LPN to RN ADMISSION REQUIREMENTS Students must turn in a complete application packet in a plain manila envelope to a Nursing Program Advisor, Room 191-B, prior to the listed application deadlines. Incomplete packets will not be accepted and each step below must be completed in order to be considered for the program. COMPLETE PROGRAM APPLICATION PACKET SHOULD INCLUDE: Completed and Signed Application Signed ADN Student Practice Standards GPA Calculation with advisor s signature; Unofficial copies of all college transcripts if they are not on file with DACC admissions. Program Level Evaluation Sheet Current copy of LPN license All PN-ADN Mobility Exam summary pages IF YOU ARE NOTIFIED OF ACCEPTANCE TO THE PROGRAM: Submit by the date listed in the acceptance letter: Immunizations and Tests Required by State Law / Clinical Facilities form Copy of current CPR card American Heart Association CPR/BLS for Health Care Providers only Completed New Mexico Department of Health Caregivers Criminal History Screening Application. This will be completed with a Nursing Program Advisor. Please bring your driver s license when completing the screening application. *The $74 payment can be made online at the time of application completion or at the fingerprint site. Forms can be obtained at: http://dacc.nmsu.edu/nurs/clinical-documentation/
Application for admission to Application for admission to: ASSOCIATE DEGREE NURSING PROGRAM Dona Ana Community College does not discriminate on the basis of a person s age, ancestry, color, disability, gender identity, genetic information, national origin, race, religion, serious medical condition, sex, protected veteran status, sexual orientation, or spousal affiliation. LPN to RN APPLICATION SEMESTER: YEAR: The New Mexico Department of Health Caregivers Criminal History Screen Application must be submitted upon acceptance into the ADN Program. Questions about packet materials may be addressed to a Nursing Program Advisor. PLEASE PRINT OR TYPE Name in Full: Home Address: Last First Middle Number & Street County City State Zip Home Phone: Alternate Phone: NMSU E-mail Address: @nmsu.edu NMSU Banner Number: Residency: State of Legal Residence: If a resident of NM, County of Legal Residence: LPN License #: State: Expires: LPN Nursing School Attended Location (City, State) FROM (mo. & year) TO (mo. & year) Reason for leaving: YES or NO DACC may contact the above listed nursing program(s) YES or NO Have you ever been terminated or banned from a healthcare facility? If yes, in which city and state did this occur? If yes, are you eligible for rehire at the facility? YES or NO Have you ever had a professional license be denied, suspended, or revoked? If yes, in which state was the license denied, suspended or revoked? If yes, please explain why the license was denied, suspended or revoked?
Provide information concerning high school(s) attended or G.E.D.: Name of School City & State Dates Attended Provide information concerning all college, university, vocational schools and/or allied health schools attended. Please list all vocational programs and certifications, including military, which relate to health care. Use additional pages if necessary. Academic regulations require that students who have registered at other colleges or universities may not disregard their records at such institutions when making application for admission to credit programs in this college. Students concealing attendance at another college or university and not submitting a transcript from that college or university will be subject to suspension. Name of Institution City & State Number of Credits Earned Are you eligible to return to the last college or university attended? YES NO NA Have you been awarded one or more university degrees or vocational/technical certificates? YES NO Degree/Certificate Year Granting Institution List other names used in previous enrollments at this or other institutions of higher education: YES or NO Have you ever been dismissed from a health occupations program? If yes, which program? If yes, are you eligible for readmission to the program? If yes, why were you dismissed from the program? I hereby certify that the information contained in this application is true and complete to the best of my knowledge, and I have completed all the steps in the application process. I understand that any misrepresentation or falsification of information is cause for denial of admission or expulsion from the College. I understand that the information contained in this application will be read by the faculty and staff of DACC, as is appropriate. By signing below, I acknowledge my responsibility for understanding and complying with the following information: 1. Withholding or falsifying the requested information, documentation of academic dishonesty, or failure to provide the required documents will make me ineligible for admission to the Nursing Program
