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CNA Handbook: Clinical Policies

Clinical Assignments/Facilities

Clinical instruction is provided throughout the program in conjunction with classroom theory. This instruction is provided in various locations, such as on campus, at local hospitals, long-term care facilities, and other community facilities.

Because of limited clinical placements, it is not possible to assign a student specific clinical time or locations due to work assignments. Students should therefore not schedule a work assignment on a clinical day.

Students may be assigned to day or evening clinical rotations, both during the week and on weekends.

Clinical Policies

  1. The clinical laboratory session is a learning opportunity where the student is expected to utilize all resources to extend the learning experience.
  2. As opportunity permits, clinical instructors facilitate student responsibility for learning, encouraging, or requiring such activities as student participation in the selection of learning experiences, sharing of personal learning goals, keeping a record of skills and evaluation of one’s own clinical performance.
  3. The instructor’s "anecdotal notes" relating to an individual student are available to that student in the nursing instructor’s office. Each instructor destroys anecdotal notes at the end of each semester after all "clinical evaluation" conferences are completed and grades are posted.
  4. Individual instructors, prior to each clinical rotation, give specific instructions regarding preparation for scheduled clinical lab sessions.
  5. The clinical laboratory experience may begin with a pre-conference. During the pre-conference, general instructions may be given and the student is assisted to plan or meet individual client needs.
  6. Clinical sessions may conclude with a post-conference, during which time is usually spent sharing learning experiences. Such sharing is part of developing professional communication skills.
  7. Students are expected to perform safely in all areas of client care. Any performance, which endangers a client's well being, may result in the student’s removal from the clinical.
  8. Students will be expected to function according to stated hospital policies in relation to parking, use of cafeteria, nursing assistant scope of practice, uniform requirements and routines established for the nursing unit.
  9. Students are evaluated weekly during the clinical rotation. Clinical checklists are utilized to ensure that skills can be demonstrated and then practiced several times. If performance is unsatisfactory, comments will be noted and student will be counseled and contacted and required to sign the performance evaluation. Signing does not imply concurrence with the evaluation. It is the student’s responsibility to be aware of the clinical objectives and behaviors to be evaluated. Students are encouraged to schedule appointments with their instructors, as needed, to discuss their progress in the program. All faculty are available to assist students.
  10. Unsafe behavior: At the discretion of the instructor, any student who does not perform CNA duties safely, in accordance with what may be considered unsafe and excluded from the clinical area. A student permanently excluded from the clinical site because of unsafe behavior shall fail the course, or may withdraw, in accordance with college policy.
  11. Accident or emergency regulations: It is the student’s responsibility to know what the appropriate policies and regulations are regarding each clinical site for handling of accidents, emergency situations, and fire regulations during the period of rotation at each site.
  12. Reporting of incidents and/or injury: If a student is involved in an incident with a resident/patient, the appropriate TMCC Accident/Exposure/Incident/Injury report form(s) must be completed immediately. Incident reports must also be completed according to each agency’s policy. Specific TMCC forms are available on the CNA Program website; forms are also available in the CNA Program office. If the student incurs an injury, the appropriate Accident/Exposure/Incident/Injury report form(s) must be completed immediately with the clinical instructor and agency. Students should be aware that some facilities require immediate drug screening. See medical care per personal insurance coverage.
  13. Phone calls: Students are not to use telephones on the units to make or receive personal phone calls. If a student needs to be located regarding an emergency please call 775-673-7117. The CNA staff will then notify the clinical instructor who will find you. Contact clinical instructor as directed. Individual faculty will provide specific information.
  14. Reporting Suspected Child or Elder Abuse: Nevada Revised Statutes (NRS) 432B.220 and NRS 200.5091 require a student to report suspected child or elder abuse or neglect to the clinical instructor. According to the statute, this includes physical or mental injury of a non-accidental nature, sexual abuse or exploitation, or negligent treatment or maltreatment. Anyone who fails to report these conditions is guilty of a misdemeanor, as indicated in NRS 432B.240 and NRS 200.5099.
  15. Reporting of problems during clinical:
    1. Students noting patient or staff problems during clinical should inform their clinical instructor immediately.
    2. The instructor will evaluate the behavior or problem against the criteria for Unprofessional Behavior before reporting to the Nevada State Board of Nursing (NSBN).
      • Generally the criteria are: gross negligence, abuse or performing duties outside the scope of practice.
      • Each clinical instructor is responsible for reporting unprofessional behavior directly to the CNA Coordinator.
      • If the incident should be reported to the CNA Coordinator, this should be discussed with the CNA Coordinator, who will evaluate it with the facility site representative, and report it if necessary.
    3. If the incident needs to be addressed, the student should:
      • Ask the staff diplomatically OR
      • Question the staff to help understand the behavior or action OR
      • Report the incident to the clinical instructor who will follow up with facility staff if necessary.
      • The student should always be prepared to state or write what they would do differently in the same circumstance and provide a rationale.
    4. The clinical instructor’s role is to manage the event for a good outcome for the student, the facility staff and the facility.
    5. Global or system issues should be discussed with the facility and the CNA Coordinator.

