Practical Nursing (PN) Program Handbook

Introduction

Practical Nursing Program is a part of the School of Health and Human Services, a place of warmth and caring. We're always looking to connect with future and current students so please don't hesitate to email hhsinfo@camosun.ca if you have any questions.

Once enrolled in a program, you're required to familiarize yourself with the information found in your school and program information pages.

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1. Welcome

Chair's Message

We, the faculty and staff of the Continuing Care department welcome you! By choosing one of our programs you are demonstrating that you care about your community and that you have an interest and commitment to working with people. During the course of your studies we will partner with you to strengthen your knowledge, skills and values in preparation for your chosen career.

We hope you'll take the time to review the information in this handbook, as well as the Health & Human Services Student Handbook. They contain Camosun College policies and procedures, student resources and other important information to assist and guide you in making your educational experience a success. Get to know the campus, your instructors and your fellow students – they will all be part of your support team.

We are delighted that you have chosen the Health Care Assistant program as your area of study and will take great pleasure in getting to know you, while we work and learn together. We hope you enjoy your experience with us, and wish you success in all that you do!

All instructors have online office hours. In addition, they can be reached by email or you can leave them a voice mail, which is operational 24 hours a day. The instructor will return your call or correspondence as soon as possible.
If you have any questions or concerns, please feel free to contact me, discuss them with one of your instructors, or reach out to any of the dedicated staff here at Camosun College.

Ros Giles-Pereira
Chair, Continuing Care Department

Contact the Continuing Care department.

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2. Program Values

The provincial practical nursing program (PPNP) is designed to provide learners with the knowledge, skills, judgments, and attitudes to perform to the full range of competencies as identified by the British Columbia College of Nurses and Midwives (BCCNM). The curriculum provides a learning experience that is integrated, professional, collaborative, and culturally sensitive with an aim to prepare graduates to care for individuals (and by extension, families of individuals) at multiple life stages and in a variety of practice settings.

Consistent with the BCCNM, Entry-Level Competencies for Licensed Practical Nurses, the focus for beginner's practice is "care of clients with less complex and more predictable outcomes". Additionally, upon successful completion of the program, learners will possess the competencies to successfully complete the Regulatory Exam – Practical Nurse (REx-PN).

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3. Teaching Philosophy

3.1 Curriculum

With this curriculum, caring is viewed as a core concept. Practical Nurses foster client empowerment in care planning and decision making, and are cognizant of their unique biological, psychosocial, spiritual, cultural, and environmental complexity. Practical Nurses care for clients across the lifespan, providing safe, knowledgeable, and integrated care through critical thinking and clinical judgement.

The curriculum supports a deliberate, client focused approach and fosters the development of a conscious relationship with the client and the environment in which the learning takes place.

Learning occurs through formal and informal study, mentorship, coaching, role modeling and experience. Learning is lifelong, and is facilitated by a learner-owned approach that promotes cultural safety, caring, independence, critical inquiry,and creativity. The curriculum uses multiple approaches to encourage learning and embraces concept-based, case-based, skill-based, and integrated learning experiences. The curriculum builds on the learners' prior learning and life experience, and promotes collaborative learning through interdisciplinary understanding and effective team functioning.

3.2 Organizing Concepts

The curriculum organizing concepts provide a foundation for program learning outcomes. The organizing concepts also guide the development of curriculum concepts and required courses. In developing these concepts, the Curriculum Advisory Group continually reflected on the BCCNM competencies, consulted the REx-PN blueprint, and synthesized the available contextual data surrounding Practical Nurse education and practice. In addition, each member contributed their vision of the practical nursing graduate of the future and answered the question: do the proposed organizing concepts encapsulate important ideas that are essential for successful practice now and into the future? Based on this process, curriculum organizing concepts were developed as being: integrative, professional, knowledgeable, competent, and client focused.

Integrative: The Practical Nurse is integral in the assessment, planning, implementation, evaluation and documentation of nursing care. The Practical Nurse promotes, supports, and advocates for client self-determination to achieve optimum health outcomes. The foundation of practical nursing is defined by relevant law, scope of practice as defined by regulation set out in legislation, standards of practice, code of ethics, and entry-level competencies.

Professional: Practical Nurses practice collaboratively, respecting the shared and unique competencies of other members of the health-care team. A code of ethics provides direction for the Practical Nurse to uphold the highest standard of care as defined by the scope of practice. The Practical Nurse maintains autonomy within the legislated scope of practice and is legally accountable to the client, the employer, and the profession. The Practical Nurse demonstrates a self-reflective approach to practice and demonstrates leadership while fostering continued growth of self and others to meet the challenges of the evolving health-care system.

