Professional Nursing at San Juan Regional Medical Center

I. Introduction

Our Approach. To satisfy the expectations of our patients and attract and retain leading physicians, nurses, and other healthcare professionals, San Juan Regional Medical Center is committed to integrating advanced medical technologies, continually improving patient care and implementing sensible and responsible business practices.

Our Culture. We have a reputation for clinical excellence, which we are committed to maintaining through personalized care and transparency. Using evidence-based best practices and published quality measures, we are responsive to the community and seek to serve the whole community's healthcare needs. We value each of our employees highly, and believe that we offer a challenging and rewarding work environment. We offer career incentives and educational opportunities to our team members to support them as they work toward individual goals and the needs of their families. High standards of care, transparency, trust in our mission, valuing people – this is our culture.

Our Core Values. Certain Core Values have always been a part of our hospital. These values have been handed down to present employees, board members and physicians through nearly a century of tradition here at San Juan Regional Medical Center. We subscribe to these values, we teach these values to others, and we live these values in our every day actions.

II. Nursing Mission and Vision

Nursing Vision
To be recognized as progressive healthcare professionals who deliver personalized care with respect and dignity for all.

Professional Nursing at San Juan Regional Medical Center, including "Practice of Nursing" means "assisting individuals, families, or communities in maintaining or attaining optimal health, assessing and implementing a plan of care to accomplish defined goals and evaluating responses to care and treatment. This practice is based on specialized knowledge; judgment and nursing skills acquired through educational preparation in nursing and in the biological, physical, social and behavioral sciences, and includes, but is not limited to:

• initiating and maintaining comfort measures;
• promoting and supporting optimal human functions and responses;
• establishing an environment conducive to well-being or to the support of a dignified death;
• collaborating on the healthcare regimen;
• administering medications and performing treatments prescribed by a person authorized in this state or in any other state in the United States to prescribe them;
• recording and reporting nursing observations, assessments, interventions, and responses to healthcare;
• Providing counseling and health teaching;
• delegating and supervising nursing interventions that may be performed safely by others and are not in conflict with the Nursing Practice Act; and
• maintaining accountability for safe and effective nursing care."*

* from State of New Mexico Nursing Practice Act, 2000

III. Nursing Philosophy

Nursing Philosophy
We shall treat each patient as an individual, recognizing cultural, religious, and social needs while including the patient and family in our plan of care.

We respect the patient´s and family´s right to make choices regarding life and death. We shall assist with education in regard to these choices and shall support the patient in a non-judgmental manner.

We believe in the values of empathy, patience, kindness and mutual trust and respect, and shall incorporate these values in our care to the best of our ability.

We believe in the patient´s right to competence from the nurses caring for him/her, and will exercise our competence as the patient´s advocate in the provision of quality healthcare.

We respect each other as caring, competent professionals/ colleagues. We realize that change is inevitable and expect input and involvement in patient care.

We commit to the education and socialization of nurses new to our profession and/or our facility, realizing they will provide care to our community in the future.

We commit to patient care quality, striving for improvement in indicators and outcomes which are related to nursing care. We review current research and evidence to continually improve our practice.

RN´s in collaboration with other disciplines, coordinate the plan of care of every patient. RN´s prescribe the nursing care of every patient and educate, administer, supervise, delegate tasks, and evaluate nursing practice as it relates to the identified healthcare needs of the patient and family/significant other.

Nursing Services are supported by a model for professional practice based on shared responsibility and accountability. Partners in Care provides the structure for the functions of nursing to be accomplished while the Bylaws of Partners in Care govern the structure.

The organized delivery of patient care and nursing practice is defined and managed by professional nursing through contributions to committees and task forces using the shared decision-making principles of partnership, equity, and ownership.

San Juan Regional Medical Center´s plan for providing nursing care is based on meeting the needs of patients and fulfilling the hospital´s mission. It is designed to support improvement and innovation in nursing practice. San Juan Regional Medical Center´s Partners in Care promotes, develops, and implements quality improvement activities and innovative nursing practice within the guidelines of nursing bylaws. Partners in Care members contribute, within the scope of education, certification/licensure, and assessed competency, to the delivery of safe, efficient, and effective patient care.

The CNO is responsible to assure that consistent standards are used throughout the care continuum and wherever nursing care is delivered. Nursing leadership is provided to alternative areas of care delivery in the development of standards relative to assessment, patient/family education, and other patient care requirements. Examples include, but are not limited to: Endoscopy, Urgent Care Center, Wound Care Center. Standards are used to monitor and evaluate the provision of nursing care in meeting patients' needs throughout the hospital. They include:

Partners in Care bylaws define the authority of nursing to:

• define and manage the delivery of nursing care and nursing practice;
• promote, develop and implement nursing quality improvement activities;
• promote, develop and implement innovative nursing practice;
• monitor and evaluate the provision of nursing care;
• set parameters for nursing assessment and reassessment;
• determine general competency requirements for nursing staff.

