Download Mandatory Requirement Packet

Mandatory Requirements Information
All charges/ costs are the responsibility of the student. You will not be ALLOWED to BEGIN the nursing program or
ATTEND clinicals if these requirements are not submitted by the 1st of August each year.
Initial Requirements to be submitted when entering the Nursing Program
Requirements
Description
CPR for Health Care
Providers
CNA Certification
Must be American Heart Association BLS- Instructor
Led Training (valid for (2) years)
Certification must be completed PRIOR to entering the
Nursing Program. Provide a copy of card front and
back. Exception: LPN or RN’s submit a copy of your
license.
IW DoN suggests the Alcohol and Drug Dependency
Service (ADDS). Offices are in Mount Pleasant,
Burlington, Wapello, and Fort Madison. Charges
apply.
Sophomores: Due PRIOR to beginning of the Fall term.
Transfer Students: Due PRIOR to beginning of first
nursing course.
IW DoN recommends use of the Area Education
Association (AEA) website. To register go to,
www.aea11.k12.ia.us. Click on Mandatory and Nonmandatory training; then “click here to enter”; register
into the system and complete registration (under
Current AEA, select Pay customer) and submit. Follow
the prompts for Mandatory Reporting of Abuse course.
It covers Child and Dependent Adult abuse training.
After you complete the course, you will need to go back
into the site in 3-4 days and print your certificate. Once
completed the certificate is good for 5 years. Takes 1 to
2 hours to complete. Charges apply.
Drug Screen
Mandatory Reporting :
Child and Dependent
Adult Abuse Training
Criminal Background
Check and Dependent
Adult and Child Abuse
Registry search
Castle Branch is IW DoN required search company.
Use link https://castlebranch.com Top right side of
page you will select place order. Next page you will
enter the Package code OW 78 (Capital O, Capital W).
Alternate access is
https://portal.castlebranch.com/OW78. Remember to
print order confirmation page. There will be extra
Completed
Copied (The
Division of
Nursing
Requires all
Students to
maintain the
originals and
Provide a
COPY to the
DoN)
Office of Inspector
General Search
Excluded Parties Search
Immunizations
paperwork to complete for the Child Abuse and the
Dependent Adult Abuse Registry checks. For prelicensure students, begin by June 1 as it takes time to
get the results. You will need to enter the site after a
week and check weekly until all three (3) reports are
complete. Print the report and send it to the Division of
Nursing. NOTE: Takes 2 to 3 weeks for records to
process. Please allow ample time for completion.
Charges apply.
On the website, www.oig.hhs.gov, go to Exclusions
then Online Searchable Database; enter last and first
name then Search; Print results- should be “no results
were found”. Print page. No charge for the search.
Please allow 5 minutes to complete.
The site is:https: //www.sam.gov/portal/public/SAM.
Under the right hand side blue box, click Search
Records. In the first box that says “Enter your specific
search term”, enter your full name: first, middle, last.
Then click on Search. Print out the next page reportshould be “no records found for current search”. There
is no charge for the search. Please allow approximately
5 minutes to complete
Submittal of Immunizations are done only ONCE with
the EXCEPTION of the Flu vaccine.
Hepatitis B. A series of three(3) or titer showing
immunity.
Measles, Mumps, Rubella (MMR): A series of (2) or
titer showing immunity.
Diphtheria, Tetanus, and Pertussis (DTP or DTaP)
Must be within the last 10 years
Varicella. A series of (2) or a titer showing immunity.
Proof of Health Insurance
2 Step TB Skin Test or
Quantiferon Lab Draw
In 2 Step TB Test a person
is given a baseline PPD test.
If the test is (-), a second
test is administered 1- 3
weeks later (i.e. the second
test can be read 7-21 days
after the first). If the second
test is negative, the person is
considered uninfected.
