VA Student Handbook

Nursing Service
Student Handbook
AY 2011-2012
Keeping the Promise to Those Who Served
America’s Nurses Caring for America’s Heroes
North Florida / South Georgia
Veterans Healthcare System
WELCOME TO THE VA
TRAINING CHECKLIST
Student Intakes/In-processing Forms packet to complete and return to Nursing Education
Affiliations Coordinator (unless instructed otherwise by your school)
1. Appointment Letter (VA Form Letter 10-294)
2. Student Data & Orientation Checklist
3. Clinical Trainee Registration Form
4. Request & Authorization for Computer Access
5. Rules of Behavior
6. Appointment Affidavit
7. Application for Health Professions Trainees (VA Form 10-2850D)
8. Declaration for Federal Employment
9. I-9 – Employment Eligibility Verification
10. Fingerprinting and obtain ID Badge from VA Police (within 1 week of completing Packet)
Review of Student Handbook
Completion of VA Mandatory Training for Trainees – MTT) on-line. Your school will
provide direction. 14 modules included with post-tests- final certification of completion
required for turn in to school’s Course Coordinator.
Completion of Computer Sign-on (if applicable) & Computer training - accessed through
school’s intranet (Power Point Presentation) – sign-on will occur first day of clinicals
For new students: Complete both mandatory trainings. Please have your school (by your identified POC instructor, course coordinator or other) validate completion of training via email to Edie Dozsa, VA Nursing
Education Affiliations Coordinator at [email protected].
For returning students: The trainings are good for one year, from the time the trainings were completed.
Glucometer training (if applicable) – will be provided first day of clinicals
Complete Learner Perception Survey (return Certificate of Completion at end of rotation)
Return ID Badge to instructor or Nursing Education at end of rotation
***You will not be allowed to begin your rotation at the VA you have completed your
fingerprinting/badging and completed Mandatory training.
Questions??? Contact Edie Dozsa at the VA (386-755-3016 ext 3367) or [email protected]
Rev 4-11
SW 16th Street
Tunnel
to
Shands
6
2
Stairs
E
In this wing of the Basement
all rooms begin with FB
G
Includes Bsmnt & 1Flr
T-7 Compensation & Pension
Includes Basement & 5 Floors
3
8
D
Elevators A
SW Archer Road
Emergency
Room
Entrance
Elevators B
F
Elevators C
Stairs
Public Entrance
(Basement)
Main Patient
Parking Lot
Public Entrance
Stairs
At least one main hallway runs the length of the Medical Center on all floors
C
Public Entrance
A
B
9
Malcom Randall VA Medical Center
1601 SW Archer Road, Gainesville, Florida
Bridge - 1st floor main bldg
Includes Basement & 5 Floors
T-4 GRECC
North
1
5
Nursing
Home
(NHCU)
SW 16th Avenue
•
All PODs are on First Floor in G Section
Admitting / Bed Control ....................................... E-100 ........................ Floor 1
Agent Cashier ..................................................... F-138-1 ..................... Floor 1
Ambulatory, Primary or Urgent Care ................... Section G .................. Floor 1
Audiology / Speech Pathology ............................ EB-36 ....................... Bsmt
Auditorium ........................................................... A-136 ........................ Bsmt
Brain Rehab Research Cntr ................................ NHCU ....................... Floor 2
Canteen (Retail Store) / Cafeteria ....................... B-049 ........................ Bsmt
Cardiology Heart (Clinic 4C)(Pre-op E-345) ....... A-134 ........................ Floor 1
Cardiac Cath Lab Heart ...................................... C-254 ........................ Floor 1
Chapel / Chaplain office ...................................... B-230 ........................ Floor 1
Compensation & Pension ................................... T-7 ............................ Trailer 7
Credit Union ........................................................ A-031 ........................ Bsmt
CT / Ultrasound ................................................... E-193 ........................ Floor 1
Cytology Cells .................................................... D-316 ........................ Floor 1
Day Stay (Medical) .............................................. A-323 3B ................ Floor 3
Day Stay (Surgical) ............................................. (Check in @ ER) ...... Floor 3
DAV Service Officer ............................................ A-165A ..................... Floor 1
Dental Teeth ....................................................... E-270 ........................ Floor 2
Details Clerk ........................................................ A-546 5C ................ Floor 5
Dialysis ................................................................ A-531 5B ................ Floor 5
EEG Brain Waves ............................................. E-236 ........................ Floor 2
EKG / ECHO Heart ............................................. E-348 ........................ Floor 3
Eligibility / Registration ........................................ F-101 ........................ Floor 1
EMG Muscle ....................................................... B-218-1 ..................... Floor 1
Emergency Room ............................................... E-104 ........................ Floor 1
ENT / Plastics Ear, Nose & Throat / Surgery .... EB-18 ....................... Bsmt
Escort Room ....................................................... A-164-a-1 ................. Floor 1
Eye Clinic ............................................................ E-405 ........................ Floor 4
Satellite (Check in at Eye Clinic first) ........... D-353 ........................ Floor 1
Evaluation Clinic ................................................. CE-128 ..................... Floor 1
FDVA Veteran Affairs ........................................... D-162 ........................ Floor 1
GRECC Geriatric Research .............................. T-4 ............................ Trailer 4
Geriatric FIRM ..................................................... NHCU ....................... Floor 2
GI Lab / Gastroenterology Digestive ................. E-324 ........................ Floor 3
Home Base Primary Care ................................... T-2 ............................ Trailer 2
Human Resources .............................................. T-1 ............................ Trailer 1
Information .......................................................... F & A Lobbies ........... Floor 1
Insurance Clerk ................................................... ES-29 ....................... Bsmt
Laboratory ........................................................... E-126a ...................... Floor 1
Library ................................................................. E-420 ........................ Floor 4
MAA Desk ........................................................... E-100 (ER Lobby) ..... Floor 1
Medical Media Production................................... E-432-1 ..................... Floor 4
Medical Clinic .................................................... A-450 4C ............... Floor 4
Medical Records (Release of Info) ...................... ES-29 ....................... Bsmt
Mental Hygiene Clinic ......................................... E-208 ........................ Floor 2
MRI Magnetic Resonance Imaging .................. Tunnel ...................... Bsmt
Neurology Nervous System .............................. E-229 ........................ Floor 2
Nuclear Medicine ................................................ A-014 ........................ Bsmt
Nursing ................................................................ E-247 ........................ Floor 2
Nursing Home Care Unit .............................. (top of map near B&C) .... NHCU
Nutrition & Food Service ..................................... B-050 ........................ Bsmt
Occupational Therapy ......................................... B-225 ........................ Floor 1
Optical Dispensory Eyeglasses ......................... B-046a ...................... Bsmt
Orthopedics Bone & Joint (Clinic 3B) ................ B-204 ........................ Floor 1
Pain Clinic (Check in @ front desk ER entrance) .................................. Floor 1
Patient Advocate (Director’s Suite) ..................... A-107 ........................ Floor 1
Patient Clothing Personal Effects ..................... C-081-1 .................... Bsmt
Pharmacy ............................................................ G-168 ....................... Floor 1
Physical & Rehabilitation Medicine ..................... B-218-1 ..................... Floor 1
Physical Therapy ................................................ B-222 ........................ Floor 1
Police .................................................................. A-158b & ER ............ Floor 1
Primary Care Clinics (PODs 1, 2, 3, 4) ............... Section G .................. Floor 1
Prosthetics .......................................................... FB-118 ...................... Bsmt
Psychiatry Mental ............................................... E-221 ........................ Floor 2
Psychology Behavioral ...................................... E-253 ........................ Floor 2
Pulmonary Lungs ............................................... E-545 ........................ Floor 5
Radiology X-Ray ................................................. E-336-1 ..................... Floor 1
Recreation Therapy (Next to Auditorium) ............ EB ............................. Bsmt
Registration ......................................................... F-101 ........................ Floor 1
Release of Information (Medical Records).......... ES-29 ....................... Bsmt
Social Work ......................................................... E-030 ........................ Bsmt
Specialty Clinic .................................................... 3A ............................. Floor 3
Travel Clerk ......................................................... F-140-1 ..................... Floor 1
Tunnel (connects VA to Shands) ......................... A ............................... Bsmt
Urgent Care or Primary Care (PODs) ................. G ............................... Floor 1
Urology / GU Urinary Track (Clinic D370A-1) .... B-137 ........................ Floor 1
Vascular Blood Stream (Clinic 3A) .................... A-578-1 ..................... Floor 5
Veterans Assistance Benefits ............................. E-520 ........................ Floor 5
Visual Impairment (VIST) .................................... E-508 ........................ Floor 5
Voluntary ............................................................. EB-55 ....................... Bsmt
Waiting Rooms CTICU, SICU ............................. B-208 ........................ Floor 1
MICU ........................................................................... Floor 3
Please
te to ask an emplo
yee ffor
or dir
ections
Please,, do not hesita
hesitate
employ
directions
ections..
