Appendices
APPENDIX A
MGH Institute of Health Professions
School of Nursing
Notification of Change of Academic Advisor
Please fill out the information below and obtain the appropriate signatures.
Student: ______________________________________________
Program Level: _____Generalist/Pre-RN _____Advanced Practice/RN
Specialty track: ____________________
Former Advisor: ______________________________________________
New Advisor: ______________________________________________
Effective Date: ______________________________________________
Signature of New Advisor: _________________________________________
Date: ______________________
Signature of Former Advisor: _________________________________________
Date: ______________________
Please return completed form to Nursing Program Office
Received in Nursing School Office: Date: _______________ by _________
cc to: Student
Former Advisor
New Advisor
Rev11
APPENDIX B
MGH Institute of Health Professions
School of Nursing
CONSENT FORM FOR PHYSICAL EXAMINATION
I volunteer to have a ___________________________________ examination performed on me by a graduate ________________________student of the MGH Institute of Health Professions for the purpose of STUDENT LEARNING ONLY, as more fully described in Attachment A.
I understand that the MGH Institute of Health Professions is a post-baccalaureate school dedicated to preparing skilled health care professionals, and that the student performing the examination on me is a student and not a fully trained specialist. In agreeing to volunteer, I have been informed on the following:
1. The tests that will be performed during the examination will not be for diagnostic purposes.
2. I may experience some minor discomfort during the examination.
3. I may ask the student to stop the examination at any time.
4. Any side effects either during or after the examination are described in Attachment A.
I agree that I will not hold the MGH Institute of Health Professions, faculty or student responsible for any problems I may encounter after this examination.
Signed: _____________________________________________
Date: ______________________________________________
Description of Examination:
Description of Possible Side Effects:
Additional Comments:
This form was prepared by: _________________________________ , _________________
Name of Faculty of Record Date
APPENDIX C
MGH Institute of Health Professions
School of Nursing
CONSENT FORM FOR PARTICIPATION IN LEARNING ACTIVITIES
I, __________________________, volunteer to participate as a subject in classroom laboratory
Subjects Name
activities for _________________ ________________________________________________.
Course # Course Title
I understand that the MGH Institute of Health Professions is a graduate school dedicated to preparing skilled health care professionals, and the class activities are part of their professional preparation. The purpose of my participation is for student learning only, and will not serve diagnostic or treatment purposes.
In agreeing to volunteer, I have been informed of the following:
Who will be interacting with me and how:
Description of activities:
Potential side effects or risks and precautions:
Additional Comments:
I have read the descriptions provided above. All questions have been answered to my satisfaction. I understand that I may discontinue my participation in these activities at any time. I agree that I will not hold MGH Institute of Health Professions, faculty or students responsible for any problems I may encounter as a result of my participation.
Signed: _____________________________________ Date: ___________________________
This form was prepared by: _________________________________ , _________________
Name of Faculty of Record Date
APPENDIX D
MGH Institute of Health Professions
School of Nursing
Honor Code
As a student health care professional,
I will act with honesty, integrity, and respect
in my academic pursuits and beyond.
Suggested placement in syllabus: in Grading Section.
Suggested use on exams: I agree to adhere to the honor code in taking this exam:
As a student health care professional, I will act with honesty, integrity, and respect in my academic pursuits and beyond.
[ ] Yes, I agree
Approved SON Faculty Apr. 15, 2015
APPENDIX E
STUDENT INCIDENT REPORTING FORM
(Submit to Program Director)
Student Name: Date of Report:
E-mail address: Preferred Phone Contact: Email
Program Enrolled: Date of Incident:
Location of Incident: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
_____________________________________________________________________________________________
Parties involved:
Description of Incident:
Witness(es):
Who Reported to: Date:
Student Signature Date:
Attached additional pages if needed.
