Welcome Student!

During your time here you will gain a valuable and

worthwhile experience with our staff. We value and
support your dedication to your chosen profession and Student Orientation Packet
wish you the best while you are on campus. Welcome and Instructions p. 1
Sincerely, Mayo Value Statements p. 2
Mayo Clinic Health System Leadership Conduct and Behavior p. 3
Alcohol and Drugs p. 3
Dress and Decorum p. 4
Diversity p. 4
Integrity p. 5
Internet and Computer Access p. 5
Language Services; Patient Care p. 6
Patient and Customer Feedback p. 6
Patient Rights p. 7
Instructions
Personal Use of Cell Phones p. 7
Patient Satisfaction, AIDET p. 8
1. Read packet information
Our Commitment to Safety p. 9
2. Complete the Student Orientation Completion Form located at SBAR p. 10
the end of packet. National Patient Safety Goals p.11
3. Return the form to your clinical instructor prior to the start of Infection Prevention & Control p. 12
your clinical experience. Scrub 15 p. 13
Hazardous Chemicals p. 14
Equipment Safety p. 14
Safe Patient Handling p. 15
Fall Prevention p. 16
Restraints p. 17
Caring for Patient with Dementia p. 18
Instruction from teachers and books teaches a man Nursing Student Guidelines p. 19
what to think, but the great need is that he should Medication Administration Tool p. 20
learn how to think. —William J. Mayo, 1938 Blood Product Administration p. 21
Emergency Preparedness p. 22-23
Confidentiality Policy p. 24-26
Student Orientation Completion Form p. 27

1
Value Statements for Mayo Clinic Health System
These values, which guide Mayo Clinic’s mission to this day, are an expression of the vision and intent of our
founders, the original Mayo physicians and the Sisters of Saint Francis.

Primary Value Teamwork

The needs of the patient come first. Value the contributions of all, blending the skills of
individual staff members in unsurpassed
collaboration.

Respect Excellence
Treat everyone in our diverse community including Deliver the best outcomes and highest quality service
patients, their families, and colleagues with dignity. through the dedicated effort of every team member.

Compassion Innovation
Provide the best care, treating patients and family Infuse and energize the organization, enhancing the
members with sensitivity and empathy. lives of those we serve, through the creative ideas and
unique talents of each employee.

Integrity Stewardship
Adhere to the highest standards of professionalism, Sustain and re-invest in our mission and extended
ethics and personal responsibility, worthy of the communities by wisely managing our human, natural
trust our patients place in us. and material resources.

Caring Community
Inspire hope and nurture the well-being of the Partner with communities to promote health and
whole person, respecting physical, emotional and wellness, improve quality of life and support
spiritual needs. economic growth and development.

2
Conduct and Behavior
 Professional behavior is expected. In consideration of patients and staff in the area, loud
conversation or laughter is discouraged. Discussions should be conducted in a quiet and
confidential manner.
 You are expected to be under the supervision of designated staff at all times during the
clinical experience.
 It is expected that you will notify designated department staff if ill, will be late, or unable to
follow through with planned clinical experiences.
 Bring minimal personal belongings and money. No valuables. Mayo Clinic Health System is
not responsible for stolen and/or misplaced personal items. A location may be assigned to
keep personal belongings during the clinical experience.
 Personal cell phones must be turned off during the clinical experience. Cell phones and/or
cameras are not allowed in the experience areas.
 Mayo Clinic Health System reserves the right to review any written journals, reports, papers,
etc. prepared by students to assure confidentiality standards are being met.
 Students are not to request patients to sign any type of Release of Information forms.
 Mayo Clinic Health System reserves the right to terminate clinical experiences at any time
for any reason. Immediate follow-up communication with a school representative will be
done.

Alcohol and Drugs

Mayo Clinic Health System is committed to maintaining a work environment which is free from
the influence of alcohol and/or illegal drugs to protect the health, safety, and well-being of
patients, employees, and visitors.

Mayo Clinic Health System prohibits the use, possession, transfer and/or sale of alcohol and/or
illegal drugs while working, while on all premises owned, leased, or otherwise controlled by
Mayo Clinic Health System, and while operating any company vehicle, machinery, or equipment.

Mayo Clinic Health System also prohibits reporting for work and working anywhere on behalf of
Mayo Clinic Health System under the influence of alcohol and/or illegal drugs.

You are also responsible for reporting suspected alcohol and/or illegal drug use by any staff
member or student to your supervisor or the person responsible for your experience.

3
Dress and Decorum
The following guidelines have been developed to promote a professional image:
 Students must wear their school issued identification badge on the upper half of the body visible
to patients, employees, and other customers at all times.
 Students will be required to present a clean and neat appearance.
 Examples of appropriate dress include khakis, cleaned and pressed polo/t-shirts.
 Inappropriate dress examples include sweatshirts, spandex, leggings, tank tops, halter tops,
tops with spaghetti straps, cargo style (i.e. pockets on the legs, ties at the bottom of the
legs), sleeveless tops, no jeans/denim (any color) of any kind, skirts above the knee.
 Pants must be at least below the knee.
 Wearing of undergarments is required and should be discreet.
 Shoes appropriate to the area and dress must be worn.
 Dress sandals are acceptable, but no flip flops are allowed.
 No excessively high platform shoes or boots.
 Stockings may also be required in some areas to insure safety and infection prevention policies
are met.
 Visible body piercing should be limited to the ears.
 Facial hair must be well groomed and trimmed.
 Perfumes, cologne, after-shave or any other scented personal products may not be worn in
consideration of patients and co-workers who have sensitivity to such odors.
 Every attempt should be made to cover all visible tattoos.
 All Mayo Clinic sites are tobacco-free work environments.
 Students will be informed of specific department dress requirements.

