CLINICAL AFFILIATION AGREEMENT
BETWEEN
CLINICAL PRECEPTOR AND ASSOCIATE
DEGREE NURSING PROGRAM
This
is the agreement between the Trinity Valley Community College Associate Degree Nursing
Program and ________________________, who has agreed to be a clinical
preceptor. The clinical preceptor is an
employee of _______________________________which has a current clinical
affiliation agreement with
PURPOSE
Clinical
preceptorships may be used to enhance clinical
learning experiences after the student has received clinical and didactic
instruction in basic areas of nursing.
RESPONSIBILITIES
OF ADN PROGRAM
The ADN liaison instructor will:
1. Verify that the clinical
preceptor meets the required BNE qualifications:
a.
Current
RN licensure in
b.
Educational
preparation is ______________________ (If not a RN must have bachelor’s degree
as health care professional).
c.
Is
competent in designated area of clinical practice. ______ Yes
______ No
d.
Has
a philosophy of health care congruent with the TVCC nursing program. ______ Yes
______ No
2. Meet with the clinical preceptor
prior to the clinical rotation. The
instructor will explain the preceptor role and responsibilities and will
describe the knowledge and skill level of the students and the level of
supervision needed. The instructor will
delineate what skills the students can and cannot do during their rotations,
and what can be expected of them.
3. Present the preceptor with a copy
of the student objectives for the experience, and a copy of the brief
evaluation form to be completed on each student.
4. Present the preceptor with a list
of the students' names and the dates and times they will be coming.
5. Be readily available by phone for
problem solving or schedule change, etc.
6. Periodically check with the
preceptor during the semester to evaluate the affiliation and make any necessary
adjustments.
RESPONSIBILITIES
OF CLINICAL PRECEPTOR
The clinical preceptor will:
1. Be responsible for monitoring and
evaluating each student during his or her experience.
2. Notify the ADN liaison instructor
or the Dean of Health Occupations of any problems or incidents that need
reporting and/or require action.
3. Retain total responsibility for
patient care.
4. Complete an evaluation sheet at
the end of the semester providing input regarding the program as a whole.
RESPONSIBILITIES
OF ADN PROGRAM AND CLINICAL PRECEPTOR:
The ADN liaison instructor and
the clinical preceptor will:
1. Mutually agree on the schedule of
clinical experiences for the semester, including times, dates, and number of
students to rotate through.
2. Meet at the end of each semester
to evaluate the experience and determine if it should be repeated, and any
changes that need to be made.
This
clinical preceptorship agreement was entered into
this _____ day of ____________, ______.
_______________________________ ______________________________
ADN Liaison
Instructor-Printed Name Clinical
Preceptor-Printed Name
_______________________________
_______________________________
ADN Liaison
Instructor-Signature Clinical Preceptor-Signature