NEd Orientation Manual : simplebooklet.com

Table of Contents Introduction ............................................................................................................................................................... 3 Welcome Letter ..................................................................................................................................................... 4 Values Statement ................................................................................................................................................... 5 Conduct and Behavior ............................................................................................................................................ 0 Orientation ................................................................................................................................................................. 1 Weekly Calendar .................................................................................................................................................... 2 Weekly Evaluation ..................................................................................................................................................... 4 Weekly Orientee Evaluation .................................................................................................................................. 5 Preceptor Evaluation ............................................................................................................................................. 6 Monthly Evaluation .................................................................................................................................................... 7 30 Day Review .................................................................................................................................................... 0 60 Day Review .................................................................................................................................................... 0 90 Day Review .................................................................................................................................................... 0 Competency ............................................................................................................................................................... 0 Learning Tools ............................................................................................................................................................ 1 SBAR ....................................................................................................................................................................... 2 BOP IT ..................................................................................................................................................................... 0 Policies & Procedures ................................................................................................................................................ 0 Personal Use of Cell Phones ................................................................................................................................... 1 Timekeeping, Attendance & Punctuality ............................................................................................................... 1 Work Hours and Breaks ......................................................................................................................................... 1 Child Security ......................................................................................................................................................... 1 Release of Information .......................................................................................................................................... 1 Visiting Hours ......................................................................................................................................................... 1

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Welcome Letter 5501 S. McColl Rd Edinburg, TX 78539 956-362-5369 www.nedsimplified.com Date: 1/1/22 Dear John Doe On behalf of the department of pediatrics, we would like to extend a very warm welcome. We are very pleased that you have accepted our offer of a position as a registered nurse. Your employment effective date is 1/1/22. Your working hours will be from 0645-1900. Your Director is Andrew Kosko and can be reached at 956-362-5375. Clinical Coordinator is Crystal Blas and can be reached at 956-362-5374 in case you have questions. If you have questions regarding education/orientation your Educator is Mark Guerra and can be reached at 956-362-5369. Please complete these forms prior to attending orientation. • What’s your learning style? (Google form-available on nedsimplified.com forms page) • Schedule Appointment with Pediatric Educator (Available on nedsimplified.com under NEd scheduling) • Acknowledgement of Cell Phone Policy • Acknowledgment of Isolation Policy • Acknowledgement of Goal Oriented Agreement Bring these forms already completed with you to Orientation. If you need assistance completing these forms, please call your Educator at 956-362-5369. Important information you will need to know or bring with you to on-floor orientation: ➢ Parking is available as per Hospital map ➢ Please arrive on your designated floor of the Mid Tower Hospital Building, at 6:45 am. Your name will be on the Assignments board. ➢ Bring Hospital Badge. ➢ Bring two ink pens (black or blue). ➢ Bring medical shears ➢ Bring stethoscope All new employees please note: You are required to complete your HealthStreams prior to beginning orientation on floor orientation. Welcome to the Doctors Hospital at Renaissance Health System Pediatrics and congratulations on your new position!

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Values Statement Primary Value The needs of the patient come first. Respect Treat everyone in our diverse community including patients, their families, and colleagues with dignity. Compassion Provide the best care, treating patients and family members with sensitivity and empathy. Integrity Adhere to the highest standards of professionalism, ethics and personal responsibility, worthy of the trust our patients place in us. Stewardship Sustain and re‐invest in our mission and extended communities by wisely managing our human, natural and material resources. Teamwork Value the contributions of all, blending the skills of individual staﬀ members in unsurpassed collaboration. Excellence Deliver the best outcomes and highest quality service through the dedicated eﬀort of every team member. Innovation Infuse and energize the organization, enhancing the lives of those we serve, through the creative ideas and unique talents of each employee. Caring Inspire hope and nurture the well‐being of the whole person, respecting physical, emotional and spiritual needs. Community Partner with communities to promote health and wellness, improve quality of life and support economic growth and development.

