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Documentation of Unprofessional Behavior and/or Unsafe Response
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Nursing B.S. (Pre-Licensure)
Nursing B.S. (RN to B.S.)
Niganawenimaanaanig Indigenous Nursing Program
Student Learning Outcomes
Application Information
Pre-Licensure Admission Process
Pre-Licensure Application
Pre-Licensure Direct Admission Application
RN to B.S. Admission Process
RN to BS Application
Niganawenimaanaanig Student Application
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Faculty & Budget (FAB) Committee
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Department of Nursing Grievance Form
Documentation of Unprofessional Behavior and/or Unsafe Response
Student Comments for Documentation of Unprofessional Behavior and/or Unsafe Response
Faculty & Staff
Faculty Emeriti
Prospective Faculty
Documentation of Unprofessional Behavior and/or Unsafe Practice
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
Select All
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
MM slash DD slash YYYY
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
Select All
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
Select All
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
Select All
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
Select All
Supporting documentation
Additional Incident description (including others involved) or comments:
Completion Date
MM slash DD slash YYYY
Goal for Remediation (if indicated as an action)
File
Max. file size: 16 MB.
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