YEARS 1, 2, and 3 Bscn

POLICIES FOR

YEARS 1, 2, and 3 BScN

NURSING STUDENTS’

EXPERIENCE

ESSEX-KENT COUNTY HOSPITALS

Developed: May 9, 1997

Revised: November , 2002 September , 2004 2

TABLE OF CONTENTS PAGE

PREAMBLE 2

1.0 ORIENTATION 3

2.0 HEALTH REGULATIONS 3

3.0 ABSENTEEISM 3

4.0 MINISTRY OF EDUCATION WORKPLACE AGREEMENT FORM 4

4.1 INCIDENTS: PERSONAL INJURY 4

4.2 INCIDENTS: NEEDLESTICK OR MUCOSAL EXPOSURE 4

4.3 INCIDENTS: PATIENT/VISITOR/PROPERTY RELATED 5

5.0 INCAPACITIES 5

6.0 CONFIDENTIALITY 5

7.0 PERSONAL APPEARANCE AND ATTIRE 5

8.0 PERSONAL CONDUCT 6 9.0 MEALS 6

10.0 ACCOMPANYING PATIENTS TO OTHER FACILITIES 6

11.0 LIBRARY 6

12.0 EXPERIENCE IN SPECIALTY AREAS 7

13.0 OPERATING ROOM - OBSERVATION EXPERIENCE 7

14.0 BLOOD BANK PROCEDURES/TRANSFUSION SERVICES 7

15.0 LEGAL DOCUMENTS/CONSENTS/DOCTOR’S VERBAL ORDERS 7

16.0 COMMUNICATION: REPORTING AND DOCUMENTATION 7

17.0 PROCEDURES AND POLICIES 8

18.0 DELEGATED CONTROLLED ACTS & MEDICAL DIRECTIVES 8

19.0 MEDICATIONS 8

19.1 MEDICATIONS: NARCOTIC & CONTROLLED SUBSTANCE HANDLING 9

20.0 INTERVENOUS THERAPY 10 3

IN HOSPITALS THROUGHOUT ESSEX – KENT COUNTIES

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 clinical instructor. Students are expected to follow the guidelines for professional nursing behaviour and scope of practice, as outlined by the College of Nurses of Ontario http://www.cno.org, their institution of learning, and the clinical agency.

Students are directly responsible to the clinical instructor assigned with them 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 clinical instructor, who 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 or Registered Practical 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 and /or clinical instructor will give a written or verbal report to a responsible staff member. A patient assignment is selected by the clinical instructor in consultation with the appropriate nursing personnel

 When the term “student” is used in the Undergraduate BScN Policies, it embraces the University of Windsor, Lambton College and St. Clair College, Years I, II, and III 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”.

 There are separate policies for those students who are in other levels of Nursing Programs. 4

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, clinical instructors, and students. Student registration/orientation according to the agency’s requirements is expected.

b. Clinical Instructors 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, clinical instructors are required to review the student policies and the Emergency codes and procedures of the agency. Clinical instructors will also review confidentiality and any other agency policies and procedures appropriate to the level of 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.

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. 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 facility prior to the clinical experience and as needed due to facial changes thereafter. The student 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 responsible person or charge nurse and clinical instructor 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 clinical instructor will handle student illnesses while on duty. Students may be sent home and/or referred to their family practitioner. A note from the practitioner may be 5

required, stating that a student is fit to return to the clinical area. This note is to be submitted to the clinical instructor. c. Students with health problems, i.e. skin rashes, infections, dressings, etc. must report to the Unit Manager/Program Director or delegate and clinical instructor 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. The other copies are submitted to the agency and the school of nursing, on the first day of clinical.

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. 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, i.e., injury or property damage that relates directly to the student. Where injuries are sustained while on duty, students must report this immediately to the clinical instructor and Unit Manager/Program Director or Delegate. If injury requires medical attention, students will be referred to the Emergency Room physician. c. The clinical instructor 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 clinical instructors and students are required to review agency policies re:needlestick 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 clinical instructor and Unit Manager and go to the Emergency Room and follow the “Occupational Health Blood- Borne Protocols”. 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 clinical instructor 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

4.3 INCIDENTS: PATIENT/VISITOR/MEDICATION and PROPERTY RELATED

All other unusual incidents, medication errors included, should be reported to the unit manager and clinical instructor. The Incident/Unusual Occurrence or Medication Incident Report must be filled out immediately upon discovery and in accordance with the agency policy and sent to the appropriate personnel.

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 clinical instructor. 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.

6.0 CONFIDENTIALITY

Students shall follow the guideliness and standards in the following College of Nurses of Ontario http://www.cno.org/docs/prac. 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 Guideline(vi)s. They shall exercise caution in written and electronic charting, written assignments, transmission of visual images and reporting, 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. 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. Photo-id badges must be worn and clearly visible at all times. 7

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. With the permission of the teacher and unit personnel, students may go to the clinical unit prior to or following the clinical experience for the purpose of collecting data as needed for planning the care of the patient. No client contact is to take place at this time. Students shall be in uniform or wear lab coat over dress clothes with the school identification badge clearly displayed. Confidentiality guidelines must be adhered to. g 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.

10.0 ACCOMPANYING PATIENTS TO OTHER FACILITIES and DEPARTMENTS FOR THE PURPOSE OF OBSERVATION

If travelling 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 travelling to another agency. Students may accompany patients to other departments with the agreement of the department and the most responsible care provider .Unstable patients must be accompanied by a staff registered nurse. Students must not transport patients in private vehicles.

