize the physical structure of the hospital & ED. Review goals, policies, & protocols of the hospital. Describe the organizational structure. Understand the communication process in the hospital. Identify functions of ED at the hospital.

Objectives Be Competent with: • Recognition, Recording and interpretation of signs and

symptoms of emergent and non- emergent adult and pediatric patients.

• Initiation of BLS and ACLS for both adult and pediatric patients

• Triage process in ED• Parenteral administration of IV fluids, blood and blood

components, emergency drugs and substances.• Safe and effective use of all electronic equipments.• Recognition and intervention for life threatening

arrhythmias.

Objectives• Infection control, including aseptic technique.• Management of wounds.• Management of sepsis.• Management of burns.• Initial management of general trauma, spinal cord and

head injuries.• Emergency delivery and initial care of the newborn.• Initial management of overdose (drugs and alcohol), and

the withdrawal syndromes.• Initial management of psychiatric emergencies including:

The violent, homicidal, and suicidal patient. Management of grief reactions.

Objectives• Recognition and initial intervention of psychological

and social problems of patients & their families.• Initial management of amputated parts.• Knowledge of regional paramedic protocols.• Recognition & management of the pediatric,

geriatric, & adult abuse/ neglect patient.• Initial management of the sexually assaulted adult

and pediatric patient.• Knowledge of emergency preparedness and disaster

plans

Who Needs Orientation?New graduates or experienced RN without

ED experience have not been exposed to any emergency nursing content, nor have they had any ED clinical experience in their nursing program had been discovered, thus, nurses come to the employer need preparation and education to function at high level in busy emergency departments (Emede K. 2003).

The Importance of Orientation Program

The Absence of Orientation Program will lead to: Increased Stress, Increased Disorientation Increased Self Missing Decreased Nurses’ Efficiency & Productivity Decreased Work Safety & Competency Increased Job Dissatisfaction, Diminished Retention Increased Turn Over

Whose Responsibility?

It is the responsibility of the hospitals’ administrators, the director of nursing, the supervisors, the preceptors & the nurse managers, who must develop a strategy for orientation in all hospitals’ departments; including the emergency department, as it had been proved it’s importance & necessity

Preceptors’ SelectionThe preceptors' group have to meet significant

characteristics and desirable qualities as follows:a. Resilience and enthusiasm (Rudzik J. 1999),

b. Experience in emergency nursing at least for two years (Alban A, et al 1999),

c. Demonstration of professionalism and knowledge (Rudzik J. 1999), (Ephron J, et al 1989),

d. Interest in precepting (Alban A, et al 1999) (Ephron J, et al 1989) (Meyer RM, et al 2000),

e. Attendance at conferences on adult learning (Ephron J, et al 1989) (Meyer RM, et al 2000) (Kidd P, et al 1999),

f. Attendance at classes or workshop for training preceptors, including topics in effective communication, establishing learning objectives, adult learning principles and techniques for providing feedback for orientee.

Orientation Program Development Since new nurses are expected to

complete an orientation program, that prepares them to perform their assigned duties, the orientation program should introduce this employee to information, knowledge and skills essential to effective performance, additionally; these nurses should be checked for competency on certain skills, knowledge, and equipments needed for job performance.

Orientation Program Schedule

The orientation program may be scheduled for three months period (Probation period), in order to allow new nurses to solidify their emergency skills; including direct continuous supervision and feedback from their preceptors.

Orientation Program Initiation

It's preferable that before initiation of orientation program; the new nurse will fill the emergency department training program questionnaire (EDTP) (Zavotsky K. 2000) for assessment and evaluation prior to commencing their duties: as follows: (see next table)

Name: ______________________________________________

Unit currently working: ________________________________

Past RN experience: __________________________________

How would you describe your performance under stress? ___________________________________________________

How would you describe your ability to work with all members of health care teams? ___________________________________

____________________________________________________

What type of patients do you most enjoy caring for? __________

____________________________________________________

What are some of your strengths as a nurse? _________________ _____________________________________________________

What are some of your weaknesses as a nurse? _______________ _____________________________________________________

Orientation Program ScheduleWithin four days (including training); the

preceptor and/or the director of nursing will explain and review with the new nurse all the following:

A. Scope of Service

B. Emergency Department (ED) Safety Orientation

C. Infection Control Policy

D. Professional/ Technical Skills

A. Scope of Service1. Describe in details the services provided by the hospital

& its ED.2. Introduce new nurse to other personnel: Identify and introduce co- workers. Identify/ introduce by name, title, and role other

personnel the new nurse will work with on a regular basis.