Diversity
Mayo Clinic Health System values and promotes diversity as a strategic advantage. Mayo Clinic
Health System defines diversity as all the characteristics which distinguish individuals or groups
from one another. It includes distinctions based on race, color, creed, religion, gender, age,
national origin, marital status, sexual orientation, veteran's status, disability, or status with
regard to public assistance. Mayo Clinic Health System’s goal is to create a caring service
environment where individual differences are valued allowing all staff to achieve and contribute
to their fullest potential.

Mayo Clinic Health System’s goal is to serve patients, families and one another with respect,
concern, courtesy and responsiveness. A climate that nurtures and supports the fullest
contributions of everyone is essential to Mayo Clinic Health System’s success in patient care,
education and research. Creating and sustaining this climate are the responsibilities of all who
provide service and learn at Mayo Clinic Health System.

4
Integrity
The following are Core Principles for our daily interactions with patients, their families, our
coworkers and others with whom we interact:
 Mutual Respect, consideration and courtesy is expected of every employee, as well as
students, visitors, patients and family members
 A Work Place free of harassment, coercion or disruptive behavior
 We follow all laws and regulations applicable to our industry
 What do you do if you believe there may be a situation that is non-compliant with these Core
Principles?
 Report it – Students and Employees who work at Mayo Clinic have a responsibility to, in
good faith, report any known or suspected violation of Mayo policy or applicable law or
regulation.
 Avenues for Reporting
• Preceptor, Supervisor, Manager, Administrator
• Anonymous Toll Free Hotline: 1-888-721-5391
• Anonymous Online: MayoClinicComplianceReport.com
 Integrity and Compliance Program booklet is available upon request.

Internet and Computer Access

Use of the Mayo Clinic Health System network, remote access service, Internet access, computers,
and related infrastructure is primarily for Mayo Clinic Health System business-related activity or
professional development.
Mayo Clinic Health System reserves the right to examine, confiscate or surveil any computer or
device connected or linked to the corporate network and any activity or information stored on or
transmitted through any Mayo Clinic Health System computer or connected/linked device.

The electronic environment is part of the workplace and carries with it the same expectation of
mutual respect and confidentiality that applies to all other activities. Users may not access or store
material that would be considered inappropriate, offensive, or disrespectful to others.
Posting anything that could be construed as a Mayo Clinic Health System endorsement or that
reflects negatively on the organization is prohibited, such as items posted to internet bulletin
boards, social networking sites, micro blogging, mailing lists, online forums, etc. This also includes
any postings that have a negative impact on the performance of their job, conflict with their
obligation to Mayo Clinic Health System or in any way negatively impact Mayo Clinic Health
System’s reputation in the community.

5
Language Services
Interpretive services will be provided at the patient or family member request, or when identified by
the provider/staff member. If there is any doubt about the patient’s level of understanding in any given
situation, interpretive services will be used. Mayo Clinic Health System staff can arrange for interpreter
services as well as other tools available to provide this service. Interpreters meet qualifications and
have the training and medical interpreting experience to assure professional, competent and safe ser-
vice. Please keep our patient safety in mind whenever an interpreter is needed.

Patient Care
Patient care responsibilities are limited to your educational level; outlined experiences by the
educational institution and/or at the discretion of the supervising clinical preceptor. Refer to details
outlined in the school affiliation agreement and department policies/procedures

Patient and Customer Feedback

Patient and customer feedback is an important part of healthcare and requires processes to be in
place to promptly address concerns, complaints and compliments. The intake and management of
patient feedback handled closest to where the issue happens, i.e. at the department or unit level,
results in greater patient satisfaction and patient loyalty. Students should direct questions or
concerns to the RN or staff member accountable for their patient or experience. We want to
address customer feedback in a timely manner. If a patient voices a concern or a complaint to a
student, but does not want to report it, the student should discuss this with their preceptor.
In addition, students have very valuable feedback that can help up improve our services.
If the department/unit frontline person and/or manager are unable to resolve the patient feedback
at the department manager level, designated Patient Experience staff will be in place to consult with
and assist with managing the resolution of the complaint.

