clinical agreement preceptor orientation

Newton TownshipTraining Division

Clinical Agreement/PreceptorOrientation

Clinical AgreementWHEREAS it is purposed that the Department of Allied Health Careers is organized for the purpose of providing an educational program to train Emergency Medical students, and/or any subdivision of the EMS Curriculum.

WHEREAS the Cooperating Fire Department is willing to provide facilities to enable the Training Division to meet this objective, and also provide clinical experiences upon terms and conditions set forth in this agreement.

Clinical AgreementWHEREAS the Cooperating Fire Department and the school mutually desire to promote excellence in the provision of professional services, health education and research, and to contribute to the professional growth and competence of students in educational programs..

Clinical AgreementIn consideration of the foregoing premises and the mutual agreements and conditions set forth in the agreements set forth in the agreement, the parties agree as follows:

Clinical ExperienceSupervisionStudent AssignmentRecordsLegal Status

Clinical AgreementClinical Experience The school shall plan and administer the Program to satisfy the requirements of all applicable laws, regulations and licensing or supervisory agencies.

Department shall provide the appropriate use of its facilities by students participating in the Program, along with an orientation at the beginning of each new training session. (any departmental orientation required by your AHJ)

Clinical AgreementSupervision The School shall supervise all students enrolled in the Program in accordance with the pertinent laws.

During clinical educational experiences, the students shall be permitted to participate in the professional services at the Department under the supervision of the appropriate professional staff of the Department and the School.

Clinical AgreementThe scope of the students’ participation will be determined by the applicable Department policies and to the extent permitted by law.

The Department specifically agrees that students will work on Department vehicles as an extra (or 3rd) person only and shall be supervised by a designated preceptor who is an experienced certified provider and has completed the Schools preceptor orientation training.

Clinical AgreementStudent Assignment The School shall assign such students to the Department, as the parties mutually agree.

Students shall have ID badges provided by the School and shall wear the designated School uniform. The students shall comply with the policies, procedures, and rules and regulations of the Department at all times.

Clinical AgreementThe Department shall have the right to request the removal of any student from the program for cause upon written notification to the School, such information shall set forth the basis for the request. The School shall comply immediately with the request for the removal.

Disciplinary proceedings against students shall be conducted by the School in accordance with its policies and procedures.

Clinical AgreementAll School faculty and students shall document appropriate training concerning applicable OSHA requirements, including without limitation, blood borne pathogens, and shall have received such immunizations as the Department requires of its faculty and students prior to being assigned to the Department.

Clinical AgreementRecords The School shall maintain all educational records and reports relating to the clinical education program completed by the students at the Department.

The Department shall have custody and control of all medical records and charts contained in patient files and neither the School nor the students may remove or copy such records except pursuant to a specific request in writing with respect to and from a patient or his/her legal representative, or patients to whom such records pertain or with written permission of the Department.

Clinical AgreementIdentity of patient, the nature of the procedures or services provided to patients and information included in the patients’ medical records shall be confidential and shall not disclosed by the students other than for use in direct patient care by authorized personnel during the current or future Department treatments

Clinical AgreementLegal Status It is understood and agreed that the students are enrolled in a professional education program offered by the School.

It is also understood and agreed that the students may participate in clinical educational experiences at the Department under appropriate supervision by the School and the Department.

Clinical AgreementExcept for those students currently but separately employed by the Department, the students shall not be deemed or considered to be employees of the Department for any purposes as a result of their participation in the Program and shall remain at all times students of the school.

Nothing in this Agreement is intended or shall be deemed or construed to create any relationship between the parties other than that of education affiliation.

Clinical AgreementThe Department shall not be liable for any claim, injury, demand or judgment arising out of any action or failure to act by the School, its agents, employees or students and the School herby agrees to indemnify and hold the Department harmless from any cost and expenses

Nondiscrimination Clause No student shall, on the grounds of race, color, sex, creed, age or national origin be excluded from participation in , be denied the benefits of, or be subject to discrimination under any provision of this agreement

Dress Code

Clinical UniformsStudents and Clinical Instructors while engaged in the

clinical setting will be required to follow the above guidelines including the following:

• Wear the school approved uniform shirt displaying student or preceptor status

• Wear the assigned ID badge indicating student or preceptor status

• Must wear black or blue uniform pants, casual dress pants or slacks. No shorts or jeans are permitted.

• Black shoes or duty boots. No open toe shoes are permitted

Admission Policy

Admission PolicyNo student will not be permitted to start any class without a complete application on file, including all signatures from

his or her agency. The application consists of:• Demographics form• Waiver and Release• Copy of any prerequisites such as copy of EMT certification to take an Advanced

Emergency Medical Technician course or higher. Certification will be verified before class approval.

