Collaborative Nursing Program. Lambton College, St. Clair College and University of Windsor

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1 Collaborative Nursing Program Lambton College, St. Clair College and University of Windsor Policies for Pre-Graduate BScN Nursing Students Clinical Experience In Essex, Kent and Lambton County Hospitals Original Development Date: May 9, 1997 Last Reviewed/Revised: April 30, 2012 Collaborative Nursing Program, University of Windsor

2 TABLE OF CONTENTS PREAMBLE ORIENTATION CONFLICT OF INTEREST POLICY: PERSONAL/FAMILIAL RELATIONSHIPS IN CLINICAL VIOLENCE AND HARASSMENT PREVENTION NON-MEDICAL AND MEDICAL REQUIREMENTS ABSENTEEISM: (Late, Ill/Absent, Bereavement) MINISTRY OF EDUCATION WORKPLACE AGREEMENT FORM INCIDENTS: PERSONAL INJURY INCIDENTS: NEEDLESTICK OR MUCOSAL EXPOSURE INCIDENTS: PATIENT/VISITOR MEDICATION AND PROPERTY RELATED INCAPACITIES CONFIDENTIALITY PERSONAL APPEARANCE AND ATTIRE PERSONAL CONDUCT MEALS ACCOMPANYING PATIENTS TO OTHER FACILITIES LIBRARY EXPERIENCE IN SPECIALTY AREAS OPERATING ROOM - OBSERVATION EXPERIENCE BLOOD BANK PROCEDURES/TRANSFUSION SERVICES LEGAL DOCUMENTS/CONSENTS/VERBAL ORDERS COMMUNICATION: REPORTING AND DOCUMENTATION DELEGATED CONTROLLED ACTS & MEDICAL DIRECTIVES Page 2 of 24

3 18.0 BLOOD GLUCOSE MONITORING MEDICATIONS MEDICATIONS: NARCOTICS AND CONTROLLED SUBSTANCES I.V. THERAPY PHLEBOTOMY REFERENCES APPENDIX A: Medical/Non Medical Program Entry Requirements.16 APPENDIX B: Student Medical Certificate.18 APPENDIX C: Social Media Policy.19 APPENDIX D: Medication Error Reporting Process APPENDIX E: Medication Error Report APPENDIX F: Definition of Independent Double Check...24 Page 3 of 24

4 Policies for Pre-Graduate BScN Nursing Students Clinical Experience in Essex, Kent and Lambton County Hospitals PREAMBLE The following policies have been developed for students placed in all clinical facilities but are subject to the practice of the individual clinical agency. Students will function in accordance with these specific policies as related to their clinical objectives/course content. It is understood that students may perform any skill which has been previously taught and supervised by the educational institution. Procedures within the scope of nursing, as outlined in the Regulated Health Professions Act, may be performed by students if they are within the students skill level. These procedures are to be performed under the supervision of the Registered Nurse (RN) Preceptor. Students are expected to follow the guidelines for professional nursing behaviour and scope of practice, as outlined by the College of Nurses of Ontario, their institution of learning, and the clinical agency. If the policy statement here and the policy statement of an agency differ, the most conservative statement will apply. Example: This policy permits students to start IV s and the agency policy does not the student cannot start IV s. Students are directly responsible to the RN Preceptor in the clinical areas. Any basic nursing skills previously taught but not practiced by the student must be performed under the direct supervision of the RN Preceptor. The RN Preceptor, after consultation with the faculty advisor, will indicate to the student when he or she may perform nursing skills without supervision. Students are expected to be familiar and in compliance with hospital policies, procedures and manuals (i.e. Fire, Disaster and Evacuation plans and Codes) as are found on each unit, or online. *Note: All patients assigned to nursing students must also be co-assigned to a registered nurse. Students are on the unit in a learning capacity and are not to be counted for staffing purposes. Students shall not be left solely responsible for the patients on the unit at any time, including breaks and lunches. Before leaving the unit, each student will give a written or verbal report to a responsible staff member. When the term student is used in the Pregraduate BScN Policies, it embraces the University of Windsor, Lambton College and St. Clair College, Level IV BScN Collaborative Nursing Students. When the term supervision is used in this document it refers to the general watching and direction of the students actions in the clinical area. Direct supervision, on the other hand, refers to being at the student s side when the student is performing a specific procedure or task from beginning to end of the procedure. There are separate policies for those students who are in other levels of nursing programs. Faculty advisors are assigned to the Pre-graduate experience by the University or College. Page 4 of 24