TO BE COMPLETED BY PROGRAM DIRECTOR:
Description of Follow-up: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Action taken: _________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Resolution: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________
Date(s) reported back to student: _________________________________________________________________
__________________________________________________________________________________________________________________________________________________________________________________________
(Attach Copy of email communications sent to student)
Inquiry ongoing? ____yes ____no
Date inquiry closed with final resolution: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Program Director Signature: ________________________________ Date: __________________
Reported to:
_____ SON Dean’s Office _____ Dean of Student Services and Alumni Services
_____ Operations/Security _______ Other _______________________________________
Attached additional pages if needed.
APPENDIX F
MGH Institute of Health Professions
School of Nursing
Prelicensure Programs
Policy Statement Regarding ATI Assessments
The MGH Institute of Health Professions School of Nursing has adopted Assessment Technologies Institute (ATI) curriculum support tools to optimize student readiness for the NCLEX examination and to increase their confidence with and understanding of nursing content. ATI is an assessment-driven, comprehensive review program that includes multiple resources including review materials, practice assessments, proctored assessments, and remediation tools.
Recommendations Regarding Practice and Proctored Assessments
Timing
Practice assessment A: once 75% of the course content has been delivered Practice assessment B: once 85% of the course content has been delivered
Proctored assessments: once 90% or more of the course content has been delivered.
Rationales will be turned off during the period that practice assessments are open for testing. Once this period has ended, rationales will be opened for student review.
Students should receive at least one week to complete the remediation for both practice and proctored assessments.
The following ATI proctored assessments will be administered in the prelicensure courses:
- Fundamentals Administered in Pharmacology
- Mental Health Administered in Bio behavioral
- Medical Surgical Nursing Administered in Common Problems
- Pharmacology to be administered in either (Policy or Leadership TBD)
- Community Health Administered in Community
- Leadership Administered in Leadership and EBP
- Maternal and Newborn Nursing and Nursing Care of Children (Combined) Administered in Maternal Child Health
- RN Comprehensive Predictor Administered in Immersion
Grading
ATI assessments and remediation comprise 5% of the total course grade in those courses that use ATI with the following exceptions:
- Maternal Child Nursing and Nursing Care of Children assessments and remediation will comprise a total of 6% of the Maternal Child Health course grade;
- Comprehensive predictor assessments and remediation will comprise 10% of the Role Immersion grade.
Proctored and Practice Assessments
- Course syllabi will state the due dates and times for completion of proctored and practice assessments and completion and submission of remediation
- Proctored assessments are mandatory and comprise a portion of the course grade as noted above.
- A total of 2 practice assessments will be given prior to the proctored assessment. (Except Maternal and Newborn Nursing, Nursing Care of Children, which only take 1 practice assessment per specialty)
- Students must complete the practice assessment and remediation prior to the proctored assessment by the assigned date and must scan and upload proof of remediation and all active learning templates to the designated D2L assignment folder.
- Students must upload proof of remediation and active learning templates to the designated D2L assignment folder for the proctored assessments by the assigned due date listed in the course syllabus. No points will be given for late submissions.
- Students who do not upload their transcript and remediation on the day of the proctored assessment will receive 50% of the points they achieve on the proctored assessment.
Proctored and Practice Assessments: Maternal and Newborn Nursing and Nursing Care of Children
- Course syllabi will state the due dates and times for completion of proctored and practice assessments and completion and submission of remediation
- One practice assessment will be completed for each specialty rotation to establish baseline knowledge.
- Students who do not upload their transcript and remediation on the day of the proctored assessment will receive 50% of the points they achieve on the proctored assessment.
- Students must complete the practice assessment and remediation for the practice assessment prior to the proctored assessment (see general guidelines below).
- A total of one proctored assessment will be given at the end of each specialty course.
Comprehensive Predictor Assessment
- A total of one proctored assessment will be given.
- Students must complete the practice assessments and remediation by the assigned date prior to the comprehensive predictor and must scan and upload proof of remediation and all active learning templates to the designated D2L assignment folder.
- Students who do not upload their transcript and remediation on the day of the proctored assessment will receive 50% of the points they achieve on the proctored assessment.
- Students must upload proof of remediation and active learning templates to the designated D2L assignment folder for the comprehensive predictor by the due date assigned by the course faculty.
