Download clinical guidelines

Acute Care
N124L-IN
Summer 2013
1
CLINICAL GUIDELINES
Acute Care
Inclusive Semester 2
General Information
1. See master schedule for specific dates for clinical rotations. Pre-conference will begin at 0700. Assignments
will be made at the beginning of pre-conference. Pre and Post conference will be in a designated area
determined by the Instructor.
2. All facilities prohibit gum chewing by staff and students. Smokers are to use breath mints or mouthwash and
spray clothing with Febreze, or some similar fabric deodorizer before entering the facility.
3. No smoking is allowed at clinical sites.
4. Because of limited space, only essential nursing equipment should be brought to the facilities: watch, black
pen, stethoscope, pen light, scissors, hemostats, small notebook and perhaps a clipboard. Reference texts
and drug guides are available. Do not bring purses or other valuables into the facility for security reasons.
All valuables, including cell phones, should be locked in your car.
5. One 30-minute lunch break is allowed during each clinical shift. Students may not leave the premises.
Lunches may be purchased in the cafeteria. Microwaves, refrigerators, and vending machines are available.
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The cafeteria has a hot lunch serving line during the day shift.
There are also cold sandwich makings and a salad bar (charged by the weight) available. ----OR-----Students can preorder a few items available from the “grill” i.e., hamburger etc in preconference. Order
slips should be completed during pre-conference.
There are lockers available to students to use to store their extra items brought to clinical (personal items,
books) in the staff locker rooms by the cafeteria. They can bring a lock with them and lock up their own things.
There is a Male Locker Room and a Female Locker Room.
6. Students will deliver total patient care (assessments, charting, meds, treatments, teaching, personal care and
other skills) on all assigned patients. The student is ultimately responsible for assuring all care is provided
and communicating ongoing status of care to the nurse techs and the primary nurse and the Instructor.
7. Above all, be courteous and professional in all your contacts and interactions with the staff and patients.
Please comply with the requested parking areas for students to help build and keep a good relationship with
the clinical facilities. Remember we are their guests and none of the facilities are obligated to offer their
businesses as teaching sites.
Clinical Expectations
Nursing is a skill that takes intense preparation. The student must be prepared in regards to pathophysiology,
medications, procedures, treatments, and complete care for ALL her/his patient(s). Students are expected to
come to the clinical rotation in appropriate uniform, on time, rested and free of contagious illness (i.e. URIs, GI
distress, elevated temperatures, etc.).
Students who do not meet these expectations will be sent home by the instructor, and applicable points will be
deducted. The applicable 9 points for an absence will be deducted from your final clinical grade for that
rotation.
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Student Preparedness
A determination of inadequate preparedness is based on the instructor’s discretion and may include the
student’s lack of ability to verbalize knowledge of meds and/or pathos, lack of ability to verbalize specific
patient care needs, incomplete required clinical paperwork, or other evidence. An unprepared student may be
sent home and a grade of ‘0’ will be recorded for the clinical day and the day cannot be made up.
The student is also expected to arrive at clinical proficient in all skills learned in skills lab. An unprepared
student will receive 5 points off her/his weekly clinical grade for each occurrence of skill unpreparedness. If
the student is consistently unprepared, the student may be sent home and a grade of ‘0’ will be recorded for the
clinical day and the day cannot be made up.
Medication Administration
Students are to follow the Seven Rights of medication administration. A student's failure to follow this policy
will result in one or more of the following consequence(s):
 a verbal warning will be given and the student will complete a CCC incident report (red card)
 a written Memorandum of Record for safety concerns will be filed by the instructor and the student will
complete a CCC incident report
 the Final Evaluation Grade for the rotation will be no more than 76 because the resident/patient was
placed in physical or emotional jeopardy. In addition, the student will complete a CCC incident report
and a written Memorandum of Record for safety concerns will be filed by the instructor
Attendance
Absences and tardiness in the nursing profession can seriously impact patient care. For nursing students,
absences and tardiness also seriously diminish the already limited clinical opportunities to acquire the necessary
skills and experience for becoming an entry-level practicing nurse.
If a clinical day must be missed, the student is to call the clinical facility at least 1/2 hour before the beginning
of the scheduled clinical day. If the clinical instructor is not there, leave a message with one of the staff. The
clinical facility is staffed 24 hours a day and a phone call can be made at any time day or night. The student is
responsible for obtaining the name of the person who took the message. EMAIL THE INSTRUCTOR IN
CANVAS TO DOCUMENT THE ABSENCE.
HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA)
CONFIDENTIALITY
The U.S. Department of Health and Human Services (2003) issued the Standards for Privacy of Individually
Identifiable Health Information (the Privacy Rule) under the Health Insurance Portability and
Accountability Act of 1996 (HIPAA). These new standards provide the first comprehensive federal
protection for the privacy of personal health information allowing patients access to their medical records
and more control over how their personal health information is used and disclosed. The final rule went into
effect in April, 2003. The Privacy Rule requires healthcare providers to take reasonable actions to safeguard
protected health information (PHI) and to discipline individuals who violate privacy policies. The
Department of Health and Human Services is charged with enforcing the HIPAA legislation. External
consequences can mean fines levied on the organization and the individual(s) involved and can include jail
time for disclosing PHI.
All patient information is confidential. You may not share any patient related information via word of
mouth, by any social network, or electronically. You will not photocopy or reproduce in any form the
patient’s medical record(s). Failure to maintain patient confidentiality may result in a grade of not more than
“76” for the course and could result in dismissal from the CCC Nursing Program.
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There are very serious consequences if a student violates HIPAA!!
Deductions
Attendance (deductions are from the rotation grade)
 Tardiness: 2 points if student is late, but arrives prior to the end of pre-conference
 Tardiness: 9 points if student is late and arrives after the end of pre-conference. She/he may be sent
home. The deduction is the same as for absence (9 points)
 Absence: 9 points/day
 No call/no show: grade of ‘0’ for the week if the student is absent and does not call the clinical site
before or early during the shift. No call/no show is an extremely serious offense that can cause the
practicing nurse to lose her/his job; thus, the serious consequences for the student nurse
 Early departure: 9 points if a student leaves at any time before dismissal from post-conference, the
deduction is the same as for absence (9 points)
 In the event a student misses two consecutive clinical days the student will receive a ‘0’ for the clinical
week for both paperwork and clinical performance. No additional points for the absence will apply
Paperwork (deductions are from the weekly Written CARE PLAN grade)
 Incorrect forms: 3 points
 Inappropriate formatting: 3 points
 Multiple spelling errors: 3 points
Professional Appearance, including but not limited to the following: (deductions will be from the
weekly Clinical Performance grade)
 Inappropriate appearance: minimum 5 points per occurrence/day. Extreme violations, as
determined by the clinical instructor, can result in the student being sent home and counted absent
with the appropriate 9 point deduction
 Students must wear a white uniform shirt/navy blue pant, with appropriate number of blue stripes,
that is well-fitting, clean, pressed, and in good repair. No hip-huggers or pants that expose the
student’s derriere or back when bending over are permitted. No skin should be exposed between
uniform top and bottom
 Undergarments must be appropriate for the clinical setting. No colored, patterned materials, which
will be seen through the shirt, (white/or flesh colored undershirt is appropriate).
 Shoes must be 85% white, closed heel and toe, soft soles (no clogs), and be clean and in good repair
 Your Clovis Community College name badge must be worn
 Hair must be pulled back at/above the line of the collar. Hair clasps are to be functional, rather
than decorative. Extremes in hair color, color patterns, and styles are inappropriate
 Students will not wear artificial nails; nails will be cut short. If polish is worn, it must be clear and
intact
 No visible body piercing jewelry is allowed, including tongue rings
 One small pair of post earrings is acceptable
 Necklaces are not permitted
 Tattoos must be covered
 Make up should be moderate
 Males must be clean shaven, or males with an established beard and mustache must be neatly
trimmed
 Because of working in close proximity to residents/patients daily bathing, use of deodorant, and
good oral hygiene are required. Do not use of perfumes, colognes, after-shave, and other heavilyscented products
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Professional Behaviors, including but not limited to the following: (deductions will be from the weekly
Clinical Performance grade)
 Inappropriate behavior: minimum 5 points per occurrence/day. Extreme violations, as determined
by the clinical instructor, can result in the student being sent home and counted absent with the
appropriate 9 point deduction
 Use of cell phones is not allowed in the clinical setting. On the rare occasion a family member may
need to get in touch with the student during clinical hours; the student may speak with her/his
clinical instructor, and request to carry her/his cell phone in case of an emergency call. The cell
phone may not be used in any patient care area
 Each student will maintain a respectful attitude toward the clinical instructor, patient, staff, and peers
during the clinical rotation utilizing low conversational tones. No loud voices, no inappropriate
language, and no inappropriate laughter are allowed
 Each student will treat each resident/patient with consideration, dignity, and respect at all times
 Each student will interact with residents/patients therapeutically
 Each student will demonstrate accountability and responsibility for her/his own actions
 Chewing gum is not appropriate
 Each student must bring the appropriate equipment to the clinical setting including the equipment
mentioned in section number 6 on page 1.
