Download Emergency Room Competency - Alaska State Hospital and Nursing

RN Competency Form: Emergency Room
Competence Verification & Learning Guide: Facility
Name (learner)
Date Initiated
Unit
☐RN  ☐LPN  ☐Recent Graduate  ☐Experienced Nurse  ☐New to Specialty  ☐Traveling Nurse 
Note: for LPN practice guidelines, see state nursing statutes & regulations
The preceptor will initial each competency when he/she, as preceptor and colleague, feels safe in allowing the learner to deliver this aspect of
care without direct supervision.
Self-Assessment: 1 – Identified Limitation (little or no experience); 2 – Capable (familiar but may need assistance); 3 – Independent - can
perform these tasks safely; 4 – Proficient - extensive experience *For further information, see instruction sheet at end of this form.
References
IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following:
Follow ENA standards
Triage patients per protocols
-determine priority of care
-use tools needed to assess chief complaint
-target assessment to triage quickly
-perform required screening
-initiate established protocols
Initiate care for patient in respiratory distress or failure
-set up for emergency airway
-implement relevant protocols consistent with patient
status
Provide care for intubated patient (RN only)
-monitor tolerance (volume pressure, synchronicity and
oxygenation)
-maintain patent airway by positioning, suctioning,
checking and securing
-check ventilator setting & that mode is appropriate for
condition
-troubleshot alarms to correctly intervene
-extubate a patient safely
Integrate ABG results into care (RN only)
-interpret results correctly
-act to correct abnormalities
Initiate care of patient with cardiac emergency per
protocols/pathways
Learning Guide #
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Preceptor initials
Verification method
& facility specific requirements
Learner initials
Required Competencies
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Date all met
Self-assessment
Learning Guide follows competency pages and contains items for each competency that need to be reviewed based on learner’s experience and unit
need, they include reminders of important teaching points that may otherwise be missed.
IA 1
IA 2
IA 3
IA 4
IA 5
IA 6
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 1
References
Learning Guide #
Preceptor initials
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Learner initials
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Verification method
& facility specific requirements
Date all met
Self-assessment
Competency Form: Emergency Room
Required Competencies
Identify ischemia, injury or infarct on a 12 lead ECG
IA 7
Care for client with transcutaneous pacemaker per
policy (RN only)
-demonstrate setting rate and sensitivity and stimulation
thresholds
-identify complications
Use bedside and central monitors for all pertinent
functions
IA 8
Manage invasive lines (RN only)
-zero and calibrate
-troubleshoot waveforms
-intervene as needed
Apply interventions for sepsis as needed per policy
IA 10
Provide initial interventions for shock per protocol
IA 12
Provide initial treatment for environmental emergencies
per protocols
IA 13
Manage initial care for abdominal emergencies per
protocols
IA 14
Manage initial care of pediatric emergencies with age
specific interventions and equipment
IA 15
Integrate measures to ensure patient safety in high risk
setting
IA 16
Apply interventions for neurologic emergencies per
protocols
IA 17
Manage initial care for OB emergencies per protocols
IA 18
Manage initial care of trauma patient per protocols
IA 19
Manage initial care of patient with dental, ENT,
ophthalmic or GU emergency per protocol
IA 20
IA 9
IA 11
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 2
References
Learning Guide #
Preceptor initials
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Learner initials
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Verification method
& facility specific requirements
Date all met
Self-assessment
Competency Form: Emergency Room
Required Competencies
Ensure patient, staff & visitor safety during mental health
emergency
IA 21
Manage care of confused patient per guidelines
IA 22
Coordinate emergency response per protocols
IA 23
IA 24
IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following:
Administer IV drips (RN only)
-calculate drip rate correctly
-titrate drip per orders/need
-wean drips per protocols
IB 1
Correlate clinical condition with drug indications, desired
effects, dosage and contraindications for commonly
given high risk medications (RN only)
IB 2
Optimize patient comfort with sedation, pain control and
paralytics as indicated (IVP & PCA dose changes RN
only)
-use sedation and & pain scales correctly
-evaluate effectiveness of paralytics using peripheral
nerve stimulator
-ensure adequate sedation & pain control with paralytic
use
-administer sedation per protocols
-wean meds per pharmacy protocol, orders and patient
tolerance
IB 3
IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include:
Perform nursing role during a procedure
-set up for procedure
-provide nursing assistance during procedure
-monitor patient during and after for complications
Manage chest drainage system
-describe chambers and normals
-assess patient and system
-identify any deviations from the norm
Operate specialty equipment per manuals and policies
IC 1
IC 2
IC 3
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 3
References
Provide employee health procedures
Learning Guide #
Preceptor initials
D—Demonstrated; T—Test;
M—Module/class;
V—Verbalized
Learner initials
Main categories followed by associated competencies
and critical elements.
