RN-BSN STUDENT
HANDBOOK
2022-2023
Physical Location
Department of Nursing, 5
th
Floor
Leon Levine Hall of the Beaver College of Health
Sciences
1179 State Farm Road Boone, NC 28608-2151
Simulation Labs
Leon Levine Hall of the Beaver College of Health Sciences, 3
rd
Floor
1179 State Farm Road Boone, NC 28608-2151
Mailing Address /Contact Information
APP STATE PO Box
32151 Boone, NC
28608-2151
Phone: (828) 262-8039
Fax: (828)262-8066
Transfer Admissions & Engagement
287 Rivers Street
John E. Thomas Hall, Suite 130
APP STATE PO Box 32166
Boone, NC 28608-2151
Phone: 828-262-7877
Fax: 828-262-7462
transfer@appstate.edu
Table of Contents
Nursing Department
Nursing Department Directory ..................................................................................................
7
Vision, Mission and Goals ........................................................................................................
8
Philosophy .................................................................................................................................
9
Program Outcomes .................................................................................................................. 10
Major Concepts of Professional Nursing Role ........................................................................ 11
Level Objectives...................................................................................................................... 12
Nursing Department Organizational Structure ........................................................................ 13
General Information
Student Advisement ................................................................................................................ 13
Student Input into Quality Program Improvement .................................................................. 13
Currency of Student Status and Contact Information ......................................................
13
Academic Affairs Policies ....................................................................................................... 14
Academic Integrity ........................................................................................................... 1
4
Plagiarism ......................................................................................................................... 1
4
APP STATE Student Support Services ................................................................................... 15
Additional Resources .............................................................................................................. 16
Financial
Aid
........................................................................................................................... 18
Complaints/Resources ............................................................................................................. 19
Student Misconduct .......................................................................................................... 19
Admission, Progression, Graduation, Dismissal and Readmission
Admission Criteria ..................................................................................................................
20
Transfer Credit ........................................................................................................................
2
0
Progression Requirements ....................................................................................................... 2
1
Learning Improvement Policy ................................................................................................ 2
1
Incomplete Courses ................................................................................................................. 22
Withdrawals ............................................................................................................................
2
2
Refund Policy ..........................................................................................................................
2
2
Graduation Requirements ........................................................................................................ 23
Dismissal Policy ...................................................................................................................... 24
Appeals and
Grieviences
.......................................................................................................... 2
4
Readmission Policy ................................................................................................................. 25
Curriculum
Curriculum Overview ............................................................................................................. 26
RN-BSN Course Descriptions ................................................................................................. 27
Computer Policy ..................................................................................................................... 29
Email Policy ............................................................................................................................ 29
3
Grading Policies
Grading Scale ..........................................................................................................................
30
Grading Disputes and Resolutions .......................................................................................... 30
Final Grade Appeal ................................................................................................................. 30
Clinical Policies and Requirements
Clinical Hours ......................................................................................................................... 3
1
Professional Behavior ............................................................................................................. 31
Just Culture Framework .......................................................................................................... 31
Verification of CPR, OSHA, and HIPAA Training ................................................................. 31
Health, Immunization, and Safety Policies
Health and Immunization Requirements ................................................................................. 32
Physical Exam/Health Status................................................................................................... 32
N-95 Fit Testing ......................................................................................................................
33
Immunizations ......................................................................................................................... 33
TB
Screening
........................................................................................................................... 35
Safety and Technical Standards Policy and Procedure ...........................................................
36
Safety and Technical Standards Requirements ....................................................................... 38
Criminal Background Check and Drug Screening
Policy ...................................................................................................................................... 40
APP STATE Guidelines for Assessing Crimes/Misconduct in Relation to Nursing
Requirements
and Activities .......................................................................................................................... 42
Consent and Release Authorization Policy ............................................................................. 46
Universal Confidentiality
Policy ...................................................................................................................................... 46
Social Media
Policy ...................................................................................................................................... 49
Accident and Injury
Policy ...................................................................................................................................... 51
Event Reporting in the Clinical Setting
Event Reporting Policy ........................................................................................................... 53
Ceremonies
Nursing Department Graduation Ceremony ............................................................................ 54
4
University
Graduation ............................................................................................................. 54
Forms
Accident and Injury Event Report ........................................................................................... 56
Blanket Release for Use of Photograph................................................................................... 58
Clinical Event Report .............................................................................................................. 59
Consent and Release Authorization ........................................................................................ 61
Drug Screening and Criminal Background Check Acknowledgement and Agreement .......... 62
Physical Examination .............................................................................................................. 63
Remediation: Academic .......................................................................................................... 64
Remediation: Clinical ............................................................................................................. 65
Safety and Technical Standards: Evaluation ........................................................................... 66
Student Handbook Agreement ................................................................................................ 68
Student Information ................................................................................................................ 69
Tuberculosis Risk Assessment ................................................................................................ 70
Tuberculosis Testing Record: Annual .....................................................................................
71
Tuberculosis Testing Record: Initial .......................................................................................
72
Universal
Confidentiality
Agreement
....................................................................................... 73
5
FORWARD
Welcome to the Appalachian State University Department of Nursing. This handbook contains the
most essential and commonly used policies of the University, as well as specific nursing program
policies.
Please note that the Handbook is subject to change as the program grows and policies are refined.
As you begin your nursing education at Appalachian State University, remember that you are the
nursing leaders of tomorrow. Take pride in Appalachian State University and in the education that is
shaping
you to be an outstanding professional nurse.
Appalachian State University’s Department of Nursing supports the mission of the University and the
Beaver College of Health Sciences which includes excellence in teaching/learning and the fostering of
scholarship and service to community. The complete text of these statements is included in the
Appalachian
State University Undergraduate Bulletin, 2022- 2023. The Department of Nursing does not discriminate
on
the basis of race, color, national origin, religion, sex, gender identity and expression, political affiliation,
age, disability, veteran status, genetic information, or sexual orientation in either the selection of Students
or as to any aspect of the education provided in this program.
6
NURSING
DEPARTMENT
DIRECTORY
Visit
Nursing.appstate.edu
for
faculty
&
staff
directory.
7
APP STATE Department of Nursing
VISION STATEMENT, MISSION, GOALS,
PHILOSOPHY,
AND EXPECTED OUTCOMES
VISION STATEMENT:
Appalachian State University Department of Nursing will provide evidence-based
nursing
education in an intellectually stimulating
and challenging environment that is designed to
prepare the professional nurse with the knowledge and skills needed to practice in
diverse
settings in a highly complex health care system.
MISSION:
The mission of the Department of Nursing at Appalachian State University is to advance
our
students’ cultural, intellectual, and personal development in order to prepare them for
professional practice as registered nurses in entry level and advanced roles. This mission
is
achieved through the efforts of faculty committed to excellence in teaching, scholarship,
and
service. A broad, in-depth curriculum is provided built on the study of arts, humanities,
mathematics, natural and social sciences, and standards for professional nursing practice.
Graduates serve their community by applying research and principles of education in their
practice of nursing in the entry level and advanced roles.
GOALS:
The goals of the RN-BSN program are to:
1
Provide a quality program in nursing based on a liberal education and professional nursing
values, competencies, and knowledge.
2
Facilitate the development and implementation of professional nursing roles in caring for
individuals, families, groups, and communities from diverse geographical and cultural
backgrounds through the application of knowledge, theory, and research from nursing
as
well as other related disciplines.
3
Instill in students an appreciation for and commitment to lifelong learning, scholarship, and
service in order to promote their personal growth, advance the profession of nursing, and
meet the health needs of society.
4
Prepare nurses who can practice as generalists in any health care setting.
5
Provide a foundation for graduate nursing education.
Approved 8/2018; Reviewed 07/2021
8
PHILOSOPHY:
Nursing
Nursing is a practice discipline that provides a vital and distinctive service to global
society through utilization of principles from nursing, physical, biological, and social
sciences, arts, humanities and mathematics to assist individuals, families, groups,
communities and populations achieve an optimal level of health. The focus is on holistic
health through evidence-based practice and patient centered care. Professional nursing
care is predicated on effective communication and critical thinking skills, current
knowledge for evidence-based practice (EBP), technical and assessment skills, the nursing
process, and a code of professional ethics.
Nurses are vital members of the collaborative healthcare team and practice in multiple
and
diverse environments, to promote optimal healthy functioning of persons.
Person
Each person is a holistic being who embodies inherent dignity and worth, and the right
to
self-determination. The focus of nursing care is persons as individual, family, groups,
communities and/or populations. There is a synergistic relationship among person,
nursing, health, and environment
Health
Health is defined by the perception of each person. Health is viewed holistically
and
includes the way persons interact with their environment.
Environment
Environment provides the context for human life, internal and external. The
combined
influences of the external and internal environments determine the growth and
development of persons and their state of health.
Nursing Education
Nursing education encompasses scholarly inquiry and evidence-based practice to
prepare
professionals to enhance well-being and healthcare outcomes for individuals, families,
groups, communities and/or populations.
While the faculty is committed to appreciating each student’s uniqueness and
accommodating each student’s learning needs, the faculty expects students to be
responsible for their own learning and to engage with the faculty in a dynamic,
interactive,
educational process. Nursing Education is a mutual endeavor in which students and
faculty share, pursue, and generate knowledge in a collaborative setting.
Approved 4/2016; Reviewed 07/2021
9
PROGRAM OUTCOMES:
The following educational outcomes are based on the mission, goals, and philosophy
of
Appalachian State University’s Department of Nursing.
The program graduate will:
1.
Utilize clinical judgment and foundational knowledge of the liberal arts and sciences to provide nursing
care that is holistic, equitable and evidence-based to diverse individuals and populations across the
lifespan
2.
Exhibit a person-centered approach respecting diversity, values, beliefs, needs, preferences, resources
and determinants of health unique to healthcare consumers and stakeholders.
3.
Collaborate with consumers, stakeholders, and healthcare team members to coordinate a continuum of
care that focuses on wellness and prevention, restorative care, chronic disease management, and
palliative care.
4.
Communicate through personal interaction and use of information technologies in a manner that
demonstrates respect, authenticity, confidentiality, while ensuring safety and quality care.
Promote personal and professional growth through participation in self-care modalities, educational
offerings, and civic partnerships that lead to healthier lifestyles and equitable care for consumers
and
communities.
5.
6.
Demonstrate leadership and accountability in accordance with ethical, legal, and professional
standards in nursing practice.
.
10
Mission, Goals, and Outcomes: Adopted 4/2007 Philosophy: Adopted 4/2007 Revised: 10/2008 Revised: 2/2009
Revised 1/2013; Reviewed 1/2014; Revised 4/2016; Reviewed 7/2021.
11
Major Concepts of Professional Nursing Role
Person Centered Care
Nursing Process
Technical
Skills
Safety/Quality
Diversity
Values
Caring
Legal/ethical issues
Cultural Competence
Teaching/learning
Theory-based Practice
Patient-centered Care
Evidence-based
Theory-based Practice
EBP/Research
Professional Values
Safety/quality
Legal/ethical issues
Caring
Theory-based Practice
Safety/Quality
Caring
Communication/
Collaboration
Educator
Clinical Judgment
Collaboration
Cultural Competence
Diversity
Inter- and
Intra-professional
Communication
Collaboration
Health Literacy
Information
management
(access, evaluate,
and disseminate
healthcare
information)
Interprofessional
healthcare team
member
Intra-professional
communication
Advocate
Educator
Empowerment
Interprofessional and
intra-professional
communication
Clinical Judgement
Inquiry
Goal
Setting
Clinical Judgment
Evaluating outcomes
Interpretive reasoning
Application of
knowledge
Prioritizing and
Inquiry
EBP/research
Prioritizing
Goal setting
Evaluating outcomes
Application of
knowledge
EBP/research
Clinical judgment
Leadership/Professional
Growth
EBP/research
Professionalism
Empowerment
Safety/quality
Autonomy
Evaluating Outcomes
Delegation
Evaluation
EBP/research
Professionalism
Health Policy
Supervision
Accountability
Legal/ethical issues
Empowerment
Health Care Systems
Professionalism
Accountability
Professional identity
Professional values
Global perspective
Life-long learner
Legal/ethical issues
Approved 4/2016; Reviewed 7/2021
12
Level Objectives 3000
Level Objectives 4000
1. Demonstrates skill in providing holistic nursing
care to individuals and families across the lifespan
based on professional nursing standards.
1. Provides competent holistic nursing care to
individuals, families, groups, communities, and
populations across the lifespan based on professional
nursing standards.
2. Select evidence-based practice approaches
through the utilization of critical thinking skills
and state-of-the-art knowledge for persons with
varying health promotion, health maintenance and
health restoration needs across the lifespan.
2. Evaluate and utilize evidence-based practice through
the utilization of critical thinking skills, and state-of-the-
art knowledge for persons with varying health
promotion, health maintenance, health restoration, needs
across the lifespan,
3. Explore the attributes and the role of the
professional nurse.
3. Participate in formal and informal experiences that
promote both personal and professional growth.
4. Demonstrates effective communication (listening,
verbal, non-verbal, written, and electronic) skills
with individuals, families and groups as well as
members of the interprofessional healthcare team
facilitating a culture of quality and safety
4. Employs competent communication and
developmentally appropriate skills in effective
communication skills (listening, verbal, non-verbal,
written, and electronic) with individuals, families,
groups, communities, and populations as well as
members of the interprofessional healthcare team
facilitating a culture of quality and safety.
5. Identify health information resources for self,
individuals, families, and colleagues.
5. Utilize technology and evaluate and disseminate
health information resources for self, colleagues, and
individuals, families, groups and communities.
6. Coordinates and collaborates with the
healthcare team in the provision of care.
6. Demonstrates leadership skills in coordinating,
collaborating, delegating, and supervising nursing care
provided by others
7. Collaborates with individuals, families and
groups through mutual goal-setting and education
to promote health and wellness.
7. Collaborates with individuals, families, groups,
communities, and populations through mutual goal-
setting, advocacy, and education to promote health and
wellness.
8. Participates in a patient centered (individual and
family) approach that reflects professional values
of altruism, autonomy, human dignity, integrity
and social justice.
8. Displays a patient-centered approach (individual,
family, groups, community, and populations) that
reflects the professional values of altruism, autonomy,
human dignity, integrity and social justice.
9. Follow procedures for economic, ethical, legal
and professional nursing standards in nursing
practice.
9. Demonstrates skill in economic ethical, legal, and
professional nursing standards in nursing practice.
10. Applies a liberal arts education to the
understanding of the continuum of care and
resource utilization.
10. Evaluate the continuum of care and resource
utilization based on the liberal arts foundation and
nursing knowledge.
NURSING
DEPARTMENT
ORGANIZATION
STRUCTURE
The Department Nursing is comprised of the Chair, Program Director(s), Tenure
Track
Faculty, Clinical Faculty, Adjunct Faculty and Administrative Staff. Unless otherwise
noted in a specific policy, students are encouraged to address their concerns (when
they
arise) to their assigned course/clinical faculty member and subsequently to the RN-
BSN
Coordinator, then program director, and finally to the department chair if not resolved.
STUDENT ADVISEMENT
Academic advisement is provided by the Beaver College of Health Sciences Office of
Advising and Academic Support located on the first floor of the Leon Levine Hall of
Health Sciences 1179 State Farm Road, Boone NC. Ms. Jessica Guggenheimer is the
current APP STATE Nursing Department Advisor, Room: 101, Phone: 828-262-8877,
email: [email protected]. For any concern or issue, students are
encouraged
to contact the RN to BSN Coordinator, Ms. Mary Coleman remotely at phone: 828-262-
colemanma1@appstate.edu
OR the Undergraduate Program Director, Dr. Jean Bernard,
Room 512B Leon Levine Hall, 828-262-8468, bernardjs@appstate.edu.
