2017-2018

Master of Nursing MN8905

Practicum in Professional Nursing Advancement

Placement Package

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Table of Contents

Introduction .......................................................................................................................................... 2

Practicum Requirements ...................................................................................................................... 3

Practicum Placement Guidelines ........................................................................................................ 4

Important Deadlines MN 8905 ............................................................................................................ 5

List of Required Forms & Supporting Documentation ...................................................................... 6

Practice Request Form ......................................................................................................................... 7

Placement Requirement Record (PRR) ............................................................................................... 8

WSIB Student Declaration of Understanding .................................................................................... 12

Practicum Placement Package Documents Checklist ....................................................................... 13

Contact Information ........................................................................................................................... 14

Acknowledgments

Thank you to the Daphne Cockwell School of Nursing faculty who assisted in the preparation of this

MN8905 Placement Package: Dr. Faith Donald, Dr. Karen LeGrow, and Dr. Sherry Espin.

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Introduction

The MN curriculum is designed to prepare nurses for advanced professional practice in a variety of roles and contexts as needed in our contemporary health care system. Therefore, the practice component of the program allows students to establish beginning level competencies in advanced practice as defined by the Canadian Advanced Practice Nursing Framework (CNA, 2002) and/or other relevant frameworks. The MN program bases the definition and description of advanced nursing practice on the work by the Canadian Nurses Association and therefore views advanced nursing practice in the broadest terms. Through broad consultation and extensive reviews of the practice of nurses in advanced roles (i.e. Clinical Nurse Specialists and Nurse Practitioners), can (2002) developed a national framework for advanced nursing practice and the following definition, “Advanced nursing practice is an umbrella term that describes nursing practice at the edges of the expanding boundaries of nursing’s scope of practice. It describes an advanced level of practice that maximizes the use of in-depth nursing knowledge and skill in order to assume leadership roles in health care organizations and/or to meet the health needs of clients (individuals, families, groups, populations or entire communities). In this way, advanced nursing practice extends the boundaries of nursing’s scope of practice and contributes to nursing knowledge as well as the development and advancement of the profession” (p. 4). The Practicum provides students with an intensive practice experience in their selected field of study. Ryerson's proximity to a broad range of health care facilities, community organizations, and government agencies enables students to have excellent practice opportunities in both the ‘leadership/education’ and ‘health/illness’ streams. Students have the opportunity to advance and apply their knowledge and skills in a variety of specialty areas of nursing practice, e.g., clinical, research, education, policy, and/or administration. The Seminar in Professional Nursing Advancement (MN 8904), taken concurrently with the practicum, provides students with the opportunity to examine linkages between theory, research, and advanced nursing practice. Please note, Ryerson requires that all official or formal electronic communications be sent from the student's official Ryerson e-mail address.

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Practicum Placement Requirements

Students work with practicum faculty (MN 8905) and the MN/NP Placement Coordinator to negotiate and confirm

a practicum placement. Students may identify a preceptor with graduate education with whom they want to be

placed during their practicum or request assistance in arranging for a preceptor. Please note that the Course

Professor must approve the preceptor. Students will be notified regarding the process and time to meet with the

Course Professor during the Spring/early Summer prior to the academic year of their practicum. Students need to

come prepared to discuss their career goals, learning needs, and placement ideas with the Course Professor.

The practicum is NOT a work study and therefore students are required to complete their practicum outside of

their place of employment. A minimum of 192 hours (approximately 2 days per week) is required over 10 to 12

weeks of the semester for MN 8905. The Seminar in Professional Nursing Advancement (MN 8904) must be taken

concurrently with the Practicum.

Students’ Program of Study forms are finalized by the first term of enrolment; therefore, students know which term

they are enrolled in MN 8904 and MN 8905. Consequently, students have ample time to prepare for the 192 hours

plus seminar time requirements.

Students are expected to meet weekly with their preceptors throughout the placement, during the preceptors’

working hours. This is an essential feature of the practicum to facilitate discussion about learning needs,

expectations, and feedback on student progress, as well as to promote student socialization into advanced practice

roles.

