PRACTICE EXPERIENCE AGREEMENT

This Agreement is entered into by and between Fill in name of organization(ORGANIZATION), with a facility located at Fill in address, City, State, Zip Code (hereinafter referred to as the “Cooperating Facility” or “CF”) and WESTERN WASHINGTON UNIVERSITY, a public agency of the State of Washington and an institute of higher learning located at 516 High Street, in Bellingham, Washington (hereinafter referred to as “WWU”)

This Agreement details the responsibilities of the Cooperating Facility (“CF”) and Western Washington University RN-to-BSN program located within theDepartment of Health and Community Studies(hereinafter referred to as the “University”) for the delivery of on-site training and educational instruction by the CF to WWU Nursing Students (hereinafter referred to as “Nursing Students”) enrolled in a University program requiring practice experience (hereinafter referred to as the “Program”) It is understood by the parties that “Cooperating Facility” or “CF” may also generally refer to any agency, facility, or organization that agrees to provide supervisory assistance to WWU Nursing Student or to other programs sponsored by the CF for WWU in addition to the Program described in the Scope of the Work, below. Such a definition is inclusive of the participation of a single building or program, or the involvement of the entire agency or organization.

Whereas, both parties desire to reach an agreement for their separate and mutual responsibilities with respect to such education;

Now, therefore, in consideration of the mutual benefits and covenants arising hereunder and in support of this exchange, faculty and staff of WWU’s Program and staff and administration of the CF will be responsible for ensuring the following:

Scope of the Affiliation

The Woodring College of Education (“WCE”) at WWU, desires to be able to provide Nursing Students of the Program with on-site clinical education opportunities of the type currently administered by the CF (hereinafter referred to as the “Program Instruction”).

The CF is an agency operating within the local geographical area, and, as such, offers a variety of services which provide an opportunity for Nursing Students of the University Program to obtain direct clinical and educational healthcare practice experience under the supervision of the CF’s staff. Nursing Students will be able to attend various Program Instruction opportunities, including but not limited to demonstrations, hands-on participation and instructional lectures, onsite at the CF. The CF, under the terms of this agreement, will provide field-based instruction in a variety of programs and procedures.

  1. Placement of WWU Nursing Students:

Prior to placing any Nursing Student on the premises of the CF:

  1. WWU will confer with the CF about the number of Nursing Students the CF might accept for placement and any rules or requirements of Nursing Students participating in the Program Instruction.
  2. Consistent with RCW 43.43.830-43.43.845, the CF will conduct background checks valid for two years, which include a national check of all counties of residence, a national database of criminal and sex offender records, and Washington State Patrol records, for the purpose of screening, advising, and placement purposes.
  3. Nursing Students will be advised by WWU regarding liability insurance, any special risks of harm or injury to which the Nursing Student may be exposed by his or her participation in the Program, and any applicable HIPAA compliance rules arising from his or her participation in the Program Instruction.
  4. Nursing Students will be advised on standards of ethical practice according to appropriate national and state nursing standards.
  5. WWU will place Nursing Students only with CF’s whose affirmative action policies prohibit discrimination based on race, color, age, creed, sex, physical disability, religion, sexual preference, national origin, or marital status.
  6. WWU may end a field placement and remove a Nursing Student from a site if the Nursing Student or CF violate WWU rules and regulations, or for such performance-based actions that WWU views as detrimental to the consultation/supervisory process.
  1. In consultation with CF and any Field Supervisors (hereinafter “FS”) working with Nursing Students:
  2. WWU will designate Program representatives with responsibilities for field education in the Program area to oversee Program Instruction being provided to the Nursing Students.
  3. WWU’s responsibilities include the following:
  4. Providing information about the WWU Program and its objectives for preparation of Program professionals;
  5. Providing handbook and evaluation materials as appropriate;
  6. Assisting or facilitating the development of educational standards and learning objectives as these relate to WWU Program students and national Program standards;
  7. Visiting the field setting on a regular basis to observe and confer with the Nursing Students and FS’s in order to review and evaluate Nursing Student learning and progress; and
  8. Participating in assessments and evaluations relative to the Program.
  9. The CF may remove a Program representative from supervision at a site for violating CF rules and regulations, or for such performance-based actions that the CF views as detrimental to the consultation/supervisory process.
  1. Placement of Nursing Students:
  2. The University will obtain a signed release from each Nursing Student candidate enabling the release of the Nursing Student’s background check information to the CF. The CF will be responsible for any decision as to whether a Nursing Student is acceptable under RCW 43.43.830-845;
  3. The University will ensure that Nursing Students have met all Program requirements, including but not limited to all immunizations and medical and drug screening required by either the CF or Program; signing any confidentiality agreement for the CF, and completing any required badging procedures;
  4. Nursing Students will be advised by the University regarding liability insurance, any special risks of harm or injury to which the Nursing Student may be exposed by his or her participation in the Program, and any applicable HIPAA compliance rules arising from his or her participation in the Program Instruction The number of hours/days spent by a Nursing Student at the CF is determined by The University;
  5. A CF representative, in cooperation with WWU’s Program representative, will assign Program Nursing Students to qualified staff members who serve as CF Mentor’s responsible for directing field-based learning experiences for these Nursing Students.
  6. The CF will permit students to use its facilities for Nursing Studentlearning experiences and will permit faculty of WWU’s Program to use its facilities to coordinate, observe and instruct students engaged in learning experiences, while not requiring Nursing Students to replace staff or give service to patients of the CF apart from its educational value.
  7. If applicable, Nursing Students will be provided by the CF with a conspicuous name badge identifying the Nursing Student and his or her affiliation with WWU’s Program Instruction. Nursing Students will display this name badge at all times when interacting with patients of the CF.
  1. Field supervision:

