TRENT/FLEMING SCHOOL OF NURSING
NURS 4021C: Independent Nursing Practice B
Symons Campus/Peterborough AND George Brown site
Fall 2015
Faculty Advisors:
Email:
Phone:
Dr. C. Thibeault
cthibeault@trentu.ca
7057481011 ext 7067
Course Coordinator: Dr. Catherine Thibeault, RN
Office:
Life and Health Sciences C162
Secretary:
Laura Jackson
School of Nursing Office
Office Location:
Life and Health Sciences C140
Email: cthibeault@trentu.ca
Email
nursing@trentu.ca
Telephone:
705-748-1099
Calendar Description
Clinical practice to consolidate nursing practice competencies integrating knowledge and skills.
Using a theoretical approach that is relevant to the practice setting, students assume increasing
responsibility for patient care assignments in a fully preceptored model.
Prerequisite(s)
 Documentation satisfactory to the School of Nursing related to completion of all nonacademic requirements, submitted a minimum of 20 business days prior to the start of
the term
 Successful completion of NURS 4020C.
Co-requisite

STUDENTS IN NURS 4021 AND GRADUATING IN DECEMBER MUST HAVE A FLU SHOT
BY November 27, 2015 at 4:00 pmNon Academic Requirements that expire before
January 6, 2016 are due BY November 27, 2015 at 4:00 pm.
Required Resources
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Student Handbook
Preceptor Handbook
Evolve Case Studies: Complete RN Collection (same access code as used in NURS 4020)
College of Nurses of Ontario National Competencies in the Context of Entry Level
Registered Nurse Practice
College of Nurses of Ontario Clinical Practice Guideline: Supporting Learners
There are no required texts for this course. It is expected that students will consult reference
materials (textbooks, drug manuals, professional journals and Internet sources) for information
directly related to their clinical practice on an ongoing basis throughout the term.
Blackboard is available for this course on the Trent system. Documents available online:
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Course syllabus
Evolve instruction sheet for case study program
Preceptor handbook containing all evaluation forms
Incident Form (injury)
Blood contact form
Course Objectives
At the completion of a period of clinical practice under the guidance of a Registered Nurse
preceptor, and within the expected knowledge, skills and abilities of a fourth year BScN student
from Trent/Fleming School of Nursing, the learner will be able to correctly and continually:
1. Demonstrate professional conduct in accordance with College of Nurses of Ontario
standards for nursing practice and ethics:
a. Critically appraise own practice in relation to nurse-client/family interactions and
as a member of the health care team
b. Demonstrate accountability and acceptance of responsibility for one’s own
actions and decisions
c. Demonstrate a professional presence and models professional behaviour
d. Consistently identify self by first and last name, and appropriate designation to
clients and the health care team
e. Display initiative, confidence and self-awareness
f. Demonstrate effective collaborative problem-solving strategies, including
conflict resolution
g. Participate in professional development based on reflective practice and critical
inquiry
2. Demonstrate knowledge that the student’s primary duty is to the person requiring
nursing care, to ensure safe, competent, ethical nursing care
a. Recognize individual competence within scope of practice and seek support and
assistance as necessary
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b. Advocate and intervene, as needed, to ensure safety of the person requiring
nursing care
3. Demonstrate safe, competent and ethical nursing practice in the area of relational
practice:
a. Engage in critical self-reflection
i. Evaluates own emerging competence in the area of relational practice
ii. Identifies barriers to development
iii. Prioritizes learning in the area of relational practice
b. Engage in therapeutic, caring, and culturally safe relationships
c. Effectively use self to initiate, maintain and terminate relationships
d. Demonstrates the intentionality of nursing by demonstrating sensitivity and
empathy, listening and questioning, creating mutuality and reciprocity in
relationships
e. Advocate for persons requiring nursing care
f. Work collegially and in concert with other health professionals
4. Demonstrate safe, competent and ethical nursing practice in the area of clinical
decision-making:
a. Continuously demonstrates critical inquiry, scientific inquiry, and clinical
reasoning:
i. Utilize diverse sources of knowledge and ways of knowing in the practice
of nursing
ii. Informed by the discipline of nursing, integrates nursing knowledge, with
knowledge from the basic sciences, health sciences, humanities,
research, and ethics
iii. Analyzes, evaluates, and applies models, theories, and frameworks from
the discipline of nursing
iv. Compares and contrasts personal approaches to critical inquiry and
clinical reasoning with those of expert nurses
v. Identifies strategies for developing expertise
5. Demonstrate safe, competent and ethical nursing practice in the area of planning,
