1 BACHELOR OF SCIENCE (BSN) PROGRAM STUDENT POLICIES AND PROCEDURES FOREWORD These policies and procedures have been developed to assist students to meet the expectations and standards required by the BCIT Bachelor of Science in Nursing Program. They apply throughout the program. This document has been organized into five categories: Academic Policies, Clinical Practice, Student Health, Student Progress and Student Issues. A - Academic Policies: The majority of the academic policies are BCIT policies which have been approved by the Education Council and apply to all BCIT students. B Clinical Practice: All nurses, including student nurses, are expected to work within government regulations, professional practice requirements, agency policies and within their own level of competence in order to provide safe, competent, and ethical patient care. These policies take direction from documents such as the Professional Standards for Registered Nurses and Nurse Practitioners (CRNBC, 2012), the Code of Ethics for Nurses (Canadian Nurses Association, 2008) and the Scope of Practice for Registered Nurses (CRNBC, 2015). The scope of practice for students progresses throughout the levels. Students are accountable for knowing the scope of practice required at each level as stated in these guidelines. C - Student Health: Policies on health are for the protection of the student, patient, the patient s family and other health care workers. The Professional Standards for Registered Nurses and Nurse Practitioners stipulates that the nurse Maintains own physical, psychological and emotional fitness to practice (Standard 1). D - Student Progress: Everyone hopes that his or her nursing education will progress smoothly. However, unexpected health problems, personal concerns or learning difficulties may result in an interruption to your course of studies. This section will assist you to manage issues related to your progress. E - Student Issues: This section provides information that is of particular interest to students such as graduation, Set Reps, references, and name/address changes. August 2015
2 1 TABLE OF CONTENTS A ACADEMIC POLICIES... 2 A-1 Institute Policies... 2 Student Regulation Policy 5101: 2 Student Code of Conduct (Non-Academic): 2 Student Evaluation: 2 Academic Integrity and Appeals: 2 A-2 Student Evaluation: 2 A-3 Assignment due Date and Lateness... 2 B NURSING CLINICAL PRACTICE... 3 B-1 Guidelines for Professional Conduct of Student Nurses in Clinical... 3 B-2 Guidelines Regarding Dress and Appearance in Clinical Practice... 4 B-3 Policies for Use of Technology... 5 B-4 Policies for Performing Clinical Techniques (Procedures) in Clinical Practice... 8 B-5 Procedure for Handling Unusual Incidents Involving BCIT Students B-6 Guidelines for Clinical Placements C STUDENT HEALTH C-1 Policy on Student Health C-2 Student Illness (Notification, Return to Clinical Practice, Missed Exams) C-3 Reporting On-Campus Safety Incidents C-4 Guidelines for Injury to Students in Clinical Practice C-5 Procedure Following Accidental Exposure to Blood and Body Fluids C-6 Procedure Following Accidental Exposure to Blood and Body Fluids by Staff and Students C-7 Guidelines for Students Wearing Casts/Brace Due to Injury While in Clinical Practice C-8 Latex Sensitivity/Allergy D STUDENT PROGRESS D-1 Guidelines for Assessing Student Progress in Clinical Practice D-2 Guidelines for Resolving Issues within Learning Partnerships D-3 Student Initiated Withdrawal D-4 Withdrawal of a Student from Clinical Practice for Unsafe Practice (Instructor Initiated) D-5 End of Term Failure D-6 Conditional Standing (Incomplete, Provisional Pass) (Policy 5103) D-7 Policy on Readmission to the Nursing Program (revised Jan 2012) E STUDENT ISSUES E-1 Guidelines for Set Representatives (Set Reps) E-2 Change of Address / Change of Name / Address E-3 Policies Regarding Access of Information by Students, Graduates and Third Parties E-4 Guidelines for Graduating Students... 39
3 2 A ACADEMIC POLICIES A-1 Institute Policies The BCIT policies available online at apply to all BCIT students. The most relevant policies related to students are: Student Regulation Policy 5101: The purpose of this policy is to set forth regulations and conditions regarding student attendance, uniforms (attire), and ownership of works produced by students. Student Code of Conduct (Non-Academic): Student Evaluation: Procedure 5103 PR1 Grading: Academic Integrity and Appeals: Procedure 5104 PR1 Academic Decision Review Process Procedure 5104 PR2 Decision Review Boards Procedure 5104 PR3 Institutional Appeal Tribunals A-2 Student Evaluation: Purpose of this policy is to provide consistent guidance to individuals responsible for the evaluation of students at BCIT. This policy includes information on how students will be evaluated as well as complete definitions of each different grade notation that could appear on a BCIT transcript. Policy specific to the BCIT BSN Program: Limits to number of Attempts to Complete a Course Applicants who have any combination of two instances of withdrawal or failure in a Nursing Theory course will be readmitted to the program with written permission from the Associate Dean, who will detail any special considerations. Applicants who have any combination of two instances of withdrawal or failure in any Nursing Clinical Course(s) for academic or performance reasons will not be readmitted to the program. A-3 Assignment due Date and Lateness This policy is to be used for nursing courses in the Bachelor of Science in Nursing Program. 1. The due date and time for assignments must be noted in the course syllabus/ D2L. 2. A Penalty of 10% per 24-hour period (e.g Monday - Sunday) will be assessed if an assignment is handed in late. The course leader can grant extensions for unforeseen circumstances and may change assignment due dates. 3. Requests for extensions must be discussed with the instructors 24 hours prior to the due date to ensure equality among instructors teaching a course.
