School of Nursing Clinical Requirements Policy OBJECTIVES: 1

Current Status: Active PolicyStat ID: 3807861

Implementation: 09/2009 Last Reviewed: 07/2017 Last Revised: 07/2017 Next Review: 07/2020 Owner: Elizabeth Cherry: Administrative Assistant Policy Area: Hospital Administration References: Applicability: PH&S Oregon Region School of Nursing Clinical Requirements Policy OBJECTIVES: 1. Define the responsibilities of the Department of Nursing and affiliated schools of nursing during clinical rotations at Providence Health & Services-Oregon Nursing (PH&S-OR). 2. Provide guidance to the nursing department on the supervision requirements with assigned students. 3. Define specific tasks or functions that require direct supervision of the student by the instructor or supervising RN/LPN. 4. Describe the process for preparing the student/ instructor assigned to PH&S-OR Nursing units prior to the beginning of the academic term. POLICY STATEMENT: ProvidenceCOPY Health & Services-Oregon Nursing recognizes the importance of providing clinical facilities for the education of student nurses. The collaboration between the schools of nursing and PH&S-OR is mutually beneficial. PH&S-OR has the obligation and responsibility to the patients, community and staff to provide safe, quality patient care. To ensure quality patient care the schools of nursing using PH&S-OR for clinical learning will be expected to follow all patient safety initiatives as established by Providence Health & Services, local facility policies and procedures, safety regulations and the Oregon State Board of Nursing Nurse Practice Act and or Scope of Practice for RN/LPN. DEFINITIONS: Clinical Affiliation Agreement: Signed contract between Providence Oregon Regional Nursing and the School of Nursing/ facility to provide clinical placement for students. The agreement specifies the expectations and responsibilities and accountability of the clinical facility and the School of Nursing during their tenure at PH&S-OR. All clinical agreements or contracts are managed through the Oregon Regional Nursing Office.

Clinical Education Coordinator: The facility employee who coordinates the clinical experiences for nursing students in the facility. This individual usually works in the Nursing Education Department.

Clinical Instructor: Qualified nurses employed by the school of nursing to supervise student nurses during their clinical rotations at PH&S-OR. The Clinical Instructor will be onsite directly overseeing cohort students. For Precepted or DEU students the Clinical Instructor may be available by pager / phone to oversee students

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 1 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC who are assigned to a specific RN/LPN preceptor from the assigned unit and are not required to be on site at all times. Clinical Instructors must complete an orientation to the facility and each unit to which the student(s) will be assigned to.

Cohort: A group of nursing students whose clinical experience is being coordinated and supervised by the Clinical Instructor.

Dedicated Education Unit (DEU): A model of clinical nursing education where the PH&S clinical unit/facility is developed into an optimal teaching/learning environment that is exclusive to a single school of nursing. In this model, nurses possess dual roles of both PH&S staff nurse and adjunct faculty for a school of nursing.

DEU Instructor: Qualified RN/LPN employed by Providence Health & Services – Oregon to supervise and precept the student nurse under the oversight of the Clinical Instructor. This occurs on a Dedicated Education Unit.

University of Portland (UP) DEU Instructors: The UP DEU Instructor differs from a RN/LPN Preceptor in that the DEU instructor is an adjunct faculty member at the University of Portland, has undergone orientation by the University of Portland, and is employed on a Dedicated Education Unit.

DEU Instructors for Universities Other Than UP: The process for establishing, training, and orienting DEU instructors for Universities other than UP will be determined if/when they establish a DEU with Providence Health & Services

Oregon State Board of Nursing Scope of Practice: This document presents the scope of practice and limitations of RN/LPNs and student nurses in RN/LPN programs. It identifies the community standard of practice for RNs and LPNs as stated in the Nurse Practice Act.