Most room numbers begin with Section letter A, B, C, D, E, F or G
Units 8 & 9
Units 2,3,4 S
Dental
Director's
Suite
VAPD
Blue
Social
Work
Units 2,3,4 N
Voluntary
Service
E.R.
WC
Orange
Chaplain
WC
DLC
Business Office
Produced by Lake City Medical Media 2006
Lake City VAMC
NHCU 1– 4
CHAPEL
Learning
Resource
Center
Smoking
Patio
CANTEEN
Parking
Outpatient
OUTPATIENT
CLINICS
AUDITORIUM
Baya Ave
RETAIL
STORE
X – RAY
South Marion St.
WC
N
Restroom (1st floor)
Nursing Home Main Entrance
Outpatient Main Entrance
Hospital Main Entrance
Emergency Room Entrance
Main Corridor/Halway
Elevator
Unpaved Grounds
Paved Grounds; Parking Areas
Support Facilities
Canteen and Retail Store
1st floor – Nursing Home Care Unit 1;
Occupational Therapy,
2nd floor – Nursing Home Care Unit 2
3rd floor – Nursing Home Care Unit 3
4th floor – Nursing Home Care Unit 4
1st floor – Outpatient Clinics, Pharmacy,
Emergency Room & Life Support
Basement – Inpatient Pharmacy
1st floor – Radiology, Dentistry,
Dietetics and Chapel
2nd floor – Units 2N, 2S; Cardiology,
Rehab and Medicine
3rd floor – Units 3N, 3S; Laboratories
4th floor – Units 4N, 4S; ICU & Surgery
LEGEND
Student Parking Pass
This authorizes _________________________________________________
(Name of student/instructor)
from _________________________________________________________
(School and program name)
to park at the Lake City VA Medical Center during their clinical rotation or for
official student business only.
Time periods include ____________________________________________
Parking is permitted in the following lots: Orange, Brown, Pink or Green
parking lots. NO parking is permitted in spots designated for patients.
For any questions, please contact Edie Dozsa, Affiliations Coordinator and
Nurse Educator at the VA Nursing Education Office
(LC 386-755-3016 ext 3367 or GV 352-379-4018)
4.
1.
2.
3.
Go to the link: http://www.va.gov/oaa/lpssurveys/login.asp?surveyid=4
Follow instructions to log on to site (u sing you r initials and last 4 of you r phone nu m ber)
After you log on, you w ill be asked to select the facility of you r training experience. The only options
are Gainesville or Lake City. If you are at a satellite clinic, please select the m ed ical center you are
closest to in d istance (Gainesville VAMC or Lake City VAMC).
Fu rther into the su rvey, you w ill be asked the total hou rs of this rotation and w hat percentage of you r
total program hou rs this rotation consu m ed . Consu lt your facu lty coord inator if you are u nsu re abou t
these figu res.
*** Exam ple: this rotation w as a total of 50 hou rs… you r program has a total clinical
requ irem ent of 200 hou rs. So you d ivid e these figu res, 50 d ivid ed by 200 = .25 (so, 25% is w hat you
d ocu m ent).
*** Su rvey STEPS:
N F/SG VHS needs your feedback on your clinical experience. Please evaluate the VA by
completing the survey (Learner Perception Survey) at the follow ing link.
Estimated time to complete is 15 minutes. Each individual can submit one survey
per fiscal year. We value and appreciate your input, thank you!
If you are finishing you r VA clinical rotation, p lease read on!
(i.e. BSN , ASN , PN , MSN , DN P, CN A, PCA, PCT, surgical tech,
m ed ical assistant or Wound Ostom y Certificate stud ents)
Attention: Students in N ursing Service
Welcome To Our Healthcare System
The North Florida/South Georgia Veterans Health System (NF/SG VHS) extends a warm welcome from
our Director and the Associate Director for Nursing Service. This handbook is a guide to assist you in
these activities. We hope your time with us is both positive and rewarding.
The NF/SG VHS consists of two medical centers (Gainesville and Lake City). There are three satellite
outpatient clinics (Tallahassee and Jacksonville) provide primary and specialty care. Six communitybased outpatient clinics provide primary care and are located in Lecanto, Marianna, Ocala, St.
Augustine, St Mary‟s, Summerville, Taylor County Rural Health Clinic, The Villages and ValdostaGeorgia. Clinics in Palatka and Perry are to open summer 2010.
Primary Service Area:
North Florida/South Georgia Veterans Health System
NF/SG VHS is part of Veterans Integrated Service Network (VISN) 8. There are 21 VISNs nationwide.
VISN 8, the Sunshine Network, includes all VA facilities and outpatient clinics located in Florida,
Valdosta, GA, and Puerto Rico.
Mission, Vision, and Values
Our MISSION is to honor America‟s veterans by providing exceptional health care that improves their
health and well being.
Our VISION is to be a patient centered integrated health care organization for veterans providing
excellence in health care, research and education; an organization where people choose to work; an
active community partner and a back-up for National emergencies.
The VALUES that guide our actions and choices in achieving excellence are TRUST, RESPECT,
EXCELLENCE, COMPASSION, and COMMITMENT.
PATIENT RIGHTS
Veteran patients have earned some/all hospital and medical service coverage by virtue of their honorable
participation in the United States Armed Forces. The goal of the health care team is to reflect the values
of trust, competence, integrity, teamwork, compassion, respect, and accountability. In order to
accomplish this, we must:
Treat patients & their families with concern, compassion, and dignity as individuals
Respect patients‟ personal values and beliefs
Uphold patient rights and responsibilities as they apply to each individual patient
The veteran has the right to receive, to the extent eligible, prompt and appropriate treatment (that is
consistent with the System capacity, capability, and resources) for physical or emotional disorders or
disabilities, in the least restrictive environment necessary for that treatment, free from unnecessary or
excessive medication. If, for any reason, the System cannot meet the patient‟s request for care, efforts
will be made to explore alternative treatment sources. Veterans deserve to be treated with dignity,
compassion, and respect. Pain will be addressed and appropriate treatment delivered.
The veteran has the right to expect privacy in all personal and physical matters. All records &
communication pertaining to patient care must be treated as confidential and must be accessed only by
those people directly involved in the care. Nurses are the patient‟s privacy advocate. Completion of
VHA HIPPA training program is required for all students. It is accessible on the web or by hard copy.
If completing the training outside of the VA hospital, use website: https://www.ees-learning.net
& if taking the program on line while at the VA, use https://vaww.ees.aac.va.gov.
Students need to submit Verification of Training.
Should there be any question regarding patient care, the student should report any concerns and
considerations immediately to staff. Patient safety is a priority of care.
Restraint use is sometimes indicated for medical or behavioral reasons. The least restrictive method
must be utilized following strict policy guidelines and documentation requirements. Successful unitbased training and demonstration is required. The three policies that must be followed are:
NF/SG VHS Memo 11-37
Use of Restraint During Acute/Medical/Surgical Care
NF/SG VHS Memo 11-38
Use of Restraints / Seclusion for Behavioral Health Reasons
Geriatrics & Extended Care
Memo 7
Use of Physical Restraints in Extended Care
ETHICS
Patient problems and difficult situations should be promptly reported to your clinical instructor,
charge/head nurse, or nursing supervisor. Concerns arising regarding care given a patient should be
reported through proper channels in a timely manner. Students & staff are not allowed to accept gifts
from patients. They are also not allowed to accept gifts from businesses because this would be a conflict
of interest if the company wants to do business with the VA. All ethical dilemmas may be addressed
through the System Ethics Committee on an on-going basis through contacting the head
nurse/supervisor.
ORGAN, EYE & TISSUE DONATION
This organ/tissue donation process is conducted through contacting Medical Administration Staff.
