Welcome to Health Sciences Centre Winnipeg

As a clinical instructor or clinical education facilitator for nursing students employed by one of Manitoba’s Educational Institutions you will be working with a team of dedicated professionals committed to our vision of "Patients First". Our culture is one of hope, where we nurture positive relationships with our patients and team members. We provide healthcare to people from many different cultural and language groups, serving

residents of Manitoba, Northwestern Ontario and Nunavut. We strive to involve the patient and family in every aspect of care, and to provide a respectful, comforting and welcoming environment. In our organization, we value: • Hope• Caring• Discovery• Excellence• Honour

Contents Welcome to Health Sciences Centre Winnipeg……………………………………………………………… 1 Contents………………………………………………………………………………………………………….. 1 HSC Policies and Procedures …………………………………………………………………………………. 2 Nursing Staff, Student and Nursing Instructor Roles and Responsibilities………………………………… 3 Supervision Requirements for Administration of Medications in Clinical Practice by Nursing Students.. 4 Computer Access………………………………………………………………………………………………… 5 Pyxis Registration for Nursing Instructors and Students…………………………………………………….. 5 Pyxis Medication Administration System……………………………………………………………………… 6 Obtaining HSC Photo ID/Access Cards……………………………………………………………………… 7 General Information and Services……………………………………………………………………………. 8

Appendices A BioID Registration Process Students Pyxis 4000 B Nursing Instructor Application for Facility Access Card Form C Student Data Change Form D HSC PYXIS Access Form for Nursing Instructors

Department of Clinical Education – Revised December 2015 [1]

HSC Policies and Procedures http://hschome.hsc.mb.ca/policies/table_corporate.asp

HSC Policies and Procedures are accessible through the HSC Intranet. Nursing Instructors need to become familiar with how to access the online policies and procedures, and ensure that they have the proper computer access before bringing students onto the patient care units.

Prior to the first clinical practice day Nursing Instructors and students must become familiar with and abide by the Policies and Procedures as outlined on this page.

Patient Safety Event Reporting To ensure timely, comprehensive and factual reporting and investigating of Patient Safety Events (PSEs), including occurrences, near misses and critical incidents, all Nursing Instructors and students shall: • Report PSEs to the appropriate individuals asdesignated.• Complete a PSE Report Form or access RL6 onlineevent reporting system when available.• Follow the procedure for reporting and managing theoccurrence, near miss or critical incident as outlined in thepolicy

Personal Health Information Act (PHIA) HSC adheres to the WRHA PHIA policies and procedures which are applicable to all WRHA governed and / or WRHA funded sites and facilities (including hospitals and personal care homes). All Nursing Instructors and students must ensure that they have their PHIA card with them at all times when practicing in the clinical area.

Post Exposure Prophylaxis (PEP) Protocol Care Map In the event of exposure to blood and/or body fluids, the PEP Protocol Care Map must be followed. All patient care units have available an “Information for Exposed Worker Package”.

Smoke Free All buildings and grounds at HSC are smoke-free. Smoking is not allowed on all facility grounds; this includes entranceways, sidewalks, driveways, green spaces, parking lots and parkades.

Workplace Hazardous Materials Information System (WHMIS) To ensure no one is put at undue risk through working with, or in proximity to, controlled products, HSC ensures compliance with Federal/Provincial legislation regarding WHMIS. You should know where the Material Safety Data Sheets (MSDS) are located on the patient care unit, as well as general WHMIS procedures.

Photo ID for Facility Access As outlined in the WRHA GOVERNED SITES Policy 65.40.010 Photo Identification (ID) any accredited Instructor or student working and operating within a facility (HSC) shall obtain and carry a Photo ID Card. The Photo ID Card must be worn at all times in a clearly visible location while on HSC property.

Effective for the 2014/2015 Academic Year, students will no longer be issued a HSC Photo ID. ID cards issued by a recognized and accredited educational institution will be accepted as the official ID badge. Students will be issued Access Cards in order to obtain common access. To obtain Access cards see instructions on page 7 Nursing Instructors: To obtain your HSC photo ID, see instructions on page 7.

Department of Clinical Education – Revised December 2015 [2]

Nursing Staff, Student and Nursing Instructor Roles and Responsibilities

Nursing Instructors are responsible for overseeing the clinical practice of nursing students at HSC. It is important to understand the roles and responsibilities of the nursing staff at the centre. There are also expectations of student nurses and the Nursing Instructors.