STUDENT INPUT INTO QUALITY PROGRAM IMPROVEMENT
The Department of Nursing invites students to provide input for quality program
improvement through completion of faculty and course evaluations, participation in
focus
groups, and through representation on the Curriculum and Student Affairs committees.
STUDENT INFORMATION
Throughout the nursing program, students are required to convey current information to the
department regarding
• contact information (changes in name, address and phone number),
•
•
•
family emergency
illness, or injury
course drops, additions, or withdrawals from one or more classes
Students must notify the RN-BSN Coordinator, and the Registrar’s Office of intent to
drop, add, or withdraw from one or more classes.
At the beginning of each academic year, students must complete the Student Information
Form and sign a Student Handbook Agreement that documents receipt and review of
the Department of Nursing Student Handbook.
Upon admission to the program, students must give consent and sign the Blanket
Release For Use of Photograph Form. Forms are all completed in the
compliance
system.
Revised 5/2017; 5/2018; 7/2019; 7/2021
13
APP STATE ACADEMIC AFFAIRS & POLICIES
Students must comply with all Appalachian State University policies including:
•
Disability
Resources
•
•
•
Attendance
Student Engagement in Coursework
Academic Integrity
Examples of academic integrity violations include:
o Cheating
Fabrication & falsification
o Multiple submission
Plagiarism
o Abuse of academic materials
Complicity in academic dishonesty
Specific policies and requirements for infection reporting & prevention (COVID-19 or other)
•
Policies may be found at:
• https://studentconduct.appstate.edu/
•
•
•
•
https://academicaffairs.appstate.edu/resources/syllabi-policy-and-statement-information
https://policy.appstate.edu/Acadmeic_Integrity_Code
https://www.appstate.edu/go/coronovis
https://policy.appstate.edu/Policy_Manual
Academic Integrity
Formal complaints related to academic dishonesty are addressed in the Appalachian State
University: Academic Integrity Code 2022-2023.
Violations of the Academic Integrity Code are addressed on a case by case basis by the Office
of
Student Conduct.
Plagiarism
Plagiarism is defined in the Appalachian State University Academic Integrity Code as
“presenting
the words or ideas of another as one’s own work or ideas”. All directly quoted material must be
properly cited. Plagiarism includes but is not limited to borrowing, downloading, cutting,
pasting and paraphrasing without acknowledgement, including from online sources, or allowing
a person’s academic work to be submitted as another’s work.
Approved 5/11/2017; Revised 7.15.19; Revised 6/30/2020
14
APP STATE Student SUPPORT SERVICES
Library Services (828-262-2186): Students are encouraged to use the APP STATE’s
library
facilities. Find the Beaver College of Health Sciences Librarian by visiting libary.appstate.edu
Counseling Center (828-262-3180), http://counseling.appstate.edu/: APP STATE’s
Counseling Center is available to students at any time. For emergencies, on weekends and
evenings, students may contact APP STATE’s Police at (828)262-2150 if counseling staff
member is needed. In addition, the counseling center may refer students to local mental
health
services.
Student Health Services (828-262-3100), https://healthservices.appstate.edu: APP STATE’s
BSN (Prelicensure) students have access to Student Health Services, however online nursing
students do not pay the student health services fee and are not eligible.
Disability Resources (828-262-3056), https://odr.appstate.edu/: Appalachian State University is
committed to making reasonable accommodations for individuals with documented qualifying
disabilities in accordance with the Americans with Disabilities Act of 1990, and Section 504 of the
Rehabilitation Act of 1973. Students must go to the Student Process webpage at:
https://odr.appstate.edu/students to make an electronic Student Accommodation Request as
part of the process for determining accommodations. For temporary accommodations, please see
this request form:
https://odr.appstate.edu/sites/default/files/documentation_form_for_temporary_impairments.pdf.
Students seeking accommodations based on a substantially limiting disability must contact and
register with The Office of Disability Resources (ODR). ODR engages in an interactive process to
review requests for accommodations with consideration of course requirements and a student’s
condition, history, and request. Once registration is complete, a student will meet with ODR staff
to
discuss eligibility and appropriate accommodations. ODR will contact and inform course faculty
of
needed accommodations. Faculty are very willing to assist students based on ODR’s
recommendations.
Diversity and Inclusion at Appalachian (828-262-2460) (diversity.appstate.edu) APP STATE
is committed to Inclusive Excellence and does not position diversity as simply the presence of
difference, but instead treats diversity as the intentional inclusion of the cultures, worldviews,
gifts, talents, history, and traditions of all people and places. Inclusive Excellence employs a
broad
definition of diversity that includes:
(Dis)ability
Gender identity
Gender
expression
Sexual orientation
Race and
ethnicity
Religion
Nationality
Age
Religion
Social class
•
•
•
•
•
•
•
•
•
•
15
APP STATE also fosters a campus that is safe and promotes the well-being of all individuals. Gender
discrimination, sexual violence, and relationship violence are counter to our values institutionally. Students
who experience interpersonal violence, may contact the Office of Title IX Compliance.
Tutoring (828-262-2291), https://studentlearningcenter.appstate.edu/tutoring-services : On campus
students should discuss tutoring with course faculty member and/or academic advisor(s). Online
students
in need of tutoring may contact faculty or the online education department.
16
ADDITIONAL
RESOURCES
Academic
Affairs
828-262-2070
Add a Class (Registrar’s Office)
828-262-2050
Adverse
Weather
828-262-7669
Appalachian
Summer
Festival
828-262-4046
Application for Graduation
828-262-6492
App State Online
828-262-3113
Athletic
Tickets
828-262-2079
Dean’s Office (Beaver College)
828-262-8145
Bookstore
828-262-3070
Career
Development
Center
828-262-2180
Cashier’s
Office
828-262-2113
Chancellor
828-262-2040
Change
of
Address
(Registrar’s
Office)
828-262-2050
Computer Shop (bookstore)
828-262-3070
Computer
Technical
Support
828-262-6266
Counseling
and
Psychological
Services
828-262-3180
Daymark
and
After-Hours
Number
828-264-8759;
877-492-2785
(After
hours)
Dean of Students
828-262-8284
Digital Learning Resources
828-262-6090
Digital
Learning
Studio
828-262-2186
Disability
Resources,
Office
of
828-262-3056
Financial
Aid
828-262-2190
Grade
Information
(Registrar’s
Office)
828-262-2050
Health
Services
828-262-3100
ID Cards
828-262-6141
Information
(APP
STATE
Campus)
828-262-2000
Information (Student)
828-262-3030
Learning
Center
828-262-2291
Legal Clinic
828-262-8284
Belk Library
828-262-2186
Loans
828-262-2190
Off-Campus
Courses
(Distance
Ed)
828-262-3113
Parking and Traffic
828-262-2878
POLICE
(Campus)
828-262-8000
Racial
Trauma
Healing
Space
828-262-2083
Registrar
828-262-2050
Substance Abuse Health Services Administration
1-800-662-HELP
Schaefer
Center
828-262-4046
Revised 07/2019; 06/30/2020, 08/2021
17
Scholarships
828-262-8453
Suicide
Prevention
1-800-272-TALK
(8255)
Testing Center
828-262-6801
Title
Nine
Equity
Office
(Grievances,
etc.)
828-262-2144
Transcript
(Registrar)
828-262-2050
Tuition & Fees
828-262-2113
Withdrawal
(Registrar)
828-262-2050
APP STATE Department of
Nursing FINANCIAL AID
Listed below are resources for information on financial aid detailing up-to-date specifics to
assist
in the appropriate funding for your needs.
•
APP STATE’s Financial Aid office–(828)262-2059 https://financialaid.appstate.edu/
They can help with programs such as Pell Grants and Stafford Loans, State-funded
programs
such as the NC Student Incentive Grant, work-studyopportunities, and scholarships
available
only to Appalachian Students.
Beaver College of Health Sciences Scholarship page:
https://healthsciences.appstate.edu/students/scholarships
American Association of Colleges of Nursing:
https://www.aacnnursing.org/Students/Financial-Aid
American Nurses Association:
https://www.nursingworld.org/education-events/scholarships/
Black Excel
http://www.blackexcel.org/nursing-scholarships.html
College Foundation of North Carolina
https://www.cfnc.org/
This program administers the NC Nurse Scholar’s Program, the NC Health, Science and
Math Scholarship program, and many other relevant programs.
North Carolina Nurses Association Foundation:
https://www.ncnurses.org/foundation/scholarships/
National Student Nurses Association Foundation:
https://www.nsna.org/foundation-of-the-nsna.html
& https://www.forevernursing.org/
Sigma Theta Tau:
https://www.sigmanursing.org/advance-elevate/careers/nursing-scholarship-opportunities
U.S. Department of Health and Human Services: https://bhw.hrsa.gov/loansscholarships
After College/AACN Nursing Student Scholarship Fund
https://www.aftercollege.com/content/article/aftercollege-aacn-scholarship/
•
•
•
•
•
•
•
•
•
•
•
18
APP STATE Department of Nursing
COMPLAINTS/RESOURSES Students enrolled in the Department of Nursing
have access
to the same resources regarding complaints of misconduct as other students at App State.
The
following information is provided as a resource for Nursing Students:
Students who believe they are victim of sexual harassment may contact the APP
STATE Office of Title IX Compliance, 123 I.G. Greer Hall, titleix.appstate.edu,
828-262-2144.
•
Student Misconduct
Definition of Misconduct from the Appalachian State University Code of Student Conduct 2022-
2023. “…any action by a student that endangers or threatens to endanger the health or safety
of the
University community or the education missio
n of the University, or any behavior that violates the
standards of conduct specified in Article IV of this Code”
The Code of Student Conduct is the primary resource related to misconduct. It contains:
Bill of Students” Rights
•
•
•
•
•
•
Disciplinary policies
Role of Conduct Boards
Procedure for conduct review
Guidelines for determining appropriate
sanctions
Rights of an accused student during a hearing
Guidelines for students appealing claims
In the event that a complaint has been made regarding student misconduct, every attempt is made
to ensure that students’ rights to a fair process are upheld. For complaints regarding student
misconduct, please contact the Office of Student Conduct: Plemmons Student Union, Rm. 320,
[email protected], 828-262-2704.
Consequences of Misconduct as per the APP STATE Code of Student Conduct may include:
•
expulsion,
•
•
•
•
•
•
suspension,
reprimand,
general probation,
specific probation,
community service,
and
restitution.
19
APP STATE Department of Nursing
RN to BSN MAJOR: ADMISSION, PROGRESSION AND GRADUATION POLICIES
The Bachelor of Science in Nursing (RN to BSN)
This accredited baccalaureate online program is designed for current registered nurses seeking to practice as
generalists in a variety of healthcare settings. The RN to BSN program provides the academic knowledge
and
skills to advance in the nursing profession and builds a foundation for graduate nursing education.
Admission Criteria
Admission decisions for the RN to BSN program are made by the Department of Nursing. To meet the RN-
BSN admission requirements, students must:
Be initially admitted to the Appalachian State University (APP STATE).
Hold an Associate in Applied Science in Nursing degree, or an Associate Degree in Nursing
from an accredited institution, or a Diploma in Nursing from an accredited hospital nursing
program.
Hold a current, unrestricted and unencumbered registered nurse (RN) license to practice in
North Carolina or a compact state prior to and throughout the RN to BSN program.
Have a cumulative GPA of 2.5 on a 4.0 scale calculated over all college coursework
(cumulative GPA as calculated by the Department of Nursing).
Have completed all lower division course work (required core, nursing cognate courses, and
any elective courses) before starting the RN-BSN program.
Provide health records and immunization documentation as requested by required deadline.
•
•
•
•
•
•
Transfer Credit:
●
All baccalaureate degrees granted by Appalachian require the completion of a minimum of 50
semester hours at a senior college or university. (Note that credit awarded for credit by exam,
military service, or “Life Experience” does not count as part of the required 50 hours.)
All nursing courses must be taken at Appalachian. The Comprehensive Articulation Agreement
(CAA) with NC community colleges will be followed in evaluating non-nursing credits from NC
community colleges.
Upon successful completion of NUR 3011- Concepts of Professional Nursing, the student
will receive 30 hours of validated credit for prior nursing courses and clinical competencies.
The Office of Transfer Services has final control over whether courses taken at another
institution of higher learning will transfer in to APP STATE. A copy of the previous course
syllabus and/or catalog course description must be submitted.
Nursing courses taken at other institutions will be evaluated by the Chair of the Department of
Nursing who will determine if courses taken are equivalent to APP STATE’s nursing courses. A
copy of the previous course syllabus and/or the course description from the catalog at the former
institution must be submitted.
•
•
•
•
Academic Success and Student Progression:
Just Culture Framework:
In collaboration with the North Carolina Board of Nursing’s philosophies, the App State Department of
Nursing uses a “Just Culture” framework. Just Culture promotes a learning culture that supports patient
safety while assigning accountability for behavioral choices. The Department of Nursing uses “Just
Culture”
concepts when reviewing practice events or errors and when identifying appropriate resolutions that
promote practice enhancement and patient safety. Just Culture concepts are outlined here at the North
Carolina Board of Nursing website: Just Culture Concepts & Definitions. For nursing students, the
STUDENT PRACTICE EVENT EVALUATION TOOL (SPEET), is used as an integral tool for
investigation and review of practice situations. A copy of the SPEET (NCBON, 2020) is available at:
https://www.ncbon.com/vdownloads/just-culture/just-culture-speet.pdf.
20
Progression Requirements
• Upon admittance and to progress thereafter, students must:
o
Adhere to all policies of the University and Department of Nursing
Achieve a grade of 77% or higher in each nursing course.
o
Maintain a cumulative nursing GPA of 2.5 at the end of fall semester and
each
semester thereafter.
o
Maintain negative Drug Screen
Maintain approved Criminal Background Check
Maintain an unrestricted, unencumbered current license to practice nursing in
NC
or a compact state.
o
•
Based on requirements of non-traditional clinical courses, students may be required to:
Maintain malpractice/liability insurance through Appalachian State University
maintain current BLS certification at the healthcare provider level, American
Heart
Association.
Maintain yearly tuberculosis screening
Maintain all immunization requirements particular to clinical agency requirements.
o
o
o
o
•
The university does not specify time limits for completion of undergraduate degrees. However,
nursing students who fail to achieve a “C (77%)” or higher in a nursing course cannot progress
in the program, must reapply, and will be required to meet all admission standards. Readmission
is a competitive process and is not guaranteed.
LEARNING IMPROVEMENT POLICY
The Department of Nursing promotes the success of every student in the program. When
students’ work indicates potential academic or clinical failure (a grade < 77%), faculty will
meet
with the student to complete a Learning Improvement Plan within 1-2 weeks of the occurrence.
The plan will be signed by both the student and faculty. A copy of the written plan will be
provided to the student and maintained in the student file. As part of creating and maintaining a
just culture, clinical remediation will incorporate the use of the North Carolina Board of
Nursing, Student Practice Event Evaluation Tool (SPEET).
Learning Improvement Plan:
A student who is not meeting program, course, and/or clinical objectives may be placed on
a
Learning Improvement Plan to help facilitate student success.
A Learning Improvement Plan is not punitive, but rather a communication tool established to
allow students, in conjunction with faculty, to address areas in need of improvement. The
plan
will note the issue of concern and related program/course/clinical objective, provide
examples
of the problem, and establish concrete action plans and timelines for addressing areas of
concern through clearly defined and measurable performance objectives.
Circumstances for a learning improvement plan include but are not limited to:
A grade of <85% on a medication calculation test.
A failing grade (<77%) on a paper or exam in any nursing course.
A mid-term evaluation with a grade of <77% in a didactic or clinical course.
A rating of less than Level two (2) on a proctored ATI exam.
Any deficiency in the classroom, lab, or clinical setting as determined by faculty.
