Graduate Nursing Program
The Graduate Nurse Orientation-Success in Specialty
(GNOSIS) program has been developed as an orientation program for new graduate nurses at High Point Regional Health (HPRHS). GNOSIS is designed to prepare the new nurse to function competently and safely within the acute care setting.
Upon completion of general nurse orientation, which is geared toward introducing the organization and the care delivery model standards of nursing practice, the new nurse will begin the generalist (basic Medical-Surgical) portion of the GNOSIS program.
The basic program consisting of weekly classes and carefully planned clinical experiences will provide the framework for development of nursing knowledge and clinical skills related to the nursing process, communication, socialization, teamwork, disease process, patient management across the continuum of care, resource management, legal aspects of care, psychomotor skills and clinical practice.
Nurses successfully completing the basic GNOSIS program will advance to unit-specific orientation in assigned clinical specialty.
The GNOSIS Program
GNOSIS is an eleven-week long orientation program that all graduate nurses/nurses with less than one year’s acute care work experience are required to complete when hired at High Point Regional Health. The program has been in place since February 1998.
The program consists of planned clinical and classroom days, weekly meetings with the program director and educators and opportunities to see all areas of the health system. Participants work the shifts they were hired for and all clinical is designed to help the nurse attain generic nursing knowledge/skills and to supplement the class topics. Clinical shifts follow the weekly classes. Classes are held on Mondays and some Tuesdays with topics including:
• Physical Therapy
– intensive education on all patient transfer techniques, patient care equipment, body mechanics and prevention of back injuries (4 hours). Participants spend 4 hours with PT staff practicing skills covered during class.
• Basic Patient Care Skills
– verification of ability to correctly perform all NA skills and tasks; this is done to ensure the nurse understands the role and performance of the NA since he/she will be responsible for precepting and verifying the new NA’s performance (8 hours). Participants spend clinical time attaining competency in all NA skills/tasks; are paired with NA and RN clinical hours.
• Basic Nursing Care Skills
– in-depth review of physical assessment techniques; review and discussion of admission/transfer/discharge documentation and correct use of forms; review and discussion of risk management issues and documentation of patient or employee incidents; review and practice with various patient care/equipment devices (foley and NG insertions/maintenance/removal, hypo/hyperthermia blanket use, etc.); practice admitting/transferring/discharging each other using fictional information (8-12 hours; depends on number in the class). Participants are required to perform 5 admissions/transfers/discharges without assistance to be considered competent in this area. Clinical is spent practicing assessments along with required admissions/transfers/discharges.
• Basic Cardiac Care
– cardiac A&P, assessment, common drugs/procedures, and common disease processes and how patients are cared for at HPRHS is discussed; the Case Managers for CHF and MI review the pathway for these patients (8 hours). Clinical is focused on caring for patients with CHF, stable post NI/PTCI patients and patients with dsysrhythmias. Participants spend 4-8 hours in Cardiac Cath Lab/Cardiology department.
• Basic Rhythm Interpretation
– identification of common sinus, atrial and ventricular rhythms, assessment and brief explanation of treatments (8 hours).
• Basic Neurovascular Care
– neurovascular A&P, assessment, common drugs/procedures and common disease processes and how patients are cared for at HPRHS; appropriate Case Managers present pathways (8-12 hours). Clinical is focused on caring for patients with CVA, TIA, stable carotid endarterectomy.
• Wound Care
– class focusing on care of wounds, both surgical and decubiti; in-depth review of skin care protocols used at HPRHS; methods for promoting wound healing; dressing changes (8 hours). Spend 4 hours in the Wound Care Center.
• Spiritual/Ethical Care
– discussion of Ethics Committee and how staff interact with members; use of committee with patient issues; discussion of code/no-code issues. Facilitated by member of hospital Pastoral Care staff sand educator with strong interest in ethics. (6hours)
• Pain Management/End of Life Care
– in-depth class on pain management principles; methods for pain control; review of pain medications (8 hours).
• Charge Nurse Class
– this is scheduled for the 11th or 12th month of employment. It is a 6 hour class designated to help prepare the RN to assume the charge nurse role.
• Preceptor Class
– this is scheduled for the 12th -15th month of employment. The nurses receive a notice from program director reminding them to register for this class and the Charge Nurse class. Also the Nursing Directors receive an email reminder asking them to facilitate getting the nurses to the class.
Everyone working days/evenings meet Friday afternoons to discuss the experiences of the week. Questions are asked and experiences shared with the group. These meetings often involve review of policy/procedure and discussion of what is the ‘usual’ at HPRHS.
The final class is a combination of discussion and ‘graduation’ from the program. All participants receive a certificate. All of the Nursing Directors and Chief Nursing Officer attend the graduation.
1. Identify personality type and learning style to promote optimal pairing of the new nurse with the nurse preceptor/clinical teacher.
2. Apply principles of body mechanics, safety and infection control in clinical practice.
3. Develop competency in providing basic patient care.
4. Develop competency in information management and documentation.
5. Demonstrate proficiency in physical and psychosocial assessment across the life span.
6. Manage patient care across the continuum to include patient admission, transfer, discharge, education, consultation and use of appropriate resources to meet individualized patient care needs.
7. Demonstrate competency in medication administration and pain management, blood/blood product administration and nutritional and intravenous therapy.
8. Provide care to the stable, uncomplicated patient experiencing cardiac, neurovascular, respiratory, diabetic, renal and gastrointestinal dysfunction/disorders.
9. Identify resources available for patient/family and staff needs related to spiritual/ethical issues.
10. Provide care to patients experiencing behavioral health needs to include substance abuse, withdrawal and detoxification in the acute care setting.
Knowledge and clinical competencies of the new nurse is assessed weekly based on the course objectives with input from the preceptor, manager, educator and orientee self-evaluation. Course content, clinical experiences and effectiveness/performance of the educator, manager and preceptor will be provided by the new nurse and utilized for on-going program evaluation and improvement.