5 University of Holy Cross DEPARTMENT OF NURSING NSG 308 CLINICAL EXPECTATIONS FOR MEDICAL SURGICAL ROTATION Clinical Instructor: Monica Johnson, DNP, MBA-HCM, RN, CMSRN, ONC, LNC Telephone number: 504-452-6933 Clinical Institution: East Jefferson Medical Center: 7 East Telephone number: 503-4700 ATTENDANCE: All students are to attend each clinical day and should be present on time. If you will be tardy or absent, please call the instructor no later than 6:00 a.m. on the clinical day. DRESS CODE: Dress in accordance with the dress code as delineated in the Student Handbook. You must wear your name pin on clinical days. On clinical days, remember to have IN YOUR POSSESSION the following: stethoscope, second hand watch or digital watch, bandage scissors, pen-light, and a black pen. CLINICAL DAYS/HOURS: Clinical days will be on Thursdays 6:30am to 6:30pm. Receive report from assigned nurse beginning at 7:00 a.m. All students will take a lunch break. Post conference will be from 1730 to 1830. PATIENT ASSIGNMENTS: Patient assignments will be posted the day prior to clinical. Should there be a need to change the posted assignment, please choose from the alternate list provided. If there is a problem, call me. Professional dress including lab coat and visible name tag are to be worn when picking up assignments. Please do not wear shorts, leggings, tight pants, jeans, or open toed shoes when picking up your patient assignments. Preparation for nursing care of assigned patients includes: 1. Notification of patient regarding care for the next day by the student nurse. 2. Examination of patient’s chart via Cerner regarding the patient’s history: Why was the patient hospitalized, diagnostic tests, surgeries, lab values, medications, treatments, any pertinent past medical history? 3. Research of patient’s diagnosis and pathophysiology. 4. Identification of priority nursing diagnosis and planning of appropriate nursing interventions. 5. Review of medications, including classification, action, purpose, side effects, and nursing implications. 6. Patient and nursing goals for the day of clinical experience. Items may be stored in the nurse’s lounge. The nurse’s drug guide and the intravenous medications book on your iPad may be used only within the nurses' area. Please do not bring into patient's room. No portion of any patient’s record/information should be printed/photographed by a camera, phone, or watch then removed from any facility under any circumstances. This could result in immediate dismissal from the DON. PATIENT CARE ACTIVITIES: Students are expected to be prepared for each clinical day and to implement the patient plan of care. Under no circumstances are you to implement any aspect of patient care without having first obtained instructor permission and appropriate instructor supervision. The instructor may only delegate the responsibility for supervision to a staff nurse. This is to ensure patient safety, legal safeguard, and adequate student supervision, instruction, and evaluation. During the morning of clinical, check physician orders for any new orders entered since report, and read physician’s progress notes for the last 24 hours. Identify the RN assigned to your patient. Obtain a copy of the current patient care summary and MAR worksheet for yourself. After bedside report, perform a head to toe assessment and document in computer no later than 9 am. Look-up and calculate (if applicable) any medications that will be administered. Check the expiration date on all IV tubings and prepare to change the ones due during your shift. Nursing activities that cannot be done by the student under any circumstances include: • Receive any orders from physicians, whether verbal or phone orders • Sign off any orders • Administration of blood products or chemotherapeutic agents, TPN Discuss the plan of care with the staff nurse assigned to your patient and communicate clearly and agree on assigned tasks and responsibilities. Inform the staff nurse and the instructor any time you leave the unit. GENERAL TIME SCHEDULE 0630 - 0700 Pre-conference 0700 - 0730 Identify primary nurse and receive report. After report, discuss with the nurse your plan-of-care for the day. Identify, by name and time, the medications you will be giving. 0730 - 0830 Introduce yourself to patient and perform an “overview” assessment of your assigned patient. Assessment to include IV sites, environment, inform of NPO status (if any), any scheduled tests, incision, tubes or drains. Perform 0800 vital signs and assist with breakfast if appropriate. (Must be charted by 0800) Assess Accucheck results before meals and as ordered Open computer charting. Check am lab results as needed. 0830 - 0900 Be ready for medications and to give a brief discussions of the medications and rationale for why the client is taking themedications0900 - 1030 Make rounds with physicians if possible. Perform nursing interventions for patients. Assist with AM care as necessary. 