•
•
•
•
•
21
Incomplete Courses
If a student receives a grade of “incomplete” for a nursing course, the “incomplete” must
be satisfied with a grade of 77% or higher before a student may progress to the next
semester of nursing courses.
Satisfaction of the incomplete coursework must occur no later than the end of the final
grading period for the current term as noted on the official academic calendar (For
example, incomplete grades for Spring and Summer terms are due by the last day to
submit final grades in the following Fall term. Incomplete grades for Fall terms are due
by the last day to submit final grades in the following Spring term)
•
•
Withdrawals
•
Students who need to withdraw (i.e., discontinue all classes) for the current term or a future
term must complete the online Withdraw from the University Form. Completed form will
automatically be forwarded to the Registrar's Office for withdrawal processing. For
withdrawal process questions, please contact the Registrar's Office at (828) 262-2050 or
registrar@appstate.edu.
Newly admitted undergraduate students who no longer plan to attend Appalachian,
must also notify the Office of Admissions.
Starting the first day of classes, discontinuing enrollment in all your classes is considered a
withdrawal for the term. If the withdrawal occurs after the official last day to withdraw
from
the term as published in the Academic Calendar, there will be no refund and grade(s) will
be recorded as "Withdrawal Failure” or “WF.” To find the last day to withdraw from the
term, please refer to the academic calendar for that term.
The Withdrawal Checklist provides students necessary steps needed in withdrawal.
•
•
•
•
21
Courses in the nursing program are taught only once a year and are sequential. Students
who withdraw must communicate via email with the Program Director
),
who will notify the academic advisor.
APP STATE Student Health Service must approve medical withdrawals and
readmissions. The student may need to provide supporting documentation from
healthcare provider.
•
•
Students who plan to return after withdrawing, must follow the university and Department of
Nursing readmission policies.
Refund Policy
Information and/or questions regarding refunds can be found on the Office of Student
Accounts website (or email them at studentaccounts.appstate.edu.)
22
Graduation Requirements
• The Bachelor of Science in Nursing (RN to BSN) consists of 120 semester hours.
An overall nursing GPA of at least 2.5 is required.
Required Core (44 SH)
ALL lower-division coursework (Nursing Required Core, Cognate Courses, and
Elective
Courses) must be completed prior to entry to the program:
•
•
English Composition (6 SH) Two
English Composition courses
Humanities/Fine Arts (12 SH) One
literature course required One fine
arts course required
Two additional courses from: art, dance, drama, foreign language, music, literature,
interdisciplinary humanities, philosophy, and religion.
Social/Behavioral Sciences(12 SH)
One history course
An introductory course in sociology An
introductory course in psychology
An additional course from: anthropology, economics, geography, history, political
science, psychology, and sociology
Mathematics (6 SH)
Introductory mathematics course (survey, college algebra, trigonometry, calculus, etc
.)
Introductory statistics course (does not have to be math prefix)
Natural Sciences (8 SH)
o
o
o
o
o
Human Anatomy and Physiology with Lab
Nursing Cognate Courses (18 SH)
Nursing cognates (18 SH) are support courses for the major that are required for the BSN
degree, and must be completed at a community college or other accredited institution.
Cognate courses required for the RN-BSN program:
Human Anatomy & Physiology* - if not taken as part of the Required Core (8 SH)
Microbiology with lab (4 SH)
o
o
o
Developmental Psychology or Human Growth and Development* - if not taken as
part of the Required Core (3 SH)
College level Statistics* - if not taken as part of the Required Core (3 SH)
o
* Courses in the cognate may also count as part of the Required Core, and additional hours
needed are made up in General Electives to total the 120 semester hours required for the
BSN degree.
Elective Course Requirements (to complete a total of 120 SH)
The BSN degree requires a total of 120 semester hours. If a student has fewer than 120
hours
on record after completing all other degree requirements, the
remaining credit hours must be
obtained by taking general elective courses that are transferable to Appalachian.
Nursing Major Coursework (30 SH)
23
Students may be sanctioned or dismissed from the Department of Nursing for any of the following reasons:
Non-compliance and/or violations of Appalachian State University or Department of
Nursing policies and procedures.
Non-compliance and/or violations of clinical agency policies and procedures.
Non-compliance and/or violations of the North Carolina Nurse Practice Act and ANA's
Code of Ethics.
Failure to achieve a grade of at least “C” (77% or >) in a nursing (NUR) course and/or achieving a
summative grade of “Unsatisfactory” in a clinical course.
Failure to pass a medication calculation test on the third attempt.
Repeated or severe inappropriate behavior that interferes with the ability of the student to
safely practice nursing.
Use of illegal substances or misuse of substances that interfere with the ability to practice safe nursing.
Denial by any clinical agency for access due to criminal background results, positive drug
screen or other outcomes that impact safe nursing practice.
Clinical behavior that is unsafe, unprofessional, unethical and/or beyond student’s scope
of practice (actions for which student has not been educated or authorized to perform
(Refer to the Just Culture SPEET form section for more details) (NCBON, 2020).
Uncivil behavior in classroom, lab, clinical or online settings directed toward patients,
family members, significant others, visitors, students, faculty or other healthcare
providers.
Behavior that threatens the physical, emotional, mental or environmental safety of
patients, family members or significant others, visitors, students, faculty or other
healthcare providers.
Excessive absences, tardiness, and/or incomplete assignments.
•
•
•
•
•
•
•
•
•
•
•
•
Performance Standards and Processes for Violations
Students in the BSN program are first and foremost Appalachian State University students. Therefore, they must
adhere to the academic standards and performance standards set forth by the University for all students.
According
to the Appalachian State University Code of Student Conduct and Academic Integrity Code, “When
students enter
the University, they assume obligations of performance and behavior relevant to the University’s mission,
processes, and functions. These expectations of students in an academic community are higher than those
expected
of other citizens.” Violations of the performance standards set forth by the University, including violations of the
Academic Integrity Code, Will be referred to the Office of Student Conduct. Please note that alleged threat or
harassment complaints must be handled according to University procedures.
When concerns are noted in any of the areas outlined under the items for sanction and/or dismissal, the
Department will utilize the policies and procedures outlined in the following paragraphs.
24
The severity of the concern will influence the level of intervention and steps followed. It is important to note that
if a Clinical placement or service learning agency requests a student be removed, the Department will
honor the
request. When an academic, behavioral, or professionalism concern is identified the following steps are strongly
•
The faculty member and student should attempt to resolve concerns as soon as possible through open
discussion of the issues. Possible solutions will be identified, implemented, and documented.
Documentation may include e-mail summaries of meetings and will include the DON Performance
Concerns Form. The form will be signed by both the student and faculty. A copy of the written form will
be provided to the student and maintained in the student file. The BSN Program Director and/or
Department Chair may serve as resources to assist the student and the faculty member in resolving
concerns.
•
If a satisfactory solution is not reached and/or if another issue arises following the meeting with the
faculty member and student, the Program Director should be contacted. The Program Director may
consult with the Department Chair. The faculty member and Program Director may use a variety of
methods including joint and individual meetings to assist in resolving the problems; efforts to resolve the
problems will be documented. Documentation may include e-mail summaries of meetings and will
include
the DON Performance Concerns Form.
•
If agreeable solutions are not found, the problem is not remedied, or a new problem occurs following
consultation with the Program Director, the Program Director will notify the Department Chair.
Possible actions may include but are not limited to the following items.
•
The Department Chair will determine a course of action and may consult with appropriate University, College
and/or Department personnel.
Gather more information which may include contact with the student, faculty members, agency, or others;
Conduct a meeting to resolve issues;
Develop a written performance contract;
Remove the student from the clinical/service learning agency or classroom; removal may be temporary or
permanent.
Dismissal from the program
•
•
•
•
•
The student will be notified in writing of the reasons for dismissal. Students have the right to follow University
procedures to file a grievance.
The procedure addressed above relates to concerns raised outside of the clinical setting. The procedure for addressing
concerns raised while students are placed in the clinical setting is described in the SPEET (NCSBON).
Student Grade Appeals or other Grievances:
Students may be sanctioned or dismissed from the University in accordance with Department of Nursing and
University policies. Students have the right to grieve or appeal issues such as final grades, academic integrity
sanctions, discrimination, harassment, student conduct sanctions, eligibility for reasonable accommodations
under the ADA, misconduct, state residency classifications for tuition purposes, decisions by the
Undergraduate
or Graduate Schools, or decisions made by the Office of Student Financial Aid. The process for such
grievances
or appeals can be found here: https://academicaffairs.appstate.edu/resources-forms/student-grievance-and-
appeal-policies-and-procedures
24
Readmission
• Students may seek readmission once if they:
o Receive a grade of C- (74-76.99) in one nursing course one time.
o Approved withdraw from a course.
https://registrar.appstate.edu/resources/policies/academic-policies/withdrawal-policy
•
•
Application for readmission does not guarantee readmission.
Students requesting readmission must complete the following form:
https://ugrad.appstate.edu/register/RNBSNreadmit
The Department of Nursing Chair and the Admissions Committee will review the
Letter
Requesting Readmission with consideration of:
•
o
o
Student’s accountability for lack of success
Plans for future success
Nursing GPA, coursework and clinical performance
Number of absences/ tardy episodes in nursing courses over the semester
o
•
The Admissions Committee may request a conference with the student or the development of a
plan overseen by the RN-BSN coordinator. This plan may include focused content review
and
scheduled meetings with faculty and/or program director
•
.
Recommendation of the Admission Committee regarding readmission will be forwarded to the
•
Department of Nursing Chair for final approval.
The Department of Nursing Chair will inform the student in writing of a readmission decision,
rationale, and instruction for next steps.
If a student is denied readmission, the student may appeal the decision in writing to the
Dean of the Beaver College of Health Sciences within 10 business days from the issuance
of the decision by the Chair.
The students should provide copies of the prior Letter Requesting Readmission which
includes:
•
•
Reasons for the request for readmission;
Factors that contributed to dismissal;
Attempted remediation actions to prevent failure and/or dismissal; and
An action plan for success including specific behaviors that will enhance
learning
if readmitted (i.e. decreased work hours, study group, testing accommodations).
-
AND-
A copy of the readmission denial letter from the Department of Nursing.
o
o
o
•
The decision of the Dean shall be final and no additional appeal rights shall be provided.
•
Students who are not readmitted will be advised regarding options for change of major
and
directed to proper departments for new advising.
25
Revised 5/2017; reviewed 07/2019; revised 07/2021; Revised 04/25/2022
APP STATE Department of Nursing
CURRICULUM OVERVIEW RN-BSN PROGRAM
Fall Semester:
•
NUR 3000 Nursing Informatics (3 Semester Hours)
•
NUR 3011 Concepts of Professional Nursing (4 Semester Hours)
•
NUR 3021 Health Assessment (4 Semester Hours)
Spring Semester:
•
NUR 4033 Nursing Research (3 Semester Hours)
•
NUR 4021 Nursing Care of Communities (4 Semester Hours)
•
NUR 4029 Nursing Leadership & Management (4 Semester Hours)
Summer Semester:
•
NUR 3031 Nursing Care of Older Adults (3 Semester Hours)
•
NUR 4032 Professional Nursing Synthesis (5 Semester Hours)
* Upon successful completion of NUR 3011- Concepts of Professional Nursing, the
student will receive 30 hours of validated credit for prior nursing courses and clinical
26
APP STATE Department of Nursing
RN-BSN CURRICULUM – COURSE DESCRIPTIONS
NUR 3000 Nursing Informatics (3); Fall.
This course examines the integration of computer science, information science, and
nursing
science in the nurse's role of designer, manager of information, and coordinator of care.
The acquisition, evaluation, and application of information from a variety
of sources are
analyzed in terms of their applicability for evidence-based practice (EBP) as well as
their
validity for public access and utilization. Lecture three hours.
Prerequisite: admission to the online RN to BSN degree program.
NUR 3011 Concepts of Professional Nursing (4); Fall.
GEN ED: Junior Writing in the Discipline (WID)
This course introduces an expanded knowledge about nurses as members of the
profession,
providers of care, and coordinators, designers and managers of care related to
differentiated
practice. Nursing history, process, and roles are explored. Students receive an
introduction
to theory, practice, and research concepts. Evidence-based and community-based
nursing
are introduced along with critical thinking. The nursing process and principles that guide
practice are explicated. Nursing trends and issues are identified. Lecture four hours.
Prerequisites: admission to the online RN to BSN degree program and R C 2001 or its
equivalent.
NUR 3021 Health Assessment (4); Fall.
This course examines the integration of evidence-based knowledge and skills of health
assessment into the nurse's roles of provider of care and designer, manager, and
coordinator of care. Through the presentation of the concepts of health assessment,
c o u p l e d with the nursing process, this course emphasizes assessment, identification
and
documentation of normal and abnormal physical and psychosocial findings across the
lifespan with an appreciation of different cultural factors that may influence health.
Lecture three hours, laboratory two hours.
Prerequisite: admission to the online RN to BSN degree program.
NUR 4021 Nursing Care of Communities (4); Spring.
In this course, students concentrate on the nurse's roles of provider of care, designer,
manager, and coordinator of care and member of the profession in caring for groups in a
community setting. The focus is on assisting vulnerable populations to achieve improved
health goals and outcomes. Students participate in a variety of techniques for improving
health care, such as patient education. Also, students partner with community agencies to
positively influence health care. Lecture three hours, 30 related clinical hours
(community
survey project
Prerequisite: admission to the online RN to BSN degree program
27
NUR 4029 Nursing Leadership and Management (4); Spring.
This course examines the role of research and theory in nursing practice and health care. In
addition, it provides an overview and an analysis of research methodologies and the
theoretical approaches with a continued look at evidence-based practice. The roles of the
professional nurse as a member of the profession and provider of care as they relate to the
application of nursing research in practice are explored.
Prerequisite: admission to the online RN to BSN degree program or permission of instructor.
NUR 4033 Nursing Research (3); Spring.
This course examines the role of research and theory in nursing practice and health care. In
addition, it provides an overview and an analysis of research methodologies and the
theoretical approaches with a continued look at evidence-based practice. The roles of the
professional nurse as a member of the profession and provider of care as they relate to the
application of nursing research in practice are explored.
Prerequisite: admission to the online RN to BSN degree program or permission of instructor.
NUR 3031 Nursing Care of Older Adults (3); Summer.
This course covers past, present and predicted trends of the elderly population and their
relationship to nursing. The course explores the roles of the nurse with the older adult and
her/his family as provider of care as well as designer, manager, and coordinator of care in
the many settings where the elder adult lives. The student explores common and chronic
health problems, holistic care, safety, ethics, resources, and a variety of health promotion
techniques related to the care of the older adult and her/his family. Lecture three hours.
Prerequisite: admission to the online RN to BSN degree program.
NUR 4032 Professional Nursing Synthesis (5); Summer.
GEN ED: Capstone Experience
This capstone course is a synthesis of knowledge, theories, and clinical experiences from
course work throughout the nursing major. Students develop learning contracts
incorporating the roles of provider of care, designer, manager, and coordinator of care,
and
the member of the profession. The course consists of 120 clinical hours.
Prerequisite: admission to the online RN to BSN degree program.
28
Revised 5/2017; reviewed 07/2019; revised 07/2021; Revised 04/25/2022
APP STATE Department of Nursing
COMPUTER POLICY
Students are expected to follow the recommended computer specifications found
at https://support.appstate.edu/about/technology-support-center/recommended-computer-
specifications. Difficulties arising from use of non-recommended products are the
responsibility of the student. Work must be submitted in the requested format if specified. If
not specified, work must be submitted in a Word or PDF format. Students have access to
many
different types of software, including Office 365 and Google.
Drive. https://support.appstate.edu/students/software-including-office-365. There may be
additional software requirements based on course assignments.
A reliable, high-speed connection is important to be able to fully participate in online
learning.
