RANGER COLLEGE
SYLLABUS
VOCATIONAL NURSING DEPARTMENT
Course Number and Title: VNSG 1660 Clinical II
Credit Hours: 6 HRS/WK LEC: 1 HRS/WK LAB 20
Instructor: Patty Davis, RN
Office Location: Early
Office Hours: 0830 to 1600
Office Phone: 325-641-5726
Monday thru Friday
E-Mail Address: pdavis@rangercollege.edu
I.
CATALOG DESCRIPTION
A method of instruction providing detailed education, training and work-based
experience, and direct patient/client care, generally at a clinical site. Specific detailed
learning objectives are developed for each course by the faculty. On-site clinical
instruction, supervision, evaluation, and placement is the responsibility of the college
faculty. Clinical experiences are unpaid external learning experiences. Courses may be
repeated if topics and learning outcomes vary.
II.
REQUIRED BACKGROUND/PREREQUISITES
Successful completion of previous semester. Mastery level of 4 on Prep-U, eligibility to
sit for boards, and pay application fee to TX BON to proceed to third semester. Random
drug testing will continue throughout second and third semester.
III.
TEXTBOOK(S)
Current drug handbook
Taber’s Cyclopedic Medical Dictionary, 21st Ed., F.A. Davis
Introductory Medical-Surgical Nursing, 10th Ed., Timby/Smith, LWW
Medical Terminology, A Systems Approach, 6th Ed., Gylys-Wedding, Davis
IV.
METHODS OF INSTRUCTION
Lecture, discussion, on site clinical experience and observation.
V.
SCANS Competencies
The course covers Scan Competencies #s C1, C2, C3, C4, C5, C6, C7, C8, C9, C10, C11,
C12, C13, C14, C19, C20, F1, F2, F3, F4, F5, F6, F8, F9, F12, F16, F17.
VI.
COURSE OBJECTIVES TO REACH DEC REQUIREMENTS
The student will:
1. Be responsible for getting patient assignments from instructor.
2. Read in nursing texts to develop and write a plan of care for each patient.
3. Report to clinical facility on time.
4. Gather and organize report information on assigned patients.
5. Perform patient activities in a timely manner.
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6. Assist to charge patients for supplies while being cost conscious.
7. Discuss pertinent patient information as needed with instructor, or other members of
health care team to provide safe and effective care.
8. Provide nursing care in a caring, nonjudgmental, nondiscriminatory manner.
9. Provide nursing care within limits of vocational nursing knowledge, education,
experience, and ethical/legal standards of care.
10. Assume accountability for own nursing practice and use self-evaluation process to
improve own nursing practice.
11. Function within the nurse’s legal scope of practice and in accordance with the
policies and procedures of the employing health care institution or practice setting.
12. Participate with patient, their families and the interdisciplinary health care team to
plan and provide patient care across the life span.
13. Do patient teaching through out the day as you care for the patient.
14. Take patient history using structured assessment tool.
15. Perform basic assessment using structured assessment tool to assist identifying health
status, monitor change, and basic health-related learning needs of the patient.
16. Contribute to the development of and appropriately implement individualized
teaching plans for selected patients.
17. Teach basic health promotion/maintenance and self-care to individuals from a
designated teaching plan and provide the patient with the information to make choices
regarding health.
18. Report and document assessment data appropriately to assist the RN in formulating
nursing diagnosis.
19. Monitor, document, and report responses to medications, treatments, and
procedures and communicate the same to other health care professionals
clearly and accurately.
20. Assist interdisciplinary health care team with examinations, health
screening, and routinely performed procedures.
21. Recognize and communicate ethical and legal concerns through
established channels of communication and report unsafe practices to the
appropriate authorities.
22. Identify short-term goals/outcomes, perform basic interventions, and
establish priorities for care in collaboration with the patient/family.
23. Maintain patient confidentiality at all times.
24. Identify priorities, make judgments concerning basic needs and implement
the plan of care of multiple patients.
25. Organize care of multiple assigned patients using problem solving and
identified priorities.
26. Using standard references, compare expected and achieved outcomes
of nursing and identify obvious conflicts between the nursing plan of care and
the plan of the interdisciplinary health care team members.
27. Identify and communicate reasons for deviations from the plan of care and
assist in modifying the plan of care and goals/outcomes to reflect the needs of the
patient.
28. Contribute to the development of nursing plan of care and assist in the
discharge planning of selected patients.
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29. Assist in promoting a safe, effective care environment conducive to the
optimal health and dignity of the patient using evidence-based policies.
30. Implement plan of care to assist patient to meet basic physiologic needs
including; circulation, nutrition, oxygenation, activity, elimination, comfort,
pain management, rest and sleep.