implementing and evaluating nursing care:
a. Use the nursing process to recognize, gather and analyze relevant data from
multiple sources in order to develop and implement a plan of care
b. In collaboration with the person requiring nursing, integrate the nurse’s
knowledge with the person’s knowledge and preferences, and factors within the
health care setting to plan and evaluate outcomes of care
c. Utilize evidence to inform nursing actions
i. Identifies gaps in current knowledge
ii. Seeks and evaluates evidence to support nursing process
d. Assess outcomes of nursing practice using evidence-informed approaches
e. Encourage collaborative interactions within the nursing and health care team,
with the person requiring nursing care as the center of the health care team
f. Collaborate with other health care providers and the person requiring nursing to
assess outcomes of health care using evidence-informed approaches
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6. Demonstrate enhanced knowledge of nursing and health related to indigenous
populations, women's and environmental health, and aging and rural populations.
7. Independently perform care of patients, within the BScN student's scope of practice
a. By midterm, the student should be able to manage a full and reasonable patient
assignment in the preceptor’s practice setting
Format
Course Orientation
Course orientation activities and specific clinical facility orientation (where applicable) must be
completed before beginning clinical placement hours. Orientation activities are mandatory.
Students who do not participate will not be permitted to attend clinical, will be removed from
the clinical setting and de-registered from the course.
Course orientation activities, which must be completed prior to beginning in the clinical
placement setting, include:
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viewing an on-line Panopto Webcast (Note: you must view the Panopto on a PC as it will
not register if you use a mobile device such as an iPad, smartphone or some laptops);
this must be completed prior to your first clinical shift or not later than 1200 hours
September 9th, 2015 whichever comes first
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meeting with your faculty advisor to discuss expectations for this clinical experience
(depending upon the individual circumstances this may occur by SKYPE or FaceTime)’
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providing your faculty advisor with your contact information, and as soon as available
your preceptor name and contact information as well as your schedule for clinical shifts.
Students are advised that entering clinical practice without completing these requirements is
considered by the School of Nursing to constitute professional misconduct, as defined in the
Student Handbook.
Nursing Practice
The scheduling of the practice experience will vary depending on the availability of the
preceptor, dates of placement and other enrolled classes and may include any or all of day,
evening, weekend and statutory holiday rotations. Students are expected to follow the clinical
practice rotation of their preceptor and practice in accord with agency policy. Students may be
in the clinical setting during Reading Week.
The placement involves the completion of 300 clinical hours, with a maximum of 308 hours,
over the course of the semester. The end date of the course, December 9th, 2015, as
established in the academic calendar, will not be extended to accommodate completion of
hours except in exceptional circumstances and as approved in advance by the course
coordinator.
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Students WILL NOT front load or bank clinical hours such that they complete the required hours
in advance of the end of the term and/or create extended periods during the term where they
are not engaged in practice. Depending on their placement shift hours students are expected to
be in practicum each week of the semester, on average two to three times/week. Students are
not expected to complete the required hours prior to week 11 (week 12 if in practice during
reading week). The student will have completed between 45 and 55% of the required hours by
the midterm evaluation.
The student will follow the assigned preceptor’s schedule, however WILL NOT exceed 72 hours
in any two week period. If changes need to be made due to special circumstances, these must
be approved by the faculty advisor.
For students contemplating holding a part time job during the clinical rotation, please be
advised that the School strongly recommends against this practice. Full time employment
cannot be accommodated within the requirements of the course. In the event that the student
decides to be engaged in part time employment, the combination of hours between the clinical
course and employment WILL NOT exceed 80 hours in any two week period. Students who
work in excess of this place patients, themselves, colleagues and organizations at risk due to
overwork and fatigue. Students in this situation will be considered to in a situation of
professional misconduct and will be removed from clinical practice.