If struggling with bandwidth issues, consider closing all of the programs except for the tools
that you are actively using, muting microphone unless speaking and downloading materials
prior to meeting times, as possible. Consider using a wired connection instead of WiFi, where
possible. Keep in mind that baby monitors, walls and cordless phones can impact WiFi signals.
EMAIL POLICY
Students are expected to follow the same expectations as faculty in responding in a timely
manner to emails and other attempts at contact. During the semester, this should be 2 business
days or by the time specifically requested by faculty, unless other arrangements are made.
APP
STATE emails will be the primary mode of contact used- students should not email professors
from their personal email.
Learning Improvement Plan/Remediation:
A student who is not meeting program, course, and/or clinical objectives may be placed on a
Learning Improvement Plan (LIP) to help facilitate student success.
A LIP is not punitive, but rather a communication tool established to allow students, in
conjunction with faculty, to address areas in need of improvement. A LIP will note the issue
of
concern and related program/course/clinical objective, provide examples of the problem, and
establish concrete action plans and timelines for addressing areas of concern through clearly
defined and measurable performance objectives.
For issues related to program requirements or professional behavior, the RN to BSN
Coordinator or course coordinator (depending on the situation) will work with the student to
develop a LIP. For issues related to clinical performance, the Clinical Instructor (in
conjunction
with the Course Coordinator), will work with the student to develop a LIP. The Undergrad
uate
Director will be notified when a LIP is issued and with a copy of the plan forwarded and to be
placed in the student’s permanent file. A student whose performance does not meet the
objectives of the LIP may be subject to course failure or administrative withdrawal from the
nursing program.
29
APP STATE Department of Nursing
GRADING POLICIES
Students are required to pass didactic classwork with a grade of C (77%) and clinical coursework with a
“Satisfactory” in order to progress in the nursing program. Grades are not rounded in the nursing
department. Requirements for evaluating performance and generation of course grades are determined
by
the course instructor. Per faculty discretion, a 5% per day deduction in score may be applied to any late
exam or assignment.
Nursing Program Grading Scale
A
A-
B
+
B
B-
C
+
C
C-
D
95-100
92-94.99
89-91.99
86-88.99
83-85.99
80-82.99
77-79.99
74-76.99
71-73.99
65-70.99
64.99 and lower
Grading Disputes/Resolutions
● Students who believe that the course grade is unfair or inaccurate, must first discuss concerns
with
course faculty.
● If unable to resolve, the student may then discuss concerns with the RN-BSN Coordinator, then
the Chair of the Nursing Department. At this point if there is a lack of resolution, the Appeal
Procedure should be followed.
Final Grade Appeal
The APP STATE Nursing Department follows the greater university policies related to student grievances
and grade appeals. Please refer to the Appalachian State University, Academic Affairs website. The
information from their main link will always be the most current.
Academic Affairs: (from academic affairs: resources: Student Grievance and Appeal Policies and
Procedures.
•
https://academicaffairs.appstate.edu/resources/final-grade-appeal-procedure
Form for appealing: (From academic affairs: resources: forms)
•
https://academicaffairs.appstate.edu/sites/academicaffairs.appstate.edu/files/final_grade_appeal_enabled. pdf
30
Revised 5/2015; 5/2017; 5/2018; reviewed 7/2019; revised 07/2021
APP STATE Department of Nursing
CLINICAL POLICIES AND REQUIREMENTS
Clinical Hours
Clinical hours in the RN-BSN program are non-traditional and include a variety of projects in which
the
student may use their own work setting with permission of the facility’s Student Programs
Coordinator.
The projects will be explained in detail when students are enrolled. Clinical sites must be located
within the state of North Carolina unless approval is given by the Undergraduate Program
Director in advance.
Although RN-BSN students do not participate in traditional clinical hours, they do complete an
evidence- based research project in NUR4032, Professional Nursing Synthesis. This course is taught
in
the final semester of the program. Students may choose to complete this coursework at their place of
employment or an alternative agency of choice. An affiliation agreement (contract) between APP
STATE and the specific facility may be required.
Professional Behavior:
Students are responsible for adhering to all Department of Nursing policies and procedures related
to
clinical, practicum/ capstone, simulation laboratory learning experiences while enrolled in the
nursing program. When in clinical settings, students are accountable for knowing and abiding by
clinical agency guidelines, regulations, and policies related to professional dress; professional
behavior that includes communication patterns, safety practices, and other parameters that support
delivery of safe, effective, and quality professional nursing care. It is the student’s responsibility
to
clarify with nursing faculty any area of professional conduct outlined in Department and/or
agency
policy that is unclear.
Just Culture Framework:
In collaboration with the North Carolina Board of Nursing’s philosophies, the App State
Department of Nursing uses a “Just Culture” framework. Just Culture promotes a learning
culture that supports patient safety while assigning accountability for behavioral choices.
The
Department of Nursing uses “Just Culture” concepts when reviewing practice events or
errors
and when identifying appropriate resolutions that promote practice enhancement and patient
safety. Just Culture concepts are outlined here at the North Carolina Board of Nursing
website: Just Culture Concepts & Definitions. For nursing students, the STUDENT
PRACTICE EVENT EVALUATION TOOL (SPEET), is used as an integral tool for
investigation and review of practice situations. A copy of the SPEET (NCBON, 2020) is
available at: https://www.ncbon.com/vdownloads/just-culture/just-culture-speet.pdf.
Verification of BLS, OSHA, and HIPAA Training
All students must comply with state, Nursing Department and clinical agency mandated regulations. Prior
to
beginning clinical experiences at any agency, students must provide proof of and upload in the
compliance
system.
•
•
•
•
•
documentation of The NCAHEC Online Core Orientation. URL address:
https://www.wakeahec.org/hctriangeclinical.htm
current American Heart Association BLS CPR certification
current OSHA and HIPAA training
current health information and immunizations status
requirements for clinical practice mandated by the clinical agency
31
•
•
criminal background check (CBC)
urine drug screen (DS) that includes:
AMP amphetamine
BAR barbiturates
COC cocaine
METH
methamphetamines
OPI opiates
PCP phencyclidine
THC marijuana
BZP benzodiazepines
MTD methadone
MDMA ecstasy
OXY oxycodone
PPX propoxyphene
•
NOTE: CBC, DS and test results from vendors other than the department compliance system
will not be accepted.
HEALTH AND IMMUNIZATION REQUIREMENTS
All Students admitted to the Department of Nursing are required to comply with all Appalachian State
University Department of Nursing health requirements in order to complete the clinical related
components of their courses. The requirements have been developed in accordance with Appalachian
State University Student Health requirements, Center for Disease Control (CDC), Immunization
Action
Coalition and facilities utilized for clinical affiliations.
● Students must submit all health and immunization information including completed forms within
6 weeks of admission to the program and prior to any clinical rotation. This information must also
be uploaded and accepted into the compliance system. Students must include:
o
Name and Banner ID (APP STATE ID) on all pages
o
The name and address of the health care provider, facility and/or lab completing required
forms.
o
Lab and X Ray results must be a laboratory or radiologist document.
Student Physical Examination and Health Status
Upon admission to the program, students must have a physical completed by their health care provider.
Results of this physical examination must be documented on the APP STATE Physical Form AND
the Department of Nursing Safety and Technical Form.
• APP STATE Physical Form
o
All blanks should be completed and signed by both student and health care provider.
o
The Health Care Provider’s address must be documented.
o
When fully completed, the APP STATE Physical Form must be uploaded into the
compliance system.
• Safety and Technical Standards
o
Review Policy and Procedure.
o
Students must complete all questions on the form and sign in preparation for their provider visit.
o
The Health Care Provider must review, provide comments related to student’s ability, and
sign this form.
o
The Safety and Technical Standards must be completed annually with Health Care
Provider visit and signature by the deadlines noted in the compliance system.
o
The completed forms should be uploaded into the compliance system data base.
•
While enrolled in the nursing program, students are required to immediately inform the Department
of Nursing of any change in health status including illness or injury. The student must notify
the
course faculty, Program Director, Department Chair, and the Director of Compliance and Student
32
Support. Any condition that is deemed to have the potential to jeopardize the quality of nursing care
or the safety of clients will be discussed with the student by the parties mentioned above and
appropriate action will be taken.
N-95 Mask Fit Testing:
•
In order for students to provide care to patients on Airborne Precautions (ex. Tuberculosis,
COVID-19, etc.), students will be required to be fit tested for N-95 masks based on agency
requirements. Should a student be unable to pass fit testing requirements, they may not be
allowed
in these patient rooms.
Fit testing is provided by some agencies directly through Employee Health and/or may be
provided through the nursing program.
•
Immunization Requirements:
● All immunization requirements and the provision of documentation to the department must be met
By October 31
st
of the first semester.
● Students must maintain current immunizations throughout the program.
● Refusal of immunizations may affect ability to complete program requirements.
● Additional immunizations or tests may be added to ensure that students are safe to practice
in assigned clinical settings.
Hepatitis B:
• A series of 3 vaccines and
•
A Hepatitis B surface antibody test (titer) showing immunity are both required.
o
Titer results should be on an official lab document. The lab name and address should be
included in the documentation.
o
Should the titer be negative or equivocal the student must repeat the three-dose series
(according to CDC schedule) AND the hepatitis B titer. The repeat titer should be
obtained
at least one month after completing the repeat vaccination series.
OR
A Hepatitis B Declination form may be completed with education provided from the
Director of Compliance/Student Support.
Influenza:
•
One dose of the quadrivalent flu vaccination is required for all students. Documentation of the
quadrivalent flu vaccination must be turned in to the Director of Compliance and Student
Support between October 1 and October 25 of each calendar year.
MMR (Measles (Rubeola), Mumps, and Rubella:
• Two MMR vaccines
o
given at least 30 days apart
o
These should have been received at age 1 or older.
•
Titers (laboratory evidence of immunity) for measles (rubeola), mumps and rubella showing
immunity to all three disease may replace the need for documentation of the two dose MMR series.
o
Titer results should be on an official lab document. The lab name and address should be
included in the documentation
o
If lab results are negative or equivocal, additional vaccinations are indicated.
33
Tetanus, Diphtheria and Pertussis:
•
•
One dose of Tdap (Adacel or Boostrix) received at age ten or older is required. And
A dose of a tetanus containing vaccination is required every ten years. This may be Td or Tdap.
Varicella (Chicken Pox):
• Two doses of the varicella vaccine
o
Received at or after age one.
o
Two doses separated by at least 30 days.
OR
•
A titer (Varicella Igg) showing immunity to chickenpox is acceptable.
o
Titer results should be on an official lab document. The lab name and address should
be
included in the documentation
o
If lab results are negative or equivocal, additional vaccinations are indicated.
Tuberculosis (TB) screening:
•
Initial TB screening
Two separate TST (tuberculosis skin test).
The two TST tests are administered 7-21 days apart.
Each test is interpreted 48-72 hours later.
Tests should be documented only on APP STATE Tuberculosis Testing Forms
Form must include the Health Care Provider’s signature and address.
Form must include the student's signature. OR
o
o
•
A lab test for tuberculosis may replace the initial TST testing and an annual lab test may replace
the annual TST test.
This is described as an IGRA test (QuantiFERON Gold or T spot)
Results must be on an official lab document. The lab name and address must be included in the
documentation
An annual TB screening test within 364 days of the previous year’s screening is required for
those
having a negative test result.
A positive TST on either the first or second step, a history of a positive TST or a positive IGRA
blood test will require a chest x-ray and a review of findings by the healthcare provider.
o
Documented on the Initial Tuberculosis Screening form in handbook
o
Those persons who have a history of a positive test result are required to complete an
annual TB exposure questionnaire.
o
If an individual has a history of completing medications for latent or active tuberculosis,
documentation of this should be provided.
If student is exposed to tuberculosis, subsequent testing will be required.
Students with a positive tuberculosis test at any time must complete the Tuberculosis Risk
Assessment. If students are unable to receive further tuberculosis testing, the Tuberculosis Risk
Assessment must be completed annually.
•
•
•
•
●
●
Revised 06/30/2020; Revised 05/2021; Revised 04/25/2022
35
APP STATE Department of Nursing
SAFETY AND TECHNICAL STANDARDS POLICY AND PROCEDURE
Purpose: To validate all students’ ability to meet the cognitive, affective and psychomotor
requirements of the curriculum, with or without reasonable accommodations, while enrolled in
any of the Appalachian State University Nursing programs. This policy and related procedures
shall be implemented in a manner consistent with Section 504 of the Rehabilitation Act of
1973
and the Americans with Disabilities Act of 1990 as subsequently amended. In addition,
students
must be compliant with the patient safety and quality standards of clinical and other regulatory
agencies.
Policy: For admission and progression in any of the Appalachian State University Nursing
programs, all students must:
•
•
Meet the required eligibility requirements and the patient safety and quality standards ofclinical
and other regulatory agencies.
Newly admitted students must:
o Complete the health appraisal and have a physical examination performed by a
licensed practitioner such as a physician or nurse practitioner.
o Complete and obtain approval of the “Safety and Technical Standards” form
(attached).
o Provide documentation of required immunizations including completion of 2-step
Mantoux (PPD) testing.
o Provide documentation of current American Heart Association BLS certification inadult
and infant/child at the health care provider level.
In order to progress in the program, all current students must submit, at the
beginning
of each subsequent academic year, the Annual Health, Safety and Technical
Standards
Self Evaluation form (in the forms section of this document) for validation of
meeting
the safety and technical standards.
All students must maintain currency of immunization status, PPD testing and BLS.
Students who incur subsequent illness or injury must be assessed at the time
of said occurrence to determine if they remain in compliance with this policy
and its intent.
•
•
•
Confidentiality: The handling of all records and subject information will be strictly confidential
and revealed only to those required to have access, e.g., ODR, Appalachian’s Department of
Nursing, clinical agencies, etc. Any breach of confidentiality will be considered serious and
appropriate disciplinary action will be taken.
Reasonable Accommodations Due to a Disability
•
At any time within the program, students needing reasonable accommodations in order
to meet any of the technical and performance standards must:
o Make requests to the Office of Disability Resources(ODR).
o ODR will engage in an interactive process to determine eligibility and may
consult with the Department of Nursing to determine reasonable
accommodations.
o If reasonable accommodations are approved ODR will notifystudents
regarding
eligibility and will create an Accommodation Plan to identify the approved
reasonable accommodations.
36
Temporary impairment verification by student of meeting required safety and technical
standards
•
If a student is injured, is ill, or the student’s health status changes, this must be reported to
the Chair of the Department of Nursing within 24 hours and/or prior to clinical
experience.
The Director of Compliance and Student Support will request that the student provide
verification from a health care provider of the student’s continued ability to perform
clinical activities. In addition, the student must also be cleared by the assigned clinical
facility and the Department of Nursing in accordance with the facility’s patient safety
and quality standards.
A copy of the “Safety and Technical Standards” form and a cover memo for the health
care provider to verify that the student can meet the safety and technical standards will
be
provided to the health care provider by the student.
•
•
o
o
The student will return the health care provider-completed and signed memo
to the Director of Compliance and Student Support.
If the student needs accommodations due to a temporary impairment
requests
should be made to ODR.
The Department of Nursing will submit all associated documentation to the clinical
facility for review and determination of the students’ ability to participate in clinical.
•
Until a decision is made, the student will not be allowed to participate in clinical courses.
Failure to provide documentation
Failure to provide appropriate documentation as requested may result in the student’s not being
allowed to participate in clinical courses and/ or dismissal from the program based on the inability.