Nursing Staff Responsibilities: • Collaborate and discuss the plan of care with thestudent when he/she has the same clinical assignment. • Ensure that medications and treatments, andultimately the plan of care, are completed for the patient in a safe manner. • Report any concerns andprovide feedback to the Nursing Instructor.

Student Nurse Responsibilities: • Collaborate and discuss the plan of care with thenursing staff when they have the same clinical assignment. • Attend clinical prepared to administermedications, provide treatments, and ultimately the plan of care for their patients in a safe manner. • Ask questions to enhance their learningexperience on the patient care unit.• Communicate any concerns and providefeedback to the Nursing Instructor about their experience. • Practice participating within the health care teamas appropriate.• Inform staff when they are off the patient care unitfor other activities.• Document provided care/assessments with thecollaboration of the nursing staff as appropriate.

Nursing Instructor Responsibilities: • Collaborate to create connection between the educational institution and the clinical setting.- Establish collegial relationships, specifically with patient care unit staff, CRNs, Manager.- Facilitate staff/student interactions.

• Orient self and students to the clinical area.- Work in the area to familiarize self with the practice setting.- Develop an orientation for students so students can function effectively in the area.

• Ensure safe practice by the students.- Develop appropriate clinical assignments which take the student’s abilities into consideration.- Be aware of own strengths and limitations.- Be available to assist students with skills as required.- Be accessible to staff and students in a timely manner.

• Present self as an effective role model.- Demonstrate effective interpersonal and nursing skills.- Has confidences in own abilities.- Share clinical expertise with staff on the unit

• Encourage patient care unit Staff/CRN/Manager and students to critique teaching strategies.

Supervision Requirements for Administration of Medications in Clinical Practice by Nursing Students

All relevant hospital/facility policies regarding medication administration must be reviewed and followed. In addition, ensure Academic Site specific policies/guidelines regarding appropriate supervision of students are followed.

Department of Clinical Education – Revised December 2015 [3]

Nursing Instructor Checklist Completing all of the “tasks” on the list will ensure that all necessary arrangements are in place to begin the clinical experience. Please see specific sections in this manual for further information pertaining to each task.

Task Completed

Arrange for “Orientation” days for self on Patient Care Unit with Manager/CRN/Designate. The Manager of Patient Care names/ contact information has been sent to your academic site. Please contact your course leader to obtain this information

Have all students complete On-line Registration for Pxyis Access (see PYXIS Registration for Nursing Instructors and Students section).

Ensure students have completed PYXIS 4000 tutorial and contact HSC Nurse Educator for bio ID (see PYXIS section).

Have each student complete a “Documentation of Pyxis Education” form (Appendix B). These forms will be provided to the Nurse Educator during bio-ID appointment.

Book rooms for post-conference(s) (see Post- Conference Room Booking section).

Arrange for student lockers (see Locker Services section).

Complete Facility Access Process. Contact Security Services for Photo ID/Access Cards (see HSC Facility Access Card section).

Note: All Nursing Instructors taking their students to the OR must complete the Nursing Instructor SCRUBSTATION ACCESS Form. This form and INSTRUCTIONS FOR NURSING INSTRUCTORS RE: SCRUBSTATION ACCESS AT THE HEALTH SCIENCES CENTRE has been sent to your academic site (placed on HSPnet). Please contact your course leader to obtain this information.

Instructors are responsible for taking out the students’ “greens” for their experience.

Department of Clinical Education – Revised December 2015 [4]

Computer Access

Access to the HSC Computer system is needed for access to information such as laboratory results, policies and procedures and skills tutorials. Computer access for both students and Instructors is managed by the academic site. Please contact your specific site for further information. Questions related to your account should be directed to 204-940-8500 or servicedesk@manitoba-ehealth.ca

HSC employees who are also Nursing Instructors at HSC can use their current computer login credentials for access.

Nursing Instructors should participate in EPR training at the academic site prior to commencing their clinical rotations with students. Manitoba eHealth has provided the academic sites with LMS modules for: Intro to EPR, EPR Patient Information, EPR Results Reporting and EPR Discharge however the students coming to HSC will be using EPR primarily for Results Reporting. The students should also be trained on the LMS modules prior to beginning their placement.

PYXIS Registration for Nursing Instructors and Students

HSC has an online process for students for requesting access to the PYXIS Medication Administration System.

• Students who have already registereddo not need to register again.

• If students have not yet registered they willneed to register online to request access to thePYXIS Medication Administration System. Go tohttps://forms.manitoba-ehealth.ca/studentForms/Select “Nursing Students” and follow theinstructions.