Physical Exam
Core Performance
Standards Document
Flu Vaccination
Universal Precautions,
Blood Borne Pathogens &
HIPAA training
Submit copy of current insurance card front and back.
2 Step TB skin test or quantiferon (lab draw) to show +
or -.
BUT
If you have had a positive skin test in the past
OR
Lived in a region of the world where you were
immunized for Tuberculosis.
THEN
Include a chest x-ray report, or Health Care Provider
Documentation, quantiferon (lab draw) to show + or -.
IW DoN has a preferred physical form which is
attached to this packet.
Sign, Date and turn in the ORIGINAL Document.
Keep a copy for your records
Flu vaccinations or waiver from Health Care Provider
(Flu Vaccine is free in the fall term at IW)
Please use the link to access two separate instructional
documents. http://www4.csudh.edu/son/info/hipaaprecautions/index
After reading each document please take the
accompanying quiz. When you have passed each test
with an 80% or higher. Please follow the instructions to
print out each certificate. The certificate for Universal
Precautions and Blood Borne Pathogens is your proof
of attendance for the morning session of the Mandatory
Meeting. The HIPAA training certificate is proof of
attendance for the afternoon session. Attendance will be
taken in both the AM and PM sessions. Attendance is
MANDATORY for both sessions.
Submit only copies of all documentation that supports the dates you record. DO NOT SUBMIT ORIGINALS with the
exception being the Core Performance Standards Document. You need to keep them in your own file. You will need
these for future employment.
The deadline for ALL mandatories is no later than the 1st of August each year. Acceptable methods of submittal are: in
person, by mail or all documents can be scanned and submitted via email.
Return All Completed Documentation to:
Iowa Wesleyan University
Alexandria A. Holtkamp
Administrative Assistant DoN
601 North Main Street
Mount Pleasant, IA 52641-1398
or Email: [email protected]
Please be aware of the following:
Pursuant to Iowa Code 655IAC:
2.8(5) Nursing courses with a clinical component.
The nursing program shall notify students and prospective students in writing that nursing courses with a clinical
component may not be taken by a person:
a. Who has been denied licensure by the Iowa Board of Nursing.
b. Whose license is currently suspended, surrendered or revoked in any United States jurisdiction.
c. Whose license/registration is currently suspended, surrendered or revoked in another country
due to disciplinary action.
Margaret Trousil, DNP, RN
Chair & Assistant Professor of Nursing
Iowa Wesleyan University
601 N Main
Mt. Pleasant, IA 52641
Office: 319-385-6343
Email: [email protected]
7/11, 1/12, 3/13, 06/14, 7/14, 4/15, 6/15, 4/16 Revised 5/16
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Mandatory Requirements Information
All charges/ costs are the responsibility of the student. You will not be ALLOWED to BEGIN the nursing program or
ATTEND clinicals if these requirements are not submitted by the 1st of August each year.
ANNUAL Requirements for RETURNING Students
Requirements
Description
Proof of Health Insurance
Submit copy of current insurance card front and back.
2 Step TB Skin Test or
Quantiferon Lab Draw
2 Step TB skin test or quantiferon (lab draw) to show +
or -.
BUT
If you have had a positive skin test in the past
OR
Lived in a region of the world where you were
immunized for Tuberculosis.
THEN
Include a chest x-ray report, or Health Care Provider
Documentation, quantiferon (lab draw) to show + or -.
In 2 Step TB Test a person
is given a baseline PPD test.
If the test is (-), a second
test is administered 1- 3
weeks later (i.e. the second
test can be read 7-21 days
after the first). If the second
test is negative, the person is
considered uninfected.
Physical Exam
Core Performance
Standards Document
Immunizations
Flu Vaccination
Universal Precautions,
Blood Borne Pathogens &
HIPAA training
IW DoN has a preferred physical form which is
attached to this packet.
Sign, Date and turn in the ORIGINAL Document.
Keep a copy for your records
Varicella. A series of (2) or a titer showing immunity.