Placement Requirement Record (PRR)

Before a student can start the placement, the student must submit a completed Placement Requirement Record

(PRR) with supporting documentation to the MN/NP Placement Coordinator, Stacey Maximo. The PRR includes:

Diphtheria Influenza Vaccine

Tetanus Hepatitis B

Pertussis TB Skin Test

Polio Mask Fit Test

Measles Vulnerable Sector Screen (VSS) Police Check

Mumps CPR Level HCP

Rubella Registration with CNO

Varicella

Placement Request Form

If a student needs help to find a placement, the Placement Request Form helps the MN/NP Placement Coordinator

and your Course Professor to secure a placement for you. A hard copy is included in this package and a digital copy

is on the MN website. This Placement Request Form is to be completed electronically and submitted via email to

your Course Professor by April 20 (draft version) and to Stacey Maximo by May 30 (final version).

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MN8905 Practicum Placement Guidelines

This Practicum Placement Package provides information and instructions on the 1) required supporting documents

and 2) submission process. All placements are facilitated by the MN/NP Placement Coordinator, Stacey Maximo, in

consultation with your Course Professor. Placement assignment takes into consideration an appropriate match

between the student’s needs and the practicum site. Placement decisions are based on the following: curriculum

requirements, placement availability, student's past experience, interviews, and faculty consultations.

There are 8 Steps to completing and submitting your Practicum Placement Package and securing your placement:

STEP I Download the 2017-18 Practicum Placement Package from the MN website. Hard copies are available from

the MN/NP Placement Coordinator, Stacey Maximo, in the PHCNP Administrative Office, POD 448.

STEP II Before April 20, respond to Course Professor email to schedule a meeting with the Course Professor. Send

your draft version of the Placement Request Form and your updated resume via email to the Course Professor at

least two business days prior to the scheduled meeting.

STEP III By May 30, submit the finalized Placement Request Form via email to your Course Professor and copy

Stacey Maximo.

STEP IV By June 29, 2017, e-mail Stacey Maximo at smaximo@ryerson.ca to schedule a 15 minute in-person

appointment time to submit your completed package and supporting documentation. Schedule this appointment

as soon as you have all supporting documentation and have completed your Practicum Placement Package. Several

supporting documents are verified and immediately returned to you as they cannot be stored at Ryerson due to

privacy legislation. Therefore, faxed, scanned, or e-mailed versions will not be accepted – no exceptions. The

scheduled appointment time is used to review your package submission and to confirm that all required

documentation is included.

STEP V All students will be notified via email by Stacey Maximo regarding their placement details.

STEP VI Arrange for an interview with the potential preceptor, as soon as possible.

STEP VII Inform the Course Professor and the MN/NP Placement Coordinator regarding the outcome of the

interview. The Course Professor is responsible to approve the placement and will notify the student and the MN/NP

Placement Coordinator via email regarding the approval decision.

STEP VIII Email the preceptor to confirm the placement approximately 6 weeks prior to the practicum start date.

**Deadline to submit, in-person, your completed practicum package is June 29, 2017 at 3:00

pm. Missing the submission deadline date may result in a delayed placement assignment

decision or loss of a confirmed placement. A delay will also jeopardize your enrollment in

both MN 8904 and MN 8905.**

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Important Deadlines MN 8905

Prior to April 20

Update your resume, including presentations in courses/workplace/conferences, your thesis topic and

supervisor (if applicable), and other relevant information. Resume resources are available on-line through

Ryerson Student Services and other websites. Please note, you are an MN Student (not an MN Candidate,

as that is not a valid term).

Respond to the email from the Course Professor to arrange a meeting to discuss your career goal, learning

needs, and MN 8905 practicum placement.

Send your draft version of the completed Placement Request Form via email to the Course Professor at

least two business days prior to the scheduled meeting.

Four Months Prior to your MN8905 Start Date

Apply for the Vulnerable Sector Screen (VSS) Police Check. Students who reside in Toronto must first

contact the MN/MP Placement Coordinator, Stacey Maximo, via email in order to pick up and complete the

Vulnerable Sector Screen Police Check consent form. Students who reside outside the City of Toronto must

visit their Police station. Your Police Check may take up to 8 weeks to process.