Once the student has completed the online registration process their pyxis access will be initiated.

Important: If the student registered on line and has had a name or graduation date change they are required to complete the Student Data Change Form (Appendix C). The student will need to bring the completed form to the Clinical Education Office/Student Placements as per the instructions on the form.

The online process is not available for Nursing Instructors. See Pyxis Medication Administration system on page 6.

If you have questions about the registration process, contact the student placement office at nursingstudentplacement@hsc.mb.ca or 204-787-2927

Department of Clinical Education – Revised December 2015 [5]

PYXIS Medication Administration System

Access for Students (online)

1. The student needs to complete the HSCstudent online registration, and the PYXISComputer Tutorial (Level 4000) available atyour educational institution or at theCareFusion online learning portalhttps://clp.carefusion.com/CLP

2. When the student has completed thetutorial, they need to print the Certificate ofCompletion and forward it to their NursingInstructor.

3. The Nursing Instructor ensures that thestudent signs the Documentation of PYXISEducation Form (see Appendix B).

4. The Nursing Instructor contacts theappropriate HSC Nurse Educator and books anappointment for the HSC Nurse Educator toregister students’ BioID (a finger scan). BioIDregistration is completed at PYXIS MedStationson the patient care units.

5. The Nursing Instructor provides the HSCNurse Educator with each student’s Certificateof Completion and one completedDocumentation of PYXIS Education Form atthe time of BioID registration.

Access for Nursing Instructors (not available online)

“NEW” Nursing Instructors who are HSC staff should use their existing HSC Pyxis account to log in.

Nursing Instructors who are not HSC staff will require a distinct Pyxis account with a one –year maximum duration without renewal and should follow the steps outlined below:

1. Complete the PYXIS Access Form for NursingInstructors (Appendix D)

2. Forward the completed form to the ClinicalPlacement Office, Room NA138, Isabel M.Stewart Building, 700 McDermot Ave., R3E 0T2nursingstudentplacement@hsc.mb.caPhone 204-787-2927.

3. Form is authorized by HSC personnel.This step is required to provide the NursingInstructor with PYXIS access. NursingInstructors are granted PYXIS access for theeducational year and access expires at the endof the educational year; a new applicationmust be completed at the start of eacheducational year (i.e. August/September)

Complete the PYXIS Computer Tutorial (Level 4000) available at your educational institution or at the CareFusion online learning portal https://clp.carefusion.com/CLP (you will be directed to login to access this site)

Print the Certificate of Completion when finished the tutorial and complete a Documentation of PYXIS Education Form (see Appendix B)

The Nursing Instructor contacts the appropriate HSC Nurse Educator and books an appointment for the HSC Nurse Educator to register their BioIDs. BioID registration is completed at the PYXIS MedStations on the Patient Care Units.

Department of Clinical Education – Revised December 2015 [6]

PYXIS Helpful Hints Once the Registration for PYXIS access is completed either on line (students) or via papercopy (Instructors), there is a time lapse before the information is in the system and you can BIOID. Registration by Instructors and students should be completed at least two weeks before your clinical practice. This will ensure that you are in the system when it is time to BIO-ID on your first day of clinical.

• If a student has already registered onlineduring one of their other clinical experiences,they do not need to register online again. However,ifthey have had a name change or graduationdate change, follow the instructions in theStudent Registration section regardingcompletion and submission of the appropriateforms. This should be done at least two weeksin advance to ensure the students updatedinformation is in the system for BIO-ID onorientation day.

• When you complete your BIO-ID, be certainto remember your user login, password, andthe finger that you used to create your electronicfingerprint. This will prevent login issues in thefuture. Remind your students to remember thisinformation as well.

Documentation of PYXIS Education Form/PYXIS Manuals Pyxis Policies you should become familiar with: • 80-120-706 MEDICATIONS: MANAGINGSTUDENT NURSE ACCESS TO THE PYXISMEDSTATION SYSTEM• 80-120-707 MEDICATIONS: MANAGING THEOVERRIDE FUNCTION OF THE PYXISMEDSTATION SYSTEM• 80-120-703 MEDICATIONS: NARCOTIC,CONTROLLED DRUGS ANDBENZODIAZEPINES:MANAGEMENT OF VIA THE PYXISMEDSTATION• 80-120-705 MEDICATIONS: CREATION OFTEMPORARY PATIENT TO OBTAINMEDICATIONFROM A PYXIS MEDSTATION

