Republic of the Philippines

Bicol University Polangui

NURSING DEPARTMENT
Polangui, Albay

SEMESTER RLE AFFILIATION RULES AND REGULATIONS A.Y 2023-2024

The Bachelor of Science in Nursing (BSN) Related Learning Experience (RLE) Affiliation will be
ruled by the following rules and regulations, which have been approved by the Nursing faculty members.

I. Clinical Assignments
1. As determined by the Commission on Higher Education (CHED) one (01) unit of RLE is
equivalent to fifty-one (51) hours of clinical experience unless changed. Students should
complete the required number of hours/RLE per year level.
2. Students are required to attend the general orientation in the affiliating agency; only those
who attend the general orientation will be allowed to go on duty in the said agency. (the same
applies to Skills Laboratory)
3. The approved clinical assignments shall be followed strictly.
4. The students in the clinical area should be in complete prescribed uniforms and with proper
complete paraphernalia.

II. Attendance
1. Students should report for duty at least fifteen (15) minutes before the start of the shift.
2. A student will be considered late up to 15 minutes after the start of the shift; beyond 15
minutes, he/she is considered absent but will be made to stay in the area for security reasons
or at the discretion of the assigned Clinical Instructor.
3. Students should indicate their time of arrival and departure in the logbook available in their
work stations.
4. A student absent from the clinical duty should present, on the first day he/she reports for duty,
an excuse letter signed by the Level Focal Person and/or the RLE Supervisor and noted by the
Department Chairperson. Students may be allowed to go on duty at the discretion of the
Clinical Instructor, otherwise, NO students will be allowed to report for duty the following
day WITHOUT the DULY SIGNED excuse letter with an appropriate attached documents
when necessary.
5. When the number of hours lost by absence of a student reaches fifty percent (50%) of the
required duty hours per shift, he/she shall be required to repeat the rotation.
6. Records of absences and tardiness shall be monitored by the RLE Supervisor/Level
Coordinator every shift of each day. The clinical instructors likewise make a monthly report
of student absences and tardiness to the respective Level Coordinators. When necessary, the
Faculty-In-Charge for Guidance Office shall likewise be informed.
7. Make up of excused absence shall be for the corresponding number of days of absence while
one (01) day of unexcused absence shall be made up for three (03) days; three (03) times late
shall be considered one (01) absence and to be made-up for one (1) duty day.
8. The respective Clinical Instructors shall REPORT to the Level Coordinator ALL tardiness and
absences from duty on a MONTHLY basis. The Level Focal Person will make a summary of
absences and tardiness for the month and for the semester. The schedule of the make-up duty
will be during the Semestral/Christmas, and Summer Vacation Months.
9. ALL absences for make-up duty from RLE should be completed BEFORE the enrolment for
the next semester of the school year or (for Graduating students) before they will be endorsed
for graduation to the campus/college academic council. NO student shall be allowed to enrol
the next higher level unless he/she has completed the required RLE hours of the prerequisite
subject.
10. Students participating in other school activities should properly inform the Clinical Instructors
and the Level Coordinators to avoid being marked absent in the clinical area. A letter or
document pertinent to the participation for the activity duly approved by the Dean should be
presented to the concerned CI’s.

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 11. Absence without due cause during the make-up duty shall be considered a DOUBLE
UNEXCUSED absence, for example one (01) unexcused absence during the make-up duty
shall
be made up for six (06) days. Excused absence during the make-up duty shall be made up
with the corresponding number of days of absence.
12. Any student who fails to go on duty for two (02) successive weeks or has been absent for 15%
of the total number of required RLE hours, shall be asked to submit a letter of explanation to
the Level Coordinator who shall then write a report about it to the Department Chairperson,
Faculty in charge for Guidance Officer and the Dean. The parent/guardian shall likewise be
notified of the absences.
13. Make-up duty shall be done outside the regular/required duty hours; hence, the student shall
pay the corresponding affiliation fee and honorarium for the Clinical Instructors. Computation
of the amount to be paid by the students for the RLE honorarium shall be based on the
prevailing approved rate per hour and the number of students reporting for duty in a particular
ward or clinical area. Computation of the affiliation fee shall likewise be based on the rate
approved by the Department of Health (DOH) Regional Committee on Affiliation Program.
Payment for make-up duty fees shall be made prior to scheduling of duty. A letter will be sent
to the parents indicating the total amount the student has to pay for his/her make-up duty.

