ACADEMIC STANDARDS and POLICIES

The following are policies for College of the Redwoods LVN and RN students.  These policies apply to all students in every semester of the two nursing programs.  In addition further directives may be instituted by individual clinical agency policies.

Clinical Practice Policies

Clinical rotations are planned by the faculty to best meet student learning needs. Therefore special consideration cannot be given to meet student preferences. Clinical rotations will be scheduled throughout the week (weekends included) and may occur at any time during the 24 hour day in locations that may extend outside of Humboldt /Del Norte counties.

Nursing students must be fully prepared to provide care in the clinical setting.  Preparation includes but is not limited to: thorough understanding of the client(s) condition, diagnostic and treatment plan, medications, and nursing care needs.  In addition students must complete required nursing skill lab competencies for specific interventions.  Students participate in the delivery of client care in collaboration with the nursing faculty and nursing staff at the clinical facility.

The following procedure policies will guide you in your clinical practice.

A.  Procedure Policy

1. All clinical procedures must be performed safely and according to standardized practice as described in clinical facility policy and procedure manuals and/or published procedure textbooks. 
2. All clinical procedures will be performed in compliance with student's scope of practice as outlined in the appropriate State of California’s Nurse Practice Acts (RN and/or LVN).
3. All procedures performed by a student in the clinical setting for the first time must be supervised by a licensed person (preferably by the clinical instructor).
4. Removal of sutures, skin clips, vaginal packing, and Penrose drains must be performed under the direct supervision of the instructor (or licensed person with the consent of instructor).
5. When caring for a deceased client, equipment must not be discontinued/ removed from a patient until pronounced dead by the physician, and the instructor has authorized the student to proceed.

B.  Consents/Physicians' Orders

1. LVN/RN students are not to witness or sign consents or wills of any nature.
2. RN students are not to take verbal or telephone physicians' orders unless witnessed and co-signed by a licensed staff nurse.
3. RN students are not to transcribe written physicians' orders unless witnessed and co-signed by a licensed staff nurse.
4. LVN students are not to transcribe written physicians' orders.
5. LVN students are not to take any verbal or telephone orders.

C.  Administration of Medications

1.      General Policies for Medication Administration

a. Initially, all medication administration will be supervised by the instructor, or with the consent of the instructor, by the staff RN. As students achieve competency in medication administration, clinical faculty will determine the degree of faculty collaboration and consultation for specific medications.

b.         Students are expected to:

1. Practice the "Five Rights' of medication administration.
2. Implement appropriate nursing actions for administered medications.
3. Make ongoing assessments of client pertinent to medication before, during and after administration (client observations, pain scale, vital signs, and lab reports).
4. Document all administered medications on appropriate client records (MAR, Flow Sheets, narcotic record, etc.) according to clinical facility policy.
5. Use filter needles for all medications drawn from ampoules.
6. Use "Z” track technique of medication administration for irritating parenteral meds (such as: oil-based delestrogen); using procedure prescribed by the clinical facility and/or published skills procedure resource.
7. Waste controlled substances only with instructor and RN witness who co-signs narcotic record.
8. Give IM medications to clients under the age of six in the vastus lateralis only.
9. Give heparin and insulin only when prepared medication has been checked by two licensed nurses (one of whom may be the instructor).
10. 10) Adhere to clinical facility policies when administering insulin, heparin, or other specially designated medications.

c.  Students may NOT:      

1. Carry narcotics keys or be responsible for change of shift narcotics count.  (N-24 Geriatric/Leadership experience may be different with the instructor’s individual approval.)
2. Administer Inferon.
3. Give Bolus or “Push” IVP meds to pediatric, newborn, and/or laboring clients.
4. Administer IV cancer chemotherapeutic agents.
5. Change or add medication to PCA pumps.
6. Prepare and/or administer emergency medications, such as: lidocaine, dopamine, Nipride, etc)
   
   

2.  Specific Policies for Intravenous Medication Administration

a.      All IV medications must be prepared and administered under the DIRECT supervision of the clinical instructor.

b.     LVN students are limited to the following activities related to IV therapy:

1)     Count drip rates, observe IV pumps, and report findings (cannot adjust rates).

2)     Observe IV sites and report findings (cannot remove or change dressings).

3)     Gather subjective data from the patient and report findings

c.  In addition to the activities listed above, RN students MAY:

4)     Superimpose IV solutions. 

5)     Flush IV lines with saline according to agency policy.

6)     Change dressings on peripheral lines.

7)     Change dressings and discontinue central lines as permitted by the facility, and after successfully completing the Nurs 53 central line skills competencies.

