Clinical Expectations

ATTENDANCE

Attendance at every clinical experience is mandatory. Absences should be reported to the faculty, the agency involved and the student’s Preceptor (if applicable) prior to the time of arrival at the agency. Clinical absences may result in failure of a course. Dates for the BSN Clinical make ups are scheduled at the beginning of each term and are included in the course syllabus. Specific arrangements for clinical makeup will be individualized to the students’ needs and will be at the discretion of the clinical faculty and course instructor. All clinical time missed must be made up in the clinical area.

CHARTING

When students record their observations on the patient's records within any hospital or agency, they are performing in the student role, and should designate their student status by using the following abbreviations after their names:

• UNS - Undergraduate Nursing Student

• DNPS - Doctor of Nursing Practice Student

• GNS - Graduate Nursing Student (MSN students)

DRESS CODE

Professional appearance is required for all clinical areas. A student may be dismissed from the clinical setting for unprofessional dress. They will be required to make up the experience.

Uniform regulations for all prelicensure students (BSN, Grad Entry DNP, and Grad Entry DNP II) have been established by members of the Student Association and the Faculty of the School of Nursing. The approved student uniforms for BSN and DNP students may be ordered from White House Uniforms. An emblem designating the School of Nursing is sewn on to the left sleeve of the uniform. Emblems are not to be pinned on uniforms. Emblems will be attached when the uniform is purchased. Students must wear the approved uniform to all clinical experiences unless the experience is taking place at a clinical site where an alternate form of dress is authorized by the instructor. The uniform should be worn only within the hospital or clinical agency, unless the student must go directly to class from the clinical agency or directly to the clinical agency after class, and there is not sufficient time to change clothes. This policy applies to all students, regardless of where they live. Students assigned to Community Health Nursing should follow guidelines of the agency. BSN students in their Community Clinicals must wear the designated polo shirt and slacks. Students are expected to use good judgment regarding appropriate attire in clinical settings.

Guidelines

1. Exceptional personal hygiene must be maintained at all times. This includes bathing on a daily basis and the appropriate use of deodorants and anti-perspirants as needed.

2. With the exception of a wristwatch and plain wedding band, jewelry is not worn with the uniform. Earrings should be small posts or hoops no larger than 1/4 inches in diameter. Rings are not permitted on any visible part of the body except fingers and ears. Studs are not permitted in any visible part of the body except ears. The maximum number of earrings and/or studs permitted is two in each ear.

3. Clothing must be clean and pressed.

4. Make-up and nail polish may be used conservatively and in good taste. Acrylic nails are not permitted.

5. Hair is to be clean, arranged neatly and kept above the collar of the uniform. Wigs and hairpieces may be worn, provided they comply with these criteria.

6. Beards and moustaches are to be neatly trimmed.

7. No open toed shoes are to be worn with the school uniform. Hose should be a neutral color.

8. At all times, students should maintain a professional appearance while in the clinical areas.

9. The laboratory coat may be worn over the uniform or street clothes, but not over shorts or jeans.

Graduate students (MSN, DNP III, DNP IV, PhD) are expected to use appropriate judgment regarding attire in their clinical settings. A badge with their name identifying themselves as an RN and a Case Western Reserve student must be worn in clinical areas. Students are expected to follow the dress code guidelines at the agency where they are having their clinical experience.

LIABILITY INSURANCE

It is mandatory that all students (graduate and undergraduate) carry liability Insurance, which offers personal and professional protection. Information on liability insurance is available in the Office of Student Services and the Program offices. The required limits of liability are no less than one million dollars of coverage. Students will be asked to present evidence of liability coverage prior to engaging in clinical learning experiences.

IMMUNIZATIONS/TB TESTING/BACKGROUND CHECK

At the beginning of each academic year, every student must provide the Program Office with documentation of immunization (xeroxed records) for Hepatitis B, measles, mumps, rubella and varicella or proof of immunity. Documentation of date of disease is not sufficient. If the student does not have documentation of any of these immunizations, he or she will be required to obtain immunization and present documentation (or waiver) prior to entry into the clinical area (whichever occurs earlier). Any student without documentation will be excluded from the clinical area. As clinical affiliates change their policies regarding immunization and background checks requirements for personnel working in their facilities, School of Nursing requirements will be adjusted.

TB Testing

A yearly Tuberculin Test is required of all students in the nursing school. On site testing is provided at the School of Nursing at the beginning of fall semester. Graduate students enrolled in clinical courses must provide documentation of TB test results and immunizations each semester.

