1 Atlanta Medical Center Clinical Rotation Guidelines

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Atlanta Medical Center Clinical Rotation Guidelines

Atlanta Medical Center (AMC) and Nursing Services is delighted that each of you has chosen us to be a clinical site in the development of your students. We here at Atlanta Medical Center value each of you and will strive to maintain solid and

productive partnerships past, present and future. We are a better institution because of the quality of your faculty, instructors and students, they contribute to our success. I appreciate your patience and assistance as we strive to meet the complex requirements of the ever changing healthcare environment. We are first and foremost only trying to assure

the safety of our patients, staff and the community Deborah

Davis MSN RN Director Nursing Education AMC

.

APPLIES TO _NOTES

Student Faculty PARKING

340 bldg. Suite 335 • 404 265-4443 • 0800-1630 M-F

x

• Obtain a new parking ticket at the beginning of each month (ticket expires at the end of each month)

IDENTIFICATION BADGES (ID)

Attachment G: Identification Badge Application

Connector 1st_{floor East}

(across from Walgreens) • 404 265-3536 • 0630-1430 • M, W, F

x

• Clearance to obtain ID is granted once a completed Student List Form is received

• All Faculty and students must wear an AMC issued badge and college issued ID badge.

o Badge is worn face forward on upper chest during clinical or associated activities (at all times above the waist) • A completed “Student List Form” is required prior to the creation

of identification badges, the form is emailed

TDAP STICKER-(Women’s Services)

Employee Health 404 265 4322

X

• Anyone performing a clinical rotation or individual practicum in Women’s Services (Labor and Delivery, Mother/Baby, Special Care Nursery…) must take immunization record to employee health services to obtain a Pink Sticker to place on AMC ID badge to gain entry into these areas

• Arrangements must be made in advance. The employee health can accommodate only with advance notice and arrangement.

HIPPA On line

Completed once

(see instructions for proof of validation)

x

Access www.healthstream.com/hlc/tenetcx. • Begin registration process.

• After you have logged in, from your account, click on the CATALOG tab.

• On the next screen, enter the name “Information and Privacy” or “S101” in the Search window and follow the instructions to access the content.

• Complete print certificate

• Place in Faculty or student educational file

UNIFORM

_x

• School Emblem attached to uniform

• White Uniform (Scrubs) or Seal Blue (Scrubs) • White Jacket

• No crocs

• Clear Nail Polish, artificial nails prohibited

• 1 pair of earrings regardless of number of piercings

MEDICATION TEST

_x

• Completed annually. Arrangement to take test is made by contacting deborah.davis2@tenethealth.com

• To be completed annually prior to clinical rotations Make arrangements with deborah.davis2@tenethealth.com in advance to complete test.

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4 ORIENTATION GUIDELINES

APPLIES TO _NOTES

Student Faculty A.

GENERAL HOSPITAL ORIENTATION

Main Hospital 4 North Classroom B

0800-1630

Tom McBeth, Director Hospital Education

x x _• _{Must be completed prior to clinical experience}

• Students conducting independent practicums only • Clinical Faculty with clinical groups

• Arrangements must be made with

deborah.davis2@tenethealth.com to attend Hospital Orientation space is limited.

• Orientation normally occurs every other week (may change during legal holidays)

• Business attire only, School Uniform may be worn

STUDENT X • Attend orientation conducted by Clinical Faculty • Sign all forms as requested

• Cannot perform individual preceptorship on unit employed or by known relative.

FACULTY X • Clinical Faculty conducts orientation covering subjects from general hospital and nursing orientation for each of their clinical groups using their orientation manual and the General Hospital

and Nursing Resource Booklet for Faculty as a resource

• A unit orientation can be done prior to the clinical rotation start date, the date of clinical, as arranged with the unit manager

o A basic unit based orientation guideline has been provided (Attachment

• Each student completes the Orientation Assessment

Questions for Clinical Groups- on the answer sheet (evaluation tool on the effectiveness and completeness of the covered

material) Clinical Faculty will document student score. o A score 80 % is needed to pass

o Remediate as needed

• Each clinical faculty and student will initial that they completed an orientation and had the opportunities to clarify and ask questions

FACULTY ORIENTATION GUIDELINE

These are the courses that are to be covered during orientation of clinical groups.