The student will file in the course drop box, at midterm and at final, a detailed timesheet signed
by the student and the preceptor indicating the days and hours of each shift in the clinical
experience.
Learning Centre
Time may be made available for skills review during the term based for specifically assessed
needs of an individual student. Assessment will be provided by the student/preceptor. Use of
the skills lab is subject to approval by the Faculty Advisor and availability of space. Please
contact Kelly Hudder (kellyhudder@trentu.ca) if you require assistance.
Contact with Faculty Advisor
1. Students are expected to maintain regular, ongoing contact with their faculty advisor
throughout the placement. At a minimum, students must provide written
documentation outlining their activities/learning at least weekly. It is expected that this
reporting will be sufficiently detailed to provide a clear view of the student’s progress
and will demonstrate both reflection and critical thinking on the part of the student.
2. The student will meet with the faculty advisor at the start of term, at midterm and for
final evaluation. Meetings may be in person in the clinical setting, at Trent University, or
may be conducted by phone or video conference (for example, Skype or Face Time).
3. Students are required to return to Trent University to meet with their faculty advisor in
the event that there is a situation judged by the faculty advisor to be serious enough to
warrant a face to face discussion.
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4. It is the student's responsibility to provide the faculty advisor with an up-to-date
schedule of shifts for the full term well in advance of the schedule beginning. In
addition, the student must notify the faculty advisor in writing in advance of any
changes to the schedule due to special circumstances (i.e. illness).
5. Students must notify their preceptor by email and phone of any unscheduled absence
before the scheduled shift beings. The faculty advisor must also be notified at that time
(i.e. before the absence) by email. It is the expectation that any missed time will be
rescheduled within the defined time limits of the course such that the students are able
to meet clinical hours required in this course.
6. Students must notify their faculty advisor of untoward events (incidents) the day of
occurrence by email and phone. Preceptors must also be notified the day of the event.
Methods of Evaluation
All assignments are due in their respective Blackboard drop box on the dates and times
stipulated. Meeting these deadlines has a direct impact of your ability to meet course
objectives and demonstrate clinical competency in the professional accountability and
responsibility.
Failure to meet due dates and assignment expectations in this course will result in an
“unsatisfactory” evaluation in the accountability criterion and/or an overall FAIL at midterm
and/or final evaluation for this clinical course. Final decision for course success/failure rests
with the clinical Faculty Advisor.
Item
Scholarly
paper:
Knowing for
Nursing
Practice
Weight
70% or
higher =
Pass
69% or
lower =
Fail
Evolve Case
Studies –
Fundamentals
Choices
75% or
higher on
each =
Pass
74% or
lower on
any one =
Fail
Pass/Fail
Midterm
Evaluation
Description
The learner will choose one theme and one foci
from the BScN curriculum framework and discuss
the how the learner used these core curriculum
concepts when working with/caring for the client.
In a paper of no more than 2000 words, the learner
will synthesize knowledge and evidence from
multiple sources, including the client’s perspective,
to demonstrate critical elements of the theme and
focus.
The student will submit a word document that
identifies the three chosen case studies selected
specifically from the Fundamentals section.
Due Date
November 27th, 2015
at 1600
The student will be required to complete the three
on-line case studies achieving a minimum mark of
75%.
All three cases
completed by
October 12th, 2015
by 1600
Midterm selfevaluation and
While clinical evaluation is an ongoing process, a
formal written mid-term evaluation will be
Selection of Cases:
September 17th 2015
by 1200
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completed by the student, preceptor, and faculty
advisor. The student will first complete the selfassessment then submit it to their preceptor for
his/her comments.
preceptor feedback
due:
October 15th , 2015
by 1200
It is expected that the student and preceptor will
include specific and detailed evidence to support
the evaluation of the student's current level of
competence including both strengths and areas in
need of improvement. The student will combine
these two evaluations into one word document
and submit the document via the Blackboard
A signed copy (student and preceptor) of the
timesheet hours completed and planned up to and
including February 15, 2015 must also be
submitted on Blackboard.
