Identification & Fingernail Hygiene Policy

The policies referenced are intended to provide healthcare staff with guiding principles for professional accountability during their tenure at Clover Health Services. It is MANDATORY to read and abide by all policies and to execute expectations for responsibilities in all practice settings. You are required to read and acknowledge that you have read this file, understand and voluntarily agree to all Clover requirements

Identification Policy:

All workers must bring identification and be prepared to provide this to the facility immediately upon arrival on the first day of orientation.

It is required that organizations verify any workers’ identity by viewing one of the following documents:

• A current picture organizational ID card
• A valid picture ID issued by a state or federal agency (for example, a driver's license or passport)

Fingernail Hygiene Policy:

It is the policy of Clover Health Services to adhere to standards to promote natural fingernails and hand hygiene.

As indicated in Facility requirements, staff are not allowed to wear acrylic or artificial fingernails while providing patient care and must keep their finger nails well-groomed and at a length of no more than ¼ of an inch. Staff found in violation of this policy with the facility regulations for fingernail hygiene may have assignment suspended, cancelled, or terminated.

Floating Policy

What to do if you are asked to float:

• Ask for orientation to the unit
• Explain your limitations, if any
• Be flexible
• Do not operate unfamiliar equipment - ask for assistance
• Do not act like you know more than you do
• If you feel you do not have the clinical competencies to work in the unit, request to be assigned a limited assignment of nursing care duties, which utilize your current clinical competencies. Additionally, please ensure Clover is notified.
• If you are not sure if you should accept the float assignment, ask yourself if accepting will be more detrimental to the patients than refusing to float.
• If you feel you must refuse to float, inform your hospital supervisor/manager and Clover, explaining that you do not possess the skills and competency for the float assignment.
• Feeling "uncomfortable" floating is NOT an acceptable reason for refusing or not floating.

Keep in mind:

• Your license requires you to maintain basic competency. This competency can be used in the majority of floating situations.
• Regardless of what unit you are assigned to work for your travel assignment, floating may be required, again, if you have the competency and skills for the alternate unit. If you have any questions or concerns about floating, please call Clover Health Services

Healthcare staff -- Expectations and Requirements

• Staff will always represent Clover in a professional, positive manner.
• Staff are expected to be at the assigned unit a couple of minutes early and prepared to start work, as per the contract, and stay through the end of each shift. Shift timings are defined by the facility and on the contract.
• Sick Calls / Cancellations: If staff had to call in sick or cancel a shift, they are required to notify both the facility and Clover Health Services (12) hours in advance, in case of emergency; at least four (4) hours prior to the shift.
• No Call / No Show: If staff cannot work a scheduled shift and they do not notify the facility and / or Clover Health Services, the assignment may be at risk of cancellation by the facility.
• Staff are required to immediately report to Clover Health Services of any incident, including medication errors, falls, unanticipated deaths, injuries and safety hazards or issues that were escalated to a Nurse Manager.
• Professional Behavior: Staff are expected to demonstrate a highly ethical and diligent mindset and always maintain a professional and courteous attitude.
• This includes both verbal and non-verbal communication with patients, patient’s family, peers and management.
• In the event of any concerns raised by the facility, it will be investigated by both the staff and the facility by Clover Health Services.
• Always maintain a clean and safe work environment.
• Staff are required to fulfill the contracted hours of shift per week by the end date of the contract. If staff choose to end the assignment early, a penalty fee may apply.
• Staff are expected to adhere to or follow all policies and procedures defined by Clover Health Services and facilities.
• Staff will be subject to the direction and instructions of the facility’s Supervisory staff during the shift and all through the end of the assignment.
• Traveler will maintain habits of punctuality, dependability, and reliability. Will be absent only in the event of incapacitating illness or family emergency that necessitates return home.

General Information

While on assignment, healthcare staff are representatives of Clover Health Services. Healthcare staff performance is integral to a facility's future use of healthcare professionals. In recognition of this responsibility, staff is expected to act in a professional manner throughout the course of the assignment. Most facilities will ask you for a copy of your license/certification and any credentials you have such as BCLS, ACLS, Fetal Heart Monitoring, etc. during your orientation to the facility.

Be sure to bring these with you. You should always have available while you are working in any facility the following:

• CPR
• Social Security card
• License/Certification
• Two references
• Any certifications needed to work in your specialty
• Resume

During your hospital orientation you may be required to do much of the same safety, HIPAA, testing, etc. that you will be doing by completing this packet. Please understand that the facilities all require this to be done prior to your start date but still require their own specific onboarding process. We strive to provide the most comprehensive, orientation and testing, and onboarding, however some facilities have very specific, individualized requirements.

• Parking
• Dress Code
• Smoking Policy
• Breaks/Lunches
• Chain of Command
• Emergency Codes

Healthcare staff will be expected to follow individual facility policy related, but not limited to, each of the above.

Additional Expectations

• The clinician is an employee of Clover Health Services and reports to both Clover Health Services and the designated supervisor(s) at the assigned facility.
• Clover Health Services healthcare staff will represent Clover Health Services in a professional, positive manner at all times - this includes arriving to work on time and completing each shift as determined by the hospital.
• Maintain clean and safe environment at all times.
• Keep Clover Health Services informed at all times if you are in any way dissatisfied with your assignment. Any issue(s) you are concerned about should first be brought to the attention of the assigned hospital supervisor or designee for resolution. If a resolution does not occur, you are expected to contact Clover Health Services to discuss your issues. Clover Health Services staff will work with you and the hospital management to work towards a resolution.
• Complete assignment as defined in contract. Early contract terminations will only be considered in extreme circumstances, and a penalty fee may apply.
• All on the job injuries are to be reported to Clover Health Services immediately.
• Sick calls will be kept to a minimum. Tardiness will not be tolerated. You will be held to the same expectations regarding excessive sick calls and/or tardiness as hospital employees.
• Complete and send all required documentation to Clover Health Services promptly, prior to beginning assignment.
• Complete and send all renewals to Clover Health Services prior to expiration. Clover will send the renewed document to the facility on your behalf. (Note, Clover Health Services will reimburse up to $200 yearly or renewals, including but not limited to, certifications, credentials, and optional continuing education).
• Complete additional continuing education, in addition to what is reimbursed.
• Attend hospital orientation & other required in-services for each facility assigned.
• Comply with all Federal & State Regulatory Acts.
• Accept only assignments for which qualified.
• Report situations in which there is a potential for Organ Donation to the nursing manager or designee. Report any security incidents, including property damage to Clover Health Services.
• Communicate with Clover Health Services staff and with management, staff, patients and family of patients of assigned facility in respectful manner at all times.
• Will not refer a patient to a specific attorney or law firm for legal assistance.
• Will not discuss any components of compensation with anyone at hospital. Follow all Clover Health Services and assigned facility policy and procedures.
• Report any unexpected patient incidents, including medication errors, falls, unanticipated deaths, injuries and safety hazards to Clover Health Services.
• Any complaints received regarding quality and safety of patient care may be reported by Clover to The Joint Commission.
• A worker may report any complaints to The Joint Commission without fear of reprisal.

Clover Standards

Clover professional standards of conduct exist to ensure orderly operation and provide the best possible work environment. All employees are required to adhere to all policies, procedures and professional standards of conduct. Failure to abide by these rules may result in disciplinary action, up to and including termination.

• Always strive for professional excellence
• Be flexible, innovative, and responsive to change
• Manage human and financial resources wisely
• Be a team player, help others succeed
• Encourage open communication
• Treat all individuals with dignity and respect
• Provide superior service to all customers
• Take pride in Clover Health Services and your role in our collective success

INFRACTIONSM – While it is not intended to be an exhaustive list, the types of misconduct listed below are examples of conduct that may lead to disciplinary action, including immediate termination.

• Violation of the hospitals policies or Clover Health Services policies or directing others to violate policies
• Dishonesty, theft, or embezzlement
• Falsification of documents (e.g., employment applications, time sheets, patient records, etc.) Referring business to a direct competitor of Clover Health Services
• Accessing, disclosing or discussing confidential information with those not involved with the care or with a need to know
• Refusal to perform work as required and/or as permitted within your scope of practice Insubordination, refusing to follow a supervisor's direction or other disrespectful conduct Use of profanity
• Possession, use, or distribution of illegal substances or alcohol on hospital or company premises – or appearing for duty under the influence of alcohol or drugs
• Retaliation, directly or indirectly, against another employee for reporting a suspected violation of policies or applicable laws or regulations
• Conduct that may cause injury to persons or damage to property
• Sleeping on the job
• Actual or threatened physical violence or abuse towards patients or other employees
• Harassment (including sexual harassment) Illegal discrimination
• The use of the working relationship to build a personal relationship for monetary gain. Offers of money and gifts to nurses healthcare staff be declined politely and firmly.
• Violating safety, health rules or practices or engaging in conduct that creates a safety/health hazard.
• Unsatisfactory job performance or failure to follow professional standards of conduct. Unexcused absence, excessive absenteeism and excessive tardiness.

