Requirements for all Nursing Instructors and Ancillary Student Supervisors
In order to process required student paperwork and meet compliance with The Joint Commission, please read all information below. Due to the large volume of students attending, we will adhere strictly to these requirements. All nursing school instructors and ancillary student supervisors are required to visit www.sjvnec.com and select Saint Agnes Medical Center from Clinical Sites.
SECTION I: Required Nursing Student Information under "If you are a Student":
A. Instructor reviews/completes Items 1 – 5.
B. Instructor returns/emails signed Acknowledgment and Confidentiality forms. Please send only these two signed pages; do not send student tests, quizzes or first two pages of Confidentiality form. If you email Acknowledgement and Confidentiality forms, please send as one complete class pdf file; do not send a pdf for each student.
C. Review all e-Learning modules with students.
SECTION II: Nursing Instructors: Under "If you are an Instructor":
A. Review Items 1-5; return/email signed Acknowledgment and Confidentiality forms. Please send only these two signed pages; do not send your tests, quizzes or first two pages of Confidentiality form.
B. Contact to float nursing students off units.
C. Complete #6, Student Immunization Roster.
1) Provide legal first, middle and last names (no nicknames/shortened names).
2) Consortium number is REQUIRED. Rosters missing consortium number or missing student information will not be accepted.
3) All instructors email to request Powerchart access.
4) Please send only one, fully completed roster as a word doc. We cannot accept pdfs, incomplete or hard copies of rosters. Students waiting for any immunization/CPR results will not be cleared to start until compliant.
SECTION III: Nursing Instructor Competencies Packet":
New Nursing School Instructor: You are required to:
A. Complete 12 hours of precepting (includes competency validation) and 4 hours of Powerchart training.
B. Print #9 and #11; place all required signed forms/completed tests or quizzes behind Summary Sheet.
Returning Nursing School Instructor: You are required to annually:
A. Complete 4 hours with a preceptor (includes competency validation).
B. Print #9 and #11; place all required signed forms/completed tests or quizzes behind Summary Sheet.
Section IV: Ancillary Students (RCP, PT, SLP, RadTech, MSW, Pharm Tech, etc.) under "If you are a Student":
A. Instructor reviews/completes Items 1-4 with student.
B. Return/email Acknowledgment and Confidentiality forms. Please send only these two pieces of paper; do not email/send student tests or quizzes. If you choose to email Acknowledgement and Confidentiality forms as a group to match students listed on roster, please send as one complete pdf file; do not send a pdf for each student.
Ancillary Instructors: Under "If you are an Instructor":
A. Complete #6, Student Immunization Roster.
1) Provide legal first, middle and last names (no nicknames/shortened names).
2) Consortium number is REQUIRED on roster. Rosters missing consortium number or with incomplete student information will not be accepted.
3) Please send only one, fully completed roster as a word doc. We cannot accept pdfs, incomplete or hard copies of rosters. Students waiting for any immunization/CPR results will not be cleared to start until compliant.