6
Patient Rights
It is the basic intent of Mayo Clinic Health System that all interactions with patients and families
exhibit respect for the rights of the patient (inpatients receive a copy of the Patient Bill of Rights).
Patients and family members are afforded the following rights:
 Reasonable access to care and responsive service to requests
 Consideration and respectfulness
 Informed participation in decisions regarding his/her own care
 Participation in the consideration of ethical issues (Many Mayo Clinic Health System sites
have ethics committees)
 Personal privacy and confidentiality of information
 Designation of representative decision maker if needed
 Method to voice grievances and complaints
 Use of personal property
 Protection and advocacy services

Personal Use of Cell Phones

Staff members/students are discouraged from using personal cell phones or work telephones for
personal calls and/or text messaging during work time except for an emergency. Personal phone
calls and/or text messaging should be made on non-work time and away from patient care areas.
If staff have friends or family members that are frequent callers, staff should let them know that
hearing from them is important, but that they need to respect the staff member's time at Mayo
Clinic Health System. Staff should discourage others from calling them during working hours.
Utilization of the MCHS Switchboard for personal incoming calls is inappropriate.
All personal phones must be turned off or in “silent” mode during work hours.
Phones with photo/recording capabilities should not be used in areas where personal privacy is
expected. Use of cell phones to photograph, video tape, or transmit any patient or portion of a
patient’s body or confidential information, is prohibited.

Additional Resources
If additional information is needed on any of the topics listed above, please ask the person
responsible for your experience for a copy of the appropriate policy.

7
Patient Satisfaction
We all have the ability to positively impact patient satisfaction no matter our role. Through
surveys and research, patients have told us what they value in their health care. They want to
trust their caregivers. They want an individualized experience. They want control, and they want
to feel safe.
AIDET– which stands for Acknowledge, Introduce, Duration, Explanation and Thanks– is a
communication tool designed to help us build trust with patients and individualize our
interactions with them. The tool is intended to support each of us in finding and using the right
words at the right time to improve patient satisfaction and inspire our patients, not only to return
to us for care, but to also recommend our care to others.

8
 In order to be trusted, we must be safe.

 We will work together to strengthen our culture of safety and eliminate

preventable harm to our patients and staff.
 The five safe behaviors define how we work and how we interact with each other.
 The principles of fair and just culture guide our response to errors.
 Together, we will create a safe and trusting environment where the most
important person in the room is always the patient.
 For more information, visit; http://intranet.mayo.edu/charlie/commitment-to-safety/

Our Five Safe Behaviors

 Pay attention to detail
 Focus on specific task. Minimize distractions.
 Ensure correct information & actions to avoid errors. Proactively assess risks.
 Communicate clearly
Be respectful, nonjudgmental & non-intimidating.
Be aware of body language & tone. Minimize use of acronyms.
Allow for clarification. Verify accuracy/understanding.
 Have a questioning & receptive attitude
Speak up to prevent harm. Be responsive & open to those who ask questions.
Manage emotions.
Respect each other’s intentions & competencies.
 Hand-off effectively
Use an SBAR format. Be interactive. Avoid interruptions.
Communicate “up the chain” to prevent harm, if needed.
 Support each other
Be mutually supportive & open-minded.
Be flexible & flatten team hierarchies for stronger collaboration.
9
SBAR

All Mayo Clinic Health System care providers, no matter what their role, are encouraged to SPEAK
UP for safer patient care.
Communication breakdown among health care providers is a root cause of over half the sentinel
events reported in our country. Using a consistent, structured framework for information exchange
is shown to lessen the potential for error and ensure continued quality patient care.

The SBAR communication tool provides a standardized framework for members of the healthcare
team to communicate about a situation.

Examples for use:

Hospital patient handoffs or change of shift reports
Emergencies or urgencies
Important information shared by phone or email

SBAR
What is happening at the
Situation present time?
What are the circumstances
Background leading up to this situation?
What do I think the
Assessment problem is?
State what you think needs
Recommendation to be done.

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National Patient Safety Goals

To provide excellent Patient Family Centered Care, we follow evidence based

practice guidelines. Included in standards that guide us are CMS Standards and
the Joint Commission National Patient Safety Goals (NPSG). Some of the NPSG
that directly affect nursing practice are listed below.

Goal 1: Improve the accuracy of patient identification.

 Eliminate transfusion errors related to patient misidentification.
 Use at least 2 patient identifiers when providing care, treatment, and services.
Goal 2: Improve the effectiveness of communication among caregivers.
 Report critical results of tests and diagnostic procedures on a timely basis.
Goal 3: Improve the safety of using medications.
 Label all medications, medication containers, and other solutions on and off
the sterile field in perioperative and other procedural settings.
 Reduce the likelihood of patient harm associated with the use of
anticoagulant therapy.
 Record and pass along correct information about a patient’s medications.
Find out what medicines the patient is taking. Compare those medicines to new medicines given to the
patient. Make sure the patient knows which medicines to take when they are at home. Tell the patient
it is important to bring their up-to-date list of medicines every time they visit a doctor.
Goal 6: Use alarms safely
 Make improvements to ensure that alarms on medical equipment are heard and responded to on time.
Goal 7: Reduce the risk of health care associated infections.
 Comply with current CDC hand hygiene guidelines. Use goals to improve hand cleaning.
 Use proven guidelines to prevent health care associated infections due to multi-drug resistant
organisms in acute care hospitals.
 Use proven guidelines to prevent central line associated bloodstream infections.
 Use proven guidelines to prevent infections after surgery.
 Use proven guidelines to prevent infections of the urinary tract that are caused by catheters.
Goal 15: The hospital identifies safety risks inherent in its patient population.
 Identify patients at risk for suicide.