4 3 B NURSING CLINICAL PRACTICE B-1 Guidelines for Professional Conduct of Student Nurses in Clinical The conduct of BCIT nursing students is governed by: 1. Code of Ethics for registered Nurses (Canadian Nurses Association, 2008): https://www.cnaaiic.ca/~/media/cna/page-content/pdf-fr/code-of-ethics-for-registered-nurses.pdf?la=en 2. Scope of Practice for Registered Nurses (CRNBC, May 2015): https://www.crnbc.ca/standards/lists/standardresources/433scopeforregisterednurses.p df 3. The Professional Standards for Registered Nurses and Nurse Practitioners (CRNBC, Nov 2012): https://www.crnbc.ca/standards/lists/standardresources/128professionalstandards.pdf 4. Entry level competencies of a new graduate (CRNBC, 2013): https://crnbc.ca/registration/lists/registrationresources/375competenciesentrylevelrn.p df 5. Requisite Skills and Abilities. Becoming a registered nurse in British Columbia (CRNBC): https://www.crnbc.ca/standards/lists/standardresources/464requisiteskillsabilities.pdf 6. BCIT student conduct policies 5101, 5102, 5104 (see above links) Professional Misconduct Misconduct related to professional nursing practice will be regarded very seriously by the involved nursing faculty. Incidents will be investigated on an individual basis and action will be taken as appropriate. Misconduct may result in withdrawal from the clinical and/or denial of readmission to the Program.
5 4 B-2 Guidelines Regarding Dress and Appearance in Clinical Practice 1. Hospital Clinical Settings (revised April 2015) Uniforms a standard BCIT BSN program uniform is worn (Effective as of August 2015 program entry). t-shirts worn under uniforms must be: o no more than ¾ length sleeves (must be not more than 2 inches below the elbow) o tight to skin o white, black, or the colour of the uniform underclothing must not be visible through uniform Shoes closed heels and toes shoe must protect entire foot from injury must be able to wipe clean no mesh running shoes are acceptable no platform soles non-slip soles footwear must provide traction not to be worn outside of clinical must comply with WorkSafeBC guidelines Policies Part 8 Footwear : WSBC Policies Part 8 Identification ID badge and name pin appropriately attached to the left side of your uniform Wristwatch watch or pocket watch with a second hand is essential no ornamental watch bracelets Hair must be clean and controlled so that it does not fall in front of the face hair clips must be a neutral colour no other adornments to be worn unscented hair products may be used beards and moustaches must be neatly maintained Fingernails must be clean and short for infection control no polish no artificial nails Jewelry not permitted with the exception of the following: plain wedding ring, one stud earring per ear, religious and medi-alert bracelets - no necklaces or chains small stud jewelry only in any visible body piercing Make-up to be used with discretion unscented products only perfume/cologne not permitted
6 5 Smoking no smoking prior to providing direct care to patients Mobile Devices are not permitted for personal use. mobile devices may be used for research and resource purposes only, as per agency policy refer to BSN policy B-3 Fanny packs, tool belts or aprons of any kind are not permitted. 2. Community Agencies, Mental Health, Continuing Care and Prevention professional, clean, washable street clothes are required all other requirements are the same as for clinical settings 3. Nursing and Simulation Labs Dress Code: Scrub top, name tag, proper footwear (flat, closed toe shoes), long hair tied back and wristwatch Leave all personal items in locker (backpacks, coats, books, etc.) NO food or drink is permitted in the BSN Simulation Lab B-3 Policies for Use of Technology Social Media Technology Definitions: Social media technologies are accessible, digital communication tools that enable people to connect, interact and share information on social networking online sites. Social media technologies include information generated via text messaging; and multimedia messaging through portable communication devices (e.g., cellular phones, smart phones, personal digital assistants, etc.), content on the Internet (e.g., blogs, instant messaging, social networking sites, posting to public media sites, mailing lists, online social forums, wikis, photo-sharing and video-sharing sites). The definition of social media technologies is ever-evolving as novel uses of existing and new technologies emerge. Current popular examples are YouTube, MySpace, Facebook, Twitter, and blogs (PHSA, 2010). Technology is useful for learning: BUT Social media provides opportunities for rapid knowledge exchange, fostering interprofessional communication, collegial networking and knowledge dissemination and discussion, enhancing student s engagement in their education, and improving educator and student communication and learning. (Junco, 2011; Cronquist & Spector, 2011, American Nurses Association, 2011). Information can take on a life of its own where inaccuracies become fact simply through repetition.
