..

CLINICAL EDUCATION MASTER AGREEMENTbetween

Minnesota State University, Mankatoand

May:o Foundation

\

RECEIVED

\ rDECl-~~~College 01AH&i'!

Minnesota State University, Mankatc

Effectiv.e October I, 2002, Minnesota State University,Mankato (the "University") and Mayo Foundation (the "ClinicalFacility") enter this Agreement to provide clinical educationopportunities to the students of the University (hereinafter"Students") in order to improve in patient care and to providemaximum utilization of community resources.

The University and Clinical Facility agree as follows:

1.0 Clinical Education.

1.1 University shall be fully responsible fororganizing, establishing and conducting its clinical educationprogram. Each University will maintain its accreditation by theaccrediting body applicable to the clinical experience asspecified in the attached Addendum.

1.2 The Clinical Facility will permit the Universityfaculty and students to use its patient care and patient servicefacilities for clinical education according to a mutuallyapproved plan. Clinical Facility shall control the number ofStudents accepted under this Agreement and the availability ofits clinical areas for training. The dates of each Student'sclinical experience shall be arranged by the mutual agreement ofthe University and Clinical Facility.

1.3 The University will provide the Clinical Facilitywith objectives for the clinical experience program and implementthe objectives in cooperation with the Clinical Facility'sdesignated representative.

1.4 University shall ensure that all Students havesatisfied appropriate academic prerequisites, are in goodstanding with University, have completed background studies asrequired by Minn. Stat. § 144.057 and § 245A.04, have passed aphysical examination and maintain health insurance throughout theentire term of their participation in the Program. Universityshall maintain all personnel and academic records relating toStudents.

1.5 On a schedule to be determined between theUniversity and the Clinical Facility and reflected in the programaddendum between them Universitv will Drovid~ th~ rl;n;r~l

clinical experience program, the units within the ClinicalFacility where they are assigned, and the dates of each student'sparticipation in the program. If no schedule for providing thelist and documentation called for above is agreed to by theUniversity and the Clinical Facility, then such list anddocumentation shall be provided no less than 30 days prior to theinitiation of the clinical experience. University shall alsoprovide the Clinical Facility with documentation establishingthat each Student (a) has health insurance coverage, (b) meetsthe health requirements stated in Exhibit A to this Agreement,(c) has professional liability coverage as required in section3.0 of this Agreement, (d) is in good academic standing, and (e)has had a background study completed within the last 12 months,and is eligible to have direct contact with hospital patients.Exhibit A sets forth the health requirements for faculty andstudents who will participate in a clinical experience atClinical Facility. The University will use a form substantiallylike Exhibit B or other mutually acceptable efficient format tocertify to Clinical Facility that faculty and students meet thehealth and other requirements set forth in this Section 1.5.

University shall also provide Clinical Facility with prior noticeof any Student subject to activity restrictions or otherwiserequires accommodation of which University is reasonably awareand not prohibited from sharing with Clinical Facility. ClinicalFacility may, upon request, evaluate the needs and abilities ofany such Student and determine the accommodation appropriate forthe Student and the clinical area where the Student will receivetraining. The form attached as Exhibit B to this agreement orother mutually acceptable efficient format shall be used for thispurpose.

1.6 When applicable to the Program and pursuant to theClinical Facility's rules, policies, and procedures, Students andfaculty shall be required to participate in the drug usescreening program in effect at Clinical Facility. In accordancewith the policies governing that program, positive resultindicating illegal use of drugs can be grounds for discipline orfor the conditioning or termination of privileges.

1.7 Students shall be subject to and follow all of theClinical Facility's rules, policies and procedures, including,but not limited to, the Electronic Medical Record in the eventthe Clinical Facility utilizes an electronic medical record.policies and procedures are subject to change, however ClinicalFacility will provide prior notice of such changes.

1.8 When applicable to the Program and Student'sclinical experience, University Faculty and Students agree tocomplete the educational training of the Electronic Medical~o~~~~ n~n~rinpnhv rlinical Facility Drior to participating in a

inform Students and Faculty they are required to sign anauthentication security agreement statement prior to beginningtheir clinical experience. The Clinical Facility will use a formsubstantially like Exhibit C attached.

