Graduate Clinical Compliance (GRAD-06)

Effective Date

August 2013

Last Revision Date

7/23/2024

Responsible Party

School of Nursing Divisional Dean, Chief Nurse Administrator, Program Directors, Clinical Placement Coordinator, faculty, staff, and students.

Scope and Audience

Graduate nursing faculty and students.

Additional Authority

CHS: Student Background Check (Policy 313), Student Drug and Alcohol Testing (Policy 314)

1. Policy Purpose

To define clinical compliance requirements and measures for the School of Nursing.

2. Policy Statement

Requirements For Attending Clinical Courses

As per contractual agreements with our clinical partners, background checks, drug screens, BLS certification, tests for tuberculosis and certain vaccinations and immunizations are required.

Students are responsible for all costs related to health requirements for the School of Nursing and any partner health systems.

These requirements will be gathered by an outside company, depending on the program. The company used will be based on contractual agreements in place at the time requirements are due. Students will be notified prior to the beginning of the program-specific Health Requirement cycles and details. Students may also be required, based on their clinical placement, to have accounts through additional outside vendors in order to meet the requirements of their clinical placement. Should this be necessary, you will be notified by your program and all costs incurred will be the responsibility of the student.

Verification Of Enrollment in Medical Insurance

Neither the College of Health Sciences, the Departments or Divisions within the College, nor the clinical agencies carry health insurance for students. All students enrolled in the School of Nursing Graduate program must be covered by a medical insurance policy. Documentation of current health insurance coverage must be provided. Documentation of health insurance must be updated annually upon its expiration.

Background Check

Students in the School of Nursing are required to have and maintain a clean background check. Students are admitted to School of Nursing Programs conditionally,
pending completion of a clean background check by the deadline date provided by specific programs.

Students are responsible for following the program-specific account set-up requirements, arranging payment, and directly handling any disputed results with the vendor at the time of check or recheck. Please note School of Nursing designated faculty or staff have access to all results but will not initiate or process appeals or corrections through the vendor. Decisions regarding program eligibility will be made based on background results in accordance with College of Health Science Policy: CHS-314.0. Background checks performed for previous employment or licensing cannot be used, per contractual agreements with our partnering health care agencies. Students will be required to maintain a clear criminal record during their time in the Program and will be required to complete subsequent background checks every six months, during the time- period directed by the individual program. “Clear criminal background” is defined as a background meeting the criteria as outlined in COHS Policy: CHS-313.0.

Upon admission to the graduate program, students residing and completing clinical rotations within Idaho are required to complete both an Idaho State background check as well as a national background check through Castlebranch. Students may be required to complete additional background checks depending on their state of residence or where the clinical rotation will take place Castlebranch background checks must be completed every 6 months and are not allowed to expire while admitted into the graduate program.

Students may also be required, based on the requirements of the community or clinical partner, to have accounts through additional outside vendors (examples are my Clinical Exchange, ACEMAPP) in order to meet the requirements of the partner to conduct their project work.

All costs incurred will be the responsibility of the student.

Clinical Health Requirements

Students will submit the following health requirements as directed prior to being accepted fully into their specific program. Students will not be allowed to register for classes until health requirements are completed or a plan in place to complete health requirements. Students will also be required to complete subsequent health requirements (or “serial” health requirements) and re-submit during the time frame indicated by their specific program and in the manner directed at the time of submission.

Tuberculosis (TB)

A verified negative baseline 2-Step TB skin test or blood test, such as T-spot or Quantiferon Gold will be required prior to the beginning of the student’s first semester in their specific program. A baseline individual TB risk assessment used in interpreting screening results may be required by the healthcare facility administering the screening.

