Module 14 – Preparing for Clinicals

Learning Objectives

• Demonstrate understanding of Illinois Central College’s clinical practicum policies
• Demonstrate understanding of professionalism in the clinical environment

Illinois Central College (ICC) Clinical Policies

In this section we’ll be discussing the policies for nursing assistant clinical practicum listed in the Illinois Central College CNA Student Handbook. The policies are specific to ICC and may not all apply universally across different programs, though the basic insights will be valuable to any nursing assistant student.

The purpose of clinicals

The purpose of the clinical is to prepare someone to transition from nursing assistant training to practice by practicing the skill in a real healthcare setting. Clinicals are graded, and a passing score must be achieved to graduate from the course.

While the Illinois Department of Public Health requires 40 hours of clinical training, ICC’s program requires a minimum of 48 hours so trainees have enough time to become confident and reliable in caregiving.

Remember that NAs do valuable and needed work. By providing excellent care, nursing assistants improve someone’s quality of life and care outcomes. They also help people feel dignified and respected in times of vulnerability.

Expectations

Attendance

• Attendance is mandatory and required by the state of Illinois. Even a single absence could affect your grade in a way that results in an F in the course.
• Absence results in a “Zero” score for the day. Every day of clinicals trainees are assigned a score based on how effectively they applied the Big Three; if you are not present, you cannot demonstrate the skills and growth required to succeed, so absences are marked as “zero.”
• Lateness results in a “tardy,” and two tardies may count for a full day’s absence.
• If you are going to be late or absent due to unforeseen extenuating circumstances, contact your clinicals instructor right away.

Dress standard

• NAs should aim to dress in a way that allows for freedom of movement, is aesthetically neutral, free of adornment, and functional. Professional appearance will be an important dimension of clinicals evaluation.
• When trainees are wearing the clinicals uniform their appearance represents their institution. The NA clinicals uniform should be neat, clean, fit appropriately, and be the require ceil blue color. There may be a patch for the uniform indicating which program you are from.
  • Pants should be ankle-length; they should not drag on the floor, and should not be cropped. There are no undergarments visible in a well-fitting uniform.
• Always wear your clip-on photo identification.
• Shoes must be either leather or vinyl; no canvas shoes are permitted, as they are more difficult to clean. Shoes must be worn with neutral white socks.
• Uniforms include a watch with a second hand to keep exact time. No smart watches permitted, since these are an extension of your phone.
• A pen and pocket notebook are required. Take notes on how you can develop your skills, and apply them during your next shift.
• Removing all jewelry is best, but there is some limited jewelry allowed. You may wear a wedding band if married, a single earring per lobe (no hoops, loops, or anything likely to catch on something).
• No visible body or facial piercings. Visible facial and body piercings should be removed, not just covered.
• No visible tattoos. Cover them with a bandage if they cannot be covered by long-sleeved clothing.
• Hair should be a natural color and away from the face and collar whether short, in a bun, braid, ponytail, or something similar. Hair carries bacteria and can get in the way of visibility and care tasks. Keep beards neat and trimmed.
• Use minimal makeup in neutral colors, if any makeup at all.
• Nails must be short, trimmed, and well-filed. Long nails can get in the way of some tasks requiring fine motor skills. They also allow for bacteria to build up under the nail, as do acrylic nails, gel nails, and tips. Nails must be well-groomed, natural, and free of nail polish.
• No cologne or perfume. Some people are sensitive to fragrances; not only could it create an unpleasant sensory environment for someone, it may even exacerbate breathing problems depending on the person and their space.
• Manage breath from smoking cigarettes, breath odors, and body odors using deodorant, mouthwash, and breath fresheners. Do not chew gum while at clinicals.
• No smoking during clinicals. Do not smoke in the uniform worn at clinicals either. If you think you’ll need nicotine in order to stay focused, alert, and positive during clinicals, consider using a nicotine patch or similar product.

CPR Requirement

• “CPR for the Healthcare Provider” certification must be obtained before starting clinicals. You cannot begin clinical training if you have not completed this course.
• Not completing CPR training prior to clinicals will result in dismissal from the program.