1.9 Prior to beginning of their clinical experience,Students shall receive instruction from University regarding (a)the obligation of patient confidentiality and (b) precautionsspecific to transmission routes of various infectious diseases toinclude practice of "standard precautions" and isolationprocedures. Students shall not disclose any patient information,except as required for patient care or as otherwise permitted byClinical Facility. University shall inform Students they arerequired to sign a confidentiality statement prior to beginningtheir clinical experience. The Clinical Facility will use a formsubstantially like Exhibit D attached.

1.10 University shall perform annual background studieson University faculty who supervise Students at Clinical Facilityand ensure that all such faculty are eligible to have directcontact with Clinical Facility's patients and residents underMinn. Stat. § 144.057 and § 245A.

1.11 Clinical Facility retains ultimate responsibilityfor the quality of care provided to its patients and the safetyof its facilities for its staff, patients and visitors.

1.12 Clinical Facility may require University toexclude from or terminate the participation of a Student in aclinical experience if the Student and/or faculty's work, conductor health may, in Clinical Facility's judgment, have adetrimental effect on its patients, staff or operations. AStudent/faculty generally will not be removed from a clinicalexperience until Clinical Facility has discussed its concernswith a representative of the University. However, ClinicalFacility reserves the right to take immediate action to suspend aStudent's/faculty's participation in response to concerns ofpatient care or the safety and respect of its staff.

1.13 Clinical Facility will attempt to arrange (a)access to classrooms and skill labs, (b) access to ClinicalFacility's Medical Libraries, (b) lockers for Students andUniversity faculty, and (c) parking for University/Collegefaculty, subject to availability and to institutional policiesthen in effect. Students and University faculty will have accessto Clinical Facility's employee cafeterias while at ClinicalFacility for training.

1.14 The Clinical Facility will allow a reasonableamount of Facility staff time for orientation and jointconferences with University faculty, for planning with University

faculty, and for such other assistance as may be mutuallyagreeable.

1.15 Neither the University nor the Clinical Facilitydoes or will discriminate on the basis of race, religion, creed,color, sex, national origin, disability, age, marital status,public assistance status, veteran status, or sexual orientation.

2.0 Addenda.

2.1 The clinical experiences to be offered under thisAgreement and specific terms applicable to each type of clinicalexperience including supervision of Students assigned to ClinicalFacility under this Agreement shall be stated in an Addendum tothis Agreement executed by the parties.

3.0 Insurance.

3.1 In order to protect the Clinical Facility and theUniversity and those persons and parties listed above, theClinical Facility and the University agree that at all timesduring the term of this agreement, and beyond such term whenrequested, the University will ensure no Students or facultyshall commence work at Clinical Facility unless covered bystudent intern malpractice insurance. The University, through theMinnesota Department of Administration Risk Management Division,has obtained private "occurrence" (not "claims made") groupstudent intern malpractice insurance for University students ahdUniversity faculty, with liability limits of $1 million/$3million annual aggregate with no deductible.

A certificate of

from the University and/orbe filed with the Clinicalinstructs. The certificatethe certificate holder andcoverage reflected above.

insurance for this policy is availablethe Risk Management Division and willFacility if the Clinical Facility soshall name the Clinical Facility asadditional insured for the liability

3.2 In lieu of the above, for each licensed

professional student participating in clinical education atClinical Facility, University (through self-insurance orotherwise) shall provide and maintain professional liabilitycoverage with limits no less than $1 million per occurrence and$3 million annual aggregate.

3.3 All such insurance shall be in full force andeffect prior to the commencement of the Program Year, and shallprovide that coverage on an occurrence basis shall not bemodified or terminated except upon sixty (60) calendar days priorwritten notice to Clinical Facility. .

Students are not state employees for purpose of Minn.Stat. § 3.732 and § 3.736 (Minnesota Tort Claims Act).

3.4 Prior to the scheduled clinical experience, theUniversity shall provide Clinical Facility with evidence of theabove-stated coverage.

