Nursing orientation checklist - Wheaton Franciscan Healthcare

FACILITY AGENCY NURSE WORKED:
NAME
TITLE
WFH-CMC
WFH-MH
WFH- SMH
WFH-Clinic
AGENCY RN/LPN
ORIENTATION CHECKLIST
HR OFFICE:
LICENSE VERIFIED YES NO
CPR EXPIRATION DATE
A. Self-Study
Print this form and Review orientation materials prior to starting work and submit to the HR Department (See Part B).
Once paperwork is submitted to the HR Dept., a name badge can be issued.
= REVIEWED NA = NOT APPLICABLE
Complete self-study items below
Reviewed Online Orientation Materials:
Contract and Allied Health Staff Orientation
• Organizational Overview
• Mission, Vision, Values
• Service Excellence
• Corporate Compliance
• Ethics
• Gratuities
• Diversity and Cultural Competence
• Team Dynamics
• Patient safety
• Falls Prevention
• Occurrence reports
• Risk Management
• Safety and Security
• Harassment/Violence in the Workplace
• Smoking Regulations
• Alcohol and Controlled Substances
• Dress Code / I.D. Badge
• EMTALA
• Patient’s/Resident’s Rights
• Pain Management
• Infection Control
• Emergency Medical Services
• Abuse, Neglect, and Exploitation
• Caregiver Misconduct
Ethical and Religious Directives
Facility/Parking information
Confidentiality (print & sign statement)
HIPAA
Expectations for the Journey (print & sign)
OSHA/Safety Training:
Review Online Materials:
Fire & Evacuation Plan
Disaster Plan
Bomb / Explosive Devices Plan
Riot and/or Civil Disturbance
Infant / Child Abduction
Utilities Failure
MSDS On-line (acute care)
Electronic Health Record (E.H.R.)
Review/complete pre-work for appropriate
E.H.R. applications
Online Orientation Materials
Unacceptable Abbreviations List
Falls Prevention PowerPoint
Pain Management PowerPoint
National Patient safety Goals PowerPoint
Abuse, Neglect, and Exploitation
Medication Management
Hazardous Meds List
Time-sensitive Meds List
IV Rate Chart
IV Site Care
Occurrence Report PowerPoint
Physician Portal Quick Reference Sheet
Micromedix Tip sheet
Caregiver Misconduct
Complete and bring
all items listed below to class
Signature Sheets:
Confidentiality agreement
Expectations for the Journey
B. Complete Department Orientation with the Manager or designee of the unit you will be working.
= REVIEWED NA = NOT APPLICABLE
Orientation Items Covered
Overview:
Expectations for the Journey (Collect
signature sheet)
Advance Directives (Federal Law)
System Overview of RN responsibilities
Dress Code/ID Badge
Shift-to-shift report
Electronic Health Record Applications as
appropriate
Documentation system for:
CMC MH SMH Clinic
Patient Care Assessment
Standards/Structured Care Methodologies
Outcomes: Protocols and Pathways
Charging Procedure
Care of the Deceased
Medication Policy and Procedure/Medication
Reconciliation
ADU/Diebold (Medication Dispensing Unit)
ADU/Diebold Tip Sheet Given
Documentation of controlled substances
and discrepancies
MAR Overview
Equipment, policies, and procedures:
Restraints Return demonstrations of
application and quick release knot
Restraint Tip Sheet Given
Special Care Companion Role (sitter)
Glucometer competency
Return demonstration
PCA Pump Return demonstration
Code Cart Review
IV pump IV Therapy Policy and Procedure
Blood Administration Policy and Procedure
Enteral feeding pump
Computer System
Cerner
Physician Portal Quick Reference Sheet
Reviewed
Micromedix Tip sheet Reviewed
Verification
1. This Agency RN/LPN has completed all orientation requirements.
____________________________ __________ ________________________
Agency RN/LPN Signature Date Orientator Signature
Signature sheets collected:
Confidentiality agreement
Expectations for the Journey
Anti-harassment form
Parking Permit
Evaluation Process Reviewed:
Initial Clinical Orientation and Evaluation
Form Given

Directions:
After completing Part B, turn in this form to the HR Department. The HR Department will distribute copies, along with
signature sheets to the agency and to any Wheaton Franciscan Healthcare site where agency RN/LPN will be working.
C. The Agency RN/LPN Unit Orientation and Competency Form is to be completed the first shift scheduled at
a Wheaton Franciscan Healthcare facility
1. Previous completion of Parts A and B must be verified by HR when an agency RN/LPN is scheduled to work for the
first time at a Wheaton Franciscan Healthcare facility.
2. The agency RN/LPN should arrive 1/2 hour early for the first shift and, with the charge RN or designee, complete the
Unit Orientation Checklist. (See Agency RN/LPN Unit Orientation and Competency Form.)
3. During the shift, the RN/LPN should be signed off on the Core Clinical Competencies. (Patient Care Supervisor,
Charge RN, or designated RN/LPN to sign off the competencies.)
4. Patient Care Supervisor, Charge Nurse, or Manager to interoffice completed form to the HR Department:
5. HR Department to file and distribute copies to the agency and to any Wheaton Franciscan Healthcare site where
agency RN/LPN will be working.