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Mail To: P.O. Box 8366 1400 E. Washington Avenue Madison, WI 53708-8366 Madison, WI 53708-8366 FAX #: (608) 266-2602 E-Mail: dsps@wisconsin.gov Phone #: (608) 266-2112 Website: dsps.wisconsin.gov BOARD OF NURSING NURSING SCHOOL SELF-EVALUATION REPORT FOR INITIAL BOARD OF NURSING APPROVAL As indicated in Chapter N 1.05, a school of nursing may apply for approval of the school of nursing upon graduation of the first class or eligibility to sit for the NCLEX, but may not apply later than graduation of the third class. The school of nursing shall submit a self-evaluation report setting forth evidence of compliance with the standards in N 1.08 and an evaluation of the NCLEX success rate. This form #3029 must be completed as part of the self-evaluation report for initial Board of Nursing approval. Directions for completing the Self-Evaluation Report: On the line next to each requirement, please indicate the date of compliance or anticipated compliance, or NA for not applicable. For each NA indicated, please explain why the requirement does not apply to the nursing school in the space provided on page six or on attached clearly labeled pages. After receiving the Self-Evaluation Report, the Board may conduct a site survey of the school of nursing to verify compliance with Board standards. Please submit this completed and signed report to dspsexaminationsoffice@wisconsin.gov. Name of Nursing School: Address: Program (ADN, BSN, Other): An electronic version of Chapter N 1 is available at: https://docs.legis.wisconsin.gov/code/admin_code/n/1.pdf. CHAPTER N 1.08(1) ORGANIZATION AND ADMINISTRATION N 1.08 (1)(a) Governing Institution NOTE: The Board may examine administrative policies during a site survey to ensure Board standards are being met. 1. Institution assumes legal responsibility for overall conduct of the school of nursing. 2. Institution has a designated educational administrator, established administrative policies and fiscal, human, physical, clinical and technical learning resources adequate to support school processes, security and outcomes. 3. Institution has maintained institutional accreditation; attach evidence of accreditation to Self-evaluation Report. 4. Institution has developed and maintained written school of nursing administrative policies which are in accord with the institution. #3029 (9/14) Page 1 of 5 Wis. Admin. Code Ch. N 1 Committed to Equal Opportunity in Employment and Licensing

5. Institution has written contracts in place between the school of nursing and institutions which offer associated academic study, clinical facilities and agencies for related services for students. CHAPTER N 1.08(2)(a) EDUCATIONAL ADMINISTRATOR 6. Nursing school educational administrator holds a current, active registered nurse license or privilege to practice in Wisconsin that is not encumbered. 7. Nursing school educational administrator has evidence of a graduate degree with a major in nursing. 8. Nursing school educational administrator has knowledge of learning principles for adult education, including nursing curriculum development, administration and evaluation, and either educational preparation or 2 years experience as an instructor in a nursing education program within the last 5 years. 9. Educational administrator has current knowledge of nursing practice. 10. Institution must notify the board within 48 hours of the termination, resignation or retirement of an educational administrator and designate the interim educational administrator within 5 business days. The institution may request board approval of an interim educational administrator who does not meet the qualifications in N 1.08 (2)(a), but the interim educational administrator may serve no longer than 6 months. The institution may request an extension of time based upon hardship. CHAPTER N 1.08(3) FACULTY NOTE: Evidence of meeting faculty standards shall be noted on Form #1114 and kept on file in the School of Nursing office and the forms may be examined by the Board representative(s) during the survey. 11. School of nursing has evidence of the faculty meeting the standards in N 1.08 on file in the school of nursing office and available to the board upon request. 12. All faculty of the school of professional nursing hold a current, active registered nurse license or privilege to practice in Wisconsin that is not encumbered. 13. All faculty of the school of professional nursing have a graduate degree with a major in nursing. Interprofessional faculty teaching non-clinical nursing courses all have advanced preparation appropriate for the content being taught. 14. All faculty of the school of practical nursing hold a current, active registered nurse license or privilege to practice in Wisconsin that is not encumbered. 15. All faculty of the school of practical nursing have a baccalaureate degree with a major in nursing. 16. If faculty exceptions are utilized, all were requested for approval following requirements in N 1.08 (3)(d). CHAPTER N 1.08(4)(a) CURRICULUM 17. Curriculum enables the student to develop the nursing knowledge, skills and abilities necessary for the level, scope and standards of competent nursing practice expected at the level of licensure. 18. Curriculum is developed by a faculty member with a graduate degree and is revised as necessary to maintain a program that reflects advances in health care and its delivery. Page 2 of 5