Initiate completion of additional requirements for the Placement Requirement Record (see pages 8-11).

Prior to May 30

Submit your Placement Request Form by May 30 (see page 7 for further details). Please email your

completed digital copy to your Course Professor and the MN/NP Placement Coordinator, Stacey Maximo

(please save file as firstname-lastname-PRF). A hard copy is included in this package, a digital version is on

the MN website.

Your resume is required by this date. Please email a current copy to your Course Professor and the MN/NP

Placement Coordinator, Stacey Maximo. (Please save file as firstname-lastname-resume)

Prior to June 29, 2017 at 3:00 pm

Arrange an appointment to submit your completed Placement Requirement Record and supporting

documentation, and your Placement Information Record by Thursday June 29, 2017 at 3:00 pm. The

completed forms and supporting documents are to be handed in in person by appointment only. See pages

8-13 for further details about the required contents for the completed forms and supporting documents.

** Please Note: If these dates are not adhered to, you may either lose a confirmed placement

or have a delay in securing your placement. You will also jeopardize your enrollment in both

MN 8904 and MN 8905.**

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List of Required Forms & Supporting Documentation

The following is a list of the required practicum placement forms and supporting documentation that must be

included with your Placement Package submission. Note that only original documents will be accepted.

Placement Requirement Record

Vulnerable Sector Screen (VSS) Police Check

CPR Certificate Healthcare Professional (HCP) level

Mask Fit Card

Vaccination records and recent laboratory results for immunization status (see pages 8-9)

WSIB Form

Signed and Dated Documents Checklist

Your finalized Placement Request Form is due to your Course Professor and Stacey Maximo via email by May 30

IMPORTANT:

Email for an appointment and submit your complete package in person to Stacey Maximo by Thursday June

29, 2017 at 3:00 pm.

Please make a copy of this package and all supporting documents for your records.

Placement consideration is given in order of submission of the Placement Request Form

Incomplete packages will not be considered for processing

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Placement Request Form

1. Prior to meeting with your Course Professor, complete a draft version of this form.

2. Save file as (firstname-lastname-PRF) and email the file and your updated resume (firstname-lastname-resume) to your Course Professor

at least two business days prior to your scheduled meeting to occur by April 20.

3. Send an electronic version of this finalized form and your resume via email to your Course Professor and Stacey Maximo by May 30.

4. Stacey Maximo will contact you via email, copied to your course professor, with details regarding your potential preceptor and

placement.

Name

Student #

Ryerson Email

Semester & Year

Have you contacted a potential masters or doctoral prepared preceptor or have someone that you are thinking of

contacting? If yes, please indicate the name and academic credential (e.g., MN), position, email address, hospital/agency,

unit (if applicable) where the potential preceptor works. If no, indicate N/A.

Name & Academic Credential

Agency

Unit

Position

Phone

Email Address

If you are currently employed in nursing, please indicate the hospital/agency and unit where you work.

Hospital/Agency: Unit:

Do you have unrestricted access to a vehicle? Some placements require that students drive. Students are responsible for

the cost of parking and gasoline.

Yes ___ No ___

Placements may be available to students who are fluent in a language other than English. Please list any other languages in

which you are fluent or indicate N/A.

If you require assistance in securing a placement, what are your areas of interest, based on your career goal? What specific

agencies/preceptors do you have in mind for MN8905?

Areas of interest for your placement (e.g., Undergraduate clinical education, Undergraduate classroom education, Nurse educator in a hospital, Policy development and analysis, Informatics, Quality improvement, Infection control, etc.)

List at least 3 agencies for each area of interest (and

potential preceptor names, if known).

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Placement Requirement Record

Last Name: First Name:

Student Number: Ryerson email:

NOTE TO STUDENT AND HEALTH CARE PROVIDER (HCP)

Ontario legislation specifies certain surveillance requirements for those entering into healthcare practice settings. The

Nursing Program policy was developed in accordance with the communicable disease surveillance protocols, specified under the Public Hospitals Act, to meet the requirements of our students’ placement settings. This process is necessary to ensure

that our students protect their health and safety, and the health and safety of patients, visitors, employees and other students. Other than the influenza vaccine, the completion of this information is not optional, and all sections must be

completed as outlined. Our placement partners have the right to refuse students who have not met their immunization standards.

