Clinical Policies

Clinical experiences allow students to apply theoretical knowledge and learned skills directly to practice. Working in a variety of clinical settings, students interact with patients, clients, various members of multidisciplinary teams, and community partners. Clinical is used in combination with classroom, skills lab, and simulation instruction. Attendance of clinical experiences is required. Clinical instruction is a CON program and Missouri State Board of Nursing (MSBON) requirement.

Students must follow the guidelines provided in the BSN Student Handbook and clinical course syllabus in addition to those assigned by the clinical site or agency. Students must adhere to all policies of the assigned clinical facility, the College of Nursing, and the University of Missouri – Saint Louis.
Students who fail to comply with clinical guidelines will be asked to leave the clinical setting and the day will be counted as a clinical absence.

Clinical Compliance Requirements

MyClinicalExchange is the College’s secure, online tracking system for clinical compliance. All students must set up a MyClinicalExchange account and submit proof of required documents, including health insurance coverage, a complete background check and clear drug test result, before the start of the semester that you begin clinicals. Students also need to complete a background check and drug test using another secure system called CastleBranch. The background check and initial drug test are completed one-time, prior to beginning clinical rotations; however, the medical document tracker must be updated at the beginning of each semester.

Students who do not comply with immunization, screening, and health coverage requirements will not be allowed to attend clinical experiences. Failure to participate in clinical experiences will result in dismissal from the program.

Missouri’s Family Care Safety Registry (FCSR) – MO FCSR is part of our criminal background check requirement. Information about MO Family Care Safety Registry (MO FCSR) can be found on Missouri Department of Health & Senior Services website.

Below are items that will need to be completed through CastleBranch:

• Criminal Background Check (CBC): A one-time criminal background check must be completed before or at the beginning of the program through CastleBranch. Results are sent directly to the UMSL CON and are confidential.
• Urine Drug Screen (UDS): A one-time UDS must be on record. Instructions are provided by CastleBranch for locations of a facility where the UDS must be completed. Results are automatically recorded in Castle Branch and are confidential between the student and the UMSL College of Nursing. If an additional drug screen is requested (after the first initial drug screen), it must be completed immediately at a LabCorp facility and will be at the expense of the student. Students testing positive will not be allowed to attend clinical.

Evidence of the following must be submitted to myClinicalExchange prior to beginning clinicals. Each item listed below must be updated each semester prior to clinical rotations.

• MMR (Measles, Mumps, and Rubella) – Documentation of either a positive MMR titer (all 3 components) or 2 MMR immunizations. If your titer result is equivocal or negative, you will need to get the immunization for MMR (1 MMR booster vaccine for equivocal and 2 dose of MMR vaccine for negative). As long as you have started the series of injections before the semester starts AND stay current with the series throughout the clinical semester, you will remain in compliance.
  
  • The MMR immunizations may interfere with the reading of your PPD skin tests, so please check with your health care provider regarding timing of these two requirements.
• Varicella (Chicken Pox) – Documentation of either a positive Varicella titer, 2 Varicella immunizations, or history of disease. If your titer result is equivocal or negative, you will need to get the Varicella immunization (1 booster vaccine for equivocal and 2 dose of Varicella vaccine for negative). If you have started the series of injections before the semester starts AND stay current with the series throughout the clinical semester, you will remain in compliance. If you have had Varicella (Chicken Pox) as a child, a medically documented history of the disease is acceptable.
  
  • The vaccine is available at the County Health Department or your private healthcare provider’s office. The Varicella immunizations may interfere with the reading of your PPD skin tests, so please check with your health care provider regarding timing of these two requirements.
• Hepatitis B – This requires several, spaced vaccinations. If you have started the series of injections before the semester starts AND stay current with the series throughout the clinical semester, you will remain in compliance. Documentation of positive titer is also acceptable. If your titer result is equivocal or negative, you will need to get the Hepatitis B immunization (1 booster vaccine for equivocal and 3 doses of Hepatitis B vaccine for negative). If you decline the Hepatitis B vaccination, complete the Hepatitis B Declination Form (available in the BSN Clinical Requirement Guide) and upload it to your myClinicalExchange account. If students receive Heplisav-B vaccine, two doses is considered sufficient.
• Tdap – Tetanus, Diphtheria, and Pertussis (Tdap) vaccine performed no more than 10 years ago is required. Upon renewal, a new Tdap vaccine is needed.
• PPD – Proof of a two-step purified protein derivative (PPD) skin test is required for the initial submission. A two-step PPD involves 2 separate injections (each skin test will need to be read 2-3 days later) at least 1 week apart and no more than 3 weeks apart. If a two-step PPD was done in the past, submitting the record along with consecutive annual PPD (single injection) is acceptable, as long as each annual PPD was performed no later than 365 days from the previous test date. Another option for the initial submission is the Interferon-Gamma Release Assays (IGRAs) or the whole-blood tests for TB infection. These include QuantiFERON®-TB Gold and T-Spot TB test.
  
