Minimum Standards Required to Participate in Practicum

The James Madison University School of Nursing strives to select diverse applicants who have the potential to become competent, client-centered, nurses. The accredited programs within the SON adhere to the current accreditation standards for nursing education. The practice of nursing occurs in complex and changing environments that require nurses to exercise clinical reasoning using knowledge, attitudes, skills, and behaviors within the context of client interactions.  Within these guidelines, the SON has the responsibility for selecting and evaluating its students; designing, implementing, and evaluating its curriculum; and determining who should be awarded a degree. Likewise, the SON has a responsibility to the public that its graduates are competent and caring capable of doing work that benefits and does not harm their clients. Students who seek to obtain an accommodation or determine their eligibility for one should contact James Madison University’s Office of Disability Services.  They can be reached by email at disability-svcs@jmu.edu or by phoning (540) 568-6705 (Voice/TDD), (540) 568-7099 (FAX). Additional information can be found on their website.

It is important that students admitted to our programs possess the intelligence, integrity, compassion, humanitarian concern, and physical and emotional capacity necessary to practice nursing in a variety of settings. Admission and retention decisions are based on multiple factors including satisfactory academic achievement, as well as the candidate’s ability to demonstrate the knowledge, skills, and attitudes for graduation, and licensure or certification. 

In order to successfully complete programs within the SON and meet the requirements to practice nursing, students must be able to meet all technical standards with or without the use of accommodations.   

Communication: Prospective and current students must possess communication skills that allow them to:

• Communicate effectively and respectfully with people verbally and nonverbally, in writing, and within a variety of electronic and virtual formats. 
• Accurately perceive verbal and nonverbal communications from others within a variety of academic, community, educational, and clinical environments. 
• Communicate sensitively and flexibly with others, taking into consideration development, cultural values, and diverse abilities of communication partner(s). 
• Be proficient in written and spoken English. 
• Adequately convey written information to meet curricular, clinical, and scholarly demands including but not limited to clinical documentation, evaluation/outcome data, and written reports. 
• Access and comprehend information from images, electronic and written materials to meet academic and clinical demands, including but not limited to academic resources, medical records, standardized assessments, and clinical reports. 

Cognition: Prospective and current students must use cognitive skills to:

• Demonstrate effective critical thinking skills in order to safely and effectively direct the nursing process. 
• Identify salient information, recognize patterns and deviations from patterns in order to effectively recognize, define and address clinical problems. 
• Comprehend, retain, recall, integrate, assimilate, infer, analyze, evaluate, and apply information from diverse sources of information in order to conduct all steps of the practice of nursing. 
• Generate discipline-specific documents, clinical reports, and scholarly works 
• Critically analyze and apply data from written scenarios and live encounters into evaluation and intervention processes. 
• Evaluate safety, and create and maintain safe environments during practice of nursing while anticipating potential risks and safety hazards in environments, and designing strategies to minimize potential for harm. 
• Take initiative to flexibly, effectively, and efficiently solve problems. 
• Demonstrate self-awareness in order to monitor and evaluate one’s own knowledge and skills. 

Social, Emotional, Behavioral and Self-regulation Skills: Prospective and current students must use social, emotional, behavioral and self-regulation skills to:

• Demonstrate one’s composure in noisy, malodorous, or visually complex, emotionally charged, and intense situations to maintain a safe and therapeutic environment. 
• Demonstrate self-care and personal hygiene routines. 
• Demonstrate self-regulation in the context of receiving feedback regarding areas for improvement. 
• Demonstrate awareness of, and attend and respond to the needs of others effectively, compassionately and respectfully in order to establish and maintain therapeutic relationships with clients. 
• Communicate professionally with peers, faculty, interprofessional team, clients, their families and the general public. 
• Demonstrate the flexibility and adaptability within dynamic clinical, professional, and academic contexts. 
• Manage time effectively in order to complete professional and technical responsibilities within time constraints. 
• Demonstrate personal and professional integrity as well as commitment to uphold professional ethics and codes of conduct that protect clients and the public 

Ethical Behavior and Adherence to Professional Codes of Conduct: Prospective and current students must:

• Adhere to professional codes of conduct and codes of ethics set forth by professional associations such as the American Nurses Association and state regulatory boards. 
• Comply with university, college, graduate school (if applicable), SON, and program-specific administrative, legal, and regulatory policies and procedures. 

