Onboarding Packet for Preceptor Nursing Students

Published by: ZSFG Department of Education & Training in collaboration with ZSFG Nursing Workforce Development & Education

DET 9/14/18 Student Placement

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This packet of the on-boarding process for Preceptor Nursing Students

includes:

□ Checklist with timeline outlining documentation & onboarding requirements for precepted

students ........................................................................................................................................... 2

□ Forms To Be Completed And Submitted By Email ...........................................................................

1. Preceptor Single Nursing Student Placement Form .........................................................3-5

2. Preceptor Student Placement Requirements Attestation Form .......................................6-8

□ Instructions accessing Litmos ......................................................................................................... 9

□ For preceptor students requiring EMR Accounts – ...................................................................... 10

□ INVISION/LCR Account Access ...................................................................................................... 11

□ ECW training module access and first time log in ........................................................................ 12

□ Nursing Dept. Policy No.: 1.21 ...................................................................................................... 15

□ CAMPUS MAP ................................................................................................................................ 21

□ Parking Fee .................................................................................................................................... 22

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Documentation and Checklist for Onboarding Preceptor Nursing Students at ZSFG Name of School: ____________________________ Preceptorship Start/Stop Dates: ______________

Preceptor Student Name: __________________ Unit(s) placed ___

Item Completed Notes

School has active student placement agreement/MOU with SFDPH

School requests preceptors for single student placements at ZSFG by emailing ZSFG student placement coordinator

2 weeks prior to first day at ZSFG, the Schools scans and emails to ZSFG student placement coordinator (cherrish.hollis@sfdph.org and janet.kosewic@sfdph.org) the following for each student requiring a preceptor:

• Preceptor Student Roster and EMR Request Form

1 week prior to first day at ZSFG, the School scans and emails the documents to the ZSFG student placement coordinator: cherrish.hollis@sfdph.org and janet.kosewic@sfdph.org

• Preceptor Single Nursing Student Placement Form

1 Week prior to first day at ZSFG, the School is notified by ZSFG student placement coordinators that onboarding requirements have been met and the placement can begin on start date. No placement can have students on

ZSFG campus without this notification • School notified preceptor placement cleared to start by ZSFG

First Clinical Day:

• Student picks up Building 25 door access badge and signs it out on the door access badge roster located in room H7004

*note: students assigned to the Psychiatry and Specialty Clinics do not need Building 25 door access badges

• Student, with preceptors guidance, logs into their ZSFG EMR accounts and signs the SFDPH IT online confidentiality agreement

Each Clinical Day:

• Student works with the ZSFG staff assigned a preceptor on their course learning objectives and follows up on evaluation per course syllabus

• Lost door access badges – Student must report their lost door access badges immediately to the ZSFG preceptor, the ZSFG nursing student placement coordinator and ZSFG bed control office H7004 if after 5pm Monday-Friday. *Note: Lost door access badge - requires the Student/Instructor paying $20

(check or money order only) by going to Human Resources on 25th Street during business hours to have the lost door access badge replaced

• Contacts ZSFG Unit Manager or ZSFG Student Coordinator (janet.kosewic@sfdph.org) with any issues

Last Clinical Day:

• Student returns their building 25 door access badge to the Bed Control Office in room H7004 and signs that they returned the badge on the sheet attached to the return envelope

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Preceptor Single Nursing Student Placement Form (submit via email) Date: _______________________

Last Name: __________________ First Name _____________________ MI _____________________

Address: _______________________________________________________________________________________

Phone: ________________________ Email: __________________________________________

Do you have a Nursing license? Yes No If yes, attach a copy of license: Yes No

Have you been placed as a student at Zuckerberg San Francisco General Hospital before? Yes No

If yes, date(s): __________________________________ Department: _________________________________

Affiliated School

Please only include the applicable degree for what you will be instructing.

School Name: __________________________________ School City/State: __________________________________

Area of Study/Practice: ______________________________________________________________________________

Type of Degree: ______________________________________________________________________________________

Course Title: ________________________________________________ # of Credits/Units: _______________________

Start Date: ___________ End Date: ___________ Course objectives attached: Yes No N/A

Please complete only if you are not the school contact.