  • TB tests are good for one year. Upon renewal, annual PPD skin test or the whole-blood tests for TB infection are required. Please keep in mind that to be considered in compliance, the renewal administered date must be no later than 365 days from the latest test date. If it is overdue (more than 365 days), a new two-step PPD skin test is required.
  • If you have a positive PPD skin test or ever tested positive, submit a chest x-ray performed no more than 2 years ago along with a completed school TB Symptom Check Form (available in the BSN Clinical Requirement Guide). You have to submit a school TB Symptom Check Form annually (within 365 days after the latest submission) throughout the remainder of your nursing program. A new chest x-ray is not required.
  • Please note that it is important that you get a PPD skin test completed BEFORE you go on to have any further vaccinations since many immunizations/vaccinations (especially live virus vaccines) interfere with the reading of a TB skin test.
• Flu (Influenza) vaccine – Proof of a current flu vaccine is required each fall semester. There are several free clinics in the St. Louis area that assist with fulfilling this requirement. You can also receive the vaccine via your private healthcare provider’s office, Target Pharmacy, Walgreen’s, etc. Please wait until the current flu season (Sept./Oct.) to fulfill this requirement. Proof of the current flu vaccine is always due by October 15th.
• COVID-19 Vaccination – proof of current COVID-19 vaccination is required by the start of the program. Keep in mind, that the vaccination may be a two-step process and so be sure to allow ample time for both injections and the two-week post vaccine period to be considered “fully vaccinated” (approximately five weeks). There may be a limited number of sites that will accept students with medical and/or religious exemptions, but documentation of such must be submitted to the clinical director for acceptance and is not guaranteed.
• COVID-19 Booster Vaccine – This requirement is currently optional. However, students who do not have proof of a booster vaccine may not be allowed to attend clinical at the sites mandating this requirement.
• CPR – The UMSL College of Nursing accepts ONLY the CPR certification from American Heart Association
• Basic Life Support (CPR and AED) Program - Your certification must remain current throughout the entire academic year. Online CPR classes that does not include the skill assessment session are not permitted.
• St. Louis Passport Program – Proof of completion or ‘transcript’ is required. All required courses must be completed regardless of whether or not you attend the entity that academic year. The Passport courses must be renewed yearly on or before its expiration date. See MO Passport Program Requirement document for more detail.
• Consent to Release SSN to Clinical Agency – The school form (available in the BSN Clinical Requirement Guide) must be signed and dated, and upload to your myClinicalExchange account.
• Lab Consent Form – The lab form (available in the BSN Clinical Requirement Guide) must be signed and dated, and upload to your myClinicalExchange account.
• Health Insurance – All students are required to have health insurance, and upload proof of such in the myClinicalExchange system at the start of the clinical major. Students are responsible for any injuries that occur at residency sites. UMSL’s Health, Wellness and Counseling Services offers student health insurance. You must provide proof of health insurance with your health documents.

Additional requirements and/or disclosures may become necessary throughout the course of the program or be required by the clinical agency. Any non-compliance to these mandates may result in failure to progress or dismissal from the program.

University Health Services may be utilized to complete clinical immunization requirements or you may obtain and submit compliance documentation from an authorized healthcare provider/clinic. If the healthcare provider uses a different form than the one provided or simply provides copies of immunization records, students are required to have the information transferred to CastleBranch.

Injury & Exposure

All students must have health insurance coverage and are financially responsible for the health care associated with any injuries or illness that may occur on or off-campus, including those at clinical agencies. UMSL students are not covered by UMSL, UMSL Worker’s Compensation, or the clinical agencies for any injuries that occur on or off-campus. If a change in coverage or insurance provider occurs, students must notify the college’s Academic Program Compliance Coordinator. All costs incurred are the student’s responsibility.

