Nursing Education Training Programs Institutional Catalog

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Nursing Education Training

Programs

Institutional Catalog

Knoxville-6921 Middlebrook Pike Knoxville, TN 37909 865-584-2999

Maryville-1741 Triangle Park Drive Maryville, TN 37801 865-983-0821

Nashville-2201 Charlotte Avenue Nashville TN 37203

615-250-4300

www.redcross.org

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“It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past.” Clara Barton

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Upon acceptance, you will be given two copies of this catalog. One is for your records and will be marked “Student Copy.” Please bring the other copy with you on the first day. Your catalog contains a TB test and physical sheet. Both parts of this sheet must be completed and are due on the first day of class unless advance arrangements have been made with a member of the Nursing Team.

We ask that you read and initial each page of this catalog as you read it. All pages must be initialed at the

bottom. When reading your catalog, you may also fill in information you already know. If you do not know the information asked for, please wait until your first class day to fill this in. A member of the Nursing team will go over the catalog collectively with all students on the first day of class and everyone will have a chance to complete any lacking information. Please make sure you bring it! We strongly urge all students to read the institutional catalog in its entirety. If a student has a question that isn‟t answered within the catalog, that student is encouraged to make notes and ask questions on the first day.

Thank you for allowing us to assist you with your training. If you have questions regarding this information, please email the Nursing team at [email protected].

Sincerely,

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HISTORY

The American Red Cross is a private, non-profit organization dedicated to helping people prevent, prepare for and respond to emergencies. The Red Cross is not a government agency and does not receive government funds. The American Red Cross relies on the support of the American people to carry out its lifesaving mission.

The American Red Cross has been involved in nursing for more than 100 years, and our Nursing Education Training courses continue the American Red Cross tradition of outstanding training that benefits participants and their

communities.

All American Red Cross Nursing Education Training Programs are authorized by the Tennessee Higher Education Commission. This authorization must be renewed each year and is based on an evaluation by minimum standards concerning quality of education, ethical business practices, health and safety, and fiscal responsibility.

American Red Cross Nurse Aide Training Programs are approved by the Tennessee Department of Health and that approval is required every 2 years based on an evaluation of minimum standards. American Red Cross Phlebotomy Technician, EKG Technician and Patient Care Technician training programs are nationally certified by the National Healthcareer Association.

NEW MISSION & VISION STATEMENT

The American Red Cross prevents and alleviates human suffering in the face of emergencies by mobilizing the power of volunteers and the generosity of donors.

Vision Statement

The American Red Cross, through its strong network of volunteers, donors and partners, is always there in times of need. We aspire to turn compassion into action so that...

...all people affected by disaster across the country and around the world receive care, shelter and hope; ...our communities are ready and prepared for disasters;

...everyone in our country has access to safe, lifesaving blood and blood products;

...all members of our armed services and their families find support and comfort whenever needed; and

...in an emergency, there are always trained individuals nearby, ready to use their Red Cross skills to save lives. Values

Along with the new mission and vision statements, we also want to lay out the values that are essential to our continued success: compassionate, collaborative, creative, credible and committed.

These values are not new to the Red Cross, but they gives us a common language and foundation to grow on. The values drive how we accomplish our goals and conduct ourselves to execute and achieve our Strategic Journey.

Compassionate: We are dedicated to improving the lives of those we serve and to treating each other with care and

respect.

Collaborative: We work together as One Red Cross family, in partnership with other organizations, and always embrace

diversity and inclusiveness.

Creative: We seek new ideas, are open to change and always look for better ways to serve those in need. Credible: We act with integrity, are transparent guardians of the public trust and honor our promises.

Committed: We hold ourselves accountable for defining and meeting clear objectives, delivering on our mission and carefully

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PURPOSE & LEARNING OBJECTIVES

The purpose of American Red Cross Nursing Education Training courses is to provide the information and skills that will enable graduates to provide quality and compassionate care in long-term care facilities,

hospitals, assisted living facilities, home health/hospice agencies, medical offices, and private duty agencies. With Red Cross training students master fundamental academic and social skills necessary to be successful in the healthcare industry. American Red Cross students not only excel academically, but also gain self-esteem and independence. And as an American Red Cross trained graduate, you‟ll be an important part of a health care team that works together to provide compassionate care for residents and patients in health care facilities. It‟s a job where you can make a difference.

