11.3 Describe the orientation and continuing education developed for clinicians, administrators and other nursing role specialties at all levels of the organization. Orientation Orientation at Mass General Hospital (MGH) is a multi-pronged process designed to provide all employees with the knowledge required to navigate through their initial period of entry into the organization. The process includes New Employee Orientation, Central Department of Nursing Orientation and Unit and/or Role Specific Orientation. •
New Employee Orientation This 1.5 day mandatory orientation to the Hospital is meant to introduce the new employee to the major topics of concern for all members of the MGH community. Organized by the Human Resources (HR) Department, presentations include information on Police and Security; HR Policies and Procedures; available benefits; HIPAA training; and customer service training (attachment 11.3.a).
•
Central Department of Nursing Orientation The Norman Knight Nursing Center for Clinical & Professional Development (Norman Knight Nursing Center) staff welcome all new employees to the Department of Nursing (DON). Building the foundation for practice, The Norman Knight Nursing Center orientation team, in partnership with leadership, introduces new employees to: ♦
Patient focused values
♦
Professional Practice Model
♦
Safe and caring patient and staff practice environment
♦
Helping Abuse and Violence End Now (HAVEN)
♦
Culturally competent care/Medical Interpreters
♦
Life-long learning environment
♦
Policies and procedures
♦
Collaborative Governance
♦
Resources and regulatory information
♦
Collaborating departments ¾ Materials Management
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¾ Bio-medical Engineering The primary goal of DON orientation is to provide a broad overview including the department mission, vision and values; organizational structure; professional practice model; resources; and a review of key policies and procedures. The orientation program introduces role responsibilities based on departmental standards of practice, support role socialization, and integration into the MGH culture and environment (attachment 11.3.b). Registered Nurses attend an additional three days of orientation, which includes a review of essential policies, procedures and equipment review; a medication assessment; and a basic arrhythmia review (attachments 11.3.c and 11.3.d). Support personnel (Patient Care Associates, Operations Associates, and Unit Service Associates) receive additional job-related training. The central program lays the foundation for staff to report to their work areas to begin unit specific orientation. All employees are assigned a unit-based preceptor or coach to assist them in completing their orientation. •
Unit Based Orientation The New Graduate in Critical Care orientation program has been discussed in Force 11.2. Full details of course objectives, content and slide presentations are available on site. Orientation to the general care units is based upon a standardized set of minimum expectations for the orientee (attachment 11.3.e). The unit-based orientation plan is designed to facilitate achievement of those expectations within approximately 8 weeks. In addition to the precepted orientation experience, didactic classes in patient acuity, respiratory care and care of the patient during bedside emergencies are also offered. Each patient care area may identify additional expectations and goals for orientation based upon the unit’s specific patient population(s).
•
Role Specific Orientation A role-specific orientation process has been developed for those employees assuming the role of Nursing Director, Clinical Nurse Specialist, or Advanced Practice Nurse. Guidelines have been developed that build upon the New Employee Orientation and the Department of Nursing Orientation and are meant to guide the employee in assuming the relevant role responsibilities. The Nursing Director (attachment 11.3.f) and Clinical Nurse Specialist (attachment 11.3.g) orientations focus on exposure to the functions of the departments and services within and outside of the Department of Nursing and Patient Care Services; the roles 36
and functions of unit/service staff members; the identification of resource manuals containing DON policies, procedures and standards. Additionally, the Nursing Director Orientation provides information and training in the use of the various information systems integral to their work. The Advanced Practice Nurse Orientation (attachment 11.3.h) shares some similarities to that of the CNS and Nursing Director, but also focuses on the information technology specific to that role. Continuing Education MGH is an approved provider of continuing education by the Ohio Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Nurse planners from The Norman Knight Nursing Center work with Staff Nurses, Clinical Nurse Specialists, Collaborative Governance committees, leadership and, as needed, other organizations to ensure the continuing education needs of nurses are met. Learning needs are continually assessed, planned and evaluated as discussed in Force 11.1. Most continuing education programs are marketed via The Norman Knight Nursing Center’s website calendar of events (attachment 11.3.i). In addition, role specific continuing education programs are developed such as the Nursing Director Leadership Development Program (attachment 11.3.j) and the Clinical Nurse Specialist Leadership Development Program (attachment 11.3.k).
