CERRITOS COLLEGE NURSING 212 Clinical...

N212 Natividad/Knowlton

CERRITOS COLLEGE NURSING 212

Clinical Information and Guidelines

Downey Regional Medical Center 11500 Brookshire Avenue

Downey, CA 90241 (562) 904-5000

Lab A & F


Facility Facts and Layout • This is a 300+ bed, acute care facility that consists of 10 departments

including Medical / Surgical, Definitive Observation Unit, Pediatrics, Emergency Department, Family Birthing Center, Operating Room, Cath Lab, Heart Center, Critical Care Unit, and Outpatient Services.

• The facility faces west with the front entrance and main lobby facing Brookshire Avenue, and the back along Patton Avenue.

Parking

• The parking lot for employees (that includes nursing students) is located along the back of the facility, directly across Patton Avenue. This parking area is free and is gated and patrolled by security. Please do not park in the parking lots adjacent to the facility as these lots are reserved for patients and their families.

• You need to allow yourself time to park in the back parking lot, walk across the street, walk along the north side of the facility, and to enter the front lobby where we will meet.

Unit Facts

• We will be working on the 4th floor, 3rd floor, and on the 2nd floor. These floors are comprised of Medical–Surgical patients, as well as Step-down Telemetry patients. There is “team nursing” on these floors, with CNAs assisting nurses with a portion of their patient load. The nursing – patient ratio varies every shift and depends on patient acuity, but it can range from 1:5 – 1:11.

• There will be respiratory therapists, physical therapists, speech therapists, dietary therapists, and discharge planners involved in the care of the patients.

• DRMC is a teaching facility. Medical students, interns, and residents, will also be sharing in the patient care and management. Please be courteous with all health care team members on these floors. We will all be sharing a small space!

• There is a nursing lounge and a small office space that you are able to utilize to gather your paperwork or to complete any charting. You are welcome to take your breaks and eat your lunches in these areas. There is a breakfast cart on the ground floor patio in the mornings from 0730-1000. The cafeteria is also open for breakfast and lunch, with a “full grill” and a salad bar, and is located in the basement. Show your student ID and you will receive an employee discount on all foods and beverages. Remember, anytime you leave for a break or for lunch, you must notify the nurse that you are working with.


Report • Students will listen to report with the facility staff. • Ask questions and seek clarification as needed. • Throughout the day and at the end of the shift, you must give report to the

nurse that you are working with. Report what has been done and not done, the patient’s response to any procedures performed, any changes in patient status or condition, any procedures, and any I/O that was not documented. Even if your nurse doesn’t act like she is interested, it is still your responsibility to communicate the necessary information.

Pre/post Conference

• Post-conference will begin according to the clinical scheduled time for that day and will be held in the basement conference room (to be announced).

Tardies/Absences

• You are required to notify the instructor prior to clinical of your anticipated absence: Rachel Natividad: (909)576-4585; Mary Knowlton (562)787-2649

• “Clinical absence make-up” is explained in the syllabus and will be enforced

• Failure to call in sick or late may result in failure of the clinical course (see clinical objective for professional responsibility).

Patient Assignments

1. You will be caring for one patient and moving up to two. 2. Students will choose patients at the clinical site the night before clinical

(Monday nights) or very early Tuesday am and have completed NPWs ready for instructor by Tuesday at 0700 (See guidelines in clinical schedule).

3. Students may not care for patients with radiation implants or TB, or receiving chemotherapy. The first student on the nursing unit on Monday afternoon will ask the charge nurse which patients students should NOT take. The room #s will be listed on the top of the assignment sheet on the student bulletin board.

4. Once the student has chosen a patient, write the room number on the student assignment form on the bulletin board to avoid two students from choosing the same patient. On the day of care, you are responsible to list your name on the nursing station assignment board for your assigned patient.

5. When on the surgical nursing unit, please take surgical patients. Your medimap will look a little different. If your patient’s admitting diagnosis was cholecystitis, but has had the gallbladder removed, your medimap will be on care of a patient with a cholecystectomy. The patient no longer has a gallbladder and will not exhibit any s/s of cholecystititis.