Knowledgeable: The Practical Nurse uses critical thinking to guide the formulation of clinical decisions, based on evidence-informed practice. Practical Nurses follow a systematic approach when applying the nursing process and deliver care while respecting diversity. Practical Nurses are knowledgeable about trends and issues that impact the client, the health-care system and team. Practical Nurses are active participants in health promotion, illness prevention, reduction of harm,and risk management activities.

Competent: Practical Nurses integrate knowledge, skills, behaviours, attitudes, critical thinking and clinical judgment expected of an entry-level Practical Nurse to provide safe, competent, and ethical care. Practical Nurses care for clients throughout the lifespan and are responsible for providing care while developing and maintaining a therapeutic nurse-client relationship. Practical Nurses perform holistic, comprehensive and specific nursing assessments to achieve mutually agreed upon health outcomes. Using evidence informed practice, Practical Nurses select and implement appropriate nursing interventions.

Client Focused: Practical Nurses assist clients to identify actual and potential health goals and outcomes, support clients to assume responsibility for their health, involve clients in developing and prioritizing their plan of care, and provide information and access to resources. Practical Nurses collaborate with clients and other health team members in discharge planning, planning and implementing strategies to enhance client learning, evaluating client learning and revise strategies as necessary. Practical Nurses provide care that affirms, respects, and fosters cultural expression by others.

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4. Program Learning Outcomes

4.1 Performance Indicators

The following program outcomes describe what learners are expected to achieve by the end of their educational program and describe key professional abilities, incorporate the curricular philosophical approach, and highlight the core concepts.

Upon completion of the Camosun College Practical Nursing Program, graduates will:

1. Apply the Entry-Level Competencies for Licensed Practical Nurses (2020) to provide safe, competent, culturally safe and ethical care.
2. Practice within relevant legislation, scope of practice, standards of practice, and code of ethics as set out by the Health Professions Act and the BCCNM.
3. Value and engage in continuous learning to maintain and enhance competence
4. Practice in collaboration with other members of the health care team to meet the collective needs of their clients
5. Participate in interprofessional problem solving and decision making processes
6. Advocate for and facilitate change reflecting evidence-informed practice
7. Make practice decisions that are client specific and consider client acuity, complexity, variability, and available resources
8. Use critical thinking, clinical judgment and knowledge of assessment to plan, implement, and evaluate the agreed upon plan of care
9. Develop a collaborative relationship with clients by connecting, sharing, and exploring with them in a caring environment
10. Provide culturally safe, person-centred care across the lifespan that recognizes and respects the uniqueness of each individual and is sensitive to cultural safety and diversity
11. Provide leadership, direction, assignment, and supervision of unregulated care providers as appropriate
12. Identify one's own values, biases, and assumptions and the influence of these on interactions with clients and other members of the health care team

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5. Professional Behaviour

5.1 Appropriate Use of Electronic Devices/Mobile Devices

In the classroom cell phones should be turned off, removed from the desk and put away unless being use for an instructor-led activity.

In the clinical environment, cell phones need to be used appropriately and in accordance with existing college or organizational policies and procedures, professional codes of conduct and provincial and federal legislation. Users will be held accountable for any and all violations to the above.

Ensuring the confidentiality of patient information, providing the highest level of care and maintaining the highest standards of professional behaviour need to be respected when using personal mobile devices. Therefore, in the absence of organizational polices &/or in addition to, the following guidelines are intended for all faculty and students. These guidelines will be reviewed and updated by the Continuing Care Department on an annual basis. In exceptional circumstances when it is determined appropriate for a student to use a cell phone in a clinical setting, the following applies:

Infection Control and Mobile Devices

• Wash hands or use alcohol based sanitizer before and after each use of your personal mobile device
• Apply a cover with smooth surface to protect your personal mobile device and facilitate cleaning
• Clean your personal mobile device daily following established infection control protocols

Confidentiality and Mobile Devices

• Do not view or access any patient information on your personal mobile device.
• Do not do any audio recording on your personal mobile device within the clinical facility.
• Do not take any pictures or video on your personal mobile device within the clinical facility.
• Do not send any identifiable patient information over your personal mobile device.

