Student Training Pharmacy & Nursing

Student Training (Observation)
Dear Student,

The Williamson Health observation program is provided as a service to our community. The program allows local students the opportunity to observe a medical career path of interest.

There is a limited amout of observation time allowed per student based on department, availabity, and time allowances.

We are unable to set up observations in certian areas due to patient safety and infection prevention concerns (ie lab).

Please note, student preferences for scheduling a observation day will be considered however, organizational priorities may take precedence as needed.

Please allow us up to two weeks after we receive ALL of your paperwork to schedule an observation.

You should not show up to Williamson Health until you are approved to do so.

Dress Code: Business Casual with comfortable shoes, you may be standing, or walking a lot!

Day of arrival: you will enter via the main entrance and go past the receptionist desk, down the hallway to the Security sliding window on the left to check in (it is across from the cafeteria) and they will ask for your id (they will hold your id for the day, but return it that afternoon, when you return your Williamson Health badge.)

For questions or concerns, you can email Susan Gates @ susangates@williamsonhealth.org
Name*

First NameLast Name
Age:*
Email*
example@example.com
Top 3 Observation Picks:
List your top three (3) choices for shadow/observation experiences (ie, Nurse, Radiologist, Respiratory Therapist). We will attempt to place you in your priority choice, but your placement will be determined by availability, staffing and time restrictions.
List other here:
THIS OBSERVATION IS SET UP AS A SHADOW OF A NURSE, NOT A MD.
Please list your availability for the requested observation so that we can contact the Department for approval. No weekend dates are available.
Scan the QR code to complete required training:

(Must be completed by ALL Students & Instructors)
Scan the QR Code below or use the hyperlink to complete your student training. Use this password to login: #WHTrain24/25
https://rise.articulate.com/share/VwQkhCQU-1Jxdj468yMwDuXheTSH6uBL
Observation & Confidentiality Form

YOU MUST PRINT AND DOWNLOAD THE CONSENT FORM, PDF FORMAT, NO PICTURES.
FLU Declination form: YOU MUST PRINT AND DOWNLOAD THE CONSENT FORM, PDF FORMAT, NO PICTURES.
(1.) Download the certificate for required training and (2.) signed Observation & Confidentiality Form (3.) Flu declination (IF YOU ARE NOT RECEIVING THE VACCINE) form here: *

Cancelof

Parking Form
Student Observer Parking Information- put NA if you are not driving yourself*
Print the parking form for your reference:

TB Risk Assessment & Symptom Evaluation- please type your full name*
Temporary or permanent residence of greater than or equal to 1 month in a country with high TB rate. Any country other than the United States, Australia, New Zealand, Northern or Western Europe. *
Current or planned immunosuppression. Including human immunodeficiency virus (HIV) infection, organ transplant recipient, treatment with a TNF-alpha antagonist (e.g. infliximab, etanercept, or other), chronic steroids (equivalent of prednisone greater or equal to 15mg/day for greater or equal to 1 month) or other immunosuppressive medication.*
Close contact with someone who has had infectious TB disease since the last TB test.*
Productive, persistent cough lasting 2-3 weeks in duration?*
Blood in sputum?*
Night Sweats?*
Weight loss not caused by dieting?*
Fatigues, tires easily?*
Unexplained fever or shortness of breath?*
If "Yes" to any question please explain:
My signature below indicates that my TB Risk Assessment is accurate:*
Date*

MonthDayYear
Date

Handwashing Agreement
Hand hygiene protects both healthcare personnel and patients. Hand hygiene means:

· Handwashing with soap and water (e.g., plain soap or with an antiseptic).

· Antiseptic hand rub (alcohol-based foam or gel hand sanitizer).

· Surgical hand antisepsis.

Cleaning your hands reduces:

· The potential spread of deadly germs to patients.

· The spread of germs, including those resistant to antibiotics.

· The risk of colonization or infection from germs received from the patient.

Hands should be cleaned:

· Immediately before and after patient interaction

· Before, during, and after preparing food or eating

· Before and after treating or touching a cut or wound

· After using the toilet

· After blowing your nose, coughing, or sneezing

· After touching hospital surfaces (elevator buttons or door handles etc)

· After handling garbage
Handwashing Attestation: I agree to wash my hands and use alcohol-based foam while observing at Williamson Health. I understand that failure to comply with the handwashing protocol can result in termination of my observation experience. My signature below indicates my understanding of the guidelines. *
Signature:*
Date*

MonthDayYear
Date
1. Name of School you are attending 2. Your major 3. what year you are in 4. who do you need to shadow (Nurse, PA, NP, Physician or doesn't matter.
Should be Empty:

Student Training (Observation)

Top 3 Observation Picks:

Scan the QR code to complete required training:

Observation & Confidentiality Form

Parking Form

Handwashing Agreement