Diphtheria, Tetanus, and Pertussis (DTP or DTaP)
Must be within the last 10 years
Flu vaccinations or waiver from Health Care Provider
(Flu Vaccine is free in the fall term at IW)
Please use the link to access two separate instructional
documents. http://www4.csudh.edu/son/info/hipaaprecautions/index
After reading each document please take the
accompanying quiz. When you have passed each test
with an 80% or higher. Please follow the instructions to
print out each certificate. The certificate for Universal
Precautions and Blood Borne Pathogens is your proof
of attendance for the morning session of the Mandatory
Completed
Copied (The
Division of
Nursing
Requires all
Students to
maintain the
originals and
Provide a
COPY to the
DoN)
CPR
Mandatory Reporting :
Child and Dependent
Adult Abuse Training
Meeting. The HIPAA training certificate is proof of
attendance for the afternoon session. Attendance will be
taken in both the AM and PM sessions. Attendance is
MANDATORY for both sessions.
Must be American Heart Association BLS- Instructor
Led Training (valid for (2) years)
Please check the expiration date of your Mandatory
Reporting Certificate. It is valid for 5 years.
Submit only copies of all documentation that supports the dates you record. DO NOT SUBMIT ORIGINALS with the
exception of the Core Performance Standards Document. You need to keep them in your own file. You will need these
for future employment.
The deadline for ALL mandatories is no later than the 1st of August each year. Acceptable methods of submittal are: in
person, by mail or all documents can be scanned and submitted via email.
Return All Completed Documentation to:
Iowa Wesleyan University
Alexandria A. Holtkamp
Administrative Assistant DoN
601 North Main Street
Mount Pleasant, IA 52641-1398
or Email: [email protected]
Please be aware of the following:
Pursuant to Iowa Code 655IAC:
2.8(5) Nursing courses with a clinical component.
The nursing program shall notify students and prospective students in writing that nursing courses with a clinical
component may not be taken by a person:
a. Who has been denied licensure by the Iowa Board of Nursing.
b. Whose license is currently suspended, surrendered or revoked in any United States jurisdiction.
c. Whose license/registration is currently suspended, surrendered or revoked in another country
due to disciplinary action.
Margaret Trousil, DNP, RN
Chair & Assistant Professor of Nursing
Iowa Wesleyan University
601 N Main
Mt. Pleasant, IA 52641
Office: 319-385-6343
Email: [email protected]
7/11, 1/12, 3/13, 06/14, 7/14, 4/15, 6/15, 4/16 Revised 5/16
Iowa Wesleyan University
Division of Nursing
Health History
Complete this portion before going to your primary health care provider for examination. Please print.
Student’s name (last, first, middle)
____________________________________________________________________________________________
Home address ____________________________________________________________________________________________
City __________________________________________ State _____________ Zip code _____________________
Telephone number ______________________________________
Student’s cell phone number ______________________________
Social Security number ___________________________________
Mother’s Maiden Name___________________________________
❑ Female ❑ Male
Date of birth _____________
Expected graduation year ___________
Marital status __________
Residence Plan:
❑ On campus
❑Commute
Emergency Information
Name ________________________________________________________________________________________
Relationship____________________________________________
Address ______________________________________________________________________________________
Telephone number _______________________________________
Accident and/or Health Insurance
Insurance company name
_____________________________________________________________________________________________
Insurance company address
_____________________________________________________________________________________________
Agreement/Policy number (include letters) __________________________________________________________
Group number ______________________________________________
Name of insured _____________________________________________
Relationship ________________________________________________
Family Medical History
Check the appropriate box if any of the following apply to your family.