31. Initiate basic interventions in emergency situations within the scope of
practice of the vocational nursing student.
32. Initiate basic nursing interventions for foster patient’s psychosocial well-being
and foster client coping mechanisms during alterations in health status.
33. Use computers and current technology as needed or assigned in clinical
areas to enhance direct patient care.
34. Perform nursing tasks per clinical policies while continually monitoring and
improving techniques.
35. Identify patient support system/major community resources that can assist in
meeting patient needs and communicate needs to the patient’s support system
members of the health care team.
36. Utilize time management skills to complete patient care and other assigned
tasks by end of clinical shift.
37. Calculate medication dosages appropriately as needed.
38. Be prepared by bringing all clinical equipment and paperwork.
39. Demonstrate ability to adhere to policy and follow instructions as given.
40. Maintain professional appearance and serve as a positive role model for
students and peers.
VII.
COURSE CALENDAR
Weekly on Wednesday, Thursday and Friday.
Mid semester evaluations March
Final Evaluation May
VIII.
COURSE/CLASSROOM POLICIES
See VN handbook and following guidelines.
.
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GUIDELINES
In order to function effectively in the health care profession, certain personal and
professional characteristics must be demonstrated. The clinical rules and regulations listed
below are for the student’s training and benefit so that he/she can function personally and
professionally in the health care profession upon the completion of the program.
Any of the infractions listed below, or others listed in the Ranger College Student
Handbook and the Department of Vocational Nursing Handbook could lead to dismissal
from the program. A student subject to dismissal from the program will have access to due
process as stated in the Ranger College Student Handbook.
A. Professional Behavior
1. Leaving the clinical area without permission.
2. Failure to call the clinical area one (1) hour prior to the shift to notify the
instructor/supervisor.
3. Displaying a disrespectful attitude to faculty, staff, patients, or peers.
4. Failure to complete assignments or turn in assignments in a timely manner.
5. Failure to return from meals or breaks at assigned time.
6. Obscene or crude language or gestures.
7. Disrupting clinical—includes receiving personal telephone calls that are not an
emergency, bringing beepers or cell phones to clinical, using facility
phones (except pay phones) when situation is not an emergency. All
personal phone calls to the facility should be directed first to the student’s
instructor.
8. Smoking in uniform while in non-smoking areas.
B. Unsafe Actions
1. Failing to follow instructions.
2. Medication errors.
3. Repeating poor clinical practices and/or showing poor judgment after being
counseled by the instructor.
4. Administering a medication without having it checked/approved by an
instructor or assigned designated supervisor.
5. Going to clinicals while taking narcotic sedatives or pain meds.
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C. Reasons a student will be dismissed from clinical and counted absent include but are
not limited to:
1. Smelling of alcohol while in the clinical area.
2. Behavior which indicated chemical impairment. Student should realize that suspicion
of chemical impairment may result in drug testing. No narcotic pain meds acceptable.
3. Dressing inappropriately when coming to clinical or exhibiting inadequate personal
hygiene. If the student can adequately improve appearance within thirty (30) minutes,
she/he may continue with clinical. (Appropriate clinical dress is specified in the
Vocational Nursing Handbook.)
4. Arriving for clinical over fifteen (15) minutes late.
5. Having an illness that may be transmitted to patients.
6. Arriving at clinical without clinical paper work. Example: care plans;
attendance sheets; procedure sheets; etc.
D. Reasons for immediate dismissals from clinical and subject to dismissal from the
program. Note: Dismissal from the program will result in a semester grade of “F” for
clinical.
1. Releasing confidential information about patients.
2. Physical or verbal abuse of a patient, staff member, visitor, peer, or
instructor.
3. Patient abandonment.
4. Cheating, lying, or stealing.
5. Failing to report medication errors.
6. Arriving at a clinical site more than once smelling of alcohol.
7. Positive drug screens while on duty (including prescribed pain meds).
8. Excessive absences (4th absence will take 10 points off clinical grade if it is a clinical
day.)
Ranger College provides a variety of services for students with
learning and/or physical disabilities. The student is responsible for making the
initial contact with the Ranger College Counselor. It is advisable to make this contact
before or immediately after the semester begins
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NEVER
GIVE
ANY MEDICATION
UNTIL YOU ARE SURE
IT HAS BEEN CHECKED
BY AN INSTRUCTOR
THERE ARE NO EXCEPTIONS!