Organ donor information is available on each patient‟s medical record. Through the admission process
each patient is asked whether they would want to be an organ donor or change their status of organ
donation. It is also mandatory that all hospital deaths and imminent deaths, regardless of age or
medical/social history be reported to the OETO Office at 1-800-535-4483. An on-line education
program is available to all staff and students on the Performance Improvement training website, titled:
Organ, Eye & Tissue Program.
ADVERSE EVENTS
All students are responsible for reporting and documenting actual and potential medication and
treatment errors and/or other patient or visitor adverse events such as falls by completing an Incident
Report (through your clinical instructor). In addition, a progress note should document what occurred
and any treatment provided.
ABUSE AND NEGLECT
All cases of abuse or neglect are immediately reported to your clinical instructor, charge/head nurse, or
nursing supervisor in accordance with Policy 122-1. Our system has criteria for identifying victims in
the following situations: physical assault, rape, sexual molestation, domestic abuse, elder neglect or
abuse, and child neglect or abuse. Staff is educated about abuse and neglect and how to refer as
appropriate. Staff screen for abuse and neglect as indicated by the patient‟s needs or conditions. Full
assessment for alleged abuse, suspected abuse, or neglect is referred to SHANDS Healthcare.
IMPORTANT PHONE NUMBERS
Gainesville: 352-376-1611
Lake City: 386-755-3016
Gainesville
1.
Medical Emergency
6911
40
All
Clinics
911
2.
6911
40
911
3.
Behavioral Crisis
Intervention
Disaster
6911
40
911
4.
Fire
6333
40
911
5.
6.
Bomb Threat
Medical Center
Police
Chemical Spills
Infection Control
Safety and Health
6911
6564
40
2026
911
4043/6616
6438
6560
2951 *
2404 *
2150
7.
8.
9.
Lake City
Comments
Repeat 3x location and
nature of emergency
Repeat 3x location and
nature of emergency
Repeat 3x location and
Nature
R.A.C.E. & Repeat 3x
location
If unable to reach dial 0
and tell operator
* Cover each other
* Cover each other
PAGING SYSTEM
1. Dial the access number 32 Gainesville and 76 or 77 Lake City
2. Enter beeper # after the voice prompt
3. Enter extension number from telephone you are calling from after the voice prompt
4. Hang up and wait for response. Keep the phone line open for a few minutes if possible.
SAFETY - KEY POINTS
Hospital Safety Officer for Gainesville can be reached by calling ext 6560.
Hospital Safety Officer for Lake City can be reached by calling ext 2150 or 2138.
Oxygen valves are located in the hallway entering your area.
- The charge nurse can shut off the oxygen in emergency situations.
KNOW LOCATION OF:
1. MSDS (stands for Material Safety Data Sheet) Manuals are blue with yellow letters.
- Gives first aid, precautions, procedures for spills, etc.
- Gainesville chemical spill, call Ext 4043 or Pager 134
- Lake City chemical spill, call Ext 2951 / 2138
2. Disaster Manual is called the Emergency Management Plan.
3. EOC Manual (Environment of Care) – holds hospital fire & safety regulations/plan.
FIRE
During a fire – follow the RACE procedure
Rescue from immediate danger
Alarm - activate fire alarm.
-Alerts the Fire Department / Notifies hospital of needed medical center staff.
- Fire alarm pull stations - at the exits, exist stairwells, and the nurses‟ stations.
- Fire alarm bells ring in sequence of four numbers such as 1-3-6-5.
- Fire alarm code boards on walls of each unit – shows fire location by bell count
Confine fire by closing doors
Extinguish Fire (if easily contained). – see PASS
E – Evacuate if necessary – Horizontally, fastest, safest way possible
- Beyond the fire/smoke doors and into another compartment
Fire Extinguishers- Use the PASS method for using fire extinguishers.
Pull the pin.
Aim the nozzle.
Squeeze the handle.
Sweep the nozzle from side to side at the base of the fire.
SMOKING REGULATIONS
All NF/SG VHS facilities are smoke-free environments. Patients, visitors, and staff may smoke in
designated areas outside the building. Nursing home residents may smoke at designated areas within the
building.
It is important that staff enforce this policy and set the proper example. There should be no smoking
allowed near any entry/exit.
TERRORISM
Types of terrorism include: Nuclear, Biological, Chemical and Explosive. A terrorist attack is a
deliberate incident that has the potential to produce large numbers of casualties. These deliberate attacks
can range from a pipe bomb placed under a tanker carrying chlorine to the release of a lethal nerve agent
in an enclosed area (e.g., subway, sports arena, or shopping mall). In comparison to the hazardous
materials routinely transported in a community, NBC (nuclear, biological, chemical) agents are more
toxic at lower concentrations. Milligram quantities of NBC agents can cause injury or death to
thousands when disseminated correctly.
Due to the sheer number of victims expected from an NBC terrorist attack, EMS providers and local
hospitals may become quickly overwhelmed with injured and psychogenic patients. This volume of
victims is rarely seen in everyday hazardous materials incidents. Regardless of the level of care
provided at the scene of the incident, most of the victims seek out the closest hospital for care. They
will arrive at the hospital by ambulance or private car, often with little or no warning.
After a terrorist attack, there may be secondary devices present at or near the incident site, as well as at
hospitals. This is especially true since hospitals represent an important resource for mitigating the
effects of the attack. These devices may be of conventional high explosive fill, or may be constructed to
deliver additional NBC material.
The focus of health care providers is domestic preparedness and the treatment of casualties. An on-line
course, “An Introduction to Nuclear, Biological and Chemical Threats” is accessible to all hospital
employees on the education webpage. Pocket guides are available
at:www.oqp.med.va.gov/cpg/cpg.htm.
CARE OF THE DYING PATIENT
Inpatient and outpatient hospice and palliative care services are offered through our interdisciplinary
palliative care team. Unique needs of the dying patient are provided through physical and psychological
comfort initiatives. Advanced Directives are given prime consideration.
STANDARD PRECAUTIONS
Disease in the healthcare workplace can spread to employees and patients. Controlling the spread of
germs may be as simple as washing your hands, or using personal protective equipment and knowing
how to dispose of infectious wastes and sharp instruments (i.e., needles, scalpels).
The NF/SG VHS adheres to the Occupational Safety and Health Administration (OSHA) standards for
blood borne pathogens and mandates the use of standard precautions by all staff at risk of exposure.
Personal protective equipment such as gloves, face shields, eye protection, etc., is provided.
Contaminated needles/sharps will not be bent or recapped, but discarded in appropriate containers. Any
significant exposure (i.e., contaminated needle stick or sharps injury) is to be reported immediately to
your supervisor.
Hand washing is the single most important way to prevent infection. It's everyone's
responsibility!!!! HANDWASHING with soap and water should be performed before and after physical
contact with patient, before eating, after using the bathroom and when there is a "build-up" of emollients
on the hands after repeated use of alcohol-based products. The CDC Fact Sheet can be accessed at:
http://www.cdc.gov/od/oc/media/pressrel/fs021025.htm
Direct patient care personnel may not wear artificial nails.
Natural nails neatly
trimmed, clean and reasonable length of no more than ¼ inch past the tip of the finger is
recommended.
Tuberculosis: NF/SG VHS adheres to the CDC guidelines concerning employees at risk of exposure to
tuberculosis. New employees will be fit tested for a respirator during orientation. The respirator must
be worn while providing care to any patient with a suspected or confirmed contagious respiratory
disease.
DOCUMENTATION
Documentation in the patient‟s medical record should reflect the patient‟s progress and the effectiveness
of the plan of care implementation as related to specific problems/diagnoses. The VA uses the
Computerized Patient Record System (CPRS). Medication and IV‟s are documented using the Bar Code
Medication Administration (BCMA) system.
If patient care and outcomes achieved are not documented, it did not occur. Using approved
abbreviations and documenting the nursing process will represent care given and results achieved.
PAIN – The 5th Vital Sign
Since 1997 the Department of Veterans Affairs launched an intensive comprehensive pain program.