Policy in accordance with HCAHPS

Healthcare Staff are Hospitals' scores on the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Clinicians need to take responsibility to increase HCAHPS scores. Under the value- based purchasing program, hospitals could be financially penalized for low HCAHPS scores. One of the foundations of a positive patient experience is communication — both between providers and patients. Patients expect a lot from clinicians - to have clinical expertise, to be advocates, to provide education, etc. Healthcare staff are the face and personality of any facility. They are everything to the patients - response time, pain management, source of information, compassion & concern. The overall perception by patients of the care received is influenced dramatically by the way you communicate.

• Greet patients by introducing yourself.
• Always state your name. Ask, "How can I help you?"
• Make eye contact, talk to patients not over them, and use their name
• Make every effort to keep patients informed and involved in their care and put things in writing whenever possible.
• Ask for questions - Ask "What additional information can I give you", instead of "Do you have any questions"
• Tell patients when they can expect you back & make sure you go back.
• Listening is frequently more important than talking.

Quality Improvement – How are you expected to participate in the facility's Quality Improvement processes as always?

• Healthcare staff have listened carefully to patients and educated patients throughout their hospital stay.
• Healthcare staff often must explain things in a way patients can understand.
• Healthcare staff need to tell patients what their medicine was for and describe possible side effects of their medicine.
• Healthcare staff will have to discuss whether they will have the help they need after leaving the hospital.
• Healthcare staff should provide information in writing about symptoms or health problems to look out for after leaving the hospital.
• Every interaction with patients is an opportunity to educate patients — about their condition, medication, post-discharge plans and follow-up plans. Patients that understand more about their condition and their care will feel more involved in their care process and less detached.

Accountability is the key

The key to a successful work environment that strives for excellence is reduced variation and strong accountability. Make a positive patient experience part of the culture.

Top-box scores for the Healthcare staff would be for:

• Pain well controlled
• Help going to the bathroom as soon as wanted
• Responsiveness of healthcare staff, got help as soon as wanted
• Healthcare staff listened carefully
• Healthcare staff explained things understandably
• Healthcare staff treated patient with courtesy/respect
• Small changes in staff behavior can influence patient satisfaction
• Maintaining cleanliness at all times Communication of medicine Discharge information

Abuse Reporting Policy

All Clover Health Services healthcare staff will report all actual and suspected incidences of child and/or dependent/elder abuse according to State & Federal mandates. healthcare staff are expected to inquire at each facility they are assigned to as to the appropriate personnel/agencies to contact in the event of abuse suspected or witnessed at the assigned facility. An inability to locate the correct agency for reporting purposes is not an acceptable reason for not reporting abuse! All events must be reported regardless of whether the incident resulted in an adverse patient outcome.

Child Abuse & Neglect

New York law REQUIRES any health practitioner, in his/her professional capacity or within the scope of his/her employment who has knowledge of or observes a child whom he/she knows or reasonably suspects has been the victim of child abuse must report the known or suspected instance of child abuse to a child protective agency immediately or as soon as practically possible by telephone and prepare and send a written report thereof within 36 hours of receiving the information about the incident. Please also ensure to notify Clover Health Services. "Reasonable suspicion" means that it is objectively reasonable for a person to entertain such a suspicion, based upon facts that could cause a reasonable person in a like position, drawing when appropriate on his/her experience, to suspect child abuse.

Dependent/Elder Abuse

New York law requires health practitioners, who (in their professional capacity or within the scope of their employment) observe evidence of or have been told by an elder or dependent adult that he/she is a victim of physical abuse are REQUIRED to report this to county adult protective services or a local law enforcement agency immediately, or as soon as possible, by telephone with a written report submitted within two working days. State law PERMITS reporting other types of abuse such as neglect, intimidation, fiduciary abuse, abandonment, isolation, or other treatment that results in physical harm, pain, or mental suffering when the reporter has knowledge of or reasonably suspects one or more of these types of abuse have occurred. Additionally, please notify Clover regarding any of the above instances. Elders are defined as persons 65 years or older and dependent adults are defined as persons between the ages of 18-64 whose physical or mental limitations restrict their ability to care for themselves.

Suspected Inflicted Injury as a Result of Assaultive or Abusive Conduct

Any health practitioner employed in a health facility, or clinic who has knowledge of, or observes, in his/her professional capacity or within the scope of his/her employment, a patient whom he/she knows or reasonably suspects is a person suffering from any wound or other injury inflicted by his/her own act or inflicted by another where the injury is by means of a knife, firearm, or other deadly weapon, or suffering from any wound or other physical injury inflicted upon the person where the injury is the result of assaultive or abuse conduct shall make a report to a local law enforcement agency, by telephone, immediately or as soon as practically possible. A written report shall be prepared and sent to the local law enforcement agency within two working days of receiving the information regarding the person. Clover should also be immediately notified regarding any of the above instances.

Substance Abuse Policy

• It is the policy of Clover Health Services that all employees must report to work completely free from the presence of illegal drugs and/or the effect of alcohol. Employees, while working, are prohibited from purchasing, transferring, using or possessing illegal drugs or from abusing alcohol or prescription drugs in any way that is illegal.
• Drug testing is a requirement for employment and for assignment. All healthcare staff must consent to drug testing prior to beginning an assignment, annually thereafter and to additional testing if illicit drug use is suspected (i.e. missing narcotics, impaired performance, erratic behavior, etc.).
• Healthcare staff who test positive or decline to undergo drug testing will not be considered for employment. Healthcare staff who test positive must wait a minimum of 12 months before they will be permitted to reapply. Healthcare staff on assignment, who tests positive in a confirmed drug test or refuses to undergo drug testing, will be subject to disciplinary action up to and including termination.
• The use of prescription drugs, as part of a prescribed medical treatment by a licensed physician is not prohibited. Healthcare staff are required to inform his/her supervisor at the assigned facility and Clover Health Services if the legal use of a prescription drug will in any way affect the ability of the worker to perform his/her assigned job. It is the employee's responsibility to determine whether a prescribed drug may impair job performance. Working while impaired in any way will be subject to disciplinary action up to and including termination.
• It is the employee's responsibility to seek assistance from drug or alcohol rehabilitation programs before this problem affects judgment, performance or behavior.
All employees should report evidence of alcohol or drug abuse by a supervisor at the assigned facility and Clover immediately. In cases where the use of alcohol or drugs poses an imminent threat to the safety of persons or property, an employee must report the violation. Failure to do so could result in disciplinary action for the non-reporting employee.
• Refusing to comply with this policy may be cause for disciplinary actions, up to and including termination.
• Nothing in this policy shall be construed to alter or amend the at-will employment relationship between Clover Health Services and its employees.

Disciplinary Action Policy

• This policy provides guidelines only related to attendance, performance, behavior and progressive disciplinary action for Clover Health Services healthcare staff; not all possible situations are covered specifically in this policy.
• Tardiness: Clover Health Services’ healthcare staff are expected to be on their assigned unit ready to begin working prior to the beginning of the shift. Tardiness is defined by the facility the worker is assigned. Excessive tardiness will be subject to disciplinary action.
• Sick Calls/Cancellations: When healthcare staff accept a contractual assignment, they have committed themselves to the assigned facility and to Clover Health Services. If a sick call or cancellation becomes necessary, the worker is expected to give both the assigned facility AND Clover Health Services a four (4) hour notice. More than two (2) sick calls/cancellations in a thirty (30) day period, or more than one (1) sick call with less than four (4) hours notice will be grounds for disciplinary action.
• Unexcused Absence - No Call/Show: When healthcare staff does not notify the assigned facility and/or Clover Health Services and does not report to duty as scheduled, the no call/no show is grounds for immediate termination.
• Performance and Behavior: Clover Health Services staff are expected to conduct themselves professionally at all times. This includes both verbal and non-verbal communication with patients, family, staff and management. All staff are expected to maintain professional, courteous attitudes at all times. Any complaints made by the assigned facility related to performance and/or behavioral issues about the worker will be investigated by Clover Health Services. Unsatisfactory work performance or behavior is unacceptable and may result in disciplinary action up to and including immediate termination.
• Disciplinary Action Procedures: Generally, Clover Health Services utilizes progressive discipline in which performance or behavior problems are dealt with progressively stricter actions if improvement is not made. However, in some cases, depending on the severity of unacceptable behavior or performance, immediate termination may be necessary. The following actions will be utilized for non-compliance with Clover Health Services policies:
• Counseling/Verbal Warning - verbal consultation with worker to identify problem(s), appropriate actions and expected outcomes.
• Written Warning - A written warning will be given if a problem/issue identified during counseling/verbal warning continues.
• Termination - Termination will occur when all efforts to satisfactorily resolve the issue of concern have been exhausted and/or if the severity of the issue warrants termination.