TMCC CNA Students

Confidentiality

Confidentiality is both a legal and ethical concern in nursing practice. Confidentiality is the protection of private information gathered about a client during the provision of health care services. It is the CNA student’s responsibility to safeguard the client’s right to privacy by protecting information of a confidential nature.

TMCC expects that all students and faculty will protect the privacy rights, including maintaining confidentiality, of all clients. It is expected that students and faculty will NOT:

  • Discuss the care of clients with anyone not involved in the client’s direct care.
  • Discuss the care of clients in any public setting.
  • Remove any actual/copied client records from the clinical setting (this includes computer printout information).
  • Use the client’s name on any written form or notation (initials only).

Dress Code

When students are in a clinical setting, they are representatives of TMCC and the CNA Program. It is expected that the student will act and dress in a professional manner. The word "professional" can be interpreted differently by each of us. In this context, it is expected that the student will be dressed in clean, neat, tidy, properly fitting, and conservative clothing when acting in a student capacity.

Students must also comply with the dress policy for each institution.

The dress policy for students in clinical experience and classroom attendance is as follows:

  • Beards/Mustaches: Clean, short, and neatly trimmed. Males without full beards must be clean-shaven (no “five o’clock shadow”) when in the clinical area. In the event a student has a mustache and/or goatee, the remainder of facial hair should be clean-shaven.
  • Clothing: The clinical instructor has the discretion to request conformity to specific uniform/apparel outside the listed items. These may vary from one instructor to another. This may be dependent on agency unit regulation. Students not complying with the instructor’s request will be excluded from clinical until in conformance. The clinical instructor’s judgment regarding appropriateness of student dress will always prevail.
    • By the end of the first week of class, students are required to wear a uniform consisting of colored scrubs for all classes, lab and clinical settings. Students will not be allowed to wear gray, black or purple solids unless a print top is also worn. Clothing must be clean, neat, and free from stains, rips, or wrinkles.
    • No tank tops, t-shirts, jeans or Levi’s of any color, sweat pants, shorts, leggings, spandex, stirrup type stretch pants, or colored underwear are allowed.
    • A white turtleneck may be worn under uniform top.
    • The student uniform may not be worn while students are working for pay.
  • Cosmetics: Light make-up, if desired. No perfume, cologne or after-shave. Basic cleanliness is expected.
  • Equipment: A watch with a second hand is required. A blood pressure cuff and stethoscope are optional.
  • Fingernails: Kept clean, neat and of moderate length. Nail polish is to be non-offensive color. No decorations. No artificial fingernails.
  • Footwear: Shoes are to be white in color, clean and kept in good repair at all times. Tennis shoes are acceptable, without colored decoration and with good support. NO shoes with open backs or straps and/or open toes. Non-permeable material is required.
  • Gait Belts: Gait belts may be required while in clinical rotation.
  • Gloves: Gloves will be provided for on-campus practice labs.
  • Goggles: Each student must obtain (and carry) a pair of safety goggles/glasses to be available throughout their clinical rotations.
  • Gum/Tobacco: No chewing gum or tobacco products of any type (class or clinical).
  • Hair: To be worn so it does not interfere with client care (short or fastened back). If long, hair must be conservative in style, must be held away from the face in a ponytail or bun. Clean, no ribbons, decorated hair clips, or scarves. Neatly combed and well groomed. No fluorescent or unusual colors.
  • Photo ID: A student photo ID will be required for entry to any clinical site. It is the student’s responsibility to obtain the TMCC photo ID card during the scheduled opportunities posted at the Welcome Center on the third floor of the Red Mountain Building. Students must attach their ID Badges to the uniform, visible above the waist. No lanyards are acceptable.
  • Rings/Jewelry: A watch with a second hand, and wedding rings are permitted. Jewelry may not be such that it could be a safety hazard. No facial or oral piercings permitted, with the exception of one small post earring in each ear lobe. No bracelets on wrists or ankles. No multiple rings on multiple fingers. No ear cuffs.
  • Tattoos: All visible tattoos must be covered.