The American Red Cross courses provide:  Hands-on, real life experience  Instructor attention

 Learning at a comfortable pace  Knowledge and confidence

 Skills to secure part-time or full-time employment

 Clinical rotation as a required component of each course  Prompt testing upon course completion

 Excellent pass rates for all programs  Assistance with job placement

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TRAINING PROGRAM OBJECTIVES NURSE ASSISTANT

 Student will recognize the importance of the nurse Assistant‟s role in improving the quality of life for people in the health care system

 Student will understand the importance of encouraging patients/residents to be as independent as possible

 Student will understand the importance of supporting and maintaining the rights of residents, clients and patients

 Student will learn and understand the importance of the healthcare worker‟s sensitivity to the physical and psychosocial needs of people in the health care system

 Student will understand the importance of clear and precise communication  Student will understand and apply basic Medical Ethics

 Student will understand and apply HIPAA guidelines

Students taking this 120 hour course will learn the basic principles of care, infection control and the

importance of maintaining HIPAA guidelines. After successful completion of this course the student is then eligible to sit for the Tennessee State Nurse Aide Examination. Tuition - 1250.00

PHLEBOTOMY TECHNICIAN-KNOXVILLE

 Student will understand basic medical laws relating to Phlebotomy  Student will understand the importance of medical ethics

 Student will understand quality control

 Student will develop an understanding of medical terminology and its use  Student will use and understand correct medical terminology

 Student will understand the importance of excellent customer service in the healthcare setting  Student will understand basic human anatomy and physiology

 Student will become proficient in blood drawing skills and specimen collection

 Student will learn procedures for transportation, handling and processing of specimens

 Student will learn how to prevent the spread of Bloodborne pathogens, and the importance of infection control

 Student will understand the importance of patient interaction  Student will pass the national certification exam

Students taking this 88 hour classroom course will learn basic anatomy and physiology, bloodborne

pathogen standards, infection control and technical blood drawing skills. After completion of the classroom portion of this course the student is assigned a clinical site and is required to complete a 40 hour clinical rotation. After completion of the rotation student is eligible to sit for the National Healthcareer Association Certified Phlebotomy Technician examination. Tuition - 1495.00

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EKG TECHNICIAN-KNOXVILLE

 Student will understand specific cardiac anatomy and normal cardiac function  Student will understand the importance of medical ethics

 Student will learn how to use diagnostic 6 and 12 lead EKG machines  Student will understand quality control

 Student will learn to recognize life threatening cardiac arrhythmias

 Student will develop an understanding of medical terminology and its use

 Student will understand the importance of excellent customer service in the healthcare setting

 Student will understand and use universal precautions to prevent the spread of bloodborne pathogens and to encourage infection control in the healthcare setting

 Student will pass National Certification Exam with an exam score of 70% or better

Students taking this 88 hour course will learn cardiac anatomy specific to the heart, medical ethics and medical terminology. After completion of the classroom portion of this course, the student is assigned a clinical site and is required to complete a 40 hour clinical rotation. After completion of the rotation the student is eligible to sit for the National Healthcareer Association Certified EKG Technician examination. Tuition - 995.00

PATIENT CARE TECHNICIAN-KNOXVILLE

Students who have a high school diploma or GED and hold a current CNA Certification, a current NHA Phlebotomy Technician Certification and a current NHA EKG Technician Certification are eligible to sit for the Patient Care Technician Certification exam. 200.00

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INSTRUCTIONAL METHODOLOGY

Students are assigned and expected to read the unit material that is being taught the next day. Instruction is given by lecture, discussion, demonstration and videos. At any time a student is free to ask questions to clarify information. At the end of the lecture/instruction or the next day, students are given a written test and if skills are included in the unit, each student must demonstrate mastery of that skill. Re-teaching takes place after the written test is checked and during skill demonstrations for mastery.

AUTHORIZATION

American Red Cross Training Programs are authorized by the Tennessee Higher Education Commission. This authorization must be renewed each year and is based on an evaluation by minimum standards concerning quality of education, ethical business practices, health and safety, and fiscal responsibility.

American Red Cross Nurse Aide Training Programs are approved by the Tennessee Department of Health. This approval is required every two years based on an evaluation of minimum standards.

American Red Cross Phlebotomy Technician, EKG Technician, and Patient Care Technician programs are approved by the National Healthcareer Association.

GRIEVANCE PROCEDURES

If any student feels that disciplinary action against them was unwarranted or the severity unfair, they must first appeal to the Instructor. If they are not satisfied with the response given them they may appealto the TN Territory Nurse Manager. The Nurse Manager can be contacted by calling 865-584-2999. If the student still feels that there is no resolution to the issue, they may contact the Institutional Director for further discussion. Any grievances that are not resolved on the institutional level may be forwarded to the Tennessee Higher Education Commission, Nashville TN 37243-0830 (615-741-5293)

BOARD OF DIRECTORS

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TENNESSEE TRAINING FACULTY Jim Johnson, Institutional Director-Knoxville

Joseph Simpson, Institutional Director-Nashville Melissa Brogger, RN, BSN, Lead Instructor – Knoxville

Samantha Stout, RN, Lead Instructor, Institutional Director - Maryville Holly Blankenship, RN, BSN, Instructor - Knoxville

Carol Cottick, RN, Instructor - Knoxville

Theresa Johnston, RN, BS Health Ed., Instructor - Knoxville Jamie Hornyak, LPN, Instructor – Nashville