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Conduct and Behavior Professional behavior is expected. In consideration of patients and staﬀ in the area, loud conversation or laughter is discouraged. Discussions should be conducted in a quiet and confidential manner. You are expected to be under the supervision of designated staﬀ at all times during the clinical experience. It is expected that you will notify designated department staﬀ if ill, will be late, or unable to follow through with planned clinical experiences. Bring minimal personal belongings and money. No valuables. Doctors Hospital is not responsible for stolen and/or misplaced personal items. A location may be assigned to keep personal belongings during the clinical experience. Personal cell phones must be turned oﬀ during the clinical experience. Cell phones and/or cameras are not allowed in the experience areas. Doctors Hospital reserves the right to review any written journals, reports, papers, etc. prepared by students to assure confidentiality standards are being met. Doctors Hospital reserves the right to terminate clinical experiences at any time for any reason.

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Nurse Orientation Weekly Calendar Week of ______________ To ______________ Expected Outcomes Completed with Preceptor Completed with Educator • Observes Bedside Report • Observes rounds with preceptor & physician • Observes Cerner documentation • Observes administration of all medications. • Observe use of appropriate pain assessment • Observe Head-to-toe assessment on all patients. • Understanding developmental milestones • Review of approaches to age-specific care • Reviewing Pain Scores • Review Head-to-toe assessment • Review SBAR • Give report on one patient • Observes Bedside Report • Observes rounds with preceptor & physician • Observes Cerner documentation • Observes administration of all medications. • Begins administering medications to one patient. • Cares for one pediatric patient (moderate assistance) • Performs use of appropriate pain assessment • Performs Head-to-toe assessment on all patients. (Focusing on respiratory assessment.) • Assessing the Respiratory System • Administering and Monitoring O2 Therapy • Skills lab: Nebulizer treatments, O2 Delivery, suctioning • Review Oral/Nasal Suctioning • Admission & Discharge Process • Review of DAR, BOPIT • Give report on one patient • Shadow Respiratory Therapist (1 day) • Begins calling MD for orders/ status updates • Admits/discharges a patient • Performs Head-to-toe assessment on all patients. (Focusing on respiratory assessment.) • Cares for two pediatric patient (moderate assistance) • Demonstrates Cerner documentation • Administers nebulizer treatment • Administers oxygen and monitors appropriately • Skills Lab: Chest X-ray, Alaris pumps, Trach care • Understanding Blood gases • Review of Acute Respiratory Distress Syndrome • Review of Respiratory Conditions • Respiratory Critical Thinking Scenarios • Give report on two patients • Receives & gives bedside report on two patients. • Cares for two pediatric patient (moderate assistance) • Performs Head-to-toe assessment on all patients. (Focusing on cardio assessment) • Begins to administer medications to all assigned patients. • Participates in rounds • Intravenous insertion/Discontinuation • Assessing the cardiovascular system • Review of Cardiac Conditions (Cyanotic) part 1 • Cardiovascular Critical Thinking Scenarios • Give report on two patients • Skills lab: Blood transfusions • Receives & gives bedside report on three patients. • Cares for three pediatric patient (moderate assistance) • Focus on time management and critical thinking • Calls the MD for order/status updates • Review of Cardiac Conditions (Acyanotic) part 2 • EKG Interpretation • Review of Cardiac Catheterization • Give report on two patients • Skills lab: Tele-monitors • Receives & gives bedside report on three patients • Cares for three pediatric patient (moderate assistance) • Performs Head-to-toe assessment on all patients. (Focusing on neurologic assessment) • Admits patient and performs correct documentation • Review Neuro Conditions part 1 • Assessing the Neurological System • Neurological Critical Thinking Scenarios • Give report on two patients • Receives & gives bedside report on four patient • Cares for four pediatric patient (moderate assistance) • Performs Head-to-toe assessment on all patients. (Focusing on cardio assessment) • Administers medications to all assigned patients • Participates in rounds • Review Neuro Conditions part 2 • Review Consents • Caring for patient undergoing Neurosurgery pre/post-op • Skills Lab: Neuro assessment, lumbar puncture • Interpretation of CSF Results 3 4 5 6 7 1 Respiratory Respiratory Cardio Cardio Neuro Neuro Growth Develop 2

