MCC Nursing and Surgical Technology Policy and Procedure for the Suspected Impaired Students in Classroom or Clinical Setting

The MCC Nursing faculty believes chemical substance dependency is a disease and supports student efforts for treatment and achievement of sobriety. However, the nursing faculty will not allow chemical substance abuse in the clinical area or classroom setting. Students in the clinical setting are held to the expectation defined for licensed professionals and/or as defined by clinical healthcare sites in contractual agreements with MCC. Our goals are to identify and guide any student experiencing impairments related to substance abuse to treatment, and to maintain professional standards of conduct and safety to the public.

Policy

• Health Related programs at MCC adhere to the Monroe Community College Student Conduct Regulations as outlined in the Catalog and Student Handbook when addressing students who may be impaired while in the classroom or clinical setting. In addition to the expectations outlined in the Student Conduct Regulations, students in the clinical setting are held to the expectations defined for licensed professionals and/or as defined by clinical healthcare sites who enter into contractual agreements with MCC. Therefore, students in Health Related programs are expected to adhere to program specific policies regarding impairment while in the clinical setting.
• The right of patients and the public to safe professional practice supersedes students’ learning and skill acquisition needs. The responsibility of the College and the faculty to protect patients, the public, and the staff of clinical settings from unnecessary exposure to dangerous situations is paramount. Faculty have the obligation to assess and make professional judgment with respect to each student’s fitness for safe and ethical practice during clinical hours.
• Students have the responsibility to practice without undue risk to themselves or others and to maintain fitness for duty throughout all clinical hours. When a faculty member, or clinical staff member charged with supervising the student, makes a professional judgment that a student’s psychological and/or physical condition has impaired his/her ability to perform in accordance with course-specific clinical behaviors, the student will be asked to leave the clinical area. The procedure for intervention for students in a clinical setting who are suspected of being impaired will be initiated. The student is given the opportunity to hear the reasons for the suspension of participation, and to discuss the incident with a representative from the College.
• Students shall not be in a clinical setting when their performance is impaired by any substance.
• When the clinical agency has a policy regarding fitness of duty (essential functions for participation), in addition to the health program’s policy, that policy will be followed.

Signs and Symptoms of Possible Impairment

1. Psychological Problems: irritability; moodiness; tendency to isolate self; avoidance of group work; dishonesty, difficulty with focus and concentration
2. Social Changes: eats alone, avoids social gatherings
3. Changes in Personal Appearance: change in dress; unkempt appearance; flushed complexion;’ red eyes; swollen face; hand tremors; persistent rhinorrhea, drowsiness
4. General Behavior Changes: inappropriate responses, elaborate and/or inconsistent excuses for behavior; intolerance of others; suspiciousness; nervousness; agitation pattern of absenteeism and tardiness; decreased clinical and academic productivity; fluctuation in clinical and academic performance; decreased alertness; falling asleep in class or conference
5. Signs Associated with Impairment: odor of alcohol; slurred or rapid speech; unsteady gait; errors in judgment; altered pupil dilation; declining health.

Faculty should keep in mind that patterns often emerge slowly over time, are often observed by more than one faculty member and can be variable.

Procedure for Intervention

If a student in a clinical setting is suspected of being impaired:

1. Approach the student and inform them of the behavior(s) that have been observed.
2. Explain briefly that the student is being removed from the clinical area according to MCC “Policy for the Suspected Impaired Student in Clinical Setting," "General Conduct Rules and Regulations," and NYS standards of professional practice; because the student has been observed behaving/presenting themselves in a manner that indicates he/she/they cannot perform duties safely and effectively.
3. If appropriate, contact the security department at the clinical site to remove student from setting.
4. Student must agree to be evaluated in the Emergency Room or they may be withdrawn from classes.
5. Arrange transportation to an Emergency Room for evaluation
   1. Do not let the student drive.
   2. This may require the assistance of a friend, relative, taxi, or police.
6. Faculty must notify the appropriate Emergency Room of the Student’s name and reason for referral.
7. Faculty must notify the Department Chair’s office and the course coordinator via email, text or telephone that a student is being referred to the Emergency Room for assessment of impairment.
   1. Nursing Department Chairperson: Colleen Caruana (ccaruana001@monroecc.edu), (585) 292-2453
8. Faculty will notify MCC Public Safety and file a report at (585) 292-2911
9. Faculty will complete an Incident Report form:
   1. Document the student’s behavior, name of a witness if present, the conversation with the student and the action taken.
   2. Documentation should include factual, descriptive, and objective information. If anecdotal information is included, (information that is reported to but not observed by the writer) the source should be identified.
   3. Document referral to Emergency Room, arrangements for transportation, and who has been notified of the situation (see above).
   4. Documentation is completed with date, time, and faculty/staff supervisor signature.
   5. Submit to Course Coordinator and Department Chairperson.
10. Complete a Behavioral Incident Report (BIR) through Student Services.
    1. Documentation should include factual, descriptive, and objective information. If anecdotal information is included, (information that is reported to but not observed by the writer) the source should be identified.
    2. Documentation is reviewed by the Office of Student Services during regular College business hours and used to determine the appropriate follow-up.
    3. BIR must be submitted with one (1) business day of the incident.
11. Contact student on or before the next business day to arrange a meeting within 5 business days of the incident.
    1. Inform the student they will be meeting with the faculty member, Department Chairperson, Program Director* (*Directors will be included for programs that have Program Directors.)
    2. One student advocate may attend the meeting if pre-arranged with Department Chairperson and faculty involved.
    3. Recommend that the student review the following policies:
       1. General Conduct Rules and Regulations (located in the MCC Catalog/Student Handbook)
       2. Student Right to Know, Consumer Information, and Disclosures
       3. Annual Campus Security Report
       4. Biennial Review of MCC's Alcohol and Other Drug Programs
12. Meeting:
    1. Discuss the reason for the meeting, introduce all members present.
    2. Review “MCC Nursing and Surgical Technology Policy and Procedure for the Suspected Impaired Students in Classroom or Clinical Setting”
    3. Review the incident report completed and the steps followed.
    4. Review the consequences related to the policy:
       1. If the initial assessment from Emergency Room indicates that the student may return to clinical, they will continue with clinical coursework and will be counseled by the faculty and/or chair regarding the specific clinical performance concerns documented on the department incident report.
       2. If student declined to comply with the initial assessment and Emergency Room evaluation, the student may receive a failing grade for the course and may be dismissed from the program.
       3. If the student complied with getting the initial assessment from Emergency Room, they may continue to attend classes but may not participate in the clinical area until results of assessment from Emergency Room are communicated to MCC Health & Wellness and the Department Chairperson.
       4. If the initial assessment from Emergency Room indicates that the student should not return to clinical, the student will receive a failing grade for the clinical portion of the course and will be dismissed from the program.
    5. If the student completes a treatment program and submits documentation of successful completion to MCC Health & Wellness the student will be eligible to apply to return to the program. Return is on a space available basis. Student Services can provide appropriate referral for services to the student if needed.
    6. If the student does return to the program and there is subsequent similar incident the student will be dismissed and will be ineligible to apply for readmission
13. Request the student provide
    1. After Visit Summary and associated lab work from the Emergency Room visit and;
    2. written documentation of their ability to meet the essential functions as outlined in the Student-Related Policy manual to MCC Health & Wellness and the Department Chairperson.
14. Document the discussion and results of the meeting. Place the documentation of the meeting in the student’s department file.