Faculty advisor
evaluation:
October 23rd, 2015
The faculty advisor will review the document(s)
with the student and provide a summative
evaluation which will be returned to the student
via Blackboard.
Evolve Case
Studies –
Elective
Choices
75% or
higher on
each =
Pass
Portfolio
Update
74% or
lower on
any one =
Fail
Pass/
Fail
Final
Evaluation
Pass/Fail
The student will submit a word document that
identifies the three chosen case studies. These
case studies must be relevant to the student’s
practice area.
The student will be required to complete the three
on-line case studies achieving a minimum mark of
75%.
Additions and changes to the student's portfolio
will be reviewed with the faculty advisor at the end
of term. This cumulative work should reflect
growth and development throughout their nursing
education.
Final evaluation will be the same process as for the
midterm. The faculty advisor will meet with the
student to review both the work of the term and
final outcomes. The student is then expected to
arrange a meeting with their faculty advisor within
the last 10 days of the term for the final summative
evaluation.
Selection of cases:
November 2nd, 2015
All three cases will be
completed by
November 27th, 2015
Via Blackboard
December 9th, 2015
Final evaluation:
Student selfevaluation and
preceptor evaluation
due:
December 9th, 2015
Faculty advisor
Evaluation:
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December 18th, 2015
Notations
 Successful completion of the course requires a “PASS” and/or the defined minimum in each
element. A “PASS” is a global assessment of competence that takes into consideration a number
of elements including, but not limited to, professional responsibility, assignments and clinical
competence.
 Midterm and final evaluation grades are indicative of a student’s overall ability to meet academic
requirements, course objectives, and practice expectations which are based on entry to practice
competencies.
 A fail at midterm may turn into a pass by the final evaluation if required improvements are
demonstrated and the course objectives are met.
 A formal written learning plan may be required from the student by the faculty advisor for any
single area in which a student is not meeting standards or for multiple areas when necessary.
Assignments
1. Evolve Hesi On-line Case Studies
The student must complete six (6) on-line case studies throughout the term. The student
must achieve 75% or higher in each of the selected case studies. Students are advised that
any case study completed prior to the start of the course (January 7, 2015) will not be
considered for this assignment. Similarly, elective case studies completed in advance of
approval from the faculty advisor will not be considered for this assignment.
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FUNDAMENTALS CASE STUDIES (minimum 75% required):
Students will select and complete three case studies from the Fundamentals
section; and
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ELECTIVE CASE STUDIES (minimum 75% required):
Students will select, and following approval by the Faculty Advisor, will complete
three cases immediately relevant to their current placement setting.
2. Scholarly Paper: Knowing for Nursing Practice
Pass mark: 70%
Purpose:
This assignment gives the learner the opportunity to synthesize relevant knowledge of the
discipline of nursing and use this knowledge to analyze nursing care of a selected patient
from the learner’s clinical practice.
Activity:
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The learner will choose a client from current clinical practice in NURS 4021 (The
learner may create a composite “fake” patient to ensure a robust level of complexity
or to maintain patient anonymity). The client chosen should be one who presents
complex care needs. Complexity is related to the overall stability of the person, the
complexity of care decisions, the predictability of patient outcomes, and the assessed
level of risk for negative outcomes.
The learner will collect data and give a 500 word synopsis that describes the client’s
current health status. In the synopsis, the learner will include:
o Primary health problem of concern to the client and nurse
o Related secondary health problems of concern to the client and nurse
o The client’s primary health/recovery goal in the next four weeks-six months
o The client’s primary supports/health resources/strengths
o The client’s main areas of challenge
o Current biomedical treatments
o Active and planned nursing and collaborative interventions (physical,
psychosocial, spiritual),
The learner will review the themes and foci of the Trent/Fleming School of Nursing
BScN curriculum.
o THEMES: ethics, leadership, professional practice/lifelong learning, relational
practice, safety in practice, social justice/advocacy
o FOCI: aging, environment, indigenous health, rural/community nursing,
women’s health
The learner will choose one theme and one foci and in no more than 1500 words,
discuss the how the learner used these core curriculum concepts when working
with/caring for the client. In this discussion, the learner will synthesize knowledge
and evidence from multiple sources, including the client’s perspective, to
demonstrate critical elements of the theme and focus.