Transportation

Students are responsible for securing transportation to and from clinical agencies. Clinical experiences are scheduled throughout the St. Louis metropolitan area, including Jefferson County and parts of Illinois. Students using public transportation must inform their Program Director and the Director of Clinical Operations.

Essential Abilities

ATI Policy

All pre-licensure nursing students will use the Assessment Technologies Institute (ATI) Nursing Education program. ATI assessments provide one way to identify student strengths and weaknesses for teaching and learning purposes. ATI assessments provide a plan for filling learning gaps by providing knowledge assessments and focused reviews to guide remediation. This program is designed to assist in identifying student mastery of content (Level 2 proficiency) and prepare the student for the National Council Licensure Examination (NCLEX).

Statement of Academic Honesty

UMSL encourages students to pursue excellence within a respectful and collegial environment and to assume responsibility for the consequences of personal actions. For that reason, the University requires students to reject any type of dishonest behavior. Conduct for which students are subject to sanctions falls into multiple categories and can be viewed in Section 200.010 Standard of Conduct. Specifically, Academic Honesty precludes cheating, plagiarism, sabotage and/or forgery, alteration, or misuse of University and CON documents.

BSN Program Professional Requirements

Each BSN student will be academically evaluated on their ability to meet the following requirements as influenced by the NSNA Code of Academic and Clinical Conduct. Failure to meet these expectations may render a student ineligible for program progression.

General Requirements may be defined as, but is not limited to:

1. Prepared and punctual attendance in all classes and clinical (includes skills lab and simulation) experiences.
2. Complete assignments according to timelines designated by the course instructor and
3. Demonstrate honesty and integrity in one’s work by giving credit for the ideas and work of others and providing proper citation of source materials.

Professional appearance may be defined as, but is not limited to:

1. Maintenance of professional attire and appearance, including by not limited to the CON student nursing uniform.
2. Adherence to agency dress-code
3. Display of appropriate professional and University

Professional conduct may be defined as, but is not limited to:

1. Protection of patient rights and
2. Maintenance of patient confidentiality and HIPPA
3. Academic Honesty (See Academic Honesty Statement below).
4. Delivery of safe nursing
5. Prompt reporting of mistakes, errors, accidents or unusual circumstances to supervising faculty and appropriate health team staff.
6. Adherence to policies of clinical agencies and those of individual
7. Functioning under the specific direction of
8. Civil, courteous and respectful interpersonal interactions (See Civility Statement).
9. Prepared, present and

A faculty member is obligated and has the authority to remove a student from any academic activity in which the student's behavior is irresponsible, unsafe, or unprofessional.

Safe Professional Practice by Students in Clinical Settings Policy

Indicators to be used as guidelines for evaluating safe practice are:

1. Biological, Psychological, Social and Cultural Realms: The student’s practice meets the needs of the patient from a biological, psychological, sociological, and cultural

Examples of unsafe practice include but are not limited to the following:

1. displays mental, physical, or emotional behavior(s) which may negatively affect others’ well-being;
2. displays disrespectful and unprofessional behavior, g. uses profanity
3. fails to follow through on suggested referrals or interventions to correct deficit areas which may result in harm to others;
4. acts of omission or commission in the care of patients, such as but not limited to:
   1. physical abuse,
   2. placing the patient in hazardous positions, conditions or circumstances,
   3. mental or emotional abuse, and
   4. medication errors;
5. interpersonal relationships with agency staff, co-workers, peers, or faculty that result in miscommunications, disruption of patient care and/or unit functioning;
6. inability to perform psychomotor skills necessary for carrying out nursing

2. Accountability: The student’s practice demonstrates consistency in the responsible preparation, documentation, communication, and promotion of continuity in the care of patients.