8)     After successfully completing the Nurs11 IV piggyback (IVPB) competencies, and with the clinical instructor or with the consent of the clinical instructor under the direct supervision of the staff registered nurse, administer any routine IVPB medication that the client has previously received.

9)     May, after successfully completing the Nurs 11 IV push (IVP) competencies, and with the clinical instructor, or the consent of the clinical instructor under the direct supervision of the staff registered nurse, administer the following IV push medications:

a.      Any routine IVP pain management medication that the client has previously received

b.      Any other routine IVP medication that the client has previously received such as IVP Lasix

7)     Hang blood and blood products after successfully completing the Nurs 53 blood products skills competencies.

 8)  Perform Venipuncture following these guidelines: 

a.      Students will be directly supervised by the clinical instructor or the assigned staff nurse with the instructor’s permission.

b.      Students have discussed the procedure with their clinical instructor prior to initiating the procedure. 

c.      Students have received instruction on Venipuncture in Nurs 53 – IV Pharmacology Skills. 

d.      Students have successfully passed a Venipuncture Skills Performance Evaluation in Nurs 53 on training manikins.

9)   May administer TPN and interlipids, after successfully completing Nurs 53 IV competencies, and with the clinical instructor, or the consent of the clinical instructor under the direct supervision of the staff registered nurse,

10)  Monitor and document PCA and epidural client response.

d.  Administration of Blood and Blood Products

1. Blood and blood products may be administered by RN students only under direct supervision of instructor.
2. Blood products will be, double-checked by instructor, students and staff nurse prior to Administration. Students will administer blood and blood products according to hospital policy.
3. Prior to initiating blood transfusion, students will obtain baseline vital signs and record data appropriately.
4. Students will make ongoing assessments during transfusion as required by hospital policy.

D.        Specialty Areas

1. Pediatrics:
   1. All medications must be prepared and administered under the direct supervision of the instructor, or with the consent of the instructor by the staff RN..
   2. IM medications to patients under the age of six will be administered only in the vastus lateralis.
   3. Students may not give IV push meds on pediatric clients.
   4. Side rails, crib covers, and infant/toddler restraints will be properly utilized at all times to prevent falls on all children under six.
2. Obstetrics:
   1. All medication administration will be supervised by the instructor, or with the consent of the instructor, by the staff RN.
   2. All IV medications must be prepared and administered under the DIRECT supervision of the clinical instructor; however, students may NOT give IV push meds on newborn, and/or laboring clients, nor give critical IV medications, such as Pitocin and Magnesium Sulfate to laboring or recovering post-partal clients.  However, students are encouraged to observe staff nurses and/or their nursing instructors in the preparation and administration of these critical IV medications to enhance their learning process.
   3. Students must have the DIRECT supervision of the clinical instructor and/or Staff RN with instructor’s permission to perform procedures (e.g., administer medications, gavage feedings, etc.) on newborn infants in the nursery.
   4. Students are not allowed to perform vaginal exams; students should consult with instructor prior to doing PKU testing.
   5. Students may care for pre-term infants under the DIRECT supervision of the assigned staff nurse.
   6. Students may do initial newborn admission assessments and provide care under DIRECT supervision of instructor.                 
3. 3.  Critical/Intensive Care Units/Telemetry/Short Stay Surgery or Emergency Department:
   1. Students will be assigned clients on a daily basis.  Students are to provide care to the assigned patients under the direct supervision of the staff nurse.
   2. Students must receive the consent of the clinical instructor, prior to performing any invasive procedures.  Once permission has been granted, students may perform the identified procedure under the direct supervision of the staff nurse and in accordance with the program and hospital policies.
   3. Students are not to administer any medications without the consent of the clinical instructor and under the direct supervision of the staff nurse or clinical instructor. 
   4. All medication administration must follow the ADN program and hospital’s policies.
   5. Students may, after successfully completing Nurs 11 and Nurs 53, with the consent of the clinical instructor and under the direct supervision of the staff nurse, administer the following IV medications:
      1. Any routine IV antibiotic therapy that the client has previously received
      2. Any routine IV pain management medication that the client has previously received
      3. Any other routine IV medication that the client has previously received such as IV Pepcid
   6. Students may NOT perform the following:
      1. Administer any IV chemotherapeutic agents
      2. Prepare and/or administer emergency medications (e.g. dopamine, lidocaine, etc.)
      3. Prepare and/or administer IV narcotics through PCA or epidural infusion

All policies listed in this Handbook are subject to change in the event of extenuating circumstances and or revision; please consult the department web page for the most current policies.  Students will be notified of changes in policies that occur during the academic year.