Sensorimotor: Prospective and current nursing students must be able to:

• Access data from diagnostic instruments, standardized assessments, and evaluations (includes but not limited to clinical observations, text, numbers, tables, graphs, images). 
• Use vision, auditory, olfactory and/or tactile information to identify anatomical structures and functions on humans, anatomical models, and environmental features. 
• Observe clients and peers in order to assess health status and to perform evaluation and intervention processes. 
• Demonstrate sufficient postural control, neuromuscular function, strength, coordination and endurance to perform evaluations and interventions accurately, safely, and effectively in classroom, community, and clinical environments during a full work day. This includes fine and gross motor functions needed to safely operate equipment, position clients for treatment, and demonstrate desired actions for educational purposes.   
• Respond to requests for help and emergency codes in a timely manner and to perform procedures such as CPR when required. 
• Safely navigate academic, clinical, and community environments. This includes the ability to maneuver in small places while safely guiding clients and their assistive devices when necessary. 
• Demonstrate sufficient fine motor function to perform nursing related skills and produce legible and accurate documentation of reports, charting, scheduling, daily correspondence, and presentations. 

James Madison University and the SON will provide reasonable accommodations to otherwise qualified students with properly documented disabilities who meet the minimum SON requirements. Reasonable accommodations will be provided as needed to facilitate a student’s progress in learning, performing, and satisfying the essential functions presented in this document. 

Clinical Sites Responsibilities

The School of Nursing contracts/affiliates with agencies for clinical placement for the practicum course and both students and faculty are guests in these agencies. Many agencies require that we provide them with documentation relative to CPR certification, criminal record, professional liability insurance, results of TB testing, Urine Drug Screen, etc.; the information you provide for us may be shared with them. It is the student’s responsibility to determine if any additional documentation is required for their selected clinical site prior to the start of the experience. This includes any additional vaccinations or background checks. In addition to other policies relative to clinical experiences, the following expectations relate specifically to clinical sites and personnel:

• Students are responsible for ensuring documentation in myRecordTracker is current and drug screen and background check have been completed through Application Station. Failure to comply will result in the student being dropped from the both the community health and clinical courses and a hold placed on the student’s account.
• Students are expected to act in a responsible, respectful manner in all interactions with patients and staff.
• Nursing students are expected to comply with written policies and procedures governing nursing practice in the practicum agency or institution, including policies and procedures regarding hazardous material, standard precautions and health requirements.
• HIPAA - Health Insurance Portability and Accountability Act- "The Department of Health and Human Services and all other health care agencies must ensure that their customers (ex: patients, insured individuals, providers and health plans) that the integrity, confidentiality, and availability of electronic protected health information they collect, maintain, use, or transmit is protected" (Federal Register, 2003, p1). Individual clinical sites may require students to attend their own HIPAA training sessions.
• Students are responsible to notify the faculty member if they will be absent from an assigned experience due to illness, weather or other reasons.
• For a clinical absence, see the Attendance Policy (p. 49).
• All information and personal data gained in practicum experiences must be treated confidentially.
• Nursing students are expected to dress in accordance with the School of Nursing policy and as acceptable to the agency.
• If a student is injured during any practicum experience, the designated agency procedure is to be followed.

Clinical Experiences

RN-BSN students provide services including direct care to individuals, groups and communities in practicum experiences and are liable for all actions taken. Students are expected to provide safe, appropriate, knowledge-based care that meets ethical and legal standards. The well-being of patients is the priority responsibility and students are expected to prepare for community practicum experience as directed.

Expectation of Competent Behavior and Performance

• Physical or mental inability to perform practicum responsibilities - If a student has sustained an injury (e.g. broken bone), illness, or disability after entry into the nursing program that prevents the student from meeting the objectives of a practicum course, the student may need to withdraw from the course. The practicum instructor will determine:
  • Whether course objectives can be met within the time frame of the course.
  • Whether the student is able to receive an incomplete (I) in the course and satisfy requirements within 3 weeks of the end of the semester; or
  • Whether the student will need to withdraw and re-take the course when the problem is resolved. This will affect student progression within the program
• Unsatisfactory or unsafe behaviors - may result in a clinical plan for success, clinical probation, or removal from the course (and subsequent failure of the course) at the discretion of the faculty practicum instructor. When a student is placed on clinical probation, the faculty instructor will document the incident or pattern of behavior. The instructor, program coordinator and student will meet to discuss the incident and to establish specific re-evaluation criteria and behavioral goals that will be put in writing and signed by the student and faculty member. Following clinical probation, subsequent unsatisfactory performance in the practicum or laboratory setting will result in faculty review and possible failure of the course.  