Liability.4.0

4.1 Each party agrees that it will be responsible forits own acts and the results thereof to the extent authorized bylaw and shall not be responsible for the acts of the other partyand the results thereof. University's liability shall begoverned by the provisions of the Minnesota Tort Claims Act,Minnesota Statute section § 3.732 et seq., and other applicablelaw.

4.2 It is the position of the Clinical Facility thatStudents and University's Clinical Faculty are not employees ofthe Clinical Facility for any purpose, including workers'compensation coverage requirements.

5.0 Notices.

All notices required to be given under this Agreementshall be in writing and delivered in person or mailed first clasand postage prepaid, to the addresses indicated below:

1) For University 2) For Clinical Facility

Carol E. Larson, PhD, RNSchool of NursingMN State University, Mankato360 Wissink HallMankato, MN 56002Phone: 507-389-6023

Kia James, EdD, RNDepartment of NursingMayo Clinic1216 Second Street SWRochester, MN 55905Phone: 507-255-3236

6.0 Te~.

6.1 The term of this Agreement shall be for the three(3) year period from October 1, 2002, through October 1, 2005,unless terminated earlier as provided herein. Either party mayterminate this Agreement for cause immediately upon delivery ofwritten notice of termination to the other party, or, withoutcause, upon thirty(30) calendar days prior written notice to theother party.

6.2 In the event that Clinical Facility exercises itsoption to terminate this Agreement, no Students participating inan ongoing clinical experience will be denied the opportunity to

complete the experience, even when the effective date oftermination occurs prior to the completion date of the clinicalexperience. In such event, all applicable provisions of thisAgreement, including the right to terminate participationpursuant to Section 1.12, shall remain in force during the periodfrom the effective date of termination until the end of theclinical experience in which the Student is participating.

6.3 The parties shall review the operation of theclinical experiences specified in each Addendum to this Agreementyearly.

7.0 Miscellaneous.

7.1 This Agreement shall be governed by the laws ofthe State of Minnesota.

7.2 This Agreement contains the entire Agreementbetween the parties pertaining to the subject matter hereof, andsupersedes all prior agreements and representations. Nomodification or amendment shall be effective unless in writingand executed by both parties.

7.3 This Agreement shall not be deemed to create arelationship of agency, employment or partnership between theClinical Facility and either the University, the University'sfaculty or the University's Students.

7.4 The persons signing this Agreement warrant thatthey have full authority to do so and that their signatures shallbind the party for which they sign.

7.5 Neither party has the right or the power to assignthis Agreement, in whole or in part, without the prior writtenconsent of the other party.

7.6 Neither party shall use the names, trademarks, orservice marks of the other party or its staff in any publicity,public announcement, advertising or promotion without the expressprior written approval of the other party.

7.7 The books, records and documents of the ClinicalFacility that are specifically relevant to this Agreement shallbe subject to examination by the University and the LegislativeAuditor. Any such examination is directed to audit of theactions of the University, is necessary because of thepossibility of records of such actions being in the hands of theClinical Facility, and is not directed to the internal affairs ofthe Clinical Facility.

7.8 The University and the Clinical Facility agree tocomply with the terms of the Minnesota Data Practices Act.

Minnesota Statutes Chapter 13, in handling data relatedspecifically to this Agreement, which data does not includeprivate confidential patient data in the possession of theClinical Facility that may be viewed or handled by students orfaculty in the course of the clinical experience.

IN WITNESS WHEREOF, the parties have executed this Agreementas of the date written above.

Signatures:

Minnesota State University,Mankato Mayo Foundation

~~e~Signature

Carol E. Larson, PhD, RN

NameName

Associate Dean, School of Nursing Secretary, Mayo Foundation

TitleTitle

10-;:15-0 :LDate Date /1/7/6J?-.

ORIGINAl SIGNEDBY H. DEANTRAUGERsi...§L ~signature

H. Dean Trauger Claire Bender, MD

NameName

Vice President for Fiscal AffairsDean, Mayo School of HealthSciences

Title Title

Date ~~ / I-d-O~())-Date

As ~Fonn and EXjf'ction. ~~ a..o!1C ~, 41.~S1gn e

Rosemary Kinne

Name

~~s~ciaLe Bu~ct~Gf~cer Itf55/51u'1+ t&' .R -for ,'AJ4NLl! ,.tJd..,.,~nTitle

/ ~// lltJ-<.Date I (

.£)~ ?~}.4AJDoreen K. Frusti, MSN, MS, RN

Name

Chair, Department of Nursing

Title

1- J6 _/JDate ~ ~

A.

