Nursing Student Guide and Policies

This policy ensures that undergraduate students fulfill their clinical responsibilities
with professionalism, accountability, and respect for the learning environment.

Compliance and Consequences

Non-compliance with this policy may result in disciplinary action, including but not limited to warnings, probation, or dismissal from the clinical program. Any deviation from this policy requires approval from the appropriate clinical instructor or program director.

Clinical Schedule:

• Student clinical schedules will be developed in conjunction with the clinical instructor.
• The student will maintain the developed clinical schedule as written without changes. Any changes needed will require a request to the Clinical Instructor before that scheduled clinical.

Attendance and Punctuality:

• Each student is responsible for being present and punctual during all clinical
  activities. The student is expected to work the entire shift which includes being on time and present for the oncoming and off-going nursing reports.
• If a student cannot attend a clinical activity as assigned due to illness or
  emergency, it is their responsibility to promptly notify the faculty/preceptor
  before the assigned shift and work with them to achieve the objectives of the missed clinical experience.

Early Dismissal:

• Students will not be excused early from clinicals unless in cases of
  emergency or extenuating circumstances with prior approval from the clinical instructor.
• Leaving clinicals early without proper notification of the clinical instructor will not be tolerated and may result in clinical failure.

(Revised 5/2024)

1. All clinical sites and preceptors must be approved prior to the start of the semester with the clinical coordinator.
2. The MSN orientation is located online in the MiSsioN Possible Canvas site. Students are required to complete the online orientation prior to their first course.

(Revised 6/12/2022)

Clinical facilities:
Undergraduate students: Students can expect to be placed in various facilities based on their clinical course objectives. Faculty assign clinical placements.

Graduate students: Students can expect to be placed in various facilities during their enrollment in the program. Graduate students choose clinical sites with their instructor's approval in various settings designed to facilitate meeting their clinical objectives

Transportation:
Students are responsible for their transportation to clinical sites. Students are not to transport patients in their own vehicles. This protects both the student and the patient. When a patient
needs transportation for health purposes, there are volunteers and agencies that provide this service. The faculty may be contacted for further information.

(Revised 11/3/2023)

Undergraduate: Level I students are assigned to one clinical instructor (semester 1 of the nursing program) clinicals. Levels 2-4, students are assigned to a clinical instructor and their
clinical assignments are delivered in a precepted model. Clinical preceptors are registered nurses who work at facilities affiliated with the SON (clinical partners). Preceptors have been oriented to the preceptor role and have agreed to precept nursing students. 

Graduate students: Students can expect to be placed in various facilities during their enrollment in the program. Graduate students choose clinical sites with their instructor's approval in various settings designed to facilitate meeting their clinical objectives. Graduate students will be under the direct supervision of clinical preceptors. Graduate clinical preceptors
are advanced practice registered nurses that have been oriented to the preceptor role and have agreed to precept nursing students. 

(Revised 11/3/2023)

As members of the health care team, students are required to follow the established Center for Disease Control (CDC) guidelines for healthcare-associated infections. Following these procedures will facilitate the prevention of exposure to potential infections.

Current guidelines and recommendations for environmental infection control, hand hygiene, immunizations, infectious diseases, isolation precautions, nosocomial infections, etc., are found on the CDC website.

All students are required to be familiar with the information found on the CDC website.

(Revised 11/3/2023)

All students utilizing the School of Nursing (SON) Skills Labs must complete bloodborne pathogen (BBP) training offered by the UT Tyler Environmental Health & Safety (EH & S) Department.

Each semester the names of students enrolled in courses utilizing the skills labs will be submitted to EH & S, who will monitor compliance with the training.

UT Tyler's exposure control plan for BBP is located here.

(Revised 11/3/2023)

1. Health care personnel must wear the appropriate personal protective equipment at all times. 

2. Health care personnel entering a negative pressure room or caring for someone requiring airborne precautions must wear a NIOSH-approved N-95 or higher-level respirator.

3. All N-95 respirators require individuals to undergo fit testing.

4. Each campus has designated individuals trained to conduct N-95 fit testing for students and faculty as needed.

5. Students and faculty may only use the N-95 mask(s) they have been fit tested for and “passed.” 

6. Any student or faculty unable to pass the fit testing with an N-95 mask is not allowed to accept an assignment nor assist with caring for any person on airborne precautions.

7. If a staff member has a question about a clinical assignment, they should be referred to the clinical faculty member.

(Revised 11/3/2023)

Guidelines: Following a contaminated Needle Stick or Hazardous Exposure to Blood, Blood Products, or Body Fluids while in Clinical Learning Experiences, including the Simulation Labs. 

The faculty of The University of Texas at Tyler School of Nursing (SON) endorses the following “Guidelines Following a contaminated Needle Stick or Hazardous Exposure to Blood, Blood Products, or Body Fluids while in Clinical Learning Experiences.” 

