Documentation of Unprofessional Behavior and/or Unsafe Response | Nursing

Student Name

First Last

Student ID

Course #

Semester and Year

Faculty Advisor

Date of Incident(s)

As documented below, this student has demonstrated professional and personal attributes that do not meet the standards of professionalism in clinical, classroom, lab or community settings, and safe clinical practice. The responsible faculty/academic staff will be taking the actions indicated below:

Faculty/Academic Staff: Check for recommended action(s)

Written Warning

Plan for Remediation

Failure of Course

Expulsion from BSU program

Maximum Events

A maximum of 3 Documentation of Unprofessional Behavior and/or Unsafe Practice events will be grounds for expulsion from BSU programs.

Faculty/academic staff

Date

1. The student fails to meet the standards of professionalism from a biological, psychological, sociological, and/or cultural standpoint:

Failure to carry psychomotor/technical skills in a safe and/or professional manner

Failure to carry out communicative skills in a safe manner

Act of omission in the care of client

Act of commission in the care of a client

Displays mental, physical and/or emotional behavior(s) which negatively affect others

Does not come to class or clinical prepared

Other

Supporting documentation:

2. The student lacks consistency in reasonable preparation, documentation and/or communication.

Attempts activities without adequate preparation or assistance

Demonstrates inaccurate or incomplete verbal/written communication

Acts in a way to create significant anxiety and/or stress to others

Is verbally abusive and/or exhibits threatening, coercive or violent behavior toward anyone

Is unable to achieve and/or exhibits threatening, coercive or violent behavior toward anyone

Is unable to achieve therapeutic nurse-patient relationships characterized by rapport, empathy and respect

Violates the boundaries of professional nurse-patient/family relationships, e.g., engages in romantic or sexual relationships

Is unable to maintain satisfactory relationships with others in clinical, university or community settings

Other

Supporting documentation:

3. The student fails to practice within the boundaries of the Minnesota Nurse Practice Act, guidelines or the course syllabus, policies of the Department of Nursing and the rules and regulations of the health care agency that is the site of the course.

Is habitually tardy/absent

Is habitually tardy in submitting assignments

Exhibits criminal behavior

Is suspected of being under the influence of drugs and/or alcohol in class, clinical or university settings

Dresses inappropriately and/or exhibits nonprofessional appearance/behavior

Exhibits behavior that is offensive to others (sexist, racist, threatening, demeaning)

Needs repeated reminders of responsibilities consistent with the policies of the Department of Nursing and/or clinical agency

Other

Supporting documentation:

4. The student fails to meet American Nurses Association's Code of Ethics and Standards of Practice

Does not maintain confidentiality

Demonstrates dishonesty

Ignores unethical behavior of others

Does not demonstrate respect for others

Does not advocate for the rights of the patient

Misrepresents or falsifies action or information

Other

Supporting documentation:

5. The student lacks effort directed toward self-improvement

Is resistant or defensive regarding suggestions to improve

Appears unaware of her/his deficiencies and the need to improve

Does not accept constructive criticism or take responsibility for errors

Is abusive or critical during times of stress

Demonstrates arrogance

Other

Supporting documentation

Additional Incident description (including others involved) or comments:

Completion Date

Goal for Remediation (if indicated as an action)

File

Max. file size: 16 MB.