5 1.0 ORIENTATION a. The educational institution will inform the clinical placement liaison as to who is coming to the hospital, the units requested, the level and number of students, as well as the dates of the experience. A brief, informal meeting (welcome) should be arranged with the unit manager, preceptors, and students. Student registration/orientation according to the agency s requirements is expected. b. Faculty are expected to contact the clinical agency prior to the students experience to determine if there are any new agency policies or legislation that could impact student clinical rotation. c. University/College Nursing Labs are to be notified by the agency of new products or equipment that impacts clinical practice. d. Where hospital/agency conducts a formal student orientation, students must attend the said orientation before participating in a clinical experience. e. During orientation, faculty advisors are required to review the student policies and the Emergency codes and procedures of the agency. Faculty advisors will also review the confidentiality policy and any other agency policies and procedures (i.e. infection control) appropriate to the Pregraduate/Level IV students. The students, in partnership with faculty, are expected to review, understand and keep a record of the review of all new policies or pertinent legislation. If the organization and/or legislation requires, they must sign indicating the review. Proof of orientation completion will be submitted to the agency when required. f. Students are required to submit an extended police clearance for vulnerable populations at minimum annually or as frequently as required by agencies. g. Students are to follow agency policy regarding parking areas. 1.1 CONFLICT OF INTEREST POLICY: PERSONAL/FAMILIAL RELATIONSHIPS IN CLINICAL Students are expected to report immediately to one of the Faculty of Nursing Clinical Coordinators if one or more of the following applies: a. A student has a family member in their clinical group; b. A student has been assigned to a clinical setting in which they are employed in a paid or unpaid position; c. A student has been assigned to a clinical setting in which one of their family members is employed or is a patient; d. A student has been assigned to a clinical instructor, faculty advisor or preceptor who is a family member. e. In any of the above situations, students will be re-assigned to a clinical area where there is no relational conflict. f. Family members include: sister, brother, mother, father, spouse, significant other, daughter, nephew, niece, uncle, aunt, cousin, or in-laws. Page 5 of 24

6 1.2 VIOLENCE AND HARASSMENT PREVENTION The University of Windsor and our community agencies/hospitals have policies related to the prevention of violence and harassment in the workplace. For more details go to: These policies (which are guided by Bill 168) are designed to protect clinical instructors and students. 2.0 NON-MEDICAL AND MEDICAL REQUIREMENTS a. The Faculty of Nursing requires students to complete certain medical and non-medical requirements annually at the beginning of each school year during their time at the University of Windsor. These clinical pre-placement requirements have been developed under the guidelines of the Ontario Hospital Association, Canada s Immunization Guide and the Ontario Medical Association. Please refer to Appendix A: University of Windsor Faculty of Nursing 4 Year BScN Collaborative Program Policies and Requirements. 1. Extended or Vulnerable Sector Police Clearance 2. Attestation of Clear Criminal Record 3. Birth Certificate 4. First Aid and CPR Certification 5. Respiratory Mask Fit Test/Card 6. Immunization Record 7. WSIB Form 8. Student Verification of Health Status Form b. Any contact with an infectious disease that requires follow-up will be done by a member of the Faculty of Nursing and possibly WSIB and Employee Health. (Please refer to the protocols outlined in the Communicable Disease Surveillance Protocols for Ontario Hospitals). It is strongly recommended that students receive the Hepatitis B vaccine and influenza vaccine prior to their clinical experience. Some institutions may not allow the students to practice without these vaccines. c. Masks will be provided by the agency as required and worn by the students according to the Infection Control policies of the organization. 3.0 ABSENTEEISM: (Late, Ill/Absent, Bereavement) a. Students are to notify the RN Preceptor, responsible person or charge nurse and faculty advisors prior to the commencement of duty if unable to report to duty as scheduled. It is recommended that the student record the name of the person with whom they spoke. Students are not to rely on voice mail to report the absence. b. The RN Preceptor will handle student illnesses while on duty. Students may be sent home and/or referred to their healthcare practitioner. Completion of the Student Medical Certificate or appropriate form from your educational institution (see Appendix B). This form is to be submitted to the faculty advisor. Page 6 of 24