19. The curriculum includes all of the following: (a) Evidence-based learning experiences and methods of instruction consistent with the written curriculum plan. Note: Method of instruction may include distance education methods. (b) Diverse, didactic and clinical learning experiences consistent with program outcomes. 20. Coursework includes all of the following: (a) Content in the biological, physical, social and behavioral sciences to provide a foundation for safe and effective nursing practice. (b) Content regarding professional responsibilities, legal and ethical issues, and history and trends in nursing and health care. (c) Didactic content and supervised clinical experiences in the prevention of illness and the promotion, restoration and maintenance of health in patients across the lifespan and from diverse cultural, ethnic, social and economic backgrounds. CHAPTER N. 1.08(5) CLINICAL LEARNING EXPERIENCES NOTE: The Board may inspect clinical facilities during a site survey to ensure Board standards are being met. 21. Patient experiences occur in a variety of clinical or simulated settings and include all of the following: (a) Integration of patient safety principles throughout the didactic and clinical coursework. (b) Implementation of evidence-based practice to integrate best research with clinical expertise and patient values for optimal care, including skills to identify and apply of best practices to nursing care. (c) Provision of patient-centered culturally competent care that recognizes that the patient or designee is the source of control and full partner in providing coordinated care by doing the following: 1) Respect of patient differences, values, preferences, and expressed needs. 2) Involvement of patients or designees in decision-making and care management. 3) Coordination and management of patient care across settings. 4) Explanation of appropriate and accessible interventions to patients and populations that may positively affect their ability to achieve healthy lifestyles. (d) Collaboration of interprofessional teams to foster open communication, mutual respect and shared decision-making in order to achieve quality patient care. (e) Participation in quality improvement processes to monitor patient care outcomes, identify possibility of hazards and errors and collaborate in the development and testing of changes that improve the quality and safety of health care systems. (f) Use of information technology to communicate, mitigate errors and support decision-making. Page 3 of 5

22. All cooperating agencies selected for clinical experiences have standards which demonstrate concern for the patient and evidence of the skillful application of all measures of safe nursing practices. 23. All faculty teaching clinical or practicum courses are experienced in the clinical areas of the course and maintain clinical expertise. 24. Faculty-supervised clinical practice includes all of the following: (a) Development of skills in direct patient care. (b) Making clinical judgments. (c) Care and management of both individuals and groups of patients across the lifespan. (d) Delegation to and supervision of other health care providers. 25. Clinical experiences shall be supervised by qualified faculty. 26. All student clinical experiences, including those with preceptors, shall be directed by nursing faculty. CHAPTER N 1.08(6) PRECEPTORS 27. Preceptors shall be approved by the faculty of the school of nursing: 28. School of nursing shall provide each preceptor with an orientation concerning the roles and responsibilities of the students, faculty and preceptors. The preceptor shall have clearly documented roles and responsibilities. 29. Clinical preceptors shall have an unencumbered license or privilege to practice in Wisconsin as a nurse at or above the licensure level for which the student is being prepared. 30. Preceptors shall demonstrate competencies related to the area of assigned clinical teaching responsibilities. CHAPTER N 1.08(7) EVALUATION 31. Educational administrator shall implement a comprehensive, systematic plan for ongoing evaluation and evidence of implementation shall reflect progress toward or achievement of program outcomes. CHAPTER N 1.09 NCLEX PASS RATES IMPORTANT: School of nursing NCLEX pass rate includes all programs or tracks in the school of nursing. The Board shall consider both the registered nurse NCLEX and practical nurse NCLEX pass rates when evaluating a school of professional nursing that grants a certificate of completion for practical nursing. 32. Nursing school must provide a self-evaluation of NCLEX success rate, including any current steps being taken to improve NCLEX success rate or plans to implement steps in the near future. Page 4 of 5

SELF-EVALUATION NOTES For each NA indicated in this report, please provide an explanation as to why the rule does not apply to the specific nursing school in the space provided below. Please write the corresponding report item number for each explanation. Attach clearly labeled additional pages as necessary. REPORT/FORM COMPLETED BY: Educational Administrator Signature Telephone Number Title Date Email Address Page 5 of 5