• Copy of NIMS 100 and 700 which can be found at www.training.fema.gov.• Student Medical Requirements form demonstrating the following requirements are

met:Copy of TB test within 1 yearHepatitis B vaccine or signed refusal waiverRubella immunization and titer if neededCopy of a recent physical within 1 yearSigned form of relative knowledge of universal precautions

Preceptor

Clinical PreceptorClinical Preceptors are defined and function under the

Newton Township Training Division’s Policy and Procedures. All Preceptors must complete the Clinical Preceptor

Orientation and have a signed waiver of acknowledgment of their duties prior to evaluating any student activity.

All signatures obtained from a Clinical Preceptor must be signed in red ink only.

Preceptor

The Newton Township has two Clinical Preceptor roles defined below:

Hospital Clinical Preceptors must be under contract and approved by the Training Coordinator and EMS Advisory Committee and maintain their current certification status and at least an EMS CEU or AEI certification.

Clinical Preceptor can only supervise students at or below their respective level of certification.

Preceptor

Hospital Clinical Preceptors are also subject to the same requirements as the students regarding vaccinations or Healthcare requirements required by the Hospital Clinical Affiliation under contract with the Newton Township Training Division.

Preceptor

Field Clinical PreceptorsOnly Employees/Volunteers of Departments or EMS agencies that have an Affiliation Agreement on file with the Newton Township Training Division are permitted to serve in the role of Field Clinical Preceptor.

Field Clinical Preceptors can only supervise students at or below their respective level of certification.

Clinical Requirements

Student Clinical RequirementsStudent will not be permitted to begin any clinical time until after all set forth requirements have been met with the class and clinical location. Students must abide by the clinical uniform outlined above and their own stethoscope. Students must also bring their clinical logbook which will include the following: Student Handbook Student and Preceptor Evaluations Student Clinical Hours Sheet BLS Skills sheet, to indicate what activities the student

performed during clinical Blank EMS reports (10)


Students in the EMT course must complete 8 hours of hospital internship under the direction of a contracted Preceptor.

Students are only allowed to perform assessments and function only in an observatory role in the hospital setting.


Students in the EMT course must complete 10 hours of documented field clinical time with Employees/Volunteers of Departments or EMS agencies that have an Affiliation Agreement on file.

A list of these Department or Agencies will be provided to each student along with their contact numbers and locations. Field clinical time is only permitted when the Department or EMS agency staffing is at least two certified EMT’s or an EMT and AEMT/Paramedic is staffed on the unit.


AT NO TIME IS THE EMT STUDENT ALLOWED TO BE COUNTED AS PART OF THE CREW or BE COUNTED AS PART

OF THE DEPARTMENTS/AGENCIES STAFFING DURING CLINICALS.

Clinical Logbook

EMS Run Sheet (yellow paper)

To be used to documentClinical Assessments in the Students own handwritingAnd signed by the preceptor

Clinical Logbook

EMS Clinical Hours (orange paper)

Students are required to complete 18 hours of clinicals. (8 hours) at Genesis Healthcare.(10 hours) completed at Departments or EMS contracted agencies with a field clinical preceptor.

Newton Township Training Division

H onor - P r ide - D edication

5490 Maysville Pike Box 181 White Cottage, OH 43791-0181

Phone: 740/849-2418 EMERGENCY 911 Fax 740/849-2324

EMS Clinical Hours

Student Name: ________________________________ Course Number: ________________________ Lead Instructor: _______________________________ Certification Number: ___________________ Course Starting Date: __________________________ Course Ending Date: ____________________

Date Time in Time Out Preceptor Name Preceptor Signature Location or Site Name No. of Calls Reports

Students are required to complete 18 hours of clinicals. (8 hours) at Genesis Healthcare Hospital Emergency

Department with a clinical preceptor. (10 hours) completed at Departments or EMS contracted agencies with a field clinical preceptor.

Clinical Logbook

Student Evaluation (hot pink)Preceptors are required to fill out an evaluation on each student at the end if their clinical period.





EMS Student Evaluation Student Name: ________________________________ Course Number: ________________________ Lead Instructor: _______________________________ Certification Number: ___________________ Course Starting Date: __________________________ Course Ending Date: ____________________

Preceptor Name Location or Site Name Date Time In Time Out No. of Hours

Please evaluate the student using a 0-5 scale for each of the following. (5=Field Competent, 4=Appropriately Uses Skills, 3=Satisfactory, 2=Some Coaching Needed, 1=Needs Improvement or Not Competent, 0=Dangerous to Practice)

Integrity-Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities

Empathy-Shows compassion towards others; responding appropriately to emotion response of patients and family; demonstrates respect for others; demonstrates and calm and compassionate demeanor towards those in need; is supportive and reassuring to others.

