Clinical preparation for nursing students is a complex process that has two distinct arms. Educationally, students must present themselves at the clinical site with the knowledge, skills, and attitudes to provide safe, quality patient care. But they must also meet the clinical site's occupational health requirements for immunization, screening, and training (IST) prior to patient contact. These requirements are mandated by federal or state laws, dictated by accrediting bodies, or determined by the facility to protect their patient populations and employees.
Serious consequences can result for health care facilities that allow nursing students to have patient contact without required preparation (Centers for Disease Control and Prevention, 2009, 2014; Occupational Safety and Health Administration, 2012). Accrediting bodies or state boards of nursing may become involved if infractions with students occur (National Council of State Boards of Nursing, 2016). Certainly the relationship between the nursing program and the facilities will be damaged, leading to potential loss of clinical placement. When errors are made public, the reputation of the nursing program and facility may be tarnished.
The consequences of failing to monitor student clinical compliance compel nursing programs to take the process very seriously. Methods for tracking student IST records include in-house management of student records, either paper or electronic, or by contracting with a specialized online vendor. Regardless of the approach, nursing programs retain full responsibility for this time-consuming process, which depends on clear communication and trust among clinical facilities, nursing programs, and students.
The clinical compliance process is optimized by an IST record tracking system that is cost effective, user friendly, accurate, and secure. When evaluated on these factors, traditional in-house management and online vendor systems are lacking in one or more ways. However, a familiar information technology product used in higher education addresses these factors and can create a high quality IST record-tracking process: the institution's own learning management system (LMS), such as Blackboard or Canvas.
RATIONALE FOR THE INNOVATION
In the early 2000s, web-based IST record-tracking systems were marketed to health care educational programs to replace paper management. This coincided with the national scramble to meet the mandates of the Healthcare Information Protection and Privacy Act (HIPAA; Wimberley et al., 2005). Fearing sanctions if student IST information was mismanaged, many nursing programs contracted with vendors to track student records. The cost was accepted as the price for privacy protection. However, student records in the United States, including IST information, are protected under the Federal Educational Rights Protection Act (FERPA), not HIPAA (US Department of Health and Human Services 2008). Nursing programs are not obliged to use a vendor to provide information security for IST records. For programs with in-house systems, electronic storage only needs to follow the institutional storage policies for all student records under FERPA. The LMS meets FERPA requirements without additional planning or security measures taken by the nursing program.
An unavoidable cost for nursing programs is paid staff who monitor the clinical compliance process, even when an external vendor is paid for tracking services. If performed externally, the cost of the vendor product must be absorbed by the program or passed on to students. The institution's LMS is part of the university budget, leaving its use cost neutral for the program and students.
For programs using in-house tracking, the LMS provides value because effective use of informational technology (IT) saves time and money for organizations (Naveh, Tubin, & Pliskin, 2010). Using the LMS is clearly beneficial for programs that rely on paper management; it eliminates worker hours in tracking, copying, and filing. For programs that have created their own methods of electronic submission and storage of records, the LMS eliminates a parallel IT system. Why run two systems when one can achieve the same result?
Nursing programs are accountable for clinical compliance and the consequences of errors. Both in-house and vendor systems direct students to provide IST documents as evidence that requirements are met. Evidence is reviewed by either a nursing program or vendor employee; students are cleared if documents are correct. A second review built into the process helps catch and fix errors.
Using the LMS, accuracy can be improved by making the student responsible as the first reviewer. The student must check each IST document, enter the compliance date, and then upload the document as evidence. The nursing program employee is the second reviewer, double-checking that each date is accurate and matches the submitted evidence. Clearance is granted or the student is contacted if there is a discrepancy. If the vendor or nursing program pays an employee to double-check each document, accuracy is increased, but so are costs of the clearance process.
Any record-tracking system should be designed to optimize the experience of students and the employees responsible for the compliance process. Technology acceptance models have sought to identify factors that influence user experience and willingness to adopt technology. In general, familiar and intuitive systems elicit higher levels of competency and engagement (Saariluoma & Jokinen, 2014).
In the clinical compliance process, students only submit IST documents a few times per year; occasional use is a barrier to students becoming comfortable on external vendor websites. Even with in-house systems, students must refamiliarize themselves with the process each time they turn in records. In contrast, the LMS provides consistency, reliability, and convenience for students and program employees. Students have 24/7 access and become accustomed to the system as they upload assignments, communicate with faculty, and check grades. Chung, Pasquini, and Koh (2013) document numerous factors that increased student satisfaction with an LMS, including ease of access and navigation, supporting its use for IST record tracking.
DESIGN OF AN LMS CLINICAL COMPLIANCE SYSTEM
The nursing program collaborates with the IT department of the institution to design the shell of a special academic course (name may vary) in the LMS. Employees responsible for compliance are designated course teachers. Clinical nursing students are added to the course and placed into cohorts/groups by level or graduation year to facilitate management. With the capabilities of a teacher, the nursing program employee designs the special course to have the look and feel of an academic course. Three modules are created to sort IST documents: one-time requirements (initial immunization records), annual requirements (HIPAA training), and alternate year requirement (BLS for Healthcare Providers). Each IST requirement is created as an assignment within the appropriate module with specific instructions for completion. For instance, the instruction might be "upload lab report of positive MMR titers" or "click on link to complete HIPAA training." Each assignment is given a due date (e.g., fall semester records due July 1) and point value of 1.
Before uploading supportive IST evidence for each requirement/assignment, the student enters the corresponding compliance date in the assignment comment box (e.g., when an immunization was done, positive titer results were received, or training was completed). Entered as an assignment, the information rolls into the grade book, where both the program employee and student can track documents and compliance dates. When each requirement is cleared, the student is given the full one point. If there is a problem, partial credit is given with instructions for the student in the comment box. Students can be emailed directly through the LMS as needed. When compliant with IST requirements, the student will score 100 percent.
Further facilitating management by the program employee, the grade book can be downloaded as a spreadsheet. To keep students interacting with the clinical compliance course, clinical site information regarding orientations, computer training, and policies relevant for students can be stored in the LMS files for access year round.
CONCLUSION
The invisibility of IST record management disguises its essential role in the clinical preparation of nursing students. Monitoring compliance of students is a task that must be done, but few think about how it gets done. When health care facilities welcome nursing students for clinical experiences, they trust that nursing programs are vigilant with record management and clinical compliance. Nursing programs can rely on their LMS to provide an accurate, efficient, secure, and cost-effective way to manage IST records. Doing so provides benefits to the students, nursing program, and clinical partners.
REFERENCES