Mad River Community Hospital (MRCH)

Student Nurse Orientation

WELCOME!!!

Note: With the following information, much of which contains MRCH policy, students should assume that any references to employees or staff include students as well. Again, Welcome!

Revised August 2019

Our Vision

• WE ARE Mad River Community Hospital.

• OUR QUEST is to become California’s leading and most innovative community health center.

• WE COMMIT to providing excellent care to patients.

• WE PLEDGE to always respect and care for those who choose us for wellness health care, employment, or as a place to practice the art and science of medicine.

Mission Statement and Standards of Excellence

• The patient is our first concern. We will do everything in our power to exceed the expectations of our patients and our community through quality care services, attention to detail, honest communication, and positive attitude. . . .

• All MRCH team members are expected to help fulfill our mission.

~ A Hospital with ~• Medical Services• Surgical Services,

inpatient, outpatient• OB Services• ED Services• ICU with extended consultation• Pediatric Services• Lab, Xray, Cardiopulmonary (RT), other

~ More Than a Hospital ~

* Mad River Community Hospital has a full network of health services:• Adult Day Health Care of Mad River• Center for Wound Care and Hyperbaric Medicine (only

wound care center on North Coast).• Home Health Services of Mad River (largest in three-

county region)• Primary Care Clinics:Humboldt Family Medical Care – McKinleyvilleSix Rivers Medical Center – Willow Creek Mad River Healthcare Clinic – at MRCH• Mad River Rehab and Sports Medicine• Occupational Health Services of Mad River• Women’s Health Center• Endoscopy/GI Suites

MRCH Staff/Student Parking During the Day(All staff parking limitations and opportunities also apply to students.)

Parking at Mad River Community Hospital is limited. For this reason, it is critical that staff not park in patient or physician parking spaces. The primary areas that staff need to avoid are the Emergency Room parking lot and the lot south of the physician office suites.

Acceptable daytime staff parking areas:• The large paved lot in the southeast corner behind the hangar (by the

Business Office)• Gravel lots (e.g., at northwest and southeast corners of the grounds)• The last three rows of the large west paved lot

• Always park to accommodate patients getting into the hospital. Do notpark in ER, MD, patient, lab, or disabled spaces.

• Also never move cones, as they are used to block off important areas, such as areas for helicopter landing – it is dangerous to drive by a working helicopter.

Excerpts (with slight edits) from MRCH cell phone policy

• All non-emergent personal calls/communications should be limited to breaks and meal periods only and are prohibited in any patient care area.

• Hospital business-related use of personal Cell Phone, Bluetooth, and other Multi Media devices, including text messaging, blue tooth communication devices, etc., shall be restricted for care and business purposes only.

• Due to HIPAA and confidentiality concerns, under no circumstances may a camera be operated within the facilities or while on duty without prior administrative approval.

• Texting of hospital or work related information should not occur.

As a student, what are you responsible for during clinicals?

• Reporting to the clinical assignment at the designated time, and receiving your assignment.

• Reporting information relative to the patient’s plan of care and student’s educational experience to the clinical instructor and staff assigned to the patient.

• Communicating with the appropriate staff in order to coordinate care.

As a student, what are you responsible for during clinicals?

• Informing the instructor or staff if you feel unable or unsafe to provide a care measure.

• Contributing to the care planning process and documenting in the appropriate interdisciplinary care records according to standards.

As a student, what are you responsible for during clinicals?

• Conducting care, treatments, assessments, and documentation according to published standards of the academic institution and the hospital.

• Protecting the rights of the patient according to standards, including confidentiality, privacy, respect, and dignity; and requesting patient’s permission for the student to participate in the patient’s care.

Students may NOT perform the following:

• Administer chemotherapeutic agents• Prepare and/or administer medications in emergent

situations• Access/administer narcotics independently• Carry narcotic keys• Conduct point of care testing

• Urine dipstick • Nitrazine paper• Occult blood and whole blood glucose testing*

*Once glucometer competency training is complete, student will be able to perform BG testing.