Education Concerning Communicable Diseases and Training in Protection Against Transmission of Communicable Diseases

An education and training session will be conducted during the class sessions for new students each semester. Attendance at such a session must be documented for all students prior to being granted entry into the clinical area. In addition, each clinical course will update and discuss applications of universal precautions specific to that clinical experience as part of the course orientation.

All students must also complete clinical agency educational requirements related to HIPAA (Health Insurance Portability and Accountability Act).

Reporting Exposure to Blood and Other Infectious Body Fluids and Postexposure Management

Specific clinical site procedures for post-exposure reporting, documentation, and management must be followed.

1. An exposure is defined as contact with blood or other potentially infectious body fluids to which universal precautions apply through percutaneous inoculation (needle stick) or contact with an open wound, nonintact skin, or mucus membrane during the performance of normal clinical practice.

2. Such an exposure should be reported within 2 hours of exposure to the Instructor and University Health Services.

3. Documentation of exposure: As part of the confidential medical record, the circumstances of exposure and a description of the source of the exposure will be recorded by the University Health Services.

4. Postexposure management: The University Health Services will assume pertinent post exposure management including medical treatment and counseling.

Reporting Exposure to Communicable Diseases Other Than HIV and HBV

1. Reporting: An exposure is defined as unprotected contact with an individual who has been diagnosed with the communicable disease or who develops the disease within one week after the contact. Such an exposure is to be reported within 24 hours to University Health Service and the School's Office of the Associate Dean for Academic Programs.

2. Documentation of exposure: As a part of the confidential medical record, the circumstances of exposure and a description of the source of the exposure will be recorded by the University Health Service and communicated to the School of Nursing.

3. Post exposure management: The University Health Services will assume post exposure management including medical treatment.

BEHAVIOR

Students are expected to conduct themselves in a professional manner when in the clinical area and all other public places when representing the FPB School of Nursing. A student may be dismissed from the clinical setting for not meeting the standards of professional behavior. Action taken at the time of the incident will be at the discretion of the clinical instructor.

Students are asked to observe the regulations concerning regular visiting hours when visiting relatives, friends, and students who are patients. Street clothes are to be worn during these visits.

The welfare and safety of the patient should be of first concern. Information acquired from nurse-patient interaction or the patient’s chart should be held strictly confidential.

POLICY ON STUDENT CONDUCT IN THE CLINICAL SETTING

Revised and Updated – Effective February 1, 2007

Consistent with rule 4723-5-12-B of the Ohio Administrative Code, the following are the standards of conduct for students engaged in interaction with clients in any clinical setting.

1. A student shall, in a complete, accurate, and timely manner, report and document nursing assessments or observations, the care provided by the student for the client, and the client’s response to that care.

2. A student shall, in an accurate and timely manner, report to the appropriate practitioner, errors in or deviations from the current valid order.

3. A student shall not falsify any client record or any other document prepared or utilized in the course of, or in conjunction with, nursing practice. This includes, but is not limited to, case management documents or reports or time records, reports, and other documents related to billing for nursing services.

4. A student shall implement measures to promote a safe environment for each client.

5. At student shall delineate, establish, and maintain professional boundaries with each client.

6. At all times when a student is providing direct nursing care to a client the student shall: (a) Provide privacy during examination or treatment and in the care of personal or bodily needs; and (b) Treat each client with courtesy, respect, and with full recognition of dignity and individuality.

7. A student shall practice within the appropriate scope of practice a set forth in division (B) of section 4723.01 and division (B)(20) of section 4723.28 of the Revised Code for a registered nurse.

8. A student shall use universal blood and body fluid precautions established by Chapter 4723-20 of the Administrative Code.

9. A student shall not: (a) Engage in behavior that causes or may cause physical, verbal, mental, or emotional abuse to a client; (b) Engage in behavior toward a client that may reasonably be interpreted as physical, verbal, mental, or emotional abuse.

10. A student shall not misappropriate a client’s property or: (a) Engage in behavior to seek or obtain personal gain at the client’s expense; (b) Engage in behavior that may reasonably be interpreted as behavior to seek or obtain personal gain at the client’s expense; (c) Engage in behavior that constitutes inappropriate involvement in the client’s personal relationships; or (d) Engage in behavior that may reasonably be interpreted as inappropriate involvement in the client’s personal relationships.

For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to the behaviors by the student set forth in this paragraph.

11. A student shall not:

• Engage in sexual conduct with a client;

• Engage in conduct in the course of practice that may reasonably be interpreted as sexual;

• Engage in any verbal behavior that is seductive or sexually demeaning to a client;

• Engage in verbal behavior that may reasonably be interpreted as seductive, or sexually demeaning to a client.