HIPAA Policy

The confidentiality of protected health information (PHI) is protected by law and Clover Health Services policy. The intent of these laws and policy is to assure that confidentiality of information is appropriately maintained when any such information is used for business or clinical operations. Nurses may see or hear confidential information in any form (oral, written, electronic) regarding patients and/or their family members (i.e. patient records, test results, conversations, and financial information).

Protected Health Information (PHI) is defined as any information, including demographic information, collected from an individual that (a) is created or received by a health care provider, health plan, employer or health care clearing hours; and (b) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision for health care to an individual and identifies the individual or with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.

All staff employed with Clover Health Services are expected to adhere to the following:

• Maintain and protect the privacy of all business and medical information relating to patients. Acknowledge that any confidential information learned on the job does not belong to the clinician and he/she has no right or ownership to it. Access to confidential information may be removed by the facility at any time for any reason.
• Will not misuse confidential information and will only access information that is necessary for the clinician to do their job. The healthcare staff will not use or disclose any confidential information in any manner (verbal, written, electronic) unless required to do so in order to provide appropriate and necessary care to a patient.
• Will not share, alter or destroy any confidential information unless it is a necessary part of the job. If it is necessary, the healthcare staff will follow the correct procedure as directed at the assigned facility. Staff will not share any patient names with Clover Health Services staff.
• Will only print or download information from any computer system when it is necessary for a legitimate work-related purpose. The clinician is accountable for this information until it is properly disposed of or filed.
• Will keep any computer password secret and will not share it. The clinician is responsible to protect his/her password or other access to confidential information. The worker understands that use of an electronic system at the assigned facility may be periodically monitored and audited to ensure compliance with the law.
• Must immediately report to the assigned hospital supervisor/manager if he/she suspects anyone is misusing confidential information or is using his/her password. Clover Health Services will not tolerate any retaliation against the clinician for making such a report.
• Upon termination of my assignment with any health care facility, the worker will promptly return any facility documents, data or equipment containing that facility's confidential information or date that is in my possession or control.
• Will follow the HIPPA policy and procedures as defined by each individual health care facility the clinician may be assigned to during employment with Clover Health Services.

Any failure to comply with each term in this agreement may result in disciplinary action up to and including termination of assignment and/or employment with Clover Health Services.

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

WHO WILL FOLLOW THIS NOTICE

This notice describes our organization's practices and that of:

• Any employee authorized to enter information into your employee file.
• All departments and units of the company.
• All employees, staff, and other hospital personnel
• All these entities, sites, and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other company/hospital operations purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create an employee record on you to ensure you meet the requirements of healthcare facilities that you may be assigned a travel healthcare position. We need this record to comply with certain legal requirements. This notice applies to all of the medical information/records of you that we receive as part of your employment with us and as required by contracted healthcare facilities. Your contracted healthcare facility may have different policies or notices regarding the healthcare facility's use and disclosure of your medical information created in our office. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

Make sure that medical information that identifies you is kept private; Give you this notice of our legal duties and privacy practices with respect to medical information about you; and Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

• For Company Operations: We may use and disclose medical information about you for company operations. These uses and disclosures are necessary to run the company and to make sure that all of our contracted healthcare facilities meet their travel healthcare staff policy and procedures and meet the requirements from regulatory agencies regarding the health status of healthcare providers. We may use medical information to determine whether or not you meet healthcare provider requirements to work at a contracted healthcare facility as travel staff. Different departments of the company also may share medical information about you in order to secure a travel assignment for you at a healthcare facility.
• Appointment Scheduling and Reminders. We may use and disclose medical information to contact you to set up appointments or as a reminder that you have an appointment for testing and/or care at a medical clinic.
• As Required By Law: We will disclose medical information about you when required to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

• Workers' Compensation: We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
• Lawsuits and Disputes: If you are involved in a lawsuit, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or to obtain an order protecting the information requested. Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
• In response to a court order, subpoena, warrant, summons or similar process.
• To identify or locate a suspect, fugitive, material witness, or missing person.
• About the victim of a crime if, under certain limited circumstance, we are unable to obtain the person's agreement;
• About a death we believe may be the result of criminal conduct.
• About criminal conduct at the company or at the assigned hospital; and
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
• National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your assignments at healthcare facilities. *To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Human Resources/Clinical. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

Right to Amend: If you feel that the medical information, we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the company. To request an amendment, your request must be made in writing and submitted to Human Resources/Clinical. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that: Was not created by us, unless the person or entity that created the information is no longer available to make the amendment; *Is not part of the medical information kept by or for the company; Is not part of the information which you would be permitted to inspect and copy; or Is accurate and complete.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. *To obtain a paper copy of this notice, please call the Human Resources/Clinical Department.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. The notice will contain an effective date.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the company or with the Secretary of the Department of Health and Human Services. To file a complaint with the company, contact the Human Resources/Clinical Department. You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the medical information that we have already received on you.

Documentation Policy

All Clover Health Services nurses are expected to adhere to the following when documenting, whether electronically or in writing. *Use correct grammar & spelling

• Date & Time ALL entries
• No "block" documentation
• No white out, tape, stickers
• Document education and pain assessments
• Check for correct name on each page you write on or on the computer "page" Never skip lines or leave blanks - fill in blanks with "N/A"
• Document every notification to MD or family
• Note every MD order - means that you have checked that everything regarding order is in place, done, etc. - always follow facility policy and procedure
• Never destroy or discard any part of a medical record.
• Include the following when documenting: Initial and ongoing assessments
• Any action taken, including reports to physicians
• Each observation (failure to document will produce gaps in the patient's record that will suggest that you neglected the patient)
• Variations from the assessment and plan
• Accountability information, including forms signed by the patient, location of patient valuables, and patient education
• Notation of care by other disciplines, i.e. physicians
• Health teaching, including content and response
• Procedures and diagnostic tests
• Patient response to any interventions, including drugs, diagnostic tests and therapy
• Statements made by patient and family
• Patient comfort and safety measures
• Document objectively, not subjectively - do not use judgments - only state the FACTS - not opinions
• All documentation must be: *Timely
• Clear, accurate, problem focused
• Succinct, brief
• Interdisciplinary
• Don't interrupt others while they are documenting
• Do not "hoard" charts - allow others access to charts
• Chart as much as you can as soon as you leave the patient's room

Each professional has a legal duty to maintain the medical record in sufficient detail. Inadequate documentation may result in liability or non-reimbursement

Documentation errors to be avoided:

• Abbreviations - use only facility approved
• Labels - use description of behavior vs. naming the behavior (i.e. yelling vs. angry) Do not document inappropriate behavior of other healthcare providers
• Never charting before care is given - this includes meds - Result is that you lose credibility and is illegal.
• Incident/Accident - don't use these words in your documentation. Document what happened in objective terms. Fill out incident report but don't write in chart, "filled out incident report"
• Staffing problems - don't document that staffing is short, etc.
• Alteration/destruction of records - Do not throw away soiled or torn documents, start a new one and keep with the old one.
• ILLEGIBLE HANDWRITING - including spelling errors. Sloppy charting will be interpreted by a jury as sloppy care. If you cannot write legible, then you MUST print. REMEMBER: If it's not documented, it wasn't done!

Communication Expectations & Guidelines

• Address patient by name
• Tell them who you are, giving your name and position
• Always wear a name tag Helps to provide security
• Provide privacy
• Knock when entering a patient room
• Close the door or draw curtains
• Maintain confidentiality at all times - If you have to ask patient personal questions, let them know why you are asking.
• SMILE - is a gesture of care and comfort. May take conscious effort to remind yourself to smile especially when you are deep in thought
• Be aware of how you communicate with co-workers *Remember actions speak louder than words - watch your body language and behaviors
• Treat others with respect at all times
• If someone misperceives what you said, make sure you communicate exactly what you want him or her to perceive.
• Never make assumptions
• Phone Etiquette -- When you pick up the phone you become the face and voice of the organization
• Treat phone contacts with the same regard as you would face-to-face contacts
• Speak on the phone with a smile
• Always state your name. Ask, "How can I help you?"

Sentinel Events Policy

Communication Expectations & Guidelines

All Clover Health Services healthcare staff are to inform Clover Health Services of any unexpected incidents, including errors, unanticipated deaths and other events, injuries, and safety hazards related to the care and services provided regardless of whether the incident resulted in an adverse patient outcome. This information will be used for record keeping and tracking purposes. Reporting errors contributes to improved patient safety and to the development of valuable educational services for the prevention of future errors.