Emphasis on Pain as the 5th vital sign has been instituted. Clinical practice includes the assessment,
treatment, reassessment, evaluation and resolution of pain by all clinical staff. A system pain policy is
in practice. The RN or MD clinically assesses veterans experiencing pain at or above the level of 4 with
a therapeutic intervention to decrease the suffering. You must notify the staff of pain level of 4 or
greater!!! JCAHO Standard compliance regarding pain is emphasized. The patient care outcome of pain
Medications and/or treatment modalities must be recorded in the CPRS record.
http://vaww.va.gov/oaa/pocketcard/pain5thvitalsign/PainToolkit
On-going pain web-based training is available: Pain Management Mandatory Training.
PROFESSIONAL CONDUCT
Professional conduct by the health care team is important in maintaining therapeutic relationships with
patients. Interactions should be patient-centered on providing care that will lead to positive patient
outcomes. Acceptance of money, gifts, loans, or favors from a patient or family member is against VA
policy. Acceptance may result in a conflict of interest that may affect performance of duties, and may
be perceived as trying to influence your actions. Students are not to assume personal responsibility for
patient‟s funds, personal effects, or valuables. See ethics.
ILLNESS OR INJURY
If you are unable to report for duty, notify your instructor before clinical begins. If you become ill, are
injured, or contract an illness while working at the VA, contact your instructor and/or preceptor. The
medical center/s maintains an Employee Health Service that is available for emergency treatment.
In Gainesville: They will refer you to Employee Health or the Emergency Room.
-Emp. Health hours are Mon-Fri (0830-0930) & (1300-1400) – Room E126A.
- Phone ext 5158
In Lake City: They will refer you to the Life Support Unit.
-Emp. Health hours are Mon-Fri (0800-1630).
-Phone ext 2605
If you are injured, your immediate supervisor will assist you in filling out the proper form (VA Form
CA-1 and in using the computer program (ASISTS) to complete the documentation of injury.
TELEPHONE CALLS
Please request friends and family to restrict call to EMERGENCY needs only. When friends and family
need to contact you, be sure that they are able to state the name of your assigned area. This
information is needed to locate you in an expeditious manner. Cell phone usage is not permitted in
patient care areas – restrict usage to meal/break periods.
UNIFORM POLICY
While at the VA Medical Center, you are required to adhere to your school‟s uniform policy or as
determined by your assigned unit. A clean, neat professional appearance is expected at all times. Hair is
to be clean & controlled. No artificial nails. Nail length no more than ¼ of an inch past tip of finger.
Students are required to wear photo identification nametags at all times while in the medical
center and on grounds.
CULTURAL DIVERSITY
The VA supports and values a culturally diverse staff. A strong education program, complaint process,
& preventative program are well established in the VA system. Discrimination based upon age,
disability, national origin, pregnancy, race, and sex will not be tolerated. Compensation and pay are
carefully monitored to maintain equality. Students are encouraged to complete our web-based 2 credit
program at http://vaww.north-florida.med.va.gov/Services/Eduation/Eeo_Mandatory.
CONTINUING EDUCATION
In-service programs are presented for all hospital personnel. Announcements are sent to all clinical
areas in advance of presentations. You may be scheduled to attend education programs. All staff is
required to have 40 hours of continuing education every year (20 hours must be in patient safety).
PARKING
Parking at the Gainesville VA is a huge concern. There are not enough parking spaces to accommodate
patients and staff. If you are leaving the VA after dark, you may contact the police officers for escort
service to your car.
Gainesville Parking:
1. Parking - available on the streets adjacent to the VA on SW 16th Ave & SW 16th St.
2. Parking is now available at four off-site lots for the GV VA students. See map in the Student
Handbook. Shuttle Service is available between 0600 and 2000 Monday through Friday. Should you
need shuttle service outside these hours, arrangements must be made with the police (phone x4091) for
transport.
3. There is also a University of Florida parking lot located to the west end of the VA lot, accessible
from SW 16th Avenue.
Lake City Parking: Parking is available in brown, orange, green, pink lots. A parking pass is located
in the handbook and must be displayed on your dash. If any questions, your instructor may contact VA
Police for other authorized parking areas (ext 2026).
th
LIBRARY
The Medical Library is located on the 4 floor in rooms (E-421, E423, E-424) in Gainesville (follow
signs for Nursing Education –they are near each other. In Lake City, the library is on the first floor near
the cafeteria. The Library maintains both a general library (for staff, patients, & students) and a
professional library (for staff & students). A variety of materials are available for patient and staff
education including periodicals, references, audiovisuals, and books. Students will be asked to show an
ID. Library hours are 8:00 AM – 4:30 PM Monday-Friday. The librarian and staff are available for
assistance in using the library upon request.
LOST AND FOUND
Lost and Found is located in the Gainesville Mail Room in the basement (Room E-051). During nonduty hours (1640 – 0800), contact Medical Administration (x6724), who will turn in found articles to the
Mail Room on the next administrative day.
In Lake City, Lost and Found Telephone Operator‟s Office, Room A 164.
CANTEEN SERVICE
The Veterans Canteen Service operates a cafeteria, retail store, and the vending machines at both the
Gainesville and Lake City divisions. These services are located on the basement level toward the rear of
the building in Gainesville and on the first floor in Lake City. The cafeteria serves full-course, hot
meals and provides a short order service. The retail store carries a range of items for patients and
personnel. Students are welcome. Vending Machines are located at strategic places throughout the
medical center and are open 24 hours a day. Canteen is closed post 1400 daily with has limited hours on
weekends.
Tips to Know at the VA
1. Using a Glucometer for ancillary testing of blood glucose: ***
a. Wipe alcohol off finger & discard the first drop of blood.
b. Need a large drop of blood to ensure sufficient sample size.
c. When result is < 50 or is > 500, this is considered a critical value.
-use the comment codes of the glucometer to insert comment.
d. If comment not inserted with glucometer, it needs to be in nursing note.
Ex: At 1146, ancillary glucose of 36 obtained. Patient not symptomatic.
Rechecked immediately – repeat ancillary glucose was 130.
e. VA policy is:
1) REPEAT – repeat the test
2) TREAT – follow the doctor‟s orders for treatment
3) SEND – send a LAB specimen
4) NOTIFY - The doctor‟s sliding scale orders always state to notify MD for critical
values (less than 50 or greater than 500).
f. Charting:
1) If you list specific glucose values, make sure you list the correct number.
2) If you did not comment in glucometer, put it in your note. – „Repeat test.‟
3) Document whether patient is symptomatic or asymptomatic. Symptoms of
hypoglycemia are:
a) Weakness
b) Restlessness
c) Nervousness
d) Hunger
e) Sweating
4) Document that you notified the RN caring for the patient.
5) Document that you notified the MD.
6) Document treatment
7) Document the patient response to treatment.
***Gainesville has 2 Ancillary Testing Coordinators:
Diane Young at 376-1611 Ext 5319
Susan Chun at 376-1611 Ext 5819
Both are willing to provide a special training class for interested faculty & students .
You can schedule them during your pre-conference, post conference, or any other convenient time. .
2. When in a patient’s record in CPRS (Computerized Patient Record System), go to the toolbar at
the top of the page. Click on ―Tools‖ and it will give you a list of helpful sites including:
a. Dangerous Abbreviations” - gives a list of abbreviations not to use
b. “Abbreviations” – gives a list of approved abbreviations
c. Nursing Procedures – pulls up Lippincott‟s Welcome to Procedure reference which is in our
procedure manual.
3. How To Call A CODE:
Step One
Gainesville VAMC, dial 6911
Lake City VAMC, dial 40
Note: OPCs & CBOCs call 911
Step Two
Say "I need to call a Code [Blue]" - state the appropriate color
Tell the operator where you are located - be specific (e.g., "in hallway near the ER")
- room numbers are not needed
Please do not hang up until the operator says it is OK
Emergency Codes
1. Code Blue = Medical Emergency
2. Code Red = Fire Alarm
3. Code Purple = Fire Alarm Out of Order
4. Code Black = Bomb Threat
5. Code Green = (12 tones) Mass Casualty Disaster or (4 tones) Internal Disaster
6. Code Brown = Severe Weather
7. Code Yellow = Lockdown
8. Code Pink = Infant/Child Abduction
9. Code Orange = Hazmat/Bioterrorism
10. Code Grey = Violence/Security Alert
11. Code White = Hostage
4. Changing Signature Block (for students who are VA employees)
Changing Signature Block
(For Students who are also Employees)

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
Open VISTA
Type TB and hit enter to open Tool box options
Type ELE (Electronic Signature Block Edit) and hit
enter
Locate the entry that reads Signature Block Title
Type your current title (e.g. SNT) and hit enter to
accept new entry. Continue to enter through until
you get back to menu prompt.