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• Receives & gives bedside report on four patients • Cares for four pediatric patients (moderate assistance) • Performs Head-to-toe assessment on all patients. (Focusing on gastro assessment.) • Performs GT Bolus/Intermittent Feedings/Residual • Insertion/Discontinue NGT • Review Gastrointestinal Conditions • Gastrointestinal Critical Thinking Scenarios • Skills lab: NGT, GT, LIS, Residual, ostomy, Feeding methods • Cares for four pediatric patient (moderate assistance) • Receives & gives bedside report on four patients • Performs an in house transfer • Administer subcutaneous injection • Review Endocrine Conditions • Review Diabetes Protocols • Endocrine Critical Thinking Scenarios • Skills lab: Blood glucose checks • Transfer unit to unit, hospital to hospital process • Preceptee will take 4 patients (Total Care) • Performs Head-to-toe assessment on all patients. (Focusing on dermatologic assessment.) • Perform wound care on patient • Application of topical medications • Review Dermatologic Conditions • Skills lab: Wound Care • Review Forms: Face sheet, census , Transferring patient from paragon • Preceptee will take 4 patients (Total Care) • Performs Head-to-toe assessment on all patients. (Focusing on renal assessment.) • Performs foley insertion, in and out catheter • Assess fluid and electrolyte balance • Analyze/Interpret lab values • Review Renal Conditions • Renal Critical Thinking Scenarios • Skills lab: Foley, in and out caths, bladder scanner • Review • Preceptee will take 4 to 5 patients (Total Care) • Perform blood transfusion • Obtain consent for blood transfusion • Sets up for Bone marrow aspiration • Review Hematologic Conditions • Hematologic Critical Thinking Scenarios • Give report on three patients • Skills lab: Blood draws • Preceptee will take 4 to 5 patients (Total Care) • Set up for lumbar puncture • Performs proper isolation precautions for patients receiving chemo. • Review Oncology Conditions • Oncology Critical Thinking Scenarios • Preceptee will take 4 to 5 patients (Total Care) • Review Infectious Disease Conditions • Isolation Precautions • Preceptee Prepares Error Presentation • Preceptee will take 4 to 5 patients (Total Care) • Cares for a patient with a cast • Review Musculoskeletal Conditions • Musculoskeletal Critical Thinking Scenarios • Preceptee will take 4 to 5 patients (Total Care) • Review Psychological Conditions 8 9 10 11 12 13 14 15 16 Gastro Endocrine Renal Musculo Infectious Disease Dermat. Hematology Psych Oncology

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WEEK _____ DAY _____ Weekly Orientee Evaluation Orientee: _______________________________ Preceptor: _____________________________ Date: ________ What % of patient care is the orientee performing independent of preceptor? Select one. 25% - Observation mode, minimal hands on 50% - Moderate assistance 75% - Required little assistance 100% - Totally independent List types of patients for this week. Any issues or concerns that came up? List accomplishments this week. Orientee’s Self-Evaluation/Comments Things doing well— Things to work on – Preceptor’s Evaluation/Comments Things doing well— Things to work on – Plan List learning needs/goals/homework for next week. Signature of Educator: _______________________________ Knowledge, Skill, & Attitude Assessment Rate each item on a scale from 1 to 10 (10 being the best). Basic safety and isolation precautions K Able to delegate appropriately S Medication knowledge/administration K Interprofessional communication A Disease pathology knowledge and interventions K Customer service A Critical thinking/problem solving K Responsiveness to alarms and changing clinical condition K/A Competence with equipment K/S Positive attitude A Individualization of education/plan of care K/S Stress management A Basic patient care S Appropriateness of questions K/A Time mgmt/prioritization (ability to adjust) S Ability to take direction/feedback A Computer charting (accuracy, completeness) S Application of learned knowledge A Assignment for next experience:

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Name of Orientee: ______________________ Preceptor: _______________________ Preceptor Evaluation On a scale of 1 to 10 (1 = unable to demonstrate competency; and 10 = high level competency). Please rank your preceptor in the following categories: 1. Preceptor provides feedback in a manner that is supportive, constructive, and respectful. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 2. Preceptor communicates his/her expectations on an ongoing basis. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 3. Preceptor uses critical clinical incidents as teaching opportunities. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 4. Preceptor is accessible, provides guidance, and is available to coach me through clinical situations that I am unsure of (e.g. changing patient condition, code blue) 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 5. Preceptor supports my socialization into the unit, inclusion among coworkers and team members. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 6. Preceptor is able to provide rationales based upon critical care knowledge and theory. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 7. Preceptor demonstrates behaviors that enhance my self-confidence. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 8. Preceptor is able to stand back and allow me to perform increasingly more complex tasks as my competency develops. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 9. Preceptor demonstrates knowledge of unit based standards and expectations and utilizes unit specific guidelines in the care of patients. 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 10. Preceptor was willing to work with me towards mutually defined goals based upon identified learning needs 1---------2---------3---------4---------5--------6---------7--------8---------9---------10 11. Preceptor is a good role model, able to address and receive issues and conflicts that may arise in a professional manner as it applies to nursing colleagues, physicians, and other members of the multidisciplinary team 1---------2---------3---------4---------5--------6---------7--------8---------9---------10

