Download advanced medical-surgical nursing

Preceptor Packet
WNMU Nursing Department
Spring 2016
Rotation1
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Dear Preceptor.
Your student has been assigned for the medical surgical II rotation. Thank you for
offering your experience and time for this preceptor ship. In the following I hope to provide
some background information on what the student has covered so far, and needs to assist them in
their path to registered nurse licensure.
The goal of this rotation is for the student to increase their skills learned in the last three
semesters and progress towards being able to function independently. Task oriented skills are
needed for all listed items if possible. In this packet is a student do not do list as well as a check
off list that can serve as a reference or documentation tool.
Expectations of this clinical are that the student will manifest the ability to make
beginning clinical decisions that are based on sound judgment and knowledge. I have included
the objectives for the program that highlight our expectations as well as the clinical evaluation
tool. Professional behavior in the areas of communication, punctuality, dress, and performance
are demanded. If a problem is occurring please utilize written documentation after verbal
interaction and problem solving has ensued. Each student is assigned an instructor of record, but
both Aimee and I are available if problems occur.
Thank you and welcome to the nursing education experience
With regards,
Rachel Owen, RN, MSN
James Vigil, RN, MSN
Medical Surgical Nursing II Instructors
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Clinical Preceptor – WNUM Nursing Program
Please Fill This Out and return to Rachel Owen or James Vigil
Name - _____________________________________
Address - ___________________________________
_____________________________________
_____________________________________
Primary Area of Work in the Hospital - _______________________________________
_______________________________________________________________________
Education - _____________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Describe briefly your years of experience in nursing, areas of expertise - ____________
_______________________________________________________________________
Describe succinctly why you volunteered for the preceptor experience - _____________
_______________________________________________________________________
_______________________________________________________________________
List your primary nursing supervisor - ________________________________________
_______________________________________________________________________
Active Certifications in Nursing - ___________________________________________
_______________________________________________________________________
Signature - ______________________________________________________________
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Preceptor Check – List
1. Meet student and establish schedule
2. Fill Out Clinical Preceptor Demographic
Sheet and Turn in to Aimee/Charnelle
3. Document Student Time in and Out on
provided sheet. Keep with preceptor packet
3. Student Evaluation #1 Send to Instructor of
Record (Time approximately 3 clinical days)
Discuss with student
5. Meet with Instructor of Record to Discuss
Student Performance, troubleshoot problems
etc.,
5. Student Evaluation #3 Send to Instructor of
Record ( Last Clinical Day)
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WNMU
Med-Surg. II Nursing
Spring 2014
Professor: Rachel Owen MSN, RN
Office: School of Nursing, Office 122
Phone: 538-6960 or 538-6975 Fax: 538-6961
E-Mail:
[email protected]
Cell: 575-519-0454
Office Hours: Monday and Tuesday 0900 - 1200
Professor: James Vigil MSN, RN
Phone: 538-6960
Office: School of Nursing Room 130
Fax: 538-6961 E-Mail: [email protected]
Cell: 575-313-3841
Office Hours: Monday 1:30-4:30, Tuesday 1:30-4:30, or by appointment
ADVANCED MEDICAL-SURGICAL NURSING
The emphasis for this course will be the development of skills necessary to manage the care of a
group of patients, or the critically ill high acuity patient. A preceptor-ship experience in the
semester will help students with the transition to the work setting following graduation.
The focus of Advanced Medical-Surgical Nursing is nursing care for the client who is who is
hospitalized and in need of emergency care. There is also emphasis on management of patient
care and advanced nursing skills.
Theory content will also include concepts of triage, managing client care and time management.
Selected topics in critical care and emergency room nursing will be addressed.
Students will be expected to meet with a faculty member every two weeks to discuss learning
experiences and to review their clinical journal. Since this is a separate course, the student will
need to pass this course independently of Psychiatric Nursing.