Daily Preparedness

• Arrive to the area on time, meaning 5 – 10 minutes before the scheduled start time.
• Arrive in uniform, do not wait until you get there to change.
• Follow all facility policies, procedures, and rules for clinical students. If you are unsure about something, ask!
• Only perform tasks that you have practiced and have been trained on. If the facility asks you to perform a task that you have not practiced, you must tell them so they can provide the proper training, or assign a different task. Performing tasks you have not been effectively trained on is outside your scope of practice, and is both illegal and unethical.
• Report observations and care given during clinicals to the clinical instructor. Always observe the residents closely; if you need to take notes to remember important details, use your pocket notebook and do not include the resident’s identifying information. Make sure you discuss your observations and care given with the clinical instructor before writing anything in the person’s chart.
• Report off to clinical personnel before leaving for the day at the end of your shift. In other words, make sure to tell the facility that you are leaving, and pass along all relevant observations and care notes.

Transportation

• Students are responsible for getting to and from clinical facilities on time, and for following any facility rules about parking.
• Drive the route to your clinical site in advance, whether carpooling, using public transportation, or taking your own or another’s vehicle; see exactly how long it takes, and whether the route will have traffic at the times that you’ll be going to clinicals.
• Plan carefully, and plan in advance.

Employment

• Clinicals should be students’ primary focus. Make sure to arrive at clinicals refreshed and ready to be present and attentive. Do not work a shift at another job right before clinicals.
• Never wear the ICC uniform anywhere other than clinicals, including another place of employment.
• Students are held personally responsible and liable for their actions at clinicals; if you mess up, it’s on you. Be attentive, and remember your skills.

Evaluation

• All clinicals trainees will receive a daily score based on their application of the Big Three during care. A “1” will involve errors made and a lack of consideration for Resident Rights, Safety, and Infection Control; a “4” indicates excellent care given, thoughtful and consistent application of the Big Three, and expectations exceeded. A “3” is a great score for the day – it means you effectively applied the Big Three across patient care. A “0” means you were absent, or were so careless during work that you may as well have been.
• Scores are cumulative; at the end of clinicals, the total score will determine passing. Students should show up every day ready to be present, fully engaged, and constantly thinking critically about how to give the best possible care.
• Failing clinicals means failing the CNA course, regardless of score during the classroom portion. Students who fail clinicals can still be admitted to the program again.
• When thinking about performing care to get the best grade possible, remember to apply the Big Three using critical thinking and efficiency.
  • Critical thinking here means to always be thinking about the Big Three in the back of your mind whenever planning or giving someone’s care. “Am I respecting the full scope of this person’s right to care? Am I practicing good infection control measures? Is there anything in this environment that presents a risk to the resident, myself, or another staff member?”
  • Efficient here means planning out tasks so that you already have everything you need and know exactly what you’re going to do before you do it. Efficient does not mean rushed, it means that you’ve managed your time well.
• Honesty, integrity, and remaining within scope of responsibility are the basis of evaluation. Always be accountable, direct, candid, and kind in your interactions with your instructor and team members.
• Accountability for behavior and time management involves showing respect for others’ humanity by treating them as equals and collaborators, respecting the chain of command, and asking for help when you need it. Accountability and time management go hand in hand – everybody’s time is valuable, and being respectful of other people’s time involves being punctual and managing your daily work effectively.
• Approach everything with a growth mindset. Work on doing all care tasks carefully and thoughtfully, and think about every day with an attitude of constant improvement.

Instructors

• Your instructors are there to support you. You can talk to them about difficulties you have on the job.
• Instructors will provide feedback one-on-ones at least every three days, or at their discretion.
• Instructors will not step in unless you are about to violate the Big Three. They are there to evaluate you and to help you learn, but not to stop you from making mistakes.
• Instructors will grade fairly. The most important thing for you to do is to focus on constant improvement.

Professionalism

Being professional in a clinical environment means always practicing accountability, conscientiousness, and excellence in all interactions.