Once the faculty instructor has attended hospital orientation the resource manual can be used with students to complete their orientation on these subjects

If you have any questions or need assistance with content contact

deborah.davis2@tenethealt h.com to discuss.

Infection Control

• Blood borne Pathogens

• Hand Washing/Infection Prevention

• Standard Precautions

• TB: Prevention and Recognition Basic Patient Rights

• Patient Confidentiality

• Patient Complaint Management Patient Safety

• Patient Safety Policy/Patient Safety Goals

• Patient/Family Education

Risk Management

• Incidents

Signature Service/PSMS Scores Employee Health Services

• Blood and Body Fluid Exposure(review college policy)

Environment of Care General Safety

• Fire Safety

• Hazardous Materials & Waste (Hazard Communication)

• Utility Systems – Electrical & Mechanical

• Emergency

Management/Disaster Plans

• Safe Medical Devices Act

• Medical Equipment

• Hospital Security

• Identifying Victims of Abuse

• Assessment of Patient

• Medication Safety Policies

• Basic Nursing Procedures

• Restraint Management

• IV Therapy

• Pain Management

• Blood Administration

• Medication Administration

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5 QUICK REFERENCE GUIDE FOR MANAGEMENT OF ATTACHEMENTS

ATTACHMENT DO NOT SCAN EMAIL WORD

DOCUMENT AND ATTACH TO

EMAIL

SCAN AND ATTACH

TO EMAIL or send maintain in Do not scan, email student campus file

A DO NOT SCAN YES NO

B DO NOT SCAN YES NO

C DO NOT SCAN YES NO

D YES NO YES

E YES NO YES

Information Privacy and

Security (HIPPA) DO NOT SCAN NO NO DO THIS

Orientation Assessment

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6 ATTACHMENT A Clinical Group Rotation Request Form

Instructions and Example

(DO NOT SCAN)

Complete and

email

this form to

deborah.davis2@tenethealth.com

, to request group clinical rotations

in which the clinical instructor has complete responsibility for the student

1. An individual form is to be used with:

2. each request

3. each separate clinical group

4. Attach syllabus that includes objectives and the skill level of the students participating in the

clinical rotation requested

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7 ATTACHMENT B Senior or Individual Practicum Request Form

Instructions

(DO NOT SCAN)

1. Complete and email this form to request placement/assignment for senior nursing/individual student who has chosen Atlanta Medical Center to complete their independent clinical practicum.

2. Email to Deborah.davis2@tenethealth.com

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8 ATTACHMENT C Clinical Group Rotation Student List

Instructions

(DO NOT SCAN)

Attachment C: Clinical Group Rotation Student List

NOTE: The number that is entered on this form will be the number that the students use to enter other signatures

and initials.

• Complete this form by entering data. Listing each student’s last and first name in the spaces provided with date of birth • Send completed form via email a minimum of 2 weeks prior to the clinical rotation to deborah.davis2@tenethealth.com

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9 ATTACHMENT D Clinical Group/Individual Practicum Experience Student Signature and Initials/

Health/Background/Drug Screening Instructions (

SCAN

)

Student Signatures/Initials/Attestations

 This section is the only place in which the student’s full signature will be needed. Therefore the document is scanned

 The form must be scanned and attached and emailed to deborah.davis2@tenethealth.com l

 STUDENTS MUST BE IN THE SAME ORDER IN WHICH THEY ARE LISTED ELECTRONICALLY on the STUDENT LIST FORM Attachment C

Health and Background Screening Attestation (as described on Affiliation Agreement) examples of the following refer to attachment for all details:

• Use Advantage/Infomart for Background Screen inform student to allow Atlanta Medical Center to access results • Social Security number verification

• Criminal Search (7 years)

• Violent Sexual Offender & Predator registry and HHS/OIG/GSA

Drug Screen

• Use Advantage/Infomart for Drug Screen inform student to allow Atlanta Medical Center to access results • Must be a ten panel

• List of person who will be available to retrieve any of the attested documentation from the college if urgently needed for validation.

