Dear Applicant: The College at Brockport Department of Nursing Application for Consideration for Admission for Fall 2015 Traditional BSN Program Thank you for considering application to the nursing program at The College at Brockport. In order for your application to be considered, you must meet the eligibility criteria. Refer to the Letter to Prospective Students which may be found on the Nursing Department website: www.brockport.edu/nursing Applicants who have not yet been accepted by The College at Brockport must have a completed college application filed through the Office of Admissions by January 1, 2015 in order for their application to the nursing program to be considered. Complete all sections of the application completely. Do not send transcripts, letters of recommendation, resumes, or a DARS/Degree Works with your nursing program application. However, where applicable, please ensure that all prerequisite courses taken at other institutions have been correctly designated as acceptable substitutions for Brockport courses. Contact Academic Advisement for information and forms. The completed application must be received in the Department of Nursing by 3:00pm on January 20, 2015. Applications will not be accepted after this time. You may mail or hand-carry your completed application to: Department of Nursing Tuttle North, Room B361 The College at Brockport 350 New Campus Drive Brockport, NY 14420-2988 Attention: Laurie Allen Traditional BSN Application Enclosed Please note: Tuttle North will be closed from December 21, 2014 through January 4, 2015. Due to the volume of applicants, we cannot make or accept phone calls or send or reply to e-mails to verify receipt of an application or report incomplete applications. Applicants will be notified with letters of acceptance/non-acceptance by the end of March 2015. Acceptance status will not be given over the phone. 1
A. Indicate your current status. Check all that apply. I am currently taking classes at Brockport and I have not attended any other Colleges. (after high school graduation) I am currently taking classes at Brockport and I have attended one or more other colleges. By the end of the fall 2014 semester, I will have earned at least 12 credits at Brockport. By the end of the fall 2014 semester, I will have earned less than 12 credits at Brockport. I have never attended classes at Brockport. I have taken classes at Brockport in the past, but am not currently (fall 2014) taking classes. My current status is not listed above. Explain: Students who have earned a baccalaureate degree may be eligible to apply to the Bachelor s to BSN Second Degree Program. See the Nursing Department web page for more information, or contact Karilee Bingham, Director at kbingham@brockport.edu B. All applicants: Read each of the following statements. In the spaces provided, sign with your initials indicating that you are aware of the stated requirements. By submitting an application, applicants acknowledge that they may be subject to urine drug testing as a condition of acceptance into the nursing program. In addition, students in the nursing program may be subject to random urine drug testing. Applicants/students will be responsible for any and all costs related to this testing. Clinical agencies with whom the Department of Nursing are affiliated may require that students undergo and pass a background check prior to student placement. Students will be responsible for any and all costs related to this background check. Students who do not favorably pass the background check may not be able to complete the clinical course, and may be dismissed from the nursing program. By submitting an application you acknowledge that you must attend a mandatory Pre-Orientation meeting on Saturday, April 25, 2015, 9am-noon if you are accepted into the nursing program. 2
C. Submit the following documents with your completed application: 1. The attached documents American Nurses Association Code of Ethics and the Department of Nursing Technical Standards, reviewed and signed. 2. A brief (typed, one page, double spaced) narrative describing why you are interested in the nursing profession and any pertinent healthcare and/or volunteer experience. 3. Optional: A brief narrative to further clarify or explain any portion of the application. It must be typed, double spaced, no longer than one page. D. Background Information: Year graduated from high school: # of college credits earned during high school: Have you applied for admission to the nursing program at Brockport previously? Have you ever been enrolled in a nursing program at another institution? If yes, where? Are you an LPN? Yes No If currently working, where? Have you or are you serving in the military? No Yes Branch: If yes, describe briefly: To what address do you want your notification letter (accept/deny) sent in March? Name: # Street Address (Apt. #): City, State & Zip : Contact phone number: Gender: Female Male Maiden name (if applicable): E-mail Address: Date of Birth: 3
E. Coursework Banner ID#: If no Banner ID#, Social Security #: Number of semesters at Brockport (including fall 2014): Total credits earned: List all institutions from which college credit has been earned after high school graduation, other than The College at Brockport. No college credit earned at other institutions. Name and address of schools(s) attended: Semester(s) Date(s) of attendance: Number of credits completed: Degrees completed: Complete the following grid by entering required information specific to prerequisite courses. If a prerequisite course has not yet been completed, indicate when and where it will be completed. Prerequisite course A&P I * BIO321 Course equivalent (if taken outside College at Brockport) Semester taken (if not completed indicate when it will be completed) Where taken (if not completed indicate where it will be completed) Grade A&P II * BIO322 Microbiology BIO323 Chemistry CHM260 Statistics course** Nutrition HLS311 Psychology course** Sociology course** Lifespan Development PRO204 * A&P I and A&P II must be taken at the same institution. ** Enter courses taken to meet the prerequisite requirement 11/11/14 4