Mayo FoundationSTUDENT/FACULTY HEALTH REQUIREMENTS

Communicable Infectious Diseases

University shall provide a list of all students and facultywho will spend time in a hospital clinical area to ClinicalFacility's Employee Health Service. The list will include theindividual's name, address and phone number. The University mustverify that the students and faculty have complied with thefollowing requirements (If applicable, insert the words "not lessthan 30 days") prior to the beginning of their clinicalexperience at Clinical Facility:

3.

4.

5.

1. A negative tuberculin test within 6 months of beginninga clinical experience. If a tuberculin test ispositive, the individual shall have a negative chest x-ray within 6 months of beginning a clinical experience.Results of the tests will be documented by theUniversity.

2. Measles, mumps, and rubella immunity.may be satisfied by:

This requirement

a. two immunizations given after 12 months ofage; ordocumentation of disease by physician; ortiter results indicating immunity.

b.c.

Hepatitis B vaccine series or a signed declination.

Current tetanus/diphtheria (within the past ten years).

Documentation of varicella status (chicken pox).

In addition, the University will have a reporting/recordingmechanism in place for Students or faculty to notify and reportan accident or incident that occurs during a clinical experienceat Clinical Facility. Reporting shall be coordinated withClinical Facility's Employee Health Service which can perform anynecessary examination or testing. Emergency medical care will beavailable at Clinical Facility. Any hospital or medical costsarising from the testing, examination or treatment of theindividual shall be the responsibility of the individual whoreceives the treatment and not the responsibility of ClinicalFacility.

B. Other Health Problems

University will screen for other health problems that maylimit the activities of students and faculty or predisposestudents or faculty to injury in the clinical education settingthrough a means substantially similar to the attachedquestionnaire titled "Employee Health History" and used byClinical Facility's Employee Health Service.

W1nnesota State University, MankatoNOTICE REGARDING PREREQUISITES

FORCLINICAL EXPERIENCE

University certifies that the list of students, their specified

program and proposed dates of clinical training experience attached:

A. have health insurance coverage for the period of the proposedclinical training;

B. meets the health requirements stated in Exhibit A to the ClinicaEducation Master Agreement between University/College and Clinical Facilil(the "Agreement");

C. have professional liability coverage in the amounts requiredunder the Agreement;

D. have passed all academic prerequisites for clinical training andis currently in good academic standing; and

E. have completed an annual background study in accordance withMinnesota law and has been found eligible to have direct contact withClinical Facility's patients and/or Residents.

If the student is subject to any temporary or permanent restrictionson his/her activities or otherwise requires accommodation to participate irclinical training, please describe the student's condition and theaccommodation proposed to the best of your knowledge and as you are

reasonably aware, and not prohibited from sharing with Clinical Facility:--

Minnesota State Universit~, Mankato

Signature

Carol E Larson, PhD, RNName

Associate Dean, School of NursingTitle

Mayo Foundation

Electronic Authentication Security Agreement Statement

University Students (~Students") and University Faculty (~Facultwith authorized access to electronic clinical applications who nto authenticate documents electronically will be issued a User Iand will select a password that uniquely identifies them aftercompetency has been demonstrated. This protects the database anmaintains the privacy of patient information. The selectedpassword should be kept confidential and should not be compromisfor any reason.

Students and Faculty are accountable for any transactionsassociated with their password and User ID.

If at any time a Student or Faculty have reason to believe that 1confidentiality of his/her password or confidential information 1been compromised, Clinical Facility's Data Security Officer shou]be notified immediately so that appropriate action can be taken.

I, therefore, understand and agree:

1.2.

My User ID/password is the equivalent of a legal signature.In order to protect the security and integrity of ClinicalFacility's electronic data, I agree to approved Data SecuritPolicies and Standards.I will not attempt to access information by using a UserID/password other than my own.I understand that failure to do any of the above mayconstitute a violation of the Data Security policies andStandards and may result in disciplinary action by ClinicalFacility as well as external regulatory bodies.