7 6 Patient privacy can be breached as information is shared even when names and specific identifying information is deleted. The public s trust of nurses can be compromised as nurses have an ethical responsibility to maintain patients confidentiality. Individual nursing careers can be undermined as nurses have a legal obligation to respect the privacy of patients. (American Nurses Association) Ethical and Professional Use of Technology Be respectful, be careful, be responsible, and be accountable (Junco, 2011) 1. Patient privacy and confidentiality is a fundamental ethical and legal obligation of a nurse (American Nurses Association, 2011). 2. Confidential information should be shared only: with a patient s informed consent when legally required to provide confidential information where failure to disclose the information could result in significant harm to others. 3. Privacy relates to the patient s expectation and right to be treated with dignity and respect. Nurses may breach confidentiality or privacy in a wide variety of ways including with information he or she posts via social media, pictures of patients comments on social media sites etc. (white paper). It is important to recognize that instances of inappropriate use of social media can and do occur, but with awareness and caution, nurses can avoid inadvertently disclosing confidential or private information about patients. See CRNBC s Privacy and Confidentiality Practice Standards: https://www.crnbc.ca/standards/confidentiality/pages/default.aspx https://www.crnbc.ca/standards/lists/standardresources/400confidentialitypracstd.pdf Principles for Social Networking The following guidelines from National Council of State Boards of Nursing (2011) are intended to minimize the risks of using social media: 1. Nurses are strictly prohibited from: Transmitting or placing online any electronic media or any patient-related image or information. Sharing, posting or otherwise disseminate any information, including images, about a patient or information gained in the nurse-patient relationship with anyone unless there is a patient care related need to disclose the information or other legal obligation to do so. Identifying patients by name or posting or publishing information that may lead to the identification of a patient. Limiting access to postings through privacy settings is not sufficient to ensure privacy. Referring to patients in a disparaging manner, even if the patient is not identified.
8 7 Taking photos or videos of patients on personal devices, including cell phones. Follow employer policies for taking photographs or video of patients for treatment or other legitimate purposes using only employer-provided devices. 2. Nurses and students should: Maintain professional boundaries in the use of electronic media. Like in-person relationships, the nurse has the obligation to establish, communicate and enforce professional boundaries with patients in the online environment. The fact that a patient may initiate contact with the nurse does not permit the nurse to engage in a personal relationship with the patient. Consult employer policies or an appropriate leader within the organization for guidance regarding work related postings. Promptly report any identified breach of confidentiality or privacy bringing any questionable social medical content posted by a colleague that violates ethical or legal standards to the attention of the colleague. If the posting could threaten the patients health, welfare or right to privacy the nurse has than obligation to report the matter to their supervisor. (American Nurses Association, 2011) Be aware of and comply with agency policies regarding use of agency -owned computers, cameras and other electronic devices and use of personal devices in the clinical setting. Not make disparaging comments about clinical sites, co-workers, instructors or students. This includes any comments that are threatening, harassing, profane, obscene, sexually explicit, racially derogatory, homophobic or otherwise offensive. Not post content or otherwise speak on behalf of the agency unless authorized to do so and follow all applicable agency policies. 3. Safety and Security: Students must not use camera, video or recording features in the clinical environment/hospital grounds or classroom and laboratory activities. Maintain patient confidentiality and privacy: do not use patient names, numbers or other identifying data. Maintain medical asepsis by protecting your mobile device with a plastic zip lock/saran wrap during patient care contact; wash hands after removing wrap and place device onto a clean surface. Maintain awareness of your surroundings while operating your device; be stationary and aware of events around you. Maintain vigilance and keep the device on your person to prevent theft. Do not loan out to others. Ensure that your device requires a password to log in and turns off automatically after three minutes if it is not being used. 4. Professional Conduct: Students are not permitted to engage in personal business while performing as a clinical student without faculty permission this includes voice calls, texting, or internet browsing for nonclinical information.