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Attachment 11.3.a
Massachusetts General Hospital MGH Human Resources – Training and Education New Employee Orientation Agenda
Day 1 8:15-8:40 8:40-8:55 8:55-9:15 9:15-9:45 9:45-10:00 10:00-10:10 10:10- 10:35 10:35-10:50 10:50-11:00 11:00- 11:15 11:15-11:50 11:50-12:30
Check in (Coffee, Tea and Juice) Welcome by Facilitator Group Exercise/Ice Breaker MGH Overview/ Administrator Guest Speaker Health and Safety Overview Employee Assistance Program Police, Security and Parking (include t-pass program) Break Photo ID Process/Distribution Emergency Management Infection Control HR Policies and Procedures
12:30 – 1:30
Complimentary Be Fit Lunch for all new hires
** Employees working less than 20 hours have completed Day 1 1:30-1:35 1:35-1:45 1:45-2:00 2:00-2:05 2:05-3:30 3:30-4:30
Association of Multicultural Members of Partners (AMMP) Blood Donor Center Tuition/Perks/Employee Services Pick up Benefits Information Benefits Overview/Questions & Answers Wrap Up and Collect Paperwork
Day 2 8:15 8:30-8:55 9:00-11:30 11:30-12:30 12:00-1:00
Sign in (Coffee, Tea and Juice HIPAA Overview Customer Service Training – Service MGH Bank of America; Citizens Bank, Harvard Credit Union PeopleSoft sign-on (Computer Labs)
Additional Orientation Fire and Safety Training To be completed within 90 days of your hire date http://intranet.massgeneral.org/ehs/ehs_programs_trainingprogram.htm#8 Orientation ends at this time for all staff with exception to the departments listed below have additional training. Please contact your supervisor if you are unsure of where to go. Day 2 Department Specific Training Outpatient Practice Support Essentials at the Yawkey Center 1:00 Department of Nursing Orientation at Charles River Plaza 1:30 (Biweekly) CONTACTS New Hire Coordinator: Mina Choe – 724-7635 NEO Facilitator: Kevin Cotter – 724-3368 MGH Training & Workforce Development
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Attachment 11.3.b
39
Attachment 11.3.c
40
Attachment 11.3.d
41
Attachment 11.3.d continued
42
Attachment 11.3.e
43
Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.e continued
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Attachment 11.3.f The Knight Center for Clinical and Professional Development Department of Nursing Massachusetts General Hospital
Nursing Director Orientation Name: _____________________________
Employee Number:
Unit: ______________________________
Date:
Directions: This is intended as a guide and builds upon the General Hospital and Department of Nursing orientations. Your preceptor will work with you to individualize your orientation experience. Content Area 1. Describe the mission, vision, guiding principles and philosophy of the Department of Nursing and Patient Care Services.
Learning Resource Department of Nursing orientation
2. Describe the functions of the departments and services within the Department of Nursing and Patient Care Services including: Administration Clinical Services Integrated Clinical Support Systems Patient acuity system Nursing Personnel Database One Staff Office of Patient Advocacy Nursing Financial Management Systems Resources/Expenses Evaluation/Analysis PeopleSoft/Document Direct Personnel management Management Support Office Systems Improvement Quality & Safety Quality Initiatives Regulatory & Risk Management Issues Diversity Program overview & current initiatives
Department of Nursing orientation
9
Executive Director, PCS Operations Associate Chiefs, Nursing Practice Director, Patient Advocacy, PCS Information Systems and PCIS staff
Director, Patient Advocacy, PCS Information Systems Director, PCS Financial Management Systems and staff
Director, Systems Improvement Director, Patient Quality & Safety
Director, Diversity Program
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Attachment 11.3.f continued Content Area 2. (Continued) The Knight Nursing Center for Clinical and Professional Development Program overview Standards/policies/procedures development and implementation Collaborative Governance Orientation, Training, Continuing Education Credentialing Clinical Recognition Program Research and Evaluation Student Affiliations Patient Family Learning Center Staff Perceptions of the Professional Practice Environment Survey Central Resource Team (CRT)
Clinical supervisors Rapid Response Program
Emergency Department
Interface with the ED
IV Team
3. Describe the roles and functions of unit/service staff members.
9
Learning Resource Director, The Knight Nursing Center for Clinical and Professional Development and staff
Nursing Director, Central Resources Activity: Coordinate Clinical Supervisor shadow experience Nursing Director, Emergency Department Activity: Coordinate ED observation experience Nursing Director, IV Team Associate chiefs and nursing director preceptor Activity: Coordinate appropriate direct care and support staff shadow experiences