Gail Bender, Admin. II, PHSS TN Territory

Kristine Navarro-Piekarski, Nurse Aide Training Coordinator, TN Territory Allison Flanary, Nurse Aide Training Coordinator, TN Territory

ADMISSION REQUIREMENTS

In order to be admitted to an American Red Cross course a student must:  be at least 18 years of age

 have a high school diploma or GED (for Phlebotomy, EKG or Patient Care Technician)  have an acceptable background check

 have proof of citizenship - current government issued photo ID

 have a social security card (if card is lost or misplaced, another one can be obtained by going to the nearest social security office and applying for a new card) The applicant will receive a letter with their full name and social security number, stating they have applied. That letter is acceptable to bring when applying for our programs.

 actively participate in an interview

 pass the entrance test - American Red Cross uses the Asset Testing Program and all potential students must achieve the following scores to be admitted into the program: The approved passing scores on this test are as follows: Reading (32), Writing (32), and Numerical (32).

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HOW TO APPLY

Interview sessions are conducted at the American Red Cross one or two days each week depending on the facility location. Applicants should be prepared to stay approximately 3.5 hours and all applicants must be prepared to take the ASSET entrance exam.

Prospective students are required to bring to the interview session: a completed application, a criminal

background check, their driver‟s license or a valid photo ID and their social security card. Students applying for Phlebotomy, EKG or Patient Care Technician are required to bring a high school diploma or GED to the

interview session.

Some offenses listed on the background check could prevent a student from gaining employment in the health care field and will also prevent enrollment in American Red Cross Nursing Education Programs. No student will be admitted with a felony conviction or with charges that are pending. Misdemeanor offenses such as theft, assault, and other offenses may also prevent the enrollment of a potential student. The American Red Cross reserves the right to deny enrollment to a student if, in its sole judgment, the charge would prevent a graduate from gaining a position in the health care industry.

COMPLETION REQUIREMENTS

 Attend and participate in all course sessions.

 Demonstrate competency in all required skills in the skills practice sessions and clinical practicum.  Participate in all skills sessions.

 Pass the final written exam and have an overall class average of 80 percent or better.  Pass the final exam with 80 percent or better.

 Complete the clinical component of the course. STUDENT CANNOT MISS ANY CLINICAL TIME.

CLASS SCHEDULE

PLEASE SEE SCHEDULE FOR COURSE DATES

CLASS HOLIDAYS

New Year‟s Day MLK

President‟s Day Memorial Day Independence Day Labor Day

Thanksgiving + day after Christmas

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FACILITY LOCATION AND DESCRIPTION Classroom Location: American Red Cross - Various Locations

Facility Description: Classes are held in the nursing laboratory and classroom. The lab is equipped with audio/visual equipment including projector, computer, DVD player and medical equipment including hospital beds, manikins, wheelchairs and various other items conducive to a hospital/nursing home setting.

EXPLANATION OF STUDENT PROGRESS & READMISSION

Due to the short nature of the course, student progress reports are made available to the student upon

request. If a student doesn‟t make satisfactory progress the instructor will individually meet with the student as soon as possible. The instructor will present the student with a written report stating the specific issues and what is needed to resolve them. Instructor will provide a copy to the student upon request at the time of the meeting.

A student that is unable to complete their course the first time, and withdrawing in good standing, can return within one year from their original start date to finish their specific course. If the student again withdraws, that student would be considered a new applicant. Student cannot transfer re-enrollment privilege to anyone for any reason.

JOB PLACEMENT ASSISTANCE

During the training program prospective employers will speak with the class to present employment

opportunities and answer students‟ questions. Prospective employers view this as an opportunity to recruit quality staff. In addition, the American Red Cross Nursing Staff proactively seeks employment opportunities for certified graduates.

CREDIT GRANTED

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Transferability of Credit Statement

Credits earned at the American Red Cross may not transfer to another

educational institution. Credits earned at another educational institution may

not be accepted by the American Red Cross. You should obtain

confirmation that the American Red Cross will accept any credits you have

earned at another educational institution before you execute an enrollment

contract or agreement. You should also contact any educational institutions

that you may want to transfer credits earned at the American Red Cross to

determine if such institutions will accept credits earned at the American Red

Cross prior to executing an enrollment contract or agreement. The ability to

transfer credits from the American Red Cross to another educational

institution may be very limited. Your credits may not transfer and you may

have to repeat courses previously taken at the American Red Cross if you

enroll in another educational institution. You should never assume that

credits will transfer to or from any educational institution. It is highly

recommended and you are advised to make certain that you know the

transfer or credit policy of the American Red Cross and of any other

educational institutions you may in the future want to transfer the credits

earned at the American Red Cross before you execute an enrollment

contract or agreement.

I have read and understand the above information.

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Pre-Enrollment Checklist

NOTE: To be filed once signed and dated.