You may want to confirm that new entry was
accepted. To confirm just choose ELE again, from
the Toolbox main menu and locate again your
signature block title. It should display the most
recent changes entered during this current process.
If information displayed in your signature block is
incorrect, you may repeat this process or contact the
Help Desk @ 6901.
Tip: You must change your Sig Block to match your
correct title every time you work !!!!
158
5.
The Joint Commission Tips of the Day
**** Storage of O2 Tanks ****
O2 tanks must be stored in a stand
Tanks standing upright without any bracket support can fall and become explosive
missile like objects
****
Exit Corridors ****
All exit corridors/hallways must be clear, nothing should be blocking a exit corridor
or entrance to a stairwell.
Nothing should be stored in any stairwell.
**** Glucose Strips & Glucometer Control Vials
Open date is required on the containers and vials
Controls good for 90 days once opened
Glucose alert value is < 50mg/dl >500 mg/dl
**** Crash Cart Locks ****
The lock number needs to be accurately recorded on the log & checked
daily
**** Invasive Procedures “Time Out” ****
For Invasive Procedures, take “time out” to ensure the following information is
correct:
-Patient
-Procedure
-Site
-Position
-Implant (if applicable)
There is an invasive procedure template that includes all the required documentation
needed for Joint Commission
**** Medication Reconciliation ****
Reconcile what medications the patient says he/she is taking with the patients records
and what is actually ordered
Make sure that herbals and over the counter medications are included
Reconcile with the patient, at every clinic appointment and with inpatient transfer of care
to a new setting, service, provider or level of care.
**** Patient Privacy ****
Ensure that restroom doors and privacy curtains are closed while in use.
Ensure that patient health information is secured by using privacy screens on computers, securing
patient information from being accessible to others (visitors, other patients, etc).
**** Hemoccult Developer Storage ****
(Use for Occult blood testing) May not be located anywhere in the clinical setting
except the Laboratory.
**** Monitor Refrigerator Temperatures ****
Refrigerator temperatures must be monitored/recorded daily with patient items
located inside, including weekends, except when clinics are not open and then
document on the next working day, the range and cross out the weekend dates.
Weekend temperatures may be captured by special thermometers, supplied by
pharmacy, that indicate any out of range temperatures.
Temperature range for the weekend must be documented on the temperature log from
the range thermometer the next working day even if the area was not used, but had
patient items stored inside, need to document under Mondays date by a note in
comment area ( the temperature range thru weekend or no patient items stored).
If temperature is out of range, action must be documented
Some medication refrigerators are hooked up to a temperature tracking automation
system, which automatically records the temperature of these refrigerators and
records are kept by pharmacy.
**** Expiration of Multi-dose Vials ****
Date must be placed on the vial once opened.
Multi-dose vials expire 28 days after opening; unless the manufacturer/ label states
otherwise (shorter expiration).
**** Linen Cart Storage ****
Store clean linen carts separate from dirty linen carts
Also keep clean and dirty linen carts covered; whether they are in a closed room or
ward hallway.
The carts must not be overly stuffed; the cart cover must cover and protect all the
linen stored on the cart.
There must be a protective barrier on the bottom shelf of the cart.
**** Stained Ceiling Tiles ****
If you see a stained ceiling tile in your work area or hallway corridors, report it to
your supervisor; a work order will need to be placed
**** Improper Storage of Food & Personal Items ****
Patients food/drink should always be separate from staffs food/drink
Staff food/personal items should not be with or in patient care areas, i.e. medication
carts or treatment carts.
Under sink storage is only for cleaning supplies.
**** Use of Personal Protection Equipment ****
Always use Universal Precautions with patient care
Use Personal Protection Equipment (PPE) appropriately
Don‟t cut off ties on mask: Tie Them!
Wash or use hand cleansers between glove changes.
**** Expired Hand Cleansers ****
Check expiration dates on alcohol based foam cleaners
Date is located on the bottom of the containers
**** Critical Values/Alert Values ****
Critical Values need to be reported timely & verbally read back.
The documentation of the verbal read back needs to be included in the patient‟s
electronic medical records (laboratory document‟s their results in the test result
comment section).
Critical Values are from Laboratory, Radiology, Nuclear Medicine, Respiratory
Therapy, and
Critical/Alert Value Documentation: there must be documented action taken as a
result of the notification of the critical result by the service.
Read Back Documentation: telephonic reporting of Critical/Alert value (critical)
results and read back verification; verify the Critical/Alert test result by having the
person receiving the test result read back the complete test result. The comment,
Provider/designee read back results and verified, will be documented in the medical
record.
**** External Shipping Boxes ****
Should not be stored in any area where patient items are kept. They should be
removed from external shipping labeled boxes to plastic storage bins.
**** Cart Barriers ****
There should always be a barrier at the bottom of carts so mops, etc. do not get
patient items dirty/wet.
Linen carts must not be overly stuffed, so linen does not hang down off the cart.
**** Separation of Clean & Dirty Items (Which Includes Personal Items) ****
Patient items need to be separated from office supplies, dirty supplies, and employee
personal items by a solid barrier.
**** Verbal Orders ****
All verbal orders need to be verbally read back and written down (either on paper for
the medical chart or electronically in the computer in CPRS. The documentation of
verbal read back needs to be included in the patient‟s medical record.
6.
2010 NATIONAL PATIENT SAFETY GOALS
The purpose of the Joint Commission’s National Patient Safety Goals is to promote specific improvements in
patient safety. The Goals highlight problematic areas in health care and describe evidence and expert-based
solutions to these problems. Please talk with your supervisor to see how these goals have been implemented at
NF/SGVHS and your role in these goals.
You might notice that some goals and requirements appear to be misnumbered or missing from the numerical
sequence. This is not a typographical error. Some goals do not apply or have become standards for that
particular program.
Note: New Goals and Requirements are indicated in bold.
2010 JCAHO Patient Safety Goals and Their Applications to NF/SGVHS
Programs
HOSP
LTC
BHC
HC
LAB
BHC = Behavioral Health Care, HC = Home Care, HOSP = Hospital, LAB = Laboratories, LTC = Long Term Care
Inpatients (All acute Med/Surg/Mental Health)
Outpatients
Laboratories (Medical Centers/Satellite Clinics)
Nursing Home Programs
Home Care
Day Treatment Program
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2011 HOSPITAL NATIONAL PATIENT SAFETY GOALS
(Hospital includes all clinics at NF/SGVHS)
Goal 1
01.01.01
01.03.01
Improve the accuracy of patient identification.
Use at least two patient identifiers when providing care, treatment or services.
Eliminate transfusion errors related to patient misidentification.
Goal 2
02.03.01
Improve the effectiveness of communication among caregivers.
The organization measures, assesses, and, if needed, takes action to improve the timeliness of
reporting and the timeliness of receipt of critical tests and critical results and values by the
responsible licensed caregiver
Goal 3
03.04.01
Improve the safety of using medications.
Label all medications, medication containers (for example, syringes, medicine cups, basins), or
other solutions on and off the sterile field.
Reduce the likelihood of patient harm associated with the use of anticoagulant therapy.
03.05.01
Goal 7
07.01.01
07.03.01
07.04.01
07.05.01
Goal 8
08.01.01
08.02.01
08.03.01
08.04.01
Reduce the risk of health care-associated infections.
Comply with current World Health Organization (WHO) Hand Hygiene Guidelines or Centers for
Disease Control and Prevention (CDC) hand hygiene guidelines.
Implement evidence-based practices to prevent health care–associated infections due to
multidrug-resistant organisms in acute care hospitals.
Implement best practices or evidence-based guidelines to prevent central line–associated
bloodstream infections.
Implement best practices for preventing surgical site infections.
Accurately and completely reconcile medications across the continuum of care.
A process exists for comparing the patient’s current medications with those ordered for the
patient while under the care of the organization.
When a patient is referred to or transferred from one organization to another, the complete and
reconciled list of medications is communicated to the next provider of service, and the
communication is documented. Alternatively, when a patient leaves the organization’s care to go
directly to his or her home, the complete and reconciled list of medications is provided to the
patient’s known primary care provider, the original referring provider, or a known next provider of
service.