DIPHTHERIA, TETANUS, PERTUSSIS, POLIO

Date of last Diphtheria Booster : _____/_____/_______ HCP Signature: ______________________________ mm - dd - yyyy Date of last Tetanus Booster : _____/_____/_______ HCP Signature: _____________________________ mm - dd - yyyy Date of last Pertussis Booster : _____/_____/_______ HCP Signature: ______________________________ mm - dd - yyyy Date of last Polio Booster : _____/_____/_______ HCP Signature: ______________________________ mm - dd - yyyy

COMMUNICABLE DISEASES Note: laboratory evidence may be required to prove immunity for sections below; you must attach a copy of blood work.

Measles, Mumps, Rubella (MMR) Laboratory evidence of immunity or Documentation of 2 doses of MMR vaccine after 1st birthday 1st Dose Date : ___/___/______ 2nd Dose Date: ___/___/_____ HCP Signature: ______________________________ mm - dd - yyyy mm - dd - yyyy Varicella (Chicken Pox) Laboratory evidence of immunity or Documentation of 2 doses of Varicella vaccine given at least 4 weeks apart 1st Dose Date : ___/___/______ 2nd Dose Date: ___/___/_____ HCP Signature: ______________________________ mm - dd - yyyy mm - dd - yyyy

INFLUENZA VACCINE (Recommended) Influenza virus vaccine is available free of charge from health services in the fall or can be obtained from your healthcare provider. Students are encouraged to submit evidence of the vaccination. Note: if you know or suspect that you have an

allergy to eggs or other vaccination preservatives, please discuss your options with your HCP.

I understand that the influenza vaccine is not mandatory; however, if an outbreak occurs at my assigned agency and I did not receive the flu vaccine, I may be denied access to the facility, thus jeopardizing successful completion of my practice.

Student Signature _____________________________ Date ____________________________________

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HEPATITIS B Note: laboratory evidence is required to prove immunity for Hepatitis B; you must attach a copy of blood work.

Laboratory evidence of immunity and Documentation of Hepatitis B vaccination series Please circle vaccination dose schedule: 2 Dose 3 Dose 1st Dose Date : ___/___/______ HCP Signature: ______________________________ mm - dd - yyyy

2nd Dose Date: ___/___/_____ HCP Signature: ______________________________

mm - dd - yyyy

3rd Dose Date: ___/___/_____ HCP Signature: ______________________________

mm - dd - yyyy

Students on 3 dose vaccination schedule must receive at least 2 doses of the vaccine in order to attend practice. Students should submit proof of final dose of series as soon as it is received. Hepatitis B chronic carriers are not required to disclose status to placement sites.

YEARLY TUBERCULOSIS SCREENING Note: If your step 1 test is positive or have tested positive anytime in the past, proceed to section B. Positive skin tests do

not require TB skin testing.

Section A: Mantoux Test If there is documentation of a previous 2-Step TB test within the last 12 months, proceed with 1-Step test only. Otherwise, if the 1st test is negative, a 2nd test is given in the opposite arm at least 1 week and no more than 4 weeks after the 1st test. You must be tested for TB annually, and you must be covered while you are in the placement. Step 1 Test Date: ____/____/______ Date Read: ____/____/______ Induration: ___ mm HCP Name: _____________________ mm - dd - yyyy mm - dd - yyyy Signature : _____________________ Step 2 Test Date: ____/____/______ Date Read: ____/____/______ Induration: ___ mm HCP Name: _____________________ mm - dd - yyyy mm - dd - yyyy Signature : _____________________

Section B: CXR - only for positive skin tests: complete below sections AND attach a copy of chest x-ray report: Chest x-ray Date ____/____/______ Result: __________________ Signs & symptoms of active TB: Yes No mm - dd - yyyy Assessment Date: ____/____/______ HCP Name: _____________________ HCP Signature: ____________________ mm - dd - yyyy

Note: Yearly chest x-rays are not required unless clinical status changes or advised by HCP. You can therefore attach a report from a previous chest x-ray taken within last 2 years. The HCP must still indicate and sign that there are no signs and symptoms of active TB (above). TB testing should be completed prior to the administration of any live vaccines or 4 weeks post receiving live vaccine.

