POLICIES FOR. PREGRADUATE BScN NURSING STUDENTS EXPERIENCE

Transcription

1 POLICIES FOR PREGRADUATE BScN NURSING STUDENTS EXPERIENCE IN ESSEX-KENT-LAMBTON COUNTY HOSPITALS Developed: May 9, 1997 Revised: April 25, 2001 September 1, 2004 June 4, 2007

2 1 TABLE OF CONTENTS PAGE PREAMBLE ORIENTATION HEALTH REGULATIONS ABSENTEEISM MINISTRY OF EDUCATION WORKPLACE AGREEMENT FORM INCIDENTS: PERSONAL INJURY INCIDENTS: NEEDLESTICK OR MUCOSAL EXPOSURE INCIDENTS: PATIENT/VISITOR/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/DOCTOR S VERBAL ORDERS COMMUNICATION: REPORTING AND DOCUMENTATION DELEGATED CONTROLLED ACTS & MEDICAL DIRECTIVES MEDICATIONS MEDICATIONS: NARCOTIC & CONTROLLED SUBSTANCE HANDLING I. V. THERAPY 8

3 2 PREAMBLE POLICIES FOR PREGRADUATE BScN NURSING STUDENTS IN HOSPITALS THROUGHOUT ESSEX KENT COUNTIES 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 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.

4 3 1.0 ORIENTATION a. The educational institution will inform the clinical placement liaison and unit manager/director as to who is coming to his/her unit 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. Where hospital/agency conduct a formal student orientation, students must attend the said orientation before participating in a clinical experience. d. 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 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. 2.0 HEALTH REGULATIONS a. Students must have current medical clearance from their practitioner as required by the Public Hospital Act, prior to their clinical experience. The students will retain evidence of the medical clearance in their Professional Profile. b. Any contact with an infectious disease that requires follow-up will be done by a member of the Faculty of Nursing. (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. According to the Ontario Hospital Act, students will be respiratory mask fit-tested by the educational institution prior to the clinical experience and as required due to facial changes thereafter. They will carry a card denoting their mask requirements. 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 family physician. A note from the physician may be

5 4 required stating that a student is fit to return to the clinical area. This note is to be submitted to the faculty advisor. c. Students with health problems, i.e. skin rashes, infections, dressings, etc. must report to the Unit Manager/Program Director or delegate 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 form is 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. The student retains his/her copy in their Professional Profile. On the first day of the clinical experience, other copies are submitted to the agency as required and to their school of nursing. 4.1 INCIDENTS: PERSONAL INJURY a. 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. b. Appropriate documentation (ie 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. 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 Room physician. c. The faculty advisors must be notified immediately and will initiate the Workplace Safety Insurance Board (WSIB) process, by reporting to the Placement Coordinator 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 and indicate review by signing off as per the Ministry of Labour directive. 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 Occupational Health Blood-Borne Protocols. Then students must report to their faculty advisors. c. Students are also responsible for ensuring that a copy of the Incident/Unusual Occurrence Report and the Workplace Safety Insurance Board (WSIB) forms are completed within 24 hours. The faculty advisors will initiate the WSIB process. A current copy of the Protocol for needlestick or mucosal exposure will be given to the student for them to follow. d. Each school of nursing will maintain appropriate documents for their own records.

6 5 4.3 INCIDENTS: PATIENT/VISITOR/MEDICATION and PROPERTY RELATED All other unusual incidents, medication errors included, should be reported to the RN preceptor and faculty advisors. The facility s documentation process (i.e. The Incident/Unusual Occurrence or Medication Incident Report) 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. 5.0 INCAPACITIES 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 guideliness 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. 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. Photo-id badges must be worn and clearly visible at all times.

7 6 8.0 PERSONAL CONDUCT a. Students may not carry a cell phone on the unit. b. Pagers are discouraged, but may be used for emergencies only. If pagers are used they must be placed on mute setting. Response to a page must not interfere with patient care. c. 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. d. 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. e. Students must take appropriate action to ensure their own safety. For example: walking in pairs when leaving the agency at night. f. Any medication on their person during the clinical experience must be kept in a correctly labeled container. 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 Students will not be solely responsible for patients travelling 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 EXPERIENCE 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).

8 OPERATING ROOM - OBSERVATION EXPERIENCE a. Students are to go to the Operating Room for observation only. 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 O.R. 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 Registered Nurse BLOOD BANK PROCEDURES/TRANSFUSION SERVICES 1. 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. 2. Students may monitor blood, and blood products under the supervision of the I.V. team, assigned R.N., R.P.N. or R.N. Preceptor. 3. Students may initiate a blood transfusion under the direct supervision of the preceptor or assigned RN LEGAL DOCUMENTS/CONSENTS/DOCTOR S 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 will not accept verbal orders or phone orders from a physician. 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 school and level. 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. e. Electronic Documentation- Faculty advisors and students must familiarize themselves with the agency s practice participating in the orientation as offered by the hospital.

9 8 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 a. Students may not initiate/activate a medical directive or perform a delegated controlled act. b. Students may perform a procedure outlined in a medical directive that has been initiated/activated by a registered nursing staff (RN or RPN) provided they have the prerequisite knowledge 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. The RN Preceptor must directly supervise the preparation and administration of all medications including intermittent and/or continuous subcutaneous needle injection until such time the preceptor in conjunction with the student deem the student competent to do this independently. f. Prior to administration of medications, appropriate testing is to be completed, i.e. PYXIS Tutorial, Medication Calculation Test. g. All medication errors must be reported immediately upon discovery to the instructor or staff registered nurse, appropriate agency practice followed and a copy of the incident to be kept in the student s school file. (also 4.3) 18.1 MEDICATIONS: NARCOTICS and CONTROLLED SUBSTANCES HANDLING a. 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. b. 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. c. Students may not pick up or accept narcotics from the Pharmacy.

10 9 d. 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. e. 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 I.V. THERAPY Students may do all of the following listed below to the level of their knowledge and skill base. a. Assess the patient s response to the intravenous therapy. b. Flush patent/non-blocked peripheral I.V. needles/catheters with saline. c. Change standard intravenous solutions for peripheral site. d. Administer IV solutions through an established peripheral line. e. Regulate the flow rate and record intravenous readings. Students may do the following listed below to the level of their knowledge and skill base, with supervision of qualified preceptor/delegate. a. Hang and monitor I.V. solutions, TNA, and Total Parenteral Nutrition (T.P.N.) above the drip chamber in an established peripheral or Central Venous Access Device (CVAD). This includes tunneled, non-tunneled, PICC lines and implanted ports. b. Change the tubing and dressing of a CVAD if allowed by agency policy. c. Initiate an IV under the direct supervision of a R.N 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. d. Discontinue peripheral intravenous therapy with a physician s written order, following consultation with the nurse directing the care. e. For a central line, students may administer medications above the drip chamber through an established central line under the direct supervision of an R.N. Students may not do any of the following listed below. a. Students will not discontinue a CVAD. b. Students will not flush a CVAD. Students must follow hospital policies designated in the I.V. Manual regarding specific medications which may or may not be administered. Bluewater Health Policies References Chatham Kent Health Alliance Policies College of Nurses of Ontario Compendium of Standards of Practice (sections III, IV. VI) Hotel-Dieu Grace Hospital Student Policies

11 10 Windsor Regional Hospital Student Policies Leamington District Memorial Hospital Student Policies Policies for Nursing Students in Health Care Facilities Throughout Essex County (1997) Regulated Health Professions Act 1991 J: hospital policies pregrad June 4, 2007