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					                                         Nursing School Checklist
                                           Faculty Orientation
          School:              ____________________________________
          Instructor Name:     ____________________________________
          Date:               ____________________________________
          Hospital:           ____________________________________
          Clinical Unit:      ____________________________________
          Rotation Times & Days of Week: ____________________________
          Rotation Dates:     _____________________________________

              Orientation/Competency                      Responsibility/Method      Completion
                                                                                       Date
Mission / Vision Statements                              NEONI Site
Confidentiality (to be signed)                           NEONI Site
Student Orientation Document (complete as directed)      NEONI Site
Standards of Behavior                                    NEONI Site
Parking and Security (site specific)                     NEONI Site
ID Picture Badge                                         CCAC
Tour Environment/Unit                                    Clinical Department
Environment of Care and Regulatory Topics*               Student Max- Student
Infection Control /Emergency Pages*                      Nurse Orientation Manual
Patient Safety*                                          Materials
Emergency Pages                                          Self-directed/ PRN Manual
Restraint & Seclusion Assessment*                        NEONI Site
Restraint Application/Release: Vest, Soft Limb, &        Return Demo. Using
Hard                                                     Performance Checklists
Pain Management Assessment*                              NEONI Site
Documentation                                            Self-directed/ PRN Manual
IV Therapy Principles                                    Self-directed/ PRN Manual
Pharmacy Policies / Services                             Self-directed/ PRN Manual
Medication Assessment                                    NEONI Site
Blood Glucose Monitoring Assessment*                     NEONI Site / Nursing
                                                         Education
Nursing School Student Affiliation List completed –      Instructor
Roster for every rotation
Meeting with Unit Clinical Manager                       Instructor
 Access to Pyxis *                                       Unit Manager /Pharmacy
MyPractice/Electronic Medical Record training *          Affiliate Instructor
(Nursing Education to provide Logins)
  Assessment or training required*

  Faculty Signature: _______________________________________ Date: ___________________

  Phone: Work:____________________Home:________________Cell:_______________________

  Last 4 Digits of Social Security Number______________ E-mail:____________________________

  MyPractice Login # ____________________

  Nursing Education: __________________________________________


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posted:10/15/2011
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