Hospital of Interest: Monroe Carell Jr. Children S Hospital at Vanderbilt

Student Name (full name)
Institution Name
Faculty Advisor
Faculty Advisor’s Email

Hospital of Interest: Monroe Carell Jr. Children’s Hospital at Vanderbilt

Vanderbilt University Medical Center (Adult Hospital)

Observational Area of interest:
Please write a statement regarding your goals or objectives for this experience:

Additional Information:

The Observational Experience program at Vanderbilt University Medical Center (VUMC) allows nursing students an opportunity to observe in areas not related to their clinical rotations. The student will be limited to 1 – 12 hour shift per academic year. This experience is different than a clinical rotation in that students participate in an “observation only” role.

The following items are required to set up an observational experience:

·  The student’s school must have a current Affiliation Agreement with VUMC.

·  This form and the Informational Grid (submitted by your school leadership to verify additional requirements) must be sent to the following email: 10 business days prior to the Observational Experience date.

·  The Vanderbilt Orientation Module must have been completed within the last year. The module is available through TCPS or online at . Once completed the TCPS certificate or online quiz should be given to the faculty advisor for review and placed in the student’s file.

After the requirements are completed, the student will receive a confirmation email. The student can then email the VUMC nursing contact to confirm a date for the observational experience. Upon completion of the shadowing shift, the student ID badge is left in the observational area to be shredded.