7 c. Students with health problems, i.e. skin rashes, infections, dressings, etc. must report to their family doctor, or clinic and faculty advisors before beginning their assignment. d. Students with a splint, cast, crutches, etc., are not allowed to work on the nursing unit without special permission from the facility. 4.0 MINISTRY OF EDUCATION WORKPLACE AGREEMENT FORM The Workplace Agreement forms are to be completed by the student and agency at the beginning of each placement to assure the agency of Ministry of Education coverage for Liability and Workplace Safety Insurance for each student. 4.1 INCIDENTS: PERSONAL INJURY Students should carry a photo copy of their Health Card, a list of any medications they are taking, and a telephone number for the next of kin with them at all times in case of injury or illness that requires Emergency Room treatment. a. Appropriate documentation (i.e. The Patient/Visitor/Property Incident Report or Unusual Occurrence Report) is to be completed by students for any situation or occurrence of a personal nature, according to agency policy i.e., injury or property damage that relates directly to the student. Both the educational institution and the hospital forms must be completed. b. When injuries are sustained while on duty, students must report immediately to the RN Preceptor and/or unit manager, program director, or delegate. If the injury requires medical attention, students will be referred to the Emergency Department. c. The faculty advisors must be notified immediately and will initiate the Workplace Safety Insurance Board (WSIB) process, by reporting to the Clinical Coordinator within 24 hours and completion of the necessary forms by the student and school. 4.2 INCIDENTS: NEEDLESTICK OR MUCOSAL EXPOSURE a. Both faculty advisors and students are required to review agency policies re: needle stick or mucosal exposure policies. b. If an injury from a needlestick/sharp object or mucosal exposure to blood/body fluids occurs, students must report IMMEDIATELY to their RN Preceptor and follow the protocol of the agency. Then students must report to their faculty advisors. c. Students are also responsible for ensuring that a copy of the appropriate documentation forms (i.e. incident report) related to personal injury and the Workplace Safety Insurance Board (WSIB) forms are completed within 24 hours. The faculty advisors will initiate the WSIB process. d. Each school of nursing will maintain appropriate documents for their own records. Page 7 of 24

8 4.3 INCIDENTS: PATIENT/VISITOR MEDICATION AND PROPERTY RELATED 5.0 INCAPACITIES All other unusual incidents, medication errors included, should be reported to the RN preceptor and faculty advisors. The facility s documentation process must be completed immediately upon discovery and in accordance with the agency policy and sent to the appropriate personnel. The College/University s form must also be completed and submitted immediately (i.e. Student Nurse Medication Error Report and Follow Up). Students reporting for clinical experience, whose behaviour may suggest they are under the influence of alcohol or drugs or in any other way incapacitated, shall be removed from the clinical area. Arrangements for safe transport home will be made either by agency personnel or the faculty advisor. Any costs incurred will be the responsibility of the student. Disciplinary action may be taken by the Faculty/School of Nursing and may also be taken by the hospital/agency, according to the event. 6.0 CONFIDENTIALITY Students shall follow the guidelines and standards in the following College of Nurses of Ontario documents: i. Guide to Standards of Practice for Nurses in Ontario ii. Standards for the Therapeutic Nurse-Client Relationship iii. The Ethical Framework for Nurses in Ontario iv. Explanation of Professional Misconduct v. Documentation Guidelines They shall exercise caution in written and electronic charting, written assignments, and reporting, transmission of visual images, and hold in confidence all information regarding patients (this includes refraining from posting patient/agency information on social media sites i.e. Facebook, Blogs, Twitter). Please refer to Appendix C: Social Media Policy. Patient matters are not to be discussed at any time in a public place either inside or outside the Hospital. Where the health care facility requires, all nursing students will need to sign a legally binding confidentiality statement. Students may disclose care-giving information to client s significant others, only with the client s consent. If confidentiality is breached, disciplinary action will be taken by the Faculty/School of Nursing and may also be taken by the hospital/agency. 7.0 PERSONAL APPEARANCE AND ATTIRE Students should demonstrate professionalism at all times while on hospital premises. It is required that they adhere to both educational and corporate policies of the institution in which they are placed. Many agencies are fragrance-free and students must comply with this. Page 8 of 24

9 Photo-ID badges must be worn and clearly visible at all times. 8.0 PERSONAL CONDUCT a. Students may not carry a cell phone on the unit. b. Students must assure that their Cardio-Pulmonary Resuscitation (Level C) and First Aid Certificates are current. The student may be asked to provide written proof of certification. c. Students may not visit a patient in the hospital while on clinical placement. They may visit only as a visitor after their clinical day, dressed in street clothes. d. Students must take appropriate action to ensure their own safety. For example: walking in pairs when leaving the agency at night. e. Any medication on their person during the clinical experience must be kept in a correctly labeled container. f. Students may not accept gifts from clients or give gifts to clients. 9.0 MEALS Designated areas are provided for eating (the cafeteria or coffee shop). It is the students responsibility to supply their own meals. If food is brought in, it may be stored in designated areas on the unit ACCOMPANYING PATIENTS TO OTHER FACILITIES If traveling with a client for the purpose of observation, a student must be accompanied by a registered regulated health professional. Students will not be solely responsible for patients traveling to another agency. Students may accompany patients to other departments with the agreement of the department and the most responsible care provider. Students must not transport patients in private vehicles LIBRARY Library resources are available to students during posted hours but must not be removed from the hospital library. Computer time should be scheduled with the librarian EXPERIENCES IN SPECIALTY AREAS Students assigned to specialty areas (ER, ICU, CCU, L&D, NICU, O.R., or PACU) are responsible for providing patient care with the R.N. Preceptor and within the scope of nursing for their skill level (see CNO RHPA Overview Part B) OPERATING ROOM - OBSERVATION EXPERIENCE a. Students are to go to the Operating Room for observation only (with prior approval of OR Manager). Page 9 of 24