3.

4.

Student Name:

Student Signature:

Date:

:;'aculty Name:

~aculty Signature:

)ate:

TO:

FROM:

SUBJECT:

Mayo Foundation

Minnesota State University, Mankato Students and Faculty

Mayo Foundation Board of Governors

Confidential Information

The Board of Governors calls your attention to Mayo Foundation'sConfidential Policy. In connection with the activities under the MasterClinical Education Agreement between Mayo Foundation and Minnesota StateUniversity, Mankato, all Students and Faculty of Minnesota StateUniversity, Mankato have an obligation to conduct themselves inaccordance with the policy and hold in confidence all informationconcerning patients, employees and business information. Confidentialinformation includes all material, both paper-based and electronic,related to the operation of Mayo Foundation including, but not limitedto:

. financial information

patient names and other identifying information

patient personal and medical information

patient billing information

employee names including salaries and employment information

proprietary products and product development

marketing and general business strategies

any discoveries, inventions, ideas, methods, or programs thathave not been publicly disclosed

any information marked "confidential"

.

.

.

.

.

.

.

.

Only physicians, or other authorized individuals, may access, use orrelease patient personal and/or medical information. Such matters areconfidential between the health care provider and the patient.

Students and Faculty must also refrain from revealing any confidentialinformation concerning employee records or business operations. Anycarelessness or thoughtlessness in this respect, leading to the releaseof such information, is not only wrong ethically but may involve theindividual and Mayo Foundation legally.

I heard or read the above statement, understand the contents and agree,unless authorized, not to access, use or release confidential informationregarding patients, employees and business operations. I also understandthat my unauthorized access, use or release of any and all confidentialinformation at Mayo Foundation may be cause for my immediate terminationfrom the clinical experience. In addition, I understand that I may bepersonally liable for any disclosure, misappropriation or use ofconfidential information.

SIGNATURE:

PRINT NAME:

DATE:

....-"

.ADDENDUM TO THE CLINICAL EDUCATION MASTER AGREEMENT

EFFECTIVE October 1,2002 BETWEENMinnesota State University, Mankato

AND

Mayo Foundation

In accordance with the terms of the above-referencedAgreement, the parties will offer the following clinicalexperience.

I.

II.

Program: Master's o£ Science in NUrsing: University shallmaintain accreditation by the National League for NursingAccrediting Commission located in New York, New York or theCommission on Collegiate Nursing Education in Washington,D.C.

The list and documentation called for by paragraph 1.5 ofthe Master Agreement to which this is an Addendum shall beprovided by University to Clinical Facility thirty daysprior to the initiation of the the clinical experience.

III. Clinical Experience:

A. DescriptionGraduated observational and patient care nursingexperiences consistent with stated degree curriculum.

B. Location(s) where clinical experience may be offered:Mayo Clinic Rochester. Mayo Health System practices mayalso offer clinical experiences under this Agreementwith the prior Agreement of the practice's management.

C. Duration of Clinical Experience:Per academic term with shorter experiences as mutuallyagreed upon by the University and Clinical Facilityrepresentatives

D. Approximate Number of Students:The number of students per term is dependent upon thenature and scope of the clinical experience as mutuallyagreed upon by University and Clinical Facilityrepresentatives.

E. Clinical Faculty:Minnesota licensed registered nurses who are on theUniversity's faculty and familiar with the ClinicalFacility's operations and policies. University willprovide Clinical Facility with updated lists of facultyand license numbers. Clinical Faculty are responsiblefor orienting the Students to Clinical Facility'srules, policies and procedures including, but notlimited to the Electronic Medical Record.

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4

F. PreceptorA person holding a Master's of Science in Nursing witha current Minnesota nursing license and practicing atMayo or a Mayo Health System practice. For nursepractitioner students, the Preceptor may be a Minnesotalicensed physician on staff at Mayo or a Mayo HealthSystem practice.

IV. University is responsible for the selection and adequacy ofthe faculty or other clinicians supervising their studentscompleting a clinical experience at Clinical Facility.University shall have full responsibility for theinstruction, supervision, control, evaluation and disciplineof its Students while at Clinical Facility.

