Download GOOD SAMARITAN HOSPITAL Vincennes, Indiana

S 19.16.19
GOOD SAMARITAN HOSPITAL
Vincennes, Indiana
Approved: 6/99
Revised: 6/00, 12/05, 8/08, 8/11,
1/14
Reviewed: 4/03
Index: S 19.16.19
Pages: 4
SHADOWING/MENTORING
PROGRAM
(ADULT/STUDENT SHADOW
PROGRAM)
President/CEO Approval
Approved by:
Hosp Wide P&P Com
1/14
Hospital Wide
Prepared by:
Kimberly Hughes RN, BSN
*PRINTED COPIES OF THIS DOCUMENT ARE NOT CONTROLLED AND ARE CONSIDERED FOR REVIEW, REFERENCE
AND/OR TRAINING PURPOSES ONLY. FOR LATEST COPY, REFER TO THE ELECTRONIC COPY ON THE GSH INTRANET.
DEFINITION:
Shadowing/mentoring is an observation only experience for students and adults age 16 or older. The program does
not allow for the shadower to perform any tasks or patient care.
POLICIES:
1.
Good Samaritan Hospital provides an opportunity for adults/students to view selected occupations in a
shadowing experience. A contract signed and dated by the student, agreeing to the Shadowing Guidelines
will be returned to Good Samaritan Hospital the morning of the shadowing experience.
2.
Shadowing experiences are to be prearranged and coordinated by the Clinical Informatics and Education
Department in conjunction with the school faculty or GSH shadowing coordinator. Arrangements can be
made by calling Clinical Informatics and Education at 885-3313 two weeks prior to the expected
shadowing date.
3.
If shadower is under 18 years of age, they must come to the Clinical Informatics and Education Department
at least one week prior to their shadowing experience and pick up a Shadowing packet to be read and
signed by both the shadower and his or her parents. For shadowers who live long distances, the packet may
be mailed to them.
4.
High school students will not be permitted to observe surgical cases/invasive procedures, or shadow
physicians.
5.
The shadower's immunization record is to be current and reviewed by the GSH Shadowing Coordinator and
a copy of this record attached to the contract.
6.
Shadowers who are considered infectious from any disease process or have developed flu like symptoms
will be unable to participate in the program until free of the symptoms and/or disease process.
7.
Each shadower will receive Good Samaritan Hospital Risk Management Safety Information and Code of
Conduct booklets. The Shadowing Program Coordinator or Designee will speak to the shadower about
infection control, corporate responsibility, and confidentiality prior to arriving on the unit/department.
8.
Shadowers are to wear an identification tag with their name and area of their shadowing experience. The
Shadowing Coordinator in Clinical Informatics and Education will provide the name tags prior to arriving
on the unit/department.
9.
Shadowers will complete an evaluation of their experience and return it to Good Samaritan Hospital’s
Clinical Informatics and Education Department the day of the visit.
10.
If a school program requires that Good Samaritan Hospital staff complete an evaluation of the student’s
performance while visiting the facility, the student will provide a postage paid self-addressed envelope the
day of the visit. This evaluation will be completed by the person the adult/student is shadowing.
PURPOSE:
To provide opportunities for the adults/student to observe services provided by a specific occupation.
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S 19.16.19
ASSESSMENT AND PLANNING:
Considerations:
In order to be accepted into the shadowing program, the following criteria must be met:
1. The shadower, parents (of minors) and instructor if applicable must sign and date the shadowing contract and all
paperwork must be completed in full.
2. Dress is casual; dress pants are acceptable for both sexes. Denim clothing, shorts, bare midriff, hemlines
shorter than four inches above the knees, sandals, high heels and clogs are not acceptable. No perfume or
cologne is permitted.
3. A current copy of the immunization record must be provided the shadower.
RESOURCES:
1.
2.
3.
4.
5.
6.
7.
Contract for learning experiences at Good Samaritan Hospital
Immunization Record
Code of Conduct Booklet
Risk Management Safety Information Booklet
Statement of Compliance
HIPAA Privacy Statement
Evaluation Form
IMPLEMENTATION:
1.
