Clinical Information & Policies

Body Fluid Exposure (BFE) Instructions for Students:

If you experience a Body Fluid Exposure while on a clinical rotation, immediately:

1. Wash the area
2. Notify your clinical supervisor*
3. Report immediately to the facility’s Occupational Medicine department, if open, or Emergency Department, if not, for evaluation of the exposure unless you are at HUP. If you are HUP, report to the Student Health Service immediately, unless it is after hours.  If it is after hours, report to HUP’s Emergency Department.
   • The goal is to be evaluated quickly so that you can be started on HIV post-exposure prophylaxis (PEP) promptly, if necessary.
   • If the facility does not have an Occupational Medicine or Emergency Department, report immediately to SHS.
   • Request a copy of treatment plan and source patient results, when available, for your primary care provider (SHS)
4. Call SHS on the day of BFE to schedule a non-urgent evaluation at SHS within 1 week
   • Not necessary if initial evaluation was performed at SHS
   • Bring treatment plan from initial evaluation, including baseline lab work and medications ordered, and source patient results to SHS

Body Fluid Exposure (BFE) Instructions for Clinical Supervisors*:

If a student under your supervision experiences a BFE,

1. Encourage the student to wash the area and report for immediate evaluation of the exposure.
   • Prompt evaluation is important in HIV post-exposure prophylaxis (PEP).
   • Direct the student to the facility’s Occupational Medicine department, if open, or Emergency Department, if not, or SHS, if the facility does not have an Occupational Medicine department. If at HUP, report to the Student Health Service immediately, unless it is after hours.  If it is after hours, report to HUP’s Emergency Department.
   • Note the name and second identifier of the source patient and give it to the exposed student to take to his/her evaluation
2. Arrange for source patient testing.
   • We find that the complicated processes surrounding source patient testing sometimes cause unnecessary anxiety in students. Your help in obtaining prompt source patient testing will be an invaluable service to your student. 
   • Contact the treating physician/provider of the source patient to explain the exposure and request testing for HIV, HBV and HCV.
   • Arrange to get the results to the student as quickly as possible. 

1. The clinical instructor is to inform the Office of Student Information (compliance@nursing.upenn.edu; 215.898.8127) and the Advising team (advisor@nursing.upenn.edu; 215.573.2205) by e-mail and telephone of the incident, including the name of the student, time, date and location of exposure. Notification should occur as soon as possible.

*A “clinical supervisor” is the resource staff member who is most readily available to the student in the clinical setting. Depending on the program and setting, it can be an intern, attending physician, primary care unit group leader, clinical instructor, preceptor, etc. 

The School of Nursing will provide an orientation to home visiting prior to the first student home visiting experience.  This orientation will include education about safe conduct in making home visits, discussion of the leaflet “Suggestions for Safe Conduct,” and clarification of the student nursing role in the community. During the community health nursing course, students will participate in an extended orientation to their particular service neighborhood in order to familiarize themselves with that area and its resources.

School faculty will have regular communication with the clinical agencies to identify and minimize/eliminate potential sources of problems. Course faculty will also review the location of cases and/or specific neighborhoods with appropriate community agencies to ascertain the safety of making home visits in these locations. Clinical instructors supervising home visiting experiences will encourage feedback and discussion concerning potential safety problems with students in their clinical groups. Clinical experiences will be planned to enable students to make independent home visits with a student partner. Please refer to the section in this Handbook titled “Travel to Clinical Sites” regarding transportation to the homes.

Students will participate in class and clinical discussions about safe conduct in making home visits. Written material will also be provided to them about safety practices, and students will seek clarification of any questions they have about applying any of the recommended practices. Students will be accountable to the faculty and each other in implementing safe-conduct practices while making home visits in the community. The concrete application of practices that facilitate safety while making home visits is considered an ongoing process involving both faculty and students. This process will be assisted by clear, open, and continuing communication between students and faculty about safety issues.

1. In addition to being thoroughly familiar with this statement, students are expected to abide by course-specific policies that are detailed in the syllabi for each clinical course.
2. In all matters, students are expected to conduct themselves as engaged, respectful visitors to clinical settings, and developing professionals.  It is important to comport one’s self in ways that engender the confidence and respect of staff members, patients, and families. Casual talk, loud speaking, and group socializing are a few examples of behaviors that reflect poorly on individual students, as well as on Penn Nursing.
3. Students are reminded that social relationships with patients, families or staff are not acceptable while in the clinical learning environment. Please strive to have positive, professional interactions with both staff members and patients/families.
4. Students are expected to adhere to all standards and guidelines of the institutions or agencies where they are assigned for clinical learning. Instructors will point out important rules/standards, especially ones that are unusual or unique to a particular setting, at the beginning of placements, but students are expected to use common sense and to ask about use of resources and scope of acts allowed to students before acting. When the School of Nursing and agency policies are in conflict, whichever is more stringent/restrictive will apply.
5. The list of issues that appears below is not exhaustive. Students are strongly encouraged to speak with their instructor whenever in doubt about proper conduct. 

1. The School of Nursing’s uniform policy for undergraduate students, found elsewhere in this student handbook, applies at all times. The student uniform not only assists students in presenting a professional image, but also enables students to be easily identified by instructors, fellow students, staff and patients.

1. In the event that the student is not able to start the clinical day because of illness, contact with the clinical faculty member must be accomplished via telephone at the earliest possible moment. At minimum a message must be left at the number the instructor specifies at the beginning of the experience. E-mail notification regarding absences is never acceptable. 
2. If a student starts the clinical day, but becomes sick and/or incapacitated during the experience, the clinical instructor will assist the student to arrange for safely going home, or to Student Health or the Emergency Department for necessary health care. If a pattern of early departure for illness develops, the student may be required to present documentation from a health care provider that the student is able to safely resume clinical experiences.

4. Use/possession of electronic equipment in the clinical setting

1. Students are strongly encouraged to bring an absolute minimum of personal possessions to clinical settings. Clinical agencies are not responsible for loss or theft of personal possessions.
2. Cell phone use for personal purposes during clinical hours is prohibited.  If a student must have a cell phone with them to receive emergency calls, it is to be turned to vibrate mode and specific permission must be obtained by the student from the instructor to make or receive calls. Under these exceptional circumstances, cell phones may only be used outside areas where patients are treated.  
3. Use of the Internet in the clinical area is restricted to those purposes necessary for patient care and permitted by agency policy. Use of the Internet for e-mail, entertainment or other purposes while in the clinical learning environment is expressly prohibited.
4. Use of personal computers and other technological tools such as PDAs and Blackberries while in the clinical learning environment is only permitted for accessing information needed to provide patient care. Particular care must be taken to ensure that patient privacy and confidentiality are completely safeguarded. Names, or other identifying data, must NEVER be entered or downloaded onto personal electronic devices.

5. Use of clinical time

1. While in the clinical learning environment, students are expected to pursue, either with faculty direction or independently, activities that will enhance their clinical knowledge. If the patient(s) that students have been assigned to do not appear, or if there is a lull in activity with assigned patients (students are encouraged to check with their instructors and staff before concluding this), it is expected that students will seek out their instructor for alternate assignments. They may also use their time to consult electronic or paper resources related to the care of patients in their setting. The following are never acceptable uses of clinical time because they do not advance the students’ clinical learning and reflect negatively on the student and Penn Nursing when observed by staff and visitors: 
   • Homework/assignments for other courses.
   • Reading non-health care related newspapers, magazines, etc.
   • Non-patient care related use of the Internet.
   • Socializing in groups