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CLINICAL PROCEDURE BOOK
Student Clinical Evaluation Forms are based on Level I, Level II and Level III progressive levels
of Clinical functioning (Clinical Competency). The Procedure Check Sheet has been structured
to coincide with the Clinical Evaluation Forms. The Students’ Clinical Competency on each
level will be determined by a combination of the Clinical Evaluation Form and the Procedure
Check Sheet.
The Procedure Check Sheet is divided into two separate Skills Levels. Level I Skills are for the
Level I Clinical Competencies. Level I is the first Clinical Rotation. Level I Skills are grouped
together, and coincide with Level II and Level III Clinical Competencies. Levels II and III are
the Students’ second and third Clinical Rotations. The Students will have three (3) Clinical
Rotations during the School Year, and will receive an Evaluation at the end of each rotation.
The Student is expected to complete a minimum of 6 procedures each level and a total of 18
before graduation of the procedures listed in the Procedure Check Sheet. Students are
encouraged to take advantage of their opportunities to perform these skills, and get as many
procedures as possible completed. The Student may perform Procedure Level II-III skills while
they are actually in Level I, if they have learned the skill in Class or Lab.
The Student must perform the skill adequately 3 times before they are allowed to perform the
procedure without supervision.
It is the Student’s responsibility to inform the Clinical Instructor of your need/desire to perform
the skill. The Instructor will supervise the Student’s performance of the skill, and if the Student
performed the skill competently, the Instructor will sign the Progress Sheet. Competency of
Student performance is at the discretion of the Instructor. The Instructor’s signature on the
Progress Sheet indicates the Student performed the skill competently. Obviously the Student
may perform a procedure several times before demonstrating Clinical Competence.
The Student’s Procedure Check Sheet must be brought to the Clinical Unit each time the Student
is in Clinical Lab. The Instructors may not sign for a procedure the next day, or any other time.
The Clinical Check Sheet and Procedure List will be turned in each time the Student is to receive
a Clinical Evaluation.
NOTE
Procedures requiring the use of Surgical Aseptic Techniques must be monitored by an Instructor
each time you perform a procedure. It is the Instructors discretion to allow the Student to
perform the skill independently after he/she has monitored the Student’s use of Surgical Aseptic
Technique. This additional supervisor of procedures using surgical Asepsis is in addition to the
required number of times listed on the Progress Sheet for the procedure.
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CLINICAL COMPETENCIES LEVEL II
Upon completion of Level II (one semester) the student vocational nurse will be learning to
function in Differentiated Essential Competencies (DECs).
1: Accept the role of the beginning vocational nurse by:
a. Demonstrating knowledge of legal and ethical responsibility and limitations
when administering patient care.
b. Demonstrating confidences by initiating patient care and by performing tasks with
minimal supervision.
c. Consulting clinical instructor regarding learning needs.
d. Utilizes constructive criticism to improve clinical performances.
2. Utilizes appropriate verbal and nonverbal skills while participating in the communication
process with patients and colleagues by:
a. Identifying barriers to communication and adapt to changing needs of the patient.
b. Recording information obtained from a head to toe assessment on the patient’s chart
legibly and concisely.
c. Relating pertinent information to colleagues and discussing appropriate nursing action.
3. Utilize the nursing process in providing care for individuals by:
a. Performing a head to toe assessment.
b. Developing a nursing care plan with the client, family and interdisciplinary health
team members, including assessment, short and long term goals, nursing intervention,
implementation and evaluation.
c. Taking client history wising a structured assessment tool.
d. Assist the RN in formulating nursing diagnosis.
4. Demonstrate a personal/professional attitude by:
a. Participating in clinical experience by attending and reporting promptly.
b. Utilizing appropriate hygienic measures to present a professional appearance.
c. Demonstrating a desire to learn by actively interacting with colleagues.
5. Demonstrate scientific principles when caring for individuals in various states of the life cycle
by:
a. Utilizing principles of microbiology and anatomy to contrast between normal body
function and disease process.
b. Utilizing basic concepts of nutrition to assist patients to comply with and understand
their dietary regime.
c. Utilizing principles of normal growth and development to appropriately care for
individuals in various states of the life cycle.
6. Complete assigned patient care by utilizing designated level objectives by:
a. Relating clinical learning with classroom theory and patient data.
b. Performing competently designated level skills as stated in the procedure book.
c. Demonstrating appropriate care and teaching to meet patient’s safety needs.
d. Demonstrating organizational skills by planning and completing patient care in a
reasonable time.
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7. Demonstrate ability to:
a. Identify conflicts between the nursing plan of care and the plan of interdisciplinary
health team members.
b. Participate in discussing the plan of care with interdisciplinary health team members.
c. Implement the plan of care taking into consideration ethical and legal parameters
including scope of education with the client and interdisciplinary health care team.
d. Assist in discharge planning for assigned client.
e. Identify health related learning needs.
f. Implement a teaching plan for clients with common health problems and well-defined
learning needs.