6. If the patient assignment or number of patients is determined to be too difficult for the student the assignment should be adjusted by the instructor. Students will be caring for 1-2 patients in N212. Generally 1 patient on Tuesdays and 2 patients on Wednesdays. On your Scenario Week, you will be caring for only 1 patient on Tuesday and 1 patient on Wednesday. If you are scheduled on a Tuesday for OR rotation, choose only 1 patient for the next day’s (Wednesday) assignment.

7. If a patient is deemed to be a risk to the student or not suitable for learning the instructor should notify the staff and then change the student assignment (i.e. choose another patient that is more appropriate or suitable for the student).

8. Patient requests not to have students caring for them should be respected and the assignment changed.

9. Students are responsible for the nursing care of all of their patients within clinical guidelines for N212.

10. Students may not have physical contact or provide care for patients when the instructor is not on site.

11. Refer to your N212 Course packet on “How to pick a Patient” for guidelines.

12. If you are getting overwhelmed during your day on the nursing unit, it is your responsibility to seek assistance from your fellow nursing students or your instructor. Do not wait until the end of the clinical day to say that something was not done because you ran out of time.

Rotation/Observation to OR (Operating Room) 1. Students will rotate out to the Operating Room (OR) only one day for

observation during clinical rotation. One student will go from Mrs. Natividad’s group and one from Mrs. Knowlton’s group.

2. Students will report their observations in the OR in post-conference. 3. If the instructor finds the student not meeting clinical objectives, the

instructor may decide not to rotate the student to OR. 4. Prepare for your OR observational experience by reading Chapter 21 in

your Iggy textbook. Pay attention to the role of the nurses, sterile technique and the types of anesthesia used.

5. The departments the student visit depends on the clinical facility and availability.

6. Students should not be assigned to specialty areas such as ICU or ER during this semester as the acuity is beyond their knowledge level. They will be assigned to med-surg areas but may follow their patients to respiratory, GI lab, OR, invasive radiology for diagnostics and other procedures.

Procedures and Treatments

1. All treatments and procedures must be supervised by the clinical instructor.


2. Students may not perform procedures or give medications with the facility staff.

3. Instructors may allow students to perform simple procedures unsupervised after it is the instructor determines that the student is competent to perform the skill. Example: accuchecks.

4. Students need instructor supervision to perform the following nursing skills: discontinuing an IV or Foley catheter, emptying Foley bags and JP drains; NGT insertion, NGT/GT feedings, foley catheter insertion, & dressing change.

5. If you see something on your patient or in your patient’s room and you don’t know what it is, it is your responsibility to ASK your instructor.

Charting

1. Students may complete shift flowsheet assessment charting according to the clinical schedule.

2. Students are to complete the VS, chart I & O (not totals), pain assessment, diabetic records initially with the instructor, and unsupervised thereafter given the instructor has determined that the student is competent to chart.

3. Students are not to complete daily RN narrative assessment charting on the patient record (this will be done on the NPW).

4. Students will narrative chart all treatments and procedures after review by the instructor in the patient record according to facility policy.

Assessment Guide (AG)

• Students to complete assessment guide with their physical assessment findings for the patients cared for on 2 days of care.

• Students to turn in 1 complete NPW with AG and Nursimap (See “What’s Due” in clinical schedule) on 1 patient on Thursday lectures.

• NPW, AG, and Nursimaps will be reviewed by instructor and given back to students the next week with instructor feedback.

Breaks

1. Students are entitled to a 15 minute break and 30 minute lunch break 2. Breaks/lunches may be combined into one long (45 minute) break 3. Students should take their breaks in shifts so that the patients are

covered. 4. Students need to report off to the responsible RN anytime they leave the

floor. 5. Students and Instructors cannot leave the facility for breaks during clinical

time.

Cell Phone Policy • No cell phones in clinical setting according to cell phone policy in packet

and student handbook.


Nursing Process Worksheet (NPW) 1. NPW is completed on each patient each week prior to clinical. Goal is to

show improvement in “bringing it all together”. Students should show improvement in assessment skills and charting.

2. Students are expected to start their clinical shift with a prepared NPW for each patient with Medimaps (concept map on medical diagnoses) on all admitting diagnoses and any of the four chronic diagnoses mentioned in the NPW form (page 2).

