Clinical Supervision

Clinical Supervision – Faculty Role
    1. Purpose: Clinical experiences are an integral component of nursing education at all levels. This policy will provide clarity and consistency in clinical education at Pacific Lutheran University (PLU) School of Nursing (SON).
    2. Policy: Clinical hours in the PLU SON nursing programs (BSN, MSN, DNP) are based on a ratio of 1 semester credit = 42 hours of clinical during the semester. Faculty will facilitate students meeting the clinical hour requirement for their respective courses.
    3. Procedures:
      1. Pre-licensure students practice under the faculty member’s license; therefore, faculty are responsible for both general and direct supervision of the student in the clinical site.
        1. Faculty are responsible for supervising pre-licensure students in medication administration until faculty have verified safety and competence, at which time student medication administration may be supervised by a registered nurse.
        2. Faculty are to determine the level of assistance required by students with technical procedures. Faculty must be available to directly assist students as needed, or when necessary and based on demonstrated student competence, ensure appropriate staff registered nurse oversight of student performance of procedures.
      2. All faculty clinical health requirements and agency on-boarding must be up-to-date prior to the start of each clinical rotation.
      3. Clinical teaching is an active teaching and practice role involving the intentional exchange of teaching-learning experiences with the student in the designated practice activities, the faculty member’s sharing of clinical expertise, mentoring of students in clinical practice roles and competencies, shaping and fostering students’ growth in clinical practice, and determining students’ accomplishment of expected levels of practice achievement.
      4. Clinical hours may be distributed differently among the SON courses, but all courses must adhere to the 1 credit = 42 hours ratio. For example a course that has 2 credits of clinical, thus 84 hours of clinical, may have those hours distributed as one 6 hour day per week for 14 weeks (no clinical during finals week) or 12 hours a week for 7 weeks if the clinical course is taught for half the semester.
      5. Clinical experiences are expected to provide active engagement in patient/client care at the appropriate clinical level for students’ practice development. Observation experiences are to be minimized. If insufficient active client care experiences are available at the appropriate level for adequate clinical learning, the faculty member is responsible for developing alternative learning experiences or working with the Clinical Placement Coordinator and within the Clinical Consortium to find appropriate alternative learning experiences.
      6. Simulation provides valuable clinical learning opportunities and is encouraged for each clinical course. Simulation experiences must be designed with specific learning objectives, must meet WA NCQAC requirements, and must be an approved element of the course and curriculum in order to count as required hours for clinical. Faculty are expected to directly participate in the simulation learning experience and to maintain competency in simulation teaching pedagogies.
      7. Clinical instructors are contracted to be available for assigned clinical day(s), including on-campus labs on assigned clinical days. Clinical instructors are responsible to assist the course coordinator with on-campus labs, with these lab hours factored into contracted faculty time. Lab hours, however, may not be used toward the WA NCQAC required minimum of 600 clinical hours for the BSN in nursing.
      8. Faculty will schedule a maximum of one (1) clinical day for orientation to the clinical unit, unless there are circumstances that require a longer orientation period (i.e. EHR training).
      9. Faculty are expected to adhere to the clinical hours scheduled for the course. Students should be at their clinical site the entire scheduled clinical time period and instructors must be on site at all times that students are providing care.
        1. Pre- or post-conference, lunch and breaks can be scheduled to meet the learning needs of the students and the healthcare needs of the patients being cared for.
        2. Any change from the normal clinical schedule must be communicated in advance to the lead instructor for the course and to the PLU SoN Clinical Coordinator, to determine if the consortium agreement allows a change in the schedule.
      10. Precepted clinical experiences (BSN, MSN, DNP)
        1. Faculty are required to orient preceptors to the program requirements, course objectives, and learning goals for the precepted experience.
        2. Faculty are required to maintain open, responsive, and frequent communications with preceptors and students throughout the clinical experience.
        3. Faculty are required to make at least one site visit per semester to every student in a precepted clinical, preferably before midpoint to identify any problems.
        4. Faculty may need to visit a precepted student more than once if there are issues with clinical performance.
        5. Student evaluation is the responsibility of the faculty with input from the preceptor. The student’s complete clinical hours must
        6. Students are to complete an evaluation of their preceptor at the end of each rotation. The evaluation is to be reviewed by the lead faculty and the evaluation is to be stored in the preceptors file.