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30 Day Review NEW EMPLOYEE/TRANSFER/PROMOTION - EXPECTED BEHAVIORS REVIEW Manager First Name: Manager Last Name: Department: Employee First Name: Employee Last Name: Employee #: Date: ____/____/____ Position Title: The employee’s manager is asked to complete this written evaluation prior to the conclusion of the thirty (30) day Orientation & Evaluation Period and place in the employees file. Please utilize the first section to obtain feedback from the new employee and input all feedback. The second section is for the manager to review the new employees thirty (30) day introductory period as it relates to the employees expected behaviors. This section should be completed before meeting with the employee. The manager is to utilize their own department form to review role competencies. Next to each factor are examples of behaviors that would describe performance at the MEETS level. If the behavior has yet to be observed, please select NOT OBSERVED. Please keep in mind, however, to observe the behavior prior to the completion of the 90 day period. EMPLOYEE REVIEW Factor Employee Comments A. What part of your job do you find most rewarding? B.Does this job meet your initial expectations? Yes No C. Are you feeling supported by your team? Yes No D. What has been the most challenging part of this job? E. Do you feel that you are getting the information and experiences you need to perform your job? F. Has there been anyone that has been especially helpful to you during your first thirty (30) days? G. What could we be doing for you now to integrate you into the team that we are not currently doing? MANAGER REVIEW Factor Examples of FULLY ACHIEVES Performance Levels Enter Factor Rating A. Availability • Reports to work on time as scheduled. • Demonstrates satisfactory attendance. Meets Does Not Meet Not Observed B. Excellence • Acts-and makes safe choices and decisions-in the best interests of patients and their loved ones, and willingly accepts accountability for outcomes. • Improves performance that enhances patient care and advances individual, team, and organizational goals. • Effectively uses resources to support optimal patient care and operational performance while adhering to organizational policies and procedures. Meets Does Not Meet Not Observed C. Teamwork • Willingly shares expertise and information with others to improve patient care, unit or departmental performance without compromising individual responsibilities. • Celebrates the accomplishments of others in making a difference in the lives of patients and the success of the organization. • Takes ownership of decisions made by specific patient care or project teams, and team leaders, and the individual role needed to support them. Meets Does Not Meet Not Observed

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D. Integrity • Is truthful and honest with patients, their loved ones, and co-workers, and consistently exhibits actions that reflect our values. • Is accountable for actions and decisions involving patient care or other operational activities, and strives to learn and improve from experience. • Follows through on commitments made to patients, visitors, co-workers and others. Meets Does Not Meet Not Observed E. Safety • Strictly adheres to all established patient, staff and faculty safety procedures • Discusses factors in the system that seem to contribute to errors or risky situations. Offers ideas about solving. • Contributes to an environment of safety and security for patients and staff through individual actions. • Speaks up about all risk of harm; reports patient, staff safety or injury events within twenty-four hours of incident or awareness of incident. • Actively participates in all mandatory patient and staff safety training. Meets Does Not Meet Not Observed F. Diversity • Applies cultural understandings and sensitivities to enhance patient care, and improves interactions with people of diverse backgrounds • Treats all individuals-- patients, visitors and co-workers -- with courtesy, dignity, and respect • Contributes to a work environment that is welcoming to all -- whether patients, visitors, staff, or faculty • Demonstrates a sensitivity and awareness of the needs of a diverse workforce and patient population Meets Does Not Meet Not Observed Comments:________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________________________________________________________ This information has been reviewed jointly. Signature (please print): ___________________________________ (Manager) Date ___/___/____ ___________________________________ (Employee) Date ___/___/____