• Accountability means reflecting on your actions honestly and taking others into consideration. To be accountable, we have to own up to what we don’t know and any mistakes we might make. This is to make it so that all residents receive care in line with their right to dignity, and so that everyone involved can learn and grow. Being a nursing an understanding that effective teamwork, honesty, and integrity are necessary to providing good care.
• Punctuality means always being on time. “On time,” in this case, means ready for pre-shift discussion between 5 and 10 minutes before the scheduled start time. Being punctual is necessary because clinicals are valuable time spent learning. You don’t want to miss any information. It also means that the team will be short-staffed; when you are late for clinicals, it shows the instructor that you need to work on time management in order to be a good NA.
• Always be honest with yourself, with your team, and with your instructor. Be honest with yourself about what you don’t know, and the areas you need to improve. Be honest with your team about when you need help, and when you see an opportunity to provide each other with constructive feedback; you can also be honest about your struggles. You’re all in this together!
  • Be honest with your instructor about when you need help, and about what you need to succeed. Clinicals are difficult, but everyone is there to support you.
• Being a good team member means communicating with your colleagues clearly and compassionately. The nursing team is able to provide the best care when everybody trusts each other and holds one another accountable in a growth-oriented way.

• Conscientiousness means carefully reflecting in a self-aware way about your presentation and the quality of the care you provide. It also means thinking ahead.
  • Clinicals students should be conscientious about professional appearance.
  • Always be on time! Don’t let yourself or your teammates down.
  • No smoking – smoking odors can create unpleasant sensory environments for residents.
  • No fragrances such as cologne or perfume. Even strongly scented soaps can create a negative sensory experience for someone who is sensitive to fragrances.

• Clinicals students should aim for excellence and kindness in all of their care and communications with residents and team members.
  • Show the utmost respect for the people you care for, for your team members, and for yourself. Always respect resident rights, and think carefully about how your actions, responses, and communication styles impact other people.
  • Show kindness in all of your interactions. Residents need kindness because it makes them feel cared for and respected, while team members need kindness because everybody is doing a difficult and high-stakes job. Similarly, show yourself kindness; you will be doing important work to improve the lives of vulnerable people. By recognizing your own human worth, you can extend that sense of human worth to others.
  • Maintaining a sense of enthusiasm will help create a positive learning environment for yourself and your fellow students. A sense of enthusiasm also translates into better care, and high-quality attention to the psychosocial needs of a resident. Enthusiasm helps you be present in your tasks, even when they feel mundane.
  • Show sincerity in your interactions, especially with residents. Try to be genuinely interested in their lives and who they are as people. The more sincere you are in your interactions the more residents will feel valued as individuals.
  • Empathy involves putting yourself in another’s position. Whenever reflecting on your actions, try to consider them from the perspective of another. Practicing empathy means being nonjudgmental – it is only by being nonjudgmental that you can cultivate a sense of understanding for the people you care for and work with.
  • Lead with integrity. Integrity means that you practice the same high standards for ethical behavior and attentive care just because that is the right thing to do, even when nobody is watching.

Clinicals and the Big Three

Conscientiously and critically applying the Big Three at all times is an important aspect of professionalism as a nursing assistant, and will be the basis of your instructor’s evaluation of you.

• Safety is an important concern at all times. It refers to the mode of thought that help notice risky situations before they become an accident or emergency; it also refers to the calm and orderly execution of responding to an accident or emergency.
  • Never run in a facility. Always remain calm and if you need to get somewhere fast, walk at a brisk pace.
  • OSHA workplace standards exist to help staff members keep themselves and one another safe. Always follow safety guidelines, and take any trainings the facility offers on safety concerns like body mechanics and preventing work place violence.
    • Watch your back! Back injuries are a big problem among healthcare workers, and even a single bad back injury could limit your career. Knowing how to move your body in healthy ways that protect your musculoskeletal system is an important dimension of continuing to provide high-quality care.
      • o If you are out of work with a back injury then your team will be short at least one member. Be a good team member and protect your back.
    • Watch out for potential workplace violence. If you see something that you think could possibly lead to a violent situation, tell the nurse right away. Workplace violence could come from residents and patients, their visitors and families, and other staff members.
  • Incident reporting is essential for facility risk management. Always report incidents like accidents, workplace violence, or errors in care.