Professionalism and Mobile Devices

• Use a low tone of voice when using your personal mobile device.
• The ring feature of your personal mobile device will be turned off while in the clinical facility. You may use the vibrate mode or silent mode.
• Delay checking or answering your mobile device when you are with patients.
• Use of your personal mobile device for professional reasons should occur in an appropriate discreet location.
• Personal use of your personal mobile device should occur during your breaks and away from patient care areas.
• If you are unclear about the use of your personal mobile device then it should not be used until you are able to confirm its appropriate use within that clinical facility.
• All communication done via your personal mobile device, whether verbal or electronic, should occur in a professional manner.
• Do not share your personal contact information with patients or their families.
• You have an ethical responsibility to bring forward, to the Continuing Care Department, any concerns you observe about the inappropriate use of a personal mobile device

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6. Classroom, Lab, or Clinic Etiquette

6.1 Expectations of Student Performance

Graduation Criteria

A minimum of 65% ("C+") in each theory course, except PNUR 119 and PNUR 129 which require a minimum of 80% (A-) are prerequisites for progression into each clinical placement. Each clinical must be successfully completed and passed in order to progress to the next term, and following the fourth clinical, progress into Preceptorship. Preceptorship must be successfully passed to graduate from the program.

The School reserves the right to change or cancel any provision or requirement at any time.

Re-entry or Transfer to the Program

The Practical Nursing program must be completed within 3 years of starting the program. Students re-entering or transfering into the program to complete a clinical or practicum course must audit, attend and demonstrate competency and safety in the lab course prior to starting practicum.

6.2 Testing and Assignments

Test and Examination Procedures

There are policies regarding written test and examination procedures including late arrivals and missed tests. Please see the Health and Human Services Student Manual for Test and Examination Procedures.

Written Assignments

Assignments are due before 2400 hours (midnight) on the assigned day unless otherwise specified. Assignments about patients, residents or clients must be completed using the individual’s initials only. Unless otherwise directed by individual course syllabi, assignments must be: word processed, double spaced, 12 font, Times New Roman font, with a title page and a reference list. Students requiring an extension for the due date of an assignment must negotiate with the instructor, at least 48 hours before the due date. Assignments submitted late without an approved extension will result in a 5% deduction in mark for each day late.

6.3 Dress Code and Guidelines

The purpose of this dress code is to guide professional appearance, promote safety, and follow infection prevention and control requirements. The goals of the Dress Code are to:

• Promote professionalism, demonstrate the value of professional nursing standards, cultivate a professional image, and represent nursing as a respected profession.
• Identify individuals as Camosun College faculty and students.
• Promote the safety of the client, the faculty member and the nursing student.
• Promote and maintain infection prevention and control.

Practical Nursing students are expected to comply with the dress code, as outlined below. Failure to comply with this guideline may result in the student being asked to leave the practice setting.

Acute and Long-Term Care Clinical Settings

• Practical Nursing students are required to wear a Camosun College PN scrub top with black scrub pants. Ensure that pants are hemmed above the heel line.
• The Camosun College name tag must be worn and visible at all times
• A washable cardigan or undershirt is permitted

• • No more than ¾ length sleeves (must not be longer than 2 inches below the elbow)
  • Tight to skin
  • White, black, or the colour of the uniform

• Uniforms and religious head coverings must be clean, wrinkle-free and washed in-between each clinical day in a hot water wash.
• A clean uniform may be worn as you travel to or from the clinical setting in your own vehicle.
• Uniforms must not be worn if travelling on public transit.
• Requirements for shoes, hair and jewellery (listed below) must be followed

Within Island Health Settings

• Island Health issued photo ID badge must be visible at all times.
• No part of the uniform will be worn outside of the clinic setting. Therefore, faculty members and students must change into and out of uniforms on-site.

Community Clinical Settings

• Appropriate dress for community experiences may be unique to the placement. Students will consult with the faculty member and organization to discuss required dress.
• This clothing must be neat and clean and should not leave your role, actions or intentions open to misinterpretation. This clothing must also enable you to participate fully in activities and situations where you may need to move quickly (e.g. run).
• Abdomens, backs, chests, shoulders and thighs should be fully covered through all range of movement.
• All other requirements are the same as for hospital and long-term care clinical settings

CHW Health Care Labs

• Students may wear scrubs or casual attire for lab classes and for open lab practice in the CHW.
• Abdomens, backs, chests, shoulders and thighs should be fully covered through all range of movement.
• Requirements for shoes, hair and jewellery (listed below) must be followed.
• The dress code for clinical settings applies during Integrated Lab Assessments, Simulation learning experiences, and Mock ILAs.

Shoes: All Clinical and Lab Settings

• Shoes must be in good condition with low heels, closed heels and toes, uppers that can be washed or wiped down (leather or similar materials), and soles with good traction (rubberized sole with ribbed, dimpled or grooved surface).
• By definition, footwear with mesh, canvas or cloth topsides are NOT appropriate as they do not protect the wearer from the hazards identified by WorkSafeBC (2017).
• For infection prevention and control purposes, clinical shoes must be worn exclusively in the clinical setting, never outside of it.
• Alternative shoes (Work Safe BC compliant and as listed above) for community and lab/simulation settings must be worn.