 Any student who does not provide privacy for their patient (for example, disrobing a patient in front
of another patient without a covering) will receive a 5-point deduction for each occurrence.
 Walking away from the computer while the patient screen and information is visible or failing to log
off the computer once you have completed your task will result in a 5-point deduction for each
occurrence.
Acute Care Clinical Sites
Plains Regional Medical Center - Clovis:
Parking is in any parking lot, in spaces furthest away from the building and the helipad.
Medical Floor: This unit is located in the south wing of the hospital.
The phone number for the nurses' station is 769-7559.
Surgical Floor: This unit is located in the north wing of the hospital.
The phone number for the nurses' station is 769-7470.
CLINICAL PAPERWORK GUIDELINES
1. Examples of the required clinical forms (Acute Care Worksheet) are loaded in Canvas. The clinical briefing
packet is provided for reference and the student is held accountable for following all instructions in the
packet.
2. Students will be expected to be able to discuss and respond appropriately to the clinical reasoning questions
included in the clinical paperwork in pre/post-conference. An unprepared student may be sent home at the
instructor’s discretion and can expect a grade deduction as a reflection of lack of student preparedness.
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3. If a student is unable to complete paperwork with the preferred resources (textbooks, Tabor’s) because the
subject is not present within these books then the student may use an online resource. If a student uses an
online resource, then he or she MUST print out a copy of the web page containing the data including the
URL and turn it in with the med card or form for the instructor to review. Failure to do this will result in a
deduction on the grade for that item/section.
4. Any paperwork submitted by one student that looks remarkably like another student’s work will receive a
zero ‘0’. The zero will apply to all papers involved. Students are responsible for protecting their individual
work. The use of computers and flash drives makes protecting individual paperwork more difficult, so
protect your work.
5. Performance and clinical worksheets will be graded throughout the day and/or during post conference. Any
disagreements as to how the grade was arrived at must be brought to the instructors’ attention at that time.
Grades will be posted in canvas prior to the beginning of the next clinical week.
6. In order to assure medications are administered on time, only a portion of the students will administer meds
each day. The instructor will inform students in pre-conference which students will administer meds each
day. The groups will be alternated to assure all students get equal opportunities to administer meds.
7. Students will provide total patient care which includes, meds, treatments, and personal care.
8. Students need to bring hard copies of paperwork with them to facility including charting pages. All pages
are to be single sided, in proper format. . Have extra copies of each page in the event your assigned
patient has more information than will fit neatly on one page.
9. Students will report off to the floor nurse by 1430 and post conference will begin at 1500.
Student Daily Paperwork Expectations: These forms are fillable format and can be completed on the
computer.
1. Once released from Pre-Conference after receiving assignment complete clinical worksheet (first page
of packet) and the Lab Value Monitoring portion on both assigned patients and bring with you when you
return to Pre Conference.
2. Daily complete the assessment sheet and vital sign monitoring section of the packet for all assigned
patients.
3. Clustering clinical data will be completed for all patients daily.
4. Clinical reasoning questions will be completed daily for all patients. The pre-clinical questions should
be prepared and ready for discussion during pre-conference. The clinical questions will be discussed
with your instructor sometime during the day. The post-clinical questions should be completed and
ready for discussion during post-conference.
5. The instructor will retain the entire completed packet at the end of the week.
6. Medi-Quick medication cards are to be brought to the clinical site. A med card for all medications
ordered for the assigned patients are to be prepared before the meds are administered. The student
should be prepared to provide information at the request of the instructor of the meds ordered for the
assigned patients. The med cards will be retained by the student. The student will be expected to
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understand why the patient is on the ordered med, which diagnosis the med is associated with and be
able to discuss the elements completed on the med cards at the instructor’s discretion.
7. Due to the nature of Acute Care, patients are discharged and new patients admitted quickly. Therefore,
student assigned patients may vary throughout the rotation. There is no guarantee the patients cared for
on day 1 will remain in facility by day 2. All paperwork as delineated above is to be completed on all
patients cared for everyday of the clinical rotation.
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Acute Care
N124L-IN
Summer 2013
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