Practical Nursing – IDL Application

Certain functional abilities are crucial to being able to perform during training. Because these skills are common practice, the student will need to be able to demonstrate the continued use of each of the following skills while attending class. Prior to enrolling for a program, each student should read carefully through each skill and assess his/her own ability to perform these skills on a continual basis. In the event that during the program a student is unable to perform these skills (with or without special accommodations) the student may be dismissed from the program.

PHYSICAL STRENGTH AND MOBILITY
Lifting, moving, pushing or pulling objects weighing over 25 pounds (i.e. equipment, assisting in moving clients).

PHYSICAL ENDURANCE
Ability to bend, move body and extremities quickly in response to emergencies, stoop, squat, stand, maintain balance, walk distances, reach above the head and below the waist. Maintain physical tolerance for entire assigned shift.

COGNITIVE ABILITY
Read, write and speak English. Read graphs, collect and analyze data. Ability to assess and use critical thinking skills, sequence information, process information, identify cause and effective relationships, problem solve, communicate information to supervisors and make clinical judgments and management decisions that promotes positive client outcome.

INTERPERSONAL SKILLS
Establish a positive rapport with clients, family members and co-workers, other students and faculty; communicate effectively both in a verbal and written format. Give clear, accurate reports and or directions to clients, co-workers and faculty. Function effectively under stress with the ability to make quick decisions. Must be able to handle emotional and or stressful situations in a positive manner. Must be able to positively motivate clients, co-workers and patient family members. Separate personal feeling from the care and wishes of the clients. Must maintain a work and school ethic that is conducive to the Nursing Code of Honor.

VISUAL ACUITY
Must be sufficient to assess clients and their environments and to implement the nursing care plans that are developed, i.e. distinguish changes in skin color, depth perception, and peripheral vision.

HEARING ABILITY
Must be sufficient to assess clients and their environments and to implement the nursing care plans that are developed, i.e. ability to use a stethoscope to assess sounds, hear a range of tones, normal speaking level sounds.

OLFACTORY
Must be sufficient to assess clients and their environments and to implement the nursing care plans that are developed, i.e. distinguish odors.

TACTILE AND FINE MOTOR SKILLS
Must be sufficient to assess clients and their environment and to implement the nursing care plans that are developed, i.e. feel for pulses, feel and identify body landmarks, detect a change of temperatures, feel the difference in surface characteristics, manipulate small equipment and containers, such as needles, vials, ampoules, syringes, medication packages.

I have read and understand the above noted skills necessary to perform my job as a Practical Nursing Student. To these best of my knowledge I believe I have the capabilities of performing each and every one of them, realizing the requirements placed upon me as a nursing student may not be limited to the above skills. I further understand that if at any time during the program, I am unable to meet these requirements I may be dismissed from the program.

I understand that as of the date of my enrollment in the Practical Nursing Program at Institute of Technology, that the credits earned are vocational credits. I understand that it is up to the discretion of each educational facility to accept or reject credits earned from any other teaching facility.

I understand that any information available to me regarding Articulation Agreements can be located in the IOT Catalog. I further understand that the training I receive at Institute of Technology, along with any other credits that have been accepted is intended to prepare me to take the NCLEX. Upon successful passing of the NCLEX in the state of Oregon, I will have all of the rights that are assigned to this license.

In the admissions and enrollment process, the applicants Social Security number is used to assist in qualifying the applicant for college admissions and enrollment, and for securing student financial aid. In order to qualify, prior to class commencement, Admissions and/or Financial Aid must review a valid Social Security card.

A Social Security number is not a permanent student identifier and it will not be required for student identification purposes. The Institute of Technology will not disclose the Social Security number of any applicant to anyone outside the college system except as allowed by law or with permission from the individual applicant.

I authorize Institute of Technology to procure my Social Security number and use it for the purposes stated above. I understand that my Social Security number will not be disclosed to anyone except for the purposes stated above, or with my permission for purposes other than those stated above.

All applicants will be required to complete a background check. The criminal background check gives permission for an agency to access all criminal data including, conviction, non-conviction, and pending data. Depending on the contents of the applicants criminal record, participation in clinical may be denied. In addition, a sex offender search is required.

Institute of Technology (“the Organization”) may obtain information about you from a third party consumer reporting agency for purposes of evaluating your application for participation in an educational program with the Organization or for participation in clinical, experiential, residency, or other education or degree requirements at a health care facility or clinical program, which may be deemed to be “employment purposes” under the Fair Credit Reporting Act (“FCRA”). Thus, you may be the subject of a “consumer report” which may include information about your character, general reputation, personal characteristics, and/or mode of living. These reports may contain information about your criminal history, social security verification, motor vehicle records (“driving records”), education or employment history/evaluations, or other background checks.

You have the right, upon written request made within a reasonable timeline, to request whether a consumer report has been run about you and to request a copy of your report. These searches will be conducted by CastleBranch Corporation, 1844 Sir Tyler Drive, Wilmington, NC 28405, 888-723-4263, www.castlebranch.com.

I acknowledge receipt of the separate documents entitled DISCLOSURE REGARDING BACKGROUND INVESTIGATION and A SUMMARY OF YOUR RIGHTS UNDER THE FAIR CREDIT REPORTING ACT and certify that I have read and understand both of those documents. I hereby authorize the obtaining of “consumer reports” and/or “investigative consumer reports” by Institute of Technology (the “Company”) at any time after receipt of this authorization and throughout my participation in the educational program or clinical, experiential, residency, or other education or degree requirements, if applicable. To this end, I hereby authorize any law enforcement agency, administrator, state or federal agency, institution, school or university (public or private), information service bureau, employer, or insurance company to furnish any and all background information requested by CastleBranch Corporation, 1844 Sir Tyler Drive, Wilmington, NC 28405, 888-723-4263, www.castlebranch.com. I agree that a facsimile (“fax”), electronic or photographic copy of this Authorization shall be as valid as the original.

Your responses to the requested essay questions reveal important attributes about you and your character which may not always be demonstrated in the sampling of grades and test scores used to in the selection criteria. The essays you provide will offer another sense of who you are and of your attitudes about becoming a licensed practical nurse.

In addition, it is opportunity for you to demonstrate your skills and techniques in professional written communications, another key component of those who succeed and excel in the field. 250 words required