4. Identify resource manuals containing MGH and DON policies, procedures, and standards.
Nursing director preceptor
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Attachment 11.3.f continued Content Area 5. Describe the functions of Patient Care Services departments outside the Department of Nursing relevant to your role responsibilities including:
Chaplaincy Occupational Therapy Physical Therapy Respiratory Therapy Social Service Speech Language Pathology
6. Describe the functions of departments/services outside Patient Care Services: Physicians Human Resources Admitting Biomedical Engineering Blood Transfusion Service Clinical Care Management Unit
Case Management Nutrition and Food Services Health Information Management Infection Control Occupational Health Interpreter Service Volunteer Department Pharmacy Public Relations Radiology Treadwell Library Environmental Services Materials Management Buildings and Grounds 7. Demonstrate use of information systems including: Outlook CAS Document Direct Peoplesoft OneStaff C-beds
8. Review and identify Nursing Director development needs with Associate Chief.
Learning Resource Select as contact person either the director of the department, or the appropriate service/unit representative. Director, Chaplaincy Director, Physical Therapy & Occupational Therapy Director, Respiratory Therapy Director, Social Services Director, Speech/ Language Pathology
Appropriate MD service leaders Assigned Human Resource Generalist Director, Admitting Director Biomedical Engineering or designee Director, Transfusion Service Director, Case Management & Unit-based CM
Select as contact person either the director of the department, or the appropriate service/unit representative.
Resources for more information available at the following link:
http://www.massgeneral.org/pcs/ccpd/Document s/PDF/Nurse_Manager_Leadership_Program_O rientation_Manual.pdf Orientation has been completed: ____Yes ____No (If No, identify issue(s) and plan).
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9
Attachment 11.3.f continued
_____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Demonstrates knowledge of nursing director role responsibilities: ____Yes ____No (If No, identify issue(s) and plan). _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Additional comments: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
_____________________________________________ Nursing Director
______________________ Date
_____________________________________________ Associate Chief, Nursing Practice
______________________ Date
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Attachment 11.3.f continued The Knight Center for Clinical and Professional Development Department of Nursing Massachusetts General Hospital
Nursing Director Orientation Name:
____
Employee Number:
Unit:
____
Date:
______
Following is a timeline for orientation. It is intended only as a guide that will be modified based on the individual needs of each Nursing Director. Weeks 1 & 2: Hospital/Departmental Focus Attend new employee and hospital orientation Meet with Associate Chief and Nursing Director preceptor to plan orientation. Schedule meetings with appropriate hospital and departmental leadership/resource staff Meet with unit staff Attend Patient Care Services Executive Committee meeting Attend Nursing Director meetings Attend Collaborative Governance leadership and committee meetings: Practice, Quality, Ethics, Diversity, Research, and Patient Education Week 3: Service Focus Meet with Clinical Nurse Specialist and Operations Coordinator Attend appropriate meetings related to product line Shadow nursing triage supervisor for ½ day Gain proficiency with relevant information systems Weeks 4 & 5: Unit Focus Shadow staff nurse on all shifts Develop knowledge of documentation systems Develop knowledge of systems for managing emergencies Observe function of all unit-based staff Develop understanding of unit operations Week 6 Identify and develop a plan to meet own learning needs. NOTE: The Partners Training Department sponsors Leadership Development programs as well as a New Manager Orientation program that includes topics related to human resources, safety, materials management, police and security, employee assistance program, telecommunications, and JCAHO. To receive a schedule of upcoming programs, please contact the Training Department at 726-2230.
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Attachment 11.3.g
The Knight Center for Clinical and Professional Development Department of Nursing Massachusetts General Hospital
Clinical Nurse Specialist Orientation
Name:
____
Employee Number:
Unit:
____
Date:
______
Following is a timeline for orientation. It is intended only as a guide which will be modified based on the individual needs of each CNS. Weeks 1 & 2: Hospital/Departmental Focus Attend new employee and hospital orientation Meet with Nurse Manager/ preceptor to plan orientation. Schedule meetings with appropriate hospital and departmental leadership/resource staff Meet with unit staff Attend Patient Care Services Combined Leadership meeting Attend Clinical Nurse Specialist meeting Attend Collaborative Governance leadership and committee meetings: Practice, Quality, Ethics, Diversity, Research, and Patient Education Week 3: Service Focus Meet with Nurse Manager and Operations Coordinator Attend appropriate meetings related to product line Shadow nursing triage supervisor for ½ day Gain proficiency with relevant information systems Weeks 4 & 5: Unit Focus Shadow staff nurse on all shifts Develop knowledge of documentation systems Develop knowledge of systems for managing emergencies Observe function of all unit-based staff Develop understanding of unit operations Week 6 Identify and develop a plan to meet own learning needs. NOTE: The Partners Training Department sponsors Leadership Development programs as well as a New Manager Orientation program that includes topics related to human resources, safety, materials management, police and security, employee assistance program, telecommunications, and JCAHO. To receive a schedule of upcoming programs, please contact the Training Department at 726-2230.