Uniforms & Dress Code

The following dress code guidelines are reflective of agency policies. As guests in practicum agencies, students are expected to convey dignity and respect through their dress and behavior.

• Identification badges are required with all uniforms, lab coats/scrub jackets, or street clothes in the clinical setting.  The JMU student ID (JACard badge obtained at orientation) must be worn above the waist with picture and name visible at all times.  Student ID badges will be obtained during the on campus orientation day. A clinical agency may require students to wear their agency ID.
• Clothing must cover the torso and undergarments should never be visible, either directly or through thin material.
• Jewelry must be simple, safe, and appropriate for the clinical area in which the student is learning. Facial and tongue piercing, and excessive (more than 2) ear adornments are not permitted. Ear “gauging” is not permitted. A simple ring worn on the ring finger of each hand may be worn. No other jewelry is allowed. A watch with a sweep second hand is required.
• Tattoos must not be visible.
• Nails are to be short in length and well groomed. Unchipped clear or pale shades of nail polish may be worn. Artificial nails are not allowed during clinical experiences for safety reasons.
• Hair must be arranged away from the face and neck. Long hair must be pulled back away from the face. Conservative hair ornaments are to be used as needed. No bandannas are to be used during practicum experiences. Males are to be neatly shaven, mustaches and beards clipped neatly.
• Fragrances are not to be worn during clinical experiences. Cleanliness of body and good dental hygiene are to be observed at all times.
• No gum chewing is permitted in the clinical settings at any time.

Attendance Policy

Students in the RN-BSN program are required by accrediting agencies to complete a minimum number of hours (45 total) in the community health practicum rotation. For this reason there is strict adherence to the following policy on attendance during this practicum course.

• The student will complete the required number of practicum hours within the designated summer session and as agreed upon with the course faculty/designated clinical preceptor. Students may complete no more than 12 hours per day of the 35 hours direct contact hour total for the practicum experience.
• In the case of clinical absence that interferes with course completion and is related to a faculty determined extenuating circumstance, a conference between student, clinical/course coordinator, and the program coordinator may be held for the purpose of planning completion of the course requirements.
• One undocumented absence will result in the student being placed on clinical probation. The clinical absence must still be reconciled.
• Two undocumented absences will result in a clinical failure.
• Students who have been absent for illness, must be afebrile and without symptoms for 24 hours prior to return to clinical.

Health Insurance

Students are required to maintain health insurance coverage while enrolled in the JMU RN-BSN program. Our associated clinical facilities require this of all faculty and students. Students must complete a verification of insurance form upon entry into the program, submit this documentation in their myRecordTracker, and notify the RN-BSN Program Coordinator if the student no longer has health insurance coverage. Students without health insurance coverage will be restricted from the clinical setting.

Liability Insurance

JMU through the State of Virginia provides malpractice coverage to the amount required in The Code of Virginia. Coverage is per occurrence for each individual student and covers student practice that is an assigned course-related activity. It will NOT cover student work outside course experiences (eg. as an aide, a volunteer, or a summer extern).

Students may purchase additional insurance beyond the state's policy. Information on purchasing liability insurance can be found by visiting the Nurses Service Organization website at http://www.nso.com/.

Potential Injury

Persons under stress from physical or emotional ill health often direct feelings on persons in the environment. Students are in settings (community agencies, institutions and homes) where agitation, hostility, anger, sexually inappropriate and other unpredictable behavior can occur and students must learn strategies for dealing with problem behavior.

When making home visits the student should be particularly alert to risks related to the consumption of alcohol, drugs or other substances, dogs or other factors that might be a threat to safety. They should be aware of locations that call for special alertness; note lighting, open spaces, shrubs or other structures that might impair vision.  The student should be sure someone knows when and where they are going. The student is encouraged not to take risks and may go in pairs as a safety measure. When the student feels uncomfortable with what is happening with a client they are responsible to inform the faculty and/or agency personnel so resolution can be found.

Blood-Borne Pathogens

In order to minimize and prevent the exposure of nursing students, faculty, and patients to Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV), the School of Nursing has adopted the following policy and exposure control plan to provide education, prevent exposure and contamination, and provide appropriate follow-up should exposure occur. This policy and exposure control plan conforms to and is not in conflict with the requirements of local, state and federal laws and the Centers for Disease Control guidelines for prevention and transmission of HIV/HBV, James Madison University and the clinical sites utilized in the nursing program. It is the responsibility of each nursing student to be familiar with the provisions of this policy and to operate accordingly.