Obtaining HSC Photo ID/ Access Cards

Nursing Instructors 1. Complete the Nursing Instructor Application forHSC Facility Access Card Form (Appendix B)

2. Forward the completed form to the ClinicalPlacement Office, Room NA138, Isabel M. StewartBuilding, 700 McDermot Ave., R3E 0T2nursingstudentplacement@hsc.mb.ca Phone 204-787-2927

3. Form is authorized by HSC personnel.

4. Clinical Placement Office will contact the NursingInstructors when the form has been authorized andmake arrangements for return of the form to theNursing Instructors. You are required to bring youracademic employee identification card with youwhen you pick up the authorized form.

5. Nursing Instructors contacts HSC SecurityServices (Phone 204-787-1465) to make anappointment for photo to be taken.

Nursing Students Effective for the 2014/2015 Academic Year, students will no longer be issued with HSC Photo ID. Students are required to wear the photo ID cards issued by their educational institution. For current students who have already been issued an ID card, they can continue to utilize existing card and processes.

Student Access Cards 1. Prior to their HSC clinical placement each Instructor must telephone HSC Security Services (Phone 204-787-1465) to make an appointment for students to obtain access cards. Security Services will provide further instructions at the time ofthe phone call.

2. At the appointed time the Instructor will go with their clinical group to Security Services, (Orange Bison Zone,Level 2, Room MS-245), to obtain Access cards. Security Services will require each student to produce the Student photo identification cards issued by their applicable educational institution and confirm the student’s name is on the list submitted to the HSC by the academic site.

3. Security Services will then issue each student with an Access card. "New" These cards must be returned to Security Services at the completion of the rotation/practicum.

Department of Clinical Education – Revised December 2015 [7]

Security Services will review non return policy for the access cards.

Return of Facility Access / Photo ID All expired facility access photo ID cards and access cards need to be returned directly to Security Services, (Orange Bison Zone, Level 2, Room MS-245), by the person that the card is issued to. Please note that if the student is later employed at HSC, Security Services will not issue the person a staff identification card without the student card being returned. Cardholder will be charged $20.00 administration if not returned.

General Information and Services

Post-Conference Room Booking To book a room contact corporateroombooking@hsc.mb.ca with the following information: 1. Date2. Start and end time of meeting3. Number of people4. Room preference (if any)5. A contact name, phone number, faxnumber,email address, and name of educationalinstitution Room availability and booking(s) will beconfirmed via email.

Locker Services Space in patient care units is limited. Students must use assigned lockers to store outdoor apparel, knapsacks, etc. Locker space is limited and students will have to share. Lockers may also be a distance from the patient care unit. To obtain locker space for students call 204-787-1284, Fax 204-787-4952, and provide the followinginformation:

1. Number of female and male lockers needed2. Start/end time that lockers are needed.3. A contact name, phone number, fax number,email address, and name of educationalinstitution.

Locker availability will be confirmed by the WRHA Capital Planning contact. Please note that students are required to bring their own locks. Locks left on lockers after the clinical experience term has ended will be removed by HSC Security and locker contents will be placed in the Lost & Found located in Orange Bison Zone, Level 1, Room MS-108.

HSC Clinical Education http://hschome.hsc.mb.ca/NursingEducationProgram/

HSC Clinical Education is a comprehensive resource for nursing education at HSC, including core curriculum and nursing specialty courses. Available on HSC Home (intranet).

HSC Maps http://www.hsc.mb.ca/mapsCampus.html

Maps of the campus and hallways are available on the HSC Web site, along with a brief explanation of the wayfinding zones, symbols and signage at HSC.

Manitoba eHealth Manitoba eHealth provides I.T. services to all health facilities in the province. For computer access service issues, contact the eHealth service desk by phone 204-940-8500, or by email servicedesk@manitoba-ehealth.ca.

Neil John Maclean Health Sciences Library Located on the 200 level of Brodie Centre, the Library supports research, program development and patient care activities of all staff and students at HSC. HSC Liaison Librarian is Carol Cook (Phone 204-789-3840).

U of M Health Sciences Book Store Located on the 100 level of Brodie Centre.

Parking, Shops, and Food Services A student portal to the HSC Web site is located at http://www.hsc.mb.ca/ with links to information about car and bike parking, shops, and food services on the HSC campus.

If you have any further questions or require further information, please email nursingstudentplacement@hsc.mb.ca. Allow up to 3 business days for a response.