Students may NOT perform the following:• Participate in emergency response for cardiac and respiratory

arrest (may observe with instructor permission)

• Pick up blood from the Lab

• Apply restraints (A little about restraints: Patients have the right to be free from restraint and seclusion. When necessary, restraints are an intervention for the protection of the staff, patient, or others from harm. The restraint must be the least restrictive intervention effective for such protection.)

• Provide care to the following patient populations:• Patients who are inmates• Patients in respiratory isolation requiring

individually fitted masks (usually airborne isolation)• Patients with radiation implants

Students may NOT sign or complete the following:

• Patient Belonging Sheet• Labor Record• Blood Transfusion Record• Record of Death• Code Blue Record• Leaving Against Medical Advice• TPA Checklist• Transfer Forms• Intra-operative Record• Discharge Instruction Sheet

(This and prior slides re student roles/responsibilities primarily contains information from MRCH “Health Occupation Students” policy, which includes additional information and can be accessed on the MRCH intranet.)

PATIENT RIGHTS

The following is excerpted from the MRCHPatient Rights and Responsibilities Policy:

Patients have the right to –• Have family members and providers notified about their admission.• Know names of licensed staff caring for them.• Make decisions about their care.• Reasonable responses to reasonable requests for service.• Appropriate assessment and management of pain as effectively as

possible.• Designate visitors (though the facility can place reasonable restrictions

on visitation).• Reasonable continuity of care, and information about reasons for

transfers and options following discharge.

If you have questions about patient rights or the MRCH Visitation Policy, ASK your instructor/preceptor/manager/House Supervisor/etc.

INFECTION CONTROL -- IMPORTANT!The most effective step to PREVENT the TRANSMISSION OF INFECTION from one person to another

is HAND HYGIENE.

~ You can isolate a patient and wear your PPE, but if you DON’T CLEAN YOUR HANDS you will carry the infection to all the patients and surfaces you touch.

Hand Hygiene at MRCH• Hand washing with soap and water:

• Use soap & water + friction

NOTE: Hand washing is NOT hand wetting – wash long and hard enough (15-20 seconds, the time it usually takes to sing the “Happy Birthday” song twice).

• Hand hygiene with alcohol gel:• Exceptions for use (so use soap and water instead):

• Physical debris or protein matter on hands• Infectious agent with spores (e.g., C. diff.) and certain other

infectious agents such as Norovirus

NOTE: Apply gel to palm of one hand (about dime-sized); rub hands together covering all surfaces until dry.

GLOVES – Most commonly used PPEGloves do NOT make you impervious: After removing, immediately perform hand hygiene.

FYI, one of the videos about how to remove gloves:https://www.youtube.com/watch?v=S4gyNAsPCbU

More about gloves: Even when gloves are removed correctly, some microbes are on skin, perhaps from tiny holes or tears in gloves, or from BACK SPRAY.

Also, don’t forget those many surfaces or pieces or equipment you may have touched between patients. So do hand hygiene when entering and leaving all patient rooms.

Emergency Hospital Codes

Your Role in Any CodeStudents can call any code in an emergent situation, but may not participate past the initial response.

There will be more about specific codes during your MRCH face-to-face orientation.

The following explains how to call codes and also covers Code Red (fire).

To Call Any Code: Emergency Phone System

• Dial 3911 - Between the hours of 0700-2300- State the type of code and

specific location. - Repeat, and briefly ensure the

operator has understood your call.• Dial 55 - Between 2300-0700

- You will be “live” on the overhead system.

- Listen for 3 beeps. State type of code and specific location. Repeat, pause, and repeat again (soit’s said on the overhead 3 times).

(Note: If you need to reach the switchboard for a non emergency, please dial 0.)

Fire Safety & Prevention

• Prevent fires from starting.

And in a Code Red:• Protect patients from fire.• Stop the spread of fire.

Your Role in Fire and Electrical/Equipment Safety• Handle all flammables, electrical equipment, and medical devices correctly

and safely.

• Recognize specific fire hazards such as oxygen tents, inhalation agents, and flammables, and take necessary precautions (e.g., keep alcohol hand gels away from ignition sources).