Registration Date: ____________________

Name of School: American Red Cross

Name of Student: ____________________

Social Security Number: ____________________

Address: ____________________

City, State, Zip: ____________________

Telephone Number: ____________________

Name of program: (CIRCLE) NURSE ASSISTANT PHLEBOTOMY TECHNICIAN

EKG TECHNICIAN PATIENT CARE TECHNICIAN (TEST ONLY)

Please check mark below each section when completed

I HAVE/UNDERSTAND:

 Toured the institution

 Received an institutional catalog

 Been given the time and opportunity to review the institutional policies in this catalog

 The length of the program for full-time and part-time students in the academic and actual

calendar time

 Been informed of the total tuition and fee costs of the program

 Been informed of the estimated cost of books and any required equipment purchase such as

stenography machine, computer, specialized tools, are supplies, etc.

 Been given a copy of the institutional cancellation and refund policy

 What the term “transferability of credits” means and the specific limitations (if any) should the

institution have articulation agreements

 Been informed that any grievances not resolved on the institutional level may be forwarded to

the Tennessee Higher Education Commission, Nashville TN 37243-0830. (615)741-5293

Printed Name: __________________________________________________

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ENROLLMENT AGREEMENT

NURSING EDUCATION TRAINING PROGRAM

AMERICAN RED CROSS ADDRESS: ________________________________________________________ CITY, STATE AND ZIP:____________________________________________________________________

American Red Cross Training Programs meet all State and Federal requirements. This program is authorized by the Tennessee Higher Education Commission. This authorization must be renewed each year and is based on an evaluation by minimum standards concerning quality of education, ethical business practices, health and safety and fiscal responsibility.

American Red Cross courses are full-time. Through lecture, video, role-playing, and hands-on laboratory and clinical practice, students learn procedural skills such as bathing, dressing, positioning, and vital signs along with key communication techniques to provide compassionate care for people within the health care system. American Red Cross classrooms/labs are equipped with hospital beds and all necessary medical equipment to practice skills. After graduation, students are eligible to sit for their state/national exam for certification.

For the American Red Cross __________________________ Training Program, I have been informed that for the July 2011/June 2012 period, the withdrawal rate is ______%, the completion rate is _____%, and the in-field placement rate is _____%. Detailed statistical data for this program may be viewed by going to

http://state.tn.us/thec and clicking on the “Authorized Institutions Data” button.

The American Red Cross is committed to a policy of providing equal educational opportunities to all candidates regardless of economic or social status and does not discriminate on the basis of race, color, ethnic origin, national origin, creed, religion, political belief, sex, sexual orientation, marital status, or age.

Please complete the information below

Last Name: First Name: MI:

SSN: - - Phone:

Home Address: Apartment #:

City: State: Zip:

County:

Phone Number: □Home □Cell □Other

Email Address:

*Place of Employment:

*Address & Contact Information of Employer:

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Nurse Assistant Training Course: $1250

Tuition is due prior to the first day of class. We cannot accept cash or personal check as payment for this course, but do accept credit/debit cards, money orders, and cashier‟s checks. Money orders and cashier‟s checks should be made payable to: American Red Cross.

Tuition Includes:

 All classroom and clinical instruction  Textbook, workbook and class materials  Blood Pressure Cuff for classroom use  Stethoscope for classroom use

 American Red Cross CPR/Automated External Defibrillator (AED) Certification  American Red Cross First Aid Certification

 American Red Cross Nursing Assistant Pin upon Graduation  The initial state testing fee ($90)

Additional Costs (not included in tuition price)*

Scrubs $35.00

Clinical Shoes $50.00

Watch with a second hand $12.00

TB Skin Test $10.00

Physical Exams Varies

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Phlebotomy Technician Training: $1495.00 (Knoxville)

Tuition is due prior to the first day of class. American Red Cross cannot accept cash for this course but does accept credit/debit cards, money orders, or cashier‟s checks. Money order/cashier‟s check should be made payable to: American Red Cross.

NOTE: The prerequisite for this course is a current „hands on‟ certification such as CNA, MA, EMT, etc.

 All classroom and clinical instruction  Textbook, workbook and class materials

 American Red Cross CPR for the Professional Responder Certification  American Red Cross First Aid Certification

 Bloodborne Pathogen Certification

 American Red Cross Phlebotomy Pin upon Graduation  National testing fee-first time only

Additional Estimated Costs not included in tuition. This is only an estimate. Actual costs may vary.

Scrubs/Uniform $30.00

Student Liability Insurance $35.00 (approximate) *

*Note: Student should seek advice from Instructor regarding monetary coverage limits before purchasing.

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EKG Technician Training: $995.00 (Knoxville)

Tuition is due prior to the first day of class. American Red Cross cannot accept cash for this course but does accept credit/debit cards, money orders, or cashier‟s checks. Money orders/cashier‟s check should be made payable to: American Red Cross.

NOTE: The prerequisite for this course is a current „hands on‟ certification such as CNA, MA, EMT, etc.