9 8 References Put your mobile device away (in your pocket) and on quiet mode when interacting with patients. Permission must be obtained by patient, health care team member or instructor prior to any form of recording. Permission of the instructor must be obtained if the student wishes to record a presentation or class. When you use the device in front of a patient/health care team member/instructor pre-empt its use by stating your purpose for using the device. Turn off all sounds when in clinical, class, meetings or conferences. Inform your supervising RN that you are using the device to access information for clinical. American Nurses Association (2011). Fact Sheet Navigating the world of social media. Silver Spring, MD: Author. American Nurses Association (2011). Principles for social networking and the nurse Guidance for the registered nurses. Silver Spring, MD: Author. Junco, R. (2011). The need for student social media policies. Educase Review. National Council of State Boards of Nursing (2011). White paper: A nurse s guide to the use of social media. Chicago, IL: Author. Provincial Health Services Authority (2010). Guidelines for participating in online communities and social networking sites. Vancouver, BC: Author B-4 Policies for Performing Clinical Techniques (Procedures) in Clinical Practice These policies are to be used for BCIT nursing students during their clinical practice. If these policies conflict with those of the agency, the MORE RESTRICTIVE policy is to be followed. Clinical Safety and Performance Students may be required to complete additional orientation and/or training online or on-site at a health care agency. In addition to meeting all BCIT clinical practice requirements, students must also meet all the requirements of the health care facilities where they are in clinical. Students must complete facility-specific paperwork before deadlines set by the nursing program. Standard Clinical Practicum Guidelines 1. Students must attend classroom activities and make up all missed clinical techniques class prior to preforming a skill in the clinical area. Isolated exceptions must be instructor approved. 2. Students must be directly supervised for each new skill by an instructor prior to performing the skill unsupervised. Students must clarify with each instructor which skill requires supervision, who can supervise the skill (RN or instructor), and if the skill can be performed independently once deemed competent by the instructor. 3. It is the responsibility of the student to come prepared to clinical to perform skills taught in clinical techniques course.
10 9 LEVEL 1 4. Students may not perform any transfer of function skills (such as blood gases, epidural medications, cardioversion/defibrillation) at any time during the program. 5. In levels 1-5 all clinical practicum groups should have two consecutive days of no longer than 8 hours, for the benefit of repeated exposure. 6. With approval from an instructor and in accordance to agency policy, a student may accompany a patient off the unit. 7. Students may not transport patients in vehicles. 8. Students may accompany a patient in an ambulance, providing an RN/Paramedic is present and responsible for the patient. Students are in an observational capacity only. 9. Students may not witness consents or any other legal documents. Students may not translate for other health care professionals obtaining consent or any other legal document from a patient. 10. Students are expected to follow agency policies for reporting suspected child and elder abuse, domestic violence and communicable diseases. 11. A student may not accompany a patient off the hospital grounds, away from the client s residence, or place of contact in community. 1. All students must have medications checked by the instructor or Registered Nurse (RN) or Registered Psychiatric Nurse (RPN) if he/she has been given the authority), until the instructor decides that the student can safely administer medications unsupervised. 2. Anticoagulants, oral hypoglycemic and narcotics must always be double checked using the MAR & co-signed with a small checkmark/initial by an instructor or RN/RPN. 3. Students are to follow hospital guidelines regarding Narcotics and Control Drugs. All narcotics and other controlled drugs must be cosigned by an instructor or RN/RPN in the Narcotic Control Book. Students may not carry the narcotic keys. 4. For all prn medications, stat narcotics and pre-anesthetic medications, the student must verify doctor s orders with an instructor or RN/RPN. The MAR is used to prepare and administer the medication. 5. Mechanical or ceiling lifts: Students must follow agency policies and receive proper training, and always have an instructor or RN in attendance when using a lift. LEVEL 2 Upon approval of instructor, the student may perform all skills from level 1 in ADDITION TO THE FOLLOWING GUIDELINES & EXCEPTIONS: 1. Students must clarify with instructor which skills must be supervised by whom (instructor or RN) prior to completing a skill. 2. Phoning the Physician: Students of all levels should be encouraged to collaborate with physicians when they are on the unit, by reporting significant assessment findings and/or patient problems, in a clear and concise manner. Students of all levels may phone the physician with information. Only Level 6 students may receive verbal orders in conjunction with an RN. 3. All students must have all PO/SC/IM/IV medications checked by an instructor before administration. To give any medications by these routes unsupervised, all students must receive direct approval from an instructor, to give medications unsupervised.
