Tomball Independent School District

Tomball Independent School District Health Science Technology Program Clinical Rotation/Internship/Practicum Agreement

This agreement is to be strictly observed at all times during your clinical rotation.

1. I will make it my responsibility to know, understand and adhere to guidelines and procedures of each clinical rotation. This will protect the patients, staff and me.

2. I will make every effort to be courteous, efficient, and accurate in tasks I am assigned, and in all contact with patients and workers.

3. I will not discuss any information about any patient, including disease, diagnosis, prognosis, history or treatment with anyone not authorized to receive such information.

ABSENCES, MAKE-UPS & TARDIES:

1. I MUST contact my instructor(s) if I am going to be absent for any reason on a clinical day. I must call ,email, or direct message through group me either the evening before I miss, or at least 2 hours prior to the time class begins. A no call, no show, will result in a zero for that clinical day and will not be made up. If I send a message and do not get a response back from my instructor, I MUST follow up with a phone call. NOTE: You are responsible for communication with your instructor, please do not relay a message through a parent or a friend.

● My attendance on clinical days is mandatory unless I am absent due to an illness requiring an absence per TISD policy/Student handbook (fever, vomiting, diarrhea or any contagious illness requiring exclusion from school). ● If I am absent on a clinical day (for any reason), I am required to make up the absence. I will discuss options and plan a scheduled make up assignment with the instructor. I understand that the make-up assignment will be completed at an alternate site and must be completed within 1 week of returning to school. Each school related (UIL)absence requires a 1 hour make up; each non-school related absence requires a 2 hour make up. If makeup assignment(s) is not completed within 1 week, a zero will be given for days absent. *NOTE: There are no make ups for missed CNA hours unless the instructor is able to be present. EMT Students must follow CCEMS attendance policy.

2. I understand that attendance is extremely important in this course and corresponds with the TEKS relating to professionalism. I have read the syllabus and understand that I will receive a Major Grade for Attendance.

3. I understand that repeated absences will result in probation and ultimate dismissal from the program. ● Any student who is absent from a clinical day 4 (four) times in a semester (for a non- school related absence) will be placed on attendance probation. ● A 5th absence will result in removal of clinical privileges from the HST program. Extenuating circumstances will be discussed on a case by case basis with final decision being made between the instructors and the student’s AP.

● An absence from a clinical day due to ISS may not be made up and will result in a zero for that clinical day.

4. The school policy on tardiness will apply. 4 Tardies will result in a Disciplinary Referral.

5. If I miss the clinical bus, arrive to school past departure time or do not attend my rotation for any reason other than absence, I will report to my AP immediately and call my HST instructor for further instructions. I will not drive myself to my site or leave the AP’s office without first speaking to and receiving instructions from the HST teachers.

I WILL FOLLOW THE FOLLOWING DRESS CODE EXACTLY:

1. I will wear the appropriate uniform required by the facility and school. My uniform is to be clean, neatly pressed, and appropriately buttoned at all times. I will wear my uniform to school unless I am required to wear an athletic uniform on a specific day. I must, however, discuss this with my instructor, and I am responsible for arriving to my clinicals class in uniform and on time. Any shirts worn underneath must be white, black or grey. I understand that if I do not wear the appropriate uniform I will automatically be sent to my AP.

2. I will wear my name badges at all times while at my clinical site. I understand that if I forget or misplace my badge, I must purchase a new one from the hospital/CCEMS for $5 immediately upon arrival or if unable to purchase a replacement badge, I will be sent to my AP. Clinicals: I will wear my hospital badge to the hospital ONLY and my Clinical badge to all other sites.

Practicums: I will wear my required badge anytime I wear my uniform to my site.

3. I will wear the appropriate shoes as described by my instructor. Clinicals: White or black leather top tennis shoes or closed clogs with white or black socks, absolutely no other shoes will be permitted.

EMT Practicum: black leather over the ankle work boots are required. Black tennis shoes are not acceptable.