(Preceptor needs to verify learner capability for these items.)
Verification method
& facility specific requirements
Date all met
Self-assessment
Competency Form: Emergency Room
Required Competencies
IC 4
Section II. The learner will incorporate relevant communication skills in all interactions to include the following:
Manage patient flow
-transfer/discharge as soon as possible
-document without delay
-inform patients/families of plan/delays
-provide ongoing patient observation
II 1
Comments/alternative learning plans:
All preceptors are to sign & initial below. Ideally new graduates should have only one to two preceptors for the entire orientation.
Preceptor Signature
Initials
Preceptor Signature
Initials
Signatures at completion of preceptorship/orientation:
Preceptee/orientee
Date
Primary Preceptor
Date
Manager
Date
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 4
Competency Form: Emergency Room
LEARNER GUIDE: Reference items in right-hand column that needs review.
IA. The learner will incorporate relevant assessment & intervention (A&I) skills in delivery of care to include the following:
IA 1
Follow ENA standards
Read and Review current ENA standards
IA 2
Triage patients per protocols
Review policies and procedures related to triage
IA 3
Initiate care for patient in respiratory distress or failure
Review policies, procedures and equipment for emergency respiratory
management
Review emergency airways: ETT, cricothyrotomy, tracheostomy
For infant/peds, review equipment size differences, lung volumes, pediatric
code management
Review treatment protocols for bronchospasm, asthma, croup, hemo &
pneumothorax, COPD
IA 4
Provide Care for intubated patient (RN only)
Review ventilator and intubation protocols, equipment, standing orders, and
troubleshooting
Review initiation and indications for jet vent if applicable
Review SVO2 monitoring, set up and data analysis if done in unit.
IA 5
Integrate ABG result into care (RN only)
Review ABG norms and interpretation of changes
Complete checklist for drawing ABGs if applicable
IA 6
Initiate care of patient with cardiac emergency per
protocols/pathways
Review protocols for initial chest pain management, dysrhythmias, significant
BP change, CHF or pulmonary edema, cardiogenic shock, cardiac arrest,
code cart management, etc.
IA 7
Identify ischemia, injury or infarct on a 12 lead ECG
Review ECG interpretation
IA 8
Care for client with transcutaneous pacemaker per policy
(RN only)
Review equipment, manufacturers recommendations, safety considerations,
how to operate the pacer, pacing modes
Review complications: failure to pace, failure to sense, failure to capture,
dysrhythmias, burns & pain
IA 9
Use of bedside and central monitors for all pertinent
functions
Review setting parameters, calculating functions, changing modules and
troubleshooting.