Universal Protocol: Prevent mistakes in surgery.

 Make sure that the correct surgery is done on the correct patient and at the correct place on the
patient’s body.
 Mark the correct place on the patient’s body where the surgery is to be done.
 Pause before the surgery to make sure that a mistake is not being made.

11
Infection Prevention & Control
Infection control is a major concern for healthcare workers. Because healthcare workers do not know
who is infected, standard precautions (see below) apply to everyone. Assume all blood, body fluids,
and needles are potentially infectious. Treat everyone with care, but use precautions with each per-
son, all used needles, and all body fluids. Infected people often have no symptoms and may not know
that they are infected.
If there is an isolation precaution sign outside a patient room, do not enter until you check with the
nursing staff.
Preventing Infection
Before reporting to your duties at Mayo Clinic Health System, cover
any cuts or open sores with a fresh bandage. If you feel ill or if you
are coughing or sneezing, it is better to stay at home.
Infection spreads through contact with a contaminated person or
object. Sneezing, coughing, and touching can spread infection.

Respiratory Hygiene/Cough Etiquette

The following measures to contain respiratory secretions are
recommended for all individuals with signs and symptoms of a
respiratory infection:
1. Cover the nose/mouth when coughing or sneezing.
2. Use tissues to contain respiratory secretions and dispose of
them in the nearest was receptacle after use.
3. Perform hand hygiene (e.g. hand washing with non-antimicrobial soap and water, alcohol-
based hand rub, or antiseptic hand wash) after having contact with respiratory secretions and
contaminated objects/materials.

Standard Precautions
Standard Precautions apply to every patient all the time. Standard precautions include the use of
Personal Protective Equipment, aka: “PPE”. PPE include: gloves, gown, mask with face shield/goggles.
Key components of Standard Precautions include the following:

12
SCRUB 15
Protecting our patients 15 seconds at a time
Before:
 Touching a patient
 Performing an invasive procedure
 Manipulating an invasive device
 Changing a wound dressing

After:
 Touching a patient
 Touching contaminated items
 Removing gloves
 Leaving a patient’s bedside or room
Remember, wearing gloves is not sufficient by itself. You must practice hand hygiene before and
after these contacts – even if you wear gloves.

But I didn’t touch the patient! Why do I have to do anything?

Many surfaces in the patient care environment, including bedrails, IV pumps, and even computer
keyboards, are often contaminated with antibiotic resistant bacteria like MRSA, VRE, and multi-drug
resistant gram negative rods. These bacteria can survive for days on these surfaces.

When should I wash with soap and water vs. using the alcohol based foam/gel?
Wash your hands with soap and water:
 If your hands are visibly soiled
 After caring for patients with C. Difficile associated diarrhea because C. Difficile spores are
not killed efficiently by alcohol
 Before eating
 After using the restroom
 In all other situations, you can either wash your hands with soap and water or use the
alcohol based foam/gel

How do I wash my hands correctly?

1. Wet your hands under warm running water
2. Apply 3-5 mL of soap to hands
3. Rub hands together vigorously for at least 15 seconds, focusing on fingertips and nails
4. Rinse hands holding fingers down to allow water to drain off
5. Dry hands thoroughly using disposable towel
6. Use a dry towel to turn off the faucet

13
Hazardous Chemicals – “Right-to-Know”
As a healthcare worker, you know the power of chemicals. They make your job easier, more
effective – and they help save lives.
Mayo Clinic Health System has developed a Hazardous Communication Program based on OSHA’s
Hazardous Communication Standard.
To locate specific chemical data, go to Mayo Clinic Intranet Homepage, type “SDS” in the address
bar and hit “enter” on the keyboard. in the Search feature to locate Safety Data Sheets, and then
enter the chemical name in the SDS Lookup field.

Equipment Safety
You will be working with a wide variety of equipment. If you are expected to use a piece
of equipment as a student, your instructor will teach you how to use it. Even If the
equipment is not your responsibility, you will still need to alert the patient’s nurse if you
think something is not correct. For example, if your patient has an IV pump, you need to
make sure it is plugged in and alert the nurse if the alarm goes off. Most importantly, if
you do not know what a piece of equipment does or how to handle it, please ask.
If an incident occurs involving the failure of a product or a piece of patient care
equipment, an incident report will need to be created. Do not change settings on the
machine. Don’t throw away any parts or pieces. In the event a piece of equipment is not
working properly, a sign should be placed on it specifying what is wrong. The patient’s
nurse will contact the house supervisor or the department manager.