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60 Day Review NEW EMPLOYEE/TRANSFER/PROMOTION - EXPECTED BEHAVIORS REVIEW Manager First Name: Manager Last Name: Department: Employee First Name: Employee Last Name: Employee #: Date: ____/____/____ Position Title: The employee’s manager is asked to complete this written evaluation prior to the conclusion of the sixty (60) day Orientation & Evaluation Period and place in the employees file. Please utilize the first section to obtain feedback from the new employee and input all feedback. The second section is for the manager to review the new employees thirty (30) day introductory period as it relates to the employees expected behaviors. This section should be completed before meeting with the employee. The manager is to utilize their own department form to review role competencies. Next to each factor are examples of behaviors that would describe performance at the MEETS level. If the behavior has yet to be observed, please select NOT OBSERVED. Please keep in mind, however, to observe the behavior prior to the completion of the 90 day period. EMPLOYEE REVIEW Factor Employee Comments A. What part of your job do you find most rewarding? B.Does this job meet your initial expectations? Yes No C. Are you feeling supported by your team? Yes No D. What has been the most challenging part of this job? E. Do you feel that you are getting the information and experiences you need to perform your job? F. Has there been anyone that has been especially helpful to you during your first sixty (60) days? G. What could we be doing for you now to integrate you into the team that we are not currently doing? MANAGER REVIEW Factor Examples of FULLY ACHIEVES Performance Levels Enter Factor Rating A. Availability • Adheres to the attendance policy. • Understands own role, appreciates what others do, and supports the team through good attendance. Meets Does Not Meet Not Observed B. Excellence • Acts-and makes decisions-in the best interests of patients and their loved ones, and willingly accepts accountability for outcomes. • Improves performance that enhances patient care and advances individual, team, and organizational goals. • Effectively uses resources to support optimal patient care and operational performance while adhering to organizational policies and procedures. • Seeks opportunities to improve service provided to patients and their loved ones related to clinical care and support. Meets Does Not Meet Not Observed C. Teamwork • Willingly shares expertise and information with others to improve patient care, unit or departmental performance without compromising individual responsibilities. • Celebrates the accomplishments of others in making a difference in the lives of patients and the success of the organization. Meets Does Not Meet Not Observed

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• Takes ownership of decisions made by specific patient care or project teams, and team leaders, and the individual role needed to support them. • Manages multiple demands while maintaining quality and courtesy; acknowledges and resolves patient or visitor issues. D. Integrity • Is truthful and honest with patients, their loved ones, and co-workers, and consistently exhibits actions that reflect our values. • Is accountable for actions and decisions involving patient care or other operational activities, and strives to learn and improve from experience. • Follows through on commitments made to patients, visitors, co-workers and others. Meets Does Not Meet Not Observed E. Safety • Strictly adheres to all established patient, staff and faculty safety procedures • Contributes to an environment of safety and security for patients and staff through individual actions. • Speaks up about all risk of harm; reports patient, staff safety or injury events within twenty-four hours of incident or awareness of incident. • Actively participates in all mandatory patient and staff safety training. Meets Does Not Meet Not Observed F. Diversity • Applies cultural understandings and sensitivities to enhance patient care, and improves interactions with people of diverse backgrounds • Treats all individuals-- patients, visitors and co-workers -- with courtesy, dignity, and respect • Contributes to a work environment that is welcoming to all -- whether patients, visitors, staff, or faculty • Demonstrates a sensitivity and awareness of the needs of a diverse workforce and patient population Meets Does Not Meet Not Observed Comments: _________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________ ___________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________________________________ ___________________________ This information has been reviewed jointly. Signature (please print): ___________________________________ (Manager) Date ___/___/____ ___________________________________ (Employee) Date ___/___/____ If at 60 days, the employee is f unctio ning be low the expected standard(s) and there is a concern that the New Hire Orientation and Evaluation Period may need to be e xten ded, or tha t the employee may not be successf ul in the Depar tment by the end of the initial 90 day s: the following sho uld be notifie d. Clinical Operations Director/Supervisor: Date Notified: Nurse Educator/Manager: Date Notified: Nurse Recruitment/Director: Date Notified: Staff and Labor Relations: Date Notified: If more training is required, please indicate below Goal/Objective Action Plan Resources Required to Complete the Goal Target Completion Date