11 10 4. Patient Controlled Analgesic (PCA): Students caring for a patient with a PCA are responsible to understand the safety considerations related to a PCA as stated in the agency policy. The student will not change any settings on the PCA pump. 5. Students caring for patients with an epidural are responsible to assess dermatomes in the presence of an RN. Students cannot do this skill alone and are not responsible for documentation. Students are responsible to understand the safety considerations of an epidural as stated in the agency policy. 6. Students may initiate subcutaneous butterflies and administer selected medications by this route with the supervision of the instructor or RN until the student is considered competent to do so on their own by the instructor. 7. All anticoagulants, insulin and narcotics orders must be visually double checked by an RN or instructor prior to administration. IV Medications 8. Adding medications to minibags and volutrols: students must be checked and supervised by the instructor or RN until the student is considered competent to do so on own by the instructor. 9. Students may not change automated infusion rates on primary medication infusions (ie. Heparin, Humulin R). A student may prepare a primary medication IV bag with an instructor or RN and prime tubing. A student may monitor a patient with a primary IV medication bag. 10. Students may add IV medication minibags and IV solutions in continuous peripheral IV therapy under the supervision of an instructor or RN. Student must receive direct approval from instructor to add medication minibags or IV solutions unsupervised. Central Venous Catheters (CVC, PICC s): 11. Students are responsible to assess CVC lines and dressings only. Students may not change dressing or access the hub on a CVC. 12. Students may not access CAPPED central venous catheter lumens. A CVC certified RN or instructor must establish/access the central line (flush and attach IV tubing) for the student. Once the central line is established, the students may administer IV minibag medications and IV solutions with the direct supervision of the instructor. 13. Students may change IV bags and administer medications via minibags through a central venous catheter (CVC) with a continuous infusion only under instructor supervision 14. Discontinuing peripheral IV s: students may remove peripheral IV needles and short length intracaths independently once considered competent by an instructor. Students may not remove CVC/CVP lines and long intracaths (PICC s). 15. Chest Tubes: Students caring for patients with a chest tube are responsible to understand the safety considerations related to a chest tube, as stated in the agency policy. Students are not permitted to change any settings on the chest tube (ie. apply suction, etc.) Administration of Immunizations: 16. Acute Care Setting: With instructor /preceptor supervision a student may administer a vaccine that has been ordered by a Dr. in an acute care setting. Examples are: MMR vaccine ordered for a post-partum woman, tetanus injection ordered for patients on a surgical or medical unit. 17. Instructors and students should refer to the website where they can review the information on the vaccine and administration method.
12 11 LEVEL 3 Upon approval of instructor, the student may perform all skills from level 1& 2 in ADDITION TO THE FOLLOWING GUIDELINES & EXCEPTIONS: 1. All students must have medications checked by the instructor or Registered Nurse (RN) or Registered Psychiatric Nurse (RPN) if he/she has been given the authority), until the instructor decides that the student can safely administer medications unsupervised. 2. All students in pediatrics, obstetrics or mental health placements must have the following medications checked by an instructor or RN: digoxin for pediatrics fractional dosages for pediatrics oral hypoglycemic anticoagulants (PO & SC) insulin 3. All IV medications (minibags & volutrols) must always be checked and supervised by an RN or instructor on pediatric units. 4. All injections (IM/SC) must be checked and supervised by an RN or instructor on all pediatric units 5. Students may not change automated infusion rates on primary medication infusions (ie. Heparin, Humulin R). 6. Students may change bags and administer medications via minibags through a central venous catheter with a continuous infusion only under instructor supervision. 7. If a student receives direct approval from instructor and the medication has been checked by the instructor, a student may change bags and administer medications independently via minibags through a central venous catheter with a continuous infusion. 8. Syntocinon for induction: the student may not administer, add or regulate syntocinon. The student may observe only. 9. Students may give Rhogam under direct supervision of instructor. 10. A student must always be in the company of an instructor, RN or RPN while a patient receives ECT and, while the patient recovers in the recovery room. 11. OB students are not permitted to give any medication or perform blood sugars/blood spot testing on a newborn. LEVEL 4 Upon approval of instructor, the student may perform all skills from level 1, 2 & 3 in ADDITION TO THE FOLLOWING GUIDELINES & EXCEPTIONS: 1. Medications by IV Push Route: Students must have all IV push medications dosage checked by an instructor. Students may administer direct IV (IV push) medications through a peripheral IV or a continuous CVC under the direct supervision of an instructor. Students may give Ativan and valium IV push under the direct supervision of an instructor. Students may not administer the following medications by IV push: sedatives (EXCEPTION Ativan and Valium) antineoplastics