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Clinical Rotation Guidelines
The clinical hours for Medical/Surgical Nursing 2 will total 135 hours. The first week of
classes, we will spend two clinical days reviewing skills in the nursing lab. The following
seven weeks you will be expected to complete 100 hours working with your assigned
preceptor. This amounts to 8 twelve hour shifts.
Have your preceptor sign in/out on your clinical days. This sheet must be turned in for you
to receive credit for your clinical. This will also verify your presence in the clinical setting.
Students will be expected to complete logs on 3patients during the seven week clinical portion of
the course. All logs must have 4 nursing diagnosis and four interventions.
PRECEPTORSHIP
The purpose of this course is to give the student the opportunity to work closely with another
nurse over a period of time. The student will be given the opportunity to plan and manage the
care of a group of patients. Upon completion of the preceptorship the student, under observation
and communication of the preceptor, will organize and manage the care of no less than three
patients. The student will assist in the planning of care following assessment of patients and
identification of problems. The theoretical content of this course will include the importance of
time management, establishing priorities, and efficiency. The course will also review the content
of previous courses and present principles of management. Upon successful completion of the
preceptorship, the student will be able to:
1.
Organize priorities for his/her assigned patients.
2.
Administer medications and monitor intravenous infusions competently and in a
timely fashion.
3.
Assess, plan, and implement care.
4.
Organize patient care with other members of the health team.
5.
Document care given in a clear, concise manner.
6.
Participate in the process of documenting new orders and carrying out prescribed therapy.
7.
Execute teaching interventions in collaboration with other members of the health team,
based on patient knowledge deficit(s).
8.
Organize patient care based on acuity.
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9.
10.
Delegate responsibilities to other members of the nursing team with preceptor input.
Evaluate management of time and resources.
Course Information
The following is provided for your information in order to give you an idea of what is
required of second students to pass this course, as well as a guideline of hours that the student is
required to be in class and at study sessions.
Class Time – Monday - 1200 – 1600
Tuesday -1200 – 1600
Students need to arrive for class and study session awake and alert. Working a night shift
the day before these sessions is contraindicated. Half shifts are ok but not recommended.
Students need study time and time to complete written work as well as taking care of
themselves and their families. Please do not allow anyone to ask them to work extra or stay late.
It may actually jeopardize their graduation. Take care of your student. Also please communicate
to staff working with you why students may not stay the whole shift, it is not that they are
allowed to come and go as they please, it is to improve their ability to successfully complete the
program and graduate.
Policies and Procedures for the
Preceptorship Experience
1.
Preceptors must demonstrate clinical expertise in their
clinical area. Most will have a minimum of one year of
experience beyond graduation.
2.
Students will not be assigned to clinical units where a
close relative, spouse or significant other is employed.
3.
Preceptors need to maintain contact on a weekly basis with the instructor of their
assigned student if problems occur. Early intervention for problems needs to
occur if needed.
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4.
Students may not select preceptors. Preceptors may not
select students.
5.
The assignment of preceptors is a decision made by the
faculty as a whole.
6.
Efforts will be made to accommodate student needs related
to shifts and facilities but faculty cannot guarantee that
all student requests can be accommodated.
7.
Preceptors are to be physically present on the unit when
the student is assigned to the unit.
8.
Students are not to be assigned to supervise medication
aides.
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ACTIVITIES BEYOND THE STUDENT SCOPE OF PRACTICE
DURING ANY CLINICAL EXPERIENCE
The following are activities which nursing students may not engage in during clinical.
Conduct of this nature may result in dismissal from the program.
1)
Preparation or IV administration of critical care drugs: Lidocaine, Dopamine,
Dobutamine, Bretylium, Levophed, Adenocard, Nitroglycerine, Nipride,Thrombolytics,
and chemotherapy agents. Oxytocin, Magnesium Sulfate, and Terbutaline may be given
under the direct supervision of faculty or preceptor in labor and delivery only.
2)
Witnessing consent forms, living wills and/or other legal documents.