Re-Entry RN: A nurse who desires to re-enter the nursing profession after allowing their nursing license to lapse. A re-entry nurse has attended a re-entry program that has provided didactic content on current nursing practices. Nurses must complete precepted clinical hours to meet OSBN requirements for re-entry into practice. RN/LPNCOPY Preceptor: Is a designated role carried out by a PH&S-OR nurse who has completed preceptor education and who is assigned to a specific student. The preceptor is responsible for the coordination and supervision of the clinical experiences and to provide appropriate learning experiences to meet the clinical objectives. In addition, the preceptor will provide an evaluation to the identified Clinical Instructor on the student's work.

School of Nursing: Colleges with accredited Associate Degree in Nursing, Baccalaureate Degree or Masters Degree in Nursing.

Student Nurse: An individual who is a matriculated student in an accredited school of nursing program. All students will have a designated Clinical Instructor from the School. Student nurses are expected to follow all PH&S-OR policies and procedures and clinical practice guidelines within their scope of practice as a student nurse.

• Precepted students are students who work under the direct supervision of a PH&S-OR RN/LPN. Typically precepted students are in their final clinical rotation prior to graduation. • Cohort students are students whose clinical experience is coordinated and supervised by school of nursing faculty.

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 2 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC EXPECTATIONS: 1. An RN student nurse is precepted only by a RN. RN students cannot be assigned to a staff LPN, however LPN students may be assigned to a staff LPN. 2. The assigned RN maintains responsibility and accountability for all patient care. a. The RN makes decisions regarding the extent of the student's participation in the patient care and therapeutic or diagnostic procedures. b. The RN delegates and supervises patient care activities when a student nurse is involved in that patient's care. c. The precepting RN/LPN must perform and document his/her own assessment of the patient (in addition to any performed by the student). d. The RN reviews all assessment information collected by the student and evaluates student documentation. 3. Policy of the Board of Nursing does not require cosigning of student documentation. Students do not work under the RN/LPN's license (no one works under a nurse's license except the nurse themselves). However, the RN/LPN must make a note in the medical record to indicate that they concur with, or provide exception to any assessment data as documented by the student nurse. 4. The preceptor RN/LPN may remove the precepted student from the clinical assignment if the student is unprepared, lacks knowledgeable about the assignment, the RN/LPN suspects that the student is under the influence of drugs or alcohol, and/or the RN/LPN assesses the situation as unsafe for the patient. a. The RN/LPN Preceptor will immediately notify the Instructor of the decision to remove the student. In addition, the situation leading to the removal should be documented in writing (via e-mail) and submitted to the pertinent clinical chain of command (e.g. charge nurse, assistant nurse manager, manager, nursing supervisor et.al.), instructor, and clinical education coordinator. b. If a student is removed for suspicion of drugs or alcohol, they will not be allowed to return to COPYProvidence unless they can show a clean drug screen (to be performed after the removal of the student from clinicals). i. Regardless of the legality of a drug, Providence is a drug free environment. Students & faculty are expected to abstain from the use of drugs while performing clinicals at any Providence facility. ii. Prescription and over-the-counter drugs are not prohibited when taken in standard dosage and/ or according to a physician prescription. Any student/faculty taking prescribed or over-the- counter medications will be responsible for consulting the prescribing physician and/or pharmacist to determine whether the medication could impair his/her clinical performance. 5. For cohort students who are observed demonstrating inappropriate or unsafe behavior, the RN/LPN who observes the behavior must immediately notify the instructor with the expectation that the student be removed from the clinical environment. a. If the instructor cannot be located, nursing leadership (charge, assistant nurse manager, nurse manager, nursing supervisor et.al.) will require the student to leave the clinical environment. 6. The students and faculty will follow the facility dress code (see Addendum #A) and all PHS policies and procedures. 7. Administration of Medications:

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 3 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC a. The student may not administer any IV medications without supervision. b. For cohort (non-precepted) students, the clinical instructor must be present for the administration of IV medications and IV push medications (including NS flush) unless arrangements have been made with the staff nurse and the staff nurse agrees to supervise the student. c. Medications administered by other routes will be given under the direct supervision of the clinical instructor or staff RN/LPN unless the student nurse is authorized by the instructor/preceptor after negotiation with the staff RN/LPN, to independently administer medications (other than IV). Note: Senior nursing students participating in their final precepted clinical may administer normal saline IV flush independently if requirements above in section 8c for independent administration of medications have been met. d. Controlled substances: i. Students and instructors will not have access to controlled substances. If a patient for whom the student is caring requires a controlled substance, a Providence RN must obtain the controlled substance and the substance must be in the RN's view at all times. With direct RN supervision, the student may co-waste (waste with a 2nd RN while 1st RN is observing), administer, & document the controlled substance administration, but the RN is to co-sign indicating that it was witnessed. Note: in order to be in compliance with the Drug Enforcement Administration (DEA) the documentation must show that the Providence RN has clear chain of custody of the controlled substance at all times (from sign out/waste in Pyxis, to wasting in Pyxis to co-signature on medication administration record) 8. The Clinical Instructor: a. Complies with and communicates to the students all pertinent policies and practice guidelines. b. Completes a minimum of 4 hours of orientation in the primary focus of the clinical rotation where COPYstudents are assigned. Orientation includes: i. Meets with the PH&S-OR Education Coordinator (or designee) to review pertinent facility and unit information as well as the establishment of clinical competencies including (but not limited to): ▪ Key equipment (e.g. how to credential on IV pump, point of care testing equipment, restraints etc.) ▪ Parking ▪ Conference Room scheduling procedures ▪ Dress code for students and faculty (see addendum b) ▪ Obtaining PH&S-OR ID badges ▪ Expectations of faculty and nursing staff ▪ Supervision of students c. Meets with the Nurse Manager (or designee) to review clinical goals and learning objectives for the students. d. Provides a list of student names and contact numbers to the Clinical Education Coordinator. i. Contacts their school of nursing clinical coordinator if EMR codes are not available or don't work

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 4 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC as expected. ii. If the computer access codes do not work, the clinical instructor refers the students to contact their local SON coordinator to problem solve the issue. If the local SON coordinator cannot help, the student should be referred to the Providence Help Desk. Note: Some nursing students (e.g. University of Portland and Mt. Hood Community College) are provided computer access codes through their graduation date. e. Ensures students are oriented to the unit and complete the orientation checklist-addendum B. f. Returns completed orientation checklist to the School of Nursing storage and, if requested, provides the orientation checklist upon request (when asked to provide by regulatory agents to prove orientation). g. Verifies that students' regulatory requirements are complete prior to allowing the student to attend clinicals. This includes current BLS certification, safety education, HIPAA/confidentiality information, immunizations, health information, health screening (TB) and criminal background check verification. h. Provides supervision of the students during the clinical rotation. The clinical instructor will be on site (in the building) when supervising cohort students. Note: Clinical Instructors who are also Providence employees need to maintain clear boundaries between the two roles. (Ex: While working as a Clinical Instructor an employee may not take an independent patient assignment, nor can the employee access or waste controlled substances). When working as a direct care nurse the employee may not add the student supervisory role. Exception is the DEU Clinical Instructor where the nurse is expected to operate as both Direct Care Nurse and Clinical Instructor. i. Monitors behavior of students & addresses issues as needed. j. Provides availability to the student and unit through pager or cell phone numbers. k. Communicates with the Nurse Manager when necessary regarding student concerns. l. Makes the student assignments or communicates assignment process to the Nurse Manager or his/ COPYher delegate. m. Supervises no more than 8 students on site per clinical instructor (OSBN requirement). n. Communicates with the Clinical Education Coordinator regarding student placement requests, concerns or questions. Note: instructors may not negotiate student placement with managers. Any negotiations regarding student placement are to be through the facility designated clinical education coordinator 9. The student nurse: a. Participates in direct care of patients in accordance with their skill level and abilities under supervision of the clinical instructor or staff RN/LPN. b. Must have the clinical instructor present if they have not performed or attained competency in a skill or procedure. If the instructor is unable to respond immediately or patient care cannot wait, the instructor may direct the student to the responsible RN/LPN for assistance. The RN/LPN may choose to perform the needed care or supervise the student. c. Will collaborate with the responsible RN/LPN regarding the patient's plan of care or changes in the patient's status. d. Must wear school picture ID at all times. .