Hair, Nails, and Jewellery: All Clinical and Lab Settings

• Hair must be clean, neat and kept up off collar and face. Long hair must be tied back or in a bun (no long ponytails). No hair extensions may be worn in practicum.
• Facial hair must be neatly trimmed and fit within a mask.
• Religious head coverings must be secured so that they do not fall into the faculty member's/nursing student's face or onto the client.
• Nails must be short, trimmed and rounded in shape. No artificial nails or nail polish.
• No jewellery is permitted in a clinical area, with the following possible exceptions: Medi-alert bracelets/necklaces; a single plain ring with no stones or carvings; facial piercings (including ears) are to be small studs only, with no bars or rings.
• Students MUST have a clip-on or pin-on watch with a second hand. Wrist watches are not allowed.
• No wearing of perfume/body spray, scented lotion, scented deodorant or scented hairspray.
• Unpleasant body odours from poor hygiene are unacceptable. Please remember to bathe and use deodorant.

Stethoscopes: All Clinical and Lab Settings

• Faculty members and students are advised for infection control to bring and use their own stethoscope.
• Stethoscopes will not be worn around the neck.
• Stethoscope to be stored in scrub top or pant pockets while not in use.
• Stethoscope diaphragm and bell are to be cleaned with alcohol wipes between clients.
• Stethoscope to be cleaned with hydrogen peroxide wipes at the end of each nursing practice shift and PRN.

Disposal of Needles and Sharps

1. Needles and sharps are disposed of in commercial plastic containers. The containers are wide mouthed and puncture proof.
2. There is at least one container available in each of the CHW 4th floor labs.
3. The Lab Supervisor is responsible for replacing full containers with empty ones.
4. A waste disposal company collects the accumulated sharps containers several times yearly.

To reduce needle stick injuries:

• Never recap used needles.
• After use, deploy the safety cover and then discard it in the nearest sharps container.

Please Note: In the CHW 4th floor labs, students are not to perform invasive procedures on each other. Camosun College does not provide coverage for injury resulting from invasive nursing skills performed on each other in the labs.

This dress code guideline is in compliance with:

• WorkSafeBC. (2017). Part 08 Personal Protective Clothing and Equipment Policy.
• Policies of Infection Prevention and Control, Hand Hygiene, and Personal Appearance of Island Health Authority of Island Health; and policies of other nursing practice community partners.

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7. Practicum Guidelines

7.1 Clinical and Community Placement Protocol

Diverse opportunities for student learning are essential in order to prepare them for the realities of the work place. Therefore, student placement occurs within a variety of Vancouver Island Health Authority facilities and agencies which offer a range of learning opportunities. Additionally, student learning is facilitated through clinical experiences with a variety of instructors. Teacher recommendations and student requests related to placement are considered in relation to student learning needs and opportunities for success.

7.2 Student Safety and Orientations on Practicums

Behaviour endangering the client

Because the people that our students look after are in a vulnerable position, we MUST be absolutely sure that their safety is secure. Consequently, when a student in the clinical setting puts the client in physical or emotional jeopardy, this will be considered a very serious matter.

Physical Jeopardy: any action or inaction on the part of the student which threatens the client's physical well-being. Such behaviours may include those which endanger the physical safety of the client, such as interference with essential care, failure to carry out required care, failure to behave in a responsible or accountable manner.

Emotional Jeopardy: any action or inaction on the part of the student which threatens the client's emotional well-being. Such behaviours may include interpersonal communications which belittle or demean the client or practices which blatantly defile the dignity of the client.

Any time a safety error occurs during the clinical experience, the student involved will be asked to fill out a Conference Form. If the safety error results in injury to the student or others, then a facility incident report must also be completed. Copies of all incident reports are placed on the student's file.

In situations where a student is displaying behaviour which places the client in physical or emotional jeopardy, the instructor will follow the Continuing Care Policy on Documentation of Concerns. The student will be clearly informed of the behaviour required for continuance in the clinical experience. If behaviour continues that places the client in physical or emotional jeopardy, the student can be required to leave the clinical site.

Note: Students who are found to be unsafe to self or others, or demonstrate unethical, unprofessional behaviour in the clinical area may be asked to leave the setting for the remainder of that day. The student, the program instructors and the Chair will subsequently meet to discuss the student's performance and develop a recommendation for remediation.