Clinical learning sites include hospitals, clinics, physicians’ offices, patients’ homes, schools, skills labs, and other settings where students may learn and apply nursing care/skills. 

All students are responsible for obtaining their own health insurance and are responsible for the costs of medical/health care assessment, treatment, and follow-up that are not covered by the student’s health insurance. Students should be aware of the coverage on their health insurance policy, as most may not cover the total cost of required medical treatment and services in the case of a needle stick or hazardous exposure to blood or blood products. 

Students exposed to needle sticks or potentially infectious blood or blood products, or body fluids should be evaluated and have treatment initiated within 2 hours according to established criteria that conform to federal and state law and Center for Disease Control (CDC) standards. The treatment/management guidelines are as follows: 

1. Wash human bites with soap and water. 
2. Wash needlesticks and cuts with soap and water. 
3. Flush splashes to nose, mouth, or skin with water.
4. Irrigate eyes with clean water, saline, or sterile wash. 

Source

Treatment/Management Guidelines

Immediately upon receiving a contaminated needle stick or exposure to blood, blood products, or body fluids, the student will:

1. Report the incident to the clinical faculty member/preceptor and the appropriate person in the clinical agency.
2. Complete the appropriate institutional incident report, plus complete the SON Clinical Incident Report Form attached to this policy. This form is to be completed for incidents in the Simulation Lab as well. The SON Clinical Incident Report Form is for the SON and is not to be given to the Clinical Facility (you will need to complete both forms.)
3. Follow institutional protocols regarding wound care and reporting procedures. Clinical faculty should be notified as soon as reasonably possible.
4. Seek treatment intervention from the Campus Health Center, the clinical facility where the incident occurred, or a private health care provider within 2 hours of the exposure incident.

Based on the information provided to the health care provider, baseline lab values and chemoprophylaxis may be ordered. In responding to an incident in which a student experiences a contaminated needle stick or exposure to blood, blood products, or body fluids, the clinical
faculty will:

1. Verify that appropriate wound care has been initiated. 
2. Counsel the student to seek follow-up care at the Campus Health Center or his/her private health care provider.
3. Advise the student to consult the Campus Health Center’s Treatment Protocol (available in the Campus Health Center) or the CDC for follow-up on contaminated needle sticks or
   exposures to blood, blood products, or body fluids should he/she choose to seek a private health care provider. 
4. Assist the student in completing any administrative paperwork that may be required.
5. Upload completed SON Clinical Incident Report Form to EAB.

(Revised 11/3/2023)

1. Wash human bites with soap and water.
2. Wash needlesticks and cuts with soap and water.
3. Flush splashes to nose, mouth, or skin with water.
4. Irrigate eyes with clean water, saline, or sterile wash.

Source

(Revised 6/12/2022)

Students may only access narcotics for patient use with a licensed nurse. At no time shall a student possess the narcotic keys or access to the narcotic cabinet unsupervised by a licensed nurse. Student signatures must always be co-signed with a licensed nurse when signing for narcotics.

(Revised 6/12/2022)

Persons Involved: UT Tyler School of Nursing (SON) BSN Students and Faculty
Purpose: To define the methodology used to calculate hours spent in clinical experiences Definition: Clinical hours – actual hours of practice and approved clinical learning experiences
Policy:

1. Clinical practice hours include actual hours of practice in nursing skills and computer laboratories, simulated clinical experiences, faculty-supervised hands-on clinical care, clinical conferences, and observational experiences (Texas BON rules 214.9 and 215.9). 
2. Clinical hours for each course are outlined in the course learning management system. The faculty are responsible for determining the number of hours per shift (e.g.,12-hour shifts) and clinical experiences needed to attain the required total clinical hours for the course.
3. In the hospital setting, daily clinical hour calculation begins no more than 15 minutes before the start of the shift unless authorized by clinical faculty. Time spent managing patients after the expected end of shift is included in the daily total clinical hours. 
4. Lunch breaks are not included in the calculation of clinical hours.
5. Students are responsible for maintaining a log of clinical hours for each course to include time in, time out, and time off the clinical setting for lunch. Clinical conferences, simulations, and other faculty-approved observational experiences should be noted on the Clinical Log. 

(Revised 6/12/2022)

The purpose of this policy is to establish guidelines as to what skills students are and are not allowed to perform in the clinical setting (also referred to do as “dos and don’ts”). The guidelines are based on the Texas Board of Nursing (BON) rules and a review of student nurse policies from hospital clinical facilities used for clinical rotations. The BON states that nursing students can perform “tasks for which he/she has been prepared in the education program” but must also “comply with any limitations placed on student participation in specific clinical areas that may be part of the contractual agreement between the nursing program and the clinical affiliating agency”.