It is understood that when a CF employee is acting in the capacity of a CF Mentor, the CF will assume all responsibility for the CF Mentor’s good faith actions while acting in this capacity.

  1. The CF and CF Mentor will plan WWU Nursing Student learning experiences in conjunction with WWU’s designated Program representatives.
  2. The CF and the CF Mentor agree to comply with all reasonable University directives regarding evaluations of Nursing Students and feedback to WWU’s Program representatives.
  3. The CF and the CF Mentor agree to participate in Program assessments and evaluations as necessary.
  4. It is the CF Mentor’s responsibility to see that all Nursing Students are made aware of all applicable CF rules and regulations, policies and procedures, and Standards of Conduct. Nursing Students should be treated as professionals and are expected to follow all rules and regulations established by the CF while on-site at the CF under this Agreement.
  5. The CF will ensure that the CF Mentor provides appropriate supervision of Nursing Students while on-site with the CF and that the CF Mentor is responsible for oversight and instruction of Nursing Students while Nursing Students are on-site at the CF
  6. The CF may independently remove a Nursing Student from placement for violating CF rules and regulations or for such actions viewed by the CF to be detrimental or harmful to clients, staff, or others. In the event that this action is challenged, CF personnel may be asked to support this decision in writing or through verbal testimony.

Relationship of the Parties

WWU and the CF are independent contractors in relation to one another and neither is authorized to act as principal/agent, partner, or employer/employee of the other by this agreement. The services rendered to the Nursing Students under this agreement are considered to be educational in nature; Nursing Students will not be considered to be employees of the CF while participating in the Program. The CF shall have no obligation to any Nursing Student for any compensation or benefits, including but not limited to Workers’ Compensation benefits.

Hold Harmless

To the extent permitted by law, each party to this agreement shall be responsible for the negligent acts or omissions of its own employees, officers, or agents. Neither party will be considered the agent of the other party, and neither party assumes any responsibility to the other party for the consequences of any act or omission of the other party.

Non-Discrimination

The parties acknowledge that they are committed to policies, practices and procedures which prohibit discrimination based on race, color, national origin, religion, handicap, age, or sex, or any other legally protected classification.

Term of Contract

  1. The term of the contract will be for a period of three (3) years, commencing upon the date of full execution by the parties hereto, with an option to renew for one additional two-year period, by a written Amendment to this agreement exercising the option to extend and signed by both parties.
  2. Termination of this Agreement can be effected by either party with a sixty (60) days written notice to the other party. Either party may terminate this Agreement immediately if the other party fails to comply with the terms of this Agreement or if it is determined by a party, in its sole discretion, that termination is in the best interests of that party.
  3. Notwithstanding anything to the contrary herein, if performance by either of the parties hereto or any term of this Agreement shall jeopardize the licensure of the CF or the full accreditation of either party, or shall be in violation of applicable any law or regulation, such term shall be renegotiated by the parties and changed by amendment hereto where possible.

Amendment

This Agreement may not be changed or amended except by a written agreement signed by both parties hereto.

IN WITNESS WHEREOF, the authorized representatives of the parties have executed this Agreement on behalf of:

Co-operating Facility:Western Washington University

Name of Co-operating Facility

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NameBrent Carbajal

TitleProvost & VP for Academic Affairs

______

DateDate

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Name and Title - OrganizationApproved as to legal form:

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DateOffice of the Attorney General

Date______