4. I will wear a watch with a second hand or digital marker.

5. I will not wear any jewelry with the exception of stud earrings in the earlobe (girls only).

6. While in the clinical site, my hair will be neatly pulled back and secured, boys will be clean shaven.

7. I will use cosmetics conservatively and in good taste and will refrain from brightly colored eye shadow or lipstick (girls). I will not wear perfume or cologne to the clinical site. 8. I will not eat, drink, chew gum, or use tobacco while I am in the clinical area. NO EXCEPTIONS. If I am given a violation by a hospital accreditation agency for breaking this policy, it is my responsibility to pay the applicable fine and I risk immediate removal from the program. If I am caught using tobacco in any form, I will be sent to my AP upon return to school and will risk immediate removal from the program.

9. I will keep my nails clean and neatly trimmed. I will only wear clear or nude colored polish. I will not wear any type of artificial finger nails or overlays. I understand that I will automatically be sent to my AP if I come to class wearing acrylic or colorfully painted nails and will receive a zero that day in the gradebook.

10. If a clinical area requires specific apparel (scrubs, lab coat, tie) I will comply with clinic policy. (For Practicum students only)

11. The morning of each rotation/EMT uniform check, I will wear my uniform to school. The only exception is students required to dress in uniform for a school sponsored event. I may change clothes after rotations or uniform check; however, no additional time is given during the period to change clothes before or after rotations/class. If you arrive late to class because you are changing clothes. You will be marked tardy (see above regarding tardies).

When in clinical uniform, I must be in full uniform including correct shoes. I may not wear a hoodie or anything that will cover or change the look of my uniform. Coats and jackets are acceptable but must be removed when in the clinical site. Lab jackets may be worn at the clinical site.

12. I understand that if I am not capable of abiding by the rules of the clinical rotation/practicum agreement, I will receive disciplinary action which may include ISS or AP referral.

13. I understand that if I am sent to ISS or the AP office on 2 occasions for any violation, my clinical/practicum privileges in the HSTE program may be removed permanently.

GENERAL RULES:

1. I will not visit other units or leave the unit I am assigned to unless authorized by my instructor. If I have any concerns, I will call my instructor immediately from unit telephone and wait for for further instructions.

2. I will not discuss details of my private life while in the presence of patients, or hospital staff. I understand that I am a reflection of our HST Program, our school, and our district.

3. I will conform to any direction from my instructor immediately and without question while in the clinical setting. Any questions will be discussed later in private.

4. I will not discuss illnesses of patients that I have observed in the hospital with other patients. I will not provide patients with answers to questions about their diagnosis, treatments or procedures without consulting the patient’s nurse or health care provider. 5. I will be cheerful and smile while I am in the presence of patients.

6. I will report any accident that occurs in the clinical area to my preceptor and HST Instructor and file the required report as directed by my HST Instructor.

7. I will behave in a professional manner at all times while in the clinical area.

8. I will respect and properly care for all equipment and supplies in my HST class and my clinical/practicum sites.

9. I will NOT bring my phone into the hospital. If in a site other than the hospital, my phone will be OFF and I will not make or take personal calls or texts. I will only use my phone to call my instructor in the event of an emergency or immediate site concern. If I am caught using my cell phone at a clinical site I will be subject to immediate removal from the program. I will not use my phone during class unless given permission by the HST Instructor. Bringing a phone to the hospital or having a phone on and in my hand at a clinical site is a serious offense and will result in disciplinary action up to and possibly including removal from the HST program. Inappropriate use of cell phones is a serious offense and will not be tolerated.

10. I will make every effort to complete all assigned tasks for each rotation area.

11. I will have a preceptor sheet signed each day of my rotation. I understand preceptor sheets must be signed by the medical professional I worked with that day. I understand forging a signature will remove me from the program immediately.

12. I will follow all facility safety rules.

13. I will not visit any clinical area or any staff member at anytime outside of my regular clinical rotation without prior approval from my instructor. I will not wear my uniform to the hospital or clinical site outside of regular clinical rotation hours unless completing assigned make up hours.