Department of Clinical Education – Revised December 2015 [8]

Appendix A

Pyxis Access and BIOid Registration Process STUDENT NURSES

Student Nurse: completes the on-line registration process via https://forms.manitoba-ehealth.ca/

studentForms/ completes the Pyxis 4000 tutorial prior to starting clinical experience at HSC (available at each educational institution and on-line) prints the tutorial “Certificate of Completion”, makes a copy and gives original to their Clinical Education Facilitator (CEF)/Clinical Instructor. Note: the CEF for each rotation may require a copy. signs the Documentation of Pyxis Education Form (attached)

Instructor/Clinical Education Facilitator (CEF)from academic program: collects completed tutorial “Certificate of Completion” forms from each student obtains student signatures on the Documentation of Pyxis Education Form (attached) contacts the HSC Nurse Educator to arrange for BioID registration. provides the PYXIS Tutorial Certificate for each student and the Documentation of Pyxis Education Form to the Nurse Educator at the time of BioID registration

EXCEPTION: For Senior practicum students without prior Pyxis access, this role is completed by the HSC Nurse Educator

To Register BIOid:

HSC Nurse Educator: confirms student nurse is in Pyxis by viewing the Userlist (under Main Menu) Receives the student nurse’s Certificate of Completion for the Pyxis 4000 and the

Documentation of Pyxis Education Form. Requests student nurse to create a password (pw). Password criteria:

• 6-8 characters. DO NOT enter a longer password.• easy to remember

Educator logs on to the nurse’s account using the nurse’s Userid (usually S_1st initial,last name) and the system password(system password changes every few months).

At “BIOid not on record” prompt, touch “yes”. Type system password; press “Enter”. At "Expired Password" prompt, touch “Ok”. At “Current Password”, type system password. Press “Enter”.

Student: At “New Password”, Student Nurse types their chosen password. Press “Enter”. At “Confirm Password”, re-type password. Press “Enter”. At "New Password Has Been Activated”, touch “Ok”. At prompt, log on using new password, press ENTER. Follow prompts to register BIO ID

HSC Nurse Educator: Signs the Documentation of Pyxis Education Form and forwards it and the nurse’s

Certificate of Completion. (See bottom of Pyxis Education Form).

Department of Clinical Education – Revised December 2015 [9]

Appendix A (continued)

Clinical Education Facilitator (CEF)/Instructor from academic program: Name: Phone/contact info:

HSC Patient Care Unit:

Educational Institution (Select): � Assiniboine Community College � Red River College � Universitaire de St Boniface � University of Manitoba � Other: ____________

Instructions to CEF/Instructor: Ensure each student in the clinical group completes PYXIS MedStation 4000 education as required below. Each student must read, date and sign this form prior to BIOid registration. The CEF/instructor contacts the HSC Nurse Educator to arrange for BioID registration. This form along with the PYXIS 4000 Tutorial Certificates for each student are given to the HSC Nurse Educator at the time of activation of the Pyxis account and BioID registration.

Documentation of Pyxis Education: Student Section

I have participated in Pyxis Education and have: 1. Completed the PYXIS 4000 Tutorial.2. Printed the PYXIS 4000 Tutorial Certificate of Completion (attach certificate tothis form).3. Reviewed the HSC PYXIS 4000 Instruction Manual.4. Reviewed all HSC Patient Care Policies related to Pyxis including:

• 80.120.703: Narcotic, Controlled Drugs and Benzodiazepines: Management of via the PYXIS MedStation;• 80.120.705 (formerly 80.115.045) Medications: Creation of a temporary patient to obtain medication from a

Pyxis medstation• 80.120.706 Medications: Managing Student Nurse Access to the Pyxis MedStation System• 80.120.707 Medications: Managing the Override Function of the Pyxis MedStation System

Student Name (print)

Signature

Date

BIOid Registered by: Name: _________________________________ Date: __________________________________

HSC Educators: Return Completed Form and Tutorial Certificates to Christina Whittaker, NA427

Electronic copies of this form are to be updated on 1) Centre-wide Education, Learning Pkg, Pyxis and 2) Centre-wide Clinical Instructor Manual

T:\All users\PDM\Students Pyxis 4000\BioID reg process Students Pyxis 4000 July 22 2014.doc

Department of Clinical Education – Revised December 2015 [10]

Appendix B

Security Services Department Hours: 9 A.M. - 3 P.M. Weekdays

Room MS245 820 Sherbrook Street

Winnipeg, MB R3A 1R9 Phone (204) 787-1465

Fax (204) 787-3464

NURSING INSTRUCTOR APPLICATION FOR HSC FACILITY ACCESS CARD

All Facility Access Cards are the property of HSC and must be returned to MS-245 upon completion of your employment with the Education Facility.