IA 10
Manage invasive lines (RN only)
Practice with equipment
Review policies and manuals
IA 11
Apply interventions for sepsis as needed per policy
Review protocols, fever reduction methods, circulatory support including
vasoactive drips
Include infant/pediatric protocols
IA 12
Provide initial interventions for shock per protocol
Review types of shock and any standing orders, protocols, guidelines for
treatment
IA 13
Provide initial treatment for environmental emergencies
per protocols
Review procedures and initial burn management protocol, fluid replacement
protocol, wound management and transfer criteria/procedure
Review care of hypothermia, frostbite and chemical burns
IA 14
Manage initial care for abdominal emergencies per
protocols
Review sources of abdominal pain and injuries, mobilizing the surgical team
and other protocols
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 5
Competency Form: Emergency Room
LEARNER GUIDE: Reference items in right-hand column that needs review.
IA 15 Manage initial care of pediatric emergencies with age
Review age specific equipment, interventions, communication techniques and
specific interventions and equipment
family care
IA 16
Integrate measures to ensure patient safety in high risk
setting
Review visitor policy/teaching, equipment safety, spinal precautions (collar fit,
back boards, alignment, turning & transferring), domestic violence screening
and sexual assault protocol
IA 17
Apply interventions for neurologic emergencies per
protocols
Review pathophysiology and treatment of CVA, subarachnoid,
subdural/epidural hemorrhage, trauma damage and swelling, HA evaluation,
dementia, seizure, spinal cord injury
Review radiology and neurology resources
Review coma scale & interventions
Review policies and guidelines
IA 18
Manage initial care for OB emergencies per protocols
Review identification and treatment of PIH, abruption placentae, precipitous
childbirth, bleeding, ectopic pregnancy, pain, and other pregnancy related
complications
Review how to obtain fetal heart tones and norms
IA 19
Manage initial care of trauma patient per protocols
Review protocols for trauma management, rewarming, forensics, trauma scale,
orthopedic, bites
IA 20
Manage initial care of patient with dental, ENT,
ophthalmic or GU emergency per protocol
Review policies and protocols, contacting specialists
Review most common injuries in the area: nose bleed, acute peritonsillar
abscess, ARP, testicular torsion, ocular injury
IA 21
Review protocols for managing violent and suicidal behaviors
IA 22
Ensure patient, staff & visitor safety during mental health
emergency
Manage care of confused patient per guidelines
IA 23
Coordinate emergency response per protocols
Review policy and role in emergency response throughout hospital, for local
disaster and trauma response
Review s/s electrolyte imbalance, fever, medication side effects and dementia
Review safety protocols
IB. The learner will incorporate relevant A & I skills in delivery of medications, IV’s & blood to include the following:
IB 1
Administer IV drips (RN only)
Review all related policies, protocols and standing orders for commonly used
IV drips
IB 2
Correlate clinical condition with drug indications, desired
effects, dosage and contraindications for commonly
given high risk medications (RN only)
Review the following medications: dopamine, dobutamine, norepinephrine,
epinephrine, nitroglycerine, nitroprusside, diltiazem, lidocaine, amiodarone,
thrombolytics, procainamide, potassium, aminophylline, heparin, insulin,
octreotide, TPA, and others as applicable
IB 3
Optimize patient comfort with sedation, pain control and
paralytics as indicated (IVP & PCA dose changes RN
only)
Review sedation and pain scales and interventions
Review use of and interpretation of results from peripheral nerve stimulator
Review policy for moderate sedation and complete any facility required training
and/or checklists
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 6
Competency Form: Emergency Room
IC. The learner will incorporate relevant A & I skills in performing procedures & utilizing equipment to include:
IC 1
Perform nursing role during a procedure
Review procedure, equipment &risks of: thoracotomy, thoracentesis,
pericardiocentesis, gastric/peritoneal lavage, suturing, casting, vaginal
exams, lumbar puncture including pediatrics, central line insertion, arterial
line insertion/monitoring, Sengstaken-Blackmore tube, Cardioversion,
external pacing, endoscopy
IC 2
Manage chest drainage system
Review P & P (include auto transfusion)
Talk through drainage system with preceptor – simulate if have no patients with
chest tubes.