Conduct While on Duty

1. All students are required to observe proper decorum while on duty. Dealing with Clinical
Instructors. patient, hospital staff and other affiliating students shall be done on a professional
manner. Familiarity with the aforementioned persons is highly discouraged.
2. Students must be punctual and prompt and are expected to actively participate in all
ward/activities.
3. Strictly NO visitor should be entertained except in very urgent cases with the permission of
the CI’s.
4. Except for a very justifiable reason (illness or death of immediate family member) NO student
is allowed to cut short his/her duty hours; the student submits written request for this to be
approved by the CI or the Dean and must specifically log out in the attendance sheet.
5. Meals or snacks shall only be taken within the hospital premises; or no account shall a student
be allowed to take his meal or snacks outside the hospital premises. Snack time is limited to
fifteen (15) minutes while mealtime shall be thirty (30) minutes only.
6. NO student is allowed to accept for safekeeping jewelry/personal belongings of client who
will undergo surgery or diagnostic or laboratory procedures. These should be endorsed to the
staff nurse and properly recorded in the patient’s chart.
7. Playing cards or other games, reading books, comics, and magazine except nursing books are
strictly prohibited while on duty. Text messaging and use of cell phones are strictly prohibited
it may only be allowed for emergency and a case-to-case basis only. Smoking is strictly
prohibited and students under the influence of alcoholic drinks shall not be allowed to go on
duty.
8. Noise should be minimized especially in the student’s area and student nurses should spend
more time with their patients rather than with their duty mates.
9. Littering, loitering and any act of vandalism is strictly prohibited.
10. The student shall at all times follow the rules and regulations governing the affiliation
imposed by the affiliating agencies and the Rule and Conduct of students as provided by
University/College or School Student Handbook. Violation of these guidelines shall have
corresponding sanctions.

III. Uniform
1. All students are required to be in prescribed uniform while on clinical or community duty.
Any student not in proper attire will not be accepted in the ward/center. This will mean the
student will be marked absent for that day equivalent to an unexcused absence.
2. Smock gowns shall be worn (all buttons closed) in reporting and coming from the clinical
areas.

For Clinical Areas:

The approved uniforms for special areas are as follows:

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 Female:
White close cap and gown (for OR, DR, and NICU) and CD Gown (isolation rooms),
Nameplate, Wrist watch with second hand

Male:
White close cap and gown (if in the OR, DR, and NICU) and CD Gown (isolation rooms),
Nameplate, Wrist watch with second hand

Note: Scrub suit are only worn inside the DR, OR, NICU, prescribed footwear

For CHN:
The required uniform for both male and female as prescribed by the institution, college, or
university:

Approved T-shirt or T-shirt; comfortable jeans; rubber shoes.

Note: Ripped or too tight jeans is strictly prohibited.

3. Every student should be equipped with the required paraphernalia as part of his/her uniform
such as bandage scissors, ballpens (red, blue, green, violet, or black), ruler, eraser, pencil,
thermometer, sphygmomanometer, and other paraphernalia required by the CI’s. That is
neatly placed in the belt bag worn during the clinical duty.
4. The no excessive make-up, no coloured nail polish, and no hair highlights policy shall be
strictly observed.
5. Female students wearing nurse’s cap are not allowed to wear ribbon nor colored hairpins or
clips.
6. For Male students, the hair should not touch the collar or the neckline of the uniform.
7. Only the wrist watch with second hand and the wedding ring for married students may be
worn during duty. Wearing of other pieces of jewelry except those earlier mentioned is
prohibited.
8. Undergarments worn should only be white or skin tone. Females are required to wear
chemise and the males should wear undershirt/sando without colored designs.
9. White rubber/plastic shoes are not allowed while on duty.

IV. Related Learning Experience

1. RLE requirements such as client care plans, case study, case analysis, drug notebook, etc.,
deemed necessary by the CI’s must be submitted by the students on time as announced by the
CI’s during the first day of duty. The students must be aware that such requirements are part
of the RLE grade.
2. Any errors in medication administration committed by the student shall be properly reported
to the Clinical Instructors who shall deal with it according to approved agency policies. The
student who committed the error shall write an incident report. This, together with the CI’s
incident report, shall be submitted by the Level Coordinator to the Dean who shall determine
the veracity of the report. The College Disciplinary Committee shall be convened when
deemed necessary. Likewise, the parents/guardians of the student shall be notified of the
incident.