8. Students will be able to:
a. Assist in promoting a safe effective care environment conducive to optimal health and
dignity.
b. Implement plans of care to meet basic needs including circulation, activity,
elimination, comfort, pain management, rest and sleep.
c. Implement nursing interventions to promote health and rehabilitation
d. Initiate basic emergency interventions as needed.
e. Initiate basic nursing interventions to foster client’s social well-being and effective
coping mechanisms.
f. Utilize basic therapeutic communication.
g. Administer medications and treatments safely and monitor, document, and report
responses to the other health care professionals accurately.
h. Assist interdisciplinary health team members with exams and procedures.
i. Observe and communicate Patients Bill of Rights.
j. Report unsafe practices.
k. Utilize current technology to enhance client care.
IX.
ASSESSMENT-GRADING SCALE
GRADING
100 – 92 = A
91 – 86 = B
85 – 80 = C
Below 80 = F
All students must achieve an average grade of 80% to remain in the program
See clinical grading sheet.
Grading tool enclosed in clinical packet. Students will be scored according to safety,
professional conduct, initiative, time management, completed paperwork and attitude.
NON-DISCRIMINATION STATEMENT
Admissions, employment, and program policies of Ranger College are nondiscriminatory in regard to race, creed, color, sex, age, disability, and national
origin.
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X.
RECEIPT OF SYLLABUS
Separate page; signed and returned to instructor
Clinical Objectives For
School Nurse Rotation
1. Identify the functions, roles, responsibilities of the school nurse.
2. Discuss what you did and what you learned during this rotation.
All school nurse papers are to be turned in to your campus coordinator.
Clinical Objectives For
Physician’s Office Rotation
1. Compare documentation for Physician’s office with documentation in an acute care facility.
2. List procedures performed in a Physician’s office. Include:
a. Definition
b. Rationale for procedure
c. Physical preparation
d. Psychological preparation
3. Compare assessment and History and Physical done in Physician’s office with same done in
an acute care facility.
Clinical Objectives For
Newborn Nursery Rotation
1. Student will understand the continuity between intrauterine and extrauterine life.
2. Student will relate knowledge of the physiologic changes which occur at birth to newborns
seen in the clinical setting.
3. Student will relate and compare theoretical knowledge of the characteristics and behavior of
the normal newborn infant as described in the textbook with that of newborns being cared for
in the nursery.
4. Student will assist the RN in making an accurate assessment of the newborn.
5. Student will begin to be able to recognize deviations from normal in the newborns seen in the
nursery.
6. Student will assist in giving safe, effective nursing care to the newborn from birth to the time
of discharge.
7. Student will assist in helping parents learn how to care for their new infant.
Written Student Expectations
1. See and complete worksheet for newborn.
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Clinical Objectives For
Postpartal Nursing Rotation
1. Student will relate theoretical knowledge of the physiology of the puerperium to patient care
in the clinical setting.
2. Student will define nursing responsibilities in the immediate postpartal period (one to four
hours after delivery) and to provide nursing care to mothers during this period.
3. Student will begin to develop the ability to give safe, effective nursing care during the
remainder of the postpartal period.
4. Student will learn specific drugs used during the puerperium, indications for their use,
expected actions, untoward reactions, precautions to be taken in their use and
contraindications to their use.
5. Students will gain an understanding of how new parents become acquainted with a newborn
infant.
6. Student will assist to help parents learn how to care for their new infant.
Written Student Expectations
1. See and complete worksheet for postpartum.
Clinical Objectives For
Intrapartal Nursing Rotation (L & D)
1. Student will relate theoretical knowledge of the physiology of labor and delivery to patient
care in the clinical setting.
2. Student will identify the needs of expectant parents during labor and delivery.
3. Students will compare maternal behavior with the textbook description of what is usual
behavior at various times during labor; for example: 1-2 cm. dilation; 3-4 cm. dilation;
5-7 cm. dilation; 8-10 cm. dilation; complete dilation, imminent birth.
4. Student will observe and contrast behavior of primigravida with that of multigravida as they
progress through the first stage of labor.
5. Student will identify nursing measures to assist laboring women to cope with the pain of
labor.
6. Student will identify specific drugs used during the course of normal labor and delivery,
indications for their use, expected actions, untoward reactions, precautions to be taken in their
use and contraindications to their use.
Written Student Expectations
1. See and complete worksheet for L & D.
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Clinical Objectives For
Medication Rotation
1. Student will demonstrate proper handwashing technique prior to medication preparation and
before and after patient contact.