School Contact Name: _______________________________________________________________________________

Title: ________________________________________________ Department: __________________________________

School Contact Email: _____________________________ Phone: ________________________________________

School Contact License Number (if applicable): _________________________________________________________

Instruction Role

ZSFG Department/Clinic/Unit Responsibilities/Course Schedule/Shift

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Orientation and Health Requirements Attestation

I attest that I have been orientated to the ZSFG hospital by completing the ZSFG Hospital Orientation Module

online (Submit your completion certificate to the school and keep a copy for your records). Note: Orientation

module is required to be completed annually. I am in full compliance with the ZSFG health requirements and can

produce a copy of my health records within 48 hours whenever requested.

Signature: ___________________________ Date: _____________________________________

For clinical faculty/instructors, health screening is required at the beginning of every clinical rotation. Faculty/Instructors are required to provide their school placement coordinator with their proof of immunizations, screenings and/or titers of the following listed health requirements BEFORE starting their placement at ZSFG. Random audits will be conducted.

Infectious Disease Immunization Health Requirements

Also known as Health Requirement Record keeping and other pertinent information

Measles Rubeola Document date of titer result or vaccination

Mumps Document date of titer result or vaccination

Rubella German Measles or 3-day measles

Document date of titer result or vaccination

Varicella Chicken pox Document date of titer result or vaccination

Influenza Seasonal Flu 1. Must receive vaccination annually. Document vaccination date. 2. Seasonal flu vaccination required annually from December through April. If

the ZSFG infection control program extends or changes the season dates at ZSFG, the school will be notified

Tuberculosis TB

TB Option 1: To be completed by those Instructors who have not had any TB skin testing within the past 13 months.

1. Student to have TB two-step skin test screening performed. Documentation of both dates with negative results.

2. Screening with TB skin test annually thereafter. Documentation of annual negative TB skin test.

3. TB skin test to be repeated if student has been exposed to TB since last results.

NOTE: Quantiferon-TB Gold blood test result is only acceptable as a substitute for TB skin testing if Quantiferon results are within the last 3 months

TB Option 2: To be completed by those instructors who have had negative TB skin test results annually

TB 1. Record of the initial TB two-step results on file. 2. Student to have annual TB skin test screening. Documentation of annual

negative TB skin test 3. TB skin test to be repeated if student has been exposed to TB since last

results. NOTE: Quantiferon-TB Gold blood test result is only acceptable as a substitute for TB skin testing if Quantiferon results are within the last 3 months

TB Option 3: To be completed by those instructors who have had positive TB skin test results with negative chest x-ray OR have been vaccinated for TB

TB 1. Chest x-ray date to assess for active TB within the past 2 years and 2. Documentation of an annual TB symptom review by student’s health care

provider written on official medical center letterhead that the student does not have signs and symptoms of TB including: drenching night sweats, persistent fever, unexplained fatigue, unexplained weight loss, unexplained loss of appetite, swollen glands, shortness of breath, persistent coughing, coughing up blood and hoarseness.

Not Required but strongly encouraged:

Hepatitis B Hep B Documentation of vaccination dates or titer results not required but strongly encouraged.

Emergency Contact Please provide a contact person in case of an emergency while on the Zuckerberg San Francisco General Hospital campus or affiliated clinics. Name: ______________________________________________________________________________________

Relationship: ______________________________________________________________________________________

Phone #1: ______________________________________ Phone #2: __________________________________________

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Oath of Confidentiality

As a condition of clinical placement, conducting research, a student internship or the observation of patient care at

Zuckerberg San Francisco General Hospital and Trauma Center, I ______________________________________

agree not to divulge any information obtained in the course of such training or research to unauthorized persons, and

not to public or otherwise make public any information regarding persons who have received services such that

the person who received services is identifiable.

I further agree not to divulge or public general patient information or statistics without prior authorization from my

preceptor or hospital administration.

I further agree to hold in strict confidentiality all matters discussed in Medical Staff of hospital committee meetings to

which I might be privy.

I recognize that the unauthorized release of confidential information may make me subject to civil action under

provisions of the Welfare and Institutions Code.