V. Incident Reporting
The primary purpose of the incident report is to document and prevent possible consequent injuries.
Classifying an event as an incident doesn’t imply that someone made a mistake; it only means that something
unusual happened.
An incident report should contain the following information:
1. The name of the client
2. The name of the client’s attending physician
3. The date and time of the incident
4. The name of all persons responsible for the care, and their responsibilities (not just the
persons involved in the incident)

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 5. The nature of the incident (equipment failure, drug allergy, medication error, etc.)
6. The nature of the client’s injuries, if there’s any
7. The physician who evaluated the client after the incident
8. The physical location of the client after the incident
9. The client’s condition before the incident
10. The client’s condition after the incident
11. The equipment or drugs involved in the incident
The incident report should be handwritten or computer printout in short bond paper and submitted
within 24 hours after the incident. The report should be in five (5) copies, one (1) each for the
college/university and Office of the affiliating agency, the Level Coordinator, the Clinical Instructor, and
personal file of the student.
All incident reports should be kept in conditional files. These guidelines may vary from school to
school.

MARY GRACE V. GESTIADA

Signature over printed name of the STUDENT

MAMERTO M. GESTIADA JR.

Signature over printed name of the FATHER

MIRASOL V. GESTIADA
Signature over printed name of the MOTHER

Signature over printed name of the LEGAL GUARDIAN

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 Republic of the Philippines
Bicol University Polangui
NURSING DEPARTMENT
Polangui, Albay

PERMIT FOR 1st SEMESTER RLE AFFILIATION

A.Y 2023-2024

TO WHOM IT MAY CONCERN

This is to certify that we are permitting our son/daughter MARY GRACE V. GESTIADA
to join the 1ST SEMESTER RLE AFFILIATION of the BSN IV students of BICOL
UNIVERSITY POLANGUI, NURSING DEPARTMENT to Malinao Treatment and
Rehabilitation Center (MTRC) in Malinao, Albay, Bicol Regional Hospital and Medical Center
(BRHMC) in Daraga, Albay, Legazpi City Hospital (LCH) in Legazpi City, Dr. Lorenzo P. Ziga
Memorial District Hospital (DLPZMDH) in Tabaco City, Josefina Belmonte Duran Albay
Provincial Hospital (JBDAPH) in Ligao City, from August 15, 2023 to January 15, 2024. This is
in compliance with the requirements on the Related Learning Experience under the subject of NCM-
118 and NCM 119.

We understand that the Bicol University and its concerned faculty and staff will take utmost
care and diligence in attending to the safety welfare and needs of our son/daughter. However, in case
of untoward events beyond their control, we shall not hold them legally liable and responsible.

We further certify and understood the affiliation rules and regulation of the Bicol University
Polangui, Campus, Nursing Department (ND).

MAMERTO M. GESTIADA JR. MIRASOL V. GESTIADA

(Signature over Printed Name) (Signature over Printed Name)
Father Mother

(Signature over Printed Name)

Legal Guardian

Date Signed: July 20, 2023

ACKNOWLEDGMENT

BEFORE ME THIS_____DAY OF__________ affiant exhibiting to me their Community

Tax No.____________________ issued on ____________________ at
________________________________________ and Community Tax No.____________________

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 know to me and to me know to be the same person who executed the foregoing instrument which we
acknowledge before me as his/her free voluntary act and deed.

WITNESSED MY HAND AND SEAL this _____ day of _________________, 20____ at

_______________________________________________________________________

Republic of the Philippines

Bicol University Polangui
NURSING DEPARTMENT
Polangui, Albay

Name of Student: MARY GRACE V. GESTIADA Date: July 20, 2023____

Name of Parents/Guardian
Name of Father : Mamerto M. Gestiada Jr._______________________________
Name of Mother : Mirasol V. Gestiada ________________________________
Guardian : __________________________________________________

Provincial Address : Barangay Abad Santos, Bulan, Sorsogon

Home Address : Barangay Abad Santos, Bulan, Sorsogon

Name and Address of relative/guardian in Legazpi City and Ligao City, where the affiliate may stay
overnight during weekend:

Name: __________________ Relationship: _________ CP#: _________

Complete Address: __________________
Name of Person who fetch her at the dorm: __________________
Indicate if she can leave the dorm alone: __________________

Other relative in Legazpi City and Ligao City or in nearby where thee affiliate may visit:

Name: ______________________ _Relationship: _________ Address: ______________ CP#: _________

Name: ______________________ _Relationship: _________ Address: ______________ CP#: _________
Name: ______________________ _Relationship: _________ Address: ______________ CP#: _________
Name: ______________________ _Relationship: _________ Address: ______________ CP#: _________
Name: ______________________ _Relationship: _________ Address: ______________ CP#: _________

We certify, that the Information Stated above, is full of knowledge and they are True and Correct.

MAMERTO M. GESTIADA JR.

Signature over printed name of the FATHER

CP#: 09701555607

MIRASOL V. GESTIADA
Signature over printed name of the MOTHER

CP# 09468556506

Signature over printed name of the LEGAL GUARDIAN

CP#
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