13 12 antihypertensive medications isotopes, vasopressors, beta blockers and digoxin 2. Students may change automated infusion rates on primary medication infusions (ie. Heparin, Humulin R) ONLY upon direct approval from the instructors and under direct supervision from an RN or instructor. 3. Students may flush peripheral saline locks as per hospital policy independently upon approval of instructor. 4. Students may change bags and administer medications via minibags independently through a central venous catheter with a continuous infusion ONLY upon direct approval by instructor. 5. Students may not access capped central venous catheter lumens. Students can only prime an IV tubing for PICC s and CVC s but MAY NOT connect the line to the hub of a CVC or PICC. 6. Blood and blood product administration. Students may: go to the blood bank and obtain blood for administration cannot check blood; students can only observe. Two RNs must check blood. After blood has been checked appropriately, a student may prime tubing and hang blood under the direct supervision of an instructor or RN. Complete assessments and monitor the patient receiving blood administration according to hospital/agency policy. 7. Students may insert and maintain nasogastric tubes on own once found competent to do so by the instructor or RN. These students may not insert N/G tubes on the following patients: those with upper GI conditions or surgery those who are unconscious neonates (less than 28 days old) exception Level 6 preceptorship those with tracheostomies 8. Students may not change the rate of infusion on epidural pumps. LEVEL 5 Upon approval of instructor, the student may administer medications and perform all skills from level 1-4 in ADDITION TO THE FOLLOWING GUIDELINES & EXCEPTIONS: 1. Students will be provided guidelines and clinical policies specific to community practice. 2. Students are expected to call 911 if emergency care is required in the community. 3. Community (Public Health) Setting: Immunization in this setting is a complex process and each health authority has their own guidelines and policies about students immunizing in public health contexts. 4. Instructors and students should refer to the website where they can review the information on the vaccine and administration method 5. Mass immunization clinics (flu and school) have different requirements than adult or childhood immunization clinics. For instance in Fraser Health students in group placement or preceptorship clinical experiences can immunize in mass immunization clinic settings (one vaccine) when they have the mass immunization education session provided and are supervised by their nursing instructor or preceptor.
14 13 6. In community students may set up medications (oral & subcutaneous) for the clients to take at a later date according to the policy of the agency. The medication administration, dispensing, system set up must be reviewed with instructor prior to intervention. LEVEL 6 Students must check Health Agency policy and unit specific policy for nursing students prior to performing all skills. Students may perform all skills from level 1-5 in ADDITION TO THE FOLLOWING GUIDELINES & EXCEPTIONS: 1. Students must have all anticoagulants (PO/SC/IV) and Insulin (SC/IV) and narcotics (PO/SC/IV) checked and /or co-signed by preceptor or another RN prior to administration. EXCEPTION: Prefilled anticoagulant syringes. 2. Automated Medication System: The preceptor RN will need to access narcotics for a Level 6 student when the automated medication system is used. The student will witness the removal, administer medication to the patient and sign for the medication on the patient s MAR. NOTE: Students may not sign as a witness to wastage. 3. IV Medications: Students may administer medications direct IV (IV push) with the supervision of the preceptor. Level 6 students many administer direct IV (IV push) through a central venous catheter with a continuous infusion only with an RN or preceptor under direct supervision. Ativan and valium can be given under direct supervision of a preceptor or RN. The following medications may NOT be given IV: Sedatives (with the EXCEPTION of Ativan and valium) antineoplastics antihypertensive medications Isotopes, vasopressors, beta blockers and digoxin 4. Students who have taken a Health Agency CVC certification course may under DIRECT SUPERVISION of the preceptor (or certified RN) and if agency policy permits may: Flush a central line Draw blood. Establish, connect or change CVC tubing Change a CVC dressing if the student complies with all the policies required of an RN in relation to CVC dressing changes. Remove CVC s and PICC s 5. If a student has not participated in the CVC care and Maintenance workshop at BCIT or another agency, the student may: Prime a line for the use with CVC Students may change IV bags and administer secondary medications independently through a central venous catheter with a continuous infusion. MAY NOT connect the IV line to the hub of the CVC or access the CVC, including PICC lines. Assess CVC lines and dressings only.
