2016 Generic BSN Application Packet

2016 Generic BSN Application Packet Application packet includes: Application and Required Supplemental Documentation Eligibility to Apply (You must meet all criteria): 1. Be a current, admitted student to MSU for the spring semester of the year you are applying. a. Transfer students must supply a copy of MSU acceptance letter and be admitted for spring term. 2. Completion of the General Education Foundations courses, except Writing II at the time of application to the program, and have no more than one General Education requirement remaining at the time the nursing program begins. a. It is recommended students meet with a nursing advisor at least one time prior to the spring semester of the year they are applying to discuss requirements and eligibility. 3. A minimum cumulative GPA of 2.75 in all attempted college course work. Completion of nursing prerequisites with a grade of C or higher. 4. Meet technical standards for Nursing Practice. a. See Appendix I 5. Complete the attached application and provide all required supplemental documentation listed on page 10. 6. Submit application to Department of Nursing no later than January 31, 2015 at 5pm CST. 7. Submit required $50 application fee via website: www.missouristate.edu/nursing/payment- Options-for-Programs.htm

Missouri State University Professional Building, Room 300 901 South National Avenue Springfield, Missouri 65897 Office 417-836-5310 Fax 417-836-5484 GENERIC BACHELOR OF SCIENCE IN NURSING APPLICATION PACKET 2016 SECTION 1: Applicant Information Incomplete applications are not considered. Please see application checklist for complete list of required documentation. Full Name: Last First Middle Other Name: If you have gone by any other name than indicated A above, please list those names here (including maiden) BearPass/MSU M#: This is your MSU student ID number Date of Birth: Month Day Year Permanent Address: Street Address Apartment/Unit # City State ZIP Code Temporary Address: Street Address Apartment/Unit # City State Zip Code Cell Phone: ( ) Social Security Number: MSU email address: Please check frequently as this will be the primary way we communicate with you during the application process Please mail any letters regarding admission status to (choose one): Permanent Address Temporary Address How did you hear about the Generic BSN Program? MSU Website Office of Admissions Professional Publication Showcase Nurse for a Day Other BSN Application 2016 Page 1 of 12

SECTION 2: Educational Preparation To be considered for application, students must be an accepted student to MSU prior to the application deadline. List previous educational preparation in chronological order. List all schools attended from high school to present, including dual credit institutions: Name of High School Address Length of Time Graduation Date Degree Earned Dual Credit Institution Name Course Name Hours completed Name of College Address Length of Time Graduation Date Degree Earned This section is for applicants transferring from another nursing program Are you transferring to the Generic BSN nursing program from another nursing program? Yes (if yes, continue to next paragraph) No Applicants who have previously attended a nursing school or another school of health-related profession must have a letter submitted from the Dean or Head of that school that includes a statement regarding the students standing at the previous school. Applicants who have been previously dismissed from a program or who were not in good standing at the time of dismissal will not be considered for admission. If you have attended another nursing school or another school of related profession, please list that program below: Name of Nursing School Address Length of Time Graduation Date Degree Earned In your words, what was the reason you left the above institution? BSN Application 2016 Page 2 of 12

Department of Nursing Clinical Security Information According to Section 335.066 Missouri Nursing Practice Act (1-16), granting of the Nursing baccalaureate degree does not guarantee eligibility to sit for the licensure examination or guarantee issuance of a license to practice nursing in the stat e of Missouri. Eligibility requirements to apply to write the Nationa l Council Licensure Examination for Registered Nurses (NCLEX- RN), as specified in section 335.046-1 of the Missouri Nursing Practice Act, include that the applicant should: 1) Be of good moral character; 2) Have completed high school or equivalent; 3) have successfully completed basic professional curriculum in accredited school of nursing. Section 335.066, Missouri Nursing Practice Act (1-2) to (1-16), provides rules for denial, revocation, or suspension of license, and grounds for civil immunity. The Board may refuse to issue any certificate of registration or authority, and permit or license stated in subsection two of this section. More information is available at http://pr.mo.gov/boards/nursing/rnexam53003.pdf Answering Yes to any of the following questions could possibly result in ineligibility for licensure upon graduation. Plea se respond to each answer honestly. Further discussion may be needed between you and the director of the generic BSN program to determine if licensure issues may be of concern. Have you ever been denied a professional license, certification, registration or permit? Have you ever been convicted, adjudged guilty by a court, plead guilty nolo contender to any crime, whether or not sentence was imposed (excluding traffic violations)? Have you ever been convicted, adjudged guilty by a court, plead guilty or plead nolo contender to any traffic offense resulting from or related to the use of drugs or alcohol, whether or not sentence was imposed? Have you ever been convicted, adjudged guilty by a court, plead guilty or plead nolo contender to acts of physical violence against another person, whether or not sentence was imposed? Do you currently, or did you within the past five years, use any prescription drug, controlled substance, illegal chemical substance, or alcohol, to the point where your ability to practice as a registered nurse would be affected? Assurances I understand and have met all of the admission requirements to be considered for admission to the Generic BSN nursing program. I understand that application and acceptance to Missouri State University does not guarantee acceptance into the Generic BSN program, which requires a separate application and process. BSN Application 2016 Page 3 of 12