When a patient leaves the organization’s care, a complete and reconciled list of the patient’s
medications is provided directly to the patient and, as needed, the family, and the list is explained
to the patient and/or family.
In settings where medications are used minimally, or prescribed for a short duration, modified
medication reconciliation processes are performed.
Goal 9
09.02.01
Reduce the risk of patient harm resulting from falls.
Reduce the risk of falls.
Goal 14
14.01.01
Prevent health care-associated pressure ulcers
Assess and periodically reassess each patient’s risk for developing a pressure ulcer and take
action to address any identified risks.
Goal 15
15.01.01
The organization identifies safety risks inherent in its patient population.
The organization identifies patients at risk for suicide.
2011 LONG TERM CARE NATIONAL PATIENT SAFETY GOALS
Goal 1
01.01.01
Improve the accuracy of patient identification.
Use at least two patient identifiers when providing care, treatment or services.
Goal 3
03.05.01
Improve the safety of using medications.
Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.
Goal 7
07.01.01
07.04.01
Reduce the risk of health care-associated infections.
Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
Implement best practices or evidence-based guidelines to prevent central line–associated
bloodstream infections.
Goal 8
08.01.01
Accurately and completely reconcile medications across the continuum of care.
A process exists for comparing the patient’s current medications with those ordered for the
patient while under the care of the organization.
When a patient is referred to or transferred from one organization to another, the complete and
reconciled list of medications is communicated to the next provider of service, and the
communication is documented. Alternatively, when a patient leaves the organization’s care to go
directly to his or her home, the complete and reconciled list of medications is provided to the
patient’s known primary care provider, the original referring provider, or a known next provider of
service.
When a patient leaves the organization’s care, a complete and reconciled list of the patient’s
medications is provided directly to the patient and, as needed, the family, and the list is explained
to the patient and/or family.
In settings where medications are used minimally, or prescribed for a short duration, modified
medication reconciliation processes are performed.
08.02.01
08.03.01
08.04.01
Goal 9
09.02.01
Reduce the risk of resident harm resulting from falls.
The organization implements a fall reduction program that includes an evaluation of the
effectiveness of the program.
Goal 14
14.01.01
Prevent health care-associated pressure ulcers (decubitus ulcers).
Assess and periodically reassess each resident’s risk for developing a pressure ulcer (decubitus
ulcer) and take action to address any identified risks.
2011 BEHAVIORAL HEALTH CARE NATIONAL PATIENT SAFETY GOALS
Goal 1
01.01.01
Improve the accuracy of patient identification.
Use at least two patient identifiers when providing care, treatment or services.
Goal 7
07.01.01
Reduce the risk of health care-associated infections.
Comply with current Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
Goal 8
08.01.01
Accurately and completely reconcile medications across the continuum of care.
A process exists for comparing the patient’s current medications with those ordered for the
patient while under the care of the organization.
When a patient is referred to or transferred from one organization to another, the complete and
reconciled list of medications is communicated to the next provider of service, and the
communication is documented. Alternatively, when a patient leaves the organization’s care to go
directly to his or her home, the complete and reconciled list of medications is provided to the
patient’s known primary care provider, the original referring provider, or a known next provider of
service.
When a patient leaves the organization’s care, a complete and reconciled list of the patient’s
medications is provided directly to the patient and, as needed, the family, and the list is explained
to the patient and/or family.
In settings where medications are used minimally, or prescribed for a short duration, modified
medication reconciliation processes are performed.
08.02.01
08.03.01
08.04.01
Goal 15
15.01.01
The organization identifies safety risks inherent in its patient population.
The organization identifies patients at risk for suicide.
2011 HOME CARE NATIONAL PATIENT SAFETY GOALS
Goal 1
Improve the accuracy of patient identification.
01.01.01
Use at least two patient identifiers when providing care, treatment or services.
Goal 7
07.01.01
Reduce the risk of health care-associated infections.
Comply with current World Health Organization (WHO) hand hygiene guidelines or Centers for
Disease Control and Prevention (CDC) hand hygiene guidelines.
Goal 8
08.01.01
Accurately and completely reconcile medications across the continuum of care.
A process exists for comparing the patient’s current medications with those ordered for the
patient while under the care of the organization.
When a patient is referred to or transferred from one organization to another, the complete and
reconciled list of medications is communicated to the next provider of service, and the
communication is documented. Alternatively, when a patient leaves the organization’s care to go
directly to his or her home, the complete and reconciled list of medications is provided to the
patient’s known primary care provider, the original referring provider, or a known next provider of
service.
When a patient leaves the organization’s care, a complete and reconciled list of the patient’s
medications is provided directly to the patient and, as needed, the family, and the list is explained
to the patient and/or family.
In settings where medications are used minimally, or prescribed for a short duration, modified
medication reconciliation processes are performed.
08.02.01
08.03.01
08.04.01
Goal 9
09.02.01
Reduce the risk of resident harm resulting from falls.
The organization implements a fall reduction program that includes an evaluation of the
effectiveness of the program.
Goal 15
15.02.01
The organization identifies safety risks inherent in its patient population.
The organization identifies risks associated with home oxygen therapy such as home fires.
2011 LABORATORY SERVICES NATIONAL PATIENT SAFETY GOALS
Goal 1
01.01.01
Improve the accuracy of patient identification.
Use at least two patient identifiers when providing laboratory services.
Goal 2
02.03.01
Improve the effectiveness of communication among caregivers.
The organization measures, assesses, and, if needed, takes action to improve the timeliness of
reporting and the timeliness of receipt of critical tests and critical results and values by the
responsible licensed caregiver.
Goal 7
07.01.01
Reduce the risk of health care-associated infections.
Comply with current World Health Organization (WHO) hand hygiene guidelines or Centers for
Disease Control and Prevention (CDC) hand hygiene guidelines.
7. National Rules of Behavior, taken from September 18, 2007 VA Handbook 6500 Appendix
G G-3 Department of Veterans Affairs (VA)
I understand, accept, and agree to the following terms and conditions that apply to my access
to, and use of, information, including VA sensitive information, or information systems of the U.S.
Department of Veterans Affairs.
1. GENERAL RULES OF BEHAVIOR
a. I understand that when I use any Government information system, I have NO expectation of
Privacy in VA records that I create or in my activities while accessing or using such information
system.
b. I understand that authorized VA personnel may review my conduct or actions concerning
VA information and information systems, and take appropriate action. Authorized VA personnel
include my supervisory chain of command as well as VA system administrators and Information
Security Officers (ISOs). Appropriate action may include monitoring, recording, copying, inspecting,
restricting access, blocking, tracking, and disclosing information to authorized Office of Inspector
General (OIG), VA, and law enforcement personnel.
c. I understand that the following actions are prohibited: unauthorized access, unauthorized
uploading, unauthorized downloading, unauthorized changing, unauthorized circumventing, or
unauthorized deleting information on VA systems, modifying VA systems, unauthorized denying or
granting access to VA systems, using VA resources for unauthorized use on VA systems, or
otherwise misusing VA systems or resources. I also understand that attempting to engage in any of
these unauthorized actions is also prohibited.
d. I understand that such unauthorized attempts or acts may result in disciplinary or other
adverse action, as well as criminal, civil, and/or administrative penalties. Depending on the severity
of the violation, disciplinary or adverse action consequences may include: suspension of access
privileges, reprimand, and suspension from work, demotion, or removal. Theft, conversion, or
unauthorized disposal or destruction of Federal property or information may also result in criminal
sanctions.
e. I understand that I have a responsibility to report suspected or identified information
security incidents (security and privacy) to my Operating Unit’s Information Security Officer (ISO),
Privacy Officer (PO), and my supervisor as appropriate.
f. I understand that I have a duty to report information about actual or possible criminal
violations involving VA programs, operations, facilities, contracts or information systems to my
supervisor, any management official or directly to the OIG, including reporting to the OIG Hotline. I
also understand that I have a duty to immediately report to the OIG any possible criminal matters
involving felonies, including crimes involving information systems. VA Handbook 6500 September
18, 2007 Appendix G G-4
g. I understand that the VA National Rules of Behavior do not and should not be relied upon to
create any other right or benefit, substantive or procedural, enforceable by law, by a party to
litigation with the United States Government.
h. I understand that the VA National Rules of Behavior do not supersede any local policies that
provide higher levels of protection to VA’s information or information systems. The VA National
Rules of Behavior provide the minimal rules with which individual users must comply.
i. I understand that if I refuse to sign this VA National Rules of Behavior as required by
VA policy, I will be denied access to VA information and information systems. Any refusal
to sign the VA National Rules of Behavior may have an adverse impact on my employment
with the Department.