 All classroom and clinical instruction  Textbook, workbook and class materials  Bloodborne Pathogen Certification

 American Red Cross CPR/Automated External Defibrillator (AED) Certification  American Red Cross First Aid Certification

 American Red Cross EKG Technician pin upon graduation  Initial national testing fee

Additional Estimated Costs not included in tuition. This is only an estimate. Actual costs may vary.

Scrubs/Uniform $30.00

Student Liability Insurance $35.00 (approximate)*

*Note: Student should seek advice from Instructor regarding monetary coverage limits before purchasing.

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Patient Care Technician $3200.00 Tuition Includes:

All classroom and clinical instruction for  Nurse Assistant course

 EKG Technician course

 Phlebotomy Technician course

 State/national examination (one time only) for all. (Multi Course Discount)

Tuition is due prior to the first day of class. American Red Cross cannot accept cash for this course but does accept credit/debit cards, money orders, or cashier‟s checks. This tuition reflects bundle discounts. Money orders/cashier‟s check should be made payable to: American Red Cross.

REFUND POLICY:

A full refund of all fees will be given if the classes are canceled or the student withdraws prior to the first day of class minus an administrative fee of one hundred dollars ($100.00)

A partial refund will be given as follows:

75% refund if a student withdraws within the first 10% of scheduled class hours minus an administrative fee of one hundred dollars ($100.00).

50% refund if the student withdraws within the first 20% of scheduled classes hours minus an administrative fee of ($100.00).

No refunds are permitted after the first 20% of scheduled class hours.

By signing below, you are verifying that you have received an exact signed copy of this enrollment agreement.

___________________________________________________________________________________

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American Red Cross

Student Information Sheet

Date: ______________ CIRCLE ONE:

NAT EKG PHLEBOTOMY PATIENT CARE TECHNICIAN-Test Mr. _____ Mrs. ___ Ms. ___

Last Name ____________________________ First Name ______________M.I. _____ SSN ______________-__________-_______________ Phone ___________________ Home Address ________________________________________ Apartment # _________ City _________________________________ State ______________ Zip ______________ County __________________________________

Phone Numbers:

Home: _________________________________________ Cell _______________________________________ Email Address ____________________________________

Note: The phone numbers and email address will be used to contact students while in the course (to send reminders, etc.) and after graduation (to forward job opportunities and track employment or continued education.)

In case of emergency, please contact: _______________________________

Phone _______________________________

Race: _____

A = African American C = Caucasian H = Hispanic O = Other

Sex: _____

Funded: Yes ____ No_____

If funded, what is the name of the agency? ________________________ Counselor name?___________________________

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STUDENT CODE OF CONDUCT

The American Red Cross endorses a safe, secure, and positive learning environment. To successfully achieve this standard, the following rules of conduct have been established:

 No Cell Phones or electronic devices are allowed in the building. The first violation will result in forfeiture of the device for the remainder of the day. The second violation will result in dismissal from the class. Each Instructor will provide the student with an emergency number so the student may be reached during class.

 Students will attend all classes on time. Students who are absent for more than one complete day of class time will be dropped from the course and will forfeit their payments to date.

 Students may not miss ANY clinical time.

 Students will be prepared for class with the appropriate materials and homework assignments completed. Students will not participate in cheating or plagiarizing.

 Students will be honest with all staff and students.

 Students will participate in positive group activities and will not be involved in any bullying, intimidating or harassing of staff or students.

 Students will show respect for others by not participating in teasing and ridiculing.  Students will wear clean, neat scrubs to class.

 Students will respect the personal property of others and the property of the American Red Cross.

 Students are responsible for chapter textbooks, reference books, name tags, or equipment loaned to, or used by them. If misused or damaged, students will be responsible for charges to repair or replace. If repayment is not received, students will not be able to test for certification, and will forfeit their payments to date.

 Students must respect classmates, program guests, volunteer staff, etc. that choose to volunteer as patients. Students also agree that information entrusted to them by anyone on American Red Cross property or as a representative of the American Red Cross, will be treated with the utmost confidentiality and will not be discussed outside the Red Cross classroom setting.

 Students will respect and follow direction from all staff of the chapter. Students are expected to treat the instructor, staff and fellow students with respect at all times.

 Students will respect the safety of others by not bringing real or imitation weapons to the chapter.

 The American Red Cross has a zero tolerance policy for any student involved in or encouraging the involvement of another student in fighting or use of other physical force.

 American Red Cross forbids smoking in areas other than designated smoking areas.

 Neither alcohol nor illegal drugs are permitted. Students may not be under the influence of illegal drugs or alcohol at any time while on American Red Cross property, at a clinical site assigned to them or while representing the American Red Cross in any capacity. Any student observed to be displaying behavior which is observed to be decidedly different from behavior normally displayed by that student may be required to submit the appropriate specimen (urine or blood) for laboratory testing.

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 Any student arrested, or found to be in violation of any law while enrolled must submit a hand written explanation of the incident to their Instructor within 48 hours of the incident. Disciplinary action may be taken. Students not submitting a written explanation or submitting a dishonest explanation of the incident will be immediately dismissed from the program and will not be allowed to return.