• Never leave trash or supplies laying around in hallways (potential “kindling”). And for rapid egress, keep corridors clear!

• Never block fire doors, exits, fire extinguishers, or hoses.

• Whenever you go to a new place to work, locate the nearest fire extinguisher(s) and nearest fire alarm pull box, and make sure you know how to get the fire extinguisher off its wall bracket. Also, locate the closest exits.

Do not use defective/damaged equipment. Report any equipment problem immediately (to your instructor, preceptor, etc.): e.g., damaged or missing external parts; frayed cords; broken, bent, or 2-pronged plugs; or overheated electrical equipment; observe indicator lights, displays, and alarm indicators.

Fire Safety – Code Red(And please check with your instructor about your role in a real Code Red)

R Remove all persons in danger

A Activate Alarm- Page by calling 3911 (day) or 55 (night)- Pull the fire alarm- Students are usually allowed to call codes

C Confine the Fire - Close doors and windows to help keep fire and

smoke from spreading

E Extinguish the Fire (if manageable)- Attempt to put out only if small - If not, evacuate the area!

Operating a Fire ExtinguisherP Pull the pin (and perhaps

break the tie, which is securing the pin so it isn’t pulled out accidentally)

A Aim hose at base of fire

S Squeeze the handle (pulling the pin enables you to squeeze the handle – the pin is a block)

S Sweep from side to side at the base of the fire

Patient Confidentiality

• HIPAA: Health Insurance Portability and Accountability Act.• HIPAA Privacy Rule: Ensures patients’ personal medical information is

protected (“Protected Health Information”).• With one exception, protected health information can only be

disclosed with prior patient authorization (e.g., signed release of information [ROI] form).

• Do not discuss a patient’s PHI in public areas such as the cafeteria. If they have PHI, do not leave papers out or computer screens unlocked after you walk away. If papers include PHI, throw away in shredder containers.

• If visitors request information about a patient, refer them to the charge nurse.

HIPAA was passed in 1996. (Per DHHS: “Under the patchwork of laws existing prior to adoption of HIPAA . . ., personal health information could be distributed—without either notice or authorization—for reasons that had nothing to do with a patient's medical treatment or health care reimbursement.”)

Protected Health Information (PHI) is any health information that can be tied to an individual.

E.g.: diagnosis, treatment, and prescription, etc., information; payment information or history; anddemographic information such as name, birth date, contact information, and identification numbers.

• PHI cannot be shared without authorization from the patient, except for treatment, payment, or health-care operations (TPO) purposes (and this exception can be important – for example, to ensure timely, optimal treatment). (If PHI is shared for TPO purposes, the information shared should be the minimum amount necessary to accomplish the purpose.)

• HIPAA is important, and penalties for violations are significant.

• If you are uncertain or have questions, ASK your instructor, preceptor, etc. (And be aware that hospital health information management/medical records staff often have a great deal of HIPAA expertise).

IT SecuritySome MRCH key points about IT security follow. Also, if you have questions about the appropriate use of IT, please ask.

• Internet access is intended for job function only.

• Access to a website or ability to download a program does NOT infer acceptable use.

• Do not use thumb drives brought from school or home on MRCH computers.

• Safeguard user names and passwords.

• Please immediately report suspected security risks (e.g., unusual computer behavior). Thank you!

MRCH Quality Assurance and Performance Improvement (QAPI)

Why care about QAPI?Because the patient really is our first concern. Quality care, best practices, and patient safety are important.

Who is involved with QAPI?• Regulatory Agencies• ALL MRCH Units and Staff• Etc.

What is involved?• Policies, including the Risk Management Plan• Occurrence Reports (filled out for events adversely affecting Hospital

operation, staff safety, or visitor/patient safety and satisfaction)• Improvement Processes• And More

Required Standards and Regulatory Bodies

MRCH carefully complies with over 2000 standards at all times.

We report to more than 50 agencies over a three-year time span.