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Attachment 11.3.h The Knight Center for Clinical and Professional Development Department of Nursing Massachusetts General Hospital
Advanced Practice Nurse Orientation Name: _____________________________
Employee Number:
Unit: ______________________________
Date:
Directions: This is intended as a guide and builds upon the General Hospital and Department of Nursing orientations. Your preceptor will work with you to individualize your orientation experience.
Content Area 3. Describe the mission, vision, guiding principles and philosophy of the Department of Nursing and Patient Care Services.
Learning Resource Department of Nursing orientation
4. Describe the functions of the departments and services within the Department of Nursing and Patient Care Services including:
Department of Nursing orientation
Clinical Services Integrated Clinical Support Systems Office of Patient Advocacy
Nursing Management Systems Systems Improvement
Quality & Safety Quality Initiatives Regulatory & Risk Management Issues Diversity Program overview & current initiatives The Knight Nursing Center for Clinical and Professional Development Program overview Standards/policies/procedures development and implementation Collaborative Governance Orientation, Training, Continuing Education, Professional Development Credentialing Clinical Recognition Program Research and Evaluation Student Affiliations Patient Family Learning Center Staff Perceptions of the Professional Practice Environment Survey
9
Associate Chief for Nursing Practice Director, Patient Advocacy, PCS Information Systems and PCIS staff Director, PCS Management Systems and staff Director, Systems Improvement Director, Patient Quality & Safety
Director, Diversity Program Associate Chief, The Knight Nursing Center for Clinical and Professional Development and staff
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Attachment 11.3.h continued
3. Describe the roles and functions of unit/service staff members.
Nurse manager/ preceptor
3. Understands and demonstrates the following:
NP preceptor
Writing orders
Discharge Tapers Hold orders Insulin orders One time orders Completing front sheet Writing discharge summary Use of house officer manual 6. Describe the functions of Patient Care Services departments outside the Department of Nursing relevant to your role responsibilities including: Chaplaincy Occupational Therapy Physical Therapy Respiratory Therapy Social Service Speech Language Pathology
Select as contact person either the director of the department, or the appropriate service/unit representative.
7. Describe the functions of departments/services outside Patient Care Services: Physicians Human Resources Admitting Biomedical Engineering Blood Transfusion Service 6. (continued) Clinical Care Management Unit Case Management Nutrition and Food Services Process for putting in consults TPN and tube feeding orders Health Information Management Infection Control Occupational Health Interpreter Service Volunteer Department Pharmacy Public Relations Radiology Treadwell Library Environmental Services Materials Management Buildings and Grounds
Select as contact person either the director of the department, or the appropriate service/unit representative.
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Attachment 11.3.h continued 7. Demonstrate use of information systems including: Outlook CAS Provider Order Entry Peoplesoft Other 8. Complete credentiali credentialing ng and privileging application for advanced nurse practitioner. Associate Chief.
The Knight Nursing Center for Clinical & Professional Development - Patient Care Services - Massachusetts General Hospital
Orientation has been completed: ____Yes ____No (If No, identify issue(s) and plan). _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
Demonstrates knowledge of advanced practice nurse role responsibilities: ____Yes ____No (If No, identify issue(s) and plan). _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Additional comments: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ________________________________________________________________________
________________________________________________ NP Preceptor
______________________ Date
________________________________________________ Nurse Manager
______________________ Date
________________________________________________ Associate Chief, Nursing Practice
______________________ Date
________________________________________________ Physician Sponsor
______________________ Date
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Attachment 11.3.h continued The Knight Center for Clinical and Professional Development Department of Nursing Massachusetts General Hospital
Advanced Practice Nurse Orientation Additional information 1. The new hire coordinator notifies Information Systems (IS) and pharmacy of RN hires to initiate: Computer Login # Email access Peoplesoft access PCIS/CAS – for access to results inquiry, patient lists and (POE) Provider Order Entry (all levels except order writing). Department of Nursing (DON) orientation includes POE training. 2. POE access to write orders Is turned on by IS after credentialing privileges are granted Contact Carol McMahon at extension 6-6788 for POE order writing training. 3. To Obtain MGH Provider # Complete Non-MD Database form and fax to Teri Spadea at 6-9099 nonmdform.doc