 All students will be issued an American Red Cross identification badge. Students must never allow anyone else to use their badge under any circumstances, and are responsible for its use/misuse. Students must wear their badge when in the building. Student must turn in their badge at graduation in order to receive diploma and be registered for state testing.

 FOR YOUR PROTECTION AND THE PROTECTION OF YOUR CLASSMATES: Video cameras may be installed in common areas of the American Red Cross building. Unregistered guests/guests without ID badges are not allowed at any time, and anyone requesting to see a student during school hours must check in with receptionist and receptionist will call the student to speak with the guest. For safety reasons, this is a chapter policy adhered to by all chapter staff and volunteers as well, and is expected to be adhered to by all visitors of the chapter.

CONSEQUENCES OF UNACCEPTABLE BEHAVIOR

Unacceptable behavior and violation of the Code of Conduct could result in dismissal from classes for the day or from the program. The decision of the Instructor/ Nurse Manager/Institutional Director shall be final. The instructor will provide to the student within one (1) week of any such dismissal a written statement for the reasons for the dismissal. Refer to the refund policy for a refund of funds, if applicable.

I agree to comply with all rules, and understand the consequences of non-compliance.

Student Name:__________________________________________________________________

Student Signature:________________________________________________________________ Date of Signature:_________________________________________________________________

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CLINICAL RULES

1. Attendance is mandatory the week of your clinical rotation. There will not be an opportunity to make up a clinical day with your class.

2. Arrive at the clinical site by 7:15am. We will meet at the spot assigned in your clinical packet. If you are more than 15 minutes late, you will not be allowed to participate.

3. Your instructor will assign you to a unit, then to a preceptor. YOU ARE A GUEST IN THESE FACILITIES. Your preceptor may do things differently than you learned them. Do not be disrespectful, but please note that your clinical grade is contingent upon your skill performance.

4. Stay on the unit you are assigned to. You must never leave your unit to find another classmate without the permission of your instructor. You may not leave the facility for lunch.

5. If the site permits smoking, an instructor will share the location of a designated site.

6. NO LONG FINGERNAILS OR COLORED NAIL POLISH

7. NO PERFUME

8. No jewelry except your wedding ring. A watch with a second hand is required. No visible body jewelry i.e.: tongue rings, earrings, etc. are allowed and students having these piercings must remove them.

9. Hair must be worn pulled up, if longer than the collar.

10. Uniform scrubs must be white. Underclothing must be fleshtone or white. No designs or print of any kind.

11. Shoes must be solid and completely encompass the foot. 12. Name badges must be worn at all times.

13. DO NOT DISCUSS PATIENTS IN THE UNIT. HIPAA is a federal law and you are personally, legally accountable for violation of others’ rights.

14. NO CELL PHONES. HIPAA is a federal law and you are personally , legally accountable for violation of others’ rights.

15. You may not leave the clinical site for any reason until you are dismissed. You may want to bring money for vending machines and do not assume that someone will be able to make change. If you leave a clinical site without permission from your instructor, you will be terminated from the program.

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16. Transportation to the clinical site is the responsibility of each student.

17. Classes (depending on size) may be divided into smaller groups and be assigned to different facilities on different days. It is not acceptable to switch assignments with another student.

18. Students are expected to be prepared to perform any Nurse Assistant skills required in the clinical setting.

19. Falsification of documentation or falsification of patient care is grounds for IMMEDIATE DISMISSAL from this program.

I agree to comply with all rules, and understand the consequences of non-compliance.

Student Name:__________________________________________________________________

Student Signature:________________________________________________________________

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UNDERSTANDING OF CLASS SKILL PARTICIPATION

I understand that as a student I must participate in skills. In some instances (such as Phlebotomy and EKG Technician courses) I understand that I may participate in a skill that would require that I remove an article of clothing. It is the practice of American Red Cross that students are paired with same sex partners for skill practice. I understand that American Red Cross instructors take every precaution to ensure that privacy is respected, but I do understand that clinical participation is required for this course. I also understand that by performing a clinical skill on my partner, I will be collecting HIPAA protected information and I am bound by federal law to protect this information. I agree only to share this information with the participant and my instructor.

Printed Name: ________________________________________

Signature:____________________________________________

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25 Init._______

STATEMENT OF CONFIDENTIALITY

It is the responsibility of you, as an American Red Cross representative, to preserve confidential Red Cross information.

It is also your responsibility as a healthcare worker to preserve and protect confidential patient care. The federal Health Insurance Portability Accountability Act (HIPAA) establishes protections to preserve the confidentiality of various medical and personal information and specify that such information may not be disclosed except as authorized by law or the patient or individual.

Confidential Information includes:

Physical medical and psychiatric information including paper, photo, video, diagnostic and therapeutic reports, laboratory and pathology samples;

Personal information such as financial or family information;

Visual observation of patients receiving medical care or accessing services; and

Information provided by or about the American Red Cross, an individual employee, a volunteer or a classmate.