15 14 6. Students may initiate IV therapy if they complete the IV Insertion Workshop at BCIT or other agency certification course. Students require supervision by a certified RN to initiate IV therapy throughout Level Students must be supervised by the preceptor or RN when changing chest tube drainage systems. 8. Level 6 students may perform specialty nursing skills if: the agency agrees, the student participates in the related agency certification program or approved alternative, (for example Health Agency IV insertion workshop) the student is supervised by agency staff, instructor or preceptor 9. Preceptorship students may give IM Vitamin K injections to a newborn with supervision. 10. Students may do the routine checks of doctors orders and MARs (medication administration records) under the supervision of a Registered Nurse. The RN should co-sign with the student that the checks were done. 11. Doctor s Orders: students may transcribe and process doctors orders AND must be checked and co-signed by the RN. Students may take verbal orders, including phone orders, providing the order is heard by, and co-signed on the doctors order sheet, by an RN. When a patient is being transferred to another facility, doctors orders must be transcribed by a RN. In community practice contacting physician regarding medication orders and medication changes must be reviewed by instructor beforehand. 12. Students may care for patients with PCA s and epidurals, including managing the equipment/pumps under the direct supervision of the preceptor/rn. 13. Check agency policy to determine if a student is permitted to insert large/ small bore NG tubes. Students may insert and maintain nasogastric tubes independently once determined competent by the RN and/or according to health agency/unit policy. Students MAY NOT insert N/G tubes on the following patients: those with upper GI conditions or surgery those who are unconscious neonates (less than 28 days old) exception Level 6 preceptorship those with tracheostomies. 14. Mechanical or ceiling lifts: After approval by preceptor and/or completion of agency training requirements, students may use lifts without supervision. 15. Oxytocin for induction or augmentation of labour: the student may not administer, add or regulate oxytocin. The student s focus of care should be to monitor fetal and mother s response to oxytocin. 16. All public health students need to take the BCCDC immunization certification exam, and then can immunize under supervision of a PHN. Students in community health can administer single antigen immunizations if they have agency permission. 17. Blood and blood product administration. Students may: Go to the blood bank and obtain blood for administration. Cannot check blood; students can only observe. Two RNs must check blood.
16 15 A student CAN prime tubing and hang blood under the direct supervision of the preceptor or RN after the blood has been checked appropriately. Complete assessments and monitor the patient receiving blood administration according to hospital/agency policy. Additional Policies regarding clinical practice in all levels Failure to follow the BSN nursing program student guidelines, policies and procedures and/or hospital/agency policies is considered a breech in BCIT policy and may result in: Completion of BCIT Unusual Incident Report and agency incident report Removal of student from the clinical area Professional practice contract between the instructor and student Additional safety checks at the discretion of the instructor and/or program head Decrease in patient workload or limitations on skills performed Failure in clinical course A required to discontinue status (RTD) B-5 Procedure for Handling Unusual Incidents Involving BCIT Students Definition of an Unusual Incident An unusual incident is defined as any situation in which a: patient injures his/her self while under the care of a BCIT student; student who finds a patient in a situation in which an injury may have occurred; student fails to fulfill orders prescribed for a patient under his/her care; student violates a policy of the agency within which s/he is receiving the clinical experience; student implements treatments or medications not prescribed for a specific patient under his/her care; student is prevented from implementing a procedure, treatment or medication by the instructor/ staff member because it will result in an actual/potential injury to the patient; student fails to use sound clinical judgment when caring for a patient. Procedure to Follow in the Event of an Unusual Incident 1. A BCIT unusual Incident Report must be completed for all unusual incidents/errors by students in clinical practice. 2. A BCIT Unusual Incident Report is completed by the student, given to the instructor, and discussed with the instructor. 3. The student must sign the form. 4. The student must fill out the agency incident report (PSLS) as per agency requirements. The decision to fill out an agency incident report may be waived at the discretion of the instructor/charge nurse.
17 16 5. The completed BCIT Unusual Incident Report is placed on the student s file. Preceptorship Students In the event of an unusual incident by a preceptorship student, the student must notify the appropriate BCIT instructor within 24 hours. A hospital incident report is filled out by the student at the time of the incident. The Nursing Program Incident Report is also completed by the student, given to the preceptor for comment, and then given or ed to the instructor. B-6 Guidelines for Clinical Placements Clinical placements are determined by the program faculty prior to the student entering the level. The priority is to meet the learning needs of the students with the available clinical resources. Due to sudden agency closures and other variables, clinical placements may be changed at any time. The nursing program reserves the right to make changes to placement location or scheduled hours based on new information. Students in all levels of the program may be scheduled for clinical experiences during a variety of hours.