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 5 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC i. For facilities that issue badges, students will wear both their student badge and the facility badge at chest level at all times. ii. For facilities that require Providence identification to be worn by students: Students may either obtain a badge from security daily or arrange to have a badge temporarily issued to them. iii. In Portland area hospital facilities, faculty may sign out temporary PH&S ID badges for their cohort students from Nursing Education. Precepted and capstone students may sign out their own badges for the rotation. These badges are issued to the student for use throughout their rotation. Loss of a badge results in a fee paid to the facility from the student's school. iv. For the remaining facilities, the application form for a photo ID is obtained as appropriate for the site (for many sites this is obtained from the Security office or Human Resources). Each student completes a form. The application forms will need to be signed by the unit nurse manager or clinical education coordinator. e. Must provide a minimum of 2 hours advance notice (prior to shift start) to the clinical area if they are unable to attend clinical. f. Communicates and documents information in the medical record per policy (cohort students collaborate with clinical faculty; precepted students collaborate with precepting RN/LPN). g. Maintains and updates Student Passport information regarding current BLS certification, safety education, HIPAA/ confidentiality information, immunizations, health information, health screening (TB) and criminal background check verification. Keeps the Student Passport with them when in the clinical setting 10. The Nurse Manager (or designee): a. Communicates any problems regarding student placement to the Clinical Education Coordinator and the instructor as appropriate. b. Assists with the orientation of faculty and students to the specific unit. c. Meets with the Clinical Instructor prior to the beginning of the rotation to review clinical objectives and COPYidentify any unit orientation needs. d. Directs all inquiries or requests for student placement to the Nursing Education Coordinator for Schools of Nursing. e. Facilitates student and instructor participation in care conferences, procedures, educational offering that would promote learning and collaboration between team members. 11. The Nursing Education Department (or designee for facilities without a nursing education department): a. Validates there is a current clinical agreement in effect with the school of nursing. Copies of the clinical agreements are held in the Oregon Regional Nursing Office. b. Coordinates the clinical placement assignments on the units in collaboration with the schools, nurse managers or designate. c. Coordinates the clinical assignments with the Nurse Managers and the schools of nursing. d. Monitors clinical placements by periodic contacts with the instructors and nurse managers. e. Participates as a liaison with the schools of nursing 12. The School of Nursing a. Validates there is a current clinical agreement in effect with the facility.

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 6 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC b. Validates the clinical instructor supervising students has current RN licensure, BLS certification, immunizations, criminal background check, drug screen, signed confidentiality agreement, signed acceptable use agreement, signed code of conduct form, and has completed a facility / unit orientation c. Coordinates the clinical placement assignments on the units in collaboration with the facility designee. d. Provides Providence with lists of student names & data necessary for regulatory compliance and electronic medical record training & access purposes at least 30 days prior to clinical rotation. e. Provides students with access codes to electronic learning management for purposes of completing EMR training. Verifies EMR training occurred (views certificate of completion), then provides student with EMR access codes. ADDENDUM A: PH&S OR Dress Code for Students and Faculty ADDENDUM B: Student Nurse Safety Orientation Checklist - attached KEY WORDS: SON, school of nursing, nursing school, student, nursing student, dress, dress code, expectations, faculty WRITTEN BY: PHS-OR Clinical Excellence Resource Team (CERT) IN COLLABORATIONCOPY WITH: PHS-OR Nursing Education Collaborative of Oregon (NECO) APPROVED BY: PHS - Oregon Nurse Executives REFERENCES/RESOURCES: Oregon Nurse Practice Act ADDENDUM A: PH&S-OR DRESS CODE FOR STUDENTS AND FACULTY

Providence facilities are places of business and the employee, faculty and students are expected to exhibit a professional demeanor and appearance at all times. Any time they are at the facility for clinical related activities, students and faculty are to follow the PH&S-OR/ facility dress code and policies and wear appropriate ID badge(s).