IV. Nursing Areas at San Juan Regional Medical Center

General Nursing Areas

• Cardiology
• Nephrology
• Medical
• Gynecology
• Orthopedic
• Pediatrics
• Surgical

Critical Care Nursing Areas

• Intensive Care
• Medical–Surgical ICU
• Post Anesthesia Care Unit

Other Specialty Nursing Areas

• Perinatal Services
• Cardiac Cath Lab
• Cardio-Pulmonary Rehab
• Case Management
• Endoscopy
• Float pool service (Professional Resource Team)
• Peri-operative services
• Out-patient Nursing Clinic / Interventional Radiology
• Emergency Department & Level III Trauma Center / flight nursing
• EMS, Ground & Air Ambulance
• Admission, transfer, & discharge nurse
• Nurse Informatics

V. Our Patients

Patient Rights/Organizational Ethics
Nursing recognizes the fundamental right of patients to considerate care and exercises patient advocacy to protect those rights as stated in the nursing philosophy. Assessed cultural, psychosocial, and spiritual values are incorporated into the patient´s plan of care. Nursing representatives are members of the hospital´s Ethics Committee. Nurses, acting in the interest of patient rights, may refer cases to the Ethics Committee or institute the "Quality of Care" policy. The nurse may request not to participate in certain aspects of patient care if in conflict with his/her cultural values or religious beliefs.

Assessment of Patients
Each patient´s nursing needs are assessed by an RN at the time of entry into the system and at designated intervals relative to the patient's physical, psychological and social status. Nursing assessment and reassessment parameters are defined by patient care policy requirements as determined by nursing. Assessment findings are communicated, as appropriate, to other disciplines and departments and incorporated into the plan of care.

Care of Patients
The care of patients is individualized to the patient´s specific needs. A registered nurse, in collaboration with other disciplines, coordinates the plan of care for every patient and prescribes each patient's nursing care. The delivery of nursing care and nursing practice are defined and managed by professional nurses using shared decision making principles.

Patient and Family Education
Patient and/or family education is individualized, interdisciplinary, and provided throughout the care continuum based on assessed needs. The scope, content and process of educating patient/family are determined by numerous factors including, but not limited to, patient preference, patient response, cognitive abilities, level of care, location where care is delivered, disease state, and whether acute or chronic in nature.

Continuum of Care
As with other important aspects of patient care, the coordination of care within and across the continuum is based on assessed patient needs. When possible, patient's needs for the care continuum are determined prior to admission. The plan of care is responsive to interdisciplinary interventions and treatment from one level of care and/or services to the next (i.e., pre-op, operating room, PACU, inpatient care, home health). Through education and involvement, the patient and family members are active members of the team, moving to the appropriate level and type of care or services through a coordinated process. The process assures communication of information required by each practitioner and/or facility who assumes responsibility for the patient´s ongoing care. We support the mission of San Juan Regional Medical Center to personalize healthcare and create enthusiasm and vitality in healing.

VI. Areas of Service

Patients Served and Locations
Patient Care is provided in nursing service practice areas based upon patient need, diagnosis, special treatments and acuity of illness. The scope of care is defined by unit staff and leadership.

Medical
Adult patients with medical and age related problems Telemetry monitoring is available.

Surgical
Adult patients requiring surgical intervention and/or non-surgical orthopedic or neurologic problems. Telemetry monitoring is available.

Pediatrics
Patients 18 years of age or younger with medical or surgical needs and/or adult med-surg patients as deemed appropriate. Telemetry monitoring is available as well as central cardiopulmonary monitoring for pediatric patients. Provides outpatient pediatric services.

Childbirth Center (Outpatient, Antepartum, Labor & Delivery, Postpartum, Special Care Nursery)
Childbearing patients requiring perinatal, postpartum and neonatal care with specialty services. May also provide nursing care for non-infectious female patients.

Critical Care/ICU
Patients who require intensive nursing care and monitoring, including those who are hemodynamically and metabolically unstable.

Outpatient Nursing Clinic/Interventional Radiology
Patients requiring nursing care, including those who have undergone a diagnostic/therapeutic procedure, on an outpatient basis.

Perioperative Services (OR, PACU, DSU, PST)
Perioperative patients requiring inpatient or outpatient surgical intervention.