Disease Relationship
Alcoholism/Drug Addiction ____________________________________________________________________
Cancer _____________________________________________________________________________________
Diabetes ____________________________________________________________________________________
Heart Disease _______________________________________________________________________________
High Blood Pressure __________________________________________________________________________
Emotional/Mental Illness ______________________________________________________________________
Stroke _____________________________________________________________________________________
Other (specify)_______________________________________________________________________________
❑
❑
❑
❑
❑
❑
❑
❑
Personal Medical History
Have you ever had any of the following medical problems?
Anemia
Anorexia Nervosa
Asthma
Bleeding Trait
Bulimia
Cancer
Chicken Pox
Chronic Inflammatory Bowel Disease
Diabetes
Emotional/Mental Illness
Fractures (type: ______________________)
German Measles (Rubella)
Head Injury or Concussion
Hepatitis (type: ______________________)
Hypertension (high blood pressure)
Joint/Muscle/Tendon Problem
(Type: ________________________________)
Kidney Stones
Measles (Rubella)
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑
❑ Mumps
❑ Obesity
❑ Mononucleosis
❑ Pelvic Infection
❑ Peptic Ulcer
❑ Phlebitis
❑ Polio
❑ Prostatitis
❑ Rheumatic Fever
❑ Seizure Disorder (Epilepsy)
❑ Tuberculosis
❑ Urinary Tract Infection
❑ Sexually Transmitted Disease
❑ Other (specify):
______________________________________
❑
Yes
No
Are you being treated for any medical condition?
Please specify: _________________________________________________________________________________
❑
❑
Are you taking any medication?
Yes
No
Please specify: _________________________________________________________________________________
❑
❑
Do you have now, or have you ever been told, that you have a heart condition?
Yes
No
Please specify: _________________________________________________________________________________
❑
❑
Yes
No
Have you ever experienced chest pain, dizziness or loss of consciousness during or after exercise?
Please specify: _________________________________________________________________________________
❑
❑
Has anyone in your family experienced a sudden, serious cardiac event before the age of 40?
Yes
No
Please specify: _________________________________________________________________________________
Allergies
Are you allergic to anything – including prescription medications, over-the-counter medications, foods, insects, environmental,
inhalants?
Please specify allergy and reaction.
No known allergies
Allergic to: ___________________________________________________________________________________
_____________________________________________________________________________________________
Reaction: _____________________________________________________________________________________
_____________________________________________________________________________________________
❑
Student’s signature ____________________________________________________________
Date ___________________
21.
Physical Examination
This section is to be completed by the primary health care provider. Please print.
Student’s name (last, first, middle)
_____________________________________________________________________________________________
Blood Pressure _________ / __________ Pulse ___________ Height ___________ Weight ___________
Visual Acuity (R) 20/ ____________ (L) 20/____________
Systems Review
Normal Abnormal Describe Abnormalities
Skin ______ _______ ___________________________________________________________________________
HEENT ______________________________________________________________________________________
Lymph Nodes ______ _______ ___________________________________________________________________
Neck ______ _______ __________________________________________________________________________
Heart ______ _______ __________________________________________________________________________
Lungs ______ _______ __________________________________________________________________________
Back ______ _______ __________________________________________________________________________
Breasts ______ _______ _________________________________________________________________________
Abdomen ______ _______ _______________________________________________________________________
Genitalia (Male) ______ _______ _________________________________________________________________
Pelvic (Female) ______ _______ __________________________________________________________________
Rectal ______ _______ _________________________________________________________________________
Musculoskeletal ______ _______ _________________________________________________________________
Neur/Psych ______ _______ ____________________________________________________________________
General Comments
Recommendations for physical activity
Unlimited __________ Limited __________ Explain: ________________________________________________
_____________________________________________________________________________________________
Do you have any recommendations regarding the care of this patient?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Is this patient now under treatment for any medical or emotional condition?
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Primary Health Care Provider’s Information
PHCP’s Name ______________________________________________________________________________
Telephone number (_________) _________________________
Address ______________________________________________________________________________________
PHCP’s Signature ___________________________________________________________________________
Date ________________________________________________
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Core Performance Standards
All nursing students are expected to have the capability to complete the entire nursing curriculum. The nursing curriculum requires demonstrated proficiency in a
variety of skills. All students should be able to perform each of the activities with or without reasonable accommodations.