14. I will only bring the required supplies with me on my rotations. (pen, folder, stethoscope)

15. I will eat breakfast every morning to lessen the chances of feeling ill during my rotation.

16. As a part of HST Clinicals, I understand that I am a representative of the HST program. I will conform to all rules in the student handbook. I understand that the way I conduct myself in all of my classes reflects on the HST program and I will be responsible and respectful to teachers and staff. Disciplinary action in non HST classes may substantiate removal from the HST clinicals class.

17. As a part of HST Clinicals, I understand that I am a representative of THS/Tomball Memorial High School and the HST program in the Tomball community. I understand that the way I conduct myself outside of the school day reflects on the my school and the HST program. If I choose to participate in any activities that reflect poorly on myself or on the HST program including online activities (Instagram, Twitter, Facebook etc.), I am subject to discipline and possible removal from the HST program.

18. As part of the HST Clinicals or Practicum program, I understand that I am a representative of the HST program and I will abstain from any alcohol or drug use. A drug test will be administered at the beginning of the school year and as part of the HST program, I am subject to random drug screens through the school year. I am subject to immediate removal from the program if I test positive for any substance at any time during the school year.

18. If I feel that I cannot meet the requirements of this agreement, I will request a conference with my instructor. Any questions or concerns about this agreement must be voiced prior to the first day of clinical rotations.

TRANSPORTATION:

I must have a signed permission form on file before being allowed to leave campus for rotations. A bus is provided for transportation to all clinical sites and is the only transportation option for Clinical Rotations. Clinical Practicum students who are driving themselves to their site must have all completed permission forms on file and sign the HST student driver contract.

TRUANCY VIOLATIONS:

I WILL ONLY BE AT MY ASSIGNED CLINICAL ROTATION SITE DURING MY CLINICAL TIME. IF I CHOOSE TO BE ANYWHERE BUT MY ASSIGNED ROTATION DURING THESE TIMES I AM CONSIDERED TRUANT. SHOULD THIS OCCUR I WILL BE IMMEDIATELY REMOVED FROM THE HSTE PROGRAM.

DISCIPLINARY ACTION FOR VIOLATIONS OF THE CONTRACT (UNLESS NOTED ABOVE):

1ST STEP WARNING - STUDENT CONFERENCE/PARENT CONTACT 2ND STEP DISCIPLINARY REFERRAL - POSSIBLE REMOVAL FROM ROTATION X 1 3rd STEP DISCIPLINARY REFERRAL- POSSIBLE ISS & REMOVAL FROM ROTATION 4th STEP REMOVAL FROM HSTE PROGRAM

CLINICAL SITES-

The clinical site has the right to terminate any student rotation at any time. If a site requests a student be removed, it is grounds for immediate removal from the program and loss of credit.

HONOR CORD Students who SUCCESSFULLY complete the HST program by completing Principles, Clinicals/Theory, and a Practicum will have the option of purchasing an honor cord to wear at graduation. If a student is removed from the clinical setting for any infraction of this contract, the student will become ineligible to purchase an honor cord. HEALTH SCIENCE CLINICAL/ PRACTICUM AGREEMENT

Being in the Health Science Clinical/Practicum course is a privilege to be taken seriously. When we are present at the hospital or in the community we represent not only Tomball Memorial High School , but the Tomball ISD Health Science program. We are considered an elite group and our expectation is that you will take pride in your participation in this program.

I ______understand that I must follow all of the rules in the clinical contract. I understand the disciplinary action that has been outlined here and that termination of my participation in the program may result from infraction of the clinical contract/agreement. I understand that the HST instructors reserve the right to terminate participation of any student, at any time, for any reason justified by contract and that termination may result in loss of class credit.

______STUDENT SIGNATURE DATE PARENT SIGNATURE DATE

______PRINTED NAME DATE PRINTED NAME DATE