      11. Graduate Clinical Education includes supervised, documented clinical experiences.
        1. The Master’s Essentials (AACN, 2011) specify that all students in an MSN program complete advanced clinical education activities that include supervised clinical experience. Clinical proficiency is facilitated through the use of focused and sustained clinical experiences designed to strengthen patient care delivery skills, as well as system assessment and intervention skills. Faculty have the responsibility for designing learning experiences that help students achieve course outcomes and meet the essentials of MSN education.
        2. The Essentials of Doctoral Education (AACN, 2006) specify that practice experiences should be aimed at helping DNP graduates to apply, integrate and synthesize the essential and specialty competencies upon completion of the program. Supervised clinical practice experiences should be designed to provide opportunities for students to develop and assimilate knowledge for advanced practice at a high level of complexity and/or systems level practice.
        3. Graduate clinical experiences are documented through a log of clinical hours that is cosigned by the student, the preceptor, and the faculty member. The completed clinical log is placed in the student academic file at the end of each semester.
        4. Graduate clinical practice hours are defined as direct or indirect patient care activities that influence outcomes for individuals or populations, including the care of individual patients, management of care for individuals and populations, development and implementation of patient care quality activities, or the development and implementation of health policy.
        5. Graduate clinical experiences are outside the student’s role as an employed RN. Students may request to apply time spent on health system quality work toward their total clinical hours, but this must be:
          1. Discussed with the faculty in advance
          2. Meet course outcomes
          3. Constitute no more than [10%] of total clinical hours
        6. Practice as a nurse educator (education process, curriculum work, or educating nursing students) does not qualify for graduate clinical practice, unless the student has specified the Nurse Educator track for the MSN curriculum.
        7. Nurse Educator students are required to complete a direct care clinical at the advanced nursing practice level in addition to nursing education practica.
      12. Attendance
        1. There is little time during the semester to make up clinical hours; therefore it is important students attend all clinical days. Absences for any reason other than illness are not acceptable.
        2. Students should not come to clinical ill. Excused absences for illness may require makeup of clinical time to meet the course objectives and complete the course.
      13. Student Evaluations:
        1. Clinical instructors will schedule an evaluation time with each student at the midpoint of the clinical rotation.
        2. Faculty are to use the SON-approved clinical evaluation form for the course they are teaching
        3. Final evaluations for the clinical course are scheduled for each student individually, outside of clinical hours, and preferably on campus.
        4. If at any point in the semester a student is not meeting clinical expectations the faculty are required to notify the student in writing, either via the midpoint clinical evaluation or through a Performance Progression Alert form. Students should not hear about any weaknesses or issues for the first time at the final evaluation.
          1. An electronic copy of the Performance Progression Alert form should be transmitted to Academic Advisor; Chair of RAP committee; Associate Director of Advising, Admission, and Student Support; School of Nursing Dean; and as appropriate, Lead Course Faculty and/or the level/track faculty as appropriate.
          2. A hard copy of the signed Performance Progression Alert goes into the student file.
        5. Student evaluations, and if applicable, logs of student clinical activity, are required to be filed in the student’s academic file in the School of Nursing office no later than {the last day of finals week] [consider: the date grades are due to the university, which is usually 5 working days after finals end. This would allow faculty time to organize the information]
      14. Faculty evaluations
        1. All faculty are evaluated each clinical rotation by students. The official PLU evaluation forms are available in your SON mailbox or the SON office.
        2. Faculty are required to follow the procedure outlined in the evaluation instructions for conducting the evaluation.
      15. Clinical site evaluations are to be conducted at least annually and recommendations for continued use of the clinical site communicated to the SON administration and Clinical Placement Coordinator.
      16. Cancelling clinical days
        1. Clinical may be cancelled for weather reasons if the university is closed.
        2. Clinical faculty should not cancel clinical for reasons other than weather without first discussing with the lead faculty for the course.
        3. Cancelling clinical days for faculty illness
          1. The clinical faculty should immediately notify the students and the clinical site to cancel the clinical day.
          2. The faculty should notify the lead faculty for the course and/or the Clinical Coordinator so alternative plans may be made to fulfill clinical hour requirements.
          3. The clinical faculty will need to arrange to be available if make-up days are scheduled.