NURS 211: Advanced Nursing Clinical Practice
Pierce College Puyallup
Section 8375 – Fall Quarter 2011
CREDIT HOURS: 6
CLINICAL LOCATION: MultiCare Good Samaritan Hospital
Time: Day shift 6:30 AM to 3:00 PM
INSTRUCTOR: Gwendolyn Darks, CMSRN, MSN, RN
Office: AAH 247
Office Phone: 253-864-3182
COURSE CATALOG DESCRIPTION
Application of advanced nursing skills, in the classroom laboratory and clinical setting,
while assuming responsibility for adult clients with common alterations in health.
Students will also provide care for obstetric clients in a variety of birthing environments.
Includes roles and responsibilities of the nurse (including methods of safe medication
administration), nursing theory, critical thinking, the nursing process, and understanding
related technology. Concepts of the Roy Adaptation Model are used to guide developing
nursing practice to individuals in the community, in a variety of settings.
A. Application of nursing skills in multiple healthcare settings while providing direct
client care under the supervision of a Registered Nurse
B. Medication Administration
C. Nursing process according to the Roy Adaptation Model
D. Service-Connected Learning Project
STUDENT OUTCOMES – At the end of this course, students will be able to:
1. Apply advanced nursing principles with emphasis on the promotion, management and
maintenance of optimum levels of physical and psychosocial wellness.
2. Apply advanced nursing principles to a diverse cross section of clients with
alterations in body systems.
3. Perform nursing care and clinical skills/procedures for adult clients within acceptable
4. Perform nursing care for families experiencing the process of pregnancy and birth in
a variety of birthing environments.
5. Perform advanced skills for medication administration, utilizing the “five rights”, to
individuals in the health care setting.
6. Develop an advanced plan of care, utilizing the Roy Adaptation Model Physiological
and Psychosocial Modes.
7. Under supervision, demonstrate advanced nursing skills as a provider of care,
manager of care, and member of the discipline of nursing, utilizing the Roy
8. Demonstrate understanding of the importance of nursing in the community.
VISION, MISSION, CORE VALUES, AND INSTITUTIONAL OUTCOMES
PIERCE COLLEGE MISSION
Pierce College creates quality educational opportunities for a diverse community of
learners to thrive in an evolving world.
PIERCE COLLEGE VISION
Possibilities realized: Innovative and engaged learners enriching our local and global
PIERCE COLLEGE CORE VALUES
It is the goal of Pierce College to prepare students to live and work in a dynamically
changing world by emphasizing whole-student development and hands-on learning.
Through experiences both in and out of the classroom, you'll be given the opportunity to
broaden your horizons and be challenged in ways that encourage the development of the
abilities vital to succeeding in life. These core abilities, with examples, include:
1. Recognizes Interconnectedness
2. Generates Choices
3. Considers Consequences
4. Implements a Course of Action
5. Accepts Consequences
6. Makes Necessary Adjustments
1. Recognizes and uses a variety of methods to convey ideas and information
2. Receives messages openly, critically, and responsively
3. Considers purpose, content, audience, and situation in sending/receiving messages
4. Recognizes that communication is influenced by perspective (e.g. gender, culture,
privilege, experience, etc.)
1. Builds knowledge of diverse ideas, values, perspectives, and experiences
2. Engages others with civility, empathy, honesty, and responsibility
3. Examines one's own attitudes, values, assumptions and considers their impact
4. Challenges past, present, and future discrimination and privilege of individuals,
societies, groups, and institutions
1. Values and engages in regular inquiry and seeks new information for lifelong
2. Applies a repertoire of creative and flexible information to take action, solve
problems, navigate the unfamiliar
3. Evaluates appropriate sources in order to assess relevant information
4. Selectively uses most appropriate technological and organizational tools in order
to access and manipulate information
5. Appraises information in order to evaluate quality, relevance, or perspective.
6. Synthesizes new information in order to create something new, acquire insight,
transform values, or expand knowledge base.