14
Safe Patient Handling
Safe Patient Handling (SPH) is based upon the patient’s mobility, not the
patient’s weight. If a patient needs more than stand by assistance with
moving, then SPH equipment should be used.
Guidelines:
 Review patient mobility status before lifting or moving them.
 Eliminate or reduce manual lifting and moving of patients whenever
possible, use equipment when available.
 Give clear, simple instructions to get patients to help as much as possible.
 Mentally plan and prepare, consider routes of travel, and clear paths.
 Use chairs, beds or other hard surfaces to keep work tasks, equipment and
supplies at the correct height.
 Make sure brakes hold properly and apply them firmly.
The purpose of our facility’s Safe  Use upright neutral working posture and proper body mechanics. (Bend
Patient Handling program is to your legs, not your back.)
improve the quality of the patient
care and comfort with transfers. It’s
aim is to reduce the physical stresses
and injuries to patient care staff
related to manual lifting, handling, Important safety step - “Catch the Latch”
transferring and repositioning
For proper lifting of a patient with a mobile or
patients. It is our expectation that
ceiling lift it is essential to ensure all the sling
staff will use the safest techniques
loops are properly in the lift bar latch and to
to accomplish patient lifting and
double check this when there is tension starting
repositioning. We use safe patient
on the loops before completely lifting a patient.
handling equipment and movement
techniques on all patients for the
protection of both patients and
staff.
Per policy, staff are not to lift over
35lb independently.

52 % of nurses
complain of chronic low
back pain.
Vertical Lift Turning / Lateral Transfer
Repositioning

Use SPH techniques to protect

yourself during high risk scenarios:
15
forceful exertion, repetition, and
awkward positioning.
 Fall Prevention

Each patient care area has a fall prevention plan and utilizes evidenced based tools for
assessing patient risk for falls. Assessment is typically done:
 On admission
 On transfer
 Reassessed at least daily & if change in condition
 If patient is asleep on night shifts, document “patient asleep”
Patients identified as being “at risk” for falling will have an individualized plan of care to
address identified risks. All post-operative patients are considered to be at risk for falls.
We use the Hendrich II Falls Risk Tool for patients 18 years old and above and the
Humpty Dumpty Fall Assessment Scale for patients 0 to 17 years old.
Document fall risk factors and the education you provide to the patient and family In the event of a Fall, the
regarding risk and prevention interventions. patient’s nurse must:

Hendrich II Fall Risk Assessment Tool Categories: Assess for injuries and
provide appropriate aid,
• Confusion/disorientation/Impulsivity including obtaining vital signs.
• Symptomatic Depression
• Altered Elimination Notify physician & family.
• Dizziness/Vertigo
• Gender (Male)
Document and execute orders
• Administration or changes in dosage of Antiepileptics (anticonvulsants)
received.
• Administration of Benzodiazepines
• Get-Up-and-Go-test
Document events in chart.

Continue to assess and

monitor the patient.

Complete an Event report.

If patient is at risk for falls, signage and documentation should include:
 Red Wing: Magnetic Room signage noting fall precautions—falling star
 Lake City: Call light noting fall precautions—yellow solid light—outside of room
 Yellow wristband noting “fall precautions”
 Red Wing: Red slippers for patient indicating at risk for falls
 Interdisciplinary care plan/treatment plan identifying specific fall precautions and
safety interventions.
 Documentation to reflect that appropriate interventions were implemented.
 Patient and family education.
16
 Restraints
Preventive measures include the
basic standards of care we
provide to all patients with
special consideration to their
physical, psychological and
environmental needs.
Utilizing Restraints
Preventive Measures and Considerations
Physical: Psychological: Environmental:
 Arrange for periods of  Use active listening  Ensure call light is within
exercise and activities. and empathy, reach.
 Manage activity level. encourage patient to  Place patient near nurses’
 Promote normal sleep express feelings and station to provide increased
patterns. thoughts. visibility to staff, patient.
 Perform relaxation  Actively include  Adjust lighting based on
techniques. patient in any patient’s safety, visual and
 Review lab results for conversations that orientation needs.
changes that may be occur in his/her  Decrease/control noise level.
contributory. presence.  Place personal items within
 Review meds for side  Explain all procedures reach.
effects/interactions before beginning;  Position commode, walker,
that may be be aware of the canes, etc. near bedside.
contributing to
effect of anxiety and  Regulate environmental
confusion,
fear. temperature.
combativeness, etc.
 Use appropriate 
 Collaborate with other De-clutter floor and room.
touch/ physical
health team members  Provide clear pathway to
on a plan of care. contact with patient
bathroom, chair and
permission.
doorways.
 Restraint must be ordered by the provider involved in the care or the patient. In an
emergency, RNs may apply restraints, but an order must be obtained immediately after
the restraint has been applied.
 The provider must be notified as soon as possible if s/he did not order the restraint.
 Standing and PRN restraint orders are not allowed.
 If possible, involve Care Manager before applying restraints to help assure that we have
tried all alternatives.
 For restraints used for Medial Healing: A restraint order must be written each calendar
day. The physician must examine the patient prior to reordering restraints each day.
 For restraints/seclusion used for Violent/Self Destructive Behavior: The patient must be
examined by the provider within 1 hour of placing the patient in restraints/seclusion.
Orders for Violent or Self-Destructive patients are time limited and expire in 4 hours for
adults (18 and older) and in 2 hours for adolescents (ages 9 through 17). If restraint/
seclusion is needed beyond expiration, re-evaluation and a new order must be written.
 Patients must be monitored and assessed every 2 hours (Medical Healing). Every 15
minutes (Violent/Self Destructive Behavior).
 Monitoring and Assessment includes:
Nutrition and Hydration
Circulation
Vital Signs
Hygiene and elimination
Physical and psychological comfort
Plan of care: Can restraint be removed?
 Nurses may remove restraints
17 and restraint order when patient no longer needs them.
 Tips for Caring for the Patient with Dementia