IC 3
Operate specialty equipment per manuals and polices
Review manuals and facility policy for fluid/blood warmer, rapid transfuser,
hypo/hyperthermia blanket, adult traction and other splints, sizing and
teaching re: crutch use, crash carts, emergency kits/packs, etc.
IC 4
Provide employee health procedures
Review employee injury and other employee health protocols
Section II. The learner will incorporate relevant communication skills in all interactions to include the following:
II 1
Manage patient flow
Review room assignment and flow pattern, triage system, transfer guidelines,
traffic control
Other facility specific items to cover:
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 7
Competency Form: Emergency Room
REQUIREMENTS: All nurses will complete these competencies upon hire. Some competencies may be reviewed annually. This form
follows the Competency Outcomes and Performance Assessment (COPA) model.
PRECEPTEE/LEARNER INSTRUCTIONS:
Complete self-assessment: Rate your skill in each area to identify the areas where you need additional experience, access to
teaching resources, and/or lab practice. Discuss your results with your preceptor to help establish a plan and goals for your learning
experience and to aid in choosing patient assignments. Scoring per instructions at the top of page 1.
PRECEPTOR INSTRUCTIONS:
A. Review self-assessment with preceptee/learner to establish plan.
B. Required Competencies: The specialty area competency forms are required for independent practice on this unit. This column
represents the Alaska Statewide required competencies per ACE-HC and should not be altered. The preceptor will sign each one off
when he/she, as preceptor and colleague, feels safe in allowing the preceptee/learner to deliver this aspect of care without
direct supervision.
C. Verification Method & Agency Specific. Document comments/check marks for the competency and any agency specific
requirements. Verification methods include:
1. Demonstration – Preceptor watches learner perform task/procedure in safe, capable manner in a simulated lab or computer
setting or as part of direct care performance. The expectation for new graduates is that they demonstrate as many of the
competencies as possible.
2. Test – Learner passes a test provided by the facility to measure competence for this skill. (Minimum passing grade indicated.
Initial only after test passed.)
3. Module –Learner has completed a training tool (computerized or written module, class, video, etc.) provided by the facility to
measure competence for this skill.
4. Verbalization - Learner explains to the preceptor the process and/or planning that evidences safe, reliable knowledge base.
This may include case scenarios, discussion, and/or description of plan.
NOTE: some competencies may have the verification method specified per facility guidelines (e.g. “test only”)
Record N/A and initials only for items that never apply to this learner’s role or performance.
D. Sign-off: Sign and date when all elements of the competency are met. If unable to sign off an area due to patient population issues
or learner needs more time, document a plan in the comments section at the end of the form. Discuss alternative ways of meeting
the requirement(s) as well as any additional time needed with the nurse manager and/or nurse educator. All preceptors assisting in
orientation of a new staff member/intern must sign and initial in the signature chart at the end of this document.
E. References: Competencies should be met in accordance with these. Add your facility approved references here.
F. Learning Guide: These are memory ticklers. The amount of time spent on each of them depends on the learner’s experience. New
graduates will likely need time on almost all of the areas listed.
REFERENCES COLUMN: List foundational documents to support the learning experience and to use as the official measure by which
the competencies are assessed. The ACE-HC group recognizes the following as sources for evidence based practice that can be
included in the reference list along with local policies, procedures and forms: Perry & Potter, Elsevier/Mosby, Lippincott, Kozier & Erb,
ANA, nationally recognized hospital related regulatory organizations (CLIA, CDC, CMS, JC, etc.), and specialty nursing organizations’
scope, standards and core curricula. This column’s content may be changed to be facility specific.
NOTE: ACE-HC competency forms are intended to be used between facilities within Alaska.
Form based on Dr. Carrie Lenburg’s “Competency Outcomes & Performance Assessment” model.
Copyright © May, 2008. Updated May, 2012. Alaska Coalition of Educators—Health Care. All rights reserved.
Page 8