2. Student will demonstrate proper handling of medication to prevent contamination.
3. Student will look up the action and side effects of a new drug prior to administration.
4. Student will calculate correct drug dosage.
5. Student will identify the patient correctly (according to facility policy).
6. Student will administer the correct drug, correct dosage, via correct route, at the correct time.
7. Student will identify correct landmarks and use correct technique in administering medication
(identification of landmarks and administration of the drug should be discussed prior to
entering the patient room. Only minimal assistance should be needed at the bedside.).
8. Student will demonstrate accurate and timely documentation (according to facility policy).
Students must pass the medication rotation to pass clinical. Reasons for failing the medication
Rotation would include (but not limited to) violation of any of the above.
Clinical Objectives
For Pharmacy
1. Student will identify functions of the pharmacy.
2. Student will discuss the process utilized in supplying the medication cart accurately every
day.
3. Student will list and use official reference sources to obtain information about a medication.
4. Student will define commonly used abbreviations associated with medication orders.
5. Student will identify basic units of weight and volume within the metric, apothecaries, and
household systems of measurement.
Clinical Objective For
Recovery Room Rotation
PURPOSE: To acquaint the student to the recovery room, its personnel, its functions and the
Care of the postoperative patient after a surgical procedure.
DIRECTIONS: The student will participate in the various activities of the department as
Designated by the supervisor of the department. The student will be
accountable to the supervisor and will be indirectly accountable to his/her
clinical instructor. The student will complete the following objectives and turn
into the clinical instructor the Monday following your rotation through the
department.
OBJECTIVES: 1. List the personnel responsible for the patient in the recovery room and a brief
Description of their responsibilities.
2. Describe three expected behaviors of patients in the two hours following
surgery with General Anesthesia and Spinal Anesthesia.
3. List three safety precautions that are required in caring for the immediate
post-operative patient.
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Clinical Objectives For
Respiratory Therapy Rotation
Upon completion of this rotation, the student should be able to:
1. Describe various procedures including:
a. Chest physiotherapy (postural drainage and percussion)
b. Oxygen administration by various devices including: Aerosol (heated or cool),
c. Arterial Blood Gases (ABG)
d. Sputum collection
e. EEG
f. Pulmonary Function Tests (PFT’s)
g. Incentive spirometer
h. Croup tent
i. Holter monitors
j. EKG
k. Ventilators
l. CPR/Resuscitation
WRITTEN STUDENT EXPECTATIONS
1.
2.
3.
4.
5.
Define Procedure
Identify Purpose of Procedure
Physical Preparation and Rationale
Psychological Preparation and Rationale
Follow-up Care and Rationale
Clinical Objectives
OR
See and complete worksheet on OR.
ICU
See and complete worksheet on ICU.
ER
See and complete worksheet on ER.
PT
Discuss therapy procedures done, type, purpose, preparation.
DAY SURGERY
See and complete worksheet for Day Surgery.
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Clinical Objectives For
Leadership
1. Define Leadership.
2. Describe what type of documentation is done in long term care and how it is different from
acute care documentation.
3. List/Describe the duties of the nurse leader in long term care.
4. How is Med Pass different in long term care from acute care?
5. What did you observe that is positive during this rotation?
What did you observe that could be changed?
How would you make changes?
All Leadership papers are to be turned into your campus coordinator.
Clinical Objectives
For X-Ray
Upon completion of this rotation, the student should be able to:
1. Describe various procedures including:
a. Organ scans and sonograms.
b. Various x-ray examinations.
2. Identify purposes of above procedures.
3. Outline measures required that will physically prepare the patient for specific
procedures.
4. Outline essential follow-up measures for specific procedures.
5. Demonstrate ability to assist patients undergoing special procedures effectively.
6. Demonstrate skills to assist the person conducting the procedure effectively.
Define Procedure
Identify Purpose of Procedure
Physical Preparation and Rationale
Psychological Preparation and Rationale
Follow-up Care and Rational
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Clinical Objectives for
Day Care Rotation
Observe an infant, a toddler, and a pre-school aged child.
1. Apply Erickson’s Theory of Developmental Stages and write a short paragraph for each child,
comparing &contrasting each child against Erickson’s Theory.
2. Apply Pediatric Developmental Milestones to each child and write a short paragraph for each
one stating your opinion on their ability to meet these milestones or not &why.
3. Observe each child for nutritional status. Write a short paragraph for each child describing
your opinion of their nutritional state.
Possible references: MN book/Maternal/Peds.
Due at the end of the Rotation.
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