TRAVEL RN MED SURG (604) PSL MC 7P 7A BACKFILL

TRAVEL - RN - MED SURG (604) - PSL MC - 7P - 7A - BACKFILLUnit Information: (9A Medical Surgical 60416)Location: Presbyterian St. Luke s Medical CenterAddress: 1719 E 19th Avenue Denver CO 80218Floor:9ABuilding: A Tower General InformationTell us about the unit(s):Number of Beds - 18Number of Staff 32Type of staff:Day Shift (Charge RNs 1 PCT)Night Shift (Charge RNs 1 PCT)Patient Ratios 5:1 RN - Estimated ratios not guaranteedType of equipment - Philips Monitors Alaris Pumps dopplers welch-allyn vs machines mobilab glucometersEMR - MeditechTypical hiring profileSkill Set Most recruited for: (Travel RNs local CNAs and sitters) Must have: candidates without these skills will not be considered for the in trachs and ostomy carePreferred or nice to have: candidates with these skills will be considered experience with general surgery List typical procedures performed on unit(s):Minimally invasive surgeries colectomy ostomy creation and takedown artificial airway creation and management podiatry and plasticsCHF COPD cellulitis sepsis DKA PNABest personality Fit:Team oriented invested in good patient outcomes upbeat and KINDEnjoys busy environment can shift priorities with ease. Enjoys precepting and coaching new nursesUnit Guidelines/Policies: Please feel free to attach unit policies and be willing to work weekend shifts Any additional information that would entice a worker to select your unit for their assignment:9A- Medical/ SurgicalRN Agency/ Float Guidelines Welcome to 9A! We are an 18-bed medical-surgical unit. We want your time with us to be a pleasant and rewarding experience. Each shift you work you will have a staff nurse designated as your resource to ensure you have the necessary knowledge and tools to be successful. Resource RN: Please review these guidelines BEFORE the start of your shift sign the attestation and turn in to the charge nurse. A copy will be provided for your reference throughout the shift. The guidelines contain important information about our processes and expectations. These processes are necessary to ensure we are providing high quality care to our patients and their families. If you encounter a procedure or situation associated with your assignment with which you are not comfortable please let your charge nurse know. Thank you for being an important part of our care team!STANDARDS OF BEHAVIORWe have high standards of behavior for all members of our PSL/RMHC team including our traveler and agency staff.v iCARE- Our standards reflect our organizational values which are known as iCARE values or behaviors.I- Integrity I am honest and do what I sayC- Compassion I am sympathetic to the needs of othersA- Accountability I take ownership for how my actions and behaviors impact outcomesR- Respect I value others and embrace diversityE- Excellence I take personal pride in exceeding expectations CUSTOMER SERVICEWe want our patients to feel confident in the care we are providing and we utilize several tools to facilitate the high quality communication that supports that goal. All team members are expected to use the following:v AIDET- provides consistent structure for communicating with patients visitors or colleagues on the phone and in person.A Acknowledge your patient by nameI Introduce: Introduce yourself affirming your experience/expertise.D Duration: Always provide a time frame and/or when you will check back in with the patient.E Explanation: Describe what you will be doing and why.T Thank you: Thank them for trusting us with their care.v No Pass Zone- Answering call lights is EVERYONE s responsibility. No one should ever pass a ringing call light or a room with an equipment alarm sounding.v Bedside Report- Shift report is performed at the bedside unless the patient requests otherwise and includes discussion of the previous shift s events/changes in condition the patient s plan of care revision of goals for the day and a review of new medications and side effects with the patient. It also includes verification of the functionality of all safety equipment equipment settings alarms and iTRACE of all lines/tubing.v Purposeful Hourly Rounding Conducted to facilitate early identification of patient needs and proactive responses. Assess the 5 Ps : Potty Pain Position Personal Items and Pumps with each SPECIFIC FLOAT/ AGENCY RN CHECKLIST Please check all boxes to indicate understanding of expectations unit policies and procedures. Sign the attestation at the end of this document and return to the charge RN. UNIT ROUTINESv Shift huddles occur at 7 AM/PM. The charge RN will review important unit information. Attend on time. Get a list of door codes from the charge RN. Receive Bedside Report using SBAR report tool. Log into Responder 5 and assign your patients on your iMobile phone.v Whiteboards are used to communicate pertinent information including the pain management plan to your patient and their family. It should be 100% complete and legible. Write your name and 4 digit phone extension. Review the board with the patient. Perform purposeful hourly rounding. Assess and respond to the 5 Ps each hour and complete the log posted in every patient room. Make a plan with your PCT for ADLS (this is a shared RN and PCT responsibility!) Continuously check Meditech for new orders. You are responsible for acknowledging all medications ordered during your shift as well as verifying all other orders completed during your POPULATIONv The patient s on med/surg are varied and range from very ill to overnight stays. We have many patients that have had abdominal surgery GYN surgery and also many medical patients who may be in with COPD DM Non-healing wounds.v GI patients-Dr. Sellers Dr. Craig Brown and Dr. Strutt perform colectomies new colostomy/ ileostomy and colostomy takedown.v Dr. Canfield performs minimally invasive general surgeries with the DaVinci Robotv GYN surgeries are usually hysterectomies with Dr. Dabelea or Dr. Forschner vaginal or laparoscopicv Medical Teaching Patients we have a large group of interns and residents who assist with this populationv Skull base/EENT. Dr. Hepworth conducts pledget studies to rule out CSF leaks he also repairs them. Dr. Lamond