Identify other pertinent hospital personnel.

3. Familiarize new nurse with the hospital organizational structure (use organizational chart):

Identify new nurse’s immediate supervisor. Identify/explain other levels of supervision.

A. Scope of Service4. Review/ discuss/ explain performance management procedure and

plan: Discuss/ define new nurse’s role and responsibilities. Discuss performance evaluation process, to include competency

assessment. Discuss evaluation process. Discuss training requirements.5. Review ED attendance procedures/ policy: Review work schedule, explain daily time schedule, reporting time,

breaks, meal breaks, signing in/ out procedures/ requirements. Discuss attendance expectations; calling in/ out notifying your

supervisor, requesting sick and annual leave time. Discuss overtime policies, procedures, and payments (if applicable). Discuss/explain and sign the work contract with new nurse. Form

should be signed by new nurse and supervisor on the 1st day and returned to the Human Resources Manager at the same day.

A. Scope of Service6. Introduce new nurse to work environment: Familiarize new nurse with immediate work area. Familiarize new nurse with other areas where work may be

performed. Familiarize new nurse with extended work areas Identify emergency exits. Explain procedure/ responsibility for hospital security, looking up,

opening areas, lost keys… etc.

7. Discuss/ explain the importance of communication with clients: Greeting clients in a courteous, friendly manner. Providing clear, concise information and instructions Meeting the needs of the clients. Responding to customers concerns, complaints, and criticism

timely.

A. Scope of Service8. Review/ explain hospital’s communication/ information

management systems: Review/demonstrate features of the telephone system Emphasize appropriate telephone etiquette and responsibility

Review how telephone is expected to be answered e.g. - State name, location…etc. “Ms. Linda, ED" Offer to be of assistance, "May I help you?"

Take/verify message (confirm/read back names). Emphasize responsibility for message being delivered

Explain internal mail distribution system: Explain external mail distribution. Locate copy & fax machines for use (if applicable) Emphasize the use of phones, copy, personal computers, and fax

machines

B. Emergency Department (ED) safety orientation

1. Review procedure for announcing an emergency; (employee may demonstrate):

Review/demonstrate how to call a code (Blue/Red/Yellow)

Demonstrate what to say when announcing an emergency

Demonstrate how to cancel an emergency Review emergency phone numbers as listed

B. Emergency Department (ED) safety orientation2. Identify/explain components of fire safety system: Locate fire alarm box; employee demonstrate use. Locate fire extinguishers (different types as necessary.) Locate sprinklers, smoke detectors. Locate/explain building evacuation plan. Review staff responsibilities during a fire emergency. Discuss evacuation procedures for fire drills.

3. Review Roles/ Responsibilities in Emergency Action (Disaster) Plan:

Location of emergency preparedness manual. Identify new nurse’s role in emergency actions plans. Locate environmental emergency plan, locate safe areas. Review responsibility during fire emergency.

B. Emergency Department (ED) safety orientation4. Review information on Hazardous Material Management Locate/demonstrate use of Material Safety Data Sheets (MSDS) Review list and locate chemicals, stored/used in area Explain procedure for handling contaminated materials, if

applicable5. Review reporting procedures for employee/ patient injuries: Discuss when to report. Discuss to whom to report. Identify location of Incident/ Accident report forms. Review worker’s compensation information and procedures. 6. Review emergency codes used in hospital: Code Blue, Medical Emergency. Code Red, Fire. Code Yellow, Assistance Needed, ASAP. Discuss employee's role/ responsibilities during codes.

C. Infection Control PolicyDiscuss/review Infection Control procedures, policies, techniques: Review the importance of Hand washing; focus attention on

posters located in bathrooms, kitchen areas. Review concept of Standard Precautions. Discuss when special precautions should be used. Discuss use of Personal Protective Equipment (Barrier Bag)

“PPE”. Discuss when to use PPE Identify location of PPE Discuss when and to whom Infections should be reported,

individual or employee infections, and Client infections.

