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

To protect the health, safety, and welfare of patients/clients, clinical agency staff, and nursing peers, there are specific requirements related to immunizations, screenings, and insurance coverage. Prior to the first clinical semester, students must fulfill compliance clearance requirements as detailed below. All requirements must be completed by a specified deadline based on program and clinical start date. Nursing students will also be responsible for remaining compliant with renewal of clinical requirements throughout the BSN nursing program. (These requirements are also listed in the Clinical Requirement Guide.) 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.

All BSN students must create a myClinicalExchange (mCE) account. 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. The background check and initial drug test are completed one-time, prior to beginning clinical rotations. The medical document tracker, however, must be updated at the beginning of each semester. 

Students must also complete a background check and drug test through a secure system called CastleBranch (CB). Students must complete all of the requirements specified in mCE and CB prior to the start of the first clinical semester. The background check and initial drug test are completed prior to the first semester of clinical placement. However, the medical document tracker will need to be updated at the beginning of each semester in mCE. Note that students are provided with clear, detailed instructions regarding the creation of mCE and CB accounts. Full compliance with mCE and CB is required prior to attending the first day of clinical. Failure to meet this requirement may impact the student’s progression through the program.

Missouri’s Family Care Safety Registry (FCSR) – MO FCSR is part of our criminal background check requirement. Students are required to register in the MO FCSR before setting up a criminal background check. Students must apply online or complete the paper form and apply by mail. There is a fee of approximately $13 (plus a one-time processing fee if you register online). If you are already registered through MO FCSR, there is no need to register again. To determine if you are an MO FCSR registrant, visit the Registry and enter your Social Security Number. CastleBranch will not be able to pull your data and upload it into your account until you have successfully registered in the MO FCSR database. All personal identifying information provided to CastleBranch must match the information in the MO FCSR. Information about MO Family Care Safety Registry (MO FCSR) can be found on the Missouri Department of Health & Senior Services website. 

Insurance Coverage Requirement 

All students must have health insurance coverage and are financially responsible for the health care associated with any injuries (needle sticks, exposures, falls, etc.) or illness that may occur on or off campus, including on-site 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, including on-site at clinical agencies.
• If a change in coverage or insurance provider changes during the program, students must notify the colleges academic program compliance coordinator.
• UMSL’s Health, Wellness and Counseling Services offers student health insurance. You must submit proof of health insurance with your compliance documents.
• Students enrolled in clinical courses are provided medical professional liability coverage under the University of Missouri Medical Professional Liability Self-Insured Plan. 

Immunizations and Screenings 

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

• Criminal Background Check: 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) - All BSN clinical students must complete a UDS as required by CastleBranch (CB) prior to initial clinical The CB package includes the cost of the required 10-panel drug screening.
  • Students must obtain the screening at a CB-authorized testing site only (LabCorp). A drug test/screen taken outside of the CB process or approved facility will not be accepted. 
  • Results of the UDS are sent to and accessible in the student’s CB account.
  • A drug test result of negative meets the compliance
  • A drug test result of dilute negative would require the student to re-test by purchasing a separate UDS (only) package from CB. 
  • If a drug test result is positive, a CB medical review officer (MRO) will contact the student to review and request documentation of prescribed medications that may have bearing on the positive result. If no documentation can be provided, the student will not be allowed to attend clinical (which is a requirement of the program).
  • Provision of documentation of prescribed medications does not guarantee clearance to attend clinical.
  • The inability to attend clinical will prohibit a student from meeting course objectives and subsequent progression through the BSN program.

Below are the requirements that must be completed and submitted to myClinicalExchange (mCE) prior to beginning clinical. Students must remain compliant with these requirements throughout the program. Expired items must be updated to continue clinical.