Faculty Signature confirms documents current and available for each student listed Contacts

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10 ATTACHMENT E Confidentiality Statement/Statement of

Responsibility/ Record of Required Orientation/ Information Privacy

and Security And HIPAA Training for Clinical Groups or Senior/

Individual Practicum

INSTRUCTIONS

(SCAN AND ATTACH TO EMAIL)

Confidentiality Statement EXHIBIT B of AFFILLIATION AGREEMENT

(

Do not submit individual copies of this form

)

• Clinical Faculty reviews these statements with each student or allows student

to read

• Each Clinical Faculty will enter name of school and date

• Faculty Instructor/designee will complete witness section

• Student will initial under their student number slot upon review

Statement of Responsibility EXHIBIT A of AFFILLIATION AGREEMENT

(

Do not submit individual copies of this form

)

• Clinical Faculty reviews these statements with each student or allows student

to read

• Each Clinical Faculty will enter name of school and date when reviewed with

student(s)

• Faculty Instructor/designee will complete witness section

• Student will initial under their student number slot

Orientation

• Clinical Faculty conducts orientation covering subjects from hospital and

nursing orientation for each clinical group

• Each student will date and initial the day that they completed the orientation

o

Students are given the opportunities to clarify and ask questions

regarding orientation materials by faculty instructor or AMC staff

• Record individual score from Orientation Assessment Quiz (keep individual

copies answer sheet in students college file for retrieval if requested)

Information Privacy And Security And HIPPA Training

• Record date student completed training located on certificate

• A Tenet certificate of completion must be placed in student’s college file

• Faculty signature validates student completion and a that a retrievable

certificate is available

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12 ATTACHMENT A Clinical Group Rotation Request

Form

1.

Complete this form to request clinical group rotations at Atlanta Medical Center

2.

Email to

deborah.davis2@tenethealth.com

3.

Attach syllabus that includes objectives and the skill level of the students participating in the clinical

rotation requested

Check one:



Spring 2013



Summer 2013



Fall 2013

Institution Name

Address city/state Zip

Telephone w: other:

Faculty Requesting Clinical Rotations

Title

Email Address

Type of Clinical Area(s)

Requested:

Clinical Rotations

for: ADN BSN RN: LVN PCA/MA SURGICAL TECH PARAMEDIC/EMT Other:

Number of Students Max 8: Level in program:

Dates FROM: TO:

Days M T W Th Fri Sat Sun

Hours

Faculty

Instructor Name

Contact

Numbers Home: Cell Email

Address

Office Use Only:

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Atlanta Medical Center Clinical Rotation Guidelines ATTACHMENT B

Senior or Individual Practicum Request Form

1. Please complete this form to request placement for students who have chosen Atlanta Medical

Center to complete their senior/individual practicum.

2. Email to

Deborah.davis2@tenethealth.com

3. Submit one form for the current quarter or semester.

Check one:



Fall 2012



Spring 2013



Summer 2013

Institution Name

Address city/state zip

Telephone w: other:

Type of Program Associate

Nursing Baccalaureate Nursing

Advance Practice

Type: Other: _{___________________} Faculty Requesting

Practicum/Responsible Party Name

Contact

Numbers Home: Cell Email

Address

Student’s Name Type of

Clinical Area Requested

Start and End

Dates

Times

Preferred Total of Hours Needed

BSN

Preferred? Name Preceptor Assigned

1.

2.

3.

4.

5.

6.

7.

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14 Attachment C: Clinical Group Rotation Student List

1. NOTE: Limit 7 students to 1 Clinical Faculty

2. Complete this form by entering data. Listing each student’s last and first name in the spaces provided with date of birth

3. Send completed form via email a minimum of 2 weeks prior to the clinical rotation to

deborah.davis2@tenethealth.com

4. NOTE: The number that is entered on this form will be the number that the students use to enter other signatures and initials on

other forms.

Name of Academic Institution: Clinical Faculty Name

Telephone/email address WORK

CELL Email:

Date Clinical Faculty Attended Hospital Orientation

Completed Date of Clinical Group Orientation

Clinical Dates Start: End:

Student Names

LAST FIRST mm/dd/yyyy must include Date of Birth

1. 2. 3. 4. 5. 6. 7.