1100-1200 Before lunch accuchecks; administer insulin and any other medications and 12 noon Vital signs 1230-1300 Lunch 1300-1700- Continue patient care and documented as needed MEDICATION ADMINISTRATION - Students are not to administer ANY medication to the patient without instructor supervision and/or the nurse assigned to the patient. Scheduled and PRN medications, and IV fluids initiated and discontinued are to be charted in the computer. You must know the rate of administration for all IV pushes and IVPBs. Students will give all medications, scheduled and PRN, through 4pm. A. Medication Administration 1. Notify primary nurse of intent to administer medications during clinical day. 2. Check ALL medications with the instructor. The student is absolutely expected to check the medication profile with the chart prior to preparing medications. 3. Check patient’s chart frequently for new medication orders (hourly) and immediately prior to the administration of a medication. 4. All medications must be scanned. 5. Students may administer tube feedings and meds via feeding tube with the instructor present. B. PYXIS Medication Removal: 1. All medications are to be removed from the PYXIS machine. 2. PYXIS does not chart medication into the computer. Medications can be removed at any time; however, the student must ensure the safety of the medication until administration. 3. As meds are removed from PYXIS, the correct count must be established. 4. ALL meds must be checked off by the instructor prior to administering. 5. Medication pass for 9am can start at 8:00am. Please remember regularly scheduled medications are administered within 1hr prior and 1hr after the designated time. IV medications must be administered 30 min within the assigned time along with PRN medications. STAT medications are administered immediately within 30min. 6. Both insulin and heparin are witnessed in the Pyxis by your instructor. The insulin syringe is filled at the Pyxis and a bar code sticker is placed on the syringe. The bottle of insulin is returned to the Pyxis drawer. You will scan the bar code before administering the insulin. Prior to drawing up insulin you will need to know the patient's accucheck and the amount of insulin the patient should receive. Medication is not charted until scanned. IV fluids are considered medications and must be checked with the instructor or primary nurse before hanging. Students may hang IV bags and change IV tubing. C. Medications: Direct IV Push and Intermittent IV medications may ONLY be given with the direct, visual supervision of the instructor. Have tubing ready and primed. Know the rate of the infusion. IV PUSH Gather supplies on table in the patient’s room. Medication, syringe, alcohol prep, etc. Know rate of administration, dilution. PO/IM/SQ Know correct dose and landmarks for injections. IV fluids are considered medications and must be checked with the instructor or primary nurse before hanging. Students may hang IV bags and change IV tubing. DOCUMENTATION/CHARTING Please note, VS must be promptly typed into the computer by 8am. The doctors round and look for their patient's vital signs. The patient’s initial head to toe assessment should be opened by 9am. Please aim to have computer assessment completed by 11am. PROFESSIONAL DEMEANOR - All students are to present themselves in a professional manner. This includes proper dress code and courtesy to the nursing staff, physicians, family members, and other hospital personnel. There should be no loud laughing, gum chewing, eating or drinking within the unit. No cell phones on the unit. Personal phone calls are not allowed on the unit except in emergency cases. Students may have their cell phones on them when walking from the garage to the nursing unit for the purpose of safety. Once on the unit, the cell phone must be kept in the nursing lounge with their belongings and not on them in the clinical area. Smart watches are allowed but notifications must be turned off while in the clinical area. CLINICAL ASSIGNMENTS: Each student will complete two careplans, one peer teaching-learning project, one clientcentered presentation, one research presentation, two community observations, and one perioperative observation. Paperwork must be in APA format, which is included in the grade. Due dates are at the discretion of the instructor. ALL assignments must be turned in by assigned due date. PERFORMANCE/EVALUATION: An evaluation of student clinical performance will be completed according to the Clinical Performance Evaluation criteria as outlined in the NSG 308 course syllabus. Students are responsible for reviewing the clinical criteria periodically and for striving to achieve these objectives. Time does not allow for student/instructor conferences to discuss clinical performance during clinical hours. The instructor will schedule individual conference times if necessary. The final evaluation and clinical grade will be scheduled by the instructor. You will be notified later regarding date, time, and location.