10 b. Students may not observe the surgery of friends or relatives. c. Students will change into an Operating Room scrub uniform, supplied by the hospital. Only two students per patient are allowed at a time, for observation. d. The OR circulating nurse will supervise the students while in the Operating Room. e. Students may care for the patient in the post anesthesia care unit under the direct supervision of the RN BLOOD BANK PROCEDURES/TRANSFUSION SERVICES a. Except where hospital policy allows, students MAY NOT PICK UP BLOOD from the Blood Bank, but may accompany the person assigned to this task in order to observe the procedure followed. b. Students may monitor blood, and blood products under the supervision of the IV team, assigned RN, RPN or RN Preceptor. c. Students may initiate a blood transfusion under the direct supervision of the preceptor or assigned RN. d. Students may administer Rhogam under the direct supervision of the preceptor or assigned RN LEGAL DOCUMENTS/CONSENTS/VERBAL ORDERS a. Students may witness a Valuables Envelope with the co-signature of the RN Preceptor. Students shall not witness a Will or other legal documents. b. Students may not obtain written consents for any procedure or treatments (including Rhogam and influenza vaccine consents). c. Students will not accept verbal orders or phone orders from a physician or NP. d. Students may transcribe written orders if they are noted by a registered nurse. Students may not be the second co-signer for the registered nurse when noting orders COMMUNICATION: REPORTING AND DOCUMENTATION a. Students are responsible for keeping the other members of their health team informed of the patients condition, changes in treatment plan, etc. b. Students must report on and off duty to their RN Preceptor when arriving and leaving the unit. c. All student signatures must include their name, level, and school (i.e. Name, SN year, UofW J.Jones SNII UofW). The preceptor verifies the student s competence to chart independently for each new nursing procedure and when there are any unusual changes or occurrences. d. Students may take laboratory results over the phone, according to agency policy. Students must repeat the lab results to the caller for verification. Students may not take reports of critical values these must be reported directly from the lab to the staff nurse. Page 10 of 24

11 e. Electronic Documentation- Faculty advisors and students must familiarize themselves with the agency s practice participating in the orientation as offered by the hospital. f. All students must register their presence at the agency and participate in orientation and registration procedures before presenting to the clinical area, according to the policy of the hospital DELEGATED CONTROLLED ACTS & MEDICAL DIRECTIVES STUDENTS ARE NOT PERMITTED TO PERFORM ANY PROCEDURE WHICH THE HOSPITAL DESIGNATES IS TO BE PERFORMED ONLY BY SPECIALLY TRAINED NURSES. a. Students may not initiate a medical directive or perform a delegated controlled act. b. Students may perform a procedure outlined in a medical directive that has been initiated by a registered nursing staff (RN or RPN) provided they have the prerequisite knowledge. Refer to the College of Nurses document related to scope of practice and controlled acts: BLOOD GLUCOSE MONITORING Students may perform blood glucose monitoring (initial supervision by preceptor) as long as they have been educated regarding the use of that specific meter, and have demonstrated the ability to accurately perform such monitoring MEDICATIONS a. No medication may be given without a Doctor s or RN(EC) s written order. b. All routes of medication administration within the Controlled Acts authorized to Nursing may be utilized. c. Immunization agents and TB skin testing may be administered by students under the supervision of the preceptor/delegate. d. Students shall not administer the following: Direct IV medications, below the drip chamber IV anti-neoplastic chemotherapeutic agents Intradermal skin tests for allergies Allergy desensitization injections Epidural medications Intrapleural medications e. PSYCHOTROPIC MEDICATIONS Students may not give psychotropic medications to clients who are on variable dosages of these medications and whose medications are adjusted by nurses (i.e. range dosing). f. The RN Preceptor must directly supervise the preparation and administration of all medications including intermittent and/or continuous subcutaneous needle injection until Page 11 of 24