- Course syllabi will state the due dates and times for completion and submission of remediation. No points will be given if these are completed past the due date.
The charts below describe point allotment for both the proctored assessments and the comprehensive predictor assessment:
POINT ALLOTMENT FOR PROCTORED ASSESSMENTS
(with exception of Maternal and Newborn Nursing and Nursing Care of Children)
Practice Assessments, Remediation, and Proctored – 5-point total
|
Practice Assessment
|
|
Maximum 1 point
|
|
Practice assessment A Remediation:
Completion of Active Learning Templates, determined by raw score on practice assessment A
0.5 point earned for completion of Practice Assessment A and Remediation
|
Practice assessment B Remediation:
Completion of Active Learning Templates, determined by raw score on practice assessment
0.5 point earned for completion of Practice Assessment B and Remediation
|
Practice Assessment Remediation
|
Raw Score on Practice Assessments A and B
|
Remediation Required
|
|
Raw Score 100%
|
No Remediation Required
|
|
Raw Score 86-99%
|
No Remediation Required
|
|
Raw Score 77-85%
|
No Remediation Required
|
|
Raw Score 70-76%
|
Completion of a total of 2 Active Learning Templates chosen from the top any of the eight topics missed
|
|
Raw Score £ 69%
|
Completion of a total of 4 Active Learning Templates chosen from the top any of the ten topics missed
|
Students must upload completed remediation assignments in the designated D2L assignment folder by assigned due date.
All Active Learning Templates must be handwritten with all sections completed.
|
Proficiency level on ATI Proctored Assessment
|
Points Awarded
|
|
Level 3 Proficiency
|
4
Achieves maximum points for this level, no remediation required
|
|
Level 2 Proficiency
|
3
Achieves maximum points for this level, no remediation required
|
|
Level 1 Proficiency
|
0.5
Points awarded for level achieved and 1.5 added if remediation complete.
|
|
Below Level 1 Proficiency
|
0
Points awarded for level achieved and 1.5 added if remediation complete.
|
Proctored Assessment Remediation
A maximum of 1.5 points is awarded if required remediation is completed in accordance with Proficiency Level scored on Proctor Assessment
Students must upload completed remediation assignments in the designated D2L assignment folder by assigned due date.
All Active Learning Templates must be handwritten with all sections completed.
|
Proficiency Level on ATI Proctored Assessment
|
Remediation Required
|
|
Level 3 Proficiency
|
No Remediation Required
|
|
Level 2 Proficiency
|
No Remediation Required
|
|
Level 1 Proficiency
|
Completion of a total of 2 Active Learning Templates chosen from the top any of the eight topics missed
|
|
Below Level 1 Proficiency
|
Completion of a total of 4 Active Learning Templates chosen from the top any of the ten topics missed
|
Total Possible Points
|
Proficiency Level
|
Practice Assessments
|
Proctored Assessment
|
Remediation
|
Total
|
|
Level 3 Proficiency
|
1
|
4
|
Not needed
|
5
|
|
Level 2 Proficiency
|
1
|
3
|
Not needed
|
4
|
|
Level 1 Proficiency
|
1
|
0.5
|
1.5
|
3
|
|
Below Level 1 Proficiency
|
1
|
0
|
1.5
|
2.5
|
POINT ALLOTMENT FOR MATERNAL NEWBORN AND NURSING CARE OF CHILDREN
Practice assessment, remediation and proctored – 6point total
|
Practice assessments
|
|
Maximum 1 points
|
|
Maternal Newborn
Practice assessment A with Remediation:
0.5 point earned for completion of practice assessment and remediation
|
Nursing Care of Children
Practice assessment A with Remediation:
0.5 point earned for completion of practice assessments and remediation
|
Practice Assessment Remediation
|
Raw Score on Practice Assessments A and B
|
Remediation Required
|
|
Raw Score 100%
|
No Remediation Required
|
|
Raw Score 86-99%
|
No Remediation Required
|
|
Raw Score 77-85%
|
No Remediation Required
|
|
Raw Score 70-76%
|
Completion of a total of 2 Active Learning Templates chosen from the top any of the eight topics missed
|
|
Raw Score £ 69%
|
Completion of a total of 4 Active Learning Templates chosen from the top any of the ten topics missed
|
Students must upload completed remediation assignments in the designated D2L assignment folder by assigned due date.