2. Filing this form does not guarantee acceptance into the nursing program. 3. This application is only valid for consideration for the semester it was originally submitted. 4. Admittance to the ADN Nursing Program is provisional until a criminal background check is completed and I am cleared for full admittance. The New Mexico Department of Health requires a criminal background clearance through their Department. Examples of some of the disqualifying convictions are: homicide, trafficking in controlled substances, kidnapping, false imprisonment, aggravated assault, or aggravated battery, rape, criminal sexual penetration; criminal sexual contact, incest, indecent exposure, or other related felony sexual offenses, crimes involving child abuse or neglect, crimes involving robbery, larceny, extortion, burglary, fraud, forgery, embezzlement, credit card fraud, or receiving stolen property; or an attempt, solicitation, or conspiracy involving any of the felonies in this subsection. 5. Admission to the program does not guarantee program completion and/or licensure after program completion. 6. History of a denied, suspended, or revoked professional license is a disqualifying event and may make me ineligible for admission to the Nursing Program. 7. The ineligibility for rehire at a healthcare facility from which I have been terminated or banned, if that facility is a clinical site, may make me ineligible for admission to the Nursing Program. 8. Dismissal from a health occupations program may make me ineligible for admission to the Nursing Program. By signing below, I acknowledge my responsibility for understanding the following information about submission of my application: 1. Submission deadlines are firm and my application is due to a Nursing Program Advisor. 2. All required information must be submitted at the same time in a plain manila envelope. 3. On the outside of the sealed application packet, I must print my name plus Nursing Program LPN to RN Track: Semester and Year. Signature of Applicant Date
Questions concerning the program or the application process can be addressed by a Nursing Program Advisor at (575) 528-7249. Associate Degree Nursing Program Student Practice Standards Minimum abilities expected include but are not limited to: The following technical standards and essential functions outline reasonable expectations of a student in the ADN Program for the performance of common nursing functions. The ADN student must be able to apply the knowledge and skills necessary to function in a variety of classroom, lab and/or clinical situations while providing the essential competencies of the ADN program. The student must be able to meet the following requirements to apply for admission and continuation in the program: Categories of Essential Functions Definition Example of Technical Standard Observation Ability to participate actively in all demonstrations, laboratory exercise, and clinical experiences in the professional program component and to assess and comprehend the condition of all clients assigned to him/her for examination, diagnosis, and treatment. Such observation and information usually requires functional use of visual, auditory, and somatic sensations. Visually discriminating incremental readings on syringes, sphygmomanometers and other various medical equipment Visually discriminating between different colored objects Discriminating between auditory stimuli Perform a comprehensive assessment on patients Communication Ability to communicate effectively in English using verbal, non-verbal and written formats with faculty, other students, clients, families and all members of the healthcare team. Ability to read English and interpret without assistance. Patient teaching End of shift reports Documentation in legal records/ charts Medication records Transcribe doctor s orders from chart, interpret, and implement Testing within the ADN program without assistance to read Collaborates with members of healthcare team Motor Sufficient motor ability to execute the movement and skills required for safe and effective care and emergency treatment. Standing for long periods of time (8-10 hrs/day) Lifting up to 50 lbs. Performing one person and two person transfers Turning, log rolling and ambulating another person Manipulating equipment Performing patient care procedures with finger and manual dexterity (i.e., starting IVs, phlebotomy, dressing changes, catheterization) Intellectual Ability to collect, interpret and integrate information and make decisions. Transcribe orders from chart, interpret the orders and intervene Ability to read and interpret the English language without assistance.
Categories of Essential Functions Definition Example of Technical Standard Display critical thinking abilities in planning patient care analyze data, formulate nursing diagnosis, and prioritize care Behavioral and Social Attributes Possess the emotional health and stability required for full utilization of the student s intellectual abilities, the exercise of good judgment, the prompt completion of all academic and patient care responsibilities and the development of mature, sensitive, and effective relationships with clients and other members of the health care team. Possess the ability to tolerate taxing workloads, function effectively under stress, adapt to changing environments, display flexibility, and learn to function in the face of uncertainties inherent in clinical settings with patients. Possess compassion, integrity, concern for others, and motivation. Possess the ability to demonstrate professional behaviors and a strong work ethic. Utilize intellectual abilities Exercise good judgment and complete tasks within required time limits Demonstrate the emotional health required for full utilization of intellectual abilities and exercise of good judgment Show integrity, concern for others, interpersonal skills, interest and motivation In general, successful applicants possess qualities such as: Interest and aptitude for math and science A strong motivation to learn Well-developed study skills Good problem-solving and decision-making skills An ability to work with people with diverse backgrounds Applicant Signature Date