Confidential Patient Care Information includes: Any individually identifiable information in possession or

derived from a provider of health care regarding a patient's medical history, mental, or physical condition or treatment, as well as the patients and/or their family members records, test results, conversations, research records and financial information (Note: this information is defined in the Privacy Rule as “protected health information.”) Examples include, but are not limited to:

Physical medical and psychiatric records including paper, photo, video, diagnostic and therapeutic reports, laboratory and pathology samples;

Patient insurance and billing records;

Visual observation of patients receiving medical care or accessing services; and Verbal information provided by or about a patient;

Confidentiality also applies to the clinical facility, with the exception of abuse, neglect or exploitation reporting purposes, and only to the appropriate authorities

I understand and acknowledge that:

1.

I shall respect and maintain the confidentiality of all discussions, patient care records and any other information generated in connection with individual patient care, risk management and/or peer review activities.

2.

It is my legal and ethical responsibility to protect the privacy, confidentiality and security of all confidential information relating to a patient directly or indirectly in my care.

3.

I shall only access or disseminate patient care information in the performance of my assigned duties and where required by or permitted by law, and in a manner which is consistent with HIPPA regulations. I shall make no voluntary disclosure of any discussion, patient care records or any other patient care, except to persons authorized to receive it in the performance of my assigned duties.

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26 Init._______

4.

I agree to discuss confidential information only in the work place and only for job related purposes and to not discuss such information outside of the work place or within hearing of other people who do not have a need to know about the information.

5.

I understand that the law specially protects psychiatric and drug abuse records, and that unauthorized release of such information may make me subject to legal and/or disciplinary action.

6.

My obligation to safeguard patient confidentiality continues indefinitely, even after my Red Cross educational obligation has ended.

7.

I agree to maintain the confidentiality of the American Red Cross, its clinical partners, its employees, volunteers and my classmates, indefinitely.

I hereby acknowledge that I have read and understand the foregoing information and that my signature below signifies my agreement to comply with the above terms. In the event of a breach or threatened breach of the Confidentiality Agreement, I acknowledge that the American Red Cross or its clinical affiliates may, as applicable and as deemed appropriate, pursue disciplinary action.

Dated: ___________ Signature: _______________________________________

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27 Init._______

HEPATITIS B VACCINATION ADVISORY/DECLINATION

OCCUPATIONAL EXPOSURE TO BLOOD OR OTHER POTENTIALLY

INFECTIOUS MATERIAL COULD PUT YOU AT RISK OF ACQUIRING

HEPATITIS B VIRUS (HBV) INFECTION. WE STRONGLY ENCOURAGE

ALL STUDENTS TO RECEIVE THE HEPATITIS B VACCINATION

SERIES. LAW DOES NOT REQUIRE THAT STUDENTS RECEIVE THIS

VACCINATION FOR ENROLLMENT, AND THEREFORE WOULD BE AT

THE STUDENT‟S EXPENSE. STUDENTS CHOOSING NOT TO HAVE

THIS VACCINATION SERIES ARE AT RISK OF ACQUIRING HEPATITIS

B WHICH IS A SERIOUS AND POTENTIALLY LIFE THREATENING

ILLNESS.

___________I certify by initialing, that I have read this information and I

have received the complete three dose series of the Hepatitis B vaccine

series.

___________I certify by initialing, that I have read this information and I am

in the process of receiving the complete three dose series of the Hepatitis B

vaccine series.

___________I certify by initialing, that I have read this information and

choose not to have the vaccine at this time.

PRINTED NAME:______________________________________

STUDENT SIGNATURE:________________________________

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28 Init._______

HEALTH EVALUATION FORM (Health History)

Name ________________________________ Age______ Birth date____________ Gender __________ Address _______________________________________________________________________________ Home Phone & Cell Phone _______________________________________________________________ In case of emergency, notify:_______________________________________________________________ Relationship:___________________________________________________________________________ Address:_______________________________________________________________________________ Telephone Numbers: _____________________________________________________________________ MY HOSPITAL OF CHOICE (WHEN POSSIBLE) IS: ___________________________________________

PERSONAL HISTORY - Please answer all questions. Leave no blank spaces.

Childhood diseases (including chickenpox)_______________________________________________________________

Do you have any allergies? If yes, please list___________________________________________________________ Anaphylactic Allergies? ___________ IF YES, DO YOU CARRY AN EPI PEN? ______________________________

Significant medical conditions (dates and diagnoses)_______________________________________________________ Recent Hospitalizations? (within the last year)____________________________________________________________ Current medications ________________________________________________________________________________ Physician‟s Name and Telephone Number: ______________________________________________________________

Are you currently under a physicians care for any reason? (If yes, please explain)

_________________________________________________________________________________________________ Females: Are you currently pregnant? YES or NO

Check boxes to indicate whether you have (or had in the past) these problems. Provide details of positive answers below.