2. SPECIFIC RULES OF BEHAVIOR.
a. I will follow established procedures for requesting access to any VA computer system and
for notification to the VA supervisor and the ISO when the access is no longer needed.
b. I will follow established VA information security and privacy policies and procedures.
c. I will use only devices, systems, software, and data which I am authorized to use, including
complying with any software licensing or copyright restrictions. This includes downloads of
software offered as free trials, shareware or public domain.
d. I will only use my access for authorized and official duties, and to only access data that is
needed in the fulfillment of my duties except as provided for in VA Directive 6001, Limited Personal
Use of Government Office Equipment Including Information Technology. I also agree that I will not
engage in any activities prohibited as stated in section 2c of VA Directive 6001.
e. I will secure VA sensitive information in all areas (at work and remotely) and in any form
(e.g. digital, paper etc.), to include mobile media and devices that contain sensitive information,
and I will follow the mandate that all VA sensitive information must be in a protected environment
at all times or it must be encrypted (using FIPS 140-2 approved encryption). If clarification is
needed whether or not an environment is adequately protected, I will follow the guidance of the
local Chief Information Officer (CIO).
f. I will properly dispose of VA sensitive information, either in hardcopy, softcopy or electronic
format, in accordance with VA policy and procedures.
g. I will not attempt to override, circumvent or disable operational, technical, or management
security controls unless expressly directed to do so in writing by authorized VA staff.
h. I will not attempt to alter the security configuration of government equipment unless
authorized. This includes operational, technical, or management security controls.
i. I will protect my verify codes and passwords from unauthorized use and disclosure and
ensure I utilize only passwords that meet the VA minimum requirements for the systems that I am
authorized to use and are contained in Appendix F of VA Handbook 6500.
j. I will not store any passwords/verify codes in any type of script file or cache on VA systems.
k. I will ensure that I log off or lock any computer or console before walking away and will not
allow another user to access that computer or console while I am logged on to it.
l. I will not misrepresent, obscure, suppress, or replace a user’s identity on the Internet or any
VA electronic communication system.
m. I will not auto-forward e-mail messages to addresses outside the VA network.
n. I will comply with any directions from my supervisors, VA system administrators and
information security officers concerning my access to, and use of, VA information and information
systems or matters covered by these Rules.
o. I will ensure that any devices that I use to transmit, access, and store VA sensitive
information outside of a VA protected environment will use FIPS 140-2 approved encryption (the
translation of data into a form that is unintelligible without a deciphering mechanism). This includes
laptops, thumb drives, and other removable storage devices and storage media (CDs, DVDs, etc.).
p. I will obtain the approval of appropriate management officials before releasing VA
information for public dissemination.,
q. I will not host, set up, administer, or operate any type of Internet server on any VA network
or attempt to connect any personal equipment to a VA network unless explicitly authorized in
writing by my local CIO and I will ensure that all such activity is in compliance with Federal and VA
policies.
r. I will not attempt to probe computer systems to exploit system controls or access VA
sensitive data for any reason other than in the performance of official duties. Authorized
penetration testing must be approved in writing by the VA CIO.
s. I will protect Government property from theft, loss, destruction, or misuse. I will follow VA
policies and procedures for handling Federal Government IT equipment and will sign for items
provided to me for my exclusive use and return them when no longer required for VA activities.
t. I will only use virus protection software, anti-spyware, and firewall/intrusion detection software
authorized by the VA on VA equipment or on computer systems that are connected to any VA
network.
u. If authorized, by waiver, to use my own personal equipment, I must use VA approved virus
protection software, anti-spyware, and firewall/intrusion detection software and ensure the software
is configured to meet VA configuration requirements. My local CIO will confirm that the system
meets VA configuration requirements prior to connection to VA’s network.
v. I will never swap or surrender VA hard drives or other storage devices to anyone other than an
authorized OI&T employee at the time of system problems.
w. I will not disable or degrade software programs used by the VA that install security software
updates to VA computer equipment, to computer equipment used to connect to VA information
systems, or to create, store or use VA information.
x. I agree to allow examination by authorized OI&T personnel of any personal IT device [Other
Equipment (OE)] that I have been granted permission to use, whether remotely or in any setting to
access VA information or information systems or to create, store or use VA information.
y. I agree to have all equipment scanned by the appropriate facility IT Operations Service prior to
connecting to the VA network if the equipment has not been connected to the VA network for a
period of more than three weeks.
z. I will complete mandatory periodic security and privacy awareness training within designated
timeframes, and complete any additional required training for the particular systems to which I
require access.
aa. I understand that if I must sign a non-VA entity’s Rules of Behavior to obtain access to
information or information systems controlled by that non-VA entity, I still must comply with my
responsibilities under the VA National Rules of Behavior when accessing or using VA information
or information systems. However, those Rules of Behavior apply to my access to or use of the nonVA entity’s information and information systems as a VA user.
bb. I understand that remote access is allowed from other Federal government computers
and systems to VA information systems, subject to the terms of VA and the host Federal agency’s
policies.
cc. I agree that I will directly connect to the VA network whenever possible. If a direct
connection to the VA network is not possible, then I will use VA-approved remote access software
and services. I must use VA-provided IT equipment for remote access when possible. I may be
permitted to use non–VA IT equipment [Other Equipment (OE)] only if a VA-CIO-approved waiver
has been issued and the equipment is configured to follow all VA security policies and
requirements. I agree that VA OI&T officials may examine such devices, including an OE device
operating under an approved waiver, at any time for proper configuration and unauthorized storage
of VA sensitive information.
dd. I agree that I will not have both a VA network connection and any kind of non-VA
network connection (including a modem or phone line or wireless network card, etc.) physically
connected to any computer at the same time unless the dual connection is explicitly authorized in
writing by my local CIO.
ee. I agree that I will not allow VA sensitive information to reside on non-VA systems or
devices unless specifically designated and approved in advance by the appropriate VA official
(supervisor), and a waiver has been issued by the VA’s CIO. I agree that I will not access, transmit
or store remotely any VA sensitive information that is not encrypted using VA approved encryption.
ff. I will obtain my VA supervisor’s authorization, in writing, prior to transporting, transmitting,
accessing, and using VA sensitive information outside of VA’s protected environment..
gg. I will ensure that VA sensitive information, in any format, and devices, systems and/or
software that contain such information or that I use to access VA sensitive information or
information systems are adequately secured in remote locations, e.g., at home and during travel,
and agree to periodic VA inspections of the devices, systems or software from which I conduct
access from remote locations. I agree that if I work from a remote location pursuant to an approved
telework agreement with VA sensitive information that authorized OI&T personnel may periodically
inspect the remote location for compliance with required security requirements.
hh. I will protect sensitive information from unauthorized disclosure, use, modification, or
destruction, including using encryption products approved and provided by the VA to protect
sensitive data.
ii. I will not store or transport any VA sensitive information on any portable storage media or
device unless it is encrypted using VA approved encryption.
jj. I will use VA-provided encryption to encrypt any e-mail, including attachments to the email that contains VA sensitive information before sending the e-mail. I will not send any e-mail that
contains VA sensitive information in an unencrypted form. VA sensitive information includes
personally identifiable information and protected health information.
kk. I may be required to acknowledge or sign additional specific or unique rules of behavior
in order to access or use specific VA systems. I understand that those specific rules of behavior
may include, but are not limited to, restrictions or prohibitions on limited personal use, special
requirements for access or use of the data in that system, special requirements for the devices
used to access that specific system, or special restrictions on interconnections between that
system and other IT resources or systems.
VA's Culture of Customer Service
Sexual Harassment
Sexual Harassment is a form of discrimination. VA does not tolerate
sexual harassment in the workplace. Engaging in this misconduct may
result in termination of training at any VA site.
Unwanted, unwelcome, or unsolicited sexual conduct imposed on a
person who regards it as offensive or undesirable, defines sexual
harassment. When the person receiving these advances
communicates that the conduct is unwelcome, the action becomes
illegal.