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90 Day Review NEW EMPLOYEE/TRANSFER/PROMOTION - EXPECTED BEHAVIORS REVIEW Manager First Name: Manager Last Name: Department: Employee First Name: Employee Last Name: Employee #: Date: ____/____/____ Position Title: The employee’s manager is asked to complete this written evaluation prior to the conclusion of the sixty (60) day Orientation & Evaluation Period and place in the employees file. Please utilize the first section to obtain feedback from the new employee and input all feedback. The second section is for the manager to review the new employees ninety (90) day introductory period as it relates to the employees expected behaviors. This section should be completed before meeting with the employee. The manager is to utilize their own department form to review role competencies. Next to each factor are examples of behaviors that would describe performance at the MEETS level. If the behavior has yet to be observed, please select NOT OBSERVED. Please keep in mind, however, to observe the behavior prior to the completion of the 90 day period. EMPLOYEE REVIEW Factor Employee Comments A. What part of your job do you find most rewarding? B.Does this job meet your initial expectations? Yes No C. Are you feeling supported by your team? Yes No D. What has been the most challenging part of this job? E. Do you feel that you are getting the information and experiences you need to perform your job? F. Has there been anyone that has been especially helpful to you during your first ninety (90) days? G. What could we be doing for you now to integrate you into the team that we are not currently doing? MANAGER REVIEW Factor Examples of FULLY ACHIEVES Performance Levels Enter Factor Rating A. Availability • Adheres to the attendance policy. • Understands own role, appreciates what others do, and supports the team through good attendance. Meets Does Not Meet Not Observed B. Excellence • Acts-and makes decisions-in the best interests of patients and their loved ones, and willingly accepts accountability for outcomes. • Improves performance that enhances patient care and advances individual, team, and organizational goals. • Effectively uses resources to support optimal patient care and operational performance while adhering to organizational policies and procedures. • Seeks opportunities to improve service provided to patients and their loved ones related to clinical care and support. Meets Does Not Meet Not Observed C. Teamwork • Willingly shares expertise and information with others to improve patient care, unit or departmental performance without compromising individual responsibilities. • Celebrates the accomplishments of others in making a difference in the lives of patients and the success of the organization. • Takes ownership of decisions made by specific patient care or project teams, and team leaders, and the individual role needed to support them. Meets Does Not Meet Not Observed

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• Manages multiple demands while maintaining quality and courtesy; acknowledges and resolves patient or visitor issues. D. Integrity • Is truthful and honest with patients, their loved ones, and co-workers, and consistently exhibits actions that reflect our values. • Is accountable for actions and decisions involving patient care or other operational activities, and strives to learn and improve from experience. • Follows through on commitments made to patients, visitors, co-workers and others. Meets Does Not Meet Not Observed E. Safety • Strictly adheres to all established patient, staff and faculty safety procedures • Contributes to an environment of safety and security for patients and staff through individual actions. • Speaks up about all risk of harm; reports patient, staff safety or injury events within twenty-four hours of incident or awareness of incident. • Actively participates in all mandatory patient and staff safety training. Meets Does Not Meet Not Observed F. Diversity • Applies cultural understandings and sensitivities to enhance patient care, and improves interactions with people of diverse backgrounds • Treats all individuals-- patients, visitors and co-workers -- with courtesy, dignity, and respect • Contributes to a work environment that is welcoming to all -- whether patients, visitors, staff, or faculty • Demonstrates a sensitivity and awareness of the needs of a diverse workforce and patient population Meets Does Not Meet Not Observed □ I recommend this employee become a regular staff member DATE □ I recommend extending the staff member’s orientation and evaluation period for 30 calendar days. DATE The following performance criteria must be met by this date. 1. _______________________________________________________________________________ 2. _______________________________________________________________________________ 3. □ I recommend this staff be discharged before the conclusion of the orientation and evaluation period for the following reasons: 1. 2. 3. I have contacted the entity/department HR Representative and Staff and Labor Relations to discuss and review this decision prior to expiration of the 90 day period. □ The staff member resigned before completion of the orientation and evaluation period. DATE OF RESIGNATION: RESIGNATION NOTICE ATTACHED □ Manager’s Signature: DATE Employee’s Signature: DATE

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Patient Name: _______________________________________ Age: ________________ Weight: _______________ Allergies: _________________ Admission Date: _____________________ Admitting Diagnosis: ________________________________________________________________________ SITUATION BACKGROUND Past Medical History: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Events Leading To This Admission: _________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Intensivist: ___________________________________________________ Consults: __________________________________________________________ ASSESSMENT NEURO RESP CARDIAC GI/GU SKIN / WOUND IV LABS / PENDING PROCEDURES NURSE COMMUNICATION: PLAN: PEDI:____ SD:____ PICU:____ PATIENT LABEL SBAR urine output ml/kg previous shift: _______ urine output ml/kg my shift: _______

NEd Orientation Manual

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