I understand and meet the Missouri State University of Nursing Technical Standards for Nursing Practice (see Appendix I). I currently and will continuously carry health insurance throughout the entire nursing program. I understand that I am expected to purchase uniforms and initial equipment before beginning nursing courses. I understand that I am expected to provide my own transportation to clinical sites. Some clinical sites may be located outside of the Springfield area. I understand that I am required to pay course fees for each clinical nursing course in which I am enrolled. I understand admission into the nursing program is pending successful completion of the criminal background check and drug screening. I understand that graduating from the Generic BSN program does not guarantee eligibility to become licensed as a professional nurse. Eligibility requirements include passing the NCLEX-RN exam and meeting RN licensure requirements for the state in which licensure is sought by the individual. I have read section 335.066 of the Missouri Revised Statutes located at http://www.moga.mo.gov/statutes/c300-399/3350000066.htm and understand the Missouri State Board of Nursing reserves the right to deny, revoke, or suspend a license. Only for students transferring from another nursing program: I understand that I must include a letter from the Head/Dean/Director from my previous school of nursing or health-related profession that includes a statement regarding my standing at the previous school. I verify that the information provided above is true and complete. I will comply with the items listed above and realize that any falsification of this application could result in the disqualification of my appl ication for admission. I understand The Department of Nursing at Missouri State will review all applicants to the Generic BSN program who have met the admission criteria and notify students of their admission status (acceptance, wait list, or rejection) in a timely manner. BSN Application 2016 Page 4 of 12

Understanding of Application Procedures The Department of Nursing Faculty and Staff are here to help you. We want all students interested in a career in nursing to b e successful. We also want students at Missouri State University to have a realistic understanding of the selectivity and limitations of our BSN program. The Department of Nursing admits 61 students once per year to the BSN program. This number is set by the Missouri State Board of Nursing and is based on an evaluation of the number of faculty in the department and the availability of clinical facilities. Selections are made by the Admissions, Promotion, and Graduation Committee (APG) in the spring semester for classes that begin in the following summer semester. Admission to the Generic BSN program is competitive due to the large number of qualified applicants. The primary criterion used for selection for admission is combined cumulative grade point average (GPA). This includes all previous dual credit and college course work. Some additional preference is given to students who are current MSU students, those with healthcare experience, and those with evidence of community service and leadership roles. Points also are awarded for the grade received on the first attempt in chemistry, anatomy, and Math 135, MTH 138, MTH 181, MTH 261 or MTH 287. While the minimum GPA for application to the BSN program is 2.75, the average GPA for students admitted is higher. The GPA of the applicant pool changes each year and we cannot predict what the minimum GPA for admission will b e in any year. Earning the minimum GPA of 2.75 does not guarantee admission. After Completion of the General Education Foundations courses, except Writing II at the time of application to the program, and have no more than one General Education requirement remaining at the time the nursing program begins, students may apply to the Generic BSN program. Applications are due by 5:00 pm CST on January 31 of the year you wish to come into the program. Only those students with a completed admission packet are considered by the APG Committee (see checklist for application requirements). Final admission into the Generic BSN program is contingent upon the successful completion of a standard background check and drug screen and a passing grade of C or higher for all spring coursework in progress at time of application. The Department of Nursing maintains a waiting list of eligible students whose admission points rank just below those of students selected for admission in any given year. Students on the waiting list are offered admission only if a seat becomes available. Students with a completed application packet who are not offered admission (including those on the waiting list) may re-apply in the following year. However, no advanced standing or guarantee of admission is offered to those who re-apply. Students interested in the Generic BSN program at MSU should make an appointment to discuss the program and its requirements with the Department of Nursing Advisor as early as possible. Nursing is a popular major, therefore students may want to apply to multiple schools in order to increase their chances of admission to a nursing program. I have read and understand the above information regarding the application and selection process for the Ge neric BSN Program at Missouri State University. (Applicant s name, please print) (Applicant's signature) (Date) BSN Application 2016 Page 5 of 12