1. Appearance will be neat and well groomed with clothing style that is conservative and traditional to the

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 7 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC business environment or specific work area. a. Facial piercings are limited to 2 earrings. Remove all nose, eyebrow, lip or tongue jewelry. b. Jewelry should not be dangling or so large it may interfere with patient care or potentially be grabbed by the patient. c. Rings are limited to one ring or wedding set per hand. d. Tattoos are to be covered. e. Facial hair on men should be trimmed and well groomed. f. Hair should be contained away from the face to prevent injury, contamination or interference with work. g. Makeup will be conservative. h. No perfumes or heavy fragrances are to be worn. i. Fingernails will be no longer than ¼ inch. j. No artificial nails will be worn in patient care areas. k. Nail polish is allowed if not chipped l. Appropriate under garments will be worn. 2. While providing patient care, the students will wear their student uniforms or follow the appropriate dress code of the facility. 3. If on the facility campus and not in the patient care setting, students will wear a lab coat over business- casual street clothes (see guidelines below), their student uniform, or follow the facility dress code. BUSINESS CASUAL GUIDELINES: Women

1. DressCOPY pants or khakis or pant suits. 2. Dresses, blouses, tops, and/or sweaters with a professional appearing neckline and length. Tops should cover the midriff; no torso skin should be exposed. 3. Skirts must be slightly above knee length or longer. 4. Hosiery is not required for skirts or dresses (unless facility dress code requires hosiery). 5. Skirts of professional fabric (not see through) and length. Men

1. Dress slacks or khakis. 2. Short or long sleeved shirt (regular or banded) and/or sweater. 3. Denim shirt (any color). Shoes

1. Shoes should cover the foot, no open toe shoes or slides without a back strap. Shoes should be clean and well maintained.

School of Nursing Clinical Requirements. Retrieved 11/03/2017. Official copy at http://phs-orpmmc.policystat.com/policy/ Page 8 of 9 3807861/. Copyright © 2017 OR - Providence Medford MC 2. Boots are acceptable. NOT ACCEPTABLE

1. Dresses, blouses, tops, and/or sweaters that do not cover the shoulders. 2. Dresses, blouses, tops, and/or sweaters with revealing necklines. 3. Shirts and tops with logos, graphics or inappropriate slogans. 4. Denim jeans (all color), athletic or warm-up suits. 5. Spandex or stretch pants. 6. Underwear-style T-shirts. 7. Shorts. 8. Sweatshirts 9. Flip flops, shower sandals, or Crocs. 10. Any type of non-religious hat.

Addendum B – Student Nurse Safety Orientation Checklist.jpg Attachments: Addendum B – Student Nurse Safety Orientation Checklist.pdf

Approval Signatures

Approver Date Judith Tatman: Reg Chief Nursing Officer Or 07/2017 Maria CallowayCOPY07/2017 Jennifer Burrows: Chief Nsg Exec-Nsg Admin 07/2017 Yvonne Kirk: Coo/Cne 07/2017 Janiece Zauner: COO/CNE 07/2017 Mary McFadden: Chief Nsg Exec-Nsg Admin [JT] 07/2017 Lisa Halvorsen: Chief Nsg Exec 07/2017 Rebecca Kopecky: Nurse Executive 07/2017 Sandra Maddux: Regional Director-Nursing Practice/Quality 07/2017