 There are different kinds of Dementia. Each requires a different approach. Dementia is not a disease,
but a broader set of symptoms. Patients with Dementia often feel unsafe when in the hospital. This
leads to fear and anxiety. Say often: "You're safe with me!" Reassure with touch. Hand holding. One
arm hug from the side. Fear and anxiety are why staff get hit. We need to work on our approach--cool,
calm, comforting, not rushed. Humor is terrific. Try for a good belly laugh.
 Create a 'comfort zone' around the patient with Dementia. Pictures of family members in room help.
Ask family to make a scrapbook for patient. Comfort items help--have family bring in. (familiar doll,
blanket...) Helps sometimes for family members to wear buttons with pictures of themselves at a young-
er age when spending time with patient.
 Behavior is Communication. A patient with dementia most likely has lost the ability to verbally express
their needs. Find meaning in the message. For example, if patient is repeatedly asking "What time is
lunch?" The patient is most likely hungry now. Get patient a snack. Staff need to think as a team to
identify the possible causes and triggers of behavior: What is the patient trying to tell us?
 Educate family members about short term memory and long term memory. If family continues to ask
patient short term memory questions (What did you have for lunch?) they are setting their loved one up
to fail over and over again. Depression is very common among patients with Dementia. Is anti-
depressant needed? Sleep disturbances can exacerbate cognitive disabilities. Sleep is like a "Reboot"
for the brain.
 The phrase "Sundowning" is old-school. Goal is to identify symptoms you are seeing (fear, anxiety,
restlessness, hallucinations) and individualize care. In late afternoon and early evenings: Patient may
have a tired brain at this time of the day. Evenings may be most scary time of the day for the patient
with dementia. Offer comfort. Take a walk with the patient in the hall if they are restless. Increase
lighting to decrease hallucinations (any time of the day). Close blinds to decrease motion from outside.
 Rule out Dehydration and urinary tract infections.
 Aroma therapy helps! Calming essential oils help calm patient
with dementia. (massage, foot rubs) Make it a routine in the
morning and/or at night.

An inconvenience is an adventure wrongly considered.

—G. K. Chesterton

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 General Care Guidelines for Instructors and Students during Clinical Site
Rotations at Mayo Clinic Health System (Cannon Falls, Lake City, Red Wing)

1. Students may hang replacement IV bags and administer IVPB only if under the direct
observation of an instructor or RN.
2. Students may NOT administer IV push medication, tube feedings, give an IM injec-
tion and administer insulin unless the patient‘s condition is stable and they under the
direct observation of the RN or Instructor and the instructor and/or RN are present to
evaluate the patient’s response.
3. Students may start peripheral IVs with direct supervision of RN. Rationale: Students
should have training and validation on IV equipment, technique, and start kits.

General Care Guidelines for Precepted Student Experiences

The Minnesota Internship Implementation Committee and Minnesota Board of Nursing have
approved the following guidelines for pre-licensure nursing students. In addition to the above
psychomotor skills, Precepted students and/or Summer Nursing Student Interns absolutely
May Not at any time (even if under the supervision of an RN):
 Initiate or hang TPN, Lipids and Medication Drips (eg. Heparin, Dobutamine, Pitocin,
etc)
 Perform Central Line Tubing Change
 Discontinue Central Lines
 Perform Line Blood Draws (from any line)
 Administer blood and assess response to blood infusion.
 Manage Passey Muir (speaking)
 Program PCA pumps
 Perform glucose monitor testing unless training is complete and they meet the com-
petency required by the Laboratory Department
 Manage epidural Infusion, Tubing or Pump settings
 Remove any Type of Wound Drain (Penrose, JP, Duval, etc)
 Take verbal or written orders
 Do EKG Interpretation
 Verify Informed Consent
 Administer chemotherapy via any route including oral
Machine exception: Epidural and PCA will be managed only by the RN assigned to the
patient. Instructors and students will observe the assigned RN for care and interventions re-
lated to adjusting the dose or machine.

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MEDICATION ADMINISTRATION TOOL FOR STUDENTS / INTERNS

Does this medication match exactly the order on the Medication

Administration Record (MAR)?
Right Medication Have you reviewed this order and medication with a staff nurse
or your instructor?
What are your patient’s allergies?

Why has this medication been prescribed for your patient?

Explain to a staff nurse or your instructor how you will deter-
mine the following:
Right Indication  How will you know the medication is working?
 What are the common side effects?
 What should you teach the patient about this medication?
 Is the patient allergic to this medication?

Does the ordered dose match the dose you are giving?
Right Dosage Is the dose appropriate for this patient?

What is the ordered route?

Right Route Does the ordered route make sense for this patient?

Does the schedule on the MAR match the current ordered time?
Right Time Is this a PRN order? If so, when was the last dose given?

Right Documentation How and where will you chart this medication?