12 such time the preceptor in conjunction with the student deem the student competent to do this independently. g. Prior to administration of medications, appropriate testing is to be completed, i.e. Automated Medication Dispensing Tutorial, Medication Calculation Test. h. Pre-packaged medications will be opened at the bedside immediately prior to administration. i. All medication errors and near miss reporting will be done as per policy at the hospital site (i.e. Risk Monitor Pro). In addition, the clinical instructor and nursing student must complete the Student Nurse Medication Error Report and Follow Up (See Appendix D and E) and submit to designated person on your campus. NO confidential patient information will be included in this document. Rationale: The Nursing Faculty supports a safe learning culture where errors are examined, not to blame the individual, but to learn how to prevent them from happening again. To support safe medication practice, systems need to be in place to track, address and learn from any medication errors that occur in the practice environment (CNO, 2008, p. 7). Definitions: Medication Error any preventable medication event that may cause or lead to inappropriate medication harm, while the medication is in the control of the health care professional, or patient. Such events may be related to professional practice, health care procedures and systems, including: prescribing; order communication; product packaging and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use (National Coordinating Council for Medication Error Reporting and Prevention, 2008). Near Miss a medication error that has the potential to cause patient harm but did not actually reach the patient. j. As per hospital policy, the College of Nurses of Ontario, and the Institute for Safe Medication Practices, Independent Double Checks (See Appendix F) will be completed on high-alert medications (i.e. insulin, oral hypogylcemics, anticoagulants, all narcotics; Refer to: for a complete list of High Alert Medications. The Independent Double Check will be documented by the student and preceptor or other registered nurse as per institutional policy. k. When preparing high-alert medications: The preceptor will observe the student s preparation of the medication until he/she is deemed competent to prepare medications independently. A second individual (preceptor or staff RN) will be asked to complete an independent double check. Rationale: High-alert medications are drugs that bear a heightened risk of causing significant patient harm when they are used in error. Page 12 of 24

13 19.1 MEDICATIONS: NARCOTICS AND CONTROLLED SUBSTANCES 20.0 I.V. THERAPY a. The preceptor or designee must directly supervise the removal and preparation of all narcotics. Students will not have access to narcotics in the automated medication dispensing systems (i.e. PYXIS, Accudose, Medidose). b. Wastages of narcotics must be witnessed and co-signed by an RN or RPN, where RPNs are approved to administer controlled substances. If the student signs for the count, it must be co-signed by two other registered staff. c. The student may not carry the narcotic keys. Students are required to ensure ongoing accuracy of narcotics counts. Narcotics counts must be done when students are leaving the facility if the student participated in the distribution of controlled substances. d. Students may not pick up or accept narcotics from the Pharmacy. e. Students may monitor, record, and discontinue a PCA pump under the direct supervision of the RN Preceptor, and may care for a patient with this equipment. f. Students must follow the policy of the agency and manufacturer regarding the use of specialized equipment and medication delivery systems when caring for clients with these devices. a. Students may do all of the following listed below to the level of their knowledge and skill base. Assess the patient s response to the intravenous therapy. Flush patent/non-blocked peripheral IV needles/catheters with saline. Change standard intravenous solutions for peripheral site. Administer IV solutions through an established peripheral line. Regulate the flow rate and record intravenous readings. b. Students may do the following listed below to the level of their knowledge and skill base, with supervision of qualified preceptor/delegate. Hang and monitor IV solutions, TNA, and Total Parenteral Nutrition (TPN) above the drip chamber in an established peripheral or Central Venous Access Device (CVAD*). This includes tunnelled, non-tunnelled, PICC lines and implanted ports. Change the tubing and dressing of a CVAD if allowed by agency policy. Initiate an IV under the direct supervision of a RN if the agency policy allows. Students must present proof of completion of the College/University s IV start program. Students may also be required to complete an agency program. Discontinue peripheral intravenous therapy with a physician s written order, following consultation with the nurse directing the care. For a central line, students may administer medications above the drip chamber through an established central line under the direct supervision of an RN. Page 13 of 24

14 Flush a PICC line (no other central line flush allowed) if agency policy allows. Monitor and/or set up infusion pumps below the drip chamber (i.e. Bodyguard, Perfusor Space syringe pump) under direct supervision of preceptor if agency policy allows and if appropriate training is obtained. c. Students may not do any of the following listed below. Administer direct IV medications (i.e. IV push), below the drip chamber (see 20.0b regarding infusion pump infusion below the drip chamber) Students will not discontinue a CVAD. Students will not flush a CVAD (with the exception of PICC lines under direct supervision). *A CVAD is an intravenous device that is inserted into the central circulation. The majority of devices are inserted directly or indirectly into the superior vena cava or right atrium either peripherally, through the external jugular or subclavian vein. There are four main types of CVADs: non-tunneled devices; tunneled devices; implantable ports; and peripherally inserted central catheters. STUDENTS MUST FOLLOW HOSPITAL POLICIES DESIGNATED IN THE IV MANUAL REGARDING SPECIFIC MEDICATIONS WHICH MAY OR MAY NOT BE ADMINISTERED PHLEBOTOMY a. Students may do the following listed below to the level of their knowledge and skill base, with supervision of qualified preceptor/delegate. Draw blood from peripheral sites for lab testing under the direct supervision of a RN if the agency policy allows. Students must present proof of completion of the College/University s IV start program. Students may also be required to complete an agency program. Page 14 of 24