Procedure:If any of the following occurs to a patient during the shift the patient is assigned to you, call Clover Health Services at (800) 579-8807 within 72 hours to report the event/occurrence. Report the date, time, type of occurrence, outcome, hospital and your name (punitive action will not be taken for reporting).

Patient falls - witnessed or unwitnessed, with or without patient injury Medication errors - includes, but not limited to, misinterpretations, miscalculations, misadministration, difficulty in interpreting handwritten orders, and misunderstanding of verbal orders, near misses.

Sentinel events - A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, "or the risk thereof" includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome.

The event has resulted in an unanticipated death or major permanent loss of function, not related to the natural course of the patient's illness or underlying condition, ("Major permanent loss of function" means sensory, motor, physiologic, or intellectual impairment not present on admission requiring continued treatment or life-style change) or The event is one of the following (even if the outcome was not death or major permanent loss of function unrelated to the natural course of the patient's illness or underlying condition): Suicide of any individual receiving care, treatment or services in a staffed around-the-clock care setting or within 72 hours of discharge Unanticipated death of a full-term infant Abduction of any individual receiving care, treatment or services Discharge of an infant to the wrong family Rape - defined as impermissible sexual contact involving a patient and another patient, staff member, or unknown perpetrator while being treated or on the premises of the health care organization, including oral, vaginal or anal penetration or fondling of the patient's sex organ(s) by another individual's hand, sex organ or object. Hemolytic transfusion reaction involving administration of blood or blood products having major blood group incompatibilities. Surgery on the wrong individual or wrong body part, and security Incidents - this would such things as theft and property damage.

Workers' Compensation

The Way It Was

In the early 20th century, a worker injured on the job had to sue his employer to recover medical expenses and lost wages. Lawsuits took months and sometimes years. Juries had to decide who was at fault and how much, if anything, would be paid. In most instances, the worker got nothing. It was costly, time consuming, and often unfair.

The Way it is

Today, workers' compensation law provides a faster, fairer way to take care of injured worker, where fault doesn't have to be proved to recover medical expenses and lost wages. This job-injury insurance is paid for by your employer and supervised by the state. If you can't work due to a job-related injury or illness, workers' compensation pays your medical bills and provides money to help replace lost wages until you can return to work.

Who's Covered?

Almost every employee in United States is protected by workers' compensation, but there are a few exceptions. People in business for themselves and unpaid volunteers may not be covered. Maritime workers and federal employees are covered by similar laws. If you have a question about coverage, ask your employer.

What's Covered?

Any injury or illness is covered if it's due to your job. It can be caused by one event, like a fall, or repeated exposures, such as repetitive motion over time. Everything from first-aid type injuries to serious accidents are covered. Workers' compensation even covers injuries - including physical or psychiatric injuries - resulting from a workplace crime. (Some injuries from voluntary, off-duty recreational, social or athletic activity - for example, the company bowling team - may not be covered. Check with your supervisor or the claim administrator listed at the end of this document if you have questions.).

Coverage is automatic and immediate. There is no qualifying period, no need to earn a certain amount in wages before you are covered protection begins the first minute you are on the job.

What You Have To Do

Immediately notify your facility supervisor so you can get medical help right away, then update Clover. If it's more than a simple first-aid injury, your employer will give you a claim form so you can describe the injury and how, when and where it happened. To file a claim, complete the "Employee" section of the claim form, keep one copy and return the rest to your employer. You employer will then complete the "Employer" section of the claim form and send one to the claims administrator, who is responsible for handling your claim and notifying you about your eligibility for benefits.

Benefits can't start until the claims administrator knows the injury, so report the injury and file the claim form as soon as possible. State law requires employers to authorize medical treatment within one working day of receiving a claim form, and employers may be liable for as much as $10,000 in treatment until a claim is accepted or rejected. Delays in reporting may delay workers' compensation benefits, and you may not be able to get benefits if you don't file a claim within one year of the date of injury, the date you knew the injury was work related, or the date benefits were last provided. To insure your right to benefits, report every injury, no matter how slight, and request a claim form if it's more than a simple first aid injury.

If you have any questions, ask Clover. Or contact the workers' compensation claims administrator. You can also contact an information and assistance officer at the State Division of Workers' Compensation (DWC). You can find out more information about authorized providers and locate authorized providers in the Injured Workers or Health Care Providers sections of this website or by calling 1-800-781-2362.

In An Emergency

• Seek first aid. If emergency medical care is needed, call for help immediately (see emergency telephone numbers below) and get the best available treatment until emergency personnel arrive
• Report injuries immediately to your facility supervisor and Clover. Your employer is required to provide you with a claim form within one working day of learning of your injury, so insure your rights to benefits by reporting every injury, no matter how slight, and request a claim form if it's more than a simple first- aid injury. Your employer must notify the claims administrator and authorize medical treatment within one working day of receiving your claim form, and will direct you to a doctor, clinic or hospital if necessary. If your claim or benefits are denied, you have a right to challenge the decision, the there are deadlines for filing the necessary papers at the Workers' Compensation Appeals Board, so don't delay.
• Call your employer representative or claims administrator if you have questions or problems. It is illegal for an employer to fire or discriminate against you just because you file, intend to file, or settle a workers' compensation claim, or because you testify for a co- worker who was injured. If you prove this kind of discrimination, you will be entitled to job reinstatement, lost wages and increased benefits, plus costs and expenses up to a maximum set but the state legislature.

ETHICS OF CARE, TREATMENT and SERVICES

ETHICS

Healthcare ethics involve each caregiver’s sense of right and wrong, and duties owed to patients and families. The 4 main principles involved are as follows:

Autonomy – To honor patient’s rights to make their own decisions regarding care

Beneficence – To help patience advance their own well being

Non-Maleficence – To do no harm

Justice – To be fair and treat all patience the same.

Ethical values are essential for ALL healthcare workers

These principles are ideally what all healthcare staff should be aware of in their daily practice. While ethical principles are sometimes confusing and often taught briefly during the licensing/certification process-- they should be constants in healthcare practice in order to provide the best, safest, and most humane care to all patients.

1. Autonomy

Autonomy is recognizing each individual patient’s right to self-determination and decision-making. As patient advocates, it is imperative that clinicians ensure that patients receive all medical information, education, and options in order to choose the option that is best for them. This includes all potential risks, benefits, and complications to make well-informed decisions.

Once the patient has all relevant information, the medical and nursing team can make a plan of care in compliance with the medical wishes of the patient.

It is important that nurses support the patient in their medical wishes and ensure that the medical team is remembering those wishes. Sometimes, nurses will need to continue to advocate for a patient despite the wishes being verbalized because the medical team might not agree in those wishes.

Many factors may influence a patient's acceptance or refusal of medical treatment, such as culture, age, gender, sexual orientation, general health, and social support system.

2. Beneficence

Beneficence is acting for the good and welfare of others and including such attributes as kindness and charity. The American Nurses Association defines this as “actions guided by compassion.”

3. Justice

Justice is that there should be an element of fairness in all medical and healthcare decisions and care. Staff must care for all patients with the same level of fairness despite the individual's financial abilities, race, religion, gender, and/or sexual orientation.

An example of this is when working at a free flu clinic or diabetes screening clinic. These are open to all individuals in the community regardless of the previously mentioned factors.

4. Nonmaleficence

Nonmaleficence is to do no harm. This is the most well known of the main principles of nursing ethics. More specifically, it is selecting interventions and care that will cause the least amount of harm to achieve a beneficial outcome

The principle of nonmaleficence ensures the safety of the patient and community in all care delivery. Nurses are also responsible to report treatment options that are causing significant harm to a patient which may include suicidal or homicidal ideations.

Ethical Standards

Ethical standards are a guide in decision-making and healthcare delivery for providers and organizations. These standards help to:

• Ensure care, treatment, and services are provided in a way that respects and promotes dignity, autonomy, positive self-regard, civil rights, and involvement of patients.
• Consider patient’s abilities and resources, the demands of their environment, and the requirement and expectations of providers and those they serve.
• Ensure that the family is involved in care and treatment decisions, with the patient’s approval.

Ethical standards include organizational ethics, individual rights, and individual responsibilities.

Organizational Ethics

Organizational ethics involve the environment where the healthcare is delivered.

The three aspects of organizational ethics include:

• Procedural justice – the policies for decision making should be coherent, consistent and transparent.
• Distributive justice – the fair allocation of resources, reward, benefits and discipline within the facility.
• Professionalism – Upholding moral principles and commitments valued by the profession and public.