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 Blood Product Administration
Why do our patient’s receive blood products?
Packed Red Blood Cells
 Improve the ability to carry oxygen
 Relieve symptoms of anemia (difficulty and/or fast breathing, fast
heart rate, poor weight gain)
 Packed red blood cell’s are given rather than whole blood to minimize
the amount of fluid given
Platelets
 Improve the body’s ability to clot
 Treat a low platelet level
Fresh Frozen Plasma
 Replacement of many factors to help the body clot
 Helps with volume expansion
Safe Administration of Blood Products
To ensure patient safety, the following must occur:
(Note: Student may NOT administer blood or independently assess response to transfusion)
1. Nurse witnesses that consent for transfusion has been obtained (non-emergent transfusion). It is the provider’s responsibility
to obtain informed consent.
2. Blood component is obtained from blood bank using a requisition that automatically prints from EMR when provider places the
order. If provider orders 2 units, 2 requisitions will print.
3. In the EMR, the first nurse enters Donor Number, Donor Type, Blood Product, Unit Expiration Date, Patient Blood Type, and
ordered Indication for Transfusion.
4. Nurse and a second nurse (or provider) verifies: 1.) The right component has been prepared and obtained for the correct pa-
tient. 2.) The patient’s full name, medical record number, and blood type match the blood tag. The first nurse reads aloud,
patient’s name and medical record number spelling the last name from ID band. Second person audibly reads same infor-
mation from blood component bag.
5. Second nurse enters verification completion into the EMR.
6. Pre-transfusion vital signs are obtained and entered into the EMR.
7. Unit is started and start time and date are entered into the EMR. The blood component must be infusing within 30 minutes of
release from Lab.
8. Transfusion begins slowly (if non-emergent). The nurse starting the transfusion must stay with the patient for the first 15
minutes of the transfusion.
9. Single units of blood should be administered and completed within a 4-hour period.
10. Repeat vital signs:
 15 minutes after the start of all transfusions
 Hourly during the transfusion
 When the transfusion is complete or discontinued

Transfusion Reaction Signs and Symptoms:

 Temperature rise greater than 2 degrees F
 Chills, rigor, flushing, clammy skin
 Difficulty breathing
 Unexpected rise or fall of blood pressure or heart rate
 Hives or itching
 Pain in back, chest or IV site
 Swelling
 Anxiety
 Bleeding 21
 Pink or Red Urine
22
23
Confidentiality Policy
Content Applies To: Mayo Clinic Health System
Scope
This Mayo Clinic Health System policy applies to all allied health staff, physicians, research
temporary professionals, residents, fellows, students, volunteers, temporary contingent workforce,
visitors, contractors, and vendors. Salary, benefits, and human resource/operational policies are
subject to change by Mayo Clinic Health System at any time. The contents of this policy are not
intended to constitute a contract of employment. Both Mayo Clinic Health System and the
individual may terminate the employment relationship at any time.
Purpose
This policy:
• Provides confidentiality guidelines for Mayo Clinic
• Defines expectations and clarifies the steps to be taken when a breach in confidentiality of
patient, employee, or institutional data or information occurs.
• Establishes guidelines and steps taken to ensure that confidential information is disposed of
in a secure manner.
Definition
Protected health information (PHI): Individually identifiable health information held or transmitted
in any form or medium, including information created or received by a health care provider, health
plan, employer or health care clearinghouse that relates to the past, present, or future physical or
mental health or condition of an individual; the provision of health care to an individual; or the
past, present or future payment for the provision of health care to an individual; and that identifies
the individual or for which there is a reasonable basis for believing that the information could be
used to identify the individual. PHI includes medical, scheduling, and billing information.
Policy Statements
Employees have an obligation to conduct themselves in accordance with the core principle of
keeping all information concerning patients, employees, and business information confidential in
accordance with applicable law and Mayo Clinic policy.
Maintaining confidentiality of patient, employee, and business information is critical to respecting
patient privacy and the integrity of medical and business information, and is the responsibility of all
Mayo Clinic employees. This policy pertains to all data and information (oral, paper, and electronic)
related to the operation of Mayo Clinic including, but not limited to:

Page 1 of 3

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 • protected health information (PHI) for example, patient’s names, personal/medical
information, billing/financial information
• financial information
• employee social security numbers and other personal identifiable information
• proprietary products and product development
• marketing and general business strategies
• any discoveries, inventions, ideas, methods, or programs that have not been publicly
disclosed
• any information that has been marked “confidential”
Negligent or intentional acts leading to the unauthorized acquisition, access or use of confidential
or sensitive information that is not necessary to perform one's job duties, disclosure of such or
releasing information to unauthorized individuals or individuals not having a legitimate business
reason to have this information is strictly prohibited and will result in corrective action up to and
including termination of employment. Employees are to refrain from revealing personal or
confidential information concerning other individuals or business operations, unless such use or dis-
closure is supported by a legitimate business purpose or is allowed by another Mayo Clinic Health
System policy. These acts may result in legal action against the individual and/or Mayo Clinic.
Patient Protected Health Information (PHI) is intended to be used in the course of treatment,
payment, health care operations, research, education, and for other institutional purposes by
employees within Mayo Clinic to perform their assigned duties. Information regarding appropriate
review of an electronic medical record (EMR) can be found in the Mayo Clinic Privacy Policy for
Electronic Access to Protected Health Information.
Employees who have a reasonable basis to believe that a breach of confidentiality has occurred or
who witness another employee breach data/information confidentiality should report the incident
as soon as possible. The incident should be reported to any of the following:
• Immediate supervisor
• Administrator
• Human Resources
• Compliance Office
• Privacy Officer
• Compliance Hotline 888-721-5391, or www.MayoClinicComplianceReport.com
The Privacy Office is responsible for bringing the alleged violation of confidentiality to the attention
of the supervisor and/or Human Resources. An investigation will be conducted by those responsible
for monitoring the performance of the employee suspected of breaching confidentiality in
collaboration with Human Resources. Information from the investigation will be reviewed with the
appropriate member(s) of management, the Compliance Office, Human Resources, and Legal
Counsel, if warranted. These individuals will determine what corrective action is to be taken, up to
and including termination of employment. Mayo Clinic will not tolerate any retaliation or
intimidation of a complainant. Employees who have a reasonable basis to believe a breach of
confidentiality has occurred but fail to report it may also be subject to corrective action.

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Employees permitted access to Mayo Clinic computer information systems and/or other sources of
confidential information, as a condition of such access, may be required to sign a confidentiality
document acknowledging their understanding of their responsibilities in preserving the
confidentiality and security of such systems and information, and their agreement to abide by all
Mayo Clinic policies governing their use of such systems and information. These individuals must:
1. Maintain confidentiality of assigned ID’s, passwords and computer devices. The ID’s and
passwords are confidential and should not be posted, shared or distributed to anyone other
than the assigned user.
2. Implement appropriate security measures for their standalone or networked work station, and
the data files they may contain.
3. Ensure the protection of information from unauthorized access, including, but not limited to
other Mayo Clinic staff and family members.
4. Adhere to appropriate computer access and data authorization requirements as outlined in oth-
er administrative policies.
5. Report any theft or loss of computer resources, including laptops, desktops, PDA’s,
smartphones, cell phones or other computing devices, to their immediate supervisor and Mayo
Clinic Security.
Human Resources has guidelines for the release of sensitive employment information. Sensitive
employment information is defined as W-2 statements, paychecks, hand drawn checks, home
addresses and phone numbers, work locations and phone numbers, social security number, and
detailed benefit and salary information. For the protection of employees, no paychecks, W-2
copies, statement of benefits, and other personal information requested from Human Resources
will be released unless a signature and picture ID is provided by the recipient.
Mayo Clinic reserves the right to provide third parties the following without the written permission
of the employee: verification of current employment, data required by law to be reported such as
EEO statistics, information required under the collective bargaining agreement, and information
necessary to protect Mayo Clinic's legal interest. Mayo Clinic's policies do not affect employees'
legal right to discuss their own wages and working conditions with others.
Each work unit within Mayo Clinic is responsible for establishing procedures to ensure
confidentiality of online information and computer-generated reports consistent with other
appropriate Mayo policy. Procedures may be required at the level of production, distribution,
storage, collection and disposal of confidential reports.
Mayo Clinic employees having access to organizational data are expected to conduct themselves in
a manner that safeguards this valuable asset from damage or inappropriate use. Data and
information determined to be confidential are to be closely controlled from creation through
destruction. All efforts will be taken to prevent inadvertent access or use of Mayo Clinic confidential
data and are to continue through to its final destruction. Confidential data is to be disposed of in a
secured manner to include use of portable shredders for on-site shredding of hardcopy
information, use of secured containers for disposal and off-site shredding, and/or overwriting of
any magnetic media (e.g. tapes, disks). Each department is instructed to utilize the option(s)
considered most appropriate, given the department’s unique set of requirements.

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Please complete and return to your clinical instructor prior to the start of your clinical experience

Student Orientation Completion Form

Please check all boxes that apply:


 Value Statements Conduct and Behavior
 Alcohol and Drugs Dress and Decorum
 Diversity Integrity
 Internet and Computer Access Language Services
 Patient and Customer Feedback Patient Rights
Personal Use of Cell Phones Patient Satisfaction, AIDET
Our Commitment to Safety SBAR
National Patient Safety Goals Infection Prevention & Control
Hazardous Chemicals  Equipment Safety
Safe Patient Handling Fall Prevention
Restraints Nursing Student Guidelines
Emergency Preparedness Confidentiality Policy

I heard or read the above information/policies included in the Student Orientation Packet.
I understand the content and agree to comply with the Clinical Facility’s policies, procedures and
guidelines.

I agree, unless authorized, not to access, use or release confidential information regarding patients,
employees and business operations. I also understand that my unauthorized access, use or release
of any and all confidential information at Clinical Facility may be cause for my immediate
termination from the clinical experience. In addition, I understand that I may be personally liable
for any disclosure, misappropriation or use of confidential information.

Print Name: _________________________________________

Signature: _________________________________________

Date: _________________________________________

Institution: _________________________________________

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