Examples of unsafe, unethical and unprofessional practice include, but are not limited to:

• arriving at the clinical site setting smelling of alcohol and/or behaving as though intoxicated and/or incapacitated by consumption of prescription or elicit drugs
• stealing from clients/staff
• destroying, defacing or otherwise knowingly damaging property
• assaulting or threatening to assault another person
• harassing other students, faculty members, facility/agency staff members or clients
• illness which interferes with the assumption of responsibilities
• not knowing own limits and not seeking help appropriately
• inadequate preparation for patient care
• not reporting significant client information to appropriate health care professional (e.g. nurse)
• dishonesty
• inappropriate behaviour toward clients, peers, staff or instructor (i.e. swearing, foul or course language)
• implementing unsafe care

Serious disregard of program policies includes such things as:

• not implementing standard safety principles in performance of lifts and transfers consequently endangering client safety
• operating a mechanical lift without supervision
• feeding a client who is at risk of choking in the client's room without supervision

If the student is temporarily removed from the clinical area, the instructor must inform the Program Leader or designate who may consult with the appropriate Chair regarding the conditions for return to the clinical assignment. The student will be advised of these conditions in writing. The student can appeal this action through the Student Appeal Procedure.

7.3 Practice Guidelines/Professional Standards of Practice

Attendance

Students must attend all clinical/preceptorship experiences. In the event of illness or other unavoidable cause of absence, the student must notify the agency prior to the time she/he is expected. The student is expected to leave a message and phone number at the college or clinical agency for the instructor. In the event a student is absent from clinical/preceptorship, the situation will be evaluated by the instructors on an individual basis, taking into consideration the amount of time missed, reason for absence and the student's ability to meet learning goals and evaluations.

During clinical/preceptorship there are a minimum number of hours that must be completed. If a student fails to meet this requirement, he/she may have the opportunity to make up the required hours pending the instructor's ability to arrange further clinical time and potentially with additional cost to the student; OR the student may be required to withdraw from the program and re-enter the following year to complete. Absences will be recorded on the final evaluation form and will become part of the student's file. Physicians' notes may be required for absences from clinical/preceptorship due to illness.

Guidelines for Practice

Please Note: All PN students must read and understand practice guidelines prior to commencing each clinical situation. Any questions for clarification may be directed to the clinical instructors.

1. PN students are considered supernumerary on any unit to which they are assigned. They will not take the place of paid personnel.
2. Students may perform all procedures independently after they have been determined competent to do so by the instructor. Approval will be given to students either verbally or in writing.
3. Students may use mechanical tubs without supervision after the instructor has been satisfied that they are competent and safe. There must always be two people present when using mechanical devices even after the student has been deemed competent.
4. When using mechanical devices and mechanical transfer devices, students must be supervised by regular staff or an instructor until the student has been certified competent and safe. There must always be two people present when using mechanical devices even after the student has been certified competent. The second person may be another student who has also been deemed competent by the instructor.
5. Students must always notify the instructor of any safety incidents that occur in the clinical setting.
6. Students may perform one person transfers without supervision once the instructor is satisfied with the students' competencies in this skill. A two person transfer may be performed by two students who have demonstrated their competency of this skill to their instructor.
7. Students will respect a client's right to confidentiality at all times.
8. Students will wear their student identification when doing home visits or agency visits.
9. Students may not witness consents or any other legal documents.
10. If a student is going to be late or absent from a clinical shift, they must phone the clinical site prior to the shift starting. They must also leave their name and a contact number where the instructor can call them.
11. If an instructor does not arrive at the clinical site for any reason, students must depart from the site immediately. After leaving the site, students should phone the instructor for further direction. Students must not be at any site without an instructor present.

7.4 Practice Appraisals

Evaluation of Learning

Principles of Giving Feedback

These principles apply whether an instructor is giving feedback to a student or the student is giving feedback to the instructor or to a peer:

• Give feedback in a timely manner, i.e. when you note excellence or as soon as issues/concerns arise.
• Describe what you observed in a clear, direct and specific manner
• Avoid labelling behaviours.
• Explore the meaning the behaviour has for each of you.
• Clearly define expected performance standards.
• Identify strategies to assist in meeting the standards. Where improvement is needed establish time lines for achieving expected outcomes.
• Outline prescriptive strategies that may assist learning.
• Clearly state consequences of not meeting expected outcomes in time.

Documentation of Concerns

In situations where issues or concerns arise and students are not meeting expected outcomes, written documentation will summarize the situation. Student Progress Notes and Learning Plans will be used. These documents will be signed by both parties.

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