The learner will support the analysis by citing from current relevant literature
APA 6th edition is required. Failure to use this standard consistently will result in a
deduction of at least 10% of the total grade for the paper.
3. Portfolio Update:
The student will submit in the drop box a document indicating the current contents of his/her
portfolio, any additions from the semester, any deletions from the portfolio as it existed prior
to the start of the course, any substantive changes in core statements such as values and beliefs
and will provide the descriptive paragraph that would be included in a resume related to the
clinical experience being completed in this semester. The faculty advisor may, if deemed
necessary, request to see the full document.
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Assignment Policies

Late submission of the scholarly paper will result in a deduction of 10% of the
assignment value for every 24 hours of lateness.
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Students cannot re-submit a piece of written work more than one time, even if the
student wishes to do so to attain a passing grade.
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Please note that the faculty advisor may require the completion of additional
assignments, for example a reflection, to ensure student learning and safety as part of
the remediation following an incident in the clinical setting.
Plagiarism
Plagiarism is knowingly presenting words, ideas, images, data, or any other form of work of
another person (including essays, theses, lab reports, projects, assignments, presentations and
posters**) in a way that represents or could be reasonably seen to represent the work as one’s
own. “Knowingly” includes ought reasonably to have known.
Plagiarism includes a) failing to acknowledge sources correctly and b) submitting materials
copied from the internet without proper acknowledgement of the source. Draft work submitted
for evaluation is subject to the same standard as final work.
Integrity in practice is essential for nurses. The Ethical Framework (CNO, 2009) specifies that
Registered Nurses:
Have an obligation to maintain the commitments they assumed as regulated
health professionals. Maintaining commitments means keeping promises,
being honest and meeting implicit or explicit obligations toward their clients,
themselves, each other, the nursing profession, other members of the health
care team and quality practice settings.
Ethical Framework, p. 9
Faculty members in the School of Nursing are expected to meet this obligation and, in turn,
expect students as future members of the profession to do the same.
For the purpose of interpreting and applying the University’s Academic Integrity policy, the
Nursing Program has adopted the following:
When a student submits a piece of written work in fulfillment of an assignment, she/he
implicitly acknowledges the following: a) that she/he is the sole author of the work; b)
that the wording and organization of the work, apart from acknowledged quotations,
paraphrasing or adaptation, is her/his own; and c) that she/he has not and will not
submit this work, either as a whole or in part, to satisfy another course requirement.
These basic assumptions will be reasonably interpreted. They do not preclude
collaboration between students upon a single project, by prior arrangement with the
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Faculty Advisor (such as a group assignment), for shared academic credit (either for
written or oral presentation).
Plagiarism will result in a charge of academic misconduct as outlined in the University policy.
Please read the note below pulled from the University policy on plagiarism, along with the
nursing-specific examples**, to ensure knowledge about the full extent of ways that plagiarism
can occur. Ignorance of this policy is not reason to prevent charges of academic dishonesty
** The nursing department has determined that these sources also include slides and other
course specific materials designed and presented by course Faculty Advisors. Adapting,
paraphrasing requires citation. Directly quoting requires quotes and citations per APA, 6 th
edition.
Additional Department and/or Course Policies
The Student Handbook posted on the School of Nursing Intranet contains substantial
information related to clinical practice settings. All students are accountable for reviewing that
material and abiding by the policies included in that document.
Absence from the Nursing Learning Centre and Practice
Nursing Learning Centre activities and clinical experiences are integral to students’ learning and
are mandatory. Nursing Learning Centre activities are designed to introduce students to skills
and concepts that they will use during their clinical practice. Clinical placement provides the
key means for student nurses to develop their nursing practice. A successful clinical experience
therefore depends upon complete and regular attendance to both learning centre and clinical
placements; for this reason attendance is expected at all laboratory and clinical opportunities.
