Nursing Workforce Development: Bridging the Transition Gap and Improving Clinical Practice

1. Nursing Workforce DevelopmentPresentation by: Patricia McGauly, RN MN Manager of Nursing Workforce Development Greenville Health System 864-455-4304 pmcgauly@ghs.org

2. What’s Happening in Nursing Workforce Development … • Bridging the New Grad Transition Gap from Student to Practice • Phase II Orientation – Total Renovation • Creation of GHS Nursing Clinical Course Curriculum & Catalog • Clinically Focused Cohorts • Interdisciplinary Exposure/Immersion Opportunities • Core Competencies and Progressive Exposure/Training/Validation Design • Best Practices for Onboarding & Orientation • New Grad Rapid Response Program • SST Transition RN Program • 2015 Nurse Extern Program

3. Clinical Practice and Quality – GHS Nursing Clinical Practice Advisory Alert System • standardized method for informing nursing personnel and other related disciplines of any existing or potential impacts to their clinical practice • ensures appropriate categorization, details and dissemination requirements • empowers leadership and frontline staff in the provision of optimal and safe patient care

4. Clinical Practice and Quality – Plan of Care / Standard of Care We’ve Made HUGE Changes to our Plans of Care and Process!! #1 – The Entire Chart (Medical Record) is now considered the POC • Flow sheets: capture assessments, interventions, and outcome of interventions (ongoing assessments) • Notes: convey the evaluation of patient’s progress toward goals • Treatment plans: include active orders and interventions within order entry • Plan of Care activity: documents patients progress using problems, goals and interventions #2 - Plans of Care will be Problem Specific or Diagnosis • Risk of Falls • Ineffective breathing • Pediatric Asthma • DKA • Vaginal Delivery #3 – Standards of Care for each Service Line/Unit • Clinical Faculty must discuss these, etc with Unit Manager/CNE before bringing students on unit for clinical BRIDGE TO EPIC!!!!

5. Comparing Old to New Column Deleted- not needed with new form Details deleted

6. Progression Form • How to utilize this form: • Print when you initiate the appropriate POC • Write problems from POC • Place “I” and initials in the date column of initiation • Each day utilize key to show progression for each problem. Write symbol and initials. Other disciplines can update their problems as needed • If new problem added put under appropriate date column and place “I” for initiated • New form every 7 days The POC printed will be used as a reference and guiding document. No need to document each day on each page.

7. Clinical Practice and Quality – Combat on CAUTI!

8. Clinical Practice and Quality – Combat on CAUTI!

9. Clinical Practice and Quality – Combat on CAUTI!

10. Clinical Practice and Quality – RESTRAINTS AND SECLUSION

11. Clinical Practice and Quality – INFORMED CONSENT “Informed consent” is a discussion between a physician and the patient and is a physician non-delegable duty • Nurses should not be “consenting a patient” for anything.  Nurses can assist in filling in blanks on the forms and in obtaining signatures on the form after confirming that the physician has discussed the procedure, risks, benefits and alternatives with the patient in enough detail that the patient can make an informed decision.  Sedation Procedures: • In order to continue to simplify the consent process, we will no longer have a separate consent for sedation. This STARTSApril 15. • New process: when a procedure will require sedation, the consent form should state “Procedure with sedation”. Example would be “Esophagogastroduodenoscopy (EGD) with sedation”

12. Clinical Practice and Quality - POSEY CHAIR ALARMS The Posey Sitter Elite Chair alarm should be used on any high fall risk patient sitting in a chair. Just as the bed exit alarm would be activated for the high fall risk patient, the Posey Sitter Elite Chair alarm should be used and activated on those patients getting out of bed and sitting in a chair.

13. Clinical Practice and Quality – GHS PATIENT PORTAL Not a responsibility of Student Nurses but for your awareness… • Providing patients electronic access to their health information engages patients in their health care • Patient Satisfaction • Requirement for hospitals to meet Meaningful Use Stage 2 NURSING • Document Accept/Decline in Soarian • Patient Portal Access Form signed and email validated • Brochure given • Form faxed to Registration

14. Clinical Practice and Quality – What’s Coming Up… • The Joint Commission • Lots of Unit Moves and Construction • HillRom Nurse Call System • Hourly Rounding Changing to “Care Rounds” • Hazardous Drug Handling Requirements • Post-Mortem Care • Patient Observation Policy • Med to Bed Pilot Expansion • Lippincott Procedure Transition • EPIC

15. Questions?