Urology/Nephrology
Primarily adult patients with diagnoses relating to the renal and/or urinary systems. Dialysis and telemetry monitoring is available.

Emergency Department
Patient´s requiring non-urgent, urgent, and emergent care that may result in discharge, admission, or transfer to another facility.

Behavioral Health Unit
Secured adult unit (18 years and older). Acute inpatient hospitalization for individuals who are a danger to themselves or to others or who are acutely mentally ill. Provide a therapeutic milieu with a multidisciplinary team that includes RNs, Techs, Psychiatrist, Social Worker, Psychologist, and Occupational Therapist.

Cardiology
Adult patients with diagnoses that are primarily cardiac in nature. Telemetry monitoring is available.

Cardiac Cath Lab (Adult only)
Adult inpatient and outpatient procedural care to include diagnostic cardiac catheterization, intra-aortic balloon pump placement, pacemaker services, and diagnostic and interventional cardiac procedures.

Cardiac Rehabilitation
Adult patients participating in phased Cardiac and Pulmonary rehabilitation in addition to providing open gym facilities. Separate from Telemetry, remote cardiac monitoring is available within the gym.

Total Joint Replacement - Education Program
Management of total joint patients through a pathway which begins in physician office and ends 30 days post-discharge. Baseline functional studies are performed pre-op, then at six months and one year.

Infection Control Patient care services are delivered through a safe and healthful work environment with an emphasis on minimizing occupational exposure to communicable pathogens and eliminating healthcare-acquired infections in our patient populations through vigilant infection control practices.

VII. Education and Training

Orientation
When you join SJRMC, you will receive an organization-wide orientation, competency assessment, personalized nursing core orientation, and a job or unit specific orientation. Organization-wide orientation focuses on SJRMC’s plan for excellence and policies that apply to all employees. Nursing core orientation provides nursing specific information for clinical units. Based on your critical thinking, communication, and technical skills; an individualized plan is created specific to the unit or job. Clinical orientation may range from six weeks to several months depending on the practice area, experience level, and assessment of clinical of clinical knowledge and nursing skill.

Ongoing Clinical Support
SJRMC nurses receive widespread clinical support from a variety of sources. Initially, a unit-based nurse manager, education supervisor, and unit-based preceptors monitor orientation to your unit. Experienced nurse co-workers provide ongoing support. For complex patient needs, clinical supervisors are also available for consultation. Nurses also have 24-hour bedside access to a comprehensive medical library.

Technology
The majority of our units use MediTech for computer charting. There is also a clinical portal – a database which contains information from several applications that allows nurses to customize and organize his or her patient team and each patient’s information, such as lab results, narrative reports, and intake/output. SJRMC also has an intranet for internal communication education as well as Outlook email accounts. Technology is an integral part of nursing at SJRMC and we continue to seek out the latest advancements to assist nurses at the bedside, help increase efficiency, and all more time with patients.

Continuing Education & Professional Certification
SJRMC offers tuition assistance for academic classes and reimbursement for professional certifications. Nursing continuing education credits are also offered throughout the year through SJRMC’s many in-services and conferences.

New Graduates
New graduates are welcome at SJRMC. If a new graduate is not licensed he/she is eligible to participate in the Graduate Nurse Program. The Graduate Nurse Program supports a novice nurse’s transition from graduation to licensure through a designed classroom and clinical experience. A new graduate who is licensed may participate in the nurse intern programs or be hired into a unit-specific position.

Nurse Interns
The nurse intern program involves extended orientation including theory, technical skills, clinical experience, and critical thinking experience to facilitate successful performance in either critical care, medical/surgical, or peri-operative environments. Orientation occurs on all related units and the intern, upon completion of the program, is welcome to bid on any available position.

Rewarding Excellence in Nursing (ReiN)
ReiN is a tool to reward professionalism in nursing. This program measures clinical and professional excellence. This career advancement program allows for nurses to self-pace their advancement. It also recognizes that all nurses cannot commit themselves at the same level. Participation is voluntary. Total years of nursing experience to include years worked as an LPN/RN.

Preceptor
Staff who are interested in becoming preceptors are recommended/approved by their manager. They have shown an interest in guiding new hires and have expertise in their areas. Continuation in the role requires a positive evaluation from new staff. Successful preceptors receive a bonus with their annual evaluation.

Nursing Staff with BSN/MSN Degrees

Tuition Reimbursement
SJRMC offers tuition assistance for academic classes and reimbursement for professional certifications.