4. To Obtain Electronic Signature Access (ESA) Complete Access Request Form for ESA and fax to R.J. Bilodariya at 6-1088 ESA FORM APPLICATION.dot
5. To Obtain Access to other Partners hospitals lab results Call IS Helpdesk (6-5085) to request that the other Partners hospitals be added to CAS lab review screen. 6. To Obtain Warfarin Dose Adjuster ID Number Contact Lynn Oertel, CNS, Anticoagulation Management Services, at extension 6-6955. 7. To Obtain Pager Communications Office (White 14) 8. To Obtain Telephone Authorization Card Communications Office (White 14) 9. To Order Lab Jackets Complete MGH lab coat order form and fax to Matt Naughton at extension 6-5394
Lab Coat Order Form.doc
10. To Obtain Discharge Express Access (Dex)
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Attachment 11.3.i
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A Attachment 11.3.i continued
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Attachment 11.3.i continued Attachmen
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Attachment 11.3.j
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Clinical Nurse Specialist Leadership Development: A Progress Report Attachment 11.3.k 2006 - 2007 October 26, 2006
Negotiation: Maximizing Gains by Pursuing Shared Interests Mike Wagner, NLA faculty Suzanne O’Connor, RN, CNS, MGH This workshop, at the Holiday Inn, was attended by 45 CNSs. NLA faculty facilitated the morning session. (NLA is offering 1/2 –day sessions only.) After lunch, we enlisted MGH’s Suzanne O’Connor, RN, to present an application piece to reinforce the morning’s content and allow CNSs opportunities for practice. This program received high marks from CNSs who appreciated the opportunity to reflect upon their roles as leaders and try out new skills.
January 8, 2007
Reflections on Transformational Leadership Dorothy Jones, RN, EdD, FAAN To continue the discussion on transformational leadership, we invited Dr. Jones back for more dialogue during a regularly scheduled CNS meeting. This forum provided many opportunities for reflection about professional leadership and role.
February 1, 2007
Communicating for Influence Mike Wagner, NLA faculty Suzanne O’Connor, RN, CNS, MGH Building on the success of our last NLA offering, we invited Mike Wagner back for a second workshop on communication. This was followed by an application session by Suzanne O’Connor, RN. This, too, received very high marks. Attendance was 40.
The task force continues to meet monthly or bimonthly, as needed, to evaluate the workshops and to plan upcoming events. Written course evaluations are reviewed and consensus is reached regarding the course offerings. Diane Carroll, RN, has stepped down due to her new duties in the Munn Center for Nursing Research. The task force is seeking a replacement member.
CNS Leadership Competencies The CNS Group desired to integrate the PCS leadership competencies with their specific, professional role, as the nurse directors had done. In order to guide that process, the CNSs began by articulating a vision and mission statement (see page 5). The CNS Group will continue to examine and revise this work and draft leadership competencies over the summer of 2007.
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Attachment 11.3.k continued 2007-2008 Program Planning The CNS Leadership Development Task Force is currently evaluating feedback from the first year’s offerings to guide curriculum planning for the second year. The proposed schedule is below: •
9/6/07
Facilitating Effective Teamwork—Combined workshop. Both directors and CNSs agreed that this topic lends itself to the synergy of directors and CNSs, who will be encouraged to attend as dyads. This workshop has been booked through NLA and will be facilitated by Mike Wagner.
•
10/4/07
Voices of Wisdom I Rosalie Tyrell, RN, Norman Knight Center for Clinical and Professional Development, will facilitate this workshop for 6 to 14 CNSs. This program, previously presented to the nurse directors, was very well received. The workshop will focus on the five practices of exemplary leadership described by Kouzes and Posner.
•
10/11/07
Managing Conflict: Bridging Differences for Improved Performance Managing conflict is a need identified in the Staff Perceptions Survey. This workshop will help participants to understand the common sources of dispute and the impact of conflict on performance as well as uncovering and aligning underlying interests to generate agreement.
•
11/1/07
Voices of Wisdom II Rosalie Tyrell, RN will facilitate part II with the same group of CNSs as on 10/4/07. Additional programs could be offered in spring and fall of 2008.
•
2/7/08
Managing Amidst Diversity: More Effective Leadership of an Evolving Staff Understanding the benefits and pitfalls of either minimizing differences or emphasizing differences, recognizing inherent bias, and identifying how diversity influences relationship building, communication, and decisionmaking will increase leadership effectiveness in an environment where patients, staff, and physicians encompass diversity of age, ethnicity, national origin, religion, and socioeconomic and cultural background.
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