The OSHA/VOSH 1910.1030 Blood Borne Pathogens Standard was issued to reduce the occupational transmission of infections caused by microorganisms sometimes found in human blood and certain other potentially infectious materials. Although a variety of harmful microorganisms may be transmitted through contact with infected human blood, Hepatitis B Virus (HBV) and Human Immunodeficiency Virus (HIV) have been shown to be responsible for infecting workers who were exposed to human blood and certain other body fluids containing these viruses, through routes like needle-stick injuries and by direct contact of mucous membranes and non-intact skin with contaminated blood/materials, in the course of their work. Occupational transmission of HBV occurs much more often than transmission of HIV. Although HIV is rarely transmitted following occupational exposure incidents, the lethal nature of HIV requires that all possible measures be used to prevent exposure of workers.

Methods of Compliance

• Standard Precautions: Standard precautions are based on the fact that the existence of pathogens cannot be known in all situations. In some instances, patients harboring blood-borne infections may never be identified as representing a potential infectious risk. In settings such as outpatient clinics, identification of patients who present a potential infectious risk is impractical if not impossible. Because one can never be sure who might be infectious, STANDARD PRECAUTIONS are recommended for all patient contacts. These precautions should minimize the risk of transmission of blood-borne infections. Therefore, all blood or other potentially infectious materials are to be handled as if they are contaminated by a blood-borne pathogen. Under circumstances in which differentiation between body fluid types is difficult or impossible, all body fluids shall be considered potentially infectious materials. Laboratory specimens from all patients must be treated as infectious.
• Engineering and Work Practice Controls: The use of appropriate practices are outlined and followed as specified in the individual practicum settings utilized to eliminate or minimize exposure. Where occupational exposure remains after institution of these controls, personal protective equipment is also used.
• Hand-washing and Other General Hygiene Measures: Hand-washing is a primary infection control measure which is protective of both the employee and the patient and must be diligently practiced. Students shall wash hands thoroughly using soap and water or other approved antibacterial waterless hand sanitizer whenever hands become contaminated and as soon as possible after removing gloves or other personal protective equipment. When other skin areas or mucous membranes come in contact with blood or other potentially infectious materials, the skin shall be washed with soap and water, and the mucous membranes flushed with water, as soon as possible. Appropriate hand-washing facilities are available in clinical facilities and in the nursing skills center. Blood and body fluid spills should be cleaned up promptly. Gloves should be worn and the area decontaminated according to institutional policy. If not specified, a freshly made solution of one part chlorine bleach to 9 parts water can be used.
• Sharps Management: Needles, especially contaminated needles and other contaminated sharps, should not be bent, recapped or removed. Shearing or breaking of contaminated needles is prohibited. Contaminated disposable sharps shall be discarded, as soon as possible after use, in the disposable sharps containers. In practicum settings procedures are followed as outlined for sharps use and disposal. In the campus-based nursing skills center appropriate containers (closable, puncture resistant, labeled or color-coded, and leak-proof on sides and bottom, and maintained upright throughout use) for the disposal of sharps are provided as a protective mechanism even though sharps are used for practice on oranges, manikins, etc. and do not involve use with human subjects. Nearly full containers are to be promptly disposed of (or emptied and decontaminated in the case of reusable sharps) and replaced. In the skills center the disposal of sharps containers is the responsibility of the skills center coordinator.
• Personal Protective Equipment: Personal protective equipment is available and is to be used according to the specifications of the individual clinical site being utilized. Students are expected to wear personal protective equipment when doing procedures in which exposure of the skin, eyes, mouth, or other mucous membranes to blood or other body fluids is likely. The articles to be worn will depend on the expected exposure.
• Protection for Hands: Gloves should be worn when handling body secretions; when contact with blood or other potentially infectious bodily fluids and mucous membranes or non-intact skin is likely; when handling soiled items or surfaces; and when performing venipuncture or giving parental medications. Gloves should be changed after direct contact with each patient. Environmental contamination should be prevented by removing gloves as soon as possible after contamination. Gloves should not be washed and reused. Hands should be washed after gloves are removed. Gloves should be replaced as soon as feasible when contaminated, torn, punctured, or when their ability to function as a barrier is compromised.
• Protection for Eyes/Nose/Mouth: Masks and protective eyewear are not routinely indicated. In many instances, personal eyeglasses will provide adequate eye protection. Students shall wear masks in combination with eye protection devices (goggles or glasses with solid side shields) or chin-length face shields whenever splashes, spray, splatter, or droplets of blood or other potentially infectious materials may be generated and eye, nose, or mouth contamination can be reasonably anticipated. When suctioning intubated patients or caring for patients with productive coughs, e.g., during a sputum induction procedure, protection with masks and eyewear shall be used.
• Protection for the Body: Gowns are not routinely necessary, but a variety of garments including gowns, aprons, lab coats, clinic jackets, etc. are to be worn when soiling of clothes with blood or other body fluids is likely. Surgical caps or hoods and/or shoe covers or boots shall be worn in instances when gross contamination can reasonably be anticipated. If penetrated by blood or other potentially infectious material, the garments should be removed as soon as possible and placed in a designated container for laundering or disposal.
• Laundry: Linen soiled with blood or other body fluids are to be placed in bags designed and marked for that purpose as specified in the given institution. Contaminated laundry shall be handled as little as possible with a minimum of agitation. Wet contaminated laundry which may soak-through or cause leakage from bag or containers must be placed in bags or containers which prevent soak- through and/or leakage of fluids to the exterior.
• Regulated Wastes and Communication of Hazards: Disposal of waste materials regulated by this standard is to be handled according to institutional policy. The presence of hazardous materials is to be identified according to accepted procedures of the given institution.