Acceptable reasons for missing Nursing Learning Centre activities or clinical experiences include
serious illness, death in the family, an emergency situation outside the control of the student,
or severe weather conditions that make travel dangerous. In each case, the student must
provide the lab/clinical Faculty Advisor with documentation that supports the reason (e.g. a
note from a physician). Students will not be penalized if Labs or Clinical are cancelled by the
Faculty Advisor or the University.
In the case of prolonged absences, it is the student’s responsibility to notify the faculty advisor
(via email or voice mail) and keep them up-to-date about the estimated time of return to the
course. Upon return, the student should develop a plan for covering the missed experience,
and meet with the faculty to obtain agreement for the learning plan. Please note that this plan
may involve extra work after academic dates for the completion of the course and/or a change
in grade status. The plan must be completed within the agreed time period in order to meet
the course requirements.
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NURS 4021 C
While reasonable efforts will be made to help students who are absent for a prolonged period
for legitimate/acceptable reasons recover lost clinical time, it may not be possible in some
circumstances for students to meet course requirements successfully within the defined
timeline. In such situations students will be advised accordingly and the result may be that they
repeat the course in a subsequent semester.
Unsafe Student Practice
Students whose behaviour and actions in nursing learning centre and practice placements puts
patients/clients, families, other students, placement personnel, or faculty at risk will be asked
to immediately leave the area. Some examples of unsafe practice include lack of preparation,
breach of confidentiality, personal health and wellbeing affecting others, leaving a patient
unattended, or leaving the unit without permission. The student conduct will be reviewed in
relation to sections of “Entry to Practice Competencies for Ontario RNs as of September 2007”
or accepted professional behaviour in addition to the terms of the course outcomes/evaluation
forms. Unsafe practice is considered to be professional misconduct, and will result in
temporary suspension from the course. Such suspension will remain until the case is reviewed
with the Dean or Collaborative BScN Program Coordinator as appropriate to program. Students
can only return to the course with approval from the Dean. Students can appeal the decision to
Special Appeals Committee.
Professionalism
This policy outlines the situations regarding professionalism. It can be found on the TFSON
Intranet website in the Student Handbook
Requests for Special Consideration
Students requesting special consideration or waiver of regulations must meet one of the two
following criteria. Students must provide the relevant documentation supporting their claim.
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Medical reasons. Students requesting special consideration or waiver of regulations for
medical reasons must provide documentation supporting their claim. In the case of medical
conditions, a letter from a health care practitioner or the Trent Health Services indicating
that the patient’s condition prevented him/her from completing an assignment/exam will
be required. Simple verbal declarations of illness will not be accepted.
Emergency situations. Students requesting special consideration or waiver of regulations
for compassionate emergency reasons (for example death or emergency of close relative)
must provide documentation supporting their claim. Simple verbal declarations of the
situation will not be accepted.
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Requests for “Incomplete” Status
Students who qualify for incomplete status (see University Calendar for the conditions
necessary to apply for INC status) for an assignment or exam must fill out the required form
with the Faculty Advisor. If the student does not meet the deadline agreed to in the INC
document, then the Faculty Advisor will give that test/assignment a grade of 0%.
University Policies
Final date to withdraw without academic penalty
November 10th, 2015
Academic dishonesty
Academic dishonesty, which includes plagiarism and cheating, is an extremely serious academic
offense and carries penalties varying from failure in an assignment to suspension from the
University. Definitions, penalties and procedures for dealing with plagiarism and cheating are
set out in Trent University’s Academic Integrity Policy which is printed in the University
Calendar. See also www.trentu.ca/
Access to instruction
It is Trent University's intent to create an inclusive learning environment. If a student
has a disability and/or health consideration and feels that he/she may need
accommodations to succeed in this course, the student should contact the Student
Accessibility Services Office (SAS), (BH Suite 132, 705-748-1281 or email
accessibilityservices@trentu.ca).
For Trent University - Oshawa Student Accessibility Services Office contact 905-4355102 ext. 5024 or email nancyhempel@trentu.ca .
Complete text can be found under Access to Instruction in the Academic Calendar.
Please see the Trent University academic calendar for University Diary dates, Academic
Information and Regulations, and University and departmental degree requirements.
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