Additional testing/screening may be required as dictated by specific clinical placement requirements.
Tine Tests are not accepted
If a student has a positive TB test:
- Students with a positive baseline TB test result will be required to provide documentation of completed Pulmonary TB rule out through a symptom evaluation, a chest x-ray by a healthcare practitioner (Physician, Nurse Practitioner, or Physician’s Assistant). Additional workup may be needed based on those results and/or as directed by the healthcare practitioner.
- Students with a known latent TB infection or positive baseline TB screening test will be required to complete an annual TB Symptom Screen.
- If the annual TB symptom screen shows the student has symptoms of TB, the student will be required to provide documentation of completed Pulmonary TB rule-out through a symptom evaluation, a chest x-ray by a healthcare practitioner (Physician, Nurse Practitioner, or Physician’s Assistant). Additional workup may be needed based on those results and/or as directed by the healthcare practitioner.

Mumps, Rubeola, Rubella

Documentation of positive titers for each (OR verification of 2 MMR vaccinations) must be submitted prior to admission unless a severe allergy is documented by a licensed healthcare provider.

Mumps
Rubeola
Rubella

These are three separate and distinct tests

If any of the titers are “equivocal” or indicate that the student is not protected, immunization(s) and follow-up titers are required. Follow-ups may be in progress but must follow standard immunization/follow-up titer timeline protocols, as recommended by the CDC.

Varicella (chicken pox)

Documentation of a positive antibody. A statement of history of illness, even from a provider, will not be accepted in lieu of titer or vaccine series.

Hepatitis B

Documentation of complete Hepatitis B Vaccination series and positive Hepatitis B titer drawn at least 1-2 months after completion of the initial series is required. Series may be two-step, or three-step series as recommended by the student’s primary care provider.

If the titer drawn 1-2 months after completion of the initial series does not show immunity, the student will be required to complete a revaccination series and repeat titer 1-2 months after completion of the second series.
Students may be in progress with documentation of at least one dose of the Hepatitis B Vaccines. These students must follow CDC guidelines for completion of the series. If the student’s provider is recommending a schedule outside of the standard CDC guidelines, a written explanation from the provider must be submitted. The series and subsequent titer must be completed within 8 months.
Some students may be “non- converters,” despite following proper protocol. In order to demonstrate “non-converter” status, the student must provide verification of 2 complete series with 2 negative titers, 1 at the end of each series. Series must be done within the CDC recommended timeframe in order to qualify. Students who do not have protective concentration of anti-HBs (>10 m IU/ m l) after revaccination (i.e ., after receiving a total of 6 doses) should be tested for HBs Ag and anti-HBc to determine their infection status (Holm berg, Suryaprasad & Ward, 2012).

Management of Hepatitis B Virus-infected student

Students must provide documentation stating that they are under care and receiving guidance with regard to management of the Hepatitis-B viral infection. This must be signed by their healthcare practitioner, state that viral load testing and other appropriate assessments will occur every 6 months, and be provided to the School of Nursing prior to the student’s first semester in the program or within 7 days of diagnosis if diagnosed while in the program.
HBV-infected students can conduct exposure prone procedures if a low or undetectable HBV viral load is documented by regular testing at least every 6 months (Holmberg et a l., 2012).
Students with active HBV infection (i.e., those who are HBs Ag-positive) who do not perform exposure-prone procedures but who practice non or minimally invasive procedures should not be subject to any restriction of their activities or study (Holmberg et al., 2012).
Students with a positive HBe Ag or circulating HBV burden of greater than or equal to 10(4) genome equivalents (GE) per mL of b loo d or approximately 2,000 IU/ml will be prohibited from performing certain pre-defined high -risk (Category III) exposure-prone procedures (EPP) (Lewis , Enfield & Sifri, 2015). The list of Category III exposure-prone procedures is found in Table 3 of the following reference: Hepatitis B in healthcare workers: Transmission events and guidance for management
Students will use double-gloving for all invasive procedures, for all contact with mucous membranes or non-intact skin, and for all instances in patient care for which glo vin g is recommended (Lewis et al., 2015).

Please see relevant tables and charts, found in the following link to summarize the recommendations, guidelines, screening, vaccination, viral load threshold and restrictions for students.

Tdap (tetanus, diphtheria, and pertussis) vaccination

Documentation of Tdap vaccination received as an adult within the past 10 years. If the TDAP vaccination is older than 10 years, the student must receive an updated TDAP vaccination.