7. Examines and uses ethical standards in order to use information appropriately and
Critical Thinking and Problem Solving
1. Creates, integrates, evaluates ideas across context, culture, and knowledge
2. Evaluates and creatively solves problems
3. Examines attitudes, values, and assumptions and assesses implications
4. Integrates experience, reason, and information to make meaningful judgments,
conclusions, and/or products
Accomodation for Students with Disabilities
Puyallup and South Hill Puyallup: Students with disabilities who believe they may need
academic adjustments, auxiliary aids or services to fully participate in course activities or
meet course requirements are encouraged to register with the Access and Disability
Services (ADS) Office, Room 102A in the Administration Building. You may also call
the ADS Office at (253) 840-3301 to make an appointment. Students requesting
accommodations must obtain the "Approve Quarterly Academic Adjustments, Auxiliary
Aids or Services" (green) form provided by ADS.
NURSING PROGRAM OUTCOMES
Nursing Process: The graduate will demonstrate a beginning competence in critical,
creative & reflective thinking within the nursing process that serves to provide the
foundation for safe, effective care delivery in a wide variety of healthcare settings.
Communication: The graduate will demonstrate effective communication through the
exchange of messages in a variety of contexts using multiple methods.
Professional Role: The graduate will demonstrate responsibility in the registered nurse
role by participating as a member of a team to promote holistic, ethical and
compassionate care while functioning within the scope of practice for the registered
Cultural Competence: The graduate will demonstrate multicultural competence by
valuing open-mindedness, inclusion, multicultural perspectives and multiple ways of
knowing, thinking and being for clients, families and colleagues in healthcare.
Information Competency: The graduate will seek, find, evaluate and use information in
healthcare to support evidence-based practice and engage in lifelong learning for nursing
PROGRAM OUTCOME/CORE ABILITY
Nursing Process: The graduate will demonstrate beginning competencies and
identify the implications associated with the nursing process to deliver care and
promote safe practice regardless of setting.
Critical, Creative, & Reflective Thinking: Graduates will be able to question,
search for answers and meaning, and develop ideas that lead to action.
METHODS OF INSTRUCTION:
Observation of nursing skills in accordance with acceptable nursing standards
Student Evaluation Form of Clinical Performance
Refer to Syllabi for NURS 210 and Labs
Nursing Care Plans
The nursing care plan (NCP) according to the Nursing Process will be utilized. A
working NCP must be formulated and ready for presentation PRIOR TO the clinical
session. The student cannot provide SAFE CARE to the patient unless he/she is prepared.
The completed NCP is due at the BEGINNING of the first clinical day of the following
1. One full care plan per clinical week, Bubbleheeb, or mini nursing care plan.
2. One partial care plan per each additional patient
You must have a preliminary plan of care which, MUST be completed PRIOR to
walking onto the unit each day. When you are on a unit where you are observing you
will need to complete the observation form (see attachment # 2).
Full Nursing Care Plan includes:
1. Nursing Assessment (Patient Profile appropriate to your unit)
2. ** Medication sheet (medications will not be administered without this)
3. Potential Nursing Diagnoses
**3 nursing diagnoses with one short term and one long term goal each
**3 minimum interventions per diagnosis
NIC & NOC
4. Fall Risk Assessment
6. Braden Scale (skin assessment)
7. Final care plan (typed)
While this is not your first Acute Care Hospital clinical rotation, I still require that you
work with a nurse the 1st day and pick a patient for that Friday before you leave the
unit. This will allow you time to familiarize yourself with, this instructor, the unit and/
or hospital, and the culture of the facility.
GRADING: This is a pass/fail course. Specific criteria included for grading is based
on actual performance and synthesis of nursing skills and knowledge.
CLINICAL COURSE POLICIES AND PROCEDURES:
Orientation to facility:
To be arranged by Clinical Liaison. This includes a tour of the facility, specific student
instructions as well as policies and procedures mandated by the unit and clinical facility,
badging, and computer training.