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SIGNATURE OF HEALTHCARE PROVIDER(S) Instructions: If you have documented on these forms please complete the section below or stamp and provide your signature. Please print clearly.

Name of Healthcare Provider (please print)

Address (street)

Address (city & postal code)

Telephone Number

Signature of HCP

Date Title (i.e. MD, RN)

Name of Healthcare Provider (please print)

Address (street)

Address (city & postal code)

Telephone Number

Signature of HCP

Date Title (i.e. MD, RN)

Name of Healthcare Provider (please print)

Address (street)

Address (city & postal code)

Telephone Number

Signature of HCP

Date Title (i.e. MD, RN)

MASK FIT

All students must be tested and fitted for an appropriate mask (respirator) in the event of flu (or other airborne/droplet) outbreak. Cards must clearly state the mask type (model) and size. Please ensure you carry your mask fit card at all times during practice. Mask fit cards are valid for 2 years after the issue date. Your Mask Fit card must be valid for the entire time that you are in your placement.

Please present your original Mask Fit card to Stacey Maximo with this form.

VULNERABLE SECTOR SCREENING (VSS) POLICE CHECK

All students are required to obtain a yearly VSS police check which must be valid for the entire time that you are in your placement. STUDENTS CANNOT ATTEND PLACEMENT UNTIL SUBMSSION OF YOUR ORIGINAL VSS POLICE CHECK REPORT -- APPLY WELL IN ADVANCE.

If you reside in Toronto, you must come to the NP office to complete a consent form. The completed consent form is then mailed to Police Headquarters to apply for your VSS police check. Note: Toronto Police Services can take up to 8 weeks or longer to process your VSS police check. If you live in other municipalities (e.g. York Region, Peel Region), please go directly to your police headquarters.

Please present your original VSS police check to Stacey Maximo with this form.

If you did not receive your police check by the submission deadline, please submit as soon as you receive it.

If your police check is positive, please contact Suzanne Fredericks ASAP at 416-979-5000 ext. 7978 or at sfrederi@ryerson.ca

CPR CERTIFICATION (HCP Level)

Cardio Pulmonary Resuscitation (CPR) Healthcare Professional (HCP) level – for placement purposes, your certification must be HCP-level and expires one year from the issue date. CPR re-certification is therefore required on a yearly basis and must

be valid for the entire time that you are in your placement.

Please present your original CPR certificate to Stacey Maximo with this form.

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STUDENT DECLARATION Please print out a copy of the “Student Declaration of Understanding Workplace Safety and Insurance Board Coverage

Unpaid Student Trainees in Clinical Placements” form. Make sure you have read and signed a copy. This is to ensure that

you have understood that you are covered under the WSIB while you attend your placement.

Please present a signed copy to Stacey Maximo with this form. CNO ANNUAL REGISTRATION

Your CNO registration will be verified at www.cno.org

Registration Number: _________________ Name as it appears on your Registration: ___________________

To be completed by Stacey Maximo:

RN

Entitled to practice:

without restrictions

with restrictions

not entitled to practice

NOTICE TO STUDENTS COMPLETION OF THE PRACTICE REQUIREMENTS RECORD IS REQUIRED IN ORDER TO ATTEND PRACTICE.

When you have completed ALL practice requirements, submit this Practice Requirements Records Package together with all original documentation in person to Stacey Maximo by 3pm on Thursday June 29th, 2017 via a scheduled appointment.

Do not fax, scan, or electronically send your records.

Please ensure you keep of all your documents; Ryerson University does not keep copies of students immunization records, bloodwork, CPR, Mask Fit, or Police check and are not responsible if you misplace your documentation.