Evaluation of the orientation program according to the evaluation key: See Table 1

D. Professional/ Technical Skills(Adopted from Al- Makassed Islamic Hospital/ Jerusalem)

No. ItemKnowledgeSkills

1.Admission process: Welcoming the pt. to

ER, Priority classification &

Triage, Does routine

investigation & Nursing care

D. Professional/ Technical Skills

No. ItemKnowledgeSkills

2. Basic Nursing Procedures:

e.g. Vital Signs

Others: …………………

D. Professional/ Technical Skills No. ItemKnowledgeSkills

3.General Nursing Procedures:

Medications; oral, IV.,IM...

Specimen Collection; urine, blood, swab…

Doctors’ instructions were carried out.

Proper documentation. Proper communication.

D. Professional/ Technical Skills No. ItemKnowledgeSkills

4.Special Care: Suctioning, N/G Tube Insertion, Bladder Catheterization IV. Insertion & Care, Blood Transfusion Care, Airway Application, Ambubagging, Dressing Care, Works properly with machines

D. Professional/ Technical Skills No. ItemKnowledgeSkills

5.Equipment Checking: Emergency Bell, Defibrillators, Emergency Trolley, Suction Machines, O2 & Ambubags, Narcotics, Plaster Trolley, Ambulance, Others …………………

D. Professional/ Technical Skills No. ItemKnowledgeSkills

6.Certain Procedures: Preparation of Pt. &

Equipments, Assisting Dr. with

Procedure/s Nursing Care post-

Procedure: Chest Tube, Lumbar Puncture, Cut Down, Suturing, CV line Insertion

D. Professional/ Technical Skills No. ItemKnowledgeSkills

7. Medication Protocol: Knows the Medication, Prepares Medication &

Calculates the Dosage, Monitors the Pt. Post-

Medication (Side Effects),

Follow Special Nursing Care for Medication

D. Professional/ Technical Skills No. ItemKnowledgeSkills

8.Emergency Protocols: Recognizes Emergency

or Urgency, Knows How to Code or

Call for Help, Performs the Proper &

Needed Care Before Emergency Team Arrival,

Works Efficiently & Fast During Emergency.

D. Professional/ Technical Skills No. ItemKnowledgeSkills

9.Transfer or Discharge Process:

Prepares Pt. Properly, Gives Proper Report, Teaches & Instruct Pt. &

Family, Communicate Properly

with Other Departments, Proper Documentation.

Summary

At. the end, we can conclude that the presence of orientation programs in ED will increase staff efficiency, productivity & creativity, in addition to work safety, increased Job satisfaction, increased retention of nurses & decreased turn over

References Alban A, Coburn M, May C. (1999). Addressing the

emergency nursing staffing shortage: implementing an internship using a nursing school instructor model. Journal of Emergency Nursing 25: 509- 513.

Central Sydney Area Health Services “CSAHS” (2002): The Emergency Department. Available at: http://www.cs.nsw.gov.au: Last updated: Jan 2002. (Accessed 06/10/2004).

Douglass L, The Effective Nurse: Leader and Manager, 4th edition, Mosby, London, 1997.

Emede K. (2003). A statewide ED nursing course for new graduates or nurses without ED experience, Journal of Emergency Nursing 29: No 5. Available at: http://www.jenonline.org. (Accessed 19/10/2004).

Ephron J, Andrea J. (1989). Collaborative university/ emergency student nurse preceptorship program. Journal of Emergency Nursing 15: 116- 119.

References Kidd P, Sturt P. (1999). Developing and evaluating an

emergency nursing orientation pathway. Journal of Emergency Nursing 21: 521- 530.

Meyer RM, Meyer MC. (2000). Utilization- focused evaluation: evaluating the effectiveness of hospital nursing orientation program. Journal of Nursing Staff Development 16: 202- 208.

Rudzik J. (1999). Establishing and maintaining competency. Journal of Intravenous Nursing 22:69- 73.

Schriver J, Talmadge R, Chuoung R, Hedges J (2003). Emergency Nursing; Historical, Current, and future roles. Journal of Emergency Nursing 29: No 5. Available at: http://www.jenonline.org. (Accessed 19/10/2004).

Zavotsky K. (2000). Developing an ED training program; How to “grow your own” ED nurses. Journal of Emergency Nursing 26: No.5. Available at: http://www.jenonline.org. (Accessed 19/10/2004).