Signature: _________________________________ Date: _________________________________________

Faculty/Instruction Declaration

I certify that the information provided on this form is true, accurate and complete. I agree to provide the

immunization/screening records upon the hospital’s request. I understand that any false information will cause

my disqualification in any programs on the Zuckerberg San Francisco General Hospital (ZSFG) campus and

affiliated clinics. I recognize that all confidential information obtained or observed at ZFGH is in confidential

nature. I agree, that at all times, to ensure the confidentially of all sensitive information I have contact with,

comply with applicable laws and maintain patient privacy. I understand that failure to comply with any of the

above requirements may result in cancellation of my instruction agreement. I further attest that I have received

appropriate written material and introduced to the hospital and the appropriate department/unit/clinic protocol

and standards.

Signature: _________________________________ Date: _________________________________________

Submission Email to school placement coordinator and to ZSFG:

cherrish.hollis@sfdph.org and janet.kosewic@sfdph.org

Department Use Only—Received Date: ______________________________ Initials:___________________________________

Email this form to ZSFG FACILITY CONTACT janet.kosewic@sfdph.org and cherrish.hollis@sfdph.org at least 2 full weeks prior to the start of the clinical rotation. Failure to do so may result in the delay of the clinical experience. Thank you in advance for your cooperation.

PRECEPTOR STUDENT PLACEMENT REQUIREMENTS ATTESTATION FORM (submit via email) This form must be completed and submitted 2 weeks prior to each preceptor clinical rotation.

SCHOOL: _____________________________ Program type (circle): MS/N ELM BSN ADN LVN Other

Program Director: __________________________ Phone ____________ Email _____________________________

COURSE Title/Topic: __________________________________ Goals, Objectives, Syllabus attached (each Semester) or on file

Clinical Instructor: ___________________________ Email: ________________________________________________

Phone: ______________________________ Cell-phone: _____________________________

CLINICAL EXPERIENCE dates: from _________ to ____________ Preceptorship Required Hours: ___________

DAY(S) OF THE WEEK: ______________________ TIME/SHIFT: ____________ UNIT(S): ___________________________

MANDATORY – School Clinical Instructor/Coordinator must read and sign:

1. I have confirmed that all participants have on file at school, current (and valid for the duration of the clinical experience) and will be able to produce

copies of these requirements for the Facility within 48 hours of the request:

✓ Cleared criminal background check

✓ Immunization status for MMR, Varicella, TB clearance, TB Symptom Review letter if +PPD, and the strongly recommended Hepatitis B immunization

✓ Influenza seasonal vaccination December through March or declination form #received__________ #not received__________

2. I verify (and have verification on file) that, prior to the first day of the clinical rotation, all listed students and clinical instructors have

✓ Completed all mandatory requirements including the ZSFG online hospital orientation module within the past 12 months.

✓ Received site-specific orientation materials and understand the need to comply with all hospital policies, protocols, guidelines/standards

✓ Students will complete the HIPAA/Confidentiality Agreement and Unit Orientation prior to being assigned to patient care.

✓ Students have registered or completed training for the site’s electronic health record where available.

By signing below, I verify that I am able to produce documentation of any and all of the above upon request.

Print Name _________________________ Signature ___________________________ Date ______________

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ZSFG Nursing Student Health Requirements

Infectious Disease Immunization Health

Requirements

Also known as Record keeping and other pertinent information

Measles Rubeola Document date of titer result or vaccination

Mumps Document date of titer result or vaccination

Rubella German Measles

or 3-day measles

Document date of titer result or vaccination

Varicella Chicken pox Document date of titer result or vaccination

Influenza Seasonal Flu 1. Must receive vaccination annually. Document vaccination date. 2. Seasonal flu vaccination required annually from December through April. If the ZSFG infection control

program extends or changes the season dates at ZSFG, the school will be notified

Tuberculosis TB

TB Option 1: To be completed by those students

who have not had any TB skin testing within the

past 13 months.

TB 1. Student to have TB two-step skin test screening performed. Documentation of both dates with negative results.