Individual Rights

This includes how a facility respects the culture and rights of patients during staff interactions, and how the staff involves patients in care decisions. Individual rights include:

• Shared decision making – You are expected to partner with the patient, not only inform the patient.
• Informed consent – This is referring to if the patient has the capacity to make decisions and can appreciate the available options, and that their decisions are voluntary. Shared decision making is documented through informed consent.
• Advance care planning – A way to promote shared decisions when a patient cannot make these decisions. The patient can document their wishes and name a person to make decisions for them when unable to do so.
• End-of-life care – How decisions are made once the goal of care switches to palliative.
• Privacy and confidentiality – Personal information must be protected, in addition to protecting patients’ autonomy.

Individual Responsibilities

This involves the patient’s role. Some ethical decisions can only be made by the patient. Providers can inform and advise, but only the patient can ultimately decide.

Process to Address Ethical Issues

Ten Steps Healthcare staff should take to address ethical issues/concerns:

• Ethics is integral to everyday healthcare practice—staff in all roles and specialties must have the requisite knowledge, skills, and competencies to recognize and address ethical issues. If you do not feel confident in your skills, seek continuing education or courses in bioethics or ethics.
• Be familiar with the Code of Ethics for: Use it as a resource and justification for ethical practice.
• Recognize signals that indicate when an ethical issue is present. Notice what your body is telling you to pay attention to (rapid heart rate, sweaty palms, shallow breathing, muscle tension). What emotions are present (fear, anger, sadness, anxiety)? Is my conscience engaged (threat to core moral values, perception of participation in moral wrongdoing, moral outrage)?
• Get the facts. Clarify assumptions, biases, and meaning among stakeholders.
• Learn to describe ethical dilemma clearly and concisely by developing a robust moral vocabulary. Go beyond “Why are we doing this?” to naming the ethical conflict by appealing to violations of core professional values.
• Use a systematic process to engage in ethical discernment and analysis. Determine an ethically justified response including action or in some cases, inaction.
• When indicated, speak up and speak out with confidence and skill.
• Know the process for exercising conscientious objection. Use judiciously and thoughtfully.
• Know your resources. Navigating ethical concerns often exceeds our individual capacities. Be comfortable asking for and receiving support and advice.
• Contribute to creating a culture of ethical practice in your workplace; participate in workplace committees or initiatives that foster culture change and professional organizations to advocate for system change.

Patient's Bill of Rights

These rights can be exercised on the patient’s behalf by a designated surrogate or proxy decision- maker if the patient lacks decision-making capacity is legally incompetent or is a minor.

• The patient has the right to considerate and respectful care.
• The patient has the right to and is encouraged to obtain from physicians and other direct caregivers relevant, current, and understandable information concerning diagnosis, treatment, and prognosis.
• Except in emergencies when the patient lacks decision-making capacity and the need for treatment is urgent, the patient is entitled to the opportunity to discuss and request information related to the specific procedures and/or treatments, the risks involved, the possible length of recuperation, and the medically reasonable alternatives and their accompanying risks and benefits.
• Patients have the right to know the identity of physicians, nurses, and others involved in their care, as well as when those involved are students, residents, or other trainees.
• The patient also has the right to know the immediate and long-term financial implications of treatment choices, insofar as they are known.
• The patient has the right to make decisions about the plan of care prior to and during the course of treatment and to refuse a recommended treatment or plan of care to the extent permitted by law and hospital policy and to be informed of the medical consequences of this action. In case of such refusal, the patient is entitled to other appropriate care and services that the hospital provides or transfers to another hospital. The hospital should notify patients of any policy that might affect patient choice within the institution.
• The patient has the right to have an advance directive (such as a living will, health care proxy, or durable power of attorney for health care) concerning treatment or designating a surrogate decision-maker with the expectation that the hospital will honor the intent of that directive to the extent permitted by law and hospital policy. Health care institutions must advise patients of their rights under state law and hospital policy to make informed medical choices, ask if the patient has an advance directive, and include that information in patient records. The patient has the right to timely information about hospital policy that may limit its ability to implement fully a legally valid advance directive.
• The patient has the right to every consideration of privacy. Case discussion, consultation, examination, and treatment should be conducted so as to protect each patient’s privacy.
• The patient has the right to expect that all communications and records pertaining to his/her care will be treated as confidential by the hospital, except in cases such as suspected abuse and public health hazards when reporting is permitted or required by law. The patient has the right to expect that the hospital will emphasize the confidentiality of this information when it releases it to any other parties entitled to review information in these records.
• The patient has the right to review the records pertaining to his/her medical care and to have the information explained or interpreted as necessary, except when restricted by law.
• The patient has the right to expect that, within its capacity and policies, a hospital will make reasonable response to the request of a patient for appropriate and medically indicated care and services. The hospital must provide evaluation, service, and/or referral as indicated by the urgency of the case. When medically appropriate and legally permissible, or when a patient has so requested, a patient may be transferred to another facility. The institution to which the patient is to be transferred must first have accepted the patient for transfer. The patient must also have the benefit of complete information and explanation concerning the need for, risks, benefits, and alternatives to such a transfer.
• The patient has the right to ask and be informed of the existence of business relationships among the hospital, educational institutions, other health care providers, or payers that may influence the patient’s treatment and care.
• The patient has the right to consent to or decline to participate in proposed research studies or human experimentation affecting care and treatment or requiring direct patient involvement and to have those studies fully explained prior to consent. A patient who declines to participate in research or experimentation is entitled to the most effective care that the hospital can otherwise provide.
• The patient has the right to expect reasonable continuity of care when appropriate and to be informed by physicians and other caregivers of available and realistic patient care options when hospital care is no longer appropriate.
• The patient has the right to be informed of hospital policies and practices that relate to patient care, treatment, and responsibilities. The patient has the right to be informed of available resources for resolving disputes, grievances, and conflicts, such as ethics committees, patient representatives, or other mechanisms available in the institution. The patient has the right to be informed of the hospital’s charges for services and available payment methods.

Source/Reference: AmericanPatient.org, Patient Bill of Rights Adopted By American Hospital Association (AHA), https://www.americanpatient.org/aha-patients-bill-of-rights/

National Patient Safety Goals

• The National Patient Safety Goals (NPSGs) were established in 2002 to help accredited organizations address specific areas of concern in regards to patient safety
• The first set of NPSGs was effective January 1, 2003
• The Joint Commission determines the highest priority patient safety issues, including NPSGs, from input from practitioners, provider organizations, purchasers, consumer groups, and other stakeholders

Goal 1:

Identify patients correctly.

• NPSG.01.01.01: Use at least two ways to identify patients. For example, ask the patient their name and date of birth. This is done to make sure that each patient gets the correct medicine and treatment.
• Applies to: Ambulatory, Assisted Living, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital, Laboratory, Nursing Care Center, Office-Based Surgery, Rural Health Clinic, Telehealth

Goal 2:

Improve staff communication

• NPSG.02.03.01: Get important test results to the right staff person on time.
• Applies to: Critical Access Hospital, Hospital, Laboratory, Telehealth

Goal 3:

Use medicine safely.

• NPSG.03.04.01: Before a procedure, label medicines that are not labeled. For example, in syringes, cups and basins. Do this in the area where medicines and supplies are set up.
• Applies to: Ambulatory, Critical Access Hospital, Hospital, Office Based Surgery, Rural health Clinic
• NPSG.03.05.01: Take extra care with patients who take medicines to thin their blood.
• Applies to: Ambulatory, Critical Access Hospital, Hospital, Nursing, Rural Health Clinic
• NPSG.03.06.01: Record and pass along correct information about a patient’s medicines. Find out what medicines the patient is taking. Compare those medicines to new medicines given to the patient. Give the patient written information about the medicines they need to take. Tell the patient it is important to bring their up-to-date list of medicines every time they visit a doctor
• Applies to: Ambulatory, Assisted Living, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital, Nursing Care Center, Office-Based Surgery, Rural Health Clinic, Telehealth

Goal 4:

Use alarms safely.

• NPSG.06.01.01: Make improvements to ensure that alarms on medical equipment are heard and responded to on time.
• Applies to: Critical Access Hospital, Hospital

Goal 5:

Prevent infection.

• NPSG.07.01.01: Use the hand cleaning guidelines from the Centers for Disease Control and Prevention or the World Health Organization. Set goals for improving hand cleaning.
• Applies to: Ambulatory, Assisted Living, Behavioral Health Care, Critical Access Hospital, Home Care, Hospital, Laboratory, Nursing Care Center, Office-Based Surgery, Rural Health Clinic

Goal 6:

Prevent patients from falling.

• NPSG.09.02.01: Find out which residents are most likely to fall. For example, is the resident taking any medicines that might make them weak, dizzy or sleepy? Take action to prevent falls for these residents.
• Applies to: Assisted Living, Home Care, Nursing Care Center

Goal 7:

Prevent bed sores.

