Student Nurses and Midwives Guidelines For Clinical Settings

The Outpatient Setting
1. Arrive professionally dressed 15-30 minutes before scheduled start time & begin reviewing the list of appointments for the day.
2. Review charts as available and ask questions of the preceptor, as needed.
3. Communicate your specific goals for that day’s experience with the preceptor
4. Come to an agreement with the preceptor about an approach/plan for the day, including the acceptable degree of management responsibility and/or amount of direct supervision needed
5. Evaluate the client history and conducting the physical examination with direct supervision from your preceptor (i.e. preceptor in the examination room) unless otherwise directed.
6. Have the preceptor validate physical exam findings, as needed.
7. Give a full case report to your preceptor privately, as needed
8. Work with the preceptor to devise & revise a clinical management plan
9. Discuss & implement the plan with the client
10. Document all encounters in the health record or separately for preceptor review. The requirements for documentation as a student will be different according to the practice site.
11. Ask the preceptor to review and co-sign all student documentation
12. Complete the electronic Medatrax evaluation form as required by the clinical course  syllabus (daily/weekly)
13. Ensure that clients never leave the facility until the preceptor has seen them and has been informed regarding the client status and a plan of care has been approved

The Intrapartum / Postpartum Setting
1. Items 2 – 15 from above apply, with the following modifications:
a. Your preceptor must be present with you when plan of care is implemented.
b. Specific priorities are clarified early (e.g., need for quick assessment and plan due to rapidity of labor).
c. You provide report of progress and management plan to preceptor at appropriate “clinical milestones” (e.g., need for vaginal examination to monitor progress).
d. Your preceptor initiates all consultations with physician back-ups, unless specifically modified by faculty or unless jointly planned otherwise.
2. Additional guidelines include:
a. The preceptor should be available and on-site when you are learning the labor
management role of a nurse-midwife. Be sensitive to the preceptor’s need to
repeat your assessments until she/he is comfortable with your skill level.
b. The preceptor is to be notified prior to any hands-on care of clients. Skills such an
AROM, or internal monitor placement require close communication with your
preceptor and she/he needs to observe and assist you.
c. All student documentation must be co-signed by the preceptor. Chart
entries/progress notes are to be completed promptly & in accordance with the
site’s clinical practice guidelines. Requirements for student documentation that
vary from the aforementioned standards should be discussed with clinical
course faculty.
Birth Experiences
1. The preceptor should be present for all births. Discuss with her/him what
you should do if a birth occurs unexpectedly and she/he is not present.
2. All documentation completed by the student must be co-signed or attested by
your preceptor.
3. In the event of birth complications requiring physician involvement, the
student should assume an assistant role or other role specifically delegated to
them. Students should never perform a skill for which they have not been
trained, but should remain involved in the care of the client to the fullest
possible extent if possible (e.g. you may assist with the birth of the baby’s body after the
physician delivers the head by vacuum extraction. In addition, you may perform the placenta
delivery and/or perineal repair after the physician completes the birth).
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4. You may observe C-sections for clients where you have participated in the
labor management and you can assess the newborn after birth.
5. Students must wear full OSHA-approved personal protective equipment
including gloves, gown, eye protection, and mask even if your preceptor does
not. This is for your safety – learning is messy work!
Postpartum Experiences
1. Discharge rounds are wonderful opportunities for patient teaching and
physical assessment; Students should participate fully in these experiences,
based on clinical course learning objectives.
2. During initial postpartum experiences, you will make rounds with the
preceptor present (at the bedside).
3. Documentation completed by students must be co-signed or attested by the
preceptor. Students should always give a full case report to your preceptor and
ensure that the preceptor sees the client before she leaves the facility.
Newborn Experiences
1. Students will perform newborn assessments on all babies whose birth you
attend. A nurse-midwife or other qualified healthcare provider can assist you
with the newborn assessment as necessary.
2. If your preceptor charts on the baby, you may chart as well. The preceptor
must co-signs the student note. If your preceptor does not manage the care of
the neonate, you may perform the assessment but should not chart on the
infant.
3. If you are in a birth center, you may go on home visits with the nurse-midwife
or nurse. During these home visits you can perform postpartum and newborn
assessments in the student role. (Students performing home visits will maintain a
nurse-level role during this type of visit until integration.) The practitioner supervising
you should sign your note.
?Failure to follow OSHA
guidelines is grounds for
dismissal from the clinical site.
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Non-Core Skills
1. Ultrasound training is not included in the basic midwifery program. Do not perform an
ultrasound, even with the assistance of your preceptor.
2. Vacuum Extraction – If a physician or nurse-midwife performs a vacuum extraction you
may complete the birth and repair after she/he has delivered the head and removed the
vacuum cup. You may not assist with the vacuum application or pull.
