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Based on the hospital's policy review, "Nursing Unit Shift Assessment Sheet" review, non-employed licensed nursing personnel files, and staff interview, the hospital failed to ensure that non-employed licensed nursing staff received a documented unit-specific orientation evaluation before assigned an independent patient care assignment in 1 of 6 sampled non-employed licensed nurses (Agency Nurse #2).

Findings include:

A review of the hospital's policy "Nursing Agency Personnel" (reviewed 08/17/2010) revealed "D. Orientation to the unit is to be provided prior to independent assignment of patient care. 1. Eight (8) to 24 hours on general units and 12-24 hours on special units is generally sufficient. E. Unit-specific skills and competencies are documented and placed in agency nurse file located in the office of ___(hospital) Agency Coordinator."

A review on 01/05/2012 of the non-employed licensed nursing personnel file for Agency Nurse #2 revealed that the nurse was contracted to work at the hospital on 12/19/2011. The review revealed that the nurse left the hospital without written notice on 12/26/2011. The review of the nurses file revealed that she was assigned unit specific orientation on the hospital's 3 South Medical-Surgical/Telemetry Unit on 12/22/2011 and 12/23/2011 for a total of 24 hours.

A review on 01/05/2012 of the hospital's "Nursing Unit Shift Assessment Sheet" dated 12/23/2011 revealed that the Agency Nurse #2 was independently assigned to a total of six (6) patient's without any other orienting nurse assigned to the same patients. The review revealed that the unit's charge nurse was originally assigned to be the orientation preceptor for Agency Nurse #2. The review further revealed that a shortage of nursing staff on the unit for 12/23/2011 changed the charge nurse's assignment to include taking a total of six (6) patients of her own. No documentation was found in the assignment sheet where Agency Nurse #2 received orientation on 12/23/2011 and did not take an independent patient assignment.

A telephone interview on 01/05/2012 at 1030 with Agency Nurse #2 revealed that she felt unsafe and overwhelmed on 12/23/2011 due to her orientation being cut short. The interview further revealed that she was told that she would receive a total of two days of orientation to the unit she was working and felt that she was let down due to the overall shortage of staff.

An interview on 01/05/2012 at 1940 with the unit charge nurse assigned to orient Agency Nurse #2 on 12/23/2011 revealed "We had a very busy night and some call outs that made our unit short. I was going to not have any patients so I could orient the nurse (Agency Nurse #2), but I had to take a full assignment and we all took care of our own patients."

An interview on 01/04/2012 at 1410 with Agency Nurse #1 revealed that the hospital provides a total of 2 days on the units. The interview revealed that she received her orientation and had no other concerns with her orientation.

An interview on 01/04/2012 at 1430 with Agency Nurse #3 revealed that the hospital provides a total of 2 days on the units. The interview revealed that she worked in the hospital's emergency department and completed both days of her orientation in the emergency department. The interview revealed that she received her orientation and had no other concerns with her orientation.

An interview on 01/04/2011 at 1510 with the hospital's Agency Coordinator revealed that the agency nursing staff should receive a total of 2 days on the unit that they work. The interview did reveal the hospital's Agency Coordinator did not know if any of the Agency Nurses actually received their individual unit orientation. "I only have a copy of their actual time. I can not tell by the time if they actually are assigned with staff for orientation.

Reference NC00077584.