• NPSG.14.01.01: Find out which patients and residents are most likely to have bed sores. Take action to prevent bed sores in these patients and residents. From time to time, re-check patients and residents for bed sores.
• Applies to: Nursing Care Center

Goal 8:

Identify patient safety risk.

• NPSG.15.01.01: Reduce the risk for suicide.
• Applies to: Behavioral Health Care, Critical Access Hospital, Hospital, Telehealth
• NPSG.15.02.01: Find out if there are any risks for patients who are getting oxygen. For example, fires in the patient’s home.
• Applies to: Home Care

Goal 9:

Improve health care equity.

• NPSG.16.01.01: Improving health care equity is a quality and patient safety priority. For example, health care disparities in the patient population are identified and a written plan describes ways to improve health care equity
• Applies to: Ambulatory Health Care, Behavioral Health, Critical Access Hospital, Hospital, Telehealth

Goal 10:

Prevent mistakes in surgery.

• UP.01.01.01: Make sure that the correct surgery is done on the correct patient and at the correct place on the patient’s body
• UP.01.02.01: Mark the correct place on the patient’s body where the surgery is to be done
• UP.01.03.01: Pause before the surgery to make sure that a mistake is not being made.
• Applies to: Ambulatory, Critical Access Hospital, Hospital, Office- Based Surgery, Rural Health Clinic

For more information…

• The National Patient Safety Goals for each program and more information are available on The Joint Commission website at www.jointcommission.org
• Questions can be sent to the Standards Interpretation Group at 630-792-5900 or via the Standards Online Question Form

Cultural Diversity in Healthcare

What is cultural diversity in healthcare?

Cultural diversity is the variety of cultural perspectives, beliefs, and practices that patients bring when seeking medical care. It encompasses ethnicity, race, age, gender expression, socioeconomic status, religion, and other factors that form a person’s identity. Healthcare workers must be prepared to interact with patients with differing beliefs.

Practicing cultural competence can create situations to improve health outcomes and increase patient satisfaction. While every individual is unique, each culture holds certain beliefs and values that distinguish it from other cultures. Cultural competency in healthcare directly influences the quality, efficacy, and accessibility of care. Acknowledging cultural diversity helps create a meaningful patient-provider relationship while improving outcomes.

Assessing One’s Own Cultural Competency

Assessing your cultural competence involves:

• An honest want to not allow biases to keep you from treating every individual with respect.
• An honest reflection on what your positive and negative assumptions are about others.

While it isn’t easy, and nobody wants to admit they suffer from cultural ignorance, learning to evaluate your own level of cultural competency must be part of your ongoing effort to provide better healthcare.

Assessing your assumptions and any prejudicial thoughts:

• Helps you understand the impact of your unconscious thinking about others
• Helps you create new mental models of your patients that will contribute to the quality of care you deliver.

Incorporating Cultural Knowledge into Care

It’s important to understand how some movements and customs can mean different things. Please see below for a list of nonverbal communications to keep in mind, created by the U.S. Department of Health and Human Services.

Facial Expressions

• Smiling can mean happiness in most cultures but can mean other things too. For example, some Chinese may smile when discussing something uncomfortable or sad.
• Winking – In some Latin American cultures, this is a romantic gesture. In Nigeria, Yoruba may wink at their children if they want them to leave the room. Many Chinese consider winking to be rude.
• In Hong Kong, it is important not to blink one’s eyes conspicuously, as this may be seen as a sign of disrespect and boredom.
• Some Filipinos and Latin American cultures will point to an object by shifting their eyes toward it or pursing their lips and point with their mouth, rather than using their hands.
• Some Venezuelans may use their lips to point at something, because pointing with a finger is impolite.
• Expressions of pain or discomfort such as crying are also specific to various cultures. Some cultures may value being stoic, while others may encourage more emotion.

Head Movements

• In Lebanon, the signal for “yes” may be a nod of the head. For ‘No’ a Lebanese may point his or her head sharply upward and raise the eyebrows. Saudis may signal “yes” by swiveling their head from side to side. They may signal “no” by tipping their head backward and clicking their tongue.

Hand and Arm Gestures

• The “OK” sign is interpreted in Japan as the symbol for money because the circular shape of the index finger and thumb together suggest the shape of a coin. In Argentina, Belgium, France, Portugal, Italy, Greece, and Zimbabwe, the sign means “zero” or “nothing.” In some Eastern European countries, the gesture indicates a bodily orifice and is highly offensive.
• In some parts of the U.S., to hold up crossed fingers is to wish good luck, but to hold crossed fingers behind your back negates whatever pledge or statement you’re thinking. In Russia, this is a way of rudely rejecting or denying something. In Argentina and Spain, this sign is made to ward away bad luck. In China, it signifies the number ten.
• The “thumbs-up” gesture has a vulgar connotation in Iran.
• In Colombia, tapping the underside of the elbow with the fingers of the other hand suggests that someone is stingy.
• Many Chinese people point with their entire hand; using the forefinger to point is viewed as rude. Similarly, in India, one may use a full hand to point, but never just a single finger.
• In Latin America, a shrug with the palms facing skyward may be interpreted as a vulgar gesture.

Personal Space

• Compared to most in the U.S., Latin Americans are accustomed to standing and sitting close to people who are not well known to them. There are important variations in the size of the personal space comfort zone.
• People from the Middle East may stand quite close when talking with each other.
• In some Muslim cultures, a woman may be alarmed if a man, even a male physician, stands or sits too close to her.

Touching

• In some cultures, light touching of the arm or a light kiss to the cheek is very common, even among people who have just met. People from Latin America and Eastern Europe may be very comfortable with this kind of touching, whereas people from many Asian cultures may prefer less physical contact with acquaintances.
• Touching another person’s head is considered offensive by some people from Asia and the Middle East. It is, Therefore, it is inappropriate to pat a child on the head.
• Some Chinese may be uncomfortable with physical contact early in a relationship. Although many Chinese will use a handshake to greet a Westerner, any other contact may be considered inappropriate. This is especially important to remember when dealing with older people or those in positions of authority.
• Men in Egypt tend to be more touch-oriented; a handshake may be accompanied by a gentle touching of the patient’s elbow with the fingers of the left hand.
• A strong, warm handshake is the traditional greeting between men in Latin America. However, because most Latin Americans show affection easily, male friends, like female friends, may embrace. Women may lightly brush their cheeks together.
• Throughout most of the Middle East, it is customary to reserve the left hand for bodily hygiene. For this reason, one should never offer the left hand to shake hands or accept a gift. This is also true of some African cultures.
• A Western woman should not initiate a handshake with a man in India. Many Indian women will shake hands with a foreign woman, but not a foreign man.
• To many Indians, it is considered rather offensive to (even accidentally) step on someone’s foot. Apologies should be made immediately.

Eye Contact

• Making direct eye contact is a sign of disrespect in some cultures. In other cultures, refusing to make direct eye contact is a sign of disrespect. Many Asians may be reluctant to make eye contact with an authority figure. For example, when greeting a Chinese, it is best to avoid prolonged eye contact as a sign of respect and deference.
• Many Middle Easterners have what North Americans and Europeans consider “languid eyes.” It may appear that the person’s eyes are half closed, but this does not express disinterest or disrespect.
• In Ghana, young children are taught not to look adults in the eye because to do so would be considered an act of defiance.
• In Latin America, good eye contact is important in both social and business situations.

Physical Postures

• In many cultures throughout the world, it is impolite to show the bottom of the shoe, which is often dirty. Therefore, one should not sit with the foot resting on the opposite knee.
• In Argentina, standing with the hands on the hips suggests anger, or a challenge.
• In many cultures, slouching or poor posture is disrespectful. For example, good posture is important in Taiwan, with Taiwanese men usually sitting with both feet firmly fixed to the floor.

How does cultural competency impact the patient experience?

1. Improved Communication: When healthcare professionals understand their patients' culture, language preferences, and specific needs, they can communicate more effectively. This can lead to a better understanding of symptoms, clearer explanations of treatments, and more informed decisions by patients.
2. Building Trust: Cultural competency allows clinicians to interact with patients in ways that demonstrate respect and understanding. This can significantly enhance the patient's trust and lead to more open conversations and a stronger provider-patient relationship.
3. Personalized Care: Every culture has beliefs and practices related to health, illness, and healing. By understanding these differences, healthcare providers can tailor their care to better suit each patient. This might include acknowledging traditional remedies, understanding cultural views on certain procedures, or being aware of dietary restrictions.
4. Emotional Comfort: For many patients, entering a healthcare facility can be intimidating. Patients can feel more at ease by seeing their culture represented and respected, whether through multilingual signage or culturally diverse staff.
5. Reduced Misunderstandings and Medical Errors: Cultural misunderstandings can lead to misdiagnoses, inappropriate treatments, or non-adherence to medical advice. By promoting cultural diversity and understanding, healthcare institutions can reduce these risks, ensuring patients receive the care they need.