Examples of unsafe practice include but are not limited to the following:

1. failure to provide concise, inclusive, written and verbal communication;
2. failure to accurately record comprehensive patient characteristics and behaviors;
3. attempting activities without adequate orientation, theoretical preparation or appropriate assistance; 

3. Regulatory: The student practices within the boundaries of the Missouri Nurse Practice Act, the guidelines set forth in the course syllabus, the UMSL College of Nursing BSN- Prelicensure Student Handbook, UMSL policies and procedures and the rules and regulations of the health care agency or agencies that are the site of the clinical

Examples of unsafe practice include but are not limited to the following:

1. failure to notify the agency and/or instructor of clinical absence
2. failure to adhere to the dress code
3. presenting for clinical practicum under the influence of drugs and/or alcohol. It is expected that students in laboratory settings will not have used alcohol for at least eight (8) hours prior to the beginning of the clinical time period, nor to use alcohol during the clinical period. At no time is the use of illicit drugs condoned.
4. habitual tardiness to clinical assignments
5. undertaking activities outside the scope of the course
6. criminal behavior

4. Ethical: The student practices according to the American Nurses Association Code of Ethics and the Standards of Practice.

Examples of unsafe practice include but are not limited to the following:

1. refusal of assignment based on patient’s race, culture, sexual orientation, or religious preference
2. failure to maintain confidentiality
3. dishonesty
4. misrepresentation of information to the public
5. ignoring unethical behavior(s) of other health care persons in the clinical setting(s) which affects patient welfare

Faculty/staff observing behaviors or circumstances that indicate that the student is potentially unable to practice safely in the clinical setting may remove the student from the clinical setting and refer them for appropriate assessment and intervention. Evidence that problems are/or have been appropriately addressed may be required before the student returns to the clinical setting.

A student whose pattern of behavior is found to be unsafe may be terminated from a clinical practicum for reason of unsafe practice at any time during the semester. If the behavior is identified before the drop date the student will be directed to drop. If the drop date has passed the student will receive a grade of “F” for the course. To continue in the nursing program a student who is terminated from a clinical practicum must appeal to the Undergraduate Committee for readmission to the nursing program.

A student whose pattern of behavior endangers a patient’s peers, staff members, or clinical instructor’s safety will be given a verbal and written warning by the primary clinical instructor. If the student’s pattern of behavior is repeated, the student and faculty will meet with the course coordinator. Upon a decision by the faculty and course coordinator that the student’s conduct is unsafe, the student may be terminated from the clinical practicum and will be directed to drop or will receive an “F” for the course. Documented evidence from the student, faculty, and/or agency staff will be considered in the decision to terminate a student from a clinical practicum. The student may appeal this decision to the Undergraduate Committee.

The primary clinical instructor will:

4. Provide instruction, guidance, and interpretation of objectives during the clinical
5. Document patterns of behavior related to attainment of clinical objectives. (Documentation may include direct observation by the clinical instructor as well as by agency personnel and patient comments as appropriate. Written work will also be )
6. Give a verbal and written warning for patterns of behavior, which are not
   1. Submit an Academic Alert and counseling
   2. Provide specific facts of problem areas or deficiencies in relation to course objectives, evaluation tool(s), and performance.
   3. Delineate corrective action, expected outcomes, and time for change in behavior in writing with copies given to the student, course coordinator, the director of the particular program and associate dean of the undergraduate program with one copy retained by the instructor. One copy will also be placed in the student’s file in the College of Nursing Student Services department. The student and the clinical instructor must sign the written counseling If the student delays meeting with the instructor a copy of the counseling record must be addressed and mailed to the student by certified mail.
7. Meet with the student and course leader to examine concerns. The student may have someone present at this meeting in an observational capacity. The student wishing the presence of an observer must so notify the instructor or the course leader before the meeting. The deliberations and conclusions of this meeting will be summarized in a letter addressed to the student and copied to the course leader, program director and associate dean for the undergraduate program.
8. Provide written summary of areas of deficiency, corrective actions, and outcomes on re- evaluation of student performance to Undergraduate Committee if requested.
9. In lieu of steps 2-4, the instructor may immediately suspend the student from the clinical practicum if the issue of safety is of significant magnitude affecting one or more parameters of safe clinical practice and/or jeopardizing the well-being of patients, staff, or peers. The student may only return to the clinical setting at the discretion of the instructor until a decision has been obtained from the Undergraduate Committee.
10. Nothing in this procedure precludes the instructor from removing the student from clinical practice on a day-to-day basis because of the potential for unsafe practice on that

The student may request a hearing by filing a verbal and written request with the Chairperson of the Undergraduate Committee. The request must contain specific allegations for which the hearing is being requested. These allegations must be substantiated by documentation from both of the involved parties. The Undergraduate Committee will follow its procedures and timeliness in conducting the hearing.