Current BLS Certification

Students must, upon entry to the program, have and maintain current Healthcare Provider (HCP) Basic Life Support (BLS) Certification.
Certification must be an HCP BLS course by the American Heart Association(AHA).
Initial certification must be obtained in an in-person/hands-on class, however, recertification can be obtained online. Providing proof of initial, in-person, certification will be necessary.

Seasonal Flu Vaccination

Proof of seasonal influenza vaccination received by October 1. Exemptions may be requested for the annual influenza vaccine under the following circumstances:

Medical Exemption – Requires the signature of a licensed healthcare provide
Religious Exemption

COVID-19 Vaccination

Proof of COVID-19 vaccination compliance may be required by participating healthcare agencies. Exemptions may be requested for the COVID-19 vaccination under the following circumstances:

Medical Exemption – Requires the signature of a licensed healthcare provider
Religious Exemption

Exemptions

Exemptions may result in clinical sites refusing to accept the exempted student and may limit clinical placement options. If no other placement option is available, the student may be delayed or prevented from meeting the requirements for progression within the program and graduation from the program. For information on the exemption process, please contact the Student Services Compliance team at nursingdnp@boisestate.edu.

Additional Information

Serial health requirements are to be satisfied by deadlines as determined by the individual program in collaboration with the Clinical Compliance Coordinator. Any student not in compliance beyond the program specific deadline dates, may not attend class or clinical rotations until all requirements are satisfied. Any assignments due during the clinical suspension will receive a grade of zero.

For assistance and questions contact the Student Services compliance team at nursingdnp@boisestate.edu.

Students must complete, submit, and always maintain clinical health requirements from admission until completion of the program. You will receive reminders from Castlebranch—please make sure to respond quickly to these. Students out of compliance (having any expired or incomplete clinical compliance requirements) are subject to the following actions:

Written warning will be sent via email and Student Success Plan (SSP) will be initiated.The student must complete the SSP with an approved plan to resolve the out-of-compliance item and email the program director and clinical coordinator of the date and action taken to comply within 72 hours of the written warning.. Course faculty will be notified.
If any/all outstanding items are not corrected within 72 hours, a letter of suspension will be sent by email from the Program Director(s). During suspension, respective faculty will be notified and students will not receive credit for any course assignments or clinical hours until the compliance issue is resolved. Once suspension occurs, the student must petition the program director to request to remain in the Graduate program and resolve compliance issues within 72 hours. If this deadline is not met, or if compliance issues are not resolved, then the student is subject to program dismissal. The School of Nursing Dismissal Policy will be initiated. The School of Nursing Dismissal Policy may be found here: Dismissal (Policy SON-16) – School of Nursing (boisestate.edu)

If students are unable to receive required vaccinations due to a health related issue, students must contact the Title IX and Institutional Equity office to receive an accommodation. If a student requests a religious exemption for vaccinations, the student must complete the exemption form associated with the clinical site and provide a copy to the Clinical Placement Coordinator.

3. Forms

N/A

BSU: None
CHS: Student Background Check (Policy 313), Student Drug and Alcohol Testing (Policy 314)
SON: Dismissal (Policy SON-16) – School of Nursing (boisestate.edu)

Last Review Date

7/31/2024

Revision History

August 2013, Spring 2015, Summer 2017, Fall 2019, October 2021, April 1st 2022, Fall 2022, Summer 2023, Summer 2024

References

Holmberg, S. D., Suryaprasad, A., & Ward, J. W. (2012). Updated CDC recommendations for the management of hepatitis B virus-infected health-care providers and students. Centers for Disease Control and Prevent Morbidity and Mortality Weekly Report, 61(3), 1–12.

Lewis, J. D., Sifri, C. D., & Enfield, K. B. (2015). Hepatitis B in healthcare workers: transmission events and guidance for management. World Journal of Hepatology, 7(3), 488–497. https://doi.org/10.4254/wjh.v7.i3.488