15 REFERENCES Bluewater Health Policies Chatham Kent Health Alliance Policies College of Nurses of Ontario Compendium of Standards of Practice College of Nurses of Ontario (2008). Practice standard medication, revised Retrieved August 24, 2009 from Hotel-Dieu Grace Hospital Student Policies Institute for Safe Medication Practices (2012). ISMP s list of high alert medications. Retrieved April 27, 2012 from Leamington District Memorial Hospital Student Policies Legislative Assembly of Ontario-Bill 168, Occupational Health and Safety Amendment Act (Violence and Harassment in the Workplace) National Coordinating Council for Medication Error Reporting and Prevention. (2008). About medication errors. Retrieved August 24, 2008, from Policies for Nursing Students in Health Care Facilities throughout Essex County (1997) Regulated Health Professions Act 1991 Windsor Regional Hospital Student Policies Page 15 of 24

16 APPENDIX A: Medical/Non-medical Program Entry Requirements University of Windsor, Faculty of Nursing MEDICAL/NON MEDICAL PROGRAM ENTRY REQUIREMENTS The Faculty of Nursing requires students to complete certain medical and non-medical requirements annually at the beginning of each school year during their time at the University of Windsor. These clinical pre-placement requirements have been developed under the guidelines of the Ontario Hospital Association, Canada s Immunization Guide and the Ontario Medical Association. The following is a list of the medical and non-medical requirements that are required. Important Note: Any and all costs associated with obtaining these requirements are the responsibility of the student. 1. Extended or Vulnerable Sector Police Clearance Because you will be involved with vulnerable populations, hospitals and clinical agencies require all staff, volunteers and students to have an extended or vulnerable sector police clearance. Windsor Police forms may be obtained on the Faculty of Nursing website or in the office in 336 Toldo. All other police agencies forms and information can be obtained in the Nursing office or via at nurse@uwindsor.ca. 2. Attestation of Clear Criminal Record You are required to sign and complete an Attestation of Clear Criminal Record form. This form can be obtained on the Faculty of Nursing website. Completion of the form acknowledges that it is your duty to inform the Faculty of Nursing at the University of Windsor if you are charged with or convicted of a criminal offense at any time while you are a student in the Faculty of Nursing. 3. Birth Certificate You must show your original birth certificate or an equivalent official document that indicates your birth date (such as passport, citizenship card, driver s license, or health card). This will be used to verify the name and birth date on your police clearance. 4. First Aid and CPR Certification Standard First Aid preparation was required when you started the program in year one. It is only required once, and is not required in future years in the program. Cardiopulmonary Resuscitation (CPR): Basic Life Support for Health Care Providers (HCP) is also required annually. This must be HCP some companies provide only Level C certification; however, this is not acceptable unless it is both Level C and HCP certification together. HCP certification alone (without Level C) is also acceptable. Annual CPR (HCP) re-qualification from a certified instructor will be required. Note: As per the Heart and Stroke guidelines, this must be re-certified annually even if your card has an expiry date that is longer than one year. 5. Respiratory Mask Fit Test/Card As mandated by the Canadian Standards Association, the Faculty of Nursing requires proof of mask fit testing for N95 respirators every two years i.e. in Years 1 and 3. Ensure that the testing service provider is testing with mask sizes that are currently available at South Western Page 16 of 24

17 Ontario hospitals (i.e. for 2012/13, these 3M N95 respirator sizes are 1860, 8110s, 1870, and 9210). 6. Immunization Record The following immunizations will be required by the Faculty of Nursing at the University of Windsor. Medical forms, including specific immunization details will be provided on the Faculty of Nursing s website. These forms must be completed by your health care provider. 1. Measles, Mumps Rubella (MMR) vaccine: up to date, serology report required to be cleared for clinical. 2. Tuberculosis (TB) vaccine: upon entry into the Collaborative Program a two-step TB Mantoux skin test or chest x-ray in case of positive TB skin test. If medical circumstances exclude you from having a TB skin test or chest x-ray, a healthcare provider must provide written evidence indicating that you are not a TB risk. In subsequent years of the program a one-step TB test is acceptable. 3. Varicella (chicken pox) vaccine: serology report showing immunity or two doses of varicella vaccine 4. Tetanus/Diphtheria (TD) vaccine: up to date 5. Polio vaccine: up to date 6. Hepatitis B vaccine: up to date Note: Annual influenza immunization (i.e. flu shot) is not mandatory; however, the Faculty of Nursing strongly encourages all nursing students to protect themselves with annual influenza immunizations. The immunization is offered free of charge at the University of Windsor each fall. Health care institutions may mandate this immunization. In this case, non-immunized students may be denied access to the facility. Furthermore, in the event of an outbreak in the clinical agency in which students are placed, non-immunized students may be required to take antiviral medication and/or be prohibited from continuing their placement, thus jeopardizing successful completion of their clinical course. 7. WSIB Form You are required to sign and complete a Student Declaration of Understanding Workplace Safety and Insurance Board (WSIB) or Private Insurance Coverage Unpaid Student Trainees in Clinical Placements form. This form will be available on the nursing website. The Ministry of Training, Colleges and Universities ensures that students on work placements receive WSIB for placement employers who have WSIB coverage and private insurance for employers who are not covered by WSIB for injuries or disease incurred while fulfilling the requirements of their placement. 8. Student Verification of Health Status Form Each year, you are required to sign and complete a Student Verification of Health Status form. This form will be available on the Faculty of Nursing website. Completion of the form acknowledges that you have no condition(s) that may affect your ability to fulfill clinical placement responsibilities. Page 17 of 24