Procedures for Evaluation and Follow-Up of Exposure Incidents

An exposure incident refers to specific contact of eye, mouth, or other mucous membrane, non-intact skin, or parenteral contact with blood or other potentially infectious material. A significant occupational exposure is defined as:

• A needle stick or cut caused by a needle or other sharp that was actually or potentially contaminated with blood or other body fluid.
• A mucous membrane (i.e., splash to the eye or mouth) exposure to blood or other body fluid.
• A cutaneous exposure involving large amounts of blood or prolonged contact with blood, especially when the exposed skin was chapped, abraded, or afflicted with dermatitis.

1. Immediately clean the skin or wound thoroughly with alcohol-based hand sanitizer (containing at least 60% alcohol). If an alcohol-based hand sanitizer is not available, wash the skin or wound with soap and water. In case of eye exposure, rinse eye(s) thoroughly with fresh water or sterile saline solution. Do not squeeze a puncture wound. This causes micro-trauma and swelling and doesn’t help.
2. The student must report any incident of exposure to the clinical instructor or preceptor immediately.  
   • The instructor or preceptor must notify the RN-BSN coordinator as soon as possible and submit documentation of the incident (Unusual Incident Report) within 24 hours to the RN-BSN Program Coordinator. 
   • In the event the RN-BSN coordinator is unavailable, the Associate Director for Undergraduate Programs should be notified. 
3. The student and preceptor must notify the appropriate individual at the clinical site who is responsible for evaluating and following up on exposure incidents (for example, occupational health or hospital supervisor). 
4. The patient involved will be tested for infectious disease according to the facility’s policy. The facility will communicate the affected patient’s test results to the exposed student, according to the facility’s policy. (The CDC recommends the involved patient be tested for: Rapid HIV, Hepatitis B Surface Antigens, Hepatitis C Surface Antigens). 
   • The student must receive notice of the patient’s rapid HIV results, without receiving other identifying information about the patient, from the facility before leaving the facility.  
5. After receiving the patient’s rapid HIV results, the student will call the JMU Health Center Patient Advocate Nurse (540-568-7777) (or a private provider if not in the vicinity of JMU or after business hours) to obtain necessary testing. The student is responsible for any fees associated with lab testing. (The CDC recommends testing for rapid HIV within 24 hours after exposure, and testing for Hepatitis B Surface Antigen within 7 days after exposure, unless the exposed student can provide evidence of a positive Hepatitis B titer).
6. After receiving the patient’s Hepatitis B and C surface antigen results, the student will report the results to the JMU Health Center Patient Advocate Nurse (540-568-7777) (or to their private provider).  
   • The decision to test the student for Hepatitis C surface antigens and antibodies will be decided by the JMU Health Center Provider (or private provider) based on the patient’s results.
   • The JMU Health Center provider (or private provider) will make treatment decisions on a case by case basis. 
   • The JMU RN-BSN Program recommends following the CDC guidelines for post-exposure follow up.  
     •  Rapid HIV testing at the time of exposure, 6 weeks, 3 months, and 6 months after exposure.  
     • If the patient is positive for Hepatitis C Surface Antigens, the student should be tested for Hepatitis C antibody at 2 weeks, 4 weeks, and 8 weeks after exposure. 
7. The student is responsible for following up with the JMU Health Center (or private provider) after an exposure and for paying for all laboratory fees.