Please keep a copy of this Practice Requirements Record; you may need to present it to your preceptor or to the agency that you are attending.

Please be aware that your VSS, CPR, and Mask Fit expires, and TB requires annual testing. You may be required to renew these in the middle of your placement (depending on when you got them done). It is the student’s responsibility to ensure they know when they expire and when they need renewal. You must be covered throughout your placement period.

Failure to comply with these instructions will jeopardize your placement.

Name (Print): __________________________________

Signature: _______________________________

Date: ___________________________________

The information on this form is collected under the authority of the Ryerson University Act and is required to process your application for your practice placement course. The information will be used in connection with placement negotiations and communication with placement agencies. If you have any questions about the collection, use, and disclosure of this information by the Daphne Cockwell School of Nursing, please contact Stacey Maximo via telephone at 416-979-5000 ext. 4176, or via email at smaximo@ryerson.ca, or in person in POD 448.

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WSIB Student Declaration of Understanding

Workplace Safety and Insurance Board (WSIB) Coverage for Unpaid Student Trainees in

Clinical Placements

Student Declaration of Understanding

Students of health sciences programs as identified by their university or college are eligible for Workplace Safety

Insurance Board (WSIB) coverage of claims while on unpaid placements required by their program of study.

Ministry of Training, Colleges and Universities ensures that students on work placements receive WSIB insurance

coverage for injuries or disease incurred while fulfilling the requirements of their placement.

Declaration

I have read and understand that WSIB coverage will be provided through the Ministry of Training, Colleges and

Universities while I am on training placements as arranged by the university or college as a requirement of my

program of study.

I understand the implications and have had any questions answered to my satisfaction.

I agree to immediately report any placement related injury or disease to the placement employer.

Release of Information

I understand that my personal information will be released to the placement employer in the event of a

workplace injury or disease at the placement employer’s workplace during an unpaid placement.

I understand that the Ministry of Advanced Education and Skills Development, the college or university and

placement employer will be required to release relevant personal information with each other and to the WSIB.

Student name (print): ___________________________________

Student signature: ___________________________________

Program/School: ___________________________________

Date: ___________________________________

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MN8905 Practicum Placement Package Documents Checklist

Please submit a completed package in person via a scheduled appointment by Thursday June 29, 2017 at

3:00 pm to Stacey Maximo. Please make sure to include the following:

Placement Requirement Record (pages 8-11)

Signed WSIB Declaration Form (page 12)

Placement Package Documents Checklist (this page)

Please also bring the following Supporting Documentation to your scheduled in-person appointment:

Vulnerable Sector Screen (VSS) Police Check

CPR Certificate - Healthcare Professional (HCP) level

Mask Fit Card

Vaccination records and recent laboratory results for immunization status (see pages 8-9)

Please email Stacey Maximo an updated resume (Please save file as firstname-lastname-resume)

IMPORTANT:

Students that submit a complete package by the deadline date will be given full placement assignment

consideration

Incomplete packages will not be considered for processing, and will jeopardize your placement and your

ability to take the MN8904 and MN8905 courses.

Please make a copy of your completed package and all supporting documents for your records as your

placement may ask to see them.

Please note that your CPR, Mask Fit, and VSS Police Check have expiry dates. VSS Police Checks are only

good for one year from when dated. They must be valid throughout you entire placement. It is your

responsibility to renew/obtain new ones during your placement, if needed.

By signing this form, I am declaring that I have read and understand this MN8905 Placement Package in its entirety,

and that I am agreeing to the terms and conditions outlined in the document.

Last Name First Name

Student Signature Date

Signature of Stacey Maximo Date

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Contact Information

Mr. Stacey Maximo, RN, BScN

MN/NP Placement Coordinator (416) 979-5000 ext 1-4176# smaximo@ryerson.ca POD-448C

Mr. Gerry Warner, MSW MN Program Administrator (416) 979-5000 ext 1-7852# gerry.warner@ryerson.ca POD-448A

Dr. Suzanne Fredericks, RN, PhD Graduate Program Director, Master of Nursing sfrederi@ryerson.ca (416) 979-5000 ext 1-7978# POD-474B