18 17 C STUDENT HEALTH C-1 Policy on Student Health 1. The CRNBC Professional Standards for Registered Nurses and Nurse Practitioners (2012) stipulate nurses Maintains own physical, psychological and emotional fitness to practice (Standard 1.6). BCIT student nurses are required to meet this standard. Students who do not meet this standard may be required to have a medical review at the expense of the Institute. The review may include a comprehensive health assessment and related diagnostic testing in order to determine suitability for nursing from a health perspective and to make recommendations regarding continuation in the program 2. Students whose health constitutes a hazard to patients will not be permitted to attend clinical experiences. 3. Level 1 students must visit Student Health Services to review their immunization and health forms as scheduled. There is a one-time charge for the immunization review. 4. If a student requires a second TB skin test an additional charge is applied. 5. All BCIT student nurses are required to maintain up-to-date immunizations while in the program and must provide evidence of updated immunization when requested. Level 5 clinical agencies require students to prove they are TB negative. Details are provided prior to this clinical course. 6. Students who do not comply with the immunization requirements of the BCIT Nursing Program may not be able to complete the clinical course. 7. All nursing students are tested for Hepatitis B serology and a booster provided if required. Hepatitis B is highly prevalent, contagious and life threatening. Immunization for Hepatitis B is available through BCIT Student Health Service and is covered by the initial charge. In Level 5 Hepatitis B series is required which will be followed by serology to ensure adequate protection. Booster required if medically indicated. 8. Students who have inadvertently cared for patients with Active Pulmonary Tuberculosis must immediately: report this to the instructor contact BCIT Student Health Services: contact Tuberculosis Control: All students are required to have a flu vaccine for winter unless medically contraindicated.this service is provided by BCIT Student Health Services. 10. All students are expected to comply with BCIT policy 5101 related to attendance in lab, clinical, and classes (www.bcit.ca.files/pdf/policies/5101.pdf).
19 18 C-2 Student Illness (Notification, Return to Clinical Practice, Missed Exams) Notification 1. Students who will be absent from clinical practice must notify the instructor as soon as possible. If the illness is sudden, then the student notifies the agency and the instructor prior to the beginning of shift. 2. If a student expects to have a prolonged absence due to illness, then s/he must notify the instructor. Return to Clinical Practice after an Illness 1. The student must notify the instructor of his/her intention to return to clinical practice in advance of the experience. 2. If a student has been absent from the clinical practice due to a serious illness, injury or surgery, then s/he must obtain a Medical Certificate* from the involved physician which includes a statement that the student is now fit to resume ALL activities in the practicum setting. 3. The student must present the Medical Certificate* to the Instructor prior to returning to the practicum setting. * Medical Certificate is a certificate, obtained at the student s expense, signed by a medical doctor, as defined by the Medical Practitioners Act, which is written on letterhead and which is specific and detailed with respect to the following: Dates during which the student was under the doctor s care for the particular medical, emotional or other problem; Dates on which the student was seen by the doctor for the particular medical, emotional or other problem; A statement regarding the seriousness of the student s medical, emotional or other problem, (without compromising the confidentiality of the student s medical record); A statement outlining the actual or potential impact of the condition on the student s ability to complete the course. Missed Exams Due to Illness 1. If an exam is missed due to illness the student must notify the course instructor and Program Head prior to the exam. 2. For any missed mid-term exam, the student and instructor will determine how to make up the missed mark as soon as the student is able to return to BCIT. 3. If a final exam is missed the mark cannot be made up. The student should discuss this with the Program Head and the Program Head will determine whether the student qualifies for an Aegrotat. (Policy 5103 Grading Elements)
20 19 C-3 Reporting On-Campus Safety Incidents All injuries on campus, including in the classroom, must be reported to First Aid, located in NE Hours of operation are 0630 to 2200 hours Monday to Friday and Saturdays 0800 to If a student goes to Student Health Services they must still report their injury to First Aid in person after they have been treated. If the student is unable to attend First Aid because of the nature of injury the student may report it to First Aid by phone at or by completing a form 6A and faxing it to or it to This form is available from Medical Services and from First Aid. The value of reporting to First Aid is: All relevant forms and paperwork will be completed (a must do). Compensation or medical expenses may not be covered if there is no timely record of the injury. If an incident warrants further investigation, all records are forwarded from First Aid to BCIT s Health and Safety Coordinator. The Reporting Process SERIOUS INJURY Requiring Immediate First Aid and/or Medical Attention o Notify the First Aid Attendant by phone at or o o If there is no answer in First Aid and the Attendant is required to come to the scene of the incident, call Security s Emergency number at 2248 or Security will locate the First Aid Attendant. The Attendant will come, tend to the situation, accompany the student to Medical Services and complete all required paper work. MINOR INJURY Requiring First Aid or Medical Attention o Direct the person(s) involved to report to the First Aid Attendant in NE as soon as possible after the event. The incident will be recorded. Safety Incidents that Do Not Involve Injuries o Safety incidents that do not involve injuries should be reported to BCIT Security. C-4 Guidelines for Injury to Students in Clinical Practice Students participating in a provincially approved clinical or apprentice component of BCIT s training or vocational programs are eligible for WorkSafeBC compensation coverage through the Ministry of Labour and Citizen s Services. In order to receive WorkSafe compensation coverage BCIT First Aid must be provided with documentation of the injury or illness in a timely manner. Student will: 1. Report to your immediate supervisor at clinical site. 2. Report to your instructor as soon as possible. 3. Call BCIT First Aid or to report the incident as soon as possible. Inform your instructor if you have difficulty in reporting the incident to BCIT First Aid.