18 APPENDIX B: Student Medical Certificate Page 18 of 24

19 What is Social Media? APPENDIX C: Social Media Policy University of Windsor Faculty of Nursing Social media refers to online technologies and practices that are used to share information and opinions, host conversations and build relationships. It can involve a variety of formats, including text, pictures, video, audio and live, real-time dialogues of a few, or thousands of participants. Examples of social media include discussion forums, blogs, social networks, wikis, and podcasts. The Faculty of Nursing supports the use of social media as an instructional tool. In this instance, sharing of information must occur through the Collaborative Learning Environment Windsor (CLEW) platform or other University of Windsor approved platforms. We also recognize that students use social media networks outside of the classroom. The following policies and guidelines provide overall policies for social networking within the Faculty of Nursing, and guidelines for individual social media use. Overall Policies: 1. Use of social media for non-academic purposes is not permitted during any clinical experience. 2. Students may not access agency computers for the purpose of social networking. 3. Use of cell phones is not permitted during clinical hours, unless required for an emergency purpose, and when there is no other means of contact available. In this situation, the student will discuss this need with the clinical instructor prior to use. 4. Unauthorized use of social media, cell phones, or the internet in the clinical setting will result in removal of the student from the clinical area. 5. Students are prohibited from posting any private or confidential content, including client health information on any social media site, even if client identifiers are removed. This also includes images of clients or agencies. 6. Social media behaviours must be consistent with the following CNO Standards and Practice Guidelines: Ethical Framework, Nurse-Client Relationship, and Documentation. The failure of any student to conform to these Standards, while using any social media site, may result in dismissal from the program. Guidelines for CLEW Site Networking: 1. Please refer to the overall policies. 2. Be respectful and professional to peers, faculty and staff in all interactions. You are more likely to be effective when applying a constructive and respectful approach to discussion and debate. 3. Do not use personal insults, obscenity or engage in any conduct that is not consistent with the CNO Standards. 4. Show proper consideration for other s privacy, and for topics that may be considered sensitive. Page 19 of 24

20 5. Assess acceptability of your message before posting. If the content of your message would not be acceptable for face-to-face conversation, over the telephone, or in another medium, it is not acceptable for posting. Guidelines for Personal Networking: 1. Respect Faculty of Nursing time and resources. You should participate in non-academic social media conversations on your own time. Ensure that your blogging and social networking activity does not interfere with your academic commitments and engagement in learning. 2. Maintain confidentiality and privacy. Do not post confidential information about the Faculty of Nursing, its students, faculty or its agencies. 3. Be aware of liability. Students are responsible for the content that is posted on their own sites, and on those of others. 4. Avoid using unprofessional online personas. Do not post defamatory, libelous or obscene content. Employers may conduct web searches on candidates before extending offers. Search engines can recall posts and pictures years after publication. Post only pictures that you would be comfortable sharing with the general public. (Adapted from the Government of Nova Scotia and the University of Michigan in compliance with Bill 168 and the proposed University of Windsor Code of Civility) Page 20 of 24

21 APPENDIX D: Medication Error Reporting Process Student makes a medication error Error Occurs Agency Documentation Student and Clinical Instructor (or Preceptor/Clinical Advisor for 4th year students) complete the agency required report (i.e. Risk Monitor Pro) Faculty of Nursing Documentation Student and Clinical Instructor (or Preceptor/Clinical Advisor for 4th year students) complete the Faculty of Nursing's Medication Error and Follow Up Form the original form is sent to the Dean/Associate Dean of Nursing (the form should not be duplicated) Communication The Clinical Instructor notifies the Level Coordinator or designee (i.e. Clinical Facilitator) The Dean/Associate Dean sends one copy of the form (no student name on form--student level and instructor name is to be included) to the chairperson of the Medication and Patient Safety Advisory Committee Follow Up The Dean/Associate Dean reviews the form, completes the portion entitled "Institution Follow Up", and decides if further action is required with the student and/or instructor The original form is filed in the student's file Page 21 of 24