Self-Motivation-Takes initiative to complete assignments and improving and/or correct behavior; is able to follow through with task without constant supervision; consistently striving for excellence in all aspects of patient care; takes advantage of learning activities

Appearance and Personal Hygiene-Clothing and uniform are neat, clean, and well maintained; good personal hygiene and grooming Self-Confidence-Demonstrates the ability to exercise good personal judgment; demonstrates an awareness of strengths and limitations Communications-Speaks clearly; writes legibly; listens actively; adjust communication strategies to various situations and audiences Time Management-Consistent punctuality; completes task and assignments on time Teamwork and Diplomacy- Places the success of the team above self-interest; not undermining the team; helps and shows respect for all Respect-Being polite to others; not using derogatory or demeaning terms; behavior in a manner that brings credit to the profession Patient Advocacy-Does not allow personal bias or feelings to interfere with patient care; places the needs of the patient above self interest Careful Delivery of Service-Mastering and refreshing skills; performing complete equipment checks; demonstrates careful and safe ambulance operations; familiar with equipment on hand; follows procedures and protocols; follows orders

Preceptor Comments: Student Comments:

Preceptor Signature___________________________ Student Signature______________________________

Clinical Logbook

Preceptor Evaluation (Lime Green)Students are required to fill out an evaluation on each Preceptor at the end if their clinical period.





EMS Preceptor Evaluation Student Name: ________________________________ Course Number: ________________________ Lead Instructor: _______________________________ Certification Number: ___________________ Course Starting Date: __________________________ Course Ending Date: ____________________

Preceptor Name Location or Site Name Date Time In Time Out No. of Hours

Please evaluate the student using a 0-5 scale for each of the following. (5=Field Competent, 4=Appropriately Uses Skills, 3=Satisfactory, 2=Some Coaching Needed, 1=Needs Improvement or Not Competent, 0=Dangerous to Practice)

Integrity-Consistent honesty; being able to be trusted with the property of others; can be trusted with confidential information; complete and accurate documentation of patient care and learning activities

Empathy-Shows compassion towards others; responding appropriately to emotion response of patients and family; demonstrates respect for others; demonstrates and calm and compassionate demeanor towards those in need; is supportive and reassuring to others.

Self-Motivation-Takes initiative to complete assignments and improving and/or correct behavior; is able to follow through with task without constant supervision; consistently striving for excellence in all aspects of patient care; takes advantage of learning activities

Appearance and Personal Hygiene-Clothing and uniform are neat, clean, and well maintained; good personal hygiene and grooming Self-Confidence-Demonstrates the ability to exercise good personal judgment; demonstrates an awareness of strengths and limitations Communications-Speaks clearly; writes legibly; listens actively; adjust communication strategies to various situations and audiences Time Management-Consistent punctuality; completes task and assignments on time Teamwork and Diplomacy- Places the success of the team above self-interest; not undermining the team; helps and shows respect for all Respect-Being polite to others; not using derogatory or demeaning terms; behavior in a manner that brings credit to the profession Patient Advocacy-Does not allow personal bias or feelings to interfere with patient care; places the needs of the patient above self interest Careful Delivery of Service-Mastering and refreshing skills; performing complete equipment checks; demonstrates careful and safe ambulance operations; familiar with equipment on hand; follows procedures and protocols; follows orders

Preceptor Comments: Student Comments:

Student Signature___________________________ Training Coordinator Signature______________________________

Clinical Logbook

BLS Skills Sheet (White)Students are required to fill out a description of any skills they performed during clinical activities. These skills can include:

VitalsSplintingImmobilizationAirwayCPREct.





EMS Clinical Sheet BLS Skills Performed

Student Name: ________________________________ Course Number: ________________________ Lead Instructor: _______________________________ Certification Number: ___________________ Course Starting Date: __________________________ Course Ending Date: ____________________

Date Location or Site Name Preceptor Name Description of Skills Preceptor Signature

Students are required to document any skills including assessments performed during clinicals

Student Handbook

Student HandbookAdditional policies and procedures are covered in the Student Handbook which is it be with the student during clinicals.

The Training Coordinator has the final say in resolving any conflicts between this document and the Training Division Policy and Procedures.

Be the example

Demand only the best from the student

Respect our motto: Honor, Pride, and Dedication

Respect the customer and public we serve

Reminders

Training DivisionThe time you have with students is valuable. This may be your only chance to effect that persons career.

The new generation needs us

Its not about you or your credentials. It’s about our students getting the full potential of each one of us.

If you have any questions feel free to call at any time

OR

Captain Josh Bryan, Training [email protected](740) 819-3622

Erika Wickham, Clinical Coordinator (740) 683-6408

mailto:[email protected]

clinical agreement preceptor orientation

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