Do you currently have a HSC Facility Access / Security card? _____Yes _____No.

If YES, please bring card and application when you attend MS-245 for your new access card.

Please Print Clearly

Date of Birth: ____________________ Expiry Date: ____________________ Yr / Mo / Dy Yr/Mo/Day

NAME: _____________________________________________________________________________ (Surname) (Usual / Legal First Name and Initial)

Home Address: _______________________________________________________________________

Postal Code:___________________________________Home Phone Number: ___________________

Program/Title: ___________________________________________________________________________

Education Facility:________________________________________________________________________

(if applicable please fill out the following:) HSC Work Location: _______________________________Work Phone #: ___________

Office Use Only COMMON ACCESS Access Areas Required: Auth. Init. Access Areas Required: Auth. Init. COMMON ACCESS: All main exterior doors (HSC) //////////// All main parkades to tunnels (HSC)

////////////

Buhler building to HSC ////////////

Authorization Signature ___________________________________Date: ____________

Print Name: ___________________________Room #: ___________ Phone: _________

Please be sure all blanks are filled as authorized. Thank you.

Security Use Only Access #: Date & Init.:

Lost Date: Deleted Date:

Department of Clinical Education – Revised December 2015 [11]

Appendix C

Student Data Change Form (name or graduation date)

Students are required to complete this form if there have been changes to the initial information they entered into the on-line Student Registration Data base. (https://forms.manitoba-ehealth.ca/studentForms/) Important: Students are only able to register on-line once.

STUDENT NAME: ____________________________________________________

STUDENT ID No. (Last five digits only):______________________

ACADEMIC SITE____Red River University of St. Boniface U of M Assiniboine CollegeBrandon U CDI College _________________________________________

NAME CHANGE:

Current Surname ______________________ Current First Name: ____________________

Previous Surname: ______________________Previous First Name: __________________

GRADUATION DATE CHANGE:

Original Graduation Date: _________________________ Month/Day/Year

New Graduation Date (please include your senior practicum when calculating the Grad date):

__________________________________ Month/Day/Year

Please print or type and be sure all blanks are filled in.

Bring the completed forms and your Student ID card to the Clinical Education Office/Student Placements:

NA138 700 McDermot Avenue, Winnipeg MB R3E 0T2 Phone: 204 787-2927

To be completed by Clinical Education Office (NOTE: student must provide Student ID card as verification of information on form)

Authorization Signature ___________________________________

Print Name: ___________________________ Room #: ___________ Phone: _________

Information updated in Student Registration Data Base: ____________Date: ___________

Department of Clinical Education – Revised December 2015 [12]

Appendix D Pyxis Access Form for Nursing Instructors at HSC (applicable to non HSC staff only)

Requestor’s Name: Barb Benoit

Requestor’s Phone No.: 787-2927

Date of Request:

Supervisor’s / Manager’s Name: Jannell Plouffe

Sup.’s / Mgr’s Phone No.: 787-2731

Date Required: (ASAP is not acceptable)

Senior Operating Secretary’s Name: n/a

Senior Secretary’s Phone No.: n/a

Date Received:

Request Type: Add Change Move Terminate

User Information:

First Name

Last Name

Title CEF/Nursing Instructor Unit assigned to:

Academic Site

Red River University of St. Boniface

U of M Assiniboine College

Brandon U CDI College

Portfolio

Office Location HSC No office – clinical rotations on Unit

Phone No. NA/ or 787-2927

Fax No. NA/ or 787-1467

Are you currently employed at the Health Sciences Centre in a nursing capacity?

Yes No

Pyxis Access Issued for one academic year:

From: __________to September 30/____ Mo/day/yr yr

Systems/Functions Requiring Access Pyxis Medication Delivery

• Nursing

PHIA PLEDGE FORM HAS BEEN SIGNED. If No, scheduled for: __________________________________

Date Applicant Signature:

Date Manager/Supervisor/ Signature:

Bring the completed form to the Clinical Placement Office, Room NA138, Isabel M. Stewart Building, 700 McDermot Ave., R3E 0T2 (Phone 204-787-2927)

Department of Clinical Education – Revised December 2015 [13]