is our neurosurgeon who performs craniotomies. PATIENT CARE (RN Responsibilities)v Offer patients daily bed and linen changes.v Hand Hygiene: Perform before gloving in between changing soiled/clean gloves after patient contact and when exiting the room.v Restraints ONLY staff who have completed the P/SL Restraint Competency may care for a patient in restraints. Reminder: Certain medications (e.g. Haldol Ativan) may be considered CHEMICAL RESTRAINTS if ordered x1 when the goal is to decrease a patient s freedom of movement or to stop a behavior depending upon the treatment context. If physical restraints or a potential chemical restraint is ordered notify the charge nurse immediately before giving/placing restraints.v Foley care is performed and documented daily. Use non-Chlorhexidine bath wipes to clean the area around the catheter entry site. Use a new CHG cloth to clean the catheter from point of insertion away from the body approximately 6 inches. Remember to document in meditech that proper foley care was provided. The drainage bag must be in a dependent position below the level of the bladder. Do not lay the bag flat or allow the filter to become wet. Perform hand hygiene and wear gloves before and after handling any part of the Foley catheter or drainage bag.v Central Lines Hand Hygiene: ALWAYS cleanse hands and wear gloves when doing anything with lines. SwabCaps : place orange caps known as alcohol impregnated caps on all unused ports central line lumens and access ports on the attached IV tubing. Caps are single use only. DO NOT REUSE. Caps must be in place for 5 minutes to be effective. Otherwise scrub the hub with alcohol for 15 seconds and let air dry. Needleless (blue) Caps: Change with IV tubing changes with each new bag of TPN of after the infusion of blood products is complete. Daily Central Line Care per unit policy. All central lines must be wiped down with CHG wipes daily and documented in meditech. Weekly Dressing Changes: Completed only by employees with demonstrated competency every 7 days and when wet soiled or no longer intact. Discontinuing Temporary Central Lines: Agency and Travel RNs may NOT d/c central lines. Notify charge RN if discontinuation of a line is ordered. PATIENT CARE (PCT Responsibilities)v The 0600/1800 vital signs should be done by nursing. If patients require q 4 hour vital signs they are at. Q shift vital signs are atand 2200.v Intentional/purposeful rounding utilizing the 4 P s (Potty Position Placement & Pain) when you are in the room. Please sign the log at the bedsidev Review bath list (up to 10 baths per PCT)v Hygiene for these patients includes bath catheter care with CHG wipes on the catheter regular wipes for peri-care teeth/denture cleaning and sheet changing.v Record intake and output on sheets in real time. Check drains foleys and ostomies for output.v Relieve patient safety attendants on unit if necessary.v Assist patients with eating if necessary.v Check blood glucose finger sticks before meals and at bedtime (or as ordered).v Stock PPE boxes and remove trash stock nutrition area and put away supplies in the back storage room and stock cabinets in hallways with gowns glove and PDI wipes.v Alert charge nurse of any change in patient condition or any abnormal vital signs DOCUMENTATION. RN s are responsible for all vital signs collected exempt the 1400 and 0200 vitals that are collected by the PCT. You must work with the PCT if on duty to ensure all vital signs are collected and recorded as ordered. (e.g. 1400 vitals) Intake and Output is documented Q 12 hours by 1659 and 0459. Please document I/O in real time in Meditech Reassess patient and document in process interventions screen of Meditech. Read and update process interventions and care plan in Meditech. Night staff completes the SIBR checklist (structured interdisciplinary bedside rounding) before 0500. Day staff participates in SIBR rounds at 0930. The charge RN will assign you an approximate time when your patients will be rounded on by the team and will call you a few minutes before rounds start. Be prepared to start on time.v Inform charge nurse of significant change in patient condition including abnormal vital signs.v Any time a patient undergoes a change in condition a rapid response call transfer to higher level of care or a fall documentation of the event in a patient note and reassessment is required. Check with the charge RN to see if a notification report should be filed.v If patient having diarrhea please follow algorithm for Cdiff testing. You must speak to the charge RN before sending stool for cdiff testing. Every time a pain med is administered a pain reassessment must be documented (30 minutes after IV meds 60 minutes after PO meds). Clear and document PCA intake q4h (or per protocol if new PCA or dose change) on PCA flowsheet. Two RNs must verify and document any change in dose/cadd and at shift change. Every pt on a PCA must be on continuous pulse ox unless there is an MD order to DC. If pt is on tele print out ECG strip from central monitor once per shift. You must be able to identify the rhythm sign RN name date time and file in pt WITH THE CHARGE RNv If you place a call to a physician ensure the charge nurse is aware so they can speak with him/her for possible other issues on the unit.v On evening shift (M-F) Edie our NP may be able to write some orders depending on the surgeon. If the patient is a teaching patient please contact them for orders. If the patient is being co-managed by a surgeon and the teaching team work with the charge RN to determine which team is handling a specific issue.v Let your charge nurse know about changes that are going on with your patient and let them know when you receive discharge orders and an approximate time they plan to leave. The charge RN also expects updates prior to making assignments for the oncoming shift around 1600 or 0400 END OF SHIFT Clear pumps and record I&O by 1800. Stock nurse servers and empty trash and linen bags. Chart Check: Verify that orders have been initiated and completed. Communicate outstanding collect by nurse labs to oncoming shift. Check for new orders throughout the shift prior to discharge and prior to transfer.