V. Research Experiences:Prior to initiating research performed at Mayo facilities orinvolving Mayo patients, approval will be obtained from MayoFoundation's Nursing Research Committee, and if necessary,the facility's Institutional Review Board.

VI. Term:Clinical Experiences shall be conducted under this Addendumfrom October 1, 2002 until October 1, 2005.

vI. Administrative Contacts:

~innesota State University,Mankato Mayo Foundation

~arol E. Larson, PhD, RN;chool of Nursingm State University, Mankato,60 Wissink Hall

[ankato, MN 56002

Kia James, EdD, RNDepartment of NursingMayo Clinic1216 Second Street SWRochester, MN 55905

hone: 507-389-6023 Phone: 507-255-3236

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Rosemary

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Name

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Title

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Carol

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Mayo

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Name

Secretary,

Mayo

Foundation

Title

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Claire

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MD

Name

Dean,

Mayo

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ADDENDUM TO THE CLINICAL EDUCATION MASTER AGREEMENTEFFECTIVE October 1, 2002 BETWEEN

Minnesota State University, MankatoAND

Mayo Foundation

In accordance with the terms of the above-referenced

Agreement, the parties will offer the following clinicalexperience.

I.

II.

Program: Bachelor of Science Degree in NUrsing: Universityshall maintain its program approval by the Minnesota Boardof Nursing located in Minneapolis, Minnesota, and theUniversity's clinical education program(s) shall beaccredited by the National League for Nursing AccreditingCommission located in New York, New York or the Commissionon Collegiate Nursing Education in Washington, D.C.

The list and documentation called for by paragraph 1.5 ofthe Master Agreement to which this is an Addendum shall beprovided by University to Clinical Facility thirty daysprior to the initiation of the clinical experience.

III. Clinical Experience:

A. DescriptionGraduated observational and patient care nursingexperiences consistent with stated degree curriculum.

B. Location(s) where clinical experience may be offered:Mayo Foundation - Department of Nursing

C. Duration of Clinical Experience:Per academic term with shorter experiencesagreed upon by the University and Clinicalrepresentatives

as mutuallyFacility

D. Approximate Number of Students:25 students per semester

E. Clinical Faculty:Minnesota licensed registered nurses who are on theUniversity's faculty and familiar with the ClinicalFacility's operations and policies. University willprovide Clinical Facility with updated lists of facultyand license numbers. Clinical Faculty are responsiblefor orienting the Students to Clinical Facility'srules, policies and procedures including, but notlimited to the Electronic Medical Record.

IV. University is responsible for the selection and adequacy ofthe faculty or other clinicians supervising their students

University shall have full responsibility for theinstruction, supervision, control, evaluation and discipl:of its Students while at Clinical Facility.

V. Term:Clinical Experiences shall be conducted under this Adden&from October 1, 2002 until October 1, 2005.

VI. Administrative Contacts:

Minnesota State University,Mankato Mayo Foundation

Carol E. Larson, PhD, RNSchool of NursingMN State University, Mankato360 Wissink HallMankato, MN 56002

Kia James, EdD, RNDepartment of NursingMayo Clinic1216 Second Street SWRochester, MN 55905

Phone: 507-389-6023 Phone: 507-255-3236

VII. Signatures:

Minnesota state University,Mankato

Ca h (J J2,~0../1 ~~Signature

Carol E. Larson, PhD, RN

Name

Associate Dean, School of Nursing

Title

~ -c;tS---D~Date

.~J~~(S1gnatu e /"'ICl.Jo..J..-it0---C '\

H. Dean Trauger

Name

Vice President for Fiscal Affairs

Title .

I~I fb(Dd-Date I

kUvn;()11K~Signa ureAs To Form and Execution

Rosemary KinneName

Associate Budget Officer

Title

Date ~c>

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Mayo Foundation

Name

Secretary, Mayo Foundation

Title

Date L.f.!W A

Si~ ~Claire Bender, MD

Name

Dean, Mayo School of HealthSciences

Title

,,-~--{)~Date

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Doreen K. Frusti, MSN, MS, RN

Name

Chair, Department of Nursing

Title

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