2. Screening with TB skin test annually thereafter. Documentation of annual negative TB skin test. 3. TB skin test to be repeated if student has been exposed to TB since last results.

NOTE: Quantiferon-TB Gold blood test result is only acceptable as a substitute for TB skin testing if Quantiferon

results are within the last 3 months

TB Option 2: To be completed by those students

who have had negative TB skin test results

annually

TB 1. Record of the initial TB two-step results on file. 2. Student to have annual TB skin test screening. Documentation of annual negative TB skin test 3. TB skin test to be repeated if student has been exposed to TB since last results.

NOTE: Quantiferon-TB Gold blood test result is only acceptable as a substitute for TB skin testing if Quantiferon

results are within the last 3 months

TB Option 3: To be completed by those students

who have had positive TB skin test results with

negative chest x-ray OR have been vaccinated for

TB

TB 1. Chest x-ray date to assess for active TB within the past 2 years and 2. Documentation of an annual TB symptom review by student’s health care provider written on official

medical center letterhead that the student does not have signs and symptoms of TB including: drenching night sweats, persistent fever, unexplained fatigue, unexplained weight loss, unexplained loss of appetite, swollen glands, shortness of breath, persistent coughing, coughing up blood and hoarseness.

Not Required but strongly encouraged:

Hepatitis B Hep B Documentation of vaccination dates or titer results not required but strongly encouraged.

Email this form to ZSFG FACILITY CONTACT janet.kosewic@sfdph.org and cherrish.hollis@sfdph.org at least 2 full weeks prior to the start of the clinical rotation. Failure to do so may result in the delay of the clinical experience. Thank you in advance for your cooperation.

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Preceptor Student Placement Roster and EMR Account Request Form (submit via email)

Legal Full Name

(First, Middle Initial, Last)

Best Contact Phone #

School Email Address (NOTE: EMR accounts will not be

created with personal email address)

If EMR access needed: Month & Day of Birth and

last 4 digits of SSN#

Instructor:

Email this form to ZSFG FACILITY CONTACT janet.kosewic@sfdph.org and cherrish.hollis@sfdph.org at least 2 full weeks prior to the start of the clinical rotation. Failure to do so may result in the delay of the clinical experience. Thank you in advance for your cooperation.

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Instructions accessing Litmos Note: For on-line ZSFG hospital orientation module (must be

completed every 12 months, both students and faculty/clinical instructors)

Welcome to Zuckerberg San Francisco General Hospital’s learning Management System, Litmos! Please spend a few minutes reviewing the

instructions below before starting your course work.

NOTE: Use Internet Explorer only. Disable your “Pop-up blockers” your

computer settings for the best experience accessing the module.

1. Setting up Your Account:

Click or copy and paste the URL below and you’ll be directed to the Litmos

logon screen.

Setup your account using the following code: Orientation. You’ll receive an

e-mail with your username and a link to the course. If you don’t see the

email in your inbox be sure to check your spam folder.

2. Finding Your Course Work:

You should see the course: “Orientation/Students, Volunteers, Sheriffs”

course on your home screen. Simply click on the course and you’re enrolled.

If you don’t see it, or you have additional course(s) to take, click on the

“Course Library” tab near the top of your screen. Find your course, click on it

and you’ll be enrolled.

3. Printing your Certificate of Completion

Click on the “Achievements” tab near the top of your screen. Find the

certificate you need to download and click the blue download button to the

right of the course name. Save it and email it to the individual who

requested you take the course.

4. User Support

Need Help? Send an e-mail to: Halogensupport@sfdph.org

Be sure to reference Litmos in the subject line. Halogen Support office hours: M-F, 8:00 am 3:30 pm

http://sfghlearn.litmos.com/self-signup/

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For preceptor students requiring EMR Accounts –

Tutorial handout on accessing the online DPH confidentiality agreement (required to be

completed annually) and first-time activation of Active Directory (AD) account

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INVISION/LCR Account Access

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ECW training module access and first time log in on student’s first clinical day

instructions: For preceptor students placed in ZSFG clinics

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Nursing Dept. Policy No.: 1.21

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CAMPUS MAP

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Parking Fee