ISSUE
STANDARD
EXAMPLES OF NECESSARY ACTIVITIES (not all inclusive)
Critical
thinking
Critical thinking ability sufficient for clinical
judgment
Identify cause-effect relationship in nursing clinical and classroom situations.
Predict outcomes based on plans of care for clients across life span.
Differentiate extraneous data from pertinent data.
Synthesize theory and apply to client care situations.
Analyze and synthesize information to support or defend a position.
Calculate prescribed drugs.
Make safe judgments.
Interpersonal abilities
Interpersonal abilities sufficient to interact with Function in groups.
peers and faculty.
Establish rapport and therapeutic relationships with clients.
Maintain professional boundaries.
Communication
Communication abilities sufficient for
interaction with others in verbal and written
form.
Express ideas/thoughts and receive those of others in classroom and clinical setting.
Explain treatment procedures, initiate health teaching, document and interpret nursing
actions and client response.
Mobility
Gross motor abilities to move from room to
room, maneuver in small spaces.
Move around in client’s room, work spaces, and treatment areas, perform
cardiopulmonary procedures, assist in ambulation, lift and transfer clients (suggested
minimum of 50 lbs.).
Possess sufficient mobility and stamina to function in a clinical setting for a given period
of time.
Fine motor skills
Manual dexterity sufficient to provide safe and
effective care.
Complete examinations/evaluations by writing, typing, or demonstration.
Calibrate and use equipment .
Hearing
Auditory ability sufficient to monitor and
assess health needs.
Hear basic conversation, monitor alarms, emergency signals, ausculatory sounds, and
cries for help.
Visual
Visual ability sufficient to monitor and assess
health needs.
Read documents (charts, lab reports).
Read calibrations of syringes, sphygmomanometer, thermometers, equipment output
(waves, printouts, digital readings).
Observe client behaviors (color changes, nonverbal communication).
Tactile
Tactile ability sufficient for physical
assessment
Perform palpation, percussion, functions of physical examination and/or those related to
therapeutic intervention, assess temperature changes.
Emotional stability
Emotional stability sufficient to assume
responsibility/accountability for actions.
Respond appropriately to suggestions for improvement.
Accept criticism.
Health
Characteristics that would not compromise
health and safety of clients.
Minimize exposure to and seek appropriate treatment for communicable diseases.
Accountability &
Responsibility
Demonstrate accountability and responsibility
in all aspects of nursing practice
Able to distinguish right from wrong, legal from illegal and act accordingly
Accept responsibility for own actions
Able to comprehend ethical standards and agree to abide by them
Consider the needs of patients in deference to one’s own needs
Adapted from:
REB Council on Collegiate Education for Nursing. (March, 1993). The Americans with Disabilities Act: Implications for nursing education. [On-line]. Available:
http://www.sreb.org/programs/nursing/publications/adareport.asp
The above statement of criteria is not intended as a complete listing of nursing practice behaviors, but is a sampling of the types of abilities needed by
the nursing student to meet program objectives and requirements. The DoN (DON) or its affiliated agencies may identify additional critical behaviors
or abilities needed by students to meet program or agency requirements. The DON reserves the right to amend this listing based on the identification
of additional standards or criteria for nursing students.
Students who are unable to meet core performance standards cannot meet objectives for clinical courses; therefore, cannot meet course requirements.
Students must withdraw from the program and may apply for readmission at such time that he/she is able to meet the core performance standards
required for the practice of nursing.
If you are unable to fully meet any criterion, you will need to make an appointment with the Chair of the DON.
I have read and I understand the above Core Performance Standards. To the best of my knowledge, I am able to meet all these criteria.
__________________________________________
______________________
Signature
Date