• MMR (Measles, Mumps, and Rubella) – Documentation of either a positive MMR antibody titer (all three components: Measles, Mumps, Rubella) or two 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 antibody titer, two 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 antibody titer result is equivocal or negative, you will need to get the Hepatitis B immunization (one booster vaccine for equivocal and three 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.
• Tetanus, Diphtheria, and Pertussis (Tdap) - Vaccine performed no more than 10 years ago is required. Upon renewal, a new Tdap vaccine is needed.
• Tuberculin (TB) Skin Test - Proof of a two-step tuberculin purified protein derivative (PPD) skin test is required for the initial submission. 
  • A two-step PPD involves two separate injections (each skin test will need to be read 2-3 days later) at least one week apart and no more than three 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 two 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 obtain a TB/PPD skin test BEFORE obtaining any further vaccinations since many immunizations/vaccinations (especially live virus vaccines) interfere with the reading of a PPD skin test.
• Influenza – Proof of a current influenza 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 15.
• COVID-19 - Proof current COVID-19 vaccination is required by the start of the program. 
  • Vaccination may be a two-step process. 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 – 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.
• Basic Life Support (BLS)/CPR - The UMSL College of Nursing accepts ONLY BLS/CPR certification from American Heart Association (AHA) (CPR and AED) Program). 
  • Your certification must remain current throughout the entire academic year. Both the online class component and skills check-off are required.
• 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, dated, and uploaded to your myClinicalExchange account.
• Lab Consent Form – The lab form (available in the BSN Clinical Requirement Guide) must be signed, dated, and uploaded to your myClinicalExchange account.
• Additional requirements may become necessary throughout the course of the program or be required by the clinical agency. Non-adherence to clinical policies and requirements may result in failure to progress or dismissal from the program.

University Health Services may be utilized to complete clinical immunization requirements or students 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 and Exposure 

• In the case of an error or adverse patient safety event in which a student is directly involved, the clinical instructor, student, and patient’s assigned staff nurse, where applicable, should notify and collaborate with the patient’s inpatient/agency medical provider team to correct/manage the error and ensure patient safety. The charge nurse/lead RN and unit/agency manager, where indicated, should also be informed of the error/adverse event. 
• For student exposure to pathogens or hazardous materials occurring in a facility or agency having a written exposure protocol, the student, with instructor support as needed, should contact the occupational health department or designated representative of the agency where the incident occurred and follow the agency protocol for the specific injury or exposure. 
• For student exposure to pathogens or hazardous materials occurring in a facility or agency not having a written exposure protocol, the student, with instructor support as needed, should immediately inform an administrative representative of the agency and complete documentation of the exposure per agency/facility guidelines. The student should notify their healthcare provider of the exposure and follow recommended protocols. 
• If a student is exposed to a patient/client with tuberculosis (TB), the student must seek treatment from a health care provider and follow the protocol established by the respective Health Department. Depending on the exposure, proof of treatment/medical clearance may be required prior to the student’s or faculty member’s return to campus or clinical.
• Following stabilization of the patient and notification of the inpatient/agency provider team and designated unit RN leadership team member, the event reporting guidelines of the specific clinical site should be followed. Appropriate and accurate documentation within the event reporting system is essential. The patient’s assigned RN, charge nurse, nurse manager or designated clinical leader should complete the event report. The student and clinical instructor may be included in the event report as indicated. 
• All adverse safety events, errors and student injury/exposure should also be communicated to the lead course faculty and Director of Clinical Operations.  A UM System incident/report will be completed and submitted. 

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 should 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).

Conduct and Academic Integrity Policy

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 Section 200.010. 

All University of Missouri students are subject to the Standard of Conduct for students which appears in Section 200.010 of the Collected Rules and Regulations of the University of Missouri and for which they may be disciplined in accordance with the procedures in Section 200.020. 

Students of nursing have a responsibility to society in learning the academic theory and clinical skills needed to provide nursing care. The clinical setting presents unique challenges and responsibilities while caring for human beings in a variety of health care environments. The Code of Academic and Clinical Conduct (Student Handbook NSNA Code of Academic and Clinical Conduct) is based on an understanding that to practice nursing as a student is an agreement to uphold the trust with which society has placed in us. The statements of the Code provide guidance for the nursing student in the personal development of an ethical foundation and need not be limited strictly to the academic or clinical environment but can assist in the holistic development of the person. 

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 punctual

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

1. The student will demonstrate patterns of professional behaviors which follow the legal and ethical codes of nursing; promote the actual or potential well-being of patients, health care workers, and self in the biological, psychological, sociological, and cultural realms; demonstrate accountability in preparation, documentation, communication and continuity of care; and show respect for the human rights of individuals.

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.

2. Procedure:

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:

1. Provide instruction, guidance, and interpretation of objectives during the clinical
2. 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 evaluated).
3. 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.
4. 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.
5. Provide written summary of areas of deficiency, corrective actions, and outcomes on re- evaluation of student performance to Undergraduate Committee if requested.
6. 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.
7. 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

3. Formal Hearing by Undergraduate Committee

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.