3)
Sign out, hanging or crosschecking of blood products. Students may monitor administration
of blood products under direct supervision of a registered nurse.
4)
Operation of hemodynamic monitoring equipment (observation only).
5)
Removal of central lines and/or arterial lines, may be done under direct supervision of
WNMU instructor or preceptor with prior experience in the procedure.
6)
Removal of wound drains (may be done only under direct supervision of instructor).
7)
Operation or removal of temporary pacemakers.
8)
Removal of subcutaneous stitches only under direct supervision of instructor/preceptor .
9)
Assuming responsibility for patient’s valuables.
10) Examinations related to progression of labor (vaginal and/or rectal, as well as internal
monitoring).
11) Primary circulating or scrub nurse.
12) Nursery (no IV or medication administration without direct supervision).
13) Unsupervised charge of a unit.
14) Taking verbal or telephone orders from a physician without supervision of instructor or RN
15) Independent application of restraints
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Performance Evaluation Points
Key: 3 = Performance above level expected for first year student
(Almost flawless performance, 1 or less prompts, performed independently, competently)
2 = Performance at level expected for first year student
(Required direction expected for a novice student, 3 prompts or less in expected areas of
performance)
1 = Performance below first year level: needs improvement
(One on one supervision required from nurse preceptor to assure task done correctly)
0 = Unsatisfactory/Unsafe/Requires – Review of Performance: Conference with Preceptor,
Clinical Instructor, and Department Chair
N/A Not applicable/No opportunity at this clinical experience
Preceptor Evaluation – This is the criteria that are to be evaluated. Please evaluate your
student as they progress through the semester by these criteria. This form should be filled
out three times during the clinical experience if possible. A student who performs in the
level of 0 to 1 points for the majority of the time needs to have a meeting with the instructor
of record, preferably before the semester is over so a learning contract can be initiated.
Student Evaluation by Preceptor
Spring 2016 – MS II Rotation
1.
Organize priorities for his/her assigned patients.
Rating: (0-3)
Strengths
Weakness
Improvement Suggestions
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2.
Administer medications and monitor intravenous infusions competently and
in a timely fashion.
Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
3.
Assess, plan, and implement care utilizing the nursing process and critical
thinking.
Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
4.
Organize patient care with other members of the health team.
Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
5.
Document care given in a clear, concise manner.
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Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
6.
Participate in the process of documenting new orders and carrying out
prescribed therapy.
Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
8.
Organize patient care based on acuity.
Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
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9.
Delegate responsibilities to other members of the nursing team with
preceptor input utilizing professional behavior.
Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
10. Evaluate management of time and resources.
Rating: (0-3)
Strengths
Weaknesses
Improvement Suggestions:
Comments:
11. Professional Behavior:
Punctuality – (Scale of 0-3) 0 –never on time, 1- on time once in a while 2- on time
75% of the time 3- always on time.
Student Rating Dress – Hygiene clean, clothes pressed, hair neat, no excessive perfumes or
odors . 0 – never 1 – sometimes 2 – most of time 3 – always Student Rating Communication – Professional in tone, body posture and appropriate to time,
situation and atmosphere. Rate on a scale of (0 – 3)
Total Score
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Procedure
Vital Signs
Temperature (Oral,
Rectal, Axillary,
Tympanic
Pulse – Apical
Pulse- Peripheral
Respirations
Blood Pressure –
Ausculatory/Palpated
Arm/Leg
Verbalize and DemonStrate methods to
Pass
Rating
Fail
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Comments
Ensure accurate
Blood pressure
measurement
Physical Assessment
Neuro - Mentation
Cranial nerves 1 – 12
Reflexes – brachial,
patellar/babinski
Clonus
Respiratory-work of
breathing, identifies
abnormal respiratory
patterns, normal
rate/rhythm
Auscultates – Clear
Breath sounds,
Rhonchi, Rales,
Wheezes, Stridor
At correct lung sites
Palpates for Tactile
Fremitus, verbalizes
Its significance
Procedure
Pass
Rating
Fail
Cardiovascular
Identify – irregular
rhythm, murmur,
S1,S2, demonstrates
apical
Radial pulse deficit
Procedure
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Comments
Auscultation over
valve sites – Identifies
valve sites, uses bell
and diaphragm
Palpates peripheral
pulses – head to toe,
rates scale of 0 to 3
JVD/Edema
Homan’s Sign
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Procedure
Pass
Rating
Fail
GI-Mouth, Abdominal
Assessement,
identifies bowel
sounds-hypoactive,
hyperactiveAbsent
Normal
GU- see physical
assessment
Integument – see
physical assessment
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Comments
Procedure
Pass
Rating
Fail
Comments
Asepsis
Handwashing
Use of Clean Gloves
Sterile – surgical
handwashing, gloving,
gowning.