A resident reports being uncomfortable in bed. She is in the supine position. What would you do, and why? Make sure to give as detailed of a description as possible. Write for 5 minutes, then discuss your answer with a friend or classmate.

• Infection Control
  • Wash your hands! Wash them often, and wash them thoroughly. Always wash your hands before patient contact, before any tasks that require asepsis (such peri-care or changing a dressing), after potential body fluid exposure, after contact with the patient, and after contact with any objects in the patient’s unit or surroundings.
    • Hand hygiene is the most important factor in infection control!
  • Break the chain of infection by practicing great hand hygiene, wearing proper PPE, and closely observing patients for early signs of infection.
  • Wear appropriate PPE; if you think it’s possible that a piece of PPE will help keep you from contracting and spreading infection, then you should just wear it. Gloves should be worn almost all of the time. Helpful pieces of PPE include face masks and respirators, gloves, gowns, and face shields.

You are assigned to a person being treated for MRSA in a wound. The nurse does not realize you have not taken care of this resident and has given you little information on what precautions to take. What should you do? Write for 5 minutes, then discuss with a friend or classmate.

• • Clean patient-care devices, such as a bedpan or incentive spirometer, after every use. Clean them after every use even if the patient is the only one using that piece of equipment.
    • Low-level disinfection for all surfaces and equipment after contact, such as bed rails and the side table, as well as equipment like blood pressure cuffs and lifting devices.

You are completing beginning tasks to assist in a Hoyer transfer. While positioning the lift pad, you notice it is damp and smells of urine. At the same time, the nurse comes by, telling you to hurry because the resident has a Dr. Appt and needs transferred to the W/C immediately. What should you do? Write for 5 minutes, then discuss with a friend or classmate.

• Residents’ Rights
  • Do not abuse or neglect residents. Abuse occurs whenever someone harms a resident physically, psychologically, emotionally, or financially. Examples include hitting, pushing, calling someone names, speaking in a harsh tone of voice, speaking in a way that lacks respect and care, and making them feel bad or less-than because of their condition. Neglect is when someone is harmed because they were ignored by someone who is meant to care for them. An example of neglect is when a resident wets themself because their call light went unanswered.
  • Always show kindness in your interactions with residents. If a resident behaves badly toward you, never retaliate and always maintain self-control.
  • Be attentive to the needs of the people in your care.
    • • HIPPA exists to protect peoples’ rights to privacy. Privacy is an important element of patient care.
        • Do not gossip about the lives and experiences of patient and residents. It is unethical, mean-spirited, and produces a hostile living condition. Similarly, do not gossip about your colleagues, even the ones who you don’t like or find annoying.
          • o Necessary discussions of residents, the nursing unit, and staff members and peers should be handled discretely and behind a closed door.
          • o The difference between gossip and a necessary conversation is that the latter is important for providing good care as a team, while the former is done for entertainment. Discussions of resident care and the happenings on the unity must be held in private, outside of anybody else’s earshot.
        • Don’t discuss medical matters, conditions, or give advice to residents and their families. This is irresponsible, and lies far outside the scope of NA responsibilities. Refer to the doctor.
        • Do not discuss a patient or a patient’s condition with your friends. It is not appropriate under any circumstances; you also never know what someone’s relation is. The person whose conditions you want to discuss with your friend may be their loved one.
        • No photos ever. Keep your cell phone turned off and out of site for the duration of your shift.
        • Do not take anything with patient info away from the medical site. This is an express violation of HIPPA.

A co-worker does not show up for work, causing staff to adjust their assignments. You stop at the nurse’s station to get an updated resident list. While at the station, you hear staff, talking about the aide who did not come in. You overhear, the aide may get fired as it is her 3rd call off this month. As you are getting Mrs. Smith up and prepared for breakfast, Mrs. Smith asks if you are short staffed today. What do you do to protect everyone’s right to adequate care and to privacy? Write for 5 minutes, then discuss it with a friend or a classmate.