3. Expect to come to clinical at least 30 minutes before the beginning of the shift to make sure your patients are still there.

4. If a patient is discharged by the time the student begins the shift, the student must choose another patient and develop NPW for the new patient. Look for patients with a diagnosis that you are familiar with. The student must be able to verbalize nursing care for the new patient prior to beginning care for the day. During the shift you can get the medication and lab information.

5. Student is to turn in one totally completed NPW each week for instructor review and feedback (See clinical schedule under “What’s Due)

Assigned Shift Report

1. Student assigned to give shift report may use the attached “Shift Report Sheet” or their NPW to give a shift report to their fellow groupmates.

2. The rest of the students will take report and ask questions to the student giving report

3. The goal is to have students practice giving and receiving report, and have the others ask appropriate questions.

4. This is an evaluation of how much the student understands what is going on with his/her patient.

NursiMaps

1. This is the main Post-Conference activity every Wednesday beginning Week 3 (See Clinical Schedule).

2. All students will work on a NursiMap for 1 patient they cared for during the week (Tuesday/Wednesday).

3. Students will turn in Nursimap with AG and NPW on Thursday Lectures (See “What’s Due” in clinical schedule).

Nursing Care Plan (NCP)

1. See NCP instructions and grading tool in the course packet. 2. Students need to have their care plan patient selection “approved” by the

clinical instructor. Do not choose patients who are non-verbal or too difficult. See selection criteria in the NCP instructions.

3. It needs to be a patient you have cared for a full day. 4. A rough draft of the nursing diagnosis problem list and NPW with

completed assessment will be submitted to the clinical instructor 2 weeks before it is due.


What Do I Bring?

• Clinical folder with the enclosed forms that are indicated in your syllabus. • Due to lack of storage space at the nursing stations and to reduce the risk

of theft or loss of valuables, please do not bring backpacks, purses, or any other type of baggage with you.

• Bring any reference books you may need: SDM, Iggy, laboratory diagnostics and medication book. To lighten the load, we suggest you share the load with one or more classmates.

• You are not allowed to bring a pager or cellular ph one to the clinical facility (per student conduct policy). If an emergency should arise, your family members must contact the Health Occupations Division Secretary at (562) 860-2451 x2551 or 2552. The secretary will then contact the clinical facility and forward the message to you. Please provide your family members with the “emergency contact number” for any emergencies.

Please remember your Professional Responsibility at all times. Please arrive to clinical on time and prepared to care for your patients. Be in full, professional, clinical attire. Have your clinical folder with the required papers included. Take advantage of all opportunities that arise. Utilize the skills that you have learned in the skills labs. Enjoy your time here and learn as much as you can. Your clinical experience is what you make of it. Remember – we are guests here! Maintain a professional attitude and behavior at all times!


N212 MEDICATION ADMINISTRATION PROCEDURE 1. You will be assigned by your clinical instructor to administer scheduled

medications to 1 patient on 2 consecutive days (2 days of care).

2. Choose a patient that has scheduled meds. Do not choose to give meds to a patient who has none or only 1 scheduled med (PO, SQ, IM, Inh., PR, Top.)

3. On the day of your scheduled Med Administration, you will administer all

scheduled meds (PO, SQ, IM, Inh., PR, Top., etc.) to your patient with instructor supervision.

4. You and any other student (not scheduled to give meds) may give PRN

IM/SQ meds with instructor supervision upon instruc tor availability. Most frequent prn/ IM/ SQ meds: Demerol/Vistaril; Morphine; Compazine; Lovenox; Heparin; Insulin.

5. You will not administer any scheduled IV fluids or IVPB medications.

6. If your patient has any scheduled IV/IVPB, be sure to remind your RN that

you are not administering these.

7. Inform your RN that you will be administering all scheduled meds for your patient (except IV/IVPB) and obtain the patient’s Medication Administration Record (MAR).

8. Inform your clinical instructor regarding the scheduled times that you are

to administer the medications.

9. Check the MAR against MD orders for all scheduled meds you will be administering to your patient.

10. Check the patient’s medication cassette for all scheduled meds as early

as possible when you begin your shift. Practice doing the five rights at this time.