Some of these key agencies:

• CMS (Centers for Medicare and Medicaid Services) (in part, determines whether a hospital gets reimbursed for Medicare patient services -- and provides increased reimbursement for high performance)

• HFAP (Hospital Facilities Accreditation Program) (does periodic on-site surveys)

• NHSN (National Healthcare Safety Network) (managed by the CDC)

• CDPH (California Department of Public Health) (in part, investigates complaints)

• OSHPD (California Office of Statewide Health Planning and Development)

• OSHA (Occupational Safety and Health Administration) (worker safety)

Cultural Awareness

Why learn about cultural awareness?

What Is Cultural Awareness?

• Considering every patient’s culture when giving care.

• Treating every patient, family member, visitor, and co-worker as an individual.

Cultural Awareness• Helps patients receive more effective and

personal care.• Meets expectations of regulatory agencies.• Improves your job performance and your job

satisfaction – it’s interesting.

What are some of the culturally influenced items that could come up in a health care setting –

for patients, for staff? Awareness

Some culturally influenced items:

• Preferred language and communication style (MRCH interpreter services are available, sometimes on-site or via LanguageLine Solutions)

• Family and community relationships (e.g., how many visitors to have when in hospital; who are decision makers)

• Different practices (Religions – Holidays - Spiritual life)

• Food limitations/preferences and foods to eat when ill

• Different views of modesty

• Different views of health, including reasons for illness and best treatments

• Other?

Three Steps Toward Greater Cultural Awareness

• Know Thyself. Understand how your own culture influenced your beliefs about health care items.

• Treat each person as an individual, no matter what you may know about aspects of their culture. And remember there are various views in all cultures

• You can’t expect to know everything about all cultures, but if you come from a place of RESPECT you will come to know more than you did.

• Ask the person/people involved what they prefer. Listen. Follow through (which does not always mean we can fulfill a request, but at least we need to let the patient know we tried).

Cultural awareness: You have help onlineHigh-quality online resources provide education about cultural competence, both as a general topic and as related to specific groups.• "Think Cultural Health" offers several options for free continuing

education credit, https://www.thinkculturalhealth.hhs.gov/education.Web sites:• EthnoMed is a web site containing information about cultural beliefs,

medical issues, and other related issues pertinent to the health care of recent immigrants, http://ethnomed.org/.

• Culture Clues are one-page tip sheets that offer insight into the health care preferences and perceptions of patients from different cultures and special needs groups (including the deaf and hard-of-hearing). The web site also covers end-of-life issues, http://depts.washington.edu/pfes/CultureClues.htm.

• The Culture, Language, and Health Literacy web site provides an exhaustive list of resources regarding cultural competence issues for specific ethnicities, religions, and special populations, https://www.hrsa.gov/cultural-competence/index.html.

Above from U.S. Department of Health and Human Services, “Health Literacy Universal Precautions Toolkit, 2nd Edition.”

BACK/NECK CARE

BODY MECHANICS and LIFTING TECHNIQUES

A Healthy Back• Composed of 24 movable bones called vertebrae• Disks act like cushions• Muscles and ligaments

support the back• Injury or disease in any of these areas =

Pain and possibly movement issues

Think ahead: What are your potential work stresses on your back/neck/shoulders/other areas? What can you do to help relieve some of this stress?

Preventive Back Care

• Always warm up (e.g., stretch), especially before lifting.

• Stretch to improve flexibility.

• Exercise the muscles that support your back (core).

• Posture is important, both in standing and sitting (for instance at work stations). Ears above shoulders and shoulders above hips; joints in natural alignment.

Safe Lifting Tips -- PLAN AHEAD

• If too bulky, heavy, or awkward, get help(mechanics or people).

• Avoid lifts that require stretching or bending to reach the load. Redesign the work area so objects you lift are close to the body and at about waist height.

• Be aware of trip or slip hazards.

* Excerpted with edits from OSHA information.

SAFE LIFTING TIPS, continued

• Lift slowly and carefully and don’t jerk the load around

• Keep your back straight• Lift with bent knees• Keep items close to body (in your “power zone”

– see next slide)• Do NOT twist: Bending and Twisting at the

same time as lifting = Injury• Push, don’t pull

POWER ZONE

The power zone for lifting is close to the body, between mid-thigh and mid-chest height. Comparable to the strike zone in baseball, this zone is where arms and back can lift the most with the least amount of effort.