22 APPENDIX E: Medication Error Report University of Windsor Student Nurse Medication Error Report and Follow-up This form is to be completed by the clinical instructor and nursing student for all medication errors. The original completed form is to be submitted to the Dean/Associate Dean. Please note: all errors must also be reported via the hospital or agency reporting mechanism (i.e. Risk Pro Monitor). Date of Incident: Time of incident: Agency and unit (if applicable): Student name: Student level: Clinical Instructor name: Was agency error report submitted (i.e. electronic or agency form)? Yes No If No, please explain: Name of Medication involved in error: Type of Incident: Extra dose/duplication Missed dose Incorrect dose/quantity Wrong patient Wrong time Wrong route Wrong medication Prescribing error Wrong administration technique Drug prepared incorrectly Mislabelling Deteriorated/expired product Wrong dosage form Other (please specify) Contributing Factors (check all that apply): Abbreviation issue Administration error Communication failure (i.e. physician to nurse or nurse to nurse/student) Confusion with physician order Confusion with MAR (i.e. illegible or incomplete) Documentation error (i.e. dose not documented) Drug delivery device problem (free flow, pump issue) Drug labeling issue (i.e. look-alike drugs, look-alike packaging) Drug storage or delivery issue (i.e. missing dose, problem with delivery) Environmental problem (i.e. interruptions, noise) Lack of independent double check Lack of knowledge related to the drug Missing patient information (circle all that apply): lab values, vital signs, allergies, age, weight, diagnosis, renal impairment, pregnancy Transcription error Other (please specify): Page 22 of 24

23 Brief factual description of incident: Immediate Actions Taken Post Incident: Patient Condition Post Incident: Recommendations (check all that apply): Improved communication with unit staff Improved communication with physician or pharmacy Use of 2 patient identifiers Bring MAR to bedside Administer medication to one patient at a time Check physicians orders Complete 3 checks of medication labels Increase knowledge of medication Improve preparation for clinical and medication administration Complete an IDC with all high risk medications according to agency policy Clarify unclear handwriting, orders or abbreviations Ensure documentation is completed after med is given Follow up on any medications that are on hold (i.e. post procedure) Label IV medications correctly Other (please specify): Note: This section is to be completed by the Dean or Associate Dean: Institution Recommendations and Follow-up Type of Medication Error: o Human Error (product of our current system design) o At-Risk Behaviour (a choice: risk believed insignificant or justified) o Reckless Behaviour (intentional or deliberate risk-taking) Follow-up Recommendations: Signature: Date: CONFIDENTIAL QUALITY ASSURANCE DOCUMENT NOT TO BE DUPLICATED Page 23 of 24

24 APPENDIX F: Definition of Independent Double Check An independent double check is a process in which a second practitioner conducts verification in the presence or absence of the first practitioner. The most critical aspect is to ensure that the first health care provider does not communicate what he or she expects the second practitioner to find; this would reduce the visibility of a mistake Steps on how to complete an Independent Double Check: 1. The first practitioner will prepare the ordered medication. If medication is further diluted in an IV Fluid; the first practitioner will leave the vial, the syringe containing the medication to be added to IV fluid and the IV fluid for the second practitioner to check. The first practitioner must NOT mix the drug into the IV fluid until checked by the second practitioner. 2. The first practitioner must NOT communicate what she/he expects the second practitioner to see. That would create bias and reduce the visibility of an error 3. The second practitioner must perform the independent double check without any advance knowledge of what finding to expect. 4. The second practitioner would check for: a. Correct Drug i. Check physicians order and MAR / appropriate flow sheet against the medication vial being used to prepare dose ii. If the medication is to be further diluted in IV fluid, the IV fluid will be checked against the physicians order and MAR / appropriate flow sheet b. Drug Dosage i. Check physicians order and MAR / appropriate flow sheet against the medication vial being used to prepare dose. ii. Check syringe that correct dose/volume prepared/withdrawn. iii. If medication is to be further diluted in IV Fluid, the syringe containing the medication shall be checked prior to further dilution. Check shall include medication and IV Fluid when applicable. c. Independent Drug Calculations i. Calculate dose to be prepared utilizing the concentration of the medication vial/ampoule and physicians order/mar to determine the volume required for the order. d. Pump settings (check against physician order) e. Correct Line being used (e.g. peripheral vs. central, IV line vs. feeding tube line) Page 24 of 24