Sexual harassment includes repeated and deliberate unwanted sexual
advances, requests for sexual favors and other verbal or physical
conduct of a sexual nature when such conduct has the purpose or
effect of unreasonable interference with an individual’s work
performance or creating an intimidating, hostile, or offensive working
environment. Sexual jokes and remarks with sexual innuendo can also
be a form of sexual harassment and are not acceptable in a
professional work environment. The key word in defining sexual
harassment is unwelcome.
Sexual harassment may occur in the interaction with a patient. If a
trainee initiates this action, it is considered patient abuse and subject
to discipline and immediate termination of training at the VA site.
Emphasis is usually made on trainees not subjecting others to sexual
harassment. However, it is also very important to note that this
situation is reciprocal. Trainees are protected from sexual harassment
from employees and from patients.
Trainees who believe that comments, gestures, or actions of a VA
employee, patient or training supervisor constitute sexual harassment
should communicate to that person that such behavior is unwelcome.
Any trainee who believes he or she has been sexually harassed or who
witnesses this type of behavior has a responsibility to report it
immediately to a supervisor. The supervisor is responsible to initiate
an immediate investigation to determine the validity of the complaint
and bring it to the EEO Officer. OAA website:
http://vaww.va.gov/oaa/orinetation/customer_harassment.asp
Updated: August 2, 2005
SBAR Report: STUDENT NURSE HANDOFF: Change of Shift
S
SITUATION
B
BACKGROUND
A
Assessment
Name of Patient & Location ______________________________________________________________
The patient’s code status is:_______________________________________________________________
Diagnosis: _____________________________________________________________________________
Surgical Service: ________________________________________________________________________
Diet:___________________________________________________________________________________
Percent (%) eaten of meal tray(s):__________________________________________________________
Allergies:_______________________________________________________________________________
Vital signs: Blood Pressure _____/_____ Pulse _______ Respiration _______
Temp _______
Fall precautions: Y/N ________________
Restraints: Y/N Type:________________________
Isolation: Y/N Type:________________
Location:______________________________________
Telemetry: Box #:_____ Rate/rhythm:______________ Tele calls: Y/N
Bath: Y/N
Linen change: Y/N
Oral care Y/N
The patient’s mental status is:
 Alert and oriented to person, place & time.
 Confused and cooperative or non-cooperative.
 Agitated or combative.
 Lethargic but conversant and able to swallow.
 Stuporous and not talking clearly and possibly not able to swallow.
 Comatose. Eyes closed. Not responding to stimulation.
The skin is:
 Warm and dry.
 Pale.
 Diaphoretic
 Mottled.
 Extremities are cold.
 Breakdown / decubitus.
 Extremities are warm

The patient: ___Is on oxygen.
___Is not on oxygen.
 The patient has been on ________ l/min or % oxygen for ___________________ minutes or hours.
 The oximeter is reading ______________ %.
 The oximeter does not detect a good pulse and is giving erratic readings.
Volume/type of IV fluid____________________ Tubing changes—site changes—infiltrations________
Urine output: ____________________ Intake / Output _____________ Last BM _______________
Medications—RT Treatments—Dressing Changes—Procedures—Pressure Reduction Devices______
Condition of any wounds: ________________________________________________________________
New orders written: _____________________________________________________________________
Lab results to be monitored and upcoming lab draws: ________________________________________
Surgery or diagnostic tests scheduled and/or completed: ______________________________________
Patient teaching needs—family information—social work intervention: __________________________
Special patient care needs: ________________________________________________________________
Any additional meaningful facts:
I have no concerns about the patient --OR-- I am concerned about the following:
Blood pressure
Pain
Pulse
Nutrition
Respiration
Constipation
Temperature
Other
Pain and scale rating:
 Time last dose pain medication given/effectiveness:
 PCA pump use and dosage:
Assessments pertinent to the patient’s diagnosis (e.g., absence of bowel sounds.)
Problem or problems to prioritize during the incoming shift.
R
Recommendation
NORTH FLORIDA / SOUTH GEORGIA VETERANS HEALTH SYSTEM
ORIENTATION-SCAVENGER HUNT
(TO BE COMPLETED UPON ARRIVAL TO UNIT, per your instructor)
Name: ____________________________________ Assigned Unit: _____________________________________
Located in Facility: ________________________ Facility Phone number: _______________________________
Nursing extension number: _______________Name of Head Nurse: ___________________________________
Names Case Manager and Team Leader: __________________________________________________________
Names of Evening & Night Nursing Supervisors:___________________________________________________
_____________________________________________________________________________________________
Evening/Night Supervisor Page number: __________________________________________________________
Names and Pager Numbers of Nursing Educators & Clinical Nurse Specialists:__________________________
_____________________________________________________________________________________________
How do you Overhead page/beep?________________________________________________________________
FIRE AND SAFETY:
Describe where the Fire Extinguishers are located: _________________________________________________
Describe where the Fire Call Box is located: ______________________________________________________
Write Fire Code number for your unit: ___________________________________________________________
Describe where Crash Cart is located: ____________________________________________________________
Describe how to call a CODE: ___________________________________________________________________
Locate Crash Cart documentation tools: __________________________________________________________
Locate Crash Cart Checklist: ______________________________________________Is list up to date:_______
Where are MSDS Sheets located:_________________________________________________________________
What do you do if BOMB Threat is received:_______________________________________________________
ENVIRONMENT:
Write Linen Closet Room number: ___________________Write Supply Closet room number: ____________
Write Utility Room number: __________________Write Kitchen-Ice Etc. Room number: ________________
Where is Employee Restroom located? ___________________________________________________________
State where Pay Phone for Unit is located? _______________________________________________________
Activate Patient Call System:_____
REFERENCES:
Locate Nursing Procedure Book: ___________________Locate Nursing Policy Books: ____________________
Locate Laboratory Manual: _______________________Locate Nutrition Manual: _______________________
Locate Environment of Care Manual: _______________Locate Safety Checklist: ________________________
Locate Facility Fire and Safety Plan: ________________Locate Facility Disaster Plan:____________________
Locate PI Manual: _______________________________List others on Unit:_____________________________
EQUIPMENT:
List all Mechanical Lifts:________________________________________________________________________
List type of Scales:_____________________________________________________________________________
State the type of Bathing System?________________________________________________________________
VA Mandatory Training
All affiliates (students) as well as instructors are required to complete Mandatory Training annually. This annual
requirement also includes Federal employees, contractors and all personnel who have access to our patient
population and associated records, electronic or otherwise. This requirement is closely monitored both locally and
nationally.
Recently, the process was automated where one must go to the website (below) to complete this learning. It is
followed by an exam which yields a certificate upon completion however once the program is completed – there
is only one opportunity to retrieve a certificate. You cannot retrieve another copy later on.
Request all students (and instructors) complete this requirement within 2 weeks of group VA Intakes. Students
are to submit their certificates to their course coordinator who will provide the entire batch of certs labeled with
school and student type soonest.
Please be aware the program takes about 2 hours and may be entered multiple times until completed however once
complete and certification pulled up --- please run off copy immediately as it will not allow another certification
attempt. This will be for the 2011/12 year but please plan to complete refreshers (w/certs submitted) at every
Student Intake period.
Below, please note instructions for the website – it is important to follow directions exactly when first logging in.
EES Librix On-Line Learning Website:
https://www.ees-learning.net/librix/loginhtml.asp?v=librix
1. Register.
Some questions that may stump you:
a) you are a non-federal
b) we are VHA
2. After registering, go back to the Login screen
3. Enter your username and password, and click on Login. You will be taken to the My
Courses page.
4. IMPORTANT: First ------ Click Available Courses on the left-hand navigation just above My
Courses before doing a Search.
5. Search for course entering the keyword Mandatory or the course title VHA Mandatory
Training for Trainees. Then, click Search button. For subsequent training, look for
Search for Refresher - if you are taking course again.
6. You will be taken to the search results page.
- IMPORTANT: Older versions of the Mandatory Training may be listed and marked as
CLOSED. However, keep looking through the list for the version that is available.
- If the course is not found, you probably did not follow step 6 above.
7. Click on the Sign Me Up link on the right side of the screen and you will be taken back to
the My Courses screen, where the course will now be listed.
8. Click on the course name link to go to the course.
9. Be sure to complete exam and get certification.
10. Give certificate to Course Coordinator