Advanced Health Directives

Advance healthcare directives are legal documents where individuals plan for future decision-making as it relates to their medical care, in case health issues make it difficult for them to make those decisions at the time they need to.

Studies show nearly one-third of all Medicare spending is done in the last months of a person’s life, and much of this expense is for patients without any advance healthcare directive in place. Increasing awareness about advanced healthcare directives can help with economic, moral, and ethical issues related to end-of-life care.

The National Institute on Aging states that advanced care planning involves:

• Learning about the types of care-related decisions that may need to be made
• Considering those decisions ahead of time
• Letting others know your preferences, often by putting them into an advanced healthcare directive

Advance healthcare directives (AHDs) commonly cover:

• Types of medical conditions the person would or would not want treated (such as a terminal illness)
• Types of medical interventions the person would or would not want (such as a feeding tube or ventilator)
• Under what conditions the person would or would not want life prolonged (such as a persistent vegetative state) Organ donation decisions
• Whom the person designates as decision-making healthcare agent or proxy should he or she be unable to make decisions independently
• What the individual values most (such as time spent with family, mental competence, pain relief)

Types of Advance healthcare directives include:

• Living will or a Natural Death Act Declaration - usually states the person’s desire to not receive life-sustaining treatment in the event of terminal illness or permanent unconsciousness.
• Medical or treatment directive - a written directive that describes the patient’s wishes in certain situations
• Durable power of attorney for health care - identifies one individual as a decision maker for the person
• Combination AHD - document that includes both a living will and a durable power of attorney or other healthcare-related directives
• Do-not-resuscitate (DNR) directives - prohibit the use of CPR in the event of cardiac or pulmonary arrest
• A values history - presents a patient’s values about healthcare and quality of life, and is intended to help providers and family members in end-of-life planning
• Organ and tissue donation wishes - can be specified as part of an AHD. *Common organ and tissue donations include the heart, lungs, pancreas, kidneys, corneas, liver, skin

Workplace Safety for Healthcare Staff

1. Safe Patient Handling & Mobility

When clinicians are lifting patients or heavy objects, it is essential to think of safety first. Lifting, turning or transferring patients can lead to musculoskeletal injuries if done incorrectly. There is no such thing as “safe” lifting, as micro-injuries can occur over time and result in a disabling injury.

According to the Occupational Safety and Health Administration (OSHA), hospitals are one of the most hazardous places to work in terms of employee days lost to injuries. “Nearly half (48%) of injuries resulting in days away from work are caused by overexertion, including lifting, bending or reaching. These motions often relate to patient handling.”

Practice safe patient handling by having others help when lifting, turning or transferring patients, and use the lifting equipment provided in the hospital.

2. Physical Hazards

According to the CDC, physical hazards are workplace agents, factors or circumstances that can cause tissue damage by transfer of energy from the agent to the person. Examples include excessive noise, elevated heat, and sources of radiation. Below are examples of physical hazards:

• Noise sources in healthcare settings include machines, alarms, ventilators, generators, ventilation systems, dental drills, etc.
• Prolonged exposure to loud noise can cause permanent hearing loss, and create physical and physiological stress. This can interfere with communication and concentration, leading to errors and contributing to workplace accidents.
• During the day shift, noise levels in patient areas should not exceed 40 decibels and during the night shift should not exceed 35 decibels, per guidance by the World Health Organization (WHO)
• A narrow beam that cuts through tissue. Exposure to laser beams can result in severe eye injuries and skin burns. Lasers, as ignition sources, can result in endotracheal tube fire, surgical drape fire, explosion of gases, and electrical damage.

3. Chemical Hazards

According to the CDC, chemical hazards include medications, solutions, gases, vapors, aerosols, and particulate matter that are potentially toxic or irritating to the body. These chemicals are used to treat patients, and make tissue specimens, and even to clean and disinfect work surfaces and instruments. The 7 types of hazardous chemicals include: Aerosolized medications, anesthetic gases, antineoplastic drugs, chemical sterilant, high level disinfectants, nitrous oxide, and surgical smoke. Latex products are also a chemical hazard.

According to the Centers for Disease Control and Prevention National Institute for Occupational Safety & Health (NIOSH), About 8 million healthcare workers who prepare or administer hazardous drugs may be exposed to toxic agents in the Workplace. Some tips include:

• Stay up to date with the latest information and facility provided training
• Wear appropriate clothing and equipment during activities with hazardous chemicals
• Do not take clothing/personal items home if they contain chemical contaminants

4. Biological Hazards

Biological hazards are pathogens that can be transmitted to individuals through various direct and indirect modes including blood and body fluid, direct contact, small particle aerosol, and fecal oral transmission. Some risk factors include improper management of sharps, improper disinfection of equipment and supplies and unsafe work practices (such as reuse of syringes, improper hand hygiene, and improper specimen transport).

According to OSHA, “Early Identification and isolation of sources of infectious agents, proper hand hygiene, worker training, effective engineering and administrative controls, safer work practices, and appropriate PPE, among other controls, help reduce the risk of transmission of infectious agents to workers”

Tips to stay safe from biological hazards

• Use PPE correctly
• Avoid physical contact with bio-hazardous waste and always wear gloves to move these items.
• Cover all cuts, abrasions and other areas of nonintact skin while on duty.
• Be aware of where the sharps containers are near you.
• Stay educated on the facility’s protocols.

There are over 20 reported pathogens that can be transmitted from needlesticks, including Hepatitis B and HIV. Always follow the necessary protocols for wearing gloves, gowns, mask and eye protection when handling sharps. When finished giving injections, always dispose of needles immediately in the sharps or biohazards container the hospital provides.

Find more details on avoiding needlesticks and sharps injuries from the Center for Disease Control and Prevention’s (CDC’s) National Institute of Occupational Health & Safety.

Other helpful tips

• Wear comfortable, appropriate footwear for walking and standing for extended periods of time
• Keep hallways, floors, and countertops free of clutter and equipment
• When in doubt, ask another clinician to help!

Safety Data Sheets (SDS)

The SDS, formerly called MSDS, is a basic hazard communication tool that provides details on chemical and physical dangers, safety procedures, and emergency response techniques. Check with your supervisor for the location of your facility’s SDS.

Below is the information provided in each of the 16 SDS sections.

Section	Topic	Description
1	Identification	Common name, product, manufacturer/importer/responsible party name, address, and telephone number Recommended use of the chemical (for example, flame retardant) and restrictions on use (for example, recommendations given by supplier)
2	Hazard(s) Identification	Hazardous classification (such as “flammable liquid”) Signal Word Hazard Statement(s) Pictograms Precautionary Statement(s) Description of any hazards not otherwise classified For a mixture that contains an ingredient with unknown toxicity, percentage of how much of the mixture consists of ingredient(s) with unknown toxicity
3	Composition/information on ingredients	For substances: Chemical name Common name and synonyms Chemical abstracts Impurities/stabilizing additives For mixtures: Same information as required for substances Chemical name and concentration of all ingredients classified as a health hazard
4	First-aid measures	Necessary first aid instructions by relevant routes of exposure (such as what to do in the event of inhalation, skin and eye contact, ingestion) Description of the most important symptoms or effects, and any symptoms that are acute or delayed Recommendations for immediate medical care and special treatment, when necessary
5	Firefighting measures	Recommendations of suitable extinguishing equipment, and information about extinguishing equipment that is not appropriate for a particular situation Advice on specific hazards that develop from the chemical during the hazardous combustion products created when the chemical burns Recommendations on special protective equipment or precautions for firefighters
6	Accidental release measures	Use of personal precautions (such as removal of ignition sources or providing sufficient ventilation) and protective equipment to prevent contamination of skin, eyes and clothing Emergency procedures, including instructions for evacuations, consulting experts when needed, and appropriate protective clothing Methods and material used for containment (such as covering drains and capping procedures) Cleanup procedures (such as appropriate techniques for neutralization, decontamination, cleaning/vacuuming, adsorbent materials; and/or equipment required for containment/cleanup)
7	Handling and storage	Precautions for safe handling, including recommendations for handling incompatible chemicals, minimizing the release of the chemical into the environment, and providing advice on general hygiene practices (such as stating that eating or drinking in work area is prohibited) Recommendations on the conditions of safe storage and incompatibility, as well as specific storage requirements (such as ventilation requirements)
8	Exposure controls/personal protection	Exposure limits as used or recommended by agency (OSHA etc.), chemical manufacturer, importer, or employer, where available Appropriate engineering controls Personal protective measures to prevent illness or injury from exposure to chemicals, such as protective equipment (PPE)
9	Physical and chemical properties	Minimum required information (as applicable/available) consists of: Appearance (physical state, color, etc.), Odor, Odor threshold, pH, Melting point/freezing point, Initial boiling point/range, Flash Point, Evaporation rate, Flammability (solid, gas), Upper/lower flammability/explosive limits, Vapor pressure/density, Relative density, Solubility(ies), Partition coefficient (n-octanol/water), Auto-ignition temperature, Decomposition temperature, and Viscosity
10	Stability and reactivity	Reactivity: Description of the specific test data such as class or family of the chemicals Chemical Stability: Indication of whether the chemical is stable or unstable
11	Toxicological information	Information on the likely routes of exposure (such as inhalation, skin, eye contact) Description of delayed, immediate, or chronic effects from short-term and long-term exposure Numerical measures of toxicity Description of symptoms Indication of whether the chemical is listed in the National Toxicology Program (NTP) Report on Carcinogens or has been found to be a potential carcinogen by International Agency for Research on Cancer IARC Monograph or by OSHA
12	Ecological information (non-mandatory)	Provides information to evaluate the environmental impact of the chemical
13	Disposal considerations (non-mandatory)	Provides guidance on proper disposal practices, recycling, or reclamation of the chemical(s) or its container, and safe handling practices
14	Transport information (non-mandatory)	Provides guidance on classification information for shipping and transporting hazardous chemicals by road, air, rail or sea
15	Regulatory information (non-mandatory)	Identifies the safety, health, and environmental regulations specific to the product that is not indicated anywhere else on the SDS
16	Other information	Indicates when the SDS was prepared or when the last known revision was made