Maximum 3 points combined
|
|
|
|
|
|
Proficiency level on ATI Proctored Assessment
|
Points Awarded Maternal Newborn
|
Points Awarded
Nursing Care of Children
|
|
Level 3 Proficiency
|
2.5
|
2.5
|
|
Level 2 Proficiency
|
2.0
|
2.0
|
|
Level 1 Proficiency
|
1.5
|
1.5
|
|
Below Level 1 Proficiency
|
0
|
0
|
Proctored Assessment Remediation
A total of 2-point maximum (1 for each proctored assessment remediation) are awarded if required remediation is completed in accordance with Proficiency Level scored on Proctor Assessment
Students must upload completed remediation assignments in the designated D2L Dropbox by assigned due date.
|
Proficiency Level on ATI Proctored Assessment
|
Remediation Required
|
|
Level 3 Proficiency
|
No Remediation Required
|
|
Level 2 Proficiency
|
No Remediation Required
|
|
Level 1 Proficiency
|
Completion of a total of 2 Active Learning Templates chosen from the top any of the eight topics missed
|
|
Below Level 1 Proficiency
|
Completion of a total of 4 Active Learning Templates chosen from the top any of the ten topics missed
|
POINT ALLOTMENT FOR COMPREHENSIVE PREDICTOR PRACTICE & PROCTORED
Practice Assessments & Remediation and Proctored = 10-point total
|
Practice Assessment
|
|
Maximum 5 points
|
|
Practice assessment A Remediation:
Completion of Active Learning Templates, determined by raw score on practice assessment A
2.5 point earned for completion of Practice Assessment A and Remediation
|
Practice assessment B Remediation:
Completion of Active Learning Templates, determined by raw score on practice assessment B
2.5 point earned for completion of Practice Assessment B and Remediation
|
Practice Assessment Remediation
|
Raw Score on Practice Assessments A and B
|
Remediation Required
|
|
Raw Score 100%
|
No Remediation Required
|
|
Raw Score 86-99%
|
No Remediation Required
|
|
Raw Score 77-85%
|
No Remediation Required
|
|
Raw Score 70-76%
|
Completion of a total of 2 Active Learning Templates chosen from the top any of the eight topics missed
|
|
Raw Score £ 69%
|
Completion of a total of 4 Active Learning Templates chosen from the top any of the ten topics missed
|
Students must upload completed remediation assignments in the designated D2L assignment folder by assigned due date.
Comprehensive Predictor Assessment
|
All Active Learning Templates must be handwritten with all sections completed.
|
|
|
|
Predicted probability of passing NCLEX
|
Points Awarded
|
|
≥ 95% on Comprehensive Predictor
|
5
|
|
86% - 94% on Comprehensive Predictor
|
4
|
|
81% - 85% on Comprehensive Predictor
|
1
|
|
< 80% on Comprehensive Predictor
|
0
|
Comprehensive Predictor Remediation
A total of 2 points maximum are awarded if required remediation is completed in accordance with Predicted % scored on Comprehensive Predictor.
Students must upload completed remediation assignments in the designated D2L assignment folder by assigned due date.
All Active Learning Templates must be handwritten with all sections completed.
|
Predicted % on Comprehensive Predictor
|
Remediation Required
|
|
³ 95% on Comp Predictor
|
No Remediation Required
|
|
86% - 94% on Comp Predictor
|
No Remediation Required
|
|
81% - 85% on Comp Predictor
|
Completion of a total of 2 Active Learning Templates chosen from the top any of the eight topics missed
|
|
< 80% on Comp Predictor
|
Completion of a total of 4 Active Learning Templates chosen from the top any of the ten topics missed
|