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15 ATTACHMENT D Clinical Group/Individual Practicum Experience Student Signature and Initials/

Health/Contact/Background/Drug Screening

Indicate form use:



Clinical Group



Senior/Individual Practicum

STUDENT SIGNATURE/INITIALS

Last/First Signature Initials

1. 2. 3. 4. 5. 6. 7.

HEALTH AND BACKGROUND SCREENING ATTESTATION { EXHIBIT C} of Affiliation Agreement

School affirms the Program Participant(s) listed have completed the following health screenings, documented health status, (Do not

submit actual documents)

MMR and Rubella and Rubella immunity by positive antibody titers;

Varicella Immunity

-PPD

within the last 12

months

or

x ray as indicated

Hepatitis

B

Circle one

Institution Liability

or

Individual Student

Liability Insurance

Current Basic

Life Support

Student

Influenza

vaccination

FACULTY SIGNATURE ATTEST THAT THESE DOCUMENTS ARE CURRENT AND AVAILABLE FOR REVIEW:

CONTACTS

Who would we contact to fax a copy of any of the listed records if needed immediately?

1. Name or Department: Telephone Number 2. Name or Department:

Telephone Number:

Office Use Only Background Checks/ Drug Screen

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ATTACHMENT E Confidentiality Statement/Statement of Responsibility/ Record of Required Orientation/ Information Privacy and Security and HIPAA Training for Clinical Groups or Senior/

Individual Practicum

CONFIDENTIALITY STATEMENT {EXHIBIT B of AFFILLIATION AGREEMENT) The undersigned hereby acknowledges his/her responsibility under applicable federal law and the Agreement between

______________________________________ (“School”) and Atlanta Medical Center (“Hospital”), to keep confidential any information regarding Hospital patients and proprietary information of Hospital. The undersigned agrees, under penalty of law, not to reveal to any person or persons except authorized clinical staff and associated personnel any specific information regarding any patient and further agrees not to reveal to any third party any confidential information of Hospital, except as required by law or as authorized by Hospital. The undersigned agrees to comply with any patient information privacy policies and procedures of the School and Hospital. The undersigned further acknowledges that he or she has viewed a videotape regarding Hospital’s patient information privacy practices in its entirety and has had an opportunity to ask questions regarding Hospital’s and School’s privacy policies and procedures and privacy practices

Dated this ____ day of ______________, 20______. WITNESS (Faculty Instructor/Title) Print Name:___________________________

WITNESS (Faculty Instructor/Title) Signature: ____________________________

STUDENT INITIALS (record in your student number)

STUDENT 1 STUDENT 2 STUDENT 3 STUDENT 4 STUDENT 5 STUDENT 6 STUDENT 7

STATEMENT OF RESPONSIBILITY {EXHIBIT A of AFFILLIATION AGREEMENT)

For and in consideration of the benefit provided the undersigned in the form of experience in evaluation and treatment of patients of Atlanta Medical

Center (“Hospital”), the undersigned and his/her heirs, successors and/or assigns do hereby covenant and agree to assume all risks of, and be solely

responsible for, any injury or loss sustained by the undersigned while participating in the Program operated by ___________________ (“School”)

at ATLANTA MEDICAL CENTER (Hospital) unless such injury or loss arises solely out of Hospital’s gross negligence or willful misconduct.

Dated this ____ day of ____________, 20__. WITNESS (Faculty Instructor/Title) Print Name:_________________________________

WITNESS (Faculty Instructor/Title)Signature: ___________________________________ STUDENT INITIALS

RECORD OF REQUIRED ORIENTATION

Attendees By initialing this form you attest to having received an orientation performed by your faculty instructor or designee. You had an

opportunity to ask questions regarding required training topics (a list of topics can be obtained from your instructor) to assure a clear understanding of your role and expectations to uphold the policies and practices at AMC during your clinical rotation.

STUDENT INITIALS/TEST SCORE FROM ORIENTATION ASSESSMENT QUIZ

Score Score Score Score Score Score Score

INFORMATION PRIVACY AND SECURITY AND HIPAA TRAINING

•

Record date student completed training.

•

The completed TENET certificate must be placed in student’s college file.

•

Faculty signature validates student completion and retrievable certificate

STUDENT INITIALS/DATE COMPLETED

Date Date Date Date Date Date Date

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