American Nurses Association Code of Ethics Nursing students at The College at Brockport are expected to act in accordance of the American Nurses Association Code of Ethics. Students who do not act in accordance to the ANA Code of Ethics will be dismissed from the nursing program. The provisions are as follows: 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness, of every individual, unrestricted by considerations of social or economic status, personal attributes, or the nature of health problems. 2. The nurses primary commitment, is to the patient, whether an individual, family, group, or community. 3. The nurse promotes, advocate for, and strives to protect the health, safety, and rights of the patient. 4. The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse obligation to provide optimum patient care. 5. The nurse owes the same duties to self as to others, including the responsibility to preserve the integrity and safety, to maintain competence, and to continue personal and professional growth. 6. The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession though individual and collective action. 7. The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. 8. The nurse collaborates with other health professionals and the public in promoting community, national and international efforts to meet health needs. 9. The profession of nursing, as represented by association and their members, is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy. http://www.nursingworld.org/mainmenucategories/ethicsstandards/codeofethicsfornurses/code-of- Ethics.pdf) Professional Behaviors Expected of Nursing Students The following behaviors are essential for professional nursing practice. These behaviors are rated by clinical faculty with each clinical rotation. Students must demonstrate satisfactory behavior in each of the following areas, otherwise the student will be dismissed from the nursing program. Accountability Responsibility Preparedness Willingness to learn Attendance Punctuality Empathy Appropriate attitude Respect Appropriate behavior Appropriate appearance Honesty Sensitivity Genuineness Non-judgmental behavior Commitment Integrity Ethical principles Appropriateness in seeking assistance Openness to change in self and others Recognition of dignity of all human beings 5
The College at Brockport Department of Nursing Technical Standards The Department of Nursing's curricula are designed to provide the education necessary for the practice of nursing at the baccalaureate level of preparation. Students build on the fundamental principles of nursing, acquire skills of critical judgment based on education and experience, and develop an ability to use principles and skills wisely in decision making and problem solving pertaining to the delivery of high quality nursing services. Students admitted to the Department of Nursing need the intellectual and physical abilities to acquire the knowledge, behaviors and skills taught within the program of nursing. In addition to satisfactory academic performance in all coursework, students are expected to fulfill the non-academic essential functions of the curriculum in a reasonably independent manner. These functions are specified by the physical, cognitive, and behavioral standards (referred to collectively as technical standards) necessary for the completion of the nursing program. Technical standards of the Department of Nursing are outlined below. The Department of Nursing will consider for admission and advancement any individual able to perform pursuant to the standards, which are used as guidelines. Reasonable accommodations will be provided to qualified individuals with a disability in accordance with applicable laws and policies, while maintaining the integrity of program standards. Accommodations will be determined on a case by case basis working in conjunction with the Office of Students with Disabilities. Technical Standards Acquire information from demonstrations and experiences in the basic and applied sciences, including but not limited to information conveyed through lecture, group seminar, small group activities and physical demonstrations. Acquire information from written documents and computer information systems (including literature searches and data retrieval), and identify information presented in images from paper, videos, transparencies and slides. Independently use and interpret information from diagnostic maneuvers, (e.g. palpation, auscultation, percussion, etc.) diagnostic instruments (e.g. sphygmomanometer, otoscope, ophthalmoscope, etc.) and other diagnostic representation of physiological phenomena during the course of conducting a comprehensive physical assessment of a client. Accurately elicit information, including a health history, and other information required to adequately and effectively evaluate a client's condition. Accurately observe and assess a client s condition, and be able to problem solve and think critically to judge which theory and/or strategy of assessment and intervention is most appropriate. Synthesize information to develop a plan of care. Utilize intellectual ability, exercise proper judgment, and timely and accurately complete responsibilities attendant to the delivery of care to clients. 6
Develop effective and appropriate relationships with clients, colleagues, coworkers and relevant others. Perform specific procedures and interventions (e.g. Basic Life Support techniques) sufficient to provide safe and effective nursing care according to prescribed therapeutic regimens. Communicate effectively and efficiently with faculty, patients, families and all members of the health care team about a patient's condition as called for under the circumstances, verbally, in writing and in an electronic medical record. Practice in a safe manner and respond appropriately to emergencies and urgencies. Adapt and function effectively under the various circumstances and rigors which are inherent in the clinical practice of nursing. Move and transfer patients and medical equipment as care provision requires. Practice universal precautions against contamination and cross-contamination with infectious pathogens (e.g. wearing personal protective equipment; working with sharp objects and hazardous chemicals; treating clients with infectious diseases.) By my signature below, I affirm that I have read and understand the ethical and professional behaviors expected of me in the nursing program. I also affirm that I understand and agree to the Technical Standards above-mentioned terms and conditions. To the best of my knowledge, I have no current restrictions or limitations that would impede my ability to fully comply with the Technical Standards. I understand that failure to comply with the Technical Standards may result in disciplinary action against me. Signature Date Revised 11/11/14 7