SAFE WORKSTATION Goal:

A comfortable working posture in which your joints are naturally aligned.

This is increasingly becoming a key issue as we spend time at our computers.

(https://www.osha.gov/SLTC/etools/computerworkstations/)

Safe Workstation Tips (along with natural alignment of joints)

Working in the same posture or sitting still for prolonged periods is not healthy.

You should change your working position frequently throughout the day, for example in the following ways:

Stretch your fingers, hands, arms, torso, etc. Do you have stretches you’d recommend – share them with your colleagues.

Stand up and walk around for a few minutes periodically.

Employee Safety

• Fitness for Duty: Mad River Community Hospital maintains a strong commitment to provide a safe, efficient, and productive work environment. As part of this, MRCH must have a drug- and alcohol-free work environment in order to protect the health and safety of employees and patients. (“Fitness for Duty” MRCH policy)

• Also, Tobacco use, or smoking of any substance, is not allowed within any hospital and clinic buildings -- or interior patios, near building entrances or windows, sidewalks, grounds, or parking lots. This restriction also applies to private autos parked on premises. (There is one exception, in the designated smoking area, which is close to the sidewalk that leads to Staff Development.)

Employee Safety• Harassment and Discrimination Prohibition: Mad River Community Hospital does

not tolerate discrimination or harassment. Any form of harassment on the basis of real or perceived race, religion, age, sex, sexual orientation, gender identity, gender expression, genetic information, national origin, marital status, registered domestic partner status, medical condition, physical or mental disability, military service, pregnancy, childbirth, or any other classification protected by federal, state, or local laws is a violation of this policy. (“Harassment, Sexual Harassment, Discrimination, and Non-Retaliation” MRCH policy)

• If you feel you are experiencing harassment, notify your instructor, preceptor, nurse manager, or others IMMEDIATELY.

• Injury and Illness Prevention Program: Mad River Community Hospital is firmly committed to maintaining a safe and healthful working environment. All employees are responsible for such safety -- and have the responsibility to immediately report any unsafe condition or hazard (with no fear of discipline for such reporting). (“Injury and Illness Prevention Program” MRCH policy)

• If you are injured while at work, immediately report the injury to your instructor/preceptor/nurse manager. ***If it is a Sharps Injury, Body Substance Exposure, or an Emergency, you may be asked to go to the Emergency Department.***

Employee and Patient Safety -- Influenza

Humboldt County DHHS policy: ALL health care workers in patient care areas within acute and long term care facilities must receive the influenza vaccine or must wear a standard surgical mask during influenza season when in patient care areas.

MRCH policy: All Mad River Community Hospital (MRCH) employees must receive the seasonal influenza vaccination through Employee Health or complete and submit an Attestation/Declination Form.

All MRCH employees who do not receive the seasonal influenza vaccination must wear a surgical mask within six feet of a patient in patient care areas.

(Above should apply to students as well.)

Maintaining a Secure Environment What is the easiest method for you to help maintain a secure environment at MRCH?

WEAR YOUR ID BADGE AT ALL TIMES WHEN ON DUTY AT THE HOSPITAL –

Above the Waist

And colleagues should be wearing their badges too.

Maintaining a Secure EnvironmentFor an agitated person, be respectful but ensure your safety by keeping clear access to an exit and a safe position/distance.

• Important: Do not handle tense situations alone!!! Immediately get help from others,

including your instructor/preceptor/etc.

• An appropriate security code may be called, such as “Dr. Strong” or “Code Gray.”

(Dr. Strong calls for more people to proceed to the area; Code Gray indicates a person who is becoming violent

with actions such as hitting and kicking; Code Silver is a person threatening with a weapon.

These will be discussed more in the face-to-face orientation.)

Disruptive Behavior: Improper conduct that interferes with patient care or a safe working environment. It may include physical or verbal abuse.