Level of Care:
Intermediate and advanced based on hospital acuity. Clinicals are held to emphasize
what is learned in the classroom. Each week, as possible, students should choose to work
with patients that are experiencing physiological and/or psychosocial stressors discussed
Participation in the educational setting enhances learning. This will occur during post-
conference. As such, all students are expected to be an active member in the learning
Patient Care Assignment:
Assignments will vary from 1 to 2 patients, depending upon the acuity and census level
of the participating clinical site. When choosing your patient care assignment, please
consult the charge nurse. You do not want to select a patient who would not be an
appropriate learning experience or has already been taken by another student. Patients are
subject to the needs of the unit and the preference of the patient/guardian. It is a
requirement that when you go to pick your patient the day before that you introduce
yourself to the potential patient, let them know that you are a student nurse and ask their
permission to provide care to them. Patients/Guardians may refuse students. Be sure to do
these before you do your preliminary paperwork.
You are responsible for your own documentation in accordance with the policy and
procedures of the participating clinical site. Your instructor and/or the supervising nurse
must review and co-sign your charting. Please complete your charting in a timely fashion
so that this can be achieved well before the end of the shift. During your orientation this
will be discussed. Please seek guidance from your instructor or your supervising nurse.
We will be using an electronic health record and you should have both your log on for
Pyxis and EPIC prior to the first full clinical day.
This is a time to ask questions regarding your patient assignment or Nursing Care Plan
(NCP). This is also a time to discuss healthcare-patient related topics. Specific locations
and times will be announced at the beginning of each clinical session.
Dress appropriately, according to the Pierce College Associate Degree Nursing Program
Student Nurse Handbook. Failure to adhere to dress code standards may result in
unsuccessful completion of the course. No fragrance or nail polish may be worn. Hair
should be neat and kept back from the face not be allowed to fall into a patient’s space.
Lab coats must be worn over appropriate street clothing if you are going the night ahead
to select your patient. Facility ID or Pierce College Nursing badge must be worn at all
times. Jewelry should be kept at a minimum and tattoos should be covered. You must
wear hospital provided scrubs when on PACU, L&D or NICU. A scrub overcoat MUST
be worn when off the unit for anything. A stethoscope, watch with a sweep 2nd hand,
black ink pen, bandage scissors, and pen light are required for all clinicals and lab
Each student will be responsible for the safe administration of medications ordered for
their assigned patient. This will include oral, rectal, transdermal, nasal, ocular, otic,
intramuscular, subcutaneous, sublingual and intravenous routes. You must have the
instructor or unit licensed nurse with you at the patients’ bedside to administer any
medication. You will NOT be allowed to administer any medication which you have not
researched. You may NOT administer epidural or PCA medications. Nor may you
administer blood or blood products.
Pierce College Puyallup has a clear policy regarding plagiarism. Any student that is
found guilty will be dealt with immediately according to the policy and procedures as
outlined in the Pierce College Student Handbook.
Late assignments will lose 5 points per day. Assignments not completed may result in
receiving a Failed grade for the course.
Each student is required to attend every clinical session that is scheduled. Missed
clinicals MUST be made up. If you are going to be absent, you MUST notify the
clinical instructor one hour prior to the start of the clinical day. Do NOT call the
hospital or charge nurse of the assigned floor to report your absence. Tardiness is
appearing at the clinical site later than the planned time at the beginning of the shift.
Since we are on day shift this will be 6:30 AM. This is not professional behavior and
repeated offenses of absence or tardiness may result in clinical failure.
During orientation, you will be provided with information on where students are allowed
to park. It is your responsibility to adhere to these provisions.
Security in the hospital:
Know the mandated emergency codes and location of the crash cart, fire alarm pulls, fire
extinguishers, evacuation plans and oxygen shut offs in your facility. You will be given
an orientation to this and your responsibilities should such an event occur during the
Emergency Evacuation Procedures and Inclement Weather:
Emergency evacuation procedures, inclement weather absences and other related issues
are to be followed per participating clinical site policies and procedures.
There are a plethora of resources available to the adult learner. There will be times that
open lab is available, please be familiar with them and make use of all opportunities