11. If a medication is missing from the patient’s cassette, send a “missing

medication” form to the pharmacy before the scheduled time to give the medication (Ask your instructor for assistance in filling out the facility’s form). NOTE: It takes pharmacy time to get the medications up on the floor, so do it early….The earlier, the better .


12. Students should be prepared with appropriate data (VS, labs, and patient assessment) necessary prior to administering scheduled medications • e.g. check BP before administering a BP med • e.g. K+ level before administering Lasix

13. Be prepared to do the five rights in the presence of your instructor. 14. Be prepared to answer questions about the medication you are to

administer • Know why the patient is receiving the particular medication (you may

need to look at the admission diagnosis or chronic illnesses from the H&P, or MD progress notes – Ask your instructor for guidance if you are having trouble with this).

• You should know the medications’ use/effect, adverse effects, nursing considerations, patient teaching, & pertinent drug-drug interactions.

15. Go into your patient’s room with your clinical instructor, patient’s

scheduled meds, and MAR. 16. Wash hands and perform IPIE.

17. Identify your patient by checking arm band against MAR and asking

patient his/her name. Ask for allergies.

18. Perform basic patient teaching (medication, dose, and indication).

19. Open all meds at the patient’s bedside and proceed to administer the medications as ordered.

Medications Not Given in N212

1. Students may not hang IV fluids or administer IVPB medications 2. Students may not hang blood but may observe and monitor the procedure

and take the VS.

3. Students may not give IV pushes.

4. Students may not give respiratory treatments with Respiratory Department.

5. Students may not manage IV drips (If the patient is on a drip you need to

know about the medication, but will not be hanging it or changing the dose. EX-Heparin drip)


6. No central line IV medication or IV administration. Students may care for patients with central lines but may not give IV or IV medications. (This is a third semester skill.)

7. Students may not give chemotherapy drugs including oral medications


What To DO…during your shift

Time Completed

0700 � Identify your nurse

� Get report on patients

� Prioritize your tasks

� Check MD orders

� Check medication schedule

� Give meds as scheduled

� Take VS and record on graphic sheet no later than 8:30 am

� Am meals – document amount

� Perform nursing assessment (within the first 2 hours of your shift)

� Am care

� Perform tasks and skills (bed bath, hygiene, ROM, NG feedings,

positioning, enemas, binders, hot/cold applications, NGT insertions,

dressing changes, foley cath insertions) with instructor supervision

� Check MD orders throughout your shift; check chart for other info

� Check diagnostic test (lab,x-ray ) results

� Lunch meal – document amount

� Chart subsequent VS and I&O

� Flow sheet charting – complete before you go to lunch

� Narrative charting ( to be checked by instructor prior to chart entry)

� Give report to staff nurse before you leave the floor for postconference


What to do first!

After receiving report, make your brief rounds Initial Contact:

Check patient status

� Make brief rounds to check on your patients for any immediate needs

o Introduce yourself

o Identify the patient – check their armband

o Make sure that they are arouseable, coherent, and breathing

o Check any environmental risks. Place call light within reach and

make sure side rails are up on patients who are at risk for falls

o If your patient is awake, you can ask if there is anything you can get

for them. Ask about their pain level.

Every time you enter the patient’s room:

Check the surroundings

� Make sure that the right IV fluid is hanging and that the rate is correct.

Assess the IV site

� Make sure that any tubes the patient is supposed to have is present e.g.

NGT, GT, FC. Follow each tube from the patient to the container to check

for its connection, patency, and its drainage. If it is a tube feeding, check

the feeding that is hanging and its rate, and make sure that the HOB is @

least 30 degrees.

Do a Quick Clean Up

� Throw out any old food, drinks, trash, or wrappers around the bedside

� Straighten up the surroundings

� Place the bedside table within the patient’s reach

� Place the trashcan near the patient or a bedside trashbag

Let the patient know that you will be back to check their vital signs and do a full assessment shortly. At that time, you will b ring back anything that they have requested, e.g. pain med, pitcher or wate r, juice.

N212 Natividad/Knowlton Page 1

CERRITOS COLLEGE NURSING 212

Clinical Information and Guidelines

Downey Regional Medical Center 11500 Brookshire Avenue

Downey, CA 90241 (562) 904-5000

Lab A & F