Shared Decision-Making – Partners in Care
Decision-making at unit and hospital levels is encouraged through SJRMC´s Partners in Care structure and by collaboration with other disciplines. Each nursing unit or division of units has its own unit council attended and chaired by staff nurses. One representative from this council participates in the monthly meeting of Partners in Care. Partners in Care reports to Nursing Leadership who in turn reports to the Board of Directors. The purpose to Partners in Care is:

• To incorporate principles of partnership, equity, and ownership among all healthcare professionals;
• To enhance effective communication between and among all levels of the organization (i.e., 4-way communication);
• To be responsive and supportive in approach and accomplishment of the "work of nursing";
• To satisfy the needs of the staff for empowerment and recognition;
• To promote nursing competence;
• To promote safe and effective nursing care;
• To advocate collaborative problem-solving;
• To reward partnering relationships;
• To promote an environment where professional registered nurses desire to practice;
• To provide a sense of control over immediate work environment;
• To make possible true participation in decision making for nursing staff.

VIII. General Information on the Work Environment

Benefits

• Insurance – health*, dental, vision, life, and disability options for full-time and half-time staff (pre-tax deductions)
  *Note: A variety of health plan options are provided including a free no cost insurance for employees and their families.
• Holidays – 6 paid holidays, 1 paid float, and 1 paid birthday holiday annually. (Holidays worked are paid at double time.)
• Tax Sheltered Annuity and Retirement (pretax deductions and matching contributions up to 4%)
• Employee Pension Plan (3% based on wage contributed on behalf of the employee)
• Continuing Education - $500 and 24 hours per year
• Sleep Time (OR specific)
• Tuition Assistance / Scholarship

Decision Making

• Staff authority for practice, competency, education, and quality
• Shared decision making between management and staff
• Staff majority in decision making model – Partners in Care

Staffing and Workloads

• Optional floating
• Staffing plan with minimum and maximum staffing levels
• Average 5 patients / nurse day shift (Cap of 6)
• Average 6 patients / nurse night shift (Cap of 7)
• No more than 2 patients / nurse in Critical Care
• Non-punitive reporting of staff concerns
• Optional overtime
• Voluntary cancellation with benefit accrual
• Premium pay for float pool and extra shift

Pay Practices / Compensation

• Market driven competitive pay scales
• Shift differentials – 15% evening; 25% night
• Pay premiums for charge nurse, float pool, and extra shifts
• Clinical ladder (optional) opportunity to receive 3%, 5%, or 7% pay over base scale utilizing clinical, education, and leadership criteria
• Standby Call pay - $2.75/hour
• Pay for experience up to 10 year scale
• Longevity bonus for staff with more than 20 years service

Grievance

• Formal policy for grievance resolution
• Non-punitive reporting of quality concerns
• Ethics Committee availability

Personal Safety

• Needleless System
• Personal protective equipment (goggles, aprons, gloves)
• Fit tested N 95 respirator masks
• Free hepatitis immunization
• Worker´s Compensation
• Free Flu vaccine
• Sleep time for operating room staff

Professional Development

• Scholarship
• Preceptorship

IX. Frequently Asked Questions

What is the nurse-to-patient ratio?
The nurse-to-patient ration varies depending upon the patient population and acuity levels.

Does SJRMC have a dress code?
SJRMC is committed to presenting a professional, neat, and clean image for our patients, their families, and other visitors. As representatives of the hospital, nurses demonstrate pride in our personal appearance and support a standard dress policy. Please ask for specific department policy details.

What if I´m interested in becoming a nurse at SJRMC but not yet licensed?

New Graduates
New graduates are welcome at SJRMC. If a new graduate is not licensed, he/she is eligible to participate in the Graduate Nurse program. The Graduate Nurse program supports a novice nurse’s transition from graduation to obtaining a license through a designed classroom and clinical experience. Orientation focuses on SJRMC’s clinical excellence standards and integration of the graduate nurse with SJRMC’s care delivery teams. Experiences help the new graduate to develop critical thinking, delegation, outcomes management, and team skills, as well as NCLEX success. A new graduate who is licensed may participate in the nurse intern programs or be hired into a unit-specific position.

Nurse Interns
The nurse intern program involves extended orientation that includes theory, technical skills, clinical experience, critical thinking experience, and evidence-based practice to facilitate successful performance in either critical care, medical/surgical, or perioperative environments. Orientation occurs on all related units and the intern, upon completion of the program, is welcome to bid on any available position. The critical care and medical/surgical nurse intern programs are available to new graduates within a year of graduation. The perioperative nurse intern program is available to both new graduates and experienced nurses who have not worked previously in the surgical area.

Pending Licenses
RNs with licenses from other states may accept a position while they await their New Mexico license. However, they may not begin working until they receive their permanent New Mexico license. New graduates awaiting licensure are welcome in the graduate nurse program prior to obtaining their license.