Disputing the decision
The student maymake a written appeal of a decision made by the Department of Nursing pursuant
to this policy. Such an appeal shall be made to the Chair of the Department of Nursing within
fifteen (15) working days from the student’s receipt of notice of the decision. If the situation
cannot be resolved at the Department level, the student may appeal to the Dean of the Beaver
College of Health Sciences or Dean’s designee within 15 working days of the Department’s
denial
of the first appeal. The appeal to the Dean must be submitted in writing and include
documentation related to the situation. The Department will also have an opportunity to provide
written documentation about the situation. The documentation will include specific details
regarding why the Department has denied the appeal, and a record of
the communication with the
student. The decision of the Dean is binding (final).
Misrepresentations
Any identified misrepresentation, falsification, or material omission of information by
the
student may result in dismissal from the Nursing program.
Amendments or Termination of this Policy: Appalachian State University Department of
Nursing reserves the right to modify, amend, or terminate this policy at any time.
Adopted 5/7/2010
Form revised 10/2014; 02/2016; 05/2017; 01/2019; 05/2021; Revised 04/25/2022
37
SAFETY AND TECHNICAL STANDARDS REQUIREMENTS
General abilities
To provide quality nursing care, the student is expected to possess functional use of the senses of
vision, touch, hearing, taste and smell. All data received by the senses must be integrated,
analyzed and synthesized in a consistent and accurate manner. The student must be able to
observe patients accurately at a distance and close at hand. In addition, the student is expected to
possess the ability to perceive pain, pressure, temperature, position, equilibrium and movement.
Observational Ability
The student is expected to be able to observe the patient/client holistically to accurately assess
any
health/illness alterations. Inherent in this observation process is the functional use of the senses
and sufficient motor capability to carry out the necessary assessment activities.
Communication
The student is expected to be able to effectively communicate and receive communication, both
verbally and non-verbally. This requires the ability to see, speak, hear, read, write, and
effectively utilize the English language. A student must be able to elicit information, describe
changes in mood, activity and posture, and receive nonverbal communications. A student must
be able to communicate effectively and sensitively with patients. Communication includes not
only speech, but reading and writing. The student must be able to communicate effectively and
efficiently in oral and written form with all members of the health care team.
Motor Ability
The student is expected to be able to perform gross and fine motor movements required to
provide
holistic nursing care. Examples of care that the student must be able to perform include turning,
transferring, transporting, and exercising the patients/clients. The student is expected to have the
psychomotor skills necessary to perform or assist with procedures, treatments, administration of
medications, and emergency interventions. Examples of emergency interventions reasonably
required of nurses are cardiopulmonary resuscitation, the administration of parenteral
medication,
the application of pressure to stop bleeding, and the suctioning of obstructed airways. A
candidate
must also be able to protect the patients in emergency situations such as a fire event. Such
actions
require coordination of both gross and fine muscular movements, equilibrium and functional use
of the senses of touch, hearing, and vision. The student is expected to be able to maintain
consciousness and equilibrium, and have the physical strength and stamina to perform
satisfactorily in clinical nursing experiences.
Intellectual – Conceptual Ability
The student is expected to have the ability to develop problem solving skills, and demonstrate the
ability to establish care plans and set priorities. This includes the ability to calculate, analyze,
and synthesize objective, as well subjective, data and make decisions that reflect consistent and
thoughtful deliberation of the appropriate data. The student is expected to be able to listen,
speak, read, write, reason, and perform mathematical functions at a level which allows the
student to process and understand the materials presented (in both a written and a verbal format)
throughout his or her course of study.
38
Behavioral/Social
Attributes
The student is expected to have the emotional stability to fully utilize his/her intellectual
abilities,
exercise sound judgment, complete assessment and intervention activities, and develop
sensitive
interpersonal relationships with patients/clients, families, and others responsible for health
care.
The student is expected to have the flexibility to function effectively under stress; that is, the
individual is expected to be able to learn to adapt to changing environments, to display
flexibility
and to learn to function in the face of uncertainties inherent in the clinical problems of many
patients. Concern for others, integrity, accountability, interest and motivation are necessary
personal qualities.
Ability to Manage Stressful Situations
The student must be able to adapt to and function effectively
to stressful situations in both the
classroom and clinical settings, including emergency situations. The student will encounter
multiple stressors while in the nursing program. These stressors may be (but are not limited
to)
personal, patient care/ family, faculty/ peer, or program related.
Approved 08/2011; Revised 06/2020; Revised 05/2021
39
Department of Nursing
STUDENT CRIMINAL BACKGROUND CHECK AND DRUG SCREENING POLICY*
1.
Introduction
1.1 It is a condition of initial enrollment in the Appalachian State University Department of Nursing
(the “Department”), and a condition of eligibility to continue enrollment in a Nursing program,
that
Nursing students meet all academic and other requirements imposed by the Department, as well as
requirements of each external health and human service agency where the Department attempts to
place the student in a given semester.
1.2 The Department must secure the cooperation of independent external health and human service
agencies (“Agencies”) to provide appropriate educational, internship,
clinical, or field experiences
for its students. Increasingly, those Agencies will not accept students who do not meet
requirements
that apply to their employees, including drug tests and criminal background checks. Because
criminal background checks are now required by the North Carolina Board of Nursing for all
licensure applicants, and because of recommendations from The Joint Commission (TJC), most
agencies now require that Nursing students who will intern at their sites successfully complete
criminal background checks and drug screening. Each student must undergo a criminal
background
check by a Department of Nursing-approved agency.
1.3 In addition to meeting all Department and other college and University academic and conduct
requirements, students have the additional responsibility to meet requirements imposed by each
Agency where they will receive clinical or field education, including internships. A
student whois
rejected by one or more Agencies because of failure to meet the Agency’s criminal background
and/or drug testing requirements will be subject to dismissal from the Nursing Program in
accordance with the Department of Nursing Academic Dismissal Policy.
2.
Agency Criminal Background Check Requirements
2.1 Students not meeting requirements regarding the criminal background checks are subject to
dismissal from the program. See Student Handbook Dismissal Policy.
2.2 University officials will have electronic access to the criminal background report.
2.3 The University seeks information on convictions, all pleas that are acknowledgements
responsibility, and all pending criminal actions. Arrests or detention orders that do not result in
convictions or pleas will not be considered. The candidate will be asked to provide information
about the candidate’s criminal and discipline records. This information is critical, and a failure
by
the candidate to provide this data or to provide it accurately will result in a rejection of the
candidacy or other decision adverse to the candidate. All materials collected pursuant to this
policy
will be held confidentially and securely, and it will be maintained in a file separate from the
regular
files maintained for each candidate.
2.4 The existence of a conviction or plea, or other determination or acceptance of responsibility for a
crime or misconduct, does not automatically render a candidate unqualified. Where such
matters
are evident, the following factors will be consideredby University officials in determining
whether a candidate is qualified:
A. the nature of the crime or misconduct;
B. the circumstances surrounding the crime or misconduct;
C. the existence, number and type of other incidents of crime or misconduct;
40
D. the time that has elapsed since the conviction or other determination;
E.
the actions and activities of the student since the date(s) of reported crime(s) or
misconduct;
F.
the rehabilitation record of the student;
G.
any related information;
H.
the honesty of the student in disclosing and/or explaining the crime or misconduct;
I.
any professional opinions about the possibility or likelihood of future criminal behavior or
other
misconduct;
J.
explanations and/or other information provided by the candidate; and
K.
the willingness of a healthcare facility or other agency to accept the candidate for any clinical
experience.
In addition, University officials may use the attached GUIDELINES FOR ASSESSING
CRIMES AND MISCONDUCT AS THEY RELATE TO NURSING
REQUIREMENTS
AND ACTIVITIES.
2.5 The criminal background check will only be used for evaluating the candidate’s qualifications; it
will not be used to discriminate on the basis of race, color, national origin, religion, creed, sex,
gender identity and expression, political affiliation, age, disability, veteran status, or sexual
orientation.
2.6 If a candidate has a criminal or disciplinary record, the University will:
A. Compare the results of the background check to the application and supplemental
information supplied by the candidate to determine discrepancies. If there are no
discrepancies, and if the University has made an individual determination that the
candidate is qualified for admission, continued matriculation, or certification or licensure,
and there is no additional information indicating that a previous decision should be
modified or rescinded, the previous decision may stand.
B. If there are discrepancies or information indicating that a decision should be further
examined, college officials must provide the candidate an opportunity either to (1)
demonstrate that the report of criminal, disciplinary or other relevant history was
erroneous
(e.g. wrong person) or to (2) explain the discrepancy.
C. If the background report is determined to be accurate and a discrepancy exists between
the reported information and the application or supporting material that the candidate
submitted, or there is additional information that amplifies the application information or
otherwise indicates that the admission should be examined further:
41
GUIDELINES FOR ASSESSING CRIMES AND MISCONDUCT AS THEY RELATE TO
NURSING REQUIREMENTS AND ACTIVITIES
1.
The presumption is that the candidate will not be admitted, allowed to continue matriculation or
be recommended for certification or licensure if the candidate has failed to accurately disclose
relevant information in response to a question on the application or inquiry by any University
official. The burden is on the candidate to demonstrate that the
omission or misinformation was
the result of an honest mistake, that it was not intended to mislead, and that a decision should
be
rendered in favor of the candidate in spite of the failure to disclose;
2. If the failure to disclose accurate information does not result in a decision adverse to the
candidate, but there is information that draws the decision into question, before the candidate
may
be admitted, matriculate, or obtain a recommendation for certification or licensure, an
authorized
University official must make an individual determination as to whether the nature of any crime
committed or other behavior disclosed, together with other available information, suggests that
the
candidate is unqualified. If the official determines that the candidate is not qualified, that
official
or a designee must notify the candidate of the decision to deny admission or continued
matriculation, or decline to make a positive recommendation for the candidate’s certification or
licensure. If not, the candidate may be admitted, matriculate or obtain a recommendation in
accordance with other University policies and procedures.
2.7
University officials must maintain a record of the background checks, if any, conducted
on each candidate and the results of those checks. If a candidate’s record shows a history of
conviction of, guilty plea to, or acceptance of responsibility for a crime or a significant
disciplinary sanction at the University or another educational institution, the University shall
maintain a record of the process used to determine whether or not the candidate was
qualified
and of the basis for that determination.
2.8
The student is accountable for reporting any charges of a misdemeanor or felonious
nature that occurs while enrolled in the nursing program within 48 hours of occurrence to the
Chair of the Department of Nursing. Reporting means that the student directly contacts the
Chair and requests an appointment to discuss the charges.
3.
Drug/Alcohol Screening Requirements
3.1 To ensure patient safety, and comply with clinical facility policies, the North Carolina
Board of Nursing regulations [21 NCAC 36.0320(d)], and the 2004 Manual for
Hospitals published by The Joint Commission (TJC), students are expected to maintain
personal health and hygiene, including, but not limited to, avoidance of any chemical
substance that could impair judgment or ability to perform clinical or other duties, or
otherwise endanger patients or other members of the healthcare team. All students
entering the nursing program are required to obtain a drug/alcohol screen. The
Department of Nursing reserves the right to direct a student to undergo drug screening
at
any time.
42
3.2 Students are admitted to the Department of Nursing pending a negative drug test.
Students are responsible for costs associated with the drug screen. Students must further
agree
that all results are available to the university and the
clinical sites associated with the
program. The program is responsible for ensuring that students comply with individual
hospital
policy regarding disclosure of results. Students not meeting requirements
regarding
the drug screen are subject to dismissal from the program. See Dismissal Policy.
3.3 The nursing program maintains a no tolerance policy regarding substance abuse. All
students must clear a drug/alcohol test. Failure to undergo this test, a positive
drug/alcohol screen, or an altered sample will result in dismissal from the program. If
the
drug/alcohol screen produces a positive result and a valid prescription exists, the test
will
be deemed negative. For the purpose of this policy, a valid prescription is one that is
verified during a time period when the student is under the current treatment of a
licensed
healthcare professional.
3.4 Students must undergo drug testing at a Department of Nursing approved drug
screening laboratory. Students will bear all expenses associated with meeting
these requirements.
4. Drug Screening and Criminal Background Check Acknowledgment/Agreement
All students upon beginning the program, will complete the Drug Screening and
Criminal Background Acknowledgement Form, which must be uploaded in the
compliance system. All drug screens and background checks are ordered through
the
compliance system at the time of initiation of a compliance system student account.
Additional screens and checks may be required by individual agencies based on
affiliation agreements.
20100324 CBC Acknowledgement and Agreement
(DTC rev).docx Revised 5/15:2015 CBC_DS
policy.docx (BK rev), 5/2017; Revised 06/2020;
05/2021
43
APP STATE GUIDELINES FOR ASSESSING CRIMES AND MISCONDUCT AS THEY
RELATE TO NURSING REQUIREMENTS AND ACTIVITIES
In trying to assess comprehensively a candidate's qualifications, the University will carefully consider
evidence of criminal convictions, court-accepted pleas indicating acknowledgement of
responsibility
and dispositions of crimes and information regarding other candidate discipline matters. The
following
guidelines may be utilized to assess particular convictions, pleas, and other dispositions of cases as
they relate to nursing and performance of professional duties.
•
Safety Risk: Evidence of conduct that may create an unacceptable risk with respect to the
safety of the University and/or school and University and/or school activities, employees,
other
students, including those
in public school settings or related activities, or the public would
likely
disqualify a candidate. Such evidence may include, but not be limited to, conviction of one
or
more felonies and/or misdemeanors involving assault, assault
with a deadly weapon, rape,
sexual assault, armed robbery, reckless endangerment, or operation of a motor vehicle while
impaired as a result of drug or alcohol ingestion and arson.
•
Integrity Risk: Evidence of conduct that indicates fraudulent behavior, deceit or dishonesty
may create an unacceptable risk with respect to positions and activities that involve
confidential documents (including medical records), security issues, sensitive data or
materials, regulated issues and materials, financial
matters and accounting. Such evidence
may include, but not be limited to, convictions of one or more felonies and/or misdemeanors
involving embezzlement, fraud, income tax evasion, forgery, burglary, robbery, larceny,
theft, check kiting, issuance of bad checks, shoplifting and similar crimes, as well as
academic
misconduct (e.g.,
plagiarism, fabrication of data, cheating on examinations or representing
someone else’s work as one’s own).
•
Illegal Drug Risk: Evidence of conduct that encompasses illegal drug distribution and sale or
like activities may create an unacceptable risk for employees and students of Appalachian
State
University in light of Appalachian State University’s strong stance concerning illegal drugs
and its commitment to a drug-free workplace and educational and living environments, as
well
as employees and students in health care settings and related activities. Such evidence may
include, but not be limited to, conviction of felonies and misdemeanors involving drug
traffick
ing, drug sales or distribution, drug possession with intent to sell, drug and/or
paraphernalia possession and similar crimes.
•
Safety Risk for Students, Employees and Patients: Evidence of conduct that encompasses
harm or injury to others may create an unacceptable risk with respect to a student’s
enrollment
in any curricular programs or participation in healthcare activities that serve patients. Such
evidence may include, but not be limited to, felonies and misdemeanors involving abuse or
neglect, molestation, taking indecent liberties with a minor, contributing to the delinquency
of
a minor, and similar crimes.
44
•
Motor Vehicle Operation Risk: Evidence of conduct that encompasses illegal, violent, or
dangerous operation of a
motor vehicle may create an unacceptable risk with respect to
employment in positions or volunteer activities that require operation of any motor vehicle
(i.e., buses, vans). Such evidence may
include, but not be limited to, DWI, DUI, speeding to
elude arrest, vehicular manslaughter, multiple convictions of careless and reckless driving
and
multiple convictions of speeding.
•
Particular Position Risk: Evidence of conduct that is likely to impede the candidate's ability
to perform a particular duty or
satisfy curricular requirements, or that otherwise indicates a
significant risk to the safety of the student or those for whom the student is responsible, or
effective conduct of University or health care institution programs.
Students are accountable for reporting any adverse event of a misdemeanor or felonious nature
that occurs while enrolled in the nursing program. Reporting must occur within 48 hours of
occurrence to the Chair of the Department of Nursing. Failure to report may result in
dismissal
from the program.