Infection Control: Standard Precautions and Hand Hygiene

Standard precautions are used for all patient care. They are based on risk assessment and make use of common-sense practices, and personal protective equipment to protect healthcare providers from infection and prevent the spread from patient to patient.

Components of Standard Precautions

• Hand Hygiene
  • The 5 moments for hand hygiene, or times where hygiene should be attended to, was developed by the WHO (World Health Organization). The 5 moments are – Before touching a client, before performing a procedure, after a procedure exposed to bodily fluids/substances, after touching a client, after touching the environment around a client.
• Use of PPE whenever there is expectation of possible exposure
  • Use of PPE whenever there is expectation of possible exposure o Including items such as - gloves, gowns and aprons, masks, eye protection, face shields.
• Respiratory hygiene and cough etiquette
• Proper cleaning and disinfection and careful handling of textiles and laundry
• Safe injection practices and handling of sharps

Standard precautions apply to all patients regardless of their diagnosis or presumed infection status. Standard precautions must be used when handling blood (including dried blood), all bodily fluids (besides sweat), non-intact skin, and mucous membranes.

The Spread of Germs

Germs can be spread through 4 different modes.

1. Airborne transmission: Occurs by dissemination of either airborne droplet nuclei or dust particles containing the infectious agent. Microorganisms transmitted by airborne transmission include Mycobacterium tuberculosis and the rubeola and varicella viruses.
2. Droplet transmission: Contact of the mucous membrane of the nose, mouth or eye with infectious articles can be produced by coughing, sneezing, talking or procedures such as bronchoscopy or suctioning. Droplet transmission requires close contact between the source and the susceptible person because particles remain airborne briefly and can travel. Microorganisms transmitted by droplet transmission include the common cold and flu.
3. Blood borne transmission: Germs can live in the bloodstream and in other body fluids that contain blood components. A person's skin prevents germs from entering into the body, but if the skin is broken because of a cut, it is possible for infected blood of another individual to enter. Mucous membranes may also allow germs to spread through contact with blood and/or secretions containing blood.
4. Direct Contact Method: Infectious agents can spread directly or indirectly from one infected person to another, often on contaminated hands. The best protection is proper hand washing (Please see Centers for Disease Control and Prevention Hand Hygiene Guideline for more information on proper hand washing).

General steps to follow to prevent the spread of germs are:

• Following the Infection Control policies of your facility
• Identifying the people, patients, and staff, who are most at risk
• Washing your hands
• Staying healthy by getting plenty of rest, eating properly, and exercising
• Getting vaccinated against flu, Hepatitis B, MMR and Varicella.
• Following the standard recommended precautions with everyone
• NOT coming to work if you are sick.

Hand Hygiene for Healthcare Workers

Why is it important?

Hand hygiene protects both healthcare workers and patients. Hand hygiene means cleaning your hands with:

• Handwashing with water and soap (e.g., plain soap or with an antiseptic)
• Antiseptic hand rub (alcohol-based foam or gel hand sanitizer)
• Surgical hand antiseptics

Cleaning your hands reduces:

• The potential spread of deadly germs to patients
• The spread of germs, including those resistant to antibiotics
• The risk of healthcare personnel colonization or infection caused by germs received from the patient

CDC Hand Hygiene Guidelines

1. Know when to clean your hands. (Immediately before touching a patient, before performing an aseptic task such as placing an indwelling device or handling invasive medical devices, before moving from work on a soiled body site to a clean body site on the same patient, after touching a patient or patient's surroundings, After contact with blood, body fluids, or contaminated surfaces and immediately after glove removal.)
2. When to use an alcohol-based hand sanitizer (ABHS). Unless hands are visibly soiled, ABHS is preferred over soap and water in most clinical situations because it is more effective at killing germs on hands than soap, is easier to use when providing care, results in improved skin condition with less irritation and improves hand hygiene adherence.
3. When to wash with soap and water. (When hands are visibly soiled, before eating, after using the restroom, and during the care of patience with suspected or confirmed c. difficile and norovirus.)
4. Know how to use ABHS. (Put product on hands and rub together. The effectiveness depends on the volume used – always use the right amount to clean your hands. Cover all surfaces and rub until hands feel dry, usually for about 20 seconds. Pay attention to areas like thumbs, fingertips, and between fingers.
5. Know how to wash hands with soap and water. Wet hands with water, then apply the manufacturer recommended amount of product to your hands. Rub hands together for at least 15 seconds, covering all services of hands and fingers. Rinse with hands and use disposable towels to dry. Use a towel to turn off the faucet.
6. Know the safety risks of refilling ABHS and Soap. ABHS should be stored and dispensed in an effective and safe manner. The safety of refilling is not well studied. Safety risks can include accidental contamination, reduced effectiveness due to alcohol evaporation and irritant effects due to mixing of formulations. Soap dispensers – Soap should not be added to partially empty dispensers. This is associated with outbreaks of pathogenic bacteria.
7. Know when to wear and change gloves. Gloves are not a substitute for hand hygiene. Perform hand hygiene before donning gloves and touching patient or surroundings. Always clean your hands after removing gloves. Remove gloves carefully to prevent contamination. Gloves are needed when you anticipate you will come into contact with blood or other infectious materials, non-intact skin, potentially contaminated skin, or contaminated equipment. Change gloves and clean hands if gloves become damaged, soiled, if moving from soiled body site to clean body site on same patient, if moving to another patient, if they look dirty or have bodily fluids on them and before exiting a patient room.
8. Follow specific recommendations when treating a patient with confirmed or suspected C. difficile.
9. Follow hand hygiene recommendations for surgery. Before wearing sterile gloves, perform surgical hand antisepsis using these steps: Remove rings, watches, bracelets. Remove debris from under fingernail using cleaner and running water. If using antimicrobial soap – scrub hands and forearms for 2-6 minutes as listed by manufacturer. If using ABHS – Prewash hands and forearms with non-microbial soap. Follow the manufacturer’s instructions.

Notice regarding Federal Earned Income Credit

Clover Health Services shall notify its employees, and shall require each subcontractor to notify its employees, that they may be eligible for the Earned Income Tax Credit under the Federal Income Tax laws. Such notice shall be provided in accordance with the requirements set forth in Internal Revenue Service's Notice 1015. https://www.irs.gov/

ADVANCE EARNED INCOME CREDIT (EIC) PAYMENT

An Employee who is eligible for the income credit (EIC) and has a qualifying child is entitled to receive EIC payments with his or her pay during the year. To get these payments, the Employee must provide to the Employer a properly completed W-5, Earned Income Credit Advance Payment Certificate, either using the paper form or using an approved electronic format. The employer is required to make advance EIC payments to employees who give the Employer a completed and signed Form W-5. Certain Employees who do not have a qualifying child may be able to claim the EIC payments.

*I ACKNOWLEDGE THAT THIS MEMO IS FOR INFORMATIONAL PURPOSES ONLY.

For most current information regarding Earned Income Credit (EIC) Payments please visit the Department of the Treasury Internal Revenue Service's website:https://www.irs.gov/

Employee Acknowledgment:

I certify that I have received, read, and understand all information regarding each of the policies/practices listed in the Clinical Staff Handbook and I agree to comply with all policies, procedures, expectations, and requirements in relation to the policies, practices and job description listed above.