The shadower will follow an employee from Good Samaritan Hospital and will observe work processes and
generate questions about the specific occupation.
2.
The shadowing experience is strictly observational. No tasks are to be performed. The shadower will
follow directions provided by the employee related to safety/emergency preparedness policy.
3.
The shadower is to remain with their mentor at all times unless directed differently.
4.
No visiting in other departments, units or areas unless directed by mentor. No personal calls may be made
or received by the student unless it is an emergency. Cell phones must be turned off during shadowing
experience.
5.
If requested by the school system, the employee may complete an evaluation of the student.
EVALUATION:
1.
Contract signed by the Education representative, adult/student and mentor (if applicable).
2.
Immunization record is reviewed and deemed current to recommended standards. Statement of
Compliance, Risk Management Safety Information and Confidentiality agreements are signed and adhered
to by the shadower.
3.
The shadower follows employee(s) and observes work processes.
4.
Completion of written evaluation(s).
5.
Annual review of program by Clinical Informatics and Education and other specific departments.
6.
Signed contract, Statement of Compliance, Risk Management, Confidentiality agreements, immunization
records and written evaluations will be maintained for three years in the Clinical Informatics and Education
Department’s records.
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S 19.16.19
STUDENT SHADOWING PROGRAM GUIDELINES
Good Samaritan, in support of the strategic plan supporting health-related education, provides an opportunity for
adults/students to view selected occupations in a shadowing experience. Shadowing is an observation experience
only; no task(s) will be performed by the shadower.
An adult/student may participate in the shadowing program by fulfilling the following guidelines:
1.
2.
3.
4.
5.
6.
Shadowing experiences are prearranged by a school faculty member or an adult individual by calling
Clinical Informatics and Education at 885-3313 two weeks prior to the anticipated shadowing date.
Completion of the attached contract and copy of the current immunization record is submitted to Good
Samaritan Hospital, Clinical Informatics and Education, the morning of the shadowing experience.
At the time of the shadowing experience, the shadower will be free of any infectious disease process,
current on immunizations, and arrive in acceptable casual dress. Unacceptable dress includes denim
clothing, bare midriff, shorts, hemlines shorter than four inches above the knees, sandals, high heels and
clogs. If the shadower's attire is inappropriate or the paperwork and immunization record is not complete or
current the shadowing experience will be cancelled for that day.
Meet with the Shadowing Coordinator in Clinical Informatics and Education or Designee to review and
understand the importance of infection control, safety, corporate compliance and confidentiality.
Wear identification, provided by the Shadowing Coordinator or Designee, and follow assigned employee
observing work processes, following directions provided by the employee and generating questions related
to the specific occupation.
Complete an evaluation of the shadowing experience and return it to Clinical Informatics and Education at
the end of the shadowing experience.
In advance, thank you for your interest in healthcare occupations. If you have questions or a need for further
clarification, please call Clinical Informatics and Education at 885-3313 and ask to speak to the Shadowing
Coordinator.
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S 19.16.19
Good Samaritan Hospital
Vincennes, Indiana
CONTRACT
for
SHADOWING EXPERIENCE
I, ______________________________, have read, understand and agree to adhere to the Shadowing Program
Guidelines. During the time of my observation, I will maintain high ethical standards, be courteous to patients,
visitors, families and employees of Good Samaritan Hospital and will maintain confidentiality of patient records in
compliance with all applicable state and federal laws.
Signature_____________________________________________________ Date_______________________
Parent’s (guardian) signature______________________________ Date______________________
Home phone number______________________________ Work phone number_____________________________
School or organization name_______________________________________ Phone number___________________
Faculty member’s/organization adult leader’s signature___________________________ Date_________________
Shadower's physician______________________________ Physician’s phone number_____________________
Area of Shadowing Experience: _____________________________
Immunization Record: Current ____Y
____N
For parents of minors:
I understand that my child will be signing forms indicating his/her agreement to abide by Good Samaritan Hospital’s
policies, procedures and confidentiality guidelines.
Parent’s (Guardian’s) Signature: __________________________________________ Date ________________
Revised 1/14
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