Approved: 5/7/2010 Reviewed: 5/15 (BK OGC); Revised 05/2017; 05/2021; Revised 04/25/2022
45
APP STATE Department of Nursing
CONSENT AND RELEASE AUTHORIZATION POLICY
In accordance with clinical agency requirements to attend clinical rotations (as noted above and in the
outline of individual clinical affiliation agreements), students will indicate authorization for the
compliance requirements to be shared/released to the clinical agency in which the student will attend
training or have a scheduled clinical placement. At the beginning of the program, the student will
complete
the Consent and Release Authorization Form and upload to the compliance system and annually
thereafter.
Appalachian State University Office of General Counsel JC document Adopted 5/10/18; Policy statement approved 05/2021
APP STATE Department of Nursing
UNIVERSAL CONFIDENTIALITY POLICY AND AGREEMENT
General
The Department of Nursing (“Department”) at Appalachian State University (“University”)
maintains strict compliance with all legal, regulatory, and policy requirements addressing
confidentiality of patient, research subject, and student records. This departmental policy and
the
related Universal Confidentiality Agreement describe departmental expectations in this regard.
For purposes of this document, the term “students” includes undergraduate and graduate
University Nursing students and students from other institutions who are completing graduate
preceptorships with the University’s Department of Nursing Faculty.
Policy
It is the Department’s policy that students, faculty, staff, visiting professionals, and general
visitors of the University comply with the requirements and regulations of this policy regardless
of
the agency or venue to which they are assigned. Such individuals may be involved in clinical
placements and/or other activities, such as classes, labs, or conferences that involve indirect or
direct contact with professional peers, clients, their families and/or significant others. This level
of
involvement requires the utmost level of professional behavior and responsibility.
Members of the aforementioned groups are provided access to placements/activities via a
contractual agreement or Memorandum of Understanding between the University, the Beaver
College of Health Sciences, the Department, and the agencies/facilities providing
learning/clinical
opportunities. Access to confidential information is permitted only on a need-to-know basis and
limited to the minimum amount of information necessary to accomplish the intended purpose of
the interaction.
Appalachian State University maintains strict confidentiality requirements and regulations in
compliance with the Gramm-Leach-Bliley Act (GLBA), Family Educational Rights and
Privacy Act of 1974 as amended (FERPA), and the Health Insurance Portability and
Accountability Act (HIPAA) in addition to other federal and state laws. These principles of
confidentiality must be strictly adhered to without exception so that the privacy of the
privileged information is totally safeguarded.
Clinical or case materials prepared or used for classroom, lab, community/professional presentations,
46
assignments, or written materials must be altered so that there is no possibility that the persons
involved can be identified. This requirement includes specific details and circumstances as well
as
names.
The classroom itself is to be considered an area of confidentiality. Information shared, clinical and
otherwise, and the reactions of classmates are not to be discussed with anyone other than the
Faculty Member of record.
Any person who knows or has reason to believe that a breach of confidentiality has occurred in
violation of this policy is required to report that information to the Chair of the Department
of
Nursing and to the Director of Compliance and Student Support.
Students are provided training on Universal Confidentiality and the Health Insurance Portability and
Accountability Act as part of initial compliance on entry into the programs. Each student completes
the Universal Confidentiality Agreement Form and uploads this to the compliance system. In
addition, each student completes a HIPAA mandatory training course and test to ensure
understanding
of privacy rules. This form and training are repeated annually.
Breaches of Confidentiality
Violations of this policy include, but are not limited to, the following:
1. Failure to be knowledgeable of, adhere to and protect the policies of the University
and assigned agencies/facilities.
2. Accessing or sharing of confidential/sensitive information that is not within the scope
of the role/assignment
3. Misuse, disclosure, or alteration of any confidential/sensitive
information, electronic access or restricted areas.
4. Use of any electronic/social media means to convey any confidential/sensitive
information related to clinical, student or faculty interactions.
The information below provides examples of mishandling of confidential information.
These examples are not exhaustive, and individuals with questions about the applicability of this policy
are expected to err on the side of protecting confidentiality until clarification can be provided.
Questions about the proper handling, use, or disclosure of confidential information should be discussed
with appropriate personnel.
47
Accessing information that is not within the scope of your
job/role as student, staff or faculty member:
Unauthorized reading of client/employee/student/subject account
information.
Unauthorized reading of a client/employee/student/subject’s
chart/file.
Unauthorized access of personnel file or business/ operational
information.
Accessing information that you do not “need-to-know” for proper
execution of your job or educational functions.
Misusing, disclosing without proper authorization, or altering
patient or personnel information:
Making unauthorized marks on a medical record.
Making unauthorized changes to a personnel file or research data
files.
Sharing or reproducing information in a client / employee / student
/subject’s chart or personnel file with unauthorized personnel.
Discussing confidential information in a public area such as a
waiting room, cafeteria or elevator.
Disclosing to another person your sign-on code and/or password
for accessing electronic confidential information or for physical
access to restricted areas:
Telling an unauthorized person your password so that he or she can
log in to your work.
Telling an unauthorized person, the access codes for personnel files
or patient accounts.
Using another person’s sign-on code and/or password for
accessing electronic confidential information or for physical
access to restricted areas:
Using another’s password to log in to a hospital, agency, university,
or other computer system.
Unauthorized use of a login code for access to personnel files or
student/client/subject’s information, or restricted areas.
Violations of Policy
Violation of this policy may constitute grounds for corrective action up to and including loss of
agency privileges, academic or employment suspension, or termination from the Nursing
Department in accordance with applicable agency/facility, Department or University procedures.
Allegations of student violations will be addressed as academic integrity matters and considered
according to the procedures set forth in the University’s Code of Academic Integrity. Allegations
of
violations by University faculty or staff, or by visitors, will be addressed by Department and
Beaver
College of Health Sciences administration consistent with applicable policies and procedures.
Violation of this policy by any member of the University’s student body, faculty or staff may
constitute grounds for termination of the contractual relationship or other terms of
affiliation
between the University and the agency.
Unauthorized release of confidential information may also subject the violator to personal,
civil, and/or criminal liability and legal penalties.
References:
http://www.hhs.gov/ocr/privacy/
http://www.jointcommission.org/standards_information/tjc_requirements.asp
x APP STATE Department of Social Work
APP STATE Department of Communication Sciences and Disorders
4837-4508-8291, v. 3
Approved 5/4/15 (BKrause OGC); Revised 05/2021
48
Leaving a secured application unattended while signed on:
Being away from an electronic device while logged into a secure
application.
Allowing another person to use your secured application for which
he or she does not have access after you have logged in.
Attempting to access a secured application or restricted area
without proper authorization or for purposes other than official
business:
Trying passwords and login codes to gain access to an unauthorized
area of the computer system or restricted area.
Using a co-worker’s application for which you do not have access
after he or she is logged in.
Using badge or login codes to gain access to facility for purposes
other than assigned clinicals/orientations.
Intentional or negligent mishandling or destruction of
confidential information:
Failure to properly secure confidential information.
Taking confidential information to areas outside your work area,
e.g. out of the facility/agency, off campus, or to your home.
Disposing of confidential information in a non-approved container,
such as a trash can.
Unintentional disclosure of personal information:
Failure to take necessary precautions to properly prevent
unauthorized viewing of displayed or printed confidential
information in all areas.
Discussing confidential information in public areas.
Inappropriate removal of documents containing confidential
information from clinical/departmental areas.
Using an email account other than an official University email
account for conveying course/clinical/research/other University
related business.
Intentional dissemination of confidential information:
Distributing sensitive information via text, email, Facebook, blogs,
etc. (See APP STATE Department of Nursing Handbook Social
Media Policy).
Electronic or digital transmission of unauthorized pictures or
audio/video recordings.
Intentional and unauthorized securement, distribution,
dissemination, modification or copying of photographs, videos or
digital course materials.
The APP STATE Release For Use of Photograph must be completed
prior to securing any photos or videos.
APP STATE Department of Nursing
SOCIAL MEDIA POLICY
Purpose: To provide faculty and students with an understanding of the position of the Appalachian
State University Department of Nursing regarding the use of use of social media and other
electronic
communications.
Definition: For the purpose of this policy Social Media is defined as any user-generated content or online
network/applications that faculty or students may contribute to from a personal or professional
perspective. Currently identified avenues include, but are not limited to texting, Facebook, Twitter,
YouTube, personal or community blogs, or educational sites such as AsULearn.
Rationale: Social media is a promising innovation with the potential to enhance global
health care information exchange and significantly impact patient care. However, social media is a tool,
which when used inappropriately, has the potential to bring harm to colleagues, patients, the profession,
and
even nurses’ careers. The ability of search engines to bring long forgotten information to current
accessibility, with just a few keystrokes, may result in far-reaching consequences for individuals and the
institution.
Policy: Representation of the University and the Department in a manner that is fair, accurate, in compliance
with all confidentiality requirements and protective of the reputation of the individual(s) the university and
any affiliated institution/agency should be the primary focus of faculty and students in any method of
communication. To insure an understanding of the parameters of these emerging technology and
applications, the following statements will serve as guidelines and will be modified as appropriate:
•
All communications should be in compliance with the Appalachian State University Code of Student
Conduct, the Appalachian State University Faculty Handbook and all university policies, as
applicable.
When representing the University, all communications should be made in a fair, accurate and
legal manner that protects the brand and/or reputation of all involved and protects all confidential
information.
When expressing personal views and when your association with the University is shared, implied or
apparent, make it clear that your opinions are personal and do not necessarily represent the views or
opinions of the University.
Communications should be made in a manner that protects confidential, sensitive, and
proprietary information including such information relating to associated clinical
facilities/agencies and their clients. HIPAA, University and other privacy, confidentiality and
security guidelines must be followed at all times.
Confidential and HIPAA protected information should not be posted in any avenue of social media
or webpage.
At no time should photographs or videos be made in a clinical facility/agency without the
written permission of the administration of the facility/agency.
•
•
•
•
•
Considerations:
49
•
Think twice about posting to any site as no site is truly private. If you are unsure about a potential post, seek
guidance and clarification from departmental faculty or staff.
Respect your audience.
You are responsible for your use of social media. It is possible to identify the source of communication
when using so-called “hidden usernames”, text messages and other types of social media.
Promptly report any concerns about breaches of social media activity to the Chair of the Department
of Nursing.
•
•
•
Consequences:
•
Misuse of social media, including sharing of unprofessional or confidential information may result
in disciplinary action that may include failure of the course or dismissal from the nursing
program/position and/or penalties under HIPAA.
Legal liabilitymay be associated with communications found to be defamatory, harassing, or
in violation of any other applicable law.
•
Please refer to information at the National Council of State Boards of Nursing position on Social Media in
the profession of Nursing. Please see this website:
download the transcript on this subject.
https://www.ncsbn.org/347.htm, to watch video or
9/19/12 OGC approved; Revised 05/2021
50
APP STATE Department of Nursing
ACCIDENT AND INJURY POLICY AND PROCEDURE
Purpose:
To comply with Nursing Department and Appalachian State University institutional
guidelines
for reporting, providing appropriate intervention, and follow-up post-accident or injury.
Definition:
An accident/injury is defined as an undesirable and unexpected event occurring in classroom, clinical, or
clinical
travel which results in potential or personal harm that impacts the student’s ability to provide safe and quality
patient care. In addition, an accident/injury includes occupational exposure to blood and body fluids, airborne
pathogens or hazardous chemicals via opening in skin (needle stick, cut, puncture, chapped or abraded skin) or
mucous membranes (eyes, nose or mouth).
Policy and Procedure:
•
Students must report any accident or injury to their faculty, Chair of the Department of
Nursing, Program Director, and Director of Compliance and Student Support immediately.
Students must complete the Accident or Injury Event Report with faculty and turn in to Director
of
Compliance and Student Support within 48 hours of the event.
Treatment should occur in a timely fashion. Students are advised to seek medical care with health
care provider of choice or APP STATE Student Health Service.
Students are responsible for the cost of any test or treatments due to accident/injuries.
The Director of Compliance and Student Support will also complete a University Report via https://
hr.appstate.edu/hr-services/leave-management/workers-compensation/initial-notification-incidentinjury-form
The Department of Nursing will assess impact of accident/injury in regards to the Safety and
Technical Standards Policy and Procedure to determine student’s continuation of clinical
activities.
When students are exposed to blood or body fluids:
•
•
•
•
•
•
Clinical facility personnel will follow agency procedure regarding serologic testing of
patient source for evidence of HIV antibodies, hepatitis C antigen and, hepatitis B antigen.
The student exposed will have hepatitis B immunization history and risks evaluated, as well
as serologic testing for HIV, and hepatitis C. Serologic testing may occur at clinical facility,
APP STATE Student Health Service, or medical facility of student’s choice.
If the patient source tests positive for AIDS, HIV antibody, hepatitis C antigen or hepatitis B
antigen or refuses the test, the student will be counseled regarding the risk of infection,
receive and evaluated clinically. Students with seronegative results for HIV should be
retested
in 6 weeks, 12 weeks, and 6 months post-exposure (CDC, 1990).
The student should be advised to report and seek medical evaluation for any acute febrile
illness that occurs within 12 weeks after the exposure. An illness characterized by fever,
rash, or lymphadenopathy may be indicative of recent HIV infection.
o
o
o
o
•
When students are exposed to tuberculosis:
o The student must seek care from a medical facility of the student’s choice or APP
STATE Student Health Service. A baseline TST will be done at student’s
expense.
o
The student must be cleared by a physician or health care provider prior to return to clinical.
51
•
When students are exposed to COVID-19:
o The student will notify the Director of Compliance & Student Support so that the extent of
exposure can be evaluated further as it may relate only to attendance at in-person activities or
clinical activities.
o Students who have been exposed, will follow University, public health, provider, and clinical
agency requirements for quarantine or isolation, depending on status.
o Students may not attend in person classes or clinical experiences until cleared from
quarantine
and/or isolation restrictions.
Reviewed: 5/26/11; 5/2015; Revised 5/2017; Reviewed 7/2019; Revised 05/2021
52
APP STATE Department of Nursing
EVENT REPORTING POLICY AND FORM
This document is a student education record protected as confidential under the Family
Educational Rights and Privacy Act.
Purpose: Event reports are used for improvement of patient care safety and quality as well as
reduction of incidents that might cause or contribute to unsafe nursing practice. When used in
this
manner, event reports become a tool for the education of students/faculty and other healthcare
providers lending support to agency quality and safety initiatives. This policy and the
accompanying form are to be used only for the purpose of education of involved parties within
the
Department of Nursing.
Definition: An event is any occurrence that is not consistent with normal, routine operation of a
clinical facility and the facility’s policies and procedures that may result in or have potential for
injury and/or property damage. This definition includes near-miss situations (situations that
could have but did not necessarily result in harm). According to the Safe Medical Devices Act,
event
reports must be filled out if there is a malfunction of a piece of medical equipment. The FDA
requires healthcare facilities to report when circumstances “reasonably suggest” that a medical
device
has caused or contributed to the death, serious injury, or serious illness of a patient. This type of
event must be reported to the manufacturer and/or the FDA.
Procedure:
•
This Clinical Event Form must be completed in conjunction with the clinical
facilities’ document and according to their policy.
The person (student and/or faculty) discovering the event should report the event according
to the facility policy and complete the facility document along with this form.
This report must be submitted to the Chair of the Department of Nursing or the Director of
Compliance and Student Support within 24 hours of theevent.
The Chair will keep the form on file in the Chair’s office.
A copy will not be placed in the student’s file. The event will not be recorded on the
student
clinical evaluation anecdotal note.
If circumstances documented suggest the need, the report will be discussed by the Chair of
the Department of Nursing with the Dean (or designee) and the Office of General
Counsel.