11.0 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.

12.0 EXPERIENCE IN SPECIALTY AREAS

Students assigned to specialty areas (ER, ICU, CCU, L&D, NICU, O.R., PACU) may participate in providing patient care under the direct supervision of the Registered Nurse or Registered Practical Nurse or clinical instructor and within the scope of nursing for their skill level (see CNO RHPA Overview Part B, page 2).

13.0 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, which is 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.

14.0 BLOOD BANK PROCEDURES/TRANSFUSION SERVICES

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. Students may monitor blood, and blood products under the supervision of the I.V. team or clinical instructor.

15.0 LEGAL DOCUMENTS/CONSENTS/DOCTOR’S VERBAL ORDERS

a. Students may witness a Valuables Envelope with the co-signature of an RN or RPN. 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.

16.0 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 co-assigned RN/RPN when arriving to and leaving the unit. 9

c. All student signatures must include their school and level. The clinical instructor verifies the student’s competence to chart independently for each new nursing procedure and when there are any unusual changes or occurrences. d. Charting done by years I and II BScN students must be co-signed by the clinical instructor when checking their charting and/or before entry. e. In Year III the clinical instructor co-signs or checks (if electronic documentation) all documentation of students: . at the beginning of each new rotation until the clinical instructor can verify the student’s documentation competency, . with each new nursing procedure, . with any unusual changes or occurrences, and . in any other situations as determined by the clinical teacher. f. Students may take laboratory results over the phone according to the agency policy. Students must repeat the lab results to the caller for verification. g. 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. h. Electronic Documentation- Clinical instructors and students must familiarize themselves with the agency’s practice –participating in the orientation as offered by the hospital. http://www.cno.org/docs/prac/41001.

17.0 PROCEDURES/POLICIES 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 a qualified clinical instructor and/or a qualified staff RN/RPN. Students are expected to be familiar and in compliance with hospital policies and procedures. Policy Manuals, Procedure Manuals, Materials Handling Data Sheet, Nursing Skills books and/or other essential references or web sites are available on each Nursing Unit.

STUDENTS MUST KNOW THE MEANING AND APPROPRIATE RESPONSE FOR ALL EMERGENCY CODES USED IN THE HOSPITAL – i.e. Blue, White, Red, Yellow, Green, Orange, Brown, Black, Pink.

18.0 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/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 theory. 10

19.0 MEDICATIONS

a. No medication may be given without an R.N. (E.C.)’s or Doctor’s written order. b. All routes of medication administration within the Controlled Acts authorized to Nursing, may be utilized. c. Students shall not administer the following: . immunization agents . direct IV medications, below the drip chamber . IV anti-neoplastic chemotherapeutic agents . intradermal skin tests for allergies . allergy desensitization injections . epidural medications . intrapleural medications

c. The clinical instructor must directly supervise the preparation and administration of all medications including intermittent and/or continuous subcutaneous needle injection until such time the clinical instructor in conjunction with the student deem the student competent to do this independently. d. Students and clinical instructor/registered nurse must check the PHYSICAN’S ORDER and the PREPARATION of all medications prior to administration. Prior to administering medications, the clinical instructor and students must be aware of the site-specific policies and procedures, i.e. med cart, medication records, etc. Policy of educational institution shall take precedence of host agency re: double- checking of specific medication prior to administration. e. Injectable oil-based medications and iron preparations must be administered under the supervision of the clinical instructor until the student is deemed proficient in this skill. f. T.B. skin testing may be done by students under the supervision of the clinical instructor. 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)

19.1 MEDICATIONS: NARCOTICS and CONTROLLED SUBSTANCES HANDLING

a. Medication withdrawn from the narcotic cupboard will be supervised and co-signed by the clinical instructor, a staff Registered Nurse or a Registered Practical Nurse The preparation and administration of a narcotic (including nebulized opioids) must be supervised by the clinical instructor, Registered Nurse or Registered Practical Nurse where approved – i.e. long term care. 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. 11

b. The student may not carry the narcotic keys. Students are required to ensure ongoing accuracy of narcotics counts. If applicable, 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. d. Students may monitor, record and discontinue a PCA pump under the direct supervision of the clinical instructor, and may care for a patient with this equipment. : Students may not start or adjust the PCA Pump. 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. f. Prior to administration of medications, appropriate testing is to be completed , i.e. PYXIS Testing

20.0 I.V. THERAPY At the discretion of, and with the supervision of the clinical instructor, students may to the level of their knowledge and skill base, do all of the following: a. Observe the intravenous site for infiltration and inflammation. b. Regulate the flow rate. c. Change standard intravenous solutions for peripheral site. d. Record Intake and Output. e. Take intravenous readings. f. Discontinue intravenous therapy with direct orders of the doctor/nurse directing care. g. Administer intravenous medications above the drip chamber per primary or piggyback bag. h. Change I.V. tubing in established peripheral lines i. Flush patent peripheral I.V. needles/catheters with saline. j. Administer I.V. solutions, medications and T.P.N. above the drip chamber per primary, or piggyback bag in an established peripheral line. k. For a central line, students may administer medications through an established central line under the direct supervision of a qualified instructor. l. Students will not be able to change the tubing or the dressing of a central line. m. Appropriate reporting and documentation is also a requirement

STUDENTS MUST FOLLOW HOSPITAL POLICIES DESIGNATED IN THE I.V. MANUAL RE: SPECIFIC NEEDS WHICH MAY/MAY NOT BE ADMINISTERED. 12

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

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