closed gowning and
gloving
Wet to Dry Dressing
change/clean to sterile
Set-up of sterile field
Isolation – Reverse
Respiratory
Contact
Strict
Shaving – Pre-op
Verbal demonstration
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Procedure
Medication
Administration
Physician order
implementation
Six Rights of
Medications
administration
followed
Documentation of
medications given
Oral
IM- identifies ventral
gluteal, dorsal gluteal,
vastus lateralis,
deltoid. Administers
correct volume and
med type in each site
Z-track IM injection
Subcutaneous
Insulin administration
Regular IV/SQ
NPH Verbalizes onset,
peak, duration,
correct use of
different insulins
Glucose finger stick
Pass
Rating
Fail
Sliding scale insulin
administration
S/S
hypo/hyperglycemia
Heparin
Intradermal injection
TB test/reading +/Intra-nasal
Ocular
Otic
Rectal
Inhaled medications
Sublingual
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Comments
Procedure
Intravenous
Medication
Administration
IV site initiation
Application of saline
lock
Peripheral Line
administration
Administer fluid bolus
Drip rate –
tubing/pump
Medication IV push
Medication – saline
lock
Medication IVPB
Heparin Drip – Start
per standing order
Titrate per Lab values
Administration of
Potassium IV
Calculate drug doses
correctly
Pass
Rating
Fail
IV discontinue
Narcotic
administration – sign
out/waste
Central Line –
Nursing Management
and Care
Central
Flush/Maintenance of
Peripheral IV
Nursing Management
of TPN Blood Draw From
Central Line
Peripheral Blood
Draw- Blood Draw
from Saline lock
Central Line Dressing
Change
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Comments
Procedure
NG Tube Insertion
NG tube Patency
Check
NG tube to Suction –
Nursing Management
NG tube Maintenance
NG/G-Tube feedings
Nursing Managment
NG Tube Removal –
Assessment after
removal
Foley Catheter
Insertion/Removal
Male/Female
Residual Cath
Cath for Specimen
Catheter Irrigation –
Sterile
Continuous Bladder
Irrigation
Tracheostomy
Suctioning/Care
Nasopharyngeal/oral
suctioning
Oxygen
Administration –NC,
Venti Mask, NonRebreather, BVM
Oral Pharyngeal
Airway insertion
Revised January 12, 2016
Pass
Rating
Fail
Comments
WNMU Student Time Sheet (120 hours required)
Medical Surgical Nursing II – 2014
Date
Time-In
Time-Out
Preceptor
1.
2.
3.
4.
5.
6.
7.
9.
10.
Student Name - ___________________________________
Preceptor - _______________________________________
Preceptor - _______________________________________
Preceptor - _______________________________________
General Guidelines – For students in specialty areas such as the OR, ER, SCU, please
allow them time to follow a patient to the medical-surgical floor so they can complete
their logs and their care plan. They have seven hours of time for care plan construction
built into their clinical. This type of study can be negotiated between you and your
student so that the time utilized can be the best for all involved. Thank you again for
contributing to nursing student education.
Rachel Owen, RN, MSN and James Vigil, RN, MSN.
Revised January 12, 2016