•
•
•
•
•
Reviewed 9/2016; Revised
5/2017; 7/2019
53
Department of Nursing
NURSING DEPARTMENT GRADUATION
At the end of the nursing program, after successfully completing coursework, students must
apply to graduate. Students will receive instructions for application from the Nursing Advisor
(Mr. Matt Crump, crump[email protected] ). Students are invited to participate in both
nursing
department and university graduation ceremonies. During the department ceremony, students
are recognized for their accomplishments in the baccalaureate (RN-BSN) program. At the
university graduation, students are recognized again and receive their diplomas.
•
All nursing students are encouraged to participate in both ceremonies and may invite
family, significant others, and friends.
Students are to wear cap and gown.
Professional dress is recommended. Please see the University guidelines for more
details:
Commencement Attire Policy
Students must arrive and be in line (alphabetically) 30 minutes prior to the beginning of
the ceremony.
•
•
•
.
54
FORMS
Attention: Forms are provided here for viewing as part of handbook and policy review.
To access individual departmental forms, please review to the APP STATE
Department
of Nursing website at this link: https://nursing.appstate.edu/student-
information/student-forms. Forms are also provided in individual AsULearn cohort
project sites (as determined by program).
55
ACCIDENT OR INJURY REPORT
Part A: Documentation of Specifics Related to the Event
Refer to Accident and Injury Policy and Procedure: Report is to be completed legibly, in detail and with factual
information by student and faculty member.
Please use additional paper if needed.
56
1. Date:
Time:
Location:
2. Circle appropriate category for person involved: Student Faculty Staff Visitor
3. Name:
DOB:
Address:
Phone Numbers:
4. Detailed statement of facts related to event and description of injury if applicable:
5. Causative Factors: Please list and describe any causative or contributing factors
Person
Equipment
Other
6. Description of Immediate Action Taken/Treatment:
7. Witnesses: Please list information below regarding persons observing/involved in the event
Name(s):
Address:
Phone numbers:
Relationship to the event:
8. Notification of Nursing Department and/or Clinical Facility
Name(s) and position of person(s) notified:
Date:
Time:
How notified:
Printed Name and Signature of Person Completing Report
Date and Time
Printed Name and Signature of Person Reviewing Report
Date and Time
Part B: Documentation of Investigative Component of the Event
05/11 Event Report for Accident or Injury.docx
57
1. Date:
Time:
2. Name of person involved in event:
3. Name and credentials of person investigating event:
4. Documentation of calls placed regarding the event:
a. To whom
b. Contact information
c. Synopsis of information gathered
5. Descriptive documentation of interventions and/or treatment:
6. Evaluation/Follow-up: Please circle appropriate category(s) and document action/plan below:
Policy and procedure review Counseling Equipment change Staff
discussion Re-education and return demonstration Disciplinary process
7. Printed Name and Signature of Person Completing Report
Date:
Department of Nursing
BLANKET RELEASE FOR USE
OF
PHOTOGRAPH
This form should be completed and submitted to
the compliance system.
•
I hereby grant to the Department of Nursing and Appalachian State University (hereafter referred to as “APP
STATE”), its legal representative and assigns, and those acting with its permission, or its employees, the right
and permission to make, use and/or copyright, reuse and/or publish, display (including in PowerPoint and other
presentations), and re-publish photographic or digital pictures or images of me, or in which I may be distorted in
character, or in form, in conjunction with my own or a fictitious name, or reproductions thereof, in color or black
and white, made through any media by the Department of Nursing and/or APP STATE, for display or other
purposes, including the use of any printed material in conjunction therewith.
I hereby waive any right to inspect or approve the finished photograph, copy or printed material that may be
used
in conjunction therewith or to the eventual use that it might be applied.
I hereby release, discharge and agree to save harmless the Department of Nursing, the State of North Carolina,
the University of North Carolina, APP STATE, and their respective representatives, assigns, employees, agents
or any persons, corporation or corporations, acting under its permission or authority, or any person, persons,
corporation or corporations, for whom it might be acting, including any firm publishing and/or distributing the
finished product, in whole or in part, from and against any liability as a result of any distortion, blurring, or
alteration, optical illusion, or use in composite form, either intentionally or otherwise, that may occur or be
produced in the taking, processing or reproduction of the finished product, its publication or distribution of the
same, even should the same subject me to ridicule, scandal, reproach, scorn, or indignity.
I hereby warrant that I am over eighteen years of age, and competent to contract in my own name insofar as the
above is concerned.
•
•
•
I HAVE READ THE FOREGOING RELEASE, AUTHORIZATION AND AGREEMENT, BEFORE AFFIXING
MY SIGNATURE BELOW, AND WARRANT THAT I FULLY UNDERSTAND THE CONTENTS THEREOF.
BSN
RN to
BSN
MSN
□
□
□
Staff
Visitor
□
□
Student from
other
institution
Faculty □
□
Signature
Date
Printed Name
Address
58
CLINICAL EVENT FORM
This document is a student education record protected as confidential under the Family Educational Rights and Privacy Act.
This report is to be completed legibly, in detail and with factual information by student and faculty member. Please use back of
form
or additional paper if needed. Completed form should be given to the Nursing Department Chair within 24 hours of the event. Due
to
the nature of the information in the report, copies/scans of the form should not be made. This document is to be used only for the
purpose of education of involved parties within the Department of Nursing.
59
Initial Data:
Date:
Time:
□ AM
□ PM
Facility Name:
Facility Address:
Exact location of event:
Type of Event:
Patient □ Student □ Faculty □ Staff □ Other □ (specify)
_ Witnessed □ Not Witnessed □
Name:
DOB:
Address:
Phone Numbers:
Student Name:
Faculty Name:
Witness(es): use back of form if needed
Name: Contact Info:
Name: Contact Info:
Name: Contact Info:
Name: Contact Info:
Provider(s): use back of form if needed
Name: Notified: Yes □ No □ Date: Time:
Name: Notified: Yes □ No □ Date: Time:
Description of the Event: (WHO, WHAT, WHEN, WHERE, WHY, HOW) (use additional paper if needed)
Medication Event: Yes □ No □ Check all that apply below
Wrong Drug Yes □ No □
Wrong Dose Yes □ No □
Wrong Route Yes □ No □
Wrong Time Yes □ No □
Wrong Patient Yes □ No □
New Medication Order Yes □ No □
High Alert Med Yes □ No □
Misread Order (student) Yes □ No □
Misread Order (faculty) Yes □ No □
Transcription Error Yes □ No □
Abbreviation Error Yes □ No □
Barcoding Error Yes □ No □
MAR Misinterpretation Yes □ No □
Look/Sound Alike Med Yes □ No □
Crowded med prep area Yes □ No □
Multiple meds simultaneous prepared Yes □ No □
Omitted Required Assessment Prior to Administration Yes □ No □
Faculty present when med prepared Yes □ No □
Faculty present when med given Yes □ No □
Two unique patient identifiers used Yes □ No □
Three safety checks omitted Yes □ No □
Student competency verified Yes □ No □
Documentation Yes □ No □
OTHER:
Reviewed 09/2016; 05/2017; 06/2019; 05/2021
60
Treatment Management Event: Yes □ No □ Check all that apply below
Wrong:
treatment Yes □ No □ patient Yes □ No □ time Yes □ No □
Treatment order verified Yes □ No □
Treatment order difficult to read Yes □ No □
Crowded prep area Yes □ No □
Wrong supplies/equipment used Yes □ No □
Omitted/Incorrect Assessment Prior to Treatment Yes □ No □
Omitted/Incorrect Assessment Following Treatment Yes □ No □
Competency to perform verified Yes □ No □
First time student performed treatment Yes □ No □
Discrepancy between facility policy/procedure and Nursing programs teachingof skill Yes □ No □
OTHER:
Patient Fall Event: Yes □ No □ Check all that apply below
Floor conditions Clean and smooth □ Slippery or wet □ Other (describe):
Pt. identified as fall risk Yes □ No □
Bed Level High □ Low □
Night light- Yes □ No □
Ambulation privilege- □ Unlimited □Limited with assistance □ Complete bedrest □ Other-
Bed Rails □ All down □ 1 up □ 2 up □ 3 up □ 4 up
Patient in bathroom □
on bedpan □ on bedside commode □ in chair □
Wheels unlocked on Bed □ Stretcher □ Wheelchair □
Restraints (used, type and extent)
Narcotic, analgesic, hypnotic, sedative, diuretic, antihypertensive or anticonvulsant administered during last 4 hours? Yes □ No □
Drug: Dose: Time:
Drug: Dose: Time
Drug: Dose: Time
Other contributing factors:
Other Safety Management Event: Yes □ No □ Check all that apply below
Patient/Site
Identification
compromised
Yes □ No □ Two unique patient identifiers used- Yes □ No □
Describe:
Patient Hand-off compromised Yes □ No □
Describe:
Bloodborne Pathogens Protocol compromised Yes □ No □
Describe:
Infection Control compromised Yes □ No □
Describe:
Confidentiality/HIPAA breached Yes □ No □
Describe:
Other type event Yes □ No □
Describe:
Persons notified other than physician: include name, date and time notified
Nurse Manager:
Risk Manager:
Department Chair:
Director of Compliance and Student Support:
Additional info from faculty perspective:
Additional info from student perspective:
Evaluation/Follow-up: Please circle appropriate category(s) and document action/plan below:
□Staff discussion □Policy and procedure review □Equipment change □Counseling
□Re-education and return demonstration □Disciplinary process
□Other
Printed Name and Signature of Faculty Completing Report
Date:
Printed Name and Signature of Student
Date:
Appalachian State University
Beaver College of Health
Sciences Department of Nursing
Consent and Release Authorization Form
This form should be completed and submitted to the compliance system.
I hereby authorize Appalachian State University through its Department of Nursing (hereinafter
“University”) to provide the following information to any and all clinical facilities and training sites to
which I may request a clinical placement: criminal background check, drug testing, physical and safety
and
technical standards examination documents, immunization/titer records, TB testing records, proof of
completion of clinical education requirements including information that constitutes an
educational record
as that term is defined by the Family Educational Rights and Privacy Act (FERPA) and any other
documents required by the Affiliation Agreement between University and the clinical facility/training site.
I understand that any statements that I have placed in my records commenting on contested
information contained in the records listed above will be released along with the records to which they
relate.
I hereby release, indemnify and hold harmless Appalachian State University, the University of North
Carolina, the State of North Carolina and their respective trustees, directors, officers, agents,
representatives and employees from and against any liability or damage in connection with the release of
criminal background check, drug testing, other health information and requirements referenced above.
I understand and agree that it is my responsibility to keep the clinical requirements current for each
semester. I should keep all original documents and be prepared to show them each semester if requested
by the assigned health care facility. It is possible that participation at a particular facility may necessitate
additional screening or that additional screening may be required during the course of the program (this
may incur an additional cost at that time). I understand clinical facilities and/or training sites may refuse
to permit me to access clients/patients based on information contained in the reports and that their criteria
may differ from the criteria of the Appalachian State University’s Department of Nursing.
I further authorize the clinical facilities and/or training sites where I am placed for my clinical experience
to share any information they have regarding my participation in the clinical training program at their site
with University. I hereby release, indemnify and hold harmless the applicable clinical facility, training
site(s) and their respective officers, employees, agents, contractors, and other representatives from any
liability or damage in connection with their release of the information noted in this provision to
University.
I have the right to terminate this consent and release at any time in writing, however, I understand that
doing so will prevent the University from providing the information necessary for me to be placed at or
permitted to engage in a clinical experience.
I HAVE READ AND UNDERSTAND THIS CONSENT AND RELEASE AND AGREE THAT IT
WILL LEGALLY BIND ME AND MY ESTATE, AND I SIGN IT VOLUNTARILY.
Student Signature
Date
Name (Print)
Banner ID
Email
Check Program/Status:
Phone number
□Faculty
□BSN
□RN-BSN
□MSN
Appalachian State University Office of General Counsel JC document
Adopted 5/10/18; Revised 05/2021
61
DRUG SCREENING AND CRIMINAL BACKGROUND CHECK
ACKNOWLEDGEMENT AND AGREEMENT
APPALACHIAN STATE UNIVERSITY EDUCATION PROGRAMS REQUIRING
EXTERNAL
HEALTH OR HUMAN SERVICE AGENCIES
This form should be completed and submitted to the compliance system.
1.
I
understand
and
acknowledge
that
Appalachian
State
University (“University”)
has affiliated
with
several
health
care and human service facilities (hereinafter “Agencies”) to provide internships, field placements or clinical
experience for students (“Students”). I further understand and acknowledge that the Agencies have a compelling
interest in the integrity of their services and the health and safety of their patients, others who may come into
contact
with Students, and the Students themselves.
2.
I
understand
and
acknowledge
that
in
order
to
protect
their
interests,
many Agencies require
Students
to
comply
with their drug testing and/or criminal background check policies and to undergo drug testing and/or criminal
background checks as conditions of participation in their education programs. In addition, such Agencies often
require that Students submit to the required drug testing and/or criminal background checks at the Students’ own
expense. I understand that the University will provide Students with information to obtain the drug testing and/or
criminal background checks required by the Agencies.
3.
I
understand
and
acknowledge
that
an
Agency
may,
in
accordance
with its
policies,
reject
or expel
a
Student
from
participation
in
its
operations
on
the
basis
of results
of the
drug
testing
and/or
criminal
background
checks.
4.
I
am or
will be
enrolled
as
a
student
in
the
University’s
Nursing
program,
and
I
plan
to
participate
as
a
Student
in
an
educational
experience
at
an Agency.
5.
Because participation
in
Agency-related
educational
programs
is a
degree
requirement
for
students
in
the
Nursing
program, I understand that I may be required to undergo a criminal background check and/or drug screening as a
condition of my participation in an internship, field placement or clinical experience at an external health or human
service agency.
6.
As a
condition of participation
as
a
Student
in
the
education
program identified
above,
I
hereby agree
to
comply
with the criminal background check requirements at each Agency to which I am assigned. If the Agency facilitates
criminal background checks, I agree to comply with such requirements and follow the procedures set forth by the
Agency. If the Agency requires that I undergo a criminal background check prior to my placement, I agree to
undergo a criminal background check by a University-approved agency at my own expense. I hereby authorize
University officials to submit my original results to the Agency, which shall determine whether the results of my
criminal background check are acceptable.
7.
The
student
is
accountable
for
reporting
any
charges
of
a
misdemeanor
or
felonious
nature
that
occurs
while
enrolled in the BSN Program within 48 hours of occurrence to the Chair of the Department of Nursing. Reporting
means that the student directly contacts the Chair and requests an appointment to discuss the charges.
8.
I hereby agree to comply with the drug screening requirements at each Agency to which I am assigned. If the
Agency facilitates drug screening, I agree to comply with such requirements and follow the procedures set forth by
the Agency. If the Agency requires that I undergo independent/third party drug screening prior to my
placement, I
agree to undergo drug testing by a University-approved testing laboratory at my own expense. I herebyauthorize
any
testing laboratory performing such services to provide the test results to the University, and I further authorize the
University to submit my original results to the Agency. Each Agency shall determine whether the results of my drug
screening are acceptable.
9.
I have read both the Criminal Background Check and Drug Screening Policy (“Policy”) and this
Acknowledgement and Agreement, and I understand their contents. I have had the opportunity to ask questions of and
discuss the Policy and this Acknowledgement and Agreement with appropriate faculty and administrators in the
Department of Nursing. I understand that I am responsible for meeting the requirements set forth in the Policy and
this
Acknowledgement and Agreement.
Student’s
Signature
Date
Student’s
Printed
Name
20100324 CBC Acknowledgement and Agreement (DTC rev).docx Reviewed 5/2014(BLK APP STATE Office of General Counsel) 2014CBC_DS
Acknowledgement
and Agreement.docx; Revised 05/2021
62
Department of Nursing
PHYSICAL EXAMINATION
This form should be
completed and
submitted to the compliance system.