Yes No Yes No Yes No Yes No

Allergies Diabetes Migraine Tuberculosis

Anemia Hearing Impairment Pneumonia Visual Impairment Asthma Heart Disease Psychological Substance abuse Bleeding Disorder Hepatitis Lung Disease Alcohol abuse

Cancer High blood Pressure Smoker Thyroid disorder

Eating Disorder HIV/ AIDS Seizure Disorder Other

If you answered “yes” to any of the above questions, please provide details here:

_________________________________________________________________________________________________ _________________________________________________________________________________________________

FAMILY HISTORY – Check if condition exists in your immediate family

_______ Allergies ________ Cancer _______ High Blood Pressure _______ Sudden death Family history of sudden _______ Anemia ________ Diabetes _______ Lung disease _______ Tuberculosis death before age 50 _______ Asthma ________ Eye disorders _______ Psychiatric disorders _______ Ulcer Yes______ No ______

_______ Bleeding disorders ________ Heart disease _______ Stroke _______ Other

I UNDERSTAND THAT THIS FORM MAY BE GIVEN TO EMERGENCY PERSONNEL IN THE EVENT OF MY ILLNESS, AND I AGREE THAT THE INFORMATION SHARED IN THIS DOCUMENT MAY BE RELEASED FOR THAT PURPOSE.

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“It irritates me to be told how things have always been done. I defy the tyranny of precedent. I go for anything new that might improve the past.” Clara Barton 29 Init._______ TB Screening Name: ________________________________________ SS#: _________________________ III. TUBERCULOSIS SCREENING

Required Tuberculosis Testing —

PPD required unless medically contraindicated or BCG vaccine has been given

1. PPD (Mantoux) within the past 12 months

Date given: ____/_____/_____ Lot # ________ Expiration Date __________ Administered by: _____________________________________

Site of injection ______________________________ Date Read:_____/_____/_____

Result: Negative ____ Positive ____ Actual mm in duration (horizontal diameter) ____ Checked by:____________________________________________

2. Chest X-ray required within the past 12 months if PPD is positive, PPD is contraindicated, or BCG vaccine has been given.

Date of Chest X-ray: ____ / ____ (Please include copy of X-ray report) 3. Received BCG/vaccine: Yes ____ No ____ Date_____/______

Signature ________________________________________________________ Date _________________ (Signature of medical practitioner required)

Printed Name ___________________________________ Telephone Number_(____)_________________

_________________________________________________________________________________________________

Physical

TO THE LICENSED HEALTH PROFESSIONAL (D.O., M.D., P.A., N.P.) PERFORMING THIS EVALUATION: Please review the student's written health history provided, and provide details as needed. This potential student is enrolled in a nursing and health education program at the American Red Cross and will be engaged in work that involves lifting and standing on a regular basis. If a potential student is pregnant, an OB/GYN must fill out this form.

Please complete the following:

Name_______________________________________________ SS#______________________________ Height:_________ inches Weight _________lbs. BP___________ Pulse_________ Temp_________ HISTORY, REMARKS or RECOMMENDATIONS: Are there any conditions of which we should be aware?

___________________________________________________________________________________________________________

❑ This candidate is found physically fit with no restrictions.

❑ This candidate is found physically fit with the following restrictions: ___________________________________________________ PRACTITIONER‟S SIGNATURE ___________________________________DATE___________________

PRINT ADDRESS_______________________________________________________________________ PRINT NAME _____________________________________________PHONE (_____)________________

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30 Init._______

Student Release of Information

I give my permission for the American Red Cross Nursing Education Training staff to release information in any form to my sponsoring agency, employer or potential employer regarding my American Red Cross class attendance, attitude, behavior, work habits and grades. I release American Red Cross and its employees from any liability for this release of information.

Printed Name:______________________________________________________

Signature:_________________________________________________________

Date:____________________________________________________________

This release is not intended to meet federal guidelines for the release of medical information. Students needing copies of their HIPPA protected documents (Physical, TB Test, etc) may get copies by coming by the chapter and requesting copies in person or by emailing/mailing a request to their chapter

address listed on the front of this catalog. That request should have the student’s full name, the last four digits of the student’s social security number, student signature and the printed address where the record should be sent.

The request must be specific. Ie: Please send the results of my TB test and my physical to the printed

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31 Init._______

Media Release

________________I give to the American Red Cross, its agents, designees and assigns, unlimited permission to use, publish and republish in any form or media, information about me and reproductions of my likeness (photographic or otherwise) and my voice, with or without identification of me by name.

________________I do not give to the American Red Cross, its agents, designees and assigns, unlimited permission to use, publish and republish in any form or media, information about me and reproductions of my

likeness (photographic or otherwise) and my voice, with or without identification of me by name. I understand that American Red Cross personnel will not take my photo for any reason, and I will not be in class photos.

NAME:_____________________________________________________________

SIGNATURE:_________________________________________________________

Nursing Education Training Programs Institutional Catalog