Coordinating Clinical Experience with Health Care Facilities

TMCC students are in clinical settings to learn as much as possible (in a very limited time) on how to give the best care possible. These experiences vary. Students should give or seek help when it is needed. Students may work alone, with each other, or with a staff member. Instructors help the students understand their roles, teach and guide the students’ learning experience.

Each agency’s nursing service is responsible for the quality of nursing care the clients receive from all members of the health care team; therefore the agency nursing staff is responsible for the quality of care the clients receive from students. Because the staff knows the client and are ultimately responsible for their clients, the instructor and students must collaborate with these nurses for their skills and knowledge to give the best nursing care possible.

The following guidelines for students, instructors and staff nurses should help clarify responsibilities for each role in the clinical setting:

The Student Will:

  • Be prompt or notify unit and clinical instructor if unable to attend or will be late before the start of the clinical experience.
  • Abide by the hospital and unit rules and regulations.
  • Seek help when needed from the instructor or appropriate staff.
  • Give complete care as possible up to their level of experience and knowledge; consult with instructor/staff when client’s problems are not within the student’s level of knowledge.
  • Participate as a team member, giving assistance and sharing responsibilities when needed, including answering call lights.
  • Be responsible for, and seek out, their own learning experience (with assistance from staff and instructor).
  • Report errors, mistakes, accidents and omissions promptly and take necessary steps for correction.
  • Report own illness or injury during clinical experience to instructor and supervisor nurse immediately.

The Instructor Will:

  • Be responsible for the overall supervision of the students.
  • Be responsible for the overall learning experience of the students.
  • Select, with assistance from staff and head nurses, appropriate client assignments for students.
  • Be in the health care facilities when students are having clinical experiences.
  • Seek out learning experiences for students.
  • Supervise students in skills, as required.
  • Keep unit informed as to: names of students, dates of experiences, changes in plans, and types of clients to meet clinical objectives; list skills students can perform.
  • Welcome ideas and suggestions from staff.
  • Evaluate student performance.
  • Confer with students in a pre/post conference.
  • Maintain a good relationship between staff, students, instructor and clients (act as a mediator when needed).
  • Arrange for special lectures or conferences with informed persons.
  • Share knowledge and experiences with staff on unit when asked.
  • Assist staff during emergencies.
  • Abide by unit and hospital regulations.

The Staff Can Assist By:

  • Helping students and instructors select clients who best fit the stated clinical objectives.
  • Giving a complete verbal report on the client and his/her needs at the beginning of each experience.
  • Assisting the students when providing care.
  • Notifying the instructor and student regarding interesting learning experiences.
  • Notifying the student and instructor if safe practice is not carried out.
  • Contacting the instructor as soon as any questions or problems arise.
  • Teaching and demonstrating when desirable.
  • Being responsible for some learning experiences of students when in areas of specialized nursing care, when this experience does not conflict with overall operation of the unit.
  • Offering suggestions to instructors and students.
  • Providing input to the instructor concerning student’s progress.