REQUIRED SUPPLEMENTAL DOCUMENTATION 2016 DOCUMENTATION 1: Essay Please indicate why you have chosen to apply to the MSU BSN program. This information should be typed on a separate sheet of paper, front side only, double spaced, Times New Roman, 12 point font, not to exceed two pages. Applicants are encouraged to use the Writing Center on the MSU campus for help with developing an essay. DOCUMENTATION 2: Resume Please attach a current resume indicating experience. This information should be typed on a separate sheet of paper, front side only, Times New Roman, 12 point font, not to exceed two pages. Applicants are encouraged to use the Career Center on the MSU campus for help with developing a resume. DOCUMENTATION 3: Spring Course work In Progress Attach a copy of spring schedule showing classes In Progress. An unofficial copy of transcripts is acceptable as documentation. DOCUMENTATION 4: CPR Certification Submit current American Heart Association BLS for Healthcare Providers CPR certification card; required to keep current throughout the nursing program. No online courses are accepted (evidence is front and back copy of the card). Students taking AHA BLS CPR for the first time will need to take a full 4 hour face-to-face CPR course for a fee. Only the American Heart Association BLS for Healthcare for Provider s CPR will be accepted. There will be an additional fee for the practice and testing portion and for the BLS Healthcare Provider card. No online practice and skills testing will be accepted. DOCUMENTATION 5: Current Health Insurance Submit evidence of Health Insurance coverage. Insurance must be paid for by the application deadline. Health Insurance is required throughout the nursing program. Evidence is front and back copy of the card. DOCUMENTATION 6: Transfer Student Information This section is for students who are transferring to MSU prior to the application deadline. 1. Provide documentation of MSU acceptance and be admitted for spring term. Examples include: MSU acceptance letter, email correspondence, etc. 2. If transferring from a nursing program: Include a letter from previous school that demonstrates applicant was in good standing at the time of departure. Letter must accompany application packet. BSN Application 2016 Page 6 of 12

DOCUMENTATION 7: Immunization Record Provide evidence of your current immunizations. All vaccinations must be kept current throughout the Generic BSN program. Dates and locations of immunization or titer should be clearly documented and legible. EVIDENCE IS ONE OF THE FOLLOWING: 1. Copy of an official immunization record from a hospital, physician s office, health department, or other health related office. 2. Copy of your childhood family immunization record. Fill in the immunization dates for the following as listed on your immunization record: MMR (2 doses required) Date 1: Date 2: Evidence included? Tetanus (not older than 10 years) Date: Evidence included? Hepatitis B (3 doses required) Date 1: Date 2: Date 3: Evidence included? PPD (not older than 1 year) (results must be negative or appropriate medical follow-up for PPD positive individuals) PPD is a TB skin test with documented return 2 days later for reading of result. If positive please provide documentation of appropriate medical follow-up. Date of return: Results: Evidence included? Varicella, select one option: a. 2 doses of vaccine Date 1: Date 2: b. Lab evidence of positive titer Date: Evidence included? BSN Application 2016 Page 7 of 12

DOCUMENTATION 8: Relevant Experience (attach as many copies as needed) This is a supplemental document to the resume. Do not use see attached to complete this page. Indicate all experience in appropriate sections. If additional pages are needed, make a copy of this form and attach it to this page. Experience may not satisfy multiple sections. Experience may count from high school to present. LIST PREVIOUS HEALTHCARE EXPERIENCE IN CHRONOLOGICAL ORDER: *Volunteer and Job Shadow experiences do not count as healthcare experience. Experience must be a paid opportunity with direct patient care. Organization Roles/Responsibilities Total Number of Hours Contact Name/Phone Grand Total Number of Hours LIST PREVIOUS COMMUNITY SERVICE IN CHRONOLOGICAL ORDER: Organization Roles/Responsibilities Total Number of Hours Contact Name/Phone Grand Total Number of Hours LIST PREVIOUS LEADERSHIP EXPERIENCE IN CHRONOLOGICAL ORDER Organization Roles/Responsibilities Total Number of Positions Contact Name/Phone Grand Total Number of Positions BSN Application 2016 Page 8 of 12

DOCUMENTATION 9: Evidence of a Job Shadow Experience Experience should be in an acute care setting (hospital) with a Nurse working as an RN. As a representative of Missouri State University, you are expected to behave in a professional manner throughout this shadowing experience. Your dress and appearance should be clean and appropriate for your clinical site. Generally, students wear a polo style shirt and khaki or black pants with closed toe shoes. Do not wear scrubs or name badges that represent your workplace or any other entity besides Missouri State University. The shadowing experience should be observation only. This means that you will not participate in any type of direct care with patients or their families. Once you have chosen your facility, contact the Human Resources Department for specific instructions on organizin g your experience. Each facility has a protocol and required documentation in allowing students to participate in job shadowing. Part 1: To be completed by the applicant Full Name: Date of Shadow Experience: Facility and Unit: Last (Include Maiden if applicable) First M.I. A minimum of 8 hours is required. It is best if all 8 hours are performed in one day. Must be an acute experience in a hospital. Facility Contact Information: Name of contact person/human Resource Representative Phone Address Part 2: To be completed by the Registered Nurse and Acute Care (Hospital) Facility Representative RN Full Name: Job Shadow hours completed by student: Last First M.I. Signature of Registered Nurse: Name of HR representative: Last First M.I. Signature of Human Resources representative: Comments: BSN Application 2016 Page 9 of 12

APPLICATION AND SUPPLEMENTAL DOCUMENT CHECKSHEET 2016 Check sheet must accompany application packet Use this check sheet as a resource to ensure you are submitting a complete packet. Ineligible packets will not be considered. Points will be awarded to students who submit complete application packets on first attempt. Please do not staple any portion of the packet. Application check sheet (pages 1-5) Sections must be filled out entirely to be considered complete. Please double check your work before submitting it to the department. Section Complete Section 1: Applicant Information (page 1) Section 2: Educational Preparation (page 2) Department of Nursing Clinical Security Information (page 3) Assurances (page 3-4) Understanding of Application Procedures (page 5) Signature (page 5) Required supplemental Documentation check sheet (pages 6-11) All documentation is required upon submission of application. Incomplete documentation will not be considered. Section Documentation Provided Documentation 1: Essay Documentation 2: Resume Documentation 3: Spring Course work In Progress Documentation 4: American Heart Association BLS for Healthcare Providers CPR Certification Documentation 5: Current Health Insurance Documentation 6: Transfer Student Information (if applicable) Documentation 7: Immunization Record MMR (2 doses) Tetanus (not older than 10 years) Hepatitis B (3 doses) PPD (not older than 1 year and appropriate follow up for positive reading) Varicella (2 doses or lab evidence of positive titer) Documentation 8: Relevant Experience (healthcare, community service, and leadership) Documentation 9: Evidence of a Job Shadow Experience (see form in packet) Required application fee Pay required $50 application fee via nursing website at the time of submission to the Department of Nursing It is recommended to submit a receipt of payment along with application packet BSN Application 2016 Page 10 of 12