Please fully read the “Disruptive Behavior Guidelines – Assessment, Intervention and Documentation Procedures” MRCH policy, which is on the MRCH intranet filed under “Work Place Violence Education.” This will be available at the face-to-face orientation.

Excerpts from this policy:

• Notify your instructor/preceptor/lead/manager of the behavior.• Maintain professionalism and use de-escalation techniques

(e.g., active listening, empathy, setting limits, using pauses, non-challenging body language).

• Leave/walk away if the patient becomes verbally abusive or threatening. • Do NOT deny a patient’s basic needs or use corporal punishment or

fear-eliciting techniques. • Thoroughly document.

IF THE PATIENT’S BEHAVIOR POSES RISK OF VIOLENCE OR THREATENS INTEGRITY OF THE ENVIRONMENT OF CARE, IMPLEMENT A DR. STRONG CODE, which will be discussed more when at MRCH.

HAZMAT SAFETYWhat are hazardous materials (hazmat)?

Some say it’s everything you can’t eat.

• Solvents• Bug spray• Contaminated linens• Sharps• pharmaceuticals

• Concentrated materials• Soaps• Disinfectants• Cleaners• Viricides• Machine oils

Safety is Priority # 1.

YouYour coworkers

Your patients Your family

“Duties & Responsibilities for a Safe Environment”

• Per OSHA, you have the RIGHT to know what hazards are present.• Per MRCH policy 21, you have the RESPONSIBILITY to know what you use and

how to use it .

• Each Mad River Community Hospital employee should USE MATERIALS SAFELY (in part, by being in accordance with manufacturer directions).

• Each MRCH employee needs to use personal protective equipment (PPE) whenever needed.

• Each MRCH employee should report hazardous material spills, accidents, misuse, orother safety hazards promptly.

• MRCH employees must ensure all materials are stored in properly labeled containers.

The above should apply to students as well.

Hazmat Information –Where to get it…

1. Your instructor/preceptor/manager/House Supervisor/Plant Operations/MSDS data base (please see below about MSDS data base)

2. MRCH Intranet (which will be discussed in person) for

(a) policies and procedures;(b) Safety Data Sheets (on the MSDS data base) about individual hazmats in

the hospital environment.

Written by manufacturers, distributors, or importers of potentially hazardous chemical products, Safety Data Sheets contain information about specific products. They address items such as the PPE to wear, how to clean up spills, what to do if exposures occur, etc. Note: If you look up an item on the MSDS data base, you need to enter and spell it correctly – so if it says “no result,” try again. Also, once you have accessed the right item, look at the pdf.

Waste Management

Disposal of Waste

Clear Bags (regular garbage): Waste material soiled(but not saturated) (e.g., a band aid with a drop of blood); Dry, non-confidential waste. (Put confidential waste in shredding containers.)

Biohazard Bags: Waste material saturated with blood or bodily fluids. (And if tying, be sure to tie securely – i.e., do NOT use the “bunny ears” tie, because it can come undone too easily.)

Pharmaceutical Waste: Use pharmaceutical containers for any medications other than those that only contain sugar, salt, electrolytes. With these limited exceptions, Do not dispose of pharmaceutical waste down the sink.

Disposal of WasteSharps• Sharps containers are for all things sharp

(acute edge that could cut).

• Sharp items include needles, scalpels, lancets, syringes, ampules.

• Sharp items are still considered sharp even if the needle has been removed (i.e., syringe).

• Sharps containers are not for tape, cotton balls or random garbage.

• Note: One cause of needle-stick injuries is use of a too-full sharps container. Do NOT try to dispose of sharps in a full or nearly full container. Sharps containers should be disposed of properly once they are ¾ full.

What is wrong with this picture?

And if you do not know what to do with a hazardous material or waste, ASK –

your instructor, preceptor, unit manager, etc.

Thank you for reviewing the MRCH Student Nurse Orientation

Please complete the post test (“Student Online Orientation Post-test”), and

bring it with you on the first day of your in-person hospital orientation.

We welcome you to our hospital team!