For the purpose of this paragraph, the client is always presumed incapable of giving free, full, or informed consent to sexual activity with the student.

12. A student shall not, regardless of whether the contact or verbal behavior is consensual, engage with a patient other than the spouse of the student in any of the following:
    (a) Sexual contact, as defined in section 2907.01 of the Revised Code;
    (b) Verbal behavior that is sexually demeaning to the patient or may be reasonably interpreted by the patient as sexually demeaning.

13. A student shall not self-administer or otherwise take into the body any dangerous drug, as defined in section 4729.01 of the Revised Code, in any way not in accordance with a legal, valid prescription issued for the student.

14. A student shall not habitually indulge in the use of controlled substances, other habit-forming drugs, or alcohol or other chemical substances to an extent that impairs ability to practice.

15. A student shall not have impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of habitual or excessive use of drugs, alcohol, or other chemical substances that impair the ability to practice.

16. A student shall not have impairment of the ability to practice according to acceptable and prevailing standards of safe nursing care because of a physical or mental disability.

17. A student shall not assault or cause harm to a patient or deprive a patient of the means to summon assistance.

18. A student shall not obtain or attempt to obtain money or anything of value by intentional misrepresentation or material deception in the course of practice.

19. A student shall not have been adjudicated by a probate court of being mentally ill or mentally incompetent, unless restored to competency by the court;

20. A student shall not aid and abet a person in that person’s practice of nursing without a license, practice as a dialysis technician without a certificate issued by the board, or administration of medications as a medication aide without a certificate issued by the board.

21. A student shall not prescribe any drug or device to perform or induce an abortion, or otherwise perform or induce an abortion.

22. A student shall not assist suicide as defined in section 3795.01 of the Revised Code.

23. A student shall not submit or cause to be submitted any false, misleading or deceptive statements, information, or document to the nursing program, its faculty or preceptors, or to the board.

PREPARATION

Students must come to clinicals prepared to deliver safe nursing care. Coming unprepared to clinical may result in removal from the clinical area and may require one clinical make-up day.

TARDINESS

Tardiness is defined as arriving to the designated clinical unit or meeting place anytime after the designated start of clinical. In the event that a student anticipates clinical tardiness, the instructor must be notified prior to the beginning of clinical day. Tardiness without prior notification at the beginning of the clinical day may result in a required make-up day. Two (2) or more tardy incidences (with or without prior notification) may result in a full clinical make-up day.

CLINICAL FAILURE

Clinical failure is defined as the inability to meet one or more clinical behaviors/objectives at a satisfactory level. Failing the clinical portion of a course will result in failure of the entire nursing course for which clinical is a component. A student demonstrating unsatisfactory or unsafe clinical performance during a semester will be notified in writing by his/her clinical instructor. A learning contract directed at correcting unsatisfactory performance will be negotiated between the student and the faculty member. Failure to fulfill the contract will result in a clinical failure.

CLINICAL EVALUATIONS

In order to meet all the requirements of the clinical course, the student must attend all scheduled clinical evaluations and bring the completed student evaluation form for that course. In the event that a student is unable to attend a scheduled evaluation, the student must notify the faculty prior to their appointment in order to reschedule. Failure to attend a scheduled evaluation may constitute a grade of unsatisfactory in the category of professional behavior. A final grade for the course will not be assigned until the clinical evaluation is completed.

CLINICAL PERFORMANCE WHICH THREATENS PATIENT SAFETY

If, in the judgment of the instructor, the student’s clinical performance constitutes a threat to patient safety, the student will be removed from the clinical area and may be subject to dismissal from the program.

CLINICAL ASSIGNMENT

Nursing students will be expected to care for any patient assigned by the clinical instructor or preceptor. Refusal to care for any patient is contrary to the ethics of the nursing profession.

ILLNESS

Nursing students under the care of a physician should bring a statement from the physician to the program assistant. The statement should indicate whether or not the student is able to return to regular clinical assignments. Consult individual course guidelines for information regarding individual policies.

TRANSPORTATION

All upper level (BSN juniors and seniors, DNP, MSN) students are expected provide their own transportation to clinical agencies. BSN freshman and sophomores will be expected to use their RTA passes to and from clinical agencies when possible. Where distance to the clinical setting is excessive, the BSN office will arrange transportation. Residential students need to be make parking arrangements with the University.

HOSPITAL TOURS

Special permission from the Nursing Director of the clinical area involved is necessary to conduct tours of specific hospitals. When conducting official approved tours, the student should wear a laboratory coat or full uniform.

REPORTING INCIDENTS

Incidents involving unexpected events in the clinical setting must be reported immediately to the clinical instructor and to the agency involved.