STUDENT NURSING ORIENTATION

1. STUDENT NURSING ORIENTATION NorthShore University HealthSystem

2. A Message from the Chief Nursing Officer Nancy T. Semerdjian, RN, BSN, MBA, FACHE

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

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

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

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

7. Nursing Core Values • Excellence • Excellence in patient centered care • Collaborative Practice • Shared decision making that fosters accountability, participation, and loyalty • Innovative Technology • Use state of the art technology to enhance innovation

8. Nursing Core Values • Education • A learning environment that advances nursing clinical and administrative leadership. • Research • Evidence based clinical research that focuses on improved outcomes

9. Emergency Codes Color Code Quick Reference Chart

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

11. Color Code Quick Reference Chart

12. Color Code Quick Reference Chart

13. Color Code Quick Reference Chart

14. Pain Management • The NorthShore philosopy towards pain and pain management is: • If a patient says he is in pain, we believe him. • Every patient has the right to pain management • Review the policy in Clinical Practice Manual (CP07-1003). • The Clinical Practice Manual is located on the NorthShore intranet, the Pulse, which may be accessed on the clinical unit from any computer.

15. Parking • All students should park in the Ryan West lot which is located on Central Street just West of Ryan Stadium, but before the Metra tracks. • Each student will be asked to fill out a parking form and take it to the Parking Office on Girard Street at the entrance to the parking structure. • The parking office will issue each student a pass for the Ryan West lot.

16. Rapid Response Team • Purpose • To improve the quality of patient care, provide support and mentoring for the nursing staff outside of the critical care units in the care of patients with a deteriorating clinical condition. • Team Members • ICU RN • Respiratory Therapist • Nursing Consultant

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

18. Rapid Response Team • When should I call? • Acute change in RR: <8 or >28 breaths per minute • Acute change in O2 sat.: <90% despite O2 @ 4L/nasal cannula or mask @ 50% • Acute change in heart rate: <40 or >130 beats/minute or change in rhythm • Acute change in SBP: <90 mm Hg • Acute change in LOC and/or seizures • Staff concern that “something is wrong” with the patient

19. Rapid Response Team • How Do I Call? • Dial “3199” and state, “The Rapid Response Team is needed, (provide the location).” • The operator will page the RRT; there will be no audible announcement. • The RRT team will arrive within 5 minutes, assist the primary nurse in the management of the patient and determine if the patient will remain on the nursing unit or transfer to the ICU

20. Rapid Response Team • What is the responsibility of Primary Nurse before the team arrives? • Remain with the patient • Alert other team members to cover other patients • Take vital signs • Place patient on bedside monitor • Have Jetson brought to the room • Have the 12-Lead EKG brought to outside of the room to have in the event it is needed.

21. Rapid Response Team • What does the Primary Nurse do when the RRT arrives? • Provide the team an “SBAR” report • Remain in the room with the RRT • Continues to function as the Primary Nurse for the patient

22. The SBAR Report • Before paging the physician: 1- Assess the patient head to toe 2- Review the chart for appropriate physician & appropriate call 3- Know the admitting diagnosis 4- Read the most recent Progress Notes and the assessment from the nurse of the prior shift 5- Have available when speaking with the physician:  The Epic chart  Allergies  Meds  IV’s  Labs/results  Recent VS [you took]  Code Status 6- Text page the physician using the computer. Always include your name and # so the doctor will know who to ask for. Let the concierge know you have placed the call

23. The SBAR Report • Situation • State your name and clinical unit. • I am calling about: [Name & Room Number] • “The problem I am calling about is: _____________” • I am concerned about: example: BP ≥ 200 ≤100 or a change of 30 mm • Pulse ≥ 140 ≤ 50 Resp. ≤ 5 ≥ 40 Temp ≤ 96 ≥ 104

24. The SBAR Report • Background Be prepared to discuss the following, especially with an on-call/consulting MD • Admission diagnosis and date of admission • Pertinent medical history • Brief synopsis of the treatment to date

25. The SBAR Report • Assessment State what you think the problem is ~ changes in  BP _______  Pulse ________ Temp._____  Pain Eval ____  O2 Sats ________ O2 ______  Mental Status  Respiratory rate/quality  Heart rhythm  Breathing  Neuro Signs  BP,  Pulse, rate/quality  Wound drainage  GI/GU  N&V  Diarrhea  Skin Color

26. The SBAR Report • Request/Recommendation  Pt. seems unstable & may get worse. We need to do something  I am not sure what the problem is but the patient is deteriorating. REQUEST: Transfer to a higher level of care  Come to see the patient  Ask for a consultant ASK: Do you need any tests?  CXR  ABG  EKG  CBC  BMP  BNP  Other Do you want to change?  Medication  Treatments What parameters do you want to be called about?

27. The SBAR Report • DOCUMENT • The change in patient’s condition, in notes • Orders received • Physician notification: time and report given