3. Surgical First Assist is not a core competency any involves the broadening of existing
skills. During the intrapartum rotation there is much to master; first assist is not to be
your focus but you can participate if there are no other experiences.
During integration you may scrub in if your preceptor acts as the first assist and closely
observe/begin to learn the first assist role. Your preceptor should be the first assist of
record and if she/he must break scrub for any reason, you also must break scrub. If you
have any questions please contact your individual course faculty prior to scrubbing in.
4. Circumcision training is not included in the basic midwifery program. Do not perform a
circumcision, even with the assistance of your preceptor.
5. Colposcopy training is not included in the basic midwifery program. Do not perform a
colposcopy, even with the assistance of your preceptor.
6. Repair of 3rd and 4th degree lacerations is not included in the basic midwifery program.
Do not perform 3rd or 4th degree laceration repairs, even with the assistance of your
preceptor.
Liability Insurance
As a Vanderbilt student, you are covered under Vanderbilt’s malpractice insurance as long
as you are within your clinical site and functioning as outlined in your program and course
objectives.
You may not take extra clinical time over break to get additional experiences unless you are
still completing a clinical course. Do not go to a clinical site to see patients without being
enrolled in a clinical course. If you need additional experiences in order to meet clinical
objectives, you and your faculty, and preceptor will discuss supplementary clinical time.
If you are working or volunteering outside of your clinical assignment, you CANNOT
represent yourself as performing such clinical or volunteer work as a VUSN NMW student.
Attending Satellite Sites with your Preceptor
Some preceptors work at different offices or deliver at multiple sites. You may only enter sites if
we have a contract in place with that organization. Please call your clinical course faculty to
check if a contract is in place BEFORE you enter a site. You may NOT follow your preceptor,
even for observation, unless we have a contract in place. Failure to follow this guideline will
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result in consequences that may affect your clinical progression. We are open to getting a
contract with satellite clinics or additional hospitals if it would improve your clinical experience.
Please notify your clinical faculty of this need.
Sometimes it is hard to understand what is a different clinical location. Here are some examples:
1. Sally is in her outpatient clinical experience, N331.
Her preceptor is called away from the office to
discharge a patient at the hospital across the street.
– Sally is NOT allowed to go with her unless there is
a contract in place with the hospital.
2. Jane is in her intrapartum rotation at a free-standing
birth center when the client is transferred to the
hospital for failure to progress. The CNM preceptor
accompanies the woman to the hospital. Jane can
NOT go to the hospital to observe unless there is a
contract in place with the hospital.
3. DW is in her integration semester and is feeling weak on estimated fetal weight. Her
preceptor sees clients in the office 2 days a week and goes to the local health department
1 day a week. Her preceptor suggests she can increase her clinical expertise if she
attends the health department clinic. DW may only enter the health department if
Vanderbilt as an agreement with that facility.
Untoward Outcomes
Please notify your clinical course faculty if there is an untoward outcome associated with any
patient you have cared for. Your faculty will help you process the experience and refer you to
additional resources, such as Vanderbilt’s Risk Management Department, if indicated.
If you are unsure if an occurrence qualifies as an untoward outcome, treat it as if it is one and
notify the faculty tracking your clinical progress. Your call serves to help you process the
experience and give you needed resources – doing so is not punitive in any way.
Clinical Record Keeping
1. Purpose
You will track numbers of clinical experiences and clinical hours as you progress through
the program. This serves as:
– Assessment of the number of experiences available at each clinical site.
– A final record of all experiences for application for certification.
– Verification of experiences for future employer.
– Documentation for the provision of learning opportunities for program
accreditation.
?Check with your
clinical course faculty
before attending ANY
clinical location other than
the primary site to which
you are assigned.
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2. Evaluations
a. Mid-term and Final evaluations are the summative evaluations. Only the final
evaluation score is included in your grade for the course.
b. Electronic Submissions – All evaluations for clinical courses are performed within
the Medatrax system. An orientation to Medatrax will be provided prior to your first
clinical course and will include how to fill out the evaluation. You should self
evaluate prior to asking for your preceptors feedback.
c. The Clinical Log – All experiences should be logged into the Medatrax clinical log.
Your log must be updated at least once a week.
3. Your Responsibilities for Evaluation
a. Fill in your ratings, comments, goals, and experiences prior to your preceptor.
b. Discuss the evaluation and the experience with the preceptor, identifying own
strengths and areas for improvement, and remain open to constructive feedback.
c. Give the preceptor and/or individual course faculty feedback as to your learning style
and learning needs.
d. You will need to turn in an electronic course portfolio at the end of each semester.
e. At the end of each semester you will be asked to evaluate each course. We use the
course evaluations to adjust the class to meet student needs. We need to know what
did not enhance your learning AND what worked within the course. The feedback is
confidential and helps ensure that our program incorporates student suggestions.