Department of Nursing, School of Health Sciences Master of Advanced Nursing Practice (Nurse Practitioner) CONFIRMATION OF EMPLOYMENT AND CLINICAL SUPPORT FORM Section 1 should be completed by applicants undertaking the Master of Advanced Nursing Practice (Nurse Practitioner (MC-ANPNP). Applicants must seek approval from their employer regarding scope of clinical practice and governance arrangements prior to enrolment into the course. Section 2 should be completed by the applicant s mentor to confirm their willingness to support the student throughout the course. Section 3 should be completed by the Director of Clinical Operations / Supervisor of the department where the student will undertake clinical practice to achieve course objectives. Section 2 should also be completed by the Executive Director Nursing Services of the organization. NOTE: You are required to complete this form at the beginning of each year of your enrolment SECTION 1 APPLICANT INFORMATION Name: Student no: (if known) Commencement year Clinical Agency Clinical field (specialty) INFORMATION FOR CLINICAL AGENCIES Clinical Requirements for Enrolment Students enrolled in the Nurse Practitioner stream will require a clinical employment/placement (here after referred to employment) for the duration of the course. The agency providing this employment will be required to provide approval for the student to undertake their placement in their organisation. This employment must be for a minimum of 38 hours/fortnight. This approval will commit the organisation to providing a suitable environment for the student to develop advanced nursing practice knowledge and skills. It is expected that a primary mentor will be nominated who will work with the student during the course to ensure that the course objectives are met. The primary mentor may allocate mentorship responsibilities to other mentors during the course but will continue to provide consistent oversight. Approval will also acknowledge that the organisation is aware and supports the student to undertake the clinical activities required to meet the subject objectives. Confirmation of Employment and Clinical Support Form Page 1 of 5
Students undertaking the subjects Health Assessment for Advanced Practice 1 (NURS90067), Health Assessment for Advanced Practice 2 (NURS90068), Quality Use of Medicines (NURS90071) and Advanced Nursing Practice in Context (NURS90072) are required to complete a clinical practicum while employed 38 hours per fortnight. Students are required to complete patient/client assessments and a clinical project while enrolled in the subjects. This will require the student to have a clinical mentor to support their knowledge and skill development. This mentor will also be responsible for some clinical based assessments to ensure that the student has developed the competence necessary for advanced practice in their clinical field. Program and clinical assessments The following table lists the subjects that the student must complete to meet the program requirements and the details the clinical assessments conducted in their placement. Year 1 Semester Subject Clinical Assessments 1 Clinical Leadership in Context N/A 1 Health Assessment for Advanced Practice 6 patient assessments 2 Implementing Evidence in Practice N/A Year 2 Semester Subject Clinical Assessments 1 Health Assessment for Advanced Practice 4 patient assessments 1 Pharmacology for Health Professionals N/A 2 Quality Use of Medicines Medication history competency 4 medication management plans 2 Advanced Practice in Context Clinical scope development project Primary Mentor Responsibilities A primary mentor acts as a resource person assisting students in gaining the appropriate clinical experience or access to appropriate persons to develop the skills, knowledge and attributes required to function effectively and independently in the clinical area The mentor is responsible for the following: Providing teaching and supervision for skill development; Providing feedback to help guide the student; Completing student assessments formative and summative; Confirmation of Employment and Clinical Support Form Page 2 of 5
Documenting assessments to be submitted to the University; Supporting the student to negotiate with alternative clinicians for teaching or assessment opportunities; Identifying progress issues and informing the course / subject coordinator Professional Experience and Aptitudes of a Primary Mentor The primary mentor should be a member of the health care team who works closely with the student and has sufficient expertise in the student s area of specialty to be able to support the student to develop advanced practice skills consistent with their intended scope of practice. In addition, the mentor should have the following experience and attributes: Current general registration as a registered nurse and endorsement as a nurse pactitioner with no conditions on registration / medical practitioner* More than 6 years experience A positive attitude towards the students, teaching and learning; A willingness to share knowledge and skills; An ability to evaluate the student s clinical abilities and plan the learning experience in collaboration with the nursing faculty and student by helping to identify specific learning objectives and organizing appropriate learning experiences It is recommended that the student negotiates with other clinicians from a range of disciplines (eg: pharmacists, physiotherapist etc), in addition to the primary mentor, to contribute to their development. * Alternatives must be negotiated with the Stream Coordinator Confirmation of Employment and Clinical Support Form Page 3 of 5
SECTION 2 PRIMARY MENTOR AGREEMENT The learning experiences during the candidature will focus on the role of a Nurse Practitioner (NP) therefore specialised clinical and management support during this time will be essential to preparing the student for this role. During the Nurse Practitioner candidature, the student will be required to undertake a clinical placement and associated clinical assessments specific to the Nurse Practitioner role in their clinical field. The aim is for the student to demonstrate increasing acquisition of skills, knowledge and competencies throughout the course. The clinical mentor will support the student in this clinical placement to meet the course requirements and meet the Competency Standards for Nurse Practitioners. Further information about the course requirements have been provided in the Mentor agreement package. Should you have any concerns regarding the Mentorship process please contact Ms Dianne Crellin Course Coordinator MC-ANP NP Program dcrellin@unimelb.edu.au Or Dr Sharon Kinney Academic Coordinator MANP sbkinney@unimelb.edu.au I have read the Mentorship Agreement and the subject outlines and agree to provide clinical support to during their Nurse Practitioner candidature. Applicant name Name: Signature: Designation: Reg no: Date: Confirmation of Employment and Clinical Support Form Page 4 of 5
SECTION 3 AGENCY APPROVAL Students enrolled in the Master of Advanced Nursing Practice (Nurse Practitioner) program are required to be employed for 38 hours per fortnight in an advanced nursing role, which will enable them to complete the clinical requirements of this program. This form is required to be signed by the Director of Clinical Operations (or equivalent) and the Executive Director Nursing Services of the clinical agency where the student will be completing the clinical requirements of the course. will be employed by this agency during the course Applicant name (min 0.5 EFT for 2 years): The student has met the Employment requirement requirements of the organisation (including OH &S police check, and immunisation requirements) A suitable primary mentor will be allocated to provide clinical support for the student for the duration of the course (2 years part-time): Primary Mentor Name: Current Position: Other members of a multidisciplinary team will be available to support and guide the student to ensure broad influences on their learning By signing this form I acknowledge that I understand the requirements of the subject in which the student is enrolling and the clinical requirements of the subject and agree to ensure that the necessary clinical support will be provided to the student to allow them to meet the subject objectives. Name: Manager of the Clinical Service Signature: Date: Name: Executive Director of Nursing Signature: Date: Confirmation of Employment and Clinical Support Form Page 5 of 5