The scope of practice is standardized to ensure consistency across all clinical facilities while ensuring students adhere to the policies of the various clinical facilities. This policy establishes if any one of our clinical partners will not allow students to perform a specific skill in the clinical setting, it is not permitted at any clinical facility.

1.1 Student Nurse Allowed Skills (Dos)

Students are only allowed to perform skills/procedures in the clinical setting that they have received training to perform. However, some skills nursing students are trained to perform are not allowed during clinicals (see Not Allowed Skills).

Examples of allowed skills students may perform independently (provided the student has been checked off as competent in the skill) include:

• Document in the medical record: shift assessments, vital signs, I&O, etc. (preceptor to co-sign as
  appropriate based on facility requirements)
• Care/discontinuation of Foley catheter
• Care/discontinuation NG/OG tube
• Basic dressing changes

Examples of allowable skills students may perform but only under the direct visual supervision of either a clinical preceptor or UT Tyler clinical instructor, regardless of how many times the student has
performed the skill, include:

• Insertion of Foley catheter (only in patients over age 18)
• Insertion of NG/OG tube (only in patients over age 18)
• Medication administration via any route (see exceptions in the Not Allowed Skills section)
• Hang an IV solution
• Flush a peripheral or midline IV
• Draw blood from a peripheral vein (only in patients over age 18)
• Change IV tubing
• Nursing skills the student has been trained in but is not proficient
• Initiating a peripheral IV (only in patients over age 18)

1.2 Student Nurse Not Allowed Skills (Don'ts)

A student nurse may not perform any skill requiring advanced training or facility-specific check-offs (see nurse extern section for specific exceptions). Students are not allowed to perform skills deemed ‘high risk’ and inappropriate for students to perform. There are some skills that student nurses have been trained to perform but are not allowed to perform in the clinical setting due to hospital policies.

Students can observe the RN performing skills a student nurse is not allowed to perform but must not
participate in the skill.

Following is a list of skills student nurses are not allowed to perform in the clinical setting:

• Specific Medications. Nursing students may not:
  • Possess or administer controlled substances via any route
    • Examples of controlled substances students may not administer include opioids,
      benzodiazepines, antipsychotics, depressants, stimulants, etc.
  • Administer
    • Paralytic medications
    • Chemotherapy
    • Moderate sedation
    • ACLS medications
    • Emergency medications
    • Experimental/research medications
  • Mix, hang, or manipulate the rate of medications administered by IV infusion, including but not limited to:
    • Inotropes
    • Vasoactive agents
    • Analgesic agents
    • Insulin
    • Heparin
    • Pitocin
  • Administer any medication or total parenteral nutrition (TPN) through a long-term central vascular access device (such as mediport, portacath, central line, PICC line)
  • Initiate or adjust PCAs/epidurals 
• Miscellaneous. Nursing students may not:
  • Document initial admission assessment (students can do the initial admission assessment, but the RN must perform their assessment and document it).
  • Access or draw blood from long-term central vascular access devices (such as mediport, portacath, central line, PICC line)
  • Access or draw blood from an arterial line
  • Discontinue an arterial line, long-term vascular access device, cardiac sheath
  • Change dressings for a long-term vascular access device
  • Restrain patients
  • Receive verbal or telephone orders
  • Witness legal documents (example: adoption, consents, power of attorney, advance
    directives)
  • Document monitoring a patient receiving moderate sedation
  • Cervical examinations
  • CPR on a newborn
  • Function as a translator/interpreter
  • Function as a hospital sitter

1.3 Clarification for Student Nurses who are also Nurse Externs
Hospitals may require an individual to hold only one role at a time (either student nurse or nurse extern but not both simultaneously). However, in cases where an agreement between the hospital and college has been approved, the hospital may allow an individual to simultaneously be paid as a nurse extern and receive clinical hours as a student nurse.

1.3.1 If not being paid as a nurse extern while in clinicals as a student nurse
Students not being paid by the facility as a nurse extern for the clinical shift must adhere to the student nurse scope of practice. In this situation, student nurses cannot perform skills that are allowed of a nurse extern but not within the scope of practice of a student nurse.

1.3.2 If simultaneously being paid as a nurse extern while in clincals as a student nurse
Students being paid by the facility as a nurse extern while simultaneously receiving approved clinical hours as a student nurse may follow the scope of practice for a nurse extern at that facility. Exception: a student in a different specialty area than hired and trained as a nurse extern can only perform the skills
they have received training. For example, a nurse extern hired to Labor and Delivery will be trained on specific skills they can perform that a nurse extern hired to a Medical/Surgical unit will not have been
trained on.

1.4 Failure to Comply
Failure to comply with the policy will result in disciplinary action. Disciplinary action can include remediation, course failure or dismissal from the program.

Reviewed 4/6/2023