7. Student Responsibilities in the Clinical Area

Student-Faculty Handbook

University of Detroit Mercy Graduate Program of Nurse Anesthesiology

Reviewed Aug 2001, Feb 2002, March 2003, Aug 2003, Jan 2004, Mar 2005, Apr 2006, Aug 2007, Aug 2008

Records

Each student will maintain a daily case record book in which pertinent case information is recorded. Each student must also maintain a monthly case spreadsheet which presents daily and cumulative case information. These grids are e-mailed to the program for monthly review and tally. The monthly case totals are due in the program office on the first of the following month, but in any case not later than CAC Wednesday (3rd Wednesday of the following month). Accuracy of records is essential and entirely the student's responsibility. Monthly grids with math or transcription errors will be returned to the student for corrections. These records remain the property of the anesthesia program. Students should use the cumulative totals on the second page to ensure that they are progressing towards the case totals required by the Councils on Accreditation and Certification. As they accumulate cases, it is their responsibility to seek assignments that will result in fulfillment of all required case totals.

The student must also submit all clinical evaluations monthly (by the third Wednesday meeting). In order to allow the process to work efficiently, this timely submission of materials is essential. Students may be suspended from clinical for failure to submit any of these records (case totals or clinical evaluations) in a timely fashion. The amount of time suspended will be deducted from the student's clinical release time.

Care Plans

Care plans are used to help students apply theoretical concepts learned in the classroom to individualized nurse anesthesia care in the clinical area. During the first month of clinical in term 2, students are expected to read up on and prepare for cases prior to the start of each clinical day. Written care plans for clinical are required beginning the second month of term 2. A standardized care plan form will be distributed to the students, which students are required to use. Written care plans must be submitted prior to the start of a case. The clinical instructors are encouraged to make written comments on the care plans as well as a notation on the evaluation form in reference to the quality of the care plan. Care plans are returned to the students with their evaluation forms daily and these are turned in to the program office monthly. Unless turned in (a Xerox is all right if you prefer to keep the original), care plans will not count towards your required totals.

The required number of care plans above refers to care plans written to help prepare the student for clinical. In addition, care plans may be assigned as part of the learning activities in the anesthesia principles classes.

Please remember that the required total number of care plans are minimums. The purpose of writing care plans is not to reach a numeric goal, but to help you to learn clinical anesthesia, individualize your care for each patient's needs, and to document your preparation for cases. Any instructor is justified in requesting a written care plan from you at any time in your education, particularly if the case is one you have never done before. The lack of a written care plan (particularly for cases for which you are a novice, or in which your clinical performance does not meet objectives for your level) often correlates with a general lack of preparedness.

For your obstetric rotation, you will not see many of your patients in time to prepare a written plan of care. One care plan per week should be prepared during your obstetric rotation:

1. elective cesarean section with SAB
2. urgent/emergent cesarean section with general anesthesia (include the drill for failed intubation)
3. vaginal delivery with all potential complications
4. neonatal resuscitation

Clinical Time

Most operating room cases start at 7:30am. Day shift clinical experiences are scheduled from 7:00 a.m. to 3:30 p.m. It is expected that the student will arrive and prepare their room and equipment by 7:00 a.m. and be ready to start assigned cases by 7:30 a.m. Clinical assignments are distributed the evening before surgery and all inpatients should be seen and evaluated preoperatively. Outpatient or same day admit patient records should be evaluated the evening before surgery in PAT (Preadmission testing) or on the Same Day Surgery unit. The plan of care developed and written for outpatients is then modified on the basis of assessing them the day of surgery.

Students who have cases that start later than 7:30 should assist other students or CRNAs with patient preparation. Students should check with the clinical coordinator regarding reassignment whenever cases are canceled, long breaks are scheduled in the room, or if the room finishes early. Students must also check with the clinical coordinator prior to leaving the operating room area for any reason. Students must comply with all department practices regarding time spent out of the department (e.g. 15 minute breaks, 30 minute lunches). It is expected that unassigned clinical time will be used for educational endeavors. Instructors will evaluate how well you utilize the learning environment.

Case preparation usually requires that students arrive earlier than 7:00 a.m. (to set up for large cases or unfamiliar situations), and stay past 3:30 p.m. (for continuity of care and educational enrichment). Students are encouraged to stay and finish all cases begun before 3:00 pm. The afternoon shift begins at 3:00 p.m. and ends at 11:30 p.m. The midnight shift extends from 11:00 p.m. to 7:30 a.m. Students are expected to continue working towards their terminal objectives on a daily basis.

Each student is required to attend and actively participate in clinical conferences as required by each clinical site. Students are also required to compile and maintain a pocket-sized reference book that contains current anesthesia information for use in the clinical area. There should be no textbooks or classroom reference notes brought into the operating room. It is against operating room infection control policies. No reading or writing of any materials except the patient chart is permitted in the OR.

Each student is expected to comply with the dress code and Department of Anesthesia policies of each affiliating institution. The student is informed of the policies at the time of orientation provided by each affiliating hospital. This includes Infection Control, Hazardous Chemical policies and attendance at department meetings.

Typical daily responsibilities of RNAS's before leaving clinical area

• restock cart, cupboards, and anesthesia machine
• untangle cords/wires
• machine turned off
• wipe down horizontal surfaces of machine and tabletop with disinfectant (found between rooms in substerile rooms)
• general check of anesthetizing areas
• return all narcotics to satellite pharmacy
• visiting post-op patients
• preop rounds on the following day's patients

Off-Shift Clinical Time

The CRNA in charge each shift is posted on the OR board. This CRNA is in charge of CRNA and student assignments for off shifts. The clinical coordinator during the day will make assignments for students on afternoons who should report to the coordinator when they arrive. If the clinical coordinator has left for the day, report to the charge CRNA for your assignment. If you are not assigned to a case, offer assistance with routine off-shift tasks (stocking carts, setting up for large cases). Typical duties of off-shift students include

• stocking all OR rooms and setting up the tabletop in rooms which are left set up for emergencies and in the OB suites. The day shift staff should set up these rooms prior to leaving for the day. If there are cases still going in those rooms at 3:30, the afternoon student must set up these rooms. This includes setting up the machine (make ready for case i.e. complete check, circuit, etc.) and tabletop (set up so that it is ready for cases).
• Blood warmers, patient warmers, equipment for pressure lines, etc. should also be readily available.
• Report to charge CRNA (OB) and offer assistance with code box stocking and cleaning and restocking of the obstetric anesthetizing areas.
• Check all ORs (i.e. oxygen left on?, medications left laying about?, etc.).
• Set up open heart rooms, and rooms with big cases, peds, etc.

Licensure

Students are required to maintain continuous and uninterrupted licensure as a Registered Nurse in Michigan, ACLS certification, and PALS certification, from enrollment through graduation. Students who do not possess a current Michigan license, ACLS, or PALS will not be allowed to participate in clinical internship. Days lost due to failure to maintain licensure will be deducted from the student's clinical release time as sick days (unscheduled absence).

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