APPENDIX I Missouri State University Department of Nursing Technical Standards for Nursing Practice The BSN degree is an undifferentiated degree attesting to general knowledge in and the basic skills required for practicing the full scope of nursing. Essential abilities and characteristics required for completion of the BSN degree consist of certain minimum mental, emotional, sensory, motor, interpersonal, communication, and critical thinking competencies to assure that candidates for admission, progression, and graduation are able to complete the entire program of study and participate fully in all aspects of the acquisition of nursing knowledge and skills required for nursing practice. The Department of Nursing intends for its BSN graduates to become competent and compassionate nurses who are capable of meeting all requirements for licensure and post-graduate work in the field of nursing. The avowed intention of an individual student to practice only a narrow part of nursing, or to pursue a non-nursing career, does not alter the requirement that all BSN students take and achieve competence in the full curriculum required by the faculty. The Department of Nursing has an ethical responsibility for the safety of the patients with whom students and graduates may come into contact. Although students learn and work under the supervision of the faculty, students interact directly with patients throughout the BSN Program. Patient safety and well-being are therefore major factors in establishing requirements involving the competencies required of BSN students for admission, progression, and graduation. For admission, progression, and graduation, prospective and current enrollees in the BSN Program must demonstrate all essential abilities and characteristics to be able to successfully complete the BSN Program and participate in all aspects of nursing education. Such abilities and characteristics include, but are not limited to, the following competencies: COMPETENCY MENTAL/EMOTIONAL: Possesses the mental and emotional ability to adapt to the environment, function in everyday activities, and cope with stressors. EXAMPLES Demonstrates behaviors appropriate to the situation, uses appropriate coping strategies. SENSORY: Possesses the ability to assess and/or evaluate patient responses and to perform nursing interventions safely and accurately. Subject to reasonable disability-related accommodations, students must have the following particular capabilities: A. Visual 1. Has normal or corrected vision within the range of 20/20-20/80 2. Distinguishes color shades and/or changes. B. Auditory 1. Has normal or corrected hearing ability within the 0-45 decibel range. C. Tactile 1. Possesses in at least one hand the ability to perceive temperature changes and pulsations and to differentiate different structures and textures. Observes patient responses, the appearance of wounds; recognizes changes in skin color or color of body fluids, medications, etc.; distinguishes gradations on syringes when drawing up medications, etc. Hears alarms, emergency signals, cries for help, auscultatory sounds. Performs functions of physical assessment and/or functions related to therapeutic interventions, e.g. insertion of catheters or IV's. MOTOR: Possesses the capacity to perform the physical manipulations and diagnostic procedures that are part of a complete nursing practice and diverse clinical Moves among patient rooms and treatment areas, moves physical patients, performs CPR, calibrates and uses equipment, dons personal protective equipment (PPE) BSN Application 2016 Page 11 of 12

experience. Subject to reasonable disability-related accommodations, students must have the following particular capabilities: MOTOR (Continued): A. Possesses four (4) functional limbs (normal or artificial) that allow the student to perform sufficiently to move from room to room and maneuver in small places, and possesses gross and fine motor abilities sufficient to provide safe and effective nursing care. B. Possesses the ability to exert 20-50 lbs. of force occasionally; 10-25 lbs. of force frequently; and negligible to 10 lbs. of force constantly to move objects. INTERPERSONAL/COMMUNICATION: A. Possesses communication abilities sufficient for appropriate and effective interaction with others in both oral and written form B. Possesses interpersonal abilities sufficient to interact appropriately and effectively with individuals, families, and groups from a diverse background. CRITICAL THINKING: A. Possesses critical thinking ability sufficient for clinical judgment. B. Applies principles of logical or scientific thinking to define problems, collects data, establishes facts, and draws valid conclusions. Interprets and implements a variety of technical instructions. Deals with several abstract and concrete variables. Positions and moves patients and equipment Explains treatment procedures and/or initiates health teachings, documents nursing actions and patient responses. Establishes rapport with patients and colleagues Identifies cause and effect relationships; develops and evaluates plan of care and appropriately evaluates situations and promotes patient safety. Practical application of factions, percentages, ratio and proportion measurements, and other relevant scientific principles, mathematical calculation The Department of Nursing does not discriminate against qualified individuals with disabilities who apply for admission to or are enrolled in the BSN Program. Otherwise qualified individuals shall not be excluded from admission or participation in the Department of Nursing s educational programs and activities solely by reason of their disability or medical condition. The Department of Nursing is committed to providing reasonable accommodation in its academic programs to qualified individuals with disabilities, including but not limited to learning disabilities. A reasonable accommodation is one that does not require a fundamental alteration in the nature of the program or lower academic and/or clinical standards. Should a current or prospective enrollee have or develop a condition that would place patients or others at risk, or that would jeopardize his or her ability to complete the BSN Program or pursue licensure, the person may be denied admission to or removed from the BSN Program. Should a current or prospective enrollee have or develop a disability that poses a significant risk to the health and safety of patients, self, or others that cannot be eliminated with a reasonable accommodation, the person may be denied admission to or removed from the BSN Program. The process for a student to request an accommodation for a disability is outlined in the University s Disability Accommodation Policy for Students which can be found online at http://www.missouristate.edu/policy/op5_05_1_accommodation.htm. Students may also contact the Disability Resource Center (DRC) at Carrington 302, 417-836-4192 (voice), 417-836-6792 (TTY), http://www.missouristate.edu/disability/; or the Learning Diagnostic Clinic (LDC) at Alumni Building, Suite 502, 417-836-4787, http://psychology.missouristate.edu/ldc/. BSN Application 2016 Page 12 of 12