Students should keep a copy in their personal records for future use.
63
I understand that the APP STATE Department of Nursing will share health and immunization information with
appropriate
clinical agencies or in the event of a medical emergency.
Student
Signature:
Date:
MD/DO/NP/PA Signature:
Date:
Address:
Normal
Abnormal
Comments
General
Appearance
Skin
HEENT
Respiratory
Cardiovascular
Abdomen
Neurological
Speech
Motor
Sensory
Musculoskeletal
Muscle Strength
Gait
Extremities
Spine
Mental Health Status
Current
Medications:
Temperature:
Pulse:
Respiration:
Blood Pressure:
Height:
Weight:
Eye Exam (all fieldsmust be completed. If healthcare provider isunable to complete, options for completion should
be discussed with APP STATE Nursing Director of Compliance and Student Support)
Peripheral Vision:
Normal/Abnormal
Acuity:
Near:
Right
Eye:
Left Eye:
Correction Used: YES / NO
Far:
Right
Eye:
Left Eye:
Correction Used: YES / NO
Ishihara Color Test:
Normal/Abnormal
Correct No. of Answers:
NAME:
BANNER
ID:
This Physical Examination is to be completed by a licensed healthcare provider. Please attach any additional
documentation regarding any category below to thisform.
APP STATE Nursing Safety and Technical Form is also to be completed by the student and healthcare provider
REMEDIATION FORM: ACADEMIC
Remediation
recommendations:
•
Review material prior to coming to class as well as after class
•
•
•
•
Study in small groups
Work NCLEX questions every day (FA DAVIS or other sources)
Strive for 80% on NCLEX questions- review rationales (this is a very important part of learning to critically
think).
Work on activities provided in course textbook and associated websites.
64
GENERAL INFORMATION
Student
Name:
Date:
Report
Prepared
by:
Class:
REASON FOR REMEDIATION
ACTIONS TAKEN
▢
Level one or below ATI testing(state test )
▢
Conference with student: date
▢
Score below 77 on unit exam
▢
Review of test
▢
Writing problems
▢
Suggest study skills
▢
Critical thinking problems
▢
Discuss stress reduction strategies
▢
Stress / anxiety
▢
Review test taking principles
▢
Classroom behavior problems
▢
Suggest decreasing amount of time working
▢
Other: (Explain)
▢
Suggest balance of college activities/ academics
▢
▢
Discuss testing accommodations
▢
▢
Referral to university services (e.g. counseling, etc.)
▢
▢
Detailed Description of student need:
OTHER ACTION(S)
▢
Note on advising record:(date/s):
▢
Team meeting (date/s):
▢
Contacted course coordinator:(date/s):
▢
Other action(s):
▢
Contact undergraduate director: (Date/s):
▢
▢
Conference with Chair:Date(s):
▢
ASSIGNMENTS OR REQUIREMENT(S) FOR STUDENT IF APPLICABLE
RESULTS (INCLUDE DATE):
STUDENT SIGNATURE: DATE:
INITIATING INSTRUCTOR SIGNATURE: DATE: SIGNATURE OF F
DATE:
REMEDIATION FORM: CLINICAL
65
GENERAL INFORMATION
Student Name: Course:
Report Prepared by: Date:
Clinical facility Unit:
REASON FOR REFERRAL (CHECK ALL THAT APPLY)
▢
Lack of familiarity with clinical skill
▢
Urinary catheterization
▢
Needs increase in confidence with skill
▢
Tube feedings
▢
Needs practice with procedure: see below
▢
Fundamental skills (bedmaking/ hygiene)
▢
IV insertion/ IV therapy
▢
Vital signs
▢
Sterile technique
▢
Trach care/ suctioning
▢
Dressing change
▢
Transfer techniques
▢
NG insertion or care
▢
Behavior issues
▢
Ostomy care
▢
Dress Code Violation
▢
Medication administration
▢
Communication problems
▢
Isolation protocols
▢
Other: (Explain)
Detailed Description of student need:
PRIOR ACTION(S) TAKEN BY CLINICAL INSTRUCTOR
▢
Note on anecdotal record:(date/s):
▢
Verbal consultation(date/s)
▢
Contacted course coordinator:(date/s):
▢
Conference with Student:(Date/s):
▢
Contact undergraduate director: (Date/s):
▢
Team meeting (date/s):
▢
Conference with Chair:Date(s):
▢
Other action(s):
REQUIREMENT(S)
FOR
STUDENT
▢
Referral to skills lab
▢
Referral to administration
▢
SPEET attached and completed by:
▢
Other action (assignment, etc.) explain:
RESULTS:
STUDENT SIGNATURE: DATE:
INITIATING INSTRUCTOR SIGNATURE: DATE: SIGNATURE OF F
DATE:
Appalachian State University Department of Nursing
SAFETY AND TECHNICAL STANDARDS: EVALUATION
This form should be completed and submitted to the compliance system at the beginning of the
program, annually, and with any changes.
Name:
Last
First
MI
Mailing Address:
Street
City
State
Zip Code
1.
If you had sufficient educational preparation would you be able to perform, with or without reasonable
accommodations, the customary techniques for physical assessment such as auscultation (listening with
a
stethoscope), percussion (tapping of the chest or abdomen to elicita sound indicating the relative density
of
the body part), palpation (feeling various body parts such as the breast or abdomen with the ability to
discern the size, shape and consistency of masses), and visual observation sufficient to note such
changes
as skin and eye color, and bodypositioning as well as to use such instruments as an otoscope
(magnifying
instrument for examining the ear) and ophthalmoscope (magnifying instrument eye examinations)?
Yes (with or without accommodations)
No
2.
If you had sufficient educational preparation would you be able to perform, with or without reasonable
accommodations, basic nursing procedures such as giving injections ofmedications, inserting
intravenous
lines, transferring, lifting, and turning patients and assistingpatients in their activities?
Yes (with or without accommodations)
No
3.
If you had sufficient educational preparation would you be able to perform quickly and effectively, with
or without reasonable accommodations, such emergency procedures ascardiopulmonary resuscitation
and
suctioning of obstructedairways?
Yes (with or without accommodations)
No
4.
Are you able to communicate orallyand in writing and receive communication so as to conductpatient
interviews, to provide patient education, and to make your assessments and plans knownto others on
the
health care team?
Yes (with or without accommodations)
No
Are you able to withstand the physical and psychological rigors of nursing education and practice? Both
may entail long classroom and clinical hours, strenuous physical activity, exposure to latex and other
allergens and taking care of patients with serious illnesses, contagious diseases, terminal diseases, and
severe emotional disorders. Consistent classattendance is mandatory due to the clinical nature of the
nursing program.
5.
Yes (with or without accommodations)
No
66
6.
Can you meet the immunization requirements for nursing students as listed below? Forinformation on costs at
APP STATE Student Health Services go to: http://healthservices.appstate.edu/pagesmith/98
MMR vaccine requirement: 2 MMR vaccines given after 1
st
birthday and at least 30 days apart are required.
Tuberculosis screening requirement: Initial TB screening – 2 separate PPD tests 7-21 days apart (a.k.a.,
“two
step”). A Quantiferon Gold or T-spot blood test may also be done annually to meet this requirement if
negative.
If history of positive PPD, provider review (risk assessment). Annual TB screening is required.
DPT/Td requirement: A series of 3 doses of DPT, DTaP, or Td -- one within past 10 years; one dose Tdap
(Adacel or Boostrix) (date must be after vaccine release day of May 2005). Td repeated if Tdap is ≥10 years.
Hepatitis B vaccine requirement: A series of 3 vaccines and a positive blood titer is required, or Hep B
Declination.
Varicella/Chicken Pox Immunity requirement: If history of chicken pox disease, a positive blood titer is
required. If a student has no history of chicken pox disease, a 2-dose series of vaccine is required.
Annual Influenza Vaccine: Required by clinical facilities.
Yes
No
If No, why:
Are you able, with or without reasonable accommodations, to listen, speak, read, write, reason and perform
mathematical functions at a level which allows you to process and understand materials which are presented
to
you (in either a verbal or a written format)?
7.
Yes (with or without accommodations)
No
8.
Having read the Safety and Technical Standards for Appalachian State University Departmentof Nursing, do you
require reasonable accommodations, consistent with the Americans with Disabilities Act, to meet any of these
requirements?
Yes
No
I certify that the information submitted in this application is complete and correct to the best of myknowledge. I
understand that submission of false or incorrect information may cause my application to be rejected or may
result in my dismissal from Appalachian State University, if admitted. I understand that any request for
accommodation will be evaluated to determine the reasonableness of the requested accommodation and the
adequacy of the supporting documents.
Applicant's Signature
Date
If you have any questions regarding the above questions, please contact the Director of Compliance & Student
Support.
Health Care Provider Verification
I have reviewed the information provided by the student in this document. I have discussed this
information with the student. To the best of my knowledge, this student is able to meet the Safety and
Technical
Standards required for the nursing programatAppalachian State University.
MD/NP/DO/PA Signature: Date:
67
Department of Nursing
STUDENT
HANDBOOK
AGREEMENT FORM
This form should be completed and
submitted to the compliance system
I,
(print
name)
•
•
•
have received the academic year 2022-2023 APP STATE Department of Nursing StudentHandbook.
am aware that the handbook is available for review on the APP STATE Nursing
Department website.
have read in its entirety, the academic year 2022-2023 APP STATE Department of Nursing
Student Handbook.
acknowledge that I am responsible for its contents and for adhering to the policies therein.
•
BSN handbook
RN-BSN
Graduate
Signature
Date
68
Department of Nursing
STUDENT INFORMATION FORM
This form should be completed and
submitted to the compliance system.
This form is to be completed at the beginning of each academic year. Please print legibly.
Current information should also be maintained at:
https://registrar.appstate.edu/students/updating-personal-information
Student Information:
Full Name:
Banner ID Number: SS Number (last four digits):
Date of Birth(mm/dd/year):
Current Physical Address:
Current MailingAddress:
Permanent Mailing Address:
Phone Number(s) Cell: Other:
APP STATE Email:
Personal Email:
Emergency Contacts
Emergency Contact Name (1):
Emergency Contact Phone Number (1):
Emergency Contact Name (2):
Emergency Contact Phone Number (2):
Vehicle Information
Revised 05/2017; 05/2018; 07/2019; 05/2021
69
Tag Number Make Model Year Color State
Department of Nursing
Tuberculosis Risk Assessment
For individuals with a history of a positive TB test
This form should be completed and submitted
to
the compliance system as directed.
NAME
(printed)
: DATE:
Please answer the following questions and provide additional information for any YES answers.
YES
NO
1. Were you born outside the USA in one of the following parts of the world:
Africa, Asia, Central America, South America, or Eastern Europe?
2. Have you traveled outside of the USA and lived for more than one month
in Africa, Asia, Central America, South America, or Eastern Europe?
Date and duration of last travel to these countries:
3. Do you have a compromised immune system such as from any of the following
conditions: HIV/AIDS, organ or bone marrow transplantation, diabetes,
immunosuppressive medications (e.g. Prednisone, Remicade), leukemia, lymphoma
cancer or the head or neck, gastrectomy or jejunal bypass, end stage renal disease
(on dialysis), or silicosis?
Date of onset of any of the above conditions:
4. Have you ever done one of the following: used crack cocaine, injected illegaldrugs,
worked or resided in a jail or prison, worked or resided in a homeless shelter, or
worked as a healthcare worker in direct contact with patients?
YES
NO
YES
NO
YES
N
Date of use of any of the above conditions:
5. Have you experienced any of the following symptoms in the past year?
Have you followed up with your health care provider regarding any categories with “yes” answers?
YES
Answers of “Yes” should be discussed with the APP STATE Nursing Director of Compliance and
Student Support
Date of last CXR (or not applicable(n/a)):
NO
Radiologist Report submitted to APP STATE Nursing Program:
YES
NO
Date completed medication for active or latent tuberculosis (or not applicable (n/a)):
This information will be evaluated and you may be required to have a statement of clearance to
participate in clinical from a healthcare provider of your choice.
The above information is accurate to the best of my knowledge.
Student signature: Date:
Reviewed by: Date:
Reviewer Signature:
70
Symptoms
YES
NO
Symptoms
YES
NO
Fatigue
Night sweats
Weight loss
Low grade fever
Loss of appetite
Chest pain
Weakness
Bloody sputum
Persistent cough**
Prolonged period of “just not feeling well”
Department of Nursing
Tuberculosis Testing Record: Annual
This form should be completed and submitted to
the compliance system.
I understand that the Department of Nursing at Appalachian State University will share health and
immunization information with appropriate clinical agencies or in the event of medicalemergency.
Signature: Date:
71
APP STATE Box 32151, Boone, NC 28607-2151
Please copy for your records before turning in to nursing office.
Name: Banner ID #:
TUBERCULOSIS (TB) SCREENING TEST:
Annually (364 days or less after initial tb testing) one of the following is required:
One tst or
IGRA test for tuberculosis.
Upon request of a clinical agency, additional TB testing may be required.
TST 0.1ml intradermal in the left arm.
READ IN 48-72 HOURS.
Date/Time administered:
By: _ Date/Time read:
Results: mm
By: _
OR
IGRA (Quantiferon Gold or T-Spot)
Date and Results:
Attach an official copy of the results to this form.
Chest x-ray required if any TB screening test is positive, yearly for two years after first
converting to positive. And every 5-6 years thereafter.
Date of x-ray: Absence of active disease: Yes No
Attach Radiology Report and fill out Annual Tuberculosis Surveillance Questionnaire.
If medication for latent tuberculosis has been completed, documentation should be provided.
Comments:
Provider Signature: Date:
Nurse, MD, PA, FNP who completed any of the above
Address:
Department of Nursing
Tuberculosis Testing Record: Initial
This form should be completed and submitted to
the compliance system.
72
STUDENT:
I understand that the Department of Nursing at APP STATE will share health and immunization
information with appropriate clinical agencies or in the event of a medical emergency.
Signature:
Date:
Interferon Gamma Release Assay (IGRA: QuantiFERON Gold or T Spot)
Date
lab
obtained:
Time:
Lab Name:
Lab Address:
A
Chest X Ray (CXR) required for any positive tuberculosis screening test
Date of CXR:
A
Tuberculosis
Risk
Assessment
completed
and
attached
to
this
form
PROVIDER COMPLETING FORM (May by RN, MD, DO, NP, or PA)
Provider Name: Provider Signature: Provider
Address:
Provider
Phone:
Tuberculin skin Test (TST) Tuberculin skin Test (TST) 7-21 days after test #1
Administered
0.1
intradermal
Administered
0.1
intradermal
Date: Time: Date: Time:
L
Date: Time: Date: Time:
R
NAME:
Banner ID:
Department of Nursing
Universal Confidentiality Agreement
This form should be completed and submitted
to the compliance system.
I have read, understand and agree to comply with the Appalachian State University Department of
Nursing Universal Confidentiality Policy.
•
Further, I will read and comply with all University, and agency/facility policies and
standards relative to confidentiality and information security.
•
I understand and agree that violation of the Universal Confidentiality Policy may constitute
grounds for corrective action up to and including loss of agency privileges, academic or
employment suspension, or termination from the Nursing Department in accordance with
applicable agency/facility, Department or University procedures, as set forth in the Policy.
•
I also understand and agree that unauthorized release of confidential information may subject me
to personal, civil, and/or criminal liability and legal penalties.
•
I further understand that violation of this policy by any member of the University’s student body,
faculty or staff may constitute grounds for termination of the contractual relationship or other
terms of affiliation